The process

There are 3 key phases in the voluntary assisted dying process and each phase has a number of steps. The person can stop the process at any time.

1. Request and assessment process
   • first request
   • first assessment
   • consulting assessment
   • second request
   • final request
   • final review
2. Administration of the voluntary assisted dying substance
   • administration decision
   • appointing the contact person
   • prescription of the voluntary assisted dying substance
   • supply of the voluntary assisted dying substance
   • administration and death
3. After the person dies
   • disposal of the substance
   • death notification

An overview of the process

1. The request and assessment process

As outlined in Figure 2, there must be at least 9 days between the first and final request, i.e., the final request can be made on the tenth day. This allows time for the person to reflect on their choices, whilst ensuring their suffering isn’t drawn out.

The 9-day period can be shortened if both the coordinating and consulting doctors believe the person is likely to die or lose decision-making capacity during that time.

Even if the 9-day period is shortened, this only applies to the request and assessment phase. All other steps in the process must still be followed, i.e., final review, administration decision, contact person appointment, prescription, supply and administration of the substance. It may be unlikely that these steps can be completed within a very short timeframe.

First request

A person asks a medical practitioner for access to voluntary assisted dying. This is the first of 3 requests.

The request must be:

• clear and unambiguous
• made by the person and not by another person on their behalf
• made verbally or by other means of communication such as gestures.

The request will ordinarily be made to the medical practitioner during a medical consultation. This can be in person or via telehealth.

If a medical practitioner chooses not to be involved, they must give the person information about other practitioners or services who may be able to help them access voluntary assisted dying. Read more information on legal obligations for all medical practitioners, including responding to a first request.

If the medical practitioner accepts the first request, they become the person’s coordinating practitioner and must give the person the approved voluntary assisted dying first request information. The coordinating practitioner supports the person through the process. To undertake the role, a medical practitioner must be an authorised voluntary assisted dying practitioner.

First assessment

The coordinating practitioner assesses if the person is eligible for voluntary assisted dying.

If the person meets the eligibility criteria, the coordinating practitioner must provide information as detailed in the assessment checklist. To be assessed as eligible for voluntary assisted dying, the person must understand this information.

If the coordinating practitioner is satisfied the person is eligible and understands the information provided, they are assessed as meeting the requirements of the first assessment.

The coordinating practitioner will refer the person to another medical practitioner for a second assessment—called the consulting assessment. If the referral is accepted, they become the consulting practitioner.

If the coordinating practitioner determines the person is ineligible, the process ends.

Consulting assessment

The consulting practitioner will complete a second assessment to determine if the person is eligible. The consulting practitioner must independently assess the person against the same eligibility criteria as the first assessment but form their own opinion.

If the person is assessed as eligible, the consulting practitioner must provide information as detailed in the assessment checklist.

If the consulting practitioner is satisfied the person is eligible and understands the information provided, they are assessed as meeting the requirements of the consulting assessment.

If the consulting practitioner assesses the person as ineligible, the coordinating practitioner can refer the person for another consulting assessment.

Second request

The person makes a second request to access voluntary assisted dying.

The second request must be completed in writing on the Second Request Form. This form must be signed in front of 2 eligible witnesses.

A witness cannot be:

• someone who is a beneficiary under the person’s will or may benefit from the person’s death, or
• the owner or person responsible for the management of any health facility where the person is being treated or lives, or
• the coordinating or consulting practitioner.

If the person is unable to write, a proxy can sign the Second Request Form. The proxy must sign this in front of the person and the 2 witnesses.

The proxy cannot be:

• someone who is a beneficiary under the person’s will or may benefit from the person’s death, or
• the owner or person responsible for the management of any health facility where the person is being treated or lives, or
• the coordinating or consulting practitioner.

The person must give the signed Second Request Form to the coordinating practitioner.

Final request

The person makes a third and final request to the coordinating practitioner. This request can be made verbally, by gestures, or other means of communication.

Final review

The coordinating practitioner undertakes a review to confirm the request and assessment process has been completed correctly.

The coordinating practitioner must confirm they believe the person:

• has decision-making capacity in relation to voluntary assisted dying
• is acting voluntarily and without coercion.

2. Administration of the voluntary assisted dying substance

Administration decision

Once the coordinating practitioner has completed the final review, the person may make an administration decision in consultation with, and on the advice of their coordinating practitioner. This must be done face-to-face.

There are 2 administration methods:

1. self-administration: the person administers the substance themselves (default method)
2. practitioner administration: the person chooses to have an administering practitioner administer the substance.

A practitioner administration decision can only be made if the coordinating practitioner advises that self-administration is not suitable, considering:

• the person’s ability to self-administer the substance
• the person’s concerns about self-administering the substance
• which method of administration is most suitable to the person.

For practitioner administration, the coordinating practitioner will by default become the administering practitioner. However, the coordinating practitioner can transfer the role to another eligible medical practitioner, nurse practitioner, or registered nurse.

Appointing a contact person

After making an administration decision, the person accessing voluntary assisted dying must appoint a contact person. The contact person must:

• be 18 years of age or over
• agree to take on this role.

The contact person can be a:

• carer
• family member, partner or spouse
• friend
• healthcare worker involved in the person's care.

The person can change their contact person, or the contact person can refuse to continue in the role. If this happens the person will need to appoint a new contact person.

The role of the contact person is different based on whether the person has made a self-administration or practitioner administration decision.

The contact person’s role includes:

• telling the coordinating practitioner when the person has died
• returning any unused substance to an authorised disposer for disposal
• if asked, providing information to the Review Board.

To appoint a contact person, the person must:

• fill in the Contact Person Appointment Form with their contact person
• give the completed form to their coordinating practitioner.

Prescription

The coordinating practitioner prescribes the voluntary assisted dying substance. Prior to prescribing, the coordinating practitioner must give the person information in writing, including:

• information about the substance
• the risks and expected effects of administration of the substance.

This information must be provided face-to-face or posted to the person.

Substances used for the purpose of voluntary assisted dying can only be supplied by authorised pharmacists employed by Queensland Voluntary Assisted Dying Pharmacy Service (QVAD Pharmacy). The coordinating practitioner will give the prescription directly to QVAD-Pharmacy and not to the person.

Supply of the voluntary assisted dying substance

QVAD-Pharmacy:

• authenticates the prescription
• confirms the identity of the coordinating practitioner who issued the prescription
• confirms the identity of the person to whom the substance is to be supplied. This could be either the person, their contact person, or their agent (someone acting on the person’s behalf).

Self-administration

The person must contact QVAD Pharmacy to request supply of the substance.

Pharmacists employed by QVAD Pharmacy will supply the substance directly to the person and give them information about the substance, including how to store, prepare and administer it.

At the discretion of QVAD Pharmacy, the pharmacist may supply the substance to the person via the person’s agent or contact person. In most cases the pharmacist will supply the substance directly to the person.

Practitioner administration

The administering practitioner will contact QVAD Pharmacy to arrange supply of the substance. It is supplied to the administering practitioner.

Administration

Self-administration

The person can choose their preferred date, time, and place to take the substance.

There is no requirement for a witness or healthcare worker to be present for self-administration, but the person should be encouraged not to self-administer alone. If the person chooses to be alone, an appropriate plan should be made to ensure the contact person can complete their role.

No one else can administer the substance to the person—the person must administer the substance themselves. Unauthorised administration of a voluntary assisted dying substance can result in criminal prosecution and imprisonment.

Practitioner administration

The administering practitioner must administer the substance to the person in front of a witness. To be eligible to witness the administration of the substance, the witness must be at least 18 years of age.

The administering practitioner must be satisfied the person:

• has decision-making capacity
• is acting voluntarily and without coercion.

The witness must confirm that:

• the person appeared to be acting voluntarily and without coercion
• the administering practitioner administered the substance to the person in their presence.

3. After the person dies

Disposal of the substance

Self-administration

For self-administration, any unused or remaining substance must be returned to an authorised disposer by the contact person and disposed of in line with the disposal requirements. If there is no unused or remaining substance the contact person can throw the substance packaging in the bin.

Practitioner administration

For practitioner administration, the administering practitioner must dispose of any unused or remaining substance in line with the disposal requirements.

Death notification

The coordinating or administering practitioner must notify the Review Board after the person has died, within 2 business days of becoming aware of the death.

If another medical practitioner completes the person’s cause of death certificate, they must also inform the Review Board if they know the person accessed voluntary assisted dying.

Read more about practical steps and legal obligations after the person dies.