The detailed proposals for a Victorian assisted dying law for people with advanced and incurable illnesses are cautious, and that is deliberate. More than 40 similar proposals have failed in various states since the Northern Territory’s short-lived laws were overturned by the federal parliament in 1997.
New South Wales is also considering a bill to legalise voluntary assisted dying, but Victoria has had a lengthy, even laborious process. Critically, it is a government-sponsored process. Professor Brian Owler, a former head of the Australian Medical Association and the chairman of the expert panel which released its report on Friday, delivered his recommendations to the health minister, Jill Hennessy.
This will not be a hopeful private members bill, as is routine. This will be a government bill, which Hennessy expects the parliament to debate by the end of the year. MPs will have a conscience vote, although Greens policy is to back voluntary euthanasia laws. If it does pass, it is likely to influence other states, after decades of resistance from opponents.
Between 70% and 80% of Australians have made clear in opinion polls they support the right of a terminally ill person to request assistance to die at a time of their choosing. That is fine in principle, but it will be the details that matter.
Even those who support the idea in theory have concerns about making sure there are rigorous safeguards to ensure laws are not abused. Owler and his fellow panellists – including palliative care specialists and disability advocates – have fleshed out those details in clear and careful language.
Owler says the proposed model is “unique, it is distinctly Victoria”, although attention has been paid to other jurisdictions. Six American states, Canada and European countries such as Belgium and the Netherlands have some form of voluntary assisted dying.
Owler asserts the Victoria scheme would be the most conservative regime in the world. He acknowledges it is closest to the American state of Oregon, which has had two decades of legal assisted dying.
To be eligible in Victoria, you will have to be at least 18 and of sound mind. You will have to have been “diagnosed with an incurable disease, illness or medical condition” that is advanced and will cause death within 12 months. The European jurisdictions allow assistance for the non-terminally ill and, in limited cases, for children.
You will have to be an “ordinary resident of Victoria” and an Australian citizen or permanent resident, and your condition must be causing suffering that is unacceptable to you. The process has several steps – an initial request to a doctor, an independent assessment by another doctor (one of the doctors is to have expertise in the illness or condition), a written request before witnesses, and a last and final request. Dementia patients will not be able to access the laws, and a person with a mental illness alone will not be eligible.
The Victorian model diverges from Oregon in two key ways. In that state, a person must be suffering a terminal illness and be likely to die within six months, although that timeframe is linked to the health system’s limited provision of hospice care. In Victoria, it’s 12 months.
The Victorian scheme is designed for a doctor to prescribe lethal drugs which the patient would take themselves at a time of their choosing. The idea is to be certain that the process is voluntary. But it will also authorise a doctor to administer a lethal direction directly in cases where a person cannot self-administer, for instance, for a person suffering motor neurone disease.
The American states allow for self-administration only, and outlaw lethal injection. The Victorian report justifies its approach by saying that people who cannot take the drugs themselves should not be discriminated against.
Owler says the claim that this would be the most conservative law is based on 68 safeguards. They are certainly extensive. There will be a statutory body, the voluntary assisted dying review board, to oversee the framework and review every case. Doctors will need training in their obligations before being involved. New criminal laws are suggested, such as to outlaw coercing a person to seek assisted dying, or falsifying records.
There are many hoops to go through for someone to use this law – no doubt too many for those who believe people should have more autonomy over the way they die. But this is contentious legislation, and caution seems justified.
If Victoria does pass this law, terminally ill people from other states will not be able to use it. A doctor will assess whether someone is a Victorian, using such indicators as whether they have a local driver’s licence or are enrolled to vote. But Owler acknowledges that people could move to Victoria in the months before their deaths.
He also knows that “some will be very critical of our recommendations. For some they don’t go far enough, for others, they should not exist at all”. Hennessy, who supports voluntary assisted dying laws, said she hoped for a respectful debate. It was not an ideological issue, she said, but a deeply personal one.
But it is an emotional issue, with many religious groups and medical organisations vehemently opposed in principle. The report, at least, answers the questions about how this law would operate. So now at least, the debate can begin.
