On 19 May 2022, New South Wales (NSW) aligned with the rest of Australia in enacting the Voluntary Assisted Dying Act 2022 (VAD Act), providing NSW residents with the autonomy to make decisions concerning their end-of-life care. This legislative development marked a significant step forward in addressing the complex and sensitive issues surrounding individuals facing terminal illnesses and commenced in November 2023.

Overview of the Law

The VAD Act aims to enable eligible individuals diagnosed with a terminal illness to access voluntary assisted dying. The legislation establishes a meticulously regulated procedure for facilitating this access. The Act institutes the Voluntary Assisted Dying Board, endowing it with defined functions and member appointments. This comprehensive framework sets the stage for a carefully considered and controlled process.

What VAD Means in NSW

Voluntary Assisted Dying (VAD) in NSW represents more than just a legal provision; it is a profound option that allows individuals to seek assistance from healthcare professionals for peacefully ending their own lives in the event they are diagnosed with a terminal illness. It is paramount to distinguish voluntary assisted dying from suicide under NSW law, as the former is not classified as such.

Who Qualifies

To qualify for VAD, several criteria must be met. Prospective individuals must have resided in NSW for at least 12 months, be over the age of 18 and have Australian citizenship or residency for a minimum of three years. A person may apply to the Board for an exemption from the requirement to have been ordinarily resident in NSW for at least 12 months. Moreover, the person must be diagnosed with a serious medical condition expected to cause death within a specific timeframe – 6 months for most conditions and 12 months for neurodegenerative diseases such as MND. The medical condition should be advanced, progressive, and causing unbearable suffering that cannot be relieved in a way the applicant considers to be tolerable. The VAD Act does not allow a family member to consent or object to the treatment.

Eligibility Exclusions

The Act explicitly specifies eligibility exclusions, emphasising that disability, dementia, or mental health impairment cannot be the sole basis for accessing voluntary assisted dying. The focus is on the intolerable nature of suffering, beyond relief in an acceptable manner to the applicant.

The Steps towards VAD

There are 11 steps in the VAD process in NSW. Accessing VAD involves a series of carefully structured steps, underscoring the gravity of the decision. It commences with making and confirming the request through a General Practitioner (GP). Subsequently, two independent doctors must assess eligibility.

Doctor Consultation

During the first appointment with applicants discussions will take place about available supports and alternatives such as palliative care. Patients should reflect on reasons for seeking VAD, express symptoms experienced and enquire about their medical condition. Encouragingly, having a trusted person accompany them is advised, recognising the significance of emotional support in such challenging circumstances.

Doctor Participation

While some doctors can provide VAD, those with conscientious objections must promptly notify patients. Eligibility may also hinge on doctors meeting specific criteria, including experience, qualifications and training.

Conscientious Objections

Conscientious objections are integral to the ethical considerations surrounding voluntary assisted dying. These occur when a doctor, due to a conflict with their personal beliefs or values, refuses to provide or participate in a legal and legitimate treatment or procedure. It is crucial to note that conscientious objections are based on sincerely-held beliefs and moral concerns, not self-interest or discrimination. In the context of VAD, doctors must minimise disruption to patient care and never intentionally impede patients' access to care based on conscientious objections.

Doctor’s Requirements

Authorised practitioners eligible for coordinating, consulting or administering roles must meet specific criteria outlined in the Act. Coordinating or consulting practitioners must be medical practitioners with specialist or general registration and at least 10 years of practice. Administering practitioners must have at least 5 years of practice and overseas-trained specialists or nurse practitioners may also be eligible. Additional requirements include completing approved mandatory training, not being a family member of the patient, not benefiting financially from the patient's death and meeting any other prescribed regulations.

Medical Authorisation

Upon a successful final review, the doctor seeks medical authorisation from the Voluntary Assisted Dying Board. If approved, the doctor prescribes end-of-life medication, providing the individual with the option to take it at their discretion.

Decision Reversal

One of the noteworthy aspects of the VAD process is the allowance for individuals to pause or stop the voluntary assisted dying process if they change their mind at any point. This provision acknowledges the fluidity and complexity of the decision-making process surrounding end-of-life choices.

Cost

Contrary to potential misconceptions, voluntary assisted dying does not incur additional costs. Standard fees for consultations with general practitioners or specialists may apply and individuals are advised to discuss potential costs with their doctor at the outset to ensure transparency and clarity.

Other Considerations

Beyond the specific provisions of the VAD Act, individuals contemplating end-of-life choices may find it prudent to consider the broader aspects of their affairs. For instance, preparing a Will is mentioned as a potential consideration, ensuring that their assets are distributed according to their wishes.

The VAD Act in NSW represents a significant legislative development that empowers individuals to assert greater control over their end-of-life choices. It addresses the complex terrain of terminal illnesses, providing a legal framework for those considering voluntary assisted dying. A comprehensive understanding of the rules and the process is imperative for anyone contemplating this option, emphasising the importance of making informed and compassionate choices in this deeply personal matter.

For those seeking additional information on voluntary assisted dying in NSW, the official NSW Health website serves as a valuable resource.