Drugs for voluntary assisted dying to be delivered in locked boxes

A small team of pharmacists at The Alfred hospital in Melbourne will be responsible for mixing the lethal cocktail of medications that will be used in the first cases of voluntary assisted dying in Victoria.

VAD will be legal in Victoria from 19 June, meaning that pharmacists will be able to make the medications, and deliver them in locked boxes, along with instructions, to patients who have been assessed and approved for the procedure.

Details of the exact medications used will not be made public, as is the practice in other countries, such as Canada and the Netherlands where VAD is legal.

Any unused medication will be returned to Alfred Health to be disposed of.

How does VAD work?

VAD will be available for Victorians aged 18 years and over, who have a terminal illness and are expected to die within six months. They must be capable of making the decision themselves and communicating their wishes with their doctor, and must have lived in Victoria for at least 12 months.

Those who are interested in accessing VAD, have to find a doctor with the appropriate qualifications to determine if they are ‘eligible’.

A second doctor will then make the same assessment to determine if the person is eligible.

If deemed eligible, the patient must then put their request in writing, and at least nine days later, they must make a second request.

On receiving the final request, the doctor will apply for a permit to prescribe the medication that can be used, when the person wishes, to end their life.

The person can administer the medication themselves in a drink, of, if they are physically unable to consume the liquid, their doctor can administer the medication.

After VAD, death certificates will show the cause of death as the medical condition the person was suffering, not VAD. The death will not be a ‘reportable death’, meaning that police will not have to be involved.

Once the VAD permit is issued, there is no expiry date. The medication can be prescribed when and if the patient chooses.

Single supplier allows for control

Professor Michalel Dooley from the pharmacy department at Alfred Health, noted in his presentation ‘Statewide pharmacy service’ from the recent Voluntary Assisted Dying Implementation Conference, that having a single supplier allows for a safe and controlled process for the prescribing, dispensing and retrieving of VAD medications.

He wrote it’s not expected there will be a large number of people accessing the VAD service, and therefore most pharmacists will not have to become familiar with the VAD medications.

Issues for doctors

Dr Greg Mewett, palliative care physician and a member of the VAD implementation taskforce, noted at the conference that health professionals aren’t able “initiate” discussion about VAD or suggest VAD as an option.

He said carers, family members, and friends can ask for information but VAD, but can’t make a VAD request on another person’s behalf.

Not all GPS have to help patients with VAD. Doctors have the ability to “conscientiously object”, which means they don’t have to provide information or support to patients about VAD.

Dr Mewett noted that requests for VAD must be specific, for example, patients might ask, “I would like you to help me die.” Less direct questions, such as, “I’ve had enough and I want to die”, are not enough to justify a conversation about VAD, he said.

If you would like to find out more about VAD, you can visit the Victorian government’s VAD website.

If you or anyone you know needs help, contact Lifeline on 13 11 14 or Beyond Blue on 1300 22 46 36.

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    1. I guess you’re a conscientious objector (for whatever reason) and have never had to watch someone dying of an incurable disease and in terrible pain … Because, towards the end, the allowable doses of pain medication stop working. I hope you aren’t a nurse because your empathy level must be zero.

  1. Alzheimer’s patients cannot use this as they cannot speak or make decisions for themselves unfortunately. Hopefully there is something in the pipeline for this.

  2. After my dad had 2x strokes on each side of his brain, he was unable to do anything for himself & relied on 2x nursing staff to care for him. He couldn’t feed or move himself & wasn’t able to talk but he could still understand & know who we were. It was heartbreaking to see a big man decline to a skeleton in the 5 slow mths of his wasting away & died from stage 4 bed sore infection that was never going to heal. His story was one that was read in Parliament to get the bill passed for assisted dying. So glad that it’s finally available for some that are terminally diagnosed as it’s taken a lot of counselling session to help me with what we went through as a family 💝

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