As ExSitu talks a lot about dignity versus risk and dignity in a care setting, we’re tackling aspects of Voluntary Assisted Dying for the purpose of clarity and education.
Please note: We believe strongly in individual, customised and values-based care is the right of all dying Australians. We recognise that the definition of quality of life, personal dignity, and unendurable conditions are deeply personal. What feels appropriate for one person is not the same for another. As such, all information provided to you here is about discussing VAD from the perspective of furthering your research in relation to care choices and supporting those who activate them through the VAD lens. Our position remains one where we believe in individual care needs being met in whatever form the individual specifies as long as they are legally, medically and practically applied with full consent of the person receiving that care.
What is Voluntary Assisted Dying?
The definition of Voluntary Assisted Dying varies slightly from state to state. This is important to note as it may influence at what point you can access VAD and what you need to have in place to be able to do so.
The End-of-Life in Law page at QUT has provided a summation of shared values across each state in Australia:
Voluntary assisted dying (VAD) refers to the assistance provided to a person by a health practitioner to end their life. It includes:
‘self-administration’, where the person takes the VAD medication themselves (this is sometimes called physician-assisted suicide or dying), and
‘practitioner administration’, where the person is given the medication by a doctor (or in some Australian States, a nurse practitioner or registered nurse) (this is sometimes called voluntary euthanasia).
‘Voluntary’ indicates that the practice is a voluntary choice of the person, and that they are competent (have capacity) to decide to access VAD.
This helpful page on VAD also provides a summation of each state, as well as policies, legality and certain areas related to end-of-life such as the refusal of food and drink on patient level and so on. We recommend referring to this information as part of your research.
Where is Voluntary Assisted Dying available?
You’ve likely seen that all states in Australia (that is, excluding the ACT and Northern Territory at this stage) have passed the bills to allow for Voluntary Assisted Dying. However, access to VAD is subject to each state’s roll out date.
How your state is dealing with Voluntary Assisted Dying:
- VAD is already operating in Victoria and Western Australia and is available in limited circumstances to people who meet the eligibility criteria.
- Tasmania Voluntary Assisted Dying commences in October 2022
- South Australia VAD will arrive in early 2023, Queensland on 1 January 2023, and New South Wales on 28 November 2023
- The ACT and Northern Territory do not have Voluntary Assisted Dying laws as the Rights of the Terminally Dying Act used to overturn the earlier VAD provision in both territories remains in place currently.
How do you access Voluntary Assisted Dying?
According to the End-of-Life Directions for Aged Care (ELDAC), accessing Voluntary Assisted Dying is a multi-step, two-doctor process that involves the following:
- A request is made by the individual asking to access VAD via a submission to the first doctor. This is the first round of such submissions made to access VAD
- The doctor undertakes an eligibility assessment of that individual
- A second doctor also undertakes an eligibility assessment based on the original submission
- The individual furthers their case for access to VAD with a second submission in the form of another written request
- This is reviewed and added to the submission already received
- A third (and in most cases, final) submission is made by the individual
- All the submissions are reviewed
- An administration decision is made. This is when the individual either receives approval or is declined access to VAD
- If the VAD submissions are approved, a prescription and dispensing of VAD to a qualified medical professional occurs
- If the VAD submissions are declined, the individual restarts the submission process
- The approved for VAD individual takes possession of the medication from the medical professional and self-administers the drugs OR a qualified health practitioner administers the drugs with the individual’s approval.
Note: The two doctors who assess VAD eligibility must both have undertaken specialised VAD training in the State where they practice.
In some situations, other opinions might be sought to ensure that the Voluntary Assisted Dying process meets all legal and medical standards.
This might occur in situations where there is doubt over whether the individual requesting Voluntary Assisted Dying can give their consent freely and in an informed way. Or where questions are raised about the nature of the suffering experienced by the individual or if their experience of end-of-life has met the appropriate six (or twelve) month timeframe.
Voluntary Assisted Dying is your choice
At all stages of the VAD process, you will be asked if you wish to continue with the process. You will also be assessed physically, emotionally, psychologically and in terms of decision-making capacity for your protection.
If you begin the process of making submissions for access to VAD, you can withdraw these submissions at any time.
Loved ones, medical professionals, aged care providers or other individuals within or outside your treatment circle cannot advocate for you to receive VAD at any time. This protection against missue and abuse exists regardless of whether you have begun submissions, finalised your submission or not made any submission. Without a properly approved, three times made written submission from you, you will not have VAD administered.
This does mean that if you cannot request access to Voluntary Assisted Dying measures three times on your own you will not be able to receive VAD. It also means that advocacy from families, loved ones or friends will in no way influence the attending medical professionals.
If you have further questions about Voluntary Assisted Dying, ExSitu recommend initiating frank and open discussions with your loved ones and treatment team so that you can fully articulate and understand your options.