This state's latest move affects doctors and patients eyeing this controversial service

Disclaimer: This article discusses distressing themes such as death. Reader discretion is advised.

As modern medicine continues to advance, several treatments and care services have been on the rise.

However, this also meant the rise of end-of-life care across the world.

In a significant shift around end-of-life care in Australia, a state recently announced several changes that could bring relief to Australians facing terminal illness.


Victoria finalised a compassionate and controversial decision to scrap a 'gag clause' that previously prevented doctors from initiating discussions about voluntary assisted dying (VAD) with their patients.

The repeal of this clause gave profound relief to doctors in the state, including Dr Nick Carr.

For several years, doctors like Dr Carr have been in a heart-wrenching ordeal as they watched patients endure excruciating pain.


compressed-pexels-man in the hospital.jpeg
Voluntary assisted dying (VAD) has been a legal medical option in several Australian states. Image Credit: Pexels/Valentin Angel Fernandez


These heartbreaking sights have been compounded by the fact that doctors could offer all legal care options, including VAD.

'It's quite perverse,' Carr remarked as he looked back at the frustration of being silenced by the law.

The inability to discuss VAD, unless directly asked by the patient, has been a source of ethical conflict for healthcare providers who are committed to comprehensive patient care.


Victoria's pioneering stance on VAD began in 2017 and officially took effect in 2019.

Since then, other Australian states except Northern Territory have enacted similar legislation.

It highlighted that Victoria's once 'groundbreaking' laws now appear more conservative compared to other jurisdictions.

The review that led to this decision found that Victoria's VAD laws were functioning as intended.

The review's findings showed that 1,527 VAD permits were issued in Victoria between 2019 and 2023.

About 912 of these individuals opted to use the VAD substance.

Compliance was remarkably high, with only 14 cases of non-compliance, half of which involved the delayed return of the VAD substance by relatives.

No misuse was reported, which reinforced the safety and integrity of the VAD process.


However, the said review also stated that certain safeguards were inadvertently hindering access to this critical end-of-life choice.

The gag clause was initially introduced to prevent coercion and the premature ending of lives.

Yet, this clause has been identified as an impediment, especially for patients suffering terminal conditions.

The state government's acceptance of the review's five recommendations marked a commitment to improving access to VAD in the state.

These reforms aimed to increase community awareness, enhance accessibility for Aboriginal and Torres Strait Islander people, and better serve multicultural communities.

Health Minister Mary-Anne Thomas emphasised the importance of reforming the VAD laws to ensure equitable access throughout Victoria.

'We're looking to remove barriers and improve the experience for all patients, their families and health practitioners,' Minister Thomas shared.


Among the proposed changes was the removal of the citizenship and residency requirement for VAD applicants.

This change was a significant development for non-citizens who may need the service.

One such case was that of Julian Bareuther, a United Kingdom citizen who was ineligible for VAD despite living in Australia for 40 years.

Dr Carr, who served on the board of Dying With Dignity, recalled Mr Bareuther's tragic case.

'He came and saw me eight days after the laws came into effect,' Dr Carr recalled.

'He had pancreatic cancer and wanted VAD, but because he was not formally an Australian citizen, he was denied the option.'

'If the government removes that requirement, it would be a huge and welcome change,' Dr Carr ended.


The government also considered extending the life expectancy rule for non-neurodegenerative diseases from six to 12 months as an acknowledgement of the variability in medical prognoses.

Additionally, the requirement for third assessments for patients with neurodegenerative conditions could be removed, and the time between the first and final VAD request could be shortened.

These proposed reforms have been met with enthusiasm from advocacy groups.

Dying With Dignity Victoria president Jane Morris and Go Gentle chief executive Linda Swan applauded the government's commitment to reducing barriers and needless suffering.

'We've heard so many unfortunate stories from people who've faced these barriers. To think that they may be righted is just the most incredible feeling,' Ms Morris stated.

'They show the government is listening to terminally ill people and their families and the health professionals who care for them,' Ms Swan added.

As Victoria aligned its legislation with other Australian jurisdictions, conversations around VAD have significantly evolved.

The proposed changes should reflect a growing recognition of the importance of patient autonomy and the need for compassionate end-of-life options.
Key Takeaways

  • Victoria scrapped the 'gag clause', which prevented doctors from initiating discussions about voluntary assisted dying (VAD) towards patients.
  • The review led to the government's commitment to reform the VAD legislation, aligning it more with other Australian jurisdictions and removing barriers to VAD access.
  • Proposed changes included removing the Australian citizenship requirement and changing the prognosis period for non-neurodegenerative diseases from six to 12 months.
  • Since the VAD laws came into effect, 1,527 VAD permits have been issued, and there is a high compliance rate with the regulation.
How do you feel about these changes to Victoria's VAD laws? Do you believe that doctors should have the right to discuss all legal, medical options with their patients? We invite you to share your thoughts on this sensitive issue in the comments section below.
 

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After having to standby and watch my husband and soul mate of 49 years bleed out over 13 days and the only form of his communicating with anyone was writing something down he had no quality of life as he was unable to enjoy a meal or even a drink. His insidious cancer had robbed him of it all. Had the option of VAD been available in NSW at the time he would have been one that would have asked for its help.
💔🙏💙🕊️I am so sorry you and your beloved husband had to go through this dreadful pain. May your husband rest in eternal peace.
Kind regards Vicki
Kind regards Vicki
 
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If you are counselled by someone who has a high profile such as a doctor you are more likely to take his/her advice than a lay person. So therefore consideration needs to be given impartial advice. Perhaps it’s not a good idea to accept such counselling
 
So sorry for such a traumatic experience I also lost my husband to Altzeimers and that was so traumatic to experience. I know he would not have wanted to endure this too but it was too late for him to make a decision because he was not in an appropriate state of mind
 
So sorry for such a traumatic experience I also lost my husband to Altzeimers and that was so traumatic to experience. I know he would not have wanted to endure this too but it was too late for him to make a decision because he was not in an appropriate state of mind
So cruel, so sad. May your husband rest in eternal peace 🙏 🕊️
Kind regards Vicki
 
I think that suicide becomes the last option of persons who just can’t handle what life has thrown at them, they are usually in a state of despair and just don’t want to be alive anymore. Even children at school are suiciding, usually from being bullied and can’t see it ever ending….. I think that VAD should be brought up as an option to patients who are terminal and suffering an undignified end of life…the patients know they are going to die but it’s the way of it that matters, of course there’d be certain amount of guilt on the patients part because it’s natural to want to stay, but only because it’s hard to say goodbye to your family….. it must be very hard on your family to watch your suffering and wonder every day how much longer you can hold on for…..Death is a fact…If I was terminal and in pain I’d rather choose a date to be assisted onward…I’d be able to have my family around, they’d all get the chance to say goodbye and their last memory of me would be cathartic and they’d see me die in peace instead of in pain. I do think that suicide is usually done in private and no one might have seen it coming and some people will struggle with it and always wonder why…why….
 
How come junkies can get enough drugs to overdose and yet others have to endure their miserable life. I think I will hoard a decent dose just in case.
 

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