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Law allows Victorians greater control over end-of-life decision making

Deakin Law School expert Neera Bhatia says Victoria's Medical Treatment Planning and Decisions Act should prompt an important public conversation.

As voluntary assisted dying comes into effect this week, Deakin University end-of-life care experts believe a different existing law will have a much wider impact on promoting dignity in death for Victorians.

Health law expert and Associate Professor at Deakin Law School Neera Bhatia said it was important to emphasise that voluntary assisted dying would only be available to, and accessed by, a very limited few.

“There may be an initial surge in interest however due to the strict criteria it will not accessible to many,” Associate Professor Bhatia said.

“But there is another piece of important legislation that ensures the wishes of all Victorians can be respected at the end of their lives.”

The Medical Treatment Planning and Decisions Act 2016, which quietly came into effect in Victoria last year, allows people to make an advance care directive outlining their future medical wishes and treatment preferences.

Associate Professor Bhatia said it offered a legally binding way for people to refuse or consent to specific treatments, including those that prolonged their life, something that could previously be overruled once a person was deemed to lack mental capacity.

“Many of us won't meet the stringent criteria for voluntary assisted dying, but we still want to die 'a good death' and have some control over our end-of-life decision making," Associate Professor Bhatia said.

“An advance care directive can be an extremely powerful individual tool, giving people choices that will have an impact on their quality of life, based on their personal beliefs and value system.

“There is a pressing need for every Victorian to be made aware of advance care planning, even though they are difficult conversations to have with loved ones.

“We might be fortunate to go through life experiencing little illness, though at some stage most of us will require medical treatment, and choices here can have a huge impact on a person’s future quality of life, as well as their quantity of life.”

End-of-life-care expert and Senior Lecturer in Deakin’s School of Nursing and Midwifery Dr Melissa Bloomer co-wrote a position statement on voluntary assisted dying for the Australian College of Nursing earlier this year.

Her research has also highlighted that despite the importance of advance care planning in enabling Australians to ensure care is provided according to their wishes, few people who are admitted to hospital have an advance care plan in place.

A recent study of Dr Bloomer's into end-of-life care in hospitals, showed that data related to advance care directives were so inconsistently recorded that she was unable to make any assumptions about the frequency of their use.

“As much as we know how good they are, we’re not seeing them, and it's critical these forms are filled out by people while they're still well and can make decisions about their future,” she said.

“We're living longer but not necessarily healthier, with multiple chronic illness, increased rates of disability, diabetes, and heart disease. That means it's critical we get end-of-life-care right.”

Dr Bhatia said the scrutiny around the voluntary assisted dying legislation had offered an important opportunity for a public conversation about death, something that was not discussed enough.

“We just aren't comfortable with death, as a state of being or as a process, but it's inevitable and it's something that unites all of us,” she said.

“I think a positive from the public debate around this new legislation is that it is making us think about death and end-of-life wishes more broadly.

“We all need to look at advance care planning as a way to control decisions about how we are cared for, because there are treatment choices we can all make.

“We must try to turn this conversation from voluntary assisted dying, which effects a very small proportion of society, to how we can all have control over our health and how we are cared for at all stages of our lives, not just at the end of life.

“It is a common misconception that advance care planning is for the elderly or the critically sick. We should be aiming for a healthcare system where it is common practice that general practitioners are discussing advance care planning with patients at routine medical appointments.”

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