Voluntary Assisted- Dying in Victoria

Medical Indemnity InsuranceOn 21 July 2017 the Victorian Ministerial Advisory Panel on Voluntary Assisted Dying released its 257-page final report, which can be found at www.apo.org.au. ‘Voluntary assisted dying’ has been used in favour of other terms, emphasising voluntariness and reflecting a ‘person-centred’ approach.

The Panel is firmly of the view that a person should not be prevented from accessing voluntary assisted dying when they exercise their right to refuse life-sustaining medical treatment that is managing the symptoms of their incurable medical condition and they meet all of the eligibility criteria for access to voluntary assisted dying.’[1]

The proposed eligibility criteria are that a person must:

    • be an adult, 18 years and over; and
    • be ordinarily resident in Victoria and an Australian citizen or permanent resident; and
    • have decision-making capacity in relation to voluntary assisted dying; and
    • be diagnosed with an incurable disease, illness or medical condition, that:
    • is advanced, progressive and will cause death; and
    • is expected to cause death within weeks or months, but not longer than 12 months; and
    • is causing suffering that cannot be relieved in a manner the person deems tolerable.

Mental illness or disability alone will not suffice. There is no requirement for family to be involved; this will always be up to the patient, who must have decision-making capacity throughout the process.

Self-administration of a lethal dose of medicine (prescription of which will require a permit from the Department of Health and Human Services) has been proposed, or if the patient is unable to self-administer, a medical practitioner (holding a specific permit) may administer it in the presence of an independent witness. A Voluntary Assisted Dying Review Board shall be set up as an oversight body.

It is emphasised that voluntary assisted dying should occur within established therapeutic relationships, in the context of existing palliative and other end of life care, to support continuity of care, openness, and diagnostic and prognostic accuracy. Medical practitioners choosing to participate will be subject to a range of new obligations (alongside their duty of care and in addition to existing obligations); these must be fully understood and specific training will be required. A primary medical practitioner and a secondary independent medical practitioner are to be involved in the process, both of whom must be Fellows of a College (or vocationally registered). At least one must have at least 5 years post fellowship experience, and at least one must have expertise in the patient’s medical condition.

It is proposed that practitioners who reasonably facilitate voluntary assisted dying ‘in good faith and without negligence’ within the legislative framework be protected from civil and criminal liability, with non-compliant conduct notifiable to AHPRA. Several offences were recommended, including inducing a person to request voluntary assisted dying or self-administer a lethal dose of medication, falsifying records, and administering a lethal dose of medication to a person who does not have decision-making capacity.

This final report will assist the Victorian Government in preparing its Voluntary Assisted Dying Bill, to be introduced in Parliament later this year. If passed, the Panel has recommended an 18-month implementation period for the legislation. Medical practitioners choosing to facilitate voluntary assisted dying may wish to ensure they have appropriate medical indemnity insurance.

This publication is general in nature and is not comprehensive or constitute legal or medical advice. You should seek legal, medical or other professional advice before relying on any content, and practice proper clinical decision making with regard to individual circumstances. Persons implementing any recommendations contained in this publication must exercise their own independent skill or judgment or seek appropriate professional advice relevant to their own particular practice. Compliance with any recommendations will not in any way guarantee discharge of the duty of care owed to patients and others coming into contact with the health professional or practice. Tego Insurance Pty Ltd is not responsible to you or anyone else for any loss su­ffered in connection with the use of this information.