Voluntary assisted dying and dementia

Voluntary assisted dying (VAD) is now available in all Australian jurisdictions except the Northern Territory. VAD presents an additional end‑of‑life option for those who may wish to access it, and evidence suggests this choice is valued by those seeking to do so.

Despite jurisdictional variation in VAD frameworks, all jurisdictions limit access to adults with a medical condition that will cause their death who:

• possess decision‑making capacity with respect to VAD throughout the process; and
• are approaching the end of their life (usually with death expected within 6 or 12 months, with the exception of the Australian Capital Territory, where no specific timeframe is prescribed).

The requirement to satisfy these two criteria contemporaneously means that not all people who may wish to access VAD can do so. One group that is practically excluded from accessing VAD is people living with dementia who seek to access VAD for their dementia alone (ie, in the absence of another qualifying condition). This is because, in many cases and in the absence of other co‑morbidities, by the time a person’s dementia is sufficiently advanced to be considered to be at the end‑of‑life, they are unlikely to possess the necessary decision‑making capacity to be deemed eligible for VAD. In New South Wales, accessing VAD for dementia is explicitly prohibited by legislation.

A complex conversation

Whether VAD should be available for dementia, and some of the ethical and practical challenges in permitting this, was one of the most discussed topics at the recent International Conference of Assisted Dying and Other End of Care, hosted by the Australian Centre for Health Law Research, Queensland University of Technology. There are ongoing conversations in Australia about whether VAD should be permitted for people living with dementia, as is the case in some other countries that permit VAD. To date, mixed views have been reported about such reform. However, given that dementia is now the leading cause of death in Australia, it is likely that this issue will continue to permeate public discussions.

While this issue has received attention in Australian public discourse, it has received less attention in the Australian academic literature. Some Australian studies have reported attitudes towards law reform to permit people with dementia to access VAD, but the literature to date has not provided an in‑depth exploration of perspectives on this issue, nor unpacked the associated complexities.

Perspectives from key interest-holders

To address this gap, we undertook a multi‑stage research project. After reviewing international and relevant domestic laws and policies, we interviewed 63 participants, including people living with dementia, past and present carers of people living with dementia, and medical practitioners, to examine their perspectives on whether VAD should be available for dementia, under what circumstances, and, if such a policy decision were made, what a desirable framework and model of care might look like.

Building on the findings from these exploratory interviews, we then conducted an in‑person Discussion Day in March 2026. This event was attended by people living with dementia, carers, medical practitioners, and representatives from peak body organisations. The Discussion Day focused on issues identified through the exploratory interviews and initial evidence review. To facilitate discussion, the researchers developed test models that could support a person living with dementia to access VAD for their dementia and used these as a springboard for discussion. In doing so, participants were able to canvass the complexities of permitting VAD for dementia and to discuss and debate these issues with others.

Safeguards and effective system design will be crucial

This research provides the first in‑depth exploration of the complexities associated with this issue in Australia. While some participants supported reform that would permit people living with dementia to access VAD, views varied regarding the circumstances under which this should be permitted.

Importantly, this research alone cannot answer the broader question of whether VAD for dementia should be permitted. However, participants were able to identify desirable features of such a framework that would enable this, including potential safeguards, should such a policy decision be made. The research also offers insights into clinical implementation, possible models of care to support service delivery, and preferred oversight mechanisms if there were support for reform.

Conversations about VAD for people living with dementia are likely to persist in public discourse. This research does not advocate for change, but rather aims to ensure that any future debate is well-informed, accounts for the social, ethical, and practical complexities, and is evidence-based.

Casey Haining is an interdisciplinary researcher with qualifications in biomedicine, population health and law. She holds research fellow appointments at the Australian Centre for Health Law Research (Queensland University of Technology) and the University of Melbourne, and has extensively researched and published on VAD since its inception in Australia.

Emeritus Professor Lindy Willmott is a Professor of Law in the Australian Centre for Health Law Research at the Faculty of Business and Law, Queensland University of Technology. She is an international expert in end-of-life law, with particular expertise in VAD.

Distinguished Professor Ben White is Professor of End-of-Life Law and Regulation in the Australian Centre for Health Law Research at the Faculty of Business and Law, Queensland University of Technology. He has been researching end-of-life law and regulation for 25 years with a particular focus on VAD and is the editor of Research Handbook on Voluntary Assisted Dying Law, Regulation and Practice (2025, Edward Elgar). 

This project is funded by the Clem Jones Foundation. The Foundation does not have any involvement in the research beyond providing the funding. The funder does not have any input into the research design, or access to the data obtained during the research project, or a role in analysis and interpretation of the data or publication decisions. The Clem Jones Foundation funds this project as part of its mission to support evidence-based law and policy deliberations about end-of-life care, including voluntary assisted dying.

Casey Haining was previously engaged as a legal writer for legislatively mandated VAD training. She was also the appointed research fellow to carry out Western Australia’s VAD statutory review. Lindy Willmott and Ben White were engaged by the Victorian, Western Australian and Queensland Governments to design and provide the legislatively mandated VAD training. They were also engaged by the Western Australian Department of Health to provide a research report for the statutory review of its legislation. Lindy Willmott is a member of the Queensland’s VAD Review Board. Ben White was appointed as an Expert Legal Advisor to the Legal and Constitutional Affairs Committee of the Legislative Assembly of the Northern Territory for its report on VAD and (with colleagues) developed the accompanying drafting instructions. He is a member of the Tasmanian Panel for the review of the End-of-Life Choices (Voluntary Assisted Dying) Act 2021.