A bill that would have changed the law to allow VAD & telehealth was blocked last week, and a new poll suggests most GPs think it’s the right call. Meanwhile, the AMA is pushing to end the ban…

Just 8% of GPs are generally supportive of assessing VAD suitability via telehealth, though 23% say they would support it in certain situations.

Most – 69% – are generally unsupportive of telehealth for VAD assessments, according to a national Healthed poll with around 1400 GP respondents.

The results suggest the majority of GPs agree with the government’s decision on Tuesday to block a bill that would have amended the law to end this barrier – despite Labor party delegates having endorsed it at the ALP national conference last month.

The VAD telehealth bill had been pushed by Kate Chaney, a teal from Western Australia, and was supported by other teal and independent MPs including Dr Monique Ryan – but was blocked on Tuesday when both Labor and the Opposition together voted 74-12 against it.

“I am not convinced that the current telehealth arrangements are particularly well-suited to VAD right now. They have not been appropriate for a whole range of ways in which new business models have been developed to use telehealth in a way that I don’t think is clinically appropriate,” Minister Butler said in parliament.

The move came after Prime Minister Anthony Albanese expressed opposition.

Where do peak bodies stand?

Although Healthed’s survey demonstrates very little support from GPs for allowing telehealth assessments for VAD, the AMA is on the record advocating for removing the barrier that prohibits it.

AMA president Dr Danielle McMullen said federal legislation that makes it an offence to use phone, videoconference or other electronic communication to counsel or incite suicide was put in place before voluntary assisted dying became a legal option in most of the country.

“These provisions were drafted well before VAD was legalised anywhere in Australia and were not intended to capture a lawful medical service,” Dr McMullen said.

“Patients in regional, rural and remote Australia — and those too unwell to travel — are being denied equitable access to a legally available choice, because of outdated laws that were never designed with voluntary assisted dying in mind.”

“The AMA’s position is that telehealth should operate for VAD as a valuable complement to in-person care, and not a replacement for clinically necessary physical attendances.”

“Voluntary assisted dying consultations could be undertaken via telehealth in accordance with appropriate regulations and protections, consistent with professional standards and good medical practice.”

The RACGP told Healthed it does not have a formal position statement on telehealth and VAD.

What’s next

The debate isn’t over. On Thursday, Greens senator Sarah Hanson-Young introduced the Equal Access to Voluntary Assisted Dying Bill in the senate which would expand access through telehealth.

What your colleagues are saying about using telehealth to assess VAD eligibility:

Opposed

“For people who live in remote areas with poor access to local care. Not as an alternative to face-to-face consults usually – far too serious an issue for routine telehealth.”

“Good rapport and adequate knowledge about who the patient is essential. This is difficult to establish via telehealth, unless patient is well known to GP.”

“I think it should be done face to face and with the patient’s permission, appropriate supportive family or very close friend in attendance at some stage. At some stage also with just the GP and patient. Possibly two to three consultations would not be unreasonable.”

“It is just too hard to truly assess what is going on in socially as well as medically. Also the drugs were diverted and used by a relative for his own suicide once. That makes me very hesitant to support the telehealth option.”

“Human nature being as it is, telehealth could easily lead to misuse by relatives or acquaintances of the patient exerting undue, hidden and disguised influence in the decision making.”

“I believe telehealth is totally inappropriate for such a discussion for most people. Such discussions need at least the immediate family and a regular GP or specialist familiar with the family.”

“I think it is inappropriate to make such considerations without firstly, decent familiarity with the patient and secondly, physical presence.”

“I believe that assessment for VAD should preferably be conducted face to face, given the complexity and sensitivity of assessing decision-making capacity, voluntariness and possible coercion.”

“Totally unsupportive of telehealth assessment – this needs to be ‘hands-on’ face to face. In rural areas this should require the assessor to travel to the prospective VAD patient.”

“It’s a bit of a slippery slope in terms of lowering the standard of assessment.”

“This is a life-or-death decision and cannot be made over the phone.”

Limited support

“Late stage terminal illness without any quality of life in situations where the service provider has good prior physical knowledge of the patient.”

“Only as one of many steps in the process perhaps.”

“Needed for rural areas access – if concerns could do as video, I don’t see an issue with this.”

“One doctor should be face to face, the second could be telehealth.”