Independent Review of the End of Life Choices (Voluntary Assisted Dying) Bill 2020 Prepared by the Tasmanian Policy Exchange at the University of Tasmania February 2021 Independent Review of the End of Life Choices (Voluntary Assisted Dying) Bill 2020 February 2021 ACKNOWLEDGEMENTS This report has been prepared by the Tasmanian Policy Exchange (TPE) at the University of Tasmania. The TPE was established by the University of Tasmania as a strategic priority in 2020 to enhance the University’s capacity to make timely and informed contributions to policy issues and debates which will shape Tasmania’s future. The Review Panel would like to thank all those who made formal submissions to the Review and to colleagues in Victoria, Western Australia and Queensland who shared their expertise and insights at the Review workshop conducted in early February. We would also like to thank the researchers and staff across the University who contributed their time and expertise to the preparation of this report. THE REVIEW PANEL Professor Richard Eccleston (Chairperson), Tasmanian Policy Exchange Professor Fran McInerney, Wicking Dementia Research and Education Centre WITH CONTRIBUTIONS FROM Professor Margaret Otlowski, School of Madeleine Archer, UTAS Science/Law graduate Law Sarah Hyslop, Tasmanian Policy Exchange Associate Professor Jenny Presser, School of Medicine Hollie Jackson, UTAS Arts/Law graduate Contents TERMS OF REFERENCE ........................................................................................................................................................3 THE REVIEW PANEL .................................................................................................................................................................4 A NOTE ON LANGUAGE ...................................................................................................................................................... 7 EXECUTIVE SUMMARY ......................................................................................................................................................... 9 PART ONE - TASMANIA’S END-OF-LIFE CHOICES (VOLUNTARY ASSISTED DYING) BILL 2020: THE CONTEXT Section 1: Introduction .................................................................................................................................... 17 Section 2: The historical development of voluntary assisted dying law ................21 2.1 The history of voluntary assisted dying legislation in Europe, the United States, New Zealand and the United Kingdom ..................................................................................................................21 2.2 The history of voluntary assisted dying legislation in Australia ....................................................................................................................................... 26 2.3 The development of voluntary assisted dying legislation in Victoria, Western Australia and South Australia ..........................................30 2.4 The history of voluntary assisted dying legislation in Tasmania ....................................................................................................................................30 PART TWO – TASMANIA’S END-OF-LIFE CHOICES (VOLUNTARY ASSISTED DYING) BILL 2020: KEY ELEMENTS AND COMPARATIVE ANALYSIS Section 3: The End of LIfe Choices (Voluntary Assisted Dying) Bill 2020: A summary ..........................................33 3.1 Objectives and principles ...............................................................................................33 3.2 Eligibility ....................................................................................................................................33 3.3 Consultation and referral process ........................................................................ 36 3.4 Administration of voluntary assisted dying substance ........................ 38 3.5 Legal and other protections ....................................................................................... 41 3.6 Monitoring and oversight ............................................................................................44 Section 4: Tasmania’s End-of-Life Choices (Voluntary Assisted Dying) Bill 2020: Comparative analysis.................45 4.1 Key elements of the Victorian Voluntary Assisted Dying Act 2017 ..............................................................................................................................................45 END OF LIFE CHOICES BILL REVIEW - FEBRUARY 2021 1 4.2 Comparative VAD tables ..............................................................................................48 4.3 Tasmania’s End-of-Life Choices (Voluntary Assisted Dying Bill 2020: Comparative analysis ..............................................................................................................54 PART THREE - END-OF-LIFE CHOICES (VOLUNTARY ASSISTED DYING) BILL 2020: PUBLIC SUBMISSIONS AND FURTHER CONSIDERATIONS Section 5: Submissions made to the independent Review Panel .............................................. 59 5.1 Key themes from public submissions ................................................................60 5.2 Specific amendments proposed in submissions ..................................... 62 5.3 Specific amendments which the Review Panel believe warrant consideration ..........................................................................................64 Section 6: Insights and further considerations for VAD in Tasmania ...................................... 67 6.1 Considerations for the implementation and administration of voluntary assisted dying ................................................ 67 6.2 Data on voluntary assisted dying access in Victoria and Canada ..........................................................................................................69 6.3 Considerations for people seeking voluntary assisted dying ....................................................................................................... 72 6.4 Considerations for health and care professionals .................................... 74 6.5 Considerations for hospitals and aged care facilities .......................................................................................................... 78 6.6 Considerations for palliative care and end-of-life planning ........................................................................................................ 81 6.7 Legal considerations ........................................................................................................84 ENDNOTES ...................................................................................................................................................................87 REFERENCES ................................................................................................................................................................... 93 APPENDIX 1 Submissions to the Review...............................................................................................100 APPENDIX 2 Complete tables 2.2 and 2.3 .............................................................................................. 101 APPENDIX 3 Summaries of VAD legislation in comparative jurisdictions .................. 103 2 END OF LIFE CHOICES BILL REVIEW - FEBRUARY 2021 The University of Tasmania’s Independent Review of the End-of-Life Choices (Voluntary Assisted Dying) Bill 2020 Terms of Reference The VAD Review Panel (the Panel) will include health, legal and social sciences expertise and will provide advice to the Tasmanian Government for dissemination to Members of the House of Assembly on specific matters in relation to the End-of-Life Choices (Voluntary Assisted Dying) Bill 2020 (‘the VAD Bill’) tabled in the Legislative Council by the Hon Michael Gaffney MLC on 27 August 2020. The Panel will conduct research and targeted consultation, through a written submissions process, in relation to the proposed VAD Bill in Tasmania and, in order to inform parliamentary debate, provide an independent and objective report to the Tasmanian Government containing: • A concise summary of the VAD Bill, following amendment by the Upper House. • Comparison of Tasmania’s Proposed VAD Bill to legislation (including Bills) relating to voluntary assisted dying, however described, in other Australian states and territories and overseas jurisdictions, including but not limited to the processes allowed by the legislation, safeguards and protections for vulnerable people. • An outline of the historical development of VAD legislation in other Australian jurisdictions in terms of scope and protections. • Synopsis of relevant reports, analysis and material in other Australian states and territories and overseas jurisdictions pertaining to the implementation and administration of VAD reform. • Objective analysis of: ₀ the safeguards put in place in other jurisdictions relating to the impact of VAD legislation on medical practice and practitioners, allied health and care professionals, family and social relationships, and provision for and practices in aged care. ₀ the interrelationship between the VAD Bill and existing palliative care and advance care directives in Tasmania and the experience of other jurisdictions in implementing VAD legislation to identify matters that might need to be addressed or monitored should the legislation pass into law. ₀ stakeholder feedback relevant to