Swiss doctors go head-to-head over liberal assisted suicide guidelines.

This article was published by Bioedge on October 28, 2018

By Michael Cook

The Federation of Swiss Medical Doctors (FMH) has refused to include in its code of ethics new guidelines on end-of-life care proposed developed by the Swiss Academy of Medical Sciences (SAMS). These provide that a physician may practice assisted suicide for patients presenting with "unbearable suffering" related to the symptoms of an incurable disease or disability. Until now, the patient had to have a terminal illness.

The FMH believes that unbearable suffering is too vague as a criterion. Michel Matter, a FMH vice president, gave the example of a bipolar patient. "When she is in a low phase, such a person would fulfil this condition of unbearable suffering, but not when she is in a high phase." For him, doctors must protect the most vulnerable patients and whose situation is not always clear. "By defending the weakest, the FMH is in step with society," he concluded.

Samia Hurst, of the University of Geneva, who participated in the development of the guidelines, criticised the decision of the FMH. "This test of unbearable suffering is found in many jurisdictions about voluntary death.” She added that "Physicians already practice assisted suicide outside end-of-life situations (for example, by accompanying, for example, elderly people with multiple pathologies). The new directives of the SAMS frame these situations, while the old ones did not. "

Canadian MP, David Anderson, sponsors bill to uphold conscience rights of health care professionals

FOR IMMEDIATE RELEASE

David Anderson MP

Ottawa, ON – Today in the House of Commons, David Anderson, MP for Cypress Hills–-Grasslands tabled Bill C-418, the Protection of Freedom of Conscience Act, to protect conscience rights for health care professionals.

The purpose of the Protection of Freedom of Conscience Act is to protect the rights of health care professionals to conscientiously object to participation in medical assistance in dying (MAiD), making it an offence to intimidate or try to force a health care professional to be involved in MAiD. It also makes it an offence to fire or refuse to employ a health care professional for refusing to take part, directly or indirectly, in the provision of MAiD.

MAiD became legal across Canada in 2016. This bill addresses a legislative gap in protecting the right to refuse participation in MAiD, which is already guaranteed in the Criminal Code, but which lacks clarity for effective enforcement.

Anderson views the protection of conscience rights for medical professionals as part of protecting the fundamental freedom of conscience and religion guaranteed to all Canadians in the Charter of Rights and Freedoms. “I believe it’s time to stand up for doctors and health care providers who aren’t willing to leave their core ethics behind when they’re at a patient’s bedside,” said MP Anderson. “Access to MAiD and the right to conscientious objection aren’t mutually exclusive.”

A recent court case in Ontario highlights the undue tension placed on health care providers in some jurisdictions to provide effective referrals for MAiD. Doctors who object to involvement in MAiD, including members of religious communities and doctors who believe their fundamental role is to heal, not take life, argue that providing referrals is tantamount to direct involvement in MAiD. The Protection of Freedom of Conscience Act will provide support for health care providers who object to providing MAiD based on conscience or religion and who are at risk of facing discrimination, coercion, or being fired for refusing to participate.

Anderson draws comparisons between his work on international human rights and the history of rights in Canada. “Canada is a nation built on the freedom to have dissenting beliefs and follow one’s conscience, and we must stand up for these rights wherever we see them being assaulted. The right of doctors to refuse to take the life of a patient is one of these.”

To read the First Reading publication of C-418, visit http://www.parl.ca/DocumentViewer/en/42-1/bill/C-418/first-reading.

– 30 –

For more information, please contact the office of:
David Anderson, MP: (613) 992-0657

The Importance of Talking to Patients

This article was published by Nancy Valko on October 29, 2018.

Nancy Valko

By Nancy Valko

As I have related before, back in the early 1970s when I was a new ICU nurse, I was teased for talking to comatose patients. I was even asked if I talked to my refrigerator. I explained that if hearing was truly the last sense to go, it made sense to talk to the patients and explain what we were doing just as we would for any other patient. The other nurses thought this was ridiculous-until “Mike”.

“Mike” was a 17-year old boy who was admitted to our intensive care unit in a deep coma with massive injuries caused by a terrible car crash. The neurosurgeon on duty pronounced, “He won’t live until morning and it’s a good thing, because he’d be a vegetable.” I was shocked that he said this in front of “Mike”!

But “Mike” didn’t die. I kept talking to him and eventually he could even move a finger on command. But he would not respond to the neurosurgeon, even with tests to see if he would move with pain stimuli.

Later on, when “Mike” was able to breathe on his own, he would even say “Hi” for me on command but it was only after I repeatedly begged that Mike finally said “Hi” to the neurosurgeon. The neurosurgeon called this a “miracle” but shortly after that, Mike was transferred to a nursing home. None of us ever expected to see him again.

However, about 2 years later, a handsome young man strode into our ICU and asked “Do you remember me?” It was Mike! He said he had driven 60 miles to tell us thanks for saving his life and we all dissolved in happy tears.

I told him that he wouldn’t remember this, but he would move and say “Hi” for us nurses but not for the neurosurgeon. Mike got very serious and said “I remember him calling me a vegetable and I wouldn’t move for him!”

After that, every nurse on our unit was told to talk to every comatose patient as if he or she was totally awake and soon we found more patients who unexpectedly woke up or improved.

And no one ever teased me about talking to “comatose” patients again.

Throughout the decades since, I have talked to other patients who were considered comatose or otherwise unconscious, not just to patients with a major brain injury but also to patients approaching death and to patients sedated while on a ventilator for breathing. I’ve always considered this talking and explaining just basic respect for every patient. I was pleasantly surprised when I followed up with patients and families after they left our ICU and found many who remembered and told me how much this had helped them.

“Observations From ICU Patients We Thought Were Asleep, But Were Not”

So I was thrilled to see this title for a new Journal of the American Medical Association (JAMA) learning audio for doctors with stories from patients about what they experienced in an ICU while their treating doctors and nurses thought they were “asleep”.

In the audio, most of the patients were on sedation while on a ventilator and assumed unaware. One such woman related how she became so angry at her doctor’s attitude that she wanted to throw something at him and was frustrated when she couldn’t. Another man related how painful it was when the electrodes checking for his level of sedation were used without explanation or warning. Another complained about hearing nurses talking about her mom and dad poorly and their lack of empathy.

But there were also good stories about nurses or doctors taking the time to explain what was happening, talking as if the patient could hear everything and helping patients communicate without words. One doctor told about how his own father was in a hospital for an extended time and his dad remembered hearing the doctor talking about all the things he couldn’t do instead of what he could do. This doctor says that his father’s discouraging experience made him a better doctor.

The audiotape also explains how difficult it can be to not over or under-medicate people, especially when it comes to pain, confusion and anxiety. The audiotape recommends that health care professionals try to avoid long acting drugs with potential side effects and continuous medication infusions and to use simple tools to assess delirium, confusion and anxiety.

The audiotape also recommends that health care professionals “treat patients like real persons”, “take the time to explain”, “be careful to assess level of awareness”, “realize that every action and word have real consequences” and that the “human element” is the most important.

Conclusion

Being in an ICU can be especially stressful for patients and their families and I hope this information is helpful. Medicine can do wonders today but it is the human connection that provides the best environment for healing for both patients and their families.

Is Euthanasia Psychiatric Treatment?

Canada legalized euthanasia and assisted suicide in June 2016 under the term: Medical Assistance in Dying (MAiD). 

Sign the petition: I Oppose Euthanasia For Psychiatric Reasons Alone (Link).

In December 2016, the federal government announced that the Council of Canadian Academies would research and provide recommendations concerning the expansion of euthanasia in three areas: mature minors, people who are incompetent but previously requested MAiD and euthanasia for psychological suffering alone. This article concerns the last group.

Dr Damiaan Denys

Download the article in pamphlet format.

The Netherlands and Belgium legalized euthanasia in 2002. The legislation in both of these countries technically allowed euthanasia for “psychological suffering.” In the early years, euthanasia for psychological suffering was rare but in the past few years it is sky rocketing.

A commentary by Dr. Damiaan Denys, the President of the Dutch Society of Psychiatrists, was published in The American Journal of Psychiatry (September 2018) titled: Is Euthanasia Psychiatric Treatment? 

Denys' commentary is based on a 42-year-old married woman who requested euthanasia for psychiatric reasons while receiving treatment from his team. The Psychiatric team disapproved of her euthanasia death because treatment options existed but the woman died by euthanasia anyway. Denys wrote:

Although we had treated her intensively for 2 years, our advice was disregarded. Eight weeks later we received the obituary of the patient.

Denys outlines the problems with psychiatric euthanasia based on experience in the Netherlands. He wrote:

…whether euthanasia is an option for psychiatric patients, there are medical and ethical dilemmas related to the practical process of decision making and execution. How can we reconcile the daily practice of reducing suicidal ideas and behaviors in patients with respecting a death wish in single cases? How can we distinguish between symptoms and existential needs? How can we decide whether a psychiatrist is sufficiently autonomous to judge euthanasia? Does the fragile therapeutic relationship between psychiatrist and patient not bias judgment? How are differences in opinion between psychiatrist and patient resolved? Although psychiatrists are not legally obliged to approve or execute euthanasia, neither can they interfere once a request is granted by a third party, as illustrated in the aforementioned case.

Dr. Mark Komrad

Dr. Mark Komrad, an American Psychiatrist on the Faculty at John’s Hopkins University examined the experience with euthanasia for psychiatric reasons in the Netherlands and Belgium. He wrote in a commentary published by the Psychiatric Times (Feb 2017) that:

Some remarkable stories have been profiled in the Dutch media. For example, a woman was granted euthanasia for chronic PTSD due to childhood sexual abuse. The arguments based on personal autonomy to justify such access to PAS/E are being pushed even further in the Netherlands. Ministers of Health and Justice have proposed to their Parliament that criteria not be limited to medical conditions, but be extended to average citizens who feel they have lived “completed lives.” 

Prominent cases profiled in the Belgian media include a pair of deaf twins euthanized on request because they were going blind, a man with gender identity disorder who was unhappy with surgical results, and another man who sought euthanasia for ego-dystonic homosexuality.

Canadians were told that euthanasia would be legalized with safeguards to prevent the problems that have occurred in the Netherlands and Belgium. Canada is now considering extending euthanasia beyond the original parameters.

The Canadian law states that MAiD can be done when it is approved by 2 doctors or nurse practitioners when the person fulfills the following conditions:

• The person is at least 18 years old, 
• The person has a serious and incurable illness, disease or disability, 
• The person has an advanced state of irreversible decline in capability, 
• The person has an enduring physical or psychological suffering that is intolerable to them, 
• The person’s natural death must be reasonably foreseeable (no definition). 

Therefore, Canada’s euthanasia law does not permit euthanasia for psychological reasons alone.
 
In fact, Canada has gone too far already. Euthanasia for psychological suffering is a bad idea that is abused in other jurisdictions and will be abused in Canada.

Contact EPC at: 1-877-439-3348 or info@epcc.ca to order the postcards to be sent to Members of Parliament. 

Download this article in pamphlet format.

Netherlands Euthanasia Cases Examined by Board of Procurators General Since 2016

By Richard Egan (researcher with the Australian Care Alliance)

Twenty three cases of failure by physicians to comply with all the requirements of the Netherlands euthanasia law referred by the Euthanasia Review Committees to the Board of Procurators General since 2016 have been considered with the following results: 

• four cases are still subject to criminal investigation; 
• five have resulted in a physician being placed on one year probation with the possibility of prosecution if there is a further breach of the law, and 
• the remaining fourteen cases have been unconditionally dismissed. 

Criminal investigation

On 28 September 2017 it was announced that the Chief Public Prosecutor of the Public Prosecution Service in The Hague would lead a criminal investigation into a suspect who was acting as a physician when she carried out euthanasia on a 74-year old severely demented and incapacitated woman in the spring of 2016.

The woman had had a will drawn up some years ago before her admittance to the nursing home, but it was ambiguous and contradictory. Furthermore, in the opinion of the Review Committees the physician crossed a line in carrying out the euthanasia - physically restraining her when she resisted being given a lethal injection!

On 8 Mar 2018 it was announced that a further four cases were now under criminal investigation.

Two cases to be investigated by a prosecutor in Noord-Holland involve the same physician. The first investigation revolves around the death in May 2017 of a 67-year-old female, who lacked the capacity to express her own will and suffering from Alzheimer. The review committee found that the physician, at the time the life of the woman was terminated, was not able to ascertain if it was a voluntary and deliberate request for euthanasia because the living will had been drafted years before and had not been reconfirmed since. Furthermore the physician failed to substantiate why the suffering of the woman was unbearable.

The second investigation is about the termination of the life of an 84-year-old woman in June 2017. The woman regarded her life as hopeless because of several physical illnesses. The review committee considered, inter alia, that the physician could not have arrived at the conviction that other solutions to eliminate the suffering were lacking and that the suffering therefore was hopeless.

A prosecutor of the Prosecution Service in The Hague has instituted an investigation into the death of an 84-year-old woman in February 2017. Her freedom of movement had been very much restricted by pulmonary emphysema. The woman had a euthanasia statement and had clearly expressed that she no longer wanted to live. She refused to undergo any further examinations or treatments. One of the conclusions of the review committee was that the physician concluded to easily that the suffering of his patient was hopeless

Nineteen other cases finalised: Most (14) unconditionally dismissed

The details of and findings on a further 19 cases referred by the Review Committees to the Board of Procurators General are available (in Dutch only).

Botched execution of assisted suicide and euthanasia

• Doctor ordered the wrong drug for an assisted suicide – patient woke up after an hour. Euthanasia then performed. (One year probation) 
• After an assisted suicide failed and the doctor had failed to follow the required precaution of previously inserting an intravenous cannula, the doctor administered the euthanatics intramuscularly. This is in violation of the guidelines as this route could be both painful and ineffective. (Dismissed unconditionally) 
• Doctor used a lower than recommended dose of sedative, failed to do a complete coma check and administered the muscle relaxant while the patient still had a clear heartbeat. (Dismissed unconditionally) 
• Before administering a barbiturate drink for assisted suicide the doctor intended to flush the infusion needle with saline but mistakenly used the muscle relaxant instead causing the possibly painful death of the patient. (Dismissed unconditionally) 
• After the inserted infusion needle ruptured the vein of the patient, the doctor served the remaining amount of the 2000 mg sedative intramuscularly, after which he administered the patient an intracardiac injection with 150 mg muscle relaxant. The doctor has taken a great risk of possible complications and pain in the patient. (One year probation) 
• After an assisted suicide failed the doctor injected the muscle relaxant without doing a full coma check. (Dismissed unconditionally) 
• Doctor injected the muscle relaxant while the patient was clearly not in a sufficiently deep coma. (Dismissed unconditionally) 
• The first two attempts at performing euthanasia on the patient failed before the doctor realised that the intravenous cannula was not properly placed and the sedative and muscle relaxant would have only been delivered subcutaneously not intravenously. In both attempts the muscle relaxant was delivered while the patient was not in a complete coma. A third attempt succeeded after the placement of a new intravenous cannula. (One year probation)

Leaving the patient after a failed attempt to get euthanatics

• Doctor failed to take back up set of euthanatics (She never had before either). When the first attempt failed she had to leave the patient to get the second set. (Dismissed unconditionally) 
• Doctor failed to bring a reserve set of euthanatics as the package was too big for his case! After the first set failed he had to leave the patient to get a second set. He also neglected to give a pain killer before inducing coma. (Dismissed unconditionally) 
• Doctor failed to bring a second set of euthanatics and left the patient to get one when the first dose of sedative failed to produce a coma. (Dismissed unconditionally) 

Eligibility criteria not met

• End of Life clinic doctor went ahead despite views of patient’s neurologist and psychiatrist that further treatment options were available for a man with mild Parkinson’s and treatable anxiety and mood disorder (One year probation) 
• End of Life clinic doctor failed to get a proper psychiatric consultation before performing euthanasia on a48 year old man with depression, anxiety attacks and paranoid delusions. (Dismissed unconditionally) 
• In an Alzheimer’s case the doctor failed to get a consultant’s opinion and instead relied on a report from an earlier treating doctor. (One year probation) 

Independence of consultant

• Three cases involved a concern from the Review Committees that the consultant used by the doctor was not independent, being a doctor in the same practice. These cases were all dismissed unconditionally as the Board concluded that “Guidelines about independence of the consulting doctor are not sufficiently clear”. The new 2018 Code states explicitly that the consultant can’t work in the same practice as the doctor. 
• Doctor inserted an intravenous cannula before the consultant arrived to assess the case. This could have put improper pressure on the consultant in making an assessment. (Dismissed unconditionally). 

Valid request

• Patient was in and out of a coma after a cerebral haemorrhage. There had been an earlier request for euthanasia but the Review Committees found that alleged confirmation of the request by hand squeezes and nods was insufficient to establish a valid request. Also it was not possible to establish that the patient had unbearable suffering as she was mostly in a coma. (Dismissed unconditionally)

Netherlands Public Prosecutor drops case against Dutch euthanasia doctor

This article was published by Bioedge on October 27, 2018

By Xavier Simons

Prosecutors in the Netherlands have dropped a case against a physician who euthanised a semi-conscious, severely impaired patient without written consent.

The case involved a 72-year-old woman suffering from metastatic pancreatic cancer, who was euthanized following cerebral haemorrhage that left her barely able to communicate. The woman had not signed a written declaration of intent, though the treating doctor said that the woman had expressed a desire for euthanasia on several occasions in the past.

The Public Prosecution Service announced Friday that it had conducted an investigation and said it was satisfied that the woman’s wish for euthanasia was voluntary and well-considered. They noted that, while the woman could not complete a written declaration of intent, she could nod and gesture with her hands, and that she had indicated that she wished to be euthanized.

The Dutch Regional Euthanasia Review Committees (RTE) had referred the case to authorities in 2017, along with three other cases of possible non-compliance with euthanasia regulations. The RTE were concerned that in this case there was no written consent, and they questioned the doctor’s interpretation of the patient’s “signals” following the brain haemorrhage. The RTE was also concerned that alternative options for relieving the patient’s suffering, such as palliative sedation, had not been adequately explored.

The Public Prosecution Service said that it intended to release its findings on the other cases within the next few weeks.

Diane Coleman: I depend on life-support to stay alive. Why I oppose assisted suicide laws.

This article was published by NJ.com on October 26, 2018.

By Diane Coleman

President and CEO of the Disability Rights Group Not Dead Yet

Diane Coleman

I have an advanced neuromuscular condition and must use breathing support with a mask 18 hours a day. As a severely disabled person who depends on life-sustaining treatment, I would be able to qualify for assisted suicide at any time where it is legal.

If I became despondent, for example if I lost my husband or my job, and decided that I wanted to die, I would not be treated the same as a nondisabled, healthy person who despaired over divorce or job loss.

If anyone doubted that someone like me would qualify for assisted suicide in a state like Oregon, those doubts were laid to rest in December 2017 when an Oregon Public Health Department official clarified in writing:

"Patients suffering from any disease (not just those that typically qualify one for the DWDA [Death With Dignity Act]) may not be able to afford some treatments or medication, and may choose not to pursue some treatments or take some medication for personal reasons. . . . If the patient does not receive treatment or medication (for whatever reason) and is left with a terminal illness, then s/he would qualify for the DWDA."

In the decade leading up to the passage of Oregon's assisted suicide referendum in 1997, proponents often revealed their view that people with disabilities should be eligible. Two thirds of "Dr. Death" Jack Kevorkian's body count were people with non-terminal conditions like multiple sclerosis.

The Hemlock Society contributed to his legal defense fund.

When the Hemlock Society morphed into "Compassion and Choices," the messaging shifted, partly in an effort to exclude disability rights organizations from the public debate. Assisted suicide is only for people expected to die within six months, they said. The person must self-administer the lethal drugs, so no one else could kill them, they said.

Any reasonably trained lawyer should be able to see the absence of meaningful patient protections in assisted suicide bills. It took a decade to pass the Washington State statute that came next.

All along, disability groups have pointed out the inherent discrimination and empty pretense of safeguards in these bills. Why does everyone else get suicide prevention, while old, ill and disabled people get suicide assistance? How could a doctor who's known a person for an average of 13 weeks know if they are being pressured to ask for assisted suicide?

Reported reasons for requesting assisted suicide pertain to disability, chronic or acquired due to illness.

Three of these reasons (feeling a loss of autonomy, loss of dignity, feelings of being a burden) could be addressed by consumer-directed in-home care services. However no disclosure or provision of such services is required. Basically, the law operates as though the reasons don't matter, and nothing need be done to address them.

People who need home care shouldn't be treated as disposable.

Assisted suicide proponents are fond of saying that many people don't go through with it, but the lethal drugs give them peace of mind. What if some of the many who change their mind have family members who are not happy about it?

If the only other person present at the end is a greedy heir or tired caregiver, there are no safeguards to determine whether they self-administered the lethal drug or were cajoled, tricked or forced.

Although these and other obvious weaknesses persist in New Jersey's assisted suicide bill (AB1504), the New Jersey Law Journal not only endorses it, but openly advocates expanding it to include active euthanasia and eligibility for people who are not expected to die in six months. No more incremental strategy, no need to hide the broader agenda.

Throughout last summer, people in wheelchairs with the group ADAPT were dragged out of Congressional hearings and arrested, leading successful efforts to save healthcare for millions of Americans. This same group asserts that "Assisted suicide is not about relieving the suffering of the dying: it is an expression of the most toxic and deadly form of ableism."

We urge New Jersey lawmakers to reject ableism, to look behind the public relations images of assisted suicide and consider the dangers to the many elders, ill and disabled people who are not safe from mistake, coercion and abuse.

Diane Coleman is the president and CEO of Not Dead Yet, a national disability rights group which she founded in 1996 to give voice to disability rights opposition to legalization of assisted suicide and euthanasia.

Doctor who planned to die by assisted suicide is happy to be alive.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Dr Randy Hilliard

The Detroit Free Press published an article by Meira Gebel about a new treatment for stomach cancer and how one man, a doctor, had planned to travel to Switzerland to die by assisted suicide, before receiving this new treatment.

Randy Hilliard, who was a professor of psychiatry at Michigan State University, was diagnosed with stage 4 stomach cancer. He became obsessive with suicide and planned his death by assisted suicide in Switzerland and his funeral. Hilliard stated:

“My immediate reaction was, 'I'm dead,' which of course shows you know why accessing your own medical records may not be the best idea," 

It was one rather pathetic way of asserting some control over my life. Cancer was going to kill me, and I did not intend to die yet." 

Hilliard abandoned the idea of assisted suicide and then agreed to the treatment. Gebel reported:

Back in 2010, the drug had just recently been approved for stomach cancer patients and promised a slightly longer life expectancy — 11 to 13 months longer. It was a long shot: Only 20 percent of cancer patients have the HER-2 protein surrounding the cancer cell targeted by the drug.

Hillard’s metastatic tumors had that specific protein. And eight years later, it still puzzles him … well, the statistics do. Stomach cancer at his stage has an 18-percent survival rate, and, not to mention, is one of the most uncommon cancers in America.

“I wake up every day shocked at how non-dead I am,”

Since 2010, Hilliard and his wife have traveled to South America, Dubai, Singapore and Sydney, he has become an outspoken patient advocate, a blogger at professional forums and a fundraiser for cancer research.

Assisted suicide ends life when a person is at their lowest point. 

How many people like Hilliard were denied the opportunity of a new life because they died by assisted suicide?

Canadian physicians warn Spanish Parliament about euthanasia

Media Release: October 23, 2018

As the Spanish Parliament debates the euthanasia and assisted suicide bill, Canadian physicians feel it is essential to bring to your attention the dangers and failures of the euthanasia and assisted suicide laws in Canada which have been in place since 2016. 

Link to this media release in Spanish (Link).

Since then, there has been constant pressure to normalize and expand these practices and to abandon the safeguards instituted to protect vulnerable people.

The Canadian government is now looking into extending euthanasia and assisted suicide to children, people with mental illness, and cognitive disorders.

Doctors and hospitals are under pressure to provide euthanasia or to refer cases to another clinician, even when it violates their fundamental principles to do so. 

(Euthanasia in Canada: A Cautionary Tale, World Medical Journal September 2018).

Dr Paul Saba

Dr. Paul Saba alleges that a patient’s consent to be euthanized cannot be free and informed if the patient does not have access to the proper health care including palliative care.

Dr. Saba’s argument is not theoretical given the report from the Quebec Commission on end of life care. It indicates that the euthanasia laws are not being respected. In Quebec, 52 cases not conforming to the law were performed in 2016-2017.

The lack of health services in the province and particularly palliative care, was denounced recently by the President of the College of Physicians which is the regulatory body for medical practice. The College reported some patients were seeking euthanasia because of the lack of palliative care.

Dr Saba states:

“The present Canadian laws are not safe. In the same way the proposed Spanish laws will have the same outcome. You cannot safely put into place euthanasia and assisted suicide without having a comprehensive palliative care system active and running. People need assistance in living and not assistance for suicide.”

Dr. Rene Leiva, a family physician contends that the present Canadian laws and proposed Spanish laws do not protect patients from ending their lives prematurely because of feelings of hopelessness, lack of future, feelings of being overwhelmed, being a burden and not having access to medical care which would treat their pain and suffering.

Dr Laurence Normand-Rivest

Dr. Laurence Normand-Rivest who is a palliative care physician reminds the world that Canada’s present legalization of euthanasia and assisted suicide and the proposed Spanish law are contrary to practices in the vast majority of countries around the world. These laws protect the lives of its citizens and particularly those facing disease, disabilities and conditions that could make them candidates for euthanasia and assisted suicide.

The World Medical Association, which comprises 114 countries worldwide, has consistently rejected euthanasia and describes this practice as unethical.

Presently only 6 countries of the world have laws legalizing either euthanasia or assisted suicide. This represents less than 2% of the world’s population.

Dr. Paul Saba, Dr. Rene Leiva and [mC1] Dr. Laurence Normand-Rivest are members of the Physicians’ Alliance against Euthanasia, representing more than 1100 Canadian doctors.

Contact information: Dr. Paul Saba 001-514-886-3447, pauljsaba@gmail.com
Link to media articles from Spain:

https://www.actuall.com/vida/medicos-canadienses-advierten-a-espana-sobre-el-peligro-de-la-eutanasia/

https://www.consalud.es/profesionales/medicos-canadienses-advierten-a-espana-del-peligro-de-la-eutanasia_56184_102.html

https://www.cope.es/actualidad/sociedad/noticias/medicos-canadienses-advierten-parlamento-espanol-sobre-peligro-eutanasia-20181023_281190