The following information provides a detailed breakdown of the voluntary assisted dying process. Reading this may be upsetting or confronting for some people. If this raises distressing issues, support is available.
There are 3 key phases in the voluntary assisted dying process and each phase has a number of steps. You can stop this process at any time.
You can download:
You may need to pay for appointments with your coordinating doctor, consulting doctor, administering doctor or nurse, or any other healthcare workers as you usually would based on their fees. You should discuss any potential costs with your doctor at the start of the process.
There are no costs for the voluntary assisted dying substance or for accessing the Queensland voluntary assisted dying support service (QVAD-Support).
Voluntary assisted dying is not emergency healthcare. You may take weeks or months to work your way through the process and make the final decision to administer the substance. Once you are deemed eligible, there is no maximum timeframe. You won’t be pressured to make decisions. You can decide to stop the process at any point.
Throughout the process you need to make 3 separate requests. There is a 9-day minimum timeframe between the first and final request, and the earliest you can make your final request is the 10th day after your first request was made and accepted, as shown in the timeline table below.
The 9-day timeframe is to safeguard access to voluntary assisted dying and ensure that your decision is well thought through.
This 9-day period can be shortened if both your coordinating doctor and consulting doctor believe you are likely to die or lose decision-making capacity for voluntary assisted dying before the 9-day period lapses.
Example: If the person made the first request on the 17 April, the earliest they could make the final request is 26 April, 9 days later.
| Day 1 | Day 2 | Day 3 | Day 4 | Day 5 | Day 6 | Day 7 | Day 8 | Day 9 | Day 10 |
|---|---|---|---|---|---|---|---|---|---|
| 17 April | 18 April | 19 April | 20 April | 21 April | 22 April | 23 April | 24 April | 25 April | 26 April |
| First request made | Last day consulting assessment can occur if final request occurs on Day 10 | Final request can be made |
There must be at least 9 days between the first and final request. This period allows time for you to reflect on your choices while ensuring your suffering isn’t drawn out.
The 9-day period can be shortened if your coordinating and consulting doctors both believe that you are likely to die or lose decision-making capacity during that time.
Only you can make a request for voluntary assisted dying, your family and carers cannot request voluntary assisted dying on your behalf.
You ask a doctor for access to voluntary assisted dying. This is the first of 3 requests.
The request must be:
If you choose to start the voluntary assisted dying process, you should make your request to your 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 legal obligations.
The Voluntary Assisted Dying Act 2021 (the Act) states that if a doctor chooses not to be involved, they must give you information about other doctors or services who may be able to help you access voluntary assisted dying. A doctor can refuse your request if they:
If the reason for refusing the first request is a conscientious objection, the doctor must immediately inform you of this reason. Otherwise, the doctor must inform you of their acceptance or refusal within 2 business days after the first request is made.
If the doctor accepts the first request, they become your coordinating practitioner (coordinating doctor) and must give you the approved voluntary assisted dying first request information. The coordinating doctor supports you through the process. To be a coordinating doctor a doctor must meet eligibility criteria and have completed the mandatory training.
Following your first request, your coordinating doctor assesses if you are eligible for voluntary assisted dying.
To be eligible for voluntary assisted dying, your coordinating doctor will assess you against each of the eligibility criteria.
You must meet all the eligibility criteria to access voluntary assisted dying.
If your coordinating doctor cannot determine if you:
they must refer you to another registered health practitioner or person with appropriate skills and training to determine if you do.
Once you have been to your referral appointment and your coordinating doctor has received the report, they can choose to:
Your coordinating doctor will use their clinical judgement and expertise in making this decision.
If your coordinating doctor believes you meet all the eligibility criteria they will give you information about:
Before you can be assessed as eligible to access voluntary assisted dying your coordinating doctor must be satisfied that you understand the information you are given.
You will be assessed as eligible and meeting the requirements of the first assessment If your coordinating doctor is satisfied you:
Your coordinating doctor will then refer you to another doctor for a second assessment–called the consulting assessment.
If the other doctor accepts the referral, they become your consulting practitioner (consulting doctor).
Your coordinating doctor can assess you as ineligible for voluntary assisted dying if they are not satisfied you:
If your coordinating doctor assesses you as ineligible, the voluntary assisted dying process ends.
If your coordinating doctor decides that you are ineligible, they will:
Your coordinating doctor may also talk to you about other care and support available to you. This could include:
If your coordinating doctor assesses you as ineligible you can:
If you do this the voluntary assisted dying process will start from the beginning.
You can also apply to have certain decisions of the coordinating doctor reviewed by QCAT.
Your consulting doctor will do a second, independent assessment, to decide if you are eligible.
Your consulting doctor can also refer you for a second opinion to determine if you:
You will be assessed as eligible and meeting the requirements of the consulting assessment If your consulting doctor is satisfied you:
They will advise your coordinating doctor that they have assessed you as eligible. You can then make a second request to your coordinating doctor.
Your consulting doctor can assess you as ineligible for voluntary assisted dying if they are not satisfied you:
If your consulting doctor assesses you as ineligible, your coordinating doctor may refer you to another doctor for another consulting assessment. There is no limit on the number of times this can happen. However, if your coordinating doctor does not think it is appropriate to refer you, the process ends.
You can also apply to have certain consulting and coordinating doctors’ decisions reviewed by QCAT.
If your coordinating doctor decides not to refer you for another consulting assessment you can:
If you do this the voluntary assisted dying process will start from the beginning.
You do not have to continue with the voluntary assisted dying process after the first and consulting assessments. You can stop the process at any time.
If you are assessed as eligible and you want to continue, you can make a second request, to your coordinating doctor in writing, to access voluntary assisted dying.
The second request can be made at any time after the consulting assessment is completed, and you have been assessed as eligible.
To make a second request you must complete the Second Request Form in writing. Your coordinating doctor will give you a copy of this form.
To complete the form, you must:
You do not need to complete the Second Request Form in the presence of your coordinating doctor.
Your witness will need to certify that:
Your witnesses must also state in the form that they are not knowingly an ineligible witness.
A witness cannot be:
If you cannot find anyone to be your witnesses, you can:
You do not need to fill in any forms to appoint someone as your witness. However, you should let your coordinating doctor know who is going to act as your witnesses.
If you are unable to write, you can ask someone else to sign the Second Request Form on your behalf. They must sign this front of you and your 2 witnesses. To be able to sign the request on your behalf the person must:
You must give the signed Second Request Form to your coordinating doctor.
The following resources are available for you and your witnesses when completing the second request:
If you wish to continue with the request process, the next step is to make a third and final request to your coordinating doctor.
After the second request is completed, signed, witnessed, and given to your coordinating doctor, you can make a third and final request for access to voluntary assisted dying.
If you decide to make a final request, you must make this request yourself to your coordinating doctor. This request can be made verbally, or by other means of communication such as hand gestures.
You should make the final request when you are ready. However, there is a 9-day minimum timeframe between the first and final request and the earliest you can make your final request is the 10th day after your first request was made and accepted, unless there are exceptional circumstances.
You must also wait until the day after your consulting assessment to make a final request.
Your coordinating doctor may start the final review process after you have made a valid final request.
In this step your coordinating doctor will confirm if the request and assessment process has been completed correctly.
Your coordinating doctor must confirm that:
If your coordinating doctor is satisfied that the requirements of the final review have been met and if you wish to continue with the voluntary assisted dying process, the next step is to make an administration decision.
You do not have to continue the voluntary assisted dying process after the request and assessment has been completed. You can stop the process at any time.
If your coordinating doctor is not satisfied, they will not move you onto the next stage.
Your coordinating doctor will:
Your coordinating doctor will also talk to you about other care and support available to you. This could include:
If your coordinating doctor is not satisfied that you still have decision-making capacity and are acting voluntarily and without coercion, you can:
If you do this the voluntary assisted dying process will start from the beginning.
You can also apply to have the decision reviewed by QCAT.
You do not have to continue the voluntary assisted dying process after the request and assessment phase has been completed. You can stop the process at any time.
Once your coordinating doctor has completed the final review you may make an administration decision or you may decide not to make an administration decision. This decision is made in consultation with, and on the advice of, your coordinating doctor.
Your administration decision must be made in person with your coordinating doctor. The Queensland Voluntary Assisted Dying Support Service (QVAD-Support) may assist you with arranging this, if needed.
There are 2 methods:
A practitioner administration decision can only be made if your coordinating doctor advises that self-administration is not suitable for you. To make this decision your coordinating doctor will consider the following:
If a practitioner administration decision is made, an administering doctor or nurse will be appointed.
Your coordinating doctor can be your administering doctor. However, your coordinating doctor can transfer the role to another eligible doctor, nurse practitioner, or registered nurse who must accept or refuse the role. Your coordinating doctor can choose to transfer the role for any reason. They will tell you if this happens.
Your coordinating doctor will give you written information about the substance and administration of the substance.
You can revoke your administration decision and make a new administration decision at any time. You can tell your coordinating doctor of your decision in writing, verbally, using gestures or in another way, for example, through a decision aid.
For example, if you make a self-administration decision but lose the ability to physically self-administer the voluntary assisted dying substance, you can revoke your decision and make a practitioner administration decision in consultation with your coordinating doctor. If you later regain your ability, you could decide to revoke your practitioner administration decision and again choose self-administration.
You can also revoke an administration decision at any time, if you do not wish to proceed.
If you make an administration decision you must appoint a contact person before a prescription can be written, by your coordinating doctor.
If you have made an administration decision you must appoint a contact person before the voluntary assisted dying substance can be prescribed by your coordinating doctor. Your contact person has an important role. You should choose someone who you think can handle the responsibility prior to your death and after you die.
Your contact person doesn't need to be present when you administer the substance.
Your contact person must:
You contact person can be a:
If you cannot find someone, you should speak to your coordinating or consulting doctor.
To appoint a contact person, you must:
Your coordinating doctor will give you a copy of this form.
You do not need to complete the Contact Person Appointment Form in the presence of your coordinating doctor.
You can choose to change your contact person, or your contact person can refuse to continue in the role. If this happens you will have to appoint a new contact person.
The role of the contact person is different based on whether you make a self-administration or practitioner administration decision.
Note: there are other statutory roles you may act in or be appointed to. These include:
The contact person is different to these roles. It has distinct responsibilities, as outlined below.
For a self-administration decision your contact person must:
The Review Board will send your contact person information via email on how to complete their role.
For a practitioner administration decision your contact person’s role includes:
If possible, it would be useful for your contact person to accompany you to an appointment to ask any questions they have.
The following resources are available to help you and your contact person:
The next step in the process is the prescription of the voluntary assisted dying substance by your coordinating doctor.
After you have appointed a contact person, your coordinating doctor can prescribe the voluntary assisted dying substance.
Your coordinating doctor will give the prescription directly to the Queensland Voluntary Assisted Dying Pharmacy (QVAD-Pharmacy).
Your coordinating doctor must give you information in writing, including:
This information must be given in a face-to-face consultation or posted to you after the consultation.
The voluntary assisted dying substances can only be supplied by pharmacists employed by QVAD-Pharmacy.
Your coordinating doctor will make a request for supply of the voluntary assisted dying substance to QVAD-Pharmacy.
QVAD-Pharmacy will:
You or your coordinating doctor must contact QVAD-Pharmacy to request them supply the voluntary assisted dying substance to you. You can request that it be supplied at a time of your choosing.
Pharmacists employed by QVAD-Pharmacy will supply the voluntary assisted dying substance directly to you, your contact person or agent. In most cases this pharmacist employed by QVAD-Pharmacy will supply the substance to you directly.
They will also supply the voluntary assisted dying substance kit and written information about the substance, including:
The pharmacist employed by QVAD-Pharmacy will check during the supply of the voluntary assisted dying substance for self-administration if you:
If the pharmacist employed by QVAD-Pharmacy believes you do not meet one of these criteria, they will not supply you with the voluntary assisted dying substance. The pharmacist will tell your coordinating doctor that they have not supplied you with the substance.
If a pharmacist employed by QVAD-Pharmacy does not supply you with the substance for a self-administration decision, you can:
Your administering doctor or nurse will make a plan with you for when practitioner administration of the voluntary assisted dying substance will occur. When a date and time has been confirmed, they will arrange for the supply of the voluntary assisted dying substance from QVAD-Pharmacy, to be supplied to them, in a timely manner.
Once supplied, your administering doctor or nurse will be responsible for the safe storage of the substance until you request for it to be administered.
Once the voluntary assisted dying substance has been supplied the next step is administration, if you choose to continue.
You can decide at any time not to continue to access voluntary assisted dying.
You can choose your preferred date, time, and place to administer the substance.
You should discuss your expectations and assumptions about administration of the voluntary assisted dying substance with your coordinating doctor or administering doctor or nurse. They may help you consider how best to support your plans for death.
These discussions could involve:
It’s recommended you include a support person in these discussions.
If you have made a self-administration decision you will be encouraged not to self-administer alone. If you choose to be alone, an appropriate plan should be put in place to ensure your contact person can complete their role, which includes:
No one else can administer the substance to you—you must administer the substance yourself. Unauthorised administration of a voluntary assisted dying substance can result in criminal prosecution and imprisonment.
Your contact person must dispose of any unused or remaining substance in line with the disposal requirements. These requirements will be provided to them by the Review Board and QVAD-Pharmacy.
Your administering doctor or nurse must administer the substance to you in front of a witness. The witness to practitioner administration must be at least 18 years of age. There are no other eligibility requirements for the witness. You may have other people present for administration if you wish.
Before administering the voluntary assisted dying substance to you, your administering doctor or nurse must be satisfied that you:
Your administering doctor or nurse must dispose of any unused or remaining substance in line with the disposal requirements.
The purpose of a witness for practitioner administration is to provide a safeguard to ensure that:
Your witness for practitioner administration must be 18 years or older. They can be:
Your witness cannot be your administering doctor or nurse.
Your witness will need to fill in the witness section of the Practitioner Administration Form. This form is for your administering doctor or nurse to make a record of the administration of the voluntary assisted dying substance to you. This form is completed after you die. Your witness will need to certify in the form that:
The following resources are available for you and your witnesses for practitioner administration:
If your administering doctor or nurse is not satisfied you:
They will not administer you the substance.
Your coordinating doctor, or administering doctor or nurse will talk to you about other care and support available to you, this could include:
If your administering doctor or nurse does not administer you the substance because you don't have capacity, if you regain capacity you can ask to reschedule the administration of the substance for another time.
After you die, the death notification and certification will be completed and any unused or remaining voluntary assisted dying substance will be disposed.
Your contact person must inform your coordinating doctor if you die from self-administration of the voluntary assisted dying substance or some other cause, within 2 business days of becoming aware of your death.
Your coordinating doctor and your administering doctor or nurse must notify the Voluntary Assisted Dying Review Board (the Review Board) that you have died, within 2 business days of becoming aware of your death.
If another doctor completes your cause of death certificate, they must also inform the Review Board, if they know you accessed voluntary assisted dying.
The doctor certifying the death must write on the death certificate that your underlying illness, disease, or medical condition was the cause of death. It must not mention voluntary assisted dying.
For self-administration, any unused or remaining voluntary assisted dying substance must be given to an authorised disposer by your contact person and disposed of in line with the disposal requirements.
For practitioner administration, the administering doctor or nurse must dispose of the voluntary assisted dying substance in line with the disposal requirements.
The process for voluntary assisted dying, 01 Mar 2023, [https://oss-uat.clients.squiz.net/health/support/voluntary-assisted-dying/explained/process]
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