Politics & Policy

Euthanasia Sets Sail

An interview with Philip Nitschke, the other “Dr. Death.”

Philip Nitschke is president of the Voluntary Euthanasia Research Foundation in Australia. He is currently in the planning stages of a “euthanasia boat” — in the model of the “abortion boat” that sails international waters to provide abortion to those women who live in countries where the procedure is illegal.

Kathryn Jean Lopez: You have long been prominent in the pro-euthanasia movement in Australia. What drives you?

Philip Nitschke: I was caught up in the issue. I watched with dismay as the Australian Medical Association did all it could to wreck the world’s first law legalizing voluntary euthanasia — the Northern Territory Rights of the Terminally Ill Act, which came into operation on July 1966. Although the initiative was popular with the people of the Northern Territory, the attitude of the AMA was that they knew what was best for the people: a breathtakingly arrogant position, which grated with my idea of the role of the profession. And I became involved in getting together a small group of doctors who took an opposing position to the AMA. While the law was in operation I had the unique opportunity to compare the situation with and without such legislation. There was no comparison.

Since the legislation was overturned by the federal Australian government, we have been once again plunged back into a jungle where people with powerful friends, people with contacts, [and] people with mates who are doctors, have no trouble getting help to peacefully end their lives at the time of their choosing. But for the rest, many people who have never broken a law in their lives find themselves having to sneak around and expose those they care about to significant legal risk. Without the existence of voluntary euthanasia legislation, it is inequitable and unjust [toward] the losers on the bottom of the socio-economic spectrum. There is an uncanny parallel with the abortion issue of 25 years ago, where women with contacts and money never had to take risks getting access to safe terminations. It is the inequity and injustice of the current situation that those seeking help to obtain a peaceful death that upsets me and drives me.

Lopez: How many deaths have you assisted?

Nitschke: The number depends a little on one’s definition of “assistance.” Nevertheless, to “assist” in the eyes of the law is now a crime, since the territory’s law has been overturned. It would be accurate to say that there have been about 20 deaths that I have been intimately associated with. Four of those were legal and took place when the euthanasia legislation was in place.

Lopez: You’ve also developed a computer program, haven’t you, that instructs people on how to give themselves lethal injections? Does it worry you that anyone can get their hands on this? You could be helping anyone die?

Nitschke:The computer program referred to was part of the “deliverance machine,” a piece of equipment I developed to allow those people who had qualified to use the Northern Territory’s Rights of the Terminally Ill Act to control the process themselves. Although it would have been legally possible for me to come to the bedside of my four patients that used the law, and give them a lethal injection, I preferred to have them initiate the process. The laptop computer displayed three questions which the person wanting to die needed to answer in the affirmative. They were deliberately blunt. The final one said, “If you press this button, you will receive a lethal injection and die in 15 seconds — Do you wish to proceed?” The deliverance machine made it clear that in each of the cases where people used the law, it was not an instance of a doctor giving an unwilling or moribund patient an involuntary needle. The machine also allowed me to leave the immediate personal space of the patient, so that the family could enter and be closest to the patient when the button was pushed.

The machine has been acquired by and is currently on display in the British Science Museum in Kensington, London.

Lopez: How big a role does the Internet play in the your pro-death movement?

Nitschke: As in many embryonic political and social movements, the pro-voluntary-euthanasia movement makes a great deal of use of the Internet. The Internet provides a means of spreading the information that empowers those wishing to exercise control at the time of death. As many supporters of voluntary euthanasia become increasingly disenchanted with the progress toward a legislative solution, a rapidly growing subset of the movement is developing and disseminating the information that will effectively make legislation irrelevant. This is information about the archetypal “peaceful pill,” the substance/method, etc., that will allow anyone access to a peaceful death at anytime, irrespective of the legislative framework in which they find themselves. Considerable work is going on in developing such solutions and the Internet is an integral and necessary part of that development.

Lopez: Do you object to the “pro-death” label?

Nitschke: The labels come with the territory, as they say. I don’t enjoy being referred to as another “Dr. Death” or having people attempt to make links between my name and the Nazis (the Nitschke’s came to Australia from Germany in the 1860s to avoid persecution), but it would be a little precious to complain every time someone called you a name you didn’t appreciate. And at some level, one can even derive some encouragement from it: People only start calling you names if and when you become effective.

Lopez: You’re looking to take your crusade to the sea. Why?

Nitschke: The concept of a vessel operating in international waters and thus freeing those traveling from the constraints of the repressive legislative regimes from where they’ve come has been around for some time. When it was first looked at, our Foundation came to the conclusion that the idea had no legal merit–one would still be bound by the laws of the country of registration of the vessel. The recent news that the Dutch have now passed laws making them the first country with voluntary-euthanasia legislation seemed to affect the legal situation. We have not been able to establish — and our foundation is now working to clarify this — what the exact legal situation would be with a Dutch-registered vessel engaging in international travel between countries. There are people prepared to back such a proposal, but only if it could be shown that there are no legal difficulties with the project. The recent comments by Dutch health minister Els Burst — that the government in the Netherlands would move to pass legislation to thwart such an initiative — is of great concern to us.

Questions about “restrictions” and “who could be served” are the questions that we are seeking answers to from those with knowledge of international law.

Lopez: Would there be any restrictions on who could be served on your boat? Do you see any restrictions that should be placed on euthanasia generally? If I am depressed, do I qualify? If an elderly woman’s husband dies and she says she no longer has anything to live for, would you help her kill herself? What about a troubled teen? Who qualifies? Who decides if a life is worth living?

Nitschke: This difficult question I will answer in two parts. My personal position is that if we believe that there is a right to life, then we must accept that people have a right to dispose of that life whenever they want. (In the same way as the right to freedom of religion has implicit the right to be an atheist, and the right to freedom of speech involves the right to remain silent). 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. So all people qualify, not just those with the training, knowledge, or resources to find out how to “give away” their life. And someone needs to provide this knowledge, training, or recourse necessary to anyone who wants it, including the depressed, the elderly bereaved, [and] the troubled teen. If we are to remain consistent and we believe that the individual has the right to dispose of their life, we should not erect artificial barriers in the way of sub-groups who don’t meet our criteria.

This would mean that the so-called “peaceful pill” should be available in the supermarket so that those old enough to understand death could obtain death peacefully at the time of their choosing. It’s hard to imagine how such a development would affect society, but I believe the impact would not be as great as people fear. One group to clearly benefit from such a development would be those terminally ill patients who would derive immense comfort from knowing that they now have such control in their hands. We have a great deal of anecdotal evidence from the clinics I run in all Australian states, that the acquisition of such substances or drugs takes away a great deal of uncertainty associated with the feeling of loss of control. Perhaps it is a paradox, but we see it time and time again, that the acquisition of lethal substances that would guarantee a peaceful death enables those suffering to keep on going, living longer, and getting more out of the remaining part of their life. So empowering the entire population in this way could result in a net increase in the integrated total of human life, something I’m sure that many of the detractors of voluntary euthanasia would support.

Any position other than this leads to considerable debate about where exactly the cut-off point should be. All the legislative models in existence (Oregon, the Netherlands, and the past law in the Northern Territory of Australia) have attempted to do just that–define this eligible sub-group — i.e., terminally ill, not depressed, over 18, articulate, and lucid, etc., etc., and laws that attempt to do this produce a great deal of confusion in the gray areas of the cut-off. What about psychic suffering from mental illness? What about teenagers with terminal cancer; why should they have to wait till they’re 18? What about the 95-year-old who is “tired of life” but not clinically depressed?

We acknowledge that suicide is a legal act, but try to preserve laws that prevent “advising, counseling, or assisting” those who would [commit] suicide except in these very select groups. I would argue that if suicide is legal, then advising, counseling, or assisting people to carry out this legal act should also be legal.

The final question that needs to be answered though is, “Whom do I want to help?” While acknowledging that all have the “right” to receive assistance without fear of legal consequence, I do not personally want to involve myself in helping those who can manage the act themselves. The purpose of the deliverance machine referred to above was to allow the individual to initiate the process and to take the responsibility for their actions. My guidelines for those whom I am prepared to assist are of course arbitrary. In this country, without protective legislation, I could do what I liked, or rather, what I could get away with. However, I choose to restrict myself to that group identified in the overturned legislation. I involve myself with terminally ill adults who are articulate, lucid, and not suffering from clinically treatable depression.

Lopez: Do you know Jack Kevorkian? What do you think of him and his assisted suicides? About his jail time?

Nitschke: I have only had indirect contact with Jack Kevorkian, and greatly admire his courage. His actions moved the work forward on this issue and I agree totally with the editorialist from the British Medical Journal who referred to him as a rare example of a true medical hero. I know of no one who looked at the 60 Minutes film of the death of Thomas Youk and believed that the actions of Jack Kevorkian constituted willful murder. As Judge Cooper sentenced him, she claimed that Jack had flouted the rule of law, and that it was the rule of law that made the nation great, but she seemed to overlook that years earlier, it was the actions of heroes prepared to “flout the rule of law” that had won for her the vote, [much less] the chance to sit on the judicial bench. Kevorkian has paid a very steep price for his courage: His incarceration shames us all.

Lopez: What do you say to those who would argue that doctors who assist patients in killing themselves are violating the Hippocratic Oath to “do no harm”? That they are aiding in a murder of a human life?

Nitschke: Over time the Hippocratic Oath has been modified on a number of occasions as some of its tenets became less and less acceptable. References to women not studying medicine and doctors not breaking the skin have been deleted. The much-quoted reference to “do no harm” is also in need of explanation. Does not doing harm mean that we should prolong a life that the patient sees as a painful burden? Surely, the “harm” in this instance is done when we prolong the life, and “doing no harm” means that we should help the patient die. Killing the patient — technically, yes. Is it a good thing — sometimes, yes. Is it consistent with good medical end-of-life care: absolutely yes.

Lopez: What do you say to those who believe that human life is sacred? Do you believe that it is?

Nitschke: Many people I meet and argue with believe that human life is sacred. I do not. I believe the so-called “sacredness” of human life has been responsible for most of the wars, genocidal crimes, and global environmental and ecological disasters that we as a species have experienced. If you believe that your body belongs to God and that to cut short a life is a crime against God then you will clearly not agree with my thoughts on this issue. I do not mind people holding these beliefs and suffering as much as they wish as they die. For them, redemptive suffering may well pry open heaven’s door that little bit wider, and if that is their belief they are welcome to it, but I strongly object to having those views shoved down my neck. I want my belief — that human life is not sacred — accorded the same respect.

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