A statutory gag on doctors raising the issue of voluntary assisted dying with terminally ill patients will be reviewed when the ruler is run over Victoria’s model right-to-die law, pushing the medical professional into a more muscular role. The default setting for patients to self-administer the lethal dose is also set to feature in the official review of the nation’s first Voluntary Assisted Dying (VAD) scheme. This will fan criticism that the coverage is expanding beyond the original remit of the Victorian law, which came into force in 2019, and raise fresh doubt about Premier Daniel Andrews’ boast that it has the world’s most “conservative” settings. All six Australian states are due to have programs up and running by next November, with the ACT likely to follow after a longstanding commonwealth veto on VAD in the territories was recently lifted by federal parliament. The Northern Territory has said it won’t legislate ahead of the 2024 election there.

VAD started on January 1 in Queensland amid deep Catholic Church anger that faith-based hospital and residential aged care services will be forced to allow assisted dying onsite. The capacity of doctors to present the option to patients is contentious, with South Australia adopting the Victorian ban for its program, set to commence in March. To date, more than 600 Victorians have taken their lives through VAD. The laws in Queensland, Western Australia, Tasmania and NSW allow doctors to initiate a discussion of VAD with patients, provided they also detail the benefits of end-of-life care and treatments. Non-medically licensed healthcare workers, however, may not start such a conversation. But Victoria’s Voluntary Assisted Dying Review Board chair Julian Gardner said there was a case for overturning the doctors’ gag. He was “sure” it would be considered when the VAD law came up for evaluation from July 1, a stipulation of the act after four years of operation.

“The restriction on medical practitioners was put in to recognise that many people have a lot of faith in their doctor and, you know … that if the doctor raises it, they may feel some undue pressure to go along with that option. It was seen as a safeguard,” Mr Gardner said. “On the other hand, if the doctor has an ethical responsibility to ensure that somebody makes an informed decision – and autonomy is at the heart of this legislation – you can only make an informed decision if you’re aware of all the options. “And for a doctor, it presents a dilemma because they’re not allowed to give them all the options. It means that a patient may in fact make a decision about treatment not knowing that (VAD) is an option, and therefore that diminishes their capacity to exercise their autonomy. “So, it is a balancing exercise. And I think those competing arguments will be something that’s looked at in the review.”

Mr Gardner, a lawyer by profession, said self-administration of the death-dealing drugs would likely be on the table when there were “arguments on both sides” over Victoria’s policy to limit the involvement of doctors. Go Gentle Australia CEO Linda Swan says the pro-VAD group was focused on raising awareness of VAD among doctors and eligible patients. Go Gentle Australia CEO Linda Swan says the pro-VAD group was focused on raising awareness of VAD among doctors and eligible patients. This meant VAD users were required to dose themselves, usually orally, except in circumstances where they were physically incapable of swallowing. Fewer than 15 per cent had a doctor administer it, Mr Gardner said. But in WA, the second state to bring in VAD, 77 per cent of the 190 people to die in the scheme’s first year of operation had asked a medical practitioner to give the drugs.

VAD accounted for 1.1 per cent of all deaths in WA, nearly double the proportion in Victoria. Mr Gardner said there could be a connection. “There are those who argue that there are problems with practitioner administration insofar as you lock yourself in to a day to make an appointment,” he said. “And the question is: do you then feel an obligation to go ahead with this, not wanting to muck the doctor around? I mean … it’s notable that in WA the percentage of practitioner administration is so high whereas in Victoria it is only 14 to 15 per cent.” Rejecting the so-called “slippery slope” theory advanced by VAD critics who point to Canada and the Netherlands as examples of how it can be widened to the non-dying, Mr Gardner said the differences from state to state amounted to “tweaks”, and the fundamental criteria for VAD eligibility and practice were consistent.

But National Seniors Australia president John McCallum said the Victorian review should consider extending access to people with end-stage dementia who had made advance care directives while still competent. Go Gentle Australia CEO Linda Swan said the pro-VAD group was focused on raising awareness of VAD among doctors and eligible patients. “Our priority is to ensure that the laws we have in Australia are well understood,” she said. But doctors needed to be compensated for the time involved in steering a patient through the process, and Dr Swan backed calls for the creation of a dedicated Medicare VAD item number. On the Victorian gag on doctors initiating discussion of assisted dying, she said: “We have clearly heard of situations and case studies where it has been a barrier.

“If you talk to healthcare practitioners in Victoria, you’ll find that it does make it very difficult in some circumstances to have a really balanced discussion with people about their end-of-life choices.” The Australian Medical Association’s federal office declined to comment; AMA Victoria could not be raised. Mr Gardner said the proportionately lower take-up rate of VAD in Victoria was another issue that could figure in the review. Queensland Health modelling reported by the ABC last month and confirmed by the state government projects between 380-430 deaths through the scheme in its opening year of operation – in line with WA in accounting for about 1.1 per cent of all deaths. Asked to account for the discrepancy, he said: “That’s a very good question and the answer is, I really don’t know. “I would expect that to be something that will be subject to examination when the review is done in Victoria.”

Source: Compiled by APN from media reports

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