Voluntary Assisted Dying Bill Reasoned Amendment

In rising to speak in this conscience debate, I would like to move a reasoned amendment to the second-reading motion. I desire to move:

That all the words after ‘That’ be omitted with the view of inserting in their place the words:

‘the house declines to read the bill a second time until concerns have been addressed regarding:

(1)   inequalities in access to best practice palliative care, particularly for lower income families and in rural and regional Victoria;

(2)   uncertainties about the substances to be used and their possible side effects and risks;

(3)   the risks of doctor shopping and the development of assisted dying clinics;

(4)   the lack of adequate protections against family violence, elder abuse and prejudice against people with disabilities; and

(5)   inadequate safeguards for persons who seek assisted dying while suffering from treatable clinical depression or other mental illness.’

Everyone in this house has a story to tell of love, compassion, pain, suffering, remorse and regret. During this debate we will hear and we have already heard many of these very personal stories — stories of youth and age, of decisions made and unmade, of treatments and research, and of deaths good and bad — that will at some point in this debate both sadden and enlighten us. At the beginning of my contribution to this debate I wish to acknowledge the hurt and the sadness that our deliberations will bring to many in this house and to the wider community, and to extend my condolences to all those who are feeling the pain of a loved one lost or suffering.

Whilst having experienced many of these emotions myself and end-of-life questions, I am not going to tell a personal story. What I want to discuss is what has brought us to this point and what we should be doing to achieve the dignified and comfortable end of life that we all wish to experience. We must not solely reflect on our own personal experiences. We must consider the impact that this will have on our society — not dispassionately, because this is an emotional topic, but certainly with a focus and clarity on evidence and reason. Let that guide our conscience because that is our collective duty in this debate.

Part of our consideration in this debate should be to speak plainly with each other. Language is important. That is why you do not hear proponents in the public debate over recent months using confronting words such as ‘euthanasia’ or ‘suicide’ — ‘suicide’, the deliberate taking of one’s own life. This is the line Parliament is contemplating crossing — state-sanctioned suicide — forever changing the doctor-patient relationship and establishing in law that the value and protection of human life is relative. The consequences for societies that have crossed this Rubicon are there for all to see.

Suicide rates do not stabilise. They do not decrease. This is not the answer to suicide. Suicides significantly increase, both in physician-assisted suicide regimes and general suicide rates in those communities. We are told that this bill provides a choice for a very limited group of people, but let us look at the reality — staggering increases in deaths. The parliamentary inquiry minority report highlighted a 725 per cent increase in assisted deaths in Oregon over the period of its operation, and that is the conservative and moderate regime that we are basing this legislation on.

The story is the same in all jurisdictions that have introduced euthanasia or physician-assisted suicide. We will not be different. The irony that articles on assisted dying in our papers are almost always footnoted with a reference to a suicide prevention helpline should be lost on no-one in this house. It is a small and awkward admission that suicide is exactly what is being countenanced here. What a confusing message that sends. Suicide is a tragedy worth preventing, yet for a group whose lives are implicitly and arbitrarily deemed less worthy, suicide is considered a necessary and needed option.

The legislation provides for assisted suicide at a 12-month prognosis, not the six months provided for in Oregon. Ours is not the most conservative model. We have all heard stories about people surviving well past a 12-month prognosis. We all know those stories. Doctors can get it wrong. Just today, at a briefing of leading practitioners, they talked about prognosis being an inexact science — doctors telling members of Parliament that doctors get it wrong more than they get it right when it comes to prognosis. According to Oregon public-health division data one patient with a six-month prognosis ingested the lethal dose two years and nine months after the prognosis.

There is also a reason that the breadth and use of euthanasia and physician-assisted suicide invariably expands where it has been introduced and it simply comes down to this: if you say that one group of people who meet certain criteria can be euthanised or assisted to commit suicide, on what basis do you deny other people? If this person has a right to die, why am I denied that right? Why not those with a severe disability — any disability? Why not children? Why not the frail and elderly? Why not those suffering from extreme loneliness, despair or mental illness? Why not those who are simply tired of living? There is no logic to deny. If death is okay for some, why is it not for others? I am not exaggerating. I am not being deliberately provocative. This is the lived experience of jurisdictions around the world that have introduced legislation that we are contemplating this week. It is the lived experience. That is what the evidence shows.

Despite all the best intentions of this Parliament, if this bill is passed its boundaries will expand. Deaths will increase. Sixty-eight protections, we are told, will ensure that the regime will not change. On what basis are we different from every other parliament that has pursued euthanasia? People in this Parliament should not succumb to the arrogant conceit that we are smarter and more informed than legislators in Canada, states in the US, Belgium, Switzerland and the Netherlands. And if this law need 68 protections to keep our citizens safe, how risky is this proposition? That is 68 things that can go wrong.

In relation to the reasoned amendment, the number one point being in regards to palliative care, dying is a part of living. Not one person in this chamber believes that in this age of modern medicine, research and treatment that any individual should suffer unduly at the end of their life. Everyone is entitled to the alleviation of their pain, to die in the surroundings of their choice, and to know that their needs and the needs of their loved ones will be addressed at this time. Yet that is currently not the case in Victoria. Indeed the parliamentary inquiry acknowledged this in its many findings and recommendations.

Palliative Care Victoria, in its detailed analysis of this bill, has estimated that 10 000 Victorians die every year — one in four deaths — without access to needed palliative care. They advise that 55 per cent of Victorian palliative care services report that they are unable to meet need, that funding has only been sufficient to meet the status quo and that they have not met growing demand.

The Victorian Parliament’s end-of-life choices inquiry made around 30 recommendations to improve access to and funding of palliative care services, particularly in rural and regional Victoria. Yet no-one is talking about recommendation 5 of that inquiry. This is the danger in this debate: 48 recommendations were unanimously supported, yet all the attention, every effort, is on that last recommendation. What about palliative care? Oregon went from being an exemplar palliative care provider to quickly falling away — not so those states that refute euthanasia.

In Victoria we have collectively failed over many years our most vulnerable citizens in not delivering equal access to quality palliative care. There is no choice if it is between poor or non-existent palliative care and suicide.

I seek an extension, by leave.

Leave granted.

Mr MERLINO — The greatest act of compassion and love for the frail, aged or terminally ill would be to double our efforts in palliative care — and we should do both, proponents of the bill will say. It is interesting when you drill down into the research and the polling. The headline figure is impressive: a clear majority respond in favour to the question of whether they support having the choice to end one’s life if they are suffering and have a terminal illness. But that polling drops significantly if a further proposition is put: would you still support assisted dying if the medical profession was divided? I will come back to that in a minute.

In thinking about their health and end-of-life care, people rightly and understandably seek control. I want to have control as to what medical treatment I receive and what medical treatment I do not want to receive. That control, that individual power, is delivered through advance healthcare directives — legislation that the Andrews Labor government committed to and recently delivered and will shortly begin to roll out. Why can we not give that a chance? Why can we not wait and then vigorously evaluate the impact of advance healthcare directives on medical practice and end-of-life care? As we have heard from palliative care practitioners in briefings to MPs in the public debate, expert and modern palliative care relieves pain and suffering in almost all circumstances. In the rare instances where it cannot, palliative sedation is available. No-one need die in pain.

Can I also make the point in terms of what happens now if, in the delivery of pain relief, death is hastened? Yes, that happens now, but that is not euthanasia — that is not assisted suicide. I put to colleagues — and it is reflected in my reasoned amendment — that we should not pursue this legislation until we address the inequalities in the provision of palliative care.

I do not have much more time in this debate and there is much that I want to say, but this legislation we are being asked to consider does not detail the drugs that are to be used. It has been suggested that a yet-to-be-determined cocktail of drugs will be developed after the legislation has passed. That is completely and utterly unacceptable — to not know the drugs and their possible risks. We must know that before we consider this legislation.

The bill provides for doctor shopping — indeed it facilitates it. There is no impediment to making a request until you find a medical practitioner who will agree, and there is no requirement that the doctors who are there to assess and certify that someone meets the criteria for assisted suicide need any clinical expertise or experience in that field.

If I can conclude with one of my greatest concerns with the bill, and that is the issue of coercion, clause 8 intends to prohibit a doctor from prompting an assisted dying request, but the drafting of clause 8 is deficient in a number of respects. In particular it does not clearly exclude pressure, undue influence, duress or coercion, which are distinct concepts in law. There is no such prohibition on a family member prompting the request, and I fear that for many people the right to die will become for them an obligation to die. A suggestion here in the household, a little comment there — after a while it becomes the idea of the vulnerable person, and off to the doctor they go. At a time when people are at their most vulnerable, frail and sick, we would have abandoned them. There is no compassion in that scenario.

You cannot legislate and you cannot adequately protect people from feeling that they are a burden on their family — that it would be easier for their family if they were no longer around. We know that elder abuse exists today. It is well hidden, and it is under-reported. Palliative Care Victoria advises that between 2 per cent and 10 per cent of older Australians experience elder abuse in any given year. This legislation will exacerbate an ugly and underground problem. There is no safety in this bill — not for the frail aged, not for the lonely, not for the disabled. I call on all colleagues to exercise their conscience, but I ask them to consider the reasoned amendment.