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Victoria’s assisted dying legislation: how it would work


Supporters of voluntary assisted dying are becoming increasingly convinced that they have the numbers to pass a controversial bill currently before the Victorian parliament.

The bill, to be debated next week, would make Victoria the first state to legislate for voluntary euthanasia in Australia if successful. But other states are not far behind: New South Wales has introduced draft legislation into parliament, and Western Australia has set up a joint select committee on end-of-life choices, due to report next year. In South Australia, voluntary euthanasia legislation was knocked back last year by a single vote.

But the momentum may have shifted since then, and Victorian Labor MPs, who are supportive of the legislation, think they may be able to peel off enough Nationals MPs to score a victory.

The legislation, which Victorian premier Daniel Andrews says is more conservative than any other current euthanasia laws currently in force across the globe, would allow terminally ill patients access to lethal medication within 10 days of a request, following a three-step process involving two independent medical assessments. The legislation covers patients who are considered to have a life expectancy of less than 12 months.

If legislation passes, there will be an 18-month period to work out how it would be implemented. One issue would be with the Medicare benefits schedule, which explicitly excludes the use of drugs for euthanasia.

Here’s how the Victorian legislation would work:

  • Only the patient can ask for assistance to die, but a doctor can refuse to be involved.
  • The patient can change their mind at any time throughout the process.
  • The clinician decides whether the patient fits the criteria, and can refer to a specialist if in doubt.
  • The doctor must verify that the patient’s request is “voluntary and enduring”.
  • A written declaration must be signed and witnessed by two non-relatives in the presence of the doctor.
  • A final request must be made, at least ten days after the initial request. It is then certified by the doctor.
  • Prescription of the lethal drugs is overseen by the department of health and human services.
  • The patient must take the medication unaided. If physically unable to do so, the doctor must seek an additional permit to assist.
  • If the doctor is administering the medication, another witness must be present.

The proposed NSW legislation is similar, although the age at which a patient can request assisted dying is 25 rather than 18. The NSW bill also requires referral to a psychiatrist. Neither of the proposed state legislations permit assisted dying for people with dementia or mental illness.

Doctors’ medical defence organisation Avant, which recently hosted a forum to explore medicolegal issues with voluntary euthanasia, says that it believes legislation will eventually be passed in one state or another, but that such legislation will pose a number of questions about how a scheme would work. These include:

  • How to determine eligibility;
  • How a treating doctor would negotiate a decision not to participate;
  • How to identify and refer to another practitioner for a second opinion;
  • How to ensure privacy and security of information;
  • How to manage assisting healthcare providers’ distress;
  • How to manage potential liability in a number of scenarios.

Six US states currently allow some form of voluntary euthanasia, as does Canada. In Europe, Switzerland, the Netherlands, Belgium and Luxembourg all have euthanasia laws.

The AMA, in its position statement, has maintained its opposition to physician-assisted euthanasia.

In places where it’s legal, how many people are ending their lives using euthanasia?

The Victorian Parliament will consider a bill to legalise euthanasia in the second half of 2017. That follows the South Australian Parliament’s decision to knock back a voluntary euthanasia bill late last year, and the issue has also cropped up in the run-up to the March 11 Western Australian election. The Conversation

With the issue back in the headlines, federal Labor’s justice spokesperson, Clare O’Neil, told Q&A that in countries where the practice is legal, “very, very small” numbers of people use the laws.

Whether or not you agree with O’Neil’s statement depends largely on your interpretation of the subjective term “very, very small”, but there is a growing body of data available on how many people are using euthanasia or assisted dying laws in places such as the Netherlands, Belgium, Luxembourg, Colombia, Canada and some US states.

Assisted dying, assisted suicide and euthanasia

Many people use the terms “assisted dying”, “assisted suicide” and “euthanasia” interchangeably. But, technically, these phrases can have different meanings.

Assisted dying (sometimes also assisted death) is where the patient himself or herself ultimately takes the medication. Euthanasia, by contrast, is usually where the doctor administers the medication to the patient.

Assisted suicide includes people who are not terminally ill, but who are being helped to commit suicide, whereas assisted dying refers to people who are already dying. Some reports do not, however, distinguish between assisted dying and assisted suicide, and I will not distinguish them here.

In some jurisdictions, the word “euthanasia” is used to refer to both assisted dying/suicide (where the patient himself or herself takes the medication) and to euthanasia (where the doctor administers the medication to the patient). So “euthanasia” can sometimes be used as a broad term to cover a range of actions.

Euthanasia and assisted suicide rates around the world

According to a peer-reviewed paper published last year in the respected journal JAMA:

Between 0.3% to 4.6% of all deaths are reported as euthanasia or physician-assisted suicide in jurisdictions where they are legal. The frequency of these deaths increased after legalization … Euthanasia and physician-assisted suicide are increasingly being legalized, remain relatively rare, and primarily involve patients with cancer. Existing data do not indicate widespread abuse of these practices.

The authors of that paper said that 35,598 people died in Oregon in 2015. Of these deaths, 132, or 0.39%, were reported as physician-assisted suicides. The same paper said that in Washington in 2015 there were 166 reported cases of physician-assisted suicide (equating to 0.32% of all deaths in Washington in that year).

Interestingly, the same paper noted that US data show that:

pain is not the main motivation for PAS (physician-assisted suicide)… The dominant motives are loss of autonomy and dignity and being less able to enjoy life’s activities.

The authors said that in officially reported Belgian cases, pain was the reason for euthanasia in about half of cases. Loss of dignity is mentioned as a reason for 61% of cases in the Netherlands and 52% in Belgium.

A 2016 Victorian parliamentary report has quoted from the UK Commission on Assisted Dying, which in turn referenced the work of John Griffiths, Heleen Weyers and Maurice Adams in their book Euthanasia and Law in Europe. The commission said:

There are no official data in Switzerland on the numbers of assisted suicides that take place each year, as the rate of assisted suicide is not collected centrally. Griffiths et al observe that there are approximately 62,000 deaths in Switzerland each year and academic studies suggest that between 0.3% and 0.4% of these are assisted suicides. This figure increases to 0.5% of all deaths if suicide tourism is included (assisted suicides that involve non‑Swiss nationals).

Around 3.7% of deaths in the Netherlands in 2015 were due to euthanasia. The Netherlands’ regional euthanasia review committees reported that there were 5,516 deaths due to euthanasia in 2015. That is out of a total of around 147,000 – 148,000 deaths in the Netherlands that year.

This figure represents an increase of 4% of deaths due to euthanasia compared to 2014.

A 2012 paper published in The Lancet reported on the results of nationwide surveys on euthanasia in the Netherlands in 1995, 2001, 2005 and 2010. The researchers said:

In 2002, the euthanasia act came into effect in the Netherlands, which was followed by a slight decrease in the euthanasia frequency … In 2010, of all deaths in the Netherlands, 2.8% were the result of euthanasia. This rate is higher than the 1.7% in 2005, but comparable with those in 2001 and 1995.

Another Netherlands-based study published in the journal JAMA Internal Medicine reported in 2015 that:

Certainly, not all requests are granted; studies conducted between 1990 and 2011 report rates of granting requests between 32% and 45%.

A 2015 paper in the New England Journal of Medicine about euthanasia rates in the Flanders region of Belgium (the northern half of the country) noted:

The rate of euthanasia increased significantly between 2007 and 2013, from 1.9% to 4.6% of deaths.

Filling in the bigger picture

It can be hard to put these rates in context, but what is clear is that euthanasia is by no means a leading cause of death in countries where it is legal. For example, Statistics Belgium said that for the year 2012, cardiovascular disease was the most common cause of death (28.8%), and cancer was the second most common cause of death (26%).

And in the Netherlands – where 5,516 of deaths were due to euthanasia in 2015 – more than 12,000 Dutch people died from the effects of dementia in 2014, approximately 10,000 Dutch people died from lung cancer and nearly 9,000 died from a heart attack. In 2013, 30% (about 42,000) of Dutch deaths were from cancer and 27% (about 38,000) of Dutch deaths were from cardiovascular disease.

If this article has raised issues for you or if you’re concerned about someone you know, call Lifeline on 13 11 44.

Andrew McGee, Senior Lecturer, Faculty of Law, Queensland University of Technology

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