Experts have reviewed Victoria’s assisted dying approval process in practice.

Victoria is the first Australian state to enact assisted dying laws and one of only two places in the world where a government department must issue a permit before the patient can receive assisted dying. 

Researchers have interviewed 32 doctors who had been involved in the first year of the lawful assisted dying approval process in Victoria to find out how the laws are functioning in practice.

Researcher Professor Lindy Willmott said the study participants’ responses suggested that not only the law but also the technology design is crucial for the system to work properly and avoid barriers to eligible patients’ access to assisted dying.

“The participants also cited time-consuming paperwork, ‘pedantic’ requests for correction to patient information, and delays through each stage of the process as procedural problems,” Professor Willmott said.

“Briefly, the process begins only after a patient has requested AD from the doctor.

“What follows are two aspects of external prospective oversight and approval. The first is by an administrative Secretariat which supports the oversight body, the Voluntary Assisted Dying Review Board (VADRB).

“The Secretariat receives, through the online VAD Portal, the legislatively-mandated forms at three stages in the AD process including when patient eligibility is assessed by two doctors.

“Then, if two doctors assess the person as eligible, the coordinating doctor applies to a civil servant in Victoria’s Department of Health and Human Services (DHHS) for a government permit.

“The DHHS must approve or decline a permit within three business days and once granted, the doctor can prescribe the medication for the patient to self-administer or for doctor-administration if necessary.”

The key themes identified from the doctors’ perspectives included:

  • The pre-approval and oversight process was overly bureaucratic – doctors said: ‘byzantine bureaucratic process’, ‘highly legalistic’ 

  • Many reported ‘frustration’ at having forms returned by the Secretariat for typos or minor corrections. However, some participants said the Secretariat’s detailed scrutiny of forms as ‘reasonable’ and ‘necessary’, even if ‘annoying’

  • The mandatory online portal technology was a barrier – doctors described it as ‘clunky’ and ‘non-intuitive’

  • Some doctors said the prospective oversight and approval process caused unnecessary delays

  • The prospective process caused difficulties for very sick patients who did not have long to live. Some doctors perceived this process ‘unfairly’ excluded some patients from AD.

The full paper is accessible here.