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Voluntary assisted dying

Position statement Last updated: Jul 2026 Published in Australia Reference: PS #67

The primary role of medical practitioners in end of life care is to facilitate good quality patient-centred care. This statement should not be taken as explicit or implied support of the legalisation of physician assisted suicide. 

Purpose

Voluntary assisted dying (VAD) continues to be widely debated across jurisdictions in Australia and New Zealand. The Royal Australian and New Zealand College of Psychiatrists (RANZCP) has developed this position statement to provide a psychiatric perspective on VAD. 

The RANZCP acknowledges the wide range of views regarding VAD and encourages discussion about relevant ethical considerations.

Key messages

  • Psychiatrists may be involved in assessing and offering treatment for people who have symptoms of mental illness as part of a terminal illness, and in supporting people with irremediable suffering.
  • Priority should be given to ensuring that all individuals at the end-of-life have access to appropriate, high-quality palliative and mental health care.
  • Capacity assessment is a minimum safeguard for any voluntary or physician assisted dying process.
  • Psychiatrists must be afforded the right to refuse to participate in voluntary or physician assisted dying.

Definition

RANZCP acknowledges that there are a range of different terms used for VAD. These alternative terms include ‘physician assisted dying’, ‘physician assisted death’ or ‘physician aided dying’. The terminology used in this position statement is based on the psychiatric and medical literature.

VAD refers to situations where doctors prescribe[1] lethal substances to informed patients who have a terminal illness or a grievous and irremediable medical condition. These individuals must possess the legal capacity to decide that they wish to end their own lives at a time of their own choosing.

Background

Recent surveys suggest that around 80% of Australians and 70% of New Zealanders support the legalisation of some kind of VAD, although these numbers vary depending on details of the proposed scheme. [1-3] Medical opinion is more divided, with the Australian Medical Association, New Zealand Medical Association and World Medical Association considering that doctors’ involvement in VAD may in some cases be inappropriate or unethical. [4]

VAD has been legalised in all Australian jurisdictions, barring the Northern Territory which is reviewing its adoption, and in Aotearoa New Zealand. The legislation legalising VAD in each of these jurisdictions is similar but has varying requirements for access, decision-making, ethical and practical safety precautions, and the role of clinicians. All medical practitioners involved in the administration of any stage of the VAD process should be familiar with the relevant legislation and regulations of their jurisdiction(s). [5]

VAD has been legalised in some international jurisdictions across Europe and the United States. Even where VAD is illegal, some patients may request VAD from their doctors.

RANZCP affirms that it is a right of medical practitioners to choose whether they wish to be involved in VAD and to determine the extent of their involvement. Psychiatrists must never be required (i.e. mandated) to participate in the VAD process.

The role of psychiatrists

During the assessment process for VAD applications, psychiatrists may be asked to see individuals who are considering or wish to discuss VAD. In these circumstances psychiatrists will, through the identification and treatment of mental illness, make recommendations about mental health treatment and care irrespective of VAD considerations. Psychiatrists may also be involved in providing consultative support to colleagues in relation to VAD; such as general practitioners, palliative care specialists and psychologists, and this should be recognised within health services. [6]

Psychiatrists may also be involved in assessing a person’s capacity to decide about VAD. Assessment of capacity in this context is challenging and requires an evaluation of the person’s thought processes and the effect that emotional factors have on their capacity. It is important to note the issue of capacity as a critical consideration in the application for and administration of VAD. An assessment of capacity is not diagnosis-specific but rather is focused on a person’s ability to make the decision. [7]

It is not necessary that a psychiatrist be involved in capacity assessments. Primary care physicians and clinicians who are responsible for initiating the process of accessing VAD should be primarily responsible for these assessments. Only where there is complex comorbidity with mental health conditions, and initial assessments have been undertaken, should a psychiatrist be involved in any capacity. In general, treating physicians are better placed to make these capacity assessments due to the extended clinical relationship that these doctors have with consumers/ tangata whaiora, allowing them to make accurate assessments of capacity rather than at a single point in time.

The motivation to access VAD in terminally ill people is likely to reflect multidimensional distress in relation to end-of-life suffering. In addition to physical suffering, people in this situation may experience depression, anxiety, organic mental disorders and delirium, as well as psychological distress. In these cases where complex mental health comorbidities are present, a psychiatrist’s specific skills in the diagnosis and treatment of psychiatric illnesses, and their expertise at differentiating those illnesses from adjustment reactions to extreme personal circumstances, are relevant to capacity assessments in terminally ill patients.

Psychiatrists should also be aware that an individual’s cultural and religious beliefs may influence their decision to access VAD. Psychiatrists can play an important role in ensuring that health services are aware of any necessary protocols important to that individual and/or their community. [8]

It is important that in all cases consumers/ tangata whaiora can access good quality mental health care irrespective of their decision to seek VAD. This care should be provided independent of any capacity assessments and should be part of the standard multidisciplinary care program that all people diagnosed with terminal or degenerative conditions receive. 

Should a person decide to access VAD, there should then be specific mental health care and support during that process. Mental health care and support is also crucial for their support network including carers, family, whanau, and kin. Support networks report significant challenges regarding understanding, stress, grief and bereavement.[9] Clinicians should be aware of these impacts and take proactive steps to ensure that all people involved in the VAD process are adequately supported with safe and effective mental health care.

Recommendations

RANZCP recommends that discussions about VAD include consideration of:

  • the primary role of medical practitioners to facilitate the provision of good-quality, comprehensive and accessible healthcare, including end-of-life care.
  • the need to consider mental health as a core factor in comprehensive end-of-life care for all people involved.
  • the role of psychiatrists in end-of-life care to assess and treat mental health conditions that are contributing to suffering, and to treat those conditions in the first instance.
  • the importance of medical practitioners being allowed to make their own ethical decisions regarding their involvement with VAD, in line with relevant legislation.

References

  1.  Cartwright C. FactCheck Q&A: do 80% of Australians and up to 70% of Catholics and Anglicans support euthanasia laws? The Conversation. 2019.
  2. Gendall P. Euthanasia support dependent on circumstances - Massey University. 2010.
  3. Hurley E. Newshub poll: Most New Zealanders support euthanasia. Newshub. 2018;Sect. Politics.
  4. Australian Medical Association. Euthanasia and Physician Assisted Suicide. 2016.
  5. Department of Health Human Services. Voluntary Assisted Dying Bill: discussion paper: Department of Health and Human Services (Vic); 2017.
  6. Australian Commission on Safety and Quality in Health Care. National Consensus Statement: Essential elements for safe and high-quality end-of-life care. 2015.
  7. Stewart C, Pesiah C, B. D. A test for mental capacity to request assisted suicide. Journal of Medical Ethics. 2011;37::34–9.
  8. Queensland Health. ‘Sad News, Sorry Business: Guidelines for caring for Aboriginal and Torres Strait Islander people through death and dying’. 2015.
  9. La Brooy C, Russell H, Lewis S, Komesaroff P. The Impact of Voluntary Assisted Dying on Grief and Bereavement for Family Members and Carers in the Australian State of Victoria: A Qualitative Study. Health & Social Care in the Community. 2024;2024(1):3172357.

This information is intended to provide general guidance to practitioners and should not be relied on as a substitute for proper assessment with respect to the merits of each case and the needs of the patient. The RANZCP endeavours to ensure that information is accurate and current at the time of preparation but takes no responsibility for matters arising from changed circumstances, information or material that may have become subsequently available.