Voluntary Assisted Dying in South Australia, 2022-2023 Annual Report

The eight member Voluntary Assisted Dying (VAD) Review Board (pictured) meets monthly to review each closed VAD case and monitor all aspects of VAD implementation. The Board is committed to open and transparent monitoring and review processes. The comprehensive and easy to read first annual report confirms that commitment.

During the first five months of VAD in South Australia, January 31 to June 30 2022, 45 people have used the VAD pathway to make their end of life choice. Six of these people died without using the VAD substance although they had received a VAD permit.

In presenting the report, the Presiding Member of the VAD Review Board, Ass Prof Mel Turner, said

I am confident that South Australia’s voluntary assisted dying pathway remains grounded in the values of compassion, dignity, and respect whilst maintaining the highest standards of care delivered with robust oversight.

The report notes that as an end of life choice,

Voluntary assisted dying is a deeply personal choice offered within the broader landscape of end of life care which includes palliative care and grief and bereavement care.

Rather than diminishing the importance of palliative care, the availability of voluntary assisted dying expands the range of options available to individuals, recognising the complexity of human experiences, beliefs, and values. For some, the integration of voluntary assisted dying into the end of life care continuum may provide a sense of security and comfort providing a legislated pathway for individuals to exercise autonomy over their own lives and permitting them to make a profoundly personal decision about when and how they will die.

Whilst palliative care is different from voluntary assisted dying, they can sit comfortably together. It is not one or the other. A person requesting voluntary assisted dying does not need to choose one or the other and palliative care can be continued until the death of the patient from voluntary assisted dying, with support for family continuing. (p7)

The observations of a brother and sister of two people who used VAD during the year provide an insight into the process:

Bridget said: “The voluntary assisted dying process was really the first time that any medical and allied health practitioners had given such understanding and empathy to my sister’s suffering, and that was such a relief.” (p8)

Daryl said: “In the end, being granted voluntary assisted dying gave my brother and myself comfort. And even though he didn’t use the kit, just knowing it was an option for him was therapeutic and life affirming in a very real way.”  (p9)

The report provides a comprehensive analysis of the people who requested VAD, the people involved in providing the service and areas where change may be needed.

Statistical analysis

• 116 first requests (1 refused)
• 109 first assessments (by coordinating medical practitioner)
• 101 were addressed as eligible
• 88 second assessments were completed (87 eligible)
• 77 VAD permit[1] applications were made with 71 VAD permits issued to 68 people: 54 (76%) were for self administration, 17 (24%) were for practitioner administration (3 people later required a practitioner permit ie they had 2 permits)
• At June 30, 45 of the 68 people who had received a VAD permit had died
• 28 people (62%) used self administration, 11 people (25%) used practitioner admin, 6 people (13%) without using substance
• Underlying cause: cancer 60%, neurodegenerative disease 22%, other 18%
• Location: 23 died at home (50%), 18 were in hospital and 4 were in an aged care facility; 65% were in metropolitan Adelaide and 35% were in a regional area
• 53% were women, 47% were men, 3 people were under 60 years of age
• 31 (68%) of people were receiving palliative care
• 75% were Australian born, with another 15% born in England
• 109 people completed the first assessment and 41 did not continue with their VAD request: 18 died prior to the issues of a VAD permit, 9 people were ineligible, and 14 withdrew
• The average time from the first request to the issue of the VAD permit was 26 days
• The average time from the issue of a VAD permit to the person’s death was 14 days
• There were 66 VAD trained medical practitioners, the majority being GPs; 75% are in metropolitan Adelaide and 25% are located in regional areas; 36 of the medical practitioners had undertaken one or more VAD assessments by June 30.

Experience of Doctors

Dr Cuong Do is a medical oncologist practising in Whyalla and Port Lincoln. Cuong observed that

voluntary assisted dying provides another end of life choice, which in his experience is used as an option when suffering is intolerable to the person.

When considering the positives and negatives of being a voluntary assisted dying practitioner, Cuong says that this legislation is all about providing choice at end of life. It is more than the prescribing and taking of a medication, it is the process that he believes patients find most rewarding. People feel listened to and that goes a long way to alleviating anxiety. (p27)

SA Health has appointed two VAD clinical advisors, Dr Chloe Furst, a Geriatric Medicine Physician who specialises in Palliative Medicine and Dr Peter Allcroft, who trained in respiratory and sleep medicine and palliative medicine.

Both VAD clinical advisors (Chloe and Peter) commented on the “privilege of providing support to patients and their families as they explore an autonomous end of life journey” (p29). Dr Furst reflected further on the transition of the person from patient to person as the person realises they will have control over their end of life. Both advisors said that the one aspect of VAD that they would most like to see changed is the prohibition on a doctor being able to discuss VAD unless the patient is already aware of VAD as a choice and has raised it first.

Community engagement

The Minister of Health and Wellbeing will be appointing an Aboriginal member to the VAD Review Board to oversee the development of culturally safe VAD services.

SA Health meets regularly with VADSA to share feedback and experience with the implementation of VAD.

Regular newsletters are provided to medical practitioners.

The report notes the additional difficulty of not being permitted to use telehealth for consultations in relation to the VAD substance due to provisions in the Commonwealth Criminal Code and efforts to have the legislation amended.

In response to concerns from medical practitioners about their ability to discuss VAD with patients, SA Health requested legal advice on whether general information about VAD could be made available in waiting rooms. The advice confirmed that providing general information about VAD on a flyer in a waiting room, or on a website, does not contravene any aspect of the VAD Act.

[1] A VAD Permit is used by SA Health after two medical assessments, a written request (which must be witnessed) and a final request. A person can withdraw from the process at any time; in some case the person dies before the VAD Permit is issued; or the person may lose decision making capacity in relation to VAD.