Deciding to participate in voluntary assisted dying as a medical practitioner is a personal and professional decision that should be made carefully.
When choosing the extent and level of involvement in discussions about voluntary assisted dying, registered medical practitioners should take into consideration:
- their personal and professional values regarding end of life care
- their therapeutic relationship with the patient
- the needs and choices of the patient
- the impact on the patient as a result of their decision
- their willingness to participate in various aspects of voluntary assisted dying, for example providing information only, assessing a patient’s eligibility, prescribing, or administering the medication
- obligations they have under relevant professional codes of conduct or ethics
- if their employing health service supports voluntary assisted dying or not
- if their employing health service has capacity to safely meet the needs of a patient seeking voluntary assisted dying
- any relevant organisational policies
- their professional obligation not to unduly delay a patient’s access to voluntary assisted dying
- the need to inform the patient of their decision as soon as possible.
Medical practitioners who meet the requirements defined in the Act may participate as the Coordinating Medical Practitioner, Consulting Medical Practitioner, or Specialist Opinion Provider.
Medical practitioners who do not meet the requirements defined in the Act may participate in voluntary assisted dying in other ways, such as providing treatment and care to reduce suffering.
Coordinating Medical Practitioner
The Coordinating Medical Practitioner is responsible for supporting the patient, and their family, friends and carers throughout the Voluntary Assisted Dying Pathway.
This includes:
- assessing the patient’s eligibility to access voluntary assisted dying
- referring the patient for a specialist opinion if required
- referring the patient to another medical practitioner for a consulting assessment
- ensuring all the relevant forms are completed and submitted to the South Australian Voluntary Assisted Dying Review Board
- applying for a permit for the voluntary assisted dying medication
- prescribing the voluntary assisted dying medication
- administering the medication if the patient is physically incapable of self-administration or digesting the medication
- recording information in the Voluntary Assisted Dying Clinical Portal and the patient’s medical record where required.
In most cases, an eligible medical practitioner becomes the patient’s Coordinating Medical Practitioner when they accept the patient’s first request.
A patient must have a dedicated Coordinating Medical Practitioner throughout all stages of the pathway. This role may be transferred to the Consulting Medical Practitioner if required.
Consulting Medical Practitioner
The Consulting Medical Practitioner is responsible for undertaking an assessment of the patient to independently determine their eligibility to access voluntary assisted dying.
An eligible medical practitioner becomes the patient’s Consulting Medical Practitioner when they accept the Coordinating Medical Practitioner’s referral to conduct the consulting assessment.
A Consulting Medical Practitioner who assesses a patient as eligible may be asked to become the Coordinating Medical Practitioner if a need to transfer the role of Coordinating Medical Practitioner arises.
Minimum eligibility requirements for Coordinating or Consulting Medical Practitioners
Registered medical practitioners who wish to act as the Coordinating or Consulting Medical Practitioner must either:
- hold a fellowship with a specialist medical college or
- be a vocationally registered general practitioner.
Either the Coordinating Medical Practitioner or each Consulting Medical Practitioner must:
- have practised as a registered medical practitioner for at least five (5) years after completing a fellowship with a specialist medical college or vocational registration (as the case requires) and
- have relevant expertise and experience in the disease, illness or medical condition expected to cause the death of the person being assessed.
When is a medical practitioner not eligible?
Medical practitioners are not eligible to act as the Coordinating Medical Practitioner or Consulting Medical Practitioner for a patient if they meet any of the below criteria:
- they are a family member of the patient
- they know or reasonably believe they may be a beneficiary under the patient’s will
- they know or reasonably believe they may otherwise benefit from the death of the patient.
Before being considered eligible to participate in voluntary assisted dying a registered medical practitioner must complete the Practitioner Registration Form on the Voluntary Assisted Dying Clinical Portal. The Voluntary Assisted Dying Operations Team reviews all registrations and confirms practitioners are eligible to participate.
Mandatory training
Before assessing a patient’s eligibility to access voluntary assisted dying a medical practitioner must complete the mandatory training.
Medical practitioners can choose to complete the mandatory training:
- before they receive a request for voluntary assisted dying
- after they have accepted a first request for voluntary assisted dying
- after they have accepted a referral for a consulting assessment for voluntary assisted dying.
The training is completed online and is valid for five years.
To access the Voluntary Assisted Dying Mandatory Medical Practitioner Training, you first need to register as a practitioner on the Voluntary Assisted Dying Clinical Portal.
Participating as a specialist opinion provider
A medical practitioner with appropriate skills and training may provide a specialist opinion on any or all of the following:
- an opinion on a patient’s decision making capacity in relation to voluntary assisted dying
- an opinion on whether a patient is acting voluntarily and without coercion
- an opinion on whether the patient’s disease, illness or medical condition meet the eligibility criteria
- a determination on whether a patient has a neurodegenerative condition that is expected to cause death within 12 months
A registered health practitioner with appropriate skills and training may provide a specialist opinion on either of the following:
- a patient’s decision-making capacity in relation to voluntary assisted dying
- whether a patient is acting voluntarily and without coercion
Medical and health practitioners can provide a specialist opinion on matters that fit within their usual scope of practice.
This specialist referral is made in addition to the referral for a consulting assessment.
The specialist practitioner should be asked to provide an opinion on whether the patient meets a specific eligibility criterion of concern. They are asked to undertake an independent determination and provide a clinical report to the referring Coordinating or Consulting Medical Practitioner.
The Coordinating or Consulting Medical Practitioner may either accept the specialist opinion or rely on their own determination (except if the patient has a neurodegenerative disease in which case, the specialist opinion must be adopted).
Requirements for specialist opinion providers
Medical practitioners and registered health practitioners are not required to complete the Voluntary Assisted Dying Mandatory Medical Practitioner Training in order to provide a specialist opinion.
The medical practitioner or registered health practitioner must have appropriate skills and training relevant to the referral criteria for which the patient is being referred.
When is a medical practitioner not eligible to provide a specialist opinion?
Medical practitioners and registered health practitioners are not eligible to provide a specialist opinion if they meet any of the below criteria:
- they are a family member of the patient
- they know or reasonably believe they may be a beneficiary under the patient’s will
- they know or reasonably believe they may otherwise benefit from the death of the patient.