Australia is no model for assisted dying
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Australian laws on voluntary assisted dying (VAD) are deemed so similar to the Terminally Ill Adults (End of Life) Bill that three quarters of overseas witnesses invited to give evidence to MPs were from Australia. 'This is not a revolutionary law reform,' Alex Greenwich, a politician from New South Wales, told the bill's scrutiny committee earlier this year. 'It has been tried and tested, we have appropriate safeguards in place throughout Australia, and they work.'
Although Australian states extend the six-month life expectancy requirement to a year for those with neurodegenerative conditions, in terms of eligibility, process and safeguards, their laws are similar to the UK's bill. The two differ only in that self-administration of life-ending drugs would be permitted here, and a multidisciplinary panel would review cases.
So when Kim Leadbeater, Labour MP and the bill's sponsor, responded with a heart emoji and '#ChoiceAtTheEndOfLife' to a Guardian article published on 7 June that showed the Australian system being abused, eyebrows were raised. An elderly couple had been granted VAD when neither were terminally ill; medics in New South Wales effectively greenlit their suicide pact.
'Looks like the safeguards didn't work,' Mark Taubert, an NHS consultant and the vice-president of the European Association for Palliative Care, responded on X. According to the palliative care doctor Rachel Clarke, the story 'could not highlight more starkly the dangers of the law we are currently debating'.
MPs hearing evidence on the bill had little time with six Australian witnesses, all of whom were supportive of VAD. Their arguments didn't always stand up to scrutiny. 'The medications are completely effective. I have not experienced any failures,' said Chloe Furst, a palliative care doctor from South Australia and board member of Voluntary Assisted Dying Australia and New Zealand. But, MPs pointed out, there is no requirement that a doctor be present when someone self-administers, nor is there provision for reporting complications. In Western Australia, where this information is collected, complications were recorded in 4.3 per cent of deaths in 2023-24.
Asked if it was a concern that a 'large proportion of people who opted for assisted dying cited being a burden as their reason', another witness, Meredith Blake from the University of Western Australia, replied this was 'not the evidence that we have got'. Except it is. Official state figures showed 35 per cent of those seeking VAD cited being a burden on family, friends or carers as their reason for doing so. Blake replied: 'If there are people who are saying they are a burden, that does not mean that their decision is not voluntary.'
While MPs were told Australian palliative care doctors had 'embraced' VAD, I have spoken with medics in Australia who are troubled by how the legislation operates. Academics and politicians are, too. Robert Clark, a former attorney-general and MP in Victoria wrote to the committee twice with his observations: the second time after his fellow Australians had addressed MPs. Numerous aspects of their evidence were 'factually incorrect or incomplete', Clark claimed. There was not adequate palliative care available to all terminally ill patients in Australia. Evidence didn't show any reduction in non-medically assisted suicide. The right of doctors to object to VAD was not respected. Many doctors 'feel unable to raise concerns about VAD… lest they suffer adverse professional or career consequences, or else they are leaving the hospital system altogether', he said.
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British palliative care doctor Alex Hughes recently relayed his experience of assisted dying while working in Australia. Hughes, who is neutral on VAD in principle, described a borderline case in which it seemed the patient had chosen to die because of poor alternative care options. In another, he suspected the man may have been influenced by depression, but this had gone unexplored in assessment. Were assisted dying to come to the UK, doctors would be 'at a heightened risk of unconscious bias… [and] may lean towards giving patients the 'benefit of the doubt', granting assisted dying to individuals who, in reality, have more than six months to live.' The events described in the Guardian confirm that risk is not merely hypothetical.
Ahead of its return to the Commons on 13 June, 1,000 doctors urged MPs to vote against the assisted dying bill. They argued it is 'deeply flawed' and unsafe. Similar statements have been made by the Royal College of Physicians and the Royal College of Psychiatrists, which say they cannot support the legislation as it stands.
Such concerns are not 'noise', as Leadbeater has suggested. Many critics have no issue with the principle of safe VAD. But the passage of the bill has revealed law-making at its worst: rushed debate, the views of the vulnerable ignored or downplayed, and crucial information on how the bill would work absent.
Supporters say there will be time to iron out details later. That is too risky. Under current plans, some vulnerable people will be helped – in Hughes's words – to have 'an inappropriate assisted death'. He now poses two critical questions for MPs: how many vulnerable people slipping through the net is acceptable? And can adequate safeguards be put in place 'without creating a system so cumbersome that it becomes unworkable'? It's time for MPs to be honest with themselves and the public: enabling some an autonomous death through assisted dying will inevitably put others at risk of harm.
[See also: Has any Chancellor faced a challenge this daunting?]
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