Note: This article discusses voluntary assisted dying in the context of mental illness and includes topics that may be difficult for some people, including chronic suffering, mental health, and end-of-life decisions which may be regarded by some as a form of suicide.

A 29-year-old woman has lived with chronic, treatment-resistant mental illness for most of her life. She’s tried everything: medication, therapy, hospitalisation, and electroconvulsive therapy. After more than a decade of illness and unsuccessful treatment, she applies for voluntary assisted dying (VAD), wanting to end her life peacefully and with medical support.

That’s the real story of Zoraya ter Beek, a Dutch woman who just last year received approval to access assisted dying in the Netherlands on the basis of ‘unbearable suffering with no prospect of improvement’ due to her chronic psychiatric conditions.

But would Ms ter Beek be eligible for assisted dying on this basis if she lived in Australia?

Voluntary assisted dying in Australia: eligibility criteria

VAD is now lawful in all six Australian states. The Australian Capital Territory has also passed VAD legislation that will come into effect in late 2025. Each state has its own legislation, but they all follow a broadly similar model – to access VAD under these laws a person must:

1. Be at least 18 years old;
2. Be an Australian citizen or permanent resident, and have resided in the relevant state for at least 12 months;
3. Have decision-making capacity in relation to VAD;
4. Be acting voluntarily and without coercion; and
5. Be diagnosed with a disease, illness or medical condition that is:
   • Incurable, advanced, progressive and will cause death;
   • Expected to cause the person’s death within 6 months (or 12 months for neurodegenerative conditions like motor neurone disease); and
   • Causing suffering that cannot be relieved in a way the person considers tolerable.

As can be seen from the fifth eligibility criterion, the person must be already dying from a physical illness. Mental illness alone does not enable a person to access to VAD.

Access to assisted dying on the basis of mental illness

If a similar situation were to arise in Australia, a person in Ms ter Beek’s position would not be able to access VAD. Ms ter Beek’s suffering was clearly significant, persistent, potentially incurable, and evidently could not be relieved in any way she considered tolerable. However, her suffering arose from mental illness, not from a terminal physical illness. She was not expected to die ‘naturally’ from her condition within any timeframe, let alone the six-month timeframe imposed by legislation in Australian states.

Further, the legislation in each state explicitly excludes eligibility based on disability or mental illness alone. Even in the ACT – where the upcoming law does not include a six-month timeframe – the legislation still explicitly excludes eligibility on the basis of psychiatric conditions.

This eligibility framework reflects a policy position taken during the legislative processes across Australia: that assisted dying should only be available to those who are already dying, and not to those who are suffering but have a potentially longer (or unaffected) life expectancy. The general principle has been to ‘start cautiously’ – Australian VAD laws reflect a conservative approach that prioritises safeguards and limits eligibility within quite strict confines.

Conclusion

There is growing public debate about whether excluding mental illness is justifiable in the context of VAD laws. Critics argue that this distinction can lead to suffering people being denied the same autonomy granted to those with physical illnesses. On the other hand, many argue that Australian VAD laws have struck the right balance and that it would be inappropriate to enable access on the basis of mental illness – they say that the risk of coercion or impaired decision-making is too high, and that finding appropriate treatments for mental health is complex.

Situations like Ms ter Beek’s are confronting but they are also very real for those experiencing them. These cases raise uncomfortable but important questions about suffering, autonomy, and the boundaries of end-of-life choices. But under the current legal framework in Australia, the answer is clear: a person suffering from mental illness – no matter how severe or incurable – is not eligible for voluntary assisted dying on that basis. 

If this article has raised concerns for you, support is available from Lifeline on 13 11 14 or Beyond Blue on 1300 22 4636.

Note that the content of this blog does not apply in all jurisdictions, does not constitute legal advice, and should not be relied upon. You should seek legal advice in relation to any particular matters you may have. All opinions expressed are our own, not necessarily those of any organisations with which we are connected.