Voluntary Assisted Dying

What is the eligibility criteria?

A person will be eligible to access VAD if he or she:

• is aged 18 or over;
• is an Australian citizen or permanent resident, ordinarily resident in Victoria, and, at the time of making a first request for VAD, has been resident in Victoria for at least 12 months;
• has decision-making capacity, meaning the person can:
  • understand information relevant to the decision to access VAD, and the effect of the decision,
  • retain that information to the extent necessary to make the decision,
  • use or weigh the information as part of the decision-making process, and
  • communicate the decision and the person’s views and needs about the decision in some way; and
• is diagnosed with a disease, illness or medical condition that is:
  • incurable;
  • advanced, progressive and will cause death;
  • expected to cause death within six months (or, in the case of a person with a neurodegenerative disease, illness or condition, within 12 months); and
  • causing suffering to the person that cannot be relieved in a manner that the person finds tolerable.

A person will not be eligible for VAD on the basis of having a disability or a mental illness alone. A person with disability or mental illness may be eligible if they also have a disease, illness or medical condition that is expected to cause their death within the timeframe, and meet all of the other eligibility criteria.

A person is presumed to have capacity to make a VAD decision unless it can be shown otherwise.

Right of review

A person who is considered ineligible for VAD because he or she:

• is not ordinarily resident in Victoria;
• was not a resident for at least 12 months prior to making the VAD request; or
• does not have decision-making capacity to make a request

may apply to the Victorian Civil and Administrative Tribunal for a review of the decision.

How is a person's eligibility for VAD assessed?

A person’s eligibility to access VAD must be independently assessed by at least two medical practitioners - a coordinating medical practitioner and a consulting medical practitioner - who have completed mandatory training, and meet other eligibility requirements.

During the first assessment the coordinating medical practitioner will determine if the person meets the eligibility criteria, and also whether:

• the person understands what VAD involves;
• the person has made the decision to access VAD voluntarily; and
• the request for VAD is enduring.

If the person is eligible, the consulting medical practitioner must carry out a further, independent assessment. If that practitioner confirms the person is eligible and the person wishes to continue, other legislative requirements must then be followed, including the person:

• making a written declaration requesting access to VAD;
• making a final request for VAD, in person, to the coordinating medical practitioner; and
• appointing a contact person (who must return any unused or remaining VAD medication to a pharmacist at the dispensing pharmacy).

On receiving the person’s final request for VAD, the coordinating medical practitioner will conduct a final review, which involves reviewing and completing forms, and certifying that the request and assessment process (and legislative requirements) have been completed.

There are timeframes that apply to each of the steps in the process. A diagram of the VAD process can be viewed in Victoria Health's Voluntary Assisted Dying - Quick reference guide for health practitioners.

How and when is VAD administered? 

There are two types of administration: Self-administration, and practitioner administration.

Self-administration

Once the coordinating medical practitioner certifies in a final review form that the request and assessment process is complete, he or she may apply for a VAD permit for the person (a ‘self-administration permit’). The permit authorises:

• the coordinating medical practitioner to prescribe and supply the VAD medication to the person for self-administration;
• the person to obtain, possess, store, use and self-administer the medication; and
• the contact person to possess, store, carry, transport and return the unused or remaining VAD medication to the dispensing pharmacy following the person’s death.

After a permit has been issued to the coordinating medical practitioner the person may access VAD.

In most cases the VAD medication will be self-administered by the person at a time and place of their choosing. Other people (e.g. family and friends) may be present if the person wishes. There is no requirement for a medical or other health practitioner, or a witness, to be present however a person may choose to have a health practitioner present. The person may change their mind at any time and choose not to take the medication.

Practitioner administration

If the person is physically incapable of self-administering or digesting the medication (e.g. those with physical disabilities that limit their ability to self-administer) the coordinating medical practitioner may apply for a practitioner administration permit authorising them to administer the medication to the person.

During practitioner administration, the VAD medication will be administered by the practitioner either intravenously, orally or through other appropriate means e.g. a PEG. It must take place in the presence of a witness, who must certify that the person appeared to have decision-making capacity at the time of making the administration request; the person appeared to be acting voluntarily, without coercion; and the person’s request appeared to be enduring. The witness must also confirm the coordinating medical practitioner administered the VAD medication to the person.

Anyone the person chooses may also be present during practitioner administration.

Do health practitioners have to participate in VAD?

Health practitioners with a conscientious objection to VAD have the right to choose not to participate in VAD. They are under no obligation to:

• provide information about VAD to a person; or
• participate in any part of the VAD process, including assessing the eligibility of a person; or supplying, prescribing, administering, or being present prior to, during or following administration of a VAD medication.

Is it lawful for a health practitioner to discuss VAD with a person?

A registered health practitioner is prohibited from initiating a discussion about VAD or suggesting VAD to a person, but can provide information about VAD at a person’s request.

What are the safeguards around VAD?

The Act contains a range of safeguards including:

• Health practitioners are prohibited from initiating a discussion about VAD. This is designed to ensure that the person’s request for VAD is voluntarily made.
• A family member or carer cannot request VAD on somebody’s behalf.
• A person must make at least three separate requests for VAD.
• The person must be provided with information about their diagnosis and prognosis, available treatment and palliative care options, and risks associated with taking the lethal medication (i.e. death). The person must also be advised that they may decide at any time not to continue the VAD process.
• VAD medication cannot be administered without a permit authorising self-administration or practitioner administration.
• Regulations governing the prescription, dispensing and disposal of VAD medications. The VAD medication must be stored in a locked box after it has been dispensed. A contact person appointed by the person accessing VAD must return any of the medication unused or remaining after the person’s death.
• Mandatory reporting requirements for health practitioners and employers where they believe another practitioner’s conduct breaches the Act.
• Offences (punishable by up to 5 years imprisonment) for anyone who induces another person to request VAD or take the VAD medication.

To provide VAD medical practitioners must have the necessary expertise and experience as set out in the legislation, and successfully complete the accredited training.

The Voluntary Assisted Dying Review Board is responsible for monitoring, reporting, compliance, safety and research functions.

What is the eligibility criteria?

A person will be eligible to access VAD if the person:

• is aged 18 or over;
• is an Australian citizen or permanent resident, and at the time of making a first request for VAD was ordinarily resident in Western Australia for at least 12 months;
• is diagnosed with at least one disease, illness or medical condition that:
  • is advanced, progressive and will cause death;
  • will, on the balance of probabilities, cause death within 6 months (or, in the case of a neurodegenerative disease, illness or condition, within 12 months); and
  • is causing suffering to the person that cannot be relieved in a manner that the person considers tolerable;
• has decision-making capacity for VAD, meaning they can:
  • understand any information or advice that must be provided to the person about a 'VAD decision' (meaning a request for access to VAD, or a decision to access VAD),
  • understand the matters involved in a VAD decision,
  • understand the effect of a VAD decision,
  • weigh up those factors in order to make the VAD decision, and
  • communicate the VAD decision in some way;
• is acting voluntarily and without coercion; and
• has an enduring request for VAD.

A person will not be eligible for VAD on the basis of having a disability or a mental illness alone. A person with disability or mental illness may be eligible if they also have a disease, illness or medical condition that is expected to cause their death within the timeframe, and meet all of the other eligibility criteria.

A person will be presumed to have capacity to make a VAD decision unless it can be shown otherwise.

Right of review

Where either of the medical practitioners assessing the person’s eligibility for VAD decide that the person:

• has, or has not been ordinarily resident in Western Australia for at least 12 months at the time of making the VAD request, or
• has or does not have decision-making capacity for VAD, or
• is or is not acting voluntarily and without coercion,

the State Administrative Tribunal will be able to review the decision.

How is a person's eligibility for VAD assessed?

A person’s eligibility to access VAD must be independently assessed by at least two medical practitioners - a coordinating  practitioner and a consulting practitioner - who have completed mandatory training and meet other eligibility requirements.

The first assessment must be performed by the coordinating  practitioner, who must decide whether the person meets each of the eligibility criteria. That practitioner must also be satisfied that the person understands information about the person’s diagnosis and prognosis, treatment options, palliative care and treatment options, risks of having the VAD medication, and the VAD process.

If the person is eligible, a consulting practitioner must carry out a further independent assessment. If that practitioner confirms the person is eligible and the person wishes to continue with VAD, other legislative requirements must then be followed, including making a written declaration, and a final request to the coordinating practitioner.

There are timeframes that apply to each of the steps in the process. The Western Australian Department of Health has a produced a summary of the VAD process in Western Australia.

How and when can VAD be administered? 

A person can access VAD once the request and assessment process is complete, and the coordinating practitioner completes a final review form certifying that the person has decision-making capacity and an enduring request for VAD, and is acting voluntarily and without coercion.

The person, in consultation with and on the advice of the coordinating practitioner, may decide whether to self-administer the VAD medication, or whether it is to be given by an administrating practitioner. A person can only elect practitioner administration if the coordinating practitioner advises that self-administration would be inappropriate due to the person’s ability to self-administer; the person’s concerns about self-administering; or the method for administering the medication that is suitable to the person.

The administering practitioner may be either the coordinating practitioner, or another medical practitioner or nurse practitioner who is eligible for this role.

Self-administration

The VAD medication is able to be self-administered by the person at a time and place of their choosing. Other people (e.g. family and friends) may be present if the person wishes. The person may change their mind at any time and choose not to take the medication.

A health practitioner or a witness is not be required to be present for self-administration but the person may choose to have a health practitioner present. The person must however appoint a contact person, who is required to return any unused or remaining VAD medication to an authorised disposer either after the person’s death, or if the person changes their mind about accessing VAD.

Practitioner administration

If the VAD medication is given by an administering practitioner, they must be satisfied at the time of administration that the person has decision-making capacity for VAD, is acting voluntarily and without coercion, and that the request is enduring.

Practitioner administration is required to take place in the presence of a witness, who must certify that the person’s request for access appeared to be free, voluntary and enduring; and that the medication was administered in their presence.

Do health practitioners have to participate in VAD?

Health practitioners with a conscientious objection to VAD have the right to choose not to participate in VAD. There is no obligation to:

• participate in the request and assessment process,
• prescribe, supply or administer VAD medication, or
• be present at the time VAD medication is administered.

If a person makes a first request for VAD to a medical practitioner with a conscientious objection, the practitioner must immediately inform the person that they refuse the request. All medical practitioners (even if they object to VAD, or are not eligible to provide VAD) have to provide approved information to a person who makes a first request for VAD.

Is it lawful for a health practitioner to discuss VAD with a person?

A medical practitioner or nurse practitioner is able to initiate a discussion or suggest VAD to a person so long as they also inform the person, at the same time, about available treatment and palliative care options, and their likely outcomes.

Health care workers (a registered health practitioner, or another person who provides health or professional care services) are prohibited from initiating a discussion or suggesting VAD but can provide information about VAD on a person’s request.

What are the safeguards around VAD?

The Act contains a range of safeguards including:

• Health care workers are prohibited from initiating a discussion about or suggesting VAD, unless they are a medical practitioner or nurse practitioner and provide information about treatment options and outcomes to the person at the same time.
• A family member or carer cannot request VAD on somebody’s behalf.
• The person requesting VAD must be given information about their diagnosis and prognosis, available treatment and palliative care options, and risks associated with taking the VAD medication (i.e. death).
• The person must make at least three separate requests for VAD (a first request, a written declaration, and a final request).
• The person’s decision to access VAD must be voluntary and made without coercion. This requirement will be confirmed at each stage of the request process, and prior to practitioner administration of VAD medication. If the medical practitioners who assess the person’s eligibility for VAD are unable to determine if the person is acting voluntarily and without coercion, they must refer the person to someone who has appropriate skills and training to decide. Health practitioners must also receive training about identifying and assessing risk factors for abuse or coercion as part of the mandatory training for VAD.
• The person can change their mind about VAD, and discontinue a request for VAD at any time.
• Regulations governing the prescription, dispensing and disposal of VAD medications.
• Protection from criminal liability for persons who, in good faith, assist a person to access VAD, or are present when VAD medication is administered.
• Protection from criminal and civil liability for health practitioners who act in accordance with the Act.
• Offences (punishable by up to 7 years imprisonment) for anyone who induces another person to request or access VAD.

The Voluntary Assisted Dying Review Board is responsible for monitoring, reporting, and research.

What are the eligibility criteria?

A person is eligible to access VAD if they:

• are aged 18 or over;
• are an Australian citizen, permanent resident of Australia, or have been resident in Australia for at least 3 continuous years prior to making a first request, and have been ordinarily resident in Tasmania for 12 months before making the first request;
• have decision-making capacity, meaning the person can:
  • understand information or advice that is reasonably required to be able to make the decision,
  • remember that information or advice to the extent necessary to make the decision,
  • use or evaluate the information or advice to make the decision, and
  • communicate the decision and the person’s opinions about the decision in some way; and
• are acting voluntarily; and
• are suffering intolerably in relation to a disease, illness, injury, or medical condition that:
  • is advanced, incurable and irreversible;
  • is expected to cause their death; and
  • will, unless an exemption is granted, cause death within 6 months (or in the case of a person with a neurodegenerative disease, illness or condition, within 12 months).

A person is presumed to have capacity to make a VAD decision unless it can be shown otherwise.

A person is not eligible for VAD on the basis of having a disability or a mental illness alone. A person with disability or mental illness may be eligible if they also have a disease, illness or medical condition that is expected to cause their death within the timeframe, and meet all of the other eligibility criteria.

A person may apply to the Commission for an exemption from the requirement that death occur within 6 months (or 12 months in the case of a person with a neurodegenerative disease, illness or condition). The Commission may grant an exemption if it is satisfied that the person's prognosis is such that this requirement should not apply. In reaching a decision, the Commission must examine the person's medical records, and seek advice from a medical practitioner with specialist knowledge about the person's medical condition.

Right of review

The following decisions made by medical practitioners during the VAD process can be reviewed by the Voluntary Assisted Dying Commission:

• whether the person is, or is not, an Australian citizen or permanent resident; has not been resident in Australia for 3 years; or has not been ordinarily resident in Tasmania for 12 months;
• whether the person does, or does not, have decision-making capacity; and
• whether the person is, or is not, acting voluntarily.

How is a person's eligibility for VAD assessed?

Two medical practitioners - a primary medical practitioner and a consulting medical practitioner - assess whether a person is eligible for VAD. Both medical practitioners must have completed mandatory training and meet other eligibility requirements.

Before a person can request VAD, they must be given approved information, including where the person can obtain information and advice about palliative care. If this information has been provided to a person they can make a first request, orally or in writing, to a medical practitioner. This starts the request and assessment process.

After receiving the person's first request, the primary medical practitioner must determine whether the person meets the eligibility criteria. If the person is eligible and wishes to continue with the process, they must make a second request, in writing, to the primary medical practitioner, who must determine for a second time whether the person is eligible for VAD.

If, after the second assessment, the person is determined to be eligible, a consulting medical practitioner will carry out a further independent assessment. If the consulting medical practitioner determines the person is eligible, other legislative requirements must be followed, including the person making a final request in writing to the primary medical practitioner.

After receiving a final request, the primary medical practitioner must again determine whether the person is eligible for VAD. Once this determination is made, the person must provide final permission, confirming that they want to access VAD.

There are timeframes that apply to each of the steps in the process. A flow chart of Tasmania’s VAD process is available from Tasmania Health.

How and when can VAD be administered?

A person can access VAD once:

• the request and assessment process (discussed above) is completed;
• an administering health practitioner has been appointed (this may be either the primary medical practitioner, another medical practitioner, or a registered nurse who meets the eligibility criteria);
• a VAD substance authorisation has been obtained from the Commission; and
• the VAD substance has been prescribed.

For a person to be supplied a VAD substance, the administering health practitioner must check again that the person has decision-making capacity and is acting voluntarily. This must occur within 48 hours of the person giving final permission. The person can then give final permission for VAD in an approved form, which includes information about how the substance will be administered.

There are two types of administration: private-self administration, and administration that is not private self-administration.

Private self-administration

For this method of administration, the administering health practitioner must be satisfied that the person can self-administer (i.e. give themselves) the VAD substance. The administering health practitioner must complete and sign a private self-administration certificate. The person must then appoint an adult to be the contact person, who will be responsible for returning any unused or remaining VAD substance to the administering health practitioner, and notifying them of the person’s death.

The person may self-administer the VAD substance at a time and place of their choosing. Other people (e.g. family and friends) may be present if the person wishes. There is no requirement for a medical or other health practitioner, or a witness, to be present. The person may change their mind at any time and choose not to take the medication.

Where there is no private self-administration

If private self-administration is not appropriate due to the person's ability to self-administer, their concerns about doing this, or the method of administration, an administering health practitioner administration certificate can be issued.

This certificate enables the administering health practitioner to:

• supply the VAD substance for self-administration by the person, while remaining in the same room or in close proximity to the person so the practitioner can assist the person if needed;
• supply to and assist the person to self-administer the VAD substance (and remain in the same room or in close proximity to the person); or
• administer the VAD substance to the person (and remain in the same room or in close proximity to the person).

Other people (e.g. family and friends) may be present when the person has the VAD substance.

Do health practitioners have to participate in VAD?

Health practitioners with a conscientious objection to VAD have the right not to participate in VAD. There is no obligation for health practitioners to take on the role of primary medical practitioner, consulting medical practitioner, administering health practitioner, or (for pharmacists) to supply a VAD substance.

However, if a person makes a first request to access VAD, the medical practitioner must provide the person with the contact details of the VAD Commission, even if they have a conscientious objection.

A medical practitioner has up to 2 days to decide whether to accept or refuse a person's first request. If they refuse, they must, as soon as is reasonably practicable (and within 7 days) advise the person of this; note the person's request (and the refusal to accept it) on the person's medical records; and notify the VAD Commission that they have refused the request.

Is it lawful for a health practitioner to discuss VAD with a person?

It is lawful for a medical practitioner to initiate a conversation about VAD if, at the same time, the medical practitioner also informs the person about the treatment and palliative care options available to the person, and the likely outcomes of those.

Other registered health practitioners (including nurse practitioners and registered nurses) can initiate conversations about VAD, but only if they inform the person during the conversation that a medical practitioner would be the most appropriate person with whom to discuss VAD and the person’s care and treatment options.

If a person requests information about VAD, nothing prevents another person (e.g. a health care worker) from providing information about the VAD process.

What are the safeguards around VAD?

The Act contains a range of safeguards including:

• there are limits on when medical practitioners and other registered health practitioners can initiate a discussion about VAD.
• a family member or carer cannot request VAD on person's behalf.
• the person requesting VAD must be provided with information about their diagnosis and prognosis, available treatment and palliative care options.
• the person must make at least three separate requests for VAD (a first request, a second request, and a final request). The person also needs to give final permission before a VAD substance can be administered.
• the person’s decision to access VAD must be voluntary and made without coercion. This requirement will be confirmed at each stage of the request process, and again prior to the person giving final permission.
• a VAD substance authorisation must be issued by the Commission before any person is able to access VAD.
• the person can change their mind about VAD at any time.
• medical practitioners, nurse practitioners and registered nurses participating in VAD must complete mandatory training and meet certain eligibility criteria.
• offences (punishable by fines or imprisonment of up to 5 years) for anyone who induces a person to access VAD.
• protections from liability for persons assisting a person, in good faith, to access VAD.

The Voluntary Assisted Dying Commission is responsible for monitoring, reporting, research, reviews of eligible decisions, and issuing the VAD substance authorisation.

What are the eligibility criteria?

A person is eligible for VAD if they:

• are aged 18 or over;
• are an Australian citizen or permanent resident of Australia, and have been ordinarily resident in South Australia for 12 months before making a first request;
• have decision-making capacity in relation to VAD, meaning the person can:
  • understand the information relevant to the decision to access VAD and the effect of the decision,
  • retain that information to the extent necessary to make the decision,
  • use or weigh that information as part of the process of making the decision, and
  • communicate the decision and the person's views and needs about the decision in some way; and
• have a disease, illness, or medical condition that is:
  • incurable, advanced, progressive, and will cause death;
  • expected to cause their death within 6 months (or in the case of a person with a neurodegenerative disease, illness or condition, within 12 months);
• are suffering intolerably because of the disease, illness, or medical condition; and
• are acting freely and without coercion.

A person is presumed to have capacity to make a VAD decision unless it can be shown otherwise.

A person is not be eligible for VAD on the basis of having a disability or a mental illness alone. A person with disability or mental illness may be eligible if they also have a disease, illness or medical condition that is expected to cause their death within the timeframe, and meet all of the other eligibility criteria.

Right of review

A person may apply to the South Australian Civil and Administrative Tribunal for a review of a decision by their coordinating medical practitioner or consulting medical practitioner that they:

• are, or are not, ordinarily resident in South Australia;
• were or were not ordinarily resident in South Australia for 12 months at the time of making the first request; or
• do, or do not, have decision-making capacity in relation to VAD.

How will a person's eligibility for VAD be assessed?

Two medical practitioners - a coordinating medical practitioner and a consulting medical practitioner - must assess whether a person is eligible for VAD. Both medical practitioners must have completed mandatory training and meet other eligibility requirements.

After receiving the person's first request for VAD, the coordinating medical practitioner must determine whether the person meets the eligibility criteria. This involves assessing whether the person meets the eligibility criteria, understands certain information, is acting voluntarily and without coercion, and is making an enduring request.

If the coordinating medical practitioner determines that the person is eligible for VAD, a consulting medical practitioner must carry out a further independent eligibility assessment. If the consulting medical practitioner determines the person is eligible, other legislative requirements must be followed, including that the person must make a final request for VAD.

The coordinating medical practitioner must certify in a final review form that the request and assessment process is complete. The person must then appoint a contact person (e.g. a family member or friend).

There are timeframes that apply to each of the steps in the process.

How and when will VAD be administered?

There are two types of administration: Self-administration, and practitioner administration.

Self-administration

The coordinating practitioner must apply for a VAD permit for the person (a ‘self-administration permit’). This permit authorises:

• the coordinating medical practitioner to prescribe and supply the VAD substance to the person for self-administration;
• the person to obtain, possess, store, use and self-administer the VAD substance; and
• the contact person to possess, store, carry, transport and return unused or remaining VAD substance to the dispensing pharmacy.

After a permit has been issued, the person may self-administer the VAD substance, at a time or place or their choosing. There is no requirement for a medical or other health practitioner, or a witness, to be present for self-administration, but the person may choose to have a health practitioner present. Other people (e.g. family and friends) may be present if the person wishes.

Practitioner administration

If a person is physically incapable of self-administering or digesting the medication (e.g. those with physical disabilities that limit their ability to self-administer or swallow a substance) the coordinating medical practitioner may apply for a practitioner administration permit. This authorises that practitioner to administer the VAD substance to the person.

A witness must be present when the VAD substance is administered by a practitioner. The witness must certify that the person appeared to have decision-making capacity, was acting voluntarily and without coercion, and that their request appeared to be enduring. Other people may also be present if the person wishes.

Will health practitioners have to participate in VAD?

Health practitioners with a conscientious objection to VAD have the right not to participate in VAD. They can choose not to:

• provide information about VAD;
• participate in the request and assessment process;
• supply, prescribe or administer a VAD substance;
• be present at the time of administering a VAD substance; and
• dispense a prescription for a VAD substance.

Do health services and residential facilities have to provide VAD, or help a person access it?

Health services and residential facilities have the right to refuse to participate in VAD, but still have some obligations.

Generally, health services (e.g. private hospitals and private institutions) who refuse to participate in VAD must ensure that patients are advised of the service’s refusal to permit VAD; have arrangements in place to transfer the person to other facilities so they can access VAD; and take reasonable steps to facilitate such a transfer.

Residential facilities (e.g. nursing homes, aged care homes and retirement villages) also have specific obligations. Generally, residential facilities must allow all residents, whether temporary or permanent, to:

• access information about VAD (including facilitating access in situations where a person requests information, but the facility does not provide it), and
• make requests for VAD.

This includes providing access to a health practitioner or other person to provide this information or receive requests. For VAD requests, if the health practitioner is unavailable to attend, the facility must arrange the transfer of the resident instead.

Where a permanent resident (i.e. a person who lives at the facility on an ongoing basis) wishes to access VAD, facilities must:

• allow a medical practitioner to access the resident at the facility to conduct an eligibility assessment, or
• if the medical practitioner is unavailable to attend the facility, take reasonable steps to facilitate the resident's transfer elsewhere for an assessment.

If the person is not a permanent resident, the facility must facilitate the transfer of the person to a place where the first assessment can be carried out. However, if the transfer would not be reasonable (e.g. because it might cause the person serious harm, undue delay or prolonged suffering) the facility must allow a medical practitioner reasonable access to the person at the facility.

Will it be lawful for a health practitioner to discuss VAD with a person?

It is unlawful for a registered health practitioner to initiate a discussion about VAD with a person, or suggest VAD to them. However, they may provide information about VAD if a person requests it.

What will be the safeguards around VAD?

The Act contains a range of safeguards including:

• Registered health practitioners are prohibited from initiating a discussion about VAD. This is designed to ensure that a person’s request for VAD is voluntarily made.
• A family member or carer cannot request VAD on somebody’s behalf.
• The person will need to make at least three separate requests for VAD (a first request, a written declaration, and a final request).
• The person’s decision to access VAD must be made voluntarily, freely and without coercion. This requirement is  confirmed at each stage of the request process, and again prior to the person making an administration request.
• During the first assessment and consulting assessment, the person must be provided with information, including information about their diagnosis and prognosis, available treatment and palliative care options.
• The person can change their mind about VAD at any time.
• A permit must be issued by the Chief Executive before any person can access VAD.
• Medical practitioners participating in providing VAD must undergo mandatory approved training and meet certain eligibility criteria.
• Offences (punishable by fines or imprisonment of up to 5 years) for anyone who induces a person to access VAD.
• Protections from liability for persons assisting another person, in good faith, to access VAD.

The VAD Review Board is responsible for monitoring, reporting, research, and reviews of eligible decisions.

What are the eligibility criteria?

A person is eligible for VAD if they:

• are aged 18 or over;
• have a disease, illness, or medical condition that is:
  • advanced, progressive, and will cause death;
  • expected to cause their death within 12 months;
• are suffering intolerably because of the disease, illness, or medical condition;
• have decision-making capacity in relation to VAD, meaning the person is capable of
  • understanding the nature and effect of decisions about access to VAD,
  • freely and voluntarily making decisions about access to VAD, and
  • communicating decisions about VAD in some way;
• are acting voluntarily and without coercion;
• are an Australian citizen, permanent resident of Australia, have been ordinarily resident in Australia for at least 3 years prior to making the first request, or they are granted an Australian residency exemption; and
• have been ordinarily resident in Queensland for 12 months before making a first request, or they are granted a Queensland residency exemption.

An Australian or Queensland residency exemption may be granted if the person has a substantial connection to Queensland and there are compassionate grounds for granting it.

A person is presumed to have capacity to make a VAD decision unless it can be shown otherwise.

A person is not eligible for VAD on the basis of having a disability or a mental illness alone. A person with disability or mental illness may be eligible if they also have a disease, illness or medical condition that is expected to cause their death within the timeframe, and meet all of the other eligibility criteria.

Right of review

An eligible person (the person the subject of the decision, their agent, or another person with a sufficient and genuine interest in the rights and interests of the person) may apply to the Queensland Civil and Administrative Tribunal for a review of a decision by the person's coordinating practitioner or consulting practitioner that the person:

• has, or has not been ordinarily resident in:
  • Australia for 3 years prior to the first request; or
  • Queensland for 12 months at the time of making the first request;
• has, or does not have decision-making capacity in relation to VAD; or
• is, or is not acting voluntarily and without coercion.

How is a person's eligibility for VAD assessed?

Two medical practitioners - a coordinating practitioner and a consulting practitioner - assess whether a person is eligible for VAD. Both medical practitioners must have completed mandatory training and meet other eligibility requirements.

After receiving the person's first request for VAD, the coordinating practitioner determines whether the person is eligible for VAD. This involves assessing whether the person meets the eligibility criteria and understands certain information.

If the coordinating practitioner determines that the person is eligible for VAD, a consulting practitioner may then carry out a further independent eligibility assessment. If the consulting practitioner determines the person is eligible, other legislative requirements must be followed, including that the person must make a second request and then a final request for VAD.

There are timeframes that apply to each of the steps in the process.

How and when can VAD be administered?

A person can access VAD once the request and assessment process is completed, and the coordinating practitioner completes a final review form.

There are two types of administration: self-administration and practitioner administration. The person, in consultation with and on the advice of the coordinating practitioner, may decide whether to self-administer the VAD substance or whether it is to be given by an administering practitioner. A person can only choose practitioner administration if self-administration is inappropriate because of: the ability of the person to self-administer the VAD substance; their concerns about self-administering the VAD substance; and/or the method that is suitable for the person.

The administering practitioner may be either the coordinating practitioner, or another medical practitioner, nurse practitioner, or registered nurse to whom the role has been transferred. They must meet the eligibility requirements and have completed the mandatory training.

Self-administration

The VAD substance can be administered by the person at a time and place of their choosing. Other people (e.g. family and friends) may be present if the person wishes. The person may change their mind at any time and choose not to take the medication.

There is no requirement for a health practitioner or witness to be present for self-administration. However, the person must appoint a contact person who has responsibilities including notifying the coordinating practitioner when the person dies. The contact person may also be contacted by the Voluntary Assisted Dying Review Board for information.

Practitioner administration

If self-administration is inappropriate, the person may make a practitioner administration decision. This enables the administering practitioner to administer the VAD substance to the person if the person has decision-making capacity and is acting voluntarily and without coercion.

An eligible witness must be present when the VAD substance is administered by a practitioner. The witness must certify that the person appeared to be acting voluntarily and without coercion. Other people may also be present if the person wishes.

The person must appoint a contact person who must inform the coordinating practitioner if the person dies as a result of a cause other than the administration of the VAD substance. The contact person may also be contacted by the Voluntary Assisted Dying Review Board for information.

Do health practitioners have to participate in VAD?

Registered health practitioners with a conscientious objection to VAD have the right not to participate in VAD. They can refuse to:

• provide information about VAD;
• participate in the request and assessment process;
• participate in an administration decision;
• supply, prescribe or administer a VAD substance; or
• be present at the time of administering a VAD substance.

If a person makes a first request for VAD to a medical practitioner with a conscientious objection, the practitioner must immediately inform the person that they refuse the request. All medical practitioners (even if they object to VAD, or are not eligible to provide VAD) have to provide the following to a person who makes a first request:

• information about other health practitioners, providers, or services that may be able to assist; or
• the details of the QVAD Support Service, which is able to give the person with information (including name and contact details) about a health practitioner, health service provider, or service who may be able to assist the person.

Speech pathologists who have a conscientious objection to VAD also have specific obligations, including that they must inform their employer and others of their conscientious objection, and must not impede the person’s access to speech pathology services in relation to VAD.

Do health services and residential facilities have to provide VAD, or help a person access it?

Facilities providing health services, residential aged care services or personal care services have the right to refuse to participate in VAD, but still have some obligations. These obligations depend on the stage of the VAD process, and also whether the person is a permanent resident or a non-permanent resident at the facility.

Generally facilities must do the following:

Permanent residents

• Allow a medical practitioner or other relevant person to access the facility so that the person can:
  • make a request for VAD,
  • have a VAD eligibility assessment, or
  • have VAD administered

  or facilitate a transfer of the person to a place where this step in the process can occur.

Non-permanent residents

• Allow a medical practitioner and other relevant persons to access the facility so that the person can make a request for VAD, or facilitate a transfer of the person to a place where this step in the process can occur.
• Facilitate the transfer of the person to a place where the person can have:
  • a VAD eligibility assessment, or
  • VAD administered or self-administer VAD,

  or, if this would not be reasonable, allow reasonable access to the facility by the medical practitioner and other relevant persons (for eligibility assessment or practitioner administration), or not hinder access by the person to a VAD substance (self-administration).

Is it lawful for a health practitioner to discuss VAD with a person?

Medical practitioners and nurse practitioners may initiate a discussion with a person about VAD if, at the same time, they inform the person about the treatment options and palliative care options available, and the likely outcomes of treatment.

Health care workers (a registered health practitioner, or another person who provides health or professional care services) are prohibited from initiating a discussion or suggesting VAD, but can provide information about VAD on a person’s request.

What are the safeguards around VAD?

The Act contains a range of safeguards including:

• Health care workers are prohibited from initiating a discussion about VAD, except for medical practitioners and nurse practitioners (if certain information is provided at the same time). This is designed to ensure that a person’s request for VAD is voluntarily made.
• A family member or carer cannot request VAD on somebody’s behalf.
• The person needs to make at least three separate requests for VAD (a first request, a second request, and a final request).
• The person’s decision to access VAD must be made voluntarily and without coercion. This requirement will be confirmed at each stage of the request process, and again prior to the person making an administration decision.
• There is a waiting period of 9 days from the first request before a person can make a final request. This ensures the person’s request is enduring.
• During the first assessment and consulting assessment, the person must be given information, including information about their diagnosis and prognosis, available treatment and palliative care options.
• The person can change their mind about VAD at any time.
• Medical practitioners, nurse practitioners, and registered nurses providing VAD must undergo mandatory approved training and meet certain eligibility criteria.
• Offences (punishable by fines or imprisonment of up to 7 years) for anyone who induces a person to access VAD.
• Protections from liability for persons assisting another person, in good faith, to access VAD.

The VAD Review Board is responsible for monitoring, reporting, research, and review of eligible decisions.

What are the eligibility criteria?

A person is eligible for VAD if they:

• are aged 18 or over;
• have at least one disease, illness or medical condition that:
  • is advanced, progressive and will cause death;
  • will, on the balance of probabilities, cause death within 6 months (or within 12 months if the person has a neurodegenerative disease, illness or medical condition);
  • is causing suffering that cannot be relieved in a way the person considers tolerable;
• have decision-making capacity in relation to VAD, meaning the person can:
  • understand information or advice about VAD that the Act requires be given to the person,
  • remember that information or advice to the extent necessary to make the decision,
  • understand the matters involved in a VAD decision, and the effect of a VAD decision,
  • weigh up the factors referred to above to make a VAD decision, and
  • communicate a VAD decision in some way;
• are acting voluntarily;
• are not acting because of pressure or duress (this may include abuse, coercion, intimidation, threats and undue influence);
• have an enduring (i.e. ongoing) request for access to VAD; and
• at the time of making a first request:
  • are an Australian citizen or permanent resident, or have been resident in Australia for at least 3 continuous years; and
  • have been ordinarily resident in New South Wales for at least 12 months. A residency exemption may be granted if the person has a substantial connection to New South Wales and there are compassionate grounds for granting it.

A person is presumed to have:

• capacity to understand information or advice about VAD if it reasonably appears they can understand an explanation of the consequences of making the decision, and
• decision-making capacity in relation to VAD unless the patient is shown not to have the capacity.

A person is no longer eligible for VAD if they permanently lose capacity for VAD at any time during the request and assessment process.

A person is not eligible for VAD on the basis of having a disability, dementia or a mental health impairment alone. A person with disability, dementia or a mental health impairment may be eligible if they also have a disease, illness or medical condition that is expected to cause their death within the timeframe, and meet all of the other eligibility criteria.

Right of review

The Supreme Court can review decisions by medical practitioners concerning whether a person:

• has been ordinarily resident in New South Wales for at least 12 months at the time of making the first request;
• has decision-making capacity in relation to VAD;
• is acting voluntarily; or
• is acting because of pressure or duress.

A review is also possible if the Voluntary Assisted Dying Board refuses an application for a VAD substance authority for the person.

Either the person seeking VAD, their agent, or another person with a sufficient and genuine interest in the rights and interests of the person (e.g. a family member or a health practitioner) can apply for a review.

How is a person's eligibility for VAD be assessed?

Two medical practitioners - a coordinating practitioner and a consulting practitioner - must assess whether a person is eligible for VAD. Both medical practitioners must have completed mandatory training and meet other eligibility requirements.

After receiving the person's first request for VAD, the coordinating practitioner will determine whether the person is eligible for VAD. This involves assessing whether the person meets the eligibility criteria.

If the coordinating practitioner determines that the person is eligible for VAD, a consulting practitioner will then carry out a further independent eligibility assessment. If the consulting practitioner determines the person is eligible, other legislative requirements  need to be followed, including that the person must make a written declaration requesting access to VAD, and make a final request for VAD to the coordinating practitioner.

How and when can VAD be administered?

A person can access VAD once:

• the request and assessment process is completed,
• the coordinating practitioner completes a final review form certifying the person meets the eligibility criteria,
• the person makes an administration decision, and
• the Board grants a VAD substance authority in relation to the person.

There are two types of VAD administration: self-administration and practitioner administration. The person, in consultation with and on the advice of the coordinating practitioner, may decide to self-administer the VAD substance or to have it administered by an administering practitioner.

Self-administration

The VAD substance may be administered by the person at a time and place of their choosing. Other people (e.g. family and friends) may be present if the person wishes. The person may change their mind at any time and choose not to take the medication.

There is no requirement for a health practitioner or witness to be present for self-administration. However, the person must appoint a contact person who has responsibilities including notifying the coordinating practitioner when the person dies, either as a result of self-administering the VAD substance or from another cause.

Practitioner administration

If the person chooses practitioner administration, the VAD substance can be administered to the person by their administering practitioner, who may be either the coordinating practitioner or another medical practitioner or a nurse practitioner who meets the eligibility requirements and has completed the mandatory training.

An eligible witness must be present when the VAD substance is administered by a practitioner. The witness must certify that the person’s request for access to VAD was free, voluntary and enduring, and that the VAD substance was given to the person by the administering practitioner in the witness’ presence. Other people may also be present if the person wishes.

Do health practitioners have to participate in VAD?

Registered health practitioners with a conscientious objection to VAD have the right not to participate in VAD. They can refuse to:

• participate in the request and assessment process;
• prescribe, supply or administer a VAD substance; or
• be present at the time of the administration of a VAD substance.

If a person makes a first request for VAD to a medical practitioner with a conscientious objection, the practitioner must immediately inform the person that they refuse the request.

Medical practitioners who do not have a conscientious objection but refuse a first request because they:

• are unable to perform the duties of a coordinating practitioner because of unavailability or another reason or
• are not eligible to act as coordinating practitioner

must provide specified information (approved by the Minister for Health) to a person who makes a first request.

Do health services and residential facilities have to provide VAD, or help a person access it?

Health care establishments (private health facilities and public hospitals) and residential facilities (e.g. residential aged care facilities and nursing homes or hostels) have the right to refuse to participate in VAD. These institutions can also refuse to have their employees participate in VAD.

However, all refusing institutions still have a legal obligation not to hinder the person’s access to information where a person requests information about VAD. This includes allowing a member of an official VAD navigator service (or, for residential facilities, a registered health practitioner) access to the facility to give information and advice.

Generally facilities are required to do the following:

Permanent residents

• Allow a medical practitioner or other relevant person to access the facility so that the person can:
  • make a request for VAD,
  • have a VAD eligibility assessment, or
  • have VAD administered

  or facilitate a transfer of the person to a place where this step in the process can occur.

Non-permanent residents

• Allow a medical practitioner and other relevant persons to access the facility so that the person can make a request for VAD, or facilitate a transfer of the person to a place where this step in the process can occur.
• Facilitate the transfer of the person to a place where the person can:
  • have a VAD eligibility assessment, or
  • have VAD administered or self-administer VAD,

  or, if this would not be reasonable, allow reasonable access to the facility by the medical practitioner and other relevant persons (for eligibility assessment or practitioner administration), or not hinder access by the person to a VAD substance (self-administration).

Is it lawful for a health practitioner to discuss VAD with a person?

Medical practitioners may initiate a discussion with a person about VAD if, at the same time, they inform the person about the treatment and palliative care options available, and the likely outcomes of those options.

Health care workers (a registered health practitioner other than a medical practitioner, or another person who provides health or professional care services) can initiate a discussion about VAD if, at the same time, they inform the person that they have palliative care and treatment options available, and that they should discuss these with the person’s medical practitioner.

A health care worker can provide information about VAD on a person’s request.

What are the safeguards around VAD?

The Act contains a range of safeguards including:

• A family member or carer cannot request VAD on somebody’s behalf.
• The person will need to make at least three separate requests for VAD (a first request, a written declaration, and a final request).
• The person’s decision to access VAD must be made voluntarily and without pressure or duress, and must be enduring. These requirements will be confirmed throughout the request process, and prior to practitioner administration.
• If at the first assessment and consulting assessment the person is assessed as eligible for VAD, the person must be provided with information about matters including their diagnosis and prognosis, and available treatment and palliative care options.
• The person is able to change their mind about VAD at any time.
• Medical practitioners and nurse practitioners participating in providing VAD must undergo mandatory approved training and meet certain eligibility criteria.
• Offences (punishable by imprisonment) for anyone who induces a person to access VAD or self-administer a VAD substance.
• Protection from liability if a person assists another person, in good faith, to request access to, or access VAD, or is present when the person self-administers, or is administered, the VAD substance.

The Voluntary Assisted Dying Board is responsible for monitoring, reporting, research, and review of eligibility decisions.