Labor backs removal of telehealth ban on voluntary assisted dying services

The position was taken at the political party’s national conference held in Adelaide where the party has indicated support for a conscience vote on lifting the current ban.

Dr Bhawani O’Brien, who provides VAD services in WA, told Medical Forum that overturning the ban would bring more equity into the process.

"It is a huge barrier to providing equity of services, especially to patients who are in rural areas in our vast state," she said.

Currently two sections of the Criminal Code Act 1995, which were passed before VAD was legalised in Australia, make it an offence to use a ‘carriage service’ (such as a telephone, videoconference, email or other forms of electronic communication) to publish or distribute material that counsels or incites committing or attempting to commit suicide.  

The AMA has said these laws have “the unintended but very real consequence of undermining access to VAD services” by prohibiting doctors and other healthcare practitioners from using telehealth to discuss with patients the delivery or administration of VAD services.

This is despite VAD being legal in every Australian state and the ACT, while the Northern Territory government is in the process of legislating for it. 

Dr O'Brien has been working with VAD patients for four years.

"One of our barriers has been not using telehealth for a certain part of our assessment, which is the final assessment," she said.

“It's when we talk to the patients about when, where, if, and how they use their medication, or we come to them with a medication - we have to see them face-to-face.

“That brings up a big issue for us, especially in WA, because it's a vast state. It can mean that we fly to Albany just to have this conversation, or fly up to Exmouth, and we're depending on flights that are often delayed or cancelled.

“We sometimes drive out to the Wheatbelt - these are patients who are waiting to have their process put in place.

“We have missed the boat for some patients because they've got so unwell that they've lost capacity."

Dr O'Brien said another inequity caused by the ban on telehealth was around providing VAD services to patients in hospitals which have a conscientious objection and do not allow any related activities to take place.

“For example, for that final assessment, I've had to have patients put in a wheelchair, brought downstairs by their loved one and we have had to wheel them out, not just to the gardens on the hospital premises, but across the road to a car park to do the assessment.

"I've had patients vomiting into plastic bags and just really struggling to do this."

She said scrapping the ban could assist in being able to communicate with these patients through alternative methods while they remain in their hospital bed.

While she said she would prefer to have elements of face-to-face contact within most VAD cases, she said the reality was that in some cases it might not be possible.

"If I had to choose between not seeing the patient face-to-face until I'm actually giving them the medication, or them missing the boat, losing capacity or dying before they get their VAD in place, I would forego seeing them face-to-face," Dr O'Brien said.

While the outcome from the vote at the Labor Party conference means the matter will become part of the party’s platform, it does not automatically trigger a vote going ahead. Prime Minister Anthony Albanese told the ABC he opposed the idea of such legislative change.

“I respect the fact that there are different views on this. My concern is the potential for misuse, but also the potential that it has to undermine the system in itself,” he said.

Dr O’Brien called on the Prime Minister to “walk through the journey” she and her colleagues go through in supporting a patient through the voluntary assisted dying process before objecting to lifting the ban.

“I would urge the PM to walk through this journey with one of us, to come and sit through first assessment, second assessment, final assessment, and then make his mind up," she said.

In May the AMA wrote to the Attorney General warning that patients with serious life-limiting illnesses, particularly those in regional and rural areas, were being disadvantaged by laws preventing doctors using telehealth to discuss voluntary assisted dying (VAD). 

A recent review of telehealth use in VAD globally showed Australia was the only country that criminalises the use of telehealth for the provision of legally available VAD services. 

Go Gentle Australia has found the ban on telehealth had contributed to Australian health professionals repeatedly making trips of 1000kms or more to visit patients and placed limitations on follow-up support provided by nurses, care navigators and pharmacists as a phone call or email to a patient or their family could breach the law. 

Go Gentle has said the current laws also mean scripts for VAD medications have to be posted, couriered or hand-delivered, rather than being sent electronically.