Last Rights: Interview With Dr Rodney Syme

Last rights: interview with Dr Rodney Syme, Feb. 7, 2011.

THIS is about you. This is about your death. But this is not morbid. We know death is certain, yet we so often fail to factor it into life, choosing instead to act as if existence is boundless. This can cause waste and regret, and goes to the very question of how to live.

Such collective cognitive dissonance is coupled with another issue: how to die.

Dr Rodney Syme has been helping people die for 35 years. He's done it hundreds of times. Under certain circumstances, he gives terminally ill people the knowledge and means to end suffering that has become intolerable and cannot be relieved other than by dying. That suffering is physical, psychological and existential.

Dr Syme is in The Zone to argue that our laws in this area are flawed and cause unnecessary suffering, and in poll after poll the majority of us agree with him. Our lawmakers have failed to enact change, although there have been a number of attempts, usually through private members bills.

''We should be more kind to ourselves, and we're not. We make death into something that can be terribly brutal and harsh,'' he says. ''It saddens me, frankly, that we can't be more mature in our debate about this matter.''

Syme, a urological surgeon, has for many years been active in Dying With Dignity Victoria; the organisation that seeks legal change to allow physician assisted dying and provides information and other resources (see links below).

By giving people control, Syme is providing some of the most effective palliative care possible. Time and again, he finds empowering people in this way improves the quality of the end of their lives. It makes perfect sense - mitigating the manifold terror that comes with terminal decline allows people to focus. It can restore some confidence and dignity to those whose conditions have stripped them of autonomy, who feel powerless and bereft of hope.

Dr Syme speaks of his experiences years ago with a woman and a man with motor neurone disease, an aggressive paralysing disorder. ''She was extremely distraught and what I learnt from her was that if you entered into a dialogue, an honest, open dialogue with these people, they just said, 'It's just terrific to be able to talk to somebody about how I feel.' And supporting her and giving her medication just had the most profound effect on her remaining life. And I realised the palliative value of having this dialogue and giving people control.

''I then struggled for years with fear. I was interrogated by the police over that because I had written to her and I had actually given her some medication - anti-nausea tablets so she wouldn't vomit when she took other medication.

''I finally reached a compelling conclusion when another man with motor neurone disease wanted assistance. For the first time I provided somebody with barbiturates, which are the ultimate medication, if you like, because if you take a dose of barbiturates of an appropriate nature, you just go to sleep in the most beautiful, peaceful, calm manner, and don't wake up, and die relatively quickly.

''And I did that for him and he died in the bosom of his family.

''You know, we talk about birth rites. I think we should consider more about a death right, or a last right. I think everybody should have the right to die in the company of their family, in peace and dignity and security. We don't have that at present.''

What we do have is what Dr Syme calls a ''benign conspiracy'', the quiet collusion of the medical world to help people in need have some control at the end of their lives.

He has written a book, A Good Death, which explains the evolution of his thoughts and actions. It is clear and powerful and, to my mind, presents an overwhelming, unimpeachable argument.

Before our interview, Dr Syme wrote to me and set out the logical core of his position, the genesis of which came from his conscience - he simply could not walk away from suffering, he said.

''I eventually defined six 'medical givens' or unarguable positions re dying,'' he said:

■ Dying may be associated with intolerable suffering, and there may be a crescendo of suffering as death draws nigh.

■ The doctor's duty is to relieve suffering.

■ Some suffering will only be relieved by death.

■ The doctor's duty is to respect his patient's autonomy.

■ Some patients rationally and persistently request assistance to die.

■ Palliative care cannot relieve all the pain and suffering of dying patients.

''It became clear that my duty as a doctor, taken seriously in conscience, put me in direct conflict with the law, which did not recognise consent (i.e. request) as a defence, and regarded hastening death intentionally, or aiding suicide (quite the wrong word in the circumstances) as a serious crime. As I saw it, there were circumstances where there was a necessity for a doctor to break the law.''

Writing the book was the hardest thing this man, who has seen so much pain and suffering, has had to do, he says.

''I wanted to tell these stories so that people would have an understanding of the context within which these decisions are made. But as I was central to every story, I couldn't do it without exposing myself, also exposing what I was doing. And essentially some people would say that what I'm doing is breaking the law.

''And as I wrote each story, I would look at myself and say, 'Goddammit, what are you bloody doing here? You're an idiot'. And then I'd say, 'No, I think this is something that has to be done'. And so I just kept going.''

Dr Syme is a gentle man. His force lies in his words, not his delivery. He is serene after his long and arduous voyage, and he is confident formalised change will come. But he believes it will probably happen first in the courts, via precedent, rather than in our parliaments, via legislation.

He's going to keep pushing, convinced, now, that the authorities do not want to prosecute him and others like him.

Syme urges people to prepare for their own deaths - it is so much harder to make decisions in a crisis. The Dying With Dignity website gives information on how to do this, including organising a medical power of attorney and completing a refusal-of-treatment certificate.

The full transcript of our interview provides ample evidence for authorities to examine, including fresh details on Rodney Syme's role in the death of Steve Guest, who had terminal cancer that started in his oesophagus. Thus far, he has only ever stated publicly that he had talked to Guest about barbiturates and that he had given him some medication.

''I deliberately have not stated what that medication was. But I have the opportunity to do so and if I do so I think there will be no argument that the authorities have all the information they need to prosecute me.

''They haven't done so, I think, because they realise they would lose the prosecution. I don't think there's a jury in this country that would convict me of a crime for doing what I did with Steve Guest. I don't regard myself as a criminal and I don't think most people would.''

He ends his book thus:

Do not go gentle into that good night
Rage, rage against the dying of the light

''The words of the great Welsh poet Dylan Thomas are wonderful poetry, but bad advice. Anger, frustration and bitterness are bad companions on life's last journey. It is a time for love, friendship and peace.''

By Michael Short, The Zone, The Age