The speed of approvals for VAD within Queensland had an unexpected and immediate impact on the culture and commitment of staff within the Palliative Care Unit (PCU) and their “Continuum of Care”. 

 

Despite continuing discussions and education there was a lack of awareness of VAD principles by staff and the understanding of their rights, roles and responsibilities resulted in tensions arising across the unit and Multidisciplinary team.  This led to differing views and levels of acceptance by individual staff members. 

 

The services Palliative Consultants were one of the most challenged groups and emotionally distressed by the resulting dilemma.

 

Another presenting issue and underlying expectation within the Health Service is that any person who elects VAD could be managed within the PCU as the perception exists that PCU is skilled in managing the dying. 

Representing dignity for the deceased and family is of significance within the PCU. VAD has brought a different challenge around dying, the acceptance of that death and best way to care for families and carers as the result of the passing of a loved one.

 

·      Ongoing provision of information and training on the role of Palliative Care in the VAD process

·      Clear delineation of roles and responsibilities of PCU staff and VAD team.

·      Utilisation of Coverlet and hand held heart framed by community and cultural symbolism

·      Open team forums to address unresolved issues around VAD and what is culturally important 

·      Helping and supporting families in managing mixed feelings as recognising there was a definite end to a person’s life

·      Managing perceptions of VAD team

 

Although there is now much written about VAD, what is not published or readily available is how to deal with the emotional and ethical dilemmas that present to all members of the Palliative Care and how it was dealt with.