Saturday, April 18, 2015

Supreme Court Assisted Dying Decision: A New Social Disorder

By Jean Echlin RN, BScN, MScN

After 35 years of many fearing and rejecting hospice palliative care programs that provide life and death with dignity, we now have Canadians enamored with doctor provided death. The Supreme Court of Canada has abolished a portion of our Criminal Code that prohibits euthanasia and assisted suicide. They have designated physicians as the group in our society to carry out the act of putting patients to death upon request. The patient must be suffering in a manner that is intolerable to them including both psychological and physical issues. 

It must be remembered that nurses work closely with doctors following their orders and monitoring patients for any positive or adverse effects to treatment. Therefore nurses will automatically be assistants and collaborators in any type of inflicted death.  In addition social workers, chaplains and other members of the inter-professional team will be affected.

Inflicting death on another human being is considered the ultimate act of violence so I ask: “How dare we ask our doctors and nurses to kill us?” But this is exactly what is proposed. 

In my opinion, those who opt to carry out euthanasia and assisted suicide will no longer be trusted. As well I believe that acute and long term care institutions that enable patients to be put to death will not be trusted. Persons afraid of being euthanized will avoid admission on the basis of fearing an untimely death. 

Other valid questions are: “How will those who inflict death deal with the emotional/ psychological aftermath? Will they develop Post Traumatic Stress Disorder (PTSD) with its’ inherent anxiety, nightmares, depression and suicidal ideation? Will they have some type of devastating spiritual/existential struggle following the process of putting patients to death?”

There are many health care professionals who have an ethical framework that will not support participation and this must be honoured. To have any leaders or directors in our professional associations dictate to those in the trenches of front-line care on the necessity to provide euthanasia or refer to another source is unconscionable and intolerable. The last time I looked, we still live in a democratic society with freedom of belief and religion sanctioned and guarded by our Canadian Charter of Rights and Freedoms.

Do patients have a “right” to die?  

I suggest there is no choice, we all die. However we can demand from our provincial and federal politicians support for hospice palliative care that will ensure excellence in the management of pain and other noxious symptoms that cause suffering. We can call for and support quality end-of-life care for every Canadian. We can support those at highest risk in this new social disorder: the elderly; persons with physical and/or emotional disabilities; patients with chronic and life-altering or life-threatening diseases.

We can teach medical and nursing students how to support and care for those who are labeled terminally ill; continue to educate current care providers on the best practice guidelines to meet the gold standard in palliative care; support and come along side those amazing professionals and volunteers who are currently involved in providing pain and symptom management; support the development of hospice palliative care in all facilities and in our communities.

The Hospice of Windsor & Essex County is regarded as an exemplary model across our nation. The successful development of our Hospice here speaks to the outstanding citizens who have given so much to help so many. Windsor’s reputation as a caring community is now a part of our national heritage. I am proud to be part of this heritage. 

Jean Echlin RN, BScN, MScN
President: Euthanasia Prevention Coalition
Nurse Consultant-Palliative Care & Gerontology
Adjunct Associate Professor, Faculty of Nursing University of Windsor (ON)

Previous articles by Jean Echlin:

Friday, April 17, 2015

Systemic injustice of assisted suicide

This article was published in the Valley Reporter on April 16, 2015.

Meghan Schrader
By Meghan Schrader

I love Vermont. My family has owned a home here since the 1980s and I guess you could say that I've adopted the state as my own. I am also a disabled woman and much of my own identification with that community was forged here as I grew up role playing, painting and dreaming alongside the streams and rivers that run through the town of Waitsfield.

Being disabled has also made me very cognizant of the right-to-die movement. Since 2007, I have engaged in an extensive exploration of what disability studies scholar Rosemarie Garland Thompson refers to as the "cultural logic of euthanasia" which I incorporated into recently published research regarding the representation of disability and assisted suicide in film music. However, the issue of assisted death is personal for me, which is why I am dismayed that Act 39 was ever implemented in the first place.

For instance, in the course of doing research for my aforementioned book chapter, I had occasion to review the writings of many utilitarian bioethicists whose arguments concerning disability and death with dignity are framed in regard to familial burden, which tends to be situated as a legitimate reason for choosing or being obliged to die. Such statements are similar to hate speech I experienced growing up and I was shocked when I first saw it in bioethics literature.

I am an autistic person who struggles with executive functioning. I still live with my parents, who serve me in completing many daily tasks. This often makes me feel guilty. Moreover, the philosophical reflection that my studies engendered means that such ideas are in my mind. During a particularly horrible bout of depression, I thought, "Maybe the assisted suicide advocates are right; maybe God is allowing this to happen because it is OK; I am a burden to my family and so maybe it would be OK if I killed myself." I wound up hurting myself impulsively and going to the emergency room. I know that the people behind Act 39 do not intend for such things to happen, but that does not change my experience.

Euthanasia Prevention Coalition (EPC) Radio Campaign


The EPC radio ad will begin airing on AM 1010 Toronto on February 23.
If euthanasia comes to Canada will safeguards protect patients from being euthanized without their consent? 
In Holland and Belgium where euthanasia is legal, patients have been euthanized without their consent or explicit request in spite of supposed safeguards. 
Choice is an illusion, someone else may decide when you die. 
Euthanasia is not health care. Euthanasia is killing. 
You need to know the truth about euthanasia.
Your life may depend on it. 
Contact the Euthanasia Prevention Coalition at: info@epcc.ca 
EPC is raising $10,000 to play this ad in Toronto, Vancouver, Ottawa and more.

EPC will give you permission to purchase air time on your local radio station for this ad. Contact us at: 1-877-439-3349 or info@epcc.ca.

Poll Shows Little Support for Assisted Suicide and Major Concerns

Link to the PR Newswire media release on April 16, 2015.
As assisted suicide failed to pass in state legislatures across the country this year, a new Marist Poll sponsored by the Knights of Columbus found that a majority of Americans do not support assisted suicide and that strong majorities harbor deep concerns over such proposals.

Assisted suicide proposals have stalled since the start of the year in a number of states, including Connecticut, Maryland, Colorado and Nevada.

More than 6 in 10 Americans (61 percent) do not support a doctor prescribing or administering a lethal drug dose, saying that a doctor should instead only manage an illness or remove life support.

Additionally, 57 percent of Americans say they are less likely to trust a doctor who engages in assisted suicide.

Strong majorities of Americans also have deep concerns about assisted suicide, including:

  • 67 percent concerned that fewer life-saving options will be given at end of life.
  • 65 percent concerned that the elderly will be at risk in nursing homes.
  • 64 percent concerned that the depressed will be more likely to take their lives.
  • 59 percent concerned about a wrong diagnosis.
  • 55 percent concerned that the doctor could misjudge a patient's state of mind.
  • 55 percent concerned that it will become a cost-saving measure for health care decisions.
  • 54 percent concerned that patients will be pressured to take their life so as not to be a burden.

Wednesday, April 15, 2015

Euthanasia motion fails in Victoria Australia Parliament

This article was originally published on the HOPE Australia website.

Paul Russell
By Paul Russell - The Director of HOPE Australia.

The on-again, off-again motion on the notice paper in the Victorian Upper House was given time for debate today.

As we reported earlier, the motion by Greens MLC, Colleen Hartland was designed to ask the State Attorney-General to refer the matter to the Victorian Law Reform Commission for an inquiry. The VLRC, as we noted, is not a body answerable to the Victorian people, is charged with reform of the law when no mandate for such reform has been made and has only a legal framework that cannot adequately account for the ethical and moral dimensions of any euthanasia law.

Speaking against the motion, Bernie Finn MLC, observed to his colleagues that to support this motion would be to effectively abrogate their responsibilities as legislators elected by the Victorian people to fulfill that function. Finn, instead, argued for a parliamentary inquiry where the issues cold be thrashed out by members of parliament. A position that we also support (see earlier article).

Other MLCs, including Rachel Carling-Jenkins, highlighted concerns for vulnerable people, the data from Belgium and the Netherlands. Carling-Jenkins had also given a speech the previous day about elder abuse; something which clearly resonated with her colleagues during the euthanasia debate. She also related, with some emotion, her concern for people living with disabilities.

After a number of speeches on both sides, it became clear that, had the motion been resolved, it would have failed. Hartland retreated and did not close the debate, ultimately leaving the question unresolved. The Daily Telegraph reports that Hartland intends to revisit the motion in May.

1/3 Dutch GPs Would Kill Mentally Ill!

Wesley Smith
This article was published on Wesley's blog on April 15.

By Wesley Smith


Whoa! Don’t tell me that euthanasia doesn’t lead off a vertical moral cliff: A recent survey of Netherlander MD general practitioners found that very high percentages would kill cancer patients, and 1/3 would be willing to euthanize the mentally ill. From the PsychCentral story
For mental illness, only 34 percent would consider helping the patient die, and 40 percent would help someone with early-stage dementia to die. The rate was slightly lower for late-stage dementia, at 33 percent. 
Only?! Good grief. 

Once killing is accepted as a proper answer to human suffering, there are no brakes. 

By the way, 42 mentally ill patients were euthanized in the Netherlands in 2013 most recent year for which statistics are available, as psychiatrists up their participation as a “liberation” for the patient and the doctors. Also, nearly 100 early stage dementia patients. And those are the ones reported. How many were killed surreptitiously cannot be known. 

How do you spell euthanasia? A.B.A.N.D.O.N.M.E.N.T.

Irish Assisted Suicide Trial Delayed.

By Alex Schadenberg
International chair - Euthanasia Prevention Coalition

The trial of Gail O'Rorke who is alleged to have assisted the suicide of Bernadette Forde, who was living with MS and died in 2011, will be delayed based on a lengthy period of discovery.

The trial, which was to begin on April 13 in Dublin, was expected to be heard over a two week period.

On April 29, 2013, the Irish Supreme Court upheld the assisted suicide law by stating, in the Fleming case, that there is no right to assisted suicide in Ireland.

International connection. Philip Nitschke, Australia's Dr Death, speaking to Bernadette Forde before her death.

Attend the Irish Symposium on Assisted Suicide - Saving Lives Not Causing Deaths - in Dublin on June 6, 2015 organized by HOPE Ireland and Euthanasia Prevention Coalition - International.






Is physician-assisted death in anyone’s best interest? NO

This article was published in the Canadian Family Physician (April 2015) with an article supporting Physician-Assisted Death.
By Dr Edward (Ted) St Godard 
The issue of physician-assisted death is complex and emotional, and we must not allow truth to become a casualty. Medical professionals and laypersons alike struggle to understand distinctions between euthanasia and physician-assisted suicide, and many more fail to distinguish either act from simple refusal or authorized withdrawal of treatment.1 We must demand and demonstrate a courageous and respectful clarity.
The expression physician-assisted death is what is kindly known as a euphemism. Euphemism is defined as “the substitution of a mild, indirect, or vague expression for one thought to be offensive, harsh, or blunt.”2 Writing recently in The New Yorker, Adam Gopnik noted:
[E]uphemism is a moral problem, not a cognitive one. When Dick Cheney calls torture “enhanced interrogation,” it doesn’t make us understand torture in a different way; it’s just a means for those who know they’re doing something wrong to find a phrase that doesn’t immediately acknowledge the wrongdoing.3
The substitution of physician-assisted death, or the ubiquitous medical aid in dying (something I provide daily), for the more accurate if somehow distasteful euthanasia (itself a euphemism) or physician-assisted suicide, represents at best a misplaced attempt at decorum or delicacy,4 and often a deliberate obfuscation. That our journal, like the Canadian Medical Association, has stooped to using this language is regrettable and, frankly, embarrassing. It is not just semantics.
Compassion
The question with which Canadians must grapple is whether it is in everyone’s best interests that the Supreme Court of Canada appears to have legally sanctioned doctors, under loosely and ambiguously defined circumstances, to kill, or assist with the suicide of, a small number (so far) of consenting (for now) patients.
I strongly believe it is not.
I agree wholeheartedly with Dr James Downar when he states that “there are types of suffering that we do not have the ability to treat”5; it would be hubris to suggest otherwise. Suffering, sadness, and pain are part of the human condition.
However, as Margaret Somerville eloquently notes, the issue at hand concerns not only
our rightful, profound sympathy for people experiencing serious suffering …, but also whether allowing physicians to intervene with a primary intention of inflicting death is inherently acceptable as a foundational principle and basic value.1
I strongly believe it is not.
Before cure eclipsed care, at the heart of medicine was a relationship between a doctor and her patient. The possessive pronoun is important: my doctor, my patient. Caring for patients is a compassionate endeavour. Compassion is derived from the Latin compati6: to suffer together. The current obstacles to compassionate physician-patient relationships are immense: an aging population; increased medical specialization; overcrowded hospitals and care facilities; and health care providers who often appear strained and distracted.
But surely we should not offer to kill patients to compensate for the fact that we have become too busy to care? As subspecialists too often appear to abandon patients once there is “nothing left to be done,” so does a society that legalizes and normalizes euthanasia and physician-assisted suicide risk abandoning its most vulnerable members.

Tuesday, April 14, 2015

Disability Rights Toolkit for Advocacy Against Legalization of Assisted Suicide

This resource was originally published on the Not Dead Yet website.
Marilyn Golden

"If this bill passes, some people’s lives will be ended without their consent, through mistakes and abuse. No safeguards have ever been enacted or proposed that can prevent this outcome, which can never be undone."
- Marilyn Golden, Disability Rights Education & Defense Fund
Introduction
The purpose of this Toolkit is to give disability rights advocates an organized set of resources to assist in defeating proposals to legalize assisted suicide in state legislatures.  The Toolkit is divided into seven brief sections, each consisting of basic information and links to related resources with more information.  The seven sections are:
  1. Why disability advocacy groups oppose legalizing assisted suicide
  2. Educating and organizing disability opposition
  3. Meeting with legislators and policy leaders
  4. Testifying at hearings
  5. Working with the media
  6. Conducting direct actions – leafleting, rallying
  7. Working in coalition
All of the major national disability groups that have taken a position on assisted suicide oppose bills to legalize the practice as a matter of public policy.  The disability role in defeating these bills has increased in visibility and importance in the last few years as both media and various stakeholders have acknowledged our effectiveness.  It is critical that our voice be heard wherever assisted suicide bills are introduced and considered.
 1. Why disability advocacy groups oppose legalizing assisted suicide
Proponents of legal assisted suicide for the terminally ill frequently claim that the opposing views of disability organizations aren’t relevant.  Nevertheless, although people with disabilities aren’t usually terminally ill, the terminally ill are almost always disabled.   People with disabilities and chronic conditions live on the front lines of the health care system that serves (and, sadly, often underserves) dying people.  One might view us as the “canaries in the coal mine,” alerting others to dangers we see first, but, unlike the canary, we loudly object to being seen as expendable.
A.  Background:
Not Dead Yet initially formed in 1996 to help articulate a disability rights critique of proposals to legalize assisted suicide.  Some of our initial observations, issues and concerns are as valid today as they were in the early years,[1] some even more so:

Sunday, April 12, 2015

Assisted Suicide - It's Civil Rights for the Affluent

This article was published by Townhall.com on April 12, 2015

Debra Saunders
By Debra J Saunders
The assisted-suicide movement is the rare self-proclaimed civil rights movement that exists to cater to the wishes of affluent Americans. On Tuesday, the California Senate Judiciary Committee held a hearing on SB 128, a bill to legalize assisted suicide in the state. (Proponents don't like the word suicide, so they call the measure the "End of Life Option Act.") Supporters talk of their fear of medical personnel's prolonging their lives, of pain and lack of autonomy; opponents fear that the bill's passage would represent a callous act of cultural abandonment of the sick and disabled.

I don't mean to suggest that life is easy for those who have a personal stake in the bill's passage. Christina Symonds, 43, gave heart-rending testimony about her battle with ALS. Because she wants the ability to choose assisted suicide, her family moved to Oregon, which legalized assisted suicide 17 years ago. "I do not want to live my last days in a wheelchair, fully paralyzed, connected to a breathing machine," she said. "To me, that is the picture of horror." That is certainly not the end any young mother would choose.

Clearly, California should have a system that provides Symonds the best care and best pain control possible. Pain control has come a long way since Oregon legalized assisted suicide. But there's this sleight of hand on the part of supporters of assisted suicide. They talk about the need to avoid pain, when their real focus is their fear of losing control. It is an understandable, human fear, but it would be wrong to change the emphasis of medicine on healing to assuage that fear.

Democratic state Sen. Hannah-Beth Jackson, a bill co-sponsor, referred to "the lack of dignity" that can occur toward the end of life. That language implies that sick people who choose to live lack dignity.

Marilyn Golden
Marilyn Golden of the Disability Rights Education & Defense Fund is living proof that someone with disabilities can face unwanted obstacles and thrive. She tried to prompt committee Democrats to think about the many things that can and do go wrong. Doctors misdiagnose. Family members have the ability to make elderly relatives feel unwanted and alone. Lethal prescriptions are cheaper than complicated treatment, so HMOs have an incentive to push patients out the door. Disease can lead to depression, but that can be treated. When people first get a horrific diagnosis, they think they want to die; later many find that their prognosis turned out to be wrong or that they want to live what life they have left.