Tasmania’s medical assistance in dying laws come into force today. Here’s how they’ll work
Tasmanian Diane Gray died in 2019 after suffering from “uncontrollable pain and relentless nausea” for six months.
The mother-of-two was diagnosed with stage four cancer the year before and documented her ordeal in a diary.
“I can accept dying. I cannot accept dying a slow death in unbearable pain”, she wrote a few days before her death.
“I want to slip away on my terms and allow my children to have a final goodbye, not to be tortured for weeks on end watching me suffer and lose every ounce of dignity I have left.
Before she died, Diane asked her daughters Natalie and Jacqui to fight to change the laws of Tasmania so those who suffer can choose to end their lives.
Tasmania’s parliament finally passed voluntary medical assistance in dying laws in March last year and the laws come into force today.
“This time is an incredibly bittersweet moment for us,” Jacqui Gray said.
“Knowing now that Tasmanians have absolute assurance that they will never need to suffer intolerably is remarkable, but on the other hand it is heartbreaking that the death of our mother has become the driving force and the determination of our advocacy campaign, and essentially, the passage of this law.
“It’s been a rollercoaster of emotions for Nat and me, but knowing that our last promise to him has now come true and been fulfilled means his death was not in vain.”
Who can access it ?
Under the legislation, medical assistance in dying can be sought by Tasmanians over the age of 18 who suffer from an advanced, incurable and irreversible for which there is no reasonably available treatment.
It is to be expected that this condition will cause their death within six or 12 months, depending on the disease.
The person making the decision must be able to understand and evaluate the advice given to him around VAD and be able to communicate his decision. This can be done verbally, in writing or by gesture.
You must be an Australian citizen or permanent resident and have lived in Tasmania for 12 months before applying.
What is the process?
A person wishing to access VAD in Tasmania must follow 14 steps.
It is a deliberately complex process, designed both to ensure that the person fully understands and consents to what they are requesting, and to ensure that they have not been misdiagnosed.
A person must make a first VAD request to a doctor who, if he accepts this request, will examine whether this person is eligible on the basis of the above criteria.
After a withdrawal period of at least 48 hours, this person will have to make a second request to their doctor.
A second physician, completely independent of the first, must then assess the person’s admissibility.
A final application must then be made before the application is sent to the Tasmanian Medical Assistance in Dying Commission for decision. If approved, the commission prescribes the VAD substance.
There are still five steps between the prescribed substance and its administration. Again, they are in place to ensure that the applicant fully understands what is happening and wants to proceed.
What are the guarantees ?
Some people have raised concerns that VAD laws will force people to end their lives, or that incorrect diagnoses will be made and people end their lives unnecessarily.
However, Annette Barratt, Deputy Executive Commissioner for Voluntary Assisted Death in Tasmania, said the measures outlined above would prevent this.
“The patient should be assessed by two physicians who are independent of each other and without collaboration so that the person’s condition is assessed in a very comprehensive way,” Dr. Barratt said.
“And also, the process requires at least three approvals before arriving at that final decision.
“I’m very confident that the legislation has everything checked and rechecked to make sure people will never be coerced, but also that people are guided through who wants to access it.”
Practitioners who wish to be part of the VAD process must also undergo specific training.
“This package will be sent to them on a USB stick, which they can do at their own pace, and it should take between five and 10 hours depending on their experience,” Dr Barrett said.
What if my GP doesn’t help me?
Requests for access to VAD can be made to a person’s GP or specialist, but the Commission on Medical Assistance in Dying expects some healthcare professionals to object to participation.
In this case, Dr Barratt said doctors are legally required to pass on contact details for the commission, which can help people.
‘There are minimum legal requirements for all GPs, including those who are conscientious objectors, who must, if they do not wish to be involved, pass the information to the commission,’ she said.
“So you don’t tell the person ‘there is no way to access it.’ They’re told, ‘I can’t help you, but these people might be willing to discuss this further.'”
If a person’s GP or specialist does not provide this information, people are advised to contact the commission directly.
What if I live in a rural area?
So far only a small number of health practitioners have signed up for VAD training in Tasmania, but the commission hopes they will have between 20 and 30 trained over the next 12 months once people start to request the service.
Dr Barratt expects this could present access issues for Tasmanians in remote and regional parts of the state trying to get through the lengthy process.
“Certainly the volunteer navigation service and the pharmacy service will be going to those areas of the state so that people are not disadvantaged,” she said.
“It can be difficult to match them with a doctor in their area … but certainly the navigation service and the commission are very keen that people are not geographically disadvantaged.”