120201 Australian Doctors Fuel Euthanasia Debate
            By JOHN SHAW

            SYDNEY, Australia, Dec. 1 — An Australian doctor accused of murdering 
            a dying patient was acquitted a few weeks before publication of a 
            survey indicating that many Australian surgeons have hastened death 
            for the terminally ill.
            This news is renewing a debate here about laws that prohibit doctors 
            from helping terminally ill patients end their lives, a practice 
            legalized in the Netherlands, and the subject of legal and ethics 
            debates elsewhere.
            Under Australian law, doctors who grant a patient's request for 
            quicker death risk prosecution, although the medical profession's 
            own ethics guidelines allow responses close to the legal limits.
            A law in the Northern Territory allowing doctors to provide the 
            means for "mercy killings" was overruled four years ago by the 
            national government after nine months of controversy in which four 
            people who were dying chose to take fatal cocktails of prescribed 
            drugs.
            According to the survey, published in the current Medical Journal of 
            Australia, one in three general surgeons, a group that performs 
            operations and provides general care, had, in terminal cases, given 
            drugs in doses "greater than those required to relieve symptoms, 
            with the intention of hastening death." One in five had done so 
            without the patient's knowledge or consent, and one in 20 said they 
            had given a lethal dose to patients who made clear requests.
            Most of the 683 surgeons questioned have treated patients in 
            palliative care or terminal stages, and they indicated that they 
            believed there were circumstances in which it was morally acceptable 
            to use drugs to end life, according to the survey report by six 
            medical researchers and Dr. Allan Spigelman of the medical faculty 
            of Newcastle University. 
            Professor Spigelman said the survey responses, made anonymously by 
            mail, "indicate the extent to which doctors work in an invidious 
            environment." 
            "In some ways it is a climate of fear because of inadequate guidance 
            on how to negotiate decisions in terminal cases," he said.
            Dr. Roger Hunt, a specialist in palliative medicine whose comments 
            accompany the report, said in an article: "If the criminal code was 
            applied many surgeons could be charged with murder. That would be 
            unjust in many terminal care situations in which doctors 
            compassionately accede to patients' requests. The duty of doctors to 
            satisfy the wishes of patients can conflict with the law." Dr. 
            Michael Ashby, a professor of palliative care who also reviewed the 
            findings, said they "reflect serious ethical confusion," adding 
            that, if doctors "are really intending to hasten patients' deaths, 
            then the community needs to know." 
            The results of the survey — answered by two-thirds of the roughly 
            1,000 general surgeons in Australia — were published a few weeks 
            after the acquittal in Fremantle, in Western Australia, of Dr. Daryl 
            Stephens, who was charged with the willful murder of a patient, 
            Freeda Hayes.
            A Superior Court jury took only 10 minutes to free Dr. Stephens, and 
            Ms. Hayes's brother and sister, who were accused of homicide and 
            assisting a suicide.
            Ms. Hayes, 48, suffering from kidney cancer, was so sure her death 
            was imminent that she organized a wake for herself at her home 
            before she was admitted to a hospice. She died there the next day 
            after a visit by Dr. Stephens and the two relatives. An inquest 
            found traces of nontherapeutic drugs in her body, but the police 
            were unable to provide evidence of how she received them.
            Dr. Kingsley Faulkner, president of the Royal Australasian College 
            of Surgeons, which helped design the survey, said that its results 
            were "probably a microcosm of public attitudes," but that his group, 
            which has a membership of 5,500, did not intend to press for law 
            reforms.
            Dr. Trevor Mudge, chairman of the ethics committee of the Australian 
            Medical Association, said: "Voluntary euthanasia is a very difficult 
            issue. Patients have rights, but so do doctors. Licensing doctors to 
            kill in terminal cases would be unacceptable, the absolute 
            antithesis of the profession." 
            The guidelines of the association, which represents most Australian 
            doctors, say that terminally ill patients have the right to relief 
            of pain "even when such therapy may shorten life," but this 
            professional principle does not have the force of law.
            Dr. Phillip Nitschke, a leading voluntary euthanasia advocate who 
            has defeated several attempts by the association to take away his 
            license, gives free consultations to terminally ill people seeking 
            advice on how to obtain drugs to hasten their deaths. "I am walking 
            a very thin line, right on the edge of the law," he said.