Systemic racism in Queensland's voluntary assisted dying policy: Advancing culturally affirming healthcare and indigenous sovereignty using ‘what is the problem represented to be?’ approach

Systemic racism within Australian health policy is rooted in settler-colonial governance and continues to marginalise Indigenous sovereignties, social and emotional wellbeing (SEWB), and rights to culturally responsive healthcare. As voluntary assisted dying (VAD) expands across Australian states and territories, little research has examined whether VAD policy frameworks are culturally affirming for Indigenous peoples. This study critically analyses Queensland's Voluntary Assisted Dying Handbook (2022) using Bacchi's what's the problem represented to be? approach, informed by Indigenous standpoint theory, social constructionism, and critical whiteness theory. The analysis found that the Handbook constructs autonomy and end-of-life decision-making as universal, individualised, and race-neutral experiences grounded in Western biomedical and legal frameworks. In doing so, the policy homogenises Indigenous peoples and marginalises Indigenous sovereignties, relational understandings of well-being, and culturally grounded approaches to passing. The findings further reveal how residency requirements, procedural safeguards, and universalised notions of culture reproduce colonial governance logics that privilege settler authority while silencing Indigenous knowledges and self-determination within end-of-life care. This study highlights the urgent need for anti-racist, anti-colonial, and sovereignty-informed VAD policy reform that meaningfully incorporates Indigenous knowledges, SEWB, and culturally responsive approaches to end-of-life care across Australian jurisdictions.