Friday, March 27, 2020

Margaret Dore: (New Jersey) Euthanasia Act "Must Be Set Aside"

This article was published by Choice is an Illusion on March 27, 2020.

Margaret Dore
On March 24, 2020, a hearing was held in Glassman v Grewal, a lawsuit, which seeks to invalidate New Jersey's euthanasia law, formally known as the "Medical Aid in Dying for the Terminally Ill Act."

The specific matter before the court was a motion to dismiss brought by the defendant, New Jersey Attorney General, Gurbir S. Grewal.

The plaintiff, Joseph Glassman, represented by E. David Smith, opposed the motion, as did Margaret Dore, president of Choice is an Illusion, representing herself as amicus curiae.

Dore, who had filed both an amicus brief and a reply brief, argued that the Act must be set aside pursuant to the New Jersey Constitution. Her arguments largely tracked her reply brief, a portion of which is set forth below.

The Court took the matter under advisement.

* * *

Reply Brief Excerpt (web version):

B. The Act’s Title Is Misleading and Therefore Unconstitutional

The Act’s title, the “Medical Aid in Dying For the Terminally Ill Act,” implies that the Act is limited to the “dying” and the “terminally ill.”[6] As described in Dore’s amicus brief, the Act also applies to people with years or decades to live.[7] For this reason alone, the title is misleading and therefore unconstitutional. The Act must be set aside.

C. Contrary to the Attorney General, the Act Allows Euthanasia

Euthanasia as traditionally defined is the administration of a lethal agent by another person.[8] The Attorney General claims that the Act does not allow euthanasia.[9] This claim is wrong for the following reasons:

1. The Act’s name means euthanasia The Act’s name, “Medical Aid in Dying for the Terminally Ill Act,” contains the phrase “Aid in Dying.”

Aid in Dying is a traditional euphemism for active euthanasia. See, for example: Craig A. Brandt, Model Aid-in-Dying Act, Iowa Law Review, 1989 (“Subject: Active Euthanasia ....”)[10]

For this reason alone, the Act allows euthanasia.

2. The Act allows euthanasia as traditionally defined The Act refers to the lethal dose as “medication.”[11] Generally accepted medical practice allows other people, including doctors and adult children, to administer medication.[12]

If the medication administered is a lethal dose, this is euthanasia as traditionally defined.

3. The Act does not require self-administration. The ADA would trump any such requirement Nothing in the Act says that self-administration is required.[13] If it were, the Americans with Disability Act [ADA] would trump the requirement to allow euthanasia for people unable to self-administer.[14] For this reason also, the Act allows euthanasia as traditionally defined.

D. Voluntariness Is Not Assured

The Attorney General claims that the Act is “strictly voluntary” for patients, which is not true.[15] As previously discussed in Dore’s amicus brief, a more obvious reason is the Act’s complete lack of oversight at the death.[16] If the patient objected or even struggled, who would know?

E. Purported Patient Protections Are Illusory

The Act sets forth patient protections, including a formal application process to obtain the lethal dose.[17] Per the Act, the attending physician:

shall ensure that all appropriate steps are carried out in accordance with the provisions of [the Act] before writing a prescription for [the lethal dose].[18] 
The Act does not define “accordance.”[19] Dictionary definitions include “in the spirit of,” meaning “in thought or intention.”[20] With these definitions, the physician’s mere thought or intention to comply with patient protections is good enough. Actual compliance is not required. Purported patient protections are illusory.

F. Deaths in Accordance With the Act Are “Natural” as a Matter of Law.

1. Action taken in accordance with the Act is not suicide or homicide The Act states:

Any action taken in accordance with the provisions of [the Act] shall not constitute ... suicide ... or homicide under any law of this State.[21]
2. The Act requires deaths to be reported as “natural” In New Jersey, death certificates have five categories for reporting the manner of death, four of which are substantive: (1) natural; (2) accident; (3) suicide; and (4) homicide.[22] The fifth category is “undetermined.”[23]

As noted in the preceding section, a death occurring in accordance with the Act does not constitute suicide or homicide under any law of the State. The death is also not an accident due its having been an intended event. This leaves “natural.” Deaths occurring pursuant to the Act are natural as a matter of law.

G. Dr. Shipman and the Call for Death Certificate Reform

Per a 2005 article in the UK’s Guardian newspaper, there was a public inquiry regarding Dr. Harold Shipman, ... determining that he had “killed at least 250 of his patients over 23 years.”[24] The inquiry also found:

that by issuing death certificates stating natural causes, the serial killer [Shipman] was able to evade investigation by coroners. (Emphasis added).[25] 
Per a subsequent article in 2015, proposed reforms included having a medical examiner review death certificates, so as to improve patient safety.[26] The New Jersey Act has instead moved in the opposite direction to require that deaths be reported as natural. Doctors and other perpetrators have been enabled to kill under mandatory legal cover.

H. The Act Renders New Jersey Residents Sitting Ducks to Their Heirs and Other Predators

New Jersey’s slayer statute prevents a killer from inheriting from his or her victim. The statute states:

[A]n individual who is responsible for the intentional killing of the decedent forfeits [his or her inheritance].”[27] 
The rational is that a criminal should not be allowed to benefit from his or her crime.[28]

Under the Act, however, a person who intentionally kills another person is allowed to inherit. This is due to the deaths being certified as natural. With the passage of the Act, New Jersey residents with money, meaning the middle class and above, have been rendered sitting ducks to their heirs and other predators.

Footnotes:

....

[6] The Act, N.J.S.A. 26:16-1, attached in the appendix at p. A-2.
[7] Dore’s Amicus Brief, dated 12/19/19, Section IX, pp. 6 to 8.
[8] AMA Code of Medical Ethics Opinion, 5.8, in the appendix at page A-17. (“Euthanasia is the administration of a lethal agent by another person....”).
[9] The Attorney General’s letter brief, dated February 4, 2020, page 8, states:
Dore’s argument that the Act violates the single object rule is premised on her misstatement that the Act permits involuntary participation and euthanasia. (Emphasis added). [10] Georgetown University information pages, summarizing the Brandt and CeloCruz articles, in the appendix at pages A-18 and A-19.
[11] The Act, attached in the appendix, at pages A-2 through A-16, referring to the lethal dose as medication throughout its text.
[12] Dr. Kenneth Stevens states:
Generally accepted medical practice allows a doctor, or a person acting under the direction of a doctor, to administer prescription drugs to a patient.
Common examples of persons acting under the direction of a doctor, include: ... adult children who act under the direction of a doctor to administer drugs to their parents in a home setting. Declaration of Kenneth Stevens, MD, attached in the appendix at pp. A-20 to A-22, quote at page A-22, ¶ 10 (spacing changed).
[13] See the Act in its entirety, attached in the appendix, at pp. A-2 through A-16.
[14] Dore’s Amicus Brief, pp. 10-11.
[15] The Attorney General‘s letter brief, dated February 4, 2020, page 8.
[16] See the Act in its entirety, in the appendix at pp. A-2 to A-16.
[17] The Act, in the appendix at pp. A-4 through A-8.
[18] Id., in the appendix, at page A-5.
[19] See the Act in its entirety, in the appendix, at pp. A-2 through A-16.
[20] Definitions attached in the appendix at pp. A-24 and A-25.
[21] The Act, C.26:16-17.a.(2), attached in the appendix at page A-10.
[22] Andrew L. Falzon, MD, and Sindy M. Paul, MPH, “Death Investigation and Certification in New Jersey,” MD Advisor, a journal for the New Jersey medical community, 2016. (Attached in the appendix at page A-25)
[23] Id.
[24] David Batty, “Q & A: Harold Shipman,” The Guardian, 08/25/05, at https://www.theguardian.com/society/2005/aug/25/health.shipman. (Attached in the appendix at pages at A-26 to A-28).
[25] Id., attached at A-28.
[26] Press Association, “Death Certificate Reform Delays ‘Incomprehensible,” The Guardian, January 21, 2015, attached in the appendix at A-29 to A-30.
[27] NJ Rev Stat § 3B:7-1.1, attached in the appendix at pages A-31 and A-32.
[28] Cf. Ilene S. Cooper and Jaclene D'Agostino, "Forfeiture and New York's 'Slayer Rule', NYSBA Journal, March/April 2015

Thursday, March 26, 2020

Death doctors use Covid-19 crisis to permit "aid-in-dying" via telehealth.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition




The assisted suicide lobby are actively promoting the approval of assisted suicide and euthanasia via telehealth. The death lobby are using the coronavirus to achieve two main goals, that being, allowing the approval of lethal prescriptions via telemedicine or telehealth and the expansion of assisted suicide to include euthanasia.

If allowed, a person could be prescribed lethal drugs for assisted suicide without ever being examined by a doctor.

According a committee of the newly formed American Clinicians Academy on Medical Aid in Dying, (death doctors) (chaired by Lonny Shavelson, a California doctor who only offers death) the coronavirus crisis requires allowing approvals by telehealth. The committee stated:

In light of the coronavirus crisis, a committee has been convened to establish recommendations pertaining to the use of telemedicine to evaluate patients’ requests to consider medical aid in dying. (See below for members of the policy committee.)

For the purposes of this policy statement, “telemedicine” and/or “telehealth” refers to a visual and verbal patient contact by electronic means, without an in-person visit. 
Long before the onset of the coronavirus pandemic, many established aid-in-dying clinicians used telemedicine visits to evaluate select aspects of terminally ill patients’ requests to consider medical aid in dying. Given the need to limit in-person contacts to decrease the speed of contagion of coronavirus, an increased use of telemedicine for select aspects of aid-in-dying evaluations and care is recommended.
The committee of death doctors concluded:
The Committee concludes that there is nothing inherent in an aid-in-dying request that prohibits or discourages the use of telemedicine.
The death doctors are using the coronavirus to achieve their goal and they have no intention of going back to examining patients, once the coronavirus crisis passes. 

It is important to recognize the language used by the death doctors. "Medical Aid in Dying" (MAiD) is a term that is used by the death lobby for euthanasia and assisted suicide. The American death lobby are trying to extend assisted suicide legislation to include euthanasia or lethal injection. Most new assisted suicide bills are not what they appear to be.

Recently I reported that another death lobby group was using the coronavirus to promote assisted suicide via telehealth.

This is not a new plan. The 2019 New Mexico assisted suicide bill included a telehealth provision and a recent bill to expand assisted suicide in Hawaii includes a telehealth provision.
State regulators should not take this group seriously. These are death doctors promoting more death. In the case of Shavelson, he does not provide medical treatment only death.

Wednesday, March 25, 2020

Washington State assisted suicide group - death may take hours.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition


A Washington State assisted suicide lobby group is informing its "clients" that death by assisted suicide may take many hours. 

In their document, Death with Dignity - Preparing for the last day, End of Life Washington states:
Every individual is different and time to death after taking the medication varies greatly depending on the person’s physical condition and ability to absorb the medication. Be assured that once the person is in a coma (generally within 5-10 minutes of taking the life-ending medication), they will be in a peaceful place and not experience any suffering. If they do not die as soon as expected, do not panic. There is little that can be done except to wait. Caregivers may administer any of the medications in a hospice kit, if one is available, in response to any symptoms that ordinarily would be treated.

It may be helpful to consider the additional hours as a time for a vigil, which often occurs during the last hours of a person’s life during a natural death.
The Washington State 2018 assisted suicide report indicated that of the 203 reported assisted suicide deaths that there were 8 reported complications in 2018, likely related to the new DDMA and DDMP2 lethal drug cocktails. Also, 62 deaths reportedly took more than 90 minutes with the time of death ranging from 7 minutes to 30 hours.

The Oregon 2019 assisted suicide report states that the time of death ranged from 1 minute to 47 hours but the report didn't indicate how many people died more than 90 minutes after taking the lethal drugs.


The fact that assisted suicide deaths can take many hours is directly related to the new lethal drug cocktails that have been developed to enable a cheaper way to kill.

The new lethal drug cocktails were developed through human experimentation. The results of the first two failed lethal drug trials were:

The (first) turned out to be too harsh, burning patients’ mouths and throats, causing some to scream in pain. The second drug mix, used 67 times, has led to deaths that stretched out hours in some patients — and up to 31 hours in one case.
In February 2019 I published the article - assisted dying can cause inhumane deaths based on research by Professor Jaideep Pandit that was published in the British Medical Journal. Pandit researched complications with assisted suicide and capital punishment deaths and indicates that the complications include:
  • difficulty in swallowing the prescribed dose (up to nine per cent) and vomiting in 10 per cent, both of which can prevent proper dosing.
  • Re-emergence from a coma occurred in two per cent of cases, with a small number of patients even sitting up during the dying process, the authors said. 
  • After oral sedative ingestion, patients usually lose consciousness within five minutes. However, death takes considerably longer. 
  • But in a third of cases, death can take up to 30 hours,
The negative outcomes associated with the lethal drug cocktails and the ethics of human experimentation related to the development of these drugs should be investigated by the US government, based on the controlled substances act.

Tuesday, March 24, 2020

Lethal Drugs Used For Assisted Suicide and Complications for Patients.

The Patients Rights Action Fund published the following information.
 
Warning: If you are experiencing suicidal thoughts, do not read this article but call: 1-800-273 (talk) 8255.


Article: Lethal drug cocktails experimented on humans (Link).

Seconal (Secobarbital)
  • A 90-100 pill dosage of Seconal (secobarbital) was widely used for assisted suicides for many years until it became too costly and in 2019 became unavailable for this use. [1]
Phenobarbital
  • To replace Seconal, proponents of assisted suicide began experimenting with combinations of drugs to induce death. One of the drug combinations used is a mixture consisting of phenobarbital, chloral hydrate and morphine sulfate. The patient mixes the powder with water, alcohol, applesauce or juice. This drug combination lowered the cost to $400-$500. 
  • In Oregon, the phenobarbital combination was used to cause the death of 65 patients. For those cases for which data on time to death after ingestion were reported, patients experienced death from 20 minutes to 72 hours. [2]
DDMP 1; DDMP2
  • Increasingly, experimentation began with other new drug cocktails. A combination using DDP (diazepam, morphine sulfate and propranolol) took a patient 18 hours to die so 10 mg. of digoxin was added to the mix to create DDMP 1. The digoxin dosage was subsequently increased to 15 mg. to form DDMP 2. [3] 
  • Researchers have described DDMP 2 as “blue-whale-sized doses…..And the mixture tastes extremely bitter. ‘Imagine taking two bottles of aspirin, crushing it up, and mixing it in less than half a cup of water or juice.’” [4]  
  • In Oregon, DDMP 1 and DDMP 2 accounted for 239 deaths through 2019. For those cases for which data on time to death after ingestion were reported, patients experienced death from a range of 5 minutes to 47 hours. Two patients regained consciousness after ingesting the drugs.[5] “The median time until death was longer for the DDMP2 compound (120 min) than for secobarbital (25 min)…”[6] The drug cocktail is taken in liquid form and is ingested orally or through a tube.
DDMA 
  • In 2019, DDMA was introduced which is a combination of diazepam, digoxin, morphine sulfate and amitriptyline. In Oregon, DDMA was used for 87 patients and for those cases for which data on time to death after ingestion were reported, the time to achieve death ranged from one minute to 19 hours. [7]
Morphine Sulphate 
General Complications From Lethal Drugs Used In Assisted Suicide Deaths
  • Experimenting with combinations of drugs is “research” which has not been approved by any ethics review committee like an "Institutional Review Board" (IRB), which appears to violate research ethics standards. 
  • According to The Atlantic: “No medical association oversees aid in dying, and no government committee helps fund the research…The doctors’ work {to experiment with drugs which kill patients} has taken place on the margins of traditional science. Despite their principled intentions, it’s a part of medicine that’s still practiced in the shadows.”[10]  
  • According to Kaiser Health News: “The first Seconal alternative turned out to be too harsh, burning patients’ mouths and throats, causing some to scream in pain.”[11] “The second drug mix, used 67 times, has led to deaths that stretched out hours in some patients – and up to 31 hours in one case…the next longest 29 hours, the third longest 16 hours and some 8 hours in length.”[12]
  •  According to the New England Journal of Medicine: “One in five Dutch patients using standard barbiturates to kill themselves experienced complications including vomiting, inability to finish the medication, longer than expected time to die, failure to induce coma, and awakening from coma.” [13]  
  • According to Anaesthesia: “However, for all these forms of assisted dying, there appears to be a relatively high incidence of vomiting (up to 10%), prolongation of death (up to 7 days), and re-awakening from coma (up to 4%), constituting failure of unconsciousness. This raises a concern that some deaths may be inhumane…”[14]
  •  According to the British Medical Journal: “Complications related to assisted dying methods were found to include difficulty in swallowing the prescribed dose (≤9%), a relatively high incidence of vomiting (≤10%), prolongation of death (by as much as seven days in ≤4%), and failure to induce coma, where patients re-awoke and even sat up (≤1.3%). ‘This raises a concern that some deaths may be inhumane,’ the researchers said. They had expected to find a single technique being used but said that ‘the considerable heterogeneity in methods suggests that an optimum method of achieving unconsciousness remains undefined.’” [15]

1. http://www.medscape.com/viewarticle/869023?src=emailthis#vp_2 https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year22.pdf, page 7

2. https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year22.pdf, page 16

3. https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year21.pdf, page 15

4. https://www.theatlantic.com/health/archive/2019/01/medical-aid-in-dying-medications/580591/

5. https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year22.pdf, page 16

6. https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year21.pdf, page 7

7. https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year22.pdfm , page 16

8. https://www.doh.wa.gov/Portals/1/Documents/Pubs/422-109-DeathWithDignityAct2017.pdf, page 9

9. https://www.doh.wa.gov/Portals/1/Documents/Pubs/422-109-DeathWithDignityAct2017.pdf, page 10

10. https://www.theatlantic.com/health/archive/2019/01/medical-aid-in-dying-medications/580591/

11. Kaiser Health News, “Docs in Northwest Tweak Aid-In-Dying Drugs to Prevent Prolonged Deaths”, February 21, 2017

12. Kaiser Health News, “Docs in Northwest Tweak Aid-In-Dying Drugs to Prevent Prolonged Deaths”, February 21, 2017

13. Groenewoud, J.H., van der Heide, A., Onwuteaka-Philipsen, B.D., Willems, D.L., et al. (2000). Clinical Problems with the Performance of Euthanasia and Physician-Assisted Suicide in the Netherlands. The New England Journal of Medicine, 342, 551-556.
 

14. Sinmyee, S., Pandit, V.J., Pascual, J.M., Dahan, A., Heidegger, T., et al. (2019). Legal and ethical implications of defining an optimum means of achieving unconsciousness in assisted dying. Anaesthesia, 74,557-559.

15. Torjesen, Ingrid. (2019) Assisted dying methods can lead to “inhumane” deaths. British Medical Journal. 364:1797 doi: 10.1136/bmj.1797

Monday, March 23, 2020

Dr Sonu Gaind: Canadian Psychiatric Association (CPA) position on euthanasia for psychiatric reasons is embarrassing

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Dr Sonu Gaind
Dr. K. Sonu Gaind is an associate professor of psychiatry at the University of Toronto, a past president of the Canadian Psychiatric Association (CPA) and a member of the Council of Canadian Academies expert advisory group on MAiD responds in the CanadianHealthcareNetwork.ca to the new position of the CPA supporting euthanasia.

Dr Gaind was the president of the (CPA) at the time of the Carter Supreme Court of Canada euthanasia decision. In response to the Supreme Court decision, the CPA held a task force, developed guidelines and provided evidence based guidance to policy makers and government committee's on euthanasia for psychiatric conditions.
 

In his recent article: I wish I didn't have to write this Gaind expresses his embarrassment by the new position by the CPA that that supports euthanasia for people with psychiatric conditions.

Gaind comments on his personal position on MAiD:
When I started all this, as CPA president in late 2015, I entered with an open mind and as neutrally as I could, both to respect my role as representing not just myself but all CPA members, and also on a personal level I did not want any pre-judgements to form my opinion without understanding the various issues and evidence. I am not a conscientious objector to MAiD in general, and in fact am physician chair of our hospital MAiD group, overseeing all the MAiD cases we undertake. However, after this extensive period of review, it is clear to me now that expanding MAiD for sole criterion mental illness would not be safe in the current context.
Gaind comments on how the euthanasia expansion advocates ignore a basic point of the law.
Expansion advocates often focus overly narrowly on issues they label as “patient autonomy” (even there the focus is on a narrow concept of what autonomy is, rarely acknowledging relational autonomy or other concepts beyond autonomy being what one individual is asking for at one point in time). However, they gloss over the simplest yet most crucial fallacy regarding potentially providing MAiD for mental illnesses. Our current MAiD framework is supposed to be for irremediable conditions. As I’ve written previously in Medical Post and elsewhere, and as CAMH has concluded, irremediability cannot be predicted for mental illnesses at this time. This is presented clearly following extensive evidence-based review in the recent Expert Advisory Group on MAiD report at www.eagmaid.org.

So, if patients with sole criterion mental illness receive MAiD, they are not getting it for a predictably irremediable condition, as they would be if they had ALS, cancer, or other medical conditions with known pathophysiology. They would be getting MAiD because society has agreed they had suffered enough, but they could get better. To me, it is discriminatory to expose those with mental illness to death based on assessors’ personal views and arbitrary opinions of irremediability, when the evidence tells us we cannot predict irremediability in mental illness.
Gaind then suggests that the new CPA euthanasia policy was developed in secrecy. He states:
...Many colleagues with senior positions in CPA leadership roles were unaware of any work CPA was continuing to do on this file (myself included, having completed my term and rotating off the board in September 2019). Despite having been chair of the sunset time-limited CPA task force on MAiD, and an expert on the CCA panel, CPA had not engaged me or any colleagues I know of with expertise in the area to assist with the file. Of more concern, since the 2016 CPA member survey done by the previous time-limited task force on MAiD, which showed only approximately 30% of Canadian psychiatrists supported MAiD for mental illness, there had been no subsequent engagement of general membership regarding their views as issues evolved.

Knowing that the six-month period after the Truchon ruling was coming up in March, and that federal government reviews were intended to start in summer 2020, I contacted the CPA CEO in mid-February to provide CPA with relevant informational updates, and to ask what the CPA was doing on this file given imminent policy changes. Other than a polite response from the CEO over a week later acknowledging receipt of my message, no information was forthcoming (other than confirmation that no-one representing CPA even phoned in on the national, open teleconference lines providing technical briefings on Bill C-7 on February 24).
Gaind continues on the new CPA position statement:
Imagine my surprise when, this past Friday, March 13, the CPA released a so-called Position Statement on Medical Assistance in Dying developed by the CPA Professional Standards and Practice (PSP) Committee. From a process point of view, this raised significant concerns, given the complete lack of member engagement on this issue preceding this statement. The PSP is a generic (i.e., not MAiD-specific) committee of several members (seven). It is unclear whether any additional expertise in the area of MAiD and mental illness was even sought through this process. If it was, it was certainly a well-kept secret from many of us who are CPA members.

Process aside, if such a Position Statement actually provided evidence-based guidance, it could still be of value. Unfortunately, not only does the PSP Position Statement fail to provide any evidence-based guidance regarding MAiD and mental illness, at this critical time when policies are being set, the Statement is actually, in my opinion, damaging and dangerous.
Dr Gaind explains his criticism of the CPA position statement:
The bulk of the one page (if you remove author affiliations) PSP Statement, consisting of five points, makes ‘apple pie’ comments referring to “having working knowledge of legislation,” being “mindful of the medical ethical principles as they relate to MAiD,” being “rigorous in conducting capacity assessments,” and providing information even if choosing to not be involved with provision of MAiD. It also makes a statement that “patients with a psychiatric illness should not be discriminated against solely on the basis of their disability, and should have available the same options regarding MAiD as available to all patients.” That’s it. No actual guidance on what any of that means. And quite remarkably for a Position Statement issued by a national expert professional medical association, after there have been years of focused review and study on the issue (for example, the CCA Panel Reports, and numerous and ongoing other national and international literature references), there is not a single reference to any citation regarding mental illness and MAiD, capacity or decision making, suffering, or above all, irremediability. Again remarkably for a psychiatric association, the three only citations are to Bill C-14 and the Carter and Truchon rulings.
Dr Gaind continues on why the new position is dangerous:
Had the PSP Position Statement simply been unhelpful, I would not have written this piece. Unfortunately, beyond being unhelpful, the Statement is dangerous. While the comment that patients with mental illness should not be discriminated against is self-evident, it is far from evident what CPA is actually saying with that comment. Does this mean that it would be discriminatory to not provide MAiD to patients with sole criterion mental illness? Or does this mean that it would be discriminatory to provide MAiD in such situations, since it would expose patients to arbitrary and unscientific determinations of irremediability that cannot be predicted? Again, remarkably for a psychiatric association, the PSP Position Statement never even once addresses or comments on the issue of predicting irremediability in mental illnesses.

Even worse than taking a position, the CPA has chosen to attempt to say nothing on this issue—and in doing so, in this politicized debate CPA has opened the door to dangerous and arbitrary interpretations of what this position statement actually means (perhaps fittingly, if they have also opened the door to expose patients to dangerous and arbitrary determinations of irremediability of mental illness that cannot be scientifically made).
Dr Gaind states that the CPA position on euthanasia for psychiatric reasons is embarrassing:
As a past president and current Distinguished Fellow of the CPA, it pains me to write this piece. I know how thoughtful, considered and hardworking all elected CPA Board members are. Many are my friends. However, my obligation to all our patients, and to what our members should expect of a member association, must outweigh these feelings. Through the process and content of this PSP Position Statement, by failing to engage or be respectful of its own members, by failing to even try to address any evidence-based recommendations and being silent on key issues needing guidance regarding mental illness and MAiD at this crucial time, the CPA has failed its members and our patients in its role as a national professional member association, and has in fact abrogated its role and lost any moral authority in this important issue.

Today, I am embarrassed to be a CPA member.
More information on this topic:

Schadenberg: Study promotes legalizing euthanasia.

This article was published by OneNewsNow on March 23, 2020 (edited).
Will governments with legalized euthanasia require it for the common good?
Alex Schadenberg
Alex Schadenberg of the Euthanasia Prevention Coalition tells OneNewsNow two Scottish doctors have published "Cost analysis of medical assistance in dying" a previous study in the Canadian Medical Association Journal looked at medical aid in dying in Canada.

"They are arguing that assisted suicide saves money for the healthcare system, but it also provides more organs for organ donations; therefore, we should be doing this. We should be encouraging this," Schadenberg relays. "They continued throughout this study to say that we're not actually promoting euthanasia, but of course … it's a lie.”
That reminds him of the 1920 book, Allowing the Destruction of Life Unworthy of Life, that doctors of Hitler's time were required to read. It promoted and justified euthanizing people with disabilities, for the "common good."
"It's very similar, actually, because it's justifying these things based on cost and based on efficacy to the nation, meaning that, you know, you're going to get a lot more healthy organs out of this if you allow this, so this is a good thing to do also," Schadenberg poses.
But he is concerned that that philosophy is leading society down the path to forced euthanasia -- killing people in the name of compassion when it really just means saving money and benefiting others with their organs.

Further information:

Friday, March 20, 2020

Assisted Suicide lobby is using Covid 19 virus to promote assisting suicides via telehealth.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition


The death lobby is promoting the approval of assisted suicide and prescribing of lethal drugs via telehealth. This means that a person could be approved for death by lethal drugs, without being examined or even meeting the death prescribing doctor.

Today's fundraising email from Kim Callinan, the President of an assisted suicide lobby group, states that the current Covid-19 crisis provides new opportunity for assisted suicide. She writes:

As always, we are responding quickly to the needs and opportunities of the times. As the workforce grapples with the pandemic, telehealth is gaining prominence as a critical mode of delivering medical care. This provides a unique opportunity to make sure health systems and doctors are using telehealth, where appropriate, for patients trying to access end-of-life care options. These efforts should improve access to medical aid in dying in the short and long-term.
This is not a new plan. The 2019 New Mexico assisted suicide bill included a telehealth provision and the recent bills to expand assisted suicide in Hawaii include a telehealth provision.

Let's think this through. A person with difficult health issues who feels like a burden on others, or experiencing depression or existential distress, could be assessed, via telehealth, and prescribed lethal drugs for suicide.



The death lobby focuses on facilitating death and protecting doctors who are willing to be involved with killing their patients. They are not concerned with protecting people.


For more information read the articles:  
 

Covid-19 reveals a deadly failure of priorities.

This article was published by the disability rights group, Not Dead Yet on March 17, 2020

Diane Coleman
By Diane Coleman

President and CEO of Not Dead Yet

With the looming and imminent threat of insufficient hospital and ICU beds, medical equipment and healthcare staff, I found myself recalling an old favorite TV show from my college years. MASH (mobile army surgical hospital) created both comedy and drama around the reality of having three operating room beds in an army tent on the war front in South Korea. Triage was part of the routine, determining who gets on the operating table first, and who gets the best surgeon (Hawkeye) of the four in the unit. Now and then, when the frontlines had faced a heavy attack and massive casualties poured in, the plot explicitly focused on triage situations. Hawkeye always struggled to do the right thing.

COVID-19 is leading to more and more news reports on the fast approaching reality that the demand for hospital beds and ventilators will exceed supply. New York’s Governor Cuomo was carried on MSNBC yesterday and today, discussing this crisis.

A few years ago, NDY’s research analyst, Stephen Drake (aka my husband, now retired), reviewed New York’s Ventilator Allocation Guidelines, released in 2015. The pandemic guidelines operate on the principles of triage.

The primary goal of the Guidelines is to save the most lives in an influenza pandemic where there are a limited number of available ventilators. To accomplish this goal, patients for whom ventilator therapy would most likely be lifesaving are prioritized. The Guidelines define survival by examining a patient’s short-term likelihood of surviving the acute medical episode and not by focusing on whether the patient may survive a given illness or disease in the longterm (e.g., years after the pandemic). Patients with the highest probability of mortality without medical intervention, along with patients with the smallest probability of mortality with medical intervention, have the lowest level of access to ventilator therapy. Thus, patients who are most likely to survive without the ventilator, together with patients who will most likely survive with ventilator therapy, increase the overall number of survivors.
Within the hospital environment, ventilators would be allocated and, if necessary, re-allocated as the pandemic proceeds. Importantly, the guidelines state:
In its consideration to protect vulnerable populations, i.e., ventilator-dependent chronic care patients, the Task Force determined that these individuals are subject to the clinical ventilator allocation protocol only if they arrive at an acute care facility for treatment.
It would be helpful if disability advocates determine whether similar guidelines exist in their state and, specifically, what they say, in order to inform their communities and ensure that individuals who use breathing support can make the best decisions for themselves if they get sick. (In my opinion, I should not go to an acute care facility if I get sick.)

It’s hard to disagree with the principle of maximizing the number of pandemic survivors but, nonetheless, a few things need to be said.

First, COVID-19 is not the only cause of the shortages we face. I’m on a New York Medicaid advocacy listserv in which one member quoted Judy Wessler, former head of the NY Commission on the Public’s Health System:

Let’s Remember That Since At Least 2006 There Has Been A Tremendous Push In New York State To Close Hospital Beds And Consolidate Hospitals. We Used To Have 4 Beds Per 1,000 And Now We Have Something Like 2.8 Beds Per 1,000. So Now We Have To Play Catch-Up.
Wessler was also quoted in a NY Post article entitled New York has thrown away 20,000 hospital beds, complicating coronavirus fight.

How many states have taken similar steps as they offload their healthcare responsibilities, letting managed care take over and allowing that industry to suck up around 20% of our healthcare dollars and put profits over people? So our shortage of beds and ventilators is not just caused by COVID-19 but also by unacceptable political and fiscal decisions made largely under the public radar.

Second, how will the idealized triage principles be implemented in practice? The NY guidelines call for a triage committee. It will not be the attending doctor. I don’t think we can count on the committee being composed only of doctors like the caring Hawkeye Pierce. And there will be a time crunch. The situation invites biases like ableism and racism to creep in.

Third, we already know that healthcare resources are denied based on disability bias under futility policies, denial of transplants and other practices reported in the National Council on Disability’s bioethics series. In this crisis, further devaluation of our lives is a real threat.

Not Dead Yet was among many organizations that signed onto a National Disability Rights Call To Action on March 3rd. We are all are trying to impress upon policymakers that our lives are valuable. We are not worth-less and we are not expendable!

This pandemic resource shortage will touch people who previously felt safe from healthcare rationing. How we treat people in need is a reflection of the priorities of the policymakers we elect. All too often, the voices of people with disabilities and other justice communities have been drowned out. Perhaps the unnecessary loss of life from this pandemic due to healthcare capacity limits will cause others to join with us in re-evaluating the priorities that got us here.

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