Euthanasia Prevention Coalition Euthanasia Prevention Coalition

Friday, October 12, 2018

The deadly advocacy of assisted suicide in Washington DC

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Dr G Kevin Donovan

The Washington Times published an excellent analysis of the assisted suicide legislation in Washington DC by G. Kevin Donovan, a physician and director of the Pellegrino Center for Clinical Bioethics and professor at Georgetown University Medical Center.

Donovan is responding to public service announcements in Washington DC promoting assisted suicide. Donovan states:

It is no wonder that the assisted-suicide lobby has resorted to such tactics — this dangerous public policy is so unpopular here that in the first year after the District of Columbia enacted a law to allow assisted suicide, not one person killed themselves with a doctor’s help, as the new law sanctions. In fact, during that time only two out of nearly 11,000 licensed D.C. physicians were willing to participate, and just one hospital cleared doctors to be involved.

People in Washington DC clearly do not want assisted suicide. Donovan then explains how legalizing assisted suicide leads to discrimination for people in vulnerable conditions.

Despite so-called safeguards, the D.C. assisted-suicide bill fails to adequately protect the most vulnerable in society. The poor, people of advanced years, persons with disabilities, both physical and developmental, and people who experience depression all find themselves at a much higher risk of being placed, even against their will, in that “second class” of people who do not receive the equal protection of suicide prevention.

This type of discrimination is a reality in places where assisted suicide is legal. We know because in Oregon (oregon.gov), where assisted suicide was legalized 20 years ago, feeling like a burden is among the top end-of-life concerns of people who asked for lethal drugs. Making suicide available to people who require significant care and resources conveys that dependency and the need for care is burdensome, perhaps even revolting.

Donovan continues by outlining the other negative effects associated with assisted suicide.

Assisted suicide also breaks down the patient-physician relationship. With these laws, a doctor is legally forbidden from listing suicide as the cause of death on the death certificate. Not only does that require a falsehood, it makes oversight nearly impossible and accurate disease data a thing of the past. These laws do precious little for patients, but they do ensure that doctors cannot be sued or subjected to criminal penalties when acting “in good faith” within this law.

For centuries, a physician’s primary focus has been to cure and comfort. Assisted suicide is an aberration that distorts that focus, medicalizing suicide. The result is a breach of trust between physician and patient — and the real risk that normalizing suicide will lead to “suicide contagion” in others. There is no mystery behind why physicians in Washington are not lining up to participate: It undermines their credibility and runs contrary to their role as healer. And physicians should be wary of promoting suicide for any reason among their patients. More doctors themselves die of suicide than in any other profession.

Donovan concludes by challenging the suicide lobby from promoting assisted suicide rather than suicide prevention, patient's rights and protection of the vulnerable.

NO DC assisted suicide deaths in the first year after legalization. DC doctors don't support assisted suicide.

Will Canada extend Euthanasia for Psychiatric reasons alone

Canada legalized euthanasia and assisted suicide in June 2016 under the term: Medical Assistance in Dying (MAiD).

In December 2016, the federal government announced that the Council of Canadian Academies would research and provide recommendations concerning the expansion of euthanasia in three areas: mature minors, people who are incompetent but previously requested MAiD and euthanasia for psychological suffering alone. This article concerns the last group.

The Netherlands and Belgium legalized euthanasia in 2002. The legislation in both of these countries technically allowed euthanasia for “psychological suffering.” In the early years, euthanasia for psychological suffering was rare but in the past few years it is sky rocketing.

Dr. Damiaan Denys

A commentary by Dr. Damiaan Denys, the President of the Dutch Society of Psychiatrists, was published in The American Journal of Psychiatry (September 2018) titled: Is Euthanasia Psychiatric Treatment?

Denys commentary is based on a 42-year-old married woman who requested euthanasia for psychiatric reasons while receiving treatment from his team. The Psychiatric team disapproved of her euthanasia death because treatment options existed but the woman died by euthanasia anyway. Denys wrote:

Although we had treated her intensively for 2 years, our advice was disregarded. Eight weeks later we received the obituary of the patient.

Denys outlines the problems with psychiatric euthanasia based on experience in the Netherlands. He wrote:

…whether euthanasia is an option for psychiatric patients, there are medical and ethical dilemmas related to the practical process of decision making and execution. How can we reconcile the daily practice of reducing suicidal ideas and behaviors in patients with respecting a death wish in single cases? How can we distinguish between symptoms and existential needs? How can we decide whether a psychiatrist is sufficiently autonomous to judge euthanasia? Does the fragile therapeutic relationship between psychiatrist and patient not bias judgment? How are differences in opinion between psychiatrist and patient resolved? Although psychiatrists are not legally obliged to approve or execute euthanasia, neither can they interfere once a request is granted by a third party, as illustrated in the aforementioned case.

The Canadian law states that MAiD can be done when it is approved by 2 doctors or nurse practitioners when the person fulfills the following conditions:

The person is at least 18 years old,

The person has a serious and incurable illness, disease or disability,

The person has an advanced state of irreversible decline in capability,

The person has an enduring physical or psychological suffering that is intolerable to them,

The person’s natural death must be reasonably foreseeable (no definition).

Therefore, Canada’s euthanasia law does not permit euthanasia for psychological reasons alone.

Dr. Mark Komrad

Dr. Mark Komrad, an American Psychiatrist on the Faculty at John’s Hopkins University examined the experience with euthanasia for psychiatric reasons in the Netherlands and Belgium. He wrote in a commentary published by the Psychiatric Times (Feb 2017) that:

Some remarkable stories have been profiled in the Dutch media. For example, a woman was granted euthanasia for chronic PTSD due to childhood sexual abuse. The arguments based on personal autonomy to justify such access to PAS/E are being pushed even further in the Netherlands. Ministers of Health and Justice have proposed to their Parliament that criteria not be limited to medical conditions, but be extended to average citizens who feel they have lived “completed lives.”

Canadians were told that euthanasia would be legalized with safeguards to prevent the problems that have occurred in the Netherlands and Belgium. Canada is now considering extending euthanasia beyond the original parameters.

In fact, Canada has gone too far already. Euthanasia for psychological suffering is a bad idea that is abused in other jurisdictions and will be abused in Canada.

Thursday, October 11, 2018

Euthanasia versus Plagiarism at the World Medical Association

Last week, the Canadian Medical Association (CMA) decided to withdraw its membership from the World Medical Association after a controversy related to euthanasia and plagiarism.

Dr Mark Komrad

Dr Mark Komrad, a psychiatrist and professor at John's Hopkins University, wrote a commentary on the drama titled: Euthanasia vs Plagiarism published in the Psychiatric Times on October 10, 2018. The Psychiatric Times considered the commentary as a follow-up to Komrad's article published online on October 3, 2018: An Open Letter to Representatives of the World Medical Association.

Komrad wrote:

A remarkable drama occurred at the World Medical Association (WMA) last week. The events were not just dramatic; they took a bizarre turn. I am an Associate Member of the WMA. As I shared with you in an earlier commentary, an initiative was mounted by the Canadian Medical Association (CMA) and the Royal Dutch Medical Association at the WMA’s semi-annual meeting in Reykjavik to dilute the WMA’s strong language against assisted suicide and euthanasia in their ethics code. This language currently reads:

Physician-assisted suicide, like euthanasia, is unethical and must be condemned by the medical profession. Where the assistance of the physician is intentionally and deliberately directed at enabling an individual to end his or her own life, the physician acts unethically.1

These two national delegations, representing countries where medical euthanasia is legal, appear to have attempted to move the WMA towards a more neutral position. In Canada, euthanasia is a legal option for some patients whose death is “in the reasonably foreseeable future”—which is undefined. In Ontario Province, there have been maneuvers both by government and medical societies to condemn and make illegal refusing to refer patients for euthanasia by physician conscientious objectors. In the Netherlands, even non-terminal chronic conditions like psychiatric disorders, could be eligible, and there is even political pressure to remove medical criteria and open euthanasia by physicians for those who feel “tired of living” or that their life is “complete.” Both countries were looking to the WMA to begin normalizing their remarkably advancing moral wavefronts by moving the fulcrum of world medical ethics.2

At the meeting, Dutch and Canadian delegations withdrew their aggressive proposals at the last minute. However, the German delegation instead proposed a potential compromise in the code’s language. This includes changing the term “physician-assisted suicide” to “physician-assisted death” and changing “unethical and must be condemned” to “physicians should not engage” in these activities. Yet, they also proposed language protecting “conscience rights” for conscientious objectors. However, there was apparently overwhelming opposition to even this “compromise” change in language among the majority of national delegations to the WMA. (Curiously, the Belgian delegation was silent and did not stand up with the Dutch on their initiative, even though their laws and practices are very similar to those in the Netherlands.) Now, the WMA has agreed to call for written opinions from all delegates on this “compromise” proposal of the Germans, to be assembled for their Spring 2019 meeting.

Now for the bizarre part. One can assume that having seen their initiative miss the mark, the CMA delegation discovered that incoming WMA President Dr Leonid Eidelman’s inaugural speech had some passages identical to a previous inaugural speech and some material on the web. They called for his resignation. Dr Eidelman, himself surprised, apologized and said that English was his 4th language and that he had actually hired a speechwriter to draft the speech. So, he was unaware of this sloppy preparation by the speechwriter. The CMA delegates declared this to be the “apex” of unethical behavior and called for his resignation. Not a single country’s delegation supported that call (including the Netherlands) and so they promptly walked out, and resigned Canada from the WMA.

Psychiatrists are familiar with the phenomenon of projection. Could the CMA be projecting a shadow of guilt regarding the remarkable and undoubtedly difficult practice of their members who are euthanizing patients? This shadow seems cast onto such a comparatively puny ethical misstep (inadvertent plagiarism), which is a mere “tempest in a teapot” by comparison.. Yet, the CMA leadership supporting their country’s euthanasia practices feel that their position on euthanasia is ethically justified.3 So, from their vantage point, where they may feel they are on higher moral ground than the WMA which condemns euthanasia, the CMA condemns the WMA President’s sloppiness as the very “apex” of unethical behavior.4 The “primary gain?” The CMA can feel more “comfortable“ not abiding by the WMA’s ethics code, since they no longer belong.

What does the resignation of the CMA from the WMA teach us? “Doctors killing patients is OK. But copying small parts of speeches is real evil—so evil in fact that it merits leaving the international community of medicine.”

References:
1. World Medical Association. WMA Statement on Physician-Assisted Suicide. https://www.wma.net/policies-post/wma-resolution-on-euthanasia. Accessed October 10, 2018.
2. Schadenberg A. Canadian and Dutch Medical Associations pressure World Medical Association to change policy opposing euthanasia. Euthanasia Prevention Coalition. September 6, 2018. http://alexschadenberg.blogspot.com/2018/09/canadian-and-dutch-medical-associations.html. Accessed October 10, 2018.
3. Blackmer J. Dr. Blackmer blog response. April 30, 2018. Physicians’ Alliance against Euthanasia. https://collectifmedecins.org/en/dr-blackmer-blog-response. Accessed October 10, 2018.
4. Rizza A. Canadian Medical Association resigns from world body amid plagiarism accusations. The Toronto Star. October 6, 2018. https://www.thestar.com/news/canada/2018/10/06/canadian-medical-association-resigns-from-world-body-amid-plagiarism-accusations.html. Accessed October 10, 2018.

Dr Mark Komrad has published several excellent articles on euthanasia and assisted suicide. Previous article by Dr Komrad:

Canadian Association of Retired Persons is pressuring governments to force medical institutions to kill.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

The Canadian Association of Retired Persons (CARP) released its policy platform for the 2019 Federal election.

CARP is focusing on 19 areas for action including pressuring the government to force every medical institution that receives government funding to provide euthanasia, also known as Medical Assistance in Dying (MAiD).

The CARP "Exceptional Health Care" policy includes to: Make Accessible End-of-Life Care a Right (page 21 of the platform).

This platform statement first demands palliative care for everyone:

Make access to palliative care a right so that all Canadians can access it regardless of where they live or receive care, including rural, remote and indigenous communities.

The platform then demands that all publicly funded medical institutions provide euthanasia:

Ensure access to medical assistance in dying (euthanasia) is provided at publicly-funded institutions and available to Canadians regardless of where they live or receive care.

By demanding that every funded medical institution provide euthanasia they are then demanding that every religiously affiliated, every palliative care and every long-term care medical institution provide euthanasia.

Promoting euthanasia is not new for CARP.

Wanda Morris

CARP officially became a pro-euthanasia advocacy group in January 2016 when CARP fired Susan Eng, the long-time Executive VP of CARP. Moses Znaimer, the President of CARP, disagreed with Eng's neutral position on euthanasia. Znaimer then hired Wanda Morris, the CEO of the euthanasia lobby group - Dying with Dignity to replace Eng.

In July 2018, Wanda Morris, the current Executive VP of CARP, published an article attacking palliative care institutions and services refusing to provide euthanasia. Morris argued that euthanasia respects the Hippocratic tradition and argued that refusing to do euthanasia causes harm to patients.

Wednesday, October 10, 2018

Sick Kids Hospital Toronto will euthanize children with or without parental consent.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

A recent report from the Hospital for Sick Children in Toronto states that they are not only ready to do euthanasia on children but their policy states that a child should be able to die by euthanasia without the consent or knowledge of the parents.

According to an article by Sharon Kirkey for Sun Media, the Hospital for Sick Children in Toronto published their policy on euthanasia and assisted suicide as a report in the recent Journal of Medical Ethics. According to Kirkey:

The Sick Kids’ working group says the hospital has willing doctors who could “safely and effectively” perform euthanasia for terminally ill youth 18 and older who meet the criteria as set out in federal law, and that it would be “antithetical” to its philosophy of care to have to transfer these patients to a strange and unfamiliar adult hospital. But it is a suggestion that euthanasia might one day take place without the involvement of parents that has provoked fresh controversy in the assisted-death debate.

Who does the Hospital for Sick Children believe that euthanasia can be safe and effective for?

Kirkey explains that the ethicists at the Children's Hospital believe that there is no difference between killing someone and letting them die. Clearly there is a difference between allowing a natural death and actually causing the death of a person. By blurring clear distinctions ethicists minimize the ethical problems associated with doctors killing their patients. Kirkey reports:

The working group said it wasn’t convinced that there is a meaningful difference for the patient “between being consensually assisted in dying (in the case of MAID) and being consensually allowed to die (in the case of refusing life-sustaining interventions).”

Kirkey explains that most Canadian provinces allow mature minors to make decisions about their own care, including withdrawing or withholding life support. She explains that in Ontario a minor can provide consent for treatment or withdrawal of treatment if they understand the “reasonably foreseeable consequences” of their decision. The Sick Kids' hospital stated that they encourage minors to involve their families in medical decisions.

Kirkey explains that the Hospitals for Sick Children is suggesting that children could decide to die by euthanasia without the consent of the parents:

The draft policy argues the same rules should apply to MAID since there is no meaningful ethical or practical distinction from the patient’s perspective between assisted dying and other procedures that result in the end of a life, such as palliative sedation (where people sleep until they die) or withdrawing or withholding life-sustaining treatments.

Kirkey explains that the Sick Kids Hospital paper came out just ahead of the report by The Canadian Council of Academies that will make recommendations in December concerning the extension of euthanasia to mature minors. The same group is examining the extension of euthanasia to cases of mental illness alone, as well as incompetent people who requested euthanasia within an “advance directive”.

Tuesday, October 9, 2018

Grief and suffering associated with death by euthanasia.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

I received a call from a woman who was seeking help to deal with the grief associated with the euthanasia death of her grandfather.

Her grandfather's death was approved by two doctors in-spite of the fact that he was not dying. He requested euthanasia because his health conditions led him to become disabled.

She offered to care for her grandfather, but he refused.

I am not a medical professional, but grief after the death of a family member is normal. If her grandfather had died by suicide or homicide grief counselors would treat her pain and suffering in a serious manner. Since her grandfather died by euthanasia (a legal homicide) she was told that "it was his choice" and "if she loved him she would be supportive."

She sought help from counselors but they refused to speak about euthanasia.

She told me that no one was willing to help her deal with her grief and suffering because her grandfather died by euthanasia and that she is expected to "be happy for him."

I asked her to write about her experience. There are no easy answers to extreme grief, but to write it out and acknowledge her pain may bring some healing. I also told her that she can talk to me about it. I do not claim to be a counselor but I understand her pain.

Her grandfather died by a legal killing and whether he asked for it or not, her grandfather was abandoned. He felt that his life was not worth living and two doctors not only agreed they lethally injected him. They couldn't use the excuse that he was dying anyway, in his case they must have thought that they wouldn't want to live like him either.

This call was likely the first of many calls we will receive from people seeking help in dealing with grief associated with euthanasia. Our culture has decided that killing people by euthanasia, at the most vulnerable time of life, is not only an acceptable answer to difficult human experiences, but our culture has also decided that everyone should support these decisions and there is something wrong with you if you don't.

The grief that she is experiencing is normal. She truly loved her grandfather.

Monday, October 8, 2018

Study uncovers questionable Hospice care and financial fraud in the US.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

From its inception, the Euthanasia Prevention Coalition (EPC) has promoted good hospice and palliative care. One of the founding purposes of EPC is:

To promote improvement in the quality and availability of hospice/palliative care, and effective methods of controlling pain and suffering.

Debate about the Palliative Care and Hospice Education Training Act (PCHETA), S. 693 / H.R. 1676, has grown since the Association of American Physicians and Surgeons opposed the legislation.

The EPC promotes good hospice and palliative care and we urge that physicians and nurses be properly trained in pain and symptom management. It is a tragedy when a person seeks out death by lethal drugs (assisted suicide) because they have not received effective care.

Concerns about the S.693/H.R 1676 stem from two main concerns: the lack of clear definitions in the bill and the abuse of hospice/palliative care.

The lack of clear definitions is important since a goal of the assisted suicide lobby is to normalize assisted suicide by infiltrating palliative care. The abuse of hospice/palliative care creates significant concern since S.693/H.R 1676 provides millions of dollars for hospice/palliative care services.

A few months ago, the US Department of Health & Human Services - Office of Inspector General issued a report titled: Vulnerabilities in the Medicare Hospice Program Affect Quality Care and Program Integrity: An OIG Portfolio. The study found:

Hospice care can provide great comfort to beneficiaries and their families and caregivers at the end of a beneficiary's life. Hospice use has grown steadily over the past decade, with Medicare paying $16.7 billion for this care in 2016. It is an increasingly important benefit for the Medicare population; 1.4 million beneficiaries received hospice care in 2016.

However, OIG has identified vulnerabilities in the program. OIG found that hospices do not always provide needed services to beneficiaries and sometimes provide poor quality care. In some cases, hospices were not able to effectively manage symptoms or medications, leaving beneficiaries in unnecessary pain for many days.

OIG also found that beneficiaries and their families and caregivers do not receive crucial information to make informed decisions about their care. Further, hospices' inappropriate billing costs Medicare hundreds of millions of dollars. This includes billing for an expensive level of care when the beneficiary does not need it. Also, a number of fraud schemes in hospice care negatively affect beneficiaries and the program. Some fraud schemes involve enrolling beneficiaries who are not eligible for hospice care, while other schemes involve billing for services never provided.

Lastly, the current payment system creates incentives for hospices to minimize their services and seek beneficiaries who have uncomplicated needs. A hospice is paid for every day a beneficiary is in its care, regardless of the quantity or quality of services provided on that day. While CMS made some changes to payments, the underlying structure of the payment system remains unchanged.

For the sake of the patients and care-givers and to protect the culture from the promotion of assisted suicide, concerns about the delivery of hospice/palliative care need to be repaired. It is not acceptable that people who are seeking pain and symptom management not receive it and that financial fraud be connected to the care of people while they are at a vulnerable time of their life.

EPC supports excellent pain and symptom management becoming mainstream in providing medical treatment rather it becoming the domain of specialists. People want to die at home and not within institutions who are making huge profits.

Prevention Is the Right Answer to Assisted-Suicide Requests

This article was published by the National Review online on October 8, 2018.

Wesley Smith

By Wesley Smith

We only seek to prevent some suicides these days. If a suicidal person lives in a state where assisted suicide is legal, and is qualified to receive prescribed poison with which to overdose, they will probably never receive prevention interventions.

That’s an abandonment. In Scientific American, Michael Shermer reviews a book about suicide and describes how prevention can benefit any suicidal person. From, “Why Do People Kill Themselves?” (my emphasis):

Like most human behavior, suicide is a multicausal act. Teasing out the strongest predictive variables is difficult, particularly because such internal cognitive states may not be accessible even to the person experiencing them. We cannot perceive the neurochemical workings of our brain, so internal processes are typically attributed to external sources. Even those who experience suicidal ideation may not understand why or even if and when ideation might turn into action.

This observation is reinforced by Ralph Lewis, a psychiatrist at the University of Toronto, who works with cancer patients and others facing death, whom I interviewed for my Science Salon podcast about his book Finding Purpose in a Godless World (Prometheus Books, 2018). “A lot of people who are clinically depressed will think that the reason they’re feeling that way is because of an existential crisis about the meaning of life or that it’s because of such and such a relational event that happened,” Lewis says. “But that’s people’s own subjective attribution when in fact they may be depressed for reasons they don’t understand.” In his clinical practice, for example, he notes, “I’ve seen many cases where these existential crises practically evaporated under the influence of an antidepressant.”

Assisted suicide advocates claim this has nothing to do with their cause because the terminally ill just don’t want to die in agony.

But that’s more fear mongering to win a political debate than reality. The actual reasons people commit assisted suicide or ask for euthanasia–verified from the published statistics from Oregon, Netherlands, and elsewhere–usually has little to do with physical pain. Rather, people ask for suicide help because of existential issues, such as fears of being a burden or being remembered poorly by their loved ones after going through a natural dying process (one of Brittany Maynard’s two primary reasons for wanting to die).

Don’t get me wrong: These are crucial issues that should be taken very seriously. The good news is that they can often be remedied:

In consulting suicide attempt survivors, Lewis remarks, “They say, ‘I don’t know what came over me. I don’t know what I was thinking.’ This is why suicide prevention is so important: because people can be very persuasive in arguing why they believe life—their life—is not worth living. And yet the situation looks radically different months later, sometimes because of an antidepressant, sometimes because of a change in circumstances, sometimes just a mysterious change of mind.”

Exactly. I have met such people who would be qualified for assisted suicide. Indeed, my last hospice patient (I was a volunteer) died peacefully in his sleep of ALS. When I first met Bob, he described being suicidal and wanting to go to Kevorkian (this was in the 90s). His family refused to cooperate and he was so glad! He told me that after some months of just wanting to be dead (because he could not properly support his family anymore and felt abandoned by his priest), that he had “come out of the fog” (his words). He later wrote about how the assisted suicide movement corroded his morale and was harmful to the wellbeing of terminally ill people. Please read it here.

When we accede to an assisted suicide request of a person with a terminal illness, we send the insidious message: “Of course you want to die. I would too in your place.” That’s potentially devastating. And families dragged into the death spiral may support their loved one’s suicidal wishes thinking they are being supportive–when they are unintentionally confirming the patient’s worst fears and unaware that with proper care, their loved one could, one day, be thankful they did not commit suicide.

Friday, October 12, 2018

The deadly advocacy of assisted suicide in Washington DC

Will Canada extend Euthanasia for Psychiatric reasons alone

Thursday, October 11, 2018

Euthanasia versus Plagiarism at the World Medical Association

Canadian Association of Retired Persons is pressuring governments to force medical institutions to kill.

Wednesday, October 10, 2018

Sick Kids Hospital Toronto will euthanize children with or without parental consent.

Popular articles opposing euthanasia and assisted suicide.

Tuesday, October 9, 2018

Grief and suffering associated with death by euthanasia.

Monday, October 8, 2018

Study uncovers questionable Hospice care and financial fraud in the US.

Prevention Is the Right Answer to Assisted-Suicide Requests

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