Form 57 - Application process - Termination of pregnancy

1. What you need to know

The Tribunal may consent, for an adult with impaired capacity for the procedure, to termination of the adult’s pregnancy only if the tribunal is satisfied the termination may be performed by a medical practitioner under the Termination of Pregnancy Act 2018.

Termination of an adult’s pregnancy, to which the Tribunal has consented for the adult, is not unlawful.

To make an application for consent to termination of an adult’s pregnancy you will need to provide the following documents:

1. Completed application for consent to special health care (Form 57)
2. Completed Health Professional Report or other medical report which addresses the capacity of the adult to themselves provide consent to the procedure.
3. A statutory declaration which sets out:
   1. the family, educational, social and employment background of the adult and
   2. the discussions that have been had with the adult about undergoing the procedure; and
   3. the views of the adult in relation to the proposed procedure.
4. If the adult is not more than 22 weeks pregnant, a medical report from the adult’s treating specialist which addresses the length of the pregnancy, details of the procedure, who would perform the procedure, whether the procedure may be performed by a medical practitioner under the Termination of Pregnancy Act 2018.
5. If the adult is not more than 22 weeks pregnant, a medical report from an independent specialist addressing the adult’s capacity for providing consent to the procedure and whether the termination may be performed by a medical practitioner under the Termination of Pregnancy Act 2018.
6. If the adult is more than 22 weeks pregnant, a report from the relevant medical practitioner that addresses the following matters:
   1. The length of the pregnancy, and details of the procedure to be performed;
   2. that, in all the circumstances including the relevant medical circumstances, the woman’s current and future physical, psychological and social circumstances and the professional standards and guidelines that apply to the medical practitioner in relation to the performance of the termination, the termination should be performed;
   3. the medical practitioner has consulted with another medical practitioner who also considers that, in all the circumstances including those outlined in (b) above, the termination should be performed.
7. If the adult is more than 22 weeks pregnant, a report from the other medical practitioner consulted by the treating medical practitioner as referred to in 6(c) above.

The Tribunal will usually appoint the Public Guardian as the representative for the adult to represent the adult’s views, wishes and interests in the proceeding. The QCAT Registry will provide the application and any documents filed in support of the application to the adult and the Public Guardian. The QCAT Registry will also give written notice of the application to those who have a close and continuing relationship with the adult.

Provision of the documents outlined above with the application will provide the best chance for the application to be heard and determined as a matter of urgency.  The Tribunal may make directions for the provision of further information, the Tribunal considers is necessary to hear and determine the application. The Tribunal will make a decision following an oral hearing.

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2. Complete and lodge this form:

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