15 Should voluntary assisted dying be raised in advance care planning: legal and ethical considerations

<h3>Aim</h3> To explore the legal and ethical considerations associated with whether and when voluntary assisted dying (VAD) should be raised during advance care planning conversations. <h3>Background</h3> VAD is legal in some form in 17 countries. Experience with the practice ranges from decades through to laws which have passed but not yet started in force. For some health professionals and members of the community, VAD is controversial and so discussing it can be difficult, particularly where it has only been relatively recently legalised. For others, VAD is something they would like to discussed openly during advance care planning. <h3>Method</h3> An analysis of laws internationally that regulate how conversations about VAD may occur was undertaken. The ethical considerations associated with whether and when VAD should be raised in advance care planning conversations were identified and evaluated. <h3>Results</h3> A small number of jurisdictions (particularly Australian jurisdictions and New Zealand) specifically regulate through law how the topic of VAD may be raised with patients. In some of those jurisdictions, health professionals are prohibited from raising the topic first and in other jurisdictions this is permitted but certain mandated topic must also be discussed at the same time. Other jurisdictions’ laws do not address this topic. Ethical considerations include supporting any conscientious objection a health professional may have to raising or discussing VAD, managing local institutional policies which may limit VAD discussions, and ensuring patients are fully informed about all of their legal options. <h3>Discussion</h3> Health professionals need to be aware of local laws that govern how the topic of VAD may be raised and discussed in advance care planning. Ethical considerations will also shape individual and institutional behaviour. There is a case for including VAD in advance care planning conversations where appropriate to ensure patients are aware if this could be an option for them. <h3>Unique Contribution</h3> This presentation addresses a topical legal and ethical debate drawing on a range of international laws. This issue is the subject of current debate in places such as Australia, New Zealand and Canada and is actively being considered in new VAD laws in the UK. <h3>Implications</h3> In countries where VAD is legal, some patients will either raise VAD or want to know about it during advance care planning conversations. Understanding legal requirements and reflecting on ethical considerations associated with raising the topic of VAD will support lawful, patient-centred care.