Aged Care Insite Issue 110 Dec-Jan 2019 | Page 35

workforce So the Act establishes some clear eligibility criteria, and there is a step-through process for requesting an assessment, which includes requirements for medical practitioners, and the access part of the voluntary assisted dying permit process which authorises the prescribing and dispensing of the voluntary assisted dying substance. It also establishes a voluntary assisted dying review board. This board will provide for a range of additional safeguards, including substance monitoring, practitioner protections, offences and a five‑year review. To give you a little more about the eligibility criteria, to access voluntary assisted dying a person has to meet all of the following: they must be aged 18 years or more; they must be an Australian citizen or permanent resident and be ordinarily resident in Victoria for at least 12 months; and they must have decision-making capacity in relation to voluntary assisted dying. The individual also needs to be diagnosed with a disease, illness or medical condition that is incurable, advanced, progressive and is expected to cause death within six months. The exception to that is if the individual has a neurodegenerative condition, and then it’s up to 12 months. It needs to be considered that the disease, illness or medical condition is causing suffering that cannot be relieved in a manner the person considers tolerable. So where do nurses come into this? Because there is every opportunity that they may be working on an acute care setting or out in the community where a patient or client might ask them what they know about voluntary assisted dying. They might be in a situation where someone has been admitted into hospital with their box of their substance to be able to end their own life, and they’ve actually come into hospital to finish their life in hospital, because there’s nothing stopping someone from doing that. So, nurses have to start thinking: “What are the implications if I find myself caring for someone and I’m not fully agreeable with, or I don’t particularly believe in, the actions that individual is taking?” How aware are nurses of the legislation? dying, whether they’ve got access to it. So that’s where you’ve got to make that decision. You’ve got to base it on your own personal values about what you consider is ethically right or wrong in that scenario. The other ethical issue is where you might be in discussion with people at work and you find yourself being challenged about your perspective. Tell us about the Voluntary Assisted Dying Act 2017. The Act provides for and regulates access to voluntary assisted dying. It took two years of consultation and development, and reflects the balance between giving people choices at the end of their life and ensuring community safety. The guiding principles behind that are every human life is of equal value. A person’s autonomy should be respected. It involves informed decision making. It’s about quality care, so looking at minimising suffering and maximising quality of life. It’s also very much centred on therapeutic relationships that need to be supported and maintained, and that there are open discussions about death and dying, and conversations about treatment and care preferences. And that there is a genuine choice balanced with safeguards and, importantly, respect for cultures, beliefs, values and personal characteristics. As for the Melbourne region for the Australian College of Nursing, we’ve posted two voluntary assisted dying seminars this year. We had one in July and one in October. Judging from the questions coming from the audience, many nurses had not given much Under this legislation, nurses are not able to initiate the conversation. consideration to how the voluntary assisted dying legislation may possibly impact on their practice. One thing that’s very important is we cannot initiate the conversation as a nurse. Under this legislation, we are not able to initiate the conversation. If a patient asks us, then we can say, “Oh, I can get you some literature.” But we cannot start the conversation. That was one of the things that came out of the seminars, that nurses were not aware of that implication of the legislation. We are not required to participate because conscientious objection is enshrined in Victorian law, and as I said, a health practitioner must not initiate that discussion about voluntary assisted dying with a patient while providing a health service. ■ agedcareinsite.com.au 33