What is VAD?
Voluntary Assisted Dying (VAD) 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. [1,2] 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. [2,3]
VAD differs from advance care planning (ACP) and palliative care. ACP is the process of documenting preferences for future care if the person loses decision-making capacity, [4] 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. [5] A person cannot request VAD through an ACP document and a person’s substitute decision maker cannot request VAD on their behalf. [6]
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. [7]
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. [2] Staff with personal or religious objections are protected by law but must still help facilitate access, requiring clear workplace policies to guide these situations. [8]
Barriers to people accessing VAD include limited staff training, ethical concerns, and organisational resistance. [4] Many workers feel unprepared to respond to VAD requests, creating stress and uncertainty. [5] Enablers such as clear policies, regular training, and counselling for staff improve confidence and reduce barriers. [3] 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. [8]
Practical considerations
Residential aged care homes require clear policies to support VAD access. [9] 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. [9]
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. [10] 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. [10]
Staff responsibilities include facilitating VAD requests, maintaining confidentiality, and supporting families. [11,12] Interdisciplinary teamwork is essential to provide comprehensive care, as demonstrated in successful international approaches. [8]
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. [13] Clear policies and communication strategies help align these services. [2]
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. [14] This exclusion potentially raises ethical concerns when residents have expressed a preference for VAD in advance directives. [15] 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 (CALD) residents and staff may hold differing views on VAD. Training in cultural sensitivity and engaging community leaders fosters understanding and ensures respectful care. [5,12]
Considerations for families
Families of individuals accessing VAD often experience a mix of emotions, including grief, guilt, and relief. [16] Transparent communication and early involvement in discussions help families feel supported and better prepared for the process. [16] Bereavement services, including counselling and peer support, are essential for families coping with VAD-related loss. [16] Internationally, Switzerland has shown that early engagement with grief counsellors significantly eases the emotional burden on families. [17]
Considerations for home care
Each state’s laws stipulate 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. [13,18]
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. [3,4]
Page updated 03 January 2025