22 November 2022

'We've seen gentle, beautiful deaths'

Fiona Jane manages a community hospice in Western Australia’s Great Southern region. She explains how the choice of voluntary assisted dying is bringing comfort to the people in her care.

Fiona Jane

Clinical Hospice Manager, Albany Community Hospice, WA

I work in an 8 bed in-patient hospice and our community has been really behind us allowing voluntary assisted dying.

Initially, we ran a lot of focus groups and even had a research paper published through the University of Western Australia about our experiences of approaching voluntary assisted dying as a community-based hospice.

In total, we’ve had five people die by voluntary assisted dying in the hospice, and three more at home after moving back into the community. We’ve also had five people get the substance but die of natural causes before taking it.

With voluntary assisted dying in place, we’ve seen gentle, beautiful deaths where the person was able to plan to the nth degree. Recently, a woman in our care chose to die in our multi-sensory room. She had a massage and asked for photos of the country she grew up on projected onto the walls. She chose to listen to Enya and simply ‘sailed away’, with her family all around her. It was very peaceful.

In our experience of patients requesting voluntary assisted dying, we've seen improved patient-related symptom control of previously difficult to manage symptoms such as fatigue and anxiety. And this has happened almost as soon as the first assessment has been completed.

The process of assessment acknowledges suffering caused by the burden of the disease process. Our experience has been that the person requesting voluntary assisted dying feels heard that their fear of increased disability, suffering and being a burden on their family is acknowledged.

Another thing we’ve noticed is the family and loved ones’ anxiety can be really heightened in the days and weeks before substance administration, so further bereavement support is definitely needed.

Also patients worry about not having the competence to say ‘yes, I want VAD’ at the final request. We’ve had people want opiates scaled back to make sure they feel in charge at the end. Our palliative care teams have been able to manage people’s pain, but it’s a new element to our practice.

My final thought for patients wanting to access voluntary assisted dying is to start early. The average timeline for us in assisting a patient navigate the process has been 12-21 days. The shorter the timeline you’re working to, the more fraught it gets.