Friday, August 31, 2018

The case for assisted suicide is inherently flawed.

This article was published by the Economist Magazine on August 28, 2018.

Kevin Yuill is author of the book: Assisted Suicide - The Liberal, Humanist Case Against Legalization.

Professor Kevin Yuill
The case for assisted suicide seems to consist of terrible stories of people dying protracted, painful deaths and prevented by a cruel law from gaining the relief they seek. But this is not always accurate. As the official reports in Oregon and Washington show, pain is not in the top five reasons why people opt for assisted deaths. It is fear that dominates people’s concerns: of loss of autonomy, loss of enjoyment of life’s activities and loss of dignity. I believe these fears are curable, even if the underlying disease that robs people of such functions is not.
Kevin Yuill: Assisted suicide and the false concept of autonomy.
Lord Falconer characterised the existing law as “incoherent and hypocritical”. But that description seems more apposite for many of the arguments for changing the law. There is an Orwellian self-deception in the idea that “assisted dying” is a safe, healthy way of dying compared to “violent” suicide. But the violence inherent in suicide comes not from the method used, but from the extinction of life from a body.

Then there is the unresolvable problem of where to draw the line. The orthodox argument, ably expressed by Lord Falconer, has it that we should draw the line at six months. But this doesn’t add up. If we argue that the relief of suffering is the most important issue, then six months to live is utterly random; people who have more time clearly suffer. As Lord Neuberger, the president of Britain’s Supreme Court between 2012 and 2017, said in relation to Tony Nicklinson, a man with locked-in syndrome who campaigned unsuccessfully for the right to die: “There seems to me to be more justification in assisting people to die if they have the prospect of living many years a life that they regarded as valueless, miserable and often painful, than if they have only a few months to live.”

When should someone be allowed to help someone else to die? The moral essence of the question concerns our attitude towards suicide. Is it okay in some instances, when someone is really suffering? When they have certain horrific diseases? When they are over 70, as a bill proposed by the Dutch government would have it? Or should we approve it whenever someone says they are suffering unbearably?

My case is not against suicide per se. Though most suicides are tragedies, others, such as that of Captain Oates, who sacrificed himself for the good of his comrades on the ill-fated Scott expedition to the South Pole in 1912, are beautiful acts, the epitome of selflessness, duty to one’s fellows and courage.

Our attitude to suicide is necessarily ambivalent. All free, competent adults should be free to make the decision whether or not to live. I disagree with my good friend Peter Saunders when he says “we recognise that personal autonomy is not absolute.” In relation to the decision to commit suicide, it must be (and with assisted suicide, it is not).

Anyone determined enough to do so will likely take their own life, regardless of laws. I am on record as supporting the removal of what I see as the patronising prevention of competent adults getting their hands on deadly drugs. It is the assistance—the complicity of the community in the death of a human being—that is the problem.
Kevin Yuill: Legalizing assisted suicide is dangerous. Just look at Canada.
Kevin Yuill lectures in history at the University of Sunderland, in the UK, and is the author of Assisted Suicide: The Liberal, Humanist Case Against Legalisation

Thursday, August 30, 2018

Dutch Minister of Health comments on forced euthanasia.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Hugo de Jonge, the Dutch Minister of Health condemns forced euthanasia.

Medish Contact reported that de Jonge was responding to the case of a doctor who killed a woman who resisted the euthanasia death when he stated: (google translated)
The holding or fixing of a patient prior to the execution of euthanasia, with the aim of preventing the patient from resisting, is and may not be part of the execution of euthanasia. That is what Minister Hugo de Jonge of VWS says in a letter to the House of Representatives, in which he responds to the current discussion about euthanasia in the case of incapacity.
The woman resisted euthanasia so the doctor put a sedative in the woman's coffee and then the doctor had the family hold her down. Medish Contact continued(google translated)
de Jonge also refers in the letter to the case of a demented woman, in whom the geriatric specialist added a sedative to the coffee prior to euthanasia to put her to sleep. The family also helped to hold the patient after she raised herself from her bed. de Jonge states that coercion for euthanasia pertinently is not in accordance with a responsible performance practice. He points out that in such a case two laws apply. Firstly, the euthanasia law (Wtl) and secondly the law for care and coercion. Only with the Law of Care and Compulsion are there exceptions to voluntariness and thus act without permission. Involuntary care, writes de Jonge, may only be used as a last resort. In addition, a step-by-step plan must be followed and external expertise must be engaged. With euthanasia there can be no question of care within the meaning of the Care and Compulsion Act, because euthanasia and also help with suicide are 'special medical treatment'.
de Jonge did not comment on the specifics of the case because it is the subject of a disciplinary case in which the geriatric specialist has appealed. There may still be a criminal investigation by the Public Prosecution Service into the case.

de Jonge is willing to discuss forced euthanasia but there is silence related to the studies that prove that there are more than 400 assisted deaths without consent in the Netherlands every year with most of these cases never being reported.

The world needs to know how the euthanasia law in the Netherlands is being abused.

Wednesday, August 29, 2018

Euthanasia in Belgium: Data on the social experiment.

This article was published by Mercatornet on August 29, 2018.

By Richard Egan (with the Australian Care Alliance)

Every two years the Belgium Federal Commission on the Control and Evaluation of Euthanasia presents a report detailing statistics and developments in the practice of euthanasia in Belgium.

The report is currently only available in French and Dutch. However, in this article, with the help of Google Translate the information from 2016 and 2017 has been extracted.

Overall, the impression is that euthanasia practice in Belgium continues on the path of normalising euthanasia as the go-to response to an ever increasing range of circumstances including children with disabilities, uncompleted suicides and victims of child abuse.

=Belgian 2017 euthanasia report. Deaths by euthanasia continue to increase and children are being killed.
Increase in numbers

Deaths by legal euthanasia have increased nearly tenfold (982%) from 235 in 2003 – the first full year of legalisation – to 2,309 in 2017. From 2016 to 2017 alone the increase was 13.85%. Officially reported euthanasia accounted for 2.1% of all deaths in Belgium in 2017.[1]

Organ donation

The 2016-2017 report notes that some patients wish to donate their organs and help others in this way. Doctors are not required to mention organ donation in the document recording. Organ donation has been reported in 8 patients for the years 2016 - 2017. Patients had either a nervous system disorder or a mental and behavioral disorder. The majority of them were Dutch speakers, aged 50 to 69, female and their deaths were not expected in the near future.

Death not expected in the short term

In 2017 there were 375 cases of reported euthanasia of people whose deaths were not expected in the near future. This represents 16.2% of all cases of reported euthanasia.[2]

In 2017 there were 181 cases of reported euthanasia for “polypathology” – two or more conditions none of which in itself is sufficient ground for euthanasia - where death was not expected soon, accounting for 7.83% of all reported cases. This represents a 69.1% increase in just two years from 2015.[3]

In 27 (7.2%) of these cases the mandatory one-month waiting period between the written request for euthanasia and its execution was not complied with by the euthanasing doctor. The Euthanasia Evaluation and Control Commission took no action on these cases other than sending the offending doctor “a didactic letter to remind the doctor of the procedure to be followed in case of unexpected death in the short term”. [4]

No physical suffering

In 2017 some 87 (3.76%) cases involved no physical suffering at all. This included 14 cancer cases and 15 other cases of physical illness. There were also 18 cases of “polypathology” as well as 40 cases of mental ill health.

The psychic suffering, apart from psychiatric conditions, included “addiction, loss of autonomy, loneliness, despair, loss of dignity, despair at the thought of losing ability to maintain social contacts, etc.”.[5]

Three children

Three children have so far been killed under the Belgian law in 2016 and 2017. These were a 17-year-old child who was suffering from muscular dystrophy; a nine-year-old child, who had a brain tumour, and an 11 year old child, who was suffering from cystic fibrosis.

Luc Proot, a member of the Belgium’s Federal Euthanasia Evaluation and Control Commission, commented to Charles Lane of the Washington Post that he “saw mental and physical suffering so overwhelming that I thought we did a good thing”[6] As Lane points out, he is referring to the Committee approving the cases after the fact based on reports from the doctors who carried out the killing. It is curious that Proot refers to “mental and physical suffering” when the Belgian law specifically refers only to “unbearable physical suffering” in relation to children -- in contrast to a reference to “unbearable physical or psychological suffering” for adults. This comment raises a doubt in relation to each of these three cases of child euthanasia as to whether there was “unbearable physical suffering” that could not be alleviated.

Good palliative care can relieve the various forms of physical suffering associated with end-stage brain tumours.[7]

Life expectancy for people with cystic fibrosis (CF) is increasing significantly in response to developments in treatment regimes. In the United States the median predicted age of survival for people with CF has now increased to 47 years.[8] It is by no means clear that the 11-year-old child euthanased in Belgium in 2016 or 2017 was facing imminent death. He or she may have had years to live. Depression is also a particular issue with CF.[9] The “mental suffering” mentioned by Luc Proot may have been relievable through appropriate treatment.

The 17-year-old child had Duchenne muscular dystrophy (DMD). “Until relatively recently, boys with DMD usually did not survive much beyond their teen years. Thanks to advances in cardiac and respiratory care, life expectancy is increasing and many young adults with DMD attend college, have careers, get married and have children. Survival into the early 30s is becoming more common, and there are cases of men living into their 40s and 50s.”[10] On the available information it is not clear whether in this case the child was both imminently dying and experiencing unbearable physical suffering that could not be alleviated.

Euthanasia to complete failed suicide attempts

Between 2014 and 2017 two patients who were in an irreversible coma after a suicide attempt were euthanased based on an advance directive 5 months and 35 months respectively before the suicide attempt.[11]

Euthanasia for psychiatric conditions and dementia

A total of 201 people with psychiatric disorders were killed by euthanasia in Belgium between 2014 and 2017 including for mood disorders such as depression, bipolar disorder (73 cases); organic mental disorders, including dementia and Alzheimer's (60 cases); personality and behavioural disorders (23 cases); neurotic disorders, and disorders related to stressors including posttraumatic stress disorder (16 cases); schizophrenia and psychotic disorders (11 cases); organic mental disorders, including autism (10 cases) and complex cases involving a combination of several categories (8 cases).[12]

Of these 201 cases there were 25 cases of people under 40 being killed by euthanasia. In relation to these troubled young people the Commission observes “In the group of patients under 40, it is mainly personality and behavioral disorders. All these patients have been treated for many years, both outpatient and residential. There has always been talk of intractable suffering. For this type of disorder, serious psychological trauma at a very young age have been mentioned several times, such as domestic violence, psychological neglect or sexual abuse.”[13]

Belgium seems to be treating the victims of child abuse by domestic violence, neglect and sexual abuse by killing them.

Between 2014 and 2017 there were 60 cases of people killed by euthanasia for dementia. Of these cases death was only expected in the short term for 9 cases.[14]

A case of euthanasia without request

One case reported in 2016/2017 concerned an interruptive act of life without request from the patient.

In this complex case where the patient had not made an explicit request, some members of the Commission felt that the law on euthanasia had been violated and that the file should be sent to the public prosecutor. Indeed, demand is one of the essential legal conditions. However, other members considered that a referral to the prosecution was not appropriate. The two-thirds majority, legally required for referral to the King's Attorney (see Article 8 of the law) was not reached (9 for referral to the King's public prosecutor, 7 against).[15]

This high threshold of two-thirds majority of the Commission for referral to the public prosecutor helps explain why only one case has ever been referred (in 2015).

Euthanasia tourism

The place of residence is only required to be reported in the second part of a euthanasia report filed by the doctor performing euthanasia. This part is only opened when questions arise. However, in 2016 and 2017 doctors did refer in the first part of the report to people who were foreigners who came to Belgium to seek euthanasia. There were 23 such cases reported in this way but there may be many more. Of the 23 reported cases “More than half of the deaths were expected in the near future” meaning several were cases where death was not expected in the short term.[16]

Richard Egan has been observing international practice on euthanasia and assisted suicide for over 30 years. He blogs on this and related bioethical issues at

A lengthier commentary on euthanasia in Belgium is available at the website of the Australian Care Alliance.


[1] European Institute of Bioethics, Euthanasia in Belgium : 10 years on, October 2012, p. 3 ; “Belgian euthanasia cases hit record high”, News24, 27 January 2016, ; “2024 cases of euthanasia reported in Belgium in 2016”, Genethique: weekly news summary, ; ; Commission fédérale de Contrôle et d’Évaluation de l’Euthanasie Huitième rapport aux Chambres législatives années 2016 – 2017, p. 2

[2] Commission fédérale de Contrôle et d’Évaluation de l’Euthanasie Huitième rapport aux Chambres législatives années 2016 – 2017, p. 3

[3] Ibid

[4] Commission fédérale de Contrôle et d’Évaluation de l’Euthanasie Huitième rapport aux Chambres législatives années 2016 – 2017, p. 18

[5] Ibid., p. 21

[6]Charles Lane “Children are being euthanised in Belgium”, Washington Post, 6 August 2018,

[7] See for example: M. Cohn et al., Transitions in Care for Patients with Brain Tumors: Palliative and Hospice Care, 2014 ;

Canadian Virtual hospice, What can be expected as brain cancer progresses?,

[8] Cystic Fibrosis Foundation,

[9] Cystic Fibrosis Foundation,

[10] Muscular Dystrophy Association, Duchenne Muscular Dystrophy (DMD),

[11] Commission fédérale de Contrôle et d’Évaluation de l’Euthanasie Huitième rapport aux Chambres législatives années 2016 – 2017, p. 14,

[12] Commission fédérale de Contrôle et d’Évaluation de l’Euthanasie Huitième rapport aux Chambres législatives années 2016 – 2017, p. 46,

[13] Ibid., p. 48

[14] Ibid., p.53

[15] Commission fédérale de Contrôle et d’Évaluation de l’Euthanasie Huitième rapport aux Chambres législatives années 2016 – 2017, p. 30,

[16] Ibid., p.58

Monday, August 27, 2018

Virginia Medical Aid in Dying report may open the door to euthanasia.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

The Virginia Joint Commission on Health Care released its Interim Report (August 22) which appears to promote the legalizing of assisted suicide.

The Commission report's use of language is particularly concerning.

The report uses the term: Medical Aid in Dying. This language is used by the pro-euthanasia lobby to promote euthanasia and assisted suicide.

Canada legalized euthanasia and assisted suicide in June 2016 under the term Medical Aid in Dying (MAiD). In Canada MAiD refers to causing death by lethal injection (euthanasia) and lethal prescription (assisted suicide).

The definition of MAiD in the Commission report includes euthanasia.

The committee defined MAiD as:

  • The ability of a patient to obtain a medication to end their life if they are competent, terminally ill, and over 18 years of age.
  • The ability of a physician to prescribe a medication that will allow a competent, terminally ill individual over the age of 18 to end their life 
  • Some individuals/organizations prefer to use terms like assisted suicide.
    • However, different legal definition with implications if worded as such in Virginia statute.

The ability of a patient to obtain a medication to end their life does not limit the
act to assisted suicide. Obtaining a medication to end life can by done with a prescription for lethal drugs and an injection (euthanasia) of lethal drugs.

Medical Aid in Dying has also been interpreted to include palliative care. When euthanasia and/or assisted suicide is legalized under the term - MAiD it threatens good palliative care.

The study does not examine how the interpretation of language has expanded Oregon's assisted suicide act to people who are not terminally ill.

Communication between Craig New, analyst for the Oregon Health Authority (OHA) and Fabian Stahle, a Swedish researcher confirmed that the Oregon assisted suicide law is interpreted to include people who only become terminally ill if they refuse effective treatment, even when that treatment may cure the patient. Even a diabetic would qualify for assisted suicide in Oregon, if that person refuses insulin.

The study does not examine how assisted suicide laws are to cover-up any potential abuse. Assisted suicide laws enable the doctor who writes the lethal prescription to also be one of the doctors who approve the prescription and is also the doctor who is required to submit the assisted suicide report to the State Health Authority. This "self-reporting" system guarantee's that no abuse of the law will be found.

Virginians need to challenge the Joint Commission on Healthcare report before euthanasia and assisted suicide, under the guise of Medical Aid in Dying is imposed on Virginians.

Assisted dying is simply another form of euthanasia.

The Economist, a Magazine that promotes a pro-euthanasia / assisted suicide position recently published a series of articles supporting and opposing assisted dying.

On August 23, 2018, the Economist published the following article by Dr Peter Saunders, the campaign director for the Care Not Killing Alliance UK.

Dr Peter Saunders
By Dr Peter Saunders.

“ASSISTED dying” is a euphemism. It has no meaning in law but it means supplying lethal drugs to people who are terminally ill with the purpose of helping them to commit suicide.

This is opposed in Britain by the British Medical Association, the Association for Palliative Medicine, the British Geriatrics Society and virtually every Royal Medical College.

It is also contrary to every historic code of medical ethics including the Hippocratic oath, the Declaration of Geneva, the International Code of Medical Ethics and the World Medical Association’s Statement of Marbella.

The line between assisted suicide and euthanasia is very thin. If a doctor places lethal drugs in a person’s hands it is assisted suicide, but on his tongue it is euthanasia. If the doctor sets up a lethal syringe-driver and pushes it himself it is euthanasia, but if the patient applies pressure or flicks the switch it is assisted suicide.

In one in seven cases of assisted suicide there are problems with “completion” leaving the doctor to step in to finish the job with a lethal injection, which is why legalising one inevitably legalises the other. There will also inevitably be those who claim that they are being discriminated against because they lack the capacity, even with assistance, to kill themselves, and so need someone to do it for them. Therefore, any law allowing assisted suicide only (and not euthanasia) would immediately be open to challenge under equality laws.

The reality is that assisted dying is just another form of euthanasia.

In Britain we have had myriad assisted-dying bills in various parliaments over the last 15 years. Each one has failed to become law due to legislators’ scepticism about so-called safeguards, and concerns about how these laws might be abused by those who have something to gain financially or emotionally from another person’s death. The three proposed entry criteria of “terminally ill”, “adult” and “mentally competent” have also proved malleable and open to interpretation.

Doctors are notoriously unreliable in estimating lifespans. As a result the definition of “adult” is easily open to extension to 12- to 14-year olds or younger, as seen in Belgium and the Netherlands, whose experience also shows how people who lack mental competence, for example with dementia, quickly get drawn in. Assessing mental competence is a specialised skill that not all doctors have, and depression, which increases suicidal thoughts, can be clouding a patient’s judgement.

In countries that have legalised any form of assisted dying, such as the Netherlands and Switzerland, we have seen incremental extension: an increase in total number of deaths and a broadening of categories of people to be included.

Legalising assisted suicide and/or euthanasia is particularly dangerous because any law allowing either or both will place pressure on vulnerable people to end their lives out of fear of being a burden upon relatives, carers or a state that is short of resources. Especially vulnerable are those who are elderly, disabled, sick or mentally ill. The evidence from other jurisdictions demonstrates that the so-called “right to die” may subtly become the “duty to die”. Feelings of being a burden were cited in 55% of Oregon and 56% of Washington assisted-suicide requests in 2017.

This is especially the case when families and health budgets are under financial pressure. Elder abuse and neglect by families, carers and institutions are real and dangerous and this is why strong laws are necessary.

All major disability-rights groups in Britain oppose any change in the law, believing it will lead to increased prejudice towards them and increased pressure on them to end their lives.

The safest law is like Britain’s current one, which places a blanket prohibition on all assisted suicide and euthanasia. This deters exploitation and abuse through the penalties that it holds in reserve, but at the same time gives some discretion to prosecutors and judges to temper justice with mercy in difficult cases.

Part of living in a free democratic society is that we recognise that personal autonomy is not absolute. And one of the primary roles of government and the courts is to protect the most vulnerable, even sometimes at the expense of not granting liberties to the desperate.

Dr Peter Saunders is the campaign director for the Care Not Killing Alliance

Child euthanasia has claimed the lives of three in Belgium

This article was published by on August 27, 2018.
An ethicist in Antwerp expresses alarm that the practice of terminating the lives of seriously ill minors is going mainstream.
John Burger
By John Burger

A recent report in Belgium noted that legal euthanasia there has claimed the lives of three children in the past two years.

The response in Belgium? A big yawn.
“The report of the control commission has provoked not one article in the press, and no comments at all,” said Willem Lemmens, Professor of Modern Philosophy and Ethics at the University of Antwerp.

Lemmens was referring to a July 17 report from the commission that regulates euthanasia in Belgium, which noted that between January 1, 2016, and December 31, 2017, Belgian physicians gave lethal injections to three children under 18. In 2014, Belgium amended its already permissive euthanasia law to allow children of any age to request the procedure.

Euthanasia deaths in Belgium have risen from 2,021 in 2015 to 2,309 in 2017.

Richard Egan: Child euthanasia in the Netherlands and Belgium.
Charles Lane, writing for the Washington Post, reported that the three euthanasias of children included an 11-year-old who had cystic fibrosis (CF).
“This congenital respiratory disease is incurable and fatal, but modern treatments enable many patients to enjoy high quality of life well into their 30's or even beyond,” Lane wrote. “Median life expectancy for new CF cases in the United States is now 43 years, according to the Cystic Fibrosis Foundation.”
The others were a 17-year-old with Duchenne muscular dystrophy and a 9-year-old with a brain tumor.
“Doctors must verify that a child is ‘in a hopeless medical situation of constant and unbearable suffering that cannot be eased and which will cause death in the short term.’ After a child makes his or her wish for euthanasia known, in writing, child psychiatrists conduct examinations, including…intelligence tests, to determine that the youngster is capable and ‘not influenced by a third party’. Parents can, however, prevent the request from being carried out.”
But Lane was unconvinced. “What, exactly, convinced doctors that these children’s cases were hopeless, that their deaths were imminent—and that the kids fully understood not only euthanasia but also the treatment options that might have alleviated their condition?” he asked.
“These questions are no longer asked in the Belgian press,” Lemmens said.

In an interview on Friday, Lemmens said he sees a process of normalization going on in Belgium. “On the one hand, people take it more and more for granted for somatic diseases like cancer, or terminal diseases of neurological origin…And there’s discussion going on whether the law will be enlarged for people with dementia or for elderly who are not terminal but are just tired of living.”

Most of Belgium’s 4,337 euthanasias in 2016-2017 involved adults with cancer.

And yet, Lemmens reports, doctors overall are, “Very concerned and very eager to address needless suffering at the end of life, and some doctors really try to avoid euthanasia. They don’t like the procedures for it. If they apply palliative sedation they don’t need to go through all these procedures that the law requires.”

Palliative sedation is the use of narcotics to the point of suppressing the body’s respiratory system. The controversial practice relieves pain, but usually hastens death.

“There’s a discussion about the proper way to do palliative sedation,” he said. “The pro-euthanasia doctors will say that palliative sedation is always a means to hasten death in a way that is not so different from euthanasia. The only difference is that with palliative sedation the doctors avoid external control and act, according to pro-euthanasia doctors, in a paternalistic way. These discussions are going on between doctors, and I think the discussions prove there has been an increase in what I would call a gray zone in end of life practices.”
But Lemmens rejects the idea that the overall care for dying patients in Belgium is decreasing. “Overall, Belgium has quite a good health system,” he said.

He affirmed that there is pressure on Catholic hospitals to cooperate with euthanasia requests, partly due to the mergers between Catholic and secular institutions in recent years and the secularization of Belgian culture. The euthanasia law does allow an objecting physician to opt out, but it’s generally expected for such a physician to refer a patient to another doctor, even though the law does not require it.

Alex Schadenberg: Belgium euthanized three children aged 9, 11 and 17.
Alex Schadenberg
For Alex Schadenberg, Executive Director of the London, Ontario-based Euthanasia Prevention Coalition, the mass media has been complicit in the advance of Belgium’s euthanasia laws. “The more cases that get promoted through the media, the worse it will become," he said. “Recently there was a case in the Netherlands of Aurelia Brouwers, a 29-year-old who died by euthanasia. She was physically healthy but was going through psychiatric issues. She intentionally went to the media; she became a media darling before she died in January this year. And the reason was: the more we hear about it, the more it is considered acceptable. What someone would never think of doing in the past, once we hear of others doing it, suddenly it becomes acceptable for somebody to do this.”

What troubles Schadenberg about Belgium’s euthanasia law is that even a 9-year-old’s “consent” to a doctor euthanizing him is accepted. “I don’t know how capable my 9-year-old was about consent, and now we’re talking about death,” he said. “In law we recognize there are limits to consent, for these very reasons, that there’s a certain level of ability, and yet we’re allowing death to be done in these cases.”

Schadenberg said child euthanasia is being talking about it in Canada right now. He said that in 2016 the government instituted committees to look at child euthanasia, euthanasia for people with dementia, and euthanasia for people with psychiatric conditions alone. “We’re expecting the reports in December,” he said. “I’m assuming that euthanasia for children will be considered very seriously.”

Saturday, August 25, 2018

Why I object to Victoria Australia's assisted dying law

This article was published by Mercatornet on August 23, 2018

By Adrian Dabscheck, a Palliative Care Consultant from Victoria Australia.

During a recent period of enforced rest, I had time to reflect on my attitude to the recently enacted voluntary assisted dying legislation in Victoria and consider my response.1 I will detail my reaction to the Act and why I have chosen to become a so-called conscientious objector.

In his essay Western Attitudes Toward Death,2 French historian Philippe Ariès illustrates the evolution of our attitudes to death.

Initially, and for millennia, there had been a general resignation to the destiny of our species for which he used the phrase, Et moriemur, and we shall all die. This was replaced in the 12th Century by the more modern concept of the importance of one’s self, and he used the phrase, la mort de soi, one’s own death.

Ariès then notes that in the 18th Century man gave death a dramatic and disquieting meaning. Man became concerned with the death of the other person, la mort de toi. Death was no longer familiar, nor were the dead. The dead had been torn from life; death had become an important event. By the 19th Century mourning had become difficult and thy death, la mort de toi, is more feared than la mort de soi, one’s own death.

Following this slow evolution in Western attitudes towards death, from being ubiquitous and familiar, with industrialisation, came the concept of the forbidden and shameful death. Life was now meant to be happy and this happiness was interrupted by the emotional disturbance of death and dying. Death was not spoken of, as illustrated by Tolstoy in “The Death of Ivan Ilyich”.3 Death was moved from home to hospital, from the care of one’s family to the sanitised, technical care whereby it is difficult to tell when the dying process actually began due to the interference of modern medicine. Death became part of the medical industrial-movement.

In a 2013 article reviewing the situation in Flanders where euthanasia is embedded in palliative care,4 it was noted:
Healthcare professionals note that family members and proxies tend, much more than before, to consider the dying process as undignified, useless and meaningless, even if it happens peacefully, comfortably and with professional support. Requests made by family members for fast and active interventions from healthcare professionals regarding elderly parents are often very coercive, with little nuance or subtlety. End-of-life interventions such as euthanasia are seen as an instrument to end a process of disease (or old age) that is demanding and difficult to bear, instead of letting it follow its course.’
We could not be further removed from Ariès’ phrase, Et moriemur, and we shall all die. Happiness is now the ultimate goal; we can no longer accept the place of death in our life.
Ariès wrote in L’Homme devant la mort:5 “Death must simply become the discreet but dignified exit of a peaceful person from a helpful society. A death without pain or suffering, and ultimately without fear.” Thus the idealised ‘good death’.

Unfortunately, for most, society is unable to achieve such utopian goals, hence the need for the modern palliative care movement. As David Roy noted in the third edition of the Oxford Textbook of Palliative Medicine,6 it is up to society to allow the palliative care movement to flourish, to remove barriers to care, to develop the broad tapestry of interconnected people, resources, services and institutions to care for those who suffer in the face of death.

For this to be successful there must be an effective ethic of care. An ethic that allows relationships to flourish, an ethic that acknowledges the vulnerability of people and views autonomy from a relational rather than an atomistic perspective. Autonomy is a product of our personhood, our development of interests and values gained by interactions with others. None of us can make decisions which are free from influence. Our decisions relating to ourselves are made in the context of relationships. We commence our life completely dependent on others to sustain us. We depend on the non-judgemental love of others to care for us, to allow us to become independent, to become autonomous in the context of family, friends and society.

I continually ask myself, how have we allowed our ethical boundaries to move to such a degree that a law allowing doctors to take life as a way of relieving suffering has been passed by our state legislature? How have we allowed our view of the individual to become so individualistic and self-gratifying, so removed from an acknowledgement of our dependence on others, so self-centred or dare I say narcissistic?

Perhaps we can learn for the world of art and aesthetics. Hans van Meegeren was an accomplished forger of Vermeer, such that Vermeer experts accepted as originals what are obvious from our current perspective as forgeries. David Roy asks:6 “What process was at work that could so distort the faculties of aesthetic perception and poor judgement? It was a process of incremental adaption to incrementally poor forgeries.”

The Netherlands introduced the Termination of Life on Request and Assisted Suicide (Review Procedures) Act in 2001. In 2005, of all deaths, 0.4 percent were the result of the ending of life without an explicit request by the patient.7 In 2013 euthanasia was performed for 97 patients with dementia and 42 patients with psychiatric diseases (percentages not reported).8 Have ethical perceptions been distorted such that incremental creep allowed this to happen, as it did with aesthetics and van Meegeren?

In an article published in May 2017 in the New England Journal of Medicine discussing the experience of the University Health Network in Toronto after the introduction of medical assistance in dying (MAiD) in Canada,9 the authors noted:
[T]hose who received MAiD tended to be white and relatively affluent and indicated that loss of autonomy was the primary reason for their request. Other common reasons included the wish to avoid burdening others or losing dignity and the intolerability of not being able to enjoy one’s life. Few patients cited inadequate control of pain or other symptoms.
I would like to question if the possible consequent good of allowing a highly selected population of privileged people the ability to request and be administered medical assistance in dying is sufficient to overturn millennia of accepted medical practice. Medicine has long been perceived by society to be beneficent and is trusted to avoid actions which would deliberately hasten death. The intent of palliative medicine is the relief of pain and suffering, not the taking of life. Should we risk the incremental creep of our values for the sake of a privileged few?

Do we wish to allow our society to become similar to Belgium, where we are so removed from the human experience that we consider the dying process useless, meaningless and undignified?

In my own city, Melbourne, we can all witness the inadequate provision of palliative care and other health services to more economically challenged sections of our society. A similar picture emerges in rural settings. Can we as a society justify allocating resources to voluntary assisted dying, when basic palliative care and health care are so lacking?

Should we really allow the values of our society to be so radically altered for the few who are so removed from an acceptance of the frailty of the human experience, from an acceptance that we are all dependent on others and vulnerable?

It is for the above reasons that I will be a so-called conscientious objector when the Voluntary Assisted Dying Act comes into operation on 19 June 2019. I will continue to practise medicine as it has been practised for millennia, for the relief of pain and suffering. I would encourage all doctors to in Victoria to do likewise.

Adrian Dabscheck is a Palliative Care Consultant from Victoria

  1. Voluntary Assisted Dying Act 2017 (Vic).
  2. Ariès P. Western Attitudes Toward Death from the Middle Ages to the Present. Johns Hopkins University Press, 1974.
  3. Tolstoy L. The Death of Ivan Ilyich. Published in 1886.
  4. Vanden Berghe P, et al. Assisted Dying – the current situation in Flanders: euthanasia embedded in palliative care. European Journal of Palliative Care 2013;20(6):266-272.
  5. Ariès P. L’Homme devant la mort (The Hour of Our Death). Published in 1977.
  6. Doyle D, et al. (eds.) Oxford Textbook of Palliative Medicine. 3rd Edition. Oxford University Press, 2005.
  7. Van der Heide A, et al. End-of-Life Practices in the Netherlands under the Euthanasia Act. New England Journal of Medicine 2007;356:1957-1965.
  8. Radbruch L, et al. Euthanasia and physician-assisted suicide: A white paper from the European Association for Palliative Care. Palliative Medicine 2016;30(2):104-116.
  9. Li M, et al. Medical assistance in dying – implementing a hospital-based program in Canada. New England Journal of Medicine 2017;376:2082-2088.

Thursday, August 23, 2018

Western Australian Liberal MP opposes report calling for Canadian style euthanasia.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coaliiton

Western Australia parliament.
The Western Australian End of Life Choices committee has released their report recommending legalization of Canadian style euthanasia (MAiD).

The Committee decided that doctors should be permitted to lethally inject or provide lethal drugs to a person who is: “experiencing grievous and irremed­iable suffering related to an advanced and progressive ­terminal, chronic or neuro-degenerative condition that cannot be alleviated in a manner acceptable to the person."

Liberal MP Hon. Nick Goiran, who was a member of the committee, wrote a 248 page minority report titled: License to Care not License to Kill opposing the legalization of euthanasia or assisted suicide. The media quoted Goiran as stating:
Hon Nick Goiran
the risks of legalising assisted suicide were too great. “Indeed, I am convinced that assisted suicide is a recipe for elder abuse,” he said.  
Download Nick Goiran's report: License to Care not License to Kill.
“The safety of the people of Western Australia ought to be our highest law. 
“I also have serious concerns for the impact upon our desperate efforts on suicide prevention in Western Australia. Our ongoing suicide rate of around one person per day is tragic, and we simply cannot afford the dangerous mixed message that comes with assisted suicide.”
Link to Nick Goiran's report titled: License to Care not License to Kill.

The Western Australian committee chose language that is very similar to the undefined language employed by Canada's euthanasia law.

In June 2017, Ontario Justice Paul Perrell, defined the language (natural death must be reasonably foreseeable) within Canada's euthanasia law to include a 77-year-old woman with osteoarthritis.

Perrell decided that the woman qualified for death by lethal injection because she was nearly 80 and lived with a chronic degenerative condition, even though her natural death was not reasonably foreseeable.

Man who woke from 21 year coma would not have had a second chance if stealth euthanasia had been an option.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Niall McGrath with family.
The family of Niall McGrath told the Irish Sun news that Niall would be dead if the decision passed by the UK’s Supreme Court last month allowing medical teams and family to withdraw life support without applying to the courts when Niall was in coma. The family is concerned that the decision to dehydrate to death people with brain injuries in the UK, may also be permitted in Ireland.

Last month, UK's Supreme Court decided that patients with permanent vegetative state (PVS) and minimally conscious state (MCS) can be dehydrated to death, without permission from the court, if the medical staff and relatives agree that this is in their ‘best interests’.

Since UK's Supreme Court decision, the British Medical Association (BMA) introduced draft guidelines that enable doctors to dehydrate and sedate to death non-dying patients with dementia, stroke or brain injuries. 
This is a recipe for euthanasia by stealth, but all in the name of autonomy and ‘best interests’ – the very worst kind of doctor paternalism justified on the grounds that the patient would ‘have wanted’ it. 
There are conceivably tens of thousands of patients in England and Wales who are vulnerable to the use and abuse of this ‘guidance’. It will be almost impossible to work out what has happened in a given case and there are no legal mechanisms in place for bringing abusers to justice.
Niall was pronounced clinically dead in 1989. Life-sustaining treatment was withdrawn from him three times, but he continued to breath on his own. In 2010, Niall awoke from Coma after 21 years and he has been steadily recovering ever since. The Irish Sun reported:
Niall could not speak or move up to eight years ago and “now he’s able to stand up for 25 minutes and he can transfer himself from the wheelchair to the bed”. 
He also uses an iPad, and attends speech therapy.
Niall currently lives in a nursing home, which is inappropriate for a 50-year-old man with a brain injury. Nonetheless, he is alive. How many people are being killed by dehydration because they have been misdiagnosed or because the family or medical practitioners are not willing to wait for a recovery.

Medical experts now agree that 40% of people deemed to be in a PVS state are misdiagnosed.

Wednesday, August 22, 2018

Elder suicide rates are a reason to oppose assisted suicide.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

The debate concerning the effect on suicide rates when assisted suicide is legal was re-awakened by a recent article by David Grube who claims that suicide rates decline when assisted suicide is legal. Grube is the medical director of an assisted suicide lobby group.

Grube stated in The Kansas City Star that:

There is absolutely no evidence that in states where medical aid in dying is authorized suicide rates have gone up. National and state level data from the Centers for Disease Control and Prevention’s National Vital Statistics System suggest that suicide rates have varied slightly, but overall have gone down in Oregon since its Death with Dignity Act went into effect in 1997.
Margaret Dore
Margaret Dore responded to Grube, in a letter to The Kansas City Star stating:

According to the Centers for Disease Control and Prevention’s “Vital Signs” website, Oregon’s suicide rate went up 28.2 percent from 1999 to 2016. 
Legal assisted suicide encourages other suicide. Don’t be fooled.
Yesterday, Today Online published an article by Singapore researcher, Michael Wee, who explains why elder suicide is a reason to oppose assisted suicide. Wee acknowledges that some researchers have suggested that suicide rates go down when assisted suicide is legal, but he explains that the data proves that the opposite is true. He states:
In 2015, two British scholars published a ground-breaking study in the Southern Medical Journal of US states that have legalised assisted suicide. 
The study looked not simply at suicide rates before and after legalising assisted suicide, but at the change in suicide rates in those states relative to the change in US states where assisted suicide is illegal, while taking into account state-specific factors like drug laws and the unemployment rate. 
This was in order to arrive at a more accurate assessment of the effect of assisted suicide laws on overall suicide rates. 
The study found that far from reducing suicides, legalising assisted suicide is associated with a 6.3 per cent increase in the total suicide rate – including both assisted and non-assisted suicides. For the over-65 age group, the increase is 14.5 per cent.
Wee then states:
the study simply reaffirms a common-sense view: Legalising assisted suicide may lead to similar behaviour in others, as more people become exposed to friends and relatives making that decision.
Margaret Dore warns us that legal assisted suicide encourages other suicide. Don’t be fooled.

Assisted suicide and the false concept of autonomy.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Professor Kevin Yuill
The Economist, a Magazine that promotes a pro-euthanasia / assisted suicide position recently published a series of articles supporting and opposing assisted dying. 

On August 22, 2018, The Economist published an article by Kevin Yuill, author of the book: Assisted Suicide - The Liberal, Humanist Case Against Legalization.

In this article, Yuill focuses on the false concept of autonomy, with respect to assisted suicide. He states:
The most serious case made by advocates for assisted suicide is autonomy. Yet what stands out for this most recent toleration of at least some suicides is the lack of autonomy; to be legitimate, it seems, suicide must be sanctioned by that new priesthood, medical authority.

In the Netherlands, euthanasia (where the doctor accomplishes the act) has risen rapidly since it was legalised in 2002. Last year 6,306 cases of euthanasia were reported to the Regionale Toetsingscommissies Euthansie, compared with 2,910 in 2010. With assisted suicides, where the patient must do it themselves, the rise is much slower: 250 reported in 2017, compared to 242 in 2014 and 182 in 2010.

As Henk Blanken, who suffers from Parkinson’s disease recently complained in the Guardian, “when push comes to shove, the patient is not the one who decides on their euthanasia. It is the doctor who decides, and no one else.” Death has become one more of life’s events that we no longer seem to be able to do ourselves.

We are not simply our bodies. Assisted suicide defines our lives in overly physical terms. ... With assisted suicide, we ask that doctors, experts only in our somatic existence, play God. When someone else is involved in our death, it is not just our wishes that are involved.
Yuill then explains the pressure exerted to extend assisted dying laws, once assisted suicide is legal. He states:
Often nations with legalised euthanasia and/or assisted suicide have quickly extended the criteria beyond the original remit of deaths inflicted by terminal illness. In Canada, where medical assistance in dying (MAiD) was legalised in 2016, what was a moral compass surely twists in the wind. One of at least 1,300 who was granted it in the first year was a 77-year-old woman suffering from non-terminal osteoarthritis. After physicians refused, a judge ruled that she must be granted her request as she was “almost 80” with “no quality of life”. Ontario has abolished freedom of conscience by requiring doctors to participate in killing patients, whatever their beliefs. The current restrictions in the law are being challenged on many fronts by those who argue that their suffering matches that of those who are granted MAiD. Who can disagree? Having already allowed euthanasia for, among other things, tinnitus and vision loss, the Dutch House of Representatives held a plenary session on the widely supported citizen’s initiative, “Completed life”, that demands the right for all Dutch people over 70 who feel tired of life to have assisted deaths.

In Belgium and the Netherlands, over the issue of “psychiatric” euthanasia, there finally appears to be some recognition that a mistake has been made somewhere along the line. In Belgium in 2014-15, 124 people were euthanised because of a “mental and behavioural disorder”.
Yuill reminds the readers that the British parliament defeated an assisted dying bill in 2015. He states:
A wise government will, like the British parliament in 2015, refuse to make assisted dying legal.
Giving doctors the right in law to kill their patients, results in an ever expanding definition of who should die.