Evolving nursing roles in assisted dying services in New Zealand: A scoping review

Abstract

Background

The implementation of New Zealand's End-of-Life Choice Act 2019 provides a unique lens for examining the early-stage implementation of assisted dying policy. As legislation expands globally, nurses are emerging as central yet under-examined actors in delivering assisted dying care. This review addresses the urgent need to understand how nursing roles evolve in newly legalised contexts.

Objective

This scoping review aimed to understand the experiences, roles, and challenges faced by registered nurses and nurse practitioners in delivering assisted dying services under the End-of-Life Choice Act in Aotearoa New Zealand.

Method

The scoping review followed Joanna Briggs Institute guidelines. A systematic search was performed across ProQuest Central, Scopus, PubMed, and CINAHL to identify literature published between 2021 and 2025. Two screened the articles and extracted the data. A convergent, segregated approach was used for thematic synthesis.

Results

Nineteen studies were included, spanning anticipatory commentary and experiential data after the End-of-Life Choice Act came into force. Four themes were identified. First, evolving nursing roles revealed fragmentation: nurse practitioners administer life-ending medication but remain excluded from eligibility assessments. In contrast, registered nurses act as frontline coordinators yet are legally barred from initiating discussions. Experiential accounts added unanticipated burdens, including family management, logistical coordination, and supporting colleagues without formal preparation. Second, ethical dimensions extended beyond legal safeguards. Anticipatory sources predicted value conflicts, while experiential studies described lived moral distress, fractured team dynamics from conscientious objection, and confidentiality risks in small communities. Third, preparedness and support showed a marked gap. While early literature assumed structured training and clear guidance, experiential findings reported uneven preparation, reliance on informal peer networks, and culturally unsafe or absent emotional support. Debriefing was valued but inconsistently delivered. Finally, contextual variations shaped implementation. Hospices diverged between integration and resistance, aged residential care exposed nurses to family conflict and role ambiguity, rural practice intensified inequities and professional isolation, and community nurses often became central coordinators of home-based deaths. Māori perspectives were largely absent.

Conclusions

New Zealand's assisted dying policy creates a fragmented framework for nursing roles, confirmed by anticipatory projections and lived experience. This contrasts with integrated approaches in countries such as Canada, while also exposing gaps in preparedness, ethical support, and cultural responsiveness. Addressing these challenges requires legislative refinement, consistent support systems, and Māori-led, longitudinal research across diverse care contexts.

Social media abstract: New Zealand's assisted dying policy fragments nursing roles, creates ethical tensions, and leads to access inequities. Cultural safety and the integration of the nurse practitioner role are essential. #PalliativeCare #NursingPolicy.