1. Voluntary Assisted Dying Act 2017 Adj
Voluntary Assisted Dying Act Adj. Professor Dale Fisher Chief Executive, Peter MacCallum Cancer Centre Member, Implementation Taskforce

2. Today’s presentation Introduction to the legislation
Process for request and assessment
Information for health professionals
Reporting
Role of the Implementation Taskforce
Model of Care Project
Timeline
Questions

3. Introduction
The Voluntary Assisted Dying Act 2017 was passed by the Victorian Parliament on 29 November 2017.
•The Act will commence operation on 19 June 2019
•The Act followed two years of consultation and development, and reflects a balance between giving people choices at the end of their life and ensuring community safety.
•The policy in the Act is now settled and the focus has shifted to implementation of the Act.

4. Guiding principles of the Act
Every human life has equal value.
A person’s autonomy should be respected.
Informed decision-making.
Quality care that minimises suffering and maximises quality of life.
Therapeutic relationships be supported and maintained.
Open discussions about death and dying.
Conversations about treatment and care preferences.
Genuine choice balanced with safeguards.
All people have the right to be shown respect for their culture, beliefs, values and personal characteristics.

5. Voluntary Assisted Dying Act 2017
The Act sets out the legal requirements of voluntary assisted dying.
Like any other clinical intervention, there are other considerations that will need to be addressed in practice.
It will come into effect on 19 June 2019
The Act provides for and regulates access to voluntary assisted dying in Victoria, it:
Establishes clear eligibility criteria
Steps through a detailed request and assessment process, including requirements for medical practitioners
Sets up a voluntary assisted dying permit process which authorises the prescribing and dispensing of a voluntary assisted dying substance
Establishes the Voluntary Assisted Dying Review Board (Review Board)
Provides for a range of additional safeguards including substance monitoring, practitioner protections, offences, and a five year review.
The Voluntary

6. Eligibility criteria
To access voluntary assisted dying, a person must meet all of the following eligibility criteria including:
be diagnosed with a disease, illness or medical condition, that:
is incurable; and
is advanced, progressive and will cause death; and
is expected to cause death within weeks or months, not exceeding 6 months (12 months for people with a neurodegenerative condition); and
is causing suffering that cannot be relieved in a manner the person considers tolerable.
To be eligible, a person must meet strict critera:
Be aged 18 years or more; and
Be an Australian citizen or permanent resident; and be ordinarily resident in Victoria for at least 12 months; and
Have decision-making capacity in relation to voluntary assisted dying.

7. Request and assessment
A person must make three separate requests.
The formal process for requesting voluntary assisted dying is follows:
The person makes their first request to a medical practitioner (who becomes the co-ordinating medical practitioner if they accept)
The person undergoes a first assessment by the co-ordinating medical practitioner
The person undergoes a consulting assessment by a consulting medical practitioner
The person makes a second written request, which is signed by two independent witnesses
The person makes a final request to the co-ordinating medical practitioner
The person’s final request must be made at least 9 days after the day on which they made their first request (exception if they are likely to die within that time)

8. If the person is eligible
The co-ordinating medical practitioner applies for a permit from DHHS to prescribe the voluntary assisted dying substance.
If the person is physically able to self-administer and digest the substance, the practitioner must apply for a self-administration permit.
If the person is not physically able to self-administer or digest the substance, the practitioner must apply for a practitioner administration permit.
Administration by a medical practitioner will only occur in very limited circumstances and will ensure those who are physically unable to self- administer are not discriminated against.
The co-ordinating medical practitioner applies for a permit from DHHS to prescribe the voluntary assisted dying substance. This is an opportunity to ensure compliance with the request and assessment process.
If the person is physically able to self-administer and digest the substance, the practitioner must apply for a self-administration permit.
If the person is not physically able to self-administer or digest the substance, the practitioner must apply for a practitioner administration permit.
Administration by a medical practitioner will only occur in very limited circumstances and will ensure those who are physically unable to self-administer are not discriminated against.

9. Information for health practitioners
A health practitioner is not required to participate.
A health practitioner must not initiate the discussion about voluntary assisted dying with a patient while providing a health service.
There are protections for health practitioners and paramedics who act in good faith and in accordance with the Act.
Information for health practitioners
A health practitioner is not required to participate.
A health practitioner must not initiate the discussion about voluntary assisted dying with a patient while providing a health service.
There are protections for health practitioners and paramedics who act in good faith and in accordance with the Act.
This includes not providing life-sustaining treatment that has not been requested if they believe the person has accessed voluntary assisted dying.
There are a range of offences, including offences to induce a request or self-administration, falsify records or make a false statement, and to provide or administer a voluntary assisted dying substance without a permit.
Roles for medical practitioners
The roles of the two assessing medical practitioners are clearly defined as the co-ordinating medical practitioner and the consulting medical practitioner.
The co-ordinating medical practitioner supports the person, undertakes the first assessment, receives the requests, and is responsible for reporting.
The consulting medical practitioner provides a consulting assessment
Both practitioners must ensure the person is properly informed of all treatment and care options and likely outcomes.
Both practitioners must undertake independent assessments to form a view as to whether:
the person meets the eligibility criteria;
the person understands the information provided;
the person is acting voluntarily and without coercion; and
the person’s request is enduring.

10. Who can participate?
Only specialist medical practitioners (including GPs) can conduct the assessment process and prescribe the substance
Between them, the coordinating and consulting medical practitioner must have:
at least five years post-fellowship experience
experience and expertise in the person’s disease, illness or medical condition
both medical practitioners must also complete training before conducting an assessment; this training will focus on the legal and practical requirements of voluntary assisted dying.

11. Role of the pharmacist The pharmacist’s role is to inform the person:
how to self-administer
about the safe storage of the substance in the locked box
that there is no obligation to take the medication
that any unused substance must be returned to the pharmacist for disposal by the person or their contact person
dispenses the substance with prescribed labelling statement
receives and disposes of any unused substance.
Inform the person:
how to self-administer
about the safe storage of the substance in the locked box
that there is no obligation to take the medication
that any unused substance must be returned to the pharmacist for disposal by the person or their contact person
Dispenses the substance with prescribed labelling statement
Receives and disposes of any unused substance

12. Reporting requirements
Mandatory reporting to the Voluntary Assisted Dying Review Board is required following the:
first assessment (co-ordinating medical practitioner)
consulting assessment (consulting medical practitioner)
final review, following the third request (co-ordinating medical practitioner)
dispensing of the substance (pharmacist)
disposal of the substance (pharmacist)
administration of the substance by a co-ordinating medical practitioner.
Reporting forms are detailed in the Schedule to the Act.

13. Implementation Taskforce
The Implementation Taskforce is undertaking a range of tasks, including developing:
clinical guidelines (which will step practitioners through legal and clinical requirements)
training (focused on the legal and clinical requirements)
a medication protocol (will be provided to participating medical practitioners and will set out exactly what to prescribe)
consumer and community information (will be available at a range of levels and for a range of situations)
models of care (will assist health services to respond to the new legislation)
This information will be available at the end of March 2019, to ensure people have sufficient time to prepare for 19 June 2019.
The Implementation Taskforce is guiding the implementation.

14. Model of Care Project
The VHA has been engaged by the Department of Health and Human Services to work alongside the DHHS Model of Care Working Group to:
support the development of a model of care and associated policies and protocols for VAD
establish processes for quality improvement and review
develop tools that support employees and that can be consistently applied across Victoria.
The VHA Working Groups – What will they deliver?
Agreed generic model of care, policy and protocols
Policies and procedures applicable for aged care facilities
A suite of resources that outline the requirements of the act and assists organisations in planning their approach to participation (or otherwise) in voluntary assisted dying
A suite of relevant and appropriate resources to support health services to engage with patients about voluntary assisted dying
A framework for quality assurance and improvement for voluntary assisted dying including development of a review process to ensure information and protocols remain up-to-date
A communication plan to support the role out of the model of care and the dissemination of resources including a focus on myth-busting and a state-wide information session series.

15. What does that mean?
A general overarching model of care that is consistent across the state
Individual care pathways that will consider all possible variances including but not limited to the following situations:
voluntary assisted dying provided in health care facility with practitioners from that facility
voluntary assisted dying available to people in their home and facilitated by current health facility and practitioner
heath facility has practitioners who are willing to participate and prescribe
health facility has limited practitioners who are willing to participate and needs referral/ assistance for second practitioner
patient initiated pathway, where unable to get access with current practitioner or health facility.

16. Model of care governance structure
Implementation Taskforce
Model of Care/ Organisational protocol development working group
Victorian Healthcare Association
Model of Care Consultative group
Model of Care Development group
Model of Care Quality Development group
As part of that work, the VHA has established 3 working groups - a broad sector-wide consultative group with 26 members who act as a sounding board and a test site for the model of care.
The project also has two smaller development groups that focus on the model of care and quality assurance.
Each of the working groups will be supported by part time project officers, whom will soon be appointed, who will continue to work within services as they prepare to implement Voluntary Assisted Dying.

17. Consultative group
The VHA will draw on the knowledge and expertise of the consultative group to develop the model of care; they will also test ideas and models within their home organisation.
This group comprises 25 representatives covering:
large metropolitan hospitals
regional hospitals
rural health services
community health
palliative care
faith based organisations
medico-legal
doctors (oncology, neurology, palliative care, ICU, psychiatry)
nurses (oncology, palliative care, aged care, home nursing services, mental health)
consumers.
The first consultative group meeting will be held on 10 September.
The VHA released an expression of interest in June. The VHA is considering how it will share the details of representatives on these groups, given the sensitivities.
The Model of Care for Voluntary Assisted Dying will be developed through a consultative process and report up to the Model of Care Working Group

18. Development groups Model of Care Development Group
Comprises four members of the consultative group
Responsible for the detailed development of the model of care and associated tools, taking key inputs from the consultative group
Work will be supported by a project officer (0.5 EFT)
Quality Development Group
Comprises four members of the consultative group
Responsible for the development of the quality assurance and control of the model, taking key inputs from the consultative group
Work will be coordinated by a project officer (0.5 EFT)
The appointments of the project officers will take place soon.
The development groups will convene following the consultative meeting in September.

19. Timelines Milestone Date
Investigation and analysis of current models of care
October 2018
Finalisation of model of care recommendations and resources
January 2019
Model of care recommendations and resources endorsed by MOC working group
February 2019
Approval of MOC and associated resources by Taskforce
Finalisation and distribution of resources
February-March 2019
Education roadshow
Implementation of Voluntary Assisted Dying in Victoria
19 June 2019
The education roadshow will be state-wide and will be for all staff – from PSAs to nurses to front of house to surgeons.