As New South Wales prepares for the statutory review of its Voluntary Assisted Dying Act, the national trajectory of euthanasia and assisted suicide offers a glimpse of what may lie ahead.
It is an everyday reality in Australia. In the last financial year in NSW alone, 1,028 people ended their lives – about 20 every week according to annual reporting data. From the day VAD became legal on 28 November 2023 to 30 June last year, 1,426 have died.
Across Australia, every jurisdiction except the Northern Territory – which could pass its own law this year – has legalised VAD. More than 7,200 people have died since it became legal in Victoria in June 2019.
According to a survey by The Australian newspaper, VAD deaths currently represent between one and three per cent of all deaths across the nation.
The NSW review will only examine whether it is operating effectively, not whether VAD should be legal. Submissions to the NSW Health Department are due by 27 February.
Supporters of VAD are looking forward to 2026 as “the year all Australian jurisdictions embrace end-of-life choice”. And in NSW they are gearing up to liberalise VAD in the review process. “Rest assured,” says Dying With Dignity NSW, “that we will be raising the issue of obstruction by religious institutions and pockets of conscientious objection which are making it more difficult for people to access VAD.”
The brief history of VAD – or more accurately, assisted suicide and euthanasia – in Australia shows that its boundaries never stop expanding.
In the last lap before Victoria legalised VAD in 2019, then-Premier Dan Andrews defended the bill as “on any measure the most conservative model anywhere in the world”. He said that it contained “68 different safeguards” to ensure that no one would ever be coerced or victimised.
He specified, for instance, that doctors could not suggest VAD to their patients and that they needed to be terminal and expected to die within six months.
In the first legislative review of the Victorian legislation, both of those safeguards were eliminated.
Furthermore, the jurisdictions which followed in Victoria’s footsteps no longer boast of being “conservative”. Instead, Rachel Stephen Smith, Health Minister in the ACT, the most recent jurisdiction to legalise VAD, claimed that its regime is the “most progressive” in Australia.
In the ACT, nurse practitioners can administer lethal drugs, not only doctors, and there is no maximum time to death.
Furthermore, three provisions which were too controversial during the debate in the ACT will be considered in the three-year statutory review: VAD for people with dementia, for children, and for people residing outside the ACT.
As the blast radius of VAD keeps expanding, its supporters are becoming more entrenched. Last year Liberal MLC Sue Carter introduced a private member’s bill in the NSW Parliament which would have given faith-based aged-care homes a right to decline VAD on their premises. Under the existing law, patients have a right to access VAD on site.
VAD supporters derided her initiative as “heartless and unfair” and it was defeated by a vote of 23 to 16.
Bishop Daniel Meagher, the delegate for the Australian Catholic Bishops Conference euthanasia taskforce, told The Catholic Weekly that despite stubborn opposition, the church will continue to fight proposals to expand VAD.
“We will use all means at our disposal to promote an understanding of the goodness, dignity and sacredness of human life and how to trust in the loving presence of God in all the ups and downs of life.”
He believes that VAD is a symptom of an ailing culture.
“The increase in VAD also reflects a society in which more people, especially the elderly and sick, are lonely and depressed and entirely without meaning or hope. This is a terrible indictment on the quality of our communities,” he said.
“It also reflects the fact that, as people lose contact with God, they lose contact with each other and with the meaning and goodness of life itself.”
However, the NSW review could be an opportunity to peer into the crystal ball and see what the future of VAD looks like for Australia. It’s unlikely to be rosy. In Canada, where euthanasia has been legal since 2016, it accounts for more than four per cent of all deaths.
In the province of Quebec, 7.9 per cent of all deaths are attributable to euthanasia, representing a 61 per cent increase in cases over the past five years. That prompts a question: will supporters of VAD get enough of it?
Bernadette Tobin, of the Plunkett Centre for Ethics at Australian Catholic University, contends that VAD bracket creep is inevitable.
She predicts two forces will be at work: “choice will not be necessary” and “choice will be the only thing that’s necessary”. For people with dementia, it will seem a pity to deny them their right to die; for everyone else, it will seem patronising and unfair.
She observes that the innocuous phrase “voluntary assisted dying” is a euphemism for a harsher reality. “I would encourage people to call it for what it is,” she told The Catholic Weekly. “In the United States, both the people who are in favour of it and the people who are against it call it ‘physician assisted suicide’.”
Carter is particularly concerned about the effect of the legislation on young people. In the United States women with “terminal anorexia” have been helped to end their eating disorder by ending their lives.
“If we normalise a response in society where I am in pain, I don’t see much hope left in my life, if we normalise the response to that as euthanasia, as VAD, as whatever we want to call it as, as taking deliberate steps to end our own life, then how do we communicate a really clear message to 19 and 20-year-olds? she asks.
The background paper for the NSW review says it will not look at whether “voluntary assisted dying should be precluded”. However, research by The Catholic Weekly uncovered a number of ways in which the Voluntary Assisted Dying Act 2022 could be amended:
- Allowing faith-based care institutions to exclude on-site VAD.
- Robust protections for nurses and doctors with a conscientious objection.
- Gathering information on whether patients had effective access to palliative care.
- Ensuring that palliative care funding is protected.
- Ensuring greater transparency by collecting socio-demographic information about marital status, disability, and patients who informed their family of their decision.
- Gathering information on the administration of the lethal medication: time between drug ingestion to death, complications after drug ingestion and the type of drugs which are used.
At the moment, the Act gathers as little information about VAD in NSW as possible. In a statistics-mad society, that is bizarre. What can’t be measured can’t be managed. Without good data, how will MPs know whether the legislation is working or not?
Carter is encouraging people to make submissions to the legislative review of the 2022 Act.
“If people of goodwill don’t put in submissions, then the government body doing the review doesn’t hear any contradictory voices, and they’re not aware of any problems or any different views about how it’s operating in the community,” she told The Catholic Weekly.
“So if we hang back, then we should expect nothing good to come from it. But if we actively participate, we can always hope that we can have an impact and an effect.”
