Home' Australian Ageing Agenda : AAA Jan-Feb 2018 Contents ®
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A Victorian doctor may administer the drug
where the terminally-ill person has decision-
making capacity but is unable to swallow or
cannot self-administer or digest the lethal dose
For those concerned that the new voluntar y
assisted dying laws will encourage family
members or care staff to hasten the deaths of
family members, a review of similar legislation
in North American and European jurisdictions
shows that strong individual protections remain
in place to prevent this.
European countries allowing euthanasia,
such as Belgium and the Netherlands, enable
doctors to administer drugs to those suffering
unbearably, and euthanasia is available to both
children and adults with terminal illnesses.
Belgium allows “competent minors” to request
euthanasia whereas in the Netherlands doctors
have published guidelines for newborns with
severe disabilities that may help doctors avoid jail
although the practice itself remains illegal.
Canada’s framework is still new as it legalised
assisted dying relatively recently following the
Canadian Supreme Court ruling in 2015 that
the Criminal Code prohibition against assisted
dying was unconstitutional because it breached
Canada’s Charter of Rights and Freedoms. Canada’s criminal
code was amended in 2016, and no further changes have
Oregon’s legislation has changed little despite pressure to do
more, for example, by extending the life expectancy requirement
from six to 12 months. However, changes have clarified what it
means to be an Oregon “resident” and required pharmacies to
report when prescriptions have been filled.
American jurisdictions permit assisted suicide, but do
not allow euthanasia. Eligibility for assisted suicide differs
depending on each state’s legislation. All US jurisdictions
require terminally ill eligible residents to have a life
expectancy of six months and be at least 18 years old.
In 2016, California became the fifth US state along with
Oregon, Washington State, Vermont and Colorado as well as
the nation’s capital, Washington DC, to allow the terminally
ill to access lethal medication.
Some doctors resisted at first saying that they saved lives
and did not end them. Some still oppose it and will not write
prescriptions. A group of doctors filed a lawsuit alleging that
the law decriminalises assisted suicide and strips terminally ill
patients of their protections under California state law. While
the case will go to trial, it is unclear at this stage when that
Patients at California’s religious care institutions have
helped highlight personal issues around death and dying
for health workers by requesting end-of-life medication
because of fears they will be a burden to their families, or are
frightened of what is to come.
As a result, Catholic church-affiliated hospitals in local
dioceses now hold end-of-life workshops. The Los Angeles
Archdiocese offers end-of-life care workshops including
ethics, palliative, hospice and pastoral care.
California doctors now have more conversations with
patients to address their needs and fears about dying.
Some now see that medical care for sick patients has
improved, even for those who don’t take advantage of it, and
there is a new standard to help the terminally ill including
getting their legal or financial affairs in order.
Sometimes patients had not previously disclosed their
degree of pain, and now doctors can adjust medicines or
treatments. Some patients go into hospice care earlier than
they would have otherwise.
Doctors say that patients are curious about the law and ask
about it, and this gives doctors opportunities to discuss patient
care as well as planning around death, including
the creation of advanced care directives.
Canada is now studying potential legislative
changes regarding assisted dying for mature
minors, advance care directives and people with a
The Victorian Medical Treatment Planning
and Decisions Act 2016 will commence in
March 2018 to create a patient-centred focus
for advance care directives and the obligations of
People will soon be able to create legally
binding advance care directives and appoint
medical treatment decision makers and support
persons for their future medical treatment.
There will be no age limit, and those who
understand the nature of their proposed
treatment and the potential outcomes if their
wishes are followed – including allowing them to
die – will be competent to make such directives.
However, the drugs to be used in Victoria to
end life are still unclear. Nembutal is not legal
in Australia, but is the main drug used by other
jurisdictions. Other legal drugs in Australia have
the potential to cause long and protracted deaths
with side effects causing unnecessar y end-of-life
suffering and distress.
For those working and residing in aged care, palliative
care remains an option. All governments must ensure that
its citizens have quality end-of-life care. In conjunction with
the new assisted dying legislation, the Victorian government
has pledged $62 million over the next five years to improve
palliative care across the state.
However, it is up to all of us to hold this government and
all future governments to account for this commitment as
there can sometimes be a wide gap between such promises
and their actual delivery. n
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