The French philosopher Edgar Morin said, “The certainty of death and the uncertainty of the hour of death is a source of grief throughout our life.”
Today, modern medicine has various modalities by which end of life does not have to be confined to pain and suffering but can be expanded to include choices by which pain and suffering are mitigated. Voluntary assisted dying is one of those modalities.
What is Voluntary Assisted Dying?
VAD refers to the assistance provided to a person by a health practitioner to end their life. It includes prescription and delivery of ‘self-administered’ medication for ending life and or ‘practitioner-administered’ modality of death where a Doctor, and in Queensland an authorised nurse practitioner or registered nurse, can give the medication to the patient to end their life.
The Voluntary Assisted Dying program is a modality used in end-of-life care by properly authorised healthcare practitioners, in those jurisdictions where VAD is lawful.
Where is VAD Lawful?
VAD became lawfully available to eligible persons in Queensland from 1 January 2023.
VAD is not yet available in all states and territories, and practitioners should understand the lawful status of VAD in their jurisdiction. In states and territories where VAD is not yet lawful, a person such as a doctor or family member who assists another person to die, may be charged with a criminal offence such as murder, manslaughter, or aiding suicide.
The passage of VAD into law has had a complex history.
Voluntary euthanasia and physician-assisted suicide were legalised in the Northern Territory between March 1996 and March 1997 until the Australian Government intervened, using its constitutional power to pass legislation overturning the Northern Territory legislation.
After years of political dispute, in December 2022 the Federal government passed laws that removed the decades-long ban, allowing the Northern Territory and the Australian Capital Territory to legislate on VAD.
Who can Deliver VAD?
In states where VAD has lawfully commenced, practitioners who are interested in delivering VAD must successfully apply for authorisation, completing a VAD Authorised Practitioner Training – typically through the VAD Unit in their state.
In Queensland a practitioner will be authorised to provide voluntary assisted dying services for three years, unless the practitioner becomes ineligible—for example, by their registration lapsing.
Persons who can Access VAD
The key eligibility criteria for a person to access the VAD program in Queensland are:
- is a QLD resident;
- has capacity;
- has a terminal illness;
- has an illness which will end their life within the next 12 months;
- is above the age of 18
The key word in VAD is ‘Voluntary” – a voluntary choice of the person, and that the person is competent (has capacity) to make the choice. Hence the process is called voluntary assisted dying, rather than euthanasia, physician-assisted suicide, or physician-assisted dying.
The VAD Process in Queensland
VAD is only available after the person has gone through a careful assessment and review process, summarised for the Queensland program in the diagram below:
Source: Queensland Health
Legal Considerations
Some considerations for health practitioners who are interested in VAD, are:
- Do not practice in the area unless and until properly trained and authorised by the relevant regulatory authority.
- Before starting to practice in the area, notify your professional indemnity insurer. Even if your medical indemnity terms may already cover the practice area, it is better to be safe.
- Keep good and contemporaneous medical records in accordance with relevant laws.
- Work with a team of practitioners and with allied health support, together ensuring the service meets the requisite standards and the expectations of the patient and their loved ones.
- Take rapport building very seriously, not rushing a step but proceeding in a considered and timely manner. Anecdotally, a patient journey from start to end of application is at least 20-30 hours of contact and non-contact time by the practitioner. Taking the necessary time can help to exclude avoidable disappointment and disputation.
- Stay current, by continuing professional learning and engaging with peers and colleagues doing the same work.
Follow this link for more information for practitioners who are interested in practising in VAD and understanding their rights and obligations.
Follow this link for more information about VAD practitioner eligibility criteria.
Some more information is available here or you can book online for an initial no-obligation chat about reviewing an employment contract or contractor agreement.