Assisted Dying: Who Makes The Final Decision?

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It is believed about people a year in Victoria will choose to die this way, but the legislation raises ethical, legal and policy challenges. Ensuring equality of access across healthcare institutions, while allowing conscientious objection by healthcare practitioners, is critical. Managing changes in doctor-patient relationships and promoting autonomy and informed consent are also key.

Assisted suicide

The Voluntary Assisted Dying Act Vic permits a doctor to enable a patient to die, subject to strict eligibility criteria and safeguards. A doctor providing a substance for a patient to use to end their life seems counterintuitive. Only people living in Victoria for the past 12 months who are Australian citizens, or have permanent residency, are eligible. The Act applies to competent adults aged 18 years or more who have a disease or condition that is advanced and progressive and expected to cause death within six months — or 12 months for neurodegenerative conditions like Motor Neurone Disease or Huntingdon disease.

A person is considered to have decision-making capacity if they can understand, retain, use and communicate information regarding their decision about voluntary assisted dying. A potential limitation for some people is their condition may affect their decision-making capacity before their expected death. The strict eligibility criteria ensure a decision is voluntary, but do mean some people will be unable to access voluntary assisted dying. So, waiting for patients to request this new option may affect access, especially for less-advantaged groups and people with lower health literacy.

A person makes a first request for voluntary assisted dying to a doctor, most likely their general practitioner or specialist. They then inform the patient about treatment options including palliative care, the outcome of taking the drug and changing their mind. If these hurdles are all passed, a written declaration is made for voluntary assisted dying.

This is signed by the patient in the presence of two witnesses and the coordinating medical practitioner. Both witnesses certify the patient appears to have decision making capacity, understands the nature and effect of their decision, and does so voluntarily.

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The patient then makes a final request for voluntary assisted dying and appoints a contact person responsible for the return of any unused substance. The coordinating medical practitioner applies for a permit to prescribe a substance which the patient may self-administer or take with the help of a doctor if they are unable to do so. The Voluntary Assisted Dying Review Board will monitor all activity under the Act and receive reports from participating health practitioners.

A patient refused access may apply to the Victorian Civil and Administrative Appeals Tribunal for review of a decision.

Authorities made the decision to have a single point of access for the euthanasia drug rather than having it dispensed from multiple pharmacies to ensure that patients are provided with consistent information, and that unused medications are returned and destroyed. The pharmacists will travel around the state to dispense the medication to patients. The lethal substance will be handed to patients in a locked box. Most people will drink the dose — a liquid of about millilitres just over a third of a cup — in their own homes at a time of their choosing. Those ending their lives will also be given medication to relax and reduce any chance of regurgitation before they take the lethal substance, which will cause unconsciousness within minutes and a peaceful, pain-free death soon after.

Under certain circumstances, those physically incapable of swallowing will be allowed to take the substance as a lethal intravenous drip set up by a doctor. Nobody else, including the pharmacist delivering the lethal substance, is permitted to administer the drugs. If someone breaches the self-administration permit, they face potential life imprisonment. Anyone who induces a person to request assisted dying faces up to five years jail.

What's the difference between assisted suicide and euthanasia? - BBC News

The patient must appoint a person who will return any unused medication to The Alfred if they die before taking the lethal substance, or decide not to take it. A pharmacist can also retrieve the the unused medication and take it back to The Alfred.

Who can apply?

Unused lethal medication must be returned within 15 days of death. The Ministerial Advisory Panel on Voluntary Assisted Dying found there was a "significant social stigma" attached to the term "suicide'" and for this reason, determined that "assisted suicide" was not an appropriate term.

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While, technically, a terminally ill person who takes a lethal drug has still died by suicide, the distinction is important, say supporters of the law, because the word carries enormous emotional weight. Suicide, they argue, connotes a violent death, usually carried out by someone suffering from depression or a mental illness that might feasibly have been treated.

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By contrast, "voluntary assisted dying" is about a decision made by a terminally ill person in full command of their mental faculties. It's about someone who is already dying choosing to end their suffering, supporters say.

Death with Dignity Acts

The advisory panel also ruled out "dying with dignity" on the basis that it implied only those who opted for assisted dying were taking a dignified path. Many opponents of the Victorian bill still use the phrase "assisted suicide", including the Catholic Church and the Australian Medical Association, which calls it "physician-assisted suicide".

The Victorian chapter of the AMA, however, calls it "physician-assisted dying". Euthanasia is a broad umbrella term for a range of different practices for ending a person's life, some of which Victoria's legislation doesn't allow for.

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At The Age we use the term euthanasia to refer to the issue, while we use the term assisted dying in relation to the laws. The term euthanasia comes from the Greek word euthanatos , which can be translated as "easy death" and is defined as the painless killing of a patient suffering from an incurable and painful disease.

It is important to note, however, the word euthanasia is not written anywhere in the state's legislation. A Voluntary Assisted Dying Review Board has been established to review each assessment that has been approved. The board is chaired by a retired judge of the Supreme and County courts, Betty King, and has 12 other members ranging from palliative care specialists to neurologists, oncologists, pharmacists and doctors.

The board's role is not to grant or refuse applications for voluntary assisted dying. Its purpose is to review each case retrospectively to ensure that laws haven't been breached. Doctors breaking the law would be likely to be quickly exposed as every assessment for euthanasia, positive or negative, will be reviewed by the board. The board can refer breaches to the police, coroner or the Australian Health Practitioner Regulation Agency. The patient's terminal illness will be listed as their underlying condition but the voluntary assisted dying act w ill be recorded as the cause of death on their death certificate and in the register.

Any health practitioner can "conscientiously object" to participating in any part of the euthanasia process. But they would not be allowed to impede someone's access to the regime.

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The Victorian Department of Health has established a training body capable of preparing medical specialists wanting to assist voluntary dying. All doctors who want to be part of the scheme must undertake this training. To date, about doctors including GPs, cancer specialists and palliative care clinicians have undertaken mandatory, specialist training ahead of the laws being enacted.

It has been estimated that about Victorians could make use of euthanasia laws each year but the state government predicts the number could be as low as 12 in the first year — experience in other places where euthanasia is legalised shows that the initial take-up can be slow. In the US state of Oregon in , after a Death with Dignity Act first came into force, 24 terminally ill people took the option to end their lives. Since then, the number has risen steadily, peaking at deaths in The Northern Territory parliament passed the Rights of the Terminally Ill Act, to allow assisted dying, in but it was overturned in Under the short-lived legislation, four people, including two terminally ill patients from NSW and South Australia, ended their lives.