Voluntary assisted dying and the law

On 19 June, the Voluntary Assisted Dying (VAD) Act 2017 comes into effect in Victoria. In preparation, there are several things that pharmacists need to be aware of.

Victoria’s Acting Minister for Health Martin Foley recently announced that all dispensing of VAD medicines would take place in a single point of access, The Alfred Hospital.

In accordance with the Act (as explained in more detail below), pharmacists should not:

• Approach, initiate or raise this topic with a person or their family. In the event of this occurrence, pharmacists could be subject to a fine and/or imprisonment.
• Receive a prescription for VAD medicines. All dispensation of medicines will occur at The Alfred.

‘The Alfred is one of Victoria’s leading hospitals,’ Mr Foley said. ‘Having a single point of access for voluntary assisted dying is just one of the ways we’re making sure the model is the safest and most conservative in the world.’

The VAD scheme is only applicable to people who have lived in Victoria for over 12 months, and has been designed according to strict guidelines:

• Only adults with decision-making capacity, who are suffering and have an incurable, advanced and progressive disease, illness or medical condition that is likely to cause death within six months (or 12 months for people with neurodegenerative conditions) can access the scheme.
• A person may only access voluntary assisted dying if they meet all of the strict eligibility criteria, make three clear requests and have two independent medical assessments that determine they are eligible.
• The request must always be initiated by the person themselves – health practitioners who are treating the patient and raise the issue are subject to unprofessional conduct investigations.

Pharmacists’ involvement

A single point of access means that VAD medicines are secure, unused medicines are returned and destroyed, and people are adequately informed about the scheme.

For people too sick to travel, the pharmacy service of The Alfred will deliver their medication and provide information on administration – then collect any unused medication. The pharmacy service will report to the Voluntary Assisted Dying Review Board in accordance with the Act.

Jarrod McMaugh, President of Chronic Pain Australia and managing partner at Capital Chemist Coburg North, said that a single point of access will benefit both the community and pharmacists.

As the people accessing the VAD scheme are usually very ill, a single point of access means they have a quick and easy way to collect the medicines – eliminating the need to travel to various pharmacies or find pharmacists that have the right training to administer it and are without conscientious objection.

Under the VAD legislation, pharmacists are not obligated to refer the person on if they have any conscientious objection to administering the treatment, Mr McMaugh said. The single point of access ensures that the onus is placed on the Victorian Government to provide a guaranteed source of the medicine – relieving the person’s search and pharmacist’s obligation.

The prescription system, if used correctly, means that pharmacists won’t be approached by people with VAD scripts. ‘When the prescription is written, it will go directly to The Alfred MD on record there,’ Mr McMaugh said.

‘The person will not physically have the prescription in their hand. Instead, they will have an information kit, for instance, that tells them how to access the service and what the prescription entails.’

If a pharmacist still receives a prescription, they should refer the person to The Alfred.

When approached by a person that is after information about VAD, there are several things to be aware of, Mr McMaugh said.

Firstly, such a discussion can only be instigated by the person, not the pharmacist. As outlined in the legislation, initiation is in breach of the law and the pharmacist could incur a fine and/or receive a significant custodial sentence. Pharmacists should also be aware of mandatory notification requirements regarding initiation.

But if a person happens to ask a pharmacist about VAD and how to access the scheme, pharmacists can exercise their conscientious objection and express their wish not to participate in the conversation, or they can refer them on to the health.vic website, where they will find all the necessary information about VAD.

For any pharmacist thinking of doing locum work in Victoria, Mr McMaugh said that it’s very important to understand the legislation around VAD – particularly about making people aware of the services.

If a pharmacist is asked about VAD outside of Victoria, they can refer people to the health.vic website and explain that the service is only applicable to Victorian residents.

The next steps

The VAD Implementation Taskforce is currently collaborating with clinicians, health services and the Victorian community in preparation for the scheme’s launch in June.

The Taskforce and the Victorian Healthcare Association are working together to manage medicines for people who want them administered in either health or aged care facilities.

Prior to the scheme’s commencement, the taskforce will provide:

• models of care and organisational protocols for health services;
• guidance for health practitioners;
• training for medical practitioners who conduct eligibility assessments; and
• community and consumer information.