For more than two decades, the Australian Nursing and Midwifery Federation (Victoria) has been pushing for the legalisation of Voluntary Assisted Dying, or euthanasia, as it’s commonly known.

Last year, Victoria became the first state in Australia to do so. From 2019, terminally ill patients will have the right to request a lethal drug to end their lives. If the patient meets all set criteria, they will receive the drug within 10 days of their request, administering it themselves if physically possible.

It’s a decision supported, not only by the ANMF, but by nurses themselves, many of whom have witnessed first hand the devastation experienced by some patients during their final weeks and months.

“The smallest number of people to benefit are those who utilise the legislation to its fullest, and their families, who will no longer face accusations, investigations, and potential prosecution for helping a suffering loved one, or even being present when they died,” says nurse Tara Nipe, who has spent the vast majority of her career caring people following serious incidents such as stroke, as well as neurogenerative diseases including motor neurone and Parkinson’s disease, end-stage kidney failure, and autoimmune diseases like lupus.

“We know from international data that, for many, the knowledge this option is available helps far more patients than take it up.

“The voluntary assisted dying legislation means hundreds of Victorians now have the reassurance and peace of mind that comes from knowing they have an alternative if palliative care measures aren’t enough.”

Ms Nipe says that most of the patients she has cared for during their final moments, have had peaceful, comfortable deaths, however there are exceptions to the rule. 

“I’ve also been directly asked, and once begged, to assist dying patients to die.

“This request most often came from people with neurodegenerative conditions like motor neurone disease, whose symptoms are usually harder to manage than pain, though no less distressing, debilitating, and dire.”

“My hope is that a number of people will achieve better palliative care as a result of these consultations, and not need to continue through the entire process.”

One of the protections of the legislation is that voluntariness is a requirement for everyone involved, including health practitioners.

“Only specifically qualified physicians will be able to administer the medication for the small percentage of those who are unable to take it themselves, so the extent of nurse participation is assisting with drug preparation, witnessing a request, witnessing drug administration, facilitating contact, on request, with doctors who will coordinate and consult on the process, and providing information and/or resources about voluntary assisted dying.

“As patients spend more time, on average, with nurses than their medical team, it’s already common for them to confide in and ask questions of us that they are uncomfortable raising with doctors, so I expect this will happen on occasion.”

“The extent of involvement is entirely up to the nurse.”

While there will no doubt be some nurses who object to voluntary assisted dying, and will have the right to refuse to provide information about voluntary assisted dying or be involved in the process.

But Ms Nipe urges those nurses who do have objections to keep a couple of things in mind.

“First, the number of people who access voluntary assisted dying will be a very small percentage of those they care for  - just 0.39% of all deaths in Oregon were due to assisted dying, and that legislation is less stringent than Victoria’s.

“Second, the compassion and care we have for our patients is independent of the life decisions they make; while some of us may disagree with a patient’s decision to explore voluntary assisted dying options, or to utilise it, our therapeutic relationships won’t change - they are, and will continue to be, patient-centred.”

ANMF Victoria Branch Acting Secretary Paul Gilbert says many nurses were aware of experiences, prior to the legislation passing parliament, where terminally ill patients took their own lives in harrowing circumstances.

“Despite the illegality, patients were sometimes able to secure life ending medication, and we saw the difference in a patient’s outlook when they had a choice to end their life, and once given that power, did not use it,” says Mr Gilbert.

“It is a power shift in the patient’s favour. 

“All involved, not only nurses, should be mindful of the importance of caring and assessment of all factors that contribute to a person requesting voluntary assisted dying. The request should not change or negate the nature of caring.”

Under the nurses’ code of conduct, nurses who choose not to be involved, will be obliged to respectfully.