Mr Finn said in part:

“In rising to speak on the Voluntary Assisted Dying Bill 2017, it is with an extraordinary sense of responsibility that I stand here today — an overwhelming sense of responsibility. This is a bill about who lives and who dies. This is not just another bill. We all take seriously the issues that we discuss every day — education, transport, community services. We obviously put a fair bit of seriousness on those. We have a great sense of responsibility for those as well, but the responsibility on our shoulders today and possibly in the weeks ahead is, as I say, quite overwhelming. Allowing someone to die cannot be taken lightly in any way. No matter can be more serious. If passed, this bill will not only change the law but change our definition of medicine. Indeed it will change the culture that we live in.

This matter in fact is so significant that we have a number of former prime ministers who are actually lining up to condemn it. I cannot help but observe that this may well be one of the very few times that Malcolm Turnbull and Tony Abbott have been in agreement in about the past four or five years, but they are certainly in agreement on this matter. When you throw in Paul Keating and Kevin Rudd that is quite a mixture, but they are all in agreement.

It is not every day that I refer to or indeed quote Paul Keating, but I would like today to quote some of the remarks that he made in the Sydney Morning Herald on 19 October on the issue.

He said:

They are comments that are well put. They are comments that I totally and absolutely agree with. Paul Keating makes the point from which we cannot escape: this bill is about killing patients. It is not about turning off machines; it is not about giving doses of morphine or some other medication that will shorten life. It is about the deliberate, premeditated killing of another human being.

I want to refer now to the editorial of the Herald Sun the day after this bill was passed in the other place. It begins by saying:

Modern pharmaceuticals and advances in palliative care can manage pain and sedation at the end stage of life. Greater resources for and access to palliative care must be Victoria's focus.

The Herald Sun believes MPs in the upper house should reject the euthanasia bill in coming weeks.

Again, I agree with that entirely. So much is at stake, so many lives are on the line, we had better get this right — we had better get this right.

As a contrast to the threat that this bill presents, I support the far greater utilisation of palliative care. I cannot help but think, as I hear stories from members in this house today and from some others who tell about the agony and the pain that they have seen others suffer as they died, that if we had proper palliative care in this state that would not happen — that would not be necessary. The fact of the matter is we do not have proper palliative care in this state.

I was greatly comforted by a professor of palliative care who said in this house just a couple of weeks ago that palliative care can control all the pain and deliver relief until death inevitably knocks. The problem is, as I say, Victoria has nowhere near the palliative care services that we need in this state. I refer to an email I received from Kathryn Bennett. She is a palliative care nurse practitioner, and she says:

This is a matter of the upmost importance. It is so important that we give dying Victorians the palliative care that they need.

One of the propositions that this bill is based on is the view that doctors do not make mistakes — that they can say, 'In 12 months you'll be gone' or 'In six months you'll be gone' or 'In 18 months you'll be gone'. Well, they do make mistakes, and I want to refer to a couple of my own experiences. My father was diagnosed with cancer when I was three years of age. I have no recollection of him as a well man. He was 27 years of age when he was diagnosed. He was at that time given 12 months to live. Clearly under this legislation he would be eligible, given the pain levels and so forth, for assisted suicide — not of course that he would ever have taken that option. He lived for a further 17 years, giving proof that when doctors say that you have got six months to live, you have 12 months to live, you have two years to live or whatever, it is quite often not a lot more than an educated guess. That is the fact of the matter. There are so many people walking around today who have been told by their doctor that they should be dead, and if they had listened to their doctor, under this legislation, they may well be dead. That is not something that we should regard as being acceptable.

There are two sorts of people who support this bill. The first are a group of people who are genuinely concerned about their own experience — about their own future if they were to contract a fatal disease. They are genuinely concerned; they do not want to die in pain. I have an enormous amount of sympathy. I have carried far too many coffins of far too many loved ones not to have a great deal of sympathy for people in that position. Indeed I might be tempted to reconsider my non-support of this bill if we could come up with a way to make it totally foolproof. If we could do that, yes, I would seriously look at it, because I do believe in choice. That is one of the reasons I am in the Liberal Party; I do believe in choice. But we cannot allow it, because there is just too much danger in this bill as it currently stands — far too much.

The second group is the one that worries me particularly. This is a group that will use this bill to kick down the door and introduce a much wider regime of euthanasia. These perhaps are best represented by the Peter Singers of this world. Professor Peter Singer is a man who has long been of the view that euthanasia is a great way to control things.

It is almost a dead certainty, if I can use that term, that if this bill is passed Philip Nitschke, that well-known purveyor of death, will be setting up his shingle somewhere in Melbourne. I have no doubt about that at all. It will be Philip Nitschke's one-stop killing shop. That is what we will have. You can put your life on it — quite literally.

This bill, as I said before, will change the definition of medicine as we know it. Now, at this point in time hospitals and doctors surgeries are places of healing. That is what we expect them to be. But if this bill is passed, hospitals in particular but doctors surgeries as well will be places where some lives are more important than others. There will be some who we will do everything to save, but there will be others who are there to be disposed of. This bill encourages value judgements on others' lives — not that some need encouragement.

My eldest son, when he was born some years ago, was born with spina bifida. We had a constant battle with the doctors at that hospital to keep him alive. They put enormous pressure on young parents — and I mean very, very young parents — with a newborn not to perform the surgery that would have kept him alive. We fought them, and he is still alive, and for that I am eternally grateful. But I often think of the couple in the room next door from country New South Wales who had a child in exactly the same situation. They made the decision that they would let the child go. It took a few days, and every day they came in and they sat with the child. They bonded with the child. They learned to love the child. One day they came in and they said they had changed their minds. They wanted the operation to close the lesion, but in the meantime that child had contracted meningitis. That child died that afternoon. I often wonder how they must feel even to this day, all these years later, and I still think about them and what they went through and indeed what they must still be going through. I recall at that time that every time I left the hospital I was concerned what would happen to my son while I was gone. I did not trust the doctors. I do not want to ever — ever — go through that again. And I do not want anybody else to ever go through that. Can you imagine having somebody you love in hospital and not knowing whether you can trust the doctors? Well, that was the thinking back then, and it is even more in place now. This legislation will open that up even more and make it more acceptable and more open to abuse.

We know that doctors are trained to heal; they are trained to cure. Will they need to be trained to kill? I refer to an Age article of 8 October which refers to a great deal of concern expressed by a number of people about the new regime that this bill would put in place for the medication — the drugs — that would presumably, hopefully, if this bill goes through, kill the people who are taking it.

Even Dying with Dignity vice-president Rodney Syme, a man who has been very active in this area for a very long time, said that whilst he supported the bill, which should not be of any surprise to anyone, he was incredibly disappointed that the government would consider a new concoction rather than negotiating with the commonwealth to allow doctors to prescribe Nembutal should the bill pass later this year. Even Philip Nitschke — Dr Death himself — questioned the proposal, telling Fairfax media:

So here we have one of the great exponents of euthanasia in this country talking about a second-rate drug combination. What happens — and this is something that this bill or any of the speakers to this point have not referred to in any detail at all — if the drugs do not work? What happens, for example, if you take the drugs, they give you a stroke and you cannot speak? What happens then? You are stuck between the devil and the deep blue sea. According to this bill, that is it — you are stuck that way. So a lot more thought has to go into this bill before it can be passed — a hell of a lot more thought. This area of 'medication', and I use that term extremely loosely, is one that has to be given a great deal more thought.

This bill is a leap — a giant leap — in the wrong direction. I ask members to join me in offering comfort, in offering support, and yes, love, to those at the end of their earthly journey. I implore members to join me in voting against this bill and giving those people who deserve it the support, the love, that they should have.

Mr Mulino said in part:

“Many of us in this place will have dealt with end-of-life situations that were difficult and distressing. To experience extreme physical or psychological pain or to witness the suffering of a loved one prompts many people to ask, 'Why can't we do more? Why can't we offer better options?'. Euthanasia and assisted suicide have long been proposed as a way to end suffering. I believe that while the impulse to relieve people of suffering is completely understandable, the framework proposed in this bill will cause more harm than good. This bill provides for both euthanasia, being a lethal dose directly administered by a doctor, and assisted suicide, being the provision of a lethal dose to a patient intended for self-administration. I will refer to both of these practices in my contribution.

The case for euthanasia and assisted suicide is often framed around the importance of respecting patient choice. The principal line of argument is that in a narrowly defined set of circumstances — including where consent is clearly given — it should be up to a person to decide how they wish to end their life. In particular many proponents argue that it is more compassionate to give individuals an additional option. Whether they take that option is up to them and will depend on their individual circumstances, their values, their pain level and their individual preferences. Proponents often focus on compelling examples of people for whom this choice would have made sense and for whom it should have been an option. I believe that framing the issue in terms of choice alone makes it seem deceptively simple.

One of the most widely respected and commonly cited investigations into end-of-life choices was commissioned by Mario Cuomo, the Democrat Governor of New York state. The task force he established included 25 doctors, lawyers, ethicists, philosophers and religious figures. It included practitioners and renowned academics across many disciplines. The members of the task force held a wide range of ethical viewpoints. Some found euthanasia and assisted suicide to be inherently wrong; others did not. Despite this diversity of views, they unanimously concluded that:

The House of Lords select committee inquiry into the Assisted Dying for the Terminally Ill Bill is another of the most globally cited reviews of this issue. That report supported this framing of the issue:

When he spoke on this issue in the federal Parliament Lindsay Tanner stressed that while he could conceive of individual instances where a strong moral case could be made in favour of euthanasia or assisted suicide, he then argued:

Proponents of this bill will argue that euthanasia and assisted suicide should only be available for those at their end of life, suffering unbearably and providing clear consent — not for everyone, but just for those few. In proceeding in this qualified way proponents undermine the foundational medical principle of 'Do no harm', and they do not replace it with a grand statement affirming personal autonomy and the right of every individual to choose when and how they die, but instead they seek to replace the Hippocratic oath, which has served the medical profession and the communities it has served for thousands of years, with an organising principle that could be described as 'This person would have died quite soon anyway. This intervention was justified in that he or she did not suffer'.

For some this bill might represent a crossing of the Rubicon at its shallowest point — the point at which the 'Do no harm' principle is most justifiably amended. But with this bill we would potentially take the first step on a longer journey where the values of society and the medical profession will be recast to include the right to die in an ever wider range of circumstances, and the organising principle will be personal choice, not the value of human life.

We risk creating a medical system in which, based upon underlying principles which are not clearly articulated, there will be two classes of people — those for whom euthanasia and assisted suicide are available and those for whom it is not. Why should euthanasia and assisted suicide only be available to some people? If a person suffering unbearably from a non-terminal condition requested assisted suicide, under the proposed regime they would be denied. The health system would instead be oriented towards providing support to that person to help them deal with their physical and psychological pain. In contrast, if a person suffering unbearably from a condition with a life expectancy of less than one year requested suicide, under the proposed regime they would be treated differently.

Before commenting on how arbitrary some of these eligibility criteria are, it is important to ask: why are we treating these two people differently? The strong implication is that even if you consent to ending your own life, if you fall outside the eligibility criteria society will not allow that choice. Instead society will do all it can to support you — all it can to prevent you from committing suicide. Implicit in the design of the scheme is the notion that because one person has less time to live and a lower quality of life the option of state-sanctioned suicide should be available. It will become one of the options that falls within standard medical practice for some people.

Creating different classes of people challenges in a profound way how it is that we view the worth of different people's lives. Many vulnerable people, particularly those whose quality of life is viewed as limited in the eyes of others, will find such a demarcation confronting. What does the proposed regime say about how we think about disability, for example? For decades our society has been increasingly focused on celebrating all that people with a disability can achieve — about how it can help them make their lives as fulfilling as possible. Many people with a disability will understandably worry about the practice of using quality of life as evaluated against a series of objective criteria as the measuring stick for whether the health system will focus exclusively on helping a person or, alternatively, on whether it will give them the additional option of being assisted with suicide. How will each of their lives stack up against eligibility criteria set by lawmakers they have never met?

Prominent playwright, actress and disability rights advocate Liz Carr has stated in relation to this bill:

Not one organisation of disabled people supports assisted suicide.

And again from Lindsay Tanner, who captured well the problem of creating different categories of people:

Numerous studies around the world have found that a high proportion of people with a terminal condition feel that they are a burden. A study of reports from family members of patients in Oregon and Washington state who had expressed a wish for a hastened death indicated that 59 per cent of patients who did not discuss wanting assisted suicide and 94 per cent of patients who did discuss wanting assisted suicide expressed distress due to feeling like a burden on others. The study found that data from other studies and from the Oregon health division supported that the fear of being a burden is common in patients who die by lethal prescription. Evidence from the Oregon department of health annual reports indicates that over 40 per cent of people who have accessed the physician-assisted dying scheme identified being a burden on family or caregivers as an end-of-life concern. For the most recent year for which data is available, 2016, the proportion was 48.9 per cent, almost half of those surveyed.

Doctor shopping is also extremely difficult to protect against. This bill contains, in my opinion, insufficient safeguards against this phenomenon. Foley and Hendon explored a well-documented case from Oregon involving a woman in her mid-80s with metastatic breast cancer who was in a hospice program. The patient's own physician was not willing to assist in her suicide, and a second physician refused on the basis that the patient was depressed. It was only when Compassion in Dying was contacted that a doctor was found who was willing to prescribe a lethal medication. The patient was seen by a psychiatrist, but only once.

Elder abuse is another significant problem in our society and is very difficult to protect against in a bill of this nature. The extent of elder abuse is hidden to a significant extent in our society, and if it is disclosed or discovered, it is often underreported. Some studies have estimated that between 2 per cent and 10 per cent of older Australians experience some form of elder abuse in any given year.

In light of all this evidence, what do the experts tell us about the likelihood of effectiveness of safeguards? The Australian Medical Association (AMA) is opposed to euthanasia and physician-assisted suicide. Dr Michael Gannon, the national president of the AMA, recently argued:

The AMA is far from alone; 107 out of 109 national peak medical bodies are opposed to doctors being involved with intentionally ending life. Last week the World Medical Association clearly stated its opposition to this bill and called on the Victorian upper house to reject the Victorian Voluntary Assisted Dying Bill 2017. It warned that vulnerable people will be placed at risk of abuse and questioned the effectiveness of the safeguards in practice.

Likewise the palliative care sector is broadly opposed to legalising euthanasia and assisted suicide. The peak body in Victoria, Palliative Care Victoria, has expressed its opposition to this particular bill. It stated that:

Last week, when commenting on the bill before us, former Prime Minister Paul Keating summarised this case strongly:

When balanced against all of these risks, how many people will this bill help? Experts in palliative care have indicated that with modern best practice pain can be managed in almost all cases. Some experts in palliative care have estimated that pain management is difficult in less than 1 per cent of cases and that even in these cases there are treatment options.

Associate Professor at Alfred Health Peter Hunter stated in evidence to the upper house committee that:

If this bill passes, it will no longer be possible for the terminally ill to simply accept that their role is to receive the care that is provided to them for as long as it is necessary. No longer will the matter of them being a burden to their family in a physical, social or economic sense be merely an unchangeable consequence of their illness. If this bill passes, they will have a choice, their family will know they have a choice and their carers will know they have a choice. Even if we lived in a utopia where relatives and carers always sought only the best for the patient at all times, that choice could be a burden in many instances. But we do not live in a utopia. Unfortunately there is abuse of the vulnerable in our society, and this bill while possibly helping some will also unfortunately expose many others to unscrupulous behaviour. This is not a bill which adds without taking away.

This bill is well-intentioned, but unfortunately I believe it is fatally flawed with inadequate protections for the vulnerable. I believe that, if it passes, our society will be worse off. I urge that the house reject this bill.”

Mr Mulino said in part:

“Many of us in this place will have dealt with end-of-life situations that were difficult and distressing. To experience extreme physical or psychological pain or to witness the suffering of a loved one prompts many people to ask, 'Why can't we do more? Why can't we offer better options?'. Euthanasia and assisted suicide have long been proposed as a way to end suffering. I believe that while the impulse to relieve people of suffering is completely understandable, the framework proposed in this bill will cause more harm than good. This bill provides for both euthanasia, being a lethal dose directly administered by a doctor, and assisted suicide, being the provision of a lethal dose to a patient intended for self-administration. I will refer to both of these practices in my contribution.

The case for euthanasia and assisted suicide is often framed around the importance of respecting patient choice. The principal line of argument is that in a narrowly defined set of circumstances — including where consent is clearly given — it should be up to a person to decide how they wish to end their life. In particular many proponents argue that it is more compassionate to give individuals an additional option. Whether they take that option is up to them and will depend on their individual circumstances, their values, their pain level and their individual preferences. Proponents often focus on compelling examples of people for whom this choice would have made sense and for whom it should have been an option. I believe that framing the issue in terms of choice alone makes it seem deceptively simple.

One of the most widely respected and commonly cited investigations into end-of-life choices was commissioned by Mario Cuomo, the Democrat Governor of New York state. The task force he established included 25 doctors, lawyers, ethicists, philosophers and religious figures. It included practitioners and renowned academics across many disciplines. The members of the task force held a wide range of ethical viewpoints. Some found euthanasia and assisted suicide to be inherently wrong; others did not. Despite this diversity of views, they unanimously concluded that:

The House of Lords select committee inquiry into the Assisted Dying for the Terminally Ill Bill is another of the most globally cited reviews of this issue. That report supported this framing of the issue:

When he spoke on this issue in the federal Parliament Lindsay Tanner stressed that while he could conceive of individual instances where a strong moral case could be made in favour of euthanasia or assisted suicide, he then argued:

Proponents of this bill will argue that euthanasia and assisted suicide should only be available for those at their end of life, suffering unbearably and providing clear consent — not for everyone, but just for those few. In proceeding in this qualified way proponents undermine the foundational medical principle of 'Do no harm', and they do not replace it with a grand statement affirming personal autonomy and the right of every individual to choose when and how they die, but instead they seek to replace the Hippocratic oath, which has served the medical profession and the communities it has served for thousands of years, with an organising principle that could be described as 'This person would have died quite soon anyway. This intervention was justified in that he or she did not suffer'.

For some this bill might represent a crossing of the Rubicon at its shallowest point — the point at which the 'Do no harm' principle is most justifiably amended. But with this bill we would potentially take the first step on a longer journey where the values of society and the medical profession will be recast to include the right to die in an ever wider range of circumstances, and the organising principle will be personal choice, not the value of human life.

We risk creating a medical system in which, based upon underlying principles which are not clearly articulated, there will be two classes of people — those for whom euthanasia and assisted suicide are available and those for whom it is not. Why should euthanasia and assisted suicide only be available to some people? If a person suffering unbearably from a non-terminal condition requested assisted suicide, under the proposed regime they would be denied. The health system would instead be oriented towards providing support to that person to help them deal with their physical and psychological pain. In contrast, if a person suffering unbearably from a condition with a life expectancy of less than one year requested suicide, under the proposed regime they would be treated differently.

Before commenting on how arbitrary some of these eligibility criteria are, it is important to ask: why are we treating these two people differently? The strong implication is that even if you consent to ending your own life, if you fall outside the eligibility criteria society will not allow that choice. Instead society will do all it can to support you — all it can to prevent you from committing suicide. Implicit in the design of the scheme is the notion that because one person has less time to live and a lower quality of life the option of state-sanctioned suicide should be available. It will become one of the options that falls within standard medical practice for some people.

Creating different classes of people challenges in a profound way how it is that we view the worth of different people's lives. Many vulnerable people, particularly those whose quality of life is viewed as limited in the eyes of others, will find such a demarcation confronting. What does the proposed regime say about how we think about disability, for example? For decades our society has been increasingly focused on celebrating all that people with a disability can achieve — about how it can help them make their lives as fulfilling as possible. Many people with a disability will understandably worry about the practice of using quality of life as evaluated against a series of objective criteria as the measuring stick for whether the health system will focus exclusively on helping a person or, alternatively, on whether it will give them the additional option of being assisted with suicide. How will each of their lives stack up against eligibility criteria set by lawmakers they have never met?

Prominent playwright, actress and disability rights advocate Liz Carr has stated in relation to this bill:

Not one organisation of disabled people supports assisted suicide.

And again from Lindsay Tanner, who captured well the problem of creating different categories of people:

Numerous studies around the world have found that a high proportion of people with a terminal condition feel that they are a burden. A study of reports from family members of patients in Oregon and Washington state who had expressed a wish for a hastened death indicated that 59 per cent of patients who did not discuss wanting assisted suicide and 94 per cent of patients who did discuss wanting assisted suicide expressed distress due to feeling like a burden on others. The study found that data from other studies and from the Oregon health division supported that the fear of being a burden is common in patients who die by lethal prescription. Evidence from the Oregon department of health annual reports indicates that over 40 per cent of people who have accessed the physician-assisted dying scheme identified being a burden on family or caregivers as an end-of-life concern. For the most recent year for which data is available, 2016, the proportion was 48.9 per cent, almost half of those surveyed.

Doctor shopping is also extremely difficult to protect against. This bill contains, in my opinion, insufficient safeguards against this phenomenon. Foley and Hendon explored a well-documented case from Oregon involving a woman in her mid-80s with metastatic breast cancer who was in a hospice program. The patient's own physician was not willing to assist in her suicide, and a second physician refused on the basis that the patient was depressed. It was only when Compassion in Dying was contacted that a doctor was found who was willing to prescribe a lethal medication. The patient was seen by a psychiatrist, but only once.

Elder abuse is another significant problem in our society and is very difficult to protect against in a bill of this nature. The extent of elder abuse is hidden to a significant extent in our society, and if it is disclosed or discovered, it is often underreported. Some studies have estimated that between 2 per cent and 10 per cent of older Australians experience some form of elder abuse in any given year.

In light of all this evidence, what do the experts tell us about the likelihood of effectiveness of safeguards? The Australian Medical Association (AMA) is opposed to euthanasia and physician-assisted suicide. Dr Michael Gannon, the national president of the AMA, recently argued:

The AMA is far from alone; 107 out of 109 national peak medical bodies are opposed to doctors being involved with intentionally ending life. Last week the World Medical Association clearly stated its opposition to this bill and called on the Victorian upper house to reject the Victorian Voluntary Assisted Dying Bill 2017. It warned that vulnerable people will be placed at risk of abuse and questioned the effectiveness of the safeguards in practice.

Likewise the palliative care sector is broadly opposed to legalising euthanasia and assisted suicide. The peak body in Victoria, Palliative Care Victoria, has expressed its opposition to this particular bill. It stated that:

Last week, when commenting on the bill before us, former Prime Minister Paul Keating summarised this case strongly:

When balanced against all of these risks, how many people will this bill help? Experts in palliative care have indicated that with modern best practice pain can be managed in almost all cases. Some experts in palliative care have estimated that pain management is difficult in less than 1 per cent of cases and that even in these cases there are treatment options.

Associate Professor at Alfred Health Peter Hunter stated in evidence to the upper house committee that:

If this bill passes, it will no longer be possible for the terminally ill to simply accept that their role is to receive the care that is provided to them for as long as it is necessary. No longer will the matter of them being a burden to their family in a physical, social or economic sense be merely an unchangeable consequence of their illness. If this bill passes, they will have a choice, their family will know they have a choice and their carers will know they have a choice. Even if we lived in a utopia where relatives and carers always sought only the best for the patient at all times, that choice could be a burden in many instances. But we do not live in a utopia. Unfortunately there is abuse of the vulnerable in our society, and this bill while possibly helping some will also unfortunately expose many others to unscrupulous behaviour. This is not a bill which adds without taking away.

This bill is well-intentioned, but unfortunately I believe it is fatally flawed with inadequate protections for the vulnerable. I believe that, if it passes, our society will be worse off. I urge that the house reject this bill.”

Dr Carling-Jenkins said in part:

We are debating a bill in this chamber today which was passed by the other place last sitting week after intense and exhaustive debate — or perhaps I should say exhausting debate, because there were very few answers given during the course of that time. It is a bill which represents injustice. If passed here in this place, we will be undermining justice everywhere, so to debate this bill is a grave responsibility. What we are debating here today will affect us all directly or indirectly. We are debating a regime which could affect us personally near the end of our very own lives. This is the destiny of this Parliament, and I believe that we will be judged harshly by our future generations if we allow this bill to pass. So I stand today to speak out against the Voluntary Assisted Dying Bill 2017 introduced by the government.

This is the most misnamed bill to ever come into our Parliament during this term. Why do we not simply call it what it is? This is the introduction of an assisted suicide regime and a euthanasia regime. The ability for these regimes to be completely voluntary is debatable at best, deceptive at worst. I think it is very important to make this point clearly to ensure that this distinction is understood. The Minister for Health, who introduced this bill, has time and time again claimed philosophical differences in the way this bill is being described; however, definitions are not philosophical, they are fact, and the fact is that this bill introduces two regimes — regimes which on 27 October even the World Medical Association called on this house, this place, to reject.

The first regime is assisted suicide, where state permits signed by the secretary of the department or her appointee will be issued to people diagnosed with 12 or less months to live, effectively accompanied by poison in a locked box, to give people the opportunity to kill themselves at home, alone, without any medical supervision in case something goes horribly, horribly wrong. The second regime is euthanasia, or physician-assisted suicide, where the doctor administers the medication, most likely through lethal injection, which is eerily similar to forms of capital punishment in the US. The only requirement for opting for euthanasia over self-administration is for a single, solitary doctor, possibly with a vested financial interest in the prospect, to certify that the person is physically incapable of self-administering or digesting the poison. What does this mean? Someone with a gag reflex who cannot swallow? Being physically unable to open the locked box on one's own? Or simply being debilitatingly scared of killing yourself so that your hands shake too much? This is not yet defined for this proposed regime.

Rather than being rare, it is likely that doctor-assisted suicide will become the norm in Victoria rather than self-administered suicide. More than 95 per cent of people in jurisdictions overseas prefer to take up doctor assistance when it is offered rather than self-administration. I do not know about you, Acting President, but this is not the state I wish to grow old in, this is not the state I wish to inflict on future generations and this is not the state I wish on our current elderly population — a state which puts a use-by date on the lives of people; a state which devalues disability in such a way that it will allow reasons such as incontinence, which is part of the everyday life of many people with disabilities, as a justification to issue a permit for someone to die; a state which thinks it is okay to encourage someone to opt for euthanasia rather than receive mental health assistance or even an assessment for depression; a state where, since we are going down the path of the Netherlands, we could see one out of every 20 deaths being death by doctor. This would equate to 2000 deaths per year in Victoria. I repeat — 2000 deaths.

I will vote against this bill because I believe it is my job, and the job of everyone in this chamber today, to protect the lives of our constituents and to prevent their unnecessary and untimely deaths. We do this when we discuss the road toll and take measures to prevent deaths on our roads, we do this when we talk about protecting our community from psychopaths who should not be receiving bail and we do this when we advocate for suicide prevention strategies — so we should also do this by rejecting this bill. I will not be voting for this bill, because it steps far outside our responsibility to protect and into a role of state-sanctioned suicide, I will not be voting for this bill because of its broad and far-reaching consequences and I will not be voting for this bill because it will undermine the fundamental relationship between a doctor and his or her patient. As nearly 400 health professionals have said in their statement 'Health professionals say no':

This sentiment was reiterated by the World Medical Association, which in expressing grave concern about this very bill, stated that:

They also warned that vulnerable people would be at risk should this bill passed. Out of 109 medical associations across the world, 107 have come out against assisted suicide and euthanasia, yet this government feels as though it knows better.

We often hear about the jurisdictions across the world which have implemented similar regimes to the ones we are debating today, but a lot less attention is given to the repeated rejection of similar legislation. In the US only five out of 50 states have implemented one of these regimes, for example. In the UK House of Commons in 2015 similar legislation was defeated by a vote of 318 to 118. In that same year the Scottish Parliament voted against the implementation of a similar regime by a vote of 82 to 36. These are overwhelming votes. This goes to the gravity of this bill.

This bill is not a progressive move on the part of the government. In fact I believe it is the height of arrogance to believe that they know better than medical associations and parliaments across the world.

As an expert in disability with 20 years experience in the field, a PhD in disability rights and lived experience, I feel that I must address the disability perspective of this bill. This bill sends a dark, discouraging, even disastrous message to many people with disabilities. This message is that your life — our lives — are not worth living, that we are better off dead than that kind of disabled and that the way to solve society's problems is to once again put us out of sight and out of mind, an archaic message that we have been fighting against for decades through the disability rights movement. This bill sets our movement back.

All we must do to qualify for this bill is to be in suffering. Yet this bill lacks any real definition of suffering, which is personal, subjective and above all situational. In Oregon, for example, some people who have taken up suicide have identified their suffering as coming from the financial cost of their treatment. Randy Stroup and Barbara Wagner were both told by their health insurers that the cancer treatment proposed for them by their doctors was not covered, but assisted suicide drugs were. Another kind of suffering mentioned by half of all people in Oregon accessing assisted suicide is their concern about being a burden to family, friends or caregivers. This is a very disturbing reason to choose to die. And I need to say here that people with disabilities are often led to feel guilty about the burden of their disability on others. This is a common reason to take up the offer of assisted suicide. Does anyone else see the warning signs here?

Others cite a decreasing ability to participate in activities that make life enjoyable, like, 'I can't play golf anymore' or 'I can't cook for my family anymore', and the loss of control of bodily functions such as incontinence or needing assistance to eat. These can all be part of the lived experience for people with disabilities. The late Stella Young, the comedian and disability activist who was a fierce opponent of euthanasia and assisted suicide laws, said this:

I agree with Stella Young. We are not yet there yet. In fact we are a long way from there.

Safeguards tend to indicate protections. However, there are very few protections under this bill. There is no protection for a frail or elderly person who is being made to feel burdened by their inheritance-impatient children. No family history or will checks need to be made prior to issuing a suicide permit. There is no protection for a person who is unable to speak, who is likely to have their gestures misinterpreted as there is no independent interpreter required to ensure that far from gesturing a desire to die, she may be gesturing that her care is inadequate and she is being abused and needs help.

There is no protection from predatory doctors, who will set up death clinics, with hostels attached, to enable them to help vulnerable people from interstate to establish residency quickly and efficiently so they can access our suicide and euthanasia regimes. And there is no protection from doctor shopping. No matter how many doctors assess a person as ineligible, a person can keep looking for two doctors who will assess them as eligible. There is no protection from death clinic doctors with a vested financial interest in the regime or with an ideological view that suicide is nearly always a rational choice to assess someone they have never met before as being free from coercion. And there is no protection from the beneficiary of the will being a witness at the time of the administration of a lethal dose by a doctor. I could keep going, but I think you have the idea.

The main argument being used in support of this bill is that there is a small group of people who, regardless of the best that palliative care can offer, still suffer from unrelievable physical pain or other physical symptoms. The only way to relieve the pain is said to be to kill them. This claim ignores the appalling situation that according to a letter dated 20 October 2017 from Dr Judi Greaves, chair of the Palliative Care Victoria Board, at least 10 000 Victorians die each year missing out on access to needed palliative care. The letter rightly warns us not to make assisted suicide a default option due to poor access to quality care. The advice I have received from Palliative Care Victoria is that there is always something that can be done to deal with pain and other physical symptoms at the end of life, including in rare cases using palliative sedation.

The bill uses the phrase 'suffering that cannot be relieved in a manner that the person considers tolerable', yet there is no definition of 'suffering' in the bill. There are no processes for assessing the nature and level of the suffering, there is no requirement to refer the person to a specialist palliative care assessment to ensure that they are getting access to gold standard palliative care and there is no requirement for the assessing doctor even to know what the best practice in palliative care is.

Some people will be helped to commit suicide or killed by euthanasia who could have had their pain or other physical symptoms relieved with the proper help. They may be one of the 10 000 Victorians dying each year now without access to the best palliative care in Victoria simply due to the lack of funding from the same government that has promoted this bill.

This bill is widely recognised as a first step towards institutionalising a retirement age or, as Philip Nitschke proposed recently, everyone aged over 70 being given a permit to commit suicide by lethal drugs in Australia. It is a first step towards extending the regime to access by a broader group of people, described by Ms Patten to the Age as 'anyone who wanted to die'. It is a first step towards extending the regime to people with an advanced illness even if not terminal, which was a feature of Ms Hartland's attempt to legalise euthanasia 10 years ago in his place. It is a first step towards devaluing the role of palliative care and ensuring that palliative care will never be available to all.

I should note that some proponents of assisted suicide and euthanasia acknowledge that some people will die who should not, but they do not care. In fact, to them, this is simply collateral damage. British neurosurgeon and advocate for assisted suicide Henry Marsh has argued that it does not matter, and I quote here:

Victorians who are genuinely suffering at the end of life need access to gold standard palliative care, a standard I have illustrated is simply not yet available to all. Victorians contemplating suicide for any reason need to be assisted to see that there is always a better way. They do not need doctors agreeing that they are better off dead, and they do not need the government authorising them to die alone with an experimental cocktail of lethal drugs.”

“But the combination turned out to be too harsh, said Dr. Robert Wood, a volunteer medical adviser for End of Life Washington.

“The chloral hydrate mixture was too caustic for some folks and our volunteers didn’t like using it,” because some patients became distressed, Wood said.

Most doses of lethal medication are bitter, often requiring patients to take anti-nausea drugs. But the new mixture was not only bitter but also caused a burning sensation in the mouths of some patients, said Glennon. “There was some profound burning,” she said. “We didn’t like working with it. As a volunteer, you want to reassure people. We’re about a peaceful, dignified death.”

“[Twenty percent] of the cases were three hours or more before death, which we think is too long,” said Robert Wood, a retired HIV/AIDS researcher who volunteers with the advocacy group End of Life Washington, in an email. “The longest was 31 hours, the next longest 29 hours, the third longest 16 hours and some eight hours in length.”

Patients and families are told to expect sleep within 10 minutes and death within four hours. When it takes far longer, family members get worried, even distressed, said Dr. Carol Parrot, a retired anesthesiologist who has prescribed drugs for dozens of aid-in-dying patients in Washington.

The elderly are at an at-risk group for a lot of reasons, including, but not limited to diminished capacity, isolation from family and other caregivers, lack of sophistication when it comes to purchasing property, financing, or using computers. Defendants are family members, lots are friends, often people who befriend a senior through church.

Many who suffer from abuse . . . don’t want to report their own child as an abuser.

The bill allows a patient to administer the lethal dose in private, without a witness or doctor present. In addition, the drugs typically used are water and alcohol soluble, such that they can be injected into a sleeping or restrained person without consent. Alex Schadenberg, Executive Director for the Euthanasia Prevention Coalition, puts it this way:

With assisted suicide laws in Washington and Oregon [and with the proposed bill], perpetrators can . . . take a “legal” route, by getting an elder to sign a lethal dose request. Once the prescription is filled, there is no supervision over administration. Even if a patient struggled, who would know?”

Review of these patients’ stories highlighted for me the importance of demoralization as a significant mental state influencing the choices these patients made. They described the pointlessness of their lives, a loss of any worthwhile hope and meaning.

Their thoughts followed a typical pattern of thinking that appeared to be based on pessimism, sometimes exaggeration of their circumstances, all-or-nothing thinking in which only extremes could be thought about, negative self-labelling and they perceived themselves to be trapped in this predicament. Often socially isolated, their hopelessness led to a desire to die, sometimes as a harbinger of depression, but not always with development of a clinical depressive disorder. It is likely that the mental state of demoralization influenced their judgement, narrowing their perspective of available options and choices. Furthermore, demoralized patients may not make a truly informed decision in giving medical consent.

Demoralization syndrome … is an important diagnosis to be made and actively treated during advanced cancer. It is recognised by the core phenomenology of hopelessness or meaninglessness about life. The prognostic language within oncology that designates ‘there is no cure’ is one potential cause of demoralization in these patients, a cause that can be avoided by more sensitive medical communication with the seriously ill. While truth telling is needed, hope must also be sustained so that life may be lived out as fully as possible. Patients with advanced cancer can be guided to focus on ‘being’ rather than ‘doing’, savouring the experiential moment of the present, so that purpose and meaning are preserved through inherent regard for the dignity of the person. Active treatment of a demoralized state by hospice services would involve counselling and a range of complementary therapies, use of community volunteers and family supports, all designed to counter isolation and restore meaning.

[I]t is "commonplace" for patients to tell doctors in front of their loved ones that they have no wish to be a burden on families.

Once this bill is passed the expectations of patients and families will change. The culture of dying, despite certain and intense resistance, will gradually permeate into our medical, health, social and institutional arrangements. It stands for everything a truly civil society should stand against. A change of this kind will affect our entire community not just a small number of dying patients. It is fatuous to assert that patients will not feel under pressure once this bill becomes law to nominate themselves for termination.

An alarming aspect of the debate is the claim that safeguards can be provided at every step to protect the vulnerable. This claim exposes the bald utopianism of the project – the advocates support a bill to authorise termination of life in the name of compassion, while at the same time claiming they can guarantee protection of the vulnerable, the depressed and the poor.

No law and no process can achieve that objective. This is the point. If there are doctors prepared to bend the rules now, there will be doctors prepared to bend the rules under the new system. Beyond that, once termination of life is authorised the threshold is crossed.

the wrong message to people contemplating suicide and undermines suicide prevention efforts. How could this not be the case? Suicide is the leading cause of death among people aged 15-44 and the second leading cause of death among people aged 45-54. International studies offer no support for the view that legalising euthanasia is associated with a decrease in non-assisted suicides.

the civilisational ethic that should be at the heart of our secular society.

The concerns I express are shared by people of any religion or no religion. In public life it is the principles that matter. They define the norms and values of a society and in this case the principles concern our view of human life itself. It is a mistake for legislators to act on the deeply held emotional concerns of many when that involves crossing a threshold that will affect the entire society in perpetuity.

Society's focus at the end of life should be on efforts to address suffering and the needs of patients and families, including improving access to effective hospice and palliative care.

Access to state-of-the-art symptom control remains limited for all dying patients. Of particular concern, evidence of ethnic and racial disparities in access, outcomes, and communication is increasing. Many patients fear they will not receive appropriate end-of-life care when they need it. Others are concerned about being a financial, physical, or other burden on their family, losing autonomy or control, or being placed in a long-term care facility. Some are alone or lonely; loneliness has a mortality risk similar to that of cigarette smoking, yet its health implications are underappreciated. Many persons approaching death are clinically depressed or have other psychiatric comorbid conditions, and some contemplate suicide. According to Wilson and colleagues, “the expression of a desire for death by a terminally ill patient should raise a suspicion about mental health problems; by itself, however, it is not definitively diagnostic of one”. This desire fluctuates over time and may be related to inadequate symptom management. Medicine can and should ameliorate many of these problems; some, however, are outside the scope or goals of medicine and should be addressed in other ways.

Legalization of physician-assisted suicide also raises social justice issues. Society and the medical profession have duties to safeguard the patient–physician relationship and human dignity. These duties apply especially to the most vulnerable members of society: the sick, the elderly, children, the disabled, the poor, minorities, and others.

Some individuals might view themselves as unproductive or burdensome and, on that basis, as candidates for assisted suicide, especially if a physician raises it or validates a request.

1. Be present, listening to the patient and keeping dialogue open, exploring the reasons for the request, trying to understand its meaning and seeking alternative solutions where possible.

2. Affirm that he or she will care for and not abandon the patient, accompanying and advising the patient through the journey of end-of-life care (studies suggest “the desire to hasten death is future focused and appears to be related to fear of distress and not coping, rather than with current levels of distress or coping ability”.

3. Discuss patient goals of care and the nature of curative and comfort care, explaining a both/and approach to disease-oriented and palliative care as well as an either/or approach and asking, for example, how do you hope I can help you?

4. Facilitate advance care planning and an understanding of surrogate decision making, as desired by the patient.

5. Ensure that the patient is fully informed of the right to refuse treatments and what that entails.

6. Discontinue or do not start medications and interventions that interfere with the patient's values, goals, and preferences.

7. Assess and treat the patient's pain and other distressing physical and psychological symptoms.

8. Assess and optimize patient function through a whole-patient focus.

9. Coordinate, as desired by the patient, the efforts of other members of the health care team, and use community-based resources to address financial, emotional, and spiritual burdens on the patient and family.

10. Prepare the patient and family for what they can expect as illness progresses, addressing uncertainty together and ensuring that the patient and family have informed expectations, including, for example, an understanding that advanced illness often entails a natural loss of appetite and thirst.

11. Regularly assess the patient's status and decision-making capacity.

12. Arrange hospice care at home if that is the patient's preference, being cognizant that palliative and hospice care expertise should be used as early as is indicated. Many patients in the United States receive such care too late or not at all.

“The identity of participating physicians is coded, but the identity of individual patients is not recorded in any manner. Approximately one year from the publication of the Annual Report, all source documentation is destroyed.”

To ensure confidentiality, our office does not maintain source information on participants.

“Before it becomes a legal option, caring for someone who needs care is just the human thing that you do. But once they have the option to 'choose' to let their lives be ended, their not doing so is to choose to burden their next of kin - and that's unfair!”

Their conclusion [the MAP] is not the conclusion that Jeanette Hall or I would use. Jeanette was saved because she saw a doctor (myself) who did not believe in assisted suicide. She strongly believes that if she had been under the care of a doctor who believed in assisted suicide that she would now be dead. Instead she is alive 17 wonderful years later.