The Western Australian GP explains why patient care remains at the heart of voluntary assisted dying.
Bhawani O’Brien is a Western Australian GP with decades of end-of-life experience. Ahead of the Assisted Dying Bill’s Second Reading in the House of Lords, she talks to Healthcare Today about capacity assessments, safeguards and why voluntary assisted dying isn’t about rushing death, it’s about reassurance.
The UK is about to debate assisted dying again. What do you think lawmakers here most need to understand from the Australian experience?
For me, sharing this experience is about reassuring colleagues in Britain that it is safe, compassionate, and that it works. What we are achieving here are calm, peaceful deaths for people whose deaths are already imminent. These patients aren’t afraid of dying itself – what they fear is how they will die.
As doctors, we see deaths that the public often doesn’t. We witness people bleed to death from cancer, suffer intestinal blockages so severe they vomit their own faeces, or gasp for air with end-stage emphysema. These are deeply traumatic experiences, and while pain is one element, it is far from the only one. Patients also endure intractable nausea, breathlessness, and other symptoms that cannot always be controlled.
When you are told this is how your final days will be, and it will only worsen, of course you want a choice. That’s what voluntary assisted dying (VAD) has given patients here: choice and control at the end of life, when they are already dying. And that has been transformative.
“There’s sometimes a fear that voluntary assisted dying and palliative care are in conflict.”
How has the introduction of VAD changed conversations about death and dying in Western Australia?
There’s sometimes a fear that voluntary assisted dying and palliative care are in conflict. In practice, the opposite is true. In Australia, they work hand in hand. One of my responsibilities as a VAD assessor is to make sure every patient is receiving palliative care. If they aren’t, I refer them. And under the Act, I can only have conversations about VAD if I also discuss palliative care options, treatments and likely outcomes.
What that has created is a strong and respectful relationship with palliative care teams. They continue to support patients’ rights until the end, knowing the patient may have VAD in their back pocket if they wish to use it.
Of course, there are still challenges, particularly in some Catholic institutions where conversations are harder. But overwhelmingly, people are reassured when they see their loved ones have calm, peaceful deaths.
Can you describe the impact it’s had on your patients and their families?
I’ve probably assessed more than 200 patients. Every time I ask why they want VAD, the same two words come up unprompted: choice and control. Patients tell me that they have lost control of everything else in their lives because of a disease, but they want control over how they die.
Once patients are found eligible, another word emerges again and again: relief. Families tell us the same – that their loved one seems to gain a new lease on life once the fear of a horrific death is lifted. They can focus on living whatever time remains, reassured that they won’t choke, bleed, or suffocate at the end. Around 30% of patients who go through the process never end up using VAD at all. For them, just knowing the option is there brings peace.
“VAD isn’t about rushing death; it’s about reassurance.”
Some critics argue that assisted dying undermines palliative care. Is that your experience?
Early on, there was concern that patients would apply for VAD and use it straight away. But in my experience – and I’ve been present at many practitioner-administered deaths – patients want to live. They want time with their loved ones. VAD isn’t about rushing death; it’s about reassurance.
Crucially, palliative care is not undermined by VAD. The two work hand in hand. Patients don’t abandon palliative care – in fact, one of my responsibilities at the first assessment is to make sure they are receiving it. If they aren’t, I refer them, whether that means linking them to a consultant in the city via telehealth or community nurses who can visit regularly.
The reality is that many patients are exhausted by their illness, juggling oncology appointments, GP visits, and treatment schedules. They don’t always have the strength to advocate for themselves. Part of our role is to do that for them – to make sure their palliative care needs are being met, while also giving them the reassurance of choice and control through VAD.
Are there any misconceptions in the UK debate that you would like to challenge?
Capacity assessment seems to be a big fear. But honestly, there’s nothing to fear. We assess capacity every single day. When a patient walks into my room, I assume they have capacity unless my conversation with them shows otherwise. It’s usually very clear when someone doesn’t. With VAD patients, it’s the same – it becomes obvious if capacity is lacking. This is no different to the consent we take for any other medical decision.
The other concern is coercion. In four years of practice in Western Australia, we haven’t seen it. In fact, it’s usually the opposite: families urging their loved one not to consider VAD too soon because they don’t want to lose them. Sometimes patients have to stand firm and say: “I love you, but I can’t go on like this”.
How do we assess coercion? The same way we would in everyday practice – by asking direct questions, having conversations and observing dynamics. In general practice, I often coach patients to ask their oncologists difficult but direct questions, because clinicians can sometimes shy away from them. The same applies in VAD: it’s a process built on repeated, honest conversations.
“This work has made my life more meaningful. I find joy in the everyday.”
What safeguards or practices do you consider most important to ensure VAD is ethical and patient-centred?
Talking is a big part of what we do, but ultimately, we are bound by the Act. Every patient must be assessed by two independent doctors. I explain to people that the second doctor isn’t there to check on them, but to check on me – to make sure I’ve done everything correctly under the law. Patients sometimes find the process long and tiring, so we talk about why: the safeguards, the safety nets, the double-checks. Everything is carefully scrutinised. After each visit, I complete detailed paperwork that goes to the oversight board, covering everything from the patient’s medical history to whether they’ve been referred to palliative care. The system is designed to keep patients safe and to ensure their options are never limited.
One example stays with me. I saw a man with end-stage renal failure who was living alone in very poor conditions, with almost no support. At the end of my assessment, I told him he was eligible for VAD, but I also urged him to consider a short stay in palliative care to get his symptoms under control and improve his quality of life. With the help of one of our excellent navigators – nurses, occupational therapists, social workers who guide patients through the system – he agreed. A few days later, I heard back: he was in a hospice, feeling pampered, and his symptoms were 80% better.
That’s what people need to understand: this isn’t a system where someone applies for VAD, is deemed eligible, and then simply chooses a date. Our role is to look at the whole patient, ensure they are supported by palliative care, and help them live as well as possible until the end. VAD is part of that, but it’s never the only part.
You’ve described this work in the past as “deeply meaningful”. Has it changed how you view your role as a doctor?
I don’t think VAD has changed my view of what it means to be a doctor, but it has transformed my life. I’ve always been passionate about medicine. I chose general practice because I loved cradle-to-grave care. But over the past decade, GP work has changed; it often feels like a rushed checklist, and I had lost some of the fulfilment I once had.
With VAD, I’ve found that connection again. This work has made my life more meaningful. I find joy in the everyday. It has taught me how precious time is.
What patients remind me, again and again, is that at the end of life, no one talks about career achievements, wealth, or possessions. They talk about love and connection. I’ve witnessed extraordinary moments: families reconciling, relationships healing.
These moments move you deeply. They strip life back to what really matters, and for me, the fulfilment comes from being able to walk alongside people in those final days.
