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7 February 2023 | Aged Care

Offering a Pastoral Approach – Voluntary Assisted Dying

You may have heard about Voluntary Assisted Dying (VAD) now being legal in Queensland. As of 1st January 2023, Queenslanders may now access medically assisted euthanasia, providing they meet certain criteria of the Voluntary Assisted Dying Act 2021 (QLD).

As a department of the Lutheran Church of Australia Queensland District, Lutheran Services does not provide voluntary assisted dying services.

While we do not support VAD, we do support people.  ​​​​​​​

  • We know some of our residents or clients may wish to explore voluntary assisted dying as an option, and we respect their right to choose.
  • If residents/clients in our care wish to access voluntary assisted dying, we will support them to do so, but Lutheran services will not play an active role in the VAD process.

 

Our Director of Chaplaincy and Ministry Development, Rev Dr Russell Briese, provides guidance on offering pastoral care to those seeking VAD, their families and friends in Queensland.

Read below for our approach to pastoral care during VAD, where we seek for all residents to feel heard and supported spiritually, whatever their choice.

 

Voluntary Assisted Dying (VAD) is legal in Queensland as of 1st January 2023. Queenslanders may now access medically assisted euthanasia, providing they meet certain criteria as per paragraph 10of the Voluntary Assisted Dying Act 2021 (QLD):
be diagnosed with a disease, illness or medical condition that

-is advanced, progressive and will cause death; 
-is expected to cause death within 12 months

-is causing suffering that the person considers to be intolerable.

have decisionmaking capacity in relation to voluntary assisted dying
be acting voluntarily and without coercion

be at least 18 years of age

be an Australian citizen, permanent resident, or have been ordinarily a resident in Australia for at least three years immediately before making their first request (or granted an Australian residency exemption by the DirectorGeneral of Queensland Health) 

have been ordinarily a resident in Queensland for at least 12 months immediately before the
person makes the first request (or granted an Australian residency exemption by the
DirectorGeneral of Queensland Health).


Furthermore, somewhat like clergy being familiar with lodging a Notice of Intended Marriage, anyone seeking VAD must make three formal requests, witnessed through approved channels within the designated period of 9 days from and including the first request (s 43.3).

It is to be noted that the above is not related in any way to current Advanced Health Care Directives, as these are relevant only when a person is no longer able to manage their own affairs.
The topic of this short paper is not medical or logistical, but pastoral. How do LCAQD pastors and pastoral carers (I will use the terms ‘pastor’ and pastoral carer interchangeably) offer pastoral support for those seeking, contemplating, or undertaking VAD? How do we care for family and friends of these same people before, during, and after the VAD process?

The LCAQD’s Submission to the Queensland Law Reform Commission Consultation on a Legal Framework for Voluntary Assisted Dying in 2021 emphasises respect for human life as a divine gift and inherently valuable, and it urges that human autonomy be balanced with the principle of the common good. It needs to be noted that churchaffiliated aged care institutions (such as those run by Lutheran Services) are not granted an organisational right of conscientious objection (although individuals working in the organisation are able to conscientiously object) since residents are living there in their ‘own home’.

Despite any misgivings, the LCAQD will need to engage with the fact that some of our members, contacts, and/or members of their family or friends may wish to explore and/or access VAD.
With the legalisation of VAD, this is our new reality. I will contend in short that while we do not support VAD, we do support people

We are all familiar with the fact that in days gone by, those who suicided were denied a religious funeral and buried outside the consecrated cemetery. Nowadays it is more likely that those who die by their own hand will be viewed with compassion, their situation lamented, and their families acknowledged as needing even more support than ever. Similarly, there may be good reasons for pastors to continue to support persons seeking VAD (and their loved ones) with pastoral understanding and support.

A significant inclusion in the Queensland legislation that differentiates itself from other jurisdictions is the threat of up to seven years imprisonment if anyone ‘dishonestly or by coercion,  induces another person to make, or revoke, a request for access to VAD’ (s 141). This could be of particular significance to pastoral carers, as the Church has a publicly stated opposition to VAD and clear moral position on the matter, and individuals may have strong feelings on the matter, possibly bringing them under scrutiny.

The Act is very strict regarding who can start a conversation with a person about voluntary assisted dying. Only doctors and nurse practitioners are allowed to initiate a conversation about voluntary assisted dying. They must, at the same time, inform the person about treatment options available and the likely outcomes of that treatment, and palliative care and treatment options available and  the likely outcomes of that care and treatment.

If anyone seeks information and/or access to VAD, pastors could choose to refer them to the Queensland Government’s
QVAD Support, where they will be provided with information. Alternatively, a pastor should suggest they make contact with a medical professional. Nonmedical professionals are never to raise the topic of VAD, and are under no obligation to provide any material or details. All other health and aged care workers, including pastors, can respond to requests for information about voluntary assisted dying, if they feel comfortable doing so, but are not permitted to raise the topic of voluntary assisted dying before the person raises the issue themselves.

Pastors would normally be expected to offer a safe place to anyone to discuss matters of life and death. It should be noted that someone expressing a general wish to die and someone  explicitly mentioning VAD are quite different situations. Once VAD is the topic of discussion, care must be taken to not contravene state laws. This is even more the case when the conversation takes place in a health care facility, such as a hospital.

Deciding whether to access voluntary assisted dying is a sensitive, personal endoflife choice for an eligible person who is suffering and dying. It is important to protect the person’s privacy and right to confidentiality throughout the voluntary assisted dying process. Personal information (including information about VAD) should only be shared as necessary with members of the care team. This means that information may not be available to the pastor unless the person raises the topic with them or requests pastor involvement.

Pastors are at full liberty to articulate the Church’s and their personal position on the matter only if and when they are asked. However, to move into a space that might be perceived as coercing someone to (assumedly) not go down the VAD path, may be considered not only illegal but in some
cases spiritually abusive. The bestcase scenario would be for the individual to feel they have been heard by the pastor and feel they will be supported spiritually whatever their choice. Documentation of conversations in this area would be prudent, noting the people involved in the conversation, the date and time, the place, whether and how VAD was raised and by whom, and any actions to be followed as a result of this discussion.

Any pastor is free to exercise their own conscientious objection, as is any individual, including health care workers, and fully absent themselves from any discussion of VAD or its process, and indeed refrain from offering pastoral care to those involved. However, it is assumed that in the great 
majority of cases, pastors will continue to provide appropriate and compassionate informal and/or formal pastoral care without prejudice to the individual and their family and friends throughout and immediately following the process. Alternatively, they could refer the patient to another pastoral carer.

In considering whether and to what extent we remain engaged with pastoral care at these times, I note ethicist Daniel Fleming of St Vincents Health suggests four reasons a pastor might provide pastoral care to someone seeking VAD. I find them persuasive due to their gospelcentredness.

There are no aspects of the human experience in which the love of God cannot break through.

The love of God has no bounds, and so remaining by the side of the sick is a sign of love and of the hope it contains.

A person who has taken the final step will still need end of life care and may experience a conversion of the heart.

That an occasion for scandal might or could exist is insufficient for withholding the spiritual and temporal goods at stake.
Of course, the presence of a pastoral carer around a VAD process could be interpreted as complicity. This could put the pastor into a vulnerable position, and yet it is clear the pastor is entering the space of someone who is themselves extremely vulnerable. I contend a pastor can in good conscience promise to not abandon someone during the VAD journey, providing pastoral care as best they can, while themselves unconvinced this is the best route. Indeed, a pastor needs to manage their absence with great care. Is absence or denial of
pastoral care going to communicate abandonment? Is abandonment by a pastoral carer a sign of God’s abandonment of the individual?

Finally, we need to consider how we care for the person and their loved ones after death. Pastors need to be concerned about appropriate funeral and other rites if requested, for which LCA liturgical rites and resources will assist.

Throughout these processes, pastors would themselves be strongly advised to remain in touch with their spiritual director or professional supervisor for their personal reflection and care. This will serve the extra purpose of documenting pastoral care in these difficult situations.
Rev Dr Russell Briese
Director, Chaplaincy and Ministry Development, Lutheran Services

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