Peak body for VAD professionals launches in Sydney
Four hundred clinicians, policymakers and patient advocates from across Australia and New Zealand met for the first time to discuss voluntary assisted dying practice and launch VADANZ, a new peak body for VAD professionals.
The inaugural Voluntary Assisted Dying Conference drew frontline VAD health professionals, end-of-life law experts and policymakers from across Australia and New Zealand to discuss assisted dying experience and practice for the first time.
Go Gentle Australia's CEO Dr Linda Swan welcomed delegates, saying the meeting was a momentous occasion that marked the first time VAD practitioners and others had met since assisted dying laws were passed across Australia and New Zealand.
“The advent of voluntary assisted dying in our countries is one of the defining social and medical reforms of the 21st Century,” Dr Swan said.
“This conference offers the first opportunity for those working in this new area of clinical practice to come together to discuss the issues most important to them.”
Launch of VADANZ (Voluntary Assisted Dying Australia and New Zealand)
The conference began with the official launch of VADANZ, the new peak body and voice for VAD professionals in Australia and New Zealand.
Inaugural VADANZ chair oncologist Dr Cameron McLaren said the emergence of VADANZ as a representative body would ensure workforce concerns were addressed and VAD services remained sustainable.
“Voluntary assisted dying across Australia and New Zealand is operating to extremely high standards with incredible care and compassion. However, its success, in large part, is due to the goodwill and dedication of a relatively small group of healthcare professionals who go above and beyond for their patients,” Dr McLaren said.
Dr McLaren stressed the importance of strong national representation and an empowered voice that would ensure the very best systems, standards and supports were in place so that patients received the care they needed.
“VAD provision is siloed and overly complex for both clinicians and patients. Many aspects are underfunded and poorly integrated with existing health services," he said.
“This poses significant challenges. We must ensure VAD funding keeps pace with the work required, that the pipeline of participating clinicians is sustainable, and unnecessary barriers to access for patients are removed.”
Telehealth reform a priority
Clinicians attending the conference’s first day discussed the challenges they faced and voted on what they saw as the most pressing VAD policy issues.
At the top of the list was telehealth reform, with delegates stressing the urgency of removing prohibitions in Australia on the use of telemedicine in VAD assessments and processes. By contrast, in New Zealand telemedicine plays an accepted part of VAD practice.
In Australia, two sections in the Commonwealth Criminal Code Act in 2007 – 474.29A and 474.29B – prohibit the use of a carriage service to discuss or send ‘suicide related’ materials. Even though VAD laws stipulate that VAD is not suicide, a lack of clarity about the scope of the Code means VAD providers are reluctant to use telehealth to discuss some aspects of VAD with their patients for fear of prosecution and a $220,000 fine.
The ambiguity causes unnecessary suffering and delays for terminally ill people, many of whom are too sick to travel to in-person consultations. It also limits access for people living in rural, regional and remote areas and increases complexity and stress for health professionals delivering VAD care.
Adequate funding and remuneration for healthcare practitioners providing VAD services was also voted a priority. Currently, there are no item numbers on the Medical Benefits Schedule (MBS) for VAD assessments or administrations. A lack of any supplementary federal funding alongside existing access schemes, means doctors must either ask their patients for a significant out-of-pocket expense or, as many do, bear the cost themselves.
This is unsustainable as the obligations of a VAD practitioner are many and varied. They include; mandatory training, travelling to patients, obtaining prognostic information, completing the required documentation, and providing support and information to patients and their loved ones.
As the then-Western Australian State VAD Clinical Lead Dr Simon Towler told MJA InSight in December 2022:
“GPs are the largest group [of VAD providers] … And for them, taking the time which is required … to assist a person, particularly with the administration phase… is actually many hours. And if you have to leave your general practice to do that [it] means you’re not making money through your normal work.
“A whole lot of VAD occurs in people’s homes. If you are like myself, an intensive care practitioner, there is no number for me to charge for a service at home because Medicare does not conceive of an intensive care doctor providing a service in somebody’s home.”
Other issues discussed at the conference included: a greater integration of VAD services in specialist palliative care; the need for tailored VAD grief and bereavement support for individuals, families and carers; the development of VAD practice standards; and public education and information campaigns to ensure people know VAD is now a legal end-of-life option in Australia and New Zealand.
Stay up to date with regular updates and information about voluntary assisted dying in Australia here.