Ian McPhee’s cardiac arrest was another crisis point in years of struggle. Photo: Paul HarrisAt 6 o’clock one Friday night last year, Ian McPhee was given five minutes to live.
Dr McPhee, an anaesthetist, had suffered a cardiac arrest after a medical procedure went catastrophically wrong, leaving his heart with no blood to pump.
“They said only five more minutes,” he recalls a doctor at the Royal Melbourne Hospital telling his distraught wife Kath, who is a nurse, that night in August. “That’s it. If he’s not resuscitated in five minutes, that’s it”.
It was another crisis point in years of struggle for Dr McPhee with Sezary syndrome – a skin-based cancer that affects only two or three ns each year.
The disease has burdened him with rounds of chemotherapy and a bone marrow transplant that required the prior “destruction” of his immune system.
That led to the emergence of three major viruses and later, multiple organ failure. A subsequent liver biopsy led to the “five minutes” crisis.
Devastatingly, the bone marrow transplant failed. Weeks later Dr McPhee endured the irradiation of his skin “from the soles of my feet to the tip of my head” in a bid to eradicate tumours.
Briefly in remission, today Dr McPhee’s prognosis is uncertain. “It would seem to have recurred,” he says of the cancer.
He is still facing death, only now it is very much on his terms.
In March, the 62-year-old, from Tweed on the NSW far north coast, contacted Melbourne-based physician Rodney Syme, who after an initial assessment has “provisionally” agreed to provide a drug, Nembutal, to Dr McPhee to use if he decides to end his life.
Provision of the drug is a legal grey area and Dr McPhee’s wife and four adult children, who support his decision, may face police questioning in the aftermath.
In three weeks, Dr McPhee and his family will travel to Melbourne to make final arrangements with Dr Syme. The drug will not be handed over, but the pair will remain in touch until such time as he decides to take the option.
Making the arrangements will not be a difficult process, he says. Rather, “there will be great comfort”.
Dr McPhee knows there is a chance he might never need to use the drug, but says the comfort is derived from knowing it is there should the moment arrive.
“If I’m in a position such as the one I was in last year of overwhelming, unrelenting discomfort, either physical or existential, with no hope of a way out of that, then that is the moment,” he says.
Dr McPhee is an advocate for voluntary assisted dying legislation.
The NSW Legislative Council is due to consider a bill this month. If passed into law, it would allow terminally ill NSW residents aged at least 25 to end their own lives with medical assistance.
A patient must be likely to die of their illness within 12 months, the decision signed off by two medical practitioners and the patient assessed by an independent psychiatrist or psychologist.
Dr Ian McPhee with wife Kath and their dog Jack at their home in northern NSW. Photo: Paul Harris
MPs from the major parties will be granted a conscience vote. While advocates are hopeful it will pass the upper house, they acknowledge the numbers are tight.
The bill, conceived by a cross-party working group of state MPs, has prompted fierce debate and lobbying from both sides.
As part of its campaign in support of the legislation, the group Dying with Dignity NSW has filmed a video with Dr McPhee.
The Catholic Church has mobilised a grassroots campaign against voluntary assisted dying laws in NSW, with parishioners, school staff and parents urged to petition MPs.
The anti-euthanasia organisation HOPE is also active, arguing that such laws “would pose a very real threat to the disabled, the elderly, those with mental health issues and those ns, including young people, struggling with suicidal ideation.”
Dr Ian McPhee says making the arrangements to end his life would not be a difficult process. Photo: Paul Harris
The medical profession has been forced to take a position.
Last December the n Medical Association updated its policy to one which “maintains the position that doctors should not be involved in interventions that have as their primary intention the ending of a person’s life”.
But it adds: “The AMA acknowledges that laws in relation to euthanasia and physician-assisted suicide are ultimately a matter for society and government”.
Should governments decide to change the law, the AMA policy states doctors “must be involved in development of the relevant legislation, regulations and guidelines”.
The NSW AMA, however, has taken a firm position against voluntary euthanasia, putting Dr McPhee – for the time being at least – at odds with the professional association.
The division’s council is due to consider in detail the NSW assisted dying legislation at a meeting next week.
“We feel that in the majority of cases palliative care is the appropriate way to manage death and dying, accepting that it’s not perfect,” says NSW AMA president Brad Frankum.
Professor Brad Frankum, NSW president of the AMA, has taken a firm position against voluntary euthanasia. Photo: Hayden Brotchie Photography
However, as a physician, Dr McPhee feels voluntary assisted dying is consistent with the medical principle of “first, do no harm”.
While he believes it “remains absolutely critical” that palliative care is supported, he says not all pain and suffering can be managed successfully that way.
He points out that for the past 20 years he has also run an acute pain service.
“So you could argue that one of the tasks I have had in medicine is to relieve pain to alleviate suffering,” Dr McPhee says. “And I see this as no different”.
Dr Syme, who is vice-president of Dying With Dignity Victoria, tells Fairfax Media he assessed Dr McPhee as a suitable patient because “he faces an appalling death”.
It has never been tested in court, but he disagrees that what he does is illegal.
This, he believes, was borne out in his successful appeal last December in the Victorian Civil and Administrative Tribunal which overturned the Medical Board of decision to prohibit him from providing advice to terminally ill patients.
Dr Syme says the aim with all of his patients “is to try and help them to go as far with their lives as they possibly can”.
Physician Rodney Syme says his intention is to improve patients’ quality of life.
Providing them with the knowledge they can access a life-ending drug relieves the intense psychological distress suffered by many patients, he says.
“Whether a person takes the medication I might give them is their intention, not mine,” he says.
“I argue that it is not my intention ever to persuade somebody to end their own life. My intention is to improve the quality of their life, to give them control. So I argue that I am not breaking the law”.
Ultimately, Dr McPhee said, the difference that passage of the NSW bill into law would make is significant for someone in his situation, including that he would not need to travel to be a patient of Dr Syme’s.
He would have the option of engaging with his local GP and dying at the time of his choice in the community he has lived in for 25 years.
In the meantime he is secure in the knowledge his plan will be in place.
“The time when I had multiple organ failure was hell; it was as awful as I can imagine any end of life,” he says. “I know I don’t want that again.”