Into the great unknown: voluntary assisted dying in Australia

“You don’t know.”

Jac Mathieson, the chief nursing officer at Peter MacCallum Cancer Centre, found herself saying this a lot when talking about the Voluntary Assisted Dying Act, soon to be law in Victoria.

In this instance she was asked, 'What if someone procures the drug, how do we know that they won’t share it with someone else such as their spouse, or even worse, use it on someone else?'

And how might the law impact nurses generally? “[It’s] hard to say. We don’t know.”

From the 19 June this year, Victorians who meet strict eligibility criteria will be able to access drugs that will end their life from specialty pharmacies.

These people must be diagnosed with an incurable disease or medical condition that causes intolerable suffering, the condition must be assessed by a doctor and, importantly, the condition must be predicted to cause the patient’s death within six months.

Eligibility only applies to those who have lived in Victoria for minimum of 12 months and are over 18, and they will need a designated support person who co-signs for the drug with them.

A piece in The Conversation, quoting a peer reviewed paper, showed that in countries where assisted dying is legal “between 0.3 per cent to 4.6 per cent of all deaths are reported as euthanasia or physician-assisted suicide and “the frequency of these deaths increased after legalisation... Existing data do not indicate widespread abuse of these practices.”

In the Australian context, Mathieson believes that the act has a number of safeguards within it and is a “long winded process” that includes the patient having to make three separate requests before they can gain access. After an initial consultation with a doctor, a second doctor will make an assessment, then a person will have to make a written declaration verified by witnesses confirming they wish to undertake the process.

No family members will be allowed to administer the drug, nor will nurses, and only in very rare circumstances – such as a patient being unable to physically self-administer – will a doctor be allowed to administer the drug.

In fact, no medical professional will be even allowed to broach the topic of assisted dying with a patient, which could cause some teething problems initially.

“I think the design [of the Act] is as good as it could be. There are unknowns because, for example, in the Act it says that every patient has the right to choose and the right to access,” Mathieson said.

“But then it also talks about medical professionals not having to participate. So, if you're the patient and you’re speaking to your doctor and they don’t have to participate, how do you actually get access?

“Those sorts of things, the logistical things, hopefully, will soon iron out.”

Other unknowns, according to Mathieson, include the number of patients who will actually exercise this right and the exact role of nurses going forward.

“People are pretty quiet at the moment to be honest,” said Mathieson when asked how her workforce felt.

“We are getting a lot of questions like, 'How do we know that they will actually die?', 'What happens if they die on the ward?' Really practical questions.”

“It’s so unlikely that it will happen on a patient ward. But if it did its only then that we will be able to assess the impact. For staff that really don’t believe in it, I think that could be really challenging,” she said.

The Act states that “no health practitioner or healthcare provider will be obliged to participate in voluntary assisted dying".

Still, the role of the nurse is not described, Mathieson said. She added that listening and communication will be key for nurses as “we can’t underestimate the amount of questions a nurse will get”. The Act is also up for review in three years’ time, so roles and practice may change.

"The first year will be interesting. I’m expecting that we will get a lot of enquiries, more than actual people following through.

“And then it will become business as usual and it's not such a big fanfare,” Mathieson said.

As for the future of voluntary assisted dying in other states, this too is unknown. In a recent paper looking into the future, professors of law Ben White and Lindy Willmott, conclude that although perhaps inevitable, country-wide adoption of the practice will not be easy.

“Voluntary assisted dying in Australia is ‘a train that has left the station’. International trends, growing Australian political support (coupled with strong and continued community expectation) and the weakening of key opposing arguments all point to other states following Victoria’s lead by legalising voluntary assisted dying.

“The heated debates last year in the Victorian Parliament about VAD laws revealed a depth of raw emotion from many politicians.

“Although reform in other Australian states is likely, that train journey will be one that is slow, uphill and with plenty of twists and turns,” they said.

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