Speak Out August 2019 Digital Edition

Aged care

VOLUNTARY ASSISTED DYING (VAD) LEGISLATION

Victoria’s Voluntary Assisted Dying Legislation: Implications for speech pathologists

is not able to self-administer the medication, they will need to follow the specific physician-assisted protocol process. • VAD cannot be requested in an advance care plan/directive. A person requesting VAD must follow the timing and number of requests as per the protocols in place for VAD and be assessed to have full decision-making capacity at the time of each stage of the process right up to the administration of VAD medications. To date, Speech Pathology Australia has been working on the following aspects related to the introduction of VAD. Advocacy around the communication accessibility of the process for those with communication difficulties. DHHS proactively sought Speech Pathology Australia’s contributions to the Guidance for Health Practitioners Manual . Key messages provided in this material were to ensure that people with communication difficulties had the same rights to access this scheme, may need to be supported to use alternative or augmentative communication methods to do so, and that speech pathologists should be consulted to inform and support this process. Additionally, discussions focused on the needs for accessible information (e.g., Easy English Patient Information is available) and flexible provisions around the need to sign a written declaration (this is no longer necessary where a person cannot sign for this). This appears to be a first globally that the needs of people with communication difficulty have been considered within a like scheme. Seeking clarification regarding the role and practice of speech pathologists working with people using AAC accessing VAD SPA is awaiting clarification from the VAD Board and from independent legal advice regarding the impacts for speech pathologists working with people requiring specific vocabulary added to their AAC to enable the initial discussion with the medical professional – and how this is seen in relation to the current legislation requirements of not being seen to be suggesting VAD to the patient prior to a first request being documented. Clarification of the considerations for speech pathologists supporting the needs of those with dysphagia SPA has sought clarification from the VAD State Wide Pharmacy (managing VAD medication distribution) regarding questions related to the swallowing of this medication. Information generally relating to this medication is tightly held and divulged on a patient by patient basis. It was noted that the protocol requires the coordinating doctor to make an assessment that the person is able to swallow and absorb the medication in the manner detailed in that protocol. Response from the Director of the SW Pharmacy

The Victorian Department of Health and Human Services has prepared resources including the answers to FAQs for services and professionals https://www2.health.vic.gov.au/hospitals-and- health-services/patient-care/end-of-life-care/voluntary-assisted- dyin g. Many health services have additionally prepared extensive internal resources, policies and education sessions around this topic. Familiarising yourself with the Act and the VAD process itself via these online resources will be a useful first step. Key points to note about VAD Speech pathologists may be involved with people who are choosing to undertake VAD. When this occurs, the primary role of a speech pathologist is envisaged to be the support of the communication access ability of someone with communication difficulty considering or requesting VAD. This may include, for example communication assessment and education of the medical professionals regarding appropriate strategies or use of AAC, or the speech pathologist may be as a skilled communication intermediary supporting the person during the VAD interview process. Family members, carers and friends cannot talk for, or support the person during this process, all requests for VAD must be initiated by the person themselves. One of the key populations that speech pathologists are expected to have input with are those with neurodegenerative conditions (comprising 11% of requests in Canada’s experience). Additionally, speech pathologists may be requested to provide some consultation with the medical professionals around the needs of people with dysphagia in swallowing the medication. • Health professionals including speech pathologists may conscientiously object to being involved, where their beliefs and values conflict with VAD. • Health professionals must NOT initiate any conversation about voluntary assisted dying with a patient/client. It is against the law for a doctor or health professional to suggest a person seeks VAD. They can however respond to a direct request for further information about VAD (*note there is the need for this request to be quite specific to VAD before any information is provided). • It is worth knowing where to direct someone to access further information if asked including the DHHS website information, and the VAD Care Navigators vadcarenavigator@petermac.org whose role includes directing people to participating health professionals. • VAD medication must be administered by the patient – no feeding assistance can be provided. Alternatively if someone

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August 2019 www.speechpathologyaustralia.org.au

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