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Voluntary assisted dying should not rely on clinical altruism, writes Dr Andrea Bendrups.
Voluntary Assisted Dying (VAD) is widely supported by Australians and is now a legal end‑of‑life choice in every Australian jurisdiction except the Northern Territory. Yet while the legislative landscape has shifted dramatically, the financial and structural support for practitioners delivering this care in Australia has not. The result is fragmented, inconsistent or absent funding, which undermines the sustainability of VAD services and the wellbeing of its workforce.
The 2025 VADANZ Remuneration Survey of VAD practitioners revealed widespread dissatisfaction with current remuneration models. Almost two‑thirds of respondents felt their state’s arrangements were inadequate, more than a quarter reported providing unpaid VAD care, and only a third received any state government reimbursement. In Victoria, dissatisfaction exceeded 80%, while in South Australia and Tasmania every respondent reported dissatisfaction. Only New South Wales stood out, with a slim majority (51%) reporting adequate remuneration.
At present, there are no Medicare Benefits Schedule (MBS) items that adequately cover the hours of time required to deliver VAD care. In addition, the current General Explanatory Notes for the MBS uses confusing and outdated language, specifying that “Euthanasia and any service directly related to the procedure (do not attract Medicare benefits). However, services rendered for counselling/assessment about euthanasia will attract benefits”. This means that any available MBS items can only be used for some parts of the VAD process, leaving a large gap between available remuneration and the cost of delivering care.
We know that VAD practitioners are going to extraordinary lengths to support patients and shield them from financial burden. However, the system cannot depend solely on their generosity; it is unreasonable to expect doctors to provide these services for free.
Behind these statistics lies a troubling reality. VAD care is complex, requiring not only clinical expertise but also extensive non‑clinical work: administration, portal documentation, coordination and travel. Current MBS items are not designed to capture this work, leaving practitioners uncompensated.
For privately practising GPs and specialists, who often have a long term relationship with the patient, the situation can become untenable. They are committed to delivering ‘person centred care’ yet the available MBS items do not cover their costs, so the choice is to provide the care as an act of clinical altruism or to charge an out-of-pocket cost. Many report doubts about whether they can continue providing VAD care under these circumstances.
When asked to provide information on private billing rates, many respondents said they were highly uncomfortable charging for VAD services. One respondent stated “It feels like profiting from death and I feel very uncomfortable with this”, a sentiment expressed by many practitioners throughout the survey. However, VAD should not rely on their goodwill.
The situation can be better for salaried doctors, where the remuneration for VAD work may be included as part of their existing salary, but many report that this was new work added to an already full clinical load.
This is not simply a workforce issue. It is a patient care issue. If practitioners withdraw from VAD work due to financial pressures, patients will face reduced access to a compassionate end‑of‑life option. Continuity of care will be disrupted, and the promise of dignity and autonomy at life’s end will be compromised.
Urgent reform is needed to ensure that VAD services remain viable and accessible. Dedicated MBS items for VAD care must be introduced, recognising the work’s unique demands. Fee schedules should cover all aspects of care, including travel costs, particularly for services delivered outside hospital settings. More funded hospital roles — whether as full time equivalent positions or visiting medical officer arrangements — would provide financial certainty for more practitioners. States must also issue clear guidance on available billing options, reducing uncertainty and inconsistency. Finally, federal updates to MBS Explanatory Notes are required to remove restrictions that unreasonably limit the use of items for VAD.
The New Zealand model provides a valuable template. There, medical and nurse practitioners who complete mandated assisted dying training are able to claim remuneration on a fee‑for‑service basis. The process is divided into five modules, each eligible for a fixed payment, with additional payments available in complex cases or where travel is required. This structured approach recognises the time and expertise involved in VAD care, and ensures that practitioners are not left carrying the financial burden of providing a legally sanctioned clinical service.
New Zealand has a system that ensures transparency, fairness, and sustainability. Australia should not hesitate to learn from this example.
The legalisation of VAD across Australia reflects a societal commitment to compassion, dignity, and patient autonomy at the end of life. But legislation alone is not enough. Without adequate remuneration, the system risks collapsing under the weight of unpaid labour and practitioner burnout. Policymakers must act to align funding structures with the reality of VAD practice. To do otherwise is to jeopardise both the workforce and the patients they serve.
Australia has taken the courageous step of recognising VAD as a legitimate end‑of‑life choice. It must now take the equally necessary step of ensuring that those who provide this care are properly supported. Anything less is unsustainable.
Dr Andrea Bendrups is President of VADANZ, the peak body for health professionals providing voluntary assisted dying (VAD) care in Australia and New Zealand.
VADANZ is co-hosting the Trans-Tasman Voluntary Assisted Dying Conference in Melbourne on Monday 19 & Tuesday 20 October 2026.
The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated.
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