The first inmate to access assisted dying in New South Wales has sparked debate about whether victims should be considered in the process.
The man, who cannot be named for legal reasons, died in hospital last week after he gained access to the scheme through Justice Health.
He had developed cancer while serving a 30-year sentence for sex crimes.
His victim, who also cannot be named, said the impact on victims of serious crimes needed to be considered when prisoners applied for assisted dying.
"Reform in how we approach victims, with how we inform victims, with how we consider victims, because our justice deserves to be considered," the victim said.
The victim said they learnt their abuser was terminally ill and had died in prison under assisted dying laws late last month after a friend sent her a news article.
"He is a criminal; in my eyes he should be serving out his natural life sentence for as long as his life naturally allows … it feels like our justice has been completely ripped from us," she said.
"It made me sick … I was shaking for a couple of minutes before I could even cry."
Right to health care
University of Sydney Law School professor of law, health and ethics, Cameron Stewart, said while he felt for victims of serious crime, decisions around end-of-life treatment for prisoners should be reserved for medical professionals.
"We could argue that that's a lack of justice because this person isn't living out their sentence the way it was intended," Dr Stewart said.
"I don't want to suggest victims don't have a right to feel that, I think they do, but the reason we have judges or juries that make decisions about punishment is because we need a dispassionate person to make that decision."
Dr Stewart said prisoners had a right to medical treatment under human rights law, with New South Wales becoming the final state to legalise voluntary assisted dying (VAD) as a legitimate treatment in 2023.
"We don't include punishments of torture, we don't inflict pain," he said.
"I understand that people want those prisoners to suffer but there is a limit to that suffering as a society and we have taken a higher road.
"We need to stick to that road."
Strict criteria
In a statement, Justice Health said "like the wider community, patients under the care of Justice Health NSW must meet specific eligibility criteria to pursue voluntary assisted dying, including approval from the NSW Voluntary Assisted Dying Board".
Palliative care specialist Chloe Furst, who was integral in developing South Australia's assisted dying legislation, including its use for inmates, said VAD needed to be considered like all other treatments and should not discriminate.
"They're only entitled to assisted dying if they have a terminal illness, and their suffering is from that terminal illness; they normally have a prognosis of less six to 12 months," Dr Furst said.
"These people are unfortunately dying anyway."
She said while personal and healthcare supports should be in place for prisoners' victims and their families, compromising confidential health information of those seeking assisted dying was not the answer.
"I think there would be significant ethical considerations around confidentiality in terms of detailing that person's choice to their victim," Dr Furst said.
"They might choose not to have the substance administered to them, so we do not want to be disclosing things to individuals or pressuring anyone down an assisted dying pathway."
Cheryl Kelly from the NSW Mid North Coast Branch of Dying with Dignity also advocated for the assisted dying legislation.
She said it was a "complex" situation.
"Under the legislation, prisoners do have a right to access this service and we are still a humane society," Ms Kelly said.
"Prisoners have a right to medical treatment in prison, no matter what they have done, so this is like an extension of that, I suppose.
"But I certainly do understand the concerns of the victims, and that they would be very upset."
Focused on surviving
The victim said providing her young child with a safe and happy childhood was helping them heal and move forward.
"My earliest memories of assault start when I am about two years old and it never stopped until I left for the military around 17, so it's a long time," they said.
"It's a very, very hard thing to deal with … it's affected every part of my life."
