Thursday, October 31, 2019

Nick Goiran introduces 357 proposed amendments to Western Australia euthanasia bill.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Hon Nick Goiran
Hon Nick Goiran, a Liberal MP and a known opponent of euthanasia, gave notice last night, that he is proposing 357 amendments to the Western Australia euthanasia bill, making it clear that a final vote on the bill will not likely occur this year.

Last August, Goiran, who was a member of the committee that examined euthanasia, wrote a 248 page minority report titled: License to Care not License to Kill opposing the legalization of euthanasia or assisted suicide.

Jacob Kagi reported for ABC news that:

The 64-page list of amendments also includes changes proposed by other MPs, including Labor's Martin Pritchard, One Nation's Colin Tincknell and independent Charles Smith.

Supporters of the Government's bill dismissed the lengthy list of amendments as an obvious attempt to delay a final vote.

"Three hundred and fifty seven amendments from the lead speaker for the Liberal Party is extraordinary," Labor's Upper House leader Sue Ellery said.
Western Australia Parliament
Kagi reports that Goiran rejected the accusation that he is simply filibustering the bill.

Mr Goiran rejected suggestions that he was attempting to filibuster the debate.

"Nothing could be further from the truth," he said.

"The simple amendments that are being put forward is to lift the standard of the Western Australian legislation to that of Victoria and Northern Territory. At the moment it's the most dangerous in the nation.

"Clearly the Premier has not read the amendments on the notice paper because had he done so he would understand that a significant number of them are simply the amendments that were proposed in the Lower House."
The Canadian experience with euthanasia should concern the Western Australian parliament. The number of euthanasia deaths have increased quickly and recently a Québec court expanded the law by striking down the requirement that a person must be terminally ill.

In August, we learned that Sean Taggert died by euthanasia in British Columbia after the government refused to provide him the necessary home care for him to live with ALS.
In September we reported on the euthanasia death of a man who was not physically ill but living with chronic depression. Alan Nichols death proves that the data does not accurately state why people die by euthanasia.

World Medical Association: Euthanasia is unethical.

This article wass published by OneNewsNow on October 31, 2019.

Alex Schadenberg
Some medical groups are unhappy with the World Medical Association (WMA) and its position on doctor-assisted suicide, and the Euthanasia Prevention Coalition says the subsequent split is probably for the best.

In spite of intense pressure, the WMA has reaffirmed its position against medical professionals helping patients kill themselves. Alex Schadenberg of the Euthanasia Prevention Coalition is pleased with the development.

“They made it very clear that these things are not within ethical healthcare," Schadenberg reports. "They also provided a new definition of euthanasia and assisted suicide, which [is] good because it makes the debate very clear to physicians what they are talking about."
The document also protects the conscience rights of physicians who object to the practice, which is important because doctors are being pressured into participating.
Still, not all doctor groups are pleased.
"The Dutch Medical Association and the Canadian Medical Associations have both left the World Medical Association because they feel that the WMA doesn't represent them," the Coalition head tells OneNewsNow. "Maybe the best thing for the WMA is to have these groups leave because they were only pressuring them to do something which was wrong."
The American Medical Association this year likewise reaffirmed its position against doctors helping their patient kill themselves, in spite of heavy pressure to change their policy.

Wednesday, October 30, 2019

Fake news article states Canadian government will legalize child euthanasia.

Alex Schadenberg
Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

There is an article circulating that claims that the Canadian government has a bill to legalize child euthanasia in Canada. This article is fake news and I hope it remains fake news.

The article is published by a blog called and republished by a website called NBCM Coalition News.

The article quotes me without providing links to the original comments. I have commented on child euthanasia several times but I have no information about a current proposal to legalize child euthanasia and I have never stated that child euthanasia is legal in Canada.

The growth of euthanasia in Canada is bad enough without fake news stories making it seem worse than it is.

Links to accurate articles about child euthanasia.

Woman pressured boyfriend to suicide.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Conrad Roy
Last February, the Massachusetts high court upheld the the voluntary manslaughter conviction of Michelle Carter for assisting the suicide of Conrad Roy who was 18 at the time of his death. Carter, who was 17 at the time of the death, was sentenced to 15 months in prison. The court found that Carter pressured Conrad to die by suicide.

Another young woman has been charged after pressuring or assisting her boyfriend to die by suicide.

Alexander Urtula
Inyoung You (21) has been charged with involuntary manslaughter in the suicide death of Alexander Urtula (22) who had an 18 month relationship. Mark Pratt reported for the Associated Press:

Inyoung You, 21, was “physically, verbally and psychologically abusive” to fellow Boston College student Alexander Urtula during an 18-month relationship, Suffolk District Attorney Rachael Rollins said at a news conference.

You sent Urtula, 22, of Cedar Grove, New Jersey, more than 47,000 text messages in the last two months of the relationship, including many urging him to “go kill yourself” or “go die,” Rollins said. You also tracked Urtula and was nearby when he died in Boston on May 20, the day of his Boston College graduation.

“Many of the messages display the power dynamic of the relationship, wherein Ms. You made demands and threats with the understanding that she had complete and total control over Mr. Urtula both mentally and emotionally,” Rollins said.
According to the Associated Press article You is currently in South Korea.
You is in her native South Korea, and it is unclear when she will be arraigned. Prosecutors are in negotiations with You's counsel to get her to return to the U.S. voluntarily, but if she does not, Rollins said, she will start extradition proceedings.
Last July, Massachusetts State Senator Barry Finegold and Representative Natalie Higgins introduced Conrad's Law, a bill to deter suicide coercion. Conrad's law would punish those who coerce others into committing or attempting to commit suicide, with punishment of up to five years in prison. The bill does not apply to assisted suicide, which is illegal in Massachusetts.

Similar to other assisted suicide cases, the person who dies may have been coerced or encouraged to suicide.

Lawyers for Michelle Carter argued that her texts were constitutionally protected free speech and yet the Massachusetts Supreme Judicial Court upheld her conviction. The Carter decision has been appealed to the U.S. Supreme Court, which hasn't yet decided whether it will take up the case.

To reach the National Suicide Prevention Lifeline, call 1-800-273-TALK (8255). You can also text a crisis counselor by messaging 741741.

Tuesday, October 29, 2019

Belgian politician promotes euthanasia for "completed life."

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Politicians in the Netherlands have been debating, for several years, a law to permit euthanasia based on "completed life." 

Gwendolyn Rutten
Gwendolyn Rutten, an Open Vld (liberal) politician was published in De Morgan on October 29 claiming that the "time is ripe" in Belgium to allow euthanasia for "completed life." Rutten wrote (computer translation):

However, the debate is not over. Legislation must evolve with the times. A few years ago, after an important debate, we made euthanasia possible for skilled minors. This expansion encountered misunderstanding worldwide, but could count on a parliamentary majority in our country. Because there is no age on unbearable suffering....
Rutten argues that Hugo Claus' death by euthanasia based on dementia, created acceptance of euthanasia for dementia. She then argues the same for completed life (computer translation):
Last weekend Lutgart Simoens, the 91-year-old celebrity of Radio 2, started the debate about completed life in an interview in Het Laatste Nieuws . "She had it," the newspaper headline. Mrs. Simoens is not incurably ill, she enjoys life, her family, and classical music. She is not tired of life, but satisfied with life. “Give me one reason for the meaning of unbearable suffering. There is none. All I want is to be able to fall asleep calmly, painlessly and before I physically or mentally deteriorate. That should be everyone's right. I want the legislator to respect that it must have been possible after a completed life. "
Rutten supports Simoens campaign to extend euthanasia to people who simply want to die. Rutten states (computer translation):
For the ground flow in our country, life is something that you as an individual have at your disposal and decide.
The completed life debate brings the euthanasia debate full circle.

The euthanasia lobby argues that euthanasia is not suicide because it is for people who don't want to die, but want to end their suffering. They then amend their position and state that euthanasia is not suicide because it is for people who want to avoid suffering. Finally they will argue that completed life is not suicide, simply because they say so. 

Completed life not only sounds like suicide, it is suicide. Completed life means that the state provides the means for suicide, not because the person is suffering or dying but because they want to die. Completed life is suicide.

The only response to this debate is don't legalize euthanasia. 

Once the bright line of killing and doctors are given the legal right to kill by euthanasia, then the only question remaining is who can be killed? The only answer to this question is don't kill.

A society that is committed to caring for its citizens does not kill its citizens.

Monday, October 28, 2019

Christian, Jewish and Muslim. Declaration against Euthanasia and Assisted Suicide.

On October 28, leaders of the Christian, the Jewish and the Muslim faiths signed a Declaration against Euthanasia and assisted suicide. (Link to the Position paper and Declaration).

Based on the arguments and justifications articulated in this position paper, the three Abrahamic monotheistic religions share common goals and are in complete agreement in their approach to end-of-life situations. Accordingly, we affirm that:

➢ Euthanasia and physician-assisted suicide are inherently and consequentially morally and religiously wrong and should be forbidden with no exceptions. Any pressure upon dying patients to end their lives by active and deliberate actions is categorically rejected.

➢ No health care provider should be coerced or pressured to either directly or indirectly assist in the deliberate and intentional death of a patient through assisted suicide or any form of euthanasia, especially when it is against the religious beliefs of the provider. It has been well accepted throughout the generations that conscientious objection to acts that conflict with a person’s ethical values should be respected. This also remains valid even if such acts have been accepted by the local legal system, or by certain groups of citizens. Moral objections regarding issues of life and death certainly fall into the category of conscientious objection that should be universally respected.

➢ We encourage and support validated and professional palliative care everywhere and for everyone. Even when efforts to continue staving off death seems unreasonably burdensome, we are morally and religiously duty-bound to provide comfort, effective pain and symptoms relief, companionship, care and spiritual assistance to the dying patient and to her/his family.

➢ We commend laws and policies that protect the rights and the dignity of the dying patient, in order to avoid euthanasia and promote palliative care.

➢ We, as a society, must assure that patients’ desire not to be a burden does not inspire them the feeling of being useless and the subsequent unawareness of the value and dignity of their life, which deserves care and support until its natural end.

➢ All health care providers should be duty-bound to create the conditions by which religious assistance is assured to anyone who asks for it, either explicitly or implicitly.

➢ We are committed to use our knowledge and research to shape policies that promote socio-emotional, physical and spiritual care and wellbeing, by providing the utmost information and care to those facing grave illness and death.

➢ We are committed to engage our communities on the issues of bioethics related to the dying patient, as well as to acquaint them with techniques of compassionate companionship for those who are suffering and dying.

➢ We are committed to raising public awareness about palliative care through education and providing resources concerning treatments for the suffering and the dying.

➢ We are committed to providing succor to the family and to the loved ones of dying patients.

➢ We call upon all policy-makers and health-care providers to familiarize themselves with this wide-ranging Abrahamic monotheistic perspective and teaching in order to provide the best care to dying patients and to their families who adhere to the religious norms and guidance of their respective religious traditions.

➢ We are committed to involving the other religions and all people of goodwill.

Marieke Vervoort: an athlete’s influence used for harm?

This article was published by the disability rights group Toujours Vivant - Not Dead Yet on October 28.

Taylor Hyatt
By Taylor Hyatt 
Policy Analyst & Outreach Coordinator,
Toujours Vivant-Not Dead Yet

After the 2016 Paralympic Games in Rio de Janeiro, Brazil, Belgian wheelchair sprinter Marieke Vervoort made two startling announcements. First, she was retiring; the Rio Paralympics would be her last sporting event. Second, she was considering euthanasia due to the progression of her neuromuscular condition.

Ms. Vervoort was an accomplished athlete. She won the gold medal in the 100-metre, and silver in the 200-metre sprints at the 2012 London Games, as well as the silver medal in the 400m and bronze in the 100m in Rio. Until that point, sport had given her “a reason to keep living.” Sadly, Ms. Vervoort has followed through with her plan; according to a statement posted on the website of her hometown of Diest, she was euthanized on October 22.

Since her desire to die became public knowledge, Ms. Vervoort made many public statements in favour of euthanasia. She told CNN that she “regained control” of her life when she was approved for the procedure in 2008. She considered euthanasia to be “going to sleep … something peaceful” and a way out of unbearable suffering. Ms. Vervoort enjoyed the feeling of “rest” that her “papers” gave her, and was relieved that she did not have to end her life in a more traditional, painful way.

Ms. Vervoort lived with severe pain and a lack of sleep because of her disability. She did not have support to manage these aspects of her condition. This raises questions, such as:

  • What palliative care measures did Ms. Vervoort receive to help manage her changing condition? We already know that palliative care is often unavailable and underfunded. As well, most doctors don’t know about advanced pain management techniques.
  • Was she supported by a peer counselor as she grappled with the drastic changes associated with retirement and a progressive condition? The “better dead than disabled” message was probably harder to counter because her identity had been tied to sports for so long. After devoting so much time to her career, the question “Who is Marieke Vervoort, if not an athlete?” would prove difficult to answer. However, like all of us, Ms. Vervoort’s worth is not tied to her supposed usefulness in a particular domain. Human beings are not cartons of milk – they do not have a “best before” date! Nor would retirement take away from her accomplishments.
  • Did anyone one match her interest in death with encouragement to live, or present her with other options?
  • If Vervoort was immersed in pro-suicide messages, did she eventually feel like she had no choice but to act on them?
Ms. Vervoort made her suicide a public matter. She used her influence to convince others that ending one’s life is an acceptable response to difficult circumstances. I imagine a young admirer of Ms. Vervoort hearing her say that death is both a valid and accessible way to cope with distress, and it breaks my heart. I’ve never been particularly interested in sports, but I have been let down by a famous person I looked up to.

Steven Fletcher and Taylor Hyatt
By high school, politics – and the underlying ethical debates – had become my passion. A teacher noticed my growing interest and pointed out that MP Steven Fletcher, a disabled man, served in the House of Commons. Mr. Fletcher and I eventually met – not on a class tour of Parliament, as I had initially hoped, but on opposite sides of the euthanasia debate in the Supreme Court. Thankfully, I was well into my university studies at that time. Although I was disappointed, I was well aware of the risks of putting famous people on pedestals.

Public figures are human and fallible, and sometimes don’t live up to our expectations. On the other hand, these same figures must remember that many people, especially youth, look to them as examples. Combined with the lack of role models for disabled people to identify with, and the effects of suicide contagion, one woman’s untimely death could have a disturbing ripple effect.

May Marieke Vervoort rest in peace. I hope all who failed her by allowing her wish for death to go unchallenged have a change of heart. If not, more young fans could be motivated to follow in her footsteps, and more lives could be lost.

CBC radio propaganda promoting euthanasia for dementia.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

CBC radio produced a "documentary" that aired on October 27 titled Ten Minutes to Midnight that is more of a propaganda production promoting euthanasia for people with dementia than a documentary investigating how Canada's euthanasia law may apply to people with dementia.

I refer to it as propaganda because the documentary is promoting euthanasia for dementia, rather than simply discussing the issue. For instance the program ends by stating:

"The more we talk about this topic, the more comfortable we'll be, the better our deaths will be, however we want to shape them,"...

Canada's euthanasia law appears to not permit euthanasia for dementia alone but a closer reading of the law indicates that the physician defines a patient's competency to consent. Canada's euthanasia law, states:
241.2 (3) Before a medical practitioner or nurse practitioner provides a person with medical assistance in dying, the medical practitioner or nurse practitioner must
(a) be of the opinion that the person meets all of the criteria set out in subsection (1)
This means that the medical or nurse practitioner is only required to "be of the opinion" that the person meets the criteria of the law. Canada's euthanasia law can and is being interpreted in a very wide manner.

The purpose of this program was to inform Canadians with dementia that they qualify for euthanasia. The program states:

Wilson died with medical assistance on Oct. 29, 2017. In February 2018, the College of Physicians and Surgeons of British Columbia opened an investigation into the three doctors involved, as reported in the Globe and Mail.

At the same time, Green's colleagues at CAMAP were assembling a new guidance document that outlined the circumstances under which people with dementia might be eligible to receive MAID.

Ten months after the Wilson investigation began, the college cleared the doctors involved of any wrongdoing.

In the spring of 2019, after extensive conversations with colleagues and legal scholars, Green decided she was ready to reconsider helping Gayle. She did a second assessment.

By then, Gayle's condition had deteriorated. His mental processing had slowed, and he struggled in conversation.

"I was able to determine that Gayle still knew what was going on around him and with him. He understood that he had dementia, that it had progressed," Green said.

"At that point I really believed that Gayle had both capacity and was suffering intolerably."

On May 9, she approved his MAID application.

But in July, Gayle woke from a nap and, for the first time, didn't recognize his wife. Barbara worried he had lost capacity and would no longer be eligible for MAID.
The first point is that the doctors that were involved with Wilson's euthanasia death were cleared of wrong-doing. 

The second point is that Dr Green decided, that in her opinion Gayle was capable of consenting to his death. The article went further:
Green said the case may still spark concerns about whether the law is being expanded, but she argued it does not represent a "so-called slippery slope."

"This is not an expansion of our law … This is a maturing of the understanding of what we're doing," she said.

Green states that the continual expansion of the euthanasia law is not a slippery slope, but rather a maturing of the law. The euthanasia lobby denies that a slippery slope exists in Canada to not create a problem in other jurisdictions, such as Australia or New Zealand, who are debating euthanasia.

Canada's national broadcasting company regularly publishes articles that promote the expansion of euthanasia in Canada. This broadcast is one more CBC propaganda production.
The fast expansion of euthanasia in Canada. 

In July, Alan Nichols, also from BC, died by euthanasia, even though he was not physically ill but rather living with chronic depression. His family told the doctors that Alan was not competent and they urged the doctors not to euthanize Alan, but to no avail.

Last month, a Québec court expanded Canada's euthanasia law by striking down the requirement that a person's natural death must be reasonably forseeable. The federal and Québec governments did not appeal the decision, thus removing the "terminal illness" safeguard within the law.

Further to that, the number of euthanasia deaths is growing quickly in Canada. The 2018 data indicated a 50% increase in deaths over 2017 and the recent Ontario data indicates that there were 368 reported euthanasia deaths in the first quarter of 2019 and 519 reported euthanasia deaths in the third quarter of 2019.

Sunday, October 27, 2019

New Zealand parliament approves referendum on euthanasia.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The New Zealand parliament has been debating a euthanasia bill for many months. On October 23, the New Zealand parliament agreed to a referendum enabling the people to decide if they want to legalize euthanasia, based on the David Seymour euthanasia bill.

According to a Newshub article, the decision to have a euthanasia referendum passed by a close vote (63 to 57). The referendum was approved after the New Zealand First party stated that they would not support the "End of Life Choice" euthanasia bill without a referendum.

Channelnewsasia reported that National lawmaker Harete Hipango described the euthanasia legislation as "abhorrent, repugnant and also dangerous".

"This is a kill bill. My focus and my intention is that I seek to kill this bill because of the repugnancy of what it intends to do," he said. 
"The state has a duty of care to protect our most vulnerable." 
The referendum will take place at the same time as the general election next year.
The Euthanasia Prevention Coalition does not take a position on whether a referendum is a good way to deal with the issue but we will be providing information and educational research to the people who lead the No campaign.

Researchers cast spotlight on Dutch euthanasia for dementia

This article was published by Bioedge on October 27, 2019

By Xavier Symons

A group of US-based researchers have published a detailed review of Dutch cases of euthanasia for patients with dementia. Their findings show that euthanasia doctors in many cases ‘read in’ what they think an incapacitated patient would say about receiving assistance in dying.

The study was published in August in the American Journal of Gereatric Psychiatry and reviewed 75 case reports submitted to the Dutch euthanasia review committees between 2011 and 2018. 59 of the cases involved a concurrent request for euthanasia and 16 were based on an advanced care directive.

Concerning the concurrent requests, the study authors state that “in some of these cases, the patient’s past conversations were used to confirm competence to request [euthanasia/assisted suicide]”. That is, the validity of a patient’s decision was determined with reference to past statements rather than standard competency tests.

The authors provide an example from a 2014 case report where the physician stated:

“[the] patient was not competent at [the time of her evaluation] but she had been until recently. Her desire for euthanasia had been so consistent lately that the reduced competence should not be a stumbling block...”.
The Dutch regional euthanasia review committees appear to condone this approach, having stated that patients can be competent even when they are “unable to present supporting arguments” for their request.

The study authors, however, claim that this approach could be problematic as it is based on the “potentially confusing process” of trying to verify and interpret a patient’s past statements about euthanasia. It also runs afoul of the idea of informed consent, as valid consent had not been obtained from many of the patients who were euthanised.

The study authors, furthermore, found significant problems with euthanasia advance care directives. The authors write that “advance euthanasia directives often included trigger criteria that could make their implementation difficult, such as ‘losing her dignity’”.

Furthermore, even when a clearer trigger criterion (e.g., ‘admission to a nursing home’) is met, advance euthanasia directives only speak to the voluntary and well-considered criterion and the physicians must still assess the patient is experiencing unbearable suffering. Indeed, the euthanasia review committees have stated that admission to a nursing home is insufficient to meet the unbearable suffering 
criterion in Dutch euthanasia law.
Xavier Symons is deputy editor of BioEdge

Saturday, October 26, 2019

World Medical Association re-affirms its opposition to euthanasia and assisted suicide.

Declaration on Euthanasia and Physician-Assisted Suicide
(Link to the Declaration)

Adopted by the 70th WMA General Assembly, Tbilisi, Georgia, October 2019

1. The WMA reiterates its strong commitment to the principles of medical ethics and that utmost respect has to be maintained for human life. Therefore, the WMA is firmly opposed to euthanasia and physician-assisted suicide.

2. For the purpose of this declaration, euthanasia is defined as a physician deliberately administering a lethal substance or carrying out an intervention to cause the death of a patient with decision-making capacity at the patient’s own voluntary request. Physician-assisted suicide refers to cases in which, at the voluntary request of a patient with decision-making capacity, a physician deliberately enables a patient to end his or her own life by prescribing or providing medical substances with the intent to bring about death.

3. No physician should be forced to participate in euthanasia or assisted suicide, nor should any physician be obliged to make referral decisions to this end.

4. Separately, the physician who respects the basic right of the patient to decline medical treatment does not act unethically in forgoing or withholding unwanted care, even if respecting such a wish results in the death of the patient.

Further reading:

Friday, October 25, 2019

Canada’s euthanasia philosophy: ‘control, choice and change’

This article was published by Mercatornet on October 25, 2019

After having spent most of your professional life in Canada, you must have a special insight into its cultural tectonics. Why does euthanasia appear to have so much support there amongst doctors and the judiciary?

Margaret Somerville: 

Margaret Somerville
Recently, I read that the beginning of wisdom is to know when one should say “I don’t know”. Certainly, I cannot give you a comprehensive answer to this question.

What we do know is that approval of physician-assisted suicide (PAS) and euthanasia is highest among highly educated, high socioeconomic status persons -- sometimes described as “elites” -- in a society. Doctors and judges belong in this group, although I hasten to point out that far from all doctors and judges support euthanasia.

Those who do support it often adopt so-called “progressive values” on a range of issues including reproductive technology decision-making, abortion, same-sex marriage, and so on. “Progressive values” adherents are characteristically intensely individualistic – they give almost absolute priority to the value of individual autonomy, which can mean that they fail to take into account what is needed to protect the “common good” and, in particular, vulnerable members of the society. They also focus just on the present – they do not take into account warnings from history (“collective human memory”) or probable future consequences that can be recognized through “collective human imagination”. I call this approach to decision-making of excluding what considering the past and the future can teach us, “presentism”.

I’ve often described the mantra which informs progressives’ worldview as “control, choice and change”: They want control over what happens, especially to them personally; choice that accommodates the outcomes they seek; and the changes, for instance, in the law or cultural norms, that will make such control and choice possible.

Is there widespread popular support as well?

Well, there certainly seems to be in Canada, especially when we look at the statistics on how many people are using MAiD (Medical Aid in Dying the euphemism used for PAS and euthanasia in Canadian law). For example, in the Province of Ontario, as of 30th September 2019, 3,822 people accessed “assisted dying”, 3821 in the form of euthanasia, one assisted suicide. (It’s an interesting question as to why, in jurisdictions where both PAS and euthanasia are legal, PAS is very rarely used.) Accurate overall statistics for Canada are not available, but it’s estimated that 1.12% of all deaths now involve MAiD and is known that there have been over 8000 such deaths since its inception.

Initially, when legalizing euthanasia was being proposed and euthanasia advocates were lobbying for its legalization, I believe that many members of the general public – and even a substantial percentage of healthcare professionals - were confused as to what was and was not euthanasia, which inflated the statistics showing the public’s approval of euthanasia. Rights to refuse all medical treatment, including life-support treatment when this would result in death, and rights to fully adequate pain management, even if it ran the risk of shortening life, but was necessary to relieve pain, are not euthanasia, but many people classified them as such. This confusion was not, however, accidental; it was a strategy used by pro-euthanasia advocates to advance their cause through showing strong public support for legalizing euthanasia.

The idea of an end-of-life slippery slope is ridiculed by many politicians and doctors. But in the case of Canada, it seems relevant. What is the next development, do you think?

Canada is already considering whether to allow access to euthanasia to children, to people with serious mental illness but no physical illness, and to people with dementia through their advance directives. In light of the widespread normalization of euthanasia and the large number of people accessing it, I believe all of these expansions are likely to be allowed.

The reason such expansion is unavoidable is that once one steps over the line that says it is never ethically acceptable to inflict death on another human being, the sole exception being where that is the only reasonable way in which to save innocent human life, as in justified self-defense, there is no logical stopping point.

I have mused about the denial of slippery slopes by euthanasia advocates, such as Andrew Denton here in Australia, when it is so well documented that once introduced access to it expands rapidly. I realized that these deniers take an approach that there is no slippery slope if they regard any given expansion of access to euthanasia as a good decision, but only such a slope if they see the expansion as a bad decision, which seems to be a rare classification.

It merits mentioning that there are also doctors who initially supported the legalization of euthanasia who are now publicly speaking out against it. A prominent example, is Dr Yves Robert the registrar of the College of Physicians and Surgeons of Quebec (the medical licensing authority in the Province) who wrote an open letter under the College banner with the headline “Death a la carte” (that is a menu of choices among the options for how one wants to die) withdrawing his support for euthanasia.

Dr Robert was a major proponent of legalizing euthanasia and in 2009 the College was one of the main instigators of the movement to do so in Quebec. At that time, Dr Robert rejected anti-euthanasia proponents' claims that effective safeguards could not be put in place to regulate euthanasia. And, as in the current Australian debate, he accepted the usual claim of pro-euthanasia advocates that it would be rarely used. The estimate given by physician proponents, including the Quebec Minister of Health who was a specialist physician, was about 100 cases a year in the province. As can be seen from the Ontario statistics above that is very far from the reality which has emerged, including in Quebec.

Dr Robert changed his mind about euthanasia when calls were made to have “death on demand” declared a constitutional right. A very recent Quebec case that has struck down as unconstitutional the requirement that “natural death must be reasonably foreseeable” as a condition for access to MAiD is a step towards this possibility.

This claim that there is a right to “death on demand” is consistent with the arguments used to legalize euthanasia: that people have a right to autonomy and self-determination concerning their own bodies and lives.

In his letter, Dr Robert notes that opinion leaders and the media have denounced cases where people who do not fulfil the conditions for access to euthanasia in Quebec have been refused it. He also notes the paradoxical discourse that calls for safeguards to avoid abuse of “medical aid in dying” which are meant to limit its availability, while asking doctors to act as if there were no restrictions. He continues that if euthanasia is an unfettered right, then it’s not within the scope of “medical aid to die”, but simply “assisting dying” and he says the society must consider other options than involving the medical profession in that.

Dr Robert says that the law was a “major opening” to euthanasia and expresses surprise at how quickly public opinion seems to have judged the opening insufficient. In short, euthanasia has become normalized with astonishing rapidity and that has caused calls for access to it to be expanded, indeed, calls to have no restrictions at all on access to it.

The question that this development leaves us with is why so many Canadian doctors and lawyers of goodwill and professional integrity, such as Dr Robert, so adamantly disagreed that such expansion would occur.

Some Canadian doctors have suggested that euthanasia organ donation would be a good idea. Could you explain what’s wrong with that if the patient wants both to end his life and to give his organs? It seems like a good way to make the best of a difficult situation.

I have recently written an article dealing with this issue in The Linacre Quarterly, "Does It Matter How We Die? Ethical and Legal Issues Raised by Combining Euthanasia and Organ Transplantation".

For a variety of reasons I conclude that the ethical dilemmas are such that euthanasia and organ donation should not be connected in any way. These reasons include uncertainty regarding the definition of death which could be more critical in the context of euthanasia. Then there is disagreement about what constitutes conscientiously objecting healthcare professionals’ involvement in euthanasia. Would a transplant surgeon using organs from a euthanized person be complicit in the euthanasia of that person? Similarly, would the recipient of an organ from a euthanized person need to be told that and give informed consent to receiving that organ? And does connecting euthanasia and transplantation makes conflicts of interest for healthcare professionals unavoidable?

The reality is, however, that euthanasia and organ transplantation already are connected in Canada: the Ontario Coroner reported that the organs of 30 of the 3822 people who died by MAiD in the province were donated for transplantation.

Some suggestions are more radical, aren’t they? The patient would be killed by the act of donation, ensuring that the organs are as fresh as possible. Is this ethically worse than other forms of euthanasia?

Yes, there are more radical suggestions. Some people who agree with euthanasia and organ donation after death by euthanasia are arguing that death by donation is ethically acceptable. This would involve giving the person a general anaesthetic and carrying out euthanasia by removing their vital organs, such as the heart, to be used for transplant. Additional ethical issues raised by death by donation include breach of the “dead-donor rule” – that the person must be dead before removal of vital organs and the donation must not be the cause of death. Other considerations include what would constitute informed consent to euthanasia by donation and what impact its acceptance would have on important foundational societal values, especially respect for human dignity and for human life. 

It’s often mentioned that euthanasia patients might feel that their life becomes worthwhile by donating organs. Your thoughts?

That’s a possibility that I discuss in my article referred to above. It’s a sad thought that one is only valuable and has a purpose when one is dead. It’s true, as Ely Wiesel said, that people need a “why” to live, but surely we should not be promoting a “why” to die.

What can put a brake on the rapidly expanding boundaries for euthanasia in Canada?

Once the barn door is open and the horses have escaped shutting the barn door does not confine them, so I’m not at all sure that a brake can be put on the expanding boundaries of euthanasia in Canada. It will take possibly many generations for the full tragedy of the legalization of euthanasia to become obvious, at which time initially small voices will be magnified by others joining them and there could be a ground swell of opposition. Perhaps the reverse of how euthanasia has come to be legalized.
I sometimes think of the outrage of a young woman who made a lasting impression on me. She was born from artificial insemination by an anonymous donor and was searching for her father because she felt that “half of her was missing”. She angrily shouted at a conference panel of which I was a member, “How could society have allowed this? How could they have let this happen to me?” Societies came to see anonymous sperm donation as unethical. The law was changed in many jurisdictions to make anonymous sperm donation illegal. Perhaps the same will happen with euthanasia, except that, unlike that young woman, dead people are no longer able to shout at a society that authorized doctors to intentionally inflict death on them.

Does the Canadian experience hold any lessons for other jurisdictions – like the Australian states – which are debating whether or not to legalise it?

Yes and here are some that I would suggest:

Recognise that we live in a post-truth era, so the first lesson should be get the real facts. Good facts are essential for good ethics and good ethics for good law.

Move beyond making public and social policy decisions -- and there is no more important one than whether to legalize euthanasia -- only on the basis of respect for individual autonomy and its impact in the present.

I believe that if people have the facts on euthanasia and on its alternatives, and look not only to what individuals want, but also to the protection of vulnerable people and the common good, and take into account what human memory can teach us and human imagination tell us about future consequences, we will decide that legalizing euthanasia is a very bad and dangerous idea.

Professor Margaret Somerville taught medical law and ethics for nearly 40 years at McGill University in Canada. Few people are better qualified to comment on Canada’s embrace of euthanasia.

Wednesday, October 23, 2019

Assisted suicide: Disability advocates worry about making it easier for physicians to help New Yorkers die

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Many people wonder why disability advocates oppose assisted suicide. 

Meagan Parker, the director of advocacy for the New York association for Independent Living explains in an OP-Ed published yesterday in the New York Daily News that disability advocates worry about making it easier for physicians to cause death. Parker explains:
As someone who is blind with a chronic condition, and who has spent years fighting for the rights of people with a range of disabilities, let me explain. 
Under assisted-suicide laws, doctors play two critical roles. First, they determine if a person is indeed terminal. Then, they prescribe a drug combination that will cause death. 
I am deeply concerned that the fate of thousands of people who struggle with serious health challenges will hinge on medical professionals’ subjective perceptions and the guidance they give. My experience tells me that as a result, we will see patients with the same diagnosis or functional levels who are more or less likely to die based on factors that shouldn’t matter. 
Assisted suicide is typically depicted by proponents as a choice for patients who have tried everything. But the legislation doesn’t ensure that assisted suicide is truly a last resort. And proponents ignore the fact that having access to “everything” is a luxury of the few. 
No one knows this better than disabled people. Complications from chronic conditions can turn deadly when the appropriate treatment or equipment cannot be promptly obtained. Survival rates for cystic fibrosis vary depending on the type of insurance a person has. 
Before we even consider legalizing assisted suicide, we must address healthcare inequities that cause people who want to live with proper care to needlessly become “terminal.” Otherwise, we are effectively relegating people with fewer options to premature death. 
More fundamentally, assisted suicide is based on the assumption that life is so burdensome for some individuals that it is reasonable for them to want to die early. To me, this sounds dangerously close to the “better dead than disabled” attitude that people with disabilities have long struggled against.
Parker then explains how these laws work
Proponents insist any law will come with safeguards, but nothing can prevent an errant prognosis or keep a vulnerable person from being subtly coerced. Official reports state that about half the people who have died by assisted suicide in Oregon felt like a burden on others. 
Terms like “terminal illness” that seem well-defined are open to varying interpretations. Is a person with muscular dystrophy who may not survive if he gets pneumonia again considered terminal? Indeed, there are many disabling conditions like Parkinson’s disease that may shorten life. 
The requirement that two doctors must agree that, in their reasonable medical judgment, a patient will die within six months or less does not mean that their predictions are right. In fact, the data show that some people don’t take their lethal drugs and far outlive their prognosis. 
One provision of the bill touted as specifically protecting disabled folks and the elderly may actually do the opposite. This is the prohibition against a person qualifying for aid in dying "solely because of age or disability.” The word “solely” implies that age or disability can be among several factors to be taken into consideration in determining if a patient can be given a lethal prescription. And the reported reasons people have requested assisted suicide in Oregon — loss of autonomy, less able to engage in activities, etc. — indicate that virtually all who die by lethal prescription have been disabled in some way.
Parker concludes:
Many disability-rights activists oppose passage of New York’s assisted suicide bill because it would put people like us at risk. But our focus is broader than that. We aim for a fair and compassionate community where everyone can get the medical care they need and want, and everyone has enough social support and affirmation that they can live without feeling a duty to die.
More articles on assisted suicide from a disability rights perspective.