November 19, 2014

Rational suicide is a challenge that we must face

Philip Nitschke, Sydney Morning Herald

The debate in recent weeks about end-of-life choices has undoubtedly raised some uncomfortable issues.

While some have accused me of expounding black-white views on rational suicide, snidely remarking that such opinions belong in first-year university philosophy, the conversation started with my trial in Darwin over my medical registration is far from Voluntary Euthanasia 101.

Rather, issues as complex and contentious as suicide (and let’s call the spade a spade) demand a level of engagement which is necessarily challenging and confronting. When and how we die is one of life’s very few defining moments.

As with others who work with people at the end of life, I am likely more aware than most of the absolute gravity of the decision. I am similarly perhaps more frustrated than others when, as a society, we show ourselves incapable or unwilling to engage intellectually.

I’ve been particularly dismayed by what Jill Kerr Conway might call the pre-Socratic politicking that has occurred over recent weeks both by, and within, the media. It is not good enough to dismiss the conversation of suicide as too hard.

We owe it to ourselves and our loved ones to participate seriously and critically if we are to better understand.

I make this call as much to old doctors who think they know it all, as to young journalists for whom death has little personal relevance. It goes without saying that we are all going to die.

Why then, should a person’s right to suicide cause such deep-seated moral panic is the issue that needs unpacking.

Last week in Darwin, my barrister Peter Nugent opened his submissions with the suggestion that a dangerous idea lurked behind the Medical Board’s decision to suspend me.

That dangerous idea, according to Nugent, is that a competent adult should not be stopped from having access to information which might be used by that person to engage in the lawful activity of suicide.

It is not in question that a terminally ill person, with no hope of recovery, should not be able to ask for medical assistance to die.

This is the question that has been repeatedly polled over the past 50 years. This is the question that has four out of five Australians consistently agreeing. This is the question that even those in the medical profession have little issue with. This is the safe face of the voluntary euthanasia debate.

It is this safe face that was contrasted with the bad and mad face that emerged before the Medical Tribunal of the Northern Territory last week.

The trial came about after the Medical Board used their emergency powers to suspend me as a doctor because I failed to respond “appropriately” to an email from Nigel Brayley.

That was last July. The controversy arose because Nigel was not terminally ill. Nigel was not on his proverbial last legs. At least, not because his health was failing him. Nor was Nigel old. And this is a key point that has been consistently focused upon in the whole saga.

As a person who was neither sick nor old, the fact that Nigel wanted to, and eventually did, suicide challenged those within and outside of the voluntary euthanasia movement.

In the societal postmortem that has taken place since, critics have railed that Nigel must have been depressed. An understandable conclusion which effectively conflates suicide with mental illness.

Given the current trend of pathologising an increasing range of normal human behaviour, including suicide, this is hardly surprising. One does not need to look beyond the ABC’s recent mental health week advertisements which claimed “mental illness” affects “over half the population” to see the extent of the “suicide is bad” message.

This is the mad face of the voluntary euthanasia debate. Next comes the bad bit.

In his lengthy suicide note, Nigel blamed the major crime squad of the WA Police for his suicide. He said he was being hounded by them following the death of his wife, Lina. That Lina’s family supported the authorities opening of a murder inquiry into her death did little to help Nigel’s demeanour.

But this is not the only way in which we can understand Nigel as the bad face of the voluntary euthanasia debate.

Nigel was also bad because he elected to go. Nigel Brayley left early.

I tried to explain this phenomenon more than a decade ago, to try to crystallise what it is about rational suicide that we find so offensive.

“There is a feeling around [suicide] that says to the rest of the world that [people like Nigel] don’t accept the world that we value. We fight so hard, we struggle so hard to stay here … we struggle to stay alive and then [Nigel] comes along and says ‘well, yep, that is your business I’m going to go’. And it’s the resentment that that seems to engender among the rest of us who take it badly when someone is seeming to say they don’t have much time for the game we’re playing, I think we find that quite hard to deal with.”

And so it is with Nigel Brayley’s suicide and my supposed inappropriate response, by way of lack of action to stop him.