Why I Support Voluntary Assisted Dying

For almost 40 years, it was my privilege to watch and medically assist mothers (and many fathers) to prepare for a new life. However, it is my belief that the medical profession is not doing enough to assist us at the other end of life. Sure, we have excellent palliative care services that are generally available but, even with the best of these, at least 5% of us are destined to experience a painful or undignified death that can be avoided if there is access to voluntary assisted dying (VAD), often called euthanasia.

After more than 37 attempts across Australia to introduce Voluntary Assisted Dying Laws, NSW became the last State to pass legislation that permits this option for its residents on the 19^th of May 2022.

The NSW Voluntary Assisted Dying Act 2022 was assembled on the back of similar legislation in the other States and most similar to the Queensland Voluntary Assisted Dying Act. The key points are:

Eligibility
* The person must be 18 years or over
* Be a resident of NSW for at least 12 months and an Australian citizen/permanent resident
* Have decision-making capacity in relation to voluntary assisted dying
* Act voluntarily without coercion of any sort
* Be diagnosed with an incurable disease, illness or medical condition that is advanced, progressive and will cause death and is expected to cause death within 6 months (or 12 months with a neuro-degenerative condition).
Application
* A person has to make one written declaration and two verbal requests
* Eligibility to be confirmed by two senior doctors who are independent of each other
* There is a minimum of five days between the initial request and final approval.
The person must make the request themselves. Nobody else is authorised to make the request, and the request cannot be made via an advance care directive.
Access
* The person must maintain decision-making capacity
* A person may opt for self-administration or a medical practitioner to administer the drug.
Doctors and Institutions
* Doctors and other healthcare workers are permitted to raise the option of assisted dying with their patients, if all other treatment options are also discussed
* Participating health practitioners must complete training for voluntary assisted dying
* Any healthcare worker may decline to participate for any reason, without penalty
* Institutions may decline to participate but must not hinder access to VAD.
Oversight
* A Review Board receives assisted dying reports, assesses reports, and can refer cases to disciplinary or prosecuting authorities
* Parliament will periodically review the law and issue summary reports.

The legislation became operative in November 2023.

However, the work is not yet complete.

We need to:
* Defend VAD legislation already passed; opponents have pledged not to stop until they “overturn them all”
* Champion the voices of dying people (despite it being their legal right, some institutions try to make people’s VAD choice difficult)
* Support Australians to make their own, informed choices at the end of life.
* Support doctors and others who are training for and/or provide VAD and seek better remuneration for these services.

VAD Limitations and Possible Future Legislation – The Problem of Dementia

Any discussion about VAD quickly turns to the problem of dementia. Existing legislation, enacted in Australia and in most places around the world, has a primary requirement for the diagnosis of a terminal illness to be made before this option can be considered and a secondary requirement that the applicant has, and maintains, capacity. The grim statistics about dementia say that it affects one person in three over the age of 90. Of course, it can occur much earlier and most of us know of the thousands of elderly living in a vegetative state or worse in our nursing homes.

There is also an issue if a person who would otherwise qualify for VAD, loses capacity for some reason or other during their terminal illness that, under current legislation, prevents them giving consent to the process in the manner required. Up to 50% of those who have elected a VAD pathway do not use it, but only a small proportion of these are denied its use because of loss of capacity. For some, the prospect of loss of access to VAD can become an intolerable suffering in itself. Others may deny themselves the use of pain-relieving palliative care medication so that their decision-making capacity is not affected. Yet others may proceed with VAD before they would otherwise do so, for fear of losing their capacity.

This situation is specifically addressed in Canada where VAD is referred to as Medical Assistance in Dying (MAiD). An amendment to their MAiD legislation, known as Audrey’s Law or a Waiver of Final Consent, provides a mechanism by which assisted dying for intolerable suffering from a terminal illness can proceed despite loss of capacity to consent at the time of a planned administration.

Finally, there is the problem for a person who, throughout their life, has clearly indicated their preference for VAD but who, for any of a number of good reasons, have not formalized this either by way of an Advanced Care Directive or an application for VAD.

Here is a Discussion Paper, written by a doctor that explores these issues and describes possible legislative changes that may overcome them. One of his proposals is an ethically-operating Community Granted Assisted Dying option.

Assisted dying for dementia is only possible in a couple of countries in the world, and where it is possible, it is rarely enacted. The main issue at stake is that the disease is slowly progressive, in most instances over many years, and capacity to consent fluctuates, fades and disappears completely in its terminal phase. VAD is no longer “voluntary” and there are enormous ethical, legal and practical challenges that complicate any system that aims to provide such a service.

Here is an abstract of my submission to the NSW Department of Health’s 2026 Review of VAD services:

“Denial of assisted dying to patients who have been approved for VAD but are unable to give final consent because of loss of capacity can be overcome with an amendment to the legislation that would enable a Waiver of Final Consent.

Issues of access for patients with intolerable suffering from a progressive and untreatable illness that does not meet the criterion of an expected death within 6 or 12 months can be overcome by removing this temporal restriction from the legislation, as occurs in the Australian Capital Territory.

Issues of assisted dying for dementia, and the enabling of VAD by an Advanced Care Directive (ACD) is complicated by:

1. A lack of legislation in support of ACD’s in NSW. However, it should be noted that an ACD that forbids an otherwise widely practised medical intervention is supported by common law in NSW.
2. Ethical issues arising from incapacity of informed choice and consent that is inherent with advanced dementia.
3. Uncertainty and unwillingness by health practitioners and family (or any other nominated others) to decide if and when a request for assisted dying in an ACD should be enacted.

I propose that medically-assisted dying should be available from an ACD with the following criteria:

1. That the conditions when a patient with dementia would choose that assistance was described in sufficient detail for the person’s nominated health care practitioner and a nominated enduring guardian (or guardians) would all agree to the enabling of that choice. Such specific conditions would, by preference, have been repeatedly confirmed whilst that person had capacity.
2. The VAD Board of NSW had evaluated the evidence provided in i) above
3. Any one of the patient’s nominated health care practitioner, enduring guardian(s) or the VAD Board of NSW, could veto the provision of assisted dying.

Such legislation would be broadly within the framework of that enacted in Quebec in 2023 and came into effect in June 2025.” A shortened description of the Quebec model can be accessed here.

A 5-part project by Professor Ben White and Professor Lindy Willmott at the Australian Centre for Health Law Research, Queensland University of Technology (QUT) aims to identify possible legislative models that could allow for access to VAD for people living with dementia in Australia. Some details about this research project can be found here, and it is intended to provide a basis for informed policy debates and law reform deliberations.

Here is a drafted Advanced Care Directive that includes VAD for dementia.

Click here for a version of my Advanced Care Directive that anticipates the problem of dementia.

A Message to Doctors

Somewhat surprisingly, whilst upwards of 85% of the general community supports VAD, this falls to as few as 40% in some survey, when doctors are asked. The reasons are complex. For some it is based on a religious belief. Others state that it is contrary to all the reasons that they chose and practise their profession. Sadly, I believe that for a few, it is unwillingness to relinquish control to their patients.

I support the following values and principles:

1. Every human life has equal value.
2. A person’s autonomy should be respected.
3. A person has the right to be supported in making informed decisions about the person’s medical treatment, and should be given, in a manner the person understands, information about medical treatment options including comfort and palliative care.
4. Every person approaching the end of life should be provided with quality care to minimise the person’s suffering and to maximise the person’s quality of life.
5. A therapeutic relationship between a person and the person’s health practitioner should, wherever possible, be supported and maintained.
6. Individuals should be encouraged to openly discuss death and dying and an individual’s preferences and values should be encouraged and promoted.
7. Individuals should be supported in conversations with the individual’s health practitioners, family and carers and community about treatment and care preferences.
8. Individuals are entitled to genuine choices regarding their treatment and care.
9. There is a need to protect individuals who may be subject to abuse.
10. All persons, including health practitioners, have the right to be shown respect for their culture, beliefs, values and personal characteristics.

Further Resources

Go Gentle Australia: Committed to making VAD available to all terminally ill Australians

Dying with Dignity NSW: Committed to making VAD available as a Choice in NSW

Christians Supporting Choice for Voluntary Assisted Dying

End of Life Law for Clinicians

Advance Care Planning Australia

Voluntary Assisted Dying Australia and New Zealand A peak body offering resources for anyone involved in the provision of VAD services.

NSW Voluntary Assisted Dying Care Navigator Service – the service by NSW Health for everyone including health practitioners and providers.

VAD First Request Patient Information Guide – from NSW Health. Provides an overview of the VAD request and assessment process, then details the 11 steps involved in Voluntary Assisted Dying in NSW.

Your Role in Advance Care Planning. A webpage for health professionals that explains their legal responsibilities and any limitations in providing VAD information for patients. It is important to note that only Victoria, South Australia and New Zealand have “gag clauses” in their legislation that prevents doctors from raising the subject. From Advanced care Planning Australia.

Voluntary Assisted Dying and Advance Care Planning. This video explores the differences between voluntary assisted dying (VAD) and advance care planning, and key laws relating to these processes, including health professionals’ legal obligations. It provides tips for VAD discussions during advance care planning conversations. This video is designed for health professionals and aged care providers. It has been produced by End of Life Law for Clinicians and Advance Care Planning Australia. Access the resources from the video by scrolling down and clicking on the links.

Navigating the Topic of Voluntary Assisted Dying in Advance Care Planning conversations – information from Advance Care Planning Australia for doctors that addresses their obligations and how to fulfill them.

NSW Voluntary Assisted Dying Clinical Practice Handbook – 92 page .pdf from the Dept of Health NSW. The complete guide for doctors accredited to this service.

Max Brinsmead

Updated 16.04.2026