The subject matter of the event was especially timely, as the state’s new voluntary assisted dying (VAD) legislation sat poised between the two houses of Parliament – it had passed the Legislative Assembly less than a week before, and is due to be debated in the Legislative Council this week.
As emphasised by the forum’s facilitator and Victoria Law Foundation’s Executive Director, Lynne Haultain, the VAD legislation sits at the crossroads of medicine and law, and to accommodate this the night’s panel was made up of a mix of well-credentialed legal and medical professionals.
Representing the medical realm were Steven Amsterdam, a palliative care nurse and author, and Dr Scott King, Clinical Director of Palliative Medicine at Calvary Healthcare Bethlehem. From the legal world were Kathy Wilson, an expert in succession and elder law from Aitken Partners, and Julian Gardner AM, Chair of Mind Australia and former Victorian Public Advocate, who sat on the Ministerial Advisory Panel on Voluntary Assisted Dying.
VAD legislation: Why now?
There were a number of thought-provoking themes that emerged from the night. The first was the question of why this legislation has a chance of success now when assisted dying laws have failed time and again to gain political momentum in Victoria. Julian Gardner put it down to politics – this is the first time assisted dying has been put forward by the government, rather than being proposed in a private member’s bill.
He noted too the persuasiveness of the evidence presented to the Ministerial Advisory Panel:
Existing laws are not being enforced, and mercy killing is not being prosecuted; one person a week commits suicide who might be eligible for VAD; and 1-5% of people suffering from terminal illness can’t be relieved by palliative care.
Another interesting explanation raised was that a generation of Baby Boomers, who tend to value ‘autonomy’ and are used to being in control of their lives, is starting to anticipate end-of-life questions. Having the option to choose VAD, it was argued, can provide a sense of control and comfort, even if the number of people who actually use it is small.
Impact of VAD on healthcare professionals
A good deal of the evening was devoted to the attitude of healthcare professionals in Australia. While support for VAD sits at around 70% of the general population, the level of support is much lower in the medical community.
Haultain teased out the possibility that VAD is in some sort of competition with palliative care. While the panel agreed that the two are not in direct competition, the medical professionals on the panel were concerned that VAD might undermine the work of palliative care specialists. Steven Amsterdam explained that palliative care has a branding problem, in that people in Australia tend to associate it with death, with the palliative care department seen as a place ‘you go to die’. Given we’re a death-averse society, people put off palliative care as long as possible, and Amsterdam raised the concern that VAD might present yet another barrier to getting people into palliative care. Dr King emphasised this point by explaining that palliative care has a much greater acceptance in other parts of the world, such as the UK, and that Australians are very wary by comparison.
Will the vulnerable be protected?
An issue that attracted attention was whether there are sufficient measures in the legislation to protect against coercion of people to end their own lives using the VAD processes. Julian Gardner explained the protections (outlined fully here) and emphasised that taken together, these measures reduce as far as possible the risk of coercion. Kathy Wilson noted that the lack of a definition of coercion in the legislation is a weakness, and that ‘undue influence’ is generally very hard to prove in cases of elder abuse. She noted that:
Doctors need to be aware of the subtle forms that coercion can take when it comes to family members attempting to abuse laws like VAD for personal gain.
Overall, the evening involved an engaging mix of dialogue and education.
Hosting a panel made up of medical and legal professionals allowed for debate on the complexities of an issue that touches on death, autonomy, elder abuse and the repercussions of law reform on both medical professionals and their patients. Opening the discussion up to the general public gave anyone who was interested the opportunity to ask questions and clarify how the proposed laws might impact them and their loved ones.
Victoria Law Foundation is a not-for-profit organisation that provides easy-to-understand information about the laws and legal system to Victorians.
