What pharmacists need to know about VAD legislation

voluntary assisted dying

Voluntary Assisted Dying (VAD) is now legal in most jurisdictions. But there’s a nation-wide regulation impeding access to the service.

Under Commonwealth law, health professionals across the country can’t legally discuss VAD with patients via telehealth services.

‘This raises significant concerns about equitable and contemporary access to care, particularly for people living in rural and remote areas where access to care is challenging,’ said PSA National President Associate Professor Fei Sim FPS.

To improve equity of access, Kate Chaney MP, Federal Member for Curtin, recently introduced a Private Member’s Bill to the House of Representatives to ensure Australians can access all options for end-of-life services.

AP explores the legalities around VAD in various jurisdictions, the impact of the current Commonwealth legislation and the need for change.

Where is VAD legal, and what are the obligations for healthcare professionals?

VAD is now legal in all Australian states, and under consideration in the ACT and Northern Territory.

As VAD legislation varies from state to state, it’s essential pharmacists understand the legal obligations in their state, with an explainer from QUT available here.

However, there is some consistency across the states around accessing VAD in Australia, outlined in the table below.

To access VAD the person must meet all of the eligibility criteria in their State. A person is eligible if they:

  • are aged 18 years or over;
  • meets Australian residency and citizen requirements, (these criteia vary from state-to-state);
  • have decision-making capacity for VAD;
  • are acting voluntarily and without coercion;
  • have a disease, illness or medical condition that is:
    • advanced and will cause death. In all States except Tasmania it must also be progressive (i.e. the person experiences active deterioration),
    • incurable (Victoria, South Australia and Tasmania only), and irreversible (Tasmania only),
    • expected to cause death within 6 months, or 12 months for a person with a neurodegenerative disease, illness or medical condition
    • causing suffering that cannot be relieved in a manner that the person finds tolerable. The person’s suffering may be physical or non-physical e.g. psychological, existential.

Can pharmacists initiate conversations about VAD with patients?

In most states, healthcare professionals can’t initiate conversations about VAD with limited  exceptions. 

For example medical practitioners and nurse practitioners can initiate VAD conversations in some states. Under current legislation, pharmacists can’t initiate can’t about VAD in any state.

There are also strict conditions under which the topic can be broached, with information about treatment and palliative care options required to be provided.

In Victoria and South Australia, patients must ask healthcare professionals about VAD before the service can be discussed, said Helen Stone MPS, PSA SA/NT Branch State Manager and member of the SA Voluntary Assisted Dying Review Board.

‘And we need to be really clear on what they are asking for by asking clarifying questions,’ she added.

Why can VAD only be discussed face-to-face?

Across Australia, the Commonwealth Criminal Code prohibits use of carriage services (including phone, internet and email) to promote or incite suicide. 

‘State jurisdictions cannot overcome this just by describing VAD as “not suicide” in their own legislation,’ said PSA Victoria State Manager Jarrod McMaugh MPS, Chair of the Medication Protocol Working Group of the Implementation Taskforce in 2019.

As it stands, pharmacists who provide advice to patients about the medicines prescribed for the purposes of VAD often have to travel vast distances for face-to-face consultations, said Mr McMaugh.

‘For example, in Victoria, the statewide pharmacy service travels to the person to provide advice on the medicine, including how it works, how to take it, and disposal of unused medicines,’ he said.

In both SA and Victoria, any person who lives outside of a reasonable travel distance will have trouble seeking advice from the statewide pharmacy service regarding the VAD substance if more questions arise at a later time. Their options include:

  • travelling to Melbourne to speak with the pharmacists at The Alfred, or Adelaide’s Repat Health Precinct, where the statewide VAD services are run
  • the pharmacist or medical practitioner providing the VAD service would need to travel to speak with the patient face-to-face.

The Cheney Bill, supported by PSA, makes a minor change to the Criminal Code, drawing a distinction between VAD and suicide.

If passed, the Bill would protect healthcare professionals, including pharmacists, delivering critical VAD consultations via telehealth from prosecution, said A/Prof Sim.

‘This Bill will remove the regulatory barrier currently impeding doctors and pharmacists from providing contemporary care to those in need, including people accessing VAD and their families,’ she said.

Ms Stone said enabling the use of telehealth will improve end-of life support for numerous demographics, including people:

  • with disability
  • with no access to private transport, or where their illness and pain restricts travel ability 
  • whose life expectancy may be days or months.

‘Allowing VAD telehealth consultations will also reduce the risk for clinicians amid rising road tolls, who are travelling when tired and under stressful circumstances,’ she said.

How should pharmacists navigate VAD conversations?

Should a patient mention intent to die, pharmacists should always seek clarification, said Ms Stone.

‘We all know people in aged care or older people living at home can say things such as, “I’d like to die”, “I’m tired of life”, “I’ve had enough” or “All my friends have died”,’ she said. ‘But that doesn’t necessarily mean they want to access VAD.’

Should a patient express such sentiments, pharmacists could respond by saying, ‘I’m really sorry to hear that. What do you mean when you say that?’ 

‘If they say they would like to access or consider VAD, you can refer them to the care navigators available in your state, or aged care provider VAD lead.’

Care navigator resources across Australia include:

Go Gentle Australia is another helpful resource covering state-specific VAD legislation and resources.

Pharmacists who conscientiously object to the service should reflect on PSA’s Code of Ethics to understand their duty of care, said Ms Stone.

Like any other illness and disease, if pharmacists don’t think they know enough about VAD or aren’t prepared to offer that service to the patient, they need to be clear about what their professional and legal obligations are in terms of advising people where they can access care,’ she said.

‘You don’t have to disclose that you’re a conscientious objector either. You can just say, “that’s not something I’m able to support you with. But you can go here to get the information you need”.’