June 1st 2019


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Articles from this issue:

COVER STORY Scomo routs Labor, the Green, GetUp and the left-wing media by Patrick J. Byrne and Peter Westmore

CANBERRA OBSERVED Surprise! Polls aren't what they used to be

GENDER POLITICS The true cost of childhood gender reassignment

OBITUARY Bob Hawke, R.I.P.: astute politician, flawed policies

POETRY AND SOCIETY T.S. Eliot and the modern condition

WATER POLICY The time is ripe to revisit the Bradfield scheme

ASIAN AFFAIRS Taiwan upgrades U.S. links, asserts sovereignty

NATIONAL AFFAIRS Recapping the trial as Cardinal Pell's appeal approaches

THE FAMILY AND SOCIETY Working to bring down the Sexual Revolution

HISTORY OF SCIENCE Faith and reason and Father Stanley Jaki Part 2: Science and ancient cultures

HUMOUR A tidy planet is a happy planet

MUSIC Charles Ives: Modern elements aimed at sounding good

CINEMA John Wick 1: The lighting of the fuse

BOOK REVIEW Novelised true crime a true thriller

BOOK REVIEW The experiences of Phoebe Raye

POETRY

LETTERS

FEDERAL ELECTION Queensland voted for jobs, life and country

NATIONAL AFFAIRS The trial of Cardinal Pell ... an injustice

EUTHANASIA D Day - June 19, 2019 - Voluntary Assisted Dying Act 2017 begins operation

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EUTHANASIA
D Day - June 19, 2019 - Voluntary Assisted Dying Act 2017 begins operation


by Terri M. Kelleher

News Weekly, June 1, 2019

Victorian doctors and health practitioners are being prepared for the implementation of assisted suicide/euthanasia.

A VAD Implementation Conference was held in Melbourne on May 8–10. There were workshops on the first day for voluntary assisted dying training for medical practitioners and a voluntary assisted dying workshop for health practitioners and allied health professionals to train them in the process – from the making of a request for assisted suicide, through the red tape of the assessment procedure, to the prescribing of the lethal substance(s), and explaining to the patient how to store the lethal dose safely and how to self-administer the lethal dose.

The Victorian Government Department of Health and Human Services (DHHS) has on its website a number of guides to VAD for medical practitioners, other health practitioners, health services (hospitals), aged-care providers and nurses. It is all pretty cold and clinical.

The Voluntary Assisted Dying Guidance for health practitioners informs medical practitioners that they must complete the requisite “training” in VAD before being able to participate. The “training” consists of just six hours of instructions: “The training can be undertaken online and takes around six hours to complete. The training is in modules, and the modules may be completed separately at times that are convenient to the medical practitioner.”

Hardly time to cover all aspects of assisting a patient to die, much less how a practitioner may feel when their patient takes their own life, especially if they are called to be present when the lethal substance is ingested or because things have not gone as smoothly as expected. The training appears to be really a practical and legal “how-to” manual taking medical practitioners through the steps required by the VAD Act.

The guidance is business like, advising health practitioners they should “seek independent legal advice and contact their professional indemnity insurers to confirm they are covered for voluntary assisted dying under their policy of insurance”.

The Voluntary Assisted Dying managing access in health services guide contains the following information.

 

About the voluntary assisted dying medication

If the patient is the subject of a self-administration permit, they may be in possession of a voluntary assisted dying self-administration kit, containing:

  • Instructions on how to self-administer the medication.
  • Pre-medication.
  • Suspension and sweet syrup liquid for mixing.
  • Voluntary assisted dying medication.
  • Measuring tools.
  • Contact information of the coordinating medical practitioner and the statewide pharmacy service.

The voluntary assisted dying self-administration kit.

The voluntary assisted dying self-administration kit provides clear instructions for the patient. The following is a summary of the main points for health practitioners:

Time prior to self-administration

Actions

24 hours prior

Stop taking laxatives

12 hours prior

Stop taking routine medications (except those for symptom management)

Four hours prior

Stop eating

One-hour prior

Take the prescribed anti-emetic medication

Check to ensure that any implantable cardioverter defibrillator (ICD) has been turned off

30 minutes prior

Take the anxiolytic medication (if prescribed)

Self-administration of the voluntary assisted dying medication

Read the step-by-step instruction leaflet

Prepare the medication (others may assist in preparation but not administration)

Patient self-administers the medication within four minutes

Patient consumes a cup of any liquid they choose, or for PEG/nasogastric tube flush the [sic] with 50mls water

Post-administration

Patient remains upright for 20 minutes to reduce risk of regurgitation (even if they become unconscious)

After 20 minutes, patient can be lowered to a semi-upright position and turned onto their right side to aid rapid absorption

The Statewide Pharmacy Service guide advises that there is no obligation for voluntary assisted dying medications to be returned if a person who has received the medications lives longer than the expected six or 12 months. Their contact person is just required to return any unused medication after the person dies. So much for the safe control and storage of the lethal substance(s).

And patients will not be required to pay for the voluntary assisted dying medications. The government will pay these costs as part of the funding for the statewide pharmacy service, which is to be provided by the Alfred Hospital. This would not seem to be fair while there are cancer patients who cannot afford medications that would enable their survival and while not all Victorians have access to the highest standard of palliative care.

The VAD Act prohibits registered health practitioners from directly raising assisted suicide/euthanasia with patients. A registered health practitioner cannot initiate a discussion about voluntary assisted dying or suggest voluntary assisted dying to a patient. But, once a patient has requested information about or access to voluntary assisted dying, treating health practitioners do not need to wait for the patient to raise voluntary assisted dying during subsequent consultations. It is not intended that every single subsequent discussion be initiated by the patient.

So health practitioners can actively inform a patient who has raised the issue about the availability of assistance to suicide.

However, if the VAD navigators are not registered health practitioners, then they are exempt from that prohibition anyway. The Peter MacCallum Cancer Centre advertisement for VAD navigators called for “Clinical Nurse Consultants Grade 6 or Grade 4 Allied Health Professionals or Grade 4 Psychologists” to apply. Whether a VAD navigator, regardless of professional qualifications, is registered under the Health Practitioner Regulation National Law would determine whether they are covered by the prohibition. Other “patient navigators” at the Peter MacCallum are described as “administrative staff”.

So, are the VAD navigators “administrative” staff? If so, then they will not be prohibited by the VAD Act from directly raising the matter of assisted suicide with patients.

This is a far cry from legislating for the handful of patients expected to die within six to 12 months, suffering intolerably with no relief that is acceptable to them, who know they want assistance to die, and raise it directly with their medical practitioner. This looks more like letting as many possibly eligible people know that assistance to suicide may be available to them.

The VAD Act commences operation on June 19. The issue of conscientious objection is very important. All those who will be affected by it need to consider their position; whether in conscience they can be involved, what their employment by a health service will mean in terms of their being able to exercise their freedom of conscience.

As it seems that health services, palliative-care services, aged-care facilities may be where requests for and deaths from assisted suicide will take place, all staff will potentially be affected. The VAD Act only provides that registered health practitioners can refuse to be involved in VAD. There is no such protection for other staff. And if health practitioners do refuse on grounds of conscience to participate, how may that affect their continuing employment with a health service that is offering assisted suicide?




























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