{"id":311,"date":"2026-04-19T07:59:52","date_gmt":"2026-04-19T06:59:52","guid":{"rendered":"https:\/\/chrisy.com.au\/?p=311"},"modified":"2026-04-19T08:08:55","modified_gmt":"2026-04-19T07:08:55","slug":"voluntary-assisted-dying-dementia-australia","status":"publish","type":"post","link":"https:\/\/chrisy.com.au\/index.php\/2026\/04\/19\/voluntary-assisted-dying-dementia-australia\/","title":{"rendered":"When Choice Comes Too Late: Why Australia Should Extend Voluntary Assisted Dying to Dementia"},"content":{"rendered":"\n[et_pb_section fb_built=”1″ _builder_version=”4.16″ global_colors_info=”{}” theme_builder_area=”post_content”][et_pb_row _builder_version=”4.16″ background_size=”initial” background_position=”top_left” background_repeat=”repeat” global_colors_info=”{}” theme_builder_area=”post_content”][et_pb_column type=”4_4″ _builder_version=”4.16″ custom_padding=”|||” global_colors_info=”{}” custom_padding__hover=”|||” theme_builder_area=”post_content”][et_pb_text _builder_version=”4.16″ background_size=”initial” background_position=”top_left” background_repeat=”repeat” hover_enabled=”0″ global_colors_info=”{}” theme_builder_area=”post_content” sticky_enabled=”0″]\n

Many of us reach a point where these questions stop being theoretical.<\/p>\n\n\n\n

A parent begins to forget small things. A grandparent declines in ways that feel gradual, then suddenly not. A friend receives a diagnosis earlier than expected. Over time, the pattern becomes familiar – and difficult to ignore.<\/p>\n\n\n\n

And alongside it, another thought tends to surface. Quietly, but persistently.<\/p>\n\n\n\n

I wouldn\u2019t want to go through that.<\/em>
I wouldn\u2019t want my family to go through that either.<\/em><\/p>\n\n\n\n

Australia\u2019s voluntary assisted dying laws, as they stand, don\u2019t allow that thought to be translated into a meaningful choice for people with dementia.<\/p>\n\n\n\n

The structural gap in the law<\/h2>\n\n\n\n

Australia has taken a cautious and deliberate approach to voluntary assisted dying (VAD). Every state where it is legal has built in strict safeguards: a person must have decision-making capacity throughout the process, and they must meet clear eligibility criteria, including a limited life expectancy.<\/p>\n\n\n\n

For many conditions, particularly cancer, those safeguards work as intended.<\/p>\n\n\n\n

But dementia sits outside that model.<\/p>\n\n\n\n

Dementia is progressive. Capacity declines over time. The stage at which suffering becomes most profound often comes after the point where a person can meaningfully engage in formal decision-making.<\/p>\n\n\n\n

At the same time, Australian law does not allow an advance request for VAD to be carried out once capacity is lost. Advance care directives can refuse treatment – but they cannot authorise assisted dying.<\/p>\n\n\n\n

The result is not simply a gap. It is a structural exclusion.<\/p>\n\n\n\n

For people with dementia, access to VAD is, in most cases, unavailable. (QUT Real Focus, 2025<\/a>)<\/p>\n\n\n\n

Why people are asking for change<\/h2>\n\n\n\n

Dementia is not a single experience, but its trajectory is well understood.<\/p>\n\n\n\n

It can involve the gradual loss of memory, then recognition, then communication. It can mean increasing dependence, confusion, distress, and the erosion of the traits that once defined a person\u2019s sense of self.<\/p>\n\n\n\n

For many people, the fear is not death itself, but the process that precedes it.<\/p>\n\n\n\n

What is often overlooked is that these concerns are usually expressed early – while the person still has full capacity. They are not hypothetical. They are considered, deliberate, and often repeated over time.<\/p>\n\n\n\n

Yet the current legal framework requires that the decision be made later, at a point when the person may no longer be able to make it.<\/p>\n\n\n\n

This creates a paradox. The law demands clarity at precisely the moment the condition is most likely to remove it.<\/p>\n\n\n\n

The real ethical tension<\/h2>\n\n\n\n

There is a reason this issue remains unresolved.<\/p>\n\n\n\n

The central question is not simply whether people should have choice. It is whether a decision made earlier in the disease should continue to apply later, when that person can no longer confirm or revise it.<\/p>\n\n\n\n

In practical terms, this raises a difficult tension: whose autonomy should prevail – the earlier self who anticipated decline, or the later self who is living through it?<\/p>\n\n\n\n

In some cases, a person with advanced dementia may appear calm or even content, despite having previously expressed strong views about not wanting to live in that state.<\/p>\n\n\n\n

Does the earlier decision still hold? Or does the present experience take precedence?<\/p>\n\n\n\n

These are not abstract philosophical questions. They go to the core of how any system would need to operate.<\/p>\n\n\n\n

What a careful pathway could look like<\/h2>\n\n\n\n

Acknowledging this complexity does not mean the issue is unsolvable. It means any reform must be designed with care.<\/p>\n\n\n\n

Extending VAD to dementia would not require broad access. It would require a narrow, highly regulated pathway based on advance requests made while a person still has capacity.<\/p>\n\n\n\n

At a minimum, such a pathway would need to include:<\/p>\n\n\n\n