Reti ShaneDr SHANE RETI (National—Whangarei): Thank you Madam Chair. I rise to speak to clause 4 a clause that has several parts to it. The first part talks to cannabidiol (CBD) and the non-psychoactive parts of THC. As was demonstrated in the previous Government we understand that CBD does have minimal psychoactive effects and we're supportive towards making it more accessible and affordable. We also understand the entourage or potentiation effect of THC and the inclusion in this clause of non-psychoactive THC" which I understand and we are agreeable to. The other significant part to this clause is the change from "terminal illness" to "palliation". Now "terminal illness" was always a bit of a problem. We heard from practitioners and from submitters—but particularly from the practitioners who would be certifying terminal illness—that this could be quite a challenge. Indeed the statement was made from Dr Tim Molloy the Chair of the Royal New Zealand College of General Practitioners that we're all actually dying but we understand that he was making the point that his mandate—the people he represents—would struggle with that. It also was a puzzle to me why that alone was the definition and why was it not "terminal illness" and "likely to benefit"? That just seemed to be the criterion: if you were terminal you were able to get access to medicinal cannabis. It seems to me that a prescribing doctor who certified you as terminal was also more than capable of certifying you as likely to benefit. In the new form the 12-month "terminal illness" clause has shifted to "palliation" and that leads to a whole set of discussions around definitions demonstrated by my colleague Chlöe Swarbrick who spoke just a moment ago who spoke about palliative care and then morphed into palliation. It is not clear to us that one is a derivative of another but the Minister could maybe explain. We presume it is and it would seem that it is but is "palliative care" "palliation" and why was "palliation" chosen—anyway just some clarification there. But if we look at the criteria for palliation as it's written in the bill there are four. First of all the disease is advanced it is progressive it is life-limiting and the person is near the end of their life. Every single one of these needs some further explanation. "Terminal illness … within 12 months" in clause 4 had challenges but all four of these conditions have greater challenges and by far and away need greater definition. It also brings us back to the question of why are we as politicians deciding which diseases indirectly are in and which diseases are out? That doesn't strike me as something we should be doing. That should be by a panel of experts—and in our hands that was how it was going to be—to decide what the eligibility criterion was. It does not seem right in this bill that we are deciding what the conditions are—the medical conditions that will be in and out of the bill. Shane Le Brun from Medical Cannabis Awareness New Zealand has raised exactly this point. He makes the point that a condition needs to be progressive or if you're advanced or it is life-threatening or if you're near the end of your life—but you're actually just stable at the moment. Let me just quote from one of the things he says: "Other conditions … are not covered. Dravet Syndrome which results in 10-20% of patients not making it to adulthood due to the severity of their condition for example. For those that do make it to adulthood the condition is generally not progressive and while the condition is debilitating it would be difficult to declare that such patients are nearing the end of [their] life." I would submit that we would probably all agree in those circumstances that someone with Dravet syndrome might well benefit from medicinal cannabis. Again that's a subject for specialists to decide and it is not for us tonight to write Dravet syndrome into the bill. But at first blush it would seem to be a valid case for a trial of medicinal cannabis and yet here we are on nearly all of the criteria put forward for palliation—it's a condition that's not generally progressive it is undoubtedly severe and those patients are not nearing the end of their lives. They will miss out as the bill is written here. I think again this talks to definitions and politicians deciding what those definitions are. So the questions we have for the Minister are: where do we find greater clarification around what these four eligibility criteria are how does he explain that and why are he as a politician and his colleagues deciding which diseases are worthy of medicinal cannabis and which are not? Again we offer—we had solutions under our hands where the offer was that we would have a panel of experts who would help us with this and who hopefully know more than we do about it and out of legislation they would guide us towards what the most suitable use of medicinal cannabis would be. Just to clarify also what we'd actually be voting on we're looking to insert "cannabis for medicinal purposes" into this bill because we think it adds greater clarity."