'Cowboy' doctor may be riding into his own sunset

By Paul Russell:

My colleague, Alex Schadenberg called Dr Rodney Syme 'a cowboy' last year in relation to Syme admitting to have supported the suicide deaths of approximately 100 people over a number of years.

Syme seems either to have been beguiled by the cult of celebrity or maybe he truly wants to become a martyr for a cause. Either way, he seems comfortable appearing in the press from time to time making outrageous and unsustainable claims about having helped yet another ill person to take their own life. I say 'outrageous and unsustainable' because while seeming to be goading the authorities to arrest him and to make a test case out of his actions, he never provides enough (if any) evidence to them or to the public to back up his claims.

And while he told Andrew Denton recently that he gets 'annoyed' when the word 'suicide' is used, it is against the statute that prohibits assisting in 'suicide' that his actions might be measured if he ever backs up his rhetoric with proofs. When a person kills themself, it is a suicide; the circumstances don't change that reality.

But he provides no proof. Even in the death of Ray Godbold, covered extensively by the Fairfax Press in May 2015, where the journalist reports on a moment in time (with pictures) that perhaps should have had the authorities acting. From the story; Syme talking to Godbold:

"That's medication for you - some Nembutal," he says. "You need to take that by mouth, and you will have total control of that. It's not my intention that you take it. I hope you don't need to take it. But if you run into a brick wall, then that is what I sometimes call the key to the fire escape."

"If you take it," says Dr Syme, "you will go to sleep relatively quickly and peacefully, and you will not wake up."

I reported the matter to the medical board (as Syme's recalls in a recent article) citing not only the conversation and the images but also the fact that a medical doctor providing a controlled substance was surely 'conduct unbecoming'. My notification was followed up but then ultimately dismissed. What proof is there that the item was Nembutal? None. So, even here there's 'nothing to see'. Syme is not such a brave hero as the press seem to want to make him out to be.

But the medical board have finally taken action; this time on a complaint from the regular doctor of a dying man as reported in various media. It seems that Syme is, according to the medical board, now a 'serious risk to the public'.

The Age newspaper reports that the doctor of Mr Bernard Erica, a man with terminal cancer, reported Syme to the medical board after the ABC TV crew for the program, Australian Story, contacted the doctor asking for an interview. Syme has a relationship with this man and reports suggest that he was intending to provide Nembutal to him.

According to The Age, Syme has now been warned by the medical board not to do anything with the "primary purpose of ending a person's life". It is unclear from The Age report whether or not this is the final judgement or an interim measure. Regardless, Syme says that he is appealing the decision. He also told the reporter that he is working with 35 other patients at the moment. The ABC online news service says that 'the Medical Board (has) also decided to conduct a wider investigation into Dr Syme's professional conduct'. Time will tell.

The ABC, unlike The Age, sought an alternative view from Doctor Karen Hitchcock:

"I guess the thing that concerns me about this is: who is Rodney Syme to decide? Is Rodney Syme the one who decides now when people's life is not worth living or is worth living, or does he triage people into suicide prevention or suicide enablement?" she said.

Dr Hitchcock, who is strongly opposed to euthanasia, said in the 13 years she had worked at public hospitals, she had never had "a single patient beg" her for death towards the end of their life.

"Physical pain towards the end of life is treatable - we have powerful drugs available to us," she said.

And of course, Dr Syme and Andrew Denton and others want all this legalised. But what precisely do they want legalised? Syme told Denton that he wants assisted suicide (he calls it assisted dying but we know what he means) for rational individuals who have intolerable and irreversible suffering. Even though 'intolerable' is subjective, and 'irreversible' not a 100% certainty, he wants this 'checked against a standard' (what standard?) by a second doctor. In other words, a regimen similar to Belgium but with assisted suicide and not euthanasia as the method of death. Note well: we are not necessarily talking about terminal illnesses nor people for whom natural death is approaching.

Syme is Vice-President of a Victorian organisation that was formerly known as a 'euthanasia society' but now advocates for a regimen that does not restrict the method of death at all. Rather, they say that the method is up to the person. They say that they have 'drawn a line in the sand that we believe is fair, reasonable, responsible and, most importantly, safe' but don't say how it is safe and can't really tell us where the line is if they won't tell us what methods are acceptable.

They say that "it shall not be an offence to confidentially advise the sufferer and/or relatives/guardian regarding end-of-life choices; nor to assist or support the sufferer in choosing to hasten death in a manner acceptable to themselves; nor to be present at the time of death." How is that safe? Again, they don't say. I guess it is safe for the doctor at least.

What can we learn from all of this? Well firstly, there will always be people who don't wish to contemplate nor experience palliative care at the end of life preferring, instead to make other choices. It was clear from the ABC TV Australian Story progam that the man, Bernard Erica, does not want palliative care. Nor did Steve Guest, Syme's other 'celebrated' patient who died a few years ago.

I find it interesting that, in the Australian Story program last what we see is a person who has become somewhat dependent on Syme. The man doesn't want palliative care, is clearly fearful of what will happen to him and Syme offers him a solution. I don't want to reduce the relationship to these elements alone, but it seems to me that, amongst it all, this man and Steve Guest and, I expect, likely many others who were given Nembutal by Syme, had a dependency upon him for, at the very least, the 'comfort' as Syme describes it, of having the lethal drug.

What, if anything, did Syme explain to these men about palliation and palliative care services? We don't know. But if Syme's own explanation of palliative care is anything to go by, they will have heard a rather jaundiced and negative view. In August 2014 Syme had an article on palliative care published in The Age newspaper where he calls the development of palliative care 'outstanding' in his opening sentence and then proceeds to tear it down thereafter.

I commented at the time that this was irrresponsble: 'The intent is clear. Burst the palliative care bubble and the world will beat a path towards euthanasia.'

Syme's approach was called out a few days later in a published reply by oncologist Dr Molly Williams. In addition to calling out Syme for 'skewing' the results of some research she added, tellingly:

"Having Dr Syme imply that PC (Palliative Care) doctors are trying to sedate them into oblivion is extraordinarily unhelpful in facilitating effective symptom management for these patients."

It's a sales trick, pure and simple; and a very cynical and sick one at that. As Dr Williams concludes: "Dr Syme's attack on palliative care to garner support for euthanasia is attacking a straw man - it doesn't further the real discussion at all." No, indeed, and it makes me wonder if Syme actually wants a discussion at all, preferring perhaps that the community should simply accept his gnostic utterings.

Syme made the same sort of claim about palliative care again on morning television. In respect to Mr Erica he said:

"What will happen is that they will give him medication that, if his suffering is considered refractory, they will give him medication by infusion that will gradually put him into a coma without any food or fluids until he dies."

How can Syme know that this is will be the pattern for Mr Erica? He doesn't and he can't. There are so many variables in addition to errors of omission here that have the potential to confuse. If relief is reached to a level satisfactory to the patient and the patient remains conscious, then there is no need to 'put him in a coma' as Syme puts it. Some patients refuse food and fluids, certainly, but it should always be available and simply because the patient is in an unconscious state should not mean that it will be routinely denied them.

A case presentation from Massachusetts General Hospital of a patient with similar circumstances to Mr Erica (and written up last year) describes this well including the comment that palliative sedation is only used in that hospital 'once or twice a year'. This in a facility with nearly 1000 beds with 48,000 inpatients and nearly 1.5 million outpatient visits each year. If we're doing it differently here in ways similar to what Syme outlines, then I think we need to be asking some very serious questions about the standard of care and practice in this country. While there's always room for improvement, Australians can take great comfort in knowing that our nation was rated the second best place in the world to die in 2015. Now there's an unalloyed good news story.

Mr Erica, even with such knowledge, may refuse such treatment options. That is his right. But it does not follow that, because of his choices that the state needs to sweep aside its homicide laws that have protected citizens for centuries. Moreover, if Mr Erica is deciding upon his options based solely on the kind of information Syme provided the ABC Morning show audience, then we are left to question whether his consent is fully informed. More broadly, if that is the level of discourse, how is the Australian public ever likely to gain a balanced and objective view?

No matter where the line is drawn, there will be those who will seek to change the law by acting outside the law in helping people to a similar end. Syme is doing that currently. Legalising euthanasia or assisted suicide or whatever else Syme and others might want to call it will not eliminate the 'cowboys'.

Nitschke recently gave up his medical licence rather than face of restrictions from the medical board; perhaps Syme may now follow. The silhouette of these two cowboys riding off into the 'sunset' and into retirement is curiously appealing.

But there will be others; there will always be others. Just another reason why the only solution is to keep the clear, bright line precisely where it is and reason enough to prosecute the outliers.

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