(SA) Allow Medical Practitioners to Initiate Conversations about Voluntary Assisted Dying

Christopher Noonan
17 hours ago
6 min read

Author: Christopher Noonan | Publish date: 18/06/2025

Problem Identification:

In SA, medical practitioners are prohibited from initiating conversations about voluntary assisted dying (VAD) with eligible patients, although VAD is legal.

Section 12 of the Voluntary Assisted Dying Act 2021 (SA) states that health practitioners must not initiate discussion about, or suggest, voluntary assisted dying whilst providing services to a patient.

This means that even when a patient may be eligible and benefit from knowing all their legal end-of-life options, they might not hear about voluntary assisted dying unless they raise the topic themselves. As a result, patients who are unaware of the law or unsure what to ask may miss out on timely information, potentially limiting their ability to make fully informed decisions about their care. Go Gentle Australia has reported that this disproportionately impacts those with lower health literacy who are less likely to be independently aware of VAD, including many culturally and linguistically diverse (CALD) Australians.

Context:

VAD refers to the practice of terminally ill patients having a medical professional assist them in ending their lives. VAD was legalised in SA in 2021, is currently legal in all other states, and will likely be available in both territories soon.

SA’s VAD legislation, including the restriction on initiating conversations with patients about VAD, was modelled on VIC’s Voluntary Assisted Dying Act 2017 (VIC). The stated intent of this clause was to protect vulnerable patients from being coerced into receiving VAD. However, a VIC Ministerial Advisory Panel on Voluntary Assisted Dying has reported that there is no evidence of coercion in jurisdictions where medical practitioners can initiate conversations about VAD. Further, they have suggested that ‘fears that people from particular groups will be pushed into making such requests are ill-founded.’

Furthermore, national VAD charity Go Gentle Australia has reported that this so-called ‘gag-clause’ means that a patient’s access to healthcare is partially dependent on their health literacy. This is because patients must initiate conversations about VAD themselves to access it. Patients who are unaware that VAD is an option for them may therefore be unable to access the treatment, as they cannot initiate a conversation about it with their doctor.

According to Voluntary Assisted Dying Australia and New Zealand (VADANZ), a peak body for healthcare professionals who provide VAD, this clause ‘disproportionately disadvantages less health-literate patients, including those of culturally and linguistically diverse (CALD) backgrounds.’ Dr Nick Carr, a Melbourne GP who has assisted dozens of patients through the VAD process, has also highlighted that this clause can prevent marginal communities from accessing VAD.

Some experts have argued that this clause also puts medical practitioners in a difficult position, as their stated professional expectations may conflict with this prohibition on initiating conversations about VAD. According to the Medical Board of Australia’s code of conduct for doctors, doctors should provide their patients with treatment options ‘based on the best available information’ and use honesty as a principle when treating patients. Therefore, some doctors have reportedly found it difficult to reconcile their professional expectations with the prohibition on initiating conversations about VAD with their patients.

Go Gentle Australia has recommended removing the restriction to allow doctors to initiate conversations about VAD in SA. They have said this could constitute a significant step forward in facilitating access to VAD. VADANZ has also recommended this reform, ‘provided it is done in the context of a broader discussion including all active and palliative treatment options, in line with other jurisdictions’. They say this could help facilitate the practice of fully informed decision-making amongst patients.

There is domestic precedent for allowing medical practitioners to initiate conversations about VAD. In WA, TAS, QLD and NSW, medical practitioners can initiate conversations about VAD with their patients, as long as they also discuss other available treatment and palliative care options. VIC has recently announced that it will be removing this clause after a review of its VAD legislation. SA will then be the only state that continues to prohibit medical practitioners from initiating conversations about VAD with their patients.

Solution Identification:

Amend section 12 of the Voluntary Assisted Dying Act 2021 (SA) to allow medical practitioners to initiate conversations about VAD in conjunction with available treatment and palliative care options.

This could improve access to VAD for lower health literacy groups and better allow medical practitioners to adhere to their professional standards.

Advice:

The SA Health and Wellbeing Minister should amend section 12 of the Voluntary Assisted Dying Act 2021 (SA) as described above at the next opportunity.

Public Support:

Where to go to learn more:

A submission from VADANZ to an inquiry about the VIC VAD legislation - ‘Review of the operation of the Voluntary Assisted Dying Act 2017 (Victoria)’, which includes a critical discussion of its ‘gag clause’. Read the full submission here.
Go Gentle Australia’s State of VAD report 2024 - Provides a detailed analysis of VAD laws across Australia, including the prohibition on initiating VAD conversations with patients in Victoria and South Australia. Read the full report here.
An article published in the Medical Journal of Australia that critiques VIC’s prohibition on medical practitioners initiating conversations about VAD - ‘Victoria’s Voluntary Assisted Dying Act: navigating the section 8 gag clause’. Read the full article here.
Victoria scraps ‘gag clause’ banning doctors from raising voluntary assisted dying with patients - A Guardian Article about the VIC government’s recent decision to remove their VAD ‘gag clause’. Read the full article he re
Discussing voluntary assisted dying with patients - SA Health webpage for medical practitioners that outlines the restrictions on discussing VAD with their patients. Access the webpage here.
Voluntary Assisted Dying Act 2021 (SA) - Access the full Act here.

Human Perspective:

When Amir’s mother, Fatemeh, was diagnosed with an aggressive neurological disease, the family leaned heavily on her local GP for support. As Farsi speakers navigating an unfamiliar healthcare system, they relied on their doctor to explain every step. The GP discussed palliative care and hospice options, but never mentioned voluntary assisted dying. By the time the family learned about VAD by looking online, Fatemeh’s condition had progressed too far, and she wouldn’t be able to access the service. This meant that Fatemah was unable to exercise autonomy in her final stage of life, which left her feeling powerless and betrayed by the South Australian medical system. Instead of ending her life on her own terms, Fatemah was forced to experience an avoidable and painful death. Her family was devastated as she missed out on a peaceful death just because she and her family were initially unaware of a treatment to which she had every legal right. To protect the anonymity of those involved, this is a fictionalised account drawn from an amalgamation of real-life stories, experiences, and testimonials gathered during the research process for this brief. Any resemblance to actual individuals is purely coincidental.

Conflict of interest/acknowledgment statement:

N/a

Support

If your organisation would like to add your support to this paper or suggest amendments, please email Info@foreaustralia.com.

Reference list:

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Legislative Council Legal and Social Issues Committee. (2022, March). Inquiry into Victoria’s criminal justice system – Volume 1.https://www.parliament.vic.gov.au/495dd9/contentassets/6961bccea1ac41dd812811ab0312170d/lclsic-59-10-vic-criminal-justice-system.pdf

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