Dr. Greg Mewett:

Thank you for the invitation to appear before the joint committee today. My involvement with voluntary assisted dying here in the state of Victoria in Australia is based on long experience as a general practitioner in the large regional centre of Bendigo in Victoria. During that time, I developed a special interest and expertise in palliative care. Later on, I left general practice and commenced specialist training in palliative medicine in Melbourne. I became a specialist palliative care physician in 2007 and since then I have practised in Ballarat, another large regional centre in Victoria, until my semi-retirement in January of this year.

In 2018, I was invited to serve on the Victorian Government’s voluntary assisted dying implementation task force. This task force was given the responsibility of guiding the introduction of the Victorian voluntary assisted dying, VAD, Act. Victoria was the first state in Australia to introduce VAD legislation. This 18-month implementation period was necessary to ensure the setting of the scene for accessibility and viability of voluntary assisted dying as an end-of-life option in our state.

Since the VAD legislation came into effect in Victoria on 19 June 2019, I have been basically been involved, as a specialist palliative care physician, in the assessment of more than 80 patients who have requested access to voluntary assisted dying. I have acted as either the co-ordinating medical practitioner - that is, the doctor who does most of the legwork and co-ordinates the patient's journey through this - or the consultant medical practitioner - that is, the second practitioner who has to offer an independent opinion. I have been involved in 73 of those patients.

Of the 49 patients for whom I have been involved as the co-ordinating doctor: 18 patients died before completion of the VAD process, for various reasons; six cases were withdrawn, usually due to lost decision-making capacity or they decided not to proceed; 21 patients died by self-administration of the VAD substance, mostly in their own homes but some in local nursing homes, and four of my patients died in our local palliative care unit with VAD; and one patient died at home by intravenous practitioner administration, which I administered.

In summary, the important things I have learned throughout this involvement with VAD are as follows. These people who had assisted VAD did not want to die – they would much rather have lived and, without fail, their families wanted them to live. However, they had a terminal illness from which they were going to die and they had reached the limits of their suffering. Second, it was interesting that they came from all walks of life – a wide variety of socioeconomic, educational and religious backgrounds. Only a very small minority - perhaps to my surprise initially - were what some people would label as "control freaks". However, without doubt and without exception in my experience, they were very determined people who had firm, well-considered views about how they wanted to manage the end of their lives with a terminal illness. Fourth, and obviously I am a palliative care physician working in a palliative care team, all of my patients had access to excellent palliative care right to the very end, either as inpatients, in the community or in both settings. The issues of coercion, cognitive impairment and severe depression, often raised as concerns as potentially adverse factors in informed decision-making, are properly and thoroughly screened out at initial interviews and repeated interviews. They are not issues of substantial importance in our practice as long as vigilance is maintained, as it should be in any other medical practice I should say. Also, the important thing is that these people are not “suicidal” and are, without exception, offended by any implication of mental illness and suicidality.

In summary, my practice, and those of a number of my palliative care colleagues here in Australia, is living proof that voluntary assisted dying, as a valid and now legal end-of-life choice, is not at odds with the overall aims of palliative care, that is, to use a patient-centred approach to support people with advanced, progressive, incurable illness and their families and relieve suffering wherever possible.