Co-authored by Alexandra Partington, Graduate

The Victorian Government has announced that it will incorporate all recommendations recently made by an expert panel on voluntary assisted dying (euthanasia) into legislation to be proposed later this year. It is anticipated it may become law in March 2018, but not implemented till a later time.

The Expert Advisory Panel released their final report in July 2017, following the consideration of submissions from various stakeholders and the review of other jurisdictions. Legislation will now be developed based on all 66 recommendations within the Panel's report and put to Parliament later this year. It is expected that Parliament will have a conscience vote on the legislation.

The framework

The Government has described the framework as the safest model in the world, with 68 safeguards in place to protect against exploitation and coercion of individuals with terminal illnesses.

Eligibility

To qualify as part of the framework, a person wishing to end their life must:

• be 18 years of age or over;
• ordinarily reside in Victoria;
• be an Australian citizen or permanent resident;
• have decision-making capacity in relation to voluntary assisted dying; and
• have been diagnosed with an incurable disease, illness or medical condition that is advanced, progressive and will cause death, is expected to cause death within 12 months, and is causing suffering that cannot be relieved in a tolerable manner.

The framework does not allow individuals with dementia from accessing assisted dying because they may not have adequate decision-making capacity.

Process

To initiate the process of voluntary assisted dying, an eligible person must themselves make three requests. The first request must be made to a medical practitioner (a doctor) and must be made verbally. The person will then be assessed for eligibility by this doctor, and then assessed a second time by another doctor. The second request must be in the form of a written declaration. The person must then make a final verbal request to the coordinating doctor. Individuals making requests to access the framework must be properly informed about:

• the diagnosis and prognosis of their condition;
• the treatment options and their outcomes;
• palliative care and its outcomes;
• the expected outcome of taking the lethal dose of medication;
• the possible risks of taking the lethal dose of medication;
• the fact that they are under no obligations to continue with their request and that they can withdraw; and
• any other information relevant to their needs.

The medication to enable assisted dying is to be provided by pharmacists in locked boxes. The medication would generally be self-administered, however doctors would be allowed to administer it on individuals who cannot take it themselves.

Importantly, an individual can change their mind and withdraw from the assisted dying process at any time. If they have withdrawn, but decide once more that they do wish to access voluntary assisted dying, they must begin the process again from the beginning.

Doctors involved in the process

The two doctors involved in the assisted dying process must be qualified as Fellows of a College or Otherionally registered. At least one of the two doctors must have 5 years or more post-fellowship experience, and at least one doctor must have expertise in the person's medical condition. In addition to this, both doctors must have completed the specified training on obligations and requirements under the legislation.

Under the framework, doctors are under no obligation to participate in the scheme and can object to performing assisted dying if they wish. However, a doctor who objects to assisting a patient voluntarily die cannot block the patient's access to the scheme.

Oversight

A voluntary review board is to be established under the framework, to review each assessment for assisted dying made under the scheme. The board will ensure that the framework is being followed correctly. The board will refer any breaches of the framework to the police, the coroner or the Australian Health Practitioner Regulation Agency.

Overview

The proposed framework appears to strike a balance between providing Victorians with sufficient access to voluntary assisted dying should they make the choice to end their lives in this way, and the need to protect vulnerable individuals with terminal illnesses from coercion or exploitation. If proposed legislation based on this framework passes through Parliament, the Panel has recommended an 18-month period for the framework to be established before the law comes into effect.