Voluntary Assisted Dying : The VAD Process

Voluntary Assisted Dying
understanding the process in NSW

In Part 1, we spoke about my personal experience of Voluntary Assisted Dying when I took my mother through the process.

In this post, we'll step through the process as per the VAD Act in NSW.

Facing a terminal illness is an incredibly challenging experience, and for some patients in New South Wales, Voluntary Assisted Dying (VAD) provides an option for a dignified and controlled end-of-life choice.  The Voluntary Assisted Dying Act 2022 (NSW) establishes a structured process that allows eligible patients to access medical assistance to end their lives on their terms.  This blog explores the VAD process from a patient’s perspective, outlining the key steps, requirements, and considerations involved.

To access VAD in NSW, a patient must meet strict eligibility criteria, ensuring that only those with a genuine need can proceed.

A patient must :

• Be 18 years or older.
• Be an Australian citizen or permanent resident, and have lived in NSW for at least 12 months.
• Have a terminal illness or condition that is advanced, progressive, and expected to cause death within six months (or 12 months for neurodegenerative conditions).
• Be experiencing intolerable suffering that cannot be relieved in a way that is acceptable to them.
• Have decision-making capacity regarding VAD.
• Make the request voluntarily and without coercion.

These safeguards help ensure that VAD remains a considered, autonomous decision by the patient and is not influenced by external pressures.

For a patient seeking VAD, the process is thorough and involves multiple steps to ensure that the decision is informed and voluntary.

1. Making the First Request

The process begins when the patient makes a clear and explicit request for VAD to a medical practitioner.  Importantly, this request must come from the patient - the law prohibits healthcare professionals from suggesting or initiating discussions about VAD.

2. First Assessment by a Medical Practitioner

Once the request is made, the coordinating medical practitioner (a trained doctor) conducts an assessment to confirm that the patient meets all eligibility criteria.  During this stage, the patient is given detailed information about :

• Their diagnosis and prognosis.
• Alternative treatment and palliative care options.
• The VAD process, risks, and potential outcomes.
• The ability to withdraw the request at any time.

If the patient meets the eligibility criteria, the process moves forward.

3. Independent Consulting Assessment

A second, independent consulting medical practitioner conducts a separate evaluation to verify the patient’s eligibility.  This additional assessment ensures fairness and protects against potential misuse.

If there are concerns about the patient’s decision-making ability, they may be referred to a specialist (such as a psychiatrist or psychologist) for further evaluation.

4. Making a Written Declaration

If both assessments confirm eligibility, the patient must complete a written declaration, formally stating their desire to proceed with VAD.

This declaration must :

• Be signed in the presence of two independent witnesses (who cannot benefit from the patient’s estate).
• Be signed by the coordinating medical practitioner.

5. Final Request and Confirmation

After a minimum five-day waiting period (unless death is imminent), the patient must make a final request to their coordinating medical practitioner.  This step ensures that the patient is still resolute in their decision.

The coordinating doctor then conducts a final review, confirming that all legal and procedural requirements have been met before proceeding.

6. Choosing the Method of Administration

Once approved, the patient and doctor decide how the VAD substance will be administered :

• Self-administration : The patient takes the prescribed substance themselves, maintaining control over the timing of their passing.
• Practitioner administration : If the patient is unable to self-administer, a medical practitioner can administer the substance on their behalf.

In both cases, a VAD Substance Authority must be obtained from the NSW Voluntary Assisted Dying Board before the medication is provided.

Emotional and Psychological Impact

Choosing VAD is a deeply personal and emotional decision.  Patients often experience a mix of relief, sadness, and anxiety.  It is important to seek counselling, psychological support, or palliative care services to navigate these emotions.

Family and Loved Ones

Discussing VAD with family and loved ones can be challenging, as opinions may differ.  While some family members may be supportive, others may struggle with the decision.  Open, honest communication can help manage expectations and ensure emotional support.

Legal and Ethical Safeguards

NSW has implemented strict safeguards to prevent coercion or misuse of VAD.  These include :

• Multiple assessments by different doctors.
• Mandatory waiting periods to ensure the decision is well considered.
• Psychological evaluations if decision-making capacity is uncertain.
• Independent witnesses for the written declaration.

Patients can feel reassured that these measures are in place to protect their rights and autonomy.

Palliative Care and Other Options

VAD is not a replacement for palliative care, which remains an essential part of end-of-life care.  Patients are encouraged to explore pain management, hospice care, and psychological support alongside VAD discussions.

The NSW Voluntary Assisted Dying Board oversees the VAD process, ensuring that :

• All applications meet legal requirements.
• Medical practitioners follow due process.
• The system is transparent and accountable.

This oversight ensures that VAD remains a safeguarded and ethical practice.

Final Thoughts: Making an Informed Choice

Voluntary Assisted Dying offers a legal and dignified option for patients facing unbearable suffering at the end of life.  While the decision is intensely personal, NSW’s structured and safeguarded process ensures that patients retain control, autonomy, and dignity in their final days.

For those considering VAD, seeking support, having open conversations with loved ones, and working closely with medical professionals can make the journey more informed and compassionate.

No one should face this decision alone, and resources are available to guide patients through every step of the process.

There's a lot to process and sometimes you don't know where to start.

I've lived through this process with my mother, so we can talk - confidentially - about whatever queries you might have.

Contact Me at any time.