The Voluntary Assisted Dying Act 2017 (Vic) will come into force in Victoria in June 2019, becoming the first law in Australia since the rescinded NT legislation to permit voluntary assisted dying. This is only the tip of the iceberg as in Western Australia a Bill to legalise voluntary assisted dying will be introduced in the second half of 2019. Queensland is the fifth Australian State or Territory since 2015 to inquire into law and policy relating to the end of life and palliative care, following Victoria, Tasmania, the Australian Capital Territory, and WA.
End of life law governs medical decisions made at the end of life, as well as around Advance Care Planning and the likelihood of legislation may remove some of the anxieties that health professionals have in relation to care of the aged and terminally ill client.
There has been considerable discussion about the adequacy of palliation treatment and medication premised on the supposition that inadequate pain relief is provided when health professionals fear the risks of hastening death as a consequence of medication. In fact there could be regulatory repercussions from inappropriate inadequate administration of medications leading to pain and suffering. The health professional can face complaints including criminal charges, civil negligence claims, coronial investigations and disciplinary proceedings.
Countering this Willmott et.al suggest that fears of legal or professional repercussions are largely unfounded, and that existing laws and other forms of regulation should not inhibit the prescription and administration of adequate pain and other symptom relief to people at the end of life (Providing palliative care at the end of life: Should health professionals fear regulation? Lindy Willmott, Ben White, Donella Piper, Patsy Yates, Geoffrey Mitchell & David Currow (2018) Journal of Law and Medicine, 26(1), pp. 214-245).
There is a great deal of uncertainty and anxiety felt by staff caring for the aged and terminally ill patient often attributed to the legal aspects of decisions about care and agreeing to specified Advanced Health Directives or refusal of consent. We all know what happens when family members hold differing opinions about how to care for their loved ones, “do everything possible” versus “a peaceful and pain free end”. This is why the existence of a health directive and good communication on admission is so helpful to staff.
There are risks of conflicts between staff. Deciding whether to transfer to hospital or initiate emergency care is in my experience something that always occurs in the middle of the night especially when you are new on the job. It is a combination of health and legal decision making and it does create stress.
While the law is moving forward and legislation is being developed we need to stay up to date and know how to navigate these situations. One of the tools that can give direction is the concise and very readable End of life law in Australia: An overview for the aged care sector (www.eldac.com.au).
There are some fabulous webinar recordings by Pam Savage regarding Nurses and the Law at the Nursing CPD Institute. The Nursing CPD Institute provides good information and CPD on an array of nursing topics in a range of easy learning ways including webinars and quizzes on the latest information that Nurses need to know – remember the Nursing CPD Institute was created by Australian Nurses for Nurses! https://www.ncpdi.com.au