The Voluntary Assisted Dying Act 2017 (Vic) (Act) commences in Victoria on 19 June 2019. The Act will allow Victorians at the end of life who are suffering and who meet strict eligibility criteria to request access to voluntary assisted dying (VAD).
As only medical practitioners can authorise access to VAD, aged care providers will not generally have any direct role to play in VAD. However, as many aged care recipients are at end of life, it is likely that some may seek to access VAD within the context of the aged care environment, whether in home care or residential care. Providers should be prepared to deal with requests from care recipients in relation to VAD.
The Department of Health and Human Services is recommending (here) that health services (including aged care providers) consider matters such as:
- The extent to which they will participate in VAD. As very few aged care providers employ medical practitioners, most won’t (and can’t) participate directly. However, it could be possible for some providers to ‘partner’ with VAD providers. Alternatively, they can act as ‘information providers’ which is likely to be the most common model of care in aged care.
- How to ensure staff understand the upcoming changes to the law. There are strict provisions in the law preventing health practitioners from initiating discussions about VAD. Registered health practitioners are required to report other health practitioners who breach these rules to AHPRA. Offences also apply to anyone who administers VAD medication or induces them to take their VAD medication. Staff will need to understand these rules.
- The policies, governance and leadership arrangements necessary to respond to VAD.
- How care recipients requesting access to VAD will be supported, eg, whether the provider will refer them to a qualified medical practitioner who can consider the request.
Complementing this, the Victorian Healthcare Association has developed a model of care resource. The resource aims to support the implementation of consistent care pathways across Victoria. Its focus is on placing the needs of a person requesting VAD at the centre of care while providing support those providing health care (here).
VAD presents some specific legal and operational challenges for aged care providers. For example, providers will need to balance their own position on VAD with their obligations under the new Single Charter of Aged Care Rights and Aged Care Quality Standards. The Charter and the Standards focus strongly on care recipient choice and control, creating particular challenges for providers who oppose VAD. In addition, security of tenure may will make it difficult to prevent care recipients from accessing VAD.
We encourage providers to consider following matters when preparing for the introduction of VAD:
- Whether prospective care recipients will be asked upon entry about their future intentions, if any, to access VAD.
- Whether prospective care recipients will be refused admission on the basis of an intention to access VAD.
- How the process will be managed if staff have a conscientious objection to VAD. For example, what will staff need to do if a care recipient asks them about VAD and the staff member has an objection?
- How care recipients will be managed if they ask about VAD – particularly when the provider, as an organisation, conscientiously objects to VAD.
- How VAD medication will be stored if brought into an aged care facility.
- How best to balance privacy considerations with providers’ need to be informed and aware of care recipients intending to access or accessing VAD.
The introduction of VAD will present providers with both ethical and operational challenges. We encourage providers to grapple with these challenges at the earliest opportunity, to ensure they are ready for the Act next month.