BE­FORE AND AF­TER

Two new books bring pas­sion and pain to the vol­un­tary euthana­sia de­bate, writes Miriam Cosic

The Weekend Australian - Review - - Books -

When I was writ­ing a book about vol­un­tary euthana­sia in the early 2000s, I was sur­prised by what I found. Though my brief was to ex­am­ine even-hand­edly both sides of the de­bate about le­gal­i­sa­tion, I pre­sumed that I per­son­ally would, one way or an­other, take my own life if it be­came phys­i­cally in­tol­er­a­ble. So, I dis­cov­ered, did more than 80 per cent of Aus­tralians, based on reg­u­lar polls.

That was borne out in con­ver­sa­tions with ev­ery­one from friends at din­ner par­ties to the lady at the newsagent where I bought my print­ing pa­per. The de­voutly re­li­gious didn’t fig­ure in my cir­cle of ac­quain­tance.

As I pro­gressed, how­ever, I be­gan to wa­ver. And so did the peo­ple whom I pre­sented with al­ter­na­tive ways of look­ing at the mat­ter. On the one hand, for ex­am­ple, there was the hypocrisy of law for­bid­ding what a sig­nif­i­cant pro­por­tion of doc­tors dis­creetly did. When Ge­orge V died of can­cer, the royal physi­cian has­tened the end with an in­jec­tion of mor­phine: with the as­sent of Queen Mary and the Prince of Wales and in time for the au­gust The Times, and not the racy evening pa­pers, to carry the news. The de­tails were clas­si­fied for 50 years.

On the other hand there was the “pre­scrip­tive force of the law”, a view of law as some­thing that sets the high­est stan­dards, even if they can’t al­ways be met. This so­lu­tion had worked well in The Nether­lands un­til vol­un­tary euthana­sia was le­galised. An age-old ac­com­mo­da­tion called “gedo­gan”, which turns a blind eye to law when prag­ma­tism de­mands it, had al­lowed Dutch so­ci­ety to over­come re­li­gious per­se­cu­tion and tol­er­ate every­thing from mar­i­juana use to open pros­ti­tu­tion, to be­come the tol­er­ant and im­mensely prac­ti­cal so­ci­ety it was.

Sur­pris­ingly per­haps, Catholic nurs­ing homes and doc­tors com­monly of­fer ter­mi­nal se­da­tion in Aus­tralia: a high enough dose of painkillers to put pa­tients into a coma, which would, in the ab­sence of hy­dra­tion and sup­port of the air­waves, rel­a­tively quickly re­sult in death. The Catholic doc­trine of “dou­ble ef­fect” — death not as the aim but as the side-ef­fect of al­le­vi­at­ing suf­fer­ing — left both re­li­gious law and the law of the land in­tact.

Time spent re­search­ing the book in The Nether­lands showed me that Dutch psy­chol­ogy and so­cial ex­pec­ta­tions of­fered lit­tle mod­el­ling for us in Aus­tralia. Anti-euthana­sia doc­tors and politi­cians, for ex­am­ple, would of­ten pref­ace re­marks with ex­pres­sions of re­spect for the com­pas­sion of their pro-euthana­sia col­leagues. In Aus­tralia, the re­li­gious, who formed the bulk of op­po­si­tion to vol­un­tary euthana­sia, were dis­gusted by their opponents and voiced it loudly. “De­bate” was ran­corous.

Other things oc­curred to me, such as the class as­pect of the ques­tion. Up­per-mid­dle-class peo­ple were more likely to have doc­tors among their fam­ily and friends: peo­ple more likely to take the pro­fes­sional and per­sonal risk of break­ing the law, in ex­tremis, for peo­ple they love. In The Nether­lands too, peo­ple still had fam­ily doc­tors they had known for years, form­ing mu­tual ties of trust across class and cul­tural cleav­ages, whereas ne­olib­er­al­ism in Aus­tralia had turned health­care into a con­veyor-belt sys­tem of clin­ics with a roster of doc­tors who might or might not care so in­tensely about the per­son sit­ting across the desk.

These were just some of the many com­pli­cat­ing fac­tors that arose as I re­searched my book, and made the writ­ing of it less a jour­nal­is­tic ex­er­cise in ob­jec­tiv­ity and more a pro­found search for le­gal and moral answers.

Rod­ney Syme has no such am­biva­lence. Un­like the noth­ing-to-lose Philip Nitschke, an out­sider who has been at the fore­front of the pub­lic cam­paign for le­gal­i­sa­tion, Syme is a mem­ber of the Melbourne es­tab­lish­ment: el­e­gant, hand­some, well-spo­ken, a re­spected urol­o­gist who has re­peat­edly bro­ken the law to help pa­tients end their suf­fer­ing. Each time he has for­mally re­ported his con­duct to the coroner. Each time the coroner has found his con­duct ap­pro­pri­ate and rec­om­mended no le­gal ac­tion be taken against him.

Syme’s new book, Time to Die, is a sum­ma­tion of eight decades of ac­cu­mu­lated wis­dom, 50 of them ex­posed to the ter­ri­ble suf­fer­ing of pa­tients in his area of ex­per­tise. Over the years, he taught him­self the skills of a coun­sel­lor so he could lis­ten prop­erly to his pa­tients’ needs and not bury them un­der lay­ers of eth­i­cal cus­tom and med­i­cal pro­ce­dure. He learned that phys­i­cal pain was of­ten the least of it, that ex­is­ten­tial and so­cial suf­fer­ing was even more un­bear­able: loss of dig­nity and con­trol, lone­li­ness, fear of be­ing a bur­den, phys­i­cal loss of the abil­ity to com­mu­ni­cate. “Locked in” syn­drome is a hor­ror even to con­tem­plate.

In his pre­vi­ous book, A Good Death, Syme made a strong and care­ful ar­gu­ment in favour of as­sisted death. The new one is more per­sonal, more philo­soph­i­cal, more lyri­cal, and so more pow­er­ful. Only the most strictly de­vout would

Polls sug­gest most Aus­tralians sup­port vol­un­tary euthana­sia; Nikki Gem­mell with her mother Elayn in 1981, right; Rod­ney Syme, far right

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