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How is VAD operating in each state?
An inaugural report assesses how voluntary assisted dying services are performing across Australia, and recommendations to improve care.
Since 2019 when laws were first implemented, 5338 Australians have sought voluntary assisted dying services.
Since Victoria became the first state to pass and implement voluntary assisted dying (VAD) five years ago, the service began rolling out across the country, with each state creating its own unique laws.
While now legal in all states and the ACT, VAD is still relatively new for many GPs, especially in NSW where the law only became operational last November.
So how is the end-of-life option operating across Australia and New Zealand – who is accessing and providing it, what are the barriers, and what is GPs’ role?
A first-of-its-kind report has all the answers.
Launched on Monday at Canberra’s Parliament House by Go Gentle Australia and Health and Aged Care Minister Mark Butler, the State of VAD report is the first ever national snapshot of VAD practice, compiled using data from the state VAD Boards.
Using the experiences of those most closely involved, the report collates data from each jurisdiction to show how it is working in practice, presenting an evidence-based picture of how systems are supporting individuals, families and health professionals.
Former GP and Go Gentle Australia Chief Executive Dr Linda Swan said the report is a ‘valuable resource’ for those seeking to understand how VAD is fulfilling its aims, what can be improved, and GPs’ role.
‘The report shows that, overall, VAD care is being delivered safely and compassionately across the country,’ she told newsGP.
‘Any GP who may have concerns about VAD will be reassured that our laws are working safely and as intended. GPs are central to the operation of VAD, representing around 60% of VAD practitioners.
‘This high representation reflects the important role that GPs play in end-of-life care for people living with a life-limiting illness.
‘If you are an active GP and haven’t been asked about it already, you will be. We encourage all GPs and practice managers to familiarise themselves with the laws in their respective jurisdictions.’
In June 2019, Victoria became the first Australian state to implement VAD, before laws were passed in every other state, the ACT and New Zealand over the next five years.
The ACT passed laws in June this year and there is now an 18-month implementation period, as required by each law before taking effect.
The Northern Territory is now the only jurisdiction yet to pass a law. Last month, an expert panel delivered a community consultation report outlining what a VAD law in the Territory might look like.
As well as who is accessing and providing VAD care, the State of VAD report details the barriers to access and equity, compliance and safety, and intersections between VAD, palliative and end-of-life care.
Since 2019, 5338 Australians and 1870 New Zealanders have sought VAD, while 2467 Australians and 775 New Zealanders have died using a VAD substance. Of these people, around four in five (79%) were receiving palliative care at the time, and around half of Australians approved for VAD died at home.
To date, more than 1200 healthcare professionals across Australia and New Zealand have completed VAD training, the majority being GPs.
While assisted deaths currently represent a small proportion (0.5–1.6%) of all deaths, demand for VAD services is growing, and more healthcare professionals are needed to meet this demand.
Citing inadequate support and poor remuneration as key barriers, the report outlines recommendations to further improve access, including:
- streamlining complex bureaucratic processes
- recognising VAD as part of high-quality, end-of-life care and include it in clinical standards
- growing the VAD health workforce to meet demand, with fair compensation
- producing clear guidance to individual practitioners, hospitals, and aged care facilities about legal and ethical obligations to the people in their care
- providing culturally safe resources and services for Aboriginal and Torres Strait Islander people and those from culturally and linguistically diverse backgrounds.
GPs are central to this model of care, according to Dr Swan, who as a former GP, has a ‘deep appreciation and understanding of their critical role’ in supporting patients and their families.
‘In many respects VAD work is exactly the kind of care GPs want to offer their patients,’ she said.
‘Those who are involved describe it as the most rewarding work they’ve done. They talk about the privilege of building on their long-term relationship with patients and accompanying them through every step of their journey, including at the end of life.
‘VAD is a final gift we can offer that can make a difference to not just one life but many.
‘But, of course, there are also challenges. GPs are amongst the busiest and most stretched practitioners with multiple competing priorities. The report provides an opportunity to openly discuss how the system can be improved to make GP participation in VAD easier.
‘Chief among these is that GPs be fairly remunerated for their VAD work, and that the VAD training be as accessible as possible.’
Despite the report’s findings that two in three VAD practitioners agree training prepared them for their role and 80% of non-VAD practitioners would consider doing training in the future, 50% of current VAD practitioners disagreed with the statement ‘I am appropriately remunerated for my role in the VAD program’.
Funding solutions are currently based on separate VAD laws governing each jurisdiction.
Dr Swan acknowledged the ‘richness of data’ the report draws on to provide better understanding of how VAD is operating across Australia and New Zealand.
‘It enables us to have strong evidence about how services are going and to recommend improvements in care,’ she said.
‘The VAD application and assessment process may seem complex, but strong support … [enables it to be] operating within the strict eligibility criteria and safeguards.’
VAD resources for GPs
- GPs can find out about laws in their respective jurisdictions from local health departments, and Go Gentle Australia also provides a summary
- Peak body VADANZ has been established to support VAD practitioners and GPs can join
- Co-hosted by Go Gentle Australia and VADANZ, the VAD conference will be held 28–29 October in Brisbane
RACGP position
The RACGP supports patient-centred decisions in end-of-life care, and respects that this may include palliative care and requests for VAD. While the college neither supports nor opposes VAD, it recognises there are patients who will request access to assisted dying if it becomes a legal option, and that any such requests require a respectful and compassionate response. More details are available in the
RACGP’s position statement on VAD.
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