After Victoria became the first state to pass voluntary assisted dying (VAD) laws in 2019, South Australia is currently on track to become the fourth state in the country to introduce its own legislation. Now, one GP has shared his emotional experiences with VAD in an interview with HealthTimes, and what other states may learn from Victoria’s journey.

“Being with people dying from voluntary assisted dying care has been immensely rewarding, because it has been giving people what they want, and the peace about it, and the gratitude, has just been extraordinary”, explained Dr Nick Carr, a GP from the St Kilda Medical Group who is on the board of Dying With Dignity Victoria.

To date, Dr Carr has been involved in 25 cases of voluntary assisted dying. “I’ve witnessed a lot of deaths, and VADs are overwhelmingly the best I’ve ever been at”, he said.

“It is a very emotional experience, but it’s emotional in the right way.”

“I remember one man, Timmy, he had motor neurone disease. It was a beautiful weekend and I took the train down to Oakleigh. Timmy’s sister had come from the country to be with him. And there he was, he was still walking around and not that unwell.”

“I said, ‘Tim, it’s such a fabulous weekend, your sister’s here, do you want me to just piss off and delay this?’”

“He said ‘Nope, I’ve made up my mind, today’s the day – I’ve just sent my last email’”.

“Timmy turned the computer off, sat in the chair and said ‘let’s do this’. Half an hour later, he was dead. Here is this man who knows he’s facing a potentially horrible end to his life otherwise, and he was absolutely firm in his decision, and was able to do it on his own terms.”

A common argument against voluntary assisted dying is that it flies in the face of the oldest principle in medicine: first, do no harm. But many GPs, including Dr Carr, reject this and say the opposite is true.

“I think it’s a mistake to think that ‘first, do no harm’ means that you shouldn’t help people at the end of their lives die how they want to.”

“To me, it means not allowing people to suffer unnecessarily. And one of the things, prior to this legislation, is that our hands were a bit tied.”

“Doctors have always helped people at the end of their lives with extra morphine, or withholding antibiotics at the patient’s request, but there’s never been a possibility for a patient to be properly in control.”

“The huge change here is that patients are finally given some control back about how they die. And that does not clash with ‘do no harm’. That is absolutely what we should be doing, helping people end their lives in a way that they want to.”

While a deeply emotional experience, Dr Carr said he has been surprised that working within VAD legislation has not been as stressful as he anticipated.

“People have already done the most difficult bit. By the time I see someone for voluntary assisted dying care, they’ve had the diagnosis, they’ve shed the tears about things not being retrievable, they’ve gotten to the stage of saying, ‘well, I am dying and it’s now only a question of how I’m going to die’”.

“One of the things that has amazed me is how much humor there is, how at ease these people are with this stage of their lives. There’s still tears, of course, but it hasn’t been the stressful journey that I expected.”

Dr Carr explained that while the term “voluntary assisted dying” can feel uncomfortable to say, it is an important way of viewing death.

“Someone who’s got a horrible end-state disease either takes the medication or we give it to them, and they just slip quietly asleep, and they die so gently and so comfortably. And that is an extraordinary experience.”

While Dr Carr said that the Victorian legislation is working reasonably well and that many doctors are grateful to have it as an option, there are areas of potential improvement.

“This has been described as the most restrictive legislation in the world, with 68 safeguards, and there are various aspects of that that I would prefer to see changed.”

“Number one, we are not allowed to tell people about the option of VAD. The patient has to raise it. and this is all very well for the educated and literate.”

“But for people where English is not their first language, they’re not very internet-connected, or perhaps come from a culture where this sort of thing isn’t easily discussed, they may not be aware that this is an option for them.”

“And how does a patient at the end of their life make a rational decision about yet another bout of hideous chemo or some other treatment, if they don’t know that they have another medical option, which is VAD?”, Dr Carr said.

“So, we believe that we should be allowed to tell people about the option.”

Dr Carr added that another barrier was the caveat that people must be an Australian citizen.

“My very first patient, Julian, whose coroner’s report came out last year, lived here for 40 years, and he had horrible pancreatic cancer.”

“He paid his taxes, he was on the electoral roll, he was a pensioner. But he never became an Australian citizen and was deemed ineligible, and he committed suicide because I couldn’t provide him the care that he asked for.”

As for the other states in Australia who are currently debating their own VAD legislation, Dr Carr had some advice.

“I’ve worked with New Zealand, Tasmania, Western Australia and New South Wales.”

“And what we’ve really encouraged them to do is to hold firm against the opposition, which largely comes from the religious right, who keep spreading misinformation about slippery slopes and coercion, neither of which have ever been really proven to be a real issue anywhere in the world where they have a legislation.”

“And then, to try to improve the legislation. For instance, in Tasmania and Western Australia, to allow doctors to raise the issue of VAD, and to allow doctors to use telehealth.”

“So, I’ve said many times that while Victoria was the trailblazer with the first legislation, what I hope is that in 5 years’ time we’ll be the dinosaurs – because everybody else’s legislation is better than ours.”