‘I’m a British doctor who helps people die in Australia – coercion is not a problem’

A British doctor who helps patients access voluntary assisted dying (VAD) in Australia says she does see coercion – but only from relatives trying to stop their loved ones ending their lives.

Opponents of a Bill seeking to change UK law have claimed that elderly and vulnerable patients could be pressured into it.

But Dr Clare Fellingham, who led the introduction of VAD at Perth Hospital in Western Australia, said this was “vanishingly rare” and would be easily detected.

She said: “Coercion absolutely exists in end-of-life care but it’s not in the way that you might expect.

“More often than not, we see coercion as a very overt and blatant thing in the form of family members desperately wishing that their loved ones weren’t going to die and imploring them to accept further lines or treatment that the patient doesn’t want, or not to consider VAD.

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“That coercion is obvious, it’s rampant, and it’s much more common than you would ever imagine.”

Some 970 people made a first request for VAD in Western Australia in 2023-24, according to an annual board report.

Of those, 292 completed the process and died after receiving life-ending medication, accounting for 1.6% of all deaths in the state that year.

Patients had an average age of 75, 71% had cancer and 84% were receiving palliative care.

Ensuring that a patient is making their own decision is “fundamental” – and something medics already routinely do when consenting people for treatment, Dr Fellingham said.

The length of time she spends with patients seeking VAD is “almost unparalleled in medicine”, including one to two hours of contact time for a first assessment alone.

The mum-of-three added: “Having got to know somebody for a couple of hours in their home environment with their family around, combined with 20 years of being a doctor, I can absolutely tell you whether somebody was being coerced. It just doesn’t happen.

“There is a wealth of publicly available evidence out there…and there has never been, to my knowledge, a documented case of coercion. It is so vanishingly rare as to be almost impossible.”

Dr Fellingham, 45, was born in London and trained at St George’s, University of London before moving to New Zealand in 2007 and then Australia in 2009.

She is visiting the UK to share her experience with VAD and took questions from dozens of MPs at a Westminster event last week.

The consultant anaesthetist was “never a placard-waving, card-carrying assisted dying rights campaigner” but came to believe it had its place in the spectrum of end-of-life options while working in palliative care.

Since VAD was legalised in Western Australia in July 2021, she has witnessed time and again how being given control can alleviate dying people’s fear and suffering.

Memorable cases include a patient who chose to die in full makeup and a ballgown, plus others who spent their final moments in their gardens or listening to their favourite music.

She said: “The power and magic of turning an inevitably sad situation into something that will have lasting positive memories for the people left behind is extraordinary.

“People who are already dying should have the option to end their suffering at a time that is right for them. It is by far the most meaningful experience of my 20-plus years of being a doctor.”

Dr Fellingham said assisted dying and palliative care were “two branches growing off the same tree” and urged MPs to listen to constituents and do their own research rather than being swayed by scaremongering.

She said: “The ability to die on your own terms is an extraordinary gift. In a humane society governed by democracy, MPs should vote in favour of the community who consistently are polling at over 80% support.”

Dr Fellingham also described Wes Streeting’s interventions against the Bill and threats of NHS cuts as “farcical”, adding: “How unfathomably disappointing that a Health Secretary would make such a baseless and inflammatory comment.

“Assisted dying is not a hugely expensive thing and certainly a lot less expensive than the latest lines of cancer treatment. There are things that health services spend an absolute fortune on without even batting an eyelid.”