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. ■
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