Australian docs tell peers to put patients at heart of assisted dying debate

Two Australian doctors who help terminally ill people access voluntary assisted dying (VAD) have urged peers to keep patients at the heart of their debate. Dr Wade Stedman and Dr Bhawani O'Brien recently visited the UK to share their experience of the country's VAD services. Victoria became the first Australian state to introduce VAD in 2019, followed by the other five states.

Intensive care specialist Dr Stedman, 48, oversaw implementation of the new law in New South Wales. He said the main concerns raised by opponents here - around risk of coercion, mental capacity, prognosis and the medications used to end life - had also been seen in Australia, but none proved to be problems after the law changed. The medic said: "[Considering] coercion, decision-making capacity and prognosis is something doctors do every day of their working life.

"If there is any question about any of those things you can always refer to a specialist, just like you do for any other part of medicine when you're unsure. In reality it's usually very obvious to determine if any of those things are an issue."

Dr Stedman said being found eligible for VAD could bring patients enormous comfort, whether or not they end up using it. He added: "One patient said: 'Now that I've got on with the dying, I can get on with the living'. That's really powerful.

"Less than 1% of the population will die from an assisted death if this bill goes through, so we're talking about a small percentage of the population.

"But for those people whose suffering can't be relieved through good quality palliative care, this provides the comfort of having another option."

Dr Stedman added that the safeguards in the Terminally Ill Adults (End of Life) Bill make it "absolutely inconceivable" that anyone could coerce a vulnerable relative through every step of the process over multiple weeks.

Dr O'Brien, 56, has been a GP for 37 years and has helped with VAD in Western Australia for three years, completing more than 200 assessments. She said the close relationship she builds with patients often involves multiple home visits where she is constantly assessing their capacity.

She explained: "We find in the assessments that consistently the words that patients use are, 'I want control and I want choice over how I'm going to die. I know I'm going to die but I don't want to suffer, I don't want to lose my autonomy, be bed-ridden or nauseated constantly'.

"If they're found eligible there is huge relief and a lot of patients will say to me, 'I'm so glad now that I have this in my back pocket, should I need it'.

"Loved ones and families also notice that the patient tends to live the rest of the time they have with more hope, not of surviving, but without the fear of how they're going to die.

"A man I saw recently said, 'I can't sleep for fear. I'm fearful all the time'. He had a brain tumour."

Dr O'Brien described granting people's end-of-life wishes as "the most fulfilling work I've ever done".

She said many die in "beautiful settings", often at home or in their garden. She added: "We have an ambulance service that will bring them out to the beach, the forest or the bush, and they can die there if they want to.

"They die with dogs on their bed, children around them, music on, candles burning - whatever they want."

Part of Dr O'Brien's role is to speak to patients about the treatment and palliative care they are receiving and arrange further support if needed.

"Palliative care is excellent but we can't help all symptoms and prevent all types of death," she said.

The doctors have shared their expertise with members of the House of Lords at events in Westminster ahead of the debate.

Dr Stedman added: "Our wish in coming here is to try and turn the focus to patients because the debates get so caught up in other things. We have pleaded with politicians to keep patients at the centre of the debate - let's hope that happens."