Friday, February 22, 2019

Summary Points Against Bills to Legalize Assisted Suicide

Not Dead Yet is a disability rights group that leads the opposition to the legalization of assisted suicide. Link to their website.

Summary Points Against Bills to Legalize Assisted Suicide
• If assisted suicide is legal, some people’s lives will be ended without their consent, through mistakes and abuse. No safeguards have ever been enacted or even proposed that can prevent this outcome, which can never be undone. 
• Assisted suicide is too dangerous.
– Assisted suicide is a recipe for abuse, including elder abuse. Where assisted suicide is legal, an heir or abusive caregiver may steer someone towards assisted suicide, witness the request, pick up the lethal dose, and even give the drug—no witnesses are required at the death, so who would know?

– Diagnoses of terminal illness are too often wrong, leading people to give up on treatment and lose good years of their lives, and endangering people with disabilities, people with chronic illness, and other people misdiagnosed as terminally ill.

– People with depression are at significant risk.

– Once the prescription is filled, there are no safeguards. Why are safeguards missing at the most important point?
• Assisted suicide will become the only option low-income people can afford.
– The cost of drugs for doctor-prescribed suicide is miniscule compared to the cost of providing treatment to make a patient more comfortable. This economic force of gravity is obvious and has already been experienced under our nation’s oldest assisted-suicide law in Oregon.

– Not all families are supportive. Some patients will feel that they should request doctor-prescribed suicide so that they wouldn’t be a financial or emotional burden on their family.

– Many families are under tremendous strain. At a time of rising food costs, home foreclosures and general economic uncertainty, it would be foolhardy to ignore the role that finances would play when making end-of-life decisions.

– Even in families where there is support for a patient diagnosed with a terminal illness, patients could feel that they are being selfish for not sparing their family. This has been documented in Oregon as a reason for requesting a lethal prescription. According to Oregon’s latest (2016) official report, 40 percent of patients who died using that state’s assisted-suicide law did so to avoid being a burden on their family, friends or caregivers.
• Assisted suicide laws feature virtually no oversight, and data collection is grossly insufficient.
– There is no investigation of abuse, nor even a way to report it. The states where assisted suicide is legal today do not report abuses and problems.

Assisted dying can cause inhumane deaths.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

An article in the Daily Mail by Vanessa Chalmers titled - Assisted Dying can cause inhumane deaths examines the article, by Professor Jaideep Pandit, as reported in the British Medical Journal.

The article explains how death by assisted suicide is often inhumane. Chalmers reports:
Patients are usually given barbiturates – strong sedatives – which knock them out and eventually cause the lungs and heart to stop. 
But the report found complications including difficulty in swallowing the prescribed dose (up to nine per cent) and vomiting in 10 per cent, both of which can prevent proper dosing. 
Re-emergence from a coma occurred in two per cent of cases, with a small number of patients even sitting up during the dying process, the authors said. 
'This raises a concern that some deaths may be inhumane,' the researchers reported in the journal Anaesthesia.
After oral sedative ingestion, patients usually lose consciousness within five minutes. However, death takes considerably longer.

Death occurs within 90 min in two thirds of cases.
But in a third of cases, death can take up to 30 hours, and some deaths took as many as seven days to occur (four per cent).
Another concern is that there is no single technique for doing assisted suicide.
'We 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.

'However, the considerable [differences] in methods suggests that an optimum method of achieving unconsciousness remains undefined,' the review said.

'It is striking,' the authors said, 'that the incidence of "failure of unconsciousness" is approximately 190 times higher when it is intended that the patient is unconscious at the time of death, as when it is intended they later awaken and recover after surgery', which occurs approximately one in every 19,000.
We have always known that there are problems with assisted death techniques but since the laws are all designed to cover-up problems with the law. Every assisted death law requires that the doctor who approves the death, is the same person who participates in the death, is the same person who reports the death. Problems with the law are covered-up by the self-reporting system.

Ontario man in "vegetative state" woke up.

Alex Schadenberg
Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

People who are diagnosed as being in a “vegetative state” (PVS) are often warehoused in institutions. After a period of time a decision is often made to withdraw all treatment including the withdrawal of fluids and food to dehydrate the person to death.

A few years ago I attended a European conference where presentations were made by physicians who operate medical treatment facilities to awaken patients through stimulation, known as awakening centers. The treatment stimulates the body to activate the brain and help it to heal.

The story of Juan Torres, from Oakville Ontario, is significant. Torres awakened from a PVS state and improved beyond expectations. 

Juan Torres with his parents.
An article by Kate Lunau published by MacLean's Magazine (December 31, 2015) tells the story:
“I don’t really know what happened,” Juan Torres, a 21-year-old from the Toronto suburb of Oakville, tells Maclean’s. “But, one day, I just woke up.” 

That Torres is speaking at all is astounding. Early one morning in July 2013, Torres, then 19, was discovered by his mother, face-down and unconscious on his bedroom floor, after choking on vomit in the night. He was left profoundly brain-damaged, and his doctors diagnosed him as vegetative: unable to speak, to eat, to deliberately control his movements, to follow basic commands. Vegetative patients retain their reflexes, and might grind their teeth or grimace; their eyes rove about the room but won’t fix on anything. They don’t demonstrate a glimmer of consciousness and can live that way for years, spending their days in hospitals, long-term-care facilities, or at home, unless families decide to end life support. The doctors who treated Torres didn’t think he’d be any different; they expected his status to be permanent, his mother says.
But Torres life changed:
Today—contrary to expectations—Torres is back home with his family. He gets around in a wheelchair; supported by his parents, he can take halting steps forward. In September, he started the general arts and science program at Oakville’s Sheridan College.

If all this wasn’t unexpected enough, there’s something else about Juan Torres that has left neuroscientists stunned. Not only did he recover, but he claims to remember what happened while he was clinically vegetative—and he has memories to prove it. In those hazy months before anyone knew he was aware, Torres says he remembers a doctor telling him to squeeze his hand, even though he couldn’t. He remembers being asked to “follow a tennis ball” with his eyes. Scientists have tested his memories, asking Torres to identify a set of faces and objects he encountered while technically “vegetative.” And he was able to do it. “I felt sad, because I couldn’t communicate with my family,” Torres says. He felt scared and “emasculated” at his inability to respond to the doctor’s cues and commands. For Torres, it was a nightmare. “I felt trapped in my own body,” he says. “I couldn’t talk. I couldn’t react.” It was like being half-asleep and frozen, he says, unable to respond.
Adrian Owen (center)
Adrian Owen, who researches communicating with people diagnosed as PVS considers Torres case as “mind-blowing”

“His case is mind-blowing,” says Adrian Owen, a British neuroscientist at Western University who has been investigating one of the most mysterious, least understood phenomena: human consciousness. It’s often said that the brain is the most complex structure in the known universe. Torres’s case shows us how much we’ve yet to understand: the fact that he was creating memories suggests he wasn’t unconscious at all, despite his doctors’ best diagnosis. “It tells us there really was a person there,” Owen says, “and that person was experiencing the world.”

Vegetative patients have not been a high priority for researchers, some of whom doubtless see them as a “lost cause.” It’s hard even to say how many people live this way, or to compare their outcomes. The vegetative state can arise from all sorts of mishaps that lead to brain injury, from a car accident or stroke, to drowning, choking, a sports or military accident. There doesn’t seem to be much consensus on their treatment, either. ...
Owen believes that Torres case is unique, but the question is, how many people are misdiagnosed?
All neuroscientists, including Owen, agree that many—probably most—of the patients diagnosed as “vegetative” truly are so, with no hope of recovery. Certainly, the vast majority will never recover like Torres: there’s no doubt that this young man is an extraordinary case. “I’ve seen hundreds of patients over almost 20 years and he is completely unique,” Owen says. But the issue is, are we misdiagnosing a subset of patients as “vegetative,” and leaving these people to languish? It’s a chilling suggestion.
Torres tells Lunau: “Don’t count me out of the fight just because I’m in bed.” Lunau explains what happened to Torres:
Torres came home around midnight, chatted with his dad and ate some salad—his father didn’t notice anything unusual in his behaviour—before going to bed. Early the next morning, Perez awoke to strange noises coming from his room. At first she thought it was the dogs. She discovered her son lying on the floor in a puddle, in respiratory arrest. How long he’d gone without oxygen is impossible to say. She performed CPR, and her daughter, Laura, called 911. “At the hospital, they said, ‘Hold his hand, because he’s leaving us,’ ” Perez recalls. Her voice falters as she’s overcome by the memory. “They said he was going to die that day.”

The period that followed was devastating, a blur. Both Perez and her husband, Jorge Javier Torres, took several months off work, staying by their son’s hospital bed day and night. ...As the shock wore off, Perez and her husband started researching how to help Torres. “You cannot leave a boy that young,” Perez says. “Not alive, not dead; just lying there. Wouldn’t you try anything?”

They discovered hyperbaric oxygen therapy, in which patients breathe pure oxygen inside a pressurized chamber. HBOT, as it’s informally called, is offered at hospitals and clinics across Canada; it’s approved to treat a range of conditions, such as decompression sickness, air or gas embolism, and carbon monoxide poisoning, but not brain injury. ...

Juan Torres’s parents had no idea whether it would benefit him, but they were desperate to try anything. So they signed him out of the hospital in Oakville on a series of day passes—itself a tricky endeavour, given all the equipment supporting him, including a feeding tube, IV and catheter—and took him by special medical transport to regular HBOT sessions at a private clinic in nearby Mississauga, Ont. ...

Hyperbaric oxygen was just part of their regimen. Torres’s parents assembled a collection of items they’d use to stimulate him daily: flashcards with “colours, words, pictures of the dogs, pictures of family members,” Perez says. She’d rub sandpaper and feathers along his toes. She’d bring in coffee beans to waft under his nose. “I remember that,” Torres says, as his mother tells the story, “the smells, like lemon, mint and hot sauce.” (They used Tabasco.) Once in a while, family members were sure they saw him respond. “The doctors would say, ‘Yes, but it’s just a reflex,’ ” Perez recalls. “It was difficult to keep hope, because there were so many days when you don’t see any signs.”

About a month into their new reality, Juan Torres’s parents took him to a little garden outside the hospital to get some fresh air. He was in a portable hospital bed, unable to sit up. “We put him in the nice sun, and started to massage him,” Perez says. “I was talking about how white he was getting.” His fair complexion has always been a running joke with his family members, who call him Snow White. “We are all kind of tan, and he’s the only one with white skin,” Perez says. Torres was “unconscious,” she continues, but he started laughing along at the joke.

They immediately reported this to doctors, who, once again, deemed it a reflex. “I couldn’t believe it. We were talking, it wasn’t random,” says Perez. Even so, vegetative patients do show automatic responses that can confuse and alarm loved ones. It’s not unusual for family members to interpret these as signs of consciousness, when it could just be wishful thinking. “I started to wonder if I was seeing something that wasn’t there,” Perez says.
Researchers, working with Adrian Owen's became involved with Torres.
In late August, Laura Gonzalez-Lara, research coordinator with Adrian Owen’s lab at Western, travelled to Oakville to examine Juan Torres. She’d heard about the young man from a hospital worker involved in his treatment. “He came out completely vegetative,” she says. “There were no signs of awareness, beyond some reflexive behaviour. It was actually pretty low,” she adds, “even for our vegetative-state patients.” A month later, he was brought to London, Ont., for further assessment, including with a functional magnetic resonance imaging (fMRI) machine, which measures and maps brain activity. Although the fMRI tests were inconclusive (Torres moved too much in the scanner), “we assessed him [behaviourally] several times that week,” says Damian Cruse, a former research scientist in Owen’s lab who is now a lecturer in psychology at the University of Birmingham. “Every time, he fulfilled the criteria for vegetative state.”
The family didn't give up.
Not long after, on Thanksgiving, Torres’s family brought him home for a day visit, his first since leaving in an ambulance three months before. As his parents carefully wheeled him into the backyard, the family dogs, Yogi and Cindy, came bounding out to greet him. His father, somehow intuiting on behalf of his son, grabbed a dog whistle and stuck it between Torres’s lips. And Torres did what no one had thought possible: He started to blow.

Not long after, the team at Western phoned Perez. “As we were explaining the results,” Gonzalez-Lara says, telling Perez that tests indicated her son was clinically vegetative, “she told us, well, he just started talking.” Soon after Thanksgiving, Torres had begun mouthing words, then whispering. He gradually regained his voice. That November, he was discharged from hospital and sent to a rehabilitation centre.
Torres went back to London Ontario where they began to test his memory of being PVS.
In May 2014, six months after Torres started speaking, Owen and his team brought him back to the lab. “There was a fair amount of disbelief,” says Cruse. “Everyone agreed it would be a good idea to test his memory, but is he really going to remember the faces of people he met six months ago?”

They showed Torres photos of people he’d met on his initial visit, when he was still clinically vegetative, mixed in with photos of others who looked similar, but whom he’d never encountered. They did the same with objects, including two hand mirrors, one framed in red, the other in white. Torres correctly identified all five faces, and three of the four objects. (Findings will be published in a future scientific paper.) Seeing a photo of Laura Gonzalez-Lara, the research coordinator whom he’d met while vegetative, he said: “That’s Laura.” About another person, he said, “I recognize her nose.” And in still another example, he described the voice of a person he’d met as “deep and monotonous,” a description so bang-on, it made the others laugh.

Recovery among vegetative patients is so rare, But Owen's research does conclude that some people who are diagnosed as “vegetative” are not. The article states:

The more patients he scans, the more he discovers about the wide variety who are labelled “vegetative”—and the possibility that some aren’t vegetative at all. Shortly after being recruited to Western in 2010 (Owen holds the Canada Excellence Research Chair in cognitive neuroscience and imaging), he met Scott Routley, who had been in a car accident 12 years before that left him in a vegetative state. In a brain scanner, Routley could answer “yes” and “no” by activating parts of his brain on command. Owen asked whether he was in pain, and Routley answered no, a first for any vegetative patient.

Juan Torres is another first. Whenever Owen discusses his work, he hears the same question. “Someone will put up his hand and say, ‘Do you have a patient who recovered and can tell you [what it was like]?’ ” Owen’s team has determined that one in five patients who appears to be vegetative retains some level of consciousness, which can’t be detected through standard clinical assessments. The number could go up, he argues, as detection methods improve—but even with a growing body of research, it remains controversial to claim consciousness among these patients. Some worry it could give families false hope, or cause feelings of guilt among those who do decide it’s best to end life support.
The article suggests that Torres's recovery is impossible to explain, except for the fact that the body stimulation that is done at awakening centers in Europe have a fairly successful recovery rate. I am not a scientist or a doctor, but it appears clear that the stimulation that the family did was likely what led to Torres's recovery. The article states:
Juan Torres’s recovery is impossible to explain, although his youth and physical strength must have helped. Medical reports on Torres’ rehabilitation, which Perez provided to Maclean’s, suggest that healthy parts of his brain may have been recruited to work on behalf of areas that were permanently damaged. Owen admits this is possible, but “his recovery was fairly swift for that to have been the case,” he says. “There’s not any clear neuroscientific explanation I can give.”

Torres says he feels pride at his recovery. “I learned a lot, actually,” he says. “I used to get mad. Now I’m more patient.” But a sense of loss hangs over him. A focused and determined young man—his recovery is no less a testament to his own resolve, and his family’s—his frustration can at times be palpable. His life has swerved down a path he never could have predicted. But he’s back in school. He’s playing sports, including wheelchair rugby. (He enjoys “the competition,” he smirks. “The violence.”) Torres spends spare hours making electronic music on a laptop at home. He dreams of becoming a platinum-selling record producer.

Every day, even now, Perez tells her son how grateful she is. The fact that Juan Torres was building memories as he lay in bed, by all accounts unconscious, is still a cause for marvel. “In a way, he was there,” Perez says, “even though he wasn’t. It’s like dying and coming back again.”
In 2004, after attending the European conference I stated that awakening centers need to be established in Canada. For those who are reading this article and have a family member who is PVS, try to stimulate the brain, as the family did for Torres. There is nothing to lose.

Thursday, February 21, 2019

Belgium doesn't kill killers but will kill the depresed.

Published by OneNewsNow on February 20, 2019.

By Charlie Butts

A study of Belgium prisoners, who were killed at their own request, has revealed tragic irony in a country with liberal euthanasia laws.
Research: Euthanasia of prisoners in Belgium.
Belgian euthanasia protest.
The study, published in magazine The Knack by Jan Lippens, followed 23 prisoners who requested euthanasia between 2011 and 2017.

Alex Schadenberg of the Euthanasia Prevention Coalition tells OneNewsNow that a majority of the prisoners were convicted of heinous crimes, such as murder, and were unlikely to ever be released. But only two of the 23 prisoners actually faced a terminal illness which, naturally, would be the expected reason to ask for a hastened death.

The remaining prisoners cited psychological reasons for asking to die, Schadenberg says, which is sadly ironic in Belgium where capital punishment is outlawed.

"So the concept is that it's wrong to kill a prisoner," he points out, "but then secondly it's okay to lethally inject them because they are experiencing psychological suffering."
Assisted death is already being done in some jurisdictions on that basis and Canada, which legalized terminating ill people in 2016, is considering expanding the list to those suffering psychologically.

Sunday, February 17, 2019

Not Dead Yet and disability rights groups against assisted suicide are being blocked at public hearings.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Anita Cameron (center)
Not Dead Yet, and other disability rights groups have been a strong and effective voice against the legalization of assisted suicide. Recent public hearings on assisted suicide bills have been orchestrated to either reduce or eliminate the opportunity for disability rights groups from speaking against assisted suicide.

Not Dead Yet reported that many disability rights organizations were blocked from giving testimony at the New Jersey committee hearing earlier this month. More recently, Not Dead Yet reported that disability rights groups were forced to wait, before they could give testimony in Maryland. Anita Cameron, from Not Dead Yet, said that people with disabilities often experience complicated health and transportation issues. Sheryl Grossman, a Maryland resident with the National Council on Independent Living had to leave before she could offer testimony.

For many years the assisted suicide lobby has tried to neutralize or eliminate the effect of the disability rights groups opposition to assisted suicide. This may be a new strategy.

Truchon, Gladu and the euthanasia of people who are not terminally ill

This article was published on February 7, 2019.

By Dr Catherine Ferrier
President, Physicians Alliance Against Euthanasia

In recent issues of this Newsletter we have considered the dangers of different ongoing schemes for enlarging the qualifying criteria for euthanasia, to include people with dementia (by advance directive), “mature” minors (with or without parental consent or knowledge) and those for whom psychiatric illness is the sole underlying condition.

Unfortunately, by virtue of a challenge currently undertaken by Mr. Jean Truchon and Ms. Nicole Gladu before the Québec Superior Court, there is now something quantitatively much worse on the table: euthanasia for people who are not at the “end of life” (as required by the Quebec law) or for whom, contrary to what Canadian law requires, “natural death is not reasonably foreseeable”. In other words, doctors may soon be asked to “medically” kill people who are not dying.

It is evident that to permit this would allow the phenomenon to assume proportions many times that of the original context of “unbearable suffering at the end of life”. Therefore, whatever dangers were first invoked in that discussion must now be multiplied a hundredfold.

Unfortunately, the plaintiffs and their counsel do not admit that any such dangers exist. Increased suicide, for example, is impossible in their world because “Medical aid in dying” is never suicide, by definition (although any qualified and suicidal patient would have the absolute right to die using a compliant doctor in the place of poison or gun). Moreover, no matter how many “vulnerable” persons were to die for the wrong reasons, that too is irrelevant, because Mr. Truchon and Ms. Gladu are not vulnerable. And in the myopic priorities of the petitioners: if even one, single, non-vulnerable ill or disabled person wishes to die, then society has a sacred duty to provide that death, even if it means completely transforming medical culture, regardless of what mayhem may ensue.

The law, however, must not uncritically endorse the perspective of any one stakeholder. The law has a duty to balance competing interests.

Jean Truchon & Nicole Gladu
These conflicting interests and the balancing function of the law were sharply illustrated on the first day of hearings by the presence of two severely disabled individuals, vehemently opposed to the demands of Mr. Truchon and Ms. Gladu, and determined to defend their own rights: not the right to benefit from a discriminatory exception to our criminal code which would allow their deaths; but the right to an equal and non-discriminatory application of existing law to prevent those deaths.

For that is what the law against assisted suicide does: it prevents deaths. Before the Carter decision and Bill C-14, it provided this protection to everyone; and even since the law was adopted, it has still protected those who are not at the end of life; but if the Truchon-Gladu challenge prevails, the entire population of chronically ill and disabled individuals will be stripped of such protection. And that is horribly wrong.

It has been reported that Mr. Truchon and Ms. Gladu’s counsel summarily rejected any notion of lost protection, using what has so often been accepted as an unassailable argument: “each one may choose”. But if apparent choice were sufficient protection from the dangers of assisted suicide, why do we still have a law at all? Why do “normal” people still require protection? The answer is obvious: Because the existing law does in fact provide real protection for the general population. And non-suicidal people who are ill or disabled (whether “vulnerable” or not), naturally resent this attempt to deprive them of their right to equal treatment before the law.

This is not different from many regulations in existence, such as, for example, those requiring doors to close off open elevator shafts (in spite of the fact that people may simply “choose” not to jump). We recognize that people can fall down the shaft by accident; or that in a period of existential weakness they might regrettably decide to jump; and yes, they may even be pushed. Doors prevent such tragedies. And so do our laws against assisted suicide.

Here, then, fundamentally, are the two sides to this issue: There are people who seek an exceptional “right” to jump, with the help of the medical profession; and there are those, every bit as qualified for that proposed exemption, who wish to benefit from the same level of protection accorded to every other citizen.

How, then, can we decide between these two competing and mutually exclusive views?
  1. The number of suicidal people like Mr. Truchon and Ms. Gladu is greatly inferior to those in similar circumstances who wish to continue living.
  2. It is impossible that people with the intellectual resources and networking skills of the non-vulnerable Mr. Truchon and Ms. Gladu can be prevented from dying if they really want to. Many thousands of Canadians commit suicide each year, and it is estimated that hundreds are assisted to do so. What Mr. Truchon and Mme Gladu risk, then, is not a requirement to live, but simply that society will not arrange for their deaths.
  3. Should Mr. Truchon and Ms. Gladu win, others, who will inevitably and regrettably succumb to the open elevator shaft of missing protection, will lose their lives. Our choice, therefore, is between providing a more convenient death for a few, or protection of ongoing life for many more.
  4. Fair minded people must realize the reality of intimidation, coercion – or even mere suggestion – originating from overwrought family, overburdened caregivers, and yes, perhaps blatantly greedy heirs; recognize also the danger of passing self-doubt, or existential despair, translated into state-sanctioned, medicalized suicide. We believe that what the legislators considered an acceptable weight of tragedy, in a compromise involving only those wishing to die more quickly and less painfully at the very end of life, should certainly be considered unacceptable when applied to the much larger population of those with non-terminal illness and disability.
  5. Law is a framework under which we live. The benefits of law should be maximized for those who are alive – and for those who wish to go on living.
From these several facts, we arrive naturally at the conclusion that the existing law (bad as it may be) should remain as it is without further expansion. Mr. Truchon and Ms. Gladu will die, as all people die, and probably much sooner, by their own hand or by the hand of others.

But when they leave this world, they must not be permitted to bequeath to us a framework that works to the detriment of those who have chosen to remain behind.

Make euthanasia unimaginable.

Catherine Ferrier
President, Physician Alliance Against Euthanasia.

Euthanasia in Canada: CMA - Take off the rose-coloured glasses.

The following article was published in the British Medical Journal (BMJ) on February 8, 2019 in response to articles published by the BMJ Drs Buchman and Blackmer.
In June 2016, Canadian legislation came into effect with Bill C-14 that legalized Medical Assistance in Dying (MAiD), a euphemism for euthanasia and physician-assisted suicide. In Canada, most cases of MAiD are via euthanasia, where patients’ lives are ended through a lethal injection of drugs administered by a physician or a nurse practitioner. Many palliative care experts object to the term ‘assistance in dying’ because that is what palliative care physicians already do by helping people to die well, without hastening or causing death. Nevertheless, the term was formally adopted by the government, and continues to contribute to confusion regarding palliative care and MAiD.

The President-Elect of the Canadian Medical Association (CMA), Dr. Sandy Buchman, a palliative care physician and euthanasia provider, has exacerbated this confusion further. In his recent invited BMJ essay (2), Dr. Buchman describes providing euthanasia as the most patient- centered way to relieve suffering. Dr. Buchman’s views are not consistent with the official policy of the CMA regarding palliative care (3), or the position of the Canadian Society of Palliative Care Physicians (CSPCP) and the majority of palliative care physicians in Canada who do not view euthanasia as part of palliative care. In a recent survey, CSPCP members strongly agreed that euthanasia is not part of the provision of palliative care. The vast majority (92% of 213 respondents) do not provide euthanasia (4). The CSPCP position that palliative care strives to reduce suffering, not to end life (5), is consistent with international standards for palliative care, such as the World Health Organization definition (6). CMA Policy on Palliative Care also recognizes that palliative care and MAiD are distinct (3).

Dr. Buchman romanticizes euthanasia. He calls it “the most patient-centered service I could offer,” leading to “the most peaceful death I had ever witnessed.” Peer reviewed, published evidence demonstrates that most requests for euthanasia are motivated by a desire for control, or a fear of dying, not by uncontrolled symptoms such as pain or shortness of breath (7). The patient Dr. Buchman refers to in his essay illustrates the existential, not symptom-based, risk factors involved. These existential issues include fear of loss of control, questioning the meaning, purpose and value of life, fear of what comes after death, demoralization, and fear of being a burden to others (8). None of these issues are properly addressed by euthanasia, and hastening the death of a patient removes any further therapeutic opportunities. Simply bowing to “patient autonomy” and ending a life without working hard to alleviate the deeper total pain is hardly “patient centered” in the most robust sense of that term. As Chochinov and Mount beautifully express, “…to be clear, palliative care is not a panacea that can eliminate every instance and every facet of end-of life suffering. However, the physician-patient relationship is complex and profound. Preserving dignity for patients at the end of life is comprised of a steadfast commitment to non-abandonment and a tone of care marked by respect, kindness, and an unwavering affirmation of patient worth.” (9).

The other group of citizens ignored in Buchman’s account are those whose lives are made even more vulnerable by the very existence of euthanasia, including those with disabilities, mental illness, dementia, children, seniors, and those who lack resources including financial, social supports, or access to palliative care. The Vulnerable Persons Standard (VPS) has been developed to provide standards for safeguards needed in Canada to protect those who are most vulnerable to coercion, or who feel that they have no other option than to choose to have their lives ended (10). Sadly, these very practical, broadly supported and meticulously documented recommendations for true “patient-centered care” have been dismissed and ignored by supporters of euthanasia and all levels of government. The few regulations that have been implemented, such as the requirement for capacity – both at the time of request and at the time of delivery of euthanasia, and a ten day waiting period between formal request and death, have no standard system of oversight to ensure compliance, and enforcement is essentially non-existent. There are no standardized training requirements for capacity assessment or psychiatric consultation for MAiD. Individual physicians or nurse practitioners are solely responsible to determine eligibility and whether or not to waive the ten day interval. The assessments for receiving government supported workers’ compensation or home oxygen are often more lengthy and stringent than those done in preparation for MAiD!

Drs. Blackmer and Buchman assert that the CMA supports physicians who refuse to participate in euthanasia (1,2). They fail to note that some provincial medical regulators, including the largest one in Canada with over 40,000 physician members, demand strict physician participation through “effective referral” (11), and that physicians who refuse such participation could be forced to withdraw from practice or lose their licences altogether. Some of these physicians are fighting a lengthy and expensive court battle to resist this coercion (12). A number of medical groups have supported these physicians by requesting intervener status in the case. The CMA has not.

Two and a half years after its legalization in Canada, strong lobbies are intensifying their push for euthanasia as a response to mental illness, physical disability, cognitively incapacitated patients through advance directives, and children. In Toronto, the Hospital for Sick Children has already drafted policy on providing euthanasia to mature minors (children felt to be capable of making their own medical decisions, despite not yet reaching the age of majority), anticipating a change in legislation later this year that would make euthanasia permissible for these children (13).

These developments, and the ongoing jeopardy faced by objecting physicians in Canada, contradict the optimistic, rosy assessment offered by Drs. Blackmer and Buchman. Other jurisdictions need to take a hard look at the reality of the Canadian context before holding Canada up as an example to be emulated.

  • Dr. Leonie Herx, Division Chair & Associate Professor of Palliative Medicine, Connell Chair in Palliative Medicine, Queen's University, Kingston, Ontario, Canada
  • Dr. Srini Chary, Associate Professor, Division of Palliative Medicine, University of Calgary, Calgary, Alberta Canada 
  • Dr. Ed Dubland, Palliative Medicine Consultant, Burnaby, British Columbia, Canada
  • Dr. Robin Fainsinger, Professor, Division of Palliative Care Medicine Medicine, Edmonton, Alberta, Canada 
  • Dr. David Henderson Palliative Medicine Consultant, Truro, Nova Scotia, Canada 
  • Dr. Bernard Lapointe, Associate Professor, Departments of Oncology & Family Medicine, Director of Palliative Care, McGill University, Montreal, Quebec, Canada 
  • Dr. Valerie Schulz, Professor, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada 

1. Blackmer J. Commentary: How the Canadian Medical Association found a third way to support all its members on assisted dying. BMJ. 2019 Jan 30;364:l415.
2. Buchman S. Why I decided to provide assisted dying: it is truly patient centred care. BMJ. 2019 Jan 30;364:l412.
3. Palliative Care (Policy). Canadian Medical Association. 2016. Accessed on February 6, 2019: (Link)
4. Medical Assistance in Dying Member Survey (October 2017). Canadian Society of Palliative Care Physicians (CSPCP) 2018 February. Accessed on February 6, 2019: (Link)
5. Key Messages: Physician-Hastened Death. Canadian Society of Palliative Care Physicians (CSPCP) 2015, October. Accessed on February 6, 2019: (Link)
6. WHO Definition of Palliative Care. Accessed on February 6, 2019: (Link)
7. Palliative Care (Policy). Canadian Medical Association. 2016. Accessed on February 6, 2019: (Link)
8. Rodríguez-Prat A et al. 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. Accessed on February 6, 2019: (Link)
9. Chochinov, H. Dying, Dignity, and New Horizons in Palliative End‐of‐Life Care. CA: A Cancer Journal for Clinicians. 2006; 56: 84-103. doi:10.3322/canjclin.56.2.84
10. Chochinov H, Mount B. Physician Hastened Death: Awaiting a Verdict. CMAJ Blog. 2014 October, 14. Accessed on February 6, 2019: (Link)
11. Vulnerable Persons Standard. Accessed on February 6, 2019:
12. Medical Assistance in Dying (Policy). College of Physicians and Surgeon of Ontario. 2016 Accessed on February 6, 2019: (Link)
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Saturday, February 16, 2019

Montana Bill prohibiting assisted suicide passes in the House

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition.

Great news: Montana House Bill 284 (HB 284) passed in the Judiciary House ensuring that it will be debated and voted in the Montana Senate. The debate on the bill may happen later this week.

It is interesting that the media have been silent on the success of HB 284.

Montanans have faced a confusing situation concerning assisted suicide. In 2009, the Baxter court decision declared that Montana citizens had a right to assisted suicide. The Baxter decision was appealed to the Montana Supreme Court where it was decided that Montana citizens do not have a right to assisted suicide but even but the Court granted a tightly worded defense of consent, if a physician was prosecuted for assisted suicide.

* Physician-Assisted Suicide is not legal in Montana.
Since the Montana Supreme Court decision, the assisted suicide lobby has claimed that assisted suicide is legal in Montana, while in fact assisted suicide is technically prohibited.

HB 284 reverses the Montana Supreme Court Baxter decision by clarifying that consent is not a defense for homicide or assisted suicide.

The assisted suicide lobby sent out an emergency appeal today calling HB 284 the physician imprisonment act. The assisted suicide lobby is confirming that assisted suicide is not legal in Montana.

Assisted suicide abandons people at their time of greatest human need.

Friday, February 15, 2019

Care Not Killing poll: public are aware of the dangers of assisted suicide

The Care Not Killing Alliance UK recently conducted a poll that indicates that the public are aware of the dangers of legalizing assisted suicide.

A ComRes poll concerning attitudes to assisted suicide, commissioned by CNK, found that:
● 51% 'would be concerned that some people would feel pressurised into accepting help to take their own life so as not to be a burden on others' if assisted suicide were legal (with only 25% disagreeing) 
● 48% say that giving GPs 'the power to help patients commit suicide' would 'fundamentally change the relationship between a doctor and patient, since GPs are currently under a duty to protect and preserve the lives of patients' (with only 23% disagreeing).
Gordon MacDonald
Dr Gordon MacDonald, a spokesman for Care Not Killing commented:

'This poll shows a greater level of understanding of the difficulties with assisted suicide than most so-called experts think possible. Usually the public are only asked a simple rights based question that is heavily framed, but these questions reveal significant unease around the removing universal protections to allow doctors to kill their patients.'
The poll found that most (51 per cent) of those surveyed were concerned that some people might feel pressured into accepting help to take their own life 'so as not to be a burden on others', while half that proportion (25 per cent) disagreed. These figures reflect what is happening in the US states of Oregon and Washington where a majority of those ending their lives in 2017 said that not wanting to be a burden was a motivation for their decision. This compared to just one in five (21 per cent) in those states who were concerned about the possibility of inadequate pain control, or experiencing discomfort.

Murder trial of Michel Cadotte or "Mercy Killing"

The following update was part of the webcast produced by the disability rights group, Toujours Vivant - Not Dead Yet. You can watch the full webcast here (Link).

In Québec, the trial of Michel Cadotte in the homicide of his wife Jocelyne Lizotte two years ago is wrapping up. Mr. Cadotte is accused of second degree murder after he admitted to smothering his wife who had dementia; he claims he wanted to end her suffering.
Québec man uses "mercy killing" defense in wife's murder.
Psychologist Gilles Chamberland testified that Cadotte’s actions were not related to depression. Nor was he overwhelmed with caring for his wife, since she was in a long-term care facility. Mr. Cadotte had asked for euthanasia on his wife’s behalf but been refused.

Evidence presented at trial showed that Ms. Lizotte’s condition was no better or worse than it had been in some time, but that Mr. Cadotte had been drinking heavily over the weekend leading up to the homicide.

Mr. Cadotte claims he killed Ms. Lizotte “out of compassion,” but a report filed by Dr. Chamberland said Cadotte wanted “end her suffering,” to stop his own pain.

Intimate partner violence among elders is neither rare nor new. A 2007 study of murder-suicides from the Clinical Interventions in Aging journal found that life-ending violence is often explained away as “altruistic,” especially in cases where one party is ill. This distortion prevents “proper investigation into the specifics of the case, especially with regard to victim consent.” In one incident, a husband “claimed his wife had terminal cancer, but the autopsy found she had no evidence of any illness.”

These murders may be inspired by the perpetrator’s “strong need to control [the spouse’s] fate.” Some even thought death was preferable over sending their partners to a nursing home.
The study rightly concludes that “[domestic] violence events should never be viewed as romantic or altruistic as it is often erroneously reported in the news media.”

Disabled girls and women are also at a higher risk for abuse, including at the hands of their partners. In a 2017 submission to the United Nations, Women Enabled International explained that “women with disabilities worldwide experience domestic violence – including physical, sexual, emotional, psychological, and financial abuse – at twice the rate of other women.”

These women must also rely on the abuser “to meet personal needs; indeed, when the abuser is also a caregiver, it is frequently impossible for women with disabilities to get help.” Women may be unable to leave a dangerous living situation because they don’t have transportation or can’t find an accessible shelter. The longer women stay in abusive environments, the higher the risk that violence will escalate to homicide.