Making decisions about end of life care

In Victoria, voluntary assisted dying may be an option for you at the end of life if you have an incurable, advanced disease, which is causing you suffering that you consider to be unacceptable. To be eligible for voluntary assisted dying, you must be expected to die in the not too distant future (normally within weeks or months, but not more than six months, or 12 months for people with a neurodegenerative condition). If you are thinking about voluntary assisted dying, then you may be considering making decisions about this last period of your life.

Often people want to make the best of the time they have left. The decisions people make are very personal. Some people may want to continue with treatment options, aiming for a longer life. People usually make decisions balancing out the effects of treatment, their quality of life and what matters to them as well as the suffering they are experiencing.

Care at the end of life can be provided in a range of settings. For example, in hospitals, at home or in aged care services. It can also be provided by a range of different health practitioners, including GPs, medical specialists, nurses, social workers and others.

Advance care planning

If you don't already have an advance care plan you may want to make one. If you already have one, you may want to update it so that it is relevant to the way your disease is likely to develop. Advance care plans are important to help those close to you know about the level and type of health care you want, if you become unable to make those decisions yourself.

If you haven't already done so, you can appoint a medical treatment decision maker to make healthcare decisions for you if you are no longer able to do so. Your medical treatment decision maker should be someone you trust to make decisions that reflect your values and wishes.

Discussing and writing down your values and preferences in a values directive may help your medical treatment decision maker feel more comfortable about the decisions they make on your behalf. You can also complete an instructional directive consenting to or refusing particular medical treatments in anticipation of losing the ability to make your own decisions.

You cannot ask for voluntary assisted dying in your advance care plan because the plan can only be used if you lose your decision-making ability. However, it may still be useful to have one to guide your medical treatment decision maker in making other decisions for you at the end of life.

Palliative care

At some point, people may start to explore what palliative care offers. Palliative care aims to help people live well with an advanced disease that will limit their life. Palliative care takes a whole-person approach, helping people to take control over the time they have and concentrating on what quality of life means to them. Palliative care can help make people feel more comfortable by treating symptoms such as:

• pain
• nausea
• loss of appetite or sleep
• fatigue
• exhaustion
• restlessness
• delirium
• feelings of breathlessness.

Palliative care plays a very important role in supporting people who are dying, wherever they die, by helping to relieve their pain and suffering and supporting their carers. For many people, palliative care can provide the reassurance they want about dying.

If you decide to ask for voluntary assisted dying, the two doctors who assess your request must tell you about your treatment and palliative care options. They will also encourage you to use palliative care services during the voluntary assisted dying process, if you are not already, to help improve your symptoms and quality of life.

Voluntary assisted dying

Voluntary assisted dying may be a further choice for a small number of people in the late stages of an advanced disease. Voluntary assisted dying involves choosing to take life-ending medication prescribed by a doctor.

There are a number of conditions you must meet to access voluntary assisted dying. There is also a voluntary assisted dying process that must be followed. See What process do my doctor and I need to follow? for more information about the process.