Seven Melbourne doctors have written an open letter to the state premier, Mr Jeff Kennett, openly declaring that they have helped terminally ill patients to die – a criminal offence which carries a sentence of up to 14 years in jail.
In a challenge for which there is believed to be no precedent anywhere in the world, the doctors have described the cases of six of their patients and confronted Mr Kennett with a clear choice, to enforce the law against them, or to change it: “For the sake of all of those who may be unfortunate enough to be trapped in suffering and anguish, we ask you to put an end to the uneasy hypocrisy of our law and to allow us to work without fear of prosecution.”
Three of the doctors who have signed the letter – Norm Roth, Darren Russell and Andrew Buchanan – are Melbourne GPs who care for patients with AIDS; David Bernshaw is a cancer specialist; Rodney Syme is a surgeon and urologist; Pat Scrivenor is an anaesthetist; and Sam Benwell is a recently retired GP.
Their declaration is explicit: “Each of us who has signed this letter has personal experience of treating terminally ill people whose condition has moved them to ask for assistance in suicide and each of us has, on occasion, after deep thought and lengthy discussion, helped such a patient to die.
“We declare this now in public, knowing that this declaration may be construed in the state of Victoria as an admission of a criminal offence. We do this because we believe passionately that this state’s law on the assistance of suicide is wrong, and because those who continue to support the law have failed to recognise the reality of our work.”
The letter provides the first confirmation of worldwide rumours that, under pressure from suffering patients, doctors have broken free of laws which forbid euthanasia.
“The assistance of suicide by doctors is already a recurrent reality in the state of Victoria,” they write. “We have assisted patients to end their lives and we know others who have. We believe that we have acted in the best tradition of medical ethics, offering our patients relief from pain and suffering in circumstances where it would have been an act of cruelty to deny them.
“We respect life. All of our professional training and work deepens that respect. However, the reality is that there are some patients who are beset by physical and mental suffering which is beyond the reach of even our most sophisticated efforts at control. When such patients clearly and repeatedly express a rational plea for help, it is out of respect for them that we have felt compelled to act.”
In The Age today, one of the doctors, Rodney Syme, describes in detail how he has practised euthanasia in Melbourne for the last 20 years. In the case histories which they have sent to Mr Kennett, the doctors describe four occasions when one or other of them has helped desperate patients to die:
*A young man in his 20s who is described as “vibrant, handsome, articulate and intelligent” developed brain cancer. He decided to commit suicide to avoid a lingering and painful death which would cause distress to his friends and family. He told his GP that he was considering throwing himself from a high building but that he was worried that he might fail to kill himself or upset those who discovered his broken body. The GP agreed to help him. The young man spent a day saying goodbye to his friends and, surrounded by friends and family, died peacefully with his GP’s help. The last thing he said to his doctor was: “You will do this well. won’t you?”
*A man in his early 50s was almost entirely paralysed by advanced Multiple Sclerosis. He was determined to die but decided not to ask for his family’s help because he was reluctant to expose them to the risk of prosecution. He took an overdose and was found unconscious by a member of his family, who rushed him to hospital where he was resuscitated. The man was devastated by his failure and by the prospect of his increasing helplessness. With the assistance of a doctor and with the support of his family, he subsequently ended his life.
*A young farmer who had been suffering from Aids was nearing the end of his life when he developed uncontrollable diarrhoea. He found this embarrassing and degrading. He became increasingly depressed. His doctor could find no way of alleviating this emotional suffering and, when the young man insisted that he wanted to hasten his death, the doctor agreed to do so.
*An elderly widow, who sadly missed her dead husband, discovered that she had breast cancer and refused to be treated. The cancer progressed, and she asked a doctor to help her to commit suicide. He urged her not to take this course. However, her illness continued to spread, causing her pain and distress, and she continued to press for the doctor’s help. She was rational and unshakeable and, after long discussion, the doctor finally agreed.
The doctors tell Mr Kennett that although some doctors are now willing to defy the law, numerous patients still die in unnecessary misery: “There are many who cry out for help and who are denied it by doctors who may sympathise with their plight but who are unwilling to break the law. There are some who attempt to end their lives unaided and who botch the attempt and survive with their misery redoubled. There are others who may be helped by a doctor but who, for fear of incriminating their friends and family, must choose to die alone without the chance to say farewell.”
The doctors describe two cases which ended in despair because there was no doctor to help.
In one, they say, a man assisted the suicide of his former lover who was dying of Aids. He lacked medical knowledge and was forced to use a method which the doctors describe as “violent and hideous”.
In the other, a healthy and successful business executive died a slow and miserable death from Aids after hospital doctors refused to act on his clear and repeated desire to die.
The doctors add: “It cannot be right to tolerate this totally unsatisfactory situation, where it is a matter of chance whether patients will receive the treatment which they so desperately seek and where it must be only a matter of time before some doctor is prosecuted by the state for following the dictates of his conscience.”
The doctors draw Mr Kennett’s attention to opinion polls which show 78 per cent of the public supporting their position. They also cite polls which show similar support among doctors and nurses.
The Victorian doctors’ move follows an attempt by the Chief Minister of the Northern Territory, Mr Marshall Perron, to change the law in the territory.
Although most developed countries have repealed laws which once made it an offence to attempt to try to commit suicide, only Holland and the American state of Oregon have allowed doctors to assist those who are unable to act without help.
Victorian law makes it an offence, punishable with up to 14 years in jail, “to aid or abet any other person in the commission of suicide or in an attempt to commit suicide”.
No doctor in the state has been prosecuted, and officials say privately that they would be reluctant to bring a prosecution unless there was a determined complaint. The doctors say they believe that Mr Kennett will not want to risk a long-running medical ‘show trial’, but they say they are prepared to face court if they have to.
Dr Norman Roth said: “To me, the fact that I might be prosecuted is not a big issue compared to the fact that the law is wrong. I am confronted all the time with these young, intelligent men who are being brought down by Aids, this ugly, debilitating disease.
“The law doesn’t cross my mind unless I am worried that someone in the family may react badly, but usually it has been between the patient and myself. It is something that you only do for the patients you really care about. It is not something that you do for people you have only met once or twice. The only anxiety I have ever felt is about whether I would do it safely and well, not about the law.
“We go to enormous lengths to ensure that people’s entrance into the world is as safe and painless as possible and yet, for difficult deaths, we provide almost nothing. The medical profession withdraws from the subject either through fear of the law or for emotional reasons. The more difficult the death, the more we withdraw.”