‘It’s a privilege’- A GP’s experience of assisted dying in Australia

Assisted dying is legal in every state in Australia. The Royal Australian College of General Practitioners does not have a position for or against law change, which has enabled it to support its members and engage effectively with lawmakers. In the UK, while the RCGP currently opposes assisted dying, in recent years other representative bodies such as the British Medical Association, Royal College of Physicians and Royal College of Surgeons have dropped their opposition.

A guest post by Dr Bu O’Brien

It is very easy, and perhaps natural, to fear the unfamiliar. I see this clearly when speaking with GP friends and former colleagues in the UK about my experience of providing voluntary assisted dying (VAD) in Western Australia. They have had lots questions to ask and they have been relieved to hear my answers. I have followed closely the proposals for assisted dying law change in the UK, and I am compelled to share my experience, to provide reassurance and assuage the fears that I’ve seen amongst some GPs.

I trained and worked as a GP in Ireland, England and Scotland before moving to Australia, so I am familiar with all three systems. I know that workloads are immense, and that is a concern I hear from GPs about assisted dying; the suggestion being that involvement will be in some way forced upon us. That is simply not how it works. All my VAD practising colleagues have other jobs; we are GPs, anaesthetists, emergency doctors, palliative care specialists. For whatever reason – and each practitioner comes with their own – we were drawn to extending our practice into voluntary assisted dying. We completed the mandatory training and acquired the necessary accreditation. Those who do not wish to do so, don’t. As health professionals we cannot be compelled to do anything, by conscience or any other reason. I am, for instance, not trained to fit a contraceptive coil. If a person comes to me asking for this, I tell them, “I am simply not trained, but I will point you in the right direction.” There is no more sense of moral obligation to provide VAD than any other type of care I don’t feel able to provide.

Like every state in Australia, VAD legislation in Western Australia sets out a clear and comprehensive legal framework for end-of-life choice. VAD is only legal for terminally ill, mentally competent adults, and its processes for scrutiny, oversight and reporting are safer and more robust than any other healthcare option. A small minority of dying people use VAD, but the comfort of its existence is immeasurable. To remove this option now would be unthinkable.

For me, VAD offers some patients the choice when death is certain in the near future. To ask for medical help to end their lives. To die without pain. To die in peace. To leave their loved ones on their terms. To have choice and control over one of the few certainties in our lives…that we will all die. And so, our role as part of the VAD service is to help them do just that.

We listen to their stories shared with us. Not just about their illness and suffering but often about so much more.

Throughout my general practice, I’ve always had an interest in palliative care. I cared for a lot of people at home when they were dying. The most meaningful part of this work has always been communication; the privilege of being welcomed into a dying person’s home, hearing their stories, understanding what matters to them. This is exactly what VAD allows and it is why I find it so fulfilling.

We listen to their stories shared with us. Not just about their illness and suffering but often about so much more. Their childhoods, their careers, their loves, their losses. Their successes, their failures, their hopes and their regrets. We have conversations …about why they have chosen this path. About how they wish to be helped down it. About where and about when. Surreal conversations. Often upsetting, for them and their loved ones but also bringing a sense of relief. Relief that their wish for VAD is being heard and acknowledged.

People who choose this path are courageous. They know they are dying, and they want to die peacefully. The three words I hear, unprompted, every time, are choice, control, and relief. Despite everything, or perhaps because of everything, more often than not they want to use these last moments to share advice and reflect on what their lives have been.

I hear fears that the relationship between doctor and patient will be fundamentally altered by the introduction of assisted dying. Perhaps, on an individual, person to person level, between myself and my VAD patients, there is some truth in that. It enables – in fact, the legislation mandates – the most truthful, open, and meaningful discussions about life, death, and everything in between, that I have ever experienced.
So in fact, a lot of what VAD requires of me is not unfamiliar at all; it is multidisciplinary, patient-centred, compassionate primary care. But for me, my experience of providing it has been in some way altering. It has made me live my life in a more meaningful way. The conversations I have remind me to find pockets of joy in every day, and I am as grateful to my patients for that as they are for the choice, control, and relief, that voluntary assisted dying provides them in their final days.

IMAGE CREDIT: Dr Bu O’Brien Source: SBS News