"Why Didn't You Want Us to Help?": Senior Palliative Care Doctor Speaks Out on Assisted Dying in New Zealand

Five years after euthanasia (assisted dying) became legal in New Zealand, a senior palliative care doctor says the effects are being felt far beyond the patients who choose it.

In a wide-ranging interview, she describes the emotional toll on hospice staff, increasing concern over subjective eligibility assessments, and why she believes the greatest changes are happening not in Parliament, but inside the culture of healthcare itself.

Most New Zealanders will never meet a palliative care doctor until someone they love is dying. A diagnosis has become terminal, treatment has given way to comfort, and families begin speaking in weeks and months instead of years.

For one senior New Zealand palliative care doctor, these moments have shaped the last fourteen years of her career.

After four decades practising medicine—including years in general practice before moving exclusively into palliative care—she has accompanied hundreds of New Zealanders through the final chapter of life. She has sat beside hospice beds, walked into family homes, managed pain and other symptoms that once seemed unbearable, and watched children say goodbye to parents.

She has also witnessed something else. 

A profound change in the culture of healthcare with the introduction of assisted dying. It is not a change most New Zealanders see.

Inside hospice, the impact has meant nurses quietly grieve when patients disappear without saying goodbye. Doctors are asked to make life-and-death decisions based on concepts like "unbearable suffering" that cannot be measured with precision. And a healthcare culture that she believes is changing in ways few outside the profession fully appreciate. 

The beauty of palliative care

When I ask why she chose palliative care, the doctor doesn't talk about death at all. Instead, she talks about time.

General practice had become increasingly busy with 15-minute appointments resulting in solving the immediate problem with no time to explore a patient's real needs before moving quickly to the next patient, she says. There is little opportunity to understand the wider story.

"I felt like I was continually sorting out a small amount of the problem," she says, "but never really getting to the bottom of it."

Palliative care offered something medicine was quietly losing: Time.

Time to listen. Time to understand and find out what’s really going on. Time to know not only the patient, but the family around them. A holistic approach - looking at a patient’s physical, emotional, social and spiritual needs.

Unlike many specialties, hospice medicine doesn't simply ask where the physical pain is - it asks what matters. Where is there suffering?

Sometimes that means adjusting medication or organising a hospital bed. Sometimes it means sitting quietly while someone speaks about fears they have never voiced before.

"When I visit people at home," she says, "it's always a privilege. You see how they're functioning. You see what's happening in the home. You get to know the family."

The goal is not to hasten death, nor is it to prolong life at any cost: It is to help people live as well as possible for whatever time remains.

Yet despite all that hospice offers, another reality has gradually entered her workplace.

The End of Life Choice Act came into force in November 2021 following a national referendum in which almost two-thirds of New Zealand voters supported legalising assisted dying for eligible adults.

Much of the country moved on, but hospice could not. Because while politicians debated principles, hospice staff still had patients to care for.

And slowly they began noticing something few outside healthcare were talking about. The law had changed far more than the “choices” available to patients. It had begun changing the people caring for them.

"Some of the nurses have found it really traumatic."

The patient who simply disappeared

The first time it happened, the nurses didn't know.

A patient they had cared for over many months died unexpectedly. They assumed the illness had simply progressed more quickly than anyone had anticipated. That happens in palliative care. Prognosis is an educated estimate, never a certainty.

Then someone saw the death notice. Only later did staff discover the patient had chosen assisted dying.

"They often don't tell us," the doctor says. "Sometimes the nurses only find out from the obituary."

She doesn't say it with bitterness. She says it with sadness.

When New Zealand debated the End of Life Choice Act, the public conversation largely focused on one question: should a terminally ill person have the option of an assisted death?

Supporters spoke of autonomy, dignity and relief from suffering. Far less attention was given to another group whose lives would inevitably be changed by the legislation. The people expected to care for everyone else.

Inside hospice, dying rarely belongs to just one person.

"The nurses are the ones who really get to know patients," the doctor explains.

By the time someone reaches the final chapter of life, they are often surrounded by a network of relationships that has quietly formed over months. Community Nurses have visited their home dozens of times. Doctors have adjusted medications when needed. Counsellors have worked with spouses and children. Volunteers have shared cups of tea and long conversations. Spiritual care workers have prayed, listened, or simply sat in silence. 

Unlike many hospital specialties, hospice care is intensely personal. These are not transactional healthcare encounters, they are relationships. And when those relationships end abruptly, the grief can run deeper than many people realise.

“...It has been horrifically traumatizing for them. They feel rejected," the doctor says. "They've given their all. And they wonder, 'Why didn't you want us to help?'"

Moral distress has become part of the job

Healthcare literature increasingly describes a phenomenon known as moral distress—the psychological discomfort experienced when clinicians believe they cannot act in accordance with their professional or ethical convictions.

It has traditionally been associated with intensive care, resource shortages and end-of-life decisions. Many palliative care clinicians now describe similar experiences surrounding assisted dying.

The doctor says her hospice now holds regular meetings where staff can openly discuss experiences related to assisted dying. Not because the policy requires it, but because people need it.

"Some are distressed by the whole thing, others said they could not provide the palliative care they had been trained to give."

The distress comes from many directions.

Some believe assisted dying should never occur. Others support it in limited circumstances but struggle emotionally when familiar patients choose that path. Still others simply grieve the loss of relationships that ended differently from how they expected.

The legislation did not eliminate suffering. In some respects, it redistributed it.

When safeguards depend on interpretation

For this doctor, one of the greatest weaknesses in the End of Life Choice Act is not necessarily what it says on paper, but how much depends on the individual doctor interpreting it.

"So even though they're properly trained, they should be following this particular criteria, each person has a different way of interpreting it," she says. "That's what really worries me."

The Act requires doctors to assess questions that sound straightforward until they are applied to a real person. Is the patient's suffering "unbearable"? Is their condition likely to end their life within six months? Are all of the eligibility criteria truly met?

On paper these appear to be objective safeguards. In practice, they rely heavily on clinical judgement.

"How do you classify unbearable suffering?" she asks. "If you stubbed your toe, it could be unbearable temporarily. But it's not a permanent thing, is it?"

Her point is not that stubbing a toe qualifies someone for assisted dying. It is that suffering itself is deeply personal and difficult to measure. Pain can be assessed, but suffering includes psychological, emotional, social and existential distress. Two doctors may hear the same story and reach different conclusions about whether the legal threshold has been met.

The doctor recalls one colleague who joined the assisted dying service, not because she enthusiastically supported euthanasia, but because she believed someone needed to apply the law carefully.

"She wanted to do it properly," the doctor explains. "She was worried other doctors might not."

It is an extraordinary irony. A doctor with serious reservations became involved precisely because she feared looser interpretations from others.

The same uncertainty exists around prognosis.

"Even now," she says, "I find it more difficult to prognosticate since I've been in Palliative Medicine than I did before, just because it's so complicated."

Anyone who has worked closely with terminal illness understands why.

Some patients deteriorate rapidly after appearing relatively stable. Others who are told they may have only months to live survive for years. In palliative care, prognosis is not a precise science but an informed estimate based on experience, evidence and probabilities.

"Somebody can suddenly die from an acute illness," she explains, "or they can go on living for years having been told they've got a six-month prognosis."

If experienced palliative care specialists acknowledge how uncertain these predictions can be, it raises an obvious question: how confidently can a legal line be drawn around an estimate that is, by its nature, uncertain?

She also worries about accountability.

"They can also say, 'Well, in my view, it was unbearable suffering,' and how do you fight that? It's not legal..." she says, trailing off before adding, "And the same with the prognosis. 'That's what I was told,' or, 'I assessed it, and that's it.'"

Once those clinical judgments have been made, there is often little practical way for others to know whether another equally qualified doctor would have reached the same conclusion.

Pressure does not only operate on patients. It can operate on clinicians too.

"There is almost a coercion or a pressure on the doctor themselves to approve it."

The safeguards in the Act ultimately depend on the judgement, confidence and integrity of individual doctors. 

When concepts like suffering and prognosis are open to genuine clinical disagreement, two patients with remarkably similar circumstances may receive very different decisions depending on who is sitting across the desk.

The Slippery Slope Doesn't Begin With the Law - It Begins With the Culture

When Parliament debated the End of Life Choice Act in 2019, supporters repeatedly reassured New Zealanders that the legislation was narrow.

It applied only to competent adults. Only those with a terminal illness. Only those expected to die within six months. Only those experiencing unbearable suffering. Only after multiple medical assessments. 

The message was clear - this would not become like Belgium. Or the Netherlands. Or Canada… It would remain tightly controlled.

Five years later, that reassurance no longer comforts this senior palliative care doctor, because she has watched something more subtle begin to happen; the culture is changing.

Before assisted dying became legal, opposition within hospice was generally strong. Today, she senses something different - not wholehearted enthusiasm, but resignation. 

Some colleagues believe hospices may eventually have little choice but to accommodate it more directly. In fact, if legislation loosens, they may be forced to.

"The worrying part," she says, "is when it just becomes normal."

That concern isn't unique to New Zealand.

Internationally, jurisdictions that have legalised assisted dying have almost all experienced some degree of expansion. 

Belgium, the Netherlands, Luxembourg, Canada and several Australian states all began with carefully defined eligibility criteria. Over time, debates have shifted from whether assisted dying should exist to who else should qualify.

New Zealand is already having many of the same conversations.

In Parliament, ACT MP Todd Stephenson has introduced a private member’s bill proposing several changes to the End of Life Choice Act, including removing the requirement that a person be expected to die within six months, forcing assisted dying to occur in aged residential care and hospice facilities, and allowing a waiver of final consent in certain circumstances if an eligible person loses decision-making capacity after completing the approval process. 

The bill remains under consideration, but it illustrates the legislation is already being revisited only a few years after it came into force.

What kind of society are we building?

Near the end of our interview, the conversation shifts from medicine to something much broader.

A patient she knew lived with a severe neurological illness. She used a wheelchair and depended heavily on others. 

“What frightened her most wasn't physical decline - it was becoming invisible,” the doctor says.

"She was terrified people would think her life wasn't worth living."

Laws do more than regulate behaviour.  They teach societies what to value.

If dependency increasingly becomes associated with burdens, cost or diminished quality of life, she fears vulnerable people inevitably begin asking themselves difficult questions.

Would everyone be better off without me?

International evidence suggests these fears are not imaginary. In Oregon, where physician-assisted suicide has been legal since 1997, the reasons patients most commonly give for requesting assisted death are not uncontrolled pain. Year after year, the leading concerns include losing autonomy, being less able to engage in activities that make life enjoyable, losing dignity, and concerns about being a burden on family, friends or caregivers.

Those findings resonate strongly with what this doctor sees.

"The physical symptoms," she says, "are often not the whole story." Sometimes they are not even the main story. 

People are wrestling with control, dependence, fear.

The question for society, she believes, is how we respond. Do we answer those fears by affirming that every person remains worthy of care? Or do we unintentionally reinforce them by offering death as a solution?

"The measure of a society," she says, "is how it cares for its most vulnerable people."

"I just hope we don't forget that."