VICTORIA'S new assisted dying laws come into effect in two months' time. This is the first state in Australia to pass a legal framework for eligible people who are suffering to choose the manner and timing of their death. Experts say, like anything new in medicine and healthcare, there is a general wariness among professionals until it takes shape in practice.
Only, this is a law that has put the spotlight firmly on the very essence of medical ethics. Doctors and medical professionals can choose not to participate but must still prepare their response for if faced with the question of a patient asking for help to die.
GREG Mewett makes clear he is not an activist in this debate. The palliative care specialist is driven by a passion to make the legislation as equitable, compassionate and practical as possible for health care professionals and patients.
Dr Mewett draws on his experience as a long-serving regional general practitioner and now a palliative care specialist, working across the Grampians, to be part of the state's voluntary assisted dying implementation taskforce.
Regardless of how a doctor, nurse or allied health professional may ethically feel about the law, Dr Mewett said they have a responsibility to know how to best respond to a patient's end of life options - of which assisted dying was one.
Only the patient, not a professional nor relative, can raise the question and while a doctor can object to helping, the hope is they would not obstruct.
Doctors need to know how to tease out, how to analyse or explore, what a patient actually means when they ask about voluntary assisted dying.
"They might be opening up about their feelings, not necessarily asking for assisted dying," Dr Mewett said. "They may need an opportunity to talk, they may not have the right support or assisted health management. A lot of exploration should occur before it goes down the actual voluntary assisted dying path."
Dr Mewett was a GP for 22 years before becoming a palliative care physician. He said he was primed early in his career by personal experience with the death of a loved one to seek better ways in caring for those who were close to death.
At the core of the issue, Dr Mewett said patient-centred care was about informed choices.
Strict eligibility criteria has medical experts guessing actual numbers of people enacting the law will be small. Health professionals have a mandated online, video training series via the state's health department. The state will appoint four assisted dying navigators for health professionals.
"Some doctors will likely be undecided in whether they will assist people for awhile. A lot will want to sit back and see what happens first. We've seen this when laws were introduced in Canada," Dr Mewett said. "People do not have the right to demand voluntary assisted dying but they have the right to request assessment for eligibility. This difference can often take away some of the anxiety for doctors."
When Bernadette Tobin takes medical students on palliative care rounds in Sacred Heart Hospice in Sydney, most have not experienced this side to healthcare before. She says it is a real eye-opener.
Central to their focus is assisting a patient to die in comfort and dignity. Associate Professor Tobin says voluntary assisted dying suggests something quite different.
Legislation protects conscientious objectors and this extends to institutions like hospitals. Associate Professor Tobin is director of Plunkett Centre for Ethics, of which Australian Catholic University is a member, but her work on this issue is in leading Catholic Health Australia's ethics working group. They want to make clear assisting people to die by issuing prescriptions for lethal drugs, to which she said the phrase voluntary assisted dying refers, would not be provided in Catholic hospital. This includes St John of God Ballarat Hospital.
While professionals in Catholic healthcare would not obstruct people from accessing voluntary assisted dying, they would not facilitate it but, if necessary, would transfer a patient to a healthcare facility of their choosing.
"Anyone who has had a family member die badly knows what a very terrible time that can be, just as anyone who has had a family member die well knows what a great blessing that is," Associate Professor Tobin said.
"Caring for people who are dying and for their family is central to our mission. Caring for the person who is dying is absolutely at the centre of our attention - but we won't help them take their own lives.
We're confident we can relieve all forms of physical suffering...either directly or indirectly by sedating a person so in effect our patients sleep out the last part of their lives.
Associate Professor Tobin is advocating for improved palliative care access and support nationwide, particularly in regional and outback communities.
MARK Yates predominantly works in the space of futile care in Ballarat and often there are patients who may feel they have no value left in being alive. They might feel they are a burden.
Associate Professor Yates said futile care and good palliative care was utterly different to assisted dying. He fears the role of medical professionals would be blurred by the law, allowing doctors to assist in administering drugs for death.
I don't think every appointment with a patient should have the confusion as to whether or not my role is to kill them or manage the best I can all their symptoms for as long as I can.Associate Professor Mark Yates
A key point of contention, he said, was the inclusion of physician assisted dying in the law. Had it remained voluntary without the aid of a doctor in actively killing the patient, Associate Professor Yates said there could more likely be support and unity across the profession.
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