Susan Reilly's mother died two decades ago, but the toll of the "degrading" experience still lingers today.
She witnessed her mother Lesley slowly succumb to breast cancer, powerless to control the manner and timing of her death.
"I know she felt degraded and almost inhuman in a way," Ms Reilly recalls.
"It was confronting and just incredibly difficult and it wasn't what she wanted.
"It left a lifelong impression on me … a terrible scar."
More than 20 years later, the Brisbane mother of three is relieved voluntary assisted dying (VAD) is now legal in Queensland — the fourth state to have a scheme in operation – 15 months after laws passed state parliament.
"It's one of the things we openly talked about … but it was highly illegal," Ms Reilly said of her mother's wishes.
"She wanted to die at home, she wanted to die her way … but there were no paths to go down."
In early 2020, just days before her 46th birthday, Ms Reilly was diagnosed with an aggressive type of breast cancer herself.
After finishing treatment last year, she is now being closely monitored by a surgeon and oncologist every three to six months.
"I'm holding my own at the moment. It's like being in limbo," she said.
She hopes she never has to access VAD but feels comfort knowing it's there as an option for terminally ill people.
"It means a lot because it just opens doors, provides opportunities for those who want it," she says.
"It's not, 'You must now go down this path' … it's just choices for Queenslanders, and that's what I wanted."
Modelling by Queensland Health projects about 400 terminally ill adults could use Queensland's voluntary assisted dying laws to legally end their lives during the first 12 months of the new laws coming into effect.
Who can access it?
To be eligible for VAD in Queensland, you must:
- be at least 18 years old
- meet residency requirements
- be suffering intolerably from a disease, illness or medical condition that is advanced and expected to cause death within 12 months
- be acting voluntarily and without coercion
- have decision-making capacity
The Queensland Civil and Administrative Tribunal will also be able to review decisions about some of the eligibility criteria, like residency requirements or whether there is decision-making capacity.
But it cannot review decisions about diagnosis or prognosis – that is for medical practitioners.
How will it work?
A person must make three separate requests for VAD — with at least nine days between the first and final request.
That nine-day period can be shortened, though, if "both the coordinating and consulting doctors believe the person is likely to die or lose decision-making capacity during that time", Queensland Health's website says.
Two doctors who have undergone mandatory VAD training must independently assess the person's eligibility.
The patient can stop the VAD process at any time.
Once all the approvals are done, the person can decide how they want the substance administered – either by themselves or choosing an administering doctor or nurse to do it.
How many doctors and nurses could be trained in Queensland?
As of December 23, about 340 clinicians across the state had applied to become VAD practitioners.
What if there is not an authorised VAD practitioner nearby?
All hospital and health service areas across the state will have VAD practitioners, Health Minister Yvette D'Ath told parliament last month.
But, with Queensland the most decentralised state in Australia, the health department also have processes in place to allow practitioners to travel to a patient, if there is not someone available nearby.
Ms D'Ath says this is necessary until there are changes to federal legislation around telehealth.
The Commonwealth Criminal Code prevents doctors from using a carriage service — the phone or internet — for suicide-related material.
Queensland Health warns practitioners the state's VAD Act "cannot override" the federal legislation and therefore some steps in the VAD process are not allowed to occur via a carriage service because it could be a potential breach of the law so need to happen face-to-face.
This is something the Queensland government — and other states — want to see changed.
Asked last month where talks were at, a spokesman for federal Attorney-General Mark Dreyfus said "this is still under discussion".
Can medical practitioners refuse to participate?
Yes, if they have a conscientious objection, do not have the training or are unavailable – but there are still some obligations.
If a person makes a first request for VAD, but the medical practitioner does not want to participate, they still must inform the person and provide them with information about accessing VAD.
This means informing them about other doctors or providers that might be able to assist, or contact details of the Queensland VAD Support Service.
What if you're a resident of a faith-based aged care home?
Practitioners and faith-based organisations have the right to refuse to participate, but they must not hinder access.
For example, if one of their residents has been approved for VAD, they must allow other medical practitioners "reasonable access" to the patient.
