Palliative care physicians work in skilled multidisciplinary teams that strive to assess, address and relieve the suffering of those with progressive, advanced and incurable illness. With most people who seek this help, we succeed in improving their quality of life and relieve their suffering to the extent that they wish to live until they die, with dignity, of their underlying disease. However, there will always be a small minority whose suffering cannot be relieved, or who choose not to seek our help.

Studies have found people who seek VAD do so more often for loss of function, control and independence, rather than pain and other symptoms. They are seeking reassurance they can have medical assistance to die at a time of their choosing when they perceive their overall dignity and quality of life is irreparably lost. People with an advanced terminal illness who are depressed deserve full assessment and appropriate management, but not all can be helped and some do not want help. It is these people who we believe deserve a legally-sanctioned option to end their life in a manner and time of their choosing.

A common argument is the “slippery slope”; that once legalised VAD would, almost by stealth, be abused and extended to vulnerable groups in society. Convincing evidence for these assertions has not been found in jurisdictions such as the US state of Oregon, and Belgium, where studies of those who seek VAD have failed to demonstrate any over-representation of these vulnerable groups. A further concern of some is that VAD would damage the doctor’s role as a healer and undermine the doctor-patient relationship. Healing is rarely possible in advanced illness but care, comfort and relief of suffering are core roles of doctors and will always remain so. Evidence from overseas jurisdictions where VAD is legal suggest the doctor-patient relationship is strengthened as they together work through the difficult decision-making near the end of life. Palliative care organisations and practitioners also fear the introduction of VAD would undermine palliative care funding and practice. An international study tour report showed this is not the case. Indeed, evidence from Oregon is that palliative care services have been expanded and strengthened. 

VAD is not part of palliative care as it is currently practiced in Australia, despite misconceptions regarding appropriate palliative care at the end of life. However, we, as palliative care physicians, would have no ethical problem referring a patient to a qualified practitioner or service where VAD was legally available, if that is what the patient desired. Palliative care and VAD are not, and should never be, mutually exclusive. They can coexist as in other places around the world. Whatever happens, excellence in palliative and aged care will overwhelmingly continue to be the “main games” in end of life care. And we will continue to do our very best for those who seek our help.