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Witnesses and Contact people

The most formal part of the Victorian Voluntary Assisted Dying (VAD) process is what’s called the written declaration. This has to be observed by two adult witnesses. It is at this time that a Contact person is also appointed.

The role of the witnesses is to provide independent oversight to ensure that the person seems to have the capacity to make such a decision, understands the consequence of ingesting the medication, and appears to make their request free from coercion.

The role of the contact person is to make sure that any unused VAD medicine is returned to the dispensing pharmacy.

Sometimes the person seeking VAD eligibility is either unable or unwilling to involve people they know as witnesses and/or contact person. In such cases DWDV members have proved invaluable in providing these services. For those interested in helping, the notes below are offered as some guidance.

The notes below have been prepared by Dr Nick Carr, MA MMed MB BChir DCH MRCGP FRACGP
DWDV Board member.

Witnesses

The Voluntary Assisted Dying Act states that not more than one of the two witnesses to the written declaration can be a family member of the patient (defined in the Act as the patient’s spouse or domestic partner, parent, sibling, child or grandchild). As a result, some people have found it hard to find eligible witnesses. This is where you come in! Here is what the official blurb from the Government website says:

The two witnesses must:

  • be at least 18 years old
  • not know or believe that they are a beneficiary under a will or otherwise going to receive a material benefit from the patient’s death
  • not be an owner or day-to-day manager of the health facility in which the patient is being treated or where they live
  • not be directly involved in providing health services or professional care services to the patient.

Witnessing a patient’s written declaration does not require prior knowledge of the patient or specialist knowledge but is based on the witness’s observation of the patient at the time. Someone in an administrative role or other role who is not directly involved in the patient’s care could be a witness.

In the presence of the witnesses, the coordinating medical practitioner should take the patient through a conversation about their decision, their understanding of the implications of their request to access voluntary assisted dying, and the potential risks and likely outcome of taking the voluntary assisted dying medication – noting that it will lead to their death.

Each witness must sign the form, in the coordinating medical practitioner’s presence, signifying that:

  • in the presence of the witness, the patient appeared to freely and voluntarily sign the declaration (or request someone nominated to sign it for them at the patient’s request)
  • at the time the patient signed the declaration, they appeared to have decision-making capacity in relation to voluntary assisted dying
  • at the time the patient signed the declaration, they appeared to understand the nature and effect of making the declaration.

Each witness must also state that they are not knowingly an ineligible witness (as described above).

However, if you agree to be a witness, your job is not just to rubber-stamp the forms. If you have any doubts about the criteria, such as the patient’s capacity or understanding, then seek clarification from the coordinating doctor and/or the patient. You should only sign the forms once you are comfortable that the patient satisfies all the criteria.

So, the process is not complicated. My suggestion would be you introduce yourself to everyone else and then allow the coordinating doctor to go through the steps as described above. You are not required to have any kind of separate interview with the patient (and some patients may be too ill or tired to want to do this anyway), but there is nothing to stop you having appropriate interaction as seems fit.

Please bear in mind that the Assisted Dying process can be stressful for both the Person and family. Please arrive on time and make contact with the person whose name you have been given by our General Manager.

If you are waiting with the patient and their family for the written declaration process to begin, please feel free to introduce yourself as a volunteer witness. However, I would ask that in general you do not seek to involve yourself in the process beyond what you are required to do. Once you have signed the paperwork, your job is done and the doctor will normally advise you that you may leave.

My experience suggests that this has been a positive and supportive occasion for the patient and others involved, and I hope you will leave with a strong sense of having helped at a crucial moment. However, keep in mind that it could be confronting or distressing to yourself. On your first experience of being a witness I would recommend that you have someone else with you to debrief and support you after the signing is finished (but that person should not be in the room for the signing – it could start getting a bit crowded!)

Many, many thanks for being prepared to help at this crucial time in someone’s care.

Nick Carr
DWDV
July 2021

Contact people

As part of the voluntary assisted dying process, a Contact Person must be appointed. This is normally done at the same time as the written declaration The role of the Contact Person is to be responsible for any unused voluntary assisted dying medication, and to act as the point of contact for the Voluntary Assisted Dying Review Board Secretariat. The role is very important, but not onerous. If you accept the role, you must sign the Contact Person appointment form. Remember to tell the doctor your date of birth, as it is required but is not on the form. Options then are: If the person will be self-administering the voluntary assisted dying medication (the most common form of VAD
  • If the person takes all their medication, then there is no action for you as the Contact Person to take.
  • If the person takes part but not all of the medication (very unusual), any unused medication must be returned to the Voluntary Assisted Dying Statewide Pharmacy Service within 15 days of the person dying. They are happy to come and collect it. The pharmacy service can be contacted on (03) 9076 5270 or by statewidepharmacy@alfred.org.au. Remember that failure to do so constitutes a criminal offence.
  • If the person dies without taking their medication (quite common), then the medication must be returned as described above.
  • If the person dies in hospital, just confirm that the medical people involved will deal with any unused medication. Otherwise, you will need to have arrangements in place so that you know that the person has died, and how to access any unused medication.
  • If the person decides not to use the VAD medication, they may request that you return the voluntary assisted dying medication to the pharmacy service before their death. This again is uncommon.
  • If the person will be having the voluntary assisted dying medication administered to them by their coordinating doctor, there is no work required of you.
  • If you accept the Contact Person’s role, you will be contacted by the Voluntary Assisted Dying Review Board Secretariat after the person’s death to seek feedback about the VAD process. This can be a good opportunity to chat to one of the Secretariat (they’re lovely people), not just to give the feedback, but also as a bit of a debrief. If you prefer, you may choose not to provide feedback to the Review Board.
  • Nick Carr DWDV November 2021

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