Victoria may soon have assisted dying laws for terminally ill patients

Ben White, Queensland University of Technology and Lindy Willmott, Queensland University of Technology

An independent group of experts set up by the Victorian government has today delivered its final report outlining 66 recommendations for how voluntary assisted dying would work in the state.

Chaired by former head of the Australian Medical Association, Brian Owler, the Ministerial Advisory Panel’s role was to work out how legislation should be drafted to allow terminally ill people to receive assistance to die. The panel based its report on the recommendations of the Parliamentary committee’s Inquiry into end of life choices in December 2016.

Legislation giving effect to the report is likely to be tabled in the Victorian Parliament within a month.

Who does the law cover?

At the heart of debates about assisted dying are eligibility criteria – who can get assistance to die and who cannot. The panel’s recommendations are broadly consistent with the report of the parliamentary committee. Access is allowed for an adult who can make their own decisions, is terminally ill and their suffering cannot be relieved. They must also be a resident of Victoria.

But the panel widens the committee’s earlier recommendation that a person must be “at the end of life (final weeks or months of life)” to be granted their request. Instead, the current report states the “incurable disease, illness or medical condition” must be expected to cause death in no later than 12 months.

While we agree eligibility should be based on a terminal illness, we don’t favour time limits as they are arbitrary and difficult to accurately predict. They can also lead to people taking harmful steps to fall inside them, such as starving themselves.

But the panel’s recommendation to extend the time to 12 months is still a better approach than the committee’s, as it is likely forming a clinical view about prognosis will be more manageable in that time. Providing a set time frame also avoids the uncertainty of the vague use of the phrase “at the end of life”.

Former AMA president, Professor Brian Owler, chaired the Ministerial Advisory Panel.

Also of note is that the panel specifically stated mental illness alone and disability alone will not satisfy eligibility requirements; but nor will they exclude access to voluntary assisted dying.

What assistance can be provided?

This is primarily a physician-assisted dying model, which means the patient is expected to take the lethal dose of medication themselves. This is a narrow approach to assisted dying as it is the person themselves who takes the final step to end life, not the doctor.

The panel’s approach is consistent with the committee’s report – both are broadly along the lines of the US assisted dying model such as the one in Oregon.

There are downsides to this and we favour a more inclusive model (like in Canada or under the European model) that permits assistance to die being directly provided by a doctor as well. This choice better reflects the autonomy that underpins these laws.

But the panel (and the committee) did recommend an exception where the person is physically unable to take the medication or digest it themselves. This may not be used often but helps address potential discrimination, for example on the grounds of physical disability which prevents someone taking the medication themselves.

What safeguards are there?

The panel has proposed a very rigorous process – comprised of 68 safeguards – that involves three separate requests for voluntary assisted dying (one which is witnessed by two independent witnesses) and two independent medical assessments.

A patient seeking assistance to die must be provided with a range of information including about diagnosis and prognosis, treatment options available, palliative care, and the expected outcome and risks of taking the lethal dose of medication. Doctors involved will have to receive special training about the law and how it operates.

Other safeguards are at the systems level, with a Voluntary Assisted Dying Review Board recommended to examine each case and also to report on how the scheme as a whole is operating. The panel has also proposed a range of new offences specifically about voluntary assisted dying to deter conduct outside the scope of the regime, such as an offence against inducing someone to request assisted dying.

Will these recommendations become law?

Strong public opinion, shifting views in the health and medical professions and international trends towards allowing assisted dying mean it will become lawful in Australia at some point. But will it be in Victoria, and soon?

The politics of assisted dying are notoriously fickle and this is the latest of over 50 bills in Australian parliaments addressing this issue over the past two decades.

But as we have argued in the past, features of this law reform effort suggest it could happen. The process of examining the issue has been very careful, inclusive and thoughtful with multiple reports and engagement with expert opinion and national and international evidence.

This is a narrow assisted dying model with a lot of safeguards. There is also high level and public support of senior politicians on both sides of politics. But as always, the ultimate test is what happens on the floor of parliament.

Ben White, Professor of Law and Director, Australian Centre for Health Law Research, Queensland University of Technology and Lindy Willmott, Professor of Law, Queensland University of Technology

This article was originally published on The Conversation. Read the original article.

Euthanasia bill unexpectedly defeated in South Australia

In a surprise victory for pro-life advocates, South Australia’s Upper House has narrowly voted down an amendment to their palliative care legislation that would have legalized euthanasia, reports Patrick B. Craine, LifeSiteNews.com.

The bill was proposed by Greens member Mark Parnell. It was expected to pass 11-10, with the support of independent member Ann Bressington, the swing vote. Bressington opted to abstain, however, after amendments she had sought failed. This abstention would have resulted in a tie, meaning that Upper House President Bob Sneath would vote to pass the bill.

In the end, however, member David Ridway announced to the shock of pro-life observers that personal reasons had led him to change his mind, and he voted against the bill.

Parnell has stated his intention to make another attempt at legalizing euthanasia after the state elections in March 2010. With the upcoming retirement of two pro-life members, pro-life advocates have indicated that such an attempt has a real risk of succeeding.

The UK-based anti-euthanasia group SPUC Pro-Life called the vote "a victory for civilised values."

Anthony Ozimic, SPUC’s communications manager and an expatriate Australian, stated: "Those seeking to develop civilised values which respect the sanctity of human life should be encouraged by this vote.

"In spite of all the money, media support and propaganda of the euthanasia lobby, many politicians recognise the dangers to public safety in introducing such legislation. This victory for civilised values joins the recent defeat of a similar bill in Tasmania, as well as the repeated votes by the British House of Lords against assisted suicide."

Report from the Christian Telegraph 

Police raid offices of assisted suicide organization in Melbourne

Police raided the Melbourne offices of the assisted-suicide advocacy organization Exit International last Thursday, seizing documents related to the alleged assisted suicide of Exit International member Frank Ward. In response to this and to the raid of another Exit International member’s home, Exit International has told its 4,000 members to be wary not to attract police activity, reports James Tillman, LifeSiteNews.com.

"We haven’t had any incidents like this for a long time," said Dr. Philip Nitschke, head of Exit International.

The raid highlights the dubious legal status of Exit International’s activities. Because assisting or even encouraging suicide is illegal in Australia, Exit International bills its workshops, books, suicide equipment, and all its activities as merely providing people with knowledge and equipment to allow them to do what they want, not as actually assisting them in the act of suicide. According to Nitschke, such was the extent of Exit International’s contact with Ward.

"[Police] were suggesting we were involved in his death but we were not," Nitschke told Television New Zealand. "We would never be actively involved in something like that, helping him end his life, which would be committing a crime."

According to Alex Schadenberg, executive director of the Euthanasia Prevention Coalition, such protestations of innocence are dubious.

"I think that this raid is long-overdue," he told LifeSiteNews.com (LSN). "Nitschke has been skirting the law for many years."

Frank Ward killed himself last June by inhaling helium, which causes asphyxia. This method of suicide is among those promoted by Dr. Nitschke. Schadenberg described to LSN how at a Right-to-Die Conference he saw Nitschke demonstrate "how a device that he claimed to have invented would regulate the flow of gas to ensure that … the act would result in their death."

"Nitschke was not concerned that he was aiding suicide by knowingly selling a device to ensure the success of a suicide."

A widespread dissemination of information on how to kill oneself, however, is precisely what Nitschke desires. In an interview

with National Review he said that someone needs to provide the knowledge of how to kill oneself "to anyone who wants it, including the depressed, the elderly bereaved, [and] the troubled teen."

"If we are to remain consistent and we believe that the individual has the right to dispose of their life, we should not erect artificial barriers in the way of sub-groups who don’t meet our criteria," he said.

The second raid on Thursday was directly related to this desire of Nitschke. Police came to the home of an elderly Exit International member in Sydney to search for the euthanasia drug Nembutal and information concerning its acquisition. They left with a small quantity of the drug and the "Peaceful Pill Handbook," a book by Nitschke and a co-author on how to kill oneself that was banned by the Australian government.

Nembutal is used by veterinarians to euthanize animals, and is tightly controlled in most places around the world. Nitschke’s organization, however, has striven to make it available to as many people as possible.

"Last year Nitschke was encouraging people to order Nembutal by mail order from a source that he had discovered," Schadenberg said. "Once again, he wasn’t concerned that people with chronic depression would access this information to kill themselves." Members of Exit International also travel to Mexico to buy the drug, where it is easily obtained.

Nitschke explained that because of the raids Exit Internatonal had sent an alert to its 4,000 members “warning them about the fact that … people should be very careful if they’ve gone to great lengths to get these drugs so that they don’t find themselves subject of any form of police activity”

Schadenberg, however, thinks it high time that such activity began in earnest.

"It is simply about time that his offices were investigated, especially now that he has set up an office in Bellingham, Washington state, where he intends to launch his group into the United States,” he said.

“He intends to grow his group Exit International and he is doing this through his recent series of speaking engagements throughout the United States, Britain and Canada."

Report from the Christian Telegraph