Tasmania's voluntary assisted dying legislation would offer control over death

First diagnosed with stage three breast cancer nine years ago, Mrs Spence bravely fought off her initial confrontation with cancer through resilience, hard-work and sheer determination.

Then, just over eight years later, her cancer had returned, but it was no longer confined to Mrs Spence's breasts.

It had metastasised to her bones and become terminal, meaning all that was left for her was to wait until it ultimately ended her life. And in that time, which can be anywhere from six months to up to 10 years, she would likely be in pain.

"My cancer is mainly through my skeleton. All up and down my spine, from the base of my skull down to my lumbar," she said.

"It's in my pelvis, in my hip, in my shoulder blade and in my ribs. The more I do, the more I can exacerbate that pain."

The voluntary assisted dying bill has now passed the upper house, inching closer to the likelihood of its enactment into law.

The latest step has offered more certainty to those who may wish to use the legislation in the future to make decisions about their own life.

But Mrs Spence's story extends far beyond herself, just as the debate over the voluntary assisted dying bill has.

When she was 20 her father died after a battle with brain cancer that left him pleading for death.

"He asked me, and he asked a lot of people at the end of life, what could they do for him? Could they get him some sleeping tablets? Could they do this? Could they do that? He was desperate," Mrs Spence said.

"He did not have any options, and he did not have any peace."

After her fathers death, Mrs Spence volunteered at a palliative care ward helping families work through similar situations. Above all else, she noticed the sheer number of people that had to suffer through their final days.

"I saw a lot more people than my Dad also go through end of life that was not dignified and was not peaceful. So my experience is far beyond my own family and my own situation," Mrs Spence said.

Like a dagger being driven into one of Mrs Spence's already cancerous and fractured ribs, the Spence family received further defeating news just six months after Mrs Spence's terminal diagnosis.

In other news:

Mrs Spence's husband Pete was told by a doctor he had metastatic bone disease.

But for him, Mrs Spence said, the choice to terminate his own life was one that he was unlikely to make.

"My husband may not choose to access the legislation if it goes through, because he's not so convinced," she said.

Despite the likelihood of her husband opting against personal voluntary assisted dying, he will probably be the one that makes the final choice for Mrs Spence.

While she remains hopeful and confident she will cognisant and capable until her final weeks alive, her husband has power of attorney to make the decision to opt for a voluntary assisted dying treatment for Mrs Spence.

"If it stays in my bones and in my organs and doesn't spread to my brain, then I should be communicative right to the end," she said.

"My husband has power of attorney and my power of guardianship. So if for some reason I'm not able to make that final call, he can legally but I will have that all in place. And I will say, when the time comes, this is the criteria for me."

Mrs Spence's life has taught her nothing if not how to be stoic. It has given her the opportunity to look ahead rather than dwell in the pure tragedy that she is facing, and has allowed her to be able to stand strong in her position.

For Mrs Spence, the situation her and her husband are in represents her side of the debate for a voluntary assisted dying bill.

"He supports the legislation only because he knows I want it. He said to me, 'I don't think I would ever access that myself, but I know that's what you want.' So he said, 'I'm going to support it'," she said.

"It will enable people to have a choice, not because it lets everybody do it. But because it will let the people that are passionate about controlling how their life ends, have the choice, rather than taking the choice away."

Reflecting on the recent suicide death of Kylie Anne Breen, a woman who said she took her own life because she was unable to access the service an assisted dying bill would offer, Mrs Spence was not sure she would be capable of doing the same.

"I'm not sure how brave I am," she said.

"I don't want him knowing his mum was desperate enough to take her own life. That's not a good example to set for him. I don't want him thinking that that's okay."

Her personal experiences have led Mrs Spence to want the option to die with dignity.

"The point at which my quality of life is so low, and the pain and negative things surrounding end of life are so big that there is nothing left for me ... that would be the point that I would want to go to bed, and go to sleep, and not wake up," she said.

"And I'd like to do that with my family there so that they won't see me struggling for my last breath, they will see me falling asleep and that's how they can remember me."

Like painting a personal vignette of how one sees oneself, Mrs Spence just wants control over the final image of her that her loved ones are left with.

"My son especially ... I don't want him to see me go through what I watched my dad go through. It was too cruel ... I still remember it now," she said.

"I still remember talking to him at his last breath and saying 'don't struggle any more. If you can't do it, it's okay to let go.' And he literally only took one more breath, then he passed away."

"I don't want that. I want to pick the time and place then just to go to sleep with my husband and that's it."