By Catherine Watson
I LOST three friends in January. All were in their 80s and 90s so their deaths were not unexpected. And all three were more than ready to depart.
One sought Voluntary Assisted Dying and was rejected.
One planned to end her own life.
One tried to end her own life but failed.
I LOST three friends in January. All were in their 80s and 90s so their deaths were not unexpected. And all three were more than ready to depart.
One sought Voluntary Assisted Dying and was rejected.
One planned to end her own life.
One tried to end her own life but failed.
We’re living longer than previous generations, kept alive by the miracles of modern medicine, but it’s not all beer and skittles. In the 21st century, most of us will live long enough to develop dementia, heart disease, cancer, diabetes, a respiratory illness or a combination of them all.
Many of us will spend our last few years in chronic pain and depression. And some of us will decide we’ve had enough.
It’s not illegal to take your own life, but it’s difficult, especially if you’re old or frail or have a debilitating illness. You used to be able to swallow a bottle of sleeping tablets, washed down by a slug of whisky, but that’s unlikely to work these days. Governments have put a lot of effort into stopping us from killing ourselves. Overdosing is harder than you might think. Nor will running the exhaust on your car (catalytic converters changed that) or putting your head in the oven (electric) do it.
This is not an economic argument, but it's impossible to ignore the costs of our longer lives. Australia’s aged care system is struggling as the boomers hit their 70s and 80s. In 2023–24, the Australian government spent $60 billion on age pensions and a further $36 billion on aged care services, not to mention the cost of health care in the last decade of life.
It’s hard to understand, then, why governments put so much effort into forcing old people to stay to the bitter end. Making Voluntary Assisted Dying available to everyone over a certain age, regardless of whether they have a terminal illness, looks like a sensible solution.
What age? Well, three score years and 10 used to be our allotted span. Before you right-to-lifers get fired up, I’m not talking about Compulsory Assisted Dying. Some people want to drink every last drop of life, and that’s fine with me. Others want to skip the last chapter.
But which politician is going to be brave enough to put their head above the parapet?
Many of us will spend our last few years in chronic pain and depression. And some of us will decide we’ve had enough.
It’s not illegal to take your own life, but it’s difficult, especially if you’re old or frail or have a debilitating illness. You used to be able to swallow a bottle of sleeping tablets, washed down by a slug of whisky, but that’s unlikely to work these days. Governments have put a lot of effort into stopping us from killing ourselves. Overdosing is harder than you might think. Nor will running the exhaust on your car (catalytic converters changed that) or putting your head in the oven (electric) do it.
This is not an economic argument, but it's impossible to ignore the costs of our longer lives. Australia’s aged care system is struggling as the boomers hit their 70s and 80s. In 2023–24, the Australian government spent $60 billion on age pensions and a further $36 billion on aged care services, not to mention the cost of health care in the last decade of life.
It’s hard to understand, then, why governments put so much effort into forcing old people to stay to the bitter end. Making Voluntary Assisted Dying available to everyone over a certain age, regardless of whether they have a terminal illness, looks like a sensible solution.
What age? Well, three score years and 10 used to be our allotted span. Before you right-to-lifers get fired up, I’m not talking about Compulsory Assisted Dying. Some people want to drink every last drop of life, and that’s fine with me. Others want to skip the last chapter.
But which politician is going to be brave enough to put their head above the parapet?
*****
Victoria led the way in Australia with the introduction of Voluntary Assisted Dying (VAD) in 2019. To qualify, you must have a terminal illness with a projected life expectancy of less than six months (12 months for neurological conditions).
When the legislation passed, the government predicted about 12 deaths in the first year and 100–150 per year afterwards. In fact there were 124 deaths in the first year (2019–20), and there are now nearly 400 each year, around 0.8 per cent of all deaths, still much lower than in more liberal jurisdictions like Canada or the Netherlands.
Since 2019, other Australian states have followed Victoria’s example. As often happens with early adopters, Victoria's regime is now the most conservative in the country.
Last November, the Victorian Parliament voted to ease several key aspects of the law: health workers will now be able to initiate discussions about VAD with patients, and the terminal prognosis requirement will be extended to 12 months for all conditions. However, the new rules will not take effect until April 2027.
They are still arbitrary, and they don’t address the elephant in the room. To qualify for VAD you need to show not only that you have a terminal illness but that you are of sound mind.
The latest figures from the ABS show the leading cause of death in 2024 was dementia, accounting for 9.4 per cent of deaths, more than 17,000 people. The rate is rising.
No use writing in your advance care directive that you wish to have VAD should you develop advanced dementia; it counts for nothing. You must be able to give informed consent when the medication is administered.
Given that a large number of us will develop dementia, we need to consider our own exit well before we reach a point where we have no say in the matter.
When the legislation passed, the government predicted about 12 deaths in the first year and 100–150 per year afterwards. In fact there were 124 deaths in the first year (2019–20), and there are now nearly 400 each year, around 0.8 per cent of all deaths, still much lower than in more liberal jurisdictions like Canada or the Netherlands.
Since 2019, other Australian states have followed Victoria’s example. As often happens with early adopters, Victoria's regime is now the most conservative in the country.
Last November, the Victorian Parliament voted to ease several key aspects of the law: health workers will now be able to initiate discussions about VAD with patients, and the terminal prognosis requirement will be extended to 12 months for all conditions. However, the new rules will not take effect until April 2027.
They are still arbitrary, and they don’t address the elephant in the room. To qualify for VAD you need to show not only that you have a terminal illness but that you are of sound mind.
The latest figures from the ABS show the leading cause of death in 2024 was dementia, accounting for 9.4 per cent of deaths, more than 17,000 people. The rate is rising.
No use writing in your advance care directive that you wish to have VAD should you develop advanced dementia; it counts for nothing. You must be able to give informed consent when the medication is administered.
Given that a large number of us will develop dementia, we need to consider our own exit well before we reach a point where we have no say in the matter.
*****
Dr Rodney Syme did more than anyone to shepherd the introduction of Voluntary Assisted Dying in Victoria. While it was a major breakthrough, he always knew it was a restrictive law that could help only a small proportion of people in practice.
Syme believed the medical model was flawed. Doctors should not be the gatekeepers making decisions for others.
In A Completed Life, he went further. He argued that law and policy focus too narrowly on physical or terminal suffering. People also experience existential suffering – loss of purpose, dignity, independence, identity, or fear of decline – which can be just as real and intolerable as physical pain.
He argued that the state and the medical profession should not override a considered, enduring wish to die simply because a person does not meet a medical threshold. An older person may reasonably conclude their life narrative is finished.
While Victoria’s laws restrict access to those with advanced, incurable illness, Switzerland takes a far broader approach. There, assisted dying is legal so long as it is not carried out for “selfish motives”, a framework that has allowed organisations such as Dignitas to accept people from overseas, including those who are not terminally ill.
David Goodall was 104 when he travelled from Perth to Basel in 2018 to end his life. He wanted his experience to be used to argue for an easing of Australia’s laws.
He was not terminally ill but described his life as “no longer worth living” and argued that older people should have the right to choose the timing of their death, even without terminal illness.
He said he resented having to travel so far to die, but was relieved the end was near. “My recent life has not been enjoyable,” he told reporters in Basel, before receiving a lethal injection of Nembutal.
Some people adjust to the idea of “being, not doing” as they age. Others do not.
My three friends had all lived rich, fulfilling lives. Each, in their own way, had reached a point where life was less about living than enduring.
Syme believed the medical model was flawed. Doctors should not be the gatekeepers making decisions for others.
In A Completed Life, he went further. He argued that law and policy focus too narrowly on physical or terminal suffering. People also experience existential suffering – loss of purpose, dignity, independence, identity, or fear of decline – which can be just as real and intolerable as physical pain.
He argued that the state and the medical profession should not override a considered, enduring wish to die simply because a person does not meet a medical threshold. An older person may reasonably conclude their life narrative is finished.
While Victoria’s laws restrict access to those with advanced, incurable illness, Switzerland takes a far broader approach. There, assisted dying is legal so long as it is not carried out for “selfish motives”, a framework that has allowed organisations such as Dignitas to accept people from overseas, including those who are not terminally ill.
David Goodall was 104 when he travelled from Perth to Basel in 2018 to end his life. He wanted his experience to be used to argue for an easing of Australia’s laws.
He was not terminally ill but described his life as “no longer worth living” and argued that older people should have the right to choose the timing of their death, even without terminal illness.
He said he resented having to travel so far to die, but was relieved the end was near. “My recent life has not been enjoyable,” he told reporters in Basel, before receiving a lethal injection of Nembutal.
Some people adjust to the idea of “being, not doing” as they age. Others do not.
My three friends had all lived rich, fulfilling lives. Each, in their own way, had reached a point where life was less about living than enduring.