Ease their pain: don't help them die

When many of us are still grieving over the suicide of that rare and abundantly talented drummer, Paul Hester, Philip Nitschke is out and about spruiking the benefits of so-called self-deliverance.

Leading the efforts to cook up a new barbiturate based suicide pill, Nitschke launched his book, Killing Me Softly: Voluntary Euthanasia and the Road to the Peaceful Pill, in Darwin this week. Written with Fiona Stewart, the book explores the DIY suicide technologies that aim to circumvent the laws prohibiting assistance with suicide. So far in his kitbag he has a carbon monoxide suicide machine and a plastic Exit Bag with an adjustable collar and Velcro strap for a comfortable fit over the head.Nitschke says he looks forward to the day when "patients would have real choice, real options". But his Peaceful Pill is no answer to the social marginalisation, economic disadvantage and oppressive stereotyping that is at the core of so many "free choices".

Women's experiences show how social and cultural biases can affect health care. Several US studies show that women receive fewer cardiac treatments and procedures than men and have worse outcomes. Women are also likelier than men to suffer inadequate pain control. Although women provide most of the care that is given to dying patients, when they need care themselves they tend to receive less assistance from family members than men and are likelier to have to pay for any care they might receive.

As feminist Susan Wolf has put it, "Dimensions of health status that may affect a patient's vulnerability to considering physician-assisted suicide and euthanasia differentially plague women". Is it just a coincidence that most of the prominent assisted suicide cases have been women? In the US there were Diane Trumbull, Janet Adkins and Marjorie Wantz; in Canada, Sue Rodriguez; in Britain, Diane Pretty; in New Zealand, Victoria Vincent and Joy Martin; and in Australia, Nancy Crick, Sandy Williamson, Norma Hall and Lisette Nigot.

Were these women just exercising their glorious right to self-determination? There are other more disturbing explanations that should give Nitschke pause for thought before drawing up his Peaceful Pill marketing plan. The ideal of feminine self-sacrifice is strongly embedded in most cultures. In Greek tragedy suicide is portrayed as a uniquely female solution. Elsewhere, elderly widows of deceased tribal leaders were killed at their own request, often by their sons. There has been no tradition of widower suicide.

This ethic of self-sacrifice was reflected in the suicides assisted by America's "Dr Death", Jack Kevorkian: 72 per cent involved women. The fear of being a burden was a prominent reason for them choosing to kill themselves. A friend of one of them commented, "She felt it was a gift to her family, sparing them the burden of taking care of her”.

None of this is likely to concern Nitschke. He declares he is not worried about the risk of the suicide pill falling into the wrong hands because, "All people qualify”. We must not erect "artificial barriers" such as psychiatric assessments. Is this what he would have told Hester? That the "right to die" is just too important to be trumped by the rights of the most vulnerable, those who are mentally ill, depressed, the elderly bereaved or the troubled teen? Nitschke says, "We need not force misery upon our sick and our elderly in their last hours, days, weeks and years. New strategies to deal with this issue are vital and they are needed now". We can all agree with that. But what an inspiringly innovative strategy he offers - suicide.

Is the best society can offer our elderly and sick the choice between a life of misery and killing themselves? A truly compassionate strategy would work for improvements to the social and health supports we provide the vulnerable members of our community, including wider access to palliative care. We must not abandon the elderly, sick and vulnerable to their "free choices". Medicalising, or legalising their suicides simply legitimises what is, to borrow a phrase from Germaine Greer, the last in a line of non-choices.