This post has been contributed by Dr Jayne Hewitt, senior Lecturer in the School of Nursing and Midwifery and a member of the Law Futures Centre.
On 25 May 2021, Premier Anastasia Palaszczuk introduced the Voluntary Assisted Dying Bill 2021 into the Queensland Parliament.
Although this is the first time such a bill has been presented in Queensland, every other Australian state and territory has at some time since 1993, introduced legislation that would permit adults who are suffering and dying, assistance to end their life at a time of their choice (Willmott et al, 2016).
In fact, before Victoria’s Voluntary Assisted Dying Bill passed in December 2017, there had been 57 unsuccessful attempts to legalise assisted dying in Australia (McGee et al, 2018).
The number and frequency of bills that have been proposed indicate that voluntary assisted dying (VAD) is a practice of importance to the Australian community. The repeated defeats suggest that changing VAD policy is extraordinarily difficult.
Since 2017, however, there has been a distinct shift in this policy landscape. Following Victoria’s lead, Western Australia and Tasmania have both passed Voluntary Assisted Dying Acts.
A bill in South Australia has recently been passed by both houses of parliament and, following 17 previously unsuccessful attempts, looks set to pass when voted on for the final time on June 9th 2021.
The reasons for this recent shift are likely to be multifactorial. However, one contributing factor appears to be the extensive consultation processes that were undertaken before any bill was introduced.
Victoria, Western Australia, South Australia, and Queensland all commenced with Parliamentary Committee inquiries to enable lawmakers to better understand the views of a range of stakeholders.
In Victoria, for example, the Legal and Social Affairs Committee received over 1,000 submissions as evidence to inform the findings in their report into end of life choices.
The Western Australian Joint Selective Committee accepted nearly 800 items of correspondence as part of their inquiry, and in Queensland, the Health, Community, Disability Services and Domestic and Family Violence Prevention Committee received over 4,700 submissions to their end of life inquiry.
Except for South Australia, whose findings were more circumspect, each Inquiry Committee recommended that their respective Parliament consider the introduction of a voluntary assisted dying bill. In each case, additional consultation processes were established to inform the development and drafting of a bill.
Victoria and Western Australia did this through the formation of a Ministerial Advisory (in Victoria) and Expert Panel (in WA), constituted by members with expertise in healthcare, law, as well as community advocates.
Once again, the Panels consulted widely with a range of stakeholders to ensure that diverse views and positions were captured.
Victoria’s Panel received written submissions in response to their discussion paper, it conducted forums and roundtables with more than 300 stakeholders across the State.
Similar processes were followed in Western Australia, where more than 1,400 consultations with stakeholders occurred.
In Queensland, rather than forming a panel of experts to inform the drafting of a bill, the Attorney General asked the Law Reform Commission to make recommendations about an appropriate legislative scheme for voluntary assisted dying in Queensland and to prepare draft legislation to give effect to those recommendations.
In addition to receiving public submissions, the Commission was also informed through meetings with people from Victoria and Western Australia who had been involved in the implementation or operationalisation of VAD.
In Victoria and Western Australia, the most notable outcome of these extensive consultative processes was the passage of bills that previously had often failed to even get to a second reading.
No matter how meticulous the process, passing a bill is only the first step to ensuring the legislative intention of an Act comes to fruition.
It must also be successfully implemented into healthcare practice.
Given its emotive and contentious content, a legacy of discontent over the passage of the Act is likely to persist and enacting VAD will remain controversial.
This was highlighted in our recent systematic mixed studies review of the barriers and enablers to the implementation of VAD in acute care health settings (Hewitt et al, 2021).
It demonstrated that the contextual and individual characteristics of those exposed to, or participating in VAD must be acknowledged for implementation to be effective.
This means that in addition to meeting the technical and procedural requirements of the enabling legislation, planning for VAD must also consider the diverse beliefs and attitudes of those clinicians who participate directly, those who choose not to, and others who play a supportive role.
Just as extensive consultation contributed to passing the law, ongoing and meaningful consultation with those tasked with implementing and operationalising it will be required.
We know that how VAD is ultimately offered and provided deeply affects the patient accessing it, as well as their families, and significant others.
The effect is felt just as deeply by all those involved in the care of these patients and their families; those who facilitate or provide VAD as well as those who do not.
Dr Jayne Hewitt was appointed as a consultant by the Queensland Law Reform Commission in its recent Voluntary Assisted Dying review.
- Hewitt, Jayne, et al (2021) ‘The Barriers and Enablers to the Implementation of Voluntary Assisted Dying Services in Acute Care Health Settings: A Systematic Mixed Studies Review and Secondary Analysis’ (Working Paper).