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Legislative Council - Fifty-Fourth Parliament, Second Session (54-2)
2021-11-18 Daily Xml
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Advance Care Directives (Review) Amendment Bill

Second Reading

Adjourned debate on second reading.

(Continued from 16 November 2021.)

The Hon. S.G. WADE (Minister for Health and Wellbeing) (17:19): I would like to thank all honourable members for their contributions. There was one issue, raised by the Leader of the Opposition, that I would seek to address as part of my summing-up remarks.

Recommendation 17 of the Lacey review recommended that section 45 of the Advance Care Directives Act be amended to require the Office of the Public Advocate to discontinue a matter where a reasonable suspicion of elder abuse exists and refer the matter to the South Australian Civil and Administrative Tribunal for determination.

Following consultation and feedback it was noted that the requirement for the Office of the Public Advocate to refer all matters to the SACAT where there may be a suspicion of abuse has the potential to miss opportunities for the Office of the Public Advocate dispute resolution service to uphold advance care directive arrangements by providing support and education to substitute decision-makers and other family members.

As a result of the feedback received it was decided that the Office of the Public Advocate should continue to have the option to refer certain matters to SACAT where abuse of a person is alleged, as is currently specified in the act. I note with respect to this matter that the honourable Leader of the Opposition has sought clarification as to how the Office of the Public Advocate currently determines whether or not an alleged abuse is a misunderstanding or is reasonably suspected.

The Office of the Public Advocate dispute resolution service practice guidelines set out the procedure for, and guide the practice of, the Office of the Public Advocate's dispute resolution service to fulfil the role conferred upon the Office of the Public Advocate by the Advance Care Directives Act 2013 and the amendments made to the Consent to Medical Treatment and Palliative Care Act 1995.

The practice guidelines outline the application process, the pre-mediation process, the principles and ethical considerations of mediation to guide dispute resolution services' mediators working with the model, and referral to SACAT. All parties to the dispute complete an application form and are screened by a nationally accredited mediator via an initial screening process to determine any risk and power imbalances, including abuse. This screening process is undertaken by trained mediators and is detailed and comprehensive and captures any actual family violence or abuse.

During this process the mediator will speak with all interested parties, including the person who made the application, any family and friends involved, the substitute decision-makers appointed under the advance care directive and representatives of the aged-care facility, accommodation providers or hospitals where the person is residing in a hospital.

The screening process for any risk, including abuse, is an ongoing assessment through the dispute resolution matter. If actual abuse is identified, the Office of the Public Advocate will immediately refer the matter to the SACAT for determination. All clients or persons at the centre of the dispute are contacted, and a visit or telephone contact is arranged to discuss the application to the dispute resolution service and hear any concerns or issues they may have, including any family violence, abuse or coercive control. Where possible, the client or person at the centre of the dispute is included in the dispute resolution process.

During this assessment and screening process and during any other interactions, if actual abuse is identified, as I said earlier, the Office of the Public Advocate will immediately refer the matter to the SACAT for determination.

Bill read a second time.

Committee Stage

In committee.

Clauses 1 to 9 passed.

New clause 9A.

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

Amendment No 1 [HealthWell–1]—

Page 5, after line 26—Insert:

9A—Insertion of section 36A

After section 36 insert:

36A—Certain provisions of advance care directive of no effect where suicide attempt or self harm

(1) Despite any other provision of this Act, the following provisions apply in circumstances where a person who has given an advance care directive attempts suicide, or otherwise intentionally causes harm to themselves:

(a) a provision of the advance care directive comprising a refusal of particular health care (whether express or implied) will, to the extent that the health care arises out of, or is directly related to, the attempted suicide or self-harm, be taken to be of no effect;

Note—

Consequently, such a provision of an advance care directive does not constitute a binding provision of the advance care directive, and a health practitioner need not comply with the provision.

(b) section 36 will be taken not to apply to, or in relation to, a health practitioner providing health care to the person where the health care is directly related to the attempted suicide or self-harm,

however, nothing in this subsection limits a provision of the Consent to Medical Treatment and Palliative Care Act 1995 or any other Act or law requiring consent to be obtained before such health care is provided to the person.

(2) Nothing in subsection (1) affects the remaining provisions of an advance care directive (including, to avoid doubt, the refusal of health care other than that directly related to the attempted suicide or self-harm).

(3) Without limiting any other provision of this or any other Act, a health practitioner or other person incurs no civil or criminal liability for a refusal or failure to comply with a provision of an advance care directive referred to in subsection (1).

The amendment seeks to insert new section 36A into the principal act clarifying the effect of an advance care directive in the case of attempted suicide or other self-harm. The government is treating this matter as a conscience issue. To highlight that fact, the clause was not made a clause in the tabled government bill. I am moving it as an amendment to the government bill. I am moving it as a private member, not as a minister. In relation to the amendment, I speak for myself alone.

In the advance care directives review on which this bill is founded, Professor Wendy Lacey recommended that advance care directives be circumscribed in the context of self-harm and suicide. Recommendation 29 of the review stated:

The Act must be amended to ensure that it is explicit, in the operative provisions of the Act, that an ACD cannot be used as the basis for refusing life-saving treatment following an attempt to suicide or cause self-harm. The remainder of an otherwise valid ACD must be preserved.

Professor Lacey's recommendation reflected the original intent of the act. An advance care directive preventing the delivery of life-saving medical treatment following an attempted suicide is not in line with the original intent of the act. Given that the act was deliberately drafted to prevent such an occurrence, coupled with the fact that in Professor Lacey's view the act would have almost certainly not been passed if this were the case, she concluded that the act should be amended to clearly reflect that fact.

In relation to the second reading explanation, which was delivered on 17 October 2012, that speech did reiterate that the use of an ACD to facilitate an act of suicide or self-harm was intended to be prohibited. I quote from the second reading explanation:

The Bill provides that the following would be void and of no effect if contained in an Advance Care Directive:

unlawful instructions or instructions which would require an unlawful act to be performed such as voluntary euthanasia or aiding a suicide

refusals of mandatory treatment such as compulsory mental health treatment under the Mental Health Act 2009

actions which would result in a breach of a professional code or standard, for example a Code or Standard issued by the Medical or Nursing and Midwifery Boards of Australia. It does not mean a hospital code or standard.

Again, section 12 of the act specifically excludes unlawful acts. Professor Lacey's recommendation reflected a regulation under the act which was originally proposed by the Chief Psychiatrist. Regulation 12A was promulgated in the advance care directives regulations 2019. This was done as a temporary measure to clarify the requirements on health practitioners in providing life-saving treatment following an attempt to suicide or cause self-harm until such time as the government could bring the appropriate form of legislation to the parliament for debate.

In fact, I gave an undertaking to the Hon. Mark Parnell that I would do that, bring appropriate legislation to parliament, and my understanding is that on that basis he did not proceed with his intent to disallow the regulation. He has since retired, but this is, if you like, the parliamentary debate that was foreshadowed in 2019. Professor Lacey in her review report concluded:

Despite the above, it is evident from the 3 cases referred to that ACDs [advance care directives] have been applied to prevent the delivery of life-saving medical treatment following an attempted suicide. Given that the Act was deliberately drafted to prevent such an occurrence, coupled with the fact that the Act would have almost certainly not been passed if this were the case, the Act should be amended to clearly reflect this. By failing to recognise the original intent of the legislation, as well as the intention of Parliament when passing the Act, the Act would have a completely unintended operation and effect without such an amendment.

As part of the review of the act, Professor Lacey recommended the act be amended to make it clear that an advance care directive cannot be used as the basis for refusing life-saving treatment following an attempt to suicide or cause self-harm.

The draft bill that was put out for public consultation included a section which was drafted to reflect recommendation 29 of the review by Professor Wendy Lacey. The purpose of the relevant clause in the original draft bill was therefore to clarify what should happen when a person with advance care directive comprising refusal of health care attempts suicide or self-harm. My understanding is that the amendment moved in my name is the same amendment that was put to the consultation process just referred to.

Broad stakeholder consultation was sought on the clause. Feedback received identified a divide in opinion between those who support the amendment to ensure there is clarity for health practitioners in providing life-saving treatment following an attempt to suicide or cause self-harm and those who believe that any such amendment would fundamentally undermine the principles of the act and weaken the principle of self-autonomy on which the act is based.

The issue is: does an advance care directive bind a health practitioner to not administer potentially life-saving treatment following an attempt of suicide or causing self-harm? The amendment I move makes it clear that following an attempt of suicide or causing self-harm an ACD is not binding on a health practitioner in requiring a health practitioner to not administer potentially lifesaving treatment, to the extent that that treatment arises out of or is directly related to the attempted suicide or self-harm.

The Chief Psychiatrist argues that the amendment is appropriate and proportionate to the requirement that paramedics and other emergency department medical staff not be bound by a pre-existing refusal of treatment in cases of attempted suicide or self-harm. If I could quote a letter from the Chief Psychiatrist to Ms Lynne Cowan in the context of the consultation:

As noted in the Discussion Paper, suicidality is characterised by ambivalence and changeability. Absent the proposed amendment, the binding nature of an ACD refusal of treatment is inconsistent with the often acute nature of a suicide attempt and any underlying mental illness. The proposed section 12A is appropriate and necessary, given the preventability of suicide and self-harm behaviours with appropriate treatment and therapy.

Importantly, the wording of section 12A is proportionate to its intended purpose. The amendment would limit the binding nature of an ACD treatment direction only to the extent that lifesaving treatment relating to the suicide or self-harm attempt can be applied; other aspects of the ACD would continue to apply. The removal of the binding nature of a refusal of treatment does not mean that the particular circumstances of a person who has attempted suicide (such as a long history of degenerative illness) cannot be considered when determining whether to withdraw treatment. The amendment simply ensures that an existing ACD that contains a refusal of treatment originally intended for another purpose (such as a condition with a poor prognosis) is not used after a suicide attempt when the nature of the attempt is acute.

I am advised that clinicians already have the responsibility to not act on an ACD when they consider it was not intended for the circumstances they face. I would like to stress that the amendment seeks to limit the binding nature of an ACD treatment direction only to the extent that life-saving treatment relating to suicide or self-harm can be applied. Other aspects of the ACD will continue to apply.

Any amendments to address cases of attempted suicide and self-harm need to ensure that the remainder of an otherwise valid ACD can remain valid and effective including the appointments of substitute decision-makers. This includes the appointment of SDMs, any other permitted directives in an ACD, the interaction of valid ACDs with the consent act, and the hierarchy of persons responsible across the LHNs.

The proposed new section 36A respects clinical discretion. It does not force health practitioners to disregard the binding refusals in an advance care directive in the case of attempted suicide or self-harm, but it does provide health practitioners the opportunity and the responsibility to make a decision on a case-by-case basis in line with relevant professional standards and good clinical practice and all the circumstances of the case, when determining whether to comply with the advance care directive to withdraw treatment.

The removal of the binding nature or refusal of treatment does not mean that particular circumstances of the person who has attempted suicide cannot be considered. Passing this amendment would ensure that health practitioners are able to make the appropriate clinical judgement for the provision of life-saving treatment in the context of attempted suicide or self-harm, protecting them against civil or criminal liability for refusing to comply with an advance care directive provision in the circumstances envisaged.

Some responses on the draft bill suggested that Professor Lacey's recommendation from 2019 is no longer fit for purpose given the significant change in public policy since the passing of voluntary assisted dying legislation in South Australia. It is argued that the passing of the voluntary assisted dying legislation by this parliament fundamentally changes the public policy context of the bill and that, for the sake of consistency, suicide should be facilitated by this bill.

As a supporter of the recent voluntary assisted dying legislation through this parliament, I am very concerned about that interpretation. Parliament has supported careful, structured requests for voluntary assisted dying. For me at least it was not supporting broad entitlement of assisted suicide without criteria and without safeguards. The fact that credible stakeholders would view the bill—this bill, the Advance Care Directives (Review) Amendment Bill 2021—without this amendment as a bill able to provide assisted suicide doubles my view that this amendment should be supported.

In conclusion, I do not want to assert that there is some binary moral clarity that justifies the amendment. I appreciate the issues are complex and not clear. Nonetheless, we are lawmakers and we need to give clinicians more clarity on this issue than they currently have.

The Hon. F. PANGALLO: I am just rising to say that SA-Best will be supporting the amendment.

The Hon. C. Bonaros: It is a conscience vote.

The Hon. F. PANGALLO: I will be supporting the amendment anyway. Sorry, I did not realise it was a conscience vote. Even though I was against voluntary assisted dying I think the minister has just made quite a compelling justification for that amendment and I will be supporting it.

The Hon. C.M. SCRIVEN: I would like to perhaps highlight a few points in this and thank the minister for bringing this amendment to the council. As he mentioned in his address, this provision is already in the regulations, so this is already in effect at the moment, and I think that is important, but by putting it into the legislation it will give even further certainty to doctors. There have been some comments that this amendment would in some way diminish autonomy, but, however, we need to recall that there already exists specific provisions to discourage suicide, suicide of course being something that is almost universally agreed in our community to be a negative and tragic event. In general, there is almost universal agreement that we should provide support to people who are contemplating suicide.

The Chief Psychiatrist, John Brayley, refers to 'the preventability of suicide and self-harm behaviours, with appropriate treatment and therapy'. In acknowledgment of that, we already have existing laws that are directed to the prevention of suicide. For example, in the Criminal Law Consolidation Act we find that:

…a person who finds another committing or about to commit an act which he believes on reasonable grounds would, if committed or completed, result in suicide is justified in using reasonable force to prevent the commission or completion of the act.

That is in existing law. Similarly, current law also allows treatment without consent in some circumstances, such as in the Mental Health Act, which says, in various places, but in particular in section 21:

A medical practitioner or authorised mental health professional may make an order that a person receive treatment as an inpatient in a treatment centre…

It goes on:

because of the mental illness, the person requires treatment for the person's own protection from harm…the person has impaired decision-making capacity relating to appropriate treatment of the person's mental illness;

There are a number of other pieces of legislation also that put limits on that autonomy, in this case for the person's own protection, particularly in the case of attempted suicide.

Also in the Chief Psychiatrist's words, it is particularly relevant in commenting on the draft bill. He refers to the very limited circumstances to which this provision would apply to an advance care directive. I will quote from that:

The amendment would limit the binding nature of an ACD treatment direction only to the extent that lifesaving treatment relating to the suicide or self-harm attempt can be applied. Other aspects of the advance care directive would continue to apply.

I think that is particularly relevant: other aspects of the ACD would continue to apply. This provision would only apply in relation to the self-harm or suicide attempt. Mr Brayley goes on:

The removal of the binding nature of a refusal of treatment does not mean that the particular circumstances of a person who has attempted suicide cannot be considered when determining whether to withdraw treatment. The amendment simply ensures that an existing ACD, that contains a refusal of treatment originally intended for another purpose, such as a condition with a poor prognosis, is not used after a suicide attempt when the nature of the attempt is acute.

I think it is clear that there are existing provisions where we say there are exemptions to the ability to refuse treatment. This is very important in terms of preventing and discouraging suicide, and therefore I would encourage members to support the amendment.

The Hon. K.J. MAHER: I thank the minister for his contribution. This is a particularly difficult area, where ethics and morality come into play between how consent to medical treatment and advance care directives work, and there are not easy answers to this. I made some points in my second reading contribution, particularly about some of the contribution evidence that the Joint Select Committee on End of Life Choices heard, which looked at voluntary assisted dying but also looked at advance care directives and particularly at the interplay with the provisions of the consent to medical treatment legislation.

I was not sure if I heard it correctly, so it would be good if I could ask the minister for some clarification. I appreciate this is being put as an amendment, so it gives us all the opportunity to not have the bill rise or fall on the basis of what is a conscience matter. I think that is a sensible way and I thank the minister for that.

On the amendment, is it the intention and the effect that doctors or healthcare providers or paramedics—whatever the case may be—administering the care, I think the wording is, are not bound by the advance care directive, so can take it into account, in effect, or is it the intention that they have to completely disregard it and not take it into account at all? The reason I ask is for completeness. This is not a got you sort of question; I do not think that is appropriate for something like this.

The way I read section 36A, certain provisions of an advance care directive have no effect, and under section 36A(1), 'Despite any other provision, the following provisions apply in circumstances' where a person who has given the provision will to the extent that health care arises out of it be taken to have no effect. The way I read that, it is not that healthcare providers are not bound. They can choose to take it into account, they are just not bound. The way I understand this is they cannot take it into account at all. They are not allowed to take into account the advance care directive in these circumstances, if that makes sense.

The Hon. S.G. WADE: If I can restate it from my point of view, my understanding is the amendment as it is put would maintain clinical discretion. A clinician in all the circumstances could decide that he or she would act on the advance care directive as though it was binding on them but, as a matter of law, it would not be binding on them.

I think it is helpful of the deputy leader to mention paramedics, because it is probably helpful for us in this debate to differentiate the context with the voluntary assisted dying. The voluntary assisted dying will often be—and the Chief Psychiatrist will correct me as will in fact the Chair, who is very experienced in suicide prevention; please forgive me if I misstate these things—in the context of a home or a hospital or a hospice with a well-developed relationship between the clinicians, the family and the patient.

With the three cases that brought this issue alive in I think 2018 and 2019, my understanding is they were more in the context of an emergency response. So you have a paramedic who is at the scene with a challenging decision to make about an advance care directive. With all due respect, they do not have the long-term relationship with the person that a palliative care team might have. Likewise, a doctor in an emergency department is confronted with an acute life-threatening situation. They have reason to believe that it was suicide or self-harm. They have an advance care directive. They have to make a difficult decision about what their ethical duties are to the patient and, if you like, to their profession.

This amendment does not say that they do not have a duty to their patient, but it says that the law is not going to bind you to honour the advance care directive if you believe it is in the context of suicide or self-harm. That may well not be in the best interests of the patient because, as the Chief Psychiatrist has said and the honourable deputy leader has quoted, that may well be a passing state.

The Hon. K.J. MAHER: I think, minister, you have introduced this to this house. This is still to go to the other chamber, and it might be something, if we do pass this today, that might need clarification. With respect, that is not how I read it.

The Hon. S.G. WADE: Could you pause? I might seek advice from the advisers.

The Hon. K.J. MAHER: Yes. I might just say the heading at 36A states that the advance care directive is to have no effect, and under 36A(1)(a) it is taken to be of no effect. The way I read that is the paramedic or the doctor cannot take into account the advance care directive. It is to actually have no effect, as if it did not exist, not that they are not bound by it, if that makes sense.

The Hon. S.G. WADE: As merely tongue in cheek, I might say this is the second time today we have talked about ambiguity of words, and is it a 'may' or is it a 'must'? I would refer the honourable member to the note at (1)(a):

Consequently, such a provision of an advance care directive does not constitute a binding provision of the advance care directive, and a health practitioner need not comply with the provision.

My understanding of that is that it does not say that a health practitioner must not comply with the provision. It is a discretion. Just to clarify, that is consistent with the advice I am receiving from advisers.

The Hon. K.J. MAHER: That is helpful. If I remember correctly, we changed the Acts Interpretation Act to allow notes to become parts of how we—

The Hon. S.G. WADE: You are taking me back to shadow attorney-general days.

The Hon. K.J. MAHER: No, we did this in this term of parliament, I think. I appreciate that, and that is helpful. The part that I think troubles me and certainly was discussed at length during the end-of-life joint committee—I am checking that I am reading this right, minister—is that just below that note, at the bottom of subsection (b), the Consent to Medical Treatment and Palliative Care Act is not affected in any way by this amendment to the Advance Care Directives (Review) Amendment Bill.

I might explain a bit more. An example could be a perfectly healthy 30 year old could have had a self-harm attempt, ended up in hospital, have regained consciousness and there be some sort of medical procedure that would necessarily save their life but, being conscious, they elect not to. Even though where they are has emanated from that self-harm attempt, they are conscious and can elect not to have that procedure. I just want to double-check that is correct.

The Hon. S.G. WADE: My advice is that, if a person regained consciousness after a suicide or self-harm attempt, and the amendment might already have been activated. The medical staff may be operating on the basis that the advance care directive is not binding them. As soon as that person regains capacity—that may not be just consciousness; the clinician would need to decide in the context whether they have capacity—to be revived, this section would no longer have effect.

The Hon. C.M. SCRIVEN: I have a supplementary on that. Is it not also possible that, in that circumstance, it could be that the provisions of the Mental Health Act could come into operation, where the medical practitioner or mental health professional could consider the person has a mental illness based on their suicide attempt, and therefore could make the determination that the person should have that medical treatment even without consent?

The Hon. S.G. WADE: I am advised that the Mental Health Act would only apply in relation to mental health treatment. Any medical treatment would still operate under the Consent to Medical Treatment and Palliative Care Act.

The Hon. K.J. MAHER: I thank the minister and I understand the Hon. Clare Scriven's point. This is where it gets down to the intersection of ethics and morality. Does the very nature of a suicide attempt—can someone ever have mental capacity if they have attempted suicide?

I do not know that there is a clear-cut answer to that. Some of the evidence from the end-of-life choices select committee, where elderly patients who are in the last stages of advanced cancer—much of the evidence was that they had mental capacity even if they attempted and went through with a suicide attempt because of the physical pain and suffering they were in at the time, but it is a difficult question, I understand.

I thank the minister and it is the way I read it as well, that if someone attempted suicide, regained consciousness, was conscious but also had the requisite mental capacity to consent under the consent to medical treatment act. In that example, that otherwise healthy 30 year old—who would, but for their refusal to the treatment for the condition that arose from their self-harm attempt, go on to live a full life for the next 40 years or 50 years—could decide to refuse that medical treatment even though it arose from a self-harm attempt.

The Hon. S.G. WADE: I share the honourable member's view that that is the case.

The Hon. K.J. MAHER: That is where I have struggled with this and that is where I think I have landed, that I am not going to support the amendment that the advance care directive scheme is set up to put a patient in the same position as if they were able to make the decision for themselves. In that case, where a person, by virtue of the consent to medical treatment act, after a self-harm attempt, if they were conscious and had the mental capacity, could make that decision for themselves, we are then differing from what the advance care directive scheme would do and diverge from that ability to make that decision for themselves.

Again, I do not think it is clear-cut and the right answer. On balance, that is where I have landed. I think many of us have probably had correspondence from former health minister, Martyn Evans, that I think goes towards that. I have had the benefit of talking to people like Dr Roger Hunt about practitioners who have practised in this area, and on balance that is where I have fallen, that the intent of the scheme is rightly to put someone in the same place as if they were conscious or had that capacity (notwithstanding they have lost it) and in circumstances where they could have refused that treatment but for not having capacity. On balance, I have landed that the advance care directive should be respected in that fashion.

The Hon. C.M. SCRIVEN: Just following on from that contribution, I think we need to remember that the provisions will only relate to health care arising out of or directly related to the attempted suicide or self-harm, so the person will not be subjected to any other kind of health care other than that essentially required to save their life as a result of their suicide attempt, and therefore all other aspects of any advance care directive would remain in place. I refer again to Dr Brayley's comments in his correspondence:

The amendment simply ensures that the existing [advance care directive], that contains refusal of treatment originally intended for another purpose, such as a condition with a poor prognosis, [for example, a terminal illness—that is my example, not Dr Brayley's] is not used after a suicide attempt when the nature of the attempt is acute.

I think in the circumstances that have been put forward, in the event that that medical treatment purely in relation to the suicide attempt took place, the person would then potentially regain consciousness, hopefully, and then any other medical treatment that is not a result of that suicide attempt could be accepted or rejected as the case may be. They would actually not be affected by this because this is only medical treatment in terms of the suicide attempt or self-harm attempt.

The Hon. C. BONAROS: Can I just indicate for the record—and I think the honourable Leader of the Opposition has articulated this well—that this is an extraordinarily complicated issue. I have always maintained the position that when it comes to conscience votes I will be guided by the expert evidence that we receive before us in this place, and I have said that time and time again, and that is how I have voted.

I can see the merit in the Leader of the Opposition's position in terms of this. I suppose my concern is that we are talking about suicide prevention strategies and plans that we have just implemented on one hand, we are talking about ACDs on the other hand, and we are talking about VAD, and they all seem to have become conflated in this one issue. It is extraordinarily difficult then to find the middle ground.

That said, I have also read the correspondence of the former minister who has made a very strong case for this amendment to not be supported, but I am going to defer to the position that I have always taken on these issues. We now have the advice before us—I have at least the advice, and the Hon. Clare Scriven has referred to the advice that has been provided to us by Dr Brayley on this issue—and I am taking that as the expert advice. We also have the outcome of the Lacey review and the recommendation that was made in that, which is consistent with the current regulatory regime, and this is simply moving that into the legislation.

So if I am to vote according to the way that I have always voted on this and take a purely clinical view of what we are dealing with, then I am really struggling to come to any other conclusion than to actually support the amendment that the minister has put today, because I think the advice that has been provided to us by the experts is that this is a necessary provision insofar as it relates to suicide attempts and ACDs and how those two things coexist.

I think it is a particularly unfortunate set of circumstances for any paramedic or doctor who finds themselves in the position where they have this conflicting situation before them where somebody has made an attempt on their life but in the same respect they have an ACD which says, 'Don't resuscitate me,' or whatever the case may be, 'Don't perform those life-saving treatments.' I note, as the Hon. Clare Scriven did, the commentary or the advice by Dr Brayley in that regard in terms of that only applying in relation to the suicide attempt itself but not in relation to any of the underlying health issues that the individual may also have.

The Hon. Kyam Maher used the example of the 30 year old who regains consciousness and says, 'I don't want that medical treatment,' but I am also very mindful of the 30 year old who is in that position and has not regained consciousness, for whatever reason. I am not sure—Dr Brayley can probably explain this better than I can—but there may be instances where that 30 year old has not regained consciousness and that is a pure suicide attempt. In that case, without this amendment, effectively doctors would be making a decision to not administer potentially life-saving treatment. I think that goes against the grain of what we are trying to achieve. I hope that makes sense, but it is for those reasons that I am inclined to support the amendment that has been put by the minister.

New clause inserted.

Remaining clause (10), schedule and title passed.

Bill reported with amendment.

Third Reading

The Hon. S.G. WADE (Minister for Health and Wellbeing) (18:06): I move:

That this bill be now read a third time.

Bill read a third time and passed.

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