Following a multi-party, Upper House inquiry into “end of life” choices; Victoria may become the first Australian state to permit assisted death.
Not the first jurisdictional State; the Northern Territory’s Rights of the Terminally Ill Act 1995 was the first legislation of this type in the world but was controversially overturned by the Federal Government’s Euthanasia Laws Act 1997. This is not an issue for Victoria as it is a self-governing sovereign State whereas the NT governs itself on behalf of the Federal Government.
Anyhow, the committee released its Report on June 9, 2016, and the Andrews government tabled its response on 8 December 2016. The Final Report has just been released. The legislation is due to go before Parliament by the end of this year, though it will be 18 months before it becomes operational.
We expect Members to be permitted to vote according to their conscience rather than party lines. Or more properly, in my opinion, according to their electorate’s instruction. I wish our MPs luck for the coming months, especially those in marginal seats that may feel their job security threatened in the process.
The Assisted Death Debate
The start of the debate has fascinated me. The “NO” responses generally come in the form of
- I don’t like it.
- God doesn’t like it.
Which is interesting, because:
- You don’t have to end your life if you don’t want to.
- Who are you to tell me what I can and can’t do with my end of life?
- Your God may (or may not) share a name with mine, but it’s unlikely they are the same God. Your God probably has enough to do worrying about you without adding me to his list.
Now and again it comes up that sick people need protection from selfish and greedy family members who will nefariously plot to kill their wealthy relatives for their money, which demonstrates:
- A very low opinion of the human race.
- An appalling lack of patience and imagination on the part of said selfish and greedy family members.
The recommendations include new criminal offences for inducing assisted death applications, and administering the dose if you aren’t an appropriately authorised medical practitioner.
Only rarely is it mentioned that poor doctors may be required kill people when they don’t want to. Which is a sad reflection on us that our health care professionals are so low in our priorities. And the current recommendations, give doctors the choice of whether to become an authorised end of life dispenser or not, so it’s a bit of a non-starter anyway.
Interestingly, I haven’t yet heard anyone express the fear that legislation allowing assisted death is the first step towards compulsory euthanasia, though I expect it won’t be long.
Nor will the name calling.
The Assisted Death Process
The Bill will largely follow the recommendations of the committee. If you want to apply for assisted death, you must be:
- The one receiving the assistance, and
- Over 18, and
- Mentally capable, and
- An Australian citizen or permanent resident, and
- Permanently resident in Victoria, and
- Likely to die within twelve months, and
- Suffering intolerably, and
- Have your prognosis confirmed by a specialist in your illness, and
- Have your prognosis confirmed by a second medical specialist who has been trained in the assisted death programme, and
- Make a declaration of request, and
- Have your declaration witnessed by two people who are not family members or beneficiaries of your estate, and
- Request assistance a third time, and
- Agree that you understand you can withdraw your request at any time, and
- Have your case reviewed by a specially convened oversight panel, and
- Wait a minimum of 10 days for the drug dispensing authority, and
- Be capable of self-administering the medication, or have access to a doctor who is willing to administer it for you.
It’s a lot to get through before you get your dose; and if you lose the capacity to self-administer in the meantime, you have to return it.
The Current Situation
While Victorians do not have the right to end their own lives, it’s no longer a crime to do so. It is, and will remain a crime to incite or assist suicide. In fact, the Crimes Act 1958 permits us to use reasonable force to prevent suicide, though I am not sure that it obliges us to do so. But not preventing a suicide is in effect assisting suicide…
The Coroners Court of Victoria submitted to the inquiry, that 8% (240) of the suicides between January 2009 and December 2013 were by people experiencing an irreversible decline in physical health, caused by disease or injury. Of those deaths, 31% (74) were by poison, 27% (64) by hanging, and 14% (34) by firearms.
Some suicides achieve their goals, and others make the situation worse for themselves and others. This is a particular fear of the people this legislation could benefit.
The overall goal of the inquiry/recommendations/legislation is to create a more holistic patient-centred end of life experience, and assisted death is only part of the suite of recommendations. It also includes relevant and needed reforms like:
- Adequate resourcing to care for those who do not wish to avail themselves of an early exit.
- Adequate resourcing for respite care.
- Extending the palliative care approach to patients with chronic conditions.
- Improving palliative care for the elderly residents in care facilities.
- Updating regulations for home storage of medication to eliminate barriers to pain management.
- Smoothing the way for people to die in their own homes.
- Updating the legal status of advanced care directives (e.g., do not resuscitate).
- Recommending changes to Medicare Benefits Scheme funding codes to permit earlier access to palliative care planning and access.
- Trigger points for end of life care discussions (e.g. residential care entry, of 75th birthday).
- Integrating end of life care into a whole of life care approach.
There is no doubt that different people feel things differently. Some:
- Are terrified of spiders, and others of dentists.
- Never get over their first love, some never find them.
- Men can’t face a prostate exam, others book in for vasectomies with no qualms.
- Women feel losing a breast reduces them while others just get both lopped off and move on.
When faced with a long and painful death we will all have different responses too. Some will prefer a quick and clean exit that minimises the suffering of all, others will want to abide by the destiny they believe their God has given them.
When I knew my peritoneal dialysis was failing I decided that when it was no longer sustainable I would refuse further treatment. With my decision certified, it would become illegal for a practitioner to force me to take treatment for kidney failure, though palliative care like pain relief is still permitted. Fortunately for me, a cadaver kidney became available before I reached that point. I can’t say what I would do now – hopefully I’ll have decades to decide on that one.
I think that whatever you prefer, you should have the right to choose it. You shouldn’t have to take poison when no one is looking in case you accidentally make your family culpable for your death. While it isn’t clear at this stage whether you can self-administer with your family present, or what their obligations are in this circumstance, it is nice to imagine a peaceful transition, surrounded by a loving family. However that comes about.
What do you want for your end of life scenario?