Monday, 7 July 2014

At last we wake up to Dr Death

In the wake of the ABC 7:30 report last week that highlighted the relationship between Dr Philip Nitschke, Exit and the suicides of two psychologically troubled Australian men, most news reports have focused on condemnation of these actions and Nitschke and Exit.

First criticism came from HOPE and two of Australia's premier suicide prevention organisations as well as critical comment from Australia's peak medical body, the AMA.
The West Australian Newspaper has a story explaining that the West Australian branch of the AMA will register a complaint with the Medical Board (known as the Australian Health Practitioners Regulation Agency or AHPRA). The article opens by quoting an AMA WA spokesperson as saying that he (Nitschke): he is a disgrace to their profession and could undo years of work by suicide prevention groups.

From the article:
AMA WA president Michael Gannon said the "poster boy for assisted suicide" had gone too far.
"Doctors have varied views on euthanasia but this is a significant deviation from the usual debate, and a horrible message to send about how doctors think," he said. "I think we have worked out what this guy stands for, and it's a perverse existentialist view that everyone should be able to take their life if they hit a dark time."
Former ABC sports broadcaster Glenn Mitchell, who considered taking his own life in 2011 while suffering depression, said he was appalled by Dr Nitschke's behaviour.
"I find it staggering he did not recognise that the vast majority of mental illnesses, with correct help, can have incredibly good outcomes," Mr Mitchell said.
"For a doctor to find ending your life as the best option is beyond belief.
"From my own experience, you need help from properly trained people and you need to know it's not something you have to bear alone."
The Herald Sun political commentator, Andrew Bolt, a long-time critic of Nitschke, chronicled some of the dubious deaths that Nitschke has been involved in over the years, asking the critical question, 'Why has it taken two decades?

From Bolt's column today:
Nitschke has alarmed me since 1996, when the Northern Territory briefly allowed
euthanasia.

He was the doctor of seven people who formally applied to kill themselves, and the publicity then suggested all were in agony or weeks from death.
For example, the first to die, Martha Alfonso-Bowes, announced she had bowel cancer and “there is no hope for me now”.
In fact, Nitschke later co-wrote an article in The Lancet revealing Alfonso actually knew with surgery her “prognosis was good”. She had no pain.
Nitschke never revealed this to journalists when appearing alongside Alfonso-Bowes to argue for the NT laws.
Nor had he revealed factors that might better explain her suicide: she was a 68-year-old divorcee whose daughter died young, and who was now estranged from her much-loved son.
I should add Nitschke denies giving Alfonso-Bowes her suicide pills, and claims he tried to talk her out of death.
But it wasn’t just her. None of Nitschke’s seven “patients” had severe pain, and a co-author of his piece in The Lancet concluded some just needed better care.
A pattern had been set. In 1997, Nitschke was filmed telling patient Peter Wiese he was terminally ill and saying a plastic bag over his head could kill him. Other doctors denied Wiese was dying. In 2002, Nitschke helped arrange Nancy Crick’s death by Nembutal.
Only after an autopsy did Crick’s son discover she had no trace left of her cancer — which he said his mother didn’t know.
“It is irrelevant,” Nitschke retorted. “The quality of her life was such that she thought death was preferable.”
In truth, Nitschke seemed to have decided he had a right to help even the healthy to die — and the young.
“I do not believe that telling people they have a right to life while denying them the means, manner, or information necessary for them to give this life away has any ethical consistency,” he said in 2001.
“And someone needs to provide this knowledge, training, or resource necessary to anyone who wants it, including the depressed, the elderly bereaved, the troubled teen.”
The “troubled teen”?
Nitschke then happily appeared in Mademoiselle and the Doctor, a documentary about a retired professor who’d decided to kill herself even though she was in good health. She left a suicide note hailing Nitschke as her inspiration.
Nitschke even told the ABC in 2009 he’d advised two women on how to help the partner of one them to die, even though the man was so gone with Alzheimer’s he literally did not know what day it was.
The partner was later jailed.
Ever the critical thinker, Bolt nailed the issue of why it has taken so long for the Australian public to begin to see Nitschke and Exit as a dangerous, public nuisance: 
EUTHANASIA guru Dr Philip Nitschke is furious the ABC has finally pinged him for actually helping the healthy to kill themselves.
“Attacked by rabid Christians & journalist jackals!” he tweeted last week.
But you don’t need to be rabid or even Christian to consider Nitschke dangerous. 
For 20 years Nitschke, founder of Exit International, has had largely positive coverage from a media which too often assumed he’s just helping the dying and the suffering.
Therein lies the real problem. Not only has Exit not been about dying and suffering in the classical and common understanding, there's very little about Exit's work that relates directly to euthanasia anyway (saving the occasional proclamation of support for legislation). It's all about suicide.

This underlying attitude that suggests that the Australian public has a tolerance for the clandestine work of Exit and others because it is somehow seen as being compassionate towards the dying is a significant problem. Suicide Prevention organisations seem also to have something of a dilemma in this regard.

The tolerance seems to be saying something like: Suicide should be prevented, except, perhaps, you know, when you're really ill or dying; or maybe when you're very old; or maybe when disability makes your life really difficult. But once we create these kind of implicit exceptions we also tolerate a double standard for which the dividing line between prevention and non-prevention is at worst, nebulous; at best, malleable.

But when you consider that studies of people seeking access to Oregon's suicide act, for example, rate pain and suffering as a lower level concern, trumped by fears of loss of autonomy, being a burden etc. and a different picture develops.

An act of suicide is classically an act of a person who sees their own death as the only solution to their problems. Fears of a loss of autonomy, of being a burden and even of suffering generally can and are dealt with every day by caring and professional medical people. They are not insurmountable.

And just as we would always counsel, for example, a young person out of attempting suicide because, even though they cannot see it, we know from experience that there are other solutions to their problems; we should look to view every request to die in the same way.

Not to do so contributes to the problem in much the same way as does the existence of Exit and its work. We're effectively saying to the old, the sick, the disabled etc. that they're somehow less worthy of life than the troubled teen.

Acts of euthanasia only compound this reality. The person wants to die - that is common to both suicide and euthanasia. But what differs is that now were adding the actions of a medical professional in delivering the fatal dose.

As Glenn Mitchell said: 
"For a doctor to find ending your life as the best option is beyond belief.
"From my own experience, you need help from properly trained people and you need to know it's not something you have to bear alone." 

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