There is much misunderstanding about voluntary assisted dying (VAD). Some of this is the result of ignorance, lack of information or deliberate misrepresentation by conservative factions. Dying with Dignity WA aims to educate and inform without prejudice to foster intelligent debate about this issue.
“Should voluntary assisted dying be legalised?”
To be able to answer this question or participate in the debate about voluntary assisted death intelligently, it is important to understand the meaning of the terms used and be conversant with the facts.
Euthanasia is the act or practice of ending the life of a chronically or terminally ill individual with the dual purpose of relieving unbearable suffering and facilitating a quick, peaceful death.
Voluntary Assisted Dying
Voluntary assisted dying is a quick and peaceful death which results from a patient taking or administering to themself a fatal dose of a medication prescribed after their rational and continued request, made in order to relieve their own suffering.
Practically, voluntary assisted dying would generally involve a doctor prescribing a lethal drug which the patient may then take at the time of their choice, without further assistance.
Voluntary Assisted Dying is also known as Physician Assisted Dying or Medical Aid in Dying.
The singular exception to self-administration of the lethal drug is where people are physically unable to take a lethal drug themselves. In this case, a doctor would assist the person to die by administering the drug, usually via an injection. In this circumstance, the assisted death is known as Voluntary Euthanasia.
Terminally-ill means suffering from a terminal illness, which is expected to end in death within a relatively short period of time, usually assumed to be 12 months. ‘Terminal’ is a legally recognised term in Australia and there is a long-standing practise by Australian insurance companies to accept a prognosis of less than 12 months to live for the payout of a life insurance policy.
People are said to be competent, or have capacity, if they have sufficient understanding and memory to comprehend the nature and consequences of a decision, and to evaluate and weigh relevant information in making that decision.
Where a person who is not capable of indicating whether they want to be helped to die, or not, is given a substance to hasten death. NB: the legalisation of Involuntary Euthanasia is not contemplated by any laws being recommended in Australia, or currently in existence globally.
This term is sometimes used to refer to the practice of ceasing treatment so that the patient dies more quickly than they might if treatment continued. NB: Every competent patient in Australia has the right to refuse any medical treatment and a doctor has a right to discontinue treatment that the doctor deems to be futile. The practise of ceasing treatment is not illegal in Australia and is NOT an example of Voluntary Assisted Dying. The practice of using ‘continuous terminal sedation’ could be described as an example of Passive Euthanasia (see below).
The intentional act of killing oneself.
NB: It is now considered preferable to restrict use of the word ‘suicide’ to those persons taking their own life who would normally have gone on to live a happy and purposeful life with appropriate intervention. According to the American Public Health Association, “Medical and legal experts have recognised that the term ‘suicide’ or ‘assisted suicide’ is inappropriate when discussing the choice of a mentally competent, terminally ill patient to seek medications that he or she could consume to bring about a peaceful and dignified death.”
Assisting a suicide or an attempted suicide is against the law in Australia, and would remain against the law after a voluntary assisted dying law is passed.
Palliative Care is healthcare that aims to relieve the suffering of patients, but not cure them. It is provided for patients in all disease stages, including those undergoing treatment for chronic diseases, and patients who are dying. The practice is often combined with hospice care, which provides palliative care specifically for the dying, while focusing on comfort rather than medical intervention. It includes a range of treatments that relieve a person’s pain or suffering. It can include medical, physical, mental and spiritual comfort for both patients and their carers. The word ‘palliative’ comes from the Latin word palliare, which means 'to cloak'. So it comes to mean alleviate or even, disguise, the pain of dying. The central credo of palliative care is ‘we shall neither prolong nor hasten death’.
Doctrine of double effect
This doctrine makes intention in the mind of the doctor a crucial factor in judging the moral correctness of the doctor’s action in treating a patient. The effect is that if a doctor is tending to someone who cannot be restored to health, the doctor can give the patient medication which may have the unintended consequence of helping them die more quickly, provided that the doctor’s actual intention is to ease suffering. What the doctor must not do is give them medication with the intention of helping them die – even if only death will end their suffering. This doctrine protects doctors where they are charged with hastening the death of patients.
Deep Continuous Palliative or Terminal Sedation
The gradual, titrated increase, by continuous infusion, of sedatives and analgesics, usually without the provision of food and fluids, until the patient enters a coma and remains so until death occurs. It is generally considered a treatment of last resort when a patient’s pain and suffering can no longer be controlled. According to Dr Rodney Syme 26/5/15 “it [terminal sedation] is used in exactly those circumstances where other doctors might provide assisted dying if they were asked”.
Nil by mouth
This is a medical instruction not to eat or drink anything at all. If it is written above a patient’s bed it alerts nurses not to provide food or drinks of any kind.
Percutaneous Endoscopic Gastrostomy (PEG) 'feeding'
This is a way of delivering food, via a tube, directly through the skin into the stomach. A doctor makes a surgical hole through the abdominal and stomach walls and fixes the tube in place. People who cannot swallow food temporarily or permanently can benefit from PEG feeding.
Advance Care Planning
This is a written list of instructions to your doctor or health practitioner, made out in anticipation of possible treatments for health problems. It must be signed and witnessed at a time when you are competent. You can list specific conditions under which you do not want particular treatments such as resuscitation, antibiotics, or artificial nutrition or hydration. In that instance your Advance Care Directive is legally binding and nobody can override it.
This is a trusted person who you provide with the legally-binding authority to make health decisions for you, if you are unable to do so for yourself . To nominate this person you must complete a statutory document at a time when you are competent to make this decision and this document must be signed by yourself, your Enduring Guardian and an independent witness (a legislated signatory). When deciding on whom to appoint, you should consider who would best understand your values and wishes, and who would have the skills to make good decisions for you.
assisted dying laws
Voluntary assisted dying was briefly permitted in the Northern Territory (1996) before the law was repealed by the Federal Government in 1997. Over the past two decades, since the Northern Territory law was overturned, there have been over thirty attempts to pass another assisted dying law. All of those attempts failed up until November 2017, when the Victorian Parliament made history by becoming the first Australian state to pass the Voluntary Assisted Dying Bill 2017.
In 2018 voluntary assisted dying, or voluntary euthanasia, is permitted in 16 jurisdictions around the world. It is legal in Switzerland (Criminal Code 1942), The Netherlands (2002), Belgium (2002), Luxembourg (2009), Germany (2015), Colombia (2015 Court Decision), Canada (2016), Australia (Victoria only 2017) and in 8 jurisdictions in the US including Oregon (1997), Washington (2009), Montana (2010 Court Decision), Vermont (2013), California (2016), Colorado (2016), Washington DC (2016) and Hawaii (2018).
Eligibility requirements, methods of administration and legal frameworks
There are differences between the various laws in regard to the eligibility criteria, the method of administration of the lethal medication and the legal framework, or process.
The American laws (on which the Australian laws are based) are considered the most restrictive, because the individual has to be suffering from a terminal illness, with less than 6 months to live, whereas the European laws do not restrict access based on a terminal illness. In Europe, the eligibility and safeguards are based on a model requiring ‘due care’ on the part of the doctor assisting a patient to die and the patient must be experiencing ‘unbearable and irremediable suffering’ to qualify.
The American laws require self-administration only, whereas under the European and Canadian models, both voluntary assisted dying and voluntary euthanasia are permitted.
It would take up too much room to provide a detailed comparison of the legal frameworks, safeguards and procedures involved in the various assisted dying models around the world. However, according to the Victorian Committee, which travelled to many of these jurisdictions, although the models differ, ‘what they all have in common is robust regulatory frameworks that focus on transparency, patient-centred care and choice.’ The Committee found no evidence of institutional corrosion or the often cited ‘slippery slope’.