VOLUNTARY ASSISTED DYING BILL 2019
Committee
Resumed from 22 November. The Chair of Committees (Hon Simon O’Brien) in the chair; Hon Stephen Dawson (Minister for Environment) in charge of the bill.
Clause 14: When person can access voluntary assisted dying —
Comments and speeches from various members
Hon CHARLES SMITH: I move —
Page 12, after line 23 — To insert —
(g) the person has considered the impact that the person accessing voluntary assisted dying may have on the person’s family.
Comments and speeches from various members
Hon ALISON XAMON: In an ideal world, when someone is facing imminent death, whether it be from their illness or because they access voluntary assisted dying, we would always hope that they would feel that they were able to reach out and get support from their loved ones, from family. However, I think it is a step too far to try to prescribe that desire within the legislation. Unfortunately, not everyone comes from a functional family. Sometimes, people are estranged, for good reason, from people who may feel that they have a vested interest in somebody else’s life, but the person who is dying may not feel that that is appropriate. It may also be the case, as has already been mentioned, that a person may decide to not tell their family that they are dying. We may have opinions about that. We may look upon such a scenario with sadness and reflect on how unfortunate that may be for those individuals, but, nevertheless, that is that individual’s choice. I do not think it is appropriate for us to try to prescribe within legislation the nature of family relationships.
Comments and speeches from various members
Amendment put and negatived.
Clause put and passed.
Clause 16: Eligibility to act as coordinating practitioner or consulting practitioner —
Comments and speeches from various members
Hon NICK GOIRAN: I move —
Page 13, line 19, to page 14, line 5 — To delete the lines and substitute —
(2) A medical practitioner is eligible to act as a coordinating practitioner for a patient if—
(a) the medical practitioner —
(i) holds specialist registration, has practised the medical profession for at least 1 year as the holder of specialist registration and meets the requirements approved by the CEO for the purposes of this subparagraph; or
(ii) holds general registration, has practised the medical profession for at least 10 years as the holder of general registration and meets the requirements approved by the CEO for the purposes of this subparagraph; or
(iii) is an overseas-trained specialist who holds limited registration or provisional registration and meets the requirements approved by the CEO for the purposes of this subparagraph;
and
(b) the medical practitioner is not a family member of the patient; and
(c) the medical practitioner does not know or believe that the practitioner —
(i) is a beneficiary under a will of the patient; or
(ii) may otherwise benefit financially or in any other material way from the death of the patient, other than by receiving reasonable fees for the provision of services as the coordinating practitioner for the patient.
(3) A medical practitioner is eligible to act as a consulting practitioner for a patient if—
(a) the medical practitioner —
(i) holds specialist registration, has practised the medical profession for at least 1 year as the holder of specialist registration and meets the requirements approved by the CEO for the purposes of this subparagraph; or
(ii) holds general registration, has practised the medical profession for at least 10 years as the holder of general registration and meets the requirements approved by the CEO for the purposes of this subparagraph; or
(iii) is an overseas-trained specialist who holds limited registration or provisional registration and meets the requirements approved by the CEO for the purposes of this subparagraph;
and
(b) the medical practitioner is not a family member of —
(i) the patient; or
(ii) the coordinating practitioner for the patient; and
(c) the medical practitioner does not know or believe that the practitioner —
(i) is a beneficiary under a will of the patient; or
(ii) may otherwise benefit financially or in any other material way from the death of the patient, other than by receiving reasonable fees for the provision of services as the consulting practitioner for the patient;
and
(d) the medical practitioner —
(i) does not own a health facility or medical facility with the coordinating practitioner for the patient; and
(ii) is not a supervisor of, or supervised by, the coordinating practitioner for the patient at a health facility or medical facility; and
(iii) is not employed or engaged under a contract for services, or a consultant, at a health facility or medical facility where the coordinating practitioner for the patient is also employed or engaged or a consultant.
(4) The CEO must publish the requirements approved for the purposes of subsections (2)(a)(i), (ii) and (iii) and (3)(a)(i), (ii) and (iii) on the Department’s website.
(5) In this section medical facility means a medical centre, medical clinic or similar facility.
The DEPUTY CHAIR (Hon Adele Farina): Members, Hon Nick Goiran has moved an extensive amendment. I think we will just take a short hold while we wait for copies of that amendment to be distributed so that members can read the amendment and understand what is currently being considered by the chamber.
Hon ALISON XAMON: Can I quickly ask a question to the member who moved the amendment?
Hon STEPHEN DAWSON: Can we wait until we have a copy of it? I would love to be able to follow the member’s question, but until I have a copy of it, it is difficult.
Hon ALISON XAMON: It is about the form of the amendment, not the substance.
The DEPUTY CHAIR: Hon Alison Xamon, the minister has indicated that it would help him to follow the discussion if he has a copy of the amendment before him and I think that is a reasonable position to hold, so I think we will just hold for a few minutes while we wait for that amendment to be distributed to members.
Can members indicate whether they are happy to continue at this point with consideration of the amendment? There has been an opportunity to peruse the lengthy amendment.
Hon ALISON XAMON: We have, of course, the quite comprehensive amendment in front of us. I note that the amendment effectively has two different intents enshrined within the one amendment. The second intent is to make sure that the medical practitioner does not have any sort of conflict of interest or any sort of capacity to benefit from a patient’s death. It strikes me that that is an eminently sound and important provision that is probably worthy of inclusion within the bill. I think that would improve the bill in its current form. I am interested that two different components have been coupled into the one amendment. My question to the minister is specifically about the provisions as outlined in clause 16(2)(a), which prescribes the professional requirements of a medical practitioner, and their eligibility. Looking only at the provisions within subclause (2)(a), are they already implied within the bill or will this in any way limit the current provisions within the bill?
Hon NICK GOIRAN: As the author of the amendment—with the benefit of parliamentary counsel, I should add—I can perhaps assist by drawing to members’ attention that clause 16(2) at page 13 of the bill sets out those professional requirements. The provision that the member has referred to in my amendment at clause 16(2)(a) is identical to that at page 13 of the bill; it is simply the numbering that is different. Subclause (2)(a)(i) refers to holding specialist registration, which is the same as subclause (2)(a) in the bill. My subclause (2)(a)(ii) equates to subclause (2)(b) in the bill; and my subclause (2)(a)(iii) equates to subclause (2)(c) in the bill.
Hon ALISON XAMON: I thank the mover of the amendment. That is very helpful because, obviously, we have only just seen this. Can I please confirm with the mover of the motion that the effect of the amendment is entirely about ensuring there will be no conflict of interest from any practitioner who is assisting a person seeking access to voluntary assisted dying?
Comments and speeches from various members
The DEPUTY CHAIR: Members, we now return to the amendment moved by Hon Nick Goiran, which is to insert certain words at page 13, line 19 to page 14, line 5. The question is that the amendment be agreed to.
Division
Amendment put and a division taken, the Deputy Chair (Hon Martin Aldridge) casting his vote with the noes, with the following result —
Ayes (14)
Noes (20)
Amendment thus negatived.
Hon STEPHEN DAWSON: I move —
Page 13, line 19 to page 14, line 2 — To delete the lines and substitute —
(2) A medical practitioner is eligible to act as a coordinating practitioner or consulting practitioner for a patient if —
(a) the medical practitioner —
(i) holds specialist registration, has practised the medical profession for at least 1 year as the holder of specialist registration and meets the requirements approved by the CEO for the purposes of this subparagraph; or
(ii) holds general registration, has practised the medical profession for at least 10 years as the holder of general registration and meets the requirements approved by the CEO for the purposes of this subparagraph; or
(iii) is an overseas-trained specialist who holds limited registration or provisional registration and meets the requirements approved by the CEO for the purposes of this subparagraph;
and
(b) the medical practitioner is not a family member of the patient; and
(c) the medical practitioner does not know or believe that the practitioner —
(i) is a beneficiary under a will of the patient; or
(ii) may otherwise benefit financially or in any other material way from the death of the patient, other than by receiving reasonable fees for the provision of services as the coordinating practitioner or consulting practitioner for the patient.
I indicated previously when I spoke on Hon Nick Goiran’s amendment why it was my intention to move this amendment. Again, I have listened to the contributions of various members throughout this debate and the government has taken those on board. I stand by the amendment standing in my name.
Comments and speeches from various members
Hon ALISON XAMON: I rise to indicate that I will also be supporting this amendment. I think it is an important improvement to the legislation and reflects the policy intention of Hon Nick Goiran’s previous amendment, which was defeated. It is essential to ensure that people who provide medical assistance for voluntary assisted dying can in no way personally benefit from their patient’s death.
Comments and speeches from various members
Amendment put and passed.
Comments and speeches from various members
Clause 19: Medical practitioner to accept or refuse first request —
Comments and speeches from various members
Hon ALISON XAMON: I respectfully disagree with the concerns being raised by Hon Aaron Stonehouse on the basis that if a medical practitioner is faced with this situation that has been described by the honourable member, in theory they may be obliged to provide the basic information, but that basic information would make it very clear that the person who may be experiencing suicidal ideation is simply not eligible to avail themselves of this. What it does do is open an opportunity with a clinician to talk to that person about their mental health issues and the fact that they are experiencing suicidal ideation. Fifty per cent of mental health presentations first occur with general practitioners. It is a very, very common occurrence, and one that general practitioners have to deal with at least weekly, sometimes on a daily basis. Part of their training is to learn how to respond to people who are experiencing deep mental health stress and then to address the issues accordingly. I do not think that the supply of the information is going to pose the sort of risk that is being contemplated by the honourable member. I think it clarifies that voluntary assisted dying is not the appropriate course of action, or even available in this instance. It opens up the opportunity for a therapeutic response to deal with serious mental health issues.
Comments and speeches from various members
Hon ALISON XAMON: In response to the amendment that has been presented, I go back to clause 19(2)(a) of the bill. It is important that we note that subclause (2)(a) is split into two different parts; one part refers to conscientious objection and the other part refers to being otherwise unwilling to perform the duties of a coordinating practitioner. The reason that is important to note in relation to this amendment is that subclause (5) refers only to the requirement to give information in the event of a conscientious objection. It is important to note that the bill currently refers to a scenario in which a practitioner is otherwise unwilling to perform the duties of a coordinating practitioner. That could well be a situation in which a practitioner is of the view that someone is at risk, is experiencing psychosis, is six years old or is clearly not dying. We could envisage a whole range of scenarios in which it would be not only inappropriate, but also potentially patently absurd for the GP to be obliged to supply that information. As I understand the minister’s response previously, if someone were to issue a complaint that the information had not been issued in those circumstances, that complaint would be unlikely to be upheld. It is important to make that distinction, because then the existing provision that the amendment seeks to amend would apply only to people who are unwilling to supply the information because they have a conscientious objection. I think the conscientious objection provision within this legislation is an important one and one that we should be absolutely prepared to protect and uphold. It is reasonable. In fact, I have not heard anybody argue against the capacity for a medical practitioner to exercise a conscientious objection to this piece of legislation. However, it says that the medical practitioner cannot just advise that they object and leave it at that, with no capacity for a patient to have any idea about where they might be able to go after that. This is not an uncommon provision in other conscientious objection regimes. For example, with teenage pregnancies and those sorts of things, people are not obliged to engage in particular procedures if they do not wish to, but nor should people be left without any idea about the options that are potentially available to them if they go elsewhere.
It is important to note that the amendment refers to the medical practitioner refusing the first request under subclause (2)(a), and that is broader than the current requirement in the bill to provide information. I wanted to at least make sure that members were aware that it is potentially imputing a requirement to give information that I am not sure currently exists within the entirety of subclause (2)(a).
Comments and speeches from various members
Clause put and passed.
Comments and speeches from various members
Progress reported and leave granted to sit again, pursuant to standing orders.