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Implications of voluntary assisted dying for advance care planning

Now that it is legal and available in all Australian states, it is inevitable that voluntary assisted dying will be raised in end-of-life discussions. But are health professionals ready?

Health professionals and services engaged in end-of-life planning must do more to prepare for discussions about voluntary assisted dying (VAD), a new research paper suggests.

In Australia, only eligible people with decision‐making capacity can request an assisted death, and a choice to pursue VAD cannot be included in end-of-life planning documents. Nor can a person's substitute decision maker seek VAD on the person's behalf.

Despite these restrictions, as VAD becomes more widely available and known, questions will inevitably arise, QUT’s end of life law researchers say.

Writing in the Medical Journal of Australia, the researchers – led by Professors Ben White and Lindy Willmott from the Australian Centre for Health Law Research – say the majority of work to date has focused on differentiating advance care planning and VAD.

While this has been important, “efforts must now extend to support optimal advance care planning in the context of new voluntary assisted dying laws”, they write. 

The authors say attempts to exclude VAD from more general discussions around end-of-life planning are “impractical”.  “Patients see end‐of‐life choices holistically and are unlikely to [separate] advance care planning and voluntary assisted dying.

“Advance care planning is centred on respecting a person's values, beliefs and preferences, which may now include a choice for voluntary assisted dying,” they write. “Existing approaches to advance care planning must adapt to reflect this, requiring thoughtful engagement at the system, program, and practitioner level.”

It is vital that health professionals react to questions about VAD ethically and lawfully. To help them have these conversations, the Australian Centre for Health Law Research and Advance Care Planning Australia have compiled Guiding Principles for Health Professionals Navigating Conversations About VAD in Advance Care Planning.

Guiding principles for conversations about VAD in advance care planning

The research article also compiles and explains:

  • each state’s differing legal requirements around raising the topic of VAD with patients [see Box 1]
  • health professionals’ conscientious objection obligations to patients who request VAD [see Box 2]
  • a conversation framework to navigate lawful and patient‐centred discussions [see Box 3]
  • existing practitioner guidance from department of health websites [see Box 4]

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