Assisted suicide bill in the UK fails public safety test.

The following article was written by Dr Peter Saunders, the campaign director for the Care Not Killing Alliance, and published on his blog on July 8, 2013 under the title: Leading Parliamentary Think Tank says Lord Falconers 'Assisted Dying' Bill fails public safety test.

Peter Saunders

By Dr Peter Saunders

Living and Dying Well (LDW) is a public policy research organisation established in 2010 to promote clear thinking on the end-of-life debate and to explore the complexities surrounding 'assisted dying' and other end-of-life issues.

It has just published a comprehensive report on Lord Falconer’s Assisted Dying Bill which was introduced into the House of Lords on 15 May.

Lord Falconer's Assisted Dying Bill [HL Bill 24] is the fourth of its kind to come before the House of Lords in the last ten years and seeks to authorise assisted suicide for mentally competent adults with less than six months to live.

None of its predecessors has made progress and the last one (Lord Joffe's Assisted Dying for the Terminally Ill Bill) was rejected in May 2006.

House of Lords

LDW’s report, jointly authored by eleven members of the House of Lords, concludes that Falconer’s bill ‘is little different from Lord Joffe's - it seeks to license doctors to supply lethal drugs to terminally ill patients to enable them to end their lives’.

The authors include leading lawyers, doctors and disabled peoples’ advocates including Baroness Butler Sloss, Lord Carlile, Baroness Finlay and Baroness Campbell.

They recognise that ‘some people support legalisation of assisted suicide on grounds of autonomy and others oppose it as immoral’ but then seek to assess the bill on the ‘criterion of public safety’ - whether its enactment would ‘put seriously ill people at risk of harm’.

The bill, say the Peers, ‘contains no safeguards, beyond stating eligibility criteria, to govern the assessment of requests for assisted suicide’. Furthermore, it ‘relegates important questions such as how mental capacity and clear and settled intent are to be established to codes of practice to be drawn up after an assisted suicide law has been approved by Parliament’.

This is ‘wholly inadequate’ and on the issue of safeguards alone, they argue, ‘the bill is not fit for purpose’.

It ‘places responsibility for assessing applicants for assisted suicide and supplying them with lethal drugs on the shoulders of the medical profession’ but at the same time ‘ignores expert medical evidence given to Parliament in recent years regarding the unreliability of prognoses of terminal illness at the range it envisages’.

‘Other considerations aside’, they assert, ‘the bill fails the public safety test by a considerable margin’.

The report concludes that the law that we have already ‘has the discretion to deal with exceptional cases in an exceptional way’ and that Lord Falconer's bill, by creating ‘a licensing system’ for assisted suicide crosses ‘an important Rubicon’.

To create exceptions to the blanket prohibition on assisted suicide which are ‘based on arbitrary criteria such as terminal illness or mental capacity, is to create lines in the sand, easily crossed and hard to defend. No convincing case has been advanced as to why these important considerations should be set aside.'

The tightly drafted report runs to eleven pages and is well worthy of careful study. 

Assisted Suicide is not safe: Dr Stephen Hutchison

I was going through my emails and I found this excellent article written by Dr Stephen Hutchison and published on June 20, 2013 in the The Herald newspaper in Scotland under the title: Agenda: Assisted Suicide. 

Hutchison, a physician who specializes in palliative care, was commenting on assisted suicide based on the expected assisted suicide bill by Scottish MSP Margo MacDonald. MacDonald's previous bill was overwhelmingly defeated in the Scottish parliament.

Agenda: Assisted Suicide.

Dr Stephen Hutchison, Herald - June 20, 2013

Hardly a week goes past without court cases about assisted suicide, or celebrities and politicians commending it.

The argument goes along these lines: "We are autonomous and assisted suicide is our right. Leaving people to die in agony or forcing them to go to Switzerland is terrible. Assisted suicide is safe and there is no slippery slope. Doctors here are doing it anyway, so let's make it legal. At the very least, let's have the debate."

Actually the debate has been pretty well had. Independent MSP Margo MacDonald's 2010 proposals were thoroughly considered in the public arena, among lay and professional groups and the media before being overwhelmingly defeated in the Scottish Parliament. Official reports show that 87% of public responses to her consultation were opposed, and nearly two-thirds were against her 2012 consultation. Casual public opinion is in favour, but considered opinion is against. On numerous occasions over the past few years assisted suicide has been debated in our parliaments and has been consistently rejected because it is unsafe. The duty of government is to protect its citizens.

Autonomy means to be self-governing, acting independently, regardless of others. But we are all interdependent, not autonomous. Autonomy is a myth. We have freedom to decide and act, but not without responsibility to others. The Parliamentary Committee examining Ms MacDonald's 2010 Bill came to the same conclusion. Being a burden to others is often cited as a reason for assisted suicide. But you can only be a burden because you have some form of relationship with others. You cannot have it both ways. It is irresponsible for politicians to peddle autonomy as the basis for any law, let alone something cataclysmic like this. Selfish individualism creates havoc.

I grow frustrated when I hear assertions that medical care of the terminally ill includes using such high doses of morphine to relieve pain that we hasten death. That is another myth. There is good recent evidence that UK doctors never practise assisted suicide. Even if they did, that would not be a sound basis for legalising it.

What about intolerable suffering? In our country you have access to the best palliative care in the world, according to an Economist Intelligence Unit report in 2010. It is usually fear of pain, not actual pain, that makes people think of assisted suicide. Where there is suffering we need to research and refine care to relieve it, not hasten death. If someone goes to Switzerland that is their choice. Nobody is forcing them, any more than if I move to that country because I prefer its tax laws.

Elder abuse is an increasing problem. The perpetrators are commonly friends or relatives of the victim. When you are facing an incurable illness, or the prospect of suffering, or the costs of care are eating into your family's inheritance, and you feel vulnerable and scared, just how little pressure would be needed to make you choose assisted suicide, particularly if you are elderly and frail or feel that you are a burden?

Assisted suicide is not safe. If it was why would proponents emphasise the need for safeguards?

There is evidence of risk to the vulnerable where assisted suicide is practised.

As for slippery slopes, how about the steady increase in people who die this way? How about progressive relaxation of diagnostic criteria? How about institutional disregard for initial restraints intended to promote safety? How about the killing of hundreds of patients every year without consent?

How about almost complete indifference towards psychiatric assessment designed to identify depression? These are happening where assisted suicide is practised. And how about the subtle anaesthetising of our own moral principles so that we think it is a good idea to kill people?

Keeping our law unchanged may be problematic for a tiny minority but it protects the majority. Superficially, assisted suicide may seem compelling. But we must not be fooled.

Dr Stephen Hutchison MD FRCP (Glasg) is a consultant physician in palliative medicine.

Vermont Assisted Suicide Law - Legislative Malpractice

The following article was written by Edward J Mahoney and published on July 5, 2013 in the Burlington Free Press under the title: My Turn: Legislative Malpractice.

----------

Edward Mahoney

Edward J. Mahoney, Burlington Free Press - July 5, 2013. President of the Vermont Alliance for Ethical Healthcare.

Vermont legislators should be mortified that they have enacted a law to allow and promote “aid-in-dying” with virtually no protections for vulnerable patients. One might contend that they have committed legislative malpractice by cutting-and-pasting together a law that has great potential to be injurious to one group of people and violates the rights of conscience of another group — clear violations of their legislative oath.

S.77 (now Act 39), “An Act Relating to Patient Choices and Control at the End of Life,” raises serious problems for hospitals and other health care facilities as well as physicians and health care professionals. A close reading of the statute reveals that Act 39:

Requires that the patient requesting hastened death be “capable” at the time of the request; however it allows someone other than the patient to interpret a patient’s request if the patient is unable to be understood by the physician.

Does not require that the patient be “capable” at the time of the lethal ingestion.

Requires that the patient request a lethal drug for self-administration, however it does not require that the patient actually self-administer the drug.

Requires that physicians inform all terminally ill patients about all available treatment options (including a drug to hasten death) even if the patient does not ask about it.

States that physicians are legally obligated to answer any specific questions about treatment options without withholding any requested information. There is no exemption for a physician who believes the request is premature, clinically inappropriate, or unethical.

The prescribing physician may not contact the patient’s primary physician unless the patient consents, possibly obscuring pertinent history such as prior incapacity, depression, suicidal statements or attempts.

Provides legal immunity for physicians, but not for nurses, pharmacists or other involved professionals.

Does not establish any oversight at all. The physician is only required to report to the Department of Health that he or she has written a lethal prescription (no patient name required) and has followed the procedure set forth in Act 39. The pharmacist is not required to report filling the prescription. There is no prescription tracking. No data is collected. No annual reports. The state and the public will have no idea how often this practice is occurring.

The Department of Health is required to adopt rules about the safe disposal of unused lethal prescriptions, but there is no way for them (or anyone) to know who has these lethal doses in their possession.

In addition — unbelievably — the legislature has declared an automatic repeal of all procedural steps as of July 1, 2016. After that date, hastening a patient’s death will be as simple as treating bronchitis.

Act 39 should be a national embarrassment to Compassion and Choices, the out-of-state organization that lobbied so hard to convince our legislature that legalization of “aid-in-dying” would be good for Vermonters.

One has to wonder how carefully Gov. Shumlin read this bill with such glaring errors and omissions before he signed it.

Act 39 is so egregious we cannot delay until the 2014 legislature to try to “fix” it. The Legislature should be called into special session to re-address this dereliction of their sworn duty.

Edward J. Mahoney of Essex Junction is president of the Vermont Alliance for Ethical Healthcare.

Eight reasons why doctors should remain opposed to euthanasia and assisted suicide.

Peter Saunders

Dr. Peter Saunders, the campaign director for the Care Not Killing Alliance, published a blog article about the questionnaire that the Royal College of General Practitioners (RCGP) in the UK have circulated to its members. 

It appears that Dr Clare Gerada, the Chair of the RCGP is suggesting that the RCGP should consider taking a neutral position on euthanasia and/or assisted suicide.

Dr Saunders responded to the RCGP questionnaire with eight reasons why the RCGP should remain strongly opposed to euthanasia and/or assisted suicide: 

1. The majority of doctors are opposed to a change in the law. Opinion polls show an average of 65% doctors opposing the legalisation of assisted suicide and/or euthanasia with the remainder undecided or in favour. Palliative Medicine Physicians are 95% opposed and the Royal College of Physicians and British Geriatrics Society are officially opposed.

2. Assisted suicide and euthanasia are contrary to all historic codes of medical ethics, including the Hippocratic Oath, the Declaration of Geneva, the International Code of Medical Ethics and the Statement of Marbella. Neutrality would be a quantum change for the profession and against the international tide.

3. Neutrality on this particular issue would give it a status that no other issue enjoys. Doctors, quite understandably, are strongly opinionated and also have a responsibility to lead. The RCGP is a democratic body which takes clear positions on a whole variety of health and health-related issues. Why should assisted suicide and euthanasia enjoy a position which no other issue shares, especially when doctors will actually be the ones carrying it out?

4. Dropping medical opposition to the legalisation of assisted suicide and euthanasia at a time of economic recession could be highly dangerous. Many families and the NHS itself are under huge financial strain and the pressure vulnerable people might face to end their lives so as not to be a financial (or emotional) burden on others is potentially immense.

5. Were the RCGP to drop its opposition, and as a consequence a law were to be passed, it would also leave the medical profession hugely divided at a time when, perhaps, more than any other time in British history, we need to be united as advocates for our patients and for the highest priorities in a struggling health service.


6. Going neutral would leave the RCGP gagged with no collective voice.  The British Medical Association (BMA) rejected an attempt to move it neutral at its 2012 annual representative meeting saying that neutrality was the worst of all positions. This was based on bitter experience. When the BMA took a neutral position for a year in 2005/2006 we saw huge pressure to change the law by way of the Joffe Bill. Throughout that crucial debate, which had the potential of changing the shape of medicine in this country, the BMA was forced to remain silent and took no part in the debate. 

7. Going neutral would instead play into the hands of  a campaign led by a small pressure group with a strong political agenda. Healthcare Professionals for Assisted Dying (HPAD), which is affiliated to the pressure group ‘Dignity in Dying’ (formerly the Voluntary Euthanasia Society) has only 520 supporters, representing fewer than 0.25% of Britain’s 240,000 doctors. But in 2012 they flooded the BMA ARM with no less than nine motions calling for the association to go neutral in an attempt to silence medical opposition ahead of new bills being introduced to parliament in 2013.

8. The RCGP has been historically opposed to a change in the law on assisted suicide and euthanasia for good reasons. These reasons have not changed.

Going neutral on assisted dying would be inappropriate, undemocratic and potentially highly dangerous. It would also be playing into the hands of a small unrepresentative pressure group and giving an advantage to only one side of the debate. Furthermore it would communicate confused messages to the public at a critical time and divide the profession at a time when a united doctors’ voice is needed more than ever.

Memorial to the victims of euthanasia, being built in Germany

The Berlin media is reporting that the German is building a memorial to all the victims of the T4 Nazi euthanasia program in Berlin.

Euthanasia victims memorial

The article states:

Building work began in Berlin on Monday for the city's fourth official monument to victims of Adolf Hitler's National Socialist government. 

The planned exhibit at Tiergartenstrasse 4 in the capital will be dedicated to the victims of the "euthanasia" program used by the Nazis to kill those with physical or mental illnesses. Hitler's Nazi regime killed more than 200,000 people who were either psychotherapy patients or physically disabled between January 1940 and August 1941. 

The euthanasia program was run out of the same Tiergartenstrasse address and was even codenamed "T4." A commemorative plaque has adorned the site since 1986. 

The German minister for cultural state affairs, Bernd Neumann, attended the laying of the foundation stone on Monday, saying that the monument should set a sign "against hate, delusion and coldheartedness - and for tolerance, empathy and a respect for life."

It is important to understand the history of the Nazi euthanasia program. Most people believe that what happened in Nazi Germany has no historical connection to the modern day pro-euthanasia ideology. 

The euthanasia philosophy came from the eugenics movement. In Germany, a book entitled: Permitting the Destruction of Life Unworthy of Life was written by Binding and Hoche and published in 1920. This book was the catalyst for the Nazi euthanasia program.

I have read Permitting the Destruction of Life Unworthy of Life several times. This book goes through a systematic explanation of why society should permit euthanasia and how it is more compassionate and better for society to kill people with disabilities or people who have chronic or terminal conditions.

Then read the Groningen Protocol. They are very similar. Link.

Then read the report of the Royal Society of Canada. Link.

Links to other articles about the T-4 Nazi euthanasia program.

* The victims of Nazi euthanasia have been forgotten.

* Holocaust memorial day. Let's not forget the key role doctors played.

* The eugenic philosophy is alive in our culture.

French national ethics committee rejects euthanasia but President Hollande intends to legislate anyway

This article was written by Dr Peter Saunders the campaign director for the Care Not Killing Alliance in the UK and published on his blog on July 4, 2013.

Link to my article on the same topic.

Peter Saunders

Dr Peter Saunders - July 4, 2013

France's medical ethics advisory council (CNNE) has voted against the legalization of assisted suicide, as found in Swiss clinics such as Dignitas, it was announced on Monday.  

But French President François Hollande has promised a law on the issue by the end of 2013.

The committee which had been asked to investigate the issue of euthanasia and come up with recommendations voted against Swiss style assisted suicide. 

However, the CCNE is in favour of ‘passive euthanasia,’ whereby treatment, hydration and nutrients are withdrawn at the request of an individual facing the end of their life.

'Deep sedation' is one 'end of life' care option the CCNE are in favour of which would see the patient put to sleep until the end of their life, if they have requested it and if they have asked for all treatments to be stopped.

France Euthanasia Protest.

‘With sedation, it is intended to relieve the patient, but in no event bring about their death,’ Vincent Morel, President of the French Society for support and palliative care and a doctor at the University Hospital of Rennes told Europe1 radio.

Later on Monday French president François Hollande announced that ‘at the conclusion of debate,’ his government would introduce legislation on end-of-life care, ‘definitely by the end of the year.’

In February, the ethics council said that out of a ‘duty of humanity’, and where there were ‘persistent, lucid and repeated requests from someone suffering from an ailment for which the treatment has become ineffective,’ it should be legal to withdraw that treatment and allow that individual to die.


But it said at the time that the condition should be verified ‘not by a sole doctor but a medical team’ and did not use the term euthanasia but spoke of ‘assisted death’.

A 2005 law in France already authorises doctors to administer painkilling drugs at levels they know will, as a secondary effect, shorten a patient's life.

A poll that was released in January 2012 found that 60% of the people in France preferred improvements to palliative care rather than legalizing euthanasia.

I have previously highlighted the rapid escalation of euthanasia and assisted suicide cases in the Netherlands, Oregon, Switzerland and Belgium.

Almost half of Belgium’s euthanasia nurses have admitted to killing without consent, despite the fact that involuntary euthanasia is illegal in Belgium and that nurses are not allowed to perform even voluntary euthanasia. 

In addition, nearly half of all cases of Belgian euthanasia are not reported to the Federal Control and Evaluation Committee. Legal requirements were more frequently not met in unreported cases than in reported cases and a written request for euthanasia was absent in 88%.

A recent study found that in the Flemish part of Belgium, 66 of 208 cases of ‘euthanasia’ (32%) occurred in the absence of request or consent.

According to a recent report Belgium is now the ‘world leader’ in organ removal after euthanasia with at least nine cases since 2005 but suggestions are that there would have been many more had more euthanasia patients had transplantable organs.

In the Netherlands there has been a 15-20% increase in euthanasia cases per year since 2006 and a  recent Lancet paper reports that 12.3% of all deaths in Holland are now due to ‘terminal sedation’.  

Paris 2012 Protest 

More recently both Belgium and the Netherlands have announced their intention to escalate their children’s euthanasia programmes.

We will have to wait until the end of the year to see the exact wording of Hollande’s proposed bill but French citizens, seeing the escalation in surrounding countries would be very wise to reject any further weakening of the law. 

Presumed consent for organ donation is both unnecessary and unethical.

The following article only concerns the issue of presumed consent for organ donation. 

Dr Saunders does not comment on issues related to the abuse of organ donation, the abuse of the dead donor rule, and the redefinition of when it is appropriate to remove organs.

Sadly the presumed consent organ donation bill passed on July 3 in Wales.

Peter Saunders

By Dr. Peter Saunders - July 2, 2013

Wales could become the only UK country with an opt-out organ donation system if politicians vote to change the law today.

Currently an ‘opt-in’ consent system operates across the UK.

Individuals can authorise organ removal from their bodies after death by joining the Organ Donor Register (ODR), or making their wishes known to their family.

However the Welsh government wants to introduce new legislation which would authorise doctors to remove organs and tissue from any patient declared dead, unless the deceased had formally registered their objection.

I strongly support organ donation but so-called 'presumed consent' involves neither consent nor donation – it is neither voluntary nor informed and involves taking organs rather than giving them.

It means effectively that the state will be able to overrule families and there is a very real danger that it could also prove counterproductive and undermine trust leading to fewer rather than more donations. Introducing this legislation would be a radical new step, which is both unnecessary and unethical as a way of increasing organ donation rates.

The claim that donation rates could increase by up to 30% through presumed consent legislation is disingenuous as there is little evidence that this is any better than other schemes in other countries, and there are alternative ways of increasing donation rates.

Donation rates in countries with ‘presumed consent’ laws do not actually differ from countries requiring explicit (opt-in) consent. In fact, some countries operating presumed consent systems have lower rates of organ donation!

Differences in rates are due to other factors including the numbers of potential donors, provision of intensive care facilities, end of life care, use of transplant coordinators, trust in the donation system and trust in the medical profession (particularly those treating dying patients) (See here for a BMJ article on this).

Organ donation is a generous gift. It resonates strongly with the Christian principles of sacrificial generosity and love for one’s neighbour. However, consent to organ donation should always be voluntary (un-coerced), informed and autonomous. 

As Patient Concern has warned: ‘Assurance that every citizen would hear of the new law, understand it, realise its implications, grasp how to opt-out and get around to doing so – if they wish – is pure fantasy.'

The groups least likely to express their views, if they hold views on this, will include those who are disabled, less well educated or informed, lacking full capacity, of different languages and race, suffering from mental illness, dependent, those who have less ready access to information and those changing their minds. Silence in many of these cases would and should not amount to consent to donation under an opt-out system.

Organ donation should be encouraged as a gift, but this system lays the framework for the taking of organs as a right. That is a very dangerous precedent indeed.

Although this specific legislation is only for Wales, there is increasing pressure to bring in similar legislation in England and Scotland. So it is not just an issue for Wales, it is one that the rest of the UK may well soon be considering.

This is why it is so important that the Welsh government rejects this measure today.

Reflection needed on whether Bill 52, on ‘medical aid in dying,’ (euthanasia) would result in abuses in Quebec

The following letter was written by Margaret Somerville and published in The Montreal Gazette on July 3, 2013.

Margaret Somerville

Margaret Somerville, Montreal Gazette - July 3, 2013

Re: “ Véronique Hivon’s long battle” (Gazette, July 2)

Bill 52 would not just extend access to “end-of-life care”­ which includes “medical aid in dying,” a euphemism for euthanasia­ to “dying patients,” as your reporter states, but to all “end of life” patients who fulfill the necessary criteria.

Among other requirements, those criteria require that a person “suffer from an incurable serious illness; suffer from an advanced state of irreversible decline in capability; and suffer from constant and unbearable physical or psychological pain which cannot be relieved in a manner the person deems tolerable.” The bill also provides that “a person may not be denied end-of-life care for previously having refused to receive a treatment or procedure or having withdrawn consent to a treatment or procedure.”

In other words, the person being euthanized might not have exhausted all reasonable pain and suffering management treatments; seems to have a complete discretion to decide whether they regard their pain ­or it might be the pain management interventions ­ as tolerable; need not be terminally ill; and might be mentally, but not physically, ill. Many disabled, old, frail and vulnerable people would fulfil these latter two criteria, in which regard it merits noting that Bill 52 provides that “medical aid in dying” may be administered in “residential and long-term care centres” or a person’s home.

Your reporter, in painting what I regard as an unrealistically reassuring picture of the effect of Bill 52, also states that a “second doctor must also agree (with the treating doctor that “medical-aid-to-die”) is the best course (for the patient).” In fact, the second doctor need only “confirm that the criteria (for access to “medical aid in dying”) have been met.” In light of the fact that Bill 52 reflects a values stance that gives priority to radical individual autonomy, it would be inconsistent with the spirit and goals of the bill for doctors to override a patient’s wishes to have access to “medical aid in dying,” with their own view of what is the “best course” for the patient.

For reasons such as I describe, we need to consider deeply whether Bill 52 would create a very serious danger of the abuse of vulnerable people, especially those who are old.

Margaret Somerville
McGill Centre for Medicine, Ethics and Law
Montreal

Let’s speak less of death and more about care

Discussion about ‘end-of-life’ issues creates an illusion of choice and avoids taking responsibility for the care of chronic cases.

By: Tom Koch, Toronto Star - Tue Jul 2, 2013, Link to the Toronto Star article.

When all three major political parties and the Toronto Star agree, I get … worried.

Tom Koch

I read the Star’s June 24 editorial, “Time to talk about death,” while worrying over the care of “Margo,” a 102-year-old woman in hospital following a fall. Her family asked me to consult on her care. Her case, like many others I’ve dealt with, is not about “end-of-life” but rather the care and preservation of “fragile life.” As an ethicist and gerontologist specializing in chronic conditions and progressive disease, I get this kind of case frequently.

We know Margo will not live to be 122 years of age but she is not going to die tomorrow. At present, she needs treatment for a range of conditions and then a skilled-nursing facility because her mobility limits mean she can no longer live in a simple “assisted-living” facility.

The hospital social workers want Margo moved out of the hospital — it is policy to move them out quickly — but there are no suitable accommodations available. They tried to pressure the family and I counselled them to refuse a transfer until an appropriate facility could be found. In the interim, she is receiving minimal but adequate treatment — the truth is, she is 102 years old and nobody cares overmuch.

And so, reading Premier Kathleen Wynne’s insistence we need a good “discussion” like Quebec’s on “end of life,” I got concerned.

“End of life” is the polite code for “ending life,” either through the withdrawal of life-prolonging treatment or physician-assisted (or directed) termination. It is not about the compassion required for chronic cases like Margo’s but about creating a structure that permits those cases to be inexpensively and safely ended.

Perram House closed this year.

That, of course, would be good news for the government, whose funding of care centres, nursing homes, home support and hospice and palliative services is lamentably inadequate. We know this from the waiting lists for skilled-nursing facilities and the failure of hospices like Perram House, which closed earlier this year because of funding problems. The province expects hospices to raise operating capital as a charity rather than be fully funded by the government. Perram House couldn’t do that.

“The end of life is messy,” NDP health critic France Géinas said in her support of Wynne’s call for a discussion. It’s not, however. The end of life is pretty clear and very simple: the heart stops beating and respiration ceases.

Life for the fragile, however, is a different matter. It involves a range of issues, an array of specialties and sometimes also special facilities. The result will not bring a person back to health — Margo will never dance and skip or hold a job — but will give them the best possible life they can live.

Margo is free to refuse care; she is free to say, “Let it happen.” But, like most in her situation, while she’s not sure she wants next year, she has made it clear she’d like tomorrow if her basic conditions can be stabilized. Her family wants that for her, too, and a place where she can live out her life in safety and maximum comfort.

This isn’t about age, however. While most frame these discussions in talk of seniors, the issue of fragile life versus a quickened death is not age-restricted. In my career, the same issues have returned — again and again — with post-stroke persons with paralysis, spinal injury patients, those who have had serious traumatic brain injuries, and patients with neurological conditions like multiple sclerosis.

All these are classes of persons who are in dire need of continuing care, rehabilitation, and either more extensive home services or better institutional service. Usually they need the institutions until they can cope with home service. And these are the areas where the provincial health service (and, to be fair, those of most other provinces) fails utterly.

Instead of providing care we have created vast layers of bureaucracy to “manage” the limits of the care we have. That’s what comes from “discussions,” rather than the plain facts of patients in need of services they often do not get.

If it is “time to talk about death,” it will not include talk about life and its fragile continuance. It never does in these cases. It will trumpet “humane” termination and “end of life” plans, which might give the illusion of choice. But I know, from experience, that what folks say in health is typically not what they want in medical extremes.

So let’s put off “death talk” and think about “care talk,” about what the fragile of our society need and how better to provide it. Let’s not “discuss” the “compassionate motives” of Quebec’s euthanasia bill (called “end of life”) and instead talk about “life care, even for the fragile.”

That’s a discussion worth joining in an area where we need to do much, much better.

Tom Koch is an ethicist and gerontologist specializing in chronic and palliative care. His most recent book is Thieves of Virtue: When Bioethics Stole Medicine.

Government of France ethics committee rejects the legalization of assisted suicide.

France

By Alex Schadenberg, 
Euthanasia Prevention Coalition - International Chair,

France's official Ethics Advisory Committee (CCNE) has rejected the legalization of assisted suicide after a majority vote.

The committee which had been asked to investigate the issue of euthanasia and come up with recommendations voted against Swiss style assisted suicide, where lethal medication is deliberately given to a patient. The vote was made public on Monday, July 1.

Last December, France's official Ethics Advisory Committee  rejected the legalization of euthanasia. The the report from the Comité Consultatif National d'Ethique that examined the issues of euthanasia and assisted suicide concluded that assisted suicide may be legalized but opposed euthanasia. The Committee stated that euthanasia is: 

“a radical medical gesture” that crossed “a forbidden barrier” – and was both impractical and immoral

The report 'severely criticised current medical care of terminally-ill patients in France and called for the development of better palliative care regimes' and it emphasized the moral use of palliative sedation rather than euthanasia or assisted suicide.

Francois Hollande

A poll that was released in January 2012 found that 60% of the people in France preferred improvements to palliative care rather than legalizing euthanasia.

A report from Reuters news stated that Francois Hollande, France's President, will introduce a bill, later this year, to legalize euthanasia. The euthanasia bill would be against the recommendations of the Ethics Advisory Committee.

The Ethics Advisory Committee in rejecting assisted suicide stated what it did support improvements to palliative care and sedation practices stated that:

'Deep sedation' is one 'end of life' care option the CCNE are in favour of which would see the patient put to sleep until the end of their life, if they have requested it and if they have asked for all treatments to be stopped.

"With sedation, it is intended to relieve the patient, but in no event bring about their death," Vincent Morel, President of the French Society for support and palliative care and a doctor at the University Hospital of Rennes told Europe1 radio.

The news reports also stated:

In February, the ethics council said that out of a “duty of humanity”, and where there were “persistent, lucid and repeated requests from someone suffering from an ailment for which the treatment has become ineffective,” it should be legal to withdraw that treatment and allow that individual to die. 

But it said at the time that the condition should be verified "not by a sole doctor but a medical team" and did not use the term euthanasia but spoke of "assisted death". 

Paris Protest in 2012.

The committee has also been emphatic in ruling out Swiss-style assisted suicide clinics such as Dignitas, where individuals not necessarily suffering from terminal or incurable illnesses, volunteer to be given lethal injections so as to end their lives. 

Last year, groups opposing euthanasia organized several effective rallies.

The Euthanasia Prevention Coalition predicts that the government of France will face massive opposition to its proposed euthanasia bill. We also predict that the euthanasia bill will be defeated in France.

Quebec medical student explains why he opposes euthanasia.

The following letter was written by David Benrimoh and published on July 1 in the Montreal Gazette newspaper under the title: Euthanasia prevents people from finding meaning at the end of life. This letter was edited from its original version.

I oppose the legalization of euthanasia.

I have never experienced what it is like to see a terminally ill family member in pain; as such, I do not for one moment pretend to judge or criticize the choices or beliefs of patients or their families. Instead, I want to offer a philosophical argument against euthanasia and in favour of alternative practices, such as expanded access to palliative care. ...

Viktor Frankl

In my opinion, our society has become preoccupied with pain and suffering and preventing it at all costs. It is of course logical and just to prevent and ease pain and suffering when we can, and to develop and use medications and technologies that can do this. But is death preferable to pain? In a video shown to us in class that was not directly related to euthanasia, Viktor Frankl — philosopher, neurologist, psychiatrist and Auschwitz survivor — spoke of the extreme suffering he and his fellow inmates were subject to in the concentration camp, and of how, even in the midst of all this suffering, he was able to find meaning in choosing his own attitude to his situation, and in thinking of the love he bore his wife, who had been sent to another camp. He is not the only example of a person who, through extreme suffering such as that caused by the Holocaust, was able to create and find meaning.

In Quebec, euthanasia is being considered for people suffering from a terminal illness who are still able to make competent decisions. And yet these are the very people who would most likely be able, with the right support, to find or create meaning at the end of their lives. This is why I am against euthanasia: because allowing it is saying that we are willing to sacrifice our potential to find meaning in order to end suffering; that we have allowed pain to conquer the pursuit that most defines our humanity.

The best counter-argument to all this is that we as a society have no right to demand that people keep on living in terrible pain when they, as competent adults, would prefer a quick death. My response is that this choice is not the one we are faced with. We have, as has been pointed out by many doctors, technologies and medications that can allow us to manage pain; we have psychologists, chaplains and other guides that can help people find and create meaning in their final days. All of this is brought together in the discipline of Palliative Care, which aims to help patients find the peace and dignity they want at the end of life, on their own terms. These technologies and approaches are not perfect, of course, but I have seen them work.

We should therefore, as a society, be putting our efforts into improving end-of-life care; Palliative Care has proven to be less resource intensive than other end-of-life care, so it is a sustainable option. Even though this process may be draining for patients, doctors, nurses and families, I believe that the beauty and power of the human experience of creating, finding, and holding onto meaning is worth it.

David Benrimoh
First-year medical student at McGill University.
Côte-St.-Luc