Victoria’s voluntary assisted dying legislation, the Voluntary Assisted Dying Act 2017, comes into effect today, making it the first state in Australia to allow people who are at the end of life who are suffering and meet strict eligibility criteria to request access to VAD.
The stringent legislation was passed on 29 November, 2017, and mirrors recent consideration of similar laws across the country.
VAD was legal in the Northern Territory between 1996 and 1997 until a federal law overturned the scheme.
Nationally, legislation is currently being looked at in Western Australia and Queensland, while New South Wales and South Australia saw recent drives to introduce laws narrowly defeated.
What is voluntary assisted dying?
VAD involves administering a medication for the purpose of causing death while following the processes set out in the law.
It must be voluntary and initiated by the person themselves and will typically be self-administered or carried out by a medical practitioner.
It is only available to people already dying from an incurable, advanced and progressive disease, illness or medical condition who face imminent death.
The law provides a range of protections to make sure VAD is safely implemented and monitored in Victoria.
Who is eligible?
In order to be eligible to access VAD in Victoria a person must:
- Be over the age of 18 and have lived in Victoria for at least 12 months
- Be suffering an incurable, advanced and progressive disease, illness or medical condition
- Be assessed as having decision-making capacity
- Have their condition assessed by two doctors who predict death within six months, or in the case of a neurodegenerative condition, 12 months
- Be experiencing suffering that cannot be relieved in a manner considered tolerable
How does VAD work?
Only the person wanting to access voluntary assisted dying may initiate discussions with health practitioners, including nurses, about VAD.
Likewise, a family member or carer cannot request it on somebody else’s behalf.
To access VAD, a person must be assessed for eligibility by two doctors to ensure the applicant is making a fully informed decision and is aware of palliative care options.
If the person wishes to proceed, they will then need to make a written declaration, witnessed by two independent individuals, of which only one can be a family member, confirming they are making an informed decision to end their life.
On receiving a final request, the doctor will apply for a permit to prescribe a medication that the person can use to end their life at a time and manner of their choosing.
The person must administer the medication themselves, unless physically unable to do so, in which case a doctor may assist.
Notably, no health practitioner or healthcare provider will be forced to participate in voluntary assisted dying.
What safeguards are in place?
The Voluntary Assisted Dying Review Board will oversee voluntary assisted dying activity in Victoria to make sure the law and its steps and safeguards are being properly adhered to and that people are not being pressured into participating in VAD.
The Board will monitor permit applications, receive reports from all health practitioners who participate and review every case of voluntary assisted dying in Victoria to make sure that the Act is being complied with.
It will also make suggestions for changes or improvements in the law and work with other organisations such as Victoria Police and the Coroner to ensure professional standards are followed.
A person who is prescribed VAD medication must also nominate a contact person so that any unused medications are safely returned.
Safeguards for health practitioners include the ability for conscientious objection.
Implications for nurses and health professionals
As stated above, no health practitioner or healthcare provider will be obliged to take part in voluntary assisted dying.
The law protects doctors and other health practitioners, such as nurses and pharmacists, who do not want to take part in VAD due to a conscientious objection or if they believe they do not have the appropriate skills and training.
This means nurses can refuse to provide information or support about VAD, assess the eligibility of a person for VAD, and prescribe or administer drugs.
Voluntary assisted dying will largely be provided by doctors and a limited number of pharmacists responsible for dispensing the medications and disposing of any unused medications.
Other health practitioners such as nurses will not directly provide VAD but may deliver care to patients who have requested VAD or are considering requesting access by helping to manage questions.
In some cases, nurses approached about VAD may not be comfortable talking about the prospect but should be prepared to respond to the request in some way and may instead refer the person to a colleague or other source of information.
Importantly, nurses are encouraged to document any discussions they have with a patient about VAD.
Similarly, health services can choose not to participate in voluntary assisted dying depending on whether they have staff with the appropriate skills and expertise, the capacity to provide the service and if the participation aligns with the values of the service.
GPs interested in participating are required to apply for a VAD permit from the Victorian Government and need to submit several forms to the VADRB.
To help with the process, the Government has also appointed voluntary assisted dying care navigators to support anyone across Victoria seeking information about VAD or assistance going through the process.
The role includes facilitating access to support needed, supporting ineligible people and providing education to health services.
For more information visit the Victorian Government’s VAD website
