France approves terminal sedation legislation.

By Alex Schadenberg
International Chair - Euthanasia Prevention Coalition

Paris protest against euthanasia (June 24, 2014)

Politicians in France have been debated the legalization of euthanasia for many years. 

In January 2011, the French Senate rejected a euthanasia bill by 170 - 142. During the 2012 election President François Hollande promised to legalize euthanasia but since then Hollande has faced strong opposition to his plan. In June 2015, France's Senate rejected a bill that permitted euthanasia by dehydration and in October 2015, a French court decided that Vincent Lambert should continue to receive food and fluids.

The Associated Press has now reporting that French lawmakers approved a bill that allows "terminal sedation" but not euthanasia. 

According to the media report the French government approved a bill that allows doctors to sedate a person, upon request, who is nearing death, and withdraw life-sustaining treatments including nutrition and hydration (food and water). According to the article:

The new law will allow patients to request "deep, continuous sedation altering consciousness until death" but only when their condition is likely to lead to a quick death. Doctors will be allowed to stop life-sustaining treatments, including artificial hydration and nutrition. Sedation and painkillers will be allowed "even if they may shorten the person's life." 

The bill will also apply to patients who are unable to express their will, following a process that includes consultation with family members. 

The methods can involve medicating patients until they die naturally of their illness or until they starve. Some doctors, however, say it may be more human to euthanize.

I have not read the bill, but if the bill allows doctors to intentionally cause the death of a person by dehydration, when the person is not otherwise dying, then the act is "slow euthanasia" or euthanasia by dehydration. If the bill clearly limits sedation and dehydration to people who are actually nearing death, then the act is closer to palliative sedation.

The European Institute of Bioethics outlined three main concerns with the legislation:

1. The new law introduces end of life in its Article 2 to an extent that many Health professionals denounce as dangerous. "Artificial" nutrition and hydration is referred to as medical treatment and not care. As such, it can be stopped at the patient's request or following a collegial procedure if the patient can not speak. 

2. Article 3 establishes a new "right of continuous deep sedation [...] until death." Many parliamentarians, health professionals, lawyers and patient organizations have denounced this fuzzy measure as unclear in its framework and conditions it poses, which could lead to a form of masked euthanasia. Indeed, the criteria often appear subjective. The terms "commits its short-term prognosis" or "likely to cause unbearable suffering", are not defined by law. The law can then be applied to a variable conditions which creates genuine legal insecurity. 

3. We strongly denounce that ... advance directives become binding and come to impose the doctor "except in life-threatening emergencies [...] and when directives are manifestly inappropriate or inconsistent with the medical situation." The risk is that it causes a shift in the role of the doctor, possibly imposing acts contrary to the doctors ethics and his conscience.

I am concerned that the bill defines food and fluid as a form of medical treatment. Food and fluid are not medical treatment but rather normal care.

I am also concerned, that the bill allows doctors to sedate and withdraw food and water from a person who is incompetent based on an advanced directive or based on the decision of a proxy. I fear that the protocols established in this bill will be followed, when a person is deemed incompetent even when the person is not otherwise dying. 

Acts of sedation and dehydration can be ethically the same as euthanasia when the intent is not based on palliating symptoms but rather causing death.

CARP is now a pro-euthanasia advocacy group.

By Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Susan Eng

The Canadian Association of Retired Persons (CARP) under the leadership of Moses Znaimer, the former owner of CITY TV, has officially become an advocacy group promoting unfettered euthanasia.

According to an article by Gloria Galloway in the Globe and Mail, Susan Eng, the long-time Executive Vice President of CARP was fired by Moses Znaimer based on her neutral position on euthanasia and assisted suicide and replaced by Wanda Morris, the former CEO of Dying With Dignity. According to the article:

The woman who has been the public face of Canada’s leading seniors organization for the past eight years says she has been dismissed by media mogul Moses Znaimer, who is also the organization’s president, because she insisted on taking a neutral approach to the emotionally charged issue of assisted dying. 

Susan Eng was told on Tuesday that she was no longer needed as the executive vice-president of advocacy at CARP Canada. She then learned on Wednesday that she was being replaced by Wanda Morris, the head of Dying with Dignity Canada, which advocates for access to physician-assisted dying and against unnecessary barriers when safeguards are being imposed to protect the vulnerable. 

... “The only reason he fired me was so that they can put out an official position for CARP saying that they want to insist on assisted dying on demand,” said Ms. Eng, a Toronto lawyer and former chair of the city’s police services board.

Znaimer has been promoting a radical pro-euthanasia position for some time. He his written one-sided propaganda articles urging "euthanasia on demand." Znaimer also wrote an article misconstruing the Bentley case in BC, a case that concerned the issue of whether normal feeding is medical treatment. 

Many seniors are members of CARP to enjoy the travel, insurance and other benefits that are obtained through a CARP membership. Many seniors will now not renew their CARP membership or seeking an alternative organization to attain similar benefits.

Canadian seniors need to know that purchasing a membership in CARP is actually supporting a euthanasia advocacy group.

The CARP media release stated:

A New Vision of Aging for Canada, Chairman, President and CEO Moses Znaimertoday announced that Susan Eng has departed CARP effective immediately. 

Moses has also announced that Wanda Morris has been appointed as CARP’s new Vice President of Advocacy and COO. 

Most recently, Wanda was CEO of Dying With Dignity Canada (DWD Canada) where she led a strategic campaign for legislative change leading up to the Supreme Court of Canada’s decision in the ground-breaking Carter v. Canadacase for the right-to-die with dignity.

Dying With Dignity also changed its position while under the leadership of Wanda Morris. Historically, Dying With Dignity officially supported assisted suicide but opposed euthanasia. Dying With Dignity is now a radical supporter of euthanasia.

Last year Dying With Dignity lost its charitable status based on the fact that had become a political lobby group and their purpose ceased being charitable. It is possible that Znaimer hired Morris because Dying With Dignity was unable to continue paying her a competitive salary.

Honouring Kevin Fitzpatrick (OBE).

Dr Kevin Fitzpatrick

By Alex Schadenberg
International Chair, Euthanasia Prevention Coalition

Dr Kevin Fitzpatrick (OBE) passed away two weeks ago but tomorrow is his funeral.

For me, Kevin was a trusted colleague and friend who I will always miss. I learned a lot from Kevin and I will carry those lessons with me forever.

Kevin accepted many leadership roles and he was an example of what can be done when people work together. Kevin was the director of EPC - International, the director of Hope Ireland and the past director of EPC - Europe.

Spokesperson for
Not Dead Yet UK

Kevin was also a key leader with Not Dead Yet - UK and acted as their spokesperson for several of their successful campaigns.

Kevin's professional background gave his approach to the debate on how to care for and support people with terminal and incurable illnesses and disabilities a particularly well-rounded quality. From disability (Disability Wales; Disability Rights Commission; Inclusion21; Not Dead Yet UK) to adoption (the Welsh Government's Adoption Expert Advisory Group; St David's Children's Society), not to mention five years with the Welsh Ambulance Trust, Kevin's outlook was firmly rooted in seeking answers to a single question: 'how can we as a society work to support and uphold the value of every person around us?' This was his life's work, with a particular focus on the most vulnerable and marginalised. (borrowed from the Care Not Killing Alliance)

Kevin was a great communicator. Kevin wrote many articles, he did many debates, he was interviewed on countless occasions and he provided excellent conference speeches. Here are links to his recent articles:

• Judgement day in Supreme Court of Canada decision - Disability discrimination to death. (July 31, 2015).
• Opposition to euthanasia and assisted suicide based on evidence of disability discrimination. (July 2, 2015).
• Belgium euthanasia leads to a decline of society. (June 26, 2015).
• Assisted suicide for disabled people - Democracy in Britain? (June 23, 2015).
• Let's have an open, honest and balanced conversation on assisted suicide in Ireland. (May 5, 2015).
• Level headed assisted suicide debate based on real evidence not misplaced emotion. (May 4, 2015).
• Deep sedation: France is in danger of buying a deadly illusion. (March 17, 2015).
• Conversation with Terry Pratchett. (March 13, 2015).
• Canadian Supreme Court condemns disabled people to death. (February 20, 2015).
• Assisted suicide campaigners' deaths prove we do not need to change assisted suicide laws. (January 7, 2015).

Hope Ireland conference

Kevin was a collaborator. Kevin knew that success came through activating many people who have different perspectives. Kevin knew that there were many reasons to oppose euthanasia and assisted suicide. He was most comfortable speaking from his personal experience with disability, but he was also incredibly effective at reaching out to multiple political points of view.

Kevin was a leader. Kevin knew the direction that we needed to go and he shared his wisdom with everyone who he worked with. He had a way of listening to perspectives and carefully correcting false ideas. Several leaders have shared with me the way that Kevin would help them and advise them in their advocacy. He was a patient leader, even when he didn't agree.

Launching EPC Europe in Brussels

Kevin was a family man and my friend. My experience with Kevin was that he put the needs of his family, especially his wife Fabienne, before himself. He was proud of his children, Terry, Gerry and Sue. He was sick for sometime, but he shared with me his concern for his family and placed them ahead of himself.

There are so many people who experienced Kevin, as a gifted friend, in their lives. I for one, will always be thankful for the opportunity of having him in my life.

Belgium 2015 euthanasia report: Deaths continue to rise.

By Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The 2015 Belgian euthanasia data indicates that the number of euthanasia deaths continue to increase. According to the Belgian media, in 2015, there were 2021 reported deaths by euthanasia, up from 1924 reported euthanasia deaths in 2014.

But Wim Distelmans, the chairman of the euthanasia commission reminded the media that they cannot say for certain the actual number of euthanasia deaths. Distelmans stated:

"Remember, there could be some euthanasia cases carried out but which are not declared so we cannot say for certain what the number is,"

Distelmans remarks are confirmed by research published in the New England Journal of Medicine (NEJM) on March 19 2015 concerning the euthanasia practice in Belgium which indicated that:

• 4.6% of all deaths in 2013 in the Flanders region were euthanasia. 
• .05% of all deaths in 2013 in the Flanders region were assisted suicide.
• 1.7% of all deaths in 2013 in the Flanders region were hastened without explicit request.

First: The data uncovered significant under-reporting of euthanasia in the Flanders region of Belgium. The official 2013 euthanasia data found that 2.4% of the deaths in the Flanders region were euthanasia, while the study examining all deaths found that 4.6% of the deaths in the Flanders region were euthanasia. Therefore nearly half of the euthanasia deaths in the Flanders region of Belgium were not reported.

In January 2014, Dr Marc Cosyns, was quoted by De Standard news saying that he never reports his euthanasia deaths, even though it is a requirement of the Belgian euthanasia law.

Second: The data uncovered a significant cultural problem in with Belgian physicians hastening deaths without request. The Associated Press article reporting on the NEJM study interviewed Belgian ethicist Freddy Mortier as stating:

Mortier was not happy, however, that the 'hastening of death without explicit request from patients,' which can happen when a patient slumbers into unconsciousness or has lost the capacity for rational judgment, stood at 1.7 percent of cases in 2013. In the Netherlands, that figure was 0.2 percent.

There were 61,621 deaths in Flanders in 2013. The study reported that 1.7% of all deaths were hastened without explicit request, therefore it is likely that more than 1000 people died by a doctor intentionally causing their death without explicit request in 2013.

There were several controversial Belgian euthanasia cases in 2015. 

• In June we learned that Psychiatrist, Dr Lieve Thienpont had approved the euthanasia death of a 24-year-old physically healthy woman who was living with suicidal ideation. The good news is that Emily has decided to live.
• In October the euthanasia death of Simona de Moor was sent for a review. It is likely that the review occurred because Dr Van Hooy agreed to have the decision making process and the death filmed.

In 2014, Belgium extended euthanasia to children. Distelmans stated that there were no reports of child euthanasia in 2015.

Euthanasia in Belgium has been approved for people with dementia, people with depression and other psychiatric conditions, 

The dark history of eugenics.

This article was written by Michael Cook and published by Bioedge on January 23.

By Michael Cook

The dark history of government-sponsored eugenics before World War II has largely been forgotten, although it is well documented. A new book, Illiberal Reformers: Race, Eugenics, and American Economics in the Progressive Era (Princeton UP, 2016), by Thomas C. Leonard, is a painful reminder that some of the best minds in the United States and Britain were in favour of purging the “race” of “defectives”.

The heyday of the eugenics movement was during World War I and the 1920s. Some geneticists distanced themselves from eugenics, but usually because it had been tainted by racism and anti-Semitism.

Eugenics was literally regarded as a religion by leading economists. In 1915 Irving Fisher, one of the greatest of the early 20th century, told a Race Betterment Conference organised by cornflakes inventor and eugenicist John Henry Kellogg, that eugenics was “the foremost plan of human redemption”. Religious opponents (notably the Catholic Church) were a shrinking minority which had also opposed Copernicus, Galileo and Darwin.

It all seemed very scientific. In The Great Gatsby, F. Scott Fitzgerald’s famous novel, the central character complains that civilization is spinning apart and that “ if we don’t look out the white race will be — will be utterly submerged. It’s all scientific stuff; it’s been proved.”

D.H. Lawrence, best known as the author of Lady Chatterley’s Lover, believed that inferior stock should be eliminated. Anticipating the horrors of Auschwitz, he wrote in 1905:

If I had my way, I would build a lethal chamber as big as the Crystal Palace, with a military band playing softly, and a Cinematograph working brightly; then I’d go out in the back streets and main streets and bring them in, all the sick, the halt, and the maimed; I would lead them gently, and they would smile me a weary thanks; and the band would softly bubble out the ‘Hallelujah Chorus’.

Leonard’s focus is the effect of eugenics upon economics, so he also covers discrimination against African Americans, disputes between labour and capital and immigration.

Charles Lewis: Challenging religious leaders to do more.

B

Cardinal von Galen fought the
Nazi euthanasia program.

y Charles Lewis

Our religious leaders are missing something. I might dare to say they are failing. They are forgetting that shouting is needed in the midst of a disaster. It is sometimes the only solution when no one seems to be listening.

We are now in the home stretch of attempting to keep euthanasia illegal, which given the indications is not likely. Nor will it end if we lose. There will be much work to be done to make euthanasia irrelevant. But that will come later.

For now, Quebec has already put the needle in at least one person's arm. They killed a patient even though our Criminal Code says it is illegal. Instead our federal government, under both Harper and now Trudeau, coming down like a ton of bricks on Quebec they have remained silent.

Let me correct that. Harper remained silent but Trudeau has been encouraging, essentially saying to the Quebec's pro-euthanasia ghouls that we support your right to murder.

So now is the time for the yelling to start. Now is the time for an uncompromising reaction to what is surely the most indecent thing our country will have ever done.

And yet I still keep waiting for our religious leaders to rally their respective flocks to stop this madness. For anyone who is out there doing this please accept my apologies. But in the main it is not happening.

I was told by a priest he would love to have me speak but there were so many other things going on. My worst experience was the priest who said he was too busy ordering the Easter flowers. If I were a nasty man I might have said you might have missed your true vocation by not becoming a florist.

What I hear all the time, particularly in my own Catholic Church, is that there are many things our religious leaders must do. They are being pulled in 20 different directions. And so all must be given equal treatment.

But why? Why can they not decide that this is the emergency? When hurricanes or tornadoes or earthquakes do their damage civil authorities make the rescue and clean up a priority. Everything else can wait, as what is before them is life and death. What a scandal it would be if a civic leader said, “I’m busy right now. Let me get back to you.”

The coming legalization — and I pray to God it will not happen — is no different. Legalized euthanasia will be a blight in which lives will be lost and those family and friends of those who choose state-sanctioned killing will be devastated.

It is not enough to issue a letter. No one reads letters except a few like-minded people. And sometimes journalists who are looking for a story.

What we need, what I beg our religious leaders to do, is  raise voices: on Sundays, in press conferences, in radio and television interviews. The time for being coy or conservative has long left the station. We need people of great moral influence to tell their people that to support euthanasia is a grave sin. They need to say that at this moment in our history this is the priority. They need to make us believe, as some of us already do, that this will change the nature of our country from one of care to one that is indifferent.

How much longer will it take? How bad does this have to get for the voices of truth and compassion to be heard over the din of those who dare to call government approved suicide "death with dignity?"

In the past two years I have done about 40 talks. Perhaps I spoke to about 2,000 people. If a Bishop holds a press conference it would reach many more than 2000 in just a few minutes.

In every talk I said the same thing: do not think about winning or losing but rather stand up for the right thing.

I now ask our religious leaders to do the same thing … not once, not twice but as long as it takes to start changing the minds of the very people who should know better. For the love of God, please.

Charles Lewis is a freelance journalist and the former reporter at the National Post.

Psychiatrist: Assisted suicide - More than meets the eye.

By Alex Schadenberg

Executive Director - Euthanasia Prevention Coalition

Dr Steven King

An article written by Psychiatrist, Dr Steven King, and published in the Psychiatric Times examines assisted suicide from a scientific point of view.

King begins his article by stating that he is not religious and he is not pro-life, that his concerns are based on science.

I am not a Catholic nor do I have any particularly strong religious beliefs. I am strongly pro–abortion rights and believe that adults should be able to marry whomever they wish regardless of gender. I also believe that it is highly unethical for physicians to impose their religious or political views on their patients and allow these to affect how they care for them. However, I do have major concerns about the RTD laws. 

My concerns are based on science, not religion. As a pain medicine specialist and psychiatrist, I believe that the already existing laws and those that have been proposed have major holes that could result in people requesting death because of potentially treatable health problems.

King examines the assisted suicide laws based on their inability to protect depressed patients.

Psychiatrists have proper concerns about making sure that no patient who requests death is allowed to die if the request is the result of a treatable mental illness such as depression. All the RTD laws seek to prevent this: they require that if the attending physicians believe a mental disorder is a potential factor in the request, they need to make a referral to a mental health specialist, usually defined in the laws as a psychiatrist or licensed psychologist. 

Any psychiatrist who has been involved in consultation/liaison psychiatry can readily recognize inherent problems in the laws. Most non-psychiatrist physicians have limited training in mental illness, so relying on them to identify such illness is a chancy proposition.

King explains why many people who ask for assisted suicide in Oregon are not being assessed for depression.

Furthermore, when it comes to terminally ill patients, there is a widespread perception that depression is normal and that there is no need to address it. The executive editor of the New England Journal of Medicine once wrote, “Dying patients who request assisted suicide and seem depressed should certainly be strongly encouraged to accept psychiatric treatment, but I do not believe that competent patients should be required to accept it as a condition of receiving assistance with suicide.” Some physicians fear that referring patients to psychiatrists and psychologists is an insult to the patients by indicating it is felt that they are considered “crazy.” A study from Oregon found that of those who died under its RTD law in 2014, fewer than 3% were referred for a mental health evaluation.

King continues by explaining that people continue to receive poor pain and symptom management, even after requesting assisted suicide.

The RTD laws also acknowledge the possibility that untreated pain can be a major factor in requests for death and seek to ensure that pain will be addressed. Again, how the laws deal with the issue is troubling. For example, the California law requires that the patient’s attending physician present “feasible alternatives or additional treatment options, including, but not limited to, comfort care, hospice care, palliative care, and pain control” [italics added]. This all sounds fine. The problem is that every study of which I am aware has shown that pain is often poorly managed, including in terminally ill patients. 

It has bothered me that many proponents of RTD laws choose to overlook this, preferring to leave the impression that this isn’t a problem and that every terminally ill person receives expert palliative care. When confronted with the evidence of the reality of deficiencies in pain management, they acknowledge it is a problem that needs to be corrected but that it shouldn’t stop the passage of RTD laws.

King continues by explaining how people who are in pain are more likely to seek suicide, but also how some of the pain killing drugs lead to a higher risk for suicide.

Another complicating factor is that not only has pain itself been associated with increased risk of suicide, but so have some of the most commonly used analgesic medications for severe pain, including opioids and antiepileptic drugs.4 Untreated pain or fear of it is far from the only reason for suicide requests but—along with a desire not to be a burden to others, fears about loss of autonomy, and depression and hopelessness—it is one of the most common.

King then explains the widespread problem of uncontrolled pain.

Pain is a widespread problem in this country. A recent study by the National Center for Complementary and Integrative Health found that over 25 million American adults reported having daily pain for at least the previous 3 months and that over 40 million experienced severe or very severe pain during that time.

King concludes:

I recently attended a debate on RTD laws, and during the question period I brought up the issue of inadequate pain management. The participants on both the pro and con sides agreed this needed to be improved, and at the end of the debate the moderator, a medical ethicist, said that this seemed to be the one thing all could agree on. Left unsaid was why states aren’t passing laws to ensure this.

The Euthanasia Prevention Coalition believes in caring for people and not killing them. Legalizing euthanasia or assisted suicide leads to abandoning of people at the most vulnerable time of their life.

New Study Shows: Assisted Suicide may be a Poison Pill at the Polls

A recent study by Dr Jacqueline Harvey and published by the Charlotte Lozier Institute shows that support for assisted suicide may have negative consequences for politicians who support assisted suicide.

Opposition to assisted suicide has historically been bi-partisan with over 99.9%, more than 175 bills in 34 states and the District of Columbia since 1991 have been rejected or quietly ignored by lawmakers, since there was little to indicate if constituents would reward them with votes - or if they would be risking re-election by championing an issue that divides Americans virtually in half. Fortunately science may finally have some answers on how voters respond to assisted suicide at the polls.

New research out of Tarleton State University, recently presented at the 2016 Southern Political Science Association Conference combed through all 180 of the 2014 Vermont races, as well as 2015 repeal efforts to determine if there were any risks or rewards when vying for election associated specifically with a candidate’s position for or against assisted suicide. Entitled “Assisted Suicide at the Polls: Risks & Rewards Associated with Voting to Legalize Assisted Suicide vs. Maintaining the Status Quo,” and available at the Charlotte Lozier Institute found that a candidate’s position on assisted suicide may present potential risk without reward for those in favor, or potential reward without risk for those opposed.

Supporting suicide reduced the likelihood of re-election for lawmakers in Vermont, the first state to pass an assisted suicide bill, Act 39 in 2013 and the only state yet to hold elections. Opposing assisted suicide presented no such risk, but may have aided challengers who unseated six pro-assisted suicide politicians - including the primary sponsor of the bill. An endorsement the state-level pro-assisted suicide political action committee, Patient Choices Vermont showed no reward for politicians.

Risks of losing an election were limited exclusively to those who supported assisted suicide and campaigned on this position, a total of six seats lost to anti-assisted suicide successors. Candidates opposing assisted suicide had no risk, and none were unseated by the opposition. Most notably, one of the casualties of the 2014 elections was the bill’s primary sponsor, Linda Waite-Simpson. Rather than rewarded for her efforts, she was replaced by a newcomer who voted to repeal.

Furthermore, if candidates opposing assisted suicide also campaigned (like those who were pro-assisted suicide), candidates opposed to assisted suicide showed a potential reward factor of nine seats, while pro-assisted suicide candidates still showed no reward factor, but the pro-assisted suicide risk factor increased to seven seats. This was statistically significant (p=.00087) with a strong relationship (v=1).

Overall, support for assisted suicide is not a winning campaign issue. Considering the casualties, assisted suicide may even be political suicide.

Euthanasia contagion - it exists!

The writer asked to remain anonymous for the privacy of the family. 

My grand-mother is 95 years old. She lives in a nursing home in Belgium, and we, her family, live on another continent. Last year, she became critically ill and told us she wanted to ask for euthanasia. Her doctor was against the idea, and then her health improved. We then used technology to better stay in touch with her. After that, she stopped talking about requesting euthanasia.

This year, on her birthday a few weeks ago, when we gave her best wishes, she said that the best wish would be that this was her last birthday. She was quite depressed after spending Christmas and New Year on her own. But we kept in touch with her, with several video calls each week. Her spirits lifted, she was happy, enthused and appeared relaxed on recent calls with her.

Today, she informs us that her only real friend at the residence, a “young woman of 75”, had requested euthanasia and her request had been approved on the basis of Parkinson’s. She is to be killed tomorrow.

My grand-mother is now extremely upset and distressed. She spoke about losing her only friend. She spoke of feeling alone and isolated. She spoke of the fact that maybe it was time for her to look at euthanasia again.

How many other residents in that home are feeling similarly? How many requests for euthanasia will happen in that nursing home in the next few weeks?

I have no hard data about “contagion effect”, but I see the very real impact her friend’s upcoming euthanasia has on my grand-mother.

There is no support in place for the residents. No one to speak to them, or to reassure them, other than the odd group presentation about why euthanasia is a good idea. (Link to previous article).

Meanwhile, in Canada, there is a Committee looking at how to implement “aid in dying”. And so far, we aren’t seeing anything about addressing the impact the “assisted death” of a nursing home resident would have on others, or the impact on the family left behind. We can’t let this go unaddressed.

• My patient became actively suicidal after watching a Britany Maynard video.

Opinion: Doctors should not Kill.

There are ethical reasons why physicians are instructed to do no harm to their patients.

This opinion column was published in the Toronto Sun on Jan 23, 2016.

Opinion: Dr Irvin Wolkoff

As a doctor, I have a question about assisted suicide that has not been clearly answered: Who will perform the procedures resulting in someone else’s death?

To look at the news, you would think it will automatically be doctors.

The media refer to this voluntary ending of life as “physician assisted suicide”, or “doctor assisted death” and — this phrase makes me cringe — “medical death”.

The Canadian Medical Association has engaged in the public dialogue about assisted death, but I’m not aware that it, federal or provincial governments, doctors’ licensing and regulating bodies, or anyone else has already decreed the people who will help very sick patients to die will be doctors.

It’s just assumed doctors will do it. Why?

There are practical obstacles to engaging doctors to carry out assisted suicides. For example, where would we find the doctors we’d need?

Canada’s physician population isn’t large enough to care for our growing and aging population as it is and governments are constantly cutting back funding to the facilities, procedures, treatments, medications and working conditions we need to do our jobs properly.

Will Canadians be happy to see scarce medical resources shifted from medical services to assisted suicide?

Canadian physicians have no training in assisting suicide or complying with whatever legal regime is set up to permit it. How will this be organized and paid for in an age of huge cuts to medicare budgets?

More important is the moral impact on the medical profession of making doctors the designated death providers of their patients.

In Greece, in the fifth century BCE, my medical colleague, Hippocrates, established ethical guidelines for physicians which ethical doctors follow to this day, including this crucial one:

“With regard to healing the sick … I will take care that they suffer no hurt or damage. Nor shall any man’s entreaty prevail upon me to administer poison to anyone; neither will I counsel any man to do so.”

In short, ethical doctors aren’t supposed to kill their patients or help them kill themselves, even in the service of supposedly noble goals.

I understand many Canadians accept that physicians who help their very sick patients die in accordance with their wishes are not murderers.

But putting doctors in charge of killing their patients assumes there will be no corrosive effect on medical ethics over time, as the practice becomes more common and accepted.

Why? Most doctors are professionals but medical skills alone do not guarantee doctors are immune from corruption.

Once we start doctors down the slippery slope of inducing death, how far is to Dr. Jack Kevorkian, who felt he was above the law when it came to helping people commit suicide, just as some doctors will ignore the law’s restrictions when it comes to legally assisted suicide?

How much further to Dr. Guy Turcotte, who fatally stabbed his five-year-old son and three-year-old daughter a total of 46 times, and was recently found guilty of second-degree murder?

How much further to Dr. Ayman al Zawahiri, the pediatric surgeon currently running al-Qaida, or Dr. Basher al-Assad, the ophthalmologist and citizen-slaughtering president of Syria?

Or to history’s most notorious killing physician, Josef Mengele, the “angel of death” at Hitler’s Auschwitz death camp?

Inevitably, I believe, the public’s association of doctors with killing, even for the supposedly benign purpose of euthanasia, will negatively impact on how the public perceives the medical profession.

The assumption by our courts and politicians that doctors are immune from corruption when it comes to killing their patients is naive and dangerous.

A year ago, the Supreme Court of Canada unanimously struck down the Criminal Code ban on assisted death, giving Parliament 12 months to create a new law to regulate the process.

Recently, the court extended this ban by four months to give Parliament more time, but added it will allow applications for assisted deaths in the interim, suggesting a sense of urgency in the matter.

What is being ignored is that a doctor’s legitimate role in assisted suicide should be strictly confined to conducting careful clinical assessments, to identify those who satisfy the criteria for a legal, voluntary death.

But it should be someone else, not doctors, who pushes the plunger.

Similar articles:

• British nurse sentenced to life for killing two patients and poisoning twenty more.
• Dr Harold Shipman, euthanasia without request or consent.
• Medical serial killer: I thought I was helping.
• Legalizing euthanasia would cover-up murders.

Scher: Stringent safeguards needed for assisted dying law.

The following article was published by Advocate Daily on January 22, 2016.

T

Hugh Scher

he only way for the federal government to bring in an assisted suicide law is to ensure there are adequate protections from the prospect of abuse, says Toronto human rights and constitutional lawyer Hugh Scher.

Psychiatric, vulnerability and palliative care assessments should all be required, along with universal access to palliative care for all people seeking assisted suicide — something that is not currently available, he says.

“A person’s choice should never be to suffer to death or kill yourself, and there’s no reason in Canada why that needs to be the case,” says Scher, of Scher Law, who has spoken and consulted widely on the topic of assisted suicide and end of life practices.

The Liberal government has struck a committee that will be tasked with looking at how to implement a doctor-assisted death law, after the Supreme Court last week added a four-month extension to the government’s deadline to come up with new legislation.

Scher expects he will be called as an expert witness before a joint committee of Parliament in the coming weeks.

In a landmark decision last February, Carter v. Canada (Attorney General), 2015 SCC 5, the high court recognized the right of consenting adults enduring intolerable physical or mental suffering to access assisted suicide.

Scher calls the four-month extension “sensible” given the change in government, but he says the time period is “extremely short.”

“It’s going to make it that much more difficult for the federal government to conduct a fulsome, broad consultation on the issues in order to determine the best and most appropriate way to respond to the Supreme Court’s decision in Carter,” Scher tells AdvocateDaily.com.

“The notion of a short extension combined with an exemption of the euthanasia regime in Quebec almost serves as a tacit acknowledgement of the appropriateness of the Quebec euthanasia regime as a model in Canada when, in my view, nothing could be further from the truth.”

Scher, who represents the Euthanasia Prevention Coalition, which is an intervener in both the Quebec and Supreme Court cases, says the Quebec euthanasia regime represents perhaps the broadest and “the most dangerous of regimes of its kind in the world.”

Quebec's law includes improved palliative care, which he says he supports, but it also implements what he calls a "Belgian-style" euthanasia regime, which has seen people killed without consent, and contrary to clear legislative provisions of second opinions, reporting, and consent.

He says the Supreme Court’s decision in Carter seems to mandate a broad approach, but then asserts Parliament’s mandate and authority to construct a safe and rigorously enforced series of safeguards.

Scher says it is ultimately up to Parliament to determine the most appropriate way to regulate assisted suicide, not the provinces or the Courts.

A requirement of judicial oversight, similar to what is now in place during the four-month extension where individuals can apply to the court for a declaration of compliance with established requirements is essential, if assisted suicide is to have a chance of safe implementation in Canada, as mandated by the Supreme Court, Scher adds.

“A model of effective, before-the-fact judicial oversight is perhaps the only way to ensure a level of adherence to the established safeguards, and to ensure a level of oversight with regard to compliance in a way that will hopefully assess and identify vulnerability, and at the same time ensure that safeguards are adhered to.”

Absent such an approach to effective before-the-fact judicial oversight, Canada is doomed to repeat the mistakes and horrible tragedies reflected by multiple unrequested killings in Belgium, he says.

Canadian Anestesiologists warn: Assisted Death is not simple.

By Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Dr Cheryl Mack

An article by Sharon Kirkey and published in today's National Post reports on an article published in the Canadian Journal of Anestesia outlining the problem with and reactions to the drugs that are used for euthanasia and assisted suicide. Kirkey reports:

Canada’s anesthesiologists, doctors who work every day with some of the drugs commonly used in euthanasia and assisted suicide, are warning hastened death may not always result in a peaceful exit. 

They say patients could experience convulsions, or a longer-than-expected “time to death,” or “awakenings” while the fatal cocktail of drugs take effect. 

Some are even questioning whether they — or any other doctor — ought to be involved at all, and recommend the task be left instead to “euthanists” or some other group.

Kirkey continues her article with her information from her interview with Dr Cheryl Mack, one of the authors of the article:

Mack, chair of the clinical ethics committee for University of Alberta hospitals, said she and her co-author don’t object, in principle, to a “rational” suicide. “But that’s assuming, of course, we can distinguish between what is a rational suicide, and what is an irrational one.”

... Patients can respond to drugs differently and in unanticipated ways. Dosing is based on careful titration and monitoring of the patient, she said. “We can foresee potential complications.”

For example, with assisted suicide, where the doctor prescribes a fatal drug overdose the patient takes himself, “depending on what kind of safeguards are in place, and who’s present, you can have reactions to overdose — convulsions, vomiting, aspirations,” Mack said. “We could actually have patients incurring harm that they may not have anticipated.”

Kirkey then examines her article by looking at the reality of euthanasia:

During surgery, “We take a lot of care with our monitoring and our assessment of the patient to judge depths of anesthesia,” Mack said. But if an error is made during euthanasia — and the muscle relaxant injected before the person is in a coma deep enough to prevent feeling the effects — he or she could die by suffocation while paralyzed, but conscious.

Guidelines for doctors in Quebec, where the first deaths from euthanasia have been reported since the act became legal in that province in December, state that while the risk of loss of consciousness being “inadequate” or too brief is low, the drugs may be less effective if the IV catheter isn’t inserted properly, or the drugs injected too slowly.

“The other concern is, how do you establish a standard of care for assisted death? How do you judge competency?” Mack said. She performs hundreds of anesthesia procedures a year to maintain her competency. “What would that look like for assisted death?”

If Canada follows the experience in the Netherlands, where euthanasia and assisted suicide make up about three per cent of total yearly deaths, deaths from “PAD” — physician-assisted death — could number more than 7,000 a year in Canada, Ottawa anesthesiologist Dr. Miriam Mottiar estimates.

“I think a lot of people feel uneasy with the entire concept of this,” said Dr. Susan O’Leary, president of the Canadian Anesthesiologists’ Society. “This is not what we intended when we became anesthesiologists.”

Alex Schadenberg

The Supreme Court of Canada, in my opinion, made their decision based on a philosophical point of view, rather than legal and human realities.

Not only will there be problems with the use of the euthanasia "drug cocktail" but, if the experience with euthanasia in Belgium and the Netherlands is examined, we will also expect there to be significant abuse of the euthanasia law.

Legalizing euthanasia gives physicians the legal right to kill you. Not only are the drugs that are employed in the act a problem, but also, the act itself should never be accepted because it permits killing people at their most vulnerable time of their life.

Why Physicians Should Oppose Assisted Suicide

By Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

The Journal of the American Medical Association (JAMA), in its current edition, published a series of articles concerning palliative care, end-of-life treatment and assisted suicide.

Dr. Y Tony Yang and Dr. Farr A Curlin offered their insights as to Why physicians should oppose assisted suicide. Dr. Yang is affiliated with George Mason University and Dr. Curlin is affiliated with Duke University.

In their article, Yang and Curlin focus on why people ask for assisted suicide and why physicians should not support or participate in assisted suicide. They begin their article with the following:

That we are debating this question of whether physician-assisted suicide is ever justifiable shows how far medicine has shifted toward redefining the role of the physician. If the medical profession accepts physician-assisted suicide, it will be declaring decisively that "physicians" are mere providers of services to be guided only by the desires of the individual patient, the will of the state or other third parties, and what that law allows.

They continue by examining the difference between palliative care and assisted suicide:

While acknowledging that death may come sooner as a side effect of palliation, physicians pledge never to intentionally hasten the patients' death. ... Yet with physician-assisted suicide, the physician is to disregard what is perhaps the most universal moral injunction - do not kill (emphasis is mine) - and wrtie a lethal prescription with the express intent of helping patients kill themselves.

Yang and Curlin then explain why people in Oregon ask for assisted suicide:

Evidence, nevertheless, indicates that calls for physician-assisted suicide are not mainly driven by the experience of pain or other refractory symptoms. ... reports from Oregon that found patients requesting physician-assisted suicide reported being concerned about "losing autonomy" (91.5%), being "less able to engage in activities making life enjoyable" (88.7%), "loss of dignity" (79.3%), "losing control of bodily functions" (50.1%) and being a "burden on family, friends/caregivers" (40%). Only 1 in 4 (24.7%) even reported "concern about" inadequate pain control.

They continue by examining what options already exist for patients and what assisted suicide actually represents:

Patients already have the right to refuse life-sustaining treatment. They have the right to proportionate palliation, even if death is hastened as a side effect. They also have the liberty to end their lives by all manner of methods that do not involve physicians. With respect to physician-assisted suicide, the "right to die" is a euphemism for the putative "right to have a physician help me kill myself." (emphasis is mine)

The writers then examine the issue of the trust relationship between patients and physicians:

"Physician-assisted suicide is fundamentally inconsistent with the physician's professional role." (emphasis is mine) If the physician were solely service providers who accomodated the self-determining choices of patients, then physician-assisted suicide would be logical, if assisted suicide were justified. ... Rather the physicians professional role is to attend to those who are sick and debilitated ... There would be no profession of medicine but for human beings' shared vulnerability to illness. There can be no practise of medicine if patients do not trust physicians to care for them when they cannot care for themselves.

Yang and Curlin continue by showing how the physicians role extends in society:

And herein is the conflict. Insofar as physicians enjoy societal trust, it is because since Hippocrates, physicians have maintained solidarity with those who are sick and disabled, seeking only to heal and refusing to use their skills and powers to do harm. This is why Doctors Without Borders treats injured Taliban soldiers. It is why physicians have refused to participate in capital punishment, or to be active combatants, or to cooperate with torture. It is why physicians have refused to help patients commit suicide.

They then re-examine the trust relationship between patients and physicians:

The boundary against intentionally causing the patient's death, however, gives patients a reason to trust physicians while also giving physicians the freedom needed to perform their duties and responsibilities... Rather than posing an obstacle to compassionate care, this boundary creates a space in which physicians can act freely and decisively to palliate distressing symptoms. (emphasis is mine) Without this commitment, patients have good reason to be concerned that morphine that leads to sedation is dosed not in proportion to the pain but in an effort to hasten death.

Yang and Curlin conclude:

In sum, physician-assisted suicide is never justifiable. It is never justifiable because it always violates the injunction not to kill. It is never justifiable because it unjustly patronizes the desires of the few who request physician-assisted suicide over the needs of the much larger number larger number... Physician-assisted suicide contradicts the physician's professional role and undermines the distinctive solidarity with those whose health is diminished that makes the practise of medicine possible. ... physicians should oppose the legalization of physician-assisted suicide and steadfastly refuse to condone or participate in it.

JAMA simultaneously published an opposing point of view titled: Responding to patients requesting Physician Assisted Death.

Lewis: Four months is not enough for a debate on euthanasia.

By Charles Lewis

Just like everyone who has taken a role in trying to combat euthanasia, I am well aware of the poll numbers on societal support for government-sponsored killing. But numbers, no matter how high, lay flat on a page. They carry no emotion and nor do they reveal the depth of support. Someone's "yes" may be weaker than another person's "yes."

I got a real taste of what real enthusiastic support for assisted suicide sounds and feels like. 

Last week, Bill Maher, the most obnoxious liberal talk show host in history of media, was interviewing California's Deputy-Governor, Gavin Newsom. Newsom, a Democrat, is tall, boyish and handsome with a full head of dark hair. He already has said he'll runs for governor and do not be surprised if his name pops up shortly after that as a likely presidential candidate. He is Kennedyesque, as Americans like to say.

Maher's interview was more of a love in. He and Newsom share the same views on a host of issues, including easy access to abortion, limiting carbon dioxide emissions and, as it turns out, assisted suicide. Newsom listed his government's accomplishments to which the audience responded with polite applause to every item ticked off. But they saved their most explosive applause for when Newsom noted legalized assisted suicide as one of those achievements.

It is not a surprise that those sitting in the studio to watch Maher lean left. Nor is it a surprise that Maher and his audience support assisted suicide — though I will never understand why legalized assisted suicide became such an American liberal project.

In the past, American liberals were an important driver of such things as civil rights, equal protection under the law, fair hiring, equal work for equal pay and voting rights for the country's black citizens, the right to health care. Most will agree that these causes were justified and life affirming.

But now the liberal banner has turned from life affirming to life ending. Newsom grinned when the audience thundered its support for killing patients. What was he grinning about? Should not someone with an ounce of morality still feel some regret about taking the life of anyone, especially someone who is innocent? Perhaps a good man might have frowned, and silenced the audience with a wave of his hand. He might have said this is nothing to celebrate. He might have added: The taking of a life is always tragic. He could have made the case that assisted suicide is an awful but needed response to what he sees as a tragic situation. Finally, he could have gone out of his way to assure his audience that he and his government would ensure that the new law be used only in the most extreme situations.

I would not have become a supporter of assisted suicide if he followed my fantasy script but at least I might have been assured that this misguided legislation was at least approached with the care and gravitas it deserves. But no: The Maher audience became a rally for death.

It is important to keep this in mind as we come down the stretch in Canada. The court gave our Liberal government a four month extension to come up with new legislation that reflects the court's Feb. 6 2015 decision to strike down the nation's ban on euthanasia.

Four months is not enough. It is not enough for debate and not enough so every Canadian gets to here a full debate on the issue — something that amazingly enough has not yet happened. But perhaps the supporters of euthanasia in Canada are as enthusiastic as their like-mined brothers and sisters in California. If that turns out to be the case, then God save us.

Charlie Lewis was a journalist for 33 years and a former columnist with the National Post.

Previous article by Charles Lewis:

• Opinion: No cooperation with killers in euthanasia and assisted suicide.

Canadian Doctors Abject Surrender to Euthanasia

This article was published by Wesley Smith on his blog on January 17, 2016.

Wesley Smith

By Wesley Smith

The complete and abject acquiescence of the Canadian medical establishment to their Supreme Court’s order transforming doctors from healers into killers is both disheartening and astonishing. 

One of the most radical transformations in the role of the doctor in medical history is moving forward with such enthusiasm, that doctors appear to be on the verge of allowing patients to tell them when a diagnosable medical condition is “grievous” and “irremediable,”–meaning that even if re-mediating treatment is available and the patient doesn’t want it, they can be killed. 

And all doctors will have to be complicit–either by doing the deed or being a death doctor pimp by finding one who they know will. 

Look at what the head of Nova Scotia’s College of Physicians and Surgeons has to say about that. From the Herald News story: 

Grant said a grievous and irremediable medical condition is subjective and “viewed through the lens of the patient.”  “It is the patient’s subjective experience that determines whether the condition is grievous,” he said. “It is the patient’s subjective decision as to whether the condition is irremediable to treatments that the patient would be willing to go through.”  

He acknowledged that this is an area of great uncertainty for doctors. “These are words that we don’t use very often in medicine — grievous and irremediable — and we’re now being tasked to participate in a decision of enormous consequence that hinges on those words.”  

While no doctor can be compelled to assist in a patient’s death, the draft document says an effort should be made to refer a patient to a willing doctor. 

During World War II, the Nazi occupiers tried to force Netherlander physicians to become death doctors and participate in that country’s euthanasia policies. Those courageous doctors refused and engaged in total noncooperation. Some were sent to concentration camps, from whence some did not return. But the peaceful civil disobedience won the day–against Nazis! 

What would those heroes think of the Canadian medical establishment? Disgusted and ashamed.