Wednesday, 29 October 2025

Clause 8 further considered (18:09)

Iwan WALTERS: In regard to clause 8, which has been partially canvassed in previous amendments, particularly touching on the increase in the time horizon from six months to 12 months, and I suppose noting that this recommendation was not present in the review – and in asking this question of the minister I am mindful of her previous comments that participation in VAD is entirely a patient-driven thing, so it might be difficult to quantify these things locally – I would be interested to know: on the basis of comparison with like jurisdictions, when the time horizon moves from six months to 12 months, has the department undertaken any modelling that might point to the estimated increase in the incidence of access to VAD, and as a related point, has the department undertaken any modelling around what that might mean for funding requirements in the hospital, hospice or palliative care systems more broadly?

Mary-Anne THOMAS: With regard to jurisdictional comparisons, updating the prognosis requirement to 12 months for all VAD applicants would see Victoria align with Queensland, who have reported a positive experience of this. I do want to make the point that extending the prognosis from six months to 12 months does not mean that there are any more people eligible for voluntary assisted dying. People are eligible for voluntary assisted dying because they are living with a life-limiting illness that is causing them pain and suffering. There are a range of other eligibility criteria, and I go back to the point that you made in relation to my description of this as always being patient led. It does not follow that with the extension to 12 months there will be more people accessing voluntary assisted dying.

Will FOWLES: On clause 8, I am just interested to know whether a compassionate exemption was considered for the prognosis rule or not.

Mary-Anne THOMAS: At all times during the development of these amendments, we have looked at the experience of other states and tried to better align Victoria’s laws with those other states, but I do not apologise for maintaining 68 safeguards in the act.

Clauses 8 and 9 agreed to.

Clause 10 (18:13)

The DEPUTY SPEAKER: I call on the member for Preston to move amendment 5A in his name.

Nathan LAMBERT: I move:

5A.   Clause 10, line 21, omit “one year” and insert “3 years”.

I do not want to speak on behalf of the member for Monbulk, but she and I have discussed our respective amendments, and I suspect she will certainly be supporting the amendment I am putting forward here over the one that she had initially put forward. I will address it briefly.

As we know, this clause deals with arrangements for the coordinating medical practitioner and the consulting medical practitioner. There are two clauses, one that relates to expertise and experience in the specific condition, and I will not foreshadow. I understand the Greens may have an amendment to that. We are dealing here with the second one, the general requirement for a certain amount of years experience. There is that minor change regarding fellowship versus specialist registration, about which there is no disagreement. A number of us have spoken to about 30 or so medical professionals about this bill in general, and we did take the opportunity to ask them about this specific question where we thought they were best placed to give us a view. They are of course conscious of the workforce issues that parts of this bill are trying to address, as are we. Even conscious of those, they suggested a range of things, obviously, but broadly, two to five years.

A lot of that was informed by the fact that, as we know, within the medical profession – certainly within medical specialists – many of them are conscious of the normal time before someone can become an accredited mentor or supervisor, which depending on your college is two to five years. Having taken all of those views on board and the recommendation of the amount of experience that people might need, we have settled on putting forward three years, which if you like was their sort of aggregate position. Hence I put forward and support this amendment.

Daniela DE MARTINO: I wish to advise the house that I withdraw my amendment to clause 10, line 21, to omit ‘one year’ and insert ‘five years’ and support the member for Preston’s amendment that he has moved.

The DEPUTY SPEAKER: Member for Monbulk, just for clarification, have you withdrawn your amendment 3?

Daniela DE MARTINO: For clarification, and the other amendment which relates to that principal clause.

Kathleen MATTHEWS-WARD: As I have mentioned before, in my view discussions about VAD with somebody who is terminally ill should only be had by doctors, nurse practitioners and those with extensive experience in palliative care. I was undecided about this clause, but in speaking to the VAD practitioner that we spoke to and a very experienced oncologist at the Northern, as well as the head of palliative care there – also a very respected clinician – they were of the strong opinion that five years was the minimum due to the need for the wisdom to have those discussions and the experience. Life experience they thought was pretty important in this case as well but also fundamentally the resilience to have some of these discussions, which are really difficult.

They thought five years. I think three years is potentially a compromise. There are not enough VAD practitioners. It was interesting that the VAD clinician who said this does all of his VAD work out of hours and on top of his full-time work. He said that because he strongly believed it, even though it was not going to reduce the pressure on people like him. I listen to the experts here, and I support the amendment put forward by the member for Preston.

Iwan WALTERS: I rise in support of this amendment. I do not think the case has been made for the bill’s diminishment of this safeguard. Three years of experience is in my view preferable to one, but self-evidently it is also less than five. I will be supporting the amendment but I do not think that the case has been made either by the review or more broadly, certainly in the consultations I have had with practitioners, that this is a desirable change in the broader sense.

Will FOWLES: Can the minister share with the house what impact on practitioner availability these various tiers of experience will likely have in the field, namely, the five years that were first proposed or perhaps the three years currently proposed by the member for Preston and then what the government’s proposal will do to availability, with a particular focus on rural and regional areas, which I know are close to the minister’s heart.

Mary-Anne THOMAS: I will address the member for Ringwood’s question and then speak to the amendment more broadly. It is our expectation that in making this amendment we will see an increase in the available workforce. The amendment that is proposed will align us with WA, Queensland and the ACT.

I note the member for Preston talked about the 30 or so practitioners that he has had the opportunity to speak with, and that the member for Broadmeadows was able to reference a practitioner who she has spoken with. My department in the course of the development of this bill has had the opportunity to consult with the college of general practice, the college of anaesthetists, the AMA, as well as a range of other healthcare practitioner professional bodies. We do not support the amendment. I do not support it. I think we need to be clear about the fact that the work that is required to attain specialist accreditation is significant, and all of that work, all of that study and training, is done on the job so that a specialist with one year of experience is actually a very highly experienced medical practitioner on account of having been in the profession for, in many places, at least around 13 years. Of course many people will complete their general medical training and work within a hospital environment for some time before they seek a trainee position as a specialist.

The SPEAKER: The house is considering the member for Preston’s amendment 5A, clause 10. The question is:

That the words proposed to be omitted stand part of the clause.

All those supporting the amendment should vote no.

Assembly divided on question:

The DEPUTY SPEAKER: The members for Richmond, Melbourne and Ringwood all seek to insert words in clause 10 after line 23. The member for Richmond’s amendment seeks to amend section 10(3) of the principal act, and the members for Ringwood and Melbourne seek to repeal section 10(3) of the principal act. I will call on the member for Ringwood to move his amendment first, as if the house resolves to repeal section 10(3), then the member for Richmond’s amendment will be redundant. If the amendment by the member for Ringwood fails, I will call on the member for Richmond to move her amendment.

I will call on the member for Ringwood to move amendment 12 in his name. I advise that if his amendment is not agreed to, he cannot move his amendment 16, as it is consequential. The member for Melbourne also will not be able to move her amendments 16 and 41, as they are consequential. Therefore I advise members to address the principles of those amendments when speaking to amendment 12.

Will FOWLES: I move:

12.   Clause 10, after line 23 insert –

“(3) Section 10(3) of the Principal Act is repealed.”.

The specialist requirements generally – albeit the fact that the jurisprudence is reasonably limited on this – have tended to be read, by people outside of this chamber, particularly, pretty narrowly, and I think that is unfortunate. I think on first principles, members in this place would intuitively say that if you are an oncologist, you are a specialist. But the rule has been read quite narrowly to say you need to be an ENT oncologist if the illness the patient is suffering, their terminal illness is, say, throat cancer, in order to be able to be the coordinating practitioner. What we would say is no, if your cancer has metastasised, if you are clearly now in stage 4 and you are in the very difficult last phase of your illness, that assessment can be made by an oncologist. It does not need to be a throat specialist, for example, if your primary was throat cancer. If it has now metastasised, an oncologist generally can make that call.

Now, treatment is different. If you have got throat cancer, you probably want an ENT oncologist to prescribe your course of treatment, and that makes enormous sense. But as I say, if you are talking about stage 4, you are talking about a metastasised cancer and it is entirely reasonable for an oncologist to make that call. It is for that reason that I am seeking to remove the requirement that one of the coordinating or consulting medical practitioners must be a specialist in the person’s disease, illness or medical condition. That is because their disease, illness or medical condition tends to be read narrowly, tends to be defined not as cancer, but as throat cancer or perhaps even a sub-sub-subspeciality. When we talk about the application of the word ‘specialist’ in this context, it would almost be more helpful if we just thought about it as being a subspecialist. Really, it is whether you need a subspecialist that is a very, very narrow band of subspecialty to have that exact sign-off.

The issue, of course, is that we do not necessarily have a whole lot of specialists on tap for some of the rarer cancers. I am thinking about some of the NETs, the neuroendocrine tumours, and the like. These are highly unusual cancers, and you do not need a specialist in the treatment of that sort of cancer, in my view, to be able to sign off on whether in fact that cancer is going to take your life within a period of time or whether you will be able to access the voluntary assisted dying scheme. You might very well want a neuroendocrine tumour specialist for your course of treatment – in fact that would be my recommendation – but when it comes to making some of the general calls about access to the voluntary assisted dying scheme more broadly, I say that the need for that subspecialty, or in some cases that sub-sub-sub-sub-subspecialty, is not as important. For that reason I do commend this amendment to the house.

We know that we have an issue with access to specialists more broadly. We have heard anecdotally that, for example, neurodegenerative disease specialists outside metropolitan Melbourne number perhaps two, and there are, like, a dozen inside metropolitan Melbourne – but the ones outside Melbourne are in Geelong anyway. The access to these specialists is very, very challenging, and in the absence of casting a definition around ‘specialist’ that is much, much broader, I am suggesting that we simply do away with that requirement so that we can ensure that patients, particularly in rural and regional areas, are able to access the care they need – so that the door into the scheme is not so impossibly narrow and so impossibly far away that they are simply not able to access the care that they need.

Ellen SANDELL: I will not get a chance, I do not think, to move my amendment 16, because I think my amendment is kind of consequential to the member for Ringwood’s – but let us see how that goes; maybe the member for Ringwood’s amendment will succeed. But I just wanted to speak a little bit to my amendment 16. This is the one that I spoke about earlier in the debate around changes to minimum requirements for coordinating and consulting practitioners. The amendment removes section 10(3) of the act, which pertains to the requirement for one of the consulting or coordinating practitioners to have expertise and experience in the disease the person is dying from. I think the member for Ringwood has really well canvassed the issues around how if you have cancer and it is stage 4 and has metastasised, it is very clearly going to result in death in a short time period and there will be great suffering. You do not necessarily need somebody with expertise in that specific cancer to be a part of your VAD journey – a general oncologist is fine. We would argue also that a GP with expertise in that illness should also qualify for this.

The issue is the interpretation of this clause in Victoria. The legislation just says that the coordinating practitioner has to have expertise and experience in the disease the person is dying from. The issue in Victoria has been with the way that this has been interpreted. The interpretation of the clause in Victoria has been quite narrow, and it limits this to non-GP specialist consultants – that is, it excludes GPs, even if they have experience and expertise in the condition. GPs, as we know, are actually a specialisation within medicine. They have to go and do their specialist training to become a GP, so they are actually quite specialised, but they are excluded under the narrow definition in Victoria. That creates a significant barrier for people, especially in rural or regional Victoria.

I grew up in regional Victoria. My mum still lives in Mildura, and it is impossible to get access to specialists at all. Generally you have to travel to Melbourne to access assessments. Telehealth is illegal for VAD under federal law. This in turn creates stress and suffering and in some cases completely prevents access to VAD for some due to frailty and/or cost. It also means there is a very limited pool of practitioners willing and able to participate in VAD for some conditions, leaving many of them really at capacity. The thing is that other jurisdictions, like Tasmania, do not have this requirement at all. In South Australia they have identical legislation to Victoria, but the difference is in the way that they have interpreted it. They have interpreted it more broadly, which allows any doctor with experience in the condition – which could include a GP – to be a consulting or coordinating practitioner. I would argue that it just makes sense to bring Victoria into line with the way that the law is interpreted in places like South Australia.

Mary-Anne THOMAS: In relation to, as I understand it, the amendment moved by the member for Ringwood and the amendment that may be moved by the member for Melbourne, I can confirm that I do not support either of those on the basis that the safeguards as they exist in the act and the way in which the definition of ‘specialist’ is applied at the moment are significant safeguards that are important to the integrity of the act. But I do appreciate that the members have raised these matters in good faith with a view to expanding access and care for people, particularly those in regional Victoria.

Amendment defeated.

The DEPUTY SPEAKER: I call on the member for Richmond to move amendment 6 in her name. I advise that if her amendment is not agreed to, she cannot move her amendment 10, as it is consequential; therefore I advise her to address the principles of both amendments when speaking to amendment 6.

Gabrielle DE VIETRI: I move:

6.   Clause 10, after line 23 insert –

‘(3) In section 10(3) of the Principal Act, for “expertise and experience” substitute “expertise or experience”.’.

Amendment 6 in my name deals with the proposal to require the coordinating practitioner or the consulting practitioner to have relevant expertise or experience rather than expertise and experience. This amendment broadens the interpretation of the minimum requirements for the coordinating and consulting practitioners. In section 10(3) of the principal act, this amendment would change the wording from have ‘expertise and experience’ to ‘expertise or experience’. This allows for a broader interpretation of the wording to allow, for example, GPs with the relevant experience in the condition, illness or disease that the person is expected to die from to meet the criteria. The point of this amendment is to expand the workforce available who can provide voluntary assisted dying, which is a huge barrier to accessing voluntary assisted dying, particularly in regional and rural communities.

It also points to workforce sustainability, because at the moment there is a very small handful of medical practitioners who work tirelessly to deliver these services, and it would increase the sustainability by sharing that load among more practitioners. We do appreciate that this bill does go some way to increase that workforce availability by reducing the amount of experience a medical practitioner has to have in order to deliver these services, but this is a further removal of those barriers to allow a broader interpretation of who is eligible.

As the member for Melbourne said, Victoria is one of the only jurisdictions in Australia that has such a narrow interpretation that excludes many very competent and qualified practitioners from being able to deliver voluntary assisted dying. The interpretation of the Victorian legislation has limited those who can be one of those practitioners to specialist consultants in the particular illness or disease or condition that the person has. Tasmania does not have those kinds of restrictions. South Australia actually has the same wording as Victoria does, but the interpretation of it via the courts has been much broader. And so in order to meet the standards of the other states, this amendment clarifies that a practitioner need have either the expertise or the experience to be able to deliver voluntary assisted dying, and it brings Victoria into line with the other states.

Nathan LAMBERT: Very briefly, we have some family experience with rare genetic conditions, and as the minister knows, I have had the opportunity to speak to other families with rare genetic conditions. I am always very grateful for her and her team’s support in the important work to provide health care to those families. I do think we referred earlier to some conversations we have had with medical practitioners and the particular amendment being put forward by the member for Richmond. I did not have it in all those conversations, but it was supported amongst those where we did have it. And so on those grounds I will be supporting the amendment.

Mary-Anne THOMAS: Again, I thank the member for Richmond and the intent with which she brings the amendment; however, it is not supported. The safeguards as they exist in the bill at the moment are very important to the trust that the community has in the voluntary assisted dying regime that we have here in Victoria.

Amendment defeated.

Brad ROWSWELL: Just to put on record my opposition to clause 10 – I am not intending to cause a division on this clause, other than recording on the voices my opposition to it.

Iwan WALTERS: Similar to the member for Sandringham, as I said in my contribution on the proposed amendment to this clause, I do not believe that either in the review or more broadly a case has been made to reduce this safeguard and to reduce the amount of experience that a specialist doctor requires. I am conscious that this bill talks about a ‘health practitioner’. Similarly to the member for Sandringham, I do not propose to cause a division, but do wish my opposition to this clause to be recognised.

Clause agreed to.

Clause 11 (18:48)

Brad ROWSWELL: As I understand it, clause 11 makes amendments to clarify that the medical practitioner must hold a specialist registration or is a vocational registered general practitioner. The registered medical practitioner must refuse the person’s first request if the practitioner is a family member of the person or believes that a practitioner is or has knowledge of being a beneficiary under the person’s will, or benefits financially or in any other material way from the person’s death, other than by receiving fees from the person for the provision of services as a registered medical practitioner. I would like to indicate to the house my support for this amendment. Of the amendments, this is one I am very happy to support. I do have a couple of questions for the minister, if I may, and that is to ask the minister: on what basis has this amendment been brought forward in this bill, and could the minister confirm whether she or her department or the government has been made aware of any circumstances of a conflict of interest after the fact which was in fact the auspice for the inclusion of this amendment?

Mary-Anne THOMAS: I welcome the question. It gives me an opportunity to inform the member for Sandringham that we have brought this forward because it is in place in every other jurisdiction, but I do want to assure the member for Sandringham that it would be a breach of a person’s registration under national law to deliver care to a beneficiary or family member in this circumstance.

Brad ROWSWELL: Just to be absolutely clear, the minister is not aware of a particular issue that arose within Victoria’s existing system that brought rise to this particular amendment, and the minister’s reasons as articulated in her response are in fact the only reasons for this amendment being proposed, being consistency with other jurisdictions.

Mary-Anne THOMAS: I can confirm that it has never happened in Victoria that a person has provided VAD care to a family member.

Iwan WALTERS: Very briefly, I think the member for Malvern in his contribution yesterday articulated surprise that this had not been considered as part of the 2017 process and that a potential loophole, if you like, remained where a person with this kind of conflict of interest could – and I am conscious that the minister has just talked about the fact that it would create a conflict with other legislation and registration requirements – potentially engage in behaviour that creates a severe conflict of interest and benefits from a patient’s death. Obviously I had similar questions to the member for Sandringham in terms of whether there was any evidence of that having taken place. I presume we will not be dividing on this so I want to make sure that my support for it is noted. In doing so I recognise that even the very robust process of consultation in 2017 sort of left a loophole here, and I think that just emphasises the importance of that widespread consultation.

Clause agreed to.

Clause 12 (18:53)

Brad ROWSWELL: As I understand, clause 12 inserts new section 13A, which provides:

If the registered medical practitioner refuses the person’s first request, the practitioner must –

(a)   advise the person that another registered medical practitioner may be able to assist the person in relation to the person’s first request; and

(b)   give the person the information approved by the Secretary.

I have a couple of questions for the minister in relation to this. Why is a government minister requiring people in the caring profession to provide information to their patients about something that I think even the government would agree would not be considered health care?

I draw upon a recent example, Minister, in asking that question. My mother Josephine is now in an aged care facility, and it has been a pretty challenging last 12 months carrying the load on behalf of my family myself. I visited Mum just last week, and this beautiful, beautiful personal care assistant came up to me. Mum had clearly shared with her what her son does for a crust, and she took the opportunity to chew my ear off. She said to me, ‘What is happening and why?’ She had a crucifix around her neck. She indicated to me that she was a member of a faith community – she was a member of the Legion of Mary in fact – and they had alerted her to the government’s bill before the house today. She said, ‘So many people in aged care have raised this with me in my course of work, but I have said to them, if they are a faithful person, say your prayers and trust in the Lord.’ That was her expression, not mine.

What I am trying to indicate to the minister and to the house is that there are many caring professionals who have found a way to navigate this in a way that aligns and sits with their own conscience. This personal care assistant is just a few weeks away from receiving her nursing qualification. She is concerned that this bill will put her in a position that is uncomfortable for her and not aligned with her own personal beliefs. That is the background to why I am asking the question in relation to the government requiring people in caring professions to provide information to their patients that the government may not even consider as a healthcare option.

Mary-Anne THOMAS: If I understand the member’s question correctly, I can assure him that he can assure the patient care assistant, who is not a registered health care practitioner, that they will only be required to provide information to a patient or hand over any information in accordance with the act, which is of course the information that we require a conscientious objecting registered healthcare practitioner to relay.

Brad ROWSWELL: I acknowledge the minister’s response, but the specific circumstances of the case that I mentioned are that this personal care assistant is but a few weeks away from receiving her nursing qualification, in which case she will be within the regime as proposed in the government’s amendments before us. I also acknowledge that the minister has addressed similar matters relating to conscientious objection previously. I respectfully convey to the minister and the house that I am not convinced by some of the reasons that the minister has presented, and on that basis I indicate that although I will not be causing a division on this particular clause, I am indicating that I oppose it.

Clause agreed to; clauses 13 to 27 agreed to.

Clause 28 (18:58)

The DEPUTY SPEAKER: The member for Preston and the member for Broadmeadows have circulated amendments to clause 28. The member for Broadmeadows’ amendment will omit lines 3 to 8 and insert new words in their place. The member for Preston’s amendment will omit lines 5 to 8 and insert new words in their place.

In order to allow both members to move their amendments, I first propose to test whether the house agrees to omit lines 3 and 4 of clause 28. If the house does not omit these lines, the member for Broadmeadows’ amendment will fail. I therefore invite the member for Broadmeadows to move her amendment in amended form. She will move that ‘clause 28, lines 3 and 4, omit all words and expressions in these lines.’

Business interrupted under sessional orders.

Danny PEARSON: I move:

That the sitting be continued.

Motion agreed to.

The DEPUTY SPEAKER: If the member for Broadmeadows’ amendment is agreed to, she may move for the omission of lines 5 to 8 and the insertion of words in their place as a separate amendment. If the member for Broadmeadows’ amendment fails, I will call on the member for Preston to move his amendment. I advise the member for Broadmeadows that if her amendment is not agreed to, she cannot move her amendment 17, as it is consequential. Therefore I advise her to address the principle of all those amendments when speaking to the amendment. I ask the member for Broadmeadows to move her amendment.

Kathleen MATTHEWS-WARD: I seek leave to withdraw this amendment.

Leave granted and amendment withdrawn.

The DEPUTY SPEAKER: I invite the member for Preston to move amendment 7 in his name.

Nathan LAMBERT: I move:

7.   Clause 28, lines 5 to 8, omit “at least 5 days after the day on which the person made the first request, beginning on and including the day on which the first request was made” and insert “at least 96 hours after the person made the first request”.

This amendment relates to the timing between the first request and the final request. I think it is important for all of us to note that there is a second clause there that does allow medical practitioners to shorten this time period if they do feel that there is a risk that the person will pass away in that period. They do not need to get authorisation for that; they can just make that decision. This particular clause deals with the circumstances in which the person is not likely to pass away, but as I think all of us understand, there are sometimes circumstances in which the patient has an abrupt increase in their suffering and there are circumstances where these clauses become very important.

The second-reading speech says that:

… the Bill shortens the minimum time between the first and final request to access VAD from 9 days to 5.

The bill does not actually do that. All of us who have read the bill will notice that it has some very convoluted language in it, but in certain circumstances the language in the bill could mean the gap between the first request and the final request could just be three days. In certain circumstances it could be four days; on some interpretations it could be five days. I put it through you, Deputy Speaker, that having an ambiguous clause about something as important as this is not good health care and not good patient care, particularly in the circumstances we are considering. If it were my family and a family member were asked to wait for five days and then I realised it could have been 3½ – I think families would be understandably upset. Hence I put forward this amendment that simply clarifies it to 96 hours, rather than the very convoluted language that is in there at the moment. That would I think on average provide a shorter waiting period, but much more importantly, it would provide a clear and consistent period. If you had an appointment at 11 am on the Monday, you would know that 11 am on the Friday, 96 hours later, was when you could make your final request. As I said, given the circumstances that people are in when they are considering making a very quick turnaround between their first and final request, I think giving them that clarity of how long that they will need to wait in a precise and unambiguous way is important. I will finish by saying that I have borrowed this from the Tasmanian model, so as members will be aware, it is already in effect. I commend this amendment to the house.

The DEPUTY SPEAKER: Minister, do you wish to respond?

Mary-Anne THOMAS: I have only heard about the amendment in the house, and I am confident with the legislation as it stands.

Ellen SANDELL: We have in the Greens some sympathy for the argument that if we can shorten the time – and if by counting it in hours rather than days it shortens it – that would be a good thing and would increase access. But we do need to probably just do a little bit more research, given the short timeline, into whether that would actually be the effect of the amendment. So we will not support it right now, but we will take a look at it and potentially something like this could be supportable when we get to the upper house.

Will FOWLES: Just to clarify – perhaps the minister can assist. As I understand it, the five-day rule as drafted would mean that if a request was made at 11:59 pm on a Monday, it could have hit the fifth day at 12:01 am on the Friday, but under the member for Preston’s amendment, if it was 11:59 pm on the Monday, it would not conclude until 11:59 pm on the Friday, the difference between those two numbers being 23 hours and 58 minutes. Is that understanding of both the bill and the amendment correct?

Nathan LAMBERT: I appreciate that the member for Ringwood suggested that it was for the minister, but I am happy to jump in to help the minister out. That is exactly the correct interpretation and the precise point that I am making. The current arrangement could be between three days and five days. I am proposing something that is very clearly just four.

Brad ROWSWELL: On the amendment raised by the member to clause 28, line 5 to 8 omit et cetera, the established timeframe is nine days. The bill proposes five days. The member proposes 96 hours. As this is a reduction in the existing safeguard, I again indicate that I will be opposing this clause, although I do not propose to cause a division on the question.

Mary-Anne THOMAS: I appreciate the comments and the questions from members in the house. It is worth reminding people that the median time between first and final requests is currently 14 days, and I remain satisfied with the amendment as it is expressed in the government bill.

Will FOWLES: What is the reason for using the median time as opposed to the mean time, and how different are those two numbers?

Mary-Anne THOMAS: The information I have relates to the median time.

Chris CREWTHER: I just want to put on the record quickly my opposition to clause 28 as it stands and my support with respect to the amendments.

Brad ROWSWELL: I failed to mention in my previous contribution – and thank goodness standing orders allow us to have two – that I understand that this is Mr Lambert’s final amendment to clauses. I indicate my thanks to Mr Lambert, for my own part, for his thoughtful contribution to this debate – more so than a lot of members, frankly. Although I indicate my opposition to this particular clause that Mr Lambert has raised, I have been supportive of the others that he has raised, and I think that is worth recording.

The DEPUTY SPEAKER: I understand the congeniality of the member for Sandringham, but I will remind members titles are preferred, please, within standing orders.

Iwan WALTERS: I have listened to a lot of the second-reading debates which have touched upon this clause and the variance in days. While I have misgivings about the reduction, I do understand that there are compelling reasons in many instances. I might reserve some of that for when we get to the clause itself. But just in the context of the amendment, I think there is some merit in additional clarification about exactly how long that span is, and I recognise the ambiguity that the member for Preston has pointed to. But on the assumption this does not get to a division, I would also indicate my opposition to it on the basis that it would curtail that length of time.

Amendment defeated.

Iwan WALTERS: I assume there will not be a division on this clause. One of the rationales for the reduction that has been canvassed in some of the supporting literature is, so it appears on my reading, that it is partly in order to provide patients in regional areas access to VAD faster, and that there may be blockages in that regard. In reading the recent annual reports of the board and the other review materials, I note that the level of access to VAD in regional areas appears higher than the population in those areas, which leads me to query whether the access to alternative options like palliative care is part of that imbalance. I am not necessarily speaking against the change in time but just wish to ask the minister if any analysis into that variance between population and incidence has been undertaken and if any consideration has been given to whether that is related to palliative care provision.

Mary-Anne THOMAS: I had the detail yesterday, but what I can assure him is that the proportion of patients receiving palliative care who access VAD is actually higher in regional Victoria than it is in metropolitan Melbourne. With regard to the question about the proportion of regional Victorians accessing VAD, I am advised that part of this reason is that the proportion of older people is higher in regional Victoria than it is in metropolitan Melbourne.

Clause agreed to; clauses 29 to 31 agreed to.

Clause 32 (19:13)

Brad ROWSWELL: I indicate to the house my opposition to clause 32. I know there was some discussion within the chamber earlier about definitions and their appropriateness or otherwise, but my concern with this clause specifically, in my view, is that it expands the scope of the existing arrangements from assisticide to enable euthanasia. I suspect that the government and the minister may have a concern with my interpretation of that. I invite them to address it if they so wish. But on that basis, although I indicate that I will not be causing a division on this clause, I indicate my opposition to it.

Iwan WALTERS: Similarly on clause 32, again listening to the debate both in consideration in detail and particularly in the second reading I was conscious of some of the bureaucratic impediments that members talked about in relation to specific cases where a patient may have had a permit for a particular course of action and then circumstances changed because of deterioration in their condition and that rendered that permit problematic.

So I am conscious that this measure, this clause, is designed to alleviate that tension in terms of the method of delivery of the substance. But I am, I suppose, concerned that some of the potential conflicts for health practitioners have not been fully addressed in that a practitioner may choose to be involved in an assessment and may be comfortable being involved in a patient-administered scenario but may not wish to administer a lethal substance to their patient. I am not sure the tension that may arise in that context has been adequately ventilated or considered. I do not really have a question here, but the minister may wish to comment upon that. But I just wish to put on record that in the event there is not a division I am not supportive of this change on that basis.

Chris CREWTHER: I just want to quickly put on the record my opposition to clause 32 as it stands as well, and I concur with the member for Sandringham with respect to expanding the scope from assisted suicide to euthanasia. This is one of the most far-reaching changes in the bill, so I am very concerned as to this clause as it stands. But I do not want to take any more time given the time of day.

Clause agreed to; clauses 33 to 41 agreed to.

Clause 42 (19:17)

Brad ROWSWELL: In relation to clause 42, I understand that each administering practitioner must be a registered medical practitioner who holds specialist registration or is a vocationally registered general practitioner or a nurse practitioner or a registered nurse who has held registration as a registered nurse for at least five years. My concern with this particular clause is that there is a series of definitions from coordinating medical practitioner, who is then able to transfer the authority to another administering practitioner, and in turn that administering practitioner can again convey their authority. My concern here is, if we are considering holistic care of a person and if we are considering something as significant as end-of-life care and assisted dying, I think it is in the best interests of the patient to have a medical professional who knows the person, understands the person, knows the complexities of their case, knows the nuances and understands them instead of that being effectively passed down the chain of medical professionals who may not have ever met the person before. I do not seek to continue in any other discussion other than on that basis to indicate my opposition to this clause and to indicate that I will not be causing a division but I will oppose it on the voices.

Chris CREWTHER: Again I concur with the member for Sandringham in that I will not be causing a division but I do oppose clause 42 with respect to the minimum requirement for administering practitioners, noting that the coordinating medical practitioner is able to transfer their authority to another administrative practitioner and that other practitioner can in turn transfer the authority to a further administering practitioner. There are a number of issues with respect to that, but as mentioned, I will not go on further.

Clause agreed to; clauses 43 to 48 agreed to.

Clause 49 (19:20)

Brad ROWSWELL: In relation to clause 49, inserting new division 1A, similar to the previous amendment considered, being clause 42, I indicate a similar position for similar reasons. Again, I do not intend to cause a division on this particular clause but indicate my opposition to it and indicate that I will be voting no on the voices.

Chris CREWTHER: I will give the shortest contribution ever. I concur with my learned colleague the member for Sandringham.

Clause agreed to; clauses 50 to 54 agreed to.

Clause 55 (19:21)

The DEPUTY SPEAKER: Clause 55: as the member for Ringwood’s amendment 8 had failed, the member will have to move his amendment 67 in amended form. The member should move amendment 67 without the insertion of words and expressions including and following ‘(1AAC)’. Before calling the member for Ringwood I advise that if his amendment is not agreed to he cannot move his amendments 69 to 71, 74 to 75, 84, 86 to 87 and 124 to 125 as they are consequential.

Will FOWLES: I move amendment 67 in amended form:

67.   Clause 55, after line 20 insert –

‘(1AA) In the heading to section 68 of the Principal Act, for “VCAT” substitute “Secretary”.

(1AAB) In section 68(1) of the Principal Act, for “VCAT” substitute “the Secretary”.’.

This is about efficiency. Again, VCAT remains the review power in relation to a whole bunch of these matters. Notwithstanding the previous reservations I have raised about the efficiency, efficacy and fairness of the department and agencies in administrating aspects of the principal act, I think it is nonetheless important to confer the review power on the secretary rather than on VCAT so that there is a mechanism by which a speedier outcome can be resolved in relation to access to the voluntary assisted dying scheme. In all of our thinking as legislators I think we should of course have appropriate safeguards but also give due regard to the stresses on families as they contemplate end-of-life decisions and, to the best extent we can, keep them away from courts and tribunals and keep them away from arbitrary bureaucratic processes. In this circumstance it is the lesser of two evils. It is still a bureaucratic process, but I would say that that is better than having a tribunal process.

Mary-Anne THOMAS: I indicate that I do not support the amendment.

Amendment defeated; clause agreed to; clauses 56 to 73 agreed to.

Clause 74 (19:24)

The DEPUTY SPEAKER: Before calling the member for Ringwood, I advise that if his amendment is not agreed to, he cannot move amendments 105, 106 and 126, as they are consequential.

Will FOWLES: I move:

104.   Clause 74, lines 2 to 9, omit all words and expressions on these lines and insert –

‘For section 115(a) of the Principal Act substitute –

“(a) must –

(i)   be accredited by a prescribed body; or

(ii)   hold a tertiary qualification in interpreting; and

Note

A person who requires the assistance of an interpreter in relation to requesting access to or accessing voluntary assisted dying may apply for an exemption from compliance with this paragraph in relation to that interpreter – see section 115A.”.’.

This amendment relates to the interpreters rule. Members of the chamber may or may not be aware – there has been a bit of a journey of learning for me too – of the way in which National Accreditation Authority for Translators and Interpreters operates and how there has been, in effect, some derogation of sovereignty, I will say, in relation to these rules. NAATI is, I think, by law a company limited by guarantee that is owned by all of the states and territories, and that puts it of course beyond the direct remit of the Victorian government. It actually puts it beyond the direct remit, I suspect, or the unilateral action of the Commonwealth government too. That makes it institutionally inert, and for that reason it is not likely to pick up on the rapidly changing face of Australian demographics. I think it is good that the government is proposing to have the ability to get an exemption from the requirement that a translator be NAATI certified. That is good, but it is also unnecessary, in my view. I think it would be far, far better to simply have laid out in statute the very rules that the secretary, in considering an application for an exemption, would likely apply. In my amendment I say that a tertiary-educated translator can be an appropriate person.

In my community of Ringwood we have very large numbers of immigrants from Myanmar, particularly from Kayin state and Chin state. The languages that both of those groups speak are not NAATI accredited languages. I will gladly be corrected on this, but I think there are 70-odd languages in NAATI land and there are something like 200 languages spoken in Australia. So the exclusion, the slimming down of the availability, is significant, and for that reason I expect that the exemption ability will be well utilised. Whilst I support the ability to have the exemption, why not simply lay out in the act itself, rather than in the secretary’s kind of how-to guide sitting in the desk, exactly the sorts of things that will be taken into consideration when allowing non-NAATI-accredited interpreters to provide interpretation services in relation to voluntary assisted dying?

There will be many, many circumstances for very large numbers of Victorians where there is not going to be a NAATI-certified interpreter available. In fact in our discussions with NAATI they were very keen for the pool to be broadened. NAATI have told us that when a patient rings and says, ‘This is a VAD matter,’ if the language is not on their list, bang, that is it, end of conversation. ‘Sorry, can’t help you.’ Bang, move on. There is literally no ability for NAATI to assist in any way in gaining the interpretation services that that person or that family needs. That, frankly, is institutional racism. It is locking people out of a government service based on the language they speak. That is an appalling public policy outcome. I am very pleased that there is a workaround for that appalling public policy outcome, but what I would very much like to see is, rather than having the secretary having to administer, yet again, a whole nother raft of exemption rules and processes that are only going to hold people up – and frankly, we have to remember that for this cohort, all of the speakers of the non-NAATI languages, navigating that process is going to be pretty challenging. But for that cohort I would say that it would be far better to have the rules laid out in the statute so that any tertiary-accredited interpreter who is not a family member, who is not involved in the care of the patient, can provide those services. That is a perfectly reasonable way of expanding the franchise of interpretation services and making sure that a very, very large cohort of Victorians, particularly vulnerable Victorians, particularly non-English-speaking Victorians and those often from refugee communities, are not by deed of this rule locked out of the scheme. That would be my strong preference, and for that reason I commend my amendment to the house.

Ellen SANDELL: The Greens MPs will be supporting this amendment on the grounds that it makes the scheme more accessible to multicultural communities.

Mary-Anne THOMAS: I do not support the amendment. The bill that is before the house is based on models that work in Queensland, ACT and Tasmania, and I think we have struck the right balance in order to meet the needs of people speaking community languages where NAATI-accredited translators are not available.

Cindy McLEISH: I support the amendment being put forward by the member for Ringwood, and I think it makes a lot of sense, because there are a lot of multicultural communities that could miss out here. So I have a question for the minister: in the event that a patient speaks a language without NAATI accreditation, what process applies to secure an interpreter under this bill?

Mary-Anne THOMAS: The process is set out whereby an exemption can be sought for a person who speaks that language to be an interpreter provided that person is not a family member.

Cindy McLEISH: Has the government assessed how many community languages in Victoria lack NAATI accreditation?

Mary-Anne THOMAS: As a proudly multicultural state, we are well aware that we have many, many people speaking many different languages. The intent of the amendment that the government has brought to the house is to expand access to voluntary assisted dying for patients wishing to access it from a multitude of language backgrounds.

Brad ROWSWELL: Just in relation to clause 74, I indicate my opposition to this clause. I do not intend to cause a division on the clause, but I indicate that I will be voting no on the voices. However, Minister, I do have a question for you in relation to this clause: what safeguards does the government have in place or intend to put in place? Given that the government is moving from using accredited interpreters to perhaps people who do not have that level of accreditation, what safeguards are you putting in place to protect against things like conflicts of interest?

Mary-Anne THOMAS: Allowing the Secretary of the Department of Health to grant an exemption in exceptional circumstances will ensure, as I have already indicated, that people who speak less common languages are not excluded from VAD. However, the act will continue to prohibit a range of people from being interpreters, including family members. This exemption will be tightly controlled and only granted when necessary, preserving the integrity of the process while ensuring inclusivity.

Iwan Walters: On a point of order, Deputy Speaker, there has been a bit of audible noise. Minister, sorry, could you repeat that part of your response to the member?

The DEPUTY SPEAKER: Order! Member for Greenvale, I will ask people – if they are going to have conversations in this informal setting, it is harder for me to hear as well. Minister, maybe you can just recap the last 20 seconds of what you were saying. I appreciate the point of order.

Mary-Anne THOMAS: I outlined that the exemption process will be tightly controlled and granted only when necessary in order to preserve the integrity of the process while ensuring inclusivity.

Iwan WALTERS: The question I had in the context of your answer, Minister, that I could not hear, was whether family members can be used as interpreters in that scenario or whether they are exempted. But perhaps I will use this as an opportunity to raise my thoughts about this clause more broadly, because I do not want to cause a division but I do represent a community that has a lot of both people who work as qualified interpreters but also people who very much rely upon them. In speaking with the interpreter dimension of that cohort and also with clinicians who very heavily rely upon NAATI-accredited interpreters, it was emphasised to me the importance of that clarity of communication and the risks that I alluded to in my second-reading contribution that unaccredited interpreters heighten the risk of messages being literally lost in translation.

I am concerned that, if there is a diminution of accreditation and independence, then it does heighten that risk of miscommunication, which obviously is incredibly pivotal in such weighty matters. The specific question I suppose I have, Minister, was just around family members.

Mary-Anne THOMAS: Family members will be prohibited from being interpreters in this instance.

Will FOWLES: I remain concerned that there is something of an abrogation of sovereignty here in that we are allowing the NAATI to control access to a Victorian statutory health scheme. NAATI, in many respects, would be in a position to not accredit an interpreter, not because of their talent or skill or expertise as an interpreter but simply because it is not a language that NAATI has on the books. This is the issue here – that you potentially have 100-odd languages that NAATI simply is not resourced for or has determined are not important enough, and for that reason it is not on the books. I fear that in this conversation we are having in the chamber there is a sense that if you are not a NAATI-accredited interpreter, you are not a real interpreter or you are not a skilled enough interpreter, and nothing could be further from the truth. It would simply be the case that your language skills are in a language that NAATI has not taken on board, and that is problematic.

The derogation of sovereignty arises because you are allowing NAATI to control access to the scheme by denying, in my community, Karen state immigrants or Chin state immigrants. These are people fleeing horrific circumstances in Myanmar, and if they happen to have the doubly appalling luck of then arriving in Australia and getting a terminal illness, they find themselves locked out of this scheme because of a body that is completely a third party to the Victorian government, being NAATI. The Victorian government has no ability to cure NAATI of the problem of not having included the Karen language and the Chin language on their list of languages. We have got no ability to actually change that outcome, so it is a derogation of sovereignty to make NAATI the great gatekeeper to the VAD scheme for members of non-English-speaking communities. I am interested if the minister can please address this, and I will take the minister to line 30 of clause 75 where it says that:

The Secretary … may exempt the applicant’s interpreter from compliance –

if they are satisfied that –

another interpreter who is accredited … is not available –

that is, a NAATI interpreter is not available –

and –

and this is the critical bit, at line 30 –

there are exceptional circumstances that warrant the exemption.

Exceptional circumstances. My plain-language reading of that is that –

The DEPUTY SPEAKER: Order! Member for Ringwood, are we moving away from the amendment now onto the clause?

Will FOWLES: Well, no, because this is this is exactly what my amendment is seeking to address.

The DEPUTY SPEAKER: Please keep it on the amendment.

Will FOWLES: On the exceptional circumstances test, on a plain reading of that, it would appear to me that the mere fact that NAATI does not have a language on the books does not feel like an exceptional circumstance – in fact NAATI has more languages off the books than it does on the books. Of the 200 languages spoken in Australia, it does about a third of them. So my question to the minister, in relation to clause 75, line 30, is: what are the exceptional circumstances that the minister anticipates would warrant the exemption?

Mary-Anne THOMAS: The circumstances will be assessed on a case-by-case basis, and I make no apologies for the safeguards that continue to be contained within the act.

Brad ROWSWELL: I have two questions to the minister. Firstly, Minister, I am keen to understand if you, your office or department engaged with multicultural health organisations or interpreter services in the drafting process of the particular clause before us.

And further, Minister, if I could just have some clarification around what you indicated earlier, around the conflict-of-interest matter which I raised in relation to saying that family members were not able to undertake this interpreter role. What are the safeguards around that, Minister? How, in this case, does the government define what a family member is?

It is direct family members? Is it a generation after that? Is it infinite? Is there a legal practice that you are relying upon in order to knock out particular groups of family members under a conflict-of-interest concern?

Mary-Anne THOMAS: With regard to the detail that the member is seeking, I am happy to take that on notice. With regard to the consultation that has occurred, we have worked to align this with other jurisdictions, which of course is a feature of the bill before this place – that we have taken good practice from around the nation to put it in place here in Victoria. I have had consultation with the Minister for Multicultural Affairs.

Chris CREWTHER: I also have some concerns with respect to this clause with respect to interpreters, particularly the risks of miscommunication.

The DEPUTY SPEAKER: On the amendment or the clause?

Chris CREWTHER: I am going to the amendment, but I have a question related to the clause as well. I do note some of the concerns raised by the member for Ringwood. My question to the minister is: how does this reduction in protections for people who require translation services align with the recommendation of the government’s own recent Victorian multicultural review, which says:

… the government should only engage NAATI credentialed interpreters and translators …

Mary-Anne THOMAS: While I am on my feet, can I just indicate I may have misspoken earlier. I just want to clarify that in terms of this amendment, it is based on legislation in Queensland, ACT and Tasmania. I might have said all jurisdictions before. I just need to clarify that it is only Queensland, ACT and Tasmania. I take note of the member for Mornington’s question. It certainly has been a consideration, and that is why I have had extensive communication and consultation with the Minister for Multicultural Affairs.

Amendment defeated; clause agreed to.

Clause 75 (19:43)

Brad ROWSWELL: In relation to clause 75, similar to the reasons expressed relating to clause 74, although I do not intend to cause a division on this clause, I do have concerns with it for similar reasons as I expressed for clause 74 – specifically, the government’s proposed new section 115A:

Exemption from compliance with requirement that interpreter must be accredited by a prescribed body

I still maintain concerns in relation to this. Again, I will not be causing a division. I will be voting no on the voices.

Clause agreed to.

Clause 76 (19:45)

The DEPUTY SPEAKER: I call on the member for Melbourne to move amendment 99 in her name. I advise that if her amendment is not agreed to, she cannot move her amendment 100, as it is consequential. Therefore I advise her to address the principles of both amendments when speaking to amendment 99.

Ellen SANDELL: I move:

99.   Clause 76, line 17, after “cause a” insert “legislative”.

This is a very simple amendment. It amends the five-yearly review of the act to a three-yearly review. Given how quickly this policy area is changing, not only with further research and experience but also societal attitudes and clinical practice, as well as the long runway to actually making changes, we believe a three-yearly review would be more appropriate. I do not intend to call a division given the late hour and the fact that it is unlikely to be successful, but I want to put on the record that this is something that we would like to see succeed.

Will FOWLES: I strongly support the view of the member for Melbourne. I think the lack of legislative component to the review has been well canvassed by members on both sides of the house, and it would be appropriate to make sure that legislation is expressly considered in the next review.

Amendment defeated.

The DEPUTY SPEAKER: I call on the member for Sandringham to move amendment 1 in his name. I advise that if his amendment is not agreed to, he cannot move his amendment 2 as it is consequential. Therefore I advise him to address the principles of both amendments when speaking to amendment 1.

Brad ROWSWELL: I move:

1.   Clause 76, after line 19 insert –

“(2A) The Minister must also cause a review to be conducted at least once every year into the effects of the availability of palliative care on the operation of this Act, which must include a review of –

(a)   the level of funding for palliative care services, including whether the funding has been maintained in real terms; and

(b)   whether equitable access to palliative care services is being provided to Victorians living in regional and rural communities.”.

My amendment 1 refers to palliative care. In my view, as I have expressed in my second-reading speech, principally there are two concerns which I have raised in relation to palliative care: firstly, the access to palliative care, and secondly, the funding allocated for palliative care. In relation to access, I am concerned by the Voluntary Assisted Dying Review Board annual report, page 7, which has established 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 actually live in rural or regional areas. That is disproportionate, so that is why I am concerned specifically about accessibility to palliative care services.

Further, I am concerned about funding for palliative care services in this state. Following the 2017 threshold debate and agreement of voluntary assisted dying being established in Victoria, the government announced a package of some $9 million a year in ongoing palliative care funding, compared to the $65 million a year minimum that Palliative Care Victoria estimated was needed. I am aware that, all these years on, the circumstance has changed. I maintain it is my belief that I do not think funding for palliative care has kept pace with the need for palliative care – not just any sort of palliative care but decent, high-quality palliative care – and I again draw attention to the issue relating to accessibility of this service.

My experience of palliative care is quite simple. Palliative care is not a passive way of caring for someone; it is quite an active way for caring for someone. I believe that this should be an important and necessary part of the conversation we are having – perhaps two sides of the same coin when we discuss voluntary assisted dying. I appeal to members in this place, on all sides of the chamber, to support this amendment for the following reason. The minister has indicated previously that she has appointed a chief palliative care adviser, which I think is a step in the right direction. In that case, there should be little objection to agreeing to this amendment, which requires the minister on an annual basis, established within the existing reporting regime of this bill, to review two things: firstly, the level of funding for palliative care services, including whether the funding has been maintained in real terms, and secondly, whether equitable access to palliative care services is being provided to Victorians living in regional and rural communities.

I commend this amendment to the house and seek the support of colleagues from every colour and type to support it.

Chris CREWTHER: I just want to quickly add my support for this amendment as moved by the member for Sandringham. We need to support our palliative care services to a much greater extent. I am sure the member for Nepean here as well will agree that groups on the peninsula that are involved with palliative care do a terrific job. Peninsula Home Hospice is one of those, and I have been privileged in the past to have secured over $500,000 for that organisation. These are the sorts of investments we need. We do need a review, as mentioned, on a regular basis as to what we are doing with respect to supporting palliative care as an alternative to VAD.

Iwan WALTERS: I support the member for Sandringham’s amendment on the basis of the terms he has set out and those I have mentioned previously.

Mary-Anne THOMAS: I do not support the amendment.

Kathleen MATTHEWS-WARD: I just want to add my support to quality palliative care services, and I am looking forward to participating in the review that the minister is bringing forward soon.

Brad ROWSWELL: Just in response to those who have made contributions, I am disappointed to hear that the minister will not be supporting this clause, on the basis that she has recognised a growing need in the palliative care space, so much so that she has appointed a bureaucrat to – sorry, an expert in the field –

Mary-Anne Thomas: Thank you, an adjunct professor.

Brad ROWSWELL: An adjunct professor. Thank you, minister. I have not got the person’s name in front of me nor his title, but I understand he is a public servant, so referring to him as a bureaucrat is probably not an unfair thing. It should be quite simple for the minister to agree to this amendment. I just wanted to convey my disappointment that the minister has indicated her opposition to it.

The DEPUTY SPEAKER: The question is:

That the words proposed to be inserted be so inserted.

All those agreeing with the member for Sandringham’s amendment will vote aye, and to the contrary no.

Assembly divided on question:

The DEPUTY SPEAKER: As the house has not agreed to the amendment, the member for Sandringham will not be able to move his remaining amendment as it is consequential. I remind the house that the scope of the bill was not extended to include consideration of the member’s amendment 3, so it may not be moved.

Clause agreed to.

Clause 77 (20:06)

Brad ROWSWELL: I rise to speak briefly on clause 77. Clause 77 relates to what have historically been within the legislation the forms that are used to process and administer the voluntary assisted dying regime in this state. The amendment to clause 77 that is being proposed by the government in fact deletes these forms. I do have some concerns with that. I think that it is an essential safeguard, really, for Victorians if the nature of these forms, the data that is collected, the questions that are asked and the nature in which the questions are asked – if that is established within the legislative framework and the law of the state, as opposed to being left up to, frankly, unelected bureaucrats to determine what is best or otherwise. Again, I will oppose this clause. I will not be causing a division on the matter, but I will be voting against it on the voices.

Iwan WALTERS: I similarly oppose this clause. I will not be voting against it in a division, but I register my opposition largely on the basis of the terms I set out at clause 6 and on the basis that these forms were an important safeguard introduced as part of the 2017 process, reading back to the proceedings then, and I do not support their removal.

Kathleen MATTHEWS-WARD: I also do not support the removal of forms. I think it is a safeguard, and as you know, I support more prescriptive legislation rather than removal of that.

Chris CREWTHER: I also quickly register my concerns as to clause 77 in its current form.

Clause agreed to; clauses 78 to 85 agreed to.

New Clause (20:09)

Ellen SANDELL: I move:

103.   Insert the following New Clause to follow clause 10 –

‘10A New Division 1A of Part 3 inserted

After section 10 of the Principal Act insert –

“Division 1A – Requests to health service providers for information about or access to voluntary assisted dying

10A   Requirements for health service provider – request for information about or access to voluntary assisted dying

(1)   This section applies if a person receiving a health service at a health service facility makes a request to the health service provider who operates that facility for information about or access to voluntary assisted dying.

(2)   Within 2 days after receiving the request, the health service provider must –

(a)   record the request in the person’s medical record; and

(b)   give the person the information approved by the Secretary.

10B   Requirement for health service provider – access to practitioners etc. for purposes of voluntary assisted dying

(1)   This section applies if a person receiving a health service at a health service facility (the service user) requests to meet or have discussions with any of the following persons (a voluntary assisted dying support person) for the purposes of the service user requesting access to or accessing voluntary assisted dying –

(a)   a registered medical practitioner;

(b)   a nurse practitioner;

(c)   a pharmacist;

(d)   the service user’s contact person;

(e)   a person who is to witness the signing of a written declaration, the appointment of a contact person or the making of a practitioner administration request;

(f)   a person who the service user nominates as a voluntary assisted dying support person.

(2)   The health service provider must ensure that the voluntary assisted dying support person is given reasonable access to meet or have discussions with the service user in accordance with the service user’s request.

10C   Offence for health service provider to withdraw or refuse to provide health service

A health service provider must not withdraw a health service from a person or refuse to provide a health service to a person on the basis that –

(a)   the health service provider knows that the person has made a request referred to in section 10A(1) or 10B(1); or

(b)   the health service provider believes that the person is likely to make a request referred to in section 10A(1) or 10B(1).”.’.

I will be quick. This amendment requires healthcare services, including aged care services, to allow reasonable access to voluntary assisted dying for residents. This is already the case in many other states and territories, including South Australia, Queensland, New South Wales and the ACT. Challenges accessing VAD in residential aged care facilities, which are essentially the home of most residents, are a significant and widespread problem in Victoria. As highlighted in Go Gentle’s recent report, 90 per cent of Victorian providers either deny access to VAD in their facilities or do not provide public information about VAD access. It is a significant barrier to access.

The 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 will not be calling a division, but we will hopefully pursue this in the upper house.

Will FOWLES: I appreciate that this is now an argument for another chamber or another day or perhaps even another time, but I want to record my strong support for this amendment. We have a situation in Victoria – and it is not reflected in other jurisdictions around Australia – where people living in their own homes are denied access to a lawful medication simply because of the faith-based views of the organisation or members of the organisation that own that facility. That is an aberration at best. I think it reflects a lack of ambition that we have not taken that on as part of this bill.

I think it is a reform that will come. It is a reform that I hope will come. It is a reform that might even be countenanced in the other place. I absolutely want to record that I think it is just outrageous that there remains the ability for organisations, who are entitled to their conscientious objection, to block access to a lawful medication administered by a medical practitioner, particularly as it relates to residential aged care and people living in their own homes. I appreciate that this amendment will fail on the voices, but I think it is an important debate. I hope that we get to see that debate progress in the other place and again sometime down the line in this place as well.

Mary-Anne THOMAS: I thank the member for Melbourne for raising this issue and for proposing this clause. I will indicate that I will not be supporting it. However, as I indicated in my contributions yesterday, I am firmly of the belief that all Victorians should be able to access lawful care and end-of-life options in their homes. I believe the best way to achieve this is to ensure that we increase the knowledge and understanding of aged care providers about voluntary assisted dying as a lawful end-of-life care choice for people who are living with life-limiting illnesses. I have raised this issue already with the Minister for Ageing Ingrid Stitt in the other place. She and I agree on this, and we look forward to progressing some work to ensure that we increase that awareness and understanding amongst our aged care providers. I do want to assure the member for Melbourne that I am committed to doing further work on this.

New clause defeated.

Bill agreed to without amendment.

The SPEAKER: The question is:

That this bill be now read a third time.

Assembly divided on question:

The SPEAKER: The bill will now be sent to the Legislative Council and their agreement requested.