November 16, 2016
Mr PICTON ( Kaurna ) ( 21:21 ):
There is no doubt that the policies and laws regarding the end of life are very important but also very difficult issues for parliament and individuals to deal with. It is a melting pot of ethics, spirituality, choice, care, risk and fear. There is a variety of views and perspectives and almost all of them are valid.
I have heard from many people in my electorate who have contacted me about this issue. They are mostly very passionate either for or against this bill. I have closely considered the opinion of each of those constituents and also met with them if they wanted to be heard to discuss their concerns directly. I have also met and listened to people from both sides of the argument and I have tried to seek out some of the opinions of doctors, nurses and other experts in this area who do not have an ideological view to push.
This issue, perhaps more than any other, is for many people a black or white, yes or no question. I can understand that viewpoint but I believe that there are many areas of grey. There are people who would support or oppose a euthanasia bill without concern for the drafting. I am not one of those people. The initial bill that we were asked to consider on this subject was not fit for purpose in my opinion. If it is put to a vote, since it is still on the Notice Paper, I would be unable to support that bill in any way.
The reasons for this have been well articulated by many of the speakers in that debate. However, suffice to say that it was far too broad and without the safeguards that I believe the community would expect. This new bill has now been introduced and addresses a number of the significant concerns that have been raised about the previous bill. However, I am still not satisfied that it is yet carefully enough drafted or provides adequate protections. I am very disappointed with the process that led us here to the point of debating this bill without what I believe is the full evidence or expertise before the parliament, or the full consideration of all the other very important end-of-life care issues and palliative care issues.
As a point of comparison, the other parliament considering voluntary euthanasia at present is Victoria. In that state, the parliament decided to establish a select committee which spent over a year researching, debating, studying and interviewing witnesses to arrive at a lengthy report proposing dozens of recommendations covering both voluntary euthanasia as well as the full spectrum of other important issues at the end of life and palliative care. That is now being considered by the government, which will report back to the parliament, drafting a bill that will inevitably be debated by their parliament with full access to the information. Therefore, I do not believe that this process compares favourably at all with what is happening in Victoria.
This is not an issue that I have had on my agenda. I have been concerned about our ability to construct laws that provide adequate safeguards, and the antics of the likes of Dr Nitschke have always made me cringe over the last couple of decades. It should be noted that we do have a strong record in South Australia for concern for end-of-life issues and the work of Martyn Evans and many others in leading to advance care directives and the Consent to Medical Treatment and Palliative Care Act should be considered in this debate and held in very high regard by everybody in our state.
Over the last few months, though, I have spent a long time listening, reading and considering this matter. There are rational arguments on both sides that need to be considered, but I am concerned about the pain and suffering of a small number of people right at the end of their life, in pain with hopeless medical outlooks, for whom the range of legal options do not currently suffice. My view differs from the views of many, in that I think it is a relatively small number of people and for a relatively short amount of time.
For everybody in this house and the community, it is hard for this not to be a personal issue. I have had family members who have died long, painful deaths. This has been traumatic not only for them obviously but for the rest of my family. This experience brings me to consider ways in which the legal system could be improved for the end of life, but I would also want to make sure that any action we take to reform the law in this area is not going to cause loved ones harm or allow something to happen that is not in their wishes. This is about loopholes and safeguards and managing risk.
With that in mind, I have considered the bill before us. While it is an improvement on the original bill brought to the house, in my view it still needs significant amendments before I would consider supporting it. In particular, I have looked at the legislation in Oregon and considered a number of protections in that act to be superior to what has been proposed in this bill. I have attempted to review the bill to identify and to remedy the areas of greatest risk. I have drafted some amendments to try and address those concerns.
Over the past few weeks, I have discussed these amendments with some of the key proponents and opponents of the bill in this place. My amendments, as circulated, are aimed to make this a safer, more cautious and less risky proposition. This is obviously my best attempt at this, and I do not claim to be the fount of all wisdom, and I certainly will be looking forward to seeing what other members have to say in the debate. I will outline some of the amendments I have tabled.
Amendment No. 1 covers telehealth. Currently, the bill proposes that any of the consultations with doctors or a psychiatrist should be able to be conducted via telehealth. This has been of concern to a number of doctors who work in palliative care, who argue that these types of consultations are difficult, lengthy and require the doctor to be present in person. Therefore, I propose that telehealth be limited to only those people who are in a remote location. People for whom it is practicable to see a doctor in person should do so.
Amendment No. 2 covers euthanasia equipment. Currently, the bill proposes that euthanasia equipment would be legal for sale. This is contradictory, in my view, to the provisions of the bill that are about the provision of a drug rather about than the use of any equipment. I would therefore propose the removal of this provision so that various suicide-assisting devices would not become legal.
Amendment No. 3 covers subjective tests. In my view, euthanasia should only be an option after a reasonable effort at palliative care and medical treatment and where the pain is actually insufferable. As currently drafted, these areas have subjective tests attached to them which I am concerned would currently block a doctor's role to properly assess this matter; therefore, I propose to amend these. This would make sure that palliative care and medical care would have to be the first option before anything else were considered.
Amendment No. 7 covers terminal illness definition. It is my belief that the option under this bill should only be considered truly at the end of life for that small number of people. However, the current provisions specify that terminal illness should not be held to involve any particular time period. This is inconsistent with other similar acts around the world, and I recommend that we should adopt a requirement for a prognosis of six months or less of life, which is consistent with the Oregon legislation.
Amendments Nos 8, 13 and 15 deal with psychiatric assessment. This is an important provision. Currently, the bill only requires an assessment from a psychiatrist when referred from a doctor. I believe that it would be a much more careful approach for parliament to say that a psychiatrist should provide a check of a person's state of mind before the request is certified. I note that the member for Morphett has also made such an amendment, albeit to broaden the definition to include other mental health professionals.
Amendments Nos 9 and 10 deal with expiry and renewal. Currently, the bill does not involve any expiry request. I believe it would be prudent for a check-in every month with the person's treating doctor to ensure that the status of the request has not changed from when it was first made, including that there is no duress that the doctor is aware of. This would be done every 28 days by just that one treating doctor.
Amendments Nos 11 and 14 cover medical expertise. Currently, a doctor providing the assessment of the patient could be any doctor. It significantly worries me that we could see specialist euthanasia doctors, such as Dr Nitschke. Apparently, the early evidence from Canada is of doctors such as fertility doctors or gynaecologists being some of the first, bizarrely, to authorise euthanasia. I have recommended that the doctor have a specialty or expertise in the area of the person's terminal illness.
Amendments Nos 16 and 17 cover witnesses, where I propose that there should be a restriction that only one of the witnesses could be a relative and that, while we already have a restriction on employees of hospitals, there needs to be an extension to apply for healthcare professionals outside of that. Those are the amendments I have proposed; I believe they would make this a more cautious approach to this legislation. Ultimately, my vote will be determined by considering what bill this process delivers tonight, whether it is cautious and considered, whether it is likely to help address that small number of people in great need, and whether it limits the risk of this bill ultimately causing harm.