Voluntary assisted dying (VAD) is now part of the end of life landscape across most of Australia. It is legal and operating in every Australian state and in the ACT, while the Northern Territory remains the only jurisdiction where it is not currently available, though reform is being considered this year.
Like all significant changes in how we approach dying, VAD asks more of us than a legal or medical response alone. It asks us to listen more deeply, to become more death literate, more grief literate, and more willing to sit with complexity.
A conversation that started in our community
Recently, in one of our Preparing the Way graduate mentoring and peer support sessions, Jacqui Williams, a Preparing the Way trainer and experienced end of life doula, held a thoughtful and generous conversation with two of our graduates, Sherryl Searles and Nicole Grundy. They both brought deep insight into the VAD space, each from a different but complementary place.
Sherryl recently attended the International Conference on Assisted Dying and Other End of Life Care (ICEL5) in Brisbane. Nicole brought extensive lived, professional and peer support experience in this space, including work with families, grief support groups, funeral homes and people navigating the VAD pathway.
What stayed with me most from that conversation was not simply the information about legislation, process, access or systems, although all that matters deeply. What stayed with me was the human story around VAD.
VAD happens inside families, not just legislation
The person who is dying is, of course, central. Their suffering, their choices, their dignity, their clarity, their fear and their wishes all matter. And they are not the only people affected. VAD happens inside families, friendships, communities, belief systems, histories, old wounds, love, fear and grief.
One of the clearest threads to emerge was that families can support a decision and still feel deeply conflicted. These two things are not opposites. A daughter, husband, partner, friend or sibling may absolutely understand why their person has chosen VAD. They may believe in that person’s right to choose. They may advocate for them, sit beside them, help with appointments, protect their wishes, and speak up when others do not understand. And still, somewhere inside, there may be a quieter voice saying, “But why are you leaving me?” or “Why can’t you stay a little longer?” or “Why aren’t you fighting for us?”
That is not judgement. That is grief.
Nicole spoke beautifully about the difference between intellectually understanding someone’s choice and emotionally living with it. For many people supporting someone through VAD, there is a kind of duality that has to be carried. There can be relief and devastation, pride and fear, peace and shock, gratitude and anger, a sense of gift, and a sense of, “I did not want this gift.” We need public conversations that are mature enough to hold all of that.
A different form of dying, a different echo
Sherryl shared that one conference participant described VAD grief in profound words: “It’s a different form of dying and it leaves a different echo.” That feels true. VAD can create a grief experience that is familiar in some ways and very particular in others. The relationship, the illness and the circumstances all matter. So do people’s beliefs, values, fears, family dynamics and the level of openness or secrecy around the decision.
The chosen date is one of the things that can make VAD grief distinct. In many deaths, even when death is expected, the exact moment remains unknown. With VAD, a date may be chosen. That can offer time for preparation, conversations, legacy work, goodbyes, music, food, ritual, letters, gathering and meaning making.
Conversely, it can also intensify the grief. Families may find themselves counting down, trying to make everything beautiful, while privately feeling as though they are falling off a cliff. The person may be clear in their decision, and still frightened. The family may be supportive, and still not ready.
The feelings people are afraid to name
A grief resource that Nicole shared names some of the feelings that may arise before a VAD death, including anticipation, guilt, anger, sadness, isolation and regret. That is so important because many people feel ashamed of these responses. They may wonder whether their sadness means they are not supportive enough, or whether their anger means they have failed the person they love. But these feelings are natural and valid. They are part of trying to love someone through a death that may be chosen, planned and deeply wanted by the person, while still being heartbreaking for those who remain.
Sherryl reflected that, as someone who is very supportive of VAD, she had not previously fully appreciated how lonely the path can be for many carers because of the stigma they may feel. There can be secrecy, because not everyone is supportive of the decision. That secrecy can add another layer to the grief. Some families tell many people. Others tell almost no one.
Some fear judgement from friends, faith communities, health professionals or extended family. Some do not know what words to use. Some feel protective of the person who died. Some feel that unless someone else has been through it, they cannot possibly understand.
This is why VAD-specific grief support, peer support and safe spaces matter so much. People need places where they can say the things they are afraid to say elsewhere, without being corrected, judged, argued with or turned into a political position. Griefline has specific VAD support groups, and Go Gentle Australia also provides information on grief and bereavement after VAD.
Where end of life doulas fit in
VAD has a clinical and legal pathway, but families also need a human pathway. This is where the role of end of life doulas becomes so important.
Doulas can hold the questions that do not always belong to the doctor, the nurse, the navigator or the funeral director. Some examples Nicole shared: Where do you want to be on the day? What do you want to wear? Who do you want in the room? What would help the room feel calm? What might the people around you need to know? What happens immediately after the death? Will the body stay at home for a while? Who will call the funeral director? Would family like to wash, dress, anoint, sit with, sing to or simply be near the person?
These may sound like small details, but they are not small when you are living them. The final image can stay with people for a very long time.
Sherryl shared reflections from the Brisbane conference about the importance of that last room, that last moment of care. A calm room, a sense of serenity, the right people close by, the right people stepping back, and the sense that nothing is being rushed can become part of how grief is carried. When the ending feels too clinical, too fast or too unsupported, that too can stay in the body and heart of those left behind.
It doesn’t look like the brochure
We also need to be honest that a VAD death may be peaceful, but that does not mean every witness experiences it as peaceful. Some people describe a beautiful, calm, dignified death. Others describe something confronting, surreal, or very fast. One of the most powerful reflections from our peer support session was that “it didn’t look like the brochure.” That is a powerful reflection. It does not mean VAD should be feared. It means people deserve truthful preparation. Planned does not always mean easy. Peaceful for the person dying may still be shocking for the person watching.
After-death care: when love keeps moving
For some families, after-death care can be a way for love to keep moving. This is something many end of life doulas understand deeply. When someone dies, especially after a planned death, the people who are still present can be carrying so much feeling that has nowhere to go.
Gentle, family-led after-death care can give grief a way to be expressed and shared. Sitting with the person, washing their face, shaving them, dressing them, placing flowers, opening a window, lighting a candle, telling stories, keeping vigil for a while, or creating a simple ritual can help the death become part of a wider story of care rather than only the moment of medication.
This is not about telling families what they should do. Some will want the funeral director to come quickly. Some will choose direct cremation and feel completely at peace with that. Others may later realise that the simplicity that suited the person dying did not fully meet the grief needs of the people left behind.
We need to be able to ask, gently and without agenda: What will help this family farewell? What will help this grief move? What will help love complete the next step?
The ethical responsibilities of doulas in this space
There are real ethical responsibilities for doulas working in this area. Nicole was very clear about this, and I agree with her. This is not work to step into lightly.
Doulas need to clearly understand the legislation in their state or territory, their scope of practice, the language they use, their own beliefs, the risk of coercion, the need for neutrality, and the difference between support and persuasion. If a doula carries strong, unresolved judgement about VAD, this may not be the right space for them. The person and their family deserve support that is steady, informed, compassionate and free of hidden agenda.
That does not mean doulas become advocates for VAD. It means we become advocates for good care, truthful conversations, family support, grief literacy, choice, preparation and dignity. It means we can sit with people in the realness of what is in front of them. We can support the person who is dying, and we can also ask: Who is supporting the person who is supporting them?
Access, equity and what still needs work
The ICEL5 conference in Brisbane made it clear that the legal, clinical and systems conversations around VAD will continue to evolve. There are real questions around access, regional inequity, workforce sustainability, aged care, palliative care relationships, dementia, capacity, legislation and consistency across Australia. These are important conversations, and we need good minds, strong ethics and careful safeguards around them.
But alongside those larger systems questions, there is a more intimate question that belongs in every lounge room, hospital room, hospice room and kitchen table conversation where VAD is being considered.
How do we care for everyone touched by this death?
The heart of it
That, for me, is the heart of it. Voluntary assisted dying is not only about the person who chooses it. It is about the circle around them. It is about the person who makes the phone calls, sits awake at night, holds the secret, supports the decision, feels the fear, prepares the room, witnesses the death, calls the funeral director, and wakes up the next morning in a world that has changed.
As end of life doulas, we are well placed to serve in this space, but only if we do so with humility, education, ethical clarity and heart. We are not there to replace doctors, nurses, navigators, counsellors, palliative care teams or funeral directors. We are there to bring the human thread, to help people talk, prepare, help them ask questions they did not know they were allowed to ask, help families understand that their mixed feelings are not a failure of love, and to help grief find a shape.
Perhaps the most important public conversation now is not simply, “What is VAD?” or “Do you agree with it?”
Perhaps the deeper question is: How do we care for the person who is dying, and how do we care for everyone who cares about them?
Because in the end, dying is never only a medical event. It is a human one. And the more we remember that, the better we will care.
With thanks to Jacqui Williams, Nicole Grundy and Sherryl Searles for their contributions to this conversation and for the depth of care they bring to this space.
VAD grief and support resources
For people supporting someone before or after a voluntary assisted death, the following resources may be helpful.
Griefline VAD support groups: Griefline offers VAD-specific support groups and grief resources for family and friends before and after a voluntary assisted death.
Go Gentle Australia: Provides information and support around VAD, including grief and bereavement resources for families and friends.
Helen Callanan
Founder & Lead Educator
Helen is a practising end of life doula and the Founder, Managing Director, and Lead Educator of Preparing the Way. With nearly 40 years of experience in traditional Chinese medicine and Reiki and working with the aging, very ill, and dying, Helen brings profound insight into health and the ‘circle of life’.