Voluntary Assisted Dying Bill 2017
The following speech was delivered by Nick Staikos MP, Member for Bentleigh, in the Legislative Assembly on 18 October 2017
Mr Staikos (Bentleigh) — Important moral questions require careful consideration, not just because of the gravity of the impact but also because, as legislators, we will live with the decisions we make for the rest of our lives. For this reason conscience votes are terribly difficult but also terribly important. Like other members of this house I have spent the last few months talking with a lot of people. They include representatives of Palliative Care Victoria and Palliative Care Australia; people like the CEO of Bethlehem Hospital; Professor Brian Owler, who chaired the ministerial advisory panel; and disability advocate Patricia Malowney, another member of the panel; Professor David Copolov, AO, and Associate Professor Steve Ellen, two psychiatrists with significant experience; and Dr Stephen Parnis, the former Victorian president of the Australian Medical Association. I met with local faith leaders, doctors and nurses from Monash Health and other networks and, most importantly, residents of my electorate who had personal experience.
Everyone I met with about this issue is a good person who, regardless of their position on this matter, approaches it from the basis of compassion and love, and I thank them for the respectful way in which they have conducted themselves throughout this process. Throughout my discussions with them I was undecided on the question: should the law allow a person with a terminal illness, where death is imminent and suffering unbearable, to end their life? I have come to the view that it should, for a number of reasons.
Firstly, there is individual choice. The bill is carefully designed so that only the individual concerned, and nobody else, can decide to initiate a request for assisted dying. Indeed the bill makes it an offence, punishable by imprisonment, to induce another person to request voluntary assisted dying. Secondly, palliative care cannot relieve all suffering. It is true to say that our dedicated palliative care specialists and nurses do an amazing job, but it is also true to say that, despite their best efforts, palliative care cannot ease all pain and suffering. I except that it can in the majority of cases, but some people’s deaths have been horrific. Thirdly, awful, violent backyard euthanasia already occurs in Victoria. We have heard many accounts of people taking their own lives in the most horrific of circumstances. I will never forget the report in the Age earlier this month on Robin Collins, who suffered from myelofibrosis. He asked his wife to stay in the house while he went to the backyard and shot himself — blood and body matter scattered on the grass.
The member for Box Hill in his contribution yesterday asked: ‘If Grandpa decides to end his own life, what effect will it have on the grandkids?’ I could not begin to imagine what impact Mr Collins’s very violent end had on his family. A number of members have already spoken of the Collins family’s experience, but I think it bears repeating, because it happens all the time. The coroner has told us that one terminally ill Victorian takes their own life each week. Euthanasia already takes place in this state in an unregulated, unsafe environment.
Opponents of the bill have made a number of claims. One is that palliative care can ease all pain and suffering. That is wrong. Palliative or terminal sedation may be an acceptable end to some, but not to others. As I said, it is about choice. One of the many local residents who came to see me to share personal experiences was Cameron. Cameron’s father-in-law battled lung cancer in 2015. He was given palliative care and he was sedated. Cameron and his ex-wife, Debra, were at the hospital with him while he was sedated. As Cameron said to me, he looked to be in great distress as he died. He struggled to breathe, he was wheezing and his lungs were gurgling. His breathing would stop for a while and then start again with desperate gasps for air. Cameron’s father-in-law did not want his life to end this way, and he should have had another option. Debra never recovered from seeing her father die in this way. She had flashbacks and would often wake screaming from nightmares about it. Debra took her own life last year.
As Cameron has said to me:
The death of a loved one is something that we all have to face at some time in our lives. We all want those we love to die in as painless and comfortable a manner as is possible under the circumstances. Our health system certainly tries to do this; however, the options currently available are sometimes poor. A difficult and distressing death is not something any of us would want for ourselves.
Opponents of the bill also question decision-making capacity and specifically how this is determined. I had a very good meeting recently with two experts, Professor David Copolov, AO, and Associate Professor Steve Ellen. Professor Copolov is a professor of psychiatry at Monash University and the University of Melbourne and formerly a director of the board of the Peter MacCallum Cancer Centre. Associate Professor Ellen, a public psychiatrist and associate professor of psychiatry at the University of Melbourne, has personally been involved with the care of 8000 medically ill patients, many with terminal illness. I will now quote directly from them:
The majority of people with depression retain decision-making capacity; in fact thousands of medical decisions requiring informed consent and capacity are made every day in Australia by people with depression.
The process for assessing capacity is set out in the Mental Health Act and the Medical Treatment Act and in the bill. In summary, the person must understand the decision they are making, be able to weigh the pros and cons, and be able to communicate their decision.
In cases where the clinicians involved with a person requesting VAD have doubt about the decision-making capacity of a person, then an expert opinion should be sought from a medical specialist. This is standard practice in routine clinical care.
If the person fails to fulfil any one of the criteria relating to capacity, then they are not competent to make the decision. Experts are well able to assess a person’s views and opinions, both longstanding and recent, and weigh the impact of the depression and other disorders on the person’s decision-making capacities. Sometimes information is sought from third parties who have known the person from before they were unwell. If in doubt, a second opinion is sought.
In cases where a person with severe depression or other mental illness is assessed to lack capacity, that person should be denied access to VAD, as well as being referred for consideration of treatment, and reassessed if treatment has been provided or if spontaneous improvement has taken place.
Mental illness might affect competence, as can many other illnesses, and so competence must be carefully assessed if in doubt, but the two (mental illness and competence) should not be confused.
That is from two people with more experience in psychiatry than anyone else that I have heard from on this particular issue.
Finally, opponents of the bill refer to the slippery slope, an argument I have never subscribed to — not when it is used on this issue and not when it is used on other moral questions. It is an argument that has not been borne out in the experience in Oregon, where its legislation has been in place unchanged for 20 years. This vote that we will take this week in this house is very important, so important that it is our only bill being debated this week. But it is also important to remember that the vast majority of Victorians will not be directly impacted by this legislation.
In Oregon in 20 years 1749 terminally ill people have been granted prescriptions under the voluntary assisted dying laws in that jurisdiction. However, only 1127 patients have taken the medication. To me that says that only a small number of Victorians will ever go down this path, but many more are comforted in the knowledge that it may be an option if pain and suffering become unbearable. We are human beings after all. It is a natural instinct to survive, to cling to life. People who may qualify for assisted dying under this legislation would not want to be in that position. They would not want to die, but equally they would not want to die in terrible pain and under horrific circumstances. Again it is about choice.
I seek leave to extend my speaking time.
Mr Staikos — I would like to finish off with a personal explanation. I was raised a certain way. I was baptised in the Greek Orthodox church. I attended Catholic schools. I consider myself a practising Christian. When people advocating against voluntary assisted dying came to see me, it was often obvious, yet not readily admitted, that their underlying reason for opposing the legislation was faith based. This was not the case at every meeting, but it certainly was in many. For this I have no criticism. I have never been one to dismiss faith as a way of shaping one’s thinking on questions like this. In fact the bill itself states:
all persons, including health practitioners, have the right to be shown respect for their culture, beliefs, values and personal characteristics.
I took the time throughout this process to speak with local faith leaders from my electorate, and I would like to thank for their time Father Michael Sierakowski, the Reverend Rachel McDougall, the Reverend Dr Julie Hall, Father Panagiotis Zoumboulis, Rabbi Elisha Greenbaum and Rabbi Allison Conyer. Views were mixed amongst this group. Some were in favour and some vehemently opposed, but where I think there is agreement — regardless of denomination, regardless of religion — is that they believe in a God of mercy. That is how I reconcile this issue with my faith — that in one’s final days there can be no greater mercy. I commend the bill to the house.