How to access voluntary assisted dying

Most West Australians will know that with effect from 1 July 2021, voluntary assisted dying (VAD) became a lawful end of life choice in WA. During the first six months after coming into operation, about 50 people chose to end their lives in this way, either with the help of a doctor, or by taking a lawfully prescribed lethal drug themselves. Anecdotal evidence from health professionals involved with the process, the Statewide Care Navigator Service (SWCNS) and Statewide Pharmacy Service (SWPS) is that the deaths have been painless and peaceful. Similar reports have been received from the family members and loved ones of people who have died using VAD.

In addition, it seems that taking control of the manner and timing of their death by making a request for VAD, and having the request accepted, often reduces a person’s anxiety about death and dying.

First steps

You don’t have to be dying to start thinking about whether VAD is an end of life choice you might make. Whether you feel anxious or philosophical about dying, it is very helpful to talk to your family and loved ones sooner rather than later to see if they support your choice. It will of course make it harder if they don’t, but this does not in any way affect the legitimacy of your decision, and there are many others who are available to support you through every step of what is a patient-centred process from beginning to end.

If you have a doctor you know and trust, that is the next person you should talk to. You need to ascertain if he or she would be willing to be your ‘coordinating practitioner’ – the doctor who will support you at each stage of VAD. To do this the doctor will have to be eligible and have completed the mandatory training to participate in VAD. If your own doctor is not able or willing to help, you, your carers or family members should contact the SWCNS for assistance, or you can contact Dying with Dignity WA through ‘Contact’ on our website at https://www.dwdwa.org.au/contact

Statewide Care Navigator Service

The SWCNS is an invaluable resource for anyone wishing to access VAD. The service can be contacted during standard work hours (8:30am - 5:00pm) on email: [email protected] or phone:  (08) 9431 2755

This service is available throughout WA free of charge and there are regional support packages for people who live outside metropolitan areas.

More information about the services provided by the SWCNS can be found here: https://ww2.health.wa.gov.au/Articles/U_Z/Voluntary-assisted-dying/Statewide-Care-Navigator-Service

Next Steps

Eligibility and Process

An overview of the eligibility criteria and process is provided below under ‘Overview’.

More detailed information can be found on the DWDWA website at https://www.dwdwa.org.au/workshop_1 , with some helpful FAQs. Once again, anyone seeking information about these matters is welcome to contact DWDWA at any time through https://www.dwdwa.org.au/contact

Overview

Eligibility

To access VAD you need to have a disease or illness that is so severe that it is causing you suffering that you find intolerable, and is likely to cause your death within 6 months, or 12 months if you have a neurodegenerative condition such as motor neurone disease. You must also have the legal capacity to understand the nature and consequences of the request you are making. This means that you will not be eligible if you have some form of dementia that affects your decision making capacity.

You must also be 18 or over, and be an Australian citizen or permanent resident who has lived in WA for at least 12 months at the time of making the first request. You must be acting voluntarily and without coercion and your request for VAD must be ‘enduring’, demonstrated by 3 separate requests for VAD (see below). You may change your mind at any time by informing your coordinating practitioner that you wish to withdraw from the VAD process. You can later start the process again should you wish to do so by making another first request.

Process

You are free to discuss VAD with anyone, but to start the process itself you must make a first request to a doctor during a medical consultation. If the doctor is unwilling (eg for conscientious reasons) or unable (eg because they are not eligible to be the co-ordinating practitioner) to accept the request, they must provide you with information about how to proceed. If English is not your first language you will be offered assistance with communication.

Once a doctor accepts your first request, he or she becomes your coordinating practitioner, and must assess whether you satisfy all of the eligibility criteria. If the coordinating practitioner is satisfied about every aspect of eligibility, you will be referred to a second doctor (the consulting practitioner) who must independently assess and verify your eligibility. If either your coordinating or consulting practitioner is unsure about any aspect of eligibility - for example the prognosis of expected time before death, or your decision-making capacity - he or she may refer the matter to a specialist for advice on that aspect.

The next step in the VAD process is for you to make a written declaration that you are acting voluntarily and without coercion and that you understand the nature and effect of your request for VAD. This declaration must be signed in the presence of two witnesses who 18 or over, are not family members and are not (to their knowledge) beneficiaries under your will or likely to benefit in any way from your death.

If you need help in finding a witness or witnesses, you may contact DWDWA committee members:

Gail Wyatt on [email protected] or 0414 293 563; or 

Murray Hindle on [email protected] or 0406 722 036

or the Statewide Care Navigator Service on the details provided above.

The final steps in the VAD process are

• Making a final request for VAD to your coordinating practitioner; and
• Deciding in consultation with your coordinating practitioner whether you wish to self-administer the prescribed lethal substance or whether you would like an eligible doctor or nurse practitioner to help you to die. The latter is called 'a practitioner administration decision' and may only be made if your coordinating practitioner thinks that self-administration is not suitable for you, or that you may be unable to self-administer the substance, or if you have concerns about self-administration. 
• There is a straightforward process for changing your mind if you feel you have made the wrong administration decision.
• If you decide that you would prefer self-administration, you will need to appoint a contact person.
• Further information about the role and responsibilities of the contact person can be found at https://ww2.health.wa.gov.au/-/media/Corp/Documents/Health-for/Voluntary-assisted-dying/Being-the-Contact-Person.pdf

The ‘Overview’ above is a summary of the steps in the VAD process. Further more detailed information is available on the Department of Health website at  https://www.healthywa.wa.gov.au/Articles/A_E/End-of-life-care  

Other End of Life matters

The manner and timing of your actual death are not the only important considerations for you and your family as that time approaches. Other issues are:

• Do you have a valid will?
• Have you signed an advance health directive, to ensure that your wishes are known to your carers and health practitioners should you be unable to speak for yourself?
• Do you need to sign an enduring power of attorney and/or an enduring power of guardianship?
• What is the relationship between voluntary assisted dying and palliative care?
• If you can no longer live at home, which aged care or palliative care facility would be best for you?

These issues were explored in a series of workshops run by DWDWA in 2020 and 2021, and information about all of them can be found at https://www.dwdwa.org.au/workshops

As always, if you have any question about any end of life issue that is concerning you, please get in touch with us and we will endeavour to help if we can. Every question will be treated respectfully and confidentially.