February 4, 2018

Last Exit to Lismore: People planning Death over Retirement

Marea Donnelly, The Daily Telegraph

After playing “executioner” in Darwin 20 years ago, euthanasia advocate and Exit International founder Philip Nitschke dreams of the day when pensioners can store a death dose of barbiturates alongside their blood pressure medication.

This afternoon up to 300 Baby Boomers will join Nitschke at Lismore Workers Club to learn what Australian laws they have to break to acquire their bitter suicide drinks or powders.

Former psychologist Brett, a healthy 71-year-old, and his wife will travel almost three hours from Coffs Harbour, where they know about 12 active Exit International members, to join today’s workshop (there are nearly 1000 Exit International members in northern NSW).

A lot of people are looking at assisted dying as a way of not even going into a nursing home

Active in right-to-die movements for more than 20 years, Brett is reluctant to use his surname in case of persecution.

“At meetings in Melbourne in the 1990s, right-to-life protesters would form queues outside and force their placards in our faces, so I am wary of publicising my views,” he says.

Brett considers his interest in voluntary euthanasia is a rational response to accepting that everyone must die.

“Not all of us will have the luck to die quickly,” he says.

“A lot of people will be incapacitated before death and will experience a painful, lingering death. If you think of it rationally, then you need to plan for your end of life.”

Well-versed in methods to end life, Brett says he knows people who have spent close to $1000 on substances that will end life, only to have their pentobarbital supply confiscated by police.

Euthanasia advocate Philip Nitschke is in town for his show ‘Dicing with Death’.

Nitschke’s recommended suicide drug is sodium-acid based pentobarbital, commonly sold as Nembutal or Embutal in Mexico and Peru, and increasingly supplied from China.

Until two weeks ago Exit International also provided online video instructions, now unavailable after YouTube shut down its account.

Based in the Netherlands since winning a legal battle against his suspension by the Australian Medical Board in 2015, Nitschke makes annual visits home to Australia, where he estimates membership of the not-for-profit Exit International is about 8000 (1.6 million Australians are aged over 75).

The highest concentration is on the NSW north coast, between Coffs Harbour and Tweed Heads, and southeast Queensland, where he estimates membership of 300 “mainly well 75-year-olds”, compared with about 200 members in Sydney.

“It’s a strong retirement area, popular with Baby Boomers,” he says.

People say they want to have the choice, and I tell them they have to make that choice while they are well enough to get their own drugs

“They are interested in self-determination and anxious to have their own strategy in place.”

He suspects many lived alternative lifestyles in their youth, and are considering options to remain in control as they age. He says they also want voluntary euthanasia laws changed to give them the right to access their own suicide drugs without obtaining medical assessments, as required by the Victorian Voluntary Assisted Dying Bill 2017, passed in November.

(While NSW rejected the bill last year, its key advocate Nationals MP Trevor Khan says he will reintroduce it as early as this year.)

Nitschke has five “workshops” scheduled this month around NSW, Queensland and Victoria.

Victoria passes historic voluntary euthanasia bill: 2017 in review

Sydney ethics professor Margaret Somerville is worried the “normalisation” of the idea of “doctors killing their patients” is already leading to people to plan their death as part of getting old.

“A lot of people are looking at it as a way of not even going into a nursing home,” she says.

“What happened within 12 months of the law coming in in Canada was the predicted 100 cases a year became 2000.

“In Belgium now, the current rate is something like 10 per cent of all deaths are by euthanasia, but by 2025
they have predicted it will be 25 per cent.”

She adds the Canadian government is, worryingly, already factoring in budgetary health savings linked to assisted dying — currently $148 million a year.

Controversial euthanasia advocate Philip Nitschke on the Gold Coast at a public forum at Robina Community Centre. Photo: Steve Holland

Dr Joe McGirr, associate dean rural at the University of Notre Dame, based in Wagga Wagga, says country towns can expect to get the services of a palliative care specialist about once a month.

“In rural and remote areas palliative care resources are not as good as metropolitan based services,” he adds.

“When people can access good quality palliative care, then interest around assisted dying doesn’t generate the same level of interest.

“When you don’t know what’s possible then, of course, you worry and you look for alternatives.

“The community should be hammering away for resources to enable people to die with dignity and without pain. That should be our priority — not facilitating death.”

The NSW government has put more money into rural palliative care investing $100 million in 2017-18 and hosting a series of round table discussions in areas including Lismore and Kempsey.

“We are listening to our communities and have continued to fill gaps in palliative care in regional and rural areas,” a spokesman for NSW Health said.

“We have strengthened the capacity of our regional and rural palliative care workforce with an extra nine palliative care specialists in rural and regional areas, two postgraduate fellow positions to provide relief for rural and regional palliative care medicine specialists, and an additional 30 palliative care nurses across NSW.”

Nitschke’s workshops outline how to achieve a “good death”, described by Nitschke’s followers as a quick, painless death in their sleep. He says most fear suffering pain from illness, although he agrees this can largely be avoided with good palliative care medication.

He argues instruction on a “good death” is necessary to avoid medical and legal pitfalls, despite Australian Federal Police seizing almost 15kg of pentobarbital since 2007, with no convictions.

“Not many drugs will reliably kill you,” Nitschke says. “Heroin and the opioids are not a good idea, partly because they cannot be taken by mouth and because of inconsistency in strength.”

Margaret Somerville, professor of bioethics at Notre Dame University Australia

Nitschke, 70, has been committed to the right-to-die, or rational suicide, movement since the Northern Territory proposed legalising voluntary euthanasia in 1995.

He was nicknamed Dr Death after the Territory passed the world’s first voluntary euthanasia laws in 1996, when he built a computer hooked up to administer a lethal dose of barbiturates, used to assist in the deaths of four terminally ill patients.

“I used to feel like an executioner back then, when I walked in with my machine,” he says, and favours laws under consideration in the Netherlands which would allow anyone over the age of 70 or 80 to access their own supplies of pentobarbital. With a shelf life of 20 years, the drug can be stored until required. As a bitter-tasting sedative, he says the risk of accidental use or illicit trade is unlikely.

“People say they want to have the choice, and I tell them they have to make that choice while they are well enough to get their own drugs.” The alternative is for a friend or loved one to risk a prison sentence for acquiring drugs to assist with their suicide, which brings Nitschke back to Australia.

His latest death machine, a human-sized capsule that can be 3D printed and can double as a coffin, allows patients to self-administer a deadly dose of nitrogen. Called the Sarco, Nitschke says the invention has earned co-designer, Dutch engineer Alexander Bannink, a European design award nomination.

Unlike the irreversible effects of pentobarbital, Nitschke says Sarco users will have a couple of minutes to change their mind.

Somerville says: “Only 5 per cent of the people who want euthanasia want it because they’re in pain, and something like 47 per cent because they feel that they’re a burden on other people. And that is terrible.

“We’ve got to kill the pain and suffering but not the person with the pain and suffering. We can’t alter our law and have our medical profession killing people.”