Calls for equal access to voluntary assisted dying using telehealth

Telehealth could vastly improve access to voluntary assisted dying (VAD) in Australia and address a significant health inequity, University of Queensland-led research has found.

Dr Helen Haydon, from UQ’s Centre for the Business and Economics of Health, and PhD candidate Imogen Summers reviewed published research about how telehealth was used for VAD in other countries, and concluded the benefits outweighed the risks.

“Australia is the only country in the world with legislation preventing telehealth to be used for VAD,” Dr Haydon said.

“We reviewed 230 articles to see what risks and benefits were associated with the practice but found nothing in the literature to suggest that it posed a risk.

“Instead, we found benefits, especially in terms of increasing access for people living in rural or remote communities and unable to travel due to severe illness.”

“It is a healthcare equity issue for those residents.”

Dr Haydon said health professionals overseas reported using telehealth for VAD could be safer.

“Telehealth allowed more consultations with the patient and their family, providing more informed care,” she said.

“Video conferencing with patients was found to be just as effective as in-person assessments, depending on what is required.

“A major part of the assessment is conversation about possible end-of-life treatments and being comfortable with their decision, which can be done effectively via video.”

Dr Haydon said outside of Australia, the use of telehealth for VAD was largely seen as a clinical decision, not a legal one.

“In countries where assisted dying exists, there are often no regulations for using telehealth," she said.

"If there are, it usually takes the form of policies and guidelines to address issues like preventing coercion, ensuring service effectiveness, maintaining privacy, cybersecurity protocols and safe prescribing and use of medication.

“In Canada, they evaluated the potential risks and deemed them so low there was no need for legislative controls, and it is up to the individual provinces to implement policy and procedures.

“Overall, there seems to be little question about the use of telehealth for VAD apart from in Australia, where the law is based on limited evidence.”

Dr Haydon said conflicting federal and state legislation made Australia’s approach complicated.

“Under the Australian criminal code, the use of internet, phone or video services to counsel, incite or provide instructions to suicide is criminalised, whereas some states’ laws have telehealth-specific clauses which attempt to permit some telehealth use,” she said.

“The debate about whether or not VAD should be classed as suicide continues, however most literature is calling for an amendment to The Code, specifying that suicide does not include VAD when carried out lawfully.

“Because of the legal discrepancies, healthcare providers fear prosecution for even discussing VAD with patients through telehealth services.

“Yet it is health professionals who hear firsthand from eligible patients the distress of not having control over how, when and with whom they die.”

Dr Haydon said most Australian literature discussing access to VAD was calling for an amendment to the criminal code.

“At a time when voluntary assisted dying is on the increase, telehealth is needed more than ever but Australian laws are preventing access.”

The research has been published in Australian Health Review.