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