New South Wales, Australia, to provide voluntary assisted dying from November 28: standards and processes

The Voluntary Assisted Dying Bill 2022 comes into force on 28 November 2023, meaning eligible people in New South Wales will be able to request medical assistance to end their life.

A person must be in the advanced stages of a terminal illness, disease, or health condition. They must also be experiencing great pain.

If a person meets all the criteria and follows the steps required by law, they can take or receive voluntary assisted dying (VAD) substances to achieve death at a time of their choosing. The substance must be prescribed by an authorized voluntary assisted dying practitioner.

"Voluntary" means that the choice must be the individual's own. The person must have decision-making capacity throughout the process to receive voluntary assisted dying.

People with dementia are generally not eligible for VAD. This is because dementia severe enough for a person to qualify for a VAD may hinder their ability to make decisions.

Disability or mental illness alone does not qualify a person for VAD unless they meet all other eligibility criteria.

Over the past 18 months, NSW Health has worked with the community and health, aged care and other stakeholders to implement the framework set out in the legislation to ensure voluntary assisted dying is safe, accessible and compliant with the law .

Strict criteria must be met to receive voluntary assisted dying . To be eligible, a person must:

• Be an adult (18 years and above), an Australian citizen or an Australian permanent resident or have resided in Australia continuously for at least three years
• Have resided in New South Wales for at least 12 months (the Voluntary Assisted Dying Commission may grant residence exemptions on compassionate grounds for people with close ties to New South Wales)

Have at least one disease, illness, or health condition where:

• is an advanced and progressive disease, disorder, or medical condition
• would, on the balance of probabilities, result in their death within six months (or within 12 months in the case of neurodegenerative diseases such as motor neurone disease), and
• is causing people pain that cannot be relieved in a way that people think is bearable
• Have decision-making capacity related to voluntary assisted dying
• act voluntarily and without pressure or coercion, and
• Have a lasting request for voluntary assisted dying

The exact process for a VAD varies by state, but the basic process involves the following steps:

• A person requests a VAD from a qualified doctor
• VAD eligibility assessment by the same qualified physician
• Second qualified physician conducts VAD eligibility assessment
• The person again requests VAD in writing
• This person makes the final request for VAD
• Officially authorized VAD. (Both physicians evaluating VAD eligibility must have received specific VAD training in the state in which they practice)
• Qualified healthcare practitioner prescribes and dispenses VAD medications

anyone:

• The eligible person takes a VAD medication, or
• Qualified healthcare practitioners provide VAD medicines to eligible people

If you take your VAD medication (self-administer), you can choose a time and place to take it. Others, such as friends and family, can also be present if you wish.

Most states require a witness if VAD medications are administered by a health care practitioner.

It is important to remember that you can withdraw (stop) a VAD request at any time, even if you have made an assessment or made a written request.

There are a variety of VAD services that provide support and assistance to patients, families, caregivers, medical practitioners and service providers through processes and procedures.

The Voluntary Assisted Death Care Navigation Service is available for:

• Provide information and support to patients and other community members who have questions about voluntary assisted dying or wish to seek voluntary assisted dying
• Support practitioner inquiries and coordinate ongoing training and support for coordinating, consulting and managing practitioners
• Provide patients with advice on voluntary assisted dying to their clinical care team and, in some cases, connect them with coordinating, consulting and management practitioners

The Voluntary Assisted Dying Pharmacy Service is responsible for:

• Coordinate the safe procurement, supply and disposal of voluntary assisted dying materials in NSW
• Support patients to access voluntary assisted dying regardless of their setting, for example the patient may be at home, in a residential care facility or in a public hospital

The Voluntary Assisted Dying Committee is an independent oversight and decision-making body whose main functions include:

• Monitor and report on the implementation of the Act
• Deciding whether to approve or deny an application for voluntary assisted dying
• Maintain a list of registered medical practitioners willing to provide voluntary euthanasia services

Voluntary assisted dying will be included in each local health district's end-of-life care pathway and patients must be informed of all options available to them, including hospice and other treatment options, to match their goals of care.

A person's decision to seek information about voluntary assisted dying or access to voluntary assisted dying does not affect that person's access to high-quality hospice care.

It is also important to note that a person cannot request a VAD as part of their advance care planning (to ensure that your family and medical team are aware of your medical wishes if you lose the ability to make your own decisions). This is because an advance directive only takes effect when you no longer have decision-making capacity.