[Euthanasia in Australia #2] The Australian Euthanasia Bill: The process from application to completion and safeguards to avoid the risk of coercion

[The Australian Euthanasia Bill: The process from application to completion, and safeguards to avoid the risk of coercion]

This paper focuses on the euthanasia law in Australia (Victoria).

・"The specific process from requesting euthanasia to its completion"

- "Safety measures in place to prevent harm to patients"

--I will explain this while focusing on the above two points.

Victoria, Australia, website on euthanasia laws

www.legislation.vic.gov.au

Voluntary Assisted Dying Act 2017

Click here for the PDF of the law

→ https://content.legislation.vic.gov.au/sites/default/files/2023-08/17-61aa006-authorised.pdf

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[Law name] (The process from application to completion as seen in the Australian Euthanasia Bill)

“Voluntary Assisted Dying Act”

*In Australia, the term "Euthanasia" is not used, and the term is Voluntary Assisted Dying, commonly known as "VAD."

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[Eligibility conditions]

・Be 18 years of age or older .

be an Australian citizen or permanent resident and ordinarily reside in Victoria and have been so for at least 12 months at the time of your first application;

-Having decision-making capacity regarding VAD .

- Have been diagnosed with an incurable , progressive, and fatal disease, illness, or medical condition .

-Depending on the disease, within a few weeks to a few months, up to a maximum of 6 months,

　or in the case of neurodegenerative diseases, be expected to result in death within up to 12 months.

( *Not applicable to non-terminal conditions . )

The illness is causing suffering that the person considers intolerable and that cannot be alleviated in an acceptable way.

- A person cannot qualify for VAD solely on the basis of a mental illness or disability .

*Neurodegenerative diseases :

ALS, Parkinson's disease, spinocerebellar degeneration, multiple system atrophy, multiple sclerosis, Huntington's disease, etc.

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[Review process]

[Application Stage ①]

- Anyone seeking access to a VAD makes a clear and unambiguous personal request to a registered healthcare professional.

- Requests can be made verbally, by gesture, or by other available means of communication.

- The healthcare professional who receives the request must inform the patient within seven days whether they will accept or reject the request .

Reasons for refusal include conscientious objection, busy schedule, and not meeting qualification requirements.

If accepted, the healthcare professional will record the patient's medical record and become the coordinating physician (first physician) .

- The patient can withdraw the request at any time, at which point the process ends, but can also start anew.

[Application stage ②]

- The coordinating physician will assess whether the patient meets the eligibility criteria .

- Approved assessment training must be completed before the assessment begins .

- If it is difficult to determine decision-making capacity (e.g., due to a psychiatric illness) or if the patient has a neurodegenerative disease and the prognosis is expected to be 6 to 12 months,

Referral for specialist (e.g. psychiatrist) opinion is mandatory.

If deemed eligible, the coordinating physician will inform the patient of the diagnosis, prognosis, available treatment and palliative care options, the risks and consequences of any medications that will be prescribed, and the patient's right to withdraw the request.

With the patient's consent, steps should also be taken to inform family members about relevant clinical guidelines and self-administration plans.

The coordinating physician must ensure that the patient's request is voluntary, not coerced, and sustained .

- The results of the assessment will be communicated to the patient and recorded in the initial assessment report , which will be submitted to the committee within seven days.

If deemed eligible, the patient will be referred to another registered healthcare professional for a consultative assessment .

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[Evaluation stage ①]

• Another registered health professional accepts or rejects the referral for consultation assessment (the reasons for rejection are the same as those in the original application).

If accepted, the healthcare professional becomes the consulting physician (second physician) .

- Make referrals for specialist opinion regarding decision-making capacity (e.g. mental illness) and illness .

If deemed eligible, the patient will be provided with the same information as in the initial assessment.

- It is necessary to ensure that requests are voluntary, not coerced, and sustained .

- The evaluation results will be notified to the patient, recorded in a consultation evaluation report , and submitted to the committee and coordinating physician within seven days.

If a patient is deemed ineligible, the coordinating physician may still refer the patient to another healthcare professional for further consultation and evaluation.

The role of coordinating physician may be assumed by the consulting physician who assessed the patient as eligible.

[Evaluation stage 2]

After eligibility assessment by both physicians, the patient will provide a written declaration requesting VAD access .

- It must be clearly stated that the action is voluntary, not coerced, and that the person understands its nature and effects (which may result in death).

- The patient (or a representative if the patient is unable to sign) signs in the presence of two witnesses and the coordinating physician .

Witnesses must be 18 years of age or older and not be ineligible witnesses ( beneficiaries of a will, owners/operators/employees of the medical facility where the patient is receiving treatment, or direct medical service providers ).

- Only one family member may be a witness.

- The witness certifies that the signature is voluntary, that the patient has decision-making capacity, and that he or she understands the nature and effect of the declaration.

- If an interpreter is involved, the interpreter must be accredited, must not be an incompetent witness, and must certify that the translation is accurate.

[Evaluation stage 3]

・Final application:

This is done by the patient himself/herself to the coordinating physician after making a written declaration.

This must be done at least nine days after the initial application and at least one day after the completion of the consultation evaluation .

A shorter period is acceptable if death is expected to occur within 9 days.

・Contact person:

After finalizing the application, patients will be required to designate someone aged 18 or older as a contact person.

The contact person accepts the appointment and is obligated to return any unused medication to the pharmacy after the patient's death (within 15 days) or if self-administration is discontinued .

The nomination form must be signed by the patient and the contact person in person, in the presence of a third party aged 18 or over.

The Committee may contact the Liaison Officer for information.

・Final review

The coordinating physician reviewed all relevant forms (initial assessment report, consultation assessment report, written declaration, and contact person nomination form).

Demonstrate that the process is completed in accordance with legal requirements.

A copy of the final review form and all forms reviewed will be sent to the Committee within seven days.

Even after certification, patients can decide to discontinue VAD at any time.

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[Discussion stage]

- The coordinating physician will apply for a permit after certification of the final review.

There are two types of permits .

1. Self-administration permit:

This applies when the patient is able to administer the medication themselves.

Coordinating physicians prescribe and supply medication, and patients are authorized to obtain, possess, store, use, and self-administer medication. If unused, the contact person returns the medication.

2. Practitioner administration permit:

Applies when patients are unable to administer medication themselves.

Allows coordinating physicians to prescribe, supply, and administer (in the presence of witnesses) medications, provided the patient has decision-making capacity, there is a voluntary and sustained request, and the medication is administered promptly upon request.

3. The responsible ministry reviews the application (grant or deny) and notifies the coordinating physician and the committee.

The permit will identify the drug and will be effective from a specified date.

A self-administration permit will be cancelled if the unfilled prescription is destroyed or the supplied medication is disposed of.

If a patient is no longer able to self-administer, they can request a medical professional administration permit, which requires them to destroy any unfilled prescriptions and return any medication already supplied.

*In Australia, euthanasia drugs can be administered either by self-administration or by a doctor. In some countries, only the former is permitted.

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[Implementation and reporting stage]

Prescription /Dispensing (Self-Administration):

The coordinating physician explains to the patient how to self-administer the medication, that there is no obligation to obtain or take the medication, that the medication must be stored in a locked box , and how to return any unused medication. Pharmacists also provide similar information when dispensing medication.

· display:

Medications must be labeled with warnings of their purpose, hazards, storage requirements, and return policies.

・Recording/Notification (Pharmacist):

Pharmacists must record the dispensing and send the form to the committee within seven days. They must also record the disposition of returned medications and notify the committee within seven days.

・Application for administration (administration by medical professionals):

The patient must apply to the coordinating physician for administration. The patient must have the capacity to make decisions, have a persistent request, and understand the need for immediate administration. A witness must be present. If the requirements are not met, the coordinating physician can refuse the application.

・Witness to administration:

Must be 18 years of age or older and independent of the coordinating physician. Demonstrate patient competence, initiative, and persistent need, and document that the coordinating physician administered the medication.

・Certification by the coordinating physician (after administration):

The coordinating physician must certify that the patient was unable to self-administer, had decision-making capacity, was voluntary, and the request was persistent. The form must be sent to the committee within seven days.

・Death notification:

Registered healthcare professionals notify the registrar and coroner of the death and the underlying condition, specifying whether the VAD medication was self-administered, administered by a healthcare professional, or not used.

Death records include information on age, sex, ethnicity, postcode, disability status, and terminal illness .

*Points to note

Under Australian euthanasia laws , in the case of self-administration , the medication must be kept in a safe at home and can be carried out whenever you want . There is no need for a doctor or nurse to be present.

It 's like having a " charm" by your side. In many cases, people die without using it, so the aforementioned contact person is necessary.

This may be cause for concern among Japanese people, but there are apparently no problems at present.

Please also refer to the following UK Parliamentary debate:

Statement by the President of the Australian Society of Palliative Medicine

Patients can qualify for euthanasia

“A Great Comfort”

The ultimate insurance policy

It was expressed as follows.

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[Other notes]

Conscientious Objection

Registered healthcare professionals have the right to refuse participation in a VAD.

Physicians must not initiate discussions or propose VADs unless the patient has requested them (this rule will be abolished in November 2025).

Voluntary Assisted Dying Review Board

An independent body has been established to monitor matters relating to VAD and review the operation of the law.

The committee will promote compliance, investigate issues, analyze data, and report annually to Congress .

If foul play is suspected, they have the power to provide information to appropriate authorities such as the police or coroner.

Liability Protection and Violations

Healthcare professionals and other parties who act in good faith in accordance with this Act will not be subject to civil or criminal liability and professional disciplinary action.

Using fraud or undue influence to induce another person to request a VAD or to self-administer the drug is a serious offence punishable by imprisonment up to life imprisonment .

Making false statements or forging or destroying documents is also a crime .

These safeguards are designed to protect patients' vulnerabilities and ensure their freedom of choice and dignity throughout the VAD process.

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[Victoria, Australia's euthanasia process]

① "Adjusting" doctor: Evaluate whether the patient meets the eligibility criteria (first check)

↓

② "Consultation" doctor: Another registered doctor gives the same evaluation as ① (second check)

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③ "Written" declaration: Signed in front of two witnesses and the coordinating physician (Check 3-1)

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④ Final check by coordinating physician: appoint a contact person (3-2 check)

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⑤ Apply for a euthanasia permit: The examination committee and the relevant ministry will examine and issue the permit (3-3 check)

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⑥ Implementation

*Slightly simplified.

① "Adjusting" doctor: Evaluate whether the patient meets the eligibility criteria (first check)

↓

② "Consultation" doctor: Another registered doctor gives the same evaluation as ① (second check)

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3) After the written declaration, the first coordinating physician will make a final check and apply for a euthanasia permit to the committee and the government agency (i.e., the national or administrative agency) (third check).

* This corresponds to what is called "SCEN" in the Netherlands .

　This corresponds to what is called a "panel review" in the UK .

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⑥ Implementation

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remarks

Australia's euthanasia system requires extremely strict implementation, and many experts have pointed out the complexity of the procedures.

In fact, it is widely known that Australia's euthanasia system has been criticized by medical professionals in the field for its overly strict design.

The procedure has now gone beyond the mere description of being "strict"; it is now considered extremely complicated and cumbersome.

The basic framework of the system is structured in three steps, but each step takes a considerable amount of time and requires the involvement of a large number of medical professionals .

The two main supervisors are a coordinating physician and a consulting physician, but in reality, multiple other physicians are often required to participate in the procedures, making the burden of operating the system no small feat.

[Reference video]

Video provided by Mufumufu Channel