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Seriously ill should have the choice to exit

19 November 2012 4 Comments

DISCUSSION of death and dying is still something of a taboo in our society.

But, as Australia’s best-known voluntary euthanasia activist Philip Nitschke argues, patients who are seriously ill deserve to have a choice about how to exit this world. That is perhaps why this medico has spent years developing peaceful and reliable methods designed to give dignity and choice to those whose physical suffering has become too much to bear.
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What the good doctor never banked on is the reaction of the Australian Health Professionals Regulatory Authority. In August, AHPRA launched an investigation to determine if Nitschke was a “fit and proper person” to hold medical registration in this country. This is because a complaint alleged he had “developed, marketed and are (sic) selling an apparatus solely used for the purpose of suicide”.

Since 1996, when the Northern Territory passed the world’s first law on voluntary euthanasia, the Rights of the Terminally Ill Act, Nitschke has slogged it out, lobbying politicians as well as creating contraptions to facilitate peaceful passing.

Nitschke’s first suicide device was something called The Deliverance Machine. Following the lead of the American right-to-die trailblazer Jack Kevorkian, who made machines such as the “Mercitron” and the “Thanatron”, Nitschke explains that he wanted to make a machine the patient could control. Nitschke says that, far from it being about doctor-assisted dying, he wanted to remove himself from the immediate vicinity of the person, thereby making way for a patient to make the ultimate decision.

The Deliverance Machine ticked all the boxes. While the doctor would insert the cannula into the patient’s vein, the patient – via a laptop computer – would control the activation of the lethal drugs. The laptop software asked three fairly blunt questions, the last of which was: “In 15 seconds you will be given a lethal injection . . . press ‘Yes’ to proceed.”

My understanding is that four people used this machine before federal parliament overturned the NT law in early 1997. The original Deliverance Machine now rests in the British Science Museum in London, while a replica can be found at the Museum of Old and New Art in Hobart.

While Nitschke’s inventions have evolved over the years, Australia’s voluntary euthanasia laws certainly have not. Even though suicide is not a crime, assisting a suicide carries a range of penalties from five years’ jail in Victoria to life imprisonment in Queensland, the Northern Territory and Western Australia. The other states lie somewhere in between.

These legal obstacles to voluntary euthanasia seem only to have strengthened Nitschke’s resolve to ensure that, at the end of their lives, the seriously ill have choice. While Nitschke can still be found traipsing door to door in Parliament House, he is also increasingly preoccupied with what might be called the technologies of death. One of his newest inventions concerns a system by which a person can use an inert gas such as nitrogen to die by hypoxia (low oxygen). Nitschke describes this method as akin to what happens when a plane depressurises. Everyone looks like they have gone to sleep. They seem peaceful and there is no blood and gore. He also claims this method is reliable.

In selling the cylinders (all proceeds flow directly to his non-profit organisation Exit International), the doctor knows he is treading a fine line in terms of the law. When quizzed, Nitschke is careful to point out that, on its own, a nitrogen cylinder is not a suicide apparatus. And he’s right, at least technically. The other vital equipment is a plastic bag and some connecting rubber tubing. The latter, Nitschke says, is something people must supply themselves. As he puts it, DIYD – Do It Yourself Dying – keeps everyone safe from the law.

Besides, he says, most people will never use the nitrogen. They simply want to know it is there in the cupboard should their health turn bad. Most are reassured they possess an insurance policy for the future. This is a sentiment I support. As I’ve written elsewhere, while I’m not particularly scared of dying I am horrified at the thought of leaving my loved ones behind. That terrifies me.

Until the past few weeks, I’ve been fortunate to be able to report that even though I soon turn 68 my health has held out quite well. I am now informed this may not be the case. Hence I’d quite like to have one of Nitschke’s nitrogen cylinders stored away in my garage, just in case.

Actually, I’m grateful someone has thought out an option for a death that is reliable and peaceful, and that if and when the time arrives I can organise myself, without the need of intervention from my wife and daughter.

So why is AHPRA investigating? Nitschke says he feels this is a quasi-religious, political witch-hunt. He points out that the complainant, Paul Russell, is one of his more vocal church-based opponents. That Russell held the Democratic Labor Party’s number one spot for the Senate in South Australia at the last federal election suggests Nitschke may have a point.

For a person who, within the context of the voluntary euthanasia debate, has made his name and reputation from the invention of suicide machines and helping the terminally ill, and who as a result has been the recipient of numerous humanitarian awards, being “fit and proper” seems to be precisely what Nitschke is.

Surely AHPRA ought to conclude the same. And surely they should take cognisance of the fact that, in a poll conducted last year, 85 per cent of Australians supported voluntary euthanasia. It’s a tough subject and sometimes uneasy to talk about, but in a democratic society we should be able to choose how we die. I know I want to do so gracefully.

Professor Ross Fitzgerald is the author of My Name is Ross: An Alcoholic’s Journey, now available as an e-book.

The Weekend Australian November 17-18, 2012 , Inquirer p 20.


  • Stephen FitzGerald and Gay FitzGerald (author) said:

    To die with dignity

    ROSS Fitzgerald wants to be able to choose how to die, but it’s against the law for anyone to assist him to do so (“Seriously ill should have the choice to exit”, 17-18/11).

    We have been committed to the individual’s right to make this choice for more than 40 years because we see it as a human right. This right should be respected and it should not be the prerogative of any individual, party, parliament, religious or other organisation, to deny that right and impose their sectional beliefs or individual fears on other people.

    The individual’s choice, freely, to die with dignity does no harm to other individuals or to society, as demonstrated in those jurisdictions around the world that permit voluntary euthanasia.

    If others choose, without coercion, to die in suffering and without dignity, we respect their choice. Philip Nitschke, in his seminars, repeatedly and emphatically advises that to assist another to die is against the law in all Australian jurisdictions. But 85 per cent of Australians wish that law to be changed.

    The Australian Health Professionals Regulatory Authority should not entertain a complaint that appears to be no more than another attempt to thwart that wish and force a sectional belief on the rights of Australians in general.

    Stephen FitzGerald and Gay FitzGerald, Surry Hills, NSW

    The Australian November 19, 2012, p 13.

  • Richard Laidlaw (author) said:

    It was interesting to read Ross Fitzgerald on voluntary euthanasia (Seriously ill should have the choice to exit, Inquirer, Nov.17-18) because he canvasses important options that in Australia’s secular society are surely common sense.

    Most Australians are not actively religious. On the basis of opinion sampling, a large majority of them appear to believe that choosing to exit a terminating life on your own terms, and before the end game becomes too distressing, is something that should be regarded as an unquestionable right.

    Shifting to such a policy should not offend committed religious people. They have their own beliefs about rights and wrongs and no one would seek to interfere with that, or to infringe their human rights by legislation. This debate is about personal decisions, which are informed by individual beliefs.

    In that context it is beyond belief that the Australian Health Professionals Regulatory Authority (AHPRA) should be pursuing Philip Nitschke to determine whether he is a fit and proper person to hold a medical registration. The panoply of acronyms through which Australians nowadays allow their lives to be regulated is a far greater social threat than anything Nitschke has done or is likely to do.

    Life is ultimately a fatal condition. Science makes possible and – in the main – modern western social precepts accept the concept that terminally ill people should have ultimate control over their lives and ending them if all hope of recovery has gone.

    It is well past time, as Fitzgerald rightly asserts, for some deep thinking about end of life management. Voluntary euthanasia should be an accepted element of both that debate and whatever is its outcome.

    Richard Laidlaw
    Bali, Indonesia

  • Margaret Pawsey & P.A.Smith said:

    Backing for euthanasia

    ROSS Fitzgerald is to be applauded for his article (“Seriously ill should have the choice to exit”, 17-18/11).

    I watched my husband slowly dying in agonising pain that no palliative care alleviated, until the doctors finally decided that he had reached the stage where the only effective drug dosage was one that was likely to cause his death.

    The horrors of it still haunt me 30 years after he was finally released from the hell he had been condemned to suffer.

    I have not the slightest doubt what the judgment of a doctor’s fitness to practise medicine will be by anyone with experience of the effects of the commandment that thou shalt live, no matter what the cost.

    Margaret Pawsey, Dandenong, Vic

    ROSS Fitzgerald is right. Surely the overwhelming number of Australians who support voluntary euthanasia should have the support of the federal parliament, support that could be given without denying the rights of the minority of Australians who elect to die without assistance.

    P. A. Smith, Mount Archer, Qld

    The Australian November 20, 2012

  • ABCTV 7.30 Report said:

    ABCTV 7.30 Report, December 18, 2012

    CHRIS UHLMANN, PRESENTER: Euthanasia advocate Philip Nitschke is facing another investigation. In the past he’s been censured for his advocacy of euthanasia drugs. This time it’s over the distribution of gases. A shelf company he has formed is selling nitrogen cylinders – usually used in home brewing, but which can also be lethal. There’s nothing illegal in the operation but it could cost him his registration as a doctor. Mike Sexton reports, and a warning, some viewers may find this story distressing.

    MIKE SEXTON, REPORTER: It’s an odd sight: voluntary euthanasia campaigner Philip Nitschke sitting in a car park in Sydney’s North Shore waiting for customers. Inside his van are pre-ordered cylinders of nitrogen from his new home brewing company.

    For some customers the contents of these brown bags has nothing to do with a fine ale; instead it represents a legal way of ending life.

    PHILIP NITSCHKE, EXIT INTERNATIONAL: Nitrogen is a gas which is never going to be restricted. We’re all sitting here breathing it right now, 80 per cent of the air, and it presents an option which a lot of people are finding quite appealing, so we can’t keep up with the… we can’t keep up with it. This is the second lot of 100 that we’ve been sold. We’ve got another 100 on order from China right now.

    MIKE SEXTON: But in doing this Philip Nitschke finds himself again under professional scrutiny that threatens his future as a doctor.

    PAUL RUSSELL, HOPE: This is a very, very serious public safety issue, and I think the marketing of it and the distribution methods of it suggest to me that there’s a wanton disregard for public safety.

    MIKE SEXTON: It’s this familiar sound that’s causing the latest argument in the debate over the rights of Australians to decide how they die. The bubbles in stout are created during the brewing process by using nitrogen. Other beers use carbon dioxide, which means for home brewers a cylinder of inert gas is an essential piece of equipment.

    Dr Nitschke, through his new company Max Dog Brewing, is selling bottles of nitrogen for two reasons.

    PHILIP NITSCHKE: You can have a cylinder, you can brew with it, and if you want to at some later stage I guess you can use the system to end your life. And I’m not being too flippant about this; the fact is there are two quite separate uses for this gas.

    (Speaking at information seminar) The big difference is one question of legality. Gases are legal. Smuggling in prohibited substances like Nembutal certainly isn’t.

    MIKE SEXTON: Philip Nitschke has spent much of his life at the legal and ethical edges of how people with end theirs. 7.30 filmed one of his information seminars held recently at a Sydney community centre. The audience had registered with Dr Nitschke’s organisation Exit International, and for three hours discussed openly end of life issues. During the seminar he outlined his new growth area in the sale and use of inert gases.

    PHILIP NITSCHKE: …which provides people with a peaceful, reliable – and in the case of the gases – totally legal means of ending your life.

    ROSS FITZGERALD, AUTHOR [AUDIENCE MEMBER]: Does the nitrogen have a lifetime guarantee, so to speak?

    PHILIP NITSCHKE: So to speak. Absolutely lifetime guarantee.

    MIKE SEXTON: Veteran political commentator Ross Fitzgerald has ordered a cylinder. The 68-year-old will soon undergo major surgery and says he wants his affairs in order in case things go wrong.

    ROSS FITZGERALD, AUTHOR: I don’t want to be in a situation when I’m older of suffering dreadful pain, being completely out of it, being a source of concern and despair to my wife and my daughter and my friends. And I’m also a person that likes to be an agent and not a pawn. I like to be someone who has some control about the way in which I go out.

    MIKE SEXTON: Paul Russell blogs for an online network called Hope that opposes moves to legalise euthanasia. He means advances in palliative care mean terminally ill patients can be cared for while protected from potential harm.

    PAUL RUSSELL: I really fear for elderly people who are perhaps in an abusive situation. The phenomenon of elder abuse is becoming more common and more known, and I can foresee an opportunity in this for someone with sinister motive perhaps to order a canister, to prepare it and perhaps to dispose of a relative for the sake of inheritance, or just to simply have them out of the way.

    MIKE SEXTON: Paul Russell’s complaint about Dr Nitschke’s distribution of nitrogen has led to an inquiry by the Australian Health Practitioners Agency, which has the power to deregister doctors if they’re not considered a fit and proper person. It’s not the first such complaint. More than 12 months ago AHPRA began an investigation into Dr Nitschke about alleged plans to import Nembutal that can be used to end life. South Australian police have also investigated but no charges have been laid.

    PHILIP NITSCHKE: The paradox is, in Australia of course, is that whereas that non-crime suicide is something which the law seems quite comfortable with, assisting is certainly a crime, and it’s the only example in law where assisting someone to do something which is lawful is a crime, and that’s an anomaly which really does need to be removed.

    PAUL RUSSELL: I think there are significant problems and I think ultimately the organisation probably does deserve to be put under scrutiny of perhaps a parliamentary committee or something like that.

    MIKE SEXTON: The Australian Health Practitioners Agency says it doesn’t comment on individual cases, and Dr Nitschke says he hasn’t heard when either inquiry will conclude. In the meantime he will continue spruiking homebrew accessories for those interested in them for other reasons.

    PHILIP NITSCHKE: I’ll be simply telling you what other people do. It’s up to you to decide whether you want to do that or not do it ,but I am suggesting that it would be wise to think ahead.

    CHRIS UHLMANN: Mike Sexton reporting and if you’re suffering from depression you can call Lifeline on 13 11 14.

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