A person must meet all the eligibility criteria required under the Voluntary Assisted Dying Act 2021 (the Act) to be able to access voluntary assisted dying.

If you are thinking about requesting access to voluntary assisted dying, you will first need to ask a health practitioner (such as your general practitioner (GP), medical practitioner, nurse or allied health practitioner) for information about it.

In South Australia, a health practitioner can only talk to you about voluntary assisted dying if you ask about it first.

Not all health practitioners want to participate in voluntary assisted dying. They may suggest another health practitioner for you to see, or you can contact the South Australian Voluntary Assisted Dying Care Navigator Service (SAVAD-CNS) to find someone who can help you.

It is important to note that you can choose not to proceed with voluntary assisted dying at any point in time.

    

There are 11 steps in the Voluntary Assisted Dying Pathway:

  1. Make a first request for voluntary assisted dying
  2. Doctor completes a first assessment
  3. A consulting doctor completes a second assessment
  4. Complete a written declaration to access voluntary assisted dying
  5. Make a final request for voluntary assisted dying
  6. Choose a contact person
  7. Doctor completes a final review
  8. Doctor prescribes medication once permit approved
  9. Arrange supply of medication with pharmacist
  10. Decide to administer medication
  11. Death certification

Step 1 Make a first request for voluntary assisted dying

If you decide to request access to voluntary assisted dying, you will need to make your first request to a medical practitioner. You can choose to have a family member or friend with you when you talk to your medical practitioner however you are the only person who can make a first request for voluntary assisted dying.

Your request should be clear, so your medical practitioner knows that you are requesting access to voluntary assisted dying. You may find that your medical practitioner asks you questions to clarify that you are asking for voluntary assisted dying.

If you have difficulty speaking, you can make a request using other means of communication, such as gestures or a communication aid, or by using a qualified interpreter if you would prefer to speak in a language other than English.

A medical practitioner to whom you made your first request must then notify you within seven days whether they accept or refuse your request. They may refuse because they do not agree with voluntary assisted dying (they have a conscientious objection to voluntary assisted dying) or because they aren’t eligible or able to accept the request. If they accept your first request, they will become the medical practitioner coordinating the Voluntary Assisted Dying Pathway for you, known as a Coordinating Medical Practitioner.

Step 2 Doctor completes a first assessment

Your Coordinating Medical Practitioner must now formally assess your eligibility for voluntary assisted dying to make sure you meet all the eligibility criteria required by the Act. This assessment is called the first assessment. Your Coordinating Medical Practitioner can only start a first assessment if they have completed the approved training requirements for voluntary assisted dying.

In some cases, the Coordinating Medical Practitioner will need to refer you for a specialist opinion to make the decision about your eligibility.

If you are assessed as eligible to access voluntary assisted dying, your Coordinating Medical Practitioner will provide you with a range of information including your diagnosis and the likely outcome of your diagnosis, treatment and palliative care options available to you, and the likely outcome of those options. They will then refer you to another medical practitioner, known as a Consulting Medical Practitioner, for a second assessment of your eligibility to access voluntary assisted dying.

If you disagree with the outcome of the first assessment, in some circumstances you can request a review of some of the assessment decisions by the South Australian Civil and Administrative Tribunal (SACAT).

Step 3 A consulting doctor completes a second assessment

Once a second medical practitioner has received a referral to undertake a consulting assessment of your eligibility for voluntary assisted dying, they will contact you. The second medical practitioner might refuse the referral because they have a conscientious objection to voluntary assisted dying, or because they are not eligible or able to accept the request. If they accept your referral, they will become your Consulting Medical Practitioner. However, they can only start the second assessment if they have completed the approved training requirements for voluntary assisted dying.

Much like the process for the first assessment, in some cases, the Consulting Medical Practitioner will refer you for a specialist opinion to make the decision about your eligibility to access voluntary assisted dying.

If you are assessed as eligible to access voluntary assisted dying, your Consulting Medical Practitioner will provide you with similar information provided to you by your Coordinating Medical Practitioner. If your Consulting Medical Practitioner assesses you as ineligible for voluntary assisted dying, your Coordinating Medical Practitioner may refer you to another medical practitioner to undertake a second assessment of your eligibility.

Step 4 Complete a written declaration to access voluntary assisted dying

If you have been assessed as eligible by your Coordinating and Consulting Medical Practitioners, you can make a written declaration requesting access to voluntary assisted dying. This will need to be done in the presence of two witnesses and your Coordinating Medical Practitioner. A person must meet the criteria to be eligible to act as a witness for you. For example, only one of your two witnesses may be a family member.

If you are not able to sign the written declaration yourself, someone may be able to sign this for you in your presence.

Step 5 Make a final request for voluntary assisted dying

You can make a final request to access voluntary assisted dying to your Coordinating Medical Practitioner once you have made a written declaration.

If you have difficulty speaking, you can make a request using other means of communication, such as gestures or a communication aid, or by using a qualified interpreter if you would prefer to speak in a language other than English if needed.

In most cases, your final request can only be made at least nine days after your first request. However, if your Coordinating Medical Practitioner has assessed that you are expected to die before nine days after your first request, you may be allowed to access the voluntary assisted dying medication sooner.

The final written request helps to make sure that your decision to access voluntary assisted dying is enduring and has not changed.

Step 6 Choose a Contact Person

After making your final request, you must appoint a Contact Person in the presence of a witness. This process does not require the Coordinating Medical Practitioner to be present.

Contact Person responsibilities and requirements

The Contact Person is responsible for:

  • returning any unused or remaining voluntary assisted dying medication to the SA Voluntary Assisted Dying Pharmacy Service
  • responding to requests for information from the Review Board.

The Act requires a Contact Person to:

  • be aged 18 years or older
  • accept the appointment as the Contact Person.

The Contact Person may be:

  • a family member, friend or carer
  • someone involved in providing your care.

If there is no other practical alternative, a care navigator can be the Contact Person.

Step 7 Doctor completes a final review

When your Coordinating Medical Practitioner receives your final request for access to voluntary assisted dying, they will complete a final review. This means the Coordinating Medical Practitioner must check the request and assessment process has been completed in accordance with the Voluntary Assisted Dying Act 2021 (the Act). The Coordinating Medical Practitioner you still have decision making capacity in relation to your request to access voluntary assisted dying, are acting voluntarily and without coercion, and still want to access voluntary assisted dying.

If your Coordinating Medical Practitioner certifies that the request and assessment process has been completed in accordance with the Act, they can apply for a voluntary assisted dying permit for you. In most cases, this will be a Self-administration Permit. In the instance that you are physically incapable of self-administration or digesting the medication, you can ask the Coordinating Medical Practitioner to apply for a Practitioner Administration Permit for you.

It is important to remember that you can choose not to proceed with voluntary assisted dying at any point in the process.

Step 8 Doctor prescribes medication once permit approved

Self-administration Permit

Your Coordinating Medical Practitioner will prescribe you the voluntary assisted dying medication. They must give you a range of information about the medication, including how to use it, your option not to obtain the medication if you do not wish to, and you may return the prescription to your Coordinating Medical Practitioner at any time.

Practitioner Administration Permit

Your Coordinating Medical Practitioner will prescribe you the voluntary assisted dying medication. Under a Practitioner Administration Permit, your Coordinating Medical Practitioner, in the presence of a witness, can administer the voluntary assisted dying medication. This can only happen if:

  • you are physically unable to do so yourself or digest the medication
  • you still have decision making capacity
  • you are acting voluntarily and without coercion
  • your request to access voluntary assisted dying is enduring
  • you are administered the voluntary assisted dying medication straight after making the practitioner administration request.

Step 9 Arrange supply of medication with pharmacist

The pharmacist who supplies the voluntary assisted dying medication must also provide you with information, including how to self-administer the medication and that you do not have to administer the medication if you decide not to go ahead with it. You or your Contact Person can return it to a pharmacist at the dispensing pharmacy at any time.

The voluntary assisted dying medication must be stored in the locked box, which will be provided by the Pharmacy Service, and the key kept in your possession.

Step 10 Decide to administer medication

Self-administration

You may self-administer the voluntary assisted dying medication at a time and place of your choosing. Other people (e.g. family and friends) may be present if you wish however, you do not need to have someone present.

It is important to remember that you can choose not to proceed with voluntary assisted dying at any point in the process.

Practitioner Administration

In circumstances where you lose the ability to self-administer or to digest the medication, you may request your Coordinating Medical Practitioner apply for a Practitioner Administration Permit. At the time of requesting the administration of the substance, and during the administration of the medication, a witness must be present.

If you have difficulty speaking, you can make the request using other means of communication, such as gestures or a communication aid. This request can only be made by you to your Coordinating Medical Practitioner. No one else can do so on your behalf.

Returning an unused medication

If you were planning to self-administer the medication your Contact Person will need to return any unused voluntary assisted dying medication to the South Australian Voluntary Assisted Dying Pharmacy Service (SAVAD-PS) within 15 days of your death. The Voluntary Assisted Dying Review Board will follow up with your Contact Person after your death to check they have returned the medication to the Pharmacy Service.

If your Coordinating Medical Practitioner administers the medication to you, the Contact Person will not have a role in returning any unused medication after death as the Coordinating Medical Practitioner will do this.

SAVAD-PS will safely dispose of the unused medication.

Step 11 Death certification

Your family, friends and carers will be asked to notify your Coordinating Medical Practitioner that you have passed away.

A registered medical practitioner will undertake procedures to certify death in accordance with the Act.