Can a person\u2019s legal right to take their own life ever be a rational decision to the point that doctors are actually obligated to make no intervention? Should that decision \u2013 even if made by a person suffering no terminal illness \u2013 then be assisted?<\/p>\n
These almost philosophical questions dominated a three-day medical tribunal hearing in Darwin last week, where the doctor and voluntary euthanasia advocate Philip Nitschke was fighting for the return of his suspended medical licence.<\/p>\n
The South Australian medical board had taken its emergency action as a result of complaints from other doctors, which were prompted by a news report on ABC\u2019s 7.30 program alleging Nitschke counselled a depressed but otherwise healthy man, Nigel Brayley, who then took his own life in May.<\/p>\n
Nitschke said 7.30 had \u201cambushed\u201d him with emails sent between the two after they met in person, in which Brayley made clear his intentions and offered to send Nitschke his final correspondence. Nitschke had said he would be interested to read it. The emails are noteworthy for the everyday tone of conversation, and lack of any plea for Brayley to think again.<\/p>\n
Special counsel Lisa Chapman, acting for the Medical Board of Australia, said Nitschke \u201cdid nothing\u201d when told by the healthy man he was going to kill himself, and for that he should lose his right to practise medicine. A doctor has a responsibility to intervene, she argued.<\/p>\n
Peter Nugent, a commercial lawyer from Melbourne who is himself suffering a terminal illness, acting for Nitschke, said his client did not have a doctor-patient relationship with Brayley, had never counseled him, and that the suspension had been introduced simply because the board had a distaste for his views and work around voluntary euthanasia.<\/p>\n
Nitschke had lobbied for his appeal to be heard in the Northern Territory \u2013 arguably the Australian region most supportive of right-to-die legislation \u2013 after the South Australian branch of the medical board stripped his licence in July in a midnight meeting.<\/p>\n
Polling shows that voluntary euthanasia, which was legal for a short time in the 1990s in the NT, has consistently high support among Australians. A draft bill from the Greens seeks to legalise it for the terminally ill.<\/p>\n
The Darwin medical tribunal was not a court of law. If an argument wasn\u2019t working for one side, or was conceded by the other, it was refocused. Reverence of the medical profession frequently jarred with legal precedents. Discussions were clinical, and the impact of a suicide on the family and friends left behind rarely \u2013 if ever \u2013 got a mention.<\/p>\n
Nugent framed the fight as one between the profession\u2019s \u201cdoctor knows best\u201d mentality and a person\u2019s free will.<\/p>\n
At the heart of all discussions however, was the concept of a \u201crational suicide\u201d.<\/p>\n
Nugent opened by saying this case was about \u201cthe dangerous idea [of] whether a person who is contemplating rational suicide ought to be required by a medical doctor not to do so\u201d.<\/p>\n
Suicide in itself is no longer a criminal act. Assisting one is, however, which is why people illegally import the drug Nembutal and then take it by themselves, not wanting to get loved ones in trouble. They die alone.<\/p>\n
It\u2019s a contradiction in the law, say Nitschke and Nugent.<\/p>\n
\u201cRational suicide\u201d is an extremely controversial cornerstone of Nitschke\u2019s advocacy for voluntary euthanasia which says that the right should not just be for those with a terminal illness. Critics say it has set back the campaign.<\/p>\n
While that was still the most common reason people gave to Nitschke for wanting to die on their own terms, some gave \u201csocial reasons\u201d such as financial difficulties or being lonely or \u201ctired of life\u201d. Depending on the context of the conversation, these could be \u201crational\u201d reasons, said Nitschke.<\/p>\n
\u201cIf I formed the opinion this person would fit the criteria of being rational, I would leave it to them to decide if they would proceed with this lawful act of ending their life,\u201d he said. \u201cI don\u2019t just walk away when they say they\u2019re going to die, to end their life \u2026 It\u2019s not a flippant exchange, but it\u2019s not in any way a doctor-patient involvement,\u201d he said.<\/p>\n
Nitschke criticised the broadening diagnoses of mental illness, and told the hearing there was no evidence of a definitive connection between suicidal feelings and an illness.<\/p>\n
A person\u2019s life \u2013 or plans for their death \u2013 could not be limited because of the presence of \u201celements\u201d of a disease such as depression, Nitschke added. A person may be depressed, but that does not mean their wish to die is caused by it.<\/p>\n
\u201cDepression can be a serious mental illness and of course it can lead to a person being of unsound mind,\u201d he said. \u201c[But] we\u2019re talking here about degrees of depression. We need to be careful about defining well people as sick.\u201d<\/p>\n
\u201cIt\u2019s not beneficial to society to pathologise large slabs of behaviour,\u201d he told the tribunal.<\/p>\n
Nitschke conceded that if a patient visited him at his surgery and told him they were contemplating suicide he would have an obligation to make a \u201cmore rigorous assessment\u201d because they were specifically seeking medical advice, but this obligation did not extend to the people he met through Exit. In those cases, he argued that he was being approached as a euthanasia advocate, not as a doctor.<\/p>\n
As he often stressed, his obligation was to not impede them if they were clearly, to his mind, rational.<\/p>\n
But the finality of such an action prompted immediate questions. What if a person\u2019s seemingly rational decision was a suicidal idea caused by a mental illness? Does the absence of a doctor-patient relationship justify not making a \u201crigorous assessment\u201d when confronted with someone who could soon die, leaving behind family and friends?<\/p>\n
Tribunal members seemed to genuinely have their thoughts provoked by the discussion. The idea of a rational suicide went against what doctors aim to do \u2013 keep people alive<\/p>\n
Nugent argued that Brayley had said he was going to take his own life but he was clearly making a rational decision to do so. Thus Nitschke did not have an obligation to intervene. But that\u2019s not to say he didn\u2019t try.<\/p>\n
After their initial introduction at an Exit International workshop Nitschke and Brayley met for a second time at an event at Perth\u2019s town hall, Nugent told the hearing, and Nitschke did indeed suggest Brayley perhaps see a counsellor but the intrusion was firmly rebuffed<\/p>\n
However this meeting had not been mentioned in the multiple media appearances by Nitschke following Brayley\u2019s death \u2013 a fact repeated often by Chapman.<\/p>\n
One of the emails between Brayley and Nitschke appeared to support the account of the second meeting.<\/p>\n
Nitschke made a rational assessment upon meeting Brayley, determined he was competent and rational and so did not impede him, it was claimed.<\/p>\n
\u201cIf Mr Nitschke had sought in some way to restrain Mr Brayley he would have committed a trespass on him,\u201d said Nugent.<\/p>\n
Chapman pushed on what possible assessment Nitschke could have done in such a short time to convince himself that Brayley was not ill, that he was contemplating a \u201crational suicide\u201d.<\/p>\n
Nitschke also disputed that his medical background had any impact. \u201cYou\u2019re effectively saying \u2018you have medical training therefore you\u2019re doing a medical assessment\u2019,\u201d he told Chapman. \u201cIt\u2019s just me, who happens to have medical training.\u201d<\/p>\n
Later, under questioning from the tribunal chair, Calvin Currie, It became clearer that Nitschke\u2019s possession of a medical license had a lot to do with reputation.<\/p>\n
Nitschke himself conceded he hardly treats any patients as a GP these days, rather concentrating on his work with Exit. But he still wanted his registration back.<\/p>\n
\u201cI\u2019m not about to say I don\u2019t use it so let\u2019s throw it away. I\u2019m proud of the degree and I don\u2019t want to lose it for unclear reasons or reasons I feel are unjust.\u201d<\/p>\n
When Nitschke confirmed his work would continue with or without a medical registration it became clearer the action taken by the medical board was perhaps more about protecting the reputation of the profession than the immediate safety of the general public.<\/p>\n
After all, Nitschke had already said his conduct would not change, but without a license it would not be \u201ca medical professional\u201d advocating voluntary euthanasia.<\/p>\n
\u201cTaking away his registration is signalling the board disapproves of his action?\u201d Currie questioned.<\/p>\n
\u201cIn a sense, yes,\u201d Chapman replied. \u201cThe board and the tribunal have an important role and yes, it is about signalling that this person poses a serious risk.\u201d<\/p>\n
The suspension was about sending a message.<\/p>\n
Outside the tribunal, Nitschke brought up a third holder of a reputation \u2013 the information he disseminated to Exit International members and purchasers of his book, the Peaceful Pill.<\/p>\n
If his medical registration was revoked, the status shifted. \u201c[It says] that this information is so dangerous people must not have it,\u201d he added.<\/p>\n
Brayley\u2019s death was not the simplest case study through which to explore the concept of rational suicide. There were too many elements that didn\u2019t sit right, not least the revelations of the murder investigation.<\/p>\n
On the final afternoon of the hearing, Nitschke said he wished he had responded differently to Brayley\u2019s emails. The sequence of events that followed could have been prevented by the addition of a single sentence, he said.<\/p>\n
\u201cI would be asking whether you\u2019re certain that this is the set course for you and do you want to talk about it. Had that sentence been in there I suspect the [ABC 7.30] story would never have had the impact it did.\u201d<\/p>\n
Whether the tribunal chooses to side with Nitschke and return his registration, or uphold the suspension citing a doctor\u2019s responsibility, Nitschke\u2019s alleged negligence, or even the reputation of the medical profession, it\u2019s a decision that may ultimately be somewhat redundant.<\/p>\n
The board revealed early on the director of pro-euthanasia organisation Exit International has been referred to the tribunal on another 12 counts of alleged professional misconduct, so there is every chance this complex, even clinical argument will be had again.<\/p>\n","protected":false},"excerpt":{"rendered":"
Can a person\u2019s legal right to take their own life ever be a rational decision to the point that doctors are actually obligated to make no intervention? Should that decision \u2013 even if made by a person suffering no terminal illness \u2013 then be assisted? These almost philosophical questions dominated a three-day medical tribunal hearing […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"ngg_post_thumbnail":0},"categories":[5],"tags":[],"yoast_head":"\n\n\n\n\n\n\n\n\n\n\n\n\t\n