Tuesday, July 31, 2012

Assisted Suicide - US Overview.

Margaret Dore

There are two states where physician-assisted suicide is legal: Oregon and Washington. In these states, statutes give criminal and civil immunity to doctors and others, including family members, who participate in a patient's suicide under certain conditions. Oregon's act was enacted via a ballot initiative in 1997. Washington's act was enacted via a ballot initiative in 2008 and went into effect in 2009.

No such law has made it through the scrutiny of a legislature despite more than 100 attempts.

The Oregon and Washington assisted-suicide acts are similar. They apply to "terminal" patients, defined in terms of having less than six months to live. Such persons are not necessarily dying. Consider, for example, Jeanette Hall, now alive 12 years after her terminal diagnosis. More recent proposals to legalize assisted suicide have included people who are clearly not dying. Click  here, here and here.  

In MontanaBaxter v. State gives doctors who assist a patient's suicide a potential defense to prosecution for homicide. Baxter does not legalize assisted suicide by giving doctors or anyone else immunity from criminal and civil liability although proponents argue that this is the case. Click here and here

In Montana, the leading group against assisted suicide is Montanans Against Assisted Suicide & For Living with Dignity.

On July 17, 2012, the Minnesota Court of Appeals upheld its law criminalizing assisted suicide as constitutional. To view the court's opinion, click here.

In 2012, Georgia and Louisiana strengthened their laws against assisted suicide. To see Georgia's new statute, click here. To learn more about Louisiana's statute, click here and here.  

In July 2011, Idaho enacted a statute strengthening its law against assisted suicide. For more information, click here.

In 2011, bills to legalize physician-assisted suicide were defeated in Montana, Hawaii and New Hampshire. In Vermont, identical legalization bills were introduced in the House and Senate, but not put on for vote before the legislative session ended. In 2012, these same bills died in committee. For more information see Vermont Against Assisted Suicide.

In Hawaii, where a bill to legalize assisted suicide was defeated in 2011 as well as in prior years, proponents claimed that assisted suicide was legal due to a 1909 statute. On December 8, 2011, the Attorney General of Hawaii  rejected this claim via a formal legal opinion. See also Hawaii Against Assisted Suicide & For Living with Dignity.

In Connecticut, a lawsuit to legalize physician-assisted suicide was dismissed in 2010. There is now a similar lawsuit pending in New Mexico.

In Massachusetts, there is a pending ballot initiative to enact an Oregon/ Washington style act that applys to "terminal" patients defined as predicted to have less than six months to live. For more information, see Mass Against Assisted Suicide.

Utah has also been targeted by assisted-suicide/euthanasia proponents. See Utah Against Assisted Suicide: "Choice" is an Illusion.

Monday, July 30, 2012

Don't make Oregon's Mistake: Assisted suicide should not be legal.

The following letter was written by Jeanette Hall from Oregon and printed in the Ottawa Citizen on July 24 2012 in response to the following article: Does the renewed debate on doctor-assisted suicide say anything about the sanctity of life in modern times? July 21.
I live in Oregon where assisted suicide is legal. In 2000, I was diagnosed with cancer and told I had six months to a year to live. I knew that our law had passed. Indeed, I had voted for it. But I didn't know exactly how to go about doing it. I tried to ask my doctor, but he didn't really answer me. In hindsight, I can see that he was stalling me. 
On my third visit, he asked me how my son would feel if I went forward with my plan. I didn't know what to say. I agreed to be treated. I had both chemotherapy and radiation. I am so happy to be alive. 
It is now 12 years later. If my doctor had believed in assisted suicide, I would be dead. I thank him and all my doctors for helping me choose "life with dignity." Assisted suicide should not be legal. Don't make Oregon's mistake. 
Jeanette Hall, King City, Oregon

Hope for Lilliana - Lilliana lives with Trisomy 18. She is not "Incompatible with Life"

Lilliana on her first birthday.
Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The most recent edition of the show Facing Life Head-On - entitled Hope for Lilliana, focuses on the life of Lilliana Dennis, a one-year old child with Trisomy 18 who is living a miraculous life.

Children with Trisomy 18 are often considered "Incompatible with Life" and therefore denied medical treatment. Parents are usually discouraged from treating children with Trisomy 18 and most of these children do not live beyond their first year of life.

Lilliana is proving that Trisomy 18 is not a death sentence, and with the proper care children with Trisomy 13/18 can thrive and live a happy life. Link to the program.

A recent study published in the current edition of the Journal Paediatrics questioned parents who have children with Trisomy 13/18. The study confirmed that the parents of children with Trisomy 13/18 considered their child to be happy and found that their lives were enriched by their child.

Link to a recent article about the Journal Paediatrics study.

The research team invited 503 parents of children who had a Trisomy 13/18 child to participate in the study. 87% of the parents responded and 332 parents (67%) of 272 children completed the questionnaire.

The parents indicated that their physicians stated to them that:
* 87% their child was incompatible with life,
* 57% their child would live a life of suffering,
* 50% their child would be a vegetable,
* 23% their child would ruin their family.
On the positive side, 60% were told by their medical provider that their child would have a short, but meaningful life.
Barbara Farlow with daughter Annie.
* 30% of the parents had requested a plan of treatment based on "full intervention."
* 79% of the children who received "full intervention" were alive at the time the questionnaire was sent. Those children were a median age of four years old.
* The survival rates for children with "full Trisomy" 13/18 was 40% lived for at least 1 year while 21% lived to at least age 5.
Half of the parents reported that caring for a child with a disability was harder than they thought it would be and yet 97% of the parents described their child as a happy child and most of the parents indicated that caring for their child had enriched their lives.

Last May, I came across the story of Lilliana Dennis. Lilliana Dennis is proving that Trisomy 13/18 is not a death sentence.  

Link to my first article about Lilliana Dennis.

Link to the Facing Life Head-On episode - Hope for Lilliana.

Link to a recent article about the Journal Paediatrics study.

Thursday, July 26, 2012

Netherlands 2010 euthanasia report - A further analysis.

By Alex Schadenberg

On July 11, the Lancet published the long-awaited 2010 euthanasia statistics based on a meta-analysis by a group of researchers.

I responded to the report by publishing an article titled: Lancet study proves significant increase in euthanasia deaths in the Netherlands.

Most of the media reported that the 2010 euthanasia statistics in the Netherlands are similar to the euthanasia numbers from 2001, before legalization which was based on the following conclusion in the study:
"8 years after the enactment of the Dutch euthanasia law, the incidence of euthanasia and physician-assisted suicide is comparable with that in the period before the law."
Is this a true statement?

Historical facts:
Euthanasia in the Netherlands was originally legalized through court decisions. In 1984, the Supreme Court in the Netherlands established a set-of-criteria that should be followed for a physician to cause the death of a person by euthanasia or assisted suicide without fear of prosecution.

From 1984 to 2002 a series of court decisions in the Netherlands led to a widening application of euthanasia. The courts allowed euthanasia for people living chronic depression (mental pain), to children who were born with disabilities, and other vulnerable groups.

In 2001, the Netherlands parliament official legalized euthanasia along the guidelines that were approved by the successive court decisions. The law officially came into effect in April 2002. Therefore euthanasia and assisted suicide were common before being legalized in the Netherlands.

The 2001 report:
The 2001 report determined that there were approximately 3800 (2.6% of all deaths) deaths by euthanasia with only 2054 of those deaths being reported. This means that only 54% of all euthanasia deaths were reported. The 2001 euthanasia report was the final meta-analysis of the practice of euthanasia and assisted suicide before it was actually legalized in 2002.

Media reports concerning the 2010 report:
The media reports focused on the 2010 euthanasia report stating that 4051 deaths by euthanasia and assisted suicide occurred in 2010 stating that since euthanasia was legalized in the Netherlands in 2002, that there has only been a minor rate of increase in deaths by euthanasia and assisted suicide. 

Are the media reports true?
1. The 2010 euthanasia report made an error in its mathematical calculation. 
There were 136,058 deaths in the Netherlands in 2010 with 4051 being caused by euthanasia and assisted suicide (3859 euthanasia deaths, 192 assisted suicide deaths). That represents 2.98% of all deaths.

2. The 2010 report indicates a continued trend to the use of deep-continuous sedation, also known as terminal sedation, over euthanasia and assisted suicide. 

Deep-continuous sedation is done by sedating the person and usually withdrawing fluids and food. When the person is not otherwise dying, death will often be caused by intentional dehydration, which is also known as "slow euthanasia.

Deep-continuous sedation must be differentiated from palliative sedation, which is a practice of sedating a person who is experiencing intractable pain or uncontrolled distress. Palliative sedation is proportionate to the need to relieve the distress of the person with the intention allowing a natural death to occur.

The 2001 Netherlands euthanasia report indicates that approximately 5.6% of all deaths were related to deep-continuous sedation. The 2005 euthanasia report indicates that approximately 8.2% of all deaths in the were related to deep-continuous sedation. The 2010 euthanasia report indicates that approximately 12.3% of all deaths are related to deep-continuous sedation.

The rate of deep-continuous sedation has more than doubled in the Netherlands since 2001 and has risen by 50% since 2005. How often are deaths by deep-continuous sedation done to intentionally cause the death of a person who was not otherwise dying?

Further to that, the rate of increase of reported euthanasia deaths has accelerated over the past few years with a 19% increase in 2010 and 13% increase in 2009.

The facts:
* After the legalization of euthanasia in 2002, there was an evident shift from death by euthanasia to death by deep-continuous sedation, also known as terminal sedation. 
* The use of deep-continuous sedation has in fact accelerated while the trend towards fewer deaths by lethal injection has reversed whereby the number of euthanasia deaths is greater than the 2001 statistic even thought the number of deaths by deep-continuous sedation has more than doubled in that time.

Euthanasia in the Netherlands:
The rate of euthanasia in the Netherlands has increased by 73% in the last 8 years (1815 reported deaths in 2003, 3136 reported deaths in 2010) and even more important, the rate of euthanasia has increased by almost 35% in the past two years (2331 reported deaths in 2008, 3136 reported deaths in 2010).

Combined with the growth in the use of terminal sedation for people who are not otherwise dying “slow euthanasia” and the slight increase in the number of unreported euthanasia deaths, one must conclude that there are abuses occurring in the Netherlands.

On March 1, a euthanasia clinic in the Netherlands launched six mobile euthanasia teams in the Netherlands. The NVVE euthanasia lobby in the Netherlands announced that they anticipate that the mobile euthanasia teams would complete 1000 euthanasia deaths per year.

The mobile euthanasia teams plan to fill unmet demand for euthanasia for people with chronic depression (mental pain), people with disabilities, people with dementia/Alzheimer, loneliness, and those whose request for euthanasia is declined by their physician. In 2010 45% of all euthanasia requests resulted in death by euthanasia.

Legalizing euthanasia and assisted suicide is not safe and the safeguards that are devised to control euthanasia do not protect the dying, but rather they protect the doctor.

Finally: Have you ever wondered why there are no prosecutions for deaths without request or consent in the Netherlands?

Wednesday, July 25, 2012

Hospital threatens to ban wife unless she agrees with doctors

Seniors at risk published the following article on July 24 concerning the case of Marilyn Nelson, who is being treated like a criminal or potential threat for her attempts to care for her husband, Arthur Hippe.
Hospital "commissars" threaten to ban wife unless she agrees with doctors.
Seniorsatrisk.org - June 24, 2012
Marilyn Nelson
Another story of abuse by health care providers. Seniors at Risk has been working with this Ontario family for the past month, after it was brought to our attention by one of our website readers.
Marilyn Nelson and her spouse Arthur Hippe, both in their sixties, have shared the last 26 years together. Today though, the loving couple is prevented from seeing one another, except for two hours a day in a Toronto-area hospital, where they are not permitted a single moment of privacy.
Arthur Hippe suffered a stroke in late May 2010 and was admitted to Ajax Pickering Hospital east of Toronto. He is paralyzed on his left side and his speech has been affected. He remains in the same hospital today, apparently having received no post-stroke treatment or rehabilitation.
Arthur granted Marilyn his Power of Attorney for Personal Care on May 12, 2009, giving her the legal authority to make all his medical care consent decisions. However from the very beginning, the hospital disregarded Marilyn’s legal authority, refused to provide her with Arthur’s medical records, and made continual efforts to thwart her in making care consent decisions on Arthur’s behalf. Marilyn has asked on several occasions that Arthur be moved to a rehab or residential care facility, but the hospital continues to claim that there are no beds available.
Ajax Pickering Hospital is one of two hospitals operated by the Rouge Valley Health System, led by CEO Rik Ganderton (previously an executive with IBM Canada). The hospital’s motto is “Patients First!”
One day, Marilyn came to visit Arthur and saw that he was staring vacantly, a marked difference. She asked hospital staff if he was on any new medications and was told he was on Zyprexa.
Marilyn Nelson researched the drug and found, to her horror, that, in addition to numerous toxic side effects, Zyprexa and other antipsychotic drugs are well-known to increase the risk of strokes (cerebrovascular events). Asserting her legal right to provide consent (or not), she instructed the hospital physician treating Arthur, Dr. Carman Price, to take Arthur off Zyprexa. That’s when the relationship with the hospital escalated further into bewildering hostility, says Marilyn.

One of us has to go, and it’s going to be you!

Dr. Price did not agree with Marilyn that Zyprexa and other antipsychotic drugs were harmful to Arthur, and in a meeting with Dr. Price and other hospital personnel, Marilyn says Price told her “One of us has to go, and it’s going to be you!”
So, what’s going on, you ask? How is it that a hospital and doctors can ignore a legal document stipulating that another person has full authority and responsibility to make medical care consent decisions?
As Seniors at Risk has reported in other cases, the powers of attorney, representation agreements and other legal documents that we are all urged to have in place, appear to be worth less than the paper they are written on.
Health care facility administrators, doctors and public agencies routinely ignore these legal documents or maliciously attempt to intimidate or discredit the individuals who have the legal authority to make decisions on behalf of their loved ones. Instead, doctors and health care facilities impose their own views about what treatment and care your loved one should receive. The unaccountable power of health care facilities to bully, threaten and ignore the directives of substitute decision makers, without any consequences, is too often reinforced by banning from the premises anyone who attempts to intervene to protect and care for their loved one.

Another case of banning by health care facility autocrats

Marilyn Nelson is concerned that her husband Arthur is not being cared for properly at Ajax Pickering Hospital. In December 2011, banned from the hospital under allegations by the hospital that police found to be baseless, Marilyn was no longer able to bring Arthur a daily meal, visit or phone him.
As a result of this action, Marilyn missed Arthur’s birthday. With no family or friends living nearby, Arthur was utterly alone. “The worst of it was that he didn’t know why I had suddenly and without warning disappeared from his life!”, cries Marilyn.
Despite the police absolving her of any wrong-doing within a week of the allegation being made, inexplicably the hospital continued the ban for almost two months. Finally, after Marilyn wrote to the hospital appealing for her visiting rights to be restored, the hospital permitted her to see Arthur for one hour a day, under guard. This “favour” was extracted only after Marilyn signed a document agreeing to abide by the doctor’s treatment plan. Marilyn signed that document “under duress” just so she could see Arthur again. The “agreement” included the prescribing of yet another antipsychotic drug, Haldol, a drug with equal or worse side effects than Zyprexa.
When Marilyn was finally permitted to see Arthur again (but not allowed to feed him any longer), she was shocked at his weight loss. Arthur’s sister, Thelma Matheson, echoes her concern. “He weighed 190 pounds when he entered the hospital,” says Thelma. Recently, the doctor and hospital staff admitted that Arthur now weighs “maybe 100 pounds”, they weren’t sure exactly.

In Marilyn’s own words

Marilyn Nelson and an elder rights advocate from Seniors at Risk were interviewed by the Sun News program, The Arena with Michael Koren on Tuesday, July 10, 2012. Marilyn Nelson provides an overview of what she has endured over the 24 months that Arthur has been hospitalized. Coren, who has had personal experience with family suffering from stroke and requiring hospitalization, expressed shock, likening the conduct of doctors and hospital officials in this case to “thugs”“bullies” and “commissars” and describing the treatment of Arthur and Marilyn as “sadistic”.
In her interview, Marilyn Nelson explains how she was threatened with not being able to see her partner of 26 years again unless she signed a paper agreeing to abide by whatever treatment the doctor ordered, and how she was threatened by Dr. Price.
Marilyn Nelson interview: Link.
Seniors at Risk interview: Link.
The two video segments run about 10-12 minutes in total.
The relationship with the hospital has worsened, despite the efforts of lawyers who have intervened on Marilyn’s behalf. See this letter to hospital CEO Rik Ganderton sent by a lawyer who assisted Marilyn. The letter attests in the strongest terms, to Marilyn’s legal authority to make care consent decisions on Arthur’s behalf.
In the next instalment of this story, you will learn how the hospital usurped Marilyn’s legal authority, and unilaterally placed Arthur on palliative care, despite the fact that he does not have a terminal illness. To Marilyn and others who have seen Arthur, he appears to be in no imminent risk of death from the effects of stroke, but at great risk of harm from negligent care.

Tuesday, July 24, 2012

Talking Points: National letter writing campaign

It is important to send letters to local and national newspapers or media expressing your opposition to the legalization of euthanasia and assisted suicide. When writing a letter you should to tell a personal story (if you have a story) and it is important to remain focused on one or two talking points.

The following is a list of talking points to help write letters to the media or to your member of parliament.
Talking Points:

1.  The Canadian government has made the prevention of elder abuse a national priority. Elder abuse is rarely reported and is usually done by someone who the abuser is dependent upon. If euthanasia and assisted suicide becomes legal, it will be the ultimate form of elder abuse.

2.  Recently Parliament passed Bill C-300, an act respecting a Federal Framework for Suicide Prevention. In Oregon, where assisted suicide has been legal for 14 years, the suicide rate has been rising since 2000. The suicide rate in Oregon is now 35% higher than the national average. Legalizing assisted suicide has a suicide contagion effect.

3. Canada prohibited capital punishment based on the possibility that the death of an innocent person may occur. Euthanasia and assisted suicide may result in the deaths of people without request or consent. Canada needs to continue prohibiting euthanasia and assisted suicide.

4. Depression is a primary risk factor for requests for euthanasia or assisted suicide. Depression is a common response of people living with chronic conditions or terminal illness. It is not possible to safeguard depressed people from euthanasia or assisted suicide

5. The Carter decision stated that prohibiting assisted suicide is an infringement upon the: right to life, liberty and security of the person, for people with disabilities. In fact the opposite is true. Legalizing euthanasia or assisted suicide will result in persons with disabilities losing their right to life, liberty and security of the person.

6.  In April 2010, Parliament defeated Bill C-384, a bill that would have legalized euthanasia and assisted suicide by a vote of 228 to 59. Judges should respect the role of Parliament. Issues such as euthanasia and assisted suicide should be decided by Parliament.

Families of children with significant disabilities indicate that their lives are enriched.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

A research study that was published in the current edition of the Journal Pediatrics found that parents of children with Trisomy 13/18, conditions whereby the child has an extra 13 or 18 chromosome, indicated that the parents considered the child to be happy and found that their lives were enriched by the child.

The findings are very different than that attitude of many pediatricians towards these conditions. The Canadian Press reported:
Medical textbooks are grim and bleak about babies born with genetic codes considered "incompatible with life." But the study says parents who have these children speak of the joy found in what is almost inevitably a short lifespan. These children, they say, can enrich a family rather than destroy it.
Lilliana Dennis - First birthday
Recently I came across the story of Lilliana Dennis, a child who is living with Trisomy 18. After reading the heartfelt story about Lilliana and the Dennis family I responded by writing an article titled: Trisomy 18 is not a death sentence.

The research study was carried out by Dr. Annie Janvier - specialist in Pediatrics and Ethics at the University of Montreal and Sainte Justine Hospital in Montreal, Barbara Farlow B Eng MBA - patient safety Canada, and Dr. Benjamin Wilfond - Center for Pediatric Bioethics, Seattle Children’s Research Institute and Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington.

The research team invited 503 parents of children who had a Trisomy 13/18 child to participate in the study. 87% of the parents responded and 332 parents (67%) of 272 children completed the questionnaire.

The parents indicated that their physicians stated to them that:
* 87% their child was incompatible with life,
* 57% their child would live a life of suffering,
* 50% their child would be a vegetable,
* 23% their child would ruin their family.
On the positive side, 60% were told by their medical provider that their child would have a short, but meaningful life.
* 30% of the parents had requested a plan of treatment based on "full intervention."
* 79% of the children who received "full intervention" were alive at the time the questionnaire was sent. Those children were a median age of four years old.
* The survival rates for children with "full Trisomy" 13/18 was 40% lived for at least 1 year while 21% lived to at least age 5.
Half of the parents reported that caring for a child with a disability was harder than they thought it would be and yet 97% of the parents described their child as a happy child and most of the parents indicated that caring for their child had enriched their lives.

Barbara & Annie Farlow
The article in the Canadian Press interviewed Barbara Farlow, one of the authors of the study. Farlow, the mother of a child who had Trisomy 13 stated:
"We didn't want our daughter to live on life support or to suffer. But if she had a chance to live comfortably and be happy . . . then we were willing and able to care for her, despite her limitations,"

Annie lived for 80 days. When an illness brought her back into hospital and she stopped breathing, the staff was slow to try to resuscitate her, despite her parents' wishes. Later, Farlow and her husband discovered Annie's medical file had a DNR — do not resuscitate — order on it, even though they hadn't authorized it.
Dr Annie Janvier stated to the Canadian Press that:
"What we predicted as doctors happening to all these families didn't happen," says Janvier, who admits the findings are receiving a lukewarm response in some quarters.

"I just want to show that these kids mean something to their parents, ... And they seem like they have a quality of life that's acceptable. Doctors are not torturing them. We're not giving them undue pain. And they should be treated as unique children."
Dr. Benjamin Wilfond, the lead research author in the study, told Reuters news that:
"There is a broader range of survival and experiences than providers know. The parents may be getting this information online and clinicians may need to rethink what they say to parents,"
"I think the point of our paper is to say these are quite serious conditions, but saying it's hopeless is inconsistent with reality."
I have known Barb Farlow and her family for several years. I have learned, through Barb, much about the lives of children with Trisomy conditions. It is my hope that society will break-through the negative bias towards children with profound disabilities, such as Trisomy 13/18. Everyone is a unique human being and people with disabilities offer other people the opportunity to accept and understand the true meaning of dignity. Hopefully this study will create new opportunities for families and the children with disabilities.

More information can be found at: http://www.trisomy.org/

Re-examined: Did Rick Santorum exaggerate the euthanasia experience in the Netherlands?

By Alex Schadenberg

Last February, Rick Santorum, who was running to become the Presidential candidate for the Republican party was lambasted for comments that he made related to the Netherlands euthanasia statistics.

Now that the 2010 meta-analysis of the Netherlands euthanasia statistics have been published in the Lancet, it is important to do a re-appraisal of what Rick Santorum said and consider where he was right and where he was wrong.

It is important to read the 2010 cross-sectional analysis and my commentary about the Lancet article before assessing the previous Santorum comments. Link to my commentary: Lancet Study proves significant increase in euthanasia deaths in the Netherlands.

What did Rick Santorum say?
1. Dutch people wear a bracelet that says - "Do not euthanize me."
2. 10% of elderly people die by euthanasia.
3. Half of the euthanasia deaths are involuntary.
4. Many Dutch people go to another country for medical care, rather than a Dutch hospital.

The facts.
1. There is a group in the Netherlands that distribute cards to people who are opposed to euthanasia that states something like: do not euthanize me. No it is not a bracelet. It is possible that a similar group is distributing bracelets, but I only have knowledge of the card. Same comment as before.

 2. The Dutch are very specific concerning what euthanasia is, and what it is not. The Dutch define euthanasia as a voluntary act that is done on request. More recently the NVVE (Netherlands euthanasia lobby) has established "Mobile Euthanasia Units" that will be oriented to euthanizing people who have dementia, who have disabilities, or who have been turned down by other doctors. It is also considered acceptable for Dutch Psychiatrists to euthanize their patients for "loneliness". The Netherlands euthanasia lobby anticipate that the mobile euthanasia units will do 1000 euthanasia deaths per year.

The number of official euthanasia deaths has increased significantly over the past few years. In 2010 it is reported that their were 3136 official euthanasia deaths which was up by 19% over 2009 and 2009 increased by 13% from 2008.

Now that the 2010 report has been published in the Lancet we know that there were actually 4050 euthanasia deaths (23% rate of under-reporting, was up from a 20% rate of under-reporting in 2005), there were 192 assisted suicide deaths, there were 310 deaths without explicit request or consent and then there are the deaths of people, who were not otherwise dying, but died by intentional dehydration.

It is interesting to note that the 2010 study that was published in the Lancet indicated that approximately 4050 euthanasia deaths occurred in 2010 (23% under-reporting) and stated that this represented 2.8% of all deaths in the Netherlands. The fact is that there were 136058 deaths in the Netherlands in 2010, meaning that 4050 euthanasia deaths represents 2.98% (almost 3%) of all deaths in the Netherlands.

A 2005 study of End-of-Life Practices in the Netherlands that was published in the New England Journal of Medicine found that death by dehydration had increased significantly from 2001. In 2005, 8.2% of all deaths in the Netherlands were done by deep-continuous sedation followed by dehydration. The 2010 report that was published in the Lancet states that 12.3% of all deaths in the Netherlands were by deep-continuous sedation. Some of the 12.3% of deaths by deep-continuous sedation followed by dehydration are cases of euthanasia by dehydration. A recent article by bioethicist Wesley Smith estimates that approximately (10% of the 12.3%) of the deaths by deep-continuous sedation/dehydration are either euthanasia deaths or they represent an abuse of the use of deep-continuous sedation.

When a person, who is not otherwise dying, is intentionally sedated and dehydrated to death, that death is clearly an act of euthanasia (euthanasia by dehydration or slow euthanasia), even though the definition used in the Netherlands, and most of the world, does not recognize euthanasia by dehydration as euthanasia.

My conclusion in February was: Santorum numbers may be high, but they also may be close to the reality. Now that I have examined the 2010 report from the Lancet it is not clear that the numbers used by Santorum were not high, but either accurate or low.

3. Santorum stated that half of all euthanasia deaths in the Netherlands are involuntary.

The 2010 study that was recently published in the Lancet indicates that there were approximately 300 deaths without explicit request or consent in the Netherlands. There would also be deaths without request or consent related to the deaths by deep-continuous sedation. This does not represent half of all euthanasia deaths.

Before we ignore the problem of deaths without explicit request or consent one needs to examine the three studies published in 2010 concerning euthanasia in Belgium:
1. 32% of euthanasia deaths that were done by physicians in the Flanders region of Belgium were done without explicit request or consent.
2. A similar study that analysed euthanasia deaths that were done by nurses in Belgium found that 45% were done without explicit request or consent.
3. The third study concerning the reporting of euthanasia in Belgium found that only 52.8% of all euthanasia deaths were reported.

4. Santorum stated that people in the Netherlands go outside of the country for medical treatment. I have read an article that stated that some people who oppose euthanasia have gone to nursing homes in Germany.

An article that was written by Raphael Cohen-Almagor entitled: "Non-voluntary and Involuntary Euthanasia in the Netherlands: Dutch Perspectives" was published in - Issues in Law and Medicine - March 2003, provides some insight into the concerns related to people avoiding medical treatment out of fear of euthanasia. This article is based on interviews with dutch doctors and others who support and oppose euthanasia in the Netherlands. Cohen-Almagor interviewed Evert van Leeuwen who argued that: "there are elderly people in nursing homes who fear that their lives will be ended without consent." Cohen- Almagor then points out that there were very few euthanasia deaths in nursing homes in the Netherlands at that time.

There is no research, that I know of, proving that people are leaving the Netherlands, out of fear of euthanasia, to receive medical treatment or to live in a nursing home. It does not mean that this doesn't happen. Maybe someone will send me an article on this issue.

In conclusion:
1. There are people in the Netherlands who carry cards in their wallets that state that they do not want to die by euthanasia.
2. The comments by Rick Santorum that 10% of all people in the Netherlands die by euthanasia is factual. The numbers may be higher than 10%.
3. Half of all euthanasia deaths are not involuntary. Even though the number of deaths without request or consent has dropped in the Netherlands, the fact is that no doctors are being prosecuted or even losing their medical license for euthanizing their patients without request or consent, even though the studies continue to show that it occurs.
4. There is no known research that proves that Dutch patients are going to other countries to avoid death by euthanasia.

Monday, July 23, 2012

Be careful about what you wish for

UK disability rights activist, Nikki Kenward speaks about what legalizing euthanasia or assisted suicide would mean for those with a serious disability

By Nikki Kenward
Nikki Kenwood
I speak as someone who constantly asks the general public what they think and want for their relatives and themselves and also as someone who has been ‘locked in’ and is now significantly disabled. I agree with Iona Heath, President of the Royal College of GPs,that assisted suicide campaigns can be predicated on an excessively rosy view of society. People simply aren’t thinking this through. We are a society that likes to make best and most use of everything that we pay for, especially in the NHS. The same will happen with assisted suicide, once we’ve got everything in place, there will be no stopping the follow through.

 So for those of us who ask what assisted suicide would be like – there will be some hassle and indecision but the doctors will see to it that it goes alright in the end – your end. Voluntary euthanasia will lead to governments saving money, while euthanasia advocates make money.

 Professor Nigel Biggar has said that the legalization of assisted suicide will “jeopardise society’s commitment to the high value of individual human lives, and its support for those lives when they are ailing. It will make society more liberal at the expense of making it less humane.”

 For those who want to take their own life, even if they make it legal for someone to kill you, they still have no right to take my life. For that is what will happen unless the voices of the disabled, elderly and marginalized are heard.

Nikki Kenward, who became partially disabled from paralysis caused by Gullain Barre syndrome, staged a protest outside parliament about the dangers that a changing the law to allow assisted suicide or euthanasia would pose to those with serious disability. Her own inspiring personal story is told in the Daily Mail and is well worth a read.

The assisted suicide slope is slick for vulnerable people

This is the original version of the article by Rhonda Wiebe that was printed in the Winnipeg Free Press on July 21, 2012, under a different title. I have used the original title Rhonda Wiebe had chosen for this article.

Rhonda Wiebe
By Rhonda Wiebe, co-Chair of the Council of Canadians with Disabilities - ending of life ethics committee.

Arthur Schafer’s portrayal of comments on the merits of physician assisted suicide need challenging. Schafer, like many other supporters of physician assisted suicide (also known as “doctor prescribed death”) does not seem to have considered the wider issues facing Canadians with disabilities, including  the ongoing social prejudice and discouraging lack of living supports that we encounter on a daily basis.

The recent decision in the British Columbia Supreme Court regarding the constitutional right of Gloria Taylor, a British Columbia ALS patient, to end her own life rather than live with disability only confirms what we with disabilities already know – that many Canadians believe it is better to be dead than disabled. What also became clear in the decision is that the judge believes it is better to be dead than disabled. The judgment was pronounced without considering the message it sends to all of us who believe that despite profound functional limitations, we want to live.

Gloria Taylor and others who are newly disabled face loss. All of a sudden you can’t do what you could easily do before. Every day you face renegotiating the world around you in new and frightening ways. No one wants it, but that’s what has to be done if you want to live a vibrant and meaningful life.

Let’s look at another very significant loss – that of the death of a child. The pain, I am told, is absolutely devastating. Every day you are reminded of what you once had that is now gone. Everywhere you turn, you have to reconfigure how you approach things, and you are constantly faced with ways of bracing yourself against this insurmountable absence of what you once had.

But when a parent loses a child, do the majority of Canadians chime in and say, “Your pain must be so horrible. You have no quality of life. Here’s a syringe – why don’t you end it all? Better yet, here’s a doctor ready to write you a deadly prescription?” If you find this notion offensive, then you know how disturbing it is for people with disabilities to hear from persons who haven’t yet adjusted to the losses inherent in acquiring a disability, or to hear from able bodied “experts” that we should have the right to end our own lives. There is no apparent discussion, either in the Taylor decision, or amongst persons such as Schafer that acknowledges the problems might lie in our lack of supports to go on living. Instead, they just want to make possibilities for us killing ourselves that much smoother.

Their argument, of course, is disguised as one of self-autonomy. They want to make sure that we have the right to commit suicide. But do you work hard to ensure that same right to grieving parents, heartbroken adolescents, or anyone else facing devastating social circumstances? It is incomprehensive that suicide prevention organizations are not more pro-active when people with disabilities feel their only option is to kill themselves.

Let’s look at another issue – pain management. If you read the Taylor case in BC, you’ll see that it actually has very little to do with physical pain. This fact is consistent with data about who is asking (and receiving) physician assisted suicide. Jack Kevorkian killed far more people with newly diagnosed disability than he did those with terminal illness and unremitting pain. Gloria Taylor’s submission didn’t talk about unretractable pain, but it did spend a lot of time describing how she was worried about not being able to go to the bathroom by herself. I know a lot of vibrant, exemplary citizens who need assistance with incontinence issues. There are products for that. But if someone is really so ashamed of needing this kind of help, able-bodied Canadians have some pretty tough questions they better face about how they judge the merits and worth of other human beings based on the fact that their bodies have leaky places.

The insidious bottom line is this – last I looked, a take-home euthanasia kit in Oregon cost $39.95. That’s a whole lot less expensive than providing someone with the supports they need to cope with the loss of having a disability, and then providing them with the means to get on with the matters of daily living. It’s way cheaper to let people suffer, or cut back services so that life is untenable, or subtly convince people with disabilities that they have lives that aren’t worth living. Imagine being inundated with the message that you have a right to end your miserable, burdensome, devalued life, because really, it’s your choice.

Unfortunately, some people with disabilities are starting to drink that Kool-Aid. 

I know of what I speak. I live with an incurable medical condition that already diminishes my capacity to live, work and play. My future holds a certainty of further losses, but the hardest thing to face is the tacit agreement on the part of ableist Canadians that the lives of people with disabilities are pitiable, disempowered, and, in the end, not worth supporting.

The slope to euthanasia and physician-assisted suicide isn’t just slippery, it’s growing slicker because Canadians aren’t willing to carefully examine their own attitudes towards living with disability, and because, like much else, we’re hurtling into a human rights-devoid world where we do the cheap thing, not the right thing.

Doubts emerge about Dutch guidelines for terminal sedation

The following article was written by Michael Cook and published on July 22 on Mercator.net under the title: Doubts emerge about Dutch guidelines for terminal sedation.

By Michael Cook

Death by dehydration
Should deep, continuous sedation at the end of life really be treated as normal medical practice in the Netherlands, ask three Dutch authors in the Journal of Medical Ethics. Although they do not appear to oppose euthanasia, they argue that “morally problematic aspects inherent to palliative sedation do not get the attention they deserve” under current guidelines. Since palliative sedation accounted for more than 12% of deaths in the Netherlands in 2010, this is an important issue.

Although euthanasia – which ends a patient’s life immediately – is the most visible and controversial aspect of end-of-life care for international observers, the innocuous-sounding treatment called “palliative sedation” (also called “terminal sedation” by some authors) also has been the centre of controversy in the Netherlands. In 2003, the then-attorney-general argued that the death of a deeply sedated patient because water was withheld was culpable homicide. However, his view did not prevail.

To clarify the situation, the Royal Dutch Medical Association (KNMG) issued guidelines for palliative sedation in 2005 (updated in 2009). These define it as the use of drugs in the last two weeks of life to induce deep unconsciousness for patients who have “refractory symptoms”, combined with the withdrawal of nutrition and hydration. The main point of the guidelines was to insist that palliative sedation is not euthanasia, not even “slow euthanasia”. It is normal medical practice. The provision of fluids for a patient under palliative sedation is regarded as medically futile.

The authors of the JME article point out, however, that this approach skates over some difficult problems. First, how can doctors be sure that the life expectancy is only two weeks? The chairperson of a regional review committees for euthanasia even said in 2007 that “It is unprofessional to render a person with a long life expectancy asleep and refrain from hydration and nutrition. That's just euthanasia with other means, because without food and fluid everyone dies after a week.”

Second, the guidelines describe it both as “a radical medical procedure” and normal medical practice. How can it be both of these? Third, because it is “normal medical practice” (which euthanasia is not), its purpose must be to alleviate suffering, not to end life. However, a 2004 study showed that in 17% of cases doctors used it to end lives.

Fourth, because it is considered “normal medical practice”, the KNMG says that a doctor does not need to consult his decision with a colleague – and in fact, almost none of them do. However, the European Association for Palliative Care and the American Medical Association insist on consultation.

The authors argue that KNMG eliminated the need for consultation in order to distinguish palliative sedation from euthanasia, which does require consultation. They point out that when consultation for palliative sedation was required at a cancer centre, the result was negative 41% of the time. “Considering consultation optional only because mandatory consultation makes palliative sedation look like euthanasia seems an unpersuasive argument,” they say.

Since it is difficult to get accurate information about what Dutch terminal sedation is, we have inserted the 2009 KNMG guidelines below.KNMG Guideline for Palliative Sedation 2009 2
Link to the recent article on the Netherlands euthanasia statistics.

Link to the article: The proper use of palliative sedation is not euthanasia.