Monday, January 30, 2012

Euthanasia or eugenics of newborns with Disabilities

The Gulf Times is reporting that at a workshop in Doha organized by the Qatar Foundation for Child and Women Protection (QFCWP) that parents of newborns with disabilities stated that euthanasia needs to be legal for their circumstances. The workshop was organized under the theme of: child protection.


The report in the Gulf Times stated:
- One doctor suggested that life-support can be withdrawn from the child with a disability, with the consent of the family and two doctors who agree that life-support is futile.
- QFCWP’s director general, Farida al-Obaidly told the story of a child who was born with disabilities and whose parents wanted treatment. The child is now seven years old and unique in his own way.
- QFCWP legal advisor, Noor al-Hor stated that the sanctity of life supersedes.

- Hamad Medical Corporations’ chief legal adviser, Abul Qasim Midwi pointed out that those who resort to objectionable conduct are punishable under the penal law of Qatar.
- It was then stated that these cases should be immediately reported to the police.

Discussions concerning the euthanasia of newborns with disabilities shows how deep attitudes towards disability exist within many cultures. 

In Canada, children are often intentionally neglected for them to die, rather than providing basic medical care. These decisions are not being made based on the best interests of the child, but rather because a decision was made that the child should die.


If society legalizes euthanasia and allows doctors or parents to intentionally inject children or others with disabilities, then, like in the Netherlands, the existing prejudices that exist will lead to some lives being eliminated. 

The cover-up will be the idea that the child or the person with a disability was suffering.

Sunday, January 29, 2012

HOPE begins letter writing campaign in South Austalia

HOPE, the young and effective group that opposes euthanasia and assisted suicide has launched a letter writing campaign in South Australia. Those who follow the issue would remember that two bills to legalize euthanasia were initiated and debated in South Australia in 2011. The euthanasia bill that was sponsored by Steph Key, last year, was promoted as a palliative care bill but it clearly legalized euthanasia.

It appears that both bills have been changed and are being re-introduced in the South Australian parliament.

Alex Schadenberg is scheduled to go to South Australia to make a few presentations and build opposition to the euthanasia bills in late June. Further information will be circulated soon.

Paul Russell
Paul Russell, the founder and leader of HOPE, posted the following article on the HOPE website.

At it again in 2012!

The South Australian Parliament has been besieged by euthanasia & assisted suicide bills over the last decade and more. In the current parliament, there have been no less than four bills introduced across both houses.

In December 2011, the Premier formally prorogued parliament which effectively wiped out all bills still under debate at that time. It remains to be seen how the pro-euthanasia MPs, Bob Such and Steph Key will respond once parliament resumes in 2012. Steph Key has the option of reinstating her ‘medical defences’ bill. (see Advertiser 4th Jan)

At the close of parliament in 2011, The Criminal Law Consolidation (Medical Defences – End of Life Arrangements) Amendment Bill (read more on this bill HERE) was close to a final resolution in the House of Assembly (Lower House).

Letter writing information.

Friday, January 27, 2012

MacDonald proposes new bill to legalize assisted suicide in Scotland

Another year, another attempt to legalize assisted suicide or euthanasia. A couple of weeks ago we learned that the euthanasia lobby in South Australia was planning to try to legalize euthanasia again, and now we learn the new strategy by Margo MacDonald and the euthanasia lobby in Scotland.

Margo MacDonald
On December 1, 2010; the Scottish Parliament stunningly defeated by a vote of 85 to 16, that was proposed by Margo MacDonald to legalize euthanasia and assisted suicide.

MacDonald has has made it clear that she intends to introduce a new bill under the title: Assisted Suicide (Scotland) bill. She is circulating a consultation document until April 30, 2012.

When reading my assessment of her previous bill, you will notice that MacDonald used imprecise language to cover-up her intention to legalize wide-open access to euthanasia and assisted suicide.

The current consultation document is an outline of the bill, but not the actual bill. It is difficult to assess her actual intentions until we see the actual legislation. MacDonald claimed that her previous bill did allow euthanasia and yet it clearly did allow euthanasia.

MacDonald is "consulting" with the Scottish people so that when she introduces the actual bill she can say that her bill represents the "will" of the Scottish people.

The Care Not Killing Alliance in Scotland is developing a stragegy to defeat the upcoming attempt by Margo MacDonald to legalize assisted suicide in Scotland.http://www.carenotkilling.org.uk/?category=12

Thursday, January 26, 2012

The Leblanc case in Quebec - Further thoughts.

On October 31, René Duval, the lawyer for Ginette Leblanc submitted the notice of claim in Trois-Rivières Quebec, asking the Quebec Superior Court to overturn Section 241b of the Criminal Code in order for Mme Leblanc to die by assisted suicide. Ginette Leblanc lives with ALS.

The Notice of Claim in the Leblanc case stated that it was challenging the constitutionality of Section 241b of the Criminal Code, which is the assisted suicide act. It did not indicate openly indicate that it was challenging any other section of the Criminal Code. After reading the Notice of Claim, I was convinced that the Leblanc case was limited to Section 241b of the Criminal Code, but after speaking to Margaret Dore and after reading her commentary on the Leblanc case, I am convinced that the Leblanc case quietly seeks to legalize euthanasia.

The Euthanasia Prevention Coalition (EPC) and Vivre dans la Dignité are seeking to co-intervene in the Leblanc case.

The Leblanc case appeared to be taking a less aggressive approach than the Carter case in British Columbia that is clearly trying to legalize euthanasia and assisted suicide in Canada. Carter Talking Points. Carter was heard by Justice Lynn Smith in Vancouver BC from November 14 - December 16, 2011. EPC and EPC - BC co-intervened in the Carter case and made its legal presentation before Justice Smith on December 14.

Margaret Dore, the fabulous lawyer and elder abuse advocate from Seattle Washington, pointed out that Section 11 of the Leblanc Notice of Claim states:
11. Due to the physical limits, the plaintiff will not without the help of a health care professional and / or that of a person acting under the supervision of such business, obtain and / or administer medication and / or the necessary treatment (s) to end her life.
To administer medication, would constitute an act of euthanasia and not an act of assisted suicide.

The other point that Margaret makes, which was not missed by myself, is that Canada's assisted suicide act does not refer to physicians, therefore striking down Section 241b of the Criminal Code would grant anyone the right to assist the suicide of another.

The Leblanc case went further by stating in Section 11 that: "a person acting under the supervision of a health care professional" could assist the suicide. This traditionally includes family members.

In conclusion, it appears that if the Quebec court accepts the pleadings in the Leblanc case, that in fact they would be decriminalizing assisted suicide and they would be, under the cover of imprecise language, decriminalizing euthanasia.

If I am wrong, please make your case.

The Leblanc Case in Quebec: A Recipe for Elder Abue and a Threat to the Individual

"Those who believe that legal assisted suicide/ euthanasia will assure their autonomy and choice are naive."

William Reichel, MD
Montreal Gazette, May 30, 2010[1]
By Margaret Dore
January 26, 2012

A. Introduction

Leblanc vs. Attorney General of Canada brings a constitutional challenge to Canada's law prohibiting aiding or abetting a suicide. Leblanc also seeks to legalize assisted suicide and euthanasia as a medical treatment. In 2010, a bill in the Canadian Parliament seeking a similar result was overwhelmingly defeated.

Legalization of assisted suicide and/or euthanasia under Leblanc will create new paths of elder abuse. This is contrary to Canadian public policy. Legalization will also empower the healthcare system to the detriment of individual patients. There will be other problems.

B. Parliament Rejected Assisted Suicide and Euthanasia

On April 21, 2010, Parliament defeated Bill C-384, which would have legalized assisted suicide and euthanasia in Canada.[2] The vote was 228 to 59.[3]

C. The Notice of Civil Claim

In Leblanc, the Notice of Civil Claim seeks to strike down § 241(b) of the Criminal Code of Canada as contrary to the Canadian Charter of Rights and Freedoms.[4] § 241(b) states:
"Every one who . . . (b) aids or abets a person to commit suicide, whether suicide ensues or not, is guilty of an indictable offence and liable to imprisonment for a term not exceeding fourteen years."[5]
If § 241(b) would be struck down, it appears that any person, without restriction, would be allowed to assist another person's suicide.

The Notice of Claim also seeks to allow a healthcare professional, not necessarily a doctor, and/or a person acting under the professional's supervision, to "obtain and/or administer medication and/or the necessary treatment to end [the plaintiff's] life."[6] This request, to allow someone to actively administer a lethal modality to another person, is a request for euthanasia. The Canadian Medical Association states:
"Euthanasia means someone taking active measures to end life."[7]
In the context of traditional medical treatment, a person acting under the "supervision" of a healthcare professional would include a family member.[8] An example would be an adult child who administers medication to a parent under the supervision of a doctor who is not present.[9] This would typically be in a home setting.[10]

The Notice of Claim does not define any particular eligibility for assisted suicide/euthanasia other than a description of the plaintiff.[11] She is a disabled woman with ALS.[12]

D. A Comparison to the United States

In the United States, there are two states where assisted suicide is legal: Oregon and Washington.[13] The laws in these states were enacted via ballot initiatives, which are similar to a referendum in Canada.[14] No such law has made it through the scrutiny of a legislature despite more than 100 attempts.[15]

The Oregon and Washington laws apply to patients predicted to have less than six months to live, who are typically age 65 or older.[16] The statutes have safeguards, for example, two doctors are required to approve a lethal prescription; there are also waiting periods.[17] These laws nonetheless leave patients unprotected against elder abuse, coercion and even murder. Alex Schadenberg, executive director of the Euthanasia Prevention Coalition, states:
"With assisted suicide laws in Washington and Oregon, [elder abuse] perpetrators can . . . take a 'legal' route, by getting an elder to sign a lethal dose request. Once the prescription is filled, there is no supervision over the administration. . . . [E]ven if a patient struggled, 'who would know?'" [18]
E. Elder Abuse

Preventing elder abuse is official Government of Canada policy.[19] Elder abuse includes physical, psychological and financial abuse.[20] Financial abuse is the most commonly reported type.[21] Elder abuse is, however, largely unreported and can be very difficult to detect.[22] This is due in part to the reluctance of victims to report. The Government of Canada website states:
"Older adults may feel ashamed or embarrassed to tell anyone that they are being abused by someone they trust."[23]
Will Johnson, MD, echoes these themes as follows:
"I see elder abuse in my practice, often perpetrated by family members and caregivers. A desire for money or an inheritance is typical. To make it worse, the victims protect the perpetrators. In one case, an older woman knew that her son was robbing her blind and lied to protect him. Why? Family loyalty, shame, and fear that confronting the abuser will cost love and care. . . .

Under current law, abusers take their victims to the bank and to the lawyer for a new will. With legal assisted suicide, the next stop would be the doctor’s office for a lethal prescription. How exactly are we going to detect the victimization when we can’t do it now?"[24]
If assisted suicide and/or euthanasia are legalized via Leblanc, new paths of abuse will be created against the elderly, which is contrary to Government of Canada public policy. For this reason alone, the relief requested in Leblanc should be denied.

F. Empowering the Healthcare System

In Oregon, where assisted suicide has been legal since 1997, patients desiring treatment under the Oregon Health Plan have been offered assisted suicide instead.[25] The most well known cases involve Barbara Wagner and Randy Stroup.[26] Each wanted treatment.[27] The Plan offered them suicide instead.[28]

Neither Wagner nor Stroup saw this scenario as a celebration of their "choice." Wagner said: “I'm not ready to die.”[29] Stroup said: “This is my life they’re playing with.”[30]

Wagner and Stroup were steered to suicide. Moreover, it was the Oregon Health Plan, a government entity, doing the steering. If assisted suicide and/or euthanasia are legalized in Canada, the Canadian health care system will be similarly empowered. Indeed, even the plaintiff could find herself pushed to her death before she is ready. She could be a Canadian "Barbara Wagner." Her "choice" would be compromised and/or denied.

F. Suicide Contagion.

Oregon's suicide rate, which excludes suicides under its physician-assisted suicide law, has been "increasing significantly" since 2000.[31] Just three years prior, Oregon legalized assisted suicide.[32] This increased suicide rate is consistent with a suicide contagion.[33] In other words, legalizing one type of suicide encouraged other suicides. In Canada, preventing suicide is a significant public health issue.[34]

G. Conclusion

In Leblanc, the relief requested should be denied.

***

Margaret Dore
Margaret Dore is President of Choice is an Illusion, a nonprofit corporation opposed to assisted suicide and euthanasia with a focus on the US and Canada. In November 2010, she appeared as an expert witness before the Select Committee on Dying with Dignity of the National Assembly of Quebec, Canada. She was an amicus curie in Baxter v. Montana, which is similar to Leblanc v. Attorney General of Canada.

Ms. Dore has been licensed to practice law in Washington State since 1986. She is a former Law Clerk to the Supreme Court of the State of Washington. She worked for the United States Department of Justice for one year. She has published multiple articles on elder abuse topics and against assisted suicide and euthanasia.

For more information, see: http://www.choiceillusion.org/ and http://www.margaretdore.com/.

Council of Europe states that: "Euthanasia must always be prohibited."

Yesterday, the Parliamentary Assembly of the Council of Europe adopted a non-binding resolution concerning Advanced Directives, Living Wills, Power of Attorneys and Consent to Treatment under the title: Protecting human rights and dignity by taking into account previously expressed wishes of patients. This resolution did not specifically concern the issue of euthanasia, nonetheless Article 5 of the resolution states:
"Euthanasia, in the sense of the intentional killing by act or omission of a dependent human being for his or her alleged benefit, must always be prohibited."
The resolution is comprised of a list of principles already elaborated in three documents previously adopted in the Council of Europe, including the Convention on Human Rights and Biomedicine (Oviedo Convention), which legally binds the majority of member States.

This statement follows a similar decision on January 20, 2011 by the European court of Human Rights which found that the state has no obligation to provide citizens with the means to commit suicide.

Even though this is a non-binding resolution, it does make it clear that euthanasia is an act that must always be prohibited.

Read the commentary about this resolution by the European Center for Law and Justice

Wednesday, January 25, 2012

Convicted killer in British Columbia tried using "assisted suicide" defense

It has taken several days to think through the issues surrounding the second-degee murder conviction of Thomas Elton in the stabbing death of his wife Brenda Turcan/Blondell. Elton was convicted last week in Surrey BC.

Elton claimed that Blondell's death was a suicide pact gone wrong, meaning that he completed the her suicide but he didn't die by suicide himself.

His defense was that this was an assisted suicide and not a homicide.

1. Elton is on parole for the stabbing death of a fellow prisoner who he murdered in 1975.
2. Blondell, who also used the name Turcan, was on parole for a 1987 murder that she committed in Burnaby BC.
3. Elton claimed that Blondell was living with terminal cancer and that his act was part of a murder-suicide.
4. Elton claimed that he found Blondell unresponsive so he finished her suicide by first strangling her, and then stabbing her, to make sure that she had died.
5. Elton claimed that he then gave the dog pills and he took pills himself, in order to commit suicide.
6. The autopsy showed that Blondell did not take any pills and that she died from strangulation.

A story written by Jennifer Saltman in the Vancouver Province actually gave credibility to Elton's claims.

There are many problems with Elton's story.
1. Even if Elton had a suicide pact, Blondell died from strangulation. Assisted suicide is defined as an act that one does to oneself with the assistance of another. Clearly this is not an assisted suicide.
2. When you do a google search concerning Thomas Elton, you come across another case in 1998 where Elton attempted to kill a man by stabbing. In that case, Elton also claimed that the attempted murder was a murder/suicide and at the trial in 1999, Elton was acquitted of murder. In other words, Elton has used this defense before. (It is likely that the court was unable to consider the fact that Elton had used this defense before).

Finally, if assisted suicide or euthanasia was legalized, then cases, such as this, will be harder to decide, especially if the person has hired an accomplished lawyer.

It appears that Elton has been given significant leniency considering the fact that he was convicted of second-degree murder and not first-degree murder.

Poll finds that people in France prefer improving palliative care over legalizing euthanasia.

A poll published today in France by Génèthique.org found that 60% of the respondents would like to focus on the development of palliative care over the legalization of euthanasia.

The Poll stated:
According to a BVA poll, conducted in particular by the Chamber of Notaries of Paris and published January 24, 2012, French public opinion has shifted on the ethical and social issues related to surrogacy and euthanasia.

As for the "right" to euthanasia, 84% of respondents declare that they recognize a "right" to euthanasia for people with incurable, terminal, and the claimant. In a similar survey in 2009, they were a little more, 86%, share this view. Moreover, the opinion poll of 2011 Way of Opinion found that 60% of French people would like to focus on the development of palliative care over the legalization of euthanasia.
It is important to note that a similar poll in Canada found that 71% of the respondents thought that the government should focus on improving palliative care over the legalization of euthanasia and only 5% thought the government should legalize euthanasia and improve palliative care.

People state that they support the legalization of euthanasia or assisted suicide out of the fear of dying a bad death. This fear is often related to personal experience. Our polling has found that very few people strongly support the legalization of euthanasia or assisted suicide while the majority of people want to reduce their fears with improvements to end-of-life care.

Tuesday, January 24, 2012

The Case Against Euthanasia and Assisted Suicide

Brescia University College
The Euthanasia Prevention Coalition co-sponsored a speaking engagement featuring Professor Margaret Somerville.
When: Wednesday, March 7, 2012 at 7:30 pm.
Where: Brescia University College - 1285 Western Rd. London, ON (Western University) the Mother St. James Memorial Building Auditorium.
Topic: The Case Against Euthanasia and Assisted Suicide.
Cost: This is a free event - Everyone is welcome.

Margaret Somerville
Professor Margaret Somerville holds professorships in both the Faculty of Law - where she holds the Samuel Gale Chair - and the Faculty of Medicine (McGill University - Montreal). She was the founding director of the McGill Centre for Medicine, Ethics and Law.

Professor Somerville is a world-renowned speaker, consultant and researcher on many topics including euthanasia and assisted suicide. She has written about the role that scientific and medical research and technology play in the formation of societal values.

Somerville consulted for international organizations such as the Global Programme on Aids of the World Health Organization, UNAIDS, the United Nations Human Rights Commission in Geneva, and law reform commissions in Canada and Australia.

She was the key-note speaker at the First International Symposium on Euthanasia and Assisted Suicide.

This is a Free Event - Everyone is welcome.

Sunday, January 22, 2012

Don't legalize assisted suicide

Yesterday, The Salt Lake Tribune published the following letter from Oregon doctor, Charles Bentz. The article was published under the title: Don't follow Oregon.


I am a doctor in Oregon, where physician-assisted suicide is legal. I disagree with the implication in “Do Utahns have the right to choose how they die?” (Tribune, Jan. 8) that Oregon’s assisted-suicide law is a good thing.

A few years ago, a 76-year-old patient presented with a sore on his arm. I referred him to a cancer specialist for therapy. As he went through that therapy, he became depressed, which was documented in his chart.

During this time, he expressed to the cancer specialist a wish for assisted suicide.

Rather than making the effort to address his depression, or to contact me, his primary physician who knew him, she asked me to be the second opinion for his suicide. 

I did not concur; addressing his depression would be better than simply giving him a lethal prescription.

Unfortunately, two weeks later my depressed patient was dead from an overdose prescribed by this doctor.
In most jurisdictions, suicidal ideation is interpreted as a cry for help.

In Oregon, the only help my patient got was a prescription intended to kill him.

Don’t follow Oregon’s lead.

Charles J. Bentz, M.D. Clinical associate professor of medicine Oregon Health and Sciences University - Portland Oregon

Saturday, January 21, 2012

Assisted Suicide is not legal in Montana

Bradley Williams
 Yesterday, The Salt Lake Tribune published a letter by Bradley Williams, the coordinator of Montanans Against Assisted Suicide. Williams explains why assisted suicide is not legal in Montana. The letter was titled: Suicide in Montana. Williams stated:
I am the coordinator of Montanans Against Assisted Suicide and for Living with Dignity. I disagree with Patty Henetz that assisted suicide is legal in Montana, or, as she wrote, to “allow doctors to legally write such prescriptions for the terminally ill, under certain circumstances” (“Do Utahns have the right to choose how they die?” Tribune, Jan. 8)
For the past five years, Montana has been targeted for legalization of assisted suicide by the Denver-based suicide promotion organization deceptively named Compassion and Choices (formerly the Hemlock Society). In 2007, Compassion and Choices initiated litigation that resulted in the 2009 Baxter decision that gives doctors, and only doctors, a potential defense to criminal prosecution for causing or assisting a suicide.

Assisted suicide is not legalized by giving doctors or anyone else criminal or civil immunity.

In 2011, Compassion and Choices tried again, backing a bill, SB167, that would have legalized assisted suicide in Montana. The Legislature did not pass it.

Legal assisted suicide is a recipe for elder abuse. It has multiple other problems as we discuss on our website (http://www.montanansagainstassistedsuicide.org/).

Bradley D. Williams
Hamilton, Montana

Thursday, January 19, 2012

Kidney Transplant denied to girl with disability

Dick Sobsey
Dick Sobsey, the past director of the JP Das Centre on Developmental and Learning Disabilities at the University of Alberta, has brought to my attention the discrimination case concerning Amelia, a young child with Wolf-Hirschorn syndrome, who has been denied a kidney transplant because of her disability.

It clearly appears that this is a case of discrimination, where Amelia is being denied equal access to healthcare, not because the kidney transplant would be less efficacious for Amelia, but because she has a significant disability and is perceived to be, less than equal.

Kidney Transplant Denied- January 19, 2012 — dsobsey

The parents of a young girl with Wolf-Hirschorn syndrome claim that she was denied a kidney transplant solely on the basis of her intellectual disability at the Children’s Hospital of Philadelphia. The mother’s account of her interaction with the social worker and physician is very specific. There seems to be little room to conclude maybe there was some other reason for the denial. Medical Ethicist Art Kaplan’s poll goes right to the heart of this. While Kaplan concludes, “But those reasons, to be ethical, have to be linked to the chance of making the transplant succeed. Otherwise they are not reasons, they are only biases,” the poll on the page asks simply, “Do you think a mental disability is a valid reason to deny a transplant?” If you have an opinion consider responding to the poll.

Discrimination and negative eugenics are still a part of our world.

Of course, Section 504 of the Rehabilitation Act of 1973 says that no Federal Funds of any kind shall be paid to an entity that discriminates on the basis of disability:

Sec. 504.(a) No otherwise qualified individual with a disability in the United States, as defined in section 7(20), shall, solely by reason of her or his disability, be excluded from the participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance or under any program or activity conducted by any Executive agency or by the United States Postal Service. The head of each such agency shall promulgate such regulations as may be necessary to carry out the amendments to this section made by the Rehabilitation, Comprehensive Services, and Developmental Disabilities Act of 1978. Copies of any proposed regulation shall be submitted to appropriate authorizing committees of Congress, and such regulations may take effect no earlier than the thirtieth day after the date on which such regulation is so submitted to such committees.
and the Convention on The Rights of Persons with Disabilities says:
Article 25 – Health

States Parties recognize that persons with disabilities have the right to the enjoyment of the highest attainable standard of health without discrimination on the basis of disability. States Parties shall take all appropriate measures to ensure access for persons with disabilities to health services that are gender-sensitive, including health-related rehabilitation. In particular, States Parties shall:

a. Provide persons with disabilities with the same range, quality and standard of free or affordable health care and programmes as provided to other persons, including in the area of sexual and reproductive health and population-based public health programmes;
…maybe it is time we started taking these things seriously.

In 2006, an article published in the American Journal of Kidney Diseases studied the outcomes for 25 individuals with multiple disabilities who had kidney transplants (American Journal of Kidney Diseases Volume 47, Issue 3, Pages 518-527, March 2006). The group included many with genetic syndromes including some with severe and some with severe intellectual disabilities. 23 got kidneys from living donors and 2 got kidneys from cadavers.The success rate was 100%. to quote the authors: “Surprisingly, the graft survival rate in the handicapped in this series is superior to that of patients with normal intellectual capability.” In other words, those with intellectual disabilities actually fared better than those without.

In addition, another 2006 article published in Pediatric Transplantation, reported 3-year survival rate results from a different sample of kidney transplant recipients and concluded excellent outcomes for individuals with intellectual disabilities. These may not have had as severe disabilities as the previous study. Surprisingly, the sample included 6 cases from Children’s Hospital of Philadelphia. The one-year and three-year survival rates for these individuals was 100%.

Martens MA, Jones L, Reiss, S. Organ transplantation, organ donation and mental retardation. Pediatric Transplantation 2006:10:658–664.

Kidney Transplantation in Pediatric Recipients With Mental Retardation: Clinical Results of a Multicenter Experience in JapanToshiyuki Ohta, MD, Osamu Motoyama, MD, Kota Takahashi, MD, Motoshi Hattori, MD,Seiichiro Shishido, MD, Naohiro Wada, MD, Yoshimitsu Gotoh, MD, Tosh. American Journal of Kidney Diseases Volume 47, Issue 3, Pages 518-527, March 2006