On 16 September 2021 Queensland became the fifth Australian state to pass voluntary assisted dying legislation. It will, however, be another 15 months before the new law comes into operation and people who are suffering and dying will be able to access the scheme. During this time, considerable time and effort will be spent to ensure that the law is implemented as smoothly as possible.
We know that one of the factors that influences how successfully new procedures are implemented in healthcare is whether they are perceived by users as a good fit for their practice. Even though all healthcare is underpinned by legal obligations, the law is not frequently perceived as a good fit for healthcare practice.
Voluntary assisted dying laws are quite prescriptive. While other laws that regulate practice may provide guidance or set boundaries, they don’t set out every detail of a particular practice. With voluntary assisted dying, strict adherence to each of the procedural elements of the law is seen as central to the overall safety of the scheme.
Voluntary assisted dying is also a process that is initiated and driven by a person suffering at the end of their life. Rather than providing advice about ongoing care and treatment, healthcare practitioners may be assessing whether a person meets prescribed eligibility criteria for access. Performing this ‘gatekeeping’ function is a fundamental change to usual practitioner–patient relationships.
To consider how to account for the differences between implementing biomedical research and a voluntary assisted dying law, it is helpful to look at what is already known about how these laws work in practice from other jurisdictions.
People need to feel confident that they know where legal boundaries lie
Putting the law into practice requires education to promote knowledge and understanding. Because the laws are prescriptive, education to inform practitioners about how the law will work in practice is imperative. The mandated legal training is necessary but not sufficient on its own.
Helping people to die using voluntary assisted dying is complex
Despite the prescriptive nature of the law, in practice, members of multidisciplinary teams are uncertain about their specific roles and responsibilities. Trying to navigate the many different aspects of voluntary assisted dying adds to the sense of complexity.
Voluntary assisted dying is deeply personal for all involved
Healthcare practitioners bring a diverse array of attitudes, beliefs, and values to their role. Some, such as compassion, empathy and caring, are embedded in—and inseparable from—healthcare directed at relieving suffering and promoting quality of life.
Voluntary assisted dying challenges this position by enabling people to intentionally hasten their death. For some practitioners, this choice can conflict with their deeply held and personal beliefs. Equally, for others, helping to end the intolerable suffering of someone with a life-limiting illness is incredibly rewarding and is a deep expression of those values that led them to the profession.
Limiting uncertainty needs to be a priority
We know that changing the law won’t necessarily change how people feel about voluntary assisted dying. For some, it will be an overdue and welcome development. For others, it represents a societal failure to adequately care for those at the end of life. In either case, there will be many who are deeply affected by the introduction of voluntary assisted dying, particularly because how this new end-of-life choice will coexist with current end-of-life and palliative care is uncertain.
Seeking to limit this uncertainty is an important part of implementing the law into practice. To the extent that it is possible, we should be clear about how the process will work. We should also ensure those who choose to assist know where to find the procedural, technical, and emotional support they need. We also need to anticipate the needs associated with post-death and bereavement care, even if we don’t yet know precisely what makes post-voluntary assisted dying care different from other after-death care.
In seeking to address these and, of course, the many more questions that voluntary assisted dying raises, we should remember that nearly three years of concerted consultation ultimately informed the drafting of the Bill, and the Health and Environment Committee’s recommendation that it be passed.
A similar consultative approach is needed as the law is implemented. Consultation will help to clarify the questions most in need of answers. Importantly, it will enable those likely to be affected by the law the feeling to feel as though they are part of the process and that their voices have been heard. This should include those who choose to participate, as well as those who choose not to.
The development of a suite of resources and strategies is imperative; ensuring they are nuanced and reflect the needs of healthcare practitioners so they can see how voluntary assisted dying fits with their current practice, how it will affect the patients they care for, and the careful consideration that is required.
We know that the impetus for these laws is the need to limit the suffering of those at the end of life. How it is implemented will ultimately determine the extent to which this policy objective is achieved.
Dr Jayne Hewitt is a registered nurse and legal scholar. Her PhD explored understandings of justice in healthcare and was awarded in 2019. Since then, she has been involved with the development of Victoria’s voluntary assisted dying training and worked with the Queensland Law Reform Commission on their review into a voluntary assisted dying framework for Queensland.
Jayne is also a Board member of Palliative Care Australia and a Council member of Palliative Care Queensland. Jayne is a Senior Lecturer in the School of Nursing and Midwifery, and a Senior Research Fellow with the Law Futures Centre at Griffith University.
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