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Voluntary Assisted Dying Is Now Legal In Victoria. What's Next?

Victoria's nation-first voluntary assisted dying laws may be too difficult to access, advocates say, but will spur other states to follow suit with their own programs.

Nation-leading laws come into force in Victoria on Wednesday. It brings an end to the years-long process to allow people the right to end their lives if they are experiencing "intolerable suffering" associated with an "incurable, advanced and progressive" medical condition.

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After clearing a strict set of legal and medical hurdles and safeguards, Victorians will be able to access medication to end their own lives.

Victorian Special Minister of State Gavin Jennings, Premier Daniel Andrews and Health Minister Jill Hennessy after the Voluntary Assisted Dying Bill 2017 passed in the Victorian Legislative Council in November 2017. Photo: AAP

The state government passed the Voluntary Assisted Dying Act in November 2017, and after an 18-month implementation phase, a scheme which Premier Daniel Andrews calls "the safest and most conservative in the world", will be available from Wednesday.

Advocates prefer -- as do governments -- the term 'voluntary assisted dying' (VAD), rather than the commonly-used 'euthanasia'.

But while experts agree with the Premier's claims, some believe the framework will mean some who need to access the scheme may not be able to.

"There is a possibility that because it is so conservative, it will be difficult to access," Associate Professor Arnold Gillespie, national convener of Doctors for Assisted Dying Choice, told 10 daily.

How will Victoria's assisted dying program work?

"From Wednesday, Victorians who are suffering with a terminal illness will be able to make an initial request to access voluntary assisted dying," Andrews said.

Patients must see several doctors before gaining access to the medication. Photo: Getty

The scheme is lengthy, peppered with numerous safeguards along the way to ensure a patient truly wants to end their life, and that the decision is theirs alone. This will be monitored by a dedicated Voluntary Assisted Dying Review Board.

For a start, only the patient themselves can initiate discussions about VAD. A doctor is not meant to bring the topic up unprompted, and a family member cannot start the process on a patient's behalf.

"This is to ensure that the request is completely voluntary and without coercion, and that the decision is the person’s own," the government's advice outlined.

The patient's eligibility to access VAD needs to be assessed by two separate, qualified doctors, to ensure the person "is making a fully informed decision and is aware of the available palliative care options"; then a written declaration, witnessed by two independent individuals.

A final request is then made to another doctor, who will apply for a permit to prescribe medication that will end the patient's life.

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"The person must administer the medication themselves, unless they are physically unable to do so, in which case their doctor may assist," the state government said, adding that any unused medication would be returned to authorities.

"That's a big difference and one safeguard that doesn't exist elsewhere,"  Professor Lindy Wilmott, of the Australian Centre for Health Law Research at Queensland University of Technology, told 10 daily.

No doctor would be forced to participate in this, allowing for medical professionals to excuse themselves on moral grounds. Patients must have lived in Victoria for 12 months to be eligible to access the scheme.

How does it compare to other assisted dying schemes?

Wilmott agreed the Victorian scheme was the most conservative in operation around the globe. VAD is not a new concept; it was decriminalised in the Netherlands in 1993, legalised in the U.S. state of Oregon in 1994, and approved in Belgium in 2002. Schemes are also in operation in Canada, Colombia, and other American states including California, Colorado, New Jersey and Washington.

Dr Philip Nitschke holds up a drug testing kit, which is used as part of assisted dying, in 2009. Photo: Getty

Australia actually has a rich history with the concept. The Northern Territory passed the world's first VAD laws in 1996 -- under which four people ended their lives, before the federal government nullified the legislation in 1997.

Australian doctor Philip Nitschke was the first in the world to administer a legal, voluntary dose to end someone's life, and remains a leading voice on VAD worldwide. Last year, he travelled to Switzerland with Australian academic David Goodall, who wanted to end his life at a Basel assisted dying clinic.

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"All these laws are based on the first one, in the state of Oregon. It established its program 20 years ago, and it's taken a long while to catch up," Arnold Gillespie told 10 daily.

Gillespie's Doctors for Assisted Dying Choice group, a gathering of medical professionals in favour of extending VAD as an end of life option, is pleased to see the Victorian legislation coming into force. Several other Australian states are at various stages along the path to legalising VAD, and Gillespie said "undoubtedly" the Victorian example would spur further progress.

Scenes in Victorian parliament when their bill passed in 2017. Photo: AAP

"Western Australia is the furthest along the line. They've had an inquiry into end of life choices, and just completed another expert panel. They're well down the track," he said, predicting the reform would be legal in WA by the end of 2019.

Queensland and South Australia are also advanced in discussions toward VAD, while NSW parliament rejected a bill after a marathon all-day sitting in 2017.

"It will start debate. There was such a careful consideration and introduction in Victoria, and it's being replicated in other jurisdictions," Wilmott said.

"It's very likely to roll out across Australia."

Goodall (centre) with Nitschke, in Switzerland in 2018. Goodall travelled to Basel to end his life, as assisted dying was not available in Australia at the time. Photo: Getty

Penny Hackett, President of Dying with Dignity NSW, called on state governments introduce similar legislation in their own parliaments.

"Politicians must listen to the vast majority of the community who supports these laws. They must be guided by facts not fear and cast their votes based on evidence not ideology," she said.

Will it be effective?

Wilmott has concerns over the self-administration rule, which she said may not work for all patients.

"There's no obligation for a health professional to supervise that death... the person should have a choice of administration, with medical supervision preferable. A patient who is eligible and very unwell may prefer a doctor to administer," she said.

Gillespie predicted only around a dozen people would want to use the Victorian scheme each year, but has doubts over access.

Photo: Getty

"The laws were deliberately made very hard... it's very onerous for people at the end of their lives," he said.

"There is a possibility that because it is so conservative, it will be difficult to access and some people may not be successful in doing this."

Gillespie conceded the laws were made very stringent so they had "the greatest chance of passing" state parliament ("they have been quite cautious, quite rightly") but said his group would monitor the laws closely.

Go Gentle Australia, a VAD advocacy group, praise Victoria's progress.

"Victoria has given us a principled road map on how these laws can be rolled out – now it is up to parliaments and individual politicians to not stand in the way of more compassionate end-of-life choices for all Australians," Go Gentle CEO Kiki Paul said.