A new review led by Associate Professor Anne Wand explores a largely overlooked issue: what happens to people who are deemed ineligible for voluntary assisted dying (VAD)?
As Voluntary Assisted Dying (VAD) becomes more widely legislated, focus has largely centred on eligibility, safeguards and access. Drawing on 14 international studies, this review instead examines what happens after ineligibility is determined. While evidence remains limited, the findings importantly highlight that for some individuals, being denied access to assisted dying is associated with significant distress and, in some cases, suicidal thoughts and behaviours.
Responses ranged from emotional distress and frustration, suicidal ideation (including the wish to die) and behaviour, voluntary stopping eating and drinking, and completed suicide. The study also highlights major gaps in current systems, particularly the lack of structured follow-up and support for those determined to be ineligible for VAD.
In response, the authors call for stronger clinical guidance, including preparing individuals for potential ineligibility, conducting assessments of suicide risk, and ensuring appropriate follow-up care.
“This work highlights a critical gap in our current systems. Whilst we have well-developed processes for assessing eligibility for voluntary assisted dying, there is little guidance on how to support people when they are found to be ineligible. Understanding and responding to this period of risk is essential to ensuring safe, compassionate and comprehensive care,” explains Associate Professor Anne Ward.
“The findings highlight the need to recognise ineligibility as a key point for intervention, ensuring vulnerable individuals are not left without support as assisted dying frameworks continue to evolve.”