The Facts

Victoria's voluntary assisted dying law came into effect on 19 June 2019. It offers a choice to competent adults with a terminal illness and six months or less to live. For those dying of neuro-degenerative diseases, the time frame is extended to twelve months. Around 450 people are believed to have applied for assistance to die under the Act in its first year. The statutory body tasked with overseeing the scheme, the VAD Review Board, confirms that, in the first 6 months, 100% of cases had been compliant with the Act and no cases were referred for investigation. For detailed, up-to-date information please refer to the Voluntary Assisted Dying website of the Victorian Department of Health.

On 10 December 2019, Western Australia became the second Australian state to pass a contemporary, compassionate and safe voluntary assisted dying law which is expected to come into effect in mid 2021. More information can be found at the Western Australian Government's Department of Health website.

The distinction between suicide and a rational decision to end suffering was clearly understood by New York’s chief medical examiner, Charles Hirsch, when investigating the deaths of office workers who jumped from the Twin Towers on 9/11. Faced with a terrible choice – a slow, agonising death by fire, or a quick death by jumping – many chose to jump. Seeing this as a rational choice to avoid needless suffering, Hirsch refused to classify their deaths as ‘suicides’. Assisted dying is not a choice between life and death. It is the choice of a terminally ill person about the manner and timing of their death (which is imminent and inevitable) and the suffering that must be endured.

This difference was underlined by the WA Parliamentary Committee investigating end-of-life choices: "It is important not to conflate suicide with assisted dying. It is possible to distinguish temporary suicidal ideation from an enduring, considered and rational decision to end one’s life in the face of unbearable suffering".

Some organisations, like Right to Life and others, assert that Voluntary Assisted Dying laws are not safe. They warn of vulnerable people being coerced to end their lives for other people's gain. Numerous independent inquiries have found no evidence that this has occurred. These include:

Australian palliative care physician Dr Linda Sheahan whose 2012 Churchill Fellowship study of how these laws work overseas concluded... "the slippery slope in terms of risk to vulnerable groups has not been demonstrated by the data"

The cross-party parliamentary inquiries in Victoria and Western Australia, the most comprehensive and forensic reviews of the issue undertaken in Australia, found... "no evidence of institutional corrosion or the often cited slippery slope".

The Victorian committee said... "assisted dying is currently provided in robust, transparent, accountable frameworks. The academic literature shows that the risks are guarded against, and that robust frameworks help to prevent abuse".

The WA Committee added... "there is no evidence to suggest, from either Oregon or the Netherlands data, that people with disabilities are at heightened risk of assisted dying".

Perhaps most telling: representatives of peak elderly and disability groups in Belgium, the Netherlands and Oregon also report no abuse of their members under VAD laws.

The Journal of the American Medical Association in 2016, concluded... "in no jurisdiction was there evidence that vulnerable patients have been receiving euthanasia or physician-assisted suicide at rates higher than those in the general population".

The laws are designed for those at the end stage of a terminal illness whose suffering is beyond meaningful medical help. It is very hard to coerce a vulnerable person into a terminal illness they don't have. Even harder to coerce two doctors, whose work will be subject to review, to agree with them. That's why the safeguards work.

As the cross-party inquiries found, Australian doctors already practice unlawful assisted dying, but they do so... "without regulation, support, transparency or accountability".

For those doctors currently faced with the agonising choice of helping a patient to die and breaking the law – or abiding by the law and leaving that patient to die with great suffering – a Voluntary Assisted Dying law provides protection. More than protection, it provides guidance and the opportunity to consult with colleagues and also the family of the person who is dying.

Those who oppose this law refer to voluntary assisted dying as 'patient killing' or 'state sanctioned killing'.

This dishonestly avoids the central fact that the law is to help those already being killed by an incurable disease. Being voluntary, it is entirely up to the patient whether or not they choose to end the suffering caused by that disease.

Nor are doctors being asked to 'kill' a patient. In reality, what they're being asked to do is what they already do - make a careful diagnosis that a patient's condition is terminal and their suffering intolerable and go through with them their treatment options.

If the patient meets the legal requirements for assistance to die, they write them a prescription for a life-ending medication. After that, it is up to the person whether or not they use it.

Only one person is being asked to make a life and death decision: the person who is dying.

Australia has one of the best palliative care systems in the world. However, it is a fact that it can't help everyone. In Palliative Care Australia's own words "even with optimal care not all pain and suffering can be relieved".

By their own estimates, the number of people truly beyond their help is about 4%. Their suffering, as recorded in evidence to the parliamentary inquiries, can be savage.

This is no criticism. It simply reflects the reality of modern medicine, which can keep us alive longer but which still has no cure for diseases like cancer and Motor Neurone Disease.

In the words of the 'father' of Australian palliative care, Professor Ian Maddocks: "If compassionate and loving care towards patients and families is what palliative care is all about then assisted dying is part of that. It is time the profession dealt with it".

The question is: why should those who palliative care can't help, be left to suffer when we have the means to help them?

The parliamentary inquiries' committees recognised the reality that for some Australians who are at the end of their lives even the best palliative care will not relieve suffering. But they also recognised that any voluntary assisted dying law has to work hand-in-hand with increased resources for good palliative care. We strongly support that.

Voluntary assisted dying is not intended to replace palliative care. It is adding one more end-of-life option alongside palliative care for doctors and their patients to explore. In Oregon, nine out of ten patients who choose a doctor's help to die are also enrolled in hospice care.

According to the AMA's code of ethics "Doctors are obliged to respect the right of a severely and terminally ill patient to receive treatment for pain and suffering, even when such treatment may shorten a patient's life".

Some doctors object to voluntary assisted dying on the basis of the Physician's or Hippocratic Oath which instructs "do no harm". Yet, others see leaving a dying patient to suffer as the opposite of "do no harm".

Under the voluntary assisted dying framework in Victoria, and the one to be implemented in Western Australia in July 2021, doctors can choose not to take part. This can be for any reason which they need not divulge.

A voluntary assisted dying law respects and protects the rights of those doctors who object. Just as it protects and respects the rights of those doctors with a different ethical view.

The extreme rhetoric being used by Right to Life and other faith-based objectors – such as 'patient killing' and 'murder' – is designed to inflame emotions. It does not acknowledge, or address, the clear evidence of suffering happening across the Australian community in the parliamentary committees' reports.

In a 2017 visit to Victoria, sponsored by Right to Life, US doctor William Toffler suggested privately to MPs that, should voluntary assisted dying become legal, that it be carried out by veterinarians who have "training in giving overdoses to living things, living animals".

The rhetoric being used by Dr Toffler, Right to Life and others – and endorsed by some MPs – seeks to trivialise the genuine suffering and trauma being faced by Australian families.

That elderly Australians are killing themselves violently at the rate of more than one a week, according to the Victorian coroner, because there is no other way they can be legally helped to end their suffering, is a serious public health issue. It requires thoughtful and respectful debate. Opposing voluntary assisted dying simply on religious grounds and with emotive language is not an answer to this suffering.

No one is forced to take part in voluntary assisted dying – neither the dying patient nor the medical professionals who care for them. Medical professionals can refuse to participate in VAD due to moral or ethical convictions without sanction or criticism. Similarly, anyone with religious views that run counter to VAD can conscientiously object – in this way VAD laws respect religious freedom. At the same time a patient's right not to have those religious beliefs imposed upon them is also respected.

If you don't approve of VAD, don't take part it in it. It's that simple.

If you want to read up on the evidence on voluntary assisted dying, here's a quick guide to a few key resources.

GGA's eBooks cover a range of topics. They are available for free from our website as a pack or you can get them individually: 

• A Guide to the Debate on Voluntary Assisted Dying
• Assisted Dying in Australia Today
• Beyond Pain

Several Australian parliaments have conducted inquiries into voluntary assisted dying. Their reports are available online:

• Victoria - Inquiry into End of Life Choices, Final Report, June 2016
• Western Australia - My Life, My Choice, Report of the Joint Select Committee on End of Life Choice, August 2018
• Queensland - Voluntary Assisted Dying, Report No. 34, 56th Parliament Health, Communities, Disability Services and Domestic and Family Violence Prevention Committee, March 2020
• South Australia - Report of the Joint Committee on End of Life Choice, October 2020

If you want learn more about the tactics of opponents, here are some resources to help put them into perspective:

• eBook: Fear, Uncertainty, Doubt
• eBook: Responding to Key Arguments Against Voluntary Assisted Dying
• eBook: The Full Picture
• Documentary: Fatal Fraud with companion eBook: A propaganda case study - Fatal Flaws

Visit our Resources page for more.

In Australia today...

• It is legal, if you are dying and suffering beyond medical help, to end your suffering by committing suicide, often violently and alone.
• It is legal to refuse all medical treatment, food and water, and to die slowly of starvation and dehydration while your disease takes its course.
• It is legal for a doctor to slowly drug you into a coma while your family waits for days, or weeks, for you to die. This can happen without your consent.
• It is NOT legal, if you are dying and suffering beyond medical help, to end your suffering painlessly and quickly with the help of a doctor.

As a patient, you do not have any legal right to insist that a doctor gives you more, or faster, pain relief. That decision is entirely up to the doctor whose personal beliefs you may not share.