Extending voluntary assisted dying to people who can no longer consent to it is not compassion – it is a grave step and the evidence shows why, writes Brigid Meney. Source: The Catholic Weekly.
Every Australian VAD law requires decision-making capacity when a person requests to undergo VAD, and capacity throughout their lifetime. This isn’t to say VAD is a genuinely free choice even now — patchy access to high-quality palliative care puts its own pressure on people’s decisions.
But contemporaneous, ongoing capacity is at least the minimum that proponents say distinguishes VAD from something done to a person rather than requested by them. Advanced dementia removes capacity before a person is finally assessed, which is why people with dementia are generally excluded from VAD as it stands.
Some argue we should allow people to lodge an advance directive while they still have capacity, to be acted on later by someone else after that capacity is lost.
This asks a person to make an irreversible decision on behalf of the person they may become: someone shaped by an illness that unfolds differently for everyone and cannot be predicted. It then asks a loved one or clinician to act on that past instruction, without any confirmation that the person still wants it.
We already have reason to doubt such decisions hold reliably over time. Victoria’s own VAD data shows around a third of people issued a permit never go on to die by it; many die naturally first. An advance directive treats a decision made years before diagnosis as more fixed than these decisions usually are.
It also opens a door that our elder abuse protections cannot guard. Substitute decision-making already sits at the centre of most elder abuse in Australia, mostly financial, mostly carried out by family members and carers a person has had to rely on.
Giving a substitute power to end a life on a past instruction cuts against our safeguards against coercion of older people.
We do not have to guess how this plays out. The Netherlands and Belgium have permitted VAD since 2001 and 2002. Only the Netherlands has extended this to include advance care directives for people who have since lost capacity.
One widely reported case saw a woman with advanced dementia given a sedative in her coffee, without being told, based on a directive whose wording was later disputed.
A review of published cases found some did not clearly meet the legal test of unbearable suffering, which many clinicians will attest is hard to assess in someone who can no longer describe it.
Ending a life on the strength of an old instruction, with no way to confirm in the moment whether the person still wants it or even understands what is happening, places a heavy burden on clinicians, as well as loved ones.
Brigid Meney is the Director of Strategy and Mission of Catholic Health Australia.
FULL STORY
VAD and advanced care directives: Fix the care gap, don’t widen the legal one (The Catholic Weekly)
