Euthanasia advocate Dr Philip Nitschke plans to import a restricted powerful sleeping pill for two terminally ill patients under a scheme offered by the Australian drug regulator that allows doctors to treat life-threatening diseases with medicines that have not gone through formal clinical trials.
Dr Nitschke said he planned to import pentobarbital, also known as Nembutal, for use by a terminally ill woman in South Australia and a terminally ill man in NSW.
Both of the patients are defined as Category A, meaning they are terminally ill and expected to die within a few months.
“Category A of the SAS is intended to allow doctors to treat life-threatening diseases with medicines that may not yet have gone through formal clinical trials. Use of unregistered medicines under Category A of the SAS requires the use to be in accordance with good medical practice, but does not involve any approval process by the TGA,” said a spokeswoman for the TGA.
“Determining whether use of a medicine by a medical practitioner is in accordance with good medical practice is not a matter for the TGA, but rather for the relevant state medical board. The TGA has written to Dr Nitschke advising him of these requirements and of the need for him to ensure his prescribing is in accordance with good medical practice.”
Dr Nitschke said the agency had “warned me that if there was some suggestion or it could be established this was not being done in accordance with good medical practice, there could be penalties applied.”
Dr Nitschke said he “made it clear this would be done not in any way to assist the person to end their life but simply because they were in need of powerful nocturnal sedation.”
However, he acknowledged that both patients had contacted him in his capacity as a euthanasia advocate.
“What I am saying is, if they misuse those drugs, that is exactly what they will get, a peaceful death. But that is not the reason they are being prescribed,” Dr Nitschke said.
Dr Nitschke will be the prescribing doctor for the woman, while the NSW man has his own GP prepared to prescribe the drug.
“There will be people saying it’s nothing more than a cynical exercise to try and get around the restrictions placed on end-of-life or euthanasia drugs but I think there’s a valid medical reason,” he said.
Normal sleeping pills are not effective for many people who are seriously ill and having access to such powerful sleeping pills can sometimes extend life for terminally ill patients, said Dr Nitschke.
“They know they are in the cupboard, they know that if things get too bad, they have got that option to take the drugs peacefully and end their life.”
The patients will sign statements saying they are aware of the risks involved in taking Nembutal, Dr Nitschke said.
Need vs want
Associate Professor Merrilyn Walton, an expert in bioethics at the University of Sydney’s School of Public Health said she would support prescription of such a drug if it was medically required.
“If the medical indications are the patient needs something to relieve pain and that happens also to hasten their death, I support it. But when it comes to administering a medication just because the patient wants it, then I think you are straying into the territory of euthanasia,” she said.
“We are jumping to an extreme position without looking at what we can do better to decrease the angst people feel about end-of-life.”
The euthanasia debate may reveal the failings of the palliative care system, she said.
“We haven’t resolved ethically how people can be pressured into asking for euthanasia. It could be they haven’t had good access to palliative care.”