IMPLEMENTING voluntary assisted dying (VAD) legislation within a health service demands respectful communication and collaboration between health professionals and community.

Writing in the MJA, authors from Western Health in Melbourne, led by Ms Sarah Booth, the Social Work Research and Data Lead, documented the process the service went through to successfully embed VAD into their hospital setting.

“[We] used policies and guidelines suggested by the Department of Health and Human Services … and shared documents from other metropolitan tertiary hospitals as a basis for developing local policies and procedures,” Booth and colleagues wrote.

A key consideration was the need to balance the staff members’ right to conscientiously object to supporting patients who wanted VAD, with “the expectation that health professionals would continue to provide care unrelated to VAD”.

“Capacity for moral injury for staff for whom their beliefs and values were at odds with the employing organisation’s approach to VAD needed to be recognised and addressed throughout the implementation process,” Booth and colleagues wrote.

Through a staff survey, the authors found that 72% of the respondents supported a patient’s access to VAD at the health service. Eight senior medical staff expressed a willingness to be involved in the facilitation of VAD.

Booth and colleagues identified a number of challenges during the planning stage of implementation:

  • the need to balance the guiding principles of the legislation, which focused on patient-centred decisions, while embedding practices to mitigate organisational risk;
  • deciding where VAD medication would be stored during an inpatient stay;
  • fulfilling the responsibility of a Pathway A public health service to provide VAD as an option while respecting the staff member’s decision to conscientiously object to facilitating or being involved in VAD; and
  • the need to consider each case individually.

“Processes were embedded to allow conscientious objectors to distance themselves when patients request VAD, including the provision of informed agency nursing staff to replace potential conscientious objectors on a shift, and the broad promotion of a single contact phone number, to which conscientious objectors could anonymously call and hand over this responsibility,” wrote Booth and colleagues.

Over a 14-month period (June 2019 to September 2020), Western Health received 42 patient requests for VAD, with four patients progressing to a prescription of VAD medications and dying as a result. Three of these four patients died after receiving VAD as inpatients and one died at home after being discharged.

“Implementing VAD in a hospital setting demanded sensitive, honest and respectful communication between multiple health professional groups and the community, particularly between individuals with opposing views,” Booth and colleagues concluded.

“Locally, discussion of case studies, engagement in multisite research and staff consultation will continue to provide vital guidance to the health service when delivering VAD, improving its processes and responding to the needs of patients and staff.”

Also online first today at the MJA

Research: Patterns of care for men with prostate cancer: the 45 and Up Study
Yap et al; doi: 10.5694/mja2.50966 … OPEN ACCESS permanently.

Perspective: Dementia prevention: the time to act is now
Chong et al; doi: 10.5694/mja2.50972 … FREE ACCESS for 1 week.

Podcast: Dr Talila Milroy is a GP and academic registrar at the University of Western Australia. Associate Professor Lilon Bandler is Principal Research Fellow with the Leaders in Indigenous Medical Education Network at the University of Melbourne. They talk about Closing the Gap, the role of the GP in the health of Indigenous people, and the need for reform of the Medicare system … OPEN ACCESS permanently.


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2 thoughts on “Making VAD work in a health care service: respect and collaboration

  1. Dr Greg Mewett (Palliative Care Physician) says:

    I agree James.
    Also the result of the staff survey that 72% support the access of eligible patients to VAD within Western Health probably means that , with sensible planning, conscientious objection (CO) should be readily accommodated without any major disruption to staffing.
    Despite the widely held notion that “palliative care does not include VAD” (a very challengeable concept, in my opinion), a survey of the permanent nursing staff at our regional palliative care unit (n = 17) revealed that 100% supported VAD as a legal end-of-life option for eligible patients, and 80% agreed that this should be available to inpatients in our unit.
    As a result we also have experience with patients completing VAD as inpatients with excellent support form all staff, whilst ensuring anyone is able to absent themselves from VAD-related care. There must be designated limits to the extent of any CO, such that it does not impede an eligible patient’s access to VAD, whilst respecting any individual’s right to a strongly held religious or moral belief.
    This must be patient-centered care par excellence!

  2. James Hurley (general physician) says:

    Excellent to note the need to balance the staff members’ right to conscientiously object to VAD versus “the expectation that health professionals would continue to provide care unrelated to VAD”.
    Conscientious objection to VAD should not preclude the provision of care unrelated to VAD [as I have encountered]. Failure to provide usual care in such circumstances amounts to discrimination [IMHO].

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