December 28, 2013
Euthanasia advocates’ overkill stymies the right-to-die debate
FOR a man on a mission to euthanasia, Philip Nitschke is remarkably pacific.
Despite 20 years of failed attempts to legalise euthanasia, including recently rejected bills in South Australia and Tasmania, Nitschke is resolute. His latest broadside is the controversial opening of Australia’s first euthanasia clinic in the sleepy streets of Adelaide.
In a broad-ranging interview, Nitschke describes the moment he chose the deathly vocation, his irritation with the “insufferable paternalism” of the Australian Medical Association and why he is more sure than ever that euthanasia is a fundamental human right.
Questions of child euthanasia, physician-assisted suicide for people who are not physically ill and new categories such as people who feel tired of life are provoking fierce debate across Europe.
While Nitschke’s organisation, Exit International, no longer supports the provision of euthanasia to children, he views the recent Dutch medical proposal to introduce a “tired of life” category as reasonable. It is, he says, a growing group.
Nitschke is less concerned about the cause of suicidal ideation than ensuring the choice to die, once made, is realised in a professional manner. The harm minimisation approach extends even to proposed social categories such as euthanasing the poor, should they choose it.
I suggest the relationship between poverty, despair and depression makes euthanasia a problematic option for otherwise healthy people. Nitschke pauses, but is unmoved. He cites a mother who recently confessed she wanted to die because she was “consuming too much money staying alive” and worried about eroding her daughter’s inheritance. The mother was not terminally ill. A difficult decision, he concedes, but made by a fully informed adult without any coercion. Who is he to deny her choice?
Nitschke followers are largely people over 70 with cancer, who intend to hasten death only when it comes knocking. But he is untroubled by the prospect of extending euthanasia as a cure for social and financial ills, as long as a person chooses it freely.
Nitschke’s road from a liberal to libertarian stance on euthanasia is sustained by his philosophical influences. He demurs when I ask their names. But the following morning a message in the inbox reads: Marcuse, Camus and Nietzsche. His hesitation is understandable – though skilled writers, Nitschke’s leading lights are a Marxist, an existentialist and a nihilist.
The common thread in Nitschke’s philosophy is libertarianism. For him, individual choice is the fundamental principle whose cause and effect are tertiary considerations. He is openly hostile to state interference with informed individual choice, taking aim at the AMA for its continued opposition to legalised euthanasia.
But the AMA’s recent submission to the Tasmanian government’s paper on voluntary assisted dying reveals a broader array of concerns. The AMA criticised Tasmania’s Labor-Greens government for being undemocratic in its proposal to legalise physician-assisted dying. The government’s consultation paper claimed that the Hippocratic oath was outdated and omitted that the majority medical view is against legalising euthanasia, said the AMA. But its main warning was that “to fundamentally change the role of (a) doctor as one who supports life to one who takes life will have profound, unpredictable effects on the perception and practice of medicine”.
The AMA’s caution is evinced by recent developments in Europe. Belgium and The Netherlands are embroiled in controversy following proposed amendments to euthanasia laws that critics have decried as a race to the bottom of medical ethics.
Euthanasia has been legal in Belgium since 2002, but legislation newly minted by the country’s senate would extend the provision to children, people suffering from dementia and other “diseases of the brain”.
The senate’s landslide approval, secured by a tactical coalition of the Socialist government, greens and liberals, has roused dormant fears that legalising assisted suicide is a slippery slope to a nihilistic world order.
The fears have been further fuelled by a series of high-profile cases in which depressed, surgically mutilated and anorexic patients have been euthanased.
In October, a woman who endured a series of botched transsexual operations was euthanased by a Belgian doctor because her body had been mutilated to the degree that she felt like a “monster”. Doctors believed the case fulfilled the requirement that the patient be in “constant and unbearable physical or psychological pain” resulting from an accident or incurable illness.
An anorexic woman who had been sexually abused by her psychiatrist, the renowned sexologist and eating disorder specialist Walter Vandereycken, was subsequently euthanased by a fellow psychiatrist.
In addition to individual cases, there is rising concern about the lack of transparent reporting on doctors’ euthanasia practices. A British Medical Journal study on euthanasia in Flanders, Belgium, found that 47 per cent of deaths were not reported. Last year The Lancet published a meta-analysis which found that 23 per cent of euthanasia deaths went unreported by doctors. In both studies, unreported euthanasia was associated with questionable and sometimes illegal practice.
Despite re-emerging ethical concerns about legal euthanasia, major medical associations are lobbying for its expansion. The Dutch Right to Die NL group has introduced mobile euthanasia units to euthanase people whose GPs refuse to do so.
In the lead-up to the Belgian senate’s decision on child euthanasia, the influential Royal Dutch Medical Association (KNMG) published a set of criteria about euthanasing newborns with disabilities. While withdrawal of medical treatment deemed futile is commonly accepted among doctors, the KNMG’s attitude towards parents warrants scrutiny.
“Where treatment is medically futile, doctors may – following consultation – decide independently to suspend or to not provide such treatment … Doctors may allow parents time to understand and accept as best they can that treatment is to be suspended, but there will be a time limit.”
The reason KNMG believes doctors can euthanase newborns without full consent is that the “doctor’s primary duty of care is towards the infant”. The bizarre logical inference is that parents who want their newborn baby to live are less caring than the doctor who wants to let the child die.
Eduard Verhagen, a key KNMG spokesman, published an article in the Journal of Medical Ethics defending the child-euthanasia criteria of the Groningen Protocol, which spells out the criteria for infant euthanasia. Verhagen notes that improvements in pre-natal screening mean fewer babies with severe disabilities are being euthanased after birth because they are aborted before it.
Many of the babies euthanased in The Netherlands were born with spina bifida, a congenital disability that most infants can survive, given proper medical care.
The KNMG has lobbied also to create new categories of people for euthanasia; loneliness, reduced income and poor eyesight are proposed as grounds.
The incremental creep of euthanasia from a palliative choice for the terminally ill to a lifestyle choice for society’s most vulnerable members may shock Australians. But in a recent survey, 20 per cent of Dutch people thought euthanasing elderly people who feel tired of life was agreeable.
The image of a lonely, tired, or impoverished person entering a GP’s office for healing and leaving with a script for suicide is so horrifying it makes the AMA’s stance against euthanasia look like divine salvation.
In the light of the nightmarish scenarios developing in Europe, it is difficult to brook the idea of legal euthanasia. But witnessing the alternative provides impetus.
Despite maladaptive developments in euthanasia practices, about 80 per cent of requests for assisted death come from adults with terminal cancer. Of the remainder, most are from those suffering from terminal heart disease.
In many cases of cancer and heart disease, death comes slowly, sometimes including a process of fluid accumulation that results in a person drowning inside their own body. My father suffered thus.
Would I have wanted Nitschke by my father’s deathbed? No, though they may have agreed on Camus. But if the AMA insists palliative care is preferable to euthanasia, it should back up the claim by providing better drugs than morphine to treat suffering people in their final days. Otherwise, Nitschke’s Nembutal option will continue to tempt the well-informed when they have little left to lose.
The best test of a revolutionary’s integrity is whether they are true to their word. So I ask Nitschke: “Will you choose to die by your own sword – by euthanasia?” He seems taken aback: “Would I? Oh look, I … I … I suppose I don’t know and I recognise the fact that people change their position, and so they should be able to, and I’ll probably be the same.”
After fleeing through a labyrinth of third-party stories, he returns to front the question of his own death: “I’ll be able to take that step if things get pretty awful, but I’m maybe one of those people who sits there demanding that every last health dollar be spent on me to keep me alive for another five minutes. I don’t know, but I think that the idea of having the choice is an important one”.
Australia’s leading euthanasia advocate has a superlative survival instinct. Adherents, take note.
Journalist: Jennifer Oriel