Give people gift of knowing there is a compassionate option

End of Life Choices Bill for those times when palliative care is not enough, says Robyn Maggs

IT is not often that our Tasmanian members of parliament are asked to legislate on life and death issues. MLC Mike Gaffney’s End of Life Choices (Voluntary Assisted Dying) Bill allows the very small number of Tasmanians who are terminally ill and cannot be sufficiently helped by palliative care to die peacefully and with those loved ones they choose to have with them. They must have attained the age of 18. There are Tasmanian residency requirements. They must have decision-making capacity. They must be acting voluntarily. They must be suffering intolerably. They must have a relevant medical condition: a disease, illness, injury or medical condition that is advanced, incurable and irreversible and is expected to cause the death of the person.

Mike Gaffney’s Bill has built on decades of hard work and research by many skilled and committed Tasmanians. It builds on the mammoth work that went into the Victorian and West Australian legislation. And beyond that, Mike educated himself, both in Australia and overseas, about both sides of the voluntary assisted dying argument. He spoke to groups involved in aged care and disability. He went overseas and learned the results of evidence-based research from those involved in this area in the US, Belgium, Switzerland, Canada and the Netherlands. Both Mike and other knowledgeable groups, such as Dying with Dignity Tasmania, have provided all Tasmanian MPs with independent, reliable, evidence-based information. It becomes their responsibility now to educate themselves on the complexities of this legislation and why it is the best option for Tasmania.

Our MPs also need to question the reality of statements from those opposing this legislation.

Among the most hostile are some religious leaders and the Australian Medical Association. There are factual reasons why our MPs, while respecting their right to a personal opinion, do not need to consider their opposition. The AMA only represents 26 per cent of doctors. And when the AMA surveyed its members in 2016, a majority, 51.55 per cent, agreed with the statement, “Euthanasia can form a legitimate part of medical care”.

Every poll in recent years shows the majority of Catholics and other Christians support voluntary assisted dying. Yet some of the strongest opposition comes from their religious leaders. Catholic Archbishop Julian Porteous, wrote, “with the right medical care and emotional support, physical and mental pain can be managed and the person can experience a relatively peaceful natural death”. But Palliative Care Australia

wrote, “complete relief of suffering is not always possible, even with optimal palliative care”. The AMA 2016 survey had 69.96 per cent of its doctors agreeing with the statement: “There are patients for whom palliative care or other end of life care services cannot adequately relieve their suffering.” Professor Michael Ashby, Director of Palliative Care in the Tasmanian Health Service wrote in 2016, “palliative care, however good and available, does not meet the needs or autonomous wishes of all people”. This legislation states that those requesting VAD must be told where advice in relation to palliative care may be obtained.

Those hostile to this Bill denigrate the issue as suicide. As a West Australian Attorney-General wrote, the WA Bill “makes it clear that voluntary assisted dying is not suicide”. That was an improvement on the Victorian legislation where this is not explicitly stated, but it is stated in the Tasmanian Bill. Another way the Tasmanian Bill has improved on, and learned from, difficulties in previous legislation, is that it does not require specialist qualifications for at least one of the two doctors involved in the assessment process, specialists that Tasmanians would know are difficult to access in our state. The Bill does not require the prognosis that death will occur within a specific period, something that is particularly difficult to predict and in practice notoriously unreliable.

In my work as a clinical psychologist, I learned that what terminally ill individuals feared on a daily basis was the ongoing pain they might not be able to tolerate and the risk that, if rendered unconscious by palliative treatment, they would lose control of their own decision-making. In the worst moments of their lives, can our MPs give these people the gift of knowing that voluntary assisted dying is a compassionate option.

Tasmanian Robyn Maggs is a clinical psychologist who has worked with people with terminal illness and their families.