Legal obligations for all medical practitioners

Medical practitioners can choose not to participate in the voluntary assisted dying process, but all medical practitioners have obligations under the Voluntary Assisted Dying Act 2021 (the Act). These are:

1. Initiating a discussion—providing specific information if the medical practitioner initiates a conversation about voluntary assisted dying with a person.
2. Responding to a first request—following a set process when receiving a first request for access to voluntary assisted dying.
3. Completing a cause of death certificate—following mandatory steps when completing a Cause of Death Medical Certificate (death certificate) for a person who died by accessing voluntary assisted dying.

Initiating a discussion about voluntary assisted dying

Only medical practitioners and nurse practitioners can initiate a discussion about voluntary assisted dying if, at the same time, they inform the person about available:

• treatment options and likely outcomes
• palliative care treatment and support options and likely outcomes of this care.

If a person raises voluntary assisted dying, all medical practitioners can provide information and answer questions if they feel comfortable and informed to do so.

If a medical practitioner has a conscientious objection and does not wish to provide information, they must provide the person with:

• information about a health practitioner, provider, or service they believe is likely to be able to assist, or
• the Queensland Voluntary Assisted Dying Support Service (QVAD-Support) contact details.

If a person raises voluntary assisted dying

From 1 January 2023, medical practitioners must follow legislated requirements under the Act if a person requests to start the voluntary assisted dying process (the first request).

If it is a general enquiry, explore the topic with respect and consideration to better understand what support the person may need and their preferences for end-of-life care.

If a person asks a medical practitioner for information about voluntary assisted dying, the practitioner should consider their response to best support the person. They should:

• listen and respectfully acknowledge what the person says
• consider if this is the right time and place, and if the medical practitioner can continue the conversation
• avoid discussing the person’s eligibility unless this is within the practitioner’s scope of practice
• record conversations about voluntary assisted dying in the person’s medical record, including any referrals made.

Learn more about how medical practitioners can participate in voluntary assisted dying.

Medical practitioners can refuse to participate in any part of voluntary assisted dying for any reason, including:

• a conscientious objection to voluntary assisted dying
• not having the appropriate skills or training to be involved in the process
• not being available to assist the person with the process.

The Act includes provisions for medical practitioners who don’t want to participate in the voluntary assisted dying process. However, they must provide the person with information to enable them to access voluntary assisted dying, including:

• information about a health practitioner, provider, or service they believe is likely to be able to assist; or
• the Queensland Voluntary Assisted Dying Support Service (QVAD-Support) contact details.

Responding to a first request

A first request is the first formal step in the voluntary assisted dying process.

A first request must be:

• clear and unambiguous
• made by the person
• made to a medical practitioner.

A first request can be made through any of the following means:

• verbally
• by gestures
• by other means of communication available to the person.

A person must make the first request themselves (directly, through a certified interpreter, or with the support of a relevant healthcare worker such as a speech pathologist or occupational therapist). The first request cannot be made by another person on the person’s behalf. This includes family members, carers, friends and any other substitute decision-maker (for example, someone appointed by an enduring power-of-attorney). A request to access voluntary assisted dying cannot be made via an advance health directive.

The person does not have to use the term ‘voluntary assisted dying’, but the request must be clear and unambiguous.

Process for responding to a first request

Accepting or refusing the first request

There is no obligation for a medical practitioner to accept a first request—it is a personal choice. Regardless of whether a first request is accepted or refused, the medical practitioner is required to complete certain steps, which are outlined above in Figure 1.

When deciding whether to accept or refuse a first request, a medical practitioner should consider their:

• willingness to be involved
• ability to perform the necessary duties, and
• eligibility to undertake a role under the Act.

Accepting a first request

A medical practitioner does not need to be an authorised voluntary assisted dying practitioner to accept a person’s first request. If the medical practitioner accepts the first request and is eligible to become an authorised voluntary assisted dying practitioner, they will become the person’s coordinating practitioner and are required to complete certain steps, which are summarised above in Figure 1.

A medical practitioner who accepts a person’s first request for voluntary assisted dying does not need to have completed the voluntary assisted dying mandatory training to accept the first request. However, they must complete the mandatory training and receive approval from the Chief Medical Officer of Queensland Health before they undertake the first assessment.

Refusing a first request

A medical practitioner must refuse the first request if they are not eligible to act as a coordinating practitioner.

A medical practitioner may refuse the first request if they:

• are unwilling to perform the duties of coordinating practitioner, for example, they do not want to be the coordinating practitioner for the person
• are unable to perform the duties of coordinating practitioner, for example, they cannot commit the time required
• hold a conscientious objection to voluntary assisted dying
• are employed by a health service that does not provide access to the request and assessment process at the facility, for example, because the entity has a policy of non-participation.

All medical practitioners must take certain steps within specified timeframes after refusing a first request, regardless of their reason for refusal, as summarised above in Figure 1.