Access to voluntary assisted dying

Directive number: QH-HSD-054:2023

Effective date: 1 January 2023

Review date: 1 January 2026

Supersedes: N/A

• Purpose
• Scope
• Principles
• Outcomes
• Mandatory requirements
• Related or governing legislation, policy and agreements
• Review
• Approval and implementation
• Definitions
• Version control

Purpose

This directive outlines the mandatory requirements for Queensland Health Hospital and Health Services to safely and effectively:

• manage and respond to requests for information about and access to voluntary assisted dying, and
• deliver voluntary assisted dying services.

The directive supports the application of the Voluntary Assisted Dying Act 2021 (the Act) under the Health Service Directive Framework pursuant to section 47 of the Hospital and Health Boards Act 2011.

The requirements of this directive are in addition to the legal requirements of the Voluntary Assisted Dying Act 2021, which commences on 1 January 2023.

Scope

This directive applies to all Hospital and Health Services.

Principles

Eight principles underpin the Act and inform this directive.

• Value of human life—human life is of fundamental importance.
• Dignity—every person has inherent dignity and should be treated equally and with compassion and respect.
• Autonomy—a person’s autonomy, including autonomy in relation to end-of-life choices, should be respected.
• High quality care and treatment—every person approaching the end of life should be provided with high quality care and treatment, including palliative care, to minimise the person’s suffering and maximise the person’s quality of life.
• Accessibility—access to voluntary assisted dying and other end-of-life choices should be available regardless of where a person lives in Queensland.
• Informed decision-making—a person should be supported in making informed decisions about end-of-life choices.
• Protecting those who are vulnerable—a person who is vulnerable should be protected from coercion and exploitation.
• Respect for diversity—a person’s freedom of thought, conscience, religion and belief and enjoyment of their culture should be respected.

Outcomes

Hospital and Health Services will achieve the following outcomes:

• Each Hospital and Health Service establishes a model of care to provide timely, publicly funded voluntary assisted dying services for eligible people.
• People who request information about voluntary assisted dying receive appropriate information and support from the Hospital and Health Service.
• Eligible people who request access to voluntary assisted dying are supported through the process by the Hospital and Health Service and receive safe, high quality, person-centred care.
• Hospital and Health Service employees are informed, educated, competent, and aware of their rights, responsibilities, and local policies and procedures in order to meet their legislative obligations.

Mandatory requirements

Context

Voluntary assisted dying in Queensland gives eligible people diagnosed with a life-limiting condition, who are suffering intolerably and dying, an additional end-of-life choice by allowing them to choose the timing and circumstances of their death.

It involves the administration of a substance prescribed by a medical practitioner, with the purpose of bringing about the person’s death. It is based on the person’s voluntary request and follows a process of requests and assessments.

There are strict eligibility criteria to access voluntary assisted dying. Additionally, there is a strict eligibility and authorisation process for medical practitioners, nurse practitioners, and registered nurses who take on the role of authorised voluntary assisted dying practitioner.

A voluntary assisted dying substance can be administered in one of two ways:

• Self-administration: the person administers the voluntary assisted dying substance themselves. This is the default method of administration.
• Practitioner administration: a medical practitioner, nurse practitioner, or registered nurse administers the voluntary assisted dying substance at the person’s request.

A person may choose to access voluntary assisted dying in their home or may seek to access voluntary assisted dying in a facility such as a hospital, hospice, or residential aged care facility. Seeking voluntary assisted dying does not preclude a person from receiving other healthcare and services.

Access requirements

Hospital and Health Services must establish a model of care to provide timely, publicly funded voluntary assisted dying services for eligible people. This includes services required to enable a person to complete all steps of the voluntary assisted dying process, from first request to administration of the voluntary assisted dying substance. It is not a requirement that voluntary assisted dying services are provided at every Hospital and Health Service facility, however, consideration should be given to a person’s preferences around location of service delivery and place of death. These services must be delivered under the governance of the Hospital and Health Service.

Hospital and Health Services may establish a central coordination role for voluntary assisted dying activity provided by the Hospital and Health Service.

Hospital and Health Services must have local policies and procedures in place including:

• responding to requests for information about and access to voluntary assisted dying
• managing the voluntary assisted dying process
• managing the voluntary assisted dying substance
• managing admissions for voluntary assisted dying from private hospitals, hospices, residential aged care, prisons, and the community
• managing access by external practitioners providing voluntary assisted dying services, including authorised voluntary assisted dying practitioners, QVAD-Support care coordinators, and QVAD-Pharmacy pharmacists
• clinical documentation of voluntary assisted dying services
• managing healthcare worker conscientious objection
• supporting people who are ineligible for voluntary assisted dying.

Hospital and Health Services must review and update existing policies and procedures to reflect how voluntary assisted dying is integrated into existing services and systems, including:

• data management, safety and quality, clinical documentation
• support frameworks, debriefing, counselling, pastoral and spiritual care, employee assistance programs
• patient deterioration, limitations of treatment, goals of care
• medical treatment decision making, e.g., assessment of decision-making capacity, patient rights and responsibilities
• care of the deceased, e.g., death certification and notification requirements.
• Local policies and procedures must comply with the Act and Regulation.

An Acute Resuscitation Plan should be reviewed and/or completed for all people accessing voluntary assisted dying.

Hospital and Health Services must ensure appropriate education, training and communication activities are undertaken so that employees are aware of relevant processes and obligations.

Participating practitioners

Hospital and Health Services should maintain a register of authorised voluntary assisted dying practitioners who are willing to provide services within the Hospital and Health Service.

In accordance with the Credentialing and defining the scope of clinical practice health service directive (QH-HSD-034: 2014) Hospital and Health Services are not required to undertake local credentialling of voluntary assisted dying practitioners. However, Hospital and Health Services may undertake due diligence to ensure a practitioner providing voluntary assisted dying services in a Hospital and Health Service facility has been approved by the Chief Medical Officer, Queensland Health, as an authorised voluntary assisted dying practitioner (valid for three years) [1].

Hospital and Health Services can confirm this by asking authorised voluntary assisted dying practitioners to show evidence of their authorisation, or by contacting QVAD-Support.

Clinical incidents

If a sentinel event, reportable event, or other SAC 1 event occurs, the Hospital and Health Service must notify the Voluntary Assisted Dying Unit in the Department of Health within 1 business day.

Data collection and reporting

Hospital and Health Services are required to report voluntary assisted dying activity provided by the Hospital and Health Service, or within a Hospital and Health Service facility by a private practitioner, using the supplied data collection template. The template will be provided to Hospital and Health Services by the Voluntary Assisted Dying Unit.

The completed template must be submitted to the Voluntary Assisted Dying Unit on or before the tenth business day of the month, covering data from the previous calendar month.

Compliance monitoring

Hospital and Health Services are responsible for ensuring compliance with this directive.

The Voluntary Assisted Dying Unit may check compliance by confirming that Hospital and Health Services have implemented local policies and processes that comply with the minimum requirements as set out in this directive.

The Voluntary Assisted Dying Unit may request that Hospital and Health Services submit evidence of compliance with the requirements of this directive. In such cases, the Voluntary Assisted Dying Unit will work with Hospital and Health Services to agree on the information and timeframes within which this is provided.

Related or governing legislation, policy and agreements

Legislation

• Voluntary Assisted Dying Act 2021 (Qld)
• Voluntary Assisted Dying Regulation 2022
• Medicines and Poisons Act 2019 (Qld)
• Medicines and Poisons (Medicines) Regulation 2021
• Hospital and Health Boards Act 2011 (Qld)

Health Service Directives

• Credentialing and defining the scope of clinical practice health service directive (QH-HSD-034: 2014)
• Guideline for credentialing, defining the scope of clinical practice and professional support for allied health professionals (QH-HSDGDL-034-1:2015)

Supporting documents

• Voluntary assisted dying practitioner authorisation guideline (PDF 438 kB)
• Queensland Voluntary Assisted Dying Handbook (PDF 8073 kB)
• Managing, storing and disposing of voluntary assisted dying substances: Guidance for health services (PDF 401 kB)
• Voluntary assisted dying safety and quality guidance for Hospital and Health Services
• Voluntary assisted dying healthcare worker wellbeing and support framework

Business area contact

Voluntary Assisted Dying Unit, Queensland Health

Review

This Health Service Directive will be reviewed at least every three years.
Date of last review: N/A
Supersedes: N/A

Approval and implementation

Directive Custodian
Associate Director General, Strategy, Policy & Reform, Queensland Health
Approval by Chief Executive
Shaun Drummond
Chief Executive

Approval date: 26 October 2022

Issued under section 47 of the Hospital and Health Boards Act 2011.

Definitions

Version control

1. Amendments to the Credentialing and defining the scope of clinical practice health service directive (QH-HSD-034: 2014) are being consulted on concurrently.