SAVES is not affiliated with Exit International / Dr Philip Nitschke and opposes the public availability of a 'peaceful pill'.

For the period of 9 months from July 96 to April 97 Marshall Perron's "Rights of the Terminally Ill" Act was operating in the Northern Territory. In that period, 4 of my terminally ill patients made use of the legislation to end their lives at a time of their choosing. This is the only experience of voluntary euthanasia in the Australian setting, and lessons can be learnt that are of relevance to others contemplating such legislation.

The Darwin experience has been documented in The Lancet under the title "Seven Deaths in Darwin: case studies under the Rights of the Terminally Ill Act", which I co-authored with Kissane and Street (1). This collaboration with academics known to be hostile to the Act was carried out so that hitherto unpublished material could be put in the public domain. It was also reasoned that criticism of the Northern Territory experience by known opponents of the legislation would provide the most useful and critical analysis of the data.

The following are the significant findings from that publication:

• Throughout the two year period, 1996 to 1998, seven people sought to use the Territory law. All had cancer, and one was ineligible because her disease was not considered terminal. Three of the seven were from the NT. Far from the predicted "rush" to die in the NT, numbers were modest, and the Act excluded those found to be ineligible. Social isolation was noted, but the authors differed in their assessment of this and the significance they placed upon it.
• Symptoms of depression were common. This is an expected finding, and the authors (specifically Kissane v Nitschke) differed over the significance they attached to this finding. My belief is that all people suffering from major life limiting disease will show "symptoms of depression". Indeed, it surprises me that there is not more evidence of this. Nevertheless, none of the patients, when examined by qualified psychiatrists, were found to be so depressed as to warrant further treatment, or to claim that they were unable to give informed consent.
• It was noted that those patients who qualified to use the Act commonly deferred their decision to proceed. This is evidence of what I have called the "euthanasia paradox" where the presence of legislation reduces the levels of anxiety of the terminally ill and enables them to relax and lessens the chance that they will act precipitously. There is evidence that legislation allows the terminally ill to live longer and improves the quality of their remaining lives.
• Medical opinions about the nature of presenting illness differed (in one case), and this difference of opinion presented problems for the patient involved and her subsequent utilisation of the Act. Janet Mills' South Australian oncologist stated clearly that he believed she had less than six months to live. The NT oncologist refused to state this (but also signed a public statement saying he would never participate in the ROTI Act). In desperation, an orthopaedic surgeon distressed by what he saw as the politicising of the medical role, signed her papers and allowed Janet to proceed. Predicting the terminal nature of illness is notoriously difficult and provided an excuse used by doctors who were hostile to the operation of the Act.
• The "gatekeeping" role of doctors was a source of difficulty, given the profession's hostility to the concept of voluntary euthanasia. Perron was wary of heavily medicalising the legislation, anticipating that there would be problems that would develop with the medical profession controlling access to the law, but this was forced upon him. There is evidence that, given the "keys to the gate", some doctors acted to subvert and damage the legislation, and strategies had to be developed to bypass these individuals. Better legislation would place doctors in an advisory role only.

(1) Kissane DW, Street A, Nitschke P (1998). Seven Deaths in Darwin: case studies under the Rights of the Terminally Ill Act. The Lancet, 352 (9134), 1097- 1102.