By Chris Kane – WA Primary Health Alliance Manager Strategy and Engagement and member of the WA Health Voluntary Assisted Dying Implementation Leadership Team
Voluntary assisted dying is now a choice for eligible Western Australians and GPs are often at the forefront of supporting patients with end of life care.
The Voluntary Assisted Dying Act 2019 (the Act) allows GPs and other medical practitioners who meet the eligibility requirements, and who have successfully completed the approved training, to participate in the voluntary assisted dying process. The Act also provides protection from criminal liability for eligible medical practitioners who assist patient access to voluntary assisted dying.
The WA Health Voluntary Assisted Dying Implementation Leadership Team has worked hard during the 18-month implementation period to ensure general practice and other care related care sectors are well informed and prepared for implementation. This has involved guiding the development of each of the elements needed to deliver voluntary assisted dying in line with the Act, including:
- Voluntary Assisted Dying Statewide Care Navigator Service
- Voluntary Assisted Dying Statewide Pharmacy Service
- WA Voluntary Assisted Dying Approved Training
- The Voluntary Assisted Dying Board
As of 1 July, patients in WA who meet the following eligibility criteria are now able to begin the process to request legal access to medication that will cause their death:
- Aged 18 years or over
- Australian citizen or permanent resident
- Ordinarily resident in WA for at least 12 months
- Diagnosed with at least one disease, illness or medical condition that:
- is advanced, progressive and will cause death
- will, on the balance of probabilities, cause death within a period of six months (or 12 months for neurodegenerative)
- is causing suffering that cannot be relieved in a manner that the patient considers tolerable
- has decision-making capacity in relation to voluntary assisted dying (as set out in the Act)
- is acting voluntarily and without coercion; and
- has an enduring request for access to voluntary assisted dying.
Under the Act, anyone involved in the care of a patient can respond to questions about voluntary assisted dying (if they are comfortable doing so), but only GPs and other medical practitioners can initiate a conversation about voluntary assisted dying to patient. However, they must also at the same time, discuss:
- Palliative care and treatment options
- The likely outcome of that care and treatment.
This differs to the Victorian legislation that prohibits a doctor raising voluntary assisted dying with a patient.
Talking about voluntary assisted dying does not begin the process and a formal request for access to voluntary assisted dying must be made (First Request). The First Request must be:
- Clear and unambiguous
- Made to a registered medical practitioner
- Made during a medical consultation
- Made either in person or, where this is not practicable, using audiovisual communication.
All GPs and other medical practitioners may receive a First Request from a patient but can only accept a First Request from a patient if they:
- Hold specialist registration, have practiced the medical profession for at least one year as the holder of specialist registration, and meet the requirements approved by the Director General of Health (as the CEO); or
- Hold general registration, have practiced the medical profession for at least 10 years as the holder of general registration, and meet the requirements approved by the CEO; or
- Are an overseas-trained specialist who holds limited registration or provisional registration and meets the requirements approved by the CEO.
Director General of Health requirements relate to recency and hours of practice, lack of AHPRA notifications and provision of two professional referees.
GPs and other medical practitioners may refuse to participate for any reason (e.g. holding a conscientious objection to voluntary assisted dying, being ineligible, unwilling or unable). However, all medical practitioners who receive a First Request from a patient must:
- Give the patient the Approved information for a person making a First Request for voluntary assisted dying booklet
- Decide if they are going to accept or refuse the First Request
- Inform the patient of their decision
- Complete and submit the First Request Form to the Voluntary Assisted Dying Board
- Document key information in the patient’s medical record
Participation in the voluntary assisted dying process must, at all times, comply with the Act. The Western Australian Voluntary Assisted Dying Guidelines have been developed by WA Health to support compliance with the Act by assisting health professionals to understand the Act and their roles and responsibilities in the voluntary assisted dying process.
A suite of further information is also available for GPs and patients on the WA Health website.
WA Primary Health Alliance will continue to work with GPs and other professionals across the health industry and related care sectors, to make sure we all understand our obligations and responsibilities under the WA Voluntary Assisted Dying legislation.