Oversight body says VAD in Tasmania operating safely and with care

The number of terminally ill people accessing voluntary assisted dying and the number of practitioners willing to support them are steadily increasing, the latest report from Tasmania’s VAD Commission says.

Twenty five people died as a result of administering a VAD substance between 23 October 2022 and 30 June 2023, the first annual report on the operation of voluntary assisted dying (VAD) in Tasmania shows. 

Executive Commissioner Louise Mollross said both the number of first requests to access the law and the number of practitioners who had successfully completed the VAD training, had exceeded predictions. 

“The interest from practitioners in accessing the training continues to be steady while the number of practitioners wishing to support their own patients through the voluntary assisted dying process is increasing.” 

Ms Mollross said while it was positive to see the number of VAD-trained practitioners rising, the effective operation of the Act was due to a small group of dedicated doctors and nurses.

“The Commission acknowledges the dedication, time, and commitment to supporting voluntary assisted dying for those who are eligible that has been displayed consistently by those participating practitioners,” Ms Mollross said

The Commission pointed to inadequate remuneration and a lack of voluntary assisted dying-specific item numbers in the Medicare Benefits Schedule (MBS) as barriers to greater practitioner involvement. 

“Benefits paid are low and do not properly cover the non-patient facing administrative burden required to be discharged by medical practitioners who choose to become involved,” the report said.

The statistics

Between 23 October 2022 and 30 June 2023, 25 Tasmanians died as a result of accessing VAD, representing 0.5% of all deaths in Tasmania during that period.

• 72 first requests were received with an age range of 42-95 years. 
• 66% of these first requests had a cancer-related diagnosis.
• 6% of applications were deemed ineligible to access voluntary assisted dying, most often because they were not expected to die within six months (or within 12 months for neurodegenerative conditions)
• 67 people successfully completed the VAD training. Of these,
  • 33 (or about 49 per cent) were medical practitioners.
  • 23 (or about 34 per cent) were registered nurses.
• Of all medical practitioners who received a request from a person to access voluntary assisted dying, the majority (81 per cent) specialised in general practice, the remaining practitioners’ specialties included emergency medicine and palliative medicine

Telehealth still a 'significant challenge'

The Commission said sections 474.29A and 474.29B of the Commonwealth Criminal Code, which effectively prohibit medical practitioners from using telehealth to discuss VAD, were having significant practical consequences for everyone involved in the process, most notably those terminally ill people seeking to access the program. 

The Commission recommended  the Tasmanian Government “continue to advocate for amendments to the Commonwealth Criminal Code to remove the limitations on providing voluntary assisted dying information by way of a carriage service, as a matter of priority”. 

Administrative and workload burdens

The Commission also noted the administrative burden placed on medical practitioners by the VAD process.

“Each of the steps is resource intensive, sometimes requiring lengthy appointments and extensive review by the medical practitioner of a participant’s medical records.”

The Commission called on the state government to explore the introduction of an online portal to facilitate the processing of documents, as happens in other states.  

The oversight body also urged a more equitable remuneration for healthcare professionals saying that the “implementation of an appropriate scheme for remuneration will remove barriers to practitioner participation.”

Dr Linda Swan, Go Gentle Australia’s CEO, said the Commission’s recommendations reflected feedback from the recent trans-Tasman Voluntary Assisted Dying Conference in Sydney.

“More than 400 healthcare practitioners, policy makers and other experts said the two biggest issues affecting equitable access to voluntary assisted dying were the prohibition on using phone, email and videoconferencing for VAD processes and the relatively small number of healthcare professionals who were trained and willing to offer VAD services.

“We commend the Commission for pushing for reform on these issues so eligible terminally ill Tasmanians can face fewer barriers to accessing this compassionate end-of-life choice.”

Read the full Annual Report report here.