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Forgione MO, Smith A, Hocking CM. Medical oncologist perceptions and willingness to participate in voluntary assisted dying in South Australia. Intern Med J 2024; 54:1219-1222. [PMID: 38949456 DOI: 10.1111/imj.16448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 05/21/2024] [Indexed: 07/02/2024]
Abstract
This study surveyed South Australian medical oncologists to capture their perceptions, willingness to participate and perceived barriers and motivations to participation in voluntary assisted dying (VAD) activities. Approximately 70% of surveyed medical oncologists reported familiarity with VAD legislation. Less than half of physicians (39.1%) reported willingness to participate in any VAD activities, and the rate of conscientious objection was 22%. The top barriers to participation were lack of time and uncertainty given no prior experience. These results demonstrate both a low rate of conscientious objection and a low rate of willingness to participate at the point of VAD implementation in South Australia, and identify barriers to participation that are largely logistical.
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Affiliation(s)
- Michelle O Forgione
- Northern Adelaide Cancer Centre, Northern Adelaide Local Health Network, Adelaide, South Australia, Australia
- Adelaide Medical School, the University of Adelaide, Adelaide, South Australia, Australia
| | - Annabel Smith
- Northern Adelaide Cancer Centre, Northern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Christopher M Hocking
- Northern Adelaide Cancer Centre, Northern Adelaide Local Health Network, Adelaide, South Australia, Australia
- Adelaide Medical School, the University of Adelaide, Adelaide, South Australia, Australia
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2
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Michael N, Jones D, Kernick L, Kissane D. Does voluntary assisted dying impact quality palliative care? A retrospective mixed-method study. BMJ Support Palliat Care 2024:spcare-2024-004946. [PMID: 38871403 DOI: 10.1136/spcare-2024-004946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Accepted: 05/15/2024] [Indexed: 06/15/2024]
Abstract
OBJECTIVES We aimed to explore the relationship between the pursuit of voluntary assisted dying (VAD) and the delivery of quality palliative care in an Australian state where VAD was newly available METHODS: We adopted a retrospective convergent mixed-methods design to gather and interpret data from records of 141 patients who expressed an interest in and did or did not pursue VAD over 2 years. Findings were correlated against quality domains. RESULTS The mean patient age was 72.4 years, with the majority male, married/partnered, with a cancer diagnosis and identifying with no religion. One-third had depression, anxiety or such symptoms, half were in the deteriorating phase, two-thirds required help with self-care and 83.7% reported moderate/severe symptoms. Patients sought VAD because of a desire for autonomy (68.1%), actual suffering (57.4%), fear of future suffering (51.1%) and social concerns (22.0%). VAD enquiries impacted multiple quality domains, both enhancing or impeding whole person care, family caregiving and the palliative care team. Open communication promoted adherence to therapeutic options and whole person care and allowed for timely access to palliative care. Patients sought VAD over palliative care as a solution to suffering, with the withholding of information impacting relationships. SIGNIFICANCE OF RESULTS As legislation is expanded across jurisdictions, palliative care is challenged to accompany patients on their chosen path. Studies are necessary to explore how to ensure the quality of palliative care remains enhanced in those who pursue VAD and support continues for caregivers and staff in their accompaniment of patients.
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Affiliation(s)
- Natasha Michael
- Monash University Faculty of Medicine Nursing and Health Sciences, Melbourne, VIC, Australia
- Faculty of Medicine, University of Notre Dame, Australia, Sydney, NSW, Australia
| | - David Jones
- Anscombe Bioethics Centre, Oxford, UK
- St Mary's University Twickenham, London, UK
| | - Lucy Kernick
- Faculty of Medicine, University of Notre Dame, Australia, Sydney, NSW, Australia
| | - David Kissane
- Monash University Faculty of Medicine Nursing and Health Sciences, Melbourne, VIC, Australia
- Faculty of Medicine, University of Notre Dame, Australia, Sydney, NSW, Australia
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Light E, Kerridge I, Skowronski G, Venkatesha V, Krishnamurthy A, Kuper S, Noonan K, Hoyle P, Arnold M, Manley S, Stedman W, Sheahan L. Clinician perspectives on voluntary assisted dying and willingness to be involved: a multisite, cross-sectional survey during implementation in New South Wales, Australia. Intern Med J 2024; 54:724-734. [PMID: 38093686 DOI: 10.1111/imj.16305] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 11/15/2023] [Indexed: 05/18/2024]
Abstract
BACKGROUND In the context of nationwide law reform, New South Wales (NSW) became the last state in Australia to legalise voluntary assisted dying (VAD) - commencing 28 November 2023. Clinicians have divergent views regarding VAD, with varying levels of understanding, support, and willingness to be involved, and these may have a significant impact on the successful implementation. AIMS To understand levels of support, understanding and willingness to be involved in VAD among clinical staff across NSW during implementation of VAD. METHODS A multisite, cross-sectional online survey of clinicians across four local health districts, assessing relevant demographics, awareness of and support for VAD legislation and willingness to be involved in different levels of VAD-related clinical activities. RESULTS A total of 3010 clinical staff completed the survey. A majority of participants were aware of VAD legislation in NSW (86.35%) and supportive of it (76%), with nursing and allied health clinicians significantly more likely than medical specialists to express support. Among medical specialists, support was statistically more likely in those who did not care for patients at the end of life and those with limited knowledge of the legislation. Willingness of medical specialists to perform key roles was significantly lower, with 41.49% willing to act in coordinating or consulting roles, and only 23.21% as administering practitioners. CONCLUSIONS The majority of clinical staff surveyed across NSW supported VAD legislation. While many eligible clinicians were reluctant to be actively involved, sufficient numbers appear willing to provide VAD services, indicating that successful implementation should be possible.
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Affiliation(s)
- Edwina Light
- Sydney Health Ethics, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Ian Kerridge
- Sydney Health Ethics, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- Haematologist and BMT Physician, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Department of Philosophy, Macquarie University, Sydney, New South Wales, Australia
| | - George Skowronski
- Sydney Health Ethics, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- St George Hospital, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | | | - Aravind Krishnamurthy
- Clinical Governance Unit, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Suzanne Kuper
- Northern NSW Local Health District, Ballina, New South Wales, Australia
| | - Kerrie Noonan
- Western NSW Local Health District, Dubbo, New South Wales, Australia
- Public Health Palliative Care Unit, La Trobe University, Melbourne, Victoria, Australia
- School of Social Psychology, Western Sydney University, Sydney, New South Wales, Australia
| | - Philip Hoyle
- Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Mark Arnold
- Western NSW Local Health District, Dubbo, New South Wales, Australia
- School of Rural Health, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Stephen Manley
- Cancer Services and Innovation, Northern NSW Local Health District, Ballina, New South Wales, Australia
| | - Wade Stedman
- Northern Sydney Local Health District, Sydney, New South Wales, Australia
- VAD Implementation, NSW Health, Sydney, New South Wales, Australia
| | - Linda Sheahan
- Sydney Health Ethics, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
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Twycross R. Assisted dying: principles, possibilities, and practicalities. An English physician's perspective. BMC Palliat Care 2024; 23:99. [PMID: 38609945 PMCID: PMC11015689 DOI: 10.1186/s12904-024-01422-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 03/26/2024] [Indexed: 04/14/2024] Open
Abstract
It seems probable that some form of medically-assisted dying will become legal in England and Wales in the foreseeable future. Assisted dying Bills are at various stages of preparation in surrounding jurisdictions (Scotland, Republic of Ireland, Isle of Man, Jersey), and activists campaign unceasingly for a change in the law in England and Wales. There is generally uncritical supportive media coverage, and individual autonomy is seen as the unassailable trump card: 'my life, my death'.However, devising a law which is 'fit for purpose' is not an easy matter. The challenge is to achieve an appropriate balance between compassion and patient autonomy on the one hand, and respect for human life generally and medical autonomy on the other. More people should benefit from a change in the law than be harmed. In relation to medically-assisted dying, this may not be possible. Protecting the vulnerable is a key issue. Likewise, not impacting negatively on societal attitudes towards the disabled and frail elderly, particularly those with dementia.This paper compares three existing models of physician-assisted suicide: Switzerland, Oregon (USA), and Victoria (Australia). Vulnerability and autonomy are discussed, and concern expressed about the biased nature of much of the advocacy for assisted dying, tantamount to disinformation. A 'hidden' danger of assisted dying is noted, namely, increased suffering as more patients decline referral to palliative-hospice care because they fear they will be 'drugged to death'.Finally, suggestions are made for a possible 'least worse' way forward. One solution would seem to be for physician-assisted suicide to be the responsibility of a stand-alone Department for Assisted Dying overseen by lawyers or judges and operated by technicians. Doctors would be required only to confirm a patient's medical eligibility. Palliative-hospice care should definitely not be involved, and healthcare professionals must have an inviolable right to opt out of involvement. There is also an urgent need to improve the provision of care for all terminally ill patients.
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Affiliation(s)
- Robert Twycross
- Emeritus Clinical Reader in Palliative Medicine, Oxford University, Oxford, UK.
- Sir Michael Sobell House, Churchill Hospital, Old Rd, Headington, Oxford, OX3 7LE, UK.
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Graves T. Voluntary assisted dying in Queensland, the first year. Emerg Med Australas 2024; 36:326-328. [PMID: 38413383 DOI: 10.1111/1742-6723.14386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 02/29/2024]
Affiliation(s)
- Timothy Graves
- Emergency Department, Bundaberg Base Hospital, Bundaberg, Queensland, Australia
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Worthington A, Finlay I, Regnard C. Assisted dying and medical practice: questions and considerations for healthcare organisations. BMJ Support Palliat Care 2023; 13:438-441. [PMID: 35473754 DOI: 10.1136/bmjspcare-2022-003652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 04/05/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Most clinical teams and organisations have not openly or formally discussed how they would react if physician-assisted suicide were to be legalised. This paper aims to discuss some of the potential challenges of introducing 'assisted dying' into medical care and produces a table of questions and considerations in light of such evidence so as to promote necessary discussion. METHODS An analysis of recent quantitative and qualitative studies from jurisdictions where 'assisted dying' is practised was conducted, with particular attention paid to studies which focus on the impact of legalising 'assisted dying' on clinical care. RESULTS 'Assisted dying' can have a significant impact on clinical practice by complicating patient care and increasing clinician workload, potentially causing stress on patient care. CONCLUSIONS If physician-assisted suicide was to be legalised as part of existing healthcare, there are many questions that healthcare organisations must consider. Such considerations are tabulated in order to encourage awareness and discussion on the topic.
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Affiliation(s)
- Ana Worthington
- Department of Theology and Religion, University of Oxford, Oxford, UK
| | - Ilora Finlay
- Professor of Palliative Medicine, Cardiff University School of Medicine, Cardiff, UK
| | - Claud Regnard
- Honorary Consultant of Palliative Medicine, St. Oswald's Hospice, Newcastle-upon-Tyne, UK
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White BP, Jeanneret R, Willmott L. Barriers to connecting with the voluntary assisted dying system in Victoria, Australia: A qualitative mixed method study. Health Expect 2023; 26:2695-2708. [PMID: 37694553 PMCID: PMC10632633 DOI: 10.1111/hex.13867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/24/2023] [Accepted: 08/30/2023] [Indexed: 09/12/2023] Open
Abstract
INTRODUCTION Voluntary assisted dying (VAD) is increasingly being legalised internationally. In Australia, all six states have now passed such laws, with Victoria being the first in 2019. However, early research in Victoria on the patient experience of seeking VAD shows that finding a connection to the VAD system is challenging. This study analyses the causes of this 'point of access' barrier. METHODS We conducted semi-structured qualitative interviews with family caregivers and a person seeking VAD, with participants recruited via social media and patient interest groups. Data were thematically analysed. We also undertook documentary analysis (content and thematic) of publicly available reports from the oversight body, the Voluntary Assisted Dying Review Board. RESULTS We interviewed 32 family caregivers and one patient across 28 interviews and analysed six Board reports. Finding a point of access to the VAD system was reported as challenging in both interviews and reports. Four specific barriers to connecting with the system were identified: (1) not knowing VAD exists as a legal option; (2) not recognising a person is potentially eligible for VAD; (3) not knowing next steps or not being able to achieve them in practice; and (4) challenges with patients being required to raise the topic of VAD because doctors are legally prohibited from doing so. CONCLUSION Legal, policy and practice changes are needed to facilitate patients being able to find a connection to the VAD system. The legal prohibition on doctors raising the topic of VAD should be repealed, and doctors and institutions who do not wish to be involved in VAD should be required to connect patients with appropriate contacts within the system. Community awareness initiatives are needed to enhance awareness of VAD, especially given it is relatively new in Victoria. PATIENT OR PUBLIC CONTRIBUTION Families and a patient were the focus of this research and interviews with them about the experience of seeking VAD were the primary source of data analysed. This article includes their solutions to address the identified point of access barriers. Patient interest groups also supported the recruitment of participants.
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Affiliation(s)
- Ben P. White
- Australian Centre for Health Law Research, Faculty of Business and LawQueensland University of TechnologyBrisbaneQueenslandAustralia
| | - Ruthie Jeanneret
- Australian Centre for Health Law Research, Faculty of Business and LawQueensland University of TechnologyBrisbaneQueenslandAustralia
| | - Lindy Willmott
- Australian Centre for Health Law Research, Faculty of Business and LawQueensland University of TechnologyBrisbaneQueenslandAustralia
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White BP, Jeanneret R, Close E, Willmott L. Access to voluntary assisted dying in Victoria: a qualitative study of family caregivers' perceptions of barriers and facilitators. Med J Aust 2023; 219:211-217. [PMID: 37308309 DOI: 10.5694/mja2.52004] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 04/05/2023] [Accepted: 05/10/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To investigate barriers to and facilitators of access to voluntary assisted dying in Victoria under the Voluntary Assisted Dying Act 2017 (Vic). DESIGN, SETTING, PARTICIPANTS Qualitative study; semi-structured interviews with people who had applied for voluntary assisted dying or their family caregivers, recruited via social media and interested advocacy groups; interviews conducted 17 August - 26 November 2021. MAIN OUTCOME MEASURES Barriers to and facilitators of access to voluntary assisted dying. RESULTS We interviewed 33 participants about 28 people who had applied for voluntary assisted dying; all but one of the interviews were with family caregivers after their relatives' deaths, and all but three were conducted via Zoom. The major barriers to access identified by participants were finding trained and willing doctors to assess eligibility for voluntary assisted dying; the time required for the application process (especially given how ill the applicants were); the prohibition of telehealth consultations; institutional objections to voluntary assisted dying; and the prohibition of health practitioners raising voluntary assisted dying with their patients. The major facilitators mentioned were care navigators (both the Statewide service and local navigators); finding a supportive coordinating practitioner; the Statewide Pharmacy Service; and system flow once the process had been initiated (although not during the early days of voluntary assisted dying in Victoria). Access was particularly difficult for people in regional areas or with neurodegenerative conditions. CONCLUSIONS Access to voluntary assisted dying has improved in Victoria, and people generally felt supported while navigating the application process once they found a coordinating practitioner or a navigator. But this step, and other barriers, often still made patient access difficult. Adequate support for doctors, navigators and other facilitators of access is vital for the effective functioning of the overall process.
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Affiliation(s)
- Ben P White
- Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, QLD
| | - Ruthie Jeanneret
- Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, QLD
| | - Eliana Close
- Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, QLD
| | - Lindy Willmott
- Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, QLD
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Haining CM, Willmott L, Towler S, White BP. Access to voluntary assisted dying in Australia requires fair remuneration for medical practitioners. Med J Aust 2023; 218:8-10. [PMID: 36463503 PMCID: PMC10108245 DOI: 10.5694/mja2.51787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 08/01/2022] [Accepted: 08/15/2022] [Indexed: 12/05/2022]
Affiliation(s)
- Casey M Haining
- Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, QLD
| | - Lindy Willmott
- Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, QLD
| | - Simon Towler
- Department of Health, Government of Western Australia, Perth, WA
| | - Ben P White
- Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, QLD
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10
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Yesil I. Whose Choice? A Qualitative Inquiry into Professionals' Moral Positions on Euthanasia in Belgium. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221123153. [PMID: 36036183 DOI: 10.1177/00302228221123153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
Death, which was once accepted as an incalculable otherworld journey initiated by the cessation of biological functions, became an object of socio-political regulation in late modernity. Euthanasia, a form of managing death and dying, has grown in popularity with accompanying controversy. What remains under-explored, however, are conceptions of selfhood animating different framings in moral and ethical debates around euthanasia from professional perspectives. Drawing on 20 interviews with physicians and other key professionals in the euthanasia field in Belgium, this study finds that moral division among participants lies in different attributes of selfhood related to euthanasia, which emphasize autonomous, social, or embodied aspects. This paper demonstrates that the diminishing role of religion in appeasing existential anxiety about death, combined with an increasing emphasis on choice as the basis of selfhood, facilitates the contemporary desire to control one's own demise.
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Affiliation(s)
- Ilay Yesil
- Sociology, University of Bern, Bern, Switzerland
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11
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Willmott L, Feeney R, Yates P, Parker M, Waller K, White BP. A cross-sectional study of the first two years of mandatory training for doctors participating in voluntary assisted dying. Palliat Support Care 2022:1-7. [PMID: 35899414 DOI: 10.1017/s1478951522000931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Voluntary assisted dying (VAD) was legalized in Victoria, Australia, in June 2019. Victoria was the first jurisdiction in the world to require doctors to undertake training before providing VAD. This study examines data from doctors who completed the mandatory training in the first 2 years of the VAD system's operation (up to 30 June 2021). It describes the doctors who are undertaking VAD training, their post-training attitudes toward VAD participation, and their experiences of the mandatory training. METHODS Through the online training, doctors completed a short demographic survey and undertook formal assessment of knowledge (90% pass mark). They also were invited to complete an optional survey evaluating the training. RESULTS In total, 289 doctors passed the training, most commonly males (56%) aged 36-65 years (82%) from an urban location (72%). Most were more than 10 years post fellowship (68%) and practising as general practitioners (51%) or medical oncologists (16%). The training most commonly took 6 h (range 2 h to over 9 h). Most doctors passed the assessment at the first (65%) or second (19%) attempt. Almost all participants (97%) found the training helpful or very helpful and most reported being confident or very confident in their knowledge (93%) and application (88%) of the VAD legislation. SIGNIFICANCE OF RESULTS Doctors reported the training was helpful and improved their confidence in knowing the law and applying it in clinical practice. The profile of trained doctors (particularly their location and specialty) suggests continued growth of participating doctors is needed to facilitate patient access to VAD. It is important that this safeguard does not discourage doctors' participation.
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Affiliation(s)
- Lindy Willmott
- Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, QLD, Australia
| | - Rachel Feeney
- Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, QLD, Australia
| | - Patsy Yates
- Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Malcolm Parker
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Katherine Waller
- Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, QLD, Australia
| | - Ben P White
- Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, QLD, Australia
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Attitudes and Arguments in the Voluntary Assisted Dying Debate in Australia: What Are They and How Have They Evolved Over Time? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312327. [PMID: 34886053 PMCID: PMC8656893 DOI: 10.3390/ijerph182312327] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/19/2021] [Accepted: 11/20/2021] [Indexed: 11/16/2022]
Abstract
This paper provides a broad discussion about voluntary assisted dying (VAD) in Australia. The discussion examines the history of the VAD debate in Australia and whether public support for VAD and the arguments that have provided the framework for the VAD debate have evolved over time. This seems a prudent time to have such a discussion, given the very recent rush by all Australian states to bring about or attempt to bring about VAD legislation. This rush, inexplicably perhaps, comes after decades of attempted but failed progress in the legalisation of VAD in Australia. The authors attempted to undertake a systematic literature review for this paper, but the paucity of academic research and the lack of consistent terminology in this area made such a search untenable. Instead, the authors examined parliamentary documentation and then widened the search via the sources found within this documentation. The examination of available data showed that VAD has enjoyed significant public support from Australians over time and that the arguments in the VAD debate in Australia have been consistent over time.
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