Dr. Peter Allcroft:

I thank the Senator for those excellent questions. The palliative care society in Australia and New Zealand has varying opinions on voluntary assisted dying. What I have found personally in my service is that we have people who hold conscientious religious and faith-based objections and those like me, who have never campaigned for voluntary assisted dying. I have certainly campaigned for the safe introduction of patient-centred care and choice. It has involved some of the most respectful conversations and discussions with my colleagues about how we implement this safely in our service.

We have a reason that we provide both palliative care and assisted dying for those patients in our hospice and our acute care setting. I see the two working side by side, on parallel tracks if the Senator wishes to think of them as such. Sometimes they intersect then become parallel again. One may end up at an intersection and then may make a decision. Many of the patients who are approved for voluntary assisted dying never take their medicine for one reason or another. Often, it is their security blanket, which is there just in case. They do not actually need it and they have good palliative care running alongside, with the knowledge that the option is there if it all becomes too much, whatever the reason might be.

I see over time, as has happened in Canada, that it is never a day-to-day occurrence in our work. It is an extraordinary aspect of the care of the dying but it is part of the end-of-life care and not seen as diametrically opposed.

In 12 months, I have seen an evolution, a comfort and a confidence that it is okay. Some of the clinicians who were opposed to it have seen it in operation and said, "Actually I'm comfortable with what's happening" and have put their hand up to do the specialist training that is required by any of our practitioners anywhere in Australia to be a voluntary assisted dying clinician.

Regarding the co-ordination and consulting roles, in Australia, two doctors must assess the patients. Both of those doctors must hold a fellowship in a college. For myself, it is the college of physicians but it could be the college of anaesthetists or general practitioners or the college of surgeons. You must hold be a member of a fellowship or a registered vocational programme. One of those two doctors must have more than five years experience after the granting of the fellowship so very experienced doctors are undertaking these complex assessments.

The co-ordinating doctor is the doctor who accepts that first request from a patient. Where I work, the patient must raise it with me. I cannot raise it with patients. There are a few states in Australia such as Western Australia, New South Wales and Queensland where clinicians can raise it as an aspect of care but the patient must raise it and I can choose to accept that first request to his or her co-ordinating doctor. I would then refer him or her to a second doctor often using the voluntary assisted dying navigation service, which is a group of nurses, social workers and occupational therapists that helps co-ordinate and navigate this complex journey for patients and their families. I refer the patient to a consulting doctor who may be a doctor with specific experience and skills in the patient's disease but, again, is a doctor who has done the training for voluntary assisted dying, holds a fellowship and so has considerable experience. That consulting opinion is a one-off opinion. He or she assesses the patient, listens to his or her symptom burden and degree of suffering and assesses a prognosis. In South Australia, the patient's prognosis for cancer or chronic disease needs to be six months or less estimated by the clinicians or if it is a neuro-degenerative disease such as motor neurone disease, the prognosis needs to be 12 months or less.

The co-ordinating doctor takes the written request from the patient. That is then submitted to the Department for Health and Wellbeing where the chief executive officer of South Australia Health approves that permit based on the legislation that all dot points have been followed precisely. A permit is then issued and I request a script for the medication. That could be medication the patient takes at a time of his or her choosing or medication that I will obtain if it is physician-administered voluntary assisted dying. I see people in their homes, age care facilities, the acute care hospital setting or outpatient clinics. We are using telemedicine for assessing the patient's eligibility. That is the limit. We are allowed to use telemedicine digital platforms for assessment of the patient's eligibility and not for talking about the medicine or how it might work. The co-ordinating role probably takes somewhere between four to eight hours in total in a number of assessments of that patient, submitting paperwork and documentation and viewing Australian residency and citizenship.

Regarding motor neurone disease, the criteria were lengthened to a prognosis of less than 12 months.

Again, it is based on symptom burden and suffering. Many of the symptoms are existential such as loss of dignity, loss or independence, loss of autonomy and being totally dependent on someone for personal hygiene. For some, that loss of dignity is breathlessness because motor neurone patients predominantly die as a complication of respiratory failure because the breathing muscles just become too weak. Ultimately, even with non-invasive ventilation, life becomes intolerable for them.