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Voluntary assisted dying process

Information about what a person has to do to apply to choose to end their life.

The procedure for applying has many steps and safeguards to ensure that the person genuinely wishes to end their life, that they have appropriate decision-making capacity and that they are not encouraged or pressured to volunteer.

Only the person who is dying, may ask for voluntary assisted dying. A person cannot ask on the dying person's behalf. The issue of voluntary dying must not be raised by a health provider.

At least 2 doctors are required to make a careful assessment to see whether the patient meets the criteria. This includes making sure that the patient is making the decision voluntarily and that their medical condition is expected to be terminal within the required time (usually within 6 months).

The person can change their mind at any time and must be fully informed about their condition, the dangers and the outcome of taking the lethal drug.

The person who wants to end thier life must follow these procedures:

First request

A terminally ill patient may ask a registered medial practitioner ('doctor') for access to voluntary assisted dying. This request must be made personally. It must be clear and unambiguous, but can be made with gestures or other means of communication if necessary.

There is no obligation to continue the assessment process after making the first request. At any time, the person may decide not to proceed and the process ends. The person may begin the process over again by making a request at another time. So, by making another first request.

See ss. 11, 12—Voluntary Assisted Dying Act 2017 (Vic)(opens in a new window).

Doctor must accept or refuse the request

Within 7 days of the first request, the doctor must either accept or refuse the request. They can only refuse this request if they:

  • have a conscientious objection to voluntary assisted dying
  • believe they will not be available to perform the duties
  • are required to refuse because they are not qualified to accept (must hold a fellowship with a specialist medical college or be vocationally registered as a general practitioner (GP)).

If the doctor accepts the first request, the request and their acceptance must be recorded on the patient's record.

See s. 13—Voluntary Assisted Dying Act 2017 (Vic)(opens in a new window).

Role of the co-ordinating doctor

The accepting doctor then becomes the co-ordinating medical practitioner (co-ordinating doctor) for the patient. The co-ordinating doctor must then asses the requests to see if the applicant meets the eligibility criteria. The doctor must complete specific training before they make this assessment.

This doctor's role is to co-ordinate and facilitate the patient's access to the lethal treatment if they meet the eligibility criteria. In cases where the patient is not able to self-administer the lethal drug, the doctor's role may also be to administer this.

See ss. 15, 16, 17—Voluntary Assisted Dying Act 2017 (Vic)(opens in a new window) and Who is eligible to apply?

If co-ordinating doctor is unsure about eligibility

If the co-ordinating doctor is not able to decide whether:

  • the patient has decision-making capacity in relation to voluntary assisted dying, or
  • the patient's disease, illness or medical condition meets the criteria
  • the patient has a neurological disease that is expected to cause death within 12 months

they must refer the person to a registered health practitioner who has the appropriate skills and training, for example, a psychiatrist if mental illness is a factor.

The co-ordinating doctor may then adopt the decision of the specialists whose assessment was sought.

See s. 18—Voluntary Assisted Dying Act 2017 (Vic)(opens in a new window) and for information about capacity see Who is eligible to apply?

If patient meets the eligibility criteria

If the co-ordinating doctor makes an assessment that the patient meets all of the eligibility criteria, they must inform the patient about:

  • their diagnosis and prognosis (likely progression and outcome of the disease)
  • treatment options available (and likely outcomes)
  • palliative care options (and likely outcomes)
  • potential risks of taking the lethal substance
  • likely cause of taking the lethal substance is death
  • patient can change their mind at any time
  • the benefits of telling any other consulting doctors who are treating them of their application.

With the patient's consent, this doctor should also carefully explain to a family member all the relevant clinical guidelines and the plan for self-administration of the lethal drug.

See s. 19—Voluntary Assisted Dying Act 2017 (Vic)(opens in a new window) and Who is eligible to apply?

Outcome of first assessment

Patient must be assessed as eligible if the co-ordinating doctor is satisfied that they:

  • meet all eligibility criteria
  • understand the information required
  • are acting voluntarily and without coercion
  • their request for voluntary assisted dying is enduring.

If the co-ordinating doctor is not satisfied that the person meets all of the criteria, then the patient is ineligible and the application process ends. Either way, they must notify the patient.

The co-ordinating doctor must also complete an assessment report and give a copy to the Voluntary Assisted Dying Review Board within 7 days.

See s. 20—Voluntary Assisted Dying Act 2017 (Vic)(opens in a new window) and Who is eligible to apply?

Next step is referral to another doctor

If the person is eligible then the co-ordinating doctor must get a second opinion. They do this by referring the patient to another doctor for a consulting assessment. The consulting doctor has 7 days to accept or reject the referral.

The reasons for refusing the referral are the same as for the co-ordinating doctor.

In addition to this the consulting doctor must have been practising for at least 5 years and have expertise in the disease, illness or medical condition that is expected to cause death. These additional requirements do not apply if the co-ordinating doctor has these qualifications. If they accept, they become the consulting doctor for the patient.

See ss. 22, 23, 24—Voluntary Assisted Dying Act 2017 (Vic)(opens in a new window).

Procedure to be followed by the consulting doctor

Like the assessment for the co-ordinating doctor the consulting doctor must:

  • complete the required assessment training before making an assessment
  • seek specialist opinions if unsure about capacity, whether the medical condition meets the criteria
  • (may) accept the determination of the specialist consulted
  • inform the patient of their prognosis, palliative care options, risks and expected outcome of the lethal medication etc
  • communicate the outcome to patient, Board and co-ordinating doctor
  • assess the patient as ineligible if they do not meet all the eligibility criteria

See ss. 25, 26, 27, 28, 29, 30—Voluntary Assisted Dying Act 2017 (Vic)(opens in a new window).

If second assessment is that patient is ineligible

If the consulting doctor decides that the patient does not meet all of the criteria, then the consulting doctor may refer the patient to another consulting doctor.

See s. 31—Voluntary Assisted Dying Act 2017 (Vic)(opens in a new window).

Procedure if patient found eligible

Patient to make written declaration

Patient may make a written declaration. This document must specify that the patient:

  • makes the declaration voluntarily and without coercion
  • understands the nature and effect of the declaration.

The declaration must be signed by the patient in the presence of 2 witnesses and the co-ordinating doctor. If the patient is unable to sign, an adult may sign on their behalf, provided that they are not a witness to the signing.

See s. 34—Voluntary Assisted Dying Act 2017 (Vic)(opens in a new window).

Eligible witnesses

A witness must be an adult and they are not eligible if:

  • they know or believe that they are a beneficiary under the patient's will
  • may otherwise benefit financially from the death of the patient
  • they own or are responsible for the day-to-day operation of a health facility where the patient lives or is being treated
  • they are directly involved in providing health or professional care services to the patient.

Only one witness may be a family member of the patient.

See s. 35—Voluntary Assisted Dying Act 2017 (Vic)(opens in a new window).

Final request by patient

After making a declaration the patient may make a final request for access to voluntary assisted dying. The patient must make this final request personally to the co-ordinating doctor. This request may be made by gestures or other communication if necessary. It cannot be made on behalf of the patient by someone else.

This final request must be made at least one day after making the declaration, and at least 9 days after making the first request. This 9 day period may be waived if the co-ordinating doctor believes that the patient is likely to die before this period expires. This belief must be consistent with the consulting doctor's assessment.

See ss. 37, 38—Voluntary Assisted Dying Act 2017 (Vic)(opens in a new window).

Note: if the patient is not capable of administering the drug themselves they must make one more 'final request' for the co-ordinating doctor to administer the lethal drug. See below Doctor (practitioner) administration permit.

Patient to appoint a contact person

After making this final request the patient must appoint an adult contact person by using an appointment form signed by the patient and the contact person. This person must return any unused drugs to the pharmacist if the person dies before the substance is administers or if the patient has changes their mind.

See ss. 39, 40—Voluntary Assisted Dying Act 2017 (Vic)(opens in a new window).

Final review by co-ordinating doctor

After the patient makes a final request the co-ordinating doctor must make a final assessment by looking at:

  • the first assessment report form
  • al consulting assessment report forms
  • the written declaration
  • the contact person appointment form.

They must then complete the final review form and certify whether the assessment process has been followed according to the Act. (Minor technical errors will not invalidate the process).

See ss. 41, 42—Voluntary Assisted Dying Act 2017 (Vic)(opens in a new window).

Doctor applies for voluntary assisted dying permit

After making the final assessment the co-ordinating doctor may apply for a voluntary assisted dying permit. There is no obligation on the patient to continue if they change their mind. They must apply to the Secretary of Department of Health and Human Services (the secretary) for either a self-administration permit, or a practitioner administration permit. These applications are in a prescribed form listed in Schedule 1 of the Voluntary Assisted Dying Regulations 2018 (Vic).

The secretary may refuse to issue the permit if they believe that the assessment process has not been properly completed. The secretary must notify the co-ordinating doctor of their decision as soon as possible. If they refuse to issue the permit, they must give reasons for doing so. They must also notify the board within 7 days of their decision.

See ss. 43, 47, 48, 49—Voluntary Assisted Dying Act 2017 (Vic)(opens in a new window) and Forms.

What these permits authorise

In most cases the permit will authorise the patient to administer the drug themselves. It is only where they are not capable of doing this that the co-ordinating doctor will administer the lethal dose.

Self-administration permit

This permit authorises the co-ordinating doctor to prescribe and supply a dose of the voluntary assisted dying substance (lethal drug) to the patient who is capable of self-administering the drug.

The permit also authorises the patient who made the request to possess, store, use and self-administer the drug.

If the person loses the capacity to self-administer the drug, they must ask their co-ordinating doctor to apply for a practitioner administration permit

Role of the contact person

The permit also requires the contact person specified in the permit to possess and store any unused portion of the drug and to transport any remainder to the pharmacist that dispensed the drug. They have 15 days from the time the person dies, to return any unused portion of the drug.

The contact is also responsible for returning the drug if the patient changes their mind and decides not to take the lethal drug.

See s. 45, 53—Voluntary Assisted Dying Act 2017 (Vic)(opens in a new window).

Doctor (practitioner) administration permit

This permit authorises the co-ordinating doctor to:

  • prescribe and supply a dose of the voluntary assisted dying substance (lethal drug) sufficient to cause death
  • receive a request from the patient to administer the drug (before a witness)
  • possess, use and administer the drug to the patient (before a witness) but only if:
    • the patient is physically incapable of administering the drug themselves
    • has decision-making capacity at the time they make the administration request
    • the person made the request voluntarily without coercion
    • the patient's administration request is ongoing (that is, they have not changed their mind)
    • the drug is administered directly after the patent makes the request.

See s. 46—Voluntary Assisted Dying Act 2017 (Vic)(opens in a new window).

Patient request for doctor to administer drug

If the patient is not able to self-administer the drug and the co-ordinating doctor has succeeded in applying for a permit from the secretary, the patient must make one final request for the doctor to administer the drug. This request can be made by gesture or other means. This request must be witnessed by an independent adult. The doctor can then administer the drug if they are satisfied that the patient still wishes to die, and has decision making capacity.

The doctor then must notify the board with 7 days of administering the drug. They do this by providing a copy of the co-ordinating medial practitioner administration form.

See ss. 64, 65, 66—Voluntary Assisted Dying Act 2017 (Vic)(opens in a new window).

More information

Legislation

Voluntary Assisted Dying Act 2017 (Vic)

  • s. 11—person may make first request to a registered medical practitioner
  • s. 12—no obligation to continue the process
  • s. 13—doctor must accept or refuse request within 7 days
  • s. 14—request and acceptance must be recorded on patient's record
  • s. 15—co-ordinating medical practitioner
  • s. 16—commencement of first assessment
  • s. 17—requirement for co-ordinating doctor to successfully complete assessment training before they assess eligibility
  • s. 18—co-ordinating doctor to get specialist opinion if unsure
  • s. 19—information to be provided to patient if doctor finds they are eligible
  • s. 20—outcome of the first assessment
  • s. 22—referral to another doctor for a consulting assessment
  • s. 23—consulting doctor must accept or refuse referral within 7 days
  • s. 25—commencement of consulting assessment
  • s. 26—requirement for consulting doctor to have required assessment training before they begin the assessment
  • s. 27—referral for a specialist opinion
  • s. 28—information to be provided to the patient by the consulting doctor
  • s. 30—requirement to record and communicate the outcome of the second assessment
  • s. 31—co-ordinating doctor may refer the patient to another consulting doctor
  • s. 35—witness to make written declaration
  • s. 37—patient may make final request
  • s. 38—final request to be made after at least one day after patient makes written declaration (plus usually 9 days after initial request made)
  • s. 39—contact person to be appointed by patient
  • s. 40—formal requirements of the appointment of the contact person
  • s. 41—final review by the co-ordinating doctor
  • s. 42—technical error in one of the forms will not invalidate the request and assessment process
  • s. 45—what the self-administration permit authorises
  • s. 46—what the practitioner administration permit authorises
  • s. 47—application for the self-administration permit
  • s. 48—application for the practitioner administration permit
  • s. 49—application to be decided by the secretary
  • s. 53—if patient loses ability to self-administer they can ask the co-ordinating doctor to apply for a doctor administration permit
  • s. 64—patient may make an administrative request to the co-ordinating doctor to administer the lethal drug
  • s. 65—role of the witness where the drug is administered by the co-ordinating doctor
  • s. 66—certification by co-ordinating doctor to the board after administering the lethal drug

See Voluntary Assisted Dying Act 2017 (Vic)(opens in a new window).

Updated