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Mr President, I rise to note and consider the Voluntary Assisted Dying Commission's annual report of 2023-24. Before commenting on the report, I am also pleased to note that every Australian state, as well as the Australian Capital Territory, has now implemented voluntary assisted dying legislation. The Northern Territory is the only one yet to do so. This seems an injustice as approximately 30 years ago the Northern Territory was the first Australian jurisdiction to pass such laws before they were voided by federal interference.

 

In November last year, while discussing Go Gentle Australia's first annual report on the state of voluntary assisted dying in Australia and New Zealand, I made reference to the authors of the report highlighting that 2024 was a year of firsts for that organisation. Indeed, it is with our own VAD act I am pleased to present the first Tasmania report to consider a full year's operation of the End-of-Life Choices (Voluntary Assisted Dying) Act 2021, which I will refer to as the act. 

 

As the act begins to mature, people are becoming aware of voluntary assisted dying as an endoflife option and jurisdictions begin to review the strengths and areas of improvement of current regulatory schemes. Although, as I stated recently in an email I sent to all members of parliament  (bar one), one of the challenges for all jurisdictions is getting accurate information into the community.

 

This challenge has been highlighted in several of the states that have undertaken VAD reviews. For example, only 33 per cent of Queenslanders are aware that VAD is available and fewer know how to access it. 

 

That challenge was also mentioned by health practitioners presenting at the Tasmanian VAD forum held last year at the Royal Hobart Hospital. Indeed, similar sentiments were expressed by Dying with Dignity Tasmania, our peak advocacy group for VAD. It is also concerned about the limited VAD appreciation and understanding. It stated, 'the Tasmanian state government should support measures designed to improve Tasmanian's health literacy about voluntary assisted dying.'

 

It is important for members of parliament to inform their electorate about webinars, forums, and presentations that allow and create a better understanding of the VAD process.I appreciate those members who assisted in forwarding that learning opportunity via their networks to their constituents.

 

This VAD commission's annual report highlights the broad success of the introduction of voluntary assisted dying in Tasmania, whilst demonstrating strength in areas of improvement itself. Tasmania is also in a positive place to undertake another first. Section 145 of the Tasmanian legislation requires its first major three-year review of the act to include the operation, scope, and potential scope of the act. The wording of the Tasmanian act, 'scope and potential scope' is, I believe, in advance of many of the other Australian VAD legislations. It indicates that the review will examine a broad range and breadth of issues. This allows a more comprehensive investigation of the scope and potential other than just the operation of the VAD process.

 

Noting the recent Victorian review of voluntary assisted dying operation and the subsequent announced implementation of all recommendations by the Victorian government, Tasmania has an opportunity to improve its regulatory tools and review its potential scope to best suit the needs of Tasmanians. 

 

This will be advantageous to those issues currently being discussed nationally and internationally, such as advanced care directives, capacity, prognosis, appropriate funding, and university training modules, to name a few.

 

The Tasmanian voluntary assisted dying report, Victorian voluntary assisted dying review, and Go Gentle Australia's state of voluntary assisted dying report all show that the voluntary assisted dying frameworks are a success and processes are being implemented as intended. 

 

The reports also highlight that review and safeguard processes are working effectively, compassion is shown throughout the process, and constant efforts are being made for improvement by implementation or legislation.

 

I would like to take this opportunity to thank members both past and present, who participated in the creation of the voluntary assisted dying legislation, including my colleagues who gave genuine and meaningful support, feedback, and even more vital critical analysis and responses. I would also like to thank those directly involved in carrying the bill in the other place, including Sarah Courtney, who carried the bill for me and did an outstanding job.

 

 I would like to acknowledge the efforts of the members of the commission and those people and organisations undertaking efforts to provide materials, continuously promote improvement, and ensure the best possible implementation of the voluntary assisted dying regulatory scheme.

 

Dying with Dignity Tasmania also thanks the commission by writing, 'Our organisation has appreciated the openness of the commission to responding to any of our concerns, including a recent inquiry about data collection.' 

 

This includes the voluntary assisted dying pharmacy service and navigation service, a pivotal point of contact for information and supportabout voluntary assisted dying to people, families, and carers, as well as healthcare professionals.

 

I have received positive reports about the services involved in VAD. Dying with Dignity wrote:

 

DWD Tas are currently available for Tasmanians with queries about VAD or who are having difficulties in accessing it. Sometimes we are dealing with distressing emails from those who for a range of reasons have been denied access. Usually the issues involved can then be worked out by Tasmania's remarkable Voluntary Assisted Dying Navigation service. For example, a woman's son emailed our Dying with Dignity Tasmanian committee, explaining that his mother had found a GP to support her access to voluntary assisted dying, but could not find the second doctor required. Having put him in touch with our navigation service, we later checked in to see if that helped. Thank you, yes, we are on track. What an amazing team and process is now available to us all.

 

I would like to acknowledge the efforts of NorthWest Dr Keith McArthur, who is an exceptional and compassionate lead of the statewide voluntary dying clinical service. In November 2024, Keith and his team coordinated a wonderful forum to acknowledge the 23 October Tasmania VAD milestone. 

 

It was pleasing to see the Minister Roger Jaensch, at that forum, with VAD being part of his Mental Health and Wellbeing portfolio. It was an extraordinarily successful and strongly supported event at the Royal Hobart Hospital.

 

Moreover, I would like to give thanks to those who have shared their experiences with voluntary assisted dying across jurisdictions, including participants and their families and friends, the practitioners and nurses involved and other stakeholders. I would like to acknowledge those who have needed and chosen the VAD pathway. I express my sincerest condolences to their friends, families and loved ones. 

 

I am pleased to state that as a second VAD report, we will consider the report continues to demonstrate both success in the legislation itself and the community and network responsibility for implementing the voluntary assisted dying scheme. 

 

Over the 12-month reporting period, there have been 129 first requests, 109 second requests, 105 final requests and 60 reported voluntary assisted deaths. Gradually growing numbers also reflect voluntary assisted dying processes in other jurisdictions and indicates that the scheme is becoming more settled, accepted and furtherreaching.

 

I would also like to note that of those who did not participate through the process fully, fewer than five were not eligible. They were all determined not to be expected to die in the next six months. This indicates that the laws are working as intended, abiding by the strict eligibility criteria and safeguards determined by the legislation. 

 

However, it should be noted that the more recent Queensland act extended that six-month time limit to 12-months. No doubt this will be a consideration for our three-year review commencing in October of this year.

 

The commission reviewed the performance and exercise by persons of functions under the act in relation to 58 of the 60 deaths that occurred as a result of the administration of a VAD substance under the act. There were no notifications of suspected contraventions. 

 

No requests were received for consideration of 15(4)(c) of the act, relating to communication assistance, nor were any applications or requests for advice of a participant's primary medical practitioner as to whether the participant meets the act's residency requirements. The single reviewed application as to whether the participant had decisionmaking capacity was withdrawn after the commission had initiated a hearing.

 

Over the period the report covers, 130 nurses and practitioners received the VAD training, decreasing from 330 in the prior reporting period. This is to be expected as the scheme matures and Tasmanians maintain a strong network, and a high percentage of medical practitioners and registered nurses trained proportionate to its population. 

 

However, it is recognised that we need to do more for the trained health practitioners to actively be able to participate in the VAD process to help spread the load.

 

The commission has undertaken various activities to promote and fulfil its role under the voluntary assisted dying legislation. For instance, the commission has sponsored fact sheets exploring various stages of the process and has updated relevant documents to provide more information on eligibility. This comes with an aim to provide support to families and friends and those undertaking the voluntary assisted dying process with clear and easily digestible information. 

 

These documents are made accessible online and in person and can be accessed in different languages, demonstrating forwardthinking accessibility measures and meeting demands being noted in other Australian voluntary assisted dying jurisdictions for access for the multicultural communities. 

 

The commission has undertaken substantial work distributing information and assisting medical operators. This includes writing to health practitioners to promote encouragement of their fellow practitioners, and encouraging existing voluntary assisted dying providers to consider assisting new patients. 

 

This promotes furtherreaching voluntary assisted dying availability, especially in more rural and regional areas. The commission also supports the delivery of more than 30 educational sessions at 26 locations across the state to 500 medical staff attendees. 'The Tasmanian Voluntary Assisted Dying Clinical Practice Handbook', published in March 2024, was to assist medical practitioners and nurses actively supporting patients and navigating the rigorous voluntary assisted dying process. Meanwhile, the Tasmanian Voluntary Assisted Dying training was updated to separate learning and assessment modules and to make assessment components more straightforward, with copies of the training schema being distributed in early 2024.

 

I turn now to the challenges and recommendations facing the implementation of voluntary assisted dying. The previous report suggested recommendations to better streamline the administration of the VAD process in Australia. 

 

As the act and the voluntary assisted dying support and improvement system has had more time to mature, some of these recommendations have been implemented, and others remain to be rectified. These are captured in the latest report's recommendations. 

 

The 2023-24 report has introduced nine key areas in need of reform to address the challenges to VAD. I usually would not read in the recommendations from annual reports, however as the threeyear review commences in October 2025, this year, it is very important to ensure our parliamentariansand our respective communities are fully aware of the review process and what is on the table. 

 

Indeed, after this 2025 review, the legislative review process for voluntary assisted dying then starts a regular fiveyear cycle. I will list each of these in order directly from the commission's 2024 report. 

 

The first ongoing recommendation is:

 

That the Commonwealth Criminal Code is amended to remove the limitations on providing voluntary assisted dying information by way of a carriage service, as a matter of priority. 

 

This recommendation is crucial to cross-jurisdictional acceptance of voluntary assisted dying as being supported by other jurisdictions, including Victoria, Western Australia, South Australia and Queensland, and now New South Wales and ACT, as well as other stakeholders including Go Gentle Australia, in the form of joint statement of various medical and health associations, including the Australian Medical Association, and the Australian Nursing and Midwifery Federation. 

 

The Commonwealth Criminal Code hinders distribution of information and restricts communication, posing a unique challenge to rural and regional participants.

 

The Tasmanian legislation is robust, however. It has safeguards in place to protect against abuse of the scheme. Reforms to the Commonwealth Criminal Code will not diminish these safeguards. In the Tasmanian legislation, the first meeting between a patient and his/her principal medical practitioner, or the PMP, is to be in person, so that there is an understanding of VAD and its processes. Indeed, the relevant fact booklet must be given to the person. Our Tasmanian act also states that VAD is not suicide, as is the focus in the Commonwealth Criminal Code. I remind listeners that suicide is a choice between life and death, and voluntary assisted dying is a choice between two deaths. 

 

The second recommendation is:

 

That the MBS is reformed as it relates to voluntary assisted dying to establish voluntary assisted dying-specific MBS items that provide appropriate benefits for the entirety of the voluntary assisted dying process, including administration of the VAD Substance. 

 

Reform of the MBS structure, including voluntary assisted dying MBSspecific items, should allow and incentivise more practitioners to undertake the necessary travel, nonpatient administration aspects and telehealth assessments.

 

The third recommendation is:

 

That privately employed medical practitioners note that there is nothing in the Act that precludes charging patients a private, out-of-pocket fee for the provision of services as a patient’s PMP, CMP, or AHP. 

 

The fourth recommendation is:

 

That the State Government implement a State-based remuneration scheme for the remuneration of privately employed medical practitioners and registered nurses who choose to act as a participant’s PMP, CMP, or AHP, until such time as the MBS is reformed to establish voluntary assisted dyingspecific MBS items that apply to the entirety of the voluntary assisted dying process. 

 

As the report succinctly puts it, a lack of state-based renumeration scheme for the renumeration of privately employed practitioners sends a negative message about the state government's level of assistance for support of voluntary assisted dying in Tasmania to existing participating practitioners, and to those that are considering performing functions as a patient's primary medical practitioner, consulting medical practitioner or administering healthcare practitioner. 

 

It is a significant barrier to achieving a sustainable medical workforce in this dimension of health care. In discussion with healthcare practitioners, I believe that this is the most significant barrier that needs addressing. 

 

The fifth recommendation is:

 

That the Act is amended to provide more options for dealing with circumstances in which a participant’s PMP becomes unable to continue in the role. 

 

This recommendation comes in the backdrop of a number of medical practitioners who were unable to continue in the role of PMP for reasons beyond their control. While solutions were found, this recommendation would remove difficult, time-consuming at times, and distressing solutions. The sixth recommendation is:

 

That the Act is amended to include, and harmonise, reporting requirements relating to Final Permissions, Private Self-Administration and AHP Administration Certificates, and notification of a participant’s death.

 

The next recommendation is:

 

That the Act’s requirements relating to the supply and return of the VAD Substance following the issue of a Private Self-Administration Certificate are reviewed to prevent an occurrence such as that which occurred in Queensland. 

 

The eighth recommendation is:

 

That the Tasmanian State Government purchase or develop an online portal for use by medical practitioners acting as PMPs, CMPs, or AHPs, and registered nurses acting as AHPs, and for the Commission. 

 

Tasmania does not have an electronic portal for medical practitioners providing services to submit forms to. Instead, we operate a manual process. This system lags behind other jurisdictions and is unnecessarily cumbersome. An online portal will rectify this. This recommendation is one which should be able to be initiated very quickly. It is my understanding that Tasmania is the only state not to have a portal available to assist with the VAD process and yet we were the third state to accept or to pass the legislation. 

 

This places greater strain and time constraints on our health practitioners. I believe this is an issue that Mr Jaensch, the Minister for Health, can address as soon as practical, and does not have to wait for the three-year review. 

 

The ninth and final recommendation is:

 

That the Tasmanian State Government supports measures designed to improve Tasmanians’ health literacy about voluntary assisted dying

 

Anecdotal evidence from stakeholders, health professionals and community members suggests many Tasmanians do not know that voluntary assisted dying exists as an option for them. 

 

While information is available online, many older Tasmanians are digitally disengaged and would benefit from further measures to improve health literacy regarding voluntary assisted dying. 

 

I think I am onto my 134th forum now. The last 30 forums have been with community organisations: Probus, Rotary, etc those groups that want to know more about what is happening in that space.These recommendations, some old, some new, will likely form a part of the upcoming review.

 

My honourable colleagues, I would like to turn briefly to lessons from other jurisdictions as they reflect and complement the current state of Tasmanian voluntary assisted dying. The recent completion of the Victorian legislative review, from the first state to take on the legislation, will come with lessons of its own, as did the recent Go Gentle Australia reports. 

 

Fortunately, of the five recommendations put forward after Victorian review, only two do not already exist in Tasmanian legislation. As mentioned previously, highlighting the Queensland act, the first is to extend the prognosis requirement to 12 months for all voluntary assisted dying patients. The second is to simplify the permit process. 

 

The current sixmonth prognosis requirement, as it currently stands, poses a problem for some individuals accessing the voluntary assisted dying program. Instead, an extension or removal of a prognosis timeframe following the lead of the Australian Capital Territory's recent legislation is an important one to discuss. 

 

As the Go Gentle Australia Report 2024 puts it, this approach shifts the emphasis back onto the nature of the illness - incurable, advanced and progressive, and expected to cause death, and the suffering the person is experiencing - rather than gatekeeping access according to prognosis. 

 

This removes one of the biggest barriers to access. Given the review and safeguarding procedures which are extensive and have been proven across Tasmania and other jurisdictions, there is a fair argument made in favour of extending or removing timeframes in line with other jurisdictional development.

 

Though the commission has already undertaken substantial work in Tasmania to reduce and simplify the voluntary assisted dying permit process, procedural elements and problematic resourcing of medical practitioners and support services are barriers to optimal provision of voluntary assisted dying. NBS funding, lack of state specific funding, and other inadequacies in resourcing each pose problems with simple and streamlined procedures for participants and medical practitioners.

 

The Victorian report also notes that tailored information for Aboriginal people and Torres Strait Islanders, as well as people of multicultural communities, must be created to ensure and promote availability of voluntary assisted dying to all. Older Tasmanians, as well as rural and regional Tasmanians, are also at risk of not being able to access information or voluntary assisted dying assistance as necessary.

 

As in my notice of motion speech in the Chamber in November last year regarding the 2024 Go Gentle Australian Voluntary Assisted Dying in Australia and New Zealand report, I made mention of a person who contacted me on the Thursday before he was to take the VAD substance on the Sunday. He wanted to say thank you to me for introducing legislation which parliament passed so that he could ease his suffering surrounded by family and friends in a place that he wanted to. That man was only 62 years of age. 

 

In October of last year I also received the following email:

 

My husband recently passed away using the VAD. He was riddled with cancer and no chance of getting better, constantly in pain and had become bedridden. He was an active man and his brain always working and planning. VAD allowed him to go out on his terms with dignity, allowing him to say goodbyes to his children.

 

The team involved in VAD were the most compassionate people I have ever met. They helped us through every step and always gave us a choice. I just wanted you to know that your work and time is greatly appreciated. I cannot think of a better way to die than with your dignity in place. Thank you from the bottom of my heart. 

 

Sometimes we focus in this place on data, dollars and statistics. The next two letters, before I close, highlight the reality of the VAD legislation. It should be noted for those listening that I received permission from individuals mentioned in the next two documents to have them read fully in this Chamber. 

 

The first letter is to Dr Sullivan from David, the son of Shirley. David's mum, Shirley, chose the VAD pathway in Tasmania.

 

Dear Patrick, a year ago today you assisted my mother, Shirley Storey, to end her own life. For mum, the ability to choose when and how to end her own life and to be able to do so in a dignified and calm manner was fundamental to who she was. As you may remember, Shirley was somewhat phobic about being swept up by the medical system and being forced to spend her remaining days in a hospital ward, surrounded by strangers and feeling she had no control over her own destiny.

 

At the time we first came to see you, mid-2023, Mum was desperate to access VAD and she was considering travelling to Switzerland to seek out potential euthanasia options offered by Dignitas. We knew that the Tasmanian VAD laws were in place, but media coverage had given her the impression that the Tasmanian VAD laws were very difficult to navigate, so mum had dismissed VAD in Tasmania as an option. Luckily, a good friend who was the daughter of a doctor suggested the Tasmanian VAD system was actually significantly less impenetrable than the Switzerland one, as we had been led to believe. Her father also gave us your name as a potential contact.

 

I accompanied Mum to your surgery in Dover in June 2023 and I was immediately struck by the way that you managed to almost instantly gain my mother's trust, a woman who was very nearly paranoid in her aversion to doctors and the medical system. Within a few minutes she consented to you giving her a physical examination. I was completely floored, but perhaps the moment I remembered the most was when Mum mentioned that she would still consider going to Switzerland if necessary and you said to her, 'I promise you, you won't need to go to Switzerland, and you'll only need to go to Switzerland if you want to see the mountains'.

 

Even then, for Mum, it took a little while for it to sink in that she could actually access VAD in her own home here in Tasmania. She couldn't believe that the outcome she most wanted was actually going to be available to her.

 

So anyway, the point of the letter is, Patrick, that I just wanted to say to you thank you, from the bottom of my heart. I just can't thank you enough for your professionalism, your compassion and your commitment. I will never forget the way you made Mum feel that she had control of her own destiny and how happy that made her. Of course we, her family, were sad to lose Mum, Gran, sister, et cetera, but it made her death so much easier to bear, and so much more positive knowing that she left this life in a calm, dignified manner with little or no suffering. So thank you, Patrick. I have some tears in my eyes as I'm writing this, but they're not tears of sadness. They're tears of gratitude that this world that we live in has such wonderful people like yourself living in it.

 

All the best to you and your family.

Love, David. 

 

The second document I am going to read in now is a speech presented at the Royal Hobart Hospital Forum in November last year, recognising the second annual report. 

 

At that forum, there were a number of very engaging speakers intimately involved with the VAD process in in Tasmania. 

 

Jodie Semmler is a registered nurse and midwife who presented at that forum. I would also like listeners and Tasmanians to appreciate that our legislation was the first in Australia to include registered nurses as part of the VAD, as an administering health practitioner or an AHP. 

 

Jody's presentation: 

 

On the 28 December 2022, I had the honour and privilege of being the first registered nurse in Tasmania to assist a patient with VAD administration. Phil, his name shared with the permission of his family, was a fabulous character known for his friendly demeanour, loud shirts and love of wine and good food.

 

Phil was diagnosed with MND in late April 2022 and chose to access his VAD medication before his ability to eat and drink was taken, as the rest of his body had failed him over the eight months since his diagnosis.

 

Phil called me the day before his planned administration to make sure everything was in order. Truth be told, when I saw his number come up on my phone, I thought it was him saying he changed his mind. However, Phil was methodically organised and wanted to have the day planned just right.

 

He was heading to the beach with the family dog Lola to say bye to his dog and human mob, a group of people so wonderful that they contributed to Phil's electric wheelchair to enable him to still be able to attend the beach each day.

 

Phil had a bottle of good wine that he wanted to have a toast to his life and asked that I be part of this. Working and wine just did not seem to be the right combo, but Phil was adamant that I was part of the toast, so I asked if we could do the toast early on my arrival so it would be a couple of hours before the planned administration. Philip planned to have the medication around 1:00 PM, he normally napped around that time.

 

Heading into my first administration, I was nervous. I had painstakingly considered my outfit for the administration. It could not be all black, that was bit morbid, but it could not be too colourful, that just seemed wrong too. I thought perhaps it was a little odd putting so much thought into an outfit.

 

However, on reading This Is Assisted Dying by Stephanie Green, a Canadian doctor who undertakes medically assisted dying, she too mentioned how on her first administration her outfit seemed so important to get it right. Maybe, she writes, this is just a female thing and all the men in the room are rolling their eyes.

 

I had gone through every possible scenario of what could go wrong and had troubleshooting ideas at the ready. As I arrived one of the family friends in some initial small talk asked, have you done many of these? I hope that 'no, this is my first one' was said with confidence and reassurance. After completing the formalities of the final permission, Phil toasted his life surrounded by family and friends as he quoted lines made famous by Meryl Streep from the movie Sophie's Choice.

 

It was the same bottle of wine in the movie as what Phil was toasting his life as he said now when you have lived a good life like a saint then you die. That must be what they make you drink in paradise.

 

I asked Phil where I could buy that bottle of wine, thinking for each year on his anniversary I could buy a bottle. Phil stated that somewhere like the Me Wah in Sandy Bay with a substantial wine list may have this bottle on the menu.

 

Realising that this was probably not just any bottle, I then asked how much it would set me back. Assuming the answer was likely be in the hundreds or maybe even early thousands, Phil proceeded to tell me the bottle was worth about $15,000. My calculation later that day made me realise my small sips alone were probably about $300 of wine.

 

A period of time passed and Phil was ready. We moved him out of his electric wheelchair and onto the outdoor setting, propping him up with cushions and his wife on one side and his daughter on the other. We took photos, we laughed and Phil declared he was ready.

 

Just before 1:00 PM I assisted Phil to take the VAD medication. After Phil took the medication, he kept on talking and talking. This I had not expected nor had I troubleshooted this scenario. I sat there and listened to him chatter normally to his family. I sat with my best nursing poker face. My logical brain told me that medications take time to work. However, that did not stop my heart from pounding and wondering if something was going wrong.

 

Approximately 3 minutes passed of Phil's chatter, which had progressively slowed and become slurred, very animated, yawn and fell asleep. Phil's family, friends and I sat in silence with the noise of the birds chirping, cars going by and lawns being mowed reminding for some of us this was still a normal day.

 

Approximately 23 minutes after taking the medication, Phil passed away. Whilst none of us are exempt from death, I have learned we can make the choice to embrace life at any time, even in its final moments. 

 

I walked into that day being completely unsure how I would feel afterwards, would it be a feeling of overwhelm and oh my goodness, what have I done moment or even complete dread and denial? I walked away with what only I could describe as a full heart. I have been fortunate in my career to be a nurse and midwife and have delivered many babies and most of these deliveries leave you with the feeling of a full heart.

 

Assisting Phil was completely different, but in many ways no different at all, both birth and death are profound transitions between two worlds. Both are full of intense love. While someone enacts their right to use their VAD medication and to pass away is a time of sadness, is intertwined with joy, determination and relief that they get to pass on their terms.

 

Phil was able to pass away with autonomy over his body and with dignity. He was able to choose his time before his disease and body took away from him that what mattered most to him, his ability to eat and drink. If you would ask years ago if I had been an administering health practitioner for voluntary assisted dying, I probably would have told you that you were mad.

 

To be honest, it was not something that could ever cross my mind or had much understanding of until my husband's mother conceded in the UK when her body failed her with Huntington's Disease. I can however say that being an administrative health practitioner is one of the most rewarding and fulfilling roles I have ever undertaken as a nurse.

 

Meeting individuals when they are at, at any given time, for some this requires the ability to quickly build trust and rapport, for others they want to keep you at arm's length until maybe the time is right for them and for others it is numerous catch-ups, the ability to learn so much more about the person and to ultimately be with them as a trusted friend as they pass. I have learned to be more comfortable with talking about death in a different way to what society has traditionally considered normal.

 

I have been humbled to meet some amazing people and their families, to be invited to funerals and celebratory wakes, to be with someone completely estranged from family and friends and to be the one to give them their final hug and wish them well on their next journey. The enormity, complexity and privilege of the role of a nursing administrating health practitioner will never be lost on me.

 

Coming mostly from an acute setting, my first intravenous administration was confronting. There is no blood pressure cuff, no oxygen saturation probe, no tubes to ensure an airway remains unobstructed and no doctor standing over my shoulder, but I am administrating drugs very similar to that of a general anaesthetic and I am in a person's house.

 

For a nurse, handwashing is firmly engraved into the procedure we do, but it is the same with tap water and drying your hands on a tea towel in someone's kitchen when you put in an IV. Whatever the method of administration, the deaths are calm, peaceful and profoundly beautiful. The people who chose to enact their right to use the substances are determined and extraordinary.

 

Having recently attended the Trans-Tasman Voluntary Assisted Dying Conference in Brisbane, supported by the Tasmanian VAD Clinical Service, it left me with a passion for getting the message out there and finding ways in which we can educate and support our junior doctors that they may wish to become part of a VAD throughout their career, our nurses, who are frontline in patients sometimes, starting a conversation.

 

For many nurses, voluntary assisted dying is still very much an unknown. Some are completely unsure, but for others they are full of intrigue and question. As we enter our third year of the legislation within Tasmania, I hope for nursing that we have the opportunity to talk and educate more about VAD, but also death and dying in general and that these conversations can become more acceptable and comfortable within patient nursing conversations.

 

There is no doubt, the work itself can be time consuming and emotionally exhausting and you give a lot of yourself to each person and family member. Finding ways in which we ensure psychological safety of our medical and nursing practitioners is paramount. This looks different for every administration and for each individual undertaking administration.

 

This element of self-care is well supported with our small but dynamic team in Tassie. Our community of practices, which meets online and statewide once a month, allow our nursing, medical and allied health practitioners to come together and to troubleshoot, to support, guide and debrief. The knowledge and skills of each profession are intertwined with collegial support, appreciation and trust. The conference highlighted that we absolutely need state and federal support for our GPs and other doctors working outside of the state services to be renumerated for the invaluable work in assessing patients become eligible for VAD.

 

There is no doubt that VAD work is fulfilling, albeit time-consuming and emotionally expensive. There is already some evidence-based research completed and more being undertaken around Australia regarding workforce sustainability, eligibility criteria, advanced care planning and other clinical initiatives.

 

I am fortunately part of an incredible team of medical, nursing and allied health staff. The knowledge of the medical practitioners and their ability to get the patients through the request process, the commission for their vigilance in ensuring that each and every patient meets criteria and that the legislation is followed, the skill and knowledge of the pharmacists overall, but mostly when I ask weird and wonderful questions, the navigators for their diversity of knowledge and skill, their incredible organisation, the ability to match the right patient with the right administering health practitioner, and lastly, to Keith for his unwavering support of the Australian administering health practitioners and statewide clinical service overall. To Phil, I hope you are in paradise during that good wine. [quote TBC]

 

Mr. President, when I heard the young nurse speak at the forum, I thought that I needed to share her experience of VAD with the people in this room and to hopefully others listening without altering word.

 

In closing, as we know, we have some wonderful, compassionate health practitioners willing to do whatever they can to assist an individual and their family during the voluntary assisted dying journey. I am very concerned, however, that we need to have systems and tools in place to support their work. 

 

I am aware that the Tasmanian VAD navigators, pharmacists and members of the clinical service would greatly benefit from access to a Tasmania VAD portal. To continue to provide an effective service, it is critical for these clinicians to have access to a contemporary portal. I would ask the minister and the commission to do all they can and immediately to put a portal capacity in place, as has been achieved in every other state. 

 

The extra time required for workarounds, emailing, coordination, processing of forms, et cetera, are negatively impacting the ability to deliver the service, maintain key performance indicators and places much unnecessary stress and strain on the health professionals striving to provide this most vital service to our vulnerable Tasmanians.

 

In closing it appears fitting for Dying with Dignity Tasmania to provide comment:

 

Our organisation finds itself at the end of a 30-year journey of fighting to have voluntary assisted dying legislated. It was a special moment for us when Mike Gaffney's bill passed the Upper House with your unanimous support, a world first. In 2025 we have voluntary assisted dying not only legislated but effectively implemented. 

 

The detailed information provided in this annual report makes it apparent that Tasmania's implementation reflects the findings across other states that VAD laws are working safely and as intended, with a high level of compassion, care and integrity. Without exception, they are operating within the strict eligibility criteria and safeguards determined by our parliament.

 

We are currently working towards the legislative review that will commence at the end of this year. It will provide the opportunity to consider aspects of voluntary assisted dying that are not yet working for all Tasmanians who need to access it, built on the foundations of some of the best voluntary assisted dying legislation in Australia. 

 

I note the report.

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