Voluntary assisted dying (often abbreviated to VAD) is now an approved end-of-life option for people living in South Australia. For those who are eligible, VAD enables access to specific medication and a wrap-around supportive service provided through SA Health to enable a planned and peaceful end of life, in accordance with the Voluntary Assisted Dying Act 2021. 

Facing the end of life can be confronting even when it is a planned and deeply considered choice. Complex feelings of grief may result – both for the person making this decision, and the people who care about or provide care for them. These feelings may be shaped by many factors, including individual experiences of the illness itself, the VAD approval and planning process, personal values, cultural or spiritual beliefs, or family circumstances.

Grief may be felt long before the person has died, as well as after a death. Being prepared for a death and knowing the expected time and place does not necessarily mean grief will feel less or be easier. There is no pattern or timeline for how people grieve, and this is true for those who are learning about or accessing VAD, and for the people who care about them.  

Grief experiences for people accessing VAD

People exploring or choosing to access a voluntary assisted death may experience different emotions that can change quickly. Planning for, or knowing the date and time of dying may intensify any feelings a person has. This might include empowerment, being at peace, or a sense of dignity, especially when illness has diminished a person’s choices or quality of life. It might also include feelings of guilt, sadness, or anger, especially where others disagree with any aspect of the person’s choice to access VAD. Many people describe the coexistence of relief and grief as one of the most challenging aspects of their experience with a voluntary assisted death.

People may also grieve the roles, relationships, or hoped-for futures they had as parents, grandparents, partners, siblings, friends, or colleagues. For some, there may be comfort in speaking openly about these feelings, while others do not feel the need to share or may feel compelled to ‘protect’ the people they care about by keeping their own grief private, even when it is deeply felt. 

Choosing VAD as an end-of-life pathway is the decision of the person who is dying and can feel intensely private, yet in some cultures, end-of-life decisions may be discussed collectively and involve extended family, elders, spiritual advisors or faith leaders.Sometimes people who could access VAD may still decide not to; simply knowing VAD is a choice they can make can bring a sense of relief and control. 

All of these experiences are a normal part of anticipatory grief, which is the kind of grief experienced before a death. 

Grief experienced by family and friends before the death

The family and friends of people accessing voluntary assisted dying may feel a similar spectrum of changing emotions. This may be a time when they are facing or coming to terms with their own beliefs and boundaries relating to VAD. 

It is common for people to start grieving the loss long before the person’s death. They may:

• grieve the ways the illness has hurt or changed the person they care for
• grapple with the emotional complexity of a planned death 
• feel relief for the person whose suffering will end through accessing VAD, while longing for more time with that person
• feel relief for themselves that they will no longer have to witness such suffering, which can also be accompanied by guilt for being ‘selfish’
• feel angry, anxious, or powerless, or notice changes in sleep, concentration, or memory 
• feel acceptance and gratitude that some control has been returned to the person accessing VAD, while grieving the circumstances that made VAD necessary. 

Although common, this push and pull of sometimes contradictory emotions, like grieving the loss of a person who is still here, is often confusing.

Belief systems, cultural traditions and spiritual frameworks can strongly influence how people understand VAD and how they experience and share grief. Voluntary assisted dying may align with values like personal choice or compassion, or may confront deeply held beliefs about life, death, or moral responsibility. These differences can make conversations sensitive or difficult. 

People may feel the need or expectation to be supportive, even if they feel conflicted about voluntary assisted dying, or disagree with it. Although VAD is the decision of the person who is dying, those who care about them – whether they agree or disagree – may hold different perspectives, and experience varying and changing feelings. Regardless of differences, these feelings, including grief, are real and valid.

When time is limited  

People accessing VAD, as well as the people who care about them, have described a sense of counting down to the day and time of the voluntary assisted death, even when at peace with the decision. The choice of when and where a person will die can intensify grief.

Many people talk about having meaningful, memorable conversations during this time, but choosing how to spend the final days and hours, and your final words at the end of life, can also be very difficult. When emotionally preparing for a planned death, these experiences and pressures are understandable. 

Ways to help cope with anticipatory grief related to VAD

• Sharing memories and stories
• Having honest conversations without pressure to feel a certain way
• Creating personal or family rituals around the day
• Recognising that each person will cope in their own way
• Accepting that strong, mixed, or muted emotions are all normal
• Being included in planning, if the person accessing VAD wants that
• Accepting the person’s reasons for choosing VAD
• Speaking with professional supports or VAD Care Navigator and Hospital Liaison services.

People’s grief experience after the death

Grief following a voluntary assisted death may not feel exactly as people expect. There may be a sense of relief knowing that a loved one’s suffering has ended, but the sudden finality can be overwhelming. People may feel numb or focus on practical tasks at first, with emotions emerging later. Mixed feelings like gratitude, sorrow, peace, anger, confusion, acceptance, or emptiness are all common. It is also normal for grief to feel more or less intense than you thought it would.

For people involved in planning the voluntary assisted death, there may be comfort or a sense of meaning after the person has died. However, this experience can also leave people feeling conflicted, and they may find themselves revisiting parts of the experience or questioning whether they made the right decisions. This can be especially difficult if people have helped prepare the VAD medication for their loved one to self-administer; their role in helping facilitate a legal voluntary assisted death can sometimes be deeply upsetting. 

In some cases, a nominated contact person has legal responsibilities like returning any unused VAD medication to the pharmacy after the death. While practical in nature and defined in law, this role can lead to a heightened sense of responsibility, guilt and grief related to the death.

Friends or family may also struggle to accept someone’s involvement in VAD, questioning decisions or wondering if things could have been otherwise. This can be difficult to work through.

Sometimes the fear of judgement or stigma can prevent people from openly sharing about their experience with VAD, which can make grief feel private or secretive. For some, VAD may conflict with deeply held beliefs which can bring spiritual distress, tension within families, fear of community judgement and even isolation. These experiences are sometimes described as disenfranchised or stigmatised grief, and can be especially hard because they are felt deeply, but not always recognised by others.

Grief experiences of children and teenagers related to VAD

Like adults, children and teenagers may have varying experiences of grief in the period before and after a voluntary assisted death. 

The process of voluntary assisted dying can give young people the chance to spend meaningful time with the person they love and say goodbye, which can help them feel prepared. Encouraging questions and talking to the child or young person about what is happening can help them understand what to expect, yet families may also choose to shield young people from direct conversations about death. Recognising that cultural approaches differ is important.

Children and teenagers may feel changing emotions like confusion, sadness, anger or anxiety, and question why their loved one has chosen to leave them. They may also show their grief through behaviours, and be unable to verbalise what is happening for them or why they feel that way. This can add to feelings of overwhelm for carers and parents in their own time of grief.   

Offering reassurance that it is okay and normal for people to experience grief differently, and that the grief experience may change before, during and after the death is important. After a death, you might encourage special ways of remembering the loved person day-to-day, as well as at important times like birthdays or anniversaries.

Grief symptoms experienced by children and teenagers most often reduce over time. But if symptoms are intense and persist after the first month, causing extreme distress and impairment in daily functioning, further support may be needed.  

Managing your own and others’ grief responses

Even within close families or friendship groups, people can feel very differently about voluntary assisted dying. While this is normal, it can be difficult to manage. These differences can influence how grief is expressed and can sometimes create tension or feeling distant from others. But this can also indicate how much the person mattered, and agreeing that they mattered may be a point of agreement amongst differences. 

Support can come from other family or friends, grief or bereavement counsellors, spiritual or cultural leaders, or VAD-related support groups or services. Finding safe listeners who understand the complexity of grief related to VAD can be very helpful. There are also other helpful resources available when talking feels difficult. 

Seeking support is especially important if your grief feels unbearable, prolonged, or starts to affect your daily life or relationships. You may also seek support if you notice ongoing sleep difficulties, withdrawal from others, intense guilt or confusion, or a sense of being ‘stuck’.

Helpful services and resources

• SAVAD-Care Navigator Service (CNS): information about VAD in South Australia, support packages, and links to services for bereavement support.

• Voluntary Assisted Dying SA: information about South Australian VAD legislation, guidelines and history, and personal accounts of VAD-related grief.

• Go Gentle Australia: information about the different types of grief and emotions pre- and post-VAD, personal accounts and stories, resources, and links to state-by-state support groups and services.
• Griefline: free 24/7 telehealth counselling for individuals experiencing grief including specialised services for Culturally and Linguistically Diverse (CALD) communities and speech/hearing services.
• Griefline VAD support groups: for individuals supporting someone choosing VAD, or seeking group support after the VAD death of a friend or family member.
• 13YARN: free, confidential phone support for Aboriginal and Torres Strait Islander people experiencing grief or crisis.
• Community Access and Services SA (CASSA): bilingual, bicultural workers across multiple language groups offering mental health support for CALD communities.
• PEACE Multicultural Services: culturally safe counselling and support offering interpreter access and community-informed approach.
• Coping with grief before voluntary assisted dying: A resource for family and friends’: gentle guidance to help family and friends prepare for the grief that may arise before the voluntary assisted death of a loved one. 

• Coping with grief after VAD: A resource for family and friends: practical information, guidance and strategies to help people cope with the different experiences of grief after VAD, and links to support groups.

• Grief after VAD: Impact and interventions webinar: information about supporting people accessing VAD and their families pre- and post-VAD.
• Kids Helpline: access to free, 24/7 counselling for young people aged 5-25 years. Call 1800 55 1800, visit the website or start a WebChat.

For children and teenagers, the Victorian Voluntary Assisted Dying Statewide Care Navigator Service has created some excellent resources about grief related to VAD. These may be requested via email: vadcarenavigator@petermac.org.

GriefLink extends special thanks to the expert advisory group who voluntarily reviewed and contributed to this content:

• Dr. Chloe Furst
• Dr. Kathleen Jurgens
• Kirsty Trebilcock

Development of this webpage and content was supported by: