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“It is not death that a man should fear, rather he should fear never beginning to live” – Marcus Aurelius
George* was a stoic and pragmatic man. At 90 years old, he knew he didn’t want aggressive treatment for the metastatic cancer which, at diagnosis, was already encasing a major artery.
Still sharp as a tack, his determination to access voluntary assisted dying (VAD) was unwavering, and I admired both his candour and his courage.
On the day of his planned VAD administration, he arrived wearing his prized possession: a Coober Pedy Akubra hat. By complete chance (or as I like to believe, fate) I had worn my favourite opal earrings, which perfectly matched the stone set in the hat’s band.
We were both awe-struck.
Just before he died, George gently touched my cheek, lifted the Akubra off his head and placed it on mine.
We stared at each other for such a long time that to this day I truly believe I caught a glimpse of his soul. I wear the Akubra often, the tops of my ears resting in the little dimples made by his.
Moments of human existence
These moments of beautiful, intimate, unparalleled connection are part of the reason I work in the area of voluntary assisted dying.
I came to the practice of VAD more by accident than design. From a young age, I was fascinated by the great transcendental moments of human existence: birth and death. As my medical career progressed, I had my sights set on dual training and being both an obstetric anaesthetist and a palliative care physician.
My palliative care fellowship coincided with when VAD was being debated in WA and I was stunned by the opposition from the specialty in general, and the perceived incongruence between VAD and other forms of supportive end-of-life care.
When my organisation put out an expression of interest for a VAD clinical lead to guide and shape the service implementation ahead of law enactment, I applied, and it’s fair to say that my experiences in offering VAD have changed the entire trajectory of my life and career.
I was one of the first VAD practitioners in WA, have remained the clinical lead for the health service I work for, and am now privileged to sit on the board of the peak body VADANZ.
Rewarding and meaningful work
It’s understandable that doctors may initially feel reluctant to become involved in VAD.
Doctors traditionally see themselves as healers in pursuit of cure and cite the Hippocratic oath as forbidding assistance to die. Many have other ethical and moral objections to assisted dying.
VAD laws in Australia enshrine the right to individual conscientious objection, and I fully support those holding this view.
But for doctors who may simply be unsure of what is involved in VAD — I can highly recommend signing up for online VAD training to learn more.
I have never questioned my ongoing involvement and like to think of myself as a resolute and determined conscientious provider not only of VAD, but of uniquely holistic, patient-centred end-of-life care.
Offering VAD is without a doubt the most rewarding and deeply meaningful work in my entire medical career.
End-of-life choice
Our laws in WA (similar to other Australian states) are among the most conservative in the world; a person can only access VAD if they are already terminally ill.
Assisted dying then does not offer a choice between living and dying, only between dying and dying. Giving a person the ability to regain a sense of agency over a disease that has all but consumed them, is the most extraordinary gift. I consider it an immense privilege to be able to bring peace and comfort to the terminally ill.
VAD is still fairly new in Australia. It became available in Victoria in 2019, with other states following. It will be implemented in the ACT in November 2025. Only the NT has not passed VAD laws.
There is much work to do in ensuring VAD doctors are properly acknowledged and remunerated for their time. Importantly, the peak body VADANZ is providing a forum for practitioners to share expertise and provide mutual support, which is important for reducing a sense of working in stigma and isolation.
VADANZ also advocates for changes to VAD laws that honour patients’ autonomous right to self-determination in end-of-life decision making.
A better death
Assisted dying is vitally important because through deep and meaningful conversations between doctors, patients and their loved ones, we can bring death and dying out of the shadows. We allow patients and their families a better quality of life, and quality of death. Everyone dies; not everyone has to suffer.
I would strongly encourage any doctor who values compassion and connection with their patients to embark on the extraordinary journey that is offering VAD care. On a personal level, I am indebted to all the dauntless warriors I’ve cared for over the last three years, for all they’ve taught me about living, loving and being.
*name has been changed
Dr Clare Fellingham is the VAD Clinical Lead of a large metropolitan health service. She is on the board of VADANZ, the peak body for voluntary assisted dying health professionals and features in the recently-released book Power of Choice (New South) by Julian Kingma documenting personal stories of VAD in Australia.
For information about online VAD training in your state or territory, see here.
The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated.
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If you would like to submit an article for consideration, send a Word version to mjainsight-editor@ampco.com.au.
There are many ways for medical staff to provide compassion to and connection with suffering patients that don’t involve ending their lives .
This shouldn’t be about how it makes doctors “ feel “ . It’s about the patients. This reads like a promotional advertisement .
If a need to be terminally ill is conservative I don’t want to think about where VAD laws in Australia will be in a few years time .
At the top of the article where it states author he title has not been included. I feel this is an oversight which female doctors often receive. I’d suggest rectifying it.
Beautiful article and an incredible role she plays for society.
It’s interesting the relative ease with which someone can end their life when they are feuds with the status quo, when compared with the extreme difficulty that can be encountered in getting an increase in aged care funding to provide assistance to similar elderly persons who want to continue their lives.
As a student, I was once asked to think about my own doctors who inspired me to study medicine. I was stuck at the time- girls were offered little in the way of informed consent or respect for autonomy in the 1990s. Thank you for sharing your insights, your values and your experience. You stand out as an exciting and inspiring role model today.