Friday, January 29, 2021

Doctors say No to Washington state assisted suicide expansion bill HB 1141.

No on Washington state HB 1141,

by Kenneth R. Stevens, Jr., MD,

Professor Emeritus & former Chair Department of Radiation Oncology,
Oregon Health & Science University.

President, Physicians for Compassionate Care Education Foundation,

When the citizens of Washington state voted in 2008 in favor of Initiative 1000, Washington’s Death with Dignity Act, they did it with the understanding that there were “safeguards” in the new law.

HB 1141 seeks to remove some of those safeguards.

1) It removes the safeguard that only medical physicians can be both the attending and consulting physicians. It expands qualifications to those with lesser medical expertise. That was not the intent of the original I-1000 initiative.

2) Instead of evaluation by mental health professionals, such as psychiatrists and psychologists, it expands the law to include mental evaluation by others with lesser credentials. That was not the intent of I-1000

3) It removes the 15-day and the 72-hour waiting periods. I-1000 and the current law allowed for this time period for the person to really understand and reflect on the decision to end their life by lethal drugs. This bill will remove that protection promised in I-1000. If passed this bill would permit a person to receive lethal drugs and end their life on the same day that they have made a decision to use the law! That was not the intent of I-1000.

4) It reduces the security of delivery of the lethal drugs by permitting delivery by expanding the type of delivery. This is dangerous.

If these changes, which remove some safeguards in the law, had been in the original initiative petition, I doubt that the voters of Washington state would have approved. They would not have voted to legalize assisted suicide in Washington state in 2008.

Eliminating safeguards will eliminate vulnerable people!

The following link tells of my patient, Jeanette Hall, who requested lethal drugs in 2000, and who is grateful to still be alive 20 years later. (Link).

I urge Washington state legislators to not remove “safeguards” from the Washington “Death with Dignity Act”.

Thursday, January 28, 2021

A Renewed Call for Black Folks: Join Us and Stop Assisted Suicide!

This article was published by the disability rights group, Not Dead Yet on January 27, 2020

By Anita Cameron

Some years ago, I wrote why Black folks should join the movement against physician assisted suicide. I spoke of racial disparities in healthcare, the tendency for us to be poor and our lives devalued and the efforts of Compassion and Choices to convince us that we’re being deprived of a basic right.

I spoke about why many Black folks feel that this is a privileged white folks issue that shouldn’t concern us because that isn’t our culture. Many of us are fighting against systemic racism, white supremacy and police violence and don’t have the energy to devote to something they feel doesn’t affect our community. 

But, that was before COVID-19. Now we see that it is ravaging communities of color, particularly Black, Indigenous and Latine communities. We’re witnessing and hearing stories of rampant medical discrimination against disabled people and Blacks, in particular.

By now, many of us have heard Michael Hickson’s story. He was the 46 year old Black disabled Texas man who was refused treatment for COVID-19 due to disability, placed in hospice and allowed to die. Dr. Susan Moore, a doctor in Indiana, contracted COVID-19 and suffered racist treatment while in the hospital. She made a video describing her treatment. She later died.

They are just the tip of the iceberg. There are many, many more Dr. Moores and Michael Hicksons.

What does this have to do with doctor assisted suicide? 

Compassion and Choices has been pushing for assisted suicide for those who get COVID-19 and pushing to do it through telemedicine visits.

They have made serious inroads into the Black community and have convinced Black nurses that doctor assisted suicide is a benefit that Blacks should take advantage of. There have been incremental increases of Blacks requesting assisted suicide. The more it gets normalized, especially in diverse states, the more those numbers will rise.

Blacks are at risk from assisted suicide laws because racial disparities in healthcare:

1. Lead to limited health choices and poorer health outcomes.
2. Make it more likely that doctors will “write off” patients as terminal.
3. Make it less likely that patients can afford life-saving treatment.
4. Make it less likely that patients will receive adequate pain treatment.
It is imperative that Blacks and Black organizations get involved in the movement against the passage of doctor assisted suicide laws, especially if you are sick, disabled, poor and seniors. Racial disparities in healthcare, as well as the tendency of doctors to devalue the lives of disabled, poor and elderly will push people into doctor assisted suicide. We can’t let this happen to our community.

Wednesday, January 27, 2021

A Swiss group caters to Dutch who are not eligible for euthanasia

This article was published by Bioedge on January 24, 2021.

Michael Cook
By Michael Cook

You might think that the Dutch, who live in a country where euthanasia is legal, would have no need for the schemes of Dr Philip Nitschke, Australia’s rogue right-to-die campaigner. You would be wrong.

The Dutch magazine Trouw profiled an 87-year-old man, Kees Kentie, who went to Switzerland to die with the help of a new assisted suicide organisation, Pegasos, which is affiliated with Nitschke’s Exit International. As he explained in a recent tweet:

"The Swiss have not medicalised their end-of-life laws. Those tired of life can be helped, and couples can die together. Pegasos makes this possible. This pisses off the Dutch, where you MUST be sick, from NL, and a doctor makes the decisions, not you."
Kentie, who is not terminally ill, but frail and tired of life, wanted to die. But no Dutch doctors would help him as he did not fulfil the euthanasia law’s criteria.

So he looked into dying in Switzerland and found Pegasos which promises shorter waiting times and less red tape and conducts business in English.

Kentie went to Switzerland with two Dutch friends who made sure that he was comfortable and accompanied him in his last days. The paperwork was minimal. He had a brief chat with one of the officials of Pegasos. According to Trouw:
That Kentie is ‘tired of life’ is explained in the context of the conversation and from the supporting documents. It does not need to be explicitly asked. It was important that [his friend] Hooimeijer had earlier helped Kentie put his thoughts down on paper.

Half an A4 page long, Kees explained that he was at a time when he felt that his life was increasingly completed and that he had a fear of further decline. He wanted to stay in control until the very end.
Nitschke – who now resides in the Netherlands -- keeps Pegasos at arm’s length, but he promotes it on the website of Exit International, his organisation. The Swiss Medical Association regards it as unethical, although it seems to act within the law. According to Trouw, it “is the only one of the six Swiss death aid organizations to also provide assisted suicide to those who are 'tired of life', older than 'around 70 to 75 years' and not seriously ill.” It seems that it has less red tape because it by-passes the Swiss requirement for “unbearable suffering”. Instead of asking a doctor to certify this, it takes the word of the patient himself. However, the head of the ethics department of the Association, Thomas Gruberski, told Trouw, “We do not agree with that interpretation.”

Michael Cook is editor of BioEdge

Portugal to vote on euthanasia bill on January 29. No terminal illness requirement.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The Portugal parliament is set to vote on a euthanasia bill on January 29, a bill that allows euthanasia for people who are not terminally ill but rather suffering from permanent injuries or a grave and incurable illness. 

Similar to Canada's euthanasia law, the bill allows euthanasia based on subjective not objective considerations. Even if the "suffering" can be alleviated, euthanasia would be permitted based on whether or not the person considers the treatment acceptable. 

The term suffering also includes psychiatric suffering, which means, euthanasia for psychiatric conditions would be permitted when the person asking to be killed considers the treatment options unacceptable.

The term permanent injuries specifically permits euthanasia for people with disabilities.

United Nations experts published a press release on January 25, titled: Disability is not a reason to sanction medically assisted dying, expresses alarm at a growing trend of nations enacting legislation enabling access to medically assisted dying based largely on having a disability or disabling conditions, including old age (Link to the Press Release). The Press release states:

“Disability should never be a ground or justification to end someone’s life directly or indirectly.”

Such legislative provisions would institutionalize and legally authorize ableism, and directly violate Article 10 of the UN Convention on the Rights of Persons with Disabilities, which requires States to ensure that persons with disabilities can effectively enjoy their inherent right to life on an equal basis with others.

In July I reported that the Portuguese Medical Association, that opposes euthanasia, informed the government that they will not permit doctors to participate on the euthanasia commission (the commission to approve euthanasia). At the same time, a group of 15 law professors, including Professor Jorge Miranda, known as the father of Portugal's Constitution, stated that the euthanasia bills are unconstitutional. 

President Marcelo de Sousa, who was re-elected on January 24, has indicated that he may veto the euthanasia bill. 

If Portuguese legislators pass the euthanasia bill, President de Sousa must veto it.

Portugal needs to care for and not kill its citizens.

Tuesday, January 26, 2021

Hawaii debates bill to expand assisted suicide law.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The Hawaii assisted suicide law came into effect on January 1, 2019. Only two years after legalizing assisted suicide, the Hawaii legislature is now debating the expansion of assisted suicide with Bill SB 323.

SB 323 proposes to expand assisted suicide by:

  • Reducing the reflection period to 15 days and then allowing the reflection period to be waived if the requester is deemed to be nearing death, 
  • Allowing registered nurses to also approve and prescribe lethal assisted suicide drugs,
  • Allowing clinical social workers to counsel people with questionable consent.

The 2019 Hawaii assisted suicide ("Our care, our choice act") report indicated that in the first year of assisted suicide:

  • 30 people were prescribed lethal drugs,
  • 15 people died by assisted suicide,
  • 8 people received a lethal prescription died but did not die by assisted suicide, and 
  • 7 people remained alive at the end of 2019. 

The 2019 Hawaii assisted suicide report was released on July 1, 2020. The report also included preliminary data for 2020 indicating that from January 1 to June 26, 2020, 24 people were prescribed lethal drugs and 13 people died by assisted suicide.

Even though assisted suicide had only been legal for one year, in 2020 the Hawaii legislature debated bill SB 3047 that would have expanded the assisted suicide law by:

  • Allowing assisted suicide for incompetent people through advanced directives,
  • Waiving the counseling requirement, 
  • Approving assisted suicide by "telehealth" and 
  • Requiring insurance companies to pay for assisted suicide.
When Hawaii legislators debated assisted suicide, in 2018, the safeguards in the bill were proposed to get legislators to vote YES to assisted suicide. It appears that the assisted suicide lobby got the assisted suicide bill passed with the intention of quickly expanding it.

Disability is not a reason to sanction euthanasia.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

United Nations experts published a press release yesterday expressing alarm at a growing trend of nations enacting legislation enabling access to medically assisted dying based largely on having a disability or disabling conditions, including old age (Link to the Press Release).

The timing of this statement should cause the Canadian government to rewrite Bill C-7, which expands Canada's euthanasia law by eliminating the terminal illness requirement and permitting euthanasia for people with chronic or conditions related to disability.

In April 2019, the UN Special Rapporteur on the rights of persons with disabilities expressed concern about Canada's euthanasia law (Link). 

In March 2020, the UN Special Rapporteur on the rights of persons with disabilities expressed concern about the world wide growth of euthanasia, assisted suicide and eugenics (Link).

UN experts, Gerard Quinn, Special Rapporteur on the rights of persons with disabilities;, Olivier De Schutter, Special Rapporteur on extreme poverty and human rights; and Claudia Mahler, Independent Expert on the enjoyment of all human rights by older persons, stated that the rights of people with disabilities are being infringed by euthanasia legislation. They stated:

“We all accept that it could never be a well-reasoned decision for a person belonging to any other protected group – be it a racial minority, gender or sexual minorities - to end their lives because they experience suffering on account of their status,” the experts said.

“Disability should never be a ground or justification to end someone’s life directly or indirectly.”

Such legislative provisions would institutionalize and legally authorize ableism, and directly violate Article 10 of the UN Convention on the Rights of Persons with Disabilities, which requires States to ensure that persons with disabilities can effectively enjoy their inherent right to life on an equal basis with others.

The experts said that when life-ending interventions are normalised for people who are not terminally ill or suffering at the end of their lives, such legislative provisions tend to rest on - or draw strength from - ableist assumptions about the inherent ‘quality of life’ or ‘worth’ of the life of a person with a disability.

“These assumptions, which are grounded in ableism and associated stereotypes, have been decisively rejected by the Convention on the Rights of Persons with Disabilities. Disability is not a burden or a deficit of the person. It is a universal aspect of the human condition.

“Under no circumstance should the law provide that it could be a well-reasoned decision for a person with a disabling condition who is not dying to terminate their life with the support of the State.”

The experts said that even when access to medical assistance in dying is restricted to those at the end of life or with a terminal illness, people with disabilities, older persons, and especially older persons with disabilities, may feel subtly pressured to end their lives prematurely due to attitudinal barriers as well as the lack of appropriate services and support.

“The proportion of people with disabilities living in poverty is significantly higher, and in some countries double, than that of people without disabilities,” they said. “People with disabilities condemned to live in poverty due to the lack of adequate social protection can decide to end their lives as a gesture of despair. Set against the legacy of accumulated disadvantages their ‘architecture of choice’ could hardly be said to be unproblematic.”

The experts also expressed concern at the lack of involvement of people with disabilities, as well their representative organizations, in drafting such legislation. “It is paramount that the voices of people with disabilities of all ages and backgrounds are heard when drafting laws, policies and regulations that affect their rights, and especially when we talk about the right to life,” they said.

“Ensuring that people with disabilities and their representative organisations participate meaningfully in key legislative processes affecting them, including with regard to assisted dying, is a key component of States’ obligations to promote, protect and fulfill human rights and respect everyone’s right to life on an equal basis.
The time has come to challenge the euthanasia laws in the Netherlands, Belgium, Luxembourg and Canada to the United Nations. Clearly these laws are grounded in ableism and associated stereotypes that have been rejected by the UN Convention on the Rights of Persons with Disabilies.

Monday, January 25, 2021

Physicians should not be forced to make referrals for (MAiD) euthanasia.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Dr's Bouchard, Coelho and Herx have written an important article that was published in the Ottawa Citizen today. Bouchard, Coelho and Herx write that physicians should not be forced to make referrals for euthanasia. Now that Bill C-7, if passed, will allow people who are not terminally ill to die by euthanasia, pressure to refer for euthanasia needs to stop. Link to the original article in the Ottawa Citizen.
Bill C-7, passed by the House of Commons and now in front of a Senate committee, raises even more ethical challenges than the original legislation. Doctors who object should not be compelled to support it.

Dr Thomas Bouchard, Dr Ramona Coelho, Dr Leonie Herx

Dr Thomas Bouchard
Bill C-7 is changing the landscape of Canadian medicine. With this legislation, the federal government is expanding medically administered death (MAiD) to individuals not at end of life and with no requirement for MAiD to be a last resort in patient care. Under Bill C-7, a patient with a chronic illness or disability could receive MAiD when therapeutic options for care that could alleviate suffering have not been provided.

While some physicians may decide to aid in ending the life of their patient who is not dying, what will become of physicians who do not believe that administering death is good medicine?

Professional medical opinions are rooted in extensive medical knowledge, years of training and practice, and an individual practitioner’s conscience. It is our conscience that navigates us through the ethics necessary for providing each patient with the best medical advice for a given situation.

Dr Ramona Coelho
Medicine is not a department store. Our role is not to check the storeroom to see if we have the display item you like in the size and colour you desire. Much like a lawyer representing a client is obligated to provide them with the best legal advice, it is our responsibility to use our education, training and expertise for the health and safety of our patients. People come to us seeking help and advice and our duty is to provide the best advice and care we can. Physicians sometimes refuse patient requests, such as antibiotics when they have a viral infection. Or we may cancel a driver’s licence against a patient’s will for their safety and the common good.

Many physicians cannot participate in or facilitate MAiD through a referral without betraying their professional medical opinion or moral obligations to the value and good of the patient. Referrals are not simply a means to provide access to something a doctor does not have expertise in or services they do not offer. Rather, with a referral, physicians endorse a treatment that is in the best interests of the patient. Referral for an act that goes against a physician’s moral obligation to the good of the patient is unconscionable.

Dr Leonie Herx
Several of the Canadian provincial colleges have created policies with positive obligations that force physician participation in MAiD. This ignores the diverse backgrounds and communities of health care professionals who have committed themselves to the practice of medicine as a life-preserving profession. This approach supposes that conscientious objectors are acting selfishly rather than out of their professional medical and moral obligations and assumes, without argument, that the weighty ethical concerns of objectors are unfounded.

Effective patient access to elective services such as MAiD need not rest on physician participation through referral. The Canadian Medical Association stated, “a forced referral policy creates a false dichotomy, pitting patient access against physicians’ conscience when no other jurisdiction has done that, and yet patient access doesn’t seem to be a problem in the rest of the world.“ In a pluralistic society with diverse beliefs, systems can be set up for ethically controversial procedures that allow direct access for those who want it without forcing anyone’s participation. There are many models within Canada and around the world that strike such a balance.

MAiD for disabled and chronically ill people who are not dying is only one of the controversial legislative changes that will alter how medicine is practised and health care is delivered in Canada. The expected expansion of MAiD to mature minors, individuals with mental health as a sole diagnosis, and advance directives will significantly impact the future practice of medicine in Canada. It is imperative that governments set up the necessary systems now to allow direct patient access and put in place robust and meaningful legislated protections for physicians to practise medicine according to their consciences and with integrity.
Dr. Thomas Bouchard is a family physician who cares for frail elderly persons in long-term care centres in Calgary. Dr. Ramona Coelho is a family doctor who cares for persons with disabilities and chronic illnesses in London, Ont. Dr. Leonie Herx is the head of Palliative Medicine at Queen’s University and immediate past-president of the Canadian Society of Palliative Care Physicians.

Thursday, January 21, 2021

Ontario (MAiD) euthanasia death data examined. Deaths continue to increase.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Analyzing the Ontario (MAiD) euthanasia data.

When (MAiD) euthanasia and assisted suicide was legalized in Canada we were told that it would be rare, that the law had "stringent" safeguards, and that death would be a "last resort."

On June 17, 2016; Canada's Senate passed euthanasia bill (C-14). Even though some groups claimed victory based on the amendments to C-14, EPC was concerned by the fact that Bill C-14 used undefined language that was designed to enable expansion of the euthanasia law. 

In July, 2020, Health Canada released its first annual report on (MAiD). The data was gathered from the reports submitted by the physicians and nurse practitioners who caused the death. There is no requirement that a third party or neutral person submit the euthanasia reports to ensure accuracy. We do not expect an update from Health Canada until July 2021.

The data from the report indicated that in 2019, there were 5,631 MAID deaths reported in Canada, up from 4467 in 2018, accounting for 2.0% of all deaths. When all data sources are considered, there were 13,946 medically assisted deaths reported in Canada from legalization until December 31, 2019.

Even though the federal government is slow in releasing data, the Ontario government sends out regular reports. Since Ontario represents 39% of Canada's population, the trend in Ontario provides a strong indication for the trend in Canada.
This article is focused on analyzing the Ontario data. 

Euthanasia and assisted suicide was legalized in June 2016. According to the Office of the Chief Coroner in Ontario reports, from legalization until December 31, 2020 there were 6696 reported assisted deaths. 

Note: that 6694 were euthanasia (clinician administered) and 2 were assisted suicide (self-administered).

The number of assisted deaths are continually increasing. In Ontario there was a 33% increase in 2020 with 2378 reported assisted deaths, 1789 in 2019, 1499 in 2018, 841 in 2017, and 189 in 2016. 

The number of cumulative reported assisted deaths when further broken down:
December 31, 2018 - 2529 (30 months)
June 30, 2019 - 3303 (774 in 6 months)
December 31, 2019 - 4318 (1015 in 6 months)
June 30, 2020 - 5445 (1127 in 6 months)
December 31, 2020 - 6696 (1251 in 6 months)
The trend also indicates that fewer physicians are observing the 10 day reflection period that Bill C-7 intends to remove from the law. Canada's MAiD law allows medical practitioners to waive the 10 day reflection period. 

This is how the data breaks down concerning waiving the 10 day reflection period:
December 31, 2018 - 23% of the time, (approx 582)
June 30, 2019 - 23% of the time, (approx 760)
December 31, 2019 - 24% of the time, (approx 1036)
June 30, 2020 - 25% of the time, (approx 1361)
December 31, 2020 - 26% of the time. (approx 1741)
Since the data is cumulative, the actual data in the second half of 2020 indicates that 1251 reported euthanasia deaths with the reflection period being waved in approximately 380 of the deaths or almost 31% of those deaths.

Euthanasia followed by Organ donation began to be reported in the Ontario data in July 2019, where the data stated that there were: 
  • 3485 assisted deaths and 29 related organ donations. 
  • December 2019 the data states that there were 4318 assisted deaths and 36 related organ donations,
  • June 2020 data states that there were 5445 assisted deaths and 43 related organ donations and 
  • December 2020 data states that there were 6696 assisted deaths and 49 related organ donations.
Since the data is cumulative, it would appear that the COVID-19 medical restrictions likely resulted in fewer organ donations followed by euthanasia deaths. In the last six months of 2020 there were 1251 euthanasia deaths with 6 related organ donations representing about, or less than 1 out of 200.

The issue of euthanasia followed by organ donation is problematic for several reasons. Here are a few articles:
On October 20, I published an article estimating that there were 19,000 euthanasia deaths in Canada since legalization. By December 31, Ontario had done 637 more euthanasia deaths.

It is likely that there has now been 21,000 euthanasia deaths since legalization. The data does not include the under-reporting of euthanasia as was uncovered in Quebec and likely occurs across Canada.

Separating myth and reality in aid in dying

This article was published by the Connecticut Mirror on January 20, 2021.

By Lisa Blumberg is a Hartford area attorney, writer and disability rights activist.

The virus is surging and the death rate is increasing as the already overburdened health system is in crisis. Yet, there is talk of the legislature again considering a bill to permit doctors to provide lethal prescriptions to terminally ill adults requesting them. This is despite the fact that such bills have stalled in committee five times in the past and due to the pandemic, the legislature may meet virtually for much of the upcoming session. Proponents will be talking about choice and compassion. Let’s separate rhetoric from reality.

Rhetoric: The bill deals with “aid in dying.”  

Reality: This suggests that the bill would increase access to hospice and palliative care. It would not. It would just enable doctors to give patients a means to end it all. There is quite a difference between a patient deciding when not to have life- prolonging treatment and a doctor actively prescribing lethal drugs for the purpose of directly causing the patient’s death, i.e assisting in a suicide.

As Dr. Joseph Marine, professor at Johns Hopkins University School of Medicine has stated, assisted suicide “is not medical care. It has no basis in medical science or medical tradition… the drug concoctions used to end patients’ lives… come from the euthanasia movement and not from the medical profession or medical research.”  In the year after Washington, D.C passed an assisted suicide law, only two doctors signed up to participate.

Rhetoric: The bill is focused on choice and personal autonomy.  

Reality: Choice implies a level playing field. In our troubled health system where both costs and profits are soaring, a patient’s medical options usually depend on the quality of their insurance (if any).  Seniors and people with disabilities struggle with “quality of life” prejudices. People of color endure deadly health disparities, which has certainly made clear in the pandemic. Audrey Chapman, a professor of medical ethics at the University of Connecticut Health Center, supports assisted suicide but paradoxically admits that “One would not want a patient to make a decision because they can’t get appropriate medical care,” though that it precisely the situation many people face.

Rhetoric: People seek to end their lives due to pain.  

Reality: Oregon data indicates that the leading reasons people request lethal prescriptions are psychosocial factors such as perceived lessening of autonomy, or feeling they are a burden. People with disabilities have shown these issues can be addressed by appropriate social supports if the community has the will.

Rhetoric: The law has safeguards that will prevent abuses.  

Reality: This is wishful thinking. Nothing can prevent erroneous or vague medical predictions even when two doctors are involved. Moreover the minimal criteria written in to the laws apply only to the prescribing of the lethal drugs. Then the person is on their own. Any mental health evaluation to determine if a person has impaired decision-making capacity is only made when he requests the drugs. No evaluation will be done just prior to taking the drugs although mental state can swing wildly based on physical factors like oxygen level. Disinterested parties need not be present when the drugs are swallowed. The practical, financial and emotional difficulties created by the pandemic have caused both domestic abuse and depression to soar, leading people to do or say things they wouldn’t otherwise. Even in ordinary times, there are bound to be cases here or there where a person falls prey to the strong suggestion of another or is the victim of coercion, trickery or worse.

Rhetoric: Doctor-assisted suicide laws only apply to people who will die soon. 

Reality: Doctors cannot say conclusively when a person will die, especially when the measure is months. Moreover, what is terminal illness is capable of interpretation. For example, an Oregon health official has opined that conditions can be deemed terminal even if there is lifesaving treatment but the person  cannot afford it. This could include diabetes, and other potentially fatal conditions which can be medically managed. Indeed some assisted suicide supporters are advocating dropping any requirement that a “suffering” person’s death be foreseeable and allowing euthanasia as well.

Reality:  In-person testimony is an essential part of governmental decision-making. As Connecticut disability activist Cathy Ludlum has stated, especially with controversial issues, legislators must see their constituents in person and witness their passion. If live public hearings cannot be held this winter or if the people most concerned about an assisted suicide bill would not feel safe attending them even if they were held, the legislature must not consider assisted suicide. It’s that simple.

There are many reasons why assisted suicide bills have failed to pass five times in progressive Connecticut. Bringing up the bill again now should be a non-starter.

Lisa Blumberg is a Hartford area attorney, writer and disability activist.

Tuesday, January 19, 2021

Euthanasia deaths increase by one third in Ontario from 2019 to 2020

This article was published by the Australian Care Alliance on January 19, 2020.

Reported deaths by euthanasia in Ontario jumped by one third (32.95%) from 1789 in 2019 to 2378 in 2020 according to statistics published by the Office of the Chief Coroner. 

Article: Euthanasia deaths continue to increase in Canada (Link).

There have been 6694 reported cases of euthanasia (and just 2 of assistance to suicide) in Ontario since it became legal throughout Canada on 17 June 2016. 

The youngest person to die by lethal injection in Ontario was 20 years of age and the oldest was 106 years old.

Although 63% of the cases involved people with a "cancer-related" condition just 2% of providers of euthanasia were oncologists, with 72% being family medicine or general practitioners.

In the whole of Canada in 2019 of the 81,913 deaths attributed to cancer-related conditions (neoplasms) 3,784 deaths (4.62%) were caused by euthanasia.

One supposed safeguard under the Canadian law is a "reflection period" of 10 clear days between a first request and the actual administration of the lethal substance to cause death. However, this was waived in more than one of four cases (26%) in Ontario in all cases of euthanasia through to December 2020.

In 736 cases (11% of all cases) the justification included "imminent death". If death is imminent why not just keep the person comfortable until they die naturally? Why administer a lethal poison?

A chart in the official report on euthanasia in Canada sets out the nature of the "suffering" cited by those who were requested to be killed by a lethal injection.

The official data shows that nearly half (46.1%) of Canadians who were killed by euthanasia in 2019 were not suffering due to any inadequacy in control of pain or even any concern about this. Of the 53.9% who said they were suffering in relation to the inadequacy of pain control the data does not distinguish between those (if any) who were were actually experiencing inadequate control of pain and those who were "suffering" - pscyhologically rather than physically - from worrying (probably quite unnecessarily) about it.

However, 82.1% were said to be "suffering" from "loss of ability to engage in meaningful life activities". And 34% were "suffering" from perceiving themselves as a burden on family, friends or caregivers.

Applying these percentages to the Ontario cases where the 10 day reflection period was waived, 604 people were killed by a lethal poison within 10 days of their expected death from natural causes because ... they couldn't get in a round of golf anymore ... and 250 people were killed to relieve them of feeling they were burdening their family, friends or caregivers by taking a few more days to die naturally.

And 234 were killed prematurely because they were distressed by incontinence.

In 1004 cases (15%) of euthanasia in Ontario since it was legalised people who were not imminently dying were killed within less than 10 days of first requesting euthanasia based on a claim - by the medical or nurse practitioner administering the lethal poison and one other medical or nurse practitioner neither of whom need any special expertise in either the underlying condition or assessing capacity to provide informed consent - that the person was imminently losing capacity to give informed consent.

How can a person be judged at the same time to certainly have that capacity but just as certainly be about to lose it? This allows same day euthanasia by request by people not imminently dying and with rapidly diminishing capacity to consent.

When the Canadian Senate resumes on 2 February 2021 debate on Bill C-7 will continue. The Bill will repeal the current provision that requires a person’s natural death be reasonably foreseeable in order for them to be eligible for euthanasia.

The number of cases of euthanasia in Canada is expected to rise even more steeply each year if this change is made.

Assisted dying legislation affects us all.

This article was published by Mercatornot on January 18, 2021.

There is a fundamental difference between assisted dying and palliative care 

Dr Helen Lord
By Dr Helen Lord

Tasmania, Australia’s smallest state, like many other jurisdictions, is currently considering legalising voluntary assisted dying (VAD). It is of great concern that legislators are seeking to incorporate this into palliative and medical care.

Voluntary assisted dying sounds like a description of what should be occurring in normal medical practice: clinicians recognising those who are dying and then assisting them to live comfortably until they die. Such medical practice is currently the domain of palliative care, which can, and does, deliver relief of pain and suffering for those who consent to receive it.

However, in the currently proposed legislation for Tasmania, VAD means no less than the legalisation of euthanasia and physician assisted suicide: the exact opposite of palliative care. As described, VAD is purely a legal process, through which people can access and be given lethal substances which will cause their deaths. In contrast, palliative care is about how each individual patient can be enabled to reach their full potential until a natural death, through the relief of pain, distressing symptoms, and suffering.

The delivery of palliative care is highly personalised; it is not an impersonal process involving the meeting of various legal criteria. Palliative care requires communication by those with the necessary skills and attitudes to assess, enable, ease, and give good holistic medical care. There is no medical condition that has as a treatment the prescription of lethal substances with the intention to kill.
Palliative care

There is an extensive, publicly available evidence base for palliative care. However, there is no publicly available evidence base for the giving of lethal substances to patients — except for that used in the United States for capital punishment.

Modern palliative care arose because many people witnessed the common experiences of dying last century: patients neglected and left alone in windowless small rooms at the end of a corridor with families and friends excluded. The hospice and palliative care movement arose to provide them with a suitable environment and with appropriate patient centred care that valued and respected the dying person. It involved and was concerned with care of the dying person’s family and friends.

The evidence bases for the pharmacology of pain relief and symptom control developed, and Palliative Medicine was recognised as a medical specialty in Australia in 2000.

Palliative care principles are based on respect, valuing the life of each individual patient, and seeking to ensure that the vulnerability of those dying does not lead to a denial of care or abandonment. These palliative care values are constantly being challenged by the increasing corporatisation, bureaucratization, striving for efficiency and fragmentation of modern health care. There continues to be a need for better, more available palliative care services — yet we now see a demand for VAD.  

Fear of pain and suffering

VAD is being driven in Tasmania by those who say they want choice because they fear pain and suffering at the end of life. They claim wide support from the community in general.

Yet experience so far in Victoria, the first Australian State to legalise VAD, is that only a small percentage of people take up the offer. Stories of pain and suffering in dying are repetitively aired by grieving relatives and friends or by treating clinicians who have not known about, or sought access to palliative care for advice. The powerful effect of transference of guilt and grief in these situations is clear, but not widely recognised.

These stories perpetuate the myth that the end of life is associated with pain and suffering, which I know from my experience is not true for the majority, and certainly not the experience of those who are referred to and are able to access palliative care in a timely manner.

There are still many people in Australia who do not have access to palliative care services or an appropriate place of care when they die. It is irresponsible that legislation based on “choice” is being proposed when there are many within society denied choices through lack of access to palliative care.
Effects on vulnerable patient groups

Patients with serious and terminal illnesses are vulnerable to suggestion due to the psychological effects of facing life-threatening disease. There are also many groups within our community who are likewise vulnerable: the elderly; those living in rural areas; those with physical disability; those with mental illness; those in marginalised minorities.

These groups of people will inevitably face increased pressure to accept VAD if such legislation is passed, because of their less privileged access to care.

Once VAD is allowed, although initially in strict circumstances, it will rapidly become normalised and will be seen by the medical profession as an easy option: the options of other care and treatment modalities will be not worth considering. This is already being observed in Victoria with VAD being suggested by clinicians as an option for people surviving suicide attempts.

Disability groups in Canada are reporting that people living with disabilities are asking to access VAD because they cannot afford financially to go on living.
Effects on the medical profession and palliative care

Maintaining the integrity of the medical profession, upon which we all rely when we are ill, should be of paramount importance. Having doctors licenced to assist in suicide or the deliberate termination of life lessens the trust that patients can have in their doctors. Such behaviours go against the long-standing convention that doctors do not harm their patients.

Doctors heal, restore, ease and comfort; they do not kill, even if asked. Being involved with VAD violates a moral code that most doctors rely on for their identity; hence the very existence of VAD creates for all doctors a risk of moral injury, in the same way as is seen in combat troops facing ethical dilemmas over life and death.

The impact of just one case of VAD on a clinician’s psychological health and practice is greater than in any other aspect of medicine. Clinicians in the Netherlands liken the psychological effort required for each case of euthanasia to being like that of “climbing Mount Everest”. It leaves “little else in the tank” for the practice of good medicine or for self-care.

For all the talk in public about VAD being for the relief of pain and suffering, it is known that most people accessing VAD do so because of issues of control or autonomy. Logically, therefore, there should be no need to involve doctors or palliative care services in the procedure of VAD. Survey results suggest most Australian doctors are unwilling to be involved in VAD, and most would refer patients for palliative care involvement. However, the legalisation of VAD places palliative care services in a moral bind.

The effects of legislation similar to Tasmania’s VAD, Canada’s Medical Assistance in Dying (MAiD), introduced in 2016, on palliative care practices are starting to become apparent. One Canadian palliative care unit has reported significant staff distress with clinicians being physically sick on the days of MAiD procedures; palliative care staff having to support patients who are ambivalent about MAiD so they can go through with it; patients not having pain relief in case it denies them being able to access MAiD on capacity grounds (perpetuating the myth of painful dying); having just one person considering MAiD causing considerable psychological involvement of all staff meaning that other patients needs are neglected; staff who are unwilling to be involved in MAiD being taunted by comments that they do not really care by patients wanting MAiD; staff being more uncomfortable in discussion of end-of-life matters in case they are misinterpreted.

Palliative care services in Victoria have also reported significant issues arising in their units since VAD was legalised there. Referrals to counselling for palliative care staff suffering from psychological distress because of their involvement in VAD have begun. Increased anxiety in palliative care patients because of the existence of VAD has been noted. In the interests of maintaining the functionality of heath care teams, and because of concern for other patients on their units, patients having VAD are being transferred elsewhere.

For all these reasons as caring communities we should be thinking most cautiously before bringing state sanctioned suicide and euthanasia into the medical and palliative care arenas.

There are fundamental ethical differences between palliative care and VAD procedures; we need to protect the vulnerable in our communities and those who are dying; and we need to support the staff of our palliative care and medical services in their work, not compromise them.

Dr Helen Lord MB BS MPHC FAChPM has worked in palliative medicine and general practice in Tasmania for over 30 years

Monday, January 18, 2021

Euthanasia (MAiD) deaths continue to increase in Canada. Stop the expansion of euthanasia by Bill C-7.

Alex Schadenberg
Executive Director, 
Euthanasia Prevention Coalition

The Ontario Office of the Chief Coroner released new MAiD data (reported euthanasia and assisted suicide deaths). In Ontario from June 17, 2016 to December 31, 2020, there were 6696 reported assisted deaths.

The 6696 reported assisted deaths since legalization represented 6694 euthanasia deaths and 2 assisted suicide deaths.

In 2020, there were 2378 reported assisted deaths in Ontario with 1127 from January 1 - June 30 and 1260 from July 1 - December 31.

Sign the Petition: Reject euthanasia Bill C-7 (Link). 

The number of assisted deaths continues to increase. In Ontario there were 2378 reported assisted deaths in 2020, 1789 in 2019, 1499 in 2018, 841 in 2017, and 189 in 2016.

In July, 2020, Health Canada released the first annual report on (MAiD) euthanasia and assisted suicide. The data was gathered from the reports submitted by the medical practitioners who caused the death. There is no requirement that a third party or neutral person submit the euthanasia reports to ensure accuracy.

The July 2020 report provided information on the 2019 Canadian MAiD deaths. According to the report:

  • In 2019, there were 5,631 MAID deaths reported in Canada, up from 4467 in 2018, accounting for 2.0% of all deaths.
  • The number of cases of MAID in 2019 represented an increase of 26.1% over 2018 with every province experiencing a steady growth in the number of cases of MAID since its introduction into law in 2016.
  • When all data sources are considered, the total of number of medically assisted deaths reported in Canada from legalization until December 31, 2019 was 13,946.

On October 20, I published an article explaining that there were approximately 19,000 euthanasia deaths in Canada since legalization. By December 31, Ontario had done 637 more euthanasia deaths. It is likely that there has now been 21,000 euthanasia deaths since legalization. The data does not include the under-reporting of euthanasia as was uncovered in Quebec and likely occurs across Canada.

On February 24, Canada's federal government introduced Bill C-7 to expand the euthanasia law. Bill C-7 was passed in the House of Commons in early December and will be debated in Canada's Senate in February.

What does Bill C-7 do?

1. Bill C-7 removes the requirement in the law that a person’s natural death be reasonably foreseeable in order to qualify for assisted death. Therefore, people who are not terminally ill can die by euthanasia. The Quebec court decision only required this amendment to the law, but Bill C-7 went further.

2. Bill C-7 permits a doctor or nurse practitioner to lethally inject a person who is incapable of consenting, if that person was previously approved for assisted death. This contravenes the Supreme Court of Canada Carter decision which stated that only competent people could die by euthanasia.

3. Bill C-7 waives the ten-day waiting period if a person's natural death is deemed to be reasonably foreseeable. Thus a person could request death by euthanasia on a "bad day" and die the same day. Studies prove that the “will to live” fluctuates.

4. Bill C-7 creates a two track law. A person whose natural death is deemed to be reasonably foreseeable has no waiting period while a person whose natural death is not deemed to be reasonably foreseeable would have a 90 day waiting period before being killed by lethal injection.

5. As stated earlier, Bill C-7 falsely claims to prevent euthanasia for people with mental illness. The euthanasia law permits MAiD for people who are physically or psychologically suffering that is intolerable to the person and that cannot be relieved in a way that the person considers acceptable. However, mental illness, which is not defined in the law, is considered a form of psychological suffering.

Bill C-7 goes much further than the Quebec Superior Court Truchon decision. 

Canada's Justice Minister, David Lametti, announced on November 24 that, once Bill C-7 is passed, he wants to expand euthanasia to people with mental illness alone.

Sign the Petition: Reject euthanasia Bill C-7 (Link).

The Canadian government must reject Bill C-7 and begin the promised 5-year review of the euthanasia law with an open view to what is actually happening rather than continuing to expand euthanasia, making Canada the most permissive euthanasia regime in the world.

Sunday, January 17, 2021

Unexplained variation in regional euthanasia rates in the Netherlands.

Is it underuse, overuse or misuse?

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The British Medical Journal (BMJ) recently published a study showing that there is an unexplained 7-fold variation in euthanasia rates across the Netherlands

According to the BMJ report, the researchers were not sure if the differences related to "underuse, overuse, or misuse."

The BMJ reported that there were also striking differences between the three largest cities in the Netherlands. The report stated that:
In Amsterdam, in the three districts with highest rates of euthanasia, the proportion of these deaths was between nearly 12% and around 14.5% higher than in Rotterdam, where the proportion remained more or less static at around 6%.

In The Hague the rate of euthanasia in the three districts with the highest rates of euthanasia, the proportion of these deaths rose from nearly 7.5% to more than 11%.

Throughout the five years, the rate in the top three municipalities was 25 times higher than that of the bottom three.
The NL Times based their article on postal codes and reported:
Euthanasia was most often used in postcode area 13, the area around Almere, in 2017. In that area, euthanasia was involved in 7.37 percent of all deaths. Almost the entire Kop van Noord-Holland is in the top 10 of most granted euthanasia requests. Postcode area 91, which includes Ameland, Schiermonnikoog and Dokkum, had the lowest percentage of euthanasia deaths at 2.15 percent.
The NL Times reported researchers Theo Boer and Stef Groenewoud saying:
"If we were to do this research for other medical procedures, say cataract operations, you'd rather think of a factor of two or one and a half,"
Researcher did not find a clear explanation for the differences in euthanasia rates but they suggested to the NL Times that it could be based on regional customs. They said: "it may be that in certain parts of the Netherlands people use euthanasia more."
According to research 20% - 23% of the Netherlands euthanasia deaths are not reported. A 5 year study sponsored by the Netherlands government that was released in August 2017 showed continued abuse of the law.

Researchers need to further examine the under-reporting, and the development of lax attitudes towards euthanasia in regions of the Netherlands.

LA Times column calls for the expansion of assisted suicide to include people with Alzheimer's in California.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Nicholas Goldberg, who is a columnist with the LA Times, wrote a column last July calling for the expansion of California's assisted suicide law to include people Alzheimer's.

Isn't assisted suicide about "autonomous" "free choice" decisions that are made by people who are able to "consent"?

Well, other than attacking people who oppose assisted suicide, Goldberg wrote:
I believe that we should make more people eligible to participate in what’s come to be known as “aid in dying,” if they choose to. Alzheimer’s patients and others facing dementia seem like an obvious place to start, although policymakers also could consider people with certain degenerative diseases or those living in chronic pain, even if they aren’t within six months of death.
Goldberg doesn't recognize that people with Alzheimer's/dementia have a questionable ability to consent. Goldberg, who was reacting to the tragic death of his mother, isn't concerned that assisted suicide activists question imposing death on people with Alzheimer's. He wrote:
Yet expanding the law to include Alzheimer’s patients and other dementia sufferers is not yet on the table in most places. Even many advocates of aid-in-dying oppose it, including Monning and Kim Callinan, president of the organization Compassion and Choices.

“One of the threshold qualifiers in our law was that the patient must be mentally competent and must be the decision maker,” says Monning. “Not a family member or a loved one or medical advisor. The conscious choice of the patient to me is so critical to the efficacy and morality of this bill.”

Callinan notes that many doctors might be unwilling to administer life-ending drugs to patients who are not competent to clearly state that it is their preference. 
Still, these are problems that can and must be worked out over time.
Working out these problems over time or ignoring the problems? 

The truth is that choice, autonomy and consent are only phrases that matter when assisted suicide legalization is being promoted. 

For instance, Canada's Justice Minister has advocated extending euthanasia to people with mental illness and in the Netherlands and Belgium, euthanasia for people with mental illness and dementia/Alzheimer's is already permitted.

Really, the only clear line in the sand is to care for people and not kill them.

Once you allow killing, the only remaining question is who will be killed and how it is done.