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 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. It can be at the request and with the consent of the person or may occur without consent or where the person does not have the capacity to request or consent to it, in which case it is called involuntary euthanasia (see below).
VOLUNTARY ASSISTED DYING
Voluntary assisted dying (VAD) is a quick and peaceful death brought about by a person taking or a doctor administering a prescribed lethal dose of medication. Access to VAD is only granted after the repeated and rational request of the person in order to relieve intolerable suffering. It is subject to eligibility criteria and safeguards for both person and doctor.
Where the person self-administers the medication this can be done either at a time of their choosing and without further assistance, or under the supervision of a doctor, depending on the law of the relevant jurisdiction.
'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 practice 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 practice of ceasing treatment is not illegal in Australia and is NOT an example of Voluntary Assisted Dying. The practice of using ‘continuous terminal sedation’ is an example of Passive Euthanasia and is also an example of the doctrine of double effect (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 may 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.
This doctrine leads to the dubious conclusion in the case of terminal sedation (see below) that it is permissible to kill someone slowly as a side effect of pain relief but not intentionally, painlessly and peacefully.
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. In its official form it is known in Western Australia as an advance health directive (AHD). An AHD 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. Provided it is properly executed an AHD 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 you, 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.
This is an assumption that safeguards, initially put in place to underpin legislative reform, may in time be eroded so they become no longer effective or may lead to other unintended, harmful consequences. The term is frequently used, but there is no evidence that this has occurred in any of the jurisdictions where assisted death is legal. It is an unwarranted assumption.
THE CURRENT LAW IN AUSTRALIA
What is legal in Australia now?
- Both suicide and attempted suicide.
- Refusing unwanted, painful and futile medical treatment leading to death from the illness.
- Refusing food and drink leading to death from starvation and dehydration.
- Being administered large doses of pain-relieving drugs, even though this may hasten death. This so-called “doctrine of double effect” is not against the law if the primary intention of the doctor is to relieve pain.
- Being put into a permanent state of unconsciousness leading to death – this is often called ‘continuous palliative sedation’ or 'terminal sedation'.
What is illegal in Australia now?
- Voluntary assisted dying.
- Voluntary euthanasia.
This means it is a crime for any person, medically qualified or not, to aid or abet another person to commit or attempt to commit suicide.
Wasn't Voluntary Assisted Dying legalised in Victoria recently?
On 29 November 2017, the Victorian Parliament made history by becoming the first Australian state to approve the introduction of a voluntary assisted dying scheme. The Victorian Voluntary Assisted Dying Law was the result of an rigorous process including a 10-month Parliamentary Inquiry Into End Of Life Choices, followed by recommendations from a Ministerial Advisory Panel led by former AMA President, Professor Brian Owler.
In announcing the passage of the legislation through Parliament nearly a year later, the Victorian Premier told reporters that “This is a day of reform, a day of compassion and a day of giving control to those who are terminally ill….I’m proud we have put compassion right at the centre of our parliamentary and political process."
The Victorian law will come into effect in June 2019.
What is the situation in WA?
In Western Australia a joint select parliamentary inquiry into end of life choices undertook an equally rigorous and comprehensive process. This included the review of nearly 700 written submissions and hearing the oral evidence given by hundreds of witnesses. The Committee handed down its recommendations on 23 August 2018. Those recommendations included that the Western Australian Government develop and introduce legislation for voluntary assisted dying having regard to the recommended framework and following consultation with the Panel established under Recommendation 21.
For further details see “The Campaign” under “ABOUT”
ADVANCE CARE PLANNING
Please see our Advance Health Plannig page for the current Australian law regarding communicating to your doctor the medical treatment that you would like to have, or would not like to have, if you are no longer able to communicate your wishes.
The Australian Centre for Health Law at the Queensland University of Technology has established an excellent website which explains the legal issues around end-of-life care and decision-making. We encourage you to visit this site for reliable and up-to-date information. Click for their website