Vol­un­tary assist­ed dying laws com­mence in Victoria

In Novem­ber 2017, after sig­nif­i­cant com­mu­ni­ty and par­lia­men­tary debate, Vic­to­ria became the first state in Aus­tralia to law­ful­ly allow ter­mi­nal­ly ill peo­ple to vol­un­tar­i­ly end their lives. The Vol­un­tary Assist­ed Dying Act (the Act) came into oper­a­tion on 19 June 2019 with the aim of pro­vid­ing for and reg­u­lat­ing access to vol­un­tary assist­ed dying. This arti­cle seeks to pro­vide a brief out­line on the nature and oper­a­tion of the Act. 

Access to vol­un­tary assist­ed dying 

The Act imple­ments strict eli­gi­bil­i­ty cri­te­ria which reg­u­lates access to vol­un­tary assist­ed dying. Sec­tion 9 of the Act pro­vides that a per­son seek­ing access must:

1. be an adult;
2. be an Aus­tralian cit­i­zen or a per­ma­nent resident;
3. ordi­nar­i­ly reside in Vic­to­ria (for no short­er time peri­od than 12 months);
4. have deci­sion-mak­ing capac­i­ty; and 
5. be diag­nosed with a dis­ease, ill­ness or med­ical con­di­tion that:
   • is incur­able; and
   • is advanced, pro­gres­sive and will cause death; and
   • is expect­ed to cause death with­in weeks or months (not exceed­ing 6 months or 12 months depend­ing on the nature of the diag­no­sis); and
   • is caus­ing suf­fer­ing to the per­son that can­not be relieved in a tol­er­a­ble manner.

Deci­sion-mak­ing capac­i­ty in rela­tion to vol­un­tary assist­ed dying is defined in sec­tion 4 as requir­ing the indi­vid­ual to under­stand the rel­e­vant infor­ma­tion, retain the infor­ma­tion in order to weigh up a deci­sion, and com­mu­ni­cate that deci­sion. A per­son is pre­sumed to have deci­sion-mak­ing capac­i­ty unless evi­dence to the con­trary is provided. 

Notably, indi­vid­u­als apply­ing only by rea­son of men­tal ill­ness (with­in the mean­ing of the Men­tal Health Act 2014) or dis­abil­i­ty (with­in the mean­ing of the Dis­abil­i­ty Act 2006) will not be eligible. 

The process

The process of request­ing access to vol­un­tary assist­ed dying pro­vides addi­tion­al safe­guards designed, amongst oth­er things, to respect indi­vid­ual autonomy. 

By way of a gen­er­al out­line, the Act requires the per­son seek­ing assist­ed dying to make three clear requests. The first request is made ver­bal­ly (or by oth­er means of com­mu­ni­ca­tion) by the patient to their doc­tor. A doc­tor who first sug­gests the idea of assist­ed dying to a patient may face pro­fes­sion­al mis­con­duct charges. Once the doc­tor has accept­ed the first request, that doc­tor becomes the co-ordi­nat­ing med­ical prac­ti­tion­er for that per­son. They are then oblig­at­ed to assess whether the request­ing per­son meets the Act’s eli­gi­bil­i­ty cri­te­ria for assist­ed dying. A refer­ral is then pro­vid­ed to a sec­ond reg­is­tered med­ical prac­ti­tion­er who will under­take a con­sult­ing assess­ment. The con­sult­ing process is also in rela­tion to iden­ti­fy­ing the request­ing per­son­’s eli­gi­bil­i­ty for assist­ed dying. A per­son assessed as eli­gi­ble must then be informed of a range of mat­ters, includ­ing alter­na­tive treat­ment and pal­lia­tive care options.

Once eli­gi­bil­i­ty has been assessed, the per­son must make a writ­ten dec­la­ra­tion signed in the pres­ence of two wit­ness­es. The dec­la­ra­tion forms the basis for the sec­ond request. It pro­vides that the per­son mak­ing the dec­la­ra­tion does so vol­un­tar­i­ly and with­out coer­cion, and that they under­stand the nature and effect of the declaration. 

The final request is one of the last steps in the process for access­ing vol­un­tary assist­ed dying. The per­son must per­son­al­ly make the request ver­bal­ly (or through oth­er means of com­mu­ni­ca­tion) to the co-ordi­nat­ing prac­ti­tion­er. Once the final request has been made, the co-ordi­nat­ing med­ical prac­ti­tion­er will review all the infor­ma­tion and cer­ti­fy that the assess­ment process has been com­plet­ed in accor­dance with the Act. A final review form will also be com­plet­ed for sub­mis­sion to the Vol­un­tary Assist­ed Dying Review Board. 

Notably, a peri­od of nine days must pass between the first and final request. The day of the first request would not be count­ed towards the nine days (see: s 44 of the Inter­pre­ta­tion of Leg­is­la­tion Act 1984), and there­fore the entire process for request­ing access to assist­ed dying can occur with­in 10 days of the first request being made. At any stage dur­ing the process, the per­son is at lib­er­ty to decide not to continue. 

Addi­tion­al protections

The pro­tec­tion of vul­ner­a­ble peo­ple and those who may be sub­ject to abuse was a key con­cern in the debates regard­ing the intro­duc­tion of assist­ed dying. In addi­tion to the strict eli­gi­bil­i­ty cri­te­ria and strin­gent appli­ca­tion process, the Act seeks to deal with this through imple­ment­ing a range of safe­guards. For exam­ple, a per­son will not be able to wit­ness a writ­ten dec­la­ra­tion where that per­son knows or believes they may be a ben­e­fi­cia­ry of a will of the per­son mak­ing the dec­la­ra­tion or will oth­er­wise finan­cial­ly or mate­ri­al­ly ben­e­fit in some way from their death. The Act also man­dates a max­i­mum 5 year impris­on­ment penal­ty for any per­son who induces a per­son to request assist­ed dying. 

Oth­er jurisdictions

It remains to be seen whether oth­er states and ter­ri­to­ries in Aus­tralia will fol­low suit. Indeed, West­ern Aus­tralia and South Aus­tralia have both held pub­lic enquiries and are con­sid­er­ing sim­i­lar euthana­sia laws. In 2017, the NSW Par­lia­ment reject­ed the pro­posed Vol­un­tary Assist­ed Dying Bill by one vote. Ulti­mate­ly, the pur­port­ed suc­cess or fail­ure of the Vic­to­ri­an leg­is­la­tion may play a crit­i­cal role in paving the way for nation-wide law reform in this area.