Thursday, 19 February 2026

 John BERGER (Southern Metropolitan) (14:02): Of course when someone is capable of providing informed consent, the choice should be theirs. Further, under this bill parents will continue to be able to make decisions that they believe are in the best interests of their children. To help them know, they will be provided with more information and more support as they make that decision. Further, we are also implementing changes, such as the use of oversight committees, to ensure that parents can feel secure that the treatment processes they choose will be as safe as possible. This is important because parents are not doctors and rely on experts who they trust to provide them with advice on these sorts of decisions. Part of what the bill does is it ensures that the relationship of trust between doctors and patients, and parents of patients, is supported. The option to follow an individual treatment plan or a general treatment plan, depending on the needs of the situation, will ensure that decisions on what path to take will be made on the evidence of what works in the relevant situation. Additionally, the importance of the oversight and the expertise, particularly in the creation of individual treatment plans, is recognised and accommodated in this bill.

To summarise, this is a bill which is important for a number of reasons. While it may only affect a very small number of people, those who it does affect, it does so profoundly. What we are doing with this bill is ensuring that we legislate for the small number of people who are born with variations in sex characteristics which are covered under this bill. We do so with the same values as we legislate for everybody else. In particular the bill relates to the importance of equality, personal choice and consent. It implements informed consent safeguards into the system, ensuring that individuals and families can receive expert advice from trusted sources so that they can be confident they are making the right decision for themselves or their children. It creates an independent oversight panel to ensure accountability and to ensure that decisions are always made in the best interests of the children whom they affect. It facilitates the creation of treatment plans, both individual and general, to address a wide variety of situations and medical needs, ensuring that medical evidence and expertise is always the basis of any procedure which is undertaken. It also creates a penalty of a potential two-year jail term for intentional or reckless provision of a restricted medical treatment to someone who does not have the capacity to provide consent.

In doing these things, the bill provides greater dignity and greater acceptance to those who are born intersex. It reaffirms our values as a government and as a state that people who are different deserve the same dignity as everybody else. We hope that the passage of this bill may provide some small solace of comfort to those who live with the negative effects of these sorts of unnecessary or irreversible medical treatments for which they never provided informed consent.

As someone who is not personally a medical professional, I think it is important that this bill has emphasised the importance of evidence, expertise and oversight, allowing doctors to do their job according to their medical best practice. Further, this bill emphasises the importance of trust relationships between patient and doctor and that maintaining trust in the medical system more broadly is key to providing better public health outcomes. The passage of this bill would mean that individuals born intersex and their families will be better able to trust the medical system and look to it to always pursue outcomes which are in their best interests. Therefore I commend the bill to the house.

 Ryan BATCHELOR (Southern Metropolitan) (14:05): I am very pleased to rise to speak on the Health Safeguards for People Born with Variations in Sex Characteristics Bill 2025. The purpose of the bill is to lay the platform to create new health safeguards to better protect people, particularly children or infants, with variations in sex characteristics from harm – a simple piece of equality giving people born with variations in sex characteristics the same autonomy over their body as everyone else. To those who have campaigned tirelessly for this change, the government has listened and brought the bill before the Parliament. People with variations in sex characteristics are born in a body that does not possess traits typical of being either male or female, in about 1.7 per cent of all births, and these can occur in reproductive organs, chromosomes or hormonal traits. Many do not require medical treatment but at a young age undergo treatment to make their body appear more typically male or female.

The reforms encapsulated in this bill reflect a commitment the government made following the release in 2021 of the (i) Am Equal report by the Victorian Intersex Expert Advisory Group. Other reports, such as Equality Australia’s The Missing Voice report, released in December last year, have also provided valuable contributions to this policy area. We have also heard firsthand from people who have been affected by surgeries, which were often unnecessary. The latter report found that a considerable risk of harm from these medical procedures remained for children. These can include sterilisation, pain, impaired sexual function, trauma or the need for further treatment. But these changes are not just about physical risks to children; they are also about choice. Consistently in this area we have heard from people who have had medical procedures inflicted upon them that they would have liked that choice, the autonomy over their bodies to choose. Too often in cases of people born with variation in sex characteristics, children undergo cosmetic procedures to make their body appear more male or female and this is not a choice that they have made – children are unable to give their consent but one of their parents have.

Being born intersex can present challenges too, of course, and not least for parents who just want the best for their children. It is about giving parents the correct information that they need, and through this bill parents are going to have access to more information and support. It will enable better healthcare outcomes and support informed decision-making. Children born with variations in sex characteristics and their families deserve accurate information and access to peer and psychosocial support. These reforms will deliver that.

The bill supports parents with their responsibility as medical decision-makers about treatments that can have significant and long-term consequences for their child. The bill supports better medical treatment decision-making for people born with variations in sex characteristics through four key mechanisms in the bill: informed consent safeguards, the establishment of an independent and expert oversight panel, better treatment plans and a prohibition with consequences for noncompliance.

In relation to consent, the bill empowers people with variations, supports parents to understand and explore treatment options and provides doctors with clearer guidelines and protection from some decision-making risk through independent oversight. Informed consent is required before a person receives any medical treatment. If someone is under 18, it is up to the treating doctor to assess their capacity to give informed consent, and usually in these cases a parent or guardian is the decision-maker unless the child is assessed as capable of giving informed consent themselves. The proposed informed consent safeguards do not change existing law regarding those who can make medical treatment decisions, but what these informed consent safeguards will mean is that doctors provide parents with easy-to-understand information about their children’s variation and treatment options, including the impact of no treatment.

The expert panel introduced through the bill does not replace parent decision-making. Parents must still give consent for treatment. But what it will do is provide a framework for the best possible treatment plans and health outcomes.

The bill provides for the deferral of permanent or difficult-to-reverse treatment until the person with a variation can give informed consent unless the treatment is approved by an expert panel with a chair, a deputy chair and a pool of ordinary panel members with demonstrated expertise, including specialist medical practitioners, mental health experts, human rights experts and, importantly, people with lived experience of variation in sex characteristics. The panel will give support to parents and doctors and provide clear guidance. Importantly, the bill will still enable people to access the treatment that they need. What it does is provide a structure for choice and a structure for better health outcomes for people with variations in sex characteristics, for intersex people, and that can only be a good thing.

 Moira DEEMING (Western Metropolitan) (14:11): This bill is built on a bunch of principles that I have long, long advocated for. I think it is very overdue that we deal properly in this state with the issue of performing irreversible medical procedures on children to alter their sex characteristics knowing that they cannot consent, especially in light of some of the reasons not being medical necessity. It is wrong to do that to children. It is wrong to transfer onto children an adult ideology or some kind of adult shame or some kind of societal inability to handle the fact that children’s bodies are not theirs to do with as they like.

Children as a class cannot consent, in my opinion. I notice that this bill, like so many other bills from this government, is very vague around the idea of what is age and what is consent. We have talked about mature minor policies. We have got Gillick competency, and now we have got this new third standard. They are all applicable in all these different circumstances in different ways. I was very pleased to hear everybody acknowledge these facts in this chamber, even though I was surprised because I thought saying things like that was somehow wrong after all the abuse that many, many people have gone through.

I was also surprised and pleased to hear a very clear line being drawn between intersex people and people with distress about their gender. I found out in the last few years that one of my friends, who I have been friends with for over a decade, is intersex, and it was absolutely shocking to me that it took her so long to tell me. I did not understand just how painful that was. I understood in theory, but I did not realise why she was one of my biggest, most fierce advocates on this kind of thing. It was because she was going through it right beside me, one of these people that I was advocating for. I am very, very, very pleased to hear that we are going to be looking after these people properly from now on.

As you would know, on our side we have concerns about the bill. We have concerns about unintended consequences when it comes to delivering the treatment. But I do want to say – credit where credit is due – the government has basically acknowledged some very, very important precedents. I will have my questions in committee.

I do not know if I am allowed to mention this, so I will just not mention the name. But a person who is intersex believed what they had read about people like me who advocate for child safeguards for every child – these same safeguards. This person, after reading this bill and looking into me, actually realised that I was on their side from the start. So this has been a wonderful opportunity, actually, for a lot of people in society to have very important conversations about it and to have them well.

You are correct that informed consent requires capacity, full disclosure of risks, the understanding of permanence, awareness of alternatives and freedom from coercion and shame. Interventions that irreversibly harm or alter a child’s fertility, future sexual function, identity development, lifelong medical dependency, psychological evolution and all those kinds of things – people are worried about those for all children.

This bill also deals with parental rights, another issue that I was very pleased to hear the government pay respect to, because parents are the primary decision-makers in paediatric medicine and in all things when it is their children. They love their children, and as you have all said here today, they need doctors to give them the very best evidence-based advice. I agree with the principle of deferring, where the child can consent for themselves later in life. I agree that we should do no interventions unless they are medically necessary and medically proven. But as we have said, we think that this bill actually undermines parental rights as well.

I apologise for flicking my notes. I just spent the morning taking my mother to one of our public hospitals here in Victoria, because they drugged her up, put a needle in her arm and then let her loose.

I worry about this bill in terms of adding another layer of bureaucracy upon decision-making for these medical interventions. I wonder; if these medical interventions are based on evidence, we have got Gillick competence and we have got parents involved, why are there all these different pathways? Why are there all these different models of consent when it comes to children in this state and when it comes to psychological and medical intervention? I have concerns about the inconsistency. But perhaps that will be explained to me in committee stage.

I have since had a deeper look into some of the consequences of the intersex condition of my very dear friend, and it is very sad. It is not something that can be chosen and it is not an identity, but it does impact every area of her life. We have all heard the stories about what was done in the past to children with children with intersex variations. We have heard even worse horror stories, where there was – and there is sometimes – a kind of parent who did not put their own child’s best interests first, but that kind of accusation is a high bar to level at a parent.

I think when it comes to child safeguards and childhood medical intervention, we need to have consistent, clear standards. All the principles that have been articulated here in this bill are good and sound.

Deferral being codified as protective – that is a good idea. Irreversible treatments without capacity, without medical evidence, being criminalised – we all agree with that. That stigma cannot justify these irreversible interventions – we all agree with that.

Some medical interventions with intersex cases suppress endogenous hormones, alter endocrine pathways, affect fertility and alter the development of sex characteristics. Here are some medical interventions that are legal in minors with gender distress: suppressing endogenous puberty, altering endocrine pathways affecting fertility and altering the development of secondary sex characteristics. My biggest query is why one group of children seems to me to have a much lower standard of care.

 Rachel PAYNE (South-Eastern Metropolitan) (14:21): I rise to speak on the Health Safeguards for People Born with Variations in Sex Characteristics Bill 2025 on behalf of Legalise Cannabis Victoria. Firstly, I would like to acknowledge all the lived experience advocates and stakeholders who are here today and thank them for their engagement and sharing their experiences with me and my colleague David Ettershank. I particularly want to thank Tony Briffa, M, Dr Sean Mulcahy and Anna Brown from Equality Australia, as well as LGBTIQA commissioner Joe Ball. Thank you so much for your engagement and sharing your stories.

More people are intersex than many people realise. Roughly 1.7 per cent of babies are born with some form of variation in sex characteristics, about the same percentage of people born with red hair, so not as uncommon as many in society think. Variations in sex characteristics may include variations to reproductive organs, chromosomes or hormones – basically, variations that do not fit the typical definitions of male and female. People born with intersex variations have experienced harm and trauma through inappropriate and unnecessary medical interventions for far too long. Many think that invasive and unnecessary medical procedures for intersex kids are a thing of the past, but this is unfortunately not the case.

In December last year Equality Australia published The Missing Voice, a report on ongoing medical interventions on intersex children. This report identified that intersex children remain at risk of medical interventions that could be deferred until they were old enough to consent for themselves. This risk arises for many reasons, often unbalanced and non-medical, without proper consideration of the potential harm decisions to medically intervene may cause. This can be driven by stigma and cosmetic considerations to justify intervention, which are highly invasive procedures and can require multiple follow-up surgeries, can cause loss of sensation and may not align with the child’s future identity. Another driver for these kinds of interventions is to reinforce gender, forcing alignment of the development of a child’s body, along with what they believe will be their gender identity based on chromosomes, hormones or a genital appearance. These decisions also present harms, creating situations where a person’s physical characteristics can become discordant with their gender identity, leading to gender dysphoria.

Equality Australia’s report found that another factor was an unbalanced assessment of medical risks, whereby risks presented to parents can be overstated. Contexts can be missing, as can an appropriate weighting of risks alongside the potential long-term harm of invasive surgeries. This leads to more interventions than medically necessary. For instance, some procedures may be recommended to lower cancer risk, but it could also result in a loss of natural hormone production and result in a person requiring lifelong hormonal replacement therapy. Alongside this, they face increased risks of osteoporosis or cardiovascular disease and other long-term health complications. Most significantly, intersex people can permanently be sterilised before they can understand what fertility means or express any preference about their reproductive future.

Finally, this report discusses parental distress and confusion as an influencing factor. Often these children are so young that the best interests of the child become the best interests of the parent who is making a decision for them. At times this decision can also be counter to the advice of doctors. The existing system fails to deal with these drivers of poor outcomes for intersex kids, and it also fails to have a robust, independent framework for resolving complex cases and proper documentation practices. This is particularly vital where there may be clinical disagreements, issues of weighing harm and the absence of diverse lived and professional experience to guide decision-making.

The bill before us today establishes new health safeguards and oversight and reporting processes to protect people born with intersex variations in sex characteristics, particularly infants and young children. It includes informed consent safeguards, an oversight panel, treatment plans and prohibitions with consequences for noncompliance. The legislation will not affect urgent interventions needed to save a life or prevent serious harm, but under the changes all other procedures and treatments would be reviewed by a new independent oversight panel. If the panel recommends treatment, parents must consent on behalf of a child who cannot, while children judged capable of making their own medical decisions can consent themselves.

The bill also creates a legal framework to protect people born with intersex variations from harm by establishing informed consent safeguards to ensure that people with intersex variations are told of treatment options and have access to peer support and counselling to make informed decisions. Where they have capacity to give consent to treatments, they will be able to do so. Where a person cannot give consent, an oversight panel would need to approve treatments before parents or guardians can give consent to treatment. The independent legislated oversight panel will ensure that irreversible decisions are properly considered.

There are consequences for noncompliance – for example, a clinician who does not meet informed consent obligations can be referred to the Australian Health Practitioner Regulation Agency for unprofessional conduct. The maximum penalty for the most serious, intentional or repeated breaches is set to be two years imprisonment or 240 penalty units.

The proposed reform will be supported by improvements to the model of care; enhanced data collection to provide better statistics on variations and procedures; and resources, guidance and education. These changes bring Victoria in line with the ACT, which banned non-consensual medical procedures on intersex people. Internationally, Malta, Germany, Greece, Spain and Portugal also have laws prohibiting these procedures.

The bill gives effect to the commitments outlined in the 2021 strategy report (i) Am Equal: Future Directions for Victoria’s Intersex Community. Importantly, this report, released in 2021, was informed through consultation with lived experience stakeholders, including the Victorian Intersex Expert Advisory Group and intersex support groups, as well as medical, legal and surgical stakeholders like the Royal Children’s Hospital, Monash hospital, the Human Rights Law Centre and the Royal Australasian College of Surgeons, as well as others. These are important and overdue reforms, and Legalise Cannabis Victoria is proud to support this bill.

 David LIMBRICK (South-Eastern Metropolitan) (14:28): I am also pleased to talk on the Health Safeguards for People Born with Variations in Sex Characteristics Bill 2025. I will start by acknowledging that I am supportive of the overall intent of this bill put forward by the government to prevent people undergoing permanent procedures unnecessarily without being able to provide informed consent. Indeed I do not actually have objections to what they are trying to do there. My main concern with this bill, though, is other people being swept up in this where treatment is not particularly controversial. For people with sex chromosomal variations such as Turner syndrome, it has actually been brought to my attention – I met with the Australian and New Zealand Society for Paediatric Endocrinology and Diabetes – that the treatment for this type of condition is fairly uncontroversial and well understood.

They were concerned that it would be swept up into this framework and that it would actually delay and make more difficult them being able to access treatment for their condition. So I am concerned about that.

I am also concerned about the possibility of unnecessary bureaucratic delays being caused by this. For those people who now would access treatment that is fairly uncontroversial, having to potentially go through panel processes and have these treatment plans drawn up – I am concerned that that might be a barrier, considering the large number that might be required. I note that in the ACT there have been very few of these plans, and I am concerned how many might be necessary in a larger state like Victoria. I also have some concerns around the make-up of the panel. It is my view that if we have a panel like this the people on the panel – if we are going to mandate qualifications – should have medical qualifications. But nonetheless, that is the concern.

These concerns aside, I applaud the attempt by the government here, but I do have some questions for committee. I am sure others are probably going to be asking the same questions. I am hoping that some of these questions can be figured out in committee and we will get some answers on these, because I do think that sweeping up a group of people into this type of reform unintentionally may be a very serious negative consequence of this bill. I hope that that actually is not the case.

 Ingrid STITT (Western Metropolitan – Minister for Mental Health, Minister for Ageing, Minister for Multicultural Affairs, Minister for Prevention of Family Violence) (14:32): The Victorian government thanks everybody for their contribution in this second-reading debate for the Health Safeguards for People Born with Variations in Sex Characteristics Bill 2025. The Victorian government committed to introducing an intersex protection system in 2021 as part of the (i) Am Equal report, which was developed by the Victorian Intersex Expert Advisory Group. I just want to note that Tony Briffa was co-chair of this group, and I also want to thank Tony for the ongoing advocacy and openness in sharing her experiences. Thank you, Tony.

This commitment is on the back of more than 20 years of campaigning and advocacy for people born with variations in sex characteristics to have the same bodily autonomy as everyone else. This has been backed up by human rights organisations and numerous national and international reports and studies. This legislation recognises the experiences of people born with variations in sex characteristics who have shared their stories of medicalisation, trauma and resilience. Victoria will be the first state and the second jurisdiction in Australia to enshrine safeguards for people born with variations in sex characteristics into law. Parents of children born with variations in sex characteristics will have access to more information and supports through this bill. This will enable better healthcare outcomes and support informed decision-making.

The bill will not stop people from accessing treatment that they need. Treatment that is primarily cosmetic would be deferred until the person can weigh the risks and benefits and make decisions about what happens to their body. The panel will approve treatment that addresses or prevents significant physical or psychological harm if there is not a less restrictive alternative, and people who can give informed consent can continue to access any treatment they want without additional approval. Urgent medical treatment that saves a person’s life or prevents serious, significant damage to their health will proceed without any additional approval. I recognise the many decades of advocacy and activism from people born with variations in sex characteristics who have led us to this point today.

Ms Crozier raised some concerns from particular bodies, such as the AMA and the Royal Australian College of General Practitioners, and these include concerns regarding criminal prosecution and the role of the panel. Ms Crozier has moved amendments relevant to these concerns. I just want to place on the record that the government will not be supporting these amendments, as we believe that the elements of the bill, including the incredibly high bar for criminal prosecution, address these concerns.

In addition, feedback from clinical stakeholders, including the AMA, was taken on board and resulted in clinician feedback being reflected throughout the bill. The offence only applies to the most egregious breaches, not to doctors acting in good faith.

The oversight panel draws on clinical expertise. For example, clinical members of the panel must be registered doctors with expertise in variations in sex characteristics. Where possible, the panel assessment committee will have expertise relevant to the treatment plan under consideration, and the assessment committee must seek advice from an independent expert whose expertise is relevant to the treatment plan under consideration. Panel oversight expressly requires the need to address clinical urgency to minimise delays to care. Existing medical definitions have been used where possible, such as ‘urgent medical treatment’, to align with established practice and to reduce risk of confusion. I understand that a number of members of the opposition and some of the crossbench will have questions in committee, which I will be very happy to follow up in committee, but I do commend the bill to the house.

Council divided on amendment:

Clause 1 (14:44)

Rikkie-Lee TYRRELL: Minister, I have heard concerns from Australian X and Y Spectrum Support and the Australia and New Zealand Society for Paediatric Endocrinology and Diabetes (ANZSPED) that this bill could delay treatments for people with sex chromosome variations such as Klinefelter syndrome and Turner syndrome. How will this bill impact the vital hormone treatments for people with sex chromosome variations, and can you assure them that it will not delay their treatments?

Ingrid STITT: I can confirm that the bill and the architecture that will flow should the bill pass the house today will not delay care, particularly care that is of an urgent nature. I can be more specific if you want me to go on, but the bill does not delay care.

Georgie CROZIER: I will come back to Ms Tyrrell’s question, because we were discussing it earlier and I want to explore that a little bit more, Minister. But can I just ask, first of all: with the (i) Am Equal report, I understand a number of medical professions were consulted. It has been said to me that they are not reflected in this report. Is there a reason for that?

Ingrid STITT: The formulation of the bill, Ms Crozier, is the result of over five years of consultation, and a range of clinicians and peak bodies were consulted as part of that process. I am just getting my hands on the detail of the number of submissions that were received as part of the most recent consultation. Just bear with me one second.

Ms Crozier, there has been extensive stakeholder engagement, as I indicated, which has occurred over more than five years, and that has included consulting directly with people born with variations in sex characteristics, specialist clinicians and health services, health sector peak bodies and professional groups and also experts in law, regulations and human rights and equal opportunity, including the Victorian Equal Opportunity and Human Rights Commission and Better Regulation Victoria. As I mentioned in my second-reading summing-up, there were the advisory groups, in particular the taskforce that I referred to, 205 responses to the Engage Victoria survey, seven facilitated workshops and one-on-one interviews to capture lived experience with clinical health regulation and legal expertise. In late 2024 the Department of Health undertook further consultation with key stakeholders just to test and secure consensus on the model that was being proposed in the development of the bill. That included, obviously, clinicians and peak bodies.

Extensive and genuine consultation has most definitely occurred in the development of this bill, and we are confident that we have also picked up some of the issues that clinicians have been raising, particularly when it comes to the offences section in the bill. We have applied that to only the most egregious breaches, not to doctors acting in good faith. The oversight panel draws on clinical expertise. For example, clinical members of the panel must be registered doctors with expertise in variations in sex characteristics, and where possible, the panel assessment committee will have expertise relevant to the specific conditions that are being considered under a treatment plan. The assessment committee must seek advice from an independent expert whose expertise is relevant to the treatment plan under consideration. There has been a range of consultation over a long period of time with the sector.

Georgie CROZIER: Minister, thank you for that response. You mentioned the egregious breaches and the criminality element. I will come to that when we get to that clause.

What number of complaints has the department received around breaches of that significance over, I do not know, the last five years, since you have been consulting?

Ingrid STITT: I just want to clarify what you want me to go to here, Ms Crozier, because obviously the bill is not in place. There will be a three-year transition period for the bill to be commenced, so it is that particular –

Georgie CROZIER: What I am trying to ascertain is around the consultation. You mentioned egregious breaches and that you had consulted on that. I am wondering how many egregious breaches have occurred in the last five years, given you have been consulting. What are those numbers and what is the department aware of?

Ingrid STITT: What I was referring to there was the way in which the bill has been drafted in respect to what would constitute a breach under this bill. In order to trigger that aspect of the bill, it would have to be the most egregious cases. Are you talking about, across the health system, how many cases have been egregious? No. That is what I meant when I talked about that. It is so that a doctor acting in good faith would not be captured by the penalties in the bill.

Georgie CROZIER: I appreciate that. I think it is just an important clarification. I suppose the reason I am asking this is you said in your summing-up there is a high bar. I have made my position clear that I do not think this needs to be in the bill. That is why I am moving an amendment regarding removing clause 7 around the criminality element. I am just wondering. You have said egregious breaches occurred and now you are saying if it comes into play, that is around if that happens. What I am asking is: is the department aware of anything that would have happened in the last five years, during the consultation period, for you to say that is why this needs to be in the bill? I am asking on how many occasions that has occurred that you are aware of.

Ingrid STITT: Essentially I think what you are asking is if there is proof that there are harmful practices still occurring in this area of health care. Yes. A 2025 Equality Australia report found that Australian children remain at risk of harm from medical procedures that could be deferred until they are old enough to give informed consent. Across 83 cases they found repeated instances of treatment being informed by non-medical considerations such as cosmetic concerns and parental confusion or distress, and this can result in treatment to normalise a child when monitoring would have been more appropriate. There was also an earlier survey of 272 Australians with variations that found that 60 per cent had undergone medical treatment related to their variation, including hormonal treatment and genital surgery, and about 60 per cent, or more than half of all treatments, were performed when these people were under the age of 18. This included genital surgeries on infants and children under five. The survey also found that 42 per cent had thought about, and 26 per cent had engaged in, self-harm. This compares to an 8.8 per cent lifetime rate of self-harm in the Australian population.

I think that is a demonstration of why there is a need for this bill and the fact that in the absence of a strong framework there is proof that harmful practices are still occurring.

Georgie CROZIER: I am aware of that, but those are Australia-wide figures. I am just wondering about the Victorian context. Have we got a breakdown of those figures? That is why I was just asking.

Ingrid STITT: It would appear that we do not have a breakdown for Victoria. They are Australian figures.

Georgie CROZIER: Okay. Minister, in the (i) Am Equal report, the report talks about a number of things, including resourcing. I think it is very relevant to have inclusive information and information that is provided to the community and affected parents and others that are caring for children and young people that may be implicated. It also says that there is a proposal for a statewide community-managed intersex health and wellbeing centre or service or clinic. Will that be run out of the Children’s hospital or Monash? Will it be a standalone clinic? What is the proposal there and what would that look like? I understand there are going to be other services and support put in place, but when will that take place and when will that occur?

Ingrid STITT: I do not believe that that is in the scope of this bill, but I will seek some advice from the box about that particular service that you are asking about.

That particular clinic that you referred to and were asking about, Ms Crozier, is not part of the scope of the bill, but there is an important need to make sure that families and people who are seeking treatment plans, particularly children, have access to those wraparound supports, those psychosocial supports and the provision of information so that families are understanding what their care options are. There is certainly work going on in making sure that we have those wraparound supports available for patients. There are also very well established clinics out of the Royal Children’s Hospital, which I am sure you are very well aware of. Also the model of care more and more is multidisciplinary teams, which I know you will also be aware of. There are tailored resources that the department will be establishing. Families and people with lived experience will be supported through educational sessions and tailored resources. They will also be supported to understand the changes by expert peer, family and psychosocial supports and their treating clinicians.

These health professionals will receive tailored training to equip them to provide this support. Finally, families and people with lived experience will be able to submit general treatment plans for the panel’s consideration, providing further opportunities to contribute to and gain clarity on the oversight processes.

Georgie CROZIER: Minister, I think a large of amount of what you have just said is going to happen already happens around multidisciplinary teams and a range of clinicians managing these complex cases, from my understanding from talking to clinicians. That is why I am asking, because it is in this document that you referred to about the consultation. Certainly the departmental reasoning for this bill comes from this document. With all due respect, I think that these questions are relevant so that we have got a bit of an idea, because in the ACT they have needed to put in additional resources, for instance, to assist with the plans. I am wondering what the government has planned to be able to support the requirements of this legislation.

Ingrid STITT: Which, Ms Crozier, in many ways goes to the implementation considerations – I am sorry; I misunderstood. I thought you were talking about what additional supports would be required. But you are correct. There are already significant supports in place, particularly through the Royal Children’s. The Department of Health is obviously undertaking budget planning, and that would be considered as part of the 2026–27 budget process.

A lot of the reform, as you say, can be delivered without significant change or significant additional investment by changing and improving the way care is delivered in health services. There obviously would be some changes that would occur as a result of setting up the new panels, but there would also need to be work done with health services to improve the model of care in some circumstances, to strengthen informed consent safeguards, to develop a suite of general treatment plans and to embed those new reporting requirements. The department will work closely, and clinicians will be involved in implementing changes to the existing model of care. They will play a key role in developing the general treatment plans as well. In addition, I have already indicated that there will be more work to be done around education and tailored resources, particularly for families.

Georgie CROZIER: I was going to ask: what is the budget, given you are setting up the panel? Has that been finalised?

Ingrid STITT: It will be part of the considerations of the 2026–27 state budget process. As you would be aware, there is a long lead time for the implementation of this change should the bill pass the house today. But the work of setting up the plans can commence almost immediately. The department’s advice is that it will not take additional investment to be able to start that work associated with setting up the new architecture of the system.

Georgie CROZIER: I want to go to that point because in the very helpful information pack, I might add, that the government did provide to us it says the oversight panel will begin considering and approving general treatment plans before the legislation commences to provide early clarity for clinicians and families and streamline approvals once the legislation does commence. How will they decide what conditions they will approve treatment plans for ahead of the implementation?

Ingrid STITT: On the work to begin those plans, obviously the establishment of the committees will be step 1, and that will include recruiting for the chair, the deputy chair and the expert panel members. It is envisaged that the work would commence immediately on making sure that those plans account for the general issues that are standard and that clinicians were dealing with quite regularly.

Just bear with me one sec. As you know, in the provisions of the bill there is a process to approve general or individual treatment plans. With the general treatment plans, a proposal can be submitted to the panel either by its members, doctors or people with variations and/or parents. The panel will also consider submissions from a public consultation process of at least 30 days. Once the panel receives a proposal the chair must appoint an assessment committee to consider the proposal, and the panel assessment committee will seek advice from an independent expert whose expertise is relevant to the treatment plan under consideration. This is the work that can commence immediately preceding the bill being passed by the Parliament and receiving royal assent as part of getting ready for the implementation of the legislation.

Georgie CROZIER: Can I go to the variations in sex characteristics and the broad definitions. You say you have modelled this on other jurisdictions, or you have looked at those other jurisdictions and you have taken advice from lived experience and others. The ACT, in their variation in sex characteristics, refer to a number of conditions. However, they do have exclusions around bladder exstrophy, epispadias, hypospadias, polycystic ovary syndrome and undescended testes, yet this legislation captures all of those, and there has been concern. I know the government says we have got a general treatment plan for the minor conditions like hypospadias, but I am still concerned why they have to be included in this. We heard from Ms Tyrrell around Turner syndrome. There are other chromosomal abnormalities that could be swept up.

I want to ask a series of questions around this, but first of all I just need to understand from you why it has gone so broad that it is sweeping up conditions that doctors and parents should be able to manage like any other paediatric condition that requires some minor surgical intervention, treatment, care or advice, rather than having a legislative framework overriding that medical relationship with a parent and a child. I am particularly talking about the large majority of the 1500 or so children born under your definition each year that are going to be, I think, unnecessarily caught up in this bill. I understand the more complex cases; I am talking about the minor cases that the ACT has not included.

Ingrid STITT: There is a bit in that, Ms Crozier, but I will do my best. The language and clinical evidence regarding variations in sex characteristics are constantly changing, so it was quite deliberate to keep the scope as broad as possible in that regard. Many clinicians and advocates advised us that the list of variations would be impossible to implement effectively, so that is why the scope of the bill is deliberately broad.

It is to ensure that vulnerable people who need additional safeguards are not excluded. This is balanced by the panel approving very specific general and individual treatment plans, and additional specificity can also be added in regulation if required. I also think that excluding treatments requires careful consideration, and there are existing mechanisms in the bill to help manage scope and prevent delays without resorting to exclusions. This is an example, I suppose, of the wide variation that can be present. Treatments that make permanent or difficult-to-reverse changes to a person’s sex characteristics require that additional oversight, because when they are provided without consent, which is the problem that we are trying to address in the bill, that can result in very serious and lasting consequences, including sterilisation. On the other end of the spectrum, there are some treatments that are intended to be fast-tracked via those general treatment plans – plans which still require oversight, reporting and consistent best practice, while simplifying the approval process. We have been quite deliberate in keeping it broad for those reasons that I have outlined.

Georgie CROZIER: Thank you, Minister; I appreciate the explanation. I do have a difference of opinion on this I think, and it is quite a strong view from me, actually. I do not think it is warranted. I am just really struggling with why the government has included that which can be managed so sensibly between medical practitioners. But I want to go to something which I am sure you are aware of. The minister certainly is, because it was part of correspondence to her. I have got a question around it, and it is one of the points raised by a senior paediatric urologist around the unintended consequences. Distortion of access – in addition to denying timely care and assuming resources will be available later, there are issues with current access to care, exemplified by the foreskin paradox. Currently, under Victorian law, parents can elect to have their son’s normal foreskin removed for non-medical reasons. But if that foreskin were to be abnormal, under these legislative proposals there would be significant barriers to care for them to access surgery for him, either to remove or repair the foreskin, for what would be considered medical indications. Why?

Ingrid STITT: Ms Crozier, cultural or religious circumcision is not in scope as it is not a medical treatment for a variation in sex characteristics. Victorian public hospitals really only provide medically necessary circumcisions, and since 2007 non-therapeutic circumcisions are only provided in private hospitals and day centres.

Georgie CROZIER: Thank you for that clarification. But the question was: if the foreskin were to be abnormal, under these legislative proposals there would be significant barriers to care for them to access surgery for him, either to remove or repair the foreskin, for what would be considered medical indications.

I am saying: why is that included in this legislation when it is relatively minor? It is not a complex case around chromosomal abnormality or the different very complex cases that I highlighted earlier in the day. That is what I am saying around the broad range, and I am just trying to get an understanding of what you would say to these doctors that are saying, ‘Well, this is just an unnecessary barrier.’

Ingrid STITT: Do you mean an unnecessary barrier when it comes to time, or are you saying that the treatment should not be subject to the safeguards that are in the bill?

Georgie CROZIER: It is around the doctor and the parent and having that discussion. As I said, if it was abnormal, you are saying that it should be left and allowed to be decided upon later, but there might be some issues around urogenital issues, and that is why often these urologists do proceed with assisting a child with removal of the foreskin, for instance, or the hypospadias example around the urethral opening. They are not uncommon and you have lumped them into this legislation, which I think is onerous and puts barriers and is going to potentially delay and confuse parents, not help them. You have got these guidelines but no case can be the same, and I think you are not taking in the individual case by giving a general framework on these cases. That is my point.

Ingrid STITT: The urgent treatment required to save a person’s life or to prevent serious damage to their health will not be delayed. There is additional oversight that will apply if a treatment is not urgent and the person is unable to give informed consent. Otherwise, it just comes back to that core principle that people should be able to make decisions about what happens to their own bodies. I appreciate that this is a big change in the way that these things have been managed in the past, but there is a reason for that, and there has been significant consultation around the development of the bill. Treatment on a person’s sex characteristics can be uniquely personal and complex. No two cases are necessarily going to be the same, which is why we are proposing the reforms in the way that we are. The model has been carefully designed so that we can continue to work with clinicians, many of whom are already doing work in principle in similar terms to what the bill outlines. There are important steps and safeguards in there that are necessary, and the bill will not stop people from accessing the treatment that they need.

Georgie CROZIER: I am not going to labour the point here – I am going to move on – but I do not think you understand what I am saying. I am not talking about an abnormal foreskin or a hypospadias being a life-threatening issue – it certainly is not. What I am saying is that it can complicate with urinary infections and really impact somebody’s quality of life and way of life. That is why there is intervention. That happens between the medical specialists and the doctor, but you have just lumped it into really complex cases that I understand need to be thought through. It has nothing to do with what you referred to, so I am going to move on in the interests of time, because we are going around in circles.

The AMA, in their feedback provided to the government, was very specific, and I said it in the second-reading speech. They do hold differing views. Nobody is disagreeing with keeping people safe and not wanting untoward surgery. For heaven’s sake, no-one wants surgery unnecessarily, I would have thought. Certainly the best interests of the patient should always be paramount, as per the code of conduct that I referred to earlier. I think this is important, because the AMA is the senior peak stakeholder body who have their members coming to them. I do not know that the government has listened appropriately or enough to them, because the members consistently identify the same practical issues. It is the practicality – exactly as I was just describing – around the abnormal foreskin and the hypospadias examples. Their first dot point is:

breadth and ambiguity of definitions –

that is what I meant, and I think the government has got it wrong –

risk of capturing common conditions (for example, hypospadias) that require early intervention to preserve long-term function –

to prevent ongoing urological issues and infections affecting a whole range of things if it is not corrected –

proportionality of the criminal offence and potential chilling effects on clinician willingness to practise in this field –

that is one of the unintended consequences that I am concerned about, and I think it is a valid reason; this is too blunt an instrument to use in this legislation –

adequacy of medical representation on the Panel and committees –

again, that is why I am moving that amendment; the feedback is again that the adolescent and paediatric specialists in this area should automatically be included, not be invited on –

the absence of mandated timelines

limited consideration of anticipated psychosocial harm

the risk of delay, inequity, stigma and loss of clinical capability

concern that severe sanctions and administrative burden may deter trainees and erode the future workforce

I am just wondering why those very, very significant concerns were not taken on board in more consideration when drafting the legislation?

Ingrid STITT: When we were having an exchange about the consultation that has occurred over the last five years, I did take you in some detail to the way in which the government has taken on board the issues raised by clinicians and some of the representative peak bodies. In terms of the claim that the bill will have a ‘chilling effect’ on clinicians, as you have just outlined, doctors acting in good faith have got absolutely nothing to fear about this legislation. We know that the absolute vast majority of our clinicians are highly ethical as well as being highly trained, so there is that absolute acknowledgement up-front. The offence, for those reasons, is carefully worded so that only the most egregious, intentional or reckless breaches are captured by the offence. The offence applies only to a person who performs restricted treatment while knowing or being reckless as to whether the treatment is a restricted treatment and who knows or is reckless as to whether the person had the capacity to give informed consent to the treatment.

Again, I would just reassure you that the implementation will be staged over three years. Doctors will be supported through guidance and training so that they can understand fully their obligations under this legislation. I do not accept that clinicians’ concerns have not been captured in the development of the bill. I want to also bring you back to the key driver behind bringing this legislation to the Parliament. It is because of the real experiences of people with variations and the need to prevent further harm, and I think it is a recognition that the way in which these issues are treated by the medical fraternity has moved on significantly, and so it should. We are bringing this bill forward to be a contemporary framework to support that work.

Georgie CROZIER: Look, I could not agree with you more. I think we have moved on – and I said that – from 20, 30, 50 years ago, when medical practice with all good intent made a knot of being in the best interest. I have certainly spoken to some of the advocates and people with lived experience, who have shared their really personal stories and have said, ‘If we’d had better guidelines’. I completely understand that; I am not concerned about that element of the bill. What I am concerned about is how other things are being swept up in the bill, and that is where I think we have got the difference, not with the very real concerns that people have around being able to put their position forward. I wanted to make that clear. Thank you, Minister. I do not have any further questions.

The DEPUTY PRESIDENT: Ms Crozier, I ask you to move your amendment 1, which tests your amendments 2 to 6 and 14 and 15.

Georgie CROZIER: I move:

1.   Clause 1, page 2, lines 5 and 6, omit all words and expressions on these lines.

I think I have explained and outlined my reasons for doing so.

Ingrid STITT: The government will not be supporting this amendment, because it would make the bill essentially ineffective. These amendments remove the prohibition on restricted medical treatment and associated exceptions, and without the prohibition there is no restriction on practitioners performing restricted medical treatment. The offence is an important consequence of the most egregious breaches, and it is also an important signal and deterrent. We know, from people with lived experience, that a breach could result in very personal, significant and long-lasting impacts, and a bill without an appropriate offence would not be trusted or supported by people with lived experience.

The DEPUTY PRESIDENT: The question is that Ms Crozier’s amendment 1 be agreed to, which is a test for her proposed amendments 2 to 6 and 14 and 15.

Council divided on amendment:

Clause 19 (15:34)

Georgie CROZIER: I move:

7.   Clause 19, page 23, line 11, omit “law.” and insert “law;”.

8.   Clause 19, page 23, after line 11 insert –

“(f) paediatric and adolescent endocrinology, paediatric and adolescent urology, paediatric and adolescent gynaecology and paediatric and adolescent psychology.”.

As explained during the debate, the reason for these amendments is to enable greater participation. The opposition believes that we need to have pertinent and relevant medical experience on the panel, as I have highlighted – paediatric and adolescent urologists, gynaecologists, endocrinologists and psychologists as well as others that may be required – to ensure that the appropriate advice and assessment is undertaken through this process.

Ingrid STITT: The government will not be supporting Ms Crozier’s amendments. This would significantly shift the balance of the panel towards a more medicalised model, which does not align with the intent to establish independent oversight with broad expertise.

A member interjected.

Ingrid STITT: You have not been in here. There is no limit on the number of doctors –

Members interjecting.

Ingrid STITT: I am talking to Ms Crozier. There is no limit on the number of doctors or experts that can be appointed to panel assessment committees, and the chair may appoint additional specialists if needed. For example, the treatment plan may include multiple treatments or specialities, or the person may have a complex history or complex needs. The committees are also already required to seek independent relevant specialist advice to inform their decisions. This amendment also limits specialities represented, including other relevant specialities such as geneticists and surgeons. The proposal would also increase the size of each assessment committee to up to nine members.

Council divided on amendments:

Clause 34 (15:42)

Georgie CROZIER: I move:

9.   Clause 34, page 35, after line 22 insert –

“(5) The assessment committee for an approval decision about an individual treatment plan must also provide each medical treatment decision maker for the protected person with an opportunity to meet with the committee to discuss the decision.”.

As outlined during the debate, the opposition believes that we need to have greater control for parental decision-making along with the panel, so this does include being involved in that assessment committee and the decision-making process and that they are not at arms length but are completely involved and central to any decisions being made. Therefore I move this with that explanation and what was previously provided.

Ingrid STITT: The government will not be supporting Ms Crozier’s amendment. These amendments propose to require panel assessment committees to offer meetings with medical treatment decision-makers before they make a decision, and parents who want more direct engagement with the panel are not restricted by the bill. By way of example, they can write a letter to be included in the treating doctor’s application, or they could request a meeting with the panel assessment committee. I also note that at least one person with lived experience must be part of all decision-making, and lived experience includes parents as well as people with variations.

Council divided on amendment:

Clause 56 (15:47)

Georgie CROZIER: I move:

12.   Clause 56, line 29, omit “fifth” and insert “third”.

13.   Clause 56, line 31, omit “sixth” and insert “fourth”.

As outlined during debate, the opposition believes that this needs to be closely monitored. Given the regulation that is coming and given that there is going to be so much that has been worked up and the concerns from the medical fraternity and others, I do think that a five-year review is too long and that the review should be three years. That is why the opposition is moving this amendment, to reflect those concerns.

Ingrid STITT: The government will not be supporting this amendment. The amendment that Ms Crozier is proposing would change the review period from the fifth to the third year of operation. I think it is important to highlight that the legislation has a three-year implementation period, so the panel will not be fully operational until year three. A review at that point in time, as proposed by Ms Crozier’s amendment, would not be very meaningful. It would only review the implementation period and not capture the legislation in full effect, which is why the government will not be supporting this amendment.

Council divided on amendments:

 Ingrid STITT (Western Metropolitan – Minister for Mental Health, Minister for Ageing, Minister for Multicultural Affairs, Minister for Prevention of Family Violence) (15:52): 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, Minister for Prevention of Family Violence) (15:52): 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 bill has been agreed to without amendment.