Voluntary Assisted Dying

18 Oct 2017

Mr MORRIS — The debate on the Voluntary Assisted Dying Bill 2017 is not unprecedented; it is certainly unusual. It is a significant event in the life of this Parliament, and if the bill passes, it will be a significant event in the history of the state. 

For some members this is an opportunity to see how a Westminster Parliament is actually supposed to work. It is the first opportunity to see legislation genuinely debated. Perhaps for a couple of days the words of one member may in fact be influential in determining how another member casts their vote.

But as one who has been here before, these are not easy debates and we are not making easy decisions. It does rekindle, however, one’s faith in the institution of the Parliament to see it working the way it has been.

Some see this as a bill that should not be before the Parliament — that the government did not foreshadow the legislation prior to the election, so it should not pass. True — it was not part of the Labor platform and it was not foreshadowed in any of the statements from the Premier as opposition leader, nor from the then shadow Minister for Health.


I do not argue that this is not a government bill, because clearly it is. It is not, however, a bill that will be forced through the house through the application of government votes.


Governments are elected to govern and parliaments are elected to legislate. We have not yet reached the time when the membership of this house is simply a rubber stamp for a pre‑approved and voter‑endorsed legislative program. As Edmund Burke reminded us 233 years ago:


… government and legislation are matters of reason and judgement …

That is why we sit in this house — to exercise our reason, to exercise our judgement, and that is what our electorate sent us here to do.


This is not a bill that has been developed in secret. It is not something that was dreamed up in Lonsdale Street. It has not been developed without the opportunity for extensive public consultation, for extensive public comment. After all, the initial recommendation came from the Legislative Council Standing Committee on Legal and Social Issues, chaired by my colleague the Honourable Edward O’Donohue in the other place.


Since the committee reported, there has been the Ministerial Advisory Panel on Voluntary Assisted Dying, and each in their final reports have indicated the extensive consultation that they undertook as part of their respective processes.


To those of us who are in the chamber today and have been debating the bill, we are all aware what our constituents have been saying. My constituents certainly have not been shy about conveying their views to me, and I welcome that feedback.


Has the process been perfect? Probably not.


If the process were different, would the feedback have been dramatically different? Would the conclusions reached and the bill prepared have been dramatically different? I very much doubt it.


Since the Parliament first sat, since it was formed to serve the colony of Victoria, the advances in medical science have been simply astounding. In the 1850s the average age of death was in the high 40s. It is now in the high 80s and rising rapidly, and that is a remarkable advance.


Many of the ailments that claimed so many young lives are now no more than distant memories. Most conditions are treatable, and — through our universal health system — treated they are.


But under the Australian health system it is left entirely up to the medical professionals to make the final decision about the treatment regimen. Sometimes, to be frank, there is a considerable divergence between the treatment outcomes sought by the patient and that anticipated by the treatment team.


However, advance care planning does give a patient an opportunity to better understand their illness — to understand the treatment options and to clearly state their goals of care. As the standing committee noted, patients with advance care plans are more likely to receive treatment that reflects their wishes and reduces the likelihood of invasive medical interventions, which in turn helps to reduce anxiety for patients and family.


Unfortunately, advance care plans cannot deal satisfactorily with every circumstance. Sometimes despite the capacity to prepare ahead of time and despite the existence of excellent palliative care services — and as we have heard, we can stand to have more of them and a lot more funding for them, but we have excellent palliative care services — patients simply do not wish to confront the pain and confront the suffering that many know await them.

If death is inevitable, then a desire to avoid further unnecessary trauma I think is entirely understandable. But in Victoria in 2017 there is no way legally to avoid the pain and suffering.


The standing committee heard evidence from Mr John Olle of the Coroners Court of Victoria. I want to briefly read to the house some excerpts from the transcript. While he referred to a number of cases, I wish to highlight two.


The first individual is a 59‑year‑old man. He had a wife of 38 years, survived by his children and his wife, with whom he shared close and loving relationships.

Mr Olle goes on to talk about him having no mental health history, and to identify the various conditions this gentleman was suffering from.


About two years before his death he underwent a liver resection for confirmed liver metastases and was subsequently treated with chemotherapy. He underwent 22 cycles of treatment —

chemotherapy —


and unfortunately a CT scan performed not long before his death showed evidence of progressive disease with a new liver lesion …

He went to hospital. He had a dry cough, but he indicated that he wanted to go home. He informed his son and his family members that he would rather take his own life than spend his life dying in bed. The quote goes on:


He was well aware of his suffering and what was ahead of him. So he would rather die than stay in a ward. Ultimately he was observed by a motorist on a major freeway in Victoria hanging from a bridge. A note indicated his intention to take his own life.

The second case that Mr Olle referred to was:


… a 90‑year‑old man, survived by his family, again with whom he shared close, loving relationships. He was described as a delightful gentleman. He was extremely fit for his age and a proficient iPad user. He had no documented mental health history. A very lengthy history included back pain, chronic obstructive pulmonary disease, asbestos exposure and the like. Not long before his death he was diagnosed with a solitary brain metastasis in a setting of metastatic melanoma. He expressed his wishes very clearly to his treating clinicians; he did not wish to have any invasive procedure done. His main priority was quality of life.

He then went through a circumstance where he lost 6 kilos in four weeks. He had a poor appetite, became dehydrated and had diarrhoea. He was diagnosed with viral gastroenteritis, and fluids were applied for rehydration. Ultimately he was discharged into the care of his grandson.

The family explained that when he learned of his cancer he went downhill emotionally. He was depressed and angry that there was no cure. He often told his family he would rather do something to end it straightaway and that if he could no longer drive, he might as well be dead. He mentioned a nail gun. He was subsequently found dying with nail gun wounds to his head and to his chest. He died ultimately from the injuries sustained from the nail gun.

The current system is not okay!


No‑one should have to end their life hanging from a bridge. No‑one should have to turn their nail gun on themselves. Yet that is the reality. That is what is happening in Victoria in 2017, and in my view it needs to change.


Perhaps it is no surprise, but given the deeply held views on both sides of this debate, language has assumed an unaccustomed prominence. The words used and the message conveyed do matter.


The short title of this bill is the Voluntary Assisted Dying Bill. Despite some views to the contrary, that is an accurate description of the legislative framework that is proposed.


Voluntary assisted dying is defined in the bill. The definition is clear, it is unambiguous and it is readily understood by the Victorian community. Yet two words have dominated this debate — more outside the chamber than in — and they are ‘suicide’ and ‘euthanasia’. They are frequently used by opponents of the bill. Neither accurately describes the framework proposed by the bill.


Let me address euthanasia first. The Oxford English Dictionary defines euthanasia as:


The painless killing of a patient suffering from an incurable and painful disease or in an irreversible coma.

Euthanasia is state‑sanctioned killing. The decision is made not by an individual but by a third party. With respect, this bill is not about killing patients.


The use of the word ‘suicide’ is more contentious, and it goes to what is, for me, one of the central issues of this debate. The dictionary definition is of course the action of killing oneself intentionally. That is a black‑and‑white definition — a definition that takes no account of circumstances.


But life is not black and white; there are nuances, and there are shades of grey. If we as legislators fail to recognise those nuances — if we fail to reflect them in the laws that we pass — then the courts will develop those nuances and insert them in the law for us through precedents, and they will probably not do so in a way that is acceptable to us.

I freely concede that the bill will allow terminally ill patients — and I stress terminally ill — with months to live, patients facing unimaginable pain and suffering, to determine for themselves the timing of their departure from the world.


That is a vastly different circumstance to a physically healthy person deciding to end their own life. It is a vastly different circumstance.


If the bill actually proposed a legal framework for suicide — suicide on demand, as some people have characterised it — then I would dismiss the bill out of hand. But that is not what is proposed.


What is proposed is that terminally ill patients — patients who will, without question, die within months, potentially suffer enormous pain and suffer undoubted indignities — be given the choice to depart this world on their own terms and in their own time.


Should the bill pass the second‑reading stage there will be ample opportunity to consider the minutiae, but in this debate I think there is one central decision to be made: to what extent does the Parliament believe an individual should be able to determine their own destiny?


I believe in freedom of the individual. I believe in freedom of religion, freedom of speech, free assembly, freedom of the press and, of course, free markets. I also believe that it is not tenable to claim to support individual freedoms and then to presume to impose through the law your own moral and ethical code. Those are matters for the individual, not for the Parliament.


Paternalism once had its place in this state. The Parliament determined when people could shop, who they could sleep with and many other things. But those days are gone, and those laws are gone. They have now been gone for a very long time.


So too should the time when the Parliament presumes to say to a terminally ill citizen, ‘We know best how your final days will be spent’. Those days should be gone.


I want to briefly refer to the reasoned amendment. There has been a suggestion that supporting the reasoned amendment will allow debate to be stalled for a few months and allow the bill to come back. That is false. The fact sheet from the Legislative Assembly makes that very clear.


Let no‑one who is not experienced in this Parliament think that is the case. If you vote for the reasoned amendment, the bill is gone, the bill is dead.


I repeat that paternalism has no place in this state. It is no longer acceptable for the Parliament to say to a terminally ill citizen, ‘We know best’. It is no longer acceptable for Victorian citizens to have to hang themselves from a bridge or turn their nail gun on themselves because that is the only option. The bill is not perfect — I think we all concede that — but it is certainly better than what we have got.


I commend the bill to the house.