What happens if someone cannot communicate shortly before a planned VAD death?

Australia · 29 August 2026 · 6 min read · Reviewed by Dr Kane Treble

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.

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.

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. In many situations, VAD cannot go ahead unless the person can communicate the required request, permission or decision themselves, with lawful communication support if needed.

Not being able to speak is not the same as not being able to communicate. A person may still be able to use gestures, writing, eye movements, a communication board, a device, an interpreter or help from a speech pathologist. These supports should be arranged early if communication is becoming harder.

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.

Why communication matters

Australian VAD laws require the person's own choice. The person must be able to make and communicate the decisions required by the law in their state or territory. Those decisions may include a final request, final review, administration decision, administration request or final permission.

Family members cannot say, "This is what they wanted, so go ahead." A substitute decision-maker cannot make the VAD request. An advance care directive cannot activate VAD after the person can no longer communicate the required decision.

This can feel harsh when the person has been clear for weeks or months. But the safeguard exists because VAD must remain voluntary at the point the law requires.

If the person can communicate in another way

If speech is difficult, tell the VAD practitioner as soon as possible. Do not wait until the planned day.

Depending on the jurisdiction and the person's needs, the team may arrange:

a communication aid
a speech pathologist
a qualified interpreter
extra time for appointments
written prompts or agreed gestures
an assessment of whether the person still has decision-making capacity

Victoria's public guidance says a person can make certain requests using gestures or a communication aid if they cannot communicate verbally, and may use a qualified interpreter or speech pathologist if needed. NSW and Queensland also recognise communication by means such as gestures in parts of the request process. The exact rules differ, so check locally.

If communication is unclear

If the practitioner cannot be satisfied about what the person is communicating, the process may need to pause. The team may assess for reversible causes, such as delirium, medicine effects, infection, pain, anxiety, dehydration, low oxygen, or exhaustion.

The person may regain enough ability to communicate after treatment, rest or better symptom control. Or they may not. If they cannot communicate the required decision, VAD may not be legally available.

Do not guess. Do not interpret a small movement as consent unless the practitioner is satisfied it is reliable and meets the legal requirements.

If practitioner administration was planned

Practitioner administration often needs a final request, administration request or final permission close to the time of administration. Some jurisdictions require this to be witnessed or recorded in a particular way.

If the person cannot communicate at that point, the practitioner may be legally unable to administer the medication. The practitioner should explain what can happen next, including whether communication support, reassessment or a later attempt is possible.

If self-administration was planned

For self-administration, the person must be able to take the medication themselves and must still be choosing to do so. If they cannot communicate, cannot swallow, cannot manage the steps, or seems unsure, no one else should administer the medication for them.

In some jurisdictions, a person who can no longer self-administer may be able to ask for practitioner administration if they still have capacity and can make the required request. If they cannot communicate that request, this may not be possible.

When to get help now

Contact the VAD practitioner or care navigator urgently if speech, swallowing, alertness or communication is getting worse. Early support gives the person the best chance of having their wishes understood within the law.

Call 000 if there is an immediate emergency outside the agreed care plan. If the person is expected to die at home, follow the plan given by the treating team.