Michelle Lensink

Consent To Medical Treatment And Palliative Care (End Of Life Arrangements) Amendment Bill

This speech is to indicate that the Hon. J.M.A. LENSINK is unable to support the Consent To Medical Treatment And Palliative Care (End Of Life Arrangements) Amendment Bill at this time.

Adjourned debate on second reading (resumed on motion).

 The Hon. J.M.A. LENSINK (20:21): This is probably one of the most difficult issues that any of us as legislators have to deal with. This is the third time I will be considering this issue. The first time was in 2003 when, as a new MLC at that time, I voted against that bill; and then again in October last year, I voted in favour of the Hon. Mark Parnell's bill. I would have to say that I come to this issue fresh each time because of the significance, depth and weight of issues we have to deal with. In principle, I believe in the liberal position that people should have the right to choose, and this extends to those who are suffering in an irretrievable situation in terminal illness.

 I acknowledge that many Australians and South Australians want to have control over their end-of-life decisions. They do not wish to die in pain, and they do not wish for their life to continue if they are demented or if they have lost control of bodily functions and so on. I think a particular part of that is a fear of prolonged suffering, which is an important consideration to which I will return later. My colleague and the leader, the Hon. David Ridgway, articulated examples in relation to those, so I will not go over those again.

 I would have to say that many people who are particularly vocal about expressing their wishes are educated and articulate and know what they want. We hope that, in reality, very few people will ever be in a situation of needing to access the provisions we have before us. I would like to refer to an article, which I think gave me a bit of a jolt, in The Australian, on the weekend of 2 and 3 October 2010. The article was written by Angela Shanahan, and it is entitled 'Right-to-die polls no basis for radical change'. We have had a lot of discussion in the debate tonight and in previous discussions about what the polls mean. They should not be seen as a blunt instrument either way; I think the debate is much more nuanced than that. In this article, Angela Shanahan says:

The 45 to 65 age group showed the most support, with 80 per cent in favour. But the age breakdown of the poll showed the greatest opposition—
and this is in relation to a poll published by News Limited—

 came from the people who are always portrayed as avid supporters of euthanasia: the elderly. Those aged 65 to 74 had only 18 per cent approval. A more nuanced poll would reveal that rather than fearing being a dribbling demented mess, most old people feared the Dr Death at the nursing home.

 End-of-life decisions are hypothetical, and I think that is the point that Angela Shanahan makes, and I think it is often an issue that is lost in this debate.

I am currently a joint custodian, together with my father, for my mum. She has had her third bout of cancer. She has had her third operation and, happily, she is alive and well. She is angry about not being as educated as she would have liked, but that is a product of her upbringing. She is articulate, and she knows what she wants.

In the lead-up to this latest round (I am not entirely sure of the terminology, but it is in relation to provisions that exist in the Consent to Medical Treatment and Palliative Care Act as they are), I think it was an anticipatory direction she applied for, which means that, should the worst happen and she is unable to make decisions or express them herself, she does not want to continue to have futile treatment. But it went to the point where it would involve my dad and me having to make decisions about whether machines were turned off and so forth and whether medical treatment was withdrawn.

At the point before she went in for her operation, I said, 'What's your intention?' She had written her intentions down, but I certainly was not getting the intention that she was ready to throw it all in. She said, 'No, no, no; I still want to fight.' I think she has felt rather tired of her many medical illnesses over the years, and at times she has felt like it is all just too hard and she wants to give in, but then the spark will come back.

I relate that story because I would take the precautionary approach with my mum and I would want to follow her wishes as closely as possible. From what I understand, clauses have been taken out of this bill which relate to those advance directives, and I think that is a wise thing because, as I say, those advance directives are hypotheticals.

The assessment needs to be made continuously for those people in order to match their wishes as closely as possible. However, ultimately, if my dad and I were faced with that choice I would not want to let her go, because I would not be convinced that that is the decision that she would want to make for herself. I think the Hon. David Ridgway articulated that quite well in his second reading contribution.

 This issue was been debated recently on ABC Radio National in an interview on 7 October 2010, where Mark Colvin, as compere, interviewed an academic from Oregon who is involved in the process, Associate Professor Barbara Glidewell, and the federal AMA President, Dr Andrew Pesce. The associate professor referred to the situation in Oregon and said:

It's really incredibly important to have structure and to have safeguards and, further, to provide for patients to understand the process.
I think we have been struggling with the issue of structure and safeguards. There have been amendments which reflect that structure and safeguards are incredibly important, and for us to support this we have to be confident individually that they are right; I do not feel that I have that situation. I have not been able to reconcile all the different pieces of how this fits together which has, quite frankly, been a question of time in terms of not being able to pull those parts together.

On these conscience matters occasionally I find myself on the same side as the Hon. Robert Brokenshire, and occasionally not. The examples that he has talked about concern Aboriginal communities, and I think there are other communities who would be similarly affected and who do not necessarily understand that, just because it is legal for voluntary euthanasia to take place under very certain strict conditions, when they seek treatment that is not going to happen to them. That has also tipped me against supporting the bill on this occasion.

In Oregon the process is that a person will request the option. I am not saying that I necessarily support that model. That is a big question I have in my mind as to which model would be ideal. If the patient meets the requirements they will receive a prescription. However, interestingly, a number of patients do not use the medication in the end. I think that goes to the point that people want to have a safeguard.

I think that many people feel that, if they are in a situation that is irretrievable and they feel it is unbearable and they are going to die anyway and they would like to have that option there, when faced with that situation they do not necessarily feel the need. I am clearly concerned about vulnerable people. I have spoken about that in my speeches before. I have seen people, having worked as a physio in hospitals, who may feel coerced, that they have become a burden on society and there is nobody to look after them, and maybe it is just better for everyone if their life was to come to an end.

There is a further issue about a potential shift in culture in our health system. We had a bit of a discussion on ABC radio about doctors this morning, and I note that the AMA remains opposed to euthanasia. As far as the medical profession is concerned, doctors are governed by a code of ethics which, to quote Dr Andrew Pesce, 'does not allow administering of a treatment whose sole fundamental purpose is to end a person's life'. There is a balance that we need to take, and some might take the view that doctors ought to comply with patients' wishes, but I think that it is important to frame this situation against what is a fundamental tenet of being a doctor and the Hippocratic Oath, which is to do no harm.

Trust is also a cornerstone of the doctor-patient relationship, and that plays again into issues of people who may not understand what their rights are and may not understand that the laws do not apply to them and that they can safely seek treatment from their doctors without fear of euthanasia. The educated and articulate people in our community will always know their rights and will have done their homework, checked it on the internet, asked questions, etc.

I am very bemused by the fact that evidence from the Netherlands is being used by both sides of this debate, and I have not had an opportunity to review that evidence. I would really like to see a full literature review conducted by an independent source such as a journal of the calibre of The Lancet. I understand the scientific process and I think that the truth lies somewhere in between.

I feel rushed in this process and I am not seeking to say anything against the honourable mover, who has sought in good faith to have a proper debate on this bill but I think, given the weight of it, I do not think that I can make a decision on something which is as important as this under the circumstances. Really, we are debating the circumstances around deliberately ending someone's life which, under other circumstances, is considered murder and is a criminal act, and the highest safeguards need to be ensured. Under the circumstances, I am unable to support the bill at this time.

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