Go Gentle’s first report on VAD services paints a ‘reassuring picture’, but work remuneration, the telehealth ban and jurisdictional inconsistencies remain sore points.
Voluntary assisted dying advocacy group Go Gentle is calling for less red tape, including shelving of the “gag clause”, following the release of the inaugural analysis of official VAD data.
Meanwhile, 17 leading health agencies have signed a joint statement renewing calls to change the Commonwealth Criminal Code to allow telehealth to be used in VAD services.
According to the nation’s first State of VAD report, produced by Go Gentle, over 2460 terminally ill Australians ended their lives through VAD with the help of around1200 VAD-trained professionals since the choice was legalised by Victoria in 2017.
All states and territories have since followed in Victoria’s footsteps, making VAD legal for terminally ill patients, apart from the Northern Territory.
The report revealed “a reassuring picture”, said Go Gentle CEO Dr Linda Swan.
“The State of VAD is overwhelmingly a good news story,” she said.
“None of the dire predictions from opponents have come to pass and systems are working safely and with great compassion.”
According to the report, VAD is helping more people die in the comfort of their own home, many of whom are in palliative care.
“The vast majority of us say we want to die at home but only around 15% of us manage to do so,” said Dr Swan.
“VAD applicants are achieving this goal at three times that rate.
“Importantly, around 80% of applicants are receiving palliative care which demonstrates the two care options can and do work together, offering opportunities for closer cooperation.”
On average, patients opting for assisted dying were more likely to be 70-79 years of age, male and have a terminal cancer diagnosis.
“We must never forget who these laws were written for – terminally ill people who are suffering intolerably and want some control over the timing and circumstances of their death,” said Go Gentle founding director Andrew Denton.
Despite the successes, the sustainability of the services remained at risk due to access barriers and funding shortfalls.
“Between 30% and 50% of people who start the process do not complete it, and one in five who are found eligible die without using the VAD substance,” said Dr Swan.
“We need more information to determine whether there is an imbalance between safeguards and accessibility.”
Dr Swan added that “gag clauses” in South Australia and Victoria, which prevent health professionals from bringing up VAD with patients, hindered care.
“People can only benefit from the choice if they know it exists,” she said.
“No other healthcare requires patients to know their treatment options before consulting a doctor.
“It runs contrary to person-centred and informed care.”
Workforce also remained an issue.
“Another challenge was encouraging enough clinicians to complete VAD training to meet demand,” said Dr Swan.
“We need to ensure health professionals are fairly remunerated and supported for their VAD work.
“Some VAD practitioners are working after hours and on weekends and receiving little or no financial compensation.”
The report was hindered by an “imperfect dataset” due to inconsistencies in reporting requirements between jurisdictions.
“Recent work to agree to a minimum dataset will assist future reports,” said Dr Swan.
“However, there is still more to be done to ensure that consistent and comparable data across jurisdictions are available to better identify areas for system improvements.”
Almost 20 health agencies have joined Go Gentle in a joint statement calling for an update to the Commonwealth Criminal Code to allow telehealth to be used to discuss VAD services.
“It is cruel and unreasonable to require dying people to travel long distances to in-person consults for every single aspect of the application process,” Dr Swan said.
“This outdated prohibition adds significant delays and uncertainty for everyone, and discriminates against people in rural and remote areas.”
