As Australia advances into a new era of voluntary assisted dying (VAD), emerging research from Edith Cowan University (ECU) reveals a critical gap in end-of-life care: the underutilization of psychologists. A pioneering study conducted by Dr. Vivienne Heng, a Master’s candidate, alongside Associate Professor Eyal Gringart, delves into the perspectives of Provisionally Registered Psychologists (PRPs) regarding their involvement in VAD. This research shines a light on the complex barriers that prevent these mental health professionals from fully engaging in VAD processes, despite their unique qualifications to support patients facing terminal illness and difficult end-of-life decisions.
The qualitative investigation involved in-depth interviews with twenty PRPs, revealing nuanced attitudes toward VAD. Many participants expressed support for the practice, acknowledging its potential benefits for terminally ill patients and even for those living with degenerative conditions such as dementia. Despite this support, the psychologists showed a reluctance to participate actively in VAD care. This reluctance was largely attributed to several significant deterrents that extend beyond personal ethics, involving systemic and structural challenges embedded within the healthcare and legal frameworks governing VAD.
Among the primary concerns identified was the emotional toll associated with involvement in assisted dying. Psychologists reported experiencing anticipatory emotional strain, exacerbated by fears of litigation and ambiguous ethical guidelines that lack clarity on the scope and limits of their practice in VAD contexts. Such legal ambiguities contribute to a professional environment where uncertainty governs day-to-day decisions, fostering anxiety and hesitance among those who would otherwise provide critical mental health support during end-of-life care.
Another prominent barrier highlighted by the study is the so-called “gag clause,” a regulatory constraint present in many Australian states that prohibits health practitioners, including psychologists, from initiating discussions about voluntary assisted dying. This legal limitation restricts open communication with patients and their families about VAD options, effectively silencing a crucial avenue for psychological support and community education. While there have been recent proposals in states like Victoria to amend or repeal this clause, its ongoing presence continues to limit the ability of psychologists to navigate conversations essential to informed decision-making in terminal care.
The study emerges against the backdrop of a nationwide shift in Australian legislation, with all states and the Australian Capital Territory having legalized VAD, and the Northern Territory in active consultation phases. The expanding legal landscape is driven by demographic changes such as an ageing population and an increased prevalence of chronic, life-limiting illnesses, which together intensify the demand for comprehensive mental health services embedded within end-of-life care frameworks. Despite this demand, psychologists remain underrepresented in VAD-related clinical settings, with only about one percent self-reporting expertise in palliative care, underscoring a missed opportunity for integrated care approaches.
Associate Professor Gringart points to historical trends within the psychology profession that may contribute to this under-engagement. Psychologists have traditionally shown less interest and interaction with older adult populations, a factor that may influence their current involvement in VAD care. Early exposure to aging-related issues and end-of-life topics during training is posited as a strategic avenue to enhance psychologists’ readiness and willingness to participate in VAD. Since VAD is a relatively novel domain with evolving legal parameters in Australia, embedding VAD-specific content into psychology curricula could foster competence and confidence among emerging professionals.
ECU’s research underscores the importance of timely intervention in training future psychologists, emphasizing that foundational education must address the psychological complexities intrinsic to VAD. Mental health assessments related to capacity, grief, bereavement counseling, and the ethical nuances of voluntary assisted dying require tailored preparation. Integrating these components into psychology education can ensure that upcoming practitioners are equipped to meet the multifaceted needs of patients, families, and healthcare teams navigating this sensitive phase of care.
Crucially, the study highlights the unique skill set psychologists bring to the VAD landscape. Their expertise goes beyond mere capacity evaluations—psychologists provide empathetic and comprehensive support that encompasses the emotional, cognitive, and existential dimensions of end-of-life decision-making. Through grief counseling, mental health interventions, and education for all VAD stakeholders, psychologists can facilitate a more compassionate and holistic approach to dying, fostering dignity and respect for patients’ choices.
Dr. Heng’s research argues for dismantling the existing barriers that dissuade psychologists from engaging fully in the VAD process. These obstacles range from regulatory constraints and lack of clear ethical guidance to inadequate remuneration structures that undermine sustainability and professional commitment. Addressing these issues is critical to enabling psychologists to fulfill their potential role in this emerging clinical context, fostering patient-centered care that truly integrates psychological wellbeing into the end-of-life experience.
Beyond individual practitioners, this research may catalyze broader systemic reforms, including legislative amendments to permit open discussion of VAD, enhanced professional development opportunities, and policy frameworks that clarify the roles and responsibilities of psychologists within assisted dying services. Such changes would align regulatory and professional domains, fostering an environment in which the psychological dimensions of VAD are recognized and prioritized alongside physical and medical elements.
As voluntary assisted dying becomes increasingly normalized across Australian jurisdictions, the insights from ECU’s study serve as a call to action. The integration of psychologists into VAD care pathways can improve outcomes for patients and families by addressing the emotional and cognitive challenges of dying. Moreover, embedding psychologists within multidisciplinary teams supporting VAD ensures that care delivery remains compassionate, evidence-based, and ethically sound, advancing the quality and humanity of end-of-life services.
In sum, the research conducted at Edith Cowan University provides compelling evidence that psychologists represent an underused resource in Australia’s voluntary assisted dying framework. Addressing systemic and educational barriers to their engagement is imperative. Doing so promises to enhance the psychological support available during one of life’s most profound transitions, helping to navigate the complex interplay of life, death, and choice with greater empathy and professionalism.
Subject of Research: People
Article Title: The Perspectives of Provisionally Registered Psychologists on Voluntary Assisted Dying in Australia: An In-Depth Qualitative Investigation
News Publication Date: 21 August 2025
Web References:
https://journals.sagepub.com/doi/full/10.1177/00302228251350511?rfr_dat=cr_pub++0pubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org
References:
Heng, V., & Gringart, E. (2025). The Perspectives of Provisionally Registered Psychologists on Voluntary Assisted Dying in Australia: An In-Depth Qualitative Investigation. OMEGA – Journal of Death and Dying. https://doi.org/10.1177/00302228251350511
Keywords: Psychological science, Grief, Voluntary Assisted Dying, Provisionally Registered Psychologists, End-of-life care, Mental health, Ethics, Palliative care, Capacity assessment
