Running with Tony Buti: Nation’s VAD director Dr Clare Fellingham reflects on the heavy toll of ending a life

London born and bred anaesthetist and consultant Dr Clare Fellingham, is Director of VADANZ (VAD Australia and New Zealand), a peak body established to pursue excellence in voluntary assisted dying care. We caught up in the Kalamunda Hills. Tony Buti: When did you immigrate to Western Australia? Clare Fellingham: In 2009, with my husband, who is also a doctor. We came to Perth from England after spending 18 months in New Zealand. TB: Your first job in Perth? CF: At Rockingham Hospital, which had recently been built. I commenced my anaesthetist training there. I had two periods of maternity leave which extended my training, finally achieving my consultant role in 2019. Then something rather significant happened in March 2020 that rather upset the apple cart. TB: COVID? CF: Yep. TB: In 2019, the WA State Parliament debated and passed voluntary assisted dying legislation. Did you pay attention to the debate? CF: So rather extraordinarily, I was paying a lot of attention to it at the time, not because I’d been a sort of lifelong placard-waving supporter of voluntary assisted dying, but because I was actually doing a six-month palliative care clinical fellowship at the time, having decided I didn’t want to remain an anaesthetist for the rest of my life. I’d always been interested in end-of-life care and palliative care. I was surprised to find out how confronted much of the palliative care community was by the notion of voluntary assisted dying becoming legal. Some senior doctors I was working with at the time wouldn’t even discuss the proposed law legalising VAD. TB: Why do you think this was the case? CF: Interesting question. If you look at the World Health Organization definition of palliative care, it says it’s a specialty that intends neither to hasten nor prolong life or death. So many people in the palliative care world feel that assisted dying is in contravention of the fundamental basis of the speciality. But it’s not that simple. The four pillars of modern medical ethical practice are autonomy, beneficence, non-maleficence and justice. Patient autonomy is such that if they have information on a range of treatment or medical options and they make a decision for themselves based on that information, with capacity to do so, we as medical practitioners don’t have the right to question or criticise that, even if we don’t think it’s in their best interest, even if we think that they’re making the wrong decision. TB: How did you feel the first time you were involved with a patient who died through the administration of a VAD substance? CF: It was in July 2021, literally days after the VAD laws became operational in WA. It was a weekday — a school day — and the morning began in the same way that all my mornings begin, with the hubbub of life just going on all around me, packing lunches and kids running around and school uniforms. But it was also an extraordinary day for me, knowing what I was set out to do that day. I needed time to myself so I got everyone out of the house. There I was in the midst of everyday life, yet about to be directly responsible for ending someone’s life. Even though I knew I was acting lawfully and with a clear conscience and with absolute certainty that this was exactly what the patient wanted and that they would suffer greatly if I didn’t help, I was still deeply confronted on a personal, spiritual and psychological level by the act of actually facilitating the end of somebody’s life. So, I hoofed everyone off out to school and sat on my couch in my kitchen and just cried for about an hour — not because I believed what I was about to do was wrong, but because of the sheer magnitude of it all. TB: Did you administer the VAD substance or did the patient self-administer? CF: The patient had motor neurone disease and was unable to swallow, so the only option was the intravenous administration pathway. When it came time to administer the substance, the patient was surrounded by family and her son played one of my favourite songs, Hallelujah. It was the most extraordinary, confronting and intense thing I’ve ever done in my entire medical career, but it was also the most meaningful. It embodied compassion, purpose, and what I believe to be the true intent of medicine, which is “to heal”. You know, people cite the Hippocratic Oath quite often as being a reason to oppose voluntary assisted dying. You know, “thou shalt not kill”. What’s interesting about the Hippocratic Oath, first of all, is that we don’t swear allegiance to it anymore. Second, it contains more than those words. It does say, “thou shalt not kill” but Hippocrates was much more learned than just that one statement. My favourite Hippocratic quote is, “cure sometimes, heal often, comfort always”. TB: Professionally and personally, what does it mean to you to be a VAD Practitioner? CF: For me, being involved in the VAD process only strengthens my resolve to continue in this important work. Giving a person the ability to take charge of that process, to regain ultimate control of a disease that has all but consumed them, is the most extraordinary gift. It is an immense privilege to be able to allay fear at the end of life and bring peace and comfort to those who surely deserve it most.