Under the Voluntary Assisted Dying Act 2022 (the Act), as of 28 November 2023, eligible people have the choice to ask for medical help to end their life.
Among the principles enshrined in the Act is the principle that a person’s autonomy in relation to end of life choices should be respected and that all persons have the right to be shown respect for their beliefs, values, and personal characteristics.
Voluntary assisted dying does not constitute suicide under the legislation which provides certain protections to persons acting in accordance with the Act from civil or criminal liability.
Eligibility
To be eligible, a person must:
- Be an adult who is an Australian citizen or a permanent resident of Australia,
- Have been living in NSW for at least 12 months, and
- Have at least one disease, illness or medical condition that:
- Is advanced and progressive,
- Will, on the balance of probabilities, cause their death within six months (or within 12 months for neurodegenerative diseases like motor neurone disease), and
- Is causing the person suffering that cannot be relieved in a way the person considers tolerable.
In order to be ‘voluntary’, the person must have decision making capacity throughout the process and must not be acting under pressure or duress.
Once the criteria are met, the person may, at the time of their choosing, take a substance that will bring about their death.
A person is not eligible for voluntary assisted dying if they have a disability, a mental impairment or dementia.
The process
Applications for voluntary assisted dying will be decided by the Voluntary Assisted Dying Board (the Board) which will consist of two legal practitioners, two medical practitioners and one member with otherwise relevant knowledge or skills.
1. First request
An applicant must make an initial request to a medical practitioner to access voluntary assisted dying, ideally in person. This first request is to determine whether the medical practitioner will agree to be involved.
2. Eligibility assessment
If the medical practitioner accepts the request, they become the “coordinating practitioner” and assess whether the patient is eligible. They may refer the client to another medical practitioner for further assessment.
3. Information to patient
If the patient meets all the eligibility criteria, the coordinating practitioner must make sure that the patient is provided with all relevant information in relation to their condition, treatment options, and voluntary assisted dying processes, and provide a plan in relation to the administration of the substance.
4. Reports
The coordinating practitioner must give the patient the results of the assessment as soon as possible and give the “first assessment report” to the Board and the patient. The patient is also then referred to another medical practitioner for a consulting assessment.
A similar process occurs again with the consulting practitioner completing and providing the Board and the patient with a “consultation referral report”.
5. Written declaration
The patient makes a written declaration in the approved form stating that the patient wishes to access voluntary assisted dying and is not acting under pressure or duress.
This written declaration is given to the coordinating practitioner and the Board.
6. Final request
After all the above steps are completed, the patient may make a final request to access voluntary assisted dying. The request must not be made before the end of the designated period (5 days from making the first request) unless the patient is likely to die or lose decision-making capacity before the end of the designated period.
The patient may decide to proceed or continue with their application.
7. Contact person
The patient nominates a contact person who may be a registered health practitioner. The contact person will receive the prescribed substance from the authorised supplier, give the substance to the patient for self-administration or administer the substance, and notify the coordinating practitioner if death occurs as a result.
At any stage in the process, the person can elect not to continue.
Health care workers
Not all medical practitioners are required to provide voluntary assisted dying services. Medical practitioners may choose not to:
- participate in the request and assessment process, and/or
- prescribe, supply or administer the assisted dying substance, and/or
- be present at the time of administration of the substance.
For those medical practitioners who agree to do all or any of the above, there are education and training programs.
Referrals can be sought from the Voluntary Assisted Dying Care Navigator Service. The Board also maintain a list of registered health practitioners who are willing to provide voluntary assisted dying services. Further work is required by NSW Health to make voluntary assisted dying services available to people living in remote, rural, and regional areas.
Health care workers will need to use caution when discussing voluntary assisted dying, as the Act restricts when such conversations can be initiated by a health professional.
- A medical practitioner can mention voluntary assisted dying if informing a patient about the options available for their condition, palliative care options, and the likely treatment outcomes.
- Other than medical practitioners, a health care worker can discuss voluntary assisted dying if informing a patient about palliative care and treatment options, and provided they advise the patient to discuss their options with a medical practitioner.
