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Legislative Council - Fifty-Second Parliament, First Session (52-1)
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CONSENT TO MEDICAL TREATMENT AND PALLIATIVE CARE (END OF LIFE ARRANGEMENTS) AMENDMENT BILL

Second Reading

Adjourned debate on second reading (resumed on motion).

The Hon. T.A. FRANKS (19:48): I rise to speak in support of this bill moved by the Hon. Mark Parnell, and I do so recognising that previous speakers have gone before me. I would also like to take this opportunity to counter some of the statements made so far. I would like to put on the record that I am agnostic. I do have beliefs, but they are certainly not rooted in the Christian faith, and they will certainly guide my conscience on this decision.

Numerous times the Hon. Dennis Hood claimed that he rejected the 80 per cent figure in the polls showing that the majority of Australians do, in fact, support the intent of this bill. He said:

I believe that many of the people surveyed had those types of passive actions in mind, that is, the withdrawal of treatment for the administration of pain relief with a double effect. None of these things are considered to fall under the category of active euthanasia. Certainly, I feel convinced that nothing like 80 per cent of the population would support the deliberate intention to kill a patient who may not even be terminally ill, as permitted by this bill.

Over the past 40 years, opinion supporting voluntary euthanasia has been in the majority and, over the past 15 years, support has been consistently at least 75 per cent for the following clear and unambiguous question in Australian Morgan and Newspoll surveys: if a hopelessly ill patient experiencing unrelievable suffering with absolutely no chance of recovering asks for a lethal dose, should a doctor be allowed to give a lethal dose or not?

This very explicitly refers to a lethal dose, not the withdrawal of treatment. The latest Newspoll conducted in October 2009 showed that 85 per cent of Australians support voluntary euthanasia, with a similar level of support shown here in South Australia. Despite the statements of some church leaders, the Newspoll research shows that three out of four Catholics and four out of five Anglicans want the option of voluntary euthanasia to be available.

The Hon. Dennis Hood appeared to put greater weight in one unrepresentative Adelaidenow online poll of a non-statistically valid sample than a consistent finding of Newspoll for the last 15 years. There is another online poll today that I like this comment from. Esme Benet, at 5.19pm yesterday in response to the question, 'Should euthanasia be legalised in South Australia?' posted: 'This poll sucks. I've just managed to cast 10 votes.' That was comment 92 out of 103 in yesterday's Adelaidenow poll.

It is also wrong to highlight the electoral result for two pro-voluntary euthanasia groups in the March state election as an indicator of support. Using this logic, support for issues such as saving the Murray or safe communities would be woefully low and we know that this is not the case. We can actually have a debate about how much weight we should attach to public opinion but there is simply no debate over the consistent, overwhelming support for voluntary euthanasia in our community from credible polls.

There are safeguards in this bill. The Hon. Dennis Hood once again called for safeguards and consultation. Members would have seen the paper sent around from the Hon. Mark Parnell—a whole page of increased safeguards. At some point, safeguards—which, ironically, minister Hill has also described as 'clunky' and 'bureaucratic'—become so restrictive that it stops people from being able to use these laws. I would suggest that we are almost at that point.

Opponents often claim that it is impossible to make a bill that will not be abused. That is equivalent to saying that there should not be road speed limit laws because people might speed. The point of law is to spell out to our citizens what is acceptable and, conversely, what will be prosecuted. Unlike current clandestine medical practice, in which patients are euthanased with no operational framework, no ethical guidelines, no requirement for multiple medical opinions, no specific assessment of the patient's mental capacity, no cooling-off period, no documentary trail, no witnesses or signatures and no oversight or reporting, this voluntary euthanasia bill makes the process explicit.

Those failing to follow the law are also open to prosecution. Surveys show that voluntary euthanasia already exists within medical practice in South Australia. It is dangerous, in fact, to leave it unregulated. It should be controlled by this parliament. In response to claims that there has been no consultation on this bill, there has been an extensive consultation process. A lot of the work over the 12 months since the last debate—when I was not in this chamber but, of course, many members were—has involved consultation with medical and legal experts and, finally, with members of parliament themselves in preparation for tonight's debate. From the consultation has come some of the amendments to the bill that we see before us.

The operation of the board has been questioned by the Hon. Dennis Hood as well. The board will not routinely tick off on every single application, but it does have powers to intervene and stop or defer a request. They can do this after being approached by people listed in clause 41(1), but there is also absolutely nothing at all stopping the board initiating its own inquiry on its own motion. I think this strikes a balance between oversight and autonomy. It acts as a reserve protection that the board will only intervene when necessary.

Referral to a psychiatrist was also mentioned in our previous speeches. There was a call for a mandatory referral to a psychiatrist to be part of any process. This is, in fact, not practical, especially for those living in regional or rural South Australia. The Hon. Dennis Hood referred to the Oregon experience where, of the 59 people who sought physician-assisted dying, none referred to a psychiatrist. The answer is pretty simple: the requesting practitioner made an assessment and found the person did not have any mental health or psychiatric concerns. This betrays the belief that anyone requesting voluntary euthanasia must be sad or mad. Could it be, perhaps, that they are instead making an entirely sensible, rational decision?

We have heard the example of Daniel James, the 23 year old young rugby player from Worcester in the United Kingdom who went to Switzerland to die. Quoting the UK tabloid newspaper, the Daily Mail, as his reference, the Hon. Dennis Hood said:

Daniel was paralysed after being crushed in a rugby scrum during training and was confined to a wheelchair. He was not terminally ill; he was not dying. He simply believed that being confined to a wheelchair was intolerable and so he was killed at the Dignitas Clinic.

I am grateful to Associate Professor Arnold Gillespie for pointing me towards an alternative description found in The Times and, in particular, a quote from his mother:

He couldn't walk, had no hand function, but constant pain in all of his fingers. He was incontinent, suffered uncontrollable spasms in his legs and upper body and needed 24-hour care.

His condition was not one which would have caused him to be merely confined to a wheelchair. However, having said all that, I do not know whether he would have qualified for voluntary euthanasia under this bill, but I am very confident that the blind artist (one of the other examples put forward) would not qualify under this bill, and I note that there have been many fine blind artists such as Lloyd Rees and in fact, Monet, one of the finest artists ever.

This bill provides potential assistance to those suffering intolerable and unrelievable suffering from advanced illness. Not only does the individual need to assert that their suffering is intolerable and unrelievable but, to qualify for assistance, they need to convince other independent objective persons including the individual's attending doctor, a second specialist, a psychiatrist through an inevitable referral, an independent witness and the medical, legal and community members of the board and registrar.

While the experience of the individual is paramount, there are a significant number of moderating influences and opinions to ensure that the full range of medical, psychological, palliative, social and spiritual care can be brought to bear in each case, and sadly, if the individual is simply so desperate to end their life, they will do it anyway, voluntary euthanasia law or no law. Insurance concerns were also raised by the Hon. Dennis Hood, in particular, a concern raised by the Financial Services Council that there was potential for conflict between the commonwealth and state acts.

As I understand it, this concern is completely unfounded. There is specific provision in the commonwealth act that expressly allows the commonwealth legislation to be read concurrently with state legislation. The issue of jurisdictional application is another furphy. Most major insurers are not based in Adelaide and an insurance company with, for example, its head office in Zürich and a major branch in Sydney will still be able to reconcile cross-jurisdictional issues because they need to do it all the time.

The scenario that the Hon. Mr Hood painted, that potentially we could have people walking into a euthanasia clinic, buying life insurance over the phone on the way and then being given a lethal injection, is ludicrous. Can you imagine any insurance company willing to grant an expensive life insurance policy over the phone without a medical examination or even a single question: 'Have you any pre-existing conditions?'

The Hon. Mr Hood claims that a medical practitioner will be forced to forward a request to the registrar of the euthanasia board and that there is no scope for conscientious objection in that regard. I respectfully suggest that he has not read the bill properly. There are obligations on a 'request practitioner', that is, someone who has already agreed to participate in the process, to forward through the necessary paperwork in a timely fashion.

However, if a doctor does not want to become a 'request practitioner' then all they have to do is say so. There is absolutely no risk to them whatsoever of imprisonment. There was another claim that this bill will erode the trust between doctors and patients, supported by this quote:

The Netherlands experience has shown frail elderly people become reluctant to seek medical attention—refusing to take pain medications, and refusing hospital and nursing home admission for fear they may be killed by their doctor.

This claim has been debunked and debunked time and time again. There is good evidence from Oregon, from Belgium and other countries that is the opposite to this claim. It is simply untrue. A survey of nine European countries put levels of trust in doctors in the Netherlands at the very top, in fact. Only a small number of doctors are likely to participate in this; their participation will not affect the level of patient trust towards other doctors who do not. This message of supporting suicide also came through in previous speeches. Again there is a complete lack of evidence to back this claim, but the biggest howler I would like to address concerns Els Borst, the health minister in the Netherlands at the time euthanasia was legalised there. It was said in the previous debate:

It is little wonder that Els Borst, who was health minister in the Netherlands at the time euthanasia was legalised, now says that she thinks it was the wrong move and that the country should have focused instead on palliative medicine. That was recently reported in LifeSiteNews in December 2009. There we have the minister responsible for bringing it in now wishing they had not, very publicly and clearly.

This claim could in fact not be further from the truth. Els Borst, in a letter written to the Dutch newspaper NRC on 1 December 2009, stated (and this has been translated from the original Dutch):

I am not of the opinion that euthanasia become law too soon. In two articles about the book 'Redeemers Beside God' by Anne Mei The (NRC, 28-11) it was put that I was of the opinion that the euthanasia law come into force too soon. Nothing of the sort. What I did say during the conversation with Mrs The was that palliative care in the Netherlands had a relatively slow start... Because I attach great importance to the wide availability of good palliative care and I consider euthanasia only to be the rounding off of good palliative care, I have in 1998 as health minister promoted a five-year stimulus program for palliative care, with an annual budget of seven million guilders. This worked well: Palliative care made up for lost time. While in 2002 euthanasia legislation become effective, the balance has been restored sufficiently to welcome this path wholeheartedly.

These are her actual words; they are clunky because they are translated from the original language. This example of not only getting something wrong but in fact 180 degrees wrong is not unusual in this debate.

As I understand, the source for the erroneous claims about Els Borst's words was once again the UK tabloid the Daily Mail. It highlights the often hysterical misrepresentation of much of the Netherlands experience. Far from being a place that callously knocks off their elderly and sick without a second thought, I respectfully encourage those who believe this to examine the evidence and, in particular, the latest country-wide comprehensive investigation, the latest instalment of what is known as the Remmelink report. The third Remmelink report shows the real experience from the Netherlands. Some key findings and quotes from this report are:

There is no empirical support for the supposition that the Netherlands are going downhill with regard to life terminating treatment by physicians.

The rate of euthanasia and assisted suicide, and the practice of medical decision making relating to the end of life in the Netherlands, appears to have stabilised in recent years.

Both life-terminating treatment on explicit request and life-terminating treatment without an explicit request are no more frequent than six years ago.

There are no signs indicating an increase in life-terminating treatment among vulnerable patient groups.

The influence of the social economic status of patients on medical decisions concerning the termination of life seems to be very limited.

Significantly, the authors of this report found in 2001-02 physicians reported more often than in previous years that they had become more restrictive about euthanasia and less often that they had become more permissive. The report also found:

The requirements of due care are being met more extensively than previously, and public control has increased further.

We were also told that this would be a slippery slope and that the duty was upon us to protect the weak and vulnerable from this slippery slope. Again, there is clear and compelling evidence against this assertion.

A multi-year analysis of data from Oregon and the Netherlands found no evidence that people in nine of 10 vulnerable groups died more often as a result of either physician-assisted suicide or euthanasia. If anything, the studies showed that people taking advantage of the laws tended to be slightly better off economically and better educated than average. A further study from the Netherlands found there is no evidence for a higher frequency of euthanasia among the elderly, people with low socio-economic status, the poor, the physically disabled, the chronically ill, minors, people with psychiatric illnesses, including depression, or racial or ethnic minorities compared with background populations.

The overseas experience from the Netherlands, Belgium, Oregon and Washington State is clear: safeguards and transparency are in place. At the end of day, patients who are in terrible suffering are being killed by doctors now in Australia. While I have no doubt it is for the best of reasons—and in my own personal family I have seen this happen and I know that these things go on—this practice is now completely unregulated. In fact, when researchers have compared the experience of the Netherlands with practice in Australia, they found the rate of doctors ending life without an explicit request was five times higher in Australia than in the Netherlands.

We have also heard that the answer here is more palliative care. To cast it as either or—palliative care or voluntary euthanasia—is a false choice; we need both. The overseas experience is very clear: voluntary euthanasia drives improved investment in palliative care. The Netherlands, Belgium and Luxembourg all rank highly in palliative care services. Belgium doubled funding to palliative care services when it introduced its law. Oregon rates in the top 10 states in America regarding PC access to hospitals.

Palliative care in the Netherlands has improved since legislation, with the rise in the number of specialist PC facilities and beds. Oregon has amongst the best palliative care in the US, and yet 96 per cent of those seeking assisted dying do so from within those services. When the Northern Territory laws were passed, investment in palliative care was increased. At the end of the day, even our first-rate palliative care services won't and don't work for every one.

We have all had the correspondence both for and against this bill. We have heard in the debates that there is always enough medication to address the pain that some people experience as they near the end of their life. I know from my personal experience that this is not the case. I also know from many of the letters that I have received in the previous weeks that this is not the case for many people.

I think it is clear that I will be supporting this bill. It is reasonably clear that this bill will not be getting up, but I do think that we all have it on our conscience to give those people who would like the choice to die with dignity that choice. We do not have to exercise the choice for ourselves or our family members, but we do have to enable others who would like the choice to be given it. I commend the bill to the house.

The Hon. R.L. BROKENSHIRE (20:07): I will not go into as much detail on this bill tonight as I did just a year ago, and I will explain why as I go through my remarks, but given events that have moved along since the last time we debated this bill, there are some other comments that I would like to make to my colleagues and put on the public record. Firstly, I acknowledge the many letters that I have received both for and against this bill.

Clearly, it is a difficult and emotive bill for all of us to vote on. I say to the people who have provided briefings and education about this important issue that I appreciate very much the efforts that they put into briefing my colleagues and me, and also I feel a better educated debate will occur as a result. Tomorrow we will be lodging a petition against this bill signed by 5,000 signatories and it will be tabled in this house.

I have to say that, in monitoring my emails and written correspondence, this time I have clearly had an absolute overwhelming majority of correspondence in opposition to the bill—much more than I had in 2009. I acknowledge that some parties have a particular policy on this. When I was in the other house, it was also a conscience vote. I was always opposed to euthanasia then and I continue to be, and I am strongly committed to the policy of Family First that we do not support euthanasia.

However, we do support palliative care and, in fact, in the other house, I was strongly supportive of the former Liberal government's initiatives to bring in palliative care and better legislation and support. However, I believe that South Australia can do a lot better when it comes to palliative care, and I would dearly like to see much more money put into palliative care in this state.

We should have a challenge as a state to have the best practice palliative care in the world. We could have R&D as part of our university and hospital precinct as well doing that, because I believe that would be an absolute positive for South Australians and, indeed, a positive for all members of society here on this planet earth.

It is interesting that a Sydney study found that, of people entering palliative care services, 2.8 per cent wanted euthanasia but, once palliative care was started, less than 1 per cent wanted euthanasia. This supports the evidence given to us by experts in the field who felt that the pain of the illness and the desire to end the pain was the dominant factor. Therefore, once the pain was dealt with, the desire for euthanasia was much lessened to that percentage of people.

I will return later to comments others have made about palliative care. It seems almost universal across the commonwealth that exploring euthanasia has seen a renewed desire to invest more heavily in palliative care, which I believe is the appropriate response of our parliament and state and, as I said, is certainly Family First policy.

In my opinion, euthanasia erodes trust in the medical profession. It runs against the Hippocratic oath. AMA policy is that euthanasia is fundamentally inconsistent with the physician's role as a healer. Medical experts told us passionately that they are seen as life savers in the community but, with this bill, they become life takers. In the eyes of the public, these noble doctors—without their consent, I might add—suddenly lose a lot of trust in the community.

I have been told that in the Northern Territory Aboriginal people became less inclined to see a doctor for fear of being euthanased. I have no doubt others in our community will do the same. The honourable member promoting the bill might say this can be tackled with education but, sadly, it is the uneducated who are often unreached by information campaigns and end up too scared to go to a doctor when they are seriously ill. We do not want that erosion of trust in the medical profession.

In this bill there is no time limit on when the terminal illness might cause death. Medical experts told us that in at least 6 per cent of cases their diagnosis of the disease being terminal can be wrong. Six per cent is a significant percentage, in my opinion. So, conceivably, over one in 20 deaths under the euthanasia regime proposed by this bill could happen after a mistaken diagnosis of a terminal illness. I note, on safeguards, that this bill has fewer safeguards and lower thresholds than a bill that was recently comprehensively rejected by the Western Australian Legislative Council.

On that issue, I want to make my point, as I see the argument, about Newspoll's surveys supposedly showing that 80 per cent of people are in favour of euthanasia. I have to say that I do not pick up the 80 per cent of people being in favour of euthanasia wherever I go across the state, and I spend a fair amount of my time (like the rest of my colleagues, I am sure) across the state. Push polling can bring a skewed answer, and I want to read into Hansard the Newspoll of October 2009, because I am not sure that we are all aware of the questions that gave those results. These are the two questions asked of the respondents to the survey:

Thinking now about voluntary euthanasia, if a hopelessly ill patient, experiencing unrelievable suffering, with absolutely no chance of recovering, asks for a lethal dose, should a doctor be allowed to provide a lethal dose or not?

The result of that question was 84.9 per cent said yes and 9.7 per cent said no. A Newspoll in February 2007 asked:

Thinking now about voluntary euthanasia, if a hopelessly ill patient, experiencing unrelievable suffering, with absolutely no chance of recovering, asks for a lethal dose, should a doctor be allowed to provide a lethal dose or not?

The result was: yes, 80 per cent and no, 14 per cent. I wonder what people would think if political parties started wording their questions in that way.

What I really want to highlight to the house is that this bill is not so well defined. It is not that tight. There are lots of anomalies and issues that can come up that do not make this bill anywhere near as tight as those questions, and that is an absolute fact. You only have to read the bill yourself to know that.

Amendments are coming into this house again, right now, before we actually debate this bill. So, clearly, as late as today, we have amendments on what is a serious bill. We see all the time problems with bills that we debate in this parliament. Members only have to look at the most recent one, the decision of the High Court on the government's bill with respect to outlaw motorcycle gangs and others, and what happened there. The consequences of this are far more horrendous.

In an open letter to Premier Rann, Associate Professor Nicholas Tonti-Filippini of Melbourne (Australia's first hospital ethicist and a former director of bioethics, and, importantly, presently suffering a terminal illness—sadly, renal failure, heart disease and auto-immune disease) wrote:

I cannot speak for all people who suffer from illness and disability, but I think I can speak more credibly about suffering, illness and disability than those people who advocate for euthanasia presenting an ideological view of suffering and disability. Facing illness and disability takes courage and we do not need those euthanasia advocates to tell us that we are so lacking in dignity and have such poor quality of life that our lives are not worth living.

Then, on palliative care, the associate professor writes tellingly:

In Australia too little is done to make adequate palliative care available to those who need it. Current entry requirements for palliative care usually exclude people with chronic pain and is often limited to people who are in the last stage of cancer with a prognosis of less than eight weeks. The pharmaceutical studies for more effective forms of pain relief are often restricted to cancer patients. People living outside major cities have little access to palliative care facilities. Few doctors are adequately trained to provide palliative care. Most pain clinics are oversubscribed and have long waiting lists.

He goes on to note that the United Kingdom has opted for improved palliative care rather than euthanasia, and that is where I come back to our policy of more effort into palliative care.

I do not have a lot more to say, but I would like to put a couple more things on the record, and I thank my colleagues for allowing me to do that. To illustrate the feeling among medical practitioners who we feel have not been consulted about this bill, Dr Rudi Zacest asked that his views be represented in parliament, and so I am going to represent them. He said that, in his Hippocratic oath, he declared:

I will neither prescribe or administer a lethal dose of medicine to any patient even if asked, nor counsel any such thing.

Dr Zacest says that as a consulting physician he saw, not infrequently, patients who confided that they changed their GP because they learnt that he or she was sympathetic to euthanasia. He never encountered the change of GP going the other way, and this is with the law as it already is, not with this bill in place.

He was concerned that the claim for a need for regulation suggested that covert euthanasia was occurring. He feels that this is an insult to the medical profession. Dr Zacest also observed that the natural consequence of the bill passing is that deans of medical schools will feel obliged to introduce courses on patient killing. Who, he asks, would become the first chair of euthanasia medicine?

We have been referred to commentary by Reverend Dr Gondarra from the 1996 debate on euthanasia that the Yolngu people said that the Northern Territory euthanasia bill was perceived by most Yolngu as 'sorcery' and that some people are refusing to go to hospital. Older people who think they have no rights to refuse do what the doctor says and go to hospital in deathly fear of what is going to happen to them.

In essence, one Aboriginal people, the Yolngu in the Northern Territory, believed that the bill was against customary law. We do not have a position from the Kaurna, Ngarrindjeri, the APY lands and other Aboriginal groups on whether this bill is likewise against customary law. At least it can be reasonably inferred that this bill will drive Aboriginal people away from health services, not towards them.

I commend my colleague the Hon. Dennis Hood's comments in this house, and I refer others to my contribution on the bill that the Greens introduced on 28 October last year. I believe there are simply too many problems with the current bill.

I have my doubts that South Australia could ever pass safe euthanasia laws, given the ethical issues, including the converting of doctors from life savers to life takers, the loopholes and flaws in this bill, the difficulty in ever having adequate safeguards, and the experience from jurisdictions with euthanasia legislation that has seen the killing of people against their will. There is a saying I have been taught over the years, and I wish I practised it more. The saying is a simple one, namely, 'If in doubt, leave out'. I have far too many doubts in relation to this bill, and that is why I will not be supporting the bill.

The Hon. J.M.A. LENSINK (20:21): This is probably one of the most difficult issues that any of us as legislators have to deal with. This is the third time I will be considering this issue. The first time was in 2003 when, as a new MLC at that time, I voted against that bill; and then again in October last year, I voted in favour of the Hon. Mark Parnell's bill. I would have to say that I come to this issue fresh each time because of the significance, depth and weight of issues we have to deal with. In principle, I believe in the liberal position that people should have the right to choose, and this extends to those who are suffering in an irretrievable situation in terminal illness.

I acknowledge that many Australians and South Australians want to have control over their end-of-life decisions. They do not wish to die in pain, and they do not wish for their life to continue if they are demented or if they have lost control of bodily functions and so on. I think a particular part of that is a fear of prolonged suffering, which is an important consideration to which I will return later. My colleague and the leader, the Hon. David Ridgway, articulated examples in relation to those, so I will not go over those again.

I would have to say that many people who are particularly vocal about expressing their wishes are educated and articulate and know what they want. We hope that, in reality, very few people will ever be in a situation of needing to access the provisions we have before us. I would like to refer to an article, which I think gave me a bit of a jolt, in The Australian, on the weekend of 2 and 3 October 2010. The article was written by Angela Shanahan, and it is entitled 'Right-to-die polls no basis for radical change'. We have had a lot of discussion in the debate tonight and in previous discussions about what the polls mean. They should not be seen as a blunt instrument either way; I think the debate is much more nuanced than that. In this article, Angela Shanahan says:

The 45 to 65 age group showed the most support, with 80 per cent in favour. But the age breakdown of the poll showed the greatest opposition—

and this is in relation to a poll published by News Limited—

came from the people who are always portrayed as avid supporters of euthanasia: the elderly. Those aged 65 to 74 had only 18 per cent approval. A more nuanced poll would reveal that rather than fearing being a dribbling demented mess, most old people feared the Dr Death at the nursing home.

End-of-life decisions are hypothetical, and I think that is the point that Angela Shanahan makes, and I think it is often an issue that is lost in this debate.

I am currently a joint custodian, together with my father, for my mum. She has had her third bout of cancer. She has had her third operation and, happily, she is alive and well. She is angry about not being as educated as she would have liked, but that is a product of her upbringing. She is articulate, and she knows what she wants.

In the lead-up to this latest round (I am not entirely sure of the terminology, but it is in relation to provisions that exist in the Consent to Medical Treatment and Palliative Care Act as they are), I think it was an anticipatory direction she applied for, which means that, should the worst happen and she is unable to make decisions or express them herself, she does not want to continue to have futile treatment. But it went to the point where it would involve my dad and me having to make decisions about whether machines were turned off and so forth and whether medical treatment was withdrawn.

At the point before she went in for her operation, I said, 'What's your intention?' She had written her intentions down, but I certainly was not getting the intention that she was ready to throw it all in. She said, 'No, no, no; I still want to fight.' I think she has felt rather tired of her many medical illnesses over the years, and at times she has felt like it is all just too hard and she wants to give in, but then the spark will come back.

I relate that story because I would take the precautionary approach with my mum and I would want to follow her wishes as closely as possible. From what I understand, clauses have been taken out of this bill which relate to those advance directives, and I think that is a wise thing because, as I say, those advance directives are hypotheticals.

The assessment needs to be made continuously for those people in order to match their wishes as closely as possible. However, ultimately, if my dad and I were faced with that choice I would not want to let her go, because I would not be convinced that that is the decision that she would want to make for herself. I think the Hon. David Ridgway articulated that quite well in his second reading contribution.

This issue was debated recently on ABC Radio National in an interview on 7 October 2010, where Mark Colvin, as compere, interviewed an academic from Oregon who is involved in the process, Associate Professor Barbara Glidewell, and the federal AMA President, Dr Andrew Pesce. The associate professor referred to the situation in Oregon and said:

It's really incredibly important to have structure and to have safeguards and, further, to provide for patients to understand the process.

I think we have been struggling with the issue of structure and safeguards. There have been amendments which reflect that structure and safeguards are incredibly important, and for us to support this we have to be confident individually that they are right; I do not feel that I have that situation. I have not been able to reconcile all the different pieces of how this fits together which has, quite frankly, been a question of time in terms of not being able to pull those parts together.

On these conscience matters occasionally I find myself on the same side as the Hon. Robert Brokenshire, and occasionally not. The examples that he has talked about concern Aboriginal communities, and I think there are other communities who would be similarly affected and who do not necessarily understand that, just because it is legal for voluntary euthanasia to take place under very certain strict conditions, when they seek treatment that is not going to happen to them. That has also tipped me against supporting the bill on this occasion.

In Oregon the process is that a person will request the option. I am not saying that I necessarily support that model. That is a big question I have in my mind as to which model would be ideal. If the patient meets the requirements they will receive a prescription. However, interestingly, a number of patients do not use the medication in the end. I think that goes to the point that people want to have a safeguard.

I think that many people feel that, if they are in a situation that is irretrievable and they feel it is unbearable and they are going to die anyway and they would like to have that option there, when faced with that situation they do not necessarily feel the need. I am clearly concerned about vulnerable people. I have spoken about that in my speeches before. I have seen people, having worked as a physio in hospitals, who may feel coerced, that they have become a burden on society and there is nobody to look after them, and maybe it is just better for everyone if their life was to come to an end.

There is a further issue about a potential shift in culture in our health system. We had a bit of a discussion on ABC radio about doctors this morning, and I note that the AMA remains opposed to euthanasia. As far as the medical profession is concerned, doctors are governed by a code of ethics which, to quote Dr Andrew Pesce, 'does not allow administering of a treatment whose sole fundamental purpose is to end a person's life'. There is a balance that we need to take, and some might take the view that doctors ought to comply with patients' wishes, but I think that it is important to frame this situation against what is a fundamental tenet of being a doctor and the Hippocratic Oath, which is to do no harm.

Trust is also a cornerstone of the doctor-patient relationship, and that plays again into issues of people who may not understand what their rights are and may not understand that the laws do not apply to them and that they can safely seek treatment from their doctors without fear of euthanasia. The educated and articulate people in our community will always know their rights and will have done their homework, checked it on the internet, asked questions, etc.

I am very bemused by the fact that evidence from the Netherlands is being used by both sides of this debate, and I have not had an opportunity to review that evidence. I would really like to see a full literature review conducted by an independent source such as a journal of the calibre of The Lancet. I understand the scientific process and I think that the truth lies somewhere in between.

I feel rushed in this process and I am not seeking to say anything against the honourable mover, who has sought in good faith to have a proper debate on this bill but I think, given the weight of it, I do not think that I can make a decision on something which is as important as this under the circumstances. Really, we are debating the circumstances around deliberately ending someone's life which, under other circumstances, is considered murder and is a criminal act, and the highest safeguards need to be ensured. Under the circumstances, I am unable to support the bill at this time.

The Hon. S.G. WADE (20:32): In rising to speak on this bill I thank all of my constituents who have had taken the time and trouble to provide input to my considerations. I will not be supporting this bill. The bill is substantially the same as the bill before the council last year, so accordingly I will summarise my position rather than repeat it.

I would describe myself as a person who is conservative on euthanasia, rather than a person who is opposed to euthanasia in principle. While my Christian faith teaches me that it is not an option that I should see as available to myself, in a pluralist society and as a Liberal I accept that others make other choices, so I do not rule out euthanasia being made legally available to South Australian adults, including adult Christians who have a different understanding of our faith.

But I am in no rush to see legislation put in place that I believe would be a significant risk to a large number of people. I have been disturbed at the extent to which this debate is polarised into whether you support euthanasia or you do not. If you do, the expectation is you have to support every euthanasia bill, whether it is a good bill or a bad bill. I do not see this bill as a good bill. This is confirmed by events in the last two days.

The Department of Health advice, tabled by the health minister in the other place yesterday, highlighted a whole series of flaws in this bill. Further, today the Hon. Mark Parnell has tabled a series of amendments to the bill—46 amendments on the very day that this bill is due to be considered. This is no way to handle complex and delicate legislative issues. I will not support this bill at the second reading and will not support any future bill that has not been the subject of an orderly, thorough review.

Issues such as end-of-life decisions are too important to be left to chamber haggling and lobbying to remove enough obstacles to slip them over the line; that does not lead to good legislation. In terms of current practice, I appreciate that the current law and practice is open to abuse and that medical practice in palliative care can take us into grey areas that are morally and legally challenging. However, I think we need to be careful that, in our attempts to eliminate grey areas through euthanasia laws, we do not merely shift the grey areas and in the process put more people at risk.

I urge the council to see that this bill is so broadly drawn that it would effectively provide assisted suicide. The eligibility criteria effectively provide euthanasia on demand to people with no life-threatening illness. This bill does not merely follow the lead of overseas jurisdictions which provide euthanasia, it leapfrogs them and takes us into unchartered waters.

I do not propose to go through the bill in detail, but I want to focus on what for me is the fundamental issue, and that is the gate, the threshold eligibility criteria. When the general public talks about euthanasia they are usually talking about providing relief to people in the terminal phase of a terminal illness. People in this situation are covered by clause 6, the new section 3(d)(a) of the bill. However, this bill goes further. Clause 6, the new section 3(d)(b)(ii), entitles an adult to voluntary euthanasia if that person has:

...an illness, injury or other medical condition (other than a mental illness within the meaning of the Mental Health Act 2009) that...irreversibly impairs the person's quality of life so that life has become intolerable to that person.

These terms are vague and ill-defined. The Hon. Mr Mark Parnell argued in his second reading explanation:

...it does set the bar very high. It needs to be an illness, injury or medical condition that irreversibly impairs the person's quality of life. We are not talking about any disease, condition or illness from which you might recover and where your quality of life will improve: it is a narrow field of qualification.

I do not agree. The terms 'illness, injury or medical condition' are very broad. It is neither a high bar or a narrow field of qualification. It is not a high bar in that the injury, illness or medical condition could be medically relatively minor and yet irreversible. If a person with such a condition, for whatever reason, wishes to end their life this bill would deem them eligible and effectively give them access to assisted suicide.

It is also not a narrow field of definition. For example, what is meant by the term 'medical condition'? The bill does not even try to define a medical condition. The concept does not defy definition, in fact the South Australian Public Health Bill, which is currently before the other place, includes a definition of exactly that term. That bill describes 'medical condition' as:

a medical symptom or pattern of medical symptoms, including symptoms discerned from any signs or results of investigations...

It goes on in another clause to talk about:

an illness or injury arising from a person being contaminated by one or more substances or biological pathogens:

That, for example, is a very broad definition. Likewise, the government's road safety website lists a range of what it deems as medical conditions that are legally relevant in terms of fitness to drive. They include conditions such as: diabetes, epilepsy, heart disease, stroke, arthritis, glaucoma, cataracts, macular degeneration, sleep disorders, ADD, ADHD, alcohol or drug dependency, fainting, Parkinson's disease and neurological conditions, dementia, Alzheimer's, giddiness, dizziness, high or low blood pressure.

Without a definition, how are we supposed to interpret this bill? All of these medical conditions are likely to come within the public health definition of medical condition. Why would they not come under the definition in this act? An euthanasia bill is dangerous if it allows criteria which are so broad and ill-defined. As I highlighted in my contribution on the previous bill, people with a disability are likely to be deemed to have an illness, injury or medical condition that irreversibly impairs the person's quality of life.

From the moment a person with a disability reaches the age of majority or from the moment of acquisition of the disability if they already are of majority, they would be entitled to voluntary euthanasia under this bill even though they might be expected to live for decades and, for that matter, live fulfilling and contributing lives.

There may not be any sign of a life-threatening illness. A person could ask for euthanasia when that person had only recently acquired a disability and before they had even had the opportunity to re-frame their life expectations in the context of that disability. I consider that the ready access in this bill of euthanasia for people with a disability is effective discrimination, but then the bill compounds the discrimination by excluding people with a psychiatric disability. The Hon. Mark Parnell in his explanation justified this double discrimination by saying:

The reference to mental illness is important because, as most of us know, mental illnesses can be treated, and can be treated successfully.

This is simply not true. There are a number of mental illnesses that can be treated in the sense of being alleviated but they are not treatable in the sense of being able to be eliminated. If a residual non-psychiatric, chronic disability which a person finds intolerable meets an eligibility criteria for euthanasia why should a residual psychiatric disability fail to do so? To me it is yet another example of the dog's breakfast that this bill has become. I urge the council to reject the bill and to do so at the second reading.

The Hon. A. BRESSINGTON (20:40): I also rise to speak to the bill put before us by the Hon. Mark Parnell to allow voluntary euthanasia to be available via palliative care in South Australia. First, I want to say that I believe that the Hon. Mark Parnell has put together a bill in good faith and I believe that he has done it for the reasons that he says. However, at the outset let me say that I believe that individuals in the final stage of a terminal illness should have the right to say, 'I have suffered enough.' I do not believe that this decision should be left up to the treating physician and other family members, as occurs now, with what is known as double effect, which technically allows a physician to administer pain relief in doses that will see the person who is ill eventually die as a result of trying to achieve pain relief. I have difficulty accepting that double effect is the ideal situation.

However, I have difficulty in coming to terms with the notion that we are all terminally ill. I must say it was this statement that caused me to rethink long and hard about how this bill could and possibly would be amended in the future. This is not a moral issue for me, nor is it one of religious belief. It is an issue of responsible legislation which I am paid by the people of this state to undertake. Those who are pro voluntary euthanasia deny such a thing as a slippery slope but I have seen for myself how that slippery slope works over years and years of persistence. The effort that goes into changing people's perception often causes confusion. First, it is my observation that this occurs by creating a problem through recruiting individuals to tell of their hardship and heartbreak so that the wider community is struck with a sense of compassion. I do not believe that compassion is why we should put together legislation in this place.

Then, of course, we see government's inability or unwillingness to address the core issue and, in this case, it is effective, accessible and affordable palliative care for the sick and dying. Then we allow the debate to rage for years, if not decades, allowing time for the message to sink in and for people to be literally worn down by the stories and the dysfunction of the system. I am also not afraid to say that, during that recruitment period of years and even decades, we are fed all sorts of statistics to ensure that, if you are opposed to the idea, you will feel as though you are in the minority and, of course, if we speak out publicly we are led to believe that we are in need of serious medication or that we are heartless fiends.

One such example is the imbalance of information. I agree with the Hon. Michelle Lensink, I might say, that we do need an absolutely independent review of all the literature because both sides of this argument (and every other argument) will come up with their own stats and research to prove their point of view. We are seeing that happen more and more. Science is being discredited in one way or another and none of us know who to believe anymore. I think that is a sad case.

Over 6,300 people participated In the Adelaidenow poll and 25.1 per cent said yes to the question 'Should euthanasia be legalised in South Australia?' That was conducted last night and today and I think these figures were obtained at 10 o'clock last night—74.17 per cent said no, and 0.73 per cent remained unsure. Then there was a poll which said that 87 per cent of Australians are in favour of euthanasia. We all know, as the Hon. Robert Brokenshire pointed out, that it is actually how we ask the question that will probably determine the answer.

I do not believe that these sorts of polls are what we should be basing our decisions on. If we are going to get down to the nitty-gritty of it, I believe, let's have the absolute poll. Let's have a referendum on this and make sure that, if we are going to vote for or against euthanasia, it is done through the will of the people. We know that, before referendums, both sides will be educating people who are prepared to listen but, at the end of the day, this voluntary euthanasia bill should be the decision of the people. I do not believe that any of us in here are qualified, or unbiased or uninfluenced enough to be able to make a decision that is going to affect every person in this state, one way or another.

The decision should be up to the people who are going to actually be accessing it or are going to be affected by it. There is a rising concern out there in the ability of the major parties to protect the best interests of the people, and I say that concern is probably well deserved. Experience shows that the best indicator for the future is the past and present. Again, I stress that I see little that convinces me that this, or any other, government is grown-up enough, or fit and proper enough, to monitor, oversee or report on what the true effects of voluntary euthanasia may be in five, 10 or 15 years' time.

We all witness every day that apologising or rectifying mistakes is not a strong point of the major parties, let alone acknowledging that a mistake has ever even occurred. It seems it is so much easier to create a story of spin to cover up any misdeeds or to persecute anyone or any person who may blow the whistle on the fact that all is not well. If there is anyone who does not believe that this occurs daily in this state, then I invite you to come into my office for a month and listen to the story upon story where public policy and legislation are being abused and our average citizens have absolutely no recourse.

I will just refresh members' memory on issues that remain unresolved and adversely affect the people of this state: drug addiction, mental health, child abuse (past and present), WorkCover, the child protection system, disabilities, the Housing Trust, victims of abuse in state care and abortion. I have got to say that the issue that absolutely was my tipping point was forced water fluoridation. I say that, not because I believe that I should be believed about the science that I have read. What has absolutely gobsmacked me is the reluctance to look at the science and then do our own studies and find out for ourselves.

If that is the case with this and with all of those other issues—child abuse, WorkCover, all of those that I mentioned—I guarantee you that most members in this place have a solution to those problems. We know what the core issue is of each one of those problems. We can put up pieces of legislation time and time again and have them rejected because it is going to cost money. What do you think is going to happen with VE down the line? If we cannot solve these problems now, and we are allowing them to roll on for decade after decade, with the same inquiries going now that were going 40 years ago, how many lives with voluntary euthanasia would be lost in the process of trying to turn that around?

That is the guts of my problem with this—no faith. I have no faith at all in governments' ability to review honestly and fix problems. Then of course, we had the breaking of the EBAs with the Public Service, which is sort of off-track again, but this government cannot keep its word. It cannot keep its promises. I stress that trust and confidence in any authority must be earned, and that is done by governments keeping their word and doing their best to solve problems for their constituents and by governments, and every member of parliament, serving the people who pay us to do so.

I believe that this issue should go to a referendum and I do not believe we are going to resolve it in any other way. I also stress that my comments should not be seen to reflect poorly on the Hon. Mark Parnell. As I said in the beginning, I believe that he has tried to put the best into this bill that could be done. He has tried to be careful but I do not think we can be careful enough. Right here and right now, I can only base my judgement on what I have seen over the past 4½ years and consider how this legislation would play out in the future. In this case, a slippery slope is a deadly slope.

Let us go back very quickly to the issue of abortion where we were told, when that legislation came in, that it would be for medical purposes only—if a mother is at risk of dying giving birth to or carrying a child—and a few minor exclusions. I have heard from a number of young women who have literally been forced to have abortions: they have been offered no other option. We are told that that is a pro-choice issue, just as we are being told that euthanasia is a pro-choice issue, but these young girls did not feel that they had a choice.

I met with a woman who had an ultrasound on her unborn baby and the doctor told her that there was a possibility that the baby could be Down syndrome; before the end of that consultation that doctor had her booked in to go over the border to Victoria to have an abortion, because she had to be there by the following Thursday. She had to go home and break the news to her husband that the baby could possibly be Down syndrome. He said, 'I don't want a disabled kid; yep, have an abortion,' but she insisted—insisted—on an amniocentesis test, and that test came back negative. It was a fine, healthy baby.

These things are happening here every day; we were promised with abortion that they would not happen, and now we are talking about a debate on decriminalising abortion, which will involve what has happened in Victoria—full-term abortions. I do not care what anyone says and I do not care if it is just not hip to be pro-life, but we cannot keep a handle on this. There are slippery slopes; they do exist and they are allowed to exist, and people's perceptions are allowed to be changed until they are confused between what is right and what is wrong. I believe that that would happen with voluntary euthanasia no matter how many safeguards we have.

There being a disturbance in the Strangers' Gallery:

The PRESIDENT: Order! The gallery will not applaud any speech or I will have you all put out on the street.

The Hon. J.S. LEE (20:53): I rise tonight to contribute to this bill introduced by the Hon. Mark Parnell. I acknowledge that I have received a total of 658 pieces of correspondence to date, consisting of 419 emails, 212 letters and 27 phone calls. I have personally opened each letter and email every day since the bill was introduced. Many letters were handwritten and very moving. I appreciate the time taken by people to submit their views with much consideration and sincerity.

I note that this is one of the few bills in this place that involves a conscience vote. As a new member of parliament, I have not spoken on the subject of voluntary euthanasia publicly before and this will be the first time I have the opportunity to place on record my views on this matter. I thank the many people who have attempted to meet with me, write to me and provide me with details of their strongly-held views, based on their own circumstances, on religious or moral grounds, or through work that they do as medical or legal professionals.

I came into parliament with an open mind to evaluate whether voluntary euthanasia is the right thing to have. I acknowledge the representations and contributions made by the public to my office which have assisted me in my deliberations. I also acknowledge the honourable member for showing compassion to those who are suffering and have no chance of recovery and commend him on his strong campaign attempting to give people the choice to die, by passing a bill to alleviate suffering.

As a Liberal, I strongly support the principle that people should be given the freedom and choice to do what they want with their lives. I do not doubt that this bill is introduced by the honourable member with good intentions. I have heard his passionate debate and his sincere plea on this matter. I would also like to commend the supporters of those who have campaigned long and hard, for example, the South Australian Voluntary Euthanasia Society, Christians Supporting Choice for Voluntary Euthanasia, and others.

I have taken the time to study the proposed legislation closely and listen carefully to all sides of the argument and tonight I have heard many contributions made by honourable members in this house. No-one enjoys seeing people suffering on their deathbeds, so I tried to look for ways to consider supporting the bill. I want to be assured there are enough safeguards in place, because this is a serious matter calling for a deliberate act of ending somebody’s life. As legislators, we are asked by our constituents to use our judgement and to take into consideration all the views people present.

From the high volume of correspondence I received—some 658 in total—people are either in favour or strongly against. There is not much of a middle path. I asked my office to meticulously organise the correspondence into two folders. The calculation provides us with the anecdotal evidence that more than 70 per cent of those people who feel strongly about the matter want the elected members to oppose the bill. The more research I did and the more submissions I read, the more concerned I became that there will be unintended consequences if this bill is passed.

Out of the piles of letters I received, I was moved by many compelling arguments both for and against voluntary euthanasia. I would like to refer to a particular letter from someone who is suffering from terminal illness. I believe he will allow me to mention his name. He is Associate Professor Nicholas Tonti-Filippini. When I read the opening of his letter, I thought he was asking me to support the bill so that he would not need to suffer any more pain and because he would like the option of dying with dignity. However, this was not the case. To allow honourable members to understand his submission, it is important that I read some paragraphs from Associate Professor Tonti-Filippini. He said:

I write this letter to you in my own name only, and not in the name of my institute, of any government committees in which I am involved, or any other organisation. I write because what happens in South Australia on this matter will affect all Australians, particularly those who, like me, meet the requirements of the bill.

I cannot speak for all people who suffer from illness or disability, but I think I can speak more credibly about suffering, illness and disability than those people who advocate for euthanasia presenting an ideological view of suffering and disability. Facing illness and disability takes courage and we do not need those euthanasia advocates to tell us that we are so lacking dignity and have such a poor quality of life that our lives are not worth living.

The Associate Professor informed me in his letter that he is dealing with a terminal illness and is dependent on haemodialysis and palliative care. He has undergone 15 angioplasty procedures and the placement of eight stents to attempt to recover some blood flow after the failure of coronary bypass surgery. The last such procedure was unsuccessful as the blocked artery could not be accessed.

He mentioned these matters to establish that he is no stranger to suffering and disability, and he is well aware of the limitations of palliative care. He understands clearly that it is particularly difficult to control chronic pain because the effectiveness of most forms of pain relief is of limited duration, given the development of therapeutic tolerance. He mentioned that he has reached the limit of what palliative care can offer; however, he strongly opposes voluntary euthanasia.

Other members in this council may also have received the same letter and would then be aware of the associate professor's professional background. I think it is important that I mention some of his career experience. He has been involved with issues to do with the care of the terminally ill for many years. He was Australia's first hospital ethicist 28 years ago at St Vincent's Hospital, Melbourne, where he was also the Director of Bioethics for a period of eight years. His current position is based at the John Paul II Institute.

Associate Professor Tonti-Filippini recently had the experience of chairing a national Health and Medical Research Council working committee, preparing guidelines for the care of people in an unresponsive or a minimally responsive state, receiving a large number of public submissions on the topic. I encourage all members to read the public submissions on the national Health and Medical Research Council's website. I will continue to quote the associate professor. He said:

As a chronically ill person, I know well what it is to feel that one is a burden to others, to both family and community, how isolating illness and disability can be, and how difficult it is to maintain hope in the circumstances of illness, disability and severe pain, especially chronic pain.

For several years, I received from my health insurer a letter that tells me how much it costs the fund to maintain my health care. I dreaded receiving that letter and the psychological reasoning that would seem to have motivated it. Each year I was reminded how much of a burden I am to my community. The fear of being a burden is a major risk to the survival of those who are chronically ill. If euthanasia were lawful, that sense of burden would be greatly increased for there would be even greater moral pressure to relinquish one's hold on a burdensome life.

He continues:

Seriously ill people do not need euthanasia. We need better provision of palliative care services aimed at managing symptoms and maximising function, especially as we approach death. Rather than help to die, the cause of dignity will be more greatly helped if more was done to help people live more fully with the dying process.

The proposal to make provision for a terminally ill person who is suffering to request assistance to die from a doctor makes it less likely that adequate efforts will be made to make better provision for palliative care services.

Medical research in this area indicates that the desire for euthanasia is not confined to physical or psychosocial concerns relating to advanced disease, but incorporates hidden yearnings for connectedness and care and respect, understood within the context of the patient's lived experience. Essentially, the bill involves setting up a category for people whose lives may be deliberately ended.

If euthanasia is lawful, then the question about whether our lives are overly burdensome will not only be in our minds, but in the minds of those health professionals and those family members on whose support and encouragement we depend. The mere existence of the option will affect attitudes to our care and, hence, our own willingness to continue.

There are many problems with this bill. The bill has a very wide scope and affects not only those who are imminently dying, but the definition of 'terminal illness' includes people who may be months or years away from their illness causing death. People who are ill and disabled need support and encouragement and the knowledge that those around them value them.

The bill has not been generated by a broad-based inquiry—which has already been recognised by other honourable members in this council—that took into account the interests of all South Australians and especially those with a chronic or terminal illness and those who are marginalised. It is a narrow approach that excludes the provision of adequate care and support for those in need.

The bill would expect the doctors involved to prescribe a drug not for legitimate purposes that define the medical vocation, such as the care of the patient or the treatment of illness, but to intentionally and actively intervene to end the life of the patient. In that respect, the bill is not supported by the Australian Medical Association, or any of the medical colleges. The AMA policy on euthanasia is to strongly oppose any bill to legalise physician-assisted suicide or euthanasia, as these practices are fundamentally inconsistent with the physician's role as a healer.

The bill has not been supported by organisations and institutions directly involved in aged care, the care of the dying or the care of those with chronic illness. Those involved in day-to-day care are generally not in favour of being given the capacity to end the lives of those they care for. The bill will not benefit South Australians who suffer from chronic illness. Instead it will make protection of their lives dependent on the strength of the will to continue. The fear of being a burden is a major risk to the survival of those who are chronically ill.

The option of euthanasia provides a way out for families and carers and the fact that the options exist will be likely to make someone who had a burdensome illness feel even less valued and increase the likelihood that they would choose death over dying alone or being a burden to others.

Pain and suffering are complex, involving physical, psychological, emotional and spiritual elements as recognised by other honourable members in the council. I believe that palliative care seeks to address the needs of those who are suffering in a multidisciplinary way that reflects the many elements involved. There are many minority and sub-populations within our society who are already vulnerable in the existing health system, such as the Aboriginals, migrants and refugees. There are also vulnerable people who are suffering from depression and mental illness who may be at risk if this bill is passed.

I work with so many people in the multicultural community and the knowledge of euthanasia among many of the non-English speaking migrants and refugees is very low. A huge amount of economic and human resources will be required to formally survey their understanding of euthanasia laws and then to educate them about their rights under those laws. This would require the services of qualified interpreters. Not only should these interpreters be competent with the specific language skills but also be armed with a good level of understanding of euthanasia and its legal implications. Unfortunately, these interpreters are not always available.

A letter I received from a doctor from the Northern Territory confirmed my views that euthanasia law will bring harm to vulnerable people who are socially marginalised and who have low health literacy in the community. I would like to read some of the paragraphs from this doctor. The letter states:

I am writing in my personal capacity as a doctor who has significant links to South Australia. I was trained at Flinders University in Adelaide. I am an adjunct associate lecturer at Flinders University. As a doctor in Alice Springs, I have referred many of my seriously ill patients for investigation and treatment in Adelaide. I also have many Pitjantjatjara patients and friends from South Australia.

My main purpose for writing is to make you and your colleagues aware of the way that this bill may adversely affect Aboriginal residents of South Australia. I acknowledge a small proportion of people with terminal illnesses cannot respond to good palliative care and are thus motivated to end their lives. However, amending the law for their sake will put the wellbeing and even the lives of many vulnerable people in danger.

As you are aware, Aboriginals in this country experience significant social disadvantage and consistently have worse health outcomes. They are overrepresented in mortality statistics and they die significantly younger than the rest of the Australian population, often of very preventable diseases.

Recently, he said he spoke to some Aboriginal friends from South Australia about this proposed bill. They had never heard of the term euthanasia before. They were horrified that, if this bill were passed, a doctor could kill them. These Aboriginal friends of his are quite typical of the northern South Australian Aboriginal community. He encountered these people regularly in his profession and he said that they do not speak, read or write much English, they have few economic assets and are reliant on Centrelink payments. They experience much social breakdown and discrimination.

With those people in mind, in summary, I would reiterate that legalising euthanasia or physician-assisted suicide is likely to create fear and mistrust in Aboriginals and other marginalised subpopulations in Australia who are sicker but who have less ability to navigate the health care system. I respect the views of others who might have a different view to mine or those I represent. What I am afraid of, and many have expressed the same view, is that voluntary euthanasia will inevitably mean in some cases involuntary euthanasia, especially those who are marginalised in our community, who may become the first victims.

I oppose the bill for the reasons I outlined. If this bill is passed, it will put many vulnerable and uneducated people at risk. It will jeopardise the trusting relationship between doctors and patients. It will allow a situation where people (especially those in vulnerable circumstances and from non-English-speaking backgrounds) are afraid to see their doctors or fill in some paperwork approved by a board which would lead to a situation that allows a doctor to legally administer a lethal injection to end a person's life. I do not believe this bill provides protection to the most vulnerable in our community, and therefore I will not be supporting this bill.

The Hon. J.A. DARLEY (21:11): I would like to speak very briefly on this bill. In 2009, I supported the Hon. Mark Parnell's bill after he made additional changes to provide safeguards. I am still satisfied with the safeguards in this piece of legislation and therefore I will be supporting the bill.

The Hon. K.L. VINCENT (21:12): I rise briefly to make my contribution to this debate. To begin, I would like to thank the Hon. Mark Parnell and Steph Key MP, member for Ashford in the other place, for hosting an information session on the topic of voluntary euthanasia some weeks ago. I would also like to thank the Hon. Dennis Hood and Tom Kenyon MP, member for Newland in the other place, for hosting a similar session here at Parliament House.

I thank the Hon. Mark Parnell for acknowledging my presence at his information session in his closing remarks. If I recall correctly, he referred to me as a new member of the Legislative Council who takes their job very seriously, and if I may flatter myself for a moment, I would say that the Hon. Mr Parnell is indeed correct. I do take this job very seriously and consequently I have not entered into my consideration of this bill lightly, particularly since it is a conscience vote.

I recognise that voluntary euthanasia is a very controversial and emotive topic and one that is often heavily interwoven with religious and spiritual beliefs. I myself am indeed a woman with religious and, moreover, spiritual conviction. In fact, I believe that I have one of the closest possible relationships to God and, if I may, I would like to take the opportunity to thank him for his guidance. He knows that I love him dearly and I believe that no matter what the outcome of this debate, our relationship will not be made weaker.

If the truth be told, I have spent more than one sleepless night—literally—debating this bill in my mind. I know that no matter which way I speak or vote, I will disappoint many people and I would not be surprised if delivering this speech should prove to be remembered as one of the most difficult things I do during my term in this chamber. However, at the very least, I have worked very hard to come to what I believe is the right decision for the citizens of this great state in which we live, and I ask members of the chamber and members of the public, regardless of their own views, to try to respect that.

I speak in support of the Mark Parnell/Steph Key bill for a variety of reasons, which I will now do my best to outline clearly, although it might not be so easy given my emotive state. Although I am not following the party line, so to speak, on voting on this bill as d4d do not have a specific policy regarding voluntary euthanasia, it is known to all in this chamber that our motto is 'Dignity through choice'. So, to put it simply, I believe that those wanting to end their life for the right reasons should have that choice.

However, I cannot possibly emphasise strongly enough that it must be an informed choice that is ultimately made by the person who is the subject of the VE request. This is fundamental to the concept of voluntary euthanasia. Of course, I am not saying that a person should come to this conclusion in complete isolation. It is only natural that one should consult one's friends and family regarding issues as intimate and interpersonal as this. But, at the end of the day, it must be the person requesting euthanasia who drives the process.

It is important to note also that a person making a request for voluntary euthanasia must be assessed by at least two doctors: one, the GP they visit when making the original request; and, secondly, a medical practitioner who specialises in the condition which the subject of the request claims is making their life intolerable for them. Both doctors must inform the requesting person of the palliative care options available that may be used as an alternative to ending life. These doctors must also make reasonable inquiries to ensure that the requesting person is not acting under duress, inducement or undue influence, for instance, the belief that they are a burden on their family. These points in the bill give me some comfort as I am acutely aware of some concern in the disability community that people with disabilities may choose to end their life so as to no longer be a burden on their families in terms of their need for personal support.

I note with some relief that, if the doctors involved in the VE request suspect that the person is in fact acting under these external pressures, the person must then be referred to a psychiatrist, who will assess their mental and emotional state to help ensure that they are making the request for the right reasons. I must say, however, that I desperately hope that anyone considering ending their life would be consulting a mental health professional in any case, and encourage them vehemently to do so.

It is important to keep in mind that under this legislation a person must be an adult, that is, over the age of 18 years, and certified as being of sound mind in order to be eligible to make a request for voluntary euthanasia. The request practitioner must also certify that the person who is subject of a request is able to understand the nature and the full implications of that request. This will protect people with intellectual disabilities, for example, those whose disabilities affect them in such a way that they cannot fully understand the nature of voluntary euthanasia. If somebody has the capacity to understand, then in my opinion they should be empowered to make that choice. Again, this bill seeks only to offer voluntary euthanasia as a last resort, available only to those who are able to make a truly informed and self-driven choice, people who are dying or people who believe their lives to be intolerable.

I now move to what is for me the most contentious part of this bill. The Hon. Mr Parnell and Ms Steph Key have made a decision I can only call courageous and gutsy to extend the eligibility for voluntary euthanasia beyond those in the terminal stage of a terminal illness. If this bill should pass, which I admit I do not expect will happen now, it would also make VE available to people with a medical condition which they consider to be mentally, emotionally or physically intolerable. It has been pointed out to me on more than one occasion—although I am already very aware—that under this section of the bill I myself technically could choose to end my life using voluntary euthanasia due to my cerebral palsy. Although I recognise that it may be somewhat emotive and even inappropriate to use my own personal circumstances as an example, I can see that this is in fact true.

Under this bill a person may choose to end their life due do a disability, and I will admit, of course, that this has been somewhat alarming and, to a certain extent, offensive to me. When I first realised that a person may request VE due to a disability under this bill, I found myself thinking: is my life worth less than average purely because of my disability? Is my life really that difficult and am I really a source of pity? But I had become far too subjective in my thinking.

I have already spoken in this chamber on several occasions about my belief that my disability is a blessing in my life. If I did not have it, I would not be here today. I feel that I have lived many lives, particularly for someone of 22 years of age, and have achieved many dreams, both in spite of and because of my disability, and I am sure that I will go on to achieve many more. Therefore, it goes without saying that I believe that the answer to the question is my life worth less than average due to my disability is a definite no, but I say this speaking only from my own perspective.

I can only ever know what it is like to live with my exact, unique case of my disability and in my body and in my mind. Yes, there are fleeting times in my life when my disability causes me some frustration and even sadness, but I cannot see a future in which this would ever cause me to want to end my life, but that is only my story. Pain and suffering are very subjective things, and though I would do all in my power to help someone with a disability who was considering ending their life because of it to see that there may be other options, at the end of the day I can never live in their skin and it is not up to me to say that their life is either tolerable or intolerable.

Although I have been a supporter of the concept of a well-informed, well-monitored voluntary euthanasia scheme for some years now, I will admit that this section of the bill has made it a lot more difficult for me to come to the decision to support it. I find myself wondering: if I oppose this bill on the grounds that I am fearful that people may choose to end their life due to a disability, am I protecting them or am I, in fact, discriminating against them? Again, I must do all I can to remain objective in my deliberation.

I have been contacted by numerous people who either have disabilities themselves or care for or love someone with a disability and who speak to me of that same fear that some people with disabilities may choose to end their lives using VE due to the negative effects of not having adequate disability supports. For example, living in an inaccessible house. I, of course, appreciate these concerns and put on the record in the strongest possible terms that I believe that this is yet another reason for the government to stop sitting on its hands in terms of efficient and adequate disability service provision.

While some may see this as a reason to oppose the bill, I believe that this bill will not lead to a greater number of people with disabilities banging down the doors of doctors for I believe that the will to live is strong in all of us, as many members have already touched on. We have not seen thousands of people taking up VE in the Netherlands or Oregon. Of course, there may be some individuals who consider their life to be intolerable because they do not have access to services, and I would encourage those people to put the government to notice, to let them know that I am here to stand for them, but, ultimately, it is not up to me to deem their life tolerable or intolerable.

Mr President, I am sure that I do not need to explain to you or anyone in this chamber that it would be a shame, an unspeakable shame on the government and the entire history of this country if people with disabilities were to start expressing an intention to end their lives in order to get the government to sit up and listen. This would yet again perpetuate the idea that this government seems to find it acceptable that people with disabilities have to beg, fight and scrounge for so-called services which the majority of people take for granted as simple human rights.

One has to wonder how many reasons for change the disability community has to present before the government will respond with more than a few crumbs. I put it to the government yet again that immediate action must be taken to improve the lives of people living with disabilities. However, I cannot rightly express how insulting it would be if the government stepped up to the plate simply because it feared people may die and not because it is and always has been a basic human right to access these services.

I do believe in the sanctity of life but, over the past few years, I personally have come to understand that there is perhaps some difference sometimes between a true life and a mere existence. This is again a very subjective and complex belief so I will not go into every detail. Yes, I believe that life is a great gift, as long as it is full of growth and joy and all of the energies that make it so. However, I do not wish to condemn any person to an existence in which all of this energy, so to speak, is gone, unless they wish to hold onto it for their own personal reasons.

I think it is important to mention also that I believe this bill does more than to allow the peace and dignity of the people who want to end their lives using voluntary euthanasia, but also their families. Just the other day I was speaking about voluntary euthanasia with a very dear friend of mine whose mother died of cancer some years ago. He said to me, and I paraphrase, 'Watching her pass away naturally was awful, but thank God she didn't ask me to do it because I would have had to.'

Although I have been fortunate enough never to have found myself in this situation, it does resonate with me enormously. If someone I loved dearly were dying or were adamant that they wished to die, for the right reasons, I would not want to let them go under any circumstances. This is only natural. However, physically, emotionally, and perhaps even morally, at some point in time I would have to let them go.

So I personally would rather it be under the circumstances and at the time which they deem appropriate and in accordance with their own wishes. No person should ever have to live with the unimaginable pain and guilt that must come from being asked to end a loved one's life and, worse still, feeling obligated to act on that request.

As I have already said, it has been a great struggle for me to come to this decision and I feel as though I have outlined my point of view as clearly as I can without becoming emotive—although, clearly, I wrote that part of the speech before I did, in fact, become emotive. To be honest, I feel that I am doing something that is against my beliefs either way I vote today, but I will conclude by saying that if I believe in the human right to a dignified and peaceful life that is driven by autonomy and choice, then I must vote for the rights of South Australians to a peaceful and self-driven dignified death.

There being a disturbance in the President's gallery:

The PRESIDENT: Order! The Hon. Mr Finnigan.

The Hon. B.V. FINNIGAN (21:28): I think the contribution from the Hon. Ms Vincent tonight has highlighted the quality of the contributions that honourable members have made, and the thought and very careful consideration that they have put into their deliberations on this bill. I commend all honourable members for that. I join with the other honourable members who have thanked the very many correspondents who have communicated with me about their views on euthanasia and on this bill.

I made a reasonably lengthy contribution on the very similar bill that the Hon. Mr Parnell moved about a year ago, and I draw honourable members' attention, or anyone who is interested in my views, to that contribution. I will not go through all of that material again, given that we have quite a bit to get through tonight, but I will just run through a few of the arguments that we have heard in relation to why this bill should be supported and then deal with some of the particular provisions of the bill.

To look at the general case for active voluntary euthanasia, I think the most common argument we hear is that it is simply a matter of choice and that individuals should have the right to choose the time of their own death. However, a number of honourable members have highlighted that it is very difficult to guarantee that they are always making that choice freely and independently however many safeguards we might put in place. I am particularly concerned that some may feel an obligation that they ought to end their lives to cease being a burden to their family—or even to the state.

In particular, I would fear that, whilst it might seem fanciful, now we all know that the pressures on the health budget will continue, I certainly would not want it to become considered desirable for people to choose euthanasia simply as an economic measure. I note one correspondent in favour of the bill said:

Our society is not at good at valuing, nurturing and caring for the elderly and infirm. It is a low public funding priority and care personnel are poorly paid. Alarmingly, some are unsuited to the role and typically receive minimal training and supervision.

I think already there are concerns in the community, clearly, about the level of care that has been provided to the elderly and infirm—and to those who might be suffering from a terminal illness, certainly, I would not want euthanasia to be seen as some sort of solution to concerns that people might have about the quality of care.

Another argument which is often raised and which has been in correspondence with me is that we put animals down, so why don't we do the same to humans because that would be the compassionate thing? I do not think that any honourable members have brought that argument up but it is certainly one of the most common I hear in the community. Perhaps it is a country thing, Mr President, that people are more accustomed to animals being euthanased. Again, I reiterate that it is not really a comparable situation because the whole point of animals being put down is that they have no choice about that at all.

The other point to make about that is simply that the reason we regularly euthanise animals is because, however much we might love and value them, we do not value their lives as highly as that of human beings. I made this point in my previous contribution a year ago that it is a reality that, however much we might value our animals, pets especially, we do not consider them to be on the same level as humans. We do not offer them the level of palliative care, organ transplants, quadruple bypasses, and so on, that we do for human beings.

Some animals do receive those sorts of treatments but, as a rule, and certainly as a public policy matter in terms of government funding, we do not provide that sort of level of care to animals. So I do not really think that we can make a comparison and say, 'Well, we put animals down therefore we should do the same to humans.' It is precisely because we do not consider animal life to be as valuable as human life that we have a very different approach to the way in which we deal with them.

One of the most common arguments, again, that gets brought up in favour of euthanasia is the level of public support, and we have heard that many times in this debate in this house; that over 80 per cent, 85 per cent—whatever figure gets thrown around—of the population support active voluntary euthanasia. Again, I would make the points as I did in my previous contribution, first, is this figure right? That is a very difficult thing, I think, to assess. I am not doubting the results of the Newspolls, and so on, but I do doubt how valuable that guide is to people's genuine views on the matter when they consider the totality of what it means to legalise euthanasia.

Certainly, I am aware of qualitative research where people are much less receptive to the notion of active voluntary euthanasia when the full context is put in place and they have a more thoughtful discussion about it rather than a 30 second phone call with a pollster. In particular, I think there is some misunderstanding about what is meant by 'voluntary euthanasia'. A considerable number of people, I think, still think it is about withdrawing treatment or not receiving treatment.

I have noticed quite a number of the correspondents in favour of euthanasia saying, 'I don't want to be stuck on a machine for years in a hospital,' and that really is not something that this debate is about. There is already means for them to ensure that that does not happen.

I highlight again that, in the United States, where there have been plebiscites of states where they have introduced doctor-assisted suicide, it has been a narrow majority who have supported it. Again, that is for doctor-assisted suicide: the provision, by doctors, of a lethal dose to patients, who take it themselves. Nowhere that I am aware of has a majority of people in a plebiscite supported active voluntary euthanasia, that is, the ability of doctors to give people a lethal injection or otherwise to directly end their life.

A number of honourable members have said that we really need more indepth study and consideration of this issue or that we should indeed have a plebiscite referendum, as the Hon. Ms Bressington said. Certainly, I would not fear any of those options, although I do not believe that a referendum is the right approach. However, where there has been indepth study of the question, such as in the United Kingdom and in the Tasmanian and Western Australian parliaments recently, when people drill down and have a look at what it would mean to have voluntary euthanasia in practice, they pretty much always come back and say that it is not good public policy.

Again, I have had a lot of people (and correspondents writing to me) saying that this is about peace of mind. Well, we do not legislate to ensure that people have peace of mind. I understand why it is that people are seeking that, but that may well be because of a fear of what might be or what might happen to them or how they might cope with something in the future rather than the reality before them. I think there are also those misunderstandings about the rights that currently exist for patients to refuse treatment or to ensure that they are not placed in a position where they are receiving treatment they would not have wanted.

We have heard that palliative care is insufficient in all cases. I think that for a lot of us there is a lack of information about the quality of palliative. It is not something that we are all expert in, and we do tend to base a lot of our understanding on our own experience with loved ones, which may or may not be particularly relevant in terms of how it affects a lot of people. My mother died of cancer in 1991, and my father died of cancer 10 years later. Even in those 10 years, there were enormous advances in palliative care to the point where one slow release pill daily was enough to provide my late father with adequate pain relief.

I am certainly grateful that my parents both died at home with their loved ones to hand. I accept that is not everyone's experience, and I do not suggest that should be the determinant of how I or anyone else vote. However, in my own circumstances, I can certainly say that the way my parents died, very much at peace with themselves and with their family, reinforced my own opposition to euthanasia.

We have also heard that, while the hierarchy of churches and some doctor organisations are against euthanasia, I am not convinced that is the case amongst the rank and file or the ordinary person in the pew or in the medical profession. While there are certainly regular churchgoers and people in the medical profession who support active voluntary euthanasia, I do not think there would be anywhere near a majority.

When it comes to Christians, I would say that, particularly among churchgoers, there would not be, in my view, a majority of people in favour of active voluntary euthanasia. Certainly, in my own experience in the holy Roman Catholic Church, I have not noticed any walkouts or anything when a priest or anyone else talks about euthanasia. Indeed, many parishes have been active, as we have seen, in responding to calls from Anglican and Catholic archbishops in recent times to make their views known on this issue.

It is not especially relevant whether or not the church hierarchies reflect the views of churchgoers because we have to decide this matter as legislators and as a matter of public policy, but it does seem to be often said by proponents of active voluntary euthanasia, in particular, that it is really just a few religious zealots who are blocking this, and that everyone else is in favour of it. I certainly do not think that is the case.

Another argument that has been advanced again in this debate is that we should regulate active voluntary euthanasia because it is happening already; therefore, we ought to regulate it and have a system for governing it. This seems to me one of the most incongruous arguments of all to suggest that doctors are currently engaging in a practice which can result in them being struck off the medical register and charged with murder and that therefore implementing a system where they sign some forms and have a couple of medical opinions about a patient's condition would be a preferable system.

It seems to me very illogical to suggest that, where people are taking inordinate risks to carry out an action against the law, where the consequences are potentially very grave for them as individuals, somehow those people will be much more respectful and abiding of a legal system that allows active voluntary euthanasia. If people are prepared to engage in that sort of conduct at the moment, with the potential consequences that it brings, I would suggest that I would be far more fearful of what conduct they might consider acceptable in a more lax or liberal regime than currently exists.

I will turn now to the particulars of the bill. As I have indicated and as I think a number of other honourable members have highlighted who are more inclined or sympathetic to active voluntary euthanasia than perhaps I am, I do think this is a particularly flawed bill in any event. A number of honourable members have raised the definition in particular about a person wanting to bring about the end of his or her life should life become intolerable for the person. That is indeed, I believe, very unfortunate standard to set.

There are other bills that people have moved, including the Hon. Mr Such in the other place, which at least specify that people have to be in the last throes of a terminal illness. The definition in this bill that life simply needs to be intolerable for that person I think throws the door far too wide open. I am not suggesting that that means people would be getting euthanased willy-nilly, but I do think it means that there is a broader range of people to whom the act could apply. I think that has been highlighted by a number of honourable members.

I have particular concern about the insurance provisions in section 55 of the bill. I am not sure that I would go so far as the Hon. Mr Hood in saying how they could be abused. Nonetheless, I do confess that I am a bit of the cable or pay TV news watcher, and the predominant form of advertising on some of the news channels seems to be for life insurance or prepaid funerals. I am not sure why, whether it is to do with the cheap costs or whatever, but that seems to be the dominant form of advertising that you find on those particular channels.

Certainly, the life insurance ads all highlight no blood tests, no medicals, ring up, instant cover and often the amounts are, from my recollection, up to about half a million dollars. Under the provisions of this bill, I cannot see any reason why people who were suffering from a terminal illness would not have an incentive, driven by a well-meaning desire to provide for their loved ones who will be left behind, and nothing to preclude those who were suffering from a terminal illness and expecting to avail themselves of active voluntary euthanasia, to take out policies and avail themselves of active voluntary euthanasia so that the insurance provisions of this bill would apply.

That is, essentially the insurance company has to pay up and cannot not pay on the grounds that someone was voluntarily euthanased. I do not overstate the case in relation to these insurance concerns, but I certainly do note what the Hon. Mr Hood said in relation to the Insurance Council. I think that is something that would need a lot more thought were this bill to go ahead.

The final thing I would say about the bill is that, as a number of honourable members have commented, it is very much an evolving bill. We have seen amendments being brought as we go along. It is clear that euthanasia advocates are not agreed on the model that they want or which provisions and safeguards are appropriate, and I think this bill and the process of it has very much highlighted that. I would certainly be concerned that, if such a bill becomes law, it then becomes very tempting for amendments to broaden the scope of it, as we have seen with other legislation.

The Hon. Mr Wade highlighted that mental illness is not grounds for seeking euthanasia under this bill and that he believes that is discriminatory, and undoubtedly there would be some who think that because those who suffer from lifelong chronic depression and other mental illness, indeed, suffer a great deal. So it would certainly concern me that, regarding those who are disabled, those who have a debilitating illness or chronic mental illness, even though they may not be dying in the immediate sense, nonetheless this bill would either allow them to access euthanasia now or would in the future be likely to be expanded to provide for that.

For those reasons, I oppose the second reading of this bill. I believe it is bad public policy. There are a great many people in our community who are vulnerable and who need protection and support. It is our most fundamental duty to ensure that those people get world-class health care, support and protection, that those honourable people get compassion and love, and not a lethal injection. I urge honourable members to oppose the bill.

The Hon. R.I. LUCAS (21:47): I rise for I do not know how many occasions now to speak to this legislation. It is one of the privileges of having served in the parliament for such a long time that I have had the opportunity to participate in similar debates on very many occasions. I am sure that I am the only person who can say that in the 1980s I debated the original natural death law (in 1983); in the 1990s, I can recall debating similar pieces of legislation moved by the Hons Anne Levy and Sandra Kanck; in the noughties, I think I can remember debating similar legislation by the Hons Sandra Kanck and Mark Parnell; and now whatever you call this decade of the 2010s, we have the first of the bills from the Hon. Mark Parnell.

The Hon. B.V. Finnigan: Let's hope you'll see the decade out.

The Hon. R.I. LUCAS: Well, thank you for that. I am sure that will be the only time the Hon. Mr Finnigan ever says that. It will only be on this particular issue. I guess, therefore, from that rare perspective that I have—and perhaps it is one of the reasons why I have significantly more grey hairs, as I debate the bill in the 2010s, than when I debated the original legislation (the natural death law) in the 1980s—there are two options the advocates of this law could adopt. One is to adopt the situation that I have observed, which is that the legislation we see in the noughties and the 2010s is much wider in its scope than the original attempts at the legislation back in the early years.

There does not appear to have been an intention from those who support voluntary euthanasia in one form or at all to move in the other direction, which is to restrict, define and confine the potential uses and the other perspective of uses of the law that will pass the land. Given the quality of the debate we have seen on this occasion, and this has been referred to by the Hon. Mr Finnigan and others, people over a period of time change their mind; they look at the legislation and on occasions make different judgements in relation to it. As I look at this piece of legislation, I share the view of some other members that it, again, as the last piece of legislation from the Hon. Mr Parnell, widened the scope, from my viewpoint, in terms of those who might be able to access the provisions in the legislation.

As a result of having spoken on similar pieces of legislation on many previous occasions, I do not propose to repeat all of the views that I have expressed. I nearly caused great grief to the young trainee in my office when I asked him to trace back the contributions I have made over the years on the legislation and to put it all together into one file; in the time available he was not able to track back all of the contributions, but managed to put together a number of them. I referred to those in my contribution last year, and the approximate dates of those, and they are well known and available on the Hansard. My views, by and large, have not changed; I therefore do not propose to repeat them.

What I will say, as I have said previously, is that I have respected the views of all who come to this particular debate. I know that many have a strongly different view to the view I express tonight and on previous occasions; I respect the views of those. Some have been close friends and colleagues, others perhaps would not describe themselves as close friends and colleagues but perhaps acquaintances, but nevertheless I respect the views of all who have put their view, either to me or to other members, in relation to this particular debate.

I will comment on a couple of issues before concluding my contribution. The first is one which always irritates me in relation to this debate and some other debates. I too have received hundreds, possibly one to two thousand, emails and letters. I am not sure why people continue to put their strongly held views to me, given the views that I have expressed over the years, but nevertheless I am grateful for that and I endeavour to respond to those emails and letters.

The often put view to me is that it is my job as a legislator to reflect the majority view of the community. I have said this once or twice before, and I will say it again tonight: I strenuously object, or reject, that particular notion. It is not my job as a legislator to reflect the majority view in the electorate. It is my job as a legislator, having been elected to this parliament for a term of office, to listen to the views of my electorate, to respect those views of the electorate and then to make a considered judgement on every issue, and then to be judged accordingly by the electorate at the end of my term in parliament.

Let me say at the outset that, in these interminable arguments we have about what is the view of the electorate on voluntary euthanasia, my view is that probably the majority of people would support some form of voluntary euthanasia. I accept the argument from some members that it depends on how you draft the question. Having a background in stats and pure mathematics and market research, I know full well the way you can colour a particular survey result, if you one so choose.

My view is that it is probably the majority of the electorate. I do not think it is 70 or 80 per cent, as the Newspolls and others claim. I suspect that if it was more definitive and more detail was provided to people that in the end it is probably a slight majority of people in the community who would support voluntary euthanasia, but that to me is not the job that I have been put in this place to do: to be a mindless robot.

Those who have seen the movie The Rise and Rise of Michael Rimmer will recall that, instead of making judgements as members of parliament, an instant poll was done in the community to indicate what the majority view was and that was what occurred in terms of the passage of laws in that particular satire or movie. I believe that is not the way we should be approaching our job as legislators and as members of parliament.

I have had many an argument with those who support voluntary euthanasia and who use the argument that it is my responsibility to reflect the view of 70 to 80 per cent of the electorate. I say to them, 'Similar polls show that 70 per cent of people support capital punishment. Do you say to me that I have to support the majority view of the 70 per cent of the community who support varying options of capital punishment in certain circumstances?' By and large, most of those who support voluntary euthanasia, for some reason, when I have had this debate or argument, are not supporters of capital punishment. They say, 'No, that is a different issue.'

I suspect that, if a member of this chamber came in with a bill supporting capital punishment for terrorists, mass murderers, child rapists or whatever and said that 70 per cent of people in the electorate supported him, some of those who use the market research argument in the voluntary euthanasia debate in this chamber would not accept the market research debate or the majority view of the electorate in relation to capital punishment because they, as members, have different views on that particular issue and it does not suit the argument to use the majority view of the community to demand support for limited forms of capital punishment. I have had vigorous arguments with some proponents of voluntary euthanasia when I have engaged in that particular debate with them.

However, it is my strongly-held view—and nothing will change it—that we are abrogating our responsibilities as members of parliament if we mindlessly subscribe to the view that because the majority bay for a particular law or piece of legislative change then it is our responsibility, as members on a conscience vote, to respond to that majority view. Yes, we must listen to it; yes, we must respect it but, no, in my humble view, we do not have to mindlessly follow that particular view on the issue. That is what has governed my views, because I do not support capital punishment. If a bill came into this chamber I would not support it. If someone said to me that 70 per cent of people want capital punishment for terrorists or whatever, I would not support it, and I do not accept the argument that, because 70 per cent say they support it, I am obligated to vote in that way.

The final point on the issue of market research is that I have a vague recollection that the issue of a referendum has been tested in this chamber albeit in the late nineties—I think by the Hon. Sandra Kanck—and some members and petitioners have raised the issue of a referendum. I do not accept that argument, either. It is our responsibility to make these judgements, as difficult as it might be. There has been emotion in this particular debate from a number of members and, frankly, I know there would be emotion from all members, even though it might not appear on the surface, in terms of their contribution. However, I still argue the view that it is our responsibility as legislators to make the decision and we should not cop out, in my humble view, by saying that this is a decision for the people to make by way of a referendum.

Having had this particular debate, as we have had on every previous occasion, I think it is important that we see a vote on this issue. A suggestion has been put to me that it may well be that the Hon. Mr Parnell and those who support the legislation, if they lose the vote on the voices, will not call for a vote or a division of the house. I hope that that is not true. I hope that I have been misled, and only the Hon. Mr Parnell can indicate in his closing contribution whether or not I have been misled. As I said, I hope I have been misled in relation to that issue, because I do not think that is an honourable way to conclude this debate.

At the moment, I think there are two or three members who have not spoken, but on my rough calculation, if there is to be a vote of say, 12 against the bill or nine for it, or even 13 against the bill and eight for it, then so be it. Let there be a division and a vote as there always has been and let the people see what the views of all the members are.

I do not know whether all members will speak in this particular debate. On the last occasion, I think, 20 out of the 21 members spoke. The Hon. Mr Wortley, as is his right, did not contribute to the second reading. Now, if the Hon. Mr Wortley, for example, is not going to speak in this particular debate again—again, that is his right, if he does not want to—and there was to be no division, we would not know what the Hon. Mr Wortley's view was on this particular vote.

I think it is important to the hundreds of people who have petitioned the Hon. Mr Wortley, on a conscience issue, to know whether he is for or against the legislation. There are other one or two members perhaps who are still to speak on this particular issue.

I think it is important that, having had this debate, and on every previous occasion for there to have been a vote, that the honourable way, and the convention in this house on these issues, is to have the vote and reflect it. If it does show that it is 12-9 against, or 13-8 against, and that the numbers have moved against the proponents of voluntary euthanasia in the space of the last 12 months, so be it. Let the people see, let the media see, let's be transparent, let's be accountable in relation to these issues.

I know transparency and accountability are issues that are near and dear to the Hon. Mr Parnell and the Greens. As I said, I hope I have been misled in relation to this particular issue and that, as is the convention, if the call is on the voices against the bill, it is the responsibility of the proponents then to call for a division to make sure that all the views are recorded in the Hansard, so that all those thousands of people who are interested in this bill will be in a position to know how each of their members have voted on what is an important piece of legislation.

I conclude my contribution by leaving that invitation to the Hon. Mr Parnell. I would hope, in the interests of transparency and accountability, he will address that issue, at least, in his concluding remarks, so that we can all be aware of what he intends to do in relation to this particular issue.

The Hon. J.S.L. DAWKINS (22:02): I rise to speak on this bill and I promise you, Mr President, and the chamber and the gallery that I will be brief at this hour. As many will know, I have supported previous bills on voluntary euthanasia. Hansard shows that I last spoke on this issue on 28 October 2009 at five minutes past midnight, so it was actually 29 October.

In dealing with these matters, issues relating to both my father-in-law and my father, when they passed away within 14 months of each other, have always strongly influenced me to consider supporting voluntary euthanasia. I do not need to go into the details of that, but there were certain things that happened on both those occasions that have always made me consider this as something that I strongly believe should be part of our law.

However, I have always considered the issues raised very thoughtfully. There are many people who have raised a range of issues with me that I have considered, particularly over the last few weeks. I have made a decision and that is to again support this bill.

Before concluding, however, I would like to make a few points. I think that many of the people who are not in favour of what the Hon. Mr Parnell has put forward in his bill generally do not refer to the full title. They generally leave the word 'voluntary' out of it, and I want to emphasise the fact that it is voluntary euthanasia.

I say to the Hon. Mr Parnell and to everybody else who supports the bill, and even to those who do not, in the lead-up to further debates and if we ever get the legislation passed, that it is vital that the communication and information about this matter are improved upon. That is no reflection at all on the number of volunteers who have worked so hard on this cause for so long (they do not have the resources), but I think there is a need. There are some who have alluded tonight to the fact that there ought to be some independent work commissioned; that the government should perhaps take a role in facilitating that, but I certainly believe there are many people who misunderstand the meaning of this legislation, and I think that is on both sides of the argument.

I will also make a couple of points. There has been some criticism of the Hon. Mr Parnell in the way that the bill has been drafted and, perhaps even more so, for the amendments that have been brought in in relatively recent days. I have personal knowledge of what it is like to introduce legislation without the backing of a government department, and the bills that I have brought to this chamber on previous occasions on the surrogacy issues were nowhere near as complicated as the voluntary euthanasia bills have been. Those who make those criticisms have little concept of what it is like to bring in legislation and not have advisers at your beck and call, not only to draft the bill but to sit next to you when you in the committee stage. I do make that point.

In conclusion, many hundreds of people have taken the time to make their points on this matter to me and, I know, to so many other people. Very few have come up to me at the events that I go to or in the course of everyday life, but email and other forms of correspondence have been used in large degrees. I thank them for taking the time. It is important for democracy that people do exercise their right to let their members of parliament know how they feel. I know many people well who do not necessarily share my view, but I am grateful for the respect that I think I have from them and that I have equally for them on their position. Finally, I will repeat what I said at the conclusion of my speech in October last year. I said:

By passing this bill, we would not be imposing voluntary euthanasia on those who are opposed to it, but we would be giving everyone the choice.

I support the bill.

The PRESIDENT (22:09): Whilst I do not get a vote unless there is a tie on the floor, I think it is only fair that I indicate to the house and to those people outside the house who have written to me—and I did write back to those that requested a letter back; I have phoned those who requested I get in touch with them and told them my views on this bill. It is only fair that I put my views on the record, because my colleagues have put their thoughts on the record, and I want to give the opportunity to those who do not agree with how I vote on this bill, if I have the opportunity, to vote against me in any election. That is only fair.

I have always supported these bills, because I have had personal experience with this. I had a very good friend, Janet Mills, who chose to euthanase herself. I know that Janet wanted to see her children grow old, and I know that she wanted to see if she had any grandchildren and watch them grow old. I know that Janet wanted to grow old with her husband, but the illness she had was a terribly painful terminal illness and she chose to be euthanased in the Northern Territory. I made a commitment to Janet—and I was not a member of parliament at the time—that if I ever did have the opportunity to support legalising this I would. I gave her that commitment and I will honour that commitment if I get an opportunity. So, if there is a tie in the chamber, rest assured I will be voting in favour of this bill.

I picked up a couple of interesting issues. I know that everybody has the right to vote on this the way they think because it is a conscience issue. I do not begrudge anybody for not supporting it: that is their prerogative, and I respect their decision. However, I am dead against a referendum, because I do not see why the well should decide something for the terminally ill; and that is what would happen if a referendum were conducted. Those people who are not sick would make a decision for those who are, and that is totally wrong.

I agree with the Hon. Mr Lucas that we are elected here, and sometimes we do get a conscience vote, and we should make it known and we should make those decisions. We make decisions every day in this chamber that do not satisfy everybody out there in the public. They argue with us and that is their right; they go crook at some of the decisions we make, and that is their right; they lobby us, and that is their right. I respect them and the way they lobby us. Only this morning, I phoned a friend in Mount Gambier who has an opposite view to me on this bill, and had a debate with him. I told him that I was sorry, I could not do what he wanted me to do, and I would be supporting it if I got the opportunity.

I was also very disappointed in the mention of somebody deciding that they would terminate a pregnancy if the child was diagnosed with Down syndrome. Being the patron for Down syndrome in South Australia, I have met many children with Down syndrome. They are wonderful human beings who are active, and I know their parents respect them and value them very highly, just as they would any other child in the family. So, I was disappointed by that. Those with handicaps and those with disabilities, who are not as fortunate as those of us who have good health, are not the people ringing radio stations whinging about everyday things that are happening; it is actually we people who are well. So, when they want to make a decision to end their lives because they have a terrible terminal illness, I support their making a decision for themselves.

The Hon. M. PARNELL (22:13): I rise to close the second reading of this debate. I would like to most sincerely thank all members who have spoken on this bill. I thank members who have spoken in favour and I thank those who have spoken against. All the contributions have been thoughtful and it has me thinking that we should have many more conscience votes in this place.

Tonight we have been discussing a matter of the utmost importance, a very serious matter. At other times in this place we spend hours and hours discussing things of little consequence at all. We can spend hours discussing the merits of registration labels in the bottom left-hand corner of a car. We do need to make sure that we have time to discuss the important issues facing perhaps not the whole of society but a proportion of society who are looking to us as legislators for assistance.

I have spoken to most people in this chamber over the last month or so on this issue. Some of you I have spoken to many times, and I thank you for making yourselves available to me and for sharing your views with me. As a result of some of those views, some changes have been made to this bill, and I will come to those shortly. I will not go through the whole list of people who have spoken, but I will go through some comments that some people have made that I feel need a response.

When saying that I thank those who have indicated support, as well as those who have indicated that they will not be supporting this bill, I note that, in their contribution, a number of members of this place have left the door open. We can go back and look at the Hansard. A large number of members have said that they understand the problem, they understand what it is this bill is trying to achieve, they understand the suffering that we need to do something about in the community but, for whatever reason, they are not particularly ready or do not think this is quite the right model.

For those people who have left the door open, I thank you. Some people have left the door ajar, others have left it with the safety latch on, and some members have welded the door shut, and I will not name those members. For some members, it would not matter what bill was before us, it would not matter what safeguards there were, whether it was a minimalist model or a maximalist model (if there is such a word), they would vote against voluntary euthanasia. However, I am still encouraged by the things that people have said today, even those who have indicated that they will not support this bill tonight but that the door is open for their later support.

In terms of commenting on what individual members have said, there are lots of opinions and there are lots of facts. The opinions cannot be wrong. I cannot do anything about the opinions people have. If you hold an opinion, it is a valid opinion, and that is your right, but many of the facts are wrong. A number of members have said that we should have more information. There is a wealth of information out there, and it may be that I need to take my share of responsibility for not sufficiently sharing with members the data from those states that have voluntary euthanasia. There is a mountain of material that shows that things like the slippery slope that haunts the fears of legislators do not, in fact, haunt the corridors of our hospitals and our hospices. They do not exist in reality in those jurisdictions that have voluntary euthanasia.

I will go through a couple of things because a number of members had some common material. First, a number of members—the Hon. Carmel Zollo, the Hon. Jing Lee and the Hon. Robert Brokenshire—mentioned the letter from the Catholic academic, Mr Tonti-Filippini. I am aware that Mr Tonti-Filippini has held the views that he has expressed to us most recently for many decades, including in the period before he contracted what sounds like a terrible condition.

I strongly respect his right to have an opinion on this matter. We all have that right. In his letter, he demonstrates some important issues for us. What is unfortunate is that, while stating that he does not have the right to speak for everyone who is in that position of suffering, he then proceeds to speak for those people who are suffering. He says that he 'cannot speak for all people who suffer from illness and disability', and that is a direct quote. He then goes on to use the words 'we' and 'us' continually, and he makes assertions about what is right for people in that circumstance.

He says, 'Seriously ill people do not need euthanasia,' and, 'You would gain nothing worthwhile for us by supporting this legislation.' You cannot have it both ways. He is entitled to his views. He does not want it for himself, but he cannot purport to speak for all those who suffer because there are other people who are suffering who might not have the qualifications or letters after their name but whose views are equally valid.

Mr Tonti-Filippini points out that he is well aware of the limitations of palliative care, and I think that is valuable to this debate. He states that he has reached the limits of what palliative care can offer, and that is important because a number of the contributions here have said that the answer to voluntary euthanasia is more palliative care. Here is someone who is saying, 'It has limits, and I have reached those limits.' As I will come to briefly, it is not a question of voluntary euthanasia or palliative care: it is a question, I think, of both in a truly humane society.

The other point that Mr Tonti-Filippini makes, which I think is well made, is that the greatest protection against the abuse of voluntary euthanasia laws is the fact that, no matter how great they are suffering, most people do not want to die, and most people will continue to endure great suffering and they will keep seeking medical treatment, as is their right. We must do what we can to make sure that all of those treatments and facilities are available, but with voluntary euthanasia, we are talking about that small group of people who cannot be properly helped with existing palliative care.

A number of members have pointed out that it is too hard for us as legislators to make decisions around this. I do not accept that it is too hard. The concept of a referendum has come up several times. Maybe that is how an issue like this will be resolved, as it has been resolved in other jurisdictions, with popular votes of the community in favour of voluntary euthanasia. My view is that, as legislators, we can deal with these issues, we can listen to and hear what the community is saying to us and we can come up with the right legal solutions.

The Hon. David Ridgway pointed out that the way he is approaching this is that he needs to be 100 per cent sure that we have everything right. My response is to say that I think that bar is too high. In fact, if we applied that 100 per cent test, as other members have said, society would grind to a halt. It is not about just suck it and see, put in place any old bit of legislation and hope that it works. We can, as legislators, as a community, come up with decent safeguards.

When voluntary euthanasia becomes law, as I believe will inevitably happen—whether it is in South Australia first or somewhere else—it will be the most scrutinised piece of legislation on the statute books. The opportunity for abuse of these laws is incredibly slight, but to suggest that we have to have the absolute perfect model up front with every i dotted and t crossed is just unrealistic in terms of legislation. That is not an excuse for slapdash drafting and it is not an excuse for poor legislation, but I think we need to be a little bit realistic about legislating for a problem that is infinitely variable in its application. People are suffering a range of conditions in a range of circumstances. They have a range of cultural backgrounds. We need to put in place the best legislation we can.

The Hon. David Ridgway, in his contribution referring to some discussions that he and I had had, may have—and I know it was not his intention—given the impression that my view was that any old bill will do, that we just need to get something passed. That is not my position at all. What I have said to a number of members is that I do think that there is a core of issues that we need to deal with in legislation but that there are peripheral issues around it that are negotiable and variable, and I will come to the amendments later on. But I am not going to support just any old euthanasia law. I want a law that is safe but is also effective and that gives to people the right, that I think they have, to decide about the final stages of their lives, under this legislation.

The Hon. Robert Brokenshire made the point that the more we talk about voluntary euthanasia, the better becomes palliative care. I think, if I have understood what he is saying, that the discussion of voluntary euthanasia has been an impetus for improved palliative care, and I agree with him entirely. That is exactly what has happened in other jurisdictions. You look at the places with voluntary euthanasia—they have the best palliative care. It is not a question of either/or.

In terms of some of the comments that other members made, the Hon. Ann Bressington, as she did last time, has sympathy and support for some of the concepts in voluntary euthanasia and, in particular, the people in the terminal phase of a terminal illness. That might be something that we need to revisit: whether the eligibility criteria is simply too broad for members of parliament to accept, but that will be a decision for another day.

The honourable member is worried about what further changes might happen in the future. My view is that we do the best we can now, and we don't not pass compassionate legislation now simply because we are fearful of what the next generation or the next parliament might do. I do not think that that particular aspect of the slippery slope argument is borne out in practice anywhere else.

In terms of some of the arguments that have been raised, my colleague, the Hon. Tammy Franks, went through a lot of those in detail and I do not propose to revisit that because this is the summing up, but I do want to refer to a couple of the newer issues that have arisen. One was in relation to the impact of voluntary euthanasia laws on Aboriginal people. The point was made that when you have vulnerable groups with below average levels of education and literary skills, I think it is a problem that they are prone to scare campaigns, and I think we need to do a lot more to engage Aboriginal people with available health care services.

However, I do not think it is sufficient to say that because traditional Aboriginal law or customary law might be against voluntary euthanasia that that is a reason for us not to pass legislation that is for the benefit of all people in this state. We need to be sympathetic to Aboriginal culture, Aboriginal heritage and Aboriginal customary law. We need to incorporate those laws as we can into relevant statutes, but you just have to bear in mind that there is a range of other issues that are against customary law: autopsies, cremation and organ donation. We have not outlawed those things.

What we need to do is focus on education and on services most importantly and resourcing for people in vulnerable communities, whether they be Aboriginal or otherwise. I would also point out that, when the Northern Territory eventually passed voluntary euthanasia laws, it was the Aboriginal member of parliament who represented Arnhem Land who voted in favour of those laws, so it is not as simple as some members might think.

In terms of the counterarguments to voluntary euthanasia, I just want to put a couple of things on the record as to what voluntary euthanasia is not. I have said before that it is not about palliative care versus voluntary euthanasia. It is in fact palliative care with a fallback of voluntary euthanasia in the hardest cases. As I say, look to the Netherlands, look to Oregon, places which have some of the best palliative care which goes hand-in-hand with voluntary euthanasia.

It is also not a debate about involuntary euthanasia because that is what we have at present. That is what is going on. That is the killing of people in hospitals at the hand of doctors and at the hand of relatives, not at the request of patients. That is involuntary euthanasia. That has always existed and the absence of a legal framework means that involuntary euthanasia will continue. A big part of this legislation is bringing into the light something which is currently occurring in the dark.

It is also not about being old; it is not about being tired of life; it is not about disability; and it is not about people who think they are a burden on society. The way the bill is drafted, those people are not eligible to apply for voluntary euthanasia, and there are checks and balances to make sure that they do not in fact get to the stage of a request being implemented.

It is also not about people being forced into accepting voluntary euthanasia, participating in voluntary euthanasia or not participating. The bill has protection for patients and there is protection for doctors, but there is also protection for those who want nothing to do with VE. One of the amendments I will talk to in fact increased that level of protection.

In relation to the amendments that I have tabled, a number of members have said, 'Well, you have only just tabled them today.' Let us be fair here: I have tabled two amendments and I have notified all members in advance of my intention to do it and I have told members why I have done it. It is part of the consultative process of legislating.

The first of those two amendments removes the advance requests because that was clearly something that members were concerned about, that people in good health could make a decision about what they wanted to happen when they came into ill-health and that there could be some period of years between the request and it being triggered, and that was a step too far for some people.

So, even though we reduced the scope for those voluntary requests to just that tiny proportion of people who basically are in a coma or permanent deprivation of consciousness, even limiting it to that was a bridge too far for some people, so I removed it from the bill. Largely those provisions are covered by the existing Consent to Medical Treatment and Palliative Care Act, so possibly not a great deal more people have been disadvantaged by removing it, but I removed it, because that is the nature of negotiating legislation through this place.

The second amendment related to something that was brought to my attention by the people who oppose voluntary euthanasia. They wanted to make sure they would have nothing to do with it, that there was no way they could be forced to be involved in any way against their will. We already had that protection for doctors and nurses—no-one would obliged to be part of this if they did not want it—but there was a loophole that would have imposed an obligation on nursing homes.

If they were going to deny voluntary euthanasia they would have had to tell their patients that and they would have had to tell them to go somewhere else. I do not think they should have to tell them anything, so I have removed that from the bill. There is no obligation on any nursing home, hospice or hospital to tell people in advance its policy on voluntary euthanasia and, if somebody asks, and they say 'No, we don't do it', they are not obliged to tell them where they can get it.

Similarly with doctors. If this becomes law, the doctor is not allowed to lie to patients. The doctor cannot say, 'I'm not going to participate in VE and no-one else will either, because it's against the law.' I am not going to allow lying, but there is no requirement for those doctors to say, 'You'd better go and see Dr Smith down the road—he'll help you.' There is no obligation to do that; their only obligation is to say, 'I won't help you; someone else might; see you later.' It is very simple for people who want nothing to do with voluntary euthanasia to bow right out of the system.

That is fair because, as the Hon. John Dawkins said, the word most commonly left out of the debate is 'voluntary'. If it is voluntary for people to ask, it is also voluntary for people to have nothing to do with it at all. So, there are only two amendments. Yes, they translate into 46 or so amendments, because you have to remove every occurrence of certain words through the bill, but let us not kid ourselves. This is not 46 amendments: it is only two.

In terms of further amendments, I will come to that at the conclusion, because it is clear we need some changes to this before it goes any further. One of the most obvious changes the Hon. Kelly Vincent referred to, as have other members, is whether or not we need to restrict the legislation to just those in a terminal phase of a terminal illness. There are some members for whom a change like that would come close to bringing them from the anti camp into the pro camp. They might need a bit more, but that would certainly be a start. That is possibly something to be looked at in the lower house.

The common criticism made of amendments is that people say, 'Well, the very fact that you've introduced a bill you said was good, and the fact that you've now moved amendments is some sort of tacit acknowledgment that what you gave us at first was no good.' That is not the case at all. There are a core of values in this legislation, and that is the right of people in limited circumstances to request help to die with dignity. That is the core: all the other business—the number of doctors, the number of psychiatrists, the colour of the paper on which the forms are printed, the composition of voluntary euthanasia boards—and other material we can negotiate and come up with the best model.

It is not at all fair for people to say that an amendment is the equivalent of a failure of process. The fact that I have said to members that I am open to amendments shows that I am willing to try to get some parliamentary consensus on this. I will mention briefly what is often lost. Whilst members have talked tonight about this bill, which is the debate, very few people have talked about the status quo: what currently happens out there and whether what is happening out there is good. What is happening out there is involuntary euthanasia at the hands of doctors and nurses and family members. Many of us, including members in this room, have talked about their experiences where they are given control of the morphine pump. The nurse says, 'I will be stepping out and I may be some time, this is how the morphine pump works.' Many, many people have had that experience. That is happening behind closed doors.

Suicide is happening, sadly, all too frequently. That is the alternative for some people when you do not have a legal framework for voluntary euthanasia. If they are capable of taking their own life and there is no authorised medical method of requesting it, they will continue to commit suicide. Many will unsuccessfully attempt suicide and perhaps end up in a far worse state. Many people who deserve our compassion will suffer unrelievedly from their conditions and from their illnesses. Many people will die dreadful and undignified deaths. There will be unnecessary suffering and a denial of the rights of people who cry out to us for our help.

It has been mentioned that, when we talk about this sort of covert euthanasia, this sort of involuntary euthanasia that is happening everywhere, that somehow we are insulting the medical profession. Well, no, listen to the medical profession, they acknowledge that this is happening. Nurses acknowledge it; palliative care practices acknowledge: it is happening.

I want to now go to the contribution of the health minister. John Hill has weighed into this debate yesterday, and whilst I welcome his interest, I am disappointed that the approach that he suggested would in fact be counterproductive and would take us back many, many years. What is disappointing I think is that, whilst all members were provided with a copy of his brief ministerial statement and a copy of a very short memo from the health department (which, we have been told, is a list of criticisms of the bill), what the health minister did not do was tell us what he had in mind instead

The health minister has had parliamentary counsel draft up a two-page bill, which, effectively, does one thing. All it does is provide a level of legal protection for doctors in the event that they are charged with murder because they have killed someone because they were asked to. That is really all the bill does. It proposes a new section 13B of the Criminal Law Consolidation Act which says:

It is a defence to a charge of an offence against this Division arising out of the death or intended death of a prescribed person if the death resulted, or was intended to result, from the administration of drugs to the prescribed person by the defendant (the relevant conduct) and the defendant proves, on the balance of probabilities, that—

(a) the defendant was, at the time of the relevant conduct, a treating practitioner of the prescribed person; and

(b) the relevant conduct occurred at the express request of the prescribed person; and

(c) the relevant conduct was, in all the circumstances, a reasonable response to the suffering of the prescribed person.

A criminal defence provision to a problem area in current medicine that is actually calling for light to be shone onto the subject. What this does is it keeps it behind closed doors and any doctor who is unfortunate enough to be prosecuted at least has a defence.

I do not think that is the best response and, in fact, as I said, it would take us back 20 years. It would take us back to where the Netherlands was before they had voluntary euthanasia laws, and they found out that it did not work and the level of involuntary euthanasia was high. Members have quoted the statistics from 1990 in the Netherlands—high levels of involuntary euthanasia.

All those figures predate voluntary euthanasia. When voluntary euthanasia came in, the level of involuntary euthanasia dropped considerably in the Netherlands. What the Netherlands and Belgium found was that regulation through legislation was necessary to provide for better protection for both patients and doctors, not just for the doctors alone. The experience was that the legislation was needed to provide a transparent and a rigorous process. It provided the checks and balances, and it had proper monitoring and review.

I do not accept the Hon. John Hill's proposed law. It does nothing to achieve what was found in those other jurisdictions to be necessary. It simply protects a few doctors, if they happen to be prosecuted.

The health department in its advice set out, effectively, six issues which it called a summary of issues. I have circulated my response around the medical profession and other circles. Effectively, the author of this health department report has not properly understood the meaning of the legislation—they just have not understood the simple drafting. They were not aware of the amendments that I had been discussing with members of the Legislative Council; and issues which they found confusing or uncertain were, in fact, no such thing. I will not go through every single point in this advice but I will go through some.

First, the health department advice points out that people appointed as medical powers of attorney or enduring guardians will not be able to ask for voluntary euthanasia on behalf of the people they represent. Well, yes—that is exactly what I intended. I do not want medical powers of attorney making decisions about euthanasia. I want the person who is suffering to do that, and that is why we wrote the bill. So, it is not a criticism of the bill to say that we are limiting it to the people to whom it applies and we are not allowing others to vicariously make that decision for them. That is part of the problem with the current status quo.

There is a range of criticisms around definitions of mental illness and I do not find those very convincing at all, because the drafter of this note has confused the issue of mental illness in relation to the competency of a person to ask for voluntary euthanasia and the issue of mental illness as being the defining illness on which their request is based, and these are two entirely different things. Clearly, the drafter of this health department advice does not understand it. As I have said, one of the sections of this advice refers to advance directives. They are no longer in the bill.

There is another comment in here which tries to find an inconsistency in the way the voluntary euthanasia board exercises its powers, because the health department advice says that the proposed new section 41 contradicts section 27. It does not contradict it at all. What the drafting note says (and members have it in the bill) is that it is not a function of the board to approve or otherwise authorise each request for voluntary euthanasia. But that is not the same as saying that the board does not have the power to look into those requests that it wants to look into. It is just saying that it does not have to look into every single one. So, there is no inconsistency between those provisions.

I think the health department advice is unhelpful, at best. Certainly no-one from the health department discussed it with me. As the Hon. John Dawkins pointed out previously, we do not have access to their resources. None was offered, and I think the result is in this fairly weak opinion that has been given which is both factually incorrect and also incorrect in its understanding of the meaning of the legislation.

What I want to do finally is acknowledge some of the people who have been involved in this debate and then to canvass where to next for this legislation. In terms of acknowledgements, I particularly acknowledge the Hon. Steph Key, the member for Ashford. A lot of people thought it was odd that we had two members of parliament from opposing parties working together on a common bill. This is not about party politics: it is about trying to get the best possible model for voluntary euthanasia and to make sure that, as a parliament, we were all talking about the same thing.

The advantage of that is that the Hon. Steph Key will no doubt pay close attention to the debate in this place and to the things people have said and, when her version of this bill is considered next year in the House of Assembly, I think that members there will need to be guided a little by things that are said here if they want that bill to pass when it comes back here, as it may do next year. So, it has been a great pleasure to work with Steph Key and, in fact, the experience has been so good that I would love to work with other members on common issues such as this. This is not about party politics or a particular party claiming the credit for any legislation.

I would also like to thank the large number of non-government organisations that have been helpful in this campaign. Certainly, Neil Frances, the Chair and CEO of yourlastright.com, has come over from Melbourne today to hear this debate; and members are all very familiar with Mary Gallnor and Frances Coombe of the South Australian Voluntary Euthanasia Society who have worked on this issue for many years. In addition, other groups are springing up all over. We have now Christians, doctors, nurses and lawyers all supporting voluntary euthanasia, and a multitude of others who have worked with me on this bill.

So, where to next? A number of members, as I have said, have expressed their support for the concept but, for a variety of reasons, they are not able to support this bill tonight; and I am disappointed in that, there is no doubt about that. However, I have heard what honourable members have said and I accept that this bill will not be going any further tonight. That will come as a disappointment to those who have campaigned long and hard for decades for law reform, and it will also disappoint the large proportion (as I believe) of South Australians who want law reform.

Now, lest we relaunch into the debate about opinion polls and the obligation of members of parliament to follow those opinion polls, I am not going down that path. What I would want honourable members to do is to pay attention to what constituents are saying and to be guided, in particular, when the question they are being asked is about choice. I think that it is different, as the Hon. Rob Lucas talked about, when the question might be capital punishment—not a lot of choice in capital punishment, but, when it comes to something like voluntary euthanasia, members need to look and decide, even if they do not want it for themselves, whether they are prepared to deny this right to others.

I take great comfort from the contributions of those who are not in a position to support the bill tonight, but they do want to do the right thing by South Australians, and they do want, I think, some change, even though we have not convinced them that this is the bill now. In relation to the Hon. Steph Key's bill, as I have said, I am sure that she will take careful note of what has been said in this place.

I will continue to work with her to see whether we can make some changes to the lower house bill and, if that bill passes successfully, it will by virtue of the legislative process come back here. I am hoping that, if it does come back here, there will have been enough changes that those members who are not in a position to support it tonight will be able to support the bill next year.

I can see that we do not have the numbers and so we will not be going into a clause-by clause-debate. I think that members have made their views very clear already, and I am satisfied with the views that have been expressed. I commend the bill to the house. I look forward to the debate in the House of Assembly. I look forward to working with the 47 members there to bring back a bill that does have the support of a majority of members of this parliament. For now, I commend this bill to the house, and I look forward to the debate continuing next year.

Second reading negatived.

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