Articles
ACT advance care planning, health directions and enduring powers of attorney
In the ACT, advance care planning commonly uses an Enduring Power of Attorney, Statement of Choices and Health Direction.
6 min readAm I eligible for voluntary assisted dying?
You may be eligible for voluntary assisted dying (VAD) only if you meet all the legal rules where you live, and if the required health practitioners assess you as eligible.
4 min readAre they suffering when breathing becomes noisy, irregular or stops for periods?
Noisy or irregular breathing near death can be very upsetting to hear, but it does not always mean the person is suffering.
2 min readAt what stage might someone with early dementia still be able to access VAD?
A person with early dementia may only be able to access VAD if they still have capacity and meet all other legal criteria, which can be a narrow and uncertain window.
4 min readCan a dying person feel the secretions in their throat?
A dying person may not feel throat secretions if they are deeply sleepy or unconscious, but comfort still needs to be checked.
2 min readCan a facility stop a VAD practitioner from visiting me?
Whether a facility can stop a VAD practitioner visiting depends on state or territory law and the type of facility.
5 min readCan a family member contact a VAD service on my behalf?
Yes, a family member, friend or carer can usually contact a VAD care navigator service to ask for general information.
7 min readCan children be present during a VAD death?
Children may be able to be present during a voluntary assisted dying (VAD) death, but this needs careful planning.
6 min readCan family play music, have a meal or perform a ceremony during a VAD death?
Often, yes.
5 min readCan I apply for VAD even if I am not sure I will use it?
In places where voluntary assisted dying (VAD) is operating, a person can usually ask for information, start the process, and later decide not to continue.
2 min readCan I decide not to return to hospital?
A person with capacity can usually decide not to return to hospital, but they need a clear home care and emergency plan.
4 min readCan I give breakthrough morphine or other medicines myself?
Sometimes, yes, but only if the medicine has been prescribed for that person and you have clear instructions.
4 min readCan I give water to someone who is having trouble swallowing?
Water may be unsafe if a dying person is too sleepy or weak to swallow properly.
2 min readCan I refuse antibiotics, hospital transfer, tube feeding or other treatment in advance?
You may be able to refuse treatments in advance, but the document must meet your state or territory rules and be clear enough to guide care.
2 min readCan I refuse artificial nutrition or hydration?
A person may be able to refuse artificial nutrition or hydration, but the decision should be documented clearly and discussed with the treating team.
1 min readCan I refuse further treatment if I do not qualify for VAD?
Yes, refusing treatment is legally different from VAD, and adults with capacity can usually refuse treatment even if they do not qualify for VAD.
2 min readCan I request VAD in an advance care directive?
You cannot make a future VAD request through an advance care directive because VAD must be requested by the person while they have capacity.
1 min readCan my palliative care doctor also be my VAD doctor?
A palliative care doctor may be able to be involved in VAD if they meet the legal requirements and choose to participate.
3 min readCan someone be sedated continuously until they die?
Yes, continuous palliative sedation until death can be used in some situations.
5 min readCan someone really die at home with proper medical support?
Yes.
2 min readCan someone receive palliative care while pursuing VAD?
Yes, a person can usually receive palliative care while asking about or going through the VAD process.
4 min readCan someone seem better shortly before they die?
Yes, some people seem briefly better before death, but the whole pattern usually matters more than one good spell.
4 min readCan someone who is unconscious still hear me?
A dying person who cannot respond may still be able to hear or sense calm voices and touch.
5 min readCan someone with a terminal illness access their superannuation early?
Yes, in some cases.
2 min readCan someone with dementia access VAD?
Dementia does not automatically rule VAD in or out, but the person must meet all legal criteria and have decision-making capacity throughout the required steps.
7 min readCan unexpected things happen during a VAD death?
Yes.
2 min readCan VAD assessments be done by telehealth?
Telehealth may be possible for some VAD-related support, but some VAD assessment or request steps may be restricted or must be done another way.
6 min readDo I ask my GP about VAD?
Yes, you can ask your GP about voluntary assisted dying (VAD).
5 min readDo I need to call 000 or the police after an expected death at home?
Usually, no.
4 min readDo I need to keep turning someone if moving them causes pain?
If turning causes pain near the end of life, ask the care team to adjust the plan so comfort comes first.
2 min readDo VAD assessments have to be face-to-face?
VAD assessment must happen face to face because Commonwealth communication laws limit remote VAD discussions.
4 min readDoes a syringe driver mean the person is about to die?
No, not always.
5 min readDoes asking for information about VAD count as my formal first request?
Usually, asking for information about voluntary assisted dying (VAD) is not the same as making a formal first request.
4 min readDoes morphine make someone die sooner?
No, morphine does not usually make someone die sooner when it is prescribed and used carefully for pain or breathlessness in palliative care.
4 min readDoes starting palliative care mean stopping treatment?
No.
4 min readDoes the death rattle mean the person is choking?
The death rattle usually means secretions are pooling in the throat, not that the person is choking in the usual sense.
5 min readHow can I tell if someone is dying?
You may be able to tell someone is dying by looking at the whole pattern of change.
4 min readHow can something that slows breathing be safe in somebody who is already dying?
Morphine and some other medicines can slow breathing if the dose is too high for that person.
2 min readHow do families cope with knowing the exact date of a VAD death?
Knowing the planned date of a VAD death can help some families prepare, but it can also create pressure, dread and complex grief.
5 min readHow do I actually get palliative care?
The most common way to get palliative care is to ask the person's GP, specialist, hospital team, community nurse or other health provider for a referral.
6 min readHow do I actually start the VAD process?
In most places where voluntary assisted dying (VAD) is operating, the process starts when you make a clear first request to the right kind of health practitioner.
4 min readHow do I change sheets when someone cannot get out of bed?
Sheets can often be changed by rolling the person gently from side to side, but ask for help if movement causes pain or feels unsafe.
4 min readHow do I do mouth care for someone who is dying?
Mouth care can ease dryness and keep a dying person comfortable when they are eating and drinking very little.
5 min readHow do I find a doctor who provides VAD?
The safest way to find a doctor who provides voluntary assisted dying (VAD) is to contact the official VAD care navigator or support service in your state or territory.
4 min readHow do I know if someone who cannot speak still wants food or drink?
You may not be able to know for sure.
4 min readHow do I know when to give breakthrough medicines at home?
Give breakthrough medicine only when the person's written plan says it is needed for the symptom you are seeing.
4 min readHow do I manage toileting when someone can no longer get out of bed?
Toileting in bed can be managed with continence aids, equipment, careful skin care and help from the care team.
4 min readHow do I prevent pressure sores when someone is dying?
Pressure sore prevention near death should protect skin while keeping the person as comfortable as possible.
4 min readHow do I tell my children that someone they love is dying?
Tell children the truth in clear, gentle words.
2 min readHow does VAD work if I live in regional or rural Australia?
Regional and rural access to VAD may involve care navigators, travelling practitioners, local clinicians, travel support or telehealth limits.
5 min readHow early should I start the VAD process?
If voluntary assisted dying (VAD) may matter to you, ask for information early.
4 min readHow long can pauses between breaths last when someone is dying?
Pauses between breaths near death can last several seconds and may become longer as death comes closer.
5 min readHow long does someone have once these changes start?
There is no exact clock.
4 min readHow often should I turn someone who is dying in bed?
Turning someone who is dying should balance skin protection with comfort, pain, breathlessness and the person's wishes.
6 min readIs a VAD death usually peaceful?
Many families and clinicians expect a voluntary assisted dying (VAD) death to be calm, planned and private.
2 min readIs it normal to feel relief as well as grief after a VAD death?
Yes, relief and grief can happen together after a VAD death, especially when someone had been suffering or the family had been under strain.
3 min readIs palliative sedation just VAD by another name?
No.
5 min readIs this person dying now, and what should I do?
They may be dying now if they are much sleepier or cannot be woken, are no longer eating or drinking, have changed breathing, have cool or mottled skin, pass very little urine, or seem confused, restless or less aware of you.
5 min readIs what I'm seeing normal dying, or are they suffering?
Some changes that look frightening can be part of normal dying.
4 min readMy loved one is dying. What does that mean for intimacy between us?
Intimacy can still matter when someone is dying, but it may need to change with energy, privacy, symptoms, consent and comfort.
3 min readNew South Wales Advance Care Directives
In New South Wales, an advance care directive can be spoken or written, and a valid directive must be followed when it applies.
3 min readNorthern Territory Advance Personal Plans
In the Northern Territory, an Advance Personal Plan can record future health, lifestyle and financial decisions, and appoint decision-makers.
3 min readQueensland Advance Health Directives
In Queensland, an Advance Health Directive is the main legally binding document for future health care directions.
4 min readShould children visit someone who is dying?
Children can visit someone who is dying if they want to, the visit is safe, and they are prepared for what they may see.
4 min readShould I call an ambulance if someone is expected to die at home?
Not automatically.
4 min readShould I keep talking to someone who is unconscious and dying?
Yes, if it feels right, keep speaking calmly to a dying person who cannot answer.
4 min readShould I make someone who is dying eat?
No. Although it might come from a place of love and care, let them decide for themselves if they want to eat.
3 min readSouth Australia Advance Care Directives
In South Australia, an Advance Care Directive can record future health, end-of-life, living and personal decisions, and appoint substitute decision-makers.
3 min readTasmania Advance Care Directives
In Tasmania, an Advance Care Directive is a legally binding document about future health care and treatment, made under the approved form.
4 min readThey've stopped eating and drinking. Are we starving or dehydrating them?
When someone is very close to death, stopping eating and drinking is usually part of the dying process.
3 min readVictoria Advance Care Directives
In Victoria, an advance care directive can include binding instructional directives and values directives for future medical treatment.
5 min readWe've just been told the illness is terminal. What happens next?
Being told an illness is terminal means the treating doctor believes it cannot be cured and is likely to cause the person's death.
3 min readWestern Australia advance health directives
In Western Australia, an Advance Health Directive records future treatment decisions and sits at the top of the treatment decision-making hierarchy.
7 min readWhat actually happens on the day of a VAD death?
On the day of a voluntary assisted dying (VAD) death, the person either takes the VAD medication themselves or, where the law allows it and the required approvals are in place, an authorised practitioner gives it to them.
4 min readWhat are anticipatory medicines and why have they been prescribed?
Anticipatory medicines are medicines prescribed in advance in case symptoms happen suddenly, especially when someone is being cared for at home near the end of life.
2 min readWhat can an advance care directive do if it cannot request VAD?
An advance care directive cannot request VAD, but it can record treatment refusals, values and who should speak for you if you lose capacity.
4 min readWhat can I use for a very dry mouth at the end of life?
A very dry mouth near the end of life can often be eased with gentle mouth care, moist swabs and lip care.
4 min readWhat do I do if something frightening happens at 2 am?
If something frightening happens overnight, first check whether the person is in immediate danger.
4 min readWhat do we do tonight if they become breathless, agitated or in pain?
Use the person's written palliative care plan first.
4 min readWhat does dying from COPD look like?
Dying from COPD often involves worse breathlessness, less energy, more chest infections and flare-ups, and needing more help with daily life.
4 min readWhat does dying from dementia look like?
Dying from dementia usually looks like a long, gradual loss of abilities, followed by a clearer final decline.
4 min readWhat does dying from frailty look like?
Dying from frailty often looks like a slow loss of strength and reserve.
4 min readWhat does dying from heart failure look like?
Dying from heart failure can be gradual, sudden, or a mix of both.
3 min readWhat does dying from kidney failure look like?
Dying from kidney failure usually means the kidneys can no longer remove enough waste and extra fluid from the body.
3 min readWhat does dying from motor neurone disease look like?
Dying from motor neurone disease usually happens because the muscles needed for breathing become too weak.
2 min readWhat end-of-life choices do I still have if I cannot access VAD?
If VAD is not available to you, you may still have choices about palliative care, treatment refusal, place of care, advance care planning and symptom relief.
4 min readWhat equipment can I get to help care for someone dying at home?
Equipment for dying at home may include a hospital bed, commode, pressure mattress, slide sheets and continence supplies.
6 min readWhat exact words do I need to say to ask about VAD?
You do not usually need magic words to ask about voluntary assisted dying (VAD).
3 min readWhat happens after a VAD death?
After a VAD death, the usual after-death steps still happen, but some paperwork and reporting are handled through the state or territory VAD system.
1 min readWhat happens if I am too unwell to travel for a VAD assessment?
If you are too unwell to travel for VAD assessment, contact the VAD navigator quickly so they can check local, visiting or lawful remote options.
2 min readWhat happens if I become too sick to transfer to another facility for VAD?
If transfer becomes unsafe, the VAD team may need to explore local access, visiting practitioners, symptom care or whether the process can continue.
5 min readWhat happens if my GP objects to VAD?
Your GP may be allowed to object to voluntary assisted dying (VAD) and choose not to take part.
2 min readWhat happens if my hospital, hospice or aged-care facility does not participate in VAD?
If a facility does not participate in VAD, it may still have duties to give information, allow access or help with transfer, depending on the law where you are.
6 min readWhat happens if someone cannot communicate shortly before a planned VAD death?
If someone cannot communicate shortly before a planned voluntary assisted dying (VAD) death, the VAD team must check what the law requires at that point.
6 min readWhat happens if someone changes their mind at the last minute with VAD?
If someone changes their mind before taking or being given voluntary assisted dying (VAD) medication, the process should stop.
7 min readWhat happens if someone loses capacity before completing the VAD process?
If a person loses decision-making capacity before completing the voluntary assisted dying (VAD) process, they usually cannot continue to access VAD.
4 min readWhat happens if the family disagrees about treatment at the end of life?
If family members disagree about treatment at the end of life, the first step is usually a careful meeting with the treating team.
5 min readWhat happens immediately after someone dies at home?
If the death was expected, there is usually no need to call `000` or the police straight away.
4 min readWhat happens when someone who is dying can no longer swallow their medicines?
When a dying person cannot swallow medicines, the care team can review what is still needed and use other routes for comfort medicines.
5 min readWhat help is available if I have to stop working to care for someone who is dying?
If you need to stop work or reduce hours to care for someone who is dying, help may include workplace leave, flexible work discussions, Centrelink carer payments, Carer Gateway support, respite, social work help and financial counselling.
2 min readWhat if I want VAD but do not qualify?
If you want VAD but do not qualify, you can ask why, check review options, and still receive palliative care and other end-of-life support.
4 min readWhat is a terminal rally?
A terminal rally is a short period where a dying person seems more awake, settled or energetic before declining again.
5 min readWhat is an Advance Care Directive?
An advance care directive records what medical care you would want if you could not make or communicate your own decisions later.
4 min readWhat is Cheyne-Stokes breathing?
Cheyne-Stokes breathing is a pattern where deeper breaths are followed by shallower breaths or pauses.
2 min readWhat is different about grief after a VAD death?
Grief after a VAD death can include ordinary grief as well as feelings linked to planning, secrecy, disagreement, relief or the known date of death.
3 min readWhat is palliative sedation?
Palliative sedation is the careful use of sedating medicines to reduce a dying person's awareness so severe suffering can be relieved.
4 min readWhat is terminal lucidity?
Terminal lucidity means a short return of clearer thinking or communication in someone who is close to death.
4 min readWhat is the death rattle?
The death rattle is noisy breathing caused by saliva or secretions pooling when a dying person is too weak to clear their throat.
4 min readWhat is the difference between palliative care, palliative sedation, stopping treatment and VAD?
Palliative care, palliative sedation, stopping treatment and voluntary assisted dying are different.
2 min readWhat options exist if symptoms become intolerable despite treatment?
If symptoms feel intolerable, the first step is urgent specialist review because medicines, care plans, palliative sedation or VAD assessment may need to be discussed.
4 min readWhat should children expect when they visit someone who is dying?
Children should be told, in plain words, what may be different before they visit someone who is dying.
5 min readWhat should we organise after being told someone may only have months to live?
If someone may only have months to live, start with the supports that affect comfort, decision-making and safety: medical contacts, palliative care, medicines, home support, legal and financial documents, carer support, and the person's wishes for care.
2 min readWhat support is available for families after a VAD death?
Families after a VAD death can seek support from palliative care, VAD services, GPs, grief services, counselling, spiritual care and crisis lines.
5 min readWhat support is needed for someone to die at home?
Someone dying at home usually needs a planned mix of medical care, nursing support, practical help, equipment, medicines, after-hours advice and family or friend support.
4 min readWhen should I call 000 for someone receiving palliative care?
Call 000 when there is a life-threatening emergency or immediate danger.
4 min readWhen should I call the palliative care team?
Call the palliative care team when symptoms change, medicines are not working as expected, the care plan is unclear, equipment is not working, or you are worried about the person or your ability to keep caring safely.
4 min readWhen should I seek urgent medical advice?
Seek urgent medical advice when a symptom is severe, new, rapidly worsening, frightening, or not settling with the palliative care plan.
5 min readWhen should palliative care start?
Palliative care can start as soon as someone is diagnosed with a life-limiting illness, not only in the last days of life.
7 min readWho can be present during a VAD death?
The person choosing voluntary assisted dying (VAD) usually decides who they want with them, if anyone.
4 min readWho can refer someone to palliative care?
A GP, medical specialist or other health provider can usually refer someone to palliative care.
4 min readWho decides when family members disagree about end-of-life care?
When family members disagree, the decision-maker is not automatically the loudest person, the closest relative in a social sense, or a family vote.
4 min readWho decides whether palliative sedation is used?
Palliative sedation is a medical treatment.
2 min readWho pays for travel needed to access VAD?
Travel costs for VAD depend on the state or territory, the person's location, available support programs and the travel scheme rules.
4 min readWhy are a dying person's hands and feet becoming cold?
Cold hands and feet near death often happen because blood flow to the skin and limbs is slowing.
5 min readWhy are they hallucinating, picking at the sheets, trying to get out of bed or calling for dead relatives?
These behaviours can happen near the end of life.
4 min readWhy are they sleepier after medication?
People can become sleepier after medicines used in palliative care.
2 min readWhy can't an advance care directive request VAD for later?
An advance care directive cannot request VAD for later because VAD law requires a current personal request and current decision-making capacity.
4 min readWhy did the morphine dose suddenly increase?
A sudden increase in morphine usually means the team is trying to catch up with pain, breathlessness or another distressing symptom that has changed.
4 min readWhy do a dying person's eyes sometimes stay partly open?
A dying person's eyes may stay partly open because the eyelid muscles relax and blinking becomes less frequent.
4 min readWhy does a dying person sometimes have a fever?
Fever near the end of life can come from infection, inflammation, medicines or the body's changing temperature control.
4 min readWhy does a dying person's breathing suddenly change?
Breathing can change suddenly near death because the brain, muscles and circulation no longer control breathing in a steady way.
4 min readWhy does a dying person's jaw move with each breath?
Jaw movement with each breath can happen when a dying person's breathing muscles are very weak.
4 min readWhy does a dying person's mouth stay open?
A dying person's mouth may stay open because the face and jaw muscles relax as the body becomes weaker.
4 min readWhy does someone who is dying become incontinent?
Incontinence near death can happen because the person is weak, sleepy, less aware and losing muscle control.
4 min readWhy does someone who is dying stop being able to swallow tablets?
A dying person may stop swallowing tablets because they are weaker, sleepier and less able to swallow safely.
4 min readWhy has a dying person stopped passing much urine?
A dying person may pass very little urine because they are drinking less and their kidneys and circulation are slowing.
4 min readWhy has someone who is dying suddenly become more awake and energetic?
A short burst of energy near death can happen, but it usually does not mean the illness is reversing.
4 min readWhy is a dying person staring into the distance?
A dying person may stare into the distance because they are very tired, less aware, delirious, or unable to focus their eyes normally.
4 min readWhy is a dying person's skin becoming blotchy or purple?
Blotchy or purple skin near death often happens because circulation is slowing and blood is not reaching the skin evenly.
2 min readWill a VAD doctor travel to me?
A VAD doctor may be able to travel in some situations, but availability depends on the jurisdiction, workforce and travel support arrangements.
2 min readWill my palliative care team judge me if I ask about VAD?
You can ask about VAD without having to justify your values, and your team should respond respectfully even if some staff do not participate.
2 min readWill my palliative care team still care for me if I ask about VAD?
A palliative care team should keep caring for you if you ask about VAD, although individual staff may have different roles or objections.
6 min readWill VAD hurt?
Voluntary assisted dying (VAD) is intended to cause death after the person takes or is given a prescribed VAD substance.
5 min readWould a feeding tube make someone stronger near the end of life?
Usually, a feeding tube does not make someone stronger when they are actively dying.
4 min readWould IV fluids help someone who is dying?
Sometimes IV fluids help in palliative care, but they do not usually help when a person is actively dying and the body is shutting down.