The complete guide to voluntary assisted dying in Australia.

Voluntary assisted dying, also known as voluntary euthanasia, is a complex and controversial topic that has been debated for many years in Australia. In recent times, there has been a growing interest and discussion about the legal, ethical, and practical aspects of voluntary assisted dying in the country. 

Voluntary assisted dying (VAD) refers to a medical process where individuals experiencing unbearable suffering from an advanced medical condition receive medical assistance to peacefully end their life.

This comprehensive guide aims to provide a thorough overview of voluntary assisted dying, covering its history, legal framework, eligibility and criteria, process, public opinion, benefits and concerns, palliative care and end-of-life options, ethical considerations, and much more.

History of voluntary assisted dying in Australia.

Voluntary assisted dying has a long history of debate and discussion in Australia. The topic gained significant attention in the late 20th century when various attempts were made to introduce legislation allowing voluntary euthanasia. 

However, these attempts faced strong opposition from different quarters, including religious groups, medical associations, and ethicists, leading to the failure of such legislation.

Legal framework for voluntary assisted dying in Australia.

The legal framework for voluntary assisted dying in Australia is complex and varies across states and territories. Several states have passed laws that allow voluntary assisted dying in limited circumstances for eligible people, while others are preparing to implement or consider similar legislation.

As of April 2023, Victoria, Western Australia, Tasmania, Queensland and South Australia have legalised voluntary assisted dying. New voluntary assisted dying laws will come into effect in New South Wales on 28th November 2023.

Voluntary assisted dying laws by state and territory in Australia

While the overall framework for voluntary assisted dying is guided by national principles, each state and territory has its own legislation outlining how the process is applied in practice. Below is an overview of how voluntary assisted dying operates across different jurisdictions in Australia.

Victoria

In Victoria, the Voluntary Assisted Dying Act 2017 was enacted, which allows eligible adults with a terminal illness and intolerable suffering to request and receive assistance to die. A person who qualifies for voluntary assisted dying (and only that person) who is suffering toward the end of their life may select the time and method of their death after following the processes outlined under Victorian law.

According to the law, a person may receive assistance from medical professionals in order to obtain medication that they can use to terminate their life whenever they choose. The procedure guarantees that the person's choice is free and permanent, and it offers precise instructions on how medical professionals may legally assist the individual in this decision.

The law also offers a number of safeguards to guarantee that voluntary assisted dying is carried out and supervised in Victoria in a safe manner.

More guidance is available through the Victorian Department of Health website.

Western Australia

Western Australia passed a Voluntary Assisted Dying law in December 2019. The law came into effect in July 2021. There were many aspects in making sure that Western Australia was ready for when voluntary assisted dying became legally available.

The Department of Health had a dedicated project to ensure that voluntary assisted dying was implemented properly in Western Australia. The Act is highly detailed and this reflects the importance of ensuring that the operation of voluntary assisted dying in WA is safe and appropriate. The Act provides protections for individuals involved in the voluntary assisted dying process but also clearly articulates offences and circumstances that may be considered professional misconduct or unprofessional conduct. The Voluntary Assisted Dying Board, an independent statutory body created by the Act, can refer matters to various agencies including WA Police, the State Coroner, the Australian Health Practitioner Regulation Agency (AHPRA), and the Director General of Health. The Director General of Health (as the CEO) has powers to investigate suspected breaches of the Act.

More guidance is available on the Government of Western Australia Department of Health website.

South Australia

In June 2021, South Australia passed a Voluntary Assisted Dying law. It commenced on January 31, 2023, and eligible terminally ill individuals can now access the law. The law sets criteria for eligibility, includes safeguards, outlines the request process, specifies the administration of assisted dying, and may involve reporting and oversight mechanisms. For detailed and up-to-date information, consult the official government sources or the text of the legislation itself.

Queensland

The Voluntary Assisted Dying Act 2021 (the Act) was passed in September 2021 and was made accessible to eligible Queenslanders starting from 1 January 2023. The Act provides for and regulates access to VAD, which is defined as 'the administration of a voluntary assisted dying substance and includes steps reasonably related to that administration'.

The Act also acknowledges the rights of healthcare workers to abstain from participating in voluntary assisted dying. It is important for medical practitioners, healthcare workers, and health services to understand their rights, responsibilities, and roles as outlined in the Act.

Throughout the implementation phase, Queensland Health focused on establishing the necessary clinical and administrative systems to ensure that voluntary assisted dying is delivered with utmost quality, safety, accessibility, and compassion.

Queensland Health provides full information on voluntary assisted dying.

Tasmania

Voluntary assisted dying in Tasmania is regulated by the End-of-Life Choices (Voluntary Assisted Dying) Act 2021 (the Act). The Act identifies when a person in Tasmania is eligible to access voluntary assisted dying and sets out the steps in the voluntary assisted dying process. It also establishes the Voluntary Assisted Dying Commission.

A person is eligible to access voluntary assisted dying in Tasmania if they meet all the eligibility criteria. These relate to age, residency, medical requirements, voluntariness, and decision-making capacity. Comprehensive guidance is published on the Tasmanian Health website.

New South Wales

The Parliament of New South Wales passed the Voluntary Assisted Dying Act 2022 (the Act) on 19 May 2022. The Act will allow eligible people the choice to access voluntary assisted dying in NSW from 28 November 2023.

NSW Health is working to prepare for voluntary assisted dying to become available in NSW within 18 months. This includes establishing an Implementation Committee to oversee the implementation of the Act and to provide expert guidance. More information can be found at NSW Health.

Australian Capital Territory and Northern Territory

As of April 2023, voluntary assisted dying remains unavailable in the ACT and NT. However, the federal restrictions that prevented these territories from passing such laws were lifted in 2022. Both governments have since announced their intention to develop legislation in the coming years.

Updates and future guidance will be available through the ACT Health Directorate and Northern Territory Department of Health.

Eligibility and criteria for voluntary assisted dying.

To be eligible for voluntary assisted dying in Australia, there are strict criteria that must be met. Different states have slightly different eligibility, however eligible adults must be mentally competent, have a terminal illness that is expected to cause death within a specified timeframe, experience intolerable suffering that cannot be relieved, and make voluntary and informed requests for assistance to die. 

These criteria are designed to ensure that only individuals who are genuinely suffering and near the end of life can access voluntary assisted dying.

Here is a comprehensive list of eligibility. A person is eligible if they:

• are aged 18 years or over; 
• are an Australian citizen or permanent resident, who has been resident in the State for at least 12 months when they first request voluntary assisted dying (these criteria can be met in other ways in Tasmania, Queensland and New South Wales); 
• have decision-making capacity; 
• are acting voluntarily and without coercion; 
• have an enduring request for voluntary assisted dying (i.e. their request is ongoing); and 
• have a disease, illness or medical condition that is: 

• advanced and will cause death. In all States except Tasmania it must also be progressive (i.e. the person experiences active deterioration), 
• incurable (Victoria, South Australia and Tasmania only), and irreversible (Tasmania only), 
• expected to cause death within six months, or 12 months for a person with a neurodegenerative disease, illness or medical condition. In Queensland, however, a person expected to die within 12 months may apply for VAD, and 
• causing suffering that cannot be relieved in a way that the person finds tolerable. The person’s suffering may be physical or non-physical e.g. psychological, existential. 

A person will not be eligible for voluntary assisted dying based on having a disability or mental illness (or in New South Wales, dementia) alone – they must meet all of the criteria above.

Process of accessing voluntary assisted dying.

The process of voluntary assisted dying in Australia involves several steps. It typically starts with the patient expressing their interest in accessing voluntary assisted dying to their attending physician. 

The patient then goes through a thorough assessment to determine their eligibility, including physical, psychological, and social assessments. They will also need to be assessed by at least two independent medical practitioners who have taken specialised training in voluntary assisted dying.

If the patient meets the eligibility criteria, they must make a written and witnessed request for assistance to die. It’s important to note that the patient can withdraw their request for voluntary assisted dying at any step of the process. Once the request is approved, the patient can self-administer a prescribed medication to end their life peacefully.

Safeguards and protections.

Voluntary assisted dying legislation in Australia includes a range of safeguards and protections to ensure that the process is carried out safely and ethically. These safeguards may include multiple assessments by different healthcare professionals, mandatory waiting periods to allow for careful consideration, and the option for patients to revoke their request at any time. 

A person’s first request for voluntary assisted dying must be made directly and unambiguously to a medical practitioner. Family members, carers, or substitute decision-makers cannot make the request on someone’s behalf, and advance health directives cannot be used for this purpose.

If a doctor initiates a conversation about voluntary assisted dying, they are legally required to also provide information about available treatment and palliative care options, along with their likely outcomes.

Additionally, there may be provisions for conscientious objection by healthcare providers who do not wish to participate in the process. These safeguards are in place to minimise the risks of abuse and ensure that voluntary assisted dying is carried out in a compassionate and responsible manner.

After a person’s death, the coordinating or administering practitioner must notify the Review Board within two business days. The cause of death recorded on the death certificate will list the underlying illness or condition that qualified the person for voluntary assisted dying.

Public opinion and controversies.

Voluntary assisted dying is a highly contentious and divisive topic in Australia, with varying opinions from different segments of society. Additionally, the introduction of legislation in Australia has been met with both support and apprehension. 

Advocates for voluntary assisted dying argue that it provides a compassionate option for individuals suffering from intolerable pain and a diminished quality of life to have control over their own death. They argue that it promotes autonomy, choice, and dignity for patients at the end of their lives. It may also alleviate the financial burden of prolonged medical care. 

However, opponents raise concerns about the potential for abuse, the devaluation of human life, and the ethical implications of intentionally ending a person's life, even in the context of terminal illness. The topic has sparked heated debates and discussions among policymakers, healthcare professionals, ethicists, and the general public.

Palliative care and end-of-life options.

Palliative care, which focuses on providing relief from pain and other distressing symptoms, is an important aspect of end-of-life care. It is often seen as a complementary approach to voluntary assisted dying, with the goal of improving the quality of life for patients who are facing a terminal illness. 

Palliative care aims to address the physical, emotional, psychological, and spiritual needs of patients and their families, providing support and comfort during this challenging time. In addition to palliative care, there may be other end-of-life options available to patients, such as hospice care, home-based care, and advanced care planning. It is important for patients and their families to be aware of the full range of options and make informed decisions based on their individual circumstances.

Ethical considerations.

The ethical considerations surrounding voluntary assisted dying are complex and multifaceted. Some argue that it is a compassionate and ethical option for individuals who are facing immense suffering and have a desire to end their life on their own terms. They argue that it respects the autonomy and dignity of patients, allowing them to make choices about their own life and death. 

However, opponents raise ethical concerns about intentionally ending a person's life, even in the context of terminal illness. They argue that it goes against the principles of medical ethics, which prioritise the preservation of life and the relief of suffering through palliative care. 

Ethical debates also revolve around issues of fairness, access to care, and the potential for societal impacts. It is crucial for policymakers, healthcare professionals, and society as a whole to carefully consider the ethical implications of voluntary assisted dying.

Implementation challenges and lessons learned.

The implementation of voluntary assisted dying legislation in Australia has posed various challenges. These challenges may include issues related to training and education of healthcare professionals, access to care in rural and remote areas, reporting and documentation requirements, and coordination among different stakeholders involved in the process. 

There may also be challenges related to public perception, stigma, and misconceptions about voluntary assisted dying. Lessons learned from other jurisdictions that have implemented similar legislation, such as the Netherlands, Belgium, and Canada, can provide valuable insights into potential challenges and best practices for implementation in Australia. 

In the Netherlands, voluntary assisted dying has been legal since 2002 and is available to patients who have unbearable suffering without prospect of improvement, and who have requested it voluntarily, explicitly, and repeatedly. According to the Dutch government's report on the implementation of the law, there has been a gradual increase in the number of cases of voluntary assisted dying, with around 7,000 cases reported in 2017. The report also indicates that the majority of cases involve patients with cancer, and that the process is generally carried out in a careful and responsible manner with high levels of compliance with the legal requirements.

In Belgium, voluntary assisted dying has been legal since 2002 as well. Similar to the Netherlands, the law allows patients to request voluntary assisted dying if they are suffering from an incurable illness, have an advanced and irreversible condition, and are experiencing unbearable suffering. According to a study published in the New England Journal of Medicine, approximately 2% of all deaths in Belgium are due to voluntary assisted dying. The study also found that most cases involved patients with cancer, and that the process was generally carried out in compliance with the legal requirements.

In Canada, voluntary assisted dying became legal in 2016 with the passage of the Medical Assistance in Dying (MAID) legislation. The law allows patients who are eligible to request and receive medical assistance in dying if they have a serious and incurable illness, disease, or disability that causes intolerable suffering, and their natural death is reasonably foreseeable. According to the latest report by Health Canada, there were 7,595 reported cases of MAID in Canada between June 2016 and October 2020. The report indicates that the majority of cases involved patients with cancer, and that the process was generally carried out in a careful and responsible manner with high levels of compliance with the legal requirements.

It is essential to learn from these experiences and address any challenges proactively to ensure the smooth and responsible implementation of voluntary assisted dying.

Final thoughts on voluntary assisted dying.

Voluntary assisted dying is a multifaceted and sensitive topic that involves various legal, ethical, medical, and societal considerations. It provides a compassionate option for individuals who are facing intolerable suffering and wish to have control over their own end-of-life decisions. However, it also raises concerns about potential risks, abuse, and ethical implications.

VAD laws in each state are similar, but there are key differences. It is essential to stay informed about the most up-to-date legislation and consult legal professionals for more accurate information.

Ultimately, this should be approached respectfully as it can be a sensitive topic for many. Allowing people to die on their own terms means they can have a good death where their access to care and choices are respected. Furthermore, openly discussing death and dying can help prepare families for the passing and voluntary assisted dying can keep them more involved in the process, so they can ensure they’re close by for the final goodbye.

Voluntary assisted dying is a deeply personal decision, and having the right support can make such a difficult time a little easier to navigate. If you are considering end-of-life arrangements, our team supports families across Australia, including the people of Sydney and Newcastle, with personalised funeral services that reflect the wishes of your loved one.

Part of being prepared for your end-of-life is planning for your funeral in advance with a Prepaid Funeral. If you’re interested in a Bare Prepaid Funeral, you can head to the link below for an instant quote for your area, or give our incredible Prepaid team a call on 1800 202 901.

Disclaimer: This article provides general information only and does not constitute professional advice. Please consult a qualified expert for guidance specific to your situation.