Assisted dying work pay rates fraught
THE pay rates for doctors who will be involved in ending a patient’s life (or deciding it shouldn’t be ended) under the provisions of the End of Life Choice Act 2019, have been published, and doctors aren’t impressed. The New Zealand
Medical Association says fees for general practitioners and other nonpsychiatrist doctors are too low.
The payments set out in the Assisted Dying Services Notice 2021, under Section 88 of the New Zealand Public Health and Disability Act
2000, published last week in the New Zealand Gazette, are total payments for private practitioners providing assisted dying services, and not doing so as employees of a district health board. The practitioner can’t ‘‘demand, claim, or accept any fee, gratuity, commission, or benefit from any person other than the Ministry [of Health] in connection with the provision of assisted dying services’’.
The notice describes the five modules into which the components of ‘‘assisted dying services’’ provided by ‘‘health practitioners’’ (isn’t there a contradiction there?) under the Act have been organised, and the payments for each module: one could describe them as payments for clinical care if one accepts, as the Act seems to, that ending a patient’s life can be part of caring for them.
Payment for assisting patients to die is a fraught subject, as GP and Royal New Zealand College of General Practitioners president Dr Samantha Murton pointed out in July. She said the fees would have to cover the provider’s costs, but not be so high that it is seen as a potential income stream, or discourage the option of palliative care.
Civis has reservations about her first caveat. Certainly, payment shouldn’t be high enough to influence decisions about assisting patients to die, but, if providing assisted dying services is taken to be part of doctors’ and nurses’ care of their patients, paying their incidental expenses but not contributing to the earnings on which they live and provide for their families is unjust, and means those doctors and nurses are personally subsidising the assisted dying service. The fees should match the hourly rate the health professionals concerned would earn in their normal work.
The notice accepts this in principle. In the case of travel being necessary, it pays not only actual travel costs by car or plane, and incidental (accommodation and meals) costs, but also for the time taken to travel. But there’s an anomaly in the details of that payment: psychiatrists will be able to claim for travel time at a rate 60% higher than that for attending medical practitioners (mostly, one assumes, GPs) and nurse practitioners. Why the difference?
Psychiatrists undertake several years of specialist training — so do vocationally registered GPs. Psychiatrists have particular expertise in the field of mental health — vocationally registered GPs have generalist expertise in the whole field of medicine (including that of mental health). And a GP will have significantly higher overhead costs to be funded through time worked, both for equipment and for other staff, than a selfemployed psychiatrist. The higher hourly rate for travel for psychiatrists suggests that the dismissive attitude of some hospital specialists (whom a past professor of general practice at Otago used to refer to as ‘‘narrowists’’) towards GPs (the foundation of New Zealand’s health system) is, regrettably, alive and dominant in the Health Ministry.
Dr Murton’s second caveat, regarding palliative care, is important. Assisteddying services are, in theory, fully funded: on October 12 Health Minister Andrew Little said, ‘‘The Government is committed to ensuring health services are available equally to everyone who needs them, and this includes assisteddying services’’.
But hospice care in New Zealand has never been fully funded: Otago Community Hospice will get only 59% of its budget from government for the year ending June 2022, and must raise the rest from donations and fundraising.
If assisted dying is to be fully funded, palliative care should be too.
Anything less means the Government considers the death of patients who request it a higher priority (because it costs less?) than providing palliative care.