Philip Nitschke in Darwin
On Wednesday the Northern Territory Civil and Administrative Tribunal wrapped up three days of appeal hearings launched by Philip Nitschke, director of the euthanasia lobby group Exit International, against the suspension of his medical registration in July.
The South Australian Branch of the Australian Medical Association (AMA) acted after the media revealed that Nitschke did not try to dissuade a Perth man, Nigel Brayley, from committing suicide. Suicide prevention associations were outraged.
The Medical Board contended that it used its emergency powers to protect vulnerable suicidal people from Mr Nitschke and his “dangerous ideas”.
Since 2012 when an officer of the Therapeutic Goods Administration, Australia’s drugs regulator, made a complaint concerning an alleged attempt by Nitschke to import Nembutal, a further 11 formal complaints have been made to the medical watchdog, the Australian Health Practitioner Regulation Agency (AHPRA).
I initiated one of these complaints because I learned that Nitschke was marketing and supplying “Max Dog Brewing” nitrogen kits to facilitate suicide. In that regard Nitschke told ABC News:
“They [MBA] were distressed about my involvement with the Max Dog nitrogen system, that formed the basis of another complaint – so it’s not all about people or involvement with individuals, it’s sometimes to do with my involvement with practices, not exactly promoting but making available a particular method a person might use to have access to a peaceful death.”
Nitschke’s defence was that he was not Brayley’s doctor and had no obligation to dissuade him from suicide especially since it was a rational decision. The Guardian framed Nitschke’s defence:
“The Medical Board claims Nitschke should have intervened when Brayley emailed Nitschke outlining his intention to end his own life. Nitschke’s lawyers maintain he was never Brayley’s doctor, did not counsel him, and that the suspension was based on the board’s dislike of his views and work on voluntary euthanasia.”
“Nugent (Nitschke’s defence counsel) said in his opening submission that the case was about ‘the dangerous idea [of] whether a person who is contemplating rational suicide ought to be required by a medical doctor not to do so.’
“He said the tribunal needed to consider if there was such a concept as rational suicide, and if it accepted that, then what it meant for a doctor’s professional obligations to a person who was not their patient.
“‘What – if any – duty does a person who is a doctor but not in a doctor-patient relationship, owe that person?” said Nugent.
“‘As a matter of law and logic … it depends on whether the [suicidal] ideation is rational or irrational,’ he said. ‘It’s clear from the material that Mr Brayley was contemplating a rational suicide.’”
The Counsel for the Medical Board, Lisa Chapman, said that Nitschke’s excuse missed the point:
“One thing on which Mr Nitschke has remained consistent is that he obtained scant info about Mr Brayley before Mr Brayley died.”
She said any attempt by Nitschke to diagnose Brayley posthumously based on information he had since received was leading the tribunal down a path that was not the focus of the hearing.
“Today is not a debate about voluntary euthanasia … or rational suicide. It’s not a debate about the role of the medical profession in regard to voluntary euthanasia or rational suicide.
“This is a very precisely focused interim hearing in regard to Mr Nitschke’s conduct regarding Mr Brayley. That’s why it’s so important. He did nothing.”
Chapman said it was important to understand the level at which Dr Nitschke provided advice to people and the likelihood that his conduct would occur again.
“Namely, failing to respond to that clear intention of suicide by a middle-aged man with no terminal illness, other than saying [in an emailed reply]: ‘I look forward to receiving your final statement’.”
Chapman made it clear that the Medical Board’s actions were not about the issue of euthanasia and assisted suicide. This seems to be a comment designed to ensure that neither the AMA (which opposes euthanasia and assisted suicide) nor the Medical Board is acting out a political agenda.
Nigel Brayley’s main stated reason for wanting to suicide was harassment by police over his wife’s death, according to The Guardian. There were suggestions that he may have also had some involvement in an earlier death. He probably feared incarceration and humiliation. In September Nitschke himself advocated for assisted suicide provisions for prisoners facing long-term incarceration, suggesting that a jail term was “equivalent to torture”.
The most important question is how anyone can determine whether a request for suicide or euthanasia is “rational”. Will we now end media stories about suicide with a link to helpline advice for irrational suicide and to Exit International for rational ones?
Nitschke defended his views on “rational” suicide by claiming that the Medical Board was paternalistic: “The board’s view is based on the simple premise that the doctor knows best.” There’s a deep irony here: hasn’t he simply replaced “doctor knows best” with “former doctor know best”?
Paul Russell is the director of HOPE: preventing euthanasia & assisted suicide and Vice Chair of the Euthanasia Prevention Coalition International.