Dr Nick Carr GP in Melbourne and a board member of Dying with Dignity Victoria.

VAD for those tired of life? We shouldn’ t be forced to stay around.

It requires a parliamentary vote, so it is not a done deal, but one plan is the removal of the so-called‘ gag clause’, which prevents doctors from raising the option of voluntary assisted dying( VAD) with patients. This is no great problem for

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the health-literate patient, fluent in English, who has read the VAD requirements and knows to ask.

But we also know that awareness of the VAD option remains relatively low among the general population.

Those with terminal illnesses face many complex decisions. Chemo or not? Surgery, radiotherapy, both or neither? Clinical trial of a yet untested treatment?

In some cases, these options may be brutal, speculative or both, but given an uncertain future and possibly unpleasant death, it is very hard for someone to say no, stop— a choice they might make if they know the option of a peaceful end under their own control is also available.

Consider the following example. Margaret *, a woman in her late 70s who has led a great life, is

diagnosed with a nasty head and neck cancer.

Her oncologist advises that, with surgery, radiotherapy and chemotherapy, it is curable but the recovery and long-term side effects will be severe.

Margaret does her research, speaks to other survivors and decides that, for her, the results of treatment are unacceptable.

Her team strongly urges treatment— after all, it will probably save her life— but she declines and comes to me for VAD.

For her, this is absolutely the right choice. But Margaret is only able to make the choice because she knows to ask.

Had she not known, she would likely have endured a course of treatment and outcome that, for her, would have been misery.

The gag clause was inserted into VAD legislation to stop doctors from saying things like:“ Let’ s not bother treating you; you could just have VAD.”

I believe that this was always a false fear.

I would like to see expanding the eligibility to include people with dementia and also those who are old and frail but without a terminal diagnosis.

In every discussion forum about VAD, dementia is the number one fear among older people, and there is strong demand for VAD to be an option for dementia.

This is a highly complex question, as evidenced by how rarely VAD is used for dementia in jurisdictions overseas where it is available.

Nevertheless, it is a crucial debate. I only hope it has become an option by the time I may need it.

Finally, there is VAD and the notion of a completed life.

I have been consulted by many older people who say they have‘ done their time’.

They have had full and rewarding lives, but now the faculties are failing and the days dominated by aches and pains and visits to the doctor.

Dr Rodney Syme, an early proponent of voluntary euthanasia in this country, used to talk about how we should not have to stay until the end of the last act, the final curtain. It is our show. We should have the choice to leave when we want to.

I strongly believe that VAD should be an option afforded to this group as well.

If that is a slippery slope, sign me up for the ride. * Not her real name.

If this story has raised issues for you or you are concerned about someone you know, call Lifeline on 13 11 14. You can also contact your local Doctors’ Health Advisory Service.