Saturday, January 19, 2019

Oregon will debate bills to expand the definition of terminal and allow physicians to wave the waiting period.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Recently the Oregon assisted suicide lobby stated that they intend to expand the definitions in the assisted suicide law. The 2017 Oregon assisted suicide report stated that number of assisted suicide deaths had, once again, increased.

Oregon House Bill HB 2232 clarifies the definition of self-administer in the Oregon assisted suicide act, in fact the bill changes the definition of terminal from a six month terminal prognosis to: 

a disease that will, within reasonable medical judgment, produce or substantially contribute to a patient’s death.

Considering the fact that the Oregon Health Authority (OHA) bases the definition of terminal to include refusing medical treatment, such as a diabetic who refuses insulin, therefore the new definition of terminal has an undefined and nearly unlimited application. 

Many people who are not close to being "terminally" ill have a disease that will, within reasonable medical judgement, produce or substantially contribute to death. When considering the OHA inclusion of refusing medical treatment, I conclude that this new definition enables wide-open assisted suicide.

There may be more concerns with HB 2232. This article is only focuses on the new definition of terminal.

Oregon Senate Bill SB 0579 creates an exception to the 15 day waiting period in the Oregon assisted suicide law enabling a physician to wave the 15 waiting period before prescribing lethal drugs for suicide.

The current Oregon assisted suicide law requires a 15 day waiting period. SB 0579 states:
Notwithstanding subsection (1) of this section, if the qualified patient’s attending physician has medically confirmed that the qualified patient will, within reasonable medical judgment, die within 15 days after making the initial oral request under this section, the qualified patient may reiterate the oral request to his or her attending physician at any time after making the initial oral request.
It also states:
Notwithstanding subsection (1) of this section, if the qualified patient’s attending physician has medically confirmed that the qualified patient will, within reasonable medical judgment, die before the expiration of at least one of the waiting periods described in subsection (1) of this section, the prescription for medication under ORS 127.800 to 127.897 may be written at any time following the later of the qualified patient’s written request or second oral request under ORS 127.840.
There may be more concerns with SB 0579. This article only focuses on the waiting period.

The Oregon legislature will debate, 2019, changing the definition of terminal illness to an undefined concept of a disease that produces or substantially contribute to a patient’s death and enabling physicians to wave the 15 day waiting period.

Thursday, January 17, 2019

Delaware bill defines assisted suicide as a palliative care option

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition


The assisted suicide lobby has instituted a new direction by redefining assisted suicide as palliative care. This has long been a talking point for assisted suicide advocates but now they are attempting to change the legal definition of palliative care.

Assisted suicide laws give physicians, or others (New Mexico bill) the right in law to assist the suicide of their patients.

The Delaware assisted suicide bill follows the new suicide by physician game plan by redefining palliative care to include assisted suicide. The bill states:

WHEREAS, the integration of medical aid in dying into the standard for end-of-life care has improved quality of services by providing an additional palliative care option to terminally ill individuals.
The World Health Organization definition of palliative care states that it:
intends neither to hasten or postpone death;
The assisted suicide lobby and the Delaware assisted suicide bill intend to change the meaning of palliative care.

The Delaware assisted suicide bill negates physicians conscience rights by forcing the physician to refer patients for assisted suicide. The bill states:

(c) An attending physician’s failure to inform an individual with a terminal illness who requests additional information about available end-of-life treatments, including medication to end their life in a humane and dignified manner, or failure to refer the individual to another physician who can provide the information, is considered a failure to obtain informed consent for subsequent medical treatment.
There are more egregious parts of this assisted suicide bill but this article focuses on the assisted suicide lobbies intention to change palliative care to include assisted suicide and to force physicians to participate in the act of suicide by physician.

Wednesday, January 16, 2019

Oregon assisted suicide lobby wants to expand the assisted suicide law.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition


I have always said that the Oregon assisted suicide law was designed to extend suicide by physicians to other states. The assisted suicide lobby controlled the law and maintained the lie that there were no problems with the law. I knew that eventually they would decided to expand the provisions of the law.

Recently, the leader of C & C, formerly the Hemlock Society, outlined their commitment to eliminate provisions in the assisted suicide laws.

This year, the assisted suicide lobby is proposing Brittany's Bill in the Oregon legislature. I have not seen the particulars but the website from the assisted suicide lobby group states:

Brittany's Bill is a new bill that will be introduced in the 2019 Oregon Legislative Session. It's purpose is to expand the current Death with Dignity Law. The end result will be to change the eligibility of people who can take advantage of this choice. Currently, only patients diagnosed with a terminal illness and a life expectancy of six months are eligible. Brittany's Bill will expand the eligibility to any patient with an incurable disease or experiencing unbearable pain.
An article by Bruce Yelle, the director of the lobby group, end-of-life choices, published in the Register Guard states:
In the upcoming 2019 Oregon Legislative session there will be bills, including one called Brittany’s Bill, introduced in both the Senate and House health committees to expand Oregonians’ end-of-life choices. 
In the article Yelle makes reference to people:
  • who have become incompetent and therefore cannot access assisted suicide;
  • who do not meet the six month prognosis requirement, a provision that is fatally flawed already;
Expansive assisted suicide bills that lack clear definitions are the new normal. For instance that New Mexico assisted suicide bill is the most radical bill that I have ever seen.

A new era in the assisted suicide debate in America has begun.


Tuesday, January 15, 2019

Nearly every suicide death at Swiss clinic are foreign clients.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition


The Australian Care Alliance is reporting that at least 6 Australians have died by suicide at the Dignitas suicide clinic in Switzerland in 2018 and 93.5% of all of the Dignitas suicide deaths are foreign clients.

The Australian Care Alliance report explains how the Swiss assisted suicide statute works and the numbers of people have become death clients of the suicide clinics.

The Care Alliance reports:

Article 115 reads “Any person who for selfish motives incites or assists another to commit or attempt to commit suicide shall, if that other person thereafter commits or attempts to commit suicide, be liable to a custodial sentence not exceeding five years or to a monetary penalty”. 
Increasing number of deaths 
The qualifier, “for selfish motives” effectively allows Dignitas to offer assisted suicide to all comers on a “cost recovery” basis. Dignitas has assisted in 2771 suicides from 1998-2018. It charges between 7500 and 10500 Swiss francs plus VAT (roughly equivalent to between $A10,000 and $A15,000) for an assisted suicide. The number of assisted suicides carried out by Dignitas in 2018 was 221, up 148% from 2009. 
Only 6.5% of assisted suicides carried out by Dignitas have been of Swiss residents. The remaining 93.5% have involved suicide tourism, including for 32 Australians (five of these in 2018). 
Eternal Spirit Foundation and its associated organisation lifecircle was founded in 2011. It also offers assisted suicide to foreigners as well as Swiss residents. No statistics are available to date. Assisted suicide is offered to anyone who does “not accept to be nursed without hope of improvement” or who has a disease which is “incurable and clearly leads to reduction in quality of life, although it does not lead to death in the near future.” Western Australian, David Goodall, was assisted to commit suicide at its Basel clinic in May 2018. Goodall was not terminally ill and had no major disease, so assisted suicide is apparently being offered also for those “tired of life”. 
Another Swiss organisation, Exit, limits its assistance in suicide to Swiss residents. In 2015, Exit was responsible for 782 deaths by assisted suicide, up 345 from 583 in 2014. Of the 734 assisted suicides involving Exit in 2017 one on four (25%) were for “old age poly morbidities”, similar to the “stack of old age disorders” in the Netherlands. 
Assisted suicides of Swiss residents rose dramatically from just 48 in 1998 to 965 in 2015 an increase of 66% from 583 in 2013. There is no age limit for assisted suicide and between 2010 and 2014 thirteen people under 35 years of age died by assisted suicide.
Deaths from assisted suicide represented 1.5% of all deaths of Swiss residents in 2017. 
Read more on Switzerland here. 
Warning: this article discusses suicide. If you or someone you know is struggling, please seek help.
The number of foreign suicide deaths is continually increasing in Switzerland. 

Recently Deborah Binner, the wife of Simon Binner, who died at a suicide clinic in Switzerland, published a book where she says that she was devasted by her husband's death.

More articles about Switzerlands failed suicide experiment:

Monday, January 14, 2019

Why euthanasia is unethical.

The following article was published in the December 2018 World Medical Association Journal (pg 33 - 37) 

Link to a PDF of the article.

This article is written by Dr Rene Leiva, Dr Tim Lau and Gordon Friesen.
‘Unanimously, a declaration was adopted which simply says that euthanasia is unethical.’ 
Thus read a brief initial note in the World Medical Journal of 1987 with reference to the key passage of a new WMA Declaration on Euthanasia adopted in the Madrid General Assembly of that year [1]. Concise as this message was, it announced the affirmation of a powerful, enduring medical dictum, and we believe it to be essential for us, today, to understand the context in which it came about. 

The WMA was founded in 1947, in part to work for the highest possible standards of ethical behaviour and care among physicians. This was considered particularly important after the gross ethical violations observed, by physicians themselves during the Second World War (1939-45) [2]. In 1987, several members of the WMA, who had had personal experience with these atrocities, were still alive. One of them, Dr. Andre Wynen, who was then Secretary General, and a Nazi camp survivor himself, was a strong advocate of the formulation of the Declaration ‘because protection of life was very important for him’ [3]. These sentiments were echoed in a 1989 essay by then WMA President Ram Ishay from the Israeli Medical Association [4]. Dr. Ishay explained that the WMA had not seen the need to pass such a Declaration earlier, because it had already adopted policies laying out what it considered to be appropriate and ethical end of life care. However, given new positions emerging within some countries, it felt the need to break this silence, and passed the present Declaration unanimously. This robust vehicle was subsequently reaffirmed in 2005 and again in 2015. 

The authors of this article are three Canadians – two are practicing physicians and the other a severely disabled individual – who have combined their efforts, here, in the hope of preserving, once again, the deep and timely precautions WMA has maintained all these years. We ask that the full language of the original Declaration – explicitly stating that euthanasia “is unethical” – be preserved.

The Nature of Euthanasia

Voluntary euthanasia, simply put, is the medicalization of suicide. The use of euphemisms such as Physician Assisted Death or Medical Assistance in Dying are misguided attempts to rebrand a practice which doctors have renounced for close to 2500 years. These terms should be rejected as linguistic deceptions.


The objective judgement of whether any suicide or assisted suicide is warranted is impossible because of the subjective nature of suffering. What is grievous, irremediable, or intolerable to one person, may not be so for another. And, unfortunately, the physician’s opinion is no less subjective than that of the patient. An illustration of this comes from the review of psychiatric euthanasia in the Netherlands which demonstrated that, in 24% of cases, there was disagreement amongst consultants [5]. Having doctors validate and assist in suicide, therefore, is a distortion of our role as healers and makes us both accomplices and supporters – if not encouragers – of suicide.

We believe doctors should never be open to euthanasia and assisted suicide as solutions to our patients’ suffering. It is our personal experience, backed up by multiple studies, that the majority number of requests for the hastening of death are based on what we call ‘existential suffering’ which includes social, psychological and spiritual reasons such as loss of autonomy, wish to avoid burdening others or losing dignity and the intolerability of not being able to enjoy one’s life [6,7]. Moreover, it is our position that, behind the fears caused by that existential suffering, there is also a call for help, to find meaning, even in the midst of such suffering. Hopelessness and the wish for death naturally arise in the course of human experience, but it should not be our role, as physicians, to judge of their validity (regardless of personal opinion), nor is it our role to give them satisfaction.

The scope of euthanasia in theory and practice: a stark contrast

Euthanasia was purportedly introduced as a solution for ‘rare cases’ involving the very end of life where unbearable suffering could, supposedly, be ended only with death. But euthanasia is not only employed for such cases.

In Canada, physicians may provide euthanasia or assisted suicide for competent adults who clearly consent, who have a grievous and irremediable medical condition (including illness, disease, or disability) that causes enduring and intolerable physical or psychological suffering that cannot be relieved by means acceptable to the individual [8]. But as stated earlier, these are entirely subjective and elastic concepts. In practice, Canadian criteria are already so broad as to have permitted the administration of lethal injections to an elderly couple who preferred to die together by euthanasia rather than at different times by natural causes [9]. Moreover, court challenges and government studies are presently underway which could soon open euthanasia access to competent minors; to people who are non-terminal (death not “reasonably foreseeable”); to dementia patients by advance directive; and to those with psychiatric disorders only [10]. In Ontario, only 15% of patients euthanized had a previous relationship with the euthanasia provider [11]

Economic pressure towards euthanasia

Economics and resource management always play a critical role in health services. Dr. Wynen, as we know from his writings, definitely feared that legalised euthanasia would eventually be used to ration health care [3]. But even then, warning about the risks of abuse from euthanasia, due to financial reasons, was not new. Dr. Leo Alexander, who served as a medical consultant to the Allied prosecutors during the Nuremberg trials, wrote in his historic essay “Medical Science under Dictatorship”, New England Journal of Medicine (1949): 
“Hospitals like to limit themselves to the care of patients who can be fully rehabilitated, and the patient whose full rehabilitation is unlikely finds himself, at least in the best and most advanced centers of healing, as a second-class patient faced with a reluctance on the part of both the visiting and the house staff to suggest and apply therapeutic procedures that are not likely to bring about immediately striking results in terms of recovery. I wish to emphasize that this point of view did not arise primarily within the medical profession, which has always been outstanding in a highly competitive economic society for giving freely and unstintingly of its time and efforts, but was imposed by the shortage of funds available, both private and public. From the attitude of easing patients with chronic diseases away from the doors of the best types of treatment facilities available to the actual dispatching of such patients to killing centers is a long but nevertheless logical step. Resources for the so called incurable patient have recently become practically unavailable ”[12].
In Canada, a recent cost analysis concluded that ‘providing medical assistance in dying should not result in any excess financial burden to the health care system and could result in substantial savings [13]. It is obvious that those patients who opt for euthanasia do provide a saving to the health care system. Therefore, the danger of exerting a hidden pressure on vulnerable people is very real. For example, hospital authorities recently denied a chronically ill, severely disabled patient the care he needed, and – faced with his inability to pay – suggested euthanasia or assisted suicide instead [14]. On another occasion, a 25-year-old disabled woman in acute crisis in a Canadian Emergency ward, was pressured to consider assisted suicide by an attending physician, who called her mother “selfish” for protecting her [15].

Private financial interests are also important. Colleagues have voiced case reports where family members may be taking advantage of the law and creating vulnerable victims [16]. Elder abuse is endemic – in Canada as elsewhere – and one of the main forms of that abuse is financial. The conflict is obvious, and so is the potential for abuse.

Breaking the promise: how euthanasia destroys trust in the medical profession

At the root of euthanasia lies an assumption that some lives are not worth living. But rational people disagree, both on the principle and on the application to each individual case. Severely disabled and chronically ill individuals disagree, also, on the value of their own lives. Some become suicidal; a greater number do not. But a critical factor in the choices they make results from the attitudes of friends, family, medical professionals and society at large. As philosopher Daniel Callahan has stated, 
“Euthanasia is not a private matter of self-determination. It is an act that requires two people to make it possible, and a complicit society to make it acceptable” [17].
Again, both Wynan and Ishay were concerned that people caring for patients would personally side with the logic of euthanasia, thus creating new risks for the abuse of patients, and especially the most vulnerable. It is our experience that in several cases the troubles of human relationships within families become accentuated, and problems of physician error and abuse in an already stressed medical system become exacerbated. In the words of President Ishay, 
“The main problem is to differentiate between what is really done for the benefit of the patient, and what is done out of comfort for the family or for the caring team. Killing can occur, not because the patient is suffering, but because the person caring for the patient can not take it any more” [4].
No wonder, then, that many doctors remain unsure of correct practice. Some emergency physicians in Quebec were, for a time, actually allowing suicide victims to die even though they could have saved their lives. President of the Association of Quebec Emergency Physicians later speculated that the law, and accompanying publicity, may have ‘confused’ the physicians about their role [18]. Dr. Damiaan Denys, President of the Dutch Society of Psychiatrists, has also recently voiced the possibility that euthanasia is causing a frustrating new therapeutic atmosphere in psychiatric treatment, lowering many people’s threshold for ending their lives and causing increased moral distress on the part of the doctor [19]. Canada’s largest children’s hospital has drafted a policy in preparation for the day when children could decide for themselves to be euthanized. On it, they entertain the possibility of not informing the parents until after the minor has been euthanized [20].

We do not deny, therefore, that doctors performing euthanasia may sincerely believe themselves to be acting virtuously. But trust between doctor and patient depends, in the end, on public perception of the whole medical profession. When some doctors perform euthanasia, patients begin to worry about the attitudes of all doctors, and trust is lost. In Canada, for example, we are personally aware that many patients, out of fear, are now directly asking for doctors who will not practice euthanasia. Already in 2005, it became apparent that some elderly Dutch were afraid that those around them would take advantage of their vulnerable state to shorten their lives. Having lost confidence in Dutch practitioners, they either went to German doctors or they settled in Germany, as reported in the 2008 French government report to the National Assembly [21]; or they carry cards with them stating that they don’t want to be euthanized when seriously ill [22]. In a recent survey among Quebec physicians caring for patients with dementia, between 14% to 43% of doctors would provide access to euthanasia to patients with advanced or terminal stage dementia respectively even if no a prior written request existed [23].

The true physician’s role

At the heart of modern medical practice, we expect to find the survival, welfare and comfort of the patient. It is this conscious devotion to life which is so urgently required from physicians by the vast majority of patients, whether they are suicidal or not. The declaration of Geneva holds as the first consideration, the health and well-being of our patients. The respect for the autonomy and dignity of our patients which is the next line of the declaration, should not ignore the first consideration, nor the third line of the declaration which includes the utmost respect for human life. Properly understood there should be no conflict at all [24]. 

One of us (Friesen) knows, first hand, the mental strain of suddenly being presented, as a young man, with serious post-traumatic disabilities which took months to fully understand, years to accommodate, and decades to accept. In his own words, 
“it is an illusion to believe that education, family relations, economic status, or present health and happiness, can effectively protect people such as myself from the risk of euthanasia, because the most ordinary chances of life – the slightest relaxation of discipline in the maintenance of my physical state – would immediately (within months at most) place me in the intended category for that lethal procedure. And so, it is, for all surviving disabled and chronically ill.”
The good doctor, we believe, does not judge the value of such lives. Doctors are -- doctors must be unconditionally devoted to supporting every life, through all the phases of therapy and palliation.

And to conclude: 
“If I had not had such doctors to guide me through the first critical weeks of Intensive Care (and the long years of recovery which followed), I would not be here to write these lines today.”
Euthanasia policy: a unique responsibility of the World Medical Association

Objectively speaking, nothing has changed in the facts of euthanasia since 1945. Our current debate has not been caused by real changes in the internal logic of medical ethics and practice. It is actually the result of those same political, social, and economic factors, which civilized medicine has rejected time and again: the attraction of economic savings, feared by Wynen and described at first hand by Alexander; the terrible possibility that doctors and families might choose their own convenience over the survival of the patient, as voiced by Ishay; the horrible notion that certain lives are objectively less valuable. When death becomes the answer, we as human beings – as doctors – have failed in our duty to sustain trust and hope. Amid the larger pressures we have described, a free, autonomous decision about euthanasia becomes impossible. Patient choice becomes a cruel illusion.


On the positive side, it is evident that most doctors will never be willing to personally practice euthanasia. This conclusion has emerged clearly from the four regional WMA symposia, held recently on the subject in Brazil, Japan, Rome and Nigeria [25]. From the records of these seminars, we are reminded that a majority of doctors, everywhere, wish only to foster the will to live, not to lay the seeds of suicidal despair. In those countries where it unfortunately becomes legal, law and policy should allow medical practice to remain largely unchanged. Those who support medical involvement should thus embrace the liberation of relinquishing such a painful technical monopoly for doctors and allow other ‘experts’ to do it.

Unwavering ethical guidance from the World Medical Association is of crucial importance in preserving this positive climate in global medical practice. Any compromising additions or modifications to existing WMA declarations can only bring harm to our patients and to our profession. A firm WMA refusal to accept euthanasia, on the other hand, will stand as a powerful aid to all doctors.

We hope the WMA will take this opportunity to make it clear that what is legal is not necessarily ethical. It is useful to note, that the WMA was recently willing to make this distinction by condemning the participation of physicians in capital punishment, even in jurisdictions where that practice is legal [26]. We believe that the WMA should also remain consistent in this principle with regard to euthanasia, and not confuse political expediency with medical ethics.

WMA policy, we hope, will continue to stand as a beacon to the world, bringing comfort to patients and physicians around the globe, proclaiming that – regardless of changing opinions from place to place – true medicine’s first value is human life. Similarly, even if some particular society may devalue human life by promoting suicide, medicine and medical practitioners should not.

We believe that euthanasia is, was, and will always be, unethical. The World Medical Association was right to say this in the past, and must continue for the future, firmly on the same path. 

Rene Leiva, MDCM, CCFP (COE/PC), FCFP Family Medicine, Palliative Care, Care of the Elderly, Bruyere Continuing Care, Assistant Professor, Department of Family Medicine University of Ottawa Ottawa, Ontario, Canada

Gordon Friesen, Advisory Assistant Physicians’ Alliance Against Euthanasia Montreal, Quebec,

Canada Timothy Lau, MD, MSc, FRCPC Geriatric Psychiatry Royal Ottawa Hospital Associate Professor, University of Ottawa Ottawa, Ontario, Canada E-mail: rene.leiva@mail.mcgill.ca



References

1. Report of the WMA Meeting. WMJ Vol 34 Issue 6, Nov-Dec 1987, pp. 83-85.

2. World Medical Association: About Us [Internet] [cited 2018 Nov 15] Available from: https://www.wma.net/who-we-are/about-us/

3. Stafford N. Andre Wynnen (Obituary). Lancet Volume 370 Number 9591 Sep 15, 2007 pp.909- 1006 [cited 2018 Nov 15] Available from: https://www.thelancet.com/journals/lancet/article/ PIIS0140-6736(07)61432-9/fulltext

4. Euthanasia – The Slippery Slope. WMJ Vol. 36 Issue 3, May-June 1989, pp. 44-45.

5. Kim SY, De Vries RG, Peteet JR. Euthanasia and Assisted Suicide of Patients With Psychiatric Disorders in the Netherlands 2011 to 2014. JAMA Psychiatry. 2016 Apr;73(4):362-8. [cited 2018 Nov 15] Available from: https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2491354

6. Rodríguez-Prat A, Balaguer A, Booth A, Monforte-Royo C. Understanding patients’ experiences of the wish to hasten death: an updated and expanded systematic review and meta-ethnography. BMJ Open. 2017 Sep 29;7(9):e016659. [cited 2018 Nov 15] Available from: https://bmjopen.bmj.com/content/7/9/ e016659.long

7. Li M, Watt S, Escaf M, Gardam M, Heesters A, O’Leary G, Rodin G. Medical Assistance in Dying – Implementing a Hospital-Based Program in Canada. N Engl J Med. 2017 May 25;376(21):2082-2088. [cited 2018 Nov 15] Available from: https://www.nejm.org/doi/ full/10.1056/NEJMms1700606#article_citing_articles

8. Carter v. Canada (Attorney General), 2015 SCC 5 [Internet]. 2015 [cited 2018 Nov 15]. Available from: https://scc-csc.lexum.com/scc-csc/ scc-csc/en/item/14637/index.do

9. Grant K. Medically assisted death allows couple married almost 73 years to die together [Internet]. The Globe and Mail; 2018 Apr 1 [cited 2018 Nov 15] Available from: https://www. theglobeandmail.com/canada/article-medicallyassisted-death-allows-couple-married-almost73-years-to-die/

10.The Expert Panel on Medical Assistance in Dying (MAID). Medical Assistance in Dying. Expected release Dec 2018. [Internet] [cited 2018 Nov 15]. Available from: https://scienceadvice. ca/reports/medical-assistance-in-dying/

11. Service MAiD Data: Statistics as of September 30, 2018. Office of the Chief Coroner/Ontario Forensic Pathology. Ontario, Canada. [cited 2018 Nov 15] Available from: http://www.mcscs.jus.gov.on.ca/english/Deathinvestigations/ OfficeChiefCoroner/Publicationsandreports/ MedicalAssistanceDyingUpdate.html

12. Alexander L. Medical science under dictatorship. N Engl J Med. 1949 Jul 14;241(2):39- 47. [cited 2018 Nov 15] Available from: https://www.mcgill.ca/prpp/files/prpp/leo_alexander_1949_---_medical_science_under_dictatorship.pdf

13. Trachtenberg AJ, Manns B. Cost analysis of medical assistance in dying in Canada. CMAJ. 2017 Jan 23;189(3):E101-E105. [cited 2018 Nov 15] Available from: http://www.cmaj.ca/ content/189/3/E101

14. Chronically ill man releases audio of hospital staff offering assisted death [Internet]. CTV News; 2018 Aug 02 [Internet] [cited 2018 Nov 15]. Available from: https://www.ctvnews.ca/health/ chronically-ill-man-releases-audio-of-hospitalstaff-offering-assisted-death-1.4038841

15. Fatal Flaws Film Clip: “They wanted me to do an assisted suicide death on her” [Video]. YouTube; 2017 Oct 10 [cited 2018 Nov 15] Available from: https://youtu.be/hB6zt43iCs8

16.Johnston W. New Assisted Dying Law Will Claim Unintended Victims [Internet] HuffPost; 2016 Sep 28 [cited 2018 Nov 15] Available from: https://www.huffingtonpost.ca/will-johnston/assisted-dying_b_12168266.html

17. Callahan D. When self-determination runs amok. Hastings Cent Rep. 1992 MarApr;22(2):52-5. [cited 2018 Nov 15] Available from: https://onlinelibrary.wiley.com/doi/ pdf/10.2307/3562566

18. Hamilton G. Some Quebec doctors let suicide victims die though treatment was available: college [Internet]. National Post; 2016 Mar 17 [cited 2018 Nov 15] Available from: https:// nationalpost.com/news/canada/some-quebecdoctors-let-suicide-victims-die-though-treatment-was-available-college

19. Damiann D. Is Euthanasia Psychiatric Treatment? The Struggle With Death on Request in the Netherlands. American Journal of Psychiatry 2018 Sep . Volume 175, Issue 9 , pages 822-23 [cited 2018 Nov 15] Available from: https:// Euthanasia Cajp.psychiatryonline.org/doi/10.1176/appi. ajp.2018.18060725

20. Kirkey S. Toronto’s Sick Kids hospital preparing policy for euthanasia for youth over 18 that could one day apply to minors. National Post. [Internet] October 9, 2018. [cited 2018 Nov 15] Available from: https://nationalpost.com/ health/sick-kids-preparing-policy-for-euthanasia-for-youth-over-18-that-could-one-dayapply-to-minors

21.Leonetti J. Rapport d’information fait au nom de la mission d’évaluation de la loi N° 2005-370 du 22 avril 2005 relative aux droits des malades et à la fin de vie [Tome 1]. Paris, Fr: Assemblée nationale française; 2008. Report No. 1287. [Internet] [cited 2018 Nov 15] Available from: http://www.assemblee-nationale.fr/13/rap-info/ i1287-t1.asp

22. Fitzpatrick K. Should the law on assisted dying be changed? No. BMJ. 2011 Apr 21;342:d1883. [cited 2018 Nov 15] Available from: https:// www.bmj.com/content/342/bmj.d1883

23.Bravo G, Rodrigue C, Arcand M, Downie J, Dubois MF, Kaasalainen S, Hertogh CM, Pautex S, Van den Block L, Trottier L. Quebec physicians’ perspectives on medical aid in dying for incompetent patients with dementia. Can J Public Health. 2018 Aug 27. [cited 2018 Nov 15] Available from: https://link.springer.com/ article/10.17269/s41997-018-0115-9#citeas

24.World Medical Association: WMA Declaration of Geneva [Internet] [cited 2018 Nov 15] Available from: https://www.wma.net/policies-post/ wma-declaration-of-geneva/

25.End of Life Seminars. WMJ Vol. 64 No 2, August 2018, pp. 14-15. cited 2018 Nov 15] Available from: https://www.wma.net/wp-content/ uploads/2018/09/WMJ_2_2018.pdf

26.World Medical Association: WMA Resolution on prohibition of physician participation in capital punishment.[Internet] [cited 2018 Nov 15] Available from: https://www.wma.net/policies-post/wma-resolution-on-prohibition-ofphysician-participation-in-capital-punishment/

Friday, January 11, 2019

Canadian woman seeks euthanasia from pelvic mesh pain

Published by the Australian Care Alliance on January 11, 2019

A Canadian study that tracked more than 57,000 women has found patients with complications after pelvic mesh implants are at increased risk of depression, self-harm – even suicide.

The study published in the journal JAMA tracked more than 57,000 women in Ontario who had complications like pain and infections after receiving the polypropylene implants used to treat incontinence. The study found that:

  • Of those referred for mesh removal surgery, 11 per cent were treated for depression
  • Meanwhile, 2.7 per cent suffered from self-harm/suicidal behavior, almost double the rate in the control group

One woman from British Columbia, who asked not to be identified, has told CTV News that after being in agony for many months and unable to find a doctor willing to remove her implant she has “filled out paperwork for assisted dying due to the agonizing pain of mesh and the fact that I have no medical care regarding mesh.”

This story illustrates two important points.

Firstly, "assisted dying" - in the Canadian context this means euthanasia - is simply another form of suicide. This woman is seeking euthanasia for the same reason as other depressed women dealing with pain from pelvic mesh are committing suicide.

Secondly, euthanasia or assisted suicide can easily become the go-to solution when the health system fails a class of patients - in this case a failure to respond quickly by providing removal of pelvic mesh from women suffering from its adverse effects.

Thursday, January 10, 2019

Assessing Competency for Assisted Suicide Is Unethical

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

A group of psychiatrists published a letter in the Journal of Clinical Psychiatry titled: Assessing Competency for Physician-Assisted Suicide is Unethical in response to the letter by Yager et al: Working With Decisionally Capable Patients Who Are Determined to End Their Own Lives.

Yager et al suggest that psychiatrists can assess a person who is asking for assisted suicide and a patient with psychiatric conditions, if decisionally capable, can be prescribed lethal drugs.

Komrad et al state that assessing competency for assisted suicide is unethical. They argue:

Dr Mark Komrad
If, as we believe, PAS is inherently unethical—a position also taken by the World Medical Association—then it is perforce unethical for psychiatrists to be involved in performing competency assessments on patients requesting PAS. By analogy: the American Psychiatric Association has taken the position that psychiatrists should not perform competency assessments on prisoners slated for execution, though psychiatrists are permitted to relieve the prisoner’s “acute suffering” while he is awaiting execution.

Again, by analogy, we believe that, where PAS or euthanasia is legal in the United States and internationally, the psychiatrist’s role vis-à-vis patients requesting PAS should be limited to (1) determining if the patient is at immediate risk of self-harm, in which case emergency procedures could be initiated, and (2) alleviating acute suffering, such as panic attacks or extreme emotional distress, using appropriate psychiatric interventions. We also envision the possibility that a connection with a psychiatrist may help the patient work through existential and psychosocial issues that may underlie the wish for death or assisted suicide.

However, in our view, performing a competency assessment entails colluding with a process (PAS) that violates the most basic tenet of Hippocratic medicine—one that has sustained it through two millennia and a multitude of societies that have come and gone, namely, “I will not give a fatal draught to anyone if I am asked, nor will I suggest any such thing.”
The issue of assisted suicide for people with mental disorders is being debated by some state legislatures where the assisted suicide bill permits people with mental disorders to die by assisted suicide.

For instance, New Mexico's assisted suicide bill (House Bill 90) allows people with mental health disorders to die by assisted suicide. The bill enables licensed psychiatrist, psychologist, master social worker, psychiatric nurse practitioner or professional clinical mental health counselor to approve assisted suicide for people with mental health disorders.


The assisted suicide lobby is pushing to expand the scope of assisted suicide laws in the United States. One of the expansions is to permit assisted suicide for people with psychiatric conditions.

Wednesday, January 9, 2019

Canadian media continue to promote expansion of euthanasia law.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition


For those who don't believe that legalizing euthanasia or assisted suicide will lead to incremental extensions (slippery slope) of the law, you only have to look to Canada.

In December the Euthanasia Prevention Coalition applied to intervene in the Lamb case in British Columbia. The Lamb case seeks to extend euthanasia to people who are not dying by striking the section of Canada's euthanasia law stating that a person's "natural death must be reasonably foreseeable." I note that the euthanasia law did not define the term "reasonably foreseeable."

Yesterday the Gladu case began to be heard in a Montreal court. Similar to the Lamb case, the plaintiffs in Gladu have degenerative disabilities but they are not terminally ill and they do not fulfill the requirement that their "natural death is reasonably foreseeable."

The CTV news article on the Gladu case interviews, as its expert, Jocelyn Downie, the long-time euthanasia activist and James Palmer chair in public policy and law at Dalhousie University. Downie, who has written books and articles and has made the promotion of euthanasia her life-time work, agrees that the law is somehow too restrictive. Downie tells  CTV news:

“The criteria should be about suffering and autonomy,” she told CTV’s Your Morning. 
“It has to be about your capacity for self-determination. So if you’re capable of making the decision and your experiencing and enduring intolerable suffering you should be allowed access assisted dying.” 
She argued that the current laws are paternalistic and patronizing.
Downie advocates for no restrictions on euthanasia.

Gordon Friesen, a disability activist from Montreal, is quoted by CTV as saying that changing the legislation would leave many Canadians vulnerable.
“Since the end of the Second World War, nobody has dared to bring up the idea (that) a sick man’s life isn’t worth as much as another man’s, but now, they are doing it again,”
Friesen seems to recognize the similarities between the German T4 euthanasia program and what is being considered by this court case? Many may consider Friesen's comments to be extreme but he could be right.

At the same time, Downie, with the help of the media, has orchestrated a campaign to force St. Martha's hospital in Antigonish NS to participate in euthanasia

A few days ago CBC news was busy promoting the expansion of euthanasia by focussing on the release of three reports from the Council of Canadian Academies (CCA) concerning: euthanasia for children, euthanasia for incompetent people who previously asked for euthanasia, and euthanasia for people with psychiatric conditions alone.

It is interesting how the media ignores the fact that the CCA report on extending euthanasia to people with psychiatric conditions alone stated:
MAID law in Canada explicitly defines intolerable suffering in subjective terms. While a healthcare practitioner must “be of the opinion that” these conditions are met, if a patient truly believes their suffering is intolerable, and believes that existing means to relieve their suffering are not acceptable to them, they thereby meet the criteria for intolerable suffering set out in the legislation. 
No other country permits MAID MD-SUMC where one of the eligibility criteria is based on an individual’s personal assessment of what conditions for relief of their intolerable suffering they consider acceptable. If Canada were to expand MAID MD-SUMC using this criterion, it could become the most permissive jurisdiction in the world with respect to how relief of suffering is evaluated.
The Gladu and Lamb cases will be decided, sometime in the future, by the Supreme Court of Canada. If the court strikes down the section of the euthanasia law requiring that a person's 'natural death must be reasonably foreseeable,' Canada would then have the most permissive euthanasia law in the world since it defines 'intolerable suffering' in a completely subjective manner.

Tuesday, January 8, 2019

Europe's top human rights court will hear case of a depressed Belgian woman who died by euthanasia.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition.

An Associated Press (AP) article by Maria Cheng is reporting that the European Court of Human Rights has agreed to hear a case that was filed by the son of a depressed Belgian woman who died by euthanasia.
Tom Mortier
Robert Clark, the lawyer for Tom Mortier, the son of Godelieva De Troyer, who was physically healthy but depressed when she died by lethal injection, stated in the AP article:
“This was a woman who was under the care of a psychiatrist and according to medical definition was a vulnerable person,” 
“The state had a duty of care to protect her and it failed.”
According to the AP article:
The court said it would now consider whether Belgium had violated two parts of the European Convention on Human Rights in euthanizing Mortier’s mother. 
Mortier’s statement to the court alleges that Belgium failed to protect his mother’s life and that there was no thorough or effective investigation into her death.

According to an article published in the Daily Signal in January 2015:
Mortier says neither Distelmans (who did the euthanasia) nor a psychiatrist he consulted to approve the life-ending procedure (also a close friend of Distelmans’) had a previous involvement with his mother’s health. 
In fact, De Troyer’s treating psychiatrist of more than 20 years refused to help her die, maintaining that she did not satisfy the requirements of Belgium law. 
At first Distelmans agreed, and he too declined to help De Troyer end her life. But after she made a donation of 2,500 euro to Life End Information Forum, an organization he co-founded, Distelmans carried out De Troyer’s request.
Canada is debating extending its euthanasia law to include people with psychiatric conditions alone. This case and the case of the Belgian doctors who were charged in the death of an autistic woman will likely influence the Canadian law.

Monday, January 7, 2019

Oregon doctor speaks out about his depressed patient who died by assisted suicide.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Dr Charles Bentz, had a depressed patient who died by assisted suicide.


I had another patient who was diagnosed with a malignant melanoma, metastatic cancer, a form of cancer that has a very poor prognosis and he was quite depressed because he was an avid outdoorsman, he loved to hike, he loved to be outdoors. He was diagnosed and he was seeing his oncologist and he was quite depressed about it and she even documented it in his note.


He went to his cancer doctor and she called me and said, you know this patient really wants assisted suicide and I need you to be the second opinion.

I said, you know, lets wait a minute. Number 1: What's going on? Let's talk about this.

What happened is she must have found someone else because two weeks later he was dead from an overdose of a medication.


So my colleague saw a patient with depression but instead of addressing his depression she gave him the means to kill himself.

The film clip is from the Fatal Flaws film. The Fatal Flaws film can be purchased or rented at: (Link).

Sunday, January 6, 2019

The assisted suicide lobby wants to eliminate "safeguards."

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition



New Mexico's assisted suicide Bill HB 90, is the most extreme assisted suicide bill that I have ever seen

After reading HB 90 I asked the question: Is the assisted suicide lobby behind HB 90 or is the author of the bill, Deborah Armstrong (Dem) more radical than the rest of the suicide lobby?

I didn't have to wait long for the answer.

In her article: End-of-Life option laws should avoid needless red tape, Kim Callinan, the CEO of Compassion & Choices, (formerly known as the Hemlock society) argues that assisted suicide laws require fewer regulations. Callinan writes:

If lawmakers want to improve medical aid in dying laws, then let’s address the real problem: There are too many regulatory roadblocks already! I am not suggesting changing the eligibility requirements, as our opposition will suggest. I am merely suggesting that we drop some of the regulations that put unnecessary roadblocks in place.
Callinan continues her article by arguing that waiting periods for assisted suicide should be eliminated and she claims that there have been no problems with assisted suicide laws.

Now I know why New Mexico's assisted suicide bill is the most extreme bill that I have ever seen. HB 90:
  1. Allows nurses and physician assistants to participate in assisted suicide by defining "health care provider" to include: a licensed physician, a licensed osteopathic physician, a licensed nurse, and a licensed physician assistant. 
  2. Does not require the person to "self administer." The bill states "may self-administer" meaning that euthanasia is possible.
  3. Reduces waiting period to 48 hours to receive the lethal drugs.
  4. Allows people with mental health disorders to die by assisted suicide by enabling licensed psychiatrist, psychologist, master social worker, psychiatric nurse practitioner or professional clinical mental health counselor to approve assisted suicide for people with mental health disorders.
  5. Does not require a second assessor unless the person has a mental health disorder or intellectual disability. 
  6. Allows the "health care provider" to approve death via "telemedicine."
  7. Replaces a the normal 6 month terminal diagnosis with the undefined term: "foreseeable future." What does it mean that a terminal illness may cause death in the foreseeable future?
  8. Requires health care providers to falsify the death certificate.
  9. Removes conscience rights for health care providers who object to assisted suicide by requiring them to refer patients to a health care provider who is willing to prescribe assisted suicide.
  10. Basis decisions on a "good faith compliance."  It is impossible to prove that someone who participated in the act did not do so in "good faith."
Years ago I stated that the assisted suicide lobby would expand the parameters for prescribing lethal drugs in the future. Callinan is saying, in her article, that she believes that the future is now.


Help us prove Callinan wrong. The Euthanasia Prevention Coalition has organized the Stopping Assisted Suicide in Your State  Conference (January 26) and campaign training session (January 25) in Albuquerque New Mexico. (Information link).

You can watch the Saturday conference via the internet for $30. Contact us at: info@epcc.ca or call us at: 1-877-439-3348.

Friday, January 4, 2019

New Mexico assisted suicide bill is radical, but it does not permit suicide tourism.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition


On December 26 I published an article stating that the New Mexico assisted suicide bill (HB 90) may allow assisted suicide tourism. My article was wrong.

New Mexico assisted suicide Bill HB 90 is a dangerous assisted suicide bill and it is also written in an awkward manner.

All assisted suicide bills include a list of requirements to approve a person for a lethal prescription. That list always includes ... a residency requirement.


For instance, the Oregon assisted suicide act states that a "Qualified patient" means a capable adult who is a resident of Oregon.

HB 90 has a list of requirements but it does not include a residency requirement. But HB 90 does define "Adult" as a resident of the state who is eighteen years of age or older.

A problem exists. Section 3 in HB 90, describes the qualifications for assisted suicide, but it does not use the term "Adult," it uses the term "individual."

The term "Adult" only shows up in the form: REQUEST FOR MEDICATION TO END MY LIFE IN A PEACEFUL MANNER. This is the form for requesting assisted suicide that says:

I ... am an adult of sound mind.
In fact the form requesting assisted suicide is the only time HB 90 uses the word "Adult."

For more information about how dangerous assisted suicide bill HB 90 is read:

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