Healthcare workers' role in the voluntary assisted dying process
A person must request voluntary assisted dying themselves
A person must request voluntary assisted dying themselves. A substitute decision-maker, such as a carer, family member or friend, cannot request voluntary assisted dying on behalf of another person.
Only medical practitioners and nurse practitioners can initiate a conversation 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.
Only a medical practitioner who meets the eligibility requirements can receive a first request and start the voluntary assisted dying process.
An interpreter or speech pathologist can assist the person in communicating their wishes about voluntary assisted dying.
What to do if a person asks about voluntary assisted dying
Healthcare workers can provide general information about voluntary assisted dying and how to access it at the person’s request.
Regardless of their views about voluntary assisted dying, healthcare workers who are registered health practitioners have obligations under the Act to provide the person with information to enable them to access voluntary assisted dying.
Unless the healthcare worker is a medical practitioner or nurse practitioner, the person must clearly and unambiguously ask the healthcare worker about voluntary assisted dying for the healthcare worker to be able to discuss it with them. Otherwise, the healthcare worker could be in breach of the Act by initiating a conversation.
The person does not have to use the term ‘voluntary assisted dying’, but the person must be clear about what they are asking.
"How can I get voluntary assisted dying?"
"What is that euthanasia law? Can I get it?"
"Can you tell me about how I can end my life?"
"I don't want to go on like this? How can I get that medicine to die?"
"I want to die on my own terms. Can you help me?"
If the healthcare worker is unsure if the person is asking about voluntary assisted dying, they should clarify with open-ended questions, being careful not to mention voluntary assisted dying.
"What do you mean by that?"
"Can you please tell me more?"
Once the person clearly requests information about voluntary assisted dying, the healthcare worker can provide general information if they feel comfortable doing so.
If the person clearly wants to start the process to access to voluntary assisted dying (the first request), refer the person to the Queensland Voluntary Assisted Dying Support Service (QVAD-Support), or to a medical practitioner who is eligible to accept the person’s first request.
Depending on the healthcare worker’s scope of practice, they can also explore why the person made the request. This helps to better understand if the person’s care is meeting their needs and if they need more support.
"Tell me more about that."
"Is it about your pain or another concern?"
What to do if a person makes a first request to access voluntary assisted dying?
A first request is when a person asks a medical practitioner for access to voluntary assisted dying.
Only medical practitioners can receive a first request and begin the voluntary assisted dying process. If medical practitioners receive a first request to access voluntary assisted dying, they have obligations under the Act.
Other healthcare workers can refer the person to QVAD-Support or another medical practitioner who can help them start the process.
Decision-making capacity assessment
As part of the strict eligibility criteria, the person must have decision-making capacity in relation to voluntary assisted dying. This means the person must be assessed as having capacity to make an informed choice about voluntary assisted dying.
If the coordinating and/or consulting practitioner is unable to determine whether a person has decision-making capacity for voluntary assisted dying, they may refer the matter for determination to a registered health practitioner with appropriate skills and training.
The person must be capable of:
- understanding the nature and effect of decisions about access to voluntary assisted dying
- freely and voluntarily making decisions about access to voluntary assisted dying
- communicating decisions about access to voluntary assisted dying verbally or by gestures or other means of communication available to them.
Some people seeking access to voluntary assisted dying may not be eligible due to impaired decision-making capacity. This should be dealt with compassionately and holistically by those caring for the person.
The person is presumed to have decision-making capacity in relation to voluntary assisted dying unless there is evidence to the contrary. The Act provides that it should not be presumed the person doesn’t have decision-making capacity because:
- of a personal characteristic such as age, appearance, or language skills
- the person has a disability or a particular illness
- the person makes a decision that other people may not agree with.
It is also important to remember that:
- the person can have decision-making capacity to make some decisions but not others; for example, the person may have capacity to pay their bills and decide where they live, but may not be able to make other decisions
- capacity can change or fluctuate and a person can temporarily lose capacity and later regain it
- the person can be capable of demonstrating they have decision-making capacity if they can do so with adequate and appropriate support.