Introduction by Croakey: All Australian states have passed legislation enabling voluntary assisted dying (VAD) in certain circumstances. However, there are differences in the laws and associated regulations between jurisdictions, in particular in how they apply to health professionals treating patients who may be considering VAD.
Below, Fiona Carberry, a counselling psychologist in private practice in Perth, discusses the role of psychologists in VAD and how laws in WA and other jurisdictions largely exclude psychologists from discussing VAD with their patients, and create a barrier to access for people with terminal and debilitating conditions.
Fiona Carberry writes:
Prior to the legalisation of voluntary assisted dying in Western Australia, people with a terminal or debilitating illness accounted for around 10 percent of suicides in WA, according to estimates from coronial data contained in the 2018 report of WA’s Joint Select Committee (JSC) on the End of Life Choices.
The JSC report, titled My Life, My Choice, includes some harrowing case studies of suicides by terminally ill people. It’s not possible to determine whether this figure has changed since the passing of this legislation from publicly available data.
Psychologists see people with existential and complex mental and physical health conditions, including terminal illnesses. We talk through their dilemmas, ambivalence and uncertainty about a range of life matters affecting their mental health, thus enabling them to make difficult decisions.
Psychologists’ work involves seeing many people who express suicidal thoughts or impulses, and it is our job to ensure their safety.
However, we are prohibited from informing clients that VAD is legal, even if they are eligible to apply for it on the basis of terminal illness and are suicidal.
On State election day in WA in 2017, I was at a local polling booth handing out how-to-vote cards, when news came via The Greens candidate that someone had died by suicide nearby. It turned out the man was Clive Deverall, the former CEO of the Cancer Council of WA, who had incurable non-Hodgkin’s lymphoma. His suicide note reportedly said “suicide is legal, euthanasia is not,” according to the ABC.
Voluntary assisted dying became legal in WA in July 2021. In its inaugural annual report, the VAD Board stated that 190 people with a median age of 73 years ended their lives through VAD in the first 12 months of the Voluntary Assisted Dying Act 2019. Most (68%) had cancer; smaller proportions had neurological (14.4%), respiratory (8.5%) or other conditions (9.1%).
Almost 60 percent of those assessed as eligible for VAD expressed concern about their loss of dignity as the reason for applying.
Legislative barriers
Medical and nurse practitioners are the only healthcare workers permitted to initiate discussions about VAD with patients, and are also required to discuss treatment and palliative care options and the likely outcomes for the patient at the same time.
Psychologists (and other health professionals) are legally prohibited from mentioning VAD to clients, unless the client raises it first, but they may respond to questions. WA Department of Health guidelines state that, in accordance with the Voluntary Assisted Dying Act 2019:
“Healthcare workers must not initiate discussion about voluntary assisted dying with, or suggest voluntary assisted dying to, a person to whom they are providing professional care services”.
The guidelines warn of the serious consequences of breaking that law – it could be deemed unprofessional conduct or professional misconduct, and the VAD Board has the power to refer matters to the Australian Health Practitioner Regulation Agency and the Police.
A national perspective
WA is not the only jurisdiction that imposes this restriction on psychologists.
All jurisdictions in Australia that have passed VAD laws have a similar restriction, with the exception of Tasmania and NSW. Tasmania permits all registered health practitioners to initiate discussions about VAD provided they also advise the client to speak to a medical practitioner about it. NSW, which commences VAD in November 2023, will permit all registered health practitioners and others who provide “health services or professional care services” to initiate discussions as long as, at the same time, they mention palliative care options and advise the person to discuss it with their medical practitioner.
There is no rationale for this gag on psychologists.
As well as having a professional responsibility for preventing our clients from taking their own life, psychologists counsel and treat people traumatised by losing family members, friends or colleagues to suicide by violent means. Surely we should be able to speak to our clients about a legal alternative for a less horrific death.
The coronial data on suicides by terminally ill people suggest that knowledge of VAD as an option may be a suicide prevention measure for some.
An example from my psychology practice illustrates this. Several years ago, I was seeing a client who had chronic obstructive pulmonary disease, panic disorder, and death anxiety. He followed with interest the introduction of VAD in Victoria and the parliamentary debates on its introduction in WA. My client oscillated between declaring his intent to suicide and saying he would “catch the train” to Victoria to be euthanised. He died naturally in his sleep one night before making a decision, and before WA enacted VAD.
Easing psychological anguish
The prohibition on initiating conversations about VAD with our clients also prevents us from easing the psychological anguish of the families of terminally ill people.
Recently, a young client of mine whose mother has terminal cancer, told me as he was leaving our session that he was present when the vet recently euthanised the sick old family dog. He remarked that “we treat animals better than humans.”
I’m unable to ask if he knows that VAD is now legal in WA, or what his mother’s stance is on assisted dying, despite her terminal illness being one of the life stressors for which he sought counselling in the first place. Surely this is an unintended consequence of the legislation.
Not mentioning a law that gives dying people the choice to be assisted to end their own life is akin to not asking a woman with an unwanted pregnancy whether she has considered abortion or exploring her views on abortion.
Psychologists’ ethics are based on a principle of respect for people’s rights and dignity. I cannot think of any other law that a psychologist would knowingly not inform a client of, or inquire about their awareness of, when it’s germane to their circumstances. We tell people about relevant matters pertaining to their healthcare such as provisions for advance health directives and guardianship, which encompass health and other end-of-life care matters such as palliative care and resuscitation, but we are forbidden from bringing up VAD.
Access to VAD shouldn’t only be for the well-informed and those who ask the right questions.
Voluntary assisted dying is now legal in WA – psychologists speaking freely about it is not.
The forthcoming statutory review of the VAD Act 2019, after the second anniversary of its operation, provides the opportunity to rectify this.
Psychologists and others with an interest in VAD could write submissions for the review to the WA Minister for Health. Or keep an eye on the WA Department of Health website www.health.wa.gov.au for announcements about the review.
Crisis supports
13YARN is a crisis support line for Aboriginal and Torres Strait Islander people. Available 24/7. No shame, no judgement, safe place to yarn.
Phone 13 92 76
Kids Helpline provides free, private and confidential 24/7 phone and online counselling service for young people between the ages of 5 and 25.
Phone: 1800 551 800
Lifeline provides free suicide and mental health crisis support for all Australians.
Phone: 13 11 14
Beyond Blue provides free telephone and online counselling services 24/7 for everyone in Australia.
Phone: 1300 224 636
1800 RESPECT provides confidential sexual assault and family and domestic violence counselling via phone and webchat. Available 24 hours a day, seven days a week.
Phone: 1800 737 732
See here for previous Croakey stories on voluntary assisted dying