Discussing a good death with Philip Nitschke

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'Damned if I do' by Philip Nitschke features the doctor standing with arms foldedI speak at a writers festival about once a year. These festivals are always good fun, inspiring and mind-expanding. Last weekend I participated in a panel discussion at Perth Writers' Festival on 'A good death'. A panel of four members was deftly facilitated by Anne Summers, asking 'What is to be gained if assisted suicide is legalised? What stands to be lost? Does society need a better approach to dying?' I was the token 'religious' person on the panel, and the only one to express satisfaction with the status quo of Australian law which presently bans physician-assisted suicide and physician administered death. Predictably the audience was pro-euthanasia.

I was able to mix with other writers bemoaning Australia's refugee policy including the confusion and obfuscation about the death of an asylum seeker on Manus Island and Julie Bishop's latest diplomatic initiative asking Hun Sen to accept refugees from Australia for permanent resettlement in Cambodia. I came away wondering how passionate refugee advocates could be so sanguine about physician assisted suicide and doctor administered death even for children.

No doubt many of the audience wondered how I could be a refugee advocate while not extending the right of self-determination to any person wanting assistance to end their life, at a time of their choosing, in a manner of their choosing, and in the company of their choosing.

Despite my insistence on distinguishing personal moral beliefs, voluntarily embraced and espoused, from laws and policies imposed with sanctions on all citizens, I suspect many thought my views on appropriate laws and policies governing death and dying were really predetermined by my Catholic moral upbringing. I did point out that the 85-year-old Hans Kung, a leading Catholic theologian who is increasingly incapacitated with Parkinson's Disease and macular degeneration, has written in the third volume of his autobiography: 'I don't want to go on existing as a shadow of myself. Human beings have a right to die when they see no hope of continuing to live according to their very own understanding of how to go on living in a humane way.'

After the session, a couple of writers expressed bewilderment how Tony Abbott and his fellow Jesuit alumni could espouse their refugee policy and still profess their Catholic faith. Law and religion, politics and policy are always a complex mix.

Dr Philip Nitschke was on the panel promoting his autobiography Damned if I Do. He spoke with some ambivalence about the policy objectives of reformers in this field. On the one hand, he agitates for the right of any person to control their life and to take their life regardless of their physical health or pain.

He suggests that the state should not impede the provision or availability of substances like Nembutal so that citizens might always be assured a simple, dignified way of ending their lives, even if they be simply sick of living. He gave the example of the Victorian couple who decided to consume Nembutal together because one did not want to go on living were the other to die of cancer.

On the other hand, Nitschke concedes that the only prospect of legislative change will be with the design of a law which contains stringent safeguards and preconditions. Presumably he thinks the safeguards can be removed over time once we cross the medico-legal Rubicon of 'Do no harm'.

The focus of the discussion was principally on the needs of those wanting to end their lives. But Nembutal is better than hanging not just for the deceased, but also for those who are left behind. Concerns about others feeling pressured by relatives to consider death as an option were discounted. Many were dubious when I quoted UK research which showed that 35 per cent of persons with a significant disability were worried that a euthanasia law might put pressure on them to end their lives, and 70 per cent feared for others with disabilities.

Recalling the Northern Territory experience in 1997, Nitschke told us that Chief Minister Marshall Perron, who spearheaded the short-lived euthanasia law, did not want to put in too many hoops for people to jump through before requesting a doctor to administer a lethal injection. Many in the audience were dubious about my claim that Aborigines on remote communities were afraid about what doctors might do to them once this law was in place. There was a suggestion these fears were whipped up by the churches and other conservative groups.

I came away wondering why the perceived urgency for changing the law. With the internet and a patchy Customs service, people are able to import Nembutal fairly readily, keeping it on the shelf for their hour of need. Fellow panellist Lionel Shriver gave the salutary warning, 'Don't put it next to the baking soda.'

Attempts at legislative change have recently fallen over in Tasmania and New South Wales. Having failed on the same sex marriage front, the ACT Legislative Assembly this week will consider a motion on dying with dignity. Chief Minister Katie Gallagher reflecting on the recent deaths of her aged parents has said:

If I was ever in a position where I had to make a choice about supporting a proposed model of voluntary euthanasia, I would have to be convinced about a range of safeguards as part of any model. I'm overwhelmingly of the view that the debate about euthanasia should be refocused on improving end-of-life care, understanding the individual person's wishes about their end-of-life care choices and how we as a community ensure that people are able to die with dignity.

Given that the number of Australians aged over 85 will quadruple in the next 40 years from 400,000 to 1.8 million, discussion about euthanasia will continue.

Even though Nitschke was accompanied by security guards, I thought it a good sign that we all engaged in a civil, good humoured discussion, and that there was room at a writers festival for one religious person happy to raise questions about the vulnerable and the common good, though being outnumbered by those who think that the issue should be primarily, if not exclusively, focused on the autonomy of the mentally able, resourceful, determined person wanting a death of their choosing. No doubt we will solve it all at the next writers festival.


Frank Brennan headshotFr Frank Brennan SJ is professor of law at Australian Catholic University, and adjunct professor at the College of Law and the National Centre for Indigenous Studies, Australian National University.

Topic tags: Frank Brennan, euthanasia, Philip Nitschke, Anne Summers, Lionel Shriver

 

 

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'Discussion about euthanasia will continue', as Frank suggests, and if it continues in the way in which the discussion at the writers' festival apparently did, then we have little to worry about. It's only when some people seek to tell us that their God, or their 'Natural Law', has already proscribed the matter for the rest of us, that we need to worry.
Ginger Meggs | 24 February 2014


Thank you for the article. Limiting my reply to people with terminal illnesses, I fear that sometimes pro-euthanasia advocates, while of good heart and very genuine, believe that people with terminal illnesses are forced into prolonged lives against their wills, that a prolonged, mentally and physically painful, undignified exit is the only option. There are other options. My 87 year old mother died recently. She had acute myeloid leukaemia, she was in pain and she was suffering. Her life was not prolonged by the doctors, the doctors and nurses were caring, understanding and professional, she was given effective palliative care, nature was allowed to take its course and she died peacefully. She did not need euthanasia. My mother is a sample of one in this debate, but her outcome does indicate that the need for euthanasia can be overstated. Euthanasia is not risk free. Fergal Fleming, Darwin.
Fergal Fleming | 24 February 2014


Frank, the statement you make about the ease of importing Nembutal is a bit fatuous. "Where's the urgency about changing the law?" you ask. If you're caught importing it, and many people have been, the penalties are grotesque: a prison sentence or a fine of up to $825,000. No doubt this suits you, so I can see that from your point of view, there's no urgency.
Marky Mark | 24 February 2014


I loved this gentle irony at the end of your piece, Frank: "No doubt we will solve it all at the next writers festival." Would life were that painless! Fergal Fleming summed up the difference between good palliative care with no unwanted prolongation of suffering and euthanasia excellently. If you look at the scandals surrounding the euphemistically named Dignitas Clinic in Switzerland and the current and proposed setups in the Netherlands and Belgium I think you have real cause to worry. Philosophers such as Peter Singer dangerously oversimplify an extremely complex issue. What concerns me is the seemingly easy progression from supposedly totally mature and unemotional logical "choice to die" to involuntary euthanasia which I believe could now happen in Belgium and the Netherlands. Perhaps it is already happening. If so that would concern me. I am also concerned about people such as Dr Philip Nitschke. Clergy are often described as fanatics who should keep out of certain issues: exactly the same could be said about him. I regard him as an extremely dangerous man.
Edward F | 24 February 2014


A great article, again. A few years ago, in Switzerland, I had the experience of knowing a man, formerly a banker, who had decided to die with the help of Exit. When the pain became too much, he almost locked himself in his home and saw no-one. All his friends were kept at bay. He spent months brooding, looking at the ceiling, and this for a refined and wealthy man who loved opera, fine dining and lively company, was tragic. Eventually the various hurdles were overcome and he died with the drugs administered. His friends, one of them my mother, were left terribly saddened and depressed that they had been unable to reach him and make his last moments less painful. Like Katy Gallagher, I believe that the need for euthanasia would decrease hugely if we focused on better care at the end of life.
Eveline Goy | 25 February 2014


The article at the attached address says it all: http://johnmenadue.com/blog/?p=421 Good palliative care and compassionate medical practice is the solution. Sedation is an option for extreme cases.
George | 25 February 2014


Precisely, Fergal Fleming! Your position describes much greater humanity than that of deranged pretenders to the ideals of Medicine like Nitschke. Father Frank - thank God you rattled their comfort at the Writer's Festival. A meddlesome priest interfering with personal beliefs and agendas yet again. Please continue to meddle! Two comments, first, the trendy cry "Do no harm" has never been part of the Hippocratic Oath and still isn't. Second, what the Oath does say and always has since 460 BC when Hippocrates wrote it is, 'I WILL GIVE NO DEADLY DRUG, NOR PERFORM ANY OPERATION FOR A CRIMINAL PURPOSE, EVEN IF SOLICITED, NOR WILL I SUGGEST ANY SUCH COUNSEL. This is what true doctors practise.
john frawley | 25 February 2014


I was present at the discussion and felt that many in the audience did not have much experience of the excellent palliative care available in most places and the lack of pain in most near death periods for cancer and other sufferers. I am also aware of the will to live and the will to die which seem to be present often. I think living wills need to be promoted and am aware that it is the people who have lost their mental capacity who are perhaps most in need of euthanasia but would still not be able to take their own life.
Marie Wilson | 25 February 2014


Good palliative care and properly managed access to euthanasia should not be seen as mutually exclusive options. I can think of many people who are much more dangerous than Peter Singer and Philip Nitschke, and most of them are in politics.
Ginger Meggs | 25 February 2014


"Predictably the audience was pro-euthanasia" - yes, predictably because there is a large majority in favor and especially among your audience: a large group of elderly, intelligent people... "I came away wondering how passionate refugee advocates could be so sanguine about physician assisted suicide " - if you're still wondering after all these years of discussion you must be not listening because I'm sure the words compassion and dignity have been used a lot. And no, it isn't just a matter of "better care" - please listen to people who don't want better care, or much care at all, but who have led a long satisfying life and would much rather die than face a major loss of control and function. Isn't it wonderfully ironic that the people most afraid to die are those who believe there's an afterlife?
Russell | 25 February 2014


Russel, "......people most afraid to die are those who believe in an afterlife". I don't think you have spent much time amongst those who are dying. My experience is that those who believe in an after life are far and away the least afraid to die as is the experience of many I know working in palliative are.
john frawley | 25 February 2014


Russell's comment that the majority agree with euthanasia is just false. Studies (and my experience as a medical practitioner) have demonstrated that the majority do not know what euthanasia is ie active deliberate killing of another person. They muddle it up with withdrawal of treatment and allowing disease process to end life, with palliation. The pro-euthanasia proponents deliberately muddy these waters by talking about "active" and "passive" euthanasia.The slippery slope argument is powerful. already we see it with the slide from legal euthanasia of adults to children in europe.
Joanne | 25 February 2014


no one is asking you or any other doctor to do anything john frawley. what people are asking for is the choice to make decisions about their own bodies and their own lives.
johannes | 26 February 2014


So given what Joanne and John Frawley say, may I assume that they are both strict pacifists?
Ginger Meggs | 26 February 2014


A "GOOD DEATH" Fr Brennan of course is one prepared and faced fortified by Sacraments of the Church! [with absolution, anointing, Holy Viaticum and Apostolic blessing with Plenary indulgences],these i have given in homes,hospitals nursing homes,road side accidents etc over near 40 years of priesthood-with conditional absolution eg to a policeman who suicided with service pistol after his girl friend rejected him. As a highly experienced death bed pastor, around Australia I warn,flirting in last moments with mortal sin of Euthanasia before Private Judgment is ill advised as doorstep to Eternity.[I couldnt give a coffin nail what Nitschke finks!]
Father John George | 26 February 2014


Pope Francis' antidote to euthanasia: “Are we afraid of the habit of calling the priest to give this Sacrament to the sick – I don't mean in the case of influenza that lasts three or four days, but rather a serious illness – and to the elderly, so that they can find the strength from Jesus to go on?” asked the Pope, and concluded by urging those present: “Let's do this" [Vatican City, 26 February 2014 (VIS) ]
Father John George | 26 February 2014


Two comments. The concept of "crossing the medico-legal Rubicon of 'do no harm' " seems simplistic to me. A doctor keeping a patient comfortable and pain-free as an inevitable death approaches is surely doing good, and beyond that there is a very grey area indeed. I recently observed the death of a loved relative who had repeatedly asked her doctor to keep her free of pain until her death, even if the pain-killers hastened her death. This he did, and she died well, with him at peace with his conscience and within the existing law. I think that she was wise in the framing of her request; others could do the same.
Anna Summerville | 28 February 2014


The cry "do no harm" is commonly limited to that of a physical nature. When someones life is extended into and beyond the place where they can cope mentally or emotionally ,then harm is being done. Let us be aware that the end of life is a time to consider the physical and mental sides of life as one, if we haven't before.
geoff Duke | 28 February 2014


Thank you Father Frank. I wonder if you'd bother debating Philip Nitschke, or indeed if any of us would give two figs about his opinion on this subject, if we understood the nature of the underground euthanasia movement that he runs. It's time the law did it's job and exposed him for the fraud that he is. He is a pied piper to a highly vulnerable population. The death count amongst the members of his organisation is high. He keeps the data secret and state coroners are none the wiser. If the current law can't catch Philip why do we dare to think new laws will help?
Pippi M | 03 March 2014


Father John George, your warning that 'flirting in last moments with mortal sin of Euthanasia before Private Judgment is ill advised as doorstep to Eternity' may make sense in terms of your world view and I respect your right to hold that view and to manage your own life and death accordingly. But for me and many other people it is meaningless and irrelevant, so why can't you respect our right to hold a different view and to manage our own lives and deaths according to that different view. It's not your beliefs that I object to, but you desire to subject the rest of us to the same beliefs, beliefs that we do not share with you.
Ginger Meggs | 03 March 2014


#Mr Meggs sir I haven't subjected anyone to anything I am not Fr Tomás de'TortureHarder'(1420-149] #matter of fact, I simply have responded to numerous calls to sick and dying. [ames 5:14 "Is any man sick among you? Let him bring in the priests of the church and let them pray over him, anointing him with oil in the name of the Lord" #[It is hardly 'subjecting' people to present church teaching on a Roman Catholic Jesuit site; [just as The Blessed Bishop Clemens August Graf von Galen (March 16, 1878 – March 22, 1946) spoke up against Nazi euthanasia of elderly,dying,sick,mentally disabled and other so called "useless eaters",thus freeing up beds and staff for growing wounded soldiers! #[I admit he struck fear in the hearts of Goebbels, Borman and Hitler. I simply post church teaching[relax Ginge!!-no burnings scheduled] ]http://www.katequinnauthor.com/images/Rack_Cartoon.jpg
Father John George | 03 March 2014


I conducted research in the NT when the Rights of the Terminally Ill Act was in place (first legislation in the world that allowed both euthanasia and physician-assisted suicide. One person wrote in his questionnaire: "Everybody is saying Aboriginal people are afraid of this law; I'm Aboriginal, I'm not afraid of it, I think it is a good thing to have this right". A palliative care colleague who attended a meeting with Kevin Andrews & staff opposing the law stood up at the meeting to try to correct some of the misinformation being "spruiked" - he was ordered out of the meeting.
Prof Colleen Cartwright | 16 March 2014


Having done some research on euthanasia, I agree wholeheartedly with Frank Brennan, even though I found the slow dying process of my husband devastating. Recently a neighbour described her reasons for dissatisfaction with the hospice her husband has been admitted to. She is a loving wife but does not want to rock the boat by complaining.
Zia | 21 March 2014


This was the discussion at the Perth Writers Festival on euthanasia: http://iview.abc.net.au/programs/big-ideas?WT.srch=1&WT.mc_id=Corp_TV-iview%7CiviewAdwords_AdWords_%3Abig+ideas+abc_e_g_46599139399_&gclid=CLfaptelqr0CFUNwvAodQaAA8g#playing
Frank Brennan SJ | 27 March 2014


Thanks for being a voice of sanity and decency.
Sarah | 27 March 2014


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