This article is part of a series of articles on voluntary assisted dying.
Australia’s ageing population and increasing rates of chronic disease mean that general practitioners (GPs) need to be well-versed in providing end-of-life (EOL) care and management, including voluntary assisted dying (VAD), which is now a legal choice.1 GPs have a central role in palliative care,2,3 demonstrated by their authorship of 90% of the 1.4 million palliative care– related prescriptions issued in 2023–24.4 Evidence shows patient outcomes at the end of life improve when patients are identified early so discussion and planning can align with patient preferences and needs.5 As the majority of Australians support VAD,6 it is important that GPs consider their approach to and understanding of VAD as something their patients might choose to explore.7
This article provides an overview of VAD in Australia for GPs, drawing on the experiences of current VAD practitioners and early insights from each state. It outlines how the VAD process operates within the EOL context, including key eligibility criteria, and summarises legal requirements GPs must consider in shaping their approach to VAD while providing care within the EOL context.
Definition of voluntary assisted dying
VAD is the term used in Australia to describe when an adult with a life-limiting illness who meets the relevant legislated criteria ‘requests and receives medication from a health practitioner which they take, or have administered, to end their life’.8 To access VAD medication, the person must complete all mandated steps laid out in the relevant state/territory’s law. Patients can choose self-administration or practitioner administration, where a VAD-trained practitioner (VAD-P) administers the VAD medication.
VAD in Australia
The Northern Territory (NT) was the first jurisdiction in Australia to legalise assisted dying, with four people accessing the law during the 2 years (1996–97) it was in effect. In 2017, Victoria (Vic) became the first state to pass legislation permitting VAD. Since then, all Australian states have enacted and implemented VAD laws. The Australian Capital Territory’s (ACT’s) legislation became operational in November 2025, and the NT has been permitted to reconsider VAD legislation.6,9,10
Since 1997, laws for assisted dying have been enacted in Switzerland, Austria, Germany, Portugal, Italy, Luxembourg, the Netherlands, Spain, Belgium, New Zealand, Canada, Colombia, Cuba, Ecuador and select US states.11 Within the international context, Australian laws are described as conservative.12
Each Australian state or territory VAD legislation is distinct, but all require patients to satisfy strict eligibility criteria. A review panel or board in each state must ensure compliance in each VAD application with VAD medication is highly regulated. The number of patients accessing VAD is increasing. Characteristics of VAD in Australia by state are shown in Table 1.
| Table 1. Summary of VAD characteristics by state across available time frames |
State and time frame reported
from most recent data report |
Date VAD implemented |
Latest
period reported |
No.
deaths
in
period |
Total deaths since
implementation
to end of current report |
% total deaths in period |
Practitioner admin |
Self-admin |
Relative change in total numbers death by VAD since last reporting period |
No. VAD-Ps who are GPs
(% total VAD-Ps) |
Vic
12 months22 |
Jun 2019 |
2023–24 |
371 |
1282 |
0.84 |
70 |
301 |
25% increase |
233
(59) |
WA
12 months23,24 |
Jul 2021 |
2023–24 |
292 |
738 |
1.6 |
635
(86%) |
103
(14%) |
14.5% increase |
45
(44.6) |
Tas
12 months25 |
Oct 2022 |
2023–24 |
60 |
87 |
1.2 |
31 |
9 |
n/a |
12
(60) |
SA
12 months26 |
Jan 2023 |
2023–24 |
156 |
195 |
1.0 |
15 |
141 |
n/a |
78
(60) |
Qld
12 months27 |
Jan 2023 |
2023–24 |
793 |
938 |
n/a |
532 |
261 |
n/a |
n/a
(n/a) |
NSW
7 months19 |
Nov 2023 |
Nov 2023–
Jun 2024 |
398 |
398 |
n/a |
315 |
83 |
n/a |
n/a
(n/a) |
Note: VAD data not available from ACT. No VAD law in NT. Variations in data reported by each state.22–28
GP, general practitioner; n/a, not available; VAD, voluntary assisted dying; VAD-P, VAD-trained practitioners. |
Eligibility criteria
Key features of state VAD laws are listed below.12–14 To be considered eligible for VAD, a patient must:
- be aged 18 years or older
- meet relevant criteria for residency in Australia and the relevant state/territory
- have an advanced, progressive medical condition that will cause death within the following time frames:
- South Australia (SA) – ‘not exceeding 6 months’, or 12 months for a neurodegenerative condition
- Tasmania (Tas) – ‘within 6 months’ and includes injury, or 12 months for neurodegenerative conditions; can request an exemption for prognosis
- New South Wales (NSW) and Western Australia (WA) – ‘on the balance of probabilities cause death’ within 6 months, or within 12 months for neurodegenerative conditions
- Queensland (Qld) – ‘within 12 months’ for all conditions
- Victoria – ‘likely to cause death’ within 6 months (12 months for neurodegenerative conditions), moving to 12 months from April 2027
- ACT – ‘approaching the end of their life’ where ‘functioning and quality of life have declined or are declining’ and ‘any treatments that are available and acceptable to the individual lose any beneficial impact’15
- have intolerable suffering related to the medical condition above
- retain decision-making capacity for VAD
specifically throughout the application, up to and including at the time of administration
- request VAD without influence or coercion and make this as a voluntary choice.
Considering VAD in planning for a patient’s end of life
A key challenge is identifying when patients are approaching end of life, defined as ‘that part of life where a person is living with, and impaired by, an eventually fatal (or terminal) condition, even if the prognosis is ambiguous or uncertain’.16 Evidence suggests that identifying end of life improves planning and coordination, ensuring outcomes align more closely with patient preferences, including where a patient wishes to explore VAD.5
Tools to guide GPs include: the Supportive and Palliative Care Indicators Tool (SPICT),17 UK Gold Standards Framework Prognostic Indicator Guidance5 and the ‘surprise’ question:
Would you be surprised if this person were to die within the next year?18
Refer to Box 1 for more tools for GPs. For patients considering VAD, early discussion and referral is preferable. The average time frame for a completed VAD application through assessments, review and access to medication ranges between 2 and 6 weeks.19
| Box 1. End-of-life tools and resources for general practitioners (GPs) |
Tools for GPs:
The Royal Australian College of Practitioners’ aged care clinical guide (Silver Book) – Provides guidance and recommendations for GPs on the care of older people.29
Prompts for End of Life Planning (PELP) Framework – Prompts to assist GPs delivering care for patients at end of life, www.caringathomeproject.com.au/for-health-professionals/pelp-framework
The GSF Prognostic Indicator Guidance – Clear, succinct clinical guidance for clinicians to assist earlier recognition of patients nearing the end of life.12
Supportive and Palliative Care Indicators Tool – ‘a widely used tool for health and care staff in the UK and around the world. SPICTTM helps us identify people with general indicators of deteriorating health, and signs that one or more life shortening conditions are getting worse’, www.spict.org.uk/
National Cancer Institute Surveillance, Epidemiology and End Results Program (SEER) – Provides statistics on cancer including prognosis, https://seer.cancer.gov/statistics
CancerSurvivalRates – Statistical models created by healthcare professionals, data scientists and technologists using the SEER database to assist in estimating survival rates for some cancers, https://cancersurvivalrates.com
BODE Index for COPD Survival – A tool developed to assist in prognostication in chronic obstructive pulmonary disease, www.mdcalc.com
MAGGIC Risk Calculator for Heart Failure – A tool developed to assist in prognostication in heart failure, www.mdcalc.com
Functional assessment (eg The Australia-modified Karnofsky Performance Scale (AKPS)) – An overall measure of a patient’s functional ability in preforming their activities of daily living, and can be used to monitor a trajectory of decline in function, www.uow.edu.au
End of life Essentials (EOLE) – Provides free online learning modules, videos and resources for doctors, nurses and allied health professionals on quality and safety of end-of-life care in hospitals, www.endoflifeessentials.com.au
Organisations for GPs:
Palliative Care Australia – The national peak body for palliative care organisations was founded in 1998. It aims to lead ‘a unified voice to strengthen … collective impact towards excellence in palliative care’, https://palliativecare.org.au
End of Life Directions for Aged Care (ELDAC) – ‘provides information, guidance, and resources for all aged care staff to support palliative care and advance care planning’. It provides resources on managing dying, responding to deterioration, recognising end of life, providing palliative care, advanced care planning and bereavement, www.eldac.com.au
National Association for Loss and Grief (NALAG) – Was founded in 1977 following the Granville Train Disaster. NALAG offers ‘grief support training, counselling, community outreach, and volunteer programs. Its mission remains rooted in providing hope, resilience, and understanding to people coping with various forms of loss, from bereavement to life transitions’, https://nalag.org.au
Voluntary Assisted Dying Australia and New Zealand (VADANZ) – The peak body representing multidisciplinary healthcare professionals providing voluntary assisted dying services in Australia and New Zealand, www.vadanz.org.au
Go Gentle Australia – A national non-government organisation founded in 2016 by Andrew Denton that supports the choice at end of life, including the option of voluntary assisted dying, www.gogentleaustralia.org.au
Dying with Dignity – State- and territory-based non-government organisations in Australia, focusing on providing information, support and advocacy for voluntary assisted dying. |
First conversations about VAD
In NSW, Tas, WA, Qld, Vic (from April 2027) and the ACT, a medical practitioner (including a GP) can raise the topic of VAD within a broader conversation about EOL care and treatment options. In SA (and Vic until April 2027), although legislation prohibits initiating discussions about VAD, once raised by a patient, GPs may discuss VAD in subsequent consultations.
Family members and substitute decision makers can ask about VAD but cannot request it on a patient’s behalf. To commence an application, a patient must clearly request VAD. This is called making a first request. Good medical practice (and in some states law) means the doctor should then:
-
document that the patient has requested VAD
-
provide the patient with approved written information relevant to their state/territory
-
tell the patient whether they can manage their VAD request as a registered VAD-P or refer them on for further support to the local VAD service (Table 2).
Referring a patient to a VAD service
To commence a VAD application, a patient must be connected to a VAD-P. This does not occur when a first request is lodged. Each state/territory has a central coordination intake centre, or navigator service, that can speak to GPs, patients, families and the public and help to coordinate and manage connections and referrals (Table 2).
The VAD pathway
A generalised flowchart of the VAD process is outlined in Figure 1.
Key steps in the formal VAD pathway include the following:
- First request. A clear and unambiguous first request for VAD is made by a patient to a VAD-P, who accepts the role to coordinate their application. This is the first of three requests to ensure a patient’s intent to proceed.
- Assessment. Two clinical consultations, usually called the First and Consulting Assessments, are conducted independently by two VAD-Ps. They review the patient’s physical, psychosocial, spiritual and cultural needs; priorities; and goals of care at end of life. The VAD-Ps determine whether the patient meets the eligibility criteria outlined in the state/territory’s law. If found not eligible, the patient cannot proceed with VAD. If there is any uncertainty, the VAD-P must refer for relevant non-GP specialist review. The specialist does not have to be a VAD-P. When a patient is determined to be not eligible, this may be because they do not have a life-limiting illness or capacity, or they are not yet prognostically eligible. Follow-up requirements will vary depending on the reason for their ineligibility and their response to this.
- Choosing a method of administration. In Vic (until April 2027) and SA, patients must choose oral self-administration unless they are physically incapable of self-administering or digesting it for themselves. In WA, Qld, Tas and NSW, the patient and practitioner share the decision, with 80–95% of patients opting for practitioner administration. For patients proceeding to self-administration, a contact person must be appointed. They are legally responsible for returning the VAD medications if the person dies without using them. Qld requires a contact person for practitioner administration as well.
- Authorisation. State/territory laws vary in mechanism of approval and/or permit for the VAD medication. A VAD Board in each provides oversight to ensure safe and compliant practice.
- Prescription. Each state has a central pharmacy service ensuring compliance in VAD medication management, including procurement, dispensing and delivery. VAD-Ps are authorised to write a prescription for the VAD medication.
- Administration. This is when the patient takes or is given the VAD medication. Approximately a third of people who have a permit for VAD medication approved do not use it.
The patient can determine whether they wish to proceed, withdraw or pause at any stage. Patients commonly report that just having the option of VAD brings comfort, enabling better engagement with life and palliative care.
Administration can occur in inpatient and community settings, including at home, apart from in institutions holding a position of conscientious objection.
Detailed planning with communication as consented by the patient between the patient/family, GP, palliative care and VAD team prior to administrations aims to safeguard all involved and to ensure appropriate coordination and safe management, including disposal, of the VAD medication(s).
For self-administration, the VAD medications are delivered to the patient. Trained pharmacists provide detailed education about the VAD medication to the patient and the contact person. This includes information about storage, disposal if not used by the patient and clear communication channels to provide adequate support. Appropriate arrangements are made for post-death care and support. The patient’s GP may be asked (in advance) to support by completing the death certificate. This may be many months after the VAD-P completes the application.
Practitioner administration requires the VAD-P to administer the VAD medications to the patient. The most common route is intravenous, but administration can also be oral or via percutaneous endoscopic gastrostomy. The VAD-P is responsible for the VAD medications. The VAD-P usually completes the relevant death certification including confirming the patient is deceased (in NSW called ‘verification of death’), Cremation Risk Assessment, Coronial Checklist (inpatients) and death certificate (Medical Certificate of Cause of Death [MCCD]).
Post-death care and support should occur as usual. VAD providers should, with consent, inform others providing care (especially GPs) in a timely fashion of a patient’s death.
Figure 1. VAD patient assessment process flowchart.22,30-34
EOL, end-of-life; VAD, voluntary assisted dying.
Ways GPs can support their patients considering VAD
Personal considerations
Whole-person care is the foundation of general practice, and pivotal to that is the strong, trusted GP–patient relationship established over time and multiple encounters.20 In this context, it is important for each GP to proactively consider their approach to VAD prior to a conversation with a patient or family member, acknowledging that this may be deeply challenging for a GP who may be uncertain or hold a position of conscientious objection. At a minimum, GPs must examine their state/territory’s law to ensure that they provide accurate information for a patient and comply with their legal and professional obligations. Patients exploring VAD can be sensitive to potential stigma and a feeling of abandonment when raising it with their doctors. In the authors’ experience, it is possible to continue to manage patient care in parallel with a VAD application to preserve the unique therapeutic relationship GPs hold.
GP can support their patients by:
- providing accurate information about VAD in the context of EOL discussions (noting restrictions in SA, and Vic until April 2027)
- being familiar with local referral pathways and contacts (refer to Table 2)
- providing medical information to assist VAD reviews, including relevant investigations and non-GP specialist correspondence confirming diagnoses
- monitoring the patient’s health and communicating clinical deterioration, with consent, to palliative care and VAD providers
- receiving updates about a patient’s VAD progress as part of EOL planning
- completing death certification where a patient chooses self-administration. The VAD team should request this well in advance. The death certificate (MCCD) should be completed within 48 hours of notification. VAD should not be listed as the cause nor an antecedent cause to protect patient privacy. The MCCD has been updated for use across Australian jurisdictions. Death certificates issued by the Registry of Births, Deaths and Marriages do not contain mention of VAD. The relevant navigator service should be contacted in advance regarding the correct processes if there are any concerns.
- considering becoming a registered VAD-P. Each state/territory has developed mandatory training. Models of care, including remuneration, vary between states. VAD-specific Medicare item numbers are not yet available. Coordination and administrative load can be high, with VAD consults averaging between 1 and 2 hours, alongside mandatory documentation requirements. The state and district navigator services are an invaluable support. Refer to Table 2 for contacts.
Further information and guidance for GPs
Each state has a freely accessible VAD Clinical Practice Handbook available online that provides details of the VAD process in each state/territory (Table 3).
A note about the ACT
VAD is newly accessible within the ACT since 3 November 2025. Although every attempt has been made to include relevant information in this article, GPs wishing to know more are encouraged to contact the ACT Care Navigator Service directly to receive the most up-to-date information about referral pathways, legal obligations, eligibility criteria and information on how to become a registered VAD-P.
Case study: Bob has respiratory failure from advanced idiopathic pulmonary fibrosis
The case study outlined in Box 2 is based on the authors’ experience of engaging with many patients through the VAD process.
| Box 2. Case study |
Bob is the first patient booked in. He is in a wheelchair, oxygen attached, pursed-lipped breathing. ‘How are you, Bob?’ you ask.
He hands you a sheaf of paper. His discharge summary reads: ‘Respiratory failure secondary to advanced idiopathic pulmonary fibrosis … Palliative care community referral on discharge.’
‘The day I went in, I was suffocating. If the ambulance had been longer, that would have been it. They’ve told me I can’t get better. I love my family, I’ve had a great life, but when you’re too knocked up to be able to enjoy spending time, that’s it.’
You look up from the discharge summary. ‘What do you mean, Bob?’
He pauses again, trying to catch his breath.
‘I’d like to apply for that new law. I’m dying and I’m not going to rush. The family and me all need as much time as we can get. You’ll make sure I’m comfortable with palliative care’s support. I’d like to have it as a back-up.’
Bob looks at you. ‘It’s okay, I know the law is new. I asked at the hospital too. They gave me a leaflet with a number to call. If you do voluntary assisted dying, I’d rather you review me. You know me best. If you can’t, the Navigators I called said they’ll allocate a doctor. It’s very important to me that I’m honest with you. Even if you disagree? Will you still be my GP?’
You are not registered for VAD but reassure Bob that you will continue care as his GP. The rest of the consult passes, talking through supports, emergencies, tweaking medications.
Over the next few weeks, the VAD application progresses. You send in Bob’s respiratory letters and latest chest CT scan. The VAD doctor phones and reviews Bob’s status with you, confirming he meets the criteria, his wider end-of-life goals and thoughts about administration. Bob is thinking about taking oral VAD medication, with the VAD coordinator providing support to the family by phone.
The community team will attend and confirm his death on the day. The VAD doctor asks if you would consider writing Bob’s death certificate. You agree, as you will have some warning and 48 hours.
A few days later, you run into Bob’s daughter, Carly. ‘Dad hasn’t told everyone about VAD. It’s not easy facing his death, but it’s coming with or without voluntary assisted dying. We are treasuring every day. The community palliative care are helping us so much, but his breathing isn’t great. He’s in bed all the time.’
Next week, your receptionist tells you Carly phoned. ‘Dad’s decided it’ll be tomorrow. The VAD medication is being delivered today. He’s very weak, but clear as a bell that he wants it. He asked me to tell you.’
You go to Bob’s home during lunch that day. He is dozing, propped on pillows in bed. His dog, Sophie, is tucked in beside him under a crocheted blanket. You can hear Bob’s family chatting in the kitchen and talk-back radio in the background.
You do a few brief checks and then sit by his bed. Bob’s time is short. You hold his hand. Saying goodbye to long-term patients is a costly privilege that GPs get.
Bob opens his eyes, smiles and speaks, a few words at a time. ‘I’ve stayed as long as I can. You’ve been a wonderful doctor. Thank you.’ He closes his eyes.
As you leave, Bob’s family tell you that the VAD pharmacist will arrive and provide detailed instructions. They will not leave the medication if Bob is not well enough to say what he wants. Bob has asked family to be with him then and when he takes it. They are teary but resolved.
The next day, you get a phone call. The community nurse is at Bob’s home and has just examined Bob. They confirmed time of death as 10:26 am. Carly comes on the phone. ‘Dad was calm and happy today. He took it just after he’d made a little speech and said goodbye to everyone. He fell asleep and died in a few minutes. Nothing will change the sadness of our Dad dying, but I’m so glad he had us with him, and that he died peacefully.’
She pauses and then says:
‘Thanks for being his GP, from all of us. We couldn’t have managed these weeks without your expertise and compassion.’ |
| CT, computed tomography; GP, general practitioner; VAD, voluntary assisted dying. |
Conclusion
VAD is now a legal EOL choice for patients in all states and the ACT. Familiarity with VAD is part of providing comprehensive care to patients with a life-limiting illnesses. With patients aged over 65 years accounting for one-third of visits to GPs,
21 and with the proportion of people aged over 65 years rising, GPs will have increasing interaction with patients wanting to explore VAD as an option.
Planning in advance on how to respond when a person asks about VAD will help ensure a continued clinical relationship with the patient regardless of the GP’s personal beliefs to ensure continuity with trusted healthcare providers during this last phase of the patient’s healthcare journey.
Key points
- VAD is now a legal option for patients with a life-limiting illness in all states of Australia and, most recently, ACT.
- Each state has a navigator service that can provide information to GPs, patients, families and the public. Patients should be provided with these contact details at a minimum.
- Early identification of patients at end of life allows for better planning and coordination of care, including those wishing to consider VAD.
- Not all those who want VAD are eligible. Not all those who start the VAD process will complete it in time to use it. Not all those who access VAD will choose to use it, but many express great comfort associated with having the option.
- GPs are encouraged to proactively consider their personal and professional values, within the legal framework of their jurisdiction, when deciding how to engage with VAD. In some cases, this means they will need to consider how they will maintain their doctor–patient bond.