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Objective: Voluntary assisted dying (VAD) began in Queensland in January 2023 but little is known about its practical operation. This research examined models of care for providing VAD in Queensland. Methods: Semi-structured interviews were conducted with 24 participants involved with VAD delivery across Queensland's 16 Health and Hospital Services (HHSs). Participants included HHS VAD Coordinators, nurse practitioners and nurses who acted as administering practitioners, and Queensland VAD Support and Pharmacy Service (QVAD SPS) staff. Results: Five themes about Queensland VAD models of care were developed: VAD is accessed almost exclusively through the public sector via HHSs, influenced by a Health Service Directive; local models of care vary; nurses play significant roles facilitating access to and providing VAD; QVAD SPS has been instrumental supporting HHSs and ensuring statewide access as back-up VAD provider; and VAD services need more resourcing. Conclusions: The Queensland approach to providing VAD has been largely successful in ensuring patient access across the state. However, it differs from previous Australian VAD models with access predominantly through the public sector, greater roles played by nurse practitioners/nurses, and VAD being provided by QVAD SPS. Under-resourcing and consistency in provision of VAD services remain challenges. What is known about the topic? Voluntary assisted dying (VAD) is generally operating as intended in Australia but access barriers remain. What does this paper add? Queensland implemented VAD differently with a statewide VAD support service that assists with provision of VAD and a Health Service Directive requiring all Health and Hospital Services to provide publicly-funded VAD services. This is the first research on the Queensland VAD system's operation. What are the implications for practitioners? VAD is likely to be provided by practitioners in the public sector. Consistency in VAD provision, resourcing and VAD workforce sustainability are ongoing challenges. [ABSTRACT FROM AUTHOR]

Background: Parents making a will most commonly distribute assets evenly to adult children. How parents of an adult child with an intellectual disability use wills to plan for future care and support has had limited policy, practice and research attention. Method: This research reports on the perceptions of 20 parents regarding the impact of the needs of their child with disability on estate planning. The participants were purposively recruited and interviewed during 2014-15. Results: Participants were more likely to consider equity of "outcomes" for their children taking into account retaining access to state services. They report difficulties in future planning in the context of changing service systems and limited specialised advice. Conclusions: Judgements about what is fair and reasonable in distributing assets reflect differing views of need and entitlement within families. Such families would benefit from specialised advice and support in estate planning, particularly given the changing context.

This article examines the role of patients and caregivers as 'regulatory actors' in healthcare. It uses and extends 'regulatory space theory' to argue that failing to consider the role of patients and caregivers as 'regulatory actors' in healthcare regulatory spaces misses a key piece of the regulatory puzzle. We argue that in assisted dying and other healthcare contexts, evidence shows that some patients and caregivers do behave as regulatory actors, engaging in sustained and focused attempts to alter behaviour. We then suggest a framework which explicitly incorporates notions of why patients and caregivers act in regulatory ways is helpful in understanding what the appropriate response to such actions should be. While the contribution of patients and caregivers to regulation is valuable and should be supported where desired by the person, if patients and caregivers are acting out of necessity to address system issues or 'regulatory failure', other regulatory actors (e.g. governments) should proactively respond and address these issues to reduce the burden on patients and caregivers of having to take regulatory action. [ABSTRACT FROM AUTHOR]

The current fallback position for the elderly frail nearing the end of life (less than 12 months to live) is hospitalisation. There is a reluctance to use the term 'terminally ill' for this population, resulting in overtreatment, overdiagnosis and management that is not consistent with the wishes of people. This is the major contributor to the so‐called hospital crisis, including decreased capacity of hospitals, reduced ability to conduct elective surgery, increased attendances at emergency departments and ambulance ramping. The authors recently conducted the largest randomised study, to their knowledge, attempting to inform specialist hospital medical teams about the terminally ill status of their admitted patients. This information did not influence their clinical decisions in any way. The authors discuss the reasons why this may have occurred, such as the current avoidance of discussing death and dying by society and the concentration of healthcare workers on actively managing the acute presenting problem and ignoring the underlying prognosis in the elderly frail. The authors discuss ways of improving the management of the elderly nearing the end of life, such as more detailed goals of care discussions using the concept of shared decision‐making rather than simply completing Advanced Care Decision documents. Empowering people in this way could become the most important driver of people's health care. [ABSTRACT FROM AUTHOR]