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Background: Eligibility to access the Victorian voluntary assisted dying (VAD) legislation requires that people have a prognosis of 6 months or less (or 12 months or less in the setting of a neurodegenerative diagnosis). Yet prognostic determination is frequently inaccurate and prompts clinician discomfort. Based on functional capacity and clinical and biochemical markers, prognostic tools have been developed to increase the accuracy of life expectancy predictions. Aims: This review of prognostic tools explores their accuracy to determine 6‐month mortality in adults when treated under palliative care with a primary diagnosis of cancer (the diagnosis of a large proportion of people who are requesting VAD). Methods: A systematic search of the literature was performed on electronic databases Medline, Embase and Cinahl. Results: Limitations of prognostication identified include the following: (i) prognostic tools still provide uncertain prognoses; (ii) prognostic tools have greater accuracy predicting shorter prognoses, such as weeks to months, rather than 6 months; and (iii) functionality was often weighted significantly when calculating prognoses. Challenges of prognostication identified include the following: (i) the area under the curve (a value that represents how well a model can distinguish between two outcomes) cannot be directly interpreted clinically and (ii) difficulties exist related to determining appropriate thresholds of accuracy in this context. Conclusions: Prognostication is a significant aspect of VAD, and the utility of the currently available prognostic tools appears limited but may prompt discussions about prognosis and alternative means (other than prognostic estimates) to identify those eligible for VAD. [ABSTRACT FROM AUTHOR]

The article explores the potential extension of voluntary assisted dying (VAD) laws in Victoria, Australia to include people with dementia. It discusses the ethical, philosophical, and social questions raised by this extension, such as defining eligibility criteria and assessing suffering in individuals with impaired decision-making capacity. The article emphasizes the importance of maintaining the legitimacy and social consensus of the existing VAD framework and highlights the need for a balanced approach to avoid exacerbating social divisions. It suggests that a renewed social debate and a harmonized national legislative framework are necessary to address the challenges associated with VAD in dementia. [Extracted from the article]