Voluntary assisted dying

Like everyone else in this house, I will be making a contribution. We cannot be reminded enough of the importance of the decision that we are going to make over the course of this debate today and in the next fortnight. This is an emotional issue and so many of us have experienced the illness, suffering and death of a loved one. All of us, I think, have been in that position. In my own family, we have been no different.

For our family, we were all present at the end of my grandmother's life, when she was in a vulnerable, incapacitated state at home. We were so fortunate that she was able to receive the very best of end-of-life palliative care. That is something our family will forever be grateful for. I know the member for Chaffey in his contribution touched on the importance of that and of witnessing that, as did the member for Davenport and so many others in this place.

I do not think any of us wants to see our family or friends suffer at the end of life, and this is such a difficult debate for so many of us, but we as legislators need to judge the legislation on what is actually printed on the pages before us and what these changes will mean if they become law. We are tasked with legislating for the wellbeing and safety of all South Australians, and we must look at this through that prism of shared values, foundational principles, love and compassion, as I think the member for Wright alluded to so well in his contribution, and how it will impact on our entire state now and into the future, because this bill impacts on each and every one of us.

Paul Keating, former Prime Minister, made some remarks as part of the 2017 Victorian debate. He went on to say: "Once this bill is passed the expectations of patients and families will change. The culture of dying…will gradually permeate into our medical, health, social and institutional arrangements."

He also said: "Opposition to this bill is not about religion. It is about the civilisational ethic that should be at the heart of our secular society…"

In public life it is the principles that matter. They define the norms and values of a society and in this case the principles concern our view of human life itself. It is a mistake for legislators to act on the deeply held emotional concerns of many when that involves crossing a threshold that will affect the entire society in perpetuity.

I believe his words and many of the points he made in those remarks are true in this debate, and that is why we should tread with an abundance of caution as we go through this debate and importantly as we embark on the committee stage where we will be looking at many of the clauses and how they will actually work in practical effect for South Australia should the bill become law.

One of my key passions ever since being in this place—and of course it is National Palliative Care Week—is around the provision of palliative care services in South Australia, and there is always going to be a big interface with palliative care services in end of life and any end-of-life legislation that comes through with it.

According to the AMA: For most patients at the end of life, pain and other causes of suffering can be alleviated through the provision of good quality end of life care, including palliative care that focuses on symptom relief, the prevention of suffering and improvement of quality of life.

The AMA also admits that palliative care 'can vary throughout Australia' and that 'we must ensure that no individual requests euthanasia or physician assisted suicide simply because they are unable to access this care'. When people are dying they need tender loving care and support, and unfortunately we too often fail in this objective. Surely before we embrace euthanasia governments should be doing everything they can to improve palliative care options and access to them, especially in regional South Australia.

This means ensuring adequate resourcing, support for research and development and ensuring our doctors and nurses are more aware of palliative care options for their patients. We know that the majority of South Australians want to die at home surrounded by their families. It means our public health networks need to provide palliative care at home just as the Mary Potter Hospice does through Calvary.
The Australian Institute of Health and Welfare's 2020 report on palliative care services found that South Australia had one palliative medicine physician and 11.3 palliative care nurses per 100,000 people as of 2018. The national standard is two palliative care physicians per 200,000 people. Right now we cannot even meet the minimum threshold for palliative care in this state, and there is much room for improvement in South Australia.

We have heard in many of the contributions that the passing of VAD legislation would give peace of mind to South Australians. I have no doubt that to a certain extent that is true, but I also know that better palliative care will also provide that peace of mind. If we as a parliament are going to progress a VAD bill, it cannot be at the expense of palliative care and see a reduction in those services. In fact, it should spur our desire to do more in that space to ensure that if this VAD legislation is passed, it becomes the absolute last resort option.

That concern about lack of palliative care feeds into some of the other concerns that many have with this bill, including myself, which are around protection for vulnerable people. Right now in debate across Australia we have just had a royal commission into aged care and elder abuse and we have had a royal commission about the abuse of people with disability. This is coming on the back of the failures at Oakden. We have the Ann-Marie Smith case. These are all tragic cases where the state has failed to adequately protect the most vulnerable. Indeed, once again we need to be looking at resources for the most vulnerable, not taking away those choices.

The Australian Medical Association advocates for relevant legislation to 'protect...vulnerable patients—such as those who may be coerced or be susceptible to undue influence, or those who may consider themselves to be a burden to their families, carers or society' if euthanasia is permitted. Labor Senator Pat Dodson remains concerned that Indigenous Australians will be adversely affected, adding to fears and lack of education about medicine and doctors while they continue to battle worse health outcomes.

There are also similar concerns for people for whom English is a second language. I know through my own migrant family background that that is a big concern for many. As the member for Narungga touched on in his contribution, this bill permits the state to become involved in the taking of life, no matter how noble and how much that decision comes from a place of love.

We are having this debate at the same time as we are looking at whole issues around mental health and ensuring that every life matters and that debate is had. As we have seen in the Victorian example, with the passing of the VAD legislation, we have not necessarily seen a reduction in recorded suicides. There quite often has been an argument made that if we have VAD legislation we will not see these sad occurrences happening in terms of people taking their own life.

I believe that if we do not have these important and proper debates around end-of-life care, and the value of supporting someone through all stages of their life, we are sending very much mixed messages throughout our society. We have seen in countries like Belgium and the Netherlands that the initial limitations in those two countries of only allowing euthanasia for the terminally ill has naturally expanded to include other groups of people as legislation has progressed.

Indeed, we have seen that most recently in Canada where VAD was passed. Before that bill was assented to, we already saw amendments being drafted for its further liberalisation. So as we progress this debate into the second reading, it is something that we are very mindful of. It is a natural path for us to ensure that we do have those safeguards in there.

To think that there are strengths in this bill that will ever stop there from being abuse of such legislation is something we should always be very careful of in going down that path. There are certainly many issues that I would like to explore in the debate around the role of practitioners in this in terms of the two-doctor framework. Another matter that I will also be supporting, in terms of the committee stage, is around conscientious objections for institutions. I believe the member for Davenport has already tabled amendments to that extent.

Like all members of parliament, I have received an incredible amount of correspondence from my constituents—those who are strong proponents of VAD legislation and those who share many concerns. I want to thank my community, as many others have indicated, for engaging in this debate in the most respectful manner. For me, the passage of this bill might provide some people with greater end-of-life choice. In its current form, if passed, I believe the bill will expose vulnerable South Australians who cannot even access the very best of palliative care services at the moment.