VAD access in an institution: what you need to know
Voluntary Assisted Dying (VAD) commences in South Australia in less than two weeks.
Our VAD system is the same as Victoria, which has been operating for three and a half years, except in one important area: the option for some institutions to conscientiously object to participation in VAD. This means that as well as an individual doctor or a health service practitioner being able to conscientiously object to providing VAD services, a whole institution – a private hospital, for example - can refuse to allow VAD services on their premises.
If you are a permanent resident of a residential aged care facility, you can request and receive all VAD services, regardless of the policy of the facility management.
It is important to have clear information on the rights and responsibilities of all stakeholders.
Residential Aged Care: if you live in a unit in a residential aged care facility, then the law defines this as your home. In your own home you can ask for and receive any medical care of your choice, just as you would in any other house or apartment you have previously lived in. So even if the aged care facility is managed by a religious group which opposes VAD, such as a Catholic or Lutheran managed facility, you are still free to choose VAD as an end of life option because you are a permanent resident of the facility and receiving that care in your own home. If you move to the high care section, you need to check that you are still considered a permanent resident to ensure your access to VAD. If you are a respite or temporary resident of a residential aged care facility which does not support VAD your access is less secure; it would depend on a medical opinion that, for example, transfer to another location would cause you prolonged suffering and undue delay.
Private Hospital or Private Hospice: the management of some private hospitals and hospices may choose not to allow VAD on their premises. The VAD Act requires private hospitals which will not allow VAD on their premises to publish this information. However it is still unclear if this information will be provided to patients before or during admission. If, after your admission, you decide to request VAD and your private hospital or hospice does not allow VAD, they are required to make arrangements for you to be transferred to another location where VAD will be supported. Delays in making these arrangements may mean you run out of time to be assessed for VAD or use the VAD substance. It is important to know the VAD policy of any private hospital or hospice you think you may be admitted to as part of your end of life treatment plan.
Nursing Home: Nursing homes must support permanent residents who request access to VAD. Short stay or respite residents of nursing homes (and other health service establishments) may be required to seek VAD off-site if they are able, although if travelling is difficult for the person then the facility must enable VAD services on site.
Public hospitals: all public hospitals and hospices will provide all VAD services.
Palliative care: if you are under the care of a palliative care physician, or in a palliative care outreach program, it is important to find out if they will support VAD. VAD can be part of your palliative care plan, but not all palliative care services will support VAD. Individuals and institutions have the right to conscientiously object to VAD; they also have a responsibility to support your end of life choice. For example, your palliative care physician may be supportive of your request for VAD as an end of life option, however if you are admitted to a hospice which does not support VAD, your palliative care physician will be unable to provide VAD services, except to assist you in being transferred to another location where VAD is allowed. Your palliative care options will be more limited in a private hospice or palliative care service which opposes VAD.
VAD Care Navigators in SA Health can assist you with identifying a VAD trained doctor or VAD supportive institution.