Conrad's law to prevent suicide coercion in Massachusetts.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Conrad Roy

Amy Sokolow, reported for The Boston Herald that Conrad's Law will once again be debated in the Massachusetts legislature. 

The bill is named for Conrad Roy who died in July 2014 after his girlfriend, Michelle Carter, pressured him through text messages and phone calls to carry out suicide. Almost seven years after his death, legislators have refiled legislation to prosecute coerced suicide in Massachusetts, bringing the state in line with almost all the others in the U.S.

Sokolow quotes Sen. Barry Finegold, D-Andover, who filed the legislation as stating:

“The fact that 42 other states have something like this on the books and we’re only one of eight states that (doesn’t) speaks volumes about why we do need something like this,”

Roland St. Denis, the husband of Conrad's mother, told the media

...having struggled with mental illness himself. He has worked with Medwed, Higgins and Finegold to shape this bill and shepherd it through the legislative process.

The lack of a coercion bill made Carter’s court case drag out longer than necessary, and “put an enormous amount of strain on Lynn, her daughters, (and) her son’s father’s family,”

Sokolow reported that Carter was convicted of involuntary manslaughter and was released from prison last year.

More articles on this topic:

• Massachusetts high court upholds manslaughter conviction for woman who assisted the suicide of her boyfriend (Link).
  

The failure of deaths by lethal injection

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Whether you oppose or support the death penalty, these deaths by lethal injection are observed and researched while deaths by euthanasia are not observed or researched.

In Canada (MAiD) euthanasia deaths are observed through a self-reporting system, whereby the person who approves the death is often the same person who carries out the death who is the same person who reports the death. This self-reporting system enables abuse of the law and problems with euthanasia deaths to remain unknown.

Death penalty lethal injection deaths are often observed by the media and usually include an autopsy thus enabling researchers to determine whether or not the person who died suffered in the process.

An article by Austin Sarat that was published on March 23, 2021 in The Verdict  examines the failure of capital punishment deaths by lethal injection.

This issue concerns me because the lethal injection drugs used in capital punishment are the same or similar to the lethal injection drugs used in euthanasia.

Sarat writes:

From its earliest adoption by the state of Oklahoma in 1999 through 2009, lethal injection meant one thing, death by a standard three-drug cocktail: sodium thiopental, an “ultrashort-acting barbiturate” to anesthetize the inmate; pancuronium bromide, a “chemical paralytic” to asphyxiate the inmate; and potassium chloride, to stop the heart. By 2009, every death penalty state used this same drug combination.

A decade later, none was employing it. Instead, they were executing people with a wide variety of novel drug combinations.

Sarat explains:

My research collaborators and I have examined every American execution during the last decade. We found that as the paradigm decomposed, the number of problems encountered during executions by lethal injection multiplied.

Of all the techniques used to put people to death in the United States during the 20th and into the 21st century, by 2010 lethal injection already had shown itself to be the most problematic. Since then things have only gotten worse.

Sarat uncovers the problems with death by lethal injection:

First, during the last decade, in more than eight percent of lethal injections, executioners struggled to find suitable veins to set IVs.

We also found that the lethal injection process itself does not always produce painless death. In almost five percent of the last decade’s lethal injections, inmates gave some verbal indication that they were experiencing pain during their execution.

One such inmate was Anthony Shore, who was executed in Texas on January 18, 2018. Soon after his execution by pentobarbital began, Shore cried, “Ohh weeee, I can feel that it does burn. Burning!” He then shook on the gurney and struggled to breathe, before dying 13 minutes later.

In another sign of lethal injection’s inhumanity, a September 2020 NPR investigation found signs of pulmonary edema—fluid filling the lungs—in 84 percent of the 216 post-lethal injection autopsies it reviewed. Inmates’ lungs had filled with fluid while they continued to breathe, which would cause them to feel as if they were drowning and suffocating.

Sarat's research suggests that from 2010-2020, 3.7 percent of barbiturate combination executions were botched in comparison with more than 22 percent of sedative combination executions.

Sarat concludes by stating:

Over the last decade, new drugs and drug cocktails may have allowed the machinery of death to keep running. New procedures may have given the increasingly jerry-rigged lethal injection process a veneer of legitimacy. But none of those changes has resolved its fate or repaired its vexing problems.

By now we should have learned that little can be done to change lethal injection’s status as America’s least reliable and most problematic death penalty method.

This column was the product of a research collaboration with five Amherst College students, Mattea Denny, Nicolas Graber-Mitchell, Greene Ko, Rose Mroczka, and Lauren Pelosi.

More articles on this topic:

• Assisted death may be a cruel death (Link).
• Is death by euthanasia similar to death by drowning? (Link).
• Is death by lethal injection similar to drowning? (Link).
• Assisted suicide deaths may not be quick or peaceful (Link).
• Do euthanasia drugs cause a painful death? (Link).
• Many assisted suicide deaths are slow and painful (Link).

Why is MAiD considered a right but palliative care is not.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Dr Janis M. Miyasaki asks the question in her article published by the conversation on June 14 that: Why is access to medically assisted death a legislated right, but access to palliative care isn’t?

Dr Miyasaki explains her concern based on personal experience. She writes:

John started his first appointment in the Neuropalliative Care Clinic with, “I want to talk about MAID.” In our clinic, his request for medical assistance in dying is common. As legislated by government, I referred him to the MAID navigator. I had one request: that John wait to make his MAID decision until after seeing a community palliative care physician.

At his next appointment, John informed us he had withdrawn his MAID request because his primary symptom —pain — was now well controlled after our suggestions and those of the community palliative care doctor. John lived for two more years, during which he became closer with his daughter and continued to enjoy the company of his siblings.

The article explains how MAiD is considered a priority:

In June 2016, the passed legislation that gave all eligible Canadians the right to request MAID. Colleges of Physicians and Surgeons required physicians to refer people who request MAID to services or arrange for a physician who would make the referral.

Since then, every province and territory devoted resources to navigate requests and assessments for MAID. Typically, provinces have a website for self-referral, easily found by internet search and/or dedicated health-care staff to help navigate the MAID process or inform those who are MAID-curious.

Dr Miyasaki then explains how palliative care is not prioritized:

By contrast, the referral process for palliative care is often convoluted. Many provincial web pages simply give a definition of palliative care (some confuse the issue by including the MAID navigation site) but do not provide a central access point for physicians or nurses. Referral forms (where available) are complex, which creates another barrier to access. Many palliative care programs have an unofficial prognosis of three to six months’ life expectancy for services, despite research demonstrating that early palliative care improves outcomes and in fact, can prolong life.

Dr Miyasaki offers a solution:

The solution requires a multi-faceted approach. All health-care providers need to have general palliative care skills because, in the way we all learn to control blood pressure and read a basic electrocardiogram, palliative care is part of good medical care.

At a systems level, placing as much importance on palliative care as we do on MAID might make navigation to palliative care less difficult for patients and clinicians. Given the broader applicability of palliative care, it is time for palliative care to become an independent department. Up to 28 per cent of Canadians will be seniors, which means more people with multiple, chronic conditions that could benefit from a palliative approach.

Building the palliative care workforce is essential. The palliative care workforce in Canada is estimated to be 773 doctors for a population of 39 million. Once the palliative care workforce is established, educating the public that palliative care includes a holistic approach to wellness and meaning in life can help re-frame and increase acceptance.

There are more people like John who should connect with a palliative care team before walking down the road to MAID. Let palliative care help you live well, now.

Sadly, (MAiD) euthanasia has changed palliative care. Palliative care centers are being forced to offer MAiD which confuses the purpose and nature of palliative care. Further to that, several palliative care professionals are advocating for MAiD, once again creating confusion about what palliative care is and what it can do.

Palliative care professionals must maintain a separation from euthanasia (MAiD) if palliative care is to maintain its purpose.

Australian woman found guilty of murder, pled guilty to the lesser charge of assisted suicide.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Natasha Darcy found guilty of murder

Natasha Darcy was found guilty of murder in the August 2, 2017 death of Mathew Dunbar, her partner of three years. 

This case was concerning because Darcy pled guilty to assisting Dunbar's suicide and not murder. The jury agreed with the prosecutor that Darcy had murdered Dunbar.

Darcy originally told the police that she had nothing to do with Dunbar's death, but on April 22 she stated that she assisted his suicide.

The Australian Associated Press article published on June 15 stated:

After sedating and gassing her grazier partner to inherit his property, Natasha Beth Darcy screamed at paramedics to keep on performing CPR after they declared him dead.

Darcy kept up her theatrics, telling authorities and first responders repeated lies, maintaining Mathew Dunbar had killed himself.

But after more than two days of deliberations, a NSW supreme court jury on Tuesday found the 46-year-old guilty of murdering the sheep farmer.

The article explains:

Darcy was accused of using a Nutribullet to blend a cocktail of sedatives to sedate her live-in partner before gassing him in his bed.

She told police of finding him unresponsive in his bed, stating: “This is the hardest bit of all. I can’t get the image out of my head. It is killing me.”

The jury was told of a letter Darcy sent to a friend after Dunbar’s death, offering her $20,000 to tell lies about him that would assist her at any murder trial.

She will face a sentence hearing on 1 October.

This Australian murder trial that lasted several months shows how assisted suicide techniques can be used to cover-up murder. I first reported on this case in November 2019. I also reported on the case on several other occasions (Link), (Link).

Canada’s Medically Assisted Dying Policy Sets ‘Dangerous Precedent’

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Dr Paul Saba

Andrew Chen interviewed Dr Paul Saba in an article published by the Epoch Times on June 11, 2021. titled - Canada’s Medically Assisted Dying Policy Sets ‘Dangerous Precedent’: Physician and Author.

Saba who authored the book - Made to Live and is a co-founder of the Physicians’ Alliance against Euthanasia in Quebec told Chen:

Canada’s medically assisted dying policy sets a “dangerous precedent” that has opened the door to other scenarios in which people can be denied medical care or have their lives prematurely ended.

“In terms of expanding, first of all we change the criteria, and then we make it easier and easier to get rid of people who are faced with life’s challenges, with health issues,”

Saba who refers to Canada's assisted dying law as a "very sad statement of affairs of our society, and what we’ve become, in terms of devaluing human life" comments on Ontario's COVID-19 Triage protocol. Saba states:

“I think an even greater issue is that how we evaluate life. Once you open up that door to ending people’s lives, and evaluate people’s lives, you have the whole issue of [COVID-19] and the triage system that was being supported, and directives being set up not to care for people who were ill,”

The pandemic protocol states that only patients with a 70% chance of surviving more than 12 months would be prioritized for critical care. Saba comments:

“Once the government starts evaluating lives, and not seeing it as their mission— health care is a mission of caring for people who need to be cared for—then we’ll decide who gets cared for, who won’t get cared for, who lives, who dies. And that’s why it is so important that we … push back on this,”

Saba became concerned about these issues in 2009 when his wife was pregnant with their daughter Jessica. Jessica, had a severe congenital heart defect—her heart’s pulmonary valve was almost completely sealed—making her survival nearly impossible, but Dr Saba and his wife wanted Jessica to live and today Jessica is a healthy 12 year old. His book, Made to Live, focuses on Jessica's story.

Chen asks Dr Saba to comment on the fact that roughly 7,600 Canadians died via medically assisted death in 2020, a 35 percent increase from the roughly 5,600 cases in 2019, a number which was itself a 26 percent uptick from the approximately 4,500 cases in 2018, Health Canada senior official Abby Hoffman told the Special Joint Committee on Medical Assistance in Dying on June 7.

Saba says that there have been approximately 25,000 assisted deaths since legalization. He then says:

“What was supposed to be just for terminally ill people really at the end of life has now been expanded to include people who are disabled, who have chronic conditions … and they are looking at and studying for people who have mental health challenges,”

Parliament has also heard arguments for expanding medically assisted death to children.

“So, basically, death, needs to be available to everybody,”

Saba then comments on how the Covid-19 pandemic has made people with disabilities more vulnerable. He said:

Saba condemned the passing of Bill C-7 during the COVID-19 pandemic, a time “when people are most vulnerable.”

“We’re encouraging and we’re supporting … killing people with disabilities, because we know that they’ve been marginalized, that they’re struggling, and it doesn’t take much to push people over the edge,”

Saba concludes by stating:

“Ultimately, I hope one day that assisted suicide and euthanasia get reversed in our country because it’s … a dangerous policy and a dangerous precedent.”

You can order the book Made to Live from the Euthanasia Prevention Coalition. Link to order the book.

Major corporations creating Telehealth empires. Say NO to Assisted Suicide by Telehealth

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Sign the petition: No Assisted Suicide by Telehealth  (Link)

US Senate Bill S. 1512 and Congress Bill H.R. 2903 are designed to normalize the COVID-19 pandemic telehealth rules permanently. 

Some major corporations are preparing to enter the telehealth industry. In the last few days Amazon and Walmart announced major expansions of their Telehealth services.

According to an article by Annie Palmer for CNBC Amazon care is working with corporations to offer employees medical services and has set its sights on disrupting the health-care industry.

An article by Kat Jercich for Healthcareitnews stated that:

The medical group for Walmart Health has filed paperwork to do business in more than a dozen more states – and a spokesperson told Insider that the moves are not related to physical clinics.

Instead, the preparation regards the retail giant's pending acquisition of telehealth vendor MeMD earlier this year.

Jercich explains:

Walmart Health's moves in this direction echo that of Amazon Care, which quietly filed to do business in dozens of states before publicly announcing its intention to provide app-based services in all 50 by this summer.

The COVID-19 pandemic triggered a "gold rush" in telehealth, with a combination of relaxed regulations and social distancing leading to an enormous uptick in virtual care use rates – and, in turn, heightened corporate interest in the modality.

So why is the Euthanasia Prevention Coalition concerned?

For several years, the assisted suicide lobby has promoted the use of telehealth for approving and prescribing lethal assisted suicide drugs. 

The language in US Senate Bill S. 1512 and Congress Bill H.R. 2903 need to clearly prohibit assisted suicide by telehealth.

Imprecise language within the bills may enable assisted suicide doctors to do assisted suicide assessments and prescribe lethal assisted suicide drugs, without meeting or physically assessing the person and without examining the patient to confirm the medical diagnosis.

These bills may permit assisted suicide by telehealth in states where assisted suicide is legal and possibly nationally with doctors approving and prescribing out-of-state assisted suicides.

Telehealth regulations may enable the assisted suicide lobby to set-up a national assisted suicide approval and prescription center.

Assisted suicide is not healthcare.

Sign the petition: No Assisted Suicide by Telehealth  (Link)

More information on this topic:

• Opposing assisted suicide by telehealth (Link). 
• Assisted suicide by telehealth and medical misdiagnosis (Link). 
• Doctors now assist suicides via zoom (Link).  
• Bill S. 1512 Connect for Health Act of 2021 (Link).

We should treat all lives as equal. With assisted suicide we don’t.

This article was published by Mercatornet on June 11, 2021.

Dr Calum MacKellar

By Dr Calum MacKellar, Director of Research of the Scottish Council on Human Bioethics

At the beginning of this year, I was invited to take part in an online debate on the topic of assisted suicide organised by a Scottish university in front of a large number of students.

During the discussion, I argued that it would be irrational for the Scottish Parliament to support the legalisation of state assisted suicide while at the same time supporting the Scottish Government’s Suicide Prevention National Action Plan. This seeks to reduce the very high number of suicides in Scotland including amongst relatively young persons.

But during the question time at the end of the debate, one of the students commented that she could not understand or accept how I could consider the prevention of suicides amongst young people as being similar to the prevention of suicides amongst elderly or disabled persons. On hearing this comment, however, I must confess that I was quite shocked and dismayed.

I had never expected such a blatant ageist and ableist statement from a university student! Was this how many young people now considered elderly or disabled persons in Scotland?

In addition, I could not comprehend how the student had come to such a conclusion. Was it because modern society only recognises a good life by the amount of pleasure and lack of suffering it experiences? If it is, then the belief that a life can become unworthy of life and should be ended is indeed rational.

The expression of a life unworthy of life was coined in Germany in 1920 by the law professor Karl Binding and psychiatry professor Alfred Hoche. It then became a slogan used between the 1930s and 1940s in this country to defend the belief that if a person becomes unable to enjoy life, then his or her life could be ended.

But when the German government, at the time, also accepted the principle that certain lives were unworthy of life and that all lives were no longer absolutely equal in value, this then had catastrophic consequences. Indeed, it meant that some lives could be seen as having less worth than others, which eventually resulted in barbarity and the killing of many different kinds of persons.

As a result, Scottish society through its parliament should avoid being naïve or gullible when considering the consequences of accepting that some lives are unworthy of life and that assisted suicide should be legalised.

Of course, because a life is seen as belonging to an individual, it could be argued that he or she should be able to decide for himself or herself whether it is a life unworthy of life. But for state assisted suicide to be possible, those around this individual (including society as whole) would also have to accept that this life is indeed unworthy of life so that they can assist in ending it. In other words, it would mean that the equality of all human life is, for the first time, no longer accepted by society.

Thus, if a parliament legalises assisted suicide, the very basis of the equality of all lives on which this parliament is built would become a thing of the past. It would also mean that the protection in compassionate care of those whose lives are difficult or who experience suffering would become meaningless. Instead, it would be seen as preferable if the lives of such persons, considered to have unworthy lives, were ended even though appropriate palliative care may be available.

In conclusion, Scottish society can choose between absolute autonomy (enabling persons to believe whatever they want about the value of their lives) or absolute equality (enabling person to believe that all lives are equal). But it cannot have both.

Alzheimer treatment and the False Compassion of Assisted Suicide

This article was published by National Review online on June 9, 2021

Wesley Smith

By Wesley J Smith

Great news. The FDA has just approved a new drug that appears to slow the cognitive decline associated with Alzheimer’s disease by 28 percent as compared to a cadre of subjects receiving placebo. The help with everyday tasks was most significant.

The approval is controversial because — well, Big Pharma! It is also based on one study, and the drug does not provide dramatic improvement. But I think a Wall Street Journal editorial has the right POV:

As for complaints about insufficient evidence, Congress amended federal law in 1997 to let the FDA approve novel drugs based on a single study in order to accelerate breakthroughs for hard-to-treat diseases. The FDA has appropriately exercised its discretion, and Biogen plans to conduct additional studies following drug approval.

I want to focus on a different point. Alzheimer’s and other dementia patients are now in the cross hairs of the euthanasia movement. In the Netherlands, Belgium, and soon in Canada, people diagnosed with Alzheimer’s can order themselves killed once they become incompetent. Or they can receive euthanasia before that time.

Meanwhile, our domestic assisted-suicide zealots teach elderly people how to commit suicide by self-starvation, with the agony of such a course palliated by a doctor — known in euthanasia parlance as VSED (voluntary stop eating and drinking). There are even legal moves afoot to allow advance directives to be written legally ordering caregivers to starve dementia patients death — even if they willingly eat! Nevada has passed such a law.

If new treatments do materialize, how many dementia patients will have died by their own or others’ hands who might have lived if they had continued on until new treatments came on line? I shudder to think.

Don’t scoff. It has happened before with AIDS.

I lived in San Francisco at the worst of the crisis. It was the most tragic circumstance I have ever witnessed: Young men who looked as if they were 80 were so weak they had to be held up by friends just to walk down the street. An underground assisted-suicide cabal of MDs serving the gay community and AIDS patients surreptitiously provided overdoses to dying patients. The supposedly empowering motto was: “You can’t tell us who to love and you can’t tell us how to die.”

Then, the new drugs suddenly came on line. Patients literally on the brink of death were brought back to vigorous life, and AIDS was suddenly redefined from a terminal to a chronic condition.

There is no doubt in my mind that the number of AIDS patients died by assisted suicide — but would have lived without being encouraged into hastened death — is considerable. Yet I never heard any of the assisted-suicide-for-AIDS pushers acknowledge their complicity in these unnecessary deaths.

I think the same may one day — soon or far — become true with Alzheimer’s patients if we follow the current course and allow their hastened deaths. Pushing killing instead of caring for our most serious diseases masks itself as compassion but is actually cruel abandonment.

Canadian Euthanasia (MAiD) deaths increased by 35% in 2020.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Joan Bryden reported for the Canadian Press on June 8, 2021 that Health Canada official Abby Hoffman told the new parliamentary Special Joint Committee on Medical Assistance in Dying that there were 7595 reported euthanasia (MAiD) deaths in Canada in 2020 representing a 17% increase from 5631 in 2019.

Hoffman was wrong. 7595 reported euthanasia deaths in 2020 is almost a 35% increase from 5631 in 2019.

7595 reported MAiD deaths represents approximately 2.5% of all deaths.

Hoffman correctly stated that the 5,631 MAiD deaths reported in 2019 was a 26% from 4467 in 2018.

According to the Health Canada data, as of December 31, 2020 there were 21,541 reported euthanasia (MAiD) deaths in Canada since legalization.

Bryden also reported Hoffman to say that:

Last year, she said 21 per cent of 9,300 written requests for assisted dying were not carried out, either because the requesters died before being assessed, were deemed ineligible or withdrew their requests. Of the latter, she said 50 changed their minds immediately before they were to receive the procedure.

Hoffman acknowledged that the data collected by the government is very general but she stated that Bill C-7 requires Health Canada to collect more data concerning “the presence of any inequality — including systemic inequality — or disadvantage based on race, Indigenous identity, disability or other characteristics.”

Bryden also reported that Justice official Joanne Klineberg says the number of cases will likely increase again as a result of recently passed legislation that expands access to assisted dying to people who are not nearing the natural end of their lives.

Bill C-7 was introduced in February 2020 as the government's response to the Quebec Superior Court's Truchon decision. Bill C-7 went much further than what Truchon required. Bill C-7 became law on March 17, 2021.

The Ontario Office of the Chief Coroner releases data on a monthly basis. 

The data released in January 2021 by the Ontario Office of the Chief Coroner indicated that in Ontario there were 2378 reported MAiD deaths in 2020 up by 33% from 1789 in 2019. Ontario represents 39% of Canada's total population.

The April 2021 (MAiD) euthanasia data indicated that even though Ontario was under a strict COVID-19 "lock-down" that April 2021 had the highest number of euthanasia deaths since legalization with 241 assisted deaths and 853 reported assisted deaths in the first four months of 2021.

More articles on this topic:

• Government committee examining further expansions of Canada's euthanasia law (Link). 
• Ontario euthanasia deaths increase inspite of COVID-19 lockdown (Link). 
• Canada passes Bill C-7 allowing euthanasia for mental illness (Link).

Paul Russell - South Australia's Assisted Dying Bill is not safe.

Dear Members of the South Australian House of Assembly, 

Voluntary Assisted Dying Bill 

Paul Russell

My name is Paul Russell. About 10 years ago I started a national organisation to oppose euthanasia and assisted suicide after working actively against such legislation for the previous decade in one guise or another.

I gave up this work during the Victorian debate nearly four years ago now when my wife, Anne, was diagnosed with metastatic breast cancer.

These last four years have been an incredible journey as our family moved from living with someone dying from cancer to living with someone living well with cancer. It has been a rollercoaster for all of us and a continuing journey of love and solidarity.

When I left my work, some wondered whether or not this ‘first-hand-experience’ would change our thinking on the subject. It has certainly informed my thinking and, because of it, I find myself even more firmly opposed.

Does this experience make my observations unique? No, not at all. But I ask you to consider that, in combination with close to two decades studying this issue, that it is at the very least, an informed opinion.

I hope you can take the time to read on.

When the Premier of this State can say, in the chamber, that this bill before you is about when, ‘… after all other efforts to cure an illness, relieve the symptoms and make daily life more bearable have been tried and failed…’1 – a claim that is not supported by anything in the bill - I am left to question whether the rhetoric has run ahead of the reality. More concerning, however, is the unsupported claim that this bill is the most conservative bill with the most safeguards.

Most conservative bill ever? 68 safeguards? Really?

The Cambridge Online dictionary defines a safeguard as:

a law, rule, or something that is done to protect someone or something from harm or damage 

The Voluntary Assisted Dying Bill 2020 in its Victorian iteration was claimed to be “the safest and most conservative (legislation) in the world”. This was based upon the claim that the legislation contained ’68 Safeguards’. The final report of the Victorian Ministerial Advisory Panel in 2017 went so far as to list these supposed ‘safeguards’ alongside other legislative instruments from various other jurisdictions to attempt to show how other jurisdictions were putatively ‘less safe’ than this new model.2

Two questions need to be considered when assessing these claims.

Firstly, what constitutes a ‘safeguard’ in such legislation and, secondly, who is it that these ’68 Safeguards’ seek to protect from ‘harm or damage’? 

It might seem somewhat trite to observe that the inclusion of safeguards in such legislation has the primary end in convincing legislators to support the proposal. However, it is worth considering that, without so-called ‘safeguards’ few legislators would support assisted dying legislation. 

Safeguards in euthanasia and assisted suicide legislation have always been thought of as those inclusions that seek to protect vulnerable people; people who, for whatever reason, may be coerced or feel pressured into choosing death; where a decision to choose death via such legislative provisions was not truly voluntary. 

In 2020, McDougall and Pratt published a paper that looked at the Victorian legislation asking the title question: Too much safety” Safeguards and equal access in the context of voluntary assisted dying legislation3. Based on a ‘rights’ framework, the authors argued that some elements of the legislative framework were too restrictive and denied equal access. 

It terms of the so-called ‘safeguards’ they made the following observations:

While the elements of the legislation within the comparison table (referred to above) are all framed as safeguards, they are not all aimed at patient safety specifically. Some, such as the conscientious objection provisions, are explicitly labelled by the Ministerial Advisory Panel as “practitioner protections” … The word “safeguards” is thus used broadly in the Victorian context, to include patient-focused and practitioner-focused elements of the legislation. Diverse provisions of the Victorian legislation – such as the prohibition on health practitioners raising VAD, the requirement for one of the doctors to have expertise in the relevant condition, the strong protection for conscientious objectors, and many others – are all framed as safeguards.4 

So, the ‘sales-pitch’ that the bill before the South Australian Parliament has “68 Safeguards” may be true in the broadest terms as described above, but in terms of protecting vulnerable persons – what we normally think of when ‘safeguards’ are mentioned – there are no more protections here than in any other form of words presented to the parliament over many decades. The same problems remain. 

The vast majority of the “68 Safeguards” either protect the doctors involved or are simply procedural. Procedural matters are always open to challenge and change as has been seen in many jurisdictions post-legislative assent.5 Erring on the generous side, only about seven of those safeguards listed could reasonably be construed as attempts to protect vulnerable people. As noted earlier, they are really no different to any we have seen in South Australia over the last 17 legislative attempts. 

I urge you therefore, to reject the notion that this bill is somehow ‘safer’ than any others. 

As with every form of legislation ever proposed in this space, no amount of so-called safeguards can guarantee total safety. It is simply an impossibility. Even if every step in the process is adhered to, once the poisonous substance is issued to the person concerned there is no way of telling whether it was ingested freely, without coercion or without force or pressure, subtle or otherwise. This creates a dangerous opportunity for abuse and no-one would ever know.

A word on vulnerability 

Every person, every one of us, can and may be vulnerable at some point in our lives. Whether by some trauma, loss of a loved one, serious illness etc., each of us and each of our family members can find our inner resilience tested and even found wanting in the face of such difficulties. 

My family has been travelling that road for a while now. In truth, it’s a bit more like a rollercoaster than a road: there are highs and lows and each of us sees and responds to things differently. Oft times conversations can be clumsy as our understanding and expectations can vary so much. 

Take an example told to me by a palliative care doctor. The family of an elderly woman were called to her side from interstate. She was dying. Her son took the doctor aside and asked him, ‘Isn’t there anything that can be done to speed this up?’ The doctor saw callous indifference in the comment. I saw it differently. Death and dying don’t fit into our daily schedules. When such things happen our worlds are turned upside down and inside out. The sure foundations of our work, life’s routines etc. can often be shaken if not destroyed. It is entirely possible that the words of that man came from such a place of uncertainty as his plans were disrupted by his mother’s dying. His words may have been innocent of any bad intent; but others may have seen it differently. 

Or my dear mother-in-law, who would often say in her later years: “Please! Just hit me on the head, dear!’ We knew this as a cry of frustration and a need for acknowledgement. Others may have seen it differently. 

We cannot legislate against vulnerability nor poor decision making or inadvertent poorly worded comments or gestures. Nor can we reasonably expect that two doctors could sniff out and eliminate the difficult and sometimes awkward expressions that are in essence the outworking of grief and not necessarily a serious request to die. 

Removing the protection of the law 

The Criminal Code sections on homicide and assisting in suicide protect every South Australian in equal measure. This bill acknowledges explicitly that doctors and others who act in accordance with this bill are exempt from the provisions of The Criminal Law Consolidation Act 1935 13a. Criminal liability in relation to suicide. What was a crime one day becomes legal by the stroke of the Governor’s pen. 

Whatever protection this law provides for all citizens is removed for those who are seeking access to their own death via Voluntary Assisted Dying. 

But more than that; once the poison is dispensed and taken home, the person involved now has no effective protection from the laws on homicide as well. 

How so? Put simply: where death is an expected outcome and a ‘success’, is there any reason to investigate what might actually be a homicide or perhaps assisting in suicide outside the provisions of the bill? 

Placing the substance in a locked tin is hardly a safeguard. No-one is safe from a person with nefarious intent. Be it forcing the person to ingest the poison when they either were not ready or did not want to, or pressuring them to take it themselves, there is no independent person to verify what took place. No police investigation, no trial. 

Remember Anne Marie Smith anyone? Abuse happens behind closed doors and in the dark places. This bill provides opportunity and obfuscates possible motive.

Two doctors

One of the supposed safeguards in this bill is the involvement of the medical profession in the process. People trust their doctors. Including them really does make us think that only those with a sound mind and settled intent will ever be prescribed the poison; that they fulfil the important role of ‘gatekeepers’.

Both the coordinating medical practitioner and the consulting medical practitioner must assess that the person is ‘acting voluntarily and without coercion’ and, their request is ‘enduring’. Surely this safeguard protects vulnerable people?

It may – but it may not.

Strangely, the bill does not mention depression, anxiety or hopelessness. Yet the detection of depression in patients by doctors is known to be a hit-and-miss affair. Likewise even for oncologists:

• UK GPs recognize depression in only 39% of all depressed patients attending their practices.6
• Oncologists recognize 33% of mild-to-moderate cases of depression and only 13% of severe depression cases in their cancer patients.7
• Nurses under-identify severe depression cases in their cancer patients.8
  

And yet all this bill does is suggest the possibility of a mental health professional being involved, whose opinion may even be discarded. 

No-one will ever be able to gainsay the opinion of either of the two doctors. That we ascribe such omniscience in our medical profession is staggering. That we even ask them to decide who lives and who dies is an appalling affront to medicine.

Doctors are human too. They can be affected by pressure, coercion and empathy in their decision making just like the rest of us:

Transference and countertransference feelings are normal and can occur in any doctor-patient relationship. When these feelings heighten around emotionally intense issues, they can exert coercive pressure on clinical decision-making with an obligatory quality that is difficult to resist.9 

Let’s be realistic. Yes, this is a safeguard. But let’s not kid ourselves into thinking it as failure proof. It isn’t!

Which begs the question? How safe is safe enough? Or to put it another way: What level of risk are you willing to accept? When the risk is that some people may die against their expressed wishes or without their ultimate consent and even by nefarious intent, I would argue that no risk is acceptable. 

Inexorable incremental extension 

Some call it the ‘slippery slope’ which is not an accurate characterisation. Incremental extension, whereby the criteria is adjusted and expanded in steps and overtime, is however a reality that cannot be ignored. 

When I think about the various euthanasia type bills that this place has seen over the last few decades, there have been many different starting points; variations usually designed to be a very minimal approach to allowing people to be made dead with the approval of the state.

Phillip Nitschke would rail against these restrictions. He, and others, would often call them ‘hoops to jump through’ or even ‘roadblocks’ to what he called ‘a peaceful end’.

Nitschke is right. He is right to observe that the restrictions in this bill are essentially bogus.

If, as this bill proposes, we accept that people can choose to die and be aided to do so by the state, what right have we to limit that?

What about a 17 year old with a terminal condition? What about someone with a prognosis of more than six months? What about simply for mental health conditions that aren’t terminal? What about people who feel that they have completed their lives and simply want to exit?

Maybe we’re not enshrining a ‘right to die’ in this bill. I say maybe because it seems to me that this slogan adopted by pro-euthanasia groups over many decades, while now discarded, is in fact the truth of it.

Some may wish to observe that ‘a ‘right’ is universal, but this is only limited to a few’.

Precisely. Limited to a few – the place where we start. It becomes thereafter a ‘right’ nevertheless.

And I think of the media stories we have heard of late, heart-rending stories of people who are using their situations in the push behind this bill.

But I ask, do you think that these kind of stories will simply go away if we pass this bill? That hasn’t happened in other jurisdictions that have gone down this road, so I don’t see why it would happen here. Already we have seen such stories emanating from Victoria pushing to amend their legislation (upon which this bill is modelled).

And it is compelling. Why? Because whether we accept that we are creating a ‘right to die’ or not, it is difficult to bat away those cries because of our natural empathy for those who are suffering and because it would seem an injustice to deny to one what we have allowed for another.

And I note with interest the recent recommendations of the Queensland Law Reform Commission on this issue. Amongst other things, they recommend ‘12 months to live’ as their starting point.

We heard much made of the notion that the various bills and Acts in each state should be uniform in their application. Well, Queensland just blew that out of the water totally!

Well, let them do what they will do. Your responsibility is for the welfare of South Australians and not to kowtow in obeisance to another state simply on the basis that they walked down this road first.

I also recall in 2010, a WA MLC who had designed a bill telling pro-euthanasia supporters that he knew not everyone would be happy with how he had framed his bill, but that it was a ‘good start’. 

Turning briefly on Canada. Canada, with a political system very much like our own. Canada legislated for what they call ‘Medical Aid in Dying’ in 2016 in response to an order to do so from the Canadian Supreme Court. In a further court decision on September 11, 2019 the Quebec Superior Court, struck down the requirement that a person be terminally ill to qualify for euthanasia in Canada.

In response, the Canadian government developed and passed bill C7 in March of this year. C7 went beyond the direction of the courts.

As Alex Schadenberg writes:

• Bill C-7 removed the requirement in the law that a person’s natural death be reasonably foreseeable in order to qualify for assisted death. Therefore, people who are not terminally ill could die by euthanasia.
• Bill C-7 created a two track law whereby a person whose natural death is deemed to be reasonably foreseeable has no waiting period, and could die on the same day as their request, while a person whose natural death is not deemed to be reasonably foreseeable would have a 90 day waiting period before being killed by lethal injection.
• Bill C-7 permits a doctor or nurse practitioner to lethally inject a person who is incapable of consenting, if that person was previously approved for assisted death.
• Bill C-7 approved euthanasia for people experiencing mental illness alone. Parliament placed a hold on this category of deaths for 24 months to enable the government to establish protocols for killing these people.

So, I ask rhetorically, why not start at where Canada is now? If that’s where this is heading, why not just bite the bullet and start a little further down that road?

I can’t imagine that anyone in our parliament would accept such a proposition at this time. Which goes to further prove the point that, in reality, all this talk of safeguards is really only there to make legislators feel less uneasy about supporting the idea of state-endorsed suicide. Because that’s what we are talking about here. It’s our starting point and it would be foolish to think that it will finish at this spot. It’s a beachhead for what will follow. It prises open the door and leaves it ajar.

By passing this bill you will have created a monster; a voracious monster that your successors will be compelled to feed. Yes, that would be their decision, but you will have made that possible.
You will have crossed a divide that has stood since ever laws were codified.

Somehow we make heroes of those who seek to push this kind of change. We all need heroes. The true heroes are those like Anne who teach us how to live well in difficult circumstances. Like her, I ask you to take courage and make a decision to choose life.

Please, don’t go there; we can all live without it.

With thanks and appreciation.

Paul Russell
paulstud@chariot.net.au 

1 HOA Hansard 26th May 2021

2 Report can be found here: https://www2.health.vic.gov.au/about/publications/researchandreports/ministerial-advisory-panel-on-voluntary-assisted-dying-final-report Tables can be found at pages 217 - 220

3 McDougall, R., Pratt, B. Too much safety? Safeguards and equal access in the context of voluntary assisted dying legislation. BMC Med Ethics 21, 38 (2020). https://doi.org/10.1186/s12910-020-00483-5 available at: https://bmcmedethics.biomedcentral.com/articles/10.1186/s12910-020-00483-5

4 Ibid.

5 See for example: https://alexschadenberg.blogspot.com/2021/05/pressure-to-expand-euthanasia-in.html

6 Thompson C, Kinmonth AL, Stevens L, Peveler RC, Stevens A, Ostler KJ, Pickering RM, Baker NG, Henson A, Preece J, Cooper D, Campbell

7 Passik SD, Dugan W, McDonald MV, Rosenfeld B, Theobald DE, Edgerton S. Oncologists' recognition of depression in their patients with cancer. J Clin Oncol. 1998 Apr;16(4):1594-600. doi: 10.1200/JCO.1998.16.4.1594. PMID: 9552071.

8 McDonald MV, Passik SD, Dugan W, Rosenfeld B, Theobald DE, Edgerton S. Nurses' recognition of depression in their patients with cancer. Oncol Nurs Forum. 1999 Apr;26(3):593-9. PMID: 10214600.

9 Hicks, M.HR. Physician-assisted suicide: a review of the literature concerning practical and clinical implications for UK doctors. BMC Fam Pract 7, 39 (2006). https://doi.org/10.1186/1471-2296-7-39

Can we find a vaccine for the euthanasia pandemic?

This article was originally published by Mercatornet on June 7, 2021.

Margaret Somerville

By Margaret Somerville

The Covid-19 virus pandemic is a threat to our physical and mental health and wellbeing, as both individuals and societies.

The euthanasia “virus” pandemic is, likewise, a threat to our physical and mental health and wellbeing, as both individuals and societies. Most seriously, it is a threat to our “human spirit”, the intangible, invisible, immeasurable reality that all of us need to find meaning in life and to make life worth living, that deeply intuitive sense of relatedness or connectedness to all life, especially other people. The “human spirit” does not require a belief in the supernatural. Everyone has a “human spirit”, whether or not they are religious.

Like the Covid-19 virus, euthanasia seems to be contagious, at least in post-modern, Western democracies. (Note: I use the word euthanasia to include medically assisted suicide.) Jurisdiction after jurisdiction has considered or is considering its legalization, although some have expressly rejected it. From one perspective, this spread is not surprising, because we know that suicide is contagious. In fact, general suicide rates — that is, exclusive of euthanasia — have risen in most and possibly all jurisdictions, which have legalised euthanasia.

As well, there is a well-established pattern, as we have seen in Australia, of pro-euthanasia advocates returning to legislatures and courts, time after time, until they achieve their initial goal of the legalization of euthanasia. Subsequently, as can be seen in the Netherlands, Belgium and, most recently, Canada, pro-euthanasia advocates persistently seek reduction of the requirements for its availability, that is, the initial safeguards, and expansion of the people who may have access to it.

In order to stem the Euthanasia pandemic, those of us who view this as a historic disaster and human tragedy must understand how it has arisen and where it is going. To do that we need to ask and seek answers to a multitude of questions. I can only very briefly mention a few of them here. I have spent over four decades researching and writing on them and still have many to address and new ones constantly emerge. We can think of this research as searching for an “anti-euthanasia vaccine”.

Before I do that, however, I want to emphasize that the people on both sides of the euthanasia debate are well intentioned and believe they are fighting for the greater good, it is just that we do not agree on what that is.

None of us on either side wants to see people suffer and the euthanasia debate is not about if we will die – we all will at some point. The debate is about how we will die and whether some ways of dying, namely euthanasia, are unethical and dangerous, especially to vulnerable and fragile people, and destructive of important shared values on which we base our societies.

We need to start our exploration of the euthanasia pandemic by asking the many questions, which could provide us with insights that will lead to understanding why the euthanasia pandemic has erupted and how we might deal with it. In the rest of this essay, I identify some of those questions.

Why now do people support legalizing euthanasia?

People have always become ill, suffered and died and, for millennia, our laws have expressly and clearly prohibited killing them, especially having doctors, who promise in their Hippocratic Oath “to cure where possible, care always and never to intentionally kill”, doing so. So why now, when there is so much more we can do to relieve pain and suffering, is euthanasia thought to be necessary and a good idea?

There is a perfect storm of causes functioning at all the levels of decision-making from that of individuals in relation to their own experience of suffering, to that of governments formulating health, social and public policy.

In post-modern societies, so-called “progressive values” have become ubiquitous. These values favour legalizing euthanasia and dominate the more traditional or conservative values, which oppose that. The progressive values advocates’ mantra is, “control, choice, change”.

Control. In the context of euthanasia, control translates to taking control of death. We cannot avoid death, but euthanasia allows a person to get it before it gets them. This eliminates uncertainty about the time, place and manner of death. It is psychologically difficult to live with uncertainty about outcomes that we dread, including because we do not know which psychological coping mechanisms we need to employ to deal with the fear we experience.

Taking control is what social psychologists call a “terror-reduction” or “terror management” device. Intense fear of death can be linked to a fear of mystery, the latter of which evokes profound free-floating anxiety. People who experience this can deal with their fear and anxiety by converting the mystery to a problem and seeking a technological solution to the problem. The mystery of death becomes the problem of death and the technological solution is a lethal injection – euthanasia.

Choice. Advocates justify euthanasia by claiming a right to choose to end one’s life, an overriding right to individual autonomy. “Intense or radical individualism” means the right to self-determination is given priority over any other considerations, such as what protecting the “common good” requires or the risks and harm to vulnerable people, such as fragile elderly people or those with disabilities. These harms include that euthanasia sends a message to them that they have “lives not worth living”.

Change. To have control and be able to choose death, the law must be changed to permit euthanasia.

Why has the pro-euthanasia case been so successful and the anti-euthanasia case so unsuccessful? *

The case for legalizing euthanasia is easy to make in contemporary post-modern Western democracies, especially those in which moral relativism and utilitarianism are the main philosophies informing the dominant worldview of a society.

Moral relativism takes a stance that nothing is absolutely or inherently wrong, rather what is right or wrong all depends on the circumstances and the individual person’s preferences. Utilitarianism in the context of euthanasia proposes that euthanasia is a means that has an outcome or end goal of reducing suffering and, therefore, can be justified and is ethical. The discussion and analysis of the impact of legalizing euthanasia is limited to only the present time – I call this restriction “presentism” – and its impact on the individual person who seeks it. What we could learn from our “collective human memory” (the past or history) and through employing our “collective human imagination” (the likely future outcomes of legalizing euthanasia) are ignored or rejected as irrelevant or invalid considerations.

The pro-euthanasia case is promoted and buttressed by stories of “bad” natural deaths – those where great suffering is experienced – and “good” euthanasia deaths – those where suffering is promptly and completely eradicated through the intentional extinguishing of life with euthanasia. The media, which overall has a bias towards legalizing euthanasia, are especially prone to presenting euthanasia as a topic for discussion in the public square in this manner, that is, with a focus on an individual suffering person and only taking into account the immediate impact in the present of providing that person with euthanasia.

The case against euthanasia is much more difficult to promote, not because it is weak – it is not – but because it is much more complex.

To convince people who do not believe that euthanasia is inherently wrong to reject it, requires looking, not just to the present, but also to our “collective human memory” for lessons from the past and to our “collective human imagination” to try to anticipate the full, wider and long-term consequences of legalizing euthanasia. Aboriginal and Torres Strait Islander people have much to teach us in these regards.

While the individual person and their wishes and respect for their right to autonomy are always important considerations, they are not alone sufficient, if we are to make wise decisions as a society with respect to the legalization of euthanasia or, if legalized, its governance. That requires, for example, taking into account the immediate and long-term, wider ramifications of authorizing physicians, and in some cases nurses, to end the life of another person through administering lethal medications with a primary intention to cause death.

These ramifications include the effects on healthcare professionals and the healthcare professions; on the institutions in which they practice, such as hospitals and aged care homes; on society and the shared values on which it is based and which create the glue that bonds us as a community; and even on our global reality. There is a dearth of literature in these regards. The 2021 book, The Other Side of Euthanasia, referred to above, recounting stories from frontline healthcare professionals in Belgium where euthanasia has been normalized as a way to die, makes an important contribution to starting to fill these lacunae.

Of particular concern in relation to the wider impact of legalizing euthanasia is the possibility of its being “thrust on” or “seeping into” the lives of fragile and vulnerable people – those who are poor, uneducated, or least vocal. For example, doctors in Belgium have admitted to euthanizing people in a coma on a ventilator, without any family present to defend their best interests. We cannot afford to trivialize or underestimate the dangers of the abuse of legalized euthanasia.

We must also keep in mind that in a secular society, such as Australia, law and medicine carry the value of respect for life for society as a whole. Euthanasia destroys their capacity to do that because the law is changed to allow intentionally taking life and medicine implements that permission in practice. If euthanasia is legal, it should be kept out of medicine and a new profession created to undertake it. Euthanasia is not medical treatment and it should have no role in palliative care. Indeed, the philosophical bases of palliative care – to live as well as possible until we die a natural death – and euthanasia – to choose death, rather than life – are in direct conflict.

It is also essential to recognize that the value of respect for life must be upheld at two levels: for the life of each individual person and for human life, in general, in society. Euthanasia damages respect for life at both these levels.

Good facts are essential for good ethics and good ethics for good law. This means we must ask, what are the correct facts about euthanasia?

Are pro-euthanasia advocates correct that euthanasia will be rarely used and there is no danger of “slippery slopes”?

Euthanasia advocates often propose that euthanasia will be rarely used and only as a last resort. Let us look at some recent Canadian statistics: “As of April 30, 2021 there has been 7549 reported assisted deaths in Ontario since legalization [in June 2016]. 7547 were euthanasia deaths (lethal injection) and 2 were assisted suicide deaths (lethal prescription)”.

This is very important information that cries out for in-depth research. What could this astonishing disparity in numbers between euthanasia and assisted suicide tell us? It is noteworthy that, so far, in the American states, which have legalised physician-assisted suicide, but have not allowed euthanasia, the number of such suicides are orders of magnitude below the Canadian statistics.

Might the explanation for the high Canadian numbers include that euthanasia masquerades as medical treatment and we trust doctors and assume they are acting ethically and only doing good? To wisely judge the acceptability of euthanasia, we must take the medical cloak off it.

Then there are the claims of pro-euthanasia advocates that legalizing euthanasia does not open up “slippery slopes”. Let us look again at Canada’s experience:

“The number of assisted deaths has been continually increasing in Ontario. There was a 33% increase in 2020 with 2378 reported assisted deaths, up from 1789 in 2019, 1499 in 2018, 841 in 2017, and 189 in 2016. Euthanasia was legalized in June 2016. Ontario euthanasia deaths have increased, in spite of COVID lock-down. …[There have been] 24,000 estimated assisted deaths in Canada since legalization”.

Again, these statistics show that euthanasia will not be used only rarely and is very quickly normalized, that is, the number of cases of euthanasia that occur once it is legalized, rapidly increase in a very short time.

This is not surprising. Once we step over the clear line that we must not intentionally inflict death, there is no logical stopping point. Currently around 5 percent of deaths in Belgium are by euthanasia, it is predicted that this number will increase to 25 percent within a few years.

The normalization of euthanasia and its frequent use, also opens up the unavoidable “logical slippery slope”, that is, once euthanasia is legalized the situations in which it is available and the people who may access it rapidly expand. Indeed, there is now discussion in Canada whether all restrictions on access to euthanasia should be abandoned. The argument is that the justification for euthanasia is respect for the individual’s right to autonomy and self-determination and this should not be limited. We can also see this justification being put forward in the Netherlands where the government is considering proposals that being “over 70 years of age and tired of life” or feeling that one has “a completed life” can be sufficient grounds to provide the person with access to euthanasia.

The pattern is that legislators who first approve euthanasia do so with “strict safeguards”, but these are quickly dropped and the people who can have access and in what conditions are greatly expanded.

As is already the case in the Benelux countries, Canada has now deleted from the MAiD (Medical Aid in Dying) legislation a requirement that “death be reasonably foreseeable”, on the grounds that it discriminates against people with serious disabilities, who are not terminally ill and want euthanasia. Canada is also legislating to allow people with early dementia to give advanced directives consenting to euthanasia to be carried out when they are incompetent to consent. In two years’, time, it will also allow people with serious mental illness, but no physical illness, to access euthanasia.

As American psychiatrist Dr Mark Komrad commented, “The proper role of a psychiatrist is to prevent suicide, not to provide it”. Moreover, some children will have access to euthanasia and a group of healthcare professionals at the renowned Toronto “Sick Kids” hospital has already published a protocol, which could govern this.

Examples of the “practical slippery slope”, that is, once euthanasia is legalized it is provided not in accordance with the law, are legion. One study of doctors in the Flanders region of Belgium who had euthanized patients found that, by their own admission, 32 percent had done so on at least one occasion not in accordance with the law. When this evidence is presented in other jurisdictions pro-euthanasia judges and politicians reject its relevance to their jurisdiction, by claiming that “our doctors are not like Belgium doctors”.

In summary, even though we might have lost the battle against legalizing euthanasia, our work is not over. We must now work to prevent its expansion and abuse.

Why is euthanasia euphemized?

In short, I believe it is because people do not want to face the reality of what is being done, intentionally killing a human being. We have natural inhibitions against killing other humans. Advocates of euthanasia even object to the words “assisted suicide”, arguing physician-assisted death is not suicide, and to euthanasia, saying it has harmful connotations and associations. They use terms such as Voluntary Assisted Dying (Victoria) or Medical Assistance in Dying (Canada) and reduce those to acronyms VAD and MAiD respectively, which have even less negative emotional impact. In the same vein of whitewashing what is involved, they speak of euthanasia as “the final act of good palliative care”.

Words, descriptions and labels matter. They activate or suppress many of our “human ways of knowing”, such as examined emotions, moral intuition, experiential knowledge and common sense, that recent research shows play an important role in decisions about ethics. Our choice of words is closely linked to whether we activate, what physician-ethicist Dr Leon Kass called the “wisdom of repugnance” to guide us.

Consequently, to argue, as I have on occasion, that “we cannot afford to have doctors killing their patients”, evokes a storm of outraged protest from pro-euthanasia advocates. However, if that is not what euthanasia involves, what does it involve?

Likewise, any mention of what we might learn from the Nazi doctors and the warnings that history (human memory) can provide triggers furious opposition. This is the case, even when one can show articles in the New York Times in the early 1930s describing the introduction of euthanasia by the Third Reich in Germany, which recount eerily similar justifications of euthanasia to those put forward today by the pro-euthanasia advocates. (See, for example, “Nazis Plan to Incurables to End Pain: German Religious Groups Oppose Move”, NYT 8 October 1933.)

Then the media’s role in promoting euthanasia through its “woke washing” of words and the ubiquitous post-truth reality of the early 21st century must be taken into account.

Recently I published an article hoping it might cause people to think differently about what euthanasia involves. The question I addressed was “Why, if one agrees with euthanasia, would they not support carrying it out by giving the person a general anaesthetic and removing their vital organs – heart, liver, lungs – for transplantation”?

Currently, 25 percent of lung transplants in Belgium are from euthanized donors and Canada uses such donors with their consent. In fact, it is reported that Ontario doctors notify the Ontario transplant authority in advance of planned euthanasias and the authority’s representatives call the patient – or family – to ask for consent to donating their organs.

In these cases, the person is first euthanized and then, after they die, the organs are taken. In my article, I questioned why combining euthanasia and organ donation into the same act, that is, giving the person a general anaesthetic and carrying out the euthanasia by removal of their vital organs, which results in more viable organs, was not employed. Many people, including those who support euthanasia, reacted very negatively to my suggestion and I explored the possible reasons for their reaction. They included that it would make organ donation seem horrific and cause people to reject donating their own organs after death.

I believe it was also that it causes us to we see directly, “unsugar-coated”, what euthanasia involves – doctors killing their patients. 

Why have so many politicians voted in favour of euthanasia?

We hear constantly that polls show that a sizeable majority of the public want euthanasia to be legalized and politicians might be trying to win these people’s votes. Whether the members of the public understand what they are agreeing to in supporting euthanasia is a further question, because surveys have shown that often they hold a mistaken belief that refusing life support treatment or its withdrawal or providing necessary pain or suffering management are euthanasia and, as we all do, they want these to be available. However, they are not euthanasia and are already legal and, appropriately used with no primary intention to cause death, are ethical, indeed, ethically required treatment.

Politicians are often reluctant to have to deal with matters that involve conscience and, for some people, religious belief, and when they must deal with these matters, they want to get rid of them quickly and with the least conflict and publicity possible, especially if an election is looming.

Might they just “read the wind” and, if the polls show voters want legalized euthanasia and its legalization seems highly likely, they just go along with that, whatever their personal values?

All postmodern Western nations are currently in a period of uncertainty about the nature and sustainability of flourishing democracy and, hence, of the ethical basis on which political decisions should be made, especially when they involve fundamental shared values on which these societies are based, such as respect for human life.

In the final section, I will suggest some possibilities regarding what we might be able to do to limit or discourage the use or extension of legalized euthanasia.

If euthanasia is legal, our goal must be to reduce to the minimum the number of people requesting it. In order to achieve that, we need to understand the reasons for their requests and to find ways to make those reasons no longer important to them. We also need to try to prevent extensions of the people who may access euthanasia and the abolition of safeguards, which restrict access.
Why do people ask for euthanasia?

Many people believe that pain is the most common reason that people ask for euthanasia, but pain is well down the list.

The three most common reasons are feelings of loss of dignity, loss of independence and of being a burden on others. Palliative care research shows many ways to change these feelings. For example, Dr Harvey Max Chochinov, a Canadian psychiatrist specializing in the care of terminally ill patients has developed a psychotherapeutic intervention called “dignity therapy”. In a book of that name, he explains how helping the terminally ill person to review and record their life story to leave as a record for future generations of their family gives them back a sense of their own worth and hope, through eliciting a feeling that something of themselves will have a presence in the future.

Hope requires a sense of connection to the future. Hope is the oxygen of the human spirit. Without it our spirit dies, with it we can overcome even seemingly insurmountable obstacles. Dying people cannot have long-term hopes, but they can be given mini-hopes that make life worth living.
How can we help dying people find a ‘why to live’?

Dr Chochinov speaks of a psychological state he calls “hopelessness” as being the trigger for the person seeking medical assistance to end their life. Professor David Kissane, an Australian specialist palliative care psychiatrist, has identified a similar condition he calls “demoralization” with its accompanying loss of the will to live, as having the same effect of triggering requests for euthanasia.

These findings are consistent with the powerful insight of Nazi Concentration Camp survivor, Victor Frankl, who famously said when asked how he helped other inmates to survive, “If you can give people a why to live, they can find a how”.

We all need to have hope and be able to find meaning in life, even when we are dying, indeed, especially when we are dying, if we are to have a “good death”. Euthanasia does not provide this, rather it eliminates the person and with that the possibility of finding hope and meaning. Helping dying people to find hope and meaning can be difficult and requires skilled carers interacting with both the dying person and their loved ones, which is one reason easy access to high quality palliative care is such an important safeguard against people choosing euthanasia.
What is the impact of ‘time compression’ on how we die?

We live in a world in which we expect instantaneous outcomes; we are not prepared to watch and wait. We have moved from primarily seeing ourselves as “human beings”, grateful for being alive, to becoming “human doings”, obsessed with what we can achieve in the shortest possible time. However, some experiences cannot be time compressed without destroying their essence. As the book, Euthanasia: Searching for the Full Story, powerfully demonstrates, dying is such an experience and not just for the dying person, but also for those who love them.
Who suffers when a loved one is dying?

When a loved one is dying, not only the dying person can suffer, but also those close to them. Much of the patient’s suffering can be ameliorated with fully adequate palliative care and even those who have asked for euthanasia may change their minds in that regard, when provided with such care.

It is appalling that a very large percentage of people, who need and could benefit from palliative care, do not have access to it – for example, studies have shown that is true for up to 70 percent of such people in Canada and, likewise, Australia. Especially if we believe that legalizing euthanasia is a terrible mistake, we must work to make high quality palliative care readily available.

Without access to good palliative care, accompanying a dying loved one can be a very traumatic experience, especially if they are in serious pain and there is poor pain management. It is easy to imagine that euthanasia could seem an attractive option in such circumstances. To remedy this situation, in 2010 the Declaration of Montreal was promulgated at a meeting of the International Association for the Study of Pain (IASP). It provides that for a healthcare professional knowingly and unreasonably to leave a patient in serious pain is a breach of fundamental human rights. The World Health Organisation and the World Medical Association have endorsed this approach, as have many national Pain Societies, including Pain Australia.

Despite how it is described by its advocates, euthanasia does not necessarily avoid the problem of the suffering of loved ones of the dying person. Accompanying a person we love who is dying through euthanasia can also be a very traumatic experience as I have witnessed first-hand.

I have a friend in Toronto whose long-term partner, a specialist physician, was diagnosed with inoperable metastasized cancer. He arranged for a physician friend to euthanize him only days after receiving this diagnosis. She and I were having lunch in a busy Bistro and she started to speak of her partner and his death. Suddenly she burst into uncontrollable sobs and kept repeating, “It was horrible, it was horrible! I couldn’t stay with him! I ran out of the room!”. I was shocked, because she is a highly respected professional woman, known for her strong emotional control in difficult circumstances, and is adamantly secular. She was clearly deeply traumatised by witnessing the euthanasia of her partner. The book referred to above, Euthanasia: Searching for the Full Story, recounts many similar narratives.

Why is it important to recognise the potentiality of euthanasia?

The potentiality of legalizing euthanasia requires that we consider what kind of world we will have left for future generations. Might it be one in which no reasonable person would want to live? What message does legalizing euthanasia send to vulnerable people – fragile elderly people and people with disabilities? It is that they have “lives not worth living” or, even more reprehensibly, that they, themselves, do not have any worth?

Paradoxically, euthanasia tells them that they lack dignity, when the pro-euthanasia case is that euthanasia is necessary to respect their dignity.

How will euthanasia affect healthcare institutions and professionals? We already know that many are psychologically traumatised by carrying it out, some developing PTSD. The Dutch Medical Society has recognised this problem and recommended, where possible, the use of assisted suicide, rather than euthanasia.

There has been a massive increase in Belgium in the use of “terminal sedation” (sometimes called “slow euthanasia”), where the patient is permanently deeply sedated until they die. (“Terminal sedation” needs to be distinguished from “palliative sedation” which is justified pain and symptom management, when means other than sedation are not sufficient, and there is no primary intention to shorten life.)

Moreover, what about respect for freedom of conscience of healthcare professionals and institutions, who believe euthanasia is unethical? This is a major field of conflict among a wide variety of people and institutions.
A momentous decision

I have been pondering a great deal lately about what we can do about stopping the “euthanasia virus” pandemic. What would vaccinate us, as both individuals and societies, against it? I have concluded that it is useless saying it is wrong or unethical or even dangerous and that we need a completely different approach, including along the lines of what we have to lose as individuals and societies by legalizing it.

Euthanasia is a very complex issue in terms of the forces that have led to the current situation, including such small yet hugely impactful changes as “time compression” – we expect everything to be instant. Applied to natural dying, which can take an extended period, euthanasia is the “quick fix”. I believe that the overall societal Zeitgeist has activated the push for legalized euthanasia and we have to change that Zeitgeist if we think, as I do, that legalizing euthanasia is a very, very bad idea.

I have written elsewhere that one step we need to take in order to move in that direction is to recover our sense of “amazement, wonder and awe” about both ourselves and our world. I believe that this experience will help to guide us ethically regarding what we should and most importantly should not do and the latter includes legalizing euthanasia.

I predict that History will see the decision whether to legalize euthanasia, as one of the two most momentous values decisions of the first half of the 21st Century. (The other decision is whether to allow the use of new molecular biology and genetic science and technologies to design our children and all their descendants, through alteration of the human germ line.) We need a new iteration of the old virtue of prudence, which can be re-named “wise ethical restraint”.

For all our sakes, both those who are dying and those who are not yet dying, we must kill the pain and suffering of dying people, not the dying people with the pain and suffering.

Note
* This section is an edited version of Margaret Somerville and E Wesley Ely, Forward 2, in Timothy Devos, Editor, Euthanasia: Searching for the Full Story: Experiences and Insights of Belgian Doctors and Nurses, Springer Cham, Switzerland 2020 pp. ix –xv. The online edition is available free of charge.