Participating doctors' perspectives on the regulation of voluntary assisted dying in Victoria: a qualitative study

To the Editor: We write regarding the study by Wilmott and colleagues1 and the accompanying editorial by McLaren and Mewett.2

There are data of interest in the study that are not found in the limited Victorian voluntary assisted dying (VAD) review reports. Notable is that four doctor participants had assessed more than 25 people each in the first year of VAD in Victoria. Given that 124 people died by VAD in the first year, the high caseload of a handful of participants highlights that few doctors choose to be VAD assessors. With a large proportion of assessments being carried out by only a strongly supportive few, this raises potential concerns about the independence of assessments, when the doctors who are the gatekeepers of VAD work together in small groups to determine eligibility. There is an association between clinicians willing to provide a hastened death (where this is legal) and advanced cancer patients in palliative care wanting just that.3

Some participants in the study acknowledged that VAD consultations via telehealth are a “second rate solution”.1 However, the legislative push for VAD telehealth assessments continues with an amendment currently before the Victorian parliament, even though this puts access ahead of safety, making it harder to exclude depression or coercion.4 It was useful to be reminded that Victorian guidelines prohibit the use of telehealth for VAD consultations due to federal criminal laws that ban suicide discussions on carriage services. However, it is known that some Victorian VAD consultations have already been conducted via telehealth.5

The editorialists state that evidence is needed to guide VAD practice that to date has been based on opinion and personal viewpoint.2 The evidence base to support the need for VAD should have been identified before and not after legalisation. Stories of distressing deaths reported by relatives can be misleading, especially when these conflict with published palliative care research that suggests excellent symptom control in dying Australians who can access and who accept specialist palliative care.6

While VAD as a new practice receives much attention, its availability does nothing to help the many thousands of Victorians each year who do not want assisted suicide but who struggle with unmet palliative care needs. Despite the time and money spent on VAD access, the palliative care needs of most Victorians at the end of life still remain largely unmet.7 Other Australian states and territories should be aware of this.