How Australia's Northern Territory led the way on assisted dying

Before Oregon, the Netherlands and Belgium passed pro-assisted dying legislation, there was Australia's Northern Territory (population: 244,000 in 2014). As Dr. David Amies describes in his latest column, the Territory's 1995 law was before its time and was quickly de-fanged by the national government in Canberra. But pioneering efforts in the Outback inspired supporters of compassion and choice worldwide — and laid a groundwork for change in Australia that is still in the process of being realized today.

In 1995, the Northern Territory Government, under the leadership of Chief Minister Marshall Perron, introduced the Rights of the Terminally Ill bill. It became law that year. The bill was opposed by the Australian Medical Association and the local catholic bishop. Chief Minister Perron was a staunch advocate of the legislation because he had stood by, helplessly, watching his mother die slowly from metastatic cancer.

The new law enabled the terminally ill to access medically assisted dying through the procurement of lethal drugs that they could self-administer or have the assistance of their personal physician. Certain conditions were required. The applicant had to be of sound mind and over the age of 18. Three doctors, one of whom had to be a specialist, were required to certify, in writing, that the patient knew what he or she wanted and that they were acting spontaneously and freely. The field of the specialist was not specified, oddly enough. Once the paperwork was assembled, a nine-day waiting period had to be observed.

Altogether four people took advantage of the law before the federal government in Canberra passed a bill in the House of Commons that de-fanged the Territory legislation. Consequently, it became illegal for further assisted dying to go ahead. Two other persons had successfully completed their applications for assisted death but were thwarted by changes to the law and left dangling.

The Bishop of Darwin, Edmund John Patrick Collins, AKA Bishop Ted, campaigned vigorously against the introduction of the law and likened physician assisted suicide to murder. Kevin Andrews, a federal MP and staunch Catholic, introduced the bill in Australia's House of Commons that essentially overturned the local legislation.

Unlikely pioneers

It is rather remarkable that an out of the way corner of Australia became the pioneer in the field of physician assisted dying. A constitutional quirk in Australian law enabled the federal government to quash local law. The Northern Territory is not fully independent of the central government in the same way the Yukon and the North West Territories in Canada are not. Had a similar bill been enacted in one of the Australian states, the central government would have been powerless to overturn it.

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The rustic beauty of Australia's Northern Territory. (Toby Hudson/Wikipedia)

Another unlikely pioneer from the Northern Territory was Dr. Philip Nitschke, a Darwin general practitioner, who invented a computer driven machine that people could use to administer intravenous drugs to bring about their deaths. He was the first medical practitioner anywhere to carry out euthanasia. After the demise of the legislation, he went on to found Exit International, an organisation that gave help and advice to those who wished to end their lives in face of terminal illness. He was and remains a thorn in the flesh of the Australian medical profession. In 2014, his license to practise was suspended. He was able to get that decision reversed by the Supreme Court of the Northern Territory in 2015.

Powerful opposition

Also interesting but hardly surprising was the resistance shown by the Australian Medical Association (AMA) and the Catholic Church. The AMA held that it was not the role of the doctor to go about deliberately bringing the lives of patients to an end. Remember this legislation was enacted 20 years ago. The AMA’s opposition overlooked the fact that many doctors had informally eased the passing of the sick by means of knowingly increasing the dosage of pain killers, accepting that such increase could cause respiratory depression and a consequently increased likelihood of death. The accepted, comforting, medical myth was that such manoeuvres were not primarily intended to end life but to ease suffering: a nice little piece of casuistry! Actual legislation to bring such matters into the open seemed to be a step too far. Organised medicine's view has since softened.

The Church held that a person’s life could only be determined by God. Consequently, attempts by mere man to order matters differently had to be considered impertinent, even blasphemous. Unlike the evolution of medical thinking in the matter, I am not certain that the Church’s view has moved on.

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Dr. David Amies, of Lethbridge, Alta.

In any case, the pioneering work by the Northern Territory was quashed and several years had to pass before countries like the Netherlands, Belgium and Luxembourg and states such as Oregon and Washington introduced their own laws. Assisted dying is on the political agenda of several other advanced states. Bills have been introduced into the House of Lords in the U.K. Discussions about how matters should progress are advanced in Canada. The question bubbles below the surface in Australia, once again. It does appear that by the end of this decade, the right of a sufferer to determine the duration of his or her life will be well established across the developed world and arguments about the rights and the wrongs and the details will seem quaint.

Dr. David Amies is a retired doctor in Lethbridge, Alta., and a member of DWD Canada's Physicians Advisory Council.


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