e-Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2021

Voluntary Assisted Dying (VAD) in Victoria - a retrospective case series comparing reasons for application with Canada and Oregon (#376)

Cameron McLaren 1 , Ross Jennens 2 , Suzanne Kosmider 3 , Peter Lange 4 , Theresa Hayes 5 , Nick Carr 6 , Deborah Harley 7 , Ingra Bringmann 8 , Chris Grossman 9 , Eli Ristevski 10 , Eva Segelov 1
  1. School of Clinical Sciences, Monash University, Clayton, VIC, 3806
  2. Epworth Healthcare, Richmond, VIC, Australia
  3. Medical Oncology, Western Health, St Albans, VIC, Australia
  4. Medicine and Aged Care, The University of Melbourne, The Royal Melbourne Hospital, Parkville, VIC, 3050
  5. South West Oncology - South West Regional Cancer Centre, Warrnambool, VIC, 3280
  6. St Kilda Medical Group, St Kilda, VIC, Australia
  7. Medical One, Waurn Ponds, VIC, Australia
  8. General Surgery, Western Health, St Albans, VIC, Australia
  9. Palliative Care, Holmesglen Private Hospital, Moorabbin, VIC, Australia
  10. Monash Rural Health, Monash University, Warragul, VIC, Australia

Aims:

Little is published regarding the reasons patients apply for Voluntary Assisted Dying (VAD) in Victoria, Australia. These are reported by coordinating practitioners from a provided list of options and multiple selection is permitted. Similar coding processes occur in both Canada and Oregon, USA. This study aims to compare the reasons patients pursue VAD in Victoria with international data.

Methods:

Deidentified consultation records were submitted by members of the VAD Community of Practice (CoP), a voluntary online forum for VAD-trained doctors in Victoria with 39 members, representing 25% of doctors who have been involved in one or more case. All reasons were listed for each patient. Data from 2020 for Canada(1) (n=7,384) and Oregon(2) (n=245) were obtained for comparison.

Results:

344 Victorian cases were submitted by 10 members of the CoP from the period July 2019 to June 2021. The mean number of reported reasons for applying for VAD was 4 (range 1-8). A single reason was stated in 11 patients; only one of which nominated inadequate pain control.

Reasons for applying were respectively in Victoria, Canada and Oregon (%):  

  • Losing autonomy: 79.1%,81.7%, 93.1%
  • Less able to engage in activities making life enjoyable: 78.2%, 84.9%, 94.3%
  • Loss of dignity: 70.9%, 53.9%, 71.8%
  • Inadequate pain control or concern about it: 54.9%, 32.7%, 57.4%
  • Losing control of bodily functions: 43.0%, 37.6%, 33.1%
  • Burden on family, friends/caregivers: 32.8%, 53.1%, 35.9%
  • Financial implication of treatment: 1.7%, not reported, 6.1%
  • Other: 9.9%, 1.0%, not reported

Of the 34 “other” reasons, nine related to symptoms other than pain.

 

Conclusion:

Reasons for applying to access VAD in Victoria are multifactorial and similar to those reported internationally. Inadequate pain control or concern about it is rarely the sole reason.

  1. Health Canada. Second Annual Report on Medical Assistance in Dying in Canada 2020. 2021
  2. Oregon Health Authority. Oregon Death with Dignity Act 2020 Data Summary. 2021