Voluntary assisted dying: time to consider the details

In less than 12 months, voluntary assisted dying (VAD) will become a reality in Victoria. The recent past has seen much passionate debate on both sides of this issue, covering aspects of its impact on society, public health, the law, medicine and an individual’s right to self-determination.

Public health interventions have provided our society with significant benefits in many areas; however, for most physicians in clinical practice, our care is focused on each individual patient. To date, little attention has been placed on the implications of VAD for each doctor–patient encounter in which a request is made.

For a clinician, the most challenging aspect of VAD now is how to support our patients. How do we balance the fundamentals of our professional and personal beliefs with our clinical and therapeutic responsibilities in practice?

The legislation allows doctors the choice to participate in VAD or not; yet, we wonder how we may navigate this therapeutic space. While we believe that directly ending life is a boundary we cannot cross, we also know we cannot abandon our patient at what would clearly be a time of need. Can the doctor–patient relationship survive when electing not to participate?

No amount of debate in Parliament will answer this question. We believe we need to derive collective wisdom to craft our compassionate response in this setting — in a considered and thoughtful manner. We believe we must recognise our own distress and anxiety and, nevertheless, remain focused on how we best care for patients. We need to remember our critical role as scientists to learn how to accurately assess, measure and report risks and benefits, to improve care for patients requesting VAD and to inform public health policy.

In Victoria, VAD will soon be available. As doctors we must consider our response to our patients and assess the resulting impact on our relationship, here and now. This is a conundrum we had hoped we would never need to face. And it is what keeps us up at night.