Voluntary Assisted Dying and Advance Directives in WA

Two Frameworks That Cannot Overlap

Western Australia legalised Voluntary Assisted Dying (VAD) on 1 July 2021 under the Voluntary Assisted Dying Act 2019. Separately, WA residents can record binding medical treatment decisions through an Advance Health Directive (AHD) under the Guardianship and Administration Act 1990. Both deal with end-of-life decisions. Neither can substitute for the other.

The core incompatibility is capacity. The VAD Act requires the person to maintain decision-making capacity throughout the entire process — from first request through to final administration. The AHD, by definition, only activates when the person has lost capacity. These two frameworks operate on opposite sides of the same boundary line: the AHD governs what happens after capacity is lost; VAD can only happen while capacity is retained.

You cannot use an AHD to pre-authorise VAD for a future scenario. You cannot use an EPG to give your enduring guardian the power to request VAD on your behalf. The Act explicitly prohibits both.

What the VAD Process Requires

To access VAD in Western Australia, a person must satisfy all of the following:

• Be an adult (18 years or older)
• Be an Australian citizen or permanent resident who has been ordinarily resident in WA for at least 12 months
• Have a disease, illness, or medical condition that is advanced, progressive, and is likely, on the balance of probabilities, to cause death within 6 months (or 12 months for a neurodegenerative condition), and is causing suffering that cannot be relieved in a manner the person considers tolerable
• Have decision-making capacity in relation to VAD
• Be independently assessed as eligible by two medical practitioners
• Make the request voluntarily, without coercion

The process involves three formal requests and independent eligibility assessments by two medical practitioners. The person can withdraw at any point. Nobody else — not a family member, not an enduring guardian, not a doctor — can initiate or consent to VAD on the person's behalf.

What an AHD Can Do Instead

While an AHD cannot request VAD, it can address many of the clinical decisions that arise at the end of life:

Refuse life-sustaining treatment. You can refuse CPR, mechanical ventilation, artificial nutrition and hydration, dialysis, and other interventions. This refusal is legally binding once you lose capacity if the AHD is valid and applicable, subject to the limited statutory exceptions. In a terminal illness, refusing these interventions allows the natural progression of the disease — which is legally and clinically distinct from actively ending life.

Consent to palliative sedation. You can consent to pain management medication administered for comfort, even when that medication may have the secondary effect of shortening life. This is protected under the doctrine of double effect — the primary intention is relief of suffering, not the hastening of death.

Set a ceiling of care. You can specify that in certain clinical scenarios (terminal illness, persistent vegetative state, advanced dementia), the focus should shift entirely to comfort-based palliative care with no escalation to intensive interventions.

These decisions, documented clearly in Part 4 of the AHD, give you significant control over your end-of-life treatment without crossing into the VAD framework.

The Planning Overlap

For someone diagnosed with a terminal condition, the practical planning timeline might look like this:

1. While capacity is retained: Consider whether VAD eligibility and access are relevant. If so, speak with a medical practitioner about the formal VAD request process. Separately, complete or update your AHD to cover treatment decisions that would apply if you lose capacity before the VAD process is completed.

2. If capacity is lost before VAD is completed: The VAD process stops. The AHD governs applicable future treatment decisions, subject to the limited statutory exceptions. The enduring guardian (if one is appointed under an EPG) makes personal and lifestyle decisions.

3. If VAD is completed while capacity is retained: The AHD is never activated for that purpose. It remains in force for any other medical event where capacity is lost (such as an unrelated accident or stroke).

The AHD and VAD are not alternatives to each other — they cover different scenarios along the same trajectory. Completing both is not contradictory; it is comprehensive.

The Emotional Dimension

Many people who search for "advance directive euthanasia WA" are not looking for a legal mechanism. They are looking for control over how they die — a way to avoid prolonged suffering that they cannot revoke once they lose the ability to communicate.

An AHD provides significant control within the legal framework: refusing interventions that extend life without improving quality, consenting to comfort care that prioritises dignity, and ensuring that the people making decisions on your behalf know your values. It does not provide the specific mechanism of VAD, but it addresses many of the same fears.

A conversation with your GP about both frameworks — what an AHD can and cannot do, and whether a VAD referral is appropriate — is the practical starting point.

The Western Australia Advance Directive & Living Will Kit covers treatment refusal decisions, palliative care consent, and clinical ceiling-of-care planning — the practical tools for end-of-life control within the AHD framework.

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