industry & reform
Into the great unknown
How will Victoria’s Voluntary
Assisted Dying Act work?
By Conor Burke
Y
“
ou don’t know.”
Jac Mathieson, the chief
nursing officer at the Peter
MacCallum Cancer Centre, found herself
saying this a lot when talking about the
Voluntary Assisted Dying Act, which is now
law in Victoria.
In this instance she was asked, “What
if someone procures the drug, how do
we know that they won’t share it with
someone else such as their spouse, or even
worse, use it on someone else?”
And how might the law impact nurses
generally?
“[It’s] hard to say. We don’t know.”
From 19 June this year, Victorians who
meet strict eligibility criteria have been able
to access drugs that will end their life from
specialty pharmacies.
These people must be diagnosed with
an incurable disease or medical condition
that causes intolerable suffering, the
condition must be assessed by a doctor
and, importantly, the condition must be
predicted to cause the patient’s death
within six months.
Eligibility only applies to those who
have lived in Victoria for a minimum of 12
months and are over 18, and they will need
a designated support person who co-signs
for the drug with them.
14 agedcareinsite.com.au
A piece in The Conversation quoting
a peer-reviewed paper showed that in
countries where assisted dying is legal
“between 0.3 per cent to 4.6 per cent
of all deaths are reported as euthanasia
or physician-assisted suicide”, and “the
frequency of these deaths increased after
legalisation ... Existing data do not indicate
widespread abuse of these practices”.
In the Australian context, Mathieson
believes the Act has a number of
safeguards within it and is a “long-winded
process” that includes the patient having to
make three separate requests before they
can gain access.
After an initial consultation with a doctor,
a second doctor will make an assessment,
then a person will have to make a
written declaration verified by witnesses
confirming they wish to undertake
the process.
No family members will be allowed to
administer the drug, nor will nurses, and
only in very rare circumstances – such as
a patient being unable to physically self-
administer – will a doctor be allowed to
administer the drug.
In fact, no medical professional will
be even allowed to broach the topic of
assisted dying with a patient, which could
cause some teething problems initially.
“I think the design [of the Act] is as
good as it could be. There are unknowns
because, for example, in the Act it says that
every patient has the right to choose and
the right to access,” Mathieson said.
“But then it also talks about medical
professionals not having to participate.
So, if you’re the patient and you’re speaking
to your doctor and they don’t have to
participate, how do you actually get access?
“Those sorts of things, the logistical
things, hopefully, will soon iron out.”
Other unknowns, according to
Mathieson, include the number of patients
who will actually exercise this right and the
exact role of nurses going forward.
“People are pretty quiet at the moment
to be honest,” said Mathieson when asked
how her workforce felt.
“We are getting a lot of questions like:
How do we know that they will actually
die? What happens if they die on the ward?
Really practical questions.
“It’s so unlikely that it will happen on a
patient ward. But if it did, it’s only then that
we will be able to assess the impact. For
staff that really don’t believe in it, I think
that could be very challenging,” she said.
The Act states that “no health practitioner
or healthcare provider will be obliged to
participate in voluntary assisted dying”.
Still, the role of the nurse is not
described, Mathieson said. She added that
listening and communication will be key
for nurses, as “we can’t underestimate the
amount of questions a nurse will get”.
The Act is also up for review in three
years, so roles and practice may change.
“The first year will be interesting. I’m
expecting that we will get a lot of enquiries,
more than actual people following
through. And then it will become business
as usual,” Mathieson said.
As for the future of voluntary assisted
dying in other states, this too is unknown.
In a recent paper looking into the future,
professors of law Ben White and Lindy
Willmott conclude that country-wide
adoption of the practice will not be easy.
“Voluntary assisted dying in Australia
is ‘a train that has left the station’.
International trends, growing Australian
political support (coupled with strong and
continued community expectation), and
the weakening of key opposing arguments,
all point to other states following Victoria’s
lead by legalising voluntary assisted dying.
“The heated debates last year in the
Victorian parliament about VAD laws
revealed a depth of raw emotion from
many politicians.
“Although reform in other Australian
states is likely, that train journey will be one
that is slow, uphill and with plenty of twists
and turns,” they said. ■