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Tragic flaw sees man use voluntary assisted dying drugs prescribed for his wife

Warning: This article contains discussions of suicide and depression that some readers may find upsetting A Queensland coroner has criticised the state's voluntary assisted dying laws, after an elderly man took his own life using drugs prescribed for his wife. The Coroner's Court in Brisbane held an inquest into the May 2023 death of a man in his 80s, referred to by the pseudonym ABC. The man's partner, who had a terminal illness, was found eligible for the voluntary assisted dying [VAD] program in March 2023. Under that law a person can self-administer a VAD substance in a private location but they must nominate a "contact person" who will be legally required to return any unused or leftover portion within 14 days. The self-administered drug was delivered to the couple's home a month later, and the man was the "contact person" responsible for the substance. On the same day the drug arrived, his wife was admitted to hospital with Covid, where they decided to take an intravenous VAD drug. She died in hospital on May 8, 2023. The man was told to return the drug within two days of his partner's death, but he failed to do so, using it to take his own life eight days later. He did not return the drug as he was unable to leave his home, and there was no arrangement made for a health professional to collect it. ABC’s adult daughter recalled the moment she found her lifeless father after returning from running errands. “I thought he was asleep in the chair. I put my arms around him. He was cold,” she told the inquest. The woman became emotional and said that she found an empty box in the kitchen and “knew immediately it was the VAD”. In his findings, coroner David O’Connell said he was not judging the merits of VAD, but it had led to a "tragedy" only 107 days after it was legalised. “Persons should not be placed in a position where they can be led into unwise decisions,” the coroner said in his findings handed down on Wednesday. O'Connell said that the laws had failed to find a balance between a patient's autonomy and lethal medication safety. “The VAD law has (the substance) provided to persons with no medical training, no regulatory oversight, and in a period of great personal and emotional turmoil,” he said. The inquest heard ABC had previously been diagnosed with, and received medication for depression, which should've been considered before approving someone as a contact person. "The fact that ABC had been medically diagnosed with depression and took medication was not something the VAD authorities considered, or even enquired on, when approving them to be a Contact Person. Indeed, there are simply no checks or enquiries of the Contact Person's suitability," he said. He added that while there was no breach of protocol or legislative processes by QVAD personnel, it was "not a well-considered law". O'Connell recommended the Queensland government implement an earlier draft of VAD laws that required oversight by a medical professional at all times. Queensland Health Minister Shannon Fentiman said the government would consider the coroner’s recommendations. “Following that case, we are working on a review of that legislation coming up to three years that will start next year, and that will obviously be one of the things that we look at,” she said. Image: Shutterstock

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Aussie airline's shock collapse

Australia's third largest airline Regional Express, better known as Rex, has entered voluntary administration. The airline will ground all its Boeing 737 jets and cease flying immediately between Australia’s major cities, as Rex struggled to compete with Qantas and Jetstar for customers. In response to the cancellation, Virgin has said it will allow Rex customers with tickets on 737 flights to transfer them to its services. Rex began connecting major cities during the pandemic, but was unable to keep up with other airlines who were more known for servicing Aussie capital cities. While flights to major cities with Rex will cease, the airline confirmed that its flights to and from regional cities, which use smaller Saab 340 turboprops, will continue as normal. The airline currently serves 56 destinations around Australia, many of them remote. In response to the cancelled flights, Qantas and Virgin Australia shared a statement saying they were “sad” for the “difficult” day. “This is a challenging day for our industry and we are sad to see Rex enter voluntary administration with the immediate suspension of its Boeing 737 operations,” a spokesperson for Qantas said. “We know this will be a difficult period for many Rex customers and employees and we stand ready to assist.” The spokesperson said Rex customers impacted by cancelled flights due to the grounding of their domestic jet services can contact Qantas and Jetstar to be reaccommodated on the same route as their original booking at no charge, where seats available. In a statement on the Rex <a href="https://www.rex.com.au/AboutRex/OurCompany/DomesticFlightUpdates.aspx" target="_blank" rel="noopener">website</a>, the stricken airline said it was working with Virgin Australia to assist impacted passengers. “An agreement has been reached with Virgin Australia to honour all prepaid tickets for the Rex Group’ direct services between domestic capital cities, at no additional cost to passengers. “If you hold a prepaid ticket for future travel on any of these routes, you can transfer your Rex booking to a similar Virgin Australia flight.” Customers must re-book their flight by Wednesday August 14th or they will lose their money. “Regional flights are unaffected by the administration and will continue to operate as normal,” it stated. Image credits: Shutterstock

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What happens if you want access to voluntary assisted dying but your nursing home won’t let you?

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/neera-bhatia-15189">Neera Bhatia</a>, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a> and <a href="https://theconversation.com/profiles/charles-corke-167297">Charles Corke</a>, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a> Voluntary assisted dying is now lawful in <a href="https://theconversation.com/voluntary-assisted-dying-will-soon-be-legal-in-all-states-heres-whats-just-happened-in-nsw-and-what-it-means-for-you-183355">all Australian states</a>. There is also <a href="https://nationalseniors.com.au/uploads/VAD-Report-correct-month-12.8.21.pdf">widespread community support</a> for it. Yet some residential institutions, such as hospices and aged-care facilities, are obstructing access despite the law not specifying whether they have the legal right to do so. As voluntary assisted dying is implemented across the country, institutions blocking access to it will likely become more of an issue. So addressing this will help everyone – institutions, staff, families and, most importantly, people dying in institutions who wish to have control of their end. <h2>The many ways to block access</h2> While voluntary assisted dying legislation recognises the right of doctors to <a href="https://theconversation.com/was-take-on-assisted-dying-has-many-similarities-with-the-victorian-law-and-some-important-differences-121554">conscientiously object</a> to it, the law is generally silent on the rights of institutions to do so. While the institution where someone lives has no legislated role in voluntary assisted dying, it can refuse access in various ways, including: <ul> <li> restricting staff responding to a discussion a resident initiates about voluntary assisted dying </li> <li> refusing access to health professionals to facilitate it, and </li> <li> requiring people who wish to pursue the option to leave the facility. </li> </ul> <h2>Here’s what happened to ‘Mary’</h2> Here is a hypothetical example based on cases one of us (Charles Corke) has learned of via his role at Victoria’s <a href="https://www.safercare.vic.gov.au/about/vadrb">Voluntary Assisted Dying Review Board</a>. We have chosen to combine several different cases into one, to respect the confidentiality of the individuals and organisations involved. “Mary” was a 72-year-old widow who moved into a private aged-care facility when she could no longer manage independently in her own home due to advanced lung disease. While her intellect remained intact, she accepted she had reached a stage at which she needed significant assistance. She appreciated the help she received. She liked the staff and they liked her. After a year in the facility, during which time her lung disease got much worse, Mary decided she wanted access to voluntary assisted dying. Her children were supportive, particularly as this desire was consistent with Mary’s longstanding views. Mary was open about her wish with the nursing home staff she felt were her friends. The executive management of the nursing home heard of her intentions. This resulted in a visit at which Mary was told, in no uncertain terms, her wish to access voluntary assisted dying would not be allowed. She would be required to move out, unless she agreed to change her mind. Mary was upset. Her family was furious. She really didn’t want to move, but really wanted to continue with voluntary assisted dying “in her current home” (as she saw it). Mary decided to continue with her wish. Her family took her to see two doctors registered to provide assessments for voluntary assisted dying, who didn’t work at the facility. Mary was deemed eligible and the permit was granted. Two pharmacists visited Mary at the nursing home, gave her the medication and instructed her how to mix it and take it. These actions required no active participation from the nursing home or its staff. Family and friends arranged to visit at the time Mary indicated she planned to take the medication. She died peacefully, on her own terms, as she wished. The family informed the nursing home staff their mother had died. Neither family nor staff mentioned voluntary assisted dying. <h2>Staff are in a difficult position too</h2> There is widespread community support for voluntary assisted dying. In a 2021 survey by National Seniors Australia, <a href="https://nationalseniors.com.au/uploads/VAD-Report-correct-month-12.8.21.pdf">more than 85%</a> of seniors agreed it should be available. So it’s likely there will be staff who are supportive in most institutions. For instance, in a survey of attitudes to voluntary assisted dying in a large public tertiary hospital, <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/imj.15285">88% of staff</a> supported it becoming lawful. So a blanket policy to refuse dying patients access to voluntary assisted dying is likely to place staff in a difficult position. An institution risks creating a toxic workplace culture, in which clandestine communication and fear become entrenched. <h2>What could we do better?</h2> 1. Institutions need to be up-front about their policies Institutions need to be completely open about their policies on voluntary assisted dying and whether they would obstruct any such request in the future. This is so patients and families can factor this into deciding on an institution in the first place. 2. Institutions need to consult their stakeholders Institutions should consult their stakeholders about their policy with a view to creating a “<a href="https://bmcpalliatcare.biomedcentral.com/articles/10.1186/s12904-021-00891-3">safe</a>” environment for residents and staff – for those who want access to voluntary assisted dying or who wish to support it, and for those who don’t want it and find it confronting. 3. Laws need to change Future legislation should define the extent of an institution’s right to obstruct a resident’s right to access voluntary assisted dying. There should be safeguards in all states (as is already legislated <a href="https://documents.parliament.qld.gov.au/tp/2021/5721T707.pdf">in Queensland</a>), including the ability for individuals to be referred in sufficient time to another institution, should they wish to access voluntary assisted dying. Other states should consider whether it is reasonable to permit a resident, who does not wish to move, to be able to stay and proceed with their wish, without direct involvement of the institution. <hr /> The opinions expressed in this article are those of the authors and do not necessarily reflect the views of Victoria’s Voluntary Assisted Dying Review Board.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/183364/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/neera-bhatia-15189">Neera Bhatia</a>, Associate Professor in Law, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a> and <a href="https://theconversation.com/profiles/charles-corke-167297">Charles Corke</a>, Associate Professor of Medicine, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-happens-if-you-want-access-to-voluntary-assisted-dying-but-your-nursing-home-wont-let-you-183364">original article</a>. </div>

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People with dementia aren’t currently eligible for voluntary assisted dying. Should they be?

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/ben-white-15387">Ben White</a>, <a href="https://theconversation.com/institutions/queensland-university-of-technology-847">Queensland University of Technology</a>; <a href="https://theconversation.com/profiles/casey-haining-1486290">Casey Haining</a>, <a href="https://theconversation.com/institutions/queensland-university-of-technology-847">Queensland University of Technology</a>; <a href="https://theconversation.com/profiles/lindy-willmott-15386">Lindy Willmott</a>, <a href="https://theconversation.com/institutions/queensland-university-of-technology-847">Queensland University of Technology</a>, and <a href="https://theconversation.com/profiles/rachel-feeney-140352">Rachel Feeney</a>, <a href="https://theconversation.com/institutions/queensland-university-of-technology-847">Queensland University of Technology</a> Dementia is the <a href="https://www.dementia.org.au/about-dementia">second leading cause of death</a> for Australians aged over 65. More than 421,000 Australians <a href="https://www.dementia.org.au/about-dementia">currently live with dementia</a> and this figure is expected to almost double in the next 30 years. There is ongoing public <a href="https://www.mja.com.au/journal/2024/220/9/should-voluntary-assisted-dying-victoria-be-extended-encompass-people-dementia">discussion</a> about whether dementia should be a qualifying illness under Australian voluntary assisted dying laws. Voluntary assisted dying is <a href="https://www.unswlawjournal.unsw.edu.au/wp-content/uploads/2023/12/Issue-464-10-Waller-et-al.pdf">now lawful in all six states</a>, but is not available for a person living with dementia. The Australian Capital Territory has <a href="https://www.canberratimes.com.au/story/8631104/marisa-paterson-to-consult-on-voluntary-assisted-dying-amendments/?cs=14329">begun debating</a> its voluntary assisted dying bill in parliament but the government has <a href="https://www.legislation.act.gov.au/DownloadFile/es/db_68610/current/PDF/db_68610.PDF">ruled out</a> access for dementia. Its view is that a person should retain decision-making capacity throughout the process. But the bill includes a requirement to <a href="https://www.legislation.act.gov.au/b/db_68609/">revisit the issue</a> in three years. The Northern Territory is also considering reform and <a href="https://www.theaustralian.com.au/subscribe/news/1/?sourceCode=TAWEB_WRE170_a_GGL&dest=https%3A%2F%2Fwww.theaustralian.com.au%2Fnation%2Fpolitics%2Fconcerning-territory-nt-surveys-public-support-on-euthanasia-for-mentally-ill%2Fnews-story%2F4e45111bb293af4cf32ac3c6df058869&memtype=anonymous&mode=premium&v21=GROUPA-Segment-2-NOSCORE&V21spcbehaviour=append">has invited views</a> on access to voluntary assisted dying for dementia. Several public figures have also entered the debate. Most recently, former Australian Chief Scientist, Ian Chubb, <a href="https://www.abc.net.au/listen/programs/melbourne-drive/voluntary-assisted-dying-dementia-victoria/103467864">called for the law to be widened</a> to allow access. Others <a href="https://www.smh.com.au/national/voluntary-assisted-dying-should-not-be-available-to-dementia-patients-20230607-p5deqo.html">argue</a> permitting voluntary assisted dying for dementia would present unacceptable risks to this vulnerable group. <h2>Australian laws exclude access for dementia</h2> Current Australian voluntary assisted dying laws <a href="https://www.unswlawjournal.unsw.edu.au/wp-content/uploads/2023/12/Issue-464-10-Waller-et-al.pdf">exclude access</a> for people who seek to qualify because they have dementia. In New South Wales, the <a href="https://legislation.nsw.gov.au/view/html/inforce/current/act-2022-017">law specifically states</a> this. In the other states, this occurs through a <a href="https://www.unswlawjournal.unsw.edu.au/wp-content/uploads/2022/04/Issue-451-White-et-al.pdf">combination of the eligibility criteria</a>: a person whose dementia is so advanced that they are likely to die within the 12 month timeframe would be highly unlikely to retain the necessary decision-making capacity to request voluntary assisted dying. This does not mean people who have dementia cannot access voluntary assisted dying if they also have a terminal illness. For example, a person who retains decision-making capacity in the early stages of Alzheimer’s disease with terminal cancer may access voluntary assisted dying. <h2>What happens internationally?</h2> Voluntary assisted dying laws in some other countries allow access for people living with dementia. One mechanism, used in the Netherlands, is through <a href="https://agsjournals.onlinelibrary.wiley.com/doi/full/10.1111/jgs.16692">advance directives or advance requests</a>. This means a person can specify in advance the conditions under which they would want to have voluntary assisted dying when they no longer have decision-making capacity. This approach depends on the person’s family identifying when those conditions have been satisfied, generally in consultation with the person’s doctor. Another approach to accessing voluntary assisted dying is to allow a person with dementia to choose to access it while they still have capacity. This involves regularly assessing capacity so that just before the person is predicted to lose the ability to make a decision about voluntary assisted dying, they can seek assistance to die. In Canada, this has been referred to as the “<a href="https://www.unswlawjournal.unsw.edu.au/wp-content/uploads/2022/04/Issue-451-White-et-al.pdf">ten minutes to midnight</a>” approach. <h2>But these approaches have challenges</h2> International experience reveals these approaches have limitations. For advance directives, it can be difficult to specify the conditions for activating the advance directive accurately. It also requires a family member to initiate this with the doctor. Evidence also shows doctors are <a href="https://link.springer.com/article/10.1186/1472-6939-16-7">reluctant</a> to act on advance directives. Particularly challenging are <a href="https://bmcmedethics.biomedcentral.com/articles/10.1186/s12910-019-0401-y">scenarios</a> where a person with dementia who requested voluntary assisted dying in an advance directive later appears happy and content, or no longer expresses a desire to access voluntary assisted dying. Allowing access for people with dementia who retain decision-making capacity also has practical problems. Despite regular assessments, a person may lose capacity in between them, meaning they miss the window before midnight to choose voluntary assisted dying. These capacity assessments can also be very complex. Also, under this approach, a person is required to make such a decision at an early stage in their illness and may lose years of otherwise enjoyable life. Some also argue that regardless of the approach taken, allowing access to voluntary assisted dying would involve unacceptable risks to a vulnerable group. <h2>More thought is needed before changing our laws</h2> There is <a href="https://www.parliament.qld.gov.au/Documents/TableOffice/TabledPapers/2020/5620T490.pdf">public demand</a> to allow access to voluntary assisted dying for dementia in Australia. The mandatory reviews of voluntary assisted dying legislation <a href="https://www.publish.csiro.au/ah/pdf/AH23005">present an opportunity</a> to consider such reform. These reviews generally happen after three to five years, and in some states they will occur regularly. The scope of these reviews can vary and sometimes governments may not wish to consider changes to the legislation. But the Queensland review “<a href="https://www.legislation.qld.gov.au/view/pdf/asmade/act-2021-017">must include a review of the eligibility criteria</a>”. And the ACT bill requires the review to <a href="https://www.legislation.act.gov.au/b/db_68609/">consider</a> “advanced care planning”. Both reviews would require consideration of who is able to access voluntary assisted dying, which opens the door for people living with dementia. This is particularly so for the ACT review, as advance care planning means allowing people to request voluntary assisted dying in the future when they have lost capacity. This is a complex issue, and more thinking is needed about whether this public desire for voluntary assisted dying for dementia should be implemented. And, if so, how the practice could occur safely, and in a way that is acceptable to the health professionals who will be asked to provide it. This will require a careful review of existing international models and their practical implementation as well as what would be feasible and appropriate in Australia. Any future law reform should be <a href="https://www.publish.csiro.au/AH/AH19201">evidence-based</a> and draw on the views of people living with dementia, their family caregivers, and the health professionals who would be relied on to support these decisions.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/224075/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/ben-white-15387">Ben White</a>, Professor of End-of-Life Law and Regulation, Australian Centre for Health Law Research, <a href="https://theconversation.com/institutions/queensland-university-of-technology-847">Queensland University of Technology</a>; <a href="https://theconversation.com/profiles/casey-haining-1486290">Casey Haining</a>, Research Fellow, Australian Centre for Health Law Research, <a href="https://theconversation.com/institutions/queensland-university-of-technology-847">Queensland University of Technology</a>; <a href="https://theconversation.com/profiles/lindy-willmott-15386">Lindy Willmott</a>, Professor of Law, Australian Centre for Health Law Research, Queensland University of Technology, <a href="https://theconversation.com/institutions/queensland-university-of-technology-847">Queensland University of Technology</a>, and <a href="https://theconversation.com/profiles/rachel-feeney-140352">Rachel Feeney</a>, Postdoctoral research fellow, <a href="https://theconversation.com/institutions/queensland-university-of-technology-847">Queensland University of Technology</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/people-with-dementia-arent-currently-eligible-for-voluntary-assisted-dying-should-they-be-224075">original article</a>. </div>

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23-year-old bravely dies on her own terms

A terminally ill young woman from Adelaide has ended her life under the state’s voluntary assisted dying laws. In a funeral notice published in the Adelaide Advertiser, the family of Lily Thai said she died at the Flinders Medical Centre on June 21. “Much loved daughter of Kate and Le. Beloved granddaughter, niece and cousin. Treasured friend to many,” the family wrote. The family have shared that her funeral will be held at Centennial Park Cemetery on June 29. She made the <a href="https://www.oversixty.com.au/health/caring/23-year-old-reveals-why-she-s-chosen-to-end-her-life" target="_blank" rel="noopener">heartbreaking decision</a> to take her own life after countless surgeries failed to improve her illness. Thai suffered from Ehlers Danlos Syndrome (EDS) – a genetic condition that left her completely bedridden and in constant pain. Her powerful story touched thousands nationwide before she passed away. Thai had long wished to take her own life with dignity after a battle with such a debilitating condition. “I decided that pain was so severe it wasn’t worth it, and I just wanted to take it into my own hands,” Thai told the Adelaide Advertiser. After her painful health battle, she spent her last days at the Flinders Medical Centre, where she said she mainly slept while in “excruciating pain” Thai had recently signed the paperwork to use South Australia’s voluntary assisted dying laws, which came into effect in January 2023, to end her life after being administered an IV medication. Image credit: The Advertiser / TikTok

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23-year-old reveals why she's chosen to end her life

23-year-old Lily Thai has made the crippling decision to end her life. The Adelaide native, who suffers from Ehlers Danlos Syndrome (EDS), will use recently passed voluntary assisted dying laws after signing the final paperwork a week prior. In January 2023, South Australia legalised assisted dying with the government funnelling in $18 million over the next five years to support safe access to the service. “I realised that I can’t have any more anaesthesia, so I (couldn’t) have any more feeding tube changes (or) surgeries,” Thai told The Advertiser. EDS is a debilitating genetic condition which has left the 23-year-old completely bedridden and in constant pain. It affects her joints, skin and walls of the blood vessels so severely she is reliant on her father as a caregiver to do everything for her, “even the most intimate things”. Doctors will administer an IV medication that will terminate the young woman’s life within 10 seconds. “I’ll no longer have any pain, I will no longer suffer with any of these issues, and I’ll finally be free of all the suffering that I have endured for so many years.” Thai had initially thought her health deterioration was caused by a spinal fluid leak, but after undergoing treatment to fix it, her condition did not improve and doctors couldn’t give her a definitive diagnosis. As a desperate last measure, she travelled to Sydney to meet a surgeon who “specialised in spinal issues (for) patients with EDS” when she was 21. She was then confined to a halo brace and required a nasal feeding tube as she "couldn’t keep anything down,” and weighed just 40kg. In May 2021, Thai had spinal fusion surgery and just a week later was fitted with a gastro Jejenul feeding tube to vent out stomach acid and secretion. Through her rehab period, hospitals were under strict Covid-19 protocols, so Thai suffered alone without any visitors. “I couldn’t stand not seeing my dad, so I got discharged early,” she said. She was later diagnosed with auto-immune autonomic ganglionopathy — a rare condition where the body’s immune system attacks the nervous system. “The neurologist said that I was in multi-organ failure, but it wasn’t until I had a severe decline after one of my surgeries, (and) when I saw my rehab doctor they found a large lesion of the left side of my brain,” she said. “He suspected I had a type of motor neurone disease.” Thai has spent the past two years at Flinders Medical Centre’s Laurel Hospice, where she shared that most of her days are filled with sleep to avoid being in “excruciating pain”. Healthcare staff there granted one of her final wishes, which was to visit a beach, and so they took Thai in the back of an ambulance to the coastline. An image (at top) shows Lily resting on a bed, enjoying her Maccas fries and looking out at the golden sand and blue water in front of her. While at the hospice, Thai also formed a strong bond with another young woman, Annaliese Holland, who was also suffering a terminal illness at the hospice. The pair say young people with a terminal illness often mourn the “life (they) never got to have.” “For elderly or older people, (they) have memories to look back on to laugh about and cry about,” Holland said. “But for a young person in palliative hospice, you haven’t formed many of them.” “You never do the normal things like going to your high school graduation,” Thai said. “What makes me sad is that … you just want to push on, but at the same time it’s really hard because you know you won’t have babies or any of that,” Holland said. Holland has vowed to do everything in her power to make Thai’s last days in hospice more bearable. “All I can do is brush her (Lily’s) hair or moisturise her legs. I just want her to know that I’m there and people care,” a tearful Holland said. Thai has been able to plan parts of her own funeral and has been busy saying goodbye to family and friends. As part of her legacy, she’s inviting donations for palliative research to The Hospital Research Foundation on her memorial card to be given to funeral attendees. Image credit: Facebook

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People thinking of voluntary assisted dying may be able to donate their organs. We need to start talking about this

<a href="https://theconversation.com/profiles/robert-ray-1441988">Robert Ray</a>, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a> The number of people needing an organ transplant vastly outweighs the number of organs available. <a href="https://www.donatelife.gov.au/sites/default/files/2023-02/OTA%202022%20Donation%20and%20Transplantation%20Activity%20Report.pdf">In 2022</a> there were about 1,800 Australians waiting for an organ but only about 1,200 people received an organ transplant. But in <a href="https://onlinelibrary.wiley.com/doi/10.1111/imj.16085">a recent paper</a>, I outline one unexplored option for increasing the number of potential organ donors in Australia – transplanting organs from people undergoing voluntary assisted dying. This would involve transplanting organs only after someone had died. It’s estimated <a href="https://jamanetwork.com/journals/jama/article-abstract/2616383">about 10%</a> of people eligible for voluntary assisted dying are likely to be medically suitable to donate their organs. Based on <a href="https://www.safercare.vic.gov.au/sites/default/files/2022-09/Voluntary%20Assisted%20Dying%20Review%20Board%20Report%20of%20Operations%20July%202021-June%2022_FINAL.pdf">Victorian figures</a> alone, this could lead to about an extra 40 potential organ donors each year. This type of organ donation has taken place <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9297969/">for more than 20 years</a> in Europe, and more recently in Canada. Organs transplanted from donors undergoing voluntary assisted dying <a href="https://jamanetwork.com/journals/jamasurgery/article-abstract/2769118">have</a> <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/ajt.16267">similar</a> <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/ajt.16971">success rates</a> to more traditional donations. Yet, this is a discussion we’ve yet to have in Australia. Here are some of the ethical and practical issues we need to start talking about. <h2>Is this ethical? It’s tricky</h2> The main ethical challenge is ensuring a person isn’t motivated to end their life prematurely so they can donate their organs. <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/ajt.13746">Internationally</a>, <a href="https://jme.bmj.com/content/42/8/486.short">this challenge</a> is mainly addressed by having <a href="https://www.sciencedirect.com/science/article/pii/S1600613523000291">independent assessments</a> by multiple doctors. This is to ensure the motivation is genuine and honest, much like assessing someone before voluntary assisted dying. Similarly, it is important the doctor of someone undergoing voluntary assisted dying isn’t persuading them to donate an organ. This means any doctor overseeing voluntary assisted dying may be limited in how much they can discuss organ donation with their patient. Again, this <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/ajt.13746">has been managed internationally</a> by having separate, independent doctors overseeing organ donation and voluntary assisted dying, <a href="https://www.cmaj.ca/content/190/44/E1305.short">without one influencing</a> the other. <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/528192/original/file-20230525-27-sjwdaa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/528192/original/file-20230525-27-sjwdaa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/528192/original/file-20230525-27-sjwdaa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=437&fit=crop&dpr=1 600w, https://images.theconversation.com/files/528192/original/file-20230525-27-sjwdaa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=437&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/528192/original/file-20230525-27-sjwdaa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=437&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/528192/original/file-20230525-27-sjwdaa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=549&fit=crop&dpr=1 754w, https://images.theconversation.com/files/528192/original/file-20230525-27-sjwdaa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=549&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/528192/original/file-20230525-27-sjwdaa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=549&fit=crop&dpr=3 2262w" alt="Elderly woman in bed hand on covers" /></a><figcaption>Is this what people really want, with so little time left? <a class="source" href="https://www.shutterstock.com/image-photo/senior-woman-laying-on-bed-hospital-1054837748">Shutterstock</a></figcaption></figure> Organ donation may also affect the way voluntary assisted dying is conducted, which <a href="https://www.sciencedirect.com/science/article/pii/S1600613523000291">may impact</a> participants’ very limited quality of life. That’s because determining if someone is eligible to donate an organ involves a number of <a href="https://jme.bmj.com/content/43/9/601.short">investigations</a>. These may include blood tests, radiology (imaging) and numerous clinical encounters to exclude diseases such as cancer, which would prevent someone donating their organs. These investigations may be exhausting but necessary. This burden must be weighed against the participant’s wishes and motivation to donate their organs. So people must also be informed of the impact organ donation will have on their limited life left. The choices of people considering this option must be respected and they must be given multiple opportunities to review their decision, without undue influence or bias. <h2>Practical issues: coordination, location, regulation</h2> Practically, combining organ donation and voluntary assisted dying is <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/ajt.13746">challenging</a>. This includes the difficulty organising and coordinating specialists in organ donation, voluntary assisted dying and transplantation. This is why, internationally, organ donation of this nature mostly occurs in large hospitals, where it’s easier to coordinate. So if people want to donate an organ this way, they may spend their last moments in an unfamiliar environment. <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/528195/original/file-20230525-15-irsqg9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/528195/original/file-20230525-15-irsqg9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/528195/original/file-20230525-15-irsqg9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/528195/original/file-20230525-15-irsqg9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/528195/original/file-20230525-15-irsqg9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/528195/original/file-20230525-15-irsqg9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/528195/original/file-20230525-15-irsqg9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/528195/original/file-20230525-15-irsqg9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" alt="Patient being wheeled on stretcher through hospital corridors" /></a><figcaption>People may have to be moved to a large hospital with the facilities and staff on hand. <a class="source" href="https://www.shutterstock.com/image-photo/surgeon-assistant-team-transport-move-stretcher-2062330820">Shutterstock</a></figcaption></figure> Efforts have been made <a href="https://jamanetwork.com/journals/jamasurgery/article-abstract/2776765">internationally</a> to prioritise these valuable last moments by giving people the choice of where voluntary assisted dying occurs (<a href="https://www.cmaj.ca/content/190/44/E1305.short">such as their home</a>). But this currently only occurs in a minority of cases and increases the complexity of organ donation. Regulating the process is also essential to developing a safe, trustworthy and effective program. Ideally a centralised organisation such as Australia’s national <a href="https://www.donatelife.gov.au">Organ and Tissue Authority</a> would organise, undertake and regulate this. However, this may be challenging given voluntary assisted dying practices are specific to each state. <h2>The challenges ahead</h2> If someone considering voluntary assisted dying wants to donate their organs and is deemed eligible, there is currently <a href="https://onlinelibrary.wiley.com/doi/10.1111/imj.16085">no legal barrier in Australia</a> to stop them. What might prevent them is how their doctor responds, and whether there are the services and organisations willing to fulfil this request ethically and practically. The next step in considering this form of organ donation is to discuss the prospect publicly. Every extra donated organ is potentially lifesaving. So we should make every effort to consider potential safe and ethical ways to increase donation and transplantation rates.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/206298/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/robert-ray-1441988">Robert Ray</a>, Affiliate Associate Lecturer, School of Medicine, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a> Image credit: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/people-thinking-of-voluntary-assisted-dying-may-be-able-to-donate-their-organs-we-need-to-start-talking-about-this-206298">original article</a>.

Body

Long Covid sufferer applies for voluntary euthanasia

After suffering with long Covid for over two years, a Canadian woman believes she has been left with no choice but to apply for voluntary euthanasia. Tracey Thompson, a Toronto resident in her 50s, told <a href="https://toronto.ctvnews.ca/ontario-woman-enduring-effects-of-long-covid-begins-process-for-medically-assisted-death-1.5976944" target="_blank" rel="noopener" data-link-type="article-inline">CTV News</a> she had begun the process of applying for Medical Assistance in Dying (MAiD), due to extreme fatigue and a lack of financial support. Tracey used to work long hours as a chef, but has been unable to work for the last 26 months, with no foreseeable end to her forced unemployment. “(MAiD) is exclusively a financial consideration,” she said. “My choices are basically to die slowly and painfully, or quickly. Those are the options that are left.” As well as a lack of financial support, Tracey has experienced long Covid symptoms such as severe fatigue, blurred vision, difficulty digesting food, difficulty breathing, an altered sense of taste and smell, and scars on her heart from swelling due to myocarditis. While health experts say long Covid is difficult to diagnosis, it is estimated that five percent of those who contract the virus will go on to have long term symptoms. Tracey also told CTV that she now struggles to get up and look after herself, which is very different to her previous fast paced life in a physically demanding job. “From being able-bodied and employed to basically bed-bound,” she said. “I can’t get up on average for 20-plus hours. I have very little capacity to expend the energy physically, mentally and emotionally, so I try to stay home all the time.” But Thompson stressed she still enjoys life and doesn’t want to die, but doesn’t think she could survive without an income. “I still enjoy life. Birds chirping, small things that make up a day are still pleasant to me, they’re still enjoyable. I still enjoy my friends. There’s a lot to enjoy in life, even if it’s small,” she said. “But I don’t relish the idea of suffering for months to come to the same conclusion." “When support is not coming, things aren’t going to change. It seems irrational to put myself through that just to die in the end.” While Tracey is unsure if she would be eligible for the Ontario Disability Support Program, she believes the maximum monthly payment would only just cover her rent, leading her to apply for the drastic action of voluntary euthanasia. In Canada, you do not need to have a terminal illness to be eligible for MAiD, but rather have an illness that “cannot be relieved under conditions that you consider acceptable”. Thompson said she was confident she would get approval. “As best I know, I would meet the criteria,” she said. "I'm very ill. There is no treatment. There is no cure." Image credits: CTV

Caring

Aussie with terminal cancer uses time left to make her mark

An Australian researcher who has been diagnosed with terminal ovarian cancer is busy making plans for when she’s gone - including a contribution she hopes will help advance research in animal studies. Siobhan O’Sullivan was diagnosed with stage 3 ovarian cancer in July 2020, finding out within a year that the cancer had spread and that her illness was terminal. “In the week prior to my diagnosis, I was starting to say to people, ‘I’m not feeling right - I think it’s stress because Dad’s going to die soon’,” she told <a href="https://7news.com.au/lifestyle/health-wellbeing/a-silent-killer-has-left-her-terminally-ill-now-this-aussie-woman-has-a-simple-message-c-6854866" target="_blank" rel="noopener">7News</a>. “The week before dad died, I went to the doctor and said, ‘Something’s not right’.” During her treatments Siobhan suffered multiple strokes - an unexpected side effect - but even extensive treatment couldn’t stop the cancer from spreading. “That was a huge blow for me because a lot of women at that point do get some remission time,” she said. “I’m now at 19 months, which means I’m on borrowed time.” Though she’s living with death, Siobhan has maintained her humour and optimism, as well as her advocacy for ovarian cancer and the legalisation of voluntary assisted dying. She also began making plans, divesting her property and funds to her niece, nephew, godson and his sister, and ensuring her podcast is in good hands once she’s gone. Siobhan has also bequeathed $50,000 to the Australisian Animal Studies Association (AASA), which she is a founder of, and is helpling to establish two awards for future researchers. She is an associate professor of politics at Sydney’s University of New South Wales and was extremely involved in research around animal studies and her other passion, the alleviation of social issues related to poverty. Thanks to her donation, the AASA is offering two new prizes: one for early-career researchers, and the other for animal studies scholars, artists or advocates who have worked to promote their insights and findings with their peers and the public. “This is an exciting way to help the field of animal studies,” she said in a <a href="https://www.inside.unsw.edu.au/awards/new-awards-scheme-advances-the-emerging-sub-discipline-animal-studies#:~:text=As%20a%20founder%20of%20the,be%20established%20in%20coming%20years." target="_blank" rel="noopener">statement</a>. “My own research … suggests that many animal studies scholars feel isolated and their research is not acknowledged by their own institutions. “These awards are a way of strengthening the animal studies community and giving scholars a sense of achievement and recognition.” As she nears the end of her life, Siobhan has said she would feel immensely comforted by the thought that she could legally end her life before her cancer brings her even more suffering. <blockquote class="twitter-tweet"> I was so honoured to speak on behalf of people facing horrible deaths in NSW. Today I'll be watching <a href="https://twitter.com/nsw_upperhouse?ref_src=twsrc%5Etfw">@nsw_upperhouse</a> & <a href="https://twitter.com/NSWParlLA?ref_src=twsrc%5Etfw">@NSWParlLA</a> closely. I hope our political leaders use their power to ease the load of the terminally ill & their friends & family. <a href="https://twitter.com/hashtag/AssistedDying?src=hash&ref_src=twsrc%5Etfw">#AssistedDying</a> <a href="https://twitter.com/hashtag/VAD?src=hash&ref_src=twsrc%5Etfw">#VAD</a> <a href="https://twitter.com/hashtag/nswpol?src=hash&ref_src=twsrc%5Etfw">#nswpol</a> <a href="https://t.co/hecIbBdBAl">pic.twitter.com/hecIbBdBAl</a> — Siobhan O'Sullivan 🥦😸♋ (@so_s) <a href="https://twitter.com/so_s/status/1527089433501405184?ref_src=twsrc%5Etfw">May 19, 2022</a></blockquote> “My view is that there is no benefit that’s going to come to me, or my family, or this world, for me to suffer the last couple of weeks of a death by ovarian cancer,” she said. But the very recent <a href="https://www.oversixty.com.au/health/caring/emotional-scenes-as-nsw-passes-law-on-voluntary-assisted-dying" target="_blank" rel="noopener">passing of the Voluntary Assisted Dying Bill</a> in NSW Parliament might still come too late for Siobhan, since it could take up to 18 months for the law to come into effect. Despite it not necessarily being an option she could take up, Siobhan says her advocacy will help others in the future. “This is for the other people, for the next people - the people in one, two, three years time,” she said. Image: Siobhan O’Sullivan (Facebook)

Caring

Emotional scenes as NSW passes law on Voluntary Assisted Dying

The NSW parliament has legalised voluntary assisted dying (VAD), with Thursday's historic vote meaning terminally ill people can now choose the timing of their death. NSW joins the rest of Australia’s states in making VAD legal with a final vote of 23 MPs in favour and 15 opposing. Independent Sydney MP Alex Greenwich, who introduced the bill to parliament late last year, told members that the “entire diversity” of parliament were involved in passing the bill, with 28 co-sponsors from all parties - the highest number in Australian parliamentary history per <a href="https://www.smh.com.au/politics/nsw/voluntary-assisted-dying-legalised-in-nsw-20220519-p5amo0.html" target="_blank" rel="noopener">The Sydney Mkorning Herald</a>. <blockquote class="twitter-tweet"> "We are celebrating this historic day" "Compassion has won" says Independent MP <a href="https://twitter.com/AlexGreenwich?ref_src=twsrc%5Etfw">@AlexGreenwich</a>, flanked by the Voluntary Assisted Dying Bill's co-sponsors and advocates. It's been 20 years since the first attempt to pass a law like this in NSW. <a href="https://twitter.com/hashtag/nswpol?src=hash&ref_src=twsrc%5Etfw">#nswpol</a> <a href="https://t.co/8wNpjSEZP3">pic.twitter.com/8wNpjSEZP3</a> — Sarah Navin (@SarahNavin) <a href="https://twitter.com/SarahNavin/status/1527131431163797505?ref_src=twsrc%5Etfw">May 19, 2022</a></blockquote> “For those wondering what happened with the Voluntary Assisted Dying Bill last night; the bill was debated till midnight and almost all amendments were dealt with,” Mr Greenwich explained on social media at 6am on Thursday morning. “There is one more amendment this morning to vote on and then a final vote in both the Upper and Lower House.” MPs debated nearly 100 amendments on Wednesday, with the sitting ending at midnight. The majority of amendments, including the push to allow aged care and residential homes to block VAD from occurring in their facilities, were voted down during the debate according to the <a href="https://www.abc.net.au/news/2022-05-19/voluntary-assisted-dying-laws-pass/101079940" target="_blank" rel="noopener">ABC</a>. At midday, it was announced that the bill had passed the upper house. The lower house then approved the bill approximately an hour later. <blockquote class="twitter-tweet"> Proud to be sitting in the NSW parliament to watch the Voluntary Assisted Dying Bill finally pass into law. This will make such a difference to the lives of so many, allowing people to choose to live the end of their lives as well as possible and to die with dignity. ✨❤️ — Abigail Boyd (@AbigailBoydMLC) <a href="https://twitter.com/AbigailBoydMLC/status/1527120671498588161?ref_src=twsrc%5Etfw">May 19, 2022</a></blockquote> Finance Minister Damien Tudehope, an opponent of the bill, told the upper house that it was a “dark day” for the state. “It was a sad day because it was an opportunity for NSW to say ‘we can be better than this’,” Mr Tudehope said. He added that it would be judged by history as a “dreadful mistake”. However, advocate groups such as Go Gentle Australia and Dying with Dignity, as well as individual supporters of VAD, have welcomed the decision. <blockquote class="twitter-tweet"> Voluntary assisted dying set to become law in NSW. Congratulations and thank you to all the advocates, especially those who fought for their right to die with dignity, and died waiting and the 28 MPs who co-signed the Bill, tabled by my MP, <a href="https://twitter.com/AlexGreenwich?ref_src=twsrc%5Etfw">@AlexGreenwich</a> <a href="https://twitter.com/hashtag/voluntaryassisteddying?src=hash&ref_src=twsrc%5Etfw">#voluntaryassisteddying</a> — Kimberley Ramplin (@Kimbo_Ramplin) <a href="https://twitter.com/Kimbo_Ramplin/status/1527130066349481985?ref_src=twsrc%5Etfw">May 19, 2022</a></blockquote> “VAD is now legal in NSW, the culmination of 50 years of advocacy. Congratulations to all involved,” Go Gentle Australia tweeted. “Congratulations to everyone involved in this campaign!” Greens Senator Mehreen Faruqi wrote. “I was part of the Working Group on Assisted Dying in NSW Parliament, which introduced the first bill. I’m proud to have played a role so that people can die with dignity.” “Genuinely stoked,” Scott Phillips, the director of City Recital Hall, said. “I have no idea if my old man would have taken the option, in his final days as he battled cancer. “But I am so pleased that the choice will be available to others in NSW as a result of this bill.” <blockquote class="twitter-tweet"> At long last. Choice & dignity for terminally ill patients in NSW. Congrats to all who fought so courageously for this change. Now legalised in every State, the Federal Government need to stop blocking the NT & ACT from debating this reform. <a href="https://twitter.com/hashtag/ausvotes?src=hash&ref_src=twsrc%5Etfw">#ausvotes</a> <a href="https://twitter.com/hashtag/auspol?src=hash&ref_src=twsrc%5Etfw">#auspol</a> <a href="https://twitter.com/hashtag/nswpol?src=hash&ref_src=twsrc%5Etfw">#nswpol</a> <a href="https://twitter.com/hashtag/vad?src=hash&ref_src=twsrc%5Etfw">#vad</a> <a href="https://t.co/UAwfar1O4X">https://t.co/UAwfar1O4X</a> — JillHennessyMP (@JillHennessyMP) <a href="https://twitter.com/JillHennessyMP/status/1527130639816093696?ref_src=twsrc%5Etfw">May 19, 2022</a></blockquote> According to <a href="https://twitter.com/10NewsFirstSyd/status/1527133466181005312" target="_blank" rel="noopener">10 News First Sydney</a>, the bill allows for people to choose to end their life if they have suffering that can’t be relieved and are likely to die of a disease within six months, or within a year in the case of neurodegenerative disease. The news comes just days after Sara Wright, a nurse who has long advocated for VAD to be legalised, <a href="https://www.oversixty.com.au/health/caring/terminally-ill-nurse-caught-in-desperate-waiting-game" target="_blank" rel="noopener">spoke out</a> about waiting for the decision to be made while being “virtually paralysed” as a result of motor neuron disease - estimating she has months left to live. “I don’t think that I will live for more than another six to eight months, as my breathing capacity is reducing very fast and I do not wish to have a tracheostomy (an operation where a breathing hole is cut into the front of the neck and windpipe),” she told 7News. “I know that all my family, my parents, my brothers, my ex-husband are all in support of voluntary assisted dying and helping me relieve my suffering. “But none of us want to break the law or risk anyone being imprisoned if they helped me.” Image: @DWDnsw (Twitter)

Caring

Terminally ill nurse caught in desperate waiting game

A nurse who has months to live as a result of her diagnosis of motor neuron disease (MND) is “virtually paralysed” and waiting for the NSW government to decide how she will die. Sara Wright had been a nurse for 33 years before she was diagnosed with amyotrophic lateral sclerosis (ALS) - a subtype of MND - two years ago, and is now dependent on a carer 24 hours a day. “The disease started as a weakness in my right foot, travelled up my right leg, then my left foot and leg,” the 54-year-old told <a href="https://7news.com.au/news/public-health/virtually-paralysed-nurse-waits-for-nsw-parliament-to-decide-how-she-will-die-c-6699939">7NEWS.com.au</a>. “Then it travelled up my torso affecting my upper body, firstly my abdominal muscles, and now it affects both of my arms and hands, my lungs and my swallowing and speaking muscles.” Ms Wright, who shared her story via dictation since speaking is difficult and painful, is waiting to see whether voluntary assisted dying laws (VAD) will be passed in the NSW Upper House next week. If they don’t pass, she says she will likely “have to deal with suffocating or choking to death”. “It’s a terminal illness and the average life expectancy is three to five years,” she explained. “Given I have already been living with the disease for three years, and the progression has been faster than I ever could have expected, I don’t know how long I will live. “I don’t think that I will live for more than another six to eight months, as my breathing capacity is reducing very fast and I do not wish to have a tracheostomy (an operation where a breathing hole is cut into the front of the neck and windpipe).” ALS/MND is more common among adults aged between 40 and 70 years, with 384 people diagnosed each day according to the <a href="https://www.als-mnd.org/what-is-alsmnd/" target="_blank" rel="noopener">International Alliance of ALS/MND Associations</a>. Ms Wright’s career as a nurse made her all too aware of the “limitations of palliative care in the final stages of terminal illness”, so she initially planned to book into Dignitas, a non-profit organisation in Switzerland that offers a range of end-of-life services. But, the COVID-19 pandemic derailed her plan with the closure of international borders. She then considered moving interstate, where VAD is legal, but she worried about uprooting her 15-year-old daughter, Ester, from her home and friends, especially since most of their family is UK-based. “(Ester) is now 15 and she needs to have her community around her for support when I die,” she said. “Obviously this is an incredibly difficult conversation to have with your own child. “We have not specifically spoken about what could happen to me if the laws aren’t passed … but I have tried to assure her that family in the UK will fly out to be with her as soon as they can if I die unexpectedly.” Ms Wright’s fate is tied to the voluntary assisted dying bill, which passed through the NSW Parliament’s lower house last year and is legal or will soon be legal in <a href="https://end-of-life.qut.edu.au/assisteddying" target="_blank" rel="noopener">every other state</a> except NSW. “I know that all my family, my parents, my brothers, my ex-husband are all in support of voluntary assisted dying and helping me relieve my suffering,” she said. “But none of us want to break the law or risk anyone being imprisoned if they helped me.” Since the bill entered the upper house last March, it has been debated passionately and passed through a second reading stage last week. It has even divided the state’s core leadership, with Premier Dominic Perrottet opposing the bill in favour of improving palliative care and Health Minister Brad Hazzard supporting it - despite opposing euthanisia for 29 years. Ms Wright, a strong supporter of VAD laws, has been brought close to the death of others during her nursing career and said she was “pretty certain” that if members debating the bill had seen people die uncomfortable, drawn-out deaths like she had, they would support the bill. “I have seen far too many people, elderly people, in the middle of the night in a ward without anyone there to hold their hand because nobody knew that was going to be their time to die,” she said. “I think that most people don’t think enough about death because we are all frightened of it. “And this could be the reason that some people are refusing to consider VAD laws, because it’s a topic that is deeply uncomfortable and taboo. “If we as a society were more mindfully aware and thoughtful about death, as it is the only certain outcome of life, then perhaps people would develop more compassion.” Though the laws could still be passed at some point if it fails to pass in next week’s final vote, Ms Wright said it would affect her whole family if it was too late for her to take advantage of it. “This will not only cause suffering to me but also to all of my family,” she said. “I wonder how many people have really stopped to think about what they would like, if they were in a position where they were going to die of (an) unpleasant and drawn-out death.” Image: 7News

Caring

TGA warns Aussies against using Ivermectin for COVID-19

<div class="body_text redactor-styles redactor-in"> The Therapeutic Goods Administration (TGA) has detected an increase in the amount of a drug called Ivermectin being imported and it warns against the use of this drug for the treatment of COVID-19 as it is untested for this condition. Ivermectin is an anti-parasitic drug which has been shown to be effective in vitro against a broad range of viruses including HIV, dengue, influenza and zika. However, it is not approved for the treatment of COVID-19. In a statement, the TGA said: ‘The Therapeutic Goods Administration (TGA), part of the Department of Health, has detected increased importation and prescribing of Ivermectin for the treatment of COVID-19.’ ‘The TGA strongly discourages self-medication and self-dosing with Ivermectin for COVID-19 as it may be dangerous to your health.’ Even the drug’s manufacturer warns against using it this way Even the drug's manufacturer, Merck Sharp & Dohme (MSD), has urged people not to use the medication to treat COVID-19, warning in a statement saying: "No scientific basis for a potential therapeutic effect against COVID-19 from pre-clinical studies; No meaningful evidence for clinical activity or clinical efficacy in patients with COVID-19 disease, and a concerning lack of safety data in the majority of studies." Despite those urgings, Ivermectin's popularity amongst fringe medical and anti-vaccination groups - and its promotion via the Internet - has seen demand for it increase here in Australia. Ivermectin is often promoted by anti-COVID figures The cheap and common drug is often promoted by anti-COVID vaccination or anti-lockdown figures, such as former Liberal backbencher Craig Kelly and a number of US conservative, fringe campaigners. Ivermectin has been used around the world for years as a treatment for a range of conditions including head lice, parasites, worms and scabies. It is available as a pill, lotion and shampoo. The drug's advocates have pointed to several studies which allegedly show its effectiveness against COVID-19. <a rel="noopener" href="https://pubmed.ncbi.nlm.nih.gov/32251768/" target="_blank">Some Australian research</a> indicated Ivermectin could inhibit the virus from replicating within a cell and reported the drug warrants further investigation into the possible benefits for humans. However, this trial was only carried out in a laboratory. Other research found the amounts needed of Ivermectin would not be possible for human and other research said there was <a rel="noopener" href="mailto:https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD015017.pub2/full" target="_blank">‘conflicting’ evidence</a> as to its benefits. The Cochrane alliance, a global collaboration between scientists to assess clinical research, said the completed studies were "small and few are considered high quality". "We are uncertain about the efficacy and safety of Ivermectin used to treat or prevent COVID‐19," the alliance reported. The TGA has not approved the drug for COVID-19 treatment, saying more investigation was needed. What’s happening overseas? In the United States, health authorities have warned people against using doses of Ivermectin. The problem has become noticeable in some states where local health authorities have noticed dramatic increases in poisoning. The Health Department of the US State of Mississippi said 70 per cent of the calls it received recently about poisoning have been related to people taking Ivermectin. Photo: Getty Images </div>

Caring

Another Aussie fashion label goes bust

Yet another Australian fashion retailer has bitten the dust, joining the likes of Diana Ferrari, Maggie T, Oroton, and David Lawrence. After 76 years, men’s fashion chain Roger David has gone into administration, its collapse because of competition from online and international retailers, reports <a rel="noopener" href="https://www.news.com.au/finance/business/retail/rogers-david-goes-into-administration/news-story/e8f278b7030938c6e2b039cf63e99f97" target="_blank">news.com.au</a>. It is now in the hands of administrators KordaMentha. “Despite the directors’ best efforts with the business, it simply could not compete with the influx of multinational retailers and the rapid, global evolution of online shopping,” Roger David directors said in a statement yesterday. “Thank you also to Roger David’s loyal customers who have been on a journey with Roger David since we opened our doors,” said the directors. “Like you, we are heartbroken but forever grateful to have served generations of your family since 1942.” KordaMentha administrator Craig Shepard said that, "Roger David, like many other fashion retailers, has been buffeted by global competition, stagnant sales and rising fixed costs," according to <a rel="noopener" href="https://www.smh.com.au/business/companies/heartbroken-roger-david-collapses-into-administration-20181018-p50adk.html" target="_blank">The Sydney Morning Herald</a>. "The company has been exploring all options, including a sale of the business, but has been unable to find an alternative to administration." “The competition in the market, the internationals and in general online, it has just got tougher and tougher." Roger David had already closed over half of its stores, downsizing from 135 to 57 locations, and the administrators announced that a closing down sale would begin immediately. Shepard said gift cards for the brand would be honoured for a month. The chain, which employs over 300 staff, is due to operate throughout the Christmas shopping season.

Beauty & Style

Jamie Durie's legal battle with former right-hand man

Jamie Durie founded his design practice in 1998 and then soon after, became a household name after appearing on home improvement shows, such as Backyard Blitz and The Block. He then received international acclaim after making regular appearances on The Oprah Winfrey Show for over four years and has now hosted more than 50 design shows around the globe. However, the 48-year-old’s multimillion-dollar design company has been quietly crumbling. On May 3, Durie’s company JPD Media and Design Pty Ltd went into voluntary administration, with Simon Cathro from Worrels Solvency and Forensic Accountants appointed to look into the company’s financial affairs. The news followed a long legal battle between Durie and his former employee Mike Curnow, who had worked as the company’s global head of licensing. Curnow was hired by the company in 2004 and let go in 2013. Curnow then launched legal action against his former employer for unpaid commissions. In March, the Supreme Court ruled Mr Curnow was owed $563,049, which does not include the judgement on interest and costs which is yet to be made. Solicitors estimate the interest and costs could push the total amount owed to more than $1 million. Mr Curnow was not paid the initial sum by April, and so his legal team filed a creditor’s statutory demand for the payment, which was due by May 4, reported the <a href="https://www.smh.com.au/entertainment/celebrity/private-sydney-dirt-flies-over-fall-of-gardening-empire-20180531-p4zims.html" target="_blank">Sydney Morning Herald.</a> However, just one day before the payment was due, Durie placed his company into voluntary administration, with just $1 in the bank. Curnow, who is still waiting for his payout, said he was “absolutely disgusted” over the situation. “This has cost me my marriage, my home and my career,” Mr Curnow said of the legal fight with Durie. “If he thinks I’m going to give up now, he’s mistaken. I’m not going anywhere.” According to the Sydney Morning Herald, the company also owes cash to other creditors including the Australian Taxation Office, with more than $215,000 in unpaid taxes for the 2016/17 financial year. The legal battle also revealed that Durie had taken a $500,000 loan from ex-Macquarie group boss Bill Moss in 2010 to keep his business running. Durie had been forced to ask for an extension on the loan, admitting to Moss that he had “made some bad decisions”. Durie previously told Fairfax reporters that Curnow had “made millions out of me over the years”.

Legal

Toys 'R' Us goes into voluntarily administration in Australia

Toys 'R' Us Australia has gone into voluntary administration months after the US and UK stores collapsed. Directors of the company appointed voluntary administrators McGrathNicol after the withdrawal of the final bidder for the sale of the Australian business, a McGrathNicol spokesman said in a statement on Monday. All Toys 'R' Us and Babies 'R' Us stores will remain open and continue to trade while the administrators look at their options – either to sell the stand-alone Australian business or a recapitalisation through the voluntary administration process. There are 44 retail stores across Australia which employs about 700 permanent staff. No employee positions are affected by the appointment, the spokesman said. However, Toys ‘R’ Us Australia will no longer offer refunds, and gift cards and vouchers will only be honoured if customers spent an additional equivalent amount. Online orders and lay-bys will be delivered or honoured where goods have been paid for in full and the stock is available. “The administrators will continue to pay employees and expect that employee entitlements will be met either through a sale of the business, recoveries from the sale of stock, or through the Commonwealth Government's Fair Entitlements Guarantee (FEG) Scheme,” the statement said. Toys 'R' Us Australia posted a $7.7 million loss in the financial year to January 2017 and a $9 million loss the previous year. It follows the announcement in March earlier this year that Toys 'R' Us in the US was preparing to sell or close all its 885 stores. Administrators closed a quarter of the company's 100 UK stores by mid-March with plans to close the remaining stores by the end of April.

Money & Banking

Bad news for Jamie Oliver’s Aussie fans

Jamie Oliver’s Australian restaurant group has gone into voluntary administration forcing the immediate closure of the Canberra-based restaurant. Two years ago, the celebrity chef bought back the Jamie’s Italian chain from failed hospitality group the Keystone Group in March 2017. The Canberra Times revealed that staff at the Canberra restaurant were given no warning of the sudden closure of the eatery. Jamie Oliver’s other Italian restaurants in Perth, Brisbane, Sydney and Adelaide will be taken over by Brisbane-based Hallmark Group. Yesterday, chief operating officer of the Australian Jamie’s Italian chain, Ben Shaughnessy, called in the voluntary administrators after consecutive meetings with Hallmark to discuss the sale and creditor HSBC. On Monday evening, the PR business representing Jamie’s Italian in Australia issued a statement, announcing “a new operating partner for its Australian business”. A spokesperson for the Jamie Oliver Restaurant Group Australia said, “Australia has and continues to be one of our best performing international markets and, after a short period of in-house management we are pleased to be partnering with Hallmark. "The team brings a huge amount of experience and passion for our brand, from collaborating with the key suppliers to our food philosophy, and we look forward to working with them as they develop the Jamie’s Italian restaurant offering across Australia." On social media the Canberra restaurant said, “This is pretty sad news for the staff but Jamie's Italian has closed suddenly this morning and it looks like it won't be reopening anytime soon.” “The remaining restaurants in Sydney, Brisbane, Perth, Parramatta and Adelaide are to remain open. The announcement follows a recent scandal where a chef at one of the Italian restaurants was caught using packet gnocchi – despite claims the restaurant makes produce fresh daily. An observant customer dining at the restaurant on Pitt Street, Sydney, took a photo of a chef preparing to use a packet of ready-made gnocchi. <img width="499" height="645" src="https://oversixtydev.blob.core.windows.net/media/7817516/1_499x645.jpg" alt="1 (118)"/> On the menus of the popular restaurants, it says that they "make fresh pasta, right here every day”. <img width="498" height="355" src="https://oversixtydev.blob.core.windows.net/media/7817517/2_498x355.jpg" alt="2 (69)"/> It has been revealed that Jamie Oliver’s international restaurant chains had a pre-tax loss of $17.5 million. The UK business entered into a Company Voluntary Arrangement believing it can trade out of its trouble. On Friday, his chain announced that twelve of his restaurants will close as part of a company restructure. The firm said, “We are pleased to have received the overwhelming support from our creditors for our proposal to reshape Jamie's Italian restaurants.” “We have a strong brand and are focused on continuing to deliver the levels of service, taste and the experience our loyal customers deserve.” The UK chef has 25 restaurants in the UK and 28 overseas. There are six Jamie’s Italian restaurants across Australia.

Money & Banking

Bad news for shoppers: Handbag brand Oroton goes bust

Luxury handbag maker Oroton has gone into voluntary administration, with shoppers swarming the retailer to snap up bargains as it attempts to clear stock. Oroton, whose most public face is Australian actor Rose Byrne, made the announcement this morning prompting shoppers to head on line and snap up the heavily-discounted stock ahead of the busy Christmas shopping season. And there are plenty of bargains to be had. For example, the large Melanie tote bag that was retailing for $595 is now going for a paltry $116. And the Signature O Baby Bag which originally cost $495 is now just $148.50. Interim chief executive Ross Lane claimed the 79-year-old Australian retailer had no choice but to go bust, after efforts to recapitalise or sell the business failed miserably. “The board is disappointed that it has had to take this step after running such a comprehensive process,” he said in a statement lodged with the Australian Securities Exchange. “However, having carefully considered the options available to the company at the conclusion of its strategic review, it is apparent that voluntary administration is necessary to protect the Oroton business and the future of this iconic Australian brand.” <iframe src="https://www.facebook.com/plugins/post.php?href=https%3A%2F%2Fwww.facebook.com%2Forotonstudio%2Fposts%2F10155176172128927&width=500" width="500" height="736" style="border: none; overflow: hidden;" scrolling="no" frameborder="0" allowtransparency="true"></iframe> Oroton is the latest company to go bust as retailers continue to struggle with pressures from online shopping, high overheads and an uncertain consumer market. What are your thoughts?

News

Historic euthanasia laws pass upper house vote in Victoria

Victoria is set to become the first Australian state to legalise assisted dying, after <a href="http://www.oversixty.com.au/health/caring/2017/10/historic-euthanasia-laws-passed-in-victoria/" target="_blank">historic voluntary euthanasia laws</a> were passed the upper house vote on Wednesday. The Bill passed Victoria’s Upper House, with 22 votes to 18. After a marathon sitting in which the Bill was debated for approximately 100 hours, the Bill passed with MPs seen weeping and hugging in emotional scenes. The Bill will be sent back down to Victoria’s Lower House in its amended form. <blockquote class="twitter-tweet"> Victoria’s euthanasia bill passed through the Upper House with amendments <a href="https://t.co/pOLroeR6rO">pic.twitter.com/pOLroeR6rO</a> — Danielle (@daniellebonica) <a href="https://twitter.com/daniellebonica/status/933202371227762688?ref_src=twsrc%5Etfw">November 22, 2017</a></blockquote> Not everyone is happy however, with former Prime Minister Tony Abbott deciding to weigh in on the issue in an interview with 2GB radio presenter Ben Fordham. “I very much regret the fact the same-sex marriage debate has very much distracted us from this bid to legalise a doctor assisted dying,” Abbott said. “People’s lives have to be respected and this idea that we should end the lives of people who have failed our test of usefulness or have failed our test of what constitutes a decent quality of life is absolutely dead wrong and I hope that a future Victorian Parliament might reverse this. “Doctors should be healers, they should never be required to be killers.” But Victorian Premier Daniel Andrews has remained steadfast in his support of the controversial Bill, posting a message on Twitter that outlined the nature of the measure. “Let's remember what we are debating here: the most conservative voluntary assisted dying model that has ever been proposed – let alone implemented – anywhere in the world,” Premier Andrews said. “This legislation is safe. Its purpose is clear. Its time has come.” <blockquote class="twitter-tweet"> Let's remember what we are debating here: the most conservative voluntary assisted dying model that has ever been proposed – let alone implemented – anywhere in the world. This legislation is safe. Its purpose is clear. Its time has come. <a href="https://twitter.com/hashtag/springst?src=hash&ref_src=twsrc%5Etfw">#springst</a> — Daniel Andrews (@DanielAndrewsMP) <a href="https://twitter.com/DanielAndrewsMP/status/933201795106594816?ref_src=twsrc%5Etfw">November 22, 2017</a></blockquote> <blockquote class="twitter-tweet"> Wow. Euthanasia passes in Victoria. Gay marriage by Christmas. A new Australia. — Pia Akerman (@pia_akerman) <a href="https://twitter.com/pia_akerman/status/933202241988698112?ref_src=twsrc%5Etfw">November 22, 2017</a></blockquote> <blockquote class="twitter-tweet"> So within 18 months, voluntary euthanasia likely to be happening in Victoria <a href="https://twitter.com/hashtag/springst?src=hash&ref_src=twsrc%5Etfw">#springst</a> — Matt Johnston (@Media_Matt) <a href="https://twitter.com/Media_Matt/status/933201478159761410?ref_src=twsrc%5Etfw">November 22, 2017</a></blockquote> What are your thoughts? Hero image credit: Twitter / Danielle

Caring

Bad news for assisted dying laws in this state

New South Wales residents have just missed out on making voluntary euthanasia legal after a marathon debate in the Upper House resulted in 19 votes in support of the assisted dying bill and 20 against. MPs were given a conscience vote on the proposal put forth by Nationals MP Trevor Khan, which would allow terminally ill people over 25 to end their lives with assistance from medical professionals. Khan admitted he was “disappointed” with the result but plans to keep campaigning for the legislation. “We had what I think is a reasonable expectation that we’d just get over the line [but] obviously we fell short by one,” he told the <a href="http://www.abc.net.au/news/2017-11-16/nsw-parliament-votes-on-euthanasia-bill/9158384" target="_blank">ABC</a>. “[But] we’ll continue to talk with the stakeholders, and work out a timing and a campaign. It’s clear that there’s a lot of community support for this. It really needs that campaign to continue and we'll get over the line in due course.” Khan added that he’s aiming to reintroduce a bill on voluntary assisted dying in the next term of Parliament.

Caring

Historic euthanasia laws passed in Victoria

Historic voluntary euthanasia laws have been passed in the state of Victoria, after a marathon sitting overnight in the state’s lower house that went well into Friday. The legislation will now head to Parliament’s upper house, with supporters of the assisted dying bill hopeful they have the numbers required to pass the laws. Exhausted MPs sat through a gruelling session with opponents moving hundreds of amendments in an effort to delay the bill’s passage, but they were all defeated. <blockquote class="twitter-tweet"> Controversial laws to legalise euthanasia in Victoria have passed the Lower House - 47 to 37 votes - after a marathon parliamentary debate. <a href="https://t.co/7retBB6p2L">pic.twitter.com/7retBB6p2L</a> — 7 News Adelaide (@7NewsAdelaide) <a href="https://twitter.com/7NewsAdelaide/status/921177655566786560?ref_src=twsrc%5Etfw">October 20, 2017</a></blockquote> The proposed laws would give terminally ill people with less than 12 months to live who are suffering unbearable pain the ability to request lethal medication. There was reportedly an applause in the chamber once the numbers were finally in. What’s your take on this story? Hero image credit: Twitter / Guardian Australia

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Tragic flaw sees man use voluntary assisted dying drugs prescribed for his wife

Aussie airline's shock collapse

What happens if you want access to voluntary assisted dying but your nursing home won’t let you?

People with dementia aren’t currently eligible for voluntary assisted dying. Should they be?

23-year-old bravely dies on her own terms

23-year-old reveals why she's chosen to end her life

People thinking of voluntary assisted dying may be able to donate their organs. We need to start talking about this

Long Covid sufferer applies for voluntary euthanasia

Aussie with terminal cancer uses time left to make her mark

Emotional scenes as NSW passes law on Voluntary Assisted Dying

Terminally ill nurse caught in desperate waiting game

TGA warns Aussies against using Ivermectin for COVID-19

Another Aussie fashion label goes bust

Jamie Durie's legal battle with former right-hand man

Toys 'R' Us goes into voluntarily administration in Australia

Bad news for Jamie Oliver’s Aussie fans

Bad news for shoppers: Handbag brand Oroton goes bust

Historic euthanasia laws pass upper house vote in Victoria

Bad news for assisted dying laws in this state

Historic euthanasia laws passed in Victoria

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Entertainment

Travel

Health

Lifestyle

Finance

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Tragic flaw sees man use voluntary assisted dying drugs prescribed for his wife

Aussie airline's shock collapse

What happens if you want access to voluntary assisted dying but your nursing home won’t let you?

People with dementia aren’t currently eligible for voluntary assisted dying. Should they be?

23-year-old bravely dies on her own terms

23-year-old reveals why she's chosen to end her life

People thinking of voluntary assisted dying may be able to donate their organs. We need to start talking about this

Long Covid sufferer applies for voluntary euthanasia

Aussie with terminal cancer uses time left to make her mark

Emotional scenes as NSW passes law on Voluntary Assisted Dying﻿﻿

Terminally ill nurse caught in desperate waiting game

TGA warns Aussies against using Ivermectin for COVID-19

Another Aussie fashion label goes bust

Jamie Durie's legal battle with former right-hand man

Toys 'R' Us goes into voluntarily administration in Australia

Bad news for Jamie Oliver’s Aussie fans

Bad news for shoppers: Handbag brand Oroton goes bust

Historic euthanasia laws pass upper house vote in Victoria

Bad news for assisted dying laws in this state

Historic euthanasia laws passed in Victoria

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Emotional scenes as NSW passes law on Voluntary Assisted Dying