This section is for medical practitioners who are not authorised voluntary assisted dying practitioners. Authorised practitioners must refer to the
NSW Voluntary Assisted Dying Clinical Practice Handbook for a description of their responsibilities.
In NSW, there are restrictions on initiating discussions about voluntary assisted dying with patients. These have been described in the section above.
Non-authorised medical practitioners who receive a first request must comply with certain obligations, for example, documenting the request in the patient's medical record and submitting the
First Request Form to the Voluntary Assisted Dying Board (full list of obligations are outlined in
Table 1).
If the practitioner is unable to accept a formal first request to access voluntary assisted dying, they should refer the patient to the NSW Voluntary Assisted Dying Care Navigator Service or an authorised practitioner as appropriate. Facilities and/or local health districts will have their own process in place to connect patients with authorised practitioners. Medical practitioners should familiarise themselves with their local policies and procedures.
There are multiple steps in the voluntary assisted dying process where medical practitioners (including those with a conscientious objection) who are not authorised practitioners have obligations under the Act. In line with best practice, practitioners should ensure that in addition to meeting minimum legislative obligations, care is patient-centred.
These are outlined in brief below.
Overview of the responsibilities of medical practitioners (other than authorised voluntary assisted dying practitioners) as specified in the Voluntary Assisted Dying Act 2022
First request
A medical practitioner who is not an authorised voluntary assisted dying practitioner is not eligible to be a patient's coordinating practitioner.
Therefore, if the practitioner receives a first request for voluntary assisted dying from a patient, the practitioner must:
- tell the patient that they refuse the request:
- immediately, if the practitioner has a conscientious objection to voluntary assisted dying, or
- otherwise within two business days of the first request.
- give the patient the
first request patient information within two days of the first request. This information can be given to patients electronically or in hard copy.
Note that medical practitioners with a conscientious objection to voluntary assisted dying do not have a legal obligation to provide this information. - record details of the first request in the patient's medical record, including the decision to refuse the request, the reason for refusal and whether the practitioner has given the patient the
first request patient information.
- complete the
First Request Form (available on the
NSW Voluntary Assisted Dying Portal) and submit it to the Voluntary Assisted Dying Board within five business days of deciding to refuse the request.
Formal voluntary assisted dying consulting assessment
A medical practitioner who is not an authorised voluntary assisted dying practitioner is not eligible to be a patient's consulting practitioner.
In NSW, coordinating practitioners will be supported by the NSW Voluntary Assisted Dying Care Navigator Service to refer patients to an
authorised voluntary assisted dying practitioner for a consulting assessment.
Therefore, medical practitioners who are not authorised voluntary assisted dying practitioners should not receive referrals for consulting assessments.
Determining patient eligibility (as part of the first assessment or consulting assessment)
If a coordinating or consulting practitioner is unable to decide, after review of relevant documentation or discussion with the treating team, whether a patient meets certain eligibility criteria, they must refer the patient to a medical practitioner, psychiatrist, registered health practitioner or other person who has appropriate skills and training to make a decision about the matter.
A person receiving a referral for expert opinion about a patient does not need to be an authorised voluntary assisted dying practitioner. However, they must not be the patient's family member or know or believe that they are a beneficiary under the will of the patient or may otherwise benefit financially or materially from the patient's death.
The referring practitioner will provide clear guidance at the time of referral on the specific requirements that need to be followed under the Act. If a patient raises questions about the voluntary assisted dying process during the referral assessment, these questions should be referred back to the patient's coordinating or consulting practitioner.
Healthcare workers with a conscientious objection to voluntary assisted dying can refuse to participate in the request and assessment process.
However, they should understand their legal obligations, including under privacy legislation, and professional obligations, including under codes of conduct and codes of ethics set by National Health Practitioner Boards, and should not obstruct the patient's voluntary assisted dying process or access to information. For example, a patient should not be denied access to their personal health information (such as medical records containing or advising on the patient's diagnosis and prognosis details) merely because this information is to be used for the purposes of a voluntary assisted dying application.
It is against the law for a treating medical practitioner to withdraw other services the practitioner would usually provide to a patient or the patient's family because of the patient's request for access to voluntary assisted dying. If this occurs, there should be prompt attention to local problem solving, and escalation according to local policies.
Notification of death
If a medical practitioner completes a Medical Certificate of Cause of Death (MCCD) for a person who they know or believe has died from self-administration or practitioner administration of a voluntary assisted dying substance, they must:
Document in the MCCD:
- that they know or believe the person self-administered or was administered a voluntary assisted dying substance; and
- the disease, illness or medical condition that the person had been diagnosed with that made the person eligible to access voluntary assisted dying.
Complete the
Notification of Death Form (available on the
NSW Voluntary Assisted Dying Portal) and submit it to the Voluntary Assisted Dying Board via the NSW Voluntary Assisted Dying Portal within five business days of becoming aware the person has died.
