Friday, September 24, 2021

Québec Covid-19 inquest uncovers nursing home deaths from abuse and neglect.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Herron nursing home
A Québec inquest into Covid related nursing home deaths has uncovered some disturbing facts. A report by Tu Thanh Ha that was published in the Globe and Mail on September 14 reports on testimony concerning the Herron nursing home in the suburb of Dorval in Montréal. The report indicates that Covid was cited as the cause of death at the Herron nursing home to hide the fact that residents were dying of dehydration, malnurishment and neglect, also known as elder abuse.

An auxilary nurse (name is protected) reportedly stated in her testimony:
Starting March 13, 2020, a government directive banned visitors, including family caregivers, from entering nursing homes in Quebec. Many elderly residents with Alzheimer’s disease declined quickly when left by themselves. “I saw firsthand that they were dehydrated, in spite of my best efforts to keep them hydrated. I saw that they were malnourished,” the auxiliary nurse said.

In her testimony, and in a 55-page report that she submitted to the inquest, she said that many fatalities at Herron were misleadingly marked as suspected COVID-19 cases, when the deaths were a result of the chaotic handling of the crisis.

“I had the impression that they were blaming the virus because it would be easier to blame the virus than to acknowledge the hard truth that these people suffered from malnourishment and dehydration. I felt that it was a way to escape culpability,” she told the inquest.
The auxilary nurse explains that when staff at the home learned that one of the residents had Covid that many of them abandoned their job and did not return leaving the nursing home critically understaffed. The auxilary nurse stated:
When she came to work on March 29, most of the personnel were missing. The registered nurses left early. One said he had a fever. Another had been told by managers to go and get tested because she had cared for a patient who was found to have been infected.

The auxiliary nurse said she and two orderlies were left to care for a floor with 60 residents. While dispensing medications, she also had to help the orderlies. “I helped out feeding, I helped serve trays, I helped wash people. I was running around like a fool.”
Some of the deaths were clearly from neglect and elder abuse. The report states:
She found one of the first fatalities at Herron, Léon Barrette, whose body was already cold when she visited his room the morning of March 29. There were no physicians or registered nurses present, so a Herron administrator told her she had to handle the paperwork, which she had never done before.

The cause of death was indicated as possibly the new disease. “Everybody was ‘COVID-19 suspected,’ regardless of what symptoms they had,” she testified.

Mr. Barrette had been admitted March 27 and needed oxygen because of breathing problems. But there were no notes on his chart from between his admission and when the auxiliary found him dead. She testified that she saw no oxygen bottle in his room. His family members believe Herron’s staff had forgotten about him.
The report states that even those who had died were treated in an abusive manner:
She said she often “butted heads” with a CIUSSS nursing supervisor when she tried to tidy and clean the bodies of deceased residents. In one case, she said, the supervisor snapped at her for reporting that a dead resident had been left in vomit. “It takes five minutes to clean someone and show respect,” the auxiliary nurse said.

In another case, in a room shared by a married couple, the wife died and was left in her bed for a day. The husband had Alzheimer’s. Every few hours, he checked on his spouse and rediscovered that she had died. “It was extremely callous,” the auxiliary nurse said.
The testimony from the auxilary nurse at the Herron nursing home proves that some of the deaths were not caused by Covid but rather neglect and level of care at this nursing home could only be described has inhumane elder abuse.

The data appeared to indicate that significant abuse was occurring in our nursing homes which prompted me to ask last year - How many Canadian seniors with Covid-19 were killed?

We need to rethink nursing homes and move to community based care (Link).

For several years EPC has been advocating for changes to funding to enable home care. For many, home care is preferable because it enables people to stay in their homes and in their communities. People experience greater respect and dignity when they are cared for by people who know of them

Thursday, September 23, 2021

Belgium: Euthanasia of Newborns Practiced Outside the Law

This article was published by the European Institute of Bioethics on June 6, 2021.

10% of newborn deaths in Belgium are euthanasia deaths.

A recent study has brought to light the practice of deliberate euthanasia to newborns for whom the medical team considered that there was "no hope of a bearable future". These practices concerned 10% of the neonates (0-1 year) who died in Flanders, between September 2016 and December 2017 (i. e., 24 babies).

This practice is illegal in Belgium, yet no authority seems to take offense. The law only allows the euthanasia of a minor if he or she is capable of discernment and conscious at the time of the request for euthanasia.

In her thesis, which served as the basis for the study in question, Laure Dombrecht, researcher at the Vrije Universiteit Brussel (VUB), refers to a similar study conducted in 1999-2000. The proportion of euthanasia to new-borns by injection of lethal substances has increased from 7 to 10% since this previous survey.

Among what is considered as "end-of-life medical decisions" involving 61% of these babies, the study distinguishes between decisions not to start or to stop "life-sustaining treatment" (e.g. ventilator), on the one hand, and the administration of certain substances to the baby, on the other hand. Note that the term euthanasia does not appear anywhere in the article.

In terms of the physician's intentions, the study distinguishes three situations. 

In the first scenario, the physician does not intend to cause or hasten the baby's death, but considers the potential effect of hastening death (e.g., decision not to administer antibiotics, administration of morphine or sedatives). 

The second scenario consists in the situation where the potential effect of hastening death is not the primary goal but is partly aimed at by the physician. 

The third scenario is that in which the physician explicitly intends to cause death (e.g., injection of a lethal muscle relaxant).

While the ethical considerations on the medical decision differ substantively depending on whether it refers to the first or second scenario (death not intended vs. intended death), the study classifies the cases neither according to these two categories of intention, nor referring to the withholding/withdrawing distinction, nor underlining the relevant moral factor actively administering substances. The criterion of proportionality (in withdrawing treatment or in the dosage of substances) is not mentioned either, even though it is decisive for judging the physician's intention.

Doctors who euthanized newborns with lethal injection indicated in 91% of the cases that the main reason for their action was that there was no hope of a "bearable future" for the child. In other words, these children had a real chance of survival, but the medical team - no doubt in agreement with their parents - considered that their lives were not worth living to the end.

Why do practitioners deviate from the legal framework when it comes to children who are unable to express themselves?

The authors of the study raise the question of the need for a framework for this "practice", similar to the paralegal framework established in the Netherlands through the Gröningen Protocol. Such a "framework" would in fact mean conditional authorization of physician infanticide.

Why do death certificates list an assisted death as a natural death and capital punishment as homicide?

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

When someone dies by lethal injection, referred to as MAiD and better known as euthanasia, the death certificate is to list the medical condition that the person had when requesting death by lethal injection and not state "MAiD" or euthanasia.

Most US states that have legalized assisted suicide (a self-administered death by a lethal drug cocktail) also require that the death certificate list the medical condition 
that the person had when requesting death by a lethal drug cocktail.

When someone dies by capital punishment in the US, which is often done by lethal injection, the death certificate will state homicide.

Why do death certificates list euthanasia and assisted suicide as a natural death and capital punishment is listed as homicide?

One reason might be that the person who dies by capital punishment does not request that death be inflicted upon them while with an assisted death, people request their death.

Nonetheless, this distinction is not always true.

When analyzing the acts, they are all done by the same or similar lethal drug cocktails. Death occurs in the same manner with the only real difference being the intention of the act.

Whether or not you support euthanasia, assisted suicide or capital punishment, I conclude that homicide is homicide and suicide is suicide. Euthanasia and capital punishment are homicide and assisting a suicide is a suicide. Any other distinction is based on symantics and not reality.

Wednesday, September 22, 2021

California judge rejects preliminary injunction to permit euthanasia within the California assisted suicide act.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

A California federal judge has rejected a preliminary injunction asking the court to permit euthanasia within the state assisted suicide act. Link to the court decision (Link).

On August 30 I wrote an article about the California court case to permit euthanasia within the state assisted suicide act. The case argued that some people with disabilities, who are approved for assisted suicide, are unable to self-administer the lethal drugs. Therefore, based on the Americans with Disabilities Act, the court must permit euthanasia (doctor administered death) in these cases.

On September 13 I wrote that the California court must reject the challenge to the state assisted suicide act based on (among other reasons):

  1. There is no right to assisted suicide, therefore there is no legal requirement to amend the perceived inequality within the state assisted suicide law. 
  2. The Supreme Court, in Glucksberg, recognized that there is no right to assisted suicide and it recognized that one state interests in prohibiting assisted suicide was the prevention of euthanasia. This court case specifically seeks to permit euthanasia.  
  3. Permitting euthanasia is not an extension of the state assisted suicide law but rather it requires the court to legislate a new law, that being legalizing euthanasia, which is a form of homicide.

On September 20 Justice Vince Chhabria of the United States District Court Northern District Of California rejected a preliminary injunction to permit death by lethal injection (euthanasia) for the plaintiffs. Justice Chhabria stated:

The plaintiffs' ADA claim does not raise a serious legal question, because it seems clear (at least on this record) that the plaintiffs are seeking a modification that would compromise the essential nature of California's program.
Justice Chhabria also makes a clear distinction between euthanasia and assisted suicide by stating:

And most relevant here, the Legislature drew a clear line between assisted suicide and euthanasia, providing that a terminally ill person cannot obtain a prescription unless they can administer the medication themselves and specifying that there is no immunity from criminal or civil liability for someone who administers the medication to a terminally ill person.
Justice Chhabria concludes his decision by stating:
In short, the line between assisted suicide and euthanasia is a significant one. See Washington v. Glucksberg... (1997). It is unlikely that the ADA could be reasonably contrued as requiring a state to cross the line to euthanasia merely because the state has chosen to authorize assisted suicide. Requiring the State of California to cross the line here would likely compromise the essential nature of the end-of-life program it created.

Link to the court decision (Link).

Link to my previous articles about this court case (Link 1) (Link 2).

Contemporary euthanasia is an updated version of early 20th century eugenics

This article was published by Mercatornet on September 22, 2021

German monument to the euthanasia victims
By Mark Sutherland
“Your son was released from a severe and incurable disease.”

“He died quickly and without pain. Considering his serious and incurable illness, death meant relief for him.”

“Considering her severe and incurable illness, life was agony for the deceased. You must therefore understand her death as deliverance.”
These short sentences contrast with the enormity of the suffering of the incurably sick. They are typical of a narrative which makes it hard to understand why anyone could oppose the euthanasia bill to be tabled in the New South Wales Parliament later this year, a narrative which damns its opponents as lacking in compassion.

In spite of this, a look at the pedigree of the euthanasia movement is instructive as to why the measure should be rejected.

The Voluntary Euthanasia Legalisation Society was founded in Britain in 1936. A significant number of its officials and supporters were also supporters of eugenics. The first chairman and secretary, Dr C.J. Bond and Dr C. Killick Millard, were also members of the Eugenics Society, as were its supporters Julian Huxley, H. Havelock-Ellis, Harold Laski and Eleanor Rathbone.

Other supporters, such as H.G. Wells and G.B. Shaw, were not members of the Eugenics Society, but their eugenic views are well documented.

Of course, membership in the Eugenics Society did not disqualify their views on euthanasia. Indeed, it is natural that they supported both, for while “eugenics” comes from the Greek words for “good” and “birth”, “euthanasia” comes from the words for “good” and “death”. A pleasing symmetry.

The eugenic link does illustrate, however, the characteristics of those who created the euthanasia movement. These people met to discuss the problem of others they perceived as defective. As intelligent and enlightened persons, it was natural that they should determine how lesser beings should live and whether they would be permitted to live.

Often, though not always, they were materialists, not religious (a word that was synonymous with superstitious), “scientific” (in ironical quotes because eugenics was a pseudoscience) and who thought that the efficiency of the state should be the ultimate aim of a society.

Like eugenics, euthanasia started with plain “does-what-it-says-it-does-on-the-label” branding. Both movements attracted opprobrium, unfairly they thought, when the Third Reich implemented their ideas on an industrial scale. The Eugenics Society reacted by adopting a policy of crypto-eugenics in the early 1960s and changing its name to the Galton Institute in 1989. The Voluntary Euthanasia Legalisation Society became the Voluntary Euthanasia Society in 1969 and Dignity in Dying in 2006. While the names have changed, the fundamental ideas and motivations of their adherents have not.

With regard to healthcare, the State sees its role as spending money and saving lives. So keen has the State been to do this that, in the past 18 months, we have seen the destruction of inherent rights and freedoms to “keep us safe” as they focus on a single disease. Whether these will be restored is a moot point, but my point here is that the state overreach has happened and that it has been largely accepted, on the basis of a narrative.

For now, let’s assume that we do go back to normal. In the future, the state government will have large debts, increasing areas of activity, a weakening fiat currency and an increasing healthcare bill as the population ages. Legalise voluntary euthanasia — and what could possibly go wrong? In short, in a secular society that has abandoned moral principles for narratives, what is to stop the State from switching from spending money and saving lives to saving money and spending lives? [2]

At this point, if you think: “Ha – got you – slippery slope loses the argument,” think again.

Euthanasia legislation is the initial and partial implementation of an agenda that was set out a long time ago. We have been here before: the quotes at the beginning of the article come from letters of condolence to families of the victims of the Nazi T4 program. Their words reveal that the enthusiasts for euthanasia understood that, when it comes to getting people to accept the murder of the vulnerable and inferior, narrative is key.


[1] Excerpts taken from page 104 of The Origins of Nazi Genocide: From Euthanasia to the Final Solution by Henry Friedlander.

[2] This phrase comes from the name of Part 1 of Death and Deliverance: Euthanasia in Germany 1900 to 1945 by Michael Burleigh.

Tuesday, September 21, 2021

Assisted suicide lobby wants to expand assisted suicide laws and promotes death by dehydration.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

A letter from Bob Free, the Board President of the assisted suicide lobby group End of Life Washington sets the agenda and the direction for the group. The letter established two key goals, that being, expanding the Washington state assisted suicide law and promoting legislation that will enable more people to die by dehydration.

In his letter Mr Free states:

As reported to you earlier, the bill to make needed improvements to Washington’s Death with Dignity Act passed the State House of Representatives, with bipartisan support, but failed to make it to the floor of the Senate due to the very crowded legislative session. For the short 60-day session beginning in January 2022, we are determined to pass this important bill. We will be asking you, our supporters, to join Constituent Meetings with your Senator via zoom, to convince them to support HB 1141. The bill’s main objectives are to:

  • Reduce the waiting period from 15 days to 72 hours.
  • Expand the definition of attending and consulting providers to include Nurse Practitioners and Physician Assistants. 
  • Protect providers working in religiously restricted health systems to provide Death with Dignity outside their regular employment.

Here is a link to my earlier article on HB 1141 (Link).

Mr Free explains why the group wants more death by dehydration. He states:

Committee members have also spent the past year drafting a bill to allow people with serious dementia, including Alzheimer’s, to hasten their death by stopping eating and drinking during the last and worst days of their disease. The bill would incorporate EOLWA’s Instructions for Oral Feeding and Drinking, similar to an advance directive, into Washington’s Natural Death Act. The document expresses a person’s decision about when to be offered food and fluids during late-stage dementia, allowing for a surrogate health care decision maker to ensure caregivers honor a person’s wishes to follow the body’s desire to reduce nourishment and die naturally. We intend to have a bill introduced during the 2022 legislative session, with the support of our legislative champions.

Since the Washington state assisted suicide act requires a person to be competent they want to ensure that people who do not qualify for assisted suicide can die by dehydration. Notice that the group is focusing on people with serious dementia and Alzheimer's.

The "safeguards" that were originally in the Washington State assisted suicide law are now being eliminated. Further to that, the assisted suicide lobby has gone back to promoting death by dehydration because they know that once it becomes more common and people witness the horrific deaths by dehydration, they will demand expanding the law to euthanasia.

BMA goes Neutral on Assisted Suicide. Leading Advocate admits more research on Painful Deaths is needed.

Dr Gordon Macdonald
Chief Executive of Care Not Killing

Dr Gordon Macdonald
On Tuesday last week the British Medical Association’s (BMA) Annual Representatives Meeting (ARM) passed a motion by a narrow majority of just 4 votes (49% to 48%) which shifted the organisation to a position of neutrality on ‘assisted dying’ from its previous position of opposition. By ‘assisted dying’ the BMA is referring to both assisted suicide and euthanasia.

The BMA debate followed a poll of its members last year. That poll itself was the result of a motion passed at the BMA’s 2019 ARM which had been proposed by Dr Jacky Davis, a radiologist and Chair of Healthcare Professionals for Assisted Dying and Board member of Dignity in Dying (formerly the Voluntary Euthanasia Society).

Last year’s poll showed that 40% of BMA members who responded voted for the union to adopt a position of support for assisted suicide and 30% for euthanasia.1  However, beneath the headline grabbing top-line numbers there was a complex picture of medical opinion on the question of whether doctors should be empowered to end patients’ lives.

The closer a specialty is to the care and support of dying people; the less likely its specialists are to support assisted suicide and euthanasia. In the poll 70% and 79% of palliative medicine doctors wanted the BMA to stay opposed to assisted suicide and euthanasia respectively – with backing for active support in single digits. Personal opposition was higher – 76% and 83% – and higher still were the percentages unwilling to participate if legalised: 76% and 84%.2

General Practitioners (family doctors) and geriatricians share this closeness to the lived experience of end of life care, and were similarly averse: 39% of GPs who responded wanted the BMA to remain opposed to assisted suicide compared to just 34% in favour and 46% were personally opposed whilst 43% were personally in favour. Similarly, 44% of geriatricians wanted the BMA to remain opposed to assisted suicide compared to 27% in favour of BMA support for assisted suicide whilst 52% were personally opposed and only 36% personally in favour of a change in the law.3

That brings us to this week’s debate because the poll was conducted on the assumption that any legislation being introduced would be limited to an assisted suicide law applying to adults who are terminally or seriously ill, mentally competent and who voluntarily request assistance to end their lives.4  However, the motion proposed for debate (and approved) has no such caveats.5  In essence, the BMA has opted for neutrality regardless of the nature of any future legislation. So the BMA is now neutral on whether or not those suffering from minor non-terminal conditions and who may have years to live, disabled people, those with psychiatric illnesses, children or just elderly people who are depressed, lonely and tired of life will be allowed under a future law to request assisted suicide or euthanasia.

Then on Thursday this week the Spectator published an article on its website by Dr Joel Zivot6  in which he stated that his research into the deaths of death row inmates has shown that in many cases of those who choose to die by lethal injection they experience pulmonary edema and essentially drown in their own secretions. They may well be suffering pain and distress in the process, often including gasping for breath. Other research suggests that signs of pulmonary edema occur in 84% of cases studied.7  This is relevant because the same drugs (Pentobarbital and Secobarbital) are used in assisted suicide deaths in the USA and euthanasia deaths in Canada.

Link to the podcast "Let's Find Out" between assisted suicide lobby leader Dr Jacky Davis and Dr Joel Zivot (Link to the podcast).
In a Spectator podcast made available online on Thursday evening,8 Dr Zivot discusses his article with Dr Jacky Davis. Dr Davis admitted that she was unaware of this issue previously and acknowledged that Dr Zivot may be right in his findings, but said that more research needs to be done to establish the facts and that Dr Zivot should not be making this information available to the public until that research had been undertaken. She even suggested that the doctors involved in conducting the assisted suicide deaths should be the ones to do the research.

In response, Dr Zivot stated that it was for those who are pushing for the legalisation of assisted suicide or euthanasia to justify their stance and that the onus is on the advocates of ‘assisted dying’ to determine what they have done. He said that the practice of ‘assisted dying’ could be construed as a poor experiment and the onus is on the advocates of ‘assisted dying’ to show that it is “sound and reasonable”.

Now there is some suggestion that the reason for the build up of fluid in the lungs of those who die by lethal injection may be due to the fact that large amount of drugs are being given intravenously over a short timeframe rather than taken orally and that this damages the lungs.9  However, since no post-mortems (autopsies) relating to those who have died by assisted suicide or euthanasia have studied and reported on this aspect of the deaths in question, it is impossible to know if that is indeed the case. Moreover, in Canada, at least in Nova Scotia10, intravenous delivery of Medical Assistance in Dying (euthanasia) seems to be common which raises the question of how many of the 7,595 people who died by MAiD in Canada during 2020 also experienced pulmonary edema, or the ‘drowning’ effect, identified by Dr Zivot in his death row examples. Evidently there is a need for more research.

Whether or not the doctors and families involved in assisted suicide and euthanasia deaths in the USA and Canada will be willing or interested to investigate this matter further remains an open question. What is clear, however, is that rather than rushing into changing the law to follow their North American counterparts in legalising assisted suicide or euthanasia, British legislators should take a much more cautious approach. The BMA should have done so also.

  2., Appendix C, pp. 99-117.
  3. Ibid.
  4., page 3.
  5., Resolution 70.
  10. Crumley E.T. et. al.; “How is the medical assistance in dying (MAID) process carried out in Nova Scotia, Canada? A qualitative process model flowchart study”,

Monday, September 20, 2021

Push for assisted suicide raises questions over disability rights

This letter was published by the Boston Globe and Not Dead Yet on September 7, 2021

John Kelly
In response to an essay on the Victorian fantasy of a peaceful death, two letter writers (“Beyond the fantasy of a gentle death,” Aug. 29) called on the state Legislature to pass the proposed assisted suicide bill.

Paula Bacon and Molly DeHaas Walsh describe the circumstances of difficult deaths and believe that assisted suicide would bring them control, choice, and dignity when their pain and suffering become unbearable.

But when doctors misdiagnose people as terminal, the possibility of real choice disappears. Studies show that 12 percent to 15 percent of people outlive hospice, but in Oregon, with its Death With Dignity Act, only about 4 percent of people have lived past six months. This suggests that as many as 1 in 10 people ended their life prematurely. No one would tolerate any other elective treatment this deadly.

The Oregon reports show that the main “end-of-life concerns” stem not from physical pain but from “existential distress” over the disabling aspects of serious illness, such as dependence, status loss (“dignity”), incontinence, and feeling like a burden on others.

As someone paralyzed below the shoulders, I am terrified of the prospect of a state law sponsoring people’s suicides as rational responses to disability. Massachusetts should instead fully fund home care and provide world-class palliative care. Equality under the law depends on it.

John B. Kelly

Previous articles on assisted suicide by John Kelly (Link). 

Assisted suicide is neither painless nor dignified.

Death by euthanasia or assisted suicide are similar to death by drowning.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

I have published several articles about the research by Dr Joel Zivot, concerning autopsy results from people who died by lethal injection. Dr Zivot is an assistant professor of anesthesiology/critical care at Emory University School of Medicine in Atlanta. The Spectator published a great article by Dr Zivot on September 18 titled: Assisted Suicide is neither painless nor dignified. Zivot is challenging the upcoming assisted suicide bill.

Link to a podcast segment "Let's Find Out" between assisted suicide lobby leader Dr Jacky Davis and Dr Joel Zivot (Link to the podcast).

Zivot explains that he is an expert witness opposing lethal injection executions in America. Zivot opens his article by provacatively stating:

I am quite certain that assisted suicide is not painless or peaceful or dignified. In fact, in the majority of cases, it is a very painful death.

The death penalty is not the same as assisted dying, of course. Executions are meant to be punishment; euthanasia is about relief from suffering. Yet for both euthanasia and executions, paralytic drugs are used. These drugs, given in high enough doses, mean that a patient cannot move a muscle, cannot express any outward or visible sign of pain. But that doesn’t mean that he or she is free from suffering.
Zivot explains his experience with death by lethal injection:
In 2014, I watched the lethal injection of Marcus Wellons in a Georgia prison. The 59-year-old had been sentenced to death for the rape and murder of his 15-year-old neighbour India Roberts in 1989. ‘I’m going home to be with Jesus’ were his final words as the drugs entered his body.

I noticed that Wellons’s fingers were taped to the stretcher, which made little sense, given his body had already been restrained by heavy straps. I kept asking myself why. I read into the subject and came across a report of the lethal injection execution of another death row inmate, Dennis McGuire, five months earlier. During that 24-minute process at the Ohio jail, McGuire clenched his fists. Perhaps it was a final, futile show of defiance. Perhaps it was an outward display of pain. With his fingers secured, Wellons could not have made any such gesture.
Based on autopsies, Zivot proves that death by lethal injection, whether it be execution, euthanasia or assisted suicide are similar to death by drowning:
In 2017, I obtained a series of autopsies of inmates executed by lethal injection, which confirmed my worst fears. Wellons’s autopsy revealed that his lungs were profoundly congested with fluid, meaning they were around twice the normal weight of healthy lungs. He had suffered what is known as pulmonary oedema, which could only have occurred as he lay dying. Wellons had drowned in his secretions. Yet even my medical eye detected no sign of distress at his execution.
Wellons was executed with a chemical called pentobarbital, which caused his pulmonary oedema. In Oregon, four in five assisted suicides have employed pentobarbital or its close relatives. (The Assisted Dying Bill is based on the Oregon system.) If a post-mortem examination were to be performed on a body after assisted suicide, it’s very likely that similar pulmonary oedema would be found.
Zivot continues by explaining why the proposed British assisted suicide bill will likely result in deaths similar to drowning:
The proposals before the House of Lords would see sick patients prescribed a lethal dose of perhaps 100 barbiturate pills. Laws in Oregon, like those proposed in the UK, require patients to take the drugs themselves, which rules out any form of general anaesthetic. Often patients are handed anti-sickness and anti-seizure tablets but nothing more in preparation, meaning they’re very much awake as the assisted suicide process begins and they start ingesting fatal quantities of barbiturates. Without a general anaesthetic, many will be in great discomfort, even if outwardly they don’t appear to be suffering.
Zivot confirms his theory based on the assisted suicide death of Linda Van Zandt:

Indeed, there are countless examples of people who have discovered just how messy, painful and distressing it can be as they watched their loved ones go through the process. Take Linda Van Zandt, who helped her aunt, suffering from amyotrophic lateral sclerosis, die in California. She later described how she had to feed 100 crushed pills in a drink to her aunt ‘who could barely swallow water’, but ‘had to drink all of it in less than five minutes to “ensure success”’. She concludes: ‘The day was fraught and frightening… We had been forced to assist in the most bizarre fashion, jumping through seemingly random legal hoops and meeting arbitrary deadlines while my aunt suffered, and finally emptying capsules, making an elixir so vile I cried when I knew she had to drink it. This was death with dignity?’
Zivot states that, when given the information about how death by lethal injection occurs, three death-row inmates chose to die by the electric chair rather than die by lethal injection. Zivot concludes:
Advocates of assisted dying owe a duty to the public to be truthful about the details of killing and dying. People who want to die deserve to know that they may end up drowning, not just falling asleep.
When Dr Zivot made a similar presentation to the Canadian Senate Committee examining the euthanasia bill, they simply ignored his warnings based on some argument that executions and assisted death are different. In fact, Zivot acknowledges that they are different, but the drugs used are similar and result in the same outcome,

Death by euthanasia or assisted suicide are similar to death by drowning.

What is the "good" of euthanasia, Part III: A true system of choice

Gordon Friesen
By Gordon Friesen, EPC Board Member.

Necessary comparisons 

I have stated, on many occasions, that I am categorically opposed to euthanasia and assisted suicide and I will continue to struggle, on the most fundamental level, for a complete prohibition thereof. However, this article is based on being faced with the necessity of choosing some rational framework, to accommodate assisted death as a fait accompli.

Some time around 2013, approximately two years after I first decided that my various writings in opposition to medically assisted death should be organized into an actual book (still incomplete to this day), I attended a public meeting, in Montreal, of the Physician's Alliance Against Euthanasia. Many very valuable things were said about the dangers of what was then mainly feared as "physician assisted suicide". In the post-presentation question period, I had the opportunity of advancing an unconditional right-to-die position according to which any rational person should be allowed to choose the time, and the manner, of their own death, with no medical criteria and in fact: with no criteria of any kind, other than a true ability to choose.

I didn't take this position because I wished to see assisted suicide legalized in Canada. Quite the contrary. However, I had become convinced that the principle of choice would inevitably prevail (as it subsequently has done), and that frankly embracing choice is the only possible way of preventing that much, much worse alternative, which consists of inaugurating a scheme of euthanasia, normalized as benign medical care (such as that which we see in Canada today).

I realize, of course, that this is counter to all intuition; and that most readers would naturally assume that assisted death, restricted by medical criteria, must still be preferable to a full-on right-to-die. And yet most sincerely, after multiple decades of considering these questions, I would wish to argue that this is not logically the case; or at least, I would wish to invite the reader to undertake a comparison of relative harms in each case (right-to-die, versus medical euthanasia), according to a very simple standard ("What is the worst that can happen ?"), applied fairly to each.

A summary quantitative analysis

Unfortunately, from the moment we accept any form of assisted death, people are going to die. That is the inescapable fact. Therefore, In order to choose our poison (that is: to choose any form of assisted death), we must mainly consider the effects of those deaths on the rest of society.

The first and simplest measure, of social impact, would be quantitative: for more deaths must produce more effect. And on this score, we see that the very permissive Swiss system, of largely choice-based assisted suicide, produces only about half as many deaths as the heavily medicalized euthanasia system of neighbouring Netherlands; and also, the number of physician assisted suicides in the relevant American States, is truly trivial in comparison with the volume of euthanasia, per capita, as already performed in Canada, only five years after legalization (2016).

And yet there is a deeper measure of harm involving the damage wreaked upon the moral compass of individuals, and indeed, upon the moral fabric of society. And it is upon these injuries that I would wish to insist in what follows.

The German example : Moral implications of a free choice of death

On February 26, 2020, the German Federal Constitutional Court struck down a recently passed law which had been intended to prevent private organizations from offering assisted suicide as a quasi-commercial service. The logic was simple : people have a (constitutional) right to commit suicide and to seek aid in so doing; but to stop the operation of organizations offering such assistance, would be to effectively nullify that right; and therefore, such organized (and presumably even commercial) activity must be allowed.

As far as the underlying moral case is concerned, it is simply recognized, in this ruling, that different moral opinions exist in a pluralist society; that it is not the role of the High Court (of a constitutional state) to make judgments of a moral nature; that such a role must be limited to ensuring the constitutionality of legislation.

Simply stated then: despite enabling assisted suicide, the German State will not affirm that assisted suicide is "good" (either in general, or in any particular case). And above all: there is no suggestion, explicit or implied, that the German government, German society, individual German citizens, or any professional group, in Germany, have the slightest obligation to provide assisted death.

Free assisted death, and protection of the sick and disabled

In keeping with this general approach there are a number of especially significant elements in the actual judgment, and in particular the following (quoted from the official translation):

"The right to a self-determined death is not limited to situations defined by external causes like serious or incurable illnesses, nor does it only apply in certain stages of life or illness. Rather, this right is guaranteed in all stages of a person’s existence. Restricting the scope of protection to specific causes or motives would essentially amount to a substantive evaluation, and thereby predetermination, of the motives of the person seeking to end their own life, which is alien to the Basic Law’s notion of freedom."

In other words, Germany does not opine on the value of motives. There is no limit on the personal freedom to die, medical or otherwise. And this, paradoxically, is precisely what protects others, in such a system, from "death by association". For to state that a person "should" be allowed to die in situation "A" (but not situation "B"), is the same thing as saying that it is "right" for "A" to die. And thus, to affirm, for instance, that only a person with a grave medical condition "should" be allowed to die, is functionally the same as saying that it is "good" for such a person to die (in a way it is not for others); which, to be sure, is only a hairsbreadth away from simply stating that such a person "should", in fact, die. The German model, however, avoids these grossly discriminatory implications entirely; and thus avoids placing a significant moral pressure towards precocious death (backed by the full authority of the State) upon particular vulnerable groups, which is to say: upon the ill and disabled.

Freely assisted death and the medical profession

To judge the independent and pluralist nature of medical ethics in Germany (and the freedom of individual doctors to practice as they wish) we note that in spite of the assumed constitutional right to die, the following were actually given as reasons for why independent suicide services are indeed necessary:

"Without (assisted suicide services) the individual is reliant on physicians ... at least in prescribing substances. ... willingness of a physician can only be expected in exceptional cases. ... physicians have shown little willingness ... and cannot be obligated... The prohibition of suicide assistance from physicians... has been incorporated into the professional codes of most State Chambers of Physicians,... (and this) guides the actions of physicians in practice even where the relevant codes are not considered legally binding."
Quite clearly, also, there is no expectation that any of this will (or should) change. For under this paradigm of mutual freedom, it is simply assumed that the protection of assisted suicide services in no way places any obligation, or demand, upon individual doctors, upon doctors' regulating bodies, or upon the medical profession as a whole.

Assisted suicide and the State

Because the German State has declined to recognize any moral validity to the constitutionally protected right to die, that State retains its own right (and assumed obligation) to do the following:
"taking measures of general suicide prevention. ... establishing that the individual’s resolution to commit suicide is sincere and final ... expanding and strengthening palliative care ... counter dangers arising from current and foreseeable living conditions capable of influencing the individual to choose suicide ... preventing assisted suicide becoming recognized as a normal way of ending life... counteract developments that create social expectations pressuring individuals to take their own life, e.g. based on considerations of usefulness."
The very last sentence, of this historic judgement protecting the operation of independent assisted suicide organizations in Germany, is the following detached statement:
Regardless (editor's italics), there can never be an obligation, on anyone, to assist in another person’s suicide.
Standing as a paragraph all of its own, this statement apparently means "regardless" of any consideration whatsoever, and the term "anyone", would logically include individuals, professions, and the State itself.

In conclusion

The measure of the value of any moral system lies in its internal coherence. The coherent implications of a free right to die (including the right to seek assistance in dying) lead logically to a position such as that of the German Federal Constitutional Court described above: with no explicit discrimination against the ill and disabled; no obligation of the medical profession; no moral association of the state; and thus, providing an optimal environment for positive regulation, and for the development of countervailing measures.

I have stated, on many occasions, that I am categorically opposed to assisted suicide and I will continue to struggle, on the most fundamental level, for a complete prohibition thereof. However, faced with the necessity of choosing some rational framework, to accommodate assisted death as a fait accompli, I find the non-medical right-to-die interpretation comparatively appealing. In a future continuation of this text, I hope to analyze, also, the rational implications (and practical results) of the medical euthanasia system, as adopted in Canada. I will then invite the reader to look, dispassionately, at the respective advantages of these two models, when laid side by side.

One might suggest, of course, that we Canadians no longer have the leisure of choosing between these paradigms. For, as a practical matter, we are already saddled with both. However, I would argue that this actually makes it all the more important to clearly distinguish between the two, in the hopes of preventing the worst properties, of one, from enabling (and enhancing) those of the other.

Gordon Friesen, Montreal, September 20, 2021 (français) (english site in development) (personal philosophical musings)

Friday, September 17, 2021

Dr Paul Saba: The mentally ill should not be euthanized.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Dr Paul Saba
Dr Paul Saba, the author of the book Made to Live and a long-time leader opposing euthanasia in Quebec, had an article published in the Suburban on September 9, 2021 titled: The mentally ill shold not be euthanized. Saba starts his article by writing about one of his patients:

This past year I cared for a young woman in her early 20s. Carole (pseudonym) has extreme anxiety and depression which has been going on for years. Carole is a community worker who works with the homeless. During the COVID pandemic her symptoms were exacerbated to the point that she has become anorexic. Unfortunately access to dieticians, psychiatrists and psychologists has been extremely difficult and limited. By seeing her on a regular basis and making myself readily available, I have kept her from giving up hope. Because of her long term psychological suffering, the recent law of Medical Assistance in Dying [MAID] could make Carole a candidate for euthanasia.

Saba then reminds the reader that the recent passing of Bill C-7 means that mental illness has been added as a reason for euthanasia. Saba writes:

I recently participated at Quebec’s Parliamentary hearings with Montreal attorney Me Natalia Manole.] Mental illness includes the following disorders: anxiety, depression, bipolarity, obsession-compulsion, psychosis, substance abuse, anorexia, and Asperger’s syndrome spectrum.

The causes of these mental disorders include: stress, substance abuse, low self-esteem, difficulty in adapting, personal loss, abuse, homelessness, isolation, job loss, and low income. Treatment of mental illness includes social supports, psychotherapies and psychiatric medications. A 2017 Canadian Psychiatric Association study indicates that only 29% of Canadian psychiatrists support MAID in cases of mental illness.

Even in the Netherlands, where euthanasia is practiced on the mentally ill, two-thirds of psychiatrists are opposed to it. In addition, studies show that at least 90% of people who have ended their lives by suicide were affected by mental health problems. Needless to add, most people who have attempted or committed suicide do not necessarily want to die; rather, they want to escape from their overwhelming emotional pain.

Saba then states that to be approved for euthanasia the person needs to be able to freely consent. Saba asks: But how can a mentally ill person give a free and clear consent when the desire to die is a symptom of mental illness? Saba explains that 9 out of 10 people who attempt suicide, but survive, do not end up dying by suicide but with euthanasia there are no failed attempts, all will be dead.

Saba concludes:

We need to communicate to those contemplating suicide that we do not want them to die, that they are valuable to us, there is always a reason to live, and we will help them solve their problems. We need to provide more psychological, social and financial help for those who are in distress. We must improve their living conditions by providing affordable housing, food, and basic life supports. Those with dependency problems need access to care. We need to care for those with mental health problems- not support or endorse MAID.

You can order Dr Saba's book, Made to Live from the Euthanasia Prevention Coalition (Link).

Thursday, September 16, 2021

Doctors warn: One in ten wrongful assisted suicide deaths.

This article was published by the Australian Care Alliance on September 16, 2021

Professor Paul Glare
Thoracic physician, Dr Luke Garske and Professor Paul Glare, Specialist Physician, Pain medicine have warned that under Queensland's Voluntary Assisted Dying Bill 2021 an estimated 10 out of 100 Queenslanders who access assistance to suicide or euthanasia will end their lives based on a wrong belief that they have a terminal illness.

As euthanasia enthusiast, comedian Andrew Denton admits "there is no guarantee ever that doctors will be 100% right".

Dr Garske and Professor Glare explain:
The Queensland Bill simplistically assumes that doctors can accurately predict how long patients with severe life limiting disease will live. It requires two doctors to agree that a patient is expected to live for less than 12 months (compared to less than 6 months in four other states). It is known that doctors are very poor at accurately predicting whether you will live less than 12 months.

At least 10% of patients predicted to live less than 12 months would have still been living in three years.

If the Queensland bill is passed, we estimate that 10 out of 100 Queenslanders who choose assisted suicide will have done so based on the wrong belief that they had a terminal illness. In contrast, in the four other states, which offer assisted suicide when you are expected to live less than 6 months, we estimate that 1 out of 100 patients will have chosen to have an assisted suicide, based on the wrong belief that they had a terminal illness.
Is it acceptable for Queenslanders to have so many extra wrongful deaths, because of an arbitrary extension of an eligibility criterion that isn’t based on expert medical advice? Why is this extra 6 months even necessary, when the assessment process takes only 9 days, and we are supposedly doing this to prevent suffering at the end of life?
Dr Luke Garske
They also note that:
The Queensland bill does not require the doctor to have any expertise in predicting death, or expertise in identifying depression. And it is very loose in its requirements to assess decision making capacity. We should identify and treat depression to relieve the desire to suicide, rather than promoting your suicide if this is caused by mental illness.

The bill also assumes that an accurate diagnosis will always be made of an incurable disease, and doctors will never miss the diagnosis of a condition that could have been treated. Yet it allows doctors in training, without any knowledge of the condition you have, to make a diagnosis that they have not been trained to make, and certify you for [assisted suicide or euthanasia]. This compares to other states, which have the advantage of specialists with experience in the disease you have. People with curable diseases have been wrongly assisted to suicide in other jurisdictions, because of a wrong diagnosis. The inexperience of the Queensland doctors would cause more wrongful assisted suicides based on incorrect diagnoses of treatable diseases.
The two experienced physicians warn of the impossibility of always identifying coercion and elder abuse and the inevitability that some Queenslanders will die wrongful deaths after being coerced by others to "request" assistance to suicide or euthanasia.
Everald Compton is a longstanding campaigner for [euthanasia], who has stated that he “has faith” that this law won’t be abused. This is a fantasy land where no-one lies, cheats or steals; in the real world, this law will be abused. It is naïve to believe that doctors, family members and others will not sometimes pressure vulnerable patients to have an assisted suicide. Elder abuse is common and the Queensland Bill would create the perfect scenario for this.

The people charged with detecting coercion are time pressured doctors, who unlike judges and lawyers, have no expertise or skills to detect coercion. If a loved one pressured you to have an assisted suicide, or you felt such a burden that you felt obliged to choose it, would you tell your doctor, or would you “go quietly”? Based on our professional experience, we strongly disagree with the “faith” that Everald Compton has, that the Queensland bill has any realistic ability to prevent or detect abuses.

For example, Queensland doctors would be able to initiate the conversation about assisted suicide. In other states the patient must initiate the discussion. It is fanciful to believe that a doctor would not sometimes guide a patient to have assisted suicide because of their own prejudices or opinions. Many patients will trust their doctor and follow their advice, and these conversations will be occurring within private non-recorded medical consultations. The fact that this change has been allowed into the legislation underlines the lack of medical experience in guiding the supposed attempts to protect the vulnerable.
Dr Garske and Porfessor Glare call for the Parliament to reject the Bil, and instead to adequately fund palliative care for all Queenslander.
We know that in overseas jurisdictions where assisted suicide has been going for about 2 decades, there is an ongoing rapid growth of numbers, and a gradual extension of indications to less serious conditions. With all of the unsafe aspects of the Queensland legislation being proposed from the outset, how can we have any confidence in how many Queenslanders will have wrongful and coerced deaths in 10-20 years? The only reliable safeguard is to keep the current law, and reject the bill.

Let’s instead focus on properly resourced palliative care. Why is it good enough for Premier Palaszczuk to provide only a fraction of the funds required to provide all Queenslanders with access to quality palliative care - when billions can be found for the 2032 Olympics? Why doesn’t parliament just properly fund palliative care for all? This is the far more compassionate option, which in clinical reality will relieve suffering for many more people. Properly funded palliative care can terminate the suffering, which is far safer than terminating the sufferer.
More articles from the Australian Care Alliance (Link).

Wednesday, September 15, 2021

Euthanasia and organ donation in the Netherlands.

This article was published by Mercatornet on September 15, 2021

By Michael Cook

One inevitable development of euthanasia which its supporters seldom mention is organ donation after euthanasia. A good number of people who request euthanasia suffer from neurological disorders, but their organs are still shipshape.

A question which many doctors ask, then, is this: why should all those perfectly good kidneys and lungs and livers go to waste? Death by misadventure cannot be timetabled, but euthanasia can. Why not arrange things so that a person can die on an operating table where his organs can be transferred quickly to the recipient?

In fact, this is not a theoretical scenario. It happens, on a small scale, in the Netherlands, Belgium and Canada. However, it still is not a very popular option. It seems to have been performed only 70 times in the Netherlands. The problem is that most people prefer to be euthanised at home and by the time their body arrives at hospital, the organs are no longer usable.

Is there a way around this problem?

Several Dutch physicians and a bioethicist believe that there is. They recently published a paper in BMC Medical Ethics recording how they successfully managed to carry combine dying at home and organ donation (ODAEH). The man who was euthanised was a healthcare professional and the husband of one of the authors of the article.
“The patient was sitting in his lounge chair in the living room facing a beautiful outdoor environment,” they write, “with his wife, children, grandchildren and his dog surrounding him, while music was playing in the background.”
Logistically, the procedure is a bit tricky. The 63-year-old patient, who was suffering from multiple system atrophy, was sedated at home and then transported to a nearby hospital. There he was euthanised by his family doctor. The transplant specialists waited for the mandated 5 minutes and then extracted the organs. They were able to retrieve both kidneys, the liver and the pancreas.

Legally, the authors acknowledged that the procedure stretched the letter of the law. In the Netherlands, a patient must be suffering hopelessly and unbearably. However, after being sedated, he is no longer suffering. How could he possibly consent to euthanasia? However, everyone involved agreed that the procedure honoured the spirit of the law.

Ethically, the authors ticked off all of the Belmont principles of autonomy, beneficence, non-maleficence, and justice. “From a utilitarian perspective,” they say, “the decision to honour the last wishes of the patient produced the greatest good for many other patients.”

They concluded that: 
“From the patient’s perspective, falling asleep in the intimacy of his own home and with his loved ones present appears to be a good alternative to the medicalisation of organ donation after euthanasia in the hospital.”

“Organ donation after euthanasia,” they declare, “is a pure act of altruism.”
Does anyone sense anything unethical about this scenario?

The authors of the proposal are confident that a home setting for organ donation after euthanasia “maximally contributes to the patient’s autonomy”. But they ignore the enormous potential for emotional blackmail if this become common. The doctors would effectively be extorting those valuable organs in exchange for a pat on the head and a few heart-warming words about their generosity.

These potential donors often feel that their lives are useless; shouldn’t we try to argue them out of their demoralised state, rather than agree with them so that we can harvest heir organs?

But this is the manipulative psychology involved in this procedure. The authors conclude with this chilling gem of utilitarian wisdom: 
“Normalizing ODAEH could make it more attractive to patients who want to donate after euthanasia but do not want to die in hospital, thus providing more organs for transplantation. Given the prospective benefits, the marginal and relative extra costs of implementing this procedure are likely to be justified.”
What was that about a slippery slope?