Labor ministers have the right idea on telehealth VAD

After the ALP national conference endorsed the use of telehealth for voluntary assisted dying (VAD) in July, the VAD lobby has strained every muscle to promote it as “a simple, safe and humane reform”.  

Earlier this month Western Australian Teal independent MP Kate Chaney introduced a private member’s bill in the House. It was blocked by a vote of 74-12. Now Greens Senator Sarah Hanson-Young has introduced her own bill in the Senate.  

Wiser heads in Canberra oppose loosening safeguards on VAD. Prime Minister Anthony Albanese supports VAD in principle but believes telehealth VAD might not be safe and would undermine confidence in the system itself.  

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Federal Attorney-General Michelle Rowland was even more sceptical. 

“I am personally not convinced that a person confronting an end-of-life decision shouldn’t be afforded the dignity of a personal face-to-face consultation with a medical practitioner,’’ she told Parliament.  

“There are currently provisions in the criminal code that make it an offence to use a carriage service, either over the phone or online, to counsel or incite suicide. These provisions are there for a good reason – they were enacted to deter ill-intentioned individuals from encouraging vulnerable people to self-harm or commit suicide. 

“This issue continues to be of serious concern, with the number of cases of incitement trending upwards. This includes many cases of young people being encouraged to self-harm or commit suicide online.” 

The Attorney-General pointed out that the internet is a jungle for vulnerable people of all ages.  

“AI is already exacerbating risks in this area – where chatbots or those with malicious intent potentially masquerading behind convincing AI-generated avatars, seek to cause serious harm, again particularly to children and young people.”  

Minister for Health Mark Butler has deep misgivings as well. 

“Telehealth has exploded, as every member of this parliament knows, since COVID,” he told Parliament.  

“My experience of telehealth over the last several years, in too many instances, has indicated that, without very strict clinical safeguards, telehealth has not been used appropriately. There is case after case after case about that.  

“I’m not convinced that the current telehealth arrangements are particularly well suited to VAD right now.”  

Butler could have been referring to some of the eleven examples of “poor practice” listed by the Australian Health Practitioner Regulation Agency in prescribing medical marijuana.  

These include practitioners who wrote “more than 10,000 prescriptions for medicinal cannabis products in six months” and “consultations lasting between a few seconds and a few minutes, making a proper patient assessment impossible”.   

If government regulation has not succeeded in weeding out rogue doctors who exploit telehealth to dole out marijuana, how can VAD lobbyists possibly claim there are no risks in telehealth for VAD?  

The stakes are so much higher. Doping doctors are prescribing highs; VAD doctors are prescribing death. Chaney has pooh-poohed this idea. “There are so many checks and balances in place that I don’t think the issues … are applicable to VAD practitioners. There’s no money in it for a start.”  

There may be no money in it, but there are bad apples.  

The VAD lobby has seemingly avoided mentioning this, but doctors are forbidden to discuss VAD on “a carriage service” – phone, video conference, email, etc – because of the stench surrounding Australia’s first VAD practitioner, Dr Philip Nitschke. He helped a few people die when VAD was legal in the Northern Territory for a few months in the early 90s.  

Since then he has been crusading around the world for the right to die and promoting methods of “self-deliverance”. His polarising and controversial views and methods have long taunted law enforcement bodies. 

From The Netherlands, Nitschke has been observing Australia’s debate over telehealth VAD. He seems indignant that the role of his pro-suicide organisation, Exit International, in provoking the 2005 ban is being ignored.  

“It is with some amusement, now, that Exit watches the handwringing of the current Labor government as they try to undo the mess that they, in part, created all these years ago,” reads a recent blog post on the organisation’s website. 

“Doctors talking about VAD via telehealth? What’s not to like?”  

The Howard government passed the ban on promoting suicide on a carriage service when Dr Nitschke started selling his how-to-top-yourself guide over the internet, The Peaceful Pill Handbook. It didn’t stop him from publishing it overseas.  

On the day the bill came into effect, 6 January 2006, Nitschke promoted a “Politicians – Go Hang Yourself” Day on which his supporters were exhorted to send anti-euthanasia politicians instructions on how to string themselves up. 

A bad apple indeed.  

Go Gentle Australia, the Australian Medical Association, and other lobbyists for VAD have tried to kick Dr Nitschke and his radical crusade down a deep memory hole. He was a bad apple; we’re nice guys.  

Oh really?  

So why did Go Gentle Australia, the most effective lobby group for VAD, in its recent research brief, “Time for Action: Voluntary assisted dying, telehealth and the Criminal Code”, report that clinicians fear that they will face criminal prosecution and even prison? 

One anonymous VAD practitioner in Western Australia said: “I could regularly be seen to violate the Criminal Code …  I tell every patient I see over video conference the names of the medications and how they’re administered. I used to be anxious. Now I just think the whole thing is ridiculous. I don’t want to be prosecuted, but if nothing else it would force the Commonwealth to do something about this.”  

If there are doctors who are prepared to adopt the “poor practices” used by some of their medical marijuana-prescribing colleagues, are vulnerable people really going to be safe if telehealth VAD is legalised?  

Anthony Albanese, Michelle Rowland, and Mark Butler are right to have concerns. Telehealth VAD is just too dangerous. It should be rejected.