Terminally ill people in New South Wales will be able to make a request to end their own lives from tomorrow.
Legislation paving the way for NSW to become the last state in the country to introduce voluntary assisted dying (VAD) was passed last year.
This is how VAD will work in NSW.
Who can access it?
People with an advanced and progressive disease, illness or a medical condition that is expected to cause their death within six months (or 12 months for neurodegenerative diseases such as motor neurone disease) can only access VAD if they meet all of the eligibility criteria.
The applicant must be at least 18 years old and either an Australia citizen, permanent resident or a resident of Australia for at least three years before making the first request.
They must have lived in NSW for at least 12 months, unless an exception is granted.
They also must have decision-making capacity, the ability to choose to end their own life without coercion, and have an ongoing request to end their own life.
The legislation also states an applicant is not eligible for VAD just because they have a disability, dementia or mental health impairment.
How do you request it?
The patient must first request to end their life to a doctor, which can be their usual GP.
However, this request can only be considered by practitioners who have undertaken specialist VAD training.
If the practitioner does not have the appropriate training, an applicant can seek out a doctor with VAD training via the NSW Voluntary Assisted Dying Care Navigator Service.
The request must be approved or rejected within two days.
Doctors may refuse the request if they conscientiously object to the practice.
What happens after the first request?
If a doctor accepts a request they become the coordinating practitioner, which means they will oversee the VAD process.
This doctor will be the first to assess whether a patient is eligible under the state’s laws.
If they approve, a second eligible doctor will undertake a consulting assessment. The first doctor must inform the patient about the VAD process, treatment and palliative care options.
If both doctors deem the applicant eligible for VAD, the patient then needs to complete a written declaration.
After the written declaration, the patient needs to make a final request to the coordinating doctor, where they confirm they want to access VAD.
This can only be done at least six days from the day of the first request and a day after the consulting assessment.
The coordinating practitioner then completes a final review, confirming all the paperwork is in order and eligibility criteria is met.
After the final review, the patient considers how they want to take the medication that will end their life.
They can either self-administer or have a doctor or nurse give them the medication.
The coordinating doctor then applies for a voluntary assisted dying substance authorisation, which is granted by the Voluntary Assisted Dying Board.
If approved, the coordinating doctor sends a prescription for the VAD medication to an authorised supplier, who checks the prescription before issuing it.
After death, a Medical Certificate of Cause of Death form is completed by the coordinating doctor.
The NSW Registry of Births Death and Marriages will issue the death certificate and it will not mention VAD.
What are the safeguards?
Several safeguards were considered and included in the legislation.
- The patient can stop or pause the VAD process at any moment without reason.
- Three separate requests to end their life must be made.
- Each decision must be made without pressure, influence or coercion.
- A family member or friend cannot make the request on a patient’s behalf.
- The patient must be given information about their diagnosis, prognosis, treatment options and palliative care during the process.
- Medical practitioners involved must have completed VAD training.
- The Voluntary Assisted Dying Board will oversee, monitor and review all decisions.
It is also an offence, punishable by a term of imprisonment, to persuade a patient to access VAD or administer VAD medication without following the formal process.
There are legal protections for people acting in good faith and providing support to those accessing VAD.
Do medical staff have to participate?
NSW medical practitioners can conscientiously object to the practice.
This means they do not have to participate in the patient’s request, the assessment period, administer VAD medication or be present when a patient administers medication.
However, they must not obstruct a patient from accessing information about it or interfere with the process.
How do the laws in NSW compare with other states?
The VAD scheme in NSW is broadly similar to laws in other states, with a few differences.
In NSW, VAD can be raised by the patient or a medical practitioner in discussion. This is the same for Western Australia, Tasmania and Queensland.
In Victoria and South Australia, practitioners cannot raise VAD as an option to patients.
Patients in NSW also have the option of either taking VAD medication themselves or can have a practitioner give it to them.
Victoria and South Australia require the patient to administer the medication themselves. If they cannot physically do so, a practitioner can administer it for them.
In NSW, medical staff with a conscientious objection to the practice are not required to provide any information relating to VAD to a patient who requests it.
This is the same for Victoria, Queensland and South Australia.
For Western Australia, a practitioner must provide information about VAD even if they have a conscientious objection.
Tasmania requires medical staff to give the patient contact details of the VAD Commission regardless of whether they approve or object.
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