Critically ill Australians seeking voluntary assisted dying (VAD) are being forced into arduous, often impossible, journeys for face-to-face medical assessments due to a federal ban on telehealth, sparking calls from medical and legal experts for an urgent policy overhaul.
This prohibition on virtual consultations for certain VAD processes, such as the initial eligibility assessments and final requests, is creating significant distress and inequity, particularly for those in regional and remote areas, and individuals too frail to travel. The Conversation AU recently highlighted the profound impact of these restrictions, arguing they don’t align with modern healthcare practices or the compassionate intent of VAD legislation.
A Cruel Anomaly in Modern Healthcare
The federal law, specifically Section 80.2A of the Criminal Code, prohibits using carriage services — including phone and video calls — to discuss VAD, except for conveying information already established by in-person assessment. This effectively mandates face-to-face consultations for the most critical stages of the VAD process: the initial request and the final binding request. This legislative quirk stands in stark contrast to the widespread adoption of telehealth across almost every other medical specialisation, a shift accelerated by the COVID-19 pandemic and now a cornerstone of accessible healthcare in Australia.
Medical practitioners, who routinely diagnose complex conditions, prescribe potent medications, and manage chronic diseases via telehealth, are barred from providing this basic convenience to patients contemplating VAD. This creates a two-tiered system where end-of-life care is uniquely disadvantaged. For a patient in significant pain or with severely restricted mobility, a journey of hundreds of kilometres to see a doctor for a procedural assessment can be an insurmountable hurdle, adding immense suffering during an already difficult time.
Geographic Disadvantage and the Vulnerable
The impact of this ban is disproportionately felt in regional and remote Australia. While VAD schemes are legal in all Australian states, access to participating doctors is often scarce outside major metropolitan centres. For a terminally ill patient residing in, say, outback Queensland or a remote WA town, accessing the multiple, separate medical practitioners required for VAD assessments can involve thousands of dollars in travel costs, accommodation, and the physical toll of long journeys – costs not covered by Medicare for these specific purposes. The Conversation AU report noted that this geographic lottery effectively denies equitable access to VAD, contradicting the spirit of the legislation which aims to provide a humane option for those facing unbearable suffering.
Furthermore, some individuals may be too frail or bedridden to travel, even short distances. For these patients, the telehealth ban can render VAD entirely inaccessible, stripping them of autonomy and choice at life's end. It forces a cruel dilemma: endure suffering or attempt an arduous, potentially fatal, journey to fulfil a bureaucratic requirement.
Unjustified and Inconsistent Policy
Critics argue there is no logical or ethical justification for singling out VAD assessments for a telehealth ban. Medical professionals are often better equipped to conduct sensitive conversations in a patient's familiar home environment, fostering comfort and trust. Telehealth also offers a layer of privacy and reduces the risk of infection exposure for immunocompromised patients, factors routinely considered in other areas of medical care. The Conversation AU article highlighted that the safeguards built into VAD legislation – such as multiple medical opinions, cooling-off periods, and assessments of capacity – are robust and not compromised by the modality of the consultation. Allowing telehealth for VAD assessments would simply make the process more accessible and compassionate, not less safe.
The current law forces doctors and patients into an unnecessary and often cruel charade. It's time for federal lawmakers to revisit Section 80.2A, aligning it with contemporary medical practice and the compassionate intent of voluntary assisted dying legislation. Removing this outdated restriction would significantly alleviate suffering and ensure equitable access for all eligible Australians, regardless of their postcode or physical limitations.
