It has been one month since voluntary assisted dying became legal in Tasmania.
It followed years of debate, discussions and amendments to get the legislation through, and to get it right, with Tasmania the third state in Australia where voluntary assisted dying (VAD) is possible.
Among the list of requirements for accessing VAD, a person needs to be assessed by two independent practitioners who have had the training.
But with only a small number of medical practitioners having completed the training, for some, the wait to access the service continues.
For Lola*, whose name has been changed for privacy reasons, working through the system has been a challenging process.
Her father was diagnosed with motor neurone disease earlier this year, and his health has deteriorated rapidly.
She says his condition is now at the point where he needs assistance to get in and out of bed and is even unable to flick on light switches.
Learning voluntary assisted dying was going to become a possibility offered him some relief, with his goal to die with dignity.
His family has been working to try to find two medical practitioners able to take on his case.
They started a few weeks before the legislation came into effect, but are still looking.
"With his disease, eventually he ends up paralysed," Lola said.
"His quality of life is diminishing, so he had comfort in knowing that in October this legislation would be coming through."
With her father's regular GP unable to assist because their workload has stopped them from being able to do the additional training required, Lola's family has spent hours trying to find alternative practitioners.
"We've just put so much time and energy into trying to organise it, and instead we've gotten nowhere," she said.
"[It's] our worry that by the time we do get someone that's done the training, that he might not be in a position to consent."
Fourteen steps to access VAD
Under the legislation, Tasmanians are able to apply to access VAD if they are over the age of 18 and suffering from an advanced, incurable, and irreversible disease, illness, injury or medical condition for which there is no reasonably available treatment.
That condition must be expected to cause their death within six or 12 months, depending on the illness, and the person making the decision must be able to understand and evaluate the advice given to them around VAD, and be able to communicate that decision.
Then there are 14 steps a person wanting to access the service must go through, including finding two independent qualified practitioners who are willing to assist in the process.
Doctors are able to complete specific VAD training in their own time and depending on their experience, it takes between five to 10 hours to complete.
The application must ultimately be sent to Tasmania's Voluntary Assisted Dying Commission for a determination and, if approved, the commission prescribes the VAD substance.
Slow uptake to be expected
The head of the Royal Australian College of GPs in Tasmania, Tim Jackson, said that unfortunately with the implementation of any new program or treatment, some people may miss out.
He said the number of practitioners completing the training would increase in time and that would happen as more patients approach their doctors about the process.
"I realise that's going to be distressing for some people who want to access it right now," Dr Jackson said, "and that's always going to be the case — some people are going to miss out when something new starts.
"I think the most important thing is it's done thoroughly and safely."
He said what happened in Victoria, where VAD came into effect in 2019, could provide guidance for what Tasmania may experience.
"Initially there was a trickle but even after six months there was a 30 per cent increase in the number of GPs doing the training," Dr Jackson said.
"We're a conservative group, by necessity, and we're going to have some early adopters and then most people will see how things are going, talk among their colleagues, and respond to patient enquiries as well."
A spokesperson for the health department said the End-of-life-Choices (Voluntary Assisted Dying) Act 2021 is operating as intended, with the specific training for medical practitioners released in late September, about a month before the laws came into effect.
The department would not specify how many GPs had accessed training.
"A small number of medical practitioners have completed the training, with modelling from other Australian states that offer access to voluntary assisted dying suggesting the number of trained practitioners will be low initially but increase over time," a spokesperson said.
"Like any training, this requires time and commitment by those completing it and the challenge of finding time is acknowledged and appreciated."
They said ongoing engagement with medical practitioners, including public information sessions, continued to take place.
For Lola's family, it remains a waiting game but they are refusing to give up.
"We're hoping by all rallying together that we get somewhere," she said.
