Damned if I Do (21 page)

‘Wendy' was a terminally ill woman from Victor Harbor in South Australia, who made contact with Exit on 31 May 2011. Two weeks earlier, she had been diagnosed with
Motor Neurone Disease (MND). Determined not to end up paralysed and at risk of choking on her own saliva, Wendy joined Exit, bought
The Peaceful Pill eHandbook
and requested a clinic visit with me. A few months earlier, in March 2011, Australian Customs issued an information sheet titled
Importing Barbiturates: Pentobarbital/Nembutal
that stressed the ­illegality of such importation, except in the very special circum­stances covered under the
Special Access Scheme of Australia's Therapeutic Goods Administration (TGA). ‘Special access' ­enables medical professionals to apply for the lawful ­importation into Australia of unapproved drugs for prescription to terminally ill people. The Customs article gave me an idea. Instead of breaking the law by illegally importing the drug, Wendy and a number of other terminally ill patients I had could apply to make use of the SAS. Wendy certainly fulfilled the necessary criteria of being a ‘Category A' patient. Under Australia's
Medical Device Regulations, Category A is defined as ‘persons who are seriously ill with a ­condition from which death is reasonably likely to occur within a matter of months …'

At the time, Wendy had been unable to get a satisfactory night's sleep and had been unsuccessfully self-medicating, using her partner's valium. Subsequent prescriptions of other sleeping medications, including Phenobarbital, had all failed her. This is perhaps not surprising, as MND is notorious for interrupting its sufferers' sleep. While I planned to warn Wendy not to misuse the drug, ultimately that would have been up to her, as it is with any drug a doctor prescribes. However, things never got that far. As soon as I submitted the initial application (stage 1) of the approval process, AHPRA received a formal complaint from the TGA. The TGA based its complaint on media reports suggesting that the application was made solely to facilitate the patient's suicide, and accused me of acting contrary to ‘good medical practice'.

At this point, Wendy knew that the special access scheme of the TGA would not be possible for her. Like so many in her situation, she didn't have time on her side. As she wrote in her suicide note:

Motor Neurone Disease is an awful disease. It deprives a person of their dignity and independence. It also ­provides an awful death when swallowing becomes impossible and one is trapped in a paralysis which has no end.

My decision to end my suffering rather than waiting for the disease to finally take hold of me is a long and considered one.

To this end I have spent the past few months acquiring the drugs that I would need.

On 11 December 2011, Wendy drank the Nembutal she had obtained illegally via the internet. She was sixty-one years old.

The TGA complaint started a long process of investigation by AHPRA into my ‘fitness to practise medicine'. Years later, I still have no idea what the outcome of this lengthy enquiry will be.

More insidious was the second investigation launched in August 2012, again to establish whether I was ‘fit and proper' enough to hold medical registration. The second enquiry started while the first was still running. That AHPRA was to initiate a new investigation was made known to
The Australian
newspaper long before I was even informed. When I complained to the regulator about this issue, they denied any complicity, claiming I should have ensured my mailing address was up to date. I still left wondering then how
The Australian
's
Dennis Shanahan could bill his article as an ‘exclusive'?
5

The issue this time concerned my involvement in the distribution of
Max Dog nitrogen cylinders. In recent years, my research focus into the use of gases to provide a peaceful death has shifted from the use of helium to the use of nitrogen gas. In terms of efficacy, any inert gas will work with an
Exit bag; a significant and unique advantage of nitrogen though is that it cannot be detected at autopsy. For many elderly Exit members, what is ultimately written on one's death certifi­cate
is
important. They say they don't want to be known in the family in years to come as ‘old Aunt Mabel who ­suicided', especially if they were to take this step after some long battle with cancer. Nitrogen also has the added benefit that the Max Dog ­cylinders are refillable, the gauges are more ­precise and, if any ­leakage does occur over the years while the ­cylinder is in storage, the gas can simply be topped up.

In his many-paged complaint to AHPRA, right-to-life activist
Paul Russell claimed that Max Dog was a ­product
used purely for suicide. He was wrong, and I trust the investigators at AHPRA will realise this. A visit to one of the many beer festivals running around the world will show the growing interest in the home use of nitrogen for dispensing craft beer. (While Guinness has long been partially gassed by nitrogen, rather than carbon dioxide, it is a much more recent development for other beer to be served this way. The effect is a beer that is creamy and, some say, more fulsome in flavour.) Exit organised Australia's first ‘Nitro Night' at the Wheatsheaf Hotel (‘The Wheaty') in Adelaide in March 2013. Max Dog sponsored the evening and gave those attending the opportunity to compare the difference when beer is served using nitrogen rather than the traditional carbon dioxide.

Of course, for a death by hypoxia to look ­unsuspicious, the equipment will all need to be removed. This presents another dilemma, in that most Crimes Acts contain an offence called ‘misconduct with regard to corpses', or some similar phrasing, although the penalty for such an offence is generally pretty lenient; nothing like the years in jail that could result from actively assisting.

What surprised me most about the second AHPRA investigation was the blatant political nature of the complaint. Russell openly acknowledged that he ‘would like to see Nitschke's work and Exit International shut down'.
While I am, of course, answerable to the law, Russell's complaint to AHPRA was not legal in character; nor was it medical. And that is the point. In my response to AHPRA, I stated:

I do not understand there to be any suggestion that I am lacking in appropriate knowledge or skills, nor in concern or commitment to the health of patients or people in general. I do not understand there to be any suggestion that I have been negligent in the treatment of patients, nor failed to observe any relevant standard of performance in medical practice.

As
Australian
columnist
Ross Fitzgerald wrote, ‘Nitschke says he feels this is a quasi-religious, political witch-hunt'.
6
How right he is. What is AHPRA doing meddling in church politics such as this?

Once again, lawyers are working pro bono in ­defending me. Indeed, offers of assistance have come from a number of surprising quarters, including some from the medical and legal professions, and also from the media. This support is greatly appreciated as the pressure to push me from the medical profession mounts. In
social media quarters, a
Facebook campaign to save my registration has been created and
Twitter has proved an effective way of keeping supporters up to date with developments. I am damned if I do attempt to help those who are desperate to die, and I'd also be damned if I turned my back and walked away from them. This nebulous ‘fit and proper' criteria applied in such a discretionary manner is hard to argue against. To those who believe in God, I will never be ‘fit and proper', but should I be a doctor?

If AHPRA makes such a decision when they finally end their long-running investigations, I could not only be suspended from practise but permanently deregistered as a doctor. While I'll do what I can to stay registered, maybe it is just as well that I am prepared to turn my attention to other issues, and even other careers, should the worst come to pass. Chief among my potential new careers is to try life on the stage, doing
stand-up comedy. I have already found an agent who sees the potential in this, and I am working on my first script.

My decade and a half of working with those close to death has brought many tears of sadness but also a good deal of joy and laughter. My persecution at the hands of fundamentalists in both medicine and the church is, if ­nothing else, grist for my comedy mill. It was
Ernest Hemingway who said, ‘A man's got to take a lot of punishment to write a really funny book.' I hope the same might be said for going on the stage because that, for sure, applies to me. I do now have a head rich in ­stories of people, places, death and dying. Many tragic, but some hysterically funny, and all of them ­entertaining. I'd like to think there are worse things than dying laughing.

 

A note from Peter Corris

A
s any filmmaker will tell you it can take time to get a project up. Clint Eastwood is said to have taken seven years to bring the Oscar-winning
Unforgiven
to the screen. Some things that seem to be crying out to be done meet unforeseen obstacles.

This book represents my third attempt to ­collaborate with Philip Nitschke in the writing of his ­autobiography. Some years ago, after I'd successfully and enjoyably ­carried out a similar exercise with Fred Hollows, environmentalist John Sinclair and actor Ray Barrett, I was keen to do ­similar work. Since the publication of those books, I'd been approached several times by people seeking my help. I declined because their stories did not meet the criteria I'd set for myself. I was interested in people who'd had active, not merely cerebral, lives, and, above all, people I admired. My agent contacted Philip to see if he was interested and a ­meeting was arranged.

We met in one of my favourite places in Sydney—the University Motel in Glebe. Now demolished, it had a seedy history as one of the places where prostitute Sallie-Anne Huckstepp used to take her clients. I'd stayed there myself and frequently used it as ‘safe house' or assignation point in my Cliff Hardy novels. It was cheap.

Philip was in one of back rooms, away from the traffic. We sat and talked for about an hour and had a beer. I liked him immediately—finding him direct and unpretentious—but he was very busy. There was talk of a film and other ­ventures and he reckoned it was premature to think about an autobiography.

I was disappointed but accepted his decision. Euthanasia and Philip Nitschke were frequently in the news and I kept an eye on developments. The next approach came about five years later from Philip himself and his partner, Fiona Stewart. The time seemed right.

We had several meetings—with one publisher at my agent's office, with another at the publisher's city office. I'd read
Killing Me Softly,
the book Philip and Fiona had published in 2005, and some press cuttings they had provided. I prepared a ‘pitch' document they approved of for the publishers. But I realised this was not your ordinary autobiography. It would take a particular character to get the project off the ground. That person would be Louise Adler at MUP, who had recently attended a workshop in Melbourne run by Philip. She was impressed, as anyone who has seen him in action as a presenter—diffident but forceful, modest, compelling, anecdotal and funny—would be. Louise is married to
Max Gillies, who I'd known at Melbourne High School in the 1950s and had occasional friendly meetings with ever since. Louise contacted me, saying she was keen to publish Philip's autobiography. I was enthusiastic and things went on from there.

I conducted ten interviews with
Philip between August 2010 and April 2012. Several of these were in Philip's and Fiona's tiny unit at Kings Cross, several in my place at Newtown and, crucially, one in Darwin in December 2011. Given how significant Darwin and the Northern Territory have been in the Nitschke story, it was important to have some first-hand experience of the place. The Wet wasn't the best time and, in the aftermath of the visit by the President of the United States, the city had a subdued air, but I saw Parliament House, where the ROTI Act was passed, and the hospital where the Nitschke-inspired ‘
free speech?
' banner flew for hours in defiance of the authorities.

At the property Philip and Fiona have outside Darwin, I saw the conditions under which he carries out scientific experiments. I also saw the Cossack motorcycle that figures largely in one chapter, and what might be considered the detritus of his adventurous life—the 4WD truck he and Marlies drove from Darwin to Perth, and the decaying boat that replaced the ill-fated
Squizz
. All this helped to provide texture and atmospherics to accompany Philip's account of events.

I saw, too, what Philip had said in his first book,
Killing Me Softly
, about the
police invasion that resulted in them breaking into containers, taking away more material than the search warrant permitted and subsequent government embarrassment: ‘The police cars swept up the drive …' I'd imagined a concrete strip. In fact, it is a dusty, weed-strewn track.

There were two major difficulties in getting the job done. The first was simply the hectic pace of Philip and Fiona's activities. They were overseas, they were in several different states, they had only two days in Sydney … We fitted in the interviews as best we could, complemented by phone calls and emails.

The second difficulty came when, a week before Christmas, with much of the work done but with still a lot to do, I was hit by a truck, and suffered a smashed elbow and a broken leg, which put me in a rehab hospital for six weeks. For much of that time, I had a cast on my arm and couldn't write and, although I had my own room, there was no way to spread the working drafts, transcripts and other papers around it. Philip visited me after the surgery, a visit that got a mention in the media. All publicity is good publicity.

Things went on hold but there was a slight side benefit. In this book, Philip describes the severe injury to his foot that put him on crutches and into hydrotherapy for a long period. I came to know exactly what that was like.

Philip Nitschke easily met my criteria for a collaborative autobiography—an active life, devoted to a cause I approve of, and pursued with a courage and commitment I admire. It was my task to help bring these qualities into sharp focus.