Strategic Plan 2025-2027 (Voluntary Assisted Dying Board Review Annual Report 2024-25)

Released in early 2025, the Voluntary Assisted Dying Review Board Strategic Plan 2025–2027 sets out the Review Board’s vision for a safe, high-quality, and sustainable voluntary assisted dying system and identifies five strategic priorities that will guide the work of the Board over the next three years:

1. A sustainable voluntary assisted dying workforce
2. Public awareness and understanding of voluntary assisted dying
3. Access to voluntary assisted dying
4. Continuous improvement of the voluntary assisted dying system
5. Research on voluntary assisted dying.

The strategic plan is underpinned by the:

• Voluntary Assisted Dying Medical Practitioner Participation Strategy
• Voluntary Assisted Dying Community and Stakeholder Engagement Plan
• Voluntary Assisted Dying Research Framework.

Priority 1 A sustainable voluntary assisted dying workforce

A sustainable voluntary assisted dying medical practitioner workforce is essential to ensure equitable, timely, and compassionate access to voluntary assisted dying. Demand for voluntary assisted dying services is steadily increasing as community awareness grows, yet participation in voluntary assisted dying by medical practitioners, who are the only health professionals authorised to deliver voluntary assisted dying remains at around 1 percent of all registered medical practitioners.

Participation in voluntary assisted dying requires specialised training, a significant time commitment, and professional and personal resilience. Without a stable and adequately supported workforce, patients may face delays and barriers to access. A sustainable voluntary assisted dying workforce creates conditions that prevent practitioner burnout, distributes clinical workload, and maintains high standards of care.

Key strategies to promote a sustainable workforce include ongoing education, appropriate remuneration, and accessible support systems for clinicians.

The Voluntary Assisted Dying Medical Practitioner Participation Strategy outlines how the Review Board will consult and engage with medical practitioners in South Australia to ensure a sustainable voluntary assisted dying trained medical workforce. We are undertaking a range of activities to help us to:

1. Better understand the challenges and considerations of medical practitioners who either participate in providing voluntary assisted dying services, or are considering doing so, and using these learnings to inform future activities.
2. Advocate and promote reasonable remuneration and other incentives for medical practitioners who perform voluntary assisted dying services.
3. Increase awareness of voluntary assisted dying within the medical practitioner community.
4. Promote connection and learnings between voluntary assisted dying trained medical practitioners and the broader voluntary assisted dying service system, to support wellbeing and shared learning.

Achievements 2024-2025

During 2024-2025 there has been a 9 percent increase in both the number of medical practitioners who are authorised to support access to voluntary assisted dying and the number of authorised practitioners who have participated in voluntary assisted dying.

While a small number of practitioners continued to provide a high number of assessments, during 2024-25, there are signs that this workload has become more distributed amongst participating medical practitioners. During 2024-2025 there was a 60 percent increase in the number of trained medical practitioners supporting more than 20 patients compared to 2023-2024. In addition, a greater percentage of regional patients (88%) are receiving support from medical practitioners located in regional areas compared to 81% in 2023-2024.

Priorities for the coming year

As voluntary assisted dying activity continues to increase, the Review Board is committed to better understanding considerations of medical practitioners who are thinking about providing voluntary assisted dying services, and for those who are active, some of the challenges they face.

The Review Board recognises that voluntary assisted dying is still a relatively new service in South Australia and will continue to take steps to increase awareness across the medical community.

The Review Board is advocating for the establishment of fair remuneration for medical practitioners with dedicated Medicare item numbers for voluntary assisted dying care. 

Priority 2 Public awareness and understanding of voluntary assisted dying

Public awareness and understanding of voluntary assisted dying are critical to ensuring equitable access, particularly in South Australia where the Act prohibits health professionals from initiating conversations about voluntary assisted dying with patients (commonly known as the ‘gag clause’). This restriction means that patients who are unaware of their legal rights may miss the opportunity to make fully informed choices at the end of life.

Increasing public knowledge helps bridge this gap by empowering individuals to raise the topic themselves where legislative restrictions limit health professionals from initiating voluntary assisted dying discussions. Otherwise, what are intended to be legislative safeguards risk becoming barriers, and patients who do not know about their rights to access voluntary assisted dying may be prevented from exercising their legal choice at end of life.

Achievements 2024-2025

This year the Review Board endorsed a Community and Stakeholder Engagement Plan that outlines structured opportunities for connection, education, and collaboration with diverse groups including patients, families, healthcare providers, advocacy organisations, and cultural communities. Since the development of the Plan, 19 of 20 engagement targets have been achieved. Highlights include:

During 2024-25 the Review Board released one annual report and four quarterly reports on voluntary assisted dying. These reports provide valuable opportunities to share feedback, insights, and learnings while keeping the community informed about voluntary assisted dying activity in South Australia. Annual and quarterly reporting will remain a key mechanism for building community awareness and understanding of voluntary assisted dying.

Past reports are available on the Voluntary Assisted Dying Review Board web page.

On 30 May 2025 the Review Board hosted the second annual Voluntary Assisted Dying Day of Reflection. This event brought together around 140 family members, friends and loved ones of those who died on the voluntary assisted dying pathway in 2024, along with clinicians and staff involved in the pathway. The Day of Reflection will continue to be held annually to honour and remember those who died on the voluntary assisted dying pathway during the previous year.

Several key stakeholders were invited to meet with the VAD Review Board throughout the year to share their unique perspectives on voluntary assisted dying including:

• The Minister for Health and Wellbeing, who is the Minister responsible for voluntary assisted dying in South Australia and the Attorney General
• Representatives from the Victorian Government Department for Health, who shared insights from their recent five-year review of the operation of the Victorian Voluntary Assisted Dying Act 2017
• SA Prison Heath and the Department of Corrections, who discussed their experience of implementing a pathway for access to voluntary assisted dying for people in custody.
• Voluntary Assisted Dying SA (VADSA), who provided a community perspective on how voluntary assisted dying might continue to evolve
• South Australian voluntary assisted dying clinical leaders, who shared their experiences supporting patients and families within the framework of the legislation
• The Chief Executive Officer and Executive Director of Medical Services for the Barossa Hills Fleurieu Local Health Network, who provided insights into service delivery and implementation across the network
• A voluntary assisted dying medical practitioner, who has supported South Australian patients to access voluntary assisted dying and created the podcast Voices from voluntary assisted dying.

We look forward to continuing to meet with and learn from individuals and organisation with expertise across a range of areas to help to inform our work in the year ahead.

Priority 3 Access to voluntary assisted dying

The Act provides eligible South Australians with the legal right to choose voluntary assisted dying as an end of life option. The legislation reflects principles of autonomy, dignity, and compassion that can only be realised if access to voluntary assisted dying is equitable across all communities.

Current barriers to access mirror many of the broader challenges faced within the healthcare system in general, such as geographical isolation, cultural or linguistic differences, and difficulties with health literacy and system navigation. However, voluntary assisted dying also presents several unique access barriers.

These include the ‘gag clause’, a section of the Act that prevents health professionals from initiating discussions about voluntary assisted dying with their patients; the restrictions imposed by the Commonwealth Criminal Code Act 1995 carriage laws prohibiting the use of telehealth for certain parts of the voluntary assisted dying pathway; and the right of conscientious objection, which allows for health practitioners to decline participation in voluntary assisted dying.

While conscientious objection is an important safeguard and right of medical practitioners, there is currently no requirement in the Act for objecting professionals to provide information about voluntary assisted dying or to refer patients to a practitioner who can offer support. Additionally, there is no offence for obstructing access to voluntary assisted dying through the withholding of information, the provision of misinformation or through reverse coercion.

Failure to ensure equitable access undermines the guiding principles of the Act - including respect for autonomy, protection from coercion, and fairness and can result in unnecessary suffering, increased emotional distress for families, and reduced confidence in the healthcare system.

Achievements 2024-2025

For many areas of healthcare, timely and comprehensive access to services  for people residing in regional and remote areas can present challenges. Despite this pattern, during 2024-2025, 35 percent of people who applied for voluntary assisted dying were residing in a regional area indicating that patients from regional areas were not disadvantaged in accessing voluntary assisted dying in South Australia.

Timeframes on the voluntary assisted dying pathway continue to reflect a highly responsive system. The average length of time between a person making a first request for voluntary assisted dying to a medical practitioner and receiving a voluntary assisted dying permit was consistently under 3 weeks.

Priorities for the coming year 

Aboriginal people represent approximately 2.4 percent of the South Australian population, however only 1 percent of applicants for voluntary assisted dying currently identify as Aboriginal. The Review Board is continuing to engage to support the development of a meaningful process and pathway to enable access to voluntary assisted dying for Aboriginal people in South Australia in a culturally sensitive manner. Over time this may allow for a more proportional representation for Aboriginal patients. As part of this work the Review Board is exploring different ways to ensure there is appropriate Aboriginal participation at Board level so as to support meaningful involvement.

Telehealth plays an important role in facilitating access to health services, in particular for people residing in regional South Australia. As has already been noted, the Commonwealth Criminal Code Act 1995 prohibits the use of telehealth and other carriage services to discuss or send ‘suicide-related’ material. This has been interpreted to impact on discussions relating to voluntary assisted dying, notably around the provision of the voluntary assisted dying medication and distribution of information and education to patients regarding administration of the voluntary assisted dying medication.

Medical practitioners are understandably concerned about inadvertently breaching the Act and the risk of prosecution while this legislation remains in place. While assessments of eligibility for voluntary assisted dying can be conducted via telehealth in South Australia, removing further Commonwealth legislative barriers to allow for discussion of administration of the voluntary assisted dying medication via telehealth where necessary would be beneficial. This change would allow for more patient centred and timely education and support for patients and their families, particularly for those who live in regional areas or who are unable to travel to appointments due to their advanced illness.

The Presiding Member of the Review Board has, in conjunction with the Trans-Tasman voluntary assisted dying Board Chairs committee, written to the Commonwealth government advocating for changes to the Commonwealth criminal code carriage laws to enable the use of telehealth for all parts of the voluntary assisted dying pathway where clinically appropriate.

Priority 4 Continuous improvement of the voluntary assisted dying system

Voluntary assisted dying is now available in all Australian states and the Australian Capital Territory, and the Northern Territory government is currently pursuing local legislation. To develop and implement legislation, each jurisdiction has taken learnings from those who went before them. In addition, each jurisdictions legislation stipulates a review of the operation of the legislation within a certain time period to ensure that legislation continues to meet the needs and expectations of the community. Through this process we can already see an evolution in Australian voluntary assisted dying legislation informed by evidence and experience.  This is likely to continue for some time into the future given voluntary assisted dying is a very new area of healthcare both nationally and internationally.

Under the Act, one of the functions of the Review Board is to provide reports to Parliament on the operation of the Act and any recommendations for the improvement of voluntary assisted dying, and to promote continuous improvement in the quality and safety of voluntary assisted dying to those who exercise any function or power under the Act.

To support this function, the Review Board is continuing to gather and collate evidence as part of day-to-day work to understand how the legislation is working and what needs to be improved both operationally on the ground and in the legislation. The Review Board gathers this evidence in a range of ways including through:

• Undertaking a detailed review of each patient journey on the voluntary assisted dying pathway for compliance with the Act including consideration of any barriers to access or factors impacting negatively on patient or clinician or community experience
• Feedback received from patients, families and the community regarding their experience, their hopes and their expectations for the end of life
• Regular engagement with medical practitioners and voluntary assisted dying staff to understand how voluntary assisted dying is working day to day on the ground
• Regular engagement with VADSA to understand contemporary community expectations regarding improvement of voluntary assisted dying
• Identification and monitoring of risks related to the operation of the Act
• Working closely with the Department for Health and Wellbeing to understand operational matters affected by the legislation.

The Review Board welcomed the findings of the 5-year review of the operation of the Victorian Voluntary Assisted Dying Act 2017 earlier this year and note the review has prompted the Victorian Government to propose new legislation to address several barriers to access including:

• Removal of the gag clause to allow health practitioners to initiate voluntary assisted dying discussions with their patients
• Extension of the 6 month prognosis timeframe to 12 months for all voluntary assisted dying applicants.
• A requirement that health practitioners who conscientiously object to voluntary assisted dying must provide minimum information about voluntary assisted dying.
• An exemption process from the current Victorian residency requirement.

During 2024-2025, representatives from Victoria involved in the review were invited to meet with the Review Board to talk about their review process and findings. The Review Board is also looking forward to engaging with NSW, QLD and WA regarding their review process and findings.

The review of the operation of the Act in South Australia must be completed after 31 January 2027 and prior to 31 January 2028.

Priority 5 Research on voluntary assisted dying

One of the functions of the Review Board is to conduct analysis of and carry out research in relation to information or forms given to the Board in accordance with the Act. The Voluntary Assisted Dying Research Framework developed in early 2024 provides a robust framework for engagement with and participation in research in relation to voluntary assisted dying under appropriate governance and in alignment with evidence-based research principles and priorities.

Achievements 2024-2025

To support the Review Board to carry out its research function, a Voluntary Assisted Dying Research Subcommittee has been established, meeting quarterly since September 2024.

Current items of focus for the subcommittee include engaging and connecting with local and national research partners, establishing and testing data governance and data sharing protocols, refining a list of priority research questions, and receiving and assessing research proposals and requests for data. Research partnerships established to date include:

• South Australia is contributing de-identified data collected by the Review Board to the Australian Research Council Voluntary Assisted Dying Data Linkage Project being led by Queensland University of Technology. This 3 year multi-jurisdictional, multi-disciplinary project aims to develop a comprehensive and rigorous evidence base to facilitate an assessment of how voluntary assisted dying practice is currently occurring in selected Australian states. It is anticipated that the findings will also inform future review of voluntary assisted dying laws
• A partnership with the University of South Australia to undertake a scoping review of the literature to identify themes that have emerged as voluntary assisted dying has commenced across Australia.

Priorities for the coming year

• Early discussions have commenced regarding a research proposal submitted to the research subcommittee proposing an analysis of non-completion of the voluntary assisted dying pathway and any lessons to support improvement of the pathway.
• Planning is underway exploring the potential to host a voluntary assisted dying research gathering in 2026
• Research findings will be disseminated through quarterly and annual reporting on voluntary assisted dying and where relevant will be presented at national forums.

Further information about the Research Subcommittee and the Research Framework can be found on the SA Health website.

The Voluntary Assisted Dying Review Board Strategic Plan 2025-2027 can be viewed on the SA Health website.