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.