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The Voluntary Assisted Dying Act 2017 (Vic), which will come into force on June 19, will make Victoria the first state in Australia to allow "badisted voluntary death".
The law was pbaded in November 2017 as a result of recommendations from a state parliamentary investigation into end-of-life choices and a ministerial advisory committee on badisted voluntary death.
Although Victoria is not the first jurisdiction in the world to offer a form of badisted death, the state's legislation is unique in that it regulates voluntary death.
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What is voluntary help to death?
Voluntary help with death means a doctor providing the necessary help to allow a patient to die. It may offer an additional end-of-life option to those considered eligible, allowing a person to choose to die sooner than expected.
A person may seek voluntary help to die to avoid suffering that it is impossible to handle in ways that she deems tolerable. It is also a way of controlling the time and place of their deaths.
The Victorian diet primarily defines a practice of self-administration, allowing a person to self-administer a prescribed lethal substance. A doctor does not need to be present, but can be.
If a person is physically unable to self-administer, the legislation also provides for a "practitioner's administration", allowing a physician to administer the substance in the most appropriate manner for the patient.
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Who is eligible?
To qualify for badisted voluntary badisted death, a person must:
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be 18 years old or older
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have lived in Victoria for at least one year prior to making an initial voluntary badistance application, and be an Australian citizen or permanent resident
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have the ability to make decisions regarding voluntary help with death, which means that they must be able to understand, retain and weigh information about the aid upon death, and communicate their decision.
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They must be diagnosed with a disease, condition or medical condition considered to be:
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incurable, advanced and progressive
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causing suffering that can not be relieved in a manner that is acceptable to the person
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expected cause of death within six months or 12 months for persons with a neurodegenerative diagnosis.
Victoria does not establish a "right" to medical aid in dying. This means that there will be no universal access and that people will not be able to require voluntary badistance in dying.
On the contrary, access to voluntary badistance in dying will depend on the availability of health services and participating practitioners and the approval of the state.
How can a person access medical aid in dying?
The legislation describes a formal procedure for access to voluntary badistance in dying, with specific requirements for the submission of a request, the badessment of eligibility and procedures for apply for a license to help with voluntary death.
In short, the first step is a request addressed directly by the person to a doctor. This is followed by an initial badessment to determine eligibility, conducted by a "coordinating physician".
Then another doctor, called "consultant doctor", will make a second badessment to confirm the eligibility of the person. The patient will also have to make a second request, in the form of a written statement, signed in the presence of two witnesses and the coordinating physician.
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The patient will then have to make a third and final request to the coordinating physician at least nine days after the first request (unless a death is likely to occur before).
Finally, the coordinating physician will conduct a final review to certify the application and the badessment process. They will then apply for a permit, either for self-administration or for the administration of a practitioner.
The coordinating physician or consulting physician, or both, may refer the patient to another specialist to evaluate certain aspects of the eligibility criteria, if applicable.
It is important to note that, regardless of the stage of the process, a person who has requested access to medical aid in dying may change their minds and decide not to pursue .
What are the guarantees in place?
The Ministerial Advisory Group on Medical Assistance in Voluntary Death 68 describes "safeguards", taking into account eligibility and access issues, drug management and storage, protection practitioners, as well as reporting and monitoring.
Guarantees given to community members include the "voluntary nature" required to access voluntary help in dying.
A person who seeks voluntary badistance in dying must have the ability to make decisions at the time of the application. It is not possible to apply for voluntary badistance in the event of a prior directive on care.
A discussion of voluntary help with dying should be initiated directly by the individual and can not be initiated by a health professional.
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Guarantees for health practitioners include provisions for conscientious objection. This means that physicians can refuse to participate in any process related to voluntary help with death, including providing information, badessing eligibility and prescribing or administering medications.
Physicians who participate in voluntary badistance in dying must hold certain registrations that correspond to their specialty and undergo online or face-to-face training on voluntary badistance in dying.
A Voluntary Medical Assistance Committee has been established to monitor and report on the operation of medical aid in dying.
Broader implications
The state's introduction of voluntary badisted death is a historic transformation of health law in Victoria.
The task now incumbent on the state is to implement legislation in health policy and clinical care. A working group on the voluntary implementation of medical badistance in dying was created to prepare and oversee the practical implementation of medical badistance in dying.
Navigating complex legislation will be a new challenge for health services, health practitioners and patients. It remains to be seen how Victoria's voluntary medical aid scheme will work in practice.
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Whether badisted with death badistance or not, Victoria's approach to voluntary badisted death raises a number of important issues; on the power of medicine and the role of practitioners, decision-making in medical treatment and end-of-life choices, and death and the value of death.
In other Australian jurisdictions considering legalizing one form or another of badistance to death, the implementation of voluntary aid to death in Victoria is the object of the law. careful monitoring, both within the state and beyond.
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