Dr. Louise Campbell:

I completely see the theoretical problem and clinical problem with advance healthcare directives. However, the importance of an advance healthcare directive is that it focuses all stakeholders - family, healthcare providers and everybody - on what the patient's wishes would have been or were, given that he or she took the time to devise this document and draw it up.

That person-centred focus is a vitally important component of any legislation making provision for advance healthcare directives. It is very unlikely that a jurisdiction considering even discussing the potential or possible legalisation of assisted dying will make provision in that legislation for advance euthanasia directives, given that it is so uncommon everywhere else in the world.

Belgium and the Netherlands are outliers in this regard. The Netherlands has the longest tradition in the world of legalised assisted dying if we go back to the 1970s when it was decriminalised in certain contexts. I can see that it is a worry but I think it is an ancillary worry in terms of the present discussion.

The question of whether an advanced health care directive is implementable or can be implemented in practice depends on how much advice and information the directive-maker got at the beginning of the process, whether he or she has a designated healthcare representative to help professionals interpret the directive if there is any ambiguity, and how well educated those clinicians interpreting the directive are. Those factors are vital. There is a right to conscientious objection in all jurisdictions in which the practice is legal. The question is whether the conscientious objector has an ethical or legal obligation to refer the person requesting assisted dying to somebody who will assist him or her. We have seen this in our recent legislation on the termination of pregnancy. I hope that addresses the Senator's question.