After 17 attempts over 3 decades South Australia has become the fourth State to legalise Voluntary Assisted Dying. The legislation has now passed both the Upper and Lower houses.

This means South Australia joins Victoria, Western Australia and Tasmania in giving people who are dying the right to end their life on their own terms with assistance. Different jurisdictions have slight variations but legislation around the States is modelled on the Victorian approach.

In general, you have to be 18, a resident of the State, competent to make decisions, likely to die within 6 months (or 12 for neurological conditions like Motor Neurone Disease) from a condition that causes intolerable suffering.

You have to make an enduring request through a process involving two and sometimes three medical and health professionals to satisfy the conditions of the law. A lethal substance that you can either administer yourself or is administered by a medical practitioner if you are unable to, is then prescribed and dispensed.

Review bodies oversee the application of the legislation, reports to parliament and take action if there are any breaches. Medical practitioners are permitted to decline to participate because they do not believe people should be allowed to end their own lives. Health professionals are permitted to discuss voluntary assisted dying and provide information and options, but patients must first initiate the conversation – not the health professional.

Voluntary assisted dying has been introduced in Australian States to address the real misery and suffering that many people experience at the end of their lives. Even world class palliative care does not always work to prevent pain, nausea, breathlessness, fatigue, loss of dignity, fear, hopelessness and anxiety. Not surprisingly, Australians overwhelmingly, want to have the choice of voluntary assisted dying.

Fears that voluntary assisted dying is a slippery slope leading to abuse and exploitation of older people, pressure to reduce health care costs, discrimination against people with disabilities and the undermining of health care ethics are are not supported.

In Victoria, the Voluntary Assisted Dying Review Board, chaired by a former Supreme Court judge, reports regularly on voluntary assisted dying in Victoria. In its February 2021 report the Board said that to date 405 people have been issued permits for assistance to die and 224 people either self administered or had medication administered. Most had cancer or neurodegenerative disease.

The Board has found only six cases out of 562 applications have been found to be non compliant with the Act. All were procedural irregularities. The Board was satisfied that in all cases the eligibility requirements had been met and there were no fundamental concerns.

Queensland is currently considering the introduction of voluntary assisted dying. This leaves New South Wales and the Commonwealth. A Voluntary Assisted Dying Bill was defeated in the New South Wales Legislative Council by one vote in 2017. A further private members bill is likely to be introduced in 2021. But it is unlikely to be supported for consideration by the Berejiklian government.

The Commonwealth government currently opposes voluntary assisted dying. It influences how the States can implement assisted dying. It regulates therapeutic goods and therefore the lethal substances that can dispensed. The States are therefore required to negotiate with the Therapeutic Goods Administration for use of existing drugs or develop their own approach.

The Commonwealth criminal code also makes it an offence to incite suicide through a carriage (communications) service. The application of the Commonwealth criminal code to voluntary assisted dying remains a matter of legal dispute.

More directly, the Commonwealth has prevented the Northern Territory and the Australian Capital Territory from legislating and implementing voluntary assisted dying.

Despite the opposition from New South Wales and the Commonwealth, after a long and difficult debate, Voluntary Assisted Dying is now becoming more accepted in Australian health care. More than 400 medical practitioners have now completed the required training for registration for voluntary assisted dying in Victoria. Slowly conservative bodies like the medical and health professional colleges are accepting that providing assistance to die for those who choose it when they are terminally ill and suffering is a legitimate role for health professionals.

Community support for the introduction of carefully regulated voluntary assisted dying is likely to see it introduced in all States and Territories over time although that may require a change of government in the Commonwealth and New South Wales.