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Proposed voluntary assisted dying legislation: protecting doctors

Sep 29, 2017

Voluntary assisted dying is a controversial issue. There are as many views within the medical profession as there are in the broader community. At Avant we recognise that our members have a range of views on whether or not voluntary assisted dying should be legalised.  As with other controversial political or moral issues it is often the strongest views that dominate the discourse. However, on this issue too it seems there is a large number of doctors who sit somewhere in the middle, unsure about how they would respond. Many feel that they need more information and that their response might depend on the specific situation, while others worry that the issue will divide colleagues and increase pressure and distress on overloaded systems.

Avant does not take a position on whether or not physician-assisted dying should be legalised. We see our role as advocating for sufficient safeguards in assisted dying legislation if passed, so that doctors are protected whether or not they choose to participate. It is also our role as a medical defence organisation to explore the potential medico-legal consequences of any regime that is introduced, and to provide information, support and guidance for our members.

Draft legislation has now been introduced in New South Wales and Victoria. Western Australia has set up a joint select committee on end-of-life choices, which is due to report in August 2018. With the passage of legislation becoming increasingly likely, Avant recently hosted a member event to help members understand the medico-legal issues and give them an opportunity to ask questions and share concerns. Avant Board member Dr Jan Dudley welcomed members to the Sydney office to hear a distinguished panel of experts discuss planned legislation to legalise voluntary assisted dying. Professor Brian Owler, Chair of the Victorian Government’s Ministerial Advisory Panel on Voluntary Assisted Dying, gave a presentation about the panel’s process and recommendations for the Victorian legislative framework. He was joined by Chair of the Avant Mutual Board, Professor Simon Willcock, Head of Medico-legal Advisory Service Kate Gillman and Head of Advocacy Georgie Haysom for an insightful panel discussion and to respond to audience questions.

Exploring the issue through a scenario highlighted that views on participation are likely to vary significantly depending on the practitioner’s relationship with the particular patient and their family. An elderly patient of long standing, where the doctor has good relationship with the patient’s family and the patient has made their wishes very clear, would present very different issues to a request for assistance from a new patient with whom the doctor does not have an existing therapeutic relationship.

Doctors still have a number of questions and concerns about how a regime would work in practice, including:

  • determining eligibility, particularly assessing the requirements of prognosis and capacity
  • how to negotiate a decision not to participate, particularly in the context of an ongoing relationship and providing team-based end of life care
  • how to identify and refer to another practitioner for a second or specialist opinions, given existing challenges of accessing specialist support, particularly in rural and remote areas
  • ensuring privacy and security of information, for example doctors who have agreed to assist or who have received training
  • managing healthcare team members’ own distress if they agree to assist
  • potential liability, for example if a patient sources the medication then dies without taking it, or if it falls into someone else’s hand.

Many of the issues raised about resourcing, team-based care, capacity and prognosis are not new issues for the profession. But in the context of voluntary assisted dying they seem to have assumed a greater significance.

We believe that legislation will eventually be passed in one state or another that legalises voluntary assisted dying. Developing resources and providing training will be critical so that doctors do feel able to participate if legislation is passed. In addition, it may be helpful to consider how far you would be prepared to assist your patient in exploring voluntary assisted dying if they asked you about it. Would you decline, provide information, prescribe medication, or administer medication?  Clarifying your own views and determining how far you would be prepared to go may assist you in preparing for the legislation if and when it is passed.

Similar questions were also asked at the recent Australian Palliative Care Conference in Adelaide, where Avant’s Head of Advocacy, Georgie Haysom appeared on the panel on assisted dying.

Expert advice whenever you need it

Visit our website, or for immediate advice, call our Medico-legal Advisory Service (MLAS) on 1800 128 268, 24/7 in emergencies.

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We welcome your feedback on this article – email the Editor at: editor@avant.org.au