The Legislative Shift: Autonomy in Dying
WA’s VAD Act, which passed in 2019 and came into effect in 2021, marked a milestone as the state became the second in Australia, following Victoria, to legalise VAD for terminally ill adults.
Under WA’s VAD Act, patients must meet strict criteria to qualify, ensuring the process is safe, transparent, and respects personal choice.
The legislation mandates a structured application process, requiring independent medical assessments to be fulfilled.
To ensure the integrity of the process, the VAD Act outlines strict eligibility criteria.
Applicants must be WA residents aged 18 or older, possess decision-making capacity, and have a terminal illness likely to result in death within six months.
Those diagnosed with neurodegenerative conditions may qualify with a prognosis of up to 12 months. These criteria are designed to protect individuals from coercion while respecting their autonomy.
While the implementation of VAD Laws in WA have made progress in end-of-life care, health professionals like VAD practitioner and Emergency Specialist Dr Sandra Rennie, believes “there needs to be more assistance [for people] preparing for death.”
“Advanced healthcare initiatives are great, but they’re not being done very well,” she said.
“I think we’ve lost some of our humanity in our institutions.
“The people who are choosing [voluntary] assisted dying, are teaching us what it can look like when it is person centred care.”
The Legislative Shift: Autonomy in Dying
Daniela Casotti’s life was a canvas of creativity and connection, much like the art she crafted.
Her death, too, was a reflection of her artistry—an intentional choice, carefully moulded with the same sense of agency and purpose that defined her life.
For much of her life, Daniela lived with the challenges of epilepsy, yet it was her diagnosis of terminal breast cancer—eventually metastasising to her lungs with the potential to spread to her brain—that presented her with her greatest battle.
Ultimately it would shape her decision to end her life through Western Australia’s voluntary assisted dying (VAD) legislation.
After her diagnosis, Daniela chose to forgo chemotherapy and radiation, knowing it would not cure her. While the treatments may have extended her time, they would have stolen her ability to truly live. “I can still put my affairs in order, I can still enjoy a walk along the beach, I can still enjoy some time,” she said.
“For me, it had [created] a whole new life where I don’t have to go through extreme pain and suffering until [the medical intervention] doesn’t work anymore.
“If it was just the stage four breast cancer, I might have considered chemotherapy, but the cancer is too far gone, and I’m uncomfortable, my life is uncomfortable.
“I don’t have a fear of death.”
This decision granted Daniela the same autonomy over her death as she had always held over her life.
By embracing VAD, she could say goodbye on her own terms, free from the confines of additional pain and suffering.
It was a final act of empowerment—one that allowed her to spend her last days in the company of loved ones, savouring the moments that mattered most.
For Daniela, this choice wasn’t about death, but about living fully until the very end.
Daniela died on April 10 2024, in the comfort of her home in Busselton, surrounded by music and love.
Death and Dying Matters: The Death Café of Margaret River
In the heart of WA’s South West region, a bold initiative called Death and Dying Matters is redefining how people talk about life’s final chapter.
“Living more fully by embracing death as a normal part of life” is the motto of Greg Styles and Paul Barlow, two co-founders at the heart of a movement advocating for VAD in WA.
For them, this mantra is not just an ideal but a call to confront the stigma surrounding death and create pathways for people facing terminal illness to die with dignity.
But behind this philosophy lies a deeper investigation into the legal, social, and ethical complexities of voluntary assisted dying—one that has divided communities, challenged lawmakers, and shaped the lives of individuals confronting their mortality.
Far from morbid, these gatherings in Margaret River, almost 300km south of Perth, aim to foster a deeper understanding of mortality, turning difficult conversations into moments of connection and clarity.
“When death becomes a normal thing, as opposed to something to fear, you look at your life in such a different way and that’s what I think is really important,” Greg says.
“There’s a kind of freedom you have to live more completely when you have embraced the topic and allowed yourself to get to the other side of it.”
What began as a small gathering of like-minded individuals has grown into a vital community hub, attracting people from all walks of life who are eager to explore the realities of death without fear or discomfort.
“When you start this conversation, people join in,” Paul says.
He says attendees come with different experiences—some grappling with terminal diagnoses, others simply curious about what it means to “die well”.
Each meeting aims to invite thoughtful discussions on topics ranging from voluntary assisted dying to end-of-life planning, all in an atmosphere of support and shared understanding.
For many, Death and Dying Matters has become a place to find not just answers, but a sense of peace and acceptance, according to Paul.
Before her death, Daniela said the sense of community generated by these meetings allowed her a sense of comfort towards the end of her life.
“I think what’s really missing in our society is talking about death.”
How VAD Practitioners Can Change the Way People View Their Death
VAD practitioners play a crucial role in guiding patients through the legal, emotional, and procedural aspects of end-of-life care.
For many individuals, understanding the resources available to them can be tricky. However, with the guidance of a licensed doctor, this process can feel a lot less lonely.
While Daniela’s doctor* provides assistance in the end-of-life process, she encourages “patients and their families to be as involved as possible” in the ritual process of preparing for death.
“Before successful institutions, hospitals, public health, oncologists and funeral directors every family did this.”
As an emergency specialist, the doctor has seen countless patients in the final stages of life.
However, it was her role in Daniela’s story that changed how she viewed her place in the VAD process.
“Daniela chose the full ceremony,” she said.
“Because of her, I now trust that every human has this instinctive knowledge of how to create their own meaningful ritual or ceremony”
With the knowledge that not all individuals choose ceremony, the doctor believes that “most people have something special if you take the time for it.”
Daniela’s doctor says for people who can’t get to so-called Death Cafes, online sources like Go Gentle Australia could be a valuable place to start.
She has constructed an induction poem that reflects the patient’s self advocacy and autonomy over their journey.
This was designed to display that while doctors hold an invaluable position within the VAD process, they are “a vessel” to assist patients in carrying out their final wishes, in a way that “empowers them at the final stage of their life.”
Looking Ahead: The Future of VAD in Western Australia
Daniela’s story is just one among hundreds since VAD was introduced in WA, but it speaks to the growing demand for end-of-life autonomy.
The process is not without its critics, but Daniela’s doctor says for many patients and their families, VAD offers a sense of dignity and control in a time often marked by helplessness.
As WA continues to navigate the ethical and logistical challenges of VAD, she says one thing is clear: the conversation about death and dying is changing.
For patients like Daniela, it’s not about choosing an end – but embracing death as a part of life.
*Doctors name has been withheld for privacy purposes.
