The clinical lead for New South Wales’ implementation of voluntary assisted dying talks about how Britain should shape its own legislation.
Wade Stedman is an intensive care unit specialist and clinical lead for New South Wales’ implementation of voluntary assisted dying (VAD). He both chaired NSW’s VAD clinical advisory group and authored the state’s first VAD practice handbook. Ahead of the Assisted Dying Bill’s Second Reading in the House of Lords, he talks to Healthcare Today about his own experience, any pitfalls the UK should avoid when shaping its own legislation and the importance of robust safeguards.
The UK is once again considering assisted dying and ahead of the Assisted Dying Bill’s Second Reading in the House of Lords, how relevant is the Australian experience here?
While there are some differences between the UK’s proposed Terminally Ill Adults Bill and the seven Australian assisted dying laws, there are more similarities than differences. Australia provides a strong model of how assisted dying can be implemented safely and effectively.
Are there any pitfalls the UK should avoid when shaping its own legislation?
We have seven different assisted dying acts in Australia, each with subtle differences, but mostly similar in approach. The risk for the UK’s proposed bill is that, in trying to add loopholes to satisfy certain groups, you could end up with legislation that isn’t truly patient-centred. The process could become cumbersome and challenging for patients. When we spoke with peers, our main message was that patients must remain at the heart of any discussion on the Terminally Ill Adults Bill, to ensure the system is both workable and genuinely patient-focused.
How do you see the role of VAD alongside palliative and critical care in a health system like the NHS?
In every country where assisted dying has been legalised, palliative care remains central to high-quality end-of-life care, and that won’t change with the Assisted Dying Bill. More than 99% of people in the UK will still die through the same pathways they do today. Fewer than 1% may want and be eligible for assisted dying, and the majority of those will still be in palliative care. In Australia, for example, over 80% of patients who request assisted dying are also receiving palliative care. That means the two processes run in parallel: patients continue to have access to high-quality palliative care while exploring assisted dying as another option. For me, palliative care will always remain at the centre, ideally working alongside assisted dying to give patients the best possible end-of-life experience.
“If you follow the Act and its due processes, you end up with what is arguably the most regulated area of healthcare.”
NSW was the last Australian state to introduce VAD. What lessons did you learn from the earlier rollouts elsewhere in Australia?
In Australia, voluntary assisted dying has been legal for six years, beginning in Victoria. In New South Wales, where I work, it has been legal for almost two years, and in the Australian Capital Territory – the seventh jurisdiction – the law will come into force this November.
My role wasn’t so much in developing the bill itself, but in implementing the clinical processes once it passed. After the legislation was voted through, we had an 18-month implementation period, during which I served as medical lead. That gave us the chance to learn a great deal from other states – what worked well and what didn’t. By that I don’t mean the medication, but the processes: how to make the system efficient and genuinely patient-centred, and how to turn the legal framework into practical, compassionate healthcare.
We decided to use the same medications as every other state, because they were already proven to be safe and effective. We knew the doses, the efficacy, the practicalities – how a patient takes it, the volume, all those details that are critical to ensuring safety. The ACT has since adopted the same approach. To me, that consistency just made sense.
How did you balance ensuring robust safeguards with making the system workable for patients and clinicians?
In many ways, the safeguards built into the UK’s proposed Assisted Dying Bill would actually enhance safety for both patients and clinicians. Right now, concepts like terminal or palliative sedation are a little ambiguous – different clinicians may define or approach them differently. By contrast, an assisted death is a clearly defined process. The safeguards are written into the legislation, so clinicians know exactly what is required of them.
Of course, some clinicians are hesitant at first because they want to be absolutely sure they get it right. But the detailed guidelines laid out in the bill provide a clear path to follow. That structure not only protects clinicians, it also protects patients. If you follow the Act and its due processes, you end up with what is arguably the most regulated area of healthcare, with extensive safeguards built in – and that makes it very safe.
“Those working in medicine and end-of-life care are already well equipped to support patients through this process.”
You authored NSW’s first practice handbook for VAD. What were the key principles you wanted clinicians to have in hand?
In New South Wales, we have a clinical practice handbook, which serves as the manual for voluntary assisted dying from start to finish. It sets out how the law translates into healthcare practice and gives clinicians detailed guidance at every stage. It covers how to assess issues such as coercion or decision-making capacity, and it outlines a practitioner’s obligations when submitting information to the oversight panel, including exactly what details the panel requires.
The UK will need a similar handbook once legislation is in place. Having a clear, workable clinical document is critical because it becomes the foundation for training and education. It gives clinicians a single point of reference – almost a textbook – to guide them through the process. If a practitioner is ever uncertain about what to do, they have that manual to turn to
What kinds of support or training do doctors and nurses need to feel confident in participating?
It’s important to remind both the community and other healthcare professionals that doctors and nurses who take part in voluntary assisted dying already have the skills they need. Those working in medicine and end-of-life care are already well equipped to support patients through this process.
They don’t need extra medical training. What they do need is a clear understanding of their obligations under the law. That’s why, in Australia, the training in every state focuses on the Act itself – what clinicians must do to help a patient navigate the process, how to assess decision-making capacity, how to recognise coercion, and when to refer people to palliative care or social work.
These are all things clinicians already do every day. Assisted dying doesn’t add new medical challenges – it simply requires practitioners to know and follow the Act.
“Internationally, there’s simply no evidence that coercion is a problem in assisted dying.”
How has the culture within the medical profession shifted since VAD became available?
Yes, it really has changed. At the beginning, some conscientious providers signed up straight away, but many clinicians were undecided or a little fearful of the unknown. Over time, though, the experience has been overwhelmingly positive. Patients and families have shared good stories, and palliative care specialists who’ve supported someone through the process have passed on those experiences to colleagues.
It’s created a domino effect, both in the community and within healthcare, because people are seeing peaceful, dignified deaths. And if you look at places like Belgium, Canada, or the Netherlands, it’s the same pattern. None of those countries advertised assisted dying, but over the years, patient stories shaped community expectations, and the general opinion has become that it’s a positive experience. I’m pleased to say the same has happened in Australia.”
What safeguards are in place to monitor and ensure that VAD remains safe and ethical?
There are so many safeguards in our Act, and in your Terminally Ill Adults Bill, that the idea of coercion is really inconceivable. Internationally, there’s simply no evidence that coercion is a problem in assisted dying. Under the UK bill, for example, you would need two independent doctors, written requests and oversight by an expert panel. The notion that a family could coerce someone through every stage of that process just isn’t realistic.
In fact, what we see in practice is the opposite: doctors and families often try to talk people out of voluntary assisted dying. Coercion tends to push people away from it, not into it. And it’s important to remember that these are patients who are already dying. It’s not a choice between life and death – it’s a choice between dying and dying. The only difference is whether that final stage comes a little earlier and with less suffering.
Many patients have excellent palliative care, but for some – whether it’s existential suffering, fear of losing independence, or other forms of distress – their suffering simply cannot be relieved. For those people, assisted dying provides a vital, dignified option. And in clinical practice, that’s exactly what we are seeing.
