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October 17, 2017

MR THOMPSON (Sandringham) (15:36:27) — When the House of Commons in the United Kingdom considered assisted dying legislation it was defeated some 330 votes to 118 votes in 2015. To my mind, one of the strongest contributions to that debate came from Fiona Bruce, who noted:

We are here to protect the vulnerable in our society, not legislate to kill them.

The proposition 'Do not kill' has been a core ethical principle of every civilisation. Earlier this year a disability rights activist, Liz Carr, produced a musical at the Malthouse Theatre in Melbourne called Assisted Suicide: The Musical. She spoke in this Parliament as well. She was a wonderful advocate for the rights of people with disabilities and was a highly articulate opponent of the British legislation. Her key argument, which struck me to the highest degree, was: when would the right to die become the duty to die?

A Melbourne comedian once noted phraseology drawn from a Mafia movie where the words were to the effect of 'Take the pressure off yourself. Do the right thing'. The inference there was that the person might take their own life. As a former lawyer who has drafted many wills, I am aware of the family circumstances and contingencies where the frail and aged may be subject to the guidance and advice of individuals as to what might be in their best interests when they are at the point of suffering, physical weakness and vulnerability. Accordingly my position in relation to this debate is to oppose assisted dying, and I will be supporting palliative care.

I am pleased to note the opposition's recent announcement that there will be a contribution of $140 million towards palliative care. In the lunch recess there were multiple medical experts who were arguing very strongly against the legislation before the house.

It might be pointed out that around the world 107 out of 109 medical associations oppose the legislation such as that which is before this chamber today. It was tweeted earlier today that there are some examples of pain and suffering that are not able to be properly addressed. I put that question to a number of speakers at lunchtime. There was a geriatrician, a palliative care expert, an emergency physician, a general physician, a couple of oncologists, a psychiatrist and a GP. I was directed to the answer that medication can meet the pain relief needs of some 96 per cent of patients and that for the 4 per cent where there are difficulties, there can be palliative sedation so that no-one ought suffer. No-one need suffer in confronting their final days of life. I am very grateful for the advocacy of Melbourne medical professionals who have made representations pointing out the flaws in the legislation before the house.

The majority of letters received by my office reflect views opposed to euthanasia; however, it is not possible to draw conclusions from a finite sample. I have attended public debates and listened to contributions by proponents for and opponents of voluntary assisted dying. Discussions have been constructively respectful. On the critical question of pain, experts to whom I have spoken and to whom I just referred suggest that good palliative care can relieve suffering.

As a member of Parliament, I have a responsibility to my electorate, to the Parliament, to my constituency and to my conscience. In the event of a conscience vote later on, it is my responsibility and challenge to balance the different community perspectives with my own reflection and my own judgement.

A leading Melbourne specialist at three teaching hospitals has raised the following:

Seven questions. That's all.

As an infectious diseases specialist with 25 years experience caring for some of Melbourne's sickest patients, many of them at death's door, I have just seven questions about the dangers of Victoria's proposed assisted suicide model, and I'm yet to find anyone — including members of Parliament — who can provide me with a satisfactory answer to a single one.

1. Why is it acceptable that no psychiatrist is involved in the proposed assisted suicide process when depression is notoriously difficult to diagnose and a major driver behind terminally ill patients wanting to die?

2. Why doesn't the model mandate the involvement of a palliative care specialist, so the patient is fully aware of all possibilities of care before killing themselves? Only palliative specialists truly know what this superior care can offer.

3. Why is l2 months the defined time frame for death? They don't like to admit it, but doctors are actually poor at predicting the time a person has to live. New and truly life-saving drugs are becoming available all the time. A reference is made to the fact that Jim Stynes and Jarryd Roughead had exactly the same disease.

The questions continue:

4. Why is it acceptable that the two doctors signing off on a patient's suicide don't need to be a treating doctor or even inform the treating doctor? A patient need only find a Dr Nitschke and a Dr Kevorkian to approve their eligibility for the process. Personally I find it astounding that a patient's treating doctor, someone who might have been their family care physician for 30 or 40 years, is not brought into the process of care.

The specialist continues:

5. Why is it acceptable that there will be no way of knowing the actual circumstances of how a lethal medication will be taken, or indeed if it is taken, and where the drug will end up? Astonishingly the model only requires self-reporting about what happens with the drug, which could be given without a patient's knowledge or even handed to someone else.

6. Why is it acceptable that under the model a patient's death certificate will be falsified, recording their terminal illness as the cause of death as opposed to suicide? Let's be clear, we are talking about knowingly populating a legal document with false information. Truly we are living in a post-truth world.

7. How many errors and wrongful deaths are Parliament and the Victorian public happy to accept? Coercion and elder abuse is real and increasingly documented. I have seen its targets in my own personal medical practice. It is also often subtle and hidden. The overseas experience is that large numbers of people who participate in assisted suicide do so because they fear being a burden. Mistakes happen in every medical system, including systems of euthanasia and assisted suicide.

They are seven questions that a senior Melbourne medical practitioner has posed and to which to date he has not received direct answers.

Additionally three Australian Medical Association (AMA) presidents and 101 Victorian oncologists have stated:

As 80 per cent of those who access physician-assisted dying legally overseas have cancer, we feel our perspective on this issue should be heard.

We add our voices to the 100 palliative care specialists who have already corresponded with — members of Parliament — … requesting that you oppose the passage of this bill.

We collectively represent a significant proportion of the oncology workforce in the state of Victoria.

We do not believe that it is possible to draft assisted dying laws that have adequate safeguards to protect vulnerable populations, especially those with incurable cancer, progressive neurological illness, the aged and disabled. These groups of people experience high rates of depression and isolation. The risks that such legislation poses for the majority of these outweigh any benefits for the few in our opinion.

Physician-assisted dying places people at risk of coercion that is both active and passive. As a consequence of assisted dying laws, society reassesses the value of life, and the individual is taught to devalue their own life.

I seek extended time,

Deputy Speaker. Leave granted.

Mr THOMPSON — The statement continued:

Those with serious illness may perceive that they are a burden on society or their carers and come to feel that assisted dying is appropriate for them.

The AMA presidents and oncologists further note:

We are very disappointed that discussion of the voluntary assisted dying bill has dominated the agenda to improve end-of-life care in Victoria. We are dismayed that the multiple recommendations made by the Victorian parliamentary inquiry into end-of-life choices (June 2016) to strengthen palliative care have not been actioned. Until this is addressed, discussing physician-assisted dying is premature.

We call for improved funding of palliative care services in Victoria, for the benefit of all Victorians, but especially those who live with incurable cancer and their families.

We all have our own observations of friends and family members in the context of death and dying. There was a report posted on the internet by Rabbi Yisrael Rutman on 19 February 2004 when he interviewed and noted the work of Dr Rachamim Melamed-Cohen, 'Israel's most famous terminally ill patient'. For Dr Melamed-Cohen, in pondering the question as to how 'to overcome the pain and hopelessness that has driven other victims of incurable illness to consider suicide':

Self-definition is a large part of it. As he explains, 'I don't define myself as 'ill', or 'a patient'. Rather, I am a human being who has an illness, and who receives treatment. The term 'ill' connotes someone who lies in bed passively and does nothing. I do many things, though I also have an illness'.

'And I am not terminally ill, no more than anyone else who is eventually going to die. It's already eight years that the doctors have been calling me 'terminally ill', but with each passing day I feel less and less terminal'. Initially, when he was diagnosed with ALS, doctors gave him three to five years to live, and he continues to disprove their prognosis.

In the case of Dr Rachamim Melamed-Cohen his religious faith was important to him. It is noted:

Equally essential to Melamed-Cohen's determination to carry on is his religious faith. 'I feel at times that God has allowed me to live in order to show the world that even in such a condition one can continue to be creative and contribute to society … The message of Judaism is that one must struggle until the last breath of life. Until the last moment, one has to live and rejoice and give thanks to the Creator'.

Melamed-Cohen further notes:

For whom is the mercy? Is it for the person with an illness? Or is it for the family, so that they should not have to suffer? For the medical establishment, to reduce expenditures? For the insurance companies? Mercy means helping others to live, and with dignity. Helping people to cut their lives short cannot be called mercy.

He finally points out that:

… the ramifications of euthanasia advocacy go far beyond the realm of the 'terminally ill'. The euthanasia movement threatens to redefine the very meaning, and sanctity, of human life.

For these reasons I will be opposing the legislation before the house.