Voluntary assisted dying legislation must be amended in the ACT

As a healthcare provider who coordinates care with partners in NSW, Calvary expresses significant concerns about potential confusion arising from discrepancies between the proposed ACT framework and that of neighboring NSW.

Calvary's submission to the Legislative Assembly Select Committee on the VAD bill 2023 proposes changes to the bill to achieve harmonisation with the established NSW model. This alignment is crucial to minimise confusion among residents, healthcare practitioners, and providers in both jurisdictions.

Calvary operates hospitals and healthcare services, including residential aged care, in five other states across Australia where VAD has already been introduced. In those jurisdictions, legislation allows for individual conscientious objection and for healthcare organisations to choose whether or not they will provide those services.

Calvary is deeply concerned the proposed ACT legislation seeks to force any healthcare provider, which chooses not to participate in VAD, to allow non-credentialled practitioners to enter their hospitals and hospices and provide a service outside of its ordinary scope of practice.

In the typical course of delivering healthcare, it is routine and unremarkable for healthcare facilities not to provide every service. This may be because the service falls outside the facility's scope of practice or it may be because the facility does not wish to provide certain services.

The proposed ACT legislation should be amended to align with the NSW existing laws allowing healthcare service providers who do not offer VAD services to make decisions about patient transfers in consultation with the patient and their treating medical practitioner.

Calvary respects patient choice and recognises some patients in our care may wish to explore the option of VAD. In these instances, our staff hold open, respectful discussions with patients and their families, including offering and organising appropriate transfer to other services.

Calvary holds concerns about the eligibility requirements for registered health practitioners to act as coordinating, consulting and administering practitioners.

Unlike other Australian jurisdictions, where the eligibility requirements are clearly outlined in the relevant acts, the ACT bill defers detailing the eligibility requirements for registered health practitioners to future regulations.

Given the broad definition of "health practitioner", we seek that the bill specify which health practitioners will be eligible to provide VAD services.

By comparison, no other Australian jurisdiction, including NSW, allows any health practitioner other than a medical practitioner to act as a coordinating practitioner or a consulting practitioner.

A coordinating or consulting practitioner is required to make clinical decisions regarding an individual's diagnosis, prognosis and decision-making capacity regarding VAD.

For most other health practitioners, decisions like these are outside their scope of practice.

Calvary also notes the substantial differences in the proposed role of the ACT VAD board from that in NSW and other jurisdictions.

In NSW, the VAD board provides direct oversight of the VAD application and approval process by granting or denying prospective approval before a substance can be prescribed. In the proposed ACT model, this role has shifted from a prospective approval to a retrospective review process.

This means it will be the individual's coordinating practitioner who will approve the assessment, the final request and prescribe the approved substances. If regulation were to broaden the eligibility criteria, it may result in a workforce performing assessments outside their ordinary scope of practice with no independent oversight of the process until after death has occurred.

Calvary's stance regarding VAD is well-documented. For this reason, we declined the ACT government's request to participate in a working group about the adoption of VAD.

Calvary cannot and will not provide for the administration of a substance that will directly and intentionally cause a person's death.

Calvary remains committed to delivering highly valued, specialised palliative care to the communities we serve. We have a strong and proud history of doing exactly this in Canberra and NSW. In order to ensure that choice is not just a principle but a reality, high quality palliative and end-of-life care must be easily accessible to all in the ACT and in NSW. We urge the ACT government to fund universal access to palliative and end-of-life care for all people who access healthcare services in the ACT, including those from the places in NSW that surround the ACT.

Over the coming months, while this emotionally-charged issue is discussed, I would encourage all participants to remember this is a debate about life and ultimately access to care. As discussions unfold, let us be respectful, acknowledging that every voice matters, and a robust, trusted governance framework must prevail to safeguard the wellbeing of all.