Voluntary Assisted Dying Bill 2017 - Second Reading Debate

Extracted from Hansard
18 October 2017

Voluntary Assisted Dying Bill 2017 – Second Reading Debate

Ms BRITNELL— Acting Speaker, I seek leave to extend my comments.

Leave granted.

Ms BRITNELL— This is possibly the most challenging bill I will ever rise to speak on in my role as a legislator, because I can understand how confronting and challenging this is for so many people. Death is not an easy topic. It is confronting, and it is deeply personal.

Death, dying and bereavement are things I have been exposed to considerably over my 30-year nursing career. I could not begin to tell you how many people I nursed who were dying and how many I sat with as they took their last breath. I supported many through the news of their diagnosis, and many tears were shed by those in my care whilst they expressed their innermost fears.

Since this legislation was first proposed I have spent considerable time discussing it with former colleagues, nurses and other clinicians, doctors and specialists — those experienced in treating the type of patients this legislation may affect. I have also heard from many of my constituents, and I want to put on the record my thanks to those who shared their stories with me. I have carried the ministerial panel’s report and the legislation with me everywhere, and I have read it at every spare moment I had. It is torn, stained, dog-eared and full of notations. I have also spent many hours reflecting on and recalling those people I nursed whose death experiences were difficult.

I remember a young mum whom I nursed for the last few months of her life as she came in and out of hospital. She had three young sons, she was about my age at the time and her boys were the same age as mine. I got to know her and her boys well. Her journey was a particularly difficult one. In the end the cerebral metastasis made her death very unpleasant. I clearly remember her screaming and wishing for it to end.

Another case I nursed was in New South Wales. A man who was admitted into the ward I was in charge of had a rotting throat cancer. He wanted nothing more than to leave his failing body and be free of his suffering. He took three weeks to die. His suffering and anxiety and the smell of his wound are things I will never forget. There are so many stories of death that have left their mark on me. I do not want to share too many graphic stories. Some are actually too hard for me to speak about.

I will never know whether any of the people I nursed would have chosen the pathway that this legislation would offer them, but I do know that many of them could have felt some comfort knowing that this path was available for them and that the fear and the worry that they spent hours discussing with me may have been alleviated somewhat. Through this legislation we can allow them to get on with living the short time they have left instead of dreading and fearing a slow and possibly arduous end to their life.

The health system respects and empowers patients, as is demonstrated through the self-determination model of care that we use. This legislation is also a reflection of that model of care and ensures the patient is empowered to self-determine what they feel is suffering. Self-determination is a basic human right.

This legislation is narrow — deliberately so. It will be for people who actually do not have the choice of living. The outcome will be the same if they take this pathway or not. Their life will shortly come to an end. We should never kill, and this is not killing. The disease is already doing that. This legislation is about an individual having the right to determine for themselves and to make their own decision to determine if this is the right path for them.

Palliative care does not become an either/or option because of this legislation. Palliative care is and always will be a key component of treatment for all people who are facing death. It should always be the first option. But even with the very best palliative care, I have not heard any health professionals claim they can guarantee that all deaths will be free from pain and suffering.

Concerns raised during this debate that a doctor may not get it right have been around for a long time — long before we started discussing assisted dying. Those concerns are always present with any disease treatment plan. The system already relies heavily on a duty of care. Doctors must always ensure due diligence in prescribing, diagnosing and treating. This legislation takes that responsibility even further. The doctor will have to be able to demonstrate that the person is assessed to be eligible. In this situation they will have even greater scrutiny as there are more checks and safeguards than for any other course of action they are involved in.

Disability, age and mental illness are not reasons alone, and anyone wishing to end their life because of these factors alone will not be eligible for assisted dying. There are already longstanding and strict laws around mental capacity that apply to assessment of sound mind. This is not a new process, but it has also been an area of concern for many opposed to the bill.

There are criminal sanctions to deter and prevent those who may want to use this for the wrong reasons, as is the fear of some opposed to this. Doctors already have enormous power and responsibility. If they want to do harm, they already can. As a health community, we have worked in many ways to alleviate suffering and pain, and we do it well. We save so many from diseases that they once would have suffered terribly from. We can reverse heart attack damage, facilitate hearing in the deaf and give people a new chance at life with transplanted organs, but dying we cannot stop. We cannot continue to keep pretending that we know what the painful truth of death feels like.

The truth is that assisted dying has been happening for a long time. Health professionals already use drugs to hasten the last days when necessary. It is not the disease in these instances that patients die from; it is respiratory depression that is the cause of death. I have been a part of many teams caring for a dying person, and often family and clergy were present and fully aware of what was happening. We do this because it is right and it is compassionate, but it is unregulated.

I cannot stress enough that this is for those who are dying — actually on the death trajectory — not likely to die, but will die shortly. Doctors cannot make this judgement without a clear indication that death is imminent. I cannot stress enough also that this is a decision that no-one else can make. It will be the patient’s and the patient’s alone, but only in the terminal stage of a terminal condition.

I have been a firsthand witness to the journey of many people — strong people — crippled by fear and anxiety of what they might face. I am comforted that we are taking this action to provide people whose life is ending the comfort that they will be able to set aside those fears. I am confident that we have a strong piece of legislation that has been well considered and ensures this process will be safe, compassionate and have appropriate safeguards. I see no compassion in leaving a person to die a slow and possibly uncomfortable death when they have determined they have had enough. Patients are already making decisions now to end their treatment and shorten their lives. Sometimes patients with chronic conditions actually just say, ‘I’ve had enough’.

As health professionals we are trained to save lives, and it is tough — really tough — to watch your patients die. This is why I understand some of the doctors who are struggling to see that this is a good concept. Those who are concerned that the legislation does not have enough detail about the drug or the process for doctors assessing the patients are not acknowledging the way the system is working currently. We do not legislate the drugs doctors use on patients or for diseases. We do not prescriptively legislate how procedures or surgeries should be done. It comes back to a doctor’s legislated duty of care.

This assisted dying legislation will require doctors to ensure they are trained in this change, and they will have to able to ensure their patient meets the very narrow eligibility criteria. To say that doctors will conspire and intentionally do wrong completely disregards the credibility that the system and the doctors currently demonstrate. There is no obligation for a doctor to be involved in the assisted dying process. There is nothing forcing a doctor who is opposed to take part. They can opt out and not take part in the process.

I entered Parliament two years ago, and I took on this role because I believe in doing the right thing. I will not be silent when I need to speak up, and I will not be quiet when I need to stand strong. This is one of those moments. While considering this bill I also found myself reflecting on my own journey. I was raised a Catholic and was taught traditional Catholic values, including compassion. It was that value that drove my nursing career.

Just prior to my election, I had also been through a very challenging, life-changing experience — I was diagnosed with cancer. My initial diagnosis was not promising, and I spent the first few days after diagnosis waiting for test results thinking what my death may look like and what my children might go through. I thought back to the patients I had nursed. I had seen people waste away and lose their abilities and independence before death. They had often become incontinent, their eyes had become sunken and they were so weak they could not speak before they slipped into unconsciousness, sometimes taking many days to stop breathing. It is traumatic, to say the least. That is the truth of many deaths. It is not wrong, nor is it right, but it is a fact. Again, we should never kill, and this is not killing. Death is already happening. I understand that people are worried, but this legislation will not change the normal process of care. It simply adds something at the end of the process — an alternative pathway.

At the moment, following a diagnosis, the first discussions with doctors are about treatment options, not dying. But of course it is natural for people to ask, ‘How long have I got?’. Health professionals do not allow the focus of the discussion to be about dying because at that stage it is not possible to know what will occur when tests and options are fully explored. I know that some patients initially will ask to begin the conversation about voluntary assisted dying, but I also know with absolute confidence that the doctors and health professionals will not be facilitating that discussion until it is appropriate, and only at the patient’s initiation.

They will do exactly what they do now. They will be talking about the options of treatment and their ability to treat or extend life. They will talk about pain management and palliative care, but when the options run out and time is clearly slipping away it is only then that a doctor will allow the person to begin the formal process of taking this assisted dying pathway, if they choose to do so. There is comfort that this legislation provides someone who is fearful of their own death to know that when the time comes, and if they need to exercise this discretion, they can.

So many people I nursed were frozen in their journey of bereavement because of the horrific fear they had of dying. It is my belief that this bill will allow people like them, crippled with fear about how their death will be, to feel somewhat at ease and to put those fears aside and get on and live — actually live and enjoy those precious last few weeks and months with the people they love. I commend the bill to the house in the memory of those whom I nursed and could not keep comfortable in death despite the best care available.