The out-of-pocket costs of voluntary assisted dying are creating “substantial barriers” for patients seeking to access euthanasia, according to doctors in Queensland who say Medicare reforms are urgently needed.
The government does not subsidise euthanasia and its associated costs under the Medicare benefits schedule, which means doctors privately bill patients. Psychology and counselling services used to assess a patient’s eligibility for voluntary assisted dying may attract Medicare subsidies.
Doctors who are part of the Queensland Voluntary Assisted Dying Working Group have proposed a standardised private billing structure in which a complete assessment and approval for self-administered euthanasia would have an out-of-pocket cost of $860.
“Unfortunately, the Medicare benefits schedule has not been updated to reflect the specific task of assessing and providing access to voluntary assisted dying services in Australia,” the doctors write in a document seen by Guardian Australia.
“This has limited capacity for doctors to offer bulk-billed services to their patients given the lengthy process required to assess patients.”
Their proposal allows for an average minimum clinician time of five hours and includes mandatory additional training that doctors undertake to be voluntary assisted dying physicians.
Guardian Australia understands the document has not been endorsed by Queensland Health or the Queensland Voluntary Assisted Dying Support and Pharmacy Service, but was written to begin a discussion about the challenges around costs and remuneration for voluntary assisted dying.
“We recognise that medical practitioners should regard themselves as being free and duty bound to make their own judgement as to what fees they will charge for any service,” the document says. “Medical practitioners should satisfy themselves in each individual case as to a fair and reasonable fee.”
Dr Roger Hunt, a member of the South Australia Voluntary Assisted Dying Review Board, recently published an editorial that examines barriers and questions around voluntary assisted dying schemes, which most states and territories now have.
“The first doctors to provide voluntary assisted dying services reported that assisting applicants was rewarding and professionally fulfilling,” said Hunt’s editorial in the August edition of the Medical Journal of Australia.
“As they are reluctant to charge fees for voluntary assisted dying services (not covered by Medicare), much of their work is unremunerated and altruistic. A sustainable voluntary assisted dying service, however, cannot rely on the goodwill of a small number of doctors who risk burnout.”
Hunt said healthcare practitioners had also been advised by state health departments not to use telehealth for certain voluntary assisted dying services, creating an additional barrier to access for the most vulnerable.
“The Criminal Code Act must be amended to permit telehealth consultations regarding voluntary assisted dying when clinically appropriate,” he wrote.
Ben White, a professor of end-of-life law at the Australian Centre for Health Law Research, said his research had not shown any evidence that patients were being denied voluntary assisted dying due to being unable to afford it.
“Most doctors, and the patients and families we have spoken to, really speak of practitioners going above and beyond, with highly qualified specialists visiting patients outside of normal hours and providing a lot of care pro bono,” he said.
“A lot of patients and families reported going to pay and being waved away.”
But White also said there was only a small pool of specialists able to provide voluntary assisted dying services because of the extra training required and the lack of Medicare subsidies.
He agreed that updated and clear guidance from Medicare around voluntary assisted dying services would assist practitioners.
“Doctors can only give so much of their time and expertise.”
Do you know more? melissa.davey@theguardian.com
