No Goodbye

After
by Nikki Gemmell
Fourth Estate, 2017, 304 pages, $29.99
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When I heard about Nikki Gemmell’s new book, After, I faced a dilemma. A memoir about the “euthanasia death” of her mother, Elayn Gemmell, would bring up my own memories. I went to the bookshop twice before I purchased.

The story opens with the drama of police at the door. The reader then shares a journey towards making some kind of sense from the pain. What do you call this death? Suicide doesn’t sit well and “euthanasia death” doesn’t quite fit either. Gemmell struggles. Structured like diary entries, the vignettes are transparent and powerful. She reveals the distance between daughter and mother, the vulnerability of a woman who’d lost connection with her children and a daughter left with a cruel blow; her mother chose to die without saying goodbye.

Gemmell thinks her mother spent the last days curled in the “foetal position” with pain in her feet from past surgery. She was frightened, alone, and dosed up on drugs. “Her bleak last days feel like they were marked by despair and anguish; overwhelmed by hopelessness,” says Gemmell. Elayn was also struggling with the disruption and indignity of having no bathroom while builders delayed a renovation. A fortnight before her death Elayn phoned her daughter, “sobbing with the abandon of a child”, afraid of her future, but she was not ly ill. Elayn was trapped in a flat, relying on children too busy to attend and suffering from pain that affected sleep and movement.

A mysterious liquid is found in the freezer. Gemmell discovers that her mother was a member of Exit International, an organisation that used to describe itself as a euthanasia advocacy group. It now identifies as a group which also provides “support” for suicide planning. Initially angry, Gemmell contacts Exit International’s infamous leader, Philip Nitschke. He confirmed that Elayn was a member and had bought Nembutal, the deadly stuff in the freezer. Nitschke also tells Gemmell that Elayn’s doctor wrote to him. “She must have asked for the letter to be sent. I don’t know why,” says Nitschke. Gemmell complained that her mother died alone without family. Nitschke explains that people tell him they don’t let family know of their intention to suicide in case there are suspicions about the death. It’s to protect family members from “legal risk”.

The coroner found “Multiple Drug Toxicity” was the cause of death, so Gemmell concludes her mother must have ditched the Nembutal and planned something different—worked it all out by herself. Nitschke tells Gemmell he’s sorry Elayn had trouble getting information but glad she died in a way that she wanted.

Here’s the thing. Having explored the workings of Exit International after my mother’s apparent suicide in 2005, aspects of the dialogue between Nitschke and Gemmell just don’t ring true.

First, all members of Exit International, anyone who wants access to Nitschke or any services provided by the organisation, have to sign a waiver when they join to say they won’t use the information provided to kill themselves. His literature is peppered with advice encouraging victims not to tell anyone who might not support a suicide plan. Gemmell includes some of those pieces of advice, like “the optimal time for killing yourself” so others won’t discover what you’re doing. Nitschke is not the neutral observer he purports to be when chatting with Gemmell.

Second, “Multiple Drug Toxicity” is also in Nitschke’s repertoire. It’s a method he recommends for members who have access to prescriptions. The letter from Elayn’s doctor is exactly the kind of document he would have asked for to find out what drugs Elayn could access by doctor-shopping.

In October 2015 Nitschke made an agreement with the Australian Medical Board to accept twenty-six conditions on his medical licence rather than face a medical tribunal hearing in relation to twelve complaints. A month later, following a poll of Exit International members to find out if they wanted him to continue his work at the organisation or keep his licence, he changed his mind. He burned his practising certificate at a press conference rather than submit to the scrutiny of the health regulator. We will never know what evidence the board had! Nitschke ducked for cover. Why would anyone believe Nitschke when he says that the secrecy practised by Exit International members is for the sake of unwitting relatives like Nikki Gemmell?

Gemmell says, “Elayn didn’t know enough about alternatives,” and points out the correlation between chronic pain and depression. She even describes the chemical process that occurs in the brain as a “vicious cycle”. Nitschke says he gets troubled by assumptions that older folk are vulnerable. He doesn’t think depression is common in the elderly. Isn’t this a flag for Gemmell? Didn’t the letter from Elayn’s doctor indicate vulnerability? What assumptions did Nitschke make about Elayn’s mental state and readiness for death; this lady who was “emotionally naked” at the time, according to her daughter?

Going public with the death leads the author to correspond with other euthanasia advocates and she gets tied up in the rhetoric of the euthanasia debate. Gemmell tries to work out whether this death was a case of “empowerment” or an act of despair. One contact makes a particular impression and Gemmell eventually decides this death was what her mother wanted, yet she still thinks it could have been different. She suggests the death might have been okay if done through the Swiss group Dignitas at a later time, allowing the family a chance to make some final memories.

My mother’s death could have been different too. I could have reassured her that a nursing home was not her lot. Maybe Gemmell’s mum could have had reassurance that she was not a burden, and some support to go see that pain specialist. Gemmell writes pages to make sure the reader knows how vulnerable her mother was. She doesn’t explain why Nitschke should not be accountable for dealing with the victim’s potential depression before giving information and support to plan a suicide. She even concludes that Nitschke is a humanitarian who “cares deeply”.

A police officer told Gemmell she sees this kind of death often but no one talks about it. I had a similar experience with police. Gemmell refers to Australia’s suicide data and the link between pain and social isolation. She tells us fatal overdoses of codeine doubled between 2000 and 2009. Several of Nitschke’s favoured suicide methods have been reported, showing increases in the data over similar time frames, but I’ve not found a researcher who has made the link to Nitschke’s activities. The police officer was right: no one’s keeping track of suicides connected to Exit International.

Nikki Gemmell didn’t hear her mother’s call for help because they were in the middle of a difficult relationship—a communication pattern that got in the way of their capacity to support each other when the chips were down. Elayn Gemmell was neither ly ill nor suffering from an incurable illness. She was a lonely, disconnected individual whose powers of reasoning were affected by depression and pain. Human connection is a concept that euthanasia advocates can’t afford to consider. To discuss connection while considering an individual’s so-called “right to die” brings the debate to an impasse. Empowerment is finding a way out of hopelessness, not ending life, vulnerable and lonely. Gemmell thinks changing the law is the answer, even though authorities are apparently failing to enact the laws we already have.

Nikki Gemmell’s trauma and the pain endured by her family are the inspiration for her story. The heart of her pain and mine is that we were daughters and we were locked out at a time when our mothers needed us. Gemmell misses the point about access to means for a vulnerable lady and is apparently now an advocate for the euthanasia cause, but when her time comes Gemmell says she won’t do what her mother did. I guess we are in agreement on that score! Once you experience a suicide you know too much to ever try it yourself.