Voluntary assisted dying will be available to more Australians this year

Here’s what to expect in 2023

By the end of 2023, eligible people in all Australian states will be able to apply for voluntary assisted dying as the final three states’ laws will become operational this year.

This year began with Queensland’s voluntary assisted dying law commencing operation on January 1. South Australia is to follow shortly, on January 31, with the New South Wales law to commence on November 28.

These states join Victoria, Western Australia and Tasmania, whose laws have been operating for more than three years, one year and three months respectively.

The territories may be poised to follow with the Commonwealth’s lifting of an over 25-year ban on territories passing voluntary assisted dying laws.

The Australian Capital Territory has already signalled it will introduce such laws by 2024 and circulate a discussion paper in coming months.

Hundreds have chosen to die this way

There is now a clear picture emerging of voluntary assisted dying in Australia, with hundreds choosing this in states where it is legal.

In Victoria, 604 people have been assisted to die in the three years between June 2019 and June 2022 (the latest figures publicly available). Some 75% of people being assisted to die since the law commenced were 65 or older; more than 80% of applicants had cancer. In the last reporting period (July 1 2021 to June 30 2022), deaths from voluntary assisted dying represented 0.58% of deaths in that state.

In WA, uptake has been much higher than expected, with 190 people (1.1% of deaths in the state) choosing voluntary assisted dying in the first year. This is more than the number of Victorians who accessed voluntary assisted dying in the first year, even though WA’s population is much smaller.

In WA, almost 88% of eligible applicants were aged 60 or over and 68% of patients requesting voluntary assisted dying had cancer.

In both states, more than 80% of patients requesting voluntary assisted dying were also receiving palliative care. Eligible applicants cited the inability to engage in activities that make life enjoyable, and the loss of autonomy, as the two most common reasons for accessing voluntary assisted dying.

How is the system working?

In Victoria and WA, bodies that oversee voluntary assisted dying have found the system safe. According to their reports, only people who meet the strict eligibility criteria have been able to access it.

Those providing voluntary assisted dying and state-based services designed to help prospective patients access it have been praised as being supportive and compassionate.

However, there are barriers to access, including:

Many of these issues are heightened in rural and remote areas.

While it is still early days in Tasmania, access issues have already been reported. These result from a lack of trained doctors, and a complicated and lengthy request and assessment process.

Many access issues are heightened in rural and remote areas.Many access issues are heightened in rural and remote areas.

How can we address these issues?

Voluntary assisted dying legislation in each state requires it to be reviewed after a certain period. For both Victoria and WA, this review will begin this year.

But it is not yet clear how these reviews will be conducted, or what evidence considered.

For some issues, law reform might be needed. For others, a policy response may be possible. For example, potential barriers might be addressed through better remuneration for participating practitioners, strategies to support individuals living in rural and remote areas and a more flexible application of the Australian residency rules.

These mandated reviews present an important opportunity to improve how voluntary assisted dying laws operate in practice. It is pivotal these reviews are evidence-based.

Fortunately, there is a growing body of published evidence that can guide and inform these reviews – from the bodies that oversee voluntary assisted dying and from research on voluntary assisted dying practice.

Now voluntary assisted dying laws are operational in all Australian states, or will be by the end of the year, the next challenge is to ensure current barriers to access are removed while continuing to ensure the system operates safely.

Katherine Waller, Project Coordinator, Australian Centre for Health Law Research, Queensland University of Technology, coauthored this article.

For the rest of this article please go to source link below.

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By Lindy Willmott / Professor of Law, Australian Centre for Health Law Research, Queensland University of Technology, Queensland University of Te

Lindy Willmott is a Professor of Law at Queensland University of Technology and a member of the Australian Centre for Health Law Research at the University. She researches in the area of the law that regulates the end of life, and particularly voluntary assisted dying, and publishes extensively in this field. Professor Willmott is the co-author of many text books in a range of areas and the website 'End of Life Law in Australia'. She also is an editor of the text Health Law in Australia.

By Ben White / Professor of End-of-Life Law and Regulation, Australian Centre for Health Law Research, Queensland University of Technology

Ben White is Professor of End-of-Life Law and Regulation and an Australian Research Council Future Fellow (Professorial level, 2020-2024) in the Australian Centre for Health Law Research at the Faculty of Business & Law, Queensland University of Technology. His area of research focus is end-of-life decision-making with a particular focus on voluntary assisted dying.

Ben graduated with first class Honours and a University Medal in Law from the Queensland University of Technology. He was awarded a Rhodes Scholarship to complete a DPhil at Oxford University, where his doctoral thesis investigated the role that consultation plays in the law reform process. Before joining the Law School, he worked as an Associate at the Supreme Court of Queensland and at Legal Aid Queensland. Between 2005 and 2007, Ben was appointed as the full-time Commissioner of the Queensland Law Reform Commission where he had carriage of the Guardianship Review on behalf of the Commission. He also served as a part-time Commissioner between 2007 and 2010.

Ben was a foundation Director of the Australian Centre for Health Law Research for six years (2013-2018). He still co-leads the End-of-Life Research Program within the Centre. He has published over 150 book chapters and journal articles in the area of health law, with a particular focus on end-of-life decision-making. His work is interdisciplinary with publications in law, medicine, bioethics, social science and psychology journals as well as those that have an interdisciplinary focus. He is an editor of the leading text Health Law in Australia (2018, 3rd ed, Thomson) and International Perspectives on End-of-Life Law Reform: Politics, Persuasion and Persistence (2021, Cambridge University Press).

Ben has been part of interdisciplinary teams that have been awarded $45 million in the field of end-of-life decision-making, including from the Australian Research Council, the National Health and Medical Research Council and Commonwealth and State governments. His five Australian Research Council grants have examined different aspects of law, policy and practice at the end of life. Key topics investigated include: What role does law play in medical decision-making? To what extent do doctors know and follow the law? Why is medical treatment that is futile/non-beneficial provided to patients at the end of life? How many people make a will or engage in advance care planning and why? What does the community know about the law of end-of-life decision-making? Do patients and families know their rights and responsibilities when making end-of-life decisions?

Ben is currently undertaking a four-year full-time Australian Research Council Future Fellowship (2020-2024) that aims to develop a new and holistic approach to regulating voluntary assisted dying. This project will enhance end-of-life care in Australia through better regulation and will draw on Canadian and Belgian case studies. Ben is a Chief Investigator on a National Health and Medical Research Council project involving an intervention to address futile or non-beneficial treatment at the end of life. He has also been an Associate Investigator on two Centres of Research Excellence, one in End-of-Life Care and the other on Chronic Kidney Disease.

Ben is also currently developing funded training and research programs about end-of-life law. These programs include the legislatively-mandated training that health professionals must complete before being involved in voluntary assisted dying in Victoria, Western Australia and Queensland (funded by these State Governments). Another is a national program funded by the Commonwealth Department of Health to enhance health professionals' knowledge of law at the end of life called End of Life Law for Clinicians. He also contributes to the Commonwealth Government-funded End of Life Directions for Aged Care project.

Ben’s research has had significant impact leading to changes in law, policy and practice. His work has been adopted by parliaments, courts and tribunals, and law reform commissions and has also influenced state and national end-of-life policy and prompted changes to clinical education in universities, hospitals and health departments. His research has also contributed to voluntary assisted dying law reform across Australia, and particularly in Queensland. His legal research is publicly available through the End of Life Law in Australia website (co-authored with Lindy Willmott and Penny Neller). This site aims to provide accessible information about law at the end of life for patients, families, health and legal practitioners, the media, policymakers and the broader community.

A list of Ben’s publications and other outputs is available here: http://eprints.qut.edu.au/view/person/White,_Ben.html.

By Katrine Del Villar / Postdoctoral research fellow, Queensland University of Technology

Katrine Del Villar is a Postdoctoral Research Fellow in end of life law with the Australian Centre for Health Law Research at Queensland University of Technology.

(Source: theconversation.com; January 27, 2023; https://tinyurl.com/mz7p7ern)
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