Advocates for voluntary assist dying are celebrating today with the passing of the Voluntary Assisted Dying Bill 2017 by the Victorian Legislative Assembly.
The Bill, still to be ratified by the Upper House, aims to provide terminally ill people with choice over the timing and manner of their death and to alleviate any intolerable suffering.
Under the terms of the Bill, at least two specialist clinicians are required to be involved in the process of assessing eligibility for voluntary assisted dying.
However medical practitioners’ choice is protected too – with the opportunity to conscientiously object to involvement in voluntary assisted dying.
In her second reading of the Bill, Victoria’s Minister for Health Jill Hennessy said the voluntary assisted dying framework was ‘safe, compassionate and workable’.
Given the vast majority of people would not be eligible, want or choose to access voluntary assisted dying, she said the bill would not affect the practice of most health practitioners.
Eligibility for voluntary assisted dying requires that the person making the request must have an incurable illness that is advanced and progressive and would be expected to cause death within weeks or months, not exceeding 12 months.
People with mental illness or disability only would not be eligible and people with dementia would be excluded due to their impaired capacity to make an informed decision.
Ms Hennessy said voluntary assisted dying would never be seen as an alternative to or inevitable extension of palliative care.
“Victoria’s end-of-life and palliative care framework commits government to strengthening the palliative care sector and ensuring that all providers across health, community and social care sectors take responsibility for delivering high-quality end-of-life care.
“Voluntary assisted dying is not a substitute for palliative care, and will not preclude access to the high standards of palliative care enjoyed by Victorians.”
Implications for practice
Speaking to the limbic, Dr Carol Douglas, president of the Australian and New Zealand Society of Palliative Medicine (ANZSPM) said the publicity around the Bill could increase referrals to specialist palliative care services.
“While that has implications for service delivery, if this law is passed there may in fact be the opportunity here to actually enhance the health system’s and public’s awareness of the need for palliative care services.”
She said the vast majority of ANZSPM members did not want to be providing voluntary assisted dying. However they were likely to have a role in supporting other disciplines who were also looking after patients at the end of their lives.
“There is definitely an opportunity. The concern will be for clinicians who don’t deal very well with end of life discussions.”
“99% of our patients have an excellent quality of life and have their symptoms managed very well, including pain. When people want to die, very often it’s the existential distress that can be hardest to support.”
“Some clinicians are excellent at talking about disease processes, research and treatments, but not very good at dealing with emotional distress, deterioration, etcetera.”
She said in Canada, doctors who said they would support their assisted dying laws were offered crash courses in palliative care so they could at least identify issues and try to support patients who were referred to them.
“I would be concerned about those doctors who would not know how to respond to these requests. It’s so seldom that someone desperately wants to end their life and it’s about how you deal with that patients so you don’t turn them off but actually start to unpick what the suffering they are experiencing is all about.”
“Clearly we want clinicians to be able to have that discussion with a patient, know what to do with it and where to take it.”
She said every level of medical education from undergraduate to postgraduate, should require the integration of palliative skills.
“I would think that every institution is going to have to be thinking about how they will manage this. There is an awful lot of work to do if this goes through.”