When Medical Forum spoke to Dr Bhawani O’Brien earlier in the week, she was travelling to Rockingham to visit a patient for one of three appointments as part of the voluntary assisted dying process.
“I’m driving to Rockingham right now to see a patient for their final assessment. That takes up the whole morning – if you’re doing telehealth assessments, you could speak to three or four patients in that time,” she said.
While Dr O’Brien said she understood if a patient wanted to do all three appointments face-to-face, she said telehealth appointments should be an option.
However, due to the wording and interpretation of the Commonwealth Criminal Code Act, practitioners are restricted from using electronic communications when providing voluntary assisted dying (VAD) care to terminally ill Australians.
This is something Go Gentle, an organisation which advocates for end-of-life choice, wants to see changed.
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In WA, patients see a doctor three times before the actual visit where VAD medication can be administered.
“The first two times, we can actually do it over video call if they’re far away, or in a public hospital, but the third time we are not allowed to, we have to be face-to-face because we’re actually talking about the substances used and administration,” Dr O’Brien told Medical Forum.
Dr O’Brien and other Perth-based doctors are often up against challenges to visit patients in regional areas.
She said following that final assessment, VAD practitioners will return to Perth, write the prescription, and then return to the patient for a face-to-face visit for the administration of the medication when or if they decide to go ahead with the process.
However, she said the logistics of getting to a patient just for the final assessment can prove difficult.
Dr O’Brien gave the example of one case, where she and a navigator took a three-hour flight and a car trip to visit a patient face-to-face for their third assessment.
“That morning, the flights were cancelled, so we drove, and it took us two days to get there and unfortunately, they had lost capacity [to be properly assessed].
“So, what we’re talking about is equity of service, there’s no equity of service to the country people,” she said.
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Telehealth is not an option for the last assessment where medication is discussed as amendments to the Criminal Code Act made in 2005 criminalised the use of a ‘carriage service’ to share material encouraging suicide online.
While suicide prevention organisations have been among those to make a clear distinction between suicide and VAD, the current wording means VAD is encompassed under the interpretation of suicide and the law was reinforced by a Federal Court decision in 2023.
Go Gentle has listed amending the Commonwealth Criminal Code to allow for the use of telehealth in the provision of VAD as one of its three priorities leading up to the 2025 Federal Election.
It said the current situation “delays and disrupts the process for dying people and their families, and puts health professionals at risk of fines and prosecution – simply for doing their jobs”.
A joint statement was also signed by 20 health and legal organisations in 2024, calling for change on the issue.
Another of Go Gentle’s priorities is updating the Medicare Benefits Schedule explanatory notes to ensure GPs get paid for their work with VAD patients.
According to Go Gentle, the current MBS explanatory notes make the job of GPs “much harder by prohibiting reimbursement for euthanasia and any service directly related to the procedure”.
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While this is an issue in some other states, WA recently announced the Department of Health would reimburse doctors for VAD services with a fixed fee.
The third priority Go Gentle has listed in the lead up to the Federal Election is including VAD in the Federal definition of end-of-life care.
“Federal agencies – and consequently stakeholders – have conflicting views on VAD’s validity as an end-of-life option and inclusion within palliative care. This results in multiple definitions and debates about responsibility and accountability,” its election priorities document states.
The AMA has also called on the next Federal Government to amend the Criminal Code, adding that currently doctors who advise patients about VAD via telehealth, email or phone consultations could face criminal charges.
AMA President Dr Danielle McMullen said the current situations disadvantages patients who are physically unable to travel for face-to-face consultations due to their medical condition.
“Doctors have an ethical duty to provide their patients with quality end-of-life care that strives to alleviate pain and suffering, supports individuals’ values and preferences for care and allows them to achieve the best quality of life possible.”
“The prohibition on the use of telehealth could have a major impact on people living in regional, rural and remote communities who may not have the same access to medical services as those in the cities and who may need to travel long distances for care.”
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