WA review: 10 recommendations for improving VAD access
The potential harm to patients caused by some health care facilities refusing to provide VAD is one of the key issues identified in a statutory review of WA’s Voluntary Assisted Dying Act 2019.
While the review panel found the Act had been successful in facilitating end-of-life choice, it made 10 recommendations, including improving patient access to VAD that may be hindered by institutional conscientious objection.
The recommendations also aim to address gaps in awareness, education, regional access and workforce sustainability.
“The Panel received evidence that the policies and practices adopted by some health professionals and institutions holding a conscientious objection to voluntary assisted dying are undermining the current processes….’’ the report said.
“In the Panel’s view, this has resulted in people eligible for voluntary assisted dying not receiving adequate support.”
The review found there was confusion among health practitioners who wrongly believed that initiating discussions about VAD was prohibited, and that there was a need for better training and education.
Sustainability of the WA VAD workforce was identified as a key issue, exacerbated by the lack of remuneration under the Medicare Benefits Schedule (MBS).
Even though the WA Government has established a remuneration model to support VAD practitioners, introducing MBS items for VAD would “expand workforce capacity, mitigating the risk of practitioner burnout and attrition” as well as improving equity of access for those who can’t afford privately billed medical care.
The ban on telehealth in VAD service provision was also affecting practitioners and their patients in rural and regional areas.
WA Health Minister Amber-Jade Sanderson accepted the panel’s 10 recommendations.
“As everyone in this place knows, this VAD legislation is close to my heart,” she said in Parliament. “Overall, the VAD Act has been a success in its first few years of operation.”
Key Findings
1. Awareness and Education
One of the main findings of the review was the variable awareness of VAD across the state. This is a barrier to access, both for patients and health professionals.
Recommendation: Improve public awareness and ensure that health professionals have a clear understanding of the Act and all available end-of-life choices.
2. Understanding the First Request
There is confusion about the "first request" process under the Act, where some medical practitioners mistakenly believe they are prohibited from discussing VAD. Additionally, patients were sometimes unsure of what constitutes a "first request," leading to delays in assessments.
Recommendation: Revise education and training materials to clarify how to make and respond to a first request for VAD, and ensure that all medical practitioners, including those with conscientious objections, understand their obligations.
3. Conscientious Objection
Some health professionals and institutions with conscientious objections to VAD are hindering access to the VAD process. Registered health practitioners are required by law to ensure the safe transfer of care, including relevant medical records, even if they object to VAD.
Recommendation: The Department of Health should collaborate with healthcare providers to clarify processes and strengthen the provision of VAD services, particularly addressing the issue of conscientious objection in both government and non-government institutions.
4. Regional Access
Patients in regional areas face significant challenges in accessing VAD services due to long travel distances, higher costs, and limited access to practitioners.
Recommendation: The Department of Health should optimise access to VAD services in regional areas through the Regional Access Support Scheme.
5. Telehealth ban
The panel raised concerns about the Commonwealth Criminal Code, which restricts the use of electronic communication, including telehealth, in VAD processes. This poses a particular challenge for regional and outer metropolitan patients, who may not always be able to attend in-person consultations.
Recommendation: The WA Government should continue to push for amendments to the Criminal Code to allow for telehealth consultations and the use of electronic prescribing.
6. Workforce Resourcing
While the review praised the dedication and professionalism of the VAD workforce, there were concerns about workforce sustainability. The demand for services has been higher than expected, leading to challenges in practitioner resourcing.
Recommendation: The Department of Health should monitor and evaluate workforce needs and ensure that health service providers adequately resource the VAD workforce.
7. Workforce Remuneration
There is widespread support for the WA Government’s recent establishment of a remuneration model to support VAD practitioners but a sustainable solution for ensuring adequate remuneration requires the Federal Government making changes to the Medicare Benefits Schedule (MBS).
Recommendation: The WA Government should continue advocating for MBS items to be introduced for VAD.
8. Substance Administration and Disposal
The panel found that the safeguards related to the administration, transport, and disposal of the prescribed substance under the Act were operating as intended. However, some stakeholders suggested improvements to the education and policy materials for those involved in these processes.
Recommendation: The Department of Health should develop best practice guidelines for the handling of the prescribed substance and improve resources to support patients in appointing a contact person for VAD.
9. Role of Interpreters
There were calls for clearer guidelines to ensure interpreters play an effective role in the VAD process.
Recommendation: The Department of Health should develop a best practice model for working with interpreters, ensuring culturally appropriate and accurate translations.
10. Information Sharing
There was confusion surrounding the sharing of patient information under the Act.
Recommendation: The Department of Health should clarify the guidelines for information sharing, specifically in regard to patient consent, to ensure compliance with the Act and maintain patient privacy protections.
The review panel concluded overall that the Act is operating effectively and does not require legislative amendment. The scope of the review did not include examining eligibility criteria for VAD.
“Processes provided under the Act are generally operating well in supporting all those involved in providing and accessing voluntary assisted dying,’’ the panel noted.
The Statutory Review of the Voluntary Assisted Dying Act 2019, was tabled on 28 November in the WA Parliament.