Voluntary Assisted Dying

Thank you to every one of you who got in touch with me to share you views on Voluntary Assisted Dying.  

I voted in favour of the legislation, and I am relieved that after such rigorous and thoughtful debate it has passed.

Below is my speech from Parliament which outlines how and why I came to support the Bill.

 

17 October, 2017

Ms THOMAS (Macedon) — I rise to speak on the Voluntary Assisted Dying Bill 2017 and indicate that I will be supporting the bill. I have reached this decision by firstly considering the threshold question: should a person of sound mind who is dying be enabled to take control of their pain and suffering and end their life peacefully at a time of their choosing? For me the answer is yes. The second question is: does the bill contain sufficient safeguards to protect the vulnerable and avoid misuse? Again for me the answer is yes.

I also want to be clear in my contribution about those matters that this bill is not about but that have been part of the debate by those opposed to the bill. The bill is not about diminishing the value of palliative care. It is not an either/or proposition, and I am very clear in my mind that the highest quality palliative care can coexist with voluntary assisted dying. I believe it is entirely possible to support greater investment in palliative care by the government, the community and healthcare providers and workers and to support voluntary assisted dying. The bill is not about diminishing the value attached to the lives of people living with disability, dementia or mental illness, nor does it seek to diminish the lives of the frail, the old and the dying. Life is precious and inherently valuable. Certainly I am motivated every single day in this place to do what I can to support all Victorians to live their best lives and to build a society that values every Victorian just as they are throughout their life course. What I am now clear about both intellectually and in good conscience is that this bill is about choice and control for what I expect to be a small number of adult Victorians who are dying and who are enduring suffering that cannot be relieved in a manner that they consider tolerable and who have chosen of their own free will to end their lives at a time and place of their choosing.

I want to discuss this bill in the context of the excellent work that has been done by both this Parliament and the government to bring overdue and much-needed attention to death, dying and end-of-life care. The Legislative Council’s Legal and Social Issues Committee inquiry into end-of-life choices and the government’s own work in developing a framework for end-of-life and palliative care have really engaged the community on a topic that we all find difficult to discuss. This has meant wideranging and thoughtful conversations across the state, and I have enjoyed, I have to say, the opportunity to speak in depth with my community at forums organised by community groups in Trentham, Lancefield and Kyneton.

I might say at this point that because of this work that has been done, because of the wideranging debate and because I believe that all views have now been canvassed, I will be opposing the reasoned amendment. I just wanted to put that on the record.

As I say to my constituents, unfortunately we cannot legislate for you to have important conversations about your end-of-life wishes with your families. It really is the most important step that anyone can take to ensure greater control over their own end-of-life care. What we can do and what we have done in this place is ensure that treatment preferences are respected, and we have done that by delivering the Medical Treatment Planning and Decisions Act 2016. That act creates obligations for health practitioners caring for people who do not have decision-making capacity and establishes a single framework for medical treatment decision-making for people without decision-making capacity that ensures that people receive medical treatment that is consistent with their preferences and values.

The act means that for the first time Victorians will be able to create a legally binding advance care directive that will allow them to make an instructional directive about treatments a person consents to or refuses; make a values directive which will describe a person’s views and values, and a medical treatment decision-maker and health practitioner will be required to give effect to that values directive; appoint a medical treatment decision-maker who will make decisions on behalf of a person when they no longer have decision-making capacity; and appoint a support person who will assist a person to make decisions for themselves by collecting and interpreting information or assisting the person to communicate their decisions. This is a huge reform and one that to my mind will, over time, change the types of treatment people are receiving towards the end of their life and change the way their care is managed at home and in hospital for the better.

This reform of course underscores the importance of having conversations with family and loved ones about values and preferences — and also with a GP in order to better understand the treatment options that may present themselves in different scenarios. The challenge right now is to increase understanding and awareness of the choices people will have from early next year to better control their treatment.

The second piece of work I congratulate the government and the Minister for Health on is the focus on palliative care in the end-of-life and palliative care framework. Again, a lot of this work is about informing the community, service providers and clinicians about the ways we can improve end-of-life care in line with the preferences of Victorians to receive more and better care at home and us being partners in decisions about their care. The framework uses a definition of palliative care drawn from the World Health Organization, describing palliative care as:

… an approach to care that improves the quality of life of people and their families who are facing the problems associated with a progressive illness. It does this by preventing and relieving suffering through early identification and assessment, by treating pain and other physical, psychosocial and spiritual problems and by addressing practical issues.

Importantly palliative care is based on the needs of the individual patients. It is not intended as curative and is delivered by a range of health and community providers in partnership with families and carers. To my way of thinking, it is essentially an approach to end-of-life care that transcends medical care. Dame Cicely Saunders, credited as the founder of modern palliative care, describes the promise of palliative care as doing ‘all we can not only to help you die peacefully, but also to live until you die’.

I see this philosophy in action across Victoria in cancer centres like the Victorian Comprehensive Cancer Centre, the Albury Wodonga Regional Cancer Centre, through their wellness centre and palliative care program, the Olivia Newton-John Cancer Wellness and Research Centre, the Austin’s palliative care services and specialist palliative care services like at Calvary Health Care Bethlehem in Caulfield South. We have excellent services. More can be done, but in my mind this does not negate the fact that for some people the very best palliative care is not sufficient and they want to be in control of the end of their life.

I will be voting in support of this bill because I am satisfied that the bill delivers the safeguards and protections I believe are appropriate to protect vulnerable people in our community. This includes very strict eligibility criteria. In order to access voluntary assisted dying a person must be an adult 18 years and older. They must ordinarily be resident in Victoria and an Australian citizen. They must have decision-making capacity in relation to voluntary assisted dying and be diagnosed with an incurable disease, illness or medical condition that is advanced, progressive and will cause death, that is expected to cause death within weeks or months, but not longer than 12 months, and that is causing suffering that cannot be relieved in a manner the person deems tolerable.

I am also satisfied that the bill contains sufficient protections and these of course include that the person who is seeking access to voluntary assisted dying has decision-making capacity. They must be dying, they must be in the final weeks and months of life, and they themselves must make the request and do it on three separate occasions, including once in writing. The requests must be enduring over a period of at least 10 days. They also require a level of expertise and training of participating doctors, the process doctors, pharmacists and others are required to follow, and the information they must submit to the Voluntary Assisted Dying Review Board that oversights the framework. There is a strict medication management regime, the requirement of the appointment of a contact person responsible for returning unused medication following the person’s death and a suite of significant new criminal offences for those who act outside of the legislation. Each of these assures me that there are sufficient safeguards in place.

I want to make clear that I understand the abuse of vulnerable people in our community is real and it is incumbent on all of us in this place to do what we can to improve the quality of life for the old and the frail, for those living with disability and for those in our community who have lost the capacity to make decisions and care for themselves. It has been our parliaments that have shone a light on the systemic physical, sexual and emotional abuse of vulnerable people against the interests of powerful institutions.

We all know of circumstances where people have abused the trust and love of family members, and it is for this reason that persons likely to materially benefit from a person’s death are specifically excluded as witnesses to the required written declaration requesting assisted dying. But I will say this, the experience in Oregon suggests it is not vulnerable people accessing assisted dying.

Finally, I wanted to thank the hundreds of my constituents who have written to me, spoken to me or completed my survey, sharing deeply personal and affecting stories of their personal experiences, their values and beliefs, both in support of and in opposition to the bill. In choosing to support the bill I know I will disappoint those in my community who have deeply held views in opposition to the bill, including many people of faith. Please be assured I respect your views and acknowledge what this debate means to you.

Many of you have suggested that this bill is a slippery slope. But I want to say here that I reject the slippery slope argument for a range of reasons — fundamentally because I believe in the power of humanity to act ethically and for the common good. I have confidence in our parliaments to reflect the will of the people and of our courts to uphold the law. Should this bill become law, any changes into the future will be subject to the same rigorous policy processes and debates we are seeing here today.

Some might describe me as an optimistic humanist. It is a label I happily wear. To those who have contacted me in support of the bill, I thank you for sharing your views and your experiences. They have shaped my thinking and led me to the position I am articulating today. I have no doubt that each and every one of you, and in particular the healthcare workers — the nurses, the paramedics, the aged-care staff and doctors — who have contacted me in support of the bill, are motivated by care and compassion and from deeply held commitments to the rights of people to control their treatment options, including their pain and suffering. I commend the bill to the house.