Voluntary Assisted Dying: Reflections from Witnesses of the Written Declaration

Recently, Australian Football League fans lost a legend: Robert Walls. Diagnosed with a rare and aggressive form of blood cancer, Walls used the Victorian Government’s Voluntary Assisted Dying Act 2017 to take control of his destiny and end his suffering. It was a brave and deeply personal decision.

Voluntary assisted dying (VAD) offers a legal option for people with a terminal illness and limited life expectancy to end their lives on their own terms. VAD is now legal in all Australian states and the ACT. The process is strictly regulated, with robust eligibility criteria and safeguards to ensure that decisions are made freely and without coercion.

Since the laws were introduced, 5,338 Australians have applied for VAD. Of these, 2,467 have ended their lives through the program, representing less than one percent of all deaths. Cancer is the most common diagnosis among applicants.

Under the legislation, two doctors must certify that the person is expected to die within six months—or within 12 months in the case of neurodegenerative conditions.

While around 70% of Australians support VAD, it remains a confronting and complex issue for many.

Health professionals, for example, may struggle with a perceived conflict between the Hippocratic oath—primum non nocere, first do no harm—and supporting a patient’s request for VAD. Reconciling personal beliefs with a duty of care can be profoundly difficult, especially when treatment is futile, death is imminent, and a patient is pleading for relief. Doctors, however, are not required to support or participate in VAD.

Patients who choose VAD often do so because they wish to maintain control over their final days, valuing quality of life over quantity when suffering becomes overwhelming.

VAD can also bring clarity for many patients and their families. The question “How much longer do I have?” is no longer a painful daily uncertainty. But that certainty can also intensify anticipatory grief among loved ones. At this time, family and friends may well benefit from the valuable advice and support offered by palliative care services.

In Victoria, the VAD process must be initiated by the patient. The law prohibits doctors from suggesting VAD as an option. The patient must make three separate requests: two verbal (starting with their doctor) and one written.

Eligibility requirements

To be eligible for VAD, a patient must be:

• Over 18 years of age
• An Australian citizen or permanent resident
• Living in the state for a required period
• Able to provide proof of identity
• Capable of making decisions freely and without pressure

They must also nominate a contact person. This individual is responsible for returning any unused medication after the person’s death, or if they choose not to take it. The contact person also serves as the point of communication for the Voluntary Assisted Dying Review Board.

A Pivotal Moment: The Written Declaration

One of the most significant moments in the VAD process is the written declaration. This is when the patient formally records their decision in writing, confirming that they are choosing voluntary assisted dying freely and without coercion. It also acknowledges their understanding that taking the prescribed VAD medication will lead to their death.

Two witnesses are required to be present and sign the declaration alongside the patient. These witnesses:

• Must not be beneficiaries of the patient’s will
• Cannot be owners or managers of the care facility where the patient is being treated
• Must not be directly involved in the patient’s medical care
• Only one may be a family member

Each witness must sign the declaration in the presence of the coordinating medical practitioner, affirming that the patient appeared to:

• be making the decision freely and voluntarily
• have decision-making capacity
• understand the nature and consequences of their declaration

This part of the process is deeply emotional—and often overlooked in public discussions about VAD.

Case Study: Josie’s Story

Josie* was in hospital with advanced gastric cancer—her third cancer diagnosis in as many years. What she hoped would be a short admission turned into something final. Her oncologist told her the cancer was untreatable. If she was lucky, she had about three months to live.

Josie, ever stoic, refused to passively wait for death. Inspired by Robert Walls’ story, she decided to apply for VAD.

One of the most difficult phone calls Josie ever made was to her closest friends—life partners Bruce and Beryl*. Through tears, she told them, “This might be confronting,” before asking them to serve as witnesses to her written declaration.

Bruce and Beryl were heartbroken but not surprised. They knew Josie wouldn’t want to linger in a hospital bed, dependent and fading. She had always been practical and decisive. A controlled and dignified exit was true to her character.

Agreeing to be her witnesses was the hardest decision Bruce and Beryl had ever faced. They read up on the legislation, discussed Josie’s wishes in depth, and leaned on each other. In the end, they decided that supporting her final wish was the greatest act of love they could offer.

It is estimated that just over 5,000 Australians have acted as witnesses for a VAD written declaration. As awareness of VAD increases, more people may be asked to take on this important role—either as witnesses or contact persons.

Being a Witness to the Written Declaration

Being a witness to a written declaration for VAD is a deeply emotional experience. It is sad, confronting—and at the same time, a privilege. It demands courage, reflection, and composure.

Bruce and Beryl offer the following reflections for anyone asked to act as a witness:

Before You Agree to Be a Witness in a Voluntary Assisted Dying Process:

• Being a witness isn’t for everyone. The role can challenge your values and beliefs about death, dying, and grief. Consider whether you’re emotionally ready and able.
• Do your homework. Learn about the VAD legislation in your state or territory. Understand the full process, especially the specific requirements for witnessing a written declaration.
• Speak with a palliative care advice service. Find out what emotional and practical support is available. Ask your loved one’s care navigator how palliative care services can assist you.
• Search your heart. Ask yourself whether this decision reflects your loved one’s values and wishes. Make sure you’re at peace with being part of the process.
• You can change your mind. You are free to withdraw at any time. Feelings of doubt or guilt may arise afterward—these emotions are natural.
• Prepare for a profound moment. Witnessing the written declaration can be emotionally intense. Josie was relieved and excited that her application was progressing. Bruce and Beryl, however, left the signing reeling with mixed emotions. This was goodbye. The finality of it all was pervasively unsettling. Yet, they had given Josie the greatest gift of all—freedom from her suffering. Every person reacts differently.
• Expect your grief to begin early. If the VAD application is approved, your loved one’s death may not be far away. Knowing an approximate date can trigger anticipatory grief.
• Be kind to yourself afterward. Take time for yourself Allow yourself to grieve. Reflect. Speak to someone you trust—a friend, a palliative care advisor, your GP, or a mental health professional.
• Be mindful of who you tell. Not everyone understands or accepts VAD. Some may judge or misinterpret your involvement. Protect your emotional wellbeing.
• You may face blame. Grief affects people in different ways. Sometimes others lash out. Though you played no role in the patient’s death, you may be unfairly criticised. Family members may be especially sensitive to your presence, knowing you supported their loved one’s final wish.
• Don’t hover by the phone. If you’re not present when the medication is taken, try not to anxiously wait for news. You will be informed in due course. Don’t torment yourself with worry.
• Seek support. You don’t have to carry the emotional weight alone. Being a witness to someone’s final wish is a moment that stays with you. It’s not just a legal responsibility—it’s an act of love, of trust, and of honouring autonomy in the most personal of decisions.

As VAD becomes a more familiar part of end-of-life care in Australia, we must recognise and support not only patients and their families—but also those quietly standing beside them, helping to uphold their final wishes with dignity and respect.

Advice and Support

Here are some suggestion for advice and support. Some are for Victoria, others are national:

• Palliative Care Australia
• Victorian Palliative Care Advice Service
• Griefline
• Dying with Dignity Victoria
• Go Gentle Australia
• Beyond Blue

*Not their real names