The Voluntary Assisted Dying Act (2017) (The Act) came into effect on 19th June 2019. The process of application is: First Request, Coordinating Assessment, Consulting Assessment, Written Declaration, approval of a VAD permit, and medication delivery. Anecdotally, many applicants do not complete the process. I In the first six months of operation,136 patients applied for VAD, with one-year data released in August 2020. Analysing timeline data may assist in understanding factors relating to provision of this service and monitor for delays that may impede patients’ access to this end-of-life option.
An audit of the first 50 patients with cancer assessed by author (CM) for eligibility to access VAD was conducted. Definitions were used as per The Act. Data was analysed according to whether the process was “completed” (received VAD medication) or “withdrawn” (not received VAD medication). The date of First Request was coded as day 1, from which subsequent milestones were timed (Table 1). Reasons for withdrawal were categorised.
Of the first 50 patients assessed, 32 were completed. All of the 18 withdrawn cases died during the application process: 2 prior to Consulting Assessment; 6 prior to Written Declaration; 6 prior to Permit Approval; and 4 prior to Medication Delivery.
Table 1: Timing of each application step
|
|
Days: mean (range) |
||
|
Timepoint |
Completed |
Withdrawn |
All |
|
Coordinating Assessment |
19 (1-255) |
13 (1-83) |
17 (1-255) |
|
Consulting Assessment |
27 (1-261) |
19 (3-91) |
24 (1-261) |
|
Written Declaration |
32 (2-261) |
29 (6-97) |
32 (2-261) |
|
Permit Approval |
37 (4-263) |
44 (13-98) |
38 (4-263) |
|
Medication Delivery |
47 (3-269) |
N/A |
46 (3-269) |
|
Administration or Death |
58 (4-270) |
26 (4-100) |
45 (4-270) |
The time to complete the various stages varied widely. In this cohort, there was no obvious difference between completed and withdrawn cases. Ongoing data collection will allow further analysis by demographic and tumour factors.