Understanding Voluntary Assisted Dying: A Compassionate Option in Advanced Bowel Cancer

Facing advanced bowel cancer is incredibly confronting. For some, despite every available treatment, the disease may progress to a point where options become limited and the focus shifts entirely to comfort and dignity. In these moments, some patients begin to explore voluntary assisted dying (VAD) as a deeply personal and compassionate option.

VAD is now legal in every Australian state (and due to be implemented in the ACT and Northern Territory in 2025), giving eligible patients the right to request medical assistance to end their lives on their own terms. This blog aims to help you understand what VAD is, how it works, and what it means for bowel cancer patients in Australia. Whether you’re just starting to explore the topic or supporting a loved one through this stage, knowing the facts is an important step toward making informed and empowered decisions.

What Is Voluntary Assisted Dying?

Voluntary assisted dying refers to a legal process that allows eligible adults with a terminal illness to choose to end their life with medical assistance. This can involve taking prescribed medication themselves or, in some states, having a doctor administer it.

The core principles behind VAD are:

• Voluntary: The decision must be made freely and without pressure.
• Assisted: Medical practitioners are involved in assessing eligibility and providing the medication.
• Dying: It is only available to people who are already dying, it is not an alternative to treatment or palliative care.

Why VAD Matters in Advanced Bowel Cancer

For Australians living with advanced or metastatic bowel cancer, the road can be incredibly challenging. Treatments may eventually stop working, and symptoms like pain, bowel obstruction, or severe fatigue can become harder to manage.

Palliative care remains the gold standard for symptom relief and quality of life, and for many, it’s enough. But for some, even the best palliative care may not relieve all suffering. This is where VAD can be an option to consider, not as a way to give up, but as a way to reclaim choice, peace, and control.

Is VAD Legal in My State?

As of April 2025, VAD is legal and accessible in the following Australian states:

• Victoria
• Western Australia
• Tasmania
• South Australia
• Queensland
• New South Wales

The Australian Capital Territory and Northern Territory have passed legislation and are in the process of implementing their programs, with access expected in late 2025.

Each state has its own process, but the eligibility criteria and safeguards are broadly similar.

Who Is Eligible for VAD?

To access VAD in Australia, you must meet all of the following criteria:

• Be aged 18 years or older
• Be an Australian citizen or permanent resident (with additional residency conditions in some states)
• Have decision-making capacity
• Be acting voluntarily and without coercion
• Be diagnosed with an advanced, incurable illness, with death expected within 6 to 12 months (depending on the state)
• Be experiencing suffering that cannot be relieved in a manner acceptable to you

For bowel cancer patients, this typically means having advanced or metastatic disease where curative treatments are no longer available. You’ll need to be assessed by at least two independent doctors who have completed VAD-specific training. Some states also require a final review step.

What’s the Process?

The VAD process varies slightly by state, but usually includes these steps:

• First request: You initiate the process by making a formal verbal request to a doctor.
• Assessment by coordinating practitioner: A doctor confirms eligibility and guides you through the process.
• Second assessment: Another independent doctor also confirms eligibility.
• Written declaration: You complete a signed, witnessed declaration.
• Final request: After a set waiting period, you make a final verbal request.
• Prescription and medication: If approved, the prescription is issued, and medication is dispensed according to state protocol.

In some cases, the medication is self-administered at home; in others, a doctor may assist directly. Patients are never forced to proceed, they can withdraw at any time.

More detailed state-by-state guides are available at the QUT End of Life Law in Australia website.

Emotional and Ethical Considerations

Choosing to pursue VAD is not an easy decision. It’s a deeply personal one that brings up big emotions, for you, your loved ones, and your care team. These might include:

• Fear about the process
• Guilt about “giving up”
• Relief in having control
• Conflict with cultural or spiritual beliefs
• Worry about how loved ones will cope

It’s important to seek support throughout this time. Palliative care teams, psychologists, spiritual care workers, and social workers can all help guide you. Some cancer centres also offer advance care planning services to talk through your wishes in a safe space.

You might also want to have open, honest conversations with your family or chosen support people so they feel informed and included.

Common Myths About VAD

• Myth: VAD is the same as euthanasia.
  Fact: In Australia, VAD is a patient-led process. The person must make the request and give consent multiple times. Euthanasia, in contrast, generally refers to someone else making the decision.
• Myth: Doctors will suggest VAD to patients.
  Fact: It is illegal for doctors to initiate a conversation about VAD in some states (like New South Wales and Victoria). You must be the one to bring it up.
• Myth: VAD is an “easy way out.”
  Fact: The process is thorough, highly regulated, and built around safeguarding. It’s only available to people who are already dying and experiencing significant suffering.

How Does It Fit With Palliative Care?

Voluntary assisted dying is not a replacement for palliative care, the two often work hand in hand. In fact, most people who access VAD are already receiving palliative care.

Here’s how they work together:

• Palliative care focuses on quality of life, symptom relief, and emotional support
• VAD offers an option when suffering becomes unbearable, and no further treatments help

Having VAD available doesn’t mean you’re giving up on palliative care. It simply means you have an extra layer of choice and control when facing the end of life.

To learn more about palliative care, visit Palliative Care Australia or Bowel Cancer Australia’s Support Services.

Talking to Your Doctor

If you’re considering VAD or just want to know more, you can start the conversation with your:

• Oncologist
• Palliative care team
• General practitioner

If you’re in a state where doctors are not allowed to raise the topic, you’ll need to ask directly: “Can we talk about voluntary assisted dying?”

Don’t be afraid to advocate for yourself. You’re allowed to ask questions, take time to decide, and change your mind at any point.

Support for Families and Carers

Watching a loved one go through the VAD process can be incredibly emotional. Family members may need time to process what’s happening, and feelings can vary, from deep respect to fear or sadness.

Support services are available for carers and families, including:

• Bereavement counselling
• Grief support groups
• Spiritual and cultural care
• Practical help with paperwork and planning

Consider reaching out to Carer Gateway or your hospital’s social work team. Some states also have VAD-specific care navigators who can help guide families through the process.

Indigenous, Cultural and Religious Considerations

Voluntary assisted dying is a sensitive topic across many cultures and faiths, including among Aboriginal and Torres Strait Islander communities. It’s important that any conversations around VAD are approached respectfully and in a culturally or spiritually safe manner.

Some health services offer Aboriginal Liaison Officers or Cultural Support Workers to help guide discussions. If you’re part of a culturally and linguistically diverse community, you can also access interpreting services and translated resources through your hospital or Health Translations Victoria.

For those with religious beliefs, the idea of VAD may raise complex ethical or spiritual questions. It’s okay to feel conflicted. You might consider speaking with a trusted faith leader, chaplain, or spiritual care worker, many hospitals have these roles available to help patients and families navigate end-of-life decisions in line with their values.

Final Thoughts

Voluntary assisted dying is not about giving up, it’s about giving people with terminal illness the right to choose a peaceful, dignified end if their suffering becomes unbearable. For those facing advanced bowel cancer, knowing that VAD is a legal, regulated, and compassionate option can offer comfort, even if they never choose to use it.

Personally, I’ve known friends who’ve chosen this path, and it’s something I’ll consider if and when I reach that point in my own journey. Everyone deserves the chance to die on their own terms, not just in pain or fear, but with agency and support.

If you’re thinking about this path, or just want to learn more, it’s okay to ask. Reach out, talk to your healthcare team, and gather the information you need to make the decision that’s right for you.