Monday, June 17, 2019

Canada Embraces Euthanasia ‘Kill and Harvest’ Organ Donation

This article was published by National Review online on June 17, 2019

Wesley Smith
By Wesley J Smith

Canada has enthusiastically embraced euthanasia and all of its implications.

For example, following the crassly utilitarianism of Belgium and the Netherlands, the Journal of the Canadian Medical Association has published guidelines — written by a “blue ribbon panel,” don’t you know! — to govern when organ donation follows death by lethal injection euthanasia, a bureaucratic procedure that I bluntly call “kill and harvest.”

The media is all in. Recently, the Globe and Mail published a story extolling the idea — and now a medical writer for the CBC named Dr. Brian Goldman has endorsed kill and harvest.

But it is interesting, Goldman sees the protocol — that requires euthanasia before organ procurement — as merely a “first step.” Where might we expect the ever so nice Canadians to go from there? It’s not pretty. From, “Organ Donation After Medical Assistance in Dying Offers Possibilities:”
A new approach discussed in the commentary makes possible organ donation after MAID at home. The death occurs at home after which anesthesia drugs and life support are used to maintain the body during transport to hospital for organ donation.
In other words, the patient would be killed — and then resuscitated — not to save his life but maintain the viability of the organs.

Here’s the second idea:
Some experts have proposed that patients be permitted to consent to what’s called organ donation euthanasia. This involves putting the patient under anesthesia followed by getting the organs ready for removal. The doctors would then use potassium chloride to stop the heart, following which the organs would be removed. 
This controversial approach could potentially make all organs including the lungs and the heart available to would-be recipients.
While we are discussing turning transplant doctors into killers, it is worth noting that an article published in New England Journal of Medicine in 2018 went even farther than the two proposals Goldman discussed, that is, to arguing that the killing itself should be accomplished by the organ harvesting. Nor is that the not the only such proposal published recently by a mainstream medical journal.

Goldman believes it is “unlikely” that these next steps will gain widespread support in the near future. Baloney. Canada has already determined to treat those who want to die — many of whom would live months or years but for being lethally injected — like so many organ farms. That’s the hard ethical hurdle. Given the speed and enthusiasm with which most of Canada has embraced euthanasia, I predict one or more of these crass proposals will be accepted by our northern neighbors within five years.

Attacks on Conscience Rights are also an American concern.

By Mark Hodges (EPC researcher)

The Canadian Parliament is debating whether doctors may follow their vow and conviction to “do no harm,” or if government can force them to violate their most sacred and deeply held belief against euthanasia (lethal injection).

On the crucial conscience rights issue, the United States is only a step behind Canada, and may be closing in fast.
Saskatchewan MP David Anderson sponsored the Conscience Rights protection bill (C-418) that will determine whether conscientious objecting physicians will leave their profession, or forced to be complicit with killing.

Over the past decade, a debate has arisen over “competing rights,” namely, the fundamental right of physicians and other citizens to practice with integrity and conscience, versus a new “right” of patients to be euthanized upon request, regardless of their doctor’s convictions.

Assisted suicide advocates in both Canada and the U.S. say doctors’ rights must be overridden or compromised in favor of the "right to die". In 2016, the Canadian Medical Association voted against physicians’ conscience rights by a margin of 71 percent.

Conscience supporters say assisted suicide is not healthcare, and it is a doctor’s right to refuse to kill his/her patients, or refuse to prescribe lethal medication, and refuse to refer or be complicit with the act.

After Canada’s Supreme Court decriminalized euthanasia in 2015, the College of Physicians and Surgeons of Ontario promoted what they called a “compromise” which did not require doctors to lethally inject patients but it required doctors who objected to refer their patients to a death doctor.

This stripping of individual conscience rights is spreading to the United States. Proposed assisted suicide bills in Massachusetts, Minnesota, New Mexico, and Wisconsin included clauses to force objecting physicians to refer for suicide.

Belgium is following Ontario by pressuring all physicians regardless of conviction to refer for death by euthanasia.

Last year, the Ontario Court of Appeal upheld the College’s coercion, admitting that physicians’ rights were indeed “infringed” by the policy, but the infringement is reasonable in a democratic society. In an unprecedented ruling against Charter rights, the court institutionalized a “limit” on fundamental freedoms in the name of “ensuring access” to death “care.” 

Alex Schadenberg
The Euthanasia Prevention Coalition criticized the decision as no “compromise” at all. Alex Schadenberg stated that facilitating suicide makes one complicit in the act. He said:
“If it’s wrong to do the act, then it’s also wrong to send a patient to somebody else who will do the act,”
Ethicist Dr. Edmund Pelligrino explained that referring is participation. He reasoned.
“Formal cooperation is absolutely and always, forbidden. ...This is the case when the physician shares the evil intent, partakes directly and freely, or in any way facilitates an intrinsically evil act like…assisted suicide.”
Pro-assisted suicide politicians and doctors in the U.S. have begun to accuse physicians who refuse to practice assisted suicide of “abandoning patients.” Ironically, even ethicists in professional journal articles have called refusal to refer for death “a toxic form of patient abandonment.”

Alex Schadenberg disagree's, in life-or-death terms.
“People ask for euthanasia because they have lost hope. They may be in depression or experiencing distress, darkened by their reality, and feel that life has lost its purpose or value. In the past, doctors took this request to die as a cry for help, and they tried to find out what their patient needs to weather his or her overwhelming difficulty. The conscientious physician isn’t abandoning his or her patient, they’re caring for that person.”
Conscience advocates add that this is as much an issue of patients’ rights as it is of physicians’ rights.
“Physician conscience rights are important for physicians, but they are more important for protecting patients,”
Schadenberg pointed out, saying that conscience rights are central to protecting patients when they are most vulnerable. 
“I want a physician who will protect my life when I’m going through my deepest darkest times. When I’m going through that physical, psychological, emotional, or existential distress and I’m so darkened that I can’t see beyond my own difficulty, I need a physician who will say ‘no’ to me and will care for me, not kill me.”
Schadenberg concludes that denying conscience rights to physicians actually denies patients their right to live.

Conscience rights are not just for the religious; there are clear secular reasons to object to assisted suicide. First of all, suicide devalues human life.

The American College of Physicians stated in 2001.
“Both society in general and the medical profession in particular have important duties to safeguard the value of human life,” 
“This duty applies especially to the most vulnerable members of society.”
A second conviction against assisted suicide is that, with modern medicine and advances in palliative care, pain can be managed.

The Canadian Society of Palliative Care Physicians issued a statement against assisted euthanasia that emphasized palliative care’s mission is 
“to help patients live as fully as possible until their natural death. Palliative care strives to reduce suffering, not to intentionally end life... The Canadian public must be able to continue to trust that the principles of palliative care remain focused on effective symptom management and psychological, social, and spiritual interventions to help people live as well as they can until their natural death.”
Janice Strukoff of the Delta hospice spoke out against a 2018 edict by the Fraser Health Authority in British Columbia ordering healthcare facilities --including hospices-- to participate in Medical Aid in Dying (euthanasia). 
“Hospice palliative care is not about hastening death, and we object to the bullying currently taking place in B.C.”
Dr Neil Hilliard
The medical director of Fraser Health Palliative Care, Dr Neil Hilliard, resigned over the edict. He stated

“Providing euthanasia or physician-assisted suicide is not in accordance with palliative care, (which) ‘affirms life and regards dying as a normal process,’”
A third argument against assisted suicide is that physician-complicit killing destroys the doctor-patient trust to heal and do no harm.
“Legalizing euthanasia or physician-assisted suicide would have a profound and detrimental effect on the doctor–patient relationship,” 
The British Medical Association stated just sixteen years ago (2003). 
“It would be unacceptable to put vulnerable people in the position of feeling they had to consider precipitating the end of their lives.”
A fourth argument comes from the experience of states and countries where assisted suicide and euthanasia are legal. History proves that once euthanasia is accepted, limitations on candidates diminish and authorized applications expand.

Examples of the limits on euthanasia eroding are happening now. Since legalizing assisted suicide, the Oregon Health Authority changed the definition of “terminal illness” from its universally-understood meaning of “incurable and irreversible fatal disease” to include treatable medical conditions if a patient refuses to take his or her medicine.

Another example of expansion is the several assisted suicide bills debated in the Oregon legislature. One redefines “self-administer” so that the suicidal patient can legally be killed (commit “suicide”) by someone else. Another bill lengthens the necessary prognosis of six months to live. Another enables a pro-suicide doctor to wave the 15 day waiting period. Another widens “terminal” to include any medical condition that ultimately could “substantially contribute to a patient’s death.”

Some euthanasia activists go so far as to elevate the “right to die” to a “duty to die” for patients whose care “costs” too much for their families or for society at large.

In a speech to the Health Lawyers Association, then-Colorado Governor Richard Lamm stated in 1984 that the terminal elderly have “a duty to die and get out of the way,” because giving them health care would turn the U.S. into a “second-rate economic nation.” Time, the Washington Post, and the New York Times reported his remarks favorably.

It must be noted that this callous, purely economic reasoning is precisely the attitude that led pre-Nazi Germany to “dispose” of human “life devoid of value.” 

Dr. Leo Alexander, a Boston psychologist and the American psychiatric representative to the Nuremberg trials, explained that the foundations of genocide lie in euthanasia. Dr. Alexander wrote in the New England Journal of Medicine in 1949:
“The beginnings were at first merely a subtle shift of emphasis in the basic attitudes of physicians in the 1920s. It started with the acceptance of the attitude, basic in the euthanasia movement, that there is such a thing as a life not worthy to be lived,”

“This attitude in its early stages concerned itself merely with the severely and chronically sick, (then)...the socially unproductive, the ideologically unwanted, the racially unwanted, and finally all non-Germans. But it is important to realize the infinitely small wedged-in lever from which the entire mindset received its impetus was the attitude toward the non-rehabilitable sick.”
Summarizing reasons to oppose euthanasia, a 2012 statement from the Ethics, Professionalism and Human Rights Committee of the American College of Physicians read
“Making physician-assisted suicide legal raised serious ethical, clinical and social concerns and that the practice might undermine patient trust; distract from reform in end-of-life care; and be used in vulnerable patients, including those who are poor, are disabled, or are unable to speak for themselves or minority groups who have experienced discrimination.”
These reasons show that physicians’ right to refuse to prescribe death is not necessarily based on faith, but grounded in foundational understandings about humanity and healthcare.

David Anderson MP
Physicians leaving medicine is just what is happening in Canada. MP David Anderson testified

“I have spoken to doctors who feel overt pressure to leave family medicine because of their conscientious beliefs,”

“I have heard of palliative care doctors in Ontario who have stopped practicing altogether. Nurses who feel increasingly bullied are choosing to shift their focus or retire early. I have had personal conversations with people who work in old folks’ homes who explain they do not want to participate in this but are increasingly feeling pressured to do so.”
The effect of Canada’s euthanasia law is to force euthanasia objectors out of their chosen practice, or out of healthcare altogether. In May of this year, the Court of Appeal for Ontario brazenly exposed that effect as intended, actually advising conscientious medical workers to find a job where assisting suicide would not be required.

Anderson lashed out against the court’s insulting advice, calling it 
“incredibly demeaning to those men and women who have gone through years of training.”
“They are being punished for holding that level of dignity, respect and honor for their patients.”
Anderson continued:
“We have such a shortage of physicians and medical services,” 
“Particularly in rural areas, there is an increasing lack of physicians in an increasingly challenged medical system... The answer does not have to be to do it, find someone else to do it or get out of medicine.”
Fortunately, a flickering spark of common sense has been ignited in various places, and we must fan that into a flame.

The U.S. State Department report on international freedoms singled out a growing trend of prospective healthcare professionals whose potential is destroyed by a lack of conscience rights. 
“Medical and nursing students...expressed their reluctance to enter the health care field as a whole, and particularly specialties...where their objections to…euthanasia might not be respected.”
The Trump administration has officially noted Canada’s trashing of doctors’ conscience rights. Last year, U.S. Secretary of State Mike Pompeo released a report pointing out that Canada’s “regulations requiring doctors to refer patients seeking assisted death...constituted facilitation and violated constitutional guarantees of freedom of conscience and religion.”

Earlier this year, the Trump Department of Health and Human Services (HHS) reversed Obama rules and mandated conscience protections 
“for physicians, pharmacists, nurses, teachers, students, and faith-based charities,” exempting them from “having to provide, participate in, pay for, provide coverage of, or refer for, services such as...assisted suicide.”
HHS regulations now protect healthcare entities that object to 
“assisted suicide, euthanasia, or mercy killing” from “being required to perform, participate in, pay for, provide coverage for, counsel or refer for...euthanasia.”
Freedom of conscience “is the bedrock of American life,” President Donald Trump proclaimed.

The new HHS rules specifically include as unlawful discrimination:
“being steered away from a career in obstetrics, family medicine, or geriatric medicine, when one has a religious or moral objection to...physician-assisted suicide or euthanasia.”
Roger Severino, director of HHS’s Office for Civil Rights, elaborated
“This rule ensures that healthcare entities and professionals won’t be bullied out of the healthcare field because they decline to participate in actions that violate their conscience, including the taking of human life.”
Besides the current U.S. administration, there are other glimmers of hope. Last year the Norwegian Supreme Court handed down a landmark conscience rights ruling supporting a Polish physician who was fired for following her conscience not to kill.

In Canada, the province of Manitoba passed conscience rights legislation in 2017 allowing doctors to opt out of killing. MP David Anderson told Parliament.
“The example of the province of Manitoba...shows there does not need to be compulsion in the medical system when it comes to this issue,” 
“Why would one try to force people into doing what they believe to be wrong?”
David Anderson’s bill (C-418) has enabled debate in the Canadian Parliament. He told Parliament Bill C-418 would:
“provides the teeth” that the current law lacks. “make it an offence to intimidate” a healthcare worker “to take part, directly or indirectly, in the provision of physician-assisted suicide.” It would also stop hospitals and employers from firing healthcare workers who opt out of assisting in a patient’s suicide.
It is said, “Where the battle rages, loyalty is proved.” The fight for conscience rights is immediate and intense, and the outcome is in question not only for Canada, but the U.S. and the rest of the civilized world.

Saturday, June 15, 2019

American Medical Association opposes assisted suicide.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Fabulous news. 

The American Medical Association (AMA) has overwhelmingly upheld its opposition to assisted suicide.

After years of deliberation the (AMA) delegates, at their House of delegates meeting, supported the assisted suicide report of the Council on Ethical and Judicial Affairs (CEJA) by a vote of 360 to 190 and re-affirmed their position opposing assisted suicide by a overwhelming vote of 392 to 162.
Joyce Frieden, reporting for Medscape on the deliberations stated that the delegates supported two opinions. That being:
... Code of Medical Ethics Opinion 5.7, which states that "permitting physicians to engage in assisted suicide would ultimately cause more harm than good. Physician-assisted suicide is fundamentally incompatible with the physician's role as healer, would be difficult or impossible to control, and would pose serious societal risks. Instead of engaging in assisted suicide, physicians must aggressively respond to the needs of patients at the end of life."

... E-1.1.7 of the AMA's Principles of Medical Ethics, states that "Physicians are expected to uphold the ethical norms of their profession, including fidelity to patients and respect for patient self-determination ... Preserving opportunity for physicians to act (or to refrain from acting) in accordance with the dictates of conscience in their professional practice is important for preserving the integrity of the medical profession as well as the integrity of the individual physician, on which patients and the public rely. Thus physicians should have considerable latitude to practice in accord with well-considered, deeply held beliefs that are central to their self-identities."
Frieden, reporting for Medscape, stated that Diane Gowski, MD, of Clearwater, Florida, an alternate delegate for the Society of Critical Care Medicine and speaking on behalf of the Chest Caucus stated:
"We would not give our patients a gun or revolver ... so we should not be supplying them with lethal drugs. Physician-assisted suicide violates natural moral law. We urge the AMA to stand firm, as any change from the current position will only confuse the public as to the intention and role of their physicians."
Dr Shane Macaulay
According to Frieden Shane Macaulay, MD, of Kirkland, Wash., speaking for the Washington delegation stated:
"Oregon legalized assisted suicide in 1997 with repeated assurances that it would stay contained and would not become euthanasia," he said. "Just last month, the Oregon state House of Representatives approved a bill to allow patient death by lethal injection, showing the inevitable progression from assisted suicide to euthanasia once physicians have accepted the idea that taking a patient's life is permissible." 
"In Canada, assisted suicide and euthanasia were legalized only 3 years ago, and in the 3 years we've debated this topic here, euthanasia has become a runaway contagion in Canada, with over 4,000 deaths last year." 
"These alarming developments show us that the wheels are coming off bus on assisted suicide. We do not have the luxury of time to continue to fail to act on the CEJA report while the real-world situation deteriorates. Unless we're willing to embrace widespread euthanasia, we must accept the CEJA report and reaffirm this policy now as a firewall against what is [happening in] Canada."
At a 2016 meeting of the AMA, delegates voted to ask CEJA to review the AMA policy on assisted suicide.

In May 2018, CEJA upheld the AMA policy on assisted suicide, but in June 2018, AMA delegates asked CEJA to continue reviewing its policy on assisted suicide.

In October 2018, CEJA adjusted the language of its policy while upholding that the AMA maintain its opposition to assisted suicide. In November 2018, AMA delegates once again decided to ask CEJA to continue reviewing the AMA policy on assisted suicide.

After three years of intense review of its assisted suicide policy, AMA delegates overwhelmingly upheld that assisted suicide is incompatible with the physician's role as healer.

Maine Governor signs assisted suicide bill.

This article was published by the National Review online on June 14, 2019

Wesley J Smith
By Wesley J Smith

Maine Governor Janet Mills (D) just signed a bill legalizing assisted suicide. That means she is pro, at least some, suicides.

But her statement justifying her signing goes even further, and in my view, crosses the line to full-bore pro-suicide advocacy. From the Courthouse News Service story:
“It is not up to the government to decide who may die and who may live, when they shall die or how long they shall live,” Mills said in a statement. “While I do not agree that the right of the individual is so absolute, I do believe it is a right that should be protected in law…
That’s a very opened-ended statement. If government has no right “to decide who may die and who may live, when they shall die or how long they shall live,” we might as well kiss government-sponsored suicide-prevention programs goodbye. We should tell cops not to pull people off bridge precipices. And no more forced hospitalizations for treatment of those found beyond a reasonable doubt to be a danger to their own lives.

Mills also said that she hopes that assisted suicide is committed “sparingly” and that the state “should respect the life of every citizen.” Talk about hollow rhetoric! When committing suicide is depicted as a “right,” on what basis would the exercise of that liberty be rarely used?

Mills also bowed to supporting hospice and palliative care. But hospice is about living. In contrast, assisted suicide is about dying. Moreover, suicide prevention is one of hospice’s core services — which legalizing assisted suicide substantially undermines. Indeed, where it is legal, most victims of doctor-prescribed death in hospice never receive any suicide prevention at all.

Perhaps Mills was clueless about the import of her words. And I have no doubt she opposes the suicides of teenagers and people with a transitory or impulsive desire to die.

But that isn’t the same thing as being anti-suicide. When a governor supports some suicides — which she clearly does — that is pro-suicide. When a governor affixes her signature to a law granting the state’s imprimatur to suicide facilitation, that is pro-suicide. Indeed, when a governor proclaims that government should have no role in saving the lives of all suicidal people, there is nothing else to call it.

Monday, June 10, 2019

American Medical Association overwhelmingly upholds its opposition to assisted suicide.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

I have great news

The American Medical Association (AMA) upheld its opposition to assisted suicide by a vote of 65% to 35% today. 

The AMA overwhelmingly maintained that:
“Physician-assisted suicide and euthanasia are fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks”
At a 2016 meeting of the AMA, delegates voted to ask the Council on Ethical and Judicial Affairs (CEJA) to review the AMA policy on assisted suicide.

In May 2018, CEJA upheld the AMA policy on assisted suicide, but in June 2018, AMA delegates once again asked CEJA to continue reviewing its policy on assisted suicide.

In October 2018, CEJA adjusted the language of its recommendation while upholding that the AMA maintain its opposition to assisted suicide. In November 2018, AMA delegates once again decided to ask CEJA to continue reviewing the AMA policy on assisted suicide.

After three years of intense review of its assisted suicide policy, AMA delegates overwhelmingly upheld that assisted suicide is incompatible with the physician's role as healer.

Dr William Reichel: Rejecting assisted suicide is a wise decision.

(Sadly the Maine Governor signed the assisted suicide bill).

I have studied assisted suicide since 1984, mostly at Georgetown University Medical Center. I am a Past President of the American Geriatrics Society and I have published a number of papers on this subject, the most important one in The Lancet in 1989. I also discuss this subject in my text Reichel's Care of the Elderly, 7th Edition, Cambridge University Press.

I am strongly opposed to assisted suicide because it may be performed for the wrong reasons. Would a selfish family member want to receive the inheritance sooner than the projected estimated time for that relative's illness? Or can the medical system selfishly want to avoid a prolonged hospital or nursing home stay? Would a doctor want to make it easier by not getting a second opinion that some states require? The literature from the Netherlands and Belgium describe many violations of government policy including not stating the true cause of death and even not getting the patient's permission.

I imagine that you may be very overwhelmed with this issue and others. But I urge you to please consider what I have shared with you. I feel certain that you will think back and realize that rejecting assisted suicide for Maine is a wise decision.

William Reichel, M.D. 

Affiliated Scholar 
Center for Clinical Bioethics 
Georgetown University Medical Center Washington, D.C.

Euthanasia and Physician-Assisted Suicide are Unethical Acts.

The following article was published in the May 2019 edition of the World Medical Association Journal. (Link)

This article is written by Dr's Ewan Galigher, Maria Gigolini, Alana Cormier, Sinéad Donnelly, Catherine Ferrier, Vladimir A Gorshkov-Cantacuzéme, Sheila Harding, Mark Komrad, Edmond Kyrillos, Timothy Lau, Rene Leiva, Renata Leong, Sephora Tang and John Quinlan.

The World Medical Association (WMA), the voice of the international community of physicians, has always firmly opposed euthanasia and physician-assisted suicide (E&PAS) and considered them unethical practices and contrary to the goals of health care and the role of the physician [1]. In response to suggested changes to WMA policy on this issue, an extensive discussion took place among WMA Associate Members. We, representing a voice of many of those involved in this discussion, contend that the WMA was right to hold this position in the past and must continue to maintain that E&PAS are unethical.
 

The Central Issue Under Debate is the Ethics of E&PAS
 

The question is whether it is ethical for a doctor to intentionally cause a patient’s death, even at his or her considered request. The fact that E&PAS has been legalized in some jurisdictions and that some member societies support these practices has no bearing on the ethical question. What is legal is not necessarily ethical. The WMA already recognizes this distinction, for example, by condemning the participation of physicians in capital punishment even in jurisdictions where it is legal. The WMA should be consistent in this principle also with respect to E&PAS.

E&PAS Fundamentally Devalues the Patient
 

This devaluation is built into the very logic of E&PAS. To claim that E&PAS is compassionate is to suggest that a patient’s life is not worth living, that her existence is no longer of any value. Since the physician’s most basic tasks and considerations are to ‘always bear in mind the obligation to respect human life’ and ‘the health and well-being of the patient’ [2, 3], E&PAS must be opposed. E&PAS distorts the notion of respect for the patient. On the one hand it claims to help suffering persons, while on the other hand it eliminates them. This is a profound internal contradiction; the ethical priority is to respect the fundamental intrinsic worth of the person as a whole.
 

E&PAS Puts Patients at Risk
 

Patients are autonomous agents but are not invulnerable to their need for affirmation from others, including their physician. Amidst the overwhelming fears of those who suffer (4, 5), a free autonomous decision to die is an illusion. Particular concern exists for those who may feel their life has become a burden due to changing perceptions of the dignity and value of human life in all its different stages and conditions, and an explicit or implicit offer of E&PAS by a physician profoundly influences the patient’s own thinking. The troubles of human relationships within families, the presence of depression, and problems of abuse and physician error in an already stressed medical system, make muddy waters even more turbulent [6]. Evidence shows that societies cannot always defend the most vulnerable from abuse if physicians become life-takers instead of healers [1, 6]. The power of the therapeutic relationship cannot be underestimated in the creation of patient perceptions and choices.

E&PAS Totally Lacks Evidence as ‘Medical Treatment’


The consequences of E&PAS are unknown as both physicians and patients have no knowledge of what it is like to be dead. Advocates of E&PAS place blind faith in their own assumptions about the nature of death and whether or not there is an afterlife when arguing that euthanasia is beneficial. E&PAS is therefore a philosophical and quasi-religious intervention, not a medical intervention informed by science. Doctors should not offer therapy when they have no idea of its effects—to offer E&PAS is to offer an experimental therapy without any plans for follow-up assessment. Therefore, key elements in any medical intervention such as informed consent are simply not possible without knowing what stands on the other side of death. Rather than a standard medical discussion of alternatives based on scientific data or clinical experience, the discussion must leave the clinical domain and enter the domain of speculation. This is not an exercise in informed-consent. This is not the accepted medical ethics of medical practice. All this is, in part, why E&PAS cannot be a medical procedure.
 

These Weighty Moral Considerations are Supported by the Ethical Intuition of the Global Medical Community
 

Only a small minority of physicians support E&PAS. The vast majority of doctors around the world wish only to foster the will to live and to cope with illness and suffering, not to facilitate acts of suicide or to create ambiguity around what constitutes a medical treatment. We must remember that
the four regional WMA symposia demonstrated that most doctors would never be willing to participate in euthanasia. Even the insistence of E&PAS proponents on (a) using ambiguous language such as ‘Medical Assistance in Dying’ to describe their practice and (b) avoiding mention of E&PAS
on death certificates suggests that they share to some degree this fundamental ethical intuition about killing patients.
 

Acceptance of E&PAS Undermines Boundaries Between End-Of-Life Care Practices That do not Intend Death (palliative care, withholding/withdrawing lifesustaining therapy) and Those that do Intend Death (E&PAS)
 

Confusion is created at a societal level about what constitutes “medical treatment,” especially when language such as “medical assistance in dying” or “voluntary assisted dying” is used. This renders the reality of such acts and their application unclear. As many patients share our conviction that deliberately causing death is wrong, a misunderstanding of the distinction between E&PAS and palliative care may lead to rejection of palliative care or insistence on futile life-sustaining therapies. The availability of E&PAS also distracts from the priority of providing social services and palliative care to those who are sick and dying [7].

The WMA’s Code of Ethics Strongly Influences Standards for the Practice of Medicine Around the World and Neutrality on E&PAS by the WMA Would be Interpreted Globally as Tacit Approval
 

A change in the WMA statement would imply a tacit endorsement of E&PAS and render the WMA complicit with such practices [8, 9]. Neutrality by professional medical organisations on E&PAS is perceived by society, governments and the international pro-euthanasia lobby as that organisation’s acceptance of them as medical practice, rather than as a response to a societal/political agenda. Those who seek international approval to justify these practices will create a silencing of the majority of the community, which has real medical, societal and ethical concerns around E&PAS and their effects on society internationally.
 

WMA policy on E&PAS reflects that which is in place in hundreds of jurisdictions with widely divergent legal and political traditions. While it may be tempting to placate some member societies so as to avoid dissension, we must not destabilize medical ethics around the world. We must continue to characterize E&PAS as unethical even if it conflicts with the demands of the state or influential groups backed by the law. We must not let imperfect law trump good medical ethics. Undoubtedly many doctors who perform E&PAS believe themselves to be acting nobly; but it does not follow that they should expect others to affirm their views or not to oppose them; nor are they wronged by existing WMA policy. Any society that insists on transforming suicide from a freedom to a right, should stand up a different profession with the duty to fulfil that new right, as killing does not belong in the House of Medicine.
 

Neutrality on E&PAS has Serious Consequences for Physicians who Refuse to Participate 

In jurisdictions where E&PAS is legalized, physicians who adhere to the long-standing Hippocratic ethical tradition are suddenly regarded as outliers, as conscientious objectors to be tolerated and ultimately excluded from the profession [10]. A neutral stance by the WMA would compromise the position of the many medical practitioners around the world who believe these practices to be unethical and not part of health care. In some jurisdictions it is illegal not to refer for these practices, creating a dystopic situation where the doctor who practises quality end-of-life care needs to conscientiously object in order to do so, and may be coerced to refer for E&PAS. Neutrality from the WMA would promote the contravention of the rights and ethical practice of these doctors, undermining their ethical medical position at the behest of a societal demand that can fluctuate with time.
 

In sum, the changes currently being debated, arising from political, social, and economic factors, have been rejected time and again and most recently by the overwhelming consensus of WMA regions. The present debate represents a crucially important moment for the WMA that must not be squandered. Given the influence of the WMA and the profound moral issues at stake, neutrality should not be an option. The WMA policy must continue to stand as a beacon of clarity to the world, bringing comfort to patients and support to physicians around the globe. The WMA should not be coerced into promoting euthanasia and assisted suicide by making its stance neutral.
 

References 
1. Leiva R, Friessen G, Lau T. Why Euthanasia is Unethical and Why We Should Name it as Such. WMJ. 2018 Dec; 64 (4) pages 33-37. [Cited 2019 Feb 05]. https://www.wma.net/wpcontent/uploads/2019/01/wmj_4_2018_WEB.pdf
2. WMA INTERNATIONAL CODE OF MEDICAL ETHICS. WMA [Internet] [cited2019 Feb 05]. https://www.wma.net/policiespost/wma-international-code-of-medicalethics
3. WMA DECLARATION OF GENEVA. WMA [Internet] [cited 2019 Feb 05]. https://www.wma.net/policies-post/wma-declarationof-geneva
4. Zaorsky NG et al. Suicide among cancer patients. Nat Commun. 2019 Jan 14;10 (1):207. [cited 2019 Feb 05]. https://www.nature.com/articles/s41467-018-08170-1
5. 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. [Cited 2019 Feb 05].https://bmjopen.bmj.com/content/7/9/e016659.long
6. Miller DG, Kim SYH. Euthanasia and physician-assisted suicide not meeting due care criteria in the Netherlands: a qualitative review of review committee judgements. BMJ Open. 2017 Oct 25;7(10):e017628. [cited 2019 Feb 05].https://bmjopen.bmj.com/content/7/10/e017628. long
7. The Canadian Society of Palliative Care Physicians-KEY MESSAGES RE HASTENED DEATH [Internet] [cited 2019 Feb 05]. https://www.cspcp.ca/wp-content/uploads/2015/10/CSPCP-Key-Messages-FINAL.pdf
8. Sulmasy DP, Finlay I, Fitzgerald F, et al. Physician-assisted suicide: why neutrality by organized medicine is neither neutral nor appropriate. J Gen Intern Med 2018; 33: 1394-1399.
9. Canadian Medical Association softens stand on assisted suicide. Globe and Mail. AUGUST 19, 2014 [Internet] [cited 2019 Feb 05]. https://www.theglobeandmail.com/news/national/canadian-medical-association-softens-stance-onassisted-suicide/article20129000/
10. Euthanasia in Canada: A Cautionary Tale. WMJ 2018 Oct; 64 (3), p 17-23. [cited 2019 Feb 05].https://www.wma.net/wp-content/uploads/2018/10/WMJ_3_2018-1.pdf (Institutional affiliations are provided for identification purposes only and do not imply endorsement by the institutions.)

Tell Governor Mills to veto the Maine assisted suicide bill.

I have bad news: 
Governor Janet Mills signed LD 1313 into law. We had hoped that she would Kill the Bill but now she has agreed to allow doctors to kill patients.  Alex Schadenberg
By Mark Hodges (EPC researcher)

Last week the Maine House of Representatives and Senate passed a bill that would legalize doctors to proscribe lethal drugs to patients who ask to be killed.

Democratic Governor Janet Mills has ten days to sign LD 1313 into law. Mills said. 
“I’m not really sure about it,”   
“I’m still talking to people on both sides.”
But even if she does nothing, after those ten days it will become law automatically. We need you to tell Gov. Mills to veto the assisted suicide bill.

Governor Janet Mills
1 State House Station 
Augusta, ME 04333
Tel: 207-287-3531 
Fax: 207-287-1034
Email: governor@maine.gov

The Democratic-controlled state House approved the death bill by one vote, 73 to 72. The Democratic-controlled state Senate was also close, with a 19 to 16 vote.

Those who oppose assisted suicide say the one-margin vote is yet another example of how important it is to vote for candidates that oppose assisting suicide. The one vote margin also shows how divided the state of Maine is on assisted suicide.

Alex Schadenberg
Assisted suicide bill LD 1313 professes to defend individual “choice” and autonomy“ but in reality these bills deceptively give physicians, the right in law, to prescribe lethal drugs to patients,” Euthanasia Prevention Coalition Executive Director Alex Schadenberg explained. 

“People are needing care and support, not lethal drugs.”
Linda Milliken wrote in the Portland Press Herald.
“Physician-assisted suicide destroys the doctor-patient relationship, as doctors now become agents of death, rather than comforters and healers,” 
Opponents of assisted suicide have pointed out multiple problems with the legislation, including defining “terminal disease” so broadly as to qualify someone with diabetes as eligible for a lethal dose.

Under the proposed law, patients with treatable conditions are considered “terminal” if they decide not to accept effective medication.

The Maine law is similar to Oregon’s assisted suicide law. An Oregon Health Authority representative admitted they interpret “terminal disease” as including treatable conditions:
“If the patient does not receive treatment or medication (for whatever reason) and is left with a terminal illness, then s/he would qualify for the Death With Dignity Act. I think you could also argue that even if the treatment/medication could actually cure the disease, and the patient cannot pay for the treatment, then the disease remains incurable.”
Nancy Elliot
Former three-term New Hampshire State Representative Nancy Elliot 
stated

“One of the biggest problems is people who qualify for Assisted Suicide are not necessarily dying. Think of a 21-year-old otherwise healthy insulin dependent diabetic. He qualifies if he rejects his insulin. This would be the same for many other people with serious conditions, who take prescription medications.”
Not Dead Yet’s Mike Reynolds cited
Oregon’s doctors have written suicide prescriptions for individuals whose medical basis for eligibility for assisted suicide was listed as diabetes,” 
“People could qualify as ‘terminal’ who have epilepsy, ongoing infections and other illnesses that can be managed with medication.”
Milliken noted in a New York Times article which reported, 
“According to psychiatric experts, the vast majority of people requesting suicide are suffering from treatable depression, and no longer want to kill themselves once their underlying depression is resolved.” 
“Once the depression lifts and people can think more clearly, the therapists say, those who were determined to kill themselves are thankful to be alive, despite their pain or grim prognosis.” 
Elliot points out.
“With Assisted Suicide on the table these mistakes can be deadly. What about the five percent rate of incorrect medical diagnosis?” 
At a hearing in Massachusetts, John Norton testified that “as a young man he was diagnosed with ALS. He stated that had Assisted Suicide been legal at that time he would have used it. A few years in, the disease’s progression just stopped. Now in his late 70s he stated he has had a great life with children and a grandchild. With Assisted Suicide on the table he would have lost all of that.” 
Critics also note that Maine’s assisted suicide bill allows someone besides the patient to administer the lethal drugs. It defines “self-administer” as the patient voluntarily “ingesting” the poison –a phrase that other pro-euthanasia states interpret very loosely.

Schadenberg explains.
“In Washington State, ‘to ingest’ means ‘to absorb,’ thus enabling another person to administer the lethal drugs, so long as it is ‘absorbed,’” 
Schadenberg points out a potential lack of impartiality in the death decision. 
“The bill requires two witnesses (to the suicide request), but one may be a relative or an heir,” he says. “Clearly, a conflict of interest may exist.” 
“The written request must be witnessed by two individuals, only one of whom may be entitled to any portion of the patient’s estate upon death. The second witness could be a close friend of the potential heir,”  
“This places victims of elder abuse and domestic abuse in great danger since they are unlikely to share their fears with outsiders or to reveal that they are being pressured by family members to ‘choose’ assisted suicide.”
Conflict of interest in assisted suicide is greatest among health insurance companies. Instances have been publicized where an insurer refuses to pay for expensive but life-saving treatment, yet will pay for a suicide prescription.

Dr Brian Callister
When Nevada physician Brian Callister transferred patients to California and Oregon, where assisted suicide is legal, each patient’s insurer actually asked if he’d suggested assisted suicide – although neither had a terminal illness.

And critics say LD 1313 has no provision for protective oversight against abuse. Once a death doctor writes the lethal prescription, there is no supervision in actually taking the life-ending drugs.

If the person administering the drugs was invested in the patient’s death, such as an heir, the patient could change his or her mind, or even struggle, yet once the poison is “absorbed,” no one would know.

Reynolds told the Bangor Daily News.
“Once the prescription is picked up from the pharmacy, there is absolutely no oversight in the law to protect the ill person from someone else who wants to hurry their death along, be it an insurance carrier, an heir or a caregiver,” 
Reynolds continued
“A friend or relative – even an heir – can ‘encourage’ an elder to make the request, sign the forms as a witness, pick up the prescription, and even administer the drug (with or without consent), because no objective witness is required at death.”
Opponents add that there is no provision for objective, third-party documentation. The same doctor who prescribes poison for his or her patient is the very one who is responsible to report the results of his death procedure.

Schadenberg assessed.
“Self-reporting systems are designed to cover-up abuse. By law, the same doctor is the judge, the jury and the executioner.”
Reynolds concluded.
“The only real protections in the law are for people other than the patient, foreclosing any realistic potential for investigation of foul play,” 
In fact, research proves assisted suicide can result in tremendous suffering by the patient, including “burning patients’ mouths and throats, causing some to scream in pain.” In other instances, “deaths stretched out hours in some patients — and up to 31 hours in one case.”

Reynolds told the Press Herald,
“This is not a ‘dignified’ death,”“It can take up to 104 hours for people to die.”
Newspaper editor John Balentine noted that the bill’s oft-repeated mantra. Balentine told The Forecaster.  
“Death With Dignity,” “purposefully avoids the word ‘suicide.’”
“Suicide is anything but dignified, because that person’s hopes and dreams are snuffed forever,” 
“The associated physical decay triggered by death is tragic and disgusting, far from dignified.” 
“Choosing…death…is also not dignified. Choosing life, rather than death, is dignified. Suffering through pain can be dignified. Giving up is not dignified.”
Balentine concluded.
“I’m always skeptical of those who use linguistic subterfuge to lobby their cause. Those employing the term ‘death with dignity’ are doing just that when lobbying for assisted suicide,”  “Here’s hoping Gov. Mills sees through the Legislature’s misguided – and undignified – political tactics.”
The Maine bill, called by supporters the “Maine Death With Dignity Act,” actually says that a lethal prescription is not suicide, and official death certificates must be falsified to list the patient’s medical condition as the cause of death:
“Actions taken in accordance with this Act do not, for any purpose, constitute suicide, assisted suicide, mercy killing or homicide under the law. State reports may not refer to acts committed under this Act as ‘suicide’ or ‘assisted suicide’…State reports must refer to acts committed under this Act as obtaining and self-administering life-ending medication. A patient’s death certificate…must list the underlying terminal disease as the cause of death.”
In other words, “the death certificate is falsified to reflect a natural death,” Elliot summarized.
“All the information is sealed and unavailable to the public.”
Critics also conclude that Maine’s proposed legislation is discriminatory. Assisted suicide not only stifles hope, encourages despair, and takes advantage of the vulnerable, it devalues certain groups of human beings, pushing them into an early death.

Diane Coleman
Not Dead Yet President Diane Coleman 
explains
“Assisted suicide sets up a double standard, with suicide prevention for some and suicide assistance for others, depending on their health or disability,” 
“If such distinctions were based on race or ethnicity, we’d call it bigotry.” 
“The dangers of mistake, coercion and abuse it poses to old, ill and disabled people are rooted in a profound and still largely unacknowledged devaluation of our lives.”
Stephanie Woodward
Stephanie Woodward, Director of Advocacy at the Center for Disability Rights, charged.

People with disabilities and certain illnesses and the elderly “will receive a fast pass, because our lives are viewed as less worthy,” 
Reynolds agreed.
“Assisted-suicide laws are the most blatant forms of discrimination based on disability in our society today,” 
Bishop Robert Deeley of Portland came out vehemently against the bill on principle. Hsaid. 
“To allow doctors to prescribe deadly prescriptions to hasten a person’s death would be a horrendous wound to the dignity of the human person,” 
The Maine bishop predicted consequences of the law would include 
“the elderly feeling undue pressure to view this as an option to prevent being a burden to others, a desensitization of the value of human life, as well as teaching young adults that people can be disposable.”
Elliot opined
“These laws are abusive in their very nature. To suggest to someone that they should kill themselves is abuse,” 
“It would be like saying, ‘You are worthless and should die.’”
Reynolds warned
“We should all be concerned about what kind of message a government sponsored, medically administered program of assisted suicide sends to anyone facing difficult times.”
“Kill the bill, not the patient.”

The American Nurses Association Maine, the Maine Medical Association, the Maine Hospice Council, the Maine Right to Life, the American Cancer Society Action Network, the Roman Catholic Diocese of Portland the Maine Osteopathic Association, all oppose the Maine legislation.

Suicide activists have tried several times to legalize assisted suicide in Maine. In 2015, a suicide measure was defeated in the state Senate by only one vote. A similar bill failed in the state House in 2017. An attempt was made in 2018 to put the issue to a popular vote.

Assisted suicide was first legalized in Oregon in 1997 after the U.S. Supreme Court essentially ruled the issue was up to the states. Since then, the state of Washington (2008), Vermont (2013 in an even less restrictive measure), California (2015, currently in effect but being fought in court), Colorado (2016), Washington D.C. (2017), Hawaii (2018), and most recently New Jersey (2019) have legalized doctor-prescribed death.  In 2009, Montana's state supreme court did not legalize assisted suicide but created a defense of consent, if a physician is prosecuted for assisted suicide. 

New Jersey Catholic Governor Phil Murphy signed his state’s killing bill in April. He said that while his faith opposed assisted suicide, 
“after careful consideration, internal reflection, and prayer.” 
“as a public official I cannot deny this alternative to those who may reach a different conclusion.”
We need you to tell Gov. Mills to veto the assisted suicide bill.

Governor Janet Mills
1 State House Station Augusta, ME  04333
Tel: 207-287-3531 or Fax: 207-287-1034
Email: governor@maine.gov

Similar bills are pending in several states with New York being the greatest concern.

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