Voluntary Assisted Dying

TW- Discussion on voluntary ending of life.

Intention- To share knowledge around the VAD process, to dispel myths and to offer resources to those seeking VAD and those who are supporting someone seeking VAD. This article is not intended to be advise or encouragement of VAD.

First of all, what is VAD? VAD stands for Voluntary Assisted Dying. We used to call this euthanasia, however the terminology has been updated to reflect the fact that we are not administering this to someone else, but rather, the person is seeking this service for themselves. In other words, a person voluntarily seeks out assistance to end their life medically.

Is VAD suicide? This is a very important question which I think has the potential to spark debate, especially when we add the complexity of personal, spiritual, religious and cultural beliefs. However, if we look at it from purely a medical, emotional and grief standpoint, there are some key differences between VAD and suicide.

Suicide can often be shocking and traumatic for the loved ones of the deceased for a number of reasons. Notwithstanding, the guilt and shame people may experience “If we just could have supported them better.” But also, the fact that suicide can often be violent in nature. There are dozens of reasons why suicide can be dramatically traumatic for everyone involved and the VAD process is a very very different scenario.

For the most part, a VAD patient has carefully consulted with friends, family and medical team around their decision. But the biggest difference is that VAD is often conducted in a very loving, gentle and caring way.

Second, VAD is a medical procedure. Just as you can receive life saving intervention, one can also access intervention to end suffering. We must also take into account the very strict access criteria. VAD does not end the life of someone without due cause. It simply hastens a process that is already happening and seeks to end suffering.

I have had the honour and privilege of baring witness to the VAD process here in QLD. So for the purposes of this blog, I will exclusively discuss the process that happens in QLD. It’s important to note that each Australian state hasb their own laws and procedures around the access and administration of VAD.

How does it work? The first contact is with your medical professional. If you are in hospital, they will have a VAD consultant that can speak with you about your decision. Outside of hospital, you would contact your GP. Your GP then must make a decision to accept or refuse your request for VAD. If they refuse, they must provide a reason, the two main reasons are that they either think that you don’t meet eligibility or, your GP has a conscious objection to VAD. Either way, you are entitled to seek a second opinion if you desire. If they accept your request, then the process begins very quickly. Once the VAD team is on board, you generally move through to receiving the medication after 10 days from initial request.

First, you will meet with one of the nurse practitioners who run the VAD service. Here they will provide you with information about the process and discuss eligibility with you in detail.

Next, you will be assessed to see if you meet eligibility. Two separate Doctors will assess you on different days for eligibility to ensure that you meet the criteria. Eligibility has 6 main components.

  1. Disease, illness or medical condition. – Here, it must be ascertained that your condition is progressive, is expected to cause death within 12 months and causes suffering.
  2. Decision making capacity.- Here it will be established that you are capable of making this decision for yourself.
  3. Acting voluntarily and without coercion.- It must be obvious to the team that nobody is persuading you to make this decision. Think in terms of consent. Your consent must be enthusiastic and coercion free.
  4. Age.- You must be over 18 years of age
  5. Australian Citizen or Resident. You must meet residency requirements.
  6. Qld Resident. – You must be a Qld resident.

More detailed information about eligibility can be found in the QVAD (Queensland Voluntary Assisted Dying) handbook which will be linked below.

What if you have speech difficulties? – An interpreter is allowed, also, the team are very skilled at navigating speech challenges and utilising communication aids. A speech disability or inability should not be a barrier to you accessing VAD

What happens next? Once you have been assessed by the two different VAD doctors on 2 different days, the first Dr will return to give a final examination and ensure you still want to go ahead. At which point, the Dr will give the green light.

At some point through the process, the nurse practitioner or Dr will speak with you about administration options. There are two options available for the administration of the life ending medication.

Either the medication will be sent to you in a drinkable solution. You must be able to pick this up and self administer (drink the entire drink in one go without assistance) in order for this option to be legally viable. Once you have the drink, you can choose a time and day to drink this at your leisure. -OR- If you are unable or unwilling to self administer, the nurse practitioner can schedule a date to come and administer the medication intravenously. NOTE- If you are utilising the intravenous method, you must be able to give consent on the day. Again, speech difficulties should not be a barrier to this process.

Is it painful? No. I am not a medical clinician so I am unable to provide specifics about the exact medications used here. However, the consultants did explain to me that the medication does contain some powerful pain relieving substances. Also, I personally witnessed a VAD patient experience great pain relief in the moments before their passing. It is very gentle and calm.

Other Considerations. As with any end of life process, this is a deeply personal process that you may choose. You are able to personalise this process any way you wish. You might want to consider who you want present with you, any spiritual or religious practices, do you want music or prayer? There is a lot to consider here and your family along with your Death Doula can help with offering choices, however, at the end of the day, the decision must ultimately be your own.

VAD provides not only a way to be released from suffering, but it also provides a unique opportunity to customise ones closing ceremony in a way that is not often afforded to most. Whilst it can be a very confronting process to witness, with the correct support, it can be deeply sacred.

However we die, all deaths, the closing ceremony of all lives, must be approached with the appropriate reverence. For it is a sacred passage to be honoured and respected.

Below I have included a link to the QVAD information PDF as well as a link to the Dying With Dignity resource site.

https://www.health.qld.gov.au/__data/assets/pdf_file/0027/1166184/qvad-handbook.pdf

https://www.dwdq.org.au/access_vad

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