The first anniversary of the operation of Victoria’s landmark Voluntary Assisted Dying Act is an important milestone for kinder, more compassionate end-of-life choices in Australia. But there is unfinished business.
Victoria remains the only Australian jurisdiction with an assisted dying scheme in place, and its first year has provided valuable insights into how Voluntary Assisted Dying (VAD) can operate throughout Australia.
It is clear from the evidence that, overall, the Victorian scheme and its safeguards are working well and as intended.
The uptake of the scheme by terminally ill Victorians reinforces what advocacy groups have long argued: that there is a great need for more compassionate end-of-life options for dying Australians who are suffering intolerably.
Most revealingly, predictions by opponents of these laws that the sky would fall in have proven to be unfounded: Abuse of the vulnerable and ‘wrongful’ deaths have not been realised.
Palliative care services have not been compromised (in fact, feedback to Go Gentle Australia shows that a majority of people who have sought VAD have also benefited from the skills and services offered by palliative care). It turns out, unsurprisingly, that dying Victorians and their doctors can be trusted to make appropriate decisions about end-of-life care and about how much suffering terminally ill people must endure.
We now await a full-year appraisal of the law’s implementation – and more detailed statistics on the people who choose VAD – in the Victorian VAD Review Board's third report, due for release in July/August.
Barriers to access
The statutory body’s previous report, covering the first six months of the scheme, confirmed that 100% of cases had been compliant with the Act and no cases were referred for investigation in the reporting period. However, the Board highlighted several concerns around the scheme’s operation – mainly to do with equity and access for eligible Victorians. This is the first of the unfinished business.
Anecdotal reports received by Go Gentle Australia also raise these concerns, as do two comprehensive academic studies of the Victorian scheme; one from QUT; the second from the University of Melbourne.
Both pieces of research emphasise that, while the Act contains elements that promote equal access, several of the law’s safeguards create significant barriers for eligible patients. Three safeguards in particular are problematic:
- that medical professionals who are conscientious objectors to VAD can refuse to refer their patients on, effectively delaying or barring patients from accessing the option;
- the prohibition on health practitioners raising the option of VAD with their patients, meaning they cannot effectively discuss all lawful treatment options available; and
- the requirement that one of the consulting doctors be a specialist in the disease from which the person is dying. Specialist doctors sometimes have lengthy waiting lists of many months. We have received several reports of desperately ill people, who are eligible for VAD, struggling in their final weeks to get the help to which they are legally entitled.
Of additional concern are the unforeseen consequences of the application of the Criminal Code Amendment (Suicide Related Material Offences) Act 2005, which has had the practical effect of restricting medical practitioners from discussing VAD by phone or email, or from using telehealth as part of their assessment and consultation requirements. This restriction, already problematic, has been further magnified by the impact of Covid-19.
There has also been a relatively low number of doctors, particularly specialists, who have undertaken the mandatory training in VAD. This has obvious ramifications for patients seeking a doctor who is qualified to guide them through the process. This reflects experience overseas where take-up of similar laws in their early years was small. We believe this can – and should – be partly addressed by a Government education campaign, targeted at the medical community, outlining their rights and responsibilities in relation to VAD law.
Go Gentle Australia encourages all of Victoria’s peak medical bodies to consider running forums for their members to better inform them about VAD, in particular, the experience from the patient’s perspective of making an application.
A law is of no benefit if the people it is intended to help are denied access to it. Go Gentle Australia urges the Victorian Government and the VAD Review Board to take note of these concerns as their attention turns to refining the operation of the Victorian scheme.
Equality for all Australians
For the rest of Australia, it is now clearer than ever that there is still more to do regarding end-of-life choice in this country. The Rule of Law, to be valid, should apply equally and to all Australians. That is currently not the case on this important issue.
Jurisdictions with no VAD scheme in place must now act swiftly to remove this inequity and bring all states and territories in line with Victoria and Western Australia by introducing safe and compassionate voluntary assisted dying laws.
Media contact: Steve Offner, Communications Manager, 0426 283 865 firstname.lastname@example.org