Assisted Suicide takes centre stage in Quebec court room

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

The Canadian Press is reporting that the case concerning Stephan Dufour (30) will begin in Alma Quebec on Tuesday, November 25, 2008.

Dufour is charged with assisting his uncle Chantal Maltais (49) to commit suicide in September 2006.

Dufour was acting as a home care worker for his uncle Maltais. Maltais had attempted to commit suicide on several occasions. Maltais died by hanging himself to death.

Michel Boudreault, the lawyer for Dufour, has requested a trial by jury with the hope of convincing the jury to find Dufour not guilty.

The Canadian Press article quoted, euthanasia activist and legal expert, Jocelyn Downie, a law professor at the Dalhousie Law School in Halifax and the Canada Research Chair for Health, Law and Ethics who stated:

“We tend not to see the full extent of the Criminal Code brought to bear on to anybody. (This case) doesn’t create a precedent that impacts across the country, but it could fit into a broader pattern.”

The Right to Die Society of Canada’s Ruth von Fuchs told the Canadian Press that:

Quebec has always been a hot zone for debate, pointing to Bloc MP Francine Lalonde. She plans to reintroduce a bill which would amend the Criminal Code to allow, under specific conditions, seriously ill people to end their lives.

“Quebec is one of the leaders in this whole area. When polls are taken, the support for aid in dying is strongest in Quebec.”

I was quoted by the Canadian Press this way:

says surveys his group (EPC) has conducted show the Canadian public tends to waffle on the issue.

“The Canadian people are not hardened on the issue. This is an important case, I’d like to see where it goes and the decision . . . will affect all other future cases.”

There is not a lot of information about this case. We will learn most of the facts during the trial.

A few weeks ago when the Francine Lalonde - Bloc MP spoke to the World Federation of Right to Die Societies conference in Paris France, alluded to the court cases that she expects to see in Quebec.

EPC is really interested in how the defense lawyer sets up the case and how the crown prosecutes the case. We find that these cases are often defended by the Crown in a less than perfect manner.

The one case that was decided well was the case of Dr. Maurice Genereaux, the Toronto physician who prescribed a lethal cocktail for two men who were HIV positive. One man died, while the other survived. Genereax was convicted and sentenced.

We will be following this case closely.

Link to the Canadian Press article:
http://www.google.com:80/hostednews/canadianpress/article/ALeqM5jMe4UIrb6cikHoxncBH9qsxNyjwQ

Lauren Richardson is going home next month

An article from the Associated Press - November 20, 2008 recounts the case of Lauren Richardson, the 24 year old woman who was in the center of a dispute between her parents over her guardianship and the removal of her fluids and food to cause her death by dehydration.

The judge issued an order last week granting Richardson and Towers joint guardianship and closing the case.

Randy Richardson told AP that his daughter, who is currently at a nursing home near New Castle, will be transferred to his home in Elkton, Md., next month.

Richardson said "When we told her she was coming home, ... she started crying and sobbing,"

The article explained that Earlier this year, Richardson challenged a Chancery Court judge's decision awarding Lauren's mother, Edith Towers, sole guardianship and authority to remove Lauren's feeding tube.

Towers commented that she hoped she never would have had to make the agonizing decision to remove the feeding tube, but she simply wanted her daughter to receive hospice care and be allowed to die a natural death.

Towers said "I said in court I don't want to have to pull Lauren's feeding tube,"

Towers had been assured by doctors that her daughter would never recover.

The article explained that Lauren Richardson was a high school honors student who wanted to become an English teacher. She had been diagnosed with bipolar disorder as a young teenager. Later, she began using heroin to escape violent mood swings. Lauren has been disabled since suffering a heroin overdose, while pregnant in 2006.

Lauren gave birth to her daughter in February 2007 while being maintained by a ventilator. After the birth, doctors discovered that Lauren could breathe on her own. Since then she has only required fluids and food to be provided through a tube.

Lauren is cognitively disabled but not dying of any medical condition. If Lauren's tube had been removed she would have died from euthanasia by dehydration, the same way that Terri Schiavo died.

Towers explained that she and Richardson, who divorced when their daughter was an infant, got conflicting medical evidence from doctors, who at one point declared Lauren to be brain dead.

Towers said that she sought sole guardianship upon the advice of a doctor after Lauren, who had been under hospice care at the nursing home after giving birth, was taken back to the hospital for further treatment.

Towers explained that she began having doubts about the lawsuit as more information became available in court documents and in postings from family members on a Web site that the Richardson set up. The turning point came this summer, when she and Richardson's wife began talking about Lauren's young daughter, and how she would respond to the questions that her grand daughter was bound to ask about how the family had cared for her mother.

Towers said "I pictured my little granddaughter asking me those questions, and I said 'That's it, we will try everything before we give up,'"

The article explained that Towers decided in August to drop the lawsuit and joined her ex-husband and other family members in visiting Lauren in September.

Towers said "Lauren, it's mom and dad and we've just come out of a meeting and you're going home ... Would you like that?" She then spent a few minutes alone with Lauren, who started sobbing.

Towers said "We want to see what we can do for her; if there's anything we can do for her. I can't wait to see how she reacts when she gets home."

Randy Richardson said his daughter is not comatose but is in a state of minimal consciousness. She responds to stimuli and can express emotions, is aware of her surroundings, has full movement of her limbs, and tries to sit up.

Richardson said "She's come a long way in the last 30 days ... We have hope,"

Link to the Associated Press article:
http://www.hometownannapolis.com:80/cgi-bin/read/2008/11_20-09/REG

For more information go to:
http://www.lifeforlauren.org

Dr. Diane Meier interviewed about why she opposes assisted suicide.

Diane E. Meier, MD, director of the Center to Advance Palliative Care in New York, a professor of geriatrics and internal medicine at the Mount Sinai School of Medicine and the school’s Catherine Gaisman Professor of Medical Ethics, talked to HemOnc Today about the difficulty in diagnosing depression in terminally ill patients, her reasons for switching sides in the assisted suicide debate and overlooked issues in medical ethics.

Meier responds to the underdiagnoses of depression as being a factor for assisted suicide by referring to the recent Ganzini et al. study on depression and assisted suicide in Oregon:

It is tough to measure the presence of clinical depression in people who are seriously ill. The usual diagnostic tools we use to detect major depression are things like weight loss, change in appetite, or change in sleep patterns, all of which are affected by the illness the person is living with. ...Then the criteria that we have to use to identify serious depression in the seriously ill are narrower, such as things like a sense of hopelessness, guilt, rumination or inability to take any pleasure in life. You can see how those are more subjective than things like having lost 10 lb and not eating and not being able to sleep. Nonetheless, those are the criteria that we have to use in this particular medically ill patient population. So the fact that 15 patients met criteria for depression and 13 met criteria for anxiety, (Ganzini study) in a way, you have to be surprised that it wasn’t all of the patients given how inclusive the criteria were. ...

Meier was then asked - Is it possible to be clinically depressed, but still make a rational decision to die? Meier responded:

That is where there is a lot of debate in the field and I don’t think there is a right answer. Many people on either side feel very strongly about their position. ...

My view as a clinician would be that if a patient approached me — and it’s not legal in New York — for help in dying and I identified signs or symptoms of depression, I would not even consider assisting them and would strongly encourage them, bordering on insisting, that they accept treatment. And I would usually offer a combination of psychopharmacology and psychotherapy or counseling.

Meier was then asked - Does it make a difference if they’re depressed and making this decision? They’re already terminally ill. ...Meier responded:

... every one of us is going to die and we don’t know when. But there are major risks to helping people ...whose problems can be addressed with tools within our reach, established and safe psychopharmacology or effective and safe counseling methods. To assist people to hasten their death in that circumstance smacks of … almost an indifference to the genuine needs of patients. Particularly in an environment of intense cost-containment pressures and an intense financial crisis in health care, anything that makes it easy to stop taking care of someone whose problems are challenging and might be expensive to address, such as depression and psychotherapy for depression …  

Yes, it is a lot easier and faster to help them kill themselves but it is absolutely wrong. Our job as physicians is to convey to our patients that their life is precious to us as physicians. How will patients ever trust us and be persuaded that our goal is to do our best by them if we are convinced during periods of depression that their life is no longer worth living?

She was then asked about her change in position, from supporting assisted suicide to opposing assisted suicide. Meier said:

I was younger and less experienced when I was an advocate of legalization and thought about it primarily as a medical ethical issue: that is, the rights of individuals to self-termination. The more experience I had as a physician taking care of very sick, fragile people with multiple illness who had all kinds of physical and emotional symptoms, all kinds of stress on their families, all kinds of financial challenges, it became clearer and clearer to me that it was impossible to meet the criteria for assisted suicide. ...

You have to make public policy based on your average doctor and your below average doctor, because not every doctor is way above average and yet this policy applies to every physician in Oregon and Washington now, many of whom are not adequately trained nor sophisticated enough to handle the nuances of this request, nor to identify and treat depression. We are notoriously bad as a profession at identifying and treating depression.

Meier was then asked if she would forsee a day when the instruments did exist to make determinations for assisted suicide? She said:

I do not know if I can answer that. Public policy is a fairly blunt instrument — it has to apply to the entire bell curve of patients and their physicians. ...I’m not sure I could ever foresee a time when every physician could go through this complex differential diagnosis when a patient approached them for aid in dying. That makes me very nervous because this an extremely vulnerable, extremely costly patient population.

Meier concludes her interview by stating:

... I feel that the harm to trust of the public in the medical profession is potentially enormous if doctors begin to take a routine role, whether it’s a separate specialty group or all doctors who take care of seriously ill patients, that you cannot always trust doctors to be on the side of your life. That might be too big of a price to pay.

The other point I should make is that it is a tiny, tiny fraction of people dying in Oregon who either seek a prescription or use it. We ought to remember where the really big ethical issues are in health care in this country. It is about access to care. It is about equity. It is about quality. It is not about a right to assisted suicide. Sometimes I get frustrated that this seems to be a sexy topic, but in the big picture it is not an important topic. The important topic is making sure everyone has access to decent health care. I wonder why that is not what we’re writing about all the time as opposed to something that is relevant to a minute fraction of people with serious illness in the United States. We are counting angels on the head of a pin while the ship is sinking.

The importance of the Meier interview is that Meier puts the experience of caring for the terminally ill and the frail into the light of the person. She is caring for people who are not just physical beings. These are complicated decisions and to add assisted suicide to the mix of medical care will result in a weaker and less caring medical system.

Link to the interview with Dr. Diane Meier in Hem Onc Today:
http://www.hemonctoday.com:80/article.aspx?rid=32922

Objections to Assisted Suicide are based on concerns over medical integrity

A response to Sir Lord Joffe by Baroness Finlay of Llandoff was printed in the Times of London today.

Baroness Finlay is challenging Joffe who was essentially stating that opposition to Assisted Suicide is essentially based on faith.

Finlay states in her letter:

Most of the medical profession (including the medical royal colleges and the BMA) object to physician-assisted suicide. These are not faith-based objections. They are concerned about the dangers to the integrity of medical ethics and to the safety of their patients. They know how easily people who are ill can feel they are a burden, and how ending life can become an easy option for the clinician. Opposition to assisted dying comes from a wide spectrum of opinion, within Parliament and in society as a whole.

Finlay then challenges Joffe to come clean on the facts of his own legislative proposals. She states:

Lord Joffe denies his safeguards are “paper-thin”, yet recent research from Oregon reveals that as many as one in six people who commit suicide with the help of their doctors is suffering from treatable but undetected depression. Also, the prognosis of a disease is notoriously unreliable — all too often patients are told they only have a few months to live, yet are alive months or even years later. As clinicians we are occasionally taken in by an apparently loving family, only to discover the real truth much later. Even when we know a patient well, it is difficult to be sure that an expressed wish for assisted suicide does not stem from undisclosed pressures, such as feelings of guilt at being a burden on the family. Lord Joffe talks of psychiatric assessment. But his last Bill would not have made this mandatory, and in Oregon only one in ten of those whose suicide was physician-assisted in the past ten years had been referred.

In fact, in 2007, of the 49 people who died by assisted suicide in Oregon none of them were referred for a psychiatric or psychological assessment even though the Ganzini study showed that 17% of those who died by assisted suicide were depressed.

Finlay then challenges Joffe's assertion that assisted suicide should be legal because it happens already. She states:

Lord Joffe quotes a Brunel University study as stating that an estimated 0.16 per cent of deaths in Britain are attributable to deaths caused by doctors breaking the law. What he omits is Brunel’s conclusion that the incidence of illegal action by doctors in the UK is “extremely low” and that “most of the doctors in the survey appear happy with the state of the UK law”. He omits also another crucial conclusion — that, so far as the UK is concerned, the argument that changing the law is necessary in order to regulate involuntary euthanasia cannot be sustained.

Finlay then concludes her letter by challenging Joffe open up the debate about assisted suicide by stating:

Lord Joffe says he wants “calm and rational debate” without inaccuracies. I agree wholeheartedly. Those who want to legalise assisted suicide should be open with their proposals rather than wrap them up, as now, in comforting “end-of-life care” or “dying with dignity” packages. They should present it for what it is — aiding and abetting suicide — rather than try to pretend it is something more comforting.

Good for Baroness Finlay of Llandoff. The reality is that we do not know what is actually happening in Oregon because the death lobby has controlled the information by being directly involved in 73% of all assisted suicide deaths and because the only information that is gathered by the reporting procedure is from the physicians who prescribed assisted suicide to the person who is now dead.

I ask the question. Will a physician self-report an incidence that represents an abuse of the statute in Oregon?

The reality is that assisted suicide is a threat to the lives of people at the most vulnerable time of their life and just because the statistics show that most of the people who have died by assisted suicide are wealthy, does not negate the question, did they want to die or did they feel like they had a duty to die?

Link to the comment by Baroness Finlay of Llandoff
http://www.timesonline.co.uk:80/tol/comment/letters/article5191546.ece

Mother agrees to let Lauren Richardson live.

Lauren Richardson is a 24 year old woman who lives in Deleware who suffered a severe brain injury in August 2006.

Richardson was pregnant at the time of her brain injury, but successfully delivered a child in February 2007.

Richardson's mother (Edith Towers), who was Lauren's legal guardian, had petitioned the court to have the food and fluids that she was receiving by a tube removed. This would have resulted in a death by dehydration, in the same way as Terri Schiavo died.

Randy Richardson, Lauren's father, had asked the courts to grant him guardianship over Lauren to enable him and his family to continue to care for her.

Alliance Defense Fund attorney's negotiated a settlement over the care of Lauren.

Richardson's mother has apparently changed her position based on - religious conviction and heartfelt interaction with her ex-husband’s family. She has - decided to join cooperatively with Randy Richardson to care for their daughter and to drop her court request to remove her daughters fluids and food.

A media release from the Alliance Defense Fund stated that:

The parents agreed to settle the case, to share joint guardianship of their daughter, and to cooperate in caring for her at Randy Richardson’s Maryland home. Lauren Richardson wept emotionally when her mother informed her of the settlement and the reconciliation of her parents, confirming to the mother that her daughter was aware and responsive. Both parents and their families continue to interact with her daily.

In the media release, Legal Counsel Matt Bowman stated that:

"This change of heart and settlement has profoundly affected everyone involved. The miracle of life is not something that should be taken lightly."

This is a very important case. By providing care for Lauren, Lauren's parents have come to agreement, they have reconciled their relationship and Lauren will be able to be cared for at home.

A tragedy has been averted. This was done because Lauren's father loved his daughter enough, that he was willing to put his life aside and fight for her life. He provided care for her resulting in a significant recovery for Lauren.

Caring not Killing is the answer.

Contact the Alliance Defense Fund at: http://www.telladf.org/

For more information go to: http://www.alliancedefensefund.org/news/story.aspx?cid=4754

Link to a previous article about Lauren Richardson:
http://alexschadenberg.blogspot.com/2008/07/good-delaware-didnt-learn-lesson-of.html

The Honolulu Star Bulletin newspaper editorial calls for Hawaii to become the third state to legalize assisted suicide.

The Honolulu Star Bulletin is suggesting that Hawaii should follow through on the recommendations by a blue-ribbon panel in 1998 that had advised the then Gov. Ben Cayetano to legalize assisted suicide in Hawaii.

Since then their were several attempts to legalize assisted suicide in their state.

In 2002, a bill resembling the “Oregon law” was approved in the Hawaii House but defeated by 3 votes in the Senate.

In last year’s Legislature a bill to legalize assisted suicide was rejected by a 6 - 1 vote by the House Health Committee.

Even though the current chair of the House Health committee Rep. Dr. Josh Green, led the opposition to assisted suicide last year, the Honolulu Star is still proposing that Hawaii be the next state to legalize assisted suicide.

We think they are wrong.

Link to the editorial in the Honolulu Star Bulletin:
http://www.starbulletin.com/editorials/20081112_Legislators_should_reconsider_Death_with_Dignity_proposal.html

New 10 in San Diego Tracks 'Suicide Drug' in Mexico

News 10, a television station news program in San Diego has tracked the sale of 'suicide drugs' in Tijuana Mexico.

The 10News I-Team went undercover to try and find the drug by following the instructions in Philip Nitschke, Australia's Dr. Death, 'Peaceful Pill' handbook. Nitschke is the leader of the euthanasia lobby group, Exit International.

The online article stated that the I-Team learned that Mexican authorities are cracking down on the sale of Nembutal, a veterinary drug used to euthanize animals, due to the adverse publicity related to a few high profile deaths.

The article then stated that the undercover I-Team unsuccessfully tried four different pharmacies in Tijuana, but they were successful in one pharmacy where they were able to obtain the veterinary drug under a different brand name and with no prescription. The price for the lethal drug was $40.

The I-Team were unable to keep the lethal veterinary drug due to a malfunction in their hidden camera that was spotted by the pharmacy owner who suddenly told them that the drug was no longer available.

The article explains that the I-Team continued travelling south to Rosario where they attempted to purchase Nembutal from a veterinarian's office. They were told that the government is cracking down and that they would require a note from a doctor (probably a veterinarian).

The I-Team also interviewed Faye Girsh, a leader of the San Diego Hemlock Society, a leading euthanasia lobby group in California.

Girsh told the I-Team:

drinking this drug, Nembutal, is "much better then shooting your head off or jumping form a building or in front a train."

Girsh also told the I-Team:

she does have her own stash of Nembutal to use if and when the time comes. She didn't go down to Mexico to get it herself, someone got it for her, and she has great sympathy for those who take that risk.

Girsh did tell the I-Team that:
she doesn't agree with is traveling to Mexico to buy this drug since it is illegal to bring back to the U.S.
Paula Goodman-Cruz, the medical bioethics director from Kaiser Permanente, told the I-Team:

Sympathy is one thing, but no one but doctors should have access to that drug.

It's not only illegal but also unethical. The solution is better end-of-life care.

She says less pain and more comfort could prevent people from risking their lives south of the border for the ability to end their lives at home.

Once again, the euthanasia lobby refuses to recognize how their promotion of suicide methods and drugs are irresponsibly causing vulnerable people to seek death.

Even Faye Girsh has a stash of illegal drug hidden for a future possible use.

I need to ask the question. What is it with the euthanasia lobby that makes them so obsessed with death that they feel the need to assist people, in all and every medical condition, to kill themselves or they seek to kill themselves, at some unforseen time in the future.

We need a society that cares for people, not kills them.

Link to 10News.com in San Diego:
http://www.10news.com/investigations/17976535/detail.html

Link to a previous blog entry concerning the Mexican crack down on Nembutal:
http://alexschadenberg.blogspot.com/2008/10/beware-of-mexico-drug-risks-and-rip.html

Landscape Evolves for Assisted Suicide

An article written by Jane Gross and published in the New York Times examines the landscape or the changes in relation to the issue of assisted suicide since 1991 when Dr. Timothy Quill published an account of his role in the death of one of his patients.

The article makes some very interesting points that need to be examined further if we are to effectively respond to future initiatives to legalize assisted suicide.

The article describes the conditions for assisted suicide in Oregon and in the Washington statute. The article states:

State residents requesting this assistance must be mentally competent, have six months or less to live according to two physicians, wait 15 days after their request and then repeat that request orally and in writing. They must be capable of administering medication themselves and agree to counseling if their physicians request it. The patients also must be told of alternatives.

Dr. Timothy Quill, who is the director of the palliative care program at the University of Rochester then states:

these options have gained acceptance over the past decade.

The article then comments on the 1997 Supreme Court Decision:

In 1997, the Supreme Court ruled that there was no constitutional right to physician-assisted suicide and upheld a prohibition against it. But in the ruling, the justices conceded that terminally ill patients were entitled to aggressive pain management, even if opiates or barbiturates had the “double effect” of hastening death.

This statement concerning the "double effect" principle is inappropriately worded because the use of opiates or barbituates for the aggressive management of pain when it is not intended to cause death, and therefore when properly administered, should not be associated with assisted suicide. A physician should not consider the "double effect" principle as an open window to euthanasia because that is an abuse of its proper use.

The article then quotes Quill concerning that options that should exist before one considers the "last resort" of assisted suicide. He states:

First and foremost, Dr. Quill and others say, all terminally ill patients should have access to palliative care, both to relieve pain and other symptoms and to provide emotional support to patients and families.

This statement begs the question, that is, when palliative care is not accessible for all people needing pain and symptom management, then is assisted suicide represents an abuse of the vulnerable person who is not actually seeking assisted suicide but rather relief from their suffering.

Quill recommends that a palliative care consultation be mandatory before anyone considers a "last resort" measure.

Quill suggests that other options be made known to the patient.
Pain management so aggressive that it may well hasten death, although that is not the primary intention. (This is the doctrine of “double effect.”)

Invoking a patient’s right to forgo life-sustaining therapies or discontinue them.

Voluntarily stopping eating and drinking. (Dr. Quill believes this is a “more morally complex” choice because over the last decade the practice has expanded beyond those with end-stage cancer or Alzheimer’s disease — who often lose interest in food or forget how to eat and drink — to people who are not “actively dying” but nevertheless have had enough of disability or dependence).

Sedation to the point of unconsciousness. (Although it was endorsed this year by a panel of the American Medical Association, Dr. Quill called it the “last, last resort.”)

Quill should acknowledge that people who voluntarily stop eating or drinking when they are not "actively dying" are often people who are suffering from undiagnosed clinical depression. Physicians should uphold a pledge that they will "do no harm" which should include protecting the vulnerable.

The primary concern around the sedation of a person to the point of unconsciousness is that usually sedation is done to intentional dehydrate of the person. It is sometimes necessary to sedate a person to the point of unconsciousness in order to relieve their neuropathic pain, but to intentionally dehydrate a person, who is not otherwise dying, is euthanasia by dehydration.

The article is correct when it states that the landscape has changed in relation to assisted suicide. What has not changed is the effect assisted suicide has on the attitude and treatment that is offered to people at the most vulnerable time of their life.

The question whether we need to strive for a culture that solves its difficult human problems by caring for the patient or a culure that solves its most difficult human problems by killing the patient?

I choose to care.

Link to the article on the New York Times:
http://www.nytimes.com/2008/11/11/health/11age.html?_r=1&oref=slogin

Washington State moves to implement assisted suicide law

There are a few very important issues that are very concerning from this article about Washington State's plans to implement assisted suicide law.

First, the article states:

Washington is now the second state in the nation to have such a law, and officials may look to neighboring Oregon for a blueprint.

The State of Oregon has imposed a "closed" style of reporting, whereby the physician who prescribes assisted suicide fills out the report. This is a form of self reporting that doesn't ensure that accurate information is reported. There is no "third party" review of the reports and no investigations.

This form of reporting provides no "safe-guard" for the person who may be seeking assisted suicide.

Second, the article states:

Department of Health spokesman Tim Church said it won't have to create a new office or section within the agency. Under the measure, any health care provider writing a prescription or dispensing medication must file a copy of the record with the Health Department, which is required to create an annual statistical report on how the law is used.

Once again, this style of reporting does not provide any protection for the person who is receiving a prescription for assisted suicide. If the physician knows that the person is experiencing dementia and incapable of deciding for themselves, but decides to provide a prescription for lethal drugs anyway, there is no way for the authorities to know about this under this system.

Third, Anne Martens, the spokesperson for the right to die lobby stated:

"I don't anticipate any legislative tinkering, but you can never rule that out," she said. "The law as written is identical to the law that's been working in Oregon. We don't see any need to change any part of it."

I have already pointed out the lack of effective safeguards in Oregon, I hope Washington State will tinker with the rules.

It is also important to note that 73% of all assisted suicide deaths in Oregon are in some way facilitated by the Compassion & Choices lobby group. Therefore the group that is in favor of assisted suicide is also the group that is carrying it out.

How will we ever be able to prevent abuses when the fox is running the hen house. This should not happen in Washington State.

Fourth, Eileen Geller from the Coalition Against Assisted Suicide have indicated that they don't plan to be part of the implementation process. Eileen stated:

"We do not concede that Initiative 1000 is a law in this state, Right now for us every option is on the table. Legal is one of them."

Whereas I agree with Eileen that every option is on the table, I also recognize that if the Coalition Against Assisted Suicide is not part of the process for establishing the rules to operate the law that the end result will be a bad law with many abuses.

Just because assisted suicide is wrong and will result in the deaths of many vulnerable people, etc, that doesn't mean that we should not attempt to mitigate the evil by becoming part of the implementation committee.

Fifth, Jennifer Hunscom, the spokesperson for the Washington State Medical Association stated:

the organization has already started educating its more than 9,600 physicians about the new law. Information is on the group's Web site, and a newsletter was being sent to members.

Since the Washington State Medical Association continues to oppose physician assisted suicide as an act which is not an act for physicians to participate, therefore they should simply say - The Washington State Medical Association considers participation in assisted suicide to be against our code of ethics.

Physicians in Washington State should simply say no to assisted suicide.

Doctors are trained to heal and to care for their patients, not kill their patients.

Link to article in the Komo TV news:
http://www.komonews.com/news/34055014.html

German politician offers to assist the suicides of UK residents

Roger Kusch, a former politician was reported in the Sunday Mercury paper as stating that he has been contacted by people in the UK and he is willing to assist their suicides.

Kusch, said that he wanted Germany to replace Switzerland as the destination of choice for Death Tourism from the UK.

Speaking through an interpreter, Kusch said:

“In fact people from Britain have made most of all the inquiries we received from foreign countries.

“And I will go on in assisting people to commit suicide and talk about it.”

Kusch made world-wide headlines last April when he displayed his suicide machine which is a modified perfusor, which is a machine normally used to inject medication over a long period of time. He modified the perfusor by installing a button to allow his suicide victim to start the machine.

Dr. Peter Saunders from the Care Not Killing Alliance in the UK responded to Kusch by stating:

"This guy sounds like Dr Death.

He should be caring for people, not killing them.

In my experience a request for suicide is always a request for help.

Doctors working in palliative care for their whole career will tell you that they come across patients who want to commit suicide.

But once their basic needs are taken care of they could count the number of people who want to go through with it using the fingers on one hand.

In my career as a surgeon I only had two requests and both patients changed their minds once we responded to their own particular needs.

What people need to remember is that in the last five years just over 100 people have gone to Dignitas to die, but in that same time period over 3 million people have died of natural causes.

So no matter what people like Kusch argue, the demand is actually very small indeed.

For example take the case of Dan James. There are over 20,000 tetraplegics in Britain but the vast majority want the help to live, not to die.

I think he (Kusch) is profoundly misguided and is only increasing the risk that vulnerable people will be abused and exploited.

There is a reason assisted suicide is illegal in most of the world, and that is to protect people and increase public safety.

We at Care Not Killing believe that the answer does not lie in suicide but in improving the care for people in the first place.”

Kusch is very clear about his long term goals. He stated:

“We are fighting for the sovereign right of any person to die in dignity.”

Once again, euthanasia and assisted suicide is not about terminal illness, or physical suffering, but rather a univeral right to die for any person who is tired of living.

There have been a number of Private Members Bills related to this issue in recent years (including the Assisted Dying for the Terminally Ill Bill) and the Government’s stance has been to remain neutral and to listen to the debate.

Link to the article in the Sunday Mercury:
http://www.sundaymercury.net/news/midlands-news/2008/11/08/german-medic-wants-to-help-midlanders-die-66331-22212718/

Link to previous article about Roger Kusch:
http://alexschadenberg.blogspot.com/2008/04/suicide-machine-sparks-outrage.html

Medical providers in Washington State say they won't assist with suicides.

An article in the November 6th edition of the spokesman review paper in Spokane Washington indicated that Providence, the State's largest healthcare provider, will not support assisted suicide, even though the new assisted suicide law will take effect in July 2009.

Karina Jennings, the Providence spokesperson stated:

We do not believe health care providers should ever be put in a position of aiding a patient in taking his or her own life.

We believe we don't have to participate and plan to exercise a conscience clause allowing us to be exempt.

Similarly the Washington State Medical Association was outspoken in its opposition to assisted suicide.

Jennifer Lawrence Hanscom, the spokesperson for the Washington State Medical Association stated that they oppose assisted suicide and support the repeal of the Oregon Death with Dignity Act. She said:

assisted suicide runs counter to the Hippocratic Oath, which directs them to do no harm.

The Hospice of Spokane stated:

Hospice of Spokane's life-affirming care is intended to neither hasten nor prolong death. Rather it is about providing patients with the best possible quality of life in the time they have remaining.

The non-profit organization does not practice physician-assisted suicide or euthanasia. They also said that they will not deny or discontinue hospice care to patients who are considering seeking help to end their lives.

The Washington State Medical Association needs to maintain its opposition to assisted suicide. Assisted suicide is not a medical practise fitting the human person.

Link to the Spokesman Review article:
http://www.spokesmanreview.com:80/breaking/story.asp?ID=17609

Link to Wesley Smith's blog on the same topic:
http://www.wesleyjsmith.com/blog/2008/11/resistance-begins-declaring-non.html

Washington State passes I-1000 assisted suicide Initiative - Just the beginning

Voters in Washington State have passed the I-1000 assisted suicide Initiative, thereby legalizing "Oregon Style" assisted suicide in their state. The Initiative 1000 passed by a 58 - 42 percent margin.

Exit polling data shows that people who identified themselves as conservatives opposed assisted suicide by a 66 - 34 percent, liberals supported assisted suicide by 81 - 19 percent and moderates supported assisted suicide by 63 - 37 percent.

Voters who considered themselves religious, either Protestant or Catholic, voted 50 - 50 percent. I guess the religious community were not convinced that the vulnerable in our society are not in need of legal protection.

Those who have followed my comments on this initiative will realize how grave a decision Washington State voters have made.

Assisted Suicide directly threatens the lives of the most vulnerable people in our culture. People with disabilities the dependent elderly, those who live with depression and mental illness and the poor will be directly threatened by assisted suicide in Washington State.

For people who believe that the I-1000 assisted suicide Initiative will not lead to a slippery slope then you need to read the comments made by Ted Goodwin, President of the Final Exit Network. Goodwin stated in a press release today:

November 5, 2008
Olympia, WA

Although the supporters of Initiative I-1000 are delighted that Washington becomes the second state to pass a "Death with Dignity Act", there is much more to be done.

Ted Goodwin, President of Final Exit Network, said, "We congratulate all those who worked so hard to achieve this important right for Washington's citizens, and we applaud the citizens of Washington State for making the right choice. "Final Exit Network and its members supported passage of this landmark initiative by donating to the advocacy effort spearheaded by Washington Death with Dignity and former Governor Booth Gardner. However, the job is not finished".

Although, like Oregon's "Death with Dignity Act," I-1000 gives doctors the authority to prescribe a lethal dose of medications to terminally ill individuals under strict controls, it condemns to continued suffering as many as 40% of those who desperately want to end their life because of intolerable suffering but cannot under the law because their illness is not diagnosed as "terminal".

"Unfortunately," said Goodwin, "many patients do not meet I-1000's strict criteria. Individuals with neurological illnesses such as Parkinson's disease, Multiple Sclerosis, Muscular Dystrophy, Amyotrophic Lateral Sclerosis (Lou Gehrig's disease) and Alzheimer's disease often lose the reason and will to live long before their disease qualifies as 'terminal'." Goodwin adds, "For these individuals, neither I-1000 nor the Oregon law go far enough. "That is why Final Exit Network pledges, until laws protect the right of every adult to a peaceful, dignified death, Final Exit Network will be there to support those who need relief from their suffering today!"

"The Network's Exit Guide Program is available nationwide," Goodwin said. "With the Network's compassionate guidance and support, physically and mentally competent adults in all fifty states are free to exercise their last human right - the right to a peaceful, dignified death. "Final Exit Network is the only organization in the United States that will support individuals who are not "terminally ill" - 6 months or less to live - to hasten their deaths. No other organization in the US makes this commitment," said Goodwin.

Goodwin and other leaders in the euthanasia lobby will continue to push for changes until they have achieved their goal - death on demand.

Goodwin's ideology and the Compassion & Choices lobby plans are very similar. Compassion & Choices, the leading euthanasia lobby group are interested in spreading acceptance for assisted suicide before expanding its application. Compassion & Choices will focus on the next State initiatives to legalize assisted suicide. Those initiatives may include another ballot initiative or they may first attempt another legislative proposal.

Once Compassion & Choices have legalized assisted suicide in enough states, they too will seek to expand its application through legislative changes to existing statutes or through the courts.

Among his other comments, Wesley Smith commented on the support from the media and the liberal elite who have given incredible sums of money to support the euthanasia lobby.

Smith then says:

Meanwhile, the opposition is generally starved for funds, marginalized in the popular media, and as a consequence, always stuck in reactive mode when we need to be proactive.

But we can't do it alone. If people and foundations wish to stop this juggernaut, they are going to have to do what proponents have done and step forward and give those of us willing to give our all to fighting the death culture the resources we need to compete. If they don't, there will be more Washington States.

Anyone who still says "it can't happen here," isn't paying attention. It is happening here, and it will happen here increasingly unless there is a greater commitment shown by those with means who oppose these agendas to reversing the current course.

Link to Wesley Smith's blog:
http://www.wesleyjsmith.com:80/blog/2008/11/dire-straights-assisted-suicide-passes.html

For further analysis of the Washington State I-1000 assisted suicide Initiative go to the International Task Force on Euthanasia and Assisted Suicide: http://www.internationaltaskforce.org/washington.htm

The Euthanasia Prevention Coalition International will continue to build a unified and organized effort of groups who are working to create a cultural barrier to euthanasia and assisted suicide while stemming the tide of the euthanasia lobby.

It is very difficult to organize and unify our efforts when we lack the necessary funds to build a stronger and more inclusive infrastructure.

Smith is correct. You will need to decide whether you are willing to invest in our work. Your support will enable us to build an effective opposition to the juggernaut of the euthanasia lobby.

It is your decision.

We know that the euthanasia lobby will continue to push their radical agenda until the right to die, becomes a duty to die.

To support or join the Euthanasia Prevention Coalition, contact:
Website: www.epcc.ca
Email: info@epcc.ca
Call toll free: 1-877-439-3348

P.S. The comments by Mark Mostert on the disability matters blog are worth reading:
http://disabilitymatters.blogspot.com/2008/11/in-washington-state-doctors-of-death.html

Ottawa physician provides hope

In a letter to the Ottawa citizen - Ottawa Physician Rene Leiva writes about how he, and others, can help those suffering to find meaning beyond human limitations:

Leiva wrote:

The most challenging clinical cases usually are the ones where patients are suffering from existential distress, or in other words, loss of purpose in life in the face of suffering. I would also name it "depression of the soul." Fortunately, there are ways to approach these problems.

One that I use frequently and I teach medical residents is the one developed by the great Jewish psychiatrist, Viktor Frankl. After losing his family and surviving a concentration camp, he managed to write his masterpiece Man's search for meaning. In it, he makes the point that people can find meaning in life: by creating a work or doing a deed, by experiencing something or encountering someone (the meaning of love) and by the attitude one takes toward unavoidable suffering (the meaning in suffering). He was fond of repeating Nietzsche's words: "He who has a why to live can bear with almost any how."

He challenges us to go beyond ourselves and move to a level where we can find meaning outside our own human limitations.

I heard of a South American young man dying of AIDS and complicated with a rare type of cancer. His daily request was to be euthanized. His treating physician asked one of the hospital volunteers to offer to visit him. The doctor noted his request stopped, and one week later, the doctor asked the man why he was not interested in euthanasia anymore. His response was: "I do not want to die; now, I have a friend."

In the face of unavoidable suffering, this man chose to find meaning in encountering someone. It is a personal choice, one which a physician does make for the patient.

At the end, as Viktor Frankl says: "love is the only way to grasp another human being in the innermost core of his personality."

René Leiva, MD,

We need more physicians like Rene Leiva who choose to care for their patients and reject the concept of killing them.

Link to the letter in the Ottawa Citizen:
http://www.canada.com/ottawacitizen/news/letters/story.html?id=fd8ea80b-e75d-43ad-b503-46a12b4e1a96

Swiss assisted suicide clinic offers death for people who are "Tired of Living".

Researchers from the University of Zurich and the University of Applied Sciences have released a study that proves that the Dignitas and Exit assisted suicide clinics are assisting in the deaths of people who are not terminally ill, but rather "tired of living".

Susanne Fischer, who co-authored the study on assisted suicide at the two clinics, explained that:

* 421 people who had assisted suicide between 2001 and 2004 in Zurich - 274 were Dignitas deaths, 147 were Exit deaths and compared them to 149 assisted suicide deaths by Exit from 1990 - 2000.
* 79% of assisted suicide deaths at Dignitas were terminally ill.
* 67% of assisted suicide deaths at Exit were terminally ill.
* 78% of assisted suicide deaths at Exit were terminally ill (1990 - 2000)

Bernard Sutter, a member of Exit's board told Reuters:

"We help only people with fatal diseases or who are very seriously ill. For the last 12 years, the number suffering from fatal diseases has always been the same, between 65 - 75 percent. The rest, maybe a third or less, are very ill."

Sutter said:

"We work with doctors who have their medical code and will not issue a prescription (for lethal drugs) if someone is not in a bad state."

Assisted suicide has been allowed in Switzerland since the 1940's if done by a non-physician who has no vested interest in the death. Both Exit and Dignitas usually use lethal drugs prescribed by a physician to end the lives.

Earlier this year, Ludwig Minelli, the founder and director of the Dignitas clinic, stated that they were using the plastic bag with helium method for assisted suicide. This method eliminates the need for a physician to agree to assisting the death. Even physicians who support assisted suicide will often refuse to write lethal prescriptions for people who are not dying or suffering.

The Reuters article stated that:

Between 2001 and 2004, 91 percent of those who died through Dignitas were foreigners, mostly from Germany, France and Britain. Only 3 percent of those turning to Exit came from abroad, according to the researchers.

Link to the artice from Reuters:
http://in.reuters.com:80/article/worldNews/idINIndia-36322720081104

Link to previous blog comment on the Dignitas assisted suicide clinic in Switzerland:
http://alexschadenberg.blogspot.com/2008/04/euthanasia-trends-in-europe-by-alex.html

Ideas have consequences

Response to Russel Ogden by Christina Alarcon

I would like to invite Mr. Ogden to read “A Merciful End: The Euthanasia Movement in Modern America” written by Canadian historian Ian Dowbiggin of the University of PEI. Doing so, he would realize that his ideas about assisted suicide and euthanasia date as far back as the early 1900’s. His linking of the right to die to abortion rights also goes back to the 1960’s ideology that an individual may do as he/she wishes with his/her own body. What Ogden has perhaps not reflected on is the possibility that ideas have consequences. For example, the theories and writings of German jurist Karl Binding were used by the Nazis to justify their T4 Euthanasia Program. As Dowbiggin documents, Binding started from the position that every person had the freedom to commit suicide. He then proceeded to justify voluntary euthanasia, then mercy killing of unconscious dying individuals, and finally the humane killing of state-dependent defectives. He believed that the benefits of legalized euthanasia would far outweigh the inevitable abuses.

History, as we all know, has proved him wrong. Closer to our day, in the 1990’s reports of massive abuses being carried out in Holland should put Canadians on the alert against accepting the legalization of mercy killing. Finally, if Ogden finds it ironic that those who most avidly oppose mercy-killing are those who believe most firmly in a blissful afterlife, I find it even more ironic that those who believe in no afterlife would want to destroy the only life they’ll ever have!

Cristina Alarcon, Vancouver pharmacist and Bioethicist

Washington State I-1000 assisted suicide Initiative: A price on your head

Commentary by: Margaret Datiles
Washington Times - Sunday, November 2, 2008

In May 2008, Barbara Wagner received a chilling rejection letter from her health-care insurance company. Employing a dollar-saving tactic, Mrs. Wagner's Oregon Health Plan denied coverage for medication that would treat her cancer and extend her life, but agreed to pay for less expensive medications to end her life.

Mrs. Wagner's lung cancer, which had been in remission for two years, had returned. Her doctor prescribed medication which would cost $4,000 per month, but the 64-year-old retired bus driver could not afford to pay. Mrs. Wagner's Oregon Health Plan administrators instead coldly offered to pay $50 for an assisted suicide. To them, that was all she was worth.

Mrs. Wagner and her family were devastated. "It was horrible," she said, tears flooding her eyes. "I got a letter in the mail that basically said if you want to take the pills, we will help you get that from the doctor, and we will stand there and watch you die. But we won't give you the medication to live."

Oregon soon may not be the only state saving money by denying coverage for lifesaving medications and encouraging suicide. The State of Washington is considering a ballot initiative that would allow the same dollar-saving opportunities for health-care insurance companies. Washington Initiative 1000 (I-1000) would legalize physician-assisted suicide and allow Washington health-care plans to financially pressure vulnerable patients into "choosing" assisted suicide.

Disturbing? Unfair? Even - dare we think it - unethical? Of course it is. But to those supporting assisted suicide - euphemistically and disingenuously called "death with dignity," that does not matter. And, if you are an over-strapped state with budget problems or a health-care insurance company looking to save money during the current economic crisis, it is a very tempting "quick fix." And so today, it's the citizens of Washington state being asked to put a price on the heads of the weak among them. But it's not just the state that can profit.

As proposed, I-1000 allows patients to receive and self-administer lethal medications if they meet cursory, unprotective, and medically unsound prerequisites. But heirs looking to inherit early could participate in requesting lethal drugs for their parents, administer those drugs, and no one will ever question what happened.

For example, a written request for death-inducing medication could be witnessed by a person with a financial interest in a patient's estate. Further, the proposed definition for "self-administer" would allow someone other than the patient - such as an heir to the patient's estate - to administer the lethal dose. To top it all off, I-1000 does not require any witnesses to the assisted suicide. This leaves no assurance that a patient took his own life and someone else did not take it for him.

For those concerned with ensuring health care for the sick, protecting those in poverty from involuntary assisted suicide, and who would rather see the elderly cared for than knocked off for the inheritance, there is much reason for alarm.

I-1000 also requires physicians to falsify death certificates in cases of assisted suicide. Physicians must state the underlying illness as the cause of death and are prohibited from naming "suicide," "assisted suicide," or "drug overdose" as the cause of death. Thus, if an eager heir decides to facilitate a patient's suicide, his tracks would be covered.

If that were not enough, I-1000 does not require family notification. Loving family members could be denied the opportunity to see and speak with loved ones who decide to prematurely end their lives. A patient's husband or wife may not find out about their spouse's decision until after their spouse is already dead and, even then, may not learn the true cause of death since the physician would be not be permitted to list "assisted suicide" on the death certificate.

This irreparably changes the standard of care for the mentally ill. Patients suffering from depression and other common, treatable mental illnesses are put in life-threatening danger by I-1000. Patients who request assisted suicide would not undergo routine psychological assessment or treatment. Rather, he would be given the "quick fix" - a prescription for lethal medications. Democratic Washington State Sen. Margarita Prentice has asserted "there is nothing to protect those suffering from psychological distress... [t]his very dangerous initiative would never have passed the legislature."

Lastly, physicians are given absolute immunity from liability. According to the initiative's "good faith" standard, physicians who are negligent, violate patient safeguards, fail to report assisted suicides or file inaccurate reports are completely immune from liability. The physician's oath to "do no harm" would be obliterated.

If I-1000 passes in Washington, we can expect an immediate deluge of similar measures nationwide. In 2005, the Oregon-based assisted-suicide advocacy group, Death with Dignity National Center (DDNC), drew out a plan to export the practice of physician-assisted suicide beyond the borders of Oregon to the entire nation. That plan was called the "Oregon plus One" plan. According to this plan, if just one other state besides Oregon were to legalize physician-assisted suicide, it would start a domino effect and the country would soon follow.

The DDNC's 2007 annual report revealed that the group spent the year "researching and collecting data to determine the state which is most likely to adopt a [physician-assisted suicide law].... Through these efforts [they]... identified Washington as that state." Since this determination, DDNC has poured all of its efforts into legalizing physician-assisted suicide in Washington, allocating $1.5 million in support of I-1000.

If I-1000 is enacted, don't be surprised if your state is next on the list. Next time, it could be your mother who is denied coverage for needed medications and offered coverage only for assisted suicide. It could be your spouse who commits suicide without your knowledge. It could be your son or daughter who is handed death-inducing drugs while going through treatable depression. Or it could be you.

Link to commentary printed in the Washington Times:
http://www.washingtontimes.com/news/2008/nov/02/a-price-on-your-head/

J. Margaret Datiles is staff counsel for Americans United for Life representing the interests of the weakest citizens of the United States and abroad.

The media's love affair with suicide outlaws

Wesley Smith has blogged an interesting article about Russel Ogden.

Ogden is a criminologist in British Columbia who is fascinated by suicide and assisted suicide. He claims to be a researcher and not an activist.

Decide for yourself.

Link to Wesley Smith's blog comment:
http://www.wesleyjsmith.com/blog/2008/11/medias-love-affair-with-suicide-outlaws.html

Link to the article in the Vancouver Sun:
http://communities.canada.com/vancouversun/blogs/thesearch/archive/2008/11/01/hard-headed-researcher-of-300-suicides-maintains-he-s-pro-life.aspx

Link to previous blog article concerning Russel Ogden:
http://alexschadenberg.blogspot.com/2008/07/professor-wants-to-witness-assisted.html