Are Assisted Dying and Palliative Care Intersecting in Australian Clinical Practice? A Case Series

Abstract

Objectives

Assisted dying and palliative care represent distinct approaches to addressing the needs of patients with advanced, progressive, and life-limiting illness. Although 5 years have passed since the Voluntary Assisted Dying (VAD) Act was passed in Victoria (Australia), little is known about the VAD and palliative care interface in clinical practice. This retrospective case series examined patients who requested VAD and received inpatient specialist palliative care (SPC).

Methods

Retrospective case series of patients admitted to a single-site public palliative care unit (PCU) between June 2019 and June 2024, who had enquired about or requested VAD at any point in time.

Results

6% of patients admitted to the PCU enquired about or requested VAD at any point in time; 2% raised VAD during their PCU admission, while the remaining patients were admitted with existing requests made in other healthcare settings. A small proportion of patients had VAD requests made by caregivers or had statements misinterpreted as VAD requests. Requests for VAD were made to palliative care professionals (50%) across multiple settings where palliative care is delivered. Most patients (44%) did not progress past an initial request for VAD, and 32% made requests in their final 2 weeks of life. Four patients administered the VAD substance and died while in the PCU. In the PCU, patients discussed VAD with their treating team (number of documented conversations ranging from 0 to 25 during admission).

Conclusions

This case series highlights a tangible intersection between SPC and VAD in that patients enquired about and requested VAD to palliative care teams, and in the PCU, they discussed and completed VAD. Implications for SPC will be discussed.