Friday, February 15, 2019

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

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

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

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

Murder trial of Michel Cadotte or "Mercy Killing"

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

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

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

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

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

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

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

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

Can doctors be neutral on euthanasia and assisted suicide?

This article was published by Mercatornet on February 14, 2019. 

By Margaret Somerville

Margaret Somerville
The BMJ has recently published two articles, one by Dr Sandy Buchman, a palliative care physician and the incoming president of the Canadian Medical Association (CMA), the other by Dr Jeff Blackmer, a physician and vice president of international health at CMA presenting a very positive and benign picture of the implementation of legalized physician-assisted suicide and euthanasia in Canada, euphemistically called “Medical Aid in Dying” (MAiD).

Canadian Medical Association exaggerates its support for conscience rights.
As an academic medical ethicist at McGill University in Montreal for nearly four decades and now living and working in Australia, I am concerned that Australian legislatures, which are currently considering whether to legalize physician-assisted suicide and euthanasia, might accept the picture presented in these articles, without identifying their deficiencies.

In focusing only on respect for the autonomy and relief of the suffering, of an individual, personally identified, educated, mentally competent patient who requests and gives informed consent to MAiD, Dr Buchman makes the strongest case possible for the ethical acceptability of euthanasia and its legalisation. But, apart from other concerns, generalizing even these justifications beyond Dr Buchman’s patient and his specific characteristics and circumstances raises problems. In reality, how many people requesting euthanasia or assisted suicide (MAiD) will have the intensive attention, medical and family support Dr Buchman describes, or be as informed, articulate and highly educated as this patient, who himself was a doctor?

Respect for individual autonomy is used, as Dr Buchman does, by pro euthanasia advocates as a justification for legalizing MAiD. But it is far from the only consideration which needs to be taken into account, even if one does not object to MAiD on the most fundamental basis that we should not authorise anyone, let alone doctors, to intentionally inflict death on other human beings.

Dr Buchman makes no mention of any such considerations, in particular, risks and harms to the “common good” and society. These include breaches of the value of respect for human life at both the individual and societal levels, and serious physical and existential risks and harms to vulnerable people, especially those who are disabled and fragile elderly people.

Whether we agree or disagree with MAiD, we can all agree with Dr Buchman’s goal of relief of suffering, but we must kill the pain and suffering, not the person with the pain and suffering.

Dr Blackmer’s article raises a wide range of important issues, which he does not identify. They include: Is MAiD medical treatment? It can be argued that it is not. Likewise, MAiD is not, as its promoters argue, just a legitimate incremental extension of “good palliative care”. The informing philosophies of MAiD and palliative care are in conflict. Palliative care is based on a commitment to help people to live as fully as possible until they die a natural death. The informing principle of MAiD is that it is ethical to intentionally inflict death to relieve suffering or even the fear of future suffering.

Whether to legalize MAiD is a societal and political decision, not primarily a medical one and it’s suggested that if a society wants it to be available and legalizes it, for many reasons, it should be kept out of medicine. I call this “taking the white coat off euthanasia”.

By embracing euthanasia and assisted suicide as medical treatment the CMA made physician participation an expectation and refusing to provide them became an exception requiring justification. Despite assurances from the CMA leadership, Canadian doctors who object to participation in “therapeutic homicide” now risk discipline and even expulsion from the medical profession.

Euthanasia has been rapidly normalized and routinized in Canada at a rate that even one of its strongest advocates, Dr Yves Robert, registrar of the College of Physicians of Quebec, has found alarming, in that it has quickly become just another choice of how to die.

Not everything that is legal is ethical. So, the Canadian Medical Association could have maintained its long-established stance -- which reflects almost 2,500 years of medical ethics wisdom -- that it is unethical for physicians to participate in MAiD, even though it is now legal in Canada. When the cloak of medical approval is absent, the public are much more likely to question the wisdom of legalizing it.

Finally, while the CMA might be neutral with respect to who may be a member, in that it accepts as members both physicians who are pro-MAiD and those who are anti-MAiD, there is not, as Dr Blackmer claims, any “neutral stance” on the ethical acceptability of MAiD. In not continuing to oppose physicians’ involvement in it as unethical, the CMA is unavoidably supporting it in some or other form, which is not a neutral position. In fact, we can see precisely that outcome in the use of CMA statements by Canadian courts, legislatures and regulators in promulgating and implementing the law legalizing MAiD in Canada.

In short, there is no neutral stance on the ethics of MAiD but a clear choice to be made as to whether one is for or against it, as the present conflict among Canadian physicians so clearly demonstrates, despite the CMA’s and Dr Blackmer’s desire to whitewash the situation.

Margaret Somerville is professor of bioethics in the school of medicine at the University of Notre Dame Australia. This article was originally published in the BMJ Rapid Responses online.

Thursday, February 14, 2019

Canada's Justice Minister says that he will not change the euthanasia law before the October 2019 election.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Hon. David Lametti
Canada's new Justice Minister, David Lametti, who voted against Canada's euthanasia law because it didn't go far enough, told Tonda MacCharles from the Toronto Star that he will not push to change the euthanasia law before the next election. Lametti said:

Any changes would have to wait until the conclusion of a five-year parliamentary review about how the new regime is working.
“the parliamentary process struck “an important balance” that he respects, and a five-year review would be able to assess “data” and “evidence” about the impact the law is having.
Lametti told MacCharles that Canada's euthanasia is only the first step:
“I think the bill as it stands is an important marker, an important first step in a moral and ethical debate, as well as health-law debate, a policy debate,”

“And so the balance that was struck was appropriate in terms of that first step; I think it’s too early to do anything else.”
Clearly, Lametti is distancing himself, for now, from extending Canada's euthanasia law.

Canada's parliament will debate conscience rights for health care professionals before the election. 

David Anderson MP introduced Bill C-418 to uphold conscience rights for healthcare professionals. Conscience rights were not protected by Canada's euthanasia law.

Barbara Kay: Canada, euthanasia and the slippery slope.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Barbara Kay
The National Post recently published an excellent article by columnist Barbara Kay concerning the incremental extensions to euthanasia that are occurring in Canada.

Kay refers to the fact that the Supreme Court euthanasia decision was promulgated four years ago with the prediction that there would be no "slippery slope" toward abuses of the future law. She quotes Andrew Coyne, the former editor of the National Post who then stated:
“When the subject is as priceless as a human life, it is not enough that consent usually be obtained. It must be in every case. It will not suffice if the safeguards are adequate. They must be perfect.”
Kay continues:
But since the right to be killed by medical practitioners paid by the state has now been normalized, individuals are stepping forward, as any student of human nature (and observer of the euthanasia histories of Belgium and the Netherlands) might have predicted, to demand custom-tailoring of that right.
Case in point, Kay writes about the Audrey Parker campaign to extend euthanasia to incompetent people who made a previous request:
Audrey Parker, a Halifax woman with terminal cancer who was assisted to death on Nov. 1, weeks earlier than she wished, left a video, released last week by Dying with Dignity Canada. In it, she said she would have preferred to stay alive until Christmas, but worried that her cancer, creeping to the lining of her brain, would render her unfit by then to invoke MAID. She asked for a “Parker’s amendment” to the law, allowing for a proxy to facilitate a previously sworn request in such circumstances. 
It sounds reasonable. All safeguard abrogations do when they are attached to sympathetic protagonists with a black-and-white narrative. They are less palatable, though, when attached to muddier stories, like the case of a Dutch woman with dementia who’d signed a living will endorsing euthanasia when of sound mind, but then, when the time came, struggling against the needle, had to be held down by relatives as the doctor killed her. 
In fact, the Canadian government already asked the Council of Canadian Academics to study advance consent, as well as euthanasia in cases of mature minors and advanced dementia. On Dec. 13 the council submitted a report including what it saw as the pros and cons of each proposal, but without recommendations. 
Federal Justice Minister David Lametti has said the government will continue to review the practice of MAID. He looks forward to “speaking with Canadians about how the (MAID) regime is working for them.”
Kay then examines the issue of conscience rights in Ontario. She states:
The College of Physicians and Surgeons of Ontario (CPSO), considered by many stakeholders to be the most aggressive association of its kind in the country on this file, took a conscience-hostile stance on physicians who refuse to perform or refer for euthanasia (or abortion) a decade ago, and hasn’t softened up since. 
According to Dr. Ryan Wilson, president of Canadian Physicians for Life (CPL), “Ontario is the only (physicians’ association) that says you have to either participate in or refer to someone who will participate.” 
CPL and other advocacy groups had hoped that Premier Doug Ford’s new administration would end the political shunning they were accustomed to under the Liberals, especially since in November, the province of Ontario dropped its intervention on CPSO’s behalf in a court case brought against the association by five doctors of conscience. But at the Nov. 16-18 Ontario PC party Toronto convention, Ford’s promise to legislate conscience rights did not make it through the policy committee. 
The five physicians’ case was heard at the Court of Appeal on Jan. 21-22, with judgment pending. If they lose, as is likely, they are determined to take it to the Supreme Court.
Kay brings up several significant concerns with the application of Canada's euthanasia law. But there are more.

Three reasons why we need to stop physician-assisted suicide.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Bill Spadea from NJ 101.5 has published articles and interviews opposing assisted suicide. New Jersey is debating assisted suicide Bill S1072.

Recently,  New Jersey Senate President Steve Sweeney exercised his political power by replacing two members on the Senate Health, Human Services and Senior Citizens Committee who were intending to vote against the Assisted Suicide bill, Bill S1072.

Sweeney replaced these members with two people who voted in favour of Bill S1072 : Senator Scutari .. and himself.

Spadea writes:
He was actually quoted in our news report saying that the assisted suicide bill is not really suicide. What? Very sad that Steve Sweeney is willing to play politics with peoples lives. Very disturbing that the top guy in the legislature is willing to ignore the pleas from medical professionals, disabled advocates, patients and families in order to push his own agenda.
Spadea interviews Kristen Hanson (above), the widow of JJ Hansen, who was the President of the Patients Rights Action Fund. Hanson explains three reasons why assisted suicide must be defeated.
First, doctors get some diagnoses wrong. In her husband's case, he was told he had only a few months to live. Those months turned into years that he was able to spend with his loving and growing family.
Second, the proposed law lacks safeguards for patients suffering from mental health issues and depression. It's a 'prescribe the death pill and move on' mentality with no follow up leaving patients vulnerable to terrible and irreversible actions.
Third, and this may be the most frightening part of the bill, legal doctor assisted suicide leaves the door open for insurance companies to DENY life saving treatments in favor of the lower cost option of suicide.
Further reasons to oppose assisted suicide:

Why Norway and Sweden Should Not Allow Physician-Assisted Suicide

Mark Komrad just returned from a 4-lecture tour of Norway and Sweden where he was invited to present arguments to help prevent the development of legislation and associated policies that would permit physician-assisted suicide (PAS) or euthanasia. He spoke to members of Parliament, academics, physicians, other health care professionals, students, advocacy organizations, and members of the public. He also debated with proponents of these practices in Norway.

This article was translated and published in newspapers in conjunction with his appearances and is reprinted with permission.

Dr Mark Komrad
By Mark S. Komrad, MD 
Faculty of Psychiatry: Johns Hopkins, University of Maryland, Tulane University

The 2300-year-old history of medical ethics is grounded in the core ethical foundations established at the dawn of medicine — the Hippocratic values “professed” by physicians as a covenant-based community of values. This is the meaning of the word “profession.” The most distinguishing principle of the Hippocratic Oath has been the tenant rejecting the practice of euthanasia: “I will give nobody a poison, nor counsel any others to do so.” This is the root of the mighty tree from which the House of Medicine was built, this value persisting as societies and their demands have come and gone. To this day, the World Medical Association and many other major medical organizations continue this venerable and persistent ethical stance against physician-assisted suicide and euthanasia.

Several governments, in the last two decades, have invited and permitted physicians to transgress this prohibition against killing their patients. For example, Oregon, Canada, and Benelux have asked physicians to provide the means for certain patients who request the means to commit suicide or receive a lethal injection. These laws have empowered one class of human beings (ironically, physicians) to literally take the life of another class of human beings. Originally, the class who can be voluntarily killed or helped to suicide was limited to those at the very end of life. However, principles of justice have made it very difficult to limit such procedures to that category of people. The more experience a country has with such practices, the more the horizon of eligibility has expanded far beyond extreme end-stage cases.

In Oregon there is no way to distinguish between encouragement and coercion by those who “support” terminally-ill loved ones taking lethal drugs prescribed to cause death. There are no regulations to keep lethal prescriptions from being diverted. There is evidence of a contagious increase in ordinary suicide, subsequent to legalizing assisted suicide. New legislation is being pursued there to move to more active euthanasia and to make prognostic criteria for eligibility more vague. The law even allows patients whose conditions are not considered “terminal” to make themselves so, by choosing to refuse life-sustaining treatments — diabetics stopping their insulin, for example.

In Canada, the rate of euthanasia increased by 30% in the last half of 2017. One province has declared that it is neither ethical nor legal for a conscientiously objecting physician to refuse to refer a patient to a colleague who is more open to providing euthanasia. As is the nature of assisted suicide and euthanasia laws, suicide has been converted from a freedom to a right. Refusing to participate in the chain of duty to service that right can have adverse legal and professional consequences for some Canadian doctors. In Sweden, there are already adverse professional consequences, supported by law, for those qualified health care practitioners who refuse to provide abortion on demand, prior to 18 weeks. Such an established pathway mandating physician participation, even against conscientious objection, would be an existing, facilitated channel into which legalized assisted suicide in Sweden would easily flow.

In the Benelux, where these practices have evolved over 18 years, and 4% of all human deaths are by physicians’ injections, the slope has slipped to include eligibility for those with non-terminal illnesses, psychiatric conditions, young children, and uncomfortable lifestyles. Advanced directives and proxy consent for euthanasia of the incompetent are honored. There are strong advocacy efforts to de-medicalize the criteria for such procedures by allowing those who are “tired of living” or feeling that their life is “complete” to ask for euthanasia, with the hopes of developing a “suicide pill” that can be obtained without a medical evaluation or prescription — a high sanctification of autonomy. Organ donation by those seeking euthanasia is encouraged as a “virtue opportunity.” 

The profound changes to a civilized society produced by such laws are unnecessary and undesirable. The suffering and disabled should have even more access to the very latest, state-of-the art palliative care, without it being economically or morally short-circuited by institutional killing promoted as a seductive virtue — referring to it as “dying with dignity” or self-determination. The so-called “choice“ that is offered to the suffering to end their lives is a pseudo-choice, filtered through a physician’s own values, and commonly forced, by having very limited choices in other domains — economics, social support, healthcare, etc. It is unjust, and therefore impossible, in a democratic society, to limit these procedures to some — like the terminally ill — but refuse it to others — like those with chronic physical and psychiatric disabilities. Yet, it signals that chronic disability and its sufferings might constitute a “life not worth living.” It is an unfair and confusing public health message to designate one category of people who are helped to suicide, but another who are actively prevented from doing so with psychiatric care. It elevates autonomy as a value that overshadows, even crushes, other values that are necessary for the common good. 

Medicalizing suicide out-sources to the medical establishment the moral responsibility for a taboo about taking one’s own life by suicide, reducing the moral deterrence to suicide and lowering the threshold of acceptability for all suicide. It takes the protected and vital ethos of health care professionals away from their millennia-old Hippocratic commitment to be providers of comfort, hope, and healing, to become providers of death, not just supporters of the dying.