Dr Rodney Syme Challenges Police To Arrest Him

Nov. 5 2007

The polls say most Australians favour it, but the law calls euthanasia a serious offence. One outspoken doctor, however, is prepared to give dying patients the knowledge and wherewithal to put an end to their suffering. And he's not afraid of the police or the AMA.

Rodney Syme's phone number is hot. Shane Warne and Nicole Kidman probably don't have it, but one day they just might kill for it. Syme is the Melbourne doctor whom those in the know - and sometimes this includes his medical colleagues - turn to when they or someone they love is facing a painful and lingering death.

Syme has arguably helped more incurably ill and suffering Australians die than any other person, including that more flamboyant euthanasia advocate, Philip Nitschke.

In an exclusive interview with The Bulletin, Syme goes further than any Australian doctor before in publicly detailing the extent of his role in mercy killings. Why now? Perhaps because there is a federal election and this long-time voluntary euthanasia campaigner would like our politicians to at least acknowledge the issue. And the Australian Medical Association has just voted - with no publicity - on a new policy, on the role of the medical practitioner in end-of-life-care, that effectively sidelines euthanasia as an issue.

Not all doctors agree with the AMA's anti-euthanasia position. A letter signed by 29 Australian GPs and specialists urges the association to adopt a neutral position on physician-assisted suicide. Syme is trying to provoke some action or a public discussion about the issue. Even if he gets himself arrested. "I'm not doing it quietly any more," he declares. He has already told the Victoria Police of his part in the death of cancer sufferer Steve Guest, the 58-year-old former Cain Labor government staffer who fatally overdosed in 2005 just weeks after making a public plea for legalised voluntary euthanasia (see page 32).

The police brief of evidence is now with Victoria's State Coroner and a decision is pending on whether or not a public or closed inquest is to be held. The smart money says it will be done behind closed doors with no opportunity for people like Syme or Guest's brothers, John and Andrew, to thump the drum for voluntary euthanasia.

It is understood the coroner has been told that traces of the barbiturate Nembutal were found in Steve Guest's blood. Syme admits he provided him with advice and medication and was, according to John Guest, at Steven's home on the day he died. Now he's daring the police to arrest him, with an admission to The Bulletin that he has provided "advice and medication" to another Victorian man, 76-year-old Peter Hammond, who was diagnosed in February with motor neurone disease.

Says Syme: "I provided Steve Guest with the advice and medication and I have done the same with Peter Hammond. I intend to keep on talking and acting in good medical faith and the authorities can jolly well come and get me."

It is illegal in all states and territories in Australia to "aid or abet" the act of suicide and in Victoria, where Syme lives and practises, he could go to jail for up to 14 years. Whether providing advice constitutes aiding or abetting is yet to be determined by a court.

Syme admits to having prescribed morphine and sedatives "numerous times" to patients over the years. His defence, if ever he were charged, would be that he had no idea they were going to overdose. "I've sailed close to the wind, no doubt about it, but the law is hypocritical and I'm not the only doctor who is operating in this murky terrain. It's just that I'm prepared to say so publicly."

Syme is not obvious like Nitschke. There's no off-the-top-of-the-head stuff about legalised euthanasia for depressives and prisoners serving life terms. No secret potions for peaceful pills and, most significantly for his " special" patients, less scrutiny. As just one of the many people interviewed remarked: "Rodney doesn't have to put people on planes and send them to Switzerland to die. He is able, very quietly but with absolute efficacy, to give people the help they need right here in Melbourne."

Simply put, this means Syme can get his hands on the good stuff. Nembutal. It's the drug used by vets to put down sick cats and dogs. It was once prescribed as a sleeping pill for humans, but was taken off the market in 1998. It is the "holy grail" for those bent on suicide. It is used at the Swiss euthanasia clinic Dignitas and was the drug Nitschke used in the Northern Territory in 1996 and 1997 for those few months when mercy killing was legal in Australia.

He has always seemed a patient man, willing to plod away at trying to achieve reform of Australian laws that ban euthanasia. Nitschke declared long ago that waiting for political reform was "bloody futile" and reverted to his guerilla war - like the tactics used by his EXIT organisation. The danger for Nitschke, though, is that along the way he can at times come across as a crackpot. Some argue that he has set the euthanasia movement back with some of his stunts. But few accuse Syme of being a whacko. Conservative, yes. Naive, certainly. Provocative - until now, only occasionally.

Admitting publicly that he has, on "numerous occasions", given patients a verbal instruction manual while supplying the drugs or a prescription for morphine and sedatives is undoubtedly provocative. But Syme has faith in the Australian people, who have overwhelmingly and for many years told pollsters they support voluntary euthanasia.

"I am challenging the authorities to say the current law is appropriate and therefore act upon it. The fact is, the law is ignored. If I am forced before a jury I firmly believe I will not be convicted of any wrongdoing."

On one level, Syme seems every bit the Toorak doctor he is. Handsome and distinguished with a well-clipped mane of silver hair, always well shod, he could be mistaken for an establishment gentleman. His medical speciality is urology. Human waterworks. Old men's swollen prostates, women's sagging post-childbirth bladders.

He's saved plenty of patients in his career, and lost a few, and increasingly in the past 15 years helped more than a few - too many to count - to die. And that's what he'd like to be remembered for. The good deaths.

"It's impossible to count them, but in 30 years I've given a lot of people advice and medication," he says. Right now he has at least five people - two with motor neurone disease, a few with cancer and one with chronic heart failure - who he's advising, "and that advice can include a prescription", he says. So far this year he's "counselled" 50 people; "counselling, not specifically advised".

Euphemisms abound in the world of the dying. Some doctors talk to families about "pain relief" when what they really mean is terminal sedation. Some patients ask for "help" when they really want to say: "Give me a lethal shot of something and let me die in peace". Others might just mean, "Stop my suffering and stop the pain". When Rodney Syme refers to "advice", it means information that will help you to die. "Counselling" is not as active

Melbourne writer Pamela Bone describes the faux language in her recently published memoir Bad Hair Days, an account of her life after being diagnosed with incurable cancer. Bone wrote to Syme after her diagnosis to ask for his help. She signed off her email with these words: "I can't talk to my specialist or anyone else about this. I am not depressed. I hope you can help me." And he did. "He gave me what I will call hereafter 'the knowledge'. The knowledge is at the time of writing illegal ... in giving me this, he gave me back the beginnings of my courage."

Not everyone gets the "advice" or "knowledge", but Syme never turns away a person who wants to talk. And he insists that he has referred many people to other specialists - particularly psychiatrists and palliative care doctors. "I try to help people go as far with their lives as possible. I've talked to many people who've taken a bucketful of drugs and survived and I always say, 'Don't do that again'."

At 71, Syme has scaled back his urology practice to allow for more time on the golf course and to concentrate his medical efforts on those his colleagues too often can't or won't help. He recounts, with no small measure of disgust, how a fellow urologist pulled him aside at a conference to ask if he would see a patient of his with terminal prostate cancer. "He wasn't prepared to do anything, but he was happy to send him my way."

Privately, that is. Syme says that during his long presidency of the pro-euthanasia group Dying with Dignity Victoria, he found significant support from politicians, but few would publicly endorse their privately held views. "I won't embarrass people by naming them, but they are there. Jeff Kennett was quite positive when he was in opposition, but when he became premier he suddenly became quite unkeen on talking about it.

"My first advice regarding assisted dying was in 1976." He says he was "rather naive", prescribing a sedative that his patient overdosed on. "A copper rang me up and asked me why I'd prescribed it. It gave me a jolt and I realised that prescribing could be quite hazardous."

Two years earlier, he had witnessed for the first time the true limitations of medicine. For two months he cared for a woman who was dying bit by bit from cancer that had invaded her spine and was causing her excruciating bone and nerve pain. Morphine did not even touch the sides of the pain the woman was enduring. That suffering was something Syme had not witnessed before.

"I'd come into the hospital and hear her crying and I felt utterly helpless. I was ignorant, operating in uncharted waters, but it got me thinking. She didn't say she wanted to die, but she wanted her suffering to end. One thing I did know was that as a doctor, I would not have tolerated it. I had access to the drugs and I would have taken them to escape from that inferno. She unfortunately did not have that option and no one would have dreamt of offering it to her."

His family has been incredibly supportive, but he wonders "whether they realise exactly what I am about". In Australia, two doctors have been charged after patients in their care died from alleged euthanasia. West Australian urologist Daryl Stephens was charged in 2001 with murder and assisting suicide, and was acquitted. A Sydney doctor, Andrew Hollo, was charged with attempted murder and acquitted in 2004.

Police have questioned Syme six times. His most humiliating moment was having his fingerprints taken, but he has been assured since that they have been destroyed. The police have always been courteous in their dealings with him. "I recall one case, terrible: the poor man had lost his wife, was alone in the world and had bladder cancer which had spread to his bones. A real shocker. He didn't want to go on. I prescribed him morphine and sedatives which I knew he might use, but he did have severe pain and trouble sleeping so, you know, it was defensible." The man died and in his suicide note mentioned Syme. "After I gave my statement to the police sergeant at Prahran, he looked up at me and said, 'poor bugger, I would have done the same thing myself'.

Peter Hammond's Story

It was always going to be tough getting to know Peter Hammond. For a start, the acquaintance is destined to be brief. He's not long for this life, living with (or dying from, depending on how one views such matters) one of the cruellest of afflictions: motor neurone disease (MND). It's the diagnosis that leaves even the most battle-hardened doctors staring blankly at their framed medical degree and perhaps pondering that line in their Hippocratic Oath, the one that unequivocally states in one translation: "To please no one will I prescribe a deadly drug nor give advice which may cause his death".

As Hammond says with every ounce of bitterness he can still muster in his ruined voice (his throat muscles have been wasted by MND), it's a bugger of a thing. It's the disease that euthanasia advocates like to cite as Exhibit A. There's no physical pain, just relentlessly progressive paralysis that makes it hard for doctors to prescribe pain relief.

The psychological pain is another matter. Reportedly, one in five MND patients in Holland, where mercy killing is legal, choose to end their lives through euthanasia or doctor-assisted suicide rather than endure a disease that doesn't affect your intellect but does your head in. "My brain is not scrambled and I'm thankful for that, although I can see why some might prefer to be gaga," Hammond says.

"There are no good days; I have an overwhelming feeling that I have nothing left to call on, no appetite for life." Could he be depressed? During our conversation, he cries several times but then, who wouldn't? "Of course I'm sad," he croaks, walking away to compose himself.

His suffering is what euthanasia advocates like Syme and Nitschke describe as existential and psychological. Very real, but impossible to treat with painkillers. Hammond's doctors estimate he has about a year left, probably less as he's being affected from his head down. The muscles in his throat and chest are already severely weakened. He relies on a ventilator at night to help him breathe and, increasingly, is seized by hacking choking fits.

Line up all the moral and ethical arguments in the world against physician-assisted suicide, then try to explain them to someone like Peter Hammond. You can't help but sound like a hollow drum. His wife Mieka, who describes herself as a "tough Dutch cookie", grew up in Holland and watched as both her mother and former father-in-law died with the assistance of their doctors: "Family members had a quiet word, and it was done."

Her husband says he was "quietly horrified" by the seemingly casual approach taken to death by the Dutch. "It seemed too flippant and I was wary and still am of giving doctors too much control. But if a person is in his right mind and his family concur, then people like me should have the final say."

As Rodney Syme has admitted, he has supplied Peter Hammond with his precious "advice" and the medication to follow it. Hammond refers to it as the "blue stuff" and plans, if he has to, to swallow it with a shot of whisky or vodka. His other option - the one his doctor would like to see him take - is palliative care.

"I'll refuse food and water and slowly die unless someone takes pity on me and gives me a decent shot of morphine. But I can't count on that, can I?" he says.

Neither the Hammonds nor Syme want to see the cops raiding the Hammond home, but they do want to push the issue publicly, hence their admissions now. This is unusual. Usually you only find out after the event that someone has a bottle of Nembutal. Or if you are told, it's strictly off the record.

Euthanasia as a political issue is not on the political radar. Don't expect to hear Kevin Rudd or John Howard mention it in this election campaign. Besides, it's a state issue and none of the premiers is keen for a debate. The AMA, as noted, has just voted on a new end-of-life care policy that effectively sidelines the issue. There has been no accompanying publicity. The association's president, Dr Rosanna Capolingua, believes most dying Australians receive good end-of-life care from their doctors. The emphasis on euthanasia in the past decade has derailed the real debate, she argues, and the new AMA policy is squarely aimed at bringing back some much-needed balance.

"Let's be clear," says Capolingua. "Euthanasia is against the law and the AMA does not believe the laws need changing. We remain opposed to physician-assisted suicide and euthanasia."

What the AMA has done is define what constitutes euthanasia and physician-assisted suicide. The new policy makes clear that doctors who decide to discontinue futile treatment or don't administer life-prolonging measures need not fear prosecution. The AMA has stuck to its position that doctors who initiate treatment which has, as a secondary consequence, the effect of hastening death are also protected by law.

The 29 "Doctors for AMA Neutrality on Voluntary Euthanasia" have called on the AMA to abandon its opposition. One of the signatories to the letter, Melbourne GP Dr Simon Benson, says Australians are facing the same situation they confronted in the '60s with the abortion issue. "Everyone knows it's going on but it's swept under the carpet," Benson says. He has a faded, peeling pro-euthanasia sticker on the back window of his car that's been there for years. No one's let his tyres down yet.

"Patients ask me about euthanasia and I say I'll do what I can to help, but not everyone can get on talkback radio like Steve Guest and suddenly find themselves with a bottle of Nembutal. Most people struggle. Life is precious - but so, too, is death."

A Brother's Story

A brave goodbye

Cancer sufferer Steve Guest, 58, died in his home at Point Lonsdale, Victoria, in 2005 after receiving "advice and medication" from Or Rodney Syme. 1 want a pill in the cupboard that 1 can reach for and take to end this nightmare," he had said. His brother JOHN GUEST recalls Steve's final hours.

0n his last day Steve phoned to ask that Andrew (our other brother) and I arrive later than usual because he wanted free time to say his goodbyes to various friends. When we arrived about 2pm Rodney Syme was still with him, but whichever of the locals had dropped in had now gone. Syme went soon afterwards and we were left alone with Steve. No one else came.

A strange afternoon. Three brothers calmly discussing the imminent death of one of them. Superficially normal, with ordinary conversation and the occasional joke, but there must have been a greater tension than was apparent at the time, for I now find that Andrew and I have differing memories of the details. Steve quipped to me when I was in the kitchen getting a coffee or something: 1f you're fossicking about in the pantry, steer clear of the almond essence" - obviously the Nembutal - which Andrew doesn't remember. Maybe he was browsing a book or changing the music at the time.

We both remember Steve crushing a couple of tablets, presumably antihistamines, in a mortar and pestle and Andrew recalls him putting these and some alcohol into his

feeding tube while the three of us were in the living room, with Steve commenting on how quickly he began to feel slightly drunk. I thought much of that was later, when lie was alone in the bedroom. Probably my squeamishness: I had seen him pump gunk into his skeletally emaciated body and felt quite queasy, so perhaps I'd preferred not to watch.

But eventually he went to bed. Ancirew helped him up from his chair and out of the living room - a courtesy rather than a necessity, for he was still capable of walking although rather unsteady on his feet, probably because of the alcohol, and he asked to be left alone.

Some time afterwards he called us and we went in: he asked us to hold his hand and within a couple of minutes he'd drifted off into sleep. We said our farewells, I kissed him, then went back to the living room and filled in time.

Half an hour later, about 9.30, we checked on him and as far as either of us could tell, he was dead. We laid our sleeping bags on the living room floor and to my surprise, I had no trouble sleeping - I was out of it before midnight. It was Tuesday the 26th of July.