Hansard debates

Mr WATT (Burwood) (17:32:34) — I rise to speak on the Voluntary Assisted Dying Bill 2017. When I have spoken to people about this particular issue some have said to me that I may not have a personal story. While personal stories are not necessarily the reason why I make a decision in what I do in this place, I certainly want to place on the record some of my personal stories.

People in this chamber will know that I have talked previously about a staff member of mine, Irene, who passed away from ovarian cancer two and a half years ago. It was an extremely distressing and emotional time for me, and I have spoken about her in this house previously. Actually, this is the first time that I have been able to speak about Irene here and not have great difficulty talking about it. Irene at the end of her life was involved in palliative care, so I had some understanding of palliative care.

Also a very dear friend of mine passed away last year. He had cancer as well. Yesterday I had a conversation with my uncle who does not have that long. He is involved in palliative care because it is not going to be long before he is not going to be with us. He is not in Victoria but my understanding is that he would probably qualify under this legislation. I raise those three examples only to put on record that I do have some understanding of the end of life and the process that people go through.

Before I start my contribution more generally I want to talk about a ride-along that I did with Eastern Palliative Care. I have an enormous amount of respect for people who work in the palliative care sector, particularly those at Eastern Palliative Care, who do an amazing job. I want to thank them for the conversations I had and for the ability to go out and see people who are using their service. I thank Kathryn particularly at Eastern Palliative Care but also all the workers there for the work they do.

I put that on record because I have some serious concerns about the bill. I have some serious concerns about a bill called the Voluntary Assisted Dying Bill 2017. I have concerns with the title, and I have concerns with parts of the bill.

At the heart of this bill is the provision for a public servant employed in the Department of Health and Human Services by the state of Victoria to issue suicide permits specifying the name of the person authorised to commit suicide. The permit will also specify the particular poison, drug of dependence or controlled substances to be used. In a fashion reminiscent of George Orwell's 1984, the government-issued suicide permits are called voluntary assisted dying self-administration permits. With the tendency to reduce everything to acronyms these are likely to be called VADSAPs. This acronym would be more accurately expanded to mean Victorian authorisation to die by suicide and poisoning.

I thought up until now that those in this chamber would have supported the government's Victorian Suicide Prevention Framework 2016–25, or at least supported its goals. In the foreword to the framework, the Minister for Mental Health states that it is:

… a whole-of government commitment to reducing suicide and suicidal behaviour, and a coordinated strategy that will help to save lives.

…

We know that suicide is complex but preventable. Through the Victorian suicide prevention framework, we will be working to save one life every day.

The bill before us is based on a completely opposite approach to suicide that denies that suicide is preventable. Rather than the government working with the community to save one life every day, some public servants will be busy processing VADSAPs to give the thumbs down to some Victorians by approving their suicides.

So now we have the government deciding whose life is worth living. Will assisted suicides under this bill be counted or not counted in Victoria's suicide statistics? Will the government claim to have achieved a reduction in suicides simply by not including assisted suicides in the count? How shabby would that be?

Suicide is contagious. Since the publication in 1774 of Goethe's novel about the suicide of a young man disappointed in love, we have known about the Werther effect. Reporting the details of suicide methods, romanticising suicide or presenting it as rational or inevitable all lead to an increase in the suicide rate. A study by David Albert Jones and David Paton published in the Southern Medical Journal in 2015 demonstrated that legalising assisted suicide was associated with a 6.3 per cent increase in total suicides and a 14.5 per cent increase in suicides in those over the age of 65. Is this what we want for Victoria?

In her second-reading speech on this bill the Minister for Health referred to the harrowing stories of many Victorians taking their own lives in painful, lonely and unacceptable ways. She claimed that evidence from the coroner indicated that one terminally ill Victorian was taking their life each week. These claims need to be carefully scrutinised. Firstly, the study from which the coroner presented evidence was of 240 Victorians who committed suicide between 2009 and 2013. This group was selected based on having an irreversible deterioration in physical health due to illness or injury. Of those people, 54 had chronic health issues from injuries; 56 had deteriorating health from illness but were not terminally ill; and nine had chronic pain from an illness that was not terminal. Of the remaining 121 with cancer or degenerative brain disorders, it is unclear how many had a prognosis of 12 months or less to live at the time of their suicide. So perhaps 24 suicides per year were of terminally ill Victorians. The Minister for Health should be careful about her facts on such an important issue. She has at least doubled the numbers in her count.

More significant than the numbers, though, is the question of whether these tragic suicides were entirely unavoidable. Coroner John Olle claimed in evidence to the end-of-life choices inquiry that the only assistance that could be offered was to meet their wishes, not prolong their life. However, Dr Jeremy Dwyer, manager of the coroners prevention unit which actually conducted the study, acknowledged that earlier and different treatment might have made a difference. Looking in detail at the five case studies presented by the Coroners Court in its initial submission to the inquiry is quite revealing. Four of them mentioned factors independent of physical health issues that could have been a motive for suicide. If these factors had been identified and addressed, the suicidal ideation may have been managed and the tragic suicides prevented.

In case 2 a young man with quadriplegia is said to have suffered depression and anxiety in addition to his numerous physical concerns. Was he given the proper psychiatric help with these mental health issues? A major concern with the bill is that it does not require any referral for assessment and help with depression. In case 3 an elderly widowed lady lived alone and was socially isolated. She lamented to a neighbour her inability to read due to a loss of vision. Those who love reading can understand the distress that the lonely lady felt. But did anybody introduce her to talking books? Perhaps something as simple as that may have helped. Did anybody address her loneliness? Did anybody encourage her adult children to visit her more frequently? Tragically, this woman cut her wrists and bled to death alone. What is this bill offering her? Not talking books or companionship to deal with her loneliness. No, just a VADSAP and an official permit from the state of Victoria saying: 'We agree your life is miserable and you would be better off dead'.

This bill authorises you to pick up a bottle of poison, go to your lonely home, swallow the poison and die alone. Perhaps, like 8.1 per cent of people in Oregon, this poor lady might have trouble swallowing the poison or regurgitate it. Or, like some people in Oregon, she might go into a coma and wake up alone as long as 3 days and 16 hours later. Is this the best the Minister for Health has to offer?

I seek leave to extend.

Leave granted.

Mr WATT — In case 4 an elderly man suffered depression and expressed resentment about his inability to pursue his hobbies. In nine out of 10 cases of assisted suicide in Oregon, one reason given for requesting suicide was that the person was less able to engage in activities that make life enjoyable. We all have hobbies of one sort or another that we enjoy. As we become old or sick we may not be able to participate in them as easily or perhaps at all. Is that a reason for the state of Victoria to authorise suicide by poison? If so, what message is this giving to a young sports player who suffers an injury resulting in quadriplegia or some other serious injury that puts an end to their career in a particular sport? Is it that you might as well commit suicide now that you cannot play football or basketball? The message in the suicide prevention framework is more positive. It is to restore hope or belief that every life is worth living. Was the elderly man referred to psychiatric help with his depression? Did an occupational therapist explore with him new hobbies that he might be able to enjoy?

In case 5 a man with a spinal injury from a workplace injury struggled with unemployment, obesity and a strained relationship with his family. He needed better pain management, help to find meaningful work, nutritional advice and perhaps family therapy. He did not need approval by the state of Victoria for his tragic decision to commit suicide. In all four of these cases the person expressed suicidal ideation to family, neighbours or a doctor or had already attempted suicide. It is not clear that in any of these cases appropriate action was initiated to respond to this disclosure.

I personally find it distressing that the Minister for Health is using 240 tragic deaths by suicide between 2009 and 2013 of Victorians suffering deteriorating physical health to justify offering Victorians state-approved assisted suicide by lethal drugs.

In my view these tragic, avoidable suicides should prompt us to work harder and smarter to address the underlying issues that lead to them. We should ensure all Victorians have equitable access to gold-standard palliative care. We should improve early intervention for people suffering chronic pain to ensure that best practice pain management is provided. We should train doctors to better identify depression and other mental health issues in persons with deteriorating physical health and refer to psychiatric specialists for appropriate treatment. We should ensure that appropriate follow-up, in accordance with the Victorian suicide prevention framework for 2016 to 2025, be given to all people who attempt suicide, including those with deteriorating physical health.

We should continue community campaigns such as R U OK? Day to broaden community knowledge of mental health issues, including suicidal ideation, and increase the likelihood that persons who express suicide ideation to family members or neighbours will be given appropriate and timely expert help.

Finally, we should reaffirm that the Victorian suicide prevention framework for 2016 to 2025 applies to all Victorians, including those with physical health issues due to illness, disability or injury.

We should consider adding 'people with deteriorating physical health' as a particular risk category in the next revision of the framework. It would be appalling if the Victorian Parliament affirmed the counsel of despair, offered by the coroner and apparently endorsed by the health minister, that Victorians suffering from depression, anxiety, social isolation, strained family relationships or disability such as loss of vision or mobility are inevitably going to commit suicide and the best way to do this is with a voluntary assisted dying self-administration permit and a bottle of poison. We can and must do better than that.

I hope that you will join with me in affirming that suicide is not a solution for any Victorian facing distress of any kind by voting against this bill and rejecting the idea of suicide permits for some Victorians.