Ministerial Advisory Panel on Voluntary Assisted Dying

265 Pages·2017·5.74 MB·English

Ministerial Advisory Panel on
Voluntary Assisted Dying
Final Report
This page has been left blank for the purpose of double-sided printing.
Ministerial Advisory Panel on
Voluntary Assisted Dying
Final Report
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© State of Victoria, Department of Health and Human Services, July 2017.
ISBN 978-0-7311-7281-8 (Print)
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ii Ministerial Advisory Panel on Voluntary Assisted Dying: Final Report
Contents
Letter from the Chair 1
The Ministerial Advisory Panel 3
Terms of reference 5
A note on language 7
Executive summary 10
Ministerial Advisory Panel Recommendations 22
Introduction 33
Purpose of the final report 33
End-of-life care context 33
The establishment of the Ministerial Advisory Panel on 35
Voluntary Assisted Dying
The consultation process 36
A framework for Victoria 37
The role of palliative care 38
Family support 41
Guiding principles 43
Report structure 47
Part A: Eligibility criteria 50
Eligibility overview 51
Be an adult, 18 years and over 53
Be ordinarily resident in Victoria and an Australian citizen 55
or permanent resident
Have decision-making capacity in relation to voluntary 58
assisted dying
Assessing decision-making capacity 60
Advance care directives 61
Referral requirement 63
Be diagnosed with an incurable disease, illness or medical condition 66
Advanced, progressive and will cause death 68
Expected to cause death within weeks or months, but not longer than 12 months 70
Is causing suffering that cannot be relieved in a manner the 74
person deems tolerable
Eligibility considerations 80
Mental illness 80
Disability 83
iii
Part B: Request and assessment process 86
Initiating a request for voluntary assisted dying 87
The request must be voluntary 87
Seeking information about voluntary assisted dying 92
Withdrawing a request for voluntary assisted dying 94
The role of interpreters 96
Receiving a request for voluntary assisted dying 98
The role of medical practitioners 98
The qualifications of the medical practitioners 102
Further training for medical practitioners 104
Transferring the role of coordinating medical practitioner 107
Conscientious objection 109
Making a request for voluntary assisted dying 112
A three request process for voluntary assisted dying 112
Properly informed decision making 116
Assessment of eligibility 119
Timing of requests 123
Written declaration of enduring request 126
Completing the voluntary assisted dying process 129
Monitoring the lethal dose of medication 129
Appointing a contact person 130
Certification for authorisation 131
Authorising the lethal dose of medication 133
Dispensing the lethal dose of medication 135
Storing the lethal dose of medication 136
When the lethal dose of medication is self-administered 137
When the lethal dose of medication is administered by 140
a medical practitioner
Roles and Process Diagrams 145
Who is involved in voluntary assisted dying 145
The voluntary assisted dying process: an overview 146
iv Ministerial Advisory Panel on Voluntary Assisted Dying: Final Report
Part C: Oversight 148
Monitoring after death 149
Cause of death 149
Notification of death 151
Coronial involvement 153
Medication monitoring 156
Roles and responsibilities 156
Diagram: Process for the safe monitoring of voluntary assisted 158
dying medication
Voluntary Assisted Dying Review Board 159
Establishment as a statutory entity 159
Role and functions 161
Membership 165
Monitoring of voluntary assisted dying 167
Data reporting 167
Medication reporting 170
Scheduled forms 171
Annual reporting and review of the framework 173
Protections and offences 176
Protection from liability 176
Professional standards 177
Criminal offences 179
Safeguard summary 181
Safeguards proposed for Victoria’s voluntary assisted dying framework 181
Part D: Implementation 184
Voluntary assisted dying in the context of existing care options 185
Implementation planning and governance 187
Implementation support 189
Research 197
Resourcing 199
Commencement 200
Appendices 202
Appendix 1: Voluntary assisted dying framework summary 203
Appendix 2: Voluntary assisted dying and human rights 210
Appendix 3: Safeguards and jurisdictional comparison 216
Bibliography 230
v
Letter from the Chair
21 July 2017
The Hon. Jill Hennessy MP
Minister for Health
50 Lonsdale Street
Melbourne VIC 3000
Dear Minister Hennessy
On behalf of the Panel, I am pleased to provide you with our final report detailing a safe
and compassionate framework for voluntary assisted dying in Victoria.
This report is the result of an extensive consultation process and considered
deliberation. The Panel received a broad range of written submissions and contributions
from forums the Panel held around Victoria. These contributions have informed our
thinking and been crucial in determining our recommendations. We are grateful to the
many stakeholders who participated in the consultation process; their participation was
constructive and respectful.
The Panel is conscious of the sensitive nature of this topic and the diversity of opinions
regarding whether voluntary assisted dying should be established in Victoria. We also
appreciate how important and significant this legislation is for many Victorians.
Our work builds on the recommendations of the Victorian Parliament’s Legal and Social
Issues Committee in their Inquiry into End of Life Choices: final report. We have also
reviewed a broad range of relevant local and international research and considered
similar frameworks in international jurisdictions. While we have benefited from this
knowledge, we have focussed on developing a framework that is most appropriate for
the Victorian context.
The framework proposed by the Panel will provide access to voluntary assisted dying for
those people, and only those people, who are at the end of their lives and suffering, to
choose the timing and manner of their death. The request and assessment process the
Panel has set out ensures that only those people who satisfy all of the eligibility criteria
will be able to access voluntary assisted dying.
The framework focuses on the eligible person who expresses their enduring wish to end
their own suffering through access to voluntary assisted dying. It respects their personal
autonomy and choice. That autonomy must of course be balanced against the safety of
the community. We seek to provide a compassionate outcome for those people who are
at the end of their life, while also addressing the concerns of the community.
Providing a safe framework for Victorians has been our paramount consideration. While
the Panel has sought to not place undue burden on a person who is suffering at the end
of their life, the framework includes a prescriptive multi-stage assessment process with
numerous safeguards and comprehensive oversight.
1 Ministerial Advisory Panel on Voluntary Assisted Dying: Final Report
We have also aimed to provide a framework that will function appropriately for eligible
people with a range of non-cancer and cancer-related conditions, regardless of their
geographical location in Victoria or their clinical setting. This framework also supports
existing therapeutic relationships between the person and their health practitioner.
The Panel is also cognisant that voluntary assisted dying will impact on others; in
particular, families and health practitioners. We have recommended a framework in
which medical practitioners play a key role in supporting the person and undertaking
the assessment process. The framework is based primarily on self-administration of a
lethal dose of medication, however in very limited cases, where a person is unable to
self-administer, a medical practitioner may administer the medication at the request of
the person.
It has been important for the Panel to provide clarity about the obligations of, and
protections for, health practitioners, including the ability to conscientiously object.
The Panel is aware of the significance of this issue for all Victorians. We understand that
parliamentarians will be asked to debate a voluntary assisted dying bill later this year
and will vote on their conscience. I hope that this report provides confidence to Victoria’s
parliamentarians that a thorough process has been undertaken to understand, consider
and address all of the relevant issues to ensure a safe and compassionate framework.
The Panel has had the benefit of a skilled and dedicated staff who have worked
extremely hard throughout the consultation process and in writing this report. On behalf
of the Panel I sincerely thank each of them for their work and support.
I would like to thank the members of the Panel for their contributions and application to
the task that we were given. Their diverse professional backgrounds and expertise have
been a strength of this process and are reflected in the recommendations.
Sincerely
Professor Brian Owler
Chair
Ministerial Advisory Panel
2
The Ministerial Advisory Panel
Professor Clinical Professor Brian Owler is an adult and paediatric
Brian Owler neurosurgeon based in Sydney. He is a Fellow of the Royal
Chair Australasian College of Surgeons and was Federal President of
the Australian Medical Association from 2014 to 2016. He has a
broad knowledge of Australia’s healthcare system through his
AMA experience and roles with other healthcare organisations and
committees.
Professor Professor Margaret O’Connor AM is Emeritus Professor of Nursing
Margaret O’Connor at Monash University. She has worked in numerous roles in palliative
AM care, encompassing clinical care, management of services, education
Deputy Chair and research. Professor O’Connor served as President of Palliative
Care Australia from 2006 to 2010 and was an Inaugural Trustee of the
World Palliative Care Alliance. She has also served as a Member of
the Australian Health Ethics Committee of the National Health and
Medical Research Council.
In 2005 Professor O’Connor was awarded a Member of the Order
of Australia and in 2012 was awarded life membership of Palliative
Care Victoria.
Ms Mary Draper Ms Mary Draper is a Board Director at Austin Health and immediate
Member past CEO of the Health Issues Centre. She has expertise in academic
and practical health administration in quality and safety, providing
experience in analysing quality and safety of healthcare from a
consumer’s point of view. Ms Draper served as the Chair of the
Health Issues Centre prior to serving as CEO until November 2014.
Ms Draper has experience representing consumer perspectives on
a range of quality-related national and state-level committees and
for seven years was the Director of Clinical Governance at the Royal
Women’s Hospital.
Mr Julian Gardner Mr Julian Gardner AM is a lawyer and immediate past Victorian
AM Public Advocate, providing experience in advocating for vulnerable
Member people. Mr Gardner has previously served as President of the Mental
Health Review Board, been the National Convenor of the Social
Security Appeals Tribunal, Chair of the WorkCare Appeals Board
and a Director of the Victorian Legal Aid Commission.
Mr Gardner is currently the Chair of Mind Australia Ltd, a non-
government organisation providing community mental health
services and the Deputy Chair of Alfred Health.
3 Ministerial Advisory Panel on Voluntary Assisted Dying: Final Report