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GP ‘gag clause’ for VAD to be scrapped
Victorian doctors could soon be allowed to raise voluntary assisted dying with their patients for the first time after the State Government vowed to update laws currently ‘impeding access’.
The RACGP supports patient-centred decisions in end-of-life care, and ‘respects that this may include palliative care and requests for VAD’.
A ‘gag clause’ preventing doctors from initiating discussions about voluntary assisted dying (VAD) with their own patients could soon be scrapped in Victoria.
More than five years after the state became the first in Australia to rollout the VAD laws, a review of their operation has called for several updates.
Released on Thursday, the review states that ‘overall, VAD is operating as intended, providing a safe and compassionate end-of-life choice to eligible Victorians’.
‘However, the review identified that some processes and safeguards impede access, undermining patient-centred care, and would benefit from improvement,’ it said.
In response, the Victorian Government has already agreed to rewrite legislation to improve access to VAD, saying that, subject to consultation, it will legislate to allow health practitioners to initiate discussion with patients – bringing it into line with other states.
It is a move welcomed by RACGP Victoria Chair Dr Anita Muñoz, who knows firsthand the impacts of the ‘gag clause’.
She said the role of a GP is to provide information about patients’ options for managing all medical conditions, ‘and this is no different’.
‘There have been patients with whom I would otherwise have raised this issue, and I purposefully haven’t,’ Dr Muñoz told newsGP.
‘I certainly know that it’s front of doctors’ minds in Victoria not to fall foul of this law.
‘It’s just an additional layer of punitive regulation that has turned doctors off getting involved in VAD in Victoria because it’s yet another way that you can be castigated by the regulatory system, and Victorians miss out as a result of that.’
The Victorian Government said changes may also require health practitioners who conscientiously object to VAD to provide minimum information to patients.
Proposed changes also include that for those with neurodegenerative conditions, a requirement for a third assessment could be removed to make the process ‘easier and less complicated’.
According to its VAD position statement, the RACGP supports patient-centred decisions in end-of-life care, and ‘respects that this may include palliative care and requests for VAD’.
However, the college says any VAD legislation must protect both patients and doctors from coercion, ensure doctors are not compelled in any way to participate, have clear eligibility criteria, and support the optimisation of end-of-life and palliative care services.
Victoria was Australia’s first jurisdiction to introduce VAD laws, which passed through its Parliament in 2017 and began in 2019.
Since then, VAD has been legalised in all Australian states.
VAD laws have also been passed in the Australian Capital Territory and will commence on 3 November this year, while it remains illegal in the Northern Territory.
Since 2019, 5338 Australians have applied for VAD, and there have been 2467 VAD deaths.
The Victorian review found GPs who are registered on the VAD portal are more widely available than other medical practitioners, while other specialists who are registered on the VAD portal are highly concentrated in metropolitan Melbourne.
‘This supports the feedback received from families and workforce about the difficulties people living in regional areas face in finding VAD-registered practitioners, particularly non-GP specialists,’ it said.
‘Yet despite this, proportionately more rural and regional Victorians have accessed VAD.’
Dr Muñoz said not allowing GPs to speak about all medical options with their patients has been disadvantaging those with ‘less health literacy, less education and less access to information’.
‘What it really means is patients who are not as health literate as others, or do not have access to accurate health information, can now receive information from their GPs to make informed choices, which is what we do with every other part of medicine,’ she said.
‘Patients are entitled to be aware of what their treatment options are, and deliberately gagging a doctor from laying out those options to patients means you’re effectively taking that right away from people who don’t otherwise have that information at hand.
‘Without GPs being able to do this, many people would miss out on this option just because they don’t know that they have access to it, and that creates an inequality in the health system.’
Victorian Health Minister Mary-Anne Thomas said that while the state’s laws were an Australian-first, ‘we know we need to update them to ensure they remain fair’.
‘Reforming our VAD laws to bring them in line with other states is critical to maintaining a service that is accessible to all Victorians, no matter where they live,’ she said.
The review made five recommendations, all of which have been accepted by the Victorian Government:
- Increase the provision of sector guidance and build on approaches to continuous improvement
- Enhance community awareness of VAD and grief and bereavement supports
- Support the workforce to ensure VAD is accessible, viable and sustainable
- Consider enhancements to the statewide service models to meet anticipated future demand
- Advocate to the Commonwealth Government for greater Federal support
The Victorian Government will now begin stakeholder consultation on how to improve the experience for those choosing to access VAD.
Log in below to join the consultation.
end-of-life care VAD voluntary assisted dying
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