Back to previous page

When you see a line of coloured and underlined hypertext, this means that you can click on that text to go to another information page.


Melbourne `euthanasia clinic': should advice on suicide be given to the terminally ill?




Echo Issue Outline 1998 / 40: copyright © Echo Education Services
First published in The Echo news digest and newspaper sources index.
Issue outline by J M McInerney

What they said ...
`When I go along to these patients who've got about six weeks to live (and say), "Just wait, then you'll be OK", I can't stand it'
Dr Philip Nitschke explaining why he is prepared to give advice on suicide to the terminally ill


`(Dr Nitschke) has nothing to offer patients but a death fixation. He doesn't even pretend to provide good palliative care'
Dr Brian Pollard, an Australian expert in palliative care

Early in October, 1998, Dr Philip Nitschke announced that he planned to establish a `euthanasia clinic' in Melbourne. The clinic would give terminally ill patients advice on how to end their lives.
On October 6, 1998, the Victorian premier, Mr Jeff Kennett, indicated that he did not oppose Dr Nitschke's plans.
The proposal has, however, been opposed by the Australian Medical Association and others. Both the legality and the ethical consequences of Dr Nitschke's proposed clinic have been questioned.

Background
Dr Philip Nitschke first came to public attention regarding his support of euthanasia in 1996. He was the only doctor to assist those wishing to suicide under the Northern Territory's Rights of the Terminally Ill Act.
The Northern Territory's Rights of the Terminally Ill Act became law in July, 1996.
Under the terms of the Act a doctor was able to deliberately administer a lethal substance to a patient or assist that patient to self-administer.
Dr Philip Nitschke aided the suicide of four of his patients between September, 1996, and March, 1997.
Each of Dr Nitschke's patients died through the action of anaesthetics and muscle relaxants. The drugs were delivered via a large syringe attached to a pump. The release of the drugs was initiated by a laptop computer operated by the patient.
Dr Nitschke co-developed the device which administered the drugs, set the device up for each of his patients and prescribed and supplied the drugs used. He was in attendance while each person died.
In March 1997 the Euthanasia Laws Act was passed by Federal Parliament. This Act specifically overrode any law such as the Northern Territory's Rights of the Terminally Ill Act.
The Euthanasia Laws Act was introduced as a private members bill by Kevin Andrews, the Liberal member for Menzies in Victoria. With the passage of the Euthanasia Laws Act active, voluntary euthanasia and physician-assisted suicide ceased to be legal in the Northern Territory.
In the October 1998 federal election Dr Nitschke stood against Kevin Andrews in his Victorian seat of Menzies. Kevin Andrews retained his seat, however, Dr Nitschke attracted some 6 per cent of the vote.
The `euthanasia clinic' Dr Nitschke is proposing to set up would be located in Kevin Andrews electorate.

Defining terms and the legal situation re suicide and euthanasia
Euthanasia is generally understood to mean the hastening of the death of a suffering, terminally ill person.
Those groups supporting euthanasia expect it to be voluntary. That is, the decision to die should be the free, informed choice of the person concerned.
A distinction can be drawn between active voluntary euthanasia, where the doctor administers a lethal substance to a patient, and doctor-assisted suicide, where the doctor facilitates and oversees the suicide of a terminally ill person. As already noted, the Northern Territory Act (now inactive) legalised both these means of hastening death.
Active, voluntary euthanasia is illegal throughout Australia and almost everywhere else in the world. In The Netherlands, while it is not formally permitted under the law, a doctor who practises it is exempt from prosecution. Active, voluntary euthanasia is legal in the North American state of Oregon.
Suicide is not a crime in any Australian state. However, it is a crime to help anyone kill themselves or to encourage them to do so.
The so-called `euthanasia clinic' proposed by Dr Nitschke appears to involve facilitating suicide rather than performing active euthanasia. It also appears that the doctor would not be prescribing or supplying fatal drugs, but would, instead, be advising clients where they could be obtained.

Provisions of the now inoperative Northern Territory Rights of the Terminally Ill Act
Dr Nitschke has claimed that he would assist, through his clinic, patients who would have qualified for euthanasia or doctor-assisted suicide under the provisions of the Northern Territory Rights of the Terminally ill Act. It is currently not possible to determine how closely he would be able to adhere to the provisions of this Act.
The Act required the following conditions be meet.
* The patient must make a request to die;
* The patient must be at least 18 and suffering from an illness that will result in death;
* A first doctor must diagnose the terminal illness and be willing to help with the death;
* A second doctor, specialising in the patient's illness, must confirm diagnosis and prognosis;
* A psychiatrist must confirm the patient is not suffering a treatable clinical depression;
* Seven days must pass after the patient formally indicates the wish to die;
* The patient must complete and sign a certificate of request, signed by the second doctor;
* The patient must share the same language as the second doctor, or an interpreter must sign the request;
* Forty-eight hours after the request has been signed, the patient can die.

There are a very large number of Internet sites supplying information on euthanasia generally and doctor-assisted suicide in particular.

A useful anti-euthanasia site is Living in Australia - without deadly deliverance. The site's home page can be found at http://www.geocities.com/CapitolHill/8270/index.html
The site has links to position statements, opposing euthanasia, by a number of churches and Aboriginal spokespeople. It also gives the viewpoint of the Australian Medical Association and hospice workers and doctors, arguing against euthanasia. In addition it has an interesting, but highly critical, overview of Dr Jack Kervorkian, an American doctor who assists suicides. An index of these links can be found at http://www.geocities.com/CapitolHill/8270/reasons.htm

An informative site supporting euthanasia has been set up by the Voluntary Euthanasia Society of Victoria. The Society's home page can be found at http://home.vicnet.net.au/~vesv/
The site gives information on the situation as it pertained in the Northern Territory, as well as the pro-euthanasia provisions which currently apply in Oregon (USA) and The Netherlands. It has an interesting sub-site supporting Dr Kervorkian.
Of particular interest regarding the suicide advice clinic proposed by Dr Nitschke are the provisions of the Victorian Crimes Act re aiding or encouraging suicide. These can be found on the Society's site at http://home.vicnet.net.au/~vesv/act.htm

Another very useful site which has a sub section dealing with euthanasia has been set up by the Ontario Consultants on Religious Tolerance. The group's writers provide background information on a wide range of ethical issues, attempting to present and discuss a range of views on each.
Their treatment of euthanasia and physician assisted suicide can be found at http://www.religioustolerance.org/euthanas.htm
This supplies a useful set of definitions and much background information on euthanasia as it occurs or has occurred in the United States and other nations, including Australia.
Though the site is generally impartial, please note that when it considers the Ethical Questions Raised by Euthanasia it appears to have a pro-euthanasia bias.

The Northern Territory's Rights of the Terminally Ill Act can be accessed at http://coburg.nt.gov.au/lant/rotti/
All the provisions of the Act can be accessed together with a range of support materials. Included is a speech made by the Northern Territory's then Chief Minister, Marshall Perron, arguing for legalised euthanasia. Marshall Perron introduced the private members bill which became the Northern Territory's Rights of the Terminally Ill Act.



Arguments in favour of establishing a `euthanasia clinic'
There are two main positions adopted by those in support of a `euthanasia clinic' being established in Melbourne.
Firstly, Dr Philip Nitschke has claimed that he would not be breaking the law in establishing a clinic and that any advice he gave would be careful and responsible.
Dr Nitschke has apparently maintained that he would not perform euthanasia or prescribe lethal doses of narcotics.
`That,' Dr Nitschke has said, `would be construed as assisting in a suicide and the legal risks there are severe.'
However, Dr Nitschke and some supporters of his proposed clinic have claimed that there are services that could be offered to the terminally ill that do not contravene the law.
The Victorian premier, Mr Jeff Kennett, has claimed, `As long as it's only an advice service, I don't think there's any laws that could stop you setting up.'
Dr Nitschke has maintained, `I can give them [terminally ill people who come to his clinic] information. I can direct them towards the fast diminishing sources of the necessary drugs ... illegal sources and black market sources.'
Dr Nitschke has indicated that he would be cautious in his treatment of those who came to him for advice and would examine what their access to palliative care had been.
This would seem to suggest that he would only proceed to advise them on euthanasia if he were confident that other avenues had been explored and found inadequate.
Dr Nitschke has said, `My approach will be one of "softly, softly" with patients whose confidential medical details will never be publicised.'
Dr Nitschke has claimed that he would only offer advice on euthanasia to those whom he believed would have qualified for medically assisted suicide under the Northern Territory's Rights of the Terminally Ill Act.
Dr Nitschke has stated, `What I want to do is go into details of their medical treatment, establish their palliative care record, before getting involved in this very murky and grey legal area of assisting them to take the next step.'
Dr Nitschke has explained what advice he would offer once he was convinced that a terminally ill patient qualified for and needed his advice.
He would first suggest that that person approach their own doctor and see if they could be prescribed a potentially lethal barbiturate. (It appears that the patient would have to hide from their own practitioner that they wanted the drug in order to commit suicide.)
If this failed, Dr Nitschke would then advise the patient to consult a `friendly vet'. There are, Dr Nitschke claims, drugs available to veterinary practitioners that a terminally ill person could use to kill themselves.
Dr Nitschke says that if this move were unsuccessful the next step would be to advise patients on how to obtain suitable drugs on the black market.
Dr Nitschke has also indicated that, while he would not administer the drugs nor be present while they were administered, he would like to `maintain a phone service when the drugs are being ingested'.
The second position taken in support of the establishment of a euthanasia clinic is in partial contradiction to the first. Dr Nitschke maintains that while some of the activities he is proposing may not be legal they are morally justifiable.
According to this line of argument, there are ethically compelling reasons for promoting euthanasia irrespective of what the law may state.
Dr Nitschke has been quoted as saying, `I have always been strongly of the opinion that there are laws there that have to be broken if you are going to maintain any sense of internal morality.'
Dr Nitschke has argued that there are large numbers of terminally ill people in significant distress who should be able to end their lives in the manner they choose.
Dr Nitschke's statements seem to imply that suicide is an option that will always be available to the terminally ill, irrespective of the legal situation.
This position has been stated overtly by a registered nurse writing to the Herald Sun in support of Dr Nitschke.
The woman states, `There will always be those who choose to end their lives by their own hand, without any prior consultation with a health professional, by employing a variety of methods freely available within the community.'
Such people, Dr Nitschke has suggested, should be given advice so that they can end their lives without the risk of failing in a suicide attempt and causing themselves and their loved ones even further distress.
Dr Nitschke has claimed there are elderly cancer patients who, wishing to avoid protracted terminal illness, have attempted to overdose on prescribed medication and when that has failed have hanged themselves.
Dr Nitschke has stated, `It is obscene when we have many people going around looking for a lump of rope to take their own lives because they are not able to get access to the right drugs.'
Dr Nitschke appears to be arguing that the choice to end one's own life should be and is in the hands of the terminally ill person and that all he would be doing is making it simpler and safer for that person to act on their wish.
In this context, Dr Nitschke seems to imply, the current laws are irrelevant. He appears to believe that the only moral course open to medical practitioners who think as he does is to help end the suffering of the terminally ill.
In reply to those who argue that he should wait for the law on euthanasia to change, Dr Nitschke states, `That's a great argument for people who are doing very well in this world ... When I go along to these patients who've got about six weeks to live (and say), "Just wait, then you'll be OK", I can't stand it.'

Arguments against establishing a `euthanasia clinic'
There are a number of arguments offered against the establishment of a `euthanasia clinic' in Melbourne.
Firstly, it has been claimed that what Dr Nitschke is proposing is illegal.
The Victorian head of the Australian Medical Association has noted that `Euthanasia is illegal in Victoria.'
However, as Dr Nitschke is not proposing to practise euthanasia in Victoria, those who have drawn attention to the provisions of the Victorian Crimes Act regarding suicide appear more relevant to this case.
A reporter for The Age, Gay Alcorn, has noted, `[Dr Nitschke's] clinic plans are almost certainly illegal. Under the Crimes Act, inciting, aiding or abetting a person to commit suicide is an offence punishable by up to five years jail ...'
Concern has also been expressed that in helping clients make connections with those supplying illegal drugs on the black market Dr Nitschke would also be likely to be breaking the law.
It has further been claimed that what Dr Nitschke is intending may be unethical under the guidelines enforced by the Medical Practitioners Board.
The Board, which registered Dr Nitschke to practise in Victoria, has indicated that it will be re-examining his case.
A spokesperson for the Medical Practitioners Board has stated, `The primary role of the board is to protect the community ... As such it is concerned about what [Dr Nitschke] is saying and will re-examine the matter.'
There are also a group of arguments which do not centre either on the legality of Dr Nitschke's actions or his technical fitness to practise medicine.
Firstly, it has been claimed that the physical suffering of the terminally ill can usually be alleviated without having to prematurely end their lives.
According to this point of view good palliative care removes the desire of most terminally ill people to take their lives. The argument appears to be that if a person knows they are going to be able to see out their lives without significant physical pain then they are likely to choose to do so.
Dr Gerald Segal, the Australian Medical Association's Victorian president, has claimed, `I've had a lot of experience with palliative care and I have always been able to alleviate pain in my patients.'
A Herald Sun editorial published on October 11, 1998, suggested, `Dr Nitschke's intention to set up a euthanasia advice clinic in Melbourne might say as much about the community's ignorance of palliative care as it does about demand for mercy killing.'
Similarly, Dr Brian Pollard, an Australian expert in palliative care, has claimed, `[Dr Nitschke] has nothing to offer patients but a death fixation. He doesn't even pretend to provide good palliative care.'
Secondly, concern has been expressed that some of those being assisted to end their own lives may be in a state of depression which, if treated, would result in their no longer wanting to hasten their own deaths.
Though the provisions of the Northern Territory's Right of the Terminally Ill Act were meant to act as a safeguard against anyone with treatable clinical depression either being euthanased or assisted to suicide it has since been claimed that some of those who died or wished to use the legislation were suffering from depression.
This position has been put in the previously cited editorial published in The Herald Sun on October 11, 1998. The editorial claimed, `a recent expert study ... found patients who favoured euthanasia were more likely to be suffering fatigue, frailty or depression than pain, indicating a need for solutions other than assisted suicide'.
Relatedly, it has been suggested that the desire to suicide might well not be lasting, particularly if the person concerned received appropriate treatment and psychological support.
A nurse unit manager at Caritas Christi, a hospice providing accommodation and support for the dying, has been paraphrased as claiming `patients frequently asked for euthanasia, but almost always changed their minds ... Usually it is a sign that we need to do better, to relieve what is causing them mental or physical anguish'.
Thirdly, concern has been expressed that suicide advice might be given to people who were not terminally ill, but merely profoundly distressed about some aspect of their lives. It has been suggested that numbers of those helped to die by the American Dr Kervorkian were not suffering any terminal condition.
Fourthly, it has been claimed that encouraging suicide is contrary to the ideals which have traditionally guided medical practice.
According to this line of argument, doctors' primary duty is to protect life and it would damage their relationships with their patients and the trust in which they are generally held if patients felt that doctors might under some circumstances encourage them to die.
Those who hold this view sometimes argue that to promote suicide is contrary to the Hippocratic Oath, a pledge which doctors have traditionally taken on starting to practise medicine and which still helps to shape their code of ethics.
The Hippocratic Oath states, `I shall never use my art to injure or wrong my patient. I shall give no deadly drug to anybody even if asked for it, nor shall I make a suggestion to this effect.'
Fifthly, some critics are concerned that if a proposal such as Dr Nitschke's were allowed to go ahead it could help to bring about a shift in society's values which might lead to euthanasia being promoted for those who do not choose it.
This position has been put by Greg Byrne in a letter published in The Herald Sun on October 8, 1998. Mr Byrne has written, `I believe many people can see that if euthanasia ever becomes optional it will soon become compulsory.'
Mr Byrne has further suggested that in addition to a shift in community values leading to an extension of euthanasia to those who have not sought it, health budget considerations could have the same effect.
Mr Bryne has stated, `The health budget is stretched so far ... a future government would be tempted to use euthanasia to cut costs.'

Further implications
The further implications of this issue are extremely far reaching.
It would appear that one of Dr Nitchke's principal objectives is to keep the euthanasia debate alive within Australia.
A number of Dr Nitschke's other actions, including standing against Kevin Andrews in the 1998 federal election seem directed toward the same end.
It seems highly likely that if he proceeds with the setting up of his clinic, Dr Nitschke will be deregistered as a doctor in Victoria. If he then goes ahead and practises medicine or gives advice on how to suicide he is likely to be charged with a criminal offence. He is also likely to be charged with a criminal offence if he becomes involved in the supply of illegal drugs.
Some of Dr Nitschke's statements appear to indicate that he would be prepared to face a criminal trial and the possibility of jail in order to help bring about euthanasia law reform in Australia.
Dr Nitschke has also recently indicated that he is developing a euthanasia pill. What is apparently meant is a substance or combination of substances, commonly and legally available, which could be used to commit suicide.
Dr Nitschke's intention here is probably not to permanently by-pass the law. It seems more likely that in developing a do-it-yourself suicide pill for the terminally ill he is really promoting his preferred alternative - legalised euthanasia which would allow people to end their lives in a carefully controlled manner with the assistance of a qualified medical practitioner.
With both the `euthanasia clinic' and the `death pill' Dr Nitschke is offering radical, relatively uncontrolled forms of suicide or euthanasia; his intention is probably to make legalised, carefully regulated and monitored euthanasia appear the more responsible option.
The long-term consequences of the changes in attitude toward death and dying being espoused by Dr Nitschke would be profound.

Sources
The Age
7/10/98 page 2 news item by Caroline Milburn, `Death clinic perils rife, lawyers warn'
7/10/98 page 2 news item by Mary-Anne Toy, `Nitschke's plan to use drug dealers'
8/10/98 page 20 letter from Dr Anthony Fisher, `Nitschke and the "culture of death"'
10/10/98 page 1 analysis by Gay Alcorn, `Legal or not, euthanasia's controversy refuses to die'
14/10/98 page 16 letter from Alison McGuinn, `Who will care for the patient?'

The Australian
7/10/98 page 3 news item by Rachel Hawes, `Right-to-die doctor under microscope'

The Herald Sun
6/10/98 page 15 news item, `Euthanasia clinic for Melbourne'
7/10/98 page 5 news item by Kelly Ryan and Sasha Baskett, `Kennett backs euthanasia bid'
7/10/98 page 18 editorial, `Dr Death in town'
8/10/98 page 20 letter from Greg Byrne, `Nitschke must be stopped'
9/10/98 page 16 letter from Lebbell F Frost, `When living is unbearable'
9/10/98 page 16 letter from Gordon Poulton, `Choosing how and when to die'
11/10/98 page 31 analysis by Felicity Dargan, `The brave choice for life"
11/10/98 page 31 news item by Greg Swift, `Geldof prevents sister's suicide'
11/10/98 page 46 editorial, `Of life and death'
12/10/98 page 13 news item by Doug Button, `Doctor denies deaths lonely'
13/10/98 page 20 letter from Kristy Stewart, `Right to die in peace'
15/10/98 page 20 letter from J W Burgess, `Don't interfere with dying'
16/10/98 page 22 letter from Thomas A Watkin, `Euthanasia a slippery slope'
16/10/98 page 33 news item, `Suicide pill row grows'
17/10/98 page 28 editorial, `Ban the death pill'
17/10/98 page 31 five letters under the heading, `Doctor shows courage over the right to die'