Dr. Phillip Nitschke and the Reinvention of Assisted Suicide

Euthanasia is back in the headlines. The US Supreme Court has reviewed Oregon’s assisted-suicide law. The UK’s House of Lords is debating a private members bill for euthanasia. And the Dutch government has approved a plan for the involuntary euthanasia of terminally ill infants. Shocking? Perhaps it depends on your point of view. In some places euthanasia is looked upon as a “progressive” cause.

Take Hollywood, for instance. At last year’s Academy Awards, Million Dollar Baby took home four Oscars, and Mar Adentro (The Sea Inside) won an Oscar as the best foreign film. The first of these, directed by Clint Eastwood, tells the story of a woman boxer who becomes a quadriplegic in her last fight. Her trainer, also played by Eastwood, is a daily-Mass-going Catholic, but when he sees that she no longer wants to live, he pulls the plug on her life-support system. The Sea Inside is a Spanish film based on the true story of Ramón Sampedro, a former ship’s mechanic who seeks help in committing suicide after 30 years as a quadriplegic.

The effect of these films is twofold: to portray the helpless, hopeless pathos of paralysis, and to question an inflexible legal system that robs people of the ultimate in personal autonomy. This rhetorical strategy has not changed much since the appearance of the first euthanasia film, a German work called Ich Klage An, or I Accuse. The movie depicts the stunningly beautiful, vibrant young wife of a brilliant medical researcher, who is struck down by multiple sclerosis. The climactic moment comes when her husband helps her drink a draught of poison as her doctor’s fingers ripple over a keyboard in the dimly lit room next door. Hanna says, “I feel so happy; I wish I were dead.” Thomas replies, “Death is coming, Hanna.” Hanna answers, “I love you, Thomas.” “I love you, too, Hanna,” says Thomas. There just weren’t enough tissues in my box of Kleenex to watch this scene, even with my wretched German.

Ich Klage An offers some telling clues about the progressive credentials of euthanasia. The script could have been cribbed from a press release for one of the many voluntary euthanasia societies in Western countries. It wasn’t, though. It was written by Nazis in 1942 as propaganda for euthanasia of the voluntary sort. For the Nazis, there was no bright line between the voluntary and involuntary kind. The road to the Holocaust was paved with the involuntary euthanasia of “useless eaters” in a little-known program called T-4. The gas chambers and ovens were given trial runs in which an estimated 100,000 people died.

But the regime also favored voluntary euthanasia (VE) for incurably ill patients like Hanna. The film even alludes to the possibility of an official commission to oversee such requests and prevent abuse, a system that has become a reality in the Netherlands. However, euthanasia never became legal in Germany because Hitler feared resistance from the Catholic Church. Some of the semi-secret involuntary euthanasia programs had to be suspended after a fiery sermon from the Catholic bishop of Münster, Clemens August Graf von Galen (recently beatified by the pope).

Lest I be accused of falling into the fallacy of reductio ad Hitlerum, or refuting an idea by associating it with Nazism, I admit that Hitler’s support for VE does not ipso facto invalidate contemporary VE. Hitler also supported full employment and vegetarianism, and these are wholesome democratic notions. But the fact that both the Nazis and films like Million Dollar Baby use the rhetoric of maudlin compassion, and the same strategy of coping with resistance to legislative change by bypassing the law, raises some awkward questions.

Innovative Euthanasia

If you want to do more than hiss at euthanasia, you have to understand it. One way to do this is to focus upon the leading figure in the Australian euthanasia movement, Dr Philip Nitschke. Following the incarceration of Jack Kevorkian, the Michigan doctor who bumped off more than 100 patients with gas, drugs, and contraptions like his “Mercitron,” the mantle of Doctor Death has fallen upon Nitschke. True, Nitschke does not speak for the whole VE movement, but he may be the most prominent euthanasia campaigner in the world nowadays. And he has just published a book outlining his theory and praxis: Killing Me Softly: Voluntary Euthanasia and the Road to the Peaceful Pill. This reveals a new side of the VE campaigner: Dr. Nitschke, the innovative new-economy entrepreneur of do-it-yourself (DIY) death.

Nitschke has emerged at a transitional stage in the VE movement. The public perception of voluntary euthanasia is that it is a desperate solution to unbearable pain. But in reality, the days of justifying lethal injections with lurid descriptions of excruciating torment are largely over. With good palliative care, patients need not suffer unbearable pain. Dying can still be an uncomfortable business marked by weakness, dependency, and lack of control, but in the past these have not been accepted as sufficient reasons for euthanasia. If Nitschke had continued to describe people racked by excruciating pain, he would have been out of a job. But—and this gives the measure of the man—he swiftly adapted to the new market environment. Now he services people who are simply tired of life and wish to die. In effect, he has reinvented himself as a universal suicide provider.

His epiphany came when he met Lisette Nigot, a 79-year-old retired French academic living in Perth. When Nitschke first became involved with euthanasia, all of the people he helped to die were ill, though not necessarily terminally ill. But there was nothing at all wrong with Lisette. Her pixie face was still strikingly handsome; she felt no pain and insisted that she was not depressed. She simply wanted to die.

From then on, Nitschke expunged the vestiges of “sanctity of life” from his program and began to describe his work as providing DIY suicide technology and know-how. He has abjured the holistic Hippocratic tradition to become a service provider, more like a clerk in a hardware warehouse than a doctor. It is a logical step, for once the link between medical practice and the sanctity or inviolability of life is severed, doctors have no philosophical framework to work in. Their technical skills serve no higher purpose.

Nitschke as Internet Entrepreneur

Nitschke’s genius has been to recognize that VE is no longer about compassionate medicine but rather providing technologies. He has effectively laid the foundation for transforming VE from a mere philosophy into an open-source internet business venture. In a 2001 interview with National Review, Nitschke even declared that, ideally, euthanasia—“the peaceful pill”—should be made available in supermarkets. He has been pilloried for this remark, but he sticks to it in Killing Me Softly: “it remains a metaphor that is useful in any discussion about universal access.”

In short, Nitschke’s campaign represents a radically individualistic, consumerist model that has more in common with the sanctified egotism of Ayn Rand than with conventional left-wing policies.

This is where he diverges from the totalitarian, bureaucratized, state-sponsored Nazi model of VE. Nitschke represents nimble, entrepreneurial, consumer-driven VE. This accounts for his enthusiasm for the internet business model pioneered by Bill Gates and Microsoft. “Where choice in dying is concerned, the Internet is allowing us to share our ideas with other activists around Australia and the globe,” he writes. It reminds me of Bill’s promotion of “business @ the speed of light” and the paradise of the information society. And that’s what Nitschke is: another huckstering prophet of consumer technology:

This is why I can envisage a time when our dying will be more technologically influenced than ever before. But instead of doctors—or politicians or legislation—calling the shots, dying will become democratized. . . . This heightened level of autonomy will open up new choices to the ordinary person.

Is this a compassionate doctor speaking? Death, for Nitschke, has lost its existential meaning and become instead an opportunity to market his weird gizmos over the internet: the Deliverance Machine, the Exit Bag, the CoGenie, and the Peaceful Pill. They are all described in loving detail in a chapter entitled “The Joys of Technology.”

Nitschke As Libertarian Economic Rationalist

As Nitschke’s VE project unfolds, it becomes clearer and clearer that instead of being a left-wing progressive, he is basically a libertarian anarchist. A decade of campaigning for VE has convinced him that laws regarding voluntary euthanasia are useless and absurd. Like many other dot-com spruikers, he envisages a future in which law is effectively rendered irrelevant by technology.

Nitschke’s expertise is the technology of death. But Killing Me Softly also reveals that he is an economic rationalist in the mould of Maggie Thatcher. His argument for VE as a way of trimming fat from government budgets would make the most flint-hearted bean counter blush. End-of-life care is expensive. If VE lopped a mere six months off the lives of ailing elderly, immense savings would result, he muses:

One can but wonder when a government will have the guts to stop digging the fiscal black hole that is their ever-deepening legacy for future generations. While the enabling of end-of-life choices will not fix the economic woes of the next forty years, it would not hurt, given half a chance.

So the next time you hear a government minister trying to argue why this or that payment or welfare program for single mothers or war veterans must be cut, counter their argument with their fiscal irresponsibility on end-of-life choices.

At this point in Killing Me Softly, you have to stand up, walk around, and take a few deep breaths. Is this man attempting a satire, like Jonathan Swift’s A Modest Proposal, for solving the food shortages in Ireland by roasting and boiling the surplus Irish babies? Or is he serious? If the latter, Nitschke’s VE proposals really do resemble Nazi economic policies. His compassion for elderly “useless eaters” may be as vast as the oceans are deep, but “useless eaters” they remain.

Nitschke’s Flawed Vision of Personal Autonomy

At the heart of Nitschke’s proposals is a notion of personal autonomy that is remarkably like the Cloud-Cuckoo-Land of the perfectly rational consumer. Ceteris paribus, all other things being equal, economic curves predict how stuff happens. But in real life the ceteris aren’t paribus, in economics or medicine. Apart from the psychological pressure not to be a burden, patients are often depressed in ways too subtle for many psychiatrists to pick up, let alone a GP like Dr. Nitschke.

Professor David Kissane, an Australian who is now head of psychiatry at Memorial Sloan-Kettering Cancer Center in New York, argues that many patients who want to die may not be judged to be clinically depressed and thus “could be perceived by clinicians to rationally choose suicide as a merciful conclusion to their life.” But in fact, he says, they may be suffering from what he calls “demoralization,” a separate psychiatric state which covers hopelessness, helplessness, meaninglessness, and existential distress, and often includes suicidal thoughts. After reading Nitschke’s folksy stories about those he helped to die, this sounds very familiar.

Remarkably, Nitschke never alludes to the fact that doctors are often tempted not to respect patients’ autonomy. Studies of how legalized euthanasia works in the Netherlands have shown that doctors fail to do their paperwork and lie about their euthanized patients. And then there is always the old-fashioned possibility of murder. If euthanasia were legalized, surely it would be easier for mad doctors to knock off their patients. This possibility never seems to occur to Nitschke.

Nor does Nitschke wonder why he has helped to kill more women than men. A US study in 2000 by psychologist Silvia Sara Canetto of Colorado State University found that two-thirds of the victims of mercy killing in the records of the Hemlock Society, the most prominent American euthanasia group (now reorganized as Compassion & Choices), were women, and 70 percent of the killers were men. She warned that the legalization of euthanasia would only victimize more women. “If older women are uniquely affected by the legalization of hastened death,” she said, “then policies presented as ‘neutral,’ enhancing self-determination, dignity, and choice in death may actually be dangerous to older women.”

Although Nitschke feels that he has a vocation to help autonomous elderly Australians to die on demand, he seems prepared to broaden his scope to people who may be even more depressed or demoralized. In the National Review interview, he spoke about providing euthanasia for “the troubled teen.” He also supports involuntary euthanasia for seriously ill newborns. He cites a slew of utilitarian philosophers in support of the view that there is no difference between a legally abor_table fetus inside the womb and an illegally killable infant outside it. Another potential market for VE is prisoners—at least those who feel that life behind bars is literally the living end. VE, muses Nitschke, may be the “last frontier in prison reform.”

As we move into the post-baby-boomer era, the aging of Western populations will put great pressure on personal lives as well as government finances. There is no doubt that Nitschke’s model of privatized, DIY death will become more attractive to many lonely people, especially women, who fear being dependent on others. And now that he has given his supporters an open-source model for euthanasia, even more entrepreneurial types could get involved, creating a commercial market for ingenious end-of-life devices. Nitschke is the future of euthanasia. It hardly seems like the type of cause that deserves the support of bleeding hearts in Hollywood. •

Hollywood Endings

Interested in a movie that frowns upon euthanasia? Tough. Hollywood has made it clear from the get-go that it tolerates only one perspective on assisted suicide.

I Accuse (1941)
Directed by: Wolfgang Liebeneiner
Featuring: Heidemarie Hatheyer and Paul Hartmann

Plot: A woman is diagnosed with multiple sclerosis. Her husband, a medical researcher, poisons her at her request. The murder is portrayed as merciful love.

An Act of Murder (1948)
Directed by: Michael Gordon
Featuring: Frederic March and Edmond O’Brien

Plot: A hard-liner judge decides to kill both his terminally ill wife and himself by driving his car off a cliff. The judge survives and must stand trial for murder. A brilliant lawyer manages to convince the jury that the judge’s actions were justified.

The Bramble Bush (1960)
Directed by: Daniel Petrie
Featuring: Richard Burton and Barbara Rush

Plot: A doctor returns to his hometown to help care for a friend who is dying of Hodgkin’s Disease. He subsequently sleeps with his friend’s wife and then assists in the friend’s suicide. The doctor is accused of murder, but the film makes it clear that his intentions were “innocent.”

I Thank a Fool (1962)
Directed by: Robert Stevens
Featuring: Susan Hayward and Peter Finch

Plot: A doctor kills her dying lover with a large morphine injection and is then convicted of murder. After serving two years in prison, the doctor is asked by the attorney who was the prosecutor in her case to assist in his wife’s suicide.

Whose Life Is It Anyway? (1981)
Directed by: John Badham
Featuring: Richard Dreyfuss and John Cassavetes

Plot: A quadriplegic sculptor wants to commit suicide but is prevented by law. The sculptor fights “the powers that be” and in the end wins the right to doctor-assisted suicide.

The Last Supper (1994)
Directed by: Cynthia Roberts
Featuring: Jack Nicholson and Ken McDougall

Plot: A dancer and choreographer with AIDS shares a last meal with his gay lover before receiving a lethal injection. The meal signifies his decision to die with dignity.

See Dick Die (1999)
Directed by: Elvis Restaino
Featuring: Kendra Jaymes and Shannon Laumeister

Plot: A man with inoperable cancer decides to enlist the services of a Kevorkian-like death doctor. The man’s girlfriend is opposed to euthanasia at the start of the film but eventually comes to appreciate the practice.

The Event (2003)
Directed by: Thom Fitzgerald
Featuring: Parker Posey and Olympia Dukakis

Plot: An assistant district attorney is investigating the suicide of an AIDS patient and finds that a social worker helped facilitate the death. Various characters debate the morality of assisted suicide, but the film ultimately sides with those supporting it.

Million Dollar Baby (2004)
Directed by: Clint Eastwood
Featuring: Clint Eastwood and Hilary Swank

Plot: A boxing trainer works with a determined woman to help make her a champion. After the woman sustains a paralyzing injury, the trainer helps her die rather than see her spirit crushed.

The Sea Inside (2004)
Directed by: Alejandro Amenábar
Featuring: Javier Bardem and Belén Rueda

Plot: Real-life quadriplegic Ramon Sampedro fights a 30-year campaign to win the right to die. His story is told through his relationships with two women: one who supports his cause and another who tries to convince him that life is worth living. The former, of course, wins.

Hot New End-of-Life Devices

“ Everyone should be free to kill or be killed at the time of mutual choosing.” —Philip Nitschke

These cutting-edge gadgets represent the latest in suicide technology. No more archaic leaps from bridges or tall building ledges. Even that once timeless classic, “the drug overdose,” will seem passé when you get a load of these cold and efficient killers. Not as dramatic as sucking on the tailpipe of your dad’s old Plymouth, to be sure, but overall, a much more stylish way to go. They’re so peaceful and trouble-free, you’ll want to die again and again. Effectiveness is rated on a scale of 1 to 5 (5 being the best).

The Exit Bag
PLUS: The elasticized opening produces one heck of a seal, so there’s little chance that any of your CO2 will escape. As for oxygen getting in: fuhgeddaboudit!
MINUS: The warning label that reads “misuse will cause death,” included to put off law enforcement, is a bit of a bummer. And there’s nothing to prevent a last-minute change of mind should you have no one to assist you. 
$30 †††

The CoGenie
PLUS: The two carbon monoxide-generating chemicals pack a wallop, and the nasal prong fits comfortably without undue pinching.
MINUS: The tube connecting chemicals to nose can be unwieldy, especially during those annoying death spasms. Also, unlike helium (likewise reliably lethal), the CO will leave you a little red in the face. NOT a good look for anyone!
$100 ††††

The Peaceful Pill
PLUS: The drug’s main ingredients, a combination of nicotine and alcohol, will be pleasantly familiar to erstwhile barflies. Plus, you won’t have to deal with those complicated instructions that can dissuade even the vehemently suicidal.
MINUS: If the drug itself doesn’t kill you, the price will. For while ostensibly made from materials found in the average home (to avoid banned substances or those that might be banned), one pill costs more than all three of these other devices put together. 
$1,000 †††††

The Deliverance Machine
PLUS: Want a suicide “doctor” but don’t want to implicate him in your murder? This is just the thing, a computer that will administer your lethal injection while the doc rests comfortably—and with a clean conscience—in an adjoining room.
MINUS: The series of questions designed to verify your intent can prove more than a little annoying (“Yes, for the last time, I’m sure I want to die!”).
$500 †††

Michael Cook is a Melbourne journalist and the editor of MercatorNet and the international bioethics newsletter, BioEdge.

From Salvo 1 (Autumn 2006)

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