Uni assignment \ subbmission on a bill, "Voluntary Euthanasia Bill 2008"

One of our assignments is to make a submission on this bill and im looking for some general comments people might have for it.

Firstly i should state that this will be a REAL submission going to the member who is suporting this bill

Secondly the submission will be suporting the general objectives of the bill so if you want to comment that vollentry euthanasia is wrong just dont bother because i wont even read the comments

Voluntary Euthanasia Bill 2008

There are some other relivent acts that tie into this:

CONSENT TO MEDICAL TREATMENT AND PALLIATIVE CARE ACT 1995

GUARDIANSHIP AND ADMINISTRATION ACT 1993

MENTAL HEALTH ACT 1993

 

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ok this is the compleated assigment (for the moment anyway

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).

Feel free to offer comments, especially about the amendment section of the assigment

i apologise for the lack of formating for it but i am not going to sit here all night fixing it for the site

 

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Question 2.

(a) Consult a copy of the most recent Bill introduced into the South Australian parliament dealing with the legalisation of medically assisted dying (physician assisted suicide or active voluntary euthanasia) – the Voluntary Euthanasia Bill 2007 proposed by the Hon Bob Such and found at http://www.legislation.sa.gov.au/listBills.aspx?key=V/
(b) Analyse the Bill and explain in clear detail precisely how it aims to overcome the standard objection: that safeguards will not work and a dangerous slide into illegal forms of killing will ensue.
(c) Explain to your reader why you would either support the passage of the Bill, or actively oppose it. A wholesale rejection of the Bill should be supported by detailed argumentative support.
(d) If you would accept the Bill but only with amendments then please state your amendments to the Bill in a parliamentary format: that is, please supply the original words in the Bill and then your proposed new wording.

 

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I am a supporter of patient autonomy and this includes the right to request assistance in dying when there isn’t a realistic prospect for continued survival and quality of life doesn’t meet the patient’s realistic standards. There for I strongly support the objectives of this bill. However there are serious flaws in the way the bill stands as printed which at best make it irrelevant, at worst complicate areas of law which have already been settled. I hope, though this submission to analyse this bill in detail and make suggestions with the aim of improving the bill.
What safe guards are present in this Bill

This bill though in need of amendment does contain safe guards to prevent abuse both by non terminal patients and by doctors and others seeking to pressure a person into accepting euthanasia against there will.
The first protection is found in Section 5. Subsection 1 requires that a person be of “sound mind” and “terminally ill”. This prevents a person who is unable to understand what they are consenting to being subject to the Bill.
Subsection 2 then goes on to require 2 separate medical practitioners to inform the patient of:
“(a) the diagnosis of the person's illness; and
(b) the prognosis of the person's illness; and
(c) the forms of treatment that may be available to the patient and the respective risks, side effects and likely outcomes of such treatments; and
(d) the extent to which the effects of the illness could be mitigated by appropriate palliative care; and
(e) the proposed voluntary euthanasia procedure, risks associated with the procedure and feasible alternatives to the procedure.”

This is to ensure that the patient is completely informed of all the facts of there case and the treatment options available before they are eligible to consent to the procedure. This also takes into account the principles set out in Rogers v Whitaker (1992) 175 CLR 479 that state a patient has an absolute right to all information pertinate to there case in order to make an informed decision about the course of treatment to be followed. Subsection 3 further goes on to explicitly state that there must be information given to the patient about palliative care options and if the practitioner isn’t a palliative care expert they must find out all information about the options from a palliative care expert to give to the patient

Next (as stated in section 6) the patient must officially make there request for voluntary euthanasia in front of the two doctors and 2 new witnesses. Now as I have stated below the previsions in regard to these witnesses needs to be amended but subject to that amendment this is a strong protection. Subject to the amendment I have listed below, the doctors are there to determine that the patient is either not suffering from a treatable depression like illness or that even if they are, that if treated euthanasia would still be there desire. This allows some leeway to the fact that facing imminate death most, if not all, people would suffer some form of depressive illness.

The witness are there to they agree that the person seems competent, and that they understand the implications of what they are requesting. However the most important part of the witnesses job is to make sure the patient is under no duress in there decision, that it is free and voluntary.

This section also allows for patients who are unable to write to still give consent to the actions but puts very strict procedures in place to facilitate this including a requirement that oral consent be video taped where practical. This may be problematic for some indigenous people where images of the dead is forbidden and this may well be the reason for the statement “where practical

Section 8 goes on to give an iron clad right to revoke a request made under this bill, through any means of communication. Further more it imposes a 10 year sentence on anyone for failure to pass on this refusal and the person may also be subject to the previsions of PART 3, Division 1 of the CRIMINAL LAW CONSOLIDATION ACT 1935 which deals with the crimes of murder and manslaughter.

Once all this has been undertaken a request must be recorded with the Registrar who must then check to make sure that they are sure the request was made on a voluntary basis and has full ability to investigate any request for voluntary euthanasia. The patients attending doctor then needs to submit a request to the Registrar to carry out the euthanasia and must be informed of all facts, including any revocation of the request current or pending.
After the doctor has received permission from the Registrar another independent doctor who isn’t involved in the day to day treatment of the patient must certify that the:

“A) there is no reason to suppose that the patient is suffering from treatable clinical depression; or
(B) if the patient does exhibit symptoms of depression—the medical practitioner is of the opinion that treatment for depression, or further treatment for depression, is unlikely to influence the patient's decision to request voluntary euthanasia;”

As I have stated this needs to be slightly amended but even as it stands it’s a strong extra layer of protection. As a final protection they also need to certify its 48 hours since they examined the patient.

Only once all of this has been completed may the treating doctor put the euthanasia request into action either through prescribing the drugs for the patient to administer or by doctor assisted suicide. The bill does also state that this could be through withdrawal of treatment but there is a problem with this provision as I have stated below and it needs to be removed from the bill.

Proposed amendments to the Bill

Amendments to the Long title and Section 3 of the Bill

Both the long title and the objects sections state the objectives as
“An Act to provide for the administration of medical procedures to assist the death of a limited number of patients who are in the terminal phase of a terminal illness, who are suffering unbearable pain and who have expressed a desire for the procedures subject to appropriate safeguards; and for other purposes.”
(a) “to give a limited number of competent adults who are in the terminal phase of a terminal illness and who are suffering unbearable pain the right to make informed choices about the time and manner of their death;”

Now as it is self evident that the number of people who would chose to access the provisions of the bill would be constrained by the requirements of the bill and the people themselves there is no real reason to state that it’s aimed at “a limited number”. This makes the bill sound as if it will limit the number of people who fit the requirements stated in the Act though some other requirement, like a lottery.

Furthermore, who judges if the patient is in unbearable pain? Is it the patient? their doctor? a politician? This is made somewhat clearer in section 4, 2b but it could be made clearer here as well

A better way to word these sections would be:

Long title
“An Act to provide for the administration of medical procedures to assist the death of competent adults who are in a terminal phase of a terminal illness and for whom life has become an unbearable burden for themselves and who have expressed a desire for the procedures subject to appropriate safeguards; and for other purposes”.

3—Objects
(a) “to give competent adults who are in the terminal phase of a terminal illness and for whom life has become an unbearable burden for themselves the right to make informed choices about the time and manner of their death

Amendments to the Section 4 with regard to the age of medical consent

In regard to the interpretations section of this Bill, the age of consent is potentially problematic. This is because the Bill fails to a line itself with the CONSENT TO MEDICAL TREATMENT AND PALLIATIVE CARE ACT 1995. The voluntary euthanasia bill states:

4—Interpretation

(1) In this Act—
adult means of or above the age of 18 years;

The definition of adult as 18 rather than 16 (as stated in the CONSENT TO MEDICAL TREATMENT AND PALLIATIVE CARE ACT 1995) is very problematic in combination with the inclusion of withdraw of treatment as Voluntary Euthanasia. This would effectively raise the age of medical consent to 18 from where it currently sits at 16. Further more there is no real benefit in having consent under this act being 18 rather than 16 considering that this act only deals with people in a “terminal phase” of a “terminal illness” as stated in the CONSENT TO MEDICAL TREATMENT AND PALLIATIVE CARE ACT 1995. Currently someone in this condition at 16 years old has an absolute right to refuse treatment given to them under the Consent Act. It seems counterproductive to both muddy this right, and to deny them the right to Voluntary Euthanasia when they won’t live to be 18 either way.
Amendments to the Section 6 in regard to witnesses

6—Procedures to be observed in the making and witnessing of requests
(1) A request for voluntary euthanasia must be made in the presence of the following witnesses (who must be assembled together at the time the request is made):
(a) the medical practitioners referred to in section 5(2);
(b) 2 other adult witnesses (not being persons related to the person making the request).

It was suggested to me that in section (b) where it states that the witnesses can not be related to the patient making the request my assumption is that this is to prevent cohesion for fanatical (or any other) gain. If this is the case then it would be better if worded to eliminate anyone who stood to gain from the patient’s death explicitly. For instance an amendment along the lines of:
“Not being related to the person making the request or standing to gain in any other way from the death of the person making the request”
This would have the objective to include nursing home staff whom the patient has left in their will and would have the intention of making sure such a person could not put pressure onto the patient for the purpose of gaining access to these assets sooner
Amendments to Section 6 in regard to strengthening the issues regarding depression

Currently the subsection 3 (b) states:

“(i) has no reason to suppose that the person is suffering from treatable clinical depression; or


(ii) if the person does exhibit symptoms of depression—is of the opinion that treatment for depression, or further treatment for depression, is unlikely to influence the person's decision to request voluntary euthanasia”

As not all depression is classified as clinical depression it would be better to reword Subsection (i) to:

“has no reason to suppose that the person is suffering a depression like illness”

This would remove any ambiguity as to wether what the patient is suffering can be classified as clinical depression

Amendments to Section 11 in regard to withdrawal of treatment

11—Administration of voluntary euthanasia

(2) A medical practitioner may only administer voluntary euthanasia by 1 or more of the following methods:
(a) by administering drugs in appropriate concentrations to end life;
(b) by prescribing drugs for self administration by a patient to allow the patient to end his or her life;
(c) by withholding or withdrawing medical treatment in circumstances that will result in an end to life.

This section needs to be amended to remove section (2) (c) completely from the bill. Under the provisions of the CONSENT TO MEDICAL TREATMENT AND PALLIATIVE CARE ACT 1995:

“3—Objects
The objects of this Act are—
(a) to make certain reforms to the law relating to consent to medical treatment—
(i) to allow persons of or over the age of 16 years to decide freely for themselves on an informed basis whether or not to undergo medical treatment;”

This gives the patient an absolute right to refuse treatment, sections 7 and 8 give a patient the right to appoint someone to refuse treatment on their behalf and section 17 gives an iron clad guarantee that doctors, who act in ways acceptable to palliative care are protected from any civil or criminal procution, even if there treatment or withdrawal of treatment causes the patient’s death.
If this section of the bill is not amended the best outcome would be that the courts would ignore it in favour of the CONSENT TO MEDICAL TREATMENT AND PALLIATIVE CARE ACT 1995. However there is a chance that this new act could take precedence and remove the right in general circumstances to refuse treatment. Further more this provision could threaten the protection afforded doctors in section 17 of the CONSENT TO MEDICAL TREATMENT AND PALLIATIVE CARE ACT 1995 if the patient and doctor are withdrawing treatment but have not filled out a request for Voluntary Euthanasia. If the intention of the bill is to strip the right of patients to decide their own treatment and the rights of palliative care workers to follow the directions of their patients, this is not an objective I can support. However if this is the objective then it’s the CONSENT TO MEDICAL TREATMENT AND PALLIATIVE CARE ACT 1995 which needs to be amended rather than a completely new bill formulated.
Amendments to Section 12 and patient’s rights

Though unlikely in practice there could be abuse of this section by groups seeking to undermine the purpose of the bill. Currently there is no requirement for a doctor who has been requested to perform euthanasia to explicitly state they do not wish to comply with the request. They could appear to comply while doing nothing. There for I suggest that section 2 be strengthened by a criminal penalty for failure to inform the patient that they are unwilling to comply with the request and for failure to take reasonable steps to seek another practitioner who will comply.

Section 3 doesn’t take into account the possibility that a person may be employed on the basis of their willingness to comply with requests for any reasonable amount of treatment including Voluntary Euthanasia. This may not be an issue in the city but could be problematic in country area’s where only a single doctor is available and the State health department or other agency (for instance a local council or the federal government) wishes to ensure this qualification is a part of a doctors duties

Section 4 seeks to make sure that patients are informed about the policy of an institution but fails to make reasonable arrangements for a patient who wishes Voluntary Euthanasia to be transferred to a facility which will perform the procedure wether this is a public hospital or another nursing home. There for I suggest the following be added to Section 4

“(4) The administering authority of a hospital, hospice, nursing home or other institution for the care of the sick or infirm may refuse to permit voluntary euthanasia within the institution but, if it does so, must take reasonable steps to ensure that the refusal is brought to the attention of patients entering the institution. They must also take reasonable steps to ensure that patients who wish the procedure are transferred to a facility which is willing to perform the procedure if requested”

Further more this section is lacking any sort of penalty (criminal or civil) for institutions who fail to take reasonable steps to inform their patients.

Amendments to Section 14 and release of confidential information

Though section 14 explicitly forbids a person from publishing information relating to the administration of Voluntary Euthanasia, it makes no mention of a person who supplied the material to a media outlet in the first place. There for this section should be amended to include the same penalty to sources for this information and should specify that any “shield laws” current or future do not override this provision. Further more this section shouldn’t just include people who administer Voluntary Euthanasia but also those who receive it in order to protect the families of deceased persons.

Amendments to Section 18 with regard to the CRIMINAL LAW CONSOLIDATION ACT 1935

The imminence of death, not withstanding a there is no reason to treat someone who through fraud or intimidation causes a person to use Euthanasia against their will should have no lesser sentence than anyone else who through fraud or intimidation caused a person’s death. There for I suggest that the penalties for these sections be amended from 10 years imprisonment to an offence of at least manslaughter with the penalty imposed there in which is a life sentence with a fine as directed by the court

General comments about the Bill

It appears to be unclear as to whether a request for euthanasia will be current even if the patient loses capacity after making such a request in accordance with the bill. Though to me nether scenario is concerning, rather this is a point which needs to be clarified.

Conclusions

Though the bill needs a lot of amendments to make it function as intended it is a bill worth supporting subject to these amendments and could help a lot of people dying in agony against there will. Hopefully I have shown the strength of the protections in this bill and how it can be improved. However as it stands this bill must not be supported because of the danger it potentially poses to the absolute right to refuse any and all treatment guaranteed by the CONSENT TO MEDICAL TREATMENT AND PALLIATIVE CARE ACT 1995. This potential danger is sadly greater than the benefits this bill could provide.