This fact sheet is applicable to all healthcare workers in NSW. Healthcare workers include registered health practitioners and individuals who provide health services or professional care services.
Eligible people in NSW have the choice to access voluntary assisted dying from 28 November 2023. All healthcare workers in NSW have obligations under the Voluntary Assisted Dying Act 2022 (the Act), regardless of whether they are eligible or choose to provide voluntary assisted dying services.
Medical and nurse practitioners who meet specific eligibility criteria outlined in the Act can choose whether they want to become an authorised voluntary assisted dying practitioner. Only an authorised practitioner can become a coordinating, consulting or administering practitioner for a patient. More information on becoming an authorised voluntary assisted dying practitioner can be found on Voluntary assisted dying.
In order to be eligible to access voluntary assisted dying, a person must:
A patient may choose to discuss voluntary assisted dying with any of the healthcare workers who provide them with care.
In NSW, all healthcare workers are allowed to answer questions and provide information to a patient who initiates a discussion about voluntary assisted dying.
Healthcare workers, as always, should only provide information which is commensurate with their level of expertise and understanding.
If a healthcare worker does not feel confident or comfortable answering a patient's questions, they can refer the patient to the patient's senior treating clinician, or the NSW Voluntary Assisted Dying Care Navigator Service, or another appropriate person, as identified in the service's model of care. Healthcare workers should familiarise themselves with their local facility or district processes to ensure that a patient's request for information on, or access to, voluntary assisted dying is managed appropriately.
Healthcare workers can initiate a discussion with a patient about voluntary assisted dying but this must be part of a broader discussion about other treatment and palliative care options.
The Act is very clear that in the same discussion:
During conversations about voluntary assisted dying, healthcare workers should be cognisant of their clinical role and the scope of their clinical practice to ensure professional conduct in line with the Health Practitioner Regulation National Law (NSW).
One of the key responsibilities of a patient's coordinating or consulting practitioner is to assess if the patient is eligible to access voluntary assisted dying. This will involve reviewing relevant documentation and may also include discussion with the treating team as per usual practice.
If, after this, a coordinating or consulting practitioner is still unable to decide whether a patient meets one of the eligibility criteria, they must refer the patient to a medical practitioner, registered health practitioner or other person who has appropriate skills and training to provide advice about the matter.
A healthcare worker who receives a referral for 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 may benefit materially from the patient's death.
The referring coordinating or consulting 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 who have a conscientious objection to voluntary assisted dying have the right to refuse to:
However, they should understand their professional obligations, including under codes of conduct and codes of ethics set by National Health Practitioner Boards, and any legal obligations legislation, including under privacy legislation, 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.
Medical practitioners who have a conscientious objection to voluntary assisted dying still have obligations under the Act (see below section: medical practitioners who are not authorised voluntary assisted dying practitioners).
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.
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:
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.
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.
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:
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.
The NSW Voluntary Assisted Dying Care Navigator Service is available to provide information and support to patients, families, practitioners and other community members; and answer questions they may have about voluntary assisted dying. They can also support patients to find a practitioner who provides voluntary assisted dying services. The NSW Voluntary Assisted Dying Care Navigator Service can be contacted Monday to Friday (excluding public holidays) between 8:30am – 4:30pm.
Phone: 1300 802 133
Email: NSLHD-VADCareNavigator@health.nsw.gov.au
This term refers to medical and nurse practitioners who meet the professional experience eligibility requirements in the Act and who have completed the approved voluntary assisted dying training.
The authorised voluntary assisted dying practitioner who accepts a patient's first request for voluntary assisted dying and is responsible for assessing and supporting the patient throughout the voluntary assisted dying process.
The authorised voluntary assisted dying practitioner responsible for undertaking an independent assessment of the patient to determine their eligibility to access voluntary assisted dying.
An expert opinion can be provided by a person who has appropriate skills and training to make a decision about the matter.
As per the Act, professional care services means any of the following provided to another person under a contract of employment or a contract for services:
