Voluntary Assisted Dying in Victoria PDF

MONASH NURSING Voluntary Assisted Dying in Victoria Margaret O’Connor AM Emeritus Professor of Nursing  related developments in Victoria  Vic. Charter of Human Rights (2016) http://www.humanrightscommission.vic.gov.au/upcoming- changes-to-medical-deci...

MONASH NURSING Voluntary Assisted Dying in Victoria Margaret O’Connor AM Emeritus Professor of Nursing  related developments in Victoria  Vic. Charter of Human Rights (2016) http://www.humanrightscommission.vic.gov.au/upcoming- changes-to-medical-decision-making-laws  Powers of Attorney Act 2014 (2015) http://www.publicadvocate.vic.gov.au  Medical Treatment Planning & Decisions Act 2016 (2018)  http://www.publicadvocate.vic.gov.au  advance care planning - http://www.caresearch.com.au/ http://advancecareplanning.org.au/  2016 - Social & Legal Issues Parliamentary Committee – Inquiry into end of life choices - – submissions, witnesses, international visits, arguments for and against. – recommendations on palliative care, advance care planning & a framework for voluntary assisted death. 2017 - Ministerial Advisory Panel – – policy advice to inform the drafting instructions for such legislation – advise on how such the framework might be implemented & supported. – discussion paper, forums & consultations – recommendations Legislation to Parliament - Oct, and passed into law Dec 2017, implementation June 2019  voluntary assisted death in Vic 2016 - Social & Legal Issues Parliamentary Committee on End of Life Choices – consultation, public hearings, international visits. 49 recommendations – community-palliative care (29), advance care planning (18), assisted dying (1) 2017 - Ministerial Advisory Panel (MAP) – consultation, interim & final reports Parliamentary debate & vote Oct-Dec 2017 4  guiding principles The Panel was asked to develop a safe & compassionate framework & did so taking into account agreed principles: – every human life has equal value. – a person’s autonomy should be respected. – informed decision making. – quality care that minimises suffering & maximises quality of life. – therapeutic relationships be supported & maintained. – open discussions about death & dying. – conversations about treatment & care preferences. – genuine choice balanced with safeguards. – all people have the right to be shown respect for their culture, beliefs, values & personal characteristics.  who will be eligible? That to access voluntary assisted dying, a person must meet all of the following eligibility criteria: – be an adult, 18 years & over; & – be ordinarily resident in Victoria for at least 12 months & an Australian citizen or permanent resident; & – have decision-making capacity in relation to voluntary assisted dying ( if a concern about mental illness, must be referred to a psychiatrist); & – be diagnosed with an incurable disease, illness or medical condition, that: o is advanced, progressive & will cause death; & o is expected to cause death within weeks or months, but not longer than 6 months (exception for people with neurodegenerative diseases (12 mths)); & o is causing suffering that cannot be relieved in a manner the person deems tolerable.  the request & assessment process a person must make three separate requests as follows: – the person makes their first request to a medical practitioner. the person undergoes a first assessment by the coordinating medical practitioner. the person undergoes a second independent assessment by the consulting medical practitioner. assessing medical practitioner must encourage the person to inform medical practitioners who are providing other care. Require that the coordinating medical practitioner with the person’s consent, explain the process to their family member. - the person makes a witnessed written declaration of enduring request to the coordinating medical practitioner. - the person makes a final request to the coordinating medical practitioner.  the role of medical practitioners two assessing medical practitioners: coordinating medical practitioner & consulting medical practitioner. the coordinating medical practitioner supports the person, undertakes the first assessment & is responsible for reporting the consulting medical practitioner provides an independent assessment both must ensure that the person is properly informed of all treatment & care options & likely outcomes both must undertake independent assessments to form a view as to whether: the person meets the eligibility criteria; the person understands the information provided; the person is acting voluntarily & without coercion; & the person’s request is enduring. conscientious objection is honoured, as enshrined in law.  medication monitoring appointment of a contact person to return of any unused medication to the dispensing pharmacist within 15 days after the person has died. before the medication is prescribed the coordinating medical practitioner must obtain a permit from DHHS. medication labels are attached clearly stating the use, safe handling, storage & return of the medication & information provided about the administration of the medication & the likely outcome. must be stored in a locked box inform the coroner mandatory reporting within 7 days to the Review Board by: o Department of Health & Human Services when the prescription is authorised; o pharmacist when the prescription is dispensed; & when unused lethal medication is returned  oversight for voluntary assisted dying a Voluntary Assisted Dying Review Board (Review Board) to monitor activity via a database mandatory reporting on completing the: o first assessment (within 7 days, regardless of the outcome); o second independent assessment (within 7 days, regardless of the outcome); & o certification for authorisation (within 7 days, including the written declaration of enduring request & appointment of contact person forms) o when the medication is administered by the coordinating medical practitioner (within 7 days). when medication is: o authorised by the coordinating medical practitioner; o dispensed by the pharmacist; o administered by the coordinating medical practitioner; & o unused medication returned.  taskforce: key projects and governance Implementation Taskforce Model of care Community Approved Medication /organisational /consumer Clinical guidelines assessment protocol protocol information development training development development development Working Group Working Group Working Group Working Group Working Group VAD Review EOLCV gap VAD Board analysis Regulations establishment (Secretariat) (Secretariat) (Secretariat)  implementation implementation taskforce - lead & coordinate implementation until 19th June 2019 models of care incorporated into existing care processes. continuity of care across a range of treatment options. test approaches and develop resources to assist health services considering their participation in VAD. practical considerations of providing VAD, such as how to support staff who choose to participate as well as those who conscientiously object supported & resourced by the Department of Health & Human Services focus on research & quality approaches that support good consistent & transparent practices  summary proposed voluntary assisted dying framework: o provides a safe & compassionate response for people who are dying & suffering, to choose the timing & manner of their death. o will allow access only for people who are dying & suffering from an advanced, progressive, incurable disease, illness or medical condition. o respects the informed & voluntary choice of a person with decision-making capacity from beginning to end. Only that person can request voluntary assisted dying. o balances respect for personal autonomy with strong safeguards that protect the person, health practitioners & the community. o is the most conservative voluntary assisted dying framework in the world.  report https://www2.health.vic.gov.au/about/publications/ research&reports/ministerial-advisory-panel-on-voluntary- assisted-dying-final-report Or health.vic.gov.au and search for voluntary assisted dying report