Why censuring Philip Nitschke clouds euthanasia debate
Dr Philip Nitschke was suspended by the South Australian Medical Board in a brief and uninformative media release issued at 12am on July 24. This seemed to occur in response to a complaint about Nitschke, but there is no indication of the complainant – both beyondblue and Black Dog Institute (suicide prevention organisations) have been suggested as complainants, but other parties such as Hope (a Catholic blog run by Paul Russell) have previously made egregious complaints about Nitschke. The medical board called on rarely used legislative powers to protect “public safety and manage risk to patients”.
This saga began on July 3 when the ABC’s 7.30 program announced that “depressed” 45-year-old man Nigel Brayley had committed suicide using Nembutal after contact with Nitschke. It should be noted at this stage that much of the information that is being used to judge this matter is hearsay. Brayley himself did not state he was depressed – he did say he was suffering. Judgements are being made in relation to the matter of Brayley (on the basis of little information – he is not an available witness – but this overlooks the suicides of 25-year-old Joe Waterman and 26-year-old Lucas Taylor, who apparently obtained information about Nembutal from Nitschke’s website.
Despite the evidence provided by Nitschke in reply to the board’s request, the suspension has occurred and a more detailed investigation will follow. This is appropriate, but it will take some time – the board moves at a glacial pace. Meanwhile, Nitschke remains condemned in the public eye, not only because of these tragic deaths, but also, I feel, because of his lack of any sense of responsibility or regret.
Nitschke’s defence revolves around two conflicting arguments. The first is that he was not acting as a doctor in relation to Brayley (and perhaps even less so in relation to Waterman and Taylor). He states that he has not practised medicine for 12 to 14 years, and did not have a consultation with Brayley, and did not give him advice – he had short non-clinical conversations with him at an Exit workshop and an email “conversation”, but maintains that Brayley did not seek his advice. Nitschke probably had even less contact, if any, with Waterman and Taylor.
If Nitschke has not practised medicine for 14 years, and did not have a patient-doctor relationship with Brayley (or Waterman or Taylor), what basis has the SA Medical Board for suspending him? One might also ask why does Nitschke masquerade as a doctor if he is not practising medicine? Could it be that this master of media manipulation is once again pulling the media’s strings to promote his cause? He has stated that interest in his workshop enrolments has jumped significantly as a result of this brouhaha.
And he has a serious point – that the Australian public are very concerned to have control over the end of their lives, and he is intent in providing them with that, and to many he is a hero.
His second argument is that Brayley was committing rational suicide, though how Nitschke could determine this by way of his scant association is a disturbing matter. Nitschke offers evidence for the concept of rational suicide from a paper by Ben A. Rich in the Cambridge Quarterly of Healthcare Ethics, which listed four criteria for rational suicide: (1) the existence of an unremitting hopeless condition; (2) an informed decision; (3) an absence of cognitive impairment that prevents realistic assessments and informed decision-making; and (4) the decision is one of free choice without external pressure. It takes careful inquiry of a person to determine if these criteria are met. Nitschke claims that Brayley’s suicide was rational, but he did not make these careful assessments of Brayley, nor are they made of any person accessing his website, obtaining his book or attending his workshops.
I endorse the concept of rational suicide, as did 86 per cent of British psychiatrists when surveyed in 1998. It is essential that these criteria are addressed before advice and medication is provided to terminally ill people, and this requires a medical assessment. Nitschke does not insist on this, which is why I view his actions as irresponsible. So, too, I imagine does the medical board. Based on any legislation, passed or proposed anywhere in the world, Brayley would not have qualified for assistance.
Whether Nitschke is suspended or not is irrelevant. He does not need to be a doctor to run his website and workshops. He is intending to continue his activities whether he is suspended or not, and claims that the publicity has increased his workshop bookings. His suspension and deregistration will not prevent his activity – it may only enhance it.
All this focus on Nitschke obscures the real issue, which is that these events occur, and are likely to continue, precisely because there is no law in Australia that deals effectively with voluntary assisted dying, the safe and effective relief of suffering at the end of life. This goes on currently in covert, unregulated and often tragic ways, as we have seen. And just as often, the proper relief of suffering does not occur because doctors fear they will be prosecuted for assisting if someone complains.
I have no doubt that Philip Nitschke is sincere in his attempts to help people with end-of-life anxiety. He believes that everyone has the right to information about how to end their life without needing the opinion of a doctor. This principle fails when some people are neither fully informed about their condition nor mentally competent to make a rational decision. His approach will never be endorsed by government, and will help only a few people. A sound law is needed to protect the whole community from harm. And even those who never use such a law will benefit psychologically from knowing that a choice is available if they are suffering badly towards the end of their life.
This article was first published in the print edition of The Saturday Paper on Aug 2, 2014 as "Turn focus to moribund policy". Subscribe here.