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Update on the Victorian Voluntary Assisted Dying (VAD) Act, Australia

In May 2015, the Legislative Council in Victoria, Australia, commissioned the Legal and Social Issues Committee to undergo an Inquiry into End of Life Choices. Many believed that this inquiry was instigated following a renewed call for the legalisation of euthanasia and assisted suicide (EAS). Whatever the reasons, following 1037 submissions and 154 public hearings, the Committee made 49 recommendations.[1] 29 of which called for significant improvement in the quality, accessibility and the integration of community palliative care services. It recognised that the demand for good quality palliative care, especially that of community palliative care, significantly exceeded the current capacity of palliative care services. These 29 recommendations included improving many aspects of palliative care. They also highlighted the lack of clarity amongst the medical profession on what constitutes futile treatment and the lack of data on continuous palliative sedation.[2] A further 19 recommendations recognised the need to significantly improve advance care planning including education about this for both the healthcare sector and the community. In recommending the 49th action of legalising assisted dying in Victoria, the Committee stated “While several submissions suggested that all pain and suffering can be alleviated through the provision of better palliative care, the Committee heard from health practitioners that not all pain can be alleviated. Palliative care cannot always be the solution to managing pain and suffering at the end of life.” [3]

Reading and listening to the submissions and the debates that followed, it became obvious that there were many people who did not receive adequate and timely palliative care, and an even greater number of people who perhaps are still suffering the distress of watching another person suffer at the end of their life. The opportunity to heal such suffering for the many who shared painful stories, seemed to be lost in the political urgency to legislate EAS.

Such suffering may also be one of the factors that underlie the desire to legislate a form of VAD in New South Wales (2017; voted down by 1 vote), Western Australia (the state government will introduce a bill in the second half of 2019) and Queensland (the Premier has launched an inquiry into end of life care which includes the possibility of legalising EAS).

In the framework proposed for the 49th recommendation the need to care for those who would be negatively impacted in their provision of assisted dying to patients was highlighted by the recommendation that counselling be made available to these practitioners. This was a telling reminder that legalising EAS will likely have an emotional and possibly negative moral impact on some of the health professionals involved, presumably based on what the Committee had gleaned from the submissions. Following on from this it would seem that improved bereavement services should also be made available to address the short and long term impact of EAS on the families and loved ones of those who choose VAD.

It could be said that legalising EAS without first ensuring the provision of excellent and timely palliative care to all who are dying, would be the proverbial “putting the cart before the horse,” given the possible negative impact on those involved and the ripple effect of this on the community. The Victorian government has however, alongside legalising EAS, committed to improving palliative services throughout the state. It is hoped that this commitment will be ongoing and enough to meet the increasing demands for palliative care.  

The Victorian Voluntary Assisted Dying (VAD) Legislation[4] was passed by the Victorian Parliament on the 29th November 2017, after a 28-hour marathon debate followed by a conscience vote. Emotions ran high during the debate with unrelenting stories of the suffering of people seeking to hasten their own death in the terminal phases of life. The question as to whether any rational and/or moral decision could be made in the midst of highly charged emotions remains. Of concern one MP concluded that the emotional imperative far outweighed the moral imperative in the case of EAS. Others argue that 100 hours of parliamentary debate attests to robust discussions, hence sound decision making.

On the 19th of June 2019, the Law will come into effect. The implementation taskforce would have had 18 months to establish policies, protocols and procedures to ensure that there are no loopholes. Hospitals and aged care facilities and other organisations involved have to decide if they will provide the procedures and, if so, how they will manage any negative consequences on their staff as well as staff who conscientiously object to involvement in any procedures. The Victorian VAD law allows for conscientious objection. Catholic organisations have categorically declared that they will not be partaking in any process that prematurely ends a person’s life. They will however continue to care for and accompany[5] persons and their loved ones in the person’s dying, and following the person’s death, will continue to care for families and loved ones in their bereavement. Policies and procedures will also have to be written as to how they can fulfil this role of non-judgemental accompaniment without involvement in VAD.

We live in a pluralistic society. There are those who believe in the value of human life and its dignity per se. This group may or may not follow a particular religious tradition. (Unfortunately, there are those who would dismiss this perspective as “religious” hence not valid in discussions, when its validity is equal to other perspectives within a pluralistic society.) This non-judgemental belief in the value of human life without exception leads organisations which hold this value to serve all in society—including those who are poor, marginalised and vulnerable—and to endeavour to provide excellent quality and equitable access of these services to everyone. This very same core belief in the value of human life would most likely make it impossible for such organisations to intentionally end a life, without violating their own integrity. The belief that human life is a gift from God, which is always lived in relationship with others, adds another nuance to the ethical stance of not ending a life prematurely. For the Church, it is based on a living tradition of almost two milleniae. Its tradition is living as it constantly seeks new expression of its core values for contemporary times. The core values essentially do not change.

This valuing of human life is expressed not just in the non-participating in VAD, but also in an ongoing commitment to care for and accompany another in a non-judgemental way, endeavouring to address concerns and fears both metaphysical and physical, manage symptoms and alleviate various forms of suffering. This follows the principle of the common good which is also part of the expression of the valuing of human life—that we endeavour to provide the social conditions that allow others “to reach their fulfilment more fully and more easily.”[6]

Significant resources have been mobilised in all healthcare sectors endeavouring to ensure as far as is possible, that the moral dilemmas and moral distress that may arise are minimised, and that the VAD legislation is diligently followed.

One positive outcome of the Inquiry into End of Life choices is that it has brought a much-needed focus on death and dying in light of significant advances in medical science and technology and increasing longevity in the community. Another positive outcome is the attention it has brought to the significant lack of resources in and accessibility to excellent and timely palliative care in Victoria.

Now that the VAD legislation is passed, it is hoped that we as a pluralistic society can work together towards the good of all, respecting and honouring each other’s values and beliefs and moral integrity.

[1] Legal and Social Issues Committee, Inquiry into end of life choices: Final Report, Parliament of Victoria, (Victorian Government Printer, June, 2016), 

[2] Others would prefer the term “proportional palliative sedation”.

[3]Legal and Social Issues Committee, Inquiry,  xxvii.

[4] Voluntary Assisted Dying Act 2017 (Vic) n. 61$FILE/17-061aa%20authorised.pdf

[5] As per Pope Francis’ Art of Accompaniment in Evangelii Gaudium.

[6] Pontifical Council for Justice and Peace, Compedium of the Social Doctrine of the Church, #164.