The Australian experience of safeguarding in assisted dying
The Australian Capital Territory became the latest Australian territory to pass assisted dying legislation last year (Alamy)
4 min read
Whether you are for or against the legalisation of assisted dying in England and Wales, creating a service with appropriate safeguarding is essential.
It is unsurprising that safety—and how it can be ensured—is one of the main topics currently debated as Westminster considers new assisted dying laws. Recent Citizens Jury evidence published by the Nuffield Council on Bioethics highlighted the importance of appropriate safeguarding.
Safety in the context of assisted dying spans several areas, including ensuring eligibility criteria are met and medication is safely handled. It also means protecting the individual from coercion, ensuring that any decision to seek assisted dying is made voluntarily and is truly their own.
The Committee tasked with reviewing the Terminally Ill Adults (End of Life) Bill has received extensive evidence about the potential for coercion and how it might be prevented. Some of this evidence has come from overseas, and I believe Australia offers useful insights on the question of voluntariness.
The word “voluntary” is significant. In Australia, it’s built into the title of every assisted dying law. Since 2017, all six Australian state parliaments have passed laws permitting voluntary assisted dying. One of the two territories—the Australian Capital Territory—has also passed legislation, though it has not yet come into effect.
Coercion is addressed in multiple ways under Australia’s voluntary assisted dying laws. Eligibility criteria state that the choice must be made voluntarily and without external pressure. This must be assessed by two separate doctors during independent eligibility assessments. Some states require a third opinion if there is any doubt. Additionally, all states mandate a final request and a reconfirmation of eligibility from the original assessing doctor.
Australia’s experience provides evidence-based lessons on how such a system might function in practice
Another layer of protection is doctor training. Across all states, clinicians who assess eligibility must complete government-approved training and score at least 90 per cent on their assessment. This training specifically addresses how to assess whether a person’s choice is truly voluntary. It provides practical techniques for identifying coercion, such as speaking with the person alone and exploring their motivations for choosing assisted dying.
This training is supported by state health department guidelines, which also provide detailed advice on ensuring the voluntariness of the decision.
Further safeguards include the requirement for independent witnesses when a person makes their request, and new criminal offences that penalise attempts to induce someone into choosing assisted dying.
Each Australian state also has an oversight body—either a board or commission—which scrutinises every case for compliance. To date, there have been no cases of a person being approved for voluntary assisted dying who was not eligible. Annual reports from these oversight bodies consistently indicate that the systems are working safely. For instance, the latest annual report from Victoria, which has the longest-running system, states: “Based on the experience of the first five years, the Board is satisfied that the objective of safety has been achieved through the Voluntary Assisted Dying Act 2017.”
This aligns with research we’ve conducted with doctors, health practitioners, patients and families involved in voluntary assisted dying. The eligibility assessment is rigorous—so much so that some find it challenging to access this option despite qualifying.
This isn’t to say vigilance about coercion is unwarranted. These concerns were central when designing Australia’s assisted dying frameworks. But when evaluating how to address this risk, there is value in drawing on international examples.
In Australia, voluntary assisted dying is safeguarded at every step. The question of whether a decision is voluntary is tested multiple times. It is subject to more oversight than any other end-of-life decision in the country. While each nation must reach its own conclusion about legalising assisted dying, Australia’s experience provides evidence-based lessons on how such a system might function in practice.
Ben White is Professor of End-of-Life Law and Regulation and an Australian Research Council Future Fellow in the Australian Centre for Health Law Research, Queensland University of Technology
