RANZCP homepage
Contact
Log in Log in
  • Become a psychiatrist
    • Psychiatry training
      • About Fellowship training
      • Entry requirements
      • How to apply
      • Time, fees and costs
      • See all
    • International specialists
      • Pathways to FRANZCP
      • Applying for specialist assessment
      • Short-term training placements
      • Area of Need positions
      • See all
    • The Psychiatry Interest Forum (PIF)
      • Join PIF
      • Opportunities for PIF members
      • Essay competition
    • What a psychiatrist does
      • Specialist areas in psychiatry
      • A day in the life
      • Information for high school students
      • Posters, presentations & fact sheets
  • Training, exams & assessments
    • Fellowship Program
      • Program overview
      • Stage 1
      • Stage 2
      • Stage 3
      • See all
    • Advanced Training
      • About Advanced Training
      • Addiction psychiatry
      • Adult psychiatry
      • Child & adolescent psychiatry
      • Consultation–liaison psychiatry
      • Forensic psychiatry
      • See all
    • SIMG placements
      • Partial comparability
      • Substantial comparability
      • Extensions, breaks and reviews of comparability
      • See all
    • Exams & assessments
      • Results and timetables
      • Rotation assessments
      • Exams
      • Psychotherapy Written Case
      • Scholarly Project
      • See all
    • Fees
    • For assessors and supervisors
    • Help centre & support
    • Go to InTrain
  • Clinical guidelines & publications
    • Journals
      • Australian and NZ Journal of Psychiatry
      • Australasian Psychiatry
      • MEDLINE Complete
      • Behavioural & psychological sciences
      • British Journal of Psychiatry
      • Explore all journals
    • Publication library
      • Clinical guidelines
      • Position statements
      • Codes of ethics & conduct
      • Submissions
      • Explore all documents
    • Explore by topic
      • ADHD
      • Electroconvulsive therapy
      • Ketamine
      • Schizophrenia
      • See all topics
  • CPD program & membership
    • CPD program
      • CPD overview
      • Program guide and requirements
      • Key dates
      • Peer review groups
      • Practice Peer Review Program
      • See all
    • Support, breaks & deferrals
      • Deferral or exemption of CPD
      • Leave and return to practice
      • Refresher and remediation programs
      • Wellbeing support
      • Mentoring
      • See all
    • Types of membership
      • Fellowship
      • Affiliate membership
      • Associate (trainee) membership
      • See all
    • Member discounts
    • Benefits of membership
    • Fees and payments
    • Conduct and ethics
    • Expense reimbursements
    • Go to MyCPD
  • Events & learning
    • Upcoming events
      • Conferences
      • Webinars
      • Courses
      • See all upcoming events
    • Catch up & learning
      • Past conference talks
      • Webinar recordings
      • Podcasts
      • Explore all catch-up
    • Series
      • rTMS courses
      • ECT courses
      • Psych Matters podcast
    • Go to Learnit
    • Congress 2023
  • Grants, awards & giving
    • Awards & member recognition
      • Branch awards
      • Faculty and section awards
      • RANZCP awards
      • See all
    • Grants
      • Event grants & scholarships
      • Research grants
      • Trainee grants
    • RANZCP Foundation
      • About the Foundation
      • Research highlights
      • Our patrons
      • Donate
  • News & analysis
  • College & committees
    • About the College
      • What the College does
      • Board
      • Executive team
      • Accreditation of the College
      • See all
    • Public & partners
      • Find a psychiatrist
      • Annual reports & evaluations
      • For health services with STP posts
      • Media centre
      • Join the CPD Program
      • See all
    • In focus
      • Aboriginal & Torres Strait Islander mental health
      • Māori mental health
      • Gender equity
      • Rural psychiatry workforce
      • See all
    • Structure & governance
      • Committees
      • Faculties
      • Sections
      • Networks
      • Committee openings
      • Elections
      • See all
    • Tu Te Akaaka Roa NZ National Office
    • Australian branches
  • Contact
Back to results

Voluntary assisted dying

Position statement Last updated: Sep 2020 Published in Australia

The primary role of medical practitioners in end of life care is to facilitate good quality patient-centred care. This statement should not be taken as explicit or implied support of the legalisation of physician assisted suicide. 

Purpose

Voluntary assisted dying (VAD) continues to be widely debated across jurisdictions in Australia and New Zealand. The Royal Australian and New Zealand College of Psychiatrists (RANZCP) has developed this position statement to provide a psychiatric perspective on VAD.

The RANZCP acknowledges the wide range of views regarding VAD and encourages discussion about relevant ethical considerations.

Key messages

  • Psychiatrists may be involved in assessing and offering treatment for people who have symptoms of mental illness as part of a terminal illness, and in supporting people with irremediable suffering.
  • Priority should be given to ensuring that all individuals at the end-of-life have access to appropriate, high-quality palliative care.
  • Capacity assessment is a minimum safeguard for any voluntary or physician assisted dying process.
  • Psychiatrists must be afforded the right to refuse to participate in voluntary or physician assisted dying.

Definition

The RANZCP acknowledges that there are a range of different terms used for VAD. These alternative terms include ‘physician assisted dying’, ‘physician assisted death’ or ‘physician aided dying’. The terminology used in this position statement is based on the psychiatric and medical literature.

VAD refers to situations where doctors prescribe 1 lethal substances to informed patients who have a terminal illness or a grievous and irremediable medical condition. These individuals must possess the legal capacity to decide that they wish to end their own lives at a time of their own choosing.

Background

Recent surveys suggest that around 80% of Australians and 70% of New Zealanders support the legalisation of some kind of VAD, although these numbers vary depending on details of the proposed scheme.  [1-3] Medical opinion is more divided, with the Australian Medical Association, New Zealand Medical Association and World Medical Association considering that doctors’ involvement in VAD may in some cases be inappropriate or unethical. [4]

VAD was legalised in Victoria in 2017 and Western Australia in 2019; for an incurable medical condition that one is suffering from and who is experiencing intolerable suffering. Debate around the legalisation of VAD is at varying stages across other Australian and New Zealand jurisdictions. VAD has been legalised in some international jurisdictions across Europe and the United States. Even where VAD is illegal, some patients may request VAD from their doctors.

All medical practitioners involved in the administration of any stage of the VAD process should be familiar with the relevant legislation and regulations of their jurisdiction(s). [5]

The role of psychiatrists

During the assessment process for VAD applications, psychiatrists may be asked to see individuals who are considering or wish to discuss VAD. In these circumstances psychiatrists will, through the identification and treatment of mental illness, make recommendations about mental health treatment and care irrespective of VAD considerations. Psychiatrists may also be involved in providing consultative support to colleagues in relation to VAD; such as general practitioners, palliative care specialists and psychologists, and this should be recognised within health services. [6]

Psychiatrists may also be involved in assessing a person’s capacity to decide about VAD. Assessment of capacity in this context is challenging and requires an evaluation of the person’s thought processes and the effect that emotional factors have on their capacity. It is important to note the issue of capacity as a critical consideration in the application for and administration of VAD. An assessment of capacity is not diagnosis-specific but rather is focused on a person’s ability to make the decision. [7] An assessment of capacity does not necessarily require a psychiatrist, and the role of the psychiatrist will not usually be as a capacity assessor.

The motivation to access VAD in terminally ill people is likely to reflect multidimensional distress in relation to end-of-life suffering. In addition to physical suffering, people in this situation may experience depression, anxiety, organic mental disorders and delirium, as well as psychological distress. A psychiatrist’s specific skills in the diagnosis and treatment of psychiatric illnesses, and their expertise at differentiating those illnesses from adjustment reactions to extreme personal circumstances, are particularly relevant in terminally ill patients. Psychiatrists should also be aware that an individual’s cultural and religious beliefs may influence their decision to access VAD. Psychiatrists can play an important role in ensuring that health services are aware of any necessary protocols important to that individual and/or their community. [8]

The RANZCP affirms that it is a right of medical practitioners to choose whether they wish to be involved in VAD and to determine the extent of their involvement. Psychiatrists must never be required (i.e. mandated) to participate in the VAD process.

Recommendations

The RANZCP recommends that discussions about VAD include consideration of:

  • the primary role of medical practitioners to facilitate the provision of good-quality, comprehensive and accessible healthcare, including end-of-life care.
  • the need to consider mental health as a core factor in comprehensive end-of-life care.
  • the role of psychiatrists in end-of-life care to assess and treat mental health conditions that are contributing to suffering, and to treat those conditions in the first instance.
  • the importance of medical practitioners being allowed to make their own ethical decisions with regard to their involvement with VAD, in line with relevant legislation.

Further reading

  • Voluntary Assisted Dying Legislation in Australian states and territories and New Zealand 

1 Note in some jurisdictions, clinicians may administer where recipients are unable.

Responsible committee: Committee for Professional Practice 



References

1. Cartwright C. FactCheck Q&A: do 80% of Australians and up to 70% of Catholics and Anglicans support euthanasia laws? The Conversation. 2019.

2. Gendall P. Euthanasia support dependent on circumstances - Massey University. 2010.

3. Hurley E. Newshub poll: Most New Zealanders support euthanasia. Newshub. 2018.

4. Australian Medical Association. Euthanasia and Physician Assisted Suicide. 2016.

5. Department of Health and Human Services (Vic). Voluntary Assisted Dying Bill: Discussion Paper.

6. Australian Commission on Safety and Quality in Health Care. National Consensus Statement: Essential elements for safe and high-quality end-of-life care. 2015.

7. Stewart C, Pesiah C, B. D. A test for mental capacity to request assisted suicide. Journal of Medical Ethics. 2011;37: 34–9.

8. Queensland Health. ‘Sad News, Sorry Business: Guidelines for caring for Aboriginal and Torres Strait Islander people through death and dying’. 2015.


Disclaimer: This information is intended to provide general guidance to practitioners, and should not be relied on as a substitute for proper assessment with respect to the merits of each case and the needs of the patient. The RANZCP endeavours to ensure that information is accurate and current at the time of preparation, but takes no responsibility for matters arising from changed circumstances, information or material that may have become subsequently available. 

Your health in mind

For the public

Expert mental health information for everyone
  • Find a psychiatrist
  • Complaints about psychiatrists
  • Mental illness fact sheets

About the College

  • Offices and branches
  • Media centre
  • About us
  • For health services with STP posts

Jobs

  • Career opportunities at the College
  • Psychiatry Jobs Hub
  • Committee openings

RANZCP Head Office

309 LaTrobe Street

Melbourne VIC 3000

Australia

T: 1800 337 448 (Australia) T: 0800 443 827 (New Zealand) E: ranzcp@ranzcp.org

Contact

  • Contact the College
  • Advertising options
  • Consultation Hub

We acknowledge Aboriginal and Torres Strait Islander Peoples as the First Nations and the Traditional Owners and Custodians of the lands and waters now known as Australia, and Māori as tangata whenua in Aotearoa, also known as New Zealand.

Our commitment to Aboriginal and Torres Strait Islander mental health Our commitment to Māori mental health
© The Royal Australian and New Zealand College of Psychiatrists
  • Privacy policy
  • Terms of use