Rising voluntary assisted dying (VAD) deaths in Victoria are best understood not as an aberration but as the predictable maturation of a tightly regulated end‑of‑life option that has been built into the state’s clinical pathways alongside palliative care.
The Short Version
- Victoria’s official reports show sustained growth in VAD deaths since inception, with hundreds annually and a small but steady share of all deaths.
- Most VAD applicants are also in palliative care; regulators explicitly frame VAD as complementary, not a substitute.
- Growth reflects program establishment, access, and patient uptake; the available data do not prove displacement of palliative care.
- Policy questions now center on safeguards, equitable access, and integration with palliative services, not legality.
What the numbers actually show
Victoria’s VAD activity has increased each year since the scheme began in 2019. Official annual reports record 306 deaths in 2022–23, 371 in 2023–24, and 389 in 2024–25. In proportional terms, the share of all registered deaths attributed to VAD moved from 0.65% to 0.84% and then 0.85% across those years. These figures place the program within a modest fraction of total mortality while confirming a consistent upward trajectory in absolute counts as the system matures and access becomes more familiar to clinicians and patients.
Cumulative program footprint offers another lens. By 2024–25, the Board reported 2,457 people who had received a VAD permit and later died since commencement, underscoring that annual totals sit atop a growing multi‑year cohort of eligible individuals who moved through assessment and permitting before death. Growth of this kind is common when a new regulated pathway is introduced: awareness rises, referral networks settle, assessment timelines improve, and administrative confidence grows. The most recent percentage increase is small, but the longer arc is unmistakable.
How the scheme is designed to work
Victoria operates what comparative scholars call an “Australian model” of assisted dying: access limited to adults with decision‑making capacity who have an incurable, advanced, progressive condition expected to cause death within months (no longer than 12), assessed independently by two trained doctors, with strict documentation and post‑factum oversight by an independent Review Board. The legal structure forbids clinician‑initiated suggestions; requests must originate with the person. This architecture is designed to tighten eligibility, reduce coercion risk, and standardize consent conversations about alternatives, including palliative care.
Critically, the regulator’s public guidance and statutory reviews are unambiguous on the relationship with palliative care: VAD is not an alternative to palliative care; the two should coexist. People who choose VAD continue to have access to palliative services, and assessors are required to inform and encourage palliative care engagement. The Board’s reports repeatedly emphasize this complementarity.
Where the evidence is strongest: coexistence with palliative care
If displacement of palliative care were occurring at scale, you would expect to see a pattern of VAD applicants arriving outside palliative pathways. The public data point in the other direction. Across the life of the program, 79% of applicants had accessed, or were being cared for by, a palliative care service; in 2024–25 specifically, 75% were already in palliative care at the time of their first VAD request. The Board explicitly interprets this as appropriate concurrent use rather than substitution, and statutory guidance to assessors is aligned with that interpretation.
Patient and family experience is inevitably varied, and the five‑year statutory review does document cases where non‑supportive palliative services limited open discussion or continuity when VAD was in play. That is a systems‑integration problem, not proof of displacement; it argues for clearer referral pathways, conscientious objection management, and better communication frameworks so that palliative teams can remain present even when a patient pursues VAD.
Why growth does not, by itself, prove erosion of care
Three dynamics can all produce higher annual VAD counts without implying harm to palliative care: higher awareness among eligible patients, smoother administration that shortens wait times, and demographic or disease‑mix changes among those near the end of life. Victoria’s five‑year review concludes the system is operating as intended, with high compliance and progressively shorter access times; that is the textbook signature of a program moving from pilot to steady state, not evidence of a zero‑sum shift away from palliative services.
Could substitution still be occurring under the surface in particular institutions or regions? Possibly—but the current public dataset does not settle that question. Absent disaggregated audits of palliative capacity, funding, and utilization before and after 2019, and without case‑level linkage across palliative and VAD registries, you cannot ascribe causation from trend lines alone. The coexistence statistics, regulator instructions, and compliance findings make the burden of proof for a displacement thesis fairly high on the evidence we have.
The real policy questions now: safeguards, equity, and integration
As with other jurisdictions, once legality is settled, the argument shifts to second‑order questions: Are safeguards tight and consistently applied? Is access equitable across geography and diagnoses that meet the statute? Do conscientious objection pathways preserve both clinician integrity and patient continuity of care? Victoria’s annual reports point to high compliance and maturing processes; they also surface provider concerns about facilitating patient choice effectively across services and regions—an operational, not philosophical, challenge.
A serious next step for evidence‑led policy would include three strands. First, de‑identified case‑level linkage across VAD and palliative datasets to analyze trajectories, service intensity, symptom burden, and place of death for matched cohorts. Second, audited palliative‑care funding, workforce, and capacity metrics over the VAD period to test whether system pressures, rather than VAD growth, explain any perceived strain. Third, structured interviews and referral audits to illuminate how conscientious objection and institutional policy shape patient experience at the margins.
How to read “400% increases” responsibly
Headline multipliers are rhetorically potent and analytically thin. Victoria recorded 52 deaths in the first six months after commencement; five years later, annual counts are in the high hundreds. That is indeed a large relative rise from a small base, exactly what you would expect as a new pathway moves from initial caution to operational normalcy. The more meaningful indicators are the absolute share of all deaths (still under 1%), the high rate of concurrent palliative care use, and the regulator’s finding that the program is operating within its intended scope and safeguards.
Bottom line
Victoria’s VAD program has grown into a stable, regulated option chosen by a small but expanding subset of terminally ill patients—overwhelmingly alongside palliative care, not in place of it. The data support normalization within defined legal guardrails; they do not support the claim that palliative care is being hollowed out by VAD. The work ahead is practical: protect safeguards, guarantee equitable access, and engineer palliative‑VAD integration so patients are accompanied well—whichever lawful path they choose.
Sources:
lifesitenews.com, health.vic.gov.au, parliament.vic.gov.au, www1.racgp.org.au, wfrtds.org, safercare.vic.gov.au, gogentleaustralia.org.au
