Voluntary Assisted Dying

1. Confirm you are eligible to witness
   • You must NOT witness the form if you are:
     1. the patient’s Primary Medical Practitioner or Consulting Medical Practitioner
     2. the patient’s designated person (the person who fills in, or fills in and signs, the Form on the patient’s behalf)
     3. a family member of the patient
     4. a person who knows or believes that they are likely to benefit from the patient’s death
     5. a staff member, resident or operator of a care facility where the patient resides.
2. Check who is signing the form
   • Confirm whether the patient is completing and signing the form themselves, or if a designated person is doing so in whole or in part on the patient's behalf due to incapacity
   • The patient must be present even if a designated person is completing, or completing and signing the form.
3. Witness the Completion and Signature
   • You must personally witness the form being completed and signed by the patient or designated person.
4. Complete the Witness Section (Parts G and H)
   • As the First Witness (CD or JP) fill in Part G with your:
     1. full name
     2. date of birth
     3. relationship to the patient
     4. contact details
   • tick ‘Yes’ to indicate you are a Commissioner for Declarations
   • as the First Witness (CD or JP) specify your status as a CD (eg JP or the profession or employment group that qualifies you for this role)
   • complete Part H by ticking the appropriate box to indicate who you saw sign the form.
5. Do not act as a second witness
   • If you're witnessing the form as a CD or JP, you are not required to complete Parts I and J as a second witness.

Please refer to the Justices of the Peace Handbook for any issues not covered above.