Wednesday, October 31, 2012

Why to vote no on Massachusetts ballot Question 2 (assisted suicide)


The following article was written by John Kelly, the leader of the disability rights group Second Thoughts and published in the Providence Journal on October 31 under the title: Why to vote no on Mass Question 2.
John Kelly
By John B. Kelly
Progressive social-justice advocates from the disability-rights community ask voters to look deeper into Massachusetts Ballot Question 2, which would permit doctors to assist in suicide, and the real threats that it poses.
Because Question 2 would establish a social policy under which certain deaths would be seen as beneficial, we must closely examine the social ramifications of passage.
Voters should be aware that people already have the well-established right to refuse any treatment, and to receive effective comfort care. But Question backers want Massachusetts to pass an Oregon-style assisted-suicide law, complete with flaws and loopholes.
Question 2 advocates say that it is all about "choice," but in reality Question 2 would limit choice, because it incentivizes insurers to restrict, or even deny, coverage. In today's cost-cutting environment, where health-care options are limited, many people already struggle with this. Question 2 would make this even worse.
We know about such Oregon resident as Barbara Wagner and Randy Stroup, who were denied chemotherapy by the state's Medicaid program but offered assisted suicide as "treatment." With all the talk of austerity and high medical costs incurred in the last year of life, it is inevitable that the cheap alternative of assisted suicide ($100) will distort future treatment decisions.
No alleged safeguard can protect patients from deciding to die based on a wrong prognosis or diagnosis. Doctors admit that they cannot predict when someone will die.
Many of us know people who have outlived their diagnoses by years. Jeanette Hall detailed her Oregon experience in a letter published in The Boston Globe. She had supported the Oregon law. After receiving a terminal diagnosis, she sought a suicide prescription. That was more than 11 years ago! Today she is "so happy to be alive" and urges Massachusetts not to make the same mistake as did Oregon.
Under the law proposed in Question 2, an heir can be one of the witnesses at the request for assisted suicide; and no doctor is required to be present when the overdose is taken. This is a prescription for elder abuse.
Question 2 has no requirement for psychological screening to eliminate the possibility that a patient is acting out of depression or dementia. Oregon's statistics for the last four years show that only 2 percent of patients were referred for a psychological evaluation or counseling. Experts agree that most doctors are not capable of identifying such psychological problems. Oregonian Michael Freeland, despite a 43-year history of severe depression, suicide attempts and paranoia, got a lethal prescription without a psychiatric consultation. The prescribing doctor said he didn't think that a consult was "necessary."
We urge Massachusetts voters to consider all the flaws in Question 2. There will be abuses. Seniors and people with disabilities will be endangered. We urge you, have "second thoughts," and vote no on Question 2.
John B. Kelly is director of Second Thoughts (www.Second-Thoughts.org), an organization of people with disabilities opposing legalization of assisted suicide .

Support plunges for assisted suicide Question in Massachusetts


An article written by Laura Krantz and published today in the Metro West Daily News is entitled: Support plunges for assisted suicide Question.

The article states: 
Support has plummeted for a ballot question to legalize assisted suicide, a poll released Tuesday shows. 
Support for the Death with Dignity measure waned from 64 percent to 47 percent since a similar poll was released last month. 
Fourty-one percent of voters oppose it, according to the Suffolk University/7News poll, giving the question only a six-point lead compared to the 37 point advantage it had six weeks ago. 
The poll surveyed 600 likely voters using live telephone interviews of landline and cell phone users and reported a 4 percent margin of error. 
The Roman Catholic Church is among the most outspoken opponents of Question 2, which would allow doctors to prescribe lethal medicine to dying patients. 
Boston Cardinal Sean O'Malley last week urged parishioners to vote against the measure in a special homily that was broadcast to all parishes in the archdiocese. 
"Laws must not be born out of emotions. Laws need to reflect the moral law, the common good and the protection of the most vulnerable," O'Malley said in the talk. 
In an appeal to non-religious voters, O'Malley also said the law is bad policy. He said terminal diagnoses are often wrong. 
Meanwhile, advocates of Question 2 say it will allow suffering patients to die peacefully. Dignity 2012 has received much out-of-state money from groups on the west coast, where assisted suicide is already legal. 
Donations can still be made to support the Committee Against Physician Assisted Suicide or the No on Question 2 campaign.

Tuesday, October 30, 2012

Commercial from the Committee Against Physician-Assisted Suicide in Massachusetts.

The Committee Against Physician-Assisted Suicide in Massachusetts has launched a new commercial opposing ballot Question 2 on the November 6 election.

Link: Stop Assisted Suicide 

Did you know that the most commonly prescribed medication in Oregon to commit physician assisted suicide is Seconal?

Did you know that you need to take up to 100 pills at once to commit suicide? 

Did you know that there's no doctor present at the time? 

Link to the previous commercials.

Vote NO on Question 2 (assisted suicide).

Monday, October 29, 2012

Vote No on Question 2 (assisted suicide)

The Cape Cod Times says: Vote No on Question 2:

Cape Cod Times - October 25, 2012

Question 2 on the Massachusetts ballot, if it were to pass on Nov. 6, would allow a physician licensed in Massachusetts to prescribe medication, at the request of a terminally ill patient who meets certain conditions, to end the person's life.
The law as proposed would give a patient, who is given a prognosis of less than six months to live, the ability to request a lethal prescription to end his life.
Question 2 is flawed because it does not require a patient to consult with a psychiatrist before receiving a prescription to commit suicide, and as many as 40 percent of terminally ill cancer patients suffer from clinical depression.
Although Question 2 requires physicians to present alternatives to assisted suicide, such as palliative or hospice care, the ballot initiative fails to ensure patients have adequate access to these forms of care, according to the Committee Against Physician-Assisted Suicide. It does not require them to seek assistance from a palliative care facility or from social workers or other professionals who are familiar with palliative care alternatives.
"Although this is referred to as physician-assisted suicide, there is no physician involved in the process, and the lethal dose is most often taken at home with no guidance or supervision," said Thomas Dwyer of the committee.
In addition, thousands of concerned doctors, nurses, hospice workers, religious leaders and citizens are opposed to Question 2.
For example, the Massachusetts Medical Society, a statewide professional association, opposes physician-assisted suicide.
Dr. Richard Aghababian, president of the society, said in a press release that the organization's stand against Question 2 is based on the idea that physician-assisted suicide is fundamentally incompatible with the physician's role as healer.
He also said that predicting a person's end of life within six months is difficult, as such predictions can be inaccurate.
Dr. Aghababian added that the ballot question also lacks provisions to ensure that patients are protected from making uninformed decisions and being coerced into making a decision.
The Massachusetts Academy of Family Physicians, the state's largest organization of family physicians, joined the society and the Massachusetts Osteopathic Society in urging voters to defeat Question 2.
"The role of family physicians is to provide compassionate, high quality health care to the all patients, in each stage of life," said Dr. Joseph Gravel, president of the academy, in a press release. "This certainly includes end-of-life care. It is clear that we need to continue to work to provide those suffering from serious illnesses, depression, and other conditions that can lead to hopelessness highly effective palliative and hospice treatments that are now available."
Dr. Gravel said the lack of safeguards in the Question 2 language is particularly troubling.
"This is literally a life-and-death issue for very vulnerable people," he said. "Using the blunt instrument of a ballot initiative in which the voter only has two choices — yes or no — to decide what a physician can or cannot do in such a nuanced, complex area of medical practice is a disservice to citizens of the commonwealth, our patients and our own families."
Gravel said the state should enhance palliative and hospice care programs, which are chronically underfunded and underutilized.
As Dwyer said, "Improving hospice, palliative and other end-of-life care options should be the priority — not promoting physician-assisted suicide."
We recommend voting "no" on Question 2.

New Lowell Sun - Reject Question 2 (assisted suicide)

The New Lowell Sun is the latest of several newspapers who are supporting the "No Side" on ballot Question 2 (assisted suicide) in Massachusetts. The other newspapers include: The Salem News, The Worchester Telegram, The Boston Herald, The Bay State Banner, The Cape Cod Times and the New Bedford Standard Times. 

The following is the position of the New Lowell Sun that was published on October 29 under the title: Vote on the side of life and reject Question 2.

Aside from races on the national, state and local levels, voters in Massachusetts on Nov. 6 will be able to weigh in on two important ballot questions. 
The more emotionally charged of the two is Question 2, which would allow a licensed Massachusetts physician to prescribe medication, at a qualified terminally ill patient's request, to end that person's life. 
Better known by its backers as the "Death with Dignity" initiative, it may seem at first glance to be a compassionate alternative for those deemed beyond the reach of medical science whose death can be calculated in months. 
Proponents say the measure contains sufficient safeguards to prevent any abuse.
Proponents say this is a humane way to allow a small number of terminally ill people an opportunity to spend what quality time they have remaining at home with loved ones, instead of in a hospital or hospice facility, sparing them unnecessary suffering. 
The drug would be dispensed directly to the patient, who would ingest the lethal dose in a private location, preferably at home, hopefully in someone's presence.
But the question doesn't mandate that anyone witness the patient's death. 
While ostensibly reasonable and humane, we believe Question 2 has the potential for misuse, a position also taken by the Massachusetts Medical Society, which opposes the initiative. 
Its main objections include potential for abuse, current laws already in place that allow patients to refuse life-prolonging treatment, the difficulty in predicting death within a six-month time frame, and the basic proposition that doctors should not be participating in assisted suicide. 
It's also obvious that most who believe in the sanctity of life, including the Massachusetts Catholic Conference, Massachusetts Family Institute and the Catholic Church, are opposed on moral grounds. 
The fact that similar life-ending laws only exist in two states, Washington (2008) and Oregon (1997), should add credence that this momentous step must be reviewed thoroughly and thoughtfully. 
After doing just that, we believe for all the reasons stated, despite what the polls suggest, there are enough questions about Question 2 to seal its defeat. 
Vote no on Question 2.

Question 2 (assisted suicide) insults Kennedy's memory

This article was written by Victoria Kennedy, the widow of Democrat Senator Ted Kennedy and published in the Cape Cod Times on October 27, titled: Question 2 insults Kennedy's memory.

By Victoria Reggie Kennedy, Cape Cod Times, October 27, 2012

Victoria Reggie Kennedy
There is nothing more personal or private than the end of a family member's life, and I totally respect the view that everyone else should just get out of the way. I wish we could leave it that way. Unfortunately, Question 2, the so-called "Death with Dignity" initiative, forces that issue into the public square and places the government squarely in the middle of a private family matter. I do not judge nor intend to preach to others about decisions they make at the end of life, but I believe we're all entitled to know the facts about the law we're being asked to enact.

Here's the truth. The language of the proposed law is not about bringing family together to make end of life decisions; it's intended to exclude family members from the actual decision-making process to guard against patients' being pressured to end their lives prematurely. It's not about doctors administering drugs such as morphine to ease patients' suffering; it's about the oral ingestion of up to 100 capsules without requirement or expectation that a doctor be present. It's not about giving choice and self-determination to patients with degenerative diseases like ALS or Alzheimer's; those patients are unlikely to qualify under the statute. It's not, in my judgment, about death with dignity at all.

My late husband Sen. Edward Kennedy called quality, affordable health care for all the cause of his life. Question 2 turns his vision of health care for all on its head by asking us to endorse patient suicide — not patient care — as our public policy for dealing with pain and the financial burdens of care at the end of life. We're better than that. We should expand palliative care, pain management, nursing care and hospice, not trade the dignity and life of a human being for the bottom line.

Most of us wish for a good and happy death, with as little pain as possible, surrounded by loved ones, perhaps with a doctor and/or clergyman at our bedside. But under Question 2, what you get instead is a prescription for up to 100 capsules, dispensed by a pharmacist, taken without medical supervision, followed by death, perhaps alone. That seems harsh and extreme to me.

Question 2 is supposed to apply to those with a life expectancy of six months or less. But even doctors admit that's unknowable. When my husband was first diagnosed with cancer, he was told that he had only two to four months to live, that he'd never go back to the U.S. Senate, that he should get his affairs in order, kiss his wife, love his family and get ready to die.

But that prognosis was wrong. Teddy lived 15 more productive months. During that time, he cast a key vote in the Senate that protected payments to doctors under Medicare; made a speech at the Democratic Convention; saw the candidate he supported elected president of the United States and even attended his inauguration; received an honorary degree; chaired confirmation hearings in the Senate; worked on the reform of health care; threw out the first pitch on opening day for the Red Sox; introduced the president when he signed the bipartisan Edward M. Kennedy Serve America Act; sailed his boat; and finished his memoir "True Compass," while also getting his affairs in order, kissing his wife, loving his family and preparing for the end of life.

Because that first dire prediction of life expectancy was wrong, I have 15 months of cherished memories — memories of family dinners and songfests with our children and grandchildren; memories of laughter and, yes, tears; memories of life that neither I nor my husband would have traded for anything in the world.

When the end finally did come — natural death with dignity — my husband was home, attended by his doctor, surrounded by family and our priest.

I know we were blessed. I am fully aware that not everyone will have the same experience we did. But if Question 2 passes I can't help but feel we're sending the message that they're not even entitled to a chance. A chance to have more time with their loved ones. A chance to have more dinners and sing more songs. A chance for more kisses and more love. A chance to be surrounded by family or clergy or a doctor when the end does come. That seems cruel to me. And lonely. And sad.

My husband used to paraphrase H.L. Mencken: for every complex problem, there's a simple easy answer. And it's wrong.

That's how I feel in this case. And that's why I'm going to vote no on Question 2.

Victoria Reggie Kennedy is an attorney, health care advocate and widow of Sen. Edward M. Kennedy

Euthanasia Prevention Coalition & HOPE Australia attacked by Philip Nitschke.


By Paul Russell, HOPE

Exit International’s latest newsletter (Sept – Nov), devotes nearly four of the twelve-pages to attacking yours truly (Paul Rusell), HOPE, Alex Schadenberg from the Euthanasia Prevention Coalition, and a list of supposed accomplices. Why did we get all this attention? Because we dared to lodge a complaint with the medical licensing organisation about the actions of Exit International and Philip Nitschke in their agency and promotion of a nitrogen death method.

HOPE
I admit to being somewhat gratified at the attention given by Exit to HOPE and the Euthanasia Prevention Coalition in as much as it shows that we’re being effective. When accusations of wrong doing against us amount to a grand conspiracy theory, as these do, citing a litany of accomplices – none of whom have any involvement in our supposed error – you’ve got to think that we’ve probably touched a nerve; that our effectiveness has been well noted. But this is just a small part of our work...

Two years on.
This attack comes as we mark the second anniversary of the creation of HOPE in 2010. It is, perhaps, fitting in as much as it is recognition that we are making a very real and tangible difference!
  • Over this last year HOPE has appeared in various media on 47 occasions including radio, TV, newspapers, online journals, magazines etc. both at home, in New Zealand and across the globe.
  • We have made new friends and allies in New Zealand and Tasmania, building together a formidable coalition to oppose the bills mooted in both places.
  • We’ve seen off two threatening bills in South Australia.
  • Since July, the new blog has recorded 84 posts of both local and international news which is viewed daily by readers across Australia and the world.
  • We have surveyed candidates at both the Queensland and ACT Elections and will continue this program in the years ahead.
  • Internationally, we continue to build on our successes and to forge new alliances and we’re now looking forward to a renewed push back in Europe.
  • We’re also about to launch a new ‘push back’ initiative in Australia called ‘The declaration of HOPE’ (more details shortly).
And through all of this we continue to grow the network, build on our alliances and expand into the realm of social media – all with the ultimate goal of continuing to prevent euthanasia & assisted suicide.

Sunday, October 28, 2012

Las Vegas man sentenced after assisted suicide in Nuevo Progreso

People who take suicide advice from Philip Nitschke, (Australia's Dr. Death) need to read this article that was written by Jared Taylor and published in The Monitor under the title: Las Vegas man sentenced after assisted suicide.

Philip Nitschke
Nitschke is advising people to go to Mexico to buy a powerful drug that is used by veterinarians for euthanasia. This drug is a controlled substance and if caught with the drug, may result in a prosecution. Further to that, Jeff George Ostfeld was sentenced for 6 years in prison for voluntary manslaughter for his part in the assisted suicide death of Jennifer Malone.

Nitschke is also encouraging people to buy similar drugs from China. Buyer beware. The following is the edited version of the original article.
Las Vegas man sentenced after Assisted Suicide 
By Jared Taylor, The Monitor, October 26, 2012 
A federal judge sent to prison a Las Vegas man convicted of smuggling powerful animal tranquilizers from Mexico used in an assisted suicide in Nuevo Progreso. 
Chief U.S. District Judge Ricardo Hinojosa sentenced Jeff George Ostfeld to six years in federal prison Wednesday, after he pleaded guilty to importation of a controlled substance. 
But after the assisted suicide in Mexico, Hinojosa opted to follow sentencing guidelines for Ostfeld under a charge of voluntary manslaughter­ not the drug charge. 
U.S. Immigration and Customs Enforcement arrested Ostfeld in May 2009 as he attempted to smuggle animal tranquilizers across the Progreso International Bridge. 
The arrest came moments after Mexican police discovered the body of 32-year-old Jennifer Malone at a Nuevo Progreso motel. 
Ostfeld shot video of Malone as she died, investigators said. He retrieved some of her personal effects and abandoned her body in the motel room. 
Mexican investigators found an empty bottle of Barbithal and a book about depression beside the body of Malone, of Roseburg, Ore.,  according to Monitor archives. The same drug was found by U.S. Customs and Border Protection officers as Ostfeld tried to return to the United States.

The American Nursing Association to oppose Assisted Suicide.


The following article was originally published by Wesley Smith on his blog entitled: Nurses Set to Oppose Assisted Suicide.

Wesley Smith
By Wesley Smith - October 28, 2012

The American Nursing Association has a draft opinion out reiterating its opposition to euthanasia and assisted suicide. It is well worth the read. From the draft opinion:
The American Nurses Association (ANA) is strongly opposed to nurses’ participation in assisted suicide and active euthanasia because these acts are in direct violation of The Code of Ethics for Nurses with Interpretive Statements (herein referred to as The Code, 2001), the ethical traditions and goals of the profession, and its covenant with society. Nurses have an obligation to provide humane, comprehensive, and compassionate care that respects the rights of patients but upholds the standards of the profession in the presence of chronic, debilitating illness and at end-of-life.
The ANA notes that the lives of the terminally ill have just as much value as the lives of other people:
Provision 1, Interpretive Statement 1.3 of
The Code (2001) speaks to the nurse’s commitment to the inherent:
“worth, dignity and rights of all human beings irrespective of the nature of the health problem. The worth of the person is not affected by death, disability, functional status, or proximity to death.”
That is a hugely important point, but typically, one the media continually ignore or refuse to see in their emotive and one-sided coverage of this crucial cultural issue.

The point of the publication of the draft position is to obtain public comment. May I suggest applause?

Paul Morelli was given six months to live. Video.

Tahni Morelli
The latest message from the Massachusetts Committee Against Physician Assisted Suicide is a short interview with Tahni Morelli and her daughter Julia about the valuable time that they spent with their husband/father after he received a terminal diagnosis.

Paul Morelli was given a six month diagnosis but lived much longer. The time he lived with a terminal diagnosis represented some of the best years of their life. 

Link to the video.

Can doctors accurately predict when someone has six months to live?

The Committee against Physician-Assisted Suicide are working to defeat ballot Question 2 (assisted suicide) that will be voted on by Massachusetts voters on November 6.

Saturday, October 27, 2012

Four Myths About Doctor-Assisted Suicide


The following article was written by Ezekial Emanuel and published in the New York Times on October 27, 2012 under the title: Four Myths About Doctor-Assisted Suicide.
Ezekial Emanuel is director of the clinical bioethics department at the US National Institutes of Health and heads the Department of Medical Ethics & Health Policy at the University of Pennsylvania.
Ezekial Emanuel
Ezekial Emanuel - Philadelphia
In a little more than a week, voters in Massachusetts will decide whether to allow doctors to “prescribe medication, at the request of a terminally ill patient meeting certain conditions, to end that person’s life.” A similar bill is being debated in New Jersey. Unfortunately, like so many health care questions, the debate about physician-assisted suicide is confused, characterized by four major falsehoods.
PAIN The fundamental claim behind arguments for physician-assisted suicide is that most patients who desire it are experiencing excruciating physical pain. The 1996 decision of the United States Court of Appeals for the Ninth Circuit supporting a constitutional right to physician-assisted suicide in Washington State summarized the conventional wisdom: “Americans are living longer, and when they finally succumb to illness, lingering longer, either in great pain or in astuporous, semi-comatose condition that results from the infusion of vast amounts of painkilling medications.”
But this view is false. A multitude of studies based on interviews of patients with cancer, AIDS, Lou Gehrig’s disease and other conditions have demonstrated that patients who desire euthanasia (in which a doctor administers a lethal drug) or physician-assisted suicide (in which the patient himself takes the lethal drug prescribed by the physician) tend not to be motivated by pain. Only 22 percent of patients who died between 1998 and 2009 by assisted suicide in Oregon— one of three states, along with Washington and Montana, where it is legal — were in pain or afraid of being in pain, according to their doctors. Among the seven patients who received euthanasia in Australia in the brief time it was legal in the ’90s, three reported no pain, and the pain of the other four was adequately controlled by medications.
Patients themselves say that the primary motive is not to escape physical pain but psychological distress; the main drivers are depression, hopelessness and fear of loss of autonomy and control. Dutch researchers, for a report published in 2005, followed 138 terminally ill cancer patients and found that depressed patients were four times more likely to request euthanasia or physician-assisted suicide. Nearly half of those who requested euthanasia were depressed.
In this light, physician-assisted suicide looks less like a good death in the face of unremitting pain and more like plain old suicide. Typically, our response to suicidal feelings associated with depression and hopelessness is not to give people the means to end their lives but to offer them counseling and caring.
ADVANCED TECHNOLOGY A second misconception about assisted suicide is that it is the inevitable result of a high-tech medical culture that can sustain life even when people have become debilitated, incontinent, incoherent and bound to a machine. It is the “inevitable consequence of changes in the causes of death, advances in medical science, and the development of new technologies,” as the appeals court put it.
But the ancient Greeks and Romans advocated euthanasia. In modern times, debate about legalizing euthanasia and assisted suicide was revived with intensity in England in the late 19th century, after a famous debate at the Birmingham Speculative Club. The first such bill introduced in the United States was in 1905, before the discovery of antibiotics and dialysis, much less respirators and feeding tubes. If interest in legalizing euthanasia is tied to any trend in history, it is the rise of individualistic strains of thought that glorify personal choice, not the advances of high-tech medicine.
MASS APPEAL A third misconception about assisted suicide is that it will improve the end of life for everyone. After all, death afflicts everyone, and legalized assisted suicide would allow any individual to avoid an excruciatingly painful death. But the fact is that, even in places where physician-assisted suicide is legal, very few people take advantage of it. In Oregon, between 1998 and 2011, 596 patients used physician-assisted suicide — about 0.2 percent of dying patients in the state. In the Netherlands, where euthanasia and physician-assisted suicide have been permitted for more than three decades, fewer than 3 percent of people die by these means. And even if we add all the dying patients who even vaguely express an interest in assisted suicide, it amounts to much less than 10 percent. For the vast majority of dying patients, it will have no impact on improving the ends of their lives.
Whom does legalizing assisted suicide really benefit? Well-off, well-educated people, typically suffering from cancer, who are used to controlling everything in their lives — the top 0.2 percent. And who are the people most likely to be abused if assisted suicide is legalized? The poor, poorly educated, dying patients who pose a burden to their relatives.
A GOOD DEATH The last misconception about assisted suicide is that it is a quick, painless and guaranteed way to die. But nothing in medicine — not even simple blood draws — is without complications. It turns out that many things can go wrong during an assisted suicide. Patients vomit up the pills they take. They don’t take enough pills. They wake up instead of dying. Patients in the Dutch study vomited up their medications in 7 percent of cases; in 15 percent of cases, patients either did not die or took a very long time to die — hours, even days; in 18 percent, doctors had to intervene to administer a lethal medication themselves, converting a physician-assisted suicide into euthanasia. (In the states where assisted suicide is legal, and under the proposed Massachusetts law, this intervention would be illegal.)
Instead of attempting to legalize physician-assisted suicide, we should focus our energies on what really matters: improving care for the dying — ensuring that all patients can openly talk with their physicians and families about their wishes and have access to high-quality palliative or hospice care before they suffer needless medical procedures. The appeal of physician-assisted suicide is based on a fantasy. The real goal should be a good death for all dying patients.

Friday, October 26, 2012

Legalizing euthanasia does not stop the abuse.


I was debating one of the leaders of the euthanasia lobby yesterday and she stated that - where euthanasia is legal, it is regulated, therefore there is less abuse. I reacted by presenting the information from the studies in Belgium and the Netherlands that prove that even though euthanasia is legal, abuse remains prevalent.

Then I was reminded of the recent email that I received from a person seeking information after her husband died after being intentionally dehydrated to death. She also thought that legalization would lead to greater controls. This is how I responded: 

In jurisdictions where euthanasia has been legalized, such as Belgium and the Netherlands, deaths by dehydration have not stopped and in fact have substantially increased. Studies from Belgium and the Netherlands prove that deaths by Deep Continuous Sedation, have increased after euthanasia was legalized. Deep Continuous Sedation is done by sedating a person and then withdrawing fluids and food. Deep Continuous Sedation or Terminal Sedation must be differentiated from Palliative Sedation which is done to kill pain and not patients.

Belgium euthanasia was legalized in 2002. An article entitled: Medical End-of-Life Practices under the Euthanasia Law in Belgium that was published in the New England Journal of Medicine (Sept 10, 2009) found that after legalization the rate of euthanasia increased, the rate of euthanasia without explicit request decreased but remained very high (1.8% of all deaths) and the rate of people who died by Continuous and Deep Continuous Sedation increased from 8.2% of all deaths in 2001 to 14.5% of all deaths in 2007. 

The article concluded: "We found that the enactment of the Belgium euthanasia law was followed by an increase in all types of medical end-of-life practices, with the exception of the use of lethal drugs without the patients explicit request."

A further examination of the facts indicates that in Belgium, 32% of all euthanasia deaths are done without explicit request. This statistic was determined by a study entitled: Physician-assisted deaths under the euthanasia law in Belgium: a population-based survey that was published in the Canadian Medical Association Journal (June 15, 2010). Even though the number of euthanasia deaths without explicit request decreased, and even though these euthanasia deaths did not follow the legal requirements for euthanasia, the number of these deaths remained "out-of-control," after legalizing euthanasia in Belgium.

In the Netherlands euthanasia was officially legalized in 2001. When examining the statistics in the Netherlands the recent study that was published (July 11, 2012) in the Lancet entitled:Trends in end-of-life practices before and after the enactment of the euthanasia law in the Netherlands from 1990 to 2010: a repeated cross-sectional survey found that deaths by Deep Continuous Sedation increased from 5.6% of all deaths in 2001 to 8.2% of all deaths in 2005 to 12.3% of all deaths in 2010. Deaths by euthanasia without request have decreased but in 2005 there were still 550 deaths without explicit request and in 2010 there were still 310 deaths without explicit request.

You suggested that once euthanasia is legal it would be "under the microscope." A study that was published in the British Medical Journal (November 2010) entitled: Reporting of euthanasia in medical practice in Flanders, Belgium: cross sectional analysis of reported and unreported cases found that 47.2% of the euthanasia deaths were unreported. The recent study that was published in the Lancet concerning end-of-life practices in the Netherlands found that 23% of the euthanasia deaths were unreported. The practice of euthanasia is not "under the microscope."

The theory that legalizing euthanasia will lead to greater control and fewer abuses is not true. The studies from jurisdictions where euthanasia has been legalized indicate that legalizing euthanasia and assisted suicide is not safe.

Assisted Suicide is not Safe: Canadian Government

The lawyers for the Government of Canada have submitted their reasons for appealing the decision by Justice Smith in BC.

On June 15, Justice Smith decided in the Carter case that Canada's assisted suicide law was unconstitutional, that euthanasia needed to be legalized for limited circumstances, that Gloria Taylor, one of the plaintiffs could have a constitutional exemption to euthanasia and assisted suicide and she ordered parliament to legalize euthanasia and assisted suicide by June 15, 2013.


The federal government appealed the extreme decision by Justice Smith and this week they released their arguments for the appeal.


The Canadian Press reported:

Legalizing doctor-assisted suicide would demean the value of life and could lead vulnerable people to take drastic steps in “moments of weakness,” the federal government argues in its appeal of a court decision that struck down the ban on the practice. 
Ottawa is defending the law that prohibits assisted suicide as it appeals a decision from a British Columbia court, which concluded it is unconstitutional to prevent the sick and dying from asking a doctor to help them end their lives. 
The government argues in court documents that allowing any form of assisted suicide creates the possibility that people with disabilities, the elderly and the terminally ill could be coerced to end their lives or do so in moments of depression and despair, even if better days may be ahead. 
“It [the current law’s purpose] is to protect the vulnerable, who might be induced in moments of weakness to commit suicide,” the government says in a 54-page legal argument filed with the B.C. Court of Appeal. 
“And it is a reflection of the state’s policy that the inherent value of all human life should not be depreciated by allowing one person to take another’s life … It also discourages everyone, even the terminally ill, from choosing death over life.” 
The case was launched by several plaintiffs in B.C., including Gloria Taylor, an ALS patient who won an immediate exemption from the law. Ms. Taylor died earlier this month without resorting to assisted suicide. 
The debate is likely destined for the Supreme Court of Canada, which last examined this country’s assisted-suicide ban in 1993, when it upheld the law in a case involving Sue Rodriguez. Ms. Rodriguez died with the help of a doctor the following year. 
The federal government argues the top court’s ruling in the Rodriguez case was final and says the B.C. Supreme Court had no right to attempt to overrule that decision. 
In the B.C. case, the judge concluded the law must allow physician-assisted suicide in cases involving patients who are diagnosed with a serious illness or disability and who are experiencing “intolerable” physical or psychological suffering with no chance of improvement. 
The decision said patients in such scenarios must personally request physician-assisted death, must be free from coercion and cannot be clinically depressed. 
The federal government argues the decision ignored evidence, presented at trial, that indicated safeguards in jurisdictions that allow assisted suicide are often not followed, including a number of cases in which patients were killed without their request. Some studies have concluded there is simply not enough evidence to conclude whether safeguards have worked. 
The government says it can be virtually impossible to determine whether a patient is making a rational decision and is not suffering from depression or other cognitive problems. 
Nor can physicians and patients be sure the patient wouldn’t change his or her mind if given more time to consider their decision, the government says. 
Given that uncertainty, the government argues it is reasonable to assume legalizing assisted suicide would be harmful, and because of that, the courts should leave it to Parliament to decide such a sensitive and emotionally fraught issue. 
In the two decades since the Rodriguez case, Parliament has examined the issue several times. In each instance, MPs opted to keep the status quo – most recently in April 2010, when a private member’s bill to legalize assisted suicide was defeated 228-59. 
“On each of those occasions, Parliament concluded that the risks inherent in physician-assisted suicide and euthanasia are too great,” the federal government says in its legal argument. 
“Parliament does what it effectively can, within its constitutional authority, to prevent and discourage all suicides.” 
Despite the B.C. decision, the law against assisted suicide remains in effect. The B.C. court’s judgment was suspended while the case is before the Appeal Court. 
Ms. Taylor was given an immediate constitutional exemption from the law, briefly making her the only person in Canada who could have legally sought doctor-assisted suicide. 
The federal government asked the Appeal Court to overturn that exemption, but the court refused in a decision released in August. 
Ms. Taylor died suddenly earlier this month due to a severe infection resulting from a perforated colon. 
The B.C. case has helped fuel debate about assisted suicide across Canada.
The comments by the lawyers for the Government of Canada are correct. Justice Smith seemed to ignore the facts and the conclusions from the Belgium study Physician assisted deaths under the euthanasia law in Belgium: a population-based survey which found that 32% of all euthanasia deaths in the Flanders region of Belgium were done without explicit request.
The same study also found that euthanasia without explicit request were usually done to people who were over the age of 80, who did not have cancer, and who were usually incompetent to make decisions. The study concluded that this demographic fit the description of a vulnerable patient group at risk of life ending without request.
Another Belgium study found that nurses were actually euthanizing their patients, sometimes without request, which is all illegal but still occurring in Belgium.

Assisted Suicide Goes to Vote in Massachusetts.

An article in the NPR today entitled: Assisted Suicide Goes to Vote in Massachusetts concerns ballot Question 2 (assisted suicide) that will go to a vote on November 6.

The article that was written by Sacha Pfeiffer interviews John Kelly, the leader of the disability rights group - Second Thoughts, and it interviews Dr. Lachlan Forrow, the director of ethics and palliative care programs at Beth Israel Deaconess Medical Center in Boston, who both oppose assisted suicide.

The article states:
Two states, Oregon and Washington, have legalized physician-assisted suicide through voter-approved ballot initiatives. Massachusetts will become the third if voters approve the so-called Death With Dignity ballot question. The measure would let terminally ill patients with six months or less to live get a lethal prescription. The outcome of that vote could change the landscape for legalized suicide nationwide.
John Kelly
The article interviewed John Kelly:
Disabilities rights activist John Kelly is ardently against the measure, as are the Massachusetts Medical Society and several religious organizations. 
"My major concern is that this bill is a recipe for abuse," Kelly says. 
The two sides disagree on whether the initiative has adequate safeguards. Kelly fears that sick people with treatable depression could feel pressure to end their lives from family members eager for an inheritance or because they feel like a burden. 
"Here I think about people with psychiatric histories, people with dementia, people who are subject to coercion. These people will be impacted," he says. 
Kelly, who is quadriplegic, says legalized suicide sends a damaging message that certain lives aren't worth living. He's also concerned that death by prescription will appeal to a health care system focused on the bottom line. 
"With cost controls, hospitals losing money, profit-making insurance companies, we're always hearing about the incredible expense in the last year of life. And this is a way to save that money," Kelly says.
Dr Lachlan Forrow
The article also interviewed palliative care leader Dr. Forrow:
Massachusetts is considered a pioneer in health care reform. So Dr. Lachlan Forrow, the director of ethics and palliative care programs at Beth Israel Deaconess Medical Center in Boston, says this vote is particularly noteworthy. 
"If Massachusetts takes the step of legalizing physician-assisted suicide, I think that would have a major transforming effect on national conversations. And a lot of people will say, 'It's even a heavily Catholic state, so maybe this should be emulated elsewhere,' " Forrow says. 
But he regrets this issue is on the ballot. Forrow says the money and energy that has gone into it would have been better spent expanding and improving end-of-life services like hospice and palliative care. So whether or not Massachusetts legalizes physician-assisted suicide, he hopes supporters and opponents will work together after Election Day to make dying a gentler process for terminally ill patients.
The article concludes by stating: 
In Montana, a state supreme court ruling gives legal protection to doctors who assist a patient's suicide, but does not explicitly legalize it.

Thursday, October 25, 2012

Assisted Suicide is not Progressive



The following article was was written by Ira Byock and published in The Atlantic under the title: Physician-Assisted Suicide Is Not Progressive.

By Ira Byock - The Atlantic, October 25, 2012

"Right to die" is just a slogan. No civil right to commit suicide exists in any social compact. 

Ira Byock
The issue of legalizing physician-assisted suicide doesn't fall cleanly along liberal-conservative lines. However, it's fair to say that most social conservatives ardently oppose assisted suicide, while a clear majority on the political left support legalization. That's the case in Massachusetts where Question 2 is on November's ballot, and according to recent polling is very likely to pass.

I am an outlier, in that I am a registered Democrat and progressive, as well as a physician who has cared for people with life-threatening conditions for more than three decades. I support universal health care, voting rights, disability rights, women's rights, Planned Parenthood, gay marriage, alternative energy, and gun control. I yearn to see an end to the war on drugs and the war in Afghanistan. And, I am convinced that legalization of physician-assisted suicide is something my fellow progressives should fear and loathe.

When cast as a rights issue, it's hard for progressives to resist. But "the right to die" is just a slogan. No civil right to commit suicide exists in any social compact. Human beings have a biologically imposed obligation to die; and, as Jean Paul Sartre reminded us, suicide is always an option. However, even if a civic right to suicide did exist, suicide and assisted suicide are very different things. Suicide might be a purely private act; but physician-assisted suicide involves two people, one of whom is trained, certified, licensed, and compensated by society.

Supporters of initiatives to legalize physician-assisted suicide worry about people who die badly. On that we agree. If the moral worth of a society can be measured by how well it cares for the most vulnerable of its members, the America in which I live and practice medicine scores poorly. Much of the suffering I see among people with advanced illness is preventable. Many of the indignities I witness are imposed.

Sick people commonly endure undertreated physical suffering and a dizzying array of system-based personal assaults. There is a maze of appointments, irrational insurance hoops, and requirements, and indecipherable bills. I hear patients express embarrassment at becoming a burden to those they love, dread at the prospect of draining their family's savings and shame of being forced into medical bankruptcy. Public policies could go a long way to dissolving this quagmire, but legalizing physician-assisted suicide isn't one of them. Giving doctors lethal authority would address none of the deficiencies in medical practice, health care financing or social services that bring ill people to contemplate ending their lives.


Related Story

Whose Right to Die?

Oregon is often held up as an example of a place where legalized physician-assisted suicide has worked well. Its Death with Dignity Act is a template for legislation in other states, including Massachusetts. It is widely assumed that if a terminally ill individual qualifies for a lethal prescription, he or she automatically qualifies for hospice care. Not true. In actuality, criteria for physician-assisted suicide in Oregon are more liberal (sic) than eligibility for hospice care.

Under scrutiny from the federal government in it's zeal to curtail Medicare fraud and abuse, hospice programs are under pressure to discharge patients who are not actively declining. In 2010, 16% of hospice patients in America were eventually discharged from hospice care. These are people with cancer, emphysema, heart failure, or dementia whose conditions improve slightly, often as a result of the meticulous care hospice has been providing. They are still dying, just not quickly enough for the bureaucracy.

No provision in Oregon's Death with Dignity Act, nor in the proposed Massachusetts law protects patients who obtain lethal prescriptions from losing hospice services if they live a bit too long.

Proponents of physician-assisted suicide portray the American Medical Association's and Massachusetts's Medical Association's steadfast opposition as self-serving. But this turns the situation on its head. In this instance the medical associations are advancing progressive values. Since antiquity, doctors have had more power than patients. From the earliest times the profession has honored self-imposed boundaries put in place to protect vulnerable people. Clinical Ethics 101 includes three inviolable prohibitions: Doctors must not intentionally kill a patient, must not have sex with a patient, and must not financially benefit beyond reasonable compensation for their professional services.

Barbara Wagner
In 2008 Barbara Wagner sought chemotherapy for late stage lung cancer. The Oregon Health Plan office refused to authorize the $4,000 per month treatment because it was not approved for her condition, but listed among the services it would pay for were prescription drugs to end her life. "To say to someone, we'll pay for you to die, but not for you to live; it's cruel," Wagner told the Eugene Register-Guard.

The term Orwellian is overused, but seems apt here. Orwell understood the power of language to reshape moral thought. In today's "Newspeak" the Hemlock Society morphed into Compassion and Choices, which promotes "death with dignity" and objects to the word "suicide," preferring "aid-in-dying" and "self-deliverance." These terms sound more wholesome, but the undisguised act is a morally primitive, socially regressive, response to basic human needs. Progressives in Massachusetts who vote for Question 2 should remember that by the end of Orwell's 1984 the protagonist, Winston Smith, loved Big Brother.

An authentic progressive agenda for improving the way we die would begin by tying physician and hospital payments to quality of care, not quantity of tests and treatments, and doubling the ratio of nurses and aides to residents in nursing homes. (Honoring the inherent dignity of a person starts with ensuring there's someone to answer the bell when the person needs help getting to the bathroom.) Also high on a liberal agenda should be repealing regulations that require sick people to give up life-prolonging treatments to receive hospice care. Finally, it's past time to insist that every medical student receives adequate training and passes competency tests in symptom management, communication and counseling related to serious illness and dying -- skills that most physicians lack today.

America is failing people who are facing the end of life and those who love and care for them. Giving licensed physicians the authority to write lethal prescriptions is not a progressive thing to do.

Ira Byock is director of palliative care at Dartmouth-Hitchcock Medical Center in Lebanon, N.H., and author of The Best Care Possible: A Physician’s Quest to Transform Care Through the End of Life.

Waltham Massachusetts, mayor and councilors, all voting no on Question 2 (assisted suicide)

An article published yesterday on Boston.com entitled: Waltham mayor, councilors say they will all vote 'no' to physician-assisted suicide ballot question. This article is one of many articles that have quoted Massachusetts politicians from every political stripe stating that they are voting no on (assisted suicide) ballot Question 2.

The article that was written by Jaclyn Reiss states:

Waltham Mayor Jeannette McCarthy and all 15 city councilors are saying that they will vote against November’s ballot question that would allow for physician-assisted suicide, and are imploring other Massachusetts residents to do the same. 
Waltham’s leaders said in a statement that they oppose the bill’s language, which allows for physician-assisted suicide without consulting a psychiatrist, notifying family members, or having a doctor present during the act itself. 
“The proposed law is flawed,” McCarthy wrote in the statement, which was released by city councilor Diane LeBlanc. “It does not provide for family or medical oversight at a most vulnerable time in a person’s life.” 
The bill would allow terminally ill adults with six months or less to live to seek a prescription for life-ending medication after seeing two different doctors. Participation by physicians is voluntary, and the doctors can require the patient to see a psychologist if they see fit. 
However, LeBlanc said in the statement that she felt the law has limitations, and that she was troubled that the ballot question has not been debated. 
“It is important that those who have examined it closely, and see the very serious flaws and lack of protections, speak out,” she wrote. “If people take a hard look at this law - even those who support assisted suicide should vote no.” 
Edmund Tarallo, ward two councilor, wrote that he wished the measure required a physician to be present during the medication’s administration, while ward seven councilor Joseph Giordano said the patient should require more overseeing. 
“It is just wrong that a mental health evaluation is not required and that there is no requirement to let a family member know that you plan to take a lethal dose of medication that will kill you,” Giorano wrote. 
The statement lists several organizations that also oppose the legislation, including the Massachusetts Medical Society and the American Medical Association.
The Waltham mayor and councilors have "hit the nail on the head." After analysing Question 2, it becomes clear that the ballot question is flawed and will lead to abuse.

Over the past several years there has been more than 100 attempts to legalize assisted suicide through a state legislature, each attempt failed due to the lack of effective safeguards.

Assisted suicide is simply not safe.

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