Tasmania: End-of-Life Choices (Voluntary Assisted Dying) Act 2021 (Tas)

End-of-Life Choices (Voluntary Assisted Dying) Act 2021 An Act to provide for, and regulate access to, voluntary assisted dying, to establish the Voluntary Assisted Dying Commission, and for related purposes [Royal Assent 22 April 2021] Be it enacted by Her Excellency the Governor of Tasmania, by and with the advice and consent of the Legislative Council and House of Assembly, in Parliament assembled, as follows: PART 1 - Preliminary 1. Short title This Act may be cited as the End-of-Life Choices (Voluntary Assisted Dying) Act 2021 . 2. Commencement This Act commences on a day to be proclaimed, but if this Act has not commenced before 18 months after the day on which it receives the Royal Assent it commences at the end of that 18-month period. 3. Objectives and principles (1) The objectives of this Act are – (a) to provide, to persons who are eligible to access voluntary assisted dying, an efficient and effective process to enable them to exercise their choice to reduce their suffering by ending their lives legally; and (b) to ensure that the process provided for the exercise of that choice protects and prevents persons from having their lives ended unwittingly or unwillingly; and (c) to provide, in certain circumstances, legal protection for persons who choose to assist, or who choose not to assist, such persons to exercise their choice to end their lives in accordance with that process. (2) A person exercising a power or performing a function under this Act must have regard to the following principles: (a) every human life has equal value; (b) a person's autonomy, including autonomy in respect of end of life choices, should be respected; (c) a person has the right to be supported in making informed decisions about the person's medical treatment, and should be given, in a manner the person understands, information about medical treatment options, including comfort and palliative care and treatment; (d) a person approaching the end of life should be provided with high quality care and treatment, including palliative care and treatment, to minimise the person's suffering and maximise the person's quality of life; (e) a therapeutic relationship between a person and the person's registered health practitioner should, wherever possible, be supported and maintained; (f) a person should be encouraged to openly discuss death and dying, and the person's preferences and values regarding their care, treatment and end of life should be encouraged and promoted; (g) a person should be supported in conversations with the person's registered health practitioner, members of the person's family and carers and community about treatment and care preferences; (h) a person is entitled to genuine choices about the person's care, treatment and end of life, irrespective of where the person lives in Tasmania and having regard to the person's culture and language; (i) a person who is a regional resident is entitled to the same level of access to voluntary assisted dying as a person who lives in a metropolitan region; (j) there is a need to protect persons who may be subject to abuse or coercion; (k) all persons, including registered health practitioners, have the right to be shown respect for their culture, religion, beliefs, values and personal characteristics. 4. Act binds Crown This Act binds the Crown in right of Tasmania and, so far as the legislative power of Parliament permits, in all its other capacities. PART 2 - Interpretation Provisions 5. Interpretation In this Act, unless the contrary intention appears – AHP, in relation to a person, means the person – (a) who is, under section 61 , the person's administering health practitioner; and (b) who has not ceased, under section 109 , to be the person's AHP; approved means approved by the Commission; approved voluntary assisted dying training means a course of voluntary assisted dying training approved by the Commission under section 117 ; authorised medical practitioner, in relation to a person, means a person who is, under section 9 , an authorised medical practitioner in relation to the person; CMP, in relation to a person, means a person – (a) who is, under section 42 , the person's consulting medical practitioner; and (b) who has not ceased, under section 108 , to be the person's CMP; Commission means the Voluntary Assisted Dying Commission established by section 110(1) ; contact person, in relation to a person, means a person who is appointed under section 85 to be the contact person in relation to the person; decision-making capacity – see section 12 ; Deputy Executive Commissioner means the Deputy Executive Commissioner appointed under section 110(2)(b) ; driver licence means a licence, permit or other authorisation issued under an Act of this State, another State, or a Territory, authorising a person to drive; eligible to access voluntary assisted dying – see section 10 ; Executive Commissioner means the person appointed to be the Executive Commissioner under section 110(2)(a) and includes the Deputy Executive Commissioner, when acting as the Executive Commissioner; final permission, in relation to a person, means a final permission given by the person under section 82 as amended, if at all, in accordance with section 82(4) ; final request, in relation to a person, means a final request made by the person under section 53 ; first request, in relation to a person, means a first request made by the person under section 18(2) ; health service has the same meaning as in the Tasmanian Health Service Act 2018 ; in person, in relation to a person, means while physically present before the person and does not include by means of a telephone, or by audio-visual link or another means of electronic communication; medical practitioner means a person who is registered under the Health Practitioner Regulation National Law (Tasmania) in the medical profession (other than a student); member of the Commission means a person appointed to the Commission under section 110 , including the Executive Commissioner and the Deputy Executive Commissioner; member of the family, in relation to a person, means a person who is – (a) the father, mother, grandfather or grandmother of the person; or (b) the spouse of the person; or (c) a brother, sister, niece or nephew of the person; or (d) a person in a family relationship, within the meaning of the Relationships Act 2003 , with the person; or (e) a person in a caring relationship, within the meaning of the Relationships Act 2003 , with the person; or (f) a child, or grandchild, of the person; nurse practitioner means a person who is registered under the Health Practitioner Regulation National Law (Tasmania) in the nursing profession and who is endorsed by the Nursing and Midwifery Board of Australia to practise as a nurse practitioner; officer of the Ambulance Service has the same meaning as in the Ambulance Service Act 1982 ; patient transport officer means – (a) a volunteer ambulance officer within the meaning of the Ambulance Service Act 1982 ; and (b) a person who is providing non-emergency patient transport services within the meaning of the Ambulance Service Act 1982 ; and (c) a person who is providing ambulance services under section 38A of the Ambulance Service Act 1982 ; pharmacist means a person who holds general registration under the Health Practitioner Regulation National Law (Tasmania) in the pharmacy profession (other than a student); PMP, in relation to a person, means a person – (a) who becomes, under section 22 or section 59(5) , the person's primary medical practitioner; and (b) who has not ceased, under section 106 , to be the person's PMP; private self-administration certificate, in relation to a person, means a private self-administration certificate completed and signed under section 84 by the person's AHP; private self-administration request, in relation to a person, means a private self-administration request given by the person under section 83(1) ; professional care service means any of the following services provided to another person under a contract of employment or contract for services: (a) assistance or support, including the following: (i) assistance with bathing, showering, personal hygiene, toileting, dressing, undressing or preparing or eating meals; (ii) assistance for persons with mobility problems; (iii) assistance for persons who are mobile but required some form of assistance or supervision; (iv) assistance or supervision in administering medicine; (v) the provision of substantial emotional support; (b) a specialist disability service, within the meaning of the Disability Services Act 2011 ; psychiatrist means a person registered under the Health Practitioner Regulation National Law (Tasmania) as a medical practitioner in the speciality of psychiatry (other than as a student); psychologist means a person registered under the Health Practitioner Regulation National Law (Tasmania) to practise psychology (other than as a student); reasonably available treatment, in relation to a person, means treatment available to the person in Australia within a reasonable time and at a cost to the person that is not prohibitive; registered health practitioner means a person registered under the Health Practitioner Regulation National Law (Tasmania) to practise a health profession (other than as a student); registered nurse means a person registered under the Health Practitioner Regulation National Law (Tasmania) in the nursing profession whose name is entered on Division 1 of the Register of Nurses, kept under that Law, as a registered nurse; relevant facts in relation to accessing voluntary assisted dying – see section 8 ; relevant information about eligibility, in relation to a person, means the relevant information about eligibility, specified in section 7 , in relation to the person; relevant medical condition – see section 6 ; request, in relation to a person, means – (a) a first request from the person; or (b) a second request from the person; or (c) a final request from the person; residency requirements – see section 11 ; residential care provider, in relation to a person, means a person who owns or operates premises at which – (a) the first-mentioned person resides; and (b) health services are, or may be, provided to the first-mentioned person by, or on behalf of, the person who owns or operates the premises; second request, in relation to a person, means a second request made by the person under section 30(1) ; spouse, in relation to a person, means – (a) the husband or wife of the person; and (b) a person in a significant relationship, within the meaning of the Relationships Act 2003 , with the person; VAD substance means a substance that is determined by the Commission under section 116 to be a VAD substance; VAD substance authorisation, in relation to a person, means a VAD substance authorisation, in relation to the person, that is issued under section 67(1)(a) ; VAD substance prescription means a prescription, issued in accordance with the Poisons Act 1971 , that is a VAD substance prescription issued by a PMP under section 70(1)(a) ; voluntary assisted dying means the administration to a person, or the self-administration by a person, of a VAD substance under this Act; voluntary assisted dying process, in relation to a person, means the following: (a) the making of a first request by the person under section 18 ; (b) the acceptance of, or refusal to accept, under section 19 , a first request made by the person under section 18 ; (c) a determination under section 26 of a first request made by the person; (d) the making of a second request by the person under section 30 ; (e) a determination under section 33 of a second request by the person; (f) a referral of the person, under section 37 , by the person's PMP; (g) the giving by the person of permission for the purposes of section 38(2) ; (h) the acceptance of, or the refusal to accept, under section 39 , a referral of the person; (i) a determination under section 47 in relation to the person; (j) the making by the person of a final request under section 53 ; (k) a determination under section 55 of a final request made by the person; (l) the giving of advice to the person under section 60 ; (m) a request to the Commission under section 66(1) for a VAD substance authorisation in relation to the person; (n) the determination under section 67 by the Commission of a request for a VAD substance authorisation in relation to the person; (o) the issue under section 70 of a VAD substance prescription, in relation to the person; (p) the supply under section 71 , to the PMP in relation to the person, of a VAD substance; (q) the supply, to the person's AHP, under section 74 , of a VAD substance by the person's PMP; (r) the making of a determination under section 78 in relation to the person and the giving to the person of a notice or advice under section 80 or 81 by the person's AHP; (s) the giving by the person of a final permission under section 82 and the amending of the final permission under section 82(4) ; (t) the giving by the person of a private self-administration request under section 83(1) ; (u) the completion of a private self-administration certificate in relation to the person under section 84 ; (v) the appointment by the person under section 85 of the contact person in relation to the person; (w) the supply of a VAD substance under section 86 or section 89 by the person's AHP; (x) the administration under section 86 , by the person's AHP, of a VAD substance to the person or the self-administration by the person of a VAD substance in accordance with section 91(3) . 6. Relevant medical condition (1) For the purposes of this Act – relevant medical condition, in relation to a person, means a disease, illness, injury, or medical condition, of the person that – (a) is advanced, incurable and irreversible; and (b) is expected to cause the death of the person; and (c) except if the person is exempted from this requirement under subsection (3) , is expected to cause the death of the person – (i) within 6 months; or (ii) if the disease is neurodegenerative – within 12 months. (2) For the purposes of this Act, a disease, illness, injury, or medical condition, of a person is incurable and irreversible and is expected to cause the death of the person if there is no reasonably available treatment that – (a) is acceptable to the person; and (b) can cure or reverse the disease, illness, injury or medical condition and prevent the expected death of the person from the disease, illness, injury or medical condition. (3) The Commission, on the application of a person, may determine that the person is exempted from the requirement of paragraph (c) of the definition of relevant medical condition in subsection (1) . (4) The Commission may only determine that a person is exempted from the requirement of paragraph (c) of the definition of relevant medical condition in subsection (1) if the Commission is satisfied that the prognosis of the person's relevant medical condition is such that the paragraph should not apply in relation to the person. (5) The Commission must, so as to assist the Commission to decide whether or not to make a determination under subsection (3) in relation to the person – (a) request medical practitioners to provide to the Commission medical records, in the possession of the medical practitioners, in relation to the person; and (b) request a medical practitioner, who has specialist knowledge as to a relevant medical condition that is a relevant medical condition in relation to a person, to advise the Commission in relation to the relevant medical condition using the collection of medical records for the person provided by the Commission. 7. Relevant information about eligibility For the purposes of this Act, the relevant information about eligibility, in relation to a person, is information as to – (a) whether the person has attained the age of 18 years; and (b) whether the person meets the residency requirements; and (c) whether the person has decision-making capacity; and (d) whether the person is acting voluntarily; and (e) whether the person is suffering intolerably in relation to a relevant medical condition; and (f) the prognosis in relation to – (i) the relevant medical condition or the relevant medical condition together with other medical conditions of the person; and (ii) any complications of a medical kind that have arisen in relation to the treatment of the relevant medical condition or the combination of that treatment with the treatment of other medical conditions of the person; and (g) the reasonably available treatment that may relieve the mental or physical suffering of the person that is related to (or that occurs in anticipation of the suffering, or in expectation, based on medical advice, of the suffering, that might arise from) – (i) the relevant medical condition or the relevant medical condition together with other medical conditions of the person; or (ii) the treatment of the relevant medical condition or the combination of that treatment with the treatment of other medical conditions of the person; or (iii) complications of a medical kind that have arisen, or may arise, in relation to the treatment of the relevant medical condition or the combination of that treatment with the treatment of other medical conditions of the person. 8. Relevant facts in relation to accessing voluntary assisted dying For the purposes of this Act, the relevant facts in relation to accessing voluntary assisted dying are information, in an approved form, that includes the following: (a) information as to the operation of this Act; (b) information as to how the person's eligibility to access voluntary assisted dying is to be determined; (c) information as to the functions of the Commission and contact details for the Commission; (d) information as to what assistance to die the person may receive from a PMP or an AHP; (e) information as to where advice in relation to palliative care, or other treatment or pain relief, may be obtained. 9. Authorised medical practitioners For the purposes of this Act, a person is an authorised medical practitioner in relation to a person if – (a) the person is a medical practitioner; and (b) the person has practised as a medical practitioner for at least 5 years after vocational registration as a general practitioner or after completing a fellowship with a specialist medical college; and (c) the person has relevant experience in treating or managing the disease, illness, injury, or medical condition expected to cause the death of the person; and (d) the medical practitioner has successfully completed an approved voluntary assisted dying training course within the 5-year period immediately before the person makes a first request to the medical practitioner under section 18 or is referred to the medical practitioner under section 37(1) ; and (e) the medical practitioner is not a member of the family of the person; and (f) the medical practitioner does not know or believe that he or she is likely to, either directly or indirectly, benefit from, or directly or indirectly receive a financial benefit as a result of, the death of the person, other than by receiving reasonable fees for the provision of services as the PMP, CMP or AHP of the person. PART 3 - When Person May Access Voluntary Assisted Dying 10. When person is eligible to access voluntary assisted dying (1) For the purposes of this Act, a person is eligible to access voluntary assisted dying if – (a) the person has attained the age of 18 years; and (b) the person meets the residency requirements; and (c) the person has decision-making capacity; and (d) the person is acting voluntarily; and (e) the person is suffering intolerably in relation to a relevant medical condition. (2) For the purposes of this Act, a person is not eligible to access voluntary assisted dying by reason only that the person – (a) has a mental illness, within the meaning of the Mental Health Act 2013 ; or (b) has a disability, within the meaning of the Disability Services Act 2011 . (3) For the avoidance of doubt – (a) a person who has a disability, within the meaning of the Disability Services Act 2011 , is eligible to access voluntary assisted dying if the person has a relevant medical condition and the other requirements of subsection (1) are satisfied in relation to the person; and (b) a person who has a mental illness, within the meaning of the Mental Health Act 2013 , is eligible to access voluntary assisted dying if the requirements of subsection (1) are satisfied in relation to the person. 11. When person meets residency requirements (1) For the purposes of this Act, a person meets the residency requirements if – (a) the person – (i) is an Australian citizen; or (ii) is a permanent resident of Australia; or (iii) has been resident in Australia for at least 3 continuous years immediately before the person makes the relevant first request; and (b) the person has been ordinarily resident in Tasmania for at least 12 continuous months immediately before the person makes the relevant first request. (2) If a person's PMP is unable to determine if the person meets the residency requirements, the person's PMP may request the Commission to advise the PMP as to whether the person meets the residency requirements. (3) The Commission may, after receiving a request under subsection (2) from a person's PMP, advise the PMP, in writing, that the person – (a) meets the residency requirements; or (b) does not meet the residency requirements. (4) If the Commission, under subsection (3) – (a) advises a person's PMP that the person meets the residency requirements, the person is to be taken for the purposes of this Act to meet the residency requirements; or (b) advises a person's PMP that the person does not meet the residency requirements, the person is to be taken for the purposes of this Act not to meet the residency requirements, unless and until the Commission issues a subsequent advice under this section. (5) For the purposes of this Act, evidence of a person being, or not being, at a particular time, ordinarily resident in Tasmania includes, but is not limited to including, evidence of any of the following: (a) the day on which the person was issued a driver licence under an Act of the State, or an Act of another State or a Territory; (b) the day on which the person became, under an Act of the Commonwealth or the State, enrolled to vote for a member of the Tasmanian parliament or for a member of the Commonwealth parliament who is to represent Tasmania; (c) the day on which the person became, under an Act of the Commonwealth or of another State or a Territory, enrolled to vote for a member of the parliament of another State or a Territory or to vote for a member of the Commonwealth parliament who is to represent another State or a Territory; (d) the day on which the person purchased property, entered into a lease of property or entered into, under the Residential Tenancy Act 1997 , a residential tenancy agreement; (e) the existence of a lease, granted by or to the person, in relation to residential premises situated in another State or a Territory; (f) the existence of a statutory declaration from the person as to where, at a particular time, the person is or was ordinarily resident. 12. When person has decision-making capacity (1) For the purposes of this Act, a person has decision-making capacity in relation to a decision for the purposes of this Act if, when the person makes the decision, the person has the capacity to – (a) understand the information or advice that is reasonably required in order to be able to make the decision; and (b) remember such information or advice to the extent necessary to make the decision; and (c) use or evaluate the information or advice for the purposes of making the decision; and (d) communicate the decision, and the person's opinions in relation to the decision, whether by speech, in writing, by gesture or by other means. (2) For the purposes of subsection (1) – (a) a person is to be taken to have decision-making capacity in relation to a decision unless there is evidence to the contrary; and (b) a person is taken to understand information and advice in relation to the making of a decision if it reasonably appears that he or she is able to understand an explanation of the consequences of making the decision. (3) In determining whether or not a person has decision-making capacity in relation to a decision, regard must be had to each of the following: (a) a person may have the capacity to make some decisions and not others; (b) a person's lack of capacity to make a decision may be temporary and not permanent; (c) an assumption that a person does not have the capacity to make a decision should not be made – (i) on the basis of the person's appearance; or (ii) because the person makes a decision that another person may consider to be unwise. (4) If a person's CMP, PMP or AHP is unable to determine whether the person has decision-making capacity in relation to a decision, the CMP, PMP, or AHP, respectively, must refer the person, under section 25 , section 32 , section 46 , section 54 or section 79 , as the case may be, to a medical practitioner, psychiatrist, or psychologist, who has the skills and training that are appropriate to make such a determination. (5) If a CMP, PMP or AHP refers a person in accordance with subsection (4) to another person, the CMP, PMP or AHP may adopt, for the purposes of the decision of the CMP, PMP or AHP in relation to which the person was referred to the other person, the decision of the other person as to whether the person has decision-making capacity at that time. 13. When person is acting voluntarily For the purposes of this Act, a person is acting voluntarily if the person is not acting under duress, coercion or because of a threat of punishment or unfavourable treatment, or a promise to give a reward or benefit, to the person or another person. 14. When person is suffering intolerably in relation to relevant medical condition For the purposes of this Act, a person is suffering intolerably in relation to a relevant medical condition if – (a) the person has a relevant medical condition; and (b) persistent suffering that is, in the opinion of the person, intolerable is being caused to the person by any one or more of the following: (i) the relevant medical condition or the relevant medical condition together with the person's other medical conditions; (ii) anticipation of the suffering, or expectation, based on medical advice, of the suffering, that may arise from the relevant medical condition or from the relevant medical condition together with the person's other medical conditions; (iii) the treatment that the person has received or the combination of that treatment with the treatment of other medical conditions of the person; (iv) anticipation of the suffering, or expectation, based on medical advice, of the suffering, that may arise from the treatment that the person may receive in relation to the relevant medical condition or the combination of that treatment with the treatment of the person's other medical conditions; (v) the complications of a medical kind arising from, or related to, the treatment of the relevant medical condition or the combination of that treatment with the treatment of the person's other medical conditions; (vi) anticipation of the suffering, or expectation, based on medical advice, of the suffering, that may arise from the complications of a medical kind arising from, or related to, the treatment of the relevant medical condition or the combination of that treatment with the treatment of the person's other medical conditions; and (c) there is no reasonably available treatment that, having regard to both the treatment and the consequences, including side effects of the treatment, is reasonably likely to – (i) improve the person's relevant medical condition, or overall health and wellbeing, in a manner, to an extent, and in a period of time, that is acceptable to the person; and (ii) in the opinion of the person, lessen the person's suffering to an extent that is acceptable to the person. PART 4 - Communication in Relation to Access to Voluntary Assisted Dying 15. When person's communication under Act may be made by another person (1) In this section – relevant communication means any of the following: (a) a first request; (b) a statement to a relevant practitioner under section 16 ; (c) the designation of a person, under section 18(4) , section 30(3)(a)(ii) , section 53(3)(b) , section 82(1)(b) or (4) , section 83(2)(b)(ii) or section 85(2)(b) , to complete and sign, or complete or sign, a document on another person's behalf; (d) a permission given by a person for the purposes of section 38(2)(b) ; (e) any other communication made to a relevant practitioner, in relation to a communication referred to in another paragraph of this definition; (f) any other communication made as part of, or in relation to, the voluntary assisted dying process; relevant practitioner, in relation to a person, means the PMP, CMP or AHP in relation to the person. (2) A relevant communication that may be made or given by a person (the VAD person) to a relevant practitioner under this Act may, if – (a) the VAD person is unable to communicate to a person who is unfamiliar with the VAD person's method of communication; and (b) the VAD person's means of communication is comprehensible to another person who is familiar with the VAD person or the method of communication – be made to the relevant practitioner by the other person, if the relevant practitioner is satisfied as to the relevant matters in relation to the VAD person and the other person. (3) A relevant communication that may be made or given by a person (the VAD person) to a relevant practitioner under this Act may, if the VAD person is unable to communicate to the relevant practitioner in a language in which both the VAD person and the relevant practitioner are fluent, be made by another person who is fluent in that language, if the relevant practitioner is satisfied as to the relevant matters in relation to the VAD person and the other person. (4) For the purposes of this section, the relevant practitioner is satisfied as to the relevant matters in relation to a VAD person and the other person if the relevant practitioner is satisfied that – (a) the VAD person has decision-making capacity; and (b) the VAD person wishes the other person to make relevant communications on behalf of the VAD person; and (c) the other person – (i) is not a member of the family of the VAD person; and (ii) where subsection (3) applies in relation to the other person – is a person who is accredited by a prescribed body as a translator in the relevant language; and (iii) does not know or believe that he or she is likely to directly or indirectly benefit from, or receive a financial benefit, directly or indirectly, as a result of the death of, the VAD person; and (iv) is not a residential care provider in relation to the VAD person; and (v) is not directly involved in providing health services or professional care services to the VAD person; and (d) the VAD person is acting voluntarily in wishing the other person to make relevant communications on behalf of the VAD person. (5) Despite subsection (4)(c) , a subparagraph of that subsection does not apply in relation to a person if the Commission is satisfied that there are reasonable grounds why the subparagraph ought not to apply in relation to the person. (6) If a relevant communication that may be made or given by a person under this Act may, under this section, be made or given by another person, the relevant communication may be made or given orally or in writing by the other person. (7) A person may not be designated under section 18(4) , section 30(3)(a)(ii) , section 53(3)(b) , section 82(1)(b) or (4) , section 83(2)(b)(ii) or section 85(2)(b) to complete and sign, or complete or sign, a document on another person's behalf, if the person so designated is the person who makes a relevant communication under this section designating the person. 16. Person may withdraw from voluntary assisted dying process at any time (1) A person may at any time, orally or in writing, inform the person's PMP or AHP that the person no longer wishes to access voluntary assisted dying. (2) If a person's PMP or AHP is informed by the person under subsection (1) that the person no longer wishes to access voluntary assisted dying, the voluntary assisted dying process, begun by the making of the first request by the person, ceases in relation to the person. (3) Nothing in subsection (2) is to be taken to prevent a person from making another first request and the voluntary assisted dying process from beginning again, accordingly, in relation to the person. (4) A person's PMP who is not the person's AHP must, if the PMP is informed by the person under subsection (1) that the person no longer wishes to access voluntary assisted dying, as soon as reasonably practicable but in any case within 2 days – (a) make a record, in the person's medical record, that the person no longer wishes to access voluntary assisted dying; and (b) notify the person's AHP, if any, that the person no longer wishes to access voluntary assisted dying; and (c) notify the person's CMP, if any, that the person no longer wishes to access voluntary assisted dying; and (d) notify the Commission, in the approved form, that the person no longer wishes to access voluntary assisted dying. (5) A person's AHP who is informed by the person under subsection (1) that the person no longer wishes to access voluntary assisted dying must, as soon as reasonably practicable but in any case within 2 days – (a) if the AHP is a medical practitioner, make a record, in the medical records kept by the practitioner in relation to the person, that the person no longer wishes to access voluntary assisted dying; and (b) if the AHP is not the person's PMP, notify the person's PMP that the person no longer wishes to access voluntary assisted dying; and (c) notify the Commission, in the approved form, that the person no longer wishes to access voluntary assisted dying. (6) If a person's PMP has been notified under subsection (5)(b) by the person's AHP that the person no longer wishes to access voluntary assisted dying, the PMP must, as soon as reasonably practicable but in any case within 2 days – (a) make a record, in the medical records kept in relation to the person by the PMP, that the person no longer wishes to access voluntary assisted dying; and (b) notify the person's CMP, if any. 17. Certain persons not to initiate discussions about voluntary assisted dying (1) A registered health practitioner who provides health services or professional care services to a person must not, in the course of providing the services to the person – (a) initiate discussion with the person that is in substance about the voluntary assisted dying process; or (b) in substance, suggest to the person that the person may wish to participate in the voluntary assisted dying process (2) Nothing in subsection (1) prevents a medical practitioner from taking an action referred to in subsection (1) if, at the time of taking the action, the medical practitioner also informs the person about – (a) the treatment options available to the person and the likely outcomes of that treatment; and (b) the palliative care and treatment options available to the person and the likely outcomes of that care and treatment. (3) Nothing in subsection (1) prevents a registered health practitioner who is not a medical practitioner from taking an action referred to in subsection (1) in relation to a person if the registered health practitioner, before the conclusion of the discussion, with the person, in which the action is taken, informs the person that a medical practitioner would be the most appropriate person with whom to discuss the voluntary assisted dying process and care and treatment options for the patient. (4) Nothing in subsection (1) prevents a person from providing to a person, at the person's request, information about the voluntary assisted dying process. (5) A contravention of subsection (1) by a registered health practitioner is capable of constituting unprofessional conduct for the purposes of the Health Practitioner Regulation National Law (Tasmania). PART 5 - First Request Division 1 - Making and acceptance of first request 18. Person may make first request to access voluntary assisted dying (1) If a person has clearly indicated to a medical practitioner that the person wishes to access voluntary assisted dying, the medical practitioner must, whether or not the medical practitioner has a conscientious objection to providing assistance to the person to die, provide to the person the contact details of the Commission. (2) A person – (a) who has received from a medical practitioner the relevant facts in relation to accessing voluntary assisted dying; and (b) who wishes to access voluntary assisted dying – may, orally or in writing, request the medical practitioner to determine whether the person is eligible to access voluntary assisted dying. (3) A person is not to be taken to have made a request under subsection (2) to a medical practitioner unless – (a) the person has received the relevant facts in relation to accessing voluntary assisted dying from the medical practitioner in person and not by way of audio-visual link; and (b) where the request is made orally, the person has clearly indicated to the medical practitioner, in person and not by way of audio-visual link, that the person wishes to access voluntary assisted dying. (4) A written request under subsection (2) to a medical practitioner may be made by an instrument in writing signed – (a) by the person; or (b) if the person is unable to complete or sign the instrument – by an adult designated by the person to complete or sign, or to complete and sign, the instrument on the person's behalf. (5) A person who makes a request under subsection (2) to a medical practitioner is taken for the purposes of this Act to have made a first request to the medical practitioner. (6) If a person has attempted to make under subsection (2) a request to the medical practitioner but has not received from the medical practitioner the relevant facts in relation to accessing voluntary assisted dying, the medical practitioner must give to the person the relevant facts in relation to accessing voluntary assisted dying. 19. Medical practitioner must accept or refuse to accept first request A medical practitioner to whom a first request is made by a person must, within 48 hours – (a) accept the request; or (b) refuse to accept the request. 20. Refusal to accept first request (1) A medical practitioner to whom a first request is made by a person must refuse under section 19(b) to accept the request if the medical practitioner is not an authorised medical practitioner in relation to the person. (2) A medical practitioner to whom a first request is made by a person may refuse under section 19(b) to accept the request for any reason, including, but not limited to, because the medical practitioner has a conscientious objection to providing assistance to the person to die. (3) A medical practitioner must, as soon as reasonably practicable, but in any case within 7 days, after refusing to accept a first request from a person under section 19(b) – (a) notify the person of the refusal of the first request; and (b) note, on the medical practitioner's medical records in relation to the person, that the person has made a first request and that the medical practitioner has refused to accept the request; and (c) notify the Commission, in the approved form, that the medical practitioner has refused a first request from the person. 21. Medical practitioner not required to give reasons for accepting or refusing request A medical practitioner to whom a first request is made by a person may, but is not required to, provide to any person reasons for accepting, or refusing to accept, the request. Division 2 - Effect of acceptance of first request 22. Medical practitioner who accepts first request becomes PMP A medical practitioner who accepts under section 19(a) a first request from a person under section 18(2) becomes the person's primary medical practitioner (the person's PMP). 23. Notification of acceptance of first request A person's PMP must, as soon as reasonably practicable, but in any case within 7 days, after accepting under section 19(a) a first request from the person – (a) notify the person of the acceptance of the first request; and (b) note on the medical practitioner's medical records in relation to the person that the medical practitioner has accepted a first request from the person; and (c) notify the Commission, in the approved form, that the medical practitioner has accepted a first request from the person. 24. Person who makes first request is to be provided with relevant information about eligibility (1) A person's PMP must, before determining under section 26 a first request from the person, give to the person the relevant information in relation to the person's first request. (2) The relevant information in relation to a person's first request is – (a) information as to – (i) the relevant medical condition of the person and any other medical conditions of the person that may affect the relevant medical condition or its treatment; and (ii) treatment of the relevant medical condition that has been, or may be, administered to the person; and (iii) treatment, of other medical conditions of the person, that may have affected, or may affect, the relevant medical condition or its treatment and that has been, or may be, administered to the person; and (b) information as to any complications of a medical kind that have arisen, or that may arise, from the treatment of the relevant medical condition or other medical conditions of the person; and (c) the prognosis in relation to – (i) the relevant medical condition or the relevant medical condition together with other medical conditions of the person; and (ii) any complications of a medical kind that have arisen, or may arise, in relation to the treatment of the relevant medical condition or the combination of that treatment with the treatment of other medical conditions of the person; and (d) information as to reasonably available treatment that may relieve the suffering of the person that is related to any of the following or to anticipation of suffering, or expectation, based on medical advice, of suffering, that may arise from any of the following: (i) the relevant medical condition or the relevant medical condition together with other medical conditions of the person; (ii) the treatment of the relevant medical condition or the combination of that treatment with the treatment of other medical conditions of the person; (iii) complications of a medical kind that have arisen, or may arise, in relation to the treatment of the relevant medical condition or its treatment or the combination of that treatment with the treatment of other medical conditions of the person; and (e) any information as to palliative care that may reasonably be able to be provided to the person. (3) As soon as reasonably practicable, but in any case within 7 days, after giving to a person the relevant information in relation to the person's first request, the person's PMP is to give, to the Commission, notice, in the approved form, that the PMP has given to the person that information. 25. PMP may refer person, request information, &c. (1) A person's PMP may, for the purpose of enabling the PMP to determine the first request from the person, do any one or more of the following: (a) refer the person to another medical practitioner for examination; (b) request the person to provide to the PMP all information that the PMP reasonably requires in order to make the determination; (c) request a medical practitioner to provide to the PMP copies of the medical records of the person that are in the possession of the medical practitioner and that the PMP reasonably requires in order for the PMP to make the determination; (d) request a person (a medical record holder) to provide to the PMP copies of medical records, in relation to the person, that are held or stored by the medical record holder and that the PMP requires in order to make the determination; (e) request a psychiatrist, psychologist, registered health practitioner, or any other person whom the PMP thinks fit, to provide to the PMP the information (which may include any medical records) that the PMP reasonably requires in order to make the determination. (2) A person to whom a request is made under subsection (1) must not fail, without reasonable excuse, to comply with the request as soon as reasonably practicable. Division 3 - Determination of first request 26. PMP to determine first request (1) A person's PMP is to determine a first request from the person by – (a) determining that the person is eligible to access voluntary assisted dying; or (b) determining that the person is not eligible to access voluntary assisted dying. (2) A person's PMP is to determine a first request from the person as soon as reasonably practicable after the PMP has sufficient information to enable the PMP to make the determination. 27. Requirements in relation to determination of first request (1) A person's PMP must not make a determination under section 26 of a first request made by the person unless – (a) the PMP has, after accepting under section 19(a) the first request from the person, met the person, in person or by way of audio-visual link; and (b) the PMP, having met the person, in person or by way of audio-visual link, is able to determine the decision-making capacity of the person or adopts under section 12(5) the decision of another person in relation to the decision-making capacity of the person. (2) A person's PMP – (a) must not determine under section 26(1)(b) that the person is not eligible to access voluntary assisted dying, by reason only that the PMP does not have sufficient information to enable the PMP to determine that the person is eligible to access voluntary assisted dying; and (b) may refuse to determine under section 26 the first request by the person until the PMP has sufficient information to enable the PMP to make the determination; and (c) must not determine under section 26(1)(a) that the person is eligible to access voluntary assisted dying until the PMP has sufficient information to enable the PMP to make the determination. (3) A person's PMP must determine under section 26 a first request by the person by determining under section 26(1)(a) that the person is eligible to access voluntary assisted dying, if the PMP is satisfied that the person is eligible under section 10 to access voluntary assisted dying. (4) If a person's PMP determines under section 26 a first request by the person by determining under section 26(1)(a) that the person is eligible to access voluntary assisted dying, the PMP must, if the person consents – (a) provide to a member of the family of the person, if any, the relevant facts in relation to accessing voluntary assisted dying; and (b) take all reasonable steps to explain to a member of the family of the person, if any, the plan for the person to access voluntary assisted dying including, in particular, the arrangements to be made in relation to the body of the person if the person is intending to obtain a private self-administration certificate and self-administer a VAD substance without the person's AHP being present. 28. Determination of first request to be in writing A determination under section 26 of a first request by a person is to be in writing and is to contain the relevant information about eligibility in relation to the person. 29. Records and notifications of determination of first request (1) A person's PMP who has made a determination under section 26 in relation to the person must, as soon as reasonably practicable but in any case within 7 days – (a) notify the person as to whether the PMP's determination states that the person is, or is not, eligible to access voluntary assisted dying; and (b) place, on the PMP's medical records in relation to the person, the determination or a copy of the determination; and (c) give to the Commission a copy of the determination and a statement, in the approved form, setting out the PMP's reasons for the determination. (2) A person's PMP who has made a determination under section 26 in relation to the person may, at the request of the person, provide to the medical practitioner who the person ordinarily attends in relation to a disease, illness, injury, or medical condition – (a) a copy of the PMP's determination; and (b) a statement of the reasons for the PMP's determination. PART 6 - Second Request Division 1 - Making of second request 30. Person may make second request (1) A person may, if the person's PMP has determined a first request from the person by determining under section 26(1)(a) that the person is eligible to access voluntary assisted dying, make a second request to the PMP to determine whether the person is eligible to access voluntary assisted dying (a second request). (2) A person must not make a second request to the person's PMP within 48 hours of the person having made a first request to the PMP, unless, in the opinion of the PMP – (a) the person is likely to die within 7 days; or (b) the person is likely to cease to have decision-making capacity within 48 hours. (3) A person makes under subsection (1) a second request to the person's PMP by providing to the PMP an instrument in writing in the approved form – (a) completed, and signed, by – (i) the person; or (ii) if the person is unable to complete or sign the instrument – an adult designated by the person to complete or sign, or to complete and sign, the instrument on the person's behalf; and (b) witnessed, in the presence of the person, by at least 2 adults, or by a commissioner for declarations, within the meaning of the Oaths Act 2001 , who have observed the instrument being completed and signed in accordance with paragraph (a) . (4) A person must not designate, under subsection (3)(a)(ii) , the person's PMP to complete or sign, or complete and sign, a second request on the person's behalf. 31. Certain persons may not witness a second request (1) One of the witnesses, or the commissioner for declarations, within the meaning of the Oaths Act 2001 , to a person's second request must not be any one or more of the following persons: (a) a member of the family of the person; (b) a person who, at the time of witnessing the request, knows or believes that he or she is likely to, either directly or indirectly benefit from, or receive a financial benefit, directly or indirectly, as a result of, the death of the person, other than by receiving reasonable fees for the provision of services to the person to whom the request relates; (c) a person who is a residential care provider in relation to the person or an employee or agent of a residential care provider in relation to the person; (d) a person who is a resident in the facility, owned or operated by a residential care provider in relation to the person, in which the person making the request resides. (2) The following persons must not be a witness to a person's second request: (a) the person's PMP or CMP; (b) another person who completes or signs, or completes and signs, the second request for and on behalf of the person making the second request. Division 2 - Determination of second request 32. PMP may refer person, request further information, &c. (1) A person's PMP may, for the purpose of enabling the PMP to determine the second request of the person, do any one or more of the following: (a) refer the person to another medical practitioner for examination; (b) request the person to give to the PMP all information that the PMP may reasonably require in order to make the determination; (c) request a medical practitioner to give to the PMP a copy of the medical records of the person that are in the possession of the medical practitioner and that the PMP may reasonably require in order for the PMP to make the determination; (d) request a person (a medical record holder) to provide to the PMP copies of medical records, in relation to the person, that are held or stored by the medical record holder and that the PMP requires in order to make the determination; (e) request a psychiatrist, psychologist, registered health practitioner, or any other person whom the PMP thinks fit, to give to the PMP the information (which may include any medical records) that the PMP may reasonably require in order to make the determination. (2) A person to whom a request is made under subsection (1) must not fail, without reasonable excuse, to comply with the request as soon as reasonably practicable. 33. Determination of second request A person's PMP to whom a second request is made by the person under section 30 must determine the request by – (a) determining that the person is eligible to access voluntary assisted dying; or (b) determining that the person is not eligible to access voluntary assisted dying. 34. Requirements in relation to determination of second request (1) A person's PMP must not make a determination under section 33 of a second request made by the person unless – (a) the PMP, after receiving the second request, has met the person, in person or by way of audio-visual link; and (b) the PMP, having met the person, in person or by way of audio-visual link, is able to determine the decision-making capacity of the person or adopts under section 12(5) the decision of another person in relation to the decision-making capacity of the person. (2) A person's PMP – (a) must not determine under section 33(b) that the person is not eligible to access voluntary assisted dying, by reason only that the PMP does not have sufficient information to determine that the person is eligible to access voluntary assisted dying; and (b) may refuse to make a determination under section 33 until the PMP has sufficient information to enable the PMP to make the determination; and (c) must not determine under section 33(a) that the person is eligible to access voluntary assisted dying until the PMP has sufficient information to enable the PMP to make the determination. (3) A person's PMP must determine under section 33 a second request by the person by determining under section 33(a) that the person is eligible to access voluntary assisted dying, if the PMP is satisfied that the person is eligible under section 10 to access voluntary assisted dying. 35. Determination of second request to be in writing and contain relevant information about eligibility A determination under section 33 of a second request by a person is to be in writing and is to contain the relevant information about eligibility in relation to the person. 36. Records and notifications of determination of second request (1) A person's PMP who makes a determination under section 33 in relation to the person must, as soon as reasonably practicable but in any case within 7 days – (a) notify the person as to whether the determination states that the person is, or is not, eligible to access voluntary assisted dying; and (b) place on the PMP's medical records in relation to the person the determination or a copy of the determination; and (c) give to the Commission a copy of the determination and a statement, in the approved form, setting out the PMP's reasons for the determination. (2) A person's PMP who has made a determination under section 33 in relation to the person may, at the request of the person, provide to the medical practitioner who the person ordinarily attends in relation to a disease, illness, injury, or medical condition – (a) a copy of the PMP's determination; and (b) a statement of the reasons for the PMP's determination. PART 7 - Referral to Medical Practitioner for Second Opinion 37. PMP who determines person eligible must refer person to medical practitioner for second opinion (1) A person's PMP who has determined a second request from the person by determining under section 33(a) that the person is eligible to access voluntary assisted dying must, in writing, refer the person to another medical practitioner for that medical practitioner to determine whether or not the person is eligible to access voluntary assisted dying. (2) A person's PMP must not, under subsection (1) , refer the person to another medical practitioner who is – (a) a member of the family of the PMP; or (b) employed by, contracted directly or indirectly by, or working under the supervision of, the PMP; or (c) a person who is the employer of, has a direct or indirect contract with, or is a supervisor of, the PMP. (3) Subject to section 38 , if a medical practitioner to whom a person is referred under subsection (1) – (a) refuses under section 39(b) to accept the referral; or (b) ceases under section 108 to be the person's CMP; or (c) determines under section 47(b) that the person is not eligible to access voluntary assisted dying – the PMP may refer the person to another medical practitioner under subsection (1) . 38. Restrictions on referral to more than one medical practitioner (1) A person's PMP must not refer the person under section 37(1) to a medical practitioner if 2 CMPs in relation to the person have determined a referral, made to them by the PMP under section 37(1) , by determining under section 47(b) that the person is not eligible to access voluntary assisted dying. (2) A person's PMP must not refer the person under section 37(1) to a medical practitioner after a CMP in relation to the person determines under section 47(b) that the person is not eligible to access voluntary assisted dying, unless the PMP – (a) has informed the person of the determination by the CMP; and (b) has obtained the permission of the person to the referral by the PMP, under section 37(1) , of the person to another medical practitioner. 39. Medical practitioner must accept or refuse to accept referral A medical practitioner to whom a person is referred under section 37(1) by a PMP in relation to the person must, within 48 hours, by notice in writing to the PMP – (a) accept the referral; or (b) refuse to accept the referral. 40. Refusal to accept referral (1) A medical practitioner to whom a person is referred under section 37(1) must refuse to accept the referral if the medical practitioner is not an authorised medical practitioner in relation to the person. (2) A medical practitioner to whom a person is referred under section 37(1) may refuse to accept the referral for any reason, including, but not limited to, because the medical practitioner has a conscientious objection to providing assistance to the person to die. 41. Medical practitioner not required to give reasons for decision as to whether to accept referral A medical practitioner to whom a person is referred under section 37 may, but is not required to, give to any person reasons for accepting, or refus