World Medical Association debates conscience rights.

This article was published by BioEdge on May 30, 2021.

Michael Cook

By Michael Cook, Editor of BioEdge

The World Medical Association is revising the International Code of Medical Ethics (ICoME) to limit the scope of conscientious objection.

According to a WMA press release, “Workgroup members and observers representing more than 15 countries have reviewed the document carefully to determine what might be missing from the ICoME, what might be superfluous, what could potentially be organised differently”.

The principal change would be to make referral a duty for a doctor who has a conscientious objection. The current code says:

Physicians have an ethical obligation to minimise disruption to patient care. Conscientious objection must only be considered if the individual patient is not discriminated against or disadvantaged, the patient’s health is not endangered, and undelayed continuity of care is ensured.

The proposal is to add a short but significant clause:

[… is ensured] through effective and timely referral to another qualified physician.

Obviously, this would force doctors who object to legal abortion and legal euthanasia to refer patients to a more compliant doctor.

Petition: Tell the World Medical Association to respect conscience rights (Link).

Professor David Albert Jones, of the UK’s Anscombe Bioethics Centre, at Oxford, has commented that this is “deeply problematic”:

In the first place it utterly fails to establish the duty of doctors to object to practices and procedures that are unconscionable because harmful, discriminatory, unjust or unethical. The right to conscientious objection is based on the duty to be conscientious which is fundamental to medical ethics. In the second place, “conscientious objection” is presented as conflicting with “patient care”. This overlooks the fact that there can be no adequate patient care without conscientious healthcare professionals.

He suggests in a press release that “effective referral” simply will not work as an ethical standard:

if a doctor objects in conscience to participation in torture or capital punishment or to force feeding of a prisoner who is on hunger strike, it would be unprincipled for them to find someone with fewer scruples to do the deed for them. To require a conscientious objector to facilitate delivery of the procedure to which they object is a direct attack on person’s conscience and moral integrity, and thus a serious harm to them. It would be much better to say nothing about conscientious objection than to undermine it by imposing a requirement for “effective and timely referral”. 

Article: Conscience duty and good medical practise (Link).

Queensland Australia assisted suicide bill is disturbing

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Liz Storer

Liz Storer a contributor with Australia's Sky News did an excellent report on Queensland's assisted suicide bill (Link to the report).

Storer calls assisted suicide a seismic shift in societal values. She also correctly states that the Queensland assisted suicide bill is the most liberal in Australia. My recent article agrees with Storer as well as I identified how the bill is deliberatively deceptive (Link).

Storer's main points about the assisted suicide bill were:

“Firstly, the bill allows access to assisted suicide much earlier than any other jurisdiction currently in Australia, it grants people given 12 months or less to live access to a state-facilitated death,” Ms Storer said.

“Secondly, and I would say most disturbingly, this bill makes ‘mental suffering’ grounds for eligibility.

 “A third point of difference is that this bill allows for terminally ill persons who are mentally ill or disabled to access a state-facilitated suicide if deemed to have decision-making capacity.

“Lastly, like WA’s laws, Queensland’s bill allows doctors and nurses to raise the option of suicide with a patient.”

Storer concludes by stating: “Make no mistake, our sanctioning this represents a seismic shift in our societal values,”

• Queensland Australia assisted suicide bill is deliberately deceptive (Link).

The Government should be helping people to live – not die through assisted suicide

This OP-Ed was published by the UK Telegraph news on May 26, 2021 and republished by Not Dead Yet.

Baroness Jane Campbell

Baroness Jane Campbell

Today a Bill to legalise assisted suicide is being presented in Parliament. Such a change has been considered many times in the past but has always been rejected for the same reasons. Despite what the propaganda says, the majority of people it is intended to help didn’t ask for it and don’t want it. In fact we are fearful of any change in the law that would weaken the protection we rely upon now.

Those seeking to change the law say it is intended to alleviate “intolerable suffering” only for those with a terminal illness and less than six months to live. Whether or not a person meets these criteria will be determined by two independent doctors and a High Court Judge. In effect, they will be required to endorse the suicidal person’s view that they would be better off dead and the state should assist in that objective.

At present, the law treats all suicidal persons equally. We try to deter them from carrying out their wishes. We protect them from themselves by giving support. It is a very necessary protection and must not be withdrawn from those of us who are ill or disabled, especially at our lowest points, when we might question the point of going on, particularly if those around us believe we would be better off dead.

In every jurisdiction where a form of assisted suicide has been legalised, the numbers dying in this way increase over time. It is logical that it should. Why deny someone their wish when safeguards are open to interpretation, or criteria have been changed?

The government should be helping people to live – not to die through assisted suicide.

The best way to help the terminally ill is to better invest in palliative care and find a solution to the social care crisis. Once assisted suicide is law, society has endorsed it as an option, equal to that of life. Those who had never considered it will be told that it is an option. Their families, friends, health and social care professions will all know it as an option too. It is hard enough already for those of us with terminal illnesses and disabilities to get the support services we need to live active independent lives. For essential support to become merely the alternative option to assisted suicide terrifies us. That is why no organisation of terminally ill or disabled people has sought a change in the law. Why do others think they know what’s best for us?

Whilst many reasons are given, they boil down to a fear of illness and disability and the changes to independence that may bring: loss of mobility, loss of income, loss of respect, neglect and, potentially, abuse. Fear of relying on others and of being a burden. It tells us a lot about how society views terminally ill and disabled people.

Of course, the vast majority of us don’t see ourselves in that way. We don’t want the special treatment of an assisted suicide. We want basic human rights to live with dignity and respect so we can enjoy life. With the right support, most of us are pretty good at it.

Covid-19 has been described as “this generation’s polio”. Its effects have been felt by everyone and, for many, it has had life-changing consequences. According to the latest figures, disabled people make up 59% of all COVID-19 related deaths. In meeting this challenge the country has come together in universal praise of those working on the NHS* and social care front lines. The desire for them to receive the funding and resources needed to expand and improve services has been overwhelming.

Legalising assisted suicide, especially now, should not be part of the solution. We need help to live – not to die. That means investment in palliative care, solutions to the social care crisis and continued financial support for our world-class NHS.

Last time the House of Commons considered legalising assisted suicide (in 2015), it was rejected by a majority of 212, affirmation that terminally ill and disabled people are entitled to equal protection under the law. What has changed in the last six years to require the issue to be debated again? Certainly not the views of palliative care doctors or geriatricians, who remain firmly opposed to a change in the law.

Have the lives of terminally ill and disabled people improved to the extent that they are now regarded as equal members of society? Clearly not, because why otherwise would supporters of today’s bill seek to limit its effect to only us?

*National Health Service

Case study: Organ donor homicide.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Most people become organ donors because the organs will be removed after they have died and shared with someone who needs the healthy organs.

A case study published in the American Journal of Case Reports titled: Pronounced dead twice: What should an attending physician do in between? concerns a homicide death of a 39-year-old woman that was caused by Acute Fentanyl toxicity due to a Fentanyl injection in the hospital.

The woman was being prepared as an organ donor. She was pronounced dead based on cardiac death. A minute after being pronounced dead the doctors noticed that her aortic and renal arteries were pumping and pulsing. The organ procurement surgery was stopped. The person was then given additional doses of Fentanyl and Lorazepam leading to the woman being pronounced dead again 18 minutes after being pronounced dead the first time.

The case study reports that the autopsy concluded:

A postmortem sub-clavian blood toxicology study found 6.3 ng/mL of Fentanyl, 17 ng/mL of Lorazepam, 15 mcg/mL of Levetiracetam, and 29 ng/mL of Ziprasidone. The cause of death was determined to be acute Fentanyl toxicity due to a Fentanyl injection in the hospital. Another significant condition contributing to death was a ruptured berry aneurysm of the Circle of Willis. The manner of death was determined to be homicide. It is our opinion that the additional dose of Fentanyl given between 3: 00 A.M. and 3: 17 A.M. was the direct cause of death.

The case study does not indicate if the physician was charged with homicide or punished by the hospital or the body that oversees physicians. The case study does state that in similar circumstances the first organ procurement team should leave the room immediately and withdraw from the case and the attending physician should let nature run its course and refrain from excessive medical intervention. 

Excessive medical intervention is not the right phrase considering that the person was given an injection that was intentionally lethal.

The rest of the case study analysis discusses the problems with autooresuscitation and the dead donor rule.

I fear that the outcome of this case is not as uncommon as presumed. It is likely that this case became known because one of the medical professionals who was involved with this case was aghast by the reality that the patient was intentionally killed. Since these acts and decisions are made in private settings, it is likely that this occurrance happens somewhat regularly without any notice or commentary by others. Further to that, the administration of a lethal dose of fentanyl is unlikely to have been done unless it had been in the past.

In countries that have legalized euthanasia, linking organ donation to euthanasia not only provides a source of healthy organs for transplant but it also turns euthanasia into a "social good." 

The new question is: why kill the person by lethal injection first if they have agreed to be an organ donor? It is far more effective to kill the person by organ donation rather than procuring the organs after euthanasia.

Several years ago, bioethicist Wesley Smith wrote that the dead donor rule was important for maintaining the integrity of the organ donor procedure. I agree, but the change in medical ethics might have made this comment a moot point.

More articles on this topic:

• Normalizing Organ Harvesting after Euthanasia (Link).
• Euthanasia and organ donation - Questionning the dead donor rule (Link).
• Euthanasia pushed as boon to organ donation (Link).
• Euthanasia by organ donation, doctors debate dead donor rule (Link).
  

Kelly Block (MP) speech in support of conscience rights for medical professionals.

The following speech was by Kelly Block (MP) in the House of Commons on May 27, 2021. Kelly Block has sponsored conscience rights Bill C-268.

Sign the petition supporting Bill C-268 (Link).

Kelly Block (MP) Carlton Trail - Eagle Creek

Madam Speaker, I am proud to rise today to begin the debate on my private member's bill, Bill C-268, the protection of freedom of conscience act. I would be remiss if I did not acknowledge this bill is built on the hard work and determination of former members of Parliament. The first iteration that sought to address this issue was introduced by the late Mark Warawa in 2016, but it did not progress when the government introduced Bill C-14.

I do consider it a tremendous honour that my bill is the same number, C-268, as his was. After Bill C-14 was passed into law, my former colleague David Anderson introduced his private member's bill, Bill C-418, which died on the Order Paper when the election was called in 2019.

I would like to thank all those who have been championing this issue for many years and for their willingness to work with me.

Experts throughout Canada provided information and advice, while thousands of Canadians have voiced their support for protecting our fundamental freedoms. While there are numerous dictionaries that define conscience, they are consistent in defining it as an individual's inner sense of knowing the difference between what is right and wrong and that guides their behaviour.

An article by Cardus called “The Imperative of Conscience Rights” references the following:

“Conscience” traces to the Latin conscientia, and is related to the Greek synderesis. While conscientia refers to the application of our moral knowledge to particular situations, synderesis refers to the moral awareness built into each person and that urges us to do good and avoid evil.

Bill C-268 is straightforward as it seeks to enshrine in law a minimum national standard of conscience protections for medical professionals while respecting the jurisdiction of my provincial colleagues to expand on it. It is a response to calls from disability rights groups, first nations, the Ontario Medical Association and many hundreds of medical and mental health professionals to protect conscience rights.

It would ensure the medical professionals who choose to not take part in, or refer a patient for, assisted suicide or medical assistance in dying would never be forced by violence, threats, coercion or loss of employment to violate the freedoms protected in section 2(a) of the charter. This bill also serves to protect the rights of patients to receive a second opinion, and by doing so, would protect our health care system.

In my consultations, I spoke with disability rights advocate Heidi Janz. She told me about being born in the Soviet Union. Doctors told her parents that Heidi would never walk, talk or think and that she would be dependent on others for the rest of her short life. They told her parents to put her into an institution and forget they ever had her. Heidi Janz has severe cerebral palsy.

Her parents did not listen to the dominant narrative of their day. They loved their daughter and believed her life had value. Eventually, they found the support they needed. Today, Dr. Heidi Janz holds a Ph.D. and is an adjunct professor of ethics at the University of Alberta. In her spare time she is a playwright and author, and somehow, despite how busy her life is, she also serves as the chair of the ending of life ethics committee for the Council of Canadians with Disabilities.

Dr. Janz is a remarkable woman. While some might pity her, she will have none of it. She says that everyone talks about how bad it must be to have a disability, but that she chooses daily to live in opposition to that narrative. She also says that disabled people can be so much more than their diagnosis, and that she is proof of that fact.

If it had been up to the dominant view of her day, she would never have had the chance to disprove that narrative. If her parents did not have the option to find the help they wanted to get that crucial second opinion, none of my colleagues in this place would be hearing about this marvellous woman. This is not just a theoretical story.

In a similar vein, earlier this year the Minister of Crown-Indigenous Relations, who is a doctor herself, wrote to her constituents about her experience of ageism in our health care system as it related to her 93-year-old father.

While I will not repeat the whole story, I will just quote her last two sentences:

My Dad got better without needing the ICU, but I remember thinking that as an MD I had been able to firmly take a stand. I worried that other families wouldn’t have been able to question the clear ageism in the choices being put in front of them.

The minister's father and all Canadians have the right to find a doctor who will offer them hope, offer them another choice, offer them a second opinion. All Canadians deserve that same right.

Now, this is anything but a guarantee in Canada. We have passed laws that have the unintended consequence of forcing doctors and medical professionals to provide patients death, regardless of whether they believe it is in their patient's best interest. Bill C-14 and Bill C-7 create a federal standard for medical assistance in dying and assisted suicide, but not for conscience protections. Despite the claims of some, it is patently absurd to argue that a conscience rights bill would somehow interfere with the role of the provinces while the legalization of medical assistance in dying does not.

We are speaking of the very first fundamental freedom laid out in the charter. Ensuring that conscience rights are protected is the responsibility of Parliament and of the Government of Canada, which is why I introduced this bill and why it should be passed. Above all, it is the right thing to do for patients and medical professionals.

Some have tried to frame conscience rights as the rights of the patient versus the rights of the doctor. Nothing could be further from the truth. In fact, conscience rights are critical to how our health care system works. Patients have the right to a second opinion, but there can be no second opinion if every medical professional is forced to provide the exact same list of options.

Health care is fundamentally about the doctor-patient relationship. Take the case of a psychiatrist who supports MAID in certain circumstances, but who has spent 15 years counselling a patient who suffers from bouts of depression and suicidality. For 15 years, they have built up an understanding and trust. What would happen if that patient, suffering from a bout of suicidality, should demand assisted suicide? Under the current law, that psychiatrist would be forced to refer the patient to someone else so that the patient could die. The psychiatrist must do this, despite knowing that the suicidal thoughts are temporary, that otherwise the patient is joyful and loves life, and that ending that life is wrong. The psychiatrist's hands are tied. Is that what passes for medical care?

Some might claim that there are safeguards in place to prevent such tragedies, but I ask, are members completely sure? With the passage of Bill C-7, many of the safeguards have been removed. We are talking about ending a human life. There is no room for “maybe” when a life hangs in the balance. Should the first line of safeguards not be the expertise of the medical professionals who know best? If they do not believe death is the answer, should we not at least consider if they are right? This is, after all, a matter of life and death.

Medical assistance in dying and assisted suicide are readily available throughout all of Canada. There are information phone lines, hospitals staffed with willing medical professionals, even email addresses to help set up appointments. In a word, MAID is becoming the status quo. To claim that protecting the conscience rights of medical professionals will somehow block access for those who truly want it is both misleading and nothing but baseless fearmongering.

The Canadian Medical Association stated clearly that conscience protections would not affect access, because there were more than enough physicians willing to offer MAID. This is further reinforced by a McGill study that showed that 71% of recent medical school graduates would be willing to offer MAID.

Every court case on the subject, as well as common sense, has stated clearly that the charter rights of medical professionals are breached when they are forced to either offer or refer assisted suicide or medical assistance in dying. Surely, we are clever enough to ensure access to MAID while still protecting the fundamental charter right to freedom of conscience.

I believe it is no accident that former prime minister, Pierre Trudeau, placed conscience rights as the first of the enumerated rights in our charter. It is an acknowledgement that the state cannot and should not attempt to force any one of us to do what we believe is immoral.

Dozens of first nations leaders wrote to every MP and senator. They said that, “Given our history with the negative consequences of colonialism and the involuntary imposition of cultural values and ideas, we believe that people should not be compelled to provide or facilitate in the provision of MAiD.”

We claim to be a pluralistic, free society. If that is true, it demands of us a tolerance of the moral views of others. Some have argued that protections already exist in Bill C-14. While I applaud the former minister of justice, the hon. member for Vancouver Granville, for ensuring that conscience rights were acknowledged in that legislation, acknowledgement is no longer enough. There are examples of medical professionals being forced or bullied into participation in assisted suicide against their conscience.

Dr. Ellen Warner, an oncologist who has served her patients for 30 years, told me about her experiences. She said:

I think it will shock Canadians to hear of healthcare providers being coerced into participating in MAID, yet such coercion has been happening frequently. A brilliant colleague of mine was bullied into becoming the physician legally responsible for MAID on his hospital ward. It was a great loss to us when he left for a different position. Two other co-workers told me that, despite strong, moral objections, they would carry out MAID if asked to do so for fear of losing their jobs. At one of our staff meetings, a psychiatrist stood up and announced that any physician who does not actively support MAID should not be working at our hospital.

Finally, some have suggested that medical professionals should leave their morality at the door. However, no one truly believes or wants that. As an example, no one would want a doctor to forget their morality if they were offered a bribe to move someone up on a waiting list. If we hold our medical professionals to a higher standard, we cannot then tell them to ignore their personal moral standards. As Dr. Ellen Warner stated, “In the absence of conscience protection, the group with the most to lose are the patients—the people we are all trying to help,”

This bill would protect the doctor-patient relationship by ensuring that doctors and other medical professionals are always able to recommend and provide the care they believe is best for their patient. Canadians need this bill to pass. Canada's medical professionals need this bill to pass. Additionally, they will need individual provincial governments to protect their rights through provincial regulations and legislation.

I encourage all members in this place to do our part and pass the protection of freedom of conscience act.

New bid to legalise assisted suicide ‘threatens disabled people’s lives.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Not Dead Yet UK rally

An article by John Pring for the Disability New Service on May 27, 2021 reports that disability activists are saying that the new bill to legalize assisted suicide in the UK is a threat to their “lives, independence and peace of mind”. The latest assisted suicide bill is sponsored by former social worker Baroness Meacher, who is also the chair of the campaigning organisation Dignity in Dying, formerly known as the Voluntary Euthanasia Society.

Pring reports that Not Dead Yet UK (NDY UK), which leads disabled people’s opposition to legalisation of assisted suicide in the UK, said that a change in the law would be “a threat to disabled people’s lives, independence and peace of mind”.

NDY UK said many disabled people had lost access to health and social care during the pandemic, making it even harder to secure the support they needed to live “active, independent lives” and bringing into “sharp focus” the value society places on them.

Pring also reported a NDY UK spokesperson as saying:

“For essential support to become merely the alternative option to assisted suicide terrifies us.

“That is why no organisation of terminally ill or disabled people has sought a change in the law.

“We need help to live – not to die. That means investment in palliative care, pragmatic solutions to social care provision and continued financial support for our world-class NHS.

“These are the issues our parliamentarians should be concentrating on, rather than the Pandora’s Box of assisted suicide which might help the few, but at the expense of the many.”

Baroness Meacher's assisted suicide bill is expected to be debated in the British House of Lords in September.

Canadian man dies by euthanasia after adverse drug reaction.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Avis Favaro, the CTV National News Medical Correspondent recently did a news program on the issue of adverse drug reactions in Canada. 

According to Favaro, advocates say that adverse drug reactions are the leading cause of death for Canadians and they are pushing for new rules for monitoring the side effects to track the reactions to adverse drug reactions.

What makes this story different than the many other stories of people who have suffered after an adverse drug reaction is that Mike Sawatsky, who Favaro follows in the report, has applied for and was approved for euthanasia (MAiD) in order to end his suffering.

When debating euthanasia I have referred to the data indicating that medical error is the third leading cause of death. The adverse drug reaction activists claim that adverse drug reaction is the leading cause of death.

People who ask for death by lethal injection are sometimes misdiagnosed, but in this case Sawatsky, who will die by euthanasia, was horribly affected by a terrible medical error.

Favaro reports on Sawatsky's story:

Crystal is Sawatsky’s wife. She witnessed her husband turn into a totally different person following his treatment.

“It completely changed our lives because we were active outdoors people. We had kids, we had lots of friends, we're very social. And we went to being a recluse,” she said. They stopped many of their previous social and outdoor activities, and sold their cabin on the lake.

Worse, Sawatsky was navigating fruitlessly through the health-care system, seeing countless specialists, trying to get someone to acknowledge what had happened and get a proper diagnosis.

Not knowing what was wrong with him, doctors would prescribe more drugs.

“I was like, look, I'm obliterated. I don't need any more drugs,” he said. “None of them would accept the fact that it was an adverse drug reaction.”

Sawatsky knew if he continued down that path he was not going to last long. After two and a half years, his nephrologist finally attributed his condition to an adverse drug reaction, he said.

After Favaro reports on how reporting and treatments for adverse drug reactions will improve the situation, she then reports that Sawatsky will die by euthanasia.

But all of these potential solutions come too late for Mike Sawatsky, however. With his health still declining, he applied for and was approved for a medically assisted death that would allow him to end his suffering at a time of his own choosing.

Once again, I recognize the suffering that Sawatsky and his family experienced, but death by lethal injection is not the answer, but rather a further medical abandonment. It may be true that Sawatsky's health has been so damaged that he won't effectively recover, nonetheless, his life and story are important and his death, by lethal injection is a tragedy.

Normalizing Organ Harvesting after Euthanasia.

This article was published in the National Review online on May 26, 2021

Wesley Smith

By Wesley J Smith

In 1993, my first ever anti-euthanasia column warned in Newsweek that once euthanasia became accepted widely, it would be followed by organ harvesting “as a plum to society.” By now, you know how that story goes. I was accused of alarmism, slippery-slope advocacy, conspiracy theories, etc., etc. And, as these kind of stories nearly always end, it came to be — in Canada, Netherlands, and Belgium, with more likely to follow over time.

Now, organ harvesting after euthanasia has become so normalized within the medical intellegentsia, that an American Medical Association publication, JAMA Surgery, had a letter debate — not about the propriety of killing and harvesting, but about whether the kill should begin at home or in a hospital.

Two doctors say that “organ donation after euthanasia starting at home” (ODEH) is the way to go:

The patient is only sedated at home, which marks the start of euthanasia in legal terms but is medically only intended to remove consciousness while vital functions are maintained and secured. Coma induction and the start of the agonal phase [killing] subsequently take place in the intensive care unit after farewells at home and transportation [to the hospital].

Their debaters says, no, start the homicides in the hospital:

A guideline for ODEH should be developed, including instructions for physicians on how to act if the condition of the patient deteriorates during transport. In the ODEH case presented by Mulder and Sonneveld, noradrena line was given to maintain adequate blood pressure during transport to the hospital. This could be interpreted as violation of an important principle of organ donation after euthanasia, namely that the euthanasia and organ donation should be at all times handled as 2 separate entities.

No one says — don’t do it!

But I will. Some of these patients (in Belgium and Netherlands) are not physically sick, but mentally ill. Believing that their deaths are more valuable than their lives — because of the lives potentially saved by their organs — could easily become the tipping point for some of these anguished patients to decide to be killed. Note: These are people who would otherwise live for years.

In other words, organ donation could be an inducement to euthanasia. That could also be true of disabled patients who are the other prime cadre of ODE targets because they have “good organs.”

Moreover, in Ontario, Canada, the organ donation society is told in advance by doctors of a planned euthanasia, and representatives call the patient/family to ask for their organs! It’s almost out of a Monty Python skit, “Hello, can we have your liver?”

No, of course suicide prevention is not offered! That might get in the way of suffering people agreeing to be transformed into so many natural resources.

Queensland Australia euthanasia bill is deliberately deceptive

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition.

Queensland Parliament

The Queensland euthanasia bill, known as the Voluntary Assisted Dying Bill, is overly wordy (113 pages) and deliberately misleading. The Tasmanian euthanasia bill (122 pages) had similar concerns. It appears that Australian governments think that the abuses and problems with euthanasia bills can be hidden by a verbose bill.

The deception begins in the first sections of the bill. For instance, Section 7 (1) states that a health care worker is not to initiate discussion about voluntary assisted dying. Section 7 (2) allows a health care worker to initiate discussion about voluntary assisted dying when talking about other treatment options. Section 7 (1) is intentionally deceptive. Health care workers can initiate discussion about euthanasia, so long as it is within a discussion about treatment options in general.

The Queensland bill uses the term health care worker, rather than physician or nurse. In other words, the Queensland bill allows a wide group of health care providers to be involved with the act.

The Queensland bill limits the act to terminally ill people but the definition is very wide. The bill states:

A person is eligible for access to voluntary assisted dying if—

• (a) the person has been diagnosed with a disease, illness or medical condition that— 
• (i) is advanced, progressive and will cause death; and  
• (ii) is expected to cause death within 12 months; and 
• (iii) is causing suffering that the person considers to be intolerable; and

• (b) the person has decision-making capacity in relation to voluntary assisted dying; and 
• (c) the person is acting voluntarily and without coercion; and  
• (d) the person is at least 18 years of age; and...
  

The 12 month terminal illness requirement is wide-open. A person can refuse effective medical treatments and still qualify for euthanasia. There are many medical conditions that will lead to death if a person refuses medical treatment.

The requirements for euthanasia are subjective. The bill states that the person considers the suffering to be intolerable. If someone has suicidal ideation and wants to die, they will state that they consider their suffering to be intolerable.

The cause of death is to be labelled as the medical condition that resulted in the approval for death by lethal drugs rather than admitting that death occurred by assisted suicide or euthanasia.

It is interesting that under the heading - Residency exemptions a person who is not a resident of Queensland could be approved for euthanasia based on "compassionate grounds." Does this mean that Queensland is willing to become a suicide tourist destination?

The bill tramples on conscience rights. The bill requires medical practitioners who refuse to participate in euthanasia to refer a patient to a medical practitioner or service that is willing to provide euthanasia.

The bill requires medical practitioners who are willing to participate in euthanasia to be trained. This does enable medical practitioners who don't want to participate in the act to decide not to be trained.

Similar to other euthanasia laws, the bill is designed to give, in this case medical practitioners, the right in law to kill their patients. After the request to be killed is made, the decision to approve and then to kill is made by the medical practitioner.

Similar to the original Canadian law this bill allows euthanasia for psychological or mental illness, as long as the person is terminally ill. Since the Queensland bill focuses on the undefined concept of suffering, is this not a set-up to permit euthanasia for mental illness, a few years down the slippery slope?

Assisted suicide is not about pain.

This article was published by Mercatornet on May 26, 2021.

Michael Cook

By Michael Cook
Editor of Mercatornet.

The Sunday Times, the leading newspaper in the UK, has launched a campaign to end the ban on assisted suicide. It has thrown its weight behind a private member’s bill in the House of Lords introduced by Baroness Meacher, who is also the chair of Dignity in Dying.

At the top of the page is the bold headline “Assisted dying bill aims to stop ‘unbearable suffering’”. This is a neat summary of the contradictions in the latest media campaign to change the law. Nowhere in the article is the phrase “unbearable suffering” mentioned in connection with Baroness Meacher’s bill. But those two words are guaranteed to make readers tremble.

True, fear of “unbearable suffering” does buttress her argument. In a brief article about her bill in The House, an on-line publication about the UK Parliament, she writes that for people who fear suffering in jurisdictions where assisted suicide has been legalized, “this is effectively an insurance policy that allows them to lead happier lives. … I want all of us to have that insurance policy and some control at the end of our lives.”

But it is not relief from pain, but relief from anxiety which is foremost in her mind. “Unbearable” is a highly elastic word, as she acknowledges: “Each of us has an idea of what we would find unbearable at the end of our life. All I ask is that we can decide for ourselves: is this level of suffering bearable for me?”

Without those vaunted safeguards, for a teenager, it might be a failed exam; for a young mother, it could be post-natal depression; for a grandmother, it could be the loneliness of lockdown. In the mind of the public “unbearable suffering” is linked to “terminal illness”. But as experience shows in the Netherlands, Belgium and Canada, this link can be — and has been — broken and the safeguards can crumble.

Baroness Meacher held up the example of the American state of Oregon for the Sunday Times. There, she said, assisted suicide was legalized in 1997. In all that time, there has been no abuse and the law is still open only to terminally ill adults.

Oregon’s Death with Dignity Act is often hailed by supporters of “dignity in dying”, in the UK and elsewhere, as an avenue to a quick and painless death. But its outcomes are seldom scrutinized. It’s worth lifting the hood of its annual report for 2020.

The first thing to note is why Oregonians asked for lethal prescriptions. Over the 23 years of the Act’s operation, from 1998 to 2020, 1,905 deaths were reported. Of these people, 90.6 percent attributed their request to the fear of losing autonomy; 89.9 percent to a fear of being “Less able to engage in activities making life enjoyable”; and 73.6 percent to loss of dignity. Other reasons were also cited: 47.5 percent did not want to be a burden and 43.1 percent feared losing control of “bodily functions”.

Unbearable pain? Almost off the radar.

Only 27.4 percent cited “Inadequate pain control, or concern about it”. It’s impossible to disaggregate those people who were in pain from those who were just worried about it. But it is astonishing that only one in four mentioned pain. They were overwhelmingly motivated by fear of loss of control in day-to-day living.

The second thing to note is that the experience of assisted suicide in Oregon was not necessarily painless and did not guarantee control.

In a substantial number of cases there were complications. Of those 1,905 deaths, 33 people had difficulty in ingesting the lethal drugs or regurgitated them; three had a seizure; and 16 had “other” difficulties. In eight cases, the patient “regained consciousness”. It’s hard to imagine how horrific it must have been for a person who expected to die peacefully – but suddenly found herself alive, awake … and possibly in great pain.

Oregon’s statistics look impressive, but the devil is in the detail. In more than half of the deaths, whether there were any difficulties is “unknown”. Someone failed to do the paperwork. Was it because there were no difficulties? Or because their pen ran out of ink? Or because the experience was unspeakably awful? It’s impossible to tell.

In any case, does this sound like a guarantee of control? In four to six cases in a million AstraZeneca Covid-19 vaccinations, people experienced blood clots – and there was international panic. A handful of instances of regurgitation, seizures, and regaining consciousness sounds like a good reason to reject “assisted dying”.

A third thing to note is that “assisted dying” in Oregon was not necessarily quick, despite assurances on the Dignity in Dying website that “In Oregon it takes an average of five minutes for people to fall unconscious and 25 minutes for them to die.”

The weasel word is “average”. Again, in almost half the cases, the time elapsed is unknown. But while the median (not the “average”) time for people to fall unconscious is five minutes, the maximum is 240 minutes. Can you imagine the distress of someone who expects to fall asleep immediately but ends up waiting and waiting, minute after agonizing minute, for four hours?

Worse still, Dying in Dignity misrepresents the time required to die. The median time to death throughout the 23 years of the Act is 30 minutes (not 25), but the maximum time is 4 days and 8 hours. Can you imagine the distress of relatives and friends as the person wheezes, gasps, and hallucinates for 104 hours?

Is this the “control at the end of our lives” that Baroness Meacher is promising Britons?

Opposing assisted suicide by telehealth.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

On May 19, the Hospice News reported that a bill will be introduced in the US Senate to extend the use of telehealth that was initiated during the COVID-19 pandemic.

Last year I reported that the assisted suicide lobby was using the Covid-19 crisis to implement assisted suicide by telehealth. 

This was not a new plan. The 2019 New Mexico assisted suicide bill and the 2020 bill to expand assisted suicide in Hawaii included assisted suicide by telehealth provisions.

In June 2020, Wesley Smith reported that assisted suicide by telehealth was happening. Quoting from an article titled: “Dying Virtually,” that was published in The Conversation Smith stated:

Parrot says she sees 90% of her patients online, visually examining a patient’s symptoms, mobility, affect and breathing. 

“I can get a great deal of information for how close a patient is to death from a Skype visit,” Parrot explained. “I don’t feel badly at all that I don’t have a stethoscope on their chest.” 

After the initial visit, whether in person or online, aid-in-dying physicians carefully collate their prognosis with the patient’s prior medical records and lab tests. Some also consult the patient’s primary physician.

I understand the benefit of expanding telehealth services but assisted suicide is not a form of health care.

Assisted suicide by telehealth means that a person with difficult health issues who feels like a burden on others, or is experiencing depression or existential distress, could be assessed, approved and prescribed a lethal drug cocktail by telehealth without ever being examined by a physician.

Assisted suicide approval by telehealth is particularly concerning for people with unidentified psychological issues or suicidal ideation.

Considering how common medical misdiagnosis is, assisted suicide by telehealth may lead to abuse of the law.

The language of the legislation is everything. 

Language refering to "specialty consultations" (assisted suicide requires consultations), or end-of-life care (the assisted suicide lobby defines assisted suicide as end-of-life care) requires clear and precise definitions to prevent its use for assisted suicide.

Imprecise language within the legislation may enable assisted suicide doctors to do assisted suicide assessments and prescribe lethal assisted suicide drugs, without meeting or physically assessing the person.

Assisted suicide is not health care.  

Assisted suicide does not treat or cure a disease or condition, but rather it causes death. 

The main goals of the assisted suicide lobby is to normalize assisted suicide by redefining it as end-of-life care and to expand the availability of assisted suicide. Assisted suicide by telehealth achieves the second goal. Telehealth may also lead to out-of-state assisted suicide deaths.

Medical error is the third leading cause of death in the US. Assisted suicide by telehealth will exasperate the problem.

Terminally Ill Dying Out of Hopelessness and Abandonment.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Dr Chris Perry

Daniel Tang, reported for the Epoch Times that Dr Chris Perry, the President of the Queensland Australia Medical Association warned Queensland legislators who are debating euthanasia that terminally ill patients choose to “take poison” and die out of hopelessness or abandonment.

Tang reporting on a press conference stated:

Dr. Chris Perry said the euthanasia experience in Victoria, Canada, and Oregon in the United States—one of the earliest jurisdictions to legalise the practice—saw many candidates choose euthanasia because they felt trapped or incapacitated.

Perry stated that killing people who feel hopeless and neglected is not right:

“So, it’s not the right way to treat human beings; we should be treating human beings as we’d like to be treated with dignity and respect,”

“You don’t want people being feeling hopeless, and being neglected, not being well cared for, and ending up taking a drink which will result in them dying in 20 to 30 minutes,”

The Queensland government will likely vote on a bill to legalize euthanasia this week.

The Western Australian published an Editorial on May 22 urging the Queensland government to amend its euthanasia bill because it requires religiously affiliated medical institutions to be complicit with killing.

 

Mental health expert opposes euthanasia for mental illness. Based on personal experience, misdiagnosis is a problem.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

A mental health expert told the Québec committee hearings on the Evolution of the Act respecting end-of-life care on Friday May 21 that based on her personal experience (MAiD) euthanasia should not be extended to people with mental illness alone.

A Global News report by Raquel Fletcher reported that Dr. Georgia Vrakas, a psychologist and mental health researcher who was diagnosed with bipolar type-2 disorder two weeks ago told the Quebec committee that extending euthanasia to people with mental illness alone is a very bad idea. Fletcher reported:

For more than 20 years, she was mistakenly treated for depression. At one point, things got so bad she called a suicide prevention hotline: “I was that low,” she said.

This is why she said she is against offering medical assistance in dying to patients where mental illness is the sole underlying condition.

Dr Georgina Vrakas

Vrakas told the committee that she is the prime example, that not enough is known about mental illness and situations can turn around. Vrakas hopes that her concerns will be reflected within future legislation. Fletcher reports:

Dr. Vrakas said extending the option to people with severe mental illness would send a message of despair.

“The message we would be sending, the message the government would be sending to people like me, is that there’s no hope,”

The Quebec government and the federal government have both established committee's to examine the further expansion of Canada's euthanasia law.

More articles on this topic:

• Canada passes Bill C-7 permitting euthanasia for mental illness alone (Link).
• Lack of evidence surrounding euthanasia for mental illness (Link). 
• Euthanasia for mental illness ignores safeguards for vulnerable people (Link).
• Trudeau government will permit euthanasia for mental illness alone (Link).

Queensland Australia euthanasia bill will force religiously affiliated medical institutions to be complicit with killing.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

An Editorial published in the Weekend Australian on May 22 focuses on a dilemma created by the Queensland Australia euthanasia bill. To ensure access, the euthanasia bill forces religiously affiliated medical institutions to be complicit with killing. The Editorial states:

Christian churches in Queensland, which operate major hospitals in the state, are facing a serious dilemma. As Walker reports in the news pages, Catholic Archbishop of Brisbane Mark Coleridge and Uniting Church in Queensland moderator Andrew Gunton say the right of institutional conscientious objection the churches had been promised is not explicit in the draft bill.

The Editorial urges the Queensland legislature to respect the freedom of religion:

The issue should be clarified in the Queensland legislation before it is voted on. The right of church-run institutions not to co-operate with VAD must be respected. Anything less would attack freedom of Christian belief and practice, which forged hospital and nursing care in the Middle Ages and is fundamental to our nation’s traditions. Churches should stand their ground.

An article published by the Medical  NewsGP also comments on the dilemma by stating:

Another novel feature is the Queensland bill limits the ability of institutions to object to voluntary assisted dying. This is an Australian-first, as Victorian, Western Australian and Tasmanian laws only deal with permitting individual health professionals to conscientiously object.

If medical institutions are denied the right to object to euthanasia then medical professionals will be the next group forced to participate in euthanasia. 

The euthanasia lobby exists to promote access to euthanasia. Religiously affiliated healthcare institutions need to fight to maintain their rights and duties within a radically secularized culture.

EPC supports Shawn's law - Pennsylvania House Bill 184.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Shawn Shatto

In July 2020, the Euthanasia Prevention Coalition published an article about the assisted suicide death of Shawn Shatto. The article explained how Shawn died by suicide, but in this case she was aided by an assisted suicide website that provided lethal directions and encouraged her to die. Jackie Bieber, Shawn's mother, is trying to prevent similar assisted suicide deaths. The article states:

Ever since the day Shawn took her life, Jackie has been advocating for "Shawn's Law," which "strengthens penalties against anyone who assists in a suicide, but especially anyone who is under the age of 18 or has a mental disability." Bieber would like to see Shawn's Law signed by Pennsylvania Governor Tom Wolf. She doesn't want anyone to feel as lost and hopeless as her daughter did the day she died.

Rep Dawn Keefer

Pennsylvania House Bill 184, also known as Shawn's Law, is sponsored by Representative Dawn Keefer. Shawn's Law states that:

A. Causing suicide as criminal homicide.--A person may be convicted of criminal homicide for causing another to die by suicide only if he intentionally causes such suicide by force, duress or deception.

(b) Aiding or soliciting suicide as an independent offense.--A person who intentionally aids or solicits another to die by suicide is guilty of a felony of the second degree if his conduct causes such suicide or an attempted suicide, and otherwise of a misdemeanor of the second degree.

Shawn's law is a proactive way to protect people from assisted suicide and websites that instruct and encourage suicide. 

The Euthanasia Prevention Coalition supports Shawn's  law and urges the Pennsylvania Senate to pass it and Governor Wolf to sign it into law.

Shawn Shatto is one of many people who were struggling with depression and anxiety to come across an assisted suicide website that provided instructions and encouraged suicide.

Don't believe the assisted suicide lobby when they say that suicide and assisted suicide are different, when the assisted suicide lobby is also involved with peddling suicide.

If you or someone you know is contemplating suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255.

• Pennsylvania House passes Shawn's law (Link).
• Suicide promotion website linked to euthanasia activist (Link). 
• Assisted suicide groups linked to suicide promotion websites (Link).

Suicide is not something to be encouraged or assisted.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Baroness Ilora Finlay

Baroness Ilora Finlay, who is a doctor, a professor of palliative medicine and a British House of Lords cross bench member, wrote an excellent article that was published by The House on May 20. Finlay, who for many years has promoted palliative care and opposed assisted suicide responded to a new push, in the UK, to legalize assisted suicide.

Finlay wrote:

The House of Lords is once again being asked to look at a Private Member’s Bill proposing so-called ‘assisted dying’. Words matter. They can inform or they can mislead. In this case it’s the latter.

Contrary to what the words might suggest, what’s being suggested isn’t that people should be given assistance as they die. That’s what doctors, and especially those of us who specialise in end of life care, do. What's being proposed is something radically different – that doctors should be licensed by law to supply lethal drugs to terminally ill people who appear to them to meet certain broadly-worded conditions. In law that’s assisting suicide and it’s unlawful.

Finlay continues:

Campaigners talk of strict safeguards. But what exactly are those ‘safeguards’? If we go by the previous Private Member Bills, they will be vague stipulations about what ought to happen in a perfect world – that someone seeking ‘assisted dying’ should have, for example, a “settled wish to die” and should be free from pressure. But what would be the minimum steps to ensure that these and other conditions were properly met? If we go by previous bills, none.

Finlay then comments on the role of doctors:

Who would be required to make these life-or-death decisions? The answer is doctors – because the people concerned would be terminally ill. Yes, doctors can diagnose terminal illness and offer an opinion (or best-guess ) on prognosis. But can, or should, overburdened doctors to be required to judge whether there is something in the patient’s life that might be influencing a request – like feelings of being a burden, or subtle pressure being exerted by others? No, they can’t assess it reliably.

Whatever the rights and wrongs of ‘assisted dying’ may be, one thing is clear. It is not part of clinical care. Most doctors who are caring for dying patients don’t want such powers. ...

Finlay then comments on compassion:

It may sound compassionate to embed such practices within health care. But it’s also dangerous. We rightly trust our doctors not to do us harm, even if that means sometimes being refused treatments we think we want. Seriously ill patients often look to their doctors, not just for treatment, but for guidance. They are susceptible to subtle messaging. A doctor who agrees to a request for lethal drugs risks sending the message, however unintended, that in his or her opinion suicide is the patient’s best course of action.

Finlay then states that suicide is not something to be encouraged:

It may sound compassionate to embed such practices within health care. But it’s also dangerous. We rightly trust our doctors not to do us harm, even if that means sometimes being refused treatments we think we want. Seriously ill patients often look to their doctors, not just for treatment, but for guidance. They are susceptible to subtle messaging. A doctor who agrees to a request for lethal drugs risks sending the message, however unintended, that in his or her opinion suicide is the patient’s best course of action.

We are told the numbers would be small, yet other legislatures have shown such deaths increase year on year, often with the law’s boundaries becoming ever slacker, rising rates of suicides and yet their palliative care remains patchy and inadequate. As observed previously – such legislation would change the moral landscape.

Thank you Baroness Finlay for your well reasoned professional article.

Some previous articles by Baroness Finlay:

• The law must protect, doctors must care and euthanasia undermines both (Link). 
• Assisted dying: What can we learn from places where it is legal (Link). 
• Objections to assisted suicide are based on concerns over medical integrity (Link).
  

Let's not romanticise the Dutch euthanasia experiment.

Theo Boer responds in the Irish Times to a letter from Corry de Jongh.

Professor Theo Boer

Sir, – I agree with Corry de Jongh that euthanasia is well-monitored in the Netherlands. In 1972 my own (Protestant) church was the first worldwide to support it. However, with hindsight, many regret supporting the law, including me. Since 2006, the numbers have increased incessantly. Last year 7,000 people received euthanasia, and in some neighbourhoods one in every five deaths is preceded by euthanasia. Is this the “last resort” we once advocated?

Given the excellent quality of palliative care in the Netherlands, there is only one explanation: supply creates demand.

Right-to-die societies have successfully made us believe that euthanasia is the most, if not only, dignified death. Let’s not romanticise the Dutch experiment. – Yours, etc,

THEO BOER,
(Professor of healthcare ethics, former member of a euthanasia review committee),
Groningen, The Netherlands.