RED JOS

26 FEBRUARY 2013

Euthanasia letter in The Age 26 FEBRUARY 2013:

YES, Joan Child was a wonderful, inspirational woman. But why must Julia Gillard say she is ''deeply saddened'' by her death, which is elsewhere described as ''a great loss''? It's reported that Child died peacefully at the age of 91. To me this was an enviable ending to her remarkable life and a cause for gladness and celebration.

The pernicious politically correct language of public leaders when it comes to death and dying feeds the great fallacy that death is always a tragedy, whatever the age or quality of life of the person doing it. It supports the lack of political will to accede to the growing demand from Australian citizens that the issue of safeguarded voluntary euthanasia be investigated.

We're not all going to die peacefully in our 90s. But it would be good to think we could die peacefully at our time of choosing, with the support of society and the law.

27 FEBRUARY 2013

Euthanasia letters in The Age:

JUSTICE Betty King did the best she could within a system that needs to be changed (''Court shows mercy in attempted murder case'', 26/2) and I applaud her; Heinz Karl Klinkermann didn't deserve to go to jail but my heart goes out to him.

Caring for a terminally ill person who you love, and who is going to become a vegetable before death arrives, is the hardest thing one can do. I sat down with my wife while she still had all her marbles and we came to complete agreement. One of my promises was that I would never put her in a nursing home unless I was incapable of caring for her. However, I did succumb to persuasion that she should stay permanently in Bethlehem Hospital, where she lived for 15 months before her God finally called her to him.

Staff at the hospital were very good but they could never care for her as well as I did at home, where she loved to be. It has been nearly 10 years but it still hurts when I think about those 15 months.

Of course Klinkermann was wrong - but people like him should be treated within a more understanding system. The fact that he was prosecuted at all is beyond belief.

BETTY King identifies exactly what is wrong with the lack of any choice-in-dying law for the terminally ill: ''To keep an animal alive in the precarious health circumstances of some of those in palliative care may well lead to charges of cruelty.'' Recognition of this truth leads to the law being mocked: judges hand down very light sentences which acknowledge that attempting to alleviate cruelty to a dying person should not be punished. This area needs urgent legal reform.

HOW terribly sad. Heinz Klinkermann tried to help his wife by ending her life, but has had the most terrible sentence imposed, in that he is no longer allowed to see her. How extraordinarily cruel for them both. He didn't want to live without her and she, never wanting to be in a nursing home, is now stuck in one until the end, unable to see the one who cared for her the most.

WHEN next we vote as Victorians perhaps we should consider the religious association of those putting themselves forward for election. The humanitarian concerns of the electorate, in relation to terminally ill patients in relentless pain, are blatantly ignored by the majority of our conservative parliamentarians, blinded apparently by unswerving adherence to religious dogma. And yet the same politicians would not condone cruelty to animals in like circumstances.

With the Tasmanian Parliament considering the possibility of legislation to give credence to the option of voluntary assisted dying, we Victorians, who are now living in the ''state of apathy'', should take more care to elect people who are willing to help us realise our reasonable expectations in this and other matters.

4 MARCH 2013

Euthanasia letters in The Age:

Thanks for publishing letters recently exposing some problems facing families with terminally ill members. We all aspire to die with dignity, but it is extremely difficult to achieve.

My wife has a rare neurological condition that will cause progressive loss of functions to the point where she will be bedridden and totally dependent. Critically, her brain will remain active. For her to maintain any semblance of dignity will be difficult, if not impossible.

In just seven months she has gone from being a fully capable, caring person to being unable to read, dress herself or walk without a frame. As a family we have discussed bringing forward her death so she doesn't suffer perhaps years of living without hope or dignity. We are agreed this should happen, but how? Even getting advice is difficult.

Our GP is constrained legally and perhaps by the Hippocratic Oath. I an unwilling to involve him so as not to put him in a potentially hazardous situation. The church has also failed its congregation in this area.

I believe I will likely assist my wife die with dignity, but without professional help it is unlikely I will achieve the best result at an appropriate time. I know I'm not alone in working through this problem and I sincerely hope the letters will lead to an open, understanding discussion about a problem that concerns many.

Patricia Edgar presents a timely reminder that our health system spends most of the resources at its disposal on people in their last year of life (Comment, 28/2). Others have highlighted the need for doctors to better educate patients about the Medical Treatment Act and appointment of medical power of attorney.

A US study showed that a group of elderly people who were educated compared with a similar group who were not on the issue of appointing a medical power of attorney did not take up this option any more frequently.

We are a death-denying society and seem not to want to have any discourse, public or private, about end-of-life treatment. It is not easy to hand over, even to a loved one, decisions about withdrawing life-sustaining treatment. Doctors are thus in a difficult position: criticised on the one hand for providing expensive, life-prolonging treatments and on the other enduring the threat of claims of negligence. I have made a medical power of attorney for myself. Have you?

As an emergency physician and medical practitioner in my 30th year of clinical work, I disagree with Dr Stephen Rodgers-Wilson (Letters, 1/3) that emergency physicians reinforce the unrealistic expectations of patients and their family members. Health professionals in emergency departments are frequently the first to discuss advanced care planning and end-of-life care.

2 APRIL 2013

Euthanasia articles and letters in The Age:

Beverley Broadbent was not depressed or suffering from a terminal illness when she took her life.

Beverley Broadbent was not dying of a terminal illness, nor was she depressed or unhappy. But at 83, she wanted to die.

After living a rich and satisfying life, the Brighton East woman said the ageing process had come to feel like a disease that was robbing her of her physical and mental fitness. In February, she said she had had enough.

''I look well and I walk well so people think I'm fine. But I have so many things wrong with me,'' she said. ''The balance is gone. It's taking so much time for me to keep fit to enjoy myself that there's not enough time to enjoy myself.''

In several interviews with Fairfax Media, Ms Broadbent said she planned to take her own life so she could have a peaceful, dignified death. She said she did not want her health to deteriorate to the point where she had dementia or found herself in a nursing home with no way out.

The environmental activist chose to tell her story because she believed many elderly people wanted to die when they felt their life was complete, but lacked the means to go gently.

''I can't understand why people who really want to can't have the means to go with the help of a doctor in a dignified manner at the time that they choose,'' she said.

''They are not asking anybody else to do it, they don't want to pressure anyone else to do it, they just want to have the right to do what I'm doing. I hope people can

see how sensible it is and that I'm not stupid, I'm not depressed, I'm not sad. I'm having a good life that I'm enjoying right to the last minute.''

Ms Broadbent said she had acquired some barbiturates - the drugs euthanasia advocates call the ''peaceful pill'' - and planned to take them when the time was right.

She died at home in her bed on February 11.

When she explained her choice, Ms Broadbent said her fear of deteriorating to the point where she would be unable to end her life made her want to go sooner rather than later. She said if physician-assisted suicide was legal, she might have pushed on knowing she could end her life at any time.

''I can't wait, I can't take the risk,'' she said.

Her story comes as the Coroners Court of Victoria launches an investigation into suicide to establish how common it is and what factors are driving it. In recent years, the court has seen an increasing number of cases in which people have made apparently rational decisions to end their lives because they were suffering a chronic or terminal illness.

Euthanasia campaigner Rodney Syme, who met Ms Broadbent several times before her death, said he believed she had not been depressed and had made a choice that many other elderly people would like to emulate.

He said an increasing number of older people were contacting him on the issue. Many wanted to avoid nursing homes.

Although polls show about 80 per cent of Australians support voluntary euthanasia for people with a terminal illness, Dr Syme said the question of elderly people being given the right to die had not been publicly debated in Australia.

This was despite the fact that many elderly people were severely disabled and experiencing great suffering on a par with that caused by cancer or other painful diseases, he said.

''Unfortunately, often people in Bev's situation who do try to talk about these things are patronised by their family, who say: 'Don't talk like that gran, no, no, no, you're all right.' They are put down and patronised, no one gives them a voice,'' he said.

''I think it's an issue for which a lot of people probably have very quiet and hidden opinions. It's an issue which is going to assume greater and greater importance and it's about time the community started to debate it in a logical way.''

But Dr Katrina Haller, senior executive officer of Right to Life Australia, said Ms Broadbent's story exacerbated her concern that elderly people were increasingly being viewed as a burden when they should be valued, supported and not ''dumped in old people's homes''.

She said increasing discussion about elderly people taking up too many hospital beds, for example, could be encouraging suicide when the community was spending a large amount of money trying to prevent people taking their own lives.

''Elderly people can be coerced into feeling they are a burden on their family and their friends and the medical staff at hospital - and hospitals have other agendas, don't they? They want to free up beds and minimise the money spent on people,'' she said.

Dr Haller said that although Ms Broadbent's story was an emotional one and might be hard to argue with, it did not amount to a case for legalising physician-assisted suicide, which would create a culture of death and turn doctors into killers.

She said legislating a right for elderly people to die would inevitably start a debate about others, including people with dementia and children with disabilities.

''Where do you draw the line? … In Belgium and the Netherlands [where euthanasia is legal for some people] the door gets opened a bit wider as years go by,'' she said.

For help or information call Suicide Helpline Victoria on 1300 651 251 or Lifeline on 131 114, or visit beyondblue.org.au

By her own account, Beverley Broadbent had lived a wonderful, fulfilling life. But she decided she'd had enough and it was time to go.

Beverley Broadbent was not depressed or suffering from a terminal illness when she took her life.

Beverley Broadbent had observed many deaths before she planned her own. When she was just six years old, her mother died of heart failure at 36, leaving her alone with her devastated father. It was a swift but cruel death that came too soon for the family of three.

Later, when she was in her 30s, she helped nurse her 100-year-old grandmother until the end. It was a difficult, long decline for a woman who in her youth had been a feisty activist with the Temperance Society.

''Why am I here?'' she kept asking her granddaughter as doctors kept treating her various ailments.

Then, when she was 50, there was the anonymous man who called her one day while she was working as a counsellor for Lifeline. He had taken a drug overdose and wanted to talk to someone as he lost consciousness. While Beverley had been taught not to judge people in such circumstances and be there for the caller, she was alarmed to realise there was a young child with the man.

''It seemed wrong that a child should be left to deal with this and so the two of us on duty decided we should try to stop him. My co-worker called the police while I continued to talk with him as the call was traced,'' she wrote in her memoirs, which she published in January.

''I anxiously did my best to keep him on the line until eventually a policeman took over the phone at the other end and told me everything was OK and the child was being cared for.''

More recently, a resident in her Brighton East retirement village went to sleep one night and never woke up. While Beverley and her neighbours were sorry to lose their friend, they all thought she had been quite fortunate. There was a feeling that if death was nearing, it might as well be as peaceful as possible.

''Everyone kept saying 'wasn't she lucky'. That's the way people feel about it,'' she tells me during a meeting at her home on January 29.

That death encouraged Beverley to keep working on a plan to end her own life when she felt the time was right. Unbeknown to many of her friends, she knew she could emulate her neighbour's gentle death at any moment.

She had acquired some barbiturates - the drugs euthanasia advocates sometimes call the ''peaceful pill'' - and an inquiry to Exit International confirmed she had enough for a lethal dose. If things went downhill, she had an escape plan.

Beverley Broadbent is 83 when she invites me to her home . When I arrive, she opens the door bright and alert. ''Isn't this weird,'' she says, before inviting me in to meet Lucy, her poodle-Maltese cross. She asks if I would like a cup of tea.

As we begin talking, she strikes me immediately as direct, no-nonsense and eager to talk. Beverley tells me she is not dying, but is ready to die. She believes elderly people of sound mind should be able to choose how and when they go. She is not depressed, she says, but feels the downsides of ageing are outweighing the joys of life.

''I look well and I walk well so people think I'm fine. But I have so many things wrong with me,'' she says, patting Lucy, who is on her lap. ''The balance is gone. It's taking so much time for me to keep fit to enjoy myself that there's not enough time to enjoy myself.''

As a woman who has been extremely active both intellectually and physically during her 70s, Beverley says the ageing process has come to feel like a terminal illness. Arthritis is radiating through her joints, making it hard to get up every day, and peripheral neuropathy is numbing her legs and feet, causing her to stumble and fall.

In the past decade, she has had a hip replacement to repair the usual wear and tear as well as two thumb operations and has had carpal tunnel syndrome in her wrist. Ophthalmic migraines are regularly flattening her for hours at a time and two cataracts have been removed from her eyes.

She also has a lump in her breast, but says she told her doctor she did not want to know anything about it. She is not going to spend her final years having invasive procedures, let alone cancer treatment.

The nights bring little relief. ''I get the most frightening cramps that wake me up every two hours,'' she says. ''I take a couple of Panadol Osteo, which helps me get through it, but each night, I think this is ridiculous, you don't have to go on like this … no one sees that, but Lucy sees it.''

Her sharp mind is also deteriorating in subtle ways. In the past year or so, she has become lost near her home and in places she has frequented for 50 years. Once-familiar names are escaping her more often and she is losing her way in discussions with friends.

''I find it completely unsupportable … Some people say 'it's OK, we're all like that'. Now they may be like that and not care, but I do care. Conversation has been such an important part of my life.''

The sum total has made Beverley want to set a date to die. She says that after she discovered the lump in her breast last July, she contacted Dr Rodney Syme, former vice-president of Dying with Dignity Victoria, to discuss her thoughts. She had sought his advice in the past when helping her close friend Betty navigate the hospital system in her dying days during 2010. She says Betty's life was prolonged against her will and that she complained to the hospital about her treatment.

After several meetings, she says Syme urged her to keep thinking about her desire to die so she could be sure she was ready to end her life. He did not think she was depressed. In fact, he says he classified her as being in ''outstanding mental health'' and thought she was still getting a lot out of life.

Beverley took Syme's advice. She decided to push on and enjoy as much of the the festive season over Christmas as she could with her friends and cousins. And it allowed her to tie up more loose ends.

But in the new year her desire to die increased. Beverley says her greatest fears are getting dementia without knowing it or falling and finding herself in a nursing home without independence. She now feels it is best to go a year too early rather than a year too late. She has chosen a date and is planning her final days.

She has decided her last day will be Monday, February 11, when many of her neighbours gather for a monthly dinner.

This will work well, she says, because they will be distracted and won't come knocking on her door. The local doctor also visits on Tuesdays, so he will be able to find her and take care of her body, which she is donating to scientists at Melbourne University.

When I meet Beverley again on February 7, her social calendar is full. She has deliberately planned to be busy doing the things she loves right up until her death. Every morning, she is devouring the daily newspapers over breakfast, walking Lucy along the beach and in Brighton parks, and is still meeting friends for lunch. She is also still teaching a young Argentinian friend English during educational trips to the Prahran market and various galleries.

Beverley has sorted out her will and organised a new home for Lucy. She has even written instructions for friends who will co-ordinate a celebration of her life. Ribbon sandwiches, cakes and cheese will be served with wine. The liquor, she has told them, should be bought from a local store that lends glasses free. A list of the contact details of her many friends is ready so no one will be forgotten.

She says any money she has is being left for loved ones with a recommendation they give away 10 per cent to someone else in need. This was inspired by the immense joy she got from giving away $100,000 she inherited from Betty in 2010.

''It was the best time I've ever had. I had friends who didn't know I had this money who told me stories about really needing $3000 for something, so I'd just say 'here, I'll write you a cheque for $3000, don't worry, it's not my money'.

''I took friends on holidays to Bhutan, to Dunk Island, to the Murray River, to Lake Eyre and I gave all the young ones I know $5000 before they went overseas or bought a car. It was absolutely wonderful.

''I don't think people realise what pleasure you get from doing that.''

Beverley wants her last day to be calm and like any other day. She says she will get up and take Lucy for one last walk before handing her over to a friend who has offered to care for her in the past if anything ever happens to her. She has told her friend to drop Lucy off the next day. If all goes to plan, he can raise the alarm when she doesn't open the door.

When I ask her if she's sad about saying goodbye to Lucy, Beverley assures me it will be fine. After all, Lucy is a dog, she says, ever pragmatic. But interestingly, Lucy's behaviour has changed in recent days. ''It's really strange, she's nearly prescient. She won't let me out of her sight at the moment. Isn't that extraordinary?'' Beverley says. ''She's always been like that to a certain extent, but not like she is now.''

On her last day, Beverley says she will take anti-nausea tablets in the morning and again at lunch and dinner time to make sure she can hold down the barbiturates. In the afternoon, she is planning to see the film Lincoln before returning home in the evening. She says there will be no sentimental music or fond farewells.

Beverley Broadbent was born in Melbourne in November 1929, just one month after the Wall Street crash plunged the world deep into depression. She grew up in Elwood in Melbourne's south-east. When her mother died, her father struggled to care for her so he sent her to board at Firbank Grammar in Brighton.

Despite feeling homeless after her mother's death, she had many happy childhood memories of eating Eskimo Pies at St Kilda beach, riding Queenie the elephant at the zoo and watching Don Bradman play cricket at the MCG.

She contracted mumps as a child, leaving her completely deaf in one ear. Nonetheless, she was a bright student who excelled at maths and loved to run and dance and sing in theatrical shows.

She did not go on to become a performer, but theatre would be an enduring love, taking her to hundreds of shows in cities around the world, including London and New York.

In her memoirs, she says her first job was as a secretary for Joy Toys in Malvern where she did extra shifts in the factory to save money for a trip to Europe. In 1952, she boarded the Stratheden at Princes Pier, which took six weeks to sail to Tilbury in England.

She met a friend there and hitch-hiked around Europe, staying in youth hostels before returning to London to watch the coronation of Queen Elizabeth II in 1953. In the diary she kept on the trip, she wrote about the large crowd that gathered until 1 o'clock the next morning at Piccadilly. It was all ''too wonderful to describe'', she notes in her diary.

After returning to Melbourne, she got a job working in the press office for the 1956 Olympic Games, where she was to manage foreign journalists. In her work she got to mix with visiting dignitaries, including Prince Philip. She remembers him complaining that the seats at a church he had opened in Alice Springs shortly before arriving in Melbourne were the hardest he had ever sat on.

During her late 20s, Beverley moved to New York to work at the Government of India Tourist Office, which was opposite the Rockefeller Centre. She took a road trip across the US before coming home in 1959.

She then joined the English Speaking Union for 10 years before settling at the Australian Conservation Foundation in 1972. She devoted much of the rest of her working life to the ACF where she was involved in campaigns to protect Kakadu, the Franklin River

and the Great Barrier Reef. She later wrote a history of the organisation titled Inside the Greening: 25 years of the Australian Conservation Foundation.

During the early 1970s, a rousing anti-Vietnam War speech by Australia Party leader Gordon Barton motivated her to become a member. Within a year, she was standing as a candidate at the next election and over the following 30 years she took part in many state and federal elections for both the Australia Party and the Democrats, but never won.

In 1973, she stood against footballer Brian Dixon who later became a minister in Rupert Hamer's Liberal government, and in 1975 she ran against Labor's Frank Crean in the federal seat of Melbourne Ports before he became a federal treasurer.

Beverley never expected to get elected, but knew both parties needed to be on every how-to-vote card if they were to have any hope in the upper house, where proportional representation gave smaller parties a chance.

When the Democrats, under Meg Lees, gave preferences to Family First ahead of Labor, Beverley was appalled and joined the Greens, who she supported financially for years thereafter.

In her 80s, she donated money to GetUp! because she thought it empowered people who felt small against lobbyists for big corporations. She had also been a member of the Victorian National Parks Association, the Port Phillip Citizens for Reconciliation, the Public Transport Users Association and Dying with Dignity.

Volunteering was a big part of her life and a constant source of optimism. She donated her time to Lifeline for several years and taught many migrants English, including Vietnamese boat people and Sudanese refugees, some of whom she remained close to.

Beverley never married, but had two long-term relationships with married men, each of which lasted about a decade. One of the men was a naval officer whom she spent time with when he was visiting Melbourne.

At one stage, she considered marrying an American widower who headed General Electric in Australia, but she decided against it. She did not feel comfortable mixing with the top end of town and he insisted that she, an atheist, try to become a Catholic. She said she would never have married for the sake of it, but regretted missing out on having children and grandchildren of her own.

In her memoir, she wrote that she had lived a happy life full of love, travel and adventure and did not feel lonely or deprived.

''I am well able to cope with being alone in old age, whereas many married friends who have lost their partner find this very difficult … I really enjoy living alone although I still work hard to keep in touch with all my friends and take part in the many activities which make Melbourne such a wonderful place to live.''

Beverley says being an atheist has made it easier to contemplate suicide. While she has envied people whose faith has comforted them in difficult times, she does not believe there is a God.

''I'm not scared because I don't believe in any afterlife and I'm not guilty because I don't have a religious belief in that way. I think my friends will understand … when they hear what has happened, they will understand.''

She says although some people will disapprove of her choice to commit suicide and to tell her story, she hopes some will see it is reasonable to end your life when you want to, especially in old age.

''It seems to me that in the last three years of your life, if you don't want to be there, why should you be there?

''I hope people can see how sensible it is and that I'm not stupid, I'm not depressed, I'm not sad. I'm having a good life that I'm enjoying right to the last minute.''

As a strong environmentalist who has campaigned with Sustainable Population Australia, Beverley says there is also an argument that people who want to go should be allowed to go for the welfare of their community and the planet.

She says she shares the views of Nobel Prize winner Peter Doherty who last year predicted governments would have to start rationing healthcare more, especially in the last few years of people's lives, if they are to keep paying for medical research and preventive health.

Beverley believes a safe system for physician-assisted suicide or voluntary euthanasia would be introduced eventually, but in the meantime, she says she would rest peacefully knowing she had contributed to the debate. ''I've been an activist since the '70s, so it would really amuse me to still be an activist when I'm dead,'' she says, laughing.

On the night of February 11, Beverley Broadbent hopped into her nightie, climbed under her bedspread and swallowed her lethal elixir. The next morning when her friend came by to return Lucy, there was no answer. When the door was finally opened, Beverley was found quiet and still beneath the covers, still clutching a chocolate frog.

Julia Medew is Health Editor.

For help or information call Suicide Helpline Victoria on 1300 651 251 or Lifeline on 131 114, or visit beyondblue.org.au

Editorial in The Age, 2 APRIL 2013

In Victoria, it is not illegal to take your own life, but someone who practises active voluntary euthanasia can be prosecuted for murder or manslaughter. Under the Crimes Act, assisting a person to commit suicide is also illegal, and carries a prison sentence of up to five years.

Fairfax Media does not believe anyone actively assisted Ms Broadbent to end her life, nor was there any suggestion that she was being encouraged or incited to do it. In deciding to tell her story, Fairfax Media believed it had a role to listen to Ms Broadbent's views and document them for public debate.

Journalist Julia Medew made it clear to Ms Broadbent that her decision to tell her story should not factor into her decision-making in any way. Ms Broadbent assured her this was not the case.

Until recently, the media have not reported the details of many suicides because of fears it will encourage others to take their lives. But mental health experts have recently recommended a new approach to suicide reporting in Australian Press Council guidelines that neither hides nor softens a major public health and community issue.

Fairfax Media's code of conduct also stipulates that it shall not publish information about individual cases of suicide unless it is justified by the wider public interest. The code also requires care be taken when reporting methods of suicide and that, wherever possible, public information on where to gain help should accompany such reports.

Letters The Age 2 APRIL 2013:

Thank you, David Campbell (Comment, 30/3). My mother, suffering with dementia, was placed in a high-care nursing home. From a proud and gentle woman, she became fierce and defiant. ''What is wrong with me?'' she continually said, lost in a world you describe so aptly.

To have to be dressed, bathed by strangers, wear nappies and told to defecate because staff were too busy to take her to the toilet broke our hearts and eventually hers. She had lived a life full of adventures, travel and the arts. Her final years were reduced to a demeaning and tragic end in ''God's waiting room''.

We sign consent forms while of sound mind to donate our organs after we die. Surely we are entitled to the decency of ending our lives in a humane manner while we are also of sound mind.

My mother died almost three years ago and all I can remember is the shell she was then and not the wonderful mother and friend she was to me. I don't want my children to remember me that way. I should have the choice.

I have worked in intensive care and aged care. I witnessed people being operated on, suffering terribly, and dying in a hospital bed. Analgesics were not sufficient to relieve them of pain, anxiety and isolation from families.

We allow an attitude to prevail that makes death seem a medical failure, not the inevitable progression of having been alive. We should be made familiar with our mortality and the fallibility of the medical profession. Nurses can despair at the orders given by remote-control doctors about ''painkillers'', intervals between dispensing them and the horrible cries of the sufferers.

I would like to know that the doctor who knows me and my family will be given the right to allow my death to be reassuring for my family. It is because of my deep respect for life that I ask to be permitted to die with dignity.

Beverley Broadbent was not depressed or suffering from a terminal illness when she took her life.

A friend of Beverley Broadbent has revealed she sat with the 83-year-old when she took her own life at her home in February.

The nurse, who wants to be known only as Amanda, contacted The Age yesterday to say that she comforted Ms Broadbent as she died on February 11, but did not assist her in any way.

Amanda said Ms Broadbent drank a lethal dose of Nembutal - the barbiturate euthanasia advocates call the ''peaceful pill'' - about 7.30pm on February 11. She died serenely in her bed about 30 minutes later.

Gerald Mayhead and Eileen Davies, both neighbours of Ms Broadbent, say she had a good death. Photo: Joe Armao

Amanda said when Ms Broadbent was waiting for the drug to put her to sleep, she said: ''You know I could do this on my own, but I am so grateful that you're here with me.''

''I said, 'I love you, Bevie', and she said, 'I love you, too'.''

A short time later, Ms Broadbent started eating a peppermint chocolate frog - one of her favourite foods - and drifted off to sleep.

''After a couple of minutes, her arm still holding the chockie frog just went slowly down onto the bed. All the time through the whole process I just kept saying, 'I love you, Bevie', hoping that if she is hearing, this is what she will hear.''

On Tuesday, The Age reported that Ms Broadbent had decided to end her life because she was tired of living and felt the downsides of ageing were outweighing the joys of life. She did not have a terminal illness, but feared she would soon find herself in a nursing home where she could not choose a peaceful, dignified death.

While assisting a suicide is a criminal offence in Victoria and carries a maximum jail term of five years, Amanda said she volunteered to sit with Ms Broadbent when she divulged her plan to commit suicide a couple of months ago. She said she respected Ms Broadbent's choice and felt no need to try to stop her. However, she did not want her friend to die alone.

Amanda said she wanted to assure Ms Broadbent's loved ones that she did not suffer a lonely or painful death, but rather a calm and beautiful end.

Several of Ms Broadbent's friends yesterday said they supported her choice to both end her life and tell her story.

But they said others did not approve of her posthumous campaign for elderly people to have access to physician-assisted suicide.

Gerald Mayhead and Eileen Davies, both neighbours of Ms Broadbent, who live in her Brighton East retirement village, said she had a good death that others should be able to emulate.

''You just hope it is pleasant and not prolonged,'' Mr Mayhead said. ''Later on in life, you accept the fact that you are going to die and you reach a point where you want to get on with it for one reason or another. And Beverley did.''

For help or information visit beyondblue.org.au, call Suicide Helpline Victoria on 1300 651 251, or Lifeline on 131 114.

The Coroners Court of Victoria is seeking a new definition for suicides with the drug euthanasia advocates call the ''peaceful pill''.

As the court deals with a rising number of planned deaths among people with chronic or terminal illnesses, it has written to Exit International about terminology.

In a December letter to the group, Jeremy Dwyer, of the Coroners Prevention Unit, said he was seeking advice on how to describe the suicide of a person who has used Exit's banned manual, The Peaceful Pill Handbook.

Dr Dwyer said the term ''voluntary euthanasia'' was unacceptable because it involved the action, inaction or otherwise intervention of a second party. ''Physician-assisted suicide'' was also inadequate, he wrote, because it required a physician to provide the means of suicide.

''The term 'rational suicide' is close to the term I am looking for, but it appears to have attracted considerable ideological baggage in recent years so I am trying to avoid it if possible,'' he wrote.

Exit International director Philip Nitschke told the court ''rational suicide'' was a suitable term.

A spokeswoman for the Coroners Court said Dr Dwyer had declined to be interviewed. But she said the court was investigating six deaths in 2011-12 that involved people with chronic and terminal illnesses who ended their own lives.

For help or information call Suicide Helpline Victoria on 1300 651 251 or Lifeline on 131 114, or visit beyondblue.org.au

The Age editorial 3 APRIL 2013

Beverley Broadbent at 83. Photo: Angela Wylie

It was a brief letter, published in The Age on May 16, 2003. ''Terminally ill people being tube fed, despite clearly expressed wishes not to have their life prolonged, is undoubtedly cruel. It should also be illegal.'' The writer, Beverley Broadbent of East St Kilda, a frequent correspondent to the letters page on environmental, political and social issues of the day, was perhaps more used to commenting on, rather than being, the news.

This has now changed. On the night of Monday, February 11, 2013, Ms Broadbent cut short her own life by taking a lethal dose of the barbiturates sometimes known as the ''peaceful pill''. The 83-year-old planned her end with purpose and precision. The date coincided with a monthly dinner at the East Brighton retirement village where she had been living, when her neighbours would be distracted, and her local doctor was due to visit the following day, so he would find her. Ms Broadbent had organised her will, her wake and a new home for her dog, Lucy.

This could easily have been a personal and private affair, creating sympathetic ripples but not controversial waves. But Beverley Broadbent felt so strongly about when and why she wanted to die that she was determined to talk about it in the most public way possible. Through her contacts with euthanasia campaigner Dr Rodney Syme, Ms Broadbent was interviewed at length by The Age's health editor, Julia Medew, in late January and early February. This was published on Tuesday along with a video in which Ms Broadbent said, ''I am not scared, not guilty. I think my friends will understand.''

The nub of Ms Broadbent's reasoning was that although she was not dying, she was ready to die. She told The Age that the ageing process had come to feel like a terminal illness: it was a combination of physical and (to a lesser extent) mental deterioration that made her set her own death date. But behind this, she said, was the encroaching fear of dementia and finding herself in a nursing home without independence. In retrospect, it could be said that Ms Broadbent's fears had been articulated 10 years earlier in her letter to The Age. It is not up to us to condone or condemn what was obviously a deeply felt and personal decision. But it is important at this stage to make the distinction between rational and assisted suicide.

Since 1967, there has been no law in Victoria against committing suicide; what is illegal is practising active voluntary euthanasia or helping a person to commit suicide. The Age has long believed such laws should not be altered for as long as possible ambiguities or abuses could still exist: euthanasia should not be permitted to become a subtle form of murder. Some countries already have long-established, functional dying-with-dignity clinics - for example, Dignitas in Zurich - but Australia has a long way to go to establish the proper legal, medical and moral climate to enable an equivalent.

What The Age continues to argue for - and what the legacy of Beverley Broadbent's death undoubtedly emphasises - is the need for a full and informed public debate on all aspects of rational and assisted suicide that could lead to wider understanding and acceptance. Without such debate, mindsets and morals are that much harder to shift. A timely and purposeful start will be the forthcoming investigation into suicide by the Coroners Court of Victoria, and the establishment of the state's first suicide register.

There are wider indications of the necessity to change public and political attitudes. In February, an elderly Victorian man, Heinz Karl Klinkermann, who tried and failed to kill himself and his terminally ill wife, was sentenced in the Supreme Court to an 18-month community corrections order - the more merciful suspended sentence having been abolished by the state government in 2011.

The media also have their part to play. As The Age stated on Tuesday, there is a general policy shift in reporting suicides: from avoiding the issue for fear of creating copycat incidents to observing recommendations by mental health experts that such reports neither highlight nor soften a major community issue. As such, the story of the late Beverley Broadbent could be told with frankness and hope. She should be thanked for her candour and for her courage.

For help or information visit beyondblue.org.au, call Suicide Helpline Victoria on 1300 651 251, or Lifeline on 131 114.

The Age letters 3 APRIL 2013

Not even Right to Life Australia could argue against the rationality of Beverley Broadbent's decision to take her own life (''Why Beverley Broadbent chose to die'', The Age, 2/4). Hers was a classic example of a considered and entirely logical approach to dying. Opponents of assisted dying consider that death is not something to be chosen, but something to be endured. That uncontrolled suffering is the price we must pay to protect possible abuses of the sick and elderly. While the cliched ''slippery slopes'' have little factual basis, protracted and unpleasant deaths are a very real, daily occurrence.

No one wants to take away the ''right to life'' but it should be a two-way street. If we have this so-called ''right to life'', then we must also have a ''right to death''. That's what real freedom of choice is all about - the right to choose the manner and timing of our final moments on earth. Is that a lot to ask?

Ms Broadbent (may she rest in peace) advocated a safe way to commit suicide for those who want to. But it can't be safe: when we as a community rationalise suicide for those who simply want to take their own lives, the flow-on effects for the depressed are dire. For every clear-thinking person like Ms Broadbent, how many collateral victims of suicidal depression are there? If this was not a real danger, there would be no need for the warnings plastered over each article. Yes, we should try to understand her plight. But we simply cannot ignore the morbid encouragement this story gives to those teetering at the precipice of suicidal depression. Our community's laws must safeguard society's most vulnerable members, and this means we can never condone Ms Broadbent's choice.

Ms Broadbent made a dignified and thoughtful choice, but instead of responding to this, Katrina Haller provides distraction by criticising caregivers for ''dumping'' old people into nursing homes, families and hospitals for coercing the elderly into feeling like a burden, and legislators who ''would inevitably start a debate''. Who are these people she refers to? The closest Haller comes to discussing a real case is to say that Ms Broadbent's story ''might be hard to argue with''. That's the whole point of debate and legislation: to actually engage with those individuals who are affected, with those who suffer, with those who provide the hard evidence for assisted dying.

Beverley Broadbent died as she lived, thoughtfully, cheerfully and wholeheartedly exercising one of democracy's most important features - choice. Congratulations to her and to Julia Medew.

Two things were noticeable in the article on Ms Broadbent. First, the photo; everything was neat and ordered, in control. Second was her ambivalence: "I'm having a good life that I'm enjoying right to the last minute" vs "It's taking so much time for me to keep fit to enjoy myself that there's not enough time to enjoy myself.'' Such stories often seem to reveal not clinical depression but existential anxiety, a treatable psychological state. Or sometimes not, in the case of those with strongly held views or an unwillingness to explore the issues that surround our inability to control life, and the meaning of ageing, in the way that we would like. Should we advocate for euthanasing people with certain personality characteristics?

How courageous of Beverley Broadbent, and how true and reasonable the words of David Campbell in his pro-euthanasia article (Comment, 31/3). There are many ageing people for whom the fear of death is a great deal less distressing than the fear of lingering on when our quality of life and/or mental faculties have deserted us.

At least we may be comforted by the knowledge that economics takes priority in health and social policy. Just how much can be spared from the national purse without further taxing workers? Our leaders will eventually agree that the only solution to the cost of soaring numbers of burdensome units of humanity is to legalise euthanasia. There are good and humane reasons to do so but, unfortunately, as in all things, it will be money, finally, that will rule.

Let's hope it is soon.

Where did the Orwellian term ''rational suicide'' come from? If a doctor assists in the death, is that ''rational murder''?

My parents wished for a similar exit, but didn't think society was quite ready to accept their choice. It's time we talked about it.

4 APRIL 2013

Article and letters in The Age 4 APRIL 2013:

Council on the Ageing wants Commonwealth to look into issue. Photo: Jason South

Federal politicians should start exploring safe models for euthanasia and assisted suicide, the peak body for older Australians says.

However, Ms Hendy said if the federal government was to look at legislation, it would need to ensure it strengthened anti-discrimination laws to protect elderly people from ageism and elder abuse.

She said COTA was extremely disappointed that Attorney-General Mark Dreyfus had not proceeded with plans to consolidate the five anti-discrimination acts launched by his predecessor, Nicola Roxon, to include age discrimination.

Ms Hendy said it was important to ensure older Australians were not discriminated against in all aspects of life, including the workforce, because such prejudice could detract from quality of life in older age and contribute to a desire to die.

In the context of debates about elderly people having a right to die when they want to, this had to be addressed first because a lot of people feared ageing more than death itself.

‘‘We know that in a whole range of ways, people are taking their lives and being assisted, but it’s all outside the law and it takes away therefore from what Beverley (Broadbent) was talking about, the quality of death,’’ she said.

‘‘But we know older people are abused. We’re involved in running a service on elder abuse and we know families behave badly. Now the extreme of that behaving badly could be forcing or somehow bringing on the idea that ‘Well, now is a good time, thanks mum, we could really do with your house.’ I’m making light heart of it but I don’t think it is a light issue.’’

Ms Hendy said although COTA did not support any particular model of euthanasia, the group wanted politicians to discuss it and examine models because a lot of elderly people liked the idea of knowing a peaceful death is there if necessary.

‘‘We believe choice and decision-making are important elements of quality of life and I guess quality of death, but that doesn’t necessarily mean we want it legislated now. There has to be checks and balances in place.’’

Melbourne woman Beverley Broadbent ignited debate about elderly people’s right to die this week after documenting her decision to suicide in February. Before her death, she told The Age she was not terminally ill, but wanted to die because she had completed her life and feared getting dementia or ending up in a nursing home where she would not have the freedom to choose a peaceful, dignified death.

Greens health spokesman Richard Di Natale said he was currently looking at whether the federal parliament could legislate on euthanasia for the nation. If there were no hurdles, he said he would release a bill during the election campaign.

Dr Di Natale is also pushing for a vote in coming weeks on restoring the territories rights to legislate voluntary euthanasia after they were banned from doing so more than a decade ago.

“Dying with dignity is an issue that deserves to be on the national agenda this election year,” said Senator Di Natale.

The Age letters:

Congratulations to Beverley Broadbent (The Age, 2/4) for her calm courage in terminating her life at a time of her choosing. No one has ownership of another person's life and no one can tell others when they may die - not right-to-lifers, religious zealots or politicians. All they can do is make a person's decision to die more traumatic and painful.

It is not surprising that Beverley was an atheist and could take this action free of externally imposed guilt.

I was very upset when I read about Beverley Broadbent. At the age of 79, my mother-in-law was depressed and at one of the lowest stages of her life.

Now aged 81, she has regained the will to live. We believe it was through her medication and prayer. She also had a new granddaughter during that time.

If she had been able to access age-related euthanasia, she could have missed out on this part of life and we could have missed having her in our lives.

What a way to die - granny has killed herself.

The articles about Beverley were sensitive, thought provoking and especially timely. With my 13-year-old summarising them for English, it unlocked an opportunity for a discussion about age, infirmity, death and dying.

Having real choices when the time comes is about growing up.

I have worked in the aged care sector for many years. My clients who live at home receive care and have a wonderful quality of life. Similarly, older Australians are often surprised to learn that they continue to enjoy great dignity, friendship and a very high level of care when they do move into residential aged care. We need to care for the elderly and sick, not influence them to feel that they are a burden. I am concerned that a ''right to die'' will soon become the duty to die.

Whatever your view on Beverley Broadbent's death, there's no doubt she led an extraordinary and inspirational life. May she rest in peace.

Thank you, Beverley Broadbent. You've struck a blow for those who want to decide how we live and die.

The joy of involvement with my sons, their partners and now my grandchildren puts paid to any fleeting thoughts of ''old age assisted dying''.

5 APRIL 2013

Euthanasia letters in The Age 5 APRIL 2013:

Like Beverley Broadbent, my son accessed Exit International's banned manual The Peaceful Pill Handbook. He also took the drug Nembutal to end his life. Like her, he feared deteriorating to the point that he would no longer be able to end his life.

My son did not have a terminal illness (he believed he did). He was only 26. Now the family is left with a lifetime of pain. No family should have to go through this but I fear they will if the community continues to ''court'' this drug.

In the euthanasia debate, doctors invariably say ''it's our job to save lives, not to end them'' - as if this ''ending of life'' were a bad thing. They denigrate veterinarians who love their patients but recognise that at some stage the only humane treatment is the euthanising of a terminally ill, suffering creature. Maybe doctors could learn from them.

Do not use the word ''suicide''. Simply say that the person died with dignity.

Hey Beverley, I'll have what you had. Sleep sweetly.

8 APRIL 2013

Euthanasia article in The Age 8 APRIL 2013:

Amid the debate over rational suicide, the law must express our prerogative to choose.

Beverley Broadbent would be thrilled at the discussion that has followed her story in The Age – it was just what she intended. She would have laughed at the psychiatrist who made an obscure diagnosis without even speaking to her. She would have questioned the notion that doctors are healers as being only partly true, and not applying to the degenerative associations of old age, strokes and dementias, and the terminal illnesses that ultimately claim us all. She would have quietly cried as she read Judith Taylor's tragic story of a 26-year-old son who mistakenly and irrationally ended his life using information from Exit International. She would have argued vehemently that such information should come through a careful, sympathetic medical dialogue. This is what protected Fay Manoni's depressed mother-in-law.

She would have been particularly pleased with the larger stories of David Campbell, Geoffrey King and Warwick McFadyen. David Campbell's mother died in a nursing home in degrading circumstances without a choice. That is exactly what Beverley (and many other writers) desperately wanted to avoid. Geoffrey King's beautiful piece described how he believed his Christian faith would sustain him through the harrowing decline due to motor neurone disease. He believed in redemptive suffering. What was most impressive was his empathy and lack of condemnation of Beverley's decision. As he wrote "I do not want to impose my views on those who do not share that faith". Warwick McFadyen's moving story of his father's inexorable and miserable journey to death due to cancer reveals an indomitable spirit and will to live, presumably for different reasons to Geoffrey King. His story illustrates how strong is the will to live – even in countries that allow voluntary assisted dying, only a few per cent of dying persons are helped in this way.

What these stories, and Beverley's, illustrate is that we are unique individuals, and that we are all capable of making different choices at the end of life. Most people will not know now what choice they might or might not make at the end.

They may have a strong inclination, but until they face the end, they cannot be sure. Two things I do know for certain is that almost everybody wants to make their own choice, and that the ability to make that choice, to have control, has a profound palliative value. It eliminates the deep, crushing, hidden psychological and existential suffering that accompanies all journeys to the end. Geoffrey King understands this, but believes his faith will help him cope – I sincerely hope that it does. Many people will make a similar journey to Warwick's dad, not because of an indomitable will, but because of the lack of another option.

None of the choices described is either right or wrong, good or bad. They are the different responses to different circumstances and of different people – people who are unique because of their genes, childhood, education, religion, culture and life experiences. They are valid expressions of our autonomy as individuals, our inherent right to make our own decisions about those things that affect us personally – and nothing is more personal than dying. Autonomy is now the predominant ethic in Western civilisation and philosophy, but unfortunately it is denied full expression in Victoria at the end of life. Our law mandates that we must go on to the bitter end, to a "natural death", not hastened by medical assistance. Of course, we can refuse medical treatment, but this option does not always exist, and the path to death is then not always easy. Most citizens are unaware that the Medical Treatment Act states that "it is desirable that dying persons should receive maximum relief of pain and suffering" – and that includes doctors.

The current prohibition on doctors providing assistance in dying on request has the consequences associated with all prohibitions.

First, it does not work – many doctors provide assistance, risking their freedom and their reputations. However, this assistance is hidden and the drugs used are not ideal, and the outcomes not always what is anticipated. It is a highly arbitrary practice, more available to the educated and well connected.

Second, it leads to tragic consequences such as the recent Klinkermann prosecution for attempted "mercy killing", an all too common event that occurs because suffering people cannot engage in open conversation with their doctors about these problems.

Third, and this was dear to Beverley's heart, it condemns many old, frail people to punishment and persecution simply because they are old. Too often, without consent but by default they end their lives in David Campbell's "vision of hell". Finally, it leads to a mass of suffering of patients despite the best palliative care, which, although it rarely fails to help, often fails to provide what is wanted. It also results in prolonged grief and disturbed memories on the part of families, as has been eloquently described in The Age.

The Age has decided not to take a position in this matter, but has committed to encourage community debate. Unfortunately, not everyone can be heard in such debates. Furthermore, such debates do need an outcome rather than a merry go round of opinion. After all, this is hardly a new discussion. An ideal forum for such a community debate would be the Victorian Law Reform Commission, a group of independent experts who could receive submissions from the whole community, and provide a detailed report with various options with safeguards against abuse for some resolutions to these problems that are occurring all too commonly at the end of life.

That would be an admirable aim for The Age to pursue.

Euthanasia letters – The Age - 8 APRIL 2013

I am 71, have lived a full and happy life and was diagnosed last year with motor neurone disease, which is incurable. I will eventually become totally dependent on the care of others, but we are all dependent to a certain degree - on farmers to provide food, mechanics to keep our cars running and, most importantly, families and friends for support and companionship. I have been the recipient of random acts of kindness from strangers who have helped me up after falls and opened heavy doors without being asked. I have also benefited from the great work done by the allied health professional team at Calvary Health Care Bethlehem and the support provided by the Motor Neurone Association, all of which is life affirming. The association's motto is ''Never give up''. Rational suicide on my part would seem to be indeed giving up, and as such an insult to all these good people and a negation of their valuable work.

Our mother/mother-in-law, a courageous 95-year-old, must now live in a nursing home. She has a number of health complaints, none of which are terminal. And herein lies her fate - enduring a slow and painful deterioration of both her mental and physical capabilities, of which she is only too keenly aware. We have lost count of the number of times she has asked, ''How much longer will this go on? I just want to go to sleep and not wake up.'' She knows each day will bring further decline. While she is receiving the best care, she is completely dependent on others for all her needs. She has led a rich and essentially happy life and is dearly loved by her family. But as she moves towards the inevitable end of her life, she deserves a peaceful and dignified death at a time of her choosing. It is high time we let common sense and compassion prevail. The law must change.

The most convincing reason given for why Beverly Broadbent committed suicide is that she was afraid that, as she became more frail, she would lose the capacity to arrange her own death (Focus, 2/2). If physician-assisted suicide were legal for mentally competent people after an extensive psychiatric assessment and a long cooling-off period, it would provide comfort to older people who may delay taking their lives until much later.

Margaret Tighe (theage.com.au, 4/4) should read the independent study in the Journal of Medical Ethics about assisted dying, which has been legal for 15 years, in Oregon. It concluded that where assisted dying is legal, there is ''no evidence of heightened risk for the elderly, women, the uninsured, people with low educational status, the poor, the physically disabled or chronically ill, minors, people with psychiatric illnesses including depression, or racial or ethnic minorities, compared with background populations''. Any law in Victoria should be based on evidence, not unsubstantiated conjecture.

4 MAY 2013

"How do you want to die?" article in The Age 4 MAY 2013:

It's the most contentious subject of all - death - and in an international conference in Melbourne next week it will inevitably cause arguments and aggravation. How could it not? Australia is not merely the host of just another global gabfest, but the driving force behind an event and a worldwide movement that aims to change the way we confront the toughest question of all: how do we want to die?

No, this is not about euthanasia - at least, not in any way intended by the founders and organisers at the Melbourne-based Respecting Patient Choices organisation. The Advance Care Planning and End-of-Life Care conference, to be held in the city from Wednesday, is instead intended to foster a more humane, personal and sensible way of dealing with medical decisions long before they become the heart-wrenching traumas at bedsides in hospitals and nursing homes.

Advocates say the benefits of setting out in advance what each of us want - and don't want - from the medical profession when the end is near include peace of mind for patients, a clear path for doctors and nurses to follow, and, crucially, an easing of the burden on loved ones who can come to a medical crisis armed with the knowledge of exactly what a husband or wife, mother or father, son or daughter desires. And there's a side-benefit: an easing of the burden on the health system - and therefore the budget.

But no one imagines a crusade for patient choice will be easy. We find it hard to talk about this stuff in our own lives. As a society, the debate is ever fraught. We are talking, after all, about life and death.

Just ask Julian Savulescu, the Melbourne-born, Oxford-based philosopher and ethicist who will be a key speaker at the conference. Savulescu, who was educated at Monash under controversial ethicist Peter Singer, believes people have a right to decide how and when their life will end, but notes that expressing such views opens you up to the extremes of such arguments, and to the extremes of abuse - such as being labelled a Nazi.

''You have to remember,'' Savulescu says, ''that it's not so long ago that people were burnt at the stake for being witches. They're not physically burnt at the stake today but the same sort of behaviour still occurs when people go against the tide.'' Savulescu believes anyone should be able to issue a directive that they do not want doctors to provide nutrition or hydration. In a landmark Victorian case a decade ago, the Supreme Court found food and water constituted ''medical treatment'' - and thus defined that under the law they could be withdrawn.

The debate over that still rages today - legally sanctioned euthanasia, critics called it. Savulescu says of the food-and-water question: ''It would be, if you like, a loophole that would allow de facto assisted suicide. So I think there's a real question whether through the refusal of eating and drinking people can control the timing and circumstances of their death - which is what assisted suicide and euthanasia aim to do.''

How far, he asks, will we go ''to allow people to decide the circumstances of their death''?

As he returns to Melbourne to join the debate, he knows he will face fierce attack for expressing such views - but he insists these are discussions we need to have.

''Even if, in the end, we decide that people can't die by refusing food and fluid, or even by refusing artificial nutrition, fine. But we should have a discussion about that and everyone should take part in a thoughtful and engaged way, rather than this lynch-mob mentality that pervades most ethical discussions today.''

Next week's conference is the fourth such conference on advance care planning organised by Dr Bill Silvester, director of the Respecting Patient Choices program based at Melbourne's Austin Hospital.

Effectively, advance care planning means that you - in a competent state, and whether you are suffering a serious illness or not - set out written and verbal guidelines to doctors and to loved ones establishing what medical treatment you want, and setting out particular circumstances in which, for example, you would not want to be resuscitated or be kept alive through artificial provision of nutrition and hydration.

The idea, says Silvester, is to remove these crucial discussions and decisions from the emotion-charged atmosphere of the intensive-care unit - or even from your own living room, where you lay prone after a heart attack or stroke, leaving loved ones to make these agonising decisions on your behalf.

''That's why we find with advance care planning [that if] discussions can occur at an earlier stage, when they do get to the point, a lot of that heart-wrenching discussion has already occurred,'' Silvester says.

He says research has found five key factors identified by people as amounting to ''a good death'': to avoid prolongation of death, to maintain control of the time of dying, to not suffer near the end, to relieve the burden on the family, and to strengthen relationships. ''Given those five key elements for having a good death, they are all things that are improved by having advance care planning.''

A study done at the Austin, he says, ''showed not only did advance care planning improve end-of-life care, but it improved the level of satisfaction for the patient and family, and it reduced the risk of post-traumatic stress, anxiety and depression in surviving family members''.

Silvester says it's important that ''we don't leave it to the families to struggle with this [on their own], and we come up with a conversation and lead the family and the patient in a sensible and compassionate way through the whole process.'' It sounds sensible enough, but the devil is, as ever, in the detail.

In Australia, the state you live in - or die in - has a crucial impact on how your wishes are interpreted, or even if they are given weight at all.

In Victoria, under the Medical Treatment Act, you can complete an advance care planning form right now - but whether that will be recognised if you happen to have a stroke while on holiday on the Gold Coast is another question. And if you were then moved across the Queensland border to a hospital in NSW? There, they have no specific laws governing this area at all.

Peter Saul, a senior intensive care specialist at John Hunter Hospital and adviser to the NSW government on ethical issues, despairs at the state-by-state discrepancies that frustrate a truly national policy stance on end-of-life planning. NSW, Saul says, stands alone because ''the lobby groups have much more purchase than in some other states. There are political reasons . . . why NSW won't deal with this issue'', for which we can read the influence of the Reverend Fred Nile in the NSW Parliament.

''The Queensland process doesn't bear much similarity to the Victorian process, in terms of how you document your wishes. In South Australia they've introduced new legislation very recently, and that's different again from neighbouring states. Western Australia has only recently introduced legislation,'' Saul says. ''Every state is doing this piecemeal, without much reference to any common framework for it.''

And what of the role of family members or other loved ones in acting on an advance care planning statement? ''It's very unclear in many states exactly what the role of the family is when it comes to the end of your life,'' Saul says. ''Are they allowed to act in what's called 'your best interests'? In NSW? No. In Victoria? Partly. In Queensland? Definitely. So even the most basic notion of the role of your family … it differs in terms of the legislation state to state.

''I think people even within the health system have really no idea of the legislative background. The general public have no idea at all. Even the people meant to administer this - who are us, the doctors - if I sent a questionnaire to 100 doctors in NSW asking what the law is about end-of-life, there'd be zero per cent who had any idea.''

Then there is the difference, legally, between advance care planning (as provided for under Victorian law, for example) and advance care directives. Saul supports the notion of a national standard for directives - legally binding documents that cannot be altered without the patient's consent.

But opponents such as Associate Professor Nicholas Tonti-Filippini, a Catholic ethicist, says the distinction is crucial. ''I support advance care planning but not advance care directives. I think people should appoint someone to make decisions for them, which is what the Victorian legislation allows for, and then they should discuss with that person what their values are and any specific things they're concerned about - but they ought not issue directives. Directives are not informed consent because they don't know what's going to happen in the future.''

Tonti-Filippini, who himself has a terminal illness - severe renal and heart problems, and auto-immune disease - says: ''It's a mistake to think you can direct the future from some time in the past.''

He also takes issue with some of the language used by Bill Silvester's Respecting Patient Choices program on its website. ''If I have an unsatisfactory condition, it basically says 'all forms of life support can be withdrawn'. Now, I just see that as euthanasia. If you withdraw things like antibiotics, nutrition and hydration, then you're just sentencing somebody to death and that's an incredible circumstance to demand of a healthcare team.

''That person has made that declaration sometime in the past when they have no experience of the illness that they eventually get. So I think their language is unfortunate.''

Tonti-Filippini adds of Julian Savulescu: ''He's pro-euthanasia. It does apply to this area and I guess that's where he and I would differ.''

There's that word - euthanasia - the word that can divert this debate down darker, more sinister paths. As Tonti-Filippini puts it, ''There are obligations to take reasonable care that still exist. They are not taken away by the Medical Treatment Act. The Medical Treatment Act doesn't allow manslaughter.''

Peter Saul argues that advance care planning isn't euthanasia, but says opponents can conflate the two issues. Saul says he doesn't support the Greens-sponsored bill, introduced into the NSW Parliament on Thursday, that would give terminally ill people the right to die. Advance care planning, he says, is for everyone, whereas situations where euthanasia might be contemplated would realistically affect only ''a tiny percentage of cases''.

He suspects that the widespread public support for right-to-die legislation is because Australians fear losing control at the end of their lives and advance care planning gives them back that control.

For his part, Savulescu - commenting generally, and not on Tonti-Filippini's remarks - says the extremes of the debate have forced even forthright advocates like himself to watch their words.

''You can connect together every fanatic around the world in a matter of seconds today … I think we're starting to self-censor what we say because you can't even put an idea out and have discussion, because suddenly the internet falls on you. ''At the end of the day it's going to mean that pressure groups, and people who threaten and who are prepared to use physical or verbal force, will be the ones that dictate social policy.''

Silvester says the advance care planning of the kind his organisation advocates in fact leads people away from thoughts of euthanasia. ''We've found that when you do advance care planning properly, that if a patient has been thinking about euthanasia - if they thought that was the only way they could maintain control in the end - they turn to us and tell us they've now turned away from euthanasia.

''They now feel like their wishes are known and will be respected. It's a huge weight off their shoulders and they can now focus on living as well as possible.''

Details of the International Advance Care Planning and End-of-Life Care conference, Melbourne International Exhibition and Conference Centre, May 9-11, can be found at acpelsociety.com.au/conference

5 MAY 2013

Article in The Sunday Age 5 MAY 2013:

Most nursing home managers and staff do not support giving cardio-pulmonary resuscitation to elderly residents who suffer heart attacks, and the technique has been found to be ineffective in reviving most.

While the policy of most nursing homes is to administer CPR, a survey of managers of the homes by Dr Bill Silvester, who heads the Respecting Patient Choices program based at the Austin Hospital, found fewer than one in five thought heart attack patients should be revived.

The reality was that in three-quarters of the homes no CPR was used in the past year, and in the few where it was, it was used only once, Dr Silvester said. ''It would appear that frequently residents were found deceased or were known to be dying and were allowed to die peacefully.''

The results of the study prompted calls for new national guidelines on when CPR should be used.

Dr Silvester said in his analysis of the study findings: ''We would also recommend that guidance be provided on when and how to discuss this with residents and their families. NSW Health state that it is reasonable to withhold CPR without explicit discussion with the patient or family if a) the resident or family do not wish to discuss it, b) the resident is aware that they are dying and has expressed a desire for comfort care or c) the facility does not provide CPR as a matter of course, consistent with the values and practices relevant to its population.''

Of more than 400 managers surveyed, fewer than 20 per cent thought CPR should be used in cases of ''witnessed cardiac arrest'', despite four out of five homes surveyed having a policy of providing CPR if the need arose.

''This revealed a significant difference between what the staff thought would be appropriate for their residents and what they were expected to do,'' Dr Silvester wrote in the report.

He cited international studies showing that on average fewer than 1 per cent of residents who had heart attacks and were given CPR survived and returned to the aged-care home.

He said the use of CPR on aged-care patients appeared to be driven by an expectation of what medical staff needed to do, rather than its effectiveness. ''The reason we did this study was we were appalled at the number of elderly people being resuscitated in aged-care homes and being brought into hospital and ending up in the intensive care unit.

''So we asked the ambulance people why this was, and they said they had no choice. And then we asked the nursing homes and they said it was because of expectation.''

The findings come on the eve of a conference in Melbourne on planning end-of-life medical care.

13 MAY 2013

BBC report 13 Many 2013

Two severely disabled men and a widow have taken their right-to-die cases to the Court of Appeal. Paul Lamb, who is paralysed, a man with locked-in syndrome known as Martin, and the wife of the late Tony Nicklinson are seeking to challenge the law.

They want health professionals to be legally protected if they assist people who wish to end their own lives.

Judges at the hearing said the case could not be decided on the basis of "personal sympathy".

In August, Mr Nicklinson, 58 - who also suffered from locked-in syndrome - lost his High Court bid to end his life with a doctor's help. He died a week later.

His widow Jane is continuing her late husband's battle in the courts by challenging the ruling, which related to England and Wales.

Mr Lamb, 57, from Leeds, was paralysed from the neck down in a car accident in 1990 and wants a doctor to help him die.

He has also taken up the case begun by Mr Nicklinson and is seeking a ruling that would give doctors a defence to a murder charge.

Martin, 48, who has locked-in syndrome caused by a massive stroke he suffered in August 2008, is seeking a change to the prosecution of assisted suicide.

Mr Nicklinson's family pledged to continue the legal fight after his death

Lord Judge, sitting with the Master of the Rolls Lord Dyson and Lord Justice Elias, will hear arguments in the three cases over the course of several days.

At the start of the hearing, Lord Judge said: "We are acutely aware of the desperate situation in which the appellants find themselves, and we are very sympathetic."

But he added that "we cannot decide this case as a matter of personal sympathy".

It had to be decided on the "basis of principles of law" after the court has heard all sides, he said.

At the High Court in August, Mr Nicklinson had sought declarations that there should be a defence known as "necessity" available to a doctor assisting him to die - based on the argument that it was necessary for a doctor to act to stop intolerable suffering.

He argued that the law was incompatible with his right to respect for private and family life under Article 8 of the European Convention on Human Rights - which he maintained included a right to autonomy and self determination at the end of life. Paul Bowen QC, representing Mrs Nicklinson and Mr Lamb in their cases against the Ministry of Justice (MoJ), said the High Court had "rejected the claims because, in summary, it considered Parliament, not the courts, should be responsible for changing the law in this area".

He said the High Court "did not decide the substantive issues at the heart of the claims" of whether the current law does "disproportionately interfere" with the right to respect for private and family life under Article 8 of the European Convention on Human Rights, nor whether the defence of necessity is available to a doctor providing the assistance to die.

Mr Bowen said Mr Lamb, who has no function in his limbs apart from a little movement in his right hand, also wished a doctor to end his life and he sought the same declarations originally sought by Mr Nicklinson.

The court heard the father of two had been in pain for 23 years, needed 24-hour care and his life consisted of "being fed and watered".

David Perry QC, for the MoJ, expressed sympathy for the late Mr Nicklinson and Mr Lamb, but said the High Court had "correctly dismissed" the case in August.

"The state of the criminal law in this respect does not violate the right to respect for private life under Article 8 of the Convention," he said.

The court also heard that Martin, who is unable to speak, virtually unable to move and who describes his life as "undignified, distressing and intolerable" wanted a "dignified suicide".

Current guidance makes it clear that friends or family assisting a suicide out of compassion are unlikely to be prosecuted. But his wife does not wish to be actively involved in his suicide.

Instead, he wants health professionals to be able to assist him to end his life.

His solicitors argue that Article 8 also requires the director of public prosecutions (DPP) to develop his policy so this could happen.

In a written argument before the court, Philip Havers QC, for Martin, said his client had "never asked the courts to decriminalise assisted suicide", but was seeking "clarity about how the DPP's prosecutorial discretion will be exercised".

Yogi Amin, representing the British Humanist Association - also a party in Mr Lamb's case - said the law "should be certain and reflect modern society".

"Both Parliament and judge-made law should develop to allow for personal autonomy," he said.

Disability rights group Scope and anti-euthanasia campaigners have argued current laws protect vulnerable people.

In Scotland, there is no specific law on assisted suicide, although in theory someone could be prosecuted under homicide legislation. The law in Northern Ireland is almost identical to that in England and Wales.

LINKS

Dying With Dignity Victoria (Rodney Syme is associated with this group)

Exit International (Philip Nitschke is associated with this group)

Red Jos: HUMAN RIGHTS ACTIVISM

Mannie and Kendall Present: LESBIAN AND GAY SOLIDARITY ACTIVISMS

Mannie's weblogs may be accessed directly by clicking on to the following links

MannieBlog (to December 2005)

Activist Kicks Backs - Blognow archive re-housed - 2005-2009

RED JOS BLOGSPOT (From January 2009 onwards)

This page created on 10 APRIL 2013 and updated on 7 JULY 2021

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