Voluntary Assisted Dying
Voluntary Assisted Dying
Voluntary assisted dying (VAD) is a legal end-of-life option that allows an eligible person with an advanced and life-limiting medical condition to choose the timing and circumstances of their death by accessing a prescribed substance intended to bring about their death.
VAD is available in Queensland, where the Voluntary Assisted Dying Act 2021 commenced on 1 January 2023. VAD legislation also operates in every Australian state. The ACT and Northern Territory have different legislative positions.
It is voluntary. A person must make the decision themselves and must be acting voluntarily and without coercion. Nobody else can request VAD on their behalf. The person must also have decision-making capacity in relation to VAD at the relevant stages of the process.
Who can access VAD in Queensland? There are strict eligibility requirements. A person must:
- be 18 years or older;
- have an advanced, progressive disease, illness or medical condition that will cause death;
- be expected to die from that condition within 12 months;
- be experiencing suffering that they consider intolerable;
- have decision-making capacity in relation to VAD;
- be acting voluntarily and without coercion; and
- meet the relevant Australian and Queensland residency requirements.
The person must meet all of the eligibility requirements. Having a serious illness, being elderly, experiencing pain or simply wanting to die is not, by itself, sufficient to access VAD.
VAD is not the same as palliative care. Palliative Care aims to relieve pain, symptoms and distress and improve quality of life. VAD has a different purpose: it involves the administration of a substance with the intention of bringing about the person’s death. A person accessing VAD can continue to receive palliative care and other healthcare.
There is a formal process. VAD cannot simply be requested from a doctor and immediately provided. In Queensland, the process includes a first request, an assessment by a coordinating practitioner, an independent consulting assessment, a second request, a final request and a final review. The person can stop the process at any time before administration.
There are safeguards. The multiple requests and independent assessments are intended to ensure that the person is eligible, understands the decision and is acting voluntarily and without coercion. The process also requires authorised practitioners and specific documentation.
How the substance is administered. In Queensland, self-administration is the default method. The person administers the VAD substance themselves. In circumstances where self-administration is not suitable, the person may choose practitioner administration, where an authorised medical practitioner, nurse practitioner or registered nurse administers the substance at the person’s request.
Where can VAD take place? A person may choose to access VAD in their home or in a facility such as a hospital, hospice or residential aged care facility, subject to the arrangements and requirements applying to that location. The person can express preferences about where they would like to receive the service and where they would like to die.
It is not an advance decision. A person cannot simply put VAD into an Advance Health Directive or other enduring decision and have someone else make the decision later. The person must have decision-making capacity at the relevant stages and personally make the required requests.
After death. Once a person dies following VAD, there are specific legal and administrative requirements. These include notification of the death and the appropriate handling and disposal of any unused VAD substance. The death is dealt with within the Queensland VAD and death-registration framework.
Cause of death. The VAD coordinating practitioner will generally provide the Form 9 — Cause of Death Certificate. This does not mean that the coordinating practitioner needs to be present when the person dies. For example, a person may die at home with a palliative care nurse present, while the coordinating practitioner subsequently completes the Form 9 based on their knowledge of the person’s medical history and the circumstances of the death. Queensland’s VAD framework specifically allows a medical practitioner to certify the death without having seen the person after death, provided they have sufficient information to form an opinion about the probable cause of death.
The underlying illness is recorded as the cause of death. Where VAD has been accessed lawfully, the Form 9 must state that the cause of death was the disease, illness or medical condition that made the person eligible for VAD. It must not refer to voluntary assisted dying as the cause of death. This is important because a person’s usual GP or treating doctor may choose not to participate in VAD. Queensland doctors can conscientiously object to participating in VAD, so the VAD process needs to account for this rather than relying on the person’s usual GP to provide the certificate.
For families and funeral service providers, it is important to understand that VAD is a legally regulated medical process rather than a funeral arrangement. A person may make decisions about their funeral, burial or cremation separately from their VAD decisions. Likewise, a funeral service provider does not provide VAD itself.
VAD therefore provides another legally regulated end-of-life choice for eligible people who are approaching death and experiencing suffering they consider intolerable, while maintaining the person’s autonomy and requiring a formal process of assessment and safeguards.