Feature Article
Supporting Bereavement for Families Navigating Voluntary Assisted Dying (VAD): Learnings from an Australian-First Pilot Program
Jane Nosworthy, Board Member, Dying with Dignity Victoria (DWDV)
Kerrie Arthur, Counselling Coordinator, Griefline
Abstract
Voluntary Assisted Dying (VAD) introduces unique grief and bereavement challenges for families, friends, and caregivers. Recognising this, Dying with Dignity Victoria (DWDV) and Griefline collaborated to design and pilot a pioneering support group program tailored to the specific needs of bereaved family members and friends of VAD participants. This white paper summarises the development, implementation, and findings from this program, which, based on overwhelmingly positive feedback, is being expanded in the upcoming fiscal year to include pre- and post-VAD support services nationwide.
Background
As the demand for compassionate end-of-life options like VAD grows in Australia, the need for specialised grief support has become clear. Family and friends of VAD participants can experience unique bereavement challenges arising from various VAD-related factors, including ambivalence, stigma, and difficulties navigating the end-of-life process. To address these needs, DWDV and Griefline joined forces, leveraging 80 years of combined experience in community support, to deliver an Australian-first program offering post-VAD bereavement support groups.
Program development
The program draws on the strengths of both organisations. DWDV’s expertise in providing VAD-related peer support and advocacy in Victoria, and Griefline’s national reputation for evidence-based bereavement support and group facilitation, created a partnership that deeply resonated with participants' needs.
The pilot aimed to:
- Provide a safe and stigma-free space for individuals to process VAD-related grief.
- Offer psychoeducation on grief and VAD-specific themes to support participants in making meaning of their unique experience.
- Equip participants with emotional tools and a support network to mitigate the impact of VAD- related grief.
Funding and duration
Funded by DWDV, the pilot ran from September 2023 to August 2024, serving 17 participants across Australia.
Program design
Informed by lived experience and overseas research, the program was structured as follows:
- Co-facilitation model: Each session was led by a peer with lived experience of supporting a loved one to access VAD and a trained bereavement facilitator, ensuring both understanding and expertise.
- Closed groups: Groups of up to six participants met weekly for six weeks for two-hour sessions.
- Accessibility: Sessions were hosted via Zoom to maximise reach across both metro and regional/rural areas.
Content structure
The program featured a combination of grief psychoeducation and VAD-specific themes, including:
- The uniqueness of VAD as a mode of death.
- Challenges in navigating the VAD process, such as procedural delays.
- Experiences of stigma from community members and healthcare providers.
- Mixed feelings surrounding the VAD decision and its impact on bereaved participants.
Demographics
- Participants: 13 women, 4 men.
- Age: Ranged from people in their 30s to over 70. Relationship to VAD participant: 41.2 per cent were parents, 47.1 per cent were partners, and 11.8 per cent other relationships.
- Geographical reach: Participants spanned multiple states, with the majority (70.6 per cent) based in Victoria, where the program originated; 53 per cent of the participants were in metro areas and 47 per cent were in regional and rural areas.
- Time since death: For just over 50 per cent of group participants, the death of their loved one was less than 12 months. For just over 20 per cent of group participants the death of their loved one was greater than 12 months and for the other 20 per cent the death was longer than 2 years.
Findings
Impact of VAD on grief
The program revealed that specific aspects of VAD, such as procedural delays and societal stigma, significantly influenced participants' grieving processes. For many, the VAD experience intensified their grief, creating a need for peer-based support that was both validating and emotionally safe.
Connection and shared experience
A sense of deep connection and bonding was formed between group members, who shared the unique experience of supporting loved ones through VAD. These connections helped alleviate feelings of isolation and provided participants with a comforting space to share their grief and complex emotions with others who truly understood.
Complex emotions and stigma
Participants expressed that VAD involves a unique and complex emotional journey, often combining relief, guilt and trauma. Additionally, as previously highlighted, there continues to be stigma and negative judgement surrounding VAD, with many participants noting they were cautious about sharing their experience openly. Participants reported experiences of stigma from health professionals as well as community members.
For some, the VAD experience was traumatic but at the same time peaceful. There was tension between what the mind understood about the choice their loved one made, and what their heart felt. After the death there was a lot to be said, however limited opportunities to be heard. We were told stories of advocating for choice and control, yet feeling unprepared for how the death would unfold.
The program’s structure allowed for open expression, balancing guided exercises with opportunities to share personal stories. Participants appreciated both the therapeutic exercises and the chance to discuss their loved ones and VAD experiences in-depth.
Mental health benefits and meaning-making
Many participants mentioned how the group significantly impacted their mental health, relieving isolation and feeling more understood. This support group acted as a vital emotional lifeline, particularly in navigating the unique challenges of the VAD experience.
Many participants expressed a need to make meaning of the VAD process, a journey uniquely addressed in this program. Participants reflected to the group that meaning came from connecting with each other, sharing their beliefs and values regarding VAD, and forging continuing bonds with their loved ones.
Accessibility and awareness
Several respondents emphasised the importance of making VAD support groups more accessible and widely known. They felt that navigating the VAD journey would have been far more challenging without such support and suggested linking this service more effectively to those who might benefit.
Feedback
Participant feedback underscored the program’s positive impact. Participants expressed feeling a greater sense of connection and understanding in their grief. In the words of one of our participants, making connections with others and hearing their own unique experiences has instilled a sense of direction and purpose to their own VAD involvement.
Despite participants communicating their gratitude for support, there was a sense that there was a missing link throughout the VAD process. Participants wondered about support pre-VAD and immediately after the death of their loved one.
Participants have expressed a willingness to contribute their time and provide ongoing feedback to improve the process for those who come after them.
Next steps
Program expansion
Due to positive outcomes and high demand, DWDV and Griefline will expand the program in FY 24/25 to include:
- 8 post-VAD support groups
- 10 pre-VAD drop-in sessions for families and friends during the VAD decision-making process.
Future goals
To meet increasing demand and deepen support, Griefline also aims to develop a meaning-centred therapy program specifically for those considering VAD. This offering, along with ongoing one-on-one peer support from DWDV, will continue to provide much-needed resources for families impacted by VAD decisions.
Acknowledgments
We extend our sincere thanks to the program facilitators and participants, whose courage and openness have allowed us to develop and refine this essential service.
Author Biography
Kerrie Arthur is a qualified counsellor and social worker and is a Group Facilitator and Counselling Coordinator for Griefline. Her own journey through loss has given her a deep understanding of the many forms grief can take and the complex emotional landscape it often involves. Kerrie believes strongly in each person’s inherent worth and autonomy—that individuals are the experts in their own lives and have the capacity to find meaning in their loss.
She co-facilitates a range of support groups, including those for individuals impacted by Voluntary Assisted Dying (VAD), and is a strong advocate for the emotional benefits of peer support. Kerrie hopes these groups help reduce the isolation and stigma often associated with VAD, creating the conditions for participants to navigate grief collectively and foster shared understanding.
Author Biography
Jane Nosworthy is a social worker and board member of Dying With Dignity Victoria (DWDV). With a professional background in law, governance, and public health, Jane brings both lived and professional experience to her advocacy for voluntary assisted dying (VAD). Following the VAD journey of her mother-in-law, Jane became committed to improving access and support for others navigating end-of-life choices. She co-facilitates Australia’s first VAD-specific bereavement support group offered by DWDV in partnership with Griefline and co-authored the article “Supporting Bereavement for Families Navigating Voluntary Assisted Dying” alongside Griefline’s Kerrie Arthur.