Monday, February 17, 2020

Competing reports on euthanasia for Canadians with mental illness.

This article was published by BioEdge on February 16, 2020

Michael Cook
By Michael Cook

The Provincial and Federal governments in Canada need to amend their euthanasia laws quickly. They have to meet a March 2020 deadline set last year by Quebec Superior Court Justice Baudouin who ruled that it was unconstitutional to deny Canadians the right to die unless their deaths were “reasonably foreseeable”.

Amongst other issues, lawmakers need to determine whether people with mental illness will be able to access euthanasia, or Medical Assistance in Dying (MAiD), as it is called in Canada.

In every jurisdiction where euthanasia has been legalised, this is a fiercely debated topic. There is no doubt that mental illness causes great suffering. But even supporters of euthanasia are divided on whether it is unbearable and whether it is incurable.

It comes as no surprise, then, that Canadians have two acronym-rich reports to digest about euthanasia and mental illness. Or, for more precision, medical assistance in dying as it relates to cases where a mental disorder is the sole underlying medical condition -- MAiD for MD-SUMC.

The first was published by the Institute for Research on Public Policy (IRPP) and was written by “the Halifax Group”, eight academics on the Council of Canadian Academies (CCA) expert panel on MAiD. Its best-known member is Jocelyn Downie, a legal expert.

They contend that persons with MD-SUMC should not be excluded from accessing MAiD, provided that their decision is “well thought out and not impulsive”. They also insist that legislation should not require their decision to be “non-ambivalent”. In other words, even if people are torn between competing values (such as desiring death but not wanting to leave their children), they can still make a rational decision.

Admittedly, there is a danger of “over-inclusion” – allowing people to access MAiD whose suffering could be alleviated. But they feel that this risk can be minimized by providing better mental health services.

The second report argues that Canada is on the way to becoming “the most permissive jurisdiction in the world for MAiD, with the fewest safeguards against unwanted deaths”. It was written by the Expert Advisory Group (EAG) on MAiD, a group of Canadian and international experts, plus people with lived experience of mental illness.

The EAG’s core recommendation is that:
“determinations of irremediability and irreversible decline cannot be made for mental illnesses at this time, and therefore applications for MAiD for the sole underlying medical condition of a mental disorder cannot fulfill MAiD eligibility requirements”. 
“The risk of providing MAiD for mental illnesses, while being unable to predict irremediability of mental illnesses, is obvious,” they argue. “Non‐dying people who would have improved will be assisted to die prematurely.”
It also recommends two other conditions: non-ambivalence about a MAiD decision and “lack of a reasonable alternative”.

The EAG authors insist that their approach is evidence-based and that the Halifax Group’s report does not represent a consensus of medical opinion. In fact, they say that “surveys of mental health providers show that while most (72%) do support MAiD in general, most do not support MAiD for mental illnesses (only 29% in support)”. They also criticise the competing report for failing to include authors with lived experience of mental illness.

Michael Cook is editor of BioEdge

Saturday, February 15, 2020

Assisted suicide laws are the most egregious form of discrimination against disabled and "terminally ill" people.

Published in the New Hampshire Union Leader on February 14, 2020

By Mike Reynolds, Not Dead Yet

For over two decades the independent people of New Hampshire have been solidly against assisted suicide. Since 1996, the New Hampshire legislature has studied or voted down this proposed law so many times it takes two hands to count them all.

Assisted suicide laws are the most egregious form of discrimination against severely disabled and “terminally ill” people. How can we call suicide a public health crisis for most people while facilitating the suicides of older, ill and disabled people? Should we not be doing everything we can to support such persons in having the best possible health care and home care so they have quality of life for however long they have?

With the experience of the laws in Oregon as a guide, the question of assisted suicide becomes, quite frankly, incompatible with New Hampshire values. [The] state motto, “Live Free or Die,” means we reject government interference in our daily lives. Oregon state government’s promotion of an assisted suicide program administered by the health care system means pushing people towards assisted suicide through denials of coverage for treatment and in-home care, covering up abuses, and ignoring incorrect prognoses that lead people to think they are dying when they are not.

The numerous flaws in HB 1659, the “Death with Dignity Act,” are so obvious that New Hampshire should reject this absurd legislation again. With HB 1659, the government would be promoting suicide for what in the preamble it calls “mental anguish over the prospect of losing control and independence, and/or embarrassing indignities.” This is a direct attack on the thousands of disabled Granite Staters who maintain their independence and dignity by directing aides to perform their care.

While assisted suicide proponents depict assisted suicide as only a last resort for people with advanced cancer, Oregon’s doctors have written lethal prescriptions for individuals whose qualifying medical diagnosis for assisted suicide was reported as chronic conditions like diabetes, gastrointestinal disease, arthritis, arteritis, sclerosis, stenosis, kidney failure, and musculoskeletal systems disorders.

As in Oregon, under bill HB1659 a person can be considered “terminal” and therefore eligible for assisted suicide simply by refusing medication they need. By that definition, people who have epilepsy, ongoing infections and other illnesses that can be managed with medication can qualify. This legislation is not limited in scope and is actually far more dangerous than the proponents want to admit.

A report released in May 2018 by the Centers for Disease Control and Prevention reveals that from 1999-2010, suicide among those aged 35-64 increased 49% in Oregon as compared to a 28% increase nationally. In Oregon, the rate of suicide is 21 percent above the national average and their rates of teen suicide have even been higher. There is a clear problem of suicide contagion.

While the bill proponents claim there are safeguards, there is absolutely no oversight once the medication is picked up from the pharmacy. Under the Oregon law and the proposed legislation, a “friend” can encourage an elder to make the assisted suicide request (“just in case”), sign the forms as a witness, pick up the prescription, and even administer the drug (since no independent witness is required). To be perfectly clear, the current bill being debated only discusses “self-administration” of the lethal drugs in the bill’s preamble; nowhere in the substantive provisions is the word mentioned.

This law is also vague about who can access it, but it would be far easier for an eighteen year old with a serious medical condition that could be controlled with medication to access this law than it would for the same eighteen-year-old to access cigarettes or alcohol.

There is nothing compassionate or caring in this bill. Instead it could serve as a template to encourage and even pressure the most vulnerable in our society, our older and critically ill populations, to hasten their deaths. And by giving legal immunity to everyone involved, it creates a legal framework where elder abuse (up to and including homicide), which nationally impacts about 10% of elders, gets a free pass. Please contact your legislators and have them oppose this very dangerous legislation.

Mike Reynolds is a member of Not Dead Yet, a disability rights group opposed to assisted suicide.

Friday, February 14, 2020

Spain debates bill to legalize euthanasia.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Reuters reported that the Spanish parliament voted 203 to 140 (2 abstained) to continue debating a bill to legalize euthanasia in Spain. Reuters stated:
“We’re talking about clearly debilitating diseases without a cure, without a solution and which cause significant suffering,” government spokeswoman Maria Jesus Montero said, adding that doctors who object to the practice will be able to opt out.
Montero is suggesting that the legislation will only allow euthanasia for extreme cases, but the reality is that once it is legal the law must be equally applied or it will be considered discriminatory.

The Quebec Minister of Health, in 2014, suggested that there would only be 100 euthanasia deaths per year. In 2019, approximately 5000 people died by euthanasia in Canada.

Euthanasia requires the direct action of a doctor to approve and carry-out a death by lethal injection.

The bill will now go to the Parliamentary Health Committee for discussion and then to the Senate before it can return to the lower house for a final vote.

Canadian euthanasia study offers more questions than answers.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

A study examining MAID data from Ontario, the largest province in Canada, reports confirms much of what we knew already about euthanasia/assisted suicide deaths worldwide, but the data actually opens questions about the use/misuse of euthanasia in Canada.
Article: Euthanasia deaths rise quickly in Ontario. Nearly 1800 reported assisted deaths in 2019 (Link).
The data indicates that many of those who died by euthanasia were not terminally ill and had decided to die by lethal injection rather than live in a nursing home / institutional setting.

The lead study author, Dr James Downar, is a founder of the Dying with Dignity physicians advisory council and a long-time euthanasia promoter. 

This study will be used to assure politicians that Canada's euthanasia law can be expanded without fear of negative effects to vulnerable groups. It will also be used to undermine the resistance of palliative care doctors to euthanasia.

The data in this study was obtained from the euthanasia reports submitted to the Chief Coroner of Ontario. The reports are submitted by the doctors or nurse practitioners who lethally injected the person. This data was submitted, in a self-reporting system, to justify the act of euthanasia.

Since doctors don't self-report controversial decisions, it is unlikely that comments from these reports will uncover abuse.

Kelly Grant, writing for the Globe and Mail newspaper reported:

Patients who choose medically assisted death are wealthier, younger, more likely to be married and less likely to live in long-term care than those who die naturally, according to a major study of assisted dying in Canada’s most populous province.
The media suggests that this study proves that euthanasia does not negatively effect people who are poor or vulnerable, but in fact this study simply confirms what we have always known that people who are white, wealthy and worried are more likely to die an assisted death.

The study examined the data from 2241 reports from the euthanasia deaths in Ontario between June 17, 2016 and October 31, 2018.

Grant reports on the data in the study:

Patients who received an assisted death were more likely to be wealthy, with 24.9 per cent of MAID recipients earning enough to be in the highest of five income brackets. By contrast, 15.6 per cent of patients who died naturally were in the top income bracket. 
The study found that Ontario MAID recipients were, on average, two-and-a-half years younger when they died, and less likely to have been living in an institution, usually a nursing home, before they died. 
Of those who died naturally, 28 per cent lived in institutional settings, while only 6.3 per cent of MAID recipients did. 
The data in the study indicates that those who died by euthanasia died at age 74.4 (average) whereas those who died a natural death died at age 77 (average). 

Why are people dying by euthanasia 2.6 years younger than those who die a natural death? 

Why are people who die by euthanasia less likely to live in an institution (nursing home etc).

The data suggests that many of those who died by euthanasia were not terminally ill and decided to die by lethal injection rather than live in a nursing home / institutional setting.

Canada's euthanasia law stated that: natural death is reasonably foreseeable, but the law did not define this. It appears that most doctors had a wide interpretation of natural death being reasonably foreseeable.

Those who died by euthanasia stated that they were experiencing physical suffering (99.5%) of the time and psychological suffering (96.4%) of the time. The Canadian law states that physical or psychological suffering "is intolerable to them and that cannot be relieved under conditions that they consider acceptable." which is completely subjective.

The study states that:

Psychiatric consultations were performed in 6.2% of cases. In 4.3% of cases, the MAiD recipient had been found ineligible for MAiD on a previous request.
Considering the conditions that people may experience as they approach death, it is surprising that only 6.2% of the MAID deaths had a psychiatric consultation.

The data indicates that people who died by euthanasia had access to palliative care (74.4%) of the time suggesting that people are not asking to be killed due to lack of alternatives.

Grant reported that Ebru Kaya, a Toronto palliative care specialist questioned this assertion:

...“They use this blanket term. Palliative care providers could mean anything. The MAID assessor who is also a palliative care physician may use that clinical encounter to assess for MAID as a palliative care encounter, but the two are very different.”
Similar to previous studies, this study examines data from reports submitted by doctors and nurse practitioners who did the lethal injection. There are no interviews with patients, before they died, to determine why are they asked for death. There are no "third party" reports to ensure that the "letter of the law" was followed.

We do not know why people are dying 2.6 years earlier than those who died a natural death.

It is likely that many of the people were not terminally ill but facing the dilemma of having to live in a long-term care institution because their health condition required care.

I suggest that this study proves that people with disabilities are right. Canadians are deciding that death is preferable to living with a disability.

Thursday, February 13, 2020

Massachusetts assisted suicide bill may permit euthanasia (homicide). Steering is the elephant in the room.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

It is important to examine the language of assisted suicide bills. The promoters of assisted suicide will often claim that a bill does one thing, where in fact the language of the bill has wider interpretations.

Assisted suicide is an act whereby one person (usually a physician) provides a prescription for a lethal drug cocktail knowing that the patient intends to use it for suicide.

The Massachusetts assisted suicide bills (S. 1208 and H. 1926) are designed as an application process for obtaining a lethal drug cocktail. 

Most assisted suicide bills state that the person must self-administer the lethal drugs, making it an assisted suicide.

The Massachusetts bills state that the patient can choose to self-administer, meaning that the law permits another person to administer the lethal dose.

The bills states: 
“Self-administer” means a qualified patient’s act of ingesting medication obtained pursuant to this chapter.
This definition does not prevent another person from administering the lethal dose, that the person "ingests." 

When another person administers the lethal dose, the act is called euthanasia or homicide.

Nancy Elliott, EPC-USA Chair, in a letter to Massachusetts politicians states that "steering is the elephant in the room." She wrote:
...Steering is the elephant in the room. I was at a hearing for Assisted Suicide in Massachusetts a few years back where a doctor stated that Assisted Suicide laws were something he was in favor of. He continued with his points and ended by saying that he felt it was the responsibility for a good doctor “to guide people to make the right choice.” I do not think he intended to say that but is there any doubt that this pro suicide doctor would try to persuade his patients to follow his wishes, concerning their Assisted Suicide.
The Massachusetts bill does admit that most assisted suicide deaths are not quick and painless. The bills state:
I further understand that although most deaths occur within three hours, my death may take longer and my physician has counseled me about this possibility. (my emphasis)
An recent article in the Spring Hill Insider looks at human experiments being done to find a cheaper lethal drug cocktail for assisted suicide. 

The article states that assisted suicide researchers are promoting a third generation of lethal drug cocktails. The results of the first two lethal drug cocktails were:
The (first) turned out to be too harsh, burning patients’ mouths and throats, causing some to scream in pain. The second drug mix, used 67 times, has led to deaths that stretched out hours in some patients — and up to 31 hours in one case.
The current drug cocktails have caused painful assisted suicide deaths that may take many hours to die.

Last month a Massachusetts Superior Court decided that there is no right to assisted suicide. The court explained:
Finally the Commonwealth produced expert testimony that the permissible end-of-life alternatives potentially involve far less risk than MAID because they occur in hospitals or other institutions devoted to medical treatment and involve numerous physicians and staff personnel, which together provide an environment that lends itself to oversight and responsibility... MAID, on the other hand, potentially takes place in an uncontrolled environment, without assurance that the patient will administer the medication when close to death and without physician oversight.
The Massachusetts assisted suicide bills are not designed to protect people at a vulnerable time in their life, but rather to protect physicians who are willing to assist in killing their patients. The bill is not limited to assisted suicide and it ignores the decision of Massachusetts citizens who rejected an assisted suicide referendum a few years ago.

Massachusetts legislators need to reject these assisted suicide bills.

Assisted suicide goes against our values

This opinion article was published by the Concord Monitor on February 11, 2020

By Steven Wade
Executive Director of the Brain Injury Association

House Bill 1659 effectively gives physicians permission to prescribe drugs that result in patient suicide. We have serious concerns about the potential impact on New Hampshire’s at-risk population if this bill passes. It normalizes suicide as medical care and corrupts the doctor/patient relationship.

New Hampshire suicide rates are up nearly 50% over the past 10 years. New laws have been passed recently to beef up suicide prevention efforts because there are populations, including veterans, teens, people with disabilities, brain injury survivors and the elderly “pre-disposed” to suicide for reasons including depression, lack of autonomy and inability to engage in activities that make life enjoyable.

New Hampshire has a suicide crisis and has set an ambitious goal of zero suicides. This bill works against that goal. What sort of a message does it send to at-risk people if New Hampshire passes a law that says suicide is an easily achieved option?

The exploitation of the elderly is another significant problem in New Hampshire. This bill could enable exploiters to misuse the law to the detriment of those dependent on others for their care. Anyone with ulterior motives like convenience and cost will have the power to steer vulnerable members of our society – who are not necessarily dying – in the direction of death instead of care. Instead the state should be investing in greatly expanded access to palliative care and mental health services for those at-risk populations relying on the state for their care.

This bill calls into question the state’s power to set standards for quality of life. If it’s a terminal illness predicted to last six months now, what might it become in the future? Laws like this inevitably expand over time. If New Hampshire opens the door to assisted suicide, we will have to face whatever might be on the other side of that door.

HB 1659 goes against the very essence of who we are as citizens of New Hampshire. If we want to show that we value the lives of at-risk teens, the elderly, people with disabilities and veterans who have fought for our country, we should be focusing our energy on providing them with care, not with death.

(Steven Wade is the executive director of the Brain Injury Association of New Hampshire in Concord and a member of the N.H. Coalition Against Assisted Suicide.)

Nancy Elliott: Speech to the New Hampshire House Judiciary Committee

Nancy Elliott
Chair: Euthanasia Prevention Coalition USA 
Nancy Elliott
HB 1659 begins by talking about reasons why a person should take their life. It talks about emotional stress, the prospect of losing control and independence and embarrassing indignities. This sounds like a disability. Before I lost my husband, this was the description of him. He had lost his independence and needed to rely on me. He also dealt with embarrassing indignities. That is no reason to kill a person. At that point, he learned that life has value at all stages. It is cruel for the State to say that someone, like my husband, should not want to live and be pushed toward Suicide.

Assisted Suicide and Euthanasia seek to eliminate the weak, sick and elderly among us, while promoting what they call autonomy, which is only valuing individuals who are healthy and productive. They seek to morph Darwin’s “Survival of the Fittest” into only the fittest are allowed to survive. While some may choose this, how many were actually steered? I was at a hearing in Massachusetts for Assisted Suicide where a doctor stated that Assisted Suicide laws were something he was in favor of. He continued with his points and ended by saying that he felt it was the responsibility for a good doctor “to guide people to make the right choice.” I do not think he intended to say that, but is there any doubt that this pro-suicide doctor would try to persuade his patients to follow his wishes, concerning their Assisted Suicide.

If a doctor or nurse had suggested to my husband that he should kill himself, it would have devastated him. It would be like saying you are worthless, a piece of junk and should get out of the way. Many would say this can’t happen yet, this did happen to a woman in Oregon, named Kathryn Judson. She took her husband to the doctors and sat down exhausted in a chair. Her ears perked up when she heard the doctor pitching Assisted Suicide to her husband, with the clincher, “Think of your wife.” They left and never came back. Her husband went on to live another five years. What they did to this man is heartless, allowed by an insensitive law. Fortunately Mr. Judson and my husband had someone to look out for them, however there are many in our state who do not.

Wednesday, February 12, 2020

Victoria Australia’s ‘voluntary assisted dying’ law has come into effect; but were legislators right to think they could avoid the ‘slippery slope’?

This article was originally published in ABC Religion & Ethics and Bioethics Outlook (Plunkett Centre for Ethics).

Professor John Keown
By John Keown

Victoria’s law permitting physician-assisted suicide (PAS) and voluntary euthanasia (VE) came into force in June last year. Other states, particularly Western Australia, may soon follow suit.

All Australians, whether legislators or voters, would do well to reflect on the warning of former Prime Minister Paul Keating, when the bill was being debated in 2017, that VE is a threshold moment for Australia, and a threshold the country should not cross. He cautioned that, once termination of life is allowed, pressure will mount for further liberalisation on the ground that the law discriminates against those denied PAS and VE. “The experience of overseas jurisdictions,” he added, “suggests the pressures for further liberalisation are irresistible.”

His article provoked a critical response from ABC/RMIT “fact checkers,” who concluded that in most jurisdictions where the law had been relaxed “little has changed regarding what practices are allowed or who can access assisted dying.”

They were mistaken. My book Euthanasia, Ethics and Public Policy, provides extensive evidence from abroad confirming slippery slope concerns.

The slippery slope argument holds that PAS and VE should not be legalised because neither prescriptions for lethal drugs, nor lethal injections, can be effectively controlled by the law. This is for two distinct reasons: practical and logical.

Practically, it is not feasible either to craft legal criteria (such as “unbearable suffering” or “terminal illness”) with sufficient precision or, even if it were, to police them. Logically, the moral arguments for lethal prescriptions for the “terminally ill” are also arguments for lethal injections, and lethal injections for patients who are chronically ill and have longer to suffer.

Moreover, the moral case for lethal injections for competent patients is also a case for lethal injections for incompetent patients such as infants: the patient’s lack of autonomy does not cancel the doctor’s duty of beneficence. If some competent patients would be “better off dead” because of their suffering, so would some incompetent patients. There is, then, a logical link between voluntary and non-voluntary euthanasia.

The disturbing experience overseas illustrates the force of both the practical argument and of the logical argument. Permissive laws have failed to ensure effective control, whether in the Netherlands or Belgium (and now Canada) that permit VE and PAS, or in those US jurisdictions like Oregon that permit only PAS. Five points will show that the “fact checkers”' conclusion that “little has changed” is wide of the mark.

First, VE and PAS became legal in the Netherlands in 1984 (not 2002 as the “fact checkers” state) through a ruling of the Dutch Supreme Court. In 1996, illustrating the logical slope, the Dutch courts declared infanticide lawful. (The “fact checkers” rightly regard this as a liberalisation of the law, though they wrongly assert that infanticide “remains illegal.”)

Second, the “fact checkers” interpret “further liberalisation” to mean that a government has taken steps to expand access or legally protected activities. But this ignores the reality that the interpretation of the law may become more permissive, whether by courts, review committees or doctors, even absent statutory amendment. And this is what has happened in the Netherlands and Belgium.

Professor Theo Boer, for example, a former member of a Dutch euthanasia review committee, has changed his mind about the law. He points to the dramatic increase in numbers and to significant bracket creep, extending to patients with mental illness, disorders of old age, and dementia. Supply has stimulated demand, euthanasia has become normalised and there has been a paradigm shift. Some slopes, he now cautions, truly are slippery.

One may add that, since 1984, official Dutch surveys have shown that thousands of patients have been killed without an explicit request, and thousands of cases have not been reported by doctors to the review committees required to check each case. Why should we expect Victoria’s “review board” to be any more effective in ensuring that the legal criteria are met and that all cases are reported?

Boer’s writing, and that of other leading scholars critical of the Dutch experience such as Dr (now Justice) Neil Gorsuch, are not mentioned by the “fact checkers.” Also noteworthy is their failure to mention the Dutch government's proposal in 2016 to extend the law to allow elderly people who are simply “tired of life” to be given suicide pills by “death counsellors.”

Third, they note that Belgium relaxed its law to allow children to access euthanasia and state that this was the only liberalisation. Not so. Although the Belgian legislation was deliberately limited to VE, the review commission has decided to approve cases of PAS. And, like the Dutch committees, the commission has permitted an increasingly elastic interpretation of the criteria.

Fourth, they write that the Canadian government, having legalised VE and PAS, commissioned studies in relation to access for mature minors, the mentally ill and by advance directive, but that these are only “potential legislative changes.” True, but why commission such studies unless you are considering extending the law? And the existing criteria are already being challenged in court as too restrictive.

Fifth, they attach importance to the fact that the Oregon-style laws in the United States have not been extended to the chronically ill or to permit VE. However, they do not consider whether this may simply be political expediency until a critical mass of states has legalised PAS.

It makes tactical sense for anyone seeking to make a radical change in the law, and whose opponents will raise slippery slope concerns, to get their foot in the door through relatively conservative proposals before prizing the door open wider. The former governor of Washington state, Booth Gardner, said he supported an Oregon-style law in his state as a first step that would weaken the nation’s resistance and produce a cultural shift resulting in laxer laws.

Professor Yale Kamisar wrote in his classic utilitarian essay against legalisation 60 years ago that the arguments against further liberalisation are weaker than the arguments against legalisation, which is itself an argument against legalisation.

Keating’s concerns are, then, amply supported by the experience overseas. Sadly, the “fact checkers” are not alone in misunderstanding that experience, as should be evident to anyone who reads the majority (though not the minority) reports of the parliamentary committees in Victoria or Western Australia. Quite frankly, any legislators who think they can avoid the slippery slope have learned little from other jurisdictions.

John Keown is the Rose F. Kennedy Professor of Christian Ethics in the Kennedy Institute of Ethics at Georgetown University.

New Hampshire Death With Dignity Act Will Create a Perfect Crime

Media Release: Concord, New Hampshire, USA

Dore: “Persons assisting a suicide or euthanasia can have an agenda to benefit themselves. More obvious reasons include inheritance money and life insurance.”

“The Act will apply to people with years or decades to live.”
Contact: Margaret Dore, Esq.
(206) 697-1217

Margaret Dore
Attorney Margaret Dore, president of Choice is an Illusion, which has fought against assisted suicide and euthanasia legalization efforts in many states, made the following statement in connection with a bill seeking to legalize these practices in New Hampshire. (HB 1659). 

Wednesday, 02/12/20, 1:00 P.M., SH Rm Reps Hall, House Judiciary.

“The proposed Death With Dignity Act seeks to legalize assisted suicide and euthanasia as those terms are traditionally defined,” said Dore. “If passed into law, the Act will apply to people with years or decades to live.”
Dore explained, 
“The Act is based on a similar law in Oregon, applying to people with a terminal disease expected to cause death within six months. In practice, such predictions are often wrong. This is due to actual mistakes and the fact that predicting life expectancy is not an exact science."

“Perhaps more importantly," said Dore, "the six months to live is determined without treatment. Consider Jeanette Hall, who was diagnosed with cancer in 2000. She made a settled decision to use Oregon’s law, but her doctor convinced her to be treated for cancer instead. Today, nineteen years later, she is thrilled to be alive.”
Dore said, 
“Persons assisting a suicide or euthanasia can have an agenda to benefit themselves. More obvious reasons include inheritance money and life insurance.”

“Medical professionals too can have an agenda,” said Dore. “Michael Swango, MD, now incarcerated, got a thrill from killing his patients. Consider also Harold Shipman, a doctor in the UK, who not only killed his patients, but stole from them and in one case made himself a beneficiary of the patient’s will.”
Dore said, 
“People who sign up for the lethal dose do not necessarily intend to take it. Sometimes they make the request at the suggestion of a doctor or family member, ‘just in case' they want to use it.’”

“Once the lethal dose is in the home, there is a complete lack of oversight,” said Dore. “No witness, not even a doctor, is required to be present at the death. If the patient objected or even struggled against administration, who would know?”
Dore said, 
“The death certificate will report a natural death, which will create a legal cover up and also allow a perpetrator to inherit. More to the point, the Act will create a perfect crime.”

“Consider also a 2005 article in the UK’s Guardian newspaper regarding a public inquiry of Dr. Shipman’s conduct,” said Dore. “The inquiry determined that he ‘killed at least 250 of his patients over 23 years.’ The inquiry also found ‘that by issuing death certificates stating natural causes, the serial killer [Shipman] was able to evade investigation by coroners.’”
Dore continued, 
“According to a subsequent article in 2015, proposed reforms included having a medical examiner review death certificates to improve patient safety. Instead, the proposed Act moves in the opposite direction to require a legal cover up as a matter of law.”
Dore concluded, 
“If the New Hampshire Act becomes law, there will be new paths of lethal abuse and exploitation, especially for older people with money, meaning the middle class and above. They will be sitting ducks to their heirs and other predators. Even if you like the concept of assisted suicide and euthanasia, the proposed Act is a recipe for abuse, exploitation and legal murder.”

Tuesday, February 11, 2020

Rally in Support of the Delta Hospice Society - April 4, 2020

Hospice organizations must NOT be forced to do euthanasia

BC Health Minister, Adrian Dix, ordered the Delta Hospice Society to provide euthanasia (MAID) by February 3 or lose its government funding (Link).

The Delta Hospice Society is refusing to kill their patients.

Link to the Rally Poster (Link).

Join the Rally to Support The Delta Hospice Society.

Saturday April 4, 2020
(12 Noon - 2 pm)
At the BC Parliament Buildings (Legislative Assembly)
Victoria BC

Speakers include:
Angelina Ireland,  President of the Delta Hospice Society
Alex Schadenberg,  Executive Director, Euthanasia Prevention Coalition
Dr Margaret Cottle, Palliative Care Physician
Dr Will Johnston, Family Physician, Chair of EPC - BC.

More information:

Why legalizing medically assisted dying for people with mental illness is misguided

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Petition: I oppose Euthanasia for psychiatric reasons alone. (Link).
Dr John Maher
CBC news published an opinion article by psychiatrist Dr John Maher titled: Why legalizing medically assisted dying for people with mental illness is misguided. Maher who is the president of the Ontario Association for ACT & FACT, and editor-in-chief of the Journal of Ethics in Mental Health. Maher stated:

I am a psychiatrist, and over the past couple of years I have had suicidal patients ask me for medical assistance in dying (MAID). I have explained this is not an option, because they are not dying (their death is not "reasonably foreseeable") and Canadian law does not allow MAID for people living with mental illness.

But now, with the Quebec court's Truchon decision, it looks like everything is about to change. And I am appalled at the unfairness.

Under the specious guise of legal equality of access to a so-called medical act, Canadian legislators are considering the use of doctors as surrogates to end the lives of our fellow citizens who suffer from treatable mental illness.
Maher then writes about a recent patient who asked for MAID:
A few days ago, a 30-year-old patient with very treatable mental illness asked me to end her life. Her distraught parents came to the appointment with her because they were afraid that I might support her request and that they would be helpless to do anything about it. It's horrific they have to worry that by going to a psychiatrist, their daughter might be killed by that very psychiatrist.

That same patient said to me, "a doctor killing me is not suicide, it is totally different."

The perverse veneer of moral acceptability that follows from medicalizing what is patently not a medical act is infuriating in its obfuscatory power. This facile reasoning, from "this person's suffering persists" to the claim that "death is the best relief of suffering," betrays profound ignorance about all of the pathways and varied means possible for the relief of suffering.
Maher comments on treatment-resistant mental illness:
I have been specializing in treatment-resistant mental illness for 17 years. I want to scream from the political and juridical mountaintop that "treatment resistant" does not mean untreatable. It means clinical experience and sophistication are needed; it means that specialized tertiary care programs are needed; it means patience and persistence are needed.

And in reality, it means that every single person with severe mental illness can experience dramatic improvement in their symptoms and concomitant reductions in their suffering.
Maher continues:
The law currently requires that to be eligible for MAID, a patient must meet the standard of "grievous and irremediable" suffering. I have seen much grievous suffering that I acknowledge took months to several years to ameliorate, but I have yet to see a patient with irremediable suffering unless left untreated by inadequate availability of services.

If you have done this work for a long time, it becomes very clear that the main reason for wanting to die is desperate loneliness and existential hopelessness. (my emphasis) Shared suffering is reduced suffering. But why live if no one will help me? Why live if my country says my doctor will end my life if I ask?
Maher then comments on the lack of access to mental health treatment. He then states:
Meanwhile, those who are not voiceless – lawyers, politicians, suicide advocacy groups - are good at shouting and oversimplifying the real issue, all under the guise of protecting rights: "You deserve to have the right to get your doctor to kill you."

Unfortunately, you do not seem to deserve the right to have the treatment or support that decades of evidence shows can help.
Maher then comments on the reality of euthanasia for psychiatric conditions:
Holding a gun to your head, sticking a needle in your arm, or holding a poison pill and a glass of water in my hands for you to take, are all morally equivalent actions. And don't tell me your desire to die changes the moral nature of my complicity. Your desire to die should call forth in me all possible action and means to keep you alive.

Such have been the laws that require me to admit you into a hospital for your own safety. We can't have it both ways: suicide prevention and facilitation are fundamentally incompatible moral and pragmatic positions.

And any proposed "safeguards" against abuse in Canada will falter. The past 15 years in Belgium and The Netherlands have shown us that some psychiatrists will ignore safeguards, and some prosecutors and courts won't enforce them.

Disturbingly, a small number of psychiatrists have done an inordinate proportion of the direct killing of mentally ill patients in these countries. Without question, some psychiatrists in Canada will also be willing to end the lives of their patients. Word will quickly get out about which psychiatrists you should go to in order to get the job done.
Maher concludes the article by urging psychiatrists to refuse to participate in euthanasia for psychiatric reasons:
In short, I can make myself meet the criteria, and I will find a psychiatrist who will confirm my capacity to choose death and go along with my request to end my life. The only possible way to stop these inevitable abuses is to ban the practice of medically assisted dying for all persons living with mental illness.

Fellow psychiatrists, please hold fast against being pressured to do what we swore we wouldn't. And please … step up, parliamentarians! Step up, ministers of health! Step up, premiers! Step up, prime minister!

And should it ever come to it, please know that I will never support you in your belief that your life is not worth living.
Thank you Dr Maher for your leadership. Here are further links to excellent articles opposing euthanasia for psychiatric reasons.

Monday, February 10, 2020

Medical Journal Pushes Harvesting Kidneys from Dying Patients

This article was published by National Review online on February 10, 2020.

Wesley Smith
By Wesley J Smith

The New England Journal of Medicine continually publishes advocacy articles that promote radical changes in medical ethics and public policies. For example, it uncritically published the Groningen Protocol, the infanticide bureaucratic checklist used by doctors in deciding which disabled or dying babies to euthanize in the Netherlands.

Now it has published an advocacy article expressing the wish that imminently dying patients be able to donate a kidney before death. Joshua Mezrich tells the story of W. B., dying of ALS (amyotrophic lateral sclerosis, or Lou Gehrig’s disease), who wanted this harvest and then die procedure. From “Altruisim in Extremis:”

Mezrich could not fulfill W.B.’s wish. As W.B. grew sicker, wheelchair-bound and unable to swallow, he and Mezrich devised a plan for “imminent death donation” (IDD). W.B. would go to the hospital, receive general anesthesia, have one kidney removed, then return to the intensive care unit, where he’d be extubated and die, presumably, from ALS. 
But despite “overwhelming” ethics-committee support, the attorneys the hospital consulted informed Mezrich that he and any staff involved would risk being charged with murder or acceleration of the patient’s death. So W.B., whose mind remained sharp and alert despite being unable to move, swallow, or speak, spent his final days in the hospice where he died. None of his organs were donated.
This is why I don’t trust hospital-ethics committees. Members are often trained to respond positively to nakedly relativistic utilitarian analyses that ignore venerable moral values and the intrinsic dignity of human life.

But Wesley, that’s what the patient wanted. And if someone wanted to sell herself into slavery, should we permit it? No. Establishing a precedent in a hard case sets us down a bad road. There are larger societal issues at stake than the case at hand.

When organ-transplant medicine was launched, a wary society was solemnly promised that organs would be taken only from the dead, a concept known as the “dead-donor rule.” Also, that prospective donors would never be objectified. Hence, no actions are supposed to be taken in preparation for donation that could harm the still-living patient and/or accelerate his or her death.

Resistance to crossing this once inviolable red line seems to be weakening. Indeed, an ethics committee convened by United Network for Organ Sharing to opine on this issue seems to have been more concerned about public relations than maintaining inviolable ethical boundaries:

Though the committee found no ethical problem with IDD [imminent death donation] under circumstances like W.B.’s, in which first-person consent is possible and the donor is well-informed, they focused on the more ethically fraught scenario of a patient with devastating neurologic injury for whom a surrogate would be deciding about organ donation before withdrawal of treatment. 
They noted the lack of data for determining whether permitting “live donation prior to planned withdrawal” (LD-PPW) would lead to an increase or decrease in available organs. This unpredictability speaks to the Catch-22 of a utilitarian approach to these scenarios. A practice such as LD-PPW could theoretically yield more donor organs. But if LD-PPW is perceived as unethical (surgeons as “vultures” stealing organs from those not quite dead), then, regardless of safeguards, potential donors may be lost. 
That’s why, as Peter Reese, a University of Pennsylvania nephrologist who led the ethics committee, explained to me, “We did not find an ethical problem. We found a political problem.” [My emphasis]
Yes, we allow altruistic kidney donation. But this bending of the dead-donor rule has been accepted by society because — even though there is a remote risk of death, often overlooked in glowing media stories — great care is taken to ensure that the donors recover and go on with their lives.

This is different. Taking a kidney from a dying patient would harm the still living human being. It would materially impact the timing of death, or perhaps cause death. Moreover, it would lead quickly to the next logical step: allowing euthanasia by organ harvest, already proposed in some journals. In short, imminent-death donation would elevate the importance of organ retrieval over the equal moral worth and lives of patients.

Organ-transplant medicine has saved countless lives. But the people from whom organs are retrieved matter too — as does their humanity until death. We must reject attempts to further undermine the dead-donor rule because if we ever go over that cliff, there is no turning back.