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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 In addition, the current General Explanatory Notes for the MBS uses confusing and outdated language, specifying that “Euthanasia and any service directly related to the procedure (do not attract Medicare benefits).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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in reply to a few comments on my post. Surveys have shown that doctors are deeply polarised on the issue of VAD and only a minority wish to take an active part in it. Until very recently the AMA was opposed to it. A recent survey in Victoria showed 53% of doctors supported legalised VAD, but with careful control. This is not a convincing majority. “Indication -creep” occurs in almost every contentious medical intervention and legalised abortion is a good example. We have already seen calls for VAD to be available via telemedicine, in mental illnesses and even to teenagers, situations that were excluded from the original VAD legislation. Those doctors who wish to take an active part in VAD presumably do so voluntarily-no one forces them, and it was predictable that remuneration might not reflect the necessary medical input.
For most dying people who request VAD, the probability that they will avoid an uncomfortable death provides enormous relief, so providing this relief becomes a very appreciated part of their palliative care. As part of palliative care VAD should be funded like any other medical service
I don’t understand why a doctor who prescribes VAD for a Motor Neurone Disease patient should be paid differently than the doctor who assesses the patient, diagnoses the disease, explains the disease process to the patient, then gives ongoing care for several years. There are Medicare items for consultations which involve long and complex discussions with patients who have complex conditions.
There is private billing if you want more per consultation. The VAD doctors could discuss with oncologists how they bill sick/dying patients. Or with their palliative care colleagues, who do not seem to be demanding higher fees.
The doctors diagnosing cancer in Delta Goodrem or John Farnham had to explain all the risks and side effects, including death, loss of career, or loss of ability to speak, then actually administer the treatment which was more complex than taking VAD drugs, over many months.
Most importantly, there must not be a ‘success fee’ like a ‘no win, no fee’ lawyer. If a patient refuses VAD at the last minute, the fee should be the same as if they go through with it. This is already the case in many Medicare items (descriptors like “by any means”) such as there is no financial difference between caesarean and vaginal delivery. The remuneration for palliative care needs to match the VAD rate, whether that is on a time basis like GP consultation, or a diagnosis basis like delivering a baby or replacing a hip.
As VAD is a State legislated choice, the State should provide for any costs in process and delivery, not Medicare or other Healthcare budgets, which are already over-stretched. In NSW the State provides for VAD and Professor Saleh comments he is well provided for. There are many subsidised services for VAD clients not available to the majority of other chronic, life-limited or vulnerable patients, and the significant inequity for those patients’ needs is never mentioned when others demand more access to those limited funds. In fact, the majority have more significant gaps in access of care and services needed. VAD clients are a minority, but have privileges not afforded to that majority, who rely on the stretched funds in Healthcare. Dr Claxton makes very true comments regarding that fact. VAD doctors are a minority. Many essential services are inadequately re-numerated through Medicare, nor have similar services available to access for that majority of doctors devoted to deliver care, for that majority of patients. Greater attention needs to be paid to the less vocal majority as greater inequity exists there when compared to those who chose or delivery VAD.
I am a GP VAD practitioner, a VMO employed for this purpose by my local Health District, working in a group of other trained GPs ( like me) for adequate sessional remuneration. We undertake this in addition to our day job as doctors in the private sector, in a range of GP positions. It works well. Personally, I enjoy the accommodation provided by the Area, including the rules , bureaucratic as they are, and the hierarchy of sitting under another specialty ( Oncology in our case). I have no desire to charge patients who I see at home, in institutions , in hospital , or wherever they want. They deserve equal care not determined by an ability to pay or limited by Medicare Bulk billing rates ( which would never cover the costs), but rather by their situation, of wanting a better death.
Why would a service approved or desired by well over 80% of our population, and requiring many, many hours of a doctor’s time, not be adequately remunerated?
While there are many doctors who have qualms about responding to a patient’s request for VAD, there is no doubt that patients very much value this service as it ‘palliates’ a dying patient’s fear of an uncomfortable death. Patients emphasise the importance of knowing that they can avoid the worst of suffering. Denying this palliative relief by not discussing VAD is, in my opinion, a dereliction of medical responsibility to our dying patients. Standard palliative care, without discussing VAD, is clearly inadequate care.
VAD, being an essential component of standard palliative care, should be remunerated like all other forms of medical care.
My husband used VAD in December 2024. He was a day admission and all sorts of things went wrong so at midday he said Enough. CMO on ward was so kind & competent. A VAD doctor came to us at 5.30 pm, having just finished a long shift at another hospital. His care & compassion was exceptional.
What can I as a person outside the medical profession do to assist proper remuneration?
I would like to see the evidence that Randal Williams has to back us the statement ‘surveys have indicated that up to 60% of Australian doctors either do not agree with VAD…directly involved’. Doctors should be remunerated for the whole process. The VAD teams in NSW are amazing and I will be eternally grateful that VAD was available for my husband (MND). Palliative care was not enough and it was good palliative care.
Parliaments Australia wide were told that VAD would be a rare undertaking for extreme suffering with Victoria alone expecting around 150 cases per year. Unlike Canada and the Netherlands Australian VAD deaths aren’t supposed to make up 5 percent of all deaths and hopefully numbers will remain low.
vAD was made legal but nowhere was it legislated to be free. Australians know they have to self fund a range of elective medical procedures. VAD is a choice and all factors including cost need consideration.
We already have some drs describing themselves as VAD is physicians and we have some public hospital “ directors of
VAD “.Some states ( ie NSW ) already have fractional VAD drs (VAD VMOs) who at times have nothing to do. This is at stark odds with the often poorly funded palliative care service that is extremely busy and very understaffed already. I don’t think Australia wants careerist VAD practitioners who work full time in VAD as exist in countries like Canada. vAD is to help suffering patients and isn’t about establishing career pathways for doctors.
The NZ VAD practitioner funding is very excessively generous ( likely for political reasons) and is totally and completely out of step with NZ medicine in general which is lacking and inadequate in very many basic respects.
There are MBS item numbers for termination of pregnancy and only a minority of doctors are involved. What is the difference?
As for “indication creep”, what is the evidence for this?
I am VAD. Customer in NSW
The process is very well organised at no cost to me
I would add to this that at least in Victoria – and likely Australia wide many private specialist practitioners are very happy to charge consult fees of $400 plus dollars per consult . Patients have informed me of this directly. While clearly a cost to the patient – for those who likely dont have long to live this is less of an issue. So at least some practitioners are being well reimbursed for VAD services .
In addition VAD navigators have access to special funds for a range of reasons – like transport or consult fees to assist patients with this. Such special funds don’t exist in palliative care .
Surely this illustrates the lack of understanding that the most appropriate way to deal with end of life issues is quality palliative care which supports dying as a natural process and does not involve unnecessary bureaucracy, heartache and expense.
Surveys have indicated that up to 60% of Australian doctors either do not agree with VAD (euthanasia) and a significant proportion who might support VAD in principle do not want to be directly involved. This possibly reflects uneasiness about “indication-creep” ( this has already happened ) and potential for abuse. Doctors who wish to take an active part in VAD are in the minority, and may have to accept that remuneration will never reflect the demands and the hours involved,