Voluntary Assisted Dying (VAD) Act 2021 was passed by the South Australian (SA) Parliament with a range of safeguards embedded and commenced January 31st, 2023. VAD polarizes opinions, is permit based and rigidly legislated. We report quantitative and qualitative data for the initial 12 months of operation, highlight aspects critical to the success of the program, areas for improvement and strategies to achieve this.

The VAD program encompasses several teams, each critical to providing VAD care: Initial contact and Navigation, Medical professionals for assessment and care of patients, operational teams in the Department of Health, a central Pharmacy team, with supervision and review by the Ministerial appointed VAD Review Board.

In the first 12 months, 195 people received a VAD permit, of which 110 died from administration of the VAD substance. This equates to < 1% of all deaths in SA. Most (57%) occurred in the person’s home, 30% in hospital/hospice. The majority (71%) had a malignancy, 75% aged > 65 years, 53% male gender. Palliative care was being received by 77% of the people issued VAD permits. The majority (68%) resided in the metropolitan area.

Seventy-one doctors provide VAD care as coordinating or consulting practitioners. Most (60%) are General Practitioners, the remainder from a range of medical specialties (Palliative Care 4%). Twenty-seven percent of doctors live in rural areas.

The VAD service has received positive feedback from patients, family, and health care professionals. Our doctors describe VAD as ‘some of the most important work they perform’. Clinicians report being well-supported by the entire team and feel safe in the work they are undertaking. Trained volunteer witnesses ensure patients without family/friends can complete requisite written documentation.

Ongoing challenges include growing a sustainable workforce, clinician remuneration, raising community awareness, bereavement processes post VAD and providing equitable access and care for all patients.