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Legislative Council - Fifty-Second Parliament, First Session (52-1)
2011-03-10 Daily Xml
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SOUTH AUSTRALIAN PUBLIC HEALTH BILL

Committee Stage

In committee.

(Continued from 8 March 2011.)

Clause 90.

The Hon. G.E. GAGO: A series of questions was posed by honourable members to which I have some answers. This was dealing with clause 90 and the Hon. Ann Bressington's amendment, which goes to the issue of requiring or mandating treatment. I was asked whether any other jurisdictions have these emergency management powers.

I have been advised that in Tasmania the Emergency Management Act 2006 schedule 1 section 3 provides a specific power for compulsory treatment; the commonwealth Quarantine Act provides for emergency measures including compulsory vaccination and other prophylactic treatment for travellers arriving in Australia; the New Zealand Health Act 1956 provides for a range of emergency powers including section 70, special powers, including preventive treatment; and the Western Australian draft Public Health Bill proposes that during an emergency a range of powers come into play including compulsory treatment.

This bill has been supported by both sides of politics. The application of this power to compulsorily treat is clearly well established, so South Australia is not doing something new or extraordinary. I am aware that honourable members have expressed a desire to have some examples of where and when these powers may be used. Again, I caution the chamber that what we are seeking to deal with here are powers that will be very rarely used and in circumstances which are very difficult to predict.

However, if one wishes to examine South Australian history for likely events I am advised that a severe outbreak of smallpox occurred in this state in 1913 and, if this outbreak occurred today, it may well be a circumstance where compulsory treatment may be used. Looking forward, other possible examples could be as follows:

a school where a student who has been exposed to a new or powerful strain of TB is not identified before they come into contact with the school population and families. We would be dealing with a highly infectious disease with a high mortality rate potentially affecting a widescale population. Current powers may not be sufficient, and we would need to compulsorily treat to save and protect lives and contain the further spread of the disease, if isolation powers alone were not sufficient;

a plane-load of passengers with a virulent strain of pneumonic plague arrives, who are already beyond the reach of commonwealth quarantine powers and must be dealt with by the state. There is sufficient supply of the target antibiotic to treat those on the plane but not enough for the protection of the broader population, or the health workers, for instance, who may be assigned to care for them. All efforts would be made to isolate the passengers; where isolation could not guarantee against the spread of the disease prophylactic treatment would be provided, if necessary using these powers.

In summary, these powers are needed and necessary. They have also been put in place to look forward, given the potential for the proliferation of disease very quickly in the future. As we know, strains can quite quickly become identifiable and, because of population density and the level of travel between communities, that puts communities at considerable risk, risks we have never had to face in the past. So, this legislation is also about enabling us to legislate for potential future problems.

They form part of a suite of emergency powers which would be used only in rare and exceptional circumstances. We have already talked about the guidelines around that which provide guidance as to when we would use those powers and how they would only be used—fundamentally, as a last resort. There are clear precedents interstate and overseas of these powers being written into statute, but the overall issue here is to ensure that we have the necessary powers to protect our community.

It is not an over-dramatisation to say that lives are at stake here, and removing this power can, and will, have serious consequences around our capacity to protect people in this state. I have been thinking about this, and I guess it is not so much about the government providing examples that have occurred in the past that might warrant this (which we have attempted to do), but rather to look at the changes in our community and the potential for much more serious spread in and quite devastating effects on that community.

I think the real question is not whether the government can provide examples: the real question is whether the Liberal Party, the Greens, Family First, the Hon. Ann Bressington, the Hon. Kelly Vincent and the Hon. John Darley can, each and every one of them, guarantee, here today and on record, on the Hansard, that their decision not to support mandatory treatment will never result in the loss of a life of any South Australian.

I challenge each and every honourable member here who is not prepared to support this to stand up in this house today and guarantee to South Australians, put it on the record, that they guarantee that their position not to support mandatory treatment will never result in the loss of a life of a South Australian.

The Hon. A. Bressington: Can you guarantee that your policy won't either?

The ACTING CHAIR (Hon. R.P. Wortley): Order!

The Hon. G.E. GAGO: This bill is about trying to maximise the protection of our community. That is what we are trying to do. To portray this as some sort of conspiracy against South Australians is, quite simply, idiotic; it is bizarre. This is a measure that is used elsewhere, so there is a precedent set. As I said, we are not doing something that has never occurred before. Even so, I do not think South Australia should be afraid to lead anyway, but that is not the case here. There is precedent.

We have parameters around this that provide the framework within which these decisions will be made. I will put this on the record: I challenge each and every one of you to stand here today and put on the record that your decision, if it is not to support mandatory treatment, will not ever result in a loss of life. I want you to guarantee to those mums and dads out there—

The Hon. A. Bressington: You do the same.

The Hon. G.E. GAGO: I guarantee that this provision maximises protections for the lives of South Australians. That is what it does.

The Hon. A. Bressington interjecting:

The ACTING CHAIR (Hon. R.P. Wortley): Will the Hon. Ms Bressington please desist and allow the minister to finish her contribution. You will have plenty of time to give a contribution after.

The Hon. G.E. GAGO: Without this provision, I guarantee you are putting the lives of South Australians at risk. That is the guarantee I give you here today. That is the pledge that I give. I give my pledge that I can guarantee mandatory treatment helps increase the protections of the lives of South Australians. By not doing this, I guarantee you are putting lives at risk. There will be blood on your hands.

The Hon. S.G. WADE: It is an unusual event today. Normally, it takes a contribution or two from the non-government members to prompt minister Gago to move into hysterics, but we have seen it today coming unprompted. Can I remind the minister where we actually left the committee stage of this debate. As I understand it, the clear statement from the Hon. Dennis Hood and myself was that we were inclined to the government amendments. What is the first thing we get? We get abuse from the minister, suggesting that we are putting the lives of South Australians at risk and that we are being reckless in terms of the public health provisions available in this state. All we are asking are simple questions, and we only got half the answers.

Let me remind the minister the questions that we did ask. We did ask whether the minister could name the provisions in the Emergency Management Act that she was referring to when she was telling us that the Emergency Management Act would operate at a later stage. We also asked what is the definition of preventative treatment? We have not had an answer to that one either. We got sort of an answer on the fifth question about where treatment was not a possibility. Instead, we got an answer to 1½ or perhaps two questions, plus a hectoring speech.

If the minister wants the Hon. Dennis Hood and myself, and those members who are associated with us, to support the government and remain sympathetic, she might make a better effort at trying to defend the government's position. We take a strong view that South Australian's deserve the best of public health care. They also deserve the best respect of their rights. As the minister claimed on Tuesday, she is being respectful of the right of people to refuse treatment. We would appreciate it if the minister would focus on the issues and avoid personal abuse of members, particularly those members who might be inclined to vote with the government.

The Hon. G.E. GAGO: I have been reminded of a further issue that we agreed to provide information on, and I am happy to put that on the record now. That is in relation to the health emergency declaration versus the Emergency Management Act declaration. The key point about having the public health emergency powers available to exercise is that they provide the ability for health to get in early and respond to an emerging public health threat, when the problem is smaller and the window of opportunity to manage or contain the problem is greatest.

As I have indicated previously, the other key point is the need to have flexibility, to be able to tailor responses appropriate to the severity of the pandemic. As the Australian Health Management Plan For Pandemic Influenza, updated December 2009, observes:

It is likely that the development of a pandemic will move through a number of different phases as the virus becomes more adept at infecting humans, spreads around the globe, and throughout Australia.

Each of these phases requires a different set of actions. The plan provides a guide to decision-making, with the aim of enabling the most appropriate action to be taken: alert, delay, contain, protect, sustain, control, recover, etc.

The health sector has responsibility under the state's emergency management arrangements for identifying and managing the response to human disease outbreak. The early recognition of warning signs of a pandemic by the Department of Health make it best placed to respond to such a situation in the first instance.

It is critical that it has adequate powers to do that, and that is why the 2009 amendments to the Public and Environmental Health Act were made and why they are included in this bill. If the situation warranted it, a public health emergency could be declared. The legislation ensures that this would not be done in isolation. There must be consultation by the Chief Executive of Health with the Chief Public Health Officer and the state coordinator, and approval by the minister before the chief executive can declare a public health emergency.

If the situation escalated in severity and magnitude such that a whole-of-government state emergency response was necessary, then the state coordinator would be approached, seeking a declaration under the Emergency Management Act. This may be at the stage when the situation has deteriorated to the point where the emphasis needs to shift to the retention of priority products and services, the maintenance of essential services and where coordination of a number of agencies is required.

There is no specific trigger provision in the legislation to move from a public health emergency declaration to an EM Act declaration. Each public health emergency would need to be considered separately. Given that the features would most likely be different and may have the potential to change rapidly, as the Australian Health Management Plan for pandemic influenza emphasises, all of the planning must incorporate a high level of flexibility.

As members may be aware, there is a state emergency management committee of senior officials from a range of agencies which includes the State Coordinator, the Chief Executive of Health and an emergency management council of ministers, including the Minister for Health. When there is an emergency situation developing or occurring they meet frequently, so there is a sharing of information as the situation develops and evolves.

It would be reprehensible for members to assume the position that we can downgrade the powers called up in this bill simply because we have preserved them in an emergency management act. This is equivalent to saying to the community, 'Don't worry, we will let the problem get worse before we will intervene.' A worsening problem means a problem where there is more widespread disease, injury, disruption and even deaths. So, that is what we face by delaying and allowing the situation to worsen.

Inevitably, it is likely to end up in more widespread disease, injury and, as I said, even deaths. I cannot believe that this chamber could seriously contemplate such a position. To deny these necessary powers would restrict the health system's capacity to deal quickly and early with an outbreak. The consequences for the community's health should, I believe, be apparent to all members.

The Hon. A. BRESSINGTON: I want to go back to a comment that the minister made about a TB outbreak in a school being one of the triggers for implementing vaccination of all children in schools. I remind the minister—and I ask if this protocol would still be in place—that when I was going to school and I was vaccinated against smallpox and TB, first of all, I had to have a test to show that I needed that vaccination. We had to have the test and then we had to wait for seven days, I think, and it came up positive or negative, and, if you needed it, you got it.

Under the provisions in this bill, is that going to happen? Are people going to be tested to see if these vaccinations or this preventative treatment is a necessity for that person or is it just going to be straight to vaccinations or preventative treatment of another kind?

Secondly, what will happen to a parent who knows and who has been told medically that her child being vaccinated with a range of vaccinations will have a detrimental effect on her child, and she absolutely refuses to allow that child to be vaccinated? What will happen in that sort of situation?

The Hon. G.E. GAGO: In relation to the first question, with the example given of TB infection and the vaccination against TB, in this bill we are looking at emergency treatment provisions. So, in the case that the Hon. Ann Bressington just referred to, the vaccination against TB would not be considered an emergency treatment.

The Hon. A. Bressington: You used the example; that is why I brought it up.

The Hon. G.E. GAGO: It is most important that we listen to each other.

Members interjecting:

The Hon. G.E. GAGO: It is important that you listen as well. In an emergency situation, for instance, where there has been an outbreak of TB (which we know can be highly contagious and can have a very high mortality and morbidity rate), where we know people have been exposed, where we know there is a high chance of infection, in this case the treatment would be the administration of antibiotics, because we know that if we do not administer prophylactic antibiotics within a 48-hour period people are at a high risk of mortality or morbidity in relation to TB, or certainly some strains of it. That is the sort of case we are looking at. In that case we would not be vaccinating but giving an emergency treatment of prophylactic antibiotics to a group of people who we have good reason to believe have been exposed and are highly likely to be infected.

In relation to the second issue the honourable member raises, public health workers will be assessing the individual needs and requirements of those people they are in charge of caring for. For instance, in this case, it might be that an individual is allergic to antibiotics, so they cannot receive them, or may have some other adverse reaction to that treatment or medication. That would be taken into consideration, and appropriate action and care and treatment would be taken. Of course, we are not going to administer medication to people who might have an anaphylactic reaction to the medication. That is how that particular situation is most likely to fall out, I have been advised.

The Hon. A. BRESSINGTON: I am still not satisfied with the answer that the minister gave about the protocols that will be in place. When I was vaccinated for TB, it was because TB was around. They did not just do it because they had spare vaccines; there was a risk, and it was coming through the milk. We were tested and, if it showed that we needed that vaccination, we would get it; if we did not need it, we would not get it. That is what I am asking: are those sort of protocols going to be in place to make sure that the people who get the vaccinations—and we are talking vaccinations here, forget antibiotics—are the people who need those vaccinations?

Secondly, the minister stated that Tasmania and the ACT had these provisions in their acts for compulsory treatment. She did not mention that, I think it is, New South Wales, Queensland and the ACT actually have open clauses. It is my understanding that the states have a bit of a wishy-washy clause in their bills about people having to comply with the directions of the chief health officer, but it does not state specifically that they must comply with compulsory treatment or that the government has a right to impose compulsory treatment.

According to our legal advice, the reason for that, referring to the Consent to Medical Care and Palliative Treatment Act, is that a physician is required, firstly, to explain the condition that is being treated. They are required to give details of the medication and of any possible side effects that could be caused by this medication.

Once a state bill is specific about the state having the right to impose mandatory treatments for any of these conditions that we may be talking about, it also removes the responsibility of the physician to give those explanations that are required in order to give people the right to refuse medical treatment. That is a serious ramification of being so specific in our bill about compulsory treatment, and it is one that we should think long and hard about in here.

We are not only removing but we are also giving the state the right to mandatorily treat people who are not going to be diagnosed or tested for these illnesses (they are just going to be treated), and the doctors and healthcare professionals are also not compelled to discuss with these people who are going to be receiving this treatment what ill effects they may suffer, what they are actually being treated for, what is in these medications—all the information that they would be required to be given under law in any other circumstance. That is what worries me about this.

The Hon. G.E. GAGO: In relation to the first part of the question, I had already clearly put on the record that, in relation to TB, the vaccination for TB is not an emergency treatment so it would not be covered by this provision. The emergency treatment for TB is the administration of antibiotics within 48 hours of exposure. The vaccination for TB in this situation would not be captured by this provision.

I have already put on record those jurisdictions that have provision for compulsory or mandatory treatment so I do not need to repeat that. But, in terms of the approach of other jurisdictions to this issue of compulsory treatment, I think it is important to remind honourable members that the public health law is in a state of flux and development, and has been since the turn of the century. Various jurisdictions have taken a range of approaches to address public health risks, including emergency public health provisions.

In reviewing the Public and Environmental Health Act, the job of our public health officials was to examine the range of legislative responses and consider their application for South Australia. Their principal task was to identify what was going to be the best range of powers and provisions to deal with public health challenges to this state. That is what is being presented in this bill.

As legislators, it is our job to confirm that and ensure that our state has the best chance to deal with public health challenges and meet genuine public health threats with robust and necessary powers. Whether or not some other jurisdictions may or may not have similar explicit powers is, in fact, immaterial to that, I believe.

The test is: what is best for South Australia? The government is not going to propose a watered down set of powers just to conform to what some other jurisdictions may or may not be doing if it weakens our capacity—particularly under a lens of contemporary analysis—to protect our citizens, and I believe that it is necessary to have that test as the superior test. That is the measure.

Regarding the Hon. Ann Bressington's questions around consent to treatment, it is about individual care. What we are dealing with here is a public health bill which is about the protection of the health of the public at large. I remind members that these are emergency powers, exercised very rarely, and in a framework of principles, as we have already discussed, which includes patients being involved in discussions about themselves and being given clear reasons for any decisions made. So, those aspects are incorporated within that framework of principles.

The CHAIR: I intend to put this amendment, because it was moved some time ago. But, the Hon. Mr Wade can have a crack.

The Hon. S.G. WADE: I am still waiting for answers to questions I put on notice during the previous session. I had questions arising from the answers that were given, so I do not think I will be in a position to vote on any amendments until I have sought further clarification. I am happy to restate No. 4, which is: could the minister define what is preventative treatment?

The Hon. G.E. GAGO: I have been advised that preventative treatment is designed to prevent the onset or development of a disease when there has been known (or there has been reason to believe or presume) exposure to a contaminant. The example is the prophylactic use of antibiotics within 48 hours of exposure to TB.

The Hon. S.G. WADE: Could I clarify, minister, and it will not take me long to show the limits of my understanding of health technology. So preventative treatment, if you like, is in the short-term prevention of disease? Normal vaccinations outside of an emergency context presumably are to manage long-term risks whereas preventative treatment in this context is very much in the short term—in other words, before a person could resume their normal life, engage their normal medical practitioner and so forth.

The Hon. G.E. GAGO: Preventative treatment can be short, medium and long-term, but we are talking about it in the context of this bill. This bill is about emergency treatment only. It only deals with preventative treatment in relation to emergency situations, not the long-term; that would be dealt with under health management plans, GPs and other measures. This only deals with the emergency preventative measures, particularly to do with the mass spread of a highly contagious disease where there is a high risk of large amounts of people being exposed and put at risk.

The Hon. S.G. WADE: To be clear, an officer who purported to impose compulsory treatment for a risk that was not immediate would be acting beyond the powers of this bill.

The Hon. G.E. GAGO: That was not part of the emergency declaration.

The Hon. A. BRESSINGTON: I am seeking clarification here. The minister, in her first example, gave the example of a plane-load of people infected with bubonic plague—because we will get over TB—and that they would be identified and mandatorily treated for bubonic plague. We are assuming here that these people have got off the plane, gone home, and it has been discovered that bubonic plague is an issue. Those people are then recalled and treated with a prophylactic antibiotic for bubonic plague.

What about all the people they have been in contact with? If you have 300 people on a plane who have been exposed to this, and they have gone home and mixed with other people and they may or may not be contagious, how does this not equate to a serious emergency? Why would you not be bringing these people in, isolating and detaining them until you can see the extent of what the infection would be? Is that still an option? That is what I am not clear on. I am referring to isolation and detention to make observations and then declare a public health emergency.

The Hon. G.E. GAGO: I have been advised that there is a wide range of possibilities and circumstances that could occur in emergency situations and each one would be dealt with on a case-by-case basis. The bill before us is particularly focusing on those powers to be provided in an emergency situation to prevent the mass spread of disease. The honourable member is referring to a situation where the horse has bolted.

For instance, we might receive advice that someone on board a flight coming from overseas has been identified as having pneumonic plague. What could happen is that, when the flight lands at Adelaide Airport, all the people on that flight might be separated and isolated. They might be just separated for a period of time for testing and assessment. If there is a high risk of TB, for instance—I know you do not like me talking about TB—we know that they have to be treated within 48 hours, so they would be treated, but not necessarily always treated—only where we know that it is going to be an effective means of preventing spread. We would contain that plane-load of people, isolate and separate them and manage the situation in that way.

These powers really would have very little effect once a plane-load of 600 people had gone home to their kids and then their kids had gone off to school. These provisions would be very difficult to apply in that sort of situation—unless it was the sort of disease where we would close down Adelaide and prevent all people in and out of Adelaide, so that the containment would be the whole of Adelaide. Now, I doubt that we would have enough antibiotics to treat them, even if that were an appropriate treatment. It depends on the extent of the pandemic, the availability of medication and facilities, etc. That would be assessed on a case by case basis.

The Hon. A. BRESSINGTON: Will the minister guarantee that, in this emergency public health act we are talking about, and in the example she just used of the plane-load coming over and being identified and isolated, we would be talking about the use of antibiotics and not vaccinations, with forced or mandated treatment?

The Hon. G.E. GAGO: This bill would apply to any form of treatment that is assessed to be appropriate to meet only those emergency needs—and only emergency prevention needs—so it could apply to nearly any form of treatment.

The Hon. S.G. WADE: I want to go back to the minister's answer to an earlier question relating to the interaction between the Emergency Management Act and the South Australian public health act. I understand that your advice is that the South Australian public health act is likely to be activated earlier than the Emergency Management Act, but I am not clear as to whether that is because of the government's understanding of the nature of public health emergencies or whether it is reflected in the acts. So, to reframe the question I asked on Tuesday, are there any triggers in the Emergency Management Act that would suggest that that act would not be able to be engaged as early as the South Australian Public Health Bill?

The Hon. G.E. GAGO: I have been advised that the Emergency Management Act has powers that deal with an emergency which would involve a large part or the whole of the state. The Public Health Act relates to specific emergencies. If I go back to the analogy of the plane-load of people coming in with pneumonic plague, whilst they are still in the plane they would potentially be captured by the public health act. Once they have all gone home, the kids have all gone off to school and the thing has spread around most of the state, it would then come under the auspice of the Emergency Management Act. I have put on record already that there are not specific triggers. That is a situation that does help delineate the difference in powers.

The operational protocol is for health to have powers via the Public Health Bill to deal early and effectively with emergencies before it has that widespread effect. The State Emergency Coordinator is involved in the declaration of an emergency under the Emergency Management Act, and it is their decision (on their expertise and the advice that they are given) as to whether to escalate from a public health provision to an emergency act provision.

The CHAIR: Hon. Mr Wade, we have been on this amendment for a fair while.

The Hon. S.G. WADE: It is a very important amendment, Mr Chair.

The CHAIR: We are still on the clause. We can deal with the amendment and stay on the clause.

The Hon. S.G. WADE: Sorry; this does relate to the amendment. You are right, Mr Chair, I should explain why I am asking this question.

The CHAIR: There have been no questions asked of the mover of the amendment.

The Hon. S.G. WADE: It takes us back to Tuesday's discussion where the minister was assuring us that the Emergency Management Act was not a relevant act under which to enforce treatment powers. That question was being asked because the Hon. Ann Bressington's amendment—so it specifically relates to the amendment—only deletes the treatment powers in relation to the South Australian Public Health Bill.

So, the Hon. Dennis Hood and I, as we were exploring this issue, were somewhat reassured. I should speak for myself only, but I imagine honourable members were somewhat reassured that, even if this treatment power was deleted, there would still be a treatment power available. Concerns were raised in that context because the minister was suggesting that the Emergency Management Act might be late coming.

This is at least the second occasion I have asked this question and I have not been given any references to the statute. On my cursory look, I can see no differential in the trigger between the two. My understanding is that the Emergency Management Act was brought into play in relation to the Port Lincoln fires. That is hardly a statewide emergency; that is a localised emergency, and I do not criticise anyone for bringing it in there. I would have thought that there would be very localised but very serious non-health-related emergencies that would justify the engagement of the Emergency Management Act.

I stress to the minister again that the relevance of this line of questioning is: why would we not delete from a health act a provision that requires mandatory treatment, when in our health legislation we have a high regard for a person's right to refuse treatment, when, if it is needed, it could be activated under the Emergency Management Act?

The Hon. G.E. GAGO: I believe that question is answered in the example I gave with the pneumonic plague and the plane-load of people. If you remove this provision, it would not allow for the instant preventative treatment of people on that aircraft. It would take some time for the provisions in the emergency act to be applied to that situation.

I am advised that there could be circumstances where it might not be able to be applied, so there are circumstances where, potentially, situations could fall through the gaps. So, this is making absolutely categorically sure that those matters that are captured by the public health powers, where assessed to be necessary; that early, instant, preventive mandatory treatment can be applied as a last resort, in those circumstances, to protect public health. I cannot be any clearer than that.

The CHAIR: I am not going to put up with this for much longer.

The Hon. A. BRESSINGTON: Then we will not vote on it. We have to be clear on this. This is a very important amendment, and it is a very important provision in this bill.

The CHAIR: You have tossed it around for a fair while now.

The Hon. A. BRESSINGTON: We are not getting the answers we want, obviously.

The CHAIR: It is your amendment.

The Hon. A. BRESSINGTON: I know.

The CHAIR: Perhaps somebody should be asking you some questions on it; I do not know.

The Hon. A. BRESSINGTON: Fire away!

The CHAIR: That is what usually happens to people who move amendments.

The Hon. A. BRESSINGTON: It is the minister who is objecting to it. Minister, can you give us an example of what would be a situation that would fall through the cracks, if we are talking pneumonic plague or whatever? What is the evidence that shows that if you tell somebody they have pneumonic plague and you are offering them an antibiotic that they would refuse that treatment?

The Hon. G.E. GAGO: I will start with the second part of the question first. We are sort of going over and over a lot of old ground. The example I gave in relation to the second part of your question was in relation to that incident with the gentleman who was infected with HIV.

The Hon. A. Bressington: That's a totally different situation, and you know it.

The Hon. G.E. GAGO: It is not a totally different situation.

The Hon. A. Bressington: That's mischievous.

The CHAIR: Order!

The Hon. G.E. GAGO: It is not. You asked for an example where people could refuse treatment. This is an example of a person—

The Hon. A. Bressington: That was a criminal act.

The Hon. G.E. GAGO: —who was completely irresponsible in terms of his behaviour. He could prevent the spread of HIV.

The Hon. A. Bressington: That doesn't apply to this bill, and you know it.

The Hon. G.E. GAGO: It does not apply to this bill and I did not suggest—

The Hon. A. Bressington: No, so don't use it as an example.

The Hon. G.E. GAGO: I can use it as an example because you asked me—

The Hon. A. Bressington: It doesn't apply to this bill.

The CHAIR: Order! The Hon. Ms Bressington will put a sock in it.

The Hon. G.E. GAGO: It is an example, and it is a reasonable example to give in relation to some individuals who hold very different and sometimes irresponsible beliefs and views about themselves and the world that are not consistent with ours and who may refuse treatment, just as that particular person refused to prevent the spread of HIV.

Anyone here in this chamber would think that is a reasonable thing. Once a person is aware that they are contagious or infected, any reasonable person would not proceed to have unprotected sex, yet we know of examples where that occurs. So, we know that different individuals have different views of the world, so the legislation needs to be able to cater for those emergency situations, like the example I have given with TB, where you have a 48-hour window of opportunity, so I have been advised, and where treatment has to be given immediately. That is a real-life example.

In relation to the second part of the question, I will beg the indulgence of the committee. I want to put something on the record just for clarification, because I did talk about instances 'falling through the cracks' and that is not a good analogy. I have been advised that it is not so much 'falling through the cracks' when we are talking about the Emergency Management Act and the public health act, but rather the Emergency Management Act has these extremely broad powers that, once they become operational, apply across agencies, so it actually harnesses every agency in a huge overall effort. It is basically applying a sledgehammer, when you do not really need it, to crack a nut.

The public health bill applies to a specific health emergency. We do not need to harness every agency across the state and set up committees and all sorts of things to coordinate services across that particular disaster like the fires. It was not a specific health emergency. It was an emergency that involved housing, water, sewerage and roads. It was appropriate in that case that, across government, efforts be coordinated.

However, the public health bill only pertains to a health emergency—so why bring out a sledgehammer when you do not need it—and in that health emergency, it is applying the principles of being able to mandate treatment. I just wanted to correct the record because I had given an analogy that was not perhaps as helpful as it could have been.

The Hon. S.G. WADE: I think both on Tuesday and today that the committee—all members, including the government members—is concerned to make sure that we maintain respect for medical self-determination, if I could use that term. The Hon. Ann Bressington referred to the Consent to Medical Treatment and Palliative Care Act as a key piece of legislation in this state that upholds that value.

I put to the minister: would the government consider an amendment to clause 14 of this bill, being the clause that deals with specific principles, so that clause 14(5) might pick up the key objects from the Consent to Medical Treatment and Palliative Care Act? In particular, I draw the minister's attention to section 3(a)(i) which talks about a person's right 'to decide freely for themselves on an informed basis whether or not to undergo medical treatment'.

I appreciate that the minister is representing the Minister for Health and may need to consult, but I suggest that that might provide reassurance to the committee that we will maximise the person's right to refuse treatment within the circumstances of the public health emergency.

The Hon. G.E. GAGO: I think that that might provide a way through this. I am not the minister responsible and obviously I would need to consult with the Minister for Health (Hon. John Hill) and see if he is amenable to that, but it does certainly hold some promise. On that note, I might seek leave to report progress.

Progress reported; committee to sit again.

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