Euthanasia: Real Choice or Illusion of Choice?

Press Release: Euthanasia Debate New Zealand

Euthanasia: Real Choice or Illusion of Choice?

Wednesday, July 24, 2013 

Real choice or illusion of choice? The End of Life Choice Bill, which has yet to be drawn from the parliamentary ballot, seeks to legalise euthanasia and assisted suicide in New Zealand. Will this bring choice to New Zealanders or will it in fact lead to less choice for individuals who will be vulnerable to subtle or even overt pressures to accept ‘voluntary’ euthanasia? That is the topic for discussion in a LIVE online conference on Wednesday July 24th.

The conference featured: Dr David Richmond – emeritus professor of geriatric medicine, Dr John Kleinsman – bioethicist, and Dr Don Mathieson – QC and previously professor of law at VUW.

The online video conference is available online. Watch the video conference online at:  http://euthanasiadebate.org.nz/euthanasia/video1/

This conference was hosted by Euthanasia Debate NZ. Euthanasia Debate NZ is a network of like-minded people whose purpose is to educate New Zealanders about issues around euthanasia, assisted suicide and palliative care. This includes drawing attention to the dangers of legalised euthanasia and assisted suicide. 

For more information visit:  www.euthanasiadebate.org.nz

The dangerous 'help' of assisted suicide, by Diane Coleman

The following article was written by Diane Coleman, is a lawyer and the founder and president of the disability rights group Not Dead Yet. The article was published by the New Jersey Star Ledger on July 23, 2013. Link to the original article.

By Diane Coleman

Proponents of legal assisted suicide for the terminally ill frequently claim that the opposing views of disability organizations aren’t relevant.

Nevertheless, although people with disabilities aren’t usually terminally ill, the terminally ill are almost always disabled. This is one of many reasons our perspective may offer some insights on this complex issue.

People with disabilities and chronic conditions live on the front lines of the health care system that serves (and, sadly, often underserves) dying people. One might view us as the "canaries in the coal mine," alerting others to dangers we see first.

Assisted suicide advocates paint themselves as "compassionate progressives," fighting for freedom against the religious right. That simplistic script ignores inconvenient truths that are all too familiar to disability advocates, such as:

• Predictions that someone will die in six months are often wrong;
• People who want to die usually have treatable depression and/or need better palliative care;
• Pressures to cut health care costs in the current political climate make this the wrong time to add doctor-prescribed suicide to the "treatment" options;
• Abuse of elders and people with disabilities is a growing but often undetected problem, making coercion virtually impossible to identify or prevent.

It’s not the proponents’ good intentions but the language of assisted suicide laws that legislators need to consider.

As one of countless disabled people who’s survived a terminal prediction, I can’t help but become concerned when the accuracy of a terminal prognosis determines whether someone gets suicide assistance rather than prevention.

The Oregon reports themselves show that non-terminal people are getting lethal prescriptions. One of the many things the reports hide is how many lived longer than six months. But we do know that those people were disabled and not terminal when they sought their lethal prescription.

Proponents also claim that safeguards to ensure it’s voluntary are working. How would they know? The Oregon reports only tell us what the prescribing doctors indicated were the patients’ reasons for wanting assisted suicide by checking off one or more of seven reasons on a multiple choice state government form. One of the reasons is feelings of being a burden on others, checked in 39 percent of the cases. But there’s no requirement that home care options that could relieve the burden on family caregivers must be disclosed, much less offered or funded.

Elder abuse is notoriously undetected and underreported. Sure, some people are safe, but with more than 175,000 estimated reported and unreported elder abuse cases in New Jersey annually, many are not.

The two witnesses who attest to the absence of coercion don’t actually have to know the person, although one can be an heir. Nothing in the law would stop a family member from urging someone to "choose" assisted suicide. Once the lethal drugs are in the home, with no witness required, the drugs could be administered with or without consent. Who would know?

When we’re talking about changing public policy that impacts the health care system we all depend on, and the real world of families that are not necessarily all loving and supportive, legislators have an obligation to think of everyone, not just those who are safe from the very real risks posed by assisted suicide legislation.

Diane Coleman is president and CEO of Not Dead Yet. 

Links to other recent articles concerning disability and assisted suicide.

- Assisted suicide fraught with consequences.
- Down Syndrome community opposes New Zealand euthanasia bill.
- Bill 52 is bad medicine for Québecers with disabilities.

South Australia Euthanasia bill uses euphemisms to bipass 'Logical Roadblocks'

The following article was written by Paul Russell, the founder and leader of HOPE Australia, a grass-roots organization that opposes euthanasia and assisted suicide. Russell is also the Vice-Chair of the Euthanasia Prevention Coalition International.

Paul Russell

This article was originally published on the HOPE Australia blog under the title: 'Logical Roadblocks' cause euthanasia advocates to go "off road" to get around them.

By Paul Russell - July 22, 2013

It has often been observed that, to make palatable what is decidedly unpalatable, euthanasia bills invariably use all sorts of euphemisms to attempt to soften or obliterate the reality that euthanasia is nothing more that deliberate killing under the cover of state approval.

Moreover, in the attempt to make into law something that is unnatural; namely: intentional killing; such bills will often come up against what we could call ‘roadblocks of logic’ in various forms. Those designing bills need to find a way around these problems.

One such ‘logical roadblock’ comes in trying to answer the question: what do we do about life insurance? Life policies usually include exclusion for certain events such as suicide or self-harm. One Australian Insurer puts it this way:

(Excluded) In the first 13 months of your policy*, suicide or intentional self-harm.*From the date the policy started or was reinstated. If you have increased your cover amount, the same waiting periods apply to the increased component of your benefit.

This stands to reason. Premiums set by insurance companies by their actuaries take into account the likely sum of premiums over the lifetime of the insured as well as the likelihood of sudden death from accidents etc. to arrive at a premium that, across the breadth of the term and the sum of premiums of all persons insured, will ensure that the company makes a profit whilst still paying out on its obligations to the insured.

The exclusion for suicide or self-harm protects the insurance company from, as far as is possible, the risk that someone would create a policy in the full knowledge that they intended to suicide after paying out only a small amount in premiums.

In his South Australian Ending Life with Dignity Bill 2013, The Hon Bob Such has attempted to deal with this roadblock by going 'off-road'. Remember, in Such’s bill anyone with a terminal illness can qualify:

(2) Despite any other Act or law, a person is only terminally ill for the purposes of this Act if—(a) the person has a terminal illness; and(b) the illness is causing unbearable suffering which cannot be alleviated to a degree the person finds acceptable.

Someone with a terminal illness who is not suffering unbearably apparently doesn’t have a terminal illness at all - at least in terms of this bill! As a friend of mine is wont to observe: life is a terminal illness! But I digress.

Note that the bill does not limit the application to the terminal phase of a terminal illness (as expressed in at least one earlier bill) or in respect to the prognosis (less than 6 or 12 months to live). So it could apply to a diagnosis where the normal trajectory of the illness could be many years or, indeed, where there’s some possibility of long-term remission.

This has implications for life insurance companies both in the particular and in a more general sense. They could be foregoing any number of years in premiums which could, overtime, affect their premium structure across their entire portfolio.

Such has not spoken, as far as I am aware, on why he included a clause that obfuscates the cause of death for anyone availing themselves of the bill’s provisions (another logical roadblock):

39—Cause of death

For the purposes of the law of this State, and for any other purpose, the death of a person resulting from the carrying out of a voluntary euthanasia request in accordance with this Act—(a) will be taken to have been caused by the person's relevant illness, injury or medical condition; and (b) is not suicide or homicide.

In addition to forcing a doctor to lie on the death certificate, this clause has further implications for the insurance industry. The Industry blog from CommInsure recently canvassed this issue:

Firstly, the 12 - 13 month preclusion period for suicide, which is built into most Australian life insurance policies, could become unenforceable if a person took their own life in accordance with a voluntary euthanasia provision. In this instance they would be deemed to have died from the relevant medical condition, and not suicide or even homicide (section 39 (a) and (b)).

Insurers would not be permitted to withhold payment under these circumstances, even if the life insurance policy prohibited suicide (section 40(3)).

There is something of a category distinction that needs to be acknowledged here. Euthanasia may well be at the request of the patient, but it is not, in the classical sense, suicide. Homicide is probably closer to what actually occurs (and Such’s clause 39(b) actually acknowledges this).

But there’s more! Also from the insurance blog article:

The new rules could also render all pre-existing condition clauses, relating to the death of an individual in the event of voluntary euthanasia, null and void. The proposed bill could impact not only on group insurance but retail life and direct insurance as well.

Secondly, under the proposed new rules, the section relating to the payment of life insurance proceeds (Section 40 (1) and (2)) would prohibit the life insurer from asking members any questions relating to their intention to end their life during the underwriting process. Insurers could attract a $10,000 fine for doing so (Section 40 (2)).

This could have a significant impact on death and terminal illness premiums as it could translate to increased risk of death or terminal illness payments. The increased risk of claim would result in increased premiums for all policy holders.

The sections of the bill referred to above are as follows:

40—Insurance

(1) An insurer is not entitled to refuse to make a payment that is payable under a life insurance policy on death of the insured on the ground that the death resulted from the carrying out of a voluntary euthanasia request if it was carried out in accordance with this Act.

(2) A person is not obliged to disclose a voluntary euthanasia request to an insurer, and an insurer must not ask a person to disclose whether the person has made a voluntary euthanasia request.Maximum penalty: $10 000.

(3) This section applies despite an agreement between a person and an insurer to the contrary.

So, the effect of this clause could well be that the terminally ill person could purchase a new policy or increase the cover of an existing policy in full knowledge of the fact that they intended to die by euthanasia in the near future. Outside the confines of this clause, this would likely amount to insurance fraud by the omission or withholding of the details. The bill may actually be, unwittingly, encouraging insurance fraud!

As the CommInsure blogger observed, this could cause the industry to radically rethink their approach to terminal illness generally. Moreover, the observation that The increased risk of claim would result in increased premiums for all policy holders points to the reality that euthanasia does have a deleterious effect upon society that, in one way or another, affects us all.

Hospice workers struggle with assisted suicide in Oregon and Washington.

The medical express reported (July 22, 2013) on a study concerning the struggle Hospice workers, who are on the front lines are having in States where assisted suicide is legal.

The article titled: Hospice workers struggle on front lines of physician-assisted death laws. 

The article states:

Laws that allow physician-assisted death in the Pacific Northwest have provisions to protect the rights of patients, doctors and even the state, but don't consider the professionals most often on the front lines of this divisive issue – hospice workers who provide end-of-life care.

The existing system, a new analysis concludes, has evolved into a multitude of different and contradictory perspectives among hospice organizations and workers, who historically have opposed physician-assisted death but are now the professionals taking care of most of the people who use it.

The study – titled "Dignity, Death and Dilemmas" - was just published in the Journal of Pain and Symptom Management by researchers from Oregon State University, and outlines a complex system in which many well-intentioned caregivers struggle to organize their thoughts, beliefs and actions when dealing with a concept they traditionally oppose. It was based on an analysis of 33 hospice programs in Washington state.

When first proposed, it was feared by some that physician-assisted death might displace the palliative and supportive care offered by hospice. Now, in practice, between 85 - 95 percent of the people in Oregon and Washington who choose assisted death also use hospice – but the interplay they have with their caregivers can vary widely.

"It might seem a little surprising that most people who use physician-assisted death also use hospice," said Courtney Campbell, the Hundere Professor in Religion and Culture in the OSU School of History, Philosophy and Religion. "Some hospice workers were originally concerned this concept would make them unnecessary, but in fact the level of hospice usage has actually increased."

Hospice is a national program in which trained professionals provide care to terminally ill patients, ensuring they get proper medical care, adequate pain control, are involved in decision-making and have other needs met in a home environment. They work with both the patient and family to help make death a natural and accepted part of life.

However, hastening or actually causing death is not an accepted part of the hospice philosophy, even though hospice programs acknowledge the right of patients to make that choice where it's allowed by law. But balancing core beliefs, such as compassion and non-abandonment of a patient, with the new laws has been difficult at best for hospice professionals, Campbell said.

"About 75 percent of hospice organizations will not allow their workers to even be present when a fatal dose of medication is used," Campbell said.

The reaction in hospice to physician-assisted death varies from one national organization to another, from one agency to another, from one worker to another. There is little consistency to many complex questions about how, whether, and when hospice workers will get involved as individuals they care for make this choice. Approaches can range from outright opposition to non-participation or non-interference.

In recent years it's become even more difficult as assisted-death has become politicized, Campbell said. Even the words used in describing the serious issues involved are emotionally-charged and inherently contentious, the researchers noted in their report, making reference to legislation that embraced "ending life in a humane and dignified manner" while working its way around such topics as "suicide, assisted suicide, mercy killing and homicide."

Somewhat caught in the middle, and caring for the people who are affected by those laws, are the hospice workers with marginal guidance and conflicted reactions, researchers said.

"The conventional approach to the question of legalized physician-assisted death . . . has missed the issue of how the requirements of a new law are carried out by the primary caregiving institution, hospice care," the researchers wrote in their report.

The OSU research offered no simple solutions to this issue, but rather outlined a broad list of questions that could form the basis for more informed discussions – either among hospice providers, the organizations they work for or the general public.

These includes such topics as the hospice mission, patient access to information, questions about legal options, how to discuss emotional or religious factors, response to specific patient requests, documentation of conversations, responsibility to the patient's family, and many other issues.

Liverpool Pathway in the UK ended over euthanasia implications

OneNewsNow - July 22, 2013 (Link to the original).

Alex Schadenberg

A dangerous policy in the United Kingdom and elsewhere that led to euthanasia is being dumped, but there's concern over what might replace it.

The Liverpool Care Pathway was designed as a protocol to help terminally ill patients die with the least amount of suffering. But Alex Schadenberg of the Euthanasia Prevention Coalition tells OneNewsNow.

“So what's happened is that people who are not dying have been put on the Liverpool Pathway,” he explains. “And of course with the Liverpool Pathway, it is going to be said, Well, this person is dying. So we will deny them any further medical treatment and even withdraw food and fluids. So people who were not dying were being dehydrated to death under the Liverpool Pathway.”

He contends the Liverpool Pathway was being abused in this way, and the U.K. decided it must change - but it is uncertain what will be its replacement. Schadenberg says the problem is that there should not be a one-plan-fits-all situation. Questions also need to be raised in this country because the policy was used worldwide.

“The fact is they're going to get rid of that, and I don't know what they're going to come up with,” Schadenberg says. “What I can say though is that this euthanasia mentality has certainly polluted the water, and it's made it very difficult to have good ethical care.”

He suggests that the policy that needs to be abandoned is euthanasia and doctor-assisted suicide.

The demise of the Liverpool Pathway and euthanasia by dehydration

Melanie Phillips

On July 14, columnist Melanie Phillips, wrote a profound article concerning the demise of the Liverpool Care Pathway in the UK. 

Her article was published in the Daily Mail under the title: "Hope at last on the pathway to death - but the NHS still has a hole where its heart should be."

Phillips begins her article by explaining what the Liverpool Care Pathway (LCP) was:

The LCP was written as a treatment programme for doctors and nurses when looking after people who are dying. 

Such a programme was deemed necessary because of the all-too-common instances of neglect or inappropriate treatment which dying people were being forced to suffer.

Phillips explains the how the LCP was abused, and how others responded to the abuse.

However, the scheme became mired in bitter controversy after relatives and patients claimed that the LCP was being used to accelerate death, or even to kill patients who were not dying at all by starving and dehydrating them until they did, in fact, die. 

Worse still were claims of financial incentives for hospital trusts to bump up the LCP numbers.

Despite vehement protests by the medical and nursing professions that these claims were unfounded, the Government set up an inquiry into the practice. 

It is expected to report today that there were numerous instances of abuse under the LCP, and to say that it should be phased out, a recommendation with which the Care and Support Minister, Norman Lamb, will agree.

Phillips then explains the reaction by her readers to the abuse of the LCP:

When I myself wrote about these abuses, I was all but swamped by the reaction. 

People wrote in droves with harrowing tales of watching in horror as their elderly relatives were deprived of food, water and medicines when they were not dying at all, but merely seriously ill or feeble in mind. 

At the same time, however, outraged doctors and nurses deluged me with accusations that I wanted to inflict cruel and wholly inappropriate treatment upon dying patients. 

Indeed, as soon as the reports first surfaced over the weekend that the Government was intending to end the LCP — even before I had seen these stories — I was already receiving tweets accusing me of having brought about an end to the humane care of the dying. 

Such ill-judged anger among health professionals and others about criticism of the LCP surely derives from precisely the fundamental confusion or callousness that led to the abuses.

The government announces significant changes:

Mr Lamb struck an ominous note, for example, when he said the LCP’s replacement would not be called a ‘pathway’ — which suggested that these practices might continue under a different name. 

He says that end-of-life care will now be tailored for individual patients. But this fails to identify the very confusion at the core of this problem. This arises over the issue of medical staff being able to identify correctly when someone’s life is about to end. For the advice at the core of the LCP is, in fact, nothing other than basic good medical practice in care for the dying. 

When someone really is dying, it may indeed be inappropriate, intrusive or even cruel to continue with treatment, feed them through tubes or inflict upon them similar pointless procedures. 

They should instead be kept comfortable and free of pain, offered nourishment if they show they want it, or merely have their mouths moistened. 

The inevitable process should be allowed to take its course — but only if it is indeed the irreversible closing down of all bodily functions which dying entails.

The article then explains why the LCP was abused:

The Liverpool Care Pathway abuses occurred, however, largely because it was applied to patients who were not at the end of their lives, but who were starved or dehydrated to death. 

Health care professionals either did not understand that someone who was extremely ill or mentally incapable was not actually dying — or, worse, they thought such a life was not worth extending and so terminated it. 

Such staff often find it remarkably difficult to tell when someone really is dying. I recall that when my own father was a few hours from death — a call made correctly by the nurse who was caring for him — the GP who arrived to treat his discomfort airily asserted that he might live for several more weeks, and was duly abashed when he had to return later that evening to pronounce my father dead. 

But this problem has been exacerbated by a deeply troubling modern development. This is the progressive inability to distinguish between someone who really is dying and someone who it is thought should be dying because they are deemed to have such a poor quality of life.

The abuses that have occurred with the Liverpool Pathway are the same abuses that are occurring in Canada and nearly every "first-world" nation. The article continues:

This appalling leap of logic was cemented into English law by the watershed case of Tony Bland, the Hillsborough disaster victim who was left in a persistent vegetative state. 

In 1993, a court ruled that his food and hydration tubes could be removed. That fateful ruling effectively permitted intentionally ending the life of someone who was not dying. 

In other words — although the courts have never acknowledged this fact — this legitimised killing a patient in certain circumstances. 

The Rubicon having thus been crossed, some health-care staff proceeded to withdraw food and hydration from numerous elderly or incapable patients on the grounds that their quality of life was inadequate. 

Indeed, so poor did they judge this quality of life to be that they claimed such patients were dying. Which, of course, they were not — until these doctors and nurses made it so. 

At the core of all this lies the crumbling of the notion that there is an absolute value to human life. ... 

And it is the erosion of this innate respect for life which lies in turn behind the steady brutalisation of care for the elderly and incapable in our hospitals. 

We saw this, to our horror, in the Mid-Staffordshire hospital trust scandal, where the neglect of patients plumbed such depths that some of them were forced to drink water from flower vases to quench their desperate thirst. 

And now another report to be published this week will apparently deliver the bleak, if all-too-predictable, revelation that shockingly inadequate standards of care in some 14 hospital trusts have caused the needless deaths of no fewer than 13,000 patients since 2005.

In Canada our healthcare system is also dehydrating people to death, who are not otherwise dying. Phillips then comments on the state of the National Health Service (NHS) in the UK:

Harsh as this may sound, it is surely hard not to conclude that — whether through the LCP abuses or shocking standards of care — one way or another the NHS has turned into something akin to a national death service for those who are too vulnerable to resist. 

This obscene brutalisation of attitudes cannot be addressed by tinkering with procedures, by yet more Whitehall directives, nor even by the firing of culpable staff (not that that last outcome ever seems to happen). 

We are simply facing nothing less than a moral breakdown: a fundamental collapse of decency, compassion and simple kindness. 

These have been replaced in too many cases by hatchet-faced self-interest, an arrogant and unchecked abuse of professional power and a brutal utilitarianism which has substituted a tendentious judgment of usefulness for innate respect for human life. 

That this has occurred in the NHS, Britain’s supposed temple of caring, does not merely explode that particular claim for the humbug that it is. It is also a judgement upon a narcissistic society which, in sentimentalising the NHS in this way in order to admire its own compassion and altruism, has, in fact, developed a cruel and callous hole where its own heart should be.

Everyone needs to read this article. The problems with the Liverpool Pathway are the same problems that are occurring across the "western-world."

In Canada we are experiencing a crisis of care within our medical system as we continue to build a more centralized, controlled, bureaucratic, financially bankrupt, morally negative system. We have stopped caring about individuals and we have turned "best practices" into a one-size fits all system.

Every nation needs adopt systems of patient centred care.

Link to similar articles:
- Mild stroke led to mother's forced death by dehydration.
- Elder abuse and death by dehydration: A personal story.

The problem with bureaucratic medicine in the UK

The following article was written by Wesley Smith and published on July 15, 2013; on the National Review Online. Link to the original article.

Wesley Smith

By Wesley Smith - July 15, 2013

The NHS (National Health Service in the UK) is melting down. As I have repeated posted about here, the Liverpool Care Pathway–intended to prevent patients from dying in agony–became instead a door to imposed back door euthanasia. So much easier to put patients into a coma and dehydrate them than provide individualized care.

NHS hospitals have so mistreated patients that thousands died who would have lived with proper care. Mothers have given birth in hallways. Emergency patients have been kept in ambulances for hours to ensure that ER rooms met their waiting time bureaucratic mandates. Etc., beyond etc. What a mess.

The magnificent Melanie Philips hits the nail about this in her latest column, “NHS has a Hole Where Its Heart Should Be:”

Harsh as this may sound, it is surely hard not to conclude that — whether through the LCP abuses or shocking standards of care — one way or another the NHS has turned into something akin to a national death service for those who are too vulnerable to resist.

This obscene brutalisation of attitudes cannot be addressed by tinkering with procedures, by yet more Whitehall directives, nor even by the firing of culpable staff (not that that last outcome ever seems to happen). We are simply facing nothing less than a moral breakdown: a fundamental collapse of decency, compassion and simple kindness.

The question is why the “collapse,” why the most caring profession can be transformed into its most callous, why as an American hospital psychologist friend told me recently, she sees a very real threat of “death squad medicine.”

There is much to consider. I have railed about how centralized control deprofessionalizes. And that is clearly true. When doctors and staffers practice to the memo, patients that don’t fit into the mold can seem a bother. This bureaucratic sclerosis is coming to the USA now thanks to Obamacare.

But I think more is involved. When preventing any and all suffering becomes the prime directive, eliminating suffering too easily morphs into eliminating the sufferer. And the very concept of ”suffering” itself becomes elastic, to the point that family suffering becomes germane and the patient is put out of their misery–and given the cost of care–ours.

At an even deeper level, the increasing inhumanity we see comes from rejecting human exceptionalism, and its corollary, the sanctity/equality of human life. If being human is morally irrelevant, when very prominent thinkers seriously assertthat some human beings aren’t human (persons) anymore (or yet), and that their suffering and/or dependency is a pointless drag, that life without a “meaningful recovery” not worth living–it becomes all too easy to think that killing is the best option and that providing individualized care to certain classes of people is not worth our time or treasure.

The crisis in health care isn’t a cause, but a symptom.

Euthanasia would have deprived young patient of her meaningful last day.

The following letter was published in the Montreal Gazette on July 18, 2013 in response to an article titled: Why palliative care is preferable to euthanasia.

By Nathan Friedland RN

Just a day before she died in my arms, I found, through the death of my patient, what David Benrimoh describes as “the desire to create and hold onto meaning in one’s life.” I had been present for every step of her deterioration and knew that her wish was to fight with everything she had until her last breath.

Somehow, through palliative care, humour, music, food and her incredible family, we were able to give her one last day free of monitors, beeping, blood tests and doctors coming in and out to check on her, not 24 hours before she died. Her room was a party-zone as she listened to music from the 1980s on an old record player her father had brought in from home, and did her best to dance with what was left of her frail body. As I listened in to the Dirty Dancing soundtrack near her door, I could not stop the tears from running down my face. How could such a young girl, at just 17 years of age, be so strong knowing she was going to die? But she was. Her desire was so deep to hold onto her life and what it meant to her that she would simply not go down without a fight. Later that afternoon, she fell asleep, and didn’t wake up again. Many considered her death tragic, though I doubt that she ever did.

All of us struggle to find ourselves and discover who we truly are, and through death, I realized that I indeed discovered the meaning of my life as a nurse dedicated to helping people.

Providing euthanasia could have deprived my patient of her last day, and that, without a doubt, really would have been tragic.

Nathan Friedland RN

Roxboro Quebec

Woman requested assisted suicide because of advanced age.

The following article was written by Ed Madden and published in the Irish Medical Times on July 18, 2013. 

Link to the article.

Ed Madden

Ed Madden, BL, looks at a recent European Court of Human Rights case in which an 82-year-old woman sought the right to be allowed to obtain a lethal dose of sodium pentobarbital to end her own life.

Ms Alda Gross is 82 years old and lives in Switzerland. For many years, she had expressed a wish to end her own life. She was becoming more and more frail as time went by and was unwilling to continue suffering the decline of her physical and mental faculties.

In 2005, following a failed suicide attempt, she received inpatient treatment for six months in a psychiatric hospital. This treatment did not, however, alter her wish to die. As she was afraid of the possible consequences of another failed suicide attempt, she wished to end her life by taking a lethal dose of sodium pentobarbital.

‘Selfish motives’

She contacted the assisted-death association, EXIT, for support. They informed her that it would be difficult to find a medical practitioner who would be ready to provide her with a medical prescription for the lethal drug. This was despite the fact that under the terms of Article 115 of the Swiss Penal Code, assisting another person to commit suicide is not a punishable offence unless it is done for “selfish motives”.

In October 2008 a psychiatrist gave an expert opinion that “there was no doubt” that Ms Gross was capable of forming her own judgment. He noted that her wish to die was reasoned and well-considered, had persisted for several years and was not based on any psychiatric illness. From a psychiatric/medical point of view, he did not have any objection to her being prescribed a lethal dose of sodium pentobarbital. However, he refrained from issuing the necessary prescription on the grounds that he did not want to confuse the roles of medical expert and treating physician.

Ms Gross subsequently made a request for a prescription to three other medical practitioners, all of whom declined to provide her with the means of ending her own life. When the Health Board of the Canton of Zurich declined a similar request, Ms Gross took her case to the Swiss courts.

Private life

She argued that her right to respect for her private life under Article 8 of the European Convention on Human Rights had been breached by the refusal of the medical authorities to provide her with the means of ending her own life. She claimed that her right under the Convention to decide by which means and at what point her life would end was “illusory”. The state was under an obligation to provide her with the necessary means to exercise her right to die in a concrete and effective way. Both the Administrative Court and the Federal Supreme Court rejected her case. Ms Gross appealed to the European Court of Human Rights.

In May 2013, the European Court issued its judgment in the case. The Court said that the notion of “private life” within the meaning of Article 8 of the Convention is a broad concept, which encompasses, inter alia, the right to personal autonomy and personal development.

Without in any way negating the principle of the sanctity of life protected under the Convention, many people are concerned that in an era of growing medical sophistication combined with longer life expectancy, they should not be forced to ‘linger on’ in old age or ‘in states of advanced physical or mental decrepitude’, which conflicted with strongly-held ideas of self and personal identity. Ms Gross’s wish to be provided with a dose of sodium pentobarbital allowing her to end her life fell within the scope of her right to respect for her private life under Article 8 of the Convention.

Under the case law of the Swiss Federal Supreme Court, a doctor was entitled to prescribe sodium pentobarbital in order to allow his patient to commit suicide, provided that specific conditions were fulfilled. In this regard, The Swiss courts had referred to the medical ethics guidelines on the care of patients at end-of-life issued by the Swiss Academy of Medical Sciences (SAMS). These guidelines did not have the formal quality of law. In any event, as Ms Gross was not suffering from a terminal illness, her case did not fall within the scope of those guidelines.

A chilling effect

The Court observed that there was no other material containing principles or standards which could serve as guidelines as to whether and in what circumstances a doctor was entitled to issue a prescription for sodium pentobarbital to a patient who, like Ms Gross, was not suffering from a terminal illness. The lack of clear legal guidelines was likely to have “a chilling effect” on doctors who would otherwise be inclined to provide someone such as Ms Gross with the requested medical prescription.

The Court said that Ms Gross “must have found herself in a state of anguish and uncertainty” regarding the extent of her right to end her life. This would not have occurred had there been clear, state-approved guidelines. The Court acknowledged that there might be difficulties in finding the necessary political consensus on a controversial question such as this with a profound ethical and moral impact. However, those difficulties were inherent in any democratic process and could not absolve the government from fulfilling its obligations.

The Court concluded that Swiss law, while providing the possibility of obtaining a lethal dose of sodium pentobarbital on medical prescription, did not provide sufficient guidelines ensuring clarity as to the extent of that right. There had accordingly been a violation of Article 8 of the Convention in that respect. The Court did not, however, adopt a stance on what should be contained in such guidelines. That was a matter for the Swiss authorities.

Three of the seven judges issued a joint dissenting judgment.

References: [2013] ECHR 429; [2013] ECHR 580

The spread of physician-assisted suicide.

Jacqueline Harvey

By Jacqueline Harvey, Public Discourse - July 18, 2013.

Link to the article.

On May 20, Vermont Governor Peter Shumlin signed “The Patient Choice and Control at the End of Life Act,” legalizing physician-assisted suicide (PAS) throughout the state. This event matters not only because this law governs life and death, but also because Vermont is the first state to sanction PAS through the legislative process, via the votes of elected representatives. The law also represents the spread of PAS from the West Coast to the opposite side of the United States.

While neither of these characteristics may alarm right-to-life and disability rights advocates (who perhaps are concerned solely for the people of Vermont), policy scholars know that both of these attributes greatly enhance PAS proponents’ ability to spread the scourge of voluntary euthanasia throughout New England and eventually nationwide.

Prior to Vermont’s action, over 120 PAS bills had been filed in the states, but overwhelming expert testimony against PAS always succeeded in persuading legislators across party lines of its danger to citizens and society. This is what led voluntary euthanasia lobbyists to abandon legislative efforts (which demand information that is damning to their agenda) and instead place their hope in the ignorance of the average voter, who unlike a lawmaker wouldn’t have the benefit of scientific facts and could therefore be swayed by emotional appeals and clever semantics. Polls show that a support for PAS varies by 20 percent based on how the question is phrased, although the outcome remains the same.

Don't give doctors euthanasia powers.

Yesterday, the National Post published an edited version of my letter that they titled: Don't give doctors euthanasia powers. 

My letter responded to the article: That terrifies us: Canadian doctors get virtually no training on handling a patients desire to die.

Alex Schadenberg

Don't give doctors euthanasia powers.

By Alex Schadenberg

Executive Director, Euthanasia Prevention Coalition

This article notes that "Most doctors finish their degrees ... with virtually no instruction on how to deal with death generally, let alone patients who ask for help with suicide." 

I believe that between the lines, this article is suggesting that if euthanasia were legal, end-of-life care would improve. Instead, legalizing euthanasia in Canada would give physicians the right, in law, to cause the death of their patients by lethal injection.

The article focuses on a few bad cases while suggesting that good end-of-life care can lead to a good death. 

When euthanasia becomes part of a medical system it leads to new ethical problems and unlike most medical errors, the abuse of euthanasia causes death.

In Belgium, where euthanasia is legal, independent studies have found that 32% of assisted deaths are done without request. These deaths are hidden from the statistics since another study found that 47% of the assisted deaths were not reported.

Considering all the difficulties that we are experiencing within Canada's medical system, do we really want our doctors to gain the right, in law, to cause our death?