Voluntary assisted dying (VAD) laws have now been passed in all of Australia’s six states - Victoria, New South Wales, Western Australia, Tasmania, South Australia, and Queensland - marking a significant change in the end-of-life care landscape. The Voluntary Assisted Dying Act 2022 just passed through NSW Parliament on 19 May.
Voluntary assisted dying laws have been implemented in Western Australia, Victoria, Tasmania, South Australia and Queensland. VAD laws will commence operation in New South Wales on 28 November 2023.
Voluntary assisted dying is still not legislated in the Northern Territory and the Australian Capital Territory as, until recently, Commonwealth laws have prevent the Territories from legislating on VAD.
Advance care planning (ACP) is known to improve end-of-life care and should be a priority consideration for individuals, families and health professionals wherever they live across Australia.
While the concepts of advance care planning and voluntary assisted dying are frequently confused in the community, they are two distinct and separate actions. Voluntary assisted dying involves a process to access medication and to enable a person to legally choose the manner and timing of their death, while advance care planning gives a person choice and control over future medical decisions and how they want to live out the rest of their life.
Advance care planning enables people to make choices about the care they want to receive if they become too unwell to speak for themselves. It puts the individual in the driver’s seat, providing a sense of control when facing chronic or progressive disease, cancer, dementia or just getting older.
Only 15 per cent of Australians have documented their future preferences in an advance care directive.
So many people are still leaving their future medical decisions for others to choose at a time when the community is seeking greater choice and autonomy over their own care.
Some important advance care planning considerations concerning voluntary assisted dying include:
- voluntary assisted dying laws require that the person has decision-making capacity – from the time of request through to the final act
- an advance care directive (ACD) remains valid and will be respected even if the person loses decision-making capacity
- an advance care directive can include instructions to refuse, consent or withdraw from treatment
- a person cannot make a request for voluntary assisted dying in their advance care directive
- a person’s substitute decision-maker is not permitted to request voluntary assisted dying on behalf of a loved one
- voluntary assisted dying should not be considered a substitute for quality advance care planning or palliative care
- in the context of a person making a request for voluntary assisted dying, ready access to advance care planning, as well as quality palliative care is essential.
It is important to remember that in countries and jurisdictions where voluntary assisted dying is legal, eligibility criteria are restrictive, meaning it is ultimately an option for a few, where advance care planning is and remains accessible and relevant to all adults – regardless of their health status or age.