Voluntary Assisted Dying
Voluntary assisted dying is a quick and peaceful death which results from a patient taking or administering to themself a fatal dose of a medication prescribed after their rational and continued request, made in order to relieve their own suffering.
Practically, voluntary assisted dying would generally involve a doctor prescribing a lethal drug which the patient may then take at the time of their choice, without further assistance.
Voluntary Assisted Dying is also known as Physician Assisted Dying or Medical Aid in Dying.
The singular exception to self-administration of the lethal drug is where people are physically unable to take a lethal drug themselves. In this case, a doctor would assist the person to die by administering the drug, usually via an injection. In this circumstance, the assisted death is known as Voluntary Euthanasia.
Terminally-ill means suffering from a terminal illness, which is expected to end in death within a relatively short period of time, usually assumed to be 12 months. ‘Terminal’ is a legally recognised term in Australia and there is a long-standing practise by Australian insurance companies to accept a prognosis of less than 12 months to live for the payout of a life insurance policy.
People are said to be competent, or have capacity, if they have sufficient understanding and memory to comprehend the nature and consequences of a decision, and to evaluate and weigh relevant information in making that decision.
Where a person who is not capable of indicating whether they want to be helped to die, or not, is given a substance to hasten death. NB: the legalisation of Involuntary Euthanasia is not contemplated by any laws being recommended in Australia, or currently in existence globally.
This term is sometimes used to refer to the practice of ceasing treatment so that the patient dies more quickly than they might if treatment continued. NB: Every competent patient in Australia has the right to refuse any medical treatment and a doctor has a right to discontinue treatment that the doctor deems to be futile. The practise of ceasing treatment is not illegal in Australia and is NOT an example of Voluntary Assisted Dying. The practice of using ‘continuous terminal sedation’ could be described as an example of Passive Euthanasia (see below)
The intentional act of killing oneself.
NB: It is now considered preferable to restrict use of the word ‘suicide’ to those persons taking their own life who would normally have gone on to live a happy and purposeful life with appropriate intervention. According to the American Public Health Association, “Medical and legal experts have recognized that the term ‘suicide’ or ‘assisted suicide’ is inappropriate when discussing the choice of a mentally competent terminally ill patient to seek medications that he or she could consume to bring about a peaceful and dignified death.” Click for reference
Assisting a suicide or an attempted suicide is against the law in Australia, and would remain against the law after a voluntary assisted dying law is passed.
Deep Continuous Palliative or Terminal Sedation
The gradual, titrated increase, by continuous infusion, of sedatives and analgesics, usually without the provision of food and fluids, until the patient enters a coma and remains so until death occurs. It is generally considered a treatment of last resort when a patient’s pain and suffering can no longer be controlled. According to Dr Rodney Syme 26/5/15 “it [terminal sedation] is used in exactly those circumstances where other doctors might provide assisted dying if they were asked”.
Nil by mouth
This is a medical instruction not to eat or drink anything at all. If it is written above a patient’s bed it alerts nurses not to provide food or drinks of any kind.
Percutaneous Endoscopic Gastrostomy (PEG) “feeding”
This is a way of delivering food, via a tube, directly through the skin into the stomach. A doctor makes a surgical hole through the abdominal and stomach walls and fixes the tube in place. People who cannot swallow food temporarily or permanently can benefit from PEG feeding.
This includes a range of treatments that relieve a dying person’s pain or suffering. It can include medical, physical, mental and spiritual comfort for both patients and their carers. The word ‘palliative’ comes from the Latin word palliare, which means to cloak. So it comes to mean alleviate or even, disguise, the pain of dying. The central credo of palliative care is ‘we shall neither prolong nor hasten death’.
Doctrine of double effect
This doctrine makes intention in the mind of the doctor a crucial factor in judging the moral correctness of the doctor’s action in treating a patient. The effect is that if a doctor is tending to someone who cannot be restored to health, the doctor can give the patient medication which may have the unintended consequence of helping them die more quickly, provided that the doctor’s actual intention is to ease suffering. What the doctor must not do is give them medication with the intention of helping them die – even if only death will end their suffering. This doctrine protects doctors where they are charged with hastening the death of patients.
For a discussion of this doctrine in relation to assisted dying see FAQs page
Advance Care Planning
This process involves thinking about and deciding what sort of medical treatment you wish to receive in the future, at the end of life. It helps guide doctors, family and friends in making decisions that fulfil your wishes and are in your best interests. Advance care planning can be done at any age or level of health. One of the most important parts of planning includes the legal appointment of someone you trust to be a substitute decision-maker if you can no longer speak for yourself. Another aspect of planning involves completing a written document, called an Advance Care Directive, which clearly outlines your wishes.
For a discussion of Advance Care Planning see our dedicated section
Advance care directive
This is a written list of instructions to your doctor or health practitioner, made out in anticipation of possible treatments for health problems. It must be signed and witnessed at a time when you are competent. You can list specific conditions under which you do not want particular treatments such as resuscitation, antibiotics, or artificial nutrition or hydration. In that instance your Advance Care Directive is legally binding and nobody can override it.
This is a trusted person who you provide with the legally-binding authority to make health decisions for you, if you are unable to do so for yourself . To nominate this person you must complete a statutory document at a time when you are competent to make this decision and this document must be signed by yourself, your Enduring Guardian and an independent witness (a legislated signatory). When deciding on whom to appoint, you should consider who would best understand your values and wishes, and who would have the skills to make good decisions for you.