"the main interest of a disabled or elderly persons is to die or not get treatment"Last June Pope Francis responded to a reported euthanasia death by stating.
"We are called never to abandon those who are suffering, never giving up but caring and loving to restore hope".On October 28, the leaders of Christian, Jewish and Muslim faith communities issued a Declaration against euthanasia and assisted suicide.
Kious and Battin argue that the long-established practice of psychiatrists to make every effort to prevent suicide including the use of involuntary commitment and the relatively new availability of physician aid-in-dying (PAD) create a moral dilemma. Their proposed resolution of the dilemma is to permit psychiatric patients, as well as those with medical illnesses, to access PAD when their suffering is severe and irremediable. Our commentary rejects the fundamental presumption that any physicians, much less psychiatrists, should be involved of the work of killing rather than the calling of healing, among other criticisms.
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| Cynthia Geppert |
This “deep dive” is precisely the process that was brought to bear by the American Medical Association (AMA) and the World Medical Association (WMA) in their recent reexaminations of their ethical opposition to these practices.4 That process was repeated several times at the request of PAS proponents, and each time, though acknowledging the caring intentions on both sides of the issues, these organizations kept coming to the same conclusion—that these practices are “firmly opposed.” Similarly, for the second largest medical organization in the US—the American College of Physicians5—and even for the organization that works professionally in the “end-zone” of life—the International Association for Hospice and Palliative Care6—these and other articulations, are not mere polls. They are robust deliberations by organizations representing physicians and others, whom society is asking to do the killing. Moreover, no medical organization in the US has actually endorsed PAS as a laudable practice so far. At most, those organizations not opposed to PAS have expressed official “neutrality” on this issue.
We now turn to Drs Kious and Battins’ critique of our philosophical position as “essentialism” and “historicism.” If by “essentialism,” they mean that we hold certain medical ethical truths to be constant, enduring, and not “will-o-the-wisp” notions dependent on polls and plebiscites, then, yes—we are guilty of “essentialism.” While we would acknowledge that “evolving social expectations” do have some influence on “what is permissible for physicians,” we would deny that such expectations are infinitely elastic and determinative, vis-Ã -vis what is ethically permissible. Would the authors change their own position favoring “assisted dying” if new polls showed that most physicians oppose the practice? Or do they base their position in favor of PAS on their own view of what is “essential” to the role of physicians? If we make medical ethics dependent upon polls, we are opening the field to a kind of post-modern relativism that undercuts the very concept of a “profession.” Medical ethics are not a kind of weather vane, changeable with each new poll that comes out! We would argue that PAS is really an outgrowth of, and is contemporaneous with, the consumer movement of the past 50 to 60 years and is therefore an anomaly in the history of medical ethics.7
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| Ronald Pies |
It is not the literal wording of the Hippocratic Oath, but the subsequent development of those values that has provided a moral compass for the medical profession. That growth, intellectually and experientially, resembles, for example, the development of religious values, not confined to, but inspired by the esteemed teachers and holy books of the world’s great religious traditions. These are evolving and venerable moral compasses for covenantal communities. The current Tree of Medicine is rooted in its Hippocratic soil. It has ramified branches of thoughts and values yet embodies a core ethos that has persisted through the rise and fall of many societies.
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| Annette Hanson |
Our colleagues should not so easily dismiss the lessons of history as mere “historicism.” We believe very much in Santayana’s famous wisdom: “Those who cannot remember the past are condemned to repeat it.” Changing social mores and highly popular notions, championed by celebrities, intellectuals, and policy makers, have swept physicians off their ethical moorings in the past. Consider the historic example of Soviet psychiatry. Civil commitment was used to isolate dissidents, and the doctors went along with it. Physicians, especially psychiatrists, participated with relish in eugenics-inspired forced sterilization programs of the mentally ill in the US.8 There are moral absolutes that our profession should stand up for, in spite of legislative or popular pressure. Public health policy should not be contingent upon popularity. Many popular ideas were proved both wrong and harmful (eg. conversion therapy for homosexuals).
They conclude their rebuttal by referring to anthropologist Margaret Mead:
Anthropologist Margaret Mead presciently warned a physician friend about the social pressure on physicians to kill in the name of mercy, observing that:I am sure that this debate will continue. Geppert, Komrad, Pies and Hanson hold to the truth, that physicians must not kill their patients and psychiatrists prevent suicide, not provide it.
The followers of Hippocrates were dedicated completely to life under all circumstances, regardless of rank, age, or intellect—the life of a slave, emperor, foreign man, defective child . . . This is a priceless legacy which we cannot afford to tarnish. But society has repeatedly attempted to make the physician into the killer . . . It is the duty of society to protect the physician from such requests.9We would do well to heed her warning.
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| CHR van Hoei Hospital |
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| Wim Distlemans |
“What happens too often is that doctors dramatically increase the doses of the drugs via the baxter to speed up the end of life. That's hypocritical, because they say to the family, "We just keep him asleep." In fact, such a doctor puts an end to life. You can't even call it euthanasia, because the patient didn't ask for it, "The intentional overdosing of palliative patients is common and is ethically the same as euthanasia. These cases of terminal sedation represent an abuse of the proper use of sedation. Palliative sedation, when done correctly and ethically, should not cause the death of the patient and should not become confused with murder.
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| Taylor Hyatt |
“Let me be clear, this bill not only protects freedom of conscience, but it also in no way limits access to health care services in the province”Butts reported that the bill amended the Alberta Human Rights Act to protect conscientious beliefs as a basis for protection from discrimination or refusal for employment.
'We welcome this decision by the Courts to reject the attempt to change the 1961 Suicide Act and introduce assisted suicide via the backdoor. As the ruling points out this is a matter for Parliament, not for judges.
'This ruling recognises that Parliamentarians across the UK continue to reject attempts to introduce assisted suicide and euthanasia - more than a dozen times since 2003 - out of concern for public safety, including in 2015 when the House of Commons overwhelmingly voted against any change in the law by 330 votes to 118. The current laws prohibiting assisted suicide and euthanasia do not need changing.
'It recognises the significant dangers of ripping up long held universal protections, that ensures the law treats all people equally and evidence from around the world confirms removing these protections puts vulnerable people at risk of abuse and of coming under pressure to end their lives prematurely.
'Just a few week ago a major US report from the National Council on Disability found the laws in the handful of States that had gone down this route, were ineffective and oversight of abuse and mistakes was absent.
'This was a highly significant and important report as those championing assisted suicide, like DiD, (formally the Voluntary Euthanasia Society), hold up Oregon and Washington as the model for making the change in England and Wales.
'These findings resonate with other official reports that show year after year, a majority of those ending their lives in both States cite fear of becoming a burden a reason.
'There are also problem outside these US states. In 2016, Canada changed their law to allow terminally ill people to request assisted suicide and euthanasia. In just three years the numbers of those dying this way has dramatically risen, with one Canadian academic reported a four-fold increase between 2016 and 2018, from 1,010 - 4235.
'Then in September, the Quebec Superior Court struck down the requirement that a person be terminally ill before they qualify for euthanasia in Canada.
'While in July a depressed, but otherwise healthy 61-year-old man, was euthanised in the province of British Columbia. Alan Nichols, a former school janitor who lived alone, had struggled with depression, was admitted to Chilliwack General Hospital, BC, in June after he was found dehydrated and malnourished. Despite not being terminally ill, he received a lethal injection. Alan's case is not isolated.Ends
'There are a growing numbers of reports that terminally ill patients and those with chronic conditions are being denied care, but offered the drugs to kill themselves. In one such case, Roger Foley from Ontario who suffers from a neurological disease, recorded hospital staff offering him a 'medically assisted death', despite his repeated statements that he did not want to die and wanted to return to his home.
'No wonder not a single doctors group or major disability rights organisation supports changing the law, including the British Medical Association, the Royal College of General Practitioners, the Royal College of Physicians, the British Geriatric Society and the Association for Palliative Medicine.'
'despite minor distinctions to be made in the conditions of the claimants, Conway is an authoritative case for present purposes, and in our judgment is binding on this court in relation to this issue... Notwithstanding the forensic analysis of the opinions in Nicklinson, the court is not an appropriate forum for the discussion of the sanctity of life, or for resolution of such matters which go beyond analysis of evidence or judgment governed by legal principle.'
Even before he swears in his new cabinet, Justin Trudeau is being urged to ask his new justice minister to move swiftly to make Canada's assisted-dying law less restrictive.
The prime minister has said he'll comply with a September court ruling that struck down as unconstitutional the requirement that only those near death can qualify for medical help to end their suffering.
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| Alan Nichols with his brother. |
The Liberal democratic party is drawing up its own legislation which would make it possible for the over-75s who consider their life is at an end to be helped to die and aims to present the measure to parliament early next year.It is interesting that the Liberal Democratic Party is basing the "completed life" on age 75. What makes 75 a death age?
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| Wesley Smith |
