Victorian Assisted-Dying Guidelines

Three pharmacists at The Alfred hospital have been given the job of mixing and delivering the lethal dose to be taken by Victoria’s first voluntary euthanasia patients.

The pharmacists will personally deliver the substance, made from a cocktail of drugs already legal in Australia, in a locked box to terminally ill people across the state.

‘‘ No matter where they are in Victoria, they will dispense the medication to them. If there is any medication remaining, they will collect that and take it back,’’ Victoria’s Health Minister Jenny Mikakos said.

The historic laws will come into force on June 19, 2019 and will allow terminally ill adults who only have about six months to live and meet other eligibility criteria – such as being able to give informed consent – access to a lethal substance.

Most people will drink the dose – a liquid of about 100 millilitres (just over a third of a cup) – in their own homes at a time of their choosing. Under certain circumstances, those physically incapable of swallowing will be allowed to take the substance as a lethal intravenous drip set up by a doctor.

Those choosing to end their lives will be given medication to relax and reduce any chance of regurgitation, before they take the dose which will cause unconsciousness within minutes and a peaceful, pain-free death soon after.

While The Alfred will be the only pharmacy in the state to provide the drugs for voluntary euthanasia, the government has hired two voluntary assisted-dying care ‘‘ navigators’ ’ who are based at Peter MacCallum Cancer Centre.

They are already providing terminally ill patients, doctors, health services and hospitals across the state with information and support.

The government plans to hire more ‘‘ navigators’ ’ but is yet to determine how many or where they will be placed.

Meanwhile, 89 doctors scattered across Victoria have begun receiving the mandatory training required to be allowed to assist terminally ill patients who need medical help to die when the laws come into effect.

The government have not revealed which medical centres the doctors are based at, but confirmed they are a mix of GPs, palliative care practitioners and specialists including oncologists.

Every region in the state has at least one public health service with appropriately qualified staff and about a third of registered doctors practise in regional Victoria.

Each of them must complete a compulsory, six-hour , online training course before being accredited to assist patients.

Medical professionals can conscientiously object to aiding any request for euthanasia but the guidelines stipulate that terminally ill people should not be impeded in their quest for a hastened death by hospitals or doctors refusing to offer the service.

Euthanasia remains a polarising matter for doctors – some are strong advocates for it but others fear the scheme could be abused or undermine their obligations to patients.

Ballarat Health palliative care physician Dr Greg Mewett has registered himself as a doctor prepared to participate in euthanasia by making an assessment of a patient and if it came to it, administering the fatal drug.

Years of experience and reflection treating terminally ill people have led him to that decision, he said.

‘‘ There’s a small percentage of patients with advanced and incurable illness that currently don’t have an option if they have reached the limits of their suffering,’’ Dr Mewett said.

‘‘ For patients who aren’t able to relieve their suffering in any other way, it’s not an issue between life and death. These people are already proceeding towards death sooner rather than later. It’s about reaching the limits of your suffering and deciding how you will die and under what circumstances.’’

There is a range of strict eligibility criteria for those wishing to access the scheme, including that two doctors would have to conduct favourable assessments of a person’s eligibility, and a person has to make three separate requests to end their life, after initiating the process themselves.

Patients must firstly find a doctor who is willing to accept their request for lethal medication and then this request must be approved by a specialist in the field of their terminal illness.

Based on international experience Ms Mikakos said, ‘‘ once people start going to their co-ordinating doctor, which is likely to be their GP, those phone calls to specialists are likely to prompt more specialists to undertake this training over time” .

‘‘ A lot of diligent work has been undertaken in the last 18 months to ensure we get every aspect of this right,’’ Ms Mikakos said.

It has been estimated that about 150 to 200 Victorians could make use of euthanasia laws each year, but in its first year, Ms Mikakos said the number could be as low as 12.

With 68 safeguards, the bill has been described as the most conservative in the world.

A Voluntary Assisted Dying Review Board has been established to review each case.

The patient’s terminal illness, not the voluntary assisted dying act, will be recorded as the cause of death on their death certificate and in the register.

Ms Mikakos said she was confident the scheme was safe and compassionate and would provide people with relief from intolerable suffering at the end of life.

‘‘ I see this as being one of the most important things I will be involved in during my time as Health Minister and I’m very conscious of the weight of responsibility to get this right,’’ she said.

Terminally ill patients will also be able to get advice on voluntary euthanasia from a 24-hour government-sponsored hotline.

If you are troubled by this report or experiencing a personal crisis, you can call Lifeline 131 114 or beyondblue 1300 224 636 or visit or

‘It’s about reaching the limits of your suffering.’
Dr Greg Mewett, Ballarat Health palliative care physician

Source: The Age Digital Edition: Pharmacists to deliver patients’ lethal dose
This article is from the June 10, 2019 issue of The Age Digital Edition.

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