Winning the battle for the legalisation of euthanasia is just a first step. To achieve open, equal and universal access to assisted dying, campaigners are trying to dismantle all roadblocks. What are they? Personal conscientious objection is one – they claim that doctors should be forced to refer to a willing doctor. Another is “institutional conscientious objection” – hospitals or nursing homes which refuse to permit euthanasia or assisted suicide on their premises.

So it is not surprising that in the Australian state of Victoria, there are moves to force hospitals to cooperate with assisted dying.

A recent article in the Sydney Morning Herald argues that there is a profound power imbalance between seriously ill patients and institutions. The journalist highlights the case of Alan Clark, an elderly man from rural Victoria, who had a terminal degenerative neurological disorder. He was approved for euthanasia, but his non-religious nursing home objected to him taking the lethal dose onsite. But he was too unwell to return home.

“When we found out that he could not access it there I was stunned. I said, ‘What will we do now?’” his wife said. “They said: ‘We’ll just transfer him home,’ but I was so concerned he would be extremely uncomfortable.” Mr Clark died in the nursing home last year at the age of 83.

The SMH report is based on a recent article in the journal BMC Medical Ethics about the Victorian law. It was based on interviews with 28 patients who had requested assisted dying. The authors, all from the Australian Centre for Health Law Research, contend that it is:

“not effective in achieving the objectives of respecting institutional positions while promoting patient access. This ‘soft regulation’ approach appears to have allowed existing power, resource, and information asymmetry to prioritise institutions’ positions over patient choice. Such an outcome is inconsistent with the wider policy goals of the Voluntary Assisted Dying Act 2017.”

The researchers also found that the policy of some institutions was not transparent and made informed choices more difficult.