Victorian VAD model sets global benchmark, study finds

Victoria’s voluntary assisted dying (VAD) model has been hailed as a global benchmark after new research found the self-administration process is both safe and effective, addressing longstanding concerns about oral VAD medication.

The study, published in BMJ Supportive & Palliative Care, analysed six years of data from the Victorian Voluntary Assisted Dying Statewide Pharmacy Service and provides what researchers described as the largest reported experience of oral self-administration of VAD medication globally.

Lead author Professor Michael Dooley, director of the Victorian Voluntary Assisted Dying Statewide Pharmacy Service and a researcher at Monash University’s Centre for Medicine Use and Safety, said the findings provide strong evidence supporting the Victorian approach.

“Our world-first data provides definitive evidence that the Victorian model is a global benchmark for safety and provides reassurance for patients, families and clinicians that voluntary assisted dying is working as intended, supporting compassionate and informed choice at end-of-life,” he said.

Researchers examined 572 anonymous feedback surveys completed by carers of patients who self-administered VAD medication between June 2019 and June 2025.

The findings showed 98.4 per cent of patients drank the medication mixture within the required four-minute timeframe and 95.1 per cent consumed the entire volume. All patients who swallowed the medication died.

Loss of consciousness occurred within 10 minutes for more than 93 per cent of patients. Nearly two-thirds died within 30 minutes and 86 per cent died within an hour.

“The focus is providing compassionate and safe care for those considering voluntary assisted dying and providing information and evidence to inform those decisions,” Professor Dooley said.

“The Victorian approach, supported by many wonderful practitioners, including doctors, nurses and pharmacists, has shown that terminally ill patients can safely self-administer medication to end their life if they choose to.”

The research addresses concerns that have historically surrounded oral assisted dying medications, including whether patients could successfully take the medication, whether complications might occur, and whether the medication would reliably result in death.

Since VAD became available in Victoria in June 2019, pharmacists from the statewide service have played a central role in assessing patients before medication is supplied. This includes confirming a patient’s decision-making capacity, ability to swallow the medication and their understanding of the process.

The medication protocol used in Victoria relies on a single-drug formulation of pentobarbital, a model that has since been adopted by other Australian jurisdictions with VAD legislation.

The study found preparation issues were uncommon, with more than 85 per cent of carers reporting no difficulties mixing the medication. Where difficulties were reported, they were mostly related to the time taken for the powder to dissolve. More than 88 per cent reported there were no problems swallowing the mixture, although some noted its bitter taste.

Professor Dooley said the outcomes compare favourably with other international approaches that rely on more complex medication combinations.

“Compared with some older international practices that use more complex multi-drug combinations, the medication protocol used in Victoria has been shown to provide a safe, effective and more consistent experience for patients,” he said.

Researchers said the findings may help inform policymakers and healthcare systems internationally as more jurisdictions consider introducing voluntary assisted dying legislation.