Assisted suicide and the autonomy myth. Do patients really have rational autonomy?

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Dr's Ronald Pies and Cynthia Geppert are psychiatrists and ethicists who are challenging the ethos of autonomy related to assisted suicide. For the past several years Pies and Geppert have argued in an academic account that autonomy is a myth with assisted suicide.

Pies and Geppert published an article in July 2018 titled: Two misleading myths regarding medical aid in dying where they challenged the concept that assisted suicide was an act of autonomy.

On October 27, Pies and Geppert were published in the Psychiatric Times with a further development of their position in an article titled - Physician Assisted Suicide and the Autonomy Myth. In their current article they recap their previous position regarding assisted suicide and autonomy but then develop it further. They state:

Rational autonomy is much more than being able to “do as you please.” After all, an infant picking up his rattle is doing as he pleases, but he is hardly acting with rational autonomy. The latter, in our view, consists of both a cognitive and an emotional component. Cognitively, rational autonomy requires, at a minimum, that the person understands the nature, risks, and benefits of the procedure or action under consideration, and has a basic understanding of the alternatives. This component is roughly what is implied in most definitions of “decision-making capacity.”

However, this minimalist criterion fails to capture the subtle cognitive distortions exhibited by some patients who are terminally ill. For example, Tomer T. Levin, MD, and Allison J. Applebaum, PhD, have noted that some cancer patients may make erroneous assumptions like, “No one can help me,” or “No one understands what I am going through.” Such cognitive distortions can cloud the patient’s judgment and undermine rational autonomy. These distortions may respond favorably to cognitive behavioral interventions, which may avert or abort a request for PAS. (Importantly, no current PAS statutes require any form of psychotherapy for patients seeking to end their lives via PAS.)

Pies and Geppert examine research related to rational autonomy, authentic voluntarism, approach to the patient and then they conclude:

This essay has challenged the all-too-commonly held belief that PAS is an instantiation of a patient’s autonomy. In fact, we have argued the contrary: The entire process of PAS is critically dependent on the authority of powerful others who must approve (or veto) every decision along the way. Even more centrally, we have argued that genuine rational autonomy and authentic voluntarism are frequently undermined by subtle cognitive and emotional factors that are likely to be missed with standard, cognitively based evaluation tools. Patients who may not meet DSM-5 criteria for a mental disorder may nevertheless be experiencing hopelessness, demoralization, or despair—any of which can compromise rational autonomy and authentic voluntarism. In addition, current PAS statutes provide no mechanism for assessing external coercive influences that may drive the patient to suicide after having left the evaluation setting. In addition to the many ethical reasons to oppose PAS, psychiatrists should also be aware of the subtle cognitive and emotional issues that compromise rational autonomy in the context of terminal illness.

I have argued a similar approach to the same issue, that assisted suicide laws are not about autonomy. With current assisted suicide laws, the person who approves assisted suicide, can be the same person who carries out the act, and is the same person who reports the act (or fails to report the act) to the government body. This self reporting system is designed to give the physician, the right in law, to approve, carry-out and potentially cover-up abuse of the law. This system is not conducive to autonomy but rather to protecting physicians who cause the death of their patients.

Netherlands man suspected in assisting 33 suicide deaths and selling a suicide powder to 700 people.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Ximena Knol (19) died from the
suicide powder in February 2018.

Last July the NL Times reported that a 28 year old man known as "Alex S" was charged with assisting the suicides of at least 6 people with a suicide powder.

The NL Times reported today that "Alex S" is now facing charges in at least 15 suicide deaths and possibly 33 deaths. He sold a suicide powder and an anti-nausea drug to as many as 700 people. The NL Times article reported:

Suicide powder allegedly sold by Alex S. from Eindhoven may have caused many more deaths than the six the authorities initially assumed, the Public Prosecution Service (OM) said in a hearing against S. on Wednesday. According to the OM, 15 people definitely died due to the suicide powder they bought from S. Another 18 died after buying suicide powder from him, but the exact cause of their deaths is still under investigation, NOS reports.

Euthanasia is legal in the Netherlands when approved under the law but assisting a suicide is illegal. Article 294, paragraph 2 states:

“Anyone who intentionally assists another person in suicide or provides him with the means to do so, shall, if the suicide follows, be punished with a term of imprisonment not exceeding three years or a fine of the fourth category.”

The NL Times reported that "Alex S" is also suspected of violating the Medicines Act and money laundering. The NL Times report stated:

The OM believes he sold the suicide powder to nearly 700 people between 2018 and June 2021. He also sold a drug that prevents vomiting. This drug is often used in suicides and is only available with a doctor's prescription.

Wim van Dijk, a member of the Coöperatie Laatste Wil (Final Wish Cooperative), an assisted suicide lobby group in the Netherlands, admitted in an interview that has been involved with more than 100 suicide deaths. van Dijk also admits that his actions are against the law but he doesn't care. van Dijk is suspected to be working with "Alex S."

Assisted suicide deaths are not what you think they are.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

David Rose, writing for the Daily Mail UK published an article on October 21 titled: Why an 'assisted death is almost certainly not what you think it is. Stories about how assisted suicide deaths actually occur are rarely published. Recently researcher Dr Joel Zivot has challenged how deaths by assisted suicide actually occur in his article - Assisted Suicide is neither painless nor dignified.

Rose states that assisted suicide deaths will often take many hours. Rose writes about the death of Colorado resident Kurt Huschle who died by assisted suicide in July 2017. Rose writes:

On the morning of July 16, a nurse arrived at their home and checked that Kurt stood by his decision. By noon, he was ready to go. Following the directions given, Susan mixed the contents of two small bottles into a bigger one and gave it to Kurt.

She had expected him to drink the drug cocktail, share a last hug, then pass away peacefully.

Instead, as Susan later told the Denver Post newspaper: ‘With every sip he’s choking and coughing, choking and coughing.’

After 20 minutes, she said, he began to gasp unevenly. He seemed to have lost consciousness. But more than four hours after he took the drugs, he was still alive.

Scared and upset, Susan called a doctor and asked for help. It was then the thought struck her that, like many dying patients, Kurt might still be partly conscious and able to hear her.

At 8.15pm, more than eight hours after Kurt took the drugs, he sat up in bed, retched and finally stopped breathing.

Susan said she still believed it was right to help him die. But it had not been a peaceful farewell and they had not been able to say goodbye as she had wanted.

The Oregon 2019 assisted suicide report states that the time of death ranged from 1 minute to 47 hours but the report didn't indicate how many people died more than 90 minutes after taking the lethal drugs.

Assisted suicide drug experimentation.

Assisted suicide activists have been experimenting for several years with lethal assisted suicide drug cocktail experiments to find a cheaper way to cause death. 

An article by Lisa Krieger published by the Medical Xpress on September 8, 2020 uncovers information about the lethal drug experiments:

A little-known secret, not publicized by advocates of aid-in-dying, was that while most deaths were speedy, others were very slow. Some patients lingered for six or nine hours; a few, more than three days. No one knew why, or what needed to change.

"The public thinks that you take a pill and you're done," said Dr. Gary Pasternak, chief medical officer of Mission Hospice in San Mateo. "But it's more complicated than that."

An article published in USA Today in February 2017 examined the experiments  being done on people to find a cheaper lethal drug cocktail for assisted suicide. The article states that assisted suicide researchers are promoting new generations of lethal drug cocktails. The results of the first two lethal drug cocktails were:

The (first) turned out to be too harsh, burning patients’ mouths and throats, causing some to scream in pain. The second drug mix, used 67 times, has led to deaths that stretched out hours in some patients — and up to 31 hours in one case.

The 2020 Oregon report emphasizes the use of the fourth generation of lethal drug cocktails show that the length of time to die has reduced but the problems with the use of these lethal drug cocktails continue.

 

Link to video by Dr William Toffler of Oregon on this topic (Link).

Austrian assisted suicide bill aimed at people with disabilities.

Alex Schadenberg

Executive Director, Euthanasia Prevention Coalition

Austrian Parliament

In December 2020, the Austrian Constitutional court decided that the law preventing assisted suicide was unconstitutional because it violated a person's right to self-determination.The Austrian assisted suicide bill seems very similar to other assisted suicide legislation other than it contains a longer waiting period.

According to a Reuters news report:

The new law lays out the conditions under which assisted suicide will be possible in the future, following a ruling by Austria's Constitutional Court last December according to which banning assisted suicide was unconstitutional because it violated a person's right to self-determination.

The new law allows chronically or terminally ill adults to make provisions for an assisted suicide.

They have to consult two doctors who have to attest the person is capable of making his or her own decisions. A delay of 12 weeks also has to be respected that can be reduced to two weeks for patients in the final phase of an illness.

When assisted suicide is permitted for chronically ill people, as Reuters states this law permits, the law will become fairly wide open. Many people with disabilities, who are not otherwise dying, have chronic conditions. People with disabilities already experience significant pressure when needing life-sustaining medical treatment, would now qualify for assisted suicide based on their chronic condition.

The Austrian assisted suicide bill, which is tauted as a tightly worded bill, is similar to other assisted suicide laws with the exception that it appears to contain a longer waiting period for people who are not actually dying.

Netherlands assisted suicide group member admits to breaking the law in at least 100 suicides.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Ximena Knol died in Feb 2018
after ingesting a suicide powder.

Wim van Dijk, a member of the Coöperatie Laatste Wil (Final Wish Cooperative), an assisted suicide lobby group in the Netherlands, admitted in an interview that has been involved with more than 100 suicide deaths. van Dijk also admits that he has broken his actions are against the law but he doesn't care.

An article by Pim Dikkers that was published by AD.nl states (google translated):

Van Dijk said in an extensive interview in the Volkskrant this Saturday. “I am a provider. I have provided Substance X to more than 100 people,"

Van Dijk said in VK that he is 'aware of the consequences' of his story... I do not care."

Euthanasia is legal in the Netherlands when approved under the law but assisting a suicide is illegal. Article 294, paragraph 2 states:

“Anyone who intentionally assists another person in suicide or provides him with the means to do so, shall, if the suicide follows, be punished with a term of imprisonment not exceeding three years or a fine of the fourth category.”

Jos Van Dijk

Van Dijk, who was recently arrested, is turning his arrest into a political campaign. Dikkers writes:

In the interview with de Volkskrant, Van Dijk goes one step further. He says, among other things: ...I now openly say here: I did this. And I want to call on other providers to do the same. I want the social unrest to become so great that the judiciary can no longer ignore it. (...) I don't care if they put me in jail.

In July the NL Times reported that a 28 year old Netherlands man known as "Alex S" was charged with assisting multiple suicides with a lethal powder. Van Dijk may be connected to Alex S.

Recently I published an article by Randy Knol, the father of Ximena, the 19-year-old who died in February 2018 by ingesting a suicide powder. For the past three years Randy has been working to get "Substance X" banned.

EPC Free Webinar on November 4 - Preventing Assisted Suicide across America.

Thank you to everyone who participated in this event.

Register for the Euthanasia Prevention Coalition 1 hour webinar on November 4, 2021 at 2 pm (Eastern Time) (12 Noon Mountain Time).

Alex Schadenberg, Executive Director of the Euthanasia Prevention Coalition (EPC) and Sara Buscher, lawyer and Chair of EPC-USA will focus on: Preventing Assisted Suicide across America.

Here is the link to register for the free webinar (Registration link).

Webinar topics will include:

• In which states is assisted suicide legal? 
• Where are assisted suicide bills being debated? (Bill to legalize or expand assisted suicide, with an analysis of the assisted suicide expansion bills). 
• How do the assisted suicide laws work?
• An analysis of the California court case to permit euthanasia.
  
• Some data from Oregon and Washington State.
  
• Information of the lethal drug cocktail experiments in America.
  
• How do we prevent the legalization of assisted suicide? 
• Learning from the Canadian experience.
  

We plan to leave ample time for questions.

The link to register for the free webinar (Registration link).

After registering, a confirmation email will automatically be sent with information for joining the meeting. If it appears that you didn't receive the email, check your spam or junk folder.

 

Large number of Peers speak in opposition to UK assisted suicide bill

Date: Friday 22nd October 2021

Release time: Immediate

Very large number of Peers speak in opposition to Lords assisted suicide bill

In line with convention, the Assisted Dying Bill had its Second Reading in the House of Lords today after over 7 hours and speeches from over 60 Peers opposing the Bill. It is the normal custom for Bills to move to Committee Stage without a division at this stage. It by no means implies the support of the House of Lords.

Given the Bill does not have Government support, it is very unlikely to be given the time in Parliament to be debated in the House of Commons and have any chance of becoming law.

The very large number of Peers who spoke against the Bill signifies that assisted suicide and euthanasia are strongly opposed by a large proportion of the House. The content and the quality of their speeches also demonstrated beyond any doubt that this Bill is unsafe and should not pass into law.

It is clear that many within Parliament robustly oppose this Bill.

Baroness Finlay

Baroness Finlay of Llandaff, officer of the All Party Parliamentary Group for Dying Well and a Professor of Palliative Medicine, said:

“Peers have today demonstrated a powerful opposition to this bill. Many vulnerable people are unaware of the dangers in going down this road, as this bill has hidden dangers, unsafe qualifying criteria, and potentially opens the door to even wider legislation.

“Instead, the focus should be on pressing the Government to do more to ensure good palliative and end-of-life care for everyone, everywhere in this country.”

Baroness Campbell

Baroness Campbell of Surbiton, Founder of Not Dead Yet UK and long-term campaigner on disability equality and human rights, said:

“Passing this law would be a dark day in our nation’s history. It would run counter to our duty to protect those in the most vulnerable situations, and would exacerbate their fears, through insidious pressure, of being regarded as an expendable burden. As has happened elsewhere, the Bill would doubtless be extended.

“No major disability rights group in the UK supports legalising assisted suicide. What they support is immediate and sustained improvement in their care. Now is not the time to abandon them to the desperate temptation of an assisted suicide under the guise of compassion.”

Baroness Grey-Thompson

Baroness Grey-Thompson DBE, Crossbench Life Peer and one of Britain’s greatest Paralympic athletes, said:

“The legal, medical and social implications of the Bill for disabled people are enormous. They need to know that doctors are obliged to do all they can to help everyone to live a good life. The current law keeps unconscious discrimination and social bias towards disabled people in check.”

For additional quotes and interviews, please contact Simon Caldwell on 07730 526847;

Or Alistair Thompson from Care Not Killing on 07970 162225;

Or Ben Furner from Not Dead Yet on 07946 355795.

ENDS

Notes to Editors The All Party Parliamentary Group for Dying Well promotes access to excellent care at end of life and stands against the legalisation of doctor assisted suicide in the UK. For more information visit https://www.dyingwell.co.uk/about/

We mourn the death of Nancy Elliott, an amazing woman and great leader.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Nancy Elliott

The Euthanasia Prevention Coalition (EPC) is mourning the loss of Nancy Elliott, the immediate Past Chair of EPC - USA.

Nancy was a former three term New Hampshire State legislator who learned about the issue of assisted suicide while sitting as a member of the New Hampshire House Judiciary Committee when they debated an assisted suicide bill.

Nancy Elliott's obituary (Link).

Nancy soon became one of the nations leading experts on euthanasia and assisted suicide as a fierce advocate for the vulnerable, disabled, and elderly regarding euthanasia and assisted suicide.

Nancy served as a leader for more than a decade speaking, writing, and testifying across America and the world on behalf of the EPC-International and as the Chair of EPC-USA.

Nancy was instrumental in contacting key legislators, committee chairs and Governors to convince them to prevent the legalization of assisted suicide. 

Her legacy is in many lives that were saved.

Nancy was featured in the film - Fatal Flaws produced by the Euthanasia Prevention Coalition and Dunn Media. In the film, Nancy spoke about how her husband would have felt if doctors were pushing assisted suicide when he was sick.

For me, Nancy was also a close friend.

Nancy wrote many articles opposing assisted suicide but she was also quoted in many articles world-wide. Here is a list of some of Nancy's great articles:

• Speech to the New Hampshire House Judiciary Committee (Link).
• Letter to Massachusetts politicians to reject assisted suicide bill (Link).
• Letter to the Maine Health and Human Services Committee (Link).
• The assisted suicide bill was aimed at people like my husband (Link).
• New Jersey Journal endorses Canadian style euthanasia law. (Link).
• Reject New York assisted suicide bill (Link).
• Mary kills people is a dangerous and irresponsible show that should be terminated (Link).

No License to Kill: 1,700 UK doctors and nurses voice opposition to legalising assisted suicide and say they will refuse to take part if legalised

Duty of Care is a group of doctors and nurses in the UK who oppose euthanasia and assisted suicide (Link to the Duty of Care website).

PRESS RELEASE FROM OUR DUTY OF CARE - UK
IMMEDIATE RELEASE

A group of 1,700 doctors and nurses have voiced their strong opposition to legalising assisted suicide and say they will refuse to kill their patients even if the law is changed. Their intervention comes ahead of next week’s second record reading of a private members bill in the House of Lords that would allow doctors to provide lethal drugs to terminally ill people wanting to end their lives.

In the letter to the Secretary of State for Health and Social Care, Sajid Javid, the doctors say:

“As healthcare professionals, we have a legal duty of care for the safety and wellbeing of our patients. We write with great concern regarding the introduction of a Bill to legalise assisted suicide.”

It goes on: “The shift from preserving life to taking life is enormous and should not be minimised.” It goes on to say: “The prohibition of killing is present in almost all civilised societies due to the immeasurable worth of every human life...”

“…It is impossible for any government to draft assisted suicide laws which include legal protection from future extension and expansion of those laws. Canada has clearly demonstrated that safeguards can be eroded in a matter of just five years. The prohibition of killing is the safeguard. The current law is the protection for the vulnerable. Any change would threaten society’s ability to safeguard vulnerable patients from abuse, it would undermine the trust the public places in physicians, and it would send a clear message to our frail, elderly and disabled patients about the value that society places on them as people.”

The doctors include: Prof Johann de Bono, Regius Professor of Cancer Research and Experimental Cancer Medicine, London, Dr Carol Davis, Consultant in Palliative Medicine, Southampton, Prof David Galloway, former President of the Royal College of Physicans and Surgeons of Glasgow, Professor Rob George, Professor of Palliative Medicine, London, Dr James Haslam, Consultant in Intensive Care, Salisbury, Professor Julian Hughes, (Retired) Consultant in Old Age Psychiatry, Bristol. Professor Chris Parker, Professor of Oncology, London, Professor Alan Thomas, Professor of Old Age Psychiatry, Newcastle.

Dr Gillian Wright, a former palliative medicine registrar who now works in medical ethics and is a spokesperson for the healthcare group Our Duty of Care (Odoc) which organised the letter, commented: “Regrettably the public are being misled about the significant problems associated with Oregon’s assisted suicide legislation and its operation. For example, in 2020, over half of those ending their lives cited the fear of being a burden on their families as a reason and a further 7.4 per cent cited financial worries.

The letter concludes: “…It is impossible for any government to draft assisted suicide laws which include legal protection from future extension and expansion of those laws. Canada has clearly demonstrated that safeguards can be eroded in a matter of just five years. The prohibition of killing is the safeguard. The current law is the protection for the vulnerable. Any change would threaten society’s ability to safeguard vulnerable patients from abuse, it would undermine the trust the public places in physicians, and it would send a clear message to our frail, elderly and disabled patients about the value that society places on them as people.

“Far from one person’s decision affecting no one else, it affects us all. Some patients may never consider assisted suicide unless it is suggested to them. The cruel irony of this path is that legislation introduced with the good intention of enhancing patient choice will diminish the choices of the most vulnerable.

“More than 1 in 60 deaths in Belgium occurred with no consent from the patient – those in coma, confused, or the elderly are euthanised because their lives are considered not ‘worth living’.

“We would not take patients’ lives – even if they asked us to – but for the sake of us all, and for future generations, we ask that the law remains unchanged.”

Dr David Randall, a medical registrar from London stated: “This letter emphasises just how much opposition there is within medicine to the legalisation of assisted suicide. The current law works well, protecting the vulnerable and allowing us to deliver to patients the kind of compassionate, individualised care to which we aspire. A change in the law would distort conversations and priorities around end-of-life care, and would threaten the world-leading hospices and palliative care services that we enjoy in this country. We call on politicians to keep the current law in place, and not to send to vulnerable patients the message that society no longer values their lives.”

Dr Wright added: “The 1,700 doctors and health care professionals who have signed this letter urge the Health Secretary, Sajid Javid and all Parliamentarians to reject this legislation and instead concentrate on ensuring that regardless of where you live or what you earn, you can access the very best palliative care – a system that caters for both the physical and psychological needs of those with terminal or chronic conditions.”

ENDS

Notes to editors

For media inquiries please contact Alistair Thompson of Team Britannia PR on 07970 162225

For further information about Our Duty of Care please visit: https://ourdutyofcare.org.uk/