Administration of the voluntary assisted dying substance Guide
You do not have to continue the voluntary assisted dying process after the request and assessment phase has been completed. You can stop the process at any time.
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Administration decision
Once your coordinating doctor has completed the final review you may make an administration decision or you may decide not to make an administration decision. This decision is made in consultation with, and on the advice of, your coordinating doctor.
Your administration decision must be made in person with your coordinating doctor. The Queensland Voluntary Assisted Dying Support Service (QVAD-Support) may assist you with arranging this, if needed.
There are 2 methods:
- self-administration: you administer the voluntary assisted dying substance yourself
- practitioner administration: your administering doctor or nurse administers you the voluntary assisted dying substance.
A practitioner administration decision can only be made if your coordinating doctor advises that self-administration is not suitable for you. To make this decision your coordinating doctor will consider the following:
- your ability to self-administer the substance
- your concerns about self-administering the substance
- which method of administration is most suitable for you.
If a practitioner administration decision is made, an administering doctor or nurse will be appointed.
Your coordinating doctor can be your administering doctor. However, your coordinating doctor can transfer the role to another eligible doctor, nurse practitioner, or registered nurse who must accept or refuse the role. Your coordinating doctor can choose to transfer the role for any reason. They will tell you if this happens.
Your coordinating doctor will give you written information about the substance and administration of the substance.
You can revoke your administration decision
You can revoke your administration decision and make a new administration decision at any time. You can tell your coordinating doctor of your decision in writing, verbally, using gestures or in another way, for example, through a decision aid.
For example, if you make a self-administration decision but lose the ability to physically self-administer the voluntary assisted dying substance, you can revoke your decision and make a practitioner administration decision in consultation with your coordinating doctor. If you later regain your ability, you could decide to revoke your practitioner administration decision and again choose self-administration.
You can also revoke an administration decision at any time, if you do not wish to proceed.
What happens next
If you make an administration decision you must appoint a contact person before a prescription can be written, by your coordinating doctor.
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Appointing the contact person
If you have made an administration decision you must appoint a contact person before the voluntary assisted dying substance can be prescribed by your coordinating doctor. Your contact person has an important role. You should choose someone who you think can handle the responsibility prior to your death and after you die.
Your contact person doesn't need to be present when you administer the substance.
Your contact person must:
- be 18 years of age or over
- agree to take on this role.
You contact person can be a:
- carer
- family member
- partner or spouse
- friend
- a healthcare worker involved in your care
- any person you trust to take on the role.
If you cannot find someone, you should speak to your coordinating or consulting doctor.
How to appoint a contact person
To appoint a contact person, you must:
- fill in the Contact Person Appointment Form with your contact person
- give the completed Contact Person Appointment Form to your coordinating doctor.
Your coordinating doctor will give you a copy of this form.
You do not need to complete the Contact Person Appointment Form in the presence of your coordinating doctor.
You can choose to change your contact person, or your contact person can refuse to continue in the role. If this happens you will have to appoint a new contact person.
The role of the contact person is different based on whether you make a self-administration or practitioner administration decision.
Note: there are other statutory roles you may act in or be appointed to. These include:
- enduring power of attorney
- statutory health attorney
- general power of attorney.
The contact person is different to these roles. It has distinct responsibilities, as outlined below.
Self-administration decision
For a self-administration decision your contact person must:
- tell the coordinating doctor when you have died
- if there is any unused or remaining substance, give it to an authorised disposer (pharmacist)
- if asked, provide information to the Voluntary Assisted Dying Review Board (the Review Board).
The Review Board will send your contact person information via email on how to complete their role.
Practitioner administration decision
For a practitioner administration decision your contact person’s role includes:
- telling the coordinating doctor when you die
- if asked, providing information to the Review Board.
Further information
If possible, it would be useful for your contact person to accompany you to an appointment to ask any questions they have.
The following resources are available to help you and your contact person:
- Choosing your contact person (PDF, 314KB)
- Being a contact person (PDF, 336KB)
- Checklist for being a contact person (PDF, 899KB)
- Completing the Contact Person Appointment Form
What happens next
The next step in the process is the prescription of the voluntary assisted dying substance by your coordinating doctor.
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Prescription and supply of the voluntary assisted dying substance
Prescription
After you have appointed a contact person, your coordinating doctor can prescribe the voluntary assisted dying substance.
Your coordinating doctor will give the prescription directly to the Queensland Voluntary Assisted Dying Pharmacy (QVAD-Pharmacy).
Your coordinating doctor must give you information in writing, including:
- information about the voluntary assisted dying substance
- the risks and expected effects of administration of the voluntary assisted dying substance.
This information must be given in a face-to-face consultation or posted to you after the consultation.
The voluntary assisted dying substances can only be supplied by pharmacists employed by QVAD-Pharmacy.
What happens after prescription
Your coordinating doctor will make a request for supply of the voluntary assisted dying substance to QVAD-Pharmacy.
Supply
QVAD-Pharmacy will:
- authenticate the prescription
- confirm the identity of your coordinating doctor who issued the prescription
- check a photo ID document to confirm the identity of the person to whom the voluntary assisted dying substance is to be supplied.
Self-administration
You or your coordinating doctor must contact QVAD-Pharmacy to request them supply the voluntary assisted dying substance to you. You can request that it be supplied at a time of your choosing.
You can decide not to take the substance, even if it has been supplied to you.Pharmacists employed by QVAD-Pharmacy will supply the voluntary assisted dying substance directly to you, your contact person or agent. In most cases this pharmacist employed by QVAD-Pharmacy will supply the substance to you directly.
They will also supply the voluntary assisted dying substance kit and written information about the substance, including:
- that you do not have to administer the substance
- what the substance is
- how to store the substance safely
- how to prepare and self-administer the substance
- the expected effects of self-administering the substance
- the period within which you are likely to die after self-administration of the substance
- the potential risks of self-administration of the substance
- the responsibilities of your contact person to give any unused or remaining substance to an authorised disposer for disposal.
The pharmacist employed by QVAD-Pharmacy will check during the supply of the voluntary assisted dying substance for self-administration if you:
- have decision-making capacity
- are acting freely and voluntarily
- are able to administer the substance yourself.
If the pharmacist employed by QVAD-Pharmacy believes you do not meet one of these criteria, they will not supply you with the voluntary assisted dying substance. The pharmacist will tell your coordinating doctor that they have not supplied you with the substance.
What you can do
If a pharmacist employed by QVAD-Pharmacy does not supply you with the substance for a self-administration decision, you can:
- ask to reschedule the supply of the substance, if you regain capacity
- ask your coordinating doctor if you can revoke your self-administration decision and make a new practitioner administration decision, if you cannot physically administer the substance.
Practitioner administration
Your administering doctor or nurse will make a plan with you for when practitioner administration of the voluntary assisted dying substance will occur. When a date and time has been confirmed, they will arrange for the supply of the voluntary assisted dying substance from QVAD-Pharmacy, to be supplied to them, in a timely manner.
Once supplied, your administering doctor or nurse will be responsible for the safe storage of the substance until you request for it to be administered.
What happens after supply
Once the voluntary assisted dying substance has been supplied the next step is administration, if you choose to continue.
You can decide at any time not to continue to access voluntary assisted dying.
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Administration and death
You can stop the voluntary assisted dying process at any time, right up until the administration of the substance.You can choose your preferred date, time, and place to administer the substance.
You should discuss your expectations and assumptions about administration of the voluntary assisted dying substance with your coordinating doctor or administering doctor or nurse. They may help you consider how best to support your plans for death.
These discussions could involve:
- when and where in Queensland administration of the voluntary assisted dying substance might occur:
- in your own home
- in another home environment
- on country
- in a hospital
- in a palliative care unit or hospice
- in a residential aged care facility
- religious, cultural, spiritual, or other aspects of death that are important to you
- discussing ongoing symptom management and other palliative care needs
- identifying who you would like to be present during administration of the voluntary assisted dying substance
- supports to navigate family conflict (if any arises in relation to voluntary assisted dying)
- how to help prepare those who will be present during voluntary assisted dying administration
- providing instruction about comfort care to family, carers and friends
- preparing for what happens immediately after your death has occurred
- broader aspects of planning for death, if appropriate, including funeral arrangements and creating a will.
It’s recommended you include a support person in these discussions.
Self-administration
If you have made a self-administration decision you will be encouraged not to self-administer alone. If you choose to be alone, an appropriate plan should be put in place to ensure your contact person can complete their role, which includes:
- telling the coordinating doctor when you die
- if there is any unused or remaining substance, giving it to an authorised disposer (pharmacist)
- if asked, providing information to the Voluntary Assisted Dying Review Board (the Review Board).
No one else can administer the substance to you—you must administer the substance yourself. Unauthorised administration of a voluntary assisted dying substance can result in criminal prosecution and imprisonment.
Your contact person must dispose of any unused or remaining substance in line with the disposal requirements. These requirements will be provided to them by the Review Board and QVAD-Pharmacy.
Practitioner administration
Your administering doctor or nurse must administer the substance to you in front of a witness. The witness to practitioner administration must be at least 18 years of age. There are no other eligibility requirements for the witness. You may have other people present for administration if you wish.
Before administering the voluntary assisted dying substance to you, your administering doctor or nurse must be satisfied that you:
- still have decision-making capacity
- are acting voluntarily and without coercion.
Your administering doctor or nurse must dispose of any unused or remaining substance in line with the disposal requirements.
Role of your witness
The purpose of a witness for practitioner administration is to provide a safeguard to ensure that:
- your request for voluntary assisted dying is voluntary
- you are not being pressured into accessing voluntary assisted dying by someone else.
Your witness for practitioner administration must be 18 years or older. They can be:
- your partner or spouse
- a family member
- a friend
- a carer
- your contact person
- a healthcare worker involved in your care
- any person you trust to take on the role.
Your witness cannot be your administering doctor or nurse.
Your witness will need to fill in the witness section of the Practitioner Administration Form. This form is for your administering doctor or nurse to make a record of the administration of the voluntary assisted dying substance to you. This form is completed after you die. Your witness will need to certify in the form that:
- you appeared to be acting voluntarily and without coercion
- they were present when the doctor or nurse administered the substance to you.
Further information
The following resources are available for you and your witnesses for practitioner administration:
- Choosing a witness for practitioner administration (PDF, 294KB)
- Being a witness for practitioner administration (PDF, 299KB)
- Checklist for being a witness for practitioner administration (PDF, 309KB)
- Completing the Practitioner Administration Form
If administration cannot proceed
If your administering doctor or nurse is not satisfied you:
- have decision-making capacity, or
- are acting voluntarily and without coercion.
They will not administer you the substance.
Your coordinating doctor, or administering doctor or nurse will talk to you about other care and support available to you, this could include:
- discussing how your treating healthcare team may help ease any physical symptoms, psychosocial or spiritual distress you may be experiencing
- updating your care plan
- providing you with alternate referrals to relevant healthcare workers
- organising additional support from a specialist palliative care team, if one is not already involved in your care
- discussing their decision with other members of your healthcare team and family—if you do not want this to happen, they will respect your privacy.
What you can do
If your administering doctor or nurse does not administer you the substance because you don't have capacity, if you regain capacity you can ask to reschedule the administration of the substance for another time.
What happens next
After you die, the death notification and certification will be completed and any unused or remaining voluntary assisted dying substance will be disposed.
Next section: After the person dies
- when and where in Queensland administration of the voluntary assisted dying substance might occur:
Administration of the voluntary assisted dying substance, 08 Dec 2022, [https://www.qldgovau.staging-services.qld.gov.au/health/support/voluntary-assisted-dying/explained/process/administration-of-the-substance]
This document is uncontrolled when printed. Before using the information in this document you should verify the current content on https://www.qldgovau.staging-services.qld.gov.au/health/support/voluntary-assisted-dying/explained/process/administration-of-the-substance.