Making the decision to support Voluntary Assisted Dying alongside inpatient palliative care
An article written by Associate Professor Kirsten Auret
Terri Pikora, Kate Gersbach and I are all rurally – based health researchers who are lucky to live in Kinjarling – Albany – on the South coast of Western Australia. For this work we also collaborated with Rob Donovan, who recently moved to Albany from Perth and has great expertise in community health promotion and wellbeing. I am an Associate Professor of Rural and Remote Medicine, a Palliative Medicine Specialist, and was the rural medical representative on the WA Government’s Expert Advisory Panel on Voluntary Assisted Dying (VAD) legislation. Albany is a beautiful rural community of ~ 36,000 people, and in 2020 we celebrated the launch of our Compassionate Albany Charter. We also have the only remaining community-owned and run inpatient palliative care unit in WA and the Albany Community Hospice is deeply embedded in the social fabric of the region.
When the VAD Act was passed in 2019, there was an 18-month period for implementation before coming into operation in July 2021. We were curious as to how the community would expect the local Hospice to respond to this change and have now published two studies to share what happened. This new article follows on from our previous paper ‘Being a safe place: a qualitative study exploring perceptions as to how a rural community hospice could respond to enactment of voluntary assisted dying legislation’ where we asked members of the community and staff at the Hospice their thoughts in relation to VAD being implemented.
This current paper ‘“Respecting our patients’ choices”: making the organizational decision to participate in voluntary assisted dying provision: findings from semi-structure interviews with a rural community hospice board of management’ reports on the decision-making process that the Board of Management went through to arrive at their final decision. The Board members used the results from our previous study to check the level of support within the community and staff for VAD as part of their decision-making process.
We interviewed seven of the nine Board members. They described the experience as a journey to reach their decision to allow full participation in VAD provision for patients in the Hospice. This involved starting from a personal view; moving to a hospice perspective; exploring if VAD can be part of end-of-life care; awareness and assessment of any risks to Hospice; arriving at a common platform to vote on; identifying factors that assisted a safe decision-making journey; and the personal impact of the journey.
There were several key things identified by the Board members as helping to reach the outcome: having enough time to make the decision and not feeling rushed; having useful resources available and being able to ask for more information if they needed it; sound Board processes that were in place across all decisions; and a trusting culture within the Board.
We feel this research is important as it is a rare exploration of organisational “conscientious participation” embedding VAD in end-of-life care within a palliative care facility. We hope this paper may assist other palliative care organisations when faced with making a decision that is triggered by VAD legislative change. The full text is available through open access too and we would love you to let us know what you think.
Assoc Professor Kirsten Auret
Clinical Director Palliative Care WACHS
MBBS, FRACP, FAChPM
Rural Clinical School of WA