UK Judge agrees to dehydration death of woman with cognitive disability

A High Court in the UK has decided to withdraw fluids from a woman who is believed to be in a PVS state.

This woman, (54) only known as "M" is a different case than the other debated case of a woman known as "M" who is in a minimally conscious state and whose parents have requested permission to have fluids and food withdrawn in order to cause her death.

Mr. Justice Charles decision will cause the death of "M" by dehydration, which is also known as euthanasia by dehydration or "slow euthanasia".

Justice Charles was reported to have stated:

"... the application by a NHS trust, which also cannot be named, was for a declaration “to render lawful” the withdrawal of hydration, nutrition and medication for a heart condition.

He said: “The consequence of that is that very sadly the patient will die.”

The judge said he was “satisfied that appropriate testing and observations have been carried out by the appropriate qualified professionals” over a significant period of time.

He concluded: “In my judgement this patient has permanent extensive brain damage and is in a permanent vegetative state. Further treatment would be futile.”

The declaration sought was “in her best interests”.

Euthanasia promoter Helga Kuhse stated in her speech to the World Federation of Right to Die Societies Conference in France - Sept 1984:

"If we can get people to accept the removal of all treatment and care – especially the removal of food and fluids – they will see what a painful way this is to die, and then, in the patient’s best interests, they will accept the lethal injection."

No one has the right to switch off a human life... I should know: One woman's story of being locked inside her own body

By Nikki Kenward
Daily Mail - July 27, 2011

Can you imagine a lonelier or more frightening place to be trapped in, unable to communicate, than your own body?

These are terrifying times for anyone who cannot speak up for themselves. Whether they know it or not, they are lying prone in a world increasingly seduced by the idea that death is preferable to the life they are living.

The increasingly vocal advocates, who promote ‘assisted suicide’ for those who are too disabled to express their own feelings on the matter, cannot begin to imagine what it is like to live such a life.

They cannot begin to imagine how profoundly illness, or physical and mental disability, might actually enhance that individual’s appreciation of the value of life itself — even if it bears scant resemblance to the life they were living before.

But I can. I have lived that life and I know how precious it is. I have experienced the torture of total paralysis and I now live with serious disability. But I will be grateful until my dying day that no one had the right to ‘turn’ me off.

So today, as the High Court deliberates over the harrowing case of ‘M’ — a 51-year-old brain-damaged woman whose family is pleading for the right to end her life — you will find me in the Old Palace Yard outside the Houses of Parliament, alongside others, both able-bodied and disabled, who are determined to give a voice to those who cannot speak for themselves.

My life changed for ever, one day in 1990, when I was struck down by a severe strain of Guillain-Barre syndrome. It left my entire body completely paralysed, but for my right eyelid.

In 24 hours, I was transformed from a happy, healthy wife and mother, to a seemingly helpless lump. I was locked in. Trapped. And I remained that way for five months, learning to communicate, eventually, by flickering my eyelashes.

Although most people who contract this rare disease go on to make a full recovery, it took a year in hospital, and many more at home, for me to fight back from total paralysis. I have never recovered the use of my legs.

At my worst, all of my muscles, including those that operate my lungs, were completely inert.

I was in terrible pain throughout my body, I regularly endured violent physical abuse at the hands of one of my nurses, and I truly believed that I might die from the agony of the heartache I felt at the thought of never holding my one-year-old son again.

Yet, to all those around me, I appeared unfeeling and unresponsive.

You might think that, if you were in my position, you’d have wished for death. Perhaps you have even spoken to your loved ones about your wishes, should you ever find yourself in such a situation. But all I knew in those dark days was that I wanted to live.

I didn’t care if this was all my life would ever be — forever lonely, frustrated and silent. I wanted to be here, living in whatever capacity I could manage, and I believe there are people lying in intensive care wards all over the country who feel exactly the same.

Yet the pro-assisted suicide lobby grows louder and ever more confident in their conviction that a hastened — and often, as I shall show, inhumane — death is what these people at our mercy would have wanted. After all, it is taken as a given by the fit and well these days that being dependent on others for love and care is no way to live at all.

And that, it seems, is the tragic conclusion reached by the family of M, who has been severely brain-damaged for the past eight years.

Over the past two weeks, they have sought to persuade a judge that M, who is in a ‘minimally conscious’ state, should be ‘allowed to die’ — a curious and emotionally-void euphemism which hides the terrible reality of condemning a person to death by (dehydration) starvation, when they are deemed to be too disabled to go on living.

In 1993, the House of Lords ruled that patients with no awareness or consciousness, in a Persistent Vegetative State (or PVS), need not be kept alive. The ruling was centred on the case of Tony Bland, a survivor of the Hillsborough disaster.

Since then, 43 PVS patients have been ‘allowed to die’ via the withdrawal of treatment and care (dehydration). Each case has been heard by a judge, and argued passionately on both sides by people who, undoubtedly, only have that patient’s best interests at heart.

Let us set aside for a moment the extremely worrying fact that since that ruling was made, neuroscientists have come to believe that as many as 40 per cent of those in a vegetative state have been misdiagnosed and may have had some form of consciousness after all.

In other words, four in ten of those who have been killed in this way, with the backing of our courts, were not unaware or unconscious of their fate, but quite the opposite.

Let us focus instead on the impact of M’s case, specifically, for it has the potential to break dangerous new ground.

M’s family believe the artificial feeding, on which she is dependent, should be stopped, even though there appear to be signs that she is aware of her surroundings. Her minimally conscious state implies that she is, in all likelihood, more conscious than those diagnosed with PVS, more capable of thought and feeling.

That is why the Official Solicitor, responsible for representing M, and the NHS trust that runs M’s care home, oppose her relatives’ application. They say she smiles at jokes, and may even be capable of communicating with a switch.

Yet, her poor family say they have ‘come to the clear view that M would not wish to continue living in her current state and that it is not in her best interests to do so’.

Although I am compelled to fight for the rights of M, and others like her who have no voice, I do not underestimate the agony that her family have gone through in the years leading up to this week.

They have had to come to terms with the fact that M will never be the person she was. She is unlikely ever to recover. I do not see this family as villains but victims, caught up in the groundswell of opinion that says death is the best and kindest option for someone in M’s condition.

As a result, no doubt, they sincerely believe that if they ever found themselves in a hospital bed, wired up to life-support systems with little hope of recovery, death would be a blessed relief.

It is a brave decision that they have made, but I would beg them to reconsider. I would first ask them to give themselves another chance to love M in a different way. She has changed, as everyone does when life deals them a terrible blow. But she is still a person, and her dependence on others should not determine her right to live.

I would also ask them to consider how they came to feel so desperate that death became the best option. Have they been sufficiently supported through this terrible time? Has M received the best possible care and rehabilitation? Do they feel entirely satisfied that they understand her condition? And are they prepared to risk subjecting her to the kind of death that no one would choose for themselves?

I would ask them to think about how much they don’t know. Our understanding of consciousness, even in this day and age, is extremely limited — a fact that the best neurologists in the world would readily admit.

A diagnosis is only as good as the technology used to make it, and there is no doubt that we have a long way to go before it is possible to know for certain how much capacity a damaged brain has.

Martin Pistorius, the author of Ghost Boy, fell into what appeared to be a comatose state at the age of 12. It wasn’t until 12 years later that a carer intuitively became convinced that he was fully aware, despite showing no outward sign of it.

And it was only when he was given the opportunity to communicate, using a technology that recognised his virtually imperceptible head movements, that he was finally able to express himself. That’s when his parents realised that he had heard their debates over whether he should live or die. How relieved they must feel now that a decision was never reached.

Cases like his prove that a decision made now, without all the facts, could transpire to be the most tragic mistake.

I would also ask M’s family to look outside her hospital room, at the impact a decision like this would have on the rest of society. Even if M is not conscious, aware or likely to improve, I would beg them, please, to be aware of the consequences of ending her life. If they open this door — which would broaden the definition of those who could be lawfully killed in this way — all of us are at greater risk.

Should you or I fall ill tonight and find ourselves, as I once did, unable to speak or move or cry, the danger of someone making the decision to end our lives for us would be greater than ever before. For death has been given a facelift. We are encouraged to think of it as a gentle walk down a white corridor to a beautiful place. We hear talk of dignity in death, as if there were no dignity to be had in a life that is not the one of an able and productive person. And while the law seems willing to bend and flex to this point of view, who speaks for those who cannot speak for themselves? Who considers whether the ‘options’ of life or death look rather different from a patient’s point of view?

The Terry Pratchetts of this world may be convinced of their ‘right to die’, and they may shout it from the rooftops. But if, for instance, they insisted on exercising their right to die by driving at break-neck speed down a busy street, we’d rightly tell them that their right to die did not override others’ right to live.

I believe that every life that ends at Dignitas, and every dependent patient who is ‘allowed to die’ by (dehydration) starvation, erodes my right to live. It normalises this kind of death, and it sanitises what is an abhorrent practice. In order to label this practice as something other than what it is — killing — the law has been fudged and euphemisms applied.

Death through the withdrawal of food and water is not a gentle walk down a white corridor. It is, according to a doctor friend, about as painful and unpleasant an end as one can imagine. We would not subject an animal to it.

It is possible that many of those who have died this way have suffered extreme anxiety, burning sensations all over their bodies, and searing pain in their kidneys that even the strongest medication can do nothing to ease. And yet, this is the death that more and more believe is the ‘dignified’ way to go.

And what about those who are left behind? Do we really believe that gradual desensitisation to killing has no impact on the rest of society?

By creating a world in which death happens whenever it is deemed convenient, are we not gradually erasing what was once an important part of our life experience? The experience of death itself: the natural loss of our loved ones, no matter how long and difficult the journey to the end may be.

A good and dignified death is not determined by schedules, budgets or the patience of a third party, it is one that teaches us the most about the realities of love and life.

Nikki Kenward is a disability rights campaigner in the UK

Half of Dutch GP's feel pressured by relatives to euthanize a patient.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

An article in today's DutchNews.nl reports that nearly half of the GP's in the Netherlands have felt pressured by relatives to lethally inject a patient while 20% are willing to euthanize a person who is simply "Tired of Living."

The article states that according to a survey of 800 family doctors in the Netherlands for the television programme EénVandaag:

- 20% are willing to help a patient who is "tired of life."
- One third of doctors have refused to carry out a euthanasia request over the past five years.
- almost 75% said they were unwilling to carry out euthanasia on someone who is worried about unbearable suffering in the future.
- Just under 70% of the doctors polled said they had actually carried out euthanasia on a patient over the past five years.
- Around half of the GPs questioned said they had felt pressured by patients or their relatives to die by euthanasia.

It is important to note that the Dutch claim to have a strict euthanasia law, but the facts show otherwise.

In the Netherlands, euthanasia deaths increased by 13% in 2009, the most recent study shows that every year there are about 550 deaths without explicit request or consent and nearly 20% of all euthanasia deaths are not reported.

Another recent article explained how the euthanasia of people with dementia has now become accepted in the Netherlands

Now this poll has found that almost half of the Dutch GP's feel pressured from relatives to euthanize patients.

The concepts of safeguards, choice and autonomy are only really only the slogans that the euthanasia lobby use.

In reality safeguards are simply barriers to be overcome, choice is only for the few and when did autonomy have anything to do with the decision by a doctor to lethally inject their patient?

Disability Campaigners Stage Mock Execution Outside Parliament in Protest Against Euthanasia

On July 25, 2011; Peter Saunders, reported in his blog that disability rights campaigners were planning to stage a mock execution of a wheelchair outside of Parliament in the UK. He announced:

Disability rights campaigners dressed in white will stage a mock execution of a wheelchair user outside Parliament on Wednesday 27 July in protest against the dangerous drift toward all-out euthanasia.

The event, from 1pm in Old Palace Yard, will be led by Nikki Kenward of the campaign group Distant Voices, a woman who knows what it is like to be ‘locked in’ after contracting Guillian Barre Syndrome, a condition which left her totally paralysed for five months but the for ability to wink an eye. She has never regained the use of her legs.

The campaigners will wear surgical masks to signify the inability of many disabled or seriously-ill people to speak out for themselves and will process by drumbeat to a set of gallows where one wheelchair user will be doused in ‘blood’.

Mrs Kenward of Aston on Clun, Shropshire, is among those who fear that pressure is mounting on Parliament and in the courts to allow the killings of seriously sick, disabled or minimally conscious, but incapacitated patients.

She is particularly concerned about the plight of some 6,000 mentally-incapacitated patients in the British health care system.

A working party funded by the Royal College of Physicians is undertaking a review of their care which, according to the media, is likely to ‘lead to fundamental changes in medical practice’.

Professor Lynne Turner-Stokes, a brain injury expert at King’s College, London, and a member of the working party, has called for a ‘centrally-funded register of the large number of half-forgotten vegetative patients’. Prof Turner-Stokes told The Sunday Times: ‘We need to take a deep breath and consider whether doctors are striving to keep people alive in inappropriate circumstances.’

The demonstration outside Parliament also comes as the Court of Protection prepares to deliver its verdict on Case M, which involves an unprecedented application to starve and dehydrate a ‘minimally conscious’ brain-damaged woman to death even though she shows signs of awareness and can move her arm and put her tongue in and out.

Mrs Kenward said: ‘Everybody is going to get old, everybody is going to be disabled. If we don’t want to value difference what differences will be acceptable in the end? Very few.’

South Australian euthanasia bill and Nitschke focus on euthanasia for dementia.

Paul Russell published this article today in response to Philip Nitschke, Australia's Dr Death, focusing on the promotion of euthanasia for people with Alzheimers or dementia and in response to the euthanasia bill in South Australia that recently passed in the South Australian lower house. The article is titled: A terror management strategy for dementia.

Paul Russell's article stated:

When the headline act in the Nitschke travelling road show’s visit to Bendigo is titled, Voluntary euthanasia: Making choices in the context of Alzheimer’s and dementia, we need to ask some serious questions about what the real agenda might be and who gets hurt.

Why Alzheimer’s and why dementia? Simply because these particular conditions are among those that we who are “past our prime” as they say, fear the most. Don’t think for a minute that Nitschke has a particular heartfelt desire to help Alzheimer’s and dementia sufferers. He is a salesman and what he does is simply marketing. Focusing on our natural fears is about demographics: pitching to an audience who are most likely to buy what he has to sell.

Professor Johnstone from the Deakin University School of Nursing and Midwifery calls the promotion of euthanasia to Alzheimer’s and dementia sufferers a “terror management strategy”. She adds, “Especially when faced by the terrifying knowledge of their own inevitable future death and ‘lack of control’. That euthanasia achieves none of these things is not seen through the illusion.” Nitschke tries to increase the terror factor, but it is an illusion.

The euthanasia bill being debated in South Australia is full of such illusions. There are no real checks and balances here and a doctor need only claim after the fact (note: patient killed already) that he or she thought the patient to be of sound mind and that his or her action, to kill the patient, was reasonable in the circumstances. When is it reasonable for a doctor to give a patient a lethal injection? A doctor could collude with a relative; a doctor could act alone and without consent. No witnesses required. Did the patient consent? No one will ever know.

Why does he limit the lower age for attendance to 50-year-olds? Good corporate citizenship perhaps? Not likely. This is the same person, after all, who was comfortable promoting his Peaceful Pill for troubled teens, who called the death of a young Australian man who had followed his advice on how to kill himself “collateral damage”. I believe that the only reason you “young folks” under 50 aren’t allowed is that there would be a public outrage if teenagers turned up to his meetings. Nitschke would be run out of town like the snake oil salesmen of Wild West fame!

And what of our youth? What do we think happens in the minds of troubled teenagers when they hear the message that rings loud and clear in Nitschke’s sales pitch that some people are “better off dead”? In Oregon following the introduction of doctor-assisted suicide, suicide by other methods went up and not down as predicted. This is consistent with suicide contagion or clusters.

Think about it: if euthanasia and assisted suicide are legal do you really think that the excellent, but often expensive and sometimes time-consuming, treatments that are now available to us will stand as a genuine option if there’s a cheaper, easier solution? Sure, perhaps no one you know would be as callous to suggest to an ailing relative that they’d be better off dead, but subtly in those circumstances people may well come to feel it their duty to die. That was certainly the opinion of the UK’s Baroness Warnock when, a few years ago, she had the audacity to tell an assembly of elderly dementia sufferers that they were an unacceptable expense on the public purse and they had a “duty to die”. Euthanasia and assisted suicide limit choice, not Alzheimer’s or dementia.

Our elderly, frail and disabled deserve to know that they will always be cared for, not killed.

Paul Russell is director of Hope, a national network working against euthanasia and assisted suicide. Paul Russell is also the Vice-Chair of the Euthanasia Prevention Coalition International. This article originally appeared in the Bendigo Advertiser.

Legalizing assisted suicide is a mistake

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

I was cleaning up my emails and I came across this excellent letter to the editor that was written by Dr William Toffler from Portland Oregon and printed in the Vancouver Sun on July 4, 2011. The letter was in response to the argument by the BC Civil Liberties Association who are attempting to legalize euthanasia and assisted suicide in Canada via the Supreme Court.

The letter by Dr. Toffler states:

I am a doctor in Oregon where physician-assisted suicide is legal. In my practice, I have discussed assisted suicide with more than a dozen patients. One of the first was with a man in a wheelchair with a progressive form of multiple sclerosis who asked me for assistance with his suicide.

I told him that I could readily understand his fear and his frustration and even his belief that assisted suicide might be a good path for him.

At the same time, I told him that should he become sicker or weaker, I would work to give him the best care and support available.

I told him that no matter how debilitated he might become, that, at least to me, his life was, and would always be, inherently valuable. As such, I would not recommend, nor could I participate in his suicide.

He simply said: "Thank you."

How we respond to someone requesting suicide can either reflect the person's inherent worth or can cause the person even deeper desperation. Patients can even feel pressured to proceed.

Under our law, there is no assurance that the deaths are voluntary. Don't make our mistake.

Link to the article

Doctor William Toffler is Director of Pre-doctoral Education within the Department of Family Medicine at the Oregon Health and Science University.

Australia - Euthanasia lobby is attempting to legalize euthanasia on two fronts.

I just learned the euthanasia bill that is sponsored by Steph Key passed 2nd reading today in the South Australian lower house. This is shocking considering the wide-open language of the bill.

My analysis of the South Australian euthanasia bill from last March concluded that:

"The South Australian parliament needs to kill the bill. The bill gives physicians near absolute power to directly and intentionally cause the death of their patients. The bill steers people with disabilities and others who live with chronic conditions to euthanasia. These are the people who the current law protects from those who believe that the lives of some people are not worth living.

The bill must be seen for what it is. It is a law that is designed to impose death on the most vulnerable in society. The bill is not concerned with the veneer of choice or autonomy because it is designed to give the power over life and death to physicians. This bill will turn healers into killers and it will redefine the nature of medical care in South Australia. The bill is a travesty of justice."

Read my analysis of the South Australian bill.

The South Australian bill had significant momentum last March until Philip Nitschke, Australia's Dr. Death, announced that he was planning to open a euthanasia clinic in Adelaide South Australia to take advantage of the wide-open language of the Steph Key bill. Link to an article.

Today's vote came forward without the public being informed probably as another political manoeuvre as the South Australian politicians attempt to legalize euthanasia before their citizens know what happened.

Paul Russell, the director of HOPE in Australia, stated that this bill is being touted as an end-of-life decisions act and not a euthanasia bill. Russell stated:

"It is becoming increasingly clear that the bill is being touted by its supporters as simply a protection for doctors if they removed burdensome treatment or if they raised the pain medication to relieve suffering and the patient died a little earlier than expected as a result; what is commonly known as the double effect where the intention is to relieve pain and/or to provide comfort at the very end, which would not be euthanasia. In fact, it is already covered extensively and well under the Consent to treatment and Palliative Care Act 1995 in SA. ... In short, doctors already enjoy such protection. Some MPs simply don’t get the distinction."

Link to Paul Russell's blog comment.

After re-reading the South Australia bill I can assure you that it is a euthanasia bill.

At the same time the Australian federal parliament is facing a bill that is being sponsored by Greens leader Bob Brown, to give power to the Territories that would enable the Northern Territory to once again legalize euthanasia.

Australia's Northern Territory legalized euthanasia in 1995. The Australian federal government overturned that law in 1997. The bill that Bob Brown is proposing would allow the Northern Territory to legalize euthanasia once more.
Link to the information from HOPE.

Paul Russell gave a fabulous talk at the Third International Symposium on Euthanasia and Assisted Suicide concerning the victories that HOPE was able to achieve. Russell, who is the Vice Chair of the Euthanasia Prevention Coalition - International is facing the battle of his life if he is to maintain the legal protection for everyone in Australia from having euthanasia imposed on them.

Previous article by Paul Russel concerning the South Australian euthanasia debate.

Euthanasia and Assisted Suicide: What in the World is Going On?

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Euthanasia and assisted suicide are legal in a few jurisdictions in the world, but most countries have rejected their legalization.

Most recently, legislation to legalize euthanasia and/or assisted suicide has been rejected in France, Israel, England, Scotland, Australia, Canada, Bulgaria, etc. In the U.S., where there have been well over 100 legislative proposals to legalize physician-assisted suicide (PAS) since 1994, California, Hawaii, New Hampshire, Vermont, Connecticut, and more have recently rejected it. (1)

In the United States, assisted suicide was legalized by voter initiatives in Oregon in 1994 and Washington State in 2008. (2) A 2009 Montana Supreme Court ruling did not legalize assisted suicide but it did create a potential defense, based on consent of the patient, for physicians who are prosecuted for assisted suicide. In 2011, a bill to prohibit PAS and a bill to create regulations for PAS were both introduced in the MT legislature. Neither bill had enough votes for passage. (3)

In May 1995, Australia’s northern territory became the first jurisdiction in the world to legalize euthanasia. The law went into effect in June 1996 but was overturned by the Australian government in March 1997. (4)

The Netherlands officially legalized euthanasia and assisted suicide in April 2002. Previous to that, the Dutch Courts approved the practice of euthanasia and assisted suicide. Some people suggest that there are no problems with the Dutch euthanasia law, but in fact there is significant abuse and the slippery slope has been very steep. (5)

In the beginning, the Dutch euthanasia law applied only to people who were terminally ill and suffering uncontrolled pain. Now the law applies to people with physical and mental pain, people with chronic conditions, infants with disabilities (Groningen Protocol), people with dementia or Alzheimer’s, and the current push is to allow euthanasia for people who are 70 years old and “tired of living.” (6) The most recent Dutch government study found that every year there are approximately 550 intentionally caused deaths without request or consent and approximately 20% of euthanasia deaths are not reported. (7)

In Belgium, euthanasia was legalized in 2003. Recent studies have revealed significant abuses of euthanasia and signs that it is “out-of-control.” Independent studies, published in May 2010, looked at the practice of euthanasia in the Flanders region. They revealed that 32% of the euthanasia deaths in that region were done without request or consent (8) and that 45% of all euthanasia deaths done by nurses in Belgium are without request or consent. (9) Another highly disturbing study published in October 2010 found that nearly half of the euthanasia deaths in the Flanders region are not reported and that “controversial” euthanasia deaths are usually not reported. Under-reporting explains why the “official” Belgium government report suggests that few if any problems exist. (10)

When looking at the studies concerning euthanasia in the Netherlands and Belgium, one must conclude that choice and autonomy (self-determination) are only the sales slogans for gaining societal acceptance of euthanasia; that in fact euthanasia has become a way to eliminate human lives deemed, by others, to be not worth living. (11)

Much research proves a direct connection between depression and requests for euthanasia or assisted suicide. Published in 2005, a study by a Dutch doctor who supports euthanasia found that people who had cancer were 4.1 times more likely to request euthanasia if they were depressed or experiencing feelings of hopelessness. (12) A similar study in Oregon, published in 2008, found that 26% of the people who requested euthanasia were depressed or experiencing feelings of hopelessness. The Oregon PAS law has a “supposed” safeguard that requires physicians to refer for psychological assessment anyone who requests assisted suicide and has signs of depression. (13) Nevertheless, of 124 people who died by assisted suicide in Oregon (2009 and 2010), only one was sent for a psychiatric or psychological assessment. (14) Yes, depressed people in Oregon are dying by assisted suicide.

Then there is the growing scourge of elder abuse in our culture. Legalizing euthanasia or assisted suicide creates new paths of abuse. Elder abuse is rarely reported because it is most often perpetrated by a person upon whom the victim is dependent. In the same way, a vulnerable person who is experiencing abuse can be steered to suicide when the law allows doctors to prescribe death. (15)

The euthanasia lobby promotes death on demand based on choice and autonomy. (16) This is an illusion. The legalization of euthanasia and assisted suicide does not give you the “right to die.” It gives another person, usually a physician, the right to intentionally and directly cause your death.

The proper use of Palliative Sedation is not Euthanasia.

By Alex Schadenberg

Alex Schadenberg

Executive Director - Euthanasia Prevention Coalition

This article was published in its original format on July 20, 2011.

I have been wanting to learn more about palliative sedation since the Quebec College of Physicians and Surgeons (Quebec College) stated in February 2010, that Canada needs to legalize euthanasia because doctors are “doing it already.” The Quebec College stated that everyday people are sedated (palliative sedation) and everyday people are given large doses of analgesics, which the Quebec College stated was the same as euthanasia.
Link to an article on the position of the Quebec College of Physicians on Euthanasia:

Last week I attended a 4 day conference on palliative sedation. It was fascinating to learn important facts concerning palliative sedation techniques, and the current practice of sedation.

Euthanasia is an action or an omission of an action that directly and intentionally causes the death of a person to relieve suffering. If an action or omission of an action is not the direct and intentional cause of death, then it is not euthanasia. Euthanasia is a form of homicide and is prosecuted as homicide.

The Euthanasia Prevention Coalition (EPC) responded to the Quebec College by stating that the proper use of sedation techniques and the proper use of large doses of analgesics (pain killers) is not euthanasia. 

Since the proper use of sedation techniques and the proper use of large doses of analgesics is not euthanasia, therefore the Quebec College must be suggesting that everyday Quebec physicians abuse the proper use of palliative sedation and abuse the proper use of analgesics. If this is true, then how does the Quebec College expect that euthanasia, if legalized, would not be abused?

The proper use of palliative sedation

The Canadian Palliative Sedation Therapy Guideline working group was particularly bothered by the statement of Quebec College comparing palliative sedation to euthanasia. They stated:

“Palliative sedation therapy, correctly practiced, neither aims at death nor shortens life. Palliative sedation therapy is the use of a sedative medication to control severe and untreatable suffering at the end of life when other measures have been exhausted. It does not shorten life.”

Link to an article from the Palliative Sedation Therapy Guideline working group:

The Palliative Sedation Therapy Guideline working group is working on “national guidelines” to ensure the proper use of palliative sedation.

What constitutes an abuse of palliative sedation making it an act of euthanasia?

Palliative sedation is defined as: neither aiming at death nor shortening life. Euthanasia constitutes the direct and intentional cause of death, Sedation, when abused can be the direct and intentional cause of death of a person, therefore terminal sedation can be an act of euthanasia.

Euthanasia by dehydration or "slow euthanasia" occurs when deep continuous sedation is done to a person who is not otherwise death, combined with the withdrawal of hydration and nutrition, whereby the cause of death is dehydration. In this circumstance, the death was not caused by the medical condition but rather the intentional decision to dehydrate the person to death. This is often referred to as “slow euthanasia” because the death is intentionally caused by dehydration and yet it takes longer to complete the act of euthanasia than giving a person a lethal injection. People who question that this act is euthanasia need to consider that by employing deep continuous sedation the person has been denied the opportunity to take fluids naturally by mouth.

When a person, who is not otherwise dying, is deeply and continuously sedated and hydration and nutrition is withdrawn, that the outcome is clear. This person will die of dehydration.

When a person is terminally ill and actually nearing death, the withdrawal of hydration and nutrition is not euthanasia because the person will die of their medical condition.

In the Netherlands, the abuse of palliative sedation appears to be a common practice. The five year report from the Netherlands (2005), indicates that number of euthanasia deaths had declined, possibly due to: “the increased application of other end-of-life interventions, such as palliative sedation.” The report stated that deep continuous sedation represented approximately 8.2% of all deaths in the Netherlands. Recent reports have indicated that the use of deep continuous sedation is increasing. Link to the Netherlands study.

EPC welcomes the work of the Palliative Sedation Therapy Guideline working group and we encourage the proper use of palliative sedation. Many people have falsely stated that euthanasia needs to be legalized to relieve suffering. Traditional palliative care practices can effectively control more than 95% of pain symptoms. When the proper use of sedation is included in the palliative care arsenal it becomes possible to effectively control all pain and symptoms.

Some people state that the proper use of sedation will cause a person to sleep through their final days of life and they claim that this is no different than causing a persons death by euthanasia. This is false. 

The proper use of sedation is not the same as killing a person by lethal dose or injection.

Recommendations:

Sedation guidelines should encourage the use of light or moderate sedation and the practice of intermittent sedation. The proper use of sedation does not necessitate that the person be permanently sedated.

1. Before deep continuous sedation is done, the person must be actually dying. Since the practice of deep continuous sedation usually includes the withdrawal of hydration and nutrition, therefore the method cannot be done on a person who has a terminal or significant condition, but who is not otherwise dying.

2. The decision to withdraw hydration and nutrition must be separate from the decision to apply deep continuous sedation. Death by dehydration can be “slow euthanasia” especially since the person who has been sedated has been denied the opportunity to sip or request fluids. The intention of sedation must be to relieve suffering and not to cause death.

3. To ensure the proper use of sedation, palliative sedation must be considered a last resort. It is important that other techniques of controlling pain are given a reasonable chance of success before resorting to sedation.

4. The person must be experiencing refractory symptoms. It is not ethical to sedate a person who can have effective pain relief without losing consciousness. To deny a person consciousness also means that the person is denied the option of changing their mind, of saying goodbye to others, or even indicating that their pain has been relieved.

5. The intention of the palliative sedation therapy is centrally important. The intention must be to relieve the refractory symptom. There is a concern that sedation is being used for people who are experiencing existential pain that may be effectively treated without denying the person consciousness.

6. The use of sedation must be proportional to the symptoms that the person is experiencing. If a person can be comfortable after light sedation then it is an abuse of the use of sedation to immediately employ deep sedation. Once again, deep continuous sedation denies a person consciousness, which should be always seen as a serious decision.

EPC encourages the proper use of palliative care and we encourage the use of palliative sedation when it is necessary and not abused. Palliative care is the care of the “whole person.” EPC encourages the continued development of patient centered care.

More research needs to be done on the alleviation of refractory symptoms. We recognize the need for Compassionate Community Care models that are oriented to the psychological, social and spiritual needs of people who are nearing death based on a model of being with the other. Compassionate Community Care should be developed in every local community.

EPC recognizes that human suffering may cause people to request euthanasia or assisted suicide, but those requests are usually a “cry for help”. Society need to care for people, even when caring is difficult, and not kill the person who it is difficult to care for.

Bill to outlaw euthanasia by dehydration passed by Italy’s lower house

LifeSiteNews reported today that a bill to outlaw euthanasia by dehydration passed in the Italian lower house. The bill is based on the case of Eluana Englaro, like Terri Schiavo, Eluana died in February 2009. Hilary White reported:

This week, the lower house of the Italian legislature voted 278-205 to pass a bill that would exclude the possibility of starving and dehydrating vulnerable patients to death. The Advance Directives Bill opens with a specific prohibition of euthanasia or assisted suicide and requires that patients, who are not otherwise dying, not be denied food and hydration.

The bill, which has been high on the agenda of both anti- and pro-euthanasia campaigners for two years, is called in Italian, “Dichiarazione anticipata di trattamento” (Dat), or Anticipated Declarations of Treatment, also known as living wills.

The national debate in Italy over advance directives and euthanasia by omission follows the dehydration death of a young cognitively disabled woman, Eluana Englaro, in 2009. Despite the law against euthanasia, Eluana’s father, Beppino Englaro, fought for ten years through the courts to have his daughter killed by dehydration.

The case caused a national uproar when the Court of Cassation, Italy’s highest constitutional court, in November 2008 ruled that Eluana could be moved by her father’s order to a nursing home that would be willing to remove her food and hydration to cause her death. Despite the fact that Eluana was not terminally ill, this was routinely described in Italy’s national newspapers as “allowing her to die naturally.”

Since his daughter’s death, Beppino Englaro has used his notoriety to engage in a campaign to legalize euthanasia by dehydration.

Undersecretary of Health, Eugenia Roccella, announced this week that the final vote on the advance directives bill will follow third reading in the Senate, which will likely happen in October. Roccella said, “I think it is a good law and can withstand the attacks of propaganda.”

Under current Italian law, patients can refuse medical treatment even in cases where refusal could tend to shorten their lives. However, nowhere is the artificial provision of food and hydration defined either as “medical treatment” that can be withdrawn, or as a necessity of life – a legal void that euthanasia activists have been attempting to exploit. Should the bill pass, it would specifically close that loophole, which enabled the court decision that led to the death of Eluana Englaro.

The only exception the bill allows to the hydration rule is when a patient, in the extreme “terminal” stages of illness, is no longer capable of assimilating food or water. The bill also retains the right of patients to refuse extraordinary or extreme and aggressive measures of a “disproportionate or experimental nature.”

The bill establishes the principle of a “therapeutic alliance” between doctor and patient in the end stages of life. In its passage through parliament, deputies added the right for terminally ill patients or those whose death is imminent to be assisted with adequate pain management in accordance with the protocols of care.

The legislation “recognizes and protects human life as inviolable” and guarantees the right to life “in the terminal phase of life and in the event that the person is no longer capable of understanding and will, until his death ascertained.” Under the proposed law, the doctor is also obliged to inform the patient on the prohibition of euthanasia.

“Advance directives,” also called a living will or personal directive, are instructions specifying what actions should or should not be taken in the event a person is no longer capable of making decisions due to illness or incapacity. They have been widely used by the euthanasia lobby around the world as a foot-in-the-door to introduce legalized active euthanasia or euthanasia by omission.

In many countries, including Canada and Britain, provision of food and hydration is specifically defined as “medical treatment.” In the UK, advance directive laws allow, and in some cases even mandate doctors to withdraw hydration to patients whose potential “quality of life” is judged to render such treatment “futile.” A recent UK government directive made it illegal for doctors to refuse to dehydrate patients to death if the patients or their legal guardians request it.

It is interesting that today I have commented on the practise of dehydrating to death people who are supposedly living in a Persistent Vegetative State and two days ago I wrote about the success of therapies that are allowing people who are supposedly living in a Persistent Vegetative State to recover.

The tragic reality of euthanasia

Today, an article was published in the National Post that was written by Derek Meidema, a researcher in Ottawa Ontario, under the title: The tragic reality of euthanasia. Meidema's article follows:

The tragic reality of euthanasia

Over the past few months, a Quebec government commission has been studying euthanasia and assisted suicide. At the end of June, its members flew to Europe to examine the issue in countries where the practices are legal (such as the Netherlands and Belgium) and in a country that rejected legalized euthanasia (France).

What is the commission likely to hear? Proponents of euthanasia will undoubtedly stress that the practice is conducted only within tight guidelines. As a recent study by a Canadian doctor shows, however, these guidelines keep shifting and are of little value in protecting the rights of patients. In fact, according to an article published in Current Oncology by Dr. José Pereira, medical chief of palliative care at Bruyère Continuing Care in Ottawa, safeguards are routinely ignored and abused.

Dr. Pereira addresses the safeguards one by one. In the Netherlands, where assisted suicide and euthanasia became legal in 2002, the law states that individuals must give written consent that they want to die. In spite of this, a 2005 study of deaths by euthanasia in the Netherlands found that almost 500 people are killed annually without their consent.

Belgium has the same safeguard. Nonetheless, a 2010 study found that in the Flemish part of the country, 32% of euthanasia cases were carried out without request or consent. Some were cases where a person couldn't give consent due to their medical condition. Others were cases where a person could have given consent but didn't. In the latter cases, doctors proceeded with euthanasia because they felt it was in the best interest of the patient, or because they thought discussing it would be too harmful to the patient.

Another suggested safeguard is mandatory reporting: All cases of euthanasia must be reported to the proper authorities so that they can ensure the other safeguards are being followed. This safeguard is weak from the start. Why would a doctor abusing patients report his abuse to the authorities? Nonetheless, the Netherlands and Belgium maintain this requirement. In Belgium, nearly half of all estimated cases aren't reported. In the Netherlands, at least 20% of all cases aren't reported.

The third safeguard is the guarantee that assisted suicide or euthanasia be carried out only by doctors. Yet a 2010 study of 120 Belgian nurses found that they administered life-ending drugs in 45% of assisted suicide cases without the patient's consent.

The fourth safeguard is a second opinion: If a doctor approves you for assisted suicide or euthanasia, you must obtain the go-ahead from another physician. This safeguard is easily circumvented. In Oregon, for example, public reports show that a physician tied to a pro-assisted suicide lobby group provided consultations in 58 of 61 cases of assisted suicide in Oregon. It appears that if you can't find a second doctor to approve your request, a lobby group will gladly provide one.

History shows that when it comes to euthanasia, safeguards, however well intentioned, do not work. Once the law defines assisted suicide and/or euthanasia as a personal right, there is always a push for the law to expand its ambit.

In the Netherlands, for example, the initial reason for legalizing euthanasia was as a last resort for adults with terminal illness facing intolerable suffering. Today, there exist medical circumstances in which newborn infants can be killed. There's even a group in the Netherlands called "Out of Free Will" who ran a successful campaign that had the Dutch parliament debating a measure allowing anyone over 70 who is merely tired of life to die by euthanasia.

The idea of safeguards sounds comforting, but it's important to know that the globe over, they have not worked to protect patients. Let's hope the Quebec delegation travelling in Europe this summer gains a robust understanding of the issue. One thing's certain: They won't hear from those who died when safeguards were abused and ignored.

Rediscovering consciousness in PVS patients

The recent edition of Discover Magazine is reporting on new research that is showing that the human brain can regenerate after traumatic injury and it is proving that certain types of stimuli has had some success at restoring consciousness for people who are thought to be in a Permanent Vegetative State (PVS).

Before explaining some of the findings in the article I question why this news is being reported as new or revolutionary. In 2004, I attended a conference in Europe on Persistent Vegetative State. At that conference there were two presentations on the success of "Awakening Centers" in Europe.

Awakening Centers didn't use electrical impulses, such as those being used by the team at Cornell Medical Center, but rather they focused on physical stimuli. The Awakening Centers would physically stimulate all the parts of the human body by simulating crawling or simulating walking as well as they would have physiotherapists stimulate all the main muscles of the body. These Awakening Centers had significant success with people who were abandoned as PVS patients.

I also question why there are no Awakening Centers in North America and there has been no information reported about the success of the Awakening Centers in Europe.

The article in Discover Magazine explains the success that Dr Giacino is having by using electrical stimulation on people who are diagnosed as PVS. The success of this work is turning our understanding of PVS up-side-down.

The article states:

The old verdict was harsh but clear-cut: Mourn your loved one, because he or she is gone.

“These are human beings who seem to have lost their humanity,” Giacino says. “The question is, is that really the case?”

The article describes the case of a man who was beat up and had been beat-up and was believed to be in a PVS state. After stimulation was applied to the brain the article stated:

As soon as the researchers switched the stimulator on, the man’s eyes opened. The doctors were not yet sure that it worked; they waited two months for the patient to completely heal from surgery before beginning their cognitive tests. The real moment of drama came during one of those first sessions, when the patient had the electrodes fully switched on for several hours. Schiff and Giacino showed him a picture of a red Radio Flyer, and before Schiff even remembered what the toy was called, the patient said, “Wagon.”

As months passed his repertoire increased; with the stimulator switched on, he could swallow, hold a cup, name objects, speak short sentences, and smile. The real impact of the stimulation is best described by his mother, who had been told the night of his beating that he would never be more than a vegetable. “My son can now eat, speak, and watch a movie without falling asleep,” she said through tears at a press conference announcing the results of the study. “He can express pain. He can cry and he can laugh. The most important part is, he can say ‘Mommy’ and ‘Pa.’ He can say, ‘I love you, Mommy.’ ”

Research concerning the rediscovering of consciousness is important because today we warehouse people in care homes who are determined to be in PVS or we abandon them to death by dehydration. They are treated as non-humans or the living dead.

The case of Terri Schiavo was even refered to in the article which stated:

In 2005, just as the deep brain stimulation patient was making his first forays into awareness, the fate of Terri Schiavo, a Florida woman who had been in a vegetative state since 1990, sparked an ideological war. Her husband wanted her feeding tube removed, ... her parents disagreed. Eventually, everyone from the governor of Florida to the U.S. Congress took sides. The arguments hinged on different impressions of how much awareness Schiavo still retained. A clip of Schiavo smiling was shown over and over again on TV. Senate majority leader Bill Frist (a heart surgeon) insisted that the video meant she was still conscious. ... Eventually her feeding tube was removed and she died

The future holds much hope for people who are declared to be PVS. The article refers to one successful case that appeared from the outset to be impossible. The article stated:

One of the Schiff group’s recent subjects was 23 years old when he sustained a severe head injury in a car crash. CT scans showed that his brain was ravaged, with a huge shadow of fluid where neural flesh should be. He spent three months in a vegetative state. A year after the accident, a physical therapist realized the patient could voluntarily move his head. The therapist trained him to use a letter board, in which a helper points to letters until the patient reacts, spelling out a message one letter at a time. His IQ turned out to be normal, and apparently his personality survived too; after several hours of being queried and quizzed by Schiff’s team, he used the board to spell G-E-T O-U-T.

Schiff’s team helped him acquire a head mouse, which allows him to use a computer by moving his head to control the cursor. He slowly continued to improve. Last winter, this man—who not long ago might have been abandoned as hopeless—sent Schiff’s group an e-mail. "Hi," it said; "I’m doing well." It was a telegram from a future world.

There is hope that many more people will soon be able to be brought out of coma to once again be treated as a human being and not as the living dead.

The Euthanasia Lobby is trying legalize euthanasia and assisted suicide in Canada through the courts.

The Euthanasia lobby has turned its attention to trying to legalize euthanasia and assisted suicide in Canada through the courts. Last April (2010), Bill C-384, sponsored by Francine Lalonde (BQ), that would have legalized euthanasia and assisted suicide in Canada, was defeated by 228 to 59 in parliament. The resounding defeat for the euthanasia lobby indicated that it was unlikely, anytime soon, that doctors would gain the right to cause the death of their patients through democratic means.

Several cases that have been launched in British Columbia with the intent of striking down the laws that protect vulnerable people from euthanasia and assisted suicide by having those laws declared unconstitutional.

The Farewell Foundation:
In February 2011, the Farewell Foundation of BC applied for incorporation status as a group that would assist the suicides of its members. The Farewell Foundation was formed as a corporation based on the principles of the Dignitas suicide center in Switzerland.

The Farewell Foundation considers the assisted suicide act in Canada to be unconstitutional.

The Registrar of Companies rejected the Farewell Foundation’s application for incorporation based on the fact that they existed for the purpose of breaking the law.

On April 8, 2011, the Farewell Foundation challenged the rejection of incorporation status and suggested that the assisted suicide law (Section 241b of the criminal code) is unconstitutional and therefore is not binding on the Registrar of Companies.

The BC Civil Liberties Association (BCCLA):
The BCCLA launched the Carter case on April 26, 2011 to strike down, as unconstitutional, Canada’s criminal code provisions that protect people, at the most vulnerable time of their life, from euthanasia and assisted suicide.

The Carter case focused the family of Kay Carter who accompanied her when she died by assisted suicide at the Dignitas suicide center in Switzerland.

The claim stated that Kay Carter’s rights were violated by an unconstitutional law that prevented her from dying by euthanasia or assisted suicide in Canada.

The claim also stated that Lee Carter (daughter) and Hollis Johnson (son-in-law) claim to have broken the law by aiding their mother by planning and possibly encouraging her to go to the Dignitas suicide center in Switzerland. Lee & Hollis are challenging the constitutionality of Canada’s laws that prevent euthanasia and assisted suicide because they could potentially be prosecuted under those laws.

The Carter case clearly intends to legalize euthanasia and assisted suicide in Canada by challenging the constitutionality of Sections 14, 21, 22, 222, 241 of the criminal code.

Section 222 is the homicide provision in the criminal code. Euthanasia is a form of homicide because it is the act of actually causing the death of another person. It is very concerning when anyone challenges provisions of the homicide Act.

Section 241 is the assisted suicide Act in the criminal code. Assisted Suicide means to aid, abet (encourage) or counsel another person to commit suicide.

After several case management meetings where the Attorney General considered the Farewell Foundation case and the Carter case to be the same legal issue, where standing for the BCCLA and the Farewell Foundation were questioned and where it was suggested that the case lacked urgency. The BCCLA went back to the drawing board and amended their case.

On June 28, 2011; the BCCLA launched an amendment to the Carter case by adding Gloria Taylor (63) to the statement of claim. Taylor, who lives with ALS, claims that she would like to die by euthanasia or assisted suicide and the laws that prevent someone else from causing or aiding her death by euthanasia or assisted suicide are unconstitutional.

Taylor’s condition, as stated by the BCCLA, creates a greater level of urgency for the case because she may be entering the terminal phase of her condition.

The amendment to the case also asks the court to grant an exemption for Taylor and her doctor so that she can be killed by euthanasia or have her suicide assisted in a manner approved by the court.

To create even greater urgency to the case, the BCCLA has requested that if the court is not able to come to decision in a timely manner or grant Taylor an exemption to the law, that the court must pay all costs related to the case and the required care for Taylor.

From this point forward we will refer to the case as the Carter case.

The Carter case, if successful, would give doctors the right to directly and intentionally cause the death of another person by lethal injection and it would give doctors the right to prescribe lethal doses to their patients, knowing that their patient intends to commit suicide.

It is sad how this case uses the stories of people with chronic degenerative conditions and disabilities to remove protections in law that exist for vulnerable Canadians. People with disabilities are more likely to be steered toward assisted suicide or euthanasia.

Disability activist, Mark Pickup, (picture) from Alberta stated to EPC:

"the newspaper described Kay Carter (89) as a Right to die proponent. She developed spinal stenosis in 2008 which causes "pain, lack of coordination, numbness, loss of bladder and bowel control and paralysis." That was enough reason to overturn laws against assisted suicide? I disagree. I've had those very same symptoms (and many others) throughout my 27 year journey with multiple sclerosis. I want our laws prohibiting assisted suicide to stay in effect and enforced, in case I despair and happen to meet someone like Kay's daughter and son-in-law who agrees with killing me."

The BCCLA emphasizes in their statement that euthanasia and assisted suicide would be limited to people who have voluntarily requested and consented to be killed.

Only parliament is able to devise rules to ensure that “safeguards” will be upheld in Canada. Where euthanasia and assisted suicide has been legalized in other jurisdictions safeguards have failed to protect people who did not consent or qualify for death by lethal injection.

When euthanasia was legalized in the Netherlands it was limited to people who were terminally ill and experiencing uncontrolled suffering. The most recent Euthanasia report includes as a category the deaths of people with dementia or Alzheimer disease. The Groningen Protocol was instituted in the Netherlands several years ago permitting death by lethal injection for infants with disabilities. It is estimated that 550 deaths occur each year in the Netherlands without request or consent and it is also estimated that 20% of all euthanasia deaths go unreported.

Recent studies concerning the practice of euthanasia in Belgium, where euthanasia became legal in 2003, shows that 32% of euthanasia deaths are done without request or consent and 47% of euthanasia deaths go unreported.

The safeguards in the State of Oregon that are promoted by the euthanasia lobby as being full-proof are illusory at best.
• The Oregon law does not require a witness at the time of death and the physician who prescribes the lethal dose is only present at the death about 20% of the time. If a person changes their mind or if the lethal dose is administered without consent, who would know?
• The Oregon statistics are invalid because the report comes from the physician who prescribes the lethal dose. The physician will not self-report abuse. The forms are submitted after the death. The information concerning the death is anecdotal at best because the physician is rarely present at the death.

The Euthanasia lobby insists that in Oregon, a physician only prescribes suicide based on the free choice of the patient.

Barbara Wagner and Randy Stroup, who had different forms of cancer, were offered assisted suicide by the Oregon Health Plan but denied treatment. We don’t want Canada’s universal health plan to steer people to suicide by offering assisted suicide or euthanasia as a “plan of treatment” to patients who are denied treatment.

When considering the scourge of elder abuse in Canada, the BCCLA should not be so sure that people will not be steered into an unwanted or unsuspecting death. Canadian statistics show that elder abuse is a growing problem with approximately 70% of all abuse being carried out by friends or family members. Elder abuse is often not reported because the victim is usually dependent on the abuser or believes that they have, in some way, caused the abuse or fear that, if reported, the abuse will become worse.

Elder abuse is often experienced as financial, psychological or physical abuse, but there have been cases of homicide. The Oregon assisted suicide statistics are consistent with the demographic that are most likely victims of elder abuse.

To give the power over life and death to another person, even a doctor, such as a law that legalizes euthanasia and assisted suicide, can be used by unscrupulous family members and medical care-givers as the ultimate form of elder abuse or to eliminate problem patients.

The Carter/Taylor factum states that a person who is “grievously and irremediably ill” only limited by the capacity to consent would be eligible to die by lethal dose.

The term, irremediably ill is not limited to a person with a terminal illness. This definition would include anyone with a terminal condition. Having a terminal condition does not make you terminally ill.

A person who has diabetes and is insulin dependent may qualify as irremediably ill.

Grievously ill would include most types of disability or chronic conditions. I have a friend with MS who is not terminally ill. He is very productive, but given different circumstances he could easily be considered grievously ill. I have another friend who has brain cancer, but is now in remission. He is well aware that the cancer is likely to return.

Another friend broke his back in two places 25 years ago in a vehicle accident. He lives with chronic pain, but he is not terminally ill. He has difficulty dealing with his pain when he is alone and feeling abandoned by the world. He is grievously ill and would be a candidate for euthanasia, especially when he is going through a difficult period.

The laws that prevent euthanasia and assisted suicide are designed to protect a person at the most vulnerable time of life. Society is already experiencing many pressures to control the cost of health care and people with disabilities and those with chronic conditions are already being made to feel like they are a burden on society.

Legalizing euthanasia and assisted suicide, for any circumstance, does not grant new rights to the individual but rather it provides doctors with the right to directly and intentionally end your life and it removes the protections that exist in law for people at the most vulnerable time of their life.