Since June 2019, the Voluntary Assisted Dying Act has provided a legal framework for Victorians to access medical assistance to end their lives with dignity.
Summary of the Act
To be eligible to access voluntary assisted dying medical assistance (VAD), a person must be over the age of 18, an Australian citizen and ordinarily resident in Victoria. They must have:
- decision making capacity;
- be diagnosed with an incurable, advanced, progressive, fatal medical condition that is expected to cause their death in no more than six months; and
- it is causing suffering that cannot be relieved.
In the case of neuro-generative disorders, such as Huntington's Disease, the condition must be expected to be fatal within 12 months.
Mental illnesses are excluded from the regime.
In order to access VAD in Victoria, the patient must be reviewed by two doctors, one of whom must be a specialist, who have completed the training required to assess patients for eligibility.
If the reviewing doctors are satisfied that the patient meets the required criteria, the doctor will need to enter the information onto the VAD portal for the Secretary of the Department of Health & Human Services to approve the request.
If the request is approved, the patient will be issued a permit allowing them to collect the medication provided by by the Statewide pharmacy (this can be either collected by the patient or delivered to the patient by the pharmacist).
The patient self-administers the medication themselves. If they are unable to administer the medication or have a condition that prevents them swallowing or absorbing it, they can make application to have a medical practitioner do it.
VAD Review Board report
In February 2020, the VAD Review Board confirmed that over 50 Victorians elected to take the medication and end their life in the first six months of the Act being active.
In addition, there were seventy'self-administration' and 11'practitioner-administration' permits approved. Of these, medication was dispensed to 66 eligible patients.
This high volume of applications was not expected by the Board; and in response they are trying to find solutions to issues that are hindering access.
Issues with accessing VAD
Restrictions on treating practitioners
Under the Act, registered health practitioners are prohibited from suggesting or initiating discussions with a person that may be eligible to access the VAD regime. Further, a practitioners ethical obligation to their patients restricts them from presenting this option of care if the patient is unaware of the regime.
If this is the best option for the patient, this obligation hinders the practitioner from providing best care options to the patient
A possible solution to this issue may be an amendment to the Act which allows doctors who have undergone the necessary VAD training to raise this care option with their patients. It is suggested that this could facilitate greater access to VAD, and allow patients to consider all their options.
Access to medical care in rural areas continues to be a barrier to best practice medicine. With only 33% of the doctors outside the metro Melbourne area having completed VAD training, those living in rural areas find it difficult to find two VAD trained doctors in close proximity to them.
Telehealth, or EHealth, would give patients in rural areas the opportunity to easily access the VAD regime, however, it is a criminal offence under federal law to use a carriage service - including telephone or the internet - to counsel or incite suicide. Meaning that doctors who discuss VAD with patients via telehealth may be prosecuted.
Doctors practising via telehealth have been advised that VAD conversations must only happen in person.
The purpose of the VAD regime is to provide an alternative treatment pathway to those with fatal medical conditions. The VAD Review Board are constantly assessing and reviewing the issues that arise with the legislation in order to provide Victorians the choice to use medical assistance to end their lives.
For more information about voluntary assisted dying, please contact VAD Review Board member and Adviceline Special Counsel, Paula Shelton, on (03) 9321 9764.