A summary of the Voluntary Assisted Dying Bill 2021

Voluntary Assisted Dying Bill – A summary of key elements

Eligibility - Patient

 

To be eligible to access voluntary assisted dying, a person must be:

• An adult
• An Australian citizen, permanent resident or living in Australia for three continuous years
• Living in NSW for 12 months or more, with provisions to exempt people in border communities
• Diagnosed with at least one terminal disease that will cause death within 12 months for neurodegenerative conditions or six months for other conditions
• Experiencing suffering that cannot be tolerably relieved
• Has decision making capacity to make a VAD decision
• Is acting voluntarily and without pressure or duress

 

Process

 

To get access to VAD:

• A person must make a first request to a doctor – this must be in person unless it is not practicable, then telehealth is permitted
• If the doctor accepts, they become the coordinating practitioner and assess the person against the eligibility criteria

• If the person is assessed as eligible, the coordinating practitioner then must refer the person to another doctor for a second assessment
• If the second doctor accepts, they become the consulting practitioner and must independently assess the person against the eligibility criteria
• If the person is assessed as eligible by both practitioners, the person then must make a written declaration in front of two witnesses declaring that their request is voluntary
• The person then makes a final request to their coordinating practitioner
• In response to the final request, the coordinating practitioner must conduct a final review of all the paperwork and certify that the person has decision-making capacity, is acting voluntarily and without pressure or duress, and that their request for assistance is enduring
• The person must then make an administration decision in which they choose whether to self-administer the substance or have a health practitioner administer it
• If the person chooses to self-administer, they must appoint a contact person who is responsible for the substance
• The coordinating practitioner then applies to the board for an authority to prescribe the substance
• If the board approves, the coordinating practitioner can then prescribe the substance
• The person, their contact person, or an agent of the person can collect the substance if the patient is self-administering
• If a practitioner administers the substance, they must do so in front of a witness

 

Other details of the process:

• Telehealth is available but is limited to instances where it does not clash with Commonwealth law
• If a coordinating or consulting practitioner is uncertain about a patient’s eligibility with regard to diagnosis, prognosis, decision making capacity or that they are acting voluntarily and without pressure or duress, the doctor must refer the patient to an appropriate person for example a specialist, psychologist or neurologist

 

 

Health Practitioners and Institutions/Facilities

 

To be eligible to act as a coordinating or consulting practitioners, a person must be:

• A specialist
• An overseas trained specialist
• A GP with 10 years’ experience
• Have conducted training approved by the Health Secretary

 

To be eligible to be an administering practitioner, a person must be:

• Eligible to be a coordinating or consulting practitioner
• A GP with 5 years’ experience
• A nurse practitioner
• A registered nurse with 5 years’ experience

 

No Health practitioner will be forced to participate and can conscientiously object or not participate for any reason

 

Provisions are made to enshrine the ability for hospitals and residential facilities to have a policy to not provide VAD services

• Facilities that don’t provide VAD services will have to publish their policies on their websites
• Facilities will not be allowed to impede a person’s access to information or a VAD care navigator
• The bill creates obligations on facilities to protect the terminally ill, differentiating between hospitals and residential facilities
• Hospitals will need to help facilitate the transfer and return of a patient seeking VAD to somewhere that offers the services where it won’t cause harm to the patient
• There are no other obligations noting that hospitals are averse to letting external doctors on their premises
• Residential facilities will need to let doctors and other participants onsite to provide VAD services to permanent residents
• For temporary residents, residential facilities will need to help transfer the person to access VAD services externally but if the transfer will cause suffering to the patient, they will have to let VAD doctors and other participants on the premises to provide VAD

 

Safeguards

 

• Interpretation of the bill is guided by a set of principles that cover matters like the value of life, importance of autonomy, the need for high quality end-of-life care, protection against pressure or duress, access to choices regardless where one lives

• The process is voluntary for all participants, at all stages
• The patient is reminded before prescribing the substance and on supplying the substance that they are under no obligation to proceed
• If a health care practitioner wants to raise VAD with patient, they must also discuss the treatment and palliative care options for the illness at the same time
• Participants (doctors, nurses and witnesses to a declaration) must not be relatives or beneficiaries to a will
• There is a thorough paper-trail of all steps with specific forms sent to the Board
• There is a five-day cooling-off period between the first request and the final request
• With the board to issue the prescribed substance authorisation, it must check all paperwork and can refuse to issue an authorisation it doesn’t have all the paperwork or if it suspects eligibility has not been met
• Only authorised suppliers will be supplying the substance
• Prescriptions go directly to the authorised suppliers
• The substance must be kept in a locked box
• There is a review process through NCAT which can be accessed by patients, a patient’s agent or someone with a special interest in the medical care and treatment of the patient
• The grounds for review are whether the patient meets the residency requirements, has VAD decision-making capacity or is acting voluntarily or without pressure or duress
• There are a range of offences with high penalties, for example:
  • Life for unauthorised administration of substance
  • 7 years for inducing someone to apply for VAD
  • 12 months for not returning a substance
• A review of the act to commence after 12 months of operations and the review must include access for regional residents and cultural or language issues.

 

The Board

• Can refer matters to police or other authorities
• Appointed jointly by health minister and Attorney General
• Chairperson and deputy chairperson must be legal practitioners – judges, qualified to be judges, judicial officers of Supreme Court etc
• Will report statistics and findings every six months