Introduction
- Voluntary assisted dying (VAD) involves a process to access medication and to enable a person to legally choose the manner and timing of their death. Put simply, VAD means that some adults could ask for medical help to end their life if they have a disease or illness that is so severe it is going to cause their death and they are suffering badly. The term 'voluntary assisted dying' emphasises the voluntary nature of the choice of the person and their enduring capacity to make this decision.
- Persons who have accessed VAD are able to acquire a 'substance' that they are entitled to carry anywhere at any time as long as they demonstrate decision making capacity. It is considered as part of the individual's possessions.
- The ingredients or make-up of the 'substance' is not known or disclosed, hence being referred to as such.
- The 'substance' is secured in a red lock box to make it obvious. It will normally be sealed and locked with a tamper proof tag and combination lock. It cannot be unreasonably withheld from the patient at any time.
- Health Professionals should be aware of The Act and its requirements
Contact and encounters
Interactions with such persons may occur for a variety of reasons including (but not limited to),
- Interfacility transfers or discharges etc.
- Calls for illness or injury requiring assessment or ED admission
- If a person has taken their 'substance' and someone calls 000
Such encounters are anticipated to be infrequent. Advance Care Directives etc. will normally be in place and communicated.
Clinical Events
Deterioration during transport or transfer should attract care and support to ensure the patient is comfortable. Acquire sound information and agree a plan prior to transport. Use the Interfacility Form as necessary.
No special storage of the 'substance' is necessary. However, good practice must include ensuring it is accounted for and included in handover summaries.
Resuscitation efforts or priority diversion to an Emergency Department should not occur in this patient group.
In the extremely rare event that persons may wish to access and take their 'substance' whilst in St John's care, they should not be actively prevented or discouraged from doing so even if there is a conscientious objection. The person should be capable of decision making capacity at that time. The Health Practitioner Advice guidance outlines that persons cannot be denied access to the VAD 'substance'. If asked to aid the person, ambulance clinicians;
- CAN open the secure case when given the code and break the tag if asked
- CAN uncap the two 'substance' bottles if asked
- CAN NOT assist the person to mix the contents of the bottles (this differs from other States)
- CAN NOT assist the person to take the 'substance' . This MUST BE independently undertaken. Unconsciousness will follow within a few minutes of ingestion.
If a person has taken the 'substance' and ended their life, there will normally be a contact person present (e.g. family or friend). These individuals are authorised to secure the 'substance' bottles and paraphernalia for safe disposal as outlined here. In other scenarios, follow the advice of Coronials.
Documentation
Clinical notes:
Complete your notes in the record as you normally would. Be tactful around how wording around VAD is entered.
It is reasonable to adopt wording to the effect :
I reasonably believe that the person self-administered, or was administered, a voluntary assisted dying substance in accordance with the Voluntary Assisted Dying Act 2019
This wording might provide additional protections under section 115 of the Act.
Life Extinct Forms:
- On electronic ROLE forms select the option aligned to 'expected death and/or advanced directive’
- Avoid annotating any hard copies of life extinct with anything extra than the original form provides (e.g. VAD).
Legal Protections
There are provisions in the act to protect emergency first responders (e.g. Paramedics and Volunteers) who do not administer lifesaving treatment to a patient who has taken the VAD 'substance' to end their life. Transport Officers are also protected persons. This is reflected in Part 8 Sec 115 of the act.
This is outlined clearly in the Information for First Responders advice by WA Health.
Important:
A low threshold to call the Clinical Support Paramedic in SOC should be applied whenever there is any uncertainty or unanticipated event.
Document Control
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