Tuesday, 28 October 2025

 Emma KEALY (Lowan) (13:21): It is a great honour to be the lead speaker on this very important and sensitive debate on voluntary assisted dying. I was the lead speaker also on the first iteration of this legislation when it came through the house. For me, that was an honour in that I was able to put both sides of the argument forward at that point, and I was able to have time to share the views of people within my electorate. I particularly note Neville Galpin, who was from my electorate. He sadly passed away with motor neurone disease before voluntary assisted dying was available in Victoria. I would like to touch on his journey again later today, but I will pre-empt that this debate today on the primary legislation but also through the consideration-in-detail process is likely to raise some really confronting issues for a lot of our members and for those who are listening.

When we talk about our end-of-life decisions it instantly for some people is a very, very difficult discussion. Some people are not comfortable in speaking about the process of ageing, of perhaps being diagnosed with an illness or a terminal illness. Some are just not comfortable at all about speaking about dying and no longer being on this earth. There are many that might have a loved one, a friend or family member or a work colleague who they know has a diagnosis of a terminal illness, and to have to share those stories or even consider those privately means that this can be a very confronting piece of legislation. For those as well who have lost somebody recently, for the people who lost somebody a long time ago, for those that have seen traumatic deaths, for those that have seen dignified deaths and for those that reflect upon whether that death could have been more comfortable, more peaceful, more appropriate to reflect the life that that individual lived, it is difficult. However, I am confident that the debate today and this evening will be just as respectful towards the sensitivity of the nature of this topic as it was back in 2017.

I thank the government for bringing this legislation forward. I would like to thank the government for their comprehensive summary of the amendments that were put. An information pack has been provided to members of Parliament in a very succinct and transparent way, where key data has been shared, with the rationale behind the amendments that have been proposed and the views of any reviews or reports, such as the coroner’s report, that fed into the rationale behind these amendments being put. I do appreciate that, and I thank the government for providing that information. In some ways I wish that that was something that was provided on every piece of legislation. It may make for a more harmonious place and for the passage of legislation to be perhaps more productive through both houses.

I would also like to acknowledge that there will be a number of amendments that will be tabled throughout today’s debate. I understand that there will be a reasoned amendment and that there are some amendments which have already been circulated privately to members. I think also the Office of the Chief Parliamentary Counsel is working very, very hard to draft some amendments that will come through as well.

I look forward to having the opportunity to make statements on specific clauses and to debate the pros and cons and otherwise of the amendments that are put forward, and I look forward to it being a constructive debate utilising the mechanisms of the parliamentary system, the Westminster system, to their full advantage.

I would like to acknowledge all of the people in Victoria who do an amazing job supporting people through their end-of-life care. Whether it is VAD practitioners, the statewide care navigator service employees and workers and those who are directly working within the VAD framework or whether it is other healthcare workers and other people in our community who are supporting people through the last weeks, months, hours and minutes of their lives, I appreciate deeply their work. I appreciate the work of palliative care nurses and the care teams, whether they are medical teams or otherwise, within our healthcare system. It might be in a hospital, it might be an aged care service or it could be in the community. It is a difficult journey, but to provide comfort to somebody in their last moments and last breaths on earth is something that I actually find deeply comforting. I really appreciate the work of everybody who is involved in those last moments of care. Having worked within a hospital system, I know how much comfort that provides to individuals who are dying but also to friends and family members and other workers around them. It does truly take people who are absolutely inspirational to dedicate their lives to a healthy journey to absolutely that last breath, and I do appreciate and thank everybody who has participated in that.

I would also like to acknowledge the carers of people in our community, particularly friends and family who are supporting a loved one through the end stages of life or through a terminal illness. They take on an incredible load in our community, and it is not always something that they signed up for and that they expected. Perhaps they sometimes doubt that they have the capacity to give as much as is required. There are many people who sacrifice their own time, their private lives and sometimes even their employment to provide care for those around them, and that is an enormous commitment. Carers are so frequently overlooked and not appreciated, but they are absolutely valuable. I think all members of this place would acknowledge the important work of carers. As I said, whether it is children, grandchildren, friends or family – sometimes it is parents and grandparents as well who are the carers – thank you so much for the care that you provide, because quite frankly Victoria’s care system could not cope without that voluntary work.

This legislation builds upon the legislation which was first passed in 2017. As those who were members of Parliament at that time would recall, it was an extensive debate with many amendments, and it was truly an honour to engage with the community to hear of their experiences around end-of-life decision-making. I would like to acknowledge the work of the former Shadow Attorney-General Robert Clark in his ability to navigate the legislation and provide support to all members of the house. I note that Robert has also provided a level of support through informing us what the implications of the proposed amendments would be through an amended version of the legislation, which has been very helpful for us. His wisdom has been enormously appreciated by all. He is a wonderful human, and even though he is, I think, either a vegan or a vegetarian, he is still a very good bloke! I have a lot of time for Robert. I do miss him, but I do appreciate that his support continues for sound legislative process in this place.

I would like to go to the key provisions of this legislation. Firstly, how we got here is that there was a review, which was part of the act, which was undertaken by the Voluntary Assisted Dying Review Board.

The review board had an obligation to review the processes and systems to see what worked, what did not work and how it could be improved. In some respects it was addressing the concerns of those who made contributions during the previous debate and those in the community who were concerned that in some way this legislation may be exploited for the wrong reasons or, on the other hand, that there may be barriers in place within the legislation that would prevent people who perhaps would otherwise have been eligible, or should have been eligible, accessing voluntary assisted dying.

The review board did an enormous amount of work in considering the operation of the legislation, particularly those systems, processes and practices involved in the voluntary assisted dying framework, and it found that generally voluntary assisted dying is working appropriately. However, it also identified areas for improvement, including addressing barriers to access, support for the health workforce and maintaining strong safeguards.

These are consistent themes that stakeholders have expressed to us. There are some stakeholders that would still prefer that voluntary assisted dying were not available on various grounds, and that is based on a belief system as opposed to any other framework. I respect that. I respect all views on this debate, and I think it is something that is exceptional but also is a positive that we can have different views and respect those around this particular piece of legislation and what it means in operation.

There are some people who still have the view that this is equivalent to voluntary suicide. As the Shadow Minister for Mental Health, I do not agree with that perception. It is an entirely different scenario when somebody is facing a mental health crisis as opposed to somebody who is suffering intolerable pain, whether through the illness itself or through the medication and treatment of that condition, where they are already working towards a timeframe of death, which is a very short timeframe towards death. The hope has gone because the diagnosis is present as opposed to the challenge of suicide, where the hope has gone from the mental framework. I see that it is quite different. I know others will not agree with that, but I do think that this is an opportunity for individuals with terminal illness when they are looking at a very painful, excruciating death, with perhaps the alternative being ever-increasing doses of morphine until somebody is asleep, in a coma and then essentially dies of a morphine overdose.

Voluntary assisted dying provides a framework that provides safety and security and safeguards. There are second opinions in place. There are appropriately trained medical professionals involved in the process. There is a review and approval process that takes place, and it is a far more robust framework than what you might see in other healthcare settings. That may still be operational now – the ever-increasing morphine overdoses. Unfortunately the reason that we have some of the amendments that are before the house today is because it is difficult in some circumstances to access voluntary assisted dying.

The key provisions of this legislation include clause 6, which is around conscientious objection. Currently there is no obligation on medical practitioners who have a conscientious objection to voluntary assisted dying to provide any information to patients on this subject, even if requested. The bill changes this position to ensure people seeking information about voluntary assisted dying are provided with minimal information on how to make inquiries and access information and services. There remains no obligation for any practitioner to provide assistance or referral to another health practitioner in relation to voluntary assisted dying, beyond the provision of information sources. This provision is different to what we see in Victorian legislation in regard to abortion services, for example, where a doctor must provide a referral to a doctor to enable those services.

This requirement can be fulfilled by medical practitioners who are conscientious objectors in that when you inevitably walk out of the doctor’s office with an envelope full of information one of those pieces of paper that has been put into the envelope can be a mention of this in a framework that is understood and of the appropriate standard. It does not mean there has to be a referral to a particular known practitioner who offers voluntary assisted dying. I do respect that there are people where this is deeply against and conflicts with their religious beliefs or their personal beliefs. However, I believe that the amendment that is being put forward by the government, from my perspective, meets that balance of providing the information without compelling somebody to speak on a process that they are not supportive of. I think it is the least best pathway forward so that people are aware that this may be available to them given their diagnosis but it does not compel them or influence them in any possible way. Clause 6(2) provides that an objecting practitioner must advise the patient seeking information that another practitioner would be better placed to assist them, noting that this does not mean that the practitioner is required to refer to another practitioner, and provide minimal information approved by the Department of Health secretary, which includes contact details for the statewide care navigator service and a link to the Department of Health VAD webpage.

Clause 7 relates to health practitioner-initiated discussions. The current law in Victoria prohibits health practitioners from starting a conversation about voluntary assisted dying with a patient. While a practitioner may raise other options for someone with a life-limiting condition, such as palliative care or treatment, VAD cannot be offered as part of this discussion – the patient must always raise it first. This new provision is intended to ensure clinicians are able to provide a full range of choices for individuals during conversations about end-of-life care.

Clause 7 inserts new section 8A and further allows registered health practitioners other than medical practitioners and nurse practitioners, such as allied health professionals regulated by the Australian Health Practitioner Regulation Agency, to initiate discussions about VAD under these conditions. These discussions will take place in the context of broader end-of-life conversations, and the health practitioner must advise their patient that the most appropriate person to talk to for further advice about VAD and palliative care is a medical practitioner. Breach of these requirements will constitute unprofessional conduct within the meaning under the Health Practitioner Regulation National Law.

This clause really acknowledges that care for an individual consists of many more people than just a doctor. There are many people involved as part of that care team. At times discussions about end-of-life care and end-of-life options may arise. This amendment to the legislation allows for those conversations to continue in a limited way to ensure that there is no inadvertent breaching of the current unprofessional conduct codes within the meaning under the Health Practitioner Regulation National Law. These are possibly conversations which are happening now. I would hate to think that a patient who had felt more comfortable with somebody else in their care team started this discussion and that practitioner was unable to continue that discussion because their registration would be at risk.

Clause 8 relates to the Australian residency requirement. Currently an applicant must be an Australian citizen or permanent resident and have lived in Victoria for at least 12 months. Prior to the introduction of VAD legislation in other states there was a greater justification for tighter residency rules to prevent people from travelling interstate to access voluntary assisted dying in Victoria. Clause 8(1) updates the residency requirement to include someone who has been ordinarily resident in Australia for at least three years. My colleague in Shepparton I believe will have a lot to say on this matter, having had a very close friend who was a resident of Australia for an extended period of time but who never became an Australian citizen. Because of that she was unable to access the voluntary assisted dying framework. I look forward to the member for Shepparton’s contribution on this bill.

Clause 9 relates to the Victorian residency requirement. Clause 9 includes compassionate exemptions to the Victorian residency requirement for people with a strong connection to Victoria, including living close to the Victorian border, being a former Victorian resident, having family or work ties to Victoria or receiving medical treatment in Victoria.

Of course for my electorate of Lowan, which is 20 per cent of the state abutting the South Australian border, this is important. We have people who live in South Australia accessing medical services, education services and work in Victoria, and vice versa. This was no more exposed than during the COVID lockdowns, when the border was shut down for extended periods of time, so this clause is important.

I would like to acknowledge at this point in time someone who has been a friend of mine for a very long time, the Honourable Kyam Maher, the Deputy Premier in South Australia, who fought for voluntary assisted dying laws over the border in South Australia, and that was in recognition of his mum Viv Maher, who was an absolute warrior in many different parts of her life and in the community. Sadly, Viv was unable to access voluntary assisted dying after her terminal diagnosis. Ky has been a fabulous advocate for voluntary assisted dying. He led the fight for voluntary assisted dying legislation in South Australia, and I would like to acknowledge his work, his wife Carmel, who is from Horsham, ironically, also his wonderful dad Jim and of course Ky’s brothers Cam and Gib and their partners. Thank you for standing up for Viv and what she believed in, and thank you, Viv, for your legacy to the community, as I said, in so many different ways. She was a feisty woman, she was a very fun woman and she certainly left her mark on the world.

Clause 8(2), the prognosis requirement standardisation, sets a consistent 12-month prognosis window for all applicants instead of a distinction between neurodegenerative illness and other conditions. This replaces the current threshold for eligibility, which is an expectation of dying within six months, or 12 months for neurodegenerative conditions. A 12-month prognosis reduces urgency, improving access and preventing the unintended effect of the six-month limit, resulting in applicants unable to access voluntary assisted dying at six months. The review board found that many patients start the VAD process very late in their illness. In 2024–25, 171 applicants died before receiving a permit.

It is obviously very difficult to ascertain what the prognosis is for an individual. It can improve; it can be quite limited. It is difficult to hear the stories of people, particularly those with motor neurone disease, as I referenced earlier. Someone who I have known my whole life, Neville Galpin, had motor neurone disease, and he actually could not access voluntary assisted dying. He asked his daughter to source the drug internationally, which she did. For Neville unfortunately the first serious implication of motor neurone disease was that it affected the lumbar area of his back and then affected his swallowing, so he was unable to take the substance. I read out Brandi Galpin’s letter to me in relation to the passage of the last VAD bill, and it still sticks with me that the barriers that Neville faced remain the barriers that are in place today so many years later.

I would like to acknowledge Emma Vulin in the chamber. Emma has been an absolute champion for motor neurone disease. For all of us this is a difficult conversation, because we know that this will impact on her choices as well. She has been a courageous advocate for many, many parts of living, and I appreciate that she has influenced and made an imprint on every single person in this chamber as well as in the community. It is difficult in many ways to talk through motor neurone disease and how it impacts the body and end-of-life decision-making, but to consider that this legislation may mean that others can make choices that have not been made available to those in the past is something we can all be proud of. So Emma, thank you very much for your advocacy in this area. We are all behind you every step of the way.

Clause 10 relates to medical practitioner eligibility, amending the requirement for a medical practitioner to have five years of experience practising as a specialist to just one year. This provision expands the eligible workforce, increasing access, especially in regional Victoria.

Specialists have already trained and practised for many years before attaining specialist registration through a medical college. The legislation still requires independent assessment by two specialist medical practitioners. As was quite eloquently put by a specialist who presented to the National Party in relation to this legislation, you study for a very long time and undertake extensive clinical placement to become a specialist in particular. They have done their time and they have experience in some serious clinical and treatment decisions which have an impact on the welfare of and also the prognosis for their patients. This is consistent with the prior training and education that they have had to get to that position in the first place.

Clause 15 concerns the removal of the third prognosis assessment. This removes the requirement for a third medical practitioner’s assessment for people with neurodegenerative disorders to confirm that the condition will result in death within six to 12 months. The first and second assessments must still be conducted by specialists with expertise and experience in the patient’s illness. This measure can help reduce the burden on these applicants, particularly in regional areas where they may have difficulty accessing a third practitioner, in addition to mobility issues.

I would like to cite at this point in time, as part of the information pack provided by the government in relation to the second diagnosis being undertaken by telehealth, that there are some in regional areas who have sought that amendment. But I would like to note that this is related to Commonwealth legislation. The Commonwealth Criminal Code prohibits discussion or distribution of information about suicide electronically, and because there is not a clear definition of voluntary assisted dying versus voluntary suicide, there is a risk that a practitioner may face criminal charges should they go down that pathway. I urge the government to advocate to their Commonwealth counterparts, because that is something else that should be considered. I know that this is always a sensitive debate, but if we are talking about equity in access, then we should be doing that at all levels of government.

Clause 28, the shortening of the request interval, reduces the time between the first and final VAD request from nine days to five days. In the majority of applications the current median time between first and final request is 14 days. It is a very short timeframe. For some that may mean the difference between being able to consume the relevant drug and not and therefore impact the ability to make that end-of-life choice. The intention is to allow compassionate consideration for a small number of applicants who experience rapid deterioration in their health and prolonged suffering while waiting for the minimum time limit to elapse.

Administration methods and permits – the current method must be self-administration of the VAD substance. If a person cannot physically take that substance, a medical practitioner can administer it for them with the requirement of a new permit specifying the administration method. Clause 32 allows for a person to make a decision in consultation with their coordinating medical practitioner to self-administer or have the substance administered to them by the administering practitioner. This is simply because in some conditions, particularly neurodegenerative disorders, the ability to self-administer is removed. At this point in time a whole other permit must be obtained. This will take pressure and a burden off people who are facing their dying days, quite literally.

In clause 42 administering practitioners includes medical practitioners, nurse practitioners and registered nurses with at least five years’ registration. They are required to complete specified training. Clause 34 provides for only a single permit to be used by a person choosing VAD without the need to make a new application. Clause 75, which we will have some debate about about during consideration in detail, is about interpreter accreditation. At the moment the legislation requires interpreters to be accredited by the National Accreditation Authority for Translators and Interpreters. Unfortunately for some languages there are very few qualified or accredited interpreters available, so this opens that up.

There are a number of other amendments, but I note that there are other speakers who wish to debate this before we go to question time. I therefore look forward to consideration in detail, and I hope that the remainder of the debate is respectful of both the sensitive nature of this and other people’s deeply personal views on this matter.

 Emma VULIN (Pakenham) (13:50): I am pleased to contribute today to speak on the Voluntary Assisted Dying Amendment Bill 2025 and some of the 13 proposed changes. This is a law that is both deeply personal and profoundly important. Firstly, I would like to thank the Minister for Health and her team for all the work they have done to get this bill to the house. I have appreciated the support and information from the minister’s team, Dying With Dignity Victoria and Go Gentle Australia, in particular the beautiful Jane Morris.

Eight years ago Victoria made history as the first state in Australia to legalise voluntary assisted dying. It was a courageous step, one that balanced compassion with careful safeguards, ensuring that terminally ill Victorians could face the end of their lives with dignity, autonomy and less suffering. It was a debate that was led by my dear long-time friend the Honourable Jill Hennessy. Today I speak not just as a Victorian but as someone living with motor neurone disease, a progressive and terminal illness. It is a condition that gradually strips away strength, movement and ultimately independence. It does not take my mind, but it does take my body. Like so many others facing this illness, I must look at my future honestly. I may one day choose voluntary assisted dying. That is not a decision that will be made lightly. It is not about giving up; it is about retaining agency over the most personal decision any person can ever make: how they leave this world.

The five-year review gave us a chance to look closely at how the law has been working well and, just as importantly, identify and address problems with the current legislation. Over the past six years more than 1600 Victorians have accessed the VAD pathway. Every single case has involved rigorous checks and multiple medical assessments. The legislation has operated with extraordinary care and oversight, with no evidence of systemic misuse. In addition to the 68 safeguards embedded in the legislation, all VAD cases are reviewed upon completion by the Victorian VAD review board to ensure compliance with legislation.

This framework has provided comfort not just to those who have chosen VAD but to many more who have found reassurance simply in knowing they have the option. For people with illnesses like mine, that reassurance is powerful. It brings peace in the face of something that often feels uncontrollable. I want to share what this means on a human level. MND does not wait. It does not pause out of kindness. It progresses relentlessly and at times insidiously. I have already had to make adjustments to daily life. I have already had to accept help that I would never have imagined needing. In time I may lose my ability to speak clearly, I may lose the ability to move and I may face the kind of suffering that no palliative care measures can fully ease. Knowing that voluntary assisted dying is there means that I, and people like me, can spend less time fearing the end and enjoy the remainder of my life without worrying too much about what the end may look like. It means that if I reach a point where my suffering becomes unbearable, I can make a choice on my own terms of when and where I would like to die, surrounded by the people I love.

Victoria’s law was deliberately built with some of the strictest safeguards in the world. Two independent doctors must assess patient eligibility. In cases in which the individual suffers from a neurodegenerative illness, a third assessment by a second neurologist is required to confirm a 12-month timeframe until death prognosis. The person must have decision-making capacity right up until the commencement of the VAD process. The illness must be incurable, advanced and expected to cause death within six months or 12 months for some conditions. The person must act voluntarily, free from coercion. And beyond these clinical safeguards, there is a cultural safeguard: this law respects choice but never imposes it. No doctor is compelled to participate, no family is forced to agree and no patient is pressured to apply.

From every aspect, participation by the individual and health providers is voluntary. In practice the law has not opened any slippery slope. Instead, it has provided dignity, structure and compassion at the most vulnerable time in a person’s life. But as this review makes clear, no law remains perfect forever, especially legislation based on societal views.

Six years of lived experience gives us an opportunity to refine and improve. It allows us to provide equitable access to VAD for the very Victorians that the act was designed to help.

With only 10 minutes, I cannot cover all 13 proposed amendments, but I will speak to a few key ones. One: remove the gag clause to allow registered practitioners to initiate discussions about VAD with eligible patients as part of holistic health care. This is an important amendment that allows patients with an eligible terminal illness to make informed choices about their options as they face their future. Only a few weeks ago I spoke with a beautiful gentleman, who told me about the painful ending his mother endured with a terminal illness 20 years ago. He then went on to say his father also died a painful death in December 2020. The family were unaware at the time that VAD was a legal option here in Victoria and that it had been in place since June 2019. He said if they had been informed by their medical team, this absolutely would have been a serious consideration for his dad, as he too had watched his wife’s passing and feared the end.

Two: amend Australian citizenship and permanent residency requirements to allow people who can demonstrate at least three years of ordinary residency in Australia to access VAD. In June I was contacted by a friend, a remarkable and courageous woman who was nearing the end of her life with MND. She had gotten to the point where life was unbearable. When she decided to seek information about VAD, she quickly learned that even though she had lived in Australia for 50 years, because she was a New Zealand citizen but not an Australian citizen and not recognised as a permanent resident, she was not eligible to access VAD. This was devastating for her, her loved ones and me. May she rest in peace.

Three: update the prognosis requirements to 12 months for all VAD applicants. For people with rapidly progressing conditions, the current timeline can be too slow. Some die waiting. We must ensure the process moves at the pace of the illness, not at the pace of bureaucracy.

Four: remove the requirement for third-prognosis assessments for people with neurodegenerative conditions. Importantly, for people suffering from neurodegenerative conditions, like me, this bill will remove the requirement to be assessed by three separate medical practitioners and reduce it to two, in line with other conditions. This one is especially relevant to rural and regional Victorians. Too many Victorians outside metropolitan Melbourne struggle to find doctors who can assess or support VAD applications. Dying well should not be a postcode lottery.

Five: shorten the time period between the first and final request to access VAD from nine days to five days. Sadly, I have spoken to many families and also witnessed firsthand the issues faced due to the current nine-day period. Lots of people who wish to access VAD do so towards the very end of their life. In some cases people have died waiting for the ninth day to make their final request, or at nine days they no longer have decision-making capability, often due to increased pain relief medication or their body shutting down. This bill will help to address some of these issues and bring Victoria in line with the other states and the ACT. It is only fair that Victorians have the same rights as most of the nation.

Choosing VAD is not about losing hope, it is about shaping hope into something deeply personal: the hope of a peaceful passing, free of unnecessary pain. It is about respecting each person’s unique journey. Some will choose palliative care alone. Some will choose to fight for every last breath. Some, like me, may one day choose to say ‘enough’, on their own terms. Each of these paths deserves equal dignity and respect.

When this Parliament passed the VAD law eight years ago, it did so with courage. It did so because Victorians wanted compassion and autonomy at the end of life. Today, as we reflect on those six years, I urge us not to accept a backward step. Instead, let us build on what we have achieved to ensure every Victorian with an eligible terminal illness is afforded equitable, fair and timely access to choice. I do acknowledge there are different views on this issue, and I respect that. This is not a political issue. It is a profoundly human one.

I do not know how my journey with MND will end, but I do know this: the knowledge that I may have voluntary assisted dying as an option gives me strength. It allows me to live with more peace, to focus on the moments that matter and to spare my loved ones from witnessing my prolonged suffering, which serves no purpose. I am grateful to live in a state where this choice exists, and I hope that through this reform we make it even more compassionate, more accessible and more humane. Let us continue to lead with empathy. Let us continue to honour the dignity of every Victorian facing the end of their life. Let us remember this is an individual choice. I commend this bill to the house.

Business interrupted under sessional orders.