The state will also explore options to require conscientious objectors to provide minimum levels of information about assisted dying to patients.
The Victorian state government has not only accepted all recommendations from a review into the first four years of its nation-leading voluntary assisted dying program, but has gone a step further by floating two potential law changes.
One would lift the ban on health practitioners initiating discussions about voluntary assisted dying as an option, and the other would potentially require conscientious objectors to provide minimum information in line with “person-centred care”.
Both would be subject to community feedback.
State health minister Mary-Anne Thomas also flagged potential changes for patients who have neurodegenerative conditions and are house-bound at the time of their application to access assisted dying without a third assessment.
“While our Australian-first voluntary assisted dying laws are giving Victorians the dignity of making their own decisions about the timing and manner of their death – we know we need to update them to ensure they remain fair,” Ms Thomas said.
“Reforming our … laws to bring them in line with other states is critical to maintaining a service that is accessible to all Victorians, no matter where they live.”
The review report was tabled in Victorian parliament today.
The five recommendations included increasing the provision of sector guidance to ensure patient requests and access rights to information are equitably addressed, enhancing community awareness, supporting workforce, improve financial support for patients and advocate to the Commonwealth for greater federal support.
Broadly, the review board found that the voluntary assisted dying system was working as intended.
QUT Australian Centre for Health Law research fellow Casey Haines, who was not involved in the review, told The Medical Republic that the findings align with her own research.
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“What we’ve heard from people that we’ve interviewed is that it is an incredibly safe system,” she said.
“It’s a valued choice; people value the opportunity to have another end-of-life choice.”
Around 1500 permits were issued between 2019 and 2023, but just 900 chose to use the assisted dying substance.
About 400 had the substance dispensed, but chose not to use it.
Regional and rural patients were slightly more likely to access the service than their metro-based peers, and were also slightly more likely to be accessing palliative care when first requesting voluntary dying.
There was no evidence to suggest that assisted dying was being used as an alternative to palliative care.
Under the current regulations there are nine steps to access assisted dying, which require the patient to make three separate requests at least nine days apart and go to three different assessments with two different doctors who assess if they meet eligibility requirements.
It’s only after these requests and assessments have been completed that a doctor applies for a permit to prescribe the assisted dying medication.
The median time taken to assess permits has steadily decreased over time, going from 28 days in 2019 to 21 days in 2023.
Around one quarter of total applicants died before the substance could be dispensed.
There were no reported instances of mishandling or misuse of the medication.
Of the 14 cases of non-compliance, representing less than 1% of total applications, half were relatives of a deceased person failing to return unused medication within 15 days.
“The [legislation] has 68 safeguards to ensure robust oversight and thorough monitoring mechanisms are in place throughout all steps of the [voluntary assisted dying] process,” the review board wrote.
“As a result of these legal and system controls, while groundbreaking at the time of its commencement, the Victorian model of [assisted dying] is now widely regarded as a conservative model in Australia with a strong focus on safety.
“Findings from this review further support this view, indicating that [assisted dying] in Victoria has been safe for patients, families and the community at large.”
Ms Haines told TMR that there was a need to balance the safety of the system with accessibility.
“Victoria was the first, so it had to be safe,” she said.
“Because if something went wrong … other states would not have followed.”
