End-of-Life Choices (Voluntary Assisted Dying) 2020 Bill Debate –
Second reading speech
I move that the Bill be read a second time.
Madam Speaker, a lot has happened in my life since a Bill of similar nature was debated in this house. I have reflected deeply on what I said in 2017, and indeed many of my comments that I made at that time I will repeat in this contribution.
However, I now bring the insight of Ministerial responsibilities, a more sophisticated understanding of the way legislation is enacted, a deeper insight & respect of the roles of health professionals, as well as a more considered appreciation of the importance of getting legislation right.
Madam Speaker, I have elected to take carriage of this Bill through the House because I respect the right of individual Tasmanians to make informed decisions about their own lives and I want to help ensure that, if the Bill should pass, Tasmania will have the most robust law and appropriate system possible.
I want it to be legal for an individual to choose the end of their life when their circumstances involve intolerable suffering due to an advanced, incurable and irreversible medical condition that is expected to cause death.
This is about people – mothers, fathers, sons, daughters, brothers, sisters, and the closest of friends - Tasmanians - potentially us - who are terminally ill and who are facing a pathway to an expected death in the near future.
Most of us do not choose the circumstances, let alone the timing, of our own deaths. We will all die. Old or young, sudden or expected, sick or an accident, with forewarning or without any expectation.
What we are doing with this legislation isn’t about reaching in, and artificially interfering with what is, ultimately inevitable for all of us – death - it is about empowering a person, an individual, a Tasmanian, at a time of grave need. It is about being compassionate and providing the best professional support and advice. It is about empowering a person to make an informed choice about themselves.
While I cannot imagine the anguish, heartbreak or distress of watching a loved one suffer with intolerable pain, this is not about the onlooker. This is about people who often, due to circumstance, cannot personally carry out what they want, nor ask a loved one to assist due to legal ramifications for those dearest to them, nor ask a health professional to carry out an act of their choosing - which in itself is a monumental decision.
For those who are able to end their own life they do so alone. Without those whom they love beside them lest they are implicated in the decision.
Madam Speaker, I would very much hope that none of the comments I am making in this debate will in any way be interpreted as me either de-valuing or reflecting on the extraordinarily high quality palliative care that is provided in Tasmania.
I cannot overstate how strongly I value the role our palliative care professionals and advocates play in our health care system, and in our society. We will all die. And I have the utmost respect and admiration for the people who help us and our families through what is an extraordinary time.
Decisions around End of Life need to be made with access to the best possible palliative care. And I know the dedicated Tasmanians who support palliative care across the State provide exceptional care.
If, through the consideration of this bill, there are mechanisms and initiatives that are raised by other members that can further enhance the provision of palliative care across our community I welcome those contributions.
Protecting the vulnerable
When we talk about legislation such as this, we talk about the need to protect the vulnerable in our community from those who may put their own personal interests above that of those who deserve their care.
This is something that I contemplate deeply across the spectrum of policy and legislation, as well as the shared obligation of both government and the community to care for our most vulnerable.
I expect that most Members’ contributions throughout the course of the second reading debate will rightly touch on this topic. This is the very role of Parliament – to ensure that we consider all the consequences, deliberate or unintended – of legislation that we debate.
While this bill has a number of safeguards in it to protect vulnerable Tasmanians, I look forward to the advice from UTAS and State Government Agencies, as to whether there are any further improvements that could potentially be made.
However, while I state that, I don’t want this legislation to have barriers for access so high that we end up disadvantaging those who we are trying to assist.
This is because I believe we also have an obligation to protect those vulnerable Tasmanians who are sick and suffering and want to make a lucid and tested decision to end their lives in a way that they choose.
What are we doing to support these vulnerable people to have their wishes enacted? Making voluntary assisted dying legal does not compel any Tasmanian to do anything they do not want. It simply offers choice to those who want and deserve to determine their own future.
What this does is to arguably hand one of the most important decisions someone can make in their life back to the individual. How could I possibly stand here and argue that I know better than a sick, dying, suffering person, who only has before them a painful and sometimes prolonged death? How could I possibly have the arrogance as a happy, healthy, pain-free person with infinite choices, to suggest I know best for that individual? No matter what decision I would choose for me, why do I have the right to prevent another from making that choice for themself?
And why would I subject a Tasmanian, who chooses to end their life because of circumstances of intolerable suffering, to do that alone and without their loved ones beside them?
Role of parliament – respect of individual – philosophy
While this is an intensely sensitive and personal issue for all of us, and I respectfully acknowledge the broad range of views and deeply-held convictions that exist on this matter, at this time and in this place our fundamental task is to consider whether Tasmania should enact landmark legislation, and if the decision is that we should, we need to decide upon the specific form that legislation should take.I have no doubt that members understand that this may be the most important Bill many of us will consider in our parliamentary careers.
For me, as a member of parliament I frame policy or legislation that comes before me by the principles of how I see the role of government. I know that might sound quite heartless or dispassionate in a debate such as this, but it is how I see my role as a legislator. I believe in a small government. Or to quote “we believe in the inalienable rights and freedoms of all people; and we work towards a lean government that minimises interference in our daily lives”. That’s why I’m a Liberal.
I support the intent of the bill because the primary question contained is a question for the individual; it is not a question for government. In my view our role as the Government of the day is to put in place legislation that protects our most vulnerable and ensures that the standards and protocols legislated reflect community expectations.
With regards to the role of health care professionals, the most current position available on the AMA website is from 2016. I read into Hansard an excerpt from this:
“The AMA believes that doctors should not be involved in interventions that have as their primary intention the ending of a person’s life. This does not include the discontinuation of treatments that are of no medical benefit to a dying patient.
The AMA recognises there are divergent views within the medical profession and the broader community in relation to euthanasia and physician assisted suicide.
The AMA acknowledges that laws in relation to euthanasia and physician assisted suicide are ultimately a matter for society and government.
If governments decide that laws should be changed to allow for the practice of euthanasia and/or physician assisted suicide, the medical
profession must be involved in the development of relevant legislation, regulations and guidelines which protect:
all doctors acting within the law;
vulnerable patients – such as those who may be coerced or be susceptible to undue influence, or those who may consider themselves to be a burden to their families, carers or society;
patients and doctors who do not want to participate; and the functioning of the health system as a whole.
Any change to the laws in relation to euthanasia and/or physician assisted suicide must never compromise the provision and resourcing of end of life care and palliative care services.
Doctors are advised to always act within the law to help their patients achieve a dignified and comfortable death.
I also note Royal Australian College of General Practitioner’s Position Statement on voluntary assisted dying legislation:
“The RACGP recognises that changes to the law are a matter for society and government and all health professionals must operate within the boundaries of state and federal law.
The RACGP supports patient-centred decisions in end-of-life care, and respects that this may include palliative care and requests for voluntary assisted dying. Any legislation must:
protect both patients and doctors from coercion
ensure doctors are not compelled in any way to participate
have clear eligibility criteria
support the optimisation of end of life and palliative care services.”
Madam Speaker, I am cognisant that there are divergent views across the breadth of the medical profession. There is no single view on this important topic. I have included these to highlight why we, this parliament, is entrusted with this decision. This is what we are tasked to do – both form a view on this matter on behalf of Tasmanians, and then ensure that it is legislated to understand the perspectives and consciences of each of the people that interact with this legislation – not just the person who is seeking to access what this legislation enables.
Just as I respect the choices of the patient, I respect that the involvement of health professionals should be guided by their own personal beliefs and values. Health professionals must not be obliged to participate in voluntary assisted dying.
Madam Speaker I also note the AMA’s Position Statement on Conscientious Objection from 2019 and read an excerpt into Hansard:
“Doctors (medical practitioners) are entitled to have their own personal beliefs and values as are all members of the community.
A conscientious objection occurs when a doctor, as a result of a conflict with his or her own personal beliefs or values, refuses to provide, or participate in, a legal, legitimate treatment or procedure which would be deemed medically appropriate in the circumstances under professional standards.o
A conscientious objection is based on sincerely-held beliefs and moral concerns, not self-interest or discrimination.o
It is acceptable for a doctor to refuse to provide or to participate in certain medical treatments or procedures based on a conscientious objection.
A doctor’s refusal to provide, or participate in, a treatment or procedure based on a conscientious objection directly affects patients. Doctors have an ethical obligation to minimise disruption to patient care and must never use a conscientious objection to intentionally impede patients’ access to care.
Doctors should be aware of relevant legislation regarding their rights and obligations if refusing to provide or participate in treatments or procedures to which they conscientiously object. If unsure, doctors should consult with their medical defence organisation and/or State or Territory AMA office for appropriate legal advice.
Doctors with conscientious objections should not be treated unfairly or discriminated against.”
Madam Speaker, I look forward, through the committee stage, to this house ensuring the rights, responsibilities and consciences of all our health professionals are fully considered.
Progress of Bill – committee stage
As members can appreciate, this is not a ‘normal’ second reading speech that we are all accustomed to. This is, quite clearly, not the regular and routine passage of a Bill through this place.
Ordinarily, legislation originates in this House, and on passing it, proceeds for consideration before the Legislative Council.
In this instance, the Bill has been introduced by the Member for Mersey, the Hon Mike Gaffney MLC, following extensive community consultation, which included a series of forums held around the state earlier this year to explain the legislation to local communities.
The Bill has in turn been received by the House, and I am taking carriage of it as a Liberal Government Member for Bass, not in my role as Minister for Health.
As Mr Gaffney has already provided a very detailed second reading speech detailing the mechanisms and intent for the Bill I will not repeat those – they are already on Hansard.
Members of the Legislative Council have all had an opportunity to contribute, and now all Members of this place will have a chance to contribute, and to express their intent on the legislation.
Should the Bill pass its second reading this week, to ensure sufficient time is provided through the Committee stage, with the agreement of the House, the Bill will become the first order of business for the House when the Parliament resumes next year.
As the Premier has indicated, he has requested the University of Tasmania establish an Independent Review Panel to consider the legislation and to provide members with information regarding how this legislation compares to similar laws in other States and around the world. UTAS will provide an independent, objective report containing:
A concise summary of the VAD Bill, following amendment by the Upper House.
A comparison of Tasmania’s VAD Bill to legislation, including Bills, relating to voluntary assisted dying in other Australian states and territories, and overseas jurisdictions, including but not limited to the processes allowed by the legislation, safeguards and protections for vulnerable people.
An outline of the historical development of VAD legislation in other jurisdictions in terms of scope and protections.
A synopsis of relevant reports, analysis and materials in other states and territories, and overseas jurisdictions, pertaining to the implementation and administration of voluntary assisted dying reform.
As well as an objective analysis of:
The safeguards put in place in other jurisdictions relating to the impact of VAD legislation on medical practice and practitioners, allied health and care professionals, family and social relationships, and provision for and practices in aged care;
The interrelationship between the VAD Bill and existing palliative care and advanced care directives in Tasmania, and the experience of other jurisdictions in implementing VAD legislation to identify matters that might need to be addressed or monitored over time should the legislation pass to law; and
Stakeholder feedback, relevant to all matters previously described.
The University, independent from Government, has selected their panel with members from the University across a range of relevant disciplines: Panel Chair, Professor Richard Eccleston, Professor Fran McInerney, Professor Marg Otlowski and Associate Professor, Jenny Presser.
The Review Panel’s findings will be provided to all Members of Parliament later in February next year, and it is the Government’s intention that the Committee stage of the Bill will commence shortly thereafter, as the first order of business upon the resumption of Parliament, subject to the agreement of the House.
This will allow sufficient time for our Government agencies to provide advice on implementation of the Bill, as well as for the University to complete its independent review, including seeking stakeholder submissions on the Bill as it is now presented.
The Premier has indicated that, should the Bill pass its second reading in the House of Assembly, an amendment to the Bill be moved during the committee stage which if supported will denote the effective start date for the 18 month time period as the end of the second reading debate in this house.
With regards to further amendments to be moved in committee stage, ordinarily I would use this opportunity to explain any amendments I was seeking and circulate those to other parties for consideration.
Noting the fact that advice, for all parliamentarians, is currently being requested I do not want to pre-empt what amendments I – or others – may be making to the Bill before us.
What I can do is commit to use my best endeavours to ensure that, post consideration of advice from UTAS, State Government Departments, as well as considering stakeholder feedback alongside that advice, I provide that rationale behind each of those proposed amendments.
The committee stage of this bill is an incredibly important one; it is easy to stand here and talk about what we think; it is much, much harder to contemplate all the potential ramifications for each decision, each clause, each definition, each timeframe, each word.
I look forward to having a committee stage that ensures we all consider this bill carefully and ensure our Parliament is proud of this landmark legislation.
However before we get to Committee we must pass the Second Reading.
This is another unusual aspect for me as we debate this Bill. Ordinarily there would be an advisors box on hand to provide me with detailed departmental and policy advice and information to help inform my summing up. As members can appreciate, I do not have that resource available for this debate. This is not a Government Bill.
I therefore ask for Members understanding that during the summing up I may not be able to provide usual detail to respond to matters raised during this debate. Noting that – it is incumbent on us all to ensure that concerns, queries and questions are clarified and dealt with during the debate so that those who will be tasked with implementing this legislation are able to do so in accordance with our intentions.
Conduct of the debate
I am looking forward to the contributions of all Members during debate on this legislation, which, as I have said, may be among one of the most important Bills we will consider in our Parliamentary careers.
Despite what can at times be portrayed simply as a highly partisan two- or three-, or even four-, sided chamber – on the issues that truly matter to our community, our Parliament debates and considers in a respectful, diligent, and thoughtful way.
We know that End of Life choice (Voluntary Assisted Dying) is important to many Tasmanians, who have strong views on either side of the issue.
I expect that throughout this debate these views will be strongly and passionately articulated. I expect that there will be aspects that we all strongly agree upon. I also expect that there will be views put forward that I disagree with.
Despite our differences I have confidence that all Members of our Parliament will listen to all perspectives, and consider the views, experiences and arguments put forward as they turn their minds to their vote on this issue.
It is incumbent upon us all to ensure that we are testing our ideas and our understandings at every step of this journey and that we are taking the perspectives of our stakeholders into account in doing so.
We owe it to the Tasmanian community to ensure that this legislation is robust.
That it has been thoroughly scrutinised.
That it accounts for the broadest range of possibilities, and reflects the compassion and feedback of our community, while meeting its intended purpose.
It is only through satisfying these goals that, at the end of this debate, we can be sure we have fulfilled our duty to the Tasmanian community.
I thank the Premier for offering those on this side of the House a conscience vote. As a Liberal I note this option has not been afforded to all members of this house on important debates such as this, and I believe it demonstrates the strength of the Liberal philosophy, as well as the Tasmanian Parliamentary Liberal Party, that we, on this side, are empowered to debate and vote as we choose on this Bill.
I also extend my thanks to all the constituents who have taken time to make their feelings and representations known to me. While I have not had the opportunity to personally respond to all of them, I have read each of them and I thank Tasmanians for their thoughtful engagement on this important issue.
Many people have shared deeply moving and personal accounts and I acknowledge and respect all their views. Even if my position on this Bill does not happen to reflect their views I would like to assure Tasmanians that I have taken their perspectives into account and that I am doing what I strongly believe is right.
My key aim is that should this Bill ultimately pass, the work we have done, together, has given us the best possible legislation that we can make it.
I commend this Bill to the house.