Voluntary Assisted Dying Bill 2017
I rise with much pleasure to make a contribution to the Voluntary Assisted Dying Bill 2017. I am not afraid of death and I am not afraid of dying. I grew up on a farm, and when you grow up on a farm, particularly with livestock, death is something you experience on a very regular basis. In a human form I have experienced it considerably as well. My parents have both moved on, as have my grandparents and also a lot of my uncles and aunties. But that is not going to make a difference in terms of the way I look at this bill, although I will come back to that shortly.
At the start of the process in terms of the way I would consider this bill I had many thoughts. It is the first time that I have had to really dedicate my mind to such a decision, and it is not a decision that any of us can or do take lightly. Many people do not have the opportunity to stand up here, after all the consideration we have had, and make a decision as significant as the one we will be making today and over the next sitting week.
I started this journey — and it has been a journey for me on many fronts — from the position that I was not against voluntary assisted dying as a theory. As this journey has progressed I have started to question why I thought that before I started on the journey. When I started this journey I said to myself that as a part of the process in terms of how I would make up my mind I would need to completely satisfy myself that this bill would be 100 per cent safe and that all the appropriate safeguards would be in place. That would be my starting point. Once I could satisfy myself that the bill was 100 per cent foolproof, then I would be in a position to determine whether I could or would support it. That is something that I had firmly in my mind the whole way through.
In my office, and as I walk down the street, I have had phone calls and contact in many other ways. I have had a considerable number of people pass on their views in relation to this matter, including people from a whole range of backgrounds — doctors, nurses, those in the palliative care field, psychiatrists, psychologists, university professors, as well as the mums and dads and the voters who have a view on this matter. It is one of those topics that people have a view on, people who probably usually do not have much of a view on bills that come before their parliaments.
Of the thousands of contacts I have had to my office in Bendigo, about two-thirds have been against the bill. I appreciate everyone who has taken the time to speak to me personally or email me or write to me in terms of what their views are, because it is not easy for people to sit down and put their views on paper in relation to these matters and send it to their local MP, and all of us have received such things. But in particular on my Facebook page I had contact from a couple of gentlemen who I know quite well from my home area who would not contact me in relation to political matters at all. One is a farmer from Patchewollock and the other is an electrician from Ouyen. These are guys who, when I talk to them, talk about how much rain we have had, about motorbike riding and about potentially what sort of fish we are going to catch the next time we go fishing.
These guys actually took the time to pass their views on to me, and theirs are views I respect enormously. Both of them are in favour of this bill. They said that they respected my decision to vote against this bill, but that they were in favour of this bill. So as a part of this speech that I am making today I want to try and explain to those guys why I am actually going to vote against this bill.
In terms of palliative care an estimated 10 000 Victorians die every year, and one in four of those people die without access to the appropriate palliative care that they need. I think as part of this process palliative care needs to be the first step in having this debate in a meaningful way. Over the last three years palliative care funding has really remained at a status quo and I think that is a part of this issue. People who may want to go down the path of considering their options into the future perhaps have not had access to appropriate palliative care in advance to actually realise that there are different ways. The argument produced by people campaigning for assisted dying is that people are committing suicide in horrific ways or dying alone in pain. How many of these people would have stopped committing suicide if they had accessed palliative care or adequate psychiatric support? That is a question that I certainly do ask. It is a flaw in this debate and this public policy journey that we are going along that palliative care has not been the first step in this process. If palliative care was given the appropriate consideration that it needed to be given, I think this would be a slightly different debate.
Robert Clark in his speech in the other place made a comment, and I wish to quote it:
When you have got more than 10 000 people a year dying in needless pain because they cannot get access to proper palliative care, how is it a solution to say that providing death for 150 people, as the advocates say, is going to be a solution?
In reference to this, a more appropriate solution would be the proper funding of palliative care; that is something I agree with.
The bill does not include any registration of the pharmacists to complete the approved training in relation to this legislation, including their roles and functions. As we know, if someone decides in their last 12 months that they want to go down this journey they not only have to go and speak to two different doctors, but obviously they have to go to a pharmacist who has to provide them with the medication that they will be taking. I find that strange as well. In terms of this debate the medication that they would be taking — the poison they would be taking, the concoction that they would be taking — is not available in Australia at the present time. Nembutal is the drug that is used around the world in terms of people undertaking to end their life on a voluntary basis, and as we know right now Nembutal has not gone through the Therapeutic Goods Administration process. So that leaves us in a bit of a bind as to what would actually be used. We have heard different stories about the types of concoctions of drugs that might be used for someone to undertake ending their life. The questions that I have are: where are the trials, what are the safeguards, what are the side effects and what happens if someone takes one of these new concocted drugs and it does not work properly? These are questions that remain unanswered to me, and I think we cannot proceed any further until we get answers to not only that question but to a whole range of other questions as well. A drug that is proposed to be used to help people goes through years and years of different trials and tests and so forth. I do not see why we should not have the same sort of processes put in place for whatever drug is going to be used as part of this legislation. That is something we do not know.
I would like to quote a lady by the name of Karen Hitchcock. Karen is a specialist in acute and general medicines at the Alfred hospital and a lecturer in medicine at Newcastle University, and she regularly writes in a whole range of journals. Karen Hitchcock said:
Over the 12 years that I have worked as a doctor in large public hospitals, I have cared for hundreds of dying patients. No-one has ever died screaming or begging for me to kill them. Patients have told me they want to die. My response to this is, 'Tell me why'. It is rarely because of pain, but it is often because of despair, loneliness, grief, the feeling of worthlessness, meaninglessness or being a burden. I have never seen a dying patient whose physical suffering was untreatable. The combination of morphine and midazolam is extremely powerful; it can be administered and titrated up very quickly. Barbiturates can render one unconscious in minutes. Palliative care practices have come a long way in the past decade.
She also went on to say:
Studies repeatedly show that the desire to hasten death for those with a terminal illness comes principally from a feeling of hopelessness. We must listen to and attempt to address this and other fears. Knowing one is dying can be excruciating: the terror of non-existence. For thousands of well-educated, affluent people in vocal advocacy groups, a euthanasia drug like Nembutal is the sole way to wrest control of the only part of their life they may not fully control.
It is clear that there is no consensus among the members of this house. It is clear there is no consensus among the medical practitioners who work in the palliative care industry. Former Australian Medical Association (AMA) president Professor Brian Owler is an advocate of this bill; former AMA vice-president Stephen Parnis opposes it. If this was such an irrefutable bill, I would think that all the medical fraternity would be singing its praises. But the more you study it, the more you look at it, the more division you actually do find.
I am pleased that the Liberal-Nationals, if we come into government next year, will dedicate $140 million to improve palliative care for patients in Victoria and the people of Victoria. I think that is a good first step. The president of the AMA, Michael Gannon, said:
Once you legislate this you cross the Rubicon. Our position is we need to do better with end-of-life care and we say that doctors should have no role in intentionally ending a patient's life. The medical profession is concerned because we will be expected to be involved.
That is strong when you have got that coming from the president of the AMA.
I have got a whole range of other quotes from other people giving their views one way or another, but I do not choose to go through them here today. There is one question I do want to raise. There was an article by Paul Kelly in the Weekend Australian a couple of Saturdays ago. The article says:
The medical director at Marie Curie says predicting the time of death is 'like predicting the weather'. Is a condition 'incurable' if a patient refuses a cure? Accuracy dealing with death over a 12-month range creates wide scope and is difficult to get right.
As we know, under this bill someone who is in their last 12 months of their life would be able to access the drugs and be able to take them home. For doctors, trying to predict how long someone has got to live is something that they do with the best information they have, with the best education and training they have and with the best experience they have, but they do not always get it right. They try and provide the best possible answers they can, but they do not always get it right.
A family friend of ours, a gentleman by the name of Ray Barwick, many years ago was given six months to live. Ray Barwick was a heavy drinker and a heavy smoker. The doctor said to him, 'If you continue on the way you are, you'll live another six months. If you give up drinking and smoking, you'll live for 12 months'. Ray liked to drink and he liked to have a smoke, so he said, 'I'm going to continue to smoke, I'm going to continue to drink and I'm going to particularly enjoy the last six months of my life, because that's what I like to do'. Ray drank twice as much and he smoked twice as much. He ended up living an extra six years, so sometimes the doctors with the best information, training and experience do not always get it right, but they try to do their best. So for this bill to have a 12-month window in it I think is too long, because I think many things can change along the way and sometimes the doctors do not get it right. But they try to do their best.
We have seen some research come out in relation to what the people around different areas of the state think of this bill, and to my surprise the results came out that showed that many people, particularly in the regional areas, were in favour of this particular piece of legislation. The question that was asked of them in a survey was, 'Should terminally ill patients be able to legally end their own lives with medical assistance?', and that is a fair enough question to ask. I would suggest the facts or figures in relation to that are accurate. With a question like that I think most people would say, 'Yes, I agree with that principle', but I do not think that one question tells the whole story.
This debate cannot be summed up with one simple question. This is a complex situation. It is a complex medical situation, it is a complex ethical situation and it is a complex religious situation, and I just do not think that one sentence sums this up. I think that research — and I do acknowledge the research and believe the results — does not tell the whole story, because quite often people will say, 'Yes, I agree with it', but once you start to say, 'Were you aware of (a), (b), (c) and (d) in relation to this legislation?', they will say, 'Oh, that changes it a little bit'.
I wish to go back to something I mentioned earlier in relation to this bill, because in some of the correspondence we have had people say, 'Obviously you've never been through this'. People have a right to say that, but that does not mean that they are right. I have been through this. My father, Brian, went through this only five or six years ago. He had cancer. He had less than a year to live. We provided him with the best care that we possibly could. It was interesting; I was just listening to what Mr Gepp said in relation to his mother in terms of whether she would have accessed this program if it were available, and I asked the same question to myself. Would my father have accessed this? He was one of those guys — he was a farmer — who would always say in a sort of whimsical way, 'If I ever get like that, push me in front of a bus'. I respect that and I probably had the same view for a while as well, but at the same time, having gone through the experience that I had with my father, I do not know whether he would have or not. It is one thing to say, 'Yes, I want to do it', but to actually do it is another thing. From my point of view, I got to say some things to my father that I would not have got to say. If he had gone down this path at a time of his choosing, I would not have got to say the things that I wanted to say to my father.
I think that is probably something that some other families would see as well, because in terms of this — say someone goes through the whole process, and they get to the point where they have got this drug at home in a locked box — the family does not know when the person is going to take it. The person may not know when they are going to take it. It is like having an unexploded bomb in the house; you do not know when it is going to go off. I would imagine that the person who has got that — and they might have it at home for six months or however long — every morning would wake up and would say to themselves, 'Is this the day? Is this the day I'm going to take it or not?'. The rest of the family and the friends would wake up every morning thinking, 'Is today going to be the day that they're going to take it?'.
I would imagine that someone who has got that drug at home would have a whole range of thoughts going through their head every day. It would almost be traumatic in itself. Would they actually tell their family that they are going to take it today, or would they take it in secrecy because they would not want to alarm the family? That is something I do not know the answer to and none of us would know the answer to, but it is one of those things where I think it might actually add stress to the patient and add stress to the family of having this unexploded bomb in the house.
In terms of the argument that this is a way that might actually alleviate loneliness and so forth, it actually might create loneliness on one hand, or it might actually work out well. I do not know the answer to that, but I will tell you what: as a patient, if I was in that situation, I would wake up every morning and I would probably think about it every hour — 'Will I take it now? Will I take it tomorrow? Will I take it after I've watched my favourite TV show? Will I wait until everyone has gone out to the supermarket? Will I wait until everyone's at home?'. I do not know. But that would be a stressful situation, and it would be particularly stressful for the family because of the unknown.
In the time that I have remaining I want to talk about some other elements. We hear about how the Oregon model is one of the models which we are following. In this year alone, 2017, Oregon have introduced a further two bills which would extend the scope of this bill in their state, and on both occasions those bills were defeated. In fact some information I was provided with is that there have been 30 examples in 2017 where similar bills have been introduced in some states of America. On 30 occasions they have been voted down for whatever reason, whether they have died in committee or have just been voted down. So I am concerned about the creep that this bill would have if it was to proceed. As we know, the Oregon legislation is there and it is in operation, but even twice this year there have been elements brought in to extend that beyond where it is now, so I think the creep factor is something that would always be there.
In concluding, I want to follow on from some comments that were made by Mr Ondarchie yesterday. This would be a monumental step for our state if we were to go down this path. This is not just passing another bill or considering another bill that is going to bring in a new road law or bring in a new regulation somewhere. This is going to fundamentally change the way we operate as a society in this state. We are legalising death, and that is a huge thing for us to consider.
If I was going to be able to support a piece of legislation that sanctions death, I would have to have absolutely no doubt in my mind that it is fail-safe. But as we know, with this piece of legislation there have been 68 safeguards put in place, and that is just the start. We have heard of a whole range of other issues and concerns in relation to this bill, outside of those safeguards, in terms of the other contributions from other members of this house and the other house. If this bill is as fail proof as we are led to believe, why does it need 68 safeguards? Why are there so many other concerns that have been raised in relation to this bill? For me to even think this bill worthy of being considered, there would have to be no hesitation in my mind that this is 100 per cent safe. Mr Ondarchie articulated it beautifully yesterday, and I agree with every word he said.
What we have got in front of us has got problems. It has got flaws. It has got safeguards. It is got unanswered questions. If we are going to bring in such a monumental change to the fundamental elements of our society, we have to have absolutely no hesitation in our mind, and if that was the case, this bill should pass 40-0, because none of us would have any issues or any concerns. If there is one concern about this legislation, it cannot go through this Parliament, and from my point of view there are several — 68 safeguards. There are questions about the doctors, there are questions about not having a psychiatrist involved, there are questions about the type of drug that would be used and there are questions about the locked box. There are so many questions that are unanswered in this piece of legislation.
We have got the responsibility to make a decision here on behalf of everyone else in the state. We are not making this decision for the 40 people who get to vote in this chamber; we are making it for the 5 million or 6 million people who live in this state. Once this legislation is decided, we have got it for a long time. If this gets up, there is no coming back from it. There is absolutely no coming back from it. In fact the only progression we get is probably further creep into other areas. So that is the reason, after much consideration, I just cannot in my heart support this piece of legislation.