The fight for end-of-life choice and voluntary assisted dying (VAD) laws in Australia has been one of the defining social and political battles of the 21st Century.
It has been fought state by state, parliament by parliament, over more than 30 years. Laws have now passed in all six states, offering terminally ill people a choice about the timing and manner of their death.
This revolution in end-of life care tells us five important things about our society.
1. Australians are honest and compassionate about death
Australia now acknowledges that some dying people experience cruel suffering which cannot be alleviated, even with the best medical care. As a society, we are no longer willing to turn a blind eye to this suffering and pretend it doesn’t happen.
Dying people are being listened to and are experiencing empowered deaths that recognise and prioritise their concerns.
28-year-old Alex Blain, suffering intolerably from terminal Dux Ewing Sarcoma, a rare and aggressive cancer, described it this way: “I handed my treatment and body over to medical professionals for over a year and in many ways lost autonomy over my body. VAD has given me the power back."
Most importantly, doctors and nurses are realising that VAD is just one option among many at the end of life and that palliative care has nothing to fear from assisted dying. The two can, and do, work together to offer people choice.
2. Australians believe in person-centred care
Not so long ago, it was assumed that the ‘doctor knows best’. Now, the individual is back in the driver’s seat when making decisions about their medical care – including at the end of life.
Paternalism has been replaced by an emphasis on individual autonomy. The Australian Charter of Healthcare Rights, approved by all health ministers, says a person has the right to access healthcare services and treatments that meet their needs, and that medical professionals should respect their patients’ choices and beliefs. While VAD laws are a step in the right direction, we still have a long way to go to ensure these rights are applied and eligible people receive the care they need.
3. Politicians are listening to their constituents
Opinion polls over the past 30 years have consistently shown that more than 70% of Australians support VAD laws backed by safeguards. In recent years, this support has climbed to almost 90%. VAD laws have gained support from across the political spectrum, showing politicians are listening to the people they are elected to represent.
4. We are persuaded by evidence, not fear
VAD laws are some of the most rigorously debated legislation in Australia’s history. The arguments for and against have been studied from every angle, including in four detailed parliamentary inquiries.
The fears about the laws – put forward by vested interests such as the Churches and conservative medical bodies – were rejected as lacking substance. Instead, parliaments looked to the wealth of evidence from around the world that showed it was possible to introduce safe and compassionate VAD laws. And they were right; VAD laws are now operating around the country and none of the dark predictions have come to pass.
5. People want to talk about what is acceptable and meaningful at the end of life
Taboos around death and dying are weakening. No-one likes to contemplate death, especially our own or that of a loved one. But the reality is we are all going to die. Only the timing and circumstances are unknown.
Australia’s VAD laws show there is a growing willingness to talk about our mortality and how we want our deaths to be. VAD laws create opportunities to discuss difficult topics – with candour and care between healthcare professionals, patients, families and loved ones.