http://www.geelonginfo.com.au/readarticle.asp?articleid=16604

Rebeca Tucker

TWO doctors who admit they advised Point Lonsdale’s Steve Guest about the best way to die are prepared to risk their medical licence for a test case on Victorian euthanasia laws.

Leading activists Dr Rodney Syme and Dr Philip Nitschke want the cancer patient’s death to force euthanasia into the political spotlight.

They yesterday said they were ready to answer an inquiry into Mr Guest’s death overnight Tuesday.

But they doubted the State Government wanted the case to be heard.

Also yesterday, the doctors revealed:

THEY know who gave Mr Guest the lethal drug Nembutal; and

MR Guest pre-empted the inquiry before he died, dictating separate letters to Dr Syme and Dr Nitschke denying either gave him the barbiturate.

Both doctors could be implicated in the death after they gave Mr Guest advice about how to die.

It is illegal to assist or advise a person about how to end their lives.

But they argue just what it means to assist or advise is “opaque” and governments are reluctant to define it because the issue is too morally sensitive.

Dr Syme, who visited Mr Guest at his home on Tuesday, said he doubted the coroner would proceed with a full inquiry.

He said he did not relish the idea of being charged, or the personal stress from a test case.

“On the other hand, I have a long held view that the status quo will remain the status quo until somebody or something pushes it off balance,” Dr Syme said.

“I also have a long-held view it won’t be pushed off balance.”

He said the law was “an ass” because “it does not provide justice”.

Dr Syme maintained the advice he gave Mr Guest was far more medicating than any pharmaceutical drug because it eased his anxiety in his last two weeks of life.

Dr Nitschke, who said “we all know where Steve got Nembutal, (but) we’re not going to be saying”, also did not expect Mr Guest’s death to become a test case.

The Darwin-based doctor, who last week hosted a euthanasia meeting in Geelong West, has been involved in several controversial investigations including the death of Queensland woman Nancy Crick after taking Nembutal in front of 21 family and friends in 2002.

No-one was prosecuted in that case. But Dr Nitschke acknowledged, although the laws were almost the same in Victoria, the outcome might differ.

But he expected the Victorian government wanted to “leave the law murky” where just what was meant by advise or assist was opaque.

The State Coroner’s Office on Thursday announced it was investigating Mr Guest’s death despite an assistant coroner on Wednesday informing GP Geoff Allen it probably would not.

By Lorna Edwards
July 29, 2005

Voluntary euthanasia campaigner Dr Philip Nitschke and Melbourne activist Dr Rodney Syme yesterday admitted advising terminally ill man Steve Guest on how to end his life.

The two euthanasia activists yesterday challenged the grey areas of the law relating to doctors advising patients on suicide while the State Coroner yesterday confirmed Mr Guest’s death was under investigation.

Mr Guest died on Wednesday morning at his Point Lonsdale home after a 10-month battle with cancer of the oesophagus.

Both doctors admitted yesterday they had visited Mr Guest in the final days of his life and had discussed options of how he could end his life.

“He asked a number of questions about ways, if you like,” Dr Nitschke said yesterday. “He asked about drugs, he asked about all sorts of questions and had done in previous times while he had been a member of Exit (the right-to-die organisation founded by Dr Nitschke),” he said.

Dr Nitschke said the coronial inquiry into Mr Guest’s death was “interesting” as he believed the death certificate signed off by a local GP stated bronchial pneumonia as the cause of death.

Neither Dr Nitschke nor Dr Syme was with Mr Guest when the former media adviser died on Wednesday.

Mr Guest received publicity after advocating voluntary euthanasia in emotional pleas on Melbourne radio in the weeks leading up to his death.

Under the Crimes Act, it is illegal to “aid or abet any person in the commission of suicide” but euthanasia campaigners believe it is a grey area under the law whether doctors giving advice to patients constitutes aiding or abetting.

“I don’t fear prosecution at all,” said Dr Syme, who as president of the Voluntary Euthanasia Society of Victoria welcomed renewed debate on the law.

“You don’t prosecute doctors for good medical practice, surely,” he said.

“I firmly believe – and Steve Guest illustrates it in spades – that if you give people advice and put them in control, the quality of their life is enhanced enormously.”

Mr Guest, 58, had two daughters and was separated from his wife.

Meanwhile, Dr Nitschke said last night he was considering taking up an invitation from the Voluntary Euthanasia Society of New Zealand to move his right-to-die organisation across the Tasman to thwart new federal legislation that comes into effect next January.

Point Lonsdale resident Steve Guest, who had incurable throat cancer, died at home yesterday morning with his brothers, John and Andrew, at his side.

The 58-year-old former Cain government media adviser made a statement to 774 ABC presenter Jon Faine on Tuesday afternoon, declaring that he would “self-medicate in my own bed”.

“I hope I’ve made a difference . . . kicked a few politicians in the goolies, made them sit up and notice and realise that people care. I want to apologise to the God-botherers. I’ve barked at them – sorry if I was rude, but that was only after politely asking them to go away.”

Euthanasia activists Dr Philip Nitschke and Dr Rodney Syme visited him in his last days.

Mr Guest’s plight gained media attention when he rang Mr Faine’s program on July 11 with a moving account of his suffering and his desire to die. He also attacked the “hypocrisy” of politicians who cited Christianity in the debate against euthanasia and abortion. Living in constant pain, with limited movement and unable to consume anything but sips of iced water, Mr Guest said he was annoyed he could not end his life as quickly and as painlessly as his beloved terrier, which was put down. “These bastards who call themselves Christians, they won’t let me have that death . . . and that’s all I want now.”

On Tuesday, Mr Guest had vowed to die on his terms with his favourite music playing. “It will be Ry Cooder or Leo Kottke, although they might be too much of a foot-tapper,” he said.

His brother John said Mr Guest had been delighted by the public’s response to his comments on euthanasia. “I believe it gave him a week of additional life,” he said.

Faine said yesterday: “The point Steve was trying to make is there is something wrong when you can’t end your own suffering the way you want to and instead you are almost compelled to go through that horrible decline. He made his point. He made it brilliantly.”

http://www.news24.com/News24/South_Africa/News/0,,2-7-1442_1740069,00.html

19/07/2005 22:00 – (SA)

Johannes de Villiers

Cape Town – Hospitals must learn to listen to chronically ill elderly patients when it is in their interests to die peacefully rather than have their suffering prolonged, said advocate Kurt Worral-Clare, chief executive of the Hospital Association of South Africa, on Tuesday.

This was one of the ways hospitals could see to it that the needs of a rapidly ageing South African population could be met, he said.

“Perhaps we should conduct dialogue with the ageing population to find out how they would want to be treated if they developed a chronic condition or a terminal illness,” he said.

Worral-Clare said South Africa could learn from the debate in the USA about cases where “continued care would bring no clinical improvement or a better quality of life to the patient. In such cases, they have considered allowing patients to die as comfortably as possible, instead of prolonging their suffering.

Dignified

“The result of such a policy is firstly a dignified death without costly, useless treatment that gives false hope to patients and their family, and secondly, a saving in medical resources.”

Worral-Clare said hospitals faced many challenges because of South Africa’s ageing population.

In 1996, only 1,4% of the medically insured population was older than 66. By 2002, this percentage was almost four times higher – 5,4%.

The result is an increase in the number of chronic diseases (conditions to which the elderly are more susceptible) which have to be treated, he said.

Older people also spend a longer time in hospitals and need far more medical expenditure. All of this puts tremendous pressure on medical resources, he added.

Problems

The medical sector would have to find ways to solve all these problems, because they would only increase in the coming decades.

He added that more had to be done in future to create a comfortable environment for the many people who would die in hospital from their chronic illnesses.

This should be a home-like surroundings where relatives and friends can also visit out of the normal visiting hours, he explained.

Kate Legge, Social affairs writer
July 22, 2005

A MELBOURNE doctor risks prosecution after confessing he has helped a terminally ill man who wants to die.

Voluntary euthanasia activist Rodney Syme yesterday revealed he had supplied information to Steve Guest, a former state government media adviser, who has appealed for the right to die with dignity.

Mr Guest, who has inoperable cancer of the oesophagus, was interviewed in The Weekend Australian and has been heard on Melbourne’s ABC radio begging for a compassionate release from his suffering. Dr Syme visited Mr Guest in his Point Lonsdale home this week.

Diagnosed with cancer in September, Mr Guest believes he has two to six weeks of life left. He weighs 50kg and is in the advanced stages of “cachexia” or death through metabolic disorders as the body wastes away.

“It is absolutely appalling, this death by degrees, and giving him the advice he is seeking is good medicine,” Dr Syme said. “It relieves the extremes of psychological and existential distress … This is the best palliative care anyone in his position could have.”

Australian law forbids assisting a person with suicide, and recent legislation forbids websites from publishing information to assist with suicide or euthanasia.

Historically the courts have not imposed penalties on those found guilty of assisting suicide and euthanasia activists are keen to embolden general practitioners who want to counsel terminally ill patients about the options.

“When you give patients appropriate information and medication then you improve their quality of life and the length of their life, because this knowledge gives them security and prevents disastrous violent and shocking suicides that occur when these people have no one to turn to,” Dr Syme said.

It has taken former journalist, political advisor, and media manager, Steve Guest, to speak out courageously this week about
how it feels to die the death you do not want.

A quintessential Baby Boomer, fifty-eight year old Guest made an impromptu phone call to ABC Radio Melbourne’s “Open
line” this week where he described in detail his fight with oesophogeal cancer and why he believes he deserves the right to die
with dignity. With only weeks to live, Steve is rapidly becoming the new face of the Voluntary Euthanasia movement in
Australia, sparking a week of impassioned talk back on Melbourne radio.

A member of Exit International and supportive of the work of Dr Philip Nitschke, on Thursday 21 July, Steve will speak (with Dr
Nitschke) at a public meeting where the rational of the Peaceful Pill option will be examined in detail (Steve calls it a “magic
bullet”). The best example of this is the highly restricted version of the barbiturate known as Nembutal.

In going public with his story, Steve is not only showing extraordinary bravery and courage, but he is trying to prevent others
from suffering the trauma and turmoil that is engulfing him in his final weeks of life.

While many people get cancer, far fewer are prepared to lay their lives open, to point out the indignity of their situation or the
unfairness that they cannot get the same end of life treatment as their pets; a point Steve makes only too succinctly.

Tuesday, July 19
REBECCA TUCKER

POINT Lonsdale’s Steve Guest wants to dial a “magic bullet” – the so-called peaceful pill – so he can die with dignity.

The 57-year-old oesophageal cancer victim is spreading the euthanasia message with Australia’s “Dr Death” Phillip Nitschke.

Mr Guest said he did not choose death – it chose him – but the end will be on his terms.

He will phone the anonymous person who has agreed to hand him a dose of the barbiturate Nembutal.

The plan is not legal.

It is mostly not politically or socially acceptable.

But it is as compassionate as it is confronting.

Mr Guest wants it to be unnerving.

“We should have to confront it,” he said of death.

In the past few days, the one-time Geelong Advertiser journalist-turned-public relations officer has been telling a story he never thought he would have to.

His own.

It is a story he struggles to tell as the media lines up since his impromptu telephone call to Melbourne’s 774 ABC radio last week.

Mr Guest’s battle is not with the knowledge he is going to die, but the disease has gripped him so much that each word is difficult.

Throughout a half-hour telephone interview, Mr Guest pauses to sip water and wet his unbearably dry mouth.

Each sip wants to regurgitate but, just as his ability to swallow is long gone, so is his body’s capacity to vomit.

“It can’t come back up so it causes an intense spasm in my oesophagus which is just so debilitating and awful,” said Mr Guest, who feeds himself via a tube directly into his stomach. He lives alone, and that’s how he wants it to stay.

He is not complaining. Just explaining.

For a man with probably only weeks to live, his eloquence and calmness is inspiring.

He said he had been calm since being diagnosed with the disease last year, even after being told in September that the cancer was inoperable.

“I have been able to accept this, I think, with a great calmness and it’s comforting to be able to do so,” Mr Guest said.

“But I’m anxious that I may not know how my death will occur and that not knowing has got on top of me at times.”

Mr Guest has always supported voluntary euthanasia because he believes nobody should die in pain and indignity.

But he never planned to become the face of the cause.

He never planned for cancer.

Earlier this year Mr Guest joined euthanasia campaigner Dr Nitschke’s group, Exit International.

He is becoming the confronting face of their cause.

On Thursday, Mr Guest plans to speak alongside Dr Nitschke at the Geelong West Town Hall during one of Exit International’s nationwide public meetings to tell older people they have a right to choose their own death.

Perillously weak, a shadow of his former self at less than 50 kilograms, he hopes his health will permit him to speak.

Dr Nitschke said stories such as Mr Guest’s were what continued to motivate his campaign as he travelled Australia to encourage the elderly to prepare for their own death.

“Steve is saying quite loudly that he’s now in a situation where he wishes he had the choice,” Dr Nitschke said.

He expected the Geelong meeting would attract the usual protestors, but said he continued to be perplexed that one group thought it had the right to dictate to the dying.

Mr Guest called them “bastards”.

“Were I still to have a dog and anyone saw it looking the way I do now, they’d call the RSPCA and I would be prosecuted for maltreatment.,” he said.

“How stupid, how utterly stupid and indecent.”

He was aware the legal danger his anonymous helper had placed themselves in by granting his wish to access the pill.

“Considering the risk they would be in should they ever be identified, I salute that,” he said, rejecting any thoughts it was suicide, or a decision made under a cloud of depression.

Now death has forced its way in and his twin daughters, about to turn 23, are the reason he wants to choose his own death.