Blog by Neil FrancisPosted on Friday 21st July 2017 at 1:53am
The Parliament of Victoria, Australia
The Victorian Government has introduced its assisted dying Bill into the Victorian Parliament. It's based on extensive consultation with a wide range of stakeholders, and over 1,000 submissions. You can read all about it here.
The Ministerial Advisory Panel on voluntary assisted dying today handed down its final report to the Government.
The Panel was comprised of seven subject experts, with Professor Brian Owler as Chair and Professor Margaret O'Connor as Deputy Chair.
It consulted extensively across Victoria, taking hundreds of submissions and appearances from relevant stakeholders, and reviewing legislation from other jurisdictions in which one form or other of assisted dying is permitted.
Today, it formally handed its report, comprising over 250 pages, to the Government.
The Panel has developed what is arguably the world's most detailed and carefully laid out principles to inform legislation, and are a credit to its efforts and professionalism.
Key aspects of the recommendations for voluntary assisted dying are:
The person must be 18 years or over; and
Be ordinarily resident in Victoria and an Australian citizen or permanent resident; and
Have decision-making capacity in relation to voluntary assisted dying; and
Be diagnosed with an incurable disease, illness or medical condition that:
is advanced, progressive and will cause death; and
is expected to cause death within 12 months; and
is causing suffering that cannot be relieved in a manner the person deems tolerable; and
Doctors and other healthcare workers are not permitted to raise assisted dying — only to respond to formal patient requests.
The person must make three formal requests, the second of which must be written and witnessed by two independent people.
The person must make the request themselves. Nobody else is authorised to make the request, and the request cannot be made via an advance care directive.
Ordinarily, the minimum timeframe between first request and opportunity to take the medication is ten days.
The person must maintain decisional capacity at all three requests.
Two doctors must reach independent assessments that the person qualifies.
Only doctors who have completed specialist training for voluntary assisted dying may participate.
Any healthcare worker may decline to participate for any reason, without penalty.
A prescription dispensed for the purpose of voluntary assisted dying must be kept in a locked box and any unused portion returned to the pharmacy after death.
The person must self-administer the medication; except if the person is unable to, a doctor may administer. An independent witness is required if the doctor administers.
Establishment of an authority to receive assisted dying reports, to assess reports, and to refer unacceptable cases to disciplinary or prosecutorial authorities.
For Parliament to review summary reports; twice in the first two years and annually thereafter; a formal review at five years.
In total, the recommendations include no fewer than 68 safeguards, designed to strike, uniquely for Victoria, an appropriate balance between access to the law, and protection of dying persons.
The Government will respond to the Final Report shortly, and it is anticipated that legislation will be introduced into the Victorian Parliament in August or early September.
A full copy of the Final Report can be obtained here.
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Safeguards proposed for Victoria's voluntary assisted dying framework
Access
Voluntary
Limited to 18 years and over
Residency requirement [Victorian resident and Australian citizen or permanent resident]
Limited to those with decision-making capacity
Must be diagnosed with condition that meets restrictive set of criteria [advanced, progressive and will cause death]
End of life is clearly defined [death expected within weeks or months, not more than 12 months]
End of life condition combined with requirement for suffering
All of the eligibility criteria must be met
Mental illness alone does not satisfy the eligibility criteria
Disability alone does not satisfy the eligibility criteria
Request
Must be initiated by the person themselves
No substitute decision makers allowed
Cannot be included as part of an advance directive
Health practitioner prohibited from raising voluntary assisted dying
Person must make three separate requests
Must have written request [witnessed in the presence of a medical practitioner]
Two independent witnesses to request [exclusions for family members, beneficiaries, paid providers]
Specified time must elapse between requests [first and third requests must be at least 10 days apart with exception when death imminent]
Additional time required to elapse between steps of completing process [second assessment and third request must be at least one day apart
Must use independent accredited interpreter [if an interpreter is required]
No obligation to proceed, may withdraw at any time
Assessment
Eligibility and voluntariness assessed by medical practitioners
Must be two separate and independent assessments by medical practitioners
Assessing medical practitioners must have high level of training/experience
Assessing medical practitioners must have undertaken prescribed training [to identify capacity and abuse issues]
Requirement to properly inform person of diagnosis, prognosis and treatment options, palliative care, etc, [by both assessing medical practitioners]
Referral for further independent assessment if there is doubt about decision-making capacity
Coordinating medical practitioner must confirm in writing that they are satisfied that all of the requirements have been met
Medication management
Person required to appoint contact person who will return medication if unused
Medical practitioner must obtain a permit to prescribe the medication to the person
Medication must be labelled for use, safe handling, storage and disposal
Pharmacist also required to inform the person about administration and obligations
Medication must be stored in a locked box
Administration
Medication must be self-administered [except in exceptional circumstances]
If physical incapacity, medical practitioner may administer
Additional certification required if administered by medical practitioner
Witness present if medical practitioner administers
Practitioner protections
Health practitioner may conscientiously object to participating
Explicit protection for health practitioners who are present at time of person self-administering
Explicit protection for health practitioners acting in good faith without negligence within the legislation
Mandatory notification by any health practitioner if another health practitioner acting outside legislation
Voluntary notification by a member of the public of a health practitioner acting outside legislation
Mandatory reporting
Reporting forms set out in legislation
Reporting mandated at a range of points and from a range of participants to support accuracy
First assessment reported [to Board]
Second assessment reported [to Board]
Final certification for authorisation reported [to Board, incorporates written declaration and contact person nomination]
Additional form reported [to Board] if medication administered by medical practitioner
Prescription authorisation reported by DHHS [to Board]
Dispensing of medication reported [to Board]
Return of unused medication to pharmacist reported [to Board]
Death notification data reported [to BDM and collected by Board]
Offences
New offence to induce a person, through dishonesty or undue influence, to request voluntary assisted dying
New offence to induce a person, through dishonesty or undue influence, to self-administer the lethal dose of medication
New offence to falsify records related to voluntary assisted dying
New offence of failing to report on voluntary assisted dying
Existing criminal offences for the crimes of murder and aiding and abetting suicide continue to apply to those who act outside the legislation
Oversight
Guiding principles included in legislation
Board is an independent statutory body
Board functions described in legislation
Board reviews compliance
Board reviews all cases of [and each attempt to access] voluntary assisted dying
Board has referral powers for breaches
Board also has quality assurance and improvement functions
Board has expanded multidisciplinary membership
Board reports to publicly [to Parliament every six months for first two years, thereafter annually
Five year review of the legislation
Guidelines to be developed for supporting implementation