The nation’s peak palliative care body is reviewing its position on euthanasia and physician-assisted dying after it became legal in Victoria, and has released two key reports on assisted dying around the world.
Victoria became the first Australian state to allow assisted dying with the passage of the Voluntary Assisted Dying Act in 2017. Victorians who meet eligibility criteria will be to able request voluntary assisted dying from June 2019.
The reports by Palliative Care Australia found that while legalising assisted dying is likely to raise difficult issues for health care workers, there is no evidence to suggest the sector will suffer as a result. On the contrary, the reports conclude that the introduction of euthanasia may even have benefits for palliative care.
Legalisation of assisted dying ‘may advance palliative care’
The Experience internationally of the legalisation of assisted dying on the palliative care sector report found the introduction of assisted dying legislation in Oregon, Washington, the Netherlands, Belgium and Canada had not adversely affected the palliative care sectors in those jurisdictions.
“If anything, in jurisdictions where assisted dying is available, the palliative care sector has further advanced,” the report concludes.
It said the implementation of assisted dying had brought about an “increased focus” on end of life care and may hold opportunities to strengthen and improve the sector.
“The implementation of (assisted dying) legislation may drive a stronger focus on upholding patient choice and autonomy, and there may be opportunities to introduce system improvements in palliative care, either as a direct or indirect consequence of the planned implementation of assisted dying.”
However, the report acknowledges that consideration needs to be given to supporting the health care workforce, which may experience “harmful effects” from the introduction of assisted dying.
Another report, Reflections and learnings, assisted dying in Canada and the US, was written after a PCA delegation visited Canada and parts of the US where assisted dying is legal in October.
The delegates concluded it was difficult for the palliative care workforce to be quarantined from medically assisted dying and said care workers should be involved in discussions to ensure people who didn’t want to be involved were protected and that “support for all staff and volunteers is vital to deal with moral distress”.
Need for support and training
“The key messages (the delegation heard) centred on the importance of respect and dialogue in the health sector and the need for formal support and training programs for health professionals, even if they are not involved with assisted dying procedures,” PCA board chair Dr Jane Fischer said in a statement.
The reports also reinforced a need for governments and health services where assisted dying is legal to prioritise workforce capability and support.
“Both reports also found that it is integral that patient-centred care is not lost in a health care environment where assisted dying is legal, but health professionals or the service as a whole conscientiously object,” Dr Fischer said.
She said the report would inform PCA’s work on how to support Australia’s palliative care sector and the wider health community when voluntary assisted dying is implemented in Victoria next year.
“PCA is currently reviewing its position statement on euthanasia and physician assisted dying and will look to develop an ethical framework for health professionals in early 2019.
PCA’s current position statement, dating from 2011 when euthanasia was illegal in Australia, says the organisation acknowledges a broad spectrum of opinion and support for reform and that “some competent people may elect to request euthanasia or physician assisted suicide”. However it says “the practice of palliative care does not include euthanasia or physician assisted suicide”.
Assisted dying legislation in Australia
- NSW – Voluntary Assisted Dying Bill voted down in November 2017
- NT – 1995 Rights of Terminally Ill Bill passed but was voided in 1996 when the commonwealth took away the territory’s power to legislate
- QLD – Inquiry ordered in September 2018
- SA – Death With Dignity Bill voted down in 2016
- Tas – Voluntary Assisted Dying Bill voted down in 2013
- Vic – Voluntary Assisted Dying Act was passed by the Victorian Parliament on 29 November 2017 and people who meet eligibility criteria will be able to request voluntary assisted dying for June 2019
- WA – Cross parliamentary committee has recommended legalisation
(source: Experience internationally of the legalisation of assisted dying on the palliative care sector, PCA Oct 2018)