Queensland

Voluntary Assisted Dying Act 2021

The Australian state of Queensland has passed the Voluntary Assisted Dying Act (2021) to legalize euthanasia and assisted suicide (EAS). It will come into force in January, 2023.

An eligible patient must be at least 18 years old, have an advanced, progressive and terminal “disease, illness or medical condition . . . that is expected to cause death within 12 months” and causes suffering the patient considers “intolerable." “Suffering” includes both physical and mental suffering caused by the terminal condition or its treatment. The patient must act “voluntarily and without coercion” and must be capable of medical decision-making. Finally, patients must have lived in Queensland for at least one year, and those who are not Australian citizens or permanent residents must have lived in Australia for at least three years, though citizenship and residency requirements can be waived for compassionate reasons. Persons who meet these requirements are eligible for euthanasia and assisted suicide if they are disabled or mentally ill, but EAS cannot be provided for disability or mental illness alone.

Medical and nurse practitioners may initiate discussion about EAS but are not required to do so. By explicitly making discussion optional, the Act supports both practitioners who want to initiate discussion about EAS and those who think it best to let patients take the lead, responding to their enquiries or apparent interests. Further, all registered health practitioners who conscientiously object to EAS may refuse to provide information about or participate in any part of the EAS process, and refuse to be present when EAS is provided. These provisions are satisfactory, and the requirement that they inform patients that other practitioners may be able to assist them is unobjectionable. They allow objecting practitioners to step aside, advising patients that they are free to seek the services from willing colleagues.

The further requirement that they provide information about those who may be willing to provide EAS does not specify that objectors must direct patients to EAS practitioners or provide contact information for them. It is sufficient if the objector provides information about a “service . . . likely to be able to assist,” such Queensland’s 13Health. This allows objecting practitioners to comply with the Act while avoiding any positive action causally connected to killing their patients, and it leaves patients free to pursue euthanasia/assisted suicide.

Objecting speech pathologists are accorded the same protection as registered health care practitioners. However, the Act also suggests that objectors are obliged to ensure that colleagues are not burdened and access to euthanasia and assisted suicide is not compromised. The Act does not suggest that health care practitioners have such duties because they can be found in existing professional guidance from the Australian Medical Association (AMA). Whether contained in the Act or in AMA guidance, this is unacceptable. The duty to ensure EAS access, accommodate objecting employees and balance workloads among staff should lie on the employer, not objecting employees. They may reasonably be expected to participate in discussion about and cooperate in accommodation, but the onus to fairly distribute employment tasks should be on the employer.

Regardless of their views about euthanasia and assisted suicide, some medical practitioners are likely to object to falsifying the cause of death in death certificates. If the state insists that death certificates must be falsified, the Act should be amended to make a medical member of the Voluntary Assisted Dying Review Board responsible for completing EAS death certificates (assuming that a Board member’s objection to doing so would also be accommodated).

The Act recognizes and addresses conscientious objection by individuals but not by entities/collectives. It implicitly acknowledges that entities/collectives may or may not provide EAS, and it addresses the obligations of entities/collectives that do not, but at no point does it imply that constitutional guarantees of freedom of conscience are relevant to decision-making by entities/collectives about involvement in killing people. It places refusal to kill people for reasons of conscience on the same level as refusals based on pragmatic considerations like lack of trained personnel or management of institutional branding. The Act does not require entities/collectives to provide euthanasia or assisted or even to provide information about the procedures, so it does not threaten institutional freedom of conscience in relation to direct participation in EAS services. Instead, the Act is designed to enable the state to compel unwilling entities/collectives to cooperate and perhaps collaborate in killing people in their care or helping them kill themselves, and to disadvantage any that resist by appeals to freedom of conscience.

For a detailed review of the Act and its effect on individual and institutional freedom of conscience, see Queensland's Voluntary Assisted Dying Act (2021): Impact on freedom of conscience for health care practitioners and institutions.

What follows are the parts of the law that pertain directly to freedom of conscience.

16 Medical practitioner to accept or refuse first request

1) The medical practitioner must refuse the first request if the practitioner is not eligible to act as a coordinating practitioner.

(2) The medical practitioner may refuse the first request if the practitioner—

(a) has a conscientious objection to voluntary assisted dying or is otherwise unwilling to perform the duties of a coordinating practitioner; or

(b) is unavailable or otherwise unable to perform the duties of a coordinating practitioner.

(3) If the medical practitioner accepts the first request, the practitioner must, at the time of informing the person of the practitioner’s decision, give the person the approved information.

(4) If the medical practitioner refuses the first request, the practitioner must, at the time of informing the person of their decision—

(a) inform the person that other registered health practitioners, health service providers or services may be able to assist the person with the person’s request; and

(b) give the person—

(i) information about a registered health practitioner, health service provider or service who, in the practitioner’s belief, is likely to be able to assist the person with the person’s request; or

(ii) the details of an official voluntary assisted dying care navigator service that is able to provide the person with information (including name and contact details) about a health practitioner, health service provider or service who may be able to assist the person with the person’s request.

(5) The medical practitioner must, within the times mentioned in subsection (6)—

(a) decide whether to accept or refuse the first request; and

(b) inform the person of the decision and, for a decision to refuse the request, the reason for the decision.

(6) For subsection (5) the following times apply—

(a) if the medical practitioner has a conscientious objection to voluntary assisted dying—immediately after the request is made;

(b) in any other case—within 2 business days after the first request is made.

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26 Medical practitioner to accept or refuse referral for consulting assessment

(1) This section applies if a person is referred to a medical practitioner for a consulting assessment under section 25, 36 or 47.

(2) The medical practitioner must refuse the referral if the practitioner is not eligible to act as a consulting practitioner.

(3) The medical practitioner may refuse the referral if the practitioner—

(a) has a conscientious objection to voluntary assisted dying or is otherwise unwilling to perform the duties of a consulting practitioner; or

(b) is unavailable or otherwise unable to perform the duties of a consulting practitioner.

(4) The medical practitioner must, within the times mentioned in subsection (5)—

(a) decide whether to accept or refuse the referral; and

(b) inform the person and the coordinating practitioner for the person of the decision and, for a decision to refuse the referral, the reason for the decision.

(5) For subsection (4) the following times apply—

(a) if the medical practitioner has a conscientious objection to voluntary assisted dying—immediately after the referral is made;

(b) in any other case—within 2 business days after the referral is made.

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81 Cause of death certificate

(1) This section applies if a medical practitioner who is required to give a cause of death certificate for a person knows or reasonably believes that the person self-administered, or was administered, a voluntary assisted dying substance under this Act.***

(3) The medical practitioner—

(a) must state in the cause of death certificate for the person that the cause of death of the person was the disease, illness or medical condition mentioned in section 10(1)(a) from which the person suffered; and

(b) must not include any reference to voluntary assisted dying in the cause of death certificate for the person.

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PART 6 Participation

Division 1 Conscientious objection

84 Registered health practitioner with conscientious objection

(1) A registered health practitioner who has a conscientious objection to voluntary assisted dying has the right to refuse to do any of the following—

(a) provide information to another person about voluntary assisted dying;

(b) participate in the request and assessment process;

(d) prescribe, supply or administer a voluntary assisted dying substance;

(e) be present at the time of the administration or self-administration of a voluntary assisted dying substance.

(2) A registered health practitioner who, because of a conscientious objection, refuses to do a thing mentioned in subsection (1) for a person seeking information or assistance about voluntary assisted dying, must—

(a) inform the person that other health practitioners, health service providers or services may be able to assist the person; and

(b) give the person—

(i) information about a health practitioner, health service provider or service who, in the practitioner’s belief, is likely to be able to assist the person; or

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85 Speech pathologist with conscientious objection

(1) A speech pathologist who has a conscientious objection to voluntary assisted dying has the right to refuse to do any of the following—

(a) provide information to another person about voluntary assisted dying;

(b) participate in the request and assessment process;

(d) be present at the time of the administration or self-administration of a voluntary assisted dying substance.

(2) A speech pathologist who, because of a conscientious objection, refuses to do a thing mentioned in subsection (1) for an employer or for any other person who has requested speech pathology services in relation to voluntary assisted dying—

(a) must inform the employer or other person of the speech pathologist’s conscientious objection; and

(b) must inform the employer or other person of another speech pathologist or speech pathology service who, in the speech pathologist’s belief, is likely to be able to assist in providing the speech pathology services requested; and

(c) must not intentionally impede the person’s access to speech pathology services in relation to voluntary assisted dying.

(3) Subsection (4) applies if—

(a) a speech pathologist is employed or otherwise engaged by a health service provider; and

(b) the speech pathologist knows, or ought reasonably to know, the health service provider provides, or is likely to provide, services relating to voluntary assisted dying.

(4) The speech pathologist must—

(a) inform the health service provider of the speech pathologist’s conscientious objection to voluntary assisted dying; and

(b) discuss with the health service provider how they can practise in accordance with their beliefs without placing a burden on their colleagues or compromising a person’s access to voluntary assisted dying under this Act.

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Division 2 Participation by entities

90 Access to information about voluntary assisted dying

(1) This section applies if—

(a) a person is receiving relevant services from a relevant entity at a facility; and

(b) the person asks the entity for information about voluntary assisted dying; and

(c) the entity does not provide at the facility, to persons to whom relevant services are provided, the information that has been requested.

(2) The relevant entity and any other entity that owns or occupies the facility—

(a) must not hinder the person’s access at the facility to information about voluntary assisted dying; and

(b) must allow reasonable access to the person at the facility by each person who—

(i) is a registered health practitioner or a member or employee of an official voluntary assisted dying care navigator service; and

(ii) is seeking the access to provide the requested information to the person about voluntary assisted dying.

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92 First requests and final requests

(1) This section applies if—

(a) the person or the person’s agent advises the relevant entity that the person wishes to make a first request or final request (each a relevant request); and

(b) the entity does not provide, to persons to whom relevant services are provided at the facility, access to the request and assessment process at the facility.

(2) The relevant entity and any other entity that owns or occupies the facility must allow reasonable access to the person at the facility by a medical practitioner—

(a) whose presence is requested by the person; and

(b) who—

(i) for a first request—is eligible to act as a coordinating practitioner; or

(ii) for a final request—is the coordinating practitioner for the person.

(3) If the requested medical practitioner is not available to attend, the relevant entity must take reasonable steps to facilitate the transfer of the person to and from a place where the person’s relevant request may be made to—

(a) the requested medical practitioner; or

(b) another medical practitioner who is eligible and willing to act as a coordinating practitioner.

93 Second requests

(1) This section applies if—

(a) the person or the person’s agent advises the relevant entity that the person wishes to make a second request; and

(b) the entity does not provide, to persons to whom relevant services are provided at the facility, access to the request and assessment process at the facility.

(2) The relevant entity and any other entity that owns or occupies the facility must allow reasonable access to the person at the facility by—

(a) the coordinating practitioner for the person; and

(b) 2 persons who are eligible to witness the signing of a second request by the person.

(3) If the coordinating practitioner is not available to attend, the relevant entity must take reasonable steps to facilitate the transfer of the person to and from a place where the person’s second request may be made to—

(a) the coordinating practitioner; or

(b) another medical practitioner who is eligible and willing to act as a coordinating practitioner.

94 First assessments

(1) This section applies if—

(a) the person has made a first request; and

(b) the person or the person’s agent advises the relevant entity that the person wishes to undergo a first assessment; and

(c) the entity does not provide, to persons to whom relevant services are provided at the facility, access to the request and assessment process at the facility.

(2) If the person is a permanent resident at the facility—

(a) the relevant entity and any other entity that owns or occupies the facility must allow reasonable access to the person at the facility by a relevant practitioner for the person to assess the person; and

(b) if a relevant practitioner is not available to attend—the relevant entity must take reasonable steps to facilitate the transfer of the person to and from a place where the person’s assessment may be carried out by—

(i) the relevant practitioner; or

(ii) another medical practitioner who is eligible and willing to act as a relevant practitioner.

(3) If the person is not a permanent resident at the facility—

(a) the relevant entity must take reasonable steps to facilitate the transfer of the person to and from a place where the person’s assessment may be carried out by a relevant practitioner for the person; or

(b) if, in the opinion of the deciding practitioner, transfer of the person as described in paragraph (a) would not be reasonable in the circumstances, the entity and any other entity that owns or occupies the facility must allow reasonable access to the person at the facility by a relevant practitioner for the person.

(4) In making a decision for subsection (3)(b), the deciding practitioner must have regard to the following—

(a) whether the transfer would be likely to cause serious harm to the person;
Examples of serious harm— •significant pain •a significant deterioration in the person’s condition

(b) whether the transfer would be likely to adversely affect the person’s access to voluntary assisted dying;
Examples of adverse effects— •the transfer would likely result in a loss of decision-making capacity of the person •pain relief or medication for the transfer would likely result in a loss of decision-making capacity of the person

(d) whether the place to which the person is proposed to be transferred is available to receive the person;

(e) whether the person would incur financial loss or costs because of the transfer.

(5) In this section— relevant practitioner, for a person, means—

(a) the coordinating practitioner for the person; or

(b) a registered health practitioner to whom the coordinating practitioner for the person has referred a matter under section 21.

95 Consulting assessments

(1) This section applies if—

(a) the person has undergone a first assessment; and

(b) the person or the person’s agent advises the relevant entity that the person wishes to undergo a consulting assessment; and

(c) the entity does not provide, to persons to whom relevant services are provided at the facility, access to the request and assessment process at the facility.

(2)If the person is a permanent resident at the facility—

(i) the relevant practitioner; or

(ii) another medical practitioner who is eligible and willing to act as a relevant practitioner.

(3) If the person is not a permanent resident at the facility—

(4) In making a decision for subsection (3)(b), the deciding practitioner must have regard to the following—

(a) whether the transfer would be likely to cause serious harm to the person;
Examples of serious harm— •significant pain •a significant deterioration in the person’s condition

(b) whether the transfer would be likely to adversely affect the person’s access to voluntary assisted dying; Examples of adverse effects— •the transfer would likely result in a loss of decision-making capacity of the person •pain relief or medication for the transfer would likely result in a loss of decision-making capacity of the person

(d) whether the place to which the person is proposed to be transferred is available to receive the person; (e)whether the person would incur financial loss or costs because of the transfer.

(5) In this section— relevant practitioner, for a person, means—

(a) the consulting practitioner for the person; or

(b) a registered health practitioner to whom the consulting practitioner for the person has referred a matter under section 32.

96 Administration decisions

(1) This section applies if—

(a) the person has made a final request; and

(b) the person or the person’s agent advises the relevant entity that the person wishes to make an administration decision; and

(c) the entity does not provide, to persons to whom relevant services are provided at the facility, access to a person’s coordinating practitioner to enable an administration decision to be made.

(2) If the person is a permanent resident at the facility—

(a) the relevant entity and any other entity that owns or occupies the facility must allow reasonable access to the person at the facility by the coordinating practitioner for the person to consult with and advise the person in making the administration decision; and

(b) if the coordinating practitioner is not available to attend—the relevant entity must take reasonable steps to facilitate the transfer of the person to and from a place where the person’s administration decision may be made in consultation with, and on the advice of—

(i) the coordinating practitioner; or

(ii) another medical practitioner who is eligible and willing to act as the coordinating practitioner for the person.

(3) If the person is not a permanent resident at the facility—

(a) the relevant entity must take reasonable steps to facilitate the transfer of the person to and from a place where the person’s administration decision may be made in consultation with, and on the advice of, the coordinating practitioner for the person; or

(b) if, in the opinion of the deciding practitioner, transfer of the person as described in paragraph (a) would not be reasonable in the circumstances—the relevant entity and any other entity that owns or occupies the facility must allow reasonable access to the person at the facility by the coordinating practitioner for the person.

(4) In making the decision under subsection (3)(b), the deciding practitioner must have regard to the following—

(a) whether the transfer would be likely to cause serious harm to the person;
Examples of serious harm— •significant pain •a significant deterioration in the person’s condition

(d) whether the place to which the person is proposed to be transferred is available to receive the person;

(e) whether the person would incur financial loss or costs because of the transfer.

97 Administration of voluntary assisted dying substance

(1) This section applies if—

(a) the person has made an administration decision; and

(b) the person or the person’s agent advises the relevant entity that the person wishes to self-administer a voluntary assisted dying substance or have an administering practitioner administer a voluntary assisted dying substance to the person; and

(c) the relevant entity does not provide, to persons to whom relevant services are provided at the facility, access to the administration of a voluntary assisted dying substance at the facility.

(2) If the person is a permanent resident at the facility, the relevant entity and any other entity that owns or occupies the facility must—

(a) if the person has made a practitioner administration decision—

(i) allow reasonable access to the person at the facility by the administering practitioner for the person to administer a voluntary assisted dying substance to the person; and

(ii) allow reasonable access to the person at the facility by an eligible witness to the administration of the voluntary assisted dying substance by the administering practitioner for the person; or

(b) if the person has made a self-administration decision—not hinder access by the person to a voluntary assisted dying substance.

(3) If the person is not a permanent resident at the facility—

(a) the relevant entity must take reasonable steps to facilitate the transfer of the person to a place where the person may be administered or may self-administer a voluntary assisted dying substance; or

(b) if, in the opinion of the deciding practitioner, transfer of the person as described in paragraph (a) would not be reasonable in the circumstances, subsection (2) applies in relation to the person as if the person were a permanent resident at the facility.

(4) In making the decision under subsection (3)(b), the deciding practitioner must have regard to the following—

(a) whether the transfer would be likely to cause serious harm to the person;
Examples of serious harm— •significant pain •a significant deterioration in the person’s condition

98 Relevant entities to inform public of non-availability of voluntary assisted dying

(1) This section applies to a relevant entity that does not provide, at a facility at which the entity provides relevant services, services associated with voluntary assisted dying, such as access to the request and assessment process or access to the administration of a voluntary assisted dying substance.

(2) The relevant entity must publish information about the fact the entity does not provide those services at the facility.

(3) The relevant entity must publish the information in a way in which it is likely that persons who receive the services of the entity at the facility, or may in future receive the services of the entity at the facility, become aware of the information.

Examples of ways of publishing information— •printing the information in brochures about the relevant entity •placing the information on the relevant entity’s website •displaying the information on signs at the facility