Time to endorse assisted dying?

Last week, we witnessed a strangely bipartisan moment in the nation’s history. An Australian parliament passed a law, with members of all parties invited to vote according to their conscience. This vote resulted in the first state-based legislation for voluntary assisted dying. There were a lot of numbers attached to the passing of this Bill in the lower house (Legislative Council) of the Victorian Parliament:

  • 28 sitting hours
  • 66 recommendations included
  • 100 amendments (of which none were passed)
  • 47 ayes, 37 nos, and two abstentions
  • and in less than 14 days the legislation will go before the 40 members of the Legislative Assembly (Victoria’s upper house) for endorsement or a knockback.

So, what does this Bill really mean for older Victorians – and possibly all older Australians should other states follow Victoria’s lead?

Will it change our lives in a fundamental way?

Probably.

At one level, the Bill to introduce the right to end our lives on our own terms is merely a continuation of the control we have already wrested from nature over our entry and exit. No longer is it considered inappropriate to plan and manage fertility and pregnancy with the latest drugs and medical intervention, be they morning-after pills, birth control pills, abortions or IVF procedures. So why should we be surprised that a medical intervention near the time of death is such a huge leap?

Is it because death is still considered a ‘final frontier’?

Perhaps.

Or is it because of the fear that it may be open to manipulation or abuse?

And here is the thing. We automatically seem to assume the decision-maker to be in sound mind when confronting birth control, abortion or IVF. But as we age, there is an implicit suggestion that we may not have sufficient control of our faculties to make a rational and irreversible decision on ending our own lives. Yes, dementia can be a factor in some cases for older people. As can be mental health issues for the broader population. But it would seem that the carefully researched safeguards included in the Victorian Government legislation (based upon feedback from a Ministerial Advisory Panel) will successfully negate the opportunity for ‘inheritance seekers’ to unduly influence older relatives to agree to an assisted death.

Much of the debate about this Bill has centred on the access to end-of-life care, in particular palliative care. There seems to be a false argument posited by those who provide palliative care that it is ‘sufficient’ for those suffering unbearable pain. Yet the feedback from carers and families of those who have die in such pain begs to differ. Their experience proves such pain cannot always be ameliorated, or even managed in a way that gives the patient an even halfway decent end to their life.

Another criticism of the Bill is that Victoria may well now become a ‘suicide destination’. This is possible, but not necessarily practical or affordable for all those so badly afflicted that they would qualify to travel to Victoria to end their lives. It is far more likely that, should the legislation pass the upper house, other states will watch the Victorian process and replicate it for their own citizens to have a dignified option.

Which begs the question, what is a ‘good death’? Interestingly, the Oxford Dictionary definition of euthanasia (The painless killing of a patient suffering from an incurable and painful disease or in an irreversible coma) shows the early 17th Century origin to be based upon the sense of an ‘easy death’ from the Greek eu ‘well’ + thanatos ‘death’.

This is not the way my dad, Jack, left this world. He basically starved to death in a coma, after a stroke, and it took six days for him to die. It seemed far longer to those who loved him, as we stood around, holding his hand, listening to his laboured, raspy breath, trying to soothe him, but unable to do a single thing which would ease his distress. I cannot believe that those extra six days added anything but pain and distress to Dad, and immense sadness and stress to rest of us.

End of life remains a mystery to all, whether you are a believer or not. Good on those who have strong faith and believe that they are headed to a better place.

But watching our loved ones suffer does not seem to be ennobling in any way. It is horrible. And the idea that thoughtful men and women have gathered in a parliament to put into place a better process for those in need seems, on balance, to be a very positive step.

What do you think?

Do you believe the proposed legislation is open to abuse by family members or those with something to gain?

Do you think death is an aspect of life that should not be controlled by individuals?

If not a resident of Victoria, would you like to see this legislation in your own state or territory?

Fast facts background:

Victorians who are terminally ill are one step closer to having access to voluntary assisted dying after the Legislative Assembly voted to pass the historic Voluntary Assisted Dying Bill 2017, without any amendments.

This historic Bill is the result of more than two years of consultation and engagement with Members of Parliament, the community, health, palliative care and legal sectors.

The Bill will still need to pass the Victorian Legislative Council before it becomes law.

The Parliament’s Legal and Social Issues Committee’s Inquiry into end of life choices heard from over 1000 people, both in person and through their submission process, and the Expert Ministerial Advisory Panel heard from over 300 stakeholders throughout their consultations.

The legislation passed by the Legislative Assembly delivers on the safe and compassionate framework designed by the Ministerial Advisory Panel, chaired by former AMA President and neurosurgeon Brian Owler.

With 68 safeguards, the framework is the safest and most conservative in the world.

It will provide Victorians with a terminal illness genuine choice at the end of their lives.

After being read in the Legislative Council today, the Bill is expected to be debated in the Legislative Council in the sitting week starting Tuesday, 31 October.

Should the Bill pass Parliament, there will be an 18-month implementation period before access to voluntary assisted dying will begin.

Taken from www.vic.gov.au

The recommendations from the Ministerial Advisory Panel
The Parliamentary Committee’s assisted dying framework (from the interim report of the Ministerial Advisory Panel: Consultation overview)

What did the Parliamentary Committee recommend?

  • the Parliamentary Committee recommended an assisted dying framework to allow adults with decision-making capacity who are suffering from a serious and incurable condition and who are at the end of life to be given assistance to die in certain circumstances
  • the Parliamentary Committee is clear that the assisted dying framework is intended to provide an option that can limit suffering at the end of life and is not a way to end life for people who are not dying
  • no doctor, other health practitioner or health service will be forced to participate in assisted dying

How would the Parliamentary Committee’s recommendation work?

  • the framework being proposed would involve a doctor prescribing a lethal drug that the person may then take without further assistance from the doctor
  • the Parliamentary Committee recognised that doctors should assist people who are physically unable to take the drug themselves. In these cases, the framework would allow a doctor to assist the person to die by administering the drug.The Parliamentary Committee did not detail where or how this should occur

Who would be able to access assisted dying?

The assisted dying framework outlines eligibility and assessment criteria for a person to be assisted to die. These are that the person:?

  • is an adult with decision-making capacity
  • is ordinarily resident in Victoria and an Australian citizen or permanent resident
  • is at the end of their life (final weeks or months of life)
  • is suffering from a serious and incurable condition that is causing enduring and unbearable suffering that cannot be relieved in a manner the person deems tolerable
  • makes the request themselves
  • shows an enduring request for assisted dying and requests it three times through an initial verbal request, a formal written request signed by two independent witnesses and a final verbal request
  • is independently assessed by a primary and secondary doctor (it will be the role of the doctors to ensure the person is properly informed, they are satisfied that the person’s request is enduring and to assess the reasonableness of the request)
  • must not be suffering as a result of mental illness only. 



How would assisted dying work in practice?

A person who meets the above criteria would be able to make a request for assisted dying. This request would need to be enduring, which means the person would need to make three separate requests, one of which is in writing and witnessed.

A primary and secondary doctor must independently assess the eligibility criteria. A primary and secondary doctor must each properly inform the person of their diagnosis and prognosis and treatment options and likely outcomes. They must also inform the person about palliative care and its likely results, that they are under no obligation to continue with their request and may rescind it at any time and of the probable result and potential risks of taking the lethal drug.

Once the requests have been made and two doctors have found the person meets the eligibility criteria, the doctor may prescribe a lethal drug. The person may then self-administer the drug at a time of their choosing. If a person is physically unable to self-administer, the doctor may assist the person to die by administering the drug.

What oversight does the Parliamentary Committee propose?

The assisted dying framework includes the establishment of a board called the Assisted Dying Review Board. The board would ensure doctors are complying with the requirements of the assisted dying framework by reviewing each approved request for assisted dying. The board would not approve or reject requests for assisted dying. The Parliamentary Committee recommends a five-year review of the assisted dying framework by a parliamentary committee.

Read more at www.legislation.vic.gov.au

Related articles:
How will assisted dying work?
New test helps dying with dignity
Voluntary euthanasia up for debate

Written by Kaye Fallick

RELATED LINKS

Victorians would be able to seek medically assisted death from 2019

Victorians with terminal illnesses could access lethal medication within 10 days of request.

New test helps dying with dignity

A new test has the ability to predict remaining life for terminally-ill patients.

Voluntary euthanasia up for debate

The subject of voluntary euthanasia will be debated in Parliament today.



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