Voluntary Assisted Dying
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Voluntary Assisted Dying (VAD)

Key messages

  • Voluntary assisted dying (VAD) is legal across all Australian states and is coming to the ACT, providing eligible terminally ill individuals with the option to manage their end-of-life care under strict safeguards.
  • VAD involves the intentional ending of life within a regulated framework, while palliative care focuses on symptom management and quality of life.
  • Aged care providers must facilitate access to VAD, even if they opt out of direct involvement, by facilitating referrals and ensuring compliance with state laws.
  • Aged care staff need clear policies, training, and support, including those with conscientious objections.
  • Families often face complex emotions during the VAD process and may benefit from grief counselling and tailored bereavement support.

What is VAD?

Voluntary assisted dying is legal in all Australian states. VAD will commence operation in the ACT on the 3rd November 2025. VAD is currently illegal in the Northern Territory. [1]

Voluntary assisted dying allows eligible individuals to end their lives with medical assistance. Eligibility criteria in Australia include a prognosis of six months for most terminal conditions, or 12 months for neurological conditions, along with enduring decision-making capacity, and the ability to provide voluntary, informed consent. [2,3] The process requires assessments by two independent, trained doctors, or other designated health professional in some jurisdictions, to confirm eligibility and safeguard the individual’s autonomy. [3,4]

VAD differs from advance care planning and palliative care. Advance care planning is the process of documenting preferences for future care if the person loses decision-making capacity, [5] while palliative care focuses on symptom relief and quality of life. VAD involves the intentional act of ending life under a carefully regulated legal framework. [6] A person cannot request VAD through an advance care planning document and a person’s substitute decision-maker cannot request VAD on their behalf. [7]

Regardless of a decision to pursue VAD, health professionals must continue to provide safe, compassionate, and competent care to people at the end of life. [8]


Why VAD matters in aged care

VAD laws allow terminally ill older people, including those receiving aged care services, to make informed decisions about their death. Residential aged care providers must support residents' access to VAD while meeting legal obligations, such as ensuring appropriate referrals if the aged care provider opts out of direct participation. [3] Staff with personal or religious objections are protected by law but must still help facilitate the person's access with clear workplace policies to guide these situations. [9]


What the evidence tells us

Residential aged care homes require clear policies to support VAD access. [10] Even when facilities opt out of direct provision, they are legally required to facilitate referrals to external providers of VAD. Transparent communication with residents and families can assist with understanding and trust throughout the process. [10]

Staff need comprehensive training on VAD legislation, ethical frameworks, and effective communication strategies. Free online training and information on VAD for staff is available from the ELDAC End of Life Law Toolkit and Module 11 of the End of Life Law for Clinicians training program for medical practitioners, nurses, and allied health professionals.

Each jurisdiction has specific rules around scope of practice and who can initiate discussions. ELDAC has developed a fact sheet for residential aged care homes in South Australia, Queensland, New South Wales and the ACT (173kb pdf), as well as one for care homes in Victoria, Western Australia and Tasmania (132kb pdf), which adhere to similar legislation respectively.

Staff attitudes and roles in VAD

Conscientious objections among staff are common and protected by Australian law. [11] Staff who object to VAD must still facilitate access by referring residents to alternative providers. Clear organisational guidelines are necessary to support this process while respecting staff beliefs. [11]

Staff responsibilities include facilitating VAD requests, maintaining confidentiality, and supporting families. [12,13] Interdisciplinary teamwork is essential to provide comprehensive care, as demonstrated in successful international approaches. [9]

Interface between VAD and palliative care

VAD and palliative care aim to reduce suffering but differ significantly. Palliative care seeks to manage symptoms and improve quality of life, while VAD provides individuals an alternative option to manage the end their life. [14] Clear policies and communication strategies help align these services. [3]

Barriers to accessing VAD

Barriers to people accessing VAD include limited staff training, ethical concerns, and organisational resistance. [5] Many workers feel unprepared to respond to VAD requests, creating stress and uncertainty. [6] Enablers such as clear policies, regular training, and counselling for staff improve confidence and reduce barriers. [4] International models, such as the Canadian approach, show that education programs and teamwork between providers enhance access and staff knowledge as to their role and legal rights and obligations in relation to VAD. [9]

Ethical and cultural considerations

In Australia, individuals with dementia can only access VAD if they retain enduring decision-making capacity, which means they must be able to make decisions for themselves. [15] This exclusion potentially raises ethical concerns when residents have expressed a preference for VAD in advance directives. [16] It is important for aged care providers to consider how to best support the concerns of staff, residents, clients, families and carers when such issues arise.

Culturally and linguistically diverse residents and staff may hold differing views on VAD. Training in cultural sensitivity and engaging community leaders fosters understanding and ensures respectful care. [6,13]

Considerations for families

Families of individuals accessing VAD often experience a mix of emotions, including grief, guilt, and relief. [17] Transparent communication and early involvement in discussions help families feel supported and better prepared for the process. [17] Bereavement services, including counselling and peer support, are essential for families coping with VAD-related loss. [17] Internationally, Switzerland has shown that early engagement with grief counsellors significantly eases the emotional burden on families. [18]

Considerations for home care

In Australia, the law of each state stipulates how the VAD substance can be handled and administered, and who is responsible for managing the substance after death. Home care providers must develop protocols for ensuring compliance with state laws. These protocols include clear guidelines on the handling and storage of medications, as outlined by state-based VAD navigation services, which provide tailored support to address logistical challenges. [14,19]

Home care teams often work closely with families during VAD processes. Training in communication, cultural competence and conflict resolution helps address family dynamics and religious or cultural concerns, which are frequently reported barriers in both Australian and international settings. [4,5]


Page updated 07 April 2025
 

  • References

  1. End of Life Law in Australia. Legal overview [Internet]. Brisbane: Australian Centre for Health Law Research; 2024 [updated 2024 Jun 6; cited 2025 Apr 7].
  2. White BP, Jeanneret R, Close E, Willmott L. Access to voluntary assisted dying in Victoria: A qualitative study of family caregivers’ perceptions of barriers and facilitators. Med J Aust. 2023;219(5):211-217.
  3. White BP, Willmott L, Close E, Hewitt J, Meehan R, Greaves LL, et al. Development of voluntary assisted dying training in Victoria, Australia: A model for consideration. J Palliat Care. 2021;36(3):162-167.
  4. Treleaven L, Komesaroff P, La Brooy C, Olver I, Kerridge I, Philip J. A review of the utility of prognostic tools in predicting 6-month mortality in cancer patients, conducted in the context of voluntary assisted dying. Intern Med J. 2023;53(12):2180-2197.
  5. Sandham M, Carey M, Hedgecock E, Jarden R. Nurses' experiences of supporting patients requesting voluntary assisted dying: A qualitative meta-synthesis. J Adv Nurs. 2022;78(10):3101-3115.
  6. Bloomer MJ, Saffer L, Hewitt J, Johns L, McAuliffe D, Bonner A. Maybe for unbearable suffering: Diverse racial, ethnic and cultural perspectives of assisted dying. A scoping review. Palliat Med. 2024;38(9):968-980.
  7. Advance Care Planning Australia, Australian Centre for Health Law Research QUT. Navigating the topic of voluntary assisted dying in advance care planning conversations: Guiding principles for health professionals (401kb pdf). Brisbane, Qld: ACPA/QUT; 2024 [cited 2024 Dec 4].
  8. Palliative Care Australia. Voluntary assisted dying in Australia: Guiding principles for those providing care to people living with a life-limiting illness [Internet]. Canberra, ACT: PCA; 2022 [cited 2024 Dec 5].
  9. Jeanneret R, Prince S. Nurses and voluntary assisted dying: How the Australian Capital Territory's law could change the Australian regulatory landscape. J Bioeth Inq. 2024;21(3):393-399.
  10. End of Life Directions for Aged Care (ELDAC). Overview of voluntary assisted dying [Internet]. ELDAC; 2024 [updated 2024 Aug 28; cited 2024 Dec 4].
  11. Haining CM, Keogh LA, Gillam LH. Understanding the reasons behind healthcare providers' conscientious objection to voluntary assisted dying in Victoria, Australia. J Bioeth Inq. 2021;18(2):277-289.
  12. Hewitt J, White B, Villar KD, Willmott L, Greaves LL, Meehan R. Voluntary assisted dying in Victoria: Why knowing the law matters to nurses. Nurs Ethics. 2021;28(2):221-229.
  13. Neller P, White B, Del Villar K, Willmott L, Yates P. Voluntary assisted dying in aged care: What you need to know [Internet]. Australian Ageing Agenda. 2022 Aug 24 [cited 2024 Dec 13].
  14. Palliative Care Australia (PCA). Palliative care and voluntary assisted dying position statement 2022. Canberra, ACT: PCA; 2022 [updated 2022 Oct 31; cited 2024 Dec 4].
  15. Willmott L, Feeney R, Del Villar K, Yates P, White B. Voluntary assisted dying: A discussion of key legal issues for Australian nurses. Collegian. 2023;30(5):701-707.
  16. Komesaroff PA, Chapman M, Lamba G, Kerridge IH, Stewart CL, Holmes A, et al. Should voluntary assisted dying in Victoria be extended to encompass people with dementia? Med J Aust. 2024;220(9):452-454.
  17. La Brooy C, Russell H, Lewis S, Komesaroff P. The impact of voluntary assisted dying on grief and bereavement for family members and carers in the Australian state of Victoria: A qualitative study. Health Soc Care Community. 2024;2024:1-10.
  18. Gamondi C, Fusi-Schmidhauser T, Oriani A, Payne S, Preston N. Family members' experiences of assisted dying: A systematic literature review with thematic synthesis. Palliat Med. 2019;33(8):1091-1105.
  19. Waller K, Del Villar K, Willmott L, White B. Voluntary assisted dying in Australia: A comparative and critical analysis of state laws. UNSW Law Journal. 2023;46(4):1421–70.