Malcolm Baalman, PHAA
From early 2023, Queenslanders will join Australians from four other states in having access to voluntary assisted dying arrangements, after the Queensland Parliament endorsed state laws yesterday.
As with all cases of such law reform in Australia, the issue was declared a conscience vote of all members of the state Parliament. Last night, after two days of debate, the parliament voted by 61 to 30 in favour of the Voluntary Assisted Dying Bill 2021.
The result leaves only NSW and the Territories as locations where no laws have been adopted.
Legal reform on the issue has come on quickly in Australia since 2017, when Victoria became the first state to legislate. Subsequent law reforms were passed in Western Australia (2017), South Australia (2021) and Tasmania (2021). Due to allowances for the community and medical advisers to prepare for the laws commencement, only the Victorian and WA laws have to date come into legal effect. Other state reforms should all be in force by early 2023.
The New South Wales Parliament took up considering a reform Bill in 2017, but lacking the support of the state government, the issue has not progressed.
While assisted dying is inherently a state-level legal issue, the Commonwealth Parliament at national level considered law reform proposals in 2014.
The two territories have yet to legislate, because a private members bill at Commonwealth level in 1997 deleted the issue from the legislative capabilities of the Territory Legislative Assemblies. That move came after the Northern Territory became the first jurisdiction to adopt an assisted dying law, in 1995. Multiple efforts have been made since to restore the Territories’ legislative power, with one such effort to restore Northern Territory powers currently before federal Parliament.
Euthanasia or assisted dying schemes have also been legislated in several overseas places internationally, including in the Netherlands in 2001, Belgium in 2002, Luxembourg in 2009, Switzerland in 2011, Canada in 2016, and New Zealand from late 2021. Laws are also in effect in several states in the United States including California, Colorado, Oregon, Vermont, Maine, New Jersey, Hawaii, Washington state and Washington DC.
The Public Health Association of Australia (PHAA) adopted a policy statement on End of Life Choices on the issue in 2018. Noting that the issue was connected to personal beliefs about the nature of life, the statement “recognises that issues around end-of-life choices are contentious and difficult to resolve in a purely objective manner. Many people have personal experiences and cultural frameworks and beliefs which inform their opinions.”
But PHAA’s ongoing position, drawing on equity principles, is that in framing legislation for end-of-life management, “the beliefs of the individual who is dying should have primacy in order to respect their autonomy.”
Legislation can accommodate the diversity of ethical stances in Australian society. In almost all cases jurisdictions with legislation allowing euthanasia or assisted suicide allow health professionals to not participate if they conscientiously object.
Not all people are able to die with dignity, for many reasons. Inequity exists in Australia in relation to people’s access to appropriate palliative treatment and care. This is particularly true of access to high quality end of life care which may be affected by location (there is reduced or lack of access in regional and remote areas), education and knowledge of health professionals, and funding mechanisms which do not support holistic care.
PHAA’s policy states that all possible action should be taken to ensure that a decision to participate in euthanasia or assisted dying is not driven by a lack of access to appropriate care.
Ultimately, the absence of legislation on end-of-life choices does not mean that some people do not end up having to face end-of-life choices. This has been recognised by medical practitioners and experts in Australia and internationally.
A lack of legislation does mean that there is inequity, with some people having the knowledge, power and opportunity to make and enact these choices, while others do not. Reasons such as disability or competence results in some people being in a position to end their life whilst others are not.
PHAA’s ongoing approach to the issue, based on the 2018 statement and revised to take account of recent law reforms, is among policy statements to be considered at the organisation’s AGM next week. The revised statement calls for the following:
- Further research and consideration of end-of-life choices should be encouraged.
- Legislation to legalise euthanasia or assisted dying should include safeguards to protect both patients and health professionals.
- Legislation to legalise euthanasia or assisted dying should also include a commitment to improve death literacy, access to palliative care and structured end of life communication such as advance care directives.
- Consistency of legislation across all States and Territories to support advance care directives is required to appropriately safeguard both individuals and health professionals.
The Commonwealth Parliament should restore the legislative capacity of the ACT and the Northern Territory to enact legislation regarding end-of-life choices.