The Victorian VAD legislation authorises medical professionals to facilitate the early death of terminally ill patients – something that previously had been illegal and, for many, inconceivable. Irrespective of the circumstances, decisions to curtail a life evoke powerful responses, often rooted in deeply entrenched moral assumptions that may be linked to religious and cultural convictions. Prior to the implementation of the Victorian Act many doctors had expressed apprehension about its possible impact on the medical profession and the practice of medicine. Two years later, although many of the initial fears have subsided and the law is widely accepted, tensions and uncertainties persist about its operation. Drawing on qualitative data from interviews conducted in the first years of the operation of the legislation this paper explores these ongoing challenges, as well as the impact it has had on clinician identity and the ethical debates it continues to stimulate.