Evolving nursing roles in assisted dying services in New Zealand: A scoping review
Bibliographic record
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.024 | 0.077 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.003 |
| Bibliometrics | 0.012 | 0.016 |
| Science and technology studies | 0.002 | 0.003 |
| Scholarly communication | 0.006 | 0.006 |
| Open science | 0.002 | 0.004 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".