This means faith-based providers of aged care in NSW will have to facilitate the administration of VAD on their premises.

“It is truly a dark day for New South Wales,” the Catholic Archbishop of Sydney Anthony Fisher said.

“I am deeply saddened that the Voluntary Assisted Dying Bill 2021 has passed the NSW Parliament.

“The disturbing nature of this legislation is compounded by the way the debate over amendments was conducted. All amendments put forward by those who would seek to make this deadly regime even a little bit safer were rejected.

“That no meaningful amendments were accepted speaks to a ‘winner takes all’ approach by the proponents of this bill and reveals an ugliness that has invaded our politics. This does not bode well for the protection of our most vulnerable citizens.”

Faith-based providers of aged care in NSW are now likely to seriously consider whether they can continue operating under a regime that forces them to facilitate VAD on their premises.

On Tuesday, Anglicare’s Andrew Ford told Eternity that the question would have to be asked if amendments to the NSW VAD Bill were not passed to exempt faith-based healthcare and aged care providers from allowing VAD on their premises.

The bill does not allow faith-based aged-care facilities to opt out of the system. There is a clause that allows them not to administer the restricted drug, but they have to open up their premises to allow doctors to give advice, assessment and treatment to their residents.

“I certainly think it changes the dynamics and the question will be asked whether to continue.” – Andrew Ford

Ford, who is Anglicare’s general manager for mission and partnerships, said the lack of a conscientious objection provision was a serious concern for faith-based providers of not just aged care but healthcare in general.

“I certainly think it changes the dynamics and the question will be asked whether to continue,” he said.

“I can’t comment on what our Board would do, but it does change what is already a difficult environment given lack of government funding, increasing compliance costs and most not-for-profit, religious providers of aged care in this space are making significant losses, so it adds another dynamic.

“It doesn’t take into account that some people really don’t want to be in places where health care providers can be assisting in death rather than assisting them in living well and as full a life as possible right up to the end,” he said.

“There are some checks and balances which are very good, but we have an in-principle opposition to euthanasia.”

He said it was odd that a bill that promotes choice won’t let providers make some choices.

“Alex Greenwich [the MP who introduced the bill] has said to Anglicare that one of his concerns – and I get this – is that if there’s only one residential aged care Home in a small town or rural setting that if that Home has a conscientious objection to VAD, a resident would haven’t a choice,” he said.

“But it would be a perverse outcome if the only Home in that setting is run by a faith-based organisation and they decide because of this that they no longer want to provide that service, then it doesn’t just affect the choice of that one person who may want VAD; it would affect the whole community’s access to residential aged care.

“Now of course some other provider may come in, but in the environment we have where many of the for-profits who previously piled into the industry are now leaving – so some big players in the for-profit space are getting out because they’re not making money in this space anymore. The provision of aged care in NSW is a space that we can’t afford to lose any more providers.”

“It doesn’t take into account that some people really don’t want to be in places where health care providers can be assisting in death.” – Andrew Ford

In an open letter to members of the NSW Legislative Council, the three largest faith-based aged-care providers – Anglicare, Catholic Health Australia and HammondCare – said any VAD scheme should be voluntary for clinical staff and medical officers and the organisations they work for.

“The Voluntary Assisted Dying Bill 2021 claims to offer choice in end-of-life matters yet it fails to protect the choice of residents in aged care facilities who do not want anything to do with assisted dying,” the letter said.

“The Bill has the veneer of protecting aged-care staff, but in fact does the opposite as it forces them to choose between abandoning residents with whom they have a long-term caring relationship or violating their conscience by being involved in assisting in their death.”

“If there’s not a complete exemption, there should be one that means they don’t have to facilitate the act itself.” – Michael Stead

A motion passed at the Anglican General Synod last week strongly opposed any legal obligation for faith-based organisations to facilitate, support or permit euthanasia or physician-assisted suicide.

“Ideally, our motion is that residential aged care facilities not be forced to facilitate VAD and if there’s not a complete exemption, there should be one that means they don’t have to facilitate the act itself,” Michael Stead, Bishop of South Sydney, told Eternity.

“They could allow other medical people to come in and do the preparatory stages and then facilitate the transfer at the end for the termination of life. That’s the very minimum acceptable from the faith communities’ point of view.”

“It’s a complete denial of rights of those vulnerable people who don’t want access to VAD.” – Megan Best

Medical ethicist Megan Best said the reason the proponents of VAD in NSW failed to include the safeguards in the Victorian legislation was that they saw them as barriers to access.

“They think people have to have access to VAD everywhere in the entire state, but they have completely ignored the concerns of vulnerable aged-care residents who feel there needs to be somewhere they can go that is safe from unwanted VAD, or even the suggestion of VAD, or having a neighbour killed by VAD while they are living there,” said Best, who is Research Associate with the Institute for Ethics and Society at the University of Notre Dame.

“It’s a complete denial of rights of those vulnerable people who don’t want access to VAD.

“Also that all healthcare and aged-care facilities now have to invest resources into facilitating a system to cope with VAD that will divert resources for other areas of care, and they’re not given the opportunity to decide where their resources are best spent.”

Another problem she sees with the NSW legislation is that doctors and staff are allowed to raise the issue of VAD with patients and residents so that “someone not feeling well or who is socially isolated may well take that advice and be killed prematurely because someone had introduced suicidal ideation into their thinking. Psychiatrists will tell you that this will be counter-productive in terms of anti-suicide strategies that are already in place, so we’ve got a state-funded system where VAD is being imposed on individuals and institutions who don’t want it. I think it’s a huge denial of individual and institutional rights.”

“Safeguards in Victoria, which persuaded a lot of politicians that the legislation would be safe, have been removed from the NSW bill.” – Megan Best

She said another amendment was needed to ensure that the doctor who decides the eligibility criteria for VAD is a specialist in the disease to avoid mistakes being made about how long a person has to live and advise on treatment options.

“WA removed this requirement, which is in the Victorian legislation, and the WA doctors have been saying ‘sometimes I have to look up textbooks about this disease because I have never come across it before’ – and these are the people deciding how long a person has to live, which can make a difference to someone deciding to opt for VAD and possibly dying prematurely just because they’re given wrong information.”

Finally, there is no provision for a person’s GP or family to be involved in any decision to access VAD.

“These are the people who know the patient best so there’s a lot of concern that personal factors and the possibility that somebody may be feeling depressed or may be feeling coerced, there’s nobody who knows the person well who has to be involved in the process,” she said.

“Safeguards in Victoria, which persuaded a lot of politicians that the legislation would be safe, have been removed from the NSW bill because the proponents view them as barriers to access, so there’s concern that vulnerable people are at risk of being killed prematurely when it’s not what they want.”