Helping patients at end, powerful GP experience

In an ideal world, every GP would be providing assisted dying for their own patient

The number of GPs helping their own patients to end their lives is growing at a “pleasing” rate as word spreads about what a rewarding experience it can be, says the head of New Zealand’s Assisted Dying Service.

There are 130 medical and nurse practitioners on the Support and Con­sultation for End of Life in New Zea­land list, and 38 per cent of them are GPs, says Kristin Good, registrar of the service at the Ministry of Health.

The list is of practitioners available to provide assisted dying for people other than their own patients, but an additional 49 GPs not on the list pro­vided assisted deaths for their own pa­tients in the three months to the end of June – compared with none in the service’s first few months.

“When one of their long-standing pa­tients comes to them and says, ‘I’m wanting to access assisted dying’, they’re actually seeing that as being something that they are prepared to do for their own patients,” says Dr Good, an Auckland-based specialist GP.

“That’s really pleasing because, in an ideal world, every GP would be provid­ing this for their own patients,” she says.

Dr Good expects the number of GPs helping their patients to end their own lives to grow as some “absolute cham­pions” of the service share their experi­ences with colleagues about how rewarding it is.

She shared, with permission, the words of a GP she contacted to find out how he was, after providing his first as­sisted death.

The GP, who wished to remain anon­ymous, wrote in an email to Dr Good: “I’m doing OK. The assisted dying ex­perience was actually quite a powerful GP experience for me, albeit very dif­ferent to any previous experiences, and the process and final day went well.

“It was helped by the patient and her partner and family, being very support­ive of the whole thing and also support­ive and respectful of my role in it all.”

Dr Good initially phoned every prac­titioner after an assisted death to check they were okay, but now sends an email. She follows up with a phone call if she doesn’t hear back.

“It’s work that tends to attract people who are described as compassionate high achievers, and certainly what I see is an incredibly dedicated workforce who are very, very compassionate and really person-focused, who really bend over backwards to meet the needs of the person,” she says.

“But I’m aware there’s a few practi­tioners who’ve done that at the expense of themselves. They’re particularly good clinicians and I don’t want to lose them. This is the type of person who burns out, so in the background, [the service is] looking after those people.

“No one has ever complained to me about it. No one.”

Dr Good spoke to New Zealand Doctor Rata Aotearoa after the release of her second quarterly report in July.

The number of people applying for assisted dying each month has trebled since the service began, climbing from fewer than 20 in November 2021 to around 60 in May and June.

By the end of June, 400 people had applied for assisted dying and 143 peo­ple had had an assisted death.

Of 153 applications that ended be­fore an assisted death, 68 were assessed as ineligible, 23 voluntarily withdrew from the process and 62 died while their application was still in progress.

Dr Good says the service is going to audit those deaths, but an initial review indicates they are the result of people leaving it “extremely late” to make their application.

“It doesn’t seem to be because we were slack and didn’t do what we need­ed to do,” she says.

It takes four to six weeks to complete an assessment properly, in line with overseas standards, according to Dr Good.

“I think the fastest one to get it, which was in the last few weeks, was 72 hours from their application to their assisted death,” she told New Zealand Doctor on 3 August.