It’s not good enough

General practitioner and pro-euthanasia advocate, Nicholas Carr, is the first person reportedly reprimanded and fined for a breach of Victoria’s euthanasia and assisted suicide laws.

According to a hearing in Victoria’s Civil and Administrative Tribunal (VCAT), a patient, Dr Carr and two witnesses were all present at his medical practice in February, 2020. The written declaration was completed at that time, except for the signature of the requesting patient and the date of that signature. Dr Carr submitted the form to the Voluntary Assisted Dying Review Board (VADRB) on 8 February 2020, and received a response from the board two days later, noting the missed signature and asking for it to be signed.

The VCAT decision describes what happened next:

Dr Carr arranged for the patient to attend his practice again, on 11 February 2020. This time, the patient attended alone. The patient inserted the missing signature and dated the form 6 February 2020. The form was submitted to the VADRB, and the VAD process continued to completion. Using a drug prescribed by Dr Carr, the patient brought about their death on 1 April 2020.

Some time in May 2020, the VADRB conducted a review and noted that the same form had been resubmitted and backdated, meaning the patient had not signed in the presence of two witnesses, as is required by the legislation.

The VCAT decision lays out what happened next, according to the following timeline:

  • 6 February 2020 - Initial meeting and filling out of paperwork (patient signed and dated the ‘contact person appointment form’ but did not sign or date the written declaration);
  • 8 February 2020 - Documents filed with VADRB;
  • 10 February 2020 - VADRB notifies Dr Carr of error;
  • 11 February 2020 - Patient attends Dr Carr’s office alone, signs written declaration and backdates it to 6 February; 
  • 11 February 2020 (at 12.31pm) - Dr Carr sends it back to the VADRB;
  • 11 February 2020 - VADRB Secretary issues a ‘voluntary assisted dying permit’ to the patient;
  • May 2020 - VADRB conducts a review and notices that the written declaration was not in accordance with the legislation;
  • 21 May 2020 - VADRB raises the issue with Dr Carr who provides “full and frank responses”;
  • 27 July 2020 - VADRB refers Dr Carr to the Medical Board of Australia (Medical Board);
  • 31 March 2022 - Medical Board commences professional disciplinary proceedings against Dr Carr in VCAT;
  • 23 December 2022 - the Medical Board and Dr Carr provide VCAT with a Statement of Agreed Facts, Findings and Determinations;
  • 1 August 2023 - VCAT hearing and decision to have the Medical Board reprimand Dr Carr and fine him $12,000;
  • 14 August 2023 - VCAT publishes its reasons for decision;
  • 12 April 2024 - Australian Health Practitioners Regulation Agency (AHPRA) issues a media release, notifying the public of the decision, describing the reprimand and fine as being “for paperwork that failed to comply with the Voluntary Assisted Dying Act 2017 (Vic).”

The VCAT decision and AHPRA announcement raise so many questions and concerns that it is difficult to know where to begin.

Firstly, AHPRA’s description of the misconduct as being for non-compliant paperwork downplays the significance of what happened: the reality is that no one except for the doctor who prescribed the lethal drugs and is the subject of the proceedings can say that they saw the patient sign the written declaration. This is more than just paperwork!

Secondly, there are some serious periods of inaction by regulatory bodies: it took the Medical Board almost 18 months to commence disciplinary action against Dr Carr, and it took AHPRA 8 months more to issue a media release. The VCAT decision notes that, at the time of this incident, Dr Carr had been the coordinating practitioner for the deaths of 8-10 patients already. By the end of December 2023, this number had grown to 60. The question needs to be asked, should a doctor who is under investigation for professional misconduct around euthanasia or assisted suicide still be allowed to act as a coordinating practitioner while the investigation is underway, or does the seriousness – and finality – of euthanasia suggest that there should be a suspension?

Thirdly, should action be taken against the two “witnesses” who signed the written declaration saying the patient had signed the form in front of them, when that was untrue? Making a false declaration around someone’s euthanasia request is a big deal.

Fourthly, should action be taken against the Secretary of the VADRB, who issued a voluntary assisted dying permit to Dr Carr on the same day he sent through the revised form? The whole reason for having a VADRB is to check the documents are in accordance with the law, and the Secretary missed the fact that the patient had not signed in front of witnesses.

Lastly, what message does the relative lenience of this action, not only for Dr Carr but for the witnesses, say about the Medical Board’s and VCAT’s willingness to uphold the law? Falsifying a form required to be made under the euthanasia law, or knowingly making a false statement in a report each carry a maximum penalty of 5 years imprisonment or a $96,000 fine, yet it was only a $12,000 fine and reprimand in this instance.

This is quite simply not good enough; not from Dr Carr, not from the Medical Board, nor VCAT, nor AHPRA. 

Victorians deserve better.