Duncan Kerr (Denison, Australian Labor Party) Share this | Hansard source

The fundamental issue that is before the House tonight is whether it is appropriate to retain the ministerial or parliamentary level of approval for the availability of a particular drug, RU486, and, in relation to the proposed amendments, for some other classifications of therapeutic products. By way of background to my contribution to the debate on the Therapeutic Goods Amendment (Repeal of Ministerial responsibility for approval of RU486) Bill 2005, I think it is appropriate to set out the framework in which assessments of drugs proposed for availability on the market in Australia occur. Drugs can be submitted for assessment by an independent scientific body. They are then put through a process which involves looking at the research background, the testing and the therapeutic effects of those drugs and, ultimately, decisions are made about whether they be made available and the limits to their availability and the purposes for which they can be utilised.

Of course, some drugs are made available on a limited prescription basis and others as non-prescription items. But, essentially, with all such products—other than one particular drug, RU486—we have consigned the decision about whether or not risk and safety are acceptable to an arms-length, independent, scientifically based process.

When we come to consider the arguments that have been addressed, particularly by the immediately preceding speaker, the member for Hume, who constructed an argument based around safety, it is a difficult argument for me to accept because we must realise that almost every therapeutic product that is on the market carries the potentiality of significant adverse health effects. For most drugs that we receive on prescription, if we look at the product disclosure information, it reveals that, under certain circumstances, those products carry with them risk. In some instances, they may create higher risks of heart conditions for people with particular backgrounds. But almost every product will have some disclosure and many indeed are prescribed after proper consultation with doctors on the basis that, whilst the risk exists, it is counterbalanced by the benefit to the patient.

I have gone through a very tragic personal instance where my father’s partner, who survived my father, was prescribed warfarin, which is a drug for blood thinning. One of the sadder side effects is that it gives rise to the potentiality for bleeding. During one evening she suffered a massive internal bleed, died and was discovered the next morning. This did not involve RU486. Warfarin is regularly prescribed by physicians. They obviously have to take into account the side-effects. On balance, for many people warfarin prolongs their life, makes them capable of activity of which they would not otherwise be capable. Some of the drugs available are put through these tests and assessed as having serious potential side effects, but they are properly available on the basis that the risk assessment is to be between the patient and the doctor, knowing the potential benefits to be achieved. Those risks were very much to the fore of my mind when that tragedy happened in my family.

So I put aside those arguments about safety. The people who make decisions about safety are the same people who routinely make decisions with all the drug products that are available on the market. Any issue of that product goes with proper discussions between the user and her medical practitioner and with full disclosure of the nature of the risks to the person—the woman in this instance, if it were RU486.

We have to also consider that in this instance it is not the case that we are comparing a risk-free process that might be available for abortion with that of RU486. Surgical procedures, which are available lawfully in teaching hospitals and institutions in Australia, carry with them some degree of risk. Every significant surgical operation which has anaesthesia associated with it—and many procedures of that nature do have anaesthesia associated with them—carries quite identifiable risks, including risks of death. So people who undertake these particular procedures do not do so lightly; they already confront degrees of risk that they must choose to accept. They make decisions which must be terribly confronting, but we are not comparing one framework where there is no risk with another where there is significant risk; we are dealing with relative risk, which needs to be properly assessed, medically assessed and disclosed and understood by people after discussion with their physicians.

The second argument turns on the nature of the procedure. The starting point is that we enter this debate accepting that, within Australia, abortion is a legally available procedure under various legal rulings, pursuant to the Menhennit rulings of courts, principally in circumstances where assessments are made that a woman’s life or her mental ease would be damaged were that procedure not to be carried out. We are not dealing with a situation where the acceptance into the market of this particular product would for the first time make available a procedure otherwise unavailable. We are simply addressing one particular way in which that objective can be achieved.

The next point I would address is some of the arguments that have been advanced to persuade me and my colleagues, notwithstanding those two starting points—that, ordinarily, drugs are assessed for safety by an independent arms-length non-political process and, secondly, that the outcome that is sought to be achieved is lawful. The first objection is put on the basis that a majority of the Australian population disapproves of terminations and that we should resist anything that would increase the number of terminations so procured. I think it must be at least doubtful that an additional choice as to the means available for abortion actually would increase the number of procedures. I do not know that there is any evidential basis for that—in my mind it seems an improbable argument—but even if it were a factually sustainable one I do not see a basis for accepting a majoritarian argument.

We each represent different electorates and views will differ enormously within those electorates. I suspect that the majoritarian outcome would support the view that I am putting to the House that this drug should be available. Certainly that is the balance of submissions I have received from within my own electorate, although not of those I have received generally from across Australia which have run in a majority in the other direction. The submissions from my electors have very strongly run in favour of the view that I am now proposing. I think a mechanical application of a majoritarian point of view is something that no parliamentarian can accept as conditioning the way in which they would make a determination in relation to these matters. If there is a majority in favour of the drug being available but no proper basis upon which we could so decide, we should reject it. On the other hand, if there is the opposite, a majority against the drug but no scientific, ethical or procedural reason to make that determination, it seems to me that we are back into an area which properly should be described as one of proper, rational law-making. How are we going to make proper, rational laws in a community where we might properly say that we come from a common obligation to respect the laws of our nation and to respect the values and aspirations of our fellow citizens but where so many of us have quite different views on some very fundamental matters?

I have tried to live a moral life without religious belief. I do so on the basis of an acceptance that, in that process, one has to strive hard to make certain that an underlying morality can be found in some coherent, sensible way—a secular way. Much of my thinking is conditioned around the work of John Rawls. His book A Theory of Justice identifies a number of circumstances in which the state is justified in interfering with the interests of the individual. I also, however, quite properly respect those in my community who hold Christian beliefs, Islamic beliefs or a variety of different views which are conditioned from a very different starting point.

At the end of the day in a democracy we have to resolve these issues not merely through the exercise of conscience but also through the exercise of intellect—and conscience and intellect come together. In that situation, that larger framework regarding the choices to be made in relation to this matter, I suppose I come down to this question: whose choice is to govern the final outcome? Is it to be the decision of a minister of the Crown about the availability of a medical product which, absent this particular piece of legislation, would be determined on its scientific, medical rights without political interference, or should it be the choice of an individual woman on the advice and with the informed opinion of her medical practitioner to assist her in making that decision?

I accept that people of goodwill have put a proposition that we should accept, as a highest order proposition, the sanctity of life. I do, but this parliament has to address matters around a framework where we accept that in some circumstances that sanctity has been reduced—

Debate interrupted; adjournment proposed and negatived.

I was speaking of the issue of sanctity of life. I certainly take the view, for example, that the death penalty is an abhorrent penalty and I have campaigned all my life against it. But we made, just the other day, a decision in this parliament, in the legislation dealing with the call-out of the military to assist the civil power, to authorise the military to shoot down civilian aircraft. I accepted—grudgingly and with great reservation—the legitimacy of that choice. It is a choice, however, that I would hate as a minister to have to address and to make. But essentially this parliament is willing in that area to say that, under very extreme circumstances, we will authorise our military forces to shoot down a plane that might be full of innocent passengers—our children, relatives, friends—in order that the greater good of the community be protected, lest that plane be seized and crashed into a large building, as happened on September 11.

We do accept under some circumstances that sanctity of life is not an absolute. We have a larger debate about when life begins. That is a debate which, were this debate about the availability of abortion, would have members of this House choosing positions which reflect their strong personal convictions in relation to those matters, their judgments of conscience, their judgments of understanding of human life and their judgments about when we ought to accord to the product of reproduction the status of protection of human life. But that is a debate, as I have indicated before, which is, in a sense, not material to this decision. We are accepting in this debate the availability of abortion.

I also want to indicate that many members have given considerable thought to what they wish to say in this debate. Some have revealed personal circumstances in which they have been involved, including Senator Minchin, Mr Laming and the Treasurer, Mr Costello. People have worn their hearts on their sleeves in this debate. But I doubt that any of us have a greater entitlement to a conclusion in relation to whether this particular product should be available or not on the basis of our particular individual experience. We cannot live the experience of others and most particularly I, as a man, cannot live the experience of a woman who might be placed in the circumstance of deciding whether or not to pursue and seek an abortion.

In the end, this parliament has to cut the Gordian knot. We have to make a decision about the bill that is now before us. Some proposals seek to keep that knot tied—in fact, to have us come back again to redebate the merits of having some external political supervision of a scientific and medical judgment after this debate. I see no wisdom in that whatsoever.

If there is a majority in the Senate and this House that the decision should be made objectively, that risks should be assessed in the same way as would occur with respect to any other therapeutic product or good, I see no wisdom in going through a process of having this debate and then reinserting into the legislation different mechanisms of imposing political control over a judgment that ought to be scientific.

We should not be the ultimate gatekeepers of choice in this debate. I have not worked out a better way than the acknowledgment of the right of a woman—properly advised by her competent medical practitioner regarding the relative risk of products, on information made known to that medical practitioner and the woman after proper assessment by an impartial scientific assessment—to make that choice. And I do not believe that any other member of this House knows of any better gatekeeper of that choice than the woman concerned. On that basis, I certainly do not wish to substitute my political judgment or to speak on behalf of others in relation to their political judgments to intervene in that ultimately important and, no doubt, always difficult choice.

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