The relationship between palliative care and voluntary assisted dying
Voluntary assisted dying is an end of life choice that for a number of people will provide a peaceful death for Western Australians at a time of their choosing, provided they satisfy the criteria and the process requirements in the Voluntary Assisted Dying Act 2019. For many people this will provide peace of mind even if they never have cause to choose it, or if they do qualify, do not actually use it.
This is of course an important and hard fought addition to a person’s control over the manner and timing of his or her death, but for the majority of Western Australians, palliative care remains critically important to providing a good death at the end of life.
VAD and palliative care go hand in hand: they are not in competition with each other. A moving and informative account of the relationship between VAD and palliative care was given by Lizz Clarke whose husband Colin Clarke died from mesothelioma. Lizz's presentation can be viewed here. Colin's story can be found here.
This is the introduction to VAD on the PCA website at https://palliativecare.org.au/
Palliative care is an approach that improves the quality of life of patients and their families facing the problems associated with life-limiting illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.
Voluntary assisted dying (VAD) refers to the assistance provided to a person by a health practitioner to end their life. The term 'voluntary assisted dying' evolved in Australia in recent years following inquiries and parliamentary debates of laws enabling a terminally ill person to seek medical assistance to die. This term is now commonly used in Australia, rather than euthanasia or physician-assisted suicide or dying. It includes:
• 'self-administration', where the person takes the VAD medication themselves, and
• 'practitioner administration', where the person is given the medication by a doctor (or in some Australian States, a nurse practitioner or registered nurse).
‘Voluntary’ indicates that the practice is a voluntary choice of the person, and that they are competent (have capacity) to decide to access VAD.
The peak body for palliative care, Palliative Care Australia (PCA), formerly opposed VAD, but this has changed. The following is an extract from the PCA position statement published in October 2022.
Voluntary assisted dying laws have been enacted in all Australian states and will be operational in all states by end of 2023. Palliative Care Australia (PCA) recognises that the topic of voluntary assisted dying raises difficult and complex ethical issues, and that there is a broad spectrum of opinion on, and support or opposition to, VAD within the Australian community. PCA represents health professionals, carers and consumers, and notes that this diversity of opinion is also reflected within the palliative care community. With an ageing population and rising chronic illness, Australia needs greater investment in palliative care and more support for the workforce that cares for people toward the end of their life.
PCA’s full position statement and guidelines to VAD can also be found on its website.
Facts about Palliative Care
These are some facts that may help to clarify the relationship between VAD and palliative care:
- In its report entitled My Life, My Choice, the cross party End of Life Choices parliamentary committee recommended legalising voluntary assisted dying with appropriate safeguards, but also acknowledged the importance of palliative care and recommended additional funding and resourcing for the palliative care sector across WA. Click here for more information.
- WA has a first-class standard of palliative care, which includes high-quality community care in metropolitan Perth provided by Silver Chain. Silver Chain has adopted a neutral stance in relation to VAD, which it neither supports nor opposes. Click here for more information.
- The WA Government through the then Deputy Premier and Minister for Health, Roger Cook, clearly stated its support for the recommendations in the ‘My Life, My Choice’ report calling for more resourcing for the palliative care sector in WA, and subsequently announced funding increases. Click here for more information.
- A 2018 report commissioned by Palliative Care Australia found that the palliative care sector has been further advanced in overseas jurisdictions where voluntary assisted dying is legal. Click here for more information.
- Another 2018 report, written by Palliative Care Australia following a study tour of Canada and Oregon, found no evidence to suggest that people access voluntary assisted dying because palliative care services were inadequate. Click here for more information.
NB: Please note that these Facts were correct in 2018, prior to the passage of the Voluntary Assisted Dying Act 2019, and the information in the links provided was also current at that time. Some things may have changed since then.