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Norma Hall

Norma died 2001

Read the transcript from ABC's 7.30 Report, 22 January 2001

Police investigate supervised suicide

KERRY O'BRIEN:
We begin tonight with an exclusive report which is bound to reignite the debate on euthanasia. On Saturday morning, a Sydney woman died in circumstances which NSW police are now investigating. Attending her long, drawn-out death was NT physician Dr Philip Nitschke.

Dr Nitschke has been at the centre of the euthanasia debate in Australia in recent years, developing a so-called 'death machine' to assist terminally ill people who wanted to end their lives.

Suicide is no longer a crime in Australia but assisting a suicide is. In fact, a Western Australian doctor is currently facing charges of murder and assisted suicide after allegedly administering a fatal dose of pain-killing drugs. This latest case in NSW, involving several doctors as well as Philip Nitschke, may also test the legal limits in NSW.

Reporter Murray McLaughlin spent time with Dr Nitschke and his patient over several harrowing days.

But before bringing you this exclusive report, we should warn parents that some children might find the subject matter disturbing.

MURRAY McLAUGHLIN:
Dr Philip Nitschke helped four people to die during the 11 months when euthanasia was legal in the Northern Territory in the mid 1990s. Now he's flown from Darwin to Sydney to nurse a 72-year-old woman, crippled by cancer, who's decided to end her life by refusing food and drink.

DR PHILIP NITSCHKE:
Obviously a person can stop eating and drinking.

Suicide is not a crime in Australia. Assisting a suicide is though.

I believe that by providing the sorts of support that she needs through what will be a difficult time doesn't substitute assisting. It does constitute providing good palliation of the symptoms.

NORMA HALL:
I began to think about it as soon as I found I had bone cancer, and liver cancer as well as lung cancer. I felt very strongly that I didn't have an option really. I just didn't want to be here. And I just wanted to leave the planet.

MURRAY McLAUGHLIN:
Norma Hall is married with two daughters and a son. Her recent medical problems are a death sentence. Her records, faxed to Dr Nitschke from Sydney's Prince of Wales Hospital, record surgical and chemotherapy treatments. But the specialist doctor who's managed her cancers apparently cannot accept her rejection of more chemotherapy and her wish to die as soon as possible.

DR PHILIP NITSCHKE:
The oncologist was trying to explain to me that he believed that because there was some chance of possible remission if one was to follow a chemotherapeutic regime, which has been been engaged in, I might add, until it's been rejected by the patient, but if it was followed more ruthlessly and rigorously, that there would be a chance of some remission which might lead to an extension of life in a period of months was how it was described to me.

NORMA HALL:
Well, chemotherapy as an outpatient, I think, which would still leave you, I think, feeling very sick indeed.

MURRAY McLAUGHLIN:
But a few extra months of dependency and pain holds no attraction for Norma Hall. She enjoyed an active life till she went into hospital for chemotherapy. Swimming at Coogee seaside baths used to be her daily exercise routine.

NORMA HALL:
Not only losing the ability to exercise, losing the ability to almost do anything really, except lie around and let other people look after you.

What I want is not looking for dignity in death.

I'm looking for comfort in death. So that's what I'm hoping to get. Instead of extreme discomfort in life. It's more than extreme discomfort.

MURRAY McLAUGHLIN:
Staff at Prince of Wales Hospital suspect that Norma Hall may be clinically depressed. But two psychiatrists, one commissioned by the hospital, the other by Philip Nitschke, have examined her and say she isn't. Nevertheless, as lawyers are telling Philip Nitschke, that to provide sedation for his patient after she gives up eating and drinking would be dangerous.

DR PHILIP NITSCHKE:
Well, I mean, in essence, it seems to be that because the patient might be perceived as being, if you like, too well – in other words not absolutely, you know, bedridden – that it would be perceived that anything that was done to facilitate her wanting to put an end to her life could be interpreted as assisting in a way which would lead to some subsequent legal serious consequence.

MURRAY McLAUGHLIN:
Not surprisingly, Norma Hall is confused about what she can legally ask her doctors to do.

NORMA HALL:
The plan is to stop eating and drinking and to have nursing care until such time as I – I don't know what I'll do – am able to be sedated.

That's probably wrong. Is it?

MURRAY McLAUGHLIN:
Soon after Philip Nitschke's arrival in Sydney, senior medical staff from the Government Palliative Care Service have apparently come to accept Norma Hall's wish to die in comfort at home.

The approach pleases but also baffles Dr Nitschke.

DR PHILIP NITSCHKE:
We were totally surprised, all of us were surprised, especially in the context with our discussion with the oncologist, who made it very clear that he felt there was no way in the world that he would endorse any form of treatment in this way.

In other words, sedating a person who was, as he said, as well as she is.

Certainly, Palliative Care didn't seem to be offering anything and that was up until a phone call yesterday at about one o'clock.

MURRAY McLAUGHLIN:
Officers of the Voluntary Euthanasia Society of NSW are briefed on the intervention of the Government's Palliative Care Service.

DR PHILIP NITSCHKE:
She then went on to make the statement that, "We sedate people who stop eating and drinking for whatever reason commonly."

MURRAY McLAUGHLIN:
Present is the Euthanasia Society patron Dr Peter Baume, former Professor of community health at the University of NSW. He was Federal Health Minister under Malcolm Fraser in the early 1980s.

DR PHILIP NITSCHKE:
Now, clearly, if you stop eating and drinking and Prince of Wales palliative care service comes and gives you sedation, that's going to be far more acceptable and less likely to attract any legal sanction than if an individual turns up and says, "I'm running this show," and starts doing something like that, where it could be called into considerable question.

MURRAY McLAUGHLIN:
There's scepticism, though, that the promised drug support will materialise. For insurance, Philip Nitschke has mustered a team of doctors who had agreed to co-sign a prescription for sedatives. One of them is Dr Peter Baume, but first he has to assess the patient.

DR PETER BAUME, NSW EUTHANASIA SOCIETY (THURSDAY, JANUARY 11):
There's only one thing that matters. That is, for you to tell me what it is you want.

NORMA HALL:
Well, I want to die in comfort. I'm not so worried about the dignity but the comfort is important and with the minimum amount of difficulty to or concern really. That's my only concern.

DR PETER BAUME:
You know, I'd hate to think that I was talking another person into a course of action.

NORMA HALL:
You had nothing to do with this.

DR PETER BAUME:
You can't stop people killing themselves if they want to. What you want to do is find out if they have depression that needs treating, and of course that's been done in this case. And the person appears not to have any depression. And at that stage, I think people are entitled to make their own decisions about whether they'll have care or not.

MURRAY McLAUGHLIN:
Philip Nitschke has prepared a statement for Norma Hall to present to staff at the hospital palliative care service. It also gives them the authority to sedate her once she stops eating and drinking.

NORMA HALL:
"I ask my doctors to take away some of the suffering I may have to endure with appropriate sedatives. This is my own decision, made freely and without any pressure from the family, friends or treating doctors."

I can swear to that.

DR PHILIP NITSCHKE:
Just let me ask you – it's not the result, is it, of pressure from other doctors beside your treating doctors?

NORMA HALL:
No, no doctors.

MURRAY McLAUGHLIN:
That night, Norma Hall has a last meal with her family. Philip Nitschke will stay with her in her home till death, but no-one knows how long that will take.

NORMA HALL:
I would think it might be a couple of days, or a little bit longer. I don't really know.

MURRAY McLAUGHLIN:
With any luck you won't know?

NORMA HALL:
I won't know. This is,  as I said to my son yesterday, one of the things about being sedated and successfully dying, dying successfully, is that you wouldn't know about it. It's a bit frustrating.

MURRAY McLAUGHLIN:
But by Friday night, more than a week after she had refused food and drink, Norma Hall was still drifting in and out of consciousness. In the end, it seems, she finished the ordeal herself. She died on Saturday morning.

DR PHILIP NITSCHKE (DARWIN, TODAY):
The end, in a sense, according to the note that was left, was that Norma had become in some ways tired of the difficulty of a person stopping drinking to end their life, and had taken all the drugs that had been prescribed by palliative care, all of the morphine, and had left a note to that effect.

MURRAY McLAUGHLIN:
Within hours of her death, detectives were at Norma Hall's house and later interviewed her family. According to Dr Nitschke, the police told the family the case was a political hot potato. Dr Nitschke himself has so far refused to be interviewed by police, and he returned to Darwin yesterday.

Do you now regret becoming involved?

DR PHILIP NITSCHKE:
No, I regret that this person had to go through what seems to have been the most difficult course to get what is a plain and simple right – the chance to be able to end her suffering at the time of her choosing.

But if we have to go through this, and if we have to tell people what's actually happening to try and get some changes to the law, I guess it's something we have to do.

KERRY O'BRIEN:
The fact is, of course, that our right to end our own life, especially with medical assistance, is anything but plain and simple, as Dr Nitschke knows only too well. That deeply troubling moral and ethical debate still rages.

We approached both the oncologist and the palliative care staff at Prince of Wales Hospital for interviews, but the medical superintendent declined on their behalf, due to the prospect of a coronial inquiry.

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