As Catholic health and aged care services across the state grapple with the introduction of Victoria’s Voluntary Assisted Dying Act (VAD), which will come into effect 19 June, questions about how the Church will handle such a significant moment in health services are permeating across parishes and echoing throughout agencies. The Act will make it legal for doctors to prescribe people who meet specific criteria—including that they are six months or less from death—a lethal substance which they can take at a time of their choosing to end their life.
This process presents unique and previously unchartered challenges for the Church. However, as its introduction has gradually edged closer, Catholic health and aged care services have carefully prepared. Leading the charge in this unfamiliar and daunting terrain is Dr Dan Fleming, Chair of the Catholic Health Australia ‘Voluntary Assisted Dying Response Taskforce’. The taskforce was established to support Catholic health and aged care services in their response to the new legislation.
Also leading ethics and formation for St Vincent’s Health Australia, Dr Fleming is in an inimitable position to address some of the anxieties capturing Victoria’s Catholic health community.
He recently sat down with Melbourne Catholic to explore some of the key areas of the VAD legislation and how the Church will respond.
What are the implications of the VAD laws on Catholic health and aged care services, and more broadly, on a Church that does not agree with their introduction come 19 June?
I’d suggest that we consider this very important question by first thinking about our tradition of care and what it entails. This gives us a context in which we can consider what the Voluntary Assisted Dying Act means for us. This means remembering the long tradition of care that our Catholic services continue today. In this country, we’ve been providing health care—with a special focus on the poor and vulnerable—for well over 150 years. Globally, our tradition of care stretches back several thousand years. All of this care has its grounding point in Jesus’ call to his disciples to ‘heal the sick’ (see Matthew 25:35).
When we see this care in action, or we’re the recipients of it, we see just how beautiful it is, and that includes care at the end of life. Within this long and great tradition of providing excellent and beautiful end-of-life care, today we continue our commitments to heal and never to harm; to relieve pain and other physical and psychosocial symptoms of illness and frailty; to withdraw life-prolonging treatments when they are medically futile or overly burdensome or when a person wants them withdrawn; and to never abandon patients. All of this sets the context for how we respond to the VAD laws—and our first response is to continue doing what we’ve always done, and get better at it.
What will become legal in Victoria from 19 June is that, in certain circumstances, a medical practitioner can either prescribe a lethal substance to a person which they can take at a time of their choosing to end their own life, or administer that substance to a person with the same goal. In plain language, this is physician-assisted suicide and euthanasia. These actions have never been part of our tradition of care and they never will be.
And so the challenge that we’re presented with at this moment of time is to uphold that long, beautiful and excellent tradition of care, to continue advancing it, to be brave with it, to push for equity and justice in it. At the same time, we make clear that we will not provide or facilitate VAD—it’s just not part of who we are.
This moment invites our services and our broader Catholic community to be very proud of our excellent tradition of care, to advance it, to commit to advancing it and to be ready to support our services as they deal with some of the new complexities that arise in this new legislative context.
How do Catholic health and aged care providers continue to provide care when VAD laws will become a part of the industry landscape?
In one sense this is very simple: our services will continue doing what we have done best for centuries, in line with that ethic of care that we’ve spoken about already. When VAD is on the scene, and we won’t be providing it, our service provision doesn’t change.
This provision includes having quality, open and sensitive discussions with people at the end of life, including about their most difficult concerns. Our services benefit from the gift of amazing staff who are able to accompany patients even in their darkest moments, and that includes when they disclose to us that they wish for a hastened death. Often such discussions provide an opportunity for our people to explore a person’s concerns and needs and to adapt care in a way that responds better to their needs at that point in time.
If a person under our care is seriously considering VAD, we’ll continue to offer care in the way we would with any patient. What we won’t do is provide or facilitate the very specific interventions made legal under the VAD Act. Our services have been spending a lot of time ensuring that they are prepared for any new situations that might arise after the Act comes into effect. And, if people wish to seek out VAD from other services, we won’t impede them from doing this.
From a theological perspective, what does this mean for the Church?
I think the way to frame the theological question is, ‘What is being asked of us by God at this point in time?’ And the answer to that question about our mission is, in broad terms, to continue the healing ministry of Jesus.
When you read the Gospels and you understand how people encountered the healing ministry of Jesus, you see that it was beautiful because it was good and because it was true. And I think our services are being called on to continue to offer what is beautiful, good and true. We’re being asked to never compromise on the good that we offer those we care for. If we expand beyond the question of end-of-life care and look at the services that many of our remarkable Catholic health and aged care services offer in the state of Victoria, we see so clearly what is beautiful, good and true. We see how they respond to people living with an addiction, we see it at the beginning of life, we see it when people are acutely ill, we see it in homeless health and aged care services.
Our primary mission is a mission of witnessing to a healing ministry. We are a testament to something good here, and we can be proud of that and confident in it. Of course, we will be critics of any interventions that we believe undermine human dignity and the common good. And yet our main game isn’t fighting those battles in politics, our main game is witnessing to the good.
So it sounds like you’re choosing to respond to the VAD laws by placing your attention on our ethic of care?
That’s right. We’re looking to give witness to something that we believe serves people at the end of life in a way that best responds to their dignity. When this legislation first emerged, one of the issues that was highlighted was that a lot of people don’t have access to adequate end-of-life care. The stories we heard during this time were often deeply tragic and deeply distressing to anyone who engaged with them. No one would want to see a loved one suffer at the end of life in this way, and none of us would want our lives to end in this way. We as a society need to do better. And our services respond by continuing to offer excellent care, and committing to ongoing improvement and innovation in it, to better respond to people’s needs.
This commitment takes us into surprising territory sometimes, because we’re willing to be courageous in our care. I would encourage your readers to look up ‘magic mushrooms’ and ‘St Vincent’s’ to read about one of our many innovative projects to better care for people at the end of life. We’re not sitting on our hands here: we’re working all the time to improve our services to those who need them, including in some very innovative ways!
So, pursuing a stronger and more effective palliative care environment for patients is where much of your efforts will be focused? Why is this so important?
In a way, the whole discussion of VAD has enabled us to put end-of-life care firmly on the radar. Twenty-five per cent of Victorians do not have access to adequate and timely palliative care when they need it, and it is worse if you are in a regional area. We live in a liberal democracy and we understand that there will be laws that don’t align with our ethic of care. However, we hope that some of the oxygen and attention being consumed by VAD can be focused back on palliative care: only a very small number of people will ever access VAD, but every Victorian deserves adequate end-of-life care.
It remains to be seen if as much energy will be put into improving those services. If not, I think that will be a tragedy for the state of Victoria. One of the criteria for VAD is that a person is acting voluntarily and without coercion. I’m not sure how they’ll ensure this is the case. ‘Voluntariness’ will be skewed if Victoria can’t give its people adequate care. We know from data in Oregon in the USA that the fourth highest reason for people there accessing a regime like VAD is that they feel they’ll be a burden on their family, those around them or their caregivers. That’s a form of coercion that isn’t necessarily measured in a one-on-one discussion with a doctor. And if we as a country and a state haven’t done our work to ensure that people know that they can access excellent care without being a burden, then we’ve opened up something quite pernicious here.
It’s also important to give people a window into what this care looks like when it’s done beautifully, so that they know what they can expect. I recently shadowed a palliative care doctor for a day. Afterwards, I went home and wept. I didn’t weep because it was tragic, although there was tragedy there. I didn’t weep because there was pain, even though I saw pain. I didn’t weep because there was sadness, despite witnessing sadness.
I wept because the care was so beautiful. And these people at the end of their life were being treated in a way that told them they are sacred. Everything was being done to make these people as comfortable and feel as valued as possible. It was truly amazing.
Treading on unfamiliar ground, how will St Vincent’s and other Catholic health care providers navigate the introduction of this legislation?
Our Catholic services have prepared well, diligently and thoughtfully for this legislation in a way that is fully informed by our ethic of care. We’ve put strong processes in place. There’s a lot of education and training happening. We’ve had ongoing and open communications with the Department of Health and Human Services and have carefully followed relevant guidelines that they’ve provided for services that won’t be participating in VAD.
There will be some degree of uncertainty throughout the health industry and for us, and there are going to be complicated cases. It’s important for people in the Church to be mindful that our services are going to be working in a new environment and we’ll need support. That might be the support of their prayers but it might also be the support of standing up and being proud of what our services do.
We have something beautiful to give Victoria in end-of-life care.
Toby Ward is a journalist at Melbourne Catholic.