A perfect storm: fear of litigation for end of life care

To the Editor: Mitchell and colleagues1 state, “Victoria has passed assisted suicide legislation, Western Australia plans to follow suit in 2019”. This statement is not accurate. Victoria passed voluntary assisted dying legislation, titled the Voluntary Assisted Dying Act 2017. There is no reference to suicide in this legislation. It is important to understand and acknowledge the substantial differences between suicide and voluntary assisted dying:

• Voluntary assisted dying involves a choice about the manner of death for a person with a terminal illness, whereas the suicidal person usually is not otherwise dying.
• Voluntary assisted dying mandates two independent medical assessments by specially trained doctors to advise on the person's decision making capacity, diagnosis, prognosis, suffering, and possible treatments, whereas suicide has no such pathway of medical scrutiny and support.
• The request for voluntary assisted dying must be from a person with decision making capacity, who does not have a mental illness or major depression underlying their request, whereas suicide frequently involves mental disorders, including depression, bipolar disorder, schizophrenia, and substance misuse.
• Suicide is usually undertaken alone, as an act of desperation, sometimes impulsively, and often violently, whereas voluntary assisted dying involves an enduring decision and a gentle peaceful death, with the person usually surrounded by loved ones.
• Suicide incurs awful bereavement for loved ones, whereas the family and friends of those who had voluntary assisted dying cope better than when a natural death occurs (less grief symptoms and post‐traumatic stress reactions).2
• Suicide is tragic and every effort should be made to prevent it, whereas most of the Australian community want legislative reform for voluntary assisted dying.3

The conflation of suicide with voluntary assisted dying is often a tactic used to denigrate legislative reform. The use of such misleading language should be rejected because it is counterproductive to essential discussions about both voluntary assisted dying and suicide prevention.