What are the responsibilities and legal obligations with a voluntary assisted death?

Voluntary assisted death is a complex and delicate matter that requires an approach with compassion, respect for individual autonomy, and careful consideration of ethical and legal implications. This article aims to provide a simple overview of the responsibilities and legal obligations on a voluntary assisted death.

What is voluntary assisted dying?

Voluntary assisted dying (VAD) refers to a medical practice where individuals, who are experiencing unbearable suffering due to an advanced medical condition, receive medical assistance to peacefully end their life. 

As of now, VAD is legally accessible in several Australian states, including Queensland, South Australia, Tasmania, Victoria, and Western Australia. Each state implements strict eligibility criteria to determine who qualifies for VAD, though these criteria may differ slightly from one state to another. 

If someone is facing a terminal medical condition, meaning a disease or illness that is expected to result in death in the near future, and they are considering VAD as an option, they can seek guidance and further information from their doctor or healthcare professional.

You can learn more about voluntary assisted dying here.

How to access voluntary assisted dying in Australia?

While the exact process may vary slightly from state to state, the general steps involved are as follows:

1. A person expresses their desire for voluntary assisted dying to an eligible medical practitioner.
2. The eligible medical practitioner conducts an assessment to determine the person's eligibility for voluntary assisted dying.
3. A second eligible medical practitioner conducts a separate assessment to verify the person's eligibility.
4. The person submits a written request for voluntary assisted dying.
5. The person makes a final request for voluntary assisted dying.
6. Relevant officials grant authorisation for the procedure.
7. An eligible healthcare practitioner prescribes and provides the necessary medication for voluntary assisted dying.
8. There are two options for administering the medication:

• The eligible person can self-administer the medication at a chosen time and place. If desired, friends and family members can be present.
• Alternatively, an eligible healthcare practitioner can administer the medication to the eligible person. In most states, this process requires a witness.

It is important to note that a person has the right to withdraw their request for voluntary assisted dying at any time, even after undergoing assessments or submitting written requests.

What roles do medical practitioners have in voluntary assisted dying?

In order for an individual to receive assistance in dying, they must undergo an assessment to determine their eligibility and follow a formal process. The primary healthcare professionals involved in this process are medical practitioners. Only medical practitioners are authorised to receive a person's request for voluntary assisted dying and assess their eligibility.

In certain states, medical practitioners, nurse practitioners, and registered nurses may have the ability to administer VAD medication. However, to perform these tasks, they must undergo mandatory training and fulfil specific requirements regarding their registration and years of experience.

The involvement of allied health professionals and enrolled nurses in VAD varies depending on their registration status, the state they practise in, and their personal choice to participate. Generally, allied health professionals and enrolled nurses are not obligated to undergo any specific training to participate in VAD, unless they are pharmacists authorised to dispense and dispose of VAD medication.

Legal obligations for all medical practitioners.

While medical practitioners have the option to opt out of participating in the voluntary assisted dying procedure, they are all bound by certain obligations outlined in their state’s voluntary assisted dying legal framework. These obligations may slightly vary in each state but generally include:

• Initiating a discussion: If a medical practitioner begins a conversation about voluntary assisted dying with an individual, they must provide them with specific information related to the process. There are restrictions on when allied health professionals and enrolled nurses can initiate discussions with a person about VAD. In some States, doing so is unprofessional conduct. These restrictions are designed to ensure a person is not pressured to request VAD. 
• Responding to a first request: When presented with an initial request for access to voluntary assisted dying, medical practitioners must adhere to a prescribed procedure in handling and responding to such requests.
• Completing a cause of death certificate: Medical practitioners must follow mandatory guidelines when completing a cause of death certificate for a person who has passed away after availing themselves of voluntary assisted dying.

Initiating a conversation regarding voluntary assisted dying.

Only medical practitioners and nurse practitioners are allowed to initiate discussions about voluntary assisted dying, provided that they also provide the person with information about:

• Available treatment options and their potential outcomes.
• Palliative care treatment options and support, along with the anticipated outcomes of such care.

If an individual brings up the topic of voluntary assisted dying, all medical practitioners are permitted to offer information and address any queries if they feel sufficiently knowledgeable and comfortable doing so.

However, if a medical practitioner holds a conscientious objection and prefers not to provide information, they must provide the person with either:

• Information regarding another health practitioner, provider, or service that they believe can offer assistance, or
• Contact details for the Voluntary Assisted Dying Support Service of their respective state.

Responding to a first request.

A first request is the initial step in the voluntary assisted dying process and must meet certain criteria. It should be clear, unambiguous, and made directly by the person to a medical practitioner. The request can be made verbally, through gestures, or by other means of communication available to the person.

The first request for voluntary assisted dying must be made by the person themselves, either directly, with the assistance of a certified interpreter or relevant healthcare worker, such as a speech pathologist or occupational therapist. It cannot be made on their behalf by family members, carers, friends, or substitute decision-makers. Additionally, an advance health directive cannot be used to request access to voluntary assisted dying.

Completing a cause of death certificate.

The coordinating or administering practitioner is required to notify the Review Board within 2 business days after the person's death, once they become aware of it.

If another medical practitioner fills out the person's cause of death certificate and knows that the person accessed voluntary assisted dying, they must also inform the Review Board.

Where the medical practitioner is clear that the death was caused by the administration of the voluntary assisted dying medication the doctor may record the cause of death as the disease, illness or medical condition that was the grounds for the patient to access voluntary assisted dying. This is what will be listed as the cause of death on the death certificate issued by BDM. 

Final thoughts on responsibilities and legal obligations with a voluntary assisted death.

The topic of voluntary assisted death in Australia raises important considerations regarding responsibilities and legal obligations. VAD laws in each state are similar, but there are key differences. It is essential to stay informed about the most up-to-date legislation and consult reliable sources or legal professionals for more accurate information. 

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