A group of people with expertise in Voluntary Assisted Dying (VAD) have suggested that all cancer specialists and GPs should undertake training for end-of-life decisions by patients.
Private Cancer Physicians of Australia (PCPA) Victorian director and board member Dr Cam McLaren led a podcast with colleagues, PCPA member and genetic oncologist Dr Hilda High and Ms Laurie Draper from the Victorian Voluntary Assisted Dying Care Navigator Service to help colleagues and patients navigate the complex and challenging medical and moral minefield of VAD.
Australians with terminal cancer dominate the VAD patient requests. Yet there is a shortage of GPs and oncologists willing to sign up for the training and end-of-life program.
VAD laws allow terminally ill, mentally competent adults with six to 12 months left to live to request help from their doctor to end their life.
Most states have now enacted laws to facilitate end-of-life as an option, including Western Australia, Victoria, Tasmania, South Australia, Queensland and most recently, New South Wales, with legislation set to commence there in November this year.
Ms Draper said if all doctors complete the voluntary training, they will have an understanding of all of the issues and complexities and can better support their patients, even without committing to undertaking the VAD process.
“The next step is to work through how to balance your conscientious objections against the needs and wants of your patients,” said Dr McLaren. ”People need to feel supported in their beliefs as well. We need not to judge the individual - doctor or patient - and the only way through this is to be as informed as possible about the process.”
The podcasters discussed the privacy issues around naming doctors who were open to VAD. The navigators’ service is linked to the VAD doctors privately. Although the service is available to the public, there is no public ‘list’ of VAD-trained or VAD-providing doctors.
Dr McLaren, Dr High and Ms Draper also delved into the challenge of time and remuneration. Although standard MBS reimbursements are available for VAD consultations, Medicare excludes funding for “euthanasia and any service directly related to the procedure".
They also discussed the ultimate rationale for patients to participate in VAD programs.
“We need to adopt a mature approach to this issue,” continued Dr McLaren. “We are all working to improve end-of-life care and we all need to appreciate and prioritise the person in the chair and their views and wishes."