Attending the NT Government Voluntary Assisted Dying Community Consultation – Thoughts

Yesterday evening I attended a community consultation event on Voluntary Assisted Dying (VAD), which is expected to be put into law by NT Government in the near future. I thought the event was very well run, and provided lots of information to me on the specifics of what is being considered for the NT’s legislation. For full information from NT Gov, see their page on VAD here:

https://cmc.nt.gov.au/project-management-office/voluntary-assisted-dying

The event was run by the expert advisory panel, which is independent of NT Gov and will provide a report at the end of their work to advise NT Gov. The event was led by Duncan McConnel SC, and also attending from the expert panel was Sue Shearer, Dr Devaki Monani, and Wendy Morton. Many thanks to the expert panel for running the event. It was very well run and informative.

My Thoughts on VAD

I am in support of VAD, and would like it to be available as soon as possible in the NT. Part of my urgency is the fact that I have been diagnosed with a terminal illness, with a fairly short prognosis.

My concerns going into the event were:

A) I believe that clinicians should be able to conscientiously object, and opt-out of providing assistance with VAD. However, in this case I feel it is important that the clinician should still inform the patient that it is available, and refer them to another clinician that will be able to assist the patient.

B) I was concerned that the time-frame for getting approval would be long, and that a patient like myself would have to suffer while waiting out the various waiting periods for approval.

Conscientious Objection

When we discussed this, it is in all current VAD schemes in Australia, and is expected to be included in the NT’s law.

Interestingly, the topic of referring was much more contentious, as some clinicians feel that even referring is breaking their Hippocratic Oath. My feel was that this view seems to be much more prevalent in religious groups, though.

This was an interesting and difficult topic, where they are trying to balance the clinician’s rights vs the patient’s right to be fully informed of their options.

I feel the patient should definitely be informed and referred.

Time-Frame for Approval

This was discussed, and sounds like it will be a non-issue. What was pointed out was that the way most schemes work is that the patient needs a prognosis of either 6 or 12 months remaining. They then need to have either 2 or 3 meetings with 2 clinicians to discuss VAD and be approved. Between these meetings there is a waiting period in the range of 3-days to 2 weeks (depending on the state).

What this means is, assuming 6-months, if the patient crosses the 6-month line they can discuss VAD with their clinician and have the 2 meetings, but then hold off on administering VAD until/if they find it necessary.

I feel this is a reasonable way to approach VAD.

Requirements for VAD

One thing that was discussed at length was what was required to be eligible for VAD. For full details definitely read the guide “Who should have access to voluntary assisted dying?“, but a summary of the requirements is:

• Competent of making decisions for themself (mentally capable)
• Suffering from a condition/illness that has a short (6/12 month) prognosis
• Experiencing “Unbearable Suffering”

This means that some degenerative neural diseases, like dementia, will not be eligible, as the patient can’t make the decision for themselves at the end.

It also means that VAD can’t be pre-approved on an Advanced Personal Plan (APP).

What suffering is eligible is also not clear, and I believe this is intentional as it allows the patient and clinician to go through what the patient feels is a necessary level for themself.

I feel these requirements seem like a good starting point, although it seems like maybe there should be a way for a patient to pre-approve VAD. However, it was discussed that having another person making the decision has the potential for abuse by family/others executing an APP and would need significant safeguards.

Other Things Discussed

One attendee asked what would be on the death certificate and what it means for statistics collection? The answer was that most states put the underlying medical condition, not VAD, on the certificate. They then separately report statistics to a VAD review body. – seems reasonable to me

Another asked about review/revision of the law. The answer was that there is expected to be a review body that reviews each case, but also would perform a larger overall review every 3 to 5 years. – seems reasonable to me