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This is a Bill, not an Act. For current law, see the Acts databases.
PARLIAMENT OF VICTORIA
Medical Treatment (Physician Assisted Dying) Bill
2008
TABLE OF PROVISIONS
Clause Page
1 Purpose 2
2 Commencement 2
3 Definitions 2
4 Doctors to respect life 4
5 Conditions under which the treating doctor may provide
assistance 5
6 Sufferer may revoke a certificate 9
7 Immunity of providing assistance or being present 9
8 Doctor's and nurse's immunity in relation to information 10
9 Duty when declining to provide assistance 10
10 Duty to respect assistance or refusal to provide assistance 11
11 Not for resuscitation 11
12 Certificates to be kept and copies provided to the Coroner 12
13 Confidentiality of records and reports 12
14 Helpers must not benefit 12
15 Improper conduct 13
16 Death certificate 13
17 Not a suicide 13
18 Certificates are evidence 13
19 Coroner's report 14
20 Power to issue guidelines 14
21 Effect on construction of wills, contracts and statutes 14
22 Insurance or annuity policies 15
__________________
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Clause Page
SCHEDULES 16
SCHEDULE 1--Certificate of Appointment of Agent 16
SCHEDULE 2 18
Certificate of Request for Assistance in Dying: Part A 18
Certificate of Request for Assistance in Dying: Part B 20
Certificate of Request for Assistance in Dying: Part C 22
ENDNOTES 24
561PM12B.I-26/5/2008 ii BILL LC INTRODUCTION 27/5/2008
PARLIAMENT OF VICTORIA
Introduced in the Council by Ms Colleen Hartland
Medical Treatment (Physician Assisted
Dying) Bill 2008
A Bill for an Act to enable a mentally competent adult person
suffering intolerably from a terminal or advanced incurable illness to
exercise their right to end their life by requesting medical assistance
from their doctors, to protect doctors who so assist, to prevent misuse
of their ability to assist, and for other purposes.
Preamble
The Parliament of Victoria affirms its belief that
life is precious, yet recognises that some persons
with a terminal or advanced incurable illness may
suffer intolerably and have a compassionate right
to a death they believe to be peaceful and
dignified.
The Parliament of Victoria therefore enacts:
561PM12B.I-26/5/2008 1 BILL LC INTRODUCTION 27/5/2008
Medical Treatment (Physician Assisted Dying) Bill 2008
s. 1
1 Purpose
The purpose of this Act is--
(a) to recognise the right of a mentally
competent adult person, who is suffering
5 intolerably from a terminal illness or
advanced incurable illness, to request a
doctor to provide medical assistance that
allows that person to end his or her life
peacefully; and
10 (b) to grant a doctor who does so immunity from
liability in criminal, civil and disciplinary
proceedings; and
(c) to provide procedural protections against the
possibility of abuse of the rights recognised
15 by this Act; and
(d) for other purposes.
2 Commencement
This Act comes into operation on the day on
which it receives the Royal Assent.
20 3 Definitions
In this Act--
adult means a person who is 18 years of age or
more;
agent means an adult person who is not the
25 treating doctor or the independent doctor and
who is appointed by the sufferer under a
Certificate of Appointment of Agent in or to
the effect of the form in Schedule 1 and who
acts only under present direction of the
30 sufferer;
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s. 3
assistance includes any one or more of: the giving
of information, the prescribing of a drug, the
preparation of a drug, the providing of a
drug, and the providing of assistance to the
5 sufferer to ingest a drug. It does not include
assistance by injection through a needle;
doctor means an individual who is a legally
qualified medical practitioner in the State of
Victoria and has been a legally qualified
10 medical practitioner anywhere in Australia
for at least 5 years;
financial benefit does not include an entitlement
to reasonable payment for medical services;
health care provider means a health care facility
15 licensed, certified, or otherwise authorised
by or permitted by law to administer health
care or dispense medication in the ordinary
course of business or practice of a
profession;
20 incurable illness means an advanced illness
which is incurable despite all reasonable and
available medical treatment, but is not a
terminal illness;
independent doctor means a doctor who is not
25 related to the treating doctor or sufferer by
blood, marriage or close personal
relationship, and who is not being supervised
by, employed by, trained by the treating
doctor, and who is not answerable to him or
30 her in any professional respect;
intolerable suffering means profound suffering
and/or distress, whether physical,
psychological or existential, that is
intolerable to the patient;
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Medical Treatment (Physician Assisted Dying) Bill 2008
s. 4
mentally competent means an ability of the
sufferer after being given relevant
information to understand the general nature
of the illness or condition; and to understand
5 the benefits and risks of, and to weigh the
pros and cons of, presented medical
treatment and palliative care options as well
as a request for assistance to end his or her
life;
10 nurse means a person registered by the Nurses
Board of Victoria to practise as a nurse in the
State of Victoria;
pharmacist means a person registered by the
Pharmacy Board of Victoria to practise as a
15 pharmacist in the State of Victoria;
psychiatrist means a doctor who is authorised to
practice psychiatry in the State of Victoria;
sufferer means a person who has a terminal
illness or incurable illness;
20 terminal illness means an illness or condition that
according to reasonable medical opinion is
likely to result in the sufferer's death in the
foreseeable future;
treating doctor means a doctor who is the primary
25 medical caregiver for the purposes of this
Act.
4 Doctors to respect life
Doctors should always assume that persons
usually have a strong wish to continue with life.
30 The request for assistance to end life is an unusual
request that is treated with both caution and
respect.
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s. 5
5 Conditions under which the treating doctor may
provide assistance
At the request of an adult sufferer, the treating
doctor may provide assistance to that sufferer to
5 end his or her life. However, the treating doctor
may only do so if all of the following conditions
are met--
(a) the treating doctor is not related to the
sufferer by blood, marriage or close personal
10 relationship; and
(b) the treating doctor is satisfied on reasonable
grounds that the sufferer has had his or her
settled or usual residence in the State of
Victoria for a minimum of 12 months; and
15 (c) the treating doctor is satisfied on reasonable
grounds that the sufferer has a terminal or
incurable illness that is causing the sufferer
intolerable suffering; and
(d) the treating doctor has informed the sufferer
20 of the nature of his or her illness, its likely
course, and medical treatments, including
palliative care, which might be available; and
(e) the sufferer has received the advice of a
doctor practising in palliative care
25 concerning the availability and likely effects
of palliative care; and
(f) no medical treatment, including palliative
care, is available that is acceptable to the
sufferer, and that is likely to relieve the
30 sufferer's intolerable suffering; and
(g) after being informed in accordance with
subsections (d) and (e), the sufferer indicates
to the treating doctor that he or she has
decided to end his or her life; and
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s. 5
(h) the treating doctor is satisfied, on reasonable
grounds, that the sufferer's decision to end
his or her life has been made freely,
voluntarily and after due consideration; and
5 (i) if the sufferer has a terminal illness--The
treating doctor is satisfied, on reasonable
grounds, that the sufferer is mentally
competent. This condition is not satisfied if
the treating doctor has reason to believe that
10 the sufferer's decision may have resulted
from a mental illness, unless the treating
doctor has obtained an opinion from a
qualified psychiatrist that the sufferer is
mentally competent and that either--
15 (i) the sufferer is not suffering from a
mental illness; or
(ii) the sufferer's decision has not resulted
from a mental illness; or
(iii) any treatment of the sufferer's mental
20 illness is unlikely to alter the sufferer's
decision; and
(j) if the sufferer has an incurable illness--
(i) the treating doctor obtains the opinion
of a qualified psychiatrist that the
25 sufferer is mentally competent, and that
he or she is not suffering from a
treatable mental illness that could
influence his or her decision to request
assistance; and
30 (ii) the treating doctor arranges and the
sufferer must attend a consultation with
a doctor who practices in palliative care
to advise the sufferer of the availability
of palliative care and of its possible
35 benefits; and
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s. 5
(iii) a cooling off period of 14 days has
elapsed after the sufferer has had both
the psychiatric and palliative care
consultations before signing Part A of
5 the Certificate of Request; and
(k) the sufferer (or, if the sufferer is physically
unable to do so, his or her agent) signs
Part A of the Certificate of Request (in or to
the effect of the form in Schedule 2) asking
10 the treating doctor to provide assistance; and
(l) the treating doctor witnesses the sufferer's or
agent's signature on Part A of the Certificate
of Request; and
(m) an independent doctor, after reviewing the
15 sufferer's medical file, interviewing and
examining the sufferer, and discussing the
case with the treating doctor and the sufferer,
and after being satisfied on reasonable
grounds that the sufferer is an adult and
20 mentally competent, and is experiencing
intolerable suffering from a terminal illness
or incurable illness and that the patient's
request for assistance in dying is made with
due consideration and without undue
25 influence, signs Part B of the Certificate of
Request; and
(n) at least one of the treating doctor and the
independent doctor has special or particular
knowledge and experience in the sufferer's
30 type of illness; and
(o) Part C of the Certificate of Request is
completed after both Parts A and B of the
Certificate have been completed; and at least
48 hours after Part A is completed; and
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s. 5
(p) before the treating doctor provides
assistance, the sufferer (or, if the sufferer is
physically unable to do so, his or her agent)
signs Part C of the Certificate of Request and
5 the signature is witnessed by a person who is
not the treating doctor or the independent
doctor; and
(q) if the treating doctor is providing services to
the sufferer in a health care provider's
10 facility or under an arrangement with a
health care provider, the treating doctor
provides to the manager (or person fulfilling
the role of manager) of the health care
provider, a copy of the Certificate of Request
15 (Parts A, B and C) before providing
assistance; and
(r) the treating doctor has no reasonable grounds
to believe that he or she, or the independent
doctor, or a close relative or associate of
20 either of them, or the Certificate of Request
Part C witness, will gain a financial or other
benefit, directly or indirectly, as a result of
the death of the sufferer under the provisions
of this Act; and
25 (s) at the time of providing assistance, the
treating doctor is satisfied on reasonable
grounds that the sufferer is mentally
competent and still wants to end his or her
life; and
30 (t) the treating doctor writes a note on any
prescription that it is for use under this Act.
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s. 6
6 Sufferer may revoke a certificate
A sufferer or, if the sufferer is physically unable
to do so, his or her agent may revoke a Certificate
of Request by writing across the certificate the
5 word "Cancelled" or "Revoked" and signing such
revocation. Immediately upon revocation the
sufferer or their agent must return in full to a
pharmacist any prescription that has been issued
in respect of the Certificate. Within 48 hours of
10 notification of revocation to the treating doctor,
the treating doctor must forward notice of such
revocation to the State Coroner.
7 Immunity of providing assistance or being present
(1) A treating doctor who provides assistance in
15 accordance with this Act is immune from
criminal, civil and disciplinary liability and
proceedings in respect of that assistance.
This does not relieve the doctor from liability for
negligence in providing the assistance.
20 (2) A nurse, health care provider or agent who in
good faith follows the instructions of a treating
doctor is immune from criminal, civil and
disciplinary liability and proceedings in respect of
his or her actions. This does not relieve the nurse,
25 health care provider or agent from liability for
negligence in following the treating doctor's
instructions.
(3) A pharmacist who dispenses in good faith a
prescription issued by a treating doctor is immune
30 from criminal, civil and disciplinary liability and
proceedings in respect of that dispensing.
This does not relieve the pharmacist from liability
for negligence in dispensing the prescription.
(4) Any person who is present at or before the time
35 the sufferer ends his or her life, and who has a
reasonably held belief that the sufferer intends to
561PM12B.I-26/5/2008 9 BILL LC INTRODUCTION 27/5/2008
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s. 8
or has ended his or her life in accordance with the
provisions of this Act, is immune from criminal,
civil, and disciplinary liability in respect of that
presence.
5 8 Doctor's and nurse's immunity in relation to
information
A doctor, nurse, lawyer or other individual is
immune from criminal, civil or disciplinary
proceedings in relation to providing information
10 or advice to a sufferer, agent or sufferer's relatives
in good faith concerning this Act or what can be
done under it.
9 Duty when declining to provide assistance
(1) A doctor is not under any duty to provide
15 assistance under this Act. A doctor who, for
conscience, professional or other reasons, declines
to provide assistance must tell the sufferer that
other doctors may be willing to provide
assistance. A doctor who fails to do so is guilty of
20 an offence.
Penalty: a fine not exceeding 5 Penalty Units.
(2) A health care provider is not under any duty,
whether by employment, contract, statute or other
legal requirement, to participate in the provision
25 of assistance to a sufferer under this Act. If a
health care provider is unable or unwilling to
permit assistance to be given in accordance with
this Act and the sufferer transfers his or her care
to another health care provider, the former health
30 care provider must, on request, transfer a full copy
of the patient's relevant medical records to the
new health care provider.
Penalty: a fine not exceeding 5 Penalty Units.
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s. 10
10 Duty to respect assistance or refusal to provide
assistance
(1) A professional organisation, association or health
care provider must not subject a person to censure,
5 discipline, suspension, loss of licence, certificate
or other authority to practise, loss of privilege,
loss of membership or other prejudicial pressure
or penalty for anything that, in good faith and
without negligence, was done or refused to be
10 done by the person and which may under this Act
lawfully be done or refused to be done.
Penalty: a fine not exceeding 50 Penalty Units
for an individual, or a fine not
exceeding 500 Penalty Units for an
15 organisation, association or health care
provider.
(2) Subsection (1) does not apply to a health care
provider in respect of a person who knew or
reasonably ought to have known that the health
20 care provider did not allow in its facility or under
any arrangement with it, assistance which is
provided for in this Act.
11 Not for resuscitation
A person who knows or should reasonably know
25 that a sufferer has ingested a drug to end his or her
life under the provisions of this Act must not
resuscitate or attempt to resuscitate the sufferer.
Penalty: a fine not exceeding 1,000 Penalty
Units and/or imprisonment of not more
30 than 5 years.
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Medical Treatment (Physician Assisted Dying) Bill 2008
s. 12
12 Certificates to be kept and copies provided to the
Coroner
(1) A treating doctor who witnesses the signature of a
sufferer or his or her agent must keep the original
5 Certificate of Request (Parts A, B and C), and
Certificate of Appointment of Agent (if any).
(2) The treating doctor must send a copy of the
Certificate of Request (Parts A, B and C), and the
Certificate of Appointment of Agent (if any), to
10 the State Coroner within 48 hours of the
completion of Part C of the Certificate of Request.
(3) The issuing pharmacist must send a copy of the
record of fulfilment of the prescription to the State
Coroner within 48 hours of fulfilment.
15 13 Confidentiality of records and reports
Information obtained by any person or health care
provider from or about a sufferer is confidential
and may not be disclosed without the requesting
sufferer's consent, except as this Act or any other
20 law may require.
14 Helpers must not benefit
A person or health care provider who provides
advice in respect of a death under the provisions
of this Act, signs, countersigns, witnesses a
25 Certificate of Appointment of Agent, a Certificate
of Request, or doctor, nurse or agent who helps
the sufferer to ingest the drug, forfeits any
financial benefit he or she would otherwise obtain,
directly or indirectly, from the death of the
30 sufferer if that death results under the provisions
of this Act.
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Medical Treatment (Physician Assisted Dying) Bill 2008
s. 15
15 Improper conduct
An individual who by fraud, deception or
improper influence, procures the signing,
witnessing or countersigning of a Certificate of
5 Request, or the ingesting of the drug by the
sufferer, commits an offence and forfeits any
financial benefit he or she would otherwise obtain,
directly or indirectly, from the death of a sufferer
if that death results under the provisions of this
10 Act.
Penalty: a fine of not more than 2,500 Penalty
Units and/or imprisonment for not more
than 14 years.
16 Death certificate
15 The doctor completing the certificate of death
must note on the certificate of death that the
person ended his or her life with the treating
doctor's assistance under this Act. The doctor
completing the certificate of death must provide
20 the State Coroner with a copy of the certificate of
death within 48 hours. The cause of death is to be
recorded as the terminal illness or incurable illness
that led to the request for assistance.
17 Not a suicide
25 Neither permissible actions taken under, nor a
death resulting from, the provisions of this Act
constitutes suicide, aiding or abetting suicide,
mercy killing, manslaughter or homicide.
18 Certificates are evidence
30 In the absence of contrary evidence, a Certificate
of Appointment of Agent, a Certificate of Request
and a certificate of death that is signed as required
by this Act is proof that the requirements of this
Act have been met.
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Medical Treatment (Physician Assisted Dying) Bill 2008
s. 19
19 Coroner's report
The State Coroner must provide an annual report
to Parliament with details concerning the nature
and frequency of assistance and deaths under this
5 Act. The report must not allow the identification
of any individual sufferer or doctor.
The State Coroner's report must be reviewed by a
joint, all-party Parliamentary Committee.
20 Power to issue guidelines
10 The Health Minister may issue guidelines in
relation to the procedures to be followed in
respect of the provision of the lethal dose to the
sufferer and the disposal of any remaining drug, or
other administrative matters but not so as to
15 circumvent or obstruct the intentions of this Act.
21 Effect on construction of wills, contracts and
statutes
(1) Any will, contract or other agreement, whether or
not in writing or executed or made before or after
20 the commencement of this Act, is void to the
extent that it affects whether a sufferer may make
or rescind a request for assistance under this Act,
or the giving of such assistance.
(2) Subsection (1) shall not apply to an employment
25 or other engagement contract, or published code
of conduct, between a health care provider and a
person so employed or engaged, in relation to the
giving of such assistance.
(3) An obligation owing under a contract or
30 agreement, whether made before or after the
commencement of this Act, is void to the extent
that it is conditioned or affected by the making or
rescinding of a request for assistance under this
Act or the giving of such assistance.
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Medical Treatment (Physician Assisted Dying) Bill 2008
s. 22
22 Insurance or annuity policies
The sale, procurement or issuing of any life,
health or accident insurance or annuity policy or
the rate charged for such a policy must not be
5 conditioned on or affected by the making or
rescinding of a request for assistance under this
Act or the giving of such assistance with the
exception of any new policy commenced and
which is not a renewal, within 366 days of the
10 death of the sufferer under the provisions of this
Act.
__________________
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Medical Treatment (Physician Assisted Dying) Bill 2008
Sch. 1
SCHEDULES
SCHEDULE 1
Section 3 ("agent")
CERTIFICATE OF APPOINTMENT OF AGENT
5 I have agreed to act as Agent under the Medical Treatment
(Physician Assisted Dying) Act 2008, acting under the direct and
current instruction of (patient's name and address):
___________________________________________________
___________________________________________________
10 I understand that as Agent I may, under direct and current
instructions of the patient, sign on behalf of the patient a
Certificate of Request for Assistance in Dying, and/or revoke a
Certificate of Request for Assistance in Dying, and/or assist the
patient to ingest a drug issued under the provisions of the
15 Medical Treatment (Physician Assisted Dying) Act 2008.
I further understand that should I be negligent in following a
doctor's instructions regarding the ingestion of the drug by the
patient, that I may be liable for prosecution for such negligence.
I agree to act as Agent.
20 Agent§ Witness§
Date: Date:
Signed: Signed:
Name: Name:
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Medical Treatment (Physician Assisted Dying) Bill 2008
Sch. 1
Address: Address:
§
By signing this Certificate, the Agent and the Witness each certify that he or
she does not reasonably expect to receive a financial benefit resulting
directly or indirectly from the death of the patient under the provisions of
5 the Medical Treatment (Physician Assisted Dying) Act 2008, and further
certify that should such a benefit arise, the Agent or Witness forfeits all
rights to such benefit. He or she also certifies that he or she is not, and does
not expect to become, the patient's treating doctor.
The Witness further certifies that he or she is not related to the patient by
10 blood, marriage or close personal relationship; and is satisfied on
reasonable grounds that the patient has asked the person identified as
Agent to act as agent under the patient's direct instructions; and has
witnessed the Agent's signature.
__________________
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Medical Treatment (Physician Assisted Dying) Bill 2008
Sch. 2
SCHEDULE 2
CERTIFICATE OF REQUEST FOR ASSISTANCE IN DYING:
PART A
Section 5(k)
5 I have been informed by my treating doctor that I am suffering
from a terminal / incurable* illness from which there is no
reasonable prospect of recovery.
The terminal / incurable* illness is causing me intolerable
suffering that cannot be relieved to my satisfaction.
10 My treating doctor (name and address below) has explained to
me the nature of my illness, its likely course, and medical
treatments, including palliative care, that might be available.
I am 18 years of age or older, and my settled or usual residence
has been in the State of Victoria for at least 12 months.
15 I have decided to request medical assistance in dying in
accordance with the Medical Treatment (Physician Assisted
Dying) Act 2008. This is a free and voluntary decision made by
me after due consideration and without undue influence.
I now make my request.
20 Patient Treating Doctor§
Date: Date:
Signed: Signed:
Name: Name:
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Sch. 2
Address: Address:
Provider Number:
* Strike through whichever is not applicable.
§
By countersigning this Certificate, the Treating Doctor further certifies that
5 he or she is certified to practice medicine in the State of Victoria and has
been registered to practice medicine anywhere in Australia for a minimum
of five years; that he or she has witnessed the patient's (or his or her
Agent's) signature; that he or she is not related to the patient by blood,
marriage or close personal relationship, and reasonably does not expect to
10 receive any financial benefit (other than reasonable payment for medical
services) resulting directly or indirectly from the death of the patient under
the provisions of the Medical Treatment (Physician Assisted Dying) Act
2008; and is not the appointed Agent of the patient under Schedule 1 of the
Act.
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Sch. 2
CERTIFICATE OF REQUEST FOR ASSISTANCE IN DYING:
PART B
OPINION OF INDEPENDENT DOCTOR
Section 5(m)
5 I have inspected the medical records of, interviewed and
examined the patient (name and address below). I have
discussed the case with the treating doctor and the patient.
I am satisfied, on reasonable grounds, that the patient is
suffering intolerably from a terminal / incurable* illness, is
10 mentally competent, and that the patient's request for assistance
in dying is made with due consideration and without undue
influence.
I have witnessed the patient's (or his or her Agent's) signature.
Patient Independent Doctor
15 Date: Date:
Signed: Signed:
Name: Name:
Address: Address:
Provider Number:
20 * Strike through whichever is not applicable.
By signing this Certificate, the Independent Doctor further certifies that he
or she is certified to practice medicine in the State of Victoria and has been
certified to practice medicine anywhere in Australia for a minimum of five
years; that he or she is not related to the patient or to the Treating Doctor
561PM12B.I-26/5/2008 20 BILL LC INTRODUCTION 27/5/2008
Medical Treatment (Physician Assisted Dying) Bill 2008
Sch. 2
(whose signatures appear in Part A of this Certificate) by blood, marriage
or close personal relationship, and reasonably does not expect to receive
any financial benefit (other than reasonable payment for medical services)
resulting directly or indirectly from the death of the patient under the
5 provisions of the Medical Treatment (Physician Assisted Dying) Act 2008.
The Independent Doctor further certifies that he or she is not being
supervised by, employed by, trained by, and is not answerable to, the
Treating Doctor.
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Sch. 2
CERTIFICATE OF REQUEST FOR ASSISTANCE IN DYING:
PART C
Section 5(o)
Forty eight (48) hours or more have elapsed since the
5 completion of my Certificate of Request for Assistance in Dying
(Part A) in accordance with the provisions of the Medical
Treatment (Physician Assisted Dying) Act 2008.
I now repeat my request for assistance in dying, in accordance
with the provisions of the Medical Treatment (Physician
10 Assisted Dying) Act 2008. This is a free and voluntary decision
made by me after due consideration and without undue
influence.
I now repeat my request.
Patient Witness
15 Signed: Signed:
Name: Name:
Address: Address:
Date: Date:
The Witness certifies that he or she has sighted the Certificate of
20 Appointment of Agent (if any), Parts A and B of this Certificate of Request;
has witnessed the patient's (or his or her agent's) signature on this Part C
Certificate of Request; and further certifies that he or she is neither the
Treating Doctor nor Independent Doctor who signed Part A or Part B of
the Certificate of Request; is not related to the patient by blood, marriage
25 or close personal relationship, nor a person who would reasonably expect a
financial benefit (other than reasonable payment for medical services)
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Medical Treatment (Physician Assisted Dying) Bill 2008
resulting directly or indirectly from the death of the patient under the
provisions of the Medical Treatment (Physician Assisted Dying) Act 2008.
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Medical Treatment (Physician Assisted Dying) Bill 2008
Endnotes
ENDNOTES
By Authority. Government Printer for the State of Victoria.
561PM12B.I-26/5/2008 24 BILL LC INTRODUCTION 27/5/2008
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