September 17, 2021

How voluntary assisted dying will work in Queensland

How voluntary assisted dying will work in Queensland

The ABC reports that Queensland Parliament has voted to legalise voluntary assisted dying (VAD), although it will still be some time before the laws take effect.

So who is eligible and what will be involved? Can doctors conscientiously object and what about access in a faith-based aged care facility?

Coming after an often emotive debate, here is what we know about how Queensland’s VAD scheme will work.

Who can access it?

The criteria is stringent.

To be eligible, a person must be at least 18 years old, meet residency requirements, be acting voluntarily and without coercion, and have decision-making capacity – meaning people with dementia will not have access to VAD.

An eligible person must have been diagnosed with a disease, illness or medical condition that is advanced, progressive, causing “intolerable” suffering and expected to result in the person’s death within 12 months.

The single 12-month timeframe is significant because it is a longer overall lead-up than other states, where it is six months or 12 months for neurodegenerative diseases.

Premier Annastacia Palaszczuk wrote to Prime Minister Scott Morrison in May, requesting the Commonwealth Government take urgent action to amend the Commonwealth legislation on VAD.

This would allow practitioners involved in the scheme to discuss VAD through telehealth, providing access to people in rural and remote areas of Queensland.

What is involved?

Access to VAD hinges on a number of steps.

Essentially, a person who is suffering, dying and meets the eligibility criteria must make three separate requests, which are documented.

The first request to a medical practitioner must be “clear and unambiguous”, and made personally — not by someone else.

It’s then up to the doctor to accept or refuse that request and provide the person with information. If they agree, they become the coordinating practitioner.

The next step is known as the first assessment, in which the doctor — who must have completed approved training in VAD — must assess whether or not the person is eligible to access the scheme.

If the doctor deems that person is eligible and understands the information, they refer them on to another medical practitioner for a second, independent assessment.

Once that is satisfied, the person can make a second request for VAD, this time in writing, signed in the presence of two eligible witnesses.

For the application to proceed, there must then be a final request to the coordinating practitioner — with at least nine days between the first and last requests.

After receiving that final request, the doctor has to complete a review of the stages and certify that the person has decision-making capacity, and is acting voluntarily and without coercion.

A copy of that must be provided within two days to a VAD oversight board.

The person may decide at any time not to take any further steps with VAD.

In fact, they must be told, more than once, that they can decide at any time to discontinue the voluntary assisted dying process.

Finally, the person may decide “in consultation with and on the advice of the coordinating practitioner” to self-administer a substance, or for it to be administered by the administering practitioner.

Aged care facilities can opt out of participating in VAD but must still allow access to other practitioners.

What safeguards are in place?

One key safeguard will be the creation of the oversight board.

The board will consist of five to nine members appointed by the minister.

It must act independently and in the public interest and will not be “subject to direction by anyone including the Minister about how it performs its functions”.

Those functions include monitoring the operation, reviewing if practitioners are complying and referring any issues to entities such as the police commissioner, the health ombudsman or the state coroner.

Healthcare workers are also not allowed to start a conversation with a patient about voluntary assisted dying.

But a medical practitioner or nurse can do this if they discuss treatment options and palliative care at the same time.

There are also a number of offences detailed in the legislation, including the unauthorised administration of VAD substance.

When does the scheme kick in?

There are a range of things that need to happen before the scheme will be up and running.

These include creating new bodies such as the oversight board and a statewide pharmacy service, training relevant people, and developing an IT system.

These are expected to take some time to implement, meaning VAD will only come into effect in Queensland on January 1, 2023.

Can doctors refuse to participate?

In short, yes.

The legislation clearly states that a registered health practitioner can conscientiously object to being part of the VAD process.

But they must inform the person that other doctors or providers might be able to help them and then provide details of an official VAD navigator service.

What about faith-based institutions?

That’s a more complicated matter.

While practitioners and faith-based organisations won’t be forced to participate in VAD – and can opt out – the laws do limit what aged care homes can do if one of their residents wants to explore the option.

In his speech this week, Deputy Premier Steven Miles explained that those aged care facilities can choose not to participate “but they must allow reasonable access by practitioners who are willing to assist”.

How about short-stay patients in private hospitals or hospices? 

This is slightly different again.

A person can be transferred to another facility if wanting to undergo VAD.

But if this is not possible – for instance, if someone is too sick to be moved – the patient could access VAD in the facility.

Mr Miles said the laws respect both the rights of entities and the rights of people seeking access to VAD.

“Just because someone has found themselves in the situation of being in a particular facility, they shouldn’t be prevented from accessing a lawful end-of-life option if it’s something they qualify for and they want to pursue,” he said.

“This is especially the case for aged care.”

In the face of a raft of concerns from faith-based institutions, Mr Miles announced this week the government agreed to develop proposed clinical guidelines to address those institution’s concerns and provide certainty, as well as consult them during the implementation.