Can unexpected things happen during a VAD death?

Australia · 29 August 2026 · 7 min read · Reviewed by Dr Kane Treble

Yes.

General information: This page gives general information for people in Australia. It cannot tell you exactly what will happen in one person's situation. If you have concerns about a symptom, medicine, treatment decision or change in someone's condition, contact their doctor, palliative care team, nurse or other treating health professional. VAD laws, forms and service pathways differ by state and territory, so confirm the current rules with the person's VAD practitioner or official VAD care navigator service.

Yes. Unexpected things can happen during a voluntary assisted dying (VAD) death, although official guidance and published Australian data suggest serious problems are uncommon. The person may take longer than expected to lose consciousness or die. They may have symptoms from their illness. Family may see breathing changes, sounds or movements that feel alarming. A planned self-administration may also become impossible if the person becomes too weak, confused or unable to swallow.

The safest way to prepare is to ask the VAD practitioner and pharmacist about expected effects, possible complications, and exactly who to call if something does not go as planned.

VAD is operating in Victoria, New South Wales, Queensland, Western Australia, South Australia, Tasmania and the Australian Capital Territory. News reports said the Northern Territory Parliament passed VAD laws on 27 August 2026, with implementation to follow. At 29 August 2026, an official operational commencement source for the Northern Territory was not verified for these pages, so the Northern Territory is treated here as not yet operational.

What counts as unexpected?

Unexpected does not always mean dangerous or painful. It may mean the death takes longer than the family expected, the person makes a sound after losing consciousness, breathing changes in a way people were not prepared for, or the room becomes emotionally harder than expected.

Possible practical problems include vomiting, trouble swallowing, trouble using equipment, a misplaced item, uncertainty about whether someone is allowed to help, or a support person becoming too distressed to do their planned role.

There can also be legal problems. For example, the person may not be able to make the required final request, final permission or administration request. They may lose decision-making capacity. They may say or show that they no longer want to go ahead. In those situations, the process must stop unless and until the law in that jurisdiction allows it to continue.

Longer timing

Families may expect death to happen within minutes. Sometimes it does. Sometimes it takes longer.

A Victorian study of self-administered VAD deaths between 2019 and 2025 found that most people lost consciousness within 10 minutes and most died within an hour. But some deaths took more than two hours, and a small number took more than six hours. This is why it is important to ask what to do if the process takes longer than expected.

Longer timing can be emotionally difficult for people present. It does not always mean the person is awake or suffering, but the treating team should explain what signs to watch for.

Symptoms or visible changes

The person may already have pain, breathlessness, nausea, weakness, agitation or anxiety because they are very ill. These symptoms should still be treated. VAD does not replace palliative care.

After the medication is taken or given, family may notice changes in breathing, colour, sounds, muscle tone or movement. Some changes may be part of dying. Others may need professional assessment if a health professional is present or contactable.

Ask before the day:

What signs are expected?
What signs mean the person may be uncomfortable?
Who can give comfort medicines if needed?
What should we do if the person vomits or cannot swallow?
What happens if the person becomes unconscious but does not die for a long time?

If something goes wrong legally

VAD has strict safeguards. A person must be acting voluntarily and have decision-making capacity at required points. In some jurisdictions, they must make a final request, administration request or final permission shortly before the medication is given or supplied.

If the person changes their mind, seems unsure, is pressured, or cannot communicate the required decision, the VAD practitioner must follow the law. Family cannot decide to proceed for them. An advance care directive or substitute decision-maker cannot request VAD on the person's behalf.

Tasmania's legislation is unusual because it expressly deals with unexpected medical complications in certain non-private self-administration situations, requiring the administering health practitioner to follow the person's recorded wishes about responding to complications. This is one reason national pages need jurisdiction-specific checking.

Planning reduces risk

Planning does not remove every risk, but it helps. Ask whether a doctor, nurse or other health professional can be present. Make sure everyone knows who is allowed to touch the medication, who will support children, who will call the doctor after death, and who will return unused medication.

If the person is in a facility, ask about the facility's VAD policy well before the planned day. Some services support VAD on site. Some do not. Some may support parts of the process but not others.

When to get help now

Before the medication is used, contact the VAD practitioner, palliative care team or care navigator if anything has changed: new confusion, weakness, inability to swallow, vomiting, distress, family pressure, conflict, or doubt about the person's wishes.

Call 000 for immediate danger or a medical emergency outside the agreed VAD or expected-death plan. If the death is expected at home, follow the plan from the treating team.