X-Message-Number: 6985
Date: Thu, 26 Sep 1996 18:00:12 -0700
From: David Brandt-Erichsen <>
Subject: more details from Australia

     From the SYDNEY MORNING HERALD (Sept 27)

     LUNCH, A FINAL JOKE AND THEN GOODBYE

     By GAY ALCORN in Darwin

     Bob Dent was well known in the still small town of Darwin.

     So well known that the local newspaper, the Northern Territory
     News, ran an obituary of him yesterday without mentioning the fact
     that he was the first person in the world to die using voluntary
     euthanasia legislation.

     The newspaper called 66-year-old Mr Dent a "true blue Territorian
     with a big sense of humour".

     He was a carpenter and a pilot who had turned to Buddhism and
     therapeutic massage. He was extremely close to his wife, Judy, to
     whom he had been married for 20 years.

     The couple left Darwin after Cyclone Tracy in 1974 and returned to
     retire in 1991.They had no children.

     In the manner of his death, according to his doctor, Dr Philip
     Nitschke, Mr Dent was a brave man, a man who wanted to control
     exactly how andwhen he died.

      (Picture of computer screen used by Mr. Dent in making his
      "final choices")

     Last Sunday, the day he decided he wanted to end five years of
     suffering from prostate cancer, he joked with Dr Nitschke and
     tried to relax him. Dr Nitschke had joined the couple for a simple
     last lunch - a ham sandwich and a glass of stout.

     "He was a very calm, very sick, very ill man," said Dr Nitschke.
     "He kept saying that he was a pilot and he knew about whether
     planes were fit to fly. He said, "look mate, if you walked around
     this plane, you'd say it's not going anywhere'."

     Then he turned to Dr Nitschke and said: "Let's get on with it,
     you're here to do a job."

     Mr Dent dictated his final statement to his wife in the last days
     before dying under the Northern Territory's Rights of the
     Terminally Ill Act, which enables a doctor to assist a patient to
     die.

     The two-page statement was produced by Dr Nitschke yesterday at a
     hastily-arranged press conference. Dr Nitschke, who assisted at Mr
     Dent's death at his Darwin home, fought back exhausted tears.

     His life has almost collapsed with the stress of coping with the
     desperate hopes of his patients and the firm opposition from the
     medical establishment, Churches and many political leaders.

     Mr Dent outlined his suffering, from being diagnosed with prostate
     cancer in 1991, having both testicles removed, his impotence,
     failed repair jobs on his hernia and the embarrassment of having
     to use a catheter and leg bag. He lost 25 kilograms and was taking
     30 tablets a day.

     For Philip Nitschke, the 49-year-old doctor with just seven years
     in the profession, the experience has almost broken him. His
     relationship with his girlfriend has all but collapsed and more
     than once he has wondered whether this issue, that affects just a
     handful of people, is worth it.

     Some of his friends have asked him why he would take on such an
     issue when there are bigger political fights - issues such as
     Aboriginal health and the environment (he stood for the Greens in
     the March Federal election).

     Dr Nitschke said he woke up in February last year to a radio
     report that the then Chief Minister, Mr Marshall Perron, was to
     introduce a euthanasia bill and the Australian Medical Association
     saying that no Darwin doctor would be involved.

     "Well, that's not on," he thought.

     Nineteen months later, his after-hours medical practice, AusDoc,
     has all but collapsed.

     "I'm going to take a holiday for about three months right now.
     This has taken a toll on my personal live, it's made things
     extremely difficult, it was a very bitter tough fight," he said.

     "It's worth it if we get this law in. I believe in this
     passionately. It would be an awful tragedy if this law was lost
     ... it would be very similar to the overturning of progressive
     abortion legislation."

     Mr Dent's funeral is to be held today at the Buddhist Temple in
     Darwin.


------------------------------------------

     THE FIGHT TO END A LIFE

     'Let's do it,' says Bob Dent and minutes later he is dead. GAY
     ALCORN looks at the months of planning to end the Darwin man's
     life and the doctor who was with him every step of the way.

     Dr Philip Nitschke had waited for days for the telephone call he
     was dreading. It came last Sunday morning and, as the phone rang,
     he felt a chill. The GP left his rural home just outside Darwin
     and drove to a house in suburban Tiwi, where Bob Dent was waiting.

     A few hours later, the 66-year-old Darwin man, who had suffered
     from prostate cancer for five years, became the first person to
     die using the Rights of the Terminally Ill Act, the first law in
     the world that legalises voluntary euthanasia. As he said in a
     statement released yesterday, both of his testicles had been
     removed, he was impotent, he had lost 25 kilograms, had worn a
     catheter and leg bag, and required 24-hour care.

     "I cannot even get a hug in case my ribs crack," he said.

     Nitschke, who has become, reluctantly, the most vocal medical
     supporter in Australia of euthanasia, had fought for weeks to get
     the necessary specialist's and psychiatrist's signatures for Dent,
     as required under the act. Yet he feels he barely had time to
     consider what he was about to do.

     "My fears about the whole thing was that I was in the
     executioner's role," said Nitschke. "I realised what a grisly
     business it is. He went right out of his way to try to calm me
     down. I was quite anxious, I was sweating, I was worried that
     there was sweat on my shirt. It was hot, but not that hot. I
     thought, "I can't muck it up.' What if my nerves failed me? I was
     half hoping that he might change his mind."

     Nitschke sat down for lunch with Dent and his wife of 20 years,
     Judy. She was the strong one in the last few weeks, extremely
     supportive of his decision, but worried that something would go
     wrong. The final meal was simple: a ham sandwich and glass of
     stout. There were some jokes, macabre but well-meant.

     Dent told Nitschke that if he drank too much, he would be unable
     to go through with it. He said more soberly that his experience as
     a pilot had taught him when planes were unable to fly - and his
     time had come. The last supper over, Dent said: "You're here to do
     a job. Let's get on with it."

     At 2.30pm, Nitschke set up the so-called "death machine", a
     computer hooked up to a "driver" that would dispense lethal drugs
     at the touch of the keyboard's space bar. It allows the patient to
     decide exactly when to die and enables the doctor not to have to
     physically inject lethal drugs.

     There were three questions to make sure Dent knew exactly what he
     was doing. The last was: "In 15 seconds, you will receive a lethal
     injection and die. Do you wish to proceed? YES/NO."

     Dent said, "Let's do it," and pressed the space bar. A drug called
     thiopentone put him to sleep in seconds. Pentobarbitone, a
     longer-lasting sleep agent that Nitschke had to get from
     veterinary supplies, because it is now off the market, was next.
     Finally there was atracurium, a muscle relaxant which stops the
     breathing. Dent died peacefully within minutes.

     At a media conference yesterday, Nitschke, 49, looked terrible. He
     barely contained his tears at times. Even the strongest supporters
     of euthanasia do not pretend it is easy, but Nitschke's scars are
     raw. He had been told to wear a tie and trousers instead of his
     customary shorts, but his respectability could not hide his deep
     emotion.

     "It was a very tense time. There was a great deal of apprehension,
     disquiet. The patient did as much as he could to keep trying to
     put people at ease, reminding me that this was an act of love and
     I should see it as an act of love," he said.

     "It [voluntary euthanasia] takes a toll out of those people who
     are participating, but perhaps, ultimately, it is the greatest
     thing you can do for a person. I felt at the end of it enhanced by
     the experience. I did not feel in any way that I have done the
     wrong thing."

     Every profession has its mavericks and Nitschke is one, although,
     this time, the costs have been huge. His relationship with his
     partner, also a doctor, has virtually collapsed, as has his AusDoc
     after-hours medical practice, whose patients are mostly heroin and
     narcotics users. This area is another of Dr Nitschke's passions,
     fighting the Territory Government's refusal to introduce a
     methadone program. He's been abused, labelled "Dr Death" and a
     murderer, and become an increasingly isolated figure within the
     medical hierarchy.

     "I'm going to take a holiday for about three months right now.
     This has taken a toll on my personal life. It's made things
     extremely difficult. It was a very bitter, tough fight. I had no
     idea that it was going to take on the bitterness. There's no kid
     gloves in this."

     THE beginning of what Dent called the "miracle" of euthanasia
     really began with a tragedy - the death of Broken Hill taxi driver
     Max Bell in early August. Bell, 66, drove 3,000 kilometres to
     Darwin to use the NT law, which came into force on July 1. But
     under the act, Nitschke had to find an NT-resident specialist in
     Bell's illness to confirm his diagnosis of stomach cancer and
     prognosis, and a psychiatrist to confirm that he was not suffering
     a treatable clinical depression.

     Not one would come forward, and Bell returned home to die what is
     termed a "natural" death in hospital. Nitschke was devastated by
     his death, at which he was present, and partly blamed himself.

     Bell's story upset many doctors and made others feel a sense of
     guilt. A local psychiatrist agreed to help the next time, then
     pulled out, citing fear of legal reprisals if the High Court
     challenge to the legislation was successful. Nitschke kept trying.

     Bob Dent first contacted Nitschke around March, wanting a doctor
     who could visit after hours. It was the usual pattern for
     terminally ill patients, who would not immediately mention
     euthanasia, but eventually did.

     An Adelaide psychiatrist rang to say that if a specialist was
     found, he would fly to Darwin to see Dent. Then, almost out of the
     blue, a local specialist said he would see the patient, on the
     condition that he remain anonymous. Nitschke was elated. He and
     Dent sat in the specialist's waiting room "with about a million
     other patients" on Friday August 30. At 11.15am, Dent, Nitschke
     and the specialist signed the necessary forms.

     Nitschke faxed the forms confirming the news to the Adelaide
     psychiatrist that day, but there was no response. Finally, the
     psychiatrist wrote back saying that he was not going to be
     involved.

     Dr Nitschke had not considered approaching Dr John Ellard, the
     Sydney psychiatrist, saying: "It would have been like approaching
     God." Ellard is the chairman of the Ellard Practice in Sydney and
     editor of Modern Medicine of Australia. But following a
     colleague's suggestion, Nitschke approached him and got an
     immediate "yes".

     The Dent family is not well-off and voluntary euthanasia societies
     around Australia donated the $1,500 for Ellard's air fares and
     accommodation in Darwin. He flew in on the midnight flight on
     September 7 and saw Dent for several hours the next morning. He
     signed the form without hesitation: Bob Dent was not suffering a
     treatable clinical depression.

     What seemed impossible had happened. The three signatures had been
     garnered and the nine-day "cooling off" period under the
     legislation had begun.

     The Dents were still desperately worried something would go wrong,
     that, somehow, the anti-euthanasia forces would stop him carrying
     out his wish.

     Very few people knew. Dr Robert Marr, a spokesman for the
     Coalition of Organisations for Voluntary Euthanasia, was made
     aware and wanted Nitschke to take the precaution of videotaping a
     final request from the patient in case of legal repercussions.
     Dent declined, preferring to make his written statement.

     "There are two issues here," says Nitschke. "What do I think about
     it? Am I worried about he ethics in what I'm doing? The answer's
     no. Am I worried about the risk to myself, the fear of
     consequences? No, not really.

     "God almighty, Christ. There are risks you take in this world, but
     this is not one of them. This bullshit about retrospective legal
     penalty. Come on. Compare that with the risks that Jack Kevorkian
     has been taking [in America] - that's dangerous. This is not an
     act of bravery."

     Nitschke says that in his "more cynical moments, I think this law
     was designed so no-one could ever use it".

     "I think they wanted to accept the international kudos for the
     piece of legislation but, at the same time, setting the bar so
     high that no-one could ever use it. Then, we could quietly repeal
     it. I guess they are a bit surprised that someone was actually
     able to fit the exhaustive criteria and use this act.

     "This patient has described that he's been searching for a miracle
     for five years. I agree with him. It was a miracle."

----------------------------------------


     TRIUMPH OVER THE ETERNAL FOE

     By LEONIE LAMONT

     IT is a momentous time for Australia's voluntary euthanasia
     groups, the pinnacle of their ambitions coming with the death of a
     man who took a computer-assisted lethal injection in Darwin.

     While the president of the Northern Territory Voluntary Euthanasia
     Society, Lynda Cracknell, said that the organisation "operates
     about one level removed from the patient-doctor exercise", the
     national VES network had helped facilitate his death.

     Cracknell confirmed that Bob Dent had been a member of the
     100-strong NT branch, set up a year ago after the NT Parliament
     passed the Rights of the Terminally Ill Act. "We operate on a
     shoestring and we don't have the finances to do anything dramatic,
     like support an individual, and nor do we do have the charter,"
     she said.

     However, the national VES network paid for a Sydney psychiatrist,
     Dr John Ellard, to go to the Territory to examine the man and
     fulfil the requirements for euthanasia.

     Dr Robert Marr, a spokesman for the Coalition of Organisations for
     Voluntary Euthanasia (COVE), said: "It was extremely courageous of
     Dr Ellard and the other two doctors to really do what a doctor
     should be doing, and that is putting the interest of the patient
     ahead of their own interests.

     "Certainly, Dr Ellard didn't charge a fee. He took time out to go
     there. We felt it was fair enough for everybody to share his costs
     to get him up there. We didn't think it was appropriate the dying
     patient should have to pay out of their own pocket."

     The death, coming just before the contentious bill by the Liberal
     backbencher Kevin Andrews to override Territory powers to
     legislate on euthanasia, is a blow to anti-euthanasia forces.

     "I would say it would give them cause for pause," said Tony
     Wright, the NSW president of VES.

     "It's been shown to work - and work effectively - in a humane way.

     "The person has made a free choice, which has been backed up by a
     system that works, and enables a person to end their life in
     dignity, with their family around them, in a humane way."

     Had the VES movement overstepped its lobbying role by financially
     facilitating death?

     "We have given donations to various sister organisations, or
     people who have interests similar to ourselves, and this would be
     an instance where we have helped out," he said.

     "We are following our aims, as it were.

     "Although lobbying is our main tool, our main objective at the end
     of the day is to see legalised opportunity for free choice in the
     end-of-life situation."

     As for the nation, Wright says it is only a matter of time before
     other States and Territories introduce euthanasia bills, with
     safeguards, putting power into the hands of patients.

     Its main fight, he says, is nobbling the Andrews bill, and wise
     eyes should look to the Senate.

 ----------------------------------------


     ALL TALK BUT NO ACTION

     By DAVID HUMPHRIES

     Euthanasia will be debated in the NSW Parliament on October 16 but
     there will be no vote and no resolution, the Premier said
     yesterday.

     Ruling out support for pro-euthanasia legislation because "no bill
     could deal adequately with the complexity and profundity of the
     issues involved", Mr Carr said MPs would be restricted to 10
     minutes' speaking time each and "two eminent members of the
     community" would address the Parliament on the pros and cons.

     "There will be no vote," Mr Carr told Parliament. "The forthcoming
     debate will give an opportunity for members of the community to
     present their views to parliamentarians and for members [MPs] to
     place on the record their own views."

     The Coalition made clear its opposition to euthanasia laws.

   * The Herald yesterday wrongly reported that the Liberal backbench
     MP Mr Jeremy Kinross was planning a private member's bill in
     support of euthanasia. Mr Kinross announced last April he would
     not proceed with such legislation.

------------------------------------------

     SIGNATURE THAT SIGNED AWAY A LIFE

     By RICHARD GUILLIATT

     John Ellard, the psychiatrist who helped authorise the world's
     first legally sanctioned euthanasia death, has long embraced
     thorny social issues and their attendant controversies.

     At 72, Ellard is an iconoclastic figure in a profession that
     normally avoids public scrutiny. An outspoken critic of the
     ethical lapses of some doctors, he has also publicly advocated
     political causes such as drug decriminalisation and the banning of
     guns.

     It transpires that euthanasia is another issue Ellard feels
     strongly about - so strongly that on September 7 he flew from his
     home in Sydney to Darwin, examined a man in his mid-60s with
     terminal cancer, and signed a release form that effectively
     endorsed the man's wish to die. No psychiatrist in Darwin was
     prepared to take such action.

     Up to that point, many of Ellard's colleagues and acquaintances
     were unaware of his views on euthanasia.

     "He's never discussed volun tary euthanasia with me, and I know
     him very well," says Professor Peter Baume, the patron of the
     Voluntary Euthanasia Society and a former colleague of Ellard's.
     "In other words, he runs his own life."

     Ellard's actions are all the more intriguing, says Baume, because
     his religion opposes euthanasia.

     "He is, as it happens, a Buddhist, but his own religious views are
     his own and he accepts other religious views. He lives his own
     life and he expects others to be allowed to do the same ... I
     suspect that he objects to third parties telling people how to run
     their lives."

     Ellard entered the medical profession after serving in the armed
     forces during World War II. Educated at Sydney University, he
     practised at Royal North Shore Hospital from 1952 to 1972, a
     period in which he also served in Vietnam, was a consultant
     psychiatrist to the RAAF and a member of Sydney University's Board
     of Studies.

     From the mid-1970s he was influential in psychiatry's pro
     fessional bodies, becoming chairman of the board of accreditation
     of the Royal Australian and New Zealand College of Psychiatry
     (RANZCP) and helping conduct an inquiry into psychosurgery. Since
     then he has often spoken out on ethical issues, criticising sexual
     misconduct among medical practitioners and faddish psychotherapy
     techniques.

     Unlike many medical practitioners, Ellard supported the work of
     the NSW Health Care Complaints Commission (HCCC), even when
     psychiatrists in his own practice in northern Sydney were
     investigated by the HCCC. Last year he publicly condemned a
     colleague, Dr Hugh Jolly, who was disciplined after admitting to a
     sexual relationship with one of his patients.

     "Ten years ago John was seen as very different because he had a
     sense of very high ethical duty," says Merrilyn Walton, the head
     of the HCCC.

     "He has been very supportive of this complaints unit when it has
     been accused of doctor-bashing."

     One of the psychiatrists who worked in Ellard's practice, Dr
     Alexander Macfie, resigned earlier this year after a complaint was
     made to the College of Psychiatry about alleged sexual misconduct.

     Ellard's influence has been heightened by his willingness to speak
     frankly and write accessibly. His 1989 book, Some Rules For
     Killing People, took its title from an essay that criticised the
     "abuse excuse" which enables murderers to claim diminished
     responsibility for their actions because of childhood abuse. Among
     his 100 published papers is a parody of psychiatric literature,
     which purports to measure the relative benefits of talking to a
     parrot as opposed to talking to a psychotherapist.

     "John is one of the truly important figures in Australian
     psychiatry and has been for many years," says Dr Jonathan
     Phillips, the chairman of the fellowships board of the RANZCP and
     a former psychiatrist at The Ellard Practice. "I think within John
     there's a deep sense of social justice."

     Uncharacteristically, Ellard was silent on that issue yesterday,
     confining his comments to a one-paragraph statement which said he
     had "no hesitation" in signing the documents that permitted Dr
     Philip Nitschke to help his patient commit suicide.

     "That's John," says Walton. "He will be committed to his
     principles and act them out."

--------------------------------------------------------

     WHY I WANT TO DIE

    A personal statement  By BOB DENT

     I WAS diagnosed with prostate cancer late in 1991. In December I
     was sent to a specialist urologist in Brisbane for a bone scan and
     possible prostatectomy (removal of prostate gland). Before such a
     difficult procedure could be performed, it was necessary to check
     the lymph nodes in the groin area to see if the cancer had spread
     out of the prostate.

     An incision was made across my lower abdomen from hipbone to
     hipbone and several lymph nodes were removed. They were all
     cancerous. It was now too late to remove the prostate and,
     instead, both testicles were removed. The incision was sewn up,
     but two days later a large hematoma (blood clot) developed at the
     right-hand end of the incision. I had then to return to theatre
     for the incision to be recut and sewn. My bone scan at this stage
     was inconclusive so I was sent back to Darwin hoping that the
     removal of my testicles and consequent loss of testosterone
     production would stop the cancer progressing. Unfortunately, this
     also made me impotent (I had been told that impotency was a remote
     possibility).

     Six months later, a hernia developed under the same right-hand end
     of the hematoma. Darwin specialist surgeon Mr Dan Campbell
     repaired the hernia, but one year later it popped out again. Mr
     Campbell did a second repair job on the hernia and again, one year
     later, it recurred. Mr Campbell was apprehensive about attempting
     a third repair on the same site. I approached another specialist
     surgeon, Mr Jonathon Wardill, but he took one look and declined to
     even consider such a repair. Fortunately, a plastic and
     reconstructive surgeon, Mr Chandra Arianayagam, agreed to do the
     job and this repair is still holding.

     By mid-1995, I was having difficulty urinating as the cancer in
     the prostate gland had closed off the urethra. I had to have a
     catheter inserted in order to empty my bladder. I continued with
     daily self-catheterisation until the passage closed right over. An
     indwelling catheter and leg bag was the next step. In August 1995,
     a trans-urethral resection of the prostate (TURP) was done by a
     Perth urologist to chip away the cancer and reopen the urethra so
     that I did not have to use the catheter and leg bag to collect the
     urine. By May 1996, the urethra had once again become blocked and
     I again had to make use of a catheter and leg bag - an
     embarrassing and uncomfortable situation, especially in Darwin's
     climate.

     In June 1996, I had another TURP and this operation worked
     reasonably well, but the rest of my body was deteriorating
     quickly.

     I have lost 25kg in weight. My latest blood tests, taken on
     (2/9/96, indicated an acceleration of the cancer, with the
     prostatic specific antigen rising to 1,298 (normal is 0 to 4). The
     red cell picture was suggestive of infiltration of the bone marrow
     by the cancer. This was confirmed by chest X-ray.

     The full results of these tests were withheld from me by Dr Guy
     Bannick of palliative care. I have always wanted to know
     everything, the bad news as well as the good. I could easily have
     broken some of my ribs by allowing myself to be hugged and surely
     should have been warned of this.

     Dr Philip Nitschke, my after-hours doctor, requested a copy of the
     X-ray report from the Darwin Hospital for me. The X-ray also
     revealed an area of collapsed lung which could have been
     contributing to my breathing distress.

     Two specialists, Mr Wardill, who performed the 1996 TURP, and Dr
     Sid Selva, oncologist, have both said nothing further can be done.
     (I did have three months' hormonal therapy supervised by Dr Selva
     but the cancer is hormone-resistant and was not slowed by this
     treatment.) Already my urine flow is diminishing. Further TURPs
     are not advisable, even if my weakened body could tolerate a
     general anaesthetic. I have no wish for further experimentation by
     the palliative care people in their efforts to control my pain. My
     current program involves taking 30 tablets a day!

     For months I have been on a roller-coaster of pain made worse by
     the unwanted side effects of the drugs. Morphine causes
     constipation - laxatives taken work erratically, often resulting
     in loss of bowel control in the middle of the night. I have to
     have a rubber sheet on my bed, like a child who is not yet
     toilet-trained. Other drugs given to enhance the pain-relieving
     effects of the morphine have caused me to feel suicidal to the
     point that I would have blown my head off if I had had a gun.

     I can do little for myself, and require 24-hour nursing care. My
     hemoglobin has fallen to 8.3 (normal is 13.5 to 18.5). My red
     cells are decreased in number and deformed because of the cancer
     in the bone marrow. This anaemia causes shortness of breath and
     fainting because of the cells' inability to carry the required
     oxygen. An attempt was made to alleviate the symptoms of the
     anaemia by giving me two units of a healthy person's blood. The
     procedure took all day, was uncomfortable, and did no good
     whatsoever.

     There is now a constant fear of a fall, which could cause terrible
     injury to my fragile bones. I cannot even get a hug in case my
     ribs crack.

     My own pain is made worse by watching my wife suffering as she
     cares for me: bathing and drying me, cleaning up after my
     "accidents" in the middle of the night, and watching my body fade
     away. If I were to keep a pet animal in the same condition I am
     in, I would be prosecuted. I have always been an active, outgoing
     person, and being unable to live a normal life causes much mental
     and psychological pain, which can never be relieved by medication.

     I read with increasing horror newspaper stories of Kevin Andrews'
     attempt to overturn the most compassionate piece of legislation in
     the world. (Actually, my wife has to read the newspaper stories to
     me as I can no longer focus my eyes.) The Church and State must
     remain separate. What right has anyone, because of their own
     religious faith (to which I don't subscribe), to demand that I
     behave according to their rules until some omniscient doctor
     decides that I must have had enough and goes ahead and increases
     my morphine until I die? If you disagree with voluntary
     euthanasia, then don't use it, but don't deny me the right to use
     it if and when I want to.

     I am immensely grateful that I have had the opportunity to use the
     Rights of the Terminally Ill Act to ask my doctor, Philip
     Nitschke, to assist me to relieve this interminable suffering and
     to end my life in a dignified and compassionate manner.

     I did want to write this statement in my own hand, but the
     weakened state of my body makes this impossible. It has been
     dictated by me and written down by my wife.

     Darwin, 21/9/96

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