The death of a Queenslander who took voluntary assisted dying medication prescribed to their partner highlights the need for better resourcing, but not wholesale changes to the law, legal academics are arguing.

It follows a coronial inquest into the death of an older person (identified by the pseudonym ABC) who died in May 2023 after purposely consuming a VAD substance intended for their terminally ill spouse.

The couple had both contracted COVID-19 after the VAD medication was delivered to their home. While ABC recovered, their spouse remained hospitalised, lost the ability to swallow, and eventually chose practitioner-administered VAD instead.

Following the spouse’s death, ABC, “overcome with grief and quite unable to function,” did not return the unused medication within the required 14-day timeframe, the inquest heard.

Four days after being contacted about returning the substance, ABC was found dead after consuming it.

In findings released September 2024 [link here], Queensland coroner David O’Connell identified “operational flaws” in the state’s VAD legislation, declaring the current self-administration procedures “inadequate to provide for medication safety and to prevent deliberate misuse.”

The coroner specifically criticised the law for permitting two VAD substances to be issued for one person, as well as the fact authorities could not compel return of unused substances, and that self-administration medications weren’t in a health practitioner’s possession.

The coroner recommended all self-administered VAD should be supervised by a health practitioner – an option considered but rejected when Queensland’s legislation was drafted. He warned of “further calamity and heartbreak” without reform, noting this approach would ensure the VAD substance remained in professional custody and verify the patient still had capacity at administration.

Tread carefully, say experts

However, any reforms would require careful balancing of competing values rather than sweeping changes, argue researchers from Queensland University of Technology’s Australian Centre for Health Law Research.

“Whether to require self-administration of VAD to be supervised is a policy choice informed by weighing evidence and competing values,” wrote Dr Eliana Close (PhD), Dr Katrine Del Villar (PhD), and Professor Ben White in the MJA [link here].

The authors argued any reviews of self-administration laws must consider consider all evidence about the safety and autonomy in the states’ current regimes as well as making sure that the health system is properly resourced to handle any changes.

“Experience with health care systems generally has shown that under-resourced systems with a poorly supported workforce can fail to deliver safe and high quality care,” they said.

“If supervised self-administration is preferred on the grounds of patient and community safety, there is a duty to provide any additional resourcing required.”

Community safety leads reasons for change 

Dr Close and colleagues highlighted three key reasons for moving towards tighter regulations for self administration: the minimisation of community risk, ensuring that patients have capacity to self-administer, and providing patients with assistance if it’s required.

“As the coroner noted, the VAD substances are prescribed in large quantities to end life and are accompanied by explicit instructions on taking them, virtually guaranteeing death,” they said.

If self-administration was overseen by a qualified practitioner, it would improve community safety risks because the substances would remain in the doctor’s custody until the time of use, they added.

Balancing safety and access 

“While the ABC case is undoubtedly tragic, this is an isolated incident,” the authors said, emphasising that a single case was not necessarily a reason for system reform and noting this was the first recorded case nationally of an individual taking a VAD dose not prescribed to them.

Patient access, safety and avoiding additional burdens on clinicians were key arguments for maintaining Australia’s current regulatory approach, they said.

“Requiring VAD to be supervised makes administration dependent on health practitioner availability, which may cause delays for all patients, but particularly those in remote and rural areas,” the authors continued.

“In some cases, delays may mean a person loses their opportunity for VAD because they lose capacity or die before a health practitioner is available.”

They noted that after the coroner’s 2024 report, Queensland had incorporated rules requiring that any medications sent out must be returned before any practitioner-assisted action was taken.

“Governments should provide sufficient resources to address access issues for patients (including rural and remote patients) and burdens on individual health practitioners and the system,” they said.

The legal academics were not alone, pointing out the AMA’s Queensland branch ha also cautioned against overreaction, stating that “a one-off event or death did not necessarily mean the laws were terrible or needed fundamental reform.”

All Australian states and the ACT now have VAD laws, with medication management likely to be a key focus in upcoming mandatory reviews.