Basics Of What You Need To Know About Assisted Dying

Introduction
Victoria became the first Australian state to pass legislation allowing Voluntary Assisted Dying on 29 November 2017.   The law gives anyone suffering a terminal illness, with less than six months to live, the right to end their life. The law had an 18-month implementation period, and came into effect on 19 June 2019.

As independent witnesses in the State of Victoria, e.g. JPs, Nurses, etc. will from time to time be requested to witness the execution of the forms required by the new legislation.   The process does not mandate the type of witness required, but as you know, the public often rely on those they trust for these sorts of things.

 The very thought of Voluntary Assisted Dying can be an anathema to some people in the community, including the witness. If you are not comfortable with being involved, feel free to say so and graciously request that an alternative witness be found. This same opportunity is afforded all health care workers involved in the new process as well.

What is voluntary assisted dying?

Voluntary assisted dying refers to a doctor providing assistance to enable a patient to die. It may offer an additional “end of life” option for those considered eligible, allowing a person to choose to die sooner than otherwise anticipated. A person may request voluntary assisted dying to avoid suffering that cannot be managed in a way they consider tolerable. It’s also a means to control the time and location of their death.

The Victorian regime primarily sets out a practice of “self-administration”, allowing a person to self-administer a prescribed lethal substance. A doctor doesn’t need to be present, though can be. If a person is physically unable to self-administer, the legislation also provides for “practitioner administration”, allowing a medical practitioner to administer the substance in a way most appropriate for the patient.

To be eligible to access voluntary assisted dying a person must:•be aged 18 or over•have lived in Victoria for at least one year before making a first request for voluntary assisted dying, and•be an Australian citizen or permanent resident•have decision-making capacity in relation to voluntary assisted dying, meaning they must be able to understand, retain, and weigh information about voluntary assisted dying, and communicate their decision.

There are several criteria a person must meet in order to qualify for voluntary assisted dying.

They must be diagnosed with a disease, illness, or medical condition that is assessed to be:•incurable, advanced, and progressive•causing suffering that cannot be relieved in a way considered tolerable by the person•predicted to cause death within no more than six months, or no more than 12 months for those with a neurodegenerative diagnosis.

Victoria is not establishing a “right” to voluntary assisted dying. This means there will not be universal access, and people cannot demand voluntary assisted dying.  Rather, access to voluntary assisted dying will depend on the availability of participating health services and medical practitioners, and the approval of the state.

How does someone access voluntary assisted dying?

The legislation outlines a formal procedure for accessing voluntary assisted dying, with specific requirements for making a request, assessment of eligibility, and processes for applying for a voluntary assisted dying permit. In brief, the first step is a request, made directly by the person to a medical practitioner. This is followed by an initial assessment to determine eligibility, conducted by a “coordinating medical practitioner”.

Next, another doctor, called a “consulting medical practitioner” will conduct a second assessment to confirm the person’s eligibility.
The patient will also need to make a second request, in the form of a written declaration, signed in the presence of two witnesses and the coordinating medical practitioner.

The patient will then need to make a third and final request to the coordinating medical practitioner at least nine days after the first request (unless death is likely to occur before).

Lastly, the coordinating medical practitioner will conduct a final review to certify the request and assessment process. They will then apply for a permit, either for self administration or practitioner administration. Either or both the coordinating or consulting medical practitioner may refer the patient to another specialist to assess aspects of the eligibility criteria if needed.

Importantly, at any stage of the process, a person who has requested access to voluntary assisted dying may change their mind and decide not to proceed.

The Voluntary Assisted Dying Act 2017

The Act provides for and regulates access to voluntary assisted dying in Victoria. It:
•establishes clear eligibility criteria;
•steps through a detailed request and assessment process, including requirements for medical practitioners;
•sets up a voluntary assisted dying permit process which authorises the prescribing and dispensing of voluntary assisted dying medication;
•establishes the Voluntary Assisted Dying Review Board (Review Board);
•provides for a range of additional safeguards including medication monitoring, practitioner protections, offences, and a five year review.
You can find out more by visiting Victoria Health at https://www2.health.vic.gov.au/hospitals-and-health-services/patient-care/end-of-life-care/voluntary-assisted-dying