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24th Jan 17

Dr Rodney Syme response to article in the Australian

An article titled 'VCAT's Syme verdict crucial to euthanasia debate' appeared in The Australian recently, wherein Bernadette Tobin voiced her criticism of the VCAT ruling on Dr Rodney Syme. Below is his response to Ms Tobin's article and the three main points that she raised in it:  

In his own words: Dr Rodney Syme

It is not surprising the ‘cradle catholic’ and Catholic ethicist and philosopher Bernadette Tobin should be disturbed by the VCAT decision regarding AHPRA’s instruction to me ‘not to engage in the provision of any medical care .... that has the primary purpose of ending a person’s life’.  It did so because it believed I was a ‘serious risk to persons’, who were not named, except for Bernard Erica.  Dr Rodney Syme with Berndard Erica

It was Bernard’s communication to his GP that I had committed to supply him with nembutal that led to AHPRA’s intervention.  In his affidavit to VCAT, Bernard stated ‘I certainly am not at risk from Dr Syme – in fact, quite the contrary’, and ‘The effect of his support and advice has been extremely valuable’.

I had acknowledged to AHPRA and VCAT that I had provided Nembutal to a small number of patients during 25 years of end of life counselling of over 1700 people. I had consistently argued to the Immediate Action Committee of the Medical Board of Victoria, to AHPRA and to VCAT that my primary purpose in such action was to provide palliation of the psychological and existential suffering of people with both terminal and advanced incurable illnesses, by providing them with control over the end of their life.

Expert palliative care witnesses Professor Ian Maddocks and Dr Roger Hunt confirmed this palliative effect, and acknowledged a place for such practice in current palliative care, were it not for the law.  They both acknowledged that, in certain circumstances, death can be a benefit, not a harm, since some suffering will only be relieved by death. VCAT agreed.

VCAT reached some important conclusions, which challenge the conventional view of medical practice at the end of life. It found that ‘Dr Syme’s intention in either promising to provide and subsequently actually provide Nembutal is not for the primary purpose of ending that patient’s life’, and that ‘there is a logical analogy between the principle of double effect used in palliative care, and the prospect that a patient may elect to ingest Nembutal, the latter effectively representing the same kind of secondary effect as the hastening of death ...as when terminal sedation is used. The only real difference is one of timing’.

Tobin states that the VCAT decision ‘misconstrues longstanding legal and ethical principles’. The history of ethics is one of constant change, and nothing has changed modern ethics more than recognition of the principle of autonomy.    

Double effect, originally a religious doctrine dating from the 14th century, was given legal effect in an extraordinary decision by Justice Devlin in the UK in 1957. Despite UK law maintaining that all were equal under the law (doctors having no special defence), and that it did not matter’ by how much or how little death was hastened, or intended to be hastened’, Devlin stated that ‘the giving of drugs to an elderly person to alleviate pain was lawful even if incidentally it shortened the patient’s life’.  

This much criticised paradoxical decision has provided doctors with a vague ‘special defence’, but not adequate to allow doctors to provide maximum relief of pain and suffering, if requested, and if that necessity existed.

One wonders if Tobin has read the report of the Victorian Parliamentary inquiry into end of life choices on which the government is basing its decision to introduce legislation for assisted dying. 

That report specifically recommended that a doctor could only respond to a request for assistance by the provision of medication for self administration. In addition written documentation of the request for assistance is necessary. Tobin’s allegation that a doctor could ‘decide to provide euthanasia to someone who hadn’t asked for it’ is fear-mongering at its worst.

Tobin’s closing statement – ‘access to state-sanctioned assistance in suicide endangers the weak, the fragile and the elderly’ – is not validated by any earlier argument; it is further ‘dog-whistling’. The evidence from the Netherlands and Switzerland, analysed by the Supreme Court of Canada shows that careful law actually protects these so-called ‘vulnerable people’. 

- Dr Rodney Syme, Vice President Dying With Dignity Victoria.

Not happy with some of Bernadette Tobin's remarks? send a letter to the editor of The Australia: letters@theaustralian.com.au