Nitschke - The fallout and the problem with the few

Article by Craig Wallace, convenor of Lives Worth Living Australia. 

In The Age (Melbourne) back in August Ian Maddocks, Emeritus Professor of Palliative Care at Flinders University and Senior Australian of the Year 2013, wrote a reflective piece arising out of the decision of the Medical Board of Australia to use emergency powers to immediately suspend the then Dr Phillip Nitschke, after he admitted to supporting 45-year-old Perth man Nigel Brayley in his decision to commit suicide despite knowing he was not terminally ill.

Professor Maddocks intelligent piece crystallises a dilemma faced by euthanasia advocates in the wake of the Nitschke deregistration as they attempt to craft a new argument for medically assisted dying based on process, nuance and evidence, not just the wielding of emotion or the idea of suicide as the exercise of a personal right. There are lessons here too for the anti-euthanasia lobby which has sometimes equally allowed itself to be painted into a corner with black and white arguments founded in dogma.

As the piece highlights, the reality of patients' lives and doctor's interventions is nuanced and dogma defying. There are shades of grey, changes in circumstances and many forces which might weigh on decisions.

For medically assisted dying to become ethical, a doctor would need to be sure of all the factors weighing in a person's mind, not just at a point in time, but across time. People change their minds. They have good days and bad days.

A doctor would also need to be alert to a layer of emotional, financial and family pressures which might be brought to bear on a person considering ending their lives. It is not hard to imagine what these pressures could be in a family under stress with money on the line.

Given the difficulty of obtaining such a spread and depth of insight, especially in the busy life of a doctor, it is little wonder that Professor Maddocks concludes that a desirable result would be one where medically assisted dying was available to "just a few" and for most as an option for peace of mind, but rarely used.

It is here that problems begin anew. In a world of total empathy, where we understood what each of us meant all of the time, I might support voluntary suicide in extremis on medical grounds for these few.

But we don't live in a world of crystal clarity so the issue becomes how definitions in legislation conceived by mortals, will be interpreted by other mortals. Legislators and Doctors alike are mortal. Ask the NSW Independent Commission Against Corruption or the Australian Medical Board who have now been forced to strike off one of their own.

Definitions like "voluntary" or "unbearable" sound like definitive terms but they are infinitely interpretive and steeped in uncertainty.

Let's start with "unbearable". Most lives involve periods of discomfort and pain - physical, emotional, mental to us or to others. Unrequited love can be a kind of incurable pain. Depression or arthritis another. Each of these may seem unbearable at one time.

I know people with disabilities who have gone through grief and loss, including suicidal feelings, and emerged with a love of life equal to anyone else's. Everyone can change choices over a lifetime. Or reach an acceptance of lives as they are. But there is no undo button for death.

It's because concepts are moveable and personal that the clientele for euthanasia seems to shift from people in pain because of cancer to people in pain because of quadriplegia or even chronic depression.

Let's talk about "voluntary". All of us know volunteering is not a consistent concept in families at the most mundane times. The volunteerism in a request like "Would you like to take the garbage out this week?" depends on the tone of voice used when asked. How much more in extremis, at the end of a long period of illness when a family inheritance is on the line?

In short "just a few", so easily becomes the many on the turn of a few words.

Words aside, we have not done all that we practically can for the few either. If we have arrived at medically assisted dying as a last resort, should we not first deploy all the options which might reduce symptoms like nausea and pain?
While many Australians loathe what illegal narcotics have done to young people in our families, we do seem to be edging closer to acknowledging a persuasive case for legalised cannabis.

Recently, New York became the 23rd state in the US to legalise medical marijuana and there is a momentum for change in Australia. Legislation to legalise the use of marijuana for medicinal purposes is being considered in the ACT and New South Wales, as well as by a cross-party group of MPs in federal Parliament.

Evidence based work to relive pain and distress should be far ahead of more quick fix legislative solutions on assisted dying. These are often introduced as private members bills arising from conviction rather than studied consultation including with people in the disability community.

The journey of Philip Nitschke from medical practitioner to outcast, like Jack Kevorkian before him, is a cautionary tale of the dangers of letting hearts rule minds on a complex issue and the difficulties that seem to arise time and again in containing euthanasia to a well-defined group of people.

Craig Wallace is the convenor of Lives Worth Living a disability advocacy group speaking out about euthanasia and eugenics as well as the President of People with Disability Australia