Assisted dying bill prompts calls for new focus on palliative care

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“We need to ensure palliative care funding is not affected by this, in fact, that it is increased because we need it to be,” she said, noting the demand for VAD has been “relatively small” because palliative care can manage most deaths.

“When the language is ‘you’re going to die a horrible death without [VAD]’ – that language is unfair”.

A report by Palliative Care Australia in 2018 found the passing of VAD laws internationally correlated with increased funding for palliative care.

Oncologist Professor Stephen Clarke said universal palliative care standards across diseases were critical.

“Historically the focus of palliative care has been on cancer,” he said, calling for more support for patients with chronic neurological disorders, kidney and heart failure.

Professor Clarke said there was a need to plug gaps with “patchy availability of services and doctors” through more consultative services and care in or near home settings.

Like Palliative Care Australia, the Royal Australian College of Physicians also believes VAD is a government issue.

Geriatricians, included in the college, have historically been critical of VAD, although the Australian and New Zealand Society for Geriatric Medicine’s position has been under review since 2019, with an updated statement expected in the next six months.

Its previous policy raised concerns about coercion of patients. The society declined to comment on the NSW bill due to the ongoing review.

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In submissions for Queensland’s bill earlier this year (since passed), society members supported the rights of older people to stop “burdensome or futile treatment” and die with “dignity” but said they must not be “put in a position where they consider VAD because they feel they are ‘a burden’ on others”.

Sydney geriatrician Dr John Obeid, who was not speaking on behalf of the society but was on its council, remained concerned by the potential for coercion by family members. He said this was observed during discussions about patients entering aged care, and was often too covert to be adequately protected against in legislation.

He was also concerned the bill assumed a person had capacity to consent unless proven otherwise.

“If you look at someone who’s older, who’s got multiple illnesses, perhaps has a malignancy and is approaching the terminal phase of an illness, the incidence of cognitive impairment is quite high … it’s not right to assume they would have capacity,” he said.

Dr Charlie Corke, acting chair of the Victorian Voluntary Assisted Dying Review Board, said coercion had not emerged as an issue in Victoria, where VAD was legalised in 2019.

“We do observe coercion for patients not to engage with it, from their family members and from medical staff they come into contact with,” he said.

According to the board’s reports, 836 people had applied for VAD in Victoria in its first two years and 597 permits were issued, with 331 people dying from taking the prescribed medications.

Seventy-four per cent of applicants were over the age of 65.

Dr Corke said palliative care, geriatric medicine and VAD needed to work in partnership.

“The evidence is the vast majority of patients who engage with VAD come from palliative care, and are very impressed with the care they get, but they still want VAD because this argument that they must go down to the end is not to everyone’s liking,” he said.

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