North Western Melbourne Primary Health Network (NWMPHN) believes it is important practices and practitioners are informed about voluntary assisted dying (VAD) and has provided the following summary.
Key points
- From 19 June 2019, Victorians at the end of life who are suffering and who meet strict eligibility criteria will be able to request access to VAD.
- To access VAD a patient will need to make a request to a doctor, who may choose whether to accept their request. A health practitioner will not be allowed to raise VAD with their patients.
- There are two main roles for doctors in VAD: the coordinating doctor (can be a GP), and the consulting doctor (usually a non-GP specialist in the patient’s condition). Both must complete VAD training prior to assessing patient’s eligibility for VAD.
- As part of the program VAD care navigators have been specifically employed to act as a point of contact for members of the public, health practitioners and health services seeking information about or assistance with VAD. The care navigators have knowledge of the networks of participating medical practitioners.
- Eligible people are prescribed a VAD substance to take themselves or, if they are physically incapable of doing so, a doctor with the appropriate permit can administer this substance.
Eligibility for voluntary assisted dying in Victoria
To access voluntary assisted dying a person must meet all of the following eligibility criteria:
- be 18 years of age or over
- be an Australian citizen or permanent resident
- be ordinarily resident in Victoria
- have been a resident in Victoria for 12 months at the time of making a first request for voluntary assisted dying
- have decision-making capacity in relation to voluntary assisted dying
- have an incurable disease, illness or medical condition that:
- is advanced, progressive and will cause their death
- is expected to cause their death within six months (or within 12 months for patients with a neurodegenerative medical condition)
- is causing suffering to the person that cannot be relieved in a manner that the person considers tolerable
The Act further requires that the person is seeking VAD voluntarily and without coercion.
Voluntary assisted dying care navigators
A statewide voluntary assisted dying care navigator support service based at Peter MacCallum Cancer Centre has been established. VAD care navigators will act as a point of contact for members of the public, health practitioners and health services seeking information about or assistance with voluntary assisted dying.
You can contact the care navigators using the following details:
Phone: (03) 8559 5823
Mobile: 0436 848 344
Email: vadcarenavigator@petermac.org
Coordinating medical practitioner (can be a GP)
A medical practitioner who accepts the patient’s first request for VAD and chooses to accept the role and its responsibilities becomes the coordinating medical practitioner. The coordinating medical practitioner has responsibility for assessing the patient’s eligibility for VAD, coordinating the request and assessment process, and prescribing the VAD medication.
They may also be responsible for administering a VAD medication under a practitioner administration permit, when a patient is physically incapable of self-administering or digesting the medication themselves.
Consulting medical practitioner (usually a non-GP specialist)
A medical practitioner who accepts a referral to conduct an independent consulting assessment of the patient’s eligibility for VAD becomes the consulting medical practitioner. The consulting medical practitioner’s only role is to conduct the consulting assessment of the patient. Other specialists may be involved for specific assessments e.g. decision-making capacity.
Either the coordinating or the consulting medical practitioner must have:
- practised as a registered medical practitioner for at least five years after completing their fellowship or vocational registration
- relevant expertise and experience in the medical condition expected to cause the patient’s death. To have expertise and experience in the patient’s medical condition the medical practitioner is required to be a medical specialist in the patient’s medical condition.
One of the medical practitioners may fulfil both these requirements, or they may each fulfil one.
Medication Supply
The Alfred Hospital Pharmacy is acting as the statewide service to supply medication for VAD. The Alfred’s pharmacy service will provide phone support and advice to co-ordinating medical practitioners about the prescription of voluntary assisted dying medications.
VAD training for coordinating and consulting medical practitioners
Medical practitioners who participate in VAD provision as either the coordinating or consulting medical practitioner must complete the VAD training prior to assessing the patient’s eligibility for voluntary assisted dying.
The training can be undertaken online and takes around six hours to complete. The training is in modules and the modules may be completed separately at times that are convenient to the medical practitioner.
You can access the training here.
Other health practitioners
Nursing, allied health and other health practitioners may be asked for information about VAD by patients or provide care and support to patients. Health practitioners who are asked about VAD can provide any information they are able to, and usual care and support, respecting the patient’s choice in the same manner as patients receiving any other type of treatment. Health practitioners may also be asked to assist in the voluntary assisted dying process in other ways such as with communication and support.
Conscientious objection
Everyone has a right to set their ethical limits and standards. Where a health practitioner’s beliefs and values conflict with VAD they may conscientiously object to being involved. If you plan to refuse a patient’s request for VAD you must formally refuse within seven days of the request being made.
If you object to VAD it is important not to dismiss patients’ concerns. Care navigators will be able to assist you to advise your patients where they can go if they wish to access VAD.
Where can I get further information?
- HealthPathways Melbourne provides clinical advice and easy-to-follow maps of referral services.
- HealthPathways Melbourne has a comprehensive Voluntary Assisted Dying page that includes processes to follow and where to go for advice and assistance.
If you do not have access to HealthPathways please contact info@healthpathways.org.au
You can find further information on the VAD legislation and access resources and training on the health.vic website.
There is also a useful video resource and diagram of the model of care on the Victorian Healthcare Association website.
By North Western Melbourne Primary Health Network, Primary Health Care Improvement Team.
Disclaimer: This article was provided by NWMPHN. While every effort has been made to ensure the information is accurate, North Western Melbourne Primary Health Network does not warrant or represent the accuracy, currency and completeness of any information or material included within.
