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Major step to remove GP ‘gag clause’
New legislation allows Victorian GPs to raise voluntary assisted dying with their patients for the first time – a change brought about by doctors’ advocacy to Government.
‘The removal of this ‘gag clause’ will have such a meaningful impact,’ says RACGP Victoria Chair Dr Anita Muñoz.
Victoria is a step closer to removing a ‘gag clause’ preventing GPs from raising voluntary assisted dying (VAD) with their patients, in a move described as a ‘sensible step’ by the RACGP.
Victorian Health Minister Mary-Anne Thomas introduced an amendment to the Voluntary Assisted Dying Act 2017 on Tuesday to remove unnecessary access barriers, improve clarity for practitioners, strengthen safety measures and make the system fairer and more compassionate.
‘We’ve listened to doctors who have told us they want to have open, honest conversations with patients about all their end-of-life options, so they can make safe and informed decisions,’ she said.
Victoria was the first state in Australia to rollout VAD laws, which passed through its Parliament in 2017 and began in 2019. Since then, the laws have allowed 1683 terminally ill Victorians to make their own decisions about their death.
The proposed changes put to Parliament come after a recent independent review into the VAD scheme’s first five years found some processes and safeguards were impeding access and undermining patient-centred care.
‘We know our Australian-first VAD laws work to alleviate suffering and give Victorians a safe choice – but we know we need to bring them into line with other states, so more Victorians can live out their final days on their own terms,’ the Health Minister said.
The reforms aim to maintain Victoria’s strong safeguards, ensuring decisions are voluntary, the person has decision-making capacity, and that they are free from coercion.
Among 13 proposed amendments, key changes include:
- removing of the ‘gag clause’, so that registered health practitioners are allowed to raise VAD with their patients during discussion about end-of-life options
- extending the prognosis requirement (life expectancy limit for eligibility) from six months to 12 months
- removing the need for a third prognosis for people with neurodegenerative diseases (like motor neurone disease) if their expected lifespan is between six and 12 months
- introducing a new administering practitioner role to expand the workforce able to support VAD.
According to its VAD position statement, the RACGP is ‘acutely aware there are a range of views on voluntary assisted dying, both within the general practice profession and the broader community’.
‘Arguments for and against legalisation for voluntary assisted dying are highly complex and raise significant practical and ethical issues,’ it states.
‘Both proponents and opponents of voluntary assisted dying wish to alleviate suffering of dying patients, and recognise that doctors as medical professionals have ethical responsibilities and are not merely providers of services.’
RACGP Victoria Chair Dr Anita Muñoz said the proposed amendments are ‘the right thing to do after listening to the experts and those impacted by the limitations of the current scheme’.
‘The removal of this ‘gag clause’ will have such a meaningful impact, as will extending the life expectancy limit for eligibility from six months to a year,’ she said.
‘Perhaps most significantly of all, we welcome the introduction of a new administering practitioner role to expand the workforce able to support voluntary assisted dying.
‘The college looks forward to working closely with the Government to better understand the finer points of this reform and the role of GPs and practice teams.’
Dr Muñoz said the amendments would remove access barriers to VAD, with too many people living outside of major cities having faced unfair obstacles to access the scheme.
‘Patients in excruciating pain who are immobile and only want to end their suffering have had to travel many hours to consult with non-GP specialists such as oncologists,’ she said.
‘By ending that requirement, voluntary assisted dying is more accessible for terminally ill people in rural and remote communities across Victoria.’
VAD laws operate in all states and will commence in the
Australian Capital Territory on 3 November after passing through parliament last year.
While the Northern Territory remains the last jurisdiction without VAD laws,
a Parliamentary committee tabled a report last month recommending the Government ‘draft legislation to introduce voluntary assisted dying in the Northern Territory’.
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