Advance Care Directive

At any time in our lives, we may not be able to make or communicate decisions about our own medical treatment care.  Advance Care Directives help those caring for you understand your wishes throughout.

Legislative Council, 7 February 2013

The Hon. S.G. WADE (16:13): The Advance Care Directives Bill 2012 was tabled by the Minister for Health in the House of Assembly on 17 October 2012. At that time the minister for health was the Hon. John Hill. The bill enables competent adults to: firstly, make decisions and give directions in relation to their future health care, accommodation arrangements and personal affairs, and, secondly, to appoint substitute decision-makers to make such decisions on their behalf.

I understand that the bill is a government bill. For the Liberal Party, however, this is a conscience vote, and the views I express today are mine alone. As a Liberal, I believe that people should live the life of their own choosing, even if others think that it is not in their best interests. In my view, this legislation makes a positive contribution to that goal. It is the result of a long and detailed consultation process.

In April 2007 the government launched the Advance Directives Review with the release of an issues paper titled 'Planning ahead: your health, your money, your life'. An independent Advance Directives Review Committee was established with the former health minister, the Hon. Martyn Evans, as chair. The 11 member review committee was supported by a panel of experts across a broad range of areas. Over 120 submissions were received on the issues paper from health, aged care and community professionals, lawyers, community organisations, consumers, Aboriginal communities, government agencies and financial institutions. My understanding is that the submissions were broadly in support of the current regime and enhancements to it. After 18 months of deliberations the Advance Directives Review Committee reported to the Attorney-General in two stages with 67 recommendations.

In 2011 the Australian Health Ministers Council endorsed a national framework for advance care directives. The framework provides a lexicon of terms (to facilitate national harmonisation), a code for ethical practice and best practice guidelines. I understand that the bill substantially accords with the national framework and only fails to address one recommendation of the review, that recommendation being that there be an integrated directive encompassing powers of attorney. Like the Hon. Tammy Franks, I pay tribute to the work of the Hon. Michelle Lensink in this area.

Having said that the bill reflects the national framework and the review, I do caution that it may not be the best way to express those reviews in legislative form, and the bill may yet be able to be improved. While I support the second reading of the bill, I look forward to more detailed consideration in the committee stage.

To summarise the benefits of the bill, I thought I would quote from a letter to me from the Australian Medical Association (South Australian division) which considers:

that the Advance Care Directives Bill offers significant key benefits, including:

It supports patient autonomy by making it easier to complete and apply ACDs.

I pause to add that ACDs in that context means advance care directives. The letter continues:

In particular, the bill aims to protect individuals who have specified a refusal of treatment, and aims to protect health practitioners who comply with these wishes.

It creates a single form of ACD to replace the current confusion that exists between the application of Enduring Power of Guardianship (Guardianship and Administration Act 1993), Medical Power Of Attorney and Participatory Directions (Consent to Medical Treatment and Palliative Care Act 1995).

It resolves issues regarding s17(2) of the Consent to Medical Treatment and Palliative Care Act which has been interpreted to provide for medical practitioners to be legally compelled to provide treatment to patients in the terminal phase of an illness even if they believe it to be of no benefit to the patient.

Later in the letter the AMA states:

We believe that the bill significantly improves the framework for medical and healthcare decision-making in SA, rectifying some of the problems with existing legislation.

I thank the government for the briefings of parliamentarians, both as individuals and groups. The bill has been the subject of a range of criticism and comments from a range of stakeholders and constituents raising legal, medical and ethical issues in relation to the bill.

Personally, I thank minister Hill and his officers for briefings on the bill and for information on the government's responses to concerns raised. In that context, I again refer to the letter to me from the Australian Medical Association dated 30 January 2012 in which it indicated that the government had well advanced amendments to address concerns with the bill. The letter stated:

The government and minister subsequently provided a number of clarifications to the AMA(SA) and we understand the government to be introduc ing some key amendments to the bill in response to the concerns we raised. In summary we understand that these amendments will:

M ean that medical practitioners who are acting in urgent situations in which there is uncertainty will be protecte d, for example, if they resuscitate a patient. This is an extremely important provision.

Protect health practitioners who believe in good faith that they are acting in accordance with the advance care directive but may have misinterpreted the provision.

Mean that medical practitioners are not required to find another practitioner to comply with a directive to which they themselves have a conscientious objection, bring ing the bill into line with current professional standards.

Allow for the correction of iatrogenic co mplications .

The AMA (SA) welcomes the s e amendments , which address the key issues we have raise d regarding the bill. W ith the s e important amendments, the AMA (SA) supports the bill.

Clearly, the government has provided these amendments to a peak body outside this chamber, but it has not felt it necessary to provide them to this chamber. I am disappointed with that, and I do not intend to address in detail the concerns raised with the bill when a peak body tells me that government amendments to address these concerns are waiting in the wings. I urge the government to table the amendments as soon as possible so that this council can consider the bill and the form that the government actually intends that it should pass.

Like the Hon. Tammy Franks, I, too, would like to address the issue of euthanasia. As the record shows, while I support individual medical self-determination, I will be very cautious in endorsing any legislative scheme for euthanasia. Concerns have been raised that the bill does provide a form of euthanasia. Again, I am reassured by the submission of the AMA which I will now quote. In a section headed 'Euthanasia and end of life care', the AMA states:

The AMA(SA) notes that it is specified that this Bill does not provide for euthanasia. The Association does not consider that this Bill advances or legalises euthanasia, nor would the Association support the introduction of amendments to the Bill which would enhance or legalise euthanasia. The AMA does not support euthanasia.

In summary, I support the second reading of the bill. I look forward to amendments from the government or other members to enhance the bill so that this council can give it due consideration and that as soon as possible South Australians can benefit from care which more closely accords with their values and wishes.