Challenges to remain for rural VAD patients despite Vic reforms
Victoria's Voluntary Assisted Dying (VAD) Act has recently been revised to be more accessible, with changes coming into effect in 2027. But accessibility for rural and regional patients will remain an issue, writes the University of Melbourne's Professor James Hurley.
While death is a sensitive topic for many, these changes are an important move towards people with terminal illnesses gaining autonomy over their lives by removing the barriers and obstacles often involved in seeking relief of suffering on their own terms.
In the 12 months of the 2024-2025 financial year, there were 837 applications for VAD in Victoria, with 519 prescriptions dispensed.
So the changes may have huge impacts for hundreds of Victorians – especially for those who previously were unaware or unable to access these services.
What has changed?
The changes to the VAD Act that passed Parliament late last year will soon make it easier for people to have a conversation about voluntary assisted dying and access the service.
The ‘gag’ clause – where medical practitioners were not allowed to initiate a discussion about VAD or even suggest it – will be removed.
Previously, no one was able to raise VAD as an end-of-life option - it could only be discussed if the patient raised it themselves.
With these changes, all medical practitioners, including nurses, Aboriginal Health Workers and psychologists can initiate a discussion.
This step is really important, because for many people, awareness of VAD as a possibility can be the first big barrier.
The new legislation will also require a prognosis of less than 12 months, where previously this was less than six (except for neurological conditions).
And the waiting period between the ‘First Request’ and ‘Final Request’ will be reduced from nine days to five days – and a matter of days can be incredibly important in these cases.
During the 2024-2025 reporting period, 171 applicants died before receiving a permit.
One of the most notable changes regards conscientious objection among health care practitioners.
Under the changes, even medical practitioners with a conscientious objection to VAD must supply minimum information if asked about the service – and an onward referral to someone who can discuss it in more detail.
Another change is that the pool of trained professionals who can participate in the delivery of VAD will be broadened to reduce the pressure on the coordinating practitioner.
The rural challenge
There are still challenges for those in more regional areas, and while the changes to the legislation have made it easier – problems persist.
Let's look at the experience of ‘G’ – a real person (de-identified) living over 250 kilometres from Melbourne – who in January 2025 was diagnosed with a malignant brain tumour.
Thanks to the guidance of his wife, ‘D’, he was able to start a conversation about voluntary assisted dying with his treating doctors.
In some regards, G was lucky – he was able to start the conversation quickly, the paperwork was handled by D while he began his treatment. The VAD Pharmacy team even came to his hometown to deliver and explain how to use the medication.
However, G’s assessment for VAD required three visits to the major regional cancer centre, still several hundred kilometres away.
As VAD cannot be discussed over telehealth, this distance is significant.
Fortunately for ‘G’, who was unable to drive, D drove him the several hundred kilometres each way.
For many people in regional areas, GPs may not be aware of who is an appropriate local VAD practitioner, which can limit people’s access or increase the costs associated with VAD (travel, time off work etc) in their last weeks of life.
The changes to legislation will hopefully ease the burden on patients seeking to use the VAD service. But as with many medical challenges, those in rural areas may need to travel long distances to get the benefits.
Autonomy till the end
The amendments to the VAD Act won’t take effect before 2027 – but my hope is that the passing of these changes will, in time, open up new conversations about the availability of this service so that those in need can access it.
In the end, 'G' was, in fact, one of the lucky ones.
Within three months of receiving the VAD medication, his symptoms progressed.
In November 2025, he took the VAD medication and died peacefully at home, as he intended, in the presence of his family.
The autonomy and comfort this gave him is of huge value.
Patients seeking VAD often describe that access to the service allows them to regain a sense of control, regardless of whether they choose to use it in the end.
For 'G', this was certainly the case:
“We (G and D) have been lucky to have a relationship where we haven’t shied away from discussions that involved death and I don’t feel daunted by VAD… dying is something that happens to all of us and I [G] can choose the end-of-life care that is right for me.”
This article was first published 16 February 2026 on Pursuit. Read the original article.