Tuesday, May 23, 2017

Do suicides increase where euthanasia is legal?

This article was published by Mercatornet on May 22.

The euthanasia debate is on the front-burner in Australia, especially in the states of Victoria and Tasmania. In one of the latest salvos, ethicist Professor Margaret Somerville claimed that suicide rates rise in jurisdictions where euthanasia and assisted suicide are legal. This prompted a blast from Neil Francis, a former President of the World Federation of Right To Die Societies and a leading campaigner for euthanasia in Australia. This is Professor Somerville’s response. 
B
Margaret Somerville
y Margaret Somerville

Neil Francis is correct in criticizing me for a loose statement that "the general suicide rate has increased in every jurisdiction that has legalized assisted suicide." 

Although I believe that my statement will prove to be correct, at this point in time I should have left out the word "every." 

One problem in obtaining the required evidence, is that it’s difficult if not impossible to know how often physician-assisted suicide or euthanasia (PAS-E) is being used in countries where those interventions are legal to commit what we should view as “ordinary suicide” – if one can ever regard suicide as “ordinary”, but for want of a better term. 

“Suicide by police” – a suicidal person engages in conduct with the intention that the police will respond by shooting them - is a recognized phenomenon. Now we can consider “suicide by physician”. 

Two features of legalized PAS-E make “suicide by physician” seem likely: The percentage of deaths occurring from PAS-E, for instance, in The Netherlands and Belgium, is rising by approximately 10 per cent each year and is now around 4 percent of all deaths. And the conditions for access to PAS-E are expanding in both jurisdictions. If one is not terminally or physically ill, neither of which is a legal requirement in either country, is euthanasia “ordinary suicide”? And what about if a person wants PAS-E because they are just “tired of life” or feel they have a completed life as the Netherlands is now contemplating allowing or, as an elderly couple proposed on ABC’s Q&A, simply want to avoid going into a nursing home, should these be classified as “ordinary suicide” cases? 

Cases in which using PAS-E as a substitute means of suicide seems very likely have made headlines around the world. They include the deaf Belgian twins who were going blind; the young gender-dysphoric woman with the botched sex-change operation; the anorexic woman in her 20s; the depressed 34 year old Eva, whose death by euthanasia is focused on in real time in the documentary film, “End Credits”, made by Dutch pro-euthanasia advocates; the convicted rapist and murderer in the Belgium prison


Dutch Professor Dr Theo Boer, a former member of one of Holland’s five Euthanasia Regional Review Committees (2005-2014) has undertaken a study which will be published shortly which, in his words, shows 
Theo Boer
the assumption that euthanasia will lead to lower suicide rates finds no support in the numbers. The percentage of euthanasia deaths of the total mortality rate tripled from 1.3% in 2002 to 4.08% in 2016. During that same period, the suicide numbers did not go down: From being 1,567 in 2002, they went up to 1,871 in 2015, a rise of 19.4%. The suicide rates reached a relative low of 1,353 in 2007, compared to which the 2015 numbers constitute a rise of 38.3%. This is even more significant given the fact that from 2007 on euthanasia started becoming available to people with chronic diseases – psychiatric diseases, dementia, and others. In terms of the percentage of the overall mortality of suicide deaths, the numbers went up from 1.01% in 2007 to 1.27% in 2015.  
…For the sake of comparison, I have looked at the suicide rates of some countries which are close to the Netherlands in terms of ethnicity, age, religion, and language but which, with the exception of Belgium, lack the option of euthanasia. If the suicide numbers in the Netherlands have gone up, one would expect, at least a similar increase in the suicide numbers would occur in countries without the option of euthanasia. However,…the Netherlands of all countries show the biggest increase in the suicide numbers.” 
Mr Francis dismisses researchers David Jones' and David Paton’s report on suicide data in Oregon on which I relied to show a rise in the state’s suicide rates on the basis that it was “published in a minor journal”, the Southern Medical Journal. This claim is specious, even if it were a “minor journal”. For the record, it is a peer-reviewed medical journal indexed and abstracted in Index Medicus, Current Contents, Science Citation Index, and EMBASE which has published over 45,000 articles. I leave it to others to decide its status. 

Moreover, if Mr. Francis’ claim as to its status were correct and if Jones’ and Paton’s article were, as Mr. Francis describes it, “a wobbly econometric modelling study”, it stands to reason that the journal would be more accessible in terms of publishing rebuttals or questions about the article. To date, to my knowledge, no one has done so, not there, not anywhere. 

Mr Francis’, at best, woolly statements about what Jones’ and Paton’s study found need clarifying. They write: 
[W]e found that legalizing PAS was associated with a 6.3% (95% confidence interval 2.70%–9.9%) increase in total suicides (including assisted suicides). This effect was larger in the individuals older than 65 years (14.5%, CI 6.4%–22.7%). Introduction of PAS was neither associated with a reduction in nonassisted suicide rates nor with an increase in the mean age of nonassisted suicide. (Emphasis added)  
Conclusions: Legalizing PAS has been associated with an increased rate of total suicides relative to other states and no decrease in nonassisted suicides. 
As Jones and Patton recall, pundits claimed at the time of the public debate in Oregon about legalizing physician-assisted suicide that having access to assisted suicide would reduce “nonassisted” or “ordinary suicide”, which it clearly did not. This is something Australian legislators should note. 

I will just mention California, which has very recently legalized physician-assisted suicide. There was concern that people who were involuntarily hospitalized because they were mentally ill and “dangerous to themselves (they were suicidal) or others” could not have access to physician-assisted suicide. This has now been “remedied” and a special process established to allow them to apply to have physician assistance in killing themselves. 

Popular articles against euthanasia and assisted suicide.

1. Margaret Dore: Physician-Assisted Suicide: A Recipe for Elder Abuse and the Illusion of Personal Choice - Feb 17, 2011.

2. Declaration of Hope – Jan 1, 2016.

3. Healthy 24 year old Belgian woman is scheduled for euthanasia - June 24, 2015.

4. Boycott Me Before You - "disability death porn" - May 26, 2016. 

5. Kitty Holman: 5 reasons why people devalue the elderly – May 25, 2010. 

6. Depressed Belgian woman dies by Euthanasia – Feb 6, 2013.

7. Emily “Laura” the healthy 24-year-old Belgian woman who was approved for euthanasia, has chosen to live. Nov 12, 2015.  

8.  Euthanasia is out-of-control in the Netherlands – Sept 25, 2012.

9. Kate Kelly: Mild stroke led to mother’s forced death by dehydration – Sept 27, 2011.

10. Belgian twins euthanized out of fear of blindness. – Jan 14, 2013. 

11.  The Euthanasia Deception documentary. - Sept 30, 2016.

12. Assisted suicide law prompts insurance company to deny coverage to terminally ill woman - Oct 20, 2016. 

13. Nitschke promotes lethal veterinary drugs – June 22, 2010.

14. South Africa Supreme Court rejects euthanasia - Dec 6, 2016.

15. Woman dies by euthanasia, may only have had a bladder infection - Nov 14, 2016. 

16. Opposing the Supreme Court of Canada assisted death decision - Feb 17, 2015. 

17. Belgium warns - Medical Assistance in Dying - Don't Go There - April 26, 2016.

18. Woman with Anorexia Nervosa dies by euthanasia in Belgium – Feb 10, 2013.

19. New Jersey Senate may vote on assisted suicide - Dec 16, 2014.

20. Netherlands euthanasia review committee decides that a euthanasia done on a woman with dementia was done in "good faith" -  Jan 28, 2017.

21. Petition: Stop euthanasia Bill in Quebec – May 24, 2014.

22.  Trisomy 18 is not a Death Sentence. The Lilliana Dennis story – May 29, 2012.

23. Oregon 2012 assisted suicide statistics: An analysis - Jan 25, 2013.

24. Dutch ethicist changed his mind - Assisted Suicide: Don't Go There - July 16, 2014.

25. Supreme Court of Canada euthanasia decision is irresponsible and dangerousFeb 7, 2015.

Become a member of the Euthanasia Prevention Coalition ($25) membership.

Monday, May 22, 2017

Euthanasia Tyranny Against Doctors in Ontario

This article was written by Wesley Smith and published on his blog on May 18, 2017

Wesley Smith
By Wesley Smith

Ontario, Canada has passed a law formally legalizing lethal injection euthanasia. And it will force all provincial doctors to be complicit by either doing the deed themselves to all legally qualified patients who request to be killed, or by tasking them with procuring a death doctor. From the Ontario Ministry of Health and Long-Term Care Website (my emphasis): 
In Ontario, health regulatory colleges are responsible for regulating their respective professions in the public interest. In doing so, colleges may establish policies and standards that their members must comply with, including policies and standards regarding medical assistance in dying. 
The College of Physicians and Surgeons of Ontario requires that when physicians are unwilling to provide certain elements of care for reasons of conscience or religion, an effective referral to another health-care provider must be provided to the patient. An effective referral means “a referral made in good faith, to a non-objecting, available, and accessible physician, other health-care professional, or agency”. 
Think about this. Three years ago, it would have been a felony for doctors to kill patients, potentially landing them in prison. 

Now, refusing to participate in homicide could cost them their medical licenses. 

The question I am often asked is, “Why?” Why force a doctor to participate in killing against her moral or religious beliefs when a patient wanting to be lethally injected could easily find a death doctor through a pro-euthanasia organization or a list of willing MDs published by the government–as has been established in other provinces. 

Here’s what I think: 

First, a doctor refusing to kill sends a powerful message that the act is wrong morally and medically. That message must be silenced. 

Second, medicine is being weaponized as a means of turning culture away from the core principles of intrinsic human dignity and the equality/sanctity of life, into a society more focused on radical and atomistic individualism and utilitarian outcomes. 

Third, compulsory euthanasia complicity marginalizes the influence of religion in society and strengthens secularism. 

Fourth, this is a splendid way to cleanse orthodox religious believers, Hippocratic Oath-accepting doctors, and pro-lifers from the health professions–and dissuade those holding such beliefs from becoming physicians, nurses, and pharmacists. 

I am sure there are other forces at work. But this much I know: Conscripting doctors to be homicide facilitators as a condition of practicing medicine is tyranny.

Friday, May 19, 2017

Ontario doctors will leave the province if forced to participate in "assisted dying."

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

O
Jeff Yurek
n May 18, the Ontario legislature rejected Bill 129, the Regulated Health Professions Amendment Act, a bill that was sponsored by Jeff Yurek (MLA) to provide conscience protection for health care workers in Ontario.

The Toronto Sun reported that a press conference organized by the Concerned Ontario Doctors and the Coalition for Healthcare and Conscience that:

Many Ontario doctors and nurses working in palliative care say their objection to playing a role in assisted suicides may force them to leave the medical profession. 
Many physicians "don’t want to make a referral that would result in the death of a patient,” 
Dr. Kulvinder Gill said, adding forcing medical workers to participate strips them of their conscience rights under the Canadian Charter of Rights and Freedoms. “Access (to assist dying) must not depend on a physician having a role.”
Dr Kulvinder Gill (centre)
Dozens of medical professionals attended the press conference. The Toronto Sun article quoted some of the medical professionals as stating:

Dr. Jane Dobson said she is at a crossroads because she won’t make referrals for assisted dying.
“There are palliative-care providers who will be forced to leave (the profession) because of the conscience,” Dobson said. 
Pharmacist James Brown says he believes drugs should be used to treat diseases — not kill someone. 
“They’re never intended to take a patient’s life. Knowing a medication is meant to take a life goes against my core values,” Brown said.
Doctors, nurses and other medical professionals must never be forced to be complicit in acts of killing their patients.

Euthanasia: Truth is the first casualty

This article was written by Paul Russell and published on the HOPE website on May 18. 

Paul Russell
By Paul Russell

Euphemisms have consequences.

The Victorian Ministerial Advisory Panel charged by Premier Daniel Andrews with the task of developing a safe way to kill people and to help them to suicide, released its interim report yesterday.

Set up in December last year the 'expert panel' has conducted state-wide hearings and accepted submissions on precisely how to make a safe law.

The Panel's introductory discussion paper made it perfectly clear that their job was not to consider the ethical/moral concerns: "The purpose of this consultation is to ensure that parliament may debate the merits of voluntary assisted dying through well-informed and workable legislation."

How that outcome could be considered as 'values-neutral' is beyond comprehension. Any proposition that has supposedly been vetted and designed through what I am sure will be described as a 'lengthy and thorough process' would seem to have the 'tick of approval'. The 'merit' is loaded into the outcome as Health Minister, Jill Hennessy confirmed today:
“We have the very best medical and legal experts working on this to make sure that when the time comes, everyone in the Victorian parliament has the information, and assurances they need to make an informed decision about this important issue.”
In the 64 pages and in 29,143 words, the interim report uses the word euthanasia only once - and that in a quotation from a submission. Assisted Suicide is mentioned three times - again, only from quotations and suicide (separately); well, that's where matters become more interesting again.
"Some denominational submissions suggested it should not be called ‘voluntary assisted dying’ because it would obscure the role of medical practitioners in aiding suicide."
Why the mention of 'denominational'? In all of the quotes from various submissions and testimony, no mention is made about the name of the individual or organisation (given only a number), what is it about this reference that requires an identifier? It is difficult to come to any other conclusion than to observe that by the use of 'denominational' the report seeks to dismiss the concerns as being a 'religious objection' only.

The very next sentence amplifies the subterfuge:
"An alternative view was expressed that the language of suicide should not be conflated with voluntary assisted dying because of the person’s proximity to death due to illness."
Who expressed that view? Suicide is suicide; no amount of qualification changes that. But here's where the euphemism becomes really useful: Read the quote again and substitute 'suicide' for 'voluntary assisted dying' and the reasons for its use become clear. This is double-speak.

If any more proof was needed, the next occasion that the 'S' word appears is in the context of a discussion about record keeping and monitoring:
"It was noted that if information about those whose request was denied was linked to other data such as suicides, it would provide a greater understanding of how the framework was operating."
So, if a person gets access to the law, then it's 'voluntary assisted dying'; if they fail to qualify for some reason and end their life by other means it can be called suicide. The premise here, of course, is that 'assisted dying' will reduce the incidence of other forms of suicide. This has proven not to be the case in Oregon and any expectation that it might be the case in Victoria is supposition at best.

There's more! In a discussion about legal liability it is noted that, 'acting outside the proposed legislation, such as aiding and abetting suicide, would still be a criminal offence.'

Indeed. The death might be by precisely the same method under precisely the same conditions - even with full consent - yet if one condition identified in the law is not met, then it is assisted suicide! You couldn't make this stuff up!

But the final mention of 'suicide' is really where obfuscation and euphemisms are so blatantly evident:
"Life insurance 
"The impact of the listed cause of death on insurance eligibility was also highlighted in forums and submissions. It was noted that there should be no loss of insurance benefits as a result of exclusion clauses for suicide. This was one of the reasons many considered that voluntary assisted dying should not be listed on a death certificate. Others were of the view that it was clearly the underlying terminal illness or disease that was the cause of death so there should be no issues with insurance."
Like many other bills we've seen in Australia, this proposition would legislate further obfuscation and would make liars out of doctors by forcing them to falsify the cause of death. Insurance industry bodies have railed against this kind of inclusion previously and for good reason. They raised the same concerns in The Australian today. It opens up the possibility of someone signing up for a life insurance policy only months before their suicide for the benefit of their estate with a minimum of paid premiums. Think of the possibilities of 'inheritance impatience', otherwise known as Elder Abuse.

Further obfuscation came via Victorian Greens MLC, Colleen Hartland in the same article:
“It is the issue around ­insurance, and the reality is that the cancer or the neurological disease is what killed them, they have just allowed to die a bit ­earlier,” she said.
What kind of policy outcome are Victorians likely to gain from all of this if their elected representatives and appointed officials can't get past the fabricated expressions of the death dealing lobby?

Buddha is often quoted as having said that, "Three things cannot be long hidden: the sun, the moon and the truth." He never visited Victoria.

The final report is said to be due at the end of July.

Sunday, May 14, 2017

Nevada Governor Brian Sandoval opposes assisted suicide bill.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition.

Governor Brian Sandoval
In 2017, the assisted suicide lobby has lost in every US state where they have introduced assisted suicide legislation. Recently, Nevada Governor Brian Sandoval stated that he opposes Senate Bill 261, a bill that would legalize assisted suicide in Nevada ensuring that the bill will die.

Alison Noon, reporting for the Associated Press wrote:
The Senate Health and Human Services Committee took no immediate action on the (assisted suicide) measure, which faces an uphill battle. Gov. Brian Sandoval does not support the policy, spokeswoman Mari St. Martin said on Wednesday.
Several weeks ago, Maine Governor LePage said he would veto the Maine assisted suicide bill. Assisted suicide bills have been introduced in more than 20 US states this year.

Legalizing assisted suicide gives doctors the power to kill their patients.

Wednesday, May 10, 2017

Canadian Medical Killers Form Trade Association

This article was published by Wesley Smith on his website on May 10, 2017

Wesley Smith
By Wesley Smith

The Hippocratic Oath reads in part, “I will give no deadly medicine to any one if asked, nor suggest any such counsel.” 

But Canadian death doctors and nurse practitioners who euthanize the sick, disabled, and mentally ill–soon perhaps, also those with Alzheimer’s–are actively embracing the very lethal act Hippocratic doctors forswore for the protection of vulnerable patients. 

How “in” to euthanasia are they? They have formed an association of euthanasia providers–killers, because that is what euthanasia is, killing–called CAMAP, the Canadian Association of MAiD Assessors and Providers. (MAID stands for “medical assistance in dying.”) The organization’s purpose
While we are predominantly an association of physicians and nurse practitioners, anyone interested in supporting this work is most welcome to join our community and become an associate CAMAP member.  
This includes nurses, pharmacists, speech & language specialists, administrators, law makers, lawyers, social workers, activists, counsellors and more. Already underway are plans for a National Conference on MAiD in June 2017 in beautiful Victoria, BC, development of an advisory board, plans for a mentorship program and a newsletter with cross-country information and case reviews.  
Membership provides you with a reduced rate for registration at our conferences, access to our newsletter, general MAiD news updates, case reviews and an opportunity to join with a passionate and compassionate group of physicians and nurse practitioners doing this vital work. 
Let’s be clear: “This work,” is lethally injecting sick people.

Monday, May 8, 2017

Where did Nazi doctors learn their ethics? From a textbook

This article was written by Michael Cook and published by Mercatornet on May 2, 2017

Note from Alex Schadenberg:
Many people are concerned about the influence that Peter Singer has had on bioethics. When you read this article, you will agree that your concerns about Peter Singer are valid. 
They had plenty of ethics. It was just the wrong kind of ethics. 
They had plenty of ethics. It was just the wrong kind - See more at: https://www.mercatornet.com/features/view/19727#sthash.oTesqVGv.dpuf
They had plenty of ethics. It was just the wrong kind - See more at: https://www.mercatornet.com/features/view/19727#sthash.oTesqVGv.dpuf
Physician Karl Brandt (center)

By Michael Cook


German medicine under Hitler resulted in so many horrors – eugenics, human experimentation, forced sterilization, involuntary euthanasia, mass murder – that there is a temptation to say that “Nazi doctors had no ethics.”

However, according to an article in the Annals of Internal Medicine by Florian Bruns and Tessa Chelouche (from Germany and Israel, respectively), this was not the case at all.

In fact, medical ethics was an important part of the curriculum for German medical students between 1939 and 1945. Nazi officials established lectureships in every medical school in Germany for a subject called “Medical Law and Professional Studies” (MLPS).

There was no lack of ethics. It was just the wrong kind of ethics.

The focus of the scholars’ study is Rudolf Ramm, a German general practitioner who became the pre-eminent purveyor of Nazi medical ethics during the War years. He was an ardent anti-Semite who demanded a “complete solution to the Jewish Question in Europe” and a “radical elimination of the Jews.”

Ramm was editor-in-chief of the journal of the German Medical Association, Deutsches Ärzteblatt, and published a textbook, Ärztliche Rechts- Standeskunde (Medical Law and Health). The textbook sold out within a year.

Ramm did not survive to be a defendant in the famous “doctors trial” in 1947. He was tried and shot by the Soviets in August 1945. His book was banned a few months later.

What did medical students learn during the Nazi era? According to Bruns and Chelouche, it was “the unequal worth of human beings, the moral imperative of preserving a pure Aryan people, the authoritarian role of the physician, the individual’s obligation to stay healthy, and the priority of public health over individual-patient care.”

However repugnant this now sounds, Ramm believed that the Nazi ideology was responsible for the “reinstatement of a high level of professional ethics.” He was delighted that “the profession had been extensively cleansed of politically unreliable elements foreign to our race” (that is, German-Jewish physicians).

Bruns and Chelouche sum up the pillars of his ethics as follows:

Ramm saw 3 distinct dangers facing the German people: “racial miscegenation,” a declining birthrate, and the “growth of inferior elements” in the German population. He traced the origins of these perceived dangers to a “disregard for the laws of nature,” caused by church dogma and socialist ideologies. Ramm denounced any form of health care for “hereditarily inferior” people and asserted that every person in Nazi Germany had a moral duty to stay healthy.
With the benefit of hindsight, it is easy to see Nazi “medical ethics” for what they are: a flimsy rationalisation to allow physicians to participate in imposing the rule of the Third Reich upon Europe. Their collaboration with the regime was shameful, to say nothing of the horrors of experimentation on unwilling prisoners and mass extermination.

But Bruns and Chelouche are less interested in raking over the coals than in drawing lessons for today’s doctors. Doctors must resist the temptation to believe that they are much more ethical than in “the bad old days,” they observe. Ethical standards do not always progress; sometimes they can regress.

In fact, in the Weimar Republic, ethical standards for human experimentation were “remarkably advanced,” they write. In 1931 the government had responded to scandals in medical practice by setting down clear guidelines. In some respects, they were even stricter than the Nuremberg Code of medical ethics which was adopted after World War II. Non-therapeutic research was “under no circumstances permissible without consent,” a cost-benefit analysis and animal experimentation were required to minimize the risk to humans; publication of results had to respect human dignity, and so on.

So the Nazi doctors could hardly plead ignorance of humane ethical standards. In fact, the authorities did not even bother to repeal the Weimar legislation. They simply redefined the subject of experimentation to exclude concentration camp inmates.

Bruns and Chelouche conclude with this warning:

It is important to realize that ethical reasoning can be corrupted and that teaching ethics is, in itself, no guarantee of the moral integrity of physicians. The history of bioethics reveals that the professional ethos of physicians is more fragile than we might believe because it depends on the moral zeitgeist and politico-social circumstances, both of which are subject to change …
Today’s danger is imposing extreme individualism upon medical practice so that ethics is defined by the single standard of autonomy. As long as a patient acts “autonomously,” with informed consent, anything goes: from abortion, to self-mutilating surgery, to euthanasia.

And in the name of this ideology, every kind of injustice can be rationalised. Today, as in Nazi Germany, the medical profession is in danger of being purged of “politically unreliable elements” – conscientious objectors.

But autonomy is only one dimension of human well-being. It is compatible with loneliness, unhappiness, physical suffering, cruelty, and anti-social behaviour – as Belgium, the Netherlands and Canada are discovering while legal euthanasia expands its reach.

In many cases, today’s medical ethicists looking for examples of corrupt ethical reasoning need not google for images of Rudolf Ramm; they can simply take a selfie.

Michael Cook is editor of MercatorNet. This appeared at mercatornet.com and is reposted with permission.

Submissions Against Euthanasia To New Zealand Government Committee Shatter Assumptions


Friday, 5 May 2017, 2:59 pm
Press Release: Euthanasia Free NZ

77% of submissions to Parliament’s Health Select Committee are opposed to changing the law on assisted suicide and euthanasia, an analysis found. 

“The Voluntary Euthanasia Society touted that ‘the Health Select Committee received a record 21,533 submissions on the issue, indicating intense public interest in a potential law change’, says Renée Joubert, executive officer of Euthanasia-Free NZ. “By their own logic, the results of this analysis demonstrate an overwhelming opposition to a law change.”

“When New Zealanders are given the opportunity to engage with the issue, as opposed to merely responding to a single poll question, most support the current legislation. This is certainly our experience when interacting with people all over the country.

“The public are understandably concerned that the legalisation of assisted suicide and voluntary euthanasia poses risks to vulnerable people, which is why advocates propose safeguards. However, these safeguards are unenforceable in practice.

“Polls often elicit a knee-jerk reaction, especially when the questions are emotive or leading, such as referring to a painful condition. In reality nowadays, terminally ill Kiwis do not need to die in pain. A poll question about euthanasia for pain is inappropriate.

“As the authors of the January 2017 NZMJ study admitted, “the item in our study included the terms ‘painful’, ‘incurable disease’ and ‘request’, which may have influenced participants to express increased support for euthanasia’.”

The Care Alliance analysed 21,277 submissions, excluding duplicates and a small number that could not be coded. An independent research company reviewed a sample of the coded submissions and concluded “with at least 95% confidence that the overall classification percentages are accurate within no more than 0.4% variation”.

The results of the full analysis shatter assumptions about public attitudes to euthanasia and assisted suicide.

• The assumption that the high number of submissions demonstrate overwhelming support for a law change:

The analysis found that 77.1 % of submissions (16,411) were opposed to a law change, 19.5 % (4,142) were in favour, and 3.4 % (724) were neutral or unclear on this issue.

• The assumption that support of legalisation is secular and opposition to legalisation is based on religious beliefs:

63.6 % of submissions (13,539) oppose a law change and also make no reference to religion. Only 18.5% of submissions (3,934) support a law change and also make no reference to religion.

There are religiously motivated people on both sides of the debate. 14.8 % of submissions included religious arguments. The majority of these (13.5% of the total) oppose a law change, and 208 submissions (0.93% of the total) support a law change.

• The assumption that submissions opposing a law change are mostly one-liners:

About 44% of submissions in opposition are between two lines and a page. Even if submissions of a certain length were to be discounted, the submissions opposing a law change would still outnumber those supporting a law change in other length categories.

The Health Select Committee conducted an investigation into ending one’s life in New Zealand, in response to a petition by former MP Hon Maryan Street and 8,974 others in June 2015 requesting Parliament to “investigate fully public attitudes towards the introduction of legislation which would permit medically-assisted dying in the event of a terminal illness or an irreversible condition which makes life unbearable”.

After extensive media coverage about the investigation, especially during January 2016, the Committee processed 21,435 written submissions, a record number of unique submissions received on any issue to date. These, and subsequent supplementary submissions, are published on Parliament’s website.

In August 2016 Dr Jane Silloway Smith analysed a random sample of these submissions and found that 78% were opposed to changing the law while 22% were in favour. The 16000voices.org.nz campaign was launched to highlight some submissions in video and written form. 


Ends

Friday, May 5, 2017

Victoria Australia: Extending euthanasia, even before the bill is written.

This article was published by HOPE Australia on their website on May 5, 2017.

Paul Russell
By Paul Russell

Anyone looking at the experience in Canada since euthanasia and assisted suicide laws came into force last year, should be struck by the moves to extend the law so soon after they had been passed. After all, when you look to Belgium and Holland and even Oregon USA, the moves to expand their laws and/or the application of their laws has taken some time to develop.

There are many reasons why the European and Oregon situations have taken time to see the various incremental legal and effective interpretational changes gather momentum. In Belgium and Holland the statutes were written in very broad terms relating to unbearable and irretrievable suffering. While the understanding at the time of their debates focussed on euthanasia as a 'last resort' option for people in the last stages of a terminal illness, the wording never restricted application in that way.

In the last five years and more there has been a continual pushing at the edges of the community understanding of the breadth of the law. Euthanasia for tinnitus, for blindness, for psychological suffering, for the accrual of minor complaints associated with old age, for fear of entering a nursing home - all unthinkable in the beginning. Add to that the 2013 statute amendment to include children in Belgium and the current discussion in Holland in respect to assisted suicide for people over 70 years of age who are simply 'tired of life', and one can legitimately wonder where it will all stop.

As Dutch journalist, Gerbert van Loenen once observed:
“Making euthanasia and physician-assisted suicide legal started a development we did not foresee. The old limit ‘thou shalt not kill’ was abandoned, a new limit is yet to be found.”
Canada seems bent on catching up with the Benelux countries at some pace.

In Victoria, Australia, there also seems to be something of a rush.

A Ministerial Advisory Panel charged with the role of consulting about how to make assisted suicide safe, is due to provide an interim report to Premier Daniel Andrews any day now. The final report is due in July and legislation is slated for the second half of this year.

The Panel's reference was the Legal and Social Issues Committee of the Victorian Parliament report in the matter of the 'Inquiry into End of Life Choices' that was finalised in mid-2016.

Recommendation 49 of that report called upon the Victorian Parliament to legislate assisted suicide for people, “suffering from a serious and incurable condition which is causing enduring and unbearable suffering” and that these persons must be “at the end of life (final weeks or months of life)”.

So, not necessarily but most likely a terminal illness but still only for those at the very end or, as the Dutch talked about: a 'last resort' option.

Politically this makes sense. The game, if I can call it that, is to gain 50% plus one support in the two chambers of parliament. The logic is, of course, that it is the first hurdle that is the hardest. Better to get something on the statute books rather than risking yet another loss from trying for too much.

In September last year, Victorian Health Minister, Jill Hennessy warned pro-euthanasia advocates not to be too greedy:
“Politicians need to ask themselves: is it about being pure or is it about saying ‘let’s get the best result we can’?”
This warning did not stop Victorian euthanasia supporter, Dr Rodney Syme from entering the debate immediately arguing for an expansion of eligibility to include "neurological failure, such as multiple sclerosis, motor neurone disease and Parkinson's disease, who have progressive diseases, and those with profound stroke or high quadriplegia who have a static condition, may have an ill-defined trajectory to death, and while suffering unbearably, may be discriminated against by narrow legislation." It is precisely the same sort of argument that could (and will) be made for a later amendment if Syme does not get his way. Think about that.

Indeed, everyone knows that later extension is a possibility via an amendment bill. Euthanasia for children was originally considered for the first Belgian debate. Trudo Lemmens relates that, ‘children were explicitly excluded from the ambit of the original law because “it was deemed so controversial that including it may have threatened approval of the Euthanasia Bill.”’

Back in Victoria, there have been a few 'leaks' about the possible direction the Panel's report might take. One article pointed to a plan not to provide effective conscience protections for doctors.

Today we are told that the Panel will recommend a prognisis-based qualifier:
But the advisory panel wants to extend the timeline and the government is believed to be considering three options: 24 months, 12 months or six months.
It is mere speculation on my part, but it would seem that this kind of qualifier might be a compromise position between the Parliamentary Inquiry's recommendation and the agitation of the likes of Syme. Either way, it is much broader than the original “at the end of life (final weeks or months of life)”.

This leaves many questions unanswered: Does this call into question the judgement of the members of the Parliamentary Committee? Is it now considered that the Victorian public are open to this kind of extension where those who submitted to the Parliamentary Inquiry were clearly not? Will the members of the Parliamentary Committee rebuke the Panel for their extension?

Lack of answers aside, the idea of incremental extension is now out in the open for all to see. No Victorian MP can ignore it. They now need to question, not whether the model presented satisfies their judgement on a set of limits, but that their vote in support of any framework will most certainly provide precursory endorsement and impetus to later extension.

Dutch Health Minister, Edith Schippers, speaking enthusiastically about euthanasia recently, confirmed: "One thing is certain: on euthanasia and assisted suicide, we will never be finished."

The Panel's interim report is likely to be made public in the next few weeks.

Thursday, May 4, 2017

Physicians, Conscience, and Assisted Dying.

This article was written by lawyers, Derek Ross and Deina Warren and published on May 4 in the publication - Policy Options.

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Deina Warren
y requiring that physicians make referrals for assisted dying, Ontario is forcing them to leave medicine or abandon their ethical framework.

Of all the jurisdictions worldwide that permit some form of assisted suicide, Ontario stands alone in mandating that physicians participate in it.

Assisted suicide, or “medical assistance in dying” (MAID), as it is now known, was decriminalized in certain specific circumstances as a result of the Supreme Court’s 2015 decision in Carter v. Canada and has been implemented through Bill C-14, which amended relevant sections of the Criminal Code in 2016.

But does permitting what was once a criminal activity now mean that all health care professionals must participate? Not according to the Supreme Court. In Carter the Court affirmed that nothing in its ruling would compel physicians to participate in assisted dying. Bill C-14 similarly affirmed that nothing in the amendments would affect the constitutional guarantee of freedom of conscience and religion.

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Derek Ross
nd yet Ontario requires its physicians to participate. Through two policies (Medical Assistance in Dying and Professional Obligations and Human Rights), the College of Physicians and Surgeons of Ontario (CPSO) mandates all physicians to provide “effective referrals” for patients seeking MAID even when their conscience dictates otherwise.

Why are these requirements so offensive? What is it about freedom of conscience that is so important? And why shouldn’t the government mandate participation in what is no longer a criminal act? Much can be written in response to these questions, but two key points will be made here. First, compelling physicians to participate in MAID results in the state deciding what everyone should believe; and second, it undermines physicians’ moral integrity, a foundational component of medical ethics and principled health care.

A blueprint for moral conformity

Demanding that physicians participate in MAID imposes state-approved morality on physicians, enforcing moral conformity. It is more than a judgment about the legitimacy of conscientious objection in general; it eliminates any room for dissenting and independent views on deeply contested moral principles, and it does so with the weight and authority of the state, meaning the state has the ability to impose sanctions for falling outside the scope of what it deems permissible.

The CPSO has chosen to draw a line between refusal to administer the fatal drug, which it will accommodate when a physician has a conscientious objection (at least for now), and refusal to make a referral for that same fatal drug, which it will not accommodate. In refusals to refer, the CPSO denies the existence of a possible violation of conscience. Why accommodate the former and not the latter? Some see the distinction as an access issue for patients but, as the Canadian Medical Association (CMA) has recognized, this position is “not empirically supported internationally, where no jurisdiction has a requirement for mandatory effective referral, and yet patient access does not seem to be a concern.”

This differentiation is also inconsistent: if patient access concerns are sufficient to override sincere conscientious objections in the context of referrals for MAID, would they not be sufficient to override sincere conscientious objections to directly providing euthanasia or assisted suicide as well? If physicians chose, en masse, to boycott assisted suicide, would the state nonetheless compel them to end their patients’ lives?

Proponents of effective referrals argue that since MAID is now authorized by law and publicly funded, all health care professionals must facilitate it, even if they cannot directly provide it themselves. However, Canada’s constitutional guarantee of freedom of conscience is not contingent on whether an objectionable act is legal.

Consider conscientious objectors in the context of war. The government may fund and authorize participation in war, considering it a public good, perhaps even a necessary public good, and yet allowance is made for conscientious objectors. Not all otherwise qualified Canadians are obliged to go to war. Even during periods of conscription, there were mechanisms to exempt conscientious objectors. (Whether they were effective or fair is another issue.)

Or consider physician participation in capital punishment in the United States. The American Medical Association is very clear that although capital punishment may be legal, “as a member of a profession dedicated to preserving life when there is hope of doing so, a physician must not participate in a legally authorized execution.” It defines participation broadly, to include directly causing death or assisting, supervising or contributing to the ability of another person to directly cause death, assessing competence, monitoring vital signs, certifying death, consulting with lethal injection personnel and other actions.

Both these scenarios provide for legally authorized killing and for protection of freedom of conscience; in the case of executions, there is a professional mandate against participation.

To be clear, MAID involves the intentional act of prematurely ending a patient’s life. It is more than simply withdrawing life-prolonging treatment or artificial life support; MAID is legalized killing. For physicians who object to euthanasia, killing a patient violates clear ethical and moral (sometimes religious) prohibitions, whether it is legal or not. Indeed, the position of the World Medical Association (WMA) is that euthanasia, defined as “the act of deliberately ending the life of a patient, even at the patient’s own request or at the request of close relatives,” is “in conflict with basic ethical principles of medical practice.” The WMA “strongly encourages all National Medical Associations and physicians to refrain from participating in euthanasia, even if national law allows it.”

Physicians were identified in the Carter case as appropriate gatekeepers for MAID precisely because their independent, professional judgment makes them uniquely capable of detecting a patient’s vulnerability. Professional judgment that detects vulnerability and professional judgment that assesses patients’ best interests are informed by the same ethical framework. Professional judgment is, by its very nature, holistic; it integrates education, clinical experience and, critically, a morally informed ethical framework. The state cannot pick and choose which aspects suit its purposes and jettison the rest.

As Justice Doherty of the Ontario Court of Appeal recognized in the context of medical marijuana in 2013, a doctor’s ability to deny a patient’s request on the basis of professional judgment — including the view that certain legal treatment options are medically contraindicated — is inherent in legislative schemes that entrust physicians with a gatekeeper role. After all, professional judgment is meant to provide the safeguards that were necessary preconditions for MAID’s decriminalization.

Decriminalization by the Supreme Court does not — indeed cannot — mandate that everyone’s conscience must align with its decision nor require that all physicians accept MAID as ethical or even good health care. Neither does it create a “right to access” that physicians are obliged to facilitate. When physicians lose their Charter-protected right to follow their conscience by state edict, it is not a mere personal loss.

Removing ethical boundaries for physicians erodes quality health care for patients

For some conscientiously objecting physicians, the effective referral requirement means they will stop accepting patients who are likely to request MAID, leave Ontario to practise where conscience is protected or leave the practice of medicine altogether, as has happened in Australia and Norway.

Mandating referral for MAID, aside from being unnecessary to facilitate access, incorrectly assumes that all patients want a physician who is willing to participate in MAID (directly or indirectly) or is willing to act against his or her own conscience by referring patients. In such a model of care, there is no room for patients who seek out health care professionals who practise medicine according to principles that reflect their own moral convictions, including those who value human life unconditionally. Conscientiously objecting physicians enhance patient health care. As the CMA has stated, it is in a patient’s best interests for the physician to act as a moral agent rather than a technician devoid of moral judgment.

Physicians who were initially willing to provide MAID have found the experience “emotionally distressing” and “overwhelming” to the point that they cannot continue the practice. It is safe to assume that for the conscientious objector, the moral distress of participating either directly or indirectly would be exponentially greater. Not only does forcing physicians to act against their conscience cause distress, it desensitizes them to what are important moral and ethical cues as to the appropriate professional response to any given situation. It diminishes — and ultimately extinguishes — the internal barometer by which physicians exercise their professional judgment. Such moral integrity is foundational to a physician’s trustworthiness

In short, by demanding effective referrals, Ontario is forcing physicians to either leave the practice of medicine or abandon their ethical framework altogether. Neither is a good outcome for health care, or for patients in need of caring and competent doctors.

Ontario prides itself on being a province committed to inclusivity, diversity and human rights. It should not stand as a global anomaly in failing to safeguard freedom of conscience, freedom of religion and religious equality in this context. Now is the time for Ontario to reflect the international consensus that conscience is worth protecting.

The authors represent three organizations jointly intervening in Christian Medical and Dental Society et al. v. College of Physicians and Surgeons of Ontario (CPSO), a case that involves a constitutional challenge to the CPSO’s “effective referral” requirement. The case is expected to be heard by the Ontario Divisional Court in June 2017.

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