SPEAKING ON A BILL | VOLUNTARY ASSISTED DYING BILL 2017
Mr MELHEM (Western Metropolitan): I also rise to speak on the Voluntary Assisted Dying Bill 2017 and in doing so to join my colleagues. I think it is fair to say that the best thing about this Parliament is when we are dealing with an important issue like this where individual members speak their own minds and from personal experience, and party politics do not play any role. I think that is when the Parliament performs at its best. I pay tribute to my colleagues on both sides of the debate, promoting both the ‘yes’ and the ‘no’ case, and I also echo some of the words of Ms Fitzherbert. We were both on the Legal and Social Issues Committee during the inquiry into end‑of‑life choices, which was quite a comprehensive inquiry that looked at this very issue. That has really shaped my view on the whole issue, and I will come to that in a minute. There were no party politics. Eight members of this house were given the responsibility to explore various opportunities and options in relation to end‑of‑life choices to bring back to this house. We all went in with individual opinions about what the outcome was likely to be. At the end of the process there were two reports — there was a majority report and a minority report.
I started this process pleading the ‘no’ case. Basically I was totally opposed to all aspects of euthanasia and assisted dying. I still hold the view that I will not support a form of euthanasia — for example, if this house considers at a future time a bill introducing a Dutch model of euthanasia, my view will probably not change. In relation to voluntary assisted dying, which is the model that has been proposed in this bill, it is something that I want to support, and there are a number of issues that I will talk about as I go on.
As I said, my view has transformed over time after listening to the evidence that was presented to the committee, listening to the witnesses, reading their submissions and looking at various jurisdictions around the world. We can all look at whether the bill actually fully reflects what the committee recommended. I think that can be debated. I think it does to a large extent. The government adopted the 48 recommendations, largely focusing on 24 recommendations out of the 48. It mainly focused on palliative care and the fact that we should be providing our citizens and patients with the best care in the world. I think we have a very good system. From memory I think we are ranked around number two in the world. I think we should be number one in the world. I think there is no question that further investment in palliative care in Victoria is very important. I think that should be our number one priority — to provide the best care possible to our patients.
Whether voluntary assisted dying becomes law or not, it should be the very last choice. We should do whatever it takes to provide the best medicine and the best palliative care for people to make sure their end of life is as comfortable as possible. I think we need to do that particularly in regional Victoria. That is the other focus we picked up on in the committee — that we need to give citizens in regional Victoria better access to palliative care.
I will quote some of the key findings of the committee:
As a society, we are hesitant to talk about death, which is considered a taboo subject. This inhibits planning for end‑of‑life care, and may result in a person’s end‑of‑life wishes not being followed.
Although most people in Victoria wish to die at home, in reality most of them will die in hospital.
Demand for palliative care is steadily increasing, and is expected to continue to do so. At the same time, palliative care patients’ diseases and needs have increased in complexity. As such, Victoria’s palliative care sector is overburdened and needs better support from government.
These were some of the issues the committee explored in great detail. As I said earlier, the government put together its response to the committee report in relation to these matters, and I believe we are on the right track to make sure that there is further investment in palliative care. The other thing is that a lot of our doctors currently do not have adequate training as to how to deal with people who are at the end of their lives. We need to strengthen that and train them in end‑of‑life and palliative care. The same goes for nurses. There is a lot of work that needs to be done in that space. That is one of the reasons the Minister for Health proposed that the implementation date of the legislation be delayed for 18 months. I think that is quite important because we need to make sure we have the right system in place and that we get it right.
The criteria recommended by the committee have been picked up in the legislation and are very strict, in my view. In order for a person to access voluntary assisted dying, it has to be voluntary; the person must be aged 18 years or more; the person must be an Australian citizen or permanent resident and ordinarily resident in Victoria; and the person must have decision‑making capacity in relation to voluntary assisted dying. I actually spent a bit of time researching how you determine that a person has the mental capacity. I think the best way to assess that is: there are a lot of legal cases in relation to that, there is a lot of assessment already in place where it is determined by law whether a person has that decision‑making capacity, and I think we need to strictly adhere to that.
The person must also be diagnosed with a disease, illness or medical condition that is incurable, advanced and aggressive, and will cause death. These points, I think, are very important. Let us not lose sight of what is being proposed in this bill and what it is trying to do.
I just want to spend a bit of time on the requirement that the disease ‘is expected to cause death within weeks or months, not exceeding 12 months’. When the committee was giving consideration to that very issue, we actually debated at length about whether or not we were talking about weeks or months, or 12 months or six months or three months. We could not arrive at a final decision, but our thinking was we are talking about weeks and months. We left it up to the expert panel to come up with a proposition, which is now enshrined in this bill. Personally I still have some reservations about 12 months. That is something I will look forward to exploring in the committee stage as to whether 12 months is appropriate or whether six months is more appropriate, but that is an area I would like to explore further.
The other requirement is that the disease or the illness is causing unbearable suffering to the person and cannot be relieved in a manner that this person considers tolerable. I do not read the bill in a way that means a person is diagnosed with a terminal illness or disease, then goes in to see a doctor and the doctor says, ‘I have got a suite of choices for you, and you can choose which one you like’. I think that is wrong. That is misreading the bill, and that is definitely not something that I would subscribe to.
As a doctor seeing patients who seek treatment you want to make people better, you want to actually make their life better, you want to actually improve the quality of their life, you want to make sure their end of life is painless if possible. I think exploring voluntary assisted dying should be the very last resort. People should be discouraged, not encouraged.
We should not be getting to a stage where we say, ‘Look, instead of going through all these processes, we will give you that pill and off you go’. That is not the intention of the government, and that is not the intention of the people who are supporting the bill. It is only in very rare cases, where a person wants to be able to have the choice, where the pain and suffering they are going through cannot be relieved through various painkillers, morphine or whatever advanced medicine. We are getting better and better at pain relief and palliative care, so hopefully we will get to a stage where we do not even have to talk about a person’s need to say ‘Give me a drug to end my life early’ or ‘I want to access voluntary assisted dying’. But these very limited cases of persons choosing to access that is what persuaded me to agree to provide people with that particular choice.
People talked about — and I touched on that earlier — making a decision, and people said, ‘Why didn’t you extend that to all cases?’. Well, I do not want, nor do I want any other person, to make a decision on someone else’s behalf about whether or not that person should live or commit suicide. I do not think any human being should make that decision on behalf of any other human being. That is why I referred earlier to the difference between people advocating for euthanasia versus voluntary assisted suicide.
It has been a very challenging time for me for the last two years or 18 months. I have been on the committee, I have had all sorts of correspondence from various people and I have been getting phone calls from all over the place in relation to people advancing their own opinion. Coming from a Christian background, it has been a challenging time, and it has been a really tough decision to make as a legislator. But I am not here to make a popular decision, I am not here to make a decision to please a particular group or a particular person or persons. It is a decision that I have arrived at, and I will stand by that. I am elected to this place to actually make some hard decisions, and that is one of them. People will say it is the right decision or the wrong decision, and that is the judgement they will make. But that is our job. What has been great about this debate in this particular chamber is its respectful nature; everybody respects everybody else’s opinion. I think that is a great thing.
Other issues were raised in relation to where a person makes the choice to access voluntary assisted dying but that person is not able to administer the drug. That is an area where the committee spent a fair bit of time debating and hearing from witnesses. The expert panel has come up with a suggestion about how that can be addressed, where a practitioner can assist that person. I think an example would be where a person in the last days of his or her life has gone through all the necessary paperwork and met all the criteria, but that person is not able to take the drug. It is my understanding that the current method requires one to be able to drink a significant amount of liquid. In such an instance there might be an intervention by a medical practitioner to assist. That is something that there might be some questions about in the committee stage in relation to how that will be administered, and so forth, but I think that is the intention of that particular clause. It is not about opening the door for medical practitioners to be able to administer a drug to terminate someone’s life, especially if that person has not got the mental capacity to do that. Definitely that is not the case. I am looking forward to some of these debates in the committee stage.
In conclusion, the reason, as I said earlier, I came to support the bill — with a reservation about the 12‑month qualifying period, which will be addressed in the committee stage — is that it is about choice. It is about giving people a choice, and it is about treating people as human beings — if a person wants to make that choice or take that choice because they have got unbearable suffering and their life is about to end and they do not want to go through that suffering; they do not want to go into the backyard, like some of the cases we heard about from the State Coroner, and shoot themselves and leave a big mess behind. In another case someone used a nail gun, and he was found by his daughter. The other cases I do not want to see. If a person wants to be able to exercise his or her right, he or she should be given that right.
On the other hand, we should not spare any expense whatsoever. We can go and play politics about palliative care and about how much we should spend on palliative care. No argument: I think we need to spend more money and have more investment in and training for palliative care. In order to make life easier for a person or to cure a person, it is going to cost whatever it costs. We should spare no expense in giving our people the care they deserve, the best care in the world. There is no question about that. My understanding is that in the jurisdictions around the world where they have got similar legislation the investment into palliative care and the standard of it have gone up. They did not go backwards. I hope that will be the case here — not hope, I am certain that should be the case in Victoria.
I have had thousands of letters and emails over the last 18 months. I have got to say I did not read all of them; I would be telling a lie if I said I had. I have not, but I have read a fair number of them. A 90‑year‑old knocked on my office door last week and paid me a visit. Unfortunately I was not there to see him, but I did speak to him on the phone when I got to the office. I would not mind reading his letter. It was addressed to myself in relation to the proposed Voluntary Assisted Dying Bill 2017:
As a terminal cancer sufferer may I ask you for your conscience vote for the bill because I would prefer to die:
(a) respectably at a time of my choosing,
(b) accepted by the state for my choice, and
(c) surrounded by members of my family cheerfully, rather than displaying increasing pain whilst in normal palliative care.
I am aged 90 and I am weak and suffering from metastatic prostate cancer for which chemotherapy has failed. I experience excruciating pain at times and prostate cancer is known to:
(i) cause one of the most miserable of cancer deaths, and to
(ii) normally exceed the capacity of the palliative medical system to relieve suffering.
Opinion polls consistently suggest that a large proportion (70–85 per cent) of respondents favour the option of doctors assisting dying in such circumstances.
Although I live in the Eastern Metropolitan Region, the conscience nature of the forthcoming vote in the Legislative Council requires that I contact all MLCs. Furthermore, whereas most electors will be mainly interested in the basic philosophy of the bill, I will want it for myself urgently in about 18 months time.
From your personal information online I read that you enthusiastically support healthy out‑of‑door activities, but I ask you to go that extra step to support those who are ill and want to be assisted to die respectably at a time of their own choosing.
If you wish, I should be pleased to discuss the matter with you …
That is from Harry Gardner. I hope he does not need it, I hope he does not get to a stage where he needs to access voluntary assisted dying, because as I said, our main focus should be on how we can provide the best palliative care to our patients, to people like Harry, and their ability to access this or to take their own life prematurely should be the very last resort. Hopefully the number will be zero. It is not about giving people an easy way out. It is about the limited number of cases of people who have tried everything — the system has not been able to alleviate their pain and suffering — and who want to leave early, at their own time, in the last few weeks of their life. I think they should be given that choice.
With those remarks and with the qualification that I talked about, the 12 months, I commend this bill to the house.
31 October 2017