Walking Alongside: How End-Of-Life Doulas Support People Choosing Voluntary Assisted Dying

By Journease | 10/21/2026

When someone decides to explore voluntary assisted dying (VAD), they step into a process built around assessments, forms, eligibility criteria and safeguards. Those safeguards matter. Yet the experience is also deeply human: it involves fear, relief, grief, family conversations that may never have happened before, and a final day that the person has the rare opportunity to shape.

I have been thinking about this a great deal this week, having just attended the VADANZ conference, which brought together people working in voluntary assisted dying from across Australia and New Zealand. I came away more convinced than ever that the legal and medical framework is only a part of the story, and that the quality of the human support around each person matters enormously.

Clinicians handle the medical and legal side. An end-of-life doula holds the space around it. This post explains what that support looks like in practice, where the boundaries sit, and what to look for if you are considering engaging a doula for yourself or someone you love.

First, what is an end-of-life doula?

An end-of-life doula (sometimes called a death doula) is a non-medical support person who walks with a dying person and their family through the last stage of life, and often beyond it. The word “doula” comes from Greek and is usually translated as a person of service.

Doulas offer practical, emotional and sometimes spiritual support. They might help someone put their affairs in order, plan a funeral, create legacy projects, sit vigil, or simply be a calm, informed presence when everyone else is overwhelmed. Research describes them as complementary to palliative care rather than a replacement for it, often attending to emotional, spiritual and legacy needs that busy health services struggle to meet.

Where VAD stands in Australia right now

VAD is now lawful in every Australian state and in the ACT, where the scheme began on 3 November 2025. The Northern Territory remains the only jurisdiction without VAD laws. Each scheme has its own eligibility rules and steps, so the details depend on where the person lives.

Victoria, the first state to legislate, is about to change. Parliament passed amendments to the Voluntary Assisted Dying Act 2017 in November 2025, and these take effect from 19 April 2027. Until then, the current rules still apply. Among the changes:

  • Doctors and nurse practitioners will be able to raise VAD as part of end-of-life conversations, ending the so-called “gag clause”.
  • Practitioners who conscientiously object will still need to give a person who asks about VAD the contact details for the Statewide Care Navigator Service and the Department of Health’s VAD information.
  • People with at least three years of Australian residency will be able to apply, not only citizens and permanent residents.
  • The prognosis timeline will be lengthened from 6 months to 12 months for all applicants.
  • A person will be able to choose, with their coordinating practitioner, whether to take the substance themselves or have a practitioner administer it. Ther person can also change their mind on method of administration at any time.

For doulas, these changes matter because they shape the conversations families will be having and the choices they will be weighing up.

How a doula supports someone through VAD

Every person’s path is different, but doula support tends to fall into five overlapping stages.

1. Exploring the choice

Many people first mention VAD to someone who is not their doctor. A doula offers a space where a person can think aloud about what they want, what they fear, and what a “good death” means to them, without being steered in any direction.

A good doula does not advocate for or against VAD. They listen, ask open questions, and help the person connect the choice to their values. They also point people toward reliable sources: in Victoria, that usually means the Statewide Care Navigator Service, which helps people and families understand the process and find participating practitioners. Victoria’s Department of Health stresses that VAD is one end-of-life option among many and that accessing it takes considerable preparation, so a doula will also make sure palliative care and other options remain part of the conversation.

2. Navigating the process

The formal VAD pathway involves several requests, two independent assessments, a written declaration and, depending on the state, permits and pharmacy arrangements. For someone who is unwell and tired, this can feel relentless. A doula can help by:

  • keeping track of appointments and what is coming next, so the person and family are not caught off guard;
  • helping the person prepare their thoughts before assessments, so they can say what they mean in their own words;
  • being a steady presence across weeks that can be emotionally exhausting;
  • helping with practical logistics such as transport, rest days and coordination with other carers.

In some cases a doula can also act as an independent witness when the person signs their written declaration. Every state sets rules about who may witness (for example, excluding certain family members, beneficiaries and the person’s VAD practitioners), so this needs checking against local law. In Victoria, Dying with Dignity Victoria keeps a directory of member doulas who are willing to support people accessing VAD and who offer volunteer witnessing.

3. Planning the day

VAD gives people something unusual: the chance to choose when, where and with whom they die. That can be a gift, and it can also feel overwhelming. Doulas help people plan a day that reflects who they are. This might include:

  • where it will happen (at home, in a favourite room, in a garden, in hospital or aged care) and who will be present;
  • music, readings, rituals, cultural or religious practices, candles, photos, or a meaningful last meal;
  • whether pets will be there;
  • how to include children;
  • what the person wants to say, and to whom, before the time comes;
  • legacy work such as letters, recorded messages, ethical wills or memory boxes.

Doulas also help families think through what happens immediately afterwards: who to call, how long the family would like to sit with the person, and whether they want to help wash or dress the body. Having these answers ahead of time spares loved ones from making hard decisions in the rawest moments.

4. Being present on the day

On the day itself, the doula’s job is to hold the space so that everyone else can simply be there. That might mean greeting the practitioner, managing the room, quietly attending to small practical tasks, supporting a family member who is struggling, or keeping the atmosphere the person asked for.

Doulas do not prepare, handle or administer the VAD substance, and they do not give medical advice. Those tasks belong to the person and their authorised practitioners. The doula’s value lies in presence, calm and continuity: often they are the one familiar face who has been there from the first conversation to the last breath.

5. After death and into grief

Doula support does not stop at the moment of death. Doulas may help with after-death care, liaise with the funeral director or help with a home funeral, support a family vigil, and check in with loved ones in the weeks that follow.

Grief after VAD can have its own texture. Some family members feel peace because they saw suffering end on the person’s terms. Others carry complicated feelings, particularly if they were unsure about or opposed to the decision. Research on caregivers in VAD has found that they want to be accompanied and not left alone at every stage of the process. A doula who knew the person and witnessed the journey is well placed to offer exactly that kind of continuity.

Supporting the whole family, not just the person dying

VAD decisions do not happen in isolation. Families can be divided, and a person may worry about how their choice will land with the people they love. Doulas often help create room for honest conversations: helping a parent explain their decision to adult children, supporting a partner who is struggling to accept it, or gently making sure the dying person’s wishes stay at the centre.

Australian research with bereaved families who engaged a death doula found their experiences were overwhelmingly positive, and that the knowledge and connection they gained rippled out into greater awareness of death and dying in their wider circles. (Rawlings et al. (2023), Experiences of Engaging a Death Doula: Qualitative Interviews with Bereaved Family Members, from Flinders University’s Research Centre for Palliative Care, Death and Dying.) That ripple effect may be especially valuable with VAD, which many people still find hard to talk about.

Important boundaries

Because VAD is tightly regulated, ethical doulas are clear about what sits outside their role. In general, a doula:

  • does not assess eligibility, decision-making capacity or voluntariness; those are clinical judgements;
  • does not pressure, encourage or discourage anyone, and stays alert to any sign of coercion from others;
  • does not handle, prepare or administer the substance;
  • refers medical and legal questions to the person’s practitioners or the relevant state VAD service;
  • takes care with how VAD is discussed by phone, email or video. The Commonwealth Criminal Code contains offences about suicide-related material sent over a “carriage service”, and in 2023 the Federal Court found these can apply to VAD. Most official guidance is written for health practitioners, and peak bodies have repeatedly called for reform, but the offences are not limited to clinicians, so many doulas still keep detailed VAD discussions to face-to-face settings and stick to logistics in electronic messages.

A doula who explains these limits upfront is a doula who understands the territory.

Choosing a doula for a VAD journey

Palliative Care Australia suggests asking any prospective doula about their background, qualifications, the services they offer and their fees. For VAD specifically, it is also worth asking:

  • How do you support people who are contemplating VAD?
  • How do you feel about VAD personally, and how do you keep your own views out of the room?
  • Are you able to act as a witness, and do you understand the local witnessing rules?
  • How do you work alongside palliative care teams and VAD practitioners?
  • What support do you offer after death and for bereaved family?

Trust your instincts too. The right doula is someone the person feels safe with, because they may be one of the last people in the room.

A final word

Voluntary assisted dying gives people a measure of control at the end of life. An end-of-life doula helps make sure that control is matched with care: that the person feels heard, that the family feels held, and that the day itself reflects a whole life rather than a medical procedure. It is quiet, unseen work, and for many families it is what they remember most.

Further information and support

Posted in Doula Service