National charity Go Gentle announces a VAD research fund to address the challenges posed by Australia’s biggest killer.
In a speech to the National Press Club, broadcaster Andrew Denton, founder of pro-voluntary assisted dying charity Go Gentle, addressed the “hardest conversation of all” – VAD for those with advanced dementia.
“Asking a doctor to end the life of someone who can’t look them in the eye and say, ‘Yes, this is what I want,’ is enormous,” he said in his address.
Mr Denton said Go Gentle had already committed startup funds to the charity’s first project, which would explore VAD practitioners’ attitudes and insights into expanding VAD for people with dementia who lack the capacity to say no at the time of their death.
“By a very wide margin, the number one question we are asked is about Australia’s biggest killer, dementia,” he said.
“It’s an issue we approach with great caution… ethically, medically, legally, and politically, this is as complex as it gets,” he said.
But he affirmed “saying ‘too hard’” was not an option, nor was it a “slippery slope”.
“[It’s] only the same merciless mountain that has to be climbed every time – of deep research, robust evidence, powerful coalitions and reasoned persuasion.”
Under Australian law, patients must have full decision-making capacity throughout. Administering doctors must obtain verbal or written consent before administering the lethal drugs.
In countries including the Netherlands and Canada, where laws allow people with dementia to access VAD through informed consent in advance care directives, uptake has been marginal.
In the Netherlands’ 2025 report on assisted dying, of 10340 VAD deaths in 2025, only seven had advanced dementia.
Mr Denton said the Netherlands’ framework had been developed with substantial input from doctors who were aware of the potential legal liability when providing VAD.
“Any solution to this wicked question will require the experience and buy-in of those who know this territory best,” he said.
Dementia Australia has long supported those living with dementia to be able to access all end-of-life care options, including VAD.
The next project, Mr Denton said, would then focus on the “hard slog” of institutional obstruction.
A national report card by Go Gentle found that only seven of 70 large aged-care providers contacted by the charity offered aged-care residents comprehensive VAD information and access.
VAD providers, who constitute less than 2% of Australia’s licensed physicians, currently risk prosecution and a $364,000 fine for inciting or counselling suicide if they use virtual healthcare.
Mr Denton said one of his biggest concerns was the sustainability of the VAD workforce, citing insufficient remuneration due to a lack of MBS items, stigma, potential prosecution, and the high emotional labour involved.
“[VAD] doctors are expected to work for nothing, but many do, and telehealth. They’re the number one and two issues, so they’re quite pressing, but they’re difficult,” he said.
Apart from the ACT, all laws currently restrict eligibility for VAD to those with no more than 12 months to live, a prognosis Mr Denton said was “rarely precise” and left many suffering, often dying before they could access it.
Moreover, only the ACT has explicitly cited that hospitals have a legal obligation not to obstruct a dying person’s access to VAD, even if they do not participate.
“This ban creates a postcode lottery, disproportionately impacting terminally ill people in rural and remote Australia who cannot manage the travel required,” Mr Denton said.
While he acknowledged the “genuine” concerns about protecting the laws from misuse, palliative care already relies heavily on telehealth’s outreach, including ceasing ventilation and palliative sedation for extreme, unrelieved symptoms, he said.
“In some jurisdictions, even the VAD script can only be delivered by hand or via snail mail. It’s nonsensical, and it’s causing preventable harm.”
“Some of this [problem] sits within the Medical Board of Australia. Some of it sits within the regulating agency. There’s a whole sea change that needs to happen, but it really has to flow from the top,” he said.
“A decade from now, I hope never to hear of a new public hospital opening that’s happened in Brisbane this year at a cost to taxpayers of a billion dollars, only to learn that the faith-based organisation running it flatly refuses to allow VAD,” he said.
