Voluntary assisted dying and telehealth: Commonwealth carriage service laws are putting clinicians at risk

To the Editor: Close and colleagues raise some important issues in their article on voluntary assisted dying (VAD) and telehealth.1 For the most part, their four key considerations give good practical advice to clinicians trying to work around Commonwealth laws introduced for a substantially unrelated purpose.

A scenario they do not address is where a patient has been assessed as eligible for VAD, and then needs to discuss with the doctor by telehealth the choice between having lethal medication administered to them, or taking it themself (self‐administration).

This is already an issue in Western Australia, and will become an issue in Tasmania and Queensland; not so much in Victoria or South Australia, where this choice is essentially restricted by clinical criteria set out in the legislation.

In the above scenario, it needs to be made clear to the patient that the doctor is not favouring self‐administration over practitioner administration, but has an open mind in talking through this choice by telehealth with the patient.

Close and colleagues are right to caution against using telehealth to discuss the VAD medication protocol for self‐administration, but their advice to have such discussions in person is not particularly helpful when the doctor is remote from the patient.

When self‐administration is chosen, Western Australian law requires written instructions to be provided to the patient by the doctor and the applicable pharmacist on how to prepare and take the lethal medication.2 It can be explained that these instructions will be provided as hard copy, with the doctor making clear that nothing said to the patient over telehealth should be construed as instruction on how to prepare or take the medication.

When the pharmacist delivers the medication to the patient for self‐administration, as is the practice in Victoria and Western Australia, any question about the written instructions can be dealt with face to face, as part of the counselling of patients expected of pharmacists under guidelines issued by the Pharmacy Board of Australia.3