Voluntary assisted dying guidance for aged care providers

Providing or supporting access to voluntary assisted dying in aged care

A residential aged care facility is a person's home for the duration of their stay. This means the approach aged care service providers take to voluntary assisted dying is pivotal to a person having the opportunity to exercise their right to consider and access all end of life care options.

All aged care service providers are expected to:

• Consider voluntary assisted dying as a part of their end-of-life care framework.
• Place the needs of a person requesting access to voluntary assisted dying at the centre of care.
• Not obstruct or unnecessarily delay a person’s access to voluntary assisted dying or necessary healthcare.
• Adopt a best practice approach and refer a person to the Statewide Care Navigator Service for information and support (particularly if the aged care service cannot provide this).
• Make their voluntary assisted dying policy available to residents and prospective residents.
• Provide support to the treating healthcare team, staff and volunteers.
• Ensure all staff and volunteers know the policies and procedures for voluntary assisted death.

Aged care service providers can decide whether or how involved they will be in providing access to voluntary assisted dying. This will depend on whether:

• the aged care service provider has the capacity to facilitate voluntary assisted dying services, such as:
  • providing access to information
  • providing referrals
  • assisting with access to medical practitioners on or off site
  • witnessing documents
  • supporting a person during the administration of a voluntary assisted dying substance and death.
• voluntary assisted dying aligns with the aged care service provider’s values.

Supporting people who ask about or ask to access voluntary assisted dying

A person may seek information or assistance about voluntary assisted dying from a medical practitioner, health practitioner or other aged care service staff.

Aged care service providers should be able to provide information and/or referrals for a person who wants to ask for voluntary assisted dying, while continuing to provide usual care and support.

Many aged care service providers support and facilitate the voluntary assisted dying assessment process. This involves two voluntary assisted dying trained medical practitioners assessing a person’s eligibility, either in the aged care service or in another suitable location.

Sometimes a person will not have a visiting or usual medical practitioner who is willing or able to provide voluntary assisted dying.

• If the person's medical practitioner is not willing or able to be their assessing medical practitioner, they may seek a referral to another medical practitioner.
• If a willing and able medical practitioner cannot be found, the person or the aged care service provider can contact the Statewide Care Navigator Service for information and support.

Staff education

Aged care service providers are encouraged to support education for health practitioners and other staff on:

• the aged care service provider’s policies and procedures about voluntary assisted dying.
• the prohibition on medical and health practitioners initiating a discussion about or suggesting voluntary assisted dying to a person.
• protections for health practitioners who conscientiously object to voluntary assisted dying.
• how to respond to a person asking for information about or access to voluntary assisted dying.
• who within the aged care service can discuss voluntary assisted dying.
• requirements for documenting interactions regarding voluntary assisted dying in a person’s medical record.
• data collection.

The Statewide Care Navigator Service can help aged care service providers with information and education.

Health practitioners and other health service providers that the Australian Health Practitioner Regulation Agency does not regulate must adhere to the Victorian Code of Conduct for General Health Services. They should also adopt their professional body and organisational codes of conduct when delivering care.

Staff support

Health practitioners are not required to provide voluntary assisted dying services. Some may conscientiously object to some or all aspects of voluntary assisted dying.

Aged care service providers should support all staff within the organisation. They should promote a culture of mutual respect, including respecting a health practitioners' right to object to any or all voluntary assisted dying services conscientiously.

Aged care service providers should seek to understand:

• the potential workforce implications of its approach to voluntary assisted dying.
• whether its staff have the competency, experience and expertise to recognise when someone may be seeking information and thinking about their end of life care options.

Aged care service providers should support staff through established lines of professional support such as:

• clinical supervision.
• debriefing and peer support networks.
• voluntary assisted dying specific supports such as pre-briefing and debriefing.

Aged care service providers should support staff to contact an Employee Assistance Program, professional association or similar support services if discussing voluntary assisted dying raises wellbeing concerns.

Review voluntary assisted dying policies, processes and capacity regularly

Aged care services providers should review voluntary assisted dying policies, procedures, processes and capacity every three years or following any significant changes to its workforce. This may also involve updating charters or values statements (where necessary).

Any policies and procedures should align with the Voluntary Assisted Dying Act 2017 and Commonwealth aged care legislation and quality standards.

Voluntary assisted dying substance

Supporting a person who has a voluntary assisted dying substance

An aged care service provider may be able to support the person once the person has the voluntary assisted dying substance and have made the decision to take it. This should be discussed with the person and their coordinating medical practitioner.

Some people who access voluntary assisted dying may have the substance administered to them by their coordinating medical practitioner (called practitioner administration). The coordinating medical practitioner will bring the substance and needs access to the premises if practitioner administration will take place on-site.

If an aged care service provider is concerned about a person taking the voluntary assisted dying substance at the aged care service, staff may meet with the person, coordinating medical practitioner or the Statewide Care Navigator Service to discuss the concerns and potential alternatives.

These discussions should respect the person's circumstances and the organisation's needs. This may include considering alternative approaches such as:

• the person may be able to go to a carer’s, family member or friend’s home when they plan to take the voluntary assisted dying substance.
• the person may remain at the service and require referral to an external health service or provider for additional care provision in relation to voluntary assisted dying.

Requirements for managing a voluntary assisted dying substance

If the person loses the ability to self-administer or digest the voluntary assisted dying substance, the person must contact their coordinating medical practitioner to request practitioner administration.

If the voluntary assisted dying substance for self-administration has already been dispensed to the person, the substance must be returned to the Statewide Pharmacy Service before a practitioner administration permit can be issued.

If the person dies without taking the voluntary assisted dying substance, the appointed contact person is responsible for returning to the Statewide Pharmacy Service within 15 days. Sometimes, the contact person may be an aged care service staff member.

Statewide pharmacy

The Statewide Pharmacy Service dispenses the voluntary assisted dying substance. It provides education and support to the person, medical practitioners and other health professionals on storage, use and disposal of voluntary assisted dying substance.

The Statewide Pharmacy Service can be contacted during business hours on:

• (03) 9076 5270
• statewidepharmacy@alfred.org.au

Support for aged care service providers

The Statewide Care Navigator Service can:

• provide targeted or general support, education, prebriefing or debriefing to aged care service providers and staff.
• assist people to access health services or medical practitioners which provide voluntary assisted dying services if the aged care service provider can’t do this.
• help aged care service providers to consider, review and update their policies and procedures on voluntary assisted dying.

For more information, see Statewide Care Navigator Service.