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Weak links in rural and remote palliative care and replicated in draft Euthanasia legislation

Weak links in rural and remote palliative care and replicated in draft Euthanasia legislation
God’s people Weak links in rural and remote palliative care and replicated in draft Euthanasia legislation

Public hearings into the draft assisted suicide and euthanasia (VAD) legislation have laid bare some of the potential weak spots caused by the scheme’s operation in a highly decentralised state. Senior public servants were quizzed on the mechanics of the draft bill by a parliamentary Health Committee hearing at Parliament House on June 14, once again chaired by VAD proponent Aaron Harper (State Member for Thuringowa). Under the legislation, people who have opted for self-administration but live in rural and remote areas and are too ill to travel will be able to despatch a nominated contact person or agent to collect the lethal substance from a statewide pharmacy service.

Ms Eve Gibson, a social policy and legislation branch manager with the Department of Health, said this method of despatch was especially intended to deal with regional and remote access issues.

“If the person is terminally ill they may not be able to travel to the statewide pharmacy service to collect the substance themselves,” Ms Gibson said.

“That is to enable family members to assist in that regard. The substance needs to be kept in accordance with the storage requirements, which will be that it is in a locked box and not easily accessible by other people,” she said.

Such safeguards will be heavily reliant upon the diligence of assessors and the good state of repair of family relationships. It may be harder to detect coercion in remote and rural areas. The hearing also heard about the administration of the lethal substance, of which there was still no precise detail as to whether it would be in liquid, tablet or intravenous form. Health Department officials were intentionally vague on this part of the scheme, so as to avoid copy-cat concoctions amongst the general public. They only elaborated to the extent it would be a schedule 4 or schedule 8 substance, or combination of both, as prescribed in the Commonwealth Poisons Standard, and would be of a medicinal quality appropriate for the function that it is designed for.

Such contortions of language were evident at another stage when the Chair asked the Acting Deputy Director General of Queensland Health, Professor Keith McNeil, whether VAD could be deemed a medical procedure? Professor McNeil said it was an interesting proposition.

“It is certainly auspiced by medical procedures,” Professor McNeil said.

“There are two ways the voluntary assisted dying can be accessed… One is through self-administration—obviously there is prescription of the substance—and the other is with practitioner assistance… Depending on your definition of ‘medical procedure’, it could be drawn out that it is a medical procedure of sorts,” he said.

Speaking again later in the hearing Ms Gibson said the scheme included a range of provisions around managing the substance to ensure there was a chain of responsibility at all times.

“Once it has been supplied by the statewide pharmacy service, if it is practitioner administration and it is in the practitioner’s possession, if the person revoked their administration decision or they died before they were able to access it then the practitioner would return the substance to the statewide pharmacy service for disposal,” she said.

“There is also a provision for that practitioner to dispose of the substance themselves, and that is to address those rural and regional access issues… For self-administration, once it is in the person’s possession, again, if they either revoke their decision, decide not to go ahead with it or die before they self-administer the substance, then there are provisions requiring their contact person to return the substance to the statewide pharmacy service,” she said.

“That needs to be done as soon as possible and within 14 days to make sure that it is not just left lying around the person’s house… It needs to be returned for disposal within that 14 days, and there is a penalty on the contact person for not complying with that,” Ms Gibson said.

Once again such a practice in rural and remote areas will rely heavily on the utmost scrupulousness of medical practitioners and family members to account for any unused lethal substance. If safeguards always worked then the Australian public wouldn’t have been so shocked and appalled by the findings of the recent Royal Commissions into the Banking, Aged Care and Disability sectors. The public are reminded it is still not too late for them to make submissions to the Health Committee with regard to their views and any suggested amendments to the draft legislation. Published submissions on the Health Committee webpage are currently running at 20 against the bill, versus 37 in favour, significantly short of the much-touted figure of 80% of public support for euthanasia and assisted suicide.

Submissions can be made here until Friday July 2 at 9.00am.