Assisted dying scheme needs more oncologists on board

End-of-life care

By Megan Howe

16 Sep 2020

Specialists utilising Victoria’s voluntary assisted dying laws to assist terminally-ill patients say there is a desperate need for more doctors to get involved, as new figures show the number of patients using the scheme has far surpassed initial estimates.

A new report from the independent Victorian Assisted Dying Review (VADR) Board shows that 124 patients have utilised the new laws to end their lives in the 12 months since the state’s landmark laws came into effect in June 2019. That compares with the Government’s initial estimate that around a dozen people would use the scheme in its first year.

Almost four out of five of the patients had terminal cancer. Others had a neurodegenerative disease (15%), or other diseases (7%) such as pulmonary fibrosis,  COPD or cardiomyopathy.

In the first year of the scheme:

  • 348 people were assessed for eligibility to access voluntary assisted dying
  • 272 eligible applicants applied for a permit
  • 231 permits were issued
  • 124 people died from taking the prescribed medications – 104 administered the medication themselves and 20 used the medication with the assistance of a medical practitioner.

In the six months from January–June 2020, there was a 50% increase in eligible applications from patients and a 30% increase in the number of doctors trained and registered in the Voluntary Assisted Dying (VAD) portal, compared to during the previous six months.

While a total of 422 medical practitioners have now registered for training, only 175 have completed the training and are registered in VAD portal, with 125 of those “active”, meaning they have dealt with cases.

Half of those registered in the portal are GPs, 16% specialise in oncology, 5% in neurology and 3% in palliative medicine.

Dr Cameron McLaren, a medical oncologist based in Berwick, Victoria, who has been involved in 100 cases since the laws came into place, said a small number of specialists were carrying a heavy load under the scheme, often at personal cost.

He often travels up to 90 minutes to assess terminally-ill patients.

More registered doctors were desperately needed to share the workload and to ensure all patients who wished to could access the scheme, Dr McLaren said.

He also raised questions about the training program, as the figures showed many doctors who registered for training had not completed it or had not become actively involved in patient cases.

“It is not a robust system and doesn’t provide equitable access. We need to bolster it significantly to be able to meet patient needs,” he said.

The report found that 38% of applications for the scheme were from patients in regional Victoria and 37% of trained and registered medical practitioners were from outside Melbourne, but said there was still a need for more specialists in regional areas.

Dr Greg Mewett, a palliative care physician in Ballarat, Victoria, who is registered with the scheme and co-ordinates patients’ care, said they were required to be assessed by a consultant specialising in their illness.

There was a particular shortage of neurologists working with the scheme, resulting in patients disabled by illnesses such as motor neurone disease having to travel long distances to undergo assessment, he said.

“We [specialists] are very thin on the ground,” he said. “If one of us is sick or on leave, what happens?”

Call for telehealth access

This VADR Board called for the Federal Government to reconsider making an exemption to the Commonwealth Criminal Code 1995 to allow Victorian patients to have conversations about voluntary assisted dying with doctors via phone or teleconference.

The Board said telehealth consults – which have proved particularly important for other medical care during COVID-19 restrictions – were “not an option for people wishing to access voluntary assisted dying” as it was an offence under the Criminal Code to use a carriage service (e.g. telephone) for suicide-related material.

While both Dr McLaren and Dr Mewett agreed telehealth consults were vital to widen access and save sick patients travelling, they disagreed such consults would contravene the Code, arguing they did not pertain to ‘suicide’ but to ‘voluntary assisted dying’.

Both doctors said they were aware some doctors had used telehealth consults with patients applying for the assisted dying scheme.

“I don’t feel that under the Federal law, telehealth consults on assisted dying can be construed as inducing people to commit suicide – that is totally erroneous,” Dr Mewett said.

According to The Age, the Federal Government is not considering changing the law, with Attorney-General Christian Porter saying it is the Victorian Government’s responsibility to ensure its laws comply with Commonwealth law.

The latest report also calls for doctors to be more supportive of patients even if the practitioner is unwilling to participate in the scheme.

“A number of people expressed concern about a lack of support by doctors or health services opposed to voluntary assisted dying. We remind doctors there is a way to decline support, without causing additional distress to the applicant and their family,” said Betty King, Chairperson of the Voluntary Assisted Dying Review Board.

The report highlights the case of one patient whose long-standing GP was not supportive of the request for voluntary assisted dying, and the patient felt he could no longer consult with this doctor.

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