Victoria at the cross roads

By Paul Russell:

The euthanasia debate returned to the public eye in Victoria once again last week with the announcement that up to half of the Victorian Premier's cabinet supports the idea of the government taking on euthanasia (rather than allowing for the possibility of a private members bill).

The Premier has apparently opened up the discussion within his cabinet and the suggestion is that he will be lead by a majority decision in that forum. The fairfax press in Melbourne has been in a feeding frenzy over these comments in what looks, for mine, like an old-fashioned wedging ploy.

The Premier, for his part, has been rather non-commital, preferring to couch his words in terms of a need to 'do better'. From the Fairfax story:

"If you search your conscience, and you search your own personal experience, I think more and more Victorians are coming to the conclusion that we are not giving a dignified end, we are not giving the support, the love and care that every Victorian should be entitled to in their final moments," Mr Andrews said.

Mr Andrews said there was momentum in the Victorian community to have a detailed conversation about people having the right to a dignified death.

"We are failing as a community," he said. "We are failing many, many people; we have to do better."

The Herald Sun reports that legislation could be brought to the parliament by December this year. This is rather speculative. Certainly, the Premier has until early December - six months since the parliamentary inquiry recommending euthanasia was originally tabled - to respond.

Recent media also suggested that up to half of Premier Andrews' own cabinet support euthanasia, placing pressure upon him to acquiesce.

This week, the Victorian Health Minister, Jill Hennessy, announced the introduction of the Medical Treatment Planning and Decisions Bill 2016 which takes up part of the earlier recommendations of the Parliamentary Committee on end-of-life choices for changes to the system of advance care directives. This same committee recommended euthanasia and assisted suicide.

At the press conference releasing the bill, Ms Hennessy indicated her support for euthanasia citing recent health difficulties experienced by her mother.

A cursory glance at the Medical Treatment Planning and Decisions Bill suggests that some of it at least may have some merit. In detail, it would appear more like the 'curates egg' - parts of it may indeed be good, but problems do exist.

In her second reading speech on this new bill, Ms Hennessy made some observations that should give pause for thought on the whole question of euthanasia.

In a section entitled; Support persons, Hennessy comments about vulnerability:

"People are often required to make medical treatment decisions at a point when they feel particularly vulnerable die to pain or discomfort, or because they are confined to a hospital bed in unfamiliar Surroundings. This may make it difficult for a person to make the necessary decisions at that time."

Indeed, one of the reasons why the idea of 'choice' is an illusion in respect to euthanasia.

Ms Hennessy also makes some welcome comments regarding subjective and abelist treatment of patients by doctors, medical staff and substitute decision makers:

"...a decision must not be based on assumed characteristics of a person because they have a particular disease or disability. Respect for a person's individuality also means that a medical treatment decision-maker cannot make decisions based on how they would respond to a disease or disability."

While welcome, this statement is, at best, aspirational. Not only is there no effective way of ensuring that either the doctor or the substitute decision maker think and act objectively at all times, there's no real way of knowing whether or not this was the case in any given circumstance.

People living with disabilities acknowledge that they are sometimes confronted with the attitude that says that people would rather be dead than be like them. A clause in a bill is not going to stop that, but maybe it might help.

Anyway, isn't this precisely the message, implicit or explicit, that a doctor who agrees to a request for euthanasia makes to his patient; that they agree that the person's life is not worth living?

Even more welcome were the comments this week from the new head of the Australian Medical Association, Dr Michael Gannon, against euthanasia and directed squarely at Victoria. Gannon told The Australian that he thought that 'Interstate terminally ill patients could flood Victoria's health system' if Victoria proceeded to legislate. Recommendation 49 of the parliamentary report actually recommended a residency requirement, however, such requirements are easily circumvented and may actually be unconstitutional.

Gannon also said: "there are many questions in this extremely complex area".

"How do you fund this? Is it covered by Medicare? Is it a service that is provided in public hospitals?

"What is the ability of individual doctors and nurses in those hospitals to participate in those arrangements? It is very easy to stand up and say you believe in dignity in dying. It's a whole lot more complicated to write laws that manage the hundreds of bits of detail that need to be sorted out before anyone can avail themselves of this service."

He urged the Victorian Parliament to focus, instead, on making sure that regional and rural Victoria has access to the best in care and also urged improvement in palliative services nation wide.