![\"Cath](\"https:\/\/exitinternational.net\/wp-content\/uploads\/2017\/12\/Cath-Ringwood-in-the-Australian-620x367.jpg\")
<\/a><\/p>\nDepression sufferers and patients with Alzheimer\u2019s, dementia and other diseases that impair the mind are excluded.<\/p>\n
Patients with motor neurone disease and a host of neuro\u00addegenerative diseases face a lower bar and can opt in with a life expectancy of 12 months.<\/p>\n
Its proponents cast the scheme as the most conservative in the world. Already, other state governments are eyeing off the legislation in preparation of euthanasia debates of their own.<\/p>\n
But for Ringwood, who is excluded from the scheme because her doctor says she still has treatment options, it\u2019s as if the debate has amounted to nought.<\/p>\n
\u201cIt\u2019s a big shift but it\u2019s not nearly big enough,\u201d she says from her home in Heidelberg in Melbourne\u2019s north.<\/p>\n
\u201cIt\u2019s hard legislation to draft and you\u2019ve got to hand it to the government for at least coming to the party, but the scheme excludes so many people who are in the worst pain, who are tired and they just want to go.\u201d<\/p>\n
Her anger isn\u2019t uncommon among the thousands of ageing Australians suffering debilitating but non-terminal diseases or the legions who euthanasia pioneer Philip Nitschke describes as the \u201cwell elderly\u201d who simply want to be the ones who decide when it\u2019s time to call stumps.<\/p>\n
But Victorian Premier Daniel Andrews and MPs who supported the legislation are adamant they\u2019ve got the balance right with a landmark bill that provides relief where the best palliative care cannot, with 68 safeguards and steep penalties to prevent coercion and misuse.<\/p>\n
Neurosurgeon and former Australian Medical Association head Brian Owler took the lead drafting the bill, choosing as a guide the law devised in the US state of Oregon that has operated for more than 20 years.<\/p>\n
Forget scope creep and slippery-slope arguments, he says. The Oregon model hasn\u2019t sustained a single change in its two decades of operation. He believes it\u2019s proof a system can operate, for many years, as it was intended.<\/p>\n
Similarly, the model stood in stark contrast to those in The Netherlands, Belgium and other jurisdictions that give access to patients who may have some health but who are tired of life.<\/p>\n
The Victorian scheme would have the same strict entry criteria but targeting only terminal patients in their final months.<\/p>\n
And it worked. Upper house MPs passed the bill with 22 votes to 18 at the end of a 28-hour sitting on November 22.<\/p>\n
Standing on the steps of parliament immediately after the vote, Andrews said that too many Victorians had been left racked with intolerable pain at the end of their lives and their needs had been overlooked. Access to a voluntary assisted dying scheme was the missing piece in the state\u2019s health system, he said.<\/p>\n
\u201cIt\u2019s about providing for those who have for too long been denied a compassionate end, and the control, the power, over the last phase of their journey.\u201d<\/p>\n
Now passed, Victoria\u2019s voluntary assisted dying scheme will admit its first patients in June 2019.<\/p>\n
An 18-month implementation program is already under way to nut out crucial details including which lethal drugs will be prescribed to patients, how pharmacists will hand them over and other guidelines dictating how the drugs can be stored in people\u2019s homes.<\/p>\n
The scheme is notable for its heavy focus on patients being able to administer the drugs themselves. Doctors will be authorised to administer the drugs only in exceptional circumstances \u2014 such as oesophageal cancer \u2014 for which patients will need a separate permit.<\/p>\n
The scheme\u2019s architects have indicated early on that the program will likely rely on compounding pharmacists who have the expertise to prepare and tailor for patients individual lethal cocktails, from barbiturates, sedatives and other heavy drugs already approved for use in Australia.<\/p>\n
The government also could proceed with a new process to get local Therapeutic Goods Administration approval for Nembutal, a powerful, lethal barbiturate used in euthanasia schemes around the world but not approved for human use in Australia. Other details were nutted out during the parliamentary debate. A raft of amendments introduced in the upper house increased the safeguards by mandating mental health checks for patients with a history of depression. Another amendment gave a greater role for patients\u2019 GPs in the application process for the euthanasia scheme.<\/p>\n
A crucial amendment passed attempted to stamp out the prospect of \u201cdeath tourism\u201d by requiring patients to prove they had lived in Victoria for at least 12 months before submitting their application.<\/p>\n
Still, there is deep uncertainty over how the scheme will operate in practice.<\/p>\n
Whether doctors and pharmacists will participate is another question.<\/p>\n
A survey of more than 4000 doctors conducted by the AMA in March last year revealed about three-\u00adquarters believed that palliative care couldn\u2019t treat all pain but less than half would be prepared to assist patients with voluntary euthanasia.<\/p>\n
The AMA relied on the survey results, in addition to the World Medical Association\u2019s staunch opposition to euthanasia and assisted dying, to rally against the scheme. It argued the medical profession\u2019s role in healing the ill would be compromised if its members were also expected to help people die. Deep opposition lingers within the medical and palliative care community, and among the Catholic and faith-based groups that deliver the bulk of the state\u2019s hospital and aged-care services.<\/p>\n
The AMA remains resolutely opposed, as does Victoria\u2019s palliative care peak body, Palliative Care Victoria.<\/p>\n
Catholic Archbishop of Melbourne Denis Hart has ruled emphatically that no Catholic care provider will assist with the scheme.<\/p>\n
Collectively, Catholic healthcare providers across the country provide one in 10 aged-care beds, and one in 10 hospital beds.<\/p>\n
St Vincent\u2019s Health is the state\u2019s largest palliative care provider and owns four hospitals in Melbourne alone, including the publicly funded St Vincent\u2019s Hospital Melbourne, which treated 54,000 inpatients last year.<\/p>\n
While the euthanasia scheme has provisions for healthcare providers to decline to take part, they are still obliged to refer patients to services that will help them.<\/p>\n
Victorian Health Minister Jill Hennessy has batted away suggestions that opposition within the medical community could hobble the scheme from the start with a lack of practitioners helping people to enter the program.<\/p>\n
\u201cWe are confident we will have the workforce needed to provide access to a voluntary assisted dying scheme should it become law,\u201d she repeatedly told The Australian throughout the debate.<\/p>\n
Others have argued that an absence of detail about which drugs could be used, and the lack of availability of Nembutal \u2014 universally considered to be the most appropriate drug for euthanasia \u2014 could emerge as a bigger problem.<\/p>\n
Federal Health Minister Greg Hunt has said he will not help or hinder the legislation, which includes taking any steps at a federal level to block or facilitate TGA approval for Nembutal or changing any laws that could make it more readily available.<\/p>\n
Even so, he remains resolute in his opposition to the scheme.<\/p>\n
\u201cThe underlying principle of our investment in health services is quality of life and this includes during end-of-life care,\u201d Hunt told The Australian.<\/p>\n
\u201cThe federal government believes that people should have access to quality palliative care and relief from pain.\u201d<\/p>\n
But even as the implementation program continues, critics highlight that a state election stands between the incumbent government and the scheme\u2019s start date.<\/p>\n
\u201cIt could be crisis averted,\u201d the Australian Christian Lobby\u2019s Victorian head, Dan Flynn, says.<\/p>\n
\u201cThis doesn\u2019t start until June 2019 and there\u2019s an election in November and if sufficient opponents to this bill were elected to the lower house, this bill could be repealed before it is ever implemented.\u201d<\/p>\n
Standing more than 182cm tall, Flynn cut a notable figure throughout proceedings, watching from the public gallery even as the debate stretched into the early hours of the morning and longer.<\/p>\n
The Premier gave him assur\u00adances before the 2014 election that he would not support any push for euthanasia or assisted dying in office. Flynn will not forget the broken promise.<\/p>\n
Micro parties including the Australian Conservatives and the Democratic Labor Party echo the statement, and say they are incensed the government never had a mandate to float the bill in the first place.<\/p>\n
The Premier has been frank throughout the debate that his support for voluntary euthanasia was forged only after witnessing his own father experience a \u201cgood\u201d death on Anzac Day 2015. It was a dignified end that too many Victor\u00adians missed out on, he says.<\/p>\n
Crucially, his change of heart occurred long after the 2014 election, and after he had written to the Australian Christian Lobby and conservative groups assuring them that an Andrews Labor government would not support euthanasia or \u00adassisted dying. This will be a key argument they will use against Labor in the approaching election.<\/p>\n
But the fallout is expected to affect MPs across the political divide.<\/p>\n
Both the Australian Conservatives and the DLP say they were bitterly disappointed to see some Liberal and Nationals MPs vote in favour of the bill, and as a result they are now reconsidering preference deals in some seats.<\/p>\n
DLP Victorian state president Frances Beaumont says the party could use preference deals to penalise Liberal and National MPs who supported the bill.<\/p>\n
\u201cWe would always look carefully at how people voted and this could very well have an impact on how we preference people,\u201d she says. \u201cThis is still a very important issue.\u201d<\/p>\n
Outwardly, the Coalition has shown a weak appetite to challenge or repeal the legislation under a new government.<\/p>\n
But more quietly, some party members say they are aware MPs who supported the bill could face challenges during preselections and could also be hurt by preference flows.<\/p>\n
Liberal veteran Robert Clark believes there is an argument to be made about the parliamentary process in which the bill was rammed through both houses, which could weaken its legitimacy under future governments.<\/p>\n
Within parliament, there is lingering resentment in some camps that MPs were forced to endure three all-nighters debating the bill, including one which only ended when an MP was rushed to hospital after collapsing in his office.<\/p>\n
\u201cThe way this bill was developed and pushed through the parliament was an embarrassment to Westminster democracy,\u201d Clark told The Australian.<\/p>\n
\u201cThis wasn\u2019t a careful consideration of the merits by individual MPs.\u201d<\/p>\n
But critics and supporters of the scheme are unanimous that the bill is likely to be the single biggest legacy of the Andrews government, which proudly calls Victoria the most progressive state in the country.<\/p>\n
While NSW in November voted down a private member\u2019s bill in the upper house proposing its own voluntary assisted dying scheme, a new legislative push is expected in Queensland, where Labor members voted at a July state conference to proceed with an assisted dying bill.<\/p>\n
Separate moves are being made in Canberra by Greens leader Richard Di Natale, who has pledged to pursue a national euthanasia bill next year. It could become a framework for each state to launch its own legislation, he says.<\/p>\n
Meanwhile, Liberal Democrat David Leyonhjelm will continue to pursue a bill that would pave the way for the ACT and the Northern Territory to have their own debates on the issue.<\/p>\n
In Victoria, MPs say they are glad the bulk of the work is over.<\/p>\n
\u201cFor me there\u2019s relief, there\u2019s no doubt about that,\u201d says Liberal MP Simon Ramsay.<\/p>\n
The country MP endured unenviable pressure from within his own party as just one of four Liberals to eventually support the bill in the upper house.<\/p>\n
Ramsay was late to disclose how he would vote and was frank from the start that he needed to be won over with amendments that halved the entry point to a life expectancy of six months from a previous threshold of 12 months, and other changes that included a pledge to boost palliative care funding, particularly in regional areas.<\/p>\n
\u201cIt was a very highly charged debate,\u201d Ramsay says. \u201cThere was a lot of passion from sides, strong religious beliefs, strong values that were fighting very, very hard to oppose and to support the bill.<\/p>\n
\u201cIt was a time-and-place thing and it wasn\u2019t easy. I\u2019m still convinced that I made the right \u00addecision.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"
Cath Ringwood is angry. The 67-year-old former palliative care nurse is racked with pain from her arthritic knees and fed up trialling invasive treatments for her chronic lymphocytic leukaemia. It has been a long 20 years of serious illness for the euthanasia supporter, but the past 18 months have been tougher than most. Late last […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"ngg_post_thumbnail":0},"categories":[5],"tags":[13,42,41,25,16,40,14],"yoast_head":"\n\n\n\n\n\n\n\n\n\n\n\n\n\t\n