Voluntary assisted dying and dementia: should it be allowed in Australia?

Casey Haining, QUT School of Law and Australian Centre for Health Law Research

Dementia is now the leading cause of death in Australia. However, those living with dementia are practically unable to access voluntary assisted dying (VAD) for their dementia due to the eligibility criteria of current VAD laws that now exist everywhere in Australia except the Northern Territory.

Specifically, the requirements of VAD laws for people to both possess decision-making capacity (i.e., make decisions about themselves and communicate them) and be close to the end of life – usually with an expected death within six to twelve months – mean VAD for dementia is practically unavailable (in the absence of another qualifying condition).

In effect, by the time a person’s dementia is so advanced that they are at the end of life, they are unlikely to be able to possess the necessary decision-making capacity to request VAD for themselves. The NSW VAD law, meanwhile, specifically prohibits VAD for dementia.

Australia’s position differs from that in other countries, such as the Netherlands, Belgium and Canada, where VAD for dementia is available. In the broadest sense this is approached in one of two ways – via a concurrent request or an advance request.

A concurrent request is where a person with decision-making capacity can request and access VAD while they have decision-making capacity, typically earlier in their dementia trajectory before they are at the end of life. In contrast, an advance request is where a person makes their preferences for VAD known while they still have decision-making capacity, which are then relied on later when the person can no longer make decisions for themselves.

Despite the possibility of VAD for dementia in other countries, its availability presents many practical and ethical challenges.

Whether VAD should be available for dementia in Australia has received sustained attention, particularly in the popular media. There is also a limited but growing evidence base about attitudes towards this reform.

Discussions and research in Australia have not yet explored what a VAD framework and system might look like in Australia, particularly in light of the known challenges associated with permitting VAD for dementia.