Our focus for the coming year (Voluntary Assisted Dying Board Annual Report 2023-24)
Building our community and stakeholder engagement approach
The Voluntary Assisted Dying Review Board has commenced a process to develop a stakeholder engagement framework and action plan in partnership with stakeholders, that will describe ongoing stakeholder engagement undertaken by the Voluntary Assisted Dying Review Board, the Department for Health and Wellbeing, and voluntary assisted dying services delivered by SA Health which include our medical practitioners, the South Australian Voluntary Assisted Dying Care Navigator Service (SAVAD-CNS), South Australian Voluntary Assisted Dying Pharmacy Service (SAVAD-PS) and Local Health Network Voluntary Assisted Dying Liaisons.
Research into voluntary assisted dying
The Review Board has recently developed a Voluntary Assisted Dying Research Framework to provide a robust framework for engagement with and participation in research, with appropriate governance and in alignment with evidence based research principles and priorities.
The framework identifies six overarching areas of interest which include:
- awareness, understanding and perception of voluntary assisted dying
- understanding why people access voluntary assisted dying
- access to voluntary assisted dying
- patient and family experience of voluntary assisted dying
- health care workforce experience of voluntary assisted dying
- voluntary assisted dying clinical workforce.
A voluntary assisted dying research subcommittee will oversee and facilitate research activities. The research subcommittee is tasked with providing guidance, reviewing proposals and making recommendations to ensure the quality and relevance of research activities and reporting on research related activities. The subcommittee will report quarterly to the Voluntary Assisted Dying Review Board.
Development of an Aboriginal voluntary assisted dying model of care
There is a recognised need for a meaningful process and pathway to be developed to support access to voluntary assisted dying for Aboriginal and Torres Strait Islander communities. Early engagement with expert cultural advisors identified the need for a co-design approach to work with Aboriginal communities to identify the issues specific to them and to seek advice on how SA Health can better develop and support equitable and culturally safe access to voluntary assisted dying.
The co-design of the model of care is expected to include the following elements:
- The development of ways to talk about death, explain what voluntary assisted dying is, and how it can be accessed; as many of the concepts around death and dying have different meanings and interpretations, particularly in language.
- The role of family and community and how to support decision making about voluntary assisted dying.
- Pathways for voluntary assisted dying teams to work with trusted health care workers to visit country to support a request for voluntary assisted dying, and to facilitate medication supply and dying on country.
The first stage of activity will be to set up an expert forum for cultural advice.
Access to voluntary assisted dying
Commonwealth Criminal Code Carriage Laws
Telehealth plays an important role in facilitating equity of access to health services, in particular for people residing in regional South Australia.
Currently the Commonwealth Criminal Code Act 1995, prohibits the use of telehealth and other carriage services to discuss or send ‘suicide-related’ material. This has been interpreted to impact on discussions relating to voluntary assisted dying, notably around the provision of the voluntary assisted dying medication and distribution of information and education to patients regarding administration of the voluntary assisted dying medication.
Medical practitioners are understandably concerned about inadvertently breaching the Act and the risk of prosecution while this legislation remains in place.
While assessments of eligibility for voluntary assisted dying can be conducted via telehealth in South Australia, removing further Commonwealth legislative barriers to allow for discussion of administration of the voluntary assisted dying substance via telehealth where necessary would allow for more patient centered and timely education and support for patients and their families in particular for those who live in regional areas or who are unable to travel to appointments due to their advanced illness. The VAD Review Board will continue to advocate for this.
Medical practitioner recruitment and sustainment
Nearly one percent of eligible medical practitioners in South Australia have undertaken the training to deliver voluntary assisted dying. There are a range of reasons why medical practitioners may not choose to be involved in voluntary assisted dying including lack of Medicare remuneration, having a conscientious objection to voluntary assisted dying, lengthy assessment and administrative processes and time to undertake the mandatory training that is also not remunerated. The small number of participating medical practitioners presents risks to the sustainability of voluntary assisted dying in South Australia.
SA Health has already implemented several initiatives to increase the number of participating medical practitioners including:
- Working with the Royal Australian College of General Practitioners (RACGP) to become a Continuing Professional Development (CPD) provider so that the voluntary assisted dying mandatory medical practitioner training is eligible for CPD points and will be available on the RACGP training dashboard.
- Offering a hybrid format for the voluntary assisted dying mandatory practitioner training to provide additional face to face support for medical practitioners in addition to online components.
- Availability of the VAD Access Support Program which provides reimbursement for General Practitioners (GPs) and private specialists for voluntary assisted dying activity where there is no existing Medicare or private billing option.
Health professional awareness and understanding of voluntary assisted dying
There is a need to expand awareness among medical practitioners and other healthcare professionals regarding the voluntary assisted dying pathway, along with a clear understanding of their rights and responsibilities in relation to this process. This effort should involve the development of targeted educational programs, and information resources that outline the legal, ethical, and practical aspects of voluntary assisted dying to ensure clinicians are well-informed and can engage with patients and families in a manner that respects patient rights and autonomy and upholds professional standards.