In Victoria, Australia, the Voluntary Assisted Dying Act (Vic) 2017, came into force in June 2019 following an 18-month period of implementation. For the first time in over 20 years of campaigning, this act enabled people suffering from uncontrollable pain and distressing symptoms of terminal illness to seek voluntary assisted dying. There are a number of factors that may have also influenced this legislation, including the changing international attitudes in favour of voluntary assisted dying. According to White and Willmott (2018), the act permits any compos mentis adult resident of Victoria to seek voluntary assisted dying. Those eligible for assistance must have incurable disease or advanced and progressive illness that is predicted to cause death within 6 months, or 12 months if there is neurological degeneration. It is clear that the success of this act in Victoria will be crucial for adoption by other states across Australia.
In Western Australia, voluntary assisted dying became permissible as of July 2021 for all people requesting it. In the same month, Western Australia witnessed its first patient (who remains unnamed for their privacy) choosing to use the state laws to end their life through assisted dying surrounded by family and friends (Shine and O'Flaherty, 2021). This seems historic, and that the family were present marks a new beginning in attitudes towards assisted dying, which can only afford people individual choices and compassionate way to end their lives with dignity. The important message to learn from this is the honesty of realising that needless suffering at the end of life does not have to be tolerated or prolonged. The choice of when to end one's life at this stage of life should be offered to all who need to die with dignity. Although this process remains emotionally distressing, it can be argued that it gives the patient a choice of when and how to end their life with reasonable control and dignity. It can be further argued that, for families, they may witness a pain-free death, which can only help with their own bereavement process.
The implication of the use of voluntary assisted dying in Western Australia for community nurses may be that the patients they care for in the UK will soon become aware of the change in the law in Western Australia, and they might ask or wonder why such choices cannot be offered to them in the UK. Community nurses should be there to care without having to wrestle with such questions.
International mood on assisted dying
First, we have to accept that the UK is still struggling with this legislative dilemma that would allow patients the choice to request assistance to die when they experience unbearable progressive terminal suffering. As of now, voluntary assisted dying or physician-assisted euthanasia is not legal in the UK. However, other countries in Europe and North America seem to have responded positively to patients and families requests, and have allowed assisted dying for much longer than Western Australia. Canada and several states in America permit assisted dying for those patients who meet the criteria set in each country and state. The Netherlands, Belgium, Switzerland and Luxembourg lead the way in Europe in permitting assisted dying, assisted euthanasia and physician-assisted dying (White and Willmott, 2018). Switzerland is well known for decriminalising assisted dying, and patients from other countries, including the UK, have travelled there to seek help in order to die with dignity.
Given what is happening around the globe, the UK remains bound by the archaic values of Victorianism and conservatism, which prevent it from moving with the changing times and embracing the liberal values that are held in most civilised nations worldwide. The struggle continues and, at the same time, the momentum is building to change the law and allow suffering terminally ill patients the choice of a dignified death. Such choice would be in line with many other choices afforded everyone in other aspects of life. While palliative care remains a superb supportive service, it is clear that it is not a panacea for every suffering. It is now time for a third way: to allow people to choose when and how they die.