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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

A flowchart outlining the process for voluntary assisted dying
Figure 1. Flowchart outlining a simplified version of the process for voluntary assisted dying

1. The request and assessment process

There is no obligation for a person to continue the voluntary assisted dying process after the request and assessment phase has been completed. The person can stop the process at any time.

Before a person can access voluntary assisted dying, they must make 3 separate requests. There must be at least 9 days between the first and final request. This allows time for the person to reflect on their choices while 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.

Voluntary assisted dying is not emergency health care. A person may take weeks or months to work their way through the process and make the final decision to administer the substance.

First request

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

The request must be:

  • clear and unambiguous, so the doctor knows exactly what the person is asking
  • 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 doctor during a medical consultation. This can be in person or via telehealth.

Not all doctors provide voluntary assisted dying services, but all doctors have obligations under the Act. Read more information on legal obligations for all medical practitioners, including responding to a first request.

The Act provides that if a doctor 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. A doctor can refuse the person’s request if they:

  • have a conscientious objection. This is the right to refuse to provide voluntary assisted dying due to personal reasons or beliefs; or
  • don’t have the appropriate skills or training to accept the first request; or
  • will not be available to help the person through the process–for example, they will be on leave.

If the reason for refusing the first request is a conscientious objection, the doctor must immediately inform the person. Otherwise, the doctor must inform the person of their acceptance or refusal within 2 business days after the first request is made.

If the doctor accepts the first request, they become the person’s coordinating practitioner (coordinating doctor) and must give the person the approved voluntary assisted dying first request information. The coordinating doctor supports the person through the process. To be a coordinating doctor a doctor must meet eligibility criteria and have completed the mandatory training.

First assessment

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

To be eligible for voluntary assisted dying, the coordinating doctor must assess that the person:

  • is diagnosed with a disease, illness or medical condition that:
    • is advanced, progressive, and will cause death
    • is expected to cause death within 12 months
    • is causing suffering that the person considers to be intolerable
  • has decision-making capacity in relation to voluntary assisted dying
  • is acting voluntarily and without coercion
  • is at least 18 years of age
  • is an Australian citizen, permanent resident, or has been ordinarily resident in Australia for at least 3 years immediately before making their first request
  • has been ordinarily resident in Queensland for at least 12 months immediately before making the first request.

If the person is assessed as eligible, the coordinating doctor must give information to the person. This information includes:

  • their diagnosis
  • their prognosis
  • available treatment options (including palliative care)
  • information about the voluntary assisted dying process.

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

The coordinating doctor will refer the person to another doctor for a second assessment–called the consulting assessment. If the other doctor accepts the referral, they become the consulting practitioner.

If the coordinating doctor determines the person is ineligible, they will talk to them about care and support services that may help them.

Consulting assessment

The consulting doctor will do a second assessment to decide if the person is eligible. The consulting doctor must independently assess the person against the same eligibility as the first assessment and form their own opinion but can work in the same health setting. For example, both the coordinating and consulting doctors can work in the same general practice.

If the person is assessed as eligible, the consulting doctor must give information to the person. This information includes:

  • their diagnosis
  • their prognosis
  • available treatment options (including palliative care)
  • information about the voluntary assisted dying process

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

The coordinating and consulting doctor must both assess the person as eligible before the person can make a second request.

Second request

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

The second request must be completed in writing in an approved form called the second request form. This form must be signed in front of 2 eligible witnesses.

A witness cannot be:

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

If the person is unable to write, they can ask someone else to sign the second request form on their behalf. They must sign this in front of the person and the 2 witnesses. To be able to sign the request on the person’s behalf, the person must not be:

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

The person must give the signed second request form to the coordinating doctor. The coordinating doctor must submit the form to the Voluntary Assisted Dying Review Board.

Final request

There must be minimum of 9 days between the person’s first request and the final request.

The 9-day period may be shortened if both the coordinating practitioner and the consulting practitioner believe the person may die or lose decision-making capacity in that time.

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

The coordinating doctor can start the final review process after the person makes a valid final request.

Final review

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

The coordinating doctor must confirm they believe the person:

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

The coordinating doctor must complete the final review form and provide a copy to the person.

2. Administration of the voluntary assisted dying substance

There is no obligation for a person to continue the voluntary assisted dying process. The person can stop the process at any time–right up until the administration of the substance.

Administration decision

Once the coordinating doctor has completed the final review, the person will decide how they want the voluntary assisted dying substance administered.

There are 2 choices:

  1. self-administration: the person administers the substance themselves
  2. practitioner administration: the person chooses to have an administering doctor or nurse administer the substance.

A person makes an informed decision about the type of administration best suited to them. This decision is made in consultation with, and on the advice of, the person’s coordinating doctor. This must be done in a face-to-face consultation.

If the person chooses practitioner administration, the coordinating doctor will by default become the administering doctor. However, the coordinating doctor can transfer the role to another eligible doctor, nurse practitioner, or registered nurse who must accept or refuse the role. The coordinating doctor can choose to transfer the role for any reason.

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 or partner
  • friend
  • healthcare worker involved in their care.

The contact person has an important role, and the person should choose someone who they think can handle the responsibility. The person can choose to change their contact person, or the contact person can refuse to continue in the role.

The contact person acts as a point of contact for the Voluntary Assisted Dying Review Board (review board). Their role can also include:

  • receiving and possessing the substance on behalf of the person
  • preparing the substance for the person (they will be given instructions on how to do this)
  • returning any unused substance to an authorised disposer for disposal
  • informing the coordinating doctor if the person dies, this must be done within 2 business days of becoming aware of the person’s death.

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 doctor.

Prescription

After the person has appointed a contact person, the coordinating doctor can prescribe the voluntary assisted dying substance.

The coordinating doctor 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 given in a face-to-face consultation.

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

Supply of the voluntary assisted dying substance

The QVAD-Pharmacy:

  • authenticates the prescription
  • confirms the identity of the coordinating doctor 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

Pharmacists from QVAD-Pharmacy will supply the substance directly to the person and give them written and oral information about the substance, including how to store, prepare and administer the substance.

At the discretion of QVAD-Pharmacy, the pharmacist may supply the substance to the person via the person’s agent or contact person.

The person or their coordinating practitioner can request QVAD-Pharmacy supply the substance for self-administration at a time of their choosing.

Practitioner administration

The administering practitioner will contact QVAD-Pharmacy to arrange the supply to 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 may choose to have friends or family with them.

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 doctor or nurse 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 doctor must be satisfied the person:

  • still 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 doctor or nurse administered the substance to the person in their presence.

3. After the person dies

Disposal of the substance

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. These requirements will be provided by QVAD-Pharmacy to the contact person. This information will also be provided by the voluntary assisted dying review board within 2 business days of receiving a copy of the contact person appointment form.

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

Death notification

The coordinating doctor or administering doctor or nurse must notify the review board the person has died, within 2 business days of becoming aware of the death.

If another doctor completes the person’s cause of death certificate, they must also inform the review board if they know the person accessed voluntary assisted dying.

The doctor certifying the death must write on the death certificate that the person’s underlying illness, disease, or medical condition was the cause of death. It must not mention voluntary assisted dying.

Reviewable decisions

The following decisions can be reviewed by the Queensland Civil and Administrative Tribunal (QCAT):

  • decision made by the coordinating practitioner in the first assessment or the consulting practitioner in the consulting assessment regarding:
    • residency eligibility
    • decision-making capacity in relation to voluntary assisted dying
    • whether the person is acting voluntarily and without coercion
  • decision made by the coordinating practitioner in the final review regarding:
    • decision-making capacity in relation to voluntary assisted dying
    • whether the person is acting voluntarily and without coercion.

The following people can seek review of a decision:

  • the person who is making the request to access voluntary assisted dying
  • an agent of the person who is making the request to access voluntary assisted dying
  • any other person who has a sufficient and genuine interest in the rights and interests of the person making the request to access voluntary assisted dying.

In order to seek a review of a decision the application must be made to QCAT within 5 business days after the later of the following days:

  • the day the relevant approved form (for that stage of the process—first assessment record form, consulting assessment record form or final review form) was given to the person requesting access to voluntary assisted dying
  • the day the person applying for review of the decision becomes aware of the reviewable decision.
Last updated: 9 June 2022