EPC - USA letter opposing Massachusetts assisted suicide bills.

Joanne M. Comerford, Chair and Members Joint Committee on Public Health

RE: H2381/S1384, O'Day and Mahoney/Comerford, an Act relative to end of life options; legalizing Assisted Suicide

Dear Chairperson and Members:

The Euthanasia Prevention Coalition USA opposes euthanasia and assisted suicide, instead supporting positive measures to improve peoples’ quality of life which also helps their families. We are aging and disability advocates, lawyers, doctors, nurses and politicians.

We are asking you to let H2381/S1384 die in your committee. You will hear several of the more obvious concerns about Assisted Suicide from other opponents. I will focus on these issues about Assisted Suicide that you may not otherwise hear.

• Assisted Suicide is not about pain or a peaceful death; both are myths.
• Assisted Suicide caters to the privileged.
• Insurance companies use Assisted Suicide to deny coverage for curative life-saving treatments, offering to pay for Assisted Suicide instead.
• People of color opposed Assisted Suicide by 2-1 margins on your 2012 ballot measure.
  

It’s Not about Pain or a Peaceful Death; Both are Myths.

Dr. Lonny Shavelson who exclusively practices in providing California’s Medical Aid in Dying (a name used for Assisted Suicide) says promoting it as avoiding pain is a political sales pitch. See webinar minutes 25:24 - 27:53. In his experience, people choose Assisted Suicide because they are low energy or afraid of losing control. He says Oregon’s data is consistent with his experience. The Oregon data show most people choose Assisted Suicide because of a decreasing ability to participate in enjoyable activities (94%), loss of autonomy (93%) and loss of dignity (72%), not fear of pain and suffering.

Dr. Shavelson says another myth is that Assisted Suicide creates a peaceful beautiful death. Actually, it does not change what happens during dying. It simply makes it faster. People gasp for air, change colors, sweat, twitch, have seizures and sometimes vomit which is why he puts them into a coma first. See webinar minutes 37:35 - 41:00. Most people who die under these laws do not have a medical person present, (two-thirds in Oregon). Either way, the family will experience this.

For many years, fatal quantities of barbiturates were prescribed to carry out Assisted Suicide. These drugs cause the lungs to fill with fluids like drowning. When these drugs became expensive, Assisted Suicide doctors experimented on people with other drug cocktails, some of which burned people’s throats causing them to scream in pain and extended the dying process by more than 3 hours and as much as 31 hours.

Assisted Suicide Caters to the Privileged

Assisted Suicide laws like the End of Life Options Act are used primarily by privileged white people. Oregon’s last report says 96.5% of those using the Oregon law in the past twenty-three years were white. Massachusetts is already in the top ten states with increasing youth suicides, positioning your state for more if you enact the End of Life Options Act. Your Office of the Child Advocate found concerning suicide trends among younger Black children, LGBTQ, Native American and Hispanic youth in Massachusetts.

More youth will commit or attempt suicide, especially youth of color, if you pass the End of Life Options Act. In so doing, you send the message that suicide is an acceptable solution to problems. Publicity about suicide leads to more suicides; this is called suicide contagion. Legalizing Assisted Suicide is linked to suicide contagion. Suicide contagion especially impacts youth of color. All of this is more fully explained below.

Publicity about the details of how to commit suicide or that normalizes suicide makes suicide contagious. In 2017 when Netflix released 13 Reasons Why, the story of a 17 year old girl’s suicide and its aftermath, teen female suicides went up by 21.7% (95% CI, 7.3%-36.2). For every person who dies by suicide, another 30 attempt suicide. This particularly impacts teens and adolescents. Because youth are far more likely to attempt than commit suicide, the medical costs for this group can be significant, especially for those who become disabled. Those less financially well off are impacted: 28.4% of medical costs for suicide and attempts are paid by Medicaid; another 24.8% are incurred by the uninsured.

Legalization of Assisted Suicide contributes to suicide contagion, again especially impacting youths. A 2019 report found teen suicides in California increased by 34% since that state legalized Assisted Suicide in 2016. Oregon’s youth suicides increased 79.3% from 2000 to 2018. Research about completed suicides in four states that legalized Assisted Suicide (Oregon, Washington, Vermont and Montana) found it was associated with at least a 6.3% increase in the rate of all suicide deaths. The study reported:

“PAS [Physician Assisted Suicide] is associated with an 8.9% increase in total suicide rates (including assisted suicides), an effect that is strongly statistically significant (95% confidence interval [CI] 6.6%-1.2%). Once we control for a range of demographic and socioeconomic factors, PAS is estimated to increase rates by 11.79% (95% CI 9.3%-14.1%). When we include state-specific time trends, the estimated increase is 6.3% (95% CI 2.7%-9.9%).”

Black and Hispanic youth are particularly impacted. The Congressional Black Caucus calls suicides by Black youth a crisis. Nationally, Black youth under age 13 are twice as likely to die by suicide than their white peers. From 1991-2017, attempted suicides by Black adolescents (boys and girls) rose 73%, while injuries from those attempts rose 122% for the boys. From 2000 to 2015, the suicide rate among Hispanic females rose by 50% overall while increasing nearly 100% among young Hispanic women. Adolescent Hispanic girls attempt suicide at much higher rates than Black or non-Hispanic white girls.

Insurance Companies Use Assisted Suicide to Deny Curative Life-Saving Treatment Insurers stop covering certain treatments due to the availability of Assisted Suicide. Dr. Brian Callister of Nevada says he was stunned when insurance would not cover life saving treatment for his patients who were transferring to California and Oregon, but offered to pay for Assisted Suicide instead. These were people who could be cured with the denied treatment rather than being rendered terminal. In effect, Assisted Suicide is being used to shunt people off the curative, restorative medicine track, especially if they cannot afford to pay for treatments out of pocket.

People of color get this. Even with insurance, people of color get poorer hospital care and pain relief according to a New York Times article. They are disproportionately dying of COVID-19. So, it is unsurprising that Black and Latinx people oppose Assisted Suicide by 2-1 margins‒ “… the voting results from [Massachusetts] Ballot Question 2 in 2012 show Assisted Suicide pits wealthier, whiter districts against those with poorer people and people of color according to Second Thoughts – Massachusetts. 

In closing, I urge you to consider the heartache for families who lose their youth to suicide and the loss of insurance coverage for curable treatments that would follow enactment of these bills, both of which contribute to inequity for people of color. If you weigh that against the so-called benefits of Assisted Suicide which Dr. Shavelson says are myths, you will let the End of Life Options Act die in your committee. 

Sincerely,

Sara Buscher, Chair
Euthanasia Prevention Coalition USA
EPC_USA@yahoo.com

Assisted dying would undermine the fight for equality

Dr Miro Griffiths

Dr Miro Griffiths is a Leverhulme Research Fellow in Disability Studies at the University of Leeds, a policy adviser and spokesperson for the Better Way campaign, was published by the Press and Journal in Scotland on September 27, 2021 explaining why assisted dying undermines the equality of people with disabilities.

Dr Griffiths establishes why the issue of euthanasia concerns him.

I have health conditions which are categorised as “life-limiting” and “progressive”. My strength, respiratory function and swallowing will continue to deteriorate.

Physical movement is primarily limited to my fingers. I require a power wheelchair, 24-hour personal assistance from trained professionals, and various medical interventions every day.

He then explains that he is a researcher and why he recognizes how legalizing assisted death will affect him. He writes:

I believe the introduction of assisted suicide in the UK will have a direct impact on me as a person, and my community as a whole – on how we are viewed and valued, and on the services and support available to us in the years ahead. It is my belief that the practice would undermine existing disability policy and legislative frameworks that aspire to protect disabled people’s rights.

The United Nations, human rights groups, and Disabled People’s Organisations have highlighted the social injustices encountered by disabled people. Legislative and policy interventions should focus on improving opportunities to participate in society and access sufficient healthcare across the life course. But in countries such as Canada that have legalised assisted suicide, the treatment of disabled citizens and their access to such services has declined.

Dr Griffiths shares a link from a Canadian physician concerning the effect of legalizing assisted death for people with disabilies:

Canadian doctors testify to disturbing changes in the way disabled people are now treated by the medical establishment. One doctor recounted how she has encountered “story after harrowing story of disabled people sharing their experiences being demeaned, disempowered, and denied dignity by the healthcare system”. 

“I learned more about power in society and who is written off and who gets given the benefit of the doubt,” she said.

Dr Griffiths discusses how people with disabilities experience human rights violations, denied opportunities to participate in the community, do not receive enough support or respect in society and how legalizing assisted death will compound these issues. He then discusses his further concerns:

Firstly, the legislation would likely be subject to legislative “creep”, where inclusion criteria is expanded to permit more people to access assisted dying mechanisms.

In other nations, similar laws were quickly extended to allow disabled people and people with mental health conditions to access assisted death. What possible assurance can lawmakers give that this will not come about in the UK five, 10 or 15 years down the line? They are opening the door to this if they agree to a narrow change.

The UK assisted dying proposals use arbitrary definitions that focus on individuals in the “last six months of their life”. It is difficult to determine timeframes for expected deaths, given the continued changes to health outcomes, emergences in medical technology, and advancements in health care provision. Access to treatments and support also differs across localities, which will affect health outcome expectations.

Assisted dying would inevitably result in patients thought to have less than six months to live ending their lives by suicide when they would, in fact, have gone on to live much longer. This is a significant ethical dilemma.

Finally, the necessary infrastructure to carry out the proposed assisted dying mechanisms also remains non-existent. No discussion has taken place on the time and resource allocation required to complete the declaration outlined in the bill, and to carry out due diligence throughout the procedures. It remains ambiguous as to how to determine the absence of coercion or duress when applications are made.

The article concludes with Dr Griffiths urging legislators not to legalize assisted death. He then calls on legislators to focus on a better way.

Québec Covid-19 inquest uncovers nursing home deaths from abuse and neglect.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Herron nursing home

A Québec inquest into Covid related nursing home deaths has uncovered some disturbing facts. A report by Tu Thanh Ha that was published in the Globe and Mail on September 14 reports on testimony concerning the Herron nursing home in the suburb of Dorval in Montréal. The report indicates that Covid was cited as the cause of death at the Herron nursing home to hide the fact that residents were dying of dehydration, malnurishment and neglect, also known as elder abuse.

An auxilary nurse (name is protected) reportedly stated in her testimony:

Starting March 13, 2020, a government directive banned visitors, including family caregivers, from entering nursing homes in Quebec. Many elderly residents with Alzheimer’s disease declined quickly when left by themselves. “I saw firsthand that they were dehydrated, in spite of my best efforts to keep them hydrated. I saw that they were malnourished,” the auxiliary nurse said.

In her testimony, and in a 55-page report that she submitted to the inquest, she said that many fatalities at Herron were misleadingly marked as suspected COVID-19 cases, when the deaths were a result of the chaotic handling of the crisis.

“I had the impression that they were blaming the virus because it would be easier to blame the virus than to acknowledge the hard truth that these people suffered from malnourishment and dehydration. I felt that it was a way to escape culpability,” she told the inquest.

The auxilary nurse explains that when staff at the home learned that one of the residents had Covid that many of them abandoned their job and did not return leaving the nursing home critically understaffed. The auxilary nurse stated:

When she came to work on March 29, most of the personnel were missing. The registered nurses left early. One said he had a fever. Another had been told by managers to go and get tested because she had cared for a patient who was found to have been infected.

The auxiliary nurse said she and two orderlies were left to care for a floor with 60 residents. While dispensing medications, she also had to help the orderlies. “I helped out feeding, I helped serve trays, I helped wash people. I was running around like a fool.”

Some of the deaths were clearly from neglect and elder abuse. The report states:

She found one of the first fatalities at Herron, Léon Barrette, whose body was already cold when she visited his room the morning of March 29. There were no physicians or registered nurses present, so a Herron administrator told her she had to handle the paperwork, which she had never done before.

The cause of death was indicated as possibly the new disease. “Everybody was ‘COVID-19 suspected,’ regardless of what symptoms they had,” she testified.

Mr. Barrette had been admitted March 27 and needed oxygen because of breathing problems. But there were no notes on his chart from between his admission and when the auxiliary found him dead. She testified that she saw no oxygen bottle in his room. His family members believe Herron’s staff had forgotten about him.

The report states that even those who had died were treated in an abusive manner:

She said she often “butted heads” with a CIUSSS nursing supervisor when she tried to tidy and clean the bodies of deceased residents. In one case, she said, the supervisor snapped at her for reporting that a dead resident had been left in vomit. “It takes five minutes to clean someone and show respect,” the auxiliary nurse said.

In another case, in a room shared by a married couple, the wife died and was left in her bed for a day. The husband had Alzheimer’s. Every few hours, he checked on his spouse and rediscovered that she had died. “It was extremely callous,” the auxiliary nurse said.

The testimony from the auxilary nurse at the Herron nursing home proves that some of the deaths were not caused by Covid but rather neglect and level of care at this nursing home could only be described has inhumane elder abuse.

The data appeared to indicate that significant abuse was occurring in our nursing homes which prompted me to ask last year - How many Canadian seniors with Covid-19 were killed?

We need to rethink nursing homes and move to community based care (Link).

For several years EPC has been advocating for changes to funding to enable home care. For many, home care is preferable because it enables people to stay in their homes and in their communities. People experience greater respect and dignity when they are cared for by people who know of them

Belgium: Euthanasia of Newborns Practiced Outside the Law

This article was published by the European Institute of Bioethics on June 6, 2021.

10% of newborn deaths in Flanders Belgium are euthanasia deaths.

A recent study has brought to light the practice of deliberate euthanasia to newborns for whom the medical team considered that there was "no hope of a bearable future". These practices concerned 10% of the neonates (0-1 year) who died in Flanders, between September 2016 and December 2017 (i. e., 24 babies).

This practice is illegal in Belgium, yet no authority seems to take offense. The law only allows the euthanasia of a minor if he or she is capable of discernment and conscious at the time of the request for euthanasia.

In her thesis, which served as the basis for the study in question, Laure Dombrecht, researcher at the Vrije Universiteit Brussel (VUB), refers to a similar study conducted in 1999-2000. The proportion of euthanasia to new-borns by injection of lethal substances has increased from 7 to 10% since this previous survey.

Among what is considered as "end-of-life medical decisions" involving 61% of these babies, the study distinguishes between decisions not to start or to stop "life-sustaining treatment" (e.g. ventilator), on the one hand, and the administration of certain substances to the baby, on the other hand. Note that the term euthanasia does not appear anywhere in the article.

In terms of the physician's intentions, the study distinguishes three situations. 

In the first scenario, the physician does not intend to cause or hasten the baby's death, but considers the potential effect of hastening death (e.g., decision not to administer antibiotics, administration of morphine or sedatives). 

The second scenario consists in the situation where the potential effect of hastening death is not the primary goal but is partly aimed at by the physician. 

The third scenario is that in which the physician explicitly intends to cause death (e.g., injection of a lethal muscle relaxant).

While the ethical considerations on the medical decision differ substantively depending on whether it refers to the first or second scenario (death not intended vs. intended death), the study classifies the cases neither according to these two categories of intention, nor referring to the withholding/withdrawing distinction, nor underlining the relevant moral factor actively administering substances. The criterion of proportionality (in withdrawing treatment or in the dosage of substances) is not mentioned either, even though it is decisive for judging the physician's intention.

Doctors who euthanized newborns with lethal injection indicated in 91% of the cases that the main reason for their action was that there was no hope of a "bearable future" for the child. In other words, these children had a real chance of survival, but the medical team - no doubt in agreement with their parents - considered that their lives were not worth living to the end.

Why do practitioners deviate from the legal framework when it comes to children who are unable to express themselves?

The authors of the study raise the question of the need for a framework for this "practice", similar to the paralegal framework established in the Netherlands through the Gröningen Protocol. Such a "framework" would in fact mean conditional authorization of physician infanticide.

Why do death certificates list an assisted death as a natural death and capital punishment as homicide?

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

When someone dies by lethal injection, referred to as MAiD and better known as euthanasia, the death certificate is to list the medical condition that the person had when requesting death by lethal injection and not state "MAiD" or euthanasia.

Most US states that have legalized assisted suicide (a self-administered death by a lethal drug cocktail) also require that the death certificate list the medical condition that the person had when requesting death by a lethal drug cocktail.

When someone dies by capital punishment in the US, which is often done by lethal injection, the death certificate will state homicide.

Why do death certificates list euthanasia and assisted suicide as a natural death and capital punishment is listed as homicide?

One reason might be that the person who dies by capital punishment does not request that death be inflicted upon them while with an assisted death, people request their death.

Nonetheless, this distinction is not always true.

When analyzing the acts, they are all done by the same or similar lethal drug cocktails. Death occurs in the same manner with the only real difference being the intention of the act.

Whether or not you support euthanasia, assisted suicide or capital punishment, I conclude that homicide is homicide and suicide is suicide. Euthanasia and capital punishment are homicide and assisting a suicide is a suicide. Any other distinction is based on symantics and not reality.

California judge rejects preliminary injunction to permit euthanasia within the California assisted suicide act.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

A California federal judge has rejected a preliminary injunction asking the court to permit euthanasia within the state assisted suicide act. Link to the court decision (Link).

On August 30 I wrote an article about the California court case to permit euthanasia within the state assisted suicide act. The case argued that some people with disabilities, who are approved for assisted suicide, are unable to self-administer the lethal drugs. Therefore, based on the Americans with Disabilities Act, the court must permit euthanasia (doctor administered death) in these cases.

On September 13 I wrote that the California court must reject the challenge to the state assisted suicide act based on (among other reasons): 

1. There is no right to assisted suicide, therefore there is no legal requirement to amend the perceived inequality within the state assisted suicide law. 
2. The Supreme Court, in Glucksberg, recognized that there is no right to assisted suicide and it recognized that one state interests in prohibiting assisted suicide was the prevention of euthanasia. This court case specifically seeks to permit euthanasia.  
3. Permitting euthanasia is not an extension of the state assisted suicide law but rather it requires the court to legislate a new law, that being legalizing euthanasia, which is a form of homicide.

On September 20 Justice Vince Chhabria of the United States District Court Northern District Of California rejected a preliminary injunction to permit death by lethal injection (euthanasia) for the plaintiffs. Justice Chhabria stated:

The plaintiffs' ADA claim does not raise a serious legal question, because it seems clear (at least on this record) that the plaintiffs are seeking a modification that would compromise the essential nature of California's program.

Justice Chhabria also makes a clear distinction between euthanasia and assisted suicide by stating:

And most relevant here, the Legislature drew a clear line between assisted suicide and euthanasia, providing that a terminally ill person cannot obtain a prescription unless they can administer the medication themselves and specifying that there is no immunity from criminal or civil liability for someone who administers the medication to a terminally ill person.

Justice Chhabria concludes his decision by stating:

In short, the line between assisted suicide and euthanasia is a significant one. See Washington v. Glucksberg... (1997). It is unlikely that the ADA could be reasonably contrued as requiring a state to cross the line to euthanasia merely because the state has chosen to authorize assisted suicide. Requiring the State of California to cross the line here would likely compromise the essential nature of the end-of-life program it created.

Link to the court decision (Link).

Link to my previous articles about this court case (Link 1) (Link 2).

Contemporary euthanasia is an updated version of early 20th century eugenics

This article was published by Mercatornet on September 22, 2021

German monument to the euthanasia victims

By Mark Sutherland

“Your son was released from a severe and incurable disease.”

“He died quickly and without pain. Considering his serious and incurable illness, death meant relief for him.”

“Considering her severe and incurable illness, life was agony for the deceased. You must therefore understand her death as deliverance.” [1]

These short sentences contrast with the enormity of the suffering of the incurably sick. They are typical of a narrative which makes it hard to understand why anyone could oppose the euthanasia bill to be tabled in the New South Wales Parliament later this year, a narrative which damns its opponents as lacking in compassion.

In spite of this, a look at the pedigree of the euthanasia movement is instructive as to why the measure should be rejected.

The Voluntary Euthanasia Legalisation Society was founded in Britain in 1936. A significant number of its officials and supporters were also supporters of eugenics. The first chairman and secretary, Dr C.J. Bond and Dr C. Killick Millard, were also members of the Eugenics Society, as were its supporters Julian Huxley, H. Havelock-Ellis, Harold Laski and Eleanor Rathbone.

Other supporters, such as H.G. Wells and G.B. Shaw, were not members of the Eugenics Society, but their eugenic views are well documented.

Of course, membership in the Eugenics Society did not disqualify their views on euthanasia. Indeed, it is natural that they supported both, for while “eugenics” comes from the Greek words for “good” and “birth”, “euthanasia” comes from the words for “good” and “death”. A pleasing symmetry.

The eugenic link does illustrate, however, the characteristics of those who created the euthanasia movement. These people met to discuss the problem of others they perceived as defective. As intelligent and enlightened persons, it was natural that they should determine how lesser beings should live and whether they would be permitted to live.

Often, though not always, they were materialists, not religious (a word that was synonymous with superstitious), “scientific” (in ironical quotes because eugenics was a pseudoscience) and who thought that the efficiency of the state should be the ultimate aim of a society.

Like eugenics, euthanasia started with plain “does-what-it-says-it-does-on-the-label” branding. Both movements attracted opprobrium, unfairly they thought, when the Third Reich implemented their ideas on an industrial scale. The Eugenics Society reacted by adopting a policy of crypto-eugenics in the early 1960s and changing its name to the Galton Institute in 1989. The Voluntary Euthanasia Legalisation Society became the Voluntary Euthanasia Society in 1969 and Dignity in Dying in 2006. While the names have changed, the fundamental ideas and motivations of their adherents have not.

With regard to healthcare, the State sees its role as spending money and saving lives. So keen has the State been to do this that, in the past 18 months, we have seen the destruction of inherent rights and freedoms to “keep us safe” as they focus on a single disease. Whether these will be restored is a moot point, but my point here is that the state overreach has happened and that it has been largely accepted, on the basis of a narrative.

For now, let’s assume that we do go back to normal. In the future, the state government will have large debts, increasing areas of activity, a weakening fiat currency and an increasing healthcare bill as the population ages. Legalise voluntary euthanasia — and what could possibly go wrong? In short, in a secular society that has abandoned moral principles for narratives, what is to stop the State from switching from spending money and saving lives to saving money and spending lives? [2]

At this point, if you think: “Ha – got you – slippery slope loses the argument,” think again.

Euthanasia legislation is the initial and partial implementation of an agenda that was set out a long time ago. We have been here before: the quotes at the beginning of the article come from letters of condolence to families of the victims of the Nazi T4 program. Their words reveal that the enthusiasts for euthanasia understood that, when it comes to getting people to accept the murder of the vulnerable and inferior, narrative is key.

Notes

[1] Excerpts taken from page 104 of The Origins of Nazi Genocide: From Euthanasia to the Final Solution by Henry Friedlander.

[2] This phrase comes from the name of Part 1 of Death and Deliverance: Euthanasia in Germany 1900 to 1945 by Michael Burleigh.

Assisted suicide lobby wants to expand assisted suicide laws and promotes death by dehydration.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

A letter from Bob Free, the Board President of the assisted suicide lobby group End of Life Washington sets the agenda and the direction for the group. The letter established two key goals, that being, expanding the Washington state assisted suicide law and promoting legislation that will enable more people to die by dehydration.

In his letter Mr Free states:

As reported to you earlier, the bill to make needed improvements to Washington’s Death with Dignity Act passed the State House of Representatives, with bipartisan support, but failed to make it to the floor of the Senate due to the very crowded legislative session. For the short 60-day session beginning in January 2022, we are determined to pass this important bill. We will be asking you, our supporters, to join Constituent Meetings with your Senator via zoom, to convince them to support HB 1141. The bill’s main objectives are to:

• Reduce the waiting period from 15 days to 72 hours.
• Expand the definition of attending and consulting providers to include Nurse Practitioners and Physician Assistants. 
• Protect providers working in religiously restricted health systems to provide Death with Dignity outside their regular employment.

Here is a link to my earlier article on HB 1141 (Link).

Mr Free explains why the group wants more death by dehydration. He states:

Committee members have also spent the past year drafting a bill to allow people with serious dementia, including Alzheimer’s, to hasten their death by stopping eating and drinking during the last and worst days of their disease. The bill would incorporate EOLWA’s Instructions for Oral Feeding and Drinking, similar to an advance directive, into Washington’s Natural Death Act. The document expresses a person’s decision about when to be offered food and fluids during late-stage dementia, allowing for a surrogate health care decision maker to ensure caregivers honor a person’s wishes to follow the body’s desire to reduce nourishment and die naturally. We intend to have a bill introduced during the 2022 legislative session, with the support of our legislative champions.

Since the Washington state assisted suicide act requires a person to be competent they want to ensure that people who do not qualify for assisted suicide can die by dehydration. Notice that the group is focusing on people with serious dementia and Alzheimer's.

The "safeguards" that were originally in the Washington State assisted suicide law are now being eliminated. Further to that, the assisted suicide lobby has gone back to promoting death by dehydration because they know that once it becomes more common and people witness the horrific deaths by dehydration, they will demand expanding the law to euthanasia.

BMA goes Neutral on Assisted Suicide. Leading Advocate admits more research on Painful Deaths is needed.

Dr Gordon Macdonald
Chief Executive of Care Not Killing

Dr Gordon Macdonald

On Tuesday last week the British Medical Association’s (BMA) Annual Representatives Meeting (ARM) passed a motion by a narrow majority of just 4 votes (49% to 48%) which shifted the organisation to a position of neutrality on ‘assisted dying’ from its previous position of opposition. By ‘assisted dying’ the BMA is referring to both assisted suicide and euthanasia.

The BMA debate followed a poll of its members last year. That poll itself was the result of a motion passed at the BMA’s 2019 ARM which had been proposed by Dr Jacky Davis, a radiologist and Chair of Healthcare Professionals for Assisted Dying and Board member of Dignity in Dying (formerly the Voluntary Euthanasia Society).

Last year’s poll showed that 40% of BMA members who responded voted for the union to adopt a position of support for assisted suicide and 30% for euthanasia.1  However, beneath the headline grabbing top-line numbers there was a complex picture of medical opinion on the question of whether doctors should be empowered to end patients’ lives.

The closer a specialty is to the care and support of dying people; the less likely its specialists are to support assisted suicide and euthanasia. In the poll 70% and 79% of palliative medicine doctors wanted the BMA to stay opposed to assisted suicide and euthanasia respectively – with backing for active support in single digits. Personal opposition was higher – 76% and 83% – and higher still were the percentages unwilling to participate if legalised: 76% and 84%.2

General Practitioners (family doctors) and geriatricians share this closeness to the lived experience of end of life care, and were similarly averse: 39% of GPs who responded wanted the BMA to remain opposed to assisted suicide compared to just 34% in favour and 46% were personally opposed whilst 43% were personally in favour. Similarly, 44% of geriatricians wanted the BMA to remain opposed to assisted suicide compared to 27% in favour of BMA support for assisted suicide whilst 52% were personally opposed and only 36% personally in favour of a change in the law.3

That brings us to this week’s debate because the poll was conducted on the assumption that any legislation being introduced would be limited to an assisted suicide law applying to adults who are terminally or seriously ill, mentally competent and who voluntarily request assistance to end their lives.4  However, the motion proposed for debate (and approved) has no such caveats.5  In essence, the BMA has opted for neutrality regardless of the nature of any future legislation. So the BMA is now neutral on whether or not those suffering from minor non-terminal conditions and who may have years to live, disabled people, those with psychiatric illnesses, children or just elderly people who are depressed, lonely and tired of life will be allowed under a future law to request assisted suicide or euthanasia.

Then on Thursday this week the Spectator published an article on its website by Dr Joel Zivot6  in which he stated that his research into the deaths of death row inmates has shown that in many cases of those who choose to die by lethal injection they experience pulmonary edema and essentially drown in their own secretions. They may well be suffering pain and distress in the process, often including gasping for breath. Other research suggests that signs of pulmonary edema occur in 84% of cases studied.7  This is relevant because the same drugs (Pentobarbital and Secobarbital) are used in assisted suicide deaths in the USA and euthanasia deaths in Canada.

Link to the podcast "Let's Find Out" between assisted suicide lobby leader Dr Jacky Davis and Dr Joel Zivot (Link to the podcast).

In a Spectator podcast made available online on Thursday evening,8 Dr Zivot discusses his article with Dr Jacky Davis. Dr Davis admitted that she was unaware of this issue previously and acknowledged that Dr Zivot may be right in his findings, but said that more research needs to be done to establish the facts and that Dr Zivot should not be making this information available to the public until that research had been undertaken. She even suggested that the doctors involved in conducting the assisted suicide deaths should be the ones to do the research.

In response, Dr Zivot stated that it was for those who are pushing for the legalisation of assisted suicide or euthanasia to justify their stance and that the onus is on the advocates of ‘assisted dying’ to determine what they have done. He said that the practice of ‘assisted dying’ could be construed as a poor experiment and the onus is on the advocates of ‘assisted dying’ to show that it is “sound and reasonable”.

Now there is some suggestion that the reason for the build up of fluid in the lungs of those who die by lethal injection may be due to the fact that large amount of drugs are being given intravenously over a short timeframe rather than taken orally and that this damages the lungs.9  However, since no post-mortems (autopsies) relating to those who have died by assisted suicide or euthanasia have studied and reported on this aspect of the deaths in question, it is impossible to know if that is indeed the case. Moreover, in Canada, at least in Nova Scotia10, intravenous delivery of Medical Assistance in Dying (euthanasia) seems to be common which raises the question of how many of the 7,595 people who died by MAiD in Canada during 2020 also experienced pulmonary edema, or the ‘drowning’ effect, identified by Dr Zivot in his death row examples. Evidently there is a need for more research.

Whether or not the doctors and families involved in assisted suicide and euthanasia deaths in the USA and Canada will be willing or interested to investigate this matter further remains an open question. What is clear, however, is that rather than rushing into changing the law to follow their North American counterparts in legalising assisted suicide or euthanasia, British legislators should take a much more cautious approach. The BMA should have done so also.

Citations:

1. https://www.bma.org.uk/advice-and-support/ethics/end-of-life/physician-assisted-dying/physician-assisted-dying-survey
2. https://www.bma.org.uk/media/3367/bma-physician-assisted-dying-survey-report-oct-2020.pdf, Appendix C, pp. 99-117.
3. Ibid.
4. https://www.bma.org.uk/media/2353/bma-physician-assisted-dying-info-pack-april-2020.pdf, page 3.
5. https://www.bma.org.uk/media/4579/2021-arm-resolutions-day-2-am.pdf, Resolution 70.
6. https://www.spectator.co.uk/article/last-rights-assisted-suicide-is-neither-painless-nor-dignified
   
7. https://www.npr.org/2020/09/21/793177589/gasping-for-air-autopsies-reveal-troubling-effects-of-lethal-injection?t=1631783805580&t=1631894393773
8. https://www.spectator.co.uk/podcast/payday-who-s-afraid-of-rising-wages-
9. https://www.npr.org/2020/09/21/793177589/gasping-for-air-autopsies-reveal-troubling-effects-of-lethal-injection?t=1631783805580&t=1631894393773
10. Crumley E.T. et. al.; “How is the medical assistance in dying (MAID) process carried out in Nova Scotia, Canada? A qualitative process model flowchart study”, https://bmjopen.bmj.com/content/11/7/e048698

Push for assisted suicide raises questions over disability rights

This letter was published by the Boston Globe and Not Dead Yet on September 7, 2021

John Kelly

In response to an essay on the Victorian fantasy of a peaceful death, two letter writers (“Beyond the fantasy of a gentle death,” Aug. 29) called on the state Legislature to pass the proposed assisted suicide bill.

Paula Bacon and Molly DeHaas Walsh describe the circumstances of difficult deaths and believe that assisted suicide would bring them control, choice, and dignity when their pain and suffering become unbearable.

But when doctors misdiagnose people as terminal, the possibility of real choice disappears. Studies show that 12 percent to 15 percent of people outlive hospice, but in Oregon, with its Death With Dignity Act, only about 4 percent of people have lived past six months. This suggests that as many as 1 in 10 people ended their life prematurely. No one would tolerate any other elective treatment this deadly.

The Oregon reports show that the main “end-of-life concerns” stem not from physical pain but from “existential distress” over the disabling aspects of serious illness, such as dependence, status loss (“dignity”), incontinence, and feeling like a burden on others.

As someone paralyzed below the shoulders, I am terrified of the prospect of a state law sponsoring people’s suicides as rational responses to disability. Massachusetts should instead fully fund home care and provide world-class palliative care. Equality under the law depends on it.

John B. Kelly
Boston

Previous articles on assisted suicide by John Kelly (Link). 

Assisted suicide is neither painless nor dignified.

Death by euthanasia or assisted suicide are similar to death by drowning.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

I have published several articles about the research by Dr Joel Zivot, concerning autopsy results from people who died by lethal injection. Dr Zivot is an assistant professor of anesthesiology/critical care at Emory University School of Medicine in Atlanta. The Spectator published a great article by Dr Zivot on September 18 titled: Assisted Suicide is neither painless nor dignified. Zivot is challenging the upcoming assisted suicide bill.

Link to a podcast segment "Let's Find Out" between assisted suicide lobby leader Dr Jacky Davis and Dr Joel Zivot (Link to the podcast).

Zivot explains that he is an expert witness opposing lethal injection executions in America. Zivot opens his article by provacatively stating:

I am quite certain that assisted suicide is not painless or peaceful or dignified. In fact, in the majority of cases, it is a very painful death.

The death penalty is not the same as assisted dying, of course. Executions are meant to be punishment; euthanasia is about relief from suffering. Yet for both euthanasia and executions, paralytic drugs are used. These drugs, given in high enough doses, mean that a patient cannot move a muscle, cannot express any outward or visible sign of pain. But that doesn’t mean that he or she is free from suffering.

Zivot explains his experience with death by lethal injection:

In 2014, I watched the lethal injection of Marcus Wellons in a Georgia prison. The 59-year-old had been sentenced to death for the rape and murder of his 15-year-old neighbour India Roberts in 1989. ‘I’m going home to be with Jesus’ were his final words as the drugs entered his body.

I noticed that Wellons’s fingers were taped to the stretcher, which made little sense, given his body had already been restrained by heavy straps. I kept asking myself why. I read into the subject and came across a report of the lethal injection execution of another death row inmate, Dennis McGuire, five months earlier. During that 24-minute process at the Ohio jail, McGuire clenched his fists. Perhaps it was a final, futile show of defiance. Perhaps it was an outward display of pain. With his fingers secured, Wellons could not have made any such gesture.

Based on autopsies, Zivot proves that death by lethal injection, whether it be execution, euthanasia or assisted suicide are similar to death by drowning:

In 2017, I obtained a series of autopsies of inmates executed by lethal injection, which confirmed my worst fears. Wellons’s autopsy revealed that his lungs were profoundly congested with fluid, meaning they were around twice the normal weight of healthy lungs. He had suffered what is known as pulmonary oedema, which could only have occurred as he lay dying. Wellons had drowned in his secretions. Yet even my medical eye detected no sign of distress at his execution.

Wellons was executed with a chemical called pentobarbital, which caused his pulmonary oedema. In Oregon, four in five assisted suicides have employed pentobarbital or its close relatives. (The Assisted Dying Bill is based on the Oregon system.) If a post-mortem examination were to be performed on a body after assisted suicide, it’s very likely that similar pulmonary oedema would be found.

Zivot continues by explaining why the proposed British assisted suicide bill will likely result in deaths similar to drowning:

The proposals before the House of Lords would see sick patients prescribed a lethal dose of perhaps 100 barbiturate pills. Laws in Oregon, like those proposed in the UK, require patients to take the drugs themselves, which rules out any form of general anaesthetic. Often patients are handed anti-sickness and anti-seizure tablets but nothing more in preparation, meaning they’re very much awake as the assisted suicide process begins and they start ingesting fatal quantities of barbiturates. Without a general anaesthetic, many will be in great discomfort, even if outwardly they don’t appear to be suffering.

Zivot confirms his theory based on the assisted suicide death of Linda Van Zandt:

Indeed, there are countless examples of people who have discovered just how messy, painful and distressing it can be as they watched their loved ones go through the process. Take Linda Van Zandt, who helped her aunt, suffering from amyotrophic lateral sclerosis, die in California. She later described how she had to feed 100 crushed pills in a drink to her aunt ‘who could barely swallow water’, but ‘had to drink all of it in less than five minutes to “ensure success”’. She concludes: ‘The day was fraught and frightening… We had been forced to assist in the most bizarre fashion, jumping through seemingly random legal hoops and meeting arbitrary deadlines while my aunt suffered, and finally emptying capsules, making an elixir so vile I cried when I knew she had to drink it. This was death with dignity?’

Zivot states that, when given the information about how death by lethal injection occurs, three death-row inmates chose to die by the electric chair rather than die by lethal injection. Zivot concludes:

Advocates of assisted dying owe a duty to the public to be truthful about the details of killing and dying. People who want to die deserve to know that they may end up drowning, not just falling asleep.

When Dr Zivot made a similar presentation to the Canadian Senate Committee examining the euthanasia bill, they simply ignored his warnings based on some argument that executions and assisted death are different. In fact, Zivot acknowledges that they are different, but the drugs used are similar and result in the same outcome,

Death by euthanasia or assisted suicide are similar to death by drowning.

What is the "good" of euthanasia, Part III: A true system of choice

Gordon Friesen

By Gordon Friesen, EPC Board Member.

Necessary comparisons 

I have stated, on many occasions, that I am categorically opposed to euthanasia and assisted suicide and I will continue to struggle, on the most fundamental level, for a complete prohibition thereof. However, this article is based on being faced with the necessity of choosing some rational framework, to accommodate assisted death as a fait accompli.

Some time around 2013, approximately two years after I first decided that my various writings in opposition to medically assisted death should be organized into an actual book (still incomplete to this day), I attended a public meeting, in Montreal, of the Physician's Alliance Against Euthanasia. Many very valuable things were said about the dangers of what was then mainly feared as "physician assisted suicide". In the post-presentation question period, I had the opportunity of advancing an unconditional right-to-die position according to which any rational person should be allowed to choose the time, and the manner, of their own death, with no medical criteria and in fact: with no criteria of any kind, other than a true ability to choose.

I didn't take this position because I wished to see assisted suicide legalized in Canada. Quite the contrary. However, I had become convinced that the principle of choice would inevitably prevail (as it subsequently has done), and that frankly embracing choice is the only possible way of preventing that much, much worse alternative, which consists of inaugurating a scheme of euthanasia, normalized as benign medical care (such as that which we see in Canada today).

I realize, of course, that this is counter to all intuition; and that most readers would naturally assume that assisted death, restricted by medical criteria, must still be preferable to a full-on right-to-die. And yet most sincerely, after multiple decades of considering these questions, I would wish to argue that this is not logically the case; or at least, I would wish to invite the reader to undertake a comparison of relative harms in each case (right-to-die, versus medical euthanasia), according to a very simple standard ("What is the worst that can happen ?"), applied fairly to each.

A summary quantitative analysis

Unfortunately, from the moment we accept any form of assisted death, people are going to die. That is the inescapable fact. Therefore, In order to choose our poison (that is: to choose any form of assisted death), we must mainly consider the effects of those deaths on the rest of society.

The first and simplest measure, of social impact, would be quantitative: for more deaths must produce more effect. And on this score, we see that the very permissive Swiss system, of largely choice-based assisted suicide, produces only about half as many deaths as the heavily medicalized euthanasia system of neighbouring Netherlands; and also, the number of physician assisted suicides in the relevant American States, is truly trivial in comparison with the volume of euthanasia, per capita, as already performed in Canada, only five years after legalization (2016).

And yet there is a deeper measure of harm involving the damage wreaked upon the moral compass of individuals, and indeed, upon the moral fabric of society. And it is upon these injuries that I would wish to insist in what follows.

The German example : Moral implications of a free choice of death

On February 26, 2020, the German Federal Constitutional Court struck down a recently passed law which had been intended to prevent private organizations from offering assisted suicide as a quasi-commercial service. The logic was simple : people have a (constitutional) right to commit suicide and to seek aid in so doing; but to stop the operation of organizations offering such assistance, would be to effectively nullify that right; and therefore, such organized (and presumably even commercial) activity must be allowed.

As far as the underlying moral case is concerned, it is simply recognized, in this ruling, that different moral opinions exist in a pluralist society; that it is not the role of the High Court (of a constitutional state) to make judgments of a moral nature; that such a role must be limited to ensuring the constitutionality of legislation.

Simply stated then: despite enabling assisted suicide, the German State will not affirm that assisted suicide is "good" (either in general, or in any particular case). And above all: there is no suggestion, explicit or implied, that the German government, German society, individual German citizens, or any professional group, in Germany, have the slightest obligation to provide assisted death.

Free assisted death, and protection of the sick and disabled

In keeping with this general approach there are a number of especially significant elements in the actual judgment, and in particular the following (quoted from the official translation):

"The right to a self-determined death is not limited to situations defined by external causes like serious or incurable illnesses, nor does it only apply in certain stages of life or illness. Rather, this right is guaranteed in all stages of a person’s existence. Restricting the scope of protection to specific causes or motives would essentially amount to a substantive evaluation, and thereby predetermination, of the motives of the person seeking to end their own life, which is alien to the Basic Law’s notion of freedom."

In other words, Germany does not opine on the value of motives. There is no limit on the personal freedom to die, medical or otherwise. And this, paradoxically, is precisely what protects others, in such a system, from "death by association". For to state that a person "should" be allowed to die in situation "A" (but not situation "B"), is the same thing as saying that it is "right" for "A" to die. And thus, to affirm, for instance, that only a person with a grave medical condition "should" be allowed to die, is functionally the same as saying that it is "good" for such a person to die (in a way it is not for others); which, to be sure, is only a hairsbreadth away from simply stating that such a person "should", in fact, die. The German model, however, avoids these grossly discriminatory implications entirely; and thus avoids placing a significant moral pressure towards precocious death (backed by the full authority of the State) upon particular vulnerable groups, which is to say: upon the ill and disabled.

Freely assisted death and the medical profession

To judge the independent and pluralist nature of medical ethics in Germany (and the freedom of individual doctors to practice as they wish) we note that in spite of the assumed constitutional right to die, the following were actually given as reasons for why independent suicide services are indeed necessary:

"Without (assisted suicide services) the individual is reliant on physicians ... at least in prescribing substances. ... willingness of a physician can only be expected in exceptional cases. ... physicians have shown little willingness ... and cannot be obligated... The prohibition of suicide assistance from physicians... has been incorporated into the professional codes of most State Chambers of Physicians,... (and this) guides the actions of physicians in practice even where the relevant codes are not considered legally binding."

Quite clearly, also, there is no expectation that any of this will (or should) change. For under this paradigm of mutual freedom, it is simply assumed that the protection of assisted suicide services in no way places any obligation, or demand, upon individual doctors, upon doctors' regulating bodies, or upon the medical profession as a whole.

Assisted suicide and the State

Because the German State has declined to recognize any moral validity to the constitutionally protected right to die, that State retains its own right (and assumed obligation) to do the following:

"taking measures of general suicide prevention. ... establishing that the individual’s resolution to commit suicide is sincere and final ... expanding and strengthening palliative care ... counter dangers arising from current and foreseeable living conditions capable of influencing the individual to choose suicide ... preventing assisted suicide becoming recognized as a normal way of ending life... counteract developments that create social expectations pressuring individuals to take their own life, e.g. based on considerations of usefulness."

The very last sentence, of this historic judgement protecting the operation of independent assisted suicide organizations in Germany, is the following detached statement:

Regardless (editor's italics), there can never be an obligation, on anyone, to assist in another person’s suicide.

Standing as a paragraph all of its own, this statement apparently means "regardless" of any consideration whatsoever, and the term "anyone", would logically include individuals, professions, and the State itself.

In conclusion

The measure of the value of any moral system lies in its internal coherence. The coherent implications of a free right to die (including the right to seek assistance in dying) lead logically to a position such as that of the German Federal Constitutional Court described above: with no explicit discrimination against the ill and disabled; no obligation of the medical profession; no moral association of the state; and thus, providing an optimal environment for positive regulation, and for the development of countervailing measures.

I have stated, on many occasions, that I am categorically opposed to assisted suicide and I will continue to struggle, on the most fundamental level, for a complete prohibition thereof. However, faced with the necessity of choosing some rational framework, to accommodate assisted death as a fait accompli, I find the non-medical right-to-die interpretation comparatively appealing. In a future continuation of this text, I hope to analyze, also, the rational implications (and practical results) of the medical euthanasia system, as adopted in Canada. I will then invite the reader to look, dispassionately, at the respective advantages of these two models, when laid side by side.

One might suggest, of course, that we Canadians no longer have the leisure of choosing between these paradigms. For, as a practical matter, we are already saddled with both. However, I would argue that this actually makes it all the more important to clearly distinguish between the two, in the hopes of preventing the worst properties, of one, from enabling (and enhancing) those of the other.

Gordon Friesen, Montreal, September 20, 2021

http://www.euthanasiediscussion.net/ (français)
http://euthanasiadiscussion.com/ (english site in development)
http://hopeandfree.com/ (personal philosophical musings)