Experts forecast disputes in aged care as voluntary assisted dying is legalised

Experts have said aged care providers will face considerable challenges when voluntary assisted dying (VAD) laws come into force in 2023.

The bill was recently passed in the NSW parliament after decades of debate and will allow those who are terminally ill to access euthanasia.

While polls indicated that over 85 per cent of older people supported access to VAD, experts expect not everyone will be willing to follow the legislation.

Penny Hackett, president of advocacy organisation Dying with Dignity has been pushing for the legalisation of VAD since the '70s.

“I foreshadow there might be some issues to work out,” she says.

"There have been stories in other jurisdictions like Canada and Victoria of aged care providers refusing to allow people to access it on their premises.

"Healthcare is a person's right – they're entitled to have the medical care of their choice without being impeded by the operator.

"Unfortunately, there's a clash between the conscientious objection rights of organisations and the rights of patients in aged care.

"They may require that their staff don't be involved and that's understood, but they can't prevent doctors from coming to consult with patients and administering the VAD substance," Hackett says.

Victoria spearheaded the legalisation of VAD and has since reported that 836 people had sought a permit, of which 331 people had passed away from the prescribed medications.

Though the state has overcome its initial teething problems, it still grapples with a lack of access to telehealth and trained practitioners.

Hackett anticipates similar roadblocks in NSW, and says that "it has proven quite difficult for people to access VAD because the medical profession is not prepared for it".

"Certainly, in the early stages, it will be hard to find enough doctors willing to sign up to do the training and be prepared to participate in the VAD process," Hackett says.

"Particularly in regional areas, people have had difficulties accessing qualified doctors, so that will be an issue in NSW."

Aside from training GPs, Hackett expects other obstacles such as policymaking in aged care facilities.

Opposed aged care facilities have said the bill forces them to comply with VAD and disregards their principles and beliefs.

Hackett says that some facilities demanded exemption and "would want to move the patient to another location to act out VAD".

"We acknowledge that some people have a religious objection to this, but denying those who don't have access to available medical treatment is akin to abandoning their duty of care to the patients," she says.

State director of the conservative Christian organisation FamilyVoice Australia, Greg Bondar, has also been campaigning during talks about the VAD bill, though from the other side of the fence.

"On behalf of over 100,000 faith groups that support our lobbying for family, freedom and faith, I have to tell you that we are cut and disappointed that this bill has gone through," Bondar says.

"It's a very dark day for NSW because it has removed the levity of conscientious objection from people who do not want to submit or be part of VAD."

Bondar is backed by the Anglican Church and Catholic Church, who echo that "from a Christian point of view, life can only be given and taken away by the creator".

Bondar plans to continue to lobby against the bill, particularly during next year's state election on the 25th of March. 

"The battle is not finished," he warns.

"We're going to make this an election issue – to make sure amendments can be put in place to get an exemption for faith-based aged care centres and hospitals."

Homes such as Catholic Health Australia and HammondCare have voiced strong objections, while Uniting Care has agreed to VAD in their facilities.

Aged Care Insite asked the general manager of Health and Palliative Care at HammondCare, Andrew Montague, how they expect to implement VAD in their facilities.

“HammondCare will be working with the relevant departments to ensure we follow the legislation.

“As an organisation, we have to be very conscious of how we will participate and that will become much clearer once we've had these discussions with NSW health,” Montague says. 

“We need to make sure our managers are on our side to be fully aware of the legalities of VAD and understand what they can and can't do. 

“We’ll also make it really clear to staff on the ground if they're asked about VAD, what information they can actually provide. 

“I'm sure over the following 18 months that we'll work something out.”

During the bill’s passage, HammondCare endorsed palliative care as the best approach for those who are terminally ill.

Yet, Montague says that “access to palliative care for aged care residents is quite a small percentage of people who actually get and are able to receive formal palliative care”.

In 2021, just under 2 per cent of older people in aged care received palliative care. 

“We think that percentage should increase significantly.

“But what really concerned us was that the whole palliative discussion was lost in the VAD debate.”

COTA NSW CEO Meagan Lawson says palliative care will continue to play a significant role in end-of-life support, alongside VAD.

"There was a lot of debate about it, and I honestly hope that doesn't go away," she says.

"I hope politicians keep talking about palliative care and provide additional funding to ensure that every person who needs palliative care gets access to it.

"We should be doing more because it makes a huge difference to the way people die."

Whether someone chooses palliative care or VAD, Lawson underlines that no differentiation should be made based on where they live.

"These are people's homes and they should have the same access as anybody else to these provisions.

"It's about a level of respect for the people who are paying you for the services they are using, and respecting their rights and agency to make decisions about their own bodies."

National Seniors Australia released a report in August 2021 about older people's views on VAD.

One participant said: "Quality of death should be given the same attention as the quality of birth."

"Planning for a dignified end of life should receive the same weighting as any other important milestone in your life." 

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