Not Dead Yet Testimony Opposing Hawaii Assisted Suicide Bill

This article was published by Not Dead Yet on February 27, 2018

Testimony Of Diane Coleman, JD, President/CEO of NOT DEAD YET

Opposing Hawaii Assisted Suicide Bill HB 2739

Judiciary and Health and Human Services Committees

Submitted February 26, 2018

Diane Coleman

I am a severely disabled woman, and head up the national disability group, Not Dead Yet, which has members in Hawaii. I’ve spent a lifetime advocating for the rights of disabled people, young and old, to control our own lives and not have our choices dictated by doctors and other professionals. So you might wonder why I oppose a bill that is widely portrayed as giving people choice and control over their own death.

But who actually has choice and control under assisted suicide laws? Anyone could ask their doctor for assisted suicide, but the law gives the authority to doctors to determine who is eligible. More importantly, the purported “safeguards” to prevent mistake, coercion and abuse are empty window dressing, with little substance or effect.

One of the most frequently repeated claims by proponents of assisted suicide laws is that there is “no evidence or data” to support any claim that these laws are subject to abuse, and that there has not been “a single documented case of abuse or misuse” in Oregon during the 18 reported years. These claims are demonstrably false.

Regarding documented cases, please refer to a compilation of individual cases and source materials pulled together by the Disability Rights Education and Defense Fund entitled Oregon and Washington State Abuses and Complications.[1] For an in-depth analysis of several cases by Dr. Herbert Hendin and Dr. Kathleen Foley, please read Physician-Assisted Suicide in Oregon: A Medical Perspective.[2]

Moreover, revisions to last year’s bill in the 2018 bill do nothing to address the fundamental deficiencies identified below.

The focus of the discussion below is the Oregon Health Division data.[3] These reports are based on forms filed with the state by the physicians who prescribe lethal doses and the pharmacies that dispense the drugs. As the early state reports admitted:

“As best we could determine, all participating physicians complied with the provisions of the Act. . . . Under reporting and noncompliance is thus difficult to assess because of possible repercussions for noncompliant physicians reporting to the division.”

Further emphasizing the serious limits on state oversight under the assisted suicide law, Oregon authorities also issued a release in 2005 clarifying that they have No authority to investigate Death with Dignity case.[4]

Nevertheless, contrary to popular belief and despite these extreme limitations, the Oregon state reports substantiate some of the problems and concerns raised by opponents of assisted suicide bills.

Non-Terminal Disabled Individuals Are Receiving Lethal Prescriptions In Oregon

The Oregon Health Division assisted suicide reports show that non-terminal people receive lethal prescriptions every year except the first.

The prescribing physicians’ reports to the state include the time between the request for assisted suicide and death for each person. However, the online state reports do not reveal how many people outlived the 180-day prediction. Instead, the reports give that year’s median and range of the number of days between the request for a lethal prescription and death. This is on page 11 of the 2017 annual report.[5] In 2017, at least one person lived 603 days; across all years, the longest reported duration between the request for assisted suicide and death was 1009 days. In every year except the first year, the reported upper range is significantly longer than 180 days.

The definition of “terminal” in the statute only requires that the doctor predict that the person will die within six months. There is no requirement that the doctor consider the likely impact of medical treatment in terms of survival, since people have the right to refuse treatment. Unfortunately, while terminal predictions of some conditions, such as some cancers, are fairly well established, this is far less true six months out, as the bill provides, rather than one or two months before death, and is even less true for other diseases. Add the fact that many conditions will or may become terminal if certain medications or routine treatments are discontinued – e.g. insulin, blood thinners, pacemaker, CPAP – and “terminal” becomes a very murky concept. Recent published emails from the Oregon Public Health Department have confirmed that a person who becomes terminal because they do not receive treatment for any reason, including lack of insurance coverage, would qualify for assisted suicide under the Oregon law.[6]

The state reports that non-cancer conditions found eligible for assisted suicide has grown over the years, to include: neurological disease, respiratory disease, heart/circulatory disease, infectious disease, gastrointestinal disease, endocrine/metabolic disease and, in the category labeled “other”, arthritis, arteritis, sclerosis, stenosis, kidney failure, and musculoskeletal systems disorders (pages 10-11).

In addition, it should be noted that the attending physician who determines terminal status and prescribes lethal drugs is not required to be an expert in the disease condition involved, nor is there any information about physician specialties in the state reports.

The Only Certifiers of Non-Coercion And Capability Need Not Know the Person

Four people are required to certify that the person is not being coerced to sign the assisted suicide request form, and appears capable: the prescribing doctor, second-opinion doctor, and two witnesses.

In most cases over the years, the prescribing doctor is a doctor referred by assisted suicide proponent organizations. (See, M. Golden, Why Assisted Suicide Must Not Be Legalized,[7] section on “Doctor Shopping” and related citations). The Oregon state reports say that the median duration of the physician patient relationship was 10 weeks in 2017, and 13 weeks over all years (page 11). Thus, lack of coercion is not usually determined by a physician with a longstanding relationship with the patient. This is significant in light of well-documented elder abuse-identification and reporting problems among professionals in a society where an estimated one in ten elders is abused, mostly by family and caregivers. (Lachs, et al., New England Journal of Medicine, Elder Abuse.[8])

The witnesses on the request form[9] need not know the person either. One of them may be an heir (which would not be acceptable for witnessing a property will), but neither of them need actually know the person (the form says that if the person is not known to the witness, then the witness can confirm identity by checking the person’s ID).

So neither doctors nor witnesses need know the person well enough to certify that they are not being coerced.

No Evidence of Consent or Self-Administration At Time of Death

In about half the reported cases, the Oregon Health Division reports also state that no health care provider was present at the time of ingestion of the lethal drugs or at the time of death. Footnote six clarifies:

“A procedure revision was made mid‐year in 2010 to standardize reporting on the follow‐up questionnaire. The new procedure accepts information about time of death and circumstances surrounding death only when the physician or another health care provider is present at the time of death. This resulted in a larger number of unknowns beginning in 2010.”

While the only specific example mentioned is the “time of death,” other “circumstances surrounding death” include whether the lethal dose was self-administered and consensual at the time of death. Therefore, although “self administration” is touted as one of the key “safeguards”, in about half the cases, there is no evidence of consent or self-administration at the time of ingestion of the lethal drugs. If the drugs were, in some cases, administered by others without consent, no one would know. The request form constitutes a virtual blanket of legal immunity covering all participants in the process.

Moreover, the addition of a form that is supposed to be signed by the patient, with no witness, within 48 hours of the administration of the lethal drugs does not add meaningful protection from involuntary administration by another person in the absence of an independent witness to the act. This form is just another bit of window dressing.

Pain Is Not the Issue, Unaddressed Disability Concerns Are

The top five reasons doctors give for their patients’ assisted suicide requests are not pain or fear of future pain, but psychological issues that are all-too-familiar to the disability community: “loss of autonomy” (91%), “less able to engage in activities” (90%), “loss of dignity” (76%), “losing control of bodily functions” (46%), and “burden on others” (44%) (page 10).

These reasons for requesting assisted suicide pertain to disability and indicate that over 90% of the reported individuals, possibly as many as 100%, are disabled.

Three of these reasons (loss of autonomy, loss of dignity, feelings of being a burden) could be addressed by consumer-directed in-home long-term care services, but no disclosures about or provision of such services is required. Some of the reported reasons are clearly psycho-social and could be addressed by disability-competent professional and peer counselors, but this is not required either. Moreover, only 4.9% of patients who request assisted suicide were referred for a psychiatric or psychological evaluation, despite studies showing the prevalence of depression in such patients.

Basically, the law operates as though the reasons don’t matter, and nothing need be done to address them.

Conclusion

The Oregon assisted suicide data demonstrates that people who were not actually terminal received lethal prescriptions in all 20 reported years except the first, and that there is little or no substantive protection against coercion and abuse. Moreover, reasons for requesting assisted suicide that sound like a “cry for help” with disability-related concerns are apparently ignored. Thus, the data substantiates problems with the implementation of assisted suicide laws and validates the concern that the risks of mistake, coercion and abuse are too great. Well-informed legislators on both sides of the aisle should vote against assisted suicide bill.

Please vote NO on HB 2739.

[1] https://dredf.org/wp-content/uploads/2015/04/Revised-OR-WA-Abuses.pdf

[2] https://dredf.org/wp-content/uploads/2012/08/Hendin-Foley-Michigan-Law-Review.pdf

[3]http://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year20.pdf

[4] https://dredf.org/wp-content/uploads/2012/08/Oregon-DHS.pdf

[5]http://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year20.pdf

[6] https://www.washingtontimes.com/news/2018/jan/11/diabetics-eligible-physician-assisted-suicide-oreg/

[7] https://dredf.org/public-policy/assisted-suicide/why-assisted-suicide-must-not-be-legalized/

[8] http://www.nejm.org/doi/full/10.1056/NEJMra1404688

[9]http://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/pt-req.pdf

Veneer of euthanasia is being peeled back in Belgium

This article was published by OneNewsNow on February 23, 2018.

Alex Schadenberg

Records show an increasing number of people in Belgium are being euthanized without having agreed to it.

In the most recent case, a bedridden mental health patient was euthanized after his family members requested it. The patient had never given a hint that he would want doctors to kill him and was incapable of consent. According to Alex Schadenberg of the Euthanasia Prevention Coalition, it was publicly reported and the doctor was not prosecuted.

"This has caused a fair amount of division within the whole euthanasia lobby and organizations within Belgium," he reports. "... One doctor who's a palliative care physician has resigned his position with the euthanasia commission because it just did not fit what was considered acceptable practice for euthanasia in Belgium."

It's not the only case. Schadenberg explains a fair amount of unrequested euthanasia is occurring in that country

"We see that in a study that was released looking at all deaths in 2015," he states. "There were 431 euthanasia deaths without request – and a study from 2013 in Belgium showed that in the Flanders region there were over a thousand."

OneNewsNow has reported on other cases, in Belgium and the Netherlands, where psychiatric patients are being euthanized, including a 29-year-old woman who was physically healthy but mentally not so. She was killed by her doctor.

Schadenberg says public knowledge of such cases is starting to "take away the veneer" being told the public that euthanasia merely brings on loving and peaceful death. "Which, of course, is a lie," he adds.

Paediatric Palliative Care Symposium and child euthanasia?

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Petition: "I Oppose Euthanasia for Children."

Canada legalized euthanasia and assisted suicide (known as MAiD) on June 17, 2016. Canada's euthanasia law required persons to be at least 18 years old and have a condition where "natural death is reasonably foreseeable," whatever that means, before doctors can go ahead with euthanasia.

Soon after the legalization of (MAiD), the Canadian government announced that the Council of Canadian Academies would examine extending euthanasia to children, people who are incompetent but have made an advanced request, and people with mental illness.

Last October, the Canadian Paediatric society published a study examining euthanasia for teens, young children, and newborns. I am concerned that study was designed to open the door to euthanasia for children.

Now the Biennial Provincial Symposium on Paediatric Palliative Care (at Sick Kids Hospital in Toronto on April 25) will feature a break-out session titled: "Developing a policy on Medical Assistance in Dying (MAiD) for Paediatric Patients." 

By the way, wine and cheese will follow.

I fear that either the Council of Canadian Academies has already decided to extend euthanasia to paediatric patients or the Canadian Paediatric Society has decided that euthanasia will be extended to children and newborns and is using this Symposium to develop a policy for when the killing begins.

Why are they so interested in euthanasia for children? Children can't choose and their autonomy is questionable. Well, children with disabilities are often seen as "better off dead." If you don't believe me, go to the Not Dead Yet website.

No, this is not about a "slippery slope" but rather an incredibly fast incremental extension. Remember, the law is not concerned with choice and autonomy but rather the rules that the doctor should follow before killing. Whether it be incompetent people, competent people or children, lethal injection is lethal injection and the decision is made by the doctor.

Netherlands euthanasia researchers recently advocated for child euthanasia, with or without consent in the Journal Pediatrics.

As I have stated before - Choice and autonomy are only slogans for selling the act.

Petition: "I Oppose Euthanasia for Children."

Learn more about euthanasia and assisted suicide. Order the Euthanasia Deception documentary.

Langley BC Hospice says NO to Euthanasia.

This article was published by National Review online on February 23, 2018

Wesley Smith

By Wesley Smith

Assisted suicide/euthanasia is completely contrary to the hospice vision espoused by the late great medical humanitarian Cecily Saunders, who created the modern hospice movement. She stood steadfastly against assisted-suicide legalization. Indeed, suicide prevention is one of hospice’s most fundamental services, I would say close in importance to pain control. As Saunders told me when I had the great honor of interviewing her in London, assisted suicide denies the intrinsic dignity of hospice patients.

Sign the petition: British Columbia Health Authority orders hospice to do euthanasia.

Alas, in recent years some U.S. hospice organizations have been weak-kneed in defending the hospice philosophy against assisted-suicide predation. Too often, movement leaders — not wanting to be controversial — have gone “neutral” on legalization. That is an abdication of duty and an abandonment of hospice patients and their families. Some hospices even participate in assisting suicides where it is legal.

This is also happening in Canada where lethal-injection euthanasia was recently legalized. Religious hospices have pushed back and received some exemptions from having to participate. Now Langley Hospice — hooray! — a secular hospice in British Columbia is saying no to euthanasia based on the philosophical precepts of the hospice movement itself.

Langley had previously required a patient seeking euthanasia to transfer out before being killed. It is apparently part of Fraser Health, which buckled and changed the policy to permit euthanasia on premises. The board of directors of Langley have pushed back. From the Langley Hospice Board of Directors statement (my emphasis):

• The Langley Hospice Society will continue to uphold our constitution, bylaws and mandate to provide palliative care for dying people and their families in a supportive environment, which means that we plan to continue upholding our founding mission and philosophy of care that we value life and accept death as a normal process and that we “neither hasten nor postpone death.”
• The Langley Hospice Society recognizes the right for all Canadians to have access to information about end-of-life options, including MAiD. However, we do not recognize that this right is a superior right to the recognized philosophy of hospice and palliative care. We do not believe that MAiD should be implemented in hospices…
• We are concerned about the adverse consequences, emotional and otherwise that the Fraser Health December 2017 directive has had; first and foremost to the patients, clients and families we serve and also, to our Langley Community, Donors, Potential Donors, Hospice Volunteers and Staff…
• We believe that as a non-faith based hospice, Fraser Health should provide Langley Hospice with the same “exemption option” it has provided to faith-based hospices as the Fraser Health mandate is in direct opposition to our mission and philosophy to “neither hasten nor postpone death.” Not granting an exemption to do so is discriminatory.

Precisely. Hospice is not “hemlock.” Whether the hospice is religious or secular, no hospice should participate in the killings or suicides of its patients. And certainly, they should never be forced to so do.

Let’s hope their courage stiffens the spines of our own domestic quavering hospice administrators.

Not Dead Yet: The Opioid Crisis the News Isn’t Talking About

Response to RFI – Opioid Public Health Emergency[1] 

February 20, 2018

We are members of Not Dead Yet, a national grassroots disability rights organization, and some of us are living with chronic pain ourselves. Based on our knowledge of the disability community through personal experience and through our work, we have not seen disabled people with chronic pain experiencing opioid use disorder. What we are seeing is many disabled people who are suffering due to the lack of access to opioid medication[2]  previously available as part of comprehensive strategies and approaches to address chronic pain. They are experiencing an increase in chronic pain and other symptoms associated with that pain. Disabled people and others with chronic pain are rarely the ones who are abusing opioids,[3] but they are the ones who are having to deal with chronic pain symptoms without access to medications that made this pain more tolerable.

That is not to say that some disabled people will not have opioid use disorder. However, from our observation, chronic pain is not a causal factor[4] in who has abused opioids. Instead, opioids are a mitigating factor in how independent those with chronic pain are able to be. Having to deal with chronic pain with no relief, when opioid medication prevented such pain, can greatly affect the quality of life[5] disabled people with chronic pain have. It can affect their ability to perform activities of daily living. It can affect their ability to sleep. It can affect their mood. It can affect their productivity. Those with chronic pain that is untreated or mistreated are more likely to be depressed,[6] and depression itself can also be linked[7] to physical pain. Being depressed and in pain can also make disabled people more susceptible to suicidal ideation,[8] especially when there is seemingly no relief to the long-term pain they experience.

For some disabled people, opioids are the only medication or treatment that can help their pain. Now, those who have chronic pain are treated with suspicion,[9] as though they are abusing opioids, especially by medical personnel at doctors’ offices and hospitals when they seek out this medication. Doctors are increasingly afraid and unwilling[10] to prescribe opioids, so instead of continuing effective treatment for those who have seen great benefits from using these medications, too often doctors are essentially abandoning those who truly need access to opioids.

Opioid abuse is a problem, but it is not a problem for the overwhelming majority[11] of the disability community or others with chronic pain. It’s a problem for those who have already been abusing these medications. Those are typically not people who need these medications to handle long-term chronic pain.

Yet, as sometimes misguided approaches to addressing the opioid crisis are hastily undertaken across the country, the very individuals, who benefit greatly in terms of health and productivity from continued opioid use as part of a comprehensive pain management strategy, are the people who face the most scrutiny and harm by not having access to medically necessary and appropriate medication.

HHS/ACL must recognize the harmful effects of a misguided crackdown on the legitimate use of opioids for chronic pain, educate state governments and providers about research on this issue, and discourage federal, state and local programs that do more harm than good in addressing the opioid crisis.

[1] https://www.acl.gov/sites/default/files/about-acl/2018-01/Final_RFI_Opioid_Use_Disorder_PwD_Jan2018.pdf
[2] Andrew Rosenblum, et al., Opioids and the Treatment of Chronic Pain: Controversies, Current Status, and Future Directions (2008)https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2711509/
[3] Maia Szalavitz, Opioid Addiction Is a Huge Problem, but Pain Prescriptions Are Not the Cause (Scientific American, May 10, 2016)https://blogs.scientificamerican.com/mind-guest-blog/opioid-addiction-is-a-huge-problem-but-pain-prescriptions-are-not-the-cause/
[4] Michael A, Yokell, et al., Presentation of Prescription and Nonprescription Opioid Overdoses to US Emergency Departments (Jama Intern Med, Dec 2014)https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1918924
[5] McCarberg BH, et al., The impact of pain on quality of life and the unmet needs of pain management: results from pain sufferers and physicians participating in an Internet survey (Am J Ther 2008) https://www.ncbi.nlm.nih.gov/pubmed/18645331
[6] Bair MJ, et al., Depression and pain comorbidity: a literature review, (Arch Intern Med, Nov 2003) https://www.ncbi.nlm.nih.gov/pubmed/14609780
[7] Madhukar H. Trivedi, M.D., The Link Between Depression and Physical Symptoms (Prim Care Companion J Clin Psychiatry, 2004)https://www.ncbi.nlm.nih.gov/pmc/articles/PMC486942/
[8] Beverly Kleiber, et al., Depression and Pain (Psychiatry, May 2005) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3000181/
[9] Chronic pain patients say opioid crackdown is hurting them (Chicago Tribune, June 5, 2017) http://www.chicagotribune.com/lifestyles/health/ct-opioid-patients-backlash-met-20170603-story.html
[10] Kelly K. Daneen, et al., Between a Rock and a Hard Place: Can Physicians Prescribe Opioids to Treat Pain Adequately While Avoiding Legal Sanction? (Am J Law Med 2016)https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5494184/

[11] Nobel M, et al., Opioids for long-term treatment of noncancer pain (Cochrane, Jan 2010) http://www.cochrane.org/CD006605/SYMPT_opioids-long-term-treatment-noncancer-pain

Expanding Assisted Suicide: Legal Safeguards and Burdensome Obstacles

This is part of the article written by Nancy Valko and published on her blog on February 21, 2018.

Nancy Valko

By Nancy Valko

Already there are impatient calls to expand medically assisted suicide and euthanasia.

Thaddeus Pope, JD, PhD, the influential Director of the Health Law Institute and Professor of Law at the Mitchell Hamline School of Law in Saint Paul, Minnesota and writer of the Medical Futility Blog, wrote an article last December titled “Medical Aid in Dying: When Legal Safeguards Become Burdensome Obstacles” for the American Society of Clinical Oncology Post. (According to ASCO, it “has taken no official position on medical aid in dying”.)

Mr. Pope notes the “uniformity and similarity” of the six current medically assisted suicide statutes but brings up four so-called “safeguards” affecting the “next-generation issues: the justifiability of prevailing eligibility criteria and procedural requirements” that will allegedly need to be addressed. (Emphasis added)

The first is “Expanding From Adults to Mature Minors” which Mr. Pope characterizes as “unduly restrictive” in part because “Many states already allow terminally ill mature minors to withhold or withdraw life-sustaining treatment”. (Emphasis added)

Mr. Pope’s second issue is “Expanding From Contemporaneous Capacity to Advance Directives”, stating that “All six statutes require that the patient concurrently have both a terminal illness and decision-making capacity. But this dual mandate excludes many patients who have no other exit options” such as those with “advanced dementia”. (Emphasis added)

The third issue he cites is “Expanding From Terminal Illness to ‘Reasonably Predictable’” because:

“(T)his rigid time frame excludes patients with grievous and irremediable conditions that cause suffering intolerable to the individual. Some medical conditions may cause individuals to irreversibly decline and suffer for a long period before dying. Instead of demanding a strict temporal relationship between a medical condition and death, these statutes might be more flexible and instead require that death be ‘reasonably predictable’.” (Emphasis added)

Mr. Pope’s final issue is “Expanding From Self-Ingestion to Physician Administration”:

“First, it excludes patients who lose the ability to self-administer before they otherwise become eligible. Second, self-ingestion is associated with complications. For example, around 3% of these patients had difficulty ingesting or regurgitated the medication. Other patients regained consciousness after ingestion.” (Emphasis added)

And, as in most of the previous issues, Mr. Pope approvingly cites the rapidly expanding assisted suicide situation in Canada:

“Canadian patients avoid all these problems (with self-ingestion), because physicians usually administer the medication. As a result, only 5 of more than 2,000 Canadian patients who used medical aid in dying self-ingested the lethal medication.” (Emphasis added)

Ironically, there is one so-called “safeguard” that Mr. Pope would like to see tightened:

“that the prescribing or consulting physician refer the patient “for a mental health specialist assessment” if “there are -indications of a mental disorder.” Yet prescribing and consulting physicians have referred only 5% of medical aid in patients who are dying. Leading experts argue that this rate is probably too low relative to the expected rate of impaired judgment. Others are “surprised by how rarely the prescribing or consulting physicians refer patients for a psychiatric consultation.” (Emphasis added)

This discrimination in suicide assessment is not acceptable for any suicidal person-except now, of course, for a person requesting medically assisted suicide.

Conclusion

Without a strong resistance movement, these proposals are only just the next step in the death agenda. So far, much of the public, government officials and medical professionals have been shielded from the real truth by euphemisms and false reassurances from assisted suicide supporters, a mostly sympathetic mainstream media and often spineless professional and health care organizations. We all must educate ourselves to speak out before it is too late.

Moral Disengagement – Mechanisms Propelling the Euthanasia/PAS Movement

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Fabian Stahle

Fabian Stahle, the Swedish researcher who recently uncovered hidden problems with the Oregon assisted suicide model, now explains the mechanism of the euthanasia lobby to change the concept of killing through the mechanism known as Moral Disengagement.

The Journal of Medical Ethics in Mental Health published (January 30, 2018) Stahle's research article: Moral Disengagement – Mechanisms Propelling the Euthanasia/PAS Movement.

It is difficult to write a summary of Stahle's substantial article. I encourage you to read it.

Stahle examines Albert Bandura's theory of Moral Disengagement to explain, based on social cognitive theory, how a social justification for acts that are otherwise considered inhumane become accepted over time.

The abstract to Stahle's article clearly explains the importance of the article:

The international movement that promotes the legalisation of euthanasia/physician-assisted suicide (PAS) is propelled by highly potent psychological mechanisms to overcome the resistance to its agenda. It is all about cognitive restructuring to justify inhumane actions. These are always in use when normal, well-socialised persons are coerced into accepting and participating in the killing of fellow human beings. Various scientific studies, pioneered by Albert Bandura, have shown that participators are able to endure their deeds by activating these powerful mechanisms of moral disengagement.

However, those who make use of such mechanisms pay a high price. These mechanisms have a personality-changing power that dehumanizes the perpetrators. For the society that has allowed itself to be manipulated by such mechanisms for the purpose of systematizing “death on demand”, there are also serious consequences. These consequences can be described in terms of dehumanization and brutalization of that society as a whole.

Fabian Stahle explains:

Osofsky et al.: “Operating at the behavior locus are three separate disengagement mechanisms that convert the construal of injurious conduct into righteous conduct. In moral justification, worthy ends are used to vindicate injurious means … Second, by the use of sanitizing euphemistic language, injurious conduct is rendered benign … Exonerative comparison with even more flagrant inhumanities is a third mechanism for cloaking injurious behavior in an aura of benevolence.

The second set of disengagement mechanisms operates at the agency locus by obscuring or minimizing the perpetrator’s agentic role in an injurious activity. Under displacement of responsibility, people view their actions as stemming from the dictates of authorities rather than being personally responsible for them … Because they do not perceive themselves to be the main causal agent of their actions, they are spared self-condemning reactions. The exercise of moral control is also weakened when personal agency is obscured by diffusing responsibility for injurious conduct…

The weakening moral control at the outcome locus is achieved by minimizing or disregarding the harmful consequences of one’s action. As long as the injurious outcomes are ignored, minimized, or disbelieved there is little reason for moral self-regulation to be activated.

The final set of disengagement mechanisms operates at the locus of the recipients or objects of detrimental acts through dehumanization and attribution of blame. Self-censure for injurious conduct can be disengaged or blunted by divesting people of human qualities, or by attributing demonic and bestial qualities to them ... Blaming the recipients of injurious treatment for bringing suffering on themselves also serves self-exonerating purposes.”

Stahle also comments on the social effect of medicalizing euthanasia and assisted suicide.

For the euthanasia movement, this medicalization is a crucial disengaging maneuver in moving forward. But just this maneuver is especially harmful, by reason of the fact that it is aimed at the care-giving sector of our communities, which makes it a devastating stab wound in the very heart of a humane society.

The use of language is just as important for opposing assisted suicide. When our opposing to euthanasia and assisted suicide also leads to a medicalization, then we are in fact helping the euthanasia lobby.

Stahle ends his article by writing:

Albert Bandura's theory of moral disengagement has been applied for a long time in in-depth analyses of various harmful activities. Nevertheless, the theory has not received much attention in the study of the euthanasia movement's activities. This theory has great significance in explaining the euthanasia/PAS phenomenon, and might have the potential to publicly de-mask the euthanasia movement. 

This can be done by conducting an in-depth scientific analysis of the disengagement mechanisms in the euthanasia movement’s various activities. Such an analysis would provide much clarity and depth of insight into an activity that is shrouded in deep obscurity and could be a contributing factor in exposing the actual driving forces behind its progress. A more thorough study should also be undertaken concerning the dehumanizing effect on the functionaries in the practice of euthanasia/PAS. 

The results of the studies then need to be popularized so that they become digestible for mass media, politicians, authorities, and the general public.
But first and foremost, the medical profession should be informed about the implications of Bandura's theory on the entire euthanasia/PAS movement and of the harmful effect their participation will have on their personal and professional integrity.

Fabian Stahle first informed us of the uncovered hidden problems with the Oregon assisted suicide model, now Stahle explains the mechanism that the euthanasia lobby has employed to change the concept of killing through a mechanism known as Moral Disengagement.

I am taking Stahle's research seriously and the Euthanasia Prevention Coalition is responding to the respect, equality and integrity of the human person through the lens of Moral Disengagement theory.

Journal of Medical Ethics in Mental Health (January 30, 2018): Moral Disengagement – Mechanisms Propelling the Euthanasia/PAS Movement.

Belgian euthanasia dispute erupts over the killing of a person with severe dementia

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Ludo Vanopdenbosch

A dispute has erupted in Belgium after a person with dementia was killed by euthanasia even though the person did not request death by lethal injection and was incapable of consenting.

The division has grown since Dr Ludo Vanopdenbosch, a palliative care specialist, resigned from the Belgian euthanasia commission. 

Maria Cheng wrote in an article published by the Associated Press that Vanopdenbosch explained in his resignation letter that:

The most striking example took place at a meeting in early September, ... when the group discussed the case of a patient with severe dementia, who also had Parkinson's disease. To demonstrate the patient's lack of competence, a video was played showing what Vanopdenbosch characterized as "a deeply demented patient." 

The patient, whose identity was not disclosed, was euthanized at the family's request... There was no record of any prior request for euthanasia from the patient.

According to Cheng, the dispute questions whether the hastened death was euthanasia:

Some experts say the case as documented in the letter amounts to murder; the patient lacked the mental capacity to ask for euthanasia and the request for the bedridden patient to be killed came from family members. The co-chairs of the commission say the doctor mistakenly reported the death as euthanasia.

Believe it or not, Dr. An Haekens, psychiatric director at the Alexianen Psychiatric Hospital in Tienen said:

"It's not euthanasia because the patient didn't ask, so it's the voluntary taking of a life,"

This appalling case of euthanasia without request is not the first dispute. Cheng wrote that:

The AP revealed a rift last year between Dr. Willem Distelmans, co-chair of the euthanasia commission, and Dr. Lieve Thienpont, an advocate of euthanasia for the mentally ill. Distelmans suggested some of Thienpont's patients might have been killed without meeting all the legal requirements. Prompted by the AP's reporting, more than 360 doctors, academics and others have signed a petition calling for tighter controls on euthanasia for psychiatric patients.

The euthanasia dispute among Belgian doctors is long overdue. A Belgium government sponsored study examining deaths in the Flanders region of Belgium (2013) concluded that 4.6% of all deaths were hastened without request. The data indicates more than 1000 people died by hastened death without request in 2013 in the Flanders region of Belgium.

Recent reports indicate that palliative care professionals in Belgium have resigned due to pressure to participate in euthanasia. 

Legalizing euthanasia gives physicians, the right in law, to end the lives of their patient.

The dispute relates to the fact that the Belgian euthanasia law gives doctors the power to decide, the power to act and the requirement to self-report their acts. The commission is only analyzing deaths that have already occurred.

By the way, the same system exists in Canada, the Netherlands, Oregon, Washington State, etc. All of these laws are designed to be abused.

• Belgium: Euthanizing the mentally ill.
• Belgian study indicates that euthanasia death are continually rising.

Non - voluntary euthanasia/organ harvesting - Coming soon to the Netherlands.

This article was published by National Review online on February 15, 2018

Wesley Smith

By Wesley Smith

It is legal in the Netherlands for doctors and psychiatrists to lethally inject the sick, disabled, elderly, and mentally ill who ask to die. 

It is not legal for them to kill patients who have not repeatedly asked to die. 

But that happens anyway, and not rarely. Various studies come up with different numbers, but it seems safe to say that hundreds of patients–431 in 2015–are killed each year non-voluntarily, which in Dutch euthanasia-speak is called ”termination without request or consent.” 

Technically, that’s murder under Dutch law, but so what? I know of no case in which any meaningful sanction was imposed on a doctor who killed a patient without consent. 

And now, in 2020 the Dutch are going to institute a “presumed consent” law, meaning that everyone is legally an organ “donor” unless they explicitly opt out. From the DutchNews.nl story: 

The Dutch senate on Tuesday narrowly voted in favour of a new law to change the Dutch organ donation system to a ‘yes unless’ register. The new system will apply to everyone over the age of 18 and registered as resident in the Netherlands with their local authority, including foreign nationals. 

The government plans to send letters to people with options they want regarding donation. Silence will be considered consent. 

So, that means a patient could very conceivably be both killed and harvested without having requested it. 

Oh Wesley! You alarmist! You slippery slope hysteric! That will never happen. 

Right. That’s what my critic also said when I predicted in 1993 that legalizing euthanasia/assisted suicide would eventually lead to conjoined killing and harvesting “as a plum to society.” 

For those with eyes to see, let them see.

British Columbia (BC) Health Authority orders hospice to do euthanasia.

Alex Schadenberg

Executive Director, Euthanasia Prevention Coalition

Sign the Petition: Killing Conscience Rights in BC Hospitals and Hospices.

The recent edict by the Fraser Health Authority in British Columbia ordering (non-religious) healthcare facilities to participate in euthanasia (MAiD) including hospices is an infringement on the conscience rights of the medical staff. I believe that:

Institutional conscience rights are about the rights of the workers within an institution to not participate in acts that they consider wrong.

Delta Hospice

The edict by Fraser Health directly effects institutions such as the Delta Hospice that is opposed to participating in euthanasia. Janice Strukoff, an administrative leader with the Delta hospice stated:

“Hospice palliative care is not about hastening death and we object to the bullying currently taking place in B.C.,”

Nancy Macey, the founder and executive director of the Delta hospice stated:

MAiD can be a traumatizing experience for staff, patients, and volunteers, and all groups might not want to stay or work there if the principals of palliative care are compromised. Hospices are already grappling with a shortage of health professionals so compelling the society to provide MAiD could exacerbate the problem.

Dr Neil Hilliard

In response to the order by the health authority, Delta hospice rejected the order and Dr Neil Hilliard, the medical director of the Fraser Health Palliative Care stated in his resignation letter:

Providing euthanasia or physician-assisted suicide is not in accordance with palliative care (which) “affirms life and regards dying as a normal process …”

Last weekend a meeting in Langley BC concerning the forcing of euthanasia upon medical facilities against the staff decision to not participate in MAiD. 

Sign the Petition: Killing Conscience Rights in BC Hospitals and Hospices.


The meeting attracted 300 people and featured federal MP Mark Warawa and provincial MLA Mary Polak, along with representatives from the Fraser Health Authority. At the meeting Warawa commented that the battle to protect conscience rights: "is not over. It's just begun." Warawa also stated:

“That (permitting MAiD) will destroy palliative care as it has developed,”

Mary Polak

Mary Polak was forthright in her comments by stating:

“To say that you are going to place medical assistance in dying — or let’s call it what it is, killing people. Sorry, but that is what it is — (and decide that) you’re going to put that into a hospice palliative circumstance, is to completely contradict what palliative care is to begin with,”

The decision of the Fraser Health Authority also affects plans to build a new hospice in Langley. Kathy Derksen, the executive director of the Langley hospice stated:

When MAiD was first law, Fraser Health consulted with stakeholders and agreed it would not be imposed on hospice and palliative care facilities.

Healthcare workers conscience rights have become a national issue in Canada. Recently, an Ontario Court decided that doctors who oppose euthanasia must participate by doing an "effective referral" for euthanasia.

Dr Will Johnston eloquently explained the pressures that are faced by medical professionals in his article: The alarming trend of forcing hospitals and hospices into doing assisted suicide.