Australia Delivers World's First Dose of Legal Euthanasia

The isolated, frontier-like Northern Territory in north-central Australia is beginning to draw worldwide attention as the first open and legal test of euthanasia, or doctor-assisted suicide, anywhere in the world.

So far, two Australians, the most recent on Jan. 3, have ended their lives there with the help of a physician.

But now that people are making use of the law, it may be short-lived. The Terminally Ill Act of 1995 faces an attempt to overturn it by the Federal Parliament, as well as a potential legal challenge in the High Court of Australia, that nation's highest court.

The United States Supreme Court hears arguments Jan. 8 on the legality of doctor-assisted suicide laws passed in New York and Washington States. Oregon has also passed an assisted-suicide law. None of them has taken effect pending the court's decision.

Predictably, anti- and pro-euthanasia advocates point to the Northern Territory's experience to support their positions. After the law passed, Oregon right-to-life lobbyist Gail Atteberry predicted the territory would become "the suicide capital of the world." But Robin Fletcher, American spokesman for the pro-euthanasia Hemlock Society, said the act was a thoughtful, compassionate approach for people diagnosed as terminally ill who want to end their suffering.

Analysts cite two reasons to explain the passage of euthanasia legislation in the Northern Territory when similar efforts elsewhere have foundered.

Unlike in Australia's six states, the territorial legislature does not have an upper house, meaning the legislation required only a single vote.

The territory's leader at the time, Chief Minister Marshall Perron, introduced the euthanasia bill, which took only three months to become law. In a heated overnight debate, the Northern Territory Legislative Assembly passed the bill 15 to 10. Critics say Mr. Perron pushed to enact the legislation because he wanted to make his mark on a hitherto undistinguished career before departing from political life.

The act allows a doctor to administer a lethal substance (known as active euthanasia) to a patient diagnosed as terminally ill who is over 18 years old and experiencing unacceptable pain, suffering, or distress. Or a doctor can prescribe or prepare a lethal substance to be administered by the patient (known as physician-assisted suicide).

The Northern Territory's position on euthanasia goes further than that taken by the Netherlands, the only country in the world where euthanasia is practiced openly. There, euthanasia has not been legalized, but doctors are guaranteed freedom from prosecution if they adhere to a set of official guidelines. A patient diagnosed as terminally ill must voluntarily request euthanasia after experiencing unacceptable suffering with no prognosis of improvement.

Polls suggest that a majority of Australians support euthanasia. The legislation has been welcomed by the Australian Federation of AIDS Organizations. The Doctor Reform Society, a coalition of doctors who also support health-care reforms and consumer rights, gives limited support to the legislation but does not force this position on its members.

Euthanasia is opposed by the largest doctors' group, the Australian Medical Association (AMA), and a coalition of religious groups, including Christians, Hindus, and Muslims. They worry that the law will lead to the sanctioning of involuntary forms of euthanasia and the devaluing of human life.

Polls have also failed to register the widespread fear and hostility toward the law among Aborigines, who make up one-third of the territory's population. The Rev. Djiniyini Gondarra, an Aboriginal leader, sees the legislation as an example of government attempts to dismantle Australia's indigenous Aboriginal culture and traditions, which are staunchly anti-euthanasia.

"Our law has been ignored," declares Mr. Gondarra, a Uniting Church of Australia minister. "There should be magaya - peace, order, and good government." According to Gondarra, Aborigines, already distrustful of doctors and hospitals, now worry that nonvoluntary euthanasia will be used by the medical profession to eliminate their race. "To them, it is genocide," he says.

Together with the AMA, Gondarra unsuccessfully tried to challenge the legislation in the Northern Territory Supreme Court last year. The High Court of Australia ruled it would not hear an appeal against the lower court findings until it knows the fate of a federal bill that seeks to overturn the euthanasia law.

The bill was introduced by Liberal Party member Kevin Andrews of Victoria last year. Under the Australian Constitution, the federal government can enact legislation to override laws made by the territory, which is less autonomous than the states.

ON Dec. 10, the Federal Parliament's lower house voted 88 to 35 in support of the anti-euthanasia bill. It still must pass the upper house, the Senate, to become law. The first Senate hearing is scheduled next month.

The federal move has rankled some pro-euthanasia Northern Territory residents, who argue the territory should become a state to prevent such interference.

Euthanasia (from the Greek "good death") has been debated since the time of the ancient Greek philosophers. But it has been only in the past 20 to 30 years that the arguments for euthanasia have been made most forcefully, according to a prominent euthanasia advocate, Helga Kuhse, an associate professor at Monash University in the state of Victoria.

She claims polls show "overwhelming support" for euthanasia in most Western countries and Japan.

According to Dr. Kuhse, it is appropriate that multicultural Australia, home to more than 50 cultural or ethnic groups, become the testing ground for the world's first active euthanasia law. "There are no more mono-religious societies in the Western world," she says. "One can no longer assume that Christian morality - that one must never intentionally take another's life - should shape the views of society."

Medical technology is improving constantly, creating more choices on whether to prolong or terminate life, she says. As consumers, patients are growing assertive and demanding the right to end their lives with dignity.

In the Netherlands, where doctors enjoy a high level of trust, a government committee has been formed to explore the issue of nonvoluntary euthanasia, in instances where individuals are incompetent to decide on the termination of their lives.

According to Kuhse, the committee was established to investigate nonvoluntary euthanasia for severely handicapped infants when it is believed they will have a limited life span and experience suffering that cannot be alleviated.

In the US, Oregon became the first state to allow physician-assisted suicides. But Oregon's Death with Dignity Act, passed in 1994, has not been put into effect because the US Supreme Court is reviewing the constitutionality of physician-assisted suicides. In the potentially landmark case Jan. 8, the court will review lower court decisions in New York and Washington States that upheld the right to assisted suicide.

Thirty-one states have passed anti-euthanasia laws. But in Michigan, retired pathologist Jack Kevorkian has presided over at least 44 suicides and continues to assist people who choose to end their lives. He has been tried and acquitted by juries three times on assisted-suicide charges.

After intense debate, Canada and Britain established committees to investigate reforming laws on euthanasia. The committees recommended against both active euthanasia and assisted suicide.

Amid fierce publicity in the Northern Territory's capital, Darwin, last September, carpenter Bob Dent became the first person to die under the territory's legislation. On Jan. 3, a second Australian, Janet Mills, was given a lethal injection in Darwin by Dr. Philip Nitschke, who was also responsible for Mr. Dent's death.

Both sides of the euthanasia debate agree there are flaws to the legislation. To qualify under the act, a patient must obtain the consent of two doctors who are satisfied that he or she is suffering from a terminal illness that cannot be cured by medical treatment. The patient must be of sound mind and have made the decision freely, after due consideration. A psychiatrist must confirm that the patient is not suffering from medically treatable depression.

But AMA president Keith Woollard points out that there is no single, scientific test to determine depression. "All you have to do is to find a psychiatrist who has the view that you are looking for," he says.

Robert Marr, spokesman for the Doctor Reform Society, argues the legislation is too prohibitive, because it specifies that doctors practicing legal euthanasia must be residents of the territory. Many Northern Territory doctors have succumbed to anti-euthanasia pressure applied by the AMA and refuse to participate, he claims. Mrs. Mills had difficulty obtaining the consent of a third doctor, which delayed her death.

The AMA argues that palliative (pain-relieving) care can allow patients to die with comfort and dignity. Dr. Marr disagrees. He says seriously ill patients are "incredibly reassured" by the suicide legislation.

But the AMA's Dr. Woollard maintains that many of the terminally ill believe they have been "let down" by the euthanasia debate. "To them, euthanasia is giving up, throwing in the towel, and taking a very negative view about what life might hold," he says. "The question really is whether doctors should be out there delivering lethal injections, actually killing people. That is a big step for society to take."

Religious leaders are saddened by the news of a second assisted suicide. "Quite clearly, we are a nation that has come to the end of its resources," says the Rev. Boak Jobbins, Anglican dean of Sydney. "We no longer have anything to offer the terminally ill, the aged, or the disabled but a quick exit at the end of a needle."

The Northern Territory's Roman Catholic bishop, the Rev. Ted Collins, says society needs to acknowledge the individuality of the patient. "If you say, 'you poor thing, I think you should die,' you might be compassionate, but you're not helping the person to see their own worth and dignity by keeping them alive."