What is voluntary assisted dying?
Voluntary assisted dying is a process that enables an eligible individual to voluntarily access and self-administer, or in some circumstances have a medical practitioner administer, a medication that will cause their death, in accordance with the steps and process set out in the Voluntary Assisted Dying Act 2021 (the Act).
It is an end of life choice available to eligible South Australians as part of high-quality, person centred end of life care.
Why would someone access voluntary assisted dying?
Most people will find that palliative care and end of life services provide the support they need at end of life. These services aim to improve the quality of life for people with advanced disease and provide support to their carers and family.
Even with the best care some people getting close to the end of their life can experience suffering that is unable to be relieved in a way that is tolerable to them and may want to ask for assistance to die.
If they meet all the eligibility criteria and follow the steps and process set out in the Act, they may access voluntary assisted dying in South Australia.
Is voluntary assisted dying the same as voluntary euthanasia?
The term voluntary assisted dying is now commonly used in Australia, rather than euthanasia. However, it is essentially the same concept. People use different words to talk about voluntary assisted dying and these words can make you think about the process in different ways.
South Australia uses the term 'voluntary assisted dying' because the law allows people who are eligible near the end of their lives to make their own decision about how and when they die.
Is voluntary assisted dying suicide?
The Act makes it clear that a person who dies as a result of the administration of the voluntary assisted dying medication in accordance with the law does not die by suicide. The person is taken to have died from the disease, illness or medical condition from which they were dying.
Can someone with a disability or mental illness access voluntary assisted dying?
People with a disability or mental illness have the same right to request voluntary assisted dying as those without a disability or mental illness. However, only having a disability or mental illness isn’t sufficient reason for a person to receive access to voluntary assisted dying without that person also meeting all the eligibility criteria.
People who have a disability or who have difficulty communicating may use a suitably qualified interpreter or their preferred means of communication (e.g. a communication aid, writing, gestures) or other assistance to communicate their choice.
Can someone with dementia access voluntary assisted dying?
A person diagnosed with dementia may be eligible if they meet all the eligibility criteria. When dementia affects a person's capacity to make a decision about voluntary assisted dying, they won’t meet the eligibility criteria to access voluntary assisted dying.
How does the legislation protect vulnerable people?
There are 70 safeguards embedded in the Act to ensure voluntary assisted dying can only be accessed by people who are eligible.
The Act ensures that a person’s decision to access voluntary assisted dying is voluntary and provides clear guidance for how health practitioners can lawfully support their choice.
The Act provides for and regulates access to voluntary assisted dying in South Australia by establishing:
- clear eligibility criteria
- a request and assessment process, including specific requirements for medical practitioners
- a voluntary assisted dying permit process which authorises the prescribing and dispensing of the voluntary assisted dying medication
- the South Australian Voluntary Assisted Dying Review Board
- safeguards including medication monitoring, practitioner protections, offences, and a five-year review.
Key safeguards in the legislation include:
- a person making a request to access voluntary assisted dying must have decision making capacity in relation to voluntary assisted dying
- a person making a request to access voluntary assisted dying must make a decision that is voluntary and without coercion
- demonstration that the choice to request voluntary assisted dying is enduring
- registered health practitioners are prohibited from initiating a discussion about voluntary assisted dying with a patient
- requirements relating to the qualifications and training of participating medical practitioners
- record keeping and reporting requirements.
In what other states and territories is voluntary assisted dying legal?
Voluntary assisted dying is now operating and may be requested by people who meet the eligibility criteria in Victoria, Western Australia, Tasmania and Queensland. New South Wales has passed legislation relating to voluntary assisted dying however, the laws are not yet operational.
The voluntary assisted dying laws across the states contain similarities but include some key differences specific to the approach in each state.
The Australian Capital Territory and Northern Territory have not passed legislation relating to voluntary assisted dying at this time.
When can a health practitioner provide information about voluntary assisted dying?
Registered health practitioners must not initiate a discussion about voluntary assisted dying or suggest voluntary assisted dying with a person they provide health or professional care services to. Doing so may constitute unprofessional conduct under the Health Practitioner Regulation National Law (South Australia) Act 2010 (SA) which may attract disciplinary action.
Health practitioners who are asked about voluntary assisted dying should provide any information they are able to and refer the person to where they can find out more.
What information should health practitioners provide about accessing voluntary assisted dying if a patient asks them about it first?
Registered health practitioners should manage discussions about voluntary assisted dying and end of life care with sensitivity, empathy, and respect for the patient’s autonomy. Questions about voluntary assisted dying present an opportunity for registered health practitioners to have an open, honest, and meaningful discussion with the patient about their suffering and end of life care needs.
People may ask about voluntary assisted dying because they are experiencing suffering and want support to understand their end-of-life care options.
Registered health practitioners may have a conversation with the patient to understand their situation, how they are feeling, their options for treatment and care and their priorities as they approach end of life.
If a patient seeks information about voluntary assisted dying, health practitioners should provide them with what information they can or tell them where to find out more. For example, people interested in finding out more about voluntary assisted dying could be encouraged to:
- speak with their treating medical practitioner (a GP or specialist)
- visit www.sahealth.sa.gov.au/vad
- read the Knowing your choices: Information for people considering voluntary assisted dying (PDF 208KB)
- contact the South Australian Voluntary Assisted Dying Care Navigator Service.
The Act permits registered health practitioners to choose the extent of their involvement in voluntary assisted dying, taking into consideration if they have a conscientious objection to voluntary assisted dying.
Do health practitioners have to participate in voluntary assisted dying if a patient asks them to?
All health practitioners have the right to choose whether or not they want to participate in voluntary assisted dying. Health practitioners are not obliged to participate in voluntary assisted dying.
They can choose their level of involvement in voluntary assisted dying, including:
- providing information
- participating in the requests and assessments
- applying for voluntary assisted dying permit
- prescribing or administering medication
- being present at the time of administration of medication.
If a health practitioner does conscientiously object it is important that they do not impede or obstruct a patient’s access to voluntary assisted dying.
I want to access voluntary assisted dying, but my treating medical practitioner has chosen not to participate. What do I do?
If a person’s treating medical practitioner chooses not to participate, the person can contact the South Australian Voluntary Assisted Dying Care Navigator Service who offer support and help connect people with an appropriate medical practitioner participating in voluntary assisted dying.
Registered health practitioners who choose not to participate in a discussion about voluntary assisted dying are encouraged be aware of their professional obligation not to impede or obstruct access to voluntary assisted dying.
Are other treatment options offered to people seeking to access voluntary assisted dying?
Voluntary assisted dying is an end of life choice available to eligible South Australians as part of high-quality, person centred end of life care.
This is in addition to other choices that people may make about their end of, including palliative care.
All people have the right to be supported in making informed decisions about their end of life care and to understand their medical treatment options including comfort and palliative care.
The Act requires a person’s Coordinating and Consulting Medical Practitioners to inform them about the treatment options available to them, including palliative care, and the likely outcomes of that treatment.
How does a person request voluntary assisted dying?
The first step for a person thinking about requesting voluntary assisted dying is to ask a health practitioner (such as a general practitioner [GP], specialist doctor or nurse) for information about it. A health practitioner can only talk about voluntary assisted dying when a person asks them about it first. A request for information does begin the voluntary assisted dying process.
A person should discuss their intent to access voluntary assisted dying with their treating medical practitioner.
A person makes a first request to access voluntary assisted dying:
- to a registered medical practitioner
- clearly and unambiguously
- by themselves personally.
The medical practitioner has seven calendar days to tell the person if they will accept the request and become the persons Coordinating Medical Practitioner or if they refuse the request, for example because they have a conscientious objection or they’re not eligible to participate.
Medical practitioners must meet the requirements in the Act to be the person’s Coordinating Medical Practitioner.
The formal process begins when a person makes the first request to their medical practitioner.
Under the Act, this process cannot be completed in less than nine days, unless the person is expected to die within that time.
For more information, you may like to refer to the Knowing your choices: Information for people considering voluntary assisted dying (PDF 208KB) resource.
What if someone needs an interpreter or assistance with communication?
A person who prefers or needs to communicate in a language other than English can use a suitably qualified interpreter to help them make their request to access voluntary assisted dying.
The Act requires an interpreter who assists you throughout the Voluntary Assisted Dying Pathway to:
- be accredited by the National Accreditation Authority for Translators and Interpreters (NAATI) or any other body determined by the Chief Executive in accordance with the Voluntary Assisted Dying Regulations 2022
- not be a member of your family
- not know or believe they may benefit from your death
- not own or be responsible for the day-to-day management of a health facility where you live or are being treated, for example as a residential aged care facility
- not be directly involved in providing health services or professional care to you.
A person who has a disability that affects their ability to be understood by others can communicate their request to access voluntary assisted dying through speech, gestures, or other means of communication available to them.
Health practitioners should take reasonable steps to support the person to communicate in their most effective form of communication and in a way that enables a person to actively participate and understand.
Can a person's family or friend or ask for voluntary assisted dying on that person’s behalf?
A person can only access voluntary assisted dying if they request it personally.
Another person, for example a family member or friend, can support the person to access voluntary assisted dying. However, they cannot request to access voluntary assisted dying on that person’s behalf.
Can a person request voluntary assisted dying in an Advance Care Directive?
An Advance Care Directive guides decision making about ongoing health care, living arrangements and other personal matters as well as who can make decisions for a person if they lose the capacity to make decisions themselves.
While a person is at liberty to include their desire to access voluntary assisted dying in an Advance Care Directive, this will not be considered a request for voluntary assisted dying. This is reflected in the Advance Care Directives Act 2013 (SA).
The Voluntary Assisted Dying Act 2021 requires people requesting voluntary assisted dying to have decision making capacity at the time of requesting access as well as throughout the entire voluntary assisted dying process to make sure their decision remains voluntary and consistent.
What if my family does not support me to access voluntary assisted dying?
For some people, death and dying can be difficult to talk about. But it is important that you do so and plan ahead to make the right choices for you.
If you would prefer to, you can keep the conversation confidential between you and your doctor. Just like any other aspect of your healthcare and treatment, you do not have to share details if you do not want to.
You may also contact the South Australia Voluntary Assisted Dying Care Navigator Service. The Care Navigator Service is available to support you to access voluntary assisted dying and help connect you with appropriate medical practitioners and health services participating in voluntary assisted dying.
What training does a doctor need to undertake to perform the assessments for voluntary assisted dying?
Medical practitioners must successfully complete the Mandatory Voluntary Assisted Dying Training for Medical Practitioners, accessed online via the Voluntary Assisted Dying Clinical Portal.
Medical practitioners can complete the training at any time, including:
- before the practitioner receives a request for voluntary assisted dying
- after the practitioner has accepted a first request for voluntary assisted dying
- after the practitioner has accepted a referral for a consulting assessment for voluntary assisted dying.
Training remains valid for five years from the date of successful completion.
How long does the voluntary assisted dying process take?
Accessing voluntary assisted dying includes a number of safeguards. A person must make three requests for voluntary assisted dying, be assessed as eligible by two independent medical practitioners, appoint a Contact Person and arrange supply of the medication. For this reason, the process takes time.
A person seeking to access voluntary assisted dying is advised to start early and plan ahead by talking about their end of life care with their treating medical practitioner. This will help avoid stress at an already challenging time.
Under the Act, the person can only make a final request to access voluntary assisted dying at least nine days from the date they made the first request and at least one day after their consulting assessment. The nine day period can only be shortened if the Coordinating and Consulting Medical Practitioners have each independently assessed that a person’s death is likely to occur before this.
What documents do I need to show I am eligible to access voluntary assisted dying?
To access voluntary assisted dying, two independent medical practitioners must verify you meet the eligibility criteria in the Act.
You will need to provide proof of all the below:
- that you are aged 18 or older
- that you are an Australian citizen or permanent resident
- that you have lived in South Australia for at least 12 months.
A driver's license, proof of age card or birth certificate are examples of documents that may be used to prove you are eligible.
You can prepare for your assessment by completing a Prepare for Assessment Form in the Voluntary Assisted Dying Clinical Portal.
It will help you to:
- collect information you will need to provide in the first assessment
- collect evidence required to establish your eligibility, for example proof of age
- understand what to expect at the first assessment.
The South Australian Voluntary Assisted Dying Care Navigator Service can also support you to prepare for your assessment.
For more information, you may like to refer to the Knowing your choices: Information for people considering voluntary assisted dying (PDF 208KB) resource.
I don’t think I will meet the criteria for voluntary assisted dying. What can I do?
If you are thinking about requesting access to voluntary assisted dying but don’t think you will meet the eligibility criteria, it might still be a good idea to talk to your general practitioner, a medical practitioner or another health practitioner (e.g. nurse, allied health practitioner) involved in your care about how you are feeling.
They can help you explore why you are thinking about voluntary assisted dying, and what treatment, end of life care options and other support services may be available to help you.
What happens if a person’s decision making capacity becomes impaired during the voluntary assisted dying process?
The Act has strict eligibility criteria to access voluntary assisted dying which includes the person having decision making capacity in relation to voluntary assisted dying.
A person is presumed to have decision making capacity, including in relation to voluntary assisted dying, unless there is evidence to the contrary. Medical practitioners must specifically assess the person’s capacity to make decisions about voluntary assisted dying.
Decision making capacity must be assessed at multiple points in the Voluntary Assisted Dying Pathway:
- as part of the eligibility assessments, including the first assessment, consulting assessment(s) and specialist opinion regarding decision making capacity
- at the time of the written declaration
- at the time of administration under a Practitioner Administration Permit.
Whether a person has decision making capacity in relation to voluntary assisted dying is a decision reviewable by SACAT.
What if I don’t agree with a decision about my eligibility for voluntary assisted dying?
South Australian Civil and Administrative Tribunal (SACAT) is an independent legal body that helps resolve issues within specific areas of law.
Under the Act, SACAT has power to review a decision in relation to:
- a decision that the person has or has not been ordinarily resident in South Australia
- a decision that the person has or has not been ordinarily resident in South Australia for at least 12 months at time of the first request
- a decision that the person does or does not have decision making capacity in relation to voluntary assisted dying
Can I change my mind about accessing voluntary assisted dying?
If at any point you change your mind about continuing with voluntary assisted dying process, you can stop the process.
Can I die at home with voluntary assisted dying?
Voluntary assisted dying is about choice. Voluntary assisted dying provides an option to choose the manner, place and time of death for eligible people who are terminally ill and experiencing suffering that cannot be relieved in a manner that they consider tolerable as they near the end of their life.
People can choose to be at home often with loved ones present when they administer the voluntary assisted dying medication. A person may also be residing somewhere other than a private home, for example a hospital.
Who can be present at a person's death?
People accessing voluntary assisted dying can choose the time and place of their death as well as who will be present.
A person should have at least one support person present when self-administering the medication. This helps to make sure that the person’s body can be cared for after death. They may also ensure the person’s Contact Person is notified if they are not present. The Contact Person is responsible for ensuring any unused medication is safely stored and returned to the South Australian Voluntary Assisted Dying Pharmacy Service for disposal.
Being present for a person’s death can be a positive experience for carers, family or friends, but may be confronting for some. People are encouraged to inform their supports so they can be prepared for what to expect and decide whether attending the death is right for them.
A person may ask a health practitioner or care worker to be present at their death. It is up to the individual health practitioner to decide whether to attend or not attend.
How will a person take the voluntary assisted dying medication?
Most people will take the medication as a mixture, either by swallowing it or by giving it through a feeding tube (enteral administration). If someone is unable to take the medication in this way it can be given intravenously, but this can only happen if they have been issued with a Practitioner Administration Permit.
Who can administer the voluntary assisted dying medication?
The voluntary assisted dying permit determines who is legally authorised to administer the voluntary assisted dying medication. If a person has a Self-administration Permit, they must self-administer the medication independently.
If a person has a Practitioner Administration Permit, only the Coordinating Medical Practitioner can administer the medication. This can only occur at the person’s request in the presence of a witness.
Do I need to take the medication within a certain timeframe?
There is no obligation to take the medication once it has been supplied. You can choose not to continue with voluntary assisted dying at any point in time.
How long does the medication take to be effective?
Most people fall asleep within a few minutes of administration of voluntary assisted dying medication. In most cases, death occurs within 60 minutes, but it can sometimes take longer.
Can I take the medication interstate?
Voluntary assisted dying permits authorise the administration of the medication within South Australian borders.
What happens to remaining or unused medication?
Remaining or unused voluntary assisted dying medication must be returned to the South Australian Voluntary Assisted Dying Pharmacy Service where it will be safely disposed of. In the event of the person’s death, the Contact Person is responsible for ensuring this is done within 15 calendar days. The pharmacist will explain how to return unused medication when it is supplied.
What safeguards are in place to ensure the medication is not misused?
Once the medication has been supplied to a person, they are responsible for storing it securely in the locked box provided until they choose to use it or return it to the Pharmacy Service.
From the experiences reporting in other states, people take this responsibility very seriously and there have been no known instances where a medication has been misplaced, stolen or misused.
If the person chooses to return the medication or dies before taking it, responsibility for returning the medication transfers to their Contact Person. If they do not fulfil their responsibilities under the Act, the Contact Person may be charged with an offence and face a penalty of up to 12 months imprisonment.
Will voluntary assisted dying deaths be reported to the State Coroner?
When someone dies, a doctor must notify Births, Deaths and Marriages of the death within 48 hours if they either:
- were responsible for a person’s medical care immediately before their death
- examined the body of the person after death.
If a doctor knows or has reason to believe that the person who died was the subject of a voluntary assisted dying permit, they must notify both:
- the Registrar of Births, Death and Marriages
- the State Coroner.
What is the role of the South Australian Voluntary Assisted Dying Care Navigator Service?
The South Australian Voluntary Assisted Dying Care Navigator Service (SAVAD-CNS) provides a service to assist people considering voluntary assisted dying, their family, friends and carers, health practitioners and health service providers to navigate the Voluntary Assisted Dying Pathway.
The Care Navigator Service provides:
- general information about end of life care services, including voluntary assisted dying and bereavement support
- individualised support for people accessing voluntary assisted dying
- assistance connecting people accessing voluntary assisted dying with appropriate medical practitioners and health services participating in voluntary assisted dying
- access to voluntary assisted dying support packages
- support for medical practitioners and health services
- education and training for health services.
SAVAD-CNS can be contacted by email and phone during standard business hours (9.00 am to 5:00 pm).
Email: Health.VADCareNavigators@sa.gov.au
Phone: 0403 087 390
What is the role of the South Australian Voluntary Assisted Dying Pharmacy Service?
The South Australian Voluntary Assisted Dying Pharmacy Service (SAVAD-PS) provides the safe supply, education about, and disposal of voluntary assisted dying medication.
The Pharmacy Service is responsible for:
- supply of the voluntary assisted dying medication kit
- educating a person accessing voluntary assisted dying about the administration process
- educating the Contact Person about their responsibilities to return the medication
- educating medical practitioners about the medication-related aspects of the pathway
- facilitating the return and safe disposal of any unused voluntary assisted dying medication
- preparing and maintaining medication-related resources
- supporting healthcare services in the preparation and maintenance of medication-related governance.
SAVAD-PS can be contacted by email and phone during standard business hours (9.00 am to 5.00 pm).
Email: Health.VADPharmacy@sa.gov.au
Phone:
(08) 7326
1746
What is the role of the Voluntary Assisted Dying Review Board?
The South Australian Voluntary Assisted Dying Review Board has been appointed by the Minister for Health and Wellbeing to oversee voluntary assisted dying in South Australia. The eight-member Review Board is responsible for the review of functions and powers exercised under the Voluntary Assisted Dying Act 2021.
What information does the Voluntary Assisted Dying Review Board collect to monitor matters relating to voluntary assisted dying?
The Act permits the Voluntary Assisted Dying Review Board to collect information on voluntary assisted dying in South Australia to ensure it is carried out in accordance with the Act and to promote improvements in delivery.
The Review Board will collect information on:
- people applying for and accessing the Voluntary Assisted Dying Pathway
- medical practitioners participating in the Voluntary Assisted Dying Pathway
- self-administered and practitioner administered permits
- feedback and complaints in relation to the Voluntary Assisted Dying Pathway.
The Review Board will use information it collects to monitor and report on voluntary assisted dying in South Australia and to make information about voluntary assisted dying publicly available at regular intervals.
Where can I go to for support?
Help and support in relation to voluntary assisted dying is available from a range of sources including:
- your doctor and your healthcare team
- your family, friends, and carers
- South Australian Voluntary Assisted Dying Care Navigator Service
- South Australian Voluntary Assisted Dying Pharmacy Service
- other support services.
Maintaining open communication with the people who are providing your health care is always important. You are encouraged to talk to your doctor and other health practitioners about how end of life care might look for you. This can include discussions of your preferred care approach, completing or updating an Advance Care Directive, planning for death, and as well as considering voluntary assisted dying.
In addition to your healthcare team, your family, friends and carers can help you think through choices you may be considering at end of life, including voluntary assisted dying. If you wish, a family member, friend or carer can go to your appointments with you and be part of your discussions about palliative care, voluntary assisted dying or planning for death.
For more information, you may like to refer to the Knowing your choices: Information for people considering voluntary assisted dying (PDF 208KB) resource.
SA Health has a range of online resources and services to support people experiencing grief and loss through the SA Health Bereavement Portal . This resource lists a selection of high-quality online bereavement resources, alongside links to face-to-face services available to all South Australians.
You can also visit the SA Health mental health services webpage for a range of services.
The following helplines and services provide support 24 hours a day, seven days a week:
- Visit the Lifeline website or call 13 11 14
- Call the Mental Health Triage Service on 13 14 65
- Call Kids Helpline on 1800 551 800