Friday, June 14, 2024

European Court: Assisted Suicide Not a Human Right

This article was published by National Review online on June 13, 2024.

Article: Court rules: There is not right to assisted suicide in Europe (Link).

Wesley Smith
By Wesley J Smith

Back in 1997, the euthanasia movement tried to gain an assisted-suicide Roe v. Wade. It didn’t work out. The Supreme Court instead ruled in Glucksberg v. Washington 9–0 that there is no constitutional right to assisted suicide, which, in a delicious irony, became the primary precedent applied in Dobbs to overturn Roe.

At the same time, the high court also ruled that refusing life-sustaining treatment is not the same thing as suicide in Vacco v. Quill. In other words, “pulling the plug” is allowing nature to take its course and not self-killing.

Now, some 27 years later, the European Court of Human Rights has issued a similar ruling. In a case brought by an ALS patient who wants to die, the court decided instead that countries can outlaw assisted suicide (PAD, physician-assisted death) without violating the human rights of the terminally ill and, moreover, that self-killing is not the same thing as refusing or withdrawing life-sustaining medical treatment (RWI). From Karsai v. Hungary:

The Court further notes that it has found it justified for Hungary to maintain an absolute ban on assisted suicide, on account, among other aspects, of the risks of abuse involved in the provision of PAD, which may extend beyond those involved in RWI…the potential broader social implications of PAD; the policy choices involved in its provision…; and the considerable margin of appreciation afforded to the States in this respect.

Similar cogent reasons exist under Article 14 for justifying the allegedly different treatment of those terminally ill patients who are dependent on life-sustaining treatment and those patients who are not, and who in consequence cannot hasten their death by refusing such treatment. The Court would note in this connection that, in contrast to the situation with regard to PAD, the majority of the member States allow RWI… Furthermore, as mentioned above, the right to refuse or withdraw consent to interventions in the health field is recognised also in the Oviedo Convention, which, in contrast, does not safeguard any interests with regard to PAD.
The Court therefore considers that the alleged difference in treatment of the aforementioned two groups of terminally ill patients is objectively and reasonably justified.

This is excellent news. But the court did not rule — as Glucksberg did not about states — that countries cannot legalize assisted suicide or euthanasia.

This puts the issue squarely in the democratic sphere. Hence, it is up to us to prevent the death agenda’s spread.

Assisted suicide lobby leader lies at Delaware HB 140 hearing.

Alex Schadenberg
Executive Director
Euthanasia Prevention Coalition

Nearly every state that has legalized assisted suicide has expanded their laws.

On Wednesday, June 12, the Delaware State Senate debated assisted suicide Bill HB 140. The last online presenter was Kim Callinan, the President of the assisted suicide group, Compassion & Choices. In her presentation Callinan lied three times about key issues.

The first lie was that there have been no abuses of the law.

An article by Jennifer Brown that was published in the Colorado Sun on March 14 reported that Dr. Jennifer Gaudiani, an internal medicine doctor who specializes in eating disorders published a paper on how she prescribed assisted suicide for three people with anorexia nervosa in Colorado. Gaudiani approves assisted suicide for Anorexia Nervosa by falsely defining the condition as terminal.

Kevin Dias, the Chief Legal Advocacy Officer for Compassion & Choices  responded to the Colorado Sun article by stating that:
Medical aid-in-dying laws apply only to mentally capable, terminally ill patients with six months or less to live who are able to self-ingest the medication. Any deviation from these requirements violates the law and places physicians, family members and others in regulatory, civil and criminal jeopardy. This law does not and was never intended to apply to a person whose only diagnosis is anorexia nervosa.
Kevin Dias admitted that the law was violated. To make matters worse, the Oregon 2021 assisted suicide report listed Anorexia Nervosa as a reason for at least one assisted suicide death.

Therefore the law had been violated at least 4 times on this issue alone.

The second lie is her statement there is no "slippery slope."

Oregon: In 2019 Oregon expanded their assisted suicide law by giving doctors the ability to waive the 15 day waiting period when a person was deemed near to death. In 2023 Oregon removed the residency requirement extending assisted suicide nationally to anyone.

California: In 2021 California expanded their assisted suicide law by reducing the waiting period from 15 days to 48 hours, it forced doctors who oppose assisted suicide to be complicit in the process (later struck down by the court).

New Mexico: In 2021 New Mexico passed assisted suicide Bill HB 47 further codifying the assisted suicide lobby's expansion plans. HB 47 did not require a 15 day waiting period but it rather required a 48 hour waiting period that can be waived if the health care provider believes that the person may be near to death, technically allowing a same day death.

New Mexico also passed an expanded definition of who could prescribe and participate in assisted suicide. HB 47 allowed non-physicians defined as "health care providers" to approve and prescribe lethal drugs. "Health care providers" includes physicians, licensed physician assistants, osteopathic physicians, or nurses registered in advanced practice. The assisted suicide lobby is expanding who can prescribe and participate since very few physicians are willing to assist a suicide.

Vermont: In 2022 Vermont expanded their assisted suicide law by removing the 48 hour waiting period, (allowing a same day death), removing the requirement that an examination be done in person, (allowing approvals by telehealth), and it extended legal immunity to anyone who participates in the act. 

In 2023Vermont expanded their assisted suicide law by removing the residency requirement expanding assisted suicide nationally by allowing anyone to die by assisted suicide in Vermont.

Washington State: In 2023 Washington State expanded their assisted suicide law by allowing advanced practice registered nurses to approve and prescribe lethal poison, by reducing the waiting period to 7 days and to force healthcare institutions and hospices to post their assisted suicide policies.

Hawaii: In 2023 Hawaii expanded their assisted suicide law by reducing the waiting period from 20 days to 5 days, by allowing the waiting period to be waived if the person is near to death and by allowing advanced practice registered nurses to approve and prescribe lethal poison.

Colorado: On June 5, Colorado Governor Gary Polis signed Senate Bill 24-068 to expand their State assisted suicide law.

Senate Bill 24-068 expanded the Colorado assisted suicide law by: allowing advanced practice registered nurses to approve and prescribe lethal poison, reducing the waiting period from 15 days to 7 days, allowing the doctor or advanced practise registered nurse to waive the waiting period if the person is near to death, Adding language specifying that if any end-of-life options conflict with requirements to receive federal money, the conflicting part is inoperative and the remainder of the law will continue to operate.

New Jersey. There is currently a lawsuit by the assisted suicide lobby challenging the New Jersey state residency requirement for assisted suicide.

Even if Callinan considers these expansions of assisted suicide to be only legal "updates" (which doesn't explain the removal of the residency requirements in Oregon and Vermont), this year's attempted expansion of assisted suicide in California (SB 1196) to include euthanasia for people who are not terminally ill is clearly proof of a slippery slope. 

The only reason Compassion and Choices opposed the California SB 1196 is that passing the bill would have made it more difficult to pass assisted suicide legislation in other states, such as Delaware.

The goal of the assisted suicide lobby is to legalize assisted suicide in more states and to expand the scope of the assisted suicide laws in the states that have legalized assisted suicide.

The third Callinan lie was stating that all of the laws are similar to the Oregon law. 

I have no love for the Oregon law, but clearly most state assisted suicide laws have similarities and differences to the Oregon law.

For instance, Oregon only allows physicians to participate in assisted suicide. Several states have redefined who can participate as being a "Health care provider" which includes doctors of osteopathy, advanced registered nurses, and physician assistants.

Another significant difference is the waiting periods. Oregon originally required 15 days, but later allowed the waiting period to be waived if a person is nearing death. Some states permit a 48 hour waiting period that can also be waived and some assisted suicide bills have had no waiting period.

As stated earlier, Vermont allows the physician to examine the person by telehealth and some jurisdictions allow the lethal poison to be sent to the person by mail/courier.

Clearly the laws differ in the states where it has been legalized.

More articles on this topic:

  • The widening scope of assisted suicide in the US (Link).
  • Nearly every US state that has legalized assisted suicide has expanded its law (Link).

Thursday, June 13, 2024

Register for the next Compassionate Community Care - Visitor Training Program - June 18 and 20.


Kathy Matusiak Costa
Register for the free online visitor training program and becoming involved with visiting people in your community who are elderly and/or living alone.
 
Caring for people. Gain the confidence to journey with those who are lonely, socially isolated, sick, or dying, to renew their hope and purpose in living until they die.
 
FREE Online Training – Live on Zoom! 
 
Alex Schadenberg
Register online (Registration Link).
 
The Training Workshop is composed of two sessions, each session is two hours on:
Tuesday June 18 (7 pm - 9 pm) (EST) and 
Thursday June 20 (7 pm - 9 pm) (EST)

With Kathy Matusiak Costa, Executive Director of Compassionate Community Care, and Alex Schadenberg, Executive Director of the Euthanasia Prevention Coalition. 

Register online now: (Registration Link)

 Compassionate Community Care: 
383 Horton St. E, London, ON N6B 1L6
Office tel. 519-439-6445 
info@beingwith.org • www.beingwith.org

CCC Helpline: 1-855-675-8749
 
Charitable registration # 824667869RR0001

Father of Calgary Autistic woman, who was seeking euthanasia, has withdrawn his appeal.

M.V. has refused food and fluid for 16 days.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The father of the Calgary autistic woman, who was scheduled to die by euthanasia on February 1, withdrew his appeal of a court decision that prevented his daughter from dying by euthanasia, because the case is essentially moot.

Meghan Grant reported for CBC news that:

A Calgary father fighting through the courts to keep his 27-year-old daughter from accessing medical assistance in dying (MAID) has abandoned his appeal, 14 days after she stopped eating and drinking.

The woman, who can only be identified as M.V. because of a publication ban, was set to receive MAID in February. Her father — W.V. — does not believe his daughter has any medical conditions that would qualify her for MAID and wanted the courts to review how she was approved. 

M.V., whose only publicly known diagnoses are autism and ADHD, has never disclosed in court the conditions she suffers from which led to her approval. 

At the end of May, M.V. began starving herself because a judge's order blocks her access to MAID until appeal arguments — originally set to take place in October — can be heard.

M.V. stopped eating and drinking on May 28. Normally someone dies by dehydration in 10 - 14 days after refusing food and fluids. W.V. dropped the appeal on Day 15 because the court case had become essentially moot. Grant reports:

Last week, after learning of M.V.'s voluntary stoppage of eating and drinking (VSED), Alberta Court of Appeal Justice Jolaine Antonio expedited the case to be heard on June 24.

But on Tuesday, W.V. filed a discontinuance of appeal.

Although no reasons were given in the document, a partially redacted letter from W.V.'s lawyer filed with the court last week alerts the court to the possibility that the appeal would be discontinued.

"We have asked counsel for the respondents, M.V. and [Alberta Health Services] for additional information or clarity on these circumstances but no information has been forthcoming prior to 3:00 p.m. today," wrote W.V.'s lawyer Sarah Miller.

In the letter, the lawyer says that a discontinuance would be filed if the question of an injunction becomes moot.

That could suggest that if M.V. continued her current course of action, the appeal would become unnecessary. 

Grant reported that the father opposed the euthanasia death of his autistic daughter because:

M.V.'s father believes his daughter is generally healthy, and his lawyer previously argued in court that any physical symptoms she presents are a result of psychological conditions. 

The daughter's only known diagnoses are autism and ADHD, but those conditions do not qualify her for MAID.

This case is very important to me (Alex Schadenberg) since I have an autistic son who is a similar age. I believe that MV, who is otherwise healthy, was only approved for euthanasia because she is autistic. This is clearly a form disability discrimination.

M.V. was originally scheduled to die by euthanasia (MAiD) on February 1, but her father obtained a temporary injunction, on January 30, 2024, preventing her death.

CBC News reported on March 12, 2024 on this case that the father argued that his daughter did not have a medical condition that qualifies under the law for death by lethal poison (MAiD) and yet the daughter had already been approved to be killed.

CBC News reporter, Meghan Grant reported on March 25, 2024 that Justice Feasby ruled that the 27-year-old daughter can die by euthanasia despite her father's concerns. Feasby withdrew the temporary injunction that prevented M.V. from dying by euthanasia but Feasby maintained a 30 day stay of the injunction, which gave the father time to appeal the decision.

Justice Feasby ordered an assessment of the role of Alberta Health Services with relation to the approval of euthanasia for the autistic daughter.

On April 2, 2024, Kevin Martin reported for the Calgary Herald that the father of the 27-year-old autistic woman appealed the decision to the Alberta Court of Appeal.

On April 8, Justice Anne Kirker ordered a stay on the injunction to prevent the death of the M.V. until after the appeal is decided. The date of the appeal was in October.

On May 30, the Euthanasia Prevention Coalition (EPC) announced that we were granted intervener standing in the case. EPC submitted it's application to intervene, with legal arguments, on May 17.

Those who advised M.V. to stop eating and drinking used her for their own political and social purposes. I am incredibly saddened by the outcome of this case.

Court rules: There is no right to assisted suicide in Europe.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The European Court of Human Rights ruled (6 to 1) that under human rights law, there is not right to assisted suicide in Europe. 

The Irish Legal News reported on June 13 that:
Dániel Karsai, a prominent human rights lawyer in Budapest, Hungary, unsuccessfully argued that the criminalisation of physician-assisted dying (PAD) violated his rights under Articles 8 (right to respect for private and family life) and 14 (prohibition of discrimination) of the European Convention on Human Rights.
Karsai was challenging the Hungarian law prohibiting assisted suicide at the European Court of Human Rights. The Irish Legal News reported:
Under Hungarian law, anyone assisting him would risk prosecution, even if he died in a country which allows physician-assisted dying. He complained to the ECtHR of not being able to end his life with the help of others and of discrimination compared to terminally ill patients on life-sustaining treatment who are able to ask for their treatment to be withdrawn.

In today’s Chamber judgment, the court observed that there were potentially broad social implications and risks of error and abuse involved in the provision of physician-assisted dying.
The Court found that proper end-of-life care provides a dignified death and that withdrawal of treatment is different than assisting someone to die. The Irish Legal News reported:
The court considered that high-quality palliative care, including access to effective pain management, was essential to ensuring a dignified end of life.

According to the expert evidence heard by the court, the available options in palliative care, including the use of palliative sedation, were generally able to provide relief to patients in the applicant’s situation and allow them to die peacefully. Mr Karsai had not alleged that such care would be unavailable to him.

As regards the alleged discrimination, the court found that the refusal or withdrawal of treatment in end-of-life situations was intrinsically linked to the right to free and informed consent, rather than to a right to be helped to die.

This is widely recognised and endorsed by the medical profession, and also laid down in the Council of Europe’s Oviedo Convention. Furthermore, refusal or withdrawal of life-support was allowed by the majority of the member states. The court therefore considered that the alleged difference in treatment was objectively and reasonably justified.
Jean-Paul Van De Walle at
European Court of Human Rights
ADF International, along with UK-based NGO Care Not Killing, intervened in the case of Karsai v. Hungary, stated in their media release that:
In its decision, the Court affirmed that prohibition of assisted suicide is in line with the country’s obligations under international law to protect life. Additionally, as the court pointed out, “the majority of the Council of Europe’s member States continue to prohibit” euthanasia and related practices (§ 165).

“We applaud today’s decision by the European Court of Human Rights, which upholds Hungary’s essential human rights protections. Although we deeply empathize with Mr. Karsai’s condition and support his right to receive the best care and relief possible, it is clear from other jurisdictions that a right to die quickly becomes a duty to die. Instead of abandoning our most vulnerable citizens, society should do all it can to provide the best standards of care,” said Jean-Paul Van De Walle, Legal Counsel for ADF International.
ADF explained how legalizing assisted suicide leads to abuses of the law.
“Worldwide, only a tiny minority of countries allow assisted suicide. Wherever the practice is allowed, legal ‘safeguards’ are insufficient to prevent abuses, proving most harmful to vulnerable members of society, including the elderly, the disabled, and those suffering from mental illness or depression. Suicide is something society rightly considers a tragedy to be prevented and the same must apply to assisted suicide. Care, not killing must be the goal we all strive towards,” Van De Walle explained.
ADF explained that the court ruled that refusal and withdrawal of treatment is different than assisting a suicide.
As regards the alleged discrimination, the court found that the refusal or withdrawal of treatment in end-of-life situations was intrinsically linked to the right to free and informed consent, rather than to a right to be helped to die.

This is widely recognised and endorsed by the medical profession, and also laid down in the Council of Europe’s Oviedo Convention. Furthermore, refusal or withdrawal of life-support was allowed by the majority of the member states. The court therefore considered that the alleged difference in treatment was objectively and reasonably justified.
More articles on this topic:
  • Hungary opposes assisted suicide (Link).
  • Assisted suicide ban challenged at Europe's top human rights court (Link).

Wednesday, June 12, 2024

Canadian doctor says assisted dying law is being used by more people than anticipated

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Dr Ramona Coelho
Canadian Dr Ramona Coelho told Manx radio in the Isle of Man that Canada's euthanasia legislation is being used more often than people anticipated.

Manx radio reported that:

A Canadian doctor has claimed that the assisted dying law, passed in her country, is being used by more people than anticipated despite it being hailed as an ‘exceptional’ procedure.

Dr Ramona Coelho, spoke to some members of the House of Keys yesterday (11 June) whilst MHKs were considering the clauses of the Isle of Man’s Assisted Dying Bill.

She’s told Manx Radio there were 13,000 assisted deaths in 2022 and around 16,000 last year.
Dr Coelho says she’s concerned about how the law impacts the most marginalised of people.
Coelho is a family physician whose practise focuses on marginalized Canadians.

Previous articles concerning Dr Ramona Coelho

Isle of Man amends euthanasia bill to require self-administration.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The Euthanasia Prevention Coalition opposes both euthanasia and assisted suicide because both are methods of killing people. Euthanasia requires the doctor, or some other person, to administer the lethal poison, while assisted suicide requires the person to self-administer the lethal poison that has been prescribed by a doctor or other person.

Whether the person self-administers or the doctor, or some other person administers the lethal person, both acts require the direct involvement of another person to carry out the death.

Nonetheless, the latest Isle of Man euthanasia debate led to an amendment to the proposal to remove the option of euthanasia, while leaving assisted suicide within the law. Ashlea Tracey reported for BBC that:
Terminally ill residents would have to self administer an approved substance to end their lives under proposed new assisted-dying laws on the Isle of Man.

Politicians discussed aspects of the legislation including how medicines would be prescribed, delivered and administered at the latest sitting of the House of Keys.

The original wording of the Assisted Dying Bill 2023, a private members bill brought forward by Alex Allinson MHK, included the option of requesting the help of a doctor.

However, members backed amendments by Julie Edge MHK and Julie Edge MHK to remove that choice from the proposed new laws.

Ms Corlett argued the "last action should be taken by the person" who wanted to end their own life.

In response, Dr Allinson said while a "large number" of responses to a public consultation agreed physicians should be able to administer the substance but he conceded "there had been clear evidence given to us that perhaps this was a line too far".
Allinson's goal is to legalize euthanasia or assisted suicide. Allinson knows that it is harder to legalize assisted dying than to expand the law once it is legal.

For instance, Canada's legalized euthanasia and assisted suicide in 2016. The original law included a "terminal illness" requirement in the law. Canada expanded their law in 2021 by removing the "terminal illness" requirement, removing the 10-day waiting period for terminally ill people (allowing a same-day death), removing the requirement that the person be competent when the lethal poison is administered and permitting euthanasia for mental illness alone.

In the US, 10 States have legalized assisted suicide and nearly all of those states have expanded their assisted suicide laws since legalization.

People who oppose euthanasia must never "cut a deal" to support a bill that permits poisoning people by assisted suicide, but not euthanasia. Once the bill is legalized, within a few years, the kill bill will be expanded.

The Euthanasia Prevention Coalition opposes the poisoning of people to death by doctors administering euthanasia or doctors prescribing assisted suicide.

Euthanasia proposal dies when France calls election.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Alex speaking at the European Parliament
I rarely provide political commentary, but elections have consequences.

The European Parliament held their elections from June 6 to June 9, 2024 resulting in a shift in the balance of power. It appears that the European Parliament will likely have more of a  conservative focus over the next few years.

In response to the European election results and the shift in european politics, French President, Emmanuel Macron, on June 10 called a snap election with his hope of catching conservative political parties off-guard. The election will be on June 29 - 30 and the second tier on July 6 - 7.

For those who oppose euthanasia, France's euthanasia proposal has technically died with the snap election. After the election the euthanasia proposal will need to be re-introduced. If Macron loses support, it is unlikely that the euthanasia proposal will immediately return.

A similar situation exists in the UK where Conservative Prime Minister Rishi Sunak called a snap election for July 4. The difference is that Keir Starmer, the leader of the Labour Party, is leading in the polls and Starmer has promised that if elected his party would legalize assisted suicide.

Clearly elections have consequences.

As I reported on June 11, as part of the European Union election there was a Slovenian referendum on the question ‘Are you in favour of adopting a law that will regulate the right to assistance in the voluntary end of life?’ that passed with 55% in favour and 45% against. The vote is non-binding, but has support from three political parties who proposed the referendum.

Euthanasia has become a significant political issue.

The only "good" that is coming from Canada's disasterous euthanasia law is that it is a warning to the rest of the world not to legalize euthanasia or assisted suicide.

Tuesday, June 11, 2024

Slovenia passes assisted suicide referendum in tight vote.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The Slovenian referendum on the question ‘Are you in favour of adopting a law that will regulate the right to assistance in the voluntary end of life?’ passed with 55% in favour and 45% against. The vote is non-binding, but has support from three political parties who proposed the referendum.

Earlier this year I travelled to Slovenia to speak to politicians and local organizers about Canada's experience with legalizing euthanasia.

In March I reported that the Slovenian government defeated the euthanasia bill. At the same time I reported that the Slovenian government announced their intend to have a referendum on the "basic question" of euthanasia rather than the bill that they were debating.

Slovenian legislation allows for a referendum on legislation that is passed by the government. Therefore if the new Slovenian government passes a bill to legalize assisted suicide, it is likely that a new referendum will be organized based on the specific language of the legislation.

The assisted suicide battle in Slovenia is far from over.

Community of Hope Outreach: Connecting with Seniors Project.

Compassionate Community Care is seeking volunteers who are willing and able to participate in the Community of Hope Outreach: Connecting with Seniors Project.

The calling service is for persons aged 55+ who may be socially or physically isolated and are looking for (needing) support, or a friendly person to talk to on a regular basis.

Compassionate Community Care is looking for volunteers to make calls and seniors to receive calls.

Volunteers are needed to provide calls in both English and French.

Contact Compassionate Community Care if you are interested in volunteering or if you know of someone who should receive calls.

This project was funded by the Government of Canada's New Horizons for Seniors Program (NHSP), which provides funding for projects that make a difference in the lives of seniors in their communities.

Compassionate Community Care
383 Horton St. E., London ON N6B 1L6
Office: 519-439-6445, Email: info@beingwith.org
Website: www.beingwith.org
CCC Helpline: 1-855-675-8749
Charitable Registration # 824667869RR001

Calgary Autistic woman (MV) is a victim of the "right to die" movement.

Update: MV continues to refuse food and fluids now for 15 days.

Meghan Schrader
By Meghan Schrader

Meghan is an autistic person who is an instructor at E4 - University of Texas (Austin) and an EPC-USA board member.

This is a follow-up post about MV, the young autistic woman who is now starving and dehydrating herself to death with the doctors helping her to die.

In Alex’s recent article about MV, he asserted that MV is a victim of the "right to die" movement, and that is true. However, I know that proponents, and probably MV, would argue that this stance deprives MV of “agency” and “infantilizes” her. However, that’s not the right way to look at the argument that MV is a victim.

What that argument about victimization really means is that autonomy is complicated. For instance, anorexia is a complex mental health disorder that can result from trauma and co-morbid psychiatric conditions. However, it’s also a well-known fact that rates of anorexia are higher in the United States and Western Europe, where people are inundated with media representations of razor thin, perfectly proportioned bodies. MV lives in a culture where MAiD is romanticized constantly. Therefore, it’s not shocking that MV has concluded, “Man, I really need to kill myself. It’s the right thing to do.”

Even though MV is an independent adult, she is being oppressed by cultural forces outside her control. MV lives in a country where MAiD is sold like the newest IPhone, and she lives in a culture where jobs, suicide prevention programs, education and community are not freely available to disabled people. That’s the culture MV lives in, and so she has experienced circumstances that have led her to consider suicide. That means that MV has experienced oppression. That’s pretty much what Alex and I mean when we assert that MV is a “victim.”

The intersection of some autistic tendencies with Canada’s current culture can also be understood as making MV a victim. I cannot know exactly what role the autistic tendency to fixate is playing in MV’s decision to kill herself. However, people with autism and ADHD, do have a higher tendency to fixate, it’s one of the medical symptoms of both disorders. So, I think it’s reasonable to suspect that fixation is playing a role in MV’s decisions, and that makes her a victim of a culture that wants to push her toward her fixation on suicide.

I’m sure that like other MAiD enthusiasts, MV would proclaim that she is not “fixated” because she has made her choice based on various concrete facts. But, the use of facts to make a choice to kill oneself does not change the definition of suicide. As an autistic person I can say from experience that it is possible to be “rational” and “fixated” at the same time. Fixation can make it difficult for the fixated person to process all the facts about important situations, and so people can wind up being victimized by their own brains. In addition to living in an ableist culture, MV did not get to choose whether to have impairments that cause people to hyper-fixate. Hence, it’s reasonable to understand MV’s choice as a result of her being bullied; by the intersection of her impairment with a culture that promotes death. That makes MV a victim of her circumstances, even if she is still technically capable of making her own choices.

Lastly, Canada’s current culture is making it difficult for people like MV to understand that some choices make a person a victim of themselves. Yes, MV is generally capable of making adult decisions. The disability rights movement often fights for disabled people to be able to make choices-the choice to get married, the choice to have sex, the choice to rent an apartment, the choice to become educated, etc. Therefore, the disability justice movement generally acknowledges that disabled people can be accountable for our choices like anyone else. In the spirit of accountability, I feel led to note that the choice to kill yourself is actually bad.

Taking your own life is an objectively bad choice, especially when your family is pleading with you not to. MAiD organizations have used millions of dollars to spread the message that MAiD somehow involves only the individual and their body. But ripping your family apart so that you can assert your autonomy and use death to solve your suffering is solipsistic. MV may be able to make the autonomous choice to kill herself, but that would make MV and others victims of her own bad choices. I say that with love and compassion, but it’s the truth-sometimes people make choices that harm themselves and others.

I really hope that MV somehow experiences the right set of circumstances to make her feel like she doesn’t need to die by suicide by dehydration; circumstances that would make her experience joi de vivre. I hope that something inspires her to eat and drink. I hope that she is able to consider how killing herself is going to affect others. I wish that people like MV weren’t being victimized by a culture that oppresses disabled people so much that it urges them to die by suicide, and I hope that disabled people everywhere are able to live in a better world very soon. 

That’s what Alex and I mean when we say that MV is a “victim.”

Monday, June 10, 2024

A critique: The Widening Scope of Assisted Suicide in the US

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Psychiatrists, Dr's Mark Komrad, Annette Hanson, Cynthia Geppert and Ronald Pies wrote an excellent article on - The Widening Scope of Assisted Suicide in the US that was published by the Psychiatric Times on June 6, 2024. Komrad et al., have been researching assisted suicide in the US for several years. Komrad et al write:
Physician-assisted suicide (PAS)—commonly but misleadingly called “medical aid in dying” (1) —is now legal in 11 jurisdictions in the US. PAS remains an area of great controversy among physicians, medical ethicists, and various patient advocacy groups, as evidenced by numerous opinion pieces in Psychiatric Times. (2,3) While we recognize that individuals of good conscience may differ on the ethics of PAS, we have consistently maintained—as the American Medical Association has opined—that (4):
“Physician-assisted suicide is fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks.”
This position has also been consistently taken by the World Medical Association. (5) Despite such clear statements, we and others have called attention to the ever-expanding eligibility criteria for PAS/euthanasia (PAS/E), particularly in Canada, Belgium, and the Netherlands. In essence, every one of these foreign jurisdictions that has legalized PAS/E has eventually expanded them—a phenomenon often referred to as “the slippery slope.” (6)
Komrad et al explain that assisted suicide laws are legalized based on restrictions related to terminal illness and then it expands.
The expansion typically begins with the “low-hanging fruit” of end-stage or terminal illness and gradually broadens to “chronic, nonterminal, or treatment-refractory illness,” as one of us (M.S.K.) has shown. (7)

Whenever a line is drawn to limit eligibility criteria, those just outside the line protest, based on understandable (if misplaced) ethical principles of justice, fairness, and parity. Consequently, the boundaries of eligibility for PAS/E have been greatly stretched—in practice, in law, and in guidelines issued by professional organizations. (8)
Komrad et al, then explain how the slippery slope exists in the US.
As opponents of PAS/E, we often hear proponents claim that the slippery slope argument is merely hypothetical—an alarmist bogeyman used to scare away supporters of PAS/E.9 We also hear that, even if the slippery slope metaphor applies in foreign countries, “it would never happen here” in the US. We respectfully disagree. Although the angle of the slope is considerably greater in Canada and the Benelux countries (Belgium, the Netherlands, and Luxembourg) than in the US, we find troubling signs of slippage here at home.

In this piece, we critically examine 2 such examples: (1) the introduction of California Senate Bill 1196, along with expanded PAS criteria in several other states; and (2) 3 cases of PAS in Colorado, in which patients with anorexia nervosa died from lethal prescribed drugs.
Komrad et al then comment on California Senate Bill 1196: A Harbinger of Things to Come?
California Senate Bill 1196, the End of Life Option Act, was introduced by Senator Catherine Blakespear and represented a radical departure from existing California law.10 SB 1196 proposed several changes (Table).11 Additionally, it contained language that would have turned these practices into a quasi-research protocol by requiring the prescribing physician to report the type of lethal medications prescribed, the time from drug ingestion/administration to death, and any observed complications.

This radical bill was “a bridge too far” even for some groups that have long supported PAS. For example, the group Compassion & Choices stated, “Compassion & Choices and the Compassion & Choices Action Network respectfully oppose SB1196…” which the group viewed as posing “…significant risks to the current medical aid-in-dying law, potentially undermining its purpose and availability.”12

Ultimately—and fortunately—Blakespear withdrew this extreme proposal, and California dodged the proverbial bullet. However, in our view, the mere fact that SB 1196 was proposed is cause for great concern and a sign of the slippage we have witnessed in other countries.
Komrad et al conclude this section by stating that SB 1196 was offering a much wider expansion of the assisted suicide law than other proposed expansions. They then comment on the expansion of the definition of terminal that permitted at least three Colorado assisted suicide deaths for Anorexia Nervosa. They write:
In March of 2022, the Colorado Sun ran the following headline: “Denver doctor helped patients with severe anorexia obtain aid-in-dying medication, spurring national ethics debate.”(17)

The backstory, as told in the Colorado Sun article, was this(17):
“Dr Jennifer Gaudiani, an internal medicine doctor who specializes in eating disorders, published a paper in which she describes the deaths of [3] patients with anorexia nervosa [AN]. One 36-year-old woman died after ingesting the lethal doses prescribed by another doctor, with Gaudiani serving as consulting physician. Another 36-year-old woman died of severe malnutrition on the same day she planned to take aid-in-dying medication prescribed by Gaudiani.”
The third patient—Alyssa B—was actually a coauthor of the paper with Gaudiani. According to the published paper, “Dr G prescribed the [medical aid in dying] medications about 6 weeks after Alyssa entered hospice care.”18The Gaudiani et al paper is notable in acknowledging that:
“Alyssa had not completed a full residential eating disorder program; never fully restored weight; never tried newer psychedelic options such as ketamine, psilocybin, or MDMA; and hadn’t had a feeding tube. Dr G acknowledged that all but the feeding tube might ordinarily be undertaken prior to someone’s seeking end-of-life care for AN. Yet, [Alyssa] had been suffering for so long, and despite many conversations about all these treatment possibilities, Alyssa would not consent to any of them. Therefore, given her clarity of understanding around these issues and her sense that she could not fight anymore, everyone had to accept that they weren’t meaningful options.”
Komrad et al explain why assisted suicide for anorexia was so wrong.
Not surprisingly, the published paper and its rationale were vociferously criticized by many in the psychiatric community. For example, Angela Guarda, MD—the director of the eating disorders program at Johns Hopkins Hospital in Baltimore, Maryland—is quoted as saying that using aid-in-dying medication for anorexia patients is “alarming” and “fraught with problems.” This is partly because “…it is impossible to disentangle this request [for PAS] from the effects of the disorder on reasoning, and especially so in the chronically ill, demoralized patient who is likely to feel a failure.”(17)

We strongly agree with Guarda and regard the 3 cases as exemplifying the slippery slope of eligibility for PAS/E in the US. One of us [C.M.A.G.] has argued that the concept of futility in the treatment of anorexia nervosa is not supported by current evidence and should not serve as the basis for decision-making in this condition. (19),(20)
Komrad et al conclude that California Bill SB 1196 and the cases of assisted suicide for anorexia are proof that a slippery slope exists with assisted suicide in America. They write:
In our view, the phenomenon of the slippery slope is, in large part, the expectable consequence of “normalizing” or naturalizing the physician’s direct or indirect killing of the patient via euthanasia or PAS, respectively. The more widely these acts are performed, the easier it becomes to mischaracterize them as forms of “medical care.” This is epitomized in the obfuscating euphemism medical aid in dying. As the American College of Physicians has stated (21):
“Terms for physician-assisted suicide, such as aid in dying, medical aid in dying, physician-assisted death, and hastened death, lump categories of action together, obscuring the ethics of what is at stake and making meaningful debate difficult.”
In truth, assisted suicide does not aid the dying process—it terminates dying by terminating the patient.

By the same token, the more PAS/E are viewed as medical care, the easier it becomes to broaden the eligibility criteria to encompass almost anyone who feels they are “suffering.” Then the slide down the slope can accelerate, from terminal conditions to chronic conditions (such as mental illness), as is happening in our culturally and geographically adjacent neighbor, Canada. That opens the path for the next drift in the evolving ethos—transforming one’s opportunity to seek these lethal procedures into the virtue of relieving loved ones from the burden of their condition.

Finally, we believe it essential that the American Psychiatric Association (APA) maintain its ethical opposition to PAS/E, consistent with the American Medical Association (AMA) Code of Ethics. (4) Doing otherwise will create a schism between the APA and the AMA. Indeed, we hope that as our colleagues consider these issues, they bear in mind the teaching from medical ethicist Leon Kass, MD: “We must care for the dying, not make them dead.” (22)
Link to the original article for references (Original article link).

Dr Komrad is a psychiatrist on the teaching staff of Johns Hopkins Hospital in Baltimore, Maryland. He is also a clinical assistant professor of psychiatry at the University of Maryland in Baltimore and on the teaching faculty of psychiatry at Tulane University in New Orleans, Louisiana.
Dr Hanson is director of the forensic psychiatry fellowship at the University of Maryland in Baltimore.
Dr Geppert is a professor in the Departments of Psychiatry and Internal Medicine and director of ethics education at the University of New Mexico School of Medicine in Albuquerque. She is the lead ethicist for the Western region and director of education at the Veterans Health Administration National Center for Ethics in Health Care in Washington, DC, and an adjunct professor of bioethics at the Alden March Bioethics Institute of Albany Medical College in New York. She serves as the ethics editor for Psychiatric Times.
Dr Ronald Pies is a professor emeritus of psychiatry and a lecturer on bioethics and humanities at SUNY Upstate Medical University in Syracuse, New York; a clinical professor of psychiatry emeritus at Tufts University School of Medicine in Boston, Massachusetts; and editor in chief emeritus of Psychiatric Times (2007-2010). Dr Pies is the author of several books. A collection of his works can be found on Amazon.

ANAD clarifies that Anorexia Nervosa is not a terminal condition.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

In the past few years several doctors that do euthanasia or assisted suicide have decided that Anorexia Nervosa and Associated Disorders (ANAD) are terminal conditions and thus have approved Medical Aid in Dying (euthanasia or assisted suicide) for people with these condition. A key statement made by the National Association is:
No matter the patients’ current frame of mind, their providers must hold space for the idea that they may be ready for full recovery in the future.
(Link to article) (Link to article) (Link to article) (Link to article)

Several people with Anorexia are known to have died by assisted suicide in Colorado and Oregon. The following statement from the National Association of Anorexia Nervosa & Associated Disorders (ANAD) clarifies that these are chronic, not terminal conditions.
ANAD Statement on 'Terminal Anorexia' (Link to statement)
By: National Association of Anorexia Nervosa & Associated Disorders (ANAD)

ANAD is putting out an urgent call to action to stop the loss of lives due to eating disorders. We are responding to the recent controversy regarding “terminal anorexia”; a label which classifies this psychiatric condition as a terminal illness.1 ANAD fears that this label could be used as a justification for providers to offer medical aid in dying and overlook the fact recovery remains possible even after decades of chronic illness.2

ANAD exists to help build nonjudgmental environments that “meet folks where they are.” This means respect for individual autonomy, a focus on well-being and quality of life, and support for the pace and direction of the individual’s goals while also keeping the door open for a full recovery whenever the person is ready.

Too often, individuals labeled with ‘severe and enduring anorexia nervosa’ (SE-AN) have been refused care because they can/do not comply with the target weights assigned or continue to struggle with eating disorder behaviors. This is a reminder that the professionals guiding recoveries must do more to offer alternative treatment options that are in line with the patient’s goals for quality of life improvement. Increasingly, studies show that individuals with SE-AN benefit from flexible, nontraditional treatments that focus on quality of life, safety, and harm reduction.3 Many professionals utilize practices based solely on published treatment standards without consideration of individual or cultural experiences. Rather than excluding patients from treatment if they are unable to meet strict indicators of progress or unrealistic goals, the more humane approach is to allow people to have input into their treatment plans. Providing opportunities to learn how to decrease the negative consequences of their eating disorder while providing a safety net for crises are strategies that can act as an alternative to more structured care.4

While full recovery will always be an important goal, ANAD recognizes that all positive changes, no matter how small, are worthy goals in their own right. For those struggling to progress to full recovery, there are still opportunities to improve quality of life, and there must be alternative forms of care to support those opportunities. No matter the patients’ current frame of mind, their providers must hold space for the idea that they may be ready for full recovery in the future.

We must not confuse ‘chronic’ with ‘terminal.’ Being labeled with a terminal illness has the potential to become a self-fulfilling prophecy. Regardless of the duration or severity of the illness, everyone deserves access to quality care.

ANAD calls for increased flexibility in and opportunities for treatment, patient autonomy in goal-setting, and provider respect for goals that include quality of life improvements and harm reduction while continuing to believe in the possibility of future recovery, even where their patients cannot. We must remain committed to holding hope and helping people find a life worth living.

References

1. Ayton, Agnes, Ali Ibrahim, Suzanne Baker, Ashish Kumar, Hope Virgo, and Gerome Breen. 2023. “From awareness to action: an urgent call to reduce mortality and improve outcomes in eating disorders.” Cambridge University Press. https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/from-awareness-to-action-an-urgent-call-to-reduce-mortality-and-improve-outcomes-in-eating-disorders/019E648156106F5D956704E7CB7727A3?utm_campaign=shareaholic&utm_medium=emai.

2. Westmoreland, Patricia, Cyntha M. Geppert, Mark S. Komrad, Annette Hanson, Ronald W. Pies, and Philip Mehler. n.d. “Terminal Anorexia”: An Invalid Construct That Does Not Justify Medical Aid in Dying.” Psychiatric Times. Accessed April 24, 2024. https://www.psychiatrictimes.com/view/terminal-anorexia-an-invalid-construct-that-does-not-justify-medical-aid-in-dying.

3. The Victorian Center of Excellence in Eating Disorders. n.d. “Harm Reduction for Adults with Harmful Eating and Body Control Behaviours: OVERVIEW of Harm Reduction and Eating Disorders.” The Victorian Center of Excellence in Eating Disorders. Accessed April 24, 2024. https://ceed.org.au/wp-content/uploads/2021/08/CEED_Harm-Reduction-for-Adults-with-EDs_Overview-Harm-Reduction_08.2021.pdf.

4. Yager, Joel. n.d. “Working with Patients with Severe and Enduring Eating Disorders Who Refuse Further Treatment.” Eating Disorders Review 32 (5). Accessed April 24, 2024. https://eatingdisordersreview.com/working-with-patients-with-severe-and-enduring-eating-disorders-who-refuse-further-treatment/.

Saturday, June 8, 2024

Nearly Every US State That Has Legalized Assisted Suicide, Has Expanded Its Law

Alex Schadenberg
Executive Director
Euthanasia Prevention Coalition

Colorado Governor Gary Polis signed  Senate Bill 24-068 on June 5 to expand their State assisted suicide law. 

Nearly every state that has legalized assisted suicide has expanded their law.

Senate Bill 24-068 expanded the Colorado assisted suicide law by:
  • allowing advanced practice registered nurses to approve and prescribe lethal poison,
  • reducing the waiting period from 15 days to 7 days,
  • allowing the doctor or advanced practise registered nurse to waive the waiting period if the person is near to death,
  • Adding language specifying that if any end-of-life options conflict with requirements to receive federal money, the conflicting part is inoperative and the remainder of the law will continue to operate.
The bill also added language concerning insurance companies:
  • Denying or altering health-care or life insurance benefits otherwise available to a covered individual with a terminal illness based on the availability of medical aid-in-dying; or
  • Attempting to coerce an individual with a terminal illness to make a request for medical aid-in-dying medication.
The original version of SB 24-068 would have reduced the waiting period to 48 hours and removed the residency requirement for assisted suicide in Colorado.

Most of the states are expanding their assisted suicide laws to allow advanced practise registered nurses to participate because very few doctors participate in assisted suicide.

Nearly every state that has legalized assisted suicide has expanded their laws. 

In 2019 Oregon expanded their assisted suicide law by giving doctors the ability to waive the 15 day waiting period when a person was deemed near to death. In 2023 Oregon removed the residency requirement extending assisted suicide nationally to anyone.

In 2021 California expanded their assisted suicide law by reducing the waiting period from 15 days to 48 hours, it forced doctors who oppose assisted suicide to be complicit in the process (later struck down by the court) and it forced all medical institutions to post their policy on assisted suicide.

In 2022 Vermont expanded their assisted suicide law by removing the 48 hour waiting period, (allowing a same day death), removing the requirement that an examination be done in person, (allowing approvals by telehealth), and it extended legal immunity to anyone who participates in the act.

In 2023 Vermont expanded their assisted suicide law by removing the residency requirement expanding assisted suicide nationally by allowing anyone to die by assisted suicide in Vermont.

In 2023 Washington State expanded their assisted suicide law by allowing advanced practice registered nurses to approve and prescribe lethal poison, by reducing the waiting period to 7 days and to force healthcare institutions and hospices to post their assisted suicide policies.

In 2023 Hawaii expanded their assisted suicide law by reducing the waiting period from 20 days to 5 days, by allowing the waiting period to be waived if the person is near to death and by allowing advanced practice registered nurses to approve and prescribe lethal poison.

There is currently a lawsuit by the assisted suicide lobby challenging the New Jersey state residency requirement for assisted suicide.

The goal of the assisted suicide lobby is to legalize assisted suicide in more states and to expand the scope of the assisted suicide laws in the states that have legalized assisted suicide.

It must be noted that the American Clinicians Academy on Medical Aid in Dying have determined that when a person, who does not otherwise qualify for assisted suicide, decides to stop eating and drinking, that they will immediately qualify for assisted suicide based on becoming terminally ill.