TWO deaths in central Victoria have highlighted a desire for voluntary assisted dying to be among the options for people planning end of life care.
AFTER enduring a chronic condition for more than 10 years, a patient in Castlemaine decided they’d had enough.
Faced with the prospect of spending the rest of their days in a hospital bed, they consulted their partner and engaged the assistance of Dying With Dignity Victoria.
With the organisation’s guidance, the patient exercised their rights to refuse medical treatment.
Dying With Dignity Victoria member, Vic Say, acted as the patient’s advocate throughout the process.
Mr Say understood Castlemaine Health supported the patient’s choice to stop medical intervention, conducted an interview with them, and engaged a regional palliative care specialist for a second opinion.
Once they were sure the decision was rational, Mr Say understood the hospital contacted the Coroner’s Office to seek advice.
“The Coroner’s Office rang back the next day and said [the patient] was completely within [their] rights and the hospital should give [them] every level of palliation,” he said.
Having been given as much relief as possible from the pain associated with their condition, and comfort from the symptoms of refusing medical treatment, the patient passed away.
“We provide palliative care for patients and aged care residents and it is care that we take pride in providing well,” Castlemaine Health executive director of nursing Kathleen Fair said.
“This entails ensuring the patient and their loved ones are cared for and supported in a quiet environment, providing pain relief, a range of comfort measures, and spiritual support when requested.”
“We strive to ensure our care is always provided with dignity and respect.”
Mr Say has authorised forms, identical to those which the patient had, which he hopes will afford him the opportunity of a dignified death, should he ever find himself in such a circumstance.
“I think the medical profession and the community need to come to grips with the fact this is an option some people would want to choose,” Mr Say said.
It's a view he has held since his father passed away when Mr Say was a child.
“If someone is in the dying process and they’ve shared what they need to share and said and done what they need to do, then to me it’s an act of cruelty to medically resist the dying process,” he said.
But he respects that not all people share his opinion.
“I’ve thought very carefully through what my values are, what other people’s values are, and as I say I’d never try and tell someone their values were wrong, and I would never want to impose mine on anyone – nor would I want them to impose theirs on someone,” Mr Say said.
His comments come as the Victorian Parliament braces for a bill which could enable doctors to hasten a patient’s death.
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Law could provide options
AS A WILLS and estates specialist, Bendigo lawyer Russell Robertson is familiar with talking about death.
The O’Farrell Robertson McMahon director has worked with a client who was adamant they would not endure a prolonged battle with a terminal illness.
That client was later diagnosed with such an illness, and chose to take their own life.
“They told all of their family as well, they all knew what [the client’s] plans were,” Mr Robertson said.
If voluntary assisted dying was legal, he said his client might have had the opportunity to pass away with family and medical professionals present.
“That wasn’t available,” Mr Robertson said.
He felt the circumstances in which the client found themselves to bring an end to their illness were “sad”.
“I think for some people, just knowing there is an option, even if it’s never exercised, might be tremendously comforting,” the lawyer said.
While Mr Roberston said assisted dying was not a conversation every client had with him, he thought if it was an option, people might not make decisions without consulting “in a thorough manner” with doctors or other professionals.
“If they did have that consultation they might learn about information they were completely unaware of,” he said.
“People go through various stages and I think for some people the idea of being caught in an illness which is unbearable is very frightening for them.
“For a lot of people the traditional palliative approach is fabulous, but for some people it’s not what they want”.
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Exactly what medically assisted dying might involve in Victoria is uncertain.
The state government committed in December to introduce legislation to legalise voluntary assisted dying for terminally ill people, consistent with the recommendations of an inquiry into end of life choices.
A final report by a Ministerial Advisory Panel, to be delivered this month, is expected to further clarify the scope of the legislation.
The panel – which consists of clinical, legal, consumer, health administrator and palliative care experts – was charged with considering issues such as eligibility, assessment, administration, mode and regulation.
Their recommendations will shape the bill, which will be subject to a conscience vote in parliament.
Announcing the commitment in December, Premier Daniel Andrews acknowledged community sentiment on the issue was changing.
“I know many in Victoria think it’s time we have this debate – a debate that respects people’s views and respects people’s lives,” he said.
Dying With Dignity Victoria president Lesley Vick said she was encouraged by what had transpired in the past 18 months, and “cautiously optimistic” for the outcome.
“I think this has been a very responsible and measured, in-depth and comprehensive process that has been adopted,” she said.
Representatives to vote with conscience
MEMBER for Bendigo West Maree Edwards believes it is time for legislation on voluntary assisted dying.
“Having lost my husband Lindsay after a seven year battle with brain cancer and knowing his wishes I am supportive of the proposal,” she said.
She considered it “extremely important” there be measures for oversight, such as the establishment of an assisted dying review board.
Also critical were “strong safe guards for people who may be vulnerable to abuse,” therefore limiting access to “individuals with decision making capacity” and excluding “those suffering solely as a result of mental illness”.
“The legislation will be totally voluntary and there is no obligation to proceed and a request can be rescinded at any time,” Ms Edwards said.
She encouraged people to read the ministerial advisory panel’s interim report and highlighted the importance of “clear, accurate and understandable information” about assisted dying.
Ms Edwards expected the panel’s final report to contain recommendations about the eligibility criteria, the request process and the oversight and safeguards required for a “compassionate, safe and practical voluntary assisted dying framework for Victoria”.
While she stressed that a decision was yet to be made on the legislation, Ms Edwards commended the panel on its “extensive” consultation process.
The process elicited more than 176 written submissions and drew about 300 individuals to consultation forums, five of which were in regional Victoria.
Medical bodies, carer groups, disability advocacy groups, legal organisations, mental health providers, health administrators and other experts contributed to roundtable discussions.
“Every member will bring their own experiences as well as consideration of community views when debating the legislation – as it should be,” she said.