Thursday, September 29, 2011

Paul Russell & Philip Nitscke agree that South Australian bill would legalize euthanasia.

‘End-of-life-arrangements’ or just plain killing?

By Paul Russell, founder of HOPE Australia.
Paul Russell
It’s not very often that I find myself in agreement with Phillip Nitschke. We’ve been on opposite sides of a number of debates both formal and informal in recent months. But in Launceston he surprised me.
In my presentation I described the bill in South Australia sponsored by Steph Key MP pointing out that it was very much a euthanasia free-for-all. I drew the audience’s attention to the fact that the bill did not even put up the pretence of safeguards (so-called). I invited the three persons in opposition to us (including Nitschke) that night to join me in opposing the bill (if they believed in ‘appropriate safeguards’ as at least one of the three states on his website).

Nitschke responded in very clear terms by saying that the bill in question was a ‘decriminalization model’ of euthanasia and that he wholeheartedly supported it. And of course, he’s right. The bill effectively removes from the homicide section of the criminal code direct killing and assisting in suicide if the defendant (doctor or nurse or others assisting) ‘believed on reasonable grounds that the person was an adult person of sound mind who was suffering from an illness, injury or other medical condition that irreversibly impaired the person’s quality of life so that life had become intolerable to that person (the qualifying illness)’.
Others attempts in the procession of euthanasia bills in South Australia have been modelled either to be stand alone acts in their own right or amendment bills to other statutes – but none before had taken such a direct route as to audaciously alter the criminal code. The debate in South Australia has been muddled by the protagonists’ assertion that the bill is not about euthanasia; rather, it proposes, they say, protections for doctors from prosecution in the normal course of their work. We have pointed out that doctors already enjoy the necessary protection in caring for patients by way of Sections 16 & 17 of the Consent to Medical Treatment and Palliative Care Act 1995. As others have observed, doctors have not been lobbying the government for additional protections and, even if they did, surely any changes would normally be by way of a government bill presented by the Health Minister seeking amendments to the treatment and palliative care provisions of the aforementioned act (not the Criminal Code). The Key bill, of course, is a private members bill.
It is difficult to tell whether MPs are genuinely confused or whether the supposed confusion allows them to vote with impunity, deflecting any criticism from their electorate. (“…but I thought it wasn’t about euthanasia…”). The clarity of the assertions of the Australian Medical Association (SA) and the SA Law Society in their joint statement last week has obviously not convinced some and it is legitimate to wonder why.
However, better that we simply look to what has occurred in respect to this bill since its first draft appeared late in 2010. On the 23rd of November, Health Minister, the Hon John Hill MP, tabled a draft euthanasia bill for consideration which he proffered as an alternative to the bill being debated in the Upper House at that time sponsored by The Hon Mark Parnell MLC (subsequently defeated). Hill had earlier commented to the media that he thought Parnell’s bill to be ‘clunky’ and unworkable. He made it clear that his draft was an alternative euthanasia scheme. This ‘Draft’ became Steph Key’s bill with some minor, yet telling amendments in the context of the current confusion:
The Hill Draft Title: Criminal Law Consolidation (Voluntary Euthanasia) Amendment Bill 2010. Insertion of section 138 l3B Criminal liability in relation to voluntary euthanasia etc
The Key Bill Title: Criminal Law Consolidation (Medical Defences—End of Life Arrangements) Amendment Bill 2011. Insertion of section 13B 13B Criminal liability in relation to end of life arrangements.
Additional clause in the Key Bill: the defendant believed on reasonable grounds that the person was an adult person of sound mind who was suffering from an illness, injury or other medical condition that irreversibly impaired the person’s quality of life so that life had become intolerable to that person (the qualifying illness);
The underlined clause (above) is the only substantive change adopted in the Key bill from Hill’s original draft. Other than that we have the Hill draft talking about euthanasia in the title of the bill and in the title of the section to be inserted while the Key bill talks about ‘medical defences’ and the euphemistic ‘end of life arrangements’.
Let’s bell the cat: John Hill designed a bill that he thought was a better way to approach legislative change on euthanasia. Steph Key changes a few words, adds one clause (that, interestingly, is the only clause in either schema that actuallylooks like it belongs in a classic euthanasia ‘safeguards’ package) and, somehow, this is now not about euthanasia?
Need more convincing? How about this quote from Professor Margaret Somerville:
First, the bill would legalize euthanasia and physician-assisted suicide. The fact that this is done by way of providing a defence for doctors who participate in these actions does not alter that fact. And contrary to the impression that some people seem to have about the bill, this is not a rare approach. Indeed, euthanasia was first legalized in the Netherlands in 1974 in exactly the same manner, with the difference that it was through a court judgment, rather than legislation.
Or this from the AMA/Law Society letter:
‘The effect of the Bill is to decriminalise murder, manslaughter, assisted suicide and voluntary euthanasia in certain circumstances’.
Or this from the group, Doctors Opposed to Euthanasia:
The bill in question has been characterized as a defence for medical practitioners when, in reality, it is about creating an opportunity for doctors to end the lives of patients, in other words: euthanasia.
Need we say more?

UK judge decides not to dehydrate woman to death

Royal Court of Justice
Yesterday, Mr. Justice Baker refused to grant the application by the family of “M” to have her intentionally dehydrated to death. Justice Baker determined that "M" continued to have "quality of life".

In the UK the Bland decision (February 1993) decided that a person who was unconscious and determined to be in a Persistent Vegetative State (PVS) could have their hydration and nutrition withdrawn with the intention of causing death. The Bland case concerned Tony Bland who experienced a profound cognitive injury in the Hillsborough disaster on April 15, 1989.

Since the Bland decision, many people in the UK who were deemed to be in a “PVS” state have been dehydrated to death, with the permission of the court.

The “M case” is a different because “M” is conscious even though the court was told that her responses are minimal and unreliable.

Justice Baker stated:
"I accept the evidence of the carers, who have far greater experience of living with M in recent years than do members of her family whose visits have become less frequent as time has gone by."

"M does have positive experiences and …although her life is extremely restricted, it is not without pleasures, albeit small ones."
Therefore “M” will not die by dehydration because it was determined that she had a “quality of life.”

All forms of euthanasia reduce the value of certain human beings and deny equality and dignity to every human being.

To withdraw fluids and food from a person who is not otherwise dying, even if that person has a significant cognitive disability, is euthanasia because death is directly and intentionally caused by the withdrawal of basic care, that being fluids and food. Whether fluids and food are provided by a fork, a spoon or a tube, they represent a basic necessary of life that should be provided unless the person cannot assimilate or is actually nearing death.

For someone who is not otherwise dying, death by dehydration results in a painful death.

Whether “M” had a certain level of quality of life or not, the issue should be whether or not the decision of the court would have caused her death, rather than allow her to live until she dies a natural death.

The Bland decision was wrong because it did not differentiate between the definitions of treatment and care. If the Bland decision had determined that only medical treatment could be withdrawn, but not basic care, meaning the provision of the basic necessaries of life, then a line would have been drawn that it is not acceptable for society to cause a persons death, which is different than allowing a person to die. The result of the language contortion is that people are being dehydrated to death because they are living with a cognitive disability.

We applaud the decision by Justice Baker, while recognizing that until the Bland decision is redefined, that other cognitively disabled people, such as “M” will intentionally die by dehydration, even though they would not be otherwise dying.

Baby Joseph was not "PVS"

Moe, Sana & Joseph Maraachli
On September 27, 2011, Joseph Maraachli, better known as baby Joseph, peacefully died at home with his family caring for him in Windsor Ontario Canada.

Some of the articles about the baby Joseph case referred to him as being in a Persistent Vegetative State "PVS". Baby Joseph was not in a "PVS" or brain dead condition, but rather he was living with a neurological condition that resulted in him dying a natural death.

The baby Joseph case gained international attention when Children's Hospital in London Ontario decided to remove the ventilator from Joseph against his parents wishes. Moe & Sana Maraachli had accepted that Joseph would likely die of a similar neurological condition that their daughter had died from several years earlier, but they were determined to bring Joseph home where they could care for him throughout the final months of his life. The baby Joseph case affected us all.

To bring Joseph home required that a Tracheotomy be done to enable Joseph to breath on his own. The doctors and the hospital refused to do a Tracheotomy and in turn brought the case to Ontario's Consent and Capacity Board who sided with the doctors. The Maraachli family appealed the decision of the Consent and Capacity Board to the Superior Court, who also sided with the doctors and the hospital.

The crux of the decision was that Joseph would not recover from a "PVS" state. The term "PVS" has come to mean that there is no hope of recovery and that all medical treatment can be withdrawn. What is ridiculous about this medical terminology evolution is that people who are labeled as "PVS" are not only being denied medical treatment but also basic care, such as fluids, food, antibiotics and oxygen.

Nonetheless baby Joseph was not in a "PVS" state.

Soon after returning from St. Louis, I went to meet with the Maraachli family and to see Joseph. When visiting the Maraachli home in Windsor it was clear that when Joseph was held, when his back was rubbed, when he was loved and cared for, that he was reacting.

Some would call these reactions "reflexes" but Joseph was not simply reacting by reflex, but rather he was reacting to touch and stimuli.

No one questions that Joseph had a neurological condition, but to label baby Joseph as "PVS" is inaccurate and dehumanizing.

Kim Hessels & Baby Joseph
A family friend, Kim Hessels, told a reporter:
They sang to him and played music for him. It calmed him when he was upset. 
He didn't like wearing socks. He fussed until someone took them off.
We need to be very careful before labeling a human being. Every person deserves to be treated with equality and dignity. People with disabilities, especially those with Neurological disabilities, need to be treated with equality and dignity.

Wednesday, September 28, 2011

Edmonton homicide cannot be an assisted suicide.

Yesterday I wrote a blog article concerning the fact that the Crown prosecutor in Edmonton had rejected a guilty plea of assisted suicide by Noel Lavery, a man who is on trial for second-degree murder in the smothering death of his wife Sherry in September, 2006.

In my article I stated:
"The Crown prosecutor appears to have made the correct decision by rejecting a plea of assisted suicide. The media reports indicate that Noel Lavery smothered his wife. Assisted suicide would be the correct charge if Sherry Lavery had killed herself with the "assistance" of Noel Lavery, but since he smothered his wife the charge of second-degree murder at least reflects the fact that he caused the death of his wife."
A CBC News article appears to confirm that the death of Sherry Lavery cannot be a case of assisted suicide. The article reprinted part of the 911 call made by Noel Lavery after he smothered his wife to death. The article stated:

He is then transferred to a dispatch officer and again calmly said, "I have just smothered my wife. My name is Noel Lavery." 
Lavery bristled when the officer asks him for his personal information such as his birthdate. 
"What the hell does that got to do with the fact I just murdered my wife," Lavery said. 
A short time later the officer asked, "Is your wife still breathing?" 
"No," replied Lavery. "I put a pillow on her face and held it there until she stopped."
When asked if his wife's death was mutual decision, Lavery responded: "We talked about it. 
"She told me she could not give me any promise of cure for her alcoholism," he said. "I'm her sole and only caregiver and I told her that I just couldn't do this anymore." 
Lavery then described what happened next.
"I put a pillow over her face. She didn't feel any pain because she was chronically alcoholic and drunk. And I held it...and I held it...and I held it...until I called you."
The defense is trying to prove that this is an assisted suicide case. Since the current evidence indicates that Sherry Lavery did not kill herself, therefore it cannot be a case of assisted suicide.

Nitschke does not have approval to import Nembutal into Australia.

Australian controversy
In the past few days, Philip Nitschke, Australia's Dr. Death, has been claiming that he has received permission from Australia's Therapeutic Goods Administration (TGA) to import Nembutal, a drug used by veterinarians for large animal euthanasia, for human euthanasia use.

Nitschke claims that he found a loophole in the TGA rules that would allow him to import the lethal drug.

Paul Russell, the founder of HOPE Australia, received information from the TGA that indicated that Nitschke had not been given approval to import the lethal drug.

Paul Russell
Yesterday, the Sydney Morning Herald confirmed the report from Paul Russell in an article titled: Nitschke to source euthanasia drug that has not been approved. The article in the Sydney Morning Herald stated:
"Nembutal is not approved for use in Australia. The Therapeutic Goods Administration said it had not given Dr Nitschke permission to prescribe the drug."
At the same time, Nitschke is attempting to find a source of the drug for import. The Danish manufacturer of the lethal drug is hesitant to be connected to Nitschke and his death dealing controversy. They were also hesitant to be connected to the use of the drug for capital punishment deaths in the United States.

The Sydney Morning Herald article stated:
"THE right-to-die campaigner Philip Nitschke will look to India and China to source a drug not yet approved in Australia that is used overseas to assist suicides."
This has become an important issue in Australia because some of the media are reporting that Nitschke has approval to import the lethal drug while others, including HOPE are stating that he does not have permission.

Meanwhile a euthanasia bill in the South Australian parliament will be voted-on today.

Is Argentina discussing the legalization of euthanasia?

The language of the euthanasia debate will often create confusion around what is euthanasia and what is not euthanasia. The confusion concerning the language of the debate is part of the recent debate in Argentina.

A recent news headline stated: Argentina mulls allowing euthanasia. When I linked to the full article in Spanish and then copied that text into a translator, I quickly learned that Argentina is discussing issues related to when it is acceptable to withhold or withdraw medical treatment.

The issue that has created the debate is a two-year old girl who was was born "dead" and revived and has been in a non-responsive condition since birth. The article is referring to the debate to withdraw treatment as being euthanasia.

Euthanasia is an action or omission of an action that directly and intentionally causes the death of a person, to eliminate suffering. Therefore, an act of euthanasia must be direct and intentional. Natural death or the withdrawal of treatment that is futile, burdensome or without benefit is not euthanasia. The proper use of large doses of pain killing drugs is not euthanasia. The proper use of sedation techniques is not euthanasia.

Ethically, it is euthanasia to withdraw fluids and food from a person, who is not otherwise dying, with the intention of causing death. The person in this case intentionally dies from dehydration and not a natural death.

But to withdraw medical treatment from a person and allowing them to die a natural death is not euthanasia and should not be referred to as euthanasia. The problem is that, in the past, the act of withdrawing medical treatment, even when it was futile, burdensome and without benefit, was referred to as passive euthanasia.

After reading the full translated article from Argentina, it appears that they are not debating the legalization of euthanasia but rather the ethical guidelines for withdrawing life-sustaining treatment.

I will require more information before further comments can be made.

Tuesday, September 27, 2011

Article concerning the Rasouli case is based on false assumptions.

Rasouli family

The following is my response to the Toronto Star article written by Hilary Young concerning the unanimous decision by a three judge panel by the Ontario Court of Appeal. The doctors have asked the Supreme Court of Canada to hear an appeal of the Rasouli decision.

The Euthanasia Prevention Coalition intervened in the Rasouli case and argued that doctors do not have the unilateral right to withdraw life-sustaining medical treatment and that the proper place to make these decisions, even though the system is not perfect, is at the Consent and Capacity Board.

I sent this response to the Toronto Star, who did not print it. Please read:

Crown rejects Edmonton man’s plea of guilty to assisted suicide in 2006 domestic slaying

The Crown prosecutors in Edmonton Alberta rejected a plea bargain by Noel Lavery, to the charge of assisted suicide in the smothering death of his wife, Sherry Lavery, on September 27, 2006.

The Crown prosecutor made the correct decision by rejecting a plea of assisted suicide. 

The media reports indicate that Noel Lavery smothered his wife. Assisted suicide would be the correct charge if Sherry Lavery had killed herself with the "assistance" of Noel Lavery, but since he smothered his wife the charge of second-degree murder reflects the fact that he appears to have caused the death of his wife.

Mild stroke led to mother's forced death by dehydration

By Kate Kelly

Kate Kelly
I watched an old woman die of hunger and thirst. She had Alzheimer's, this old woman, was child-like, trusting, vulnerable, with a child's delight at treats of chocolate and ice cream, and a child's fear and frustration when tired or ill.

I watched her die for six days and nights.

I watched her suffer, and I listened to the medical practitioners, to a son who legally decided her fate, and to an eldest daughter who advised him and told me that the old woman, my mother, was "comfortable," except when she was "in distress," at which times the nurses medicated her to make her "comfortable" again.

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I watched the old woman develop ulcerations inside her mouth as she became more and more dehydrated; the caregivers assured me these were not painful.

I listened to her breathing become more and more laboured, as her lungs became congested from the morphine administered every three to four hours, and later every hour.

That is what morphine does, you see. It relieves pain, but its cumulative effect is that eventually it shuts down the respiratory system.

No one explained why the old woman was given morphine in the first place, since she was conscious and trying to speak. It is normal that a mild stroke causes temporary inability to swallow, slurred speech, and a severe headache, but all of these are often reversed when the stroke victim is treated and the treatment includes nourishment and water.

The explanation for not giving nourishment and water - a feeding tube and IV (intravenous) - is that these were "extraordinary measures" for keeping someone alive.

I watched the old woman day and night for six days. The first night, after the first shot of morphine, her mouth hung open and her tongue started to roll and flutter. At the same time, her jaw trembled continuously.

This went on all night and into the early hours of the morning. Her mouth never closed again, except to clamp tightly on wet cloths placed on her lips. Her eyes were partially closed, but they moved back and forth, back and forth, becoming small slits after seven or eight hours, not closing fully until that long first night was over.

She opened her eyes only once after that, when the nurse was late with the morphine, on the third, or maybe the fourth, day.

The old woman started to moan.

Not moaning, said the nurses and the old woman's eldest daughter. Just air escaping from the lungs. Not moaning at all.

The old woman's eyes started to open, and the air escaping from the lungs sounded exactly like a moan of agony, as the old woman's face twisted in horrible contortions. I screamed, 

"Her eyes are opening! Oh, God. Oh, God!"
Even as the morphine, quickly injected by a disconcerted nurse, caused the old woman's eyes to close and her face to relax, I doubted its efficacy. I thought back to the night before, when I, in tears at the old woman's slow dying, had been confronted by a delegation of four of the nursing staff, each of them in turn trying to convince me that the old woman was not suffering in any way at all. The morphine, they said, takes away all pain.

But, I answered them, she can feel: she's squeezing my hand, and if I try to take my hand out of hers, she squeezes tighter, and when I hold a little piece of gauze to her lips, she tries to suck the water out of it. She's thirsty! This is a horror; this is cruelty!

No, they said. She's not thirsty. It's just reflex. But, I tell them, I watched her clamp her lips on the gauze so tightly that I had to pull to get it out of her mouth.

She reacts when you touch her feet, her legs, and her hair. If she can feel that she can feel thirst, I plead with them.

It's not the same, they tell me. She's not in pain.

I look at her. But what if you're wrong? I say. What if you're wrong?

They stand there, saying nothing. Then one looks at the old woman and says, we'd better turn her now. She and another care worker go about the business of repositioning the old woman, to keep her “comfortable" and the other two leave.

The days and nights went in and out of focus. I sat in a chair at the side of the old woman's bed, one hand grasped tightly by her hand. I slept an hour or two, here and there, waking always with a start.
"I'm here," I murmured, so the old woman would know I was keeping the promise I made to her on the first night, after her son and eldest daughter left to get some food, drink, and rest. I promised her then, "I will not leave here until you do."
The old woman was fading by the fourth day. Her eldest daughter had been visiting for an hour or so each day, usually mid-morning. This daughter, a former hospital worker, lightly stroked her mother's face and hair and timed the length of her mother's "breath apnea," the length of time her mother stopped breathing.

She announced the number of seconds, and then counted the number of breaths between each stopped breath. Seven breaths, she said, 11 breaths.

Sometimes she described the progress of her mother's death, She's probably down to about 60 pounds now, she pronounced.

Sometimes - I'm not sure when I noticed it first - the nurses asked us to leave while they attended to the old woman. Other times they didn't. Once, perhaps on the fourth day, I told them I didn't have to leave: I had watched them turn her, I had seen her tiny naked body as they gently washed her. I didn't even flinch anymore when they injected the syringe of morphine.

We have to give her a suppository, they said.

A suppository? Why?

For anxiety, they said.

Anxiety. So that she would appear to die with dignity. The morphine was no longer enough. This courageous old woman, who could face, who had faced, unimaginable hardships with nothing but her faith and her dignity, she could teach you about dignity, I thought to myself.

On the fifth day the eldest daughter visited twice. On her second visit, several staff members entered the room with her. They were all talking loudly, about nothing in particular, except for one care worker, fond of the old woman, who walked over to the bed and called the old woman's name loudly enough to interrupt the others' light conversation. She examined the old woman's hands, lifted the sheet covering her and looked at her legs and feet. She called the old woman's name again, and the care worker's face showed alarm.

How long has it been? she asked. She's not even mottling! (Mottling is the term given to describe the blackening of the feet and hands as the body, dehydrating, tries to preserve the vital organs by stopping the flow of blood to the limbs).

You know, continued the care worker, I don't think it's her time. It's been, what, five days? If she had been ready to go, she'd have gone in 24 hours.

The room went quiet. The care worker and I looked at each other. You're right, I said. The eldest daughter and one of the nurses began to tell her she was wrong, and a nurse hustled her out of the room.

By the sixth night I was not sure I could go on. I slept for an hour or so every four or five hours. I still sat in the chair by her bed, but now I slept with my head on bed, near her stomach.

The old woman's breathing was laboured, her will to live defying the system and the foolish young doctor who, on that first night, gave her 24 hours to live, as though he were God Himself.

My heart was breaking for her. I could do nothing to save her, could do nothing but suffer with her. I cried much of the time, but softly, so she would not know. I didn't want to add to her agony.

I had been there six days. She could no longer hold my hand, so I slipped my hand gently under hers. I felt an anguish so profound that I began to wonder if I could survive it.

The old woman's breathing was suddenly no longer laboured. Her breath eased from her, and her face - oh, her face had become the colour of pearls.

In a split second, the frown that had creased the line between her brows was smoothed away. Her head rested gently to one side. Two care workers entered the room. I saw them in my peripheral vision, but I kept my gaze on the old woman.

We're just going to turn her, one of the workers said.

No, I said, my mother is dying.

One of them left to get a nurse, and then the old woman - my dear mother, my little, child-like, beautiful mother - died.

I put my arms round her, kissed her poor, closed eyes and her now relaxed mouth, and held her limp, tiny body, no more struggling for breath.

I watched an old woman die of hunger and thirst. I watched her die for six days and nights. I watched her suffer, and struggle, and hold onto life.

She had not often found life easy, but she had always found it worthwhile. She was 94 years old. She had been born and had lived all her life in Canada. She had worked hard all her life, married, raised three children, voted, paid taxes, saved enough money to buy her own home, obeyed the laws, donated to charity, done volunteer work, paid her bills, and given much love and brought much joy to many, many people in her 94 years.

In return, in the spring of 2009, her son and her eldest daughter, with the permission and assistance of the law, because this old woman had had a mild stroke, refused her food and water. She could not swallow, so she would have needed the food and water administered artificially.

And the youngest daughter could do nothing except watch her mother die slowly, and write
this, in the hope that my mother's death, like her life, will have made a difference. 

Monday, September 26, 2011

Tragic death of 11 year old boy needs to lead to more awareness about suicide prevention

I just read the tragic story of the suicide death of 11-year-old Mitchell Wilson, who was living with Muscular Dystrophy. Mitchell was bullied and beat-up by older boys. It is tragic that Mitchell suffered so greatly by the destructive attitudes of other people who took advantage of Mitchell's disability and treated him in such a destructive manner.

People need to know about an excellent resource that exists for people who show signs of being suicidal. Your Life Counts is a great service that cares and is truly life-affirming.

We need to be aware that many people with disabilities live with bullying and descrimination on a regular basis. There will always be heartless people, but society as a whole must first recognize the existence of ingrained negative attitudes towards people with disabilities before it can assure equality and dignity for every citizen.

Nitschke and Nembutal, Paul Russell responds.

Paul Russell, the leader of HOPE, the group that is working to prevent euthanasia and assisted suicide in Australia, responded to an article in the Adelaide Advertiser that stated that Philip Nitschke, Australia's Dr. Death, has been given permission to import Nembutal, as a sleeping pill, knowing that the person who receives the drug intends to intentionally overdose to cause death.

Russell has obtained documentation from the TGA (Therapeutic Goods Administration in Australia) that indicates that Nitschke does not have permission to import Nembutal. Link to this important article.

Nitschke, Nembutal and the TGA

by Paul Russell:

For some time now, Philip Nitschke has been claiming that he had ‘discovered’ a ‘loophole’ in the Therapeutic Goods Administration’s (TGA) procedures and protocols that would allow him to import the drug Nembutal into Australia.
The Adelaide Advertiser today (26th September) reports that, ‘…Nitschke has gained permission to import a drug used in voluntary euthanasia.’ Not so. Nor was there a ‘loophole’.
The TGA gave the following explanation today:
  • The TGA has not approved the use of Nembutal by Dr Nitschke.
  • Dr Nitschke has notified the TGA that he intends to use Nembutal for a patient under Category A of the Special Access Scheme (SAS).
  • Category A of the SAS is intended to allow doctors to treat life-threatening diseases with medicines that may not yet have gone through formal clinical trials.
  • Use of unregistered medicines under Category A of the SAS requires the use to be in accordance with good medical practice, but does not involve any approval process by the TGA.
  • The TGA has written to Dr Nitschke advising him of these requirements and of the need for him to ensure his prescribing is in accordance with good medical practice
  • There is a clear process for doctors to follow in order to import and prescribe unapproved drugs and if Dr Nitschke does not follow appropriate clinical practice, he could face a range of serious sanctions from professional bodies
  • There are strong safeguards in place to ensure that practitioners act in accordance with good medical practice and Professional bodies have very high standards in place so that this occurs
The conditions under which an ‘unregistered medicine’ could be used seem to indicate that Nembutal would not qualify. It is not a drug which is ‘yet (to) have gone through formal clinical trials’; it could not be construed as ‘a treatment’ in the ordinary understanding of that term, nor could it be said that prescribing Nembutal would be ‘good medical practice’ given the fact that for use as a sedative, there are any number of legally available, effective alternatives. But, of course, providing a good night’s sleep is not really what this is all about.
The Advertiser article quotes Nitschke as saying: “The drugs will be provided to her (a Victor Harbor patient) with clear instructions,” he said. “ They are to help her sleep.
“If she breaches those instructions she will be aware there are significant dangers."
And, “The patient will also have to sign a statutory notification that she is aware of the risks associated with taking more than one tablet a night to help her sleep.”
Nothing new here. All prescription drugs come with instructions and, where there are possibilities of significant side-effects – warnings. The statutory declaration seems to be something Nitschke himself cooked up as a protection mechanism.
The Advertiser also says: ‘Dr Nitschke said there was not much doubt that Nembutal was the best end-of-life drug.’ Indeed.
Nembutal was, at one time, used as a sedative. However, its use ceased because of inherent dangers and the high risk of addiction. It remains in use in veterinary practice to euthanase animals and its only use in humans, in places such as Switzerland and Oregon, is to kill humans.
Euthanasia supporters can often be heard to say that ‘we put dogs out of their misery – why not humans?’ This implies either that we wish to treat dogs like humans or humans like dogs. Either way, Nembutal’s only use is to that end. Nitschke is kidding us to suggest otherwise.