Wednesday, September 2, 2015

Death is anything but standard - Response to: Quebec issues standard euthanasia kits.

The following letter was published in the Montreal Gazette on September 1, 2015. 

Re: Quebec doctors to get euthanasia kits (Montreal Gazette, Sept. 1)

For a sick patient nearing the end of life, intravenous insertion can be incredibly traumatic and difficult. While it is refreshing to see that Quebec is taking a proactive role in trying to ease a patient’s suffering, creating a “standardized” euthanasia kit that relies solely on IV access is like treating the patient like a parcel in the mail and not like a human being.

Many patients do not want to be stabbed with a needle when they are well, let alone when they are dying. The process of finding a suitable vein on a sick patient that will not collapse as a catheter is thread into it is not easy, often takes one or more attempts, and frankly, is sometimes impossible.

Combine that with the fact that this vein, assuming it is accessible, must then accommodate three different drugs, some of them “thick,” and what doctors will face will be “blown” veins and a patient who is suffering as they die, having to endure poke after poke with a needle. Provisions should be put in place. What if IV insertion is not possible? How many times should a patient be stabbed with a needle? Who should be attempting to insert the IV?

Standardizing the process of euthanasia sets a dangerous precedent as it assumes patients fit a mould that can be satisfied with a lawmaker’s bill. Having seen the process of death up close, it is everything but standard. Human beings are precious because we are not all the same and to assume otherwise might only create a painful death for patients when that is surely not what Bill 52 had in mind.

Nathan Friedland, Roxboro QC

New Mexico Supreme Court to hear assisted suicide case.

Alex Schadenberg 
By Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

On August 11, the New Mexico Court of Appeals handed a defeat to the right-to-die movement by reversing an activist lower-court ruling that legalized assisted suicide. In overturning the lower court decision, the Court of Appeals upheld the assisted suicide law in New Mexico.

The assisted suicide lobby appealed the Court of Appeals decision quickly the next week.

The New Mexico Supreme Court has now scheduled to hear the assisted suicide case on October 26.

The original case was based on a word game. The case argued that "aid in dying", which is also known as assisted suicide, is not prohibited by the New Mexico assisted suicide law because "aid in dying" is not assisted suicide.

The case argued, that if "aid in dying" is assisted suicide, then the New Mexico assisted suicide law is unconstitutional because it undermines the right to privacy and autonomy.

But, Aid in dying is assisted suicide and assisted suicide does not constitute medical treatment. Therefore prohibiting assisted suicide does not undermine the right to privacy or autonomy.

A similar case was dismissed by the Connecticut court in 2010.

Tuesday, September 1, 2015

Québec euthanasia kit offers no effective oversight over life and death.

Alex Schadenberg
By Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

According to an article written by Sharon Kirkey and published by newspapers affiliated with the National Post, the Québec government will distribute euthanasia kits with step by step instructions for killing patients. The Québec government is following a similar protocol to the Netherlands euthanasia law.

After several years of language games, it is clear that the Québec government has given physicians the right, in law, to kill their patients by lethal injection. The article states:

Modelled on a formula used in the Netherlands, the Quebec protocol calls for a three-phase approach to assisted death via lethal injection. 
First, a benzodiazepine, a of sedative, would be injected to help control anxiety and "help calm the patient," Robert said. 
Next, a barbiturate drug would be injected to induce a coma. The third step would be a neuromuscular block, a derivative of curare that acts on the respiratory muscles to cause "cardiorespiratory arrest."
Euthanasia is about life and death. Errors or abuse of the law results in death.

Under the Québec euthanasia law, doctors will be sent euthanasia kits where the only actual oversight is a report that is sent-in after the death of the person by the doctor who lethally injected that person. Since the doctor who lethal injects a person is also the one who reports the death, the oversight is not only easily abused but it is impossible to prove that the "safeguards" in the law are being followed.

Clearly the system will allow abuse or maybe the Québec government is naive in thinking that doctors will never abuse their new found power over life and death.

The Québec euthanasia law gives doctors the right in law to lethally inject their patients for physical or psychological reasons.

Mixed signals from the Netherlands and Belgium about euthanasia.

This first appeared at and is reprinted with permission.

By Michael Cook

There is good news and bad news about euthanasia from the Netherlands and Belgium in JAMA Internal Medicine earlier this month. But which is which depends on which side of the fence you sit.

From the Netherlands comes a report about how a euthanasia clinic which handled people whose regular doctor had rejected their request for euthanasia. The staff of the Levenseindekliniek are clearly more committed to euthanasia than the general run of Dutch doctors. However, they still turned away nearly half of the requests for euthanasia and physician-assisted suicide, mostly because these patients only had psychological suffering or were tired of living.

The clinic has a reputation for aggressively pushing euthanasia. Of the 162 patients it euthanized in 2012, the year of study, 8.2% were suffering from a psychological or psychiatric ailment and 7% were “tired of life.” It has a growing fleet of mobile vans (about 40 at the moment) which buzz around the countryside assessing patient’s requests for euthanasia. Nevertheless, it “granted fewer requests for euthanasia and physician-assisted suicide than are granted in the Netherlands on the whole.”

So the report – which was funded by the end-of-life clinic — paints a picture of moderation and sound judgment on the part of euthanasia doctors.

From Flanders, the Dutch-speaking region of Belgium, comes a different picture. Belgium legalized euthanasia in 2002. Between 2007 and 2013, the prevalence of euthanasia there rose from 1.9% to 4.6% of all deaths. One in every 20 deaths is by euthanasia nowadays. The Flemish authors attempt to explain this enormous change in social mores.

First, they argue that “values of autonomy and self-determination” have become more important for the Flemish. And approval of euthanasia continues to rise, perhaps with the help of very positive reporting in the media.

The second reason is that doctors are more willing to perform euthanasia. Like their fellow citizens, they esteem autonomy, but they also are confident that they will not be prosecuted. Euthanasia is treated “as part of the palliative care continuum, as formally expressed in a position statement from the Federation of Palliative Care Flanders.”

American observers were alarmed by this new data. “As the number of overall deaths like this becomes more frequent than 1 in 20, say, I think red flags really need to be raised,” the author of a commentary in the same issue, Dr. Barron Lerner told Reuters [1]
“Most of us were trained to never condone speeding death at all,” he added. 
“To the degree that some physicians are comfortable doing so, they will be in cases in which someone has an intractable physical suffering that will only persist or get worse; it is quite a leap for most of us to also see psychological suffering as a valid reason for speeding death.”
[1] Dr. Lerner and bioethicist Arthur Caplan wrote a commentary for JAMA Internal medicine titled “Euthanasia in Belgium and the NetherlandsOn a Slippery Slope?” [].

Thursday, August 27, 2015

National Post: Assisted Suicide, respect the conscience rights of all

Alex Schadenberg
By Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Yesterday, delegates at the Canadian Medical Association (CMA) annual meeting rejected a motion (79%) to respect the conscience rights of physicians who oppose euthanasia and assisted suicide. 

The CMA has not announced its final policy yet but many physicians want nothing to do with killing their patients by euthanasia or assisted suicide, even after the Surpreme Court struck down Canada's assisted suicide law and gave parliament 12 months to legislate on the issue.

Today, the National Post published an editorial titled: On physician-assisted suicide, respect the conscience rights of all. The National Post first examined the position of physicians.

According to a poll of 1,047 doctors by the Canadian Medical Association (CMA), released as part of the organization’s annual general meeting in Halifax, 63 per cent would refuse to provide so-called “medical aid in dying.” 29 per cent said they would consider killing a patient upon request, with 19 per cent saying that they “would be willing to help end the life of a patient whose suffering was psychological, not physical.” 
The results suggest there remains strong opposition to assisted suicide among the membership of the CMA, which until recently was officially opposed to a loosening of anti-euthanasia laws in any form. At the same time, it suggests there are enough doctors willing to aid a patient to commit suicide to serve the demand. Unfortunately, that is not enough to settle the matter of just when and how physicians will be involved.
The National Post editorial then examines the effect on physicians:
Put yourself in the position of a doctor who believes euthanasia to be a deep moral wrong. This is not an antiquated or otherwise-dismissible position. The legalization of physician-assisted suicide is a revolution in medicine, which turns the role of doctors as a provider of care on its head and intrudes upon the Hippocratic Oath’s instruction to “not play at God.” It violates the traditional conception of medicine, beseeching the physician to do no harm. It is a new and relatively unchartered territory — altogether so here in Canada. It is imperative that the conscience rights of all be protected. 
Any doctor should have the right to say, “I want nothing to do with this.” While this would obviously not allow him or her to interfere in the decision of another doctor to help a patient commit suicide, the conscientiously objecting doctor should equally be under no obligation to abet the killing of a patient in any way, whether directly or by referral to another doctor. 
The Supreme Court’s finding ... means there are limits on how far Parliament can restrict the practice. It does not — and should not — imply an obligation upon all doctors to participate in the new assisted-suicide regime.
The National Post ends the editorial by urging parliament to recognize conscience rights.
As the CMA poll suggests, there remains considerable hesitation on the part of Canada’s physicians to jump on the euthanasia bandwagon. Accordingly, Parliament’s new law should be explicit in affording the utmost protection to doctors who do not wish to participate in this new and morally troubling enterprise.
The Euthanasia Prevention Coalition recognizes that if euthanasia and assisted suicide become legal, the only way to protect people is by protecting the conscience rights of physicians.

When physicians have the right to say - I will not kill you - then they also have the right to say - I will protect you in your time of need.

Wednesday, August 26, 2015

Canadian Medical Association rejects conscience rights for physicians with regard to euthanasia.

Alex Schadenberg
By Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The Canadian Medical Association (CMA) voted to rejected a motion that would protect the conscience rights of physicians who refuse to refer patients to die by euthanasia at their annual General Council meeting today in Halifax.

A media release from the CMA today stated:

Conscientious objection was a contentious issue, with 79% of delegates voting against a motion to support conscientious objectors who refuse to refer patients for medical aid in dying. 
"What we expect from physicians, at a minimum, is that they provide further information to patients on all the options including the spectrum of end-of-life care and … how to access those services," CMA Vice President of Medical Professionalism Dr. Jeff Blackmer told reporters at a press conference Aug. 26.
Yesterday, the CMA released the data from an online consultation of 1407 members which found that 63% would refuse to assist the death of their patients, 29% would assisted the death of their patients upon request and 8% were unsure.

But only 29% of the physicians who would refuse to lethally inject their patients would also refuse to refer patients to their death.

The Globe and Mail quoted Dr Jennifer Tong of Vancouver who warned:
“coercing physicians against their conscience” would damage patient-doctor relations and push some out of the profession.
The Euthanasia Prevention Coalition recognizes that if euthanasia and assisted suicide become legal, the only way to protect people is by protecting the conscience rights of physicians. 

When physicians have the right to say - I will not kill you - then they also have the right to say - I will protect you in your time of need.

Family challenges $1.8 million Will bequest to euthanasia group, after their father died by suicide.

By Alex Schadenberg
Alex Schadenberg
International Chair, Euthanasia Prevention Coalition

The family of a man, who died by suicide are challenging their father's Will that gave $1.8 million to Philip Nitschke and his euthanasia lobby group, Exit International.

According to the Herald Sun William O’Brien’s children Gai and Brett challenged the 89-year-old’s will after he took his own life last year. The Herald Sun reported Philip Nitschke, the founder of Exit International, as saying:
Mr O’Brien believed that every elderly person, terminally ill or not, should have that choice. 
the legal challenge was “very surprising” given Mr O’Brien felt that he had provided for his children “very adequately”, and the directions for his estate should be respected by the court.
According to the Herald Sun Mr O'Brien died in July 2014 even though he was reportedly in good health. The Herald Sun also reported that O'Brien left $5000 to each of his surviving children.

Dying With Dignity Canada received almost 24% of their income in 2014 from bequests.

Tuesday, August 25, 2015

63% of Canadian physicians will refuse to assist their patients suicide.

Alex Schadenberg
By Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Today, the Canadian Medical Association (CMA) released to the media the results of their online survey of members. The survey that was based on responses from 1407 CMA members found that 63% would refuse to assist the death of their patients, 29% said that they would assisted the death of their patients upon request and 8% were unsure.

For those who would assist the death of their patients, 43% would do so for non-terminal patients and 19% would do so for patients who live with psychological suffering.

The Supreme Court of Canada decision defined Assisted Death to include euthanasia (lethal injection) and assisted suicide (prescribing a lethal dose).

Dr Sheila Harding
Saskatoon hematologist Dr Sheila Harding strongly opposes assisted death. CBC news reported Harding as saying:

"I feel strongly that hastening death is not part of medicine. I think it eviscerates what medicine is intended to be. I think that asking physicians to be killers is contrary to the very core of medicine,"
Physicians conscience rights.

According to the Globe and Mail, 75% of the CMA conference delegates agreed that:
physicians should provide information to patients on all end-of-life options available to them but should not be obliged to refer.
The Globe and Mail article quoted Dr. Jennifer Tong of Vancouver who warned: 
“coercing physicians against their conscience” would damage patient-doctor relations and push some out of the profession.
Dr. Jeff Blackmer, vice president of medical professionalism with the CMA stated:
"No physician should be forced to participate against their conscience," 
"But there's disagreement about what this means."
29% of the physicians who refuse to kill their patients are also opposed to having anything to do with assisted death, while the others were either unsure or willing to refer their patient to another physician or administrator in some manner.

The Euthanasia Prevention Coalition recognizes that if euthanasia and assisted suicide become legal, that the only way to protect people is by protecting the conscience rights of physicians. 

When physicians have the right to say - I will not kill you - then they also have the right to say - I will protect you in your time of need.

New Euthanasia Push in Tasmania

This article was published on the HOPE Australia website on August 25, 2015

Paul Russell and
Alex Schadenberg outside
Tasmanian Parliament.
By Paul Russell, Director of Hope Australia

News today that the Tasmanian State Conference of the Australian Labor Party endorsed a motion in support of a push for euthanasia has reignited the issue in the island state.

Euthanasia was last debated in Tasmania on the 17th of October 2013 when the Voluntary Assisted Dying Bill was defeated 13 votes to 11 in the State's Lower House. Since that time, the State Election has changed the make up of the chamber offering, perhaps, the mover of the last bill, Lara Giddings MP, some hope that this time the outcome might be different.

The ALP motion - now part of the party's Tasmanian platform - is subject to the normal provision of a conscience vote and is, we understand, not binding upon State ALP Members of Parliament.

However, as noted in The Examiner, the three new members on the government benches for the Liberal Party are holding their cards close and claiming, at this time, to be 'openminded' on the subject.

Readers should note that, in 2013, Lara Giddings was Premier which provided her with additional control over the debate process. This time around she is a Shadow Minister on the opposition benches.

Time will tell. The Examiner reports that Lara Giddings will be looking to introduce her bill later this year.

Euthanasia at the Heart of the Federal Election

While the federal election campaign is in full swing, the question of Euthanasia is beginning to make its way among major election issues in healthcare. Indeed, the next federal government will have the mandate to enact a law before February 6 in response to the Supreme Court’s judgment on "medical assistance in dying."

To stimulate discussions, the Ontario Ministry of Health has announced the creation of a second Expert Advisory Group in addition to the Federal External Panel set up by the federal government shortly before the dissolution of Parliament.

Composed of 11 provinces and territories, this new advisory group, led by Ontario, will too be responsible for providing advices on the development of policies, practices and protective measures to be taken with the legalization of assisted suicide on their respective territories. Several experts are featuring on its board, namely Maureen Taylor, Jocelyn Downie and Arthur Schaefer are well known pro-Euthanasia activists.

Since each election campaign launches political parties in a race for votes, candidates for the next government will be forced to gauge public opinion in order to establish their position on this social issue. It is therefore crucial that everyone takes part in the debate by answering the online survey of the Provincial-Territorial Expert Advisory Group, as well as the online consultation of the Federal External Panel.

We also strongly encourage you to take advantage of this key moment in our democracy to contact your candidates and discuss with them about issues regarding Euthanasia and assisted suicide, in particular their social impact on families and caregivers and the measures to be taken to protect vulnerable people.

Living with Dignity, the Physicians’ Alliance against Euthanasia and the Euthanasia Prevention Coalition are stressing the importance of expressing yourself in the polls, especially during electoral period. By doing so, you add weight to the experts’ recommendations in order to contain the excesses that the law on Euthanasia and assisted suicide will generate in a few months.