Tuesday, January 22, 2019

Canada's new Justice Minister is radically pro-euthanasia.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition.

I am concerned about the expansion of euthanasia to children in Canada.
On January 16, Prime Minister Trudeau indicated his intention to expand Canada's euthanasia law when he appointed David Lametti as Justice Minister.

Jody Wilson-Raybould (left)
David Lametti (right)
Based on the fact that the previous Justice Minister, Jody Wilson-Raybould, after the release of the Council of Canadian Academies (CCA) recently published their reports on the expansion of euthanasia in Canada to include children, psychiatric conditions alone and incompetent people who previously requested euthanasia, stated that no changes to the law were coming, it seems likely that Lametti was appointed to expand the law.

Lametti voted against Bill C-14, the bill that legalized euthanasia in June 2016, because he thought that the law was too restrictive and thus unconstitutional.

● Article: Is Child Euthanasia Next in Canada?
I am concerned about the expansion of euthanasia to children. The CCA report on Child Euthanasia stated:
Denying MAID to mature minors would pose a potential future legal challenge if a case were to be brought forward in which a mature minor argued that their constitutional rights were being denied.
● Sign the online petition: I oppose Child Euthanasia.
The CCA reports were negative to the idea of expanding euthanasia to people with psychiatric conditions alone while the report on expanding euthanasia to incompetent people, who made a prior request, was mixed in its response. The euthanasia lobby is running a campaign to expand euthanasia to incompetent people who previously requested it.

I am also concerned about the conscience rights of medical professionals and institutions that refuse to participate in killing. 

Long-time euthanasia activist and "academic" Jocelyn Downie, is campaigning to force St. Martha's hospital to participate in euthanasia. Even though this is a provincial issue, the federal government could impact this debate.

Since the Liberals have a majority government, I hope that Lametti will wait until after the October 21 federal election, but it is possible that the Liberals will view euthanasia as a wedge issue and move to expand the law before summer.

Monday, January 21, 2019

Doctors Induce Twenty-Five Percent of Dutch Deaths

This article was published by National Review online on January 21, 2019

Wesley J Smith
By Wesley J Smith
An exposé on Dutch euthanasia published in The Guardian discloses that around twenty-five percent of Dutch deaths are induced/caused by doctors.
These are not all lethal-injection euthanasia deaths. As I have written here before, many more people are killed in the Netherlands by “terminal sedation”–a slow motion euthanasia wherein patients not in the active stage of dying are put into artificial comas and denied all sustenance until they dehydrate to death–than die by lethal jabs. (Terminal sedation should never be confused with the proper practice of “palliative sedation,” which eases a dying patient’s symptoms while not intentionally causing death.)

Back in 2012, I estimated that combined euthanasia, assisted suicide, and terminal sedation killings totaled about fourteen percent of all Dutch deaths. In the years since, these induced-death practices have apparently grown significantly, a phenomenon that did not escape the attention of The Guardian. From “Death on Demand: Has Euthanasia Gone Too Far?” (my emphasis):
As people got used to the new law, the number of Dutch people being euthanised began to rise sharply, from under 2,000 in 2007 to almost 6,600 in 2017. (Around the same number are estimated to have had their euthanasia request turned down for not conforming with the legal requirements.) 
Also in 2017, some 1,900 Dutch people killed themselves, while the number of people who died under palliative sedation – in theory, succumbing to their illness while cocooned from physical discomfort, but in practice often dying of dehydration while unconscious [that is, terminal sedation] – hit an astonishing 32,000. Altogether, well over a quarter of all deaths in 2017 in the Netherlands were induced.
Since euthanasia was first decriminalized in the Netherlands, the country’s doctors have traveled a very dark road. Induced deaths have expanded from the terminally ill who ask for it, to the chronically ill who ask for it, to people with disabilities and the elderly who ask for it, to people with dementia, psychiatric patients with mental illness (83 in 2017), and the infanticides of babies born with serious or terminal illnesses or disabilities, who don’t have the capacity to ask for it.

Dutch law permits organ harvesting to be conjoined with euthanasia. There have been joint geriatric killings of couples fearing widowhood. In 2015, Dutch statistics revealed that 431 patients were killed by doctors who never asked for euthanasia–known in the lexicon as “termination without request or consent”–with next to nothing done about it even though such unasked-for lethal acts are technically murder under the law.

Does this mean the Dutch are horrible, ghoulish people? Absolutely not. But they are logical. Once the population widely accepted the premise that killing is an acceptable answer to suffering, the country took that belief precisely where it leads.

Such horrors will happen here too if we allow ourselves to be similarly seduced by euthanasia consciousness. Those with eyes to see, let them see.

Sunday, January 20, 2019

Has euthanasia gone too far?

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Christopher de Bellaigue in his comprehensive article published on January 18 in the Guardian asks the question: Has euthanasia gone too far?

de Bellaigue, (the author) examines the experience with euthanasia in the Netherlands, by interviewing supporters and critics of euthanasia. The author outlines how euthanasia was originally promoted as a response to exceptional circumstances and is now being considered for people who think their life is "complete." He writes:
As the world’s pioneer, the Netherlands has also discovered that although legalising euthanasia might resolve one ethical conundrum, it opens a can of others – most importantly, where the limits of the practice should be drawn.
The author interviews Theo Boer, who he calls the most prominent skeptic. Boer who was a member of a regional euthanasia review committee from 2005 - 14, says to interested inquiries:
“when I’m showing the statistics to people in Portugal or Iceland or wherever, I say: ‘Look closely at the Netherlands because this is where your country may be 20 years from now.’”
Theo Boer
Boer tells states:

“The process of bringing in euthanasia legislation began with a desire to deal with the most heartbreaking cases – really terrible forms of death,” 
“But there have been important changes in the way the law is applied. We have put in motion something that we have now discovered has more consequences than we ever imagined.” 
The author also interviews Bert Keizer, one of 60 doctors who work with the Levenseindekliniek (End of Life Clinic), which was responsible for 750 euthanasia deaths in 2017. Keizer, did his first euthanasia in 1984, when euthanasia was still illegal in the Netherlands. Keizer was not prosecuted.

Keizer states that the patient that he euthanized in 1984 was not in pain but he was experiencing symptoms indicating that he was nearing death. Keizer consider euthanasia as a new era and he believes that euthanasia prevents suicide.

The author explains how euthanasia was normalized:
As people got used to the new law, the number of Dutch people being euthanised began to rise sharply, from under 2,000 in 2007 to almost 6,600 in 2017. (Around the same number are estimated to have had their euthanasia request turned down as not conforming with the legal requirements.) Also in 2017, some 1,900 Dutch people killed themselves, while the number of people who died under palliative sedation – in theory, succumbing to their illness while cocooned from physical discomfort, but in practice often dying of dehydration while unconscious – hit an astonishing 32,000. Altogether, well over a quarter of all deaths in 2017 in the Netherlands were induced.
The author then explains why the number of euthanasia deaths increased quickly.
One of the reasons why euthanasia became more common after 2007 is that the range of conditions considered eligible expanded, while the definition of “unbearable suffering” that is central to the law was also loosened. At the same time, murmurs of apprehension began to be heard, which, even in the marvelously decorous chamber of Dutch public debate, have Concerns center on two issues with strong relevance to euthanasia: dementia and autonomy.
Euthanasia for the incompetent.

Berna Van Baarsen
The author continues by discussing euthanasia for people with dementia. The article explains that last January Berna Van Baarsen resigned from a euthanasia review board based on the growing number of people with dementia who are being euthanised on the basis of a written directive that they are unable to confirm Van Baarsen told the Trouw paper that

“It is fundamentally impossible to establish that the patient is suffering unbearably, because he can no longer explain it.”.
Since then a Dutch doctor has been prosecuted in a case of a woman with dementia who had previously requested euthanasia but at the time of the euthanasia she refused. The doctor put sedation in her coffee and then when she continued to resist the family held her down as the doctor injected her.

Patients demand euthanasia.

Patients have gone from requesting euthanasia to demanding euthanasia leading to some doctors refusing to do euthanasia. Theo Boer shared a story of a physician friend who has stopped doing euthanasia. Boer explains
“In the coldest weeks of last winter, a doctor friend of mine was told by an elderly patient: ‘I demand to have euthanasia this week – you promised.’ The doctor replied: ‘It’s -15C outside. Take a bottle of whisky and sit in your garden and we will find you tomorrow, because I cannot accept that you make me responsible for your own suicide.’ The doctor in question, Boer said, used to perform euthanasia on around three people a year. He has now stopped altogether.
Boer is also concerned about the effects that euthanasia has on the physicians. Boer stated:
“When you euthanise a final-stage cancer patient, you know that even if your decision is problematic, that person would have died anyway. But when that person might have lived decades, what is always in your mind is that they might have found a new balance in their life.”
Steven Pleiter
The author attended a conference organized by the NVVE on psychiatric euthanasia where he had the opportunity to speak with Steven Pleiter, the director of the Levenseindekliniek. Pleiter explains that his goal is to create a "shift in the mindset" about euthanasia. The author explains:

Pleiter said he hoped that in the future doctors will feel more confident accommodating demands for “the most complex varieties of euthanasia, like psychiatric illnesses and dementia” – not through a change in the law, he added, but through a kind of “acceptance … that grows and grows over the years”.
Pleiter clearly adds grease to the slippery slope. Pleiter believes that it is unethical for a doctor not to participate in euthanasia.

Pleiter then says that after opening the euthanasia clinic (Levenseindekliniek) that he negotiated with the insurance companies who agreed to pay the clinic 3000 euro per death, including the same payment if the patient changes his mind. When the author asks Pleiter if it is cheaper to do euthanasia rather than care for the person until they die Pleiter responds:
“This isn’t about money … it’s about empathy, ethics, compassion.” And he restated the credo that animates right-to-die movements everywhere: ‘I strongly believe there is no need for suffering.’
The author continues his investigation by recognizing that not all euthanasia deaths are "ideal" and collateral damage does exist. The author writes:
This legal nicety would become painfully significant to a middle-aged motorcycle salesman from Zwolle called Marc Veld. In the spring of last year, he began to suspect that his mother, Marijke, was planning to be euthanised, but he never got the opportunity to explain to her doctor why, in his view, her suffering was neither unbearable nor impossible to alleviate. On 9 June, the doctor phoned him and said: “I’m sorry, your mother passed away half an hour ago.”
Marc explains that his mother was not terminally ill but depressed. Since his mother wanted euthanasia she made complaints about her health and slumped over when speaking to her physician. Some people suggest that it was none of Marc's concern that his mother died by euthanasia. 

Theo Boer confirms the concern about euthanasia for depression. The author writes:
During his time on the review board, Theo Boer came across several cases in which the “death wish preceded the physical illness … some patients are happy to be able to ask for euthanasia on the basis of a physical reason, while the real reason is deeper”.
The author interviews a physician whose patient die by euthanasia without consent. The patient, who had dementia, had requested euthanasia will still competent. The patient had now changed his mind about euthanasia, but his wife strongly supported euthanasia. The man's wife exclaimed:
“If only he had the courage! Coward!”
When the doctor went on vacation, her colleague, who strongly supports euthanasia, lethally injected this patient. The doctor, who is now planning to move her practice, stated:
“How can I stay here?” 
“I am a doctor and yet I can’t guarantee the safety of my most vulnerable patients.”
The author completes his article by discussing the Netherlands debate concerning the "completed life pill" once known as the last will pill.

The concept of the "completed life" is that medical criteria would not be necessary to receive a lethal prescription only the desire to end one's life.

The author writes that some physicians support this idea because it frees them from euthanizing their patients and enables the patient to do it themselves. The reality is that most people would rather have the physician lethally inject them than the person take the lethal mixture themselves.

de Bellaigue does an excellent job of explaining the support for euthanasia while uncovering the concerns with euthanasia. Since de Bellaigue has received funding to research euthanasia it is likely that he will continue to write articles on this topic. I hope that his future articles will continue in this engaging style.

Saturday, January 19, 2019

Oregon Attempts to Expand Assisted-Suicide License

This article was published by National Review online on January 18, 2019.

Wesley J. Smith
By Wesley J. Smith

Oregon’s assisted-suicide legalization was the tip of the spear. Its provisions were never intended to remain restricted in perpetuity, but rather, were designed to give people false assurance that the ambitions of the euthanasia movement are limited.

They aren’t. And now true to form, a bill has been filed in Oregon to greatly expand eligibility and add other liberalizing provisions. First, HB 2232 would broaden the definition of terminal illness to the point that the term is stripped of any logical or cogent meaning:

“Terminal disease” means a disease that will, within reasonable medical judgment, produce or substantially contribute to a patient’s death.

Do you see how utterly open-ended that is? The condition could be a non-terminal illness or disability that would eventually contribute to — not necessarily cause — a patient’s death years in the future.

The bill also does away with the current requirement that the prescribed poison be taken orally, a provision intended to prevent third parties from killing the patient and disguising it as an assisted suicide. The new requirement is “self-administration,” which is also broadly defined:

“Self-administer” means a qualified patient’s physical act of ingesting or delivering by another method medication to end his or her life in a humane and dignified manner
Hence, a healthcare provider could hook the patient to an IV line containing a lethal dose of fentanyl that only required the patient to flip a switch to administer, sort of like Jack Kevorkian’s infamous suicide machine. Under this provision, poison could also be delivered by feeding tube, which could be done easily — if illegally — by someone other than the patient without anyone being the wiser.

Current Oregon law restricts lethal prescribing to licensed physicians. But many Beaver State MDs want no part of assisted suicide. So, the bill would expand eligibility to prescribe lethally to non-doctors:

“Health care provider” means a person licensed, certified or otherwise authorized or permitted by the law of this state to administer health care or dispense medication in the ordinary course of business or practice of a profession, and includes a health care facility.
Physician’s assistants can prescribe in Oregon, for example. The point is obviously to increase the cohort of willing lethal prescribers.

The bill maintains the current law’s phony definition of “counseling.”

“Counseling” means one or more consultations as necessary between a psychiatrist or licensed psychologist and a patient for the purpose of determining that the patient is capable and not suffering from a psychiatric or psychological disorder or depression causing impaired judgment.

In other words, mental illness or depression that may be diagnosed need not actually be treated — which is the usual purpose of “counseling.” Rather, the sole purpose of the mental-health referral is to deem the patient “capable,” which means,“the ability to make and communicate health care decisions to health care providers.” People can be very disturbed and still be “capable.”

There is an even more radical assisted-suicide legalization bill pending in New Mexico, which I described here. Delaware assisted-suicide enthusiasts will follow up a radical bill from last session with another, that I will detail once it has been officially filed.

Why do I keep bringing these proposals up? I want people to understand that the glib promises of tight restrictions made by U.S. activists are tactical lies designed to convince the reluctant to accept legalization. They are not intended to be permanent features of assisted-suicide practice going forward.

Those with eyes to see, let them see.

Oregon will debate bills to expand the definition of terminal and allow physicians to wave the waiting period.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Recently the Oregon assisted suicide lobby stated that they intend to expand the definitions in the assisted suicide law. The 2017 Oregon assisted suicide report stated that number of assisted suicide deaths had, once again, increased.

Oregon House Bill HB 2232 clarifies the definition of self-administer in the Oregon assisted suicide act, in fact the bill changes the definition of terminal from a six month terminal prognosis to: 

a disease that will, within reasonable medical judgment, produce or substantially contribute to a patient’s death.

Considering the fact that the Oregon Health Authority (OHA) bases the definition of terminal to include refusing medical treatment, such as a diabetic who refuses insulin, therefore the new definition of terminal has an undefined and nearly unlimited application. 

Many people who are not close to being "terminally" ill have a disease that will, within reasonable medical judgement, produce or substantially contribute to death. When considering the OHA inclusion of refusing medical treatment, I conclude that this new definition enables wide-open assisted suicide.

There may be more concerns with HB 2232. This article is only focuses on the new definition of terminal.

Oregon Senate Bill SB 0579 creates an exception to the 15 day waiting period in the Oregon assisted suicide law enabling a physician to wave the 15 waiting period before prescribing lethal drugs for suicide.

The current Oregon assisted suicide law requires a 15 day waiting period. SB 0579 states:
Notwithstanding subsection (1) of this section, if the qualified patient’s attending physician has medically confirmed that the qualified patient will, within reasonable medical judgment, die within 15 days after making the initial oral request under this section, the qualified patient may reiterate the oral request to his or her attending physician at any time after making the initial oral request.
It also states:
Notwithstanding subsection (1) of this section, if the qualified patient’s attending physician has medically confirmed that the qualified patient will, within reasonable medical judgment, die before the expiration of at least one of the waiting periods described in subsection (1) of this section, the prescription for medication under ORS 127.800 to 127.897 may be written at any time following the later of the qualified patient’s written request or second oral request under ORS 127.840.
There may be more concerns with SB 0579. This article only focuses on the waiting period.

The Oregon legislature will debate, 2019, changing the definition of terminal illness to an undefined concept of a disease that produces or substantially contribute to a patient’s death and enabling physicians to wave the 15 day waiting period.

Thursday, January 17, 2019

Delaware bill defines assisted suicide as a palliative care option

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

The assisted suicide lobby has instituted a new direction by redefining assisted suicide as palliative care. This has long been a talking point for assisted suicide advocates but now they are attempting to change the legal definition of palliative care.

Assisted suicide laws give physicians, or others (New Mexico bill) the right in law to assist the suicide of their patients.

The Delaware assisted suicide bill follows the new suicide by physician game plan by redefining palliative care to include assisted suicide. The bill states:

WHEREAS, the integration of medical aid in dying into the standard for end-of-life care has improved quality of services by providing an additional palliative care option to terminally ill individuals.
The World Health Organization definition of palliative care states that it:
intends neither to hasten or postpone death;
The assisted suicide lobby and the Delaware assisted suicide bill intend to change the meaning of palliative care.

The Delaware assisted suicide bill negates physicians conscience rights by forcing the physician to refer patients for assisted suicide. The bill states:

(c) An attending physician’s failure to inform an individual with a terminal illness who requests additional information about available end-of-life treatments, including medication to end their life in a humane and dignified manner, or failure to refer the individual to another physician who can provide the information, is considered a failure to obtain informed consent for subsequent medical treatment.
There are more egregious parts of this assisted suicide bill but this article focuses on the assisted suicide lobbies intention to change palliative care to include assisted suicide and to force physicians to participate in the act of suicide by physician.

Wednesday, January 16, 2019

Oregon assisted suicide lobby wants to expand the assisted suicide law.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

I have always said that the Oregon assisted suicide law was designed to extend suicide by physicians to other states. The assisted suicide lobby controlled the law and maintained the lie that there were no problems with the law. I knew that eventually they would decided to expand the provisions of the law.

Recently, the leader of C & C, formerly the Hemlock Society, outlined their commitment to eliminate provisions in the assisted suicide laws.

This year, the assisted suicide lobby is proposing Brittany's Bill in the Oregon legislature. I have not seen the particulars but the website from the assisted suicide lobby group states:

Brittany's Bill is a new bill that will be introduced in the 2019 Oregon Legislative Session. It's purpose is to expand the current Death with Dignity Law. The end result will be to change the eligibility of people who can take advantage of this choice. Currently, only patients diagnosed with a terminal illness and a life expectancy of six months are eligible. Brittany's Bill will expand the eligibility to any patient with an incurable disease or experiencing unbearable pain.
An article by Bruce Yelle, the director of the lobby group, end-of-life choices, published in the Register Guard states:
In the upcoming 2019 Oregon Legislative session there will be bills, including one called Brittany’s Bill, introduced in both the Senate and House health committees to expand Oregonians’ end-of-life choices. 
In the article Yelle makes reference to people:
  • who have become incompetent and therefore cannot access assisted suicide;
  • who do not meet the six month prognosis requirement, a provision that is fatally flawed already;
Expansive assisted suicide bills that lack clear definitions are the new normal. For instance that New Mexico assisted suicide bill is the most radical bill that I have ever seen.

A new era in the assisted suicide debate in America has begun.

Tuesday, January 15, 2019

Nearly every suicide death at Swiss clinic are foreign clients.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The Australian Care Alliance is reporting that at least 6 Australians have died by suicide at the Dignitas suicide clinic in Switzerland in 2018 and 93.5% of all of the Dignitas suicide deaths are foreign clients.

The Australian Care Alliance report explains how the Swiss assisted suicide statute works and the numbers of people have become death clients of the suicide clinics.

The Care Alliance reports:

Article 115 reads “Any person who for selfish motives incites or assists another to commit or attempt to commit suicide shall, if that other person thereafter commits or attempts to commit suicide, be liable to a custodial sentence not exceeding five years or to a monetary penalty”. 
Increasing number of deaths 
The qualifier, “for selfish motives” effectively allows Dignitas to offer assisted suicide to all comers on a “cost recovery” basis. Dignitas has assisted in 2771 suicides from 1998-2018. It charges between 7500 and 10500 Swiss francs plus VAT (roughly equivalent to between $A10,000 and $A15,000) for an assisted suicide. The number of assisted suicides carried out by Dignitas in 2018 was 221, up 148% from 2009. 
Only 6.5% of assisted suicides carried out by Dignitas have been of Swiss residents. The remaining 93.5% have involved suicide tourism, including for 32 Australians (five of these in 2018). 
Eternal Spirit Foundation and its associated organisation lifecircle was founded in 2011. It also offers assisted suicide to foreigners as well as Swiss residents. No statistics are available to date. Assisted suicide is offered to anyone who does “not accept to be nursed without hope of improvement” or who has a disease which is “incurable and clearly leads to reduction in quality of life, although it does not lead to death in the near future.” Western Australian, David Goodall, was assisted to commit suicide at its Basel clinic in May 2018. Goodall was not terminally ill and had no major disease, so assisted suicide is apparently being offered also for those “tired of life”. 
Another Swiss organisation, Exit, limits its assistance in suicide to Swiss residents. In 2015, Exit was responsible for 782 deaths by assisted suicide, up 345 from 583 in 2014. Of the 734 assisted suicides involving Exit in 2017 one on four (25%) were for “old age poly morbidities”, similar to the “stack of old age disorders” in the Netherlands. 
Assisted suicides of Swiss residents rose dramatically from just 48 in 1998 to 965 in 2015 an increase of 66% from 583 in 2013. There is no age limit for assisted suicide and between 2010 and 2014 thirteen people under 35 years of age died by assisted suicide.
Deaths from assisted suicide represented 1.5% of all deaths of Swiss residents in 2017. 
Read more on Switzerland here. 
Warning: this article discusses suicide. If you or someone you know is struggling, please seek help.
The number of foreign suicide deaths is continually increasing in Switzerland. 

Recently Deborah Binner, the wife of Simon Binner, who died at a suicide clinic in Switzerland, published a book where she says that she was devasted by her husband's death.

More articles about Switzerlands failed suicide experiment:

Monday, January 14, 2019

Why euthanasia is unethical.

The following article was published in the December 2018 World Medical Association Journal (pg 33 - 37) 

Link to a PDF of the article.

This article is written by Dr Rene Leiva, Dr Tim Lau and Gordon Friesen.
‘Unanimously, a declaration was adopted which simply says that euthanasia is unethical.’ 
Thus read a brief initial note in the World Medical Journal of 1987 with reference to the key passage of a new WMA Declaration on Euthanasia adopted in the Madrid General Assembly of that year [1]. Concise as this message was, it announced the affirmation of a powerful, enduring medical dictum, and we believe it to be essential for us, today, to understand the context in which it came about. 

The WMA was founded in 1947, in part to work for the highest possible standards of ethical behaviour and care among physicians. This was considered particularly important after the gross ethical violations observed, by physicians themselves during the Second World War (1939-45) [2]. In 1987, several members of the WMA, who had had personal experience with these atrocities, were still alive. One of them, Dr. Andre Wynen, who was then Secretary General, and a Nazi camp survivor himself, was a strong advocate of the formulation of the Declaration ‘because protection of life was very important for him’ [3]. These sentiments were echoed in a 1989 essay by then WMA President Ram Ishay from the Israeli Medical Association [4]. Dr. Ishay explained that the WMA had not seen the need to pass such a Declaration earlier, because it had already adopted policies laying out what it considered to be appropriate and ethical end of life care. However, given new positions emerging within some countries, it felt the need to break this silence, and passed the present Declaration unanimously. This robust vehicle was subsequently reaffirmed in 2005 and again in 2015. 

The authors of this article are three Canadians – two are practicing physicians and the other a severely disabled individual – who have combined their efforts, here, in the hope of preserving, once again, the deep and timely precautions WMA has maintained all these years. We ask that the full language of the original Declaration – explicitly stating that euthanasia “is unethical” – be preserved.

The Nature of Euthanasia

Voluntary euthanasia, simply put, is the medicalization of suicide. The use of euphemisms such as Physician Assisted Death or Medical Assistance in Dying are misguided attempts to rebrand a practice which doctors have renounced for close to 2500 years. These terms should be rejected as linguistic deceptions.

The objective judgement of whether any suicide or assisted suicide is warranted is impossible because of the subjective nature of suffering. What is grievous, irremediable, or intolerable to one person, may not be so for another. And, unfortunately, the physician’s opinion is no less subjective than that of the patient. An illustration of this comes from the review of psychiatric euthanasia in the Netherlands which demonstrated that, in 24% of cases, there was disagreement amongst consultants [5]. Having doctors validate and assist in suicide, therefore, is a distortion of our role as healers and makes us both accomplices and supporters – if not encouragers – of suicide.

We believe doctors should never be open to euthanasia and assisted suicide as solutions to our patients’ suffering. It is our personal experience, backed up by multiple studies, that the majority number of requests for the hastening of death are based on what we call ‘existential suffering’ which includes social, psychological and spiritual reasons such as loss of autonomy, wish to avoid burdening others or losing dignity and the intolerability of not being able to enjoy one’s life [6,7]. Moreover, it is our position that, behind the fears caused by that existential suffering, there is also a call for help, to find meaning, even in the midst of such suffering. Hopelessness and the wish for death naturally arise in the course of human experience, but it should not be our role, as physicians, to judge of their validity (regardless of personal opinion), nor is it our role to give them satisfaction.

The scope of euthanasia in theory and practice: a stark contrast

Euthanasia was purportedly introduced as a solution for ‘rare cases’ involving the very end of life where unbearable suffering could, supposedly, be ended only with death. But euthanasia is not only employed for such cases.

In Canada, physicians may provide euthanasia or assisted suicide for competent adults who clearly consent, who have a grievous and irremediable medical condition (including illness, disease, or disability) that causes enduring and intolerable physical or psychological suffering that cannot be relieved by means acceptable to the individual [8]. But as stated earlier, these are entirely subjective and elastic concepts. In practice, Canadian criteria are already so broad as to have permitted the administration of lethal injections to an elderly couple who preferred to die together by euthanasia rather than at different times by natural causes [9]. Moreover, court challenges and government studies are presently underway which could soon open euthanasia access to competent minors; to people who are non-terminal (death not “reasonably foreseeable”); to dementia patients by advance directive; and to those with psychiatric disorders only [10]. In Ontario, only 15% of patients euthanized had a previous relationship with the euthanasia provider [11]

Economic pressure towards euthanasia

Economics and resource management always play a critical role in health services. Dr. Wynen, as we know from his writings, definitely feared that legalised euthanasia would eventually be used to ration health care [3]. But even then, warning about the risks of abuse from euthanasia, due to financial reasons, was not new. Dr. Leo Alexander, who served as a medical consultant to the Allied prosecutors during the Nuremberg trials, wrote in his historic essay “Medical Science under Dictatorship”, New England Journal of Medicine (1949): 
“Hospitals like to limit themselves to the care of patients who can be fully rehabilitated, and the patient whose full rehabilitation is unlikely finds himself, at least in the best and most advanced centers of healing, as a second-class patient faced with a reluctance on the part of both the visiting and the house staff to suggest and apply therapeutic procedures that are not likely to bring about immediately striking results in terms of recovery. I wish to emphasize that this point of view did not arise primarily within the medical profession, which has always been outstanding in a highly competitive economic society for giving freely and unstintingly of its time and efforts, but was imposed by the shortage of funds available, both private and public. From the attitude of easing patients with chronic diseases away from the doors of the best types of treatment facilities available to the actual dispatching of such patients to killing centers is a long but nevertheless logical step. Resources for the so called incurable patient have recently become practically unavailable ”[12].
In Canada, a recent cost analysis concluded that ‘providing medical assistance in dying should not result in any excess financial burden to the health care system and could result in substantial savings [13]. It is obvious that those patients who opt for euthanasia do provide a saving to the health care system. Therefore, the danger of exerting a hidden pressure on vulnerable people is very real. For example, hospital authorities recently denied a chronically ill, severely disabled patient the care he needed, and – faced with his inability to pay – suggested euthanasia or assisted suicide instead [14]. On another occasion, a 25-year-old disabled woman in acute crisis in a Canadian Emergency ward, was pressured to consider assisted suicide by an attending physician, who called her mother “selfish” for protecting her [15].

Private financial interests are also important. Colleagues have voiced case reports where family members may be taking advantage of the law and creating vulnerable victims [16]. Elder abuse is endemic – in Canada as elsewhere – and one of the main forms of that abuse is financial. The conflict is obvious, and so is the potential for abuse.

Breaking the promise: how euthanasia destroys trust in the medical profession

At the root of euthanasia lies an assumption that some lives are not worth living. But rational people disagree, both on the principle and on the application to each individual case. Severely disabled and chronically ill individuals disagree, also, on the value of their own lives. Some become suicidal; a greater number do not. But a critical factor in the choices they make results from the attitudes of friends, family, medical professionals and society at large. As philosopher Daniel Callahan has stated, 
“Euthanasia is not a private matter of self-determination. It is an act that requires two people to make it possible, and a complicit society to make it acceptable” [17].
Again, both Wynan and Ishay were concerned that people caring for patients would personally side with the logic of euthanasia, thus creating new risks for the abuse of patients, and especially the most vulnerable. It is our experience that in several cases the troubles of human relationships within families become accentuated, and problems of physician error and abuse in an already stressed medical system become exacerbated. In the words of President Ishay, 
“The main problem is to differentiate between what is really done for the benefit of the patient, and what is done out of comfort for the family or for the caring team. Killing can occur, not because the patient is suffering, but because the person caring for the patient can not take it any more” [4].
No wonder, then, that many doctors remain unsure of correct practice. Some emergency physicians in Quebec were, for a time, actually allowing suicide victims to die even though they could have saved their lives. President of the Association of Quebec Emergency Physicians later speculated that the law, and accompanying publicity, may have ‘confused’ the physicians about their role [18]. Dr. Damiaan Denys, President of the Dutch Society of Psychiatrists, has also recently voiced the possibility that euthanasia is causing a frustrating new therapeutic atmosphere in psychiatric treatment, lowering many people’s threshold for ending their lives and causing increased moral distress on the part of the doctor [19]. Canada’s largest children’s hospital has drafted a policy in preparation for the day when children could decide for themselves to be euthanized. On it, they entertain the possibility of not informing the parents until after the minor has been euthanized [20].

We do not deny, therefore, that doctors performing euthanasia may sincerely believe themselves to be acting virtuously. But trust between doctor and patient depends, in the end, on public perception of the whole medical profession. When some doctors perform euthanasia, patients begin to worry about the attitudes of all doctors, and trust is lost. In Canada, for example, we are personally aware that many patients, out of fear, are now directly asking for doctors who will not practice euthanasia. Already in 2005, it became apparent that some elderly Dutch were afraid that those around them would take advantage of their vulnerable state to shorten their lives. Having lost confidence in Dutch practitioners, they either went to German doctors or they settled in Germany, as reported in the 2008 French government report to the National Assembly [21]; or they carry cards with them stating that they don’t want to be euthanized when seriously ill [22]. In a recent survey among Quebec physicians caring for patients with dementia, between 14% to 43% of doctors would provide access to euthanasia to patients with advanced or terminal stage dementia respectively even if no a prior written request existed [23].

The true physician’s role

At the heart of modern medical practice, we expect to find the survival, welfare and comfort of the patient. It is this conscious devotion to life which is so urgently required from physicians by the vast majority of patients, whether they are suicidal or not. The declaration of Geneva holds as the first consideration, the health and well-being of our patients. The respect for the autonomy and dignity of our patients which is the next line of the declaration, should not ignore the first consideration, nor the third line of the declaration which includes the utmost respect for human life. Properly understood there should be no conflict at all [24]. 

One of us (Friesen) knows, first hand, the mental strain of suddenly being presented, as a young man, with serious post-traumatic disabilities which took months to fully understand, years to accommodate, and decades to accept. In his own words, 
“it is an illusion to believe that education, family relations, economic status, or present health and happiness, can effectively protect people such as myself from the risk of euthanasia, because the most ordinary chances of life – the slightest relaxation of discipline in the maintenance of my physical state – would immediately (within months at most) place me in the intended category for that lethal procedure. And so, it is, for all surviving disabled and chronically ill.”
The good doctor, we believe, does not judge the value of such lives. Doctors are -- doctors must be unconditionally devoted to supporting every life, through all the phases of therapy and palliation.

And to conclude: 
“If I had not had such doctors to guide me through the first critical weeks of Intensive Care (and the long years of recovery which followed), I would not be here to write these lines today.”
Euthanasia policy: a unique responsibility of the World Medical Association

Objectively speaking, nothing has changed in the facts of euthanasia since 1945. Our current debate has not been caused by real changes in the internal logic of medical ethics and practice. It is actually the result of those same political, social, and economic factors, which civilized medicine has rejected time and again: the attraction of economic savings, feared by Wynen and described at first hand by Alexander; the terrible possibility that doctors and families might choose their own convenience over the survival of the patient, as voiced by Ishay; the horrible notion that certain lives are objectively less valuable. When death becomes the answer, we as human beings – as doctors – have failed in our duty to sustain trust and hope. Amid the larger pressures we have described, a free, autonomous decision about euthanasia becomes impossible. Patient choice becomes a cruel illusion.

On the positive side, it is evident that most doctors will never be willing to personally practice euthanasia. This conclusion has emerged clearly from the four regional WMA symposia, held recently on the subject in Brazil, Japan, Rome and Nigeria [25]. From the records of these seminars, we are reminded that a majority of doctors, everywhere, wish only to foster the will to live, not to lay the seeds of suicidal despair. In those countries where it unfortunately becomes legal, law and policy should allow medical practice to remain largely unchanged. Those who support medical involvement should thus embrace the liberation of relinquishing such a painful technical monopoly for doctors and allow other ‘experts’ to do it.

Unwavering ethical guidance from the World Medical Association is of crucial importance in preserving this positive climate in global medical practice. Any compromising additions or modifications to existing WMA declarations can only bring harm to our patients and to our profession. A firm WMA refusal to accept euthanasia, on the other hand, will stand as a powerful aid to all doctors.

We hope the WMA will take this opportunity to make it clear that what is legal is not necessarily ethical. It is useful to note, that the WMA was recently willing to make this distinction by condemning the participation of physicians in capital punishment, even in jurisdictions where that practice is legal [26]. We believe that the WMA should also remain consistent in this principle with regard to euthanasia, and not confuse political expediency with medical ethics.

WMA policy, we hope, will continue to stand as a beacon to the world, bringing comfort to patients and physicians around the globe, proclaiming that – regardless of changing opinions from place to place – true medicine’s first value is human life. Similarly, even if some particular society may devalue human life by promoting suicide, medicine and medical practitioners should not.

We believe that euthanasia is, was, and will always be, unethical. The World Medical Association was right to say this in the past, and must continue for the future, firmly on the same path. 

Rene Leiva, MDCM, CCFP (COE/PC), FCFP Family Medicine, Palliative Care, Care of the Elderly, Bruyere Continuing Care, Assistant Professor, Department of Family Medicine University of Ottawa Ottawa, Ontario, Canada

Gordon Friesen, Advisory Assistant Physicians’ Alliance Against Euthanasia Montreal, Quebec,

Canada Timothy Lau, MD, MSc, FRCPC Geriatric Psychiatry Royal Ottawa Hospital Associate Professor, University of Ottawa Ottawa, Ontario, Canada E-mail: rene.leiva@mail.mcgill.ca


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