Wednesday, 15 October 2025

 Mary-Anne THOMAS (Macedon – Leader of the House, Minister for Health, Minister for Ambulance Services) (10:46): In accordance with the Charter of Human Rights and Responsibilities Act 2006, I table a statement of compatibility in relation to the Voluntary Assisted Dying Amendment Bill 2025:

In accordance with section 28 of the Charter of Human Rights and Responsibilities Act 2006 (the Charter), I make this statement of compatibility with respect to the Voluntary Assisted Dying Amendment Bill 2025 (the Bill).

In my opinion, the Bill, as introduced to the Legislative Assembly, is compatible with, and promotes, the human rights protected by the Charter. I have this opinion for the reasons outlined in this statement.

Overview of the Bill

This Bill introduces amendments to the Voluntary Assisted Dying Act 2017 (VAD Act) which was introduced in 2017 and came into effect in June 2019. The purpose of the Bill is to improve equity of access to, and the experience of people in Victoria who seek voluntary assisted dying as part of their end-of-life care.

The importance of the Bill

The VAD Act establishes a mechanism for adults with decision-making capacity who are suffering from a serious and incurable condition to access voluntary assisted dying. The voluntary assisted dying framework established in the VAD Act seeks to strike the appropriate balance between ensuring that eligible persons have access to high quality end-of-life care, consistent with their preferences, while at the same time requiring robust eligibility criteria to protect against abuse, such as through undue influence or coercion.

Following the commencement of the VAD Act, the framework provided for in the VAD Act – which includes a prescriptive, multi-stage assessment process with numerous safeguards and comprehensive oversight – has received consistent stakeholder feedback, including by way of stakeholder contributions to the ‘Five Year Review into the Operation of the Voluntary Assisted Dying Act 2017’ (the 5-Year Review), identifying some processes and safeguards having the unintended effect of impeding access to, and the timeliness of, voluntary assisted dying in Victoria.

In response to this feedback and the evidence set out in the 5-Year Review, this Bill removes a number of access barriers in, and unintended consequences flowing from, the VAD Act. The amendments set out in the Bill seek to uphold the rights of persons who face death because of an incurable disease, illness or medical condition, to live their lives with freedom and dignity, while at the same time, retaining the necessary safeguards to prevent any potential exploitation or abuse arising in the context of voluntary assisted dying, ensuring confidence in the operation of the VAD Act.

In this context, the Bill makes the following amendments to the VAD Act:

•   allowing registered health practitioners to initiate discussions about voluntary assisted dying with patients;

•   requiring registered health practitioners who conscientiously object to voluntary assisted dying to provide minimum information about voluntary assisted dying to patients;

•   adding an ‘ordinarily resident’ requirement to satisfy Australian residency requirements;

•   providing an exemption to the Victorian residency requirement;

•   removing the third assessment requirement for neurodegenerative conditions;

•   introducing an exemption process to interpreter accreditation requirements;

•   providing that medical practitioners cannot be a family member, beneficiary or otherwise benefit from a voluntary assisted dying applicant’s death;

•   reducing the timeframe between the first and final request for voluntary assisted dying;

•   extending the prognosis requirement from 6 to 12 months;

•   simplifying permits to improve applicant choice and prevent delays due to permit change and introducing an ‘administering practitioner’ role;

•   amending the medical practitioner eligibility requirements to reduce years of experience required;

•   removing forms from the VAD Act and instead providing in regulations; and

•   requiring additional review of the VAD Act.

Human rights

In light of the scope of this Bill, this Statement of Compatibility commences with an outline of the rights generally engaged by the Bill and then discusses the compatibility of relevant provisions of the Bill with those rights.

The human rights protected by the Charter that are relevant to this Bill are as follows:

Right to equality and protection from discrimination (section 8)

Section 8(1) of the Charter provides that every person has the right to recognition as a person before the law. Section 8(3) provides that every person is entitled to equal protection of the law without discrimination and has the right to equal and effective protection against discrimination. The purpose of this component of the right to equality is to ensure that all laws and policies are applied equally, and do not have a discriminatory effect. ‘Discrimination’ under the Charter is defined by reference to the definition in the Equal Opportunity Act 2010 (EO Act) on the basis of an attribute in section 6 of that Act. Direct discrimination occurs where a person treats, or proposes to treat, a person with an attribute unfavourably because of that attribute. Indirect discrimination occurs where a person imposes a requirement, condition or practice that has, or is likely to have, the effect of disadvantaging persons with a protected attribute, but only where that requirement, condition or practice is not reasonable.

Right to life (section 9)

Section 9 of the Charter provides that every person has the right not to be arbitrarily deprived of life. An ‘arbitrary’ deprivation of life may be described as one that is unreasonable or disproportionate. The right imposes a negative obligation on public authorities to refrain from conduct that causes an arbitrary deprivation of life, and it is possible that it also imposes some positive obligations to take steps to prevent arbitrary deprivation of life such as introducing appropriate safeguards to minimise the risk of loss of life. The right to life is said to be an inherent and ‘supreme’ right, without which all other human rights would be devoid of meaning. However, despite the fundamental nature of the right, it is not absolute, meaning that it can be limited where justifiable.

Right to protection from torture and cruel, inhuman or degrading treatment (section 10)

Sections 10(a)–(b) of the Charter provide that a person must not be subjected to torture or treated or punished in a cruel, inhuman or degrading way. The right is concerned with the physical and mental integrity of individuals, and their inherent dignity as human beings.

Cruel or inhuman treatment or punishment includes acts which do not constitute torture, but which nevertheless possess a minimum level of severity. Degrading treatment or punishment involves acts of a less severe nature again but which inflict a level of humiliation or debasement of the victim. Whether conduct meets the necessary threshold will depend upon all the circumstances, including the duration and manner of the treatment, its physical or mental effects on the affected person, and that person’s age, sex and state of health.

Right to privacy (section 13)

Section 13(a) of the Charter provides that a person has the right not to have their privacy unlawfully or arbitrarily interfered with. The fundamental values which the right to privacy protects include physical and psychological integrity, individual and social identity, and the autonomy and inherent dignity of the person. An interference will be lawful if it is permitted by a law which is precise and appropriately circumscribed, and will be arbitrary only if it is capricious, unpredictable, unjust or unreasonable, in the sense of being disproportionate to the legitimate aim sought.

Right to freedom of thought, conscience religion and belief (section 14)

Section 14(1) of the Charter provides that every person has the right to freedom of thought, conscience, religion and belief, including the freedom to have or adopt a religion or belief of one’s choice, and to demonstrate one’s religion or belief individually or as part of a community. The concept of ‘belief’ extends to non-religious beliefs, as long as they possess a certain level of cogency, seriousness, cohesion and importance. This right is grounded in the principles of personal autonomy and self-determination. It also acknowledges that people may live their lives in accordance with their beliefs and that the State should not arbitrarily interfere with the expression of people’s beliefs. While the freedom to hold a belief is considered absolute, the freedom to manifest that belief may be subject to reasonable limitations.

Right to liberty and security of the person (section 21)

Section 21 of the Charter provides that every person has the right to liberty and security, including the right not to be subject to arbitrary arrest or detention. It has been suggested by the Victorian courts that the right to security of the person in section 21(1) may be broader than just physical freedom and is an instance of the human right to personal integrity or inviolability, which in turn is an expression of the bedrock value of human dignity.

Human rights issues

Allowing registered health practitioners to initiate discussions about voluntary assisted dying with eligible patients

Clause 7 of the Bill substitutes current section 8 of the VAD Act with new sections 8 and 8A.

Current section 8 of the VAD Act prohibits registered health practitioners who provide health services or professional care services from initiating discussions with their patient about the availability of voluntary assisted dying. That is, a registered health practitioner can only provide information about voluntary assisted dying if the patient requests such information on their own initiative. The provision was inserted as a safeguard to ensure that patients were not pressured, or felt pressured, by their health practitioner to consider, or undergo, voluntary assisted dying. However, the 5-Year Review, and stakeholder feedback generally, has shown that that the prohibition in current section 8 has had the unintended effect of negatively affecting patients’ awareness of the end-of-life options available to them.

It is against this background that new section 8 provides that a registered medical practitioner or a nurse practitioner who provides health services or professional care services to a person may initiate a discussion with that person about voluntary assisted dying if the discussion is in the course of a discussion about end-of-life care, and in doing so, they take reasonable steps to ensure that the person knows about the treatment and palliative care options available to the person and the likely outcome of those treatments.

New section 8A provides that registered health practitioners – who provide health services or professional services to a person and are not a registered medical practitioner or nurse practitioner – may initiate a discussion about voluntary assisted dying with the person if the discussion is in the course of a discussion about end-of-life care, and, in doing so, advises the patient that the most appropriate person with whom to discuss available treatment and palliative care options and voluntary assisted dying, is their medical practitioner.

Right to life (section 9)

The scope of the right to life in section 9 of the Charter is unsettled and may, on a broad reading, impose a positive obligation on the State to take positive steps to prevent arbitrary deprivation of life, such as by implementing safeguards to minimise the risk of loss of life. The removal of the prohibition on registered health practitioners to raise voluntary assisted dying may be seen as the removal of a safeguard previously legislated to minimise the risk of loss of life. This being so, the voluntary assisted dying framework provided under the VAD Act is carefully and appropriately confined through stringent eligibility criteria (Part 2 of the VAD Act), a multi-stage request and assessment process (Part 3 of the VAD Act) as well as other safeguards that protects against abuse of vulnerable persons in end-of-life care.

Accordingly, to the degree that clause 7 of the Bill engages the right to life, the very limited circumstances in which voluntary assisted dying may be accessed, together with the numerous safeguards embedded in the voluntary assisted dying process, I am of the view that any possible limit on right to life is demonstrably justified in a free and democratic society.

Right to personal autonomy and dignity of the person (sections 13(a) and 21(1))

In Canada, the Supreme Court has held that a prohibition on voluntary assisted dying would contravene the ‘right to life, liberty and security of the person’. The Court found that the right relates to a person’s autonomy and quality of life and by denying a person the opportunity to determine the manner and timing of their death in response to serious pain and suffering, the person was denied their right to liberty and security. While section 21(1) of the Charter differs from the Canadian provision in that it does not include the word ‘life’, section 21(1), if directly considered by the Victorian courts, may be found to relate to the autonomy and quality of life of a person, rendering the withholding of an opportunity to determine the manner and timing of one’s death in response to serious pain and suffering an infringement on the right to security.

It follows that clause 7 of the Bill, which seeks to ensure that eligible persons are properly informed of their end-of-life options and provided the ability to make well informed choices about the manner and timing of their death, promotes their right to physical and psychological integrity, personal security, mental stability, autonomy and inherent dignity. Accordingly, the rights in section 13(a) and 21(1) of the Charter are, in my view, promoted by clause 7 of the Bill.

Right to protection from inhuman treatment (sections 10(b))

Whether conduct meets the necessary threshold of cruel, inhuman or degrading treatment for the purposes of section 10(b) depends upon all the circumstances, including the duration and manner of the treatment, its physical or mental effects on the affected person, and that person’s age and state of health. Ensuring that eligible persons who are suffering without relief from a serious and incurable condition are informed by their medical practitioner or medical team of voluntary assisted dying which would allow them to determine the timing and manner of their death and reduce their suffering at the end of their lives, does, in my view, promote the right in section 10(b).

Requiring health practitioners who conscientiously object to voluntary assisted dying to provide minimum information about voluntary assisted dying to patients

Recognising that some medical practitioners conscientiously object to voluntary assisted dying, section 7 of the VAD Act currently provides registered health practitioners with the right to refuse participating in the voluntary assisted dying process. This includes the right to refuse the provision of information about voluntary assisted dying to a patient. Further, section 13 provides registered medical practitioners to whom a first request for access to voluntary assisted dying is made, the right not only to refuse the request, but also to refrain from providing the patient with information about the process and other medical practitioners able to assist the patient.

Recognising that the right of refusal in sections 7 and 13 of the VAD Act has negatively affected equitable access to voluntary assisted dying, clause 6 of the Bill amends section 7 so as to require all registered health practitioners who conscientiously object to voluntary assisted dying to advise patients that another registered health practitioner or health service provider may be able to assist them in relation to information about, or access to, voluntary assisted dying, and to provide patients with pre-approved information about voluntary assisted dying. Similarly, clause 12 introduces new section 13A to require all registered medical practitioners who refuse a first request for voluntary assisted dying to advise patients that another registered medical practitioner may be able to assist them in relation to the person’s first request, and to provide patients with pre-approved information about voluntary assisted dying.

Right to freedom of thought, conscience religion and belief (section 14)

Introducing the requirement that registered health practitioners who conscientiously object to participate in the voluntary assisted dying process or registered medical practitioners who refuse a first request for voluntary assisted dying, must provide to patients who request information about, or access to, voluntary assisted dying, with pre-approved information about the service and advise patients that another registered health practitioner or health service provider may be able to assist the patient, may engage these practitioners’ right to freedom of thought, conscience, religion and belief. This right is grounded in the principles of personal autonomy and self-determination and the principle that the State should not arbitrarily interfere with the expression of people’s beliefs. However, while the freedom to hold a belief is considered absolute, the freedom to manifest that belief may be subject to reasonable limitations.

Having regard to the findings in the 5-Year Review discussed above, I consider the requirements imposed on practitioners to be a reasonable limitation on their freedom to manifest their objection to voluntary assisted dying. This is particularly so when having regard to the fact that practitioners who conscientiously object to voluntary assisted dying remain free to refuse to participate in the request and assessment process; apply for a voluntary assisted dying permit; supply, prescribe or administer a voluntary assisted dying substance; be present at the time of administration of a voluntary assisted dying substance, or dispense a prescription for a voluntary assisted dying substance.

Furthermore, when balancing practitioners’ and patients’ right to freedom of thought, conscience, religion and belief, and the patients’ rights to personal autonomy and dignity and protection from inhuman treatment, I consider the limitation on practitioners’ freedom to manifest their belief, by way of consciously objecting to voluntary assisted dying, to be minimal and demonstrably justified in a free and democratic society. This is especially so, when considering that health professionals should not allow their own beliefs to interfere with their patients’ access to lawful medical treatment.

For these reasons, I am of the opinion that the right to freedom of thought, conscience, religion and belief, if limited by clauses 6 and 12 of the Bill, is reasonably justified.

Adding an ‘ordinarily resident’ requirement to satisfy Australian residency requirements and providing an exemption to the Victorian residency requirement

Section 9 of the VAD Act contains the eligibility criteria for access to voluntary assisted dying in Victoria. Section 9(1)(b) deals with the residency requirements and subsection 9(1)(b)(i) provides that in order to be eligible to access voluntary assisted dying the person must be a citizen or permanent resident in Australia. The meaning of ‘permanent resident’ has been interpreted consistently with Commonwealth law as being limited to a holder of a permanent resident visa. This has had the effect of precluding many Australian residents who, while entitled to reside in Australia, are not permanent residents. New section 9(1)(b)(iii), extends the eligibility requirement to persons who at the time of making a first request, have been ordinarily resident in Australia for at least 3 years.

Further to the Australian residency requirement, current subsections 9(1)(b)(ii) and (iii) imposes a Victorian residency requirement by providing that a person must be an ordinarily resident in Victoria and, at the time of making a first request, the person must have been an ordinarily resident in Victoria for at least 12 months. This State residency requirement has had the effect of excluding persons who live in communities outside of Victoria but near the border and who access health, residential aged or palliative care or have family support in Victoria. It also excludes persons who have only recently moved to Victoria. Clause 9 of the Bill inserts new section 9A which provides an exemption to the State residency requirement where the applicant can show that they have a substantial connection to Victoria or there are compassionate grounds that warrants an exemption.

Right to equality and protection from discrimination (section 8)

Section 6(1) of the Charter provides that all persons physically present in Victoria – irrespective of their citizenship or residency status – have the human rights set out in Part 2 of the Charter. Section 8(3) of the Charter provides that every person is entitled to equal protection of the law without discrimination and has the right to equal and effective protection against discrimination.

Under the current s 9(1)(b) of the VAD Act, only a person who is ordinarily resident in Victoria and either an Australian citizen or permanent resident may access assisted dying. Although citizenship or permanent residency status is not an attribute protected in section 6 of the EO Act, the attribute ‘race’ has been defined to include ‘nationality or national origin’. Courts have in turn considered that the term ‘nationality’ can be equivalent to citizenship, leaving it open that a requirement that a person must be an Australian citizen or permanent resident in order to access voluntary assisted dying amounts to discrimination on the ground of race.

Extending the eligibility criteria in current s 9(1)(b) of the VAD Act, so as to include persons who while entitled to reside in Australia, are not citizens or permanent residents, arguably promotes the right to equality and protection from discrimination in s 8 of the Charter. Further, the amendments to the Australian and State residency requirements promotes the rights of persons who suffer from a terminal illness at the end of their lives, and who previously did not fulfill the residency criteria under section 9(1)(b), to personal autonomy and dignity and protection from inhuman treatment under sections 13(a), 21(1) and 10(b) of the Charter.

Removing third assessment requirement for neurodegenerative conditions

A person suffering from a life-limiting illness who wants to access voluntary assisted dying is under the VAD Act required to be assessed for eligibility by two separate medical practitioners, and for neurodegenerative conditions, by three separate medical practitioners.

The 5-Year Review has shown that the requirement for an additional third consultation for those suffering from a neurodegenerative condition unnecessarily lengthens and complicates the voluntary assisted dying process for patients. To remove the third assessment requirement in the VAD Act, clause 15 repeals sections 18(4), 18(5) and 18(6) of the VAD Act.

Right to equality and protection from discrimination (section 8)

A neurodegenerative condition that affects a person’s physical or mental functions is a disability which is an attribute protected under section 6 the EO Act. Accordingly, a person must not be discriminated against based on their neurodegenerative condition. The removal of the additional third consultation applicable to persons suffering from a life-limiting neurodegenerative condition promotes their right not to be discriminated against under s 8(2) of the Charter as it removes the additional hurdle presented by the legislation in regard to persons suffering from this condition seeking to access voluntary assisted dying. By repealing sections 18(4), 18(5) and 18(6) of the VAD Act and aligning the voluntary assisted dying process for persons with neurodegenerative conditions with persons with other life-limiting illnesses, the inequitable application of the VAD Act to the subset of applicants suffering from a neurodegenerative condition is removed.

By reducing the burden on, and improving assessment timeliness for, persons suffering from life-limiting neurodegenerative conditions, their right to personal autonomy and dignity in sections 13(a) and 21(1) and their right to protection from inhuman treatment in section 10(b) are also promoted by the Bill.

Introducing an exemption process to interpreter requirements

Section 115(a) provides that an interpreter who assists a person in relation to requesting access to or accessing voluntary assisted dying must be accredited by a prescribed body. Clause 75 of the Bill inserts new section 115A which provides that a person who requires the assistance of an interpreter may apply to the Secretary for an exemption from the requirement of having an accredited interpreter where an interpreter accredited in accordance with section 115(a) is not available and there are exceptional circumstances that warrant the exemption.

Right to equality and protection from discrimination (section 8)

The amendments introduced in the VAD Act seek to improve access to the voluntary assisted dying process for Victorians that are from small language communities where accredited interpreters are either not available or are difficult to access. New section 115A creates an exemption process overseen by the Secretary, where the Secretary is able to grant an exemption if satisfied that no accredited interpreter is available in the particular case and there are exceptional circumstances for granting the exemption.

Although language is not in and of itself an attribute protected in section 6 of the EO Act, the attribute ‘race’ is often seen to encompass the language spoken by members of the race. Current section 115(a) therefore has the potential of indirectly discriminating against members of small language communities who are unable, or experiencing significant delay in accessing information about, or accessing, the voluntary assisted dying process.

The exemption provision in new section 115A removes the difficulty and inequity currently experienced by members of small language communities who face these circumstances. By facilitating access to voluntary assisted dying for persons in these communities, clause 75 of the Bill promotes the right to equality and protection from discrimination in s 8 of the Charter. It is also likely to promote their right to personal autonomy and dignity in sections 13(a) and 21(1) and their right to protection from inhuman treatment in section 10(b).

Restricting medical practitioners from being a family member, beneficiary or otherwise benefit from a voluntary assisted dying applicant’s death

The VAD Act does not currently prevent a coordinating or consulting medical practitioner from being a beneficiary or family member of the person applying to access voluntary assisted dying. Recognising that further safeguards are needed to prevent any actual or perceived conflicts of interest between a medical practitioner and the person requesting access to voluntary assisted dying, clauses 11 and 19 introduces new sections 13(3) and 23(2A) in the VAD Act.

New subsection 13(3) provides that a registered medical practitioner must refuse a person’s first request if the practitioner is a family member, beneficiary or otherwise benefits financially or in any other material way from that person’s death. New section 23(2A) provides that a registered medical practitioner must refuse the referral for a consulting assessment of a person if the practitioner is a family member, beneficiary or otherwise benefits financially or in any other material way from that person’s death. New section 63B provides that a registered medical practitioner, nurse practitioner or nurse must not accept transfer of administration authorisation under a permit if the practitioner is a family member, beneficiary or otherwise benefits financially or in any other material way from that person’s death.

The right to life (section 9)

Clause 11 and 19 inserts in the VAD Act additional safeguards to prevent abuse of vulnerable persons in end-of-life care by family members, beneficiaries or persons who in any other way benefits financially, or in any other material way from that person’s death. By inserting this requirement, the Bill removes any risk of a conflict of interest arising in regard to a health professional involved in the voluntary assisted dying process and thereby minimise the risk of loss of life. Accordingly, assuming the right to life in section 9 of the Charter imposes positive obligations on the State, clauses 11 and 19 of the Bill promote that right.

Amendments to various provisions providing safeguards that regulate access to voluntary assisted dying

The framework for voluntary assisted dying set out in the VAD Act seeks to achieve the appropriate balance between ensuring all Victorians have access to high quality end-of-life care, consistent with their preferences, while requiring robust eligibility criteria to protect against the abuse of vulnerable persons at the end of their life. However, to reflect stakeholder feedback and the evidence emerging from the 5-Year Review, this Bill makes a number of amendments to the existing framework so as to improve equity of access, remove unintended consequences and improve the experience of people involved in the voluntary assisted dying process. The amendments to these processes are set out in turn below.

1.   Reducing the timeframe between the first and final request for voluntary assisted dying

Clause 28 of the Bill amends section 38(1)(a) of the VAD Act so as to require that a person’s final request for voluntary assisted dying be made at least 5 days, rather than 9 days, as required in the current provision, after the day on which the person made their first request. The new provisions further clarify how these days are to be counted.

2.   Extending the prognosis requirements from 6 to 12 months

Clause 8(2) of the Bill amends the time prognosis requirement in section 9(1)(d)(iii) of the VAD Act from 6 to 12 months, so as a person diagnosed with a disease, illness or medical condition that is:

• incurable; and

• advanced, progressive and will cause death; and

• expected to cause death within 12 months;

• causing suffering to the person that cannot be relieved in a manner that the person considers tolerable,

may be eligible to access voluntary assisted dying.

3.   Simplifying permits to improve applicant choice and prevent delays due to permit change

The Bill amends the VAD Act by replacing the current voluntary assisted dying permit system – consisting of two separate permits: the ‘self-administration permits’ and the ‘practitioner administration permits’ – with a one-permit system. This is achieved through clauses 29–68 of the Bill which repeal or amend all provisions in the VAD Act dealing with, or referencing, self-administration permits and practitioner administration permits and inserts new provisions providing the framework for the newly created voluntary assisted dying permit. Some notable clauses are set out below.

Clause 32 inserts new Part 3A and 3B (sections 44A–44F) in the VAD Act, introducing a new ‘administration decision’. A person who makes a final request may decide, in consultation with the person’s co-ordinating medical practitioner, that the person intends to access voluntary assisted dying by self-administering a voluntary assisted dying substance or having an administering practitioner administer a voluntary assisted dying substance to the person. New Part 3A provides the framework for making and revoking administration decisions. Part 3B sets out the requirements for the appointment of a contact person in relation to self-administration decisions.

Clause 36 inserts new section 47, which provides the process applicable to applications for the new voluntary assisted dying permit. Clause 39 inserts new division 2 of Part 4 (sections 51A–51D) in the VAD Act, which provides for what is authorised under the voluntary assisted dying permit, including the requirements applicable for obtaining, possessing, storing, using and destroying voluntary assisted dying substance. Clauses 43–49 regulates the prescription, dispensing and administration of voluntary assisted dying substance, including the information to be provided to the person administering the substance, by the dispensing pharmacy.

Clause 49 of the Bill inserts new Division 1A of Part 5 (sections 63A–63E) of the VAD Act which regulates instances where the co-ordinating medical practitioner transfers the authorisation to administer the voluntary assisted dying substance to another medical practitioner, a nurse practitioner or a registered nurse with 5 years’ experience.

Clause 51 amends section 64(1) which provides for when a person may request their administering practitioner to administer a voluntary assisted dying substance. Clause 52 amends section 65 which sets out the requirements for witnessing a person make a practitioner administration request and for witnessing the administration of a voluntary assisted dying substance. Clauses 53 and 54 make amendments to the provisions of the VAD Act setting out the processes applicable after the administration of the voluntary assisted dying substance to a person has occurred.

4.   Introducing an ‘administering practitioner’ role

Under the current Act, practitioner administration of voluntary assisted dying substances can only be administered by the coordinating medical practitioner (or the consulting medical practitioner or a third medical practitioner, if the coordinating medical practitioner role is transferred to them). In order to provide more flexibility regarding the administration of a voluntary assisted dying substance, the Bill introduces a new ‘administering practitioner’ role.

Clause 42 inserts new Division 1AA of Part 5 of the VAD Act which deals with the minimum requirements for administering practitioners, and provides in new section 56A that an administering practitioner must be either a registered medical practitioner who holds specialist registration, a vocationally registered general practitioner, a nurse practitioner or a registered nurse who has held registration as a registered nurse for at least 5 years. The Bill further makes the necessary amendments to authorise the newly introduced administering practitioner role to handle and administer the voluntary assisted dying substance in accordance with the processes and requirements provided for in the VAD Act.

5.   Amending medical practitioner eligibility requirements to reduce years of experience required

Current section 10 of the VAD Act sets out the minimum requirements for coordinating medical practitioners and consulting medical practitioners to provide voluntary assisted dying. Clause 10 of the Bill amends section 10 so as to require that co-ordinating medical practitioners and consulting medical practitioners hold specialist registration or are vocationally registered general practitioners. Clause 10 further reduces the number of years co-ordinating medical practitioners and consulting medical practitioners must have practised as a registered medical practitioner from at least 5 years after completing a fellowship with a specialist medical college or vocational registration, to 1 year after completing the fellowship or attaining vocational registration.

The right to life (section 9)

The various amendments to the existing legislative framework (as set out above) may be seen to remove safeguards currently in place in the legislation to minimise the risk of loss of life and thus potentially limit the right to life. However, the amendments made to the voluntary assisted dying framework make the voluntary assisted dying process more efficient and accessible while at the same time maintaining stringent eligibility criteria, multi-stage request and assessment processes as well as oversight mechanisms to ensure the safety of voluntary assisted dying in Victoria.

Although the time prognosis requirement in section 9(1)(d)(iii) of the VAD Act is increased from 6 to 12 months, affecting the eligibility criteria for accessing voluntary assisted dying, the current 6-month limitation period has presented difficulties for medical practitioners in prognostication, negatively affecting the ability of persons who are otherwise eligible, to access voluntary assisted dying. Further, the new 12-month prognosis requirement aligns with the Ministerial Advisory Panel on voluntary assisted dying, which recommended a 12-month limit for all diseases, illnesses and conditions to ensure clarity and consistency with Victorian practice in defining the end of life. On this basis, I do not believe the safeguards built into the stringent eligibility criteria are in any way removed by this amendment.

One amendment that could be perceived to remove an important safeguard embedded in the multi-stage request process is the reduction in the minimum timeframe between the first and final request for voluntary assisted dying. However, the current requirement that a person make their final request at least nine days after the first request has been shown by the 5-Year Review to cause unreasonable delays for persons suffering without relief. By reducing the required time period between the first and final request to five days, the legislation reduces risks of delays while simultaneously safeguarding the authenticity of a person’s request to access voluntary assisted dying, ensuring that the request is voluntary, considered and enduring.

The new voluntary assisted dying permit process is intended to improve patient choice and reduce complexity. By allowing the prescription of a voluntary assisted dying substance without the permit having to specify the method of administration (either self-administration or practitioner administration), the person will be able to choose, and change, their administration decision after being granted a permit. Allowing a person to choose their administration method enhances their autonomy and supports their self-determination. Further, where a person wishes to change the administration method in circumstances where their deterioration is rapid, the requirements under the current framework have augmented what is already a difficult and distressing experience for the person, their family and their supporting health team. The safeguards embedded in the permit process continue to ensure the safety of voluntary assisted dying.

By introducing the ‘administering practitioner’ role and amending medical practitioner eligibility requirements to reduce the years of experience required to administer voluntary assisted dying substance, the cohort of medical practitioners who may provide voluntary assisted dying services will increase, allowing greater access for those requiring it. The experience and skills of medical practitioners that qualify under the amendment to provide the voluntary assisted dying service should be a safeguard against any abuse.

For the reasons set out above, I am of the view that the changes made to the voluntary assisted dying framework under this Bill do not detract from the strong safeguards against potential abuse embedded in the framework and does not limit the right to life. Further, I am of the view that by simplifying and improving the current permit system and authorising a greater cohort of practitioners the authority to provide voluntary assisted dying services to those who cannot be provided the relief needed to address their suffering at the end of their life, the right to personal autonomy and dignity in sections 13(a) and 21(1) and the right to protection from inhuman treatment in section 10(b) are promoted by the Bill.

Conclusion

I am therefore of the view that the Bill is compatible with the Charter.

The Hon. Mary-Anne Thomas MP

Minister for Health

 Mary-Anne THOMAS (Macedon – Leader of the House, Minister for Health, Minister for Ambulance Services) (10:47): I move:

That this bill be now read a second time.

I ask that my second-reading speech be incorporated into Hansard.

Incorporated speech as follows:

With the passage of the Voluntary Assisted Dying Act (the Act) in 2017, Victoria led the nation in offering a safe, compassionate, and dignified end-of-life choice for those suffering from a life-limiting illness. Today, we build on that legacy, incorporating 13 targeted amendments to improve equity of access and experience for Victorians who choose to access VAD, to continue to enhance safety, and to make practical improvements to support effective administration of the scheme.

The Bill is not a departure from the values and principles that underpin VAD; rather, it reaffirms them. It is about compassion. It is about autonomy. It is about recognising that for some people, despite the best palliative care, suffering remains. And it is about ensuring that those people are not left on the margins of our system. It also retains and builds on the important legislative safeguards that were put in place in 2017.

The Bill builds on what VAD is about. It offers choice. Not about whether to die, but how, where, and with whom. VAD has allowed people to choose the setting of their final moments: at home, in hospital, or where they felt most at peace. It has given families the chance to say goodbye with grace, to be present, to support, and to honour the wishes of someone they love.

Since VAD was first introduced in 2017, we have been listening and learning. We have heard that Victoria needs to catch up to the rest of Australia. In developing the proposed amendments, we have listened intently and respectfully to people with lived experience, families of people who have accessed VAD, clinicians, advocates, and people and organisations that oppose VAD. We have also studied the implementation of similar legislation in other Australian jurisdictions, including Queensland, Western Australia, Tasmania, and New South Wales. Like these states, we recognise that this is not a choice between life and death; rather, it is an additional end-of-life option for those who are already dying and want to end their suffering.

One of the main purposes of the Bill is to improve equity of access.

The Bill addresses barriers that have prevented eligible Victorians, Victorians who are suffering with life-limiting illness from accessing VAD, and do not go any further than laws in any other jurisdiction. The reforms are grounded in compassion, clinical experience, and the evolving national landscape of end-of-life care.

First, the Bill permits registered health practitioners to initiate discussions about VAD within strict safeguards. Medical practitioners and nurse practitioners will be able to raise VAD as an option their patient can consider, provided they also discuss other available options, such as potential treatment and palliative care, and assist the person to access support. Other registered health practitioners, such as nurses and allied health professionals who may be part of a person’s treating or care team, can also initiate discussions in the course of broader end-of-life discussions, but they must advise the person that a medical practitioner is the most appropriate person to speak to about VAD and other care options.

This change removes the ethical dilemma faced by clinicians who feel constrained from providing complete information during critical conversations about end-of-life options. It will also improve awareness among communities with lower health literacy, ensuring that no one is denied the opportunity to consider VAD simply because they were unaware of their options. Importantly, there will still be at least 2 doctors and 2 independent witnesses tasked with confirming that the applicant is voluntarily requesting VAD and there is no coercion.

Second, the Bill requires health practitioners who conscientiously object to VAD to provide minimum information to patients. This is intended to be contact information for the Statewide Care Navigator Service and the relevant Department of Health website – no more, no less. This approach does not compel anyone to participate in the VAD process, and we are not introducing any new offences. It simply ensures that patients are not left uninformed at a critical moment in their care. This approach respects and reaffirms the right to conscientious objection, but it also sends a clear message: no Victorian should be left without access to information about their options or obstructed from accessing legal care.

Third, the Bill addresses unintended consequences of existing provisions in the Act by amending citizenship and residency requirements. The amendments expand Australian citizenship and permanent residency requirements to permit access to people who can demonstrate 3+ years’ Australian residency, and introduce an exemption process to the Victorian residency requirement on compassionate grounds. These changes remove arbitrary barriers that have caused distress and confusion for patients and clinicians alike.

The Victorian residency requirement in particular is much less relevant than it was back in 2017. It was designed to prevent cross-border access at a time when other Australian jurisdictions lacked VAD legislation. That landscape has changed. Today, this requirement disproportionately affects people living near state borders, those who move to Victoria for aged care or family support, and those with strong ties to the state but insufficient time to meet the residency threshold.

Fourth, the Bill updates the prognosis requirement to a consistent 12 months for all applicants. Under the current Act, VAD applicants must be expected to die within 6 months, or 12 months for people with neurodegenerative conditions. However, determining prognosis is not an exact science, and many practitioners report being conservative in their estimates. As a result, a significant number of applicants have died, deteriorated, or lost decision-making capacity before completing the process. Moreover, it is discriminatory to permit access to applicants at different times based on the type of condition they will die from.

Queensland’s experience shows that a 12-month prognosis window reduces urgency, improves equity of access, and offers a more compassionate pathway for patients and families. This amendment will ensure that fewer people with terminal illness are forced to wait until the final weeks of life to seek relief from intolerable suffering.

Finally, the Bill amends medical practitioner eligibility requirements and modernises the terminology used in the Act. Allowing assessing medical practitioners to have one year’s experience practising as specialist medical practitioners rather than 5 widens the eligible VAD medical practitioner workforce, particularly in regional Victoria, while continuing to ensure that these practitioners are suitability qualified and experienced to carry out their responsibilities. Medical practitioners practice for many years before obtaining specialist registration, which requires rigorous training and assessment by the relevant medical college. Clinical competence will not be in question.

Together, these amendments will improve equity of access for people who have long lived in our community, contributed to our society, and are now facing life-limiting illness but have been excluded from VAD due to settings no longer in place in most other jurisdictions. These Victorians are already dying and suffering, and our system is not responding as well as it should. The Bill affords them the same dignity and choice afforded to others.

Another main purpose of the Bill is to improve experience.

The Bill makes a series of practical amendments to improve the experience of those navigating the VAD process, particularly those facing mobility challenges, language barriers, or rapidly deteriorating health. These changes are designed to reduce unnecessary delays, improve equity, and uphold dignity.

First, the Bill removes the requirement for a third prognosis assessment for people with neurodegenerative conditions. Under the current Act, these applicants must undergo an additional assessment to confirm that their condition will cause death in the next 6 to 12 months. This safeguard was originally intended to provide further assurance where the person has a neurodegenerative condition, given the potential impact on decision-making capacity. However, it disproportionately affects applicants located in regional areas who may struggle to locate a third medical practitioner and those with mobility issues who may struggle to leave the house.

It is important to note that the first and/or second prognosis assessment must be conducted by a medical practitioner with relevant expertise and experience in the person’s condition; therefore, specialist assessment will have already occurred. As per standard clinical practice, medical practitioners always have the option to seek a third prognosis or specialist advice if they need to.

Second, the Bill shortens the minimum time between the first and final request to access VAD from 9 days to 5. This will allow but not require the process to occur within a shorter period. This change will improve the experience of a small number of applicants whose suffering is increased by having to wait for this time period to elapse. People who access VAD often spend significant time reflecting on their end-of-life preferences prior to making their first request, and continue to reflect on their choice after being permitted access. And there is never an obligation on applicants to receive or use the VAD substance even after a permit is granted. The process is entirely patient-led.

Third, the Bill facilitates greater applicant choice in how the VAD substance is administered. Currently, self-administration is the default method except in cases where the applicant cannot physically consume or digest the substance. The amendment allows applicants, following consultation with and advice from their coordinating medical practitioner, to decide between self-administration and practitioner-administration. Permits will be amended to no longer specify administration method. If their condition changes, which it often can quite rapidly, they can change their decision without needing to apply for a new permit. This is rightly a process that takes place between a doctor and their patient, and should not require additional hassle and paperwork.

This flexibility recognises that people facing life-limiting illness may have differing physical capabilities, emotional preferences, and support needs. For some people, self-administration may offer a sense of control and privacy. For others, practitioner-administration may provide reassurance, especially if they are concerned about self-administering the substance and want more support for themselves and their family.

To support this change, the Bill introduces a new role: the administering practitioner. This practitioner, who may be a medical practitioner, nurse practitioner, or registered nurse, will administer the VAD substance instead of the coordinating medical practitioner. Nurse practitioners and registered nurses will be required to complete specific training and access specific supports, including guidance resources and existing clinical and professional supervision arrangements.

This approach acknowledges that the clinical skills required to administer the VAD substance fall within the usual scope of practice of other qualified health practitioners. By expanding the range of health practitioners who can provide this service, we are recognising the skills, experience, and compassion of Victoria’s nurses and harnessing their expertise to ensure people can exercise their choice, particularly in regional Victoria. This approach also provides support to the many doctors who we know want to assist their patients to access VAD but may not be comfortable or confident administering the VAD substance.

Finally, the Bill introduces an exemption process to the requirement for interpreters to be specifically accredited by the national body. While the current requirement for an accredited interpreter is a vital safeguard, rigid requirements can unintentionally exclude some people. The National Accreditation Authority for Translators and Interpreters has acknowledged that there are no credentialled interpreters available for some small language groups. Although there has not yet been a case of a VAD applicant being unable to progress an application due to a lack of credentialled interpreters, this may happen in future.

Per the amendment, an interpreter must be accredited by a prescribed body or have been granted an exemption to this requirement by the Secretary of the Department of Health under exceptional circumstances. Introducing a limited exemption pathway with appropriate oversight ensures that people are not disadvantaged simply because their language is rare or their location remote. It balances safety with compassion and equity.

Together, these amendments will create a more patient-centred, timely, and equitable experience for those who choose to access VAD. They uphold the principles of dignity and autonomy while responding to the lived realities of applicants and practitioners alike.

Another purpose of the Bill is to improve safety.

The Bill introduces a new commonsense safeguard to reinforce the integrity of the VAD framework and ensure continuing public confidence in its operation. While addressed in medical practitioner codes of conduct, the current Act does not prohibit medical practitioners from being a beneficiary or family member of a VAD applicant. It is proposed that the Act be amended to prohibit medical practitioners, nurse practitioners, and registered nurses from acting as the coordinating or consulting medical practitioner or the administering practitioner if they are the beneficiary or family member of the applicant.

This safeguard provides additional reassurance about coercion, particularly in light of the amendment allowing registered health practitioners to initiate discussions about VAD within broader end-of-life conversations. By making it crystal clear that those who stand to benefit financially or personally from a VAD applicant’s death cannot participate in the assessment or administration process, we reinforce the voluntary, considered, and independent nature of the decision.

This amendment is not about casting doubt on the integrity of practitioners. It is about ensuring that the system is transparent, fair, and free from any perception of undue influence.

The final purpose of the Bill is to improve administration of the scheme.

The Bill introduces targeted amendments to improve the administrative efficiency of the VAD framework, ensuring that the system remains responsive and aligned with national best practice.

First, the Bill removes prescribed forms from the Act and provides them in regulations instead, to make it much easier to update forms in response to clinical feedback, legal developments, or evolving best practice. Any changes to the forms will remain subject to Parliamentary oversight through the regulations, which will also continue to be published and accessible. This amendment ensures that the administrative tools supporting VAD are as efficient and effective as possible.

Second, the Bill strengthens the oversight of the systems and programs that support VAD by requiring ongoing review of the Act, with the first 3 years after commencement of these amendments and then at intervals of no more than 5 years. The current Act does not provide for continued evaluation. It specified just one review, which was tabled in Parliament earlier this year. Updating the Act to require regular review ensures that safety, quality, and timeliness remain subject to formal scrutiny. This change reflects a commitment to continuous improvement, informed by lived experience and emerging evidence.

Together, these amendments will ensure that the administrative backbone of the VAD framework remains robust, responsive, and accountable.

The Bill is not about indiscriminately or substantially expanding eligibility for VAD. It is about refining a compassionate framework to better serve those it was designed to help. It is about ensuring that no eligible Victorian is denied access due to scheme settings that are no longer fit-for-purpose, geography, or administrative delay. Most importantly, it is about reaffirming our commitment to dignity, autonomy, and the highest quality care at the end of life.

VAD remains a deeply personal choice. The Bill strengthens the safeguards that ensure that choice is informed, voluntary, and enduring. It enhances the experience for applicants and practitioners alike, while preserving the integrity of the system.

We cannot give people their lives back. But we can give them more choice and control over how they die. We can offer them more peace, dignity, and the comfort of knowing they will not suffer needlessly.

I commend the Bill to the house.

 Cindy McLEISH (Eildon) (10:47): I move:

That this debate be adjourned.

Motion agreed to and debate adjourned.

Ordered that debate be adjourned for 13 days. Debate adjourned until Tuesday 28 October.