What you need to know about Voluntary Assisted Dying (VAD) Implementation in South Australia

A blog post written by Kate Swetenham

Background

The South Australian Parliament passed the Voluntary Assisted Dying Act on 24 June 2021. This legislation is deemed to be one of the safest in the world due to the number of safeguards embedded, and the mandated education requirement for participating medical practitioners.

The Act outlines eleven guiding principles starting with every human life having equal value and ending with the right of the individual to make decisions about medical treatment freely without pressure, coercion, or undue influence of others.

There are specific criteria for access, with age, residency within SA, and the need for the person to retain decision-making capacity throughout the VAD process clearly outlined within the legislation. The medical condition disease or illness must be incurable, advanced, and progressive and will cause death within 6 months (12 months for people with a neurodegenerative condition) and is causing suffering that cannot be relieved in a manner that the person considers tolerable.

The South Australian legislation only allows medical practitioners to provide voluntary assisted dying. These are senior clinicians with at least 5 years' experience after completing a fellowship with a specialist medical college or vocational registration. One of the assessing medical practitioners must have relevant experience in the disease, illness, medical condition expected to cause the death of the person being assessed.

There are provisions for conscientious objection and South Australian clinicians have the right to refuse to be involved in all aspects of the voluntary assisted dying process.

Implementation

The Implementation Taskforce commenced in December 2021 under the leadership of Dr Chris Moy to guide complex activities across nine discrete work streams.

As the implementation team formed, key pieces of work were undertaken.

• Process mapping that demonstrates the patient journey through the voluntary assisted dying process. This work has informed the Information Technology build as well as the development of the mandatory education package for medical staff.
• Implementation of a risk and issues management system. Risks are identified and managed, and Issues are investigated and presented to the Implementation Taskforce for management, or resolution.
• Development of clinical guidelines to assist medical practitioners to understand the Voluntary Assisted Dying Act 2021 as well as their roles and responsibilities in the voluntary assisted dying process.
• Preparing the sector for voluntary assisted dying, through readiness workshops with Local Health Networks, Primary Care, Aged and Disability Care providers through to commencement of the Act in January 2023 and beyond.
• Development and endorsement of the Care Navigator Service, a statewide service to support patients, families, clinicians, and health care organisations in the access of information and support services related to voluntary assisted dying.
• Development of a Regional Patient Support Scheme to ensure access is enabled for people living in regional and remote areas of South Australia.
• Establishment of the South Australian Voluntary Assisted Dying Pharmacy Service.
• Development of a prescription and administration handbook, for coordinating medical practitioners who have completed the mandatory training. This handbook outlines the process required to prescribe, supply, and administer the substance.
• Mandatory training package for medical practitioners has been developed with Flinders University of South Australia responsible for content development and the Women’s and Children’s Digital Learning and Design Team for translating the content into online education modules.
• Development of the Information Technology Portal. This is a secure online system that medical practitioners will use to complete and submit forms required to access voluntary assisted dying.
• Community information sheets translated into 12 languages are in the process of development. The information will be downloadable and printable for the community to access.
• The Voluntary Assisted Dying Review Board has been recruited and commenced in September 2022.

The South Australian voluntary assisted dying pathway

The voluntary assisted dying pathway commences when a patient initiates a discussion with any registered health practitioner involved with their care.

Health practitioners in South Australia must not initiate a discussion about voluntary assisted dying to a person that they provide health or professional care services to.

If the initial discussion progresses to the patient making a first request, the patient will need to make the first request to a registered medical practitioner, clearly and unambiguously, in person, and verbally or by gestures or other means of communication available to the patient.

The registered medical practitioner has 7 days in which to decide if they will accept the request. They must complete the mandatory training prior to proceeding with the first assessment.

The patient must be assessed by 2 eligible registered medical practitioners, the coordinating practitioner, and the consulting practitioner, to determine that they meet the eligibility criteria. Both medical practitioners must have completed the mandatory training prior to undertaking an assessment for voluntary assisted dying access.

The patient then makes a written declaration requesting access. This declaration must be signed in the presence of the coordinating medical practitioner and two eligible witnesses.

A final request is then made, and then the patient is required to appoint a contact person. Once this has occurred the coordinating medical practitioner uploads all required documentation to the portal for the Voluntary Assisted Dying Review Board.

The coordinating medical practitioner will then apply for either a self administration permit or a practitioner administration permit. A practitioner administration permit is only sought where the patient is physically unable to administer the substance, or unable to digest the substance.

The SA VAD pharmacy service will deliver the substance to the person and provide education about the medication and how to administer it.

The patient self administers the substance when they choose. They may have carers, family and friends present if they choose, and they may ask a health practitioner to be present.

After the person dies a medical practitioner notifies Births, Deaths and Marriages, and the Coroner.

The contact person is responsible for returning any unused substance to the dispensing pharmacy within 15 days of the patient’s death.

Next steps

As South Australia works to a 31 January 2023 start date the community can remain updated by accessing the SA Health website at www.sahealth.sa.gov.au and searching for voluntary assisted dying.

The Taskforce will continue to review the timeframe as implementation progresses and explore opportunities to bring the commencement date forward safely.

Joining the mailing list can be done by emailing Health.VoluntaryAssistedDying@sa.gov.au and adding “Join the mailing list” to the subject line.
 

Kate Swetenham, RN, BN, Grad Dip Psycho Oncology, M of Pall Care, MSc. CF.
Clinical Lead
End of Life Care
Department for Health and Wellbeing