Coroner Simon McGregor on Tuesday found Mr McConachy would not have been eligible to access Voluntary Assisted Dying (VAD) despite his "greatly reduced quality of life" due to a lack of terminal prognosis.

He said there had been eight deaths by suicide since the laws came into effect in 2017, where the investigating coroner found their decline in health was irreversible but their efforts to access to VAD were rebuffed "because they did not meet the strict criterion".

A ninth death after an attempt to access VAD could not be confirmed as suicide but it was a possibility.

"A recurring theme throughout many of these deaths was the impact that voluntary assisted dying refusal had on the deceased," Mr McGregor said in his findings.

He said family members reported when people were refused access to assisted dying their "consequent despair and frustration contributed to their decision to take their own life".

"Victoria's coroners are among the very few people in a position to identify and investigate when the voluntary assisted dying process does not meet the needs of Victorian community members," the coroner said.

"I believe I therefore have a duty and responsibility to notify such instances to the bodies responsible for administering Victoria's voluntary assisted dying process."

He asked the Voluntary Assisted Dying Review Board to consider developing a body of evidence "about where there may be opportunities to improve the operation of voluntary assisted dying in the state".

His finding on Mr McConachy's death will be referred to the board.

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