Australians consistently and overwhelmingly support Voluntary Assisted Dying as an end of life choice for people with intolerable suffering. Polling consistently shows 70% to 80% support for a compassionate end of life choice. The most recent poll by The Australia Institute (2021) showed 76% support across Australia.
Assisted dying includes both self administration of medication which will cause death as well as administration by a doctor or nurse practitioner.
Voluntary assisted dying is a legal end of life choice for a person who meets the eligibility criteria for voluntary assisted dying, and includes both self administration of medication which will cause death, as well as administration by an assisted dying trained doctor, nurse or nurse practitioner.
Here’s our guide to some of the facts that surround the voluntary assisted dying (VAD) debate. Deliberate distortion of these facts and misinformation has caused fear and mistrust in the community. Now that the six Australian states have a VAD Act in place, the evidence from the regular VAD reports from each state confirm that voluntary assisted dying is a safe, well regulated end of life choice for people with intolerable suffering.
More comprehensive factsheets on specific topics can be accessed on the VADSA website.
Australia is recognised as providing one of the best palliative care systems in the world. However, Palliative Care Australia recognises that even the best of palliative care “cannot relieve all pain and suffering even with optimal care.” For that small number of people, suffering at the end of life can be intolerable.
The legalisation of voluntary assisted dying gives people experiencing intolerable suffering a compassionate end of life choice. The VAD Acts passed in each Australian state require that before a person can be assessed for VAD, each assessing doctor must provide the person with all other treatment and palliative care options. This ensures that a choice of VAD is informed and voluntary.
Opponents argue that once voluntary assisted dying legislation is introduced, it will inevitably be broadened to apply to those for whom it was never intended. They call this the ‘slippery slope’.
Over the last decade, numerous, wide-ranging, official inquiries into these laws have rejected allegations of the ‘slippery slope’ – including the extensive cross-party parliamentary inquiries in Victoria, Western Australia and the ACT. All inquiries found high levels of compliance with safeguards and monitoring procedures in jurisdictions where VAD is lawful and no evidence of institutional corrosion or the often cited ‘slippery slope’. The rare changes that have been made have either been as a result of a Supreme Court decision or introduced and debated in accordance with due parliamentary process. This is otherwise known as democracy.
Often opponents refer to the European laws, especially in Belgium and The Netherlands, to suggest that laws written to apply only to the terminally ill have since been broadened to provide access to those who do not have a terminal illness. This is incorrect – the laws in Europe were never written purely for the terminally ill, but for those with a ‘medically futile condition that causes unbearable suffering’. The overwhelming majority of people who use these laws have cancer, but they also allow people with degenerative and chronic illnesses, such as Motor Neurone Disease, Multiple Sclerosis, and Chronic Rheumatoid Arthritis, to ask for assistance to die. In very rare instances, people with long-term and extreme psychiatric suffering have also been helped.
All of this is consistent with how the laws in Europe were written. In the USA, access to voluntary assisted dying is restricted to people with a terminal illness and a prognosis of six months or less to live. Since the law in Oregon was passed in 1997, many states have followed Oregon by adopting similar laws, to the extent that now one in five USA citizens have the choice of VAD. In more than 23 years of operation in the USA the laws relating to VAD have rarely been changed.
Some opponents have suggested that people with disabilities or mental illness will be placed at risk if assisted dying is legalised. This is not true. Voluntary assisted dying laws come with strict eligibility criteria and strong safeguards to protect the vulnerable from coercion or abuse. A person living with a disability or a mental illness would only be eligible for VAD if they also develop a terminal illness and meet all the eligibility criteria listed in each VAD Act. The criteria include the capacity to make an informed choice. Disability of any kind does not allow a person to access VAD in any state of Australia.
Exhaustive, peer-reviewed evidence about how these laws operate overseas has not shown any threat to people with a disability, a fact confirmed by leading disability rights groups in those countries.
Some opponents have suggested that family members or carers could pressure an elderly patient to request assistance to die, for instance so that they may access an inheritance or the family estate.
It is a sad reality that elder abuse and coercion occurs in our society. The strong regulatory framework contained in all voluntary assisted dying laws, combined with the strict eligibility criteria and the many layers of monitoring and reporting, provide strong safeguards and a safe environment which protects vulnerable people.
The requirements for access to VAD in all states of Australia stipulate that the person seeking access must be a mentally competent adult, Australian citizen or permanent resident, who is ordinarily resident in the relevant state. The person must have at least one disease, illness or medical condition that is advanced and progressive and is likely to cause death within a specified time, and is causing suffering to the person that cannot be relieved in a manner that the person considers tolerable.
Two independent VAD trained medical practitioners, with many years of experience, must certify that in their opinion the person satisfies these requirements, and has been given information about all their end of life options, including palliative care. The person must make three requests for VAD, including one in writing, witnessed by independent witnesses.
To circumvent these safeguards the doctors would need to collude with family members and in doing so risk prosecution with serious consequences, including losing their licence to practice and imprisonment.
As with the slippery slope argument, the close monitoring of VAD by each state VAD monitoring authority shows no evidence of elder abuse as a result of these laws. This is confirmed by leading rights groups for the elderly in international jurisdictions. By contrast, the only evidence of pressure has been in the other direction, namely relatives expressing the wish that the patient not avail themselves of a VAD option.
Some opponents have suggested that the legalisation of voluntary assisted dying will lead to an increase in suicides, referred to as ‘suicide contagion’. Suicide is entirely distinct from voluntary assisted dying and most VAD Acts state that VAD is not suicide.
Suicide is often an act of desperation where there is no alternative. In the lead up to the VAD debate in Western Australia the head of the WA police union came out in support of voluntary assisted dying for this reason. In his own words: “People experiencing an irreversible deterioration in their health are taking their own lives, often in horrific circumstances. We need a compassionate assisted dying law to give people in certain circumstances a choice to die in a dignified way”. Similar comments were made by both the Victorian and South Australian coroners.
VAD laws in Australia enable those who satisfy the eligibility criteria to make a rational decision in consultation with their doctors and family to die a peaceful and dignified death at a time of their choosing. The person can die surrounded by their family and friends in a caring and loving environment.
There is no credible evidence of increased rates of suicide as a result of assisted dying laws in any jurisdiction where VAD is legal.
Opponents of VAD sometimes refer to Belgium, where in very narrow circumstances, a child can request assistance to die. The legislation provides for a child in a ‘medically futile condition’, and who is experiencing constant and unbearable suffering that cannot be alleviated, to request voluntary assisted dying.
However, this law carries even greater safeguards, and stricter criteria, than the already strict laws relating to adults. Along with two doctors, a child psychiatrist has to confirm that the child knows what they are requesting. The child’s parents must also participate in, and approve of, the request. Passed into law by a two-thirds majority of the Belgian parliament, this is a recognition that even children can die from illnesses which, in spite of the best treatment, cause terrible suffering. Use of this provision is extremely rare.
All the laws being proposed in Australia apply only to competent adults. References to Belgium are intended to create fear.
In all state debates there has been support and opposition from doctors. For example in WA, a number of high profile doctors were outspoken ambassadors for the introduction of voluntary assisted dying, including Professor Fiona Stanley. In October 2019, 150 doctors from WA signed an open letter to members of parliament in support of VAD.
Palliative Care Australia and the Australia New Zealand Society of Palliative Medicine (palliative care physicians) take a neutral stance on VAD, recognising that it is a matter for society to determine. In the 2019 WA debate, the AMA worked constructively with the Government in discussing possible amendments, and finally reached an agreement to support the Bill. (The AMA represents about 30% of all doctors in Australia.)
The recently established VADANZ provides a community of practice for doctors to discuss VAD practice and provide informed advice to government and the community. The national organisation Doctors for Assisted Dying Choice has always strongly supported VAD. During the 2019 WA debate, the WA Primary Health Alliance and the Royal Australian College of GPs came out in support of VAD.
Voluntary assisted dying is voluntary and is about choice, and this applies to medical professionals as well as to patients. Doctors can state their conscientious objection to participating in any aspect of VAD. The law in each state mandates that a person who is ethically or morally opposed to voluntary assisted dying is exempted from participating. Everyone, including the person requesting VAD and the doctors and nurses involved in the process, has the right to opt out at any time.
Two decades ago, a 2002 Newspoll found 69% support among people registering as Catholics. A decade later, a 2012 Newspoll survey showed that 88% of Anglicans and 77% of Catholics agreed that a doctor should be allowed to meet a request from a hopelessly ill patient for help to die.
The 2019 ABC Vote Compass found that 77% of Catholics supported the legalisation of voluntary assisted dying for the terminally ill. A similar response was revealed in the 2019 Australian Election Study, with 74% support from Catholic voters.
Organised opposition to the legalisation of VAD has principally come from the Catholic Church. While the Catholic and Anglican Church hierarchies may remain opposed to voluntary assisted dying, they do not speak for the majority of their parishioners or believers.
Other jurisdictions with predominantly Catholic populations, including Spain and Belgium, have passed VAD laws with less stringent criteria than in Australia.
Catholic managed hospitals are able to conscientiously object to providing a VAD service in their private hospitals in South Australia, Queensland and New South Wales, however they are required to facilitate a patient’s access to VAD if they make a VAD request.