On 19 June 2019, voluntary assisted dying became legal in Victoria. This regime permits Victorian adults with terminal conditions to seek medical assistance with ending their life in limited circumstances.
It is the first time in over 20 years that such a regime has been legal anywhere in Australia. It follows multiple unsuccessful attempts to introduce such a regime in different parts of Australia.
The Western Australian Government intends to introduce legislation into parliament to permit voluntary assisted dying. Both South Australia and Queensland are undertaking parliamentary inquiries into end of life issues, including voluntary assisted dying.
What does this mean for doctors, nurses, other healthcare professionals and organisations? MIGA is conscious our members and clients hold a range of moral, ethical and professional views about voluntary assisted dying. We have no position on whether such regimes should be legal or not. These are matters for the profession and broader community.
Whatever one’s position, a voluntary assisted dying regime poses a range of medico-legal and other practical issues which doctors, other healthcare professionals and organisations may be confronted with if they have patients asking about voluntary assisted dying, irrespective of whether or not they are willing and able to participate in such a process.
Conscious of this, and as part of its commitment to sensible, practical and fair regulation, MIGA is involved in advocacy around the practicalities of voluntary assisted dying regimes. Our focus is on how they would work if legalised, any uncertainties and risks created, and issues requiring further work or clarification. In doing so, we have in mind the interests of health professionals who might be involved, those who would object to being involved and those uncertain about what they would do.
What you should know
Some features of the recently commenced Victorian voluntary assisted dying regime include:
- Conscientious objection
— There is no obligation to participate, provide information or refer to a doctor who may assist
- Do not initiate discussions about voluntary assisted dying
— Voluntary assisted dying can only be discussed with a patient when they raise it in clear and unambiguous terms
- Multiple doctors involved
— Two doctors must be involved in the process – a co-ordinating medical practitioner and a consulting medical practitioner
— Certain specialists can be consulted for further opinions, such as on condition eligibility and patient capacity – there is a mandatory referral to assess prognosis for neurodegenerative conditions
- Compulsory training and necessary qualifications and experience
— A doctor cannot take a co-ordinating or consulting practitioner role until they have undergone compulsory training
— Both practitioners must have particular levels of qualification and experience
- Patient eligibility – patients must
— Have decision-making capacity throughout the process
— Be an Australian citizen or resident, ordinarily resident in Victoria for 12 months
— Have an incurable, advanced and progressive disease, illness or condition causing intolerable suffering and expecting death within 12 months for degenerative neurological conditions, or 6 months for other terminal conditions
- Timeframes and information
— Normally at least 9 days between initial and final requests by a patient
— There are specific requirements on information to be given to patients, including treatment and palliative care options, risks and ability to withdraw anytime
- Documentation, reporting and approval
— There are detailed documentation requirements
— Throughout the process reports must be given to the Voluntary Assisted Dying Board
— A permit is required before a medication prescription can be made
— Provided by a statewide pharmacy service (at The Alfred Hospital in Melbourne)
- Implications of getting it wrong
— Initiating discussion about voluntary assisted dying unless on explicit patient request is grounds for disciplinary action and mandatory reporting
— There are penalties for not lodging required forms
— There are serious criminal offences consequent of administering substances not in accordance with the regime, or inducing a person to access the regime.
Comprehensive information, including a guide for medical and other health practitioners, has been produced by the Victorian Department of Health and Human Services. See below.
Key matters for Victorian doctors to consider include:
- How you will respond to patients requesting access to voluntary assisted dying, whatever your willingness and ability to be involved
- If willing and able to be involved, the need for you to take the time to fully understand the regime requirements, and whether you can put appropriate procedures in place
- MIGA expects those overseeing the regime will interpret its requirements strictly
- The potential emotional and other personal impact involvement may have on you.
Victorian Dept of Health and Human Services
Comprehensive information about the legislation and process
Guide for medical and other health practitioners
Produced by the Victorian Dept of Health and Human Services
Good medical practice
Medical Board of Australia’s Good Medical Practice: A Code of Conduct for Doctors in Australia
Western Australian Ministerial Expert Panel on Voluntary Assisted Dying – Final report
MIGA recently contributed to the panel’s consultation