Friday, 14 November 2025

Clause 6 further considered (14:02)

Gaelle BROAD: Just briefly, I am very supportive of this being very specific about the information and then having it in the act so that it is under the Parliament.

David LIMBRICK: The Libertarians will also be supporting this amendment. Although I accept the intent as outlined in the explanatory memorandum by the minister that this minimum amount of information was all that was intended, I have spoken to many people who have expressed concerns about the expansion of this. I appreciate the amendment by Mr Batchelor that limits that expansion.

Amendment agreed to.

Enver ERDOGAN: I move:

1.   Clause 6, lines 15 to 33, omit all words and expressions on these lines and insert –

‘(1) For section 7(a) of the Principal Act substitute –

“(a)   to participate in any part of the provision of voluntary assisted dying, including the provision of information or referral;”.

(2) At the end of section 7 of the Principal Act insert –

“(2)   A registered health practitioner who has a conscientious objection to voluntary assisted dying must not be required by any person, body, employer or professional standard, to –

(a)   advise a person that another registered health practitioner or a health service provider may be able to assist the person in relation to information about or access to voluntary assisted dying, or any other medical or health service to which the practitioner has a conscientious objection; or

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

(3)   A registered health practitioner who has a conscientious objection to voluntary assisted dying –

(a)   does not contravene any professional duty, standard or code of conduct; or

(b)   is not subject to any civil, criminal, administrative, or disciplinary liability, or any detriment in employment or professional standing, for acting in accordance with subsection (2).

(4)   Nothing in this section prevents a registered health practitioner who does not have a conscientious objection from providing such advice or information if they so choose.

(5)   This section has effect despite anything to the contrary in any other Act or law.”.’.

This is the first one, which is I guess on the same point about conscientious objection. I will not speak at length on this because I have already spoken earlier. I do want to obviously commend the house as well, as we have made significant improvements. Many of my concerns have been alleviated, but not all of them, through the amendment which we supported, Mr Batchelor’s amendment, which we just voted on. Thank you, Mr Batchelor, for that amendment. However, I do still have some concerns about the conscientious objection and that human right being contested and removed in effect through this section of the act. In particular I know Dr Mansfield made it sound like it is just a procedural courtesy, a simple handover. As I view it, in substance, it turns the right of withdrawal into a compulsion for facilitation. That is still my fundamental concern, and it is what I heard from medical practitioners in this field, including Dr Parnis and others, that I did speak to during this debate on this issue in the lead-up to today.

I have already outlined my other concerns about how I feel like this is asking some health professionals to surrender a very important freedom of conscience in these matters, which does not sit comfortably with me. This section has been my principal concern all along with this bill, and that is why I feel like my amendment is stronger than what has already been accepted by the house, and I urge all members to support it.

David LIMBRICK: I thank Mr Erdogan for bringing forward this amendment. Although Mr Erdogan and I landed at slightly different places in our weighing up of the expansion of the rights of patients versus the limitation of the rights of doctors, I share his concern – and this is my main concern about the bill – in having this limitation of the rights of doctors and other health professionals, and therefore I strongly support this amendment.

Gaelle BROAD: I just appreciate you putting forward this amendment – through you, Deputy President – because I think it is so important that we maintain people’s freedom, and to have that specifically put into the act I think is a positive move.

Georgie CROZIER: Mr Erdogan, I appreciate that you have brought this amendment to the house. I think your concerns are very genuine, although we have not had an opportunity or you did not reach out to speak to me about your amendments, so I have not had that conversation with you. I do appreciate and understand the intent, but I will not be supporting your amendments.

Ann-Marie HERMANS: Mr Erdogan, I appreciate, value and respect your fight for doctors and for the need for people to have their conscientious objection. We did have an opportunity to have a short chat in this chamber, and I am very happy to support your amendment.

Ingrid STITT: I do not support this amendment to remove the requirement for health practitioners with conscientious objection to VAD to provide minimum information. The AMA position on conscientious objection states that medical practitioners:

… have an ethical obligation to minimise disruption to patient care and must never use a conscientious objection to intentionally impede patients’ access to care.

I note that we have talked at some length today in committee about the minimal nature of the information.

Evan MULHOLLAND: I will be supporting this amendment for the reasons that I explained before. I see this as an improvement to the bill. I hear the arguments about the need to have a sensible balance between the rights of the patient and the rights of the medical professional. We should actually view laws in this place that we make as a shield, not a sword. What I see this amendment doing is creating that shield for conscientious objectors. In the electorate that Mr Erdogan and I represent there are very deep concerns about impinging on very, very deeply held beliefs and viewpoints. This is certainly an amendment that comes from a good place and comes from a huge amount of correspondence, as I am sure Mr Erdogan is getting as well, and feedback from medical professionals in our community who are very concerned about their rights, about protecting their conscience and about the need for them to be protected, so I will be supporting this amendment.

Sarah MANSFIELD: As I have indicated previously, we think clause 6 of the bill is really important and will be supportive of it. While I appreciate where Mr Erdogan is coming from with this – and other members of the chamber – as I have said before, I think patients also have a right of access to information and to health care. I think just to touch on some comments that were made earlier about things like the Hippocratic oath, we do not typically use the Hippocratic oath anymore; it is the World Medical Association Declaration of Geneva. There are some really important principles in that for medical practitioners, which are that you solemnly pledge to dedicate your life to the service of humanity:

THE HEALTH AND WELL-BEING OF MY PATIENT will be my first consideration …

is something in that, and –

I WILL RESPECT the autonomy and dignity of my patient …

They are really critical principles that medical practitioners sign up for, and I think that is reflected in this amendment, ensuring that they have access to that basic bit of information.

As I have said, I think the practitioner’s right to conscientiously object is a really important one. They do not have to assist in the provision of voluntary assisted dying. They do not have to be a consulting or coordinating practitioner. They do not have to be involved in administration. But if a patient comes to them and asks for some information about a legally available healthcare option, they should be able to access that information. Health practitioners are looked to for that sort of information, and they should be able to obtain it.

Lizzie BLANDTHORN: I have already spoken at length on these matters and indicated that I wish to support Mr Erdogan’s important amendment. I guess, to continue my earlier comments, our approach to this should not be about individuals and individual decision-making but how as a Parliament of a civil society we have a responsibility to act in the best interests of the whole of society. As a democratic society there can be nothing more important, in my view, than upholding the fundamental democratic principles on which our society is built, and I think the Victorian charter of human rights is a particularly profound reflection of this. As I indicated earlier, it says:

Every person has the right to freedom of thought, conscience, religion and belief, including –

…

the freedom to demonstrate –

his or her –

… belief in … observance, practice and teaching, either individually or as part of a community, in public or in private.

I think to not support Mr Erdogan’s amendment is to not support the Victorian charter of human rights, and it is also contrary to, I guess, the fundamental principles of our democratic society.

Ann-Marie HERMANS: I do want to just read something based on what Dr Mansfield said. While it is acknowledged that the declaration of Geneva is often the process which Australian doctors now go through, Victorian doctors’ commitment to the profession is expressed in both the declaration of Geneva and the Hippocratic oath. On the Australian Federation of Medical Women website, the voice of Australian medical women, you will find the Hippocratic oath, where it talks about the importance of practising a profession with conscience and dignity, and also:

I will maintain the utmost respect for human life;

I will not use my medical knowledge to violate human rights and civil liberties, even under threat;

I make these promises solemnly, freely and upon my honour.

That, for many people in the medical profession, means that they do not feel that they can be participating or even expressing anything to do with voluntary assisted dying. It really goes against their conscience and their beliefs. So again, acknowledging what was shared by Minister Blandthorn about human rights, I do feel that this is a really important proposition and amendment that has been put forward by Minister Erdogan, and I just thank him for the work he has done on this and his acknowledgement of talking to the doctors.

Council divided on amendment:

Ann-Marie HERMANS: I move:

2.   Clause 6, lines 15 to 33, omit all words and expressions on these lines and insert –

‘(1) For section 7(a) of the Principal Act substitute –

“(a)   to participate in any part of the provision of voluntary assisted dying, including the provision of information or referral;”.

(2) At the end of section 7 of the Principal Act insert –

“(2)   A registered health practitioner who has a conscientious objection to voluntary assisted dying must not be required by any person, body, employer or professional standard, to advise a person that another registered health practitioner or a health service provider may be able to assist the person in relation to information about or access to voluntary assisted dying, or any other medical or health service to which the practitioner has a conscientious objection.

(3)   A registered health practitioner who has a conscientious objection to voluntary assisted dying –

(a)   does not contravene any professional duty, standard or code of conduct; or

(b)   is not subject to any civil, criminal, administrative, or disciplinary liability, or any detriment in employment or professional standing, for acting in accordance with subsection (2).

(4) Nothing in this section prevents a registered health practitioner who does not have a conscientious objection from providing such advice or information if they so choose.

(5) This section has effect despite anything to the contrary in any other Act or law.”.’.

In this I have sought to do exactly as many of my colleagues have also been doing. This amendment is simply to allow people to have a conscientious objection. It is another attempt to go through the opportunity to have that conscientious objection. I am aware that with some of the changes we have made we have defined some of these practitioners who will be involved and who will not, so there are perhaps some areas where this could have been changed in retrospect. But again, I am such a strong proponent of people who work in the medical profession having the right to have a conscientious objection. Given that we have already attempted to vote on that, I suspect we are not going to get anywhere again by putting it forward a second time. I am considering whether I should withdraw this on that basis.

A member interjected.

Ann-Marie HERMANS: Yes. I am happy to vote to support it and not divide on it. Again, I feel very strongly about this, living in a world where I rub shoulders with doctors, nurses and professionals all the time. Those in the south-east have expressed concerns to me that they feel constantly bombarded by the current government now and in its previous term and unable to work and live freely in this state according to their conscience without repercussions. That was the reason that I put this forward, based on the concerns that people have.

The DEPUTY PRESIDENT: I would just like to clarify, because you said you were withdrawing the amendment and then you said you were moving it. Which one are you doing?

Ann-Marie HERMANS: I am just listening to my colleague here. I am going to call it, but I am happy to take it on the voices.

Georgie CROZIER: I will not be supporting Mrs Hermans’s amendment.

Ingrid STITT: I will not be supporting the amendment.

Evan MULHOLLAND: I will be supporting this amendment for the same reasons I outlined that I am supporting Mr Erdogan’s amendment, but I am seeking not to divide.

Sarah MANSFIELD: I will not be supporting this amendment on the same basis as previous comments about similar amendments.

Enver ERDOGAN: I wish to express my support for this amendment, as it is quite consistent with the principles I outlined, and I want to thank everyone for their work in bringing these really important amendments to the chamber. But I will not be calling for a division.

Renee HEATH: I will also be supporting this amendment for the reasons I outlined in my speech.

Lizzie BLANDTHORN: I also indicate that I support the amendment.

Moira DEEMING: I also would like to indicate that I will be wholeheartedly supporting this amendment.

Gaelle BROAD: I wish to voice my support for this amendment, because I do believe that it is important to give people freedom of choice and freedom of conscience.

Amendment negatived.

Ann-Marie HERMANS: I move:

1.   Clause 6, line 31, omit “and” and insert “or”.

This is one that I feel very strongly about as well, given that we have clarified – and I do feel very grateful that we have clarified – what the secretary will be providing. We have also clarified how a doctor will be able to do the referral, given that we have taken away the ability for a doctor to have that freedom of choice. I feel that by changing the ‘and’ to an ‘or’, it provides an option for doctors who feel that they need to work according to their conscience. By prescribing an ‘and’ it actually puts them in a situation which they still may not feel entirely comfortable, but by changing the ‘and’ to an ‘or’, it at least gives the medical profession a little bit of autonomy to decide which way they will provide that information on voluntary assisted dying. It is a very innocuous change, but it gives just the smallest element of choice to a doctor without taking away the opportunity to provide voluntary assisted dying to any patient that is in the situation where they are at end of life. So it would still allow that patient to have access to voluntary assisted dying, but it gives the doctor a choice as to how they provide that information according to their own conscience. I would strongly urge the house to please support this, because it is a very, very minor change to the bill, but just provides the tiniest bit of autonomy for doctors to have that choice. Instead of doing two things, they have the choice of one or the other, and the patient still has access to voluntary assisted dying.

Ingrid STITT: I will not be supporting Mrs Hermans’s amendment. This would have the effect of undoing the amendments that we have had broad support for, from both Mr Galea and Mr Batchelor, which were the subject of a lot of discussion across the chamber. So no, we will not be supporting this amendment.

Sarah MANSFIELD: I will not be supporting this amendment. While it might be one small word change, it actually has quite a significant effect on the application of this clause. It would mean that a conscientious objector could, for instance, if someone asked about voluntary assisted dying, say, ‘You can see someone else to provide that.’ There is no obligation to actually do the referral or indicate who that person might be. It would then mean that that doctor does not have to follow through with the information requirement, which I think is one of the key things in this amendment. It is barely an improvement on what we have now, to insert an ‘or’. The ‘and’ is actually critical. So it is important that someone knows there are other people out there who can provide this service. That is useful information to have, but it needs to be backed up by some basic information which will, following Mr Batchelor’s amendments, quite clearly be information about the care navigator service and the website. That set of information altogether is what is really critical here.

Georgie CROZIER: Given my comments in relation to Mr Galea’s and Mr Batchelor’s amendments, and being consistent with that, I agree with what the minister has said and therefore will not be supporting this amendment.

Ann-Marie HERMANS: I have a point of clarification. I fail to understand, and maybe that is from still being relatively new in the chamber, how changing the ‘and’ to an ‘or’ completely takes away from the amendments that have been passed by Mr Galea and Mr Batchelor. When there are two requirements at the moment and we have now simply specified what those two requirements are, it does not actually take away from Mr Galea’s or Mr Batchelor’s amendments at all, as I understand it. I would like to seek the counsel of the house, because as I understand it we are simply giving doctors a choice of one or the other. It is not taking away from whether the person has access to voluntary assisted dying. It does not mean that they simply do not have to say or do anything; they do have to do something. They have to make a choice, and they have to make sure that the person has access to voluntary assisted dying and that they have access to the information. It does not negate that; it simply gives them a choice as to how they receive that information and to what extent the doctor is involved in prescribing that information. Could I have some clarity, please, from the house, as to how this negates Mr Batchelor’s and Mr Galea’s amendments?

The DEPUTY PRESIDENT: That is not a point of order or a point of clarification; it is actually a question. I believe it was the minister that said that.

Ingrid STITT: Essentially replacing ‘and’ with ‘or’ has a fundamental impact on any clause. We have just gone through amendments that deal with both the requirement for a health practitioner with conscientious objection to VAD to provide information. All the house has adopted Mr Batchelor’s amendment, which I understand was very, very similar, almost identical, to Mr Mulholland’s amendment, to give clarity on what information would need to be provided. To only say ‘Someone else can help you’ without anything more does change the intent of the clause. I think we just need to agree to disagree on this question.

Ann-Marie HERMANS: My understanding is that whilst we may agree to disagree, it does not actually delete Mr Batchelor’s or Mr Galea’s amendments; it provides the choice. And it does not delete the option for the person to have voluntary assisted dying, because the doctor, should they choose to pick referral as the option, is having to refer to a place that is going to actually provide all the details and the information and the opportunity for voluntary assisted dying. Would that be accurate, Minister?

Ingrid STITT: This is your amendment, Mrs Hermans, so presumably you are clear on what the implication of your own amendment would be. I am not sure exactly what else there is for me to say other than what I have already put on the record about why I will not be supporting your amendment.

Ann-Marie HERMANS: I respect that, but the issue is that the impression that was just given in the response was that it is going to mean that the person will not have access to voluntary assisted dying. That seems to be the objection to it, but that is actually not the case. As you and I both understand, they will have the access to it; they just will have the doctor only having to prescribe one option for themselves and having the most minute amount of autonomy in the decision-making process. Is that accurate?

Ingrid STITT: No. Mrs Hermans, I just do not accept your explanation of these matters. The point about Mr Batchelor’s and Mr Galea’s amendments is about how the scheme operates for those medical practitioners with conscientious objection to VAD. I am sorry, but I think you are misunderstanding the operation of your own amendment.

Evan MULHOLLAND: I will be supporting this amendment, but I do appreciate holistically the connections in the clauses with Mr Galea’s amendment and my amendment, which is now Mr Batchelor’s amendment, and operationally how this may make things different in different parts. But overall, I think it is an improvement to the bill, so I will be supporting it. Having read the room, I will be calling it and seeking not to divide, but that is for the chamber.

David LIMBRICK: I will be opposing this amendment. My understanding of the effect of this amendment is that it will have a sort of weird consequence in that a medical professional would be able to tell someone that they need to go somewhere else and then tell them nothing else, which I think is actually worse than what has been agreed on already. I will not be supporting it.

Amendment negatived.

Evan MULHOLLAND: I have some questions on clause 6, and I can go to others after this group of questions. I assume there will not be a division for a little while, if anyone wants to go back to their offices. There was, Minister, a 2024 paper for the Australian Health Journal that basically found that whether you provide VAD or not, it is an added resourcing pressure. Some of our bigger public hospitals here in Victoria – St Vincent’s, for example – hire specialised legally trained VAD officers to navigate the VAD laws here in this state. They currently receive no additional funding for this. How is the government managing or supporting the resources of those services that interact with VAD, given the well publicised financial pressures on our health services?

Ingrid STITT: Mr Mulholland, the 2021 budget committed $23 million over four years and $5.8 million ongoing for delivery of VAD in Victoria. That includes the statewide pharmacy service; the care navigator service, which includes support packages; the Voluntary Assisted Dying Review Board; the voluntary assisted dying portal, development and improvement, which is used by the VAD board for applications; and departmental staffing. Separate to that funding, it is also part of the overall funding that each health service would receive based on their budget deliberations with the department each year and their activity.

Evan MULHOLLAND: I am just seeking to understand the last part of your answer in regard to the overall budget – and I am happy for you to take this on notice; these are genuine questions that I can come back to – whether there is a specific amount, a specific line item, that hospitals would receive. The bigger hospitals do absorb this cost. It is a cost that is absorbed. I would be keen to know, particularly towards the end of your contribution, ballpark figures. What services are provided? What is the funding provided specifically to our hospitals to navigate the VAD laws? From my understanding many hospitals absorb that cost and it is not a cost that is offset. I am seeking greater clarification, and I am very happy for you to take that on notice.

Ingrid STITT: What I can say broadly, Mr Mulholland, is that our health services, including obviously major tertiary hospitals, negotiate their model budgets with the department each year, and presumably if they have need in this area they would seek for their model budgets to include this work. Each health service signs off on that process. But in terms of specific figures, I am not in a position to have them to hand right now. I can see if we can take it on notice, but we may not be able to get precise figures because of the nature of how model budgets are reached.

Evan MULHOLLAND: How is the government ensuring adequate staffing and training involving compliance with the VAD legislation?

Ingrid STITT: As well as accepting in principle the recommendations of the five-year review, Mr Mulholland, this does include greater support for medical practitioner engagement through expanding statewide availability. Obviously we are debating these issues around expanding the statewide availability of medical practitioners and supporting their psychological safety and wellbeing and enhanced training. To address the issue now, the statewide care navigator service runs a number of medical practitioner training days each year, which is where most medical practitioners who provide VAD complete the required training. There is also a community of practice providing peer support, debriefing and consultation to medical practitioners who provide VAD services to support ongoing engagement. But there will be, as I indicated, further work as a result of accepting recommendations from the five-year review.

Evan MULHOLLAND: I thank the minister for answering those questions. Again, they were all genuine answers. I am looking forward to receiving the information on that on notice, and I thank the minister for that. The minister kind of indicated in the lower house that there is no new offence created in relation to a breach of this clause. However, does the government acknowledge that compliance with civil law is a normal requirement for insurance, registration and employment contracts for health practitioners, so the penalty for conscientiously objecting to VAD is that your job and ability to earn a living could be put at risk?

Ingrid STITT: Mr Mulholland, health practitioners’ registration and conduct are regulated by the Health Practitioner Regulation National Law, which is administered by the Australian Health Practitioner Regulation Agency. Another health practitioner, employer or member of the public can choose to notify AHPRA if they consider a health practitioner is not acting in accordance with their profession’s code of conduct or relevant registration, and AHPRA and the relevant health practitioner national board assess and deal with notifications. So the types of regulatory action a board takes in response to notifications change as risk changes.

Evan MULHOLLAND: I guess that is the whole reason I particularly asked this question. It seems to me like the government, in a roundabout way, does acknowledge that any breach of civil law could – and likely would if someone complained about it to AHPRA and others – result in a loss of insurance and possibly a loss of registration, and their ability to earn a living within their field would be put at risk. That is not a particular question, but it is something that I have great fear about occurring in my community. I know many medical professionals who consider this as a matter of serious conscience that they do not think that they can abide by. Yes, it is something that we are all here putting into new legislation, but for people out in my community, it is very serious. They are very, very worried about the consequences and their future in the profession as a result of this legislation. I will leave it there.

Ingrid STITT: I will comment further. Just to clarify, Mr Mulholland, that no offences or penalties have been included in relation to this part of the bill, and the Department of Health will take an educative approach to support health practitioners to meet their patients’ needs in a way that minimises what is required of them, and they will be providing guidance as well on these matters. It is important in the context of your concerns to note that there are no penalties or offences in the bill.

Ann-Marie HERMANS: There may not be some consequences put into the bill, but the reality is that the way the bill is and the way it is being passed, doctors that choose not to refer, facilitate or have that conversation are going to be in a situation where they will be in breach of legislation and will therefore have the impact of the full consequences of the law. We know quite well that in the past, when doctors have tried to express their conscientious objections and when nurses have tried to express their conscientious objections in other fields – be it COVID vaccination, be it abortion and working in the abortion wards – there have been consequences for those people in the medical profession.

I do want to also express – and I have this from somebody who has sent this in – that many doctors’ practices are small businesses. Putting the requirement on these small businesses, who do not provide VAD, do not wish to have the conversations, to have to find, establish and maintain the administrative records of other professionals who do, is creating that administrative red tape. I know some of that has been dealt with in some of the amendments but not really fully. People should be reminded that doctors are often in small businesses, and it would be perhaps a better outcome if the government had considered that there be specific health professionals who provide a helpline service. I know that we have passed some of Mr Batchelor’s amendments to have an internet site, but it would have been helpful if there were certain people that were set aside with an info helpline number to have that extra red tape taken out of the hands of doctors, so that those that do not feel comfortable would have had an option.

I think the situation is that in no other industry, other than what we are now prescribing here, has any legislation required a small business to refer people to competitors if they cannot provide the goods or services. In this case, with people having to be forced to have these conversations, we are not only putting these doctors with these small businesses at risk but also expecting people to have conversations which they may not feel comfortable with. This particular new section is all about having people who can actually initiate these conversations, who perhaps may not even know the full details, too, of patients. To me, it is negligent of the government to be pushing this into legislation, and the effects that this can have on people’s lives are troubling for me.

Ingrid STITT: Mrs Hermans, I am finding it challenging to respond to some of the issues that you are raising because they are based on a false premise or understanding of what the bill before us is seeking to do. No-one is being forced to have conversations; that is the first important point to clarify. You are also making a number of assertions about what you are saying has not been provided to medical practitioners which are also based on perhaps not having the full picture. The care navigator service provides the supports that you described in your most recent contribution. Providing VAD services is still a choice, and that is the fundamental point here.

It is probably timely for me to just remind the chamber that this provision in the bill that we have been discussing for a while aligns Victoria with Queensland and the ACT, where the system has been operating safely and effectively.

Ann-Marie HERMANS: Sorry if I am a bit slow on the uptake here, Minister, but I would just like to clarify: are you saying that there will be an info helpline that will be available through the navigator services? Could you please clarify that? I obviously am not in the know if that is the case and have not been given that information.

Ingrid STITT: Those medical practitioners and specialists that provide VAD services already have access to that type of support now through the care navigator system.

Council divided on amended clause:

New clause 6A (15:05)

Enver ERDOGAN: I move:

1.   Insert the following New Clause to follow clause 6 –

‘6A New section 7A inserted

After section 7 of the Principal Act insert –

“7A   Application of human rights and equal opportunity legislation to conscientious objection

A conscientious objection to voluntary assisted dying –

(a)   is an aspect of the right to freedom of thought, conscience, religion and belief under section 14 of the Charter of Human Rights and Responsibilities Act 2006; and

(b)   is taken to be an attribute for the purposes of the Equal Opportunity Act 2010 as if it were listed in section 6 of that Act; and

(c)   is taken to be a protected attribute for the purposes of Part 6A of the Equal Opportunity Act 2010 as if it were listed in section 102B of that Act.”.’.

I appreciate the opportunity to speak to my new clause to follow clause 6, clause 6A, which seeks to insert a new section 7(a) into the act. The purpose of this is similar to the principles we have just discussed, about conscience being a living principle that allows people to exist with difference but without fear. I think that is the key, that principle in the Charter of Human Rights and Responsibilities about freedom of thought, conscience, religion and belief. This will ensure that where people exercise that fundamental human right they are not persecuted. I think that is appropriate and consistent with some of the other legislation we have in our state, such as the Equal Opportunity Act 2010, the human rights charter and our very own anti-vilification legislation that this session of Parliament passed. In light of that, I move this new clause, because for many people that work in the profession compassion and conscience are not competing instincts – they are one and the same. I do not believe they should be compelled to act against their conscience, and they should not face adverse action as a result of holding those instincts and acting on them or choosing not to act in relation to them.

Evan MULHOLLAND: I would like to really thank Mr Erdogan for moving this new clause. I think this is a really interesting way of looking at things. It is certainly something I would not have thought to put in there, but I quite like how this new clause is put together and how it relates to the different acts of Parliament that have been passed in this place that do provide those significant protections for people of different beliefs. I know many in this chamber who might be inclined to support this bill or oppose this amendment have spoken of the specific need – I think everyone has – to protect religious communities from vilification and from discrimination. Highlighting that in this new clause is really important. It is something that my community would appreciate. I think this is an amendment worth supporting. The intent of it is very good and it will hopefully go a long way to making clear the intent of a whole bunch of pieces of legislation in this place and not cast them to one side like they do not matter because of this. This is where we talk about conflicting rights. As I said before, legislation should be a shield, not a sword. This certainly goes a long way to doing that, so I thank Mr Erdogan for bringing this forward, and I will be supporting it.

Ann-Marie HERMANS: I absolutely want to thank Minister Erdogan for his contribution, particularly for the work that he has put into this new clause to place into the amendment bill information on aspects of freedom of thought, conscience, religion, the Charter of Human Rights and Responsibilities Act 2006, the Equal Opportunity Act, and the purposes that are underlined. I do think this new clause will protect our medical profession in Victoria and sustain our medical professionals so that they feel that they are also protected by the law. It will give some comfort to those who have felt in the past persecuted by this government through legislation, that they have not been protected, that they have not had the opportunity to be protected by the charter of human rights or that there has been conflict in legislation that has been passed in Victoria in the past. They need to know that there is some comfort and some protection and that there will not be a loss of practice, loss of their small business or loss of their services, so that we do not have a mass exodus from this state. We already have a shortage of teachers and a shortage of police; the last thing we need is a continual spiral of a shortage of doctors, medical practitioners and nurses. We need to protect our professions. We need to show respect to every individual in this state, and we need to govern for all people, not just some. On that basis I wholeheartedly support this amendment, and I thank the minister for his work on it.

Lizzie BLANDTHORN: I also thank Mr Erdogan for this amendment. Again, as a unionist, I find this a particularly important amendment. I think it is one, as Mr Mulholland and others have spoken to, that speaks to consistency across our legislation in terms of how people are treated before the law and how their rights and responsibilities are upheld and also that people not be penalised for exercising their fundamental freedoms of thought, conscience, religion and belief, which as I outlined in my earlier contributions, is a fundamental human right. It is absolutely true that following the 2017 debate there are particularly doctors but others in this state as well who have experienced adverse impositions on them as a result of the positions that they have taken in relation to the application of the voluntary assisted dying scheme. I think coming from the perspective that Mr Erdogan does as a former workplace lawyer, this is a particularly important amendment that is grounded in deep experience and understanding of the law. I thank Mr Erdogan for his contribution, which I think was particularly eloquent, in relation to this matter and for his persistence with this amendment, because I think for anybody who wishes to uphold not just fundamental freedoms but also workplace rights this amendment is worthy of support, and I certainly support it to that end.

Moira DEEMING: I would just like to put on the record that I appreciate this amendment, and I will be supporting it.

Michael GALEA: I wish to indicate that I will be supporting this amendment, and I thank Minister Erdogan for bringing it to the chamber. I agree that this is a fundamental principle of human rights and indeed workplace rights as well, as Minister Blandthorn has outlined. I believe that it would fit well and in accordance with this act that these rights that are enshrined in this act are further protected in the way that Minister Erdogan has outlined.

David LIMBRICK: I also thank Mr Erdogan for bringing forward this amendment. It is a very interesting, probably the most interesting, amendment to the entire bill. I have undergone a bit of a change in my views on the human rights charter, though. When I first came here I think you could call me a true believer in the human rights charter. I have gone from that to now I would happily repeal the charter and abolish the human rights commission without the slightest hesitation. I am also deeply sceptical of the anti-vilification laws. Regardless of that, I do think that it is a good idea to have this in there, and therefore I will support it.

Sarah MANSFIELD: I will not be supporting this amendment. This is quite a significant amendment in that it makes conscientious objection to voluntary assisted dying a protected attribute in and of itself. Religious belief and activity are protected under these charters, and that will remain so – and under all of the relevant acts. I think that is appropriate. I think there are adequate protections for conscientious objection in all of these pieces of legislation and in the voluntary assisted dying bill that is before us. I think to make a conscientious objection to voluntary assisted dying a specific and explicit protected attribute is a considerable change to these acts. In the interests of the potential consequences of this, with all respect, Mr Erdogan had not canvassed these amendments with me and has not explained the implications of them. I have not had the opportunity to think about what the implications of this might be into the long term. This is quite a significant change. I am not comfortable with supporting such a considerable change to the interpretation of some of these other acts.

Georgie CROZIER: I wanted to listen to the debate on this amendment, and I am glad I have been sitting here, because I think it has been actually quite interesting. On the face of it, it actually is understandable why Mr Erdogan would move this to enable doctors to be able to exercise their conscientious objection. However, I do have somewhat of an issue with it, given that this is not going against those people that do have the conscientious objection, it is just allowing patients that want the information to have it provided. For those reasons, I cannot support it, but I have been quite interested in this one. As Mr Mulholland just said in my ear, it has been quite creative. However, on this occasion I will not be supporting it, but I do thank you for bringing it forward and adding this interesting element to the debate.

Renee HEATH: Minister, I want to thank you for bringing forward this amendment. I think that it is very difficult to say on one hand that we support a free and pluralistic society, and on the other hand not allow people to live according to their individual conscience if that does not come under what the state thinks you should say. I think it is fantastic and I will wholeheartedly be supporting this.

Ingrid STITT: I am indicating that I do not support this amendment of my colleague. I have already made some comments in relation to a different amendment about how the freedom to hold a belief, such as conscientious objection to VAD, is absolute, but that has to be balanced and subject to reasonable limitations so that patients can also exercise their freedom. The right to conscientious objection is already protected under human rights and equal opportunity legislation, and indeed, the bill before us and the VAD act, so on that basis we will not be supporting the amendment.

Gaelle BROAD: I just want to thank the minister for putting forward the amendment because I guess this has been a big issue in the bill for me, so I see it certainly as an improvement. I do feel that there has been a shift in this debate that will widen, and the safeguards that were put in place when this was first debated back in 2017 are now being seen as barriers that are being removed. I feel that this would go some way to addressing the concern I have with that expansion, so I will certainly be supportive of this.

Council divided on new clause:

Clause 7 (15:25)

Michael GALEA: I move:

6.   Clause 7, page 9, lines 2 to 4, omit “a registered health practitioner who is not a registered medical practitioner or nurse practitioner” and insert “certain registered health practitioners”.

7.   Clause 7, page 9, lines 7 to 12, omit all words and expressions on these lines and insert –

“(1) This section applies to the following registered health practitioners who provide health services or professional care services to a person –

(a)   a registered nurse (other than a nurse practitioner);

(b)   a registered psychologist;

(c)   a registered Aboriginal and Torres Strait Islander health practitioner.”.

8.   Clause 7, page 9, line 34, omit ‘Law.”.’ and insert “Law.”.

9.   Clause 7, page 9, after line 34 insert –

‘8B Discussion about voluntary assisted dying must not be initiated by other classes of registered health practitioners

(1)   This section applies to a registered health practitioner who –

(a)   provides health services or professional care services to a person; and

(b)   is not a registered medical practitioner, registered nurse, registered psychologist or registered Aboriginal and Torres Strait Islander health practitioner.

(2)   A registered health practitioner to whom this section applies must not, in the course of providing health services or professional care services to a person –

(a)   initiate discussion with the person that is in substance about voluntary assisted dying; or

(b)   in substance, suggest voluntary assisted dying to that person.

(3)   Nothing in subsection (2) prevents a registered health practitioner to whom this section applies providing information about voluntary assisted dying to a person at that person’s request.

(4)   A contravention of subsection (2) is to be regarded as unprofessional conduct within the meaning and for the purposes of the Health Practitioner Regulation National Law.”.’.

These make amendments to clause 7 of this bill, which in turn make amendments to clause 8 of the act – specifically, amendments to the new section 8A, as well as I am proposing a new section 8B. This has been canvassed already in the chamber earlier this morning, but I will confirm that the amendments that I am moving here will provide that a discussion about VAD may be initiated by a medical practitioner, a nurse practitioner, a registered nurse, a psychologist and an Aboriginal and Torres Strait Islander health practitioner. It specifically defines those five health practitioners as being able to initiate VAD discussions. In keeping with the existing provisions of the bill, this will require it to be done in the context of broader end-of-life conversations. It will also provide that health practitioners not in those five categories will still be able to discuss VAD with the patient if that patient is the one to initiate the conversation.

Georgie CROZIER: As consistent with my previous comments and questioning to Mr Galea around the broader aspects of his amendments, I will be supporting these amendments.

Ingrid STITT: As I indicated earlier, I will be supporting Mr Galea’s amendment.

Gaelle BROAD: Earlier we had similar ones, but mine was perhaps more restrictive to limit that conversation to doctors. I think a restriction is better than no restriction in the bill, but I do see this being an extension of the ability to bring up the topic with people, certainly an extension on the safeguards that were put in place in 2017. I prefer that it not be in there but am otherwise supportive.

Ann-Marie HERMANS: I agree with Mrs Broad, and I thank Mr Galea for bringing this to the house. As I have stated earlier, I feel very strongly that Aboriginal and Torres Strait Islanders should be having the same medical attention and care and opportunities as everybody else, and I am concerned that with the addition of this, this is going to potentially take away from that. However, because I think it is an improvement on what is currently in there – which is extending out to all sorts of medical practitioners – and it is providing some sort of scope that is bringing it back to only certain professional people, on that basis, in spite of the fact that I still feel that I would like to offer Aboriginal and Torres Strait Islanders the same options, rather than the additional option where they may not get the same level of care and understanding, I will be supporting this amendment.

Evan MULHOLLAND: I will be supporting this amendment. I will have some questions to flag later, just more broadly on clause 7. I thank Mr Galea for the way in which he has gone about these amendments and for the pragmatism he and others have shown. His amendment, but also the amendment by Jess Wilson and Daniela De Martino, obviously attracted quite a bit of support. I think it really touched on a big issue where the government, the minister or advocates from that side of this bill had slightly overreached. To get this outcome is a really, really good thing. I will be supporting it.

Lizzie BLANDTHORN: I also want to acknowledge the work of Mr Galea but also Mr Mulholland and Daniela De Martino and Jess Wilson in the other place. This is an important concession in relation to this bill. As Mr Mulholland has just said, there remains in a number of places significant overreach and significant diminution of safeguarding, but this is an important protection, and I thank those whose collaboration has led to this concession.

Sarah MANSFIELD: I have spoken to the previous amendments that are linked to this, but we are supporting this amendment in the interests of ensuring that this part of the bill can get through if there is support across the chamber. However, I indicate that my preference would have been for this not to be in the bill. As I have indicated before, I think it just creates potential for confusion. I do not think it was necessary. I think there are enough other provisions and protections within the bill, within the existing act and in other forms, including professional codes of conduct, that would have managed some of the concerns that people have. However, in the interests of making sure that we get some improvements to the existing act, I will be supporting this one.

Amendments agreed to.

Evan MULHOLLAND: Just a couple of questions to get on the record. What is to stop a doctor who does not know enough about palliative care giving incorrect advice to a patient about their palliative care options?

Ingrid STITT: Mr Mulholland, the bill says that if the health practitioners raise VAD they must take reasonable steps to ensure the person also knows about treatment and palliative care options, and those reasonable steps mean the doctor or nurse practitioner may discuss that and other options over multiple conversations. They may need to gather more information, talk to colleagues and make sure the person has fulsome information about their options. I would say that, similar to the way in which Minister Thomas in the other place answered similar questions in their consideration of the bill in the Assembly, palliative care is a very common and normal part of what our health professionals guide their patients and carers about very regularly.

Evan MULHOLLAND: How does the minister propose to address what I think is a massive power imbalance that exists between a patient and their doctor, particularly if the patient is ill, reeling from a recent terminal diagnosis or has some other vulnerability?

Ingrid STITT: The way in which the voluntary assisted dying framework operates is it is entirely patient-led and there are, as you know, a range of safeguards built into the legislation to protect against any form of coercion.

Evan MULHOLLAND: What are the reasonable steps a practitioner must undertake to ensure a patient knows about the treatment and palliative care options available to them and the likely outcome?

Ingrid STITT: I think I covered that, but I can go over it again if you wish. Reasonable steps means that a doctor or nurse practitioner may discuss VAD and other options over multiple consultations, and they may need to gather more information or talk to their colleagues to make sure the person has fulsome information about their options. They may need to refer the person to access information about treatment and palliative care from another health practitioner specialising in the relevant area, and they may also start the conversation and continue it later when the person feels ready to fully consider their options or has time for a longer conversation. Again, I would just indicate that this is within the scope of practice of medical professionals to have these sorts of conversations with patients very often about what their end-of-life choices might be.

Evan MULHOLLAND: Finally, the Minister for Health, in response to several questions in the lower house, said:

… that there should be no wrong door for patients who are receiving end-of-life care.

Is the endorsement now of this amendment acknowledging that there perhaps are some wrong doors for discussing options for end-of-life care?

Ingrid STITT: Are you talking about the amendment which we just dealt with or are you talking about the amendments to clauses 6 and 7 around –

Evan MULHOLLAND: The amendment we just dealt with.

Ingrid STITT: I think that our chamber has reached an accommodation or registered an agreed amendment to have clear definitions about which medical professionals are able to initiate these conversations, and then in turn in respect to some other related amendments what information needs to be provided. I think it, if anything, gives more clarity. I know that palliative care is something that the Minister for Health is very committed to continuing to strengthen. There has been a palliative care chief medical officer appointed in the department. There has been a commitment by the government to develop a palliative care framework and to improve and strengthen that, as well as additional funding in respect to palliative care. I hope that answers your question.

Evan MULHOLLAND: It does. I do not have any further questions on this clause. I just would like to acknowledge that there was a significant view and, as Minister Blandthorn said, now significant concessions – quite significant. I am glad we have been able to come to that accommodation and have the chamber acknowledge that there are some wrong doors for that discussion to take place.

Ann-Marie HERMANS: On the situation of clause 7, I do have concerns given that there are different levels of expertise for doctors, and that has always been the case – different levels of understanding and knowledge. Those things that they prefer to specialise in, they tend to be well versed in and well read in. Every doctor cannot be across absolutely everything. It is a concern that there may be situations with discussions where some of the effects of certain drugs may not be fully understood. My question I have for the minister on this is: to what degree are the facts about drugs based on empirical and external evidence, given that we do not get to see that information? It is not, as you said on Wednesday, publicly available. It is not provided.

To what extent will that information on side effects, complications et cetera be expected to be provided by the person who is going to be having those conversations? To what extent do they need to have that knowledge and understanding? Because quite clearly there are going to be diverse references and points of understanding of what can be used, what will be used, what can be expected and how this will take place. I am not a person that is intending to ever use voluntary assisted dying, but as I understand it, there are different methodologies and different drugs in different situations. And so for people that are engaging in these conversations, to what extent do they need to have that knowledge and to what extent will they be expected to know? Will this be fully provided? Will the external sources be making sure that those implications are well known to anyone that engages in these conversations – that the patient has full access to an understanding of what they are actually taking on and what they can expect?

Ingrid STITT: Mrs Hermans, we canvassed these issues extensively in clause 1 on Wednesday, and I would refer you to my answers to very, very similar questions on Wednesday that you are asking now. I went through in some detail the requirements for those medical practitioners that are engaged in the VAD process to make sure that their patients are cognisant of all of the steps of the process. In fact that is part of the assessment process and part of the process when somebody is seeking to have a VAD application approved. I would refer you to Hansard from Wednesday.

Ann-Marie HERMANS: I do remember that conversation, and one of the things I guess I would like to have clarified is: how many different methods are we talking about or different drugs are we talking about? Given that you cannot release the information of what they are, is there just one, are there two, are there three, are there four? Are there different pharmaceutical companies just providing exactly the same thing under different names? It is not clear to me what that information would be and what that expectation would be, so I did not feel that I got that clarified on Wednesday. I do apologise. I wonder if you might at least be able to clarify, without providing the name of the drug, how many different methods there are of VAD and how many different drugs are currently in use in Victoria and that this legislation would provide access to.

Ingrid STITT: Which medications are being used as VAD substances is not information that is made public, for obvious reasons.

Ann-Marie HERMANS: I did not ask you which ones, I asked you how many.

Ingrid STITT: And my point is that that information is not shared publicly for obvious community safety reasons.

The DEPUTY PRESIDENT: I will now put the clause as amended. Mrs Hermans is seeking to omit this clause, so if you are supporting Mrs Hermans’s proposal, you should vote no to the clause. The question is that clause 7, as amended, stand part of the bill.

Amended clause agreed to.

Clause 8 (15:45)

Ann-Marie HERMANS: I would like to thank someone that cannot be seen in the room, and that is the Honourable Robert Clark, for his very comprehensive understanding and review of the amendment bill. On advice, I will be withdrawing my amendments for clause 8 – all of them.

Sarah MANSFIELD: I move:

11.   Clause 8, lines 26 to 28, omit all words and expressions on these lines and insert –

“(2) Section 9(1)(d)(iii) of the Principal Act is repealed.”.

This is something I covered in my second-reading speech, but for the benefit of the chamber I will explain again the purpose of this amendment because it is a significant one. It is a proposal to remove the 12-month prognosis timeframe within the eligibility criteria. We very much welcome the government’s change from six months to 12 months with the timeframe element of the eligibility criteria. However, I think there are some fundamental issues with a time-based prognosis generally. Our amendment would simply remove that time-based prognosis. All other eligibility requirements would remain. The important element is that all the qualitative criteria remain. So the illness still must be incurable, it must be advanced, it must be progressive and it must be expected to cause death. Additionally, it must be causing suffering to the person that cannot be relieved in a manner that the person considers tolerable. We believe that these qualitative criteria are sufficient safeguards.

I accept that the ACT’s legislation is not currently in operation, but they have decided in their legislation to remove the time-based criteria. The Northern Territory’s Legal and Constitutional Affairs Committee has just recommended the same for any voluntary assisted dying laws that jurisdiction introduces. Time-based prognoses within voluntary assisted dying schemes are clinically and legally challenging. Estimates of prognosis are just that – they are an estimate. Even experienced clinicians have difficulty providing certain timeframes to death beyond days or weeks. I think what is important for us to consider is that a time-based prognosis was never intended to be a legal test. A prognosis is not a legal test. It is something that you provide to patients to allow them to plan the remainder of their lives. It is something you provide to patients to help inform their treatment decisions. When you are told perhaps your prognosis is approximately three months, six months or 12 months, it is never intended to be something that is a legal test that could potentially be tested in a court. The challenge with it is: how certain do you have to be – 50 per cent certain, 75 per cent certain or 90 per cent certain – that someone’s time to death is expected to be within that timeframe?

I think by creating a law that references a specific timeframe, some clinicians may err on the side of caution and wait until they are very certain that death is approaching for fear of breaching the law. It is something that is already a problem with the existing legislation, with it being a six-month prognosis. I think 12 months will help with that, but I still think there is the risk that for many people it will mean that they are forced to wait until it is too late. Again, this chamber has heard stories about that. I think several stories have been provided that indicate that that is an issue. People entering voluntary assisted dying at very advanced stages of their illness has been noted by the Voluntary Assisted Dying Review Board to be a particular issue in Victoria. I think the statistics, when compared to other jurisdictions, bear that out. A lot of people are dying before they are able to get through the process because of the very late stage at which they are entering it, and the time-based prognosis is very likely a contributor to that.

I think I also in my second-reading contribution highlighted this just in a very practical way. I talked about the experience of a friend of mine whose father wanted to access voluntary assisted dying. He had motor neurone disease, to which a 12-month prognosis actually already applies in the existing act. He was living regionally, had to travel to Melbourne to access an assessment and was told during that assessment that his prognosis was likely greater than 12 months, so he was not eligible yet for voluntary assisted dying. He had to return home, then very quickly deteriorated – rapidly – and had to go back to Melbourne to get another assessment to say, ‘Actually, your prognosis is now less than 12 months.’ That second assessment was extremely difficult to access for a number of reasons, primarily the frailty and the medical condition that that person then experienced. This was a condition where the outcome of this person’s condition was undisputed. It is a terminal condition. It is incurable. It was progressive. It was going to cause death. It was very advanced, and it was causing suffering that could not be relieved in a manner that that person considered tolerable. I think that should have been sufficient criteria for this man to be able to start the voluntary assisted dying process when he first sought assistance. The time-based prognosis I think does create a number of issues.

That is why I am putting this forward. It is something that, although I suspect it may not get support from across the chamber, is an issue that I think we really have to look at going forward. I understand my colleague Ms Copsey will move an amendment, should this one fail, which also speaks to this issue. Instead of it being a blanket removal of the time-based prognosis, it would allow for a compassionate exemption. That is a process that actually exists and is in operation in Tasmania, and I think at the very least it would provide a pathway for some of those people whose stories we have heard about where there is some uncertainty about where they sit on one side or the other of that time-based prognosis. I think that could be a step along that journey, but I actually think that the best outcome here is to remove that time-based prognosis altogether.

David LIMBRICK: I would like to thank Dr Mansfield for her engagement on this amendment and discussion about it. I actually share Dr Mansfield’s concerns about the time-based prognosis. I note that people on both sides of this debate have expressed scepticism about this time-based prognosis, and as Dr Mansfield rightfully points out, this type of prognosis was never really or should never really be intended for some sort of legal test for access to particular health care. The whole point of it is to give the patient some indication so that they can get their affairs in order and get those sorts of things in their life sorted out. Although I do agree that maybe removing the prognosis requirement would be ideal, I am concerned about potentially some of the unintended consequences of it. I do feel that extending it to 12 months relieves some of these issues. However, I will be supporting the compassionate exemption amendment that I anticipate will be put forward by Ms Copsey. I think that that is an acceptable compromise for those situations where the prognosis is not clear. The case which was very well articulated by Dr Mansfield, maybe in that case they would have received an exemption under that sort of scenario. I will not be supporting this amendment, but I am sympathetic to the motivations behind it.

Evan MULHOLLAND: As I understand it, only the time-related test will be advanced, which I think is a highly subjective term that is open to interpretation by practitioners. I agree with Mr Limbrick in the sense that even the time-related test is not ideal, which is why, as I said in my maiden speech, there will never be enough safeguards and that is why there is no ideal test. I really dislike the subjective nature of this test. The example being: if I am clocked at 120 in a 100 zone, that is because a camera has busted me for doing so. I cannot just say I thought I was going 100 and have that be the test. It is I think quite subjective in its nature, open to interpretation by practitioners and does not provide a true test, because it is purely what the person says they find intolerable. This creates a risk that people with slow-acting chronic conditions will seek VAD due to depression or distress from a diagnosis that might not be coming for some time. I can see the logic, and I can see the reality in which colleagues are making their minds up on this amendment. To my mind, it says to me there is no good outcome regarding these tests or these laws. I will be opposing it.

Ingrid STITT: I just want to indicate that I will not be supporting Dr Mansfield’s amendment. I understand exactly where you are coming from, Dr Mansfield, but moving from a six- to a 12-month prognosis timeframe will allow us to maintain the safeguard of a defined timeframe until death while at the same time allowing people to begin the VAD process at a time that suits their condition and level of suffering without forcing them to wait until the final months or weeks of their life, when we know that many people, sadly, start the VAD process but do not make it to the end of the process. On that basis and given the fact that there is not really any evidence to draw from in other jurisdictions on this question, I will not be supporting the amendment.

Georgie CROZIER: Thank you, Dr Mansfield. This was the area I was most concerned with the first time around with the initial legislation. I really did struggle with this part of it, given some personal circumstances that I was experiencing at the time. Whilst I do understand exactly where you are coming from, I do feel strongly about having some safeguard in there, and I do think it is important that we have that to give confidence to the system and enable it to operate, even though you might have a slightly different view on that. However, I think that is very important to maintain, and that is why I will not be supporting Dr Mansfield’s amendment either.

Melina BATH: I will not be supporting it. I feel that there has been a thorough review process. When I made my contribution those many years ago, I did talk about – not radically by any stretch – creep, as in the creep of the intent of the bill. I think this has been well considered. We have specialists and we have qualified doctors looking at this, and I take the point that it is not a legal test, but I do not want to see a prognosis into the never-never. I think there needs to be that level of clarity around 12 months. Certainly if someone lives longer than 12 months, then family can rejoice in that quality, and the agency is still with them. There is no reason why this has to be taken within those 12 months; it is just there. But I do not want to see it going off into the future.

Michael GALEA: I acknowledge and thank Dr Mansfield for bringing this in, and like others, I appreciate the intent. As I outlined in my second-reading speech, this and the question of prognosis is something I have weighed up heavily. As per what I said in that speech, though, I do think the government has got the balance right on this particular amendment.

Ann-Marie HERMANS: As Dr Mansfield would well know, it is very difficult sometimes for doctors to be able to predict the actual timeline on which someone’s life is going to take place. As many of us have referred to in our speeches, either through this amendment bill or in other amendments, when doctors are trying to figure out how long someone is going to live – and I remember asking the oncologist this for my father, ‘What are we talking about here? How much time do we actually have?’ – trying to put a date on the timelines is incredibly difficult. The reality is that we were told if my father had chemotherapy he may live an additional six months, maybe. And then when we asked ‘Well, how long do you think he has?’ the doctor said ‘To be honest with you, we don’t really know. It’s stage 4 cancer. It could be three months, it could be six months, it could be a year’. In the case of my uncle, technically with the level of where he was at in stage 4 bowel cancer, he should have only lived for 12 months. He lived for 18 months. He did have chemo. In the case of my father, he did not have the chemo, and he went on to live for a few years. It was an infection in the end that took him out.

It is incredibly difficult for doctors to predict. I believe that that is the reason why Dr Mansfield has tried to place this amendment, and I understand and respect the spirit in which that has been put in there, because doctors honestly do not have a crystal ball to know if it is six months or 12 months. They do not really know. However, I am so concerned about removing the safeguards. I completely respect the issue that doctors have in trying to predict it. They literally cannot do that, because in every case where you may have stage 4 cancer, for example, it can be very, very different individually as to how that cancer spreads, how quickly it spreads, in what direction it goes and how that affects each patient. We are not really capable 100 per cent of locking down if it is three months, six months or 12 months. We really are not. Doctors do not have that capacity either, no matter how great they are. When they do know is in those last days. Even in the last days for my father when I said to the oncologist, ‘What are we looking at here?’ – and we said that more than once when he was in hospital – he would say, ‘I don’t really know.’ Then we got to those last few days, and he said, ‘We’re probably not looking at more than two weeks.’ When you get to that point it is fairly clear those signs of death are starting to set in, but beyond that it is not.

I respect 100 per cent the spirit in which Dr Mansfield maybe has tried to put those safeguards in as a doctor by making it a bit more open slather, but my fear is that it also allows it to be abused. I do not like the six months and 12 months. I do not like it; I will be honest. We cannot predict these things. But I also do not want to open it up to allow people who could have actually had a reasonably great life for five years to suddenly be told, ‘Well, you’re in the advanced stage.’ That advanced stage can also be misconstrued. There is not enough tightness in this for me to be able to support it. But I do want to thank Dr Mansfield for representing the medical profession in the sense that they really cannot predict the end-of-life term for each individual.

Council divided on amendment:

Katherine COPSEY: I move:

1.   Clause 8, lines 26 to 28, omit all words and expressions on these lines and insert –

‘(2) For section 9(1)(d) of the Principal Act substitute –

“(d)   the person must be diagnosed with a disease, illness or medical condition that –

(i)   is incurable; and

(ii)   is advanced, progressive and will cause death; and

(iii)   is causing suffering to the person that cannot be relieved in a manner that the person considers tolerable; and

(e)   the person must be diagnosed with a disease, illness or medical condition that is expected to cause death within 12 months.

Note

A person requesting access to voluntary assisted dying may apply for an exemption from compliance with the eligibility criteria set out in this paragraph – see section 9B.”.’.

We have just canvassed at some length some of the difficulties that can arise in relation to uncertainty when it comes to time-based prognosis. The effect of this amendment would be that a person who meets all of the eligibility criteria except the 12-month prognosis would be able to apply to the secretary for an exemption from that requirement on compassionate grounds. That means a person who is diagnosed with a disease, illness or medical condition that is incurable, advanced, progressive and will cause death and is causing suffering to the person that cannot be relieved in a manner that the person considers tolerable but who, however, does not have a prognosis that that disease will cause end of life within 12 months would still be able, if they chose, to seek an exemption from the secretary to initiate VAD healthcare access on compassionate grounds –

The DEPUTY PRESIDENT: If we could have some quiet in the chamber, please, for Ms Copsey. It is very difficult for the minister and me to hear.

Katherine COPSEY: Further on the amendment: the secretary in these circumstances would be required to seek certain information from that person in order to inform their decision as to whether the compassionate exemption would be granted, including relevant parts of the person’s medical record, and the secretary could seek expert advice as well.

This is a process that is in place in Tasmania; this is a process and a ground of exemption that is tested in another jurisdiction in the country already. Another benefit that may be gained from the creation of such an exemption is that, if it were in place, it would allow us to gain some data and some experience regarding the nature and the number of applications that were made on this ground, which could in turn inform further, future reviews of the act. It would give us a more accurate picture of people who are wanting to seek access to VAD but are falling foul of the 12-month prognosis requirement. It could give us information about certain common conditions in which people want to access VAD but are barred from doing so due to perhaps inherent uncertainty around prognosis or about the advanced state of diseases or conditions that cause intolerable suffering but may not fit within that 12-month window.

Having listened to the debate on the previous amendment put forward by my colleague Dr Mansfield, I actually think that this compassionate exemption amendment is a very sound one to meet some of the concerns that have been raised in the chamber, on both sides of this debate, about the inherent difficulty that applies – the uncertainty that sometimes applies to prognosis – the barrier that this does create for people accessing it and, importantly, simply initiating conversations with a healthcare practitioner about access to voluntary assisted dying. I commend the amendment. I think it could solve a significant amount of suffering. It could address a barrier that is there whilst still providing the safeguards that are there in the legislation. But it would just simply give people who wish to access information grounds to do so, a pathway to do so that still provided some oversight but could decrease barriers without losing that oversight.

David LIMBRICK: I will be supporting this amendment. I share the concerns about the prognosis requirement articulated by Ms Copsey and Dr Mansfield. However, I was not willing to totally remove the prognosis requirement. I agree with Ms Copsey that this provides a reasonable compromise where there are those situations that do not fit the prognosis requirements – that a petition, effectively, can be made to the secretary to provide an exemption. I think that this is a sensible way to ensure that the wishes of the patient and their desire to access this scheme may be facilitated despite not meeting the prognosis requirements, which I think most seem to agree are maybe not fit for purpose for this type of decision. Therefore I will be supporting this amendment.

Ingrid STITT: I thank Ms Copsey for bringing this amendment forward. I do want to indicate, however, that I will not be supporting the amendment. Whilst Tasmania has an exemption process, there is very little evidence to draw from because the numbers have been so small, and there is very little ability for us to draw evidence from anywhere else in Australia either. For the reasons already stated around why we are bringing forward the 12-month period in the bill around giving people better opportunity to access VAD, we will not be supporting going beyond that. I also just want to note that the 12-month prognosis period does align us with the Queensland jurisdiction.

Katherine COPSEY: I will conclude by saying, as the minister has observed, in the Tasmanian experience this would apply to probably a very small number of people, but it would be incredibly meaningful to the individuals who did access it to leave life on their terms and with the ability to minimise their suffering where desired. I think it is an argument for supporting the amendment.

The DEPUTY PRESIDENT: The question is that Ms Copsey’s amendment 1 be agreed to, which tests her amendments 2 to 5, 7 to 9 and 12 to 14.

Council divided on amendment:

The DEPUTY PRESIDENT: I invite Mrs Broad to move her amendment 4, which tests her amendment 7.

Gaelle BROAD: I move:

4.   Clause 8, lines 26 to 29, omit all words and expressions on these lines.

This is more to stick with the existing act to have the six months, not the expansion to the 12 months as suggested by this bill. I think we have heard in this chamber today that it is very hard with timeframes, and with extended timeframes there could be an unintended eligibility expansion and it could apply to more people. It is to stick to the existing act.

Ingrid STITT: I do not support this amendment brought by Mrs Broad. For all the reasons stated, I believe the 12-month period is appropriate for all VAD applicants.

Sarah MANSFIELD: I thank Mrs Broad for the amendment, but I sit really on the opposite side of this one, and the previous couple of amendments I think indicated that.

Evan MULHOLLAND: I support this amendment.

Council divided on amendment:

Clause 10 (16:32)

The DEPUTY PRESIDENT: We move to clause 10, and we have identical sets of amendments here from Mrs Broad and Mrs Hermans.

Gaelle BROAD: I move:

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

This is the part of the bill that refers to doctors. It is reducing it from five years experience down to one year of experience. I think it is an interesting one, but it does not speak to the gravity of the issue being discussed. I think that experience in this important conversation is vital. I know it has been said that the shortage of doctors in regional areas is a reason to reduce that. But I feel that we should not be changing the rules because of the situation we are in. We need to look at getting more doctors in regional areas, for example. But I will keep my comments short other than saying that this is about retaining what is in the existing act rather than further expanding it.

Ann-Marie HERMANS: Obviously I will be withdrawing my amendment, because we have the same amendment. I feel very strongly on behalf of those in the medical profession that we are not putting our first-year doctors into a situation which is incredibly difficult for them. I think that the current act requires a level of experience, and we are now taking away that level of experience. I understand the desire to make VAD more accessible to people throughout Victoria, but at the same time I do feel that it is incredibly important that we keep those safeguards in there, that we protect those in the medical profession, that we do not throw people out after their first year when they are still getting their head around all sorts of things that they have to navigate in their profession.

I think if we just look at my own experience here, it is not the same, but I am just saying in the first year as a member of Parliament there was so much to learn. Here I am in my third year, still floundering through some of the things, some procedures, because there is still so much to learn, so many things where I have not yet encountered a precedential circumstance or situation. I think that by asking this of doctors, again, who may have a lack of experience and are new in their profession, also those who may be even challenged with voluntary assisted dying or have not yet even had their own perspective properly moulded, we are actually putting them at risk. I do not like the original bill, but I prefer the original bill to this bill, which puts in these amendments that remove all the safeguards that originally got the VAD bill approved by members of both chambers in the first place. I do feel that we ought to retain the five years and not change it to one year. I will be supporting the amendment.

Sarah MANSFIELD: I will not be supporting this amendment, and I think it is worth clarifying a couple of points that have been raised. This is about years post fellowship. When you fellow from a training program, that is speciality training, so that is additional training on top of your years as a junior doctor. It starts with being an intern and resident. You then become a vocational trainee in different speciality programs. You are working as a doctor for all of that time. So these are not first-year-out interns who are potentially able to be part of VAD. You are talking about people one year post fellowship. In Australia the average time from graduation from medical school to fellowship is probably around 10 to 15 years. It varies depending on your speciality, but that is typically the time. For someone like an oncologist, that would be probably the typical time, and they are often going to be involved in these sorts of assessments. You are talking about someone with a significant amount of experience working as a doctor, and then it is one year post that fellowship. I do not accept the comments that have been made that this is one year. It is just not correct to say that these are first-year doctors. They are people with a significant amount of experience. When you look at it like that, the difference between one and five years then suddenly becomes somewhat arbitrary. I think all it does is it limits the pool of practitioners available and the workforce available to provide voluntary assisted dying, because you are talking about people who are then perhaps 20 years into practice before they are able to participate in voluntary assisted dying. I just think that is an unnecessary restriction. I think what the government has proposed here is very sensible, and we will be supporting the government’s proposed changes.

Georgie CROZIER: I want to thank Dr Mansfield. I am glad she got up there and articulated exactly what a specialist is and the training that is required. It is not one year out. I think there is some confusion amongst members around the level of experience that is needed. She spoke very well about that, and I think explained to the house the many, many years that are undertaken to become a specialist. My understanding is that the government, through the review – this was one of the issues that was quite significant in relation to the barriers that were there, particularly for regional Victorians. I do not support Mrs Broad’s or Mrs Hermans’s reasoning for this or their amendments. Given the exceptional experience that these doctors have undertaken, they know what they are talking about. I will not be supporting this amendment put forward by Mrs Broad.

David LIMBRICK: When I first looked at this bill, I also had concerns about this lowering of the threshold. However, I have found myself much more comfortable with it after seeing what it actually means. Dr Mansfield is entirely correct that one year post fellowship is already someone who is a very, very experienced specialist. Therefore the difference between one year and five years, I agree with Dr Mansfield, is rather arbitrary and does, to my mind, unnecessarily limit the workforce available for this. Therefore I will not support the amendment.

Ingrid STITT: I want to concur with Dr Mansfield, Ms Crozier and Mr Limbrick on this amendment. To become a specialist you need extensive training, and the approach in the bill has been to widen the eligible VAD medical practitioner workforce while at the same time ensuring that we are continuing to have medical practitioners who provide VAD that are suitably qualified and experienced. I will not be supporting the amendments from Mrs Broad or Mrs Hermans.

Evan MULHOLLAND: I would like to thank the chamber for its education and for its discussion on this amendment. I will try to be as fast as possible. I am fully aware of the amount of time it takes to become a specialist. I still see this amendment as an improvement to the bill, and I support any improvement to the bill. I will be supporting this amendment – but depending on the read of the room I may or may not divide.

Amendment negatived.

Sarah MANSFIELD: I move:

17.   Clause 10, after line 23 insert –

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

While I appreciate the government’s move to reduce the minimum experience requirements as one way of addressing some of the challenges with finding practitioners who are willing and able to participate in voluntary assisted dying, it continues to be a significant access barrier for many people in Victoria. Some of the challenges in finding practitioners who are able to provide voluntary assisted dying relate to the very narrow interpretation of clause 10(3) in the principal act. This clause pertains to the requirement for one of the consulting or coordinating practitioners. You have to have two – you have to have a consulting and a coordinating practitioner involved in the VAD process. One of those has to have expertise and experience in the disease the person is dying from. While that does not state specifically that the person has to be a specialist consultant in the disease the person is dying from, that is how it has been interpreted in Victoria. What that means is it can be very challenging in practice for people to be able to find the appropriate specialist – they may have that specialist involved in their care, but they also need to find a specialist of that type who is willing and able to be involved in voluntary assisted dying.

Again, I think the chamber has heard some stories of where that has been a specific barrier. I know that in parts of regional Victoria, for example, there are no local neurologists who are willing or able. It is not always conscientious objection; sometimes it is just capacity and sometimes they are just not familiar with it or not comfortable with it. There are lots of reasons why they might not be able to participate in voluntary assisted dying. There are no neurologists in some areas who are willing to participate, which cuts off access for a huge range of people. So their treating doctor might not be willing to be part of it.

I just think it is worth putting yourself in a patient’s shoes when you think about what this journey is like. Think about how hard it is when you need to see a specialist – you have to go see your GP and get a referral. It is a difficult enough process a lot of the time anyway. There are often wait times, they are hard to find, it can be expensive and it is tricky. If your specialist is not willing or able to participate in voluntary assisted dying, trying to then navigate the process to find someone who is can be really tricky. How do you find that person? Where are they going to be? Are you going to have to travel? I think it is quite a significant barrier. By removing this clause, you still require two doctors to be the coordinating and consulting practitioners, but we believe it would mean that this narrow interpretation would be lifted. It would limit the restriction to only being non-GP specialist consultants. It would mean that GPs with experience in the condition and expertise in the condition could actually provide voluntary assisted dying. Two well-qualified, experienced GPs who understand the patient and who understand the condition I think are well placed to be able to provide support for someone going through voluntary assisted dying. It is what happens in practice in many other jurisdictions. While they might have very similarly stated laws, their interpretation has not been as strict as it is in Victoria.

We believe that this amendment primarily improves access for patients. The secondary thing that I think it does that is really important is it improves workforce availability and sustainability going into the future. I think there is an issue around having enough practitioners who are willing and able to provide voluntary assisted dying because of the very limited pool that is allowed to participate, given the interpretation of the Victorian law.

Ingrid STITT: Thank you, Dr Mansfield, for this amendment. I do not support the amendment. There are other measures in the bill which address some of the workforce challenges. The expertise and experience requirement maintains that safeguard that provides the Victorian community with confidence that a person accessing VAD has been assessed by at least one medical practitioner who has specialist knowledge in the person’s condition, illness or disease.

Evan MULHOLLAND: On my read it will mean that neither practitioner need have training or qualification in the patient’s condition, and thus the risk of misdiagnosis, misprognosis and inaccurate or inadequate advice on treatment options will be greater than at present. In that respect, I will oppose this amendment.

Council divided on amendment:

Katherine COPSEY: 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”.’.

This amendment relates to broadening the eligibility criteria by changing the requirement of this clause from a coordinating practitioner having ‘relevant expertise and experience’ to having ‘relevant expertise or experience’. By broadening these interpretive criteria, the effect will be to increase the workforce that can provide VAD advice and support. The effect of this amendment will be that people will still have relevant expertise or experience and so still be appropriately qualified to support a patient who is seeking advice and support in relation to VAD. The effect of this will, as Dr Mansfield spoke to in relation to our previous amendment, be greatly felt where there is a dearth of practitioners currently who are willing and able to support access to VAD. But this amendment would, for example, broaden the interpretation criteria to allow for, say, a GP who has relevant experience in relation to that patient’s condition to be able to provide them two GPs rather than having a GP and a specialist. There will still be significant experience or expertise by those practitioners applied to a patient’s case. What this will do is overcome some of those significant practical barriers that we have seen in practice in Victoria, which mean that purely through workforce limitations we are seeing patients who are unable to find relevant medical specialists to support their access to this health care.

Ingrid STITT: For similar reasons to those reasons outlined for not supporting Dr Mansfield’s amendment we will not be supporting this. I will not be supporting this amendment. It is important to maintain those safeguards around experience requirements.

Georgie CROZIER: I will not be supporting Ms Copsey’s amendment either.

Ann-Marie HERMANS: I will not be supporting it either, as I do feel quite strongly that we need to have at least some checks and balances and both requirements should remain in the bill.

Amendment negatived; clause agreed to.

New clause 10A (16:58)

 Sarah MANSFIELD (Western Victoria) (16:58): I move:

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

‘10A New Division 1A of Part 3 inserted

After Division 1 of Part 3 of the Principal Act insert –

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

10A   Requirement 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   Requirement for health service provider – withdrawal of or refusal 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).”.’.

This amendment introduces a requirement for health services, including residential aged care facilities, to provide reasonable access to voluntary assisted dying. Currently this is something that is required in other jurisdictions, including South Australia, Queensland, New South Wales and the ACT, but Victoria does not have any such obligation for reasonable access to be provided. Challenges in accessing voluntary assisted dying, in particular in residential aged care facilities, which I think we should all acknowledge are the homes of most residents in those facilities, is a significant and widespread problem in Victoria. This is highlighted in Go Gentle’s recent report, where it was found that 90 per cent of Victorian providers either deny access to voluntary assisted dying in their facilities or do not provide any public information about voluntary assisted dying access.

The effect of this amendment is, in addition to making it an obligation to provide reasonable access to voluntary assisted dying if someone wishes to access it, to make it an offence for a health service provider to withdraw a health service from a person or to refuse to provide a health service to a person on the basis that the health provider knows that the person has made or is likely to make a request regarding voluntary assisted dying. There have been reports of obstruction of access to care in some residential aged care facilities because there is concern that someone might be accessing care and then seeking voluntary assisted dying. This is really concerning because, as we have canvassed throughout this debate, it is something that is currently legal but there are people in our community who through the circumstances of where they are living are being prevented from accessing this care. What we have proposed here is very reasonable. As I said, it is already something that exists in a number of other jurisdictions, so it has been operational. We can see the evidence of it. It just provides an obligation for some expectations around reasonable access.

Ingrid STITT: I will not be supporting this amendment. We have already seen acceptance of and our capability to provide VAD in both our health and aged care services grow over time. We would obviously like to see this continue to improve, and the Department of Health will continue to work with our public health and aged care services on publishing their VAD policies and improving how requests to access VAD are supported in these services. I would note that the five-year review identified some opportunities to strengthen existing departmental guidance and support for these services, and the Victorian government has accepted in principle all the recommendations of the review.

Georgie CROZIER: This is an interesting area. I understand some of the points that Dr Mansfield is making. However, I do have concerns about the extent of this. I think we have to be very, very careful, and I am not convinced by the amendment that the safeguards would be in place. For that reason I will not be supporting the amendment, but I will be interested to see that ongoing work. If patients are being restricted, then the reasons for that need to be understood. Likewise, there has to be some understanding from some of the facilities that may not support and respect VAD. I think there is a balance here, but I do not fully appreciate letting those safeguards go at this point in time. I think we need to maintain those very strongly. Therefore I will not be supporting this amendment.

David LIMBRICK: I understand some of the motivations, thinking about the patient, that have been brought forward by Dr Mansfield. However, I am very concerned about the idea of forcing private facilities to effectively cooperate with something that may be against their policy or their beliefs, and I think that this is a step too far. A far better approach, as was outlined by the minister, is to make sure that facilities do publish their policies so that people who are going to go into those facilities know in advance what those policies are and can properly consent to that or not. I think that is a far better approach – to have a market mechanism where the market is transparent and people can understand what they are signing up for rather than forcing facilities to provide access or other services that they do not believe in or consent to.

Lizzie BLANDTHORN: I also will be opposing Dr Mansfield’s new clause, and I would reiterate the same concerns as Mr Limbrick and Ms Crozier. I think that this is an important protection that needs to be preserved as a safeguard within the legislation.

Sarah MANSFIELD: There is another point to make about reasonable access and expectations of reasonable access. Again it is really important to centre the patients who are trying to access VAD. There are places in Victoria where there may only be one aged care facility in the area in which someone lives. They may already be a resident before they think about whether they want to access voluntary assisted dying. It might not be something they think about when they are entering that facility. So while a public policy might be useful, I just think people do not necessarily have as much choice as in an ideal world, where maybe you would have all the choices in the world of the type of facility you go in and where it is. Anyone who has experienced having had a family member or someone close to them trying to navigate the aged care system will know that getting a place in a residential aged care facility can be very difficult. If you look at that standpoint, for someone who does not have all the choice in the world of knowing what sort of facility they are going to be going into, while VAD might be important to them it may not be the only factor in their decision of going into that particular facility.

The word ‘reasonable’ is there. There is an understanding that some facilities, for various reasons, may not want VAD happening on their premises. But then I think there is an expectation that they would help to support that person to access it in some other way or provide an avenue for them to do so in another location if it was so fundamentally objectionable. This is someone’s home. It is where they have chosen to live. This is still something that they voluntarily enter into. All this would do is allow, for example, external providers to come in and assist someone in their place, which is their home. I think reasonable access is something that people should expect. As I said, a number of other jurisdictions have this in operation. It seems to work quite well. I understand the objections to it, but I think what that really does is it ignores the real-world experiences of the Victorians out there who are living in or potentially moving into residential aged care facilities.

Ingrid STITT: Further to my comments, I would also just point members to Minister Thomas’s comments in the Assembly about this and about her commitment to work with me as the Minister for Ageing on those identified opportunities in the five-year review to strengthen the existing departmental guidance and supports for aged care services.

Council divided on new clause:

Clause 12 (17:14)

Gaelle BROAD: I guess I feel that this provision of information on the request for information has probably already been prosecuted earlier in the chamber. I am aware of the chamber’s position on this. I do thank Mr Batchelor for defining what the information is. I would certainly prefer that we do not force doctors to provide information, so I do support Mrs Hermans’s amendment to omit it, but I will be withdrawing both of my amendments.

Ryan BATCHELOR: I move:

2.   Clause 12, lines 27 and 28, omit all words and expressions on these lines and insert –

‘(b) give the person the following information –

(i)   contact details for the prescribed voluntary assisted dying care navigator service;

(ii)   the address of an Internet site of the Department of Health that provides information about voluntary assisted dying.”.’.

These are identical terms to my earlier amendments.

Ingrid STITT: I support Mr Batchelor’s amendment.

Evan MULHOLLAND: I support my amendment, which is now Mr Batchelor’s amendment. It is an important concession by the government. Something that Dr Mansfield said actually – that I did not think about – was to even suggest that under a change of government, which is looking more and more likely, a Department of Health secretary under a Liberal government could also redefine what minimum information is. So this is a great backdown, and I again thank the chamber for working with me on my amendment, which is now being moved by Mr Batchelor.

Lizzie BLANDTHORN: In the unusual circumstances in which we find ourselves, I also thank Mr Mulholland for his amendment that has become Mr Batchelor’s amendment and for the cooperative way in which we have worked together on these matters.

Ann-Marie HERMANS: I thank Mr Mulholland for his work, Mr Batchelor for taking it on and the government therefore for considering it. I think that these are important amendments. I would prefer that we remove the whole clause, but under the circumstances I will be supporting this amendment.

Amendment agreed to.

Ann-Marie HERMANS: I still maintain that I would prefer that we were not having to do this at all. As I said, we already have VAD. We have checks and balances. We have made some progress in amendments, which is great, but I would prefer that we omit this whole provision and the information requirement. I am pleased that Mr Batchelor’s and – from the background – Mr Mulholland’s amendment has got forward, but I will admit that I am finding this whole procedure today extremely difficult and very tiring and very personal. But I still would not support this particular clause, and that is what my proposal is with my amendment.

Ingrid STITT: I do not support this amendment. Requiring medical practitioners with a conscientious objection to VAD to give people, who have made a first request for VAD, information about the statewide care navigator service on the Department of Health’s website is a simple way of connecting people with reliable and trustworthy sources of information about VAD at what is no doubt a critical moment in their care.

Georgie CROZIER: No, I will not be supporting Mrs Hermans’s amendment either.

Sarah MANSFIELD: I will not be supporting Mrs Hermans’s amendment for the reasons previously stated.

The DEPUTY PRESIDENT: If there are no further comments, I will put the clause as amended. If people want to support Mrs Hermans’s position, they can vote against the clause.

Amended clause agreed to; clauses 13 to 25 agreed to.

Clause 26 (17:21)

The DEPUTY PRESIDENT: Mrs Hermans, I invite you to move your amendment 9, which tests your amendments 11, 20 and 21 on your sheet 1C.

Ann-Marie HERMANS: I move:

9.   Clause 26, lines 22 to 26, omit all words and expressions on these lines.

My concerns in this are around the multicultural community. Again, I totally understand that this is all about making VAD more accessible, but I feel very strongly about protecting the multicultural community, protecting those who have English as a second language and protecting those who require an interpreter. I know that in other jurisdictions people are actually moving away from having interpreters and moving towards things like Google Translate, which is turning out to be quite helpful, and moving towards having those external practices using AI. But again, I just feel that we are taking away a protection here. I am concerned about the possibility of somebody taking their life with VAD through misunderstanding and misinterpretation. I understand that all sorts of precautions certainly have been in place and that this is removing that barrier. I feel quite strongly that we need to protect as much as possible our multicultural communities and those who may be Indigenous, where English may be their second language, from being misguided, misunderstood or misrepresented. That was the spirit in which I have proposed these amendments, simply as a protective guard, with the concern that we are removing so many protective guards with this VAD bill. I for one do not want to have anybody have their life end through misunderstanding and misinterpretation. I think that would be tragic. Once gone, they can never come back. I do understand that we are looking at people with terminal illnesses and diseases and degenerative diseases, but again, they never know how long their life is going to go for in these situations, and it just seems to me that they could be taken advantage of in this situation.

Ingrid STITT: I just want to put a few things on record. I know this was extensively canvassed in clause 1 on Wednesday. I want to indicate that I do not support Mrs Hermans’s amendment associated with removing an exemption to interpreter accreditation requirements. Allowing the Secretary of the Department of Health to grant an exemption from this requirement in exceptional circumstances ensures that those individuals who speak less common languages where there is no National Accreditation Authority for Translators and Interpreters (NAATI) accredited interpreter available are not excluded from accessing interpreter support. The act will continue to prohibit a range of people from being interpreters, including family members and people who believe they are or who have knowledge of being a beneficiary of the VAD applicant. The exemption will be tightly controlled and only granted when necessary – for example, if there is no accredited interpreter in Victoria – to preserve the integrity of the process while ensuring inclusivity. I want to reiterate what I put on record yesterday, and I want to strongly refute what Mrs Hermans’s concerns are around somebody losing their life as a result of this provision. There are strong safeguards in other parts of the legislation that would prevent that from occurring, including that a medical practitioner assessing a person for VAD must be satisfied the person’s request is voluntary and without coercion, irrespective of whether an interpreter is used or not. If they are not satisfied of that, then they cannot find a person eligible to access VAD.

Georgie CROZIER: I will just ask a couple of questions if I may given that we are talking about this topic and we did, as you said, go through this in detail on Wednesday. Thank you very much for providing the information that I requested, but I have a couple of points of clarification if you would not mind. In the response that you have provided, 196 languages other than English are spoken in Victoria by nearly 1.8 million Victorians, according to the 2021 ABS census data. There are 3600 professionals who interpret across 190 languages, so there are six languages not included in that. You have advised me that LOTE spoken by 130,000 people have no NAATI-credentialed interpreters located in Victoria as of May 2025. Languages lacking NAATI-credentialed interpreters in Victoria include Gujarati, Dutch and Kannada. Could you just tease that out a little bit more, those six languages that are not included, which you have not provided to me, but also those three that you have? I understand that they are very, very small numbers, and in here you have said that it is important to note that many of those people would also be proficient in English. If they are proficient in English, why is an interpreter service required? Wouldn’t that apply to most languages that interpreter services are required for?

Ingrid STITT: I think what I was trying to do here was to give you as much data as we could get in a short period of time and to give you a sense of the scale of the number of people who speak languages that we do have NAATI-accredited interpreters to cover and the number of people who speak languages where there are no NAATI-credentialed interpreters. With the 130,000 we do not know whether any of them will apply or seek to access VAD, but I think the point we were making is that for these particular language groups, just because there is no NAATI-accredited interpreter, it does not mean that they do not have proficiency either in English or in a different dialect within a language group. That was just a distinction we were trying to make there. I think I ran through, in my previous comments, how the exceptional circumstances would be strictly controlled and how the secretary of the department would have to be satisfied that a person without a NAATI accreditation has other suitable qualifications, as we traversed on Wednesday in committee.

Georgie CROZIER: This is quite a concern to a number of us and a number of people. We need to ensure that there are interpreter services available for those that require them when they are seeking information and, as you quite correctly said, to have those safeguards in place to not allow family members or those involved in care or those beneficiaries of that person involved. I am very satisfied with that. You just mentioned in your preamble, before I asked my question, that there are not accredited interpreters in Victoria, but if they were available in Australia, would the secretary undertake to try and access that service from interstate?

Ingrid STITT: I would expect that the secretary would have to be satisfied that the health service or the VAD medical professional has made every effort to have a NAATI-accredited interpreter available, and that would be part of the assessment the secretary would need to make about whether there were exceptional circumstances or not. I am not an expert in how the health services arrangements with different interpreter services are operating, but I do know as Minister for Multicultural Affairs that for our language services it is not unusual to try and source an interpreter with NAATI-accreditation online or interstate if there is not a person that is available. But I guess the intent behind this amendment is just to make sure that in the very rare circumstances where someone might need an interpreter in a language group where we do not have a NAATI-accredited translator available, they do not miss out on that vital language support.

Evan MULHOLLAND: Minister, one of the languages provided on a question on notice is Dutch. The last census had just over 3000 Dutch-born people speaking Dutch at home, almost 32 per cent. Over 98 per cent of those people speak English. Don’t you think that is not really a practical example to use when you are talking about a community that by and large speaks English anyway?

Ingrid STITT: I think, in the response I provided Ms Crozier, I was very up-front about the fact that many of those people would be proficient in English. I was giving examples in the time that we had available to try and pull some of the information together for Ms Crozier. We made that point in the response.

Sarah MANSFIELD: We will not be supporting this amendment for the reasons the minister has outlined. I think this is an important exemption. It is unlikely to apply to many people at all and may not ever be used, but if you speak a language and for whatever reason do not have another language you can speak proficiently enough to feel confident in having a conversation about VAD, to be denied access to VAD because there is no NAATI-accredited interpreter available seems to me deeply problematic. Given that there could be alternative arrangements – safe arrangements – made, I think what the government has proposed is very sensible. There are still a whole lot of checks and balances and bureaucracy involved for anyone seeking this exemption. It is not a free-for-all; just anyone cannot come and be the interpreter. The secretary has to be satisfied that a range of criteria are met.

Importantly, there are other provisions within this bill around conflict of interest, which I think are really important protections, including that a person cannot stand to benefit in any way from that person’s death, to reduce the risk of coercion, which I think some people may be worried about. So I actually think this is a really sensible change. It is very unlikely it will be used very often, but I think it is an important provision in order to give equity of access to people and not have the language they speak in be a barrier to them accessing something that everyone else is able to. On those grounds we will not be supporting this amendment.

Ingrid STITT: I want to add a couple of additional points, and one is that this exemption process is operating effectively in Queensland, the ACT and Tasmania. I also placed on the record when were discussing clause 1 the fact that in Queensland the provision has only been used once since 2023.

Evan MULHOLLAND: Just to quickly speak on this amendment, I do not think opposing this amendment because the number of people using the intended exemption is small is a good enough reason not to support this amendment. I think there could never be enough safeguards regarding VAD. Dr Mansfield spoke about conflict of interest. I went through in detail examples on Wednesday evening of how many of the communities that might be captured by this are quite small – and we are talking about small numbers; the government has admitted it is talking about small numbers – and are smaller communities where everyone knows each other. And so I just do not think that using non-accredited interpreters – in some of these small communities that we are talking about there are a multitude of different dialects and there are a multitude of different slangs, and certainly a lot of the multicultural groups and organisations and services that I have consulted with and spoken to regarding this amendment are deeply fearful of this amendment and what this amendment might mean. So for that reason, I will be supporting Mrs Hermans’s amendment.

Gaelle BROAD: I think if there is ever a time when you need to ensure that you have got the most appropriate person for the job with the best qualifications, this is the type of issue that would require that high level of experience when it comes to understanding language and the complexity of it, so I am certainly supporting Mrs Hermans’s amendment.

Ann-Marie HERMANS: In closing and in summary for this amendment, obviously it rules out a whole lot of other areas. I believe that every human life is of great value and that every single person deserves the dignity of the safeguards, and even if somebody is in this state in a minority, a significant minority – and I agree with Mr Mulholland; quite often when they are in a minority they do all know each other because they band together and maybe have even come out together from another nation and have shared experience – on the basis that every life is of tremendous value and that every single person deserves to have the same safeguards regardless of what level of a minority group they are in and what sort of language barriers there may be, I simply reiterate that this is an important amendment. I will be taking it to the vote because I believe that I am standing up for every individual, particularly those who may not have those safeguards and deserve the safeguards that are in place for every other Victorian.

Council divided on amendment:

Clause 28 (17:46)

The DEPUTY PRESIDENT: Mrs Broad has an amendment and Mrs Hermans has a proposal to omit this clause. Mrs Broad, I believe you are going to withdraw, so I will call on you to formally withdraw that amendment.

Gaelle BROAD: I just want to point out that this is the part about the minimum consultation period moving from nine days to five days, as proposed by this bill. My intention is to maintain the safeguards that are there from the original debate back in 2017. I understand Mrs Hermans is moving to omit this clause, so by voting no to this clause, that is the same. So I will be voting no.

Evan MULHOLLAND: I just have one or two questions on this clause if that is all right. I will speak very quickly; I did not get an opportunity before. With VAD available under this bill within five days, what is the government doing to guarantee that patients can access alternative options just as quickly, including proper palliative care assessments and treatments closer to home, particularly in the regions, where we know that there is a proportionally higher uptake than in metropolitan Melbourne?

Ingrid STITT: Thank you for your patience, Mr Mulholland. There are a number of issues that are relevant here. The five-year review found that between 83 and 88 per cent of people who were seeking to access VAD were already in palliative care, so that is really a demonstration, I think, that it is not about a lack of access to palliative care. People are seeking to access VAD while they are already in that stream of care, and patients will continue to have full access to palliative care and curative options. VAD does not replace these options but provides an additional choice for those facing that intolerable suffering at the end of their life, which is obviously a patient-led decision. Doctors are required to discuss palliative care and other treatment alternatives before proceeding, and most patients who choose VAD, as I said, are already receiving high-quality palliative care. Their decisions generally reflect a desire for autonomy when suffering becomes unmanageable despite the best medical support available. I think I went to these issues in clause 1 at some length. I know that the minister in the other place is extremely committed to strengthening our palliative care services. She has appointed a chief palliative care adviser in the department, and we are working on refreshing the palliative care framework. The Victorian government also funds the Victorian Palliative Care Advice Service, which offers free confidential advice to all Victorians seeking information about life-limiting illness, palliative care or end-of-life care.

Ann-Marie HERMANS: I thank Mrs Broad for allowing me to put this forward given that we have very similar amendments and that she has withdrawn hers in favour of this one because it has, as she said, the same effect. I have a question for the minister about this change in the period of time between the first and final requests. What empirical evidence is this based on? Have there been situations? It seems to me like we are just narrowing everything here – or actually it is the complete opposite: we are just opening the lid on a whole lot of things. I mean, nine is an arbitrary number. Five is just as arbitrary, it appears, unless there is some empirical evidence to suggest otherwise. Minister, are you aware of any cases where the nine-day period was not appropriate or sufficient? Can you please back up, with empirical evidence, the reason for this change?

Ingrid STITT: I think, as I shared with the chamber on Wednesday, my own mother is an example that I have. This is a serious issue. We have all got our own personal experiences, which have been shared broadly, about some of the access and equity issues that exist in the current VAD system, hence the reason why the minister has brought forward these amendments contained in the bill. There is nothing arbitrary around the proposal for reducing the number of days from nine to five days between the first and final request; it has increased suffering for some VAD applicants who have had to wait until the minimum time has passed before they can complete the assessment process to obtain a permit. Shortening the minimum time period between first and final requests will allow the VAD assessment process to occur within a shorter period where appropriate but will not require that process to occur within a shorter time. The five-year review certainly pointed to a number of areas that needed to be improved in terms of equitable access to a reduced timeframe between first and second assessments, so it is certainly based on the feedback that has been gathered through the five-year review process and also the work of the VAD review board. I would also indicate that this proposal aligns Victoria with New South Wales, where the timeframe has been operating safely and effectively for a period of time now, since 2023. Tasmania has four days, and the ACT has removed a timeframe altogether. So on the basis of the various frameworks that exist in other jurisdictions, we think this is a sensible and balanced approach, and we will not be supporting your amendment.

Sarah MANSFIELD: On this one I also agree with the minister; I will not be supporting this amendment. As has been outlined, there is actually substantial evidence that has been gathered through the work of the voluntary assisted dying board and the data that they have collected about people’s experience of the process. Many people, as has already been highlighted, enter the process very late. It is a process that typically takes, putting aside this period between the first and final request, between two to five weeks at a minimum to navigate, which given a lot of people enter this process quite late in their illness, can feel like an eternity for the people who are trying to navigate this. Many people are dying before they finish the application process. Other jurisdictions, including New South Wales and Tasmania, have a similar period to what is being proposed here with the government’s changes, and I think the ACT’s proposal to remove that mandated time interval between the first and final request is actually an appropriate response. We had actually considered moving an amendment, which I decided late not to put forward, to actually reduce the period to 48 hours, recognising that it is I guess another way of demonstrating that the request is enduring. But I am certainly very comfortable with reducing it to five days.

We have also got lots of feedback from people who have been through this experience that things like weekends and public holidays can delay further those requests. So at the moment, with nine days, it can actually turn into more like two weeks between that first and final request. And during that time, we have certainly heard of many experiences of people passing away before they have been able to exercise their wishes and their choice to use VAD. So we are very supportive of what the government has proposed here. Obviously it is something that the Voluntary Assisted Dying Review Board will continue to monitor and collect data on and something that I think in the future we may look to modify again, but I certainly do not support the proposal here to retain the nine-day period.

Evan MULHOLLAND: I will be supporting this amendment but not be dividing. I think we should. I hope the government is serious about providing just as speedy support with palliative care. I think there is probably not any Victorian that is not touched by palliative care and issues with palliative care, and I think we should be doing everything possible to accompany those in their final days and try to avoid and alleviate the suffering rather than eliminate the sufferer. And for that I will be supporting this amendment but will not be seeking to divide on it.

Ann-Marie HERMANS: In light of the minister’s explanation I will not be seeking to divide. However, as I said, I still feel that the reduction of the time of reflection, regardless of how many states it is in, can often not allow people to change their minds. We do know that there are a number of people that do change their mind; that has been recorded, and that data is available. There are many people that think that they are going to go through with VAD and then decide otherwise. It does bother me that we are speeding things up. I do not want anyone to be suffering. I think good palliative care does allow people to not have that level of suffering. If we only invested as much or significantly more in improving our palliative care and our palliative care resources, then I think that the option of VAD would not be so necessary. It would then only be those who have the degenerative diseases that want to consider their options. Certainly those in situations where they are suffering from things like cancer would I think prefer in many cases to have palliative care if it was operable and accessible. As we know, it has not been as accessible as it should be to the degree that it needs to be in places like the regional areas. I will not be taking this to a division but do want to have that on record.

Ingrid STITT: Without labouring the point, I just want to place on the record that the VAD review board annual report from July 2024 to June 2025 showed that 75 per cent of VAD applicants during that year were accessing palliative care services already.

The DEPUTY PRESIDENT: Mrs Hermans’s amendment is to omit the clause. If you support Mrs Hermans’s position, you should vote no to the clause.

Clause agreed to; clauses 29 to 58 agreed to.

Clause 59 (18:03)

Michael GALEA: I move:

10.   Clause 59, lines 3 to 10, omit all words and expressions on these lines and insert –

‘(1) Before section 75(1)(a) of the Principal Act insert –

“(aa)   who is a registered medical practitioner, registered nurse, registered psychologist or registered Aboriginal and Torres Strait Islander health practitioner is, in the course of providing health services or professional care services to a person, initiating or attempting to initiate a discussion about voluntary assisted dying with that person that is not, or would not be, in accordance with this Act; or”.

(2) In section 75(1)(a) of the Principal Act –

(a)   for “provides health services or professional care services to a person is” substitute “is not a registered medical practitioner, registered nurse, registered psychologist or registered Aboriginal and Torres Strait Islander health practitioner is, in the course of providing health services or professional care services to a person”;

(b)   in subparagraph (i) omit “in the course of providing those services to the person,”.’.

These are the consequential amendments to what was already moved earlier today. They relate to notification requirements to AHPRA and mandatory reporting. There are three amendments to three clauses here. I will not go through everything again for the chamber, but I am happy to take questions if there are any.

Evan MULHOLLAND: I would like to stand in support of Mr Galea’s amendments and in doing so again acknowledge Jess Wilson, Daniela De Martino, Mr Galea and others that have seen this amendment come to pass – both this amendment and my amendment, which is now Mr Batchelor’s amendment – in good-faith negotiation with the chamber. So well done to Mr Galea. It was also at one point Ms Crozier’s amendment. I would like to credit Ms Crozier, who along this journey, particularly on that amendment, has been very good, because she is actually in tune with her health stakeholders and speaks to them often about concerns that they have and, I know, responds to them very well, so there you go.

Ingrid STITT: I support Mr Galea’s amendment.

Lizzie BLANDTHORN: Again, like Mr Mulholland, I thank Mr Galea for his amendment and the constructive way he has worked across the chamber. This has facilitated some important compromises and concessions that, while there is much in this bill that I still fundamentally oppose, do improve some clauses. So I thank him for that and continue to support his amendments and recognise those such as Daniela De Martino in the other place, Jess Wilson in the other place, Mr Mulholland and others who have also contributed to that process.

Amendment agreed to; amended clause agreed to.

Clause 60 (18:06)

Michael GALEA: I move:

11.   Clause 60, lines 12 to 19, omit all words and expressions on these lines and insert –

‘(1) Before section 76(1)(a) of the Principal Act insert –

“(aa)   who is a registered medical practitioner, registered nurse, registered psychologist or registered Aboriginal and Torres Strait Islander health practitioner is, in the course of providing health services or professional care services to a person, initiating or attempting to initiate a discussion about voluntary assisted dying with that person that is not, or would not be, in accordance with this Act; or”.

(2) In section 76(1)(a) of the Principal Act –

(a)   for “provides health services or professional care services to a person is” substitute “is not a registered medical practitioner, registered nurse, registered psychologist or registered Aboriginal and Torres Strait Islander health practitioner is, in the course of providing health services or professional care services to a person”;

(b)   in subparagraph (i) omit “in the course of providing those services to the person,”.’.

Ingrid STITT: I support Mr Galea’s amendment.

Amendment agreed to; amended clause agreed to.

Clause 61 (18:07)

Michael GALEA: I move:

12.   Clause 61, lines 21 to 28, omit all words and expressions on these lines and insert –

‘(1) Before section 77(a) of the Principal Act insert –

“(aa)   who is a registered medical practitioner, registered nurse, registered psychologist or registered Aboriginal and Torres Strait Islander health practitioner is, in the course of providing health services or professional care services to a person, initiating or attempting to initiate a discussion about voluntary assisted dying with that person that is not, or would not be, in accordance with this Act; or”.

(2) In section 77(a) of the Principal Act –

(a)   for “provides health services or professional care services to a person is” substitute “is not a registered medical practitioner, registered nurse, registered psychologist or registered Aboriginal and Torres Strait Islander health practitioner is, in the course of providing health services or professional care services to a person”;

(b)   in subparagraph (i) omit “in the course of providing those services to the person,”.’.

At the risk of upsetting Ms Crozier, I would like to also acknowledge all the members, particularly in this place, who I have been able to work with across all of these amendments. I should have acknowledged Ms De Martino and Ms Wilson as well, and quite rightly, Mr Mulholland, and you, Ms Crozier. But to the members in this place, I am happy for us all to take the credit, because this is I think a sensible set of amendments. I would like to acknowledge the minister and her team for working collaboratively on these amendments and the minister at the table, the Minister for Mental Health.

Ingrid STITT: I support Mr Galea’s amendment.

Evan MULHOLLAND: I support Mr Galea’s amendment.

Amendment agreed to; amended clause agreed to; clauses 62 to 71 agreed to.

Clause 72 (18:09)

The DEPUTY PRESIDENT: Mrs Hermans, I invite you to move your amendment 18 on your sheet 1C.

Ann-Marie HERMANS: I am happy to withdraw the amendment in the interests of the fact that I can see where we are heading here. But I do want to say that it does concern me in this bill – in so many other bills that come through this house, we clearly indicate additional powers and responsibility and accountability for the minister. In this case, we are giving the secretary a great deal of power, we do not refer to the minister and we also allow the secretary to defer to bureaucrats that work in an office when the secretary is not available. On an issue like life and death I find that an extraordinary thing to do, because whilst some might say this is just how we operate within our departments and how bureaucracy works, this is not just anything in bureaucracy. This is not just anything within departments or within government. This is a matter of life and death. This is about choices, but it is also about the extermination of life deliberately, wilfully, intentionally, and that will always bother me. That was the reason why I had proposed this.

Again, it does bother me that we are just breezing through this and we are allowing these things to happen and we are not going to be reviewing this for five years. The complications that could arise – I just hope that they will be transparent and available to everybody to enable them to make informed decisions when looking at reforms. I do not feel that we have necessarily had all of that transparency in the formation of accepting many of the amendments that are part of this bill, and that bothers me. So while I am happy to withdraw that in the interest of time and in the interest of where this is heading, I just want to have that on record, because these amendments do concern me, this process does concern me and this accountability of who signs off and how they sign off does concern me.

Ingrid STITT: I understand that Mrs Hermans is withdrawing this amendment, but I make the point that this is a very practical provision. It has been in place without issue in the current act since 2017.

Clause agreed to; clauses 73 and 74 agreed to.

Clause 75 (18:13)

The DEPUTY PRESIDENT: Mrs Hermans, we move to clause 75. You have amendments 2 and 3 on your sheet 2C.

Ann-Marie HERMANS: Again, I am happy to withdraw these. I recognise that we are nearly at the end of this and there is not much that I can do to protect the original act to stand in place as opposed to all these amendments. Therefore I am happy to withdraw any further amendments.

Clause agreed to.

Clause 76 (18:14)

Sarah MANSFIELD: I move:

109.   Clause 76, line 16, after “cause a” insert “legislative”.

110.   Clause 76, line 17, omit “5 years” and insert “3 years”.

This is a straightforward amendment that reduces the time period for the review period. Currently in the proposal here there is a five-yearly review period proposed. This is an area where things are changing rapidly as different states and territories introduce their own laws, things are learned from those practices and social attitudes change. Even from this debate we can see that there are a number of things that there are still questions about, whether things could be further improved. I think having a shorter review period for legislation like this, until perhaps it settles a little bit, is a reasonable thing to do. The other change that this makes is it explicitly states that it is a statutory review, which I think is important. We had a situation with the current legislation whereby the review outlined was an operational review. That is a point that has been raised by a number of members. What it meant was that the only obligation was to perform a review on whether the laws were operating as intended. I am very appreciative that the government recognised that we needed to undertake a statutory review and amend some of the laws based on all the feedback from the Voluntary Assisted Dying Review Board and a range of other sources, including that operational review over time. There was a world in which these laws may not have been amended or updated because there was no legislative requirement for that to occur. I think a statutory review is a really important thing to have and shortening that to a three-yearly review really makes a lot of sense for this particular issue.

Georgie CROZIER: Whilst I appreciate what Dr Mansfield has indicated in her reasoning for shortening the review process, I do not support going from five to three years at this point in time. I think we need to ensure that the safeguards and the amendments that we have put in place through this process and the debate today are working as intended, and I do believe that it needs that five-year period to enable a sufficient review process to be undertaken before any further amendments are made.

Ingrid STITT: I just want to indicate that the bill already amends the act to enable a review of the act itself, not just the operation of the existing act, and a five-year period between each review is necessary to ensure that there is sufficient time to implement and gather evidence on the effectiveness of any changes resulting from the previous review. This is also consistent with the review periods for VAD schemes in other Australian jurisdictions. On those grounds I will not be supporting this amendment.

Evan MULHOLLAND: I will not be supporting this amendment. I think five years is the appropriate time. There have been a lot of different amendments. I did not get to speak on the previous Greens amendment, but perhaps any sort of statutory review might be able to look at services in our aged care settings. It might find what Arthur Moses found recently. I was curious that the Legalise Cannabis Party voted with them on that amendment, because it was the Legalise Cannabis Party that last week commissioned legal advice from Arthur Moses, a very distinguished and respected lawyer. You cannot kick someone out of an aged care facility for accessing VAD under the federal Aged Care Act 1997. It is an issue of compliance and not legislation, so while it is not in conflict with the federal Aged Care Act, it is not something that needs to be legislated. The legal advice said that any aged care facility who transferred or denied service on the basis of VAD would be in violation of the Aged Care Act. Again, an eminent Australian lawyer found that. Perhaps a statutory review might say something different.

I think five years is an appropriate time. I can see the logic of Dr Mansfield and the Greens wanting to limit it to three years so they can have another round of amendments and so we can be right back here again. Looking at the experience in places like Canada and some countries throughout Europe, where there are all sorts of reasons that people can end their life – an ever-expanding list – I think this is something that people need to think very carefully about, very seriously about, before very quickly coming back to the well for another review.

Ann-Marie HERMANS: I understand the concerns, and I have a lot of concerns with the new amendments we have proposed in this amendment bill. However, I am also aware that there are many people that would be very content to have even less safeguards than we are now going to have. It seems like there is a desire from some to have even more reductions, and I think that the number of safeguards that are being reduced by this amendment bill is already significant. If I felt confident that we were going to go back to increasing the safeguards in a shorter period of time, then I would be very supportive of Dr Mansfield’s amendment. However, given that it appears to me that the intent would be to increase the reduction of safeguards and make it far more accessible and therefore have far more people accessing VAD and going through with it – again, as I said, to me life is of tremendous value. Every life is a gift, and I believe that it ought to be treated as such. VAD distresses me enormously, given my own life experience and upbringing, and I simply cannot support the decrease to three years on that basis, although I do feel that some of the amendments that we have put in place today through this amendment bill may be problematic, and there may be issues that we cannot foresee and circumstances that may be regrettable.

I feel incredibly awkward about what may happen to the elderly in aged care services. I would hate to think that any of them could ever be taken advantage of in a moment of lack of clarity. They may be English-speaking but have a moment that lacks clarity, and then they may lack clarity again. Whilst I understand that people will argue that we have all the safeguards and that we have to accept that the professionals will do their jobs and that we will be able to keep those safeguards in place, all I can say is: I hope so. So while I thank Dr Mansfield, I am simply so concerned that I will not be supporting this amendment.

Amendments negatived; clause agreed to; clauses 77 to 85 agreed to.

Reported to house with amendments.

 Ingrid STITT (Western Metropolitan – Minister for Mental Health, Minister for Ageing, Minister for Multicultural Affairs) (18:25): I move:

That the report be now adopted.

Motion agreed to.

Report adopted.

 Ingrid STITT (Western Metropolitan – Minister for Mental Health, Minister for Ageing, Minister for Multicultural Affairs) (18:25): I move:

That the bill be now read a third time and do pass.

Council divided on motion:

The PRESIDENT: Pursuant to standing order 14.28, the bill will be returned to the Assembly with a message informing them that the Council has agreed to the same with amendments.

Sitting suspended 6:31 pm until 7:32 pm.