Voluntary assisted dying in the Australian state of Victoria: an overview of challenges for clinical implementation.

On 19 June 2019 the Voluntary Assisted Dying Act 2017 (Vic) came into effect, making Victoria the first state in Australia to permit the practice of 'voluntary assisted dying'. As defined in the legislation, voluntary assisted dying refers to "the administration of a voluntary assisted dying substance and includes steps reasonably related to such administration", "for the purpose of causing a person's death". In essence, the model of voluntary assisted dying established in Victoria is designed for patients within the final weeks or months of life, who may receive medical-assistance to 'choose the manner and timing of their death'. The purpose of this paper is to overview the clinical implementation of voluntary assisted dying in Victoria, attending to three broad challenges: balancing tensions in policy goals and ensuring the legislated 'safeguards' function as intended, translating the complex legislation into clinical practice, and managing conscientious objection to voluntary assisted dying. While there is somewhat limited information available regarding the practice of voluntary assisted dying in Victoria, available data and anecdotal reports indicate the implementation of the state's complex model of voluntary assisted dying has not been without challenges, particularly in terms of balancing the legislated 'safeguards' and patient access to voluntary assisted dying, and translating aspects of the complex legislation into clinical practice. The release of more systematic voluntary assisted dying data by the state, alongside independent research into the operation of voluntary assisted dying, is necessary to better evaluate the implementation and impact of voluntary assisted dying as a new component of clinical practice.