The day after the program screened, a surgeon called Jon Wardill rang me. He had been one of the many doctors who had refused to see Max and sign his papers.
‘I’ve just seen Four Corners, about your patient.’
‘Yes,’ I said.
‘I felt like shit,’ he said.
‘Yeah, well …’
‘If it ever happens again, ring me.’
Wardill’s reaction was a shock and emphasised to me the power of the image. Journalist Gay Alcorn had written some powerful stories about Max and his time in Darwin for The Age newspaper, but it was the live action on the television screen that hit home. If this taught me one thing, it was never to underestimate the impact of television in portraying a human story to change opinions.
* * *
Jon Wardill got his chance sooner than he might have expected.
Bob Dent, a Darwin resident, was a carpenter, a fiercely independent character, whose life had been reduced to what he called ‘a rollercoaster of pain’ by five years of prostate cancer and its treatment. Bob saw the ROTI Act as a gift—a way to end his suffering and die with dignity, with those who cared for him. He contacted me and asked for my help.
By this time my interest in voluntary euthanasia was such that I had read much about the subject, and had learned about American doctor Jack Kevorkian’s involvement in assisted suicide, in particular the machines he invented to help people die. His first was the ‘Thanatron’, a mechanical device consisting of three bottles suspended from a metal frame for dispensing lethal drugs, via an intravenous drip, into a patient’s vein. Kevorkian’s other machine of note was the ‘Mercitron’ (or mercy machine), which was a gas mask connected to a canister of carbon monoxide. Both devices provided in-built patient control in the act of dying, something I agreed with. I had decided to see if I could improve on Kevorkian’s machines.
With the help of Des Carne, my friend from the days in the Sydney squat, I had built what I called the ‘Deliverance Machine’.3 It consisted of a laptop computer that automated the delivery of the drugs through a line to a venous cannula. The person who wanted to die had to answer three questions that appeared on the laptop screen:
1Are you aware that if you go ahead to the last screen and press the ‘Yes’ button, you will be given a lethal dose of medications and die?;
2Are you certain you understand that if you proceed and press the ‘Yes’ button on the next screen that you will die?;
3In 15 seconds you will be given a lethal injection … press ‘Yes’ to proceed.
If the wrong button were pressed, or a button pressed outside of a specified time limit, the program would stop and need to be restarted.
This was, in effect, doctor-assisted suicide, as opposed to voluntary euthanasia, and it had the great advantage of allowing the doctor to step aside, leaving the patient in complete control of the process. It also took the doctor out of the patient’s personal space and allowed them free access to their loved ones. Bob Dent saw it as the answer to his problem. But there was still the question of getting doctors’ signatures in order to comply with the law. I remembered Jon Wardill’s pledge and rang him.
‘Now’s your chance,’ I said.
His reply was crisp. ‘Bring him in.’
Even with a leading surgeon’s signature secured, it wasn’t easy to get the others we needed to complete the requirements. I rang practically every psychiatrist in Australia. Among the myriad excuses I heard were, ‘I agree with you but I simply can’t because I’m pregnant’, or ‘I want to help, but my wife won’t let me.’
A colleague suggested I ring John Ellard, a Sydney psychiatrist. I hesitated to do this, remembering him from Sydney medical school days, where he was a formidable presence. But in desperation, I did eventually ring, and Professor Ellard immediately said he’d fly to Darwin and see Bob.
‘What about the College of Psychiatrists?’ I asked, wondering how he’d deal with his peers.
‘I am the college,’ was his simple reply. In August 1996 Professor Ellard travelled to Darwin, saw Bob and signed the necessary papers.
Finally, I could tell Bob that everything was in order. He was a Buddhist, and he’d been to the Darwin temple to say his farewells and give his thanks. He said, ‘Bring the machine around on Sunday afternoon and I’ll die around two.’ Then he added, ‘Come to lunch.’
On Sunday morning I packed up the equipment (I’d tested it more times than I could count), and drove to the suburb of Tiwi, where Bob and his wife Judy lived. I’ve described the lunch in some detail in many a media interview, including on Andrew Denton’s Enough Rope program on ABC television in 2008.4
The lunch, which took about an hour, was something of an ordeal, though I was the most agitated person there. We ate ham sandwiches and drank stout and, as I told Denton, my mouth was like sand. I almost choked on my sandwich and had only the smallest sip of stout, just enough to keep my mouth wet so I could speak. While it’s hot in Darwin in September, it’s not as hot as it gets; yet I remember my shirt was drenched in sweat. Conversation was difficult, as it is when a person is about to die. I felt I had to watch every word I said; I tried hard not to reference the future because, for Bob, there wasn’t one. We watched an AFL game on TV, and then Bob left the room and laid down on the lounge on the veranda.
To say I was nervous as I prepared the machine would be an understatement. Surprisingly, the needle of the cannula slid easily into Bob’s vein the first try. That doesn’t always happen and I’d been worried there might be a problem. I then connected up the syringe of lethal barbiturates and booted up the computer, and stepped away.
‘Are you sure, Bob?’ I said.
His answer was to lean towards the computer and press the button that asked the first question about the process. He then pressed the button again, and again for the last time. As the fifteen seconds it took for the delivery of the drugs ticked away, I realised that my shirt was dripping with sweat.
I had two thoughts: I was glad that Bob was getting the peaceful death he wanted but I was also acutely aware that this was the first time something like this had ever happened. And, as I watched from the other side of the room, I knew that nothing would ever be quite the same again.
Bob sighed as his wife held him and he fell into a deep sleep. With her still holding him, he died in just a few minutes. We sat there, still and silent, for about half an hour. Slowly, she lifted her hand in a gesture, and I came over and confirmed that Bob was dead.
I must have removed the cannula and packed up the machine, but I have no clear memory of doing so. Then I left. I had a book of death-certificate forms and I signed one for Bob. The regulations to the Act stipulated that the cause of death be entered as the underlying disease; the legislation recognised that people didn’t want ‘suicide’ on their death certificates. In Bob’s case, I simply entered ‘prostate cancer’, accompanied by ‘respiratory arrest’, which is an accurate description of the effect of the administered Nembutal and Pancuroniun, although the drugs didn’t get a mention.
Outside, I took a deep breath and slowly drove home. There was a suspicion in Darwin that the law may have been used and I started to get phone calls from the media, asking me to confirm or deny the rumours. I wanted some time. Judy Dent was shaky and not ready for the media frenzy that we knew would follow, and wanted to wait. I went along with this and was pleased to have some time to calm down and collect my thoughts. I remember getting a call from Kerry O’Brien, of the ABC’s 7.30 Report.
He said, ‘I know the law’s been used. Will you talk about it?’
I said, ‘No.’
‘Are you saying the law hasn’t been used?’
‘That’s right,’ I lied.
O’Brien has never forgiven me for that. A similar situation developed much later after the death of Norma Hall, adventurer Lincoln Hall’s mother, at which I was present.
This matter is covered in Killing Me Softly, but what is not mentioned there is that it almost cost me a friendship.
In 2000, Norma was terminally ill with lung cancer and wanting to die. After failing to get the palliative-care doctors to agree to what amounted to slow euthanasia (terminal sedation), for which she had my support, she stopped eating and drinking. She then ingested the entire contents of a bottle of liquid morphine that had been prescribed for her. My journalist friend at the ABC, Murray McLaughlin, then working for 7.30 Report, had followed Norma’s case closely, and had filmed her handing an open letter, declaring her intention, to Peter Baume, a former Federal Health Minister.
Murray considered he had the right to be kept fully informed of the progress of the case, but I found myself lying to him about exactly when Norma died. Her death was not easy. The liquid morphine she drank did not kill her immediately, and it took many hours for her to die. If the news of her death had got out on the Friday it occurred, it would have dominated the media over the weekend, to her children’s distress. There was also the matter of the law and my exact role in her death. My own actions are often under the police spotlight, a worry that few journalists have.
My lie to Murray meant that it was Monday before the story broke. He felt betrayed. Our friendship cooled and has only recently come anywhere near recovering. I didn’t regret what I’d done but, to this day, I feel conflicted about giving the media what they want while trying to consider the feelings and emotions of those close at hand, of those good people whose lives and deaths are playing out.
The documents relating to Bob Dent’s case—the death certificate and the certificates signed by the three doctors—were lodged with the coroner on the Wednesday, which was when everything became public. So, I bought forty-eight hours by lying to Kerry O’Brien, and others. I was gutted and close to tears at the press conference after Bob’s death. Nothing could have prepared me for the global publicity that followed. From that moment on, I was typecast—by my supporters, as a determined advocate for the right to choose; by my opponents, as ‘Dr Death’. Three more of my patients—Janet Mills, Valerie Purcell and Bill Worthington—all used the Deliverance Machine over the following months to die peacefully, and at the time and place of their choosing.
Janet Mills’ case presented a particular problem. She was from Naracoorte in South Australia, and was suffering from mycosis fungoides, a rare skin cancer that breaks down the skin cells, leaving scarring, recurrent infection and constant, unendurable itching. This is the disease that killed Paul Eddington—Jim Hacker of the BBC’s Yes Minister and Yes, Prime Minister television series. Janet, with her husband, Dave—a shearer and one of the nicest and strongest people you’d ever hope to meet—came to Darwin to take advantage of the law. Over the years, Janet had been given every available treatment and she’d had enough.
Janet was shockingly ill when I visited her at her motel in Darwin; the room smelled of what was effectively her festering body. She was admitted to Darwin Private Hospital and given a palliative care bed, while I ran around trying again to get the necessary signatures organised for her. The problem was that we needed a Territory-registered specialist to sign the papers and confirm diagnosis, but I couldn’t find one. An Adelaide dermatologist with the unforgettable name of Jack Russell had testified to Janet’s terminal condition, but that wouldn’t do, as he was down south.
I organised a media conference for Janet and Dave to appeal for a Territory specialist to come forward and help them. Her courage in facing the world, in her wasted, disfigured condition, was extraordinary. The hospital wouldn’t cooperate, so the press conference was held at Bob Dent’s house. But the appeal didn’t work. No doctor put up their hand.
I became very despondent, and one night while sitting with Dave, having a few beers, I said I didn’t think we were going to be able to do it. He wouldn’t have it.
‘We’ve come all this way,’ he said, ‘and she’s so very sick. You can’t give up now.’
Tristan even tried the doctors in her field of paediatrics, only to get short shrift with comments like, ‘What’s mycosis fungoides got to do with paediatrics?’ I rang every specialist in the Territory; it didn’t matter what their field was, they only had to be a specialist and undertake a normal consultation with the patient.5 As I worked my way down the list of more than sixty names, I developed a sort of patter:
‘Hello, this is Philip Nitschke. I’m trying to find a specialist to see a patient of mine who’s dying of mycosis fungoides and I need …’
The response was almost exactly the same every time. Something like, ‘Give me a break. I’m not a dermatologist.’
I’d say, ‘Thank you very much,’ and ring off, then dial again. Eventually, I reached the orthopaedic specialists and started by ringing Steve Baddeley, the sports-car-driving surgeon who had fixed my heel years earlier and later supervised my first intern term. I gave him my spiel and was about to hang up when he interrupted me.
‘I’ll do it,’ he said. ‘I’ll see her.’
I could hardly believe my ears and kept on talking until his response sank in.
‘Did you hear me? I believe in what you’re doing,’ he said.
Dave cried when I told him. We bundled up Janet and took her to Steve Baddeley’s rooms in the Darwin CBD and he gave her a meticulous examination. He’d been in touch with the Adelaide dermatologist, and had researched the disease and Janet’s condition. He signed the papers. Ever since, Steve has copped flak over his actions from people who say he acted wrongly, that an orthopaedic specialist should not be signing the papers of a person dying from a dermatological condition. Those who criticised him have misread the Act; all the Act stipulated was that a ‘normal consultation’ had to be conducted with a specialist. Adelaide dermatologist Dr Warren Weightman, a right-to-life stalwart, compounded the confusion when he weighed in with his opinion that mycosis fungoides wasn’t even a terminal disease. To his great credit, Steve stood his ground and remains a strong supporter of voluntary euthanasia.
Janet Mills had paid her dues. For years, when hospitalised, she’d made it possible for doctors and medical students to see her and learn about this dreadful condition. If anyone had earned the right to a peaceful death, she had. And she got it. She died in Dave’s arms.
* * *
The question I am most commonly asked about when describing these events is, ‘How did you feel when you killed these patients?’
The answer has several aspects. First, it was paramount I hold myself together. After the deaths, I was always in a mess, but saw no point in letting the patient’s family see this. So, I managed to keep my composure, but it was always difficult. Knowing someone is going to die at a certain time puts you in a unique and very strange place. On those four occasions, travelling to meet with a patient who would die before I left, gave me a strange and uncomfortable feeling, similar I imagine to one that executioners must experience.
In The Australian Book of Atheism, which was published in 2011, I tried to describe the effect of these deaths on me. I wrote: ‘… each time, as I packed up the machine and walked back into the sunlight, it felt good to be alive and good to have done the right thing. And as for any possible breach of “god’s law”? What god, and what law would that be?’ But there was more to this than meets the eye.
When you are personally involved in the act of killing a person—even if it is what they want, and even if it is lawful—in my experience the action has a strange effect on you. In my case, it created a desperate need for something life-affirming. It was as though I needed to prove to myself that it was not me who had just passed on. It was not me who, in Jean Paul Sartre’s words, had entered the existential nothingness, which is how an atheist like me sees the state of being deceased, of being dead. I’m in agreement with Kerry Packer on this one: ‘let me tell you, son, there’s fucking nothing there’. I’ve been with plenty of people when th
ey have died, but it was the act of being instrumental in these peoples death that made these deaths so different.
So when these four patients died, my response was a desperate craving for intimacy. In retrospect I think I needed to feel a connection to those still living and to the world as a whole as it continued to turn. At the time I was having an affair with a local journalist in Darwin. She—we—came together in a manner not dissimilar to Bob Seger’s ‘Nightmoves’ song in which we both got what we wanted, using each other as we went. I can now fully understand where David Walsh is heading with his MONA Museum’s Sex and Death theme. There is something primordial about the beginning and ending of life. I’m pleased that a replica of my Deliverance Machine has found a spot to be exhibited within a context that asks important social, political and artistic questions of the two.
Apart from the four people who used the ROTI law to die, there was a fifth, Esther Wild. Esther had been a nurse at Royal Darwin Hospital and was terminally ill with carcinoid syndrome, a rare type of cancer. Esther qualified to make use of the law but was prevented from doing so for reasons that should shame the people involved, as I will explain later. Now though, even as these initial four people used the ROTI Act to put an end to their suffering, opponents of the Territory legislation were mustering force to move against me and every Australian citizen who believed in their right to voluntary euthanasia.
TEN
The overturn
There is nothing moral about our exercising a free conscience vote as members of parliament and then voting to deny to others the right to exercise their
Damned if I Do Page 9