Why I Support Voluntary Assisted Dying

For almost 40 years, I had the privilege of helping parents prepare for new life. That experience strengthened my belief that medical professionals should bring the same compassion, honesty and respect for personal choice at the end of life.

Our palliative care services are excellent and mostly available. However, even excellent care cannot relieve every person’s suffering in a way that they find acceptable. Voluntary assisted dying (VAD) gives eligible adults with an advanced and progressive condition an additional, carefully regulated end-of-life choice.

This page reflects my personal views and is general information only. It is not medical or legal advice.

VAD in New South Wales

VAD has been available in New South Wales since 28 November 2023 under the Voluntary Assisted Dying Act 2022 (NSW).

To be eligible, a person must meet every requirement in the Act. In summary, they must:

• be 18 or older and meet the citizenship, residency and NSW residence requirements
• have an advanced and progressive disease, illness or medical condition expected to cause death within six months—or within 12 months for a neurodegenerative condition
• be experiencing suffering that cannot be relieved in a way they consider tolerable
• have decision-making capacity throughout the process
• act voluntarily, without pressure or coercion.

Two independent, appropriately qualified medical practitioners must assess eligibility. Only the person seeking VAD can make the request; it cannot be made by someone else or through an advance care directive. The person may pause or stop the process at any time.

Under the NSW law:

• Doctors and other healthcare workers are permitted to raise the optionof assisted dying with their patients, if all other treatment options are also discussed
• Health practitioners must complete special training to participate in the provision of VAD
• Any healthcare worker may decline to participate for any reason but must declare their conscientious objection and refer their patients on to others who are willing to provide VAD
• Institutions may decline to participate but must not hinder access to VAD
• A Review Board receives assisted dying applications, grants authority to proceed, and can refer cases to disciplinary or prosecuting authorities
• The Parliament periodically reviews the law and issues summary reports.
  
  

For current, authoritative guidance, visit Voluntary assisted dying in NSW, contact the NSW Voluntary Assisted Dying Care Navigator Service or read the First Request Patient Information Guide.

What still needs to change

• Protect access: defend laws already passed and ensure eligible people can use them in practice.
• Respect the person’s voice: remove avoidable institutional barriers and keep the individual’s informed choice at the centre of care.
• Support informed decisions: help Australians understand palliative care, advance care planning and VAD.
• Support the workforce: train and fairly remunerate clinicians and other professionals who provide VAD services.

Dementia, capacity and future reform

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.

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. Under current legislation, this means they cannot consent to the process in the manner required and prevents their access to a planned VAD

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. However, for some, the prospect of loss of access to VAD becomes 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.

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.

In May 2026 the ACT Government announced that it would establish a “citizens’ jury (to) … provide recommendations … on how to establish a substitute decision-making process … if a person loses decision-making capacity after the final assessment stage of the voluntary assisted dying process.”

Assisted Dying for Dementia

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” so there are enormous ethical, legal and practical challenges that complicate any system that aims to provide such a service.

The Report by Churchill Fellow, Miranda Batten, published in September 2026, about the practice of VAD for dementia in The Netherlands, Belgium, Spain and Canada from the perspective of providers and lawmakers, is a comprehensive and contemporary overview of this international experience.

MAiD in Quebec with an Advanced Care Directive is described by Miranda Batten as:

“…only available when a person with decision making capacity has been diagnosed with a serious and incurable illness leading to a loss of decision-making capacity i.e. incapacity to give consent to care. This formalised process includes the need for the person to complete the request with a physician or specialised nurse practitioner (competent professional), clinical manifestations to be described in the request, the presence of two witnesses and the need for completed requests to be registered. As part of this process, a ‘trusted third person’ can be designated. Their role is to ensure that the person’s wishes, as outlined in their advance request for MAiD, are known and respected.

The request then needs to be activated at a later stage i.e. when the person has lost decision-making capacity. Once activated, a second competent professional undertakes a second assessment to determine whether the person is eligible for MAiD. This includes needing to assess whether the clinical manifestations set out in the person’s advance request have been met.”

When Australians living with dementia are surveyed to assess their views about assisted dying, an overwhelming majority want this to be available. Moreover, they consider withholding that option is an infringement of their human rights and another example of the discrimination that they face. Maybe this could be regarded as the “ultimate discrimination” or indignity. See thesis by Adrienne Matthys, published May 2026.

Dementia Australia issued its Position Statement on VAD for Dementia in April 2023.

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.

Research planned

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.

For health professionals

VAD raises important professional, ethical, cultural and personal questions. Health professionals may choose to participate or conscientiously object, subject to their legal obligations. Whatever their position, patients deserve respectful communication, accurate information and continuity of care.

Principles I support

• Every human life has equal value.
• Autonomy and informed decision-making should be respected.
• High-quality palliative and end-of-life care should be available to everyone.
• Patients should receive information in a form they can understand.
• Therapeutic relationships should be supported wherever possible.
• People should be encouraged to discuss death, dying, values and treatment preferences.
• Safeguards must protect people who may be vulnerable to coercion or abuse.

Patients, families, carers and health practitioners should be treated with respect.

Further Resources

• NSW Voluntary Assisted Dying Care Navigator Service — information and support for patients, families and health practitioners.
• First Request Patient Information Guide — an overview of the NSW request and assessment process.
• Go Gentle Australia
• Dying with Dignity NSW
• End of Life Law for Clinicians
• Advance Care Planning Australia
• Christians Supporting Choice for Voluntary Assisted Dying
• End of Life Law for Clinicians
• Hem’s Law: A Facebook-based petition that calls for merciful conclusion to a medically confirmed imminent and irreversible death. It only applies after a progressive dementia has permanently destroyed a person’s ability to swallow, and two independent doctors have confirmed that death is now imminent. Hem’s Law is proposed to sit alongside VAD reform, and cater for those dying with dementia without an Advanced Care Directive.
• Voluntary Assisted Dying Australia and New Zealand A peak body offering resources for anyone involved in the provision of VAD services.
• 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.
• For a short, but comprehensive, description of what parts of an Advanced Care Plan are legally binding, use this YouTube video from ELLC Australia and Advanced Care Planning Australia. It covers state differences, so you need to listen carefully.
• 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.

For an overview of how medical assistance in dying evolved and operates in Canada, go MAiD Infographics, written and maintained by MAiD in Canada. It also contains useful information about how to challenge misinformation and engage respectfully with opponents of VAD.

Max Brinsmead

Updated 7/10/2026 with AI assistance (Copilot)