When New Zealand voted to introduce assisted dying two years ago, it was framed by supporters as a "victory for compassion and kindness".

Since the End of Life Choice Act came into force in November 2021, around 1440 people have applied for the process and, of those, 565 went on to have an assisted death.

The only hospice in the country to offer its patients the choice is Tōtara Hospice, in Auckland, and, in that time, 18 people have opted to end their lives.

Tōtara's chief executive Tina McCafferty is originally from Glasgow and this week spoke at the Scottish Parliament to give MSPs her reflections on what is an issue under close scrutiny here as a bill from MSP Liam McArthur is under consideration.

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For Tōtara, Ms McCafferty said, the decision to provide assisted dying came from viewing the option as an extension of the organisation's existing values.

She said: "We looked at what underpinned palliative care: patient-centred, patient in the driving seat, managing total pain - ie spiritual pain, emotional pain, physical pain - and we looked at our values as an organisation.

"We looked at some of the evolving definitions of palliative care. The World Health Organisation (WHO) definition is fine but there's nothing within that context that should stop it evolving along with changing norms and expectations of society.

"And we simply viewed assisted dying for terminally ill, cognitively competent adults, as an evolution in our practice - as another legal choice in our menu of legal choices."

The matter of assisted dying was put to a referendum in New Zealand and saw an 86% turnout rate; 65% of voting-age New Zealanders voted in favour of legalisation.

Eligibility rules are strict and it was expected when the Bill was introduced that around two thirds of applicants would be turned down for it.

New Zealanders - and applicants must be from New Zealand - are assessed by two doctors for competency and must also be over 18 years of age, have a terminal illness likely to end their life within six months and be experiencing “unbearable suffering that cannot be relieved".

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They have to further be competent to make the decision, and be experiencing advanced stages of irreversible decline in their physical ability.

On the issue of Tōtara being the only hospice to introduce assisted dying, Ms McCafferty said: "I think that it's complex.

"So many aspects of healthcare, including our secondary hospitals all over the world, are often founded out of faith-based institutions and a desire to do good and to show compassion.

"So I think there's a history of that, that I would encourage colleagues to reflect on.

"I think also the WHO definition of palliative care is long and complex, it's many paragraphs and bullet points, but one bullet point amongst nine or 10, the one that says palliative care neither hastens nor postpones death, has kind of become the soundbite.

"And I would ask colleagues respectfully to reflect on whether that one bullet point should be an altogether definition or whether the spirit of the definition should be about informed consent and holistic care of patients with them being in the driving seat."

Ms McCafferty herself is certain that being able to offer assisted dying is the morally correct position to take when people have "absolute certainty that they are dying."

She added: "I think that personal autonomy and human rights are really important.

"We're not talking about the right for anyone to die under any circumstance, we're talking about the right of people who are living, they are dying and when they come to the active end of their life they are dying in the way that they want to and I don't have any difficulty with recognising that as a human right."

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Polls in New Zealand had consistently shown strong public support for assisted dying, which was backed by the then-Prime Minister Jacinda Ardern.

There was also, as is the case in Scotland, strong opposition to the move, including from Euthanasia-Free NZ, which shared a variety of concerns including that the legalisation of assisted dying would undermine suicide prevention and cause harm to society.

Coercion was also a concern, as well as fears that those with chronic conditions could feel they are a burden on their families and opt to end their lives for that reason.

In the two-and-a-half years that Tōtara Hospice has been offering assisted dying, 18 patients have opted to end their lives.

The chief executive added: "We haven't had any go wrong. We haven't had anyone say, 'That was awful, I wish that it had never happened'.

"All we have had is relief, love, acceptance, autonomy, good outcomes.

"Why would one not continue with that as the provider of a service that helps people die in the best way that they can on their terms."