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March 2021 Newsletter



Never before has Tasmania been so close to getting a compassionate law for people who are suffering intolerably at the end of their life, with no hope of relief. While we are confident that Mike Gaffney’s End of Life Choices (VAD) Bill 2020 will pass, the potential impact on politicians from well-resourced opponents, who ignore the positive report from the University Review Panel and seek to weaken the Bill, is of concern.  This Bill has been thoroughly debated in the Upper House; whose members passed it unanimously.

Getting this message out into the public arena that we want this Bill passed, without any amendments that will diminish it, is of vital importance. The recent Candlelight Vigil on the Parliament lawns achieved this beautifully. There were nearly one thousand candles placed on the lawn, and as darkness fell and Parliament House was lit up with purple lights, it was a very moving and impressive sight indeed. For so many who placed candles it was obviously a profoundly moving experience.
Please contact your local members of Parliament, and as many other MPs as you can, and tell them that you want this important Bill passed promptly and without  any diminishing amendments.
We are so close to getting VAD legislation for Tasmanians! The final part of the debate starts this week on 2 March. Please join with us in one last effort to make it the best legislation we can get.  Contact Premier Gutwein, Minister Sarah Courtney and other House of Assembly MPs to tell them not to delay the vote and not to support unnecessary nit-picking and restrictive amendments that will make it harder for already suffering people to access their VAD choice.
These are the key points you can make:
  1. There’s no need for any delay in the debate or vote on the EOLC (VAD) Bill.
  • House of Assembly MPs are as capable as Legislative Councillors in assessing proposed amendments and should finalise the debate and have a final vote on the Bill this week.  
  • Tiny groups of opponents will continue to oppose the legislation no matter how many amendments are made and continue to fear-monger without providing any evidence or reasonable arguments.
  1. The EOLC (VAD) Bill 2020 as passed by the Legislative Council has all the safeguards necessary to prevent feared risks to people who may be vulnerable to coercion or abuse.
  • The University review panel confirmed the DwDTas view that the evidence shows this very clearly. The panel went even further saying the Bill has “among the most stringent safeguards in the world”.
  1. The EOLC (VAD) Bill 2020 provides compassionate and effective access to VAD without compromising the safeguards that prevent proven or potential risks and without including unnecessary hurdles or barriers to compassionate, fair, equal and timely access to VAD that respects people’s choices. 
  • This is similar to the major point of the University review panel report that there has to be an appropriate balance between the need to establish a VAD system which is accessible to terminally ill people who are suffering intolerably at the end-of-life and the safeguards included in the Bill to protect vulnerable persons against exploitation and abuse.
  • There is no need for more amendments claiming to be safeguards.  Extra amendments won’t make the legislation “safer” but make it less effective and caring, harder for people to access their VAD choice when they are seriously ill with intolerable suffering and harder for doctors and other health practitioners to do their best to help people achieve their choice.
  • Parliament needs to protect those who want to request VAD as well as those who don’t and may be vulnerable to coercion.  It also needs to protect “conscientious choice” for all health practitioners including those who work in religious-run services.  “Conscientious participation” must have the same respect and the same protection as “conscientious objection”. 
  • We support minor amendments that help make it better for people and their doctors and health practitioners but oppose those that don’t.  On the telehealth issue, we support one face to face consultation between someone requesting VAD but agree with the Legislative Council that all other consultations can be safely and effectively done by telehealth.  There must be no amendment to give religious-run health or residential facilities the right to impose their choice on clients or residents or to discriminate on religious grounds to prevent their fair, equal and timely access like everyone else.  The Legislative Council got it right on both of these and the House of Assembly must do the same. 
The DwDTas Committee believes that ensuring that there are no amendments in relation to ‘Entities’ and Telehealth should be our main areas of focus at this stage. If you have strong views about either or both, please communicate as soon as you can with any MHAs or others you think most likely to make a difference.
This is a complex issue and relates to the push by entities of any hospital or residential care facility to be able to prohibit all VAD processes and practices on their premises. An amendment to achieve this failed in the Legislative Council but still has some traction. Our Committee is concerned that the Review uses the term ‘organisations’ rather than the legal term  ‘entities’, which masks the potential legal power this amendment would give to, eg, religious based organisations. To allow ‘entities’ this right of refusal, which does not exist in any other VAD legislation, would create a very flawed precedent. The Review Panel does suggest that consideration should be given as to whether these rights and obligations need to be codified in legislation at all, or should be allowed to evolve in policy and practice over time. (P81 6.5.7). Since there will be 18 months to work on such matters, this would be a position acceptable to DwDTas, however, ultimately, DwDTas' position is that ‘entities’’ rights to refusal would never be acceptable.
Some issues that you may want to address include:
  • Religious based organisations play a major role in the aged care sector in Tasmania - there can be limited options for non-religious aged care placements
  • Inevitably, not all residents subscribe fully to the religious philosophies of these organisations (such as the sanctity of life) and therefore they must not restrict residents’ access to VAD
  • Can aged care facilities which rely on government funding for the most part of their operations impose their religious view on residents in relation to accessing a legal service such as VAD?
  • “I find it problematic when some seek to impose their moral or faith position on others, or to constrain the options available to others in alignment with their moral, personal or faith position”. Meg Webb speech
  • Residents must have the basic right to have qualified medical practitioners and other health professionals attend their usual place of residence (that they consider their homes) to provide VAD services upon their legal request
  • It would be inhumane and indefensible for residents to need to be transferred (possibly by ambulance) to another facility for VAD
  • Where would they be transferred to? People don’t die on command, or when there is a vacancy
  • Those working in these ‘entities’ at any level already have the right to refuse participation in legal VAD, if they so choose (‘conscientious objection’)
  • Equally, those working in these ‘entities’ at any level must have the right to participate in legal VAD, if they so choose (‘conscientious participation’)
  • For ‘entities’ to be allowed to have this refusal right undermines the ‘conscientious participation’ rights of all those working in and living in these ‘entities’
  • This could be used as precedent for ‘entities’’ rights to be included in human rights bills that Tasmanian Parliaments consider in the future.
  • Support for VAD by Christians is high – amongst Australians who still counted themselves as affiliated with the major Christian denominations in 2019, sizeable majorities supported VAD (Neil Francis Blog – Surging Support for VAD)
The Bill as it stands requires the first request for the VAD option to be face to face, but if it is necessary and is acceptable to the doctor and the patient involved, then any other consultations can be through the distance option of telehealth. It is difficult to believe that Sarah Courtney’s proposed amendment around telehealth would require all VAD requests and assessments, and particularly the final requests, to be face to face. To expect this would be callous in the extreme when a legitimate alternative is available. The unavailability of telehealth has been identified as a key weakness in the Victorian VAD model.
Arguments against telehealth rely on the commonwealth law that suicide material cannot be conveyed via a carriage service. That VAD is not suicide has been argued and demonstrated academically and legally over and over, and is covered in the Tasmanian Bill (Clause 137). There may still be some legal issues to be clarified but these should not hold up the legislation. DwDTas cannot support any amendments to the telehealth provisions.
Some issues that you may want to address include:
  • Tasmania has few doctors in rural and regional areas
  • Telehealth gives equitable access across Tasmania, and has been proven to be a great asset for both doctors and their patients during Covid restrictions
  • Telehealth can be conducted in the comfort and security of the dying person’s own home
  • VAD is not suicide, but rather a legitimate medical procedure when a person is terminally ill and therefore commonwealth laws about misuse of carriage services must not be applied to VAD legislation
  • Telehealth is endorsed by the Australian Health Practitioner Regulation Agency (AHPRA) which states that no specific equipment is required to provide telehealth services. Services can be provided through telephone and widely available video calling apps and software. Free versions of applications (ie non-commercial versions) may not meet applicable laws for security and privacy. 
  • The Review indicates that without some use of telehealth, the three requests and four assessments (more than those required for Victoria and WA) required under the Tasmanian legislation would be far too onerous for both patients and medical practitioners (P78 6.4.9)
It is important to keep pressure on all HA Members – the anti brigade certainly will be."
Importantly, he says: 
The Uni Report is positive, detailed and will be of great assistance in reassuring and supporting HA Members in their deliberations.     
None of the Review Panel's suggestions take away from the intent of the current Bill (except the institutional entities).
Whilst the Panel have suggested amendments for consideration some of those could be addressed in regulations.
It is difficult to make comment on proposed amendments until they are clearly written to see what impact each would have, but I imagine some will just be proposed to be in the Bill with little impact on the actual process. 
This will still all be about getting the bill through, and making amendments if indeed they help the Bill deliver for the person.
The Member for Bass, Sarah Courtney, is currently considering amendments, as are other HA Members.  If DWD have suggested amendments, or concerns about ones that might be put up, now is the time to contact her, or your preferred Member.
The legislation passing is close and the debate once finalised in the House should see the bill pass . 
University of Tasmania Independent Review of the End of Life Choices (VAD) Bill
Members of the House of Assembly details including email addresses
Meg Webb MLC’s Speech on the Bill
Newspaper Letters to the Editor templates
The paper DWDT newsletter was kindly printed by the office of Nic Street MP, Liberal Member for Franklin.
Copyright © 2021 Dying with Dignity Tasmania Inc, All rights reserved.

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