Roy Williams, reviewer

June 30, 2008

Should such people, if they wish it, be provided with the means to end it all? Dr Rodney Syme believes so, passionately.

Author Rodney Syme Genre Society/Politics Publisher Melbourne University Press Pages 320 RRP $32.95

IN 1998, "Jane", a desperate 52-year-old Melbourne woman with advanced multiple sclerosis, dictated a letter to a man she did not know, Dr Rodney Syme. She begged him to "advise and help to end a situation over which I no longer have any control".

Faced with such a plea, what should a doctor do? What should the law permit the doctor to do?

These are the questions posed in Syme's brave and thought-provoking new book. Syme, an eminent urologist and euthanasia advocate, draws upon case studies from his 45-year career. They are harrowing. Most involve people afflicted by one of two conditions: malignant cancer or a chronic and progressive neurological disorder, such as MS, motor neurone disease or paranoid schizophrenia.

For some sufferers, acute physical pain is the least distressing symptom - even worse is the psychological trauma caused by feelings of gross degradation, fear of the future and loss of control. Living hell.

Should such people, if they wish it, be provided with the means to end it all? Syme believes so, passionately. He supports the decriminalisation of euthanasia, if defined as "an action taken by, or at the request of, a rational fully informed individual, whose intention is to be relieved of intolerable and otherwise unrelievable suffering, that hastens death in a dignified manner".

Syme's philosophy is based on two principles: "respect for the autonomy of a suffering person … and the necessity to relieve their suffering". He does not endorse mercy killing, "do-it-yourself" suicide (a la Dr Philip Nitschke) or euthanasia on demand.

Rather he advocates medical supervision of the dying process; careful investigation into whether the patient has treatable depression; second opinions; and consultation with family. Ultimately, the patient alone should decide and - if possible - die by his or her own hand.

Euthanasia ("physician-assisted dying") is to be distinguished from a patient's long-recognised legal right to refuse treatment. It is also to be distinguished from palliative care - the use of high doses of pain-killing drugs and/or strong sedatives to induce unconsciousness. These practices are legal even if incidentally - and foreseeably - they hasten death.

But, Syme says, palliative care can be protracted and "undignified". More efficient is a lethal dose of a fast-acting barbiturate. Does that sound, if macabre, at least necessary and reasonable? Or do hard cases make bad law? The fact remains that euthanasia is illegal in most countries throughout the Western world. The relevant crimes are murder and assisting suicide.

Yet very few doctors in Australia are prosecuted for euthanasia, even though it is quite widely practised. There is, Syme contends, a "benign conspiracy" among police, lawyers, politicians and the medical profession.

Syme regards this situation as intolerably uncertain. He dismisses the alleged "practical" problems of legalisation - vastly increased red tape and bureaucracy, much more frequent litigation, the risk that people will be "pressured" to die by greedy relatives. It seems these arguments are not (yet) borne out by evidence from Holland, Belgium, Switzerland and Oregon, the four jurisdictions where euthanasia is legal. Still, many like me will remain sceptical.

That leaves the moral arguments. Syme asserts upfront that he "deliberately avoided discussing the role of religion in this matter" because it has "no place in where we ought to go". Even so, his use of the word "ought" betrays the fact that this is - unavoidably and quintessentially - a moral issue over which conscientious people will differ.

"Jane", the woman with MS who wrote to Syme, had a devoted sister. The heavy burden of caring for Jane had fallen to her yet she wanted Jane to continue living. Understandably, though in my view regrettably, Jane was permitted to choose death.

http://www.smh.com.au/news/book-reviews/a-good-death/2008/06/30/121467792 3070.html