GP resources for voluntary assisted dying

GPs are often the first point of contact for a person seeking to access voluntary assisted dying (VAD).
 
And, according to national end-of-life advocacy group Go Gentle Australia, GPs account for more than half of all doctors trained to provide VAD care.
 
In Australia, VAD is now legal in all six states and operating in five, with it available in New South Wales from 28 November, and the Northern Territory and Australian Capital Territory expected to follow suit soon. Although all laws follow a broad model of VAD, there are some key differences in eligibility criteria and processes across each jurisdiction.
 
The RACGP recognises that, as every state has implemented VAD or is in the process of doing so, GPs need to be aware that patients may request it, and that this requires a respectful and compassionate response.
 
Dr Linda Swan, Go Gentle Australia’s CEO and a former GP, agrees.
 
She told newsGP that it is ‘almost certain’ GPs will be asked about VAD, and that being informed and prepared are key steps.
 
‘It’s important that GPs can answer patients’ questions and know where to direct people for further information and advice,’ she said.
 
‘Even if a GP decides not to be involved in VAD – which is a right entrenched in all VAD laws – they have an obligation to provide accurate information or at least refer patients on to someone who can.’
 
To further support and educate GPs in this role, Go Gentle Australia, in collaboration with VADANZ, is hosting the inaugural Voluntary Assisted Dying Conference at the end of September.
 
The first national gathering of the VAD healthcare community, the conference includes a range of VAD clinicians, policymakers and peak bodies presenting about the practicalities of delivering VAD care, discussing frontline experiences, exploring new care models, and identifying and aligning policy areas for improvement.
 
Dr Swan said the two-day conference will provide a forum for those already providing VAD services and anyone who is considering training to support patients who make this choice.
 
‘The conference is a must for any healthcare professional who supports person-directed care and choice at the end of life,’ she said.
 
‘It’s the first time that doctors, nurses and others working in VAD will have the opportunity to come together to share their experiences and discuss the future of this new and growing area of clinical practice.
 
‘First and foremost, it’s a forum for those at the frontlines of VAD to discuss their experiences. But it is also for those who support VAD processes and systems, for researchers and policymakers and for anyone who is considering becoming involved.’
 
As a former GP, Dr Swan has ‘a deep appreciation and understanding’ of the critical role that GPs play in supporting patients and their families, and believes that GPs have ‘stepped up’ in their role of providing VAD care.
 
‘Without GPs’ incredible commitment, care and compassion, VAD could not operate,’ she said.
 
‘Many GPs become involved when one of their regular patients raises the option with them. Understandably, people want their family doctor to be with them on this final journey and most GPs would see this as important too.’
 
Go Gentle Australia is committed to ensuring GPs are supported in their VAD work, which many describe as ‘the most rewarding work they’ve done’, according to Dr Swan.
 
But she also acknowledges that GPs face some substantial barriers to becoming involved.
 
‘The first challenge is how to fit VAD work into an already busy practice,’ Dr Swan said.
 
‘Many GPs also struggle with the ethics of charging their patients for end-life-care. There are no dedicated MBS item numbers for VAD and existing item numbers do not come close to covering the time and costs of VAD care. Hence the bulk of VAD work is unpaid and carried out after hours.
 
‘With GPs accounting for more than half of the VAD workforce, the current system is just not sustainable.’
 
GPs are well represented among the list of speakers at the conference, with a key issue being how to remunerate GPs and other healthcare professionals who want to be involved fairly, and how to encourage more doctors to take up VAD training. As VAD laws are state specific, training is currently available mostly online under each state’s health department.
 
‘We want to provide a forum where all aspects can be openly discussed and explore how we can improve care delivery and the patient experience,’ Dr Swan said.
 
‘GPs can consider doing VAD training, even if they are unsure whether they want to be involved in VAD – there’s no better way to get up to speed.
 
‘Many doctors who now practise VAD said they never intended to until they were asked by a patient.’
 
Outside attending the conference, the VAD Care Navigator Service in each state is the ‘first port of call’ for any questions about a VAD request, Dr Swan said, and useful resources are available via each state health department’s website.
 
‘Remember who these VAD laws are for – dying people who are suffering intolerably and who want some say in the timing and circumstances of their death,’ she said.
 
‘How can we best support them? We like to say VAD is a permissive law – not because it is somehow easy but because it permits us to have open conversations about death and dying and to look deeply into something many of us have previously chosen to look away from.’
 
The Voluntary Assisted Dying Conference takes place at University of Technology Sydney, across 27 and 28 September. Tickets to the VAD Conference are subsidised for healthcare professionals and attendance qualifies for CPD points via self-reported hours.
 
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