On the days that Dr Clare Fellingham assists a person with dying, she wakes up early and tries to have a good breakfast, although she’s never really hungry.
She looks carefully through her wardrobe for the most appropriate attire: scrubs are too clinical, black is too maudlin, yellow is too happy. For older patients, who may have a more traditional concept of what their voluntary assisted dying (VAD) doctor should look like, she leans towards corporate clothing.
For a young person, or someone more free-spirited or fun-loving, she will likely wear colour. Next, she puts on a specific set of earrings with little trees on them. They are symbolic of the circle of life: birth, growth, death and rebirth. They also represent strength and endurance.
Then Fellingham travels to the patient’s location, normally a house, sometimes a hospital. She is never early and never late. She arrives ahead of time and sits in her car outside, waiting until it’s the exact agreed moment. Time is a precious commodity, even when death is a choice. Perhaps especially then.
When she enters, Fellingham greets whoever is there, usually close family and friends. She has one final private conversation with her patient about what is going to happen.
As with a birth plan, there is a profound relationship and strong level of trust between recipient and doctor. Fellingham, who is the Western Australia director of the peak body Voluntary Assisted Dying Australia and New Zealand (VADANZ), does not use euphemisms – she talks about death in clear terms.
She asks the patient if they are certain about why she is there, what is going to happen, and the finality and irreversibility of the process. This is in part to fulfill some of the core eligibility criteria for VAD – each patient must have decision-making capacity and be acting of their own free will, without pressure or coercion – but it’s also about ensuring she can look them in the eyes, hold their hand and be satisfied within herself that this is what they’ve chosen.
“What is almost universal is that people are incredibly relieved the day has finally come,” says Fellingham. “Typically they are happy, I would say even joyous and elated, because they know that the relief of their suffering is imminent. They are grateful to be offered the opportunity to have some agency and control over the process of dying.”
When the patient is ready, they swallow a liquid medication. If they aren’t able to ingest the medication on their own, or if they would prefer not to, Fellingham administers it directly via an intravenous line or feeding tube (in Victoria and South Australia, self administration is the default legal policy). It doesn’t take long for the person to lose consciousness, with a peaceful death following shortly after.
“The key thing to remember is that voluntary assisted dying is only available to people who are in the late stages of a life-limiting illness,” Fellingham says.
One of VAD’s eligibility criteria is that the recipient must be terminally ill, with death expected to occur within six to 12 months. They must also be suffering intolerably. “These are not people who are looking at a choice between living and dying; they’re people who are making a decision between dying and dying.”
Voluntary assisted dying is legal in all Australian states except for the Northern Territory, although the NT government is currently drafting legislation. Since laws were introduced, first in Victoria in 2019, about 14,000 people in Australia have applied for assisted dying and there have been more than 7000 deaths using a VAD substance. Eligible applicants must be 18 years or older.
The typical applicant is in their seventies, has terminal cancer and is receiving palliative care, with slightly more men than women choosing VAD. National charity Go Gentle Australia’s 2026 State of VAD report reveals assisted dying increased by approximately 40 per cent nationwide in 2024-25, with the largest growth in Tasmania, followed by WA, South Australia and Queensland.
VAD now accounts for about two per cent of all deaths nationally, including about five per cent of cancer deaths and one in three motor neurone disease deaths. While the vast majority of applicants are 65 and older, about one per cent of applicants are under 40.
This year saw a spate of news reports about young people choosing “No-one should be forced to endure unbearable suffering when there is no hope of recovery” – Annie Hollanassisted dying.
Annaliese Holland inadvertently became an advocate for VAD when the 26-year-old South Australian’s story was first reported on Triple J’s Hack program in March.
Annie (as she prefers to be called) has been living with autoimmune autonomic ganglionopathy since she was 18. It’s a condition that causes the immune system to attack the autonomic nervous system, leaving her in agony with myriad health complications. While ticking items off her bucket list – she calls it her Fuck It List – Annie is also dedicating her remaining time to raising awareness of what end-of-life care looks like for young people.
Annie’s chosen day of death remains private. In June, she told her 50,000 Instagram followers (@annaliese_holland), “The truth is, I don’t want to die. I want to live. But I don’t want to suffer like this. That’s why voluntary assisted dying matters so deeply to me. No-one should be forced to endure unbearable suffering when there is no hope of recovery.”
For the families of these young people, it is understandably difficult to process their decision. Annie described how when she told her dad, “I’ve had enough, I can’t do this,” he initially thought she was giving up.
He ultimately backed her decision to access VAD. In the case of 25-year-old Spanish woman Noelia Castillo, getting her family on board was challenging until the end. According to The Guardian, Noelia had struggled with psychiatric illness as a teenager, and in late 2022 attempted suicide after being sexually assaulted.
She became a paraplegic confined to a wheelchair and in constant pain. She secured permission to use Spain’s euthanasia law to end her life, but her father opposed the decision.
With the support of an ultra-conservative advocacy group, he argued that her mental state meant she could not consent to ending her life. For two years, Noelia fought her father in court until the European Court of Human Rights eventuallyrejected her father’s claims and she was granted VAD in March this year. In contrast, support from WA resident Robbi Flynn’s family was unwavering.
Robbi was 33 when she chose voluntary assisted dying after suffering from terminal cancer, and she died in late October 2022. Fellingham, who was Robbi’s VAD doctor, said she is one of her most memorable patients.
“At that stage, she was the youngest person I’d cared for, and it was hugely confronting,” Fellingham says.
She still catches up with Robbi’s mum, Gina Sanderson, regularly. “Robbi was neurodiverse, independent, strong and stubborn,” Gina says of her daughter. “She had a real passion for dogs. She was a dog trainer, and did a lot of advocacy work.”
As special as Robbi was, Gina is determined to keep her memory realistic too. “Robbi said to me, ‘Don’t forget after I die that I can’t have this halo around me like I’m this amazing, perfect, wonderful human being, because I was also a pain in the arse,’” she adds, laughing.
Even though Robbi ultimately died the way she wanted – at home, with loved ones by her side – the road to get there was rocky. When Robbi enquired about VAD at the hospital she was in, she was told she needed to be moved to a different hospital to access it and that no assessments of Robbi’s eligibility could be conducted on site.
Robbi and Gina had not realised that the faith-based hospital, which was Robbi’s local hospital with her trusted oncology team, might make things difficult in accessing assisted dying. Ultimately, she had to be transferred out of the hospital to a medical clinic twice to be assessed for VAD, and then a final time to go to her father’s home to die.
Since part of the criteria for VAD is to be in the very late stages of illness, those transfers were very complex and extremely uncomfortable for Robbi, given how sick she was, her neurodivergency, the equipment she was attached to, and the considerable weight she’d gained with the adenocarcinoma.
She vomited several times and had severe trauma from the stress. Circumstances remained challenging right up to her “death day”, with the hospital not allowing Robbi to leave with her intravenous access port.
The psychological and physical strain of removing the port and getting a new one implanted would have been terrible for her, so Gina did what many mothers would do: she stole the port. “Robbi was like, ‘What do we do?’ and I’m like, ‘I’m gonna organise our own ambulance, and, pardon the French, but we’re fucking off outta here, and we’re taking the port with us.’ She was like, ‘Yes! Go Mum!’”
Telehealth consultation would have helped Robbi tremendously, but Australia is the only country that criminalises the use of telehealth for the provision of legally available VAD services.
This makes access to VAD for those living in remote, rural and regional areas incredibly hard, as they’re required to travel long distances, while exceptionally ill, to meet doctors in person. The Australian Medical Association, the Royal Australian College of General Practitioners, and other advocacy groups are actively lobbying for amendments to the criminal code.
While the Labor Party supports making telehealth VAD available, Prime Minister Anthony Albanese opposed his party’s policy in July. Another obstruction is gag clauses, which prohibit doctors from initiating discussion about VAD.
“South Australia is currently the only state that still has this gag clause, which is very problematic,” says Dr Chloe Furst, the SA director of VADANZ. Victoria, which also had a gag order, only recently passed amendments to its legislation, which comes into effect later this year. “It means we cannot bring up voluntary assisted dying with our patients unless they raise it with us first,” adds Furst. “This is problematic because patients may not know that it is a legally valid option, or they might know that it’s legal and valid, but they might not know that they’re eligible. It’s further stigmatising VAD because it becomes the only part of healthcare that we can’t talk about in an open way.”
There’s also a lack of VAD doctors, in part due to the intensive amount of recording and monitoring that accompanies assisted dying to ensure every death is within the confines of the law.
Go Gentle CEO Linda Swan says about half of those who undergo training do not go on to become VAD practitioners. “Voluntary assisted dying work is not easy,” Swan says. “
Health practitioners genuinely care about these people. Sometimes they’ve been someone they have cared for their whole life, and they’re following them through to the end. That takes an emotional toll. The vast majority of volunteer assisted dying is actually being delivered by a very small cohort of doctors who have the time and the energy and the capacity to do this on a regular basis … The other thing that is undermining our workforce and our services is a pervasive stigma, even though VAD is probably one of the most socially accepted health reforms we’ve ever had. Statistics show that between 80 and 85 per cent of Australians support assisted dying.”
Furst, who is Annie Holland’s VAD doctor, says death is fundamentally the great equaliser. “Someone’s suffering is no more or less based on their age or their life experiences, and I would attest to that,” she declares.
“I’ve supported people who have had no family and people with family. I’ve supported CEOs and I’ve supported people who are homeless. And, again, I would say that it is death that is the equaliser. There are differences that are important to every different individual. [But ultimately] people want that sense of connection at the end.” On the last day of her life, Robbi had a few bites of her favourite tuna patties cooked by her brother, Jay. She reminded her mum that they hadn’t watched the animated movie Encanto, so they piled on the couch – Robbi; her friend, Cee; Gina; Jay; Robbi’s dad; and Gina’s husband, Andrew – to watch. About halfway through, she asked for the film to be paused and said, “Mum, can you ring the VAD people and ask them if they’ll come an hour later?”
Thinking maybe she’d changed her mind, Gina said, “Are you OK? Are you starting to feel nervous about it all?” But Robbi replied, “No, I just don’t want to miss the end of the movie.”
Gina laughs now, remembering. “So that was her day. She felt relieved. She was jubilant. It was empowering for her to be offered the how and the when. She did her goodbyes, and then she was lying there and she looked around. It’s always a moment that makes me feel amazingly grateful and sad. She got the medication … and she said, ‘Goodnight, Grammy’ – that’s me – ‘Goodnight, Da. Goodnight, Jay. Goodnight, Cee. Goodnight, Andrew.’ And then she died,” Gina’s voice shakes with emotion.
“She was peaceful and ready, and for that I’ll be forever grateful. I got to be a part of that journey. I brought her into the world and I got to be part of the journey to see her out of the world. That’s a privilege.
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