Wednesday, April 24, 2019

Good news: The Nevada assisted suicide bill died a natural death. Dr Kirk Bronander wrote an excellent article explaining why assisted suicide should not be legal.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Congratulations to the many groups and individuals who worked to defeat Nevada's assisted suicide bill SB 165. SB 165 passed in the Nevada Senate Health and Human Services Committee (3 - 2) on March 25.

A few days ago, a well researched article by Dr Kirk Bronander, a professor of medicine at the University of Nevada, Reno School of Medicine and director of academic hospitalists for UNR Med., titled: Physician assisted suicide a flawed process was published in the Reno Gazette.


Dr Kirk Bronander
In his article Dr. Bronander first challenged the concept of a six month prognosis. He wrote:

The fact is that physicians frequently make errors with diagnosis and predicting timing of death in terminal conditions. My family has personal experience with this: My father was diagnosed with a malignant brain cancer (glioblastoma) and given a prognosis of less than six months to live. He survived for almost four years after his diagnosis. This is also well-documented in the medical literature: A study of hospice patients in the Chicago area showed that of 468 predictions of timing of death, only 20 percent were accurate. Inaccurate diagnoses or prognoses coupled with PAS will result in patients dying that may have years of life remaining.
Dr. Bronander then questioned the ability to regulate the lethal assisted suicide prescriptions. He wrote:
I trust many of my colleagues but there are always going to be some physicians that are unscrupulous, incompetent or unethical. That means this type of law can easily be abused. In Reno, Dr. Robert Rand contributed to the death at least one patient by overprescribing opioids. He did this for years even though opioids are the most highly regulated medications we can prescribe. The lethal drugs used for suicide will be much less scrutinized since there is no requirement for the federal government to monitor them. The law itself will protect the identity of the prescribing doctor, so no one will ever be able to determine if abuse is occurring. Do you trust every physician in Nevada?
Dr. Bronander then examines the effect legalizing assisted suicide has on the elderly and people who become depressed. He wrote:
Unfortunately, many elderly and terminal patients feel they are a burden to loved ones and this law will encourage suicide as an answer. The statistics from Oregon in 2017 (which has a similar law to the one proposed in Nevada) are clear that the reasons stated for obtaining the lethal prescription are for reasons other than pain. “Losing autonomy” is No. 1 and “burden on family, friends/caregivers” is a more frequent reason than “inadequate pain control,” which is sixth on the list. 
Many patients diagnosed with a terminal condition are depressed and there is no requirement to refer to psychiatry or counseling in the law. The Oregon statistics show that only 3.8 percent of patients receiving lethal drugs were referred for psychiatric evaluation while a 2008 study conducted in Oregon found 25 percent of patients requesting assisted suicide were clinically depressed. Depression is a treatable condition; obviously a completed suicide is not treatable.
Thankfully, Nevada's assisted suicide bill is dead in 2019. Sadly, the assisted suicide lobby will likely introduce another bill in 2020. Hopefully Dr Bronander's research will help Nevada, and other states, defeat future assisted suicide bills.

The NCET named Dr Kirk Bronander educator of the year in 2018.

Tuesday, April 23, 2019

Ontario: 268 people die by euthanasia in the first quarter of 2019.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition.

The Ontario Coroner's Office sent a quarterly report stating that there have been 2897 reported assisted deaths in Ontario since legalization (June 17, 2016) with 268 reported euthanasia deaths in the first three months of 2019.


The current rate of euthanasia, in Ontario, is slightly lower than in 2018. There were 1499 reported assisted deaths in 2018, 841 reported assisted deaths in 2017 and 189 reported assisted deaths in 2016.

The 2897 reported assisted deaths, represented 2896 deaths by euthanasia (lethal injection) and 1 death by assisted suicide (lethal prescription).

The Euthanasia Prevention Coalition works with Compassionate Community Care (CCC) to offer advice and support for family members and friends who are concerned about an assisted death or end-of-life medical treatment decision. Contact CCC at: 1-855-675-8749.

Data from Alberta Health Services indicates that there have been 654 reported assisted deaths since legalization representing 79 reported assisted deaths in 2019. There were 307 reported assisted deaths in 2018 in Alberta.

Contact the Euthanasia Prevention Coalition if you have concerns with the circumstances related to a euthanasia death at: 1-877-439-3348.

Canada's federal government is slow in releasing data, therefore EPC has been searching for assisted death data from the provinces.

Monday, April 22, 2019

Oregon assisted suicide. The myth of "oversight" and "control."

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

As the Executive Director of the Euthanasia Prevention Coalition (EPC) my position opposing assisted suicide is clear. For the sake of this article, I will simply share some information about assisted suicide in Oregon.

Recently two Oregon doctors were investigated for abuse of the assisted suicide act. Since the Oregon assisted suicide act employs a self-reporting system (the physician who assists the suicide is also the physician who reports) it is difficult to uncover abuse of the law.

A search of the Oregon Medical Board disciplinary actions on September 15, 2018, found that Dr Rose Kenny was disciplined by the Medical Board. The order from the meeting states:
3.1 Licensee must not prescribe or manage the prescriptions for any medication for any patient enrolled in hospice care,
3.2 Licensee must not prescribe or manage the prescriptions for any medication for any patient requesting Death with Dignity.
Recent assisted suicide research has uncovered excessive suffering related to death by assisted suicide. An article by JoNel Aleccia published by Kaiser Health News on March 5, 2017 reported that the following occurred while doing research on assisted suicide drug cocktails: 
The first Seconal alternative turned out to be too harsh, burning patients’ mouths and throats, causing some to scream in pain. The second drug mix, used 67 times, has led to deaths that stretched out hours in some patients — and up to 31 hours in one case.
The myth that the Oregon assisted suicide law has effective oversight has enabled the assisted suicide lobby to push for an expansion of the Oregon assisted suicide law.

Oregon is proposing to expand the assisted suicide law.

The Oregon legislature is debating several bill including Bill HB 2217 to expand the assisted suicide law to permit euthanasia (homicide) by redefining the term "self administer" to allow  patients to take the lethal drugs into their body using any method, including an IV tube or injection. The bill states:
“Self-administer” means a qualified patient’s physical act of ingesting or delivering by another method medication to end his or her life in a humane and dignified manner.
Bill HB 2232  proposes to change the definition of terminal from a six month prognosis to:
a disease that will, within reasonable medical judgment, produce or substantially contribute to a patient’s death.
This new definition eliminates the requirement that a person, who dies by assisted suicide, be terminally ill. 

Many people have a disease that will within reasonable medical judgement, produce or substantially contribute to death, are not "terminally" ill. This new definition will give doctors the right to prescribe suicide drugs to many more people.

Oregon Bill SB 0579 enables a physician to wave the 15 waiting period in the assisted suicide law. 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 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.
By waving the 15 day waiting period, a person who is approved for assisted suicide could receive the lethal drugs immediately with no opportunity for a depressed person to change their mind.

When analyzing the recent Oregon assisted suicide report we notice significant problems with the law beyond the fact that assisted suicide causes death.

The Oregon assisted suicide report states that there were 168 reported assisted suicide deaths in 2018 up from 158 reported assisted suicide deaths in 2017. The longest duration before death being 21 hours in 2018 while one person died 807 days (more than 2 years and 2 months) after being approved for assisted death.

In December 2017, Fabian Stahle, a Swedish researcher, communicated by email with a representative of the Oregon Health Authority.

Stahle confirmed that the definition of terminal illness, used by the Oregon Health Authority includes people who may become terminally ill if they refuse effective medical treatment.

The responses to Stahle from the Oregon Health Authority also confirmed that there is no effective oversight of the Oregon assisted suicide law.
Assisted suicide and "other" suicide deaths.

The Oregon suicide rate is increasing faster than the national average. In 2007 Oregon's conventional suicide rate was 35% higher than the national average while in 2014, Oregon's conventional suicide rate was 43% higher than the national average.


It has been argued that there is not a direct co-relation between the Oregon suicide rate and assisted suicide, nonetheless, it must be noted that there appears to be a suicide contagion effect.

Oregon assisted suicide law is designed to cover-up abuse of the law.

The Oregon law enables the physician who assesses a person requesting assisted suicide to be the same physician who prescribes the lethal assisted suicide drugs and then be the same physician who is required to report the assisted suicide death.

By law, the same doctor is the judge, the jury and the executioner.

The yearly Oregon DWD reports are based on data from the physicians who prescribe and carry-out the assisted suicide death and the data is not independently verified. Therefore, we don't know if the information from these reports is accurate or if abuse of the law occurs. There is no third party oversight or intervention it is all a mirage.

Since doctors rarely self-report abuse of the law or even self-report controversial decisions, therefore the law enabled a cover-up of any and all concerns.
Every state that has legalized assisted suicide has also employed the same system to cover-up potential problems with the law.

If the facts concerning assisted suicide were known and openly debated, people would reject assisted suicide and demand excellent care.

To share this information, order the pamphlet: Shedding Light on Assisted Suicide in America.

We believe in Caring Not Killing.

Oregon Bill HB 2217 would extend assisted suicide to allow euthanasia.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Oregon bill HB 2217 which expands assisted suicide to include euthanasia by redefining "self-administer" passed in the House by a vote of 37 to 21. HB 2217 states:
“Self-administer” means a qualified patient’s physical act of ingesting or delivering by another method medication to end his or her life in a humane and dignified manner.
The difference between euthanasia and assisted suicide is how it is done. Euthanasia is done by one person causing the death of another person, usually by lethal injection. Assisted suicide is when one person is directly involved with causing the death of another person, usually by prescribing lethal drugs that patients take themselves. 

Chris Lehman with KLCC in Oregon explains that HB 2217 enables lethal drugs to be taken by any method, including lethal injection:
Oregon’s “Death With Dignity Act” allows doctors to prescribe lethal medications to people who are thought to have less than six months to live. Patients have to take the medicine themselves. Since the law took effect in the late 90’s, that’s generally been interpreted to mean taking the deadly dose through oral ingestion.

The measure under consideration would clarify that patients could take the medication into their body using any method, including an IV tube or injection.
On January 1, 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) argued 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.

The assisted suicide lobby considers the homicide laws as a roadblock to assisted suicide. If HB 2217 becomes law, it will create an exception for homicide under the assisted suicide act.

Complications with Lethal Drugs Used for Assisted Suicide

The Patients Rights Action Fund published the following information.

Warning: If you are experiencing suicidal thoughts, do not read this article but call: 1-800-273 (talk) 8255
Seconal
· The lethal dose prescribed to cause the death of the patient is 9 grams of seconal (secobarbital) capsules. To reach this dosage, the patient takes 100 capsules which are opened and mixed with a sweet substance to mask the bitter taste.

· The price of seconal in 2009 was estimated at around $200. The price increased over the next few years to $1,500. When Valeant bought seconal in early 2016, the price increased to $3,000 -- $7,000. [1]
Phenobarbitol
· To counter the cost increase of seconal, proponents of assisted suicide began experimenting with combinations of drugs to induce death. One of the drug combinations being used is a mixture consisting of phenobarbital, chloral hydrate and morphine sulfate. The patient mixes the powder with water, alcohol, applesauce or juice. This drug combination lowered the cost to $400-$500.

· In Oregon, the phenobarbital combination has been used to cause the death of 65 patients. For known durations, 59.1% of patients experienced deaths from one to six hours in length and 22.7 % experienced deaths over 6 hours in length. [2]
DDMP 1; DDMP2
· Increasingly, a four drug-cocktail consisting of diazepam, digoxin, morphine sulfate and propranolol (DDMP) is being used to reduce costs. DDMP 1 contains 10 grams of morphine sulfate and DDMP 2 contains 15 grams.[3]

· When a patient took 18 hours to die using DDP (diazepam, morphine sulfate and propranolol), digoxin was added to the mix and the dosage was subsequently increased to form DDMP2. Researchers have described DDMP2 as “blue-whale-sized doses…..And the mixture tastes extremely bitter. ‘Imagine taking two bottles of aspirin , crushing it up, and mixing it in less than half a cup of water or juice.’”[4]

· In Oregon, DDMP 1 and DDMP 2 accounted for 145 deaths through 2018. For known durations, 40% of patients experienced deaths from one to six hours in length and 24% experienced deaths over six hours in length. Two patients regained consciousness after ingesting the drugs.[5] “The median time until death was longer for the DDMP2 compound (120 min) than for secobarbital (25 min)…”[6]

· In Oregon in 2018, DDMP was prescribed for 38.1% of patients compared to 13.2% in previous years.[7]
Morphine Sulphate
· In Washington State in 2017, 130 out of 196 deaths (63%) were attributed to use of morphine sulfate in isolation.[8] Deaths from secobarbital and morphine sulfate lasted from 5 minutes to 35 hours in range.[9]
General Complications From Lethal Drugs Used In Assisted Suicide Deaths
· Experimenting with combinations of drugs is “research” which has not been approved by any ethics review committee like an "Institutional Review Board" (IRB), which appears to violate research ethics standards.

· According to The Atlantic: “No medical association oversees aid in dying, and no government committee helps fund the research……... The doctors’ work {to experiment with drugs which kill patients} has taken place on the margins of traditional science. Despite their principled intentions, it’s a part of medicine that’s still practiced in the shadows.”[10]

· According to Kaiser Health News, “The first Seconal alternative turned out to be too harsh, burning patients’ mouths and throats, causing some to scream in pain.”[11] “The second drug mix, used 67 times, has led to deaths that stretched out hours in some patients – and up to 31 hours in one case……the next longest 29 hours, the third longest 16 hours and some 8 hours in length.”[12]

· According to the New England Journal of Medicine: One in five Dutch patients using standard barbiturates to kill themselves experienced complications including vomiting, inability to finish the medication, longer than expected time to die, failure to induce coma, and awakening from coma.[13]
 
· According to Anaesthesia: “However, for all these forms of assisted dying, there appears to be a relatively high incidence of vomiting (up to 10%), prolongation of death (up to 7 days), and re-awakening from coma (up to 4%), constituting failure of unconsciousness. This raises a concern that some deaths may be inhumane……”[14]

1. http://www.medscape.com/viewarticle/869023?src=emailthis#vp_2

2. https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year21.pdf, page 15

3. https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year21.pdf, page 15

4. https://www.theatlantic.com/health/archive/2019/01/medical-aid-in-dying-medications/580591/

5. https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year21.pdf, page 15

6. https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year21.pdf, page 7

7. https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year21.pdf, page 7

8. https://www.doh.wa.gov/Portals/1/Documents/Pubs/422-109-DeathWithDignityAct2017.pdf, page 9

9. https://www.doh.wa.gov/Portals/1/Documents/Pubs/422-109-DeathWithDignityAct2017.pdf, page 10

10. https://www.theatlantic.com/health/archive/2019/01/medical-aid-in-dying-medications/580591/

11. Kaiser Health News, “Docs in Northwest Tweak Aid-In-Dying Drugs to Prevent Prolonged Deaths”, February 21, 2017

12. Kaiser Health News, “Docs in Northwest Tweak Aid-In-Dying Drugs to Prevent Prolonged Deaths”, February 21, 2017

13. Groenewoud, J.H., van der Heide, A., Onwuteaka-Philipsen, B.D., Willems, D.L., et al. (2000). Clinical Problems with the Performance of Euthanasia and Physician-Assisted Suicide in the Netherlands. The New England Journal of Medicine, 342, 551-556.
 

14. Sinmyee, S., Pandit, V.J., Pascual, J.M., Dahan, A., Heidegger, T., Kreienbuhl, G.,…Pandit, J.J. (2019). Legal and ethical implications of defining an optimum means of achieving unconsciousness in assisted dying. Anaesthesia, 74,557-559.

Friday, April 19, 2019

Scotland is being pressured to legalize assisted suicide. They need to care not kill.

Dr Gordon Macdonald, the parliamentary officer for Care for Scotland, wrote an excellent article that was published in the Scotsman on April 19, explaining why assisted suicide should not be legalised.

Dr Gordon Macdonald
Macdonald begins his article by discussing why the previous assisted suicide bill was defeated.

A new campaign has been launched in the ­Scottish Parliament by a ­cross-party group of MSPs to ­legalise assisted suicide. They plan to bring forward proposals for a new law before the next Scottish parliament election in 2021. 
The last time MSPs voted on the issue of assisted suicide in 2015, they rejected Patrick Harvie’s Assisted Suicide Bill by 82-36. It was a clear, ­comprehensive victory. If you listen back to the speeches made during that debate, it was clear that MSPs did not think the law could be made safe. 
Most members realised then that the risks of legalising assisted suicide were too high and would put vulnerable people at risk of harm. 
But pro-assisted suicide advocates, including a few MSPs, are determined to change the law in Scotland. The well-funded, London–based campaign group Dignity in Dying are taking their campaign to ­Scotland. They are saying that if they can change the law in Scotland, it will put huge pressure on the rest of the United Kingdom to follow suit. They are fundraising so they can buy ­billboards, posters and placards in order to pressurise MSPs to change the law.
Macdonald argues that legalizing assisted suicide will affect their caring society
Scotland has a long and proud ­history as being a compassionate, caring society where we look after each other. Assisted suicide would undermine this heritage in a radical and unalterable way. 
It would also undermine palliative care, put vulnerable people at risk and put doctors in an invidious ­position. It would heap ­pressure on some of the most vulnerable in ­society to end their life, perhaps ­prematurely because they feel as though they are a burden to loved ones or caregivers. Such an outcome is unavoidable. Instead of encouraging suicide, we should be ­helping ­people to see that they are valuable and of worth to ­family, friends and society, even in old age or ­experiencing ill-health.

Macdonald then explains how assisted suicide laws have expanded in other jurisdictions:
When introduced, assisted suicide laws might be focused on a certain, set of circumstances. As time goes on, the categories of eligibility extend to include more and more people. It can quickly expand from the terminally ill to include those with chronic illnesses, but not terminal conditions; from adults to children; from those with physical illness to include those who have psychiatric and psychological problems and even dementia. 
There are proposals in some ­countries to extend laws to include elderly people who are just tired of life and suggestions that elderly ­people over a certain age should not get significant medical assistance if they are unwell. 
There is a case at the European Court on Human Rights where three doctors are being investigated after a 64-year-old Belgian ­woman in good health with depression was ­euthanised, despite there being no official diagnosis. Her son only found out about it when the ­hospital ­contacted him to arrange the ­disposal of her remains. 
In the USA there are instances of people been denied health insurance for cancer treatment whilst being offered funding to commit suicide. We would be naïve to assume that such cases will not also ­happen here.
Macdonald then explains why assisted suicide safeguards don't work:
It’s not good enough to talk about safeguards when the ­evidence ­suggests there is no way assisted ­suicide legislation could ever be made fully safe from abuse. Is this really the sort of society in which we want to live? In Scotland, our Christian tradition has left a legacy of concern for the most vulnerable and a sense of responsibility to look after those unable to care for themselves. 
Sadly, our culture too readily equates dependence and vulnerability with weakness. But being vulnerable helps us to realise our dependence upon other human beings.
Dr Gordon Macdonald has been a long-time promoter of the belief that society needs to care for its citizens, not kill.

Thursday, April 18, 2019

2018 Netherlands euthanasia deaths are lower. We are concerned about euthanasia for "completed life."

Alex Schadenberg
Euthanasia Prevention Coalition

The Dutch media reported that, the 2018 euthanasia report indicates that there were 6126 reported euthanasia deaths in 2018 down from 6585 reported euthanasia deaths in 2017. 

Annemarie de jong, writing for the Nordhollands Dagblad, quoted Jacob Kohnstamm, the Chairman of the Regional Review Committee on Euthanasia, that the number of euthanasia deaths was "a fluctuation in the figures".

The article by de jong also suggests that there will be an increase in euthanasia deaths in 2019. She reported that the Nivel research institute stated:
It is striking that the number of euthanasia reports increased by 9 percent in the first quarter of 2019 compared to the same period last year
According to research 20% - 23% of the euthanasia deaths are not reported in the Netherlands. It is possible that some of the controversial euthanasia cases were simply not reported.

I am convinced that the lower number of reported euthanasia deaths is primarily related to the euthanasia cases that are being prosecuted in the Netherlands and Belgium. Doctors simply don't want to be brought before a tribunal or court to justify why they lethally injected a patient.

The number of euthanasia deaths for dementia and psychiatric problems also declined in 2018 while a new category of death causes me concern. The Dutchnews.nl reported:
Of the cases reported to the committee last year, 146 concerned people with dementia and 67 people had severe psychiatric problems. In 205 cases, patients had multiple problems derived from the ageing process.
In 2017, 169 people died by euthanasia for dementia (3 were advanced dementia) and 83 people died by euthanasia for psychiatric reasons.

The 205 people who had multiple problems derived from the aging process were part of a new category: "the completed life."

There were several controversial Netherlands euthanasia stories in 2018.

In August 2017, a 5 year study sponsored by the Netherlands government showed significant increases in assisted deaths and continued abuse of the law.

In January we learned that Berna van Baarsen, who had been a euthanasia assessor for 10 years, resigned over cases of euthanasia for dementia.


In March we learned that the public prosecutor was investigating several controversial euthanasia deaths. The public prosecutor was also investigating a euthanasia group in the Netherlands after the death of a 19-year-old woman.



The euthanasia train left the station a long time ago in the Netherlands. Sadly, Canada is quickly riding the same euthanasia track and experiencing the same concerns.

Euthanasia was sold to the public as an "option" for people who are nearing death and suffering. It was then promoted for people who are not nearing death and fear possible future suffering. It was then extended to children and people with dementia. Finally it has extended to anyone who claims to have a "completed life."

Reject euthanasia. A culture that cares and not kills is the only way to go.

New Zealand lawyers oppose euthanasia bill.

The following statement can found at: Lawyers for Vulnerable New Zealanders.


We are lawyers and legal academics from across New Zealand, with experience in diverse fields of law, representing a variety of ideological and political views, and unanimous in our concern over the care of New Zealand’s vulnerable communities and the compassionate treatment of its sick, disabled and terminally ill.

We make this public statement to express our opposition to the End of Life Choice Bill (“the Bill”) and its proposed introduction of euthanasia and assisted suicide into New Zealand law, and to warn both Parliamentarians and New Zealanders against the dangers of voting the Bill into legislation.

If it is passed into law, the Bill will legalise what it terms “assisted dying”. Under the Bill’s provisions this will involve medical professionals, overseen by the Ministry of Health, ending the lives of their patients through lethal injection upon request (known as euthanasia), or assisting them in their suicide through the ingestion or intravenous delivery of lethal medication. Under current New Zealand law, as the case of Seales v Attorney General confirmed, “assisted dying” constitutes the offences of culpable homicide and aiding and abetting suicide under sections 160(2)(a) and (3) and 179 of the Crimes Act 1961. In order to further the interests of purportedly only a "small" number of New Zealanders,1 the Bill proposes to override these fundamental provisions in New Zealand criminal law by effectively permitting homicide and assisted suicide in some medical cases. In addition to impacting many other laws, this development would represent a profound shift in New Zealand law, the practice of medicine, and the field of medical ethics. It will also profoundly impact New Zealand society.

We acknowledge that this issue is fraught with complexity, and recognise the difficult choices that many of us in New Zealand must make when we are near the end of our lives. We also empathise with those New Zealanders who live with disabilities, chronic illnesses or mental illnesses; some of our number are amongst them.

We believe that the mark of our civilised society is measured by the manner in which we treat and protect our weakest and most vulnerable members. While the Bill purports to be targeted to a "small but significant group of competent adults who are not vulnerable and who wish to die without unbearable suffering and pain", we consider that it will in fact place many vulnerable members of our community (whether terminally or chronically ill, disabled or mentally ill) at greater risk of premature death by homicide or suicide as a result of neglect, coercion and other forms of abuse, as well as misdiagnosis or prognostic error and uncertainty. Its definition of a "person who is eligible for assisted dying" is so broad in its coverage of a range of conditions and illnesses that it could extend to New Zealanders with disabilities, relatively common chronic health conditions, and in some cases even mental health or psychological disorders such as depression, anorexia or bi-polar disorder. We concur with the New Zealand Disability Rights Commissioner’s assessment that the Bill undermines the position of disabled and vulnerable New Zealanders and poses significant risks to them, both as individuals and as a group. We are particularly concerned at its potential impact on Māori, who are over-represented in our suicide rates each year, in terminal, mental and chronic health illnesses, and in disabilities. We note that according to the Waitangi Tribunal, “many of these illnesses and problems are practically at epidemic levels"2 and that in December 2018 the Tribunal commenced an investigation into more than 200 claims that the Crown is operating a “sick, racist system that fails Māori”, leading to Māori dying earlier and suffering the worst health outcomes.

The Bill lacks important safeguards, and the purported safeguards that it does propose (such as its safeguard against coercion) are completely inadequate in protecting New Zealand’s vulnerable communities. We agree with the Disability Rights Commissioner that its safeguards are deficient, both procedurally and substantively, for both terminal and non-terminal conditions.

As lawyers working across a range of fields, we are keenly aware of the diversity of vulnerabilities which many New Zealanders experience, not only within their families and communities but also across the health system (including, for example, inequitable regional variances in palliative care resources and a lack of government funding for some life-prolonging medications). Given these very serious problems, and having considered the impact of euthanasia and assisted suicide laws on vulnerable populations in other countries, we have very serious misgivings over whether a safe regime for euthanasia and assisted suicide can be implemented in New Zealand. The risk of abuses resulting from the legalisation of euthanasia and assisted suicide through this Bill is very high. We are supported in this view by a reputable body of experienced opinion that has been informed by the harms which have resulted in the few overseas jurisdictions that have legalised these practices.3

We believe the implementation of the Bill could create harmful social pathologies, as well as result in the dangerously contradictory message being promoted within New Zealand society that suicide can actually be a good and dignified act. We note in this regard that the Bill will vest the Ministry of Health, the government department presently responsible for suicide prevention in New Zealand, with responsibility for overseeing the practice of helping some New Zealanders to commit suicide at the same time as advising others not to. Both of these groups will receive the message that our society and state endorse the ending of a person’s life as an appropriate response to suffering, the only difference being that those who are “ineligible” for assistance in their suicide will be left on their own to achieve it. This message will confuse New Zealand’s attempts to eliminate suicide.

We have many other concerns over the Bill, including its lack of any effective or meaningful oversight and the false or questionable assertions of fact in its Explanatory Note. One final, significant, concern of note is that it compels all New Zealand doctors to facilitate euthanasia and assisted suicide in violation of the rights of many doctors to freedom of conscience in section 13 of the Bill of Rights Act, and makes those conscientious objecting doctors who refuse to refer a patient to another doctor for help in ending their lives liable to prosecution, imprisonment or a substantial fine. We consider that to be an unacceptable intrusion into the personally-held beliefs which many of our doctors have regarding their duty to their patients: a duty to care for them, rather than to be complicit in killing them.

After 16 months of investigation and after reviewing some 39,000 submissions, the Justice Select Committee has now confirmed in its Report to Parliament that it has not even been able to agree that the Bill be passed and that it is unworkable in its present state.4 It appears the Committee has been left in considerable disarray over how to repair it. In the result, our Parliament has now been handed an extremely dangerous Bill with no real insight into how it might be remedied, or even if it can be remedied. Indeed, the Committee’s Report suggests very strongly that the Bill, to borrow from its own terminology, is irremediable.

As lawyers we believe the End of Life Choice Bill is not fit for purpose and is not salvageable. For many vulnerable New Zealanders this issue is literally a matter of their life and death. When it comes to safeguarding their wellbeing and safety, we consider the risks associated with the Bill to be unacceptably high.

Assisted Suicide and “Failure of Unconsciousness”

This article was published by Nancy Valko on April 18, 2019

By Nancy Valko

As a nurse, I have seen patients assumed to be unconscious while in a coma or sedated on a ventilator later tell me about some memories and feelings during that time. This is why I always cared for such patients as if they were awake.

Now in a stunning February, 2019 Association of Anaesthetists article titled: “Legal and ethical implications of defining an optimum means of achieving unconsciousness in assisted dying”, a group of international doctors explore the difficulty in ensuring unconsciousness to death in lethal injection capital punishment and assisted suicide/euthanasia. (Note: Since the authors are international, some quoted terms here are spelled differently than here in the US)
Believing that “A decision by a society to sanction assisted dying in any form should logically go hand‐in‐hand with defining the acceptable method(s)”, the authors reviewed the methods commonly used and contrast these with an analysis of capital punishment in the US. They “expected that, since a common humane aim is to achieve unconsciousness at the point of death, which then occurs rapidly without pain or distress, there might be a single technique being used.”

They were wrong.

They found that with self-administered lethal overdoses “with death resulting slowly from asphyxia due to cardiorespiratory (heartbeat and breathing) depression”, helium self-suffocation and the Dutch lethal injection that resembles US capital punishment, “there appears to be a relatively high incidence of vomiting (up to 10%), prolongation of death (up to 7 days), and re‐awakening from coma (up to 4%), constituting failure of unconsciousness.” (Emphasis added)

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