How voluntary assisted dying in the NT would be different to down south

Melbourne, Oct 16 (The Conversation) Voluntary assisted dying is being debated in the Northern Territory (NT) parliament this week.

The NT is now the last jurisdiction in Australia without voluntary assisted dying laws. But it wasn’t always this way. Once, the NT was a pioneer in legalising assisted dying.

Here’s what’s happened since then, and why this time, the conversation looks very different.

A brief history --------------- It’s been nearly 30 years since the NT made history as the first jurisdiction in the world to legalise assisted dying.

In 1995, the NT passed the Rights of the Terminally Ill Act, allowing terminally ill adults to choose a medically assisted death. Four people used the law.

But the Commonwealth overturned it in 1997, removing the power of the NT and Australian Capital Territory to legislate on the issue.

It’s almost three years since the Commonwealth restored the NT’s right to make its own voluntary assisted dying laws.

Now, every other jurisdiction in Australia has legalised voluntary assisted dying, most recently the ACT in 2024.

Why the NT is unique ----------------------- The NT’s context is unlike anywhere else in Australia. It is vast and sparsely populated. It is home to more than 250,000 people, spread across an area more than five times the size of the United Kingdom.

About 30 per cent of Territorians identify as Aboriginal and Torres Strait Islander, and about three-quarters of Aboriginal Territorians live in remote or very remote communities.

Health-care access is limited. Many communities rely on small remote health clinics that face chronic staff shortages and high turnover.

Northern Territory residents, collectively, suffer from disease and die prematurely about 58 per cent more than the national average. The number of years of life lost by Indigenous Territorians as a result of ill health, poor nutrition and other causes is 3.5 times the number for non-Indigenous residents.

Against this backdrop, introducing voluntary assisted dying raises complex questions. How can Territorians exercise equal choice at the end of life – either with each other or in comparison with Australians in other jurisdictions – when access to doctors, nurses, interpreters, and even reliable internet varies so widely? Telehealth is a major barrier ------------------------------- Under the Commonwealth criminal code, using “a carriage service” such as a phone or the internet to discuss or arrange assisted dying remains illegal, as it falls under prohibitions on suicide-related material.

A federal court confirmed in 2023 this restriction applies to voluntary assisted dying. For people in remote NT communities, where the nearest doctor might be hundreds of kilometres away, this makes equitable access almost impossible.

Until this issue is resolved, voluntary assisted dying in the NT and elsewhere in Australia can only occur through face-to-face consultations. This is an unrealistic expectation for many rural, remote and frail residents, when telehealth is an accepted part of health care in other areas.

Aboriginal perspectives ------------------------- Views among Aboriginal Territorians on voluntary assisted dying are diverse and deeply nuanced, as we heard during consultations led by the NT Voluntary Assisted Dying Independent Expert Advisory Panel.

Many Aboriginal organisations told the panel they supported equitable access to all end-of-life services. Others raised cultural, spiritual and religious concerns.

As one community-controlled organisation told the panel: 1) People might engage better with health services knowing that it could be an option to come back [to Country].

2) Others expressed unease, noting that assisted dying could conflict with cultural or religious beliefs. One Aboriginal organisation told the panel: 3) For the older generation, [who have] one foot in the Dreamtime and another in religion, this would probably be really difficult.

In research published earlier this year in the Medical Journal of Australia, we expand on such issues and highlight an important difference in world views.

Western medical models emphasise individual autonomy, while Aboriginal decision-making often happens collectively, in kinship networks.

Voluntary assisted dying laws that require a person to act independently and without influence may not easily align with cultural norms around family consultation and shared decision-making.

Cultural safety and co-design -------------------------------- “Cultural safety” is care that Aboriginal patients and communities define as safe. This will be essential if voluntary assisted dying becomes law. However, it means more than translating forms or providing interpreters. It involves building trust, recognising power imbalances, and ensuring Aboriginal voices are central to governance and service delivery.

The Legal and Constitutional Affairs Committee report tabled this month recommends voluntary assisted dying. Like our earlier research, the report calls for co-design with Aboriginal organisations to ensure culturally safe implementation, ongoing consultation, and appropriate training for clinicians.

If the NT does proceed, success will depend on Aboriginal leadership in governance, properly resourced services, and flexibility to adapt as communities engage with the law in their own way.

Voluntary assisted dying in the NT cannot simply be imported from elsewhere. It must be built for the Territory, and with the Territory. (The Conversation) GRS GRS