Providing support to patients who are exploring voluntary assisted dying

October 16, 2019
/ By: Michael Collins

Category: Career & Practice

Victoria has recently enacted legislation that permits people who are at the end of life and meet strict eligibility criteria can request access to voluntary assisted dying (VAD).

The act requires patients seeking VAD to be assessed by two different appropriately trained medical professionals who have completed mandatory training in VAD.

Patients may initiate conversations with all health professionals. Nurses have more direct contact time with terminally ill patients and families than other health professionals and may develop close clinical and therapeutic relationships with their patients.

Through holistic patient assessment nurses may develop awareness around the dimensions of the patients suffering which may include physical, psychological, social and spiritual distress.

They may be the first clinicians to have to respond to these requests and are likely to be key staff involved in providing support and comfort to patients at this time.

I work as a nurse practitioner in an outpatient palliative care clinic in a cancer centre in Victoria and several patients have raised this new legislation with me during clinical consultations.

On most occasions they had heard about the legislation from watching TV or reading newspapers and indicate that this is something that they may like to pursue in the future. Over many years as a cancer/palliative care nurse patients have discussed with me the desire for a hastened death.

The new situation is that they have the capacity to progress this option via legal and medically supervised channels.

Despite being very experienced in cancer and palliative care it has taken me some time to develop a position on this new legislative framework.

The organisation’s policy recommends that patients are advised to raise these concerns with the medical practitioner who they have a therapeutic relationship with, which is consistent with the legislative framework.

I feel patients and their families would benefit from a more comprehensive response than solely referring these enquiries on.

My goal as a palliative care nurse is to ensure that appropriate care is provided to patients at all times. Patients and their family members should feel supported and respected whether they choose to explore voluntary assisted dying or not.

I feel that it is important to adopt a professional attitude by accepting the request seriously with a level of openness and taking time to listen carefully to patients, with the aim of uncovering their reasons for requesting euthanasia.

Identifying these reasons is critical to formulating an adequate palliative response to deal with the specific issues of suffering that underlie the euthanasia request.

Patients often raise these requests spontaneously without prior discussion with their families. If family members are present when the initial requests are made they can find these situations confronting and upsetting. Family members may need someone to listen to their thoughts and feeling.

I am often the first point of contact that patients and their families have with palliative care. My role is to be an advocate and ambassador for palliative care and to provide information and assistance on how we can assist them with at this point in their treatment.

Many patients and their family members raise negative perceptions of palliative care including a frightening association with death, hopelessness and loss of independence. Palliative care healthcare system if far from perfect and many patients may not experience the outcomes that they desire. I value the opportunity to collaborate with many palliative care professionals across all sectors and I find that it is the personal qualities and skills of my colleagues that enable excellent care within the limitations of resources. I am excited by some of the new innovations in research and service delivery models that are currently being undertaken by our team.

I view my role to be not an advocate or opponent of the new legislation and I am not involved is assessing the eligibility of patients wishing to access VAD.

I will follow the Palliative Care Australia guiding principles that indicate people living with a life-limiting illness do not have undue delays to access voluntary assisted dying. I have an underlying commitment to support and respect our patients regardless of their views on VAD and I use the best available evidence when providing them with care. I understand that some healthcare professionals will hold different views to me on VAD and that discussion on this important issue be conducted with respect.

Victoria has recently enacted legislation that permits people who are at the end of life and meet strict eligibility criteria can request access to voluntary assisted dying (VAD). The act requires patients seeking VAD to be assessed by two different appropriately trained medical professionals who have completed mandatory training in VAD.