Almost three years ago, Independent MP Kate Chaney pushed to amend federal laws that ban telecommunications services from being used to incite suicide, so that patients wishing to access voluntary assisted dying appointments could do so via telehealth.
It went nowhere, with the bill lapsing.
The issue is now back on the political agenda.
The Labor national conference, which closed on 25 July, voted to repeal the law and to give Labor MPs a conscience vote on the issue, only for the prime minister, Anthony Albanese, to say the government might not progress the laws though parliament.
He said while he supports voluntary assisted dying, also known as VAD, he believes the telehealth change risks undermining proper medical safeguards.
So what is behind the push to repeal the law and who is calling for it?
What laws are in place?
Currently every state and territory allows VAD except for the Northern Territory, though proposed laws there are expected to pass in August.
Professor of end-of-life law and regulation with Queensland University of Technology Ben White said: “This is not about whether voluntary assisted dying should be allowed or not.”
“The question is, how much suffering are we willing to inflict on people in order to access it?”
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Criminal legislation introduced in 2005 to address internet chatrooms and websites where suicide was being promoted and encouraged means it is also unlawful for doctors to discuss many aspects of VAD over the phone or internet with patients.
“The legislation was not intended to deal with lawful voluntary assisted dying, which of course wasn’t in force until more than a decade later,” White said.
Australia is now the only country with legislation that prevents telehealth VAD consultations.
A significant burden for some
Chaney said she has heard reports of people in severe pain, often unable to move and at the end of life, unable to travel to attend a VAD appointment because of their circumstances. It particularly affects those living rurally and regionally, with some doctors and pharmacists travelling for hours to visit their patients.
“For years, VAD practitioners have been saying this telehealth issue is the most important issue to be dealt with,” Chaney said.
A review of use of telehealth globally in VAD and other sensitive areas of health, published in November, found telehealth’s benefits outweigh its risks.
An analysis of multiple pieces of research examining the impact of the criminal legislation in Australia found it has led to delays in VAD care. In some cases, patients were no longer eligible to access VAD by the time of their in-person appointment, because they were too sick to consent, or take the medication.
Safeguards would remain
Concerns have been raised by the attorney general, Michelle Rowland, around vulnerable people and those suffering elder abuse being coerced and pushed towards a consult via telehealth.
Kate Chaney MP: ‘At the moment, you can’t even ring your doctor and ask some questions after you’ve got the medication.’ Photograph: Matt Jelonek/AAP
Chaney said there are many checks and balances in place that would ensure telehealth is used appropriately, adding telehealth is already used for a range of other critical medical decisions.
While state laws differ, generally “you need to request VAD three separate times from two doctors, who have to assess your eligibility”, Chaney said.
“Of course the preference would be that it’s in person. But at the moment, you can’t even ring your doctor and ask some questions after you’ve got the medication, even after you’ve made your three requests for VAD in person.
“If the doctor speaks to you about it on the phone at all, then they are open to criminal prosecution. So you end up with doctors having to speak in cryptic terms when they should be able to speak clearly, which is what patients deserve.”
Two witnesses to the decision who are not family members or beneficiaries are also required.
Some states already allow telehealth consultations as part of their VAD laws, but the federal legislation overrides it. It also means scripts for VAD medications have to be posted, couriered or hand-delivered in some jurisdictions.
The Medical Board of Australia already sets guidelines around appropriate telehealth use, which would apply to VAD.
What do the peak bodies say
The Australian Medical Association (AMA) has long supported the telehealth changes proposed by Chaney and end-of-life advocacy organisations.
AMA president, Dr Danielle McMullen, said: “telehealth should operate for VAD as a valuable complement to in-person care, and not a replacement for clinically necessary physical attendances”.
The Royal Australian College of Physicians stated it “does not have a position on the intersection of telehealth and VAD” in its submission to the Northern Territory’s community consultation process.
“The RACP recognises that legalisation of voluntary assisted dying is for governments to decide, having regard to the will of the community, to research, and to the views of medical and health practitioners,” its position statement says.
The Law Council of Australia has called for legislation to be “urgently amended to allow for consultations on VAD to occur via a carriage service” so people are “armed with all the medical knowledge and support they deserve”.
There are some religious leaders including Melbourne archbishop Peter Comensoli who want the law to stay the same, and have urged Albanese to hold firm. Comensoli believes VAD, overall, is unsafe.
While there are also concerns telehealth VAD consults may lead people to bypass palliative care, VAD doctors are legally required to discuss palliative options with patients and this would not change with telehealth. A report from Queensland Health found 77% of people who used VAD were accessing palliative care.
What’s next?
Chaney has a bill before the parliament calling for the criminal laws to be amended to make it clear that VAD is not suicide, and on 11 August, she will bring that bill for debate.
“That’s the opportunity for the prime minister to make good on the conscience vote that he promised,” she said.
White said there are other issues with VAD that also need urgent addressing, such as Catholic-run public hospitals and aged care homes refusing to allow VAD consultations onsite, a lack of public awareness that VAD is now legal in most jurisdictions, and state-based residency requirements that mean in some cases people can’t move interstate to die closer to loved ones.
But the telehealth issue is one of the most pressing, he said.
“There is a relatively small pool of practitioners who provide voluntary assisted dying, and the telehealth barrier makes this work a lot more demanding and time-consuming than it needs to be,” he said.