The law and patient choice with end-of-life care

18 Aug 2021

Prompted by the changes to Voluntary Assisted Dying (VAD) laws in some states, in the latest episode of Taking care we discuss what greater patient choice in end-of-life care looks like for patients and practitioners.

In the first of two episodes on VAD, host Susan Biggar is joined by intensive care specialist and Deputy Chair of the VAD Review Board in Victoria, Dr Charlie Corke, and medical practitioner and Chair of the VAD Board in Western Australia, Dr Scott Blackwell.

Drawing on their decades of work as doctors, and particularly their experiences with end-of-life care, our guests provide context to the current legal structures.

‘This has always been there, it’s just that it’s now legislated, and it’s now sort of inside the tent rather than outside … it’s always been outside the tent,’ Charlie said.

Both Scott and Charlie cited patient-centred care as a guiding principle for their practice, noting also that patient choice and control in determining what a good death looks like underpins both the Victoria and Western Australia VAD models.

While the VAD legislation has been in effect in Victoria since 2019, it remains relatively new and uncharted territory to the community and practitioners. In Victoria, practitioners are not able to raise the issue with patients; it must be patient-led. This is not the case under the WA legislation.

Medical practitioners also must undergo specific training to be involved with VAD, and Scott and Charlie note that there has been too low an uptake among practitioners so far. They note that practitioners remain cautious, and the biggest concerns are about legal implications: what to do if they are asked about VAD and what their role will be at the end.

‘We talk about conscientious objectors. But I’m also recognising that there’s a conscientious provider who feels, as part of their medical practice, this is something they should be providing for their patients’, Charlie said. 

Things are much newer in Western Australia, and Scott is seeing the response to the new law around him:

'It is at that very early stage where people are relieved that at last, they have this choice to avoid suffering that in many senses, doesn’t make any sense,’ Scott said.

While feedback from the community and families has been positive in both states, both Charlie and Scott hope the next five years will see greater take-up of training by practitioners and normalisation of the VAD conversation among the public.

Charlie adds: ‘Personally, I just feel a little more relieved medicine is not turning its back on a reality of life and death.’

Listen to the full episode now. 

If you have found themes of this episode upsetting, please contact Lifeline on 13 11 14. 

DRS4DRS offer an independent, safe, supportive and confidential service for medical practitioners drs4drs.com.au.

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The Taking care podcast series offers professional and consumer perspectives on current issues and answers some frequently asked questions about public safety in healthcare. Download and listen to the latest Taking care episode today. 

Ahpra releases a new episode fortnightly, discussing current topics and the latest issues affecting safe healthcare in Australia. You can also listen and subscribe on Spotify, Apple Podcasts and by searching ‘Taking Care’ in your podcast player.

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