Bills

Voluntary Assisted Dying Bill

Committee Stage

Debate resumed.

The Hon. K.J. MAHER: I am not going to be supporting this amendment. I fundamentally disagree with it. I think this represents a significant and very fundamental departure from what we have talked about as the Australian model. This issue has been considered and rejected in other states that have implemented voluntary assisted dying, and I think there are very good reasons why the Victorian expert panel, in their deliberations and in their report, and parliaments around Australia have rejected this idea.

Take, for example, residential aged care, which is included in this amendment. There are around 16,000 South Australians who live in residential aged care. It is their home. People who live in residential aged care pay a refundable accommodation deposit, also known as a bond. Almost always they sell their house to essentially move into residential aged care, which becomes their home. It averages $440,000 and ranges up to $1 million to buy into their new home in residential aged care.

Particularly if a couple moves into residential aged care, a surviving partner in that couple after one passes away can live for years, even decades in residential aged care. It becomes their home as much as any other home that you or I might live in. To say that someone should be denied the possibility, if this bill passes, of legal medical intervention in their own home I think is a pretty fundamental departure from what we would consider reasonable.

People would find themselves in their own home unable to access their choice of care and would effectively be told, 'If you want to pursue this, move out of your own home.' In many areas that might not be financially possible. Particularly in areas of limited choice in regional South Australia, that might not even be a possibility to find other suitable care.

The wording of this amendment states that premises in both retirement villages and residential aged care are potentially captured because it refers to premises that are owned or operated by residential aged-care providers, which could be retirement villages, which I think would be even more problematic. But just on the residential aged care, I think it is a significant and fundamental departure from the Australian model. It appears in none of the other jurisdictions in Australia.

I will not go into all of them, but particularly in the Tasmanian debate, this occupied quite a deal of time for Tasmanian parliamentarians, who talked about that not just in aged care but in other hospital services it would be a perverse outcome if someone who had already been accepted and issued a permit in a VAD scheme was then denied other sorts of treatment by a hospital or residential aged-care facility by virtue of availing themselves, if this passed, to what would be a legal intervention. I cannot support something that is such a fundamental departure from what is the Australian model.

The Hon. J.A. DARLEY: For the record, and for the reasons given by the Leader of the Opposition, I will not be supporting this amendment.

The Hon. R.P. WORTLEY: I find this amendment quite appalling, to the fact that we are being asked to support an amendment which would in effect deny someone a service from a service provider for the simple reason that they may choose a process which is legal under the law. If I go to hospital, if I wanted to go to the Calvary hospital and wanted to indicate that I may want to use this legislation to assist my voluntary death, I would find it appalling that they would refuse me entry to that hospital. It is discriminatory; it is an appalling piece of discrimination.

It was not long ago when religious schools would not hire gays. They were very discriminatory, because it was against their religious principles. I fundamentally disagree with this amendment, and I hope it does not get up in this chamber.

The Hon. T.A. FRANKS: I indicate that I will also be quite strongly opposing this amendment. Not only was there a time—and there still is, unfortunately—when religious schools discriminated against both staff and students, there have also been times when hospices have refused to treat those with HIV/AIDS because of their sexuality. I certainly do not believe they should be in receipt of government funding should they do that.

I am also not of the belief that we can fool ourselves that this will not be used to diminish this legislation, and people in their own homes is the example the Hon. Kyam Maher has put quite profoundly and powerfully. It would be far more pervasive than that, but the fact that people in their own homes would not be given the choice to die with dignity is fundamental as to why this amendment should be defeated.

The Hon. D.G.E. HOOD: I will be supporting the amendment. The reason I will be supporting the amendment is encapsulated well by an opinion piece I think members would have seen. It was published in The Advertiser yesterday, I think. It was written by Jim Birch, the chairman of Calvary Health Care in South Australia. In part, he says:

This is why Calvary cannot—and will not participate—in VAD. We do not believe assisting a suffering person to end their own life actually addresses and responds to their suffering. Rather, it ignores and fails to address the complex physical, psychosocial and spiritual causes of a person's suffering at end of life.

If VAD is to be voluntary for the public, then it should be voluntary for clinical staff and medical officers and for the organisations that they work for.

I do not want to overstate this, so I am careful and genuinely do not want to be alarmist about this, but my concern is that if we compel these organisations to do things they do not want to do, ultimately they are going to stop existing—full stop.

These are not-for-profit organisations. They do not exist to make money: they exist to fulfil what they consider to be their mission. In fact, Calvary has a mission statement around its reasons for being, essentially. Something like voluntary assisted dying is so fundamentally against their mission statement that I worry about pushing these organisations into corners they do not want to be in, with the possibility of them just saying, 'Well then, we're not going to do it.'

I urge members to consider that. I think it is a real risk. Here we have the chairman of Calvary coming out and quite emphatically saying that they cannot and will not perform these tasks. So you do wonder what would happen if push comes to shove, and that concerns me.

The Hon. C.M. SCRIVEN: Another aspect to consider is that this amendment, if it were to pass, actually provides those who support voluntary euthanasia and who may want to avail themselves of it with real transparency. They know that if they may want to consider VAD in the future, then they do not go to an organisation such as Calvary.

It may be that organisations such as Calvary lose some of the market share, if I can use that term. Well, so be it. That is the opportunity for people to know; 'Okay, I will choose this organisation's hospital or aged-care facilities because their values align with mine in regard to voluntary assisted dying,' or, 'I will choose that one.'

It will ensure that people know what they are getting into, because they will know that if they go to an organisation such as Calvary and then want access to VAD there will be huge problems. They will not be able to do it, and it is likely to be full of conflict, which I am sure is not something we would want anybody to be experiencing as they are nearing the end of life. They will have transparency knowing this organisation will not provide those services; therefore, they can choose a different organisation. I would have thought that that kind of transparency, that kind of visibility, over what an organisation will or will not provide would only be of benefit to those who are nearing the end of their life.

The Hon. F. PANGALLO: I will point out to the Hon. Russell Wortley as well as the mover of the bill that their comments seem to be at odds with clause 9—Conscientious objection of registered health practitioners. Can the Hon. Kyam Maher tell me: when you refer to a registered health practitioner who has a conscientious objection to voluntary assisted dying, who would you be referring to in that case?

The Hon. K.J. MAHER: I would be referring to a registered health practitioner.

The Hon. F. PANGALLO: But who would they comprise, do you think? Who would have a conscientious objection?

The Hon. K.J. MAHER: I am just trying to find the definition of a registered health practitioner. A registered health practitioner means:

a person registered under the Health Practitioner Regulation National Law [Act 2009] to practise a health profession (other than as a student);

That national law says a registered health practitioner means an individual who:

(a) is registered under this Law to practise a health profession, other than as a student; or

(b) holds non-practising registration under this Law in a health profession.

These individuals are health practitioners who provide health services to patients. I think the Hon. Frank Pangallo said—and I agree with him—that the health practitioner at their work should be well covered, and they should be. It is the express intention and effect of the next section, clause 9 of this bill, that no individual should be compelled to be involved in any part of the voluntary assisted dying act. They should not be compelled to be a coordinating medical practitioner. They should not be compelled to be a consulting medical practitioner.

No registered health practitioner should be required to take part in what is entailed in the Voluntary Assisted Dying Bill, and that is exactly what clause 9 does. What it does not do is take away that voluntary aspect. It does not take away the ability of the health practitioner who does wish to be involved in that. It is that choice that I think is fundamentally taken away not just from health practitioners but, more importantly, from patients, from someone who, as I said, is living in their own home.

I received a message, and I think I may have accidentally misspoken when I said the number of people in aged-care facilities is 16 in South Australia. I meant to say 16,000. It is a massive number of South Australians whose choice will be taken away.

The Hon. S.G. WADE: Just to elaborate on the comment the Hon. Kyam Maher is making, I think it is important to understand that registered health practitioners here are much more than the medical practitioners who are involved in the process. The Australian Health Practitioners Regulatory Authority (AHPRA) is the body that registers health professionals in Australia. I think about 13 professions are registered. Some of them one would not expect to be involved in the end-of-life journey, but many you would.

Let me mention a few that might well be involved: Aboriginal and Torres Strait Islander health practice, medical—and medical would also include psychiatric—nursing and midwifery, occupational therapy, pharmacy, physiotherapy, psychology. The Hon. Kyam Maher's bill puts forward a provision which does not have a limited provision of conscientious objection; it is actually quite inclusive. By way of contrast, we only recently considered the Termination of Pregnancy Bill. My memory might fail me, but my recollection is that we had quite a narrow scope for those who could claim conscientious objection. In terms of registered health practitioners, it is not only medical practitioners.

The Hon. F. PANGALLO: I must be missing something here. In terms of the health practitioners, there would be those who would have some sort of ethical opposition to VAD, but would the Hon. Kyam Maher also concede that some of those health practitioners perhaps hold Christian beliefs and would want to exercise those beliefs in their conscientious objection?

The Hon. K.J. MAHER: Absolutely, and that is exactly what clause 9 does—it precisely allows that.

The Hon. F. PANGALLO: Which is what my proposed new clause does as well. It covers organisations.

The CHAIR: I cannot have more than one person standing at a time, but I will call the Hon. Mr Wade now.

The Hon. S.G. WADE: Yes, I do not think he is a member of our house.

The CHAIR: No, I am talking about the Hon. Mr Pangallo. The Hon. Mr Wade has the call now.

The Hon. S.G. WADE: Thank you, Mr Chair. Again, I do not want to delve too far into this because I have not researched it properly. I merely observe that the Termination of Pregnancy Bill has a similar conscientious objection provision as the Hon. Kyam Maher's bill before us has. It does not provide a similar organisational exemption. I might have missed something, but Catholic health services are not compelled to provide abortion services in South Australia. I do not believe that the Hon. Kyam Maher's bill would have that effect in relation to voluntary assisted dying.

The Hon. F. PANGALLO: Does the Hon. Kyam Maher see there could be a situation now, if my amendment does not flow through and his bill passes, that you could actually have these organisations then having to, before they employ somebody, get them to enter contracts where they may have to disclose whether they are opposed or supportive of it, and that may impact on their potential employment?

The Hon. K.J. MAHER: Again, I am not going to delve too deeply into this, but I suspect you are probably going to fall foul of other legislation. I do not think health services have that sort of right of discrimination based on religious beliefs, but I am happy to check that and, as this goes between the houses, come back.

The Hon. S.G. WADE: The only observation I would make that I can think of in a case in Australia is that there is a hospital in the ACT—I think it is called Calvary—which is a public hospital run by Catholic health services. My understanding is that they do not provide abortion. So again, I would make the point that termination of pregnancy legislation in this state does not provide, if you like, conscientious objection to an organisation. I am yet to hear an argument about why we need to make it different in this bill.

The Hon. R.I. LUCAS: I, too, want to refer to the article Jim Birch published in The Advertiser yesterday. I guess for the benefit of members, I am sure we all realise that Jim Birch AM is a highly regarded health administrator. I think he might actually be assisting the government in its endeavours in relation to the Women's and Children's Hospital, but prior to that, of course, he was a highly regarded senior health administrator in this state.

His current role and the reason he wrote this op-ed in The Advertiser is that he is the chair of the Little Company of Mary Health Care Limited, otherwise known as Calvary Health Care, and is therefore in charge of the Calvary hospital.

The Hon. Mr Hood, I think it was, referred to one element of his op-ed, but I am going to refer to the concluding paragraphs. In it Jim Birch says that Calvary has served the South Australian community for over 120 years. It has been able to serve its most vulnerable citizens with compassionate dedication because Calvary in itself is a community of practice. He says the mission, vision, by-laws, policies and procedures attract and bind every person called to practise in this community.

The article states that many people choose Calvary and other faith-based services precisely because there is a clear, identifiable focus of purpose. There is an articulated code of practice, a strong and clear ethical and values-based proposition and a sense of continuity of care which is grounded in mission. The services are valued by the people in its care, as well as those who choose to practice as part of the Calvary community, because of this commitment. If the South Australian parliament attempts to impose VAD on its services it would violate the consciences of most of the individuals involved, together with the institutional commitment to promoting and upholding critical, ethical and other values.

The article goes on to state that the current bill does not provide for organisational conscientious objection and this needs to be addressed. If not provided, parliament risks choice being valued only when individual autonomy aligns with that of the state. Mr Birch says that we are all strengthened when we nurture communities, including faith-based communities, where people can maintain a sense of personal integrity while making their contributions to the common good of all. Choice must be honoured if assisted dying is to be voluntary.

I accept in part the concerns expressed by the Hon. Mr Maher in relation to residential facilities where persons might be in what is tantamount to their home environment and the potential interpretation of this particular proposed amendment in relation to that. That criticism certainly cannot be directed at a hospital or an institution such as Calvary. Whilst I can understand the criticisms he directs in relation to the other elements of this particular amendment, the issue that Jim Birch has raised is quite specific.

I am sympathetic to that aspect of the amendment, but I cannot support the amendment in its current form for the reasons that the Hon. Mr Maher has raised. I am, however, hopeful and I would expect that the more refined version of an amendment like this might be moved in another place to cater for the sort of circumstances that Jim Birch has outlined in, I think, a clear and concise argument regarding Calvary. I cannot immediately think of others but there may be other hospitals in similar circumstances where a similar argument might be made.

I accept the fact that this amendment has only been circulated in the last 24 hours. The op-ed was only published yesterday. I must admit the issue in and of itself had not been raised with me before. Should this be unsuccessful, as it will appear to be in this particular chamber this evening, there is the opportunity for the issue at least again to be canvassed and further explored in the House of Assembly debate, when it gets there. I would certainly be encouraging my colleagues at least to explore this issue in a more specific and refined way.

I have huge regard for Calvary as an institution. I hold it in the highest of esteem in terms of the quality of the service it has provided to the South Australian community, as Jim Birch says, over 120 years. I also hold Jim Birch in high regard. He is a man of considerable reputation and I think he has argued a case that the parliament deserves to at least consider further, specifically, whilst removing from it some of the understandable concerns the Hon. Mr Maher has expressed in relation to its further extension into other institutions.

Again, the Hon. Mr Wade has more knowledge of the circumstances that relate to termination of pregnancies in various hospitals, where either the Catholic Church or churches might be involved but similar principles, I guess, as he has at least outlined, have certainly allowed, permitted to occur—I am not sure what the legal circumstances are in relation to the delivery of those sorts of health services. What it would appear that Jim Birch is arguing is similarly that the parliament should consider, as it relates to Calvary anyway, an amendment that caters for their situation.

I am sympathetic, the Hon. Mr Pangallo, to the amendment but because of the understandable concerns the Hon. Mr Maher has raised, I will not support the amendment in its current form this evening, but I will nevertheless argue to colleagues in the House of Assembly that a more refined amendment that at least addresses the Calvary circumstance should be addressed by members in the House of Assembly.

The Hon. C.M. SCRIVEN: I move to amend the Hon. Mr Pangallo's amendment as follows:

Delete subclause (5)(b).

Subclause (5)(b) is the part that says what a health service establishment means, saying it is a 'premises owned or operated by a residential care provider as defined', etc. This would overcome the problem that has been raised by the Hon. Mr Maher and that the Hon. Mr Lucas has said is also a problem for him in that it would only apply to a hospital or private health facility of a kind prescribed by the regulations.

That way, people will have the clarity of knowing not to choose a hospital such as Calvary if they want to avail themselves of VAD, but it would not impact on those who are already living in residential care facilities or residential facilities of any sort that might be owned by an organisation with such policies and concerns.

The CHAIR: If that was successful, there might need to be some other wording changes necessary as well, but we will work through that.

The Hon. S.G. WADE: I think the comment you just made in terms of the consequential flow-on impacts of even what seems to be a simple amendment by the Hon. Clare Scriven highlights the profound wisdom of the Leader of the Government in this place. I think these matters are best considered between the houses. Amendments on the run often look very ugly in the light of day.

The Hon. C. BONAROS: The Hon. Mr Wade almost took the words right out of my mouth. I think I indicated, again, during my second reading contribution that my biggest concern in this bill would be considering amendments on the fly and amendments being moved on the floor on the fly, and that is precisely what this is. I understand the dilemma that has been canvassed by all members, including the honourable Leader of the Government and including my colleague the Hon. Frank Pangallo, including the honourable Leader of the Opposition, but this is not the way to address this issue.

If we want to address this between the houses, then, by all means, let's do that, but simply trying to address this now, when we only had 24 hours to consider the amendment in its original form, is entirely inappropriate and not one that I will support at this stage.

I would like to make a couple of other points, generally, in relation to these amendments. I think my colleague has referred to what would happen in the hospital setting, and I appreciate that that is a concern for those who do not support this bill. I appreciate the concerns that are raised by Mr Birch. Hypothetically, I think if every doctor at a faith-based hospital or a Catholic hospital, whatever the case may be, was to conscientiously object, then voluntary assisted dying where you are relying on those doctors themselves to administer or to somehow be present for that process would be very difficult.

Of course, you are not always relying on those doctors to be present to administer, to supply the drugs or whatever the case may be. I may present to the hospital with a little box in my hands and not need any assistance from a doctor at that institution to be able to self-administer the substance that ultimately results in my dying. There are an array of issues here that I think we need to consider in the cool light of day and certainly not on the floor and on the fly in this place.

I also have a lot of sympathy for the points just made by the Leader of the Government and, indeed, by the Hon. Mr Maher in relation to aged-care facilities and the impact this would have on long-term residents, both prospectively and of course retrospectively for those residents who have already been living in those facilities for some time.

For all those reasons, I do not think this is the appropriate way to deal with this amendment. I will not be supporting in its original form, and I will not be supporting it in its amended form. But if there is discussion between the houses and we come back with something that is a sensible and acceptable to all that does not deviate from the scheme that is before us—because I think that is the key that the Hon. Mr Maher has said all along and what I have said all along in terms of my position on this bill—provided it does not deviate from what has become the Australian standard, then there may be some merit to it, but at this stage that is certainly not the case.

The Hon. K.J. MAHER: I think I have indicated that I will not be supporting the Hon. Frank Pangallo's amendment that was filed yesterday afternoon, and I also will not be supporting the amendment to the amendment that was foreshadowed moments ago. Just to be clear, whilst I have very serious concerns and problems with the inclusion of aged-care facilities, I do not want it to be misinterpreted that I do not also have problems even if that was taken out. I do, and I do not agree with it. I was going to make the point that the Hon. Connie Bonaros has made, that even with that taken out it is still a very significant departure from the Australian model. This has been considered and rejected in other parliaments. It has been considered and rejected by expert panels leading up to this.

I might just make an observation that I always get worried when the Hon. Rob Lucas says that he agrees with me. I often feel it is a trap, but I appreciate his points. I do not want it to be misinterpreted that I only think it is a problem with aged care; I think it is a problem with the other parts of the amendment as well. But when the Hon. Rob Lucas suggests that colleagues in another place might want to look at it, I am sure they will take his advice and look at it.

The Hon. N.J. CENTOFANTI: I rise to indicate that I will be supporting the amendment to the amendment. I want to echo the sentiments put very eloquently by the Leader of the Government. In this bill, just as it is the decision of an individual to choose voluntary assisted dying, it should also be a decision of a doctor and indeed an entity, such as a private hospital, to conscientiously object to carrying out voluntary assisted dying in their facility because of their religious, moral or ethical beliefs.

The Hon. C.M. SCRIVEN: I have a question for the Hon. Mr Maher. Is it his intent with this bill that an organisation such as Calvary Care would be required to allow VAD in their hospitals if an inpatient requested it and the patient were able to have a visiting doctor?

The Hon. K.J. MAHER: Perhaps the best way to answer it is: no doctor would be required to administer it; no doctor would be required to be involved in it. But it is the Australian model that an institution or organisation cannot be a conscientious objector. It may well be that a hospital is not set up to provide that service, and I think the Hon. Stephen Wade has talked about the fact that that is the case in some settings with termination of pregnancy.

It may be that it cannot be provided in all circumstances, but I agree with every other parliament that has considered this, that an organisation or an institution should not have the ability to be a conscientious objector. I think it is right and proper that individuals can, and that is what the bill provides for and the Australian model provides for.

The Hon. C.M. SCRIVEN: I want further clarification from the Hon. Mr Maher. Is it his intent that voluntary assisted dying should be allowed in an organisation, such as Calvary Care, that is fundamentally opposed to such a practice?

The Hon. K.J. MAHER: I think I have answered that question. I do not think an organisation or an institution should be able to conscientiously object. I will give you an example that I think spells it out quite well. If someone has been approved for a scheme and then needs hospital admission, particularly if it is in a regional area where there are not many choices and it is a Catholic hospital or institution, I do not believe that the person who has had prior admission to the Voluntary Assisted Dying Scheme should be able to be refused medical treatment. I do not think that is right.

The Hon. I. PNEVMATIKOS: Can I indicate that I will not be supporting the amendment or the amendment to the amendment. The whole tenor of the amendment as proposed by the Hon. Frank Pangallo is inappropriate, inconsistent and discriminatory.

The CHAIR: The Hon. Mr Pangallo, and then I am going to put the question.

The Hon. F. PANGALLO: Yes, you can, Mr Chairman. I rise to say that I support the amendment to my amendment by the Hon. Clare Scriven. I have been in this place for three years now and I have seen many amendments done on the fly to far more complicated pieces of legislation. This is actually quite simplistic, and it goes a long way to addressing what the Hon. Rob Lucas has pointed out, and it quite simply addresses that issue with aged care. I can concede a lot of the comments that the Hon. Kyam Maher made in relation to aged-care providers. But again, as I said, it would certainly contradict what he is trying to do in clause 9 in relation to health practitioners.

The CHAIR: The first question I am going to put is that the amendment moved by the Hon. C.M. Scriven to the amendment moved by the Hon. F. Pangallo be agreed to.

Amendment to amendment negatived.

The CHAIR: The next question I put is that new clause 8A as proposed to be inserted by the Hon. F. Pangallo be so inserted.

The committee divided on the new clause:

Ayes 6

Noes 15

Majority 9

New clause thus negatived.

The Hon. D.G.E. HOOD: My amendment, as members would be well aware, is very similar to the Hon. Mr Pangallo's amendment which has just failed, so I will not proceed with it.

The ACTING CHAIR (Hon. T.T. Ngo): Is that No. 5 as well?

The Hon. D.G.E. HOOD: Yes, Nos 4 and 5.

Clause 9 passed.

Clause 10.

The Hon. C.M. SCRIVEN: I have a question for the mover of the bill. Clause 10 says that voluntary assisted dying must not be initiated by a registered health practitioner and that such a practitioner must not initiate discussion with the person that is in substance about voluntary assisted dying or suggest voluntary assisted dying to that person. I am paraphrasing. Could the mover indicate how this will be monitored?

The Hon. K.J. MAHER: Like many things that have been monitored, I do not think there will be some sort of official standing in in every consultation that a patient has with their doctor to make sure this does not happen. I suspect it will be, like nearly all other offences, monitored upon complaint.

The Hon. C.M. SCRIVEN: So it would be up to the person to whom VAD has been suggested, who is facing a terminal illness, to lodge a complaint while they are in their final weeks or months; is that correct?

The Hon. K.J. MAHER: It might be one person. It might be a family member. It might be anyone else. Any time that there are transgressions of standards, of regulations, of codes of conduct or indeed of laws of the state, there are not people sitting around waiting to try to catch someone out, as a general rule. It would not just be a patient in the final stages of a terminal illness who could make a complaint; it could be anyone. It could be a family member or anyone else.

Clause passed.

Clauses 11 and 12 passed.

Clause 13.

The Hon. D.G.E. HOOD: This is the substantive amendment we debated earlier at clause 3 and it was defeated. This is consequential to that amendment, so there is no point in moving it, but I do have a question on this clause. May I proceed with that?

The ACTING CHAIR (Hon. T.T. Ngo): Yes.

The Hon. D.G.E. HOOD: Thank you. My question on this clause for the mover of the bill, the Hon. Mr Maher, is with respect to subclause (1)(c). It says:

(c) the person must have decision making capacity in relation to voluntary assisted dying;

My question is: how is that to be judged?

The Hon. K.J. MAHER: I thank the honourable member for his question. Clause 4 of the bill before us delves into quite some detail in relation to the meaning of 'decision making capacity' for the purposes of this bill. It is of course a concept that is exceptionally well understood by the medical profession and medical practitioners. Every day of every week, most doctors will have to turn their mind to that.

Doctors have to turn their mind to the decision-making capacity of someone who, for example, elects to end or refuse treatment that may actually hasten or cause their death or any ordinary treatment that may have that effect. The double effect rule in the Consent to Medical Treatment and Palliative Care Act allows an intervention if it improves comfort but might have a secondary effect of hastening death. A doctor necessarily will have to turn their mind to the decision-making capacity of a patient who requests that.

It is a concept that nearly every day of practice a lot of doctors, particularly working with older people, particularly in the geriatrics area, will have to consider. It is given further clarity in clause 4 of the bill, which we have already passed, specifically in relation to voluntary assisted dying where it defines it further. A person has decision-making capacity if they can:

(a) understand the information relevant to the decision relating to access to voluntary assisted dying and the effect of the decision; and

(b) retain that information to the extent necessary to make the decision; and

(c) use or weigh that information as part of the process of making the decision; and

(d) communicate the decision and the person's views and needs as to the decision in some way, including by speech, gestures or other means.

I think it is a very well understood and well used concept by medical practitioners that is given further guidance by clause 4.

The Hon. S.G. WADE: I agree with the Hon. Kyam Maher that this will not be an unfamiliar concept to medical practitioners. Day by day, when they are providing any form of medical treatment, they need to have informed consent. To obtain informed consent to any medical treatment, you need to be confident that the person has the decision-making capacity to give you that informed consent. If they have not, then you need to go to other processes, perhaps the guardianship and administration act. So I believe that not only is this unsurprising but to not see it would be surprising.

I would like to make a comment, and this is, if you like, a comment for the future. As I have repeatedly said, I support this bill because it reflects the well-considered Australian model, which, as I have mentioned before, has its roots in Canadian legislation. I think it is really important going forward that we maintain national consistency, but I am not naive enough to think that the model is perfect and that it cannot be improved.

One issue, for example, I would flag that needs to be considered but needs a lot more consideration than this parliament could give and would need consultation with other jurisdictions is the issue of mutual recognition or the residency provisions. The reason it is relevant to this clause is that part 2, clause 13(1)(b) provides that for a person to be eligible for access to voluntary assisted dying they must be ordinarily resident in South Australia and have been ordinarily resident in South Australia for a least 12 months.

That is the sort of provision you put in a piece of legislation to avoid medical tourism. In other words, you do not want each state or territory's legislative regimes being undermined by the capacity or, if you like, an inappropriate flow of patients in response to varying legislative regimes in adjoining states.

It becomes less and less relevant the more jurisdictions take on the Australian model. It may well be that, as a matter of national consistency, in the not too distant future clauses such as this should be removed because they serve no useful purpose. I also think it is something that should be considered, particularly in the South Australian context. It is our privilege as a South Australian health service to provide a significant amount of services to people from the Northern Territory. Many of those services are cancer services. The experience in Victoria is that the majority of people seeking voluntary assisted dying are people on the cancer journey.

The impact of this clause as it stands is that people from the Northern Territory would be coming and receiving treatment in our cancer services in South Australia, and you could have two patients alongside one another and the treatment options available to them are based on the postcode, even though it is basically the one pool of patients. The issue of medical tourism is complicated in this context because the commonwealth has limited the legislative competence of the territory legislative assemblies to deal with voluntary assisted dying. Personally, as a federalist I do not believe that that limitation is appropriate, but that is a matter for the commonwealth parliament.

In the meantime, it means that we will have people coming from the Northern Territory who will be, as I said, receiving care from our clinicians in our services and the clinicians will not be able to offer them treatment options that they will be able to offer other patients. I believe that is an example of an issue where we may well need to consider developing the Australian model going forward.

Personally, as the chair of the health ministers' meeting at the national level, I think the health ministers' meeting should take it upon itself to monitor the implementation of the Australian model and discuss possible changes going forward. I would suggest that, in a situation such as that to which I referred, if the commonwealth maintains its limitation on legislative competence in the Northern Territory, the appropriate process may well be for the Northern Territory Legislative Assembly to pass a resolution for the Northern Territory government to advise the South Australian government that it seeks access for its citizens to voluntary assisted dying in our state at an appropriate time, either as an amendment to the act or a regulation, so that people who are not ordinarily resident in South Australia but are ordinarily resident in the Northern Territory might be provided access.

That is one example, and I appreciate that lots of people have different views about whether that is an issue and whether it needs to be addressed, but I come back to the fundamental point, which is that I agree with the Hon. Kyam Maher that a strength of this bill is that it is based on an Australian model. As we go forward, as the bill evolves, I think it would be very useful to share the wisdom of different jurisdictions. To be frank, it would be perhaps a handbrake on ill-considered reform, if it goes through an appropriate national consultative arrangement.

Personally, I believe it is appropriate for us to have a set of nationally consistent laws rather than a national uniform law. I am very happy for state and territory parliaments to continue to be custodians of these bills, but it would be useful for all the parliaments if there was to be an appropriate process for the jurisdictions to discuss amendments to the Australian model going forward.

Clause passed.

Clause 14.

The Hon. C.M. SCRIVEN: I have a question to the mover of the bill. This is really around trying to understand how this will operate in practice. It refers to the coordinating medical practitioner and consulting medical practitioner and what they must be. One of the things that they can be is a vocationally registered general practitioner, a GP, who has practised for at least five years; however, in subclause (3) of clause 14, it states:

(3) Either the coordinating medical practitioner or each consulting medical practitioner must have relevant expertise and experience in the disease, illness or medical condition expected to cause the death of the person being assessed.

I am a little unclear. For example, if we are talking about cancer, what would be the relevant expertise and experience that a GP might have? I am not trying to make any judgement either way. I am just trying to better understand what would be relevant expertise or experience in cancer if we are talking about a GP.

The Hon. K.J. MAHER: I thank the honourable member for her question. To be clear, it is not a requirement that one of the two medical practitioners has to be a GP. I think it is a misreading if it is thought that the coordinating medical practitioner necessarily has to be a general practitioner. My understanding is that that is not the way that this is drafted or the way the scheme works.

What it requires is that one of the two (the coordinating medical practitioner or the consulting medical practitioner) have relevant expertise or experience in the disease—I think they are the ordinary meanings of the word—so that at least one has a more indepth understanding of what the disease is. Further on in the bill, it talks about the ability of the practitioners to refer for further specialist advice if they have questions around that. I think the requirements in here are exceptionally onerous to have both the coordinating and the consulting medical practitioners sign off on all the elements that we have canvassed a few of in clause 13. I think it puts in very strong safeguards.

The Hon. C.M. SCRIVEN: I was not suggesting what I think the honourable member thought I was suggesting. In my reading of it—and I am happy to be corrected if I am mistaken—it appears that both the coordinating medical practitioner and the consulting medical practitioner could both be GPs.

The Hon. K.J. MAHER: If each one of them has expertise or experience in the disease or medical condition, there is nothing necessarily that would prevent that, bearing in mind also that, as we go onto clause 22 and the relevant clause further on for the coordinating GP, a further specialist can be brought in. I do not think there is a limitation on them doing that.

I think that in many of these areas we place a lot of stock and trust in the expertise of our medical professionals. There are practitioners across all different fields of practice who are involved in these sorts of life and death decisions very regularly. I think there will be across the range of medical practice those who have expertise and experience in a whole range of things. I think the Australian model does not limit that range of practice where they come from as long as they have the relevant expertise or experience as the bill requires.

The CHAIR: Before I call the Hon. Ms Scriven, I respect that the Hon. Mr Maher was answering a question directly to his immediate adjacent colleague, but he should try to face me as much as he can. If he is going to turn a bit, he should angle his microphone a little bit closer to him.

The Hon. C.M. SCRIVEN: I am just trying to clarify. Thank you to the Hon. Mr Maher for confirming. Both the coordinating practitioner and the consulting practitioner can both be GPs as long as they have had five years' practice, etc. That then comes back to my question: if they are both GPs, what is the relevant expertise and experience? An example I would use is if it is ovarian cancer, for example.

The Hon. K.J. MAHER: It may well be there will be certain conditions. There may well not be a GP who has expertise, but it may be that there are.

The Hon. C.M. SCRIVEN: I place on the record my concern that that is not as robust as it should be.

Clause passed.

New clause 14A.

The Hon. S.G. WADE: I move:

Amendment No 2 [Wade–2]—

Page 16, after line 16—Insert:

14A—Certain registered medical practitioners not eligible to act as coordinating medical practitioner etc for person

A registered medical practitioner is not eligible to act as the coordinating medical practitioner or a consulting medical practitioner (as the case requires) for a person if the practitioner—

(a) is a family member of the person; or

(b) knows, or has reasonable grounds to believe, that they—

(i) may be a beneficiary under a will of the person; or

(ii) may otherwise benefit financially or in any other material way from the death of the person (other than by receiving reasonable fees for the provision of services as the coordinating practitioner or consulting practitioner for the person).

I have had positive indications of interest in this and related amendments, so I propose not to labour; I will just introduce the general point. This amendment and the following related amendments ensure that medical practitioners involved in voluntary assisted dying do not benefit, or are not family members of the person seeking assistance and they do not stand to benefit from the death. As I indicated previously, this is not an innovation on the Australian model; it is a preference for a Western Australian version or clause of the model rather than the original Victorian version. I think it is a sensible safeguard.

I do not demur from the point made by the Hon. Kyam Maher earlier that it may well substantially reinforce ethical obligations that medical practitioners already have, but I do think it is reassuring in the context of voluntary assisted dying to have this safeguard in place. It reflects Western Australia and also, as the minister responsible for elder abuse, I think it does reinforce the importance of protecting the rights of older people.

New clause inserted.

Clauses 15 and 16 passed.

Clause 17.

The Hon. S.G. WADE: I move:

Amendment No 3 [Wade–2]—

Page 17, after line 10—Insert:

or

(iv) is not eligible to act as the coordinating medical practitioner for the person.

I would suggest that this is consequential on the amendment we have just discussed.

Amendment carried; clause as amended passed.

Clauses 18 and 19 passed.

Clause 20.

The Hon. D.G.E. HOOD: My amendment to this clause is consequential on an amendment that did not proceed earlier, so I will not be moving it.

Clause passed.

Clause 21 passed.

New clause 21A.

The Hon. D.G.E. HOOD: I move:

Amendment No 8 [Hood–1]—

Page 17, after line 37—Insert:

21A—Referral to psychiatrist where person may be mentally ill

(1) If the coordinating medical practitioner believes on reasonable grounds that a person has, or may have, a mental illness, the coordinating medical practitioner must refer the person to a psychiatrist for the psychiatrist to determine whether the person's mental illness is, or is not, the primary cause of the person making a request for access to voluntary assisted dying.

(2) If the coordinating medical practitioner refers a person to a psychiatrist under this section, the coordinating medical practitioner—

(a) must adopt any determination of the psychiatrist in relation to the matter in respect of which the person was referred; and

(b) must have regard to that determination in determining whether the person meets all the eligibility criteria.

This is relatively straightforward. I will just read it out as it is almost self-explanatory. It is essentially requiring a referral to a psychiatrist when the person considering VAD may be mentally ill.

Subclause (1) states that if the coordinating medical practitioner believes on reasonable grounds that a person has, or may have, a mental illness, the coordinating medical practitioner must refer the person to a psychiatrist for the psychiatrist to determine whether the person's mental illness is, or is not, the primary cause of the person making a request for access to voluntary assisted dying. That is the crux of it, essentially.

If that is the case, subclause (2) states that if the coordinating medical practitioner refers a person to a psychiatrist under this section, the coordinating medical practitioner (a) must adopt any determination of the psychiatrist in relation to the matter in respect of which the person was referred; and (b) must have regard to that determination in determining whether the person meets all the eligibility criteria. That is the amendment in a nutshell.

The reason for the amendment is to ensure that people who are not suffering intolerable mental illness do not turn to see assisted dying as the only way forward for them. For the record, I remind members—not that they probably need reminding—that in clause 13, where it lists the criteria for voluntary assisted dying, it specifically says that the condition from which the person is suffering must be incurable and that it cannot be relieved in a manner the person considers tolerable.

I refer again to the AMA position statement on euthanasia and physician assisted suicide—their words. In section 2.1, it states:

A patient's request to deliberately hasten their death by providing either euthanasia or physician assisted suicide should be fully explored by their doctor. Such a request may be associated with conditions such as depression or other mental disorders, dementia, reduced decision-making capacity and/or poorly controlled clinical symptoms. Understanding and addressing the reasons for such a request will allow the doctor to adjust the patient’s clinical management accordingly or seek specialist assistance.

That is what this amendment will require. Again, I just stress that the criteria to qualify for voluntary assisted dying under this bill is that it be incurable, yet the World Health Organization states in their fact sheet on mental disorders, and I quote directly from their website, that 'there are effective treatments for mental disorders and ways to alleviate the suffering caused by them.'

Dr Caryl Barnes, a leading psychiatrist specialising in the diagnosis and treatment of depression and bipolar disorder, has said on an ABC news report, and I quote directly:

Euthanasia… is when people voluntarily seek to end their lives when they're faced with a terminal illness. Depression is not a terminal illness. It's a treatable mental disorder.

The Royal Australian and New Zealand College of Psychiatrists does not believe that psychiatric illness should ever be the basis for physician assisted suicide, according to the news archives on their own website. Furthermore, the former president of the Royal Australian and New Zealand College of Psychiatrists Professor Malcolm Hopwood has said, and I quote directly:

Unrelievable psychiatric suffering is rare, and ensuring that a person suffering from mental illness has the appropriate capacity to make decisions in this context poses significant challenges. Mental illnesses are treatable, and there are many ways to get help.

If we refer back to the bill itself, it requires that the condition the person is suffering from is incurable—I agree with that, by the way. I am not criticising that in any way; it is as it should be in this bill. As the Australian Medical Association has said, as senior psychiatrists have said and as the Royal Australian and New Zealand College of Psychiatrists has said, mental illness in most cases is not an incurable condition and in most cases it certainly will not result—in some cases it does—in death.

Of course, that is another criteria in this bill. Clause 13(1)(d)(i) requires that a disease, illness or medical condition be incurable, subparagraph (ii) requires that it is advanced, progressive and will cause death, and then subparagraph (iii) says it will cause death within weeks or months, not exceeding six months.

I am taking a long time to say that mental illness is a significant concern for people who are considering voluntary assisted dying. It is something that can be treated; therefore, in my mind it clearly does not qualify under this bill as a reason to be successful. In fact, the bill specifically states that if it is a standalone condition it does not qualify. I am anticipating what the Hon. Mr Maher might say. I am fully aware that the bill says that. In fact, it is in this clause that it says that, is it not? Yes, it is in clause 13(2). It says that a standalone is not a reason, but my amendment requires the treating doctor to refer the person to a psychiatrist if they suspect they have a mental illness problem. I think it is prudent and, if I have not already, I move the amendment standing in my name.

The Hon. K.J. MAHER: I thank the honourable member for his contribution and the amendment that forces us to consider these things. I think it is worth delving into, and certainly the discussion that happened around amendments in other parliaments I found very useful in better understanding many of the issues involved.

I was going to say that I agree with much if not the vast majority of what the Hon. Dennis Hood has said, that a mental illness alone should not qualify a person for voluntary assisted dying. As the honourable member pointed out at the end of his contribution, the bill specifically provides for that under clause 13(2) of the bill:

(2) A person is not eligible for access to voluntary assisted dying only because the person is diagnosed with a mental illness within the meaning of the Mental Health Act 2009.

I think the quotes read out by the Hon. Dennis Hood go to that and I agree with him, and that is indeed why this is in there, and this is a feature of the Victorian bill that this is modelled on exceptionally closely and a feature of the Western Australian bill and I think, but I will need to double-check, a feature of the Tasmanian legislation. I agree with him in that respect.

I might make two points. If that is all we were debating, then this would be entirely redundant because it is very explicitly provided for in clause 13(2). But in relation to a couple of other things I think this does, I will explain why I also disagree with other elements of this. I do not agree—and, from my discussions with practitioners who have been involved not just with this but in other areas of treatment of patients, particularly end of life, having a mental illness does not necessarily mean you lack decision-making capacity in relation to choices in your life, particularly choices for your medical treatment.

Many people in our society live with a mental illness and have decision-making capacity for most if not every part of their life. I do not think the Hon. Dennis Hood is necessarily suggesting it means you necessarily lack decision-making capacity, but I think the amendment he has moved tends to suggest that you may do, so I do not agree with that.

There is another thing I do not agree with, and this was specifically considered in the expert report for the Victoria legislation before it was enacted. It considered very closely, from page 63 onwards, that issue of decision-making capacity and mental illness. I think it included similarly that a mental illness does not necessarily mean and quite often will not mean that you lack decision-making capacity in relation to your treatment, including for voluntary assisted dying, but they canvassed who would be appropriate to assess that.

I think they made the good point that, even if you were to suggest that or that there was something like the Hon. Dennis Hood is suggesting here, limiting it just to a psychiatrist would not be an appropriate thing to do. They point out in the expert panel's report that there may be other medical practitioners and specialists who are more appropriate in the circumstances for a particular patient than a psychiatrist—for example, geriatricians, psychogeriatricians, neurologists, neuropsychologists, psycho-oncologists, psychologists and even palliative care experts may actually be in a better position to assess someone's capacity in a given circumstance.

From the reasoning the Hon. Dennis Hood gave for the amendment, I think that field is explicitly covered by clause 13(2) of the bill. However, even if all the reasons were not just in relation to that, many people living with a mental illness in our community do, in fact, have decision-making capacity in some if not all their choices in life, including choices of medical treatment and including choices of voluntary assisted dying. The fact is that by limiting it to only a psychiatrist necessarily excludes other professionals and specialists who may be more appropriate in the circumstances.

The Hon. D.G.E. HOOD: I thank the Hon. Mr Maher for his response. There is a lot of agreement here. Clearly, 13(2) is in the bill and it specifically rules out—it provides 'is not eligible for…voluntary assisted dying only because the person is diagnosed with a mental illness'. That is clear, we are not disputing that.

Where we do have a dispute is when the Hon. Mr Maher talked about other medical professionals being in a better position to judge mental illness. That is specifically what this amendment is about. Psychiatrists are the specialists who deal with mental illness, and I am not specifically saying that it is necessarily in respect of decision-making capacity, although that may be an element.

I want to talk about things like depression, for example, as I mentioned in one of the quotes I just gave. It can be very sad; depression can become an overwhelming thing for some and it drives their behaviour. It spirals downward, and some people may want to choose to just end it all through a VAD scheme as a result of depression.

It is not just depression, of course, but also personality disorders, as they are called. I actually have a case study here that might be worth quoting at this time to emphasise my point, if I have not enunciated it particularly clearly. I turn to a case from the Netherlands:

where a 36-year-old man with a history of attention-deficit hyperactivity disorder, drug abuse, psychological trauma, obsessive-compulsive personality disorder, and therapy resistant schizophrenia had been experiencing psychotic episodes with delusions and…(hearing voices) for [some] 10 years.

So quite an extensive period. It continues:

their intensity—

that is, the voices—

increased when his mood worsened and when he was in a stressful environment.

The patient was unsuccessfully treated with antipsychotics and the condition became increasingly unbearable for the patient, eventually resulting in a request for 'physician-assisted death' (those are their words). It continues:

During the initial assessment period he was referred to an academic hospital—

Sorry, that is a misprint there; it should be 'after'. What happened was that he was initially treated by his GP and unsuccessfully with antipsychotics, as I have just said. After the initial assessment period he was referred to an academic hospital under specialist care for an obligatory second opinion. During admission the patient's symptoms were carefully analysed and his condition was recognised as what is known as 'intrusive thoughts' and not psychotic phenomena.

He was given the appropriate treatment for intrusive thoughts, and within three weeks of treatment that patient had significant clinical improvement. Some time afterwards—I am not sure how long exactly, we could not find that out—cognitive behavioural therapy was added to the pharmacological treatment, and a few weeks later the patient reached full remission, leading him to withdraw his request for 'physician-assisted death'.

My contention is this: psychiatrists are the experts in mental health, and they are the people best placed to judge to what extent someone's mental health problems are driving the request for physician assisted suicide, or voluntary assisted dying. As I said before, and as I have indicated in the quotes I read out, many—not all, but many—mental health conditions are very treatable and some really substantial improvements can occur, as in the case I just read out to the chamber.

It is a simple amendment. It is another—what is the word?

An honourable member interjecting:

The Hon. D.G.E. HOOD: Safeguard, thank you. It is another safeguard in the process of making sure that people who end up qualifying and going through the process of voluntary assisted dying are genuinely those who cannot be treated in other ways that would, as in the case study I have just read out, lead to them actually completely recovering. If he had not gone to the hospital and had specialist assistance, that gentleman, 36 years old at the time, would be dead today. It is one case; I am sure there are many, many others that we are not aware of.

The Hon. S.G. WADE: With all due respect, the case studies the honourable member has just sketched for us would fail to meet three of the four criteria in section 13(1)(d). The condition that the honourable member is referring to is not incurable, the condition would not have caused death, it would not have caused death within weeks or months not exceeding six months. The only criteria that it might have met is not an 'or' criteria; it is an 'and' criteria, and that is 'causing suffering to the person that cannot be relieved in a manner that the person considers tolerable'. So under this legislation, the case the honourable member is referring to would not be eligible.

I know the Hon. Kyam Maher has alluded to this, but I think it is worth specifically highlighting clause 22(1). Clause 22 provides that where a coordinating medical practitioner is unable to determine the decision-making capacity of an individual seeking voluntary assisted dying—for example, due to a past or current mental illness of the person—the coordinating practitioner is required to refer the person seeking voluntary assisted dying to a registered health practitioner who has appropriate skills and training, such as a psychiatrist in the case of a mental illness.

That clause acknowledges the comments that the Hon. Kyam Maher made, which is that a person with a mental illness may well have the capacity to make decisions and, to the extent they are able, they should be allowed. It also recognises the point that the Hon. Dennis Hood is making, that in assessing that capacity one may well need to have specialist skills, and it specifically references psychiatric skills. I think the legitimate concern that the honourable member is raising is appropriately addressed in the bill.

The Hon. T.A. FRANKS: I have some questions for the mover. He noted that 'psychiatrists are the experts in mental health' in his contribution. Does he believe that only a psychiatrist is relevant in terms of mental health expertise? What mental health expertise did he seek to support this amendment? Who has he consulted with and who supports this amendment within the mental health sector?

The Hon. D.G.E. HOOD: Thank you for the question, the Hon. Ms Franks. I missed some of the end of it. I might ask you to repeat that. I think the start of what was: do I accept psychiatrists as a specialist in mental health? Was that the thrust of the question?

The Hon. T.A. FRANKS: I noted and reflected back to the Hon. Dennis Hood's words that were, I quote, 'psychiatrists are the experts in mental health'. I will elaborate more fully now. Why has the Hon. Dennis Hood chosen only a psychiatrist here? What consultation did he take with the mental health sector? What mental health advocacy bodies or professionals support this particular amendment that he has brought to us today?

The Hon. D.G.E. HOOD: I thank the honourable member for the question. Yes, it is my understanding. Perhaps I should have said 'in the treating of mental health problems or mental health conditions'. They treat schizophrenia, they treat psychosomatic disorders, they treat personality disorders. They are the experts we turn to when it comes to mental health problems. Yes, GPs treat these problems and some other doctors do as well, but those who require significant assistance would almost always end up in the hands of a psychiatrist.

They will be on drugs like risperidone and olanzapine and a whole lot of these medications which have been around for quite some time and which are now used by general practitioners but certainly in their origins were used exclusively by psychiatrists because they are recognised as the experts in treating mental health conditions. There are a number of medications treating mental health conditions which are still exclusively prescribed by psychiatrists in the medical field. That is why I consider them experts in treating mental health conditions. That is my answer to that part of it.

In terms of who I have consulted—I think was the next part of the questions—I have spoken to I think five psychiatrists about this particular amendment, on the condition of anonymity, so I will not name them. The general theme of my discussion with these people was that there is concern about the underdiagnosis of mental health in any potential assisted dying scheme, and they did think it appropriate on the whole, some more enthusiastically than others, that a mental health diagnosis is ruled out, basically.

Can I just go to a point the Hon. Mr Wade made just before I resume my seat; that is, I fully accept that the case study I read out would not qualify under this bill. That was not the intention. The intention of reading out that case study was simply to explain that this person had had the benefit of a specialist psychiatrist to diagnose a mental health problem which was misdiagnosed previously, and that did help in this person's recovery, so the value of the psychiatrist, I think, in treating mental health should not be undervalued. That is what my amendment attempts to do.

The Hon. T.A. FRANKS: So there have been five individual psychiatrists consulted with regard to this particular amendment. I am certainly concerned about language that has been used in discussing mental health in the promulgation of this amendment. I certainly would dispute that psychiatrists are the only experts in mental health. I heard no mention of psychologists, for example, or, indeed, other clinicians in this area.

I saw very little understanding of comorbidities. So was that consultation on comorbidities? Indeed, when one has a diagnosis of a physical condition that means one is going to be dead within six months and one is in intolerable, insufferable pain, I imagine one probably would be able to get a diagnosis of depression and anxiety, but it would be very cold comfort indeed.

The Hon. D.G.E. HOOD: I think we are in agreement. These people are obviously in very difficult times, and they are suffering. The thing about psychologists is, psychologists are not doctors; psychologists do not prescribe medication. The intention here was to provide the capacity for an individual to see a psychiatrist and, if appropriate, to diagnose medical illness, which can be treated with medication. That was the intention.

The Hon. S.G. WADE: I would, again, commend to the house clause 22(1). It talks in general terms about decision-making capacity and, in the context of concern about decision-making capacity, that a registered health practitioner who has appropriate skills and training be engaged. I agree with the Hon. Tammy Franks in relation to the fact that the person with appropriate skills and training may not be a psychiatrist. I have it on very good authority that one of the leading disorders causing mortality, that being eating disorders, is very successfully treated in many cases by psychologists. It may well be that in section 22(1) the appropriate referral to a specialist is not to a psychiatrist; it is to a psychologist.

Likewise in the area of older persons' mental health, if somebody is experiencing BPSD—sorry, the behavioural and psychological symptoms of dementia—it may well be a geriatrician who has the appropriate skills and training. I also think it is important, and I respect the fact, that the Hon. Tammy Franks reminded us of comorbidity. Let us not forget that decision-making capacity can be affected by things other than a mental illness: a brain injury, for example, or intellectual disability. Again, a psychologist may be a more appropriate specialist to ensure that the decision-making capacity of the individual is respected.

So as I said in my earlier remarks, I am fully behind the concerns that the Hon. Dennis Hood is raising, but I believe that the bill handles the issue well and handles the issue well by keeping it general. We are not in a position to say this disorder should be dealt with by a registered health practitioner. What the bill requires is that you identify the decision-making capacity issue, and you are then in a position to identify which registered health practitioner has appropriate skills and training.

The Hon. N.J. CENTOFANTI: I rise to indicate that I will be supporting this amendment. As the Hon. Tammy Franks pointed out, I think it does become quite difficult for a number of people who are in pain, especially chronic pain. They are not necessarily suffering intolerably but they are dealing with pain, and they often do experience some form of depression due to that pain. Consequently, whilst they may or may not have a known history of a mental illness and are still mentally capable of making a decision, I think that those people are at risk of choosing voluntary assisted dying for perhaps the wrong reasons. We do talk about the importance of safeguards within this bill and I think that this is another critical safeguard.

The committee divided on the new clause:

Ayes 7

Noes 14

Majority 7

New clause thus negatived.

The Hon. D.G.E. HOOD: Just very briefly, members will be pleased to know that all my remaining amendments are consequential, so I will not be moving them.

Clause 22.

The Hon. S.G. WADE: I move:

Amendment No 4 [Wade–2]—

Page 18, after line 34—Insert:

(5a) A registered health practitioner or specialist registered medical practitioner is not eligible to act in relation to the referral of a person under this section if the practitioner—

(a) is a family member of the person; or

(b) knows, or has reasonable grounds to believe, that they—

(i) may be a beneficiary under a will of the person; or

(ii) may otherwise benefit financially or in any other material way from the death of the person (other than by receiving reasonable fees for the provision of services referred to in this section).

I put that this amendment is consequential on amendments previously supported by the council.

Amendment carried; clause as amended passed.

Clauses 23 to 26 passed.

Clause 27.

The Hon. S.G. WADE: I move:

Amendment No 5 [Wade–2]—

Page 20, after line 29—Insert:

or

(iv) is not eligible to act as a consulting medical practitioner for the person.

I put it to the council that that is a consequential amendment or a related amendment to amendments previously supported by the council.

Amendment carried.

The Hon. K.J. MAHER: I move:

Amendment No 1 [Maher–1]—

Page 21, line 9 [clause 27(6)]—After 'person's' insert 'death'

I emailed members earlier in the week that after discussions with parliamentary counsel there were identified two typographical errors. This is the first one of them. I think it is apparent to members that the word 'death' is missed out. It says 'a person's' and it makes no sense without the word in there, and I thank parliamentary counsel for their very thorough due diligence to make sure every i is dotted and t is crossed.

Amendment carried; clause as amended passed.

Clauses 28 to 30 passed.

Clause 31.

The Hon. S.G. WADE: I move:

Amendment No 6 [Wade–2]—

Page 21, after line 36—Insert:

(2a) A registered health practitioner or specialist registered medical practitioner is not eligible to act in relation to the referral of a person under this section if the practitioner—

(a) is a family member of the person; or

(b) knows, or has reasonable grounds to believe, that they—

(i) may be a beneficiary under a will of the person; or

(ii) may otherwise benefit financially or in any other material way from the death of the person (other than by receiving reasonable fees for the provision of services referred to in this section).

I put it to the council that that is a consequential and related amendment to amendments previously supported by the council.

Amendment carried; clause as amended passed.

Clauses 32 to 34 passed.

Clause 35.

The Hon. N.J. CENTOFANTI: I want to ask the Hon. Kyam Maher a question in regard to clause 35—Coordinating medical practitioner may refer person assessed as ineligible for further consulting assessment. Basically, the clause provides:

If a consulting medical practitioner assesses a person requesting access to voluntary assisted dying as ineligible for access to voluntary assisted dying, the coordinating medical practitioner for the person may refer the person to another registered medical practitioner for a further consulting assessment.

My question to the honourable member is whether there is a potential for continuous further assessments until the desired outcome is achieved. In other words, what is to stop doctor shopping in this instance?

The Hon. K.J. MAHER: I thank the honourable member for that question. It is something that is raised in all jurisdictions where voluntary assisted dying is proposed. I do not think this clause necessarily would either allow or encourage that, but it is a reasonable question to ask, so I will answer it.

In terms of this clause, though, the coordinating medical practitioner also may not refer someone on, so that may be the end of it. I am not aware of any scheme around the world, particularly not a scheme that is part of the Australian model, that precludes a person from seeking other medical opinions. It would be very perverse if we cut off the ability for someone looking for this intervention to have further medical advice and opinions sought when we do not for any other sort of medical intervention.

One of the things that it does do—and it is something that I have asked, based on the experience in Victoria—is ask: what is there to monitor or guard against this? Every step of the way, each of the forms—the initial request, the consulting medical practitioner's form, the coordinating medical practitioner's form and the final written request form—have to be submitted to the Voluntary Assisted Dying Review Board as you go through the process. So, if there were a suggestion of that, the Voluntary Assisted Dying Review Board would see those forms and refusals come in.

the clause does not preclude the possibility of a patient seeking further medical opinions and nor should it, because we do not do that in any other way that a person seeks treatment. But there is that oversight because, every step of the way, including the decision of a coordinating or even a consulting medical practitioner to say someone is ineligible, such things need to be forwarded to the review board.

Clause passed.

The CHAIR: I seek some clarification from the Hon. Mr Hood. Is my judgement correct that none of your remaining amendments are going to be moved?

The Hon. D.G.E. HOOD: That is right. They are consequential on ones that have failed or have not progressed. But I would like to ask two brief questions on clauses 40 and 68.

Clauses 36 to 39 passed.

Clause 40.

The Hon. D.G.E. HOOD: There are two final questions from me, and members will be happy that that is it from me.

The Hon. D.W. Ridgway: Hear, hear!

The Hon. D.G.E. HOOD: Yes, thank you, the Hon. Mr Ridgway.

The CHAIR: The Hon. Mr Ridgway is out of order.

Members interjecting:

The Hon. D.G.E. HOOD: You wonder if it is worth pursuing, but I will ask the question for the sake of clarity. Clause 40 talks about witnesses witnessing declarations. I am particularly interested in subclauses (1)(a)(iii) and (2)(a)(iii). I will read them:

that, at the time the person signed the declaration, the person appeared to understand the nature and effect of making the declaration;

My question is a pretty simple one: how can a layperson objectively judge that? What is the experience either interstate or elsewhere?

The Hon. K.J. MAHER: I thank the Hon. Dennis Hood for his question. Again, it is probably not surprising that the things the Hon. Dennis Hood has turned his mind to are things that, as this bill was being developed and I became more familiar with it, these are the questions I asked practitioners, not just here but in Victoria.

In particular, that goes to a topic that we talked about before—that is, someone who does not necessarily have the capacity to communicate in a more traditional way by speech or writing—to make sure that the field is covered for someone who communicates in a different way, so that someone who appears to understand the nature and effect can make that communication. In those sort of situations it will often be someone who has known that person for a long time who will be best placed to do that.

The honourable member raises that it is a witness, it does not require a further medical practitioner, but before we get to section 40 we have gone through the coordinating medical practitioner and we have gone through the consulting medical practitioner and both of them have had to turn their mind to capacity issues. In fact, every step of the way the issue of capacity has to be resolved for it to continue.

This is that final step and there have been medical practitioners, or at least one, who have expertise or experience in the disease or condition who has gone before that. It intends to capture the field so that it might be those cases where someone is not speaking or writing but the witnesses say that the person appeared to understand the nature and effect of the making of the declaration—in those situations where, for example, someone cannot write.

The Hon. C.M. SCRIVEN: I am sorry, this is something that is not clear to me: is it correct that there needs to be a witness at that time, regardless of whether the person communicates by those other means or communicates verbally, and if so, is there any limit on who the witness can be other than the definition of ineligible witness?

The Hon. K.J. MAHER: In terms of the limitations, yes. The preceding clause 39(2)(a) precludes someone witnessing if they know or believe that they are a beneficiary under a will of the person making the declaration or may benefit otherwise financially in a way from the death of the person. They are precluded from being a witness.

Now that I have answered that, I think the other question was that if the person who is seeking voluntary assisted dying cannot communicate in writing, for instance, does there still have to be a witness? I think, and I will double-check to see if it is wrong later but, yes, there still needs to be that witness.

The Hon. C.M. SCRIVEN: I am sorry, that was not—

The Hon. K.J. MAHER: Was that the question?

The Hon. C.M. SCRIVEN: No, that was not my question. My question was, firstly, are witnesses required every time? At this step are witnesses always required? Is that correct?

The Hon. K.J. MAHER: According to section 40, yes, witnesses are required at this step.

The Hon. C.M. SCRIVEN: My second question was: other than the definition of ineligible witness, which is fine and understood, is there then no limit on who the witness could be? I guess my question is—

The Hon. K.J. Maher: A family member.

The Hon. C.M. SCRIVEN: Yes, a family member, that is all under the ineligible part. My question is: if it is, I do not know, a person making a delivery of flowers at the time, can that person be a witness?

The Hon. K.J. MAHER: I think what the Hon. Clare Scriven is asking is: does it have to be someone who knows the person exceptionally well? No, it does not. Is it going to be someone who is delivering flowers at the time? I doubt it very much but I am not sure they are excluded from that, as long as they meet all the other criteria.

From my discussions with practitioners in the scheme that is operating in Victoria, witnesses will almost always be people who have known the person quite well. Often they will be friends of the person. As part of the difficult decision and the difficult progress of a voluntary assisted dying application, the witnesses are often those who are close to the person, but there is no qualification about how well the witness has to know the person.

The Hon. C.M. SCRIVEN: That really leads to the crux of my concern, which is that it can be pretty much anyone, as long as they are not precluded through one of those other criteria, and therefore their ability to assess whether the person understands the nature and effect of the declaration is not necessarily particularly meaningful at all.

I appreciate that in the current short-lived time of the Victorian legislation it might generally be someone who is well known to the person who is requesting voluntary assisted dying, but there is nothing in the legislation to ensure that it is someone who actually does know them well or has really any capacity to be able to make a judgement of whether the person understands the nature and effect of the declaration.

The Hon. K.J. MAHER: I think we just do not agree on the necessity for involving more people who have intimate knowledge of the patient in this circumstance. As I have answered the Hon. Dennis Hood, the steps that are gone through before you get to that stage are pretty rigorous and onerous safeguards.

The Hon. D.G.E. HOOD: It is good news, Mr Chairman. I just want to let the chamber know that the discussion that has just ensued here has aired my issue at clause 68, so I will not need to ask the question.

Clause passed.

Clauses 41 to 67 passed.

Clause 68.

The Hon. C.M. SCRIVEN: I have a question at clause 68. On reflection, I suspect it is actually more of a statement, which I just want to put on record, rather than a question, because I think it has been answered by the Hon. Kyam Maher already. I draw members' attention to the fact that this is where there will be a witness to the administration of the substance that will end the life of the person.

Again, it says that the witness must certify in writing that the person at the time of making the administration request appeared to have decision-making capacity in relation to voluntary assisted dying. Again, at this stage, the actual stage where the administration of the substance will occur that will end the life, it is someone who does not necessarily have any ability to assess whether the patient has capacity at all. I think that is a defect.

Clause passed.

Clause 69 passed.

Clause 70.

The Hon. C.M. SCRIVEN: Regarding division 3, Notification of cause of death, could the mover of the bill indicate whether the death certificate will record that voluntary assisted dying was the cause of death or that the underlying condition was the cause of death?

The Hon. K.J. MAHER: I thank the honourable member for her question. I think she will have noticed this does not prescribe that. What it does do is interact with clause 5, but it is not regarded as suicide. The intention here is that there is a recording of the fact that voluntary assisted dying has been used, but in practice this will be one of those ones where it is how it is done in practice rather than how it is legislated. I suspect, in practice, on the death certificate it will list the underlying cause rather than the administration of a substance according to voluntary assisted dying. For the reasons that were advocated earlier on, I think that is appropriate.

Clause passed.

Clauses 71 to 98 passed.

Clause 99.

The Hon. R.I. LUCAS: I address some comments to the functions and powers of the Voluntary Assisted Dying Review Board, but they also will relate to the constitution of that board, which is clause 93. The issue of doctor shopping was something that I addressed in the second reading. Whilst I acknowledge the response the Hon. Mr Maher gave, and I do not necessarily disagree with that, it is very difficult to address what is a significant issue in a number of areas of public policy—the issue of doctor or forum shopping.

I instanced in the second reading the clear examples in relation to workers compensation, which I am sure is evident to anyone who has been involved in the workers compensation field. In addressing comments back to clause 93, which is the constitution of the members of the board, given the time line the Minister for Health has indicated, which was a little more conservative than the time line the mover of the bill did, which was that this would all be up and going in 12 months, the health advice to the minister is that it is more likely to be 18 to 24 months.

If it is closer to the estimate of the mover of the bill, which is 12 months, given I am rapidly approaching my political demise I might have the good fortune of being in the party of the government that consults in relation to the constitution of the members of the board. If it is closer to the Department of Health's estimate, which I suspect is more likely to be the case, it will certainly be beyond my powers of limited influence.

Nevertheless, I place on the record, given this debate and the fact that the legislation is likely to pass at least the Legislative Council, it is certainly my very strong view that the membership of the Voluntary Assisted Dying Review Board should be a broad church—and I use that word with a small 'c' church; it might offend some people if I use the capital C. That is, in particular, there should be representation on the board of either a devil's advocate or an active opponent, a cynic or a sceptic—someone who is prepared to ask the hard questions in relation to the implementation of the policy.

The membership of the board should not all be card-carrying members and supporters of voluntary assisted dying, there should be at least some representation, in my view, on the board that promotes genuine review of how the policy is being implemented within the board. The reason I do that comes back to the functions and powers of the board, which are fairly broad, and I have no great opposition to them.

In relation to the issue of forum shopping, one way it has been addressed in the workers compensation field is that the board—management also but the board in particular—of ReturnToWorkSA has identified the particular concerns and has considered policies. In their case, they have the capacity to implement those policies. In this case, this board would not. It would have to recommend options to either government or ministers—they have collected statistics and identified those who, for example, appeared regularly in terms of workers compensation claims, and in this particular public policy area it would be perhaps the names of doctors who appear regularly in terms of signing off on voluntary assisted dying, etc.

A board that is capable of looking at that and, if there are particular issues, I note that under the functions and powers the board has the following functions: it can refer any issue or identify the board in relation to it to relevant persons, authorities or bodies, one being the Australian Health Practitioner Regulation Agency. That would be a pretty serious step; it would have to be a pretty serious offence to justify a reference to that particular body.

Nevertheless, I think that in terms of the functions there ought to be a regular reporting mechanism at the very least within the board in terms of evidence that might be able to be gathered on doctor shopping in relation to the issue, and then a consideration of advice to the minister in particular in relation to whether there are any options in terms of a policy response.

Again, I return to the workers compensation field, which is different because, as I said, the corporation does have the power to institute policy change themselves without reference to government or ministers, and they have done so in relation to some policy directions in terms of trying to provide greater rigour and oversight in relation to this important policy area. It is an issue that the Hon. Mr Maher has acknowledged is an ongoing debate in other jurisdictions. I raised it in the second reading and a number of members raised the issue during the committee stage of the debate as well.

I just wanted to place it on the record during the particular debate about the board, because when one looks at who might have power and authority to do anything, to monitor anything, to report on anything, in relation to this it will be the board. Therefore, the make-up of the board is important and the way they set about collecting information and reporting to the particular minister of the day will also be important in terms of at least considering whether or not there is an issue.

It may well be that there is not an issue, but if there is an issue, what if any policy response is open to the government of the day or the minister of the day in terms of seeking to address a response if sufficient evidence is gathered that doctor shopping has become much too apparent and beyond what might be deemed to be acceptable in terms of the practices of a particular doctor in relation to the legislation that has been outlined?

The Hon. S.G. WADE: Very quickly, I agree with the Hon. Rob Lucas that monitoring and the implementation of the legislation will be very important. The issues he raises, particularly in relation to doctor shopping, I think he called it, are covered by a number of the functions and I am sure the board could do that.

I would like to bang the drum again for the Australian model and national consistency, because the fact that we have a board in South Australia that will be similar to other boards operating around the country I believe will give us the opportunity of having not only nationally consistent legislation but nationally comparable data so that we can identify issues. After all, how do we know that our patterns in terms of referrals and the like are a concern if we cannot see how it compares with other jurisdictions? If you like, we can benchmark. I support the approach taken by this council tonight, which is to try to be part of an Australian model movement.

The Hon. R.I. LUCAS: I will quickly respond to those comments and indicate that I am not aware of the functions and powers of the equivalent bodies in the other jurisdictions, but certainly between the houses it would be worthwhile, and I ask one of my colleagues in the House of Assembly to pursue the issue as to whether or not there is the capacity in the legislation in other states to actually share information or whether they will be producing public information, which would throw light on it.

Whilst I completely understand the point the Hon. Mr Wade has outlined, if the legislation in and of itself is either not producing information capable of being shared or something prevents the information from being shared, we will not be able to learn from what would be an important point that the Hon. Mr Wade has made. I think it is an issue. I do not intend to delay further the debate this evening. I will just flag the issue and I will certainly pursue it with one of my colleagues in the House of Assembly to pursue the issue in the House of Assembly. It is an issue I would invite the Hon. Mr Maher, given his knowledge of the equivalent boards in the other jurisdictions, between the houses perhaps, to better inform the debate in the House of Assembly.

The Hon. K.J. MAHER: I will not comment very expansively. In relation to doctor shopping, I know that there have been reviews, particularly in the north American experience. I think one review in Oregon is that two-thirds of doctors wrote only one prescription. There has not been a lot of evidence internationally that this has been a major problem once implemented.

I do agree with the Hon. Rob Lucas. I think it is something that those who do not support and those who support a scheme would agree on. I think it meets both interests that a scheme is vigorously reviewed. I think those who support a scheme would be inclined to vigorous review to dispel myths or concerns that people have. I do agree with the Hon. Rob Lucas that a scheme is better if it is vigorously reviewed and interrogated.

I think it is not a bad idea to be able to have the powers to be able to have that ability to perhaps look between boards in different states, given that the functions of our board are almost identical to the Victorian ones. I do note clause 103 allows the board to disclose any identifying information obtained as a result of the board performing a function for the purpose of referring the matter to a range of people that includes the commissioner; the Registrar of Births, Deaths and Marriages; the chief executive and the Australian Health Practitioner Regulation Agency, which I suspect may cover the thought that the Hon. Rob Lucas had but it is something worth looking at between the houses.

The Hon. S.G. WADE: I want to comment on what the Hon. Rob Lucas said earlier. The Victorian Voluntary Assisted Dying Review Board does publish reports. On 25 February, it released its fourth report, which is public and detailed. It is available on the web.

On the honourable member's further point about the appropriateness of sharing between the boards, I note the remarks of the Hon. Kyam Maher. Again, no matter what cooperative regulatory arrangements are put in place between the jurisdictions, the health ministers do have oversight of AHPRA and it may well be that AHPRA is the repository of that information sharing arrangements with all of the privacy provisions that it has, so the oversight of the Australian model may well be supported by AHPRA.

Clause passed.

Clauses 100 to 107 passed.

Clause 108.

The Hon. K.J. MAHER: I move:

Amendment No 2 [Maher–1]—

Page 50, lines 30 and 31 [clause 108(1)]—Delete 'the rights, development and wellbeing of children and young people at a systemic level' and substitute 'voluntary assisted dying'

This is one of those typographical amendments that had a wrong cut and paste essentially in relation to this particular area. I again thank parliamentary counsel for the diligent work that they do and I commend the amendment to the chamber.

Amendment carried; clause as amended passed.

Remaining clauses (109 to 115), schedule and title passed.

Bill reported with amendment.

Third Reading

The Hon. K.J. MAHER (Leader of the Opposition) (23:25): I move:

That this bill be now read a third time.

The Hon. C.M. SCRIVEN (23:25): I want to make some final comments as a third reading contribution. We know that no-one wants to suffer themselves, and no-one wants to see someone they love suffer, but there is clear evidence, for those who care to look, that safeguards in voluntary assisted dying are ignored or diluted in practice once voluntary euthanasia becomes legal.

In jurisdictions that have had voluntary assisted dying for decades, the number of people who are euthanised without asking for it is about the same number as those who do ask, including people with disability, people with dementia and people with mental health challenges, regardless of the model in law, regardless of the safeguards in the law.

Victoria has not had its legislation in place even for two years. Culture and practices change over time. There are already calls to make changes in Victoria on the basis of equity. Doctors have already noted a change towards euthanasia instead of presenting all the options for relief of suffering. We need to ask: do we want our loved ones to feel pressured to end their life? Do we want our loved ones to feel they are a burden on society or on their family? Do we want our loved ones to feel that they have a duty to ask to die prematurely?

It does not matter what the model is in law or how many safeguards are in the law if they are ignored, and over time experience in other places in the world has showed that they are ignored. As a legislator, I have a responsibility to legislate for the safety of all citizens, so I will not be supporting this bill.

The Hon. T.A. FRANKS (23:27): I will make a brief third reading contribution because I want to put on the record that I thank all those members of the community who wrote to me and the other members of this chamber. Many of those pieces of correspondence were quite personal and deeply traumatic, and I appreciate their sharing their stories with me as an elected member. Indeed, they are very reflective of what we know now from the Australia Institute poll, that some four in five South Australians do believe we need voluntary assisted dying laws. For the Greens, 97 per cent of our membership believes that we need voluntary assisted dying laws. But it is significantly high for all members of all political parties.

This is simply the right thing to do for the wellbeing of our society, to ease the burden on those who are suffering, as well as their friends and family, their loved ones. No matter how caring or supportive palliative care staff are, there is only so much they can do to ease the suffering, and the toll that it takes on them as workers must be quite significant.

This bill is and always has been about the overall quality of life and enhancing that for these people, who are deserving of choice in the most difficult times and of that choice of how to end their time—a choice of autonomy, dignity and control, of not being forced to suffer an agonising death, of not being forced to spread the suffering to their loved ones, who are often needlessly traumatised, and that bereavement comes with its own particular pain and suffering that we can help them avert.

As an elected member of parliament, I am very proud tonight to see that we are probably going to pass this bill. I urge the other place to afford this piece of legislation, which is overwhelmingly supported by the public, the unfettered debating time that it needs to be done properly in the other place. We have seen time and time again bills prorogued, bills not getting to a final vote or bills rushed and then voted on in the very early hours of the morning, with people regretting that they were put under undue stress and time constraints and that perhaps their votes may have been different.

I believe people should be given the voice and control over their own deaths in their own way and I believe this bill is deserving of time in the other place that is reflective of the importance of this issue.

The Hon. K.J. MAHER (Leader of the Opposition) (23:30): I wish to take this opportunity to make a few brief comments. I will again reiterate, as I did when we started this before the dinner break, that I think it reflects very well on us as individual members and as a parliament that we can have a discussion with deeply held opposing views on such a sensitive issue yet maintain respect and decorum. Contributions tonight, but particularly on the second reading debate, have been heartfelt, sincere and emotional.

I want to acknowledge all those that have come before in this parliament on the issue. I think there were 16 different bills, and if you count the reintroduction of the same bills I think the bill that was introduced in the Legislative Council and by my colleague Dr Susan Close in the lower house is now the 24^th separate piece of legislation to have been introduced over 26 years.

I want to acknowledge John Quirke, way back in 1995; Anne Levy; Sandra Kanck; Bob Such, who if you count those 24 separate times was responsible for 11 of them; Lyn Such, who has been a regular communicator with me and has provided a great deal of support and advice; Mark Parnell; Steph Key; and Duncan McFetridge. I know quite a number of those ought to be referred to as honourable but I am pretty sure most of them probably prefer not to be.

There have been nine second reading votes on voluntary assisted dying and the second reading vote on this bill last month became the fifth successful one out of those nine occasions. It has been to a third reading vote three times previously, most notably on the last occasion in the lower house where it failed on a casting vote after a 23-all tie.

Unlike other attempts before in South Australia, this time our scheme, if successful, would not be the first in the country, nor the second or the third, but we will be the fourth state to implement what we have discussed and what has become known as the Australian model. I think that has given a significant degree of comfort to some members in both chambers who may not have voted for this before and may not have considered voting for it before but may this time.

I wish to sincerely thank the many people in SA who have been advocating and campaigning for these changes over many years and, in some cases, even decades. I will single out particularly Frances Coombe and Anne Bunning. If it were parliamentary to do so, I would probably acknowledge that they are in the chamber, but it may not be so I will not. I wish to thank my staff, both the current kids in the office and the ones who have been there before. It has been a rollercoaster of a journey.

I want to thank the politicians and practitioners, particularly in Victoria, who have shared their expertise and experience. I want to single out Dr Roger Hunt, whose expertise in voluntary assisted dying is probably unrivalled. I think Roger is the only person who has been on both the Victorian and the Western Australian governments' expert panels in setting up the scheme. He has provided heaps of time and advice, including a big chunk of last Sunday, to help with preparation and understanding for this bill.

It would be remiss of me not to thank Andrew Denton, who has almost become a full-time advocate for voluntary assisted dying and whose persuasiveness is well known to most politicians around Australia who have considered these end-of-life issues.

Most of all, I want to thank the many South Australians who have been in touch with me on this issue over the last six months. It has been a rare privilege indeed to share some of the most intimate and difficult moments of your lives. The traumatic last moments and days of witnessing the extreme suffering of a loved one that people have shared—I know exactly what you mean.

To the people who I have met, talked to and messaged who are themselves in the final stages of a terminal illness, the fact that you take your time in those last precious moments to try to ensure that others do not have to suffer and go through what you do is an extraordinary thing. I have shared the whole gamut of human experience and emotion with so many people: courage, distress, sadness, strength, love, loss and coping. Thank you, everybody. I commend this bill to the chamber.

The council divided on the third reading:

Ayes 14

Noes 7

Majority 7