Sunday, June 30, 2019

Psychiatric euthanasia is a death sentence for depressed people.

By Mark Hodges (EPC Researcher)

This is for all the lonely people, thinking that life has passed them by: Don’t Give Up...” sang the pop group America in their 1974 number five hit song. Today, however, more and more doctors say to lonely people, “If you think life has passed you by, we’ll help kill you.” 

As we get older, it is normal to have regrets, or miss the exuberance of youth. The elderly can often experience reflective, sometimes melancholy moods. With age come various physical limitations and pains.

It often takes a loss of our youthful self-reliance to foster introspection necessary to recognize the most important things in life. “Teach me to number my days,” says the ancient proverb, “that I may gain a heart of wisdom.”

But today, instead of addressing the stages of life and its challenges, more and more doctors, where euthanasia is legal, are willing to end life --for no physical reason.

Alex Schadenberg of the Euthanasia Prevention Coalition explained.
“I have significant experience with people as they approach death, and it is natural to become unsure, or to feel your life has lost purpose, or to be depressed, or have feelings of loneliness. These are normal feelings,”  
“The sad reality with euthanasia and assisted suicide is that these normal feelings, once killing is legal, can become a death request, rather than a normal process of being human.”
Charles Bentz
Oregon Dr. Charles Bentz is just one example among many. His patient, an avid outdoorsman, was diagnosed with cancer, and became depressed. Dr. Bentz’ was asked to approve the assisted suicide death of his patient.

I said, ‘Wait a minute... What’s going on? Let’s talk about this,” Dr. Bentz recounted. But his colleague “must have found someone else, because two weeks later his patient was dead from an overdose of a medication.”
“So my colleague saw a patient with depression, but instead of addressing his depression, she gave him the means to kill himself.”
Dr. Bentz’ experience is not unique.

In the Netherlands, a woman in her twenties suffering from post-traumatic stress was given a lethal injection –despite her documented improvement after therapy. Doctors even admitted that a request for death could be really a cry for help. The woman’s therapy “was temporarily partially successful,” yet she was killed anyway.

Another healthy woman was euthanized because she and her deceased husband had agreed not to go on living after one of them died. She was granted a lethal injection, even though she “did not feel depressed at all. She ate, drank and slept well. She followed the news and undertook activities.”

In 2014, a healthy Italian woman was killed at a Swiss suicide clinic because she was depressed over how she looked.

Rosie DiManno
The Toronto Star’s Rosie DiManno explains what happens when someone falls into dark despair. 

“The ‘black dog’ clinical depression…locks on with pit bull jaws. And you forget that it will pass or at least abate. In the moment, it feels unendurable. Sometimes, you want to die.”
DiManno reasons that clinical depression clouds one’s thinking, and therefore depressed patients should not be candidates for assisted suicide. She says:
“Descending into that dark place where hopelessness – and psychical fatigue, really, just so damn tired of misery – renders rational thought impossible”
Enabling suicide is the opposite of medical treatment. All the more so for depressed patients. DiManno criticizes Belgium and the Netherlands –which now kill non-terminal people suffering from “incurable distress”— as “knocking off the depressed, because that’s what they want, as if the deeply disconsolate can possibly make an informed decision.”
“Among those “approved’’ for death have been people with autism, anorexia, borderline personality disorder, chronic fatigue syndrome, partial paralysis, manic depression, Alzheimer’s and a 24-year-old transgender man devastated by the failure of a sex-change surgery. None of these patients was dying. They just feel real bad… They were morbidly disconsolate and frail of mind. Which is a far sight from terminally ill and dying.”
Senator Denise Batters
Canada also legalized euthanasia for “psychological suffering.” Canadian Senator Denise Batters, whose husband died by suicide, spoke against assisted suicide for depression. 
“The committee did not require that illness be terminal or life-threatening. It included psychological suffering as grounds for physician-assisted death — without any requirement to consult a psychiatrist. It even recommended extending physician-assisted suicide to…those under 18.”
The New York Times ran an article pointing out that, 
“According to psychiatric experts, the vast majority of people requesting suicide are suffering from treatable depression, and no longer want to kill themselves once their underlying depression is resolved.” 
“Once the depression lifts and people can think more clearly, the therapists say, those who were determined to kill themselves are thankful to be alive, despite their pain or grim prognosis.”
Senator Batters argued.
“The preservation of hope for mentally ill people is absolutely paramount,” 
“Those who endure psychological suffering need our support, our resources and our promise that we will never give up on them, even when they can see no other option but to give up on themselves.”
An analysis of Maine’s new so-called “Death With Dignity” law noted that 
“severely depressed or mentally ill patients can receive assisted suicide without having any form of counseling.”
Indeed, there is nothing in existing Maine law (or Oregon, Washington, or Vermont law) that requires doctors to refer patients to a therapist in order to screen for treatable depression or mental illness before enabling their suicide.

Society’s response to depression in the elderly or in youth or for people with disabilities must not be to enable their death, but to reach out to them on a personal level, and connect them to people and activities that restore a sense of being loved and wanted.

Instead, the number of suicides keeps growing, along with the rising rates of depression. Our Western culture canonizing individualism only exacerbates the depression epidemic.

The Center for Disease Control documented that between 1999 and 2016, the suicide rate in America increased in every state (except Nevada, which remained in the top ten states for suicide).

Judith Shulevitz in The New Republic reports that one in three Americans over 45 identifies as chronically lonely. One survey found:

“One in four Americans (27 percent) rarely or never feels as though there are people who really understand them. Two in five Americans…feel that they are isolated from others (43 percent). One in five people report they rarely or never feel close to people (20 percent) or feel like there are people they can talk to (18 percent).”
Signs of depression include feelings of helplessness or hopelessness, a loss of interest in daily activities, and a loss of energy. A severely depressed person my also idealize suicide by talking about self-harm, becoming pre-occupied with death, or saying things like “everyone would be better off without me.”

Schadenberg reveals 
“Society can reduce the scourge of suicide and the cultural abandonment associated with assisted suicide by caring for and being with others at their time of need,” 
“It is essential that people who feel their life lacks value or purpose, or feel no one cares, are offered purpose, support and genuine hope from their significant community.”
Schadenberg concludes
“Suicide is a symptom of mental illness, not a cure for it,”  
“The answer is not only talking about it, the answer is inclusion, caring and being with others as they journey through the difficult times of their lives.” 
Tom Mortier
Tom Mortier, who wasn’t informed of his mother’s death until the day after a doctor killed her for being depressed commented 
“The big problem in our society is that we have apparently lost the meaning of taking care of each other,” 
Professor Gregory Crawford of the Australasian Chapter of Palliative Medicine for the Royal Australian College of Physicians emphasized that people asking to die often need to be diagnosed and treated for depression. He relayed an example of one of his terminal patients who wanted to die. He treated her for severe depression by changing her medication, and
“She made a miraculous improvement, both physically and psychologically. She improved and lived for another 12 months. She had serious, progressive disease but her physical function and her ability to interact and live improved. She went off on a holiday, achieved some other things on her wish list and made lots of other nice memories for her family. She died at home, supported by our palliative care.”
Crawford concluded. 
“It showed me that sometimes the symptoms of impending death and the symptoms of advanced depression can look very much the same,” 
Andrew Lawton
Another example is Canadian media personality Andrew Lawton. He shared.   
“Nearly seven years ago I overdosed on dozens of pills — causing multiple cardiac arrests and weeks in hospital on life support,” 
“Everything from the method to the date and time was meticulously thought out... I’m sure I could have sold my own suicide given how convinced I was that it was the right call. That wouldn’t have made it any less flawed a conclusion.”
Lawton continued
“Suicidal people are irrational... This is true even when decisions appear to be made through logic and reason.” 
“I appeared normal, despite not thinking normally. I saw suicide as the answer to pain I was convinced wouldn’t abate. I had tried myriad therapies, medications, and treatment throughout my years-long battle with depression. By the time I tried to pull the plug on my own existence, none had made an impact.”
After Lawton’s nearly successful suicide attempt, his attitude changed. Healing didn’t happen overnight, he says, and his circumstances didn’t change -- “but my outlook did.”
“In 2010, no one could have told me happiness was possible. Today, I am married to the love of my life, working in a successful career, and able to look forward each day — all just a few years after I signed my own death warrant.”
People who are depressed are in the middle of, as Alcoholics Anonymous puts it, “stinking thinking.” They need help out of their depression, not the enabling and furthering of their mental darkness by assisted death.

Senator Batters points out the fallacy in suicide as a treatment for depression. She argues
“Physical and psychological illnesses are (not) the same,”“Psychological suffering on its own is not terminal. It is usually treatable.”
 Lawton agrees
“Mental and physical illness can’t be lumped into one category,” 
“When illness is in the mind, rather than the body, it calls any decision into question — an irreversible one all the more so.”
Batters adds
“Delivering the means to suicide straight into the hands of mentally ill individuals directly contradicts the suicide prevention standard in the mental health field.”
Lawton concludes.
“The role of health-care practitioners is…not to enable one’s disordered thinking by killing them,”  
“State-sanctioned death doesn’t help the mentally ill — it robs them of a chance for healing.”
Another problem with legalizing suicide for depressed people is there is no legal standard for “unbearable suffering” or “incurable depression.”

A major study published in the Journal of the American Medical Association Psychiatry concluded, “There is no evidence base to operationalize ‘unbearable suffering,’ there are no prospective studies of decision-making capacity in persons seeking EAS for psychiatric reasons, and the prognosis of patients labeled as ‘treatment-resistant depression’ varies considerably, depending on the population and the kind of treatments they receive.”

The British Medical Journal also published a study which concluded, “‘Unbearable suffering’ has not yet been defined adequately.” 

Schadenberg explains.
“People ask for euthanasia because they have lost hope. They may be in depression or experiencing distress, darkened by their reality, and feel that life has lost its purpose or value,”  
“In the past, doctors took this request to die as a cry for help, and they tried to find out what their patient needs to weather his or her overwhelming difficulty… I want a physician who will protect my life when I’m going through my deepest darkest times. When I’m going through that physical, psychological, emotional, or existential distress and I’m so darkened that I can’t see beyond my own difficulty, I need a physician who will say ‘no’ to me and will care for me, not kill me.”
Assisted suicide and euthanasia are not about freedom for the sufferer; it’s about abandoning the patient –particularly patients in despair. 

Friday, June 28, 2019

Dutch doctors blackmailed and pressured in euthanasia requests.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

This week I wrote an article titled: Dutch doctors pressured in euthanasia requests based on the abstract of a study and and an article in the Medical Bag

This follow-up article reports on the full study - Pressure in dealing with requests for euthanasia or assisted suicide. Experience of general practitioners.

The study interviewed 22 General Practitioners (GPs) and did indepth interviews with 15 GPs. The indepth interviews concerned 36 euthanasia deaths whereby the GP felt pressured. The study concluded that:

GPs experienced in dealing with EAS requests were revealed: (1) emotional blackmail, (2) control and direction by others, (3) doubts about fulfilling the criteria, (4) counterpressure by patient’s relatives, (5) time pressure around referred patients and (6) organisational pressure.
According to the study 11 of the 15 GP's had done euthanasia many times, while the other four had done it once. The study described incidences of emotional blackmail:
GPs experienced pressure in cases where they felt emotionally blackmailed to perform EAS as if it were the patients’ right. This may be patient’s threatening to commit suicide: ‘If you do not help me this week I will have to jump’ (Case 2.3); family members threatening to murder the patient: ‘Well, will I have to do it myself then, will I have to put a pillow over her head? And then you will be the guilty one’ (Case 9.1); or jointly by patient and family: The patients says: ‘I want it [euthanasia] now, or else I will hang myself from the bridge,’ to which the partner of the patient reacts by saying: ‘he will do it for real’ (Case 6.2). 
These examples show how euthanasia can be a form of suicide by doctor, whereby the doctor reacts to suicide ideation with lethal injection. 

Under the heading, control and direction by others, the study states:
For example, in the case where the GP was still in the process of willingness to discuss euthanasia in due time and the patient suddenly said: ‘I have made up my mind, I want it [euthanasia] after my birthday, because I still want to celebrate my birthday.’ At this point, this GP started ‘feeling pressure, because she [the patient] very much took over control’ (Case 5.1). ... Another GP described his unpleasant feeling when the patient who was about to receive euthanasia opened the door himself and led the GP into the living room which was full of people as if it was a birthday party: ‘Everybody had a glass of wine in his hands, while I was preparing the euthanatica’ (Case 13.3).
Case 13.3 shows a person who was not dying, opened the door to let the doctor into a room full of people who were having a "euthanasia party."

The study comments on circumstances when the GP had doubts about the death fulfilling the criteria.
GPs reported also to experience pressure, in case they had doubts about fulfilling the legal criteria for EAS. One GP provided the example of a patient who was suffering from increasing dependency and loss of control: ‘I needed multiple meetings and time for myself to feel this [type of suffering] was enough for euthanasia.’ Looking back she felt forced to make a decision in a situation which to her felt as ‘too soon’ (Case 11.2). Another GP told about how she questioned herself whether the request for euthanasia of a patient with metastatic colon cancer was perhaps grounded in fear and ‘Can unbearable fear be a ground for euthanasia?’ She sighed: ‘In the acute moment you are actually on your own [to decide]’ (Case 6.3). 
These instances show how decisions are made to approve euthanasia in questionable circumstances.

The study then comments on counterpressure by patient’s relatives.
One GP counteracted this pressure by encouraging the patient to explicitly state to her partner: ‘I am dying, not you, and I am the one making this decision’ (Case 4.1). Another GP decided ultimately to not grant the EAS request because she did not want to ‘give your [the patients] wife a unacceptable problem and huge grief to [his] children,’ but was left with the feeling ‘we could have saved him [the patient] from dreadful weeks’ (Case 5.3).
Physicians should never euthanize a patient when the spouse is opposed. The death tranfers the pain from the person who is dying to the person who survives and the survivor is forced to live with the emotional and psychological pain, related to the euthanasia death. Last year I published this article: Grief and Suffering associated with death by euthanasia

Under the title: time pressure and referred patients, the study states:
There are cases where the GP feels pressured by the circumstances of a referred patient, with whom he/she lacks time to develop a trusting relationship. ... While the patient felt ‘I have already talked this through and I want it [euthanasia] now,’ the GP found herself at the beginning of the decision-making process because this patient was just referred to her. Another GP described a patient who had ‘moved’ to one of his colleagues because they did not bond very well. Unfortunately, this colleague was not able to work around the moment the euthanasia was planned to be performed. The GP told: ‘Then I took back the euthanasia case of this patient, and I experienced it as a very annoying euthanasia.…I rather had not performed this euthanasia’ (Case 4.3). The GP felt he had no other option than to continue the euthanasia process his colleague already started
The last area, the study examines, is organisational pressure. The study reports:
Many GPs made reference in general terms to the difficulty of combining a euthanasia case with the daily work in their GP practice. All the arrangements to be made with regard to the pharmacy and the planning of consultations with other patients are referred to as ‘organizational hassle.’ ... Euthanasia may also interfere with a GP’s family life, as explained by a GP who became very introvert and not very nice around the time cases took place, even to the extent that his wife had told him, ‘I do not want you to do that anymore.’
The concern that this study uncovers is that some euthanasia deaths are done based on pressure by the patient or by the family. In other words, these doctors are agreeing to kill a patient because they feel pressured to do the act.

This study purports to be the first study to explore the content of the pressure experienced by GP's concerning euthanasia requests, but a much larger Netherlands study interviewed 800 GP's in 2011 

I was recently contacted by a man living with quadriplegia who felt pressured by medical staff to "ask" for euthanasia. Candice Lewis and Roger Foley were also pressured to "request" euthanasia. The common denominator is that the person who is being pressured to death is living with a significant disability.
The studies concerning doctors being pressured to do euthanasia, likely share the same common denominator, that being the patient is significantly disabled and in this case, the family wants euthanasia.

This survey helps explains the incidence of euthanasia without request in the Netherlands. According to a study published in the New England Journal of Medicine in 2017, there were 431 terminations of life without request in the Netherlands in 2015.

It is natural that once euthanasia is legal, promoted, and normalized, that physicians will be pressured to do the act. It is also normal that once euthanasia is legal, that those physicians who do euthanasia will start to view certain life experiences as being "better off dead."

Euthanasia is the killing of patients, usually on request. Society should always care for people and not kill.

Thursday, June 27, 2019

Psychiatric euthanasia examined in the Netherlands.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Dr Scott Kim
While researching the issue of psychiatric euthanasia I came across an article by Psychiatrist Scott Kim published in the Atlantic on June 6, 2019. The article explains how psychiatric euthanasia is approved in the Netherlands. The article: How Dutch Law Got a Little Too Comfortable with Euthanasia is based on the death of Noa Pothaven, who the english language media originally claimed had died by euthanasia. Kim explains that even though she didn't die by euthanasia, that it was legally possible. Kim states:
I have researched the Netherlands’ experience in detail and written a number of peer-reviewed papers about it. In Dutch usage, the term euthanasia legally covers cases in which medical professionals administer lethal injection and those in which doctors provide drugs that patients ingest to end their life. The Dutch system gives deference to doctors’ expertise; it respects the relationship between an individual doctor and a patient; and it recognizes that mental illness can be painful and debilitating. Yet this system illustrates how priorities that appear logical on their own terms combine, in some cases, to produce disturbing results. A respected Dutch-language medical journal recently reported that an 18-year-old had died via medically assisted suicide for psychiatric problems.
Kim continues:
Until about 2010, the controversial practice of psychiatric euthanasia was rare, despite being permitted since the mid-1990s. Most Dutch psychiatrists—like most other doctors and the Dutch public—disapprove of psychiatric euthanasia. Still, there has been a steady increase, with 83 cases in 2017; the per-capita equivalent in the United States would be about 1,600 cases a year. Unlike euthanasia in general, psychiatric euthanasia is predominantly given to women. Most of these cases involve the End of Life Clinic, a network of facilities affiliated with the largest Dutch euthanasia-advocacy organization. These clinics routinely handle euthanasia requests refused by other doctors. (Noa Pothoven sought euthanasia there but was refused.)
Kim distinguishes between euthanasia for physical reasons compared to psychiatric reasons:
Compared with cases involving cancer or other terminal illnesses, the application of the eligibility criteria in psychiatric euthanasia depends much more on doctors’ opinions. Psychiatric diagnosis is not based on an objective laboratory or imaging test; generally, it is a more subjective assessment based on standard criteria agreed on by professionals in the field. Some doctors reach conclusions with which other doctors might reasonably disagree. Indeed, an otherwise healthy Dutch woman was euthanized 12 months after her husband’s death for “prolonged grief disorder”—a diagnosis listed in the International Classification of Diseases but not in the Diagnostic and Statistical Manual of Mental Disorders used by psychiatrists and psychologists around the world. 
Psychiatric disorders can indeed be chronic, but their prognosis is difficult to predict for a variety of reasons. There is a paucity of relevant, large longitudinal studies. Patients may get better or worse due to psychosocial factors beyond the control of mental-health providers. Also affecting prognoses is the varying quality and availability of mental-health care—which, even in wealthy countries, patients with significant symptoms may not receive. Noa Pothoven and her family had criticized the dearth of care options available in their country for patients like her. Indeed, more than one in five Dutch patients receiving psychiatric euthanasia have not previously been hospitalized; a significant minority with personality disorders did not receive psychotherapy, the staple of treatment for such conditions. When treatments are available, doctors in the Netherlands have the discretion to judge that there are “no alternatives” if patients refuse treatment.
Kim then explains the difficulty with psychiatric euthanasia:
It is not easy to distinguish between a patient who is suicidal and a patient who qualifies for psychiatric euthanasia, because they share many key traits. In some cases, psychiatric euthanasia is simply a highly effective means of suicide, as in the case of a man who attempted suicide, was hospitalized, and then received psychiatric euthanasia. 
In the end, one does not need to be a psychiatrist to appreciate how psychiatric disorders, especially when severe enough to lead to euthanasia requests, could interfere with a patient’s ability to make “voluntary and well considered” decisions—especially when that patient is a minor. The basis for concluding that any teenager with a psychiatric disorder has “no prospect of improvement” and “no alternatives” is likely to be uncertain at best.
Kim concludes that even though Noa Pothoven did not die by euthanasia, the Dutch law would have permitted it.

New Zealand Disability Commissioner Canada's euthanasia concerns confirmed in UN report

The following media release was published by defend NZ on June 25, 2018

Paula Tesoriero
Disability Commissioner Paula Tesoriero outlayed her concerns about the End of Life Choice Bill to John Campbell on TVNZ’s Breakfast yesterday morning.
"I'm concerned that the safeguards are woefully inadequate,” she said. “I'm deeply troubled by the fact that this conversation is taking place in the absence of having a wider discussion about adequate disability support services in New Zealand.”
Ms Tesoriero referenced a recent report from the United Nations Special Rapporteur on the rights of persons with disabilities, Ms. Catalina Devandas-Aguilar, on her visit to Canada.

The UN report, published in April 2019, highlights concerns that disabled people are being pressured to consider euthanasia in Canada.

Ms. Devandas-Aguilar
In the report Ms. Devandas-Aguilar said, 
"I am extremely concerned about the implementation of the legislation on Medical Assistance In Dying from a disability perspective [in Canada].

“There is no protocol in place to demonstrate that persons with disabilities have been provided with viable alternatives when eligible for assisted dying. I have further received worrisome claims about persons with disabilities in institutions being pressured to seek medical assistance in dying, and practitioners not formally reporting cases involving persons with disabilities.” Ms. Devandas-Aguilar added.
David Seymour proposes to limit eligibility to people with either a terminal illness and six months or less to live, or a neurodegenerative condition and 12 months or less to live. Such an amendment may not succeed, because politicians on both sides are likely to vote against it: Those who want the Bill to fail and those who don’t want to discriminate against non-terminally ill people.

However, even if eligibility were limited to those with terminal or neurogenerative conditions, concerns from the disability community would still be relevant. Terminal illness usually involves disability.

The Bill’s eligibility criteria includes the clause, 
“in an advanced state of irreversible decline in capability”, which is a description of “disability”.

"When we talk about choice, proponents of this bill talk about it as though everybody exercises their choice from an even playing field, and that is just not the case," Ms Tesoriero remarked.
This sense of burden that comes with choice is acknowledged by many disabled and terminally ill people, and is very real.

TVNZ’s Breakfast posted the interview on their Facebook page.

In response, a commenter posted, 
“I don’t want to be a burden on my family. The world has become selfish and greedy. I don’t want to take up my families time and energy that most families don’t have these days let alone financial assistance.”
Another reported, 
“I am terminal with ALS. These types of laws dehumanise people like me, as if our lives, pain and suffering are somehow less worthy of being experienced compared to any other hard work. They ignore the effects on family and friends, and ignore the opportunity of others to care and show compassion. If laws like this are passed, less effort will be spent finding a cure for ALS.”
Visiting Canadian euthanasia practitioner, Stefanie Green, didn’t think that people who feel like a burden would be allowed to access euthanasia. She said, 
"If a patient comes and says to me, 'Look, I’m a burden on my family. This is something I feel I need to do for the best for my family,' that's not an eligibility requirement.”
In response Ms Tesoriero pointed out that, 
"International evidence shows that one of the top five reasons that people request euthanasia or assisted dying is precisely because they feel like a burden on their families.”
There is a distinction between the eligibility criteria and the underlying reasons for requesting death.

In Oregon assisted suicide drugs are available to people with a terminal illness that is likely to end their lives within six months or less.

Feeling like a burden is not one of the eligibility criteria in Oregon. However, according to the 2019 official report, over half of recipients of ‘assisted dying’ cited “concern about being a burden on family, friends/caregivers” as a motivator.”

Alarmingly the most common reasons are related to disability – about the fear of being dependent on support for daily living. About 92% reported concern about “losing autonomy” as a reason. 91% cited concern about “being less able to engage in activities making life enjoyable”. 44% were concerned about “losing control of bodily functions”.

Only a quarter cited 
“inadequate pain control or concern about it.”
#DefendNZ encourage MPs to consider the impact the End of Life Choice Bill could have on Kiwis who have life-limiting conditions as well as disabilities – people who are already feeling emotionally vulnerable as a result of the euthanasia debate.

Wednesday, June 26, 2019

Dutch doctors pressured in euthanasia requests

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

The British Medical Journal published a study "Pressure in dealing with requests for euthanasia or assisted suicide. Experiences of general practitioners." 

The study interviewed 22 General Practitioners and indepth interviews with 15 General Practitioners concluded that:
GPs experienced in dealing with EAS requests were revealed: (1) emotional blackmail, (2) control and direction by others, (3) doubts about fulfilling the criteria, (4) counterpressure by patient’s relatives, (5) time pressure around referred patients and (6) organisational pressure.
The Medical Bag reported:
The study researchers conclude that “the pressure experienced by [general practitioners] in dealing with EAS requests can be attributable to factors associated with the patient-physician relationship and/or the relationship between the physician and the patient’s relative(s), the inherent complexity of the decision itself and the circumstances under which they have to make the decision to (not) grant EAS requests or perform EAS.
A much larger Netherlands study interviewed 800 GP's in 2011 and concluded that half of the GP's felt pressured by relatives to do euthanasia. The study indicated that two-thirds of the GP's had done at least one euthanasia in the past 5 years.

Physicians being pressured to do euthanasia is not new, but patients also feel pressured to "ask" for euthanasia. 

I was recently contacted by a man living with quadriplegia who felt pressured by medical staff to "ask" for euthanasia. Candice Lewis and Roger Foley were also pressured to "request" euthanasia. The common denominator is that the person who is being pressured to death is living with a significant disability.

The studies concerning doctors being pressured to do euthanasia, likely share the same common denominator, that being the patient is significantly disabled and in this case, the family wants euthanasia. 

This survey also explains the incidence of euthanasia without request in the Netherlands.

According to a study published in the New England Journal of Medicine in 2017, there were 431 terminations of life without request in the Netherlands in 2015.

Some physicians will agree that the person's life is not worth living while others are weak and will succumb to the pressure of the family.

Disability rights leaders oppose assisted suicide bill

Press Conference opposing Massachusetts assisted suicide bill.

At least seven disability rights advocates were prepared to testify on one of two panels. The following are links to three of those testimonies with short excerpts from each.

John Kelly
 John Kelly’s Testimony

Like most progressives, I strongly oppose capital punishment. We simply can’t stomach the fact that at least 4% of people sentenced to die are not guilty. We know that when there is a mistake, there’s no remedy.

H.1926 would in effect sentence to death non-dying people. Doctors misdiagnose all the time, and it’s estimated that 12 to-15% of people will outlive their six-month terminal diagnosis. . . .

And when more than half of suicide deaths in Oregon last year were reported to feel like a burden on others, we can see evidence of bullying, shame, and loss of options. When you read the title of the bill with different emphasis, it doesn’t mean options for the end-of-life but “the end [pause] of life-options.”

Ruthie Poole’s Testimony

Those of us in M-POWER know that depression is insidious in how it affects thinking. Against the new provision, we know that depression does impair judgment. As a therapist once told me, depression does not cause black and white thinking; it causes black and blacker thinking. Absolute hopelessness and seeing no way out are common feelings for those of us who have experienced severe depression. Personally, as someone who has been suicidal in the past, I can relate to the desire for “a painless and easy way out.” However, depression is treatable and reversible. Suicide is not.

We applaud the Joint Committee on Public Health and other members of the Legislature who have worked hard to expand funding for suicide prevention efforts. Passing this bill would be a slap in the face of those efforts. Suicide contagion is real. Any assisted suicide program will send the message to people in mental distress – old, young, physically ill or not – that suicide is a reasonable answer to life’s problems.

Anita Cameron
 Anita Cameron’s Testimony Although assisted suicide requests in Oregon (which this bill and others are modeled on) are lower among Blacks and people of color, that doesn’t mean that this won’t change in more diverse areas, especially as healthcare support lessens and assisted suicide becomes more acceptable due to the efforts of groups like Compassion and Choices. . . . Further, doctors often make mistakes about whether a person is terminal or not. In June, 2009, while living in Washington state, my mother was determined to be in the final stages of Chronic Obstructive Pulmonary Disease and placed in hospice. Two months later, I was told that her body had begun the process of dying. My mother wanted to go home to Colorado to die, so the arrangements were made. A funny thing happened, though. Once she got there, her health began to improve! Ten years later, she is still alive, lives in her own home in the community and is reasonably active.

Tuesday, June 25, 2019

Three Netherlands euthanasia deaths are being investigated.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

An article, on June 23, by Senay Boztas, for the Guardian outlines several euthanasia deaths that are being investigated or prosecuted in the Netherlands.

EPC supporters will remember the case of the euthanasia death of a woman with dementia, in 2016, who resisted the lethal injection. Boztas explains: August, a Dutch doctor will be the first prosecuted for failings, in a 2016 case, in which sedatives were put in a dementia patient’s coffee and her family asked to hold her down when she struggled against the euthanasia injection.
According to Boztas two other cases were investigated in 2017:
The two other cases, from 2017, involve a woman in her 60s with Alzheimer’s whom an independent consultant did not judge to be suffering badly enough, and another in her 80s with osteoarthritis and other problems who refused other treatment.
Boztas reports about another case in 2018. Boztas reported:
... prosecutors are investigating a doctor for failing to treat the case of a woman with “due diligence” last year. According to the report, a woman in her 70s with depression had been operated on for abdominal problems when surgeons found evidence of lung cancer. She approached her doctor, saying she was experiencing unbearable psychological suffering and wanted euthanasia. Her doctor’s colleague took on the case, but, the review committee said, failed to obtain a second opinion from an independent psychiatrist, as is required.
Recently Wesley Smith wrote about nine couples that were euthanized together.

EPC explained that the 2018 Netherlands euthanasia statistics that the number of reported euthanasia deaths was down by 7%, likely related to the investigations by the Netherlands Prosecutor. We stated our concern that a new euthanasia category indicates that 205 people died by euthanasia based on multiple problems derived from the aging process. We fear that these deaths are based on "completed life."

The Netherlands euthanasia controversy continues. 
In January 2018, we learned that Berna van Baarsen, who had been a euthanasia assessor for 10 years, resigned over cases of euthanasia for dementia. In the same month,  Aurelia Brouwers (29) died by euthanasia for psychiatric reasons. even though she was physically healthy.

The euthanasia train left the station a long time ago in the Netherlands. Sadly, Canada is quickly riding the same euthanasia track and experiencing the same concerns.

Reject euthanasia. A culture that cares does not kill.

Nancy Elliott letter to Massachusetts politicians to reject assisted suicide.

Dear Senators & Representatives,

Nancy Elliott
Please reject identical bills S.1208 and H.1926, the “End -Of-Life Options Act”. I know there are some that believe we have a right to die. Anyone can kill themselves. What Assisted Suicide laws do is give rights to doctors to make you dead. They are also giving rights to the government to decide who has the right to live and who is deserving of death. Governments should not be trusted with this power.

Assisted Suicide and Euthanasia are at their heart are eugenic. They seek to eliminate the weak, sick and elderly among us, while promoting what they call autonomy, which is only valuing individuals who are healthy and productive. They seek to morph Darwin's "Survival of the Fittest" into, only the fittest are allowed to survive. This thinking was gaining traction in the US until the Nazi's tried their human experiment and Americans were repulsed.

Proponents say the new Euthanasia is not like the earlier form. They claim it is entirely voluntary. While some may think they chose this, how many were actually steered? Steering is the elephant in the room. I was at a hearing for Assisted Suicide in Massachusetts a few years back where a doctor stated that Assisted Suicide laws were something he was in favor of. He continued with his points and ended by saying that He felt it was the responsibility for a good doctor “to guide people to make the right choice”. I do not think he intended to say that but is there any doubt that this pro suicide doctor would try to persuade his patients to follow his wishes, concerning their Assisted Suicide.

Then there is steering done by family and “so called” friends. It is easy to persuade people that they should give up. Perhaps they are tired of caring for a person or are looking to inherit. We see the most egregious example in the Dutch woman, whose doctor had the family hold her down while she fought and was euthanized against her will. Our opponents call this compassionate, caring and choice.[1]


Seniors are at risk and easily fall victim to coercion as the process is open to that. In most states, heirs can be there for the request and even speak. Anyone can pick up the lethal dose. Once in the house all oversight is gone, there is no witness required at the death. Even if they struggled who would know.

Eligible people are not necessarily dying. Think of John Norton who testified to this committee in the past. Diagnosed as a young man with ALS. He stated that had assisted suicide been legal he would have done it. A few years in, the progression of the disease just stopped. He was in his 70’s the last time I heard him testify. He had a grandchild and was happy to be alive. His life would have been wasted. What about new cures that could come up and save a person’s life? Why rush into death? You will always have another opportunity.

What about the 5% of incorrect medical diagnosis? With Assisted Suicide on the table these mistakes are deadly.

This is about disability. If you have a disability you are encouraged to commit suicide. If, on the other hand, you are young and healthy, you are given suicide counselling. This is discrimination. This law is a “special” carve out, for the sick, elderly and disabled. 

Follow the money. There are people and entities that stand to make a profit if "expensive" individuals are euthanized at the earliest moment. Winners would include, insurers, nursing homes, hospitals, government entities and people who are heavily invested in these areas.

Assisted Suicide and Euthanasia are not in the public interest. Please keep this bill from passing as it is dangerous to the people of Massachusetts.

Nancy Elliott
Euthanasia Prevention Coalition USA