A TALE OF TWO DEATHS
The following article by Dr Rodney Syme, President of the VE Society
of Victoria (VESV),
was first published in the August 97 edition of their Newsletter.
The Northern Territory's "Rights of the Terminally Ill" Act, initiated
by Marshall Perron, came into operation on 1 July, 1996. Bob Dent became
the first person to die legally with medical assistance by voluntary euthanasia
(VE) on 22 September, 1996. Kevin Andrews' private members bill to overturn
the NT Act was passed in the Senate on 25 March, 1997. Esther Wild died
in the Northern Territory on 18 April, 1997 by a process of deliberate
medically induced coma, known in palliative care circles as pharmacological
oblivion (PO). It is important to contrast certain issues relating to these
two deaths.
Both Bob Dent and Esther Wild had a terminal illness (cancer) causing
severe pain and suffering; were fully informed about their disease, its
prognosis, options for treatment, and of the ability of palliative care
to minimise their pain and suffering; moreover, they were of sound mind,
were making persistent enduring requests for assistance in dying, and were
not acting from external duress. These facts were confirmed by at least
two experienced medical practitioners. Further a psychiatrist had concluded
that they were not suffering from treatable depression.
Bob Dent, after due consideration, pressed a button indicating his decision
to end his own life, and went to sleep within 30 seconds, and died within
10 minutes. Esther Wild, unable to use this method due to Kevin Andrews'
Act, acquiesced to be put into a coma, from which she fitfully awoke in
pain during the first 48 hours, providing the justification for deepening
the coma, which eventually caused her death after 4 days.
Bob Dent's death was legal at the time. Esther Wild's death was quasi-legal,
because such deaths are not reported to the coroner (in contravention of
the Coroner's Act), are not recorded on the death certificate as due to
medical treatment, but as due to cancer, and are described as "good medical
treatment" by the A.M.A. and by palliative care experts. Dr Philip Nitschke
and Ester Wild reluctantly chose the PO method as the best available "legal"
choice.
Kevin Andrews finds Esther Wild's death acceptable and Bob Dent's not,
on the supposed basis that Bob Dent's death was intended by Dr Nitschke
but Esther Wild's was not. Does anyone seriously believe that Esther Wild's
wish to die humanely or Philip Nitschke's intent was changed by the passage
of Kevin Andrews' Bill? All that changed was the method of assistance,
from one that is now illegal to one which is quasi-legal and of which Kevin
Andrews, the Catholic Church, the A.M.A. and the Federal Parliament approve.
The real facts are that the major difference between these deaths is
time and method. When Kevin Andrews' spoke in the Federal Parliament he
appeared to be arguing about morals - he approved of palliative care but
not once did he or his supporters mention method. It seems that method
as a distinction between good and bad medical practice is more important
than morals. The longer the coma process takes, the less likely is it that
an intention to hasten death can be alleged, and so the doctor's alibi
is created. In short, the process of pharmacological oblivion is more of
benefit to the doctor's conscience and legal protection, than it is for
the patient and her family.
Currently, intention is the singular basis on which the law in relation
to murder operates. Does anyone by now not understand Philip Nitschke's
intent in the death of Bob Dent? It was to relieve his pain and suffering
in the most humane way. Yet if he had been involved in Esther Wild's death
in the same manner, he would probably have been charged with murder. Being
aware of the alternative would anyone blame Esther Wild for wanting to
choose VE rather than PO. Surely it is time, in respect of medical decisions
at the end of life, that consent, necessity (to relieve pain and suffering),
and absence of malevolence become paramount legal arguments.
A spokeswoman for Kevin Andrews said, after Esther Wild's death, "The
object of the opposition to euthanasia was to protect the many vulnerable
people from being euthanased without their consent". The NT Act did not
allow for this, and there is nothing in current medical practice to prevent
PO being used to end the lives of vulnerable people without their consent.
She also said it was incorrect to describe what had happened to Ms Wild
as "slow euthanasia" when it was the legal "palliation of pain with drugs
which can hasten death". You could have fooled me!
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