Should telehealth be allowed for VAD consults?

Researchers are calling for reforms to allow the use of telehealth for voluntary assisted dying (VAD) consultations, while a separate study is urging improved remuneration and streamlined processes for GPs who choose to deliver the highly sensitive treatment.
 
The research, published in the Australian Health Review, analysed 230 articles, examining the risks and benefits of VAD telehealth consults.
 
‘Telehealth can improve access to VAD, particularly in remote areas, reducing travel burdens for terminally ill patients,’ the analysis concluded.
 
‘Global evidence from VAD and other sensitive medical fields supports the conclusion that telehealth’s benefits outweigh its risks.
 
‘Legislative clarity in Australia is necessary to resolve conflicts between federal and state laws and to provide clarity for healthcare providers and improve access for eligible patients.’
 
The call for changes follows a 2023 Federal Court of Australia ruling which determined that telehealth cannot be used during the VAD process as it is an offence to use a ‘carriage service’, such as a phone or video call, to counsel or incite suicide.
 
University of Queensland (UQ) researcher Dr Helen Haydon said Australia is the only country in the world with legislation preventing telehealth from being used for VAD, and conflicting federal and state legislation is making the approach even more complicated.

‘Under the Australian criminal code, the use of internet, phone or video services to counsel, incite or provide instructions to suicide is criminalised, whereas some states’ laws have telehealth-specific clauses which attempt to permit some telehealth use,’ she said.
 
‘Because of the legal discrepancies, healthcare providers fear prosecution for even discussing VAD with patients through telehealth services.
 
‘Yet it is health professionals who hear firsthand from eligible patients the distress of not having control over how, when and with whom they die.’

According to the RACGP’s VAD position statement, the college supports patient-centred decisions in end-of-life care, and ‘respects that this may include palliative care and requests for VAD’.
 
However, the college says any VAD legislation must protect both patients and doctors from coercion, ensure doctors are not compelled in any way to participate, have clear eligibility criteria, and support the optimisation of end-of-life and palliative care services.
 
Since Victoria became the first Australian jurisdiction to introduce VAD laws in 2019, 14,000 people have applied for VAD and there have been more than 7000 deaths using a VAD substance.
 
According to a new insight into the practice, a typical VAD applicant is in their 70s, has terminal cancer and is receiving palliative care, with slightly more men choosing VAD than women.
 
VAD activity increased by 40% nationwide in 2024–25, and VAD now accounts for around 2% of all deaths nationally, including 5% of cancer deaths and one in three motor neurone disease deaths.
 
It comes as a separate study explored the experiences of 12 Queensland GPs during the first year of the state’s VAD legislation.
 
It concluded there was a wide variation in GP involvement, ranging from GPs who were not involved in any VAD cases, to two involved in more than 50 cases.
 
The researchers say their study highlights the need for improved remuneration, streamlined processes, and broader education, with GPs reporting the paperwork was too complex and time-intensive and they were worried about making mistakes.
 
Currently, around 1600 trained health professionals provide VAD services nationwide.
 
Lead author Dr Laura Ley Greaves said while GPs are well suited to deliver VAD, the system design and administrative demands are creating barriers.
 
‘Many GPs told us the application process, training requirements, and lack of clear remuneration made participation difficult, especially for those working outside the public system,’ she said.
 
‘A broader GP workforce could help ease pressure on the public system and improve continuity of care for patients.
 
‘But that will only be possible if structural and financial barriers are addressed.’
 
Complexities around the delivery and sensitivity of VAD continue to exist across Australia, where laws differ from state to state.
 
Last year, Victoria took a step closer to scrapping a ‘gag clause’ preventing doctors from initiating discussions about VAD with their own patients.
 
This was a move welcomed by RACGP Victoria Chair Dr Anita Muñoz, who also believes that telehealth could be an appropriate way to deliver VAD.
 
‘If one thinks about how to use carrier services appropriately, and ethically, and professionally, like all other branches of medicine, we can use this to reduce issues like equity of access and to manage people who are too sick to travel,’ she told newsGP.
 
‘We need to recognise that if we can use telehealth for all other forms of medicine, we should not be excluded, and like all other forms of telehealth, the clinician needs to make sure that the person has the appropriate privacy and they're able to speak their mind freely.’

Dr Haydon said health professionals overseas reported using telehealth for VAD could be safer.
 
‘Overall, there seems to be little question about the use of telehealth for VAD apart from in Australia, where the law is based on limited evidence,’ she said.

‘At a time when VAD is on the increase, telehealth is needed more than ever but Australian laws are preventing access.’
 
All six Australian states and the Australian Capital Territory have now passed VAD laws, with Victoria implementing them first in 2019.
 
The Northern Territory is expected to follow.
 
The UQ researchers say future study is now needed to ‘include more robust measures of the efficacy of telehealth’.
 
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end-of-life care telehealth VAD voluntary assisted dying