You can check out any time you like but ….

… you can never leave. Most of us are familiar with these lyrics from the Eagles’ song, Hotel California.

By happenstance these lyrics approximate the fate that faces many thousands of citizens lying comatose for long lengths of time in hospices, nursing homes and similar.

This issue has not received the attention it deserves.

The proposed amendment by religious-minded politicians to NSW legislation to force aged care residents out of residential aged care if they seek Voluntary Assisted Dying (VAD), and changes to the federal government’s Aged Care Act which will likely increase fees and charges to senior citizens managing their own care in their own homes, using a partly funded package aimed to assist them, or those in residential aged care, have received nearly all recent attention.    

Ian Chubb’s 23 September 2024 Canberra Times article, ‘Given the choice, would my wife have chosen to ‘let dementia take its course?’’, raised an equally important issue.

 Ian Chubb is a former chief scientist of Australia, and former vice-chancellor of The Australian National University.  He described the beyond appalling circumstances of his wife’s long drawn-out death from the effects of dementia. But her situation is grimly common.

A 16 April 2025 article on the website of the Go Gently organisation details an instance of how this legislation worked in an end-of-life moment in Victoria.

John Hunt, 62, signed up for VAD when it was discovered he had the worst kind of brain tumour, a glioblastoma.   

Philippa Featherstone, John’s sister, reports that ‘although John was in terrible pain, he couldn’t have any morphine on the day of VAD as he needed capacity to be eligible for the procedure. Emphasis added.

So, John Hunt needlessly faced great pain, which was like state-imposed torture at the worst possible time, so he could say ‘I want to die’.

If that isn’t bad enough, what of those who ‘lack the capacity’ to say ‘I want to die’ so the VAD process can commence?

It would seem that if the thousands of dementia patients subsisting in residential aged care across Australia cannot say these words they cannot go. They cannot leave until they die of natural causes, many after long periods of time, in dreadful circumstances like Ian Chubb’s wife.

In these situations, to all intents and purposes, hospices and the like across Australia could be characterised as Hotel Californias where many desperately ill citizens who would say they want the VAD process are ‘prisoners of their own device’because they have lost their capacity.

Advanced Directives only allow a citizen to ask that all life support systems, food and water be stopped. They do not include a provision that facilitates assisted dying to commence when it is plainly obvious the desperately ill should be helped to go.  

It seems this is the current legal and moral absolutist positions of state governments.

But how many of us are moral absolutists? The very democracy we live in is based on compromises, relativities and trade-offs.

The ACT government itself is relativist when it comes to the start of life: a woman’s right to choose to have an abortion is free up to 16 weeks of pregnancy.

A woman’s future in this social-medical situation is in her hands. She can choose, but the current Advanced Directive of a desperately ill citizen in a social-medical end of life situation discredits choice.

We have all heard of reports that life support is turned off, with family agreement, after it is clear a person is brain dead.

There are very many end-of-life situations where a person is to all intents and purposes brain dead, but not quite.

Surely, we can legislate for citizens who are suffering very badly in particular situations, with zero hope of recovery, to state in a revised, more humanitarian Advance Directive, that should they be in this situation they want the process to facilitate their death to happen.

In Hotel California there is also the line:

This could be Heaven or this could be Hell.

That is a possible future facing senior citizens when they enter an end-of-life residence. The Royal Commission into Aged Care Quality and Safety found ‘the prevalence of elder abuse in Australian residential care is estimated to be 39.2%.’

One thing is for sure: a direct experience of a loved one dying in a desperately bad way is usually convincing that there is more Hell than Heaven in our nursing homes and hospices, and law reform to let certain citizens go easily, and without pain, is a just outcome. 

In November the ACT government will be addressing its Voluntary Assisted Dying (VAD) legislation.  A better outcome for residents in these situations is now in the hands of ACT legislators.