Shane Leavy reports on a recent talk in Ireland by the controversial Australian Dr Philip Nitschke, who took part in the world’s first legal, physician-assisted suicide in 1996
In 1996, an Australian man suffering from prostate cancer had a needle, attached to a computer, inserted into his arm. On the computer screen, there was a single question: “Are you aware that if you go ahead to the last screen and press the ‘yes’ button, you will be given a lethal dose of medications and die?”
The man, 66-year-old Bob Dent, clicked ‘yes’ and was given a computer ‘are you sure?’ question. Finally, a third screen read: “In 15 seconds, you will be given a lethal injection…press ‘yes’ to continue.”
Dent clicked ‘yes’ again and became the world’s first participant in legal, physician-assisted suicide, dying in the arms of his wife. The doctor who designed the machine, Dr Philip Nitschke, administered lethal injections with it to three other Australians, before the law allowing it was overturned in 1997.
A strong advocate for voluntary euthanasia, Nitschke has advised hundreds of others on how to end their lives since then, written a book full of technical advice for suicide and toured the world giving practical euthanasia workshops to elderly people.
The Peaceful Pill
Controversy and outrage have followed him. His book, The Peaceful Pill, is banned in Australia and New Zealand. A short and rather innocuous video made by a 79-year-old member of Nitschke’s Exit International organisation, which demonstrated the construction of plastic ‘exit bags’ for placing over the head and filling with lethal inert gas, was added to the Australian government’s list of banned websites. Nitschke joined Holocaust denier David Irving as one of the only people in Oxford University’s history to ever have an invitation from its debating society rescinded.
His plans to hold a public talk in Dublin this March failed four times as venue after venue cancelled his booking, due to some unknown pressure being brought to bear on each.
Labelled ‘Dr Death’ by the media, Nitschke’s goal is to give information to people to do something perfectly legal – but if he actually assists them, he could face jail.
“Suicide is not a crime. You can go home and end your life, but as far as the law in Ireland is concerned, it doesn’t matter – there’s no penalty,” he told a packed room at Dublin’s Seomra Spraoi last week. “Assisting is a serious crime. It doesn’t just attract a small penalty. It attracts a penalty of significance and savagery: 14 years.”
While supporting the legislation that briefly allowed him to deliver four lethal injections, Nitschke goes much further, saying that all adults of sound mind should have the right to die as they wish – even healthy people with long lives ahead of them. “The commonest method used by people in Ireland today to end their lives is by hanging,” he said. “It’s a grim and horrible death. Why is it used so often? Because it’s cheap and available; because they can’t ban rope; because you don’t have to know anything; because it works and shows up as that damning and bleak statistic. We can do better than that.”
Since the 1990s, Nitschke has come up with several controversial ideas for ‘doing better’, among them a proposed death ship that would take elderly people into international waters to avoid criminal prosecutions for assisted suicide. His workshops demonstrate practical ways to end life, mainly by using the barbiturate pentobarbital, but also with exit bags attached to helium or nitrogen canisters. He advises members on how to buy pentobarbital legally in Mexico, and has accompanied members to Switzerland, the only country in the world where foreigners are allowed to travel specifically for legal euthanasia.
This Christmas, Nitschke even drew fire for saying some elderly Australians were giving one another suicide pills as Christmas presents.
Much of Nitschke’s time seems to be spent edging around illegality and exploiting legal loopholes to guarantee Exit’s members control over the nature of their deaths.
Last year, Australian Don Flounders, suffering from mesothelioma and determined to secure the means to die, decided to travel to Tijuana to buy pentobarbital to smuggle back to Australia. When it emerged that Flounders could not afford to make it to Mexico, Nitschke introduced him to another Australian, a woman dying from breast and bone cancer called Angie Belecciu.
Belecciu was too sick to travel, but she had money and helped pay for Flounders to travel to Mexico to bring back one bottle for him, one for her. Both Flounders and Belecciu were assisting one another’s suicide but since they were both dying, long periods in prison held little concern. Belecciu later took her pentobarbital and died.
Don Flounders lives, but still has his drugs. For Nitschke, this is an important point.
He describes another man who became too affected by Alzheimer’s disease to get euthanasia drugs for himself and ended up asking for help from his wife and a friend, both of whom were later convicted for their role in his death.
“He should have got his own drugs early, locked them in the cupboard and then when everything went wrong, later, he could have gone to the cupboard and he wouldn’t have broken any laws,” Nitschke said. “As it is, he’s left one hell of a mess.”
The elderly audience at the Dublin meeting seemed to respond well to these anecdotes, laughing at Nitschke’s jokes and applauding warmly at the end of the speech. The threatened protestors did not show up.
Nitschke thinks there are two main groups who oppose his campaign. The first are conservative religious groups; those who believe life belongs to God and only God can take it. They oppose all suicide, assisted or otherwise, and some have tried to halt talks on euthanasia from ever taking place.
Prof Len Doyal of the University of London was shouted to silence by a crowd of such protestors in Cork last April.
The other group, Nitschke says, is the medical profession.
In 2000, the Irish Association for Palliative Care (IAPC) released a position paper opposing the use of euthanasia, explaining that many requests for euthanasia arise from fear of physical or psychological distress in the patient’s last days. “Widespread and equitable availability of specialist palliative care services will reduce requests for euthanasia,” it said.
Nitschke is dismissive of this argument. “We have too many people who have the best palliative care in the world and they still want to know that they can put an end to things,” he said. “By and large, palliative care have done pretty well out of the argument over the euthanasia issue, because they are the ones that have argued that they just need better funding and then no one will ever want to die – that’s a lie.”
The IAPC paper also included the common medical argument over euthanasia that doctors should never injure or harm their patients. “Trust between health care professionals and patients may be eroded if euthanasia were legalised,” it said. “Euthanasia may be considered an expression of personal autonomy. However, individual autonomy is not absolute.
“Personal autonomy must be balanced with consideration of the needs of society as a whole. The legalisation of euthanasia would put severe pressure on vulnerable groups such as the elderly and disabled.”
The Exit website, going far beyond physician-assisted suicide to actually educate people in DIY euthanasia, gives a few limited videos showing part of the process in constructing ways to die. One incongruous example has 79-year-old retired nurse educator Betty Peters donning hard hat and visor to cut up pieces of sodium metal for making homemade pentobarbital. Peters, showing the belief in complete personal autonomy concerning the IAPC, was indignant when she discovered the Australian government had censored her video.
“My generation has lived through a lot, including World War II. We, more than most people, know about death and many of us don’t want to suffer the pain and indignity of illness or a prolonged period as a vegetable in a nursing home,” she told Exit. “My videos aim to teach people how to take control of their dying days. As adults, it’s our right to make these decisions.”
A fundamental right
This is a sentiment Nitschke repeats often: the right to control one’s death is, he argues, as fundamental as the right to control one’s life. At the Dublin meeting, several journalists asked him if he counselled attendees of public workshops not to kill themselves.
“We’re talking about well people, so why would I tell them to get counselling?” he replied. “I’m not talking about sick people.”
Yet Exit walks a thin line between supporting adult individuals’ right to euthanasia and supplying suicidal depressives with the means to kill themselves. Nitschke said that he has occasionally asked people with obvious mental illness or depression to leave workshops. The electronic version of The Peaceful Pill has a disclaimer in tiny print at the bottom of its homepage: ‘This eBook is not intended for the mentally ill or depressed. Those with psychiatric conditions should contact their family physicians.’
But Nitschke has acknowledged that healthy young people with depression could have sometimes used Exit’s suicide information to die. “Just because that could happen, I don’t think should be used as a justification for closing the whole operation down,” he said.
Nitschke refuses to rule out using pentobarbital to end his own life one day in the future, insisting that the important thing is to have the option. This, for him, is not a grim or depressing act, but a life-enhancing one. “I think that, by and large, when people get these strategies in place – perhaps it’s lethal drugs in the cupboard – they stop worrying. When they stop worrying, they actually live happier and longer lives.
“A paradox perhaps,” he concluded, “but you could almost say that having access to lethal drugs in the cupboard prolongs life.”