Standing firm against assisted suicide.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Two weeks I published an article titled: Is assisted suicide a suicide? based on the ongoing debate in the Psychiatric Times between Psychiatrist, Dr Mark Komrad and long-time euthanasia activist Margaret Battin PhD.

Dr John Maher

Today I published an article by psychiatrist, Dr Komrad's responding to Battin's assertion that there is no proof of a slippery slope in jurisdictions that have legalized euthanasia or assisted suicide.

Yesterday, eminent psychiatrist Dr John Maher also responded to the ongoing debate with his article published in the Psychiatric Times, titled: Why Stand Firm Against Physician-Assisted Suicide.

Maher who is president of the Ontario Association for ACT & FACT and editor-in-chief of the Journal of Ethics in Mental Health also responds to Battin's theory negating slippery slopes in jurisdictions that have legalized euthanasia or assisted suicide. Maher responds to Battin by stating:

The letter objects to slippery slope arguments, saying that allowing medical aid in dying (MAID) will not lead to abuses. In response it must be said that there are already unequivocally widespread abuses in the Benelux countries (euthanasia without consent, euthanasia without standard treatments tried first, euthanasia with psychiatrists’ objections on eligibility being overruled/ignored, doctor shopping to get the desired outcome) and these abuses could not have occurred without the original practices being allowed, paving the way. The slippery slope is indisputably real, and the reality is that given an inch, proponents of MAID in those nations took a mile...

The letter claims that, “it is deeply contentious whether euthanasia for patients who regard themselves as having had a complete life, or who find that they are tired of living, is itself wrong.” This statement completely undermines the claim that slippery slopes are not a concern. Once assisted suicide is allowed for some, it will be allowed for others, for increasingly dubious reasons.

Maher then responds to Battin's assertion that legalizing assisted death does not negatively affect people with disabilities. Maher writes:

The letter also claims that “thus far there is no compelling evidence that aid-in-dying legislation in any country is causally associated with worsened treatment of patients with disabilities.” Is the repeated, passionate testimony from individuals with disabilities who were offered medical suicide before care not compelling? The 7-minute testimony of Gabrielle Peters before the Senate of Canada is particularly poignant and compelling in this regard. The stories and experiences of individuals with disabilities are being ignored.

Maher concludes his article by stating:

If you substitute the word suicide for MAID in this sentence what is apparent is that the important questions are really: can rational suicide be morally acceptable? And should psychiatrists do only selective suicide prevention? I believe the answer, to both questions, is no. Either psychiatrists have a unique and sacrosanct duty of care (that inextricably entails the preservation of life) or they do not. Our job as psychiatrists is to help bring meaning, purpose, and hope and to be unfailing in our efforts to do so.

Margaret Battin Phd has been a promoter of euthanasia and assisted suicide for most of her professional life. I thank these emminent psychiatrists for challenging Battin's false statements and beliefs. The euthanasia lobby has created a false reality by redefining suicide and denying the existence of a slippery slope. Experts are now challenging Battin's assertions.

Does a slippery slope exist when legalizing assisted suicide?

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Dr Mark Komrad

Two weeks I published an article titled: Is assisted suicide a suicide? based on the ongoing debate in the Psychiatric Times between Psychiatrist, Dr Mark Komrad and long-time euthanasia activist Margaret Battin PhD.

Komrad's response to Battin's assertion that there is no proof of a slippery slope in jurisdictions that have legalized euthanasia or assisted suicide was published in the Psychiatric Times, on August 27. Komrad responds:

The letter objects to my use of a slippery slope argument. Unfortunately, the slope is very real. We have chilling observations of these practices outside the halls of political debate and philosophical discourse. When MAID laws are first passed, they initially have limited conceptions and eligibility, but the eligibility always expands over scope and time. Even now, many US states with legalized assisted suicide are trying to expand eligibility criteria and decrease waiting times. These creeping thresholds of acceptability, propagating the emerging new tier of supposedly good and noble suicide —celebrated with goodbye parties and lauded by the press—may be having the effect of suicide contagion. For example, the success of the Netflix television series 13 Reasons led to a marked increase in googling methods of suicide. By 2012, Oregon’s suicide rate rose 41% higher than the national rate. In Canada, children and teenagers are starting to ask their pediatricians about receiving euthanasia, though this option is not available for minors, for now. So, references to slippery slopes are not philosophical casuistry. The reality is that such slopes lessen the traction of suicide prevention. A taboo (not stigma) against suicide is an instrumental piece of suicide prevention.

Of course, the absence of evidence is not evidence of absence. Though many disability organizations have strongly objected to MAID practices (and provided disturbing anecdotal evidence of how a euthanasia option may short circuit the care of the disabled) no one has systematically studied the effects of euthanasia on individuals with disabilities. We have very few data regarding any outcomes of this practice, although we know that suicide loss survivors have profound secondary trauma.

Komrad then comments on Canada's upcoming experiment with permitting euthanasia for psychiatric reasons:

Furthermore, there is no validated empirical method or agreed-upon standard for determining that any psychiatric illness is irremediable; or when it would be reasonable to so conclude. There is tremendous controversy over futility in psychiatry and prognostication regarding psychiatric illness is highly unreliable. An absence of response to treatments already provided is in no sense, and by no stretch of logic, a demonstration that the patient’s condition is irremediable. Canada will be struggling mightily to figure this out in the next 2 years.

Komrad completes his response by refering to the research by psychiatrist Robert J Lifton:

When we lower the threshold for killing other human beings, disaster can follow. The celebrated psychiatrist, Robert J. Lifton, MD, author of The Nazi Doctors: Medical Killing and the Psychology of Genocide, warned of “malignant normality,” times when what we put forward as self-evident and normal may be deeply dangerous and destructive. “When normality becomes malignant, professionals can be all too ready to serve that version of it as well. Indeed professionals are required for maintaining that malignant normality and bringing others into it.”

Thank you Dr Komrad for continuing the debate on whether psychiatrists should be involved with killing their patients.

California court case would extend assisted suicide law to euthanasia.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

In the past few years the American assisted death lobby has pushed the limits of state assisted suicide laws. In 2019, Oregon eliminated the 15 day waiting period for assisted suicide and currently California is debating assisted suicide expansion bill SB 380 which, among other things, eliminates the requirement of a formal examination of the law.

The New Mexico assisted suicide law only requires a 48 hour waiting period, that can be waived, and it redefined who could approve assisted suicide to include nurses.

The California assisted death lobby is supporting a court case to expand assisted suicide to euthanasia in California. 

Legally, assisted suicide is a form of suicide where the law requires a person to "self-administer" a lethal drug cocktail with the assistance of a "medical professional" while euthanasia is a form of homicide whereby the "medical professional" lethally injects the person with a lethal drug cocktail.

Therefore the assisted death lobby is not asking the court to extend the assisted suicide law but rather they are asking the court to legislate an exception to homicide.

As reported by Lisa Krieger for the Bay Area News Sandy Morris, who is living with ALS, is challenging the California assisted suicide law based it being discriminatory to people with disabilities.

According to Krieger due to the degenerative effects of ALS Morris may not be capable of self-administering the lethal drug cocktail. Krieger reports:

Doctors who help the terminally ill confront a legal dilemma: Disability law mandates assistance and equal access to health care, while the aid-in-dying law mandates the opposite.

“I am trapped between two contradictory laws,” said Dr. Lonny Shavelson of Berkeley, chair of the American Clinicians Academy on Medical Aid in Dying. “When working with a patient with neuromuscular disease or various other neurological diseases, I’m forced to break one law or the other. There’s no other choice.”

It doesn't surprise me that the long-time assisted suicide activist, Kathryn Tucker, is the lead lawyer for the plaintiffs and Lonny Shavelson is a plaintiff. After California legalized assisted suicide, Shavelson turned his attention full-time to assisting suicides.

When a state legalizes assisted suicide the law is only a stepping stone. The legislators create "safeguards" for the purpose of selling the legalization of assisted suicide but once assisted suicide is legal, the goal is to expand the law.

Since legislators in California appear to be unwilling to legalize euthanasia therefore the assisted death lobby is resorting to a court case and are asking the court to legalize euthanasia.

If a California court grants Morris an exception or declares that the assisted suicide law discriminates against people with disabilities, then other states that have legalized assisted suicide will also expand their laws to allow killing by lethal injection.

The problem is that California legalized assisted suicide which allows doctors to be intentionally involved with killing people. Once medical killing is permitted, the only questions that remain are: Who can do it? For what reasons? and What methods are acceptable? 

Society needs to focus on caring for its citizens not killing.

Hawaii 2020 assisted suicide report - more death - and the report demands even more death.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The Hawaii assisted suicide law came into effect on January 1, 2019. The 2019 Hawaii assisted suicide ("Our care, our choice act") report indicated that in the first year of the assisted suicide law: 

• 30 people were prescribed a lethal drug cocktail, 
• 15 people died by assisted suicide, 
• 8 people who received a lethal prescription died a natural death and 
• 7 people who received a lethal prescription were alive at the end of 2019.

The Hawaii 2020 assisted suicide report that was recently released indicated that:

• 37 people where prescribed a lethal drug cocktail, 
• 25 people died by assisted suicide, 
• 7 people who received a lethal prescription died a natural death,
• the status of four people who received a lethal presciption is unknown.

When the status is unknown, the person may have died by assisted suicide but no reports were received.

Similar to the 2019 report, the 2020 report concludes with the Hawaii Department of Health lobbying for an expansion of the assisted suicide law. The report states:

The DOH recommends the following changes to the OCOCA.

1. Waiver of any waiting periods if the attending provider and consulting provider agree that patient death is likely prior to the end of the waiting periods. 
2.  Given access to health care providers is limited, the DOH recommends authorizing advance practice registered nurses to serve as attending providers for patients seeking medical aid in dying. 

As stated by Wesley Smith's commentary on the Hawaii assisted suicide report:

Please understand, dear readers, that when assisted-suicide advocates promise strict guidelines to protect against abuse, they don’t really mean it. The promise’s purpose is to get the law passed, not to be kept.

Hawaii is not the only jurisdiction pushing for more death. A court case was just launched by the assisted death movement in California to expand its assisted suicide law to euthanasia (homicide).

Italian referendum focuses on legalizing assisted suicide for people with disabilities.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Italian assisted suicide campaigners

An Italian assisted suicide group, the Luca Coscioni Association, announced on August 16 that they had collected at least 500,000 signatures, enough to establish an assisted suicide referendum. Since then they announced that they have another 250,000 online signatures in support of the referendum.

The case that has been exploited to generate support for the refendum is that of a quadriplegic man, who asked doctors to end his life after becoming paralyzed from a car accident ten years ago.

Acording to an article by Hannah Roberts in the Politico Campaigners launched a petition for a referendum after the 43-year-old man with a spinal-injury, identified as Mario, last April, won a landmark case to force the local health authority to carry out an assessment to determine if Mario is incurably ill and lucid. So far the health service has not carried out the order.

As much as the assisted suicide referendum is concerning, the Italian disability community is directly affected since every precedent setting Italian assisted suicide case concerns persons with disabilities.

For instance, in December 2019 a Milan court acquitted Italian assisted suicide activist, Marco Cappato, in the assisted suicide death of Fabiano Antoniani (known as DJ Fabo), who died in February 2017. Antoniani, who became disabled, died at the Dignitas assisted suicide clinic in Switzerland.

In July 2020 an Italian court acquitted assisted suicide activists Marco Cappato and Mina Welby in the assisted suicide death of Davide Trentini in the April 2017 Dignitas assisted suicide clinic death in Switzerland. Trentini was also a person with a disability. Cappato and Welby, who are leaders of the Luca Coscioni Italian assisted suicide association, turned themselves into Italian authorities the day after Trentini died by assisted suicide in order to challenge the law.

Clearly the assisted suicide lobby in Italy has focused on legalizing assisted suicide for people with disabilities.

Euthanasia by organ donation for healthy people?

"May I give my heart away?"

This article was published by National Review on August 21, 2021.

By Wesley Smith

We have entered the era of what I call “do harm medicine,” in which the concept of what constitutes harming the patient has become entirely malleable and subjective. I even wrote a book covering that subject.

Here’s an example: When organ transplant medicine began, the “dead donor rule” was instituted to assure a wary public that people’s vital organs would only be procured after the person was dead. A corollary to that rule assures the public that people will not be killed for their body parts.

The dead-donor rule has been under attack for some time within the utilitarian bioethics movement. (I am not writing about the brain-death controversy, which is a separate discussion.) Many bioethicists are now pushing to allow doctors to kill via organ harvest, sometimes called “organ donation euthanasia” (ODE).

At first, this proposed killing license was supposed to be limited to patients on the verge of death or the permanently unconscious. Now, a prominent bioethics journal has published a piece urging that healthy people be allowed to die by removal of vital organs.

The author claims that because people can instruct life-sustaining treatment to be withdrawn (LST), and can donate their organs after death, that ODE is also OK because it will result in death, too, and result in more usable organs procured and more lives saved. From, “May I Give My Heart Away?: On the Permissibility of Living Vital Organ Donation:”

In this situation, according to proponents of ODE, the doctor should respect the decision, even when this will cause the death of the patient. It seems commonly accepted that patient autonomy allows patients to refuse any medical intervention initiated on one’s body and life, and therefore, doctors are morally obligated to withdraw LST when this is what the patient wants. If we should uphold the DDR in such situations, the doctor should wait until the patient is declared dead to procure the patient’s organs.

Proponents of ODE argue that if the patient consents, it would be permissible to procure the patient’s organs before death. This will of course mean that the patient will die from donating his or her vital organs instead of dying from having his or her treatment withdrawn. However, this seems ethically immaterial in this situation since the outcome for the patient will be the same.

But that’s not true. Not everyone dies after having life-sustaining treatment withdrawn. Indeed, under current organ-donation protocols, if the patient doesn’t die, he is taken back to the ward and usually disqualified as an organ donor thereafter.

Once death ceases to be the necessary predicate for donating vital organs — and is replaced with “consent” — there would be no natural limiting principle. And so it is here. Rather than being a form of euthanasia to end suffering, the idea is to permit someone to have themselves killed for the altruistic purpose of saving other people’s lives, called living vital organ donation (LVOD). All that matters would be consent, and moreover, such a program would allow for tailored killing by harvesting:

If the autonomous desire to sacrifice oneself to benefit others should count as a morally relevant reason, all things being equal, this desire will have a greater chance of being fulfilled when the donor is not imminently dying. In such cases, the donation can be postponed until a suitable recipient is in place. By contrast, when the primary motivation is death, as it is in ODE, it is plausible that patients would not be willing or able to wait for months, maybe years, until a receiver match appears.

But consent has the power to justify abundant “do harm” medical practices. Example, policies that allowed sex-change surgeries for the few have now expanded to validate puberty blocking for children, for which there is scant evidence of benefit and the potential for material physical harm. Look ma, no brakes!

Besides, once a fundamental moral principle is breached, it is like a dam breaking. The deluge may begin as a trickle, but soon the reservoir empties flooding the plains below. Hence:

• Assisted suicide/euthanasia for the terminally ill who ask to die was legalized as a means to prevent suffering at the end of life. 
• That morphed in some places into allowing people with disabilities and chronic conditions who ask to die to be killed to eliminate suffering. 
• Which morphed into allowing the mentally ill who ask to die to be killed in some jurisdictions to eliminate suffering. 
• Which morphed into conjoining organ harvesting with euthanasia (in the Netherlands, Belgium, and Canada) if the person to be killed consents. 
• Which morphed into several proposals to permit killing by organ harvesting for those facing imminent death. 
• Which has now morphed into a proposal to allow healthy people to ask to be killed for altruistic reasons. 
• Which will one day morph into proposals to allow surrogates to authorize euthanasia via organ harvesting for the incapacitated or letting people order themselves harvested once they become incapacitated in advance medical directives.
  

Please understand that these proposals are not fringe ideas. Bioethics, which published this article, is a wholly mainstream publication. The idea of killing for organs is considered respectable in the field. And it gives these advocates no pause that their plans would also transform organ-transplant doctors — known for focusing exclusively on saving lives — into outright killers.

The only way I can think of to thwart this drip-drip-drip-into-deluge process is to cast a bright light on where the thought leaders in bioethics want to take health-care policy in coming years. Forewarned, I hope, is forearmed. Hopefully, the people upon whom these policies would be imposed will disagree and thwart the best-laid plans of utilitarians and bioethicists.

CCHR condemns Euthanasia of Mental Health Patients

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

The Citizens Commission on Human Rights sent a media release today urging that assisted suicide for psychiatric patients be rejected in the US and other countries. The watchdog group pointed out that assisted suicide has now been legalized in several US states, the CCHR warned that extending assisted suicide to mental patients is dangerous. The CCHR stated that:

While the U.S. limits this to terminally ill individuals, ... it’s a quick jump from this to killing patients who do not have terminal illnesses but are suffering emotional, not physical disabilities after failed psychiatric treatments.

The CCHR pointed to Canada that legalized euthanasia in 2016 and has already extended euthanasia to include people with mental illness.

CCHR points to Canada where legalized euthanasia was enacted in 2016. This year, a senator, who is also a psychiatrist, declared that excluding individuals with psychiatric disorders from being euthanized was “discriminatory.” The law now allows mental health patients to be euthanized, which goes into effect in two years.

The CCHR then commented on euthanasia for psychiatric reasons in the Benelux countries:

Since 2002, Belgium, the Netherlands, and Luxembourg laws have allowed psychiatric patients who are suicidal to voluntarily receive death by lethal injection (euthanasia) or a self-administered prescription for lethal medication (assisted suicide). Between 100 and 200 psychiatric patients are euthanized annually between Belgium and the Netherlands,

According to Professor Willem Lemmens of the University of Antwerp, requests for euthanasia in psychiatry became more and more acceptable and common in Belgium, but allowing euthanasia to become an option for often-suicidal patients is a “profound” change in the culture.

Jan Eastgate, president of CCHR International said: 

“Were Europe and Canada’s trend to be adopted here (US), after forced psychiatric hospitalization and treatment fail, the desperate state patients are left in means suicidal behavior would no longer constitute a danger, but would be grounds for psychiatrists to euthanize them—a shift from ‘suicide prevention’ to ‘suicide assistance.’”

The media release then comments on the problems with many anti-depresant drugs. The media release concludes by stating:

CCHR is monitoring the advent of all psychiatric-assisted suicide laws and condemns the practice, saying psychiatrists should never been given such power and the failure of their treatments, with rising suicide rates, should be investigated. Since 1969, the group has helped achieve more than 190 laws worldwide to protect patients.

Link to the full CCHR report (Link).

Queensland Australia - Dissenting report opposing euthanasia and assisted suicide.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Dr. Mark Robinson MP in the Queensland Australia parliament and the member for Oodgeroo wrote a dissenting report to the official parliamentary report on the proposed assisted dying bill.

Link to the Dissenting report by Dr Robinson (Link).

Similar to the minority report on assisted dying written for the Western Australian parliament that was by the Hon Nick Goiran, Dr Robinson's report creates a strong basis for opposing assisted dying.

Nick Goiran wrote a 248 page report titled: License to Care not License to Kill opposing the legalization of euthanasia or assisted suicide which was meticulously researched, documenting world-wide concerns with legalizing euthanasia and assisted suicide.

Dr Robinson's dissenting report is 24 pages of strong arguements against euthanasia. Robinson first argues that since the World Medical Association and the Australian Medical Association that physicians should not be involved in interventions that have as their primary intention, the ending of a persons life, therefore acts of euthanasia and assisted suicide are unethical.

Dr Robinson then emphasizes that if proper end-of-life care and palliative care were properly available that there would be no demand for euthanasia. Robinson points out that the administration of poison has become an alternative to the lack of proper end-of-life care.

Dr Robinson then quotes Dr Philip Nitschke, also known as Australia's Dr Death, who now believes that death should be an available option for people who are "Tired of Living," Robinson explains that - Once the euthanasia genie is out of the bottle it doesn’t go back in. He states:

The flow on affect from initial legalisation has proven to be unstoppable and irreversible once introduced. What is initially proposed as a measure to help a very small number of people, said to be in intolerable physical pain, is progressively broadened to apply to thousands of people, including those with no physical medical condition. Initial procedural safeguards are also relaxed. Once you lift the lid on Pandora’s box, there’s no going back.

Many vulnerable people experience subtle pressure to take their own life – some are made to feel almost duty bound to their family or to society to end their life prematurely. When elder abuse is combined with legalised access to the administration of life-ending poisons, it inevitably leaves the most vulnerable at risk of being coerced into ending their lives by assistance to suicide or euthanasia. This results in wrongful deaths, whereby people’s lives are taken from them without their full cognisance or consent. Wrongful deaths have followed these laws everywhere they are introduced.

Queensland Parliament

Dr Robinson challenges the Queensland Voluntary Assisted Dying Bill based on the following eight “Findings”:

• Finding 1: The Bill would make it legal for one person to take the life or help end the life of another person, or to counsel or help another person to take their life. 
• Finding 2: The BiIl would increase the number of suicides in Queensland as opposed to reducing them.
• Finding 3: The Bill fails to ensure that only eligible people will be able to access assisted suicide or euthanasia. 
• Finding 4: The Bill fails to ensure that patients are offered all options to manage their illness prior to the commencement of any life-ending procedure. 
• Finding 5: The Bill fails to adequately define “suffering” to limit it to intolerable physical pain. 
• Finding 6: The Bill provides inadequate protection to those affected by a mental illness. 
• Finding 7: The Bill fails to protect the vulnerable from coercion and undue influence. 
• Finding 8: The Bill fails to safeguard the vulnerable from a prolonged, complicated or painful death as a result of the administration of a poison prescribed under the Bill’s provisions.

I encourage my readers to read Dr Robinson's dissenting report to the Queensland Parliament. There has been much pressure to extend euthanasia to every jurisdiction in Australia and I hope that cooler heads will prevail, preventing the legalization of euthanasia in Queensland.

Link to the Dissenting report by Dr Robinson MP (Link).

Is the assisted suicide debate about healthcare savings in the UK?

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The assisted suicide lobby must have forgot to tell Polly Toynbee that legalizing assisted suicide has nothing to do with money as she argues that assisted suicide needs to be legalized in the UK based on healthcare savings.

Toynbee wrote an opinion article that was published in the Guardian today. 

Toynbee doesn't come out with a crass statement demanding that people die to save money, instead she writes about The National Institute for Health and Care Excellence (Nice) decisions and protocols concerning end-of-life care as Nice attempts to control healthcare spending.

Toynbee writes:

On Thursday, it (Nice) opened a consultation period for new guidelines on how much NHS England should spend on end-of-life drugs, planning to remove some of the extra funding for very expensive drugs that may only delay death a little. About 15% of hospital spending goes on patients in their last year, and nearly a third on people in the last three years of life. 

Nice sets a standard limit: no drug can cost more than £30,000 a year, and it has to be a year of good-quality life. But a while back, under pressure, Nice raised that to £50,000 for drugs in the last three months of life. Professor Gillian Leng, Nice’s chief executive, tells me public opinion demanded it (the Mail had been running a ferocious campaign for hyper-expensive end-of-life cancer drugs). But now, she says, public opinion has shifted considerably against spending more on final months after Nice’s consultation with patients, the public and medical professionals. That extra £20,000 should be reapportioned.

Toynbee is saying that the purpose for Nice's consultation on spending guidelines is to save money in the healthcare system. Toynbee takes the issue of healthcare savings further. She writes:

Parliament may soon debate a bill on assisted dying proposed by Baroness Meacher and there are more new MPs ready to back the public view. One argument often used by opponents is that dying people would feel pressured “not to be a burden”. But supporters ask why that should be an illegitimate reason. Many in terminal illness have no wish to stay alive a few months longer as a great burden to family and community. That’s a matter for each person to decide.

Toynbee states - That's a matter for each person to decide - after she explains that the UK can't afford treatment at the end of life. In other words, if Toynbee is serious about the need for healthcare savings, then eventually the option will be no treatment or death.

While Canada's parliament was debating the expansion of the euthanasia law through Bill C-7, The Parliamentary Budget Officer projected that Canada's provinces would save at least $149 Million per year if Bill C-7 passed.

If its not all about the money, you cannot deny that legalizing assisted death is about the money.

Providing or facilitating suicide is a betrayal of a fundamental ethos of psychiatry.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Dr Mark Komrad

Last week I published an article titled: Is assisted suicide a suicide? based on the ongoing debate in the Psychiatric Times between Psychiatrist, Dr Mark Komrad and long-time euthanasia and assisted suicide activist Margaret Battin PhD.

One physician responded to one of Dr Komrad's articles that were published in the Psychiatric Times with his personal story of accompanying his mother when she died by assisted suicide in Switzerland. Komrad's response did not challenge this physician but rather delved into The Meaning of Compassion.

I have great respect for Dr Komrad. Komrad explains compassion based on the following proposition: Proponents of medical aid in dying often accuse their opponents of lacking compassion. But what does that word really mean?

Dr Komrad writes:

I am grateful for Michael von Poelnitz, MD’s letter “A Psychiatrist’s Personal Perspective on Medical Aid in Dying.” It is a valuable addition to Psychiatric Times ongoing debate on assisted suicide. I feel great compassion for him and his mother. I also appreciate his proper use of the word kill in this context, referring to the procedure used with his mother in Switzerland, as opposed to many of the other euphemisms that are often deployed, particularly by proponents of assisted suicide and euthanasia. Language plays a very important role in this conversation. Indeed, as George Orwell famously said, “If thought corrupts language, language can also corrupt thought.”

The letter seems to imply that the medical killing discussed in my article about developments in Canada is involuntary, in contrast to the voluntary and cooperative nature of the process in his mother’s case. I note in my opening paragraph, however, that all these laws involve voluntary participation by patients in these procedures. Typically, a patient makes the initial request. However, some Canadian colleagues tell me they are being pressured to inform potentially eligible patients of the euthanasia option, even if patients do not bring it up. Even some physicians who are conscientious objectors are pressured to do this. However, there is also evidence that euthanasia is provided without request for some incompetent patients in the Benelux countries (Belgium, the Netherlands, and Luxembourg) who have no family members available for proxy consent, nor advanced directives for euthanasia.

The letter also raises the issue of who does the killing. In some cases, it is indeed a patient’s psychiatrist. In one Dutch series, Scott Kim, MD, PhD and his team found that 73% of psychiatric euthanasias in 66 patients were performed by doctors who were already caring for the patient. Specifically in cases involving euthanasia for personality disorders, 30% of the euthanizing physicians were psychiatrists. As psychiatric euthanasia becomes available in 2 years in the large nation of Canada, numerous psychiatrists will have to confront euthanasia as a legal option for their suicidal patients, and they will increasingly be in positions to possibly approve it, and even provide the service.

Finally, a standard canard of those favoring euthanasia and assisted suicide is to portray those opposed to it as lacking empathy for patients’ agonies. I would turn that charge around. A core competency in psychiatry is to have a deep immersion and empathic understanding for such feelings, to have what Karl Jaspers, MD, PhD called verstehen— a sense of standing in a patient’s shoes. What the letter calls “a willingness to go beyond one’s own limitations in order to sense and perceive more broadly” should not mean transcending empathic understanding to aid and abet suicide. Rather, it should give us a deeper standpoint from which to deploy support and advocacy, to help patients find a path into the future, to help mobilize their support systems and state-of-the-art palliative care, and to attend to them devotedly in their suffering—demonstrating the true meaning of compassion: to suffer with. To provide or facilitate their suicide is a betrayal of a fundamental ethos of psychiatry.

More articles related to Dr Mark Komrad (Link).

Dr Komrad is a psychiatrist on the teaching staff of the Johns Hopkins Hospital in Baltimore, Maryland. He is also clinical assistant professor of Psychiatry at the University of Maryland, and Teaching Faculty of Psychiatry at Tulane University in New Orleans.

EPC-USA opposes California assisted suicide expansion Bill

To the California Assembly Appropriations Committee

SB 380 – Eliminates existing 2025 sunset date and legislative re-evaluation option for Medical Aid in Dying (Assisted Suicide) and stops future oversight or evaluation of annual reports about assisted suicide requests and their outcomes, in particular the impact on Medi-Cal’s budget.

Dear Chairperson and Members:

The Euthanasia Prevention Coalition USA opposes euthanasia and assisted suicide, instead supporting positive measures to improve the quality of life of people and their families. We are aging and disability advocates, lawyers, doctors, nurses and politicians.

We are asking you to let SB 380 die in your committee. California’s MAiD legislation should be evaluated for its impact on youth suicides and the associated costs to your state budget. SB 380 would preclude such a study.

Suicide Contagion and Assisted Suicide (MAiD) Laws

Publicity or knowledge about suicide leads to more suicides and attempts. When Marilyn Monroe killed herself, the suicide rate went up 12%. When people experience a personal suicide loss they are 65% more likely to attempt suicide than if they experienced a natural death. For every person who dies by suicide, another 30 attempt suicide. This particularly impacts teens and adolescents. Because youth are far more likely to attempt than commit suicide, the medical costs for this group can be significant, some of which is funded by Medi-Cal. Overall, California had avoided the upward trend in suicide seen in other states, but that may have changed

Because suicide is contagious, publicity that details incidents or normalizes suicide like the many news stories about Brittany Maynard leads to more suicides. Legalizing Assisted Suicide is a way of normalizing suicide, a way of saying suicide solves your problems. When assisted suicide web sites provide drug regimens and encouragement, people like 25 year old Shawn Shatto die. The heartache and sadness of her mother is beyond words.

Research about completed suicides in Oregon, Washington, Vermont and Montana found legalizing assisted suicide was associated with at least a 6.3% increase in the rate of suicide deaths. The study reported:

PAS [Physician Assisted Suicide] is associated with an 8.9% increase in total suicide rates (including assisted suicides), an effect that is strongly statistically significant (95% confidence interval [CI] 6.6%--11.2%). Once we control for a range of demographic and socioeconomic factors, PAS is estimated to increase rates by 11.79% (95% CI 9.3%--14.1%). When we include state-specific time trends, the estimated increase is 6.3% (95% CI 2.7%--9.9%)When it comes to medical costs for suicide and attempts, 28.4% are paid by Medicaid, on average, because many on Medicaid have mental health diagnoses; another 24.8% are incurred by the uninsured.

Cost Shifting to Medi-Cal due to Availability of Assisted Suicide

An additional cost to Medi-Cal could come from people whose insurance stops covering certain treatments due to the availability of Assisted Suicide. Dr. Brian Callister of Nevada says he was stunned when insurance would not cover life saving treatment for his patients who were transferring to states, including California, where Assisted Suicide is legal. Some of those people could turn to Medi-Cal to get their treatments paid for.

In closing, I urge you to consider the costs to families who lose their youth to suicide, the contribution of those suicides to inequity and the costs to your state’s economy and budget and then let this bill die in committee.

Sara Buscher, Chair
Euthanasia Prevention Coalition USA

Canada's new assisted dying law threatens vulnerable citizens

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Dr Sonu Gaind, a professor of psychiatry at the University of Toronto, a former president of the Canadian Psychiatric Association and honorary member of the World Psychiatric Association, leads his hospital MAID team and sat on the Council of Canadian Academies Expert Panel on MAID and Mental Illness wrote a scathing article opposing Bill C-7, that the Liberals passed in March 2021.

In his article - New assisted dying law threatens vulnerable citizens - that was published in the Hamilton Spectator on August 17, 

Gaind states that he came from an immigrant family who came to Canada when Pierre Trudeau was Prime Minister. He states that he finds it painful to watch Justin Trudeau enact legislation that endangers the lives of vulnerable citizens. Gaind wrote:

MAID has been sold as an issue of autonomy and the right to “die with dignity.” But is it true autonomy for the marginalized who will seek death to escape a life they never had the right to live with dignity?

As physician lead of our hospital MAID team, I am keenly aware that suffering does not compartmentalize into neat little boxes. Cumulative life distress fuels MAID requests. Introduced to help avoid painful deaths, MAID in Canada now risks enticing nondying disabled who are marginalized by sexism, racism, ageism or ableism with state-sanctioned death to escape painful lives.

Canada’s reckless MAID expansion has been abetted by disconcerting failures of due diligence. Through consultations on mental illness and dying, Canadian Psychiatric Association leadership never once raised concerns about mental illness related suicide risk or discussed suicide prevention. After giving assurances for a year that C-7 would safeguard against MAID for mental illness, the Liberal government reversed its commitment in February and less than a month later pushed C-7 through parliament.

Gaind continues by writing about the struggles that Margaret Trudeau had with mental illness and explaines how the United Nations High Commissioner for Human Rights cautioned that Canada’s MAID expansion is grounded in prejudiced ableism assumptions, a clear concern for the disability community. 

He concludes by stating:

To provide increased autonomy to privileged voters who have lived well and want to die well, it seems our current Prime Minister Trudeau is willing to sacrifice marginalized lives of those who never had the chance to live well, and are suffering from life distress during periods of resolvable despair.

... It is not Justin Trudeau’s mother who is at risk, but all of ours.

Thank you Dr Gaind for sharing your concern for the lives of people who live with mental illness.

Suicide is not a death wish. Stopping suicide encouragement.

Article by: Randy Knol, the father of Ximena who died at the age of 19 from ingesting a suicide powder. Randy is the founder and chairman of Ximena’s Butterfly Foundation in the Netherlands.

The misunderstanding of suicide

Randy Knol with his wife

In my previous article I wrote about suicide as being the wish to escape the situation somebody is in, I stated that suicide is not the desire to die. There are many theories about why people commit suicide unfortunately there are also far to many misconceptions. In this article I will try to explain the mechanism of suicide as I see it.

Suicide ideation is a seed

Everybody has at some times in their life suicidal ideations, however they hardly lead to a suicide. Suicidal ideation is like a small seed, a seed that everybody has within their emotions. Sometimes this seed sprouts and we prune it, we stop it from growing. At the other side sometimes we can’t prune it and we need help from others to help with the pruning. Sometimes the seed behaves like a weed and starts to proliferate, you can prune but if you cut one twig, another twig will sprout somewhere else. It is becoming increasingly difficult to control the proliferation. Then someone gets to the point where dying appears to the person to be a real option for them.

Unfortunately I also see situations where the seed is not pruned but fertilized. There are fora on the internet that idealize suicide, people talk about their ideas and are encouraged by others. People exchange methods and how to information. They livestream their suicide and others congratulate them with the decision. They have honorary lists that publish the names and the method they used to die. These fora make death heroes, the suicide a heroic act, these fora are one of the fertilizers for the seed.

Suicide encouragement

But we also have groups that promote suicide as a right they’re radicals claiming that having the right to live also means you have the right to end your own life. In The Netherlands we have a group who promote death under their own control, no single therapy or any other way of counselling. Anyone older then 18 years old can join them, as they say at 18 you’re responsible and you can decide about your own life and therefor decide about your death.

They organize so called “lounge meetings” where small groups come together discussing their will to die, there is a near certainty that the FWC promoted "Substance (agent) X" that is being distributed in the Netherlands, or at least told where to get it. They inform the crowd that their “agent X’ is fast, painless, certain and thus humane. However scientific publications state otherwise, it can take up to five days for death to occur, the death is painful suffocation. Their is no antidote or life saving therapy. There is no room for regrets once you take the poison there’s no way back.

About a year ago a Dutch 28 year old woman took ”agent X” and almost immediately had serious regrets and phoned the emergency services. In the short time it took for the services to arrive she was no longer capable of opening her door, they had to enter by force. The woman was taken to hospital and died 19 hours after ingestion in agonizing pain, even artificial coma was not enough to take the pain away. She went prior to her death to the “lounge meetings” as organized by the FWC.

The main concern for the use of “agent X” is not just the way of dying but also the danger for the person that finds the body or first responders. When dissolved in water, the agent produces a chemical reaction that produces a highly toxic gas. This reaction is also enhanced in the body by the gastric acid. It’s so hazardous that the guidelines for autopsy are:

“During autopsy, medical examiners must exercise caution due to the potential for liberation of XXXXX acids from the stomach. Unless it is absolutely necessary, the medical examiner should avoid opening the stomach. If this is unavoidable, the autopsy should occur in a well-ventilated setting with the examiner wearing a supplied air respirator to limit exposure in a high-risk scenario”

For me promoting an agent like this is a criminal act where it is also hazardous to people finding victim or responding to a distress call.

Suicide is not a death wish

The biggest misconception is people thinking that suicide is a wish to die, this cannot be further from the truth. Suicide is not wanting to live in the situation you’re in at that moment. Taking your own life is the most drastic act someone can commit, it’s against every natural instinct of survival. Therefore the worst thing people can say to someone that lost a loved one on suicide is saying that it was the victim’s own choice. It’s never a choice it’s an escape where someone doesn’t see any other way out. For that reason laws on euthanasia for mental illnes have to be looked at in the most sceptical way possible, prevention is the solution. However it’s important to acknowledge that suicide prevention has to start before suicide ideation has taken hold. If you start prevention when the suicide ideation is already there it’s very difficult to reach the person. Prevention starts far before the seed sprouts it starts with resilience at an early age.

Euthanasia for people with mental problems is a weakness, it is a result of failing mental health care and often an easier path than intensive treatment. But it is also a direct result of the increasingly heard call for control over life and death, where often death is romanticized.

Consider donating to Ximena’s Butterfly Foundation. We pay all costs from our private money and through donations from concerned people. 

Please help us in preventing suicide by donating through our website: https://ximenavlinder.nl/doneer/