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A psychologist with over 45 years of experience describes the daunting challenge of discussing voluntary assisted dying with three close friends who have progressive illnesses, weighing when to raise the topic and when to step back.
A retired psychologist with more than 45 years of experience says he is grappling with how best to navigate likely conversations about voluntary assisted dying with three close friends who have progressive illnesses.
Sam Faces Time Pressure for VAD
He describes the situation as daunting. The three friends, identified only as Sam, Jackie and Sue, each face different circumstances and different degrees of eligibility for voluntary assisted dying, or VAD, in Australia. The first friend, Sam, was diagnosed with Parkinson's five years ago. After the diagnosis, the psychologist asked whether Sam had considered a Plan B, a shorthand between intimates that Sam understood but declined, feeling optimistic about treatment breakthroughs.
Now Sam's condition is deteriorating, and he understands that because he is unlikely to die soon, he may be ineligible for VAD in Australia. His alternatives include travelling overseas, perhaps to Switzerland, where the criteria are less restrictive. The psychologist worries that time is running out for Sam to fully investigate these possibilities and, if he decides to proceed, to finalise all the necessary arrangements.
An Australian study of VAD patients' loved ones described their sense of a race to complete the process before the person died, became too unwell, or lost decision-making capacity. The psychologist admits to a tendency to plan, organise and initiate action, calling himself a bit of a control freak who feels strongly inclined to raise the topic again. But he also knows he must let Sam arrive at his own conclusion in his own time frame, not the psychologist's own.
He considers whether to wait until Sam brings up the topic again and then offer assistance, or to tentatively suggest: Would you like to talk again about the Plan B we discussed, or would you prefer I leave it alone? He is 90 per cent decided on the second option, which he sees as respectful and sensitive while not avoiding the issue. The second friend, Jackie, has multiple sclerosis.
Jackie Weighs VAD and Family Conflict
Even though it will not kill her any time soon, it may eventually land her in a nursing home. Her understandable terror is a stranger wiping her bum. She has raised the Plan B option with the psychologist on numerous occasions recently. Like Sam, Jackie is probably ineligible for VAD in Australia, so she is actively researching similar alternatives.
Her intentions seem equivocal, as she fluctuates between guarded enthusiasm and avoidance. Patience on the psychologist's part is paramount. So far he has responded by listening, sitting in silence and showing empathy. Critically, he makes space for whatever view she is expressing, even if it is the opposite of last week's.
He asks Jackie how her family members are coping with her deliberations. She sighs and rolls her eyes, for not everyone is on board. There are philosophical differences between her children on the morality of assisted suicide, which are rekindling long-suppressed sibling rivalries. These leave Jackie understandably hesitant.
This is not uncommon, but family therapy is a plausible way to address it. The psychologist mentions this to Jackie and she seems relieved. He cautions her that while universal agreement may not be attainable, a trained facilitator could help relatives understand her wishes, express their own reservations and prevent any disagreement from paralysing her. It is one step forward, one back, one sideways.
Sue Seeks VAD Without Burdening Loved Ones
The third friend, Sue, has advancing motor neurone disease. She is adamant that she wants to access VAD in Australia before her symptoms become unbearable. Sue also feels strongly that, apart from avoiding pain and suffering, she does not want to burden her caregivers or disrupt her loved ones' lives. Conundrums abound here.
How do you support someone wanting VAD if you question their reasoning? Does supporting Sue validate her view that she would be a burden? The psychologist's own approach is to respect and support Sue's right to make this decision while clearly communicating to her that she remains wanted, valued, and loved.
He has come to the conclusion that raising the option of VAD or other forms of assisted dying morphs into pressure when we ignore our loved one's values, agenda and timeline and instead impose our own. In these delicate conversations, the role of a friend is neither to promote VAD nor to avoid it.
Instead, we should ask whether the person wants to talk, help source accurate information if it is requested, sit with the inevitable uncertainty and, crucially, recognise when to step back. This excruciating decision must remain theirs, but they should not have to contemplate it alone. All names and details have been changed. Peter Quarry is a retired psychologist and writer.
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theage:I want to talk to a friend about voluntary assisted dying, but I feel like I’m pressuring them 
brisbanetimes:I want to talk to a friend about voluntary assisted dying, but I feel like I’m pressuring themThis story was compiled and edited by the HeadTopics newsroom and HT AI from the reports above.
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