Alison Biscoe likes to remember her mother Linda Doreen Koehne as the “beautiful person” she was.
“I know I’m biased, but she was an elegant, charming and loving person. No-one had a bad word to say about her,” she said.
This year, Mrs Koehne died via the voluntary assisted dying (VAD) law in NSW. It was a peaceful end.
“Mum had often spoken about voluntary assisted dying and was very much for it,” Mrs Biscoe said.
“She always wanted to be in control of the way in which she ended her life. She didn’t see any point in suffering.”
In February 2023, Mrs Koehne was diagnosed with a malignant melanoma, which had metastasised to her lung.
Twelve years prior, Mrs Koehne had a melanoma successfully removed but “she always knew it could pop up somewhere else in her body eventually”, her daughter said.
Mrs Koehne had five cycles of immunotherapy, but for various reasons — such as the spin-off effects the treatment was having on her general health and wellbeing — it was decided that no further cycles would be undertaken.
By the end of 2023, Mrs Koehne had the terminal prognosis necessary to commence the official path towards accessing VAD.
“Throughout her life, she had watched her father and brother die from lung cancer. It was not a scenario she wanted for herself,” Mrs Biscoe said.
“After deciding the date for her death with the VAD team, she lived life as normal. We just did more reminiscing and looked through old photo albums.
“Even on the day itself, Mum still took her vitamins, read the newspaper and had her hair done the day before. She was cool and calm.”
On March 28, Mrs Koehne died via VAD at her daughter’s home in Sydney, surrounded by loved ones and an authorised practitioner. She was 87 years old.
“She was relaxed, comfortable and assured in her decision,” Mrs Biscoe said.
“We had cake, opened a fabulous bottle of champagne and Mum had Frank Sinatra’s My Way playing as we made our final farewells.”
Ultimately, Mrs Biscoe looks back on her mother’s death with comfort.
“I’m grateful. There wasn’t a prolonged period of pain. The process isn’t something to be afraid of and there are trained professionals you can speak to about it — people just deserve that choice. It’s a gift.”
How many people have used assisted dying in NSW?
The Voluntary Assisted Dying Board released their annual report in the final days of November.
It provided an overview of the statistics between November 28 last year and June 30.
In this seven-month period, 1,141 people in the state made a first request to access the VAD process.
In total 398 people passed away via assisted dying in this same period.
During the first assessment phase, 55 per cent of applicant patients were male, 45 per cent female. The median age was 75.
“We will continue to focus on ensuring voluntary assisted dying is accessible across the state to diverse populations, where it aligns with their goals of care,” the board’s chair Jenni Millbank said in the report.
Accessibility to VAD still an issue
Each state — and the ACT once its laws take effect in November next year — requires people to have lived there for at least 12 months in order to access VAD, along with other conditions.
The aim behind the residency requirements was to prevent “death tourism”, which refers to the practice of potential VAD candidates travelling to a jurisdiction for the purpose of assisted dying.
But some feel the laws are restricting access.
The annual report found 63 per cent of applicant patients during the first assessment phase were regionally based in the state. The rest were in Greater Sydney.
Those seeking end-of-life care in NSW rural areas are not allowed to access VAD in neighbouring states and territories, despite assisted dying being legalised across most of Australia.
Many people in remote areas of the state visit doctors and specialists interstate because it’s more accessible, geographically closer and often cheaper.
For example some Broken Hill residents who have their medical care in South Australia.The legal quirk restricting access to VAD
Experts believe there’s “no need” for the outdated voluntary assisted dying restriction.
It is possible, though rare, for VAD recipients to receive exemptions to this rule.
Mrs Koehne was the first person in NSW to apply for and receive an exemption.
She was a long-term resident of South Australia, who decided to move to Sydney in August 2023 to be cared for by her daughter.
Following an earlier separate request process for VAD, Mrs Koehne was then eligible to access the laws in NSW.
“It all worked out perfectly thanks to the residency exemption,” Mrs Biscoe said.
“It would be great if all states and territories would align on legislation and access, because it’s ridiculous — we’re one country.”
Plus, there are federal restrictions of electronic communication in the VAD process.
The Criminal Code Act made it an offence to use a carriage service to publish or distribute material that counsels or incites a person to suicide.
State VAD laws are caught up in the same prohibition via a technicality — which in theory means no conversations about the delivery or administration of a VAD substance can take place over the phone, video call or email between a practitioner and patient.
Experts and Australian suicide prevention organisations agree VAD should not be described as suicide because conflating the two can be damaging.
Dying with Dignity NSW president Penny Hackett said an amendment to legislation to address this issue would be wise.
“It’s a big obstacle that all the states’ VAD boards have highlighted,” Ms Hackett said.
“It puts unnecessary burden on patients or doctors in regional and rural areas to travel large distances, so that they don’t risk legal conjecture.”
‘Challenging but rewarding’
Ms Hackett reflected on the one-year anniversary of the state’s VAD laws “positively”.
“What we’ve seen so far from the clinicians we’ve met is that they’re incredibly supportive of the scheme and committed to the work.”
As per the annual report from the Voluntary Assisted Dying Board, there are 296 authorised practitioners in NSW.
Wade Stedman is the NSW clinical lead voluntary assisted dying as well as being an authorised practitioner for VAD.
With a background in intensive care medicine, Dr Stedman said when the NSW VAD law passed, he had “great interest in it”.
“[Being an authorised practitioner] is a full spectrum of life’s emotions — it’s sad, at times there’s laughter, but in general it is very peaceful.
“A lot of what we do in intensive care is end-of-life care, so I was interested in working in the voluntary assisted dying space. It’s challenging but rewarding.”
Dr Stedman said he had liaised with approximately 10 patients at various stages of the VAD process.
“I want people to know that this is an option for them to consider and to feel reassured,” he said.
“It’s safe, and patients will be well-supported. They can trust that they’ll receive high-quality end of life and palliative care.”
