Killing Me Softly: Voluntary Euthanasia and the Road to the Peaceful Pill
By Philip Nitschke & Fiona Stewart
Penguin Books, 2005
354 pages, $32.95 (pb)
REVIEW BY PHIL SHANNON
http://www.greenleft.org.au/node/36152
"May I wish Mr Kevin Andrews a long and excruciatingly painful life" was the response of a letter writer to the Sydney Morning Herald at the federal parliament's passing of a bill by then Liberal Party backbencher Kevin Andrews, which overturned the Northern Territory's voluntary euthanasia legislation in 1997. Dr. Philip Nitschke shares the angry frustration of the letter writer, who is just one of the 80% of the population who supports the right of the terminally ill to end their suffering through a voluntary, quick and dignified medically assisted death.
In Nitschke and Fiona Stewart's book, Killing Me Softly, the excruciatingly painful existence of incurably ill patients, denied a merciful and legal death, is rhetorically seen as the only way that the fundamentalist "God-botherers" and the out-of-touch "pro-life" politicians of the major parties might understand the torment of the people over whom they exercise their inhumane religious and political tyranny.
Nitschke hitched his early social conscience to the left as an opponent of the Vietnam War whilst at Adelaide University in the late 1960s, and as a supporter of Aboriginal land rights in the '70s. He was a Greens candidate in the 1995 federal elections. Nitschke's commitment to social justice has continued with his campaigning for voluntary euthanasia (VE).
When the NT parliament passed the "Rights of the Terminally Ill" legislation in 1995, which allowed medically assisted VE under strict safeguards, it was Nitschke's dogged work that eventually made the law work in practice by winning over medical practitioners who were initially reluctant to use its powers because of the history of illegality of VE and the hostile response to the new legislation in Canberra.
Four people were delivered from their end-of-life suffering under the VE legislation before Canberra reacted, via Andrews' bill. Coalition and ALP politicians contemptuously killed the legislation using Canberra's undemocratic, but constitutional, powers over the territories.
To avoid being painted as heartless, Canberra politicians and other opponents of VE latch on to palliative care (the management of the symptoms of the dying) as the humane alternative to VE. Palliative care has strong religious origins, which makes it a favourite with fundamentalists, who can oppose the taking of life regardless of the quality of "living", without appearing to be uncaring in their ideological dogmatism.
Palliative care, however, does not have all the answers, says Nitschke. Some of the side effects of pain control are worse than the pain, while pain-control does not address nausea, weakness, itching, incontinence and breathlessness, which seriously degrade the quality of a dying person's life. For Nitschke, palliative care and VE should not be seen as opposites but as part of a continuum for relief of suffering.
Despite condemnation of VE by the "right to life" ideologues, there is a form of VE practised in Australia. It is widespread (70% of doctors do it), covert (no doctor will publicly admit to it for fear of legal repercussions), slow (taking hours, days, or weeks rather than the few minutes taken by "active" VE), and undignified (the patient spends his/her last time in a drug-induced stupor).
This "passive" or "slow" euthanasia is the "medical practice that dare not speak its name". It protects doctors who wish to end the suffering of their patients through the loophole of "double effect", in which a gradual increase in dosage of a pain-killing drug such as morphine both treats pain (the claimed goal), but also results in eventual death (the real aim). There is no moral distinction between passive and active euthanasia (both assist in a patient's death), yet the moral guardians from the religious and political right apply a double standard in opposing VE but quietly accepting the less merciful and less dignified slow euthanasia.
VE, argues Nitschke, should be an option not just for the terminally ill but for the incurably (but not terminally) ill such as motor neurone disease sufferers who face gradual and total paralysis. Parents should also have the option of VE for "seriously deformed babies" who face a life of pain or severely diminished quality of life. This should be treated as no more than a "very late abortion" and is preferable to the passive euthanasia of neonates through slow starvation, which is common practice in hospitals and very traumatic for hospital staff and parents alike.
VE in Australia is not a legal option for anyone, however, and the only recourse for people wishing to avoid an undignified, painful prolongation of life is to make their wish to refuse medical treatment for certain conditions known through "living wills". This provides little guarantee, however, because only around 12% of people with living wills facing end-of-life choices have their living wills discussed by their doctors. Neither can a patient simply choose to die by refusing food and water because, on losing consciousness from starvation, palliative care can be initiated against their will.
If other people try to assist their terminally ill loved ones to die, they face harsh penalties. Whilst the person's suicide may be legal, assisting that suicide is illegal. Although bizarrely illogical — it is a crime to assist someone to do something that is itself not a crime — just sitting in the same room without intervening as a dying person takes his/her own life could land that comforter in jail (in three states, for life). Before the court of religious fundamentalism, someone who, acting out of deepest love, assists in the suicide of a painfully dying person is a criminal, but the legislators and clerics who, by opposing VE, cruelly extend the infliction of pain and distress are innocent saints.
There is, however, safety in numbers for those wanting to assist in patient-administered VE. Gold Coast retiree Nancy Crick suffered serious abdominal pain, vomiting, diarrhoea, weight loss and intense cold, with no relief in sight, as a result of "successful" surgery for bowel cancer. When she took her own life in 2002, only the presence of 21 family, friends and supporters in her room persuaded the Queensland Labor government not to prosecute and thus avoid a "Nancy Crick 21" criminal justice scandal. Nitschke cites this as an example of the power of mass civil disobedience in challenging bad laws.
Frustrated by the fate of the NT's VE law, and the failure of VE bills in NSW, SA and WA to become law, Nitschke has turned in favour of practical strategies that "democratise dying" by putting technologies in the hands of the dying person. The projects include the "Exit Bag", which gives a peaceful, low-oxygen death, the "CoGenie" carbon monoxide generator, and the "Peaceful Pill" (pain-free poisoning from a drug easily made from common and unrestrictable ingredients).
This strategy puts Nitschke's organisation, EXIT International, at odds with other VE societies that are focused solely on law reform, although both share the same goal — dying with choice and dignity. Continuing its political hostility to VE, the federal government has legislation in the wings to make it a crime to use the Internet to "view, copy, download or transmit 'suicide promotion material'", a law aimed at restricting Nitschke's work on practical DIY end-of-life choices.
Nitschke could have made more of the grossly hypocritical, anti-VE "pro-life" brigade in parliament and church, whose "moral" zealotry to prolong "bare biological existence" and defend life at all costs regardless of pain and misery, silently evaporates when they form the vanguard for criminal wars that inflict involuntary pain and death on hundreds of thousands at the drop of a carefully crafted lie. The VE opponents' claim to a moral monopoly on love and mercy sinks into the sands of Iraq and their other killing fields every bit as much as it does at the bedsides of the painfully dying, where they exercise their self-appointed moral tyranny.