Saturday, July 14, 2018

Euthanasia drug Execution drug controversy.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition



I have always wondered why the same drug cocktail can be both controversial and promoted at the same time. We are shocked when a drug cocktail is used for capital punishment or suicide but promote the same drug cocktail when used for euthanasia.

The first story concerns a drug company that filed a lawsuit to stop the use of a drug that it produces being used for executions in Nevada.

The ACLU wrote, concerning this drug cocktail that Nevada was planning to use a risky and experimental drug cocktail to execute a prisoner. The article explains the side-effects of using this drug cocktail and it concludes:

A government that would risk torturing someone to death is not dispensing justice or serving the public good. It is deeply troubling that Nevada government officials are barreling ahead with execution when the chances of torturing Dozier are so high.
It is important to know that the same or similar drug cocktails are used for euthanasia and the ACLU supports euthanasia.

For clarity, I oppose capital punishment and I believe that the state should not have the right to kill, or be involved with killing its citizens. At the same time I believe that medical professionals should not have the right to kill or be involved with killing their patients.

Another article concerns a probe into euthanasia drugs that may have been illegally imported into the United States. The article states:

The solution in question, called "...," contains ..., which is used in lethal injection cocktails. The trade of ... is highly regulated by European Union anti-torture directives and is subject to strict export restrictions. 
(I omitted the name of the drug to prevent promotion of these drugs)
Don't get me wrong, it is very concerning that euthanasia drugs may have illegally entered the United States, but the concern from the drug company is that these drugs may be used for capital punishment. The fact is that this type of drug is being used for euthanasia.

Everyday I receive euthanasia related news stories. Tragically, stories about veterinarians who use euthanasia drugs to die by suicide are not uncommon. There have also been stories about euthanasia drugs being stolen from veterinary clinics. One euthanasia activist promotes buying euthanasia drugs from veterinary suppliers in the third world.

Suicide is always a tragedy. Sadly veterinary workers have one of the highest suicide rates. Some studies indicate that the euthanasia of animals is a contributing factor to the high suicide rate.


I ask the question, how can drugs be considered risky, experimental and a form of torture in one circumstance, and a human right when it is used for euthanasia?

Every human person deserves to be treated with dignity, care and respect, but the state should never have the right to kill its citizens. At the same time medical professionals should never have the right to kill their patients. 

Current attitudes toward euthanasia are delusional. Killing people or encouraging people to self-kill is wrong.

Friday, July 13, 2018

Your help is needed to stop assisted suicide in California.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

The California assisted suicide law is being successfully challenged through the courts and the outcome may depend on you.

Life Legal Defense Foundation is successfully arguing that the California assisted suicide law is unconstitutional, but they are being challenged by the assisted suicide lobby and California Attorney General (AG), Xavier Becerra. Life Legal Defense Foundation needs your financial support to prevent this case from turning into a David and Goliath story.

On May 15, 2018 Judge Daniel Ottolia declared that the California assisted suicide law was unconstitutional when it enacted the assisted suicide law during a special session dedicated to health care funding. Life Legal Defense stated in their media release:
Judge Ottolia found that the End of Life Option Act “does not fall within the scope of access to healthcare services” and “is not a matter of healthcare funding.” Moreover, the court ruled that, “The legislation decriminalizing assisted suicide cannot be deemed a matter incidental to the purpose of the emergency session.”
The California AG appealed the decision to the 4th District Court of Appeal, who upheld the decision of Judge Ottolia and since the court of appeal refused to stay the decision assisted suicide was once again prohibited in California.

The California AG then went back to the 4th District Court of Appeal to request a stay of the decision and on June 15, the court of appeal granted a stay of the decision, once again permitting assisted suicide in California.

Alexandra Snyder
The most recent article, published in Valley News, explains that the fate of the California assisted suicide law will be decided by the appellate court later this summer. The Valley News article states:
Life Legal Defense Foundation Executive Director Alexandra Snyder said her organization remains dedicated to seeing the law permanently invalidated to protect “citizens from being ‘helped’ to commit suicide.” 
The foundation has underscored in literature what it describes as troubling aspects of the law, including that a “family member can initiate the request for assisted suicide ... not the person seeking suicide;” “an interested ‘witness’ – someone who will benefit financially from the person’s death – can sign off on the suicide drug request” and “any doctor or osteopath can write the prescription” without a history of interaction with the patient.
The reality is that Life Legal Defense has proven that the California assisted suicide law is unconstitutional but they are facing mammoth opponents who have infinite resources to promote assisted suicide in California. 

Life Legal Defense Foundation needs your financial support to ensure that the lives of Californians are protected from assisted suicide.

According to the assisted suicide lobby 504 people have died by assisted suicide in California since June 2016.

Thursday, July 12, 2018

Not Dead Yet: Tracy Latimer Must Not Be Erased; Her Murder Must Not Be Pardoned.


Media Release

Contact: Amy Hasbrouck 450-921-3057 12 July 2018

TRACY LATIMER MUST NOT BE ERASED; HER MURDER MUST NOT BE PARDONED.

Multiple news outlets are reporting that Robert Latimer has submitted a letter to the Minister of Justice seeking a pardon or a new trial following his conviction for the murder of his daughter Tracy in 1993.

Latimer has been free on parole since 2010. Contrary to some media reports, Latimer has been able to travel outside Canada since 2015, according to the Globe and Mail.

Disability rights activists are concerned that the pardon request is a “symptom and effect of the continuing devaluation of disabled people” as shown by the legalization of assisted suicide and euthanasia in 2016, according to Amy Hasbrouck, director of Toujours Vivant-Not Dead Yet. She notes that individual choice is supposed to be key to the suspension of homicide laws in cases of assisted suicide and euthanasia. “Yet Tracy was not given a choice.”

Hasbrouck says public policies that favour institutional care over home-based supports, and failure to fund such supports, as well as palliative care, deprive disabled people of any real choice in where and how they live. “Under those circumstances, how can the choice to die be truly ‘free’?” she said.

Though Hasbrouck agrees that Tracy Latimer should have received effective pain relief, she finds the statement that ‘Tracy Latimer's life should have ended 'unintentionally' as a secondary consequence of her physicians' administration of opiates to alleviate her pain,” to be “ignorant, insulting, and offensive.”

Hasbrouck also points to a claim made by Latimer’s attorney Jason Gratl that "[g]ranting a pardon to Mr. Latimer does not detract from any value or principle.”

“Pardoning Tracy’s killer would signal a failure of the Government’s commitment to equality, justice, and ending discrimination against disabled Canadians,” said Hasbrouck.

She noted that the Latimer conviction was “the exception to the rule” that parents who kill their disabled children receive more lenient treatment from the criminal justice system than do parents who kill their non-disabled children.

Toujours Vivant-Not Dead Yet (TVNDY) is a nonreligious and nonpartisan organization established in 2013 by and for people with disabilities as a project of the Council of Canadians with Disabilities. Our goal is to inform, unify and give voice to the disability rights opposition to assisted suicide, euthanasia, and other life-ending practices that have a disproportionate impact on people with disabilities.


TRACY LATIMER NE DOIT PAS ÊTRE EFFACÉ; SON MEURTRE NE DOIT PAS ÊTRE EXCUSÉ.

Contact:  Amy Hasbrouck 450-921-3057                                         12 July 2018

Plusieurs médias rapportent que Robert Latimer a envoyé une lettre au ministre de la Justice pour demander la grâce ou un nouveau procès pour le meurtre de sa fille Tracy en 1993.

Latimer est en liberté conditionnelle depuis 2010. Contrairement à certains reportages dans les médias, Latimer a pu voyager à l'extérieur du Canada depuis 2015, selon le Globe and Mail.

Selon Amy Hasbrouck, directrice de Toujours Vivant-Not Dead Yet, les militants des droits des personnes en situation de handicap craignent que la demande de grâce soit un « symptôme et effet de la dévaluation continue des personnes avec déficiences ». Elle note que le choix individuel est censé être la clé de la suspension des lois sur l'homicide dans les cas de suicide assisté et d'euthanasie. « Pourtant, Tracy n'a pas eu de choix. »

Hasbrouck dit que les politiques publiques qui favorisent les soins institutionnels plutôt que les soins à domicile, et le manque de financement de tels soutiens, ainsi que les soins palliatifs, privent les personnes avec des incapacités de tout choix réel quant à où et comment elles vivent. « Dans ces circonstances, comment le choix de mourir peut-il être vraiment "libre"? » A-t-elle dit.

Bien qu'Hasbrouck convienne que Tracy Latimer aurait dû recevoir un soulagement efficace de la douleur, elle trouve l’énonce « la vie de Tracy Latimer aurait dû se terminer "involontairement" comme une conséquence secondaire de l'administration d'opiacés par ses médecins pour soulager sa douleur, » être ignorante, insultant et offensant. "

Hasbrouck fait également allusion à une affirmation de l'avocat de Latimer, Jason Gratl, selon laquelle « le fait de gracier un pardon à M. Latimer ne porte atteinte à aucune valeur ou principe. »

« Pardonner l'assassinat de Tracy signifierait un échec de l'engagement du gouvernement envers l'égalité, la justice et l'élimination de la discrimination contre les Canadiens avec déficiences, » a déclaré Hasbrouck.

Elle a noté que la condamnation Latimer fait « l'exception à la règle » que les parents qui tuent leurs enfants ayant des incapacités reçoivent un traitement plus clément du système de justice pénale que les parents qui tuent leurs enfants non handicapés.

Toujours Vivant-Not Dead Yet (TVNDY) est une organisation non religieuse et non partisane fondée en 2013 par et pour les personnes handicapées dans le cadre d'un projet du Conseil des Canadiens avec déficiences. Notre objectif est d'informer, d'unifier et de donner une voix à l'opposition aux droits des personnes handicapées contre le suicide assisté, l'euthanasie et d'autres pratiques qui mettent fin à la vie et qui ont un impact disproportionné sur les personnes handicapées.
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90 des Ceminots Valleyfield QC J6T 2V2, www.tvnyd.ca / info@tv-ndy.ca /450-921-3057

Wednesday, July 11, 2018

Winnipeg man (Ron Siwicki) sentenced to three months in horrific elder abuse case.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition


Ron Siwicki (left)
Elizabeth Siwicki (right)
Ron Siwicki, the Winnipeg man who left his mother to die over 3 weeks, was sentenced to three months in jail, after pleading guilty to negligence causing death last January.

This is a horrific case of elder abuse neglect. It was also a story that euthanasia activists used to promote euthanasia in Canada.

According to a July 10 CBC News report by Erin Brohman Elizabeth Siwicki, who died in December 2014, was living with dementia. The report states:
She fell out of bed in November 2014 and couldn't get up. 
Siwicki, who was her caregiver, cried as he said his mother did not want to go to a hospital. 
She was left in the spot where she had fallen for more than three weeks, covered in her own excrement. 
She died of sepsis after the bed sores covering her body from the prolonged immobility became infected. An autopsy found that the bed sores were so severe, they went down to her bones. 
Siwicki said he tried to care for his mother after her fall by giving her nutritional supplement drinks and water. He waited until his mother died before he tried to clean her or call an ambulance. 
There was so much human waste around her that the carpet underneath had buckled, court was told.
Siwicki claimed that he was following the wishes of his mother but based on the statement of facts, it seems very hard to believe him.

This is a tragic case of elder abuse. Even if his mother refused to go to the hospital leaving her for three weeks to lay in her own excrement is inhumane. 

The fact that a euthanasia activist used this case to promote euthanasia, shows the mentality of those who push death upon our culture rather than recognizing how Elizabeth Siwicki was neglected and abused.

Germany Grapples With Assisted Suicide In Courts and Parliament

The following article by Sarah Carver was published by Not Dead Yet on July 9, 2018

By Sarah Carver

This hasn’t previously been on NDY’s radar (h/t to Euthanasia Prevention Coalition), but Germany has been grappling with assisted suicide since at least 2005, when a woman disabled by paralysis, Bettina Koch, sought to purchase suicide drugs domestically. She was denied, and then travelled to Switzerland and committed suicide “with the help of the Dignitas euthanasia association.”
*Recently Germany's Health Minister decided to stop providing euthanasia drugs.
In 2012, after a years-long legal battle, her surviving husband received a ruling from the European Court of Human Rights. Although it did not rule broadly on individuals’ rights to assisted suicide, the Court did state that “German courts were negligent in refusing to hear [his wife’s] case,” sending it back to the German courts.

According to DW.com, a German news outlet, the European Court of Human Rights — “decided not to issue a ruling on the right to assisted suicide, saying this duty fell to individual countries. . . . [T]he court said it would not issue a binding ruling on the matter, especially as only four of the 42 comparative states the court examined allowed active assisted suicide. Only three EU member countries – the Netherlands, Belgium and Luxembourg – currently permit active assisted suicide, when someone agrees to a request from the patient to help them end their life. Switzerland is not in the EU.” (As of 2013, there are 28 countries in the EU.)

In a 2015 article, DW.com reported that, “In Germany, assisted suicide is not illegal under criminal law, but the doctors’ own professional code of ethic prohibits it.”

However, in 2015, the German Parliament voted against allowing commercial associations to help people to commit suicide. This criminalized the practice for such groups. At the same time, Parliament rejected other bills to fully legalize assisted suicide. Nevertheless, family members or close associates were reportedly still exempted from punishment in assisted suicide cases.

The after-effects of the 2012 “special case” were again keenly felt in 2017. After subsequent proceedings, on March 2, 2017, DW.com reported that Germany’s federal court ruled that people:

. . . “in extreme circumstances” should have legal access to drugs to end their own lives.
The federal administrative court in Leipzig ruled in favor of “the right for a patient who is suffering and incurably ill to decide how and when their life should end” provided the patient “can freely express their will and act accordingly.”

Reportedly, the purchase of deadly drugs in Germany is forbidden (though not criminal except for commercial associations), but the court found that the right of self-determination meant there should be exceptions for extreme cases “if, because of their intolerable life situation, they had freely and seriously decided to end their lives” and if there were no palliative-medical alternatives.

The “extreme cases” concept based on Mrs. Koch’s case of paralysis is extremely objectionable from a disability perspective, and the absence of a definition of what constitutes an extreme and exceptional case meriting assisted suicide is more than troubling.

In the same year, German Parliament strengthened palliative care to require greater insurance coverage of hospice care for patients in the country.

Then, in January of 2018, the 2017 ruling was called into question by former German Supreme Court judge Udo di Fabio. Also an attorney for Germany’s Federal Institute for Drugs and Medical Devices (BfArM), di Fabio asserted that the state providing drugs to individuals is unconstitutional, as it means the state intervening in some of an individual’s most personal choices. Since 2017, the BfArM had “not only [been] ordered to supply the pill, but also to decide on its own which cases effectively warranted suicide and which didn’t.”

Among other things, the shadow of the Holocaust renders Germany especially sensitive to state intervention in the lives and deaths of its citizens. The BfArM fears the possibility of enacting similar levels of state violence if it continued to be granted the power to give suicide drugs to patients. Although the outcome of di Fabio’s challenge remains to be seen, he has influential people such as Germany’s Federal Health Minister, Hermann Gröthe, on his side; as well as organizations like the German Foundation for Patient Protection. We hope that these and other actors will continue to stand in opposition to state involvement in assisted suicide in Germany. But frankly, if families are permitted to assist suicide, one wonders if these opponents have ever heard of elder abuse, because from Not Dead Yet’s point of view they’ve certainly left a gaping hole in patient protections.

Monday, July 9, 2018

12 Myths About Assisted Suicide and Medical Aid In Dying

This article written by Ronald W. Pies, MD and Annette Hanson, MD and it was published by mdmag.com on July 7, 2018

Dr Annette Hanson

Introduction

In an age of “alternative facts”, it’s hard to sort out myth from reality when it comes to so-called ‘medical-aid-in-dying’ (MAID)—also called physician assisted suicide (PAS). By whatever label we attach to it, this practice involves a physician’s prescribing a lethal drug for a patient with a putatively terminal illness who is requesting this “service.” Some form of MAID/PAS is now legal in 5 states and the District of Columbia.

People of good conscience, including many physicians, are sharply divided on the ethics of MAID/PAS. Unfortunately, much of the support for this practice is founded on several myths and misconceptions regarding existing MAID laws and practices. Here are 12 of the most common.

1. Everyone has a “right to die”, including a right to take one’s own life, acting alone or with assistance.

Dr Ronald W. Pies
In contrast to “liberties”, rights entail the cooperation or assistance of others.1 Mentally competent people may be at liberty to end their own lives (i.e., will not be prosecuted), but there is no recognized right to suicide that involves the cooperation of others. In Washington v. Glucksberg [521 U.S. 702 (1997)], the US Supreme Court (USSC) denied that there is a constitutionally-protected “right to commit suicide” or a right to PAS. To rule otherwise, the majority held, would force them to “reverse centuries of legal doctrine and practice, and strike down the considered policy choice of almost every state.”

That said, the USSC has held that all competent persons have the right to refuse unwanted or “heroic” measures that merely prolong the dying process.2 Similarly, in Vacco v. Quill [521 U.S. 793(1997)], the USSC held that there is a legal difference between withdrawal of care and provision of a lethal intervention; i.e., everyone has a right to refuse medical care, but no one has a “right” to receive a lethal means of ending one’s life.

2. People who request “medical aid in dying” usually do so because they are experiencing severe, intractable pain and suffering.

Most requests for medical-aid-in-dying are not made by patients experiencing “untreatable pain or suffering”, as data from Oregon have shown; rather, the most common reasons for requesting medical aid in dying were loss of autonomy (97.2%), inability to engage in enjoyable activities (88.9%), and loss of dignity (75.0%).3

Many patients who request assisted suicide are clinically depressed and could be successfully treated, once properly diagnosed.

3. In states such as Oregon and Washington, where PAS is legal, there are adequate safeguards in place to ensure proper application of the PAS law.

In Oregon, reporting to the state is done solely by the physician prescribing the lethal drugs, who has a vested interest in minimizing problems. Moreover, if a physician was negligent in making the initial diagnosis or prognosis, there is no way to track this, since, by law, all death certificates will state that the person died of the putative underlying disease. At the same time, the physician is rarely present at the time the patient ingests the lethal drug, so the possibility of abuse—e.g., by coercive family members—cannot be adequately assessed.

The Oregon department of human services has said it has no authority to investigate individual death-with-dignity cases,4 and Oregon has acknowledged that its law does not adequately protect all people with mental illness from receiving lethal prescriptions.5 Thus, it is nearly impossible to determine cases in which, for example, terminally ill patients were pressured to end their lives by family members. A study in the Michigan Law Review (2008) found that “seemingly reasonable safeguards for the care and protection of terminally ill patients written into the Oregon law are being circumvented…[and that]…the Oregon Public Health Division (OPHD), which is charged with monitoring the law…does not collect the information it would need to effectively monitor the law…OPHD…acts as the defender of the law rather than as the protector of the welfare of terminally ill patients.”6

Kenneth R. Stevens, Jr., MD, and William I. Toffler, MD, both of the Oregon Health & Science University, point to other actual or potential abuses in PAS-permissive states, including "physician shopping" to get around safeguards; nurse-assisted suicide without orders from a physician; and economic pressures to use PAS, such as Oregon Medicaid patients being denied cancer treatment but offered coverage for assisted suicide.7 Furthermore, an investigative piece by the Des Moines Register revealed that mandatory reporting requirements were not followed by hundreds of doctors in states where MAID/PAS is legal.8

4. In the US, only people with terminal or incurable illnesses are eligible for PAS.

Most PAS legislation applies to an adult with a terminal illness or condition predicted to have less than 6 months to live. In Oregon and Washington State, nearly identical criteria are interpreted to mean less than 6 months to live—specifically, without treatment. Thus, a healthy 20-year-old with insulin-dependent diabetes could be deemed “terminal” for the purpose of Oregon’s “Death with Dignity Act.”

So, too, patients refusing appropriate treatment may be deemed “terminal” under current interpretation of the Oregon law. Thus, a patient with anorexia nervosa who refused treatment could be eligible for PAS under Oregon law, even though she could recover with intensive therapy. As Swedish investigator Fabian Stahle observes, “This is in fact an alteration of the traditional meaning of the concept of ‘incurable.’”9

5. “Slippery slope” arguments against PAS are overblown. In European countries that allow PAS, there is no evidence that patients are being euthanized improperly.

People with non-terminal illnesses have been legally euthanized at their own request in several countries for nearly 15 years. This has included certain eligible patients who have only psychiatric disorders. In 2002, Belgium, the Netherlands, and Luxembourg removed any distinctions between terminal and non-terminal conditions—and between physical suffering and mental suffering—for legally permitted PAS. Between 2008 and 2014, more than 200 psychiatric patients were euthanized by their own request in the Netherlands (1% of all euthanasia in that country). Among them, 52% had a diagnosis of personality disorder, 56% refused 1 or more offered treatments, and 20% had never even had an inpatient stay (1 indication of previous treatment intensity). When asked the primary reason for seeking PAS/euthanasia, 66% cited “social isolation and loneliness.”

Despite the legal requirement for agreement between outside consultants, for 24% of psychiatric patients euthanized, at least 1 outside consultant disagreed.10-12

The US has not been immune to the slippery slope, either. For example, in Oregon, a psychiatrist opened a fee-for-service death clinic, where for $5,000, “terminally ill patients who are eligible to take advantage of…Oregon's suicide law can book a death that might look a lot like a wedding package.”13

6. The method of “assisted dying” now used in Oregon and other PAS-states assures the patient of a quick, peaceful death, without serious complications.

A peaceful death is by no means guaranteed using current methods of PAS, as a recent piece by Lo pointed out: 14 “Physicians who support PAD need to consider how to address the potential for adverse outcomes, including longer time to death than expected (up to 24 hours or more), awakening from unconsciousness, nausea, vomiting, and gasping.”

Data collected between 1998-2015 showed that the time between ingestion of lethal drugs and death ranged from 1 minute to more than 4 days. During this same period (1998-2015), 27 cases (out of 994) involved difficulty ingesting or regurgitating the drugs, and there were 6 known instances in which patients regained consciousness after ingesting the drugs. However, it is difficult to know the actual rate of drug-induced complications, since in the majority (54%) of cases between1998-2015, no health care professional was present to attend and observe the patient’s death.15

7. “Death with Dignity” all comes down to the patient’s autonomy, and the right of patients to end life on their terms.

In the first place, under current legislation permitting so-called medical aid in dying, the patient is completely dependent on the judgment, authorization, and prescriptive power of the physician—hardly a state of autonomy.1 Moreover, autonomy is only 1 of the 4 ‘cornerstones’ of medical ethics; the others are beneficence, non-malfeasance and justice. As Desai and Grossberg observe in their textbook on long-term care:

“The preeminence of autonomy as an ethical principle in the United States can sometimes lead health care providers to disregard other moral considerations and common sense when making clinical decisions…we strongly feel that the role of the medical profession is to understand but not to support such wishes [for physician-assisted death]. Every person’s life is valuable, irrespective of one’s physical and mental state, even when that person has ceased to deem life valuable.”16

8. Doctors who conscientiously oppose PAS are perfectly free to refuse participation in it.

In theory, the California guidelines state that "A healthcare provider who refuses to participate in activities under the act on the basis of conscience, morality or ethics cannot be subject to censure, discipline … or other penalty by a healthcare provider, professional association or organization," the guidelines say.17 However, prior to its PAS law being declared unconstitutional, physicians in California could be compelled to participate in PAS, under certain circumstances.

California's health department regulation requires a state facility to provide PAS. If the request is denied, the patient has a right to a judicial hearing on the matter. If the court determines the patient is qualified, the attending physician must write a prescription for lethal drugs.18 Moreover, there is evidence that physicians are sometimes pressured or intimidated by patients to assist in suicide.7

9. Terminally ill people who request MAID are not suicidal and don’t commit suicide. They are dying, and simply want “hastening” of an inevitable death. In contrast, genuinely suicidal people are not dying of a terminal condition, yet they want to die.

This argument plays fast and loose with language, logic, and law. In fact, it turns ordinary language on its head, thereby eliminating suicide by linguistic fiat. As the American Nursing Association states, “suicide is the act of taking one's own life,”19 regardless of the act’s context. There may indeed be different psychological profiles that distinguish suicide in the context of terminal illness from suicide in other contexts, but that does not overturn the ordinary language meaning of suicide. Thus, when a terminally ill patient (or any other person) knowingly and intentionally ingests a lethal drug, that act is, incontrovertibly, suicide.

Most suicides occur in the context of serious psychiatric illness. Yet patients who express suicidal ideation in the context of a condition such as major depression rarely want to die; rather, as numerous suicide prevention websites note, “Most suicidal people do not want to die. They are experiencing severe emotional pain, and are desperate for the pain to go away.” 20

10. People requesting PAS are carefully screened by mental health professionals to rule out depression.

Most PAS statutes modeled after the Oregon Death with Dignity statute do not require examination by a mental health professional, except when the participating physician is concerned and decides to do so. Specifically, “The patient is referred to a psychologist or psychiatrist if concern exists that the patient has a psychiatric disorder including depression that may impair judgment.”21

A study of the Oregon law concluded that “Although most terminally ill Oregonians who receive aid in dying do not have depressive disorders, the current practice of the Death with Dignity Act may fail to protect some patients whose choices are influenced by depression from receiving a prescription for a lethal drug.”21

In Oregon, 204 patients were prescribed lethal drugs in 2016 under the “Death with Dignity” statute, yet only 5 patients were referred for psychiatric or psychological evaluation.22

11. Doctors who participate in PAS are almost always comfortable doing so and rarely regret their decision.

Many doctors who have participated in euthanasia and/or PAS are adversely affected— emotionally and psychologically—by their experiences. In a structured, in-depth telephone interview survey of 38 US oncologists who reported participating in euthanasia or PAS, nearly a quarter of the physicians regretted their actions. Another 16% reported that the emotional burden of performing euthanasia or PAS adversely affected their medical practice.23 For example, one physician felt so “burned out” that he moved from the city in which he was practicing to a small town. Similarly, reactions among European doctors suggest that PAS and euthanasia often provoke strong negative feelings.24

12. For terminally ill patients, the only means of achieving “death with dignity” is by taking a lethal drug prescribed by one’s doctor.

Only a small minority of persons with a terminal disease seek a physician’s prescription for a lethal drug. It is not clear why self-poisoning confers more dignity to one’s death than more traditional and much more common ways of dying. Many people who are dying choose to “bear with” their pain. Some seek hospice care and—in cases of severe, intractable pain—merit palliative sedation.25

Some choose voluntary stopping of eating and drinking (VSED), which, according to one study involving hospice nurses, results in a more satisfactory death than seen with PAS. In fact, “as compared with patients who died by physician-assisted suicide, those who stopped eating and drinking were rated by hospice nurses as suffering less and being more at peace in the last two weeks of life.”26

A form of VSED called ‘sallekhana’ has been practiced in the Jain religion for centuries and is regarded as an ethical and dignified means of achieving a “natural” death.27
Conclusion

The case for physician-assisted suicide legislation rests on a number of misconceptions, as regards the adequacy, safety, and application of existing PAS statutes. The best available evidence suggests that current practices under PAS statutes are not adequately monitored and do not adequately protect vulnerable populations, such as patients with clinical depression. The American College of Physicians,28 the American Medical Association, the World Medical Association and the American Nurses Association have all registered opposition to physician-assisted suicide.

It is critical that physicians inform themselves as regards the actual nature and function—or dysfunction—of medical aid in dying legislation. The first step is to recognize and challenge the many myths that surround these well-intended but misguided laws.

Acknowledgments

The authors wish to recognize the important contributions of Dr. Mark Komrad and Mr. Alex Schadenberg to the discussion of physician-assisted suicide.

Ronald W. Pies, MD is Professor Emeritus of Psychiatry and Lecturer on Bioethics at SUNY Upstate Medical University, Syracuse, NY; and Clinical Professor of Psychiatry, Tufts U. School of Medicine, Boston.

Annette Hanson, MD, is Director of the Forensic Psychiatry Fellowship Program, and Clinical Assistant Professor, Department of Psychiatry, University of Maryland School of Medicine.

References

  1. Szasz T: Fatal Freedom. Syracuse University Press, 1995. 
  2.  https://constitutioncenter.org/blog/does-the-constitution-protect-a-right-to-die
  3. Loggers ET, Starks H, Shannon-Dudley M et al. Implementing a Death with Dignity program at a comprehensive cancer center. N Engl J Med. 2013 Apr 11;368(15):1417-24. https://www.nejm.org/doi/full/10.1056/NEJMsa1213398
  4. Oregon board investigates failed assisted suicide. Jun 20, 2005 http://www.drugtopics.com/community-pharmacy/oregon-board-investigates-failed-assisted-suicide
  5. The Oregon Death With Dignity Act: A Guidebook for Healthcare Providers, page 43. Accessed at: http://www.ohsu.edu/xd/education/continuing-education/center-for-ethics/ethics-outreach/upload/Oregon-Death-with-Dignity-Act-Guidebook.pdf
  6. Hendin H, Foley K.  Physician-Assisted Suicide in Oregon: A Medical Perspective, Mich. L. Rev. 106; 1613 (2008). Available at: https://repository.law.umich.edu/mlr/vol106/iss8/7
  7. Stevens KR, Toffler WI. Euthanasia and physician-assisted suicide. JAMA, 2016;316(15): 1599 https://jamanetwork.com/journals/jama/article-abstract/2569774
  8. Suicide with a helping hand worries Iowans on both sides of 'right to die'. Desmoine Register, 2016 Nov 25 https://www.desmoinesregister.com/story/news/investigations/2016/11/25/too-weak-kill-herself-assistance-legal/92407392/
  9. Stahle F. Oregon Health Authority Reveals Hidden Problems with the Oregon Assisted Suicide Model. https://www.masscitizensforlife.org/oregon-health-authority-reveals-hidden-problems-with-the-oregon-assisted-suicide-model
  10. Kim SYH, De Vries RG, Peteet JR. Euthanasia and Assisted Suicide of Patients With Psychiatric Disorders in the Netherlands 2011 to 2014. JAMA Psychiatry. 2016;73(4):362-368 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5530592/
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  20.  https://medicine.umich.edu/sites/default/files/content/downloads/macomb-county-cmh-holding-on-to-life-toolkit.pdf
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  25. Statement on Palliative Sedation. Approved by the AAHPM Board of Directors on December 5, 2014 http://aahpm.org/positions/palliative-sedation
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