Reti ShaneDr SHANE RETI (National—Whangarei): Thank you Madam Chair. It's a pleasure to speak to the bill here tonight and I want to speak to Part 2 of the bill and address Supplementary Order Paper (SOP) 210 and across some of the contributions I hope to make tonight I want to offer some perspectives—my own personal observations around medical practitioner involvement. What I say here tonight is in the context I think by necessity of a required higher standard of medicine a higher standard of scrutiny than usual because this activity is rare it's untested in New Zealand and the desired outcome is very definitely definitive and intended to be irreversible. So I think across everything I'm going to say tonight I set it in that context.Now this SOP is in name of Simeon Brown. It talks to prescribing the lethal medication and it talks to notifying or advising the intended recipient of what some of the side effects of that medication might be. Now informed consent is clearly important. It's a requirement for all health interventions not just the notification of side effects. Medication consequences and side effects are actually codified—or the requirement to notify patients of side effects is codified—under the Health and Disability Commissioner's code of patient rights: Right 6(1)(b) and Right 7(1). Right 6(1)(b)—again we're focusing just on the requirement to tell patients of the side effects of proposed medications—says every consumer has the right to an explanation of the options available including an assessment of the expected risks side effects benefits and costs of each option;" and Right 7(1) talks about the consumer's right to make an informed choice and give informed consent: "Services may be provided to a consumer only if that consumer makes an informed [consent]". Now I want to draw on a representative case where a medical practitioner—it is representative of many but a medical practitioner was taken to task by the Health and Disability Commissioner for not advising the patient of the side effects of medication they prescribed and that representative example is case number 14HDC01100. In this situation the prescribing doctor prescribed fentanyl for pain relief to a patient and the patient suffered dizziness nausea and vomiting and they were not side effects that the practitioner had advised the patient of. The practitioner was taken to the Health and Disability Commissioner. He found against them in that case that I'm just elucidating.Can I also introduce an interesting part of Australian legislation from the Northern Territory clause 89 where they actually require a practitioner to advise the patients and family of the side effects of the lethal medication they may be administering so that they can make a decision as to whether they want to be there at the time. It reads "Where the doctor is to assist the patient by administering lethal drugs the doctor should provide … the effects of those drugs to the patient's friends and family members so that they may decide to be present at the death [or not]." Well goodness if we're going to tell the family and friends surely we're going to tell the patient what the proposed side effects would be.So I think when we're advising side effects this should definitely be a requirement for several reasons. First of all it's a standard care with all medication so we're not doing anything different than we do with standard medications but these are different—these should surely be required because they are much stronger and by definition they are lethal. It's embodied in the code of patient rights and prescribers face consequences for non-adherence. I think the consequences of these medications we're talking about warrant special mention and I think they specifically should be set aside in legislative commentary which is the nature of this is SOP. Can I also conclude by saying that I think to follow a minimum of standard practice let alone what should be an escalated practice in this situation somewhat creates the narrative of "Why bother? They're going to die anyway." And I have to say that view must never be at the death side and most surely it must never advance its way from the death bed and further into society. Thank you Madam Chair."