Final-wish travel opportunities for the terminally ill: A reflection on the legalisation of voluntary assisted dying in Australia

Assisted death sparked discussions on the difficult choice between dying in dignity and human rights as well as implications on the individuals choosing to end their lives prematurely, write Joshua Aston and Jun Wen, academics from Western Australia Edith Cowan University, in this exclusive research-based commentary.

MY LIFE has been rather poor for the last year or so. And I’m happy to end it” were the last words from Professor David Goodall who traveled to Switzerland in 2018 to commit physician-assisted suicide. Tourism scholars have observed that tourism plays a role in final- wish travel opportunities for the terminally ill. Such stories call to mind a pertinent question: What is the most difficult choice you have ever made? Maybe it concerned a relationship or a professional situation that has had far-reaching impacts on your life. Just imagine how traumatic it would be for a person to decide to end their life, knowing the implications of this choice for their family and friends.

In some jurisdictions, voluntary assisted dying, also referred to as end-of-life choice, medical assistance in dying, and physician-assisted suicide, grants individuals who meet certain eligibility criteria (e.g., extreme suffering) the option to seek medical assistance to end their lives. The process involves access to lethal medication where an individual can choose the manner, place, and time of their death. Making such requests for premature death has sparked a debate around the legality and ethics of these practices in many countries. Yet the option also brings solace to terminally ill people with incurable, degenerative conditions who have no hope of recovery.

Several international and regional human rights treaties advocate for the right to life, such as the Universal Declaration of Human Rights (Article 3), the International Covenant on Civil and Political Rights (Article 6), and the African Charter on Human and Peoples’ Rights (Article 4). However, no specific treaty has established the right to die. In law, the right to life is known to include the right to live with human dignity. It is the state’s duty to refrain from engaging in actions that violate the right to life and to take steps to safeguard it.

As more countries revisit legislation – and, in some cases, amend their prohibitions – to potentially legalize voluntary assisted dying, it is time for the international community to reconsider the status quo on the right to die with dignity. Voluntary assisted dying laws currently apply in certain countries such as New Zealand, the Netherlands, Belgium, Luxembourg, Canada, and certain U.S. states (California, Colorado, District of Columbia, Hawaii, Maine, New Jersey, New Mexico, Oregon, Vermont, and Washington). Legislation has also recently been passed in Spain.

As for Australian states, voluntary assisted dying has been legal in Victoria since June 2019, in Western Australia since July 2021, in Tasmania since October 2022, and in Queensland since January 2023. The practice was also legalized in South Australia at the end of January 2023; it will be effective in New South Wales in November 2023. Each state’s model of voluntary assisted dying is based on shared principles but differs in some respects. For example, Victoria’s Voluntary Assisted Dying Act 2017 requires that the relevant illness be “incurable,” whereas Western Australia’s Voluntary Assisted Dying Act 2019 does not have this condition. Western Australian lawmakers have argued that the injunction that a disease is “advanced, progressive, and will cause death” emphasizes “the terminal nature of the illness or disease.” Despite variations, the eligibility criteria across legislative models are largely similar and seek to achieve the same policy goals.

As nations mature, so do their legal systems. Human rights are both fundamental and inalienable. Every human deserves a peaceful life and a peaceful death. The fact that citizens of one country undertake travel to die in another country, far from their home, friends, and family, highlights the importance of the universality of such laws. Carme Barahona recalled the passing of her son, Ivan Martí, in late 2017: “He sent me a message saying, ‘Thanks for taking care of me, Mom. I am going to rest’.” Ivan, 43, had been diagnosed with amyotrophic lateral sclerosis, an incurable neurodegenerative disease that led to his death. Immediately after receiving her son’s farewell message, Carme made sure to return to her job to prove she had not helped him take his life. Now that assisted dying is legal in Spain, Carme and many others like her are elated.

Public discussions about voluntary assisted dying have increased as more regions and countries legalize it. The complex and controversial nature of this practice has attracted academic attention with implications for stakeholders. Some scholars have explored this subject through the lens of tourism, namely physician-assisted suicide tourism. One such study analyzed YouTube video comments associated with documentaries and stories about voluntary assisted dying. Main discussion themes included human rights, religion, legal issues, and fear of the dying process. Other topics have revolved around the travel required for voluntary assisted dying: physician-assisted suicide travel constraints, travelers’ actual physician-assisted suicide behavior based on a planned behavior approach, physician-assisted suicide travel constraints drivers/motivations, and segmentation of physician-assisted suicide as a niche tourism market (i.e., suicide candidates/patients, caregivers, medical specialists, and relatives). A firm understanding of stakeholders’ perceptions, experiences, attitudes, and associated behavior should develop as more primary data become available. This increased comprehension will substantiate voluntary assisted dying as an ethical path for terminally ill people. However, the public will likely need time to accept this practice and eventually
support people who pursue it.

People around the world have varying beliefs and cultural traditions when it comes to death and dying. Discussions on the Act and legalization of voluntary assisted dying are therefore challenging. As more people start to talk about this option, their conversations can open doors for people who wish to consider it. Now that more lawmakers are willing to review related legislation, it is an opportune time to revisit the term “death with dignity”: an end-of-life option that allows certain eligible individuals to legally request and obtain medications from their physician to end their life in a peaceful, humane, and dignified manner. Voluntary assisted dying could enable more people to pursue death with dignity. Perhaps we should reflect on whether voluntary assisted dying offers a feasible means for people with certain illnesses and conditions to die with dignity. It would also be worthwhile to look into final-wish travel opportunities for the terminally ill. Hopefully, tourism will come to serve more purposes beyond the typical leisure and recreation to cater to other travel segments’ rights and values.

Joshua Aston is an Associate Professor, an Associate Dean (Law), and a member of the Executive in the School of Business and Law, Edith Cowan University. His research focuses on human rights violations, a timely topic in modern civil society.
Jun Wen is a Lecturer in Tourism and Service Marketing at the School of Business and Law, Edith Cowan University.

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