A frontline New Zealand GP has exposed a troubling financial incentive at the heart of our end-of-life system — assisted dying pays up to six times more than palliative care. According to an article in Doctor NZ, Fiordland Medical Practice specialist GP Stephen Hoskin has written to Deputy Prime Minister David Seymour, raising urgent questions about why the system is structured this way, and who is responsible for fixing it.
The numbers are stark. Under his PHO, Dr Hoskin can claim $517.50 per patient for providing palliative care in the community. This covers every visit, every call, every hour spent supporting a dying person and their family. By contrast, the Te Whatu Ora website indicates a GP could claim up to $3,080 for a single assisted death. This isn’t a technical error either. This is a system that has been built (unintentionally or not) to reward ending lives over supporting them.
This isn’t a claim from a lobby group. It’s the assessment of a working rural doctor. Dr Hoskin describes the situation as “deeply concerning and unethical,” warning that even well-meaning doctors carry unconscious biases. When a patient raises assisted dying, and a doctor knows they could earn six times more by proceeding rather than redirecting towards palliative care, can we truly say that the consultation is unbiased? Dr Hoskin doesn’t think so, and neither should we.
The rural health disparities make this worse. Some palliative care visits in rural New Zealand are reimbursed at under $50 — less than the cost of a standard GP consultation, and a fraction of what urban patients may receive. Why doesn’t a dying person in Fiordland deserve the same quality of end-of-life support as someone in Wellington? Despite the Government spending $119 million on hospice care for 2025/26, these disparities persist.
Before the End of Life Choice Act was passed, and again during its three-year review, pro-life advocates and organisations, including Family First NZ, warned that financial disparities and perverse incentives would follow. Those concerns were dismissed as scaremongering. Well, it looks like this recent exposure by Dr Hoskin confirms what we have always said — the system is not neutral. It structurally incentivises death over palliative care, and it has been doing so since the Act came into force in November 2021.
And it appears from the deflection in responses from Seymour to the Health Minister to Te Whatu Ora, no one is taking accountability for a system that Dr. Hoskin describes as “deeply concerning and unethical. While Te Whatu Ora recognises that palliative care funding is “inconsistent across New Zealand” and mentions a National Palliative Care Work Programme but provides no timeline or specific commitments.
Three deflections. Zero answers. Nobody owns this.
And the push to expand the system continues regardless. A proposed amendment bill, lodged by ACT’s Todd Stephenson, wants to make it easier for doctors to raise assisted dying directly with patients — removing one of the few remaining safeguards in the current legislation. Even more troubling, the bill includes removing the 6-month prognosis time-limit and looks to pressure palliative care facilities to participate in assisted dying services. Organisations built around the sanctity of life and caring for the dying could be compelled to facilitate death instead. Combined with the financial incentives already baked into the system, this expansion should alarm every New Zealander who cares about protecting the elderly, the vulnerable, and the dying.
A society’s priorities are revealed by what it funds. Right now, New Zealand is paying more to end lives than to cherish them.
Source: New Zealand Doctor Rata Aotearoa. All quotes and figures cited are drawn from their original reporting.
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