Nitschke Q&A: in defence of a rational exit

Philip Nitschke: “People who are facing difficult situations whereby it is in the best interest to die should have access to information that would allow them to carry out this step efficiently, peacefully and reliably.” PIC: Ratel, BioEdge.org

Nigel Brayley, who had attended one of Dr Nitschke’s workshops on assisted suicide, had been in email contact with Dr Nitschke, alerting him to his planned death “within . . . two weeks”.

The board used its emergency powers to suspend Dr Nitschke from practising medicine last month, claiming that he presented “a serious risk to the health and safety of the public”.

At the core of Dr Nitschke’s defence is his belief in so-called “rational suicide”, in which people who decide to end their lives may not necessarily be mentally impaired or depressed.

The case of Mr Brayley, who died in May, has been muddied by suggestions that he was being investigated for the alleged murder of his former wife.

In an email to Dr Nitschke, dated April 15, he said that although he did not fit the profile of those people being helped by Dr Nitschke’s group Exit International – essentially, the terminally ill and the elderly – he was nevertheless “suffering and have been now for some nine months”.

Around this time, WA police had raided Mr Brayley’s premises apparently in search of the banned euthanasia drug Nembutal. Searches were also carried out by police in South Australia following the suicide last month of terminally ill Adelaide man Max Bromson, who had also been in contact with Dr Nitschke.

Dr Nitschke has described the raids as political. He spoke to Ali Winters about his current predicament.

The Medical Board of Australia has long held a belief that you are working outside the system. Why did the board suspend you now and not earlier?

There have been three complaints over the course of four years that have been lodged to the medical board to investigate me. Nigel Brayley was just the latest justification to initiate action.

Did the complaints start when you began running your voluntary euthanasia information workshops?

No, my organisation, Exit International, has been running the workshops for well over a decade. We started the workshops after the Howard Government overturned the Rights of the Terminally Ill Act of the Northern Territory. The Nigel Brayley issue appears to have been the incident that I think allowed the Medical Board to sweep up all these issues at once.

Did the ABC 7.30 report prompt the suspension action by the MBA?

Yes. The 7.30 report in Perth contacted me and they told me that “Nigel Brayley, a young man who attended one of your workshops has ended his life”. They also told me that Nigel Brayley was being investigated for the murder of his wife. I had no prior knowledge of this. I agreed to do an interview about Nigel’s death and the fact that younger people who are not sick do come to my workshops occasionally, and we don’t try to talk them out of having access to good information.

During the interview, they produced some emails between me and Nigel Brayley. Mostly, the emails were about the police searching his residence for the drug Nembutal. We had 10 raids to various members of Exit International over the course of about two weeks, all in Perth. We wanted to get some publicity, so I asked Nigel via email would he go public about the police raids. He replied that he wouldn’t, and more or less told me to mind my own business. That was the last I heard from him.

The 7.30 report used the emails to say Nigel was depressed, and that I’d given him information about how to die.

The emails didn’t say he was depressed at all; [they] said he was distressed. They accused me of assisting his death, and I said: “All he effectively did was come to a workshop.” Then the ABC said: “You are helping young, depressed people die.”

The MBA suspended me not long after this program went to air.

What are your views on people who are being investigated for murder like Nigel Brayley, convicted criminals or people serving life sentences, in the absence of illness wanting to end their life?

People who are facing difficult situations whereby it is in the best interest to die should have access to information that would allow them to carry out this step efficiently, peacefully and reliably.

We will get people, not many, but we will get people who make a rational decision about suicide, because they believe quite rationally that their circumstances are so bleak in the future, that they think death is a wiser course than life. Anyone has a right to rational suicide.

Rational suicide is heavily linked to your practice and beliefs. Did you coin the term ‘rational suicide’? Can you clearly define it?

I didn’t invent the term at all. There are a lot of articles in the medical literature, psychiatric journals about it and it is becoming an increasingly argued point in medicine. Opposed to the idea is that all suicide is associated with some kind of mental impairment, usually depression. That is the line that beyondblue and Jeff Kennett, and many other organisations have come out to say. In fact, Jeff Kennett said there is no such thing as rational suicide.

Is rational suicide a philosophy?

Well, yeah, I think it could be seen in that context. And certainly I don’t have any trouble with [the] concept. I see plenty of examples where if I was in that position, I would see myself taking the same steps and I don’t think we have to postulate any sort of psychiatric impairment to explain suicide.

Is it hurtful that the voluntary euthanasia movement has turned their back on you now? Why are they against you?

That’s been upsetting, but that issue has been around for some time because in the movement there are a spectrum of opinion, but the most common stance is that there should be a change in the law, so that people who have terminal illness, under strict conditions, can choose to die. Working towards that political change through legislative reform is the biggest part of the voluntary euthanasia movement. [To] try to make it possible for people who are sick to access good information to end their life, as we have done – regardless of the law — this has led to friction between what I do and other pro-voluntary euthanasia groups, who see changes to the law as being the goal, because if your goal is to change the law, you don’t want anyone out there working outside and against the law. They think the right thing to do is sit at the feet of politicians and lobby for a change of the law.

But you have done that yourself. You were very involved in the Northern Territory legislative change. Can’t you see where they are coming from?

Yes that’s right. If your only goal is to change the law, then you don’t want someone like myself running workshops, because it doesn’t help in the process of changing the law. Changing the law is a political process which is why we have registered the Voluntary Euthanasia Party, that’s a political process, but it’s not helped by people running workshops, and it’s not helped by the Nigel Brayleys of the world. But on the other hand, telling people in their 70s they have to wait another 20 years for the law to change while they live in pain and suffering, isn’t helpful either. We’ve had 17 attempts to change the law and they’ve all failed.

What duty of care do you feel as the distributer of Nembutal information at your workshops?

Obviously there is some obligation that vulnerable people don’t get exposed to dangerous information. The idea of trying to screen out these people is almost impossible. We try to screen people out who make contact when it is clear through their communication that our information, isn’t the sort they should be receiving. This is based on a judgment call, based on emails and phone conversation. You can see right away that these are not the sorts of people would necessarily benefit from a workshop, they’d probably benefit from a stay in a psychiatric ward.

Your vetting process for vulnerable people sounds very subjective and not at all fool-proof. Does this outweigh the benefits of the workshop?

You’re right, it becomes logistically impossible to vet without doubt, but there are immense benefits to people who are not vulnerable, so trying to trade off the benefit the majority will derive, against the possible dangers the small minority might also be exposed to, is quite a difficult one and my feeling is that we shouldn’t disenfranchise the majority because there is in existence people out there who might misuse the information.

The question of freedom of information is absolutely vital and that’s what this medical board case is going to focus on – who should have access to information, who should decide who dolls it out and why should doctors be the arbiters?

Tell me about your crowd funding campaign for legal costs?

We are using Go Fund Me. We set a target of 100k (currently at $95,000). There are two possible legal actions that the money will go towards. There is the medical board deregistration going on up here in Darwin and there is a possible legal action of the assisted suicide of Max Bromson, which again I’ve had to get lawyers for with the police raiding my place in Adelaide. So we are going into very important legal battles and we are going to need the best legal representation, especially when the Adelaide body of the MBA have hired an eminent QC. We need to be able to counter that and it’s going to cost.

Tell me about the legal concerns around Max Bromson, a terminally ill man connected to your organisation?

He was a very ill man. His family travelled from all over the world to be with him when he took his Nembutal. The next day, the police were called. Seventeen South Australian police turned up and confiscated phones, computers etc. It was extremely distressing for the family. It smacked of political interference. Then it was announced that the police wanted to interview me. I am currently under investigation for the death of Max Bromson. They are seeking the charge of ‘assisting suicide’, a conviction that can carry up to 14 years in prison.

What will you do if your appeal is not successful and your licence to practice medicine is not given back to you? Will it have an effect on your livelihood?

It won’t change much in terms of my running of workshops and provision of information. I haven’t done general practice in a long time. Most of my income comes from my organisation Exit International, and the sale of the book I wrote, The Peaceful Pill Handbook.

It’s been a suggestion in the communications with the MBA that my being registered gives a certain validity to the workshops I run, thus needs to be stopped. But there is no substance to that, people will come, and they are coming in greater numbers because they want this information. If you can provide the information, they will take it.