Telehealth and voluntary assisted dying: leave it to the doctors  

For patients in remote and regional areas, telehealth has been a game changer. It has made timely, high quality care possible, especially for those who cannot travel for in-person appointments, either because they are too unwell, or too far away.

Unfortunately, for terminally ill Australians who want to access voluntary assisted dying (VAD), a telehealth option does not exist. In fact, using telehealth for VAD assessment is banned by federal law.

At present, the decision about whether telehealth is clinically appropriate in VAD care lies with politicians in Canberra.

An anomaly in the Commonwealth Criminal Code Act 1995 means that health professionals are prohibited from discussing large parts of the VAD process via any electronic communications; this includes telehealth, phone, email, text — even fax. If they do, they risk criminal prosecution and a $300 000 fine.

These restrictions affect not only doctors conducting VAD assessments, but also nurses, pharmacists and social workers who cannot provide advice or answer questions from patients or colleagues over the phone or receive scripts via fax or email.

VAD allows terminally ill people with advanced and progressive illnesses, and who are suffering, to have a choice over the timing and circumstances of their death. It is legal and available in all six Australian states, with the ACT expected to pass a law later this year.

During the pandemic, we became familiar with telehealth. Something that began out of necessity has continued.

For VAD, in-person appointments are always preferred by clinicians. However, for terminally ill people who may be unwell or living in remote areas, requiring in-person appointments for every part of the VAD process is unreasonable. At worst, it can be the difference between accessing care and not.

Like Tom*, a 79-year-old with end-stage lung disease in Far North Queensland. Dying with a list of increasingly harrowing symptoms, Tom requested access to VAD, but was too unwell to travel for in-person assessments by two independent doctors. Denied the option of telehealth, a doctor in Ipswich made a 3000 km round trip to assess his eligibility. A week later, a second independent doctor travelled 2500 km to provide his second assessment. Finally, the first doctor had to return (another 3000 km) to witness and accept Tom’s final request.

Five days later, the pharmacy received the VAD prescription (which the telehealth ban also requires must be hand-delivered) but unfortunately those three weeks and 8500 km were to no avail; Tom, by now a very sick man, died before the medication could be dispensed.

Tom spent his final precious days stuck in a stressful cycle of pain and uncertainty when he should have been supported and at peace.

Australia is an outlier when it comes to the telehealth ban for VAD. Telehealth for VAD care is routinely used in New Zealand, the United States and Canada.

Electronic communication, including telehealth, is used successfully in other sensitive areas of medicine such as mental health, palliative care and termination of pregnancy. The same high standards apply to VAD care, regardless of whether it is provided by telehealth or in person. And all telehealth consults are covered by guidance from the Australian Health Practitioner Regulation Agency.

Telehealth should be available, when needed, to support all types of health care, including VAD.

The Australian Medical Association, the Society of Hospital Pharmacists of Australia (SHPA), and the Law Council of Australia agree.

In February, Western Australian independent Member of Parliament Kate Chaney introduced a bill to the House of Representatives to fix this issue. Will politicians provide time to debate this much-needed reform?

Almost five years of evidence shows that VAD is operating safely, and with great care and compassion. Banning telehealth does not make it any safer. It is time to remove this antiquated and discriminatory impediment to high quality care.

*Tom’s name has been changed to protect his privacy.

Dr Linda Swan is a former GP and the CEO of Go Gentle Australia, a charity working nationally to promote choice at the end of life, including the option of voluntary assisted dying.

Go Gentle Australia and VADANZ (the peak body for voluntary assisted dying health professionals) will present the second trans-Tasman Voluntary Assisted Dying Conference, to be held in Brisbane on 28-29 October 2024.