November 16, 2016
The Hon. J.M. RANKINE ( Wright ) ( 19:58 ):
This is probably one of the most important pieces of legislation we as members of parliament are asked to consider and vote on. It is a huge responsibility, and one that weighs heavily on me and, I know, my colleagues. Many people have strong views on both sides of this argument, and in the main I think they reflect very much our own personal experiences. I am no different. I will not be supporting this bill brought in by the member for Morphett, and I do not support the bill brought in by the member for Ashford, which has been adjourned and remains on the Notice Paper.
I do not support these bills because no matter how carefully or thoughtfully these bills are drafted, they cannot ensure vulnerable people will not be pressured or coerced into choosing euthanasia and, importantly, neither the independence nor the quality of the medical profession involved in the process of approving someone's death can be guaranteed. Just like other countries where euthanasia has been introduced, this is simply the first step. If people think this is the end of the journey as far as euthanasia is concerned, they are kidding themselves; this is just the start. This bill was not the preferred option. We will see bit by bit the loosening of criteria and safeguards.
My concern is always ensuring that euthanasia is not the first port of call, that it is not something people can feel pressured into accepting as they feel they really do have no other choice. This legislation gives me no assurance or comfort that this will not be the case. No-one wants to see unnecessary suffering—people suffering unbearable pain and suffering unbearable anguish as end of life nears. There are circumstances where families and loved ones face the cruellest of circumstances. Our priority should be ensuring that expertise, skill and funding are available to all those who need it when faced with debilitating medical conditions which are ending their lives.
This bill does not promote or require palliative care as a first option. It simply requires that the two doctors assessing the request for euthanasia explain the palliative care options that are reasonably available. There is nothing in these bills which actually requires doctors assessing an applicant for euthanasia to have any real in-depth knowledge of palliative care. There is nothing in this bill that requires either of the doctors to have any specialisation. They can be any GP, anywhere.
My concerns were reinforced when, during a briefing provided by the palliative care association, the comment was made by a senior doctor that, in all professions, there are different standards and expertise. That really goes to the heart of the matter. It goes to the heart of my fears and my concerns. With the greatest of respect, I do not trust that the processes that are meant to occur will actually occur, nor will they occur with the thoroughness required. There is no requirement that doctors actually have the necessary information in fact to provide the advice envisaged in this legislation.
The second medical practitioner who does the follow-up assessment is required to be independent of the first doctor, yet there is nothing that specifies how they must be independent. Is it just a different doctor? Perhaps a country town with two GPs? Would they really be independent? Could it be someone of the same practice with a different billing number? Could it be the neighbouring practice and they refer to each other?
We already have legislation which requires independent assessment by two doctors, and I can tell you from bitter experience it can simply be a 'tick and flick' exercise. Two doctors are working independently. A senior doctor alters a junior doctor's recommendation. The senior doctor does not fulfil his legislative responsibility. A third and fourth doctor are made aware of this and not one of them is prepared to overturn the decision. There is much harm and distress caused because no-one is prepared to stand up and change a decision, so please do not tell me doctors act independently.
This bill tries to ensure that any person wanting to access euthanasia is doing so of their own free will, that they are of sound mind and are not coerced into choosing euthanasia. Yet, while the bill stipulates a person must be of sound mind to make an application, it also states that 'a person may fluctuate between having impaired decision making capacity and full decision making capacity'. They are not precluded if they are incapable of retaining information merely because the person can only retain the information for a limited time. What is that limited time? A few minutes, an hour, a day, a week?
The bill precludes advanced age, disability and mental health conditions as eligible criteria. Dementia is a terminal illness. It inevitably kills you, it is incurable and, depending on the stage the sufferer is at, they fluctuate in and out of reasoned thinking. It would be really easy to pressure and coerce or confuse someone in this situation to choose to die. Who is going to assess what phase they might be in when they sign an application: the doctor with limited knowledge of both dementia and palliative care, or the witness or a local JP?
What expertise does this legislation require of those making the assessments of people requesting to die? What teaching or training is required? The answer is none. The criteria for a person requesting euthanasia require that the person's death has become inevitable by reason of the terminal medical condition. It provides no time frame. I well remember a woman who had chosen to end her life. The issue was being promoted by Dr Nitschke. Luckily for her, her diagnosis was reviewed prior to her taking her life. It turned out she never had a terminal illness at all.
It is naive in the extreme to think that old people will not be pressured and coerced when it serves a purpose. The pressure can be subtle, but it happens now in relation to many things. Elder abuse is an increasing concern. What do people really think will happen? The legislation requires an applicant for euthanasia to be suffering a terminal medical condition, yet suffering has no objective standard. The legislation provides for the revocation of a request for euthanasia. The request can be revoked in writing, orally or through any other indication of revocation. To whom is the revocation made? How is it recorded? What guarantee is there that it will be recorded appropriately if given orally?
This is the compromise legislation. It is the first step, not the last. If this bill is passed by this parliament, the next step will be to weaken the constraints. There will be a push for those with dementia, stroke victims and people with a disability to be accessing euthanasia. If we are serious about ensuring all options are truly available to people suffering terminal illness, this legislation should have ensured that patients are fully informed of all available options and that the information is provided by people with expertise in this area, not the vague or general knowledge of general practitioners.
The Consent to Medical Treatment and Palliative Care Act allows for palliative care sedation and palliative care pain relief. It makes it clear that doctors are not obliged to continue life-sustaining treatment for people approaching death, and there is no restriction on the use of pain and other relieving medications, even if this hastens death.
I had this debate with my youngest son some years ago. He is a nurse by training. We were at a function and I was talking to a senior oncologist at one of our public hospitals. My son bounded up and said, 'Sir, mum and I have been discussing euthanasia. What do you think?' He looked at my son and said, 'I want my patients to think I'm fighting to keep them alive, not trying to kill them.' Make no mistake, this legislation will forever change the doctor-patient bond.