Friday, August 31, 2012

HOPE, Philip Nitschke & Max Dog

The following is a message from Paul Russell, the founder and leader of HOPE Australia. Russell has challenged Philip Nitschke, Australia's Dr Death, to explain how the import of nitrogen cylinders for suicide fits within the parameters of the law. Please read.

Paul Russell
A message from Paul Russell and HOPE Australia:

Today’s Australian ran an article on page three about Dr. Nitschke and Exit International’s latest death method promotion.

You can read the article at my blog by clicking HERE.

Contrary to the headline, I have not accused Nitschke of anything – but he does have some serious questions to answer about where the nitrogen cylinders come from and what advice he is giving purchasers of his latest death process.

Nitschke tweeted this morning: “Christians get medical regulator AHPRA to carry out their anti-Euthanasia witch hunt”. This is wrong on so many levels. It’s not an anti-euthanasia issue – people have a right to their views. Nor did we influence the medical regulator – I simply made a submission and they decided to follow it up – no collusion here.

ACTION: You can help by sending a Letter to the Editor of The Australian by going to the letters page and using the online letter form (CLICK HERE).

In other news:

The Tasmanian Government has made the welcome announcement of the creation of an Elder Abuse Hotline in the Apple Isle. This is a great initiative but one that runs directly contrary to the Tasmanian Premier’s own support of euthanasia legislation. Read my article HERE.

The New Zealand Prime Minister, John Key, shot himself in the foot recently when he discussed his support for euthanasia. He got it horribly wrong which caused outrage in the medical profession that generated a whole barrage of media. You can read my original comments HERE, a radio interview about palliative care HERE and my follow up story HERE.

For New Zealand supporters: There’s a great new website initiative called The Euthanasia Debate. I encourage you and all our NZ friends to register for updates by clicking HERE.

Dr. Nitschke was in the news again recently, this time advocating for a Swiss-Dignitas type death clinic to be set up in Fiji. It seems that his idea of a holiday to die for at the ‘Last Resort’ (as was one media outlet’s headline) was doomed before it even began. You can read my original article HERE and the follow up HERE.

Social Media: HOPE has been on facebook for some time now but we’re changing over from a ‘group’ to a ‘page’. To get HOPE updates on your facebook profile you simply have to ‘Like’ the page. CLICK HERE to ‘Like’ HOPE.

We’re also now on Twitter. You can follow Paul on twitter at the hash tag. Paul Russell@PaulRusell12.

The Government of Canada will, once again, appeal the Constitutional Exemption that was granted to Gloria Taylor.

Hon Rob Nicholson
The following letter was received today from the Honourable Rob Nicholson announcing that the government  of Canada intends to appeal the decision by Madam Justice Prowse. 

On August 3 Justice Prowse heard arguments concerning the validity of the constitutional exemption that was granted to Gloria Taylor to die by euthanasia and assisted suicide. On August 10, Justice Prowse upheld the decision by Justice Lynn Smith to grant Gloria Taylor a constitutional exemption to die by euthanasia and assisted suicide.

The Euthanasia Prevention Coalition asked the Hon Rob Nicholson to appeal the August 10 decision because it allows a legislative framework for euthanasia and assisted suicide. The constitutional exemption that was granted to Gloria Taylor, could also be requested by other Canadians who are living with similar conditions. Link to the EPC position on the Constitutional Exemption.

The letter from the Hon Rob Nicholson:
Thank you for your correspondence concerning euthanasia and assisted suicide. 
As you may be aware, the case of Carter v. Canada (Attorney General) is a court challenge under the Canadian Charter of Rights and Freedoms in relation to the prohibition on assisted suicide. The British Columbia Supreme Court heard this case and made its ruling on June 15, 2012. After careful consideration, the Government of Canada appealed this decision to the British Columbia Court of Appeal. We also sought a stay of all aspects of the lower court decision. On August 10, 2012, the Court of Appeal refused to stay the decision granting a constitutional exemption to one of the plaintiffs in this case. We have sought to appeal this refusal as the Government views this exemption as resembling a regulatory framework for assisted suicide. 
The Criminal Code prohibits the practice of euthanasia and assisted suicide in Canada. These laws exist to protect all Canadians, including the most vulnerable members of our society, such as those who are sick or elderly and persons with disabilities. 
 We believe that the provisions prohibiting a medical professional, or anyone else, from counselling or providing assistance in a suicide are constitutionally valid. As you may know, in 1993, the Supreme Court of Canada upheld the constitutionality of the existing legislation in Rodriguez v. British Columbia (Attorney General)In addition, in April 2010, the legalization of medical euthanasia and assisted suicide under certain conditions was democratically debated in the House of Commons. A large majority of Parliamentarians voted against changing these laws.  
The Government will provide its full position to the British Columbia Court of Appeal when the case is heard.  As this case continues to be before the courts, I cannot comment further at this time. 
Thank you again for writing.  
Yours truly, The Honourable Rob Nicholson
Links to important articles concerning the Carter case in BC.
Link to the EPC response to the appeal of the Carter decision.
A message from EPC executive director as to why the Carter decision needed to be appealed.
Link to the Talking Points for the letter writing campaign.
Link to the EPC response to the Carter decision on June 15, 2012.
Link to the EPC response to the Carter and Leblanc court cases in Canada.

Wednesday, August 29, 2012

Tasmania launches elder abuse prevention initiative.

Paul Russell
By Paul Russell, the founder and director of HOPE Australia.

News from Tasmanian Premier Lara Gidding's website talks about the launch of the Tasmanian Elder Abuse helpline. An undoubtedly worthwhile initiative, the helpline is set against a background where, as the media release observes: “It is estimated up to 4200 older Tasmanians suffer physical, emotional verbal or financial abuse at the hands of someone close to them.” This is set to increase statistically as Tasmania moves towards a peak population cohort of over-65s in 2021, totaling one in four Tasmanians.

The Department of Health and Human Services document, Protecting Older Tasmanians from Abuse describes Elder Abuse, defines its topic: “Abuse of older people is a single or repeated act occurring within a relationship where there is an implication of trust, which causes harm to an older person.” This can include physical, psychological/emotional, financial, sexual and social abuse as well as intentional or unintentional neglect. The department further wisely advises:

“Abuse of older Tasmanians is a violation of their human rights and a rejection of the fundamental respect that our older people deserve.

“Older Tasmanians deserve dignity and to feel secure and safe. Preventing abuse is a community responsibility and requires all sectors of society to actively address its causes and reduce its harmful effects.”

Indeed. To remain true to such an important and worthwhile objective, the Tasmanian Government cannot proceed with creating euthanasia and assisted suicide law.

It is not hard to imagine a situation where a relative or other person of trust could abuse an elder to the point where he or she might agree that their life's not worth living. The incentive of an inheritance cannot be dismissed.

The likelihood, if euthanasia and assisted suicide were ever legal, that such abuse would remain hidden, (just as elder abuse in any form is hard to detect and act upon) is made all the more concerning because the only witness would be deceased. Who would ever know? It should never be the role of government to make crime easy and detection, unlikely.

Indeed, whether or not this, the ultimate in elder abuse, would be widespread, occasional or even only rare, the possibility cannot be dismissed. We cannot, as some would suggest, only base decisions on empirical evidence. That would require us to legislate and then monitor - the ultimate problem being that some would lose their lives to prove the point.

No, there is sufficient doubt based simply on human nature and the prevalence of elder abuse added to the financial incentive. The precautionary principle must apply here.

The Tasmanian Premier needs to rethink her commitment to euthanasia legislation and turn instead to make protecting ageing Tasmanians a higher priority.

This post has been republished, with permission from Hope, a national network working against euthanasia and assisted suicide.

Is brain death - death? New Canadian brain-death guidelines.

This article that was written by Tom Blackwell and published in the National Post asks the question whether or not organ donors are actually dead before their organs are removed? 

The new Canadian guidelines for brain death are designed to increase the number of available organs for transplant. Some experts say they make it less likely that the donor is actually dead.

There have been many concerns about whether organ donors are dead before their organs are removed. The Canadian guidelines appear to make it more likely that death will occur from the removal of organs rather than waiting for death to occur and then removing organs.

Alex Schadenberg

'Legally dead' may still be alive: warning over new organ-donor guidelines

By Tom Blackwell, National Post - August 29, 2012

Months into the latest national campaign to recruit desperately needed organ donors, a legal scholar is arguing that new guidelines for declaring people brain dead and eligible for organ harvesting likely violate the Charter of Rights and Freedoms.

The non-binding rules developed by a government-appointed expert panel in 2004 — designed to expand the pool of transplant donors — make it more likely that people are being declared dead when they are still alive, and were drafted with no public input, complains Jacqueline Shaw in the McGill Journal of Law and Health.

Given that the panel’s “inappropriately one-sided” guidelines emerged from a government transplant initiative, they are subject to the Charter, and appear to violate the right to life, liberty and security of the person, she argues.

“The recent government issuance of significant, dangerous, under-the-radar changes in guidelines for brain death determination in Canada is virtually unknown and warrants greater public attention,” she said in an email exchange with the National Post. “The brain-death changes dramatically increase the potential to misdiagnose as ‘brain dead’ patients who are simply suffering from temporary, reversible neurological states.”

A spokesman for the country’s largest transplant organization dismissed the lengthy analysis, though, saying the rules are “highly respected worldwide” and designed to make the process of determining brain death consistent and rigorous, not faster or easier.

“More often than not, it delays the declaration of death, so the physician at the bedside gets it right,” said Dr. Sonny Dhanani, a pediatric critical-care specialist in Ottawa and chief medical officer with Ontario’s Trillium transplant network. “At the end of the day, the goal … was to make declaration more consistent and rigorous so that we felt better about moving toward organ donation, rather than uneasy about it.”

Dr. Sam Shemi, a prominent Montreal intensive-care physician who headed the panel Ms. Shaw criticizes, told the National Post last year that current practice leaves no doubt that donors are dead, with a process that is “performed according to a higher standard than in any other [medical] situation.”

Underlying the debate are some stark statistics — the chronic shortage of donor organs means about 300 sick Canadians die every year on the waiting list.

Still, the journal article adds to a simmering controversy around declaring when critically ill patients are dead. While most in the medical community seem to accept the validity of the Canadian Council for Donation and Transplantation (CCDT) guidelines issued in 2004, a small but persistent minority of intensive-care physicians, bio-ethicists and others in Canada and the United States continue to argue that some donors may still be alive, at least technically.

A 2010 journal paper by Canadian and U.S. doctors called for a moratorium on the relatively new practice of declaring death after the heart has stopped, but without determining brain death. Another paper, co-authored by a Toronto intensive-care physician, suggested last year that the dead-donor rule be abandoned and replaced with what the doctors called a more transparent approach: telling families that their loved one is ultimately doomed, but may not be completely dead at the time the organs are removed.

The CCDT was set up by federal and provincial governments as concern grew in the 1990s about the continuing shortage of organs for transplant. The rules it drafted have been adopted by many jurisdictions across the country.

The article singled out a number of changes that Ms. Shaw said increase the potential for mistakes by making it possible to declare brain death earlier and more simply.

One was that brain death could be declared when the brain stem is no longer functioning, altering the previous “whole brain” rule that required doctors to determine that the cortex had also shut down, the article said. Ms. Shaw argues there could still be some consciousness in the cortex even after the stem has died.

But Dr. Dhanani said that when the brain stem — the most primitive part of the organ that controls basic functions like breathing — no longer works, it follows that the entire brain must be dead.

The article also suggested that the guidelines’ abandoned “time-honoured” safeguards, such as not declaring brain death until anticonvulsants, sedatives or other drugs that can bring about a death-like state have drained completely from the system. Dr. Dhanani said the rules still require care to ensure such medicines are not affecting the patient’s condition, but said there is really no way to determine they are completely gone from someone’s body.

The 2004 rules say the separate brain-death tests that must be carried out by two different doctors can be performed simultaneously. The previous guidelines called for a wait time of up to 24 hours in between examinations, which Ms. Shaw said allowed for the slim possibility the person could be deemed alive at the second test. There is no evidence, though, that the lag-time ever made any difference, said Dr. Dhanani.

Ms. Shaw argued the CCDT’s recommendations “dramatically redefined” how death is determined, but said the broad public was never consulted in advance, or notified of the changes after the fact.

Previous articles on the same topic:

Friday, August 17, 2012

Paul Russell and Philip Nitschke - debate euthanasia in Australia.

Paul Russell
Philip Nitschke
The following is the text of the speech by Paul Russell at his debate with Philip Nitschke, Australia's Dr Death, on August 16 in Adelaide Australia. Paul Russell is the founder and leader of HOPE Australia, a group that opposes the legalization of euthanasia and assisted suicide. 

Paul is the Vice President of the Euthanasia Prevention Coalition International. He will be speaking at the First European Symposium on Euthanasia and Assisted Suicide in Edinburgh Scotland, September 7 - 8, 2012.

By Paul Russell - August 16, 2012

Thursday evening was cold, wet and windy in Adelaide. But that did not stop 120 people from turning up to a debate at Adelaide University between yours truly and Dr. Philip Nitschke.

Hosted by the Adelaide University Liberal Club (for non-Australian readers, The Liberal Party is the conservative party - yeah, go figure!) it was a very successful debate with many good and respectful questions - so much so that Philip and I fielded questions long after the official closing time.

Many thanks to the AULC, to Philip and to everyone who came along (and thanks to my daughter, Hannah for the photos!)

Here's the text of my talk:

Thank you to the AULC and the organisers of this debate for your invitation to address this gathering today.

What is at issue here is the way our society responds to concerns at the end-of-life and, more specifically the appropriateness of euthanasia & assisted suicide as a compassionate response. Even in the pursuit of our right to make our own choices, to take control of our own circumstances we must ever be mindful of the effect that such pursuits have or may have on the fundamental rights of others.

Euthanasia & assisted suicide legislation will put some people in circumstances where they may be abused, where their rights may be compromised. Euthanasia & assisted suicide legislation cannot be made safe.

What we’re talking about is legislating to allow people to kill other people.

Unless you’re posing a serious and present threat to my life, I can’t kill you. That’s a good thing. We all enjoy this protection in law equally, every one of us.
Paul Russell delivering his speech.

But, now we’re saying that it’s okay for someone else to kill you.

That is the fundamental issue: we will be making an exception to the Criminal Code that changes the laws on homicide. That is serious stuff.

We’d be creating a right for someone else to kill us or, to put it another way, a right to be killed.

We’re clearly talking about rights now. But what would be the nature of this right? Firstly and fore mostly it would be a ‘human right’. After all we’re not talking about our pet hamster.

Human Rights have universal application. Human Rights intrinsically apply to all people in all places at all times – that’s their nature. I don’t believe that this is a human right, but that’s effectively what it would become.

So all this talk of limiting the scope of such legislation to sub sets of the human family such as the terminally ill for example is baloney.  We can’t create such a right and then expect to legitimately limit its application.

But that’s precisely what almost every euthanasia bill has attempted to do. People may genuinely believe that their bill should only ever apply to a limited number of people in limited severe circumstances. However, insurmountable problems exist both in the framing of these limiting factors and associated safeguards (so-called) and in the consideration of the implications of the right to be killed as a universal.

The Dutch passed euthanasia legislation in 2002. From 1984 the Dutch courts began to extend euthanasia to people living with chronic depression (mental pain); later to children who were born with disabilities, and other vulnerable groups. The 2002 legislation sought to codify the court rulings and to limit the practice.

Euthanasia practice in the Netherlands now includes access for teenagers (with or without parental consent) to people with Alzheimer’s (for whom the ability to give informed consent has diminished) and to people experiencing loneliness.

In 2005 there were 550 cases of euthanasia in the Netherlands without request or consent. In 2010 the figure was 310. In the Flanders region of Belgium request or consent was absent in 32% of cases. Informed consent is absolutely necessary for any medical procedure – it is notably absent here – and yet there have been no prosecutions. For those people who died that way, a fundamental human right to make their own choices has been denied.

In 2005, 20% of Dutch euthanasia deaths were not reported. In 2010 this rose to about 23%. In the Flanders region of Belgium only 52.8% of euthanasia deaths were reported in 2007.

Recently the Dutch created mobile euthanasia teams to ‘meet unfulfilled need’ in the community by visiting people where they live. One press statement suggested that this was partly about where the local doctor had refused euthanasia to a patient. The thought of vulnerable or frail people being euthanased in their homes where the possibility that they might be pressured by a relative to ‘do-the-right-thing’, which cannot be discounted or accounted for, really shook me.

I’m reminded of a comment Philip (Nitschke) made at one debate in respect to the Dutch where he said that he felt that they were quite wedded to their legislation. And I think he’s right. But why?

The only valid conclusion, I believe is that the Dutch by and large see the right to be killed as exactly that: a universal right. Little-by-little over more than two decades they’ve seen the expansion of euthanasia to more and more circumstances, to more and more people. In that context, the mobile units give people access to their so-called ‘human right’ to be killed.

Paul Russell answering a question.
Think: If, for example, Bob Such’s most recent bill was successful in its attempt to limit the application to people in the terminal phase of a terminal illness, how long do you think it would be before someone who was not at that final stage piped up and said: That’s not fair, I want to die too! I’m being discriminated against!

And what if that bill had passed and then we began another debate in which someone put an amendment to broaden the extent of euthanasia to another sub set of the community: would we then be debating whether or not a ‘right to be killed’ is justified under our law? No, we will have already accepted that principle in passing the earlier bill. We’d only then be debating the merits or otherwise of including others.

Such a debate would effectively be a foregone conclusion – there would be no rational reason for denying that right to a particular group; to argue this way would be totally illogical not to mention discriminatory.

In respect to safeguards and limiting factors: their purpose is simply to help make us and our legislators feel a little less uncomfortable about legislating for killing. That’s about it.

In the last Western Australian debate MP Robin Chapple said that he knew his restricted bill wouldn’t please everyone but that it was a ‘good start’. This clearly implies that someone else can come back and try to amend and expand it at some future moment. Sir Terry Pratchett who funded the Falconer Inquiry in the UK bemoaned the fact that the final recommendations didn’t go far enough. In 2010 Mark Parnell observed that too many safeguards would make any bill too restrictive and inaccessible; the corollary of this stark admission is that to make a bill work we must accept an increasing level of risk from abuse.

The pro-euthanasia lobby seems often to have a difference of opinion on what model they should adopt, but they’re unified in their intention of getting ‘something’ on the statutes. That’s their goal – fair enough.

Let’s look at it from another angle. In many bills we’ve seen that two doctors need to examine the patient and complete forms. What if this wasn’t done? Would the responsible doctor be charged with homicide? No, he or she might simply say that they’d done all the prerequisite checks but simply hadn’t done the paperwork. That might be true, but it might not be true – who would ever know – the principal witness is dead. Let’s face it, they would probably get some kind of reprimand or fine for not filing the correct forms where the reality might be that they’ve gotten away with murder! In the Netherlands it is acknowledged that some of the under reporting is due to the fact that some doctors do see killing a patient as a law-given right rejecting any necessity at all for reporting.

There will always be people whom, for whatever reason, have a diminished ability to stand up for themselves or who suffer some significant ailment that makes even the basics of daily living difficult. We know too, that the worldwide phenomenon of Elder Abuse is a serious and growing concern: where elderly people are preyed upon, usually by people who care for them – often a family member; that such abuse includes financial, sexual, physical and emotion abuse. These people need and deserve protection from the ultimate in elder abuse: being pressured into agreeing to ask to be killed.

I said at the beginning that the criminal code prohibiting homicide protects us all equally. With euthanasia & assisted suicide legislation we begin to treat some sections of our community unequally; we begin to put some at risk of abuse. And for some the advent of such legislation may create thoughts that they’re ‘better off dead’ that their lives are of less value than others. 

How many people would be abused under such laws? I can’t say. But what we can say is that whenever we talk about the statistics we’re talking about real people. If the law failed to protect one person then it’s a bad law.

This type of legislation deals with life and death; that’s a far more serious a matter than our parliaments usually deal with and if we are to retain equal protection of the lives of all Australians we need to take this very seriously.

Ultimately, euthanasia & assisted suicide law is bad law because it fails to protect people. Equality is honoured and served by maintaining the current laws. Our abiding instincts to be compassionate can and should be expressed, but compassion is about bringing care and relief to people suffering, not to eliminate the sufferer. I think we can do much better than that.

Thursday, August 16, 2012

Locked-in syndrome survivor did not want to die.

Locked-in syndrome: rare survivor Richard Marsh recounts his ordeal

When Richard Marsh had a stroke doctors wanted to switch off his life-support – but he could hear every word but could not tell them he was alive. Now 95% recovered, he recounts his story.

By Amelia Hill - The Guardian (UK) - August 7, 2012

Richard & Lili Marsh
Two days after regaining consciousness from a massive stroke, Richard Marsh watched helplessly from his hospital bed as doctors asked his wife, Lili, whether they should turn off his life support machine.

Marsh, a former police officer and teacher, had strong views on that suggestion. The 60-year-old didn't want to die. He wanted the ventilator to stay on. He was determined to walk out of the intensive care unit and he wanted everyone to know it.

But Marsh couldn't tell anyone that. The medics believed he was in a persistent vegetative state, devoid of mental consciousness or physical feeling.

Nothing could have been further from the truth. Marsh was aware, alert and fully able to feel every touch to his body.

"I had full cognitive and physical awareness," he said. "But an almost complete paralysis of nearly all the voluntary muscles in my body."

The first sign that Marsh was recovering was with twitching in his fingers which spread through his hand and arm. He describes the feeling of accomplishment at being able to scratch his own nose again. But it's still a mystery as to why he recovered when the vast majority of locked-in syndrome victims do not.

"They don't know why I recovered because they don't know why I had locked-in in the first place or what really to do about it. Lots of the doctors and medical experts I saw didn't even know what locked-in was. If they did know anything, it was usually because they'd had a paragraph about it during their medical training. No one really knew anything."

Marsh has never spoken publicly about his experience before. But in an exclusive interview with the Guardian, he gave a rare and detailed insight into what it is like to be "locked in".

"All I could do when I woke up in ICU was blink my eyes," he remembered. "I was on life support with a breathing machine, with tubes and wires on every part of my body, and a breathing tube down my throat. I was in a severe locked in-state for some time. Things looked pretty dire.

"My brain protected me – it didn't let me grasp the seriousness of the situation. It's weird but I can remember never feeling scared. I knew my cognitive abilities were 100%. I could think and hear and listen to people but couldn't speak or move. The doctors would just stand at the foot of the bed and just talk like I wasn't in the room. I just wanted to holler: 'Hey people, I'm still here!' But there was no way to let anyone know."

Locked-in syndrome affects around 1% of people who have as stroke. It is a condition for which there is no treatment or cure, and it is extremely rare for patients to recover any significant motor functions. About 90% die within four months of its onset.

Marsh had his stroke on 20 May 2009. Astonishingly, four months and nine days later, he walked out of his long-term care facility. Today, he has recovered 95% of his functionality; he goes to the gym every day, cooks meals for his family and last month, he bought a bicycle, which he rides around Napa Valley, California, where he lives.

But he still weeps when he remembers watching his wife tell the doctors that they couldn't turn off his life support machine.

"The doctors had just finished telling Lili that I had a 2% chance of survival and if I should survive I would be a vegetable," he said. "I could hear the conversation and in my mind I was screaming 'No!'"

Locked-in syndrome is less unknown than it once was. The success of the 2007 film, The Diving Bell and the Butterfly, the autobiography of the former editor of French Elle magazine editor, Jean-Dominique Bauby, brought awareness of the condition to the general public for the first time.

Then in June, Tony Nicklinson challenged the law on assisted dying in England and Wales at the High Court as part of his battle to allow a doctor to end a life he said was "miserable, demeaning and undignified".

Judgment was reserved until the Autumn.

Marsh, however, did something almost unheard of: he recovered. On the third day after his stroke, a doctor peered down at him and uttered the longed-for words: "You know, I think he might still be there. Let's see."

The moment that doctor discovered Marsh could communicate through blinking was one of profound relief for Marsh and his family – although his prognosis remained critical.

"You're at the mercy of other people to care for your every need and that's incredibly frustrating, but I never lost my alertness," he said. "I was completely aware of everything going on around me and to me right from the very start, unless when they had me medicated," he said.

"During the day, I was really lucky: I never spent a single day when my wife or one of my kids wasn't there. But once they left, it was lonely – not in the way of missing people but the loneliness of knowing there's no one there who really understands how to communicate with you."

The only way for Marsh to sleep, was to be medicated. That, however, only lasted four hours, after which there had to be a three-hour pause before the next dose could be administered.

In questions submitted by Guardian readers to Marsh ahead of this interview one asked about his experience of his hospital care while the staff did not think he was conscious. Marsh said: "The staff who work at night were the newest and least skilled, and I was totally at their mercy. I felt very vulnerable. I did get injured a couple of times with rough handling and that always happened at night. I knew I wasn't in the best of care and I just counted the minutes until I would get more medicine and just sleep.

In response to another question, about the right-to-die debate, Marsh said he has no opinion. All he will say is: "I understand the despair and how a person would reach that point." But he is co-writing a book that he hopes will inspire hope and provide information to victims of locked-in syndrome and their families.

"When they first told my family that I was probably locked-in, they tried to find information on the internet – but there wasn't any. One of my goals now is to change that … to be able to reach out to families who find themselves in the same situation that mine were in so they can help their loved ones.

"Time goes by so slow ... It just drags by. I don't know how to describe it. It's almost like it stands still.
"It's a terrible, terrible place to be but there's always hope," he added. "You've got to have hope."

• This article was amended on 10 August 2012. The original said that Tony Nicklinson had failed in his High court bid to change the law on assisted dying in England and Wales. This has been corrected. 
(Tony Nicklinson has failed in his High court bid to change the law on euthanasia and assisted suicide in England and Wales.)

UK court rejects euthanasia cases: 'dispassionate court' gets it right - compassionately

The following is the commentary by Dr Andrew Fergusson, leader of the Care Not Killing Alliance in the UK concerning the decision in the Nicklinson/Martin case in the UK. 

The three judges decided that only the parliament can decide whether or not to legalize euthanasia or assisted suicide.

'Dispationate court' gets it right compassionately

Dr Andrew Fergusson
By: Dr. Andrew Fergusson

The two cases of men with conditions resembling locked-in syndrome have been concluded. Heard before three judges in the High Court from 19-22 June, judgment was handed down at 2pm on Thursday 16 August.

Tony Nicklinson, 59 and paralysed from the neck down after a stroke in 2005, was actually arguing for permission that a doctor who performed voluntary euthanasia on him would have an effective defence when prosecuted for murder. He argued this on two grounds:
  1. A common law defence of necessity - his physical condition meant he could not kill himself even with assistance, and there was no other way he could achieve adequate relief from his overwhelming distress. (See Peter Saunders' blog on necessity for fascinating historical background.)
  2. That the current legal position was interfering with his right to a private life under Article 8 of the European Convention on Human Rights, now incorporated in British law.
His legal team had described these applications as 'a full frontal assault on the law on murder' and agreed in court it was a 'bold' approach.

Tony Nicklinson had sought and achieved massive media publicity for months beforehand, and it will doubtless continue, but the other patient linked in the hearing (Martin) had avoided publicity, and indeed had a court ruling to protect his anonymity. He was seeking more modest ends to do with assisted suicide: greater clarification from the court about the likelihood of the Director of Public Prosecutions bringing criminal charges against a health professional or solicitor who might give assistance with his suicide at Dignitas, and similar clarification about disciplinary action from professional regulatory bodies.

The Care Not Killing Alliance intervened formally in these cases via pro bono help from solicitors and counsel. The CNK submission confined itself to a succinct review of UK and European law and argument, and refused to enter the many 'controversial and easily rebuttable' arguments put forward in very lengthy submissions from both men's legal teams.

The hearing itself stayed clearly focused on principle and legal precedent. So does the judgment which rejected all the arguments to change the law. The court examined in great detail the merits of these arguments, drawing on statute law, UK and European court rulings, debates in Parliament, the European Convention on Human Rights, evidence from advocates on both sides of the debate, and expert advice from the General Medical Council and Solicitors Regulation Authority.

The three judges, Lord Justice Toulson, Mr Justice Royce and Mrs Justice Macur, acknowledged cogently that while these are two tragic cases, it would be wrong for the court to change the current law. That issue is for Parliament, which has debated and voted against law change several times in recent years.

Months before the hearing, Tony had said 'I am delighted that we can now move on to discuss the pertinent issues properly in a dispassionate court of law'. That dispassionate discussion has now happened, and disabled people are all the safer for this welcome result.

But - and it may be small comfort to Tony - I have been impressed by the compassionate approach of the court: recognizing the desperate situations of the two men, in the fairness and tone of debate, and in that the three judges watched the Channel Four documentary about Tony transmitted the night before the hearing began.

A compassionate court got it right - dispassionately.

UK court rejects euthanasia - Nicklinson and Martin cases.

The following is the media release concerning the decision in the Nicklinson case in the UK. The court decided that - even though these cases are tragic, that it is the role of parliament to change the law, and not the court. The Supreme Court of Canada needs to make the same decision in the Carter case.

Press Release: The Court has rejected the Tony Nicklinson and Martin cases.

Care Not Killing (CNK), the UK's leading anti-euthanasia campaign group, has welcomed the decision by the High Court today to reject the Tony Nicklinson and Martin cases.

Dr Andrew Fergusson, a spokesman for CNK said, "We welcome today's ruling by the High Court on the Tony Nicklinson and Martin cases, in which CNK intervened. The judgment strongly rejected the notion that voluntary euthanasia should be a defence in murder cases, saying this was not compatible with English Law, and the prohibition on assisted suicide in the UK is not contrary Article 8 of the European Convention.

"It recognises that changing the law is for Parliament alone. And it confirms the simple truth that the current law exists to protect those without a voice: the disabled, terminally ill and elderly, who might otherwise feel pressured into ending their lives."

"The Court examined in great detail the merits of the arguments for changing the law, drawing on the substantial volume of statute law, UK and European court rulings, debates in Parliament, the European Convention on Human Rights, evidence from advocates on both sides of the debate, and expert advice from professional regulatory organisations like the General Medical Council and Solicitors Regulation Authority."

"The three hugely respected and experienced judges, Lord Justice Toulson, Mr Justice Royce and Mrs Justice Macur, acknowledged cogently that while these are two tragic cases, it would be wrong for the court to change the current law, which has been debated and voted upon in Parliament frequently in recent years."

 "The ruling confirms the view that even in a free democratic society there are limits to choice. Every law limits choice and stops some people doing what they might desperately wish to do, but this is necessary in order to protect others, especially the most vulnerable in our society."

"Hopefully the decision to reject both cases will now draw a line once and for all under legal debate and allow decision makers and society to focus attention on how we care for the terminally ill and severely disabled."

For media inquiries, please contact Alistair Thompson of Media Intelligence Partners Ltd on 07970 162 225, or 0203 008 8145.


Editors Notes
Care Not Killing is a UK-based alliance bringing together over 40 organisations - human rights and disability rights organisations, health care and palliative care groups, faith-based organisations groups - and thousands of concerned individuals.
We have three key aims:
• to promote more and better palliative care;
• to ensure that existing laws against euthanasia and assisted suicide are not weakened or repealed;
• to inform public opinion further against any weakening of the law.
We seek to attract the broadest support among health care professionals, allied health services and others opposed to euthanasia by campaigning on the basis of powerful arguments underpinned by the latest, well-researched and credible evidence.

Wednesday, August 15, 2012

Euthanasia is not the answer.

The following article was written by Isaac Davison and published on August 16, 2012 in the New Zealand Herald under the title: Maggie Barry: Euthanasia is not the answer.

By Isaac Davison - New Zealand Herald - August 16, 2012

Maggie Barry
National Party MP Maggie Barry says the standard of healthcare for New Zealanders with terminal and chronic illnesses is so high euthanasia should not be considered as an alternative.

Ms Barry's All Party Parliamentary Group on Palliative Care will meet for the first time today and aims to improve MPs' understanding of the care available.

Palliative care focuses on relieving the suffering of patients with chronic or life-threatening illnesses.
Ms Barry was partly inspired to form the group after witnessing the high-quality care her parents received before their deaths.

Her father was diagnosed with cancer and stayed in Mary Potter Hospice until his death 15 years ago.
"Mum and I were able to go up there and spend time with him. I had dreaded it but it was as good as it could have been."
But her primary motivation is to oppose assisted suicide as an alternative for seriously ill patients.

She said euthanasia was part of the discussion when she chaired a working party on "Care of people who are dying", but she had concluded it was not a sensible option.

Assisted suicide is illegal in New Zealand, but Labour MP Maryan Street is working on a private member's bill that would legalise some end-of-life options.

Ms Barry said many advocates of euthanasia were unaware of the world-class palliative care available in New Zealand's 35 hospices, palliative care homes, and in hospitals.

The parliamentary group would aim to ensure palliative care remained free and would look to expand and increase hospice services.

Ms Barry said interest had been strong, with 25 MPs planning to attend the inaugural meeting.

Dangers of euthanasia spelt out.

The following article was written by John Gibb and published on August 15, 2012 in the Otago Daily News (New Zealand). Baroness Prof Ilora Finlay, a Welsh palliative care specialist, spoke about the need to protect the vulnerable. Her talk was sponsored by Hospice New Zealand, and the Otago Health Sciences Division, in association with the Otago Bioethics Centre.

Baroness Ilora Finlay

By John Gibb - Otago Daily News - August 15, 2012

Many older people could be subjected to subtle pressures to end their lives prematurely if voluntary euthanasia was made lawful in this country, Baroness Prof Ilora Finlay warned in Dunedin yesterday.

Prof Finlay, a Welsh palliative care specialist, said legalising medically assisted euthanasia and assisted suicide was likely to have significant unintended consequences.

In the Netherlands, where euthanasia was lawful, one in 45 of all deaths was now physician-assisted.

The rate of physician-assisted deaths had also risen significantly in Oregon, in the United States, since this had been legalised.

Asked about widespread problems of elder abuse, Prof Finlay said there were many subtle ways to undermine the confidence of older people, who might feel they no longer wished to be a "burden" to younger relatives, or to spend money which their relatives might otherwise inherit.

There were "dangers of subtle coercive influence" which could not be detected by others.

And depression, which, sometimes at least, was undiagnosed and untreated, could also undermine people's enjoyment of life.
"You're burdening people with a so-called choice, which is creating a sense that they ought to think about the time to end their life."
Although much media attention had been given to claimed problems with pain control, several other issues were more important for patients facing the end of their lives.

Many people tended to be "control freaks" and wished to control every aspect of their lives. They found it hard to appreciate death was part of a natural process, which was ultimately beyond their control.

She also urged a more positive view of the value of older people who sometimes felt vulnerable and under-appreciated.

By tending to push older people to one side, society was depriving itself of the accumulated wisdom, and many skills built up over many decades.

Everything should be done to ensure people could live out their remaining days with proper support and dignity.
"Everyone who's dying should have good end-of-life care."
Prof Finlay, of Cardiff University, is a former president of the Royal Society of Medicine and an independent member of the British House of Lords. She also chairs the All Party Parliamentary Group on Dying Well.
She yesterday gave a public lecture at the University of Otago, Dunedin, on "Risk Assessing Assisted Suicide and Euthanasia".

Last month, New Zealand Labour MP Maryan Street officially submitted her End of Life Choice Bill to the private member's ballot in Parliament.

Prof Finlay's visit to Dunedin has been supported by Hospice New Zealand, and the Otago Health Sciences Division, in association with the Otago Bioethics Centre.  

Users of Assisted Suicide are Seniors with Money

The following article was written by attorney, Margaret Dore, and published yesterday on the website: Massagainstassistedsuicide under the title: Users of Assisted Suicide are Seniors with Money

By Margaret Dore, Esq.

This week, a New York Times article expressed "surprise" regarding the users of assisted suicide: "They are overwhelmingly white, well educated and financially comfortable."[1] They are also age 65 and older.[2] In other words, users are older people with money, which would be the middle class and above, a group disproportionately at risk of financial abuse and exploitation.[3]  

In the United States, elder financial abuse costs elders an estimated $2.9 billion per year.[4] Perpetrators include strangers, family members and friends.[5]. The goals of financial abuse perpetrators are achieved "through deceit, threats, and emotional manipulation of the elder."[6]

The Oregon and Washington assisted suicide acts, and the similar Massachusetts proposal, do not protect users from this abuse. Indeed, the terms of these acts encourage abuse. These acts allow heirs and other persons who will benefit from an elder's death to actively participate in his or her lethal dose request.[7] There is also no oversight when the lethal dose is administered, not even a witness is required.[8] This creates the opportunity for an heir, or someone else who will benefit from the person's death, to administer the lethal dose to that person without his consent. Even if he struggled, who would know?

For more information about problems with the Massachusetts' proposal, click here and here. For a "fact check" on the proposal, click here.
 [1] Katie Hafner, "In Ill Doctor, a Surprise Reflection of Who Picks Assisted Suicide," New York Times, August 11, 2012.
[2] See e.g., the most current official report from Oregon, "Oregon Death with Dignity Act--2011" ("Of the 71 DWDA deaths during 2011, most (69.0%) were aged 65 years or older; the median age was 70 years"), available at
[3] The MetLife Study of Elder Financial Abuse, " Crimes of Occasion, Desperation, and Predation Against America's Elders," June 2011 (a follow up to MetLife's 2009 " Broken Trust: Elders, Family, and Finances"), available at
[4] Id., page 2, key findings  
[5] Id.
[6] Id., page 3.
[7] See Memo to Joint Judiciary Committee (regarding Bill H.3884, now ballot measure No. 2), Section III.A.2. ("Someone else is allowed to speak for the patient"), available at
[8] See above memo at Section III.A.1("No witnesses at the death").  See also entire proposed Massachusetts Act at