Tuesday, 28 October 2025

 Brad ROWSWELL (Sandringham) (14:56): I rise to address the Voluntary Assisted Dying Amendment Bill 2025. In doing so, I would like to thank a number of people, especially my colleague in the other place Ms Crozier, the Shadow Minister for Health, for her leadership and carriage of this bill from an opposition perspective. I would like to thank my colleagues and stakeholders who have engaged in a meaningful but also respectful way, and I thank the Office of the Chief Parliamentary Counsel and the clerks for their guidance as well.

My framework for undertaking consideration of this bill and of these matters is reasonably straightforward in my view. My starting point is this: every Victorian, in my view, deserves to be loved, to be valued and to be respected. While I acknowledge there are deeply held views on this matter, I have formed the view myself that the majority of government amendments proposed in this bill do not have my support. I have a number of evidentiary points to convey during this contribution.

Firstly, I believe that the government’s consultation was not as comprehensive as it could have been. The terms of reference for the triggered five-year review under the existing legislation, the Voluntary Assisted Dying Act 2017, did not include consideration of changes to legislation. In fact the Victorian government at the time made it clear that as this legislated five-year review is operational, it is not considering changes to the legislation itself. In practice this means that many respondents to the review will not have had the opportunity to offer views on potential legislative changes. The review itself makes no recommendation for legislative change. In fact possible amendments are raised only in the addendum to the review, based solely on the feedback of a proportion of respondents who made submissions outside the review’s initial terms of reference.

The government’s proposed legislative changes are therefore, in my view, neither supported by their own review nor based on the submissions of all participants to that review. The Department of Health has undertaken this consultation, in my view, in some haste, offering respondents just two weeks to respond to what amounted to some very vague descriptions of proposed changes that could have far-reaching consequences for many Victorians. Given the magnitude and seriousness of what is being proposed, I believe it is appropriate that any changes be carefully and thoughtfully examined. Any proposed amendments should be first published as an exposure draft to allow thorough public consideration and debate, particularly given the many participants in the review who were not invited to comment on potential legislative changes.

I am grateful, as I mentioned at the start of the engagement, for a number of stakeholder groups, including Palliative Care Victoria. They have provided a submission to the opposition and have outlined a number of their key concerns, including use of non-accredited interpreters and culturally accessible interpreters; prognosis clarity and timing of eligibility; face-to-face specialist requirements and rural access; removal of practitioner experience requirements and a number of other matters. It is in that light that I, under standing orders, wish to advise the house of amendments to this bill and request that they now be circulated.

These amendments are in relation specifically to palliative care. Although one of the government’s amendments in the bill inserts a new section 8 specifically referencing that a practitioner must take reasonable steps to ensure the person knows that palliative care options are available to them and palliative care is also mentioned by the minister in their second-reading speech and the bill’s statement of compatibility and frequent and specific references are made in the government’s information pack for MPs, I am advised by the clerks that one of my proposed amendments is in fact out of scope of the bill. As a remedy to that I have been advised by the clerks that at the commencement of the consideration-in-detail stage I will be required, if I choose to proceed with these amendments, to seek leave for the scope of the bill to be extended to include palliative care in relation to two elements, being funding and access – two very important things which I believe should be considered as part of the conversation underway in the chamber today. I think that it should have been mentioned in the principles section of the bill, and that may be an omission on the part of the government. All the same, I alert the house to my intention to move that amendment at that stage.

I also wish to note, in addressing matters relating to palliative care, that at both the 2018 and 2022 state elections I was very proud to be part of an opposition or alternative government team which proposed quite a significant uplift in funding for palliative care in this state, acknowledging that your postcode should not determine the health care that is provided to you, acknowledging that there are practitioners within the palliative care space that do their very best in an under-resourced environment and acknowledging that regional communities are disproportionately impacted by a lack of funding and therefore a lack of access.

The 2024–25 Voluntary Assisted Dying Review Board annual report, on page 7, revealed that 39 per cent of all VAD applications in Victoria come from applicants living in rural or regional areas, even though only 25 per cent of Victorians live in rural or regional areas. One perspective on the gap in those statistics is that in regional Victoria accessibility to palliative care options is in fact not an option. Further, it is important that additional funding be provided for such treatment.

In 2017 when the threshold question was asked and answered in relation to voluntary assisted dying, the government at the time announced a package that provided some $9 million a year in ongoing palliative care funding, but that was compared to the $65 million a year minimum that at the time Palliative Care Victoria estimated was needed. I contend at this point in time that that disproportionate amount of funding has continued to our present day.

In anticipation of the consideration-in-detail stage, there are a number of concerns that I have in relation to amendments proposed by the government, in relation specifically to the government’s specifications on information about voluntary assisted dying, which practitioners opposed to voluntary assisted dying must provide; the allowing of any registered health practitioner to initiate a discussion about voluntary assisted dying; clause 8, in reference to extending the time-based prognosis to death from six months to 12 months; specifically in relation to clauses 8 and 9, which amend residency requirements; clause 10, which references the reduced standards for coordinating and consulting practitioners; clauses 11, 19 and 49, relating to the exclusion of practitioner conflict of interest, which in fact I signal at this point in time my support for but wish to engage on during the consideration-in-detail stage with a series of questions to the minister in relation to that; in relation to clause 28, which reduces timeframes for voluntary assisted dying to proceed; clause 32, which expands the scope from assisted suicide to euthanasia; clauses 74 and 75, relating to the exemptions from interpreter requirements; and so on.

I have sought to engage in this debate, in this contribution, in a respectful way. I trust that every contribution forthcoming, as with those prior to mine, will be addressed in a similar way.

 Lily D’AMBROSIO (Mill Park – Minister for Climate Action, Minister for Energy and Resources, Minister for the State Electricity Commission) (15:06): I rise to speak in support of the Voluntary Assisted Dying Amendment Bill 2025. I do want to take the opportunity to thank the Minister for Health for bringing this bill forward. I wish to say from the outset that I will not be utilising my full 10 minutes. I know that there are many, many people who want to speak on this bill, and I say that not as a signal to anyone else to curtail their contributions but simply to affirm that everyone should be afforded the opportunity to have their say. I am very keen to and confident that I will be able to acquit my sentiments in a shorter period of time.

When the original act passed the Parliament in 2017 Victoria became the first state in the nation to legislate for voluntary assisted dying. That day was a landmark moment for dignity and choice. This bill builds on that legislation, and it makes the law fairer. It does that by improving equitable access to the pathway of voluntary assisted dying for those who choose it. The amendments respond to lived experience and a lot of conversation and dialogue that occurred around the five-year review by the Voluntary Assisted Dying Review Board. This government has always approached this issue with empathy and care, regardless of individual member views on such reforms, and that is why every safeguard that existed in the 2017 legislation remains in place. The amendments follow a long and respectful dialogue with a broad cross-section of the community – a dialogue that has been informed by the operationalisation of the 2017 laws, by what works well and what could certainly be improved and also by the fact that other jurisdictions have incorporated further improvements not contained within the Victorian law. That is by virtue of the fact that they have come subsequent to Victorian legislation and have had opportunities to consider further fine-tuning.

There are certainly important reforms here. Presently, clinicians cannot mention that VAD exists unless the patient knows to ask, and we have heard many examples from many community members that some have gone by without actually knowing or acknowledging that they had the opportunity to make such a request. There is no other area of medicine where a doctor must withhold legal information from their patient. By removing this, access to the scheme will be much more equitable. It will boost access to the scheme for Victorians who come from marginalised communities or those who are less engaged in public life. These conversations will be accompanied by discussions of alternative options such as palliative care – that is another safeguard.

Safeguards against coercion remain comprehensive, with independent assessments, strict eligibility tests and offences for undue influence. All other jurisdictions, except for South Australia, have already introduced this change, and they have done this safely.

For practitioners who hold a conscientious objection, this bill also provides clarity. It recognises their right to abstain from participation but balances that with a patient’s right to information about their medical options, similar to the way the abortion reforms operate in Victoria. It is also about ensuring that no Victorian is left without a pathway to lawful, compassionate care because of someone else’s personal belief. At the same time, it is careful not to compel participation.

Although the VAD service is used infrequently, for the patients and their families who do use it, it is a profound exercise of human agency. The ability to exercise this agency during one’s final days echoes far beyond the patient’s final days. In 2017 the government promised that Victorians with a terminal illness would be empowered at the end of life. This bill honours that promise.

I do want to, just in passing, reflect on the contribution of the member for Pakenham. The member for Pakenham’s contribution just preceded mine. For me, no clearer am I in my thinking on the life-changing matter in this bill than when I hear the member for Pakenham talk about her own personal experiences of motor neurone disease. Her contribution to this debate puts into focus, for me, every Victorian who has freely chosen the pathway of VAD and those who will benefit in the future from these reforms who also may choose that pathway. I will leave my comments there, and I certainly do commend this bill to the house.

 Nicole WERNER (Warrandyte) (15:12): I rise to contribute to the debate about the Voluntary Assisted Dying Amendment Bill 2025. At the outset, I acknowledge that there are many different views in this chamber and in Victoria and appreciate that we have the opportunity to have a respectful debate in this place to discuss a matter of such importance.

To the bill at hand, we have concerns given the removal of safeguards that were imposed when the bill was first introduced, which were deliberately designed to protect vulnerable Victorians. When the Voluntary Assisted Dying Act 2017 was passed, the Labor government called it the safest in the world, with 68 safeguards. Now the government is attempting to remove those same safeguards, despite there not being public demand and also no clinical evidence to justify it. So we are concerned, and I do hold concerns on this. There have been many in my community that have written to my office listing their concerns on the amendments that are being proposed today.

The five-year review of the Voluntary Assisted Dying Act did not recommend these legislative changes. None of these major amendments appear in the recommendations. The government is claiming safety improvements while it is ignoring its own expert framework. The other concern is that the department’s consultation was limited. It was very limited. It was very narrow too. It was also rushed, and it was not transparently communicated. Stakeholders were misled that no legislative changes were being considered. This, to me, shows a lack of mandate and trust. Some stakeholders were given full access to the bill, whilst others were given limited access. Therefore it was not equitable and there was not proper consultation that took place, given that the limited stakeholder consultation that did take place only gave stakeholders two weeks to respond. Following the review, the Department of Health wrote to a limited number of stakeholders, providing them, as I said, only two weeks to respond on such serious matters as life, death and freedom of conscience. That is concerning.

Now to clauses 74 and 75, where it speaks to the interpreters that are used. The bill allows exemptions from using certified interpreters. What these two clauses, 74 and 75, mean is that there is an exemption from accredited interpreters being used. This directly contradicts the government’s own multicultural review recommendations and creates a risk of misunderstanding or coercion via mistranslation.

That does beg the question that if the recommendation is already in the government’s own multicultural review, then why is it being disregarded and contradicted in this bill at hand and in these amendments at hand? Coming from a multicultural background myself and having a second language – English was actually my second language growing up – it is of concern to me, because there are language nuances, there are translation nuances and there is slang that is used as well when you are translating from one language to another. When you are not having an accredited translator being used in a major decision about life and death in these scenarios, that is concerning.

In clauses 74 to 75, just to present them here, it says at present all interpreters who assist patients with accessing voluntary assisted dying need to be accredited by a prescribed body. This bill amends this by allowing the Secretary of the Department of Health to grant an exemption from this requirement if no such interpreter is available and if there are exceptional circumstances. This exemption is contrary, as I said, to the Victorian government’s own policy in this review, which says:

Victorians who cannot communicate effectively through spoken or written English must have access to professional interpreting and translation services …

And it lists the reasons and when:

• when required to make significant decisions concerning their lives

• when being informed of their rights

• where essential information needs to be communicated to inform decision making, including obtaining informed consent

Interpreters and translators –

and I am reading this from this review –

should be credentialed by the National Accreditation Authority for Translators and Interpreters … at the Certified Interpreter / Translator level.

This is the government’s own policy, which states:

Failure to provide a qualified interpreter can have significant negative impacts including:

• Reduced or adverse health outcomes, for example due to incorrect diagnosis because of miscommunication between a patient and a health professional …

To me it is extraordinary that the government is failing to adhere to its own policy in this area, when voluntary assisted dying so clearly involves life-and-death decisions and risks of adverse health outcomes. Allowing exemptions from using an accredited interpreter for such weighty decisions – literally on life and death – contradicts the recommendation of the government’s own recent multicultural review, where it indicates all of these areas in which we would need an accredited interpreter.

I think having had this language barrier with family members – with my parents, with my grandparents and with different members of my family – I can understand that it is a challenge to interpret when there are vulnerable people involved or when there are very sensitive issues at hand, particularly when it might be a family member that stands in as the interpreter or as the conduit between the health practitioner and the patient. That is quite concerning. It is also concerning where there might be financial benefit that is sought – where a family member might seek to derive an outcome from this patient’s life and there might be financial benefits for them. That also opens up the issue of possible elder abuse or abuse of the vulnerable person that is at hand, who now does not have access to an independent, third-party accredited translator. That is of deep concern to me and of deep concern to multicultural communities, who we are here to represent and whose rights we are here to stand up for in the Parliament. These people should be afforded the opportunity to have accredited interpreters to be able to help them be guided in translating when it is something to do with the life-and-death choices that they are making.

So as a person from a multicultural background, as a person who is an English-as-a-second-language speaker, I am concerned that this is in the bill, I am concerned that this exemption has been carved out and I am concerned that this is not supportive of multicultural communities as the Labor government purports to be. I want to put that on record today.

With the limited time that I have left I also want to look at clause 7, which inserts new section 8A, which I am concerned gives Victoria the weakest coercion protections in Australia. Victoria is one of only two jurisdictions that currently prohibit practitioner initiation, and this bill would remove that safeguard. It also, in clause 6, forces conscientious objectors to act against their principles. On this side of the house we stand for people being able to have their own views and practise according to their own ethos and perhaps religious beliefs or personal beliefs and their own conscience. Practitioners will now be compelled to provide government-prescribed voluntary assisted dying information with no limits on what the government can require, given that it is written into the bill that it is up to the bureaucracy to be able to decide post the fact. This is a risk to these vulnerable individuals, and this is why there will be an amendment moved in this place around that, because this is a challenge for these individuals who might have a differing opinion and who might not want to actually go against their own conscience, go against their own beliefs, go against their own religious practices, go against their own lived experience. I put to the house that it is going to remove that freedom for individuals to be able to then have that freedom of conscience and to be able to make the decision for themselves as the health practitioner. I know that has been raised with us by many health practitioners, and that has been raised in my community as well. I will leave it at that, given the time that I have left on the Voluntary Assisted Dying Amendment Bill.

 Iwan WALTERS (Greenvale) (15:22): I acknowledge previous speakers and the hurt that deliberations in this place today will bring to many inside this Parliament and those watching beyond, and I extend my sympathies and condolences to those who are suffering, those who are caring for others in pain and those who have lost loved ones in difficult circumstances. We all have experiences of witnessing and experiencing the distress of suffering and of the process of loved ones dying. And yet as a Parliament we have the invidious task of both acknowledging individual cases while also considering deeply the wider social, ethical, practical and medicolegal impacts that this bill would have. This debate is not about the ethics or legality of euthanasia and assisted suicide as threshold issues. This Parliament engaged in an extensive debate in 2017, following a robust and long period of public and expert consultation. That debate and vote meant that euthanasia and assisted suicide became legal in Victoria, and there is no campaign in this place to rescind those laws. Both forms of death are accessible for those whose circumstances meet the criteria of the VAD act, with 634 permits issued and 389 deaths occurring through the provisions of the act in 2024–25, noting that original projections envisaged demand for VAD stabilising at around 100 to 150 people per year.

The passage of the 2017 act was predicated upon the notion that both methods of prematurely ending one’s life must only be available in the most extremely limited circumstances – a tacit acknowledgement of the risks of harm associated with VAD and the need to protect the vulnerable from a system failure that would result in a premature or wrongful death. A close review of the second-reading debates in both houses emphasises that votes at the margin, which resulted in the legislation passing, were focused on particularly difficult cases, with fears expressed by parliamentarians that crossing the Rubicon might create unmanageable risks of harm, abuse and coercion for vulnerable Victorians, allayed by the assurance of safeguards and what was described as the world’s most robust and safe euthanasia and assisted suicide regime. And yet now, despite assurances that crossing that Rubicon in 2017 would not result in a creeping process of wider eligibility, what might be termed the slippery slope, here we are only a few years later, within the life of the same government, where those safeguards are now barriers and those essential protections apparently undue hindrances for Victorians to be able to be euthanised by a health practitioner or to access self-administered assisted suicide.

In seeking to remove those safeguards and protections, this bill will necessarily render Victoria’s VAD laws less safe for both patients and the health practitioners who facilitate them. In fact it rather seems to bear out what Paul Keating cautioned on the very day that this house last considered these issues:

… once termination of life is authorised the threshold is crossed. From that point it is much easier to liberalise the conditions governing the law. And liberalised they will be.

I am interested in the process that has led us to this point of proposed liberalisation. As other speakers have noted, the statutory five-year review that was undertaken of the operation of the existing assisted suicide and euthanasia framework, the VAD five-year review, did not consult upon or propose changes to the VAD act. The Department of Health noted at the time that because the review was an operational exercise it would not be considering changes to the legislation itself. A brief addendum to the review, appendix 6, suggests that a limited number of advocate organisations proposed legislative changes during the review, and subsequently the minister has elected to adopt the recommendations of this narrow subset of consulted parties.

In practice, only those who knew the review would in fact report on potential legal changes made fulsome submissions to the review on that basis. Other stakeholders were not afforded that opportunity. Given the magnitude of the amendments we are considering as part of this bill, I am concerned that there has been limited consultation across Victorian society and that inadequate consideration has been given to the profound risks that these amendments pose to patient wellbeing, the integrity of our healthcare and palliative care systems or to bedrocks of that democratic polity like freedom of conscience. This should not be a rushed, furtive or selective process that ignores the consequences for both patients and their health practitioners. Indeed the risks, both overt and unintended, of such substantive changes to our existing and settled assisted suicide and euthanasia laws and to our society deserve proper discussion, consideration and scrutiny. Therefore I move:

That all the words after ‘That’ be omitted and replaced with the words ‘this house refuses to read this bill a second time until adequate time is given to allow full consideration of the anticipated and unintended consequences of changes to the Voluntary Assisted Dying Act 2017 and until further and broader consultation is undertaken.’

If this bill is not about the legalisation of euthanasia or assisted suicide laws, what then does it seek to do? By clause 7 it would, for the first time, allow medical practitioners to raise euthanasia and assisted suicide with patients who have never asked about it at the time in their life when they are at their most vulnerable.

Emma Vulin: On a point of order, Acting Speaker, sorry to interrupt, but I would like the member on his feet to stop referring to it as ‘assisted suicide’.

The ACTING SPEAKER (Meng Heang Tak): There is no point of order.

Iwan WALTERS: By clause 7 it would, for the first time, allow medical practitioners to raise – forgive me, Acting Speaker; I will speak directly and in the terms of my speech – euthanasia and assisted suicide with patients who have never asked about it at the time in their life when they are at their most vulnerable. When the VAD act was passed in 2017 the bar on doctors initiating discussions about both methods was portrayed as an essential safeguard. This bill seeks to depict it instead as an access barrier, the removal of which will elevate assisted suicide and euthanasia from a legal but exceptional end-of-life option into a standard or expected response to suffering that carries a professionally endorsed equivalence with health care. If a doctor initiates these conversations with vulnerable members of my community, I am concerned that power dynamics, language barriers and other cultural factors will mean that both assisted suicide and euthanasia may be interpreted less as part of a pallet of options that may be available but rather as a prescription. This amendment would not solely enable doctors who may have clinical expertise in end-of-life care and decision-making to initiate conversations about euthanasia or assisted suicide. Instead clause 7 applies to all Australian Health Practitioner Regulation Agency registered health practitioners, a remarkably wide spectrum of professionals, including many whose practice and training is not customarily centred on end-of-life care, such as podiatrists and optometrists.

The dangers inherent in the changes proposed in clause 7 for vulnerable members of my community are compounded by clauses 77 and 79, which propose diminishing interpreter requirements. This contradicts the recent Lekakis review, which recommended that government should only engage properly National Accreditation Authority for Translators and Interpreters credentialed interpreters and translators. Doing so in the context of such nuanced and sensitive areas of patient care demonstrably increases the risk of misinterpretation and confusion. In these settings where decisions carry such significance, precise and accurate communication should be central. Health practitioners are continually warned of the inadvisability of amateur interpreters and translators in standard health care. There is even more of a reason to avoid it in end-of-life care, where abuses and mistakes most certainly cannot be undone.

This bill also impinges upon an essential democratic freedom by compelling health practitioners with a conscientious objection to euthanasia or assisted suicide to provide information at the discretion of an unelected official that would be neither immediately subject to parliamentary oversight nor made explicit in legislation. The current drafting contains no limits at all on what information the department secretary may require to be provided.

The VAD review did not recommend this change and in fact noted broad support for the retention of conscientious objection provisions. Those drawn into palliative and geriatric medicine are often called by a sense of vocation and a belief in the worth and value of the elderly and infirm, guided in their clinical practice by ethical principles of nonfeasance, the idea of doing no harm. Compelling them to share information that goes beyond a referral to another practitioner and instead could include substantive details about assisted suicide and euthanasia may be interpreted as rendering them active participants in interventions that have as their primary intention the ending of life.

This measure risks driving those with a genuine commitment to palliative care and the alleviation of suffering throughout the end-of-life process away from the specialism, depriving vulnerable Victorians of their skills, empathy and dedication. At a time when deficiencies and funding challenges remain in palliative care systems in all developed and ageing societies, including Australia, I am concerned that this bill does nothing to address those but renders assisted suicide and euthanasia less exceptional and recasts them as pillars of the state’s palliative care system.

In expanding eligibility criteria to those with a 12-month prognosis of death the bill also amplifies the risks and uncertainties associated with diagnosis and prognosis of terminal conditions. By moving the point of eligibility for VAD further from the time of anticipated death the bill also deepens the intellectual and conceptual inconsistencies in our society about the value of life and the inherent tension between our state’s suicide prevention policies and these proposals to expand our VAD system. I only note that the further those limits on accessibility to euthanasia and assisted suicide are loosened and the longer the time span between death without intervention and eligibility for assisted suicide and euthanasia becomes, the greater is that inconsistency between divergent policies’ commitments to the protection of life on the one hand and to individual autonomy on the other.

Given the difficulty in intellectually and conceptually defending any particular set of requirements, once separate classes of people exist in the health system with access to different courses of treatment and action and noting that the pressure to expand eligibility will remain strong even if this bill is passed, my question to its proponents is: when will the eligibility criteria stop moving, and which safeguards will be deemed barriers next time the VAD act comes under review?

I suggest that this bill has come to this place in haste, without due consideration of the anticipated and unintended consequences and with little robust consultation beyond a select group of advocates. VAD is legal, and this bill will not change that. VAD is accessible, and this bill will not limit that. But if enacted, these measures would substantially weaken the safeguards in the 2017 VAD act, with profound consequences for the safety of vulnerable people in our community; diminish the capacity of doctors to exercise their conscience; and fundamentally transform the nature of the doctor–patient therapeutic relationship. Each colleague will need to examine their own conscience on the approach of the bill as a whole, but I do ask them to consider the reasoned amendment I have moved.

 Ellen SANDELL (Melbourne) (15:32): I rise to speak on the Voluntary Assisted Dying Amendment Bill 2025 amendments we have before us today. I am one of the MPs in this place who was here in 2017 when we first introduced and passed voluntary assisted dying legislation in Victoria. There is probably a shrinking group of us who were here back then, and not everyone in this chamber who is here now was here then, but that was a really historic moment and one that I was really proud to be a part of, despite the very, very long nights. I remember I was actually breastfeeding my first child at the time. She was just a few months old. We were here all through the night, and I had to pump milk all through the night, exhausted, as we sat I think until 2 am one night then 2 am again and then all through the night to midday the next day to pass the historic laws. It is probably too much information, but I think I brought home enough pumped breast milk that week to feed a whole nursery of babies. It was one of the most gruelling experiences we have had in this place but also one of the most meaningful and memorable.

I want to thank my Greens colleagues who were here at the time, especially Colleen Hartland, who played a really important role in that legislation in campaigning for it to be brought to Parliament in the first place, in the parliamentary inquiry that recommended it and then in making sure it ultimately had the votes to pass. I would also like to thank the former health minister Jill Hennessy, who did a great job on the legislation and also plied MPs with hot chips at 2 am when they were needed. I hope the current Minister for Health will do the same.

One of the reasons that the 2017 legislation was so important was that Victoria ended up being a catalyst for other states to follow suit on a really important piece of health reform. After Victoria passed our laws we saw state after state finally introduce their own laws. Back in 2017 though, unfortunately, as we were sitting all through the night here, there were a lot of amendments put to the legislation in this place, and in order to get enough votes to pass these historic laws, some of the laws had to be watered down, and that meant that they ended up being quite conservative in some ways. There were lots of safeguards, and restrictions were put in place. Safeguards are really good when they protect people from harm, but unfortunately some of the restrictions that had to be put into the legislation at the time so that it would pass ended up putting significant barriers in front of people who simply wanted to access the health care, voluntary assisted dying, as it was intended, and it has meant that it has become extraordinarily difficult for some people to simply access VAD. The legislation we have before us is trying to fix some of that.

Other states, when they introduced their own laws, actually fixed some of these things from the start. If you look around now, you will see that Victoria is not really a leader anymore in this space, it is actually a laggard. We are behind almost every other state, and our scheme has become one of the most restrictive in the country. So this bill tries to fix some of those issues and simply brings us into line with other states where the legislation is working really well.

I also want to thank the current health minister for bringing these updates to the Parliament – they are very much needed – and also thank my Greens colleague Dr Sarah Mansfield in the upper house. She has done a power of work bringing these issues to light, working with stakeholders over many years. I do not think it is fair what the member for Greenvale was saying – that consultation has not happened. She has been talking for several years to stakeholders about the fact that these reforms are needed. She has been advocating, and she brought her own private member’s bill to the Parliament to deal with a lot of these issues that the government has now picked up. So this has not come in a rush. Dr Mansfield deserves a lot of credit for this outcome. We are fortunate in the Greens to have two former medical doctors as Greens MPs. One of them is sitting near me here, Dr Tim Read, and their expertise and experience with patients have been invaluable in informing our work on this important matter.

So what are the things that the bill is trying to fix? Currently you need a prognosis that you are likely to die within six months to access VAD or 12 months for some conditions. The bill proposes to change that to 12 months overall, which is a much more reasonable timeframe. It was only reduced to six months in 2017 in order to get the numbers to get it over the line in the first place. Other states do have 12 months, and we are simply bringing our laws into line with the other states. We have also heard many stories of people who cannot access the scheme because they are not an Australian citizen or permanent resident, even if they have lived here for years and years. Maybe they are a New Zealand citizen, they cannot get Australian citizenship or they have not been able to get Australian citizenship, but they have lived here for years. Now they will be able to access the scheme if they have been ordinarily resident in Australia, and that just simply makes sense.

The amendments also mean that a person from another state or territory would be able to access and apply for VAD in Victoria rather than in their home state or territory. You might want to do this for a number of reasons. You might want to be closer to family and friends or closer to a specialist in the disease. Or it may be that your closest healthcare service is in Victoria and you might just live on the other side of the border – you should be able to access it as well.

The bill also removes the requirement for a third consulting practitioner in the case of neurodegenerative illness, which the Greens support, to make it easier for people to access VAD. And the bill removes the ban on practitioners from initiating conversations about VAD as an option for end-of-life care, the so-called gag clause. Currently doctors cannot even raise VAD with their patients at all. They cannot initiate a conversation. They cannot even let patients know that it is available. The bill will remove that gag clause so doctors can have an honest conversation with their patients, and that just makes more sense.

This bill tackles some of the overly restrictive safeguards, but also just some of the logistical issues with accessing practitioner-administered medication. Currently individuals have to self-administer the medication or, if they are unable to, their practitioner needs to apply for a practitioner administration permit, and the process is pretty cumbersome and slow. It has led to some pretty distressing situations, which we would like to avoid in the future.

Finally, the bill inserts a section which requires an ongoing review of the act, which is a sensible thing. We know that the previous review could only focus on operational matters, not on the legislation, and that does not really make sense, because things change and legislation might need to keep up.

So overall, the Greens are very supportive of these amendments and we will be voting for them. However, there are a number of patients, healthcare practitioners and stakeholders who have raised with us that there are other issues that make it difficult for people to access VAD that are not included in this bill in these amendments but still do need to be fixed so that people can reasonably access VAD. So the Greens will be moving some amendments to ensure that people are not unnecessarily prevented from accessing VAD, particularly in rural and regional areas. I grew up in a regional area myself, so I know the restrictions on health care. Some of these will be moved in my name; then there are some alternatives, if they should fail, that will be moved in the name of the MP for Richmond. So I would now like to ask that those amendments be circulated.

The ACTING SPEAKER (Meng Heang Tak): I was just advised that the amendments are not ready to be circulated, so the member can circulate them later.

Ellen SANDELL: Okay. I will circulate those amendments later. They have been circulated by email to all members, and I would like to say if any members have any questions about those amendments, I am very much available to have those conversations. I just want to go through some of them so that members are aware of the amendments that the Greens will be moving and the intentions behind them.

The first is that this bill means that you will need to have a condition where death is expected within 12 months. One of my amendments is seeking to remove that timeframe entirely, and I want to explain why. It is not to just have open slather. The reality is that the progression of many terminal illnesses can be unpredictable, meaning that requiring a really strict time-based prognosis has become a significant access barrier for many people because even though they are suffering greatly and their condition is terminal, they may not be able to find a doctor who will say that they are likely to die within six months or within 12 months. According to Go Gentle Australia, health professionals are often reluctant to give specific estimates of time of death and can be particularly cautious in the context of VAD because it has legal implications. It is also often very hard for doctors to be able to tell exactly when someone is likely to pass away and give a definitive timeline, and that has created a kind of lottery where some people can access VAD because they encounter a practitioner who is comfortable giving a time-based prognosis while another eligible person in the same situation might have their application rejected because their practitioner is just not comfortable giving that specific certainty around the timeframe for the prognosis. Also, a time-based prognosis means that some people start the process simply too late, leading to suffering that does not need to happen. Go Gentle notes that since the commencement of the act a total of 765 applications, or 35 per cent of all applications, have been withdrawn before the substance was dispensed, and of these, 45 per cent were withdrawn because the applicant died less than two weeks after making the first request. That is our first amendment, to remove the time-based prognosis.

If that amendment is not successful, the member for Richmond will move an amendment that means that there could be a compassionate exemption to the 12-month timeframe, which I think is a very reasonable suggestion. This is what they do in Tasmania – people can apply to a board for an exemption from that 12-month period. In our case, with the way that our law is written, it would mean that the application goes to the Secretary of the Department of Health and then that secretary is given discretion to determine whether an exemption can be granted if death is not strictly expected within 12 months but there are other important factors to consider and it is a terminal illness. Similar to the Tasmanian legislation, we would like the secretary to have to seek expert advice to inform their decision regarding that particular type of exemption, so the safeguards are still in there. That is our first amendment.

Our second amendment is to repeal the requirement in section 10(3) of the Voluntary Assisted Dying Act 2017 for one of the consulting or coordinating practitioners to be a specialist in the disease the person is dying from. Victoria is the only state to have this restriction. It is a huge barrier to access, especially in rural and regional Victoria where it is difficult to find a specialist at all, let alone a specialist in the exact disease a person is dying from. We also believe that nurse practitioners should act as coordinating or consulting practitioners. They have the qualifications and the experience to do so. There are many nurse practitioners already playing an important role in VAD, and they are well placed to take on more formal roles. There will still be a requirement for at least one appropriately qualified doctor to be either the coordinating or consulting practitioner to ensure safeguards are still in there. That is our second amendment.

Thirdly, we will seek an amendment to require healthcare services to allow VAD to occur onsite, including in aged care services, as is the case in other states, including South Australia, Queensland, New South Wales and the ACT. We believe that people should have a reasonable expectation that they can access VAD in their home. For many people that home is a residential aged care facility. These facilities should not be able to reasonably prevent someone from accessing VAD onsite in their home, but there are currently challenges to this.

It is a significant and widespread problem in Victoria, as highlighted in Go Gentle’s recent report. In fact 90 per cent of Victorian providers either deny access to VAD in their facilities or do not provide any public information about VAD access. That is pretty shocking – 90 per cent.

This amendment also makes it an offence for a health service provider to withdraw a health service from a person or refuse to provide a health service to a person on the basis that the health provider knows the person has made or is likely to make a request regarding voluntary assisted dying. I think that is a pretty commonsense amendment. People are in their home – they should not have to leave their home to go somewhere else to access VAD. But if that amendment is not amenable to the house or not successful, we will seek an assurance from the minister that health services will be required to have a VAD policy and be transparent about communicating this to the people in their care, to avoid a person only discovering they cannot access it in their aged care residence only after they apply for it.

Our fourth amendment is to seek to amend section 13 of the act to require that a health practitioner who is not comfortable participating in the VAD process at least document that request and their refusal to participate. That is simply so that a person’s medical files reflect their requests to access VAD and have those requests adequately documented in their medical files – a small but important change.

Fifth, we will move an amendment to clause 28 of the bill that would seek to further shorten the required time period between the first and last request to 48 hours, and that is for no other reason than to limit suffering as far as possible. There have been many instances we have heard of of people requesting access to VAD but then having to wait, suffering in pain for days – for too long – while they wait for that approval. If we can reduce that suffering but still have the safeguard of 48 hours, surely that would be a good thing for patients. That is our fifth amendment.

Our sixth and final amendment is to amend the five-yearly review of the act to a three-yearly review. We know a lot can change in this space. We know that things move quickly – clinical practice, other jurisdictions, changing social expectations – and we think that three years is reasonable for reviews.

I very much hope that MPs will consider these amendments carefully and support them as commonsense improvements – small improvements, but commonsense improvements – to the legislation. And as I said, I am open to any conversations, as is the member for Brunswick Dr Tim Read and as is member for Western Victoria in the upper house Dr Sarah Mansfield. For any questions or any conversations about why we have chosen these specific amendments or the evidence behind them, please, please come and talk to us.

I understand that people have very different views about this legislation; I absolutely respect that. All of us in this place – yes, many of us represent parties – are informed by our own experiences, our faith, our family and our histories. That includes me. In my original speech I spoke about the reason I supported VAD, and one of those reasons was my dad. He passed away in 2014 – just before I was elected to Parliament – from melanoma. It is the kind of disease that strikes an otherwise healthy and fit person seemingly at random, and if you did not catch it early enough, the survival rate back then, 10 years ago, was very, very low. It was less than two years from diagnosis to death for my dad. Fortunately now, due to some incredible advances in medicine, which I am so grateful for, the survival rate for late-stage melanoma is much, much better than it was 11 years ago. But not everyone is lucky enough to survive. Not every cancer has these success stories. There are still so many people in our communities that have a diagnosis that leads to a painful drawn-out death. They deserve more comfort and control at the end of their life.

I always remember when my dad was diagnosed he would say to my mum, ‘When the time comes, you won’t let me suffer, will you?’ But she would look at him – and she was a health professional – and what an extraordinarily difficult position to put her in, because she knew back then that if the time came that he was suffering greatly, there would be very little she could do within the law to help end his life peacefully and with less pain. What a horrible position to put loved ones in. Now, with VAD, we are not putting people in that position. And we heard back in the debate in 2017 that unfortunately often what ends up happening is people take matters into their own hands and try to relieve their own suffering and take their own life, often in violent and painful ways, and that is just awful.

I absolutely understand those who say, ‘Let’s invest in better palliative care instead.’ In the last two days of my dad’s life he was fortunate to get one of the very, very rare public palliative care beds in the Royal Melbourne Hospital. He had come down from Mildura for some appointments and unfortunately had an episode where he collapsed and ended up in the Royal Melbourne – not somewhere we ever expected him to be. But he was very fortunate to get one of those beds, and I cannot thank the nurses there enough – they provided extraordinary care at the end of his life. They also provided a lot of defence against the other elements in the hospital who wanted to give him treatment beyond the point he had said, ‘No, I do not want any more treatment.’ Those nurses were absolute saints. But the thing is that it is not an either/or. We do not need to have VAD or more palliative care; we can actually have both. The government can invest more in palliative care; we can prioritise palliative care as well as giving people the dignity of choice at the end of their life. People have the right to choose for themselves, and there are simply some conditions and symptoms that cannot be alleviated sufficiently with just palliative care – that is simply a medical fact.

Thinking back to the first time that we discussed this bill, in 2017, the question we were being asked as MPs was essentially the same one we are being asked now: should people with a terminal illness have the right to choose the end of their life with dignity, with the least amount of pain and trauma as possible, or should this remain illegal – or in this case, should we continue to have significant barriers for them to do so? Supporting assisted dying legislation is Greens policy, but my view is also informed by my experience. I think it is ultimately the compassionate and commonsense choice, so I very much hope this bill will pass and that some of our amendments will pass as well.

 Jacinta ALLAN (Bendigo East – Premier) (15:52): In rising to speak on the Voluntary Assisted Dying Amendment Bill 2025 I would like to start by paying tribute to my friend and our colleague the member for Pakenham for her incredibly powerful and personal contribution to the chamber earlier today. It was back in 2017 – and I was proud to be part of that debate at the time – that this Parliament made a decision that has gone on to change the lives of thousands of Victorians. Like this debate we are having today, it was difficult and deeply personal for so many of us in this place, because this was not just any typical piece of legislation, this was about people, real people in the hardest moments of their lives: Victorians who were dying and their families forced to witness the suffering of those they loved most. I pay tribute to the member for Melbourne and her family, as she has shared what it was like for her family to witness the suffering of her much-loved father who passed away.

Back then in 2017 we spoke a lot about pain. We also spoke a lot about courage and the simple wish for people to have peace at the end of their life. Through that debate Victoria became the first state in the nation to give terminally ill people the right to choose a dignified, peaceful end to their suffering. It was a decision built on compassion, and I witnessed the deep compassion that ran through the debate at the time on the belief that dignity should not end when illness begins. Because of that choice, thousands of Victorians have been able to face their final days on their own terms. Also, because of the actions of the Victorian Parliament in 2017 other states have followed, and across the country many thousands more families have been given the chance to have access to something they once thought impossible: comfort, control and the chance to say goodbye with peace instead of fear.

Back before 2017 we began the process carefully and deliberatively. We built some of the strongest safeguards in the world to make sure compassion could never be separated from care. Six years on we know that approach was right, because we have seen how voluntary assisted dying has worked safely, responsibly and humanely. But since the passage of the legislation here back in 2017 and the actions of other states who have since followed, it has also shown us where the system here in Victoria can be clearer, fairer and kinder and where people who are already suffering have been left to navigate barriers that were not meant to be there. That is what this bill is about: strengthening those same principles that guided the debate in this house in 2017 – of dignity, safety and compassion – and making them work better for the people who need them the most, because we must always remember at the heart of this legislation that we are debating today are real lives and real families.

I will share today a story I also shared when I addressed the house on this matter in 2017. It was an incredibly powerful meeting I held in my office in Bendigo, and it was this meeting with **Graham and his daughter Diana that shaped my own process and thinking, alongside other discussions with family members, with friends and with professionals. But I want to retell the story about Graham and his daughter Diana that they shared with me back then. It was about their wife and mother Dorothy. She was frail and in pain. She had no lawful option to end her suffering. She ended up taking her own life, and in the immediate time after Dorothy had passed away her husband Graham, in his 80s, was questioned by police for hours, treated like a criminal simply for being by the side of his wife when she died. That story is a story that has never left me, and it reminds me of what happens when we leave people without a safe, regulated and compassionate choice. And it is a key reason, among others, that I voted back in 2017 for Victoria to take that step, and as we have heard through the course of this debate, since then more than 3500 Victorians have accessed the process and 1683 have used it to end their suffering and have done so not out of despair but out of love – love for their families and the wish to spend their last moments in calm and dignity.

I was reminded of Graham and Diana and their mother Dorothy’s story when I met a few weeks ago Liz Tower, who joined the minister and me when we talked publicly about bringing this bill to the Parliament. Often we think of these people who are accessing voluntary assisted dying as people who are older – much, much older. Well, hearing Liz talk about her fiancé Alex, they were in their 20s. Alex had cancer. It was a rare form of cancer, a cruel illness. It was taking everything from him. And Liz spoke about how when Alex was approved to be able to access voluntary assisted dying, something in him changed. His fear eased. His laughter returned. His family got their brother back. And as Liz said, he did not die because of VAD, he lived because of it. And I want to thank Liz and the countless other Victorians who have shared their personal story, because it is hearing those personal stories, understanding the power that accessing voluntary assisted dying has had on people like Alex, that is helping all of us to understand what we need to do to continue to support Victorians to be able to access voluntary assisted dying and to do so in a way that is about compassion, dignity and choice. The amendments that are in this bill are built on that purpose. They do make the process clearer for patients and simpler for doctors. They make sure that people with long unpredictable illnesses are not forced through unnecessary hurdles. They also let doctors speak openly and honestly with their patients about the options that are available, and they ensure that families already carrying so much worry and so much grief and concern for their loved one are not trying to make sense of a complicated process.

These are careful, measured changes drawn from that six years of experience we have here in Victoria and guided by those strict safeguards that have protected this law from the start, because those safeguards remain. Every person must act freely, must have decision-making capacity and must make multiple requests that are witnessed and verified. It is safe, it is steady and it is working.

This is not about expanding access to death, it is about extending and expanding compassion for those who are dying. As I have said, we have heard directly from those with a terminal illness that people know that when they have a choice they live their remaining time with less fear and more peace. Doctors and nurses tell us what a difference it makes not only for the patients that they are caring for but for the families, who can share stories, hold hands and say goodbye without panic or pain.

That is what this reform protects – the right to choose comfort over suffering and calm over chaos. And I choose to support them – to support those Victorians with a terminal illness – to have the right to have that choice of being able to access voluntary assisted dying.

This reform is careful. It is kind. It is right. It is about the simple belief that how a life ends matters and that it should end with that care, comfort and respect. That is what this bill protects, and that is why I am so proud to support it and acknowledge the work of the Minister for Health and so many others who have continued to work with the government to bring the bill to the Parliament today. I hope to see it supported and pass through this Parliament as we continue to provide Victorians in the most difficult of times to have that choice, because we know it gives them that care, comfort and respect. I commend the bill to the house.

 Brad BATTIN (Berwick – Leader of the Opposition) (16:00): I rise to speak on the Voluntary Assisted Dying Amendment Bill 2025. I join the Premier in thanking the member for Pakenham for her obviously very emotional position, which everyone in this place felt and listened to intently. I thank you very much for putting your voice on the record and the Premier for the stories that she has told from personal experiences as well.

Most in the room who were here – I think there were 30-odd here in 2017 who are still here today; 39 I think, if I am correct – will know that at the time I voted against the Voluntary Assisted Dying Bill in 2017. Since then many things have happened that have had impacts on my life and how I think about what happens when it comes to voluntary assisted dying. In this place we should look at what is happening in our community, but also you have to take into consideration your personal circumstances and how they impact the way you think, the way you feel and what you see people go through.

[NAMES AWAITING VERIFICATION]

I am going to give two different examples. One is one of my best friends – one of my groomsmen – Paul, whose father Cliff ended up with pancreatic cancer. Cliff was a very proud man. He was larger than life in more ways than one, and he enjoyed a drink. We loved our time with him. To watch him make the decision to use voluntary assisted dying for his ending of his life gave us an opportunity to go to his place and have a glass of red at his calling when he knew he still had some time left. I did promise him I would buy an expensive bottle.

A member interjected.

Brad BATTIN: It was $200, but he is not going to complain now. We sat down and we had a glass. I will not forget it because Kay, his wife, when he went to have the second bottle with us, turned around and said, ‘Cliff, you don’t need it.’ He said, ‘Well, it’s not going to wait around for me. I’m not going to be here much longer, so let’s enjoy it while we can.’ It is those moments that will now stick with me forever. Speaking to Paul after was when the impact was real. Paul got a phone call in the evening, and his father said, ‘I’m going to leave tonight.’ Paul went around and sat with him, and we had the view – Paul was pretty convinced – Cliff was going to be gone by about 9. It was all planned. About 5 in the morning was when Cliff decided it was time to go because he wanted to spend those few extra hours with his family. As others have said, it was in a place of peace and a place of safety. He knew everything was in his hands then – everything was in his hands. He made that decision at 5 in the morning to depart. Obviously Paul had the opportunity to spend all those hours with his dad that he probably would not have in other circumstances.

The other side of it: my best mate Matt lost his wife last year to cancer. We watched, as everyone does when you see people with cancer, the impact on them, on their body, on the way they look and on the way they act. Chrissy lived every moment of her life to the fullest, and in the end she did not go down the path of voluntary assisted dying. She believed that every last breath was there for Maddy and Ellie and for Matt and it was there for her friends so each and every one of us could have memories with her that last a lifetime. It was actually that that impacted me more, not for the fact that we are all sad when we lose someone, but it was proof there was the choice. I am a fundamental believer in freedom of choice. I did say that the first time I made a contribution in here. I think it takes a bit to come into a place like this and have a total change of position on something that is so serious, but it does highlight this place when it is at its best.

I agree with the Premier, because it is about people, it is not about politics. People in this room will have a totally different view to me, and I 100 per cent accept that. I will make some decisions on the amendments as we go through, but overall my position has changed on the facts of what I have done and what I have seen. Then you do go and speak to others in your community. I do believe that out in the electorate of Berwick people have over time moved in the way they think about this, as a rule and as a whole – not everyone, but people have moved.

But the best thing about this is that for those that do not want to move and those that say, ‘I want to go through and get palliative care. I want to get the support in the health network. I want to live every last breath with my family,’ that is a choice they have, and I believe that that should be their choice. But those that opt not to – and I am going to say the Cliffs of this world – are going to be leaving a message behind with their kids and their family that they can sit with them in their time and leave this world when they are ready.

To come in here today and talk about two people that obviously I dearly loved was always going to be a challenge, but I will walk out of here today knowing that I have made the right decision based on what I have had to live with in those experiences as well. I do implore people that it is a good thing to think about. It is not just about what you want, it is about giving and creating choice for every person in this place. I have listened to Emma, the member for Pakenham, and we all know the circumstances for the member for Pakenham at the moment. We all stand with you. We know that. But hearing you in here as well should send a very, very clear message that it is about choice. You may get to a stage where you say, ‘No, I don’t want to do that.’ That is fantastic. But we need to make sure that choice is here.

I will say now that I will be supporting this bill as it goes through the Parliament. I will be looking at some of the amendments. I will hold my position on a couple of those, but for the rest of it, I think it should be going through and that the people in Victoria should be getting the choice they deserve.

 Steve McGHIE (Melton) (16:06): I rise to contribute to this very important debate on the Voluntary Assisted Dying Amendment Bill 2025. Firstly, I would also like to acknowledge the member for Pakenham’s contribution; it was amazing, and I thank her for it. But I also want to commend the Leader of the Opposition for his contribution and the personal stories that he told. Of course he has changed in regard to his position on the bill. I think the most important thing that has been raised today is that it is a personal choice. It is an individual choice. No-one is right. No-one is wrong. It is about their body. It is about their life. It is about their choice, and we should not interfere with someone choosing what they would like to do at end of life, whether that is live it out to their last breath or whether they think they want to reduce and stop the suffering. It is a personal choice.

Many members of this place would know back in 2017 we saw the passage of the Voluntary Assisted Dying Act 2017. This act led the nation in offering a safe, compassionate and dignified end-of-life choice for those suffering from a life of limiting illness. In the eight years since this act came into force many of the other states obviously have followed Victoria’s path and introduced their own voluntary assisted dying models. They have taken the Victorian legislation and made it their own and even improved on the original legislation. That has since left the Victorian legislation in need of some important adaptions to catch up to the rest of Australia. When the legislation was passed in 2017 we did not stop listening or learning to better improve this act for Victorians. Importantly, we have listened intently to people with lived experiences, families of people who have accessed VAD, clinicians, advocates and people and organisations that oppose VAD. All these discussions have been had with respect and compassion, and that is really important. It remains essential that the discussion here today retains respect and compassion for people’s individual positions on this important bill.

Since 2017, 79 per cent of the patients that have both applied for and accessed VAD have been in palliative care. Palliative care is an essential provision, and we all know that. The integration of palliative care options remains an important aspect of the end-of-life care delivery model. In 2024–25 75 per cent of applicants were accessing palliative care when they first requested VAD. This suggests that VAD is being appropriately accessed in conjunction with palliative care rather than as an alternative to it. It is not an alternative to it, it is part of the continuum of care. Since 2017 there have been more than 2700 permits issued to prescribe self-administration or practitioner administration of VAD substance and 1683 deaths from administration of VAD substance.

Of the 2700 permits that were given, 32 per cent of those applicants with a permit died without administration of a VAD substance, so obviously their life ended before they could action taking the VAD substance. These people who chose to access VAD to end their pain and end their suffering did not want to live with the pain anymore, and so they should be able to decide when they have had enough and are ready to end their suffering. Again I come back to what the Leader of the Opposition said and what others have contributed, and that is it is the individual’s choice. These decisions are theirs to make. As other VAD laws have been rolled out across the nation there has been no evidence of coercion in our Victorian experience or in any other state. No evidence has been provided in regard to coercing a patient into accessing VAD. It 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 pain and suffering. It should be seen as a continuum of care, and it is a continuum of care. It should be obvious that these choices are not made lightly or without great consideration of all options.

The 13 proposed amendments that are before this house are designed to improve equity of access, improve the practical experience of those patients and families navigating VAD, improve safety for all involved and finally, but still importantly, improve the administration of the scheme. Allowing registered practitioners to initiate discussions has been one of the issues that has been raised in concerns. Of course humans innately struggle when it comes to talking about death. Whether it boils down to death being a primal fear or it is simply too overwhelming to even think about, humans struggle to talk about death, even if we are already suffering from a life-ending illness. It is taboo, but that does not mean it should be. Some of these discussions about our own end of life may be some of the most important conversations that one will have, especially if we do become unwell and want to make sure our wishes are known to those around us. It is important that we talk to our family members early on if we are diagnosed with a terminal illness.

Dealing with death has changed over the years. I remember when I first started as a paramedic and we attended someone that either was dying or had died, it was almost taboo – you know, the person would be put into a bedroom, doors would be locked and family members would not attend to the body and sit with the family member that had passed away. As a paramedic, we would load that patient up and take them via a public hospital for certification of death and then off to the city morgue. I am pleased to say that that has all changed now. We have become more compassionate and are dealing with grieving in a better way, where we encourage family members to sit with their family member that has passed away. Paramedics no longer transport people to public hospitals for certification and then off to the Coroners Court. It is all done through the police, and you ring the private undertakers that will come and pick up the body and work with the family. It is a much more humane process.

The first proposed amendment that I will talk to will allow registered health practitioners to initiate discussions with patients about VAD rather than waiting for the patient to raise it first. Not only can this ensure that the patient is aware of all their options, this is also about information sharing by practitioners to their patients. It may also even speed up the process for some who may have not been aware of all of the options available to them in regard to their issues. The amendment will further empower the patients to hold on to a level of autonomy and agency over how they wish to move forward with their life. Nothing is being taken away from those patients; they will still be able to refuse VAD if it is raised with them by their practitioner. But it still provides the patients with the information on all of the options available for them, and they can decide what is next for them. It is the patient’s choice and their choice only – no-one else’s choice, not their family’s. It is the individual’s choice, not their practitioner’s. No-one else around them can choose for them to access VAD, only the patient. This proposed amendment is in line with WA, Tasmania, Queensland, New South Wales and the ACT, and it recognises that VAD is part of health care and arguably one of the most important healthcare discussions a patient can have with their practitioner and with their family.

This amendment will allow for enhancing safe, compassionate and dignified end-of-life choices for those who continue to suffer from a life-threatening illness.

Of course conscientious objection is another issue that has been raised. VAD discussions encompass more than just the patient themselves and their families; the health practitioners also play a vital role in the discussions. Those who choose to conscientiously object to providing VAD should be able to object and refuse to provide VAD as well as provide information on VAD. This amendment respects and protects the autonomy of the health practitioners also. Maybe it is the taboo-ness of death coming into play or other valid reasons for not wanting to be involved in the VAD process; nonetheless this amendment will bring the Victorian legislation into line with other Australian jurisdictions. Other than the minimum information on VAD to patients – that being the contact information for the statewide care navigator service and relevant department website – any practitioner who objects to this process will not be compelled to do any more. Again, it is just about providing the statewide care navigator service and the relevant department website. It is not about coercing their patients. It is not about informing their patients. It is just telling them about that information. This is an important bill, and I commend this bill to the house.

 David SOUTHWICK (Caulfield) (16:16): I rise to make some comments on this amendment bill, and also I begin by acknowledging the contributions made by those in this chamber. This is a very difficult bill, and as we know, there are varying views on the bill. I appreciate the importance of those views that they have both personally but also with many of their constituents. I also want to recognise the member for Pakenham – her contribution and her own struggle and how very difficult this would be for the member. I also understand the choice that the member wishes to make and the very personal circumstances in which she is in. That is something that I have had to really think about and contemplate, because back in 2017 my view was probably slightly different to what it is right now. For me, I absolutely understand that there should be choice, but also it should be very informed choice, and there do absolutely need to be safeguards. That choice needs to very much be with the patient, particularly those suffering a terminal illness, but it is also the choice of the medical practitioner. So I will, in a minute, propose some amendments dealing with that.

Personally, when the VAD was first introduced, in 2017, it was the year in which my father passed and a very, very difficult time. People know when they lose a loved one – a father, a mother. I was his carer – as I was my mother’s carer – and had to go through those moments in palliative care when the morphine would be slightly increased, to the point at which he passed. I will never forget that night in which I slept in the hospital alongside him and stayed with him until his last breath. I suppose that informed a lot of my thoughts, because he was well managed in that process and he had really good palliative care.

I know in my area, as around the state, we have some really good palliative care facilities. Calvary Bethlehem does a fantastic job of managing all of the stages, from those in retirement, with their new facilities, all the way through into palliative care. I think it is really important when we talk about choice that we ensure that those palliative care services are well funded and well supported to give everybody all of that choice.

Back in 2017 I did talk about elder abuse, and I think, again, there need to be protections around that to ensure that a loved one – a parent, a grandparent – does not get to the point where they are choosing to end their life because they are feeling like a burden on somebody.

That is where those safeguards need to be protected.

I know part of this bill talks about interpreters for those for whom English is a second language and for our multicultural communities. Again, that is something which I do think needs to be looked at as part of this, because we need to ensure that those that are vulnerable have the right information. Accredited translators are very, very important when dealing with that, and I know that is something that many in my community would support, as would many of my constituents. I would like to see that strengthened.

In dealing with health professionals and talking about choice, I think it is really important that people of faith that have very strong views and are conscientious objectors to providing this information based on their own religion or their own views also have that choice and those freedoms protected. It is about managing that, and I understand the sensitivity in dealing with that. It is with that that under standing orders I wish to advise the house of amendments to this bill and request that they be circulated, which I will do now.

The ACTING SPEAKER (Lauren Kathage): The amendments will be circulated.

David SOUTHWICK: They deal with clauses 6 and 12:

1.   Clause 6, line 32, after “information” insert “about the voluntary assisted dying care navigator service that is”.

2.   Clause 12, line 27, after “information” insert “about the voluntary assisted dying care navigator service that is”.

This specifically deals with the information that the health provider is obliged to pass on. In the current form of clause 6, talking about the department secretary having the ability to approve, it talks about minimal information, but what that information might be is a little open to interpretation. I think it is really important for that information to be very specific – as in name and number. But in terms of additional information, if that is to change, I do not think that should be up to the department secretary to make those decisions in terms of what additional information would be provided – that should be up to Parliament. If there is an obligation on the health professional to have to continually provide more and more information, then we should debate that. We should discuss that. I do not think we should abdicate responsibility and say to the department secretary, ‘Off you go. Let’s have more obligations on somebody,’ particularly somebody that is of faith and who does not believe it is their obligation to do that.

I know all health professionals – really everyone in the health sector – are all about ensuring life and working in terms of life, but when I talk specifically to many of the medical professionals in my constituency of a Jewish background, they are really concerned about what they would be forced to have to provide. I think that when we talk about choice we have got to look at choice from all aspects. When we talk about freedoms we talk about freedoms with all people and for all people. Absolutely we should value those with a terminal illness having that choice, but at the same time, those providing the health advice should also have that choice and those protections as well in terms of what they signed up to. Those protections should be mutually protected at both ends of the scale.

The final thing that I would raise is in terms of the definition of medical professionals. I know that has been extended to other services and other providers in terms of who is providing advice. I see in here that clause 12 applies to all registered health practitioners, which includes Chinese medicine practitioners, chiropractors, dentists, midwives, occupational therapists et cetera. Again, I think it is important to have the right people, when you are talking about this particular situation, providing the right advice.

These are very serious stakes. These are the highest stakes on offer when you are talking about someone’s life. We need to be protecting that, the information and those that are properly qualified to provide that information, so I do query that in terms of the extension of all of this.

Again, it has been a tough bill, but an important one, to talk to. I do hope that the amendment that I put forward will be considered, because I think it is really important to protect everybody, certainly those that have signed up in the profession that save lives each and every day. Their whole profession is about ensuring life and protecting life, and they should also have that choice.

 Matt FREGON (Ashwood) (16:25): I will make a brief contribution on the bill before us today. I originally was not on the list – and I thank members on my side for allowing me to jump up – mainly because, without anticipating debate, I will probably spend a very long time sitting in the chair as we go through consideration in detail, and I will do my best to be completely impartial in that sense. But after hearing the member for Pakenham and all members, I felt it was at least necessary to give a small contribution, because although we stand here today with a conscience vote and we represent in some ways ourselves, we also represent the 50,000-odd people in our communities who have varied views. So, if for no-one else but for them, I will at least try and relay where I am.

To those who have contacted me, I have responded that this is a very serious bill, as we all are taking it, and my considerations are such. We all come into contact with death in our lives more often than we would like. I can recall my grandmother many, many years ago had bowel cancer and it was not a good way to go. I can remember my grandfather had dementia and we saw him to the end of his life. As I think the member for Lowan mentioned, all too often before VAD was an option, people just kept upping the morphine until they would have a chat with the doctor and would all nod at each other, and we all know what happened next. Now, in his case, dementia would not be part of VAD, and I do not think any of us are suggesting it should be.

I had an experience myself about 13 years ago where my appendix burst and I had peritonitis following that and I was in hospital for about a month. I am all fine now – thank you, antibiotics – but there was a moment during the course of that. Essentially with peritonitis your guts look like something out of Alien and your whole gastric system stops. I can tell you it is not good, and during that time I had a gastric tube. I have got to tell you, I do not know how people live with these things. I had a tube down my throat for, I do not know, 12 hours, and I could not get my head around it. To feel like you are constantly choking and to know that this thing is keeping you alive – 12 hours. So for people who are in the position where they know exactly where the path leads – and if I can hopefully quote, with enough respect, the Member for Pakenham – I do not see the point of unnecessary suffering.

I was not here in 2017. On probability – and this is what I have told constituents – should I have been here, I probably would have voted for the bill. The review has said the bill is working well. I do have some concerns about some aspects in the sense that I think maybe we could have worded them a bit better. I will look at amendments. I will consider it very, very carefully. But no matter what we do in this house today, VAD is still a part of medical treatment in our state and should be. I think regardless of where we end up here, we need to all consider ourselves, our families and those that we do not know as well.

I probably should not pre-empt myself or anything, but on balance I may have questions on amendments but I am most likely to support the bill. There is a sort of oxymoron in there or a contrast of opinion. In general I have some concerns about conscientious objection. We use the word ‘provide’ in the explanatory memorandum for the bill. We use the word ‘provide’ elsewhere. We have changed the word to ‘give’ in the bill. I am not suggesting to put forward any amendments. That is not part of my role when I am sitting there, and I would not be doing it anyway, but that is one thing I think probably does not make that much of a difference.

I do not oppose removing the gag clause for medical practitioners. I understand there will be a time and a place when medical practitioners should have that conversation with compassion. We could put more caveats around that – that the person would qualify for VAD – but again it is not really going to change the emphasis of it. I have some queries about the health practitioners. I notice in the Queensland legislation health practitioners are able to respond on request. To that I would say that in our original legislation, as others have said, we were very cautious. The review says that has served us well. I understand that we can go further. I am not a slippery slope argument sort of bloke. I do wonder in regard to health practitioners whether we could go to that request model and still allow them the roles that they have in terms of them caring for their patients where that is relevant.

I will leave it there. This is going to be a very long and serious debate. We are all going to think of loved ones. We are all going to think of what the rest of our lives are like, what the rest of their lives are like and potentially what we leave behind afterwards. This could be the house at its best, and so far I thank everyone for a very respectful debate. I will leave it there.

 Jess WILSON (Kew) (16:33): Voluntary assisted dying is surely one of the most profound and complex ethical challenges that we will grapple with in this chamber. The legislative framework we put around a person’s ability to choose the manner of their passing goes to the very heart of how we as Victorians value life, dignity, compassion and personal choice. It is an issue in which I feel deep personal struggle between two of my sincerely held values: that of personal choice alongside the inalienable value of all human life. When we consider voluntary assisted dying, we must seek to balance two vital principles: on the one hand the right of individuals to make decisions about their own lives and on the other hand the responsibility of society to protect the most vulnerable and affirm the sanctity of life. Striking this balance is no easy task. I have reflected at length on these values and principles as I have considered the bill before us today.

I want to thank the many residents of Kew who have reached out to me and shared their own views about voluntary assisted dying. I have read carefully and considered every single email and letter. I thank the member for Pakenham for her incredible strength and her ability to articulate what must be immense pain and suffering at many times. You are a simply wonderful person, and I am proud to be able to serve alongside you in this place.

For context, I note that the legal framework establishing voluntary assisted dying in Victoria was debated and passed before I entered the Parliament. I have heard incredibly powerful stories from current and former members of Parliament about the debate that ensued at the time, from both perspectives. What most people talk about and what most former members and current members recount is the incredible passion and respect that was on display at the time. From the debate that I have seen today, I believe we will see similar respect right across the chamber here as we debate this piece of legislation into the night.

Voluntary assisted dying, as we know, came into effect in 2019, and since then 1683 people have accessed VAD in Victoria using this option. Voluntary assisted dying is just one of the options for people with a terminal prognosis and exists alongside other options, including treatment and palliative care. The act requires a review to be undertaken by the VAD review board in the fifth year of operation, and the bill before us today seeks to implement a number of changes to that pre-existing framework. I approach this bill from a place where I have accepted that the threshold has already been crossed and voluntary assisted dying is now legal in Victoria and accepted as part of the end-of-life care offered to Victorians in our healthcare system. As such, I have examined each change proposed in this bill on its standalone merits within the existing framework, rather than trying to reprosecute the many valid arguments both for and against voluntary assisted dying itself.

There are a number of amendments contained in this bill, and I do not propose to speak to all of them given time limitations, but I do want to address a number in detail. The first is the set of amendments that will allow greater choice of administration method for the VAD substance. In doing so, I want to acknowledge Dr Roy Karna, a resident of Kew who has very recently lost his wife to lung cancer and wrote to me to share the experience of her passing. Dr Karna’s wife wished to access VAD and had been granted approval to do so given the progression of her lung cancer, but a rapid deterioration in her condition days before her death prevented her from fulfilling her deeply personal choice around her end-of-life care. With his permission, I will share her story here. Dr Karna writes:

[QUOTE AWAITING VERIFICATION]

My wife, somewhat unexpectedly, rapidly deteriorated over one day and night. In doing so, she lost the capacity to swallow, and with it her chance to access VAD and ameliorate the suffering. To access the intravenous option, notwithstanding having been granted the initial permit, would have been a bureaucratic nightmare, with further doctor interviews and a submission to the board taking up to 10 days. She died two days later. Knowing how she wanted to access VAD to prevent her own and the family’s suffering, this turn of events was devastating.

As a doctor, I can also say at the very end of life, when a neurological event occurs, often randomly, without warning, and with that, VAD option goes. Clearly this is wrong and unacceptable. I believe at the time the permit is given, the intravenous option, based on contemporaneous medical evidence, should be made more easily accessible. Safeguards to the process can be added, but the option needs to be there.

Clearly the situation experienced by Dr Karna’s wife and her family is intolerable, and I thank Dr Karna for reaching out and sharing what is a deeply personal story.

Previously this chamber voted to make VAD legal for Victorians. They did so in the belief there is inherent dignity in allowing people to choose to reduce their own suffering and the suffering of their families at the very end of their life. But overly complex rules around accessing VAD are not giving effect to the intent of that legislation. This particular amendment before us today seeks to resolve this clear failure of the framework, and I am pleased to offer my support for it. No Victorian family should endure what Dr Karna endured, where final wishes cannot be granted due to bureaucracy.

I am now going to turn to the second aspect of the bill that I wish to address, namely the requirement for doctors to provide minimum information about VAD to patients who request it. I do have deep concerns about this measure. I am incredibly uneasy with the idea that healthcare professionals who conscientiously object to VAD should be forced to provide information about it to patients. It is one thing for them to be expected to provide contact details for practitioners who do support VAD, but it is another thing to expect them to provide what the government deems to be minimum information about VAD. While the minister said in her second-reading speech that the minimum information was simply a referral to a healthcare practitioner who can assist a patient to access VAD, the bill itself contains two instructions that a conscientious objector must follow, the first being to make a referral to a healthcare provider who can assist the patient to explore VAD as an option, and the second being to give the person the information approved by the secretary.

This lack of clarity creates uncertainty, and uncertainty creates distrust. There has been, I think, some unfortunate demonisation of healthcare practitioners who find VAD to be irreconcilable with their duty to preserve human life, but it is entirely a valid ethical position that many healthcare professionals hold, having reflected and consulted their own conscience and their experience caring for people at the end of their life. I feel it is wrong for these healthcare practitioners to have their sincerely held views so disregarded. That is why I will be shortly circulating amendments that would ensure conscientious objectors need only provide contact information for the statewide care navigator service and the relevant Department of Health website. I believe this is a sensible, middle-ground reform that would allow patients seeking VAD to still access information about its availability, without asking conscientious objectors to provide unspecified information from the Secretary of the Department of Health.

I encourage colleagues in the chamber to consider supporting this modest amendment as a way to improve the bill and allow it to better strike a balance between two important ethical considerations.

I will now turn to the set of measures that has been collectively referred to as lifting the gag clause, which enable practitioners to raise VAD as an option in their discussions with patients about end-of-life care. I want to recognise that these amendments have troubled many constituents of mine who have reached out to share their concerns. I reflected on this at length and have found I am compelled to place my trust in doctors and nurse practitioners to use their judgement about when raising VAD is appropriate for their patients. I place my trust in them that they will raise it only when a patient’s condition is truly terminal and their suffering likely to become so intolerable that VAD would be an act of compassion. I appreciate that not all will share my assessment, but that is the judgement I have come to after careful consideration and deep reflection. What I cannot reconcile with my conscience, however, is delegating that authority to raise VAD to healthcare practitioners who do not have the same degree of medical expertise as doctors and nurse practitioners. The definition of a registered health practitioner who is not a medical or nurse practitioner is incredibly broad and raises concerns about these discussions taking place in inappropriate settings.

I believe these conversations should only be had with medically trained professionals – with doctors and nurse practitioners. This will ensure conversations are navigated sensitively and in a manner that is appropriate to a person’s diagnosis. For that reason I will be shortly circulating amendments to the bill that will remove section 8A of part 2, which in its current form will allow healthcare providers who are not doctors or nurse practitioners to raise VAD with patients. Again I would ask colleagues to consider this amendment as a way to improve the safeguards we put in place for vulnerable Victorians to ensure VAD is always raised only when medically appropriate.

On balance I have chosen to cast my vote in support of the passage of the bill before us today. I do this because on balance I believe it will make the existing VAD framework better for Victorians who seek to choose the manner of their own passing. I am, for the most part, satisfied with the safeguards in place to protect vulnerable Victorians, although I believe the amendments that I have just spoken to would offer further important protection, and I commend them again to the house. I note that this debate will never entirely be settled and that deep and ethical questions of morality can never be answered to the satisfaction of every single individual. But as policymakers we face the same dilemma that healthcare workers face when confronting this issue. We must grapple between the competing priorities of the preservation of life and the alleviation of suffering. These are never easy questions to answer and nor should they be, but I believe this bill strikes the right balance.

 Paul MERCURIO (Hastings) (16:43): I am very happy to stand and talk about the VAD legislation before us. My body, my mind, my spirit, my soul, my life, my choice – a lot of people have talked about choice in this debate today, and I think that is one of the key elements of this debate and this legislation. In making that statement about my body, my life, my choice, I also understand that VAD exists. It was debated in 2017, and I thank everyone for the amazing work they did then. It came into law in 2019. This debate and this bill, this legislation, does not change that at all. It does not affect that at all, which is good.

There are so many things going around in my head. In a lot of ways I think once the member for Pakenham had made her speech in the debate we should have just voted. Anyone that still wants to debate this I feel in some ways misses the point. We are talking about a very serious subject, but we are also talking about people’s pain. I do not know if we can really talk about people’s pain without feeling it. We are talking about legislation. We are talking about making different choices. We are talking about what a doctor might say or when someone should be allowed to apply for VAD or any of those things, but in the background, every second of every day, every moment, these people are in extreme pain and suffering.

I find it a little bit difficult to quibble about some of these things in here, because I just want to help them, to support them, to save them, and I cannot. None of us can, but we can be with them, walk with them and hopefully help them a little bit.

A lot of people are saying that this debate is really difficult, and I guess talking about death is difficult. The member for Lowan in her debate mentioned that voluntary assisted dying is different to suicide and the reason for that is people applying for voluntary assisted dying have a terminal illness, and that is true. They are in extreme pain, and that is true. But people who commit suicide – and I go back to when my brother wrote me a letter, his suicide letter. In that letter he said, ‘I don’t want to die. I just want the pain to stop,’ so there are some similarities. I know the word ‘suicide’ has been used in here, and we have talked about whether it is a great word or not, and I would like the sense of shame around suicide to disappear so that we can better help those people in our community deal with those feelings and especially with the shame. I think we would be able to save more people. In fact the definition of suicide is ‘the act or an instance of ending one’s own life voluntarily and intentionally’. I know I am being a bit cheeky, but maybe we will call suicide ‘voluntary unassisted dying’. I think that is fair enough.

What this debate is about and what this legislation is about, I just wonder – I am taking it seriously, but I just wonder if we have got it right. What it is about is life and living. I hear a lot about dying and death, but what VAD does and what this legislation does – or is meant to do, and I know we are going to have a lot of amendments, and I look forward to hearing them and debating them – is focus on giving someone with a terminal disease the best possible living experience of life right up to the moment of their last breath. It is not about them dying. I learned this when I went to a palliative care unit in Frankston a while ago. I visited there. They had done a cookbook and they were launching the cookbook, and they asked me to come and launch it. I thought this was great. I walked through the palliative care unit and it was incredibly confronting because I saw people dying and waiting to die. I mentioned this to one of the nurses and doctors there and expressed my discomfort, and they said, ‘Absolutely not, Paul. We are here to give them the best quality of life up until their last breath.’ I would really like everyone in this chamber and the other chamber to make that the focus of whatever amendments we bring into this. I would like people to make that the focus of the debate: the best quality of life for people who are suffering intolerably.

This idea of a nine-day cooling off period I find sort of absurd because it is like an added punishment. Someone is saying, ‘Hey, I’m feeling so bad I want to die,’ and we go, ‘Hey, just wait nine days and we’ll see how you’re going then’. They are terminal. That is not giving someone the best quality of life. That is not giving someone hope. You would think if you were terminal, maybe you would think there was no hope, that you would not have hope. As we all know, hope lives rent free in my heart. Hope lives rent free in everyone’s heart. Everyone deserves hope and everyone should have hope no matter what, even when we are terminal and we are looking at VAD.

One of the other things, and the reason I wanted to speak in the debate after the member for Pakenham spoke, is that we on this side always talk about lived experience. We pride ourselves on the lived experience, and it has been wonderful to hear some stories in this chamber about lived experience and dealing with and being confronted by people as they live their last few months or few moments.

We have again the member for Pakenham who is living this experience, and I thank the member for sharing that so bravely and honestly. I have only had people email my office in support of this. Well, actually, I am sorry, that is incorrect. I have had people write to my office in support of it, but the only people that have written to me that are not in support of it are from faith-based places. That is okay, we are all entitled to our own opinion and to our own choice.

I still want to go back to this fact: if we focus on what this is about, the quality of someone’s life up until their very last breath, I do not think there is any other outcome. I think we can understand what we are here to do. That is pretty much what I want to say. I just want to make sure people focus on that aspect. I will leave with just a statement. We hear about the journey of people getting VAD and getting the medicine and all of that. I was talking to someone, a doctor who had a patient, and basically they said that this person on securing their meds said, ‘Now I have my death sorted out, I can get on living my life.’ That is what this debate is about. I commend the bill to the house.

 John PESUTTO (Hawthorn) (16:51): I am pleased to rise on this bill. I would like to begin by saying that it is such a wonderful thing to be able to listen to speeches right across the chamber and that I hope that more and more Victorians can see Parliament at its best. I have to confess to being overwhelmed by a sense of great empathy for those opposite when I am listening, something that we are not always used to in the hustle and bustle of the debates we have. It is a very human experience to be able to hear the very personalised stories of all members of this chamber. It is a wonderful thing, and it is reminiscent of the debate back in 2017, with a similar kind of exchange of viewpoints and many diverse ones on the same sides of the house, to be quite honest. But it is something that I hope all Victorians can look at with great pride to see the Parliament operating in this fashion.

In 2017 I did vote against the bill that became the law at that time, and I explained my reasons at the time. I approach this debate on the basis that it is now law. It is part of the established law and, I would argue, the customs of this state. So I look at the bill in terms of what changes are proposed to make the system work more smoothly for those who want to use it. I guess this would be a similar experience for a lot of us in the house. A lot has happened in the last eight years, and the reflections that I would offer – and I only have a few to make – are that terminal illnesses are really cruel, they are random and they give no quarter. I approach the debate on the basis that we all have experiences, in my case in my own family, where we have seen the ravages of those long-term illnesses. Anything that we can do to support people going through those ordeals with the capacity to maintain their humanity, their dignity and their agency is something that I am prepared to support now.

It does not mean that there should be an unfettered licence to do whatever we would like to do under the scenarios we are discussing here. I do think it is important that there are safeguards that remain in place and that we do not, in the process of watering them down for good reasons, wash them away and extinguish the benefits that come from an appropriate level of scrutiny. I will come to some of those comments in a short moment.

There are some of the amendments, and I only want to speak about a few. I think the change that is proposed to allow registered medical practitioners to raise those issues is something that I am prepared to support. I think in a system where voluntary assisted dying is legal that we should not be requiring that registered medical practitioners actually desist from what may well be, and often is, a very obvious extension to a conversation; they should be allowed to initiate those discussions, and I am prepared to trust in our medical profession that they will apply that in a very professional and humane way.

I think those who are consulting their clinicians in those circumstances in any way will have an increased level of awareness about the options generally that are available – perhaps not everybody. But I do think it is a sensible change to approach the exercise in a very candid way, not to pretend that this is not part of a discussion that should take place when somebody has an obviously diagnosed terminal condition. I think that obviously follows in those circumstances.

I come to the conscientious objection. I just want to make a couple of comments about that. I do think that if as a matter of legislative policy we want to respect the ability of registered medical practitioners not to have to in any way participate in something they deeply disavow and resist, we should maintain a system that respects that – otherwise get rid of it. To require people in the profession to take a step that for them triggers the resistance that they have to a particular issue is something that we can balance better than this bill does. I do think there is an opportunity to require registered medical practitioners to at least refer patients to the navigator service, and I am comfortable with that. I am a little resistant to the idea that the secretary shall determine what information will be prescribed, because that leaves it totally open-ended, and I do not think that is an appropriate policy outcome that I am prepared to support. I do have a partiality to the amendments which have been raised which would limit that capacity of the secretary to do that. I think something that is fairly non-contentious that does require registered medical practitioners at least to refer patients in those circumstances to a general information service on the one hand respects the need to provide some level of guidance to those who are seeking advice but also does respect what I said before was the inherent right, which we continue to respect – even in this bill – of registered medical practitioners to maintain their conscientious objections.

To adopt a very humane and realistic approach to the bill, amendments that reduce the timeframe from nine to five days and also extend the prognosis period in the circumstances of someone who is facing a certain death in a certain period of time are in my mind a very humane approach. Again, I say that as somebody who is working on the premise that we have a system that is in place now – it is operating. Let us do what we reasonably can to tend to the challenges that terminally ill patients and their families and friendship groups are experiencing at that time and do whatever we can do to address that.

I am prepared to support the changes in relation to people in regional areas and translation services, but I do call on the government to invest in the resources that will make sure that as far as possible those services will be available in regional areas. I will leave my comments there, having indicated that there are some amendments that I will support. But for the sake of the people of my electorate, I would like to conclude by saying that I do thank everybody who has contacted me as the member for Hawthorn to raise their issues. I know they feel very strongly about these matters, and there are different views that have been brought to my attention. I respect those views and thank them for reaching out.

 Alison MARCHANT (Bellarine) (16:59): I rise to speak on the Voluntary Assisted Dying Amendment Bill 2025. In 2017 Victoria became the first jurisdiction in Australia to pass voluntary assisted dying legislation – a historic, courageous step that placed compassion, dignity and choice at the heart of end-of-life care. It was the result of many years of consultation, evidence and deep personal stories – stories of pain, courage and love. Members of this house debated with sincerity and conviction and, in doing so, set a standard of what it meant to legislate with humanity. That legislation has given Victorians with a terminal illness the ability to make an informed, voluntary and compassionate choice about the end of their own lives.

It was built upon the principle that while death is fated, suffering should never be.

Speaking and voting today, though, is slightly different to other legislation that I have dealt with in here in that we have a conscience vote. I come to this place every time always representing the best interests of the Bellarine community, and today I do the same. These are moments that not only test our judgement but also our compassion. Conscience votes are rare and difficult and can be deeply personal, but I believe the Bellarine community would expect me to approach this with humility, care and courage.

The question before us, the accessibility for terminally ill Victorians to have a choice about how they face death, represents one of those moments, and it is not an abstract issue. It has been lived and felt in homes and hospitals across Victoria. Over the recent months I have spoken to constituents who have shared their personal stories of illness, care and loss. I have listened to doctors and palliative care experts who bring professionalism and compassion to some of life’s hardest moments, and I have corresponded with advocates and families and people who hold deep values and heartfelt convictions, often coming from very different perspectives. And like many members in this place, I have deliberated carefully on this bill.

Five years on, we have now reviewed how this law is working in Victoria. The findings are clear and reassuring: that Victoria’s voluntary assisted dying scheme is operating safely, ethically and as intended. The independent five-year review found no evidence of misuse or coercion. It found that safeguards are robust and that the scheme provides comfort and autonomy to those facing the most difficult circumstances. Since 2019 that scheme has provided hundreds of Victorians and their families with peace of mind, knowing that they have choice. Even for those who do not ultimately access voluntary assisted dying, the knowledge that it exists does bring profound comfort. But the review also identified areas for improvement, areas where the law can better reflect the realities of a terminal illness and the experience of those navigating the process. We have listened to patients, families and practitioners, and we have heard that while the law is strong, the process can be complex, the timelines can feel unforgiving and access, particularly in regional Victoria, can be difficult.

I would like to take a moment to thank the constituents that I have met regarding VAD for opening their hearts and sharing their deeply personal experiences with me. I would just like to share a couple of those examples. Despite living and working in Australia for over 55 years, voting in our elections, paying taxes and participating fully in our community, a Bellarine family has been grappling not only with a terminal diagnosis but with the realisation that they were not eligible for VAD because they were not deemed Australian citizens. Currently, limiting access to only citizens and permanent residents has unintended consequences and has excluded a significant amount of long-term residents who have lived in Australia for decades and who consider Australia home. This group includes people who are not required to hold permanent residency, a visa or citizenship to remain in the country – for example, people who came from New Zealand or British citizens who made Australia their home before current visa requirements. For this Bellarine family, our current laws denied a choice that they had earned after a lifetime of contribution. Their son also shared recently with me and begged for Parliament to urgently simplify VAD laws, to help other families with this commonsense and humane legislative change.

I also spoke with a Bellarine gentleman whose wife passed away suddenly after an unexpected cancer diagnosis. He told me that they had so little time and no real opportunity to consider voluntary assisted dying. Under the current laws, the timeframes and application process meant that by the time they understood what was happening, the chance for that conversation had already passed. He carries with him a profound grief, not only for the loss of his wife but for the way she died. It was a distressing death and one that left him wishing she had more control, more peace and more dignity in her final days. Today he speaks out around courage and for change. He believes that voluntary assisted dying should give those with only a short amount of time left – and their families – the right to make a choice, to receive comfort, control and compassion when suffering cannot otherwise be eased. I will never forget those conversations, and I will always be grateful for the trust that he placed in me in sharing his deeply personal story. I trust that after today’s debate – and I am sure he is listening – hopefully these reforms if passed will give him some peace.

We have a few amendments to the Voluntary Assisted Dying Act 2017. This is not about reopening the old fears or revisiting the debate from six years ago, where we had careful evidence which was already settled, but rather it is about drawing on the review’s evidence to make thoughtful, modest reforms, practical improvements that are already working well in other states, without altering the core principles or social contract that underpins Victoria’s original and world-leading legislation. I will not go into all the amendments. I have them listed here, but I will not go into all the amendments today because of time. I support the amendments that have been put in this bill. Those amendments will honour the original intent of the law: giving Victorians the right to choose the manner and timing of their death within a framework of compassion, integrity and care.

Before I conclude, I would also like to acknowledge the member for Pakenham. Thank you for sharing your voice in this debate. You share your lived experience with grace, with courage, and you give so much of yourself at what must be a very difficult time to bring awareness to MND and to VAD. Thank you for your courage.

This debate is not theoretical, it is personal. Each of us have known or will know someone who has faced the end of life with pain that medicine cannot relieve, someone who has faced the question of choice, control and dignity. This bill is for them – for the families who have sat beside loved ones through suffering that no-one should endure, for the clinicians that have walked beside them with care and compassion and for the individuals who, faced with the end, have asked for the simple right to choose peace. Victoria was the first state in Australia to legislate VAD, and today we take another careful, considered and compassionate step forward, ensuring that we respect the choice, that compassion remains central and that a person who is terminally ill can choose dignity at the end of their life. I commend the bill to the house.

 Danny O’BRIEN (Gippsland South) (17:07): I will not say I am pleased to rise. This is always a difficult topic for everyone in this chamber to deal with. For some it is not, for some it is straightforward and easy, but it is certainly an issue that has caused me a lot of thought. I would say, to be frank, I was blessed or privileged to have been here in 2017 and to have gone through the debate over whether we should in fact have voluntary assisted dying in Victoria. I remind those who were not here at the time that I opposed the introduction of voluntary assisted dying at the time. But in considering my position today, and for all of us, I must acknowledge that this legislation today is not a debate about whether or not we have voluntary assisted dying. It is about changes. What we are debating today will not change whether voluntary assisted dying is available in Victoria or not. We are considering whether there are worthwhile changes to be made to it.

In saying that, I do need to go back briefly to the 2017 debate and point out – and I did this to the Minister for Health, and I thank the Minister for Health for the opportunity she gave to brief me on this bill a couple of weeks ago – the slippery slope argument. Many of us argued at the time that whilst the government was planning a number of safeguards – I think 68 safeguards was what the Premier and the minister at the time talked about – many of these are now being removed. It is a point of argument, not necessarily a point of policy, but it is relevant nonetheless that many of us said that that would be the start and those so-called safeguards would be removed over time. And to be frank, that is what some of today’s legislation is doing. I think the Premier talked about the bill in 2017 having strong safeguards, and now they are seen as barriers. That is the point I wish to make.

Having said that, as I indicated, we are faced with the fact that we have voluntary assisted dying. It is not up for debate today. Even if it were, I strongly suspect that the vote would remain in the majority in terms of the people in this place.

I know many of my colleagues have already indicated that they have probably changed their position somewhat since 2017, and I would probably also be one of them. I am not sure, if we were debating it today, what my position would be, but I certainly have grappled with it over the years. There have been a number of individuals who came to me at the time with concerns. Acknowledging the member for Pakenham, one of those individuals spoke about having motor neurone disease in her family and simply wanting the option. I have thought about that person a lot ever since, even though I voted against it. It highlights that this is a tricky decision. I think it is not easy to decide on voluntary assisted dying in principle. It is even harder when it comes to the practice of a certain individual, and previous members have spoken of their experience with individuals.

On that score, I would like to reference a person from my electorate, Amanda Mundy, who has spoken on behalf of Dying with Dignity Victoria about her experience with her father Don Wright, who I knew. I played footy with Amanda’s brother Danny and her other brother Matthew. Amanda gave a very eloquent explanation of the experiences of her father, particularly the experience of him being a regional Victorian and some of the challenges that that caused. Her position was very moving. Again, I am influenced to some degree by that specific experience.

In saying all of that, I raised at the time concerns particularly about coercion and about the prospect of that occurring. I must say, eight years down the track I have seen no evidence nor heard stories of the things that I was concerned about then actually occurring with voluntary assisted dying. I emphasise that is not to say that they have not. It is very unlikely that anyone would be able to ever prove that a person was coerced or pushed into voluntary assisted dying.

It is on that issue that I still am somewhat conflicted on two of the amendments in this legislation. One is with respect to clause 7, which allows health practitioners to initiate discussions about VAD. The mere fact of a health professional giving the option to someone could be interpreted by them as something that it is being suggested that they should do. The second matter is the issue of interpreters. Again, there is a risk – I think a very small one but a risk nonetheless – that an unaccredited interpreter, perhaps a family member, could make statements that would make it difficult for someone facing a decision on this. They are two issues that I grapple with as well. I will be interested to listen to further debate on this.

As I said, I remain conflicted on parts of the bill. There are some, though, that I am happy to support. Clause 8, about Australian citizenship requirements, and clause 9, about Victorian residency requirements, I have no issue with. Clause 10, about medical practitioner eligibility, and clause 15, removing the requirement for third prognosis assessments for people with neurodegenerative conditions, I do not have any issue with. Shortening the time period from nine to five days between the first and second request – I understand the concerns about that, I genuinely do, but I think when it comes to someone who is genuinely at the end of their life this becomes an issue. Simplifying the permits, removing the forms from the act and requiring the additional review of the act every five years I certainly support. Even though there are parts of the bill that I am uncomfortable with or that I am grappling with, I would certainly support clause 11, the prohibition on practitioners from being a beneficiary or a family member.

As I said, I think in respect of allowing health practitioners to initiate discussions on VAD, so removing the so-called doctor gag, there is a risk that people are not informed. As MPs we deal with certain things day after day and we know what is available, and there is no doubt that there are people, particularly someone going through a very stressful time, who will not be aware of these issues. I think it is a tricky one, and I am conflicted on this because there is the risk that doctors simply raising it, as I said, does potentially send a signal to someone that they should take up the option of VAD, but I will consider discussion on that further.

The conscientious objection is the other one. I am concerned that anyone should be forced to do anything against their will or their conscience, but I am pleased that the proposal here is not that a health practitioner must refer to another health practitioner, as is the case with abortion, but that they must simply provide further information. I will consider some of the amendments that have already been flagged and proposed to tighten that a bit to ensure that it is simply not the secretary’s information. I am not sure that it is too much to ask that if you are an objector to this you at least provide information if someone is raising the concern.

I will carefully consider the debate as it goes. I will listen to arguments about amendments. I think we all want to see people have a good life and a good death. Since 2017, sadly, I have lost my mum to a kidney issue that was effectively a terminal illness. She had a good death. That was a great thing. It was very peaceful and calm and largely without pain. I guess we would all like to see that. I, again, remain conflicted on aspects of this bill. I look forward to the ongoing debate.

 John LISTER (Werribee) (17:17): I just want to rise to briefly provide my wholehearted support for the amendments to the Voluntary Assisted Dying Act 2017 in the form proposed by the Minister for Health, mostly because this does bring us in line with other jurisdictions. But I think, like all social issues, we should never see these sorts of things as set and forget, and it is important to continue to review them as we move along through this.

There are two main aspects I want to focus on, and as this is a conscience vote, I do approach this not just as a person, not just as who I am, but also as the member for Werribee and the representative of my particular community. Some of the amendments that are being made and how they will apply to my community in particular I think are important to highlight. It is no surprise that across a set of professionals that work so closely to life and death there will be a range of different moral positions when it comes to what that looks like to health professionals. But I would point out that just like every other profession, when you walk through that door you become that profession. It is important that while we have our personal views we also need to reflect the profession as a whole.

I would not claim to be an expert in conscientious objections and the way that process works and the ethics behind it, but I have done a little bit of reading recently into it, and particularly around the advice the AMA provides. I think it is important to respect conscientious objection and uphold that right to hold a certain belief about an issue like abortion or assisted dying. However, a health professional also has a responsibility to ensure that the human walking through their door leaves knowing the extent of medical options that are available for them in the circumstances that they are in. In the case of local abortion services, say, our Catholic health service running our public hospital does a great job in ensuring those people are referred to the appropriate service for advice. I note the previous speaker did reflect on that briefly and the differences in the level of what advice needs to be given under the voluntary assisted dying laws and under those other laws where there may arise conscientious objections to what is being required of health professionals.

[The Legislative Assembly report is being published progressively.]