Voluntary assisted dying Australia: State-by-state guide to laws and regulations

By the end of 2023, eligible people in all Australian states will be able to apply for voluntary assistance in dying, as the last three states’ laws come into effect this year.

These states join Victoria, Western Australia and Tasmania, whose laws last more than three years, one year and three months respectively.

Legislation allowing eligible New South Wales residents to choose to end their own life became law last year. (Brooke Mitchell)

The Australian Capital Territory and Northern Territory could be poised to follow after the Commonwealth lifted a more than 25-year ban on territories passing voluntary assisted dying laws.

The ACT has already indicated that it will introduce such laws by 2024 and will circulate a discussion paper in the coming months.

Hundreds have chosen to end their lives with voluntary assisted dying

There is now a clear picture of voluntary assisted dying in Australia, with hundreds choosing it in states where it is legal.

In Victoria, 604 people were helped to die in the three years between June 2019 and June 2022 (the latest figures publicly available). About 75 percent of people assisted in dying since the law took effect were 65 or older; more than 80 percent of applicants had cancer.

In the last reporting period (July 1, 2021 to June 30, 2022), deaths due to voluntary assisted dying represented 0.58 percent of deaths in the state.

In Western Australia, uptake was much higher than expected, with 190 people (1.1 per cent of deaths in the state) choosing voluntary assisted dying in the first year. This is higher than the number of Victorians who volunteered to die in the first year, even though WA’s population is much smaller.

In the western state, nearly 88 percent of eligible applicants were age 60 or older and 68 percent of patients who voluntarily assisted in dying had cancer.

In WA, almost 88 per cent of eligible applicants were aged 60 or over and 68 per cent of patients who volunteered for assisted dying had cancer. (Nick Moir)

In both states, more than 80 percent of patients who requested voluntary assisted death also received palliative care. Eligible applicants cited the inability to engage in activities that make life enjoyable and the loss of autonomy as the two most common reasons for accessing voluntary assisted dying.

How does the voluntary assisted dying system work?

In Victoria and WA, bodies that oversee voluntary assisted dying have found the system safe. According to their reports, only people who met the strict eligibility criteria could access it.

Those who provide voluntary assisted dying and state-based services designed to help prospective patients access them have praised the set-up as supportive and compassionate.

However, there are barriers to access, including:

• The statutory ban preventing Victorian doctors from initiating discussions about voluntary assisted dying
• Commonwealth restrictions on discussing voluntary assisted dying via Telehealth and email
• The need to show evidence of Australian citizenship or permanent residency may prevent some long-term residents from accessing voluntary assisted dying if they cannot prove their status
• The lack of qualified doctors willing to provide voluntary assisted death
• The lack of proper compensation for doctors long and complicated administrative processes
• Non-participation by some aged care and healthcare providers

Many of these issues are exacerbated in rural and remote areas.

Although it is still early days in Tasmania, access issues have already been reported. This is the result of a lack of trained doctors, and a complicated and lengthy application and assessment process.

How can the issues be addressed?

Voluntary assisted dying legislation in each state requires it to be reviewed after a certain period of time. For both Victoria and WA, the review will start this year.

But it is not yet clear how these reviews will be carried out, or what evidence will be considered.

Voluntary assisted dying laws in every state require it to be reviewed after a certain period of time (9News)

For some issues, law reform may be necessary. For others, a policy response may be possible.

For example, potential barriers could be addressed through better remuneration for participating practitioners, strategies to support individuals living in rural and remote areas and a more flexible application of the Australian residency rules.

These mandate reviews provide an important opportunity to improve how voluntary assisted dying laws operate in practice. It is crucial that these reviews are evidence-based.

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Fortunately, there is a growing body of published evidence that can guide and inform these reviews – from the bodies that oversee voluntary assisted dying and from research into voluntary assisted dying practice.

Now that voluntary assisted dying laws are in force in all Australian states, or will be by the end of the year, the next challenge is to ensure that current barriers to access are removed while continuing to ensure that the system is safe work.