The Hon. Carmel Zollo: One of them, not all of them.

The Hon. SANDRA KANCK: No, it was one of the reasons that the honourable member gave. The Hon. Carmel Zollo said that it is not only the Catholic Church that does not sanction voluntary active euthanasia: so do all Christian religions. I do not believe that to be the case. In fact, the Uniting Church does not oppose it and, clearly, when one looks at the annual survey done by the Roy Morgan Institute, one sees that the leaders of many of the Christian denominations in Australia are clearly out of step with their followers. That poll shows, for instance, that 73 per cent of Roman Catholics responded to that survey positively in favour of euthanasia and 84 per cent of Anglicans did so. Amongst other world religions, I do not believe that Buddhists oppose voluntary euthanasia.

Members would have received correspondence, I think, from the Reverend Dr Andrew Dutney, who some years ago wrote a paper on the issue of Christian support for voluntary euthanasia which the South Australian Voluntary Euthanasia Society has encapsulated in a leaflet. I would like to read just a little bit from that leaflet, as follows:

As it happens, Christians have always been active in the modern voluntary euthanasia lobby. Among the founders of the American Euthanasia Society in 1945 were prominent Christians such as the New York divines Henry Sloan Coffin, the President of the Union Seminary and Harry Emerson Fosdick, the minister of the Baptist Riverside Church.

He refers to the Australian philosopher, Max Charlesworth, stating:

He takes a position which has been characteristic of Christian supporters of voluntary euthanasia, affirming that God has created human beings to make their own decisions and to accept responsibility for themselves and their neighbours. There is nothing faithful about relinquishing that responsibility in the face of the power of nature or history. "It is not `playing God' to seek freely to control the direction of my life," Charlesworth writes, "and it is not `playing God' to seek freely to control the mode of my dying. For a Christian, God is not honoured by a person (made in the `image' of God) abdicating her autonomy and freedom of will and passively submitting to `fate'."

Hans Kung, a well-known Catholic theologian, has taken a similar position. In his view, `God, who has given men and women freedom and responsibility for their lives, has also left to dying people the responsibility for making a conscientious decision about the God-given character of human autonomy-he adds his confidence in the promise of eternal life.' For Kung, `precisely because I am convinced that death is not the end of everything, I am not so concerned about an endless prolongation of my life-certainly not under conditions that are no longer compatible with human dignity.'

I observe also that the Scottish philosopher Hume said:

Were the disposal of human life so much preserved as the peculiar providence of the Almighty that it were an encroachment on His right for men to dispose of their own lives, it would be equally criminal to act for the preservation of life as for its destruction.

The Hon. Carmel Zollo took issue with what I had to say about intent and made the observation that even children understand that. I agree with what the Hon. Carmel Zollo has said, but she has missed my point that the issue of intent and double effect forces doctors into lying both to themselves and to their patients.

Again in the correspondence we have received on this bill, members would have received a copy of a lecture given by Ian Kennedy, the Professor of Law and Ethics, Kings College, London. It was given to the Royal Society on 25 April 1994. I will just refer to one small excerpt from that lecture, which states:

Everything turns on what the doctor claims he was trying to achieve. As long as he uses the right verbal formula and records it in the patient's notes and to be on the safe side does not use too unusual a drug, he will stay within the law. Knowing how to play the game becomes the crucial determinant of criminal liability, rather than what objectively is done or what results. When the crime is murder, this can hardly be satisfactory.

The Hon. Carmel Zollo told us that she respects the sanctity of life. Well, so do I, but there is no sanctity in having smelly, gangrenous wounds. There is no sanctity in being incontinent of faeces and urine. There is no sanctity in choking to death. The Hon. Carmel Zollo said:

I do not think we should compare decent human behaviour with that of animals where life and death is purely based on instinct and survival of the fittest.

Again she has missed the point-

The Hon. SANDRA KANCK: Exactly. The point I was making was that we do not make animals stay alive to satisfy some Christian view, that relates to some Christians, of the sanctity of life. The Hon. Carmel Zollo should look at my record and see how much of my political activity is based on respect for the individual. We are asking for the right for people to choose to die with dignity. The Hon. Carmel Zollo makes the comparison between humans and animals on the basis that animal behaviour is based on instinct and survival of the fittest. An individual's request for euthanasia is the exact opposite of that: it is reasoned, informed, intelligent, rational, caring and, if it involves someone from within your own family, very loving-all the best attributes of human beings.

The Hon. Carmel Zollo says that we should not be applying pressure on our elderly or their families by implying that there is a duty to die when a particular stage in life is reached. I agree. No-one has a duty to die and part of this legislation requires-

The Hon. SANDRA KANCK: Everyone will die. The unfortunate thing is that you actually hear some people in this debate talk about `if they die', which is a rather peculiar notion. However, this legislation-

The Hon. SANDRA KANCK: Obviously, some people think they are immortal. Part of this legislation requires that those involved in signing and witnessing must indicate that the person making the request was not under any apparent pressure.

The Hon. Carmel Zollo quoted from the Lutheran Church's Commission on Social and Bioethical Questions, asking which people from of a number of examples given should be treated with a lethal dose. The answer is that none of the people in the examples given would be best treated with a lethal dose, firstly because most people's pain was able to be relieved, and there was a great deal of concentration in those examples on pain. Secondly, the bill has requirements regarding treatable clinical depression, and a doctor would not be allowed to administer voluntary euthanasia if the person requesting it had treatable clinical depression. Thirdly, being a burden on one's family is not a criterion to allow access to this legislation, and no doctor wanting to continue practising would sign the form if either of those was the reason for the person seeking to use voluntary euthanasia.

The comments that the Hon. Robert Lawson made about jumping through hoops were very interesting. Yes, this legislation requires people to jump through hoops. There are 14 different hoops that people would have to jump through before they could access voluntary euthanasia. I remember when the Social Development Committee dealt with this issue and Marshall Perron, the architect of the Rights of the Terminally Ill Act in the Northern Territory, appeared before the committee. He said that safeguards could be put in place. The hoops, which are what the safeguards are, could be put there for people to jump through and there could be 14, as I have suggested, or 20 or 30 hoops, and the chances are that by the time a patient got through the thirtieth hoop, they would probably have died from exhaustion trying to get there rather than from their disease. That is what the opponents of voluntary euthanasia call for those who are supporting euthanasia to do, to put up hoops for people to jump through.

I must say that I was very surprised at the comments that the Hon. Robert Lawson made about doctors. He appeared to be taking a nudge-nudge, wink-wink approach, that parliament really ought not to be dealing with it, that we should allow the doctors to continue to bump people off covertly and place themselves at risk of being charged with murder.

The Hon. SANDRA KANCK: It is incredible that a lawyer would come up with that sort of response, but it is the sort of thing that would create more work for lawyers. The Hon. Caroline Schaefer referred back to the recommendations of the Social Development Committee's inquiry into voluntary euthanasia. She said that the Hon. Bob Such and I `continue to allege that, because the other members found against their belief, somehow we were biased.' Of course the other members of the committee were biased.

The Hon. SANDRA KANCK: That would appear to be the logical conclusion. Of course the four members of the Social Development Committee who recommended that voluntary euthanasia legislation not be dealt with in this parliament were biased, and of course the Hon. Bob Such and I, who opposed that view, were biased. What is wrong with acknowledging that bias? I am not going to run around telling everybody that they were biased and we were biased, because it really does not need to be said. We all knew the purpose back then of referring the matter to the Social Development Committee rather than a select committee, as moved originally by the Hon. Carolyn Pickles, because it was designed to produce the result it did, that is, a report opposing voluntary euthanasia. That is history.

The Hon. Caroline Schaefer has invoked the AMA position as proof of the correctness of her beliefs. Yet I remind members that the AMA has never polled its membership on this issue. By contrast, the Royal Australian College of General Practitioners has adopted a far more mature and responsible attitude, and I will read from an editorial in their Faculty/Training Program News of April 2001, as follows:

It is a big step to support euthanasia and I believe that it is one that can only be made individually from our own hearts and beliefs. The college cannot and should not impose standards based on personal beliefs and convictions. The college will not support the bill, nor will it actively object. It is properly the parliament as the voice of the people that must make this decision.

The Hon. Caroline Schaefer says that the current law is sufficient. She says that under common law anyone can refuse treatment. She is correct; yes, they can, but what is the effect of that? I remind the Hon. Caroline Schaefer and other members of this chamber of the case of Norma Hall who died earlier this year in Sydney. She had cancer in her bones, liver and lungs. She wanted to meet death on her own terms, so she refused any further medical treatment. She took the option of what is sometimes called slow euthanasia. It is legal so there are no problems in doing it. She took herself off food and drink but after more than a week she was still alive, at which point she asserted control and downed the contents of a bottle of morphine. The Hon. Caroline Schaefer is right: you can refuse treatment. One can subject oneself to slow euthanasia, but I hope, for her sake, that she does not ever have to watch a member of her family die in this way.

The Hon. Caroline Schaefer says that current law is sufficient and she refers to the pain relief aspect in the Consent to Medical Treatment and Palliative Care Act and, of course, double effect. Under that act you can die easily provided you are suffering severe pain because you can keep demanding increased levels of painkillers, particularly morphine. People in the know about the law can pretend because pain is subjective. The doctor cannot tell when you say, `I have increasing levels of pain,' that you have not got it. But what if you do not know about that particular loophole and you have not got unremitting pain as a driver, because that is not the only thing that happens when people are in these situations. It is why I have a definition of `hopelessly ill' in this bill.

I have a letter from Marshall Perron which is addressed to all members of the South Australian Legislative Council and the House of Assembly and which is dated 4 May 2001. He provides a list of examples. I will cite a few of the problems that people can face. One is raised intracranial pressure due to inoperable brain tumour: the symptoms are severe head pain due to pressure on sensitive nerve structures by tumour expansion in a confined space; it may be accompanied by a loss of function, for example, blindness, paralysis and incontinence. Another is recurrent bowel obstruction due to widespread abdominal cancer: diffuse deposits of cancer obstruct the bowel causing pain, nausea and vomiting, and abdominal distension. Surgery may be advised which may be either futile or of only very short-term benefit. Vomiting and malnutrition lead to a kind of starvation until death. This is what the opponents of voluntary euthanasia say that these people have to put up with.

Another is spinal cancer with nerve root pain, vertebral collapse: it can have varying degrees of paraplegia; one of the worst situations possible, confined to bed with episodic excruciating neuritic pain with simple movement. That is one of those examples where it is probably unlikely that pain will be relieved. Another example is inoperable bladder cancer with very frequent and painful urination, often with bleeding, blockage to flow and incontinence. Hence, the old medical saying, `Please God, do not take me through my bladder.' There is chronic inexorably progressive neuropathic syndrome leading to paralysis of all limbs, loss of speech, blindness, loss of control of bowel and bladder, and perhaps inability to breathe or swallow as in multiple sclerosis or motor neurone disease. The person's body functions disintegrate, yet trapped within that shell may be a perfectly lucid mind. I imagine there are some members in this chamber who say that we are honouring the sanctity of life in keeping such people alive under those conditions. I certainly do not see it that way. My colleague the Hon. Ian Gilfillan disappointed me with his speech. He began by saying:

I believe that the fear of anticipated distress beyond endurance and fear of lingering on as an incontinent, incoherent and maybe comatose person are also factors in convincing people to support voluntary euthanasia.

Right on, Ian; absolutely right on. These are the concerns that are motivators for people to say that they want voluntary euthanasia at some stage in their life. But the Hon. Ian Gilfillan clearly thinks that people who are dying or suffering under the sorts of conditions which I have mentioned and which were cited in Marshall Perron's letter are not entitled to intervention because some people may be pressured into requesting voluntary euthanasia.

The evidence is that some people may die incontinent, incoherent and maybe comatose, in his words, and that is just the half of some of these conditions. Dr Michael Irwin, former Medical Director of the United Nations, told the World Conference on Assisted Dying in Boston last year that `much medical end of life treatment is torture'. The Hon. Ian Gilfillan suggests that some dying people would feel they are a nuisance to their family and opt for voluntary euthanasia. Places where voluntary euthanasia or assisted suicide is permitted show that the availability to voluntary euthanasia allows an honest and open discussion to occur and actually prevents that pressure from emerging. Because the discussion is open, the medical practitioners can, in turn, openly address the issue with greater awareness of the potential for pressure.

Helga Kuhse, who is the Senior Honorary Research Fellow at Monash University Centre for Human Bioethics, undertook a study which revealed that intended deaths without consent in the Netherlands was 8.3 per cent while in Australia it was 28.4 per cent and 18.7 per cent in Belgium. `Without consent' means the patient was not asked at the time, although there might have been a prior indication to the family or the doctors. Doctors in Belgium and Australia place themselves at risk by asking the question. Hence, the very large differences in those numbers.

The Hon. Ian Gilfillan quoted Dr Anthony Radford, and I indicate that, like many other members, I received a copy of that same paper and I was extremely disappointed by the lack of intellectual rigour in it. He quoted Anthony Radford as saying:

If those advocating euthanasia or assisted suicide prevail it will be a reflection that as a culture we are turning away from efforts to improve our care of the mentally ill, infirm and the elderly.

The reality is, whatever legislation for voluntary euthanasia or assisted suicide is introduced, palliative care is highlighted, its deficiencies acknowledged and funding is subsequently increased. The Hon. Ian Gilfillan, again quoting Anthony Radford, said:

Instead, we would be licensing the right to abuse and exploit the fears of the ill and accepting the view that death is a preferred solution to the problems of illness, age and depression.

I really feel quite insulted by that sort of comment being included by the Hon. Ian Gilfillan, because he knows that, just as I fight for voluntary euthanasia, I fight for the better treatment of the mentally ill, the infirm and the elderly. The two things are not mutually exclusive. It is not a case that if you support one you are opposed to the other. It is a dishonest argument, and I am very surprised that my colleague has used it and been taken in by it. He also referred to Dr Kavorkian and the deaths that he has assisted in the US. These people all requested his assistance. Most doctors act covertly if they are involved in assisting suicide in this way, so it is difficult as a patient to know who to turn to. Kavorkian was honest and built up a reputation and, obviously, ill people sought him out.

I was disappointed also that my colleague chose to quote from Jeff Heath regarding Dutch laws, when he knows that Jeff Heath as a paraplegic approaches this issue with the view that those of us fighting for voluntary euthanasia are intent on bumping off people with disabilities.

The Hon. SANDRA KANCK: I admire Jeff Heath's passion, but he does not approach this issue in a rational way, and his knowledge of the new Dutch law is flawed. He claimed that the Dutch law requires a person to be both terminally ill and suffering uncontrollable pain to give them the right to seek legal voluntary euthanasia and that it is therefore better legislation than my Dignity in Dying Bill, which requires that a person be hopelessly ill, but Jeff Heath got it wrong. The basis for asking for medical intervention to die in Dutch law is that the person must be facing interminable and unendurable suffering, which bears a great deal of similarity to my `hopelessly ill'.

In their speeches the Hon. Legh Davis and the Attorney-General concentrated on definitions and particularly that of `hopelessly ill'. Again, when Marshall Perron appeared before the Social Development Committee, he gave some evidence about a young man who had become a quadriplegic in Darwin. He told us that that young man went from person to person, asking them to help him commit suicide. Because he was a quadriplegic, he could not even push a button in a lift to take him to the top floor of a building.

Even if he got to the top floor of a building, he could not get himself out of his wheelchair to get to the edge of the building to be able to jump. That man went from person to person to person. It was not just an odd thing; he did it all the time. He asked people to assist him to die all the time. Who is the Hon. Legh Davis that he should decide that life is not intolerable for that young man? Who else but that young man knows whether his life is intolerable? It is intolerable for me that I could develop Alzheimer's, gradually losing memory and understanding, having to depend on others to lift me out of bed, to feed and bathe me, to take me to the toilet and wipe me clean. For that reason alone, I want to be able to sign an advance directive to say that at a certain point I want medical intervention to end my life. If the Hon. Mr Davis was to get a diagnosis of Alzheimer's and did not want medical intervention at some point in the deterioration, that would be entirely his decision. But if I was to be given such a diagnosis, it would not be Mr Davis's or anyone else's problem; it would be mine.

The Hon. Legh Davis says that he does not accept that anyone at all should be able to sign an advance directive on the off chance that one person might change their mind and that somebody might not know. On the basis of a series of mights, he would deny to everyone access to voluntary euthanasia through an advance directive. It is fairly logical that, if we survive past 75 years of age, the chances increase that we will be debilitated or demented or both. The busybody approach that is exemplified by the Hon. Mr Davis's position leads to a particular option of pre-emptive suicide. That option suggests that you should take your life now while you are still in possession of all your faculties, because if you do not the do-gooders will keep your body alive when your faculties are heading out of control. I cannot say that the Hon. Legh Davis misled the Council-I guess he was misled by material that he read-but he told this parliament that the Netherlands has voluntary euthanasia law because palliative care is not well practised there. That is simply not true.

The Hon. L.H. Davis: I did not say that, either.

The Hon. SANDRA KANCK: Well, re-read Hansard ; I read it this morning. Back in 1995, the British House of Lords was debating a motion that was critical of Dutch voluntary euthanasia law, and that same sort of dishonest argument about Dutch palliative care was being promoted. A very frustrated Dutch ambassador felt compelled to issue a public statement to refute what was being said.

Contrary to the misinformation being put about by the opponents of voluntary euthanasia, the Netherlands, with a population of just over 15 million people at that time, had 53 000 palliative care beds, projected to increase to 57 000 beds by 1998. At the same point in time, with a population nudging 18 million, we in Australia had 5 000 palliative care beds. It is totally dishonest of the people who have written what must obviously be described as rubbish but which Mr Davis upholds to decry palliative care in the Netherlands. I doubt that any other country in the world does it better. One thing I have found in the arguments of the opponents of voluntary euthanasia is that they never let facts get in the way of a good argument.

The Hon. Ron Roberts made many references to palliative care, suggesting that this issue is either about palliative care or voluntary euthanasia. I refer the Hon. Ron Roberts to the dissenting view that Bob Such and I put in the Social Development Committee report, namely, that voluntary euthanasia is one aspect of palliative care. It is at the very end-one that most people who receive palliative care will never need to use. Nevertheless, it ought to be a valid tool.

Palliative Care Australia put out a very interesting position statement on euthanasia on 19 March 1999, and I will read two relevant statements, as follows:

Palliative Care Australia acknowledges that, while pain and other symptoms can be helped, complete relief of suffering is not always possible, even with optimal palliative care; and recognises and respects the fact that some people rationally and consistently request deliberate ending of life.

The attitude is, `We will acknowledge and we will recognise, but we will deny you the right to die as you choose. Instead, we will put you in a coma that will last for days, so that you will die not recognising your surroundings and any loved ones who might be there but, of course, we will do it respectfully.' What bunkum!

The Hon. Ron Roberts kept referring to the alleviation of pain but, for the most part, pain can be alleviated. People in Oregon who had indicated to their doctor that they wanted to access their physician assisted suicide act were asked why they were accessing it. Of those people, loss of autonomy and dignity were given as the principal reasons, not pain.

The Hon. Carmel Zollo said that she objected to the title of this bill, Dignity in Dying, as she regarded it as Orwellian. There is nothing Orwellian in that. Just as people in Oregon say that they accessed the physician assisted suicide act because of the potential loss of autonomy and dignity so, too, do people in Australia want voluntary euthanasia. If anything, I might have considered calling my bill the `dignity and autonomy in dying bill' because that is what we are setting out to achieve.

Because I have felt the need to respond to the rationale given by those who are opposing my bill, I have of necessity concentrated on the negatives. However, I do remind members that the great majority of the public-their electors-support voluntary euthanasia. I want to thank the Hons Di Laidlaw, Carolyn Pickles, Mike Elliott, Terry Roberts, Bob Sneath and Trevor Crothers for their up-front support of the bill.

The Hon. John Dawkins has indicated an open mind, and he will support the reading. The Angus Redford and the Hon. Nick Xenophon have indicated that they will support the second reading vote, although they are very likely to vote against the bill. I record my appreciation to them for being willing to allow the bill to go into committee.

I thank all members, including those who have indicated they will vote against the bill, for their prompt responses. There have been only two days on which private members' business has been listed since I introduced this bill that someone has failed to speak on it. I record my thanks to the South Australian Voluntary Euthanasia Society for their tireless lobbying work in both talking to MPs and in providing some excellent written materials.

Should this bill be defeated today, I remind members that it took ten years of attempts for a successful bill to pass the South Australian parliament to allow women the right to vote. If we pass it at the second reading today, I will move on the committee stages when parliament resumes in September.

Dr Roger Hunt, who is a palliative care specialist, said about this bill:

It seeks to make a crude criminal code more discriminating. It recognises the special context of voluntary euthanasia-the doctor- patient relationship. The patient is a victim of advanced and terminal disease rather than a victim of crime. The doctor acting in accordance with the patient's wishes and interests is fulfilling a duty of care rather than being a murderer with sinister motives. In ethical medical practice, examining a patient is not regarded as indecent assault and prescribing medicine is not illicit drug dealing. Similarly, VE is not murder and the criminal code should reflect this.

We are living much longer than ever before because of medical intervention in all its forms. Medical intervention ensures that we live longer, but medical intervention also ensures we take longer to die. Longer lives is the flip side of longer deaths. Life prolonging technology is also death prolonging technology. A majority of people in our society are asking for legalised VE. As one of that very large group, I ask this parliament to recognise that we are asking to end death, not to end life. We are asking for an end to terrorised dying. We are asking for the right to die with dignity.

The Council divided on the second reading:

AYES (10)

Cameron, T. G. Crothers, T.

Dawkins, J. S. L. Elliott, M. J.

Kanck, S. M. (teller) Laidlaw, D. V.

Pickles, C. A. Redford, A. J.

Sneath, R. K. Xenophon, N.

NOES (9)

Davis, L. H. Gilfillan, I.

Griffin, K. T. Holloway, P.

Lawson, R. D. Lucas, R. I.

Roberts, R. R. Stefani, J. F.

Zollo, C. (teller)

PAIR(S)

Roberts, T. G. Schaefer, C. V.

Majority of 1 for the ayes.

Second reading thus carried.