PCHETA (Pa Cheetah) -- the bill with 9 lives

By Sara Buscher, Attorney, Past Chair, EPC USA 

They say a cat has 9 lives. The  "Pa Cheetah" certainly does. 

The first version of the Palliative Care and Hospice Education and Training Act (PCHETA) was introduced in 2004. It evolved into the current version in 2015. Come 2024 that will be 9 years. The Euthanasia Prevention Coalition USA has been opposing PCHETA since 2017. According to the HHS Office of Inspector General:

“Our reports and investigations have revealed several concerning issues, including poor—sometimes harmful—quality of care, fraud schemes that involve enrolling beneficiaries without their consent, inappropriate billing practices, limited transparency for patients and their families, a payment system that creates incentives to minimize services, and a rapid growth in the number of new hospices, often to take advantage of these conditions.”

We see the Bill rewarding those who nudge people into hospice (by way of palliative care programs) where they are subjected to abuse and, in some cases, euthanasia. One reason supporters keep trying to get this Bill passed, are its meaningless safeguards.

The Bill’s Safeguards are Illusions.

The current bill, S. 2243 has two safeguards in Section 5. Two years ago, Senator Baldwin the bill’s sponsor, got PCHETA language added to a House budget reconciliation bill without the Section 5 safeguards. The Senate Finance Committee refused to include PCHETA, so once again the Bill died. In mid-September 2023, Senator Baldwin announced she will try to get it included in a bipartisan bill that must pass, probably without safeguards. She said this as she withdrew S. 2243 from action by the Senate Health, Education, Labor and Pension (HELP) committee.

The Section 5 safeguards are unenforceable and pretty much meaningless.

Don’t talk about it, Section 5(a). Section 5(a) prohibits using the Bill’s funds to provide, promote, or provide training about any item or service subject to the Assisted Suicide Funding Restriction Act (ASFRA). Nothing prohibits federal funding of teaching about assisted suicide and euthanasia as long as the funding does not come from PCHETA. The ASFRA itself does not prohibit federal funding for speaking about assisted suicide and euthanasia, only the provision of items and services for that purpose. Nor, does it prohibit withholding or withdrawing medical care, nutrition or hydration. It also allows funding for relieving pain or discomfort with an increased risk of death, as long as death is not intended. Lastly, Compassion & Choices has a goal of repealing ASFRA.

Don’t do it, Section 5(b). This section says: 

“As used in … [PCHETA], palliative care and hospice shall not be furnished for the purpose of causing, or the purpose of assisting in causing, a patient’s death, for any reason.” 

Sounds good, doesn’t it? Here’s the problem. It only applies to PCHETA funds, nothing else; PCHETA only funds education, research and public information, not the furnishing of care. In other words, Section 5(b) does nothing.

Man dies after taking wife's assisted suicide drugs

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The Guardian reported  that a man in Queensland, Australia died when he ingested assisted suicide drugs prescribed for his wife.

Andrew Messenger reported on September 25 for the Guardian:

Queensland’s health minister has suggested the state may need to strengthen voluntary assisting dying (VAD) legislation after a woman’s euthanasia drugs were used by her husband after she died in hospital.

The coroner is investigating the reported incident, in which the elderly woman was approved to use the drugs at home under Queensland’s voluntary assisted dying scheme – but she died suddenly in hospital. Her husband subsequently used the drugs to kill himself.

According to Queensland law, unused lethal assisted suicide drugs are to be returned 14 days after a person's death. In this case a husband, whose wife had been approved for assisted suicide, consumed the lethal drugs.

Queensland's Health Minister, Shannon Fentiman, admits that this may have been the first time the law has been abused. 

Fentiman states:

“We will look at absolutely whether we need to strengthen the legislation about that 14-day turnaround for medication to be returned, which I suspect we will do,” she said.

“But we’re going to await the outcomes of that investigation. That investigation will also go to the coroner and I also expect the coroner will have some recommendations around that.”

An ABC News report by Rachel Riga published in September 25 states:

The ABC understands the man's wife had met the criteria and had been given the medication but she was admitted to hospital.

She passed away in hospital before taking the VAD substance.

Her husband was required to return the medication within 14 days but consumed it instead.

Messenger reported that even though the abuse of the new law has resulted in a death, Health Minister Fentiman is recommending that euthanasia be offered through telehealth: 

It also recommended amendments to the commonwealth criminal code to permit doctors to use telehealth for VAD consultations. The code is perceived to prohibit electronic transmission of prescriptions for a substance under the scheme.

Fentiman said more Queenslanders had taken up the option than in any other jurisdiction, and there had been almost no errors in the scheme’s first year.

She said the report showed the state’s system is “safe, accessible and compassionate”.

Those who oppose killing argue that legalizing euthanasia results in errors and premature deaths; euthanasia promoters respond by saying "there will be safeguards". When a person, who was not approved for assisted suicide, dies by taking another person's lethal drugs, the euthanasia promoters say there were "almost no errors."

Society needs to care not kill people.

MAiDHouse -- a Canadian charity -- kills 125 people in 2022

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The 2022 MAiDHouse Annual Report  reveals that MAiDHouse facilitated 125 euthanasia deaths in 2022, up significantly from 2021.

MAiDHouse, is a euthanasia clinic in Toronto that offers euthanasia for people do not wish to die by euthanasia in a hospital.

In September 2022, Margaret Marsilla ran a petition campaign to prevent the euthanasia death of her 23-year-old son Kiano who was scheduled to die at the MAiDHouse on September 28, 2022. 

In her media release, Margaret Marsilla wrote:

Dr. Joshua Tepper and Dr. Laurie Morrison (“Dr. Death”) have approved the application for medical assistance in dying (MAiD) for my son, set to take place on September 28, 2022, at MAiDHouse. Both the doctors and MAiDHouse, run by Tekla Hendrickson, continue to turn their nose up to the requirements of legislation, which was to have built-in safe guards to protect vulnerable individuals.

The MAiDHouse Annual Report exposes their plan to expand euthanasia by opening more death clinics. 

In contrast, the Delta Hospice Society that provided excellent end-of-life care, was defunded and had its 10 bed hospice building expropriated by the British Columbia government because of their commitment to provide a no kill hospice.

MAiDHouse exclusively provides euthanasia.

MAiDHouse and CAMAP (Canadian Association of MAiD Assessors and Providers) exist to provide and promote euthanasia. Both have been designated as charities by the Canadian government.

Free Online Patient Advocacy Training Program - September 27, 2023

Register for the free online Patient Advocacy Training Program on Wednesday, September 27, 2023 from 7 - 9 pm.

Kathy Matusiak Costa

Seminar (Registatration Link).

Learn how to be an effective patient advocate. Help family members, friends, elderly people and people with disabilities in your community, receive the medical care and supports that they need.

This program focuses on issues related to advocacy, patients rights, effective advocacy communication, advocacy at the doctor's office, advocacy at the hospital or nursing home, and issues related to dementia and other health concerns.

Alex Schadenberg

Join Kathy Matusiak Costa, Executive Director of the Compassionate Community Care, and Alex Schadenberg, Executive Director of the Euthanasia Prevention Coalition. 

Register: (Registration Link) Meeting capacity is limited!

Compassionate Community Care
383 Horton St. E., London ON N6B 1L6
Office: 519-439-6445
info@beingwith.org • www.beingwith.org

CCC Helpline: 1-855-675-8749

Compassionate Community Care Charitable registration # 824667869RR0001

Opposing The Palliative Care and Hospice Education and Training Act (2023); S. 2243 (118th Congress)

*Bill S. 2243 is not currently moving but the sponsors of the bill are still working to get it debated or inserted within another piece of legislation.

Link to The Palliative Care and Hospice Education and Training Act (Bill S. 2243)

EPC-USA Position Statement

The Euthanasia Prevention Coalition USA supports positive measures to improve peoples’ quality of life and well being instead of offering them assisted suicide and euthanasia. We are aging and disability advocates, lawyers, doctors, nurses and politicians.

Palliative care defined by hospice pushes patients with chronic serious illness down a path toward death long before they become terminal.(1) Palliative care defined by hospice and insurers is focused on cost-cutting where “quality and comfort take a backseat to profits” with a disparate impact on low-income patients and people of color.(2) We believe people should be empowered to live well with chronic serious illness without placing them at risk of hospice abuse, serious harm and premature death.(3)

Talking Points

1. The Bill wrongly links palliative care with hospice instead of primary and specialty care for non-terminal patients, thereby pushing them down a path toward premature death.

• The Bill repeatedly links palliative care with hospice even in the few places it mentions integration with primary and specialty care.
• Proponents say palliative care should start upon diagnosis of chronic serious illness.(4) Life expectancy at diagnosis averages 5-10 more years;(5) many people will live longer. Palliative care should be part of their primary and specialty care, not linked to hospice in the Bill.
• Palliative care linked to hospice leads to the deaths of people who are not otherwise dying; typically by indifferently assessing people as terminal and providing them “comfort care” where they are heavily sedated, overdosed on pain killers and denied food and water so the prognosis becomes self-fulfilling.(6)

2. The Bill is equated to euthanasia and assisted suicide by supporters. 

• Compassion and Choices says the Bill will enable people to access a peaceful death.(7) They urge their followers to equate support for the Bill to support for Medical Aid in Dying, their euphemism for euthanasia and assisted suicide, in contacts with Congress.(8)
• The Bill’s Section 5 limits on funding of euthanasia and assisted suicide are unenforceable. The first on education and training in grant funded classes is not enforceable because HHS does not have the data; the second applies to the furnishing of care under the Act, but the Act funds education, research and public information, not the furnishing of care.

3. The workforce shortage to be met by the Bill has disappeared. 

• The seminal 2018 study that says the shortage of palliative physicians in 2040 will range from 2,500 to 5,000 and can be eliminated by growing fellowships to 500-600 per year.(9)
• Available fellowships reached 518 in 2020-21 without PCHETA(10) which is likely why it is now being described as addressing future (not current) needs.(11)
• From another perspective, the “shortage” disappears when we count the more than 39,000 family/general practice physicians(12) who currently provide palliative care.

4. Palliative care’s focus is on cost-cutting where “quality and comfort take a backseat to profits” with a disparate impact on low-income patients and people of color.(13)

• The Center to Advance Palliative Care (CAP-C) says “Palliative care is for all individuals with serious illness who face heightened risks of crisis hospitalization and preventable spending −often over years.”(14)
• An NBC investigation says a national hospital chain nudges patients into palliative care as a gateway to hospice to reduce regular mortality, readmission and length of stay metrics.(15)
• Hospices are already using palliative care as a “loss leader” to enroll more patients into hospice earlier.(16) The HHS OIG reported people were inadequately informed their care had switched to hospice and sometimes were placed in hospice without their knowledge.(17)
• Private equity investors are increasingly buying hospice and palliative care companies.(18)
• Private equity ownership increased deaths and costs to the government for nursing home residents,(19) which is likely in other settings as well.
• Insurers offering Medicare Advantage plans, like Humana and Anthem,(20) are running palliative care programs, with clinicians working for insurers.

5. The Bill would spend $100 million over five years and likely forgo hundreds of millions in fraud recoveries that could be better spent elsewhere. 

• The HHS OIG says hospices are enrolling patients who are not terminally ill without their knowledge or under false pretenses, providing poor quality care, and wrongly billing Medicare hundreds of millions of dollars.(21)
• The HHS OIG says hospices are defrauding Medicare of hundreds of millions of dollars by enrolling people who are not terminal and then billing at the highest rates.(22) Most hospice settlements listed on the Fraud in Healthcare site are for enrolling ineligible people.(23)
• The only legal Medicare reference to palliative care is care provided to hospice patients. 42 CFR 418.3. The Bill could erase federal fraud recoveries for enrolling non-terminal people in hospice by extending eligibility for palliative care (as a type of hospice care) to those with a “serious or life-threatening illness”, to be defined after enactment by federal bureaucrats and palliative care insiders (Bill Section 904(c)(3)).

6. The Bill substitutes a stamp of approval by the Agency for Healthcare Research and Quality (AHRQ) for patient safety concerns about dangerous hospice and palliative care.

• Bill Section 4 permits the Agency for Healthcare Research and Quality (AHRQ) to disseminate only positive information about palliative care, thereby silencing AHRQ’s concern about palliative care safety issues(24) and evidence-based recommendations.
• Clinical practices in hospice-style palliative medicine regularly shorten lives.(25) This is so prevalent it was described by the Washington Post in a 2014 series26 and identified as a serious problem by Duke University professor Farr Curlin, M.D.in 2015.(27)
  

End Notes:

1. Blog post at https://www.multiplechronicconditions.org/blog/u-s-senate-defeats-the-deadly-palliative-care-bill-for-thethird-time/ by Dr. Kim Kuebler, a palliative care nurse and thought leader. https://www.linkedin.com/in/drkimkuebler/
2. Letter linked to at https://www.finance.senate.gov/chairmans-news/wyden-brown-warren-probe-private-equityownership-of-kindred-at-home
3. https://oig.hhs.gov/oei/reports/oei-02-16-00570.asp linking to the complete report; https://oig.hhs.gov/oei/reports/oei-02-17-00020.asp linking to the complete report; Peter Whoriskey, As More Hospices Enroll Patients Who Aren’t Dying, Questions about Lethal Doses Arise, Washington Post, August 21, 2014 https://www.washingtonpost.com/news/storyline/wp/2014/08/21/as-more-hospices-enroll-patients-who-arent-dyingquestions-about-lethal-doses-arise/
4. https://getpalliativecare.org/palliative-care-can-help-right-diagnosis/
5. Murray SA et al., Illness Trajectories and Palliative Care, BMJ. 2005 April 30; 330(7498): 1007–1011.
6. Farr A. Curlin, M.D., Hospice and Palliative Medicine’s Attempt at an Art of Dying, chapter 4 in Dying in the Twenty-First Century, edited by Lydia Dugdale, MD, MIT Press 2015 at pages 47-8.
7. https://www.compassionandchoices.org/docs/default-source/default-document-library/pcheta-endorsement-letter---final---6.7.22.pdf?sfvrsn=b731f7fb_1
8. https://join.compassionandchoices.org/a/thank-senator-baldwin-today?sourceid=1075543&emci=863203ed-89ecec11-b47a-281878b83d8a&emdi=11ef0ed9-99ed-ec11-b47a-281878b83d8a&ceid=1588667
9. Lupu D, et al, The Growing Demand for Hospice and Palliative Medicine Physicians: Will the Supply Keep Up? at https://www.jpsmjournal.com/article/S0885-3924(18)30031-9/fulltext is pointed to be AAHPM at http://aahpm.org/career/workforce-study and by CAPC https://www.capc.org/documents/download/1093/
10. https://aahpm.org/uploads/Program_Data_102820.pdf
11. https://www.capc.org/documents/download/1093/
12. 118,198 physicians practice family/general practice medicine. https://www.aamc.org/data-reports/data/2020-physician-specialty-data-report-executive-summary One-third or over 39,000 say they provide palliative care. https://patientengagementhit.com/news/33-of-primary-care-providers-also-deliver-palliative-care
13. Letter linked to at https://www.finance.senate.gov/chairmans-news/wyden-brown-warren-probe-private-equityownership-of-kindred-at-home
14. CAPC, The Case for Community Based Palliative Care 2021 at p 6, at https://www.capc.org/documents/867/
15. https://www.nbcnews.com/health/health-care/doctors-say-hca-hospitals-push-patients-hospice-care-rcna81599
16. https://hospicenews.com/2019/05/14/study-71-of-u-s-adults-have-never-heard-of-palliative-care/ A loss leader is a service sold below cost to attract more customers who will then buy more profitable services. www.businessdictionary.com/definition/loss-leader.html
17. https://oig.hhs.gov/oei/reports/oei-02-16-00570.asp linking to the complete report.
18. See note 2.
19. https://www.nber.org/papers/w28474
20. See note 2 for Humana. Anthem owns Aspire, a palliative care company. https://d3d8hkm9o9zt51.cloudfront.net/ourcompany
21. https://oig.hhs.gov/oei/reports/oei-02-16-00570.asp linking to the complete report.
22. See note Error! Bookmark not defined..
23. https://fraudinhealthcare.com/results/?entity%5B%5D=301
24. https://search.ahrq.gov/search?q=palliative+comfort+harm
25. Cohen L, et al., Accusations of Murder and Euthanasia in End of Life Care, J Pall Med 2005.8.1096 at 1102.
26. Peter Whoriskey, As More Hospices Enroll Patients Who Aren’t Dying, Questions about Lethal Doses Arise, Washington Post, August 21, 2014 https://www.washingtonpost.com/news/storyline/wp/2014/08/21/as-more-hospicesenroll-patients-who-arent-dying-questions-about-lethal-doses-arise/
27. Farr A. Curlin, M.D., Hospice and Palliative Medicine’s Attempt at an Art of Dying, chapter 4 in Dying in the Twenty-First Century, edited by Lydia Dugdale, MD, MIT Press 2015 at pages 47-8.

Canada: How Death Care is pushing out Health Care

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Alexander Raikin has written another excellent exposé on Canada's euthanasia regime published in the National Review on September 14, 2023 entitled: How Death Care pushed out Health Care. 

Raikin's previous article: No other options: An exposé on euthanasia in Canada, published by the New Atlantis on December 16, 2022, provides important insights into Canada's euthanasia law.

Raikin focuses on proceedings from the Canadian Association of MAiD Assessors and Providers (CAMAP), training seminars and interviews with patients and doctors concerning death 'care'. 

CAMAP is an independent organization funded by Canada's federal government to train doctors and nurse practitioners on how to euthanize (kill) patients (MAiD).

A panel at the CAMAP training seminar explained how "strict" the law is:

On the same day that a patient enters into an optional written agreement with only one of his or her two MAID assessors — even if it is unsigned, without any witnesses, and with no family members having been informed — the clinician can administer the lethal injection without asking for the final consent of the patient.

Quoting from a CAMAP training seminar, Raikin writes:

"Next question is from Debbie," the moderator of a discussion on medical decision-making capacity said to her fellow physicians. “How would folks interpret someone who has lost capacity with a waiver in place and is now delirious, shouting, pulling their arm away as one tries to insert the IV to provide MAID?”

The question is important because the patient is clearly unable to consent and is showing signs of resisting. 

The Moderator, Dr Ellen Wiebe, possibly Canada's most prolific euthanasia doctor, responds to the question by stating:

“I’m guessing I would bring in one of their other providers, you know, palliative care or, or whatever, and get them sedated. But what would you say?”

First to speak is Jim MacLean, who claims that he has performed more than 75 “provisions” since MAID expanded to include non-dying patients. “I don’t think I have any great thoughts on this one.” Wiebe laughed. “Everyone’s different. I mean, you try to deal with the situation. Calm the room down. See what you can achieve through conversation and calmness.”

Chantal Perrot is the co-chairman of a clinician advisory council for Canada’s largest pro-MAID lobby group. She described herself to a parliamentary committee as someone who has “cared for hundreds of patients . . . as they navigated the MAID process.” Responding to Wiebe, she said, “That’s a question. If they’re sedated, then have we sedated them into being accepting of MAID? You know, that’s a whole other question.”

Kevin Reel, a senior ethicist at Sunnybrook Hospital in Toronto and former president of the Canadian Bioethics Society, answers in part with another question: “If what we’re doing by trying to honor the waiver is reducing distress for the patient and also for maybe even the family around them, would it be acceptable to do something similarly covert to keep them from reacting in that way?”

Reel continues, “That might be a way around it, but — ” before being interrupted by MacLean, whose new answer takes the question from the hypothetical to the actual and clarifies what he meant by “conversation and calmness”: “One waiver I did use, the patient was a little agitated. So we did give her some subcutaneous hydromorphone” — an opiate ordinarily used for acute-pain control instead of sedation — “before I did the MAID, did the provision. So we did, we did use it in that situation and it was very helpful.”

“Good,” the moderator says, before moving on to the next question. 

No one on the panel or audience objects.

Raikin explains:

The asterisk in the law is that the agreement is in place only as long as the patient “does not demonstrate, by words, sounds or gestures, refusal,” or “resistance to its administration.” If this demonstration is “involuntary” and “made in response to contact,” the death of the patient may still proceed. But consent is a spectrum, and patients with delirium can flicker between having capacity and not; patients can also change their minds about dying at the hands of their physician or nurse.

The recording from an October 2021 training session documents the use of sedation to obtain consent. 

Raikin explains the importance of the use of sedation to obtain consent for death:

At the core of death care is the presumption that safeguards work and that consent, the most important safeguard, prevents death care from slipping into rampant homicide or suicide contagion. Instead, it is turning into the end of medicine.

Raikin provides examples of the use of sedation to gain consent for death:

In Belgium last year, after a lethal injection failed to kill a 36-year-old woman with terminal cancer, the presiding physician smothered her with a pillow. In New Zealand and Canada, suicidal patients seeking medical care for suicide prevention were prompted to consider assisted suicide instead.

In the Netherlands, a similar story of a physician sedating her patient into accepting euthanasia led to the first criminal trial of a euthanasia physician. She was acquitted. The judges said, “We believe that given the deeply demented condition of the patient the doctor did not need to verify her wish for euthanasia,” even though the patient repeatedly attempted to fight off her physician.

I have written previously about how a failed suicide attempt in Canada was completed through euthanasia, despite concerns of illegality by physicians involved with CAMAP, an organization that has held internal seminars on patients requesting euthanasia because of poverty, lack of medical care, homelessness, and credit-card debt.

Raikin quotes Michel Bureau, head of the Commission sur les soins de fin de vie (Commission on end-of-life care), the independent monitoring agency for MAID in Quebec who told the Canadian Press news agency this summer:

“We’re now no longer dealing with an exceptional treatment, but a treatment that is very frequent.”

In every jurisdiction that has legalized assisted suicide, the number of deaths have ballooned and "safeguards" have been rescinded. Raikin writes:

In California, the number of assisted suicides last year increased by more than 63 percent. In Canada, the number of deaths by euthanasia is on track to increase more than 13-fold in just the first seven years of the practice’s legalization. Belgium has seen a more than twelvefold increase since 2003. In Switzerland, which legalized assisted suicide in 1941, the number of such suicides has doubled every five years since 1999.

Raikin gives examples of deaths that are outside of the law:

A sibling found out that his brother’s MAID paperwork in British Columbia listed only “hearing loss” as his qualifying condition. In the Netherlands, dozens of patients qualified for euthanasia only because of autism. In Canada, “advanced age” helps qualify patients to die, even though Quebec cautions that to rely on it as the sole criterion is illegal. Young patients have died through euthanasia in Belgium for a range of reasons, including a botched sex change, sexual exploitation by a psychiatrist, unresolved post-traumatic stress disorder after a terrorist attack, and again, this time in twins, hearing loss.

Last year the Swiss Medical Association saw a need to issue a statement reminding physicians, for the first time, that “assisted suicide for healthy persons is not medically and ethically justifiable.” The agency responsible for monitoring assisted suicides in Quebec issued a similar reminder over the summer.

Raikin quotes bioethicist Leon Kass, who warns that if the value of a human being is considered subjective, invariably the right to die metamorphoses into the duty to die.

Raikin explains the planning and goals of CAMAP:

In 2018, at CAMAP’s annual conference, the leading death-care practitioners gamed out their plan. It was nothing short of prescient. Many speakers, such as the CEO of Dying with Dignity, stressed that MAID is a “political issue” and that it would require “the political will to speak out against Catholic institutions around MAID.” Moreover, as some panelists insisted, it was important for practitioners to “recognize the harm to vulnerable populations that comes with the assertion of freedom of religion.”

 In comparison, MAID was “sacred.” One speaker implored non-MAID clinicians “to keep the spirit of MAID intact.”

 Just two years into Canada’s euthanasia experiment, physicians were busy laying plans for how to expand euthanasia to children, especially Indigenous children, since they “are considered wise because they are closest to the ancestors.”

Raikin explains how CAMAP promotes euthanasia for poverty:

Senior CAMAP leadership has repeatedly denied that patients are receiving euthanasia primarily because of poverty. Yet in 2018, it devoted an entire panel to “providing MAID to vulnerable, Indigenous, homeless, and frail elderly populations.” Panelists described how they could “help to empower vulnerable populations” by helping “patients fight for options that would allow them to have access to MAID” — in other words, to help find “what supports” patients might need to die instead of to live.

“I have a First Nation patient who meets all the criteria for MAID, but much of their suffering is due to a life lived in poverty,” one panelist said. “If I could change their social determinants of health, their situation might improve.” Even a hypothetical example of a patient with “fixed delusions that are causing him severe suffering” was deemed potentially eligible because “it doesn’t matter what he wants [MAID] for.”

Stephanie Green, the leader of  CAMAP, advocated that opposition by hospices to euthanasia will be overcome. Raikin quotes Green as stating:

“Over time, perhaps ten years from now, I think this conversation will happen again. If we push it now too hard and too fast, I think that will put more wedges in.”

CAMAP’s strategy has already succeeded. In 2017, Vancouver Island had a Catholic hospital and four hospice beds. Now as a consequence of a public campaign by death-care advocates, there are no remaining “MAID-free” spaces on the island.

In 2021, Vancouver Island had the highest euthanasia rate in Canada. 

Raikin discusses the cases of several Catholic hospitals that have been taken over by the Australian government in order to provide access to death services. 

Raikin writes of the doctors who object to euthanasia and are being forced out of medicine:

Helen Lord, one of the nine palliative specialists in Tasmania, retired once                "death care" began.

“I know I actually can’t kill someone, I can’t do it.  

“I said I’m not going to have any part of this. It’s not medicine. It’s just not what we do. . . . Half of the people who came into [my] palliative care were scared that they were going to be euthanized.”

When Lord spoke out against euthanasia she was accused of being a right-wing Evangelical, which she is not. Lord does believe that "life is precious" and "time is precious."

Félix Pageau, a geriatrician practicing in Quebec, testified to a national parliamentary committee in Ottawa that in his opinion as a physician, based on research, Canada was not ready to expand MAID to advanced dementia. For this, he said, a colleague in his home hospital “filed a complaint to the Collège des médecins” saying he “lied” to the committee. The Collège decided to “open an inquiry, even though they don’t have jurisdiction over testimony at the federal [level] or in the Parliament.” The investigation became an ordeal — and an expensive one, since Pageau needed to hire a lawyer. Pageau in his parliamentary testimony was exercising his free-speech rights. Eventually, the Collège ruled that it did not have jurisdiction, but the point was made.

Raikin continues:

Another physician, a former director of a palliative clinic in Canada, told me, “I had to leave a job that I loved” because “the MAID situation” made it “just too difficult to practice medicine here.” After she spoke up publicly to urge that MAID and palliative care be separate, she was constantly harassed; her email was flooded with dozens of gory images. Another palliative-care physician told me that he started his own small clinic rather than stay at the hospital where he practiced. “Physicians that go against the narrative are sanctioned,” he said. “They’re marginalized. It’s hard. It’s risky.”

David D’Souza, a physician in Ontario:

“I think already there’s a lot of abuse going on, and I’m seeing it in my own practice,” including when families pressure loved ones to die so that estates or insurance payouts become available sooner. “It’s making me think twice about whether I should be continuing in geriatric care.” His brother, Mark, also a physician, left palliative care entirely. “We’re literally doing harm even though it’s under the guise of compassion,” Mark said.

Raikin states: 

The effect of legalizing death care is not just the hostile takeover of medicine. It hurts those who are the most vulnerable, those who want not to die but to be helped to live.

Gabrielle Peters, a disabled writer and policy analyst in Canada, told Raikin that it is essential that there are MAiD free places in Canadian healthcare. Raikin interviewed Rachel, who lives with chronic pain, PTSD and depression.

Rachel, a woman with a condition that causes chronic pain, told me about the difficulties of the past year. “Every day was really hard to stay alive,” she told me. “I really felt like I was dead.” She also suffers from major depression and has a history of PTSD from childhood abuse. “If I said that I wanted to die or that I couldn’t hack it anymore” when she spoke with health-care practitioners before MAID was legalized, “I was met with, ‘Here’s some coping skills and let’s talk about it,’ and various forms of therapy and resources being brought to bear.”

Once her condition qualified for MAID, in 2021, she began to notice a trend. “I would call the crisis line, the suicide crisis line. Many of these mental-health professionals, their advice would be to go look up Dying with Dignity’s website.” She tried to get help for thoughts of suicide, and instead she was being offered advice for how to die from assisted suicide.

“I have been afraid, you know, over this last couple of years to go to just my local hospital, because I was afraid that if any doctor either brought up MAID themselves or met my kind of ambivalent desire for MAID, all I needed was a push and I would be dead right now.”

Rachel found help at the Centre for Addiction and Mental Health (CAMH), Canada’s largest mental-health teaching hospital, located in Toronto. 

Raikin writes:

Its policy is that no CAMH clinicians can provide MAID on site. She felt that she had found a MAID-free space that could treat her illnesses. (CAMH is yet to release a statement on whether its MAID policy will change when, in six months, MAID will be expanded to include mental illnesses.)

Rachel decided to risk everything. With her meager savings from her disability benefits, she purchased a one-way, long-distance bus ticket, not knowing whether she would be admitted to the hospital or instead end up homeless.
“I literally just presented myself at the CAMH ER,” she said. “Part of the reason I felt safe to go to CAMH is just because I knew that they do not endorse MAID for mental illness. They’re pretty strict on that.” In a sense, Rachel lucked out. Despite the usual long wait times at Canadian emergency rooms, especially for psychiatric illnesses, her poor condition meant that her case was triaged to the front of the queue. She soon discovered how MAID was viewed by doctors at the center. “On the psych ward at CAMH, my psychiatrist was terrified — terrified,” Rachel said, carefully enunciating every syllable, “that I would talk about MAID on the floor with the other patients. She was terrified of suicide contagion.”

Over the span of weeks, Rachel began to recover. She was finally put on a new form of pain control; her depression improved. But the most important change at CAMH was that, finally, she felt listened to. “Sometimes, all you need is someone to come alongside you. And just help you cope through the everyday,” she said. “Whether it’s a doctor or just the person who is walking alongside me while I’m in a lot of pain. It may not change how much pain I actually have. But it sure makes a big difference to how much I suffer from that pain.”

Rachel is now happily back home. “I have no intention of using MAID. I have 100 percent turned away from it. Only because I had health care. All I needed was health care and pain care.”

Raikin recounts his previous article about Rosina Kamis, who died by euthanasia and her friend James, who has a similar medical situation:

In the first story that I wrote about death care, “No Other Options,” published in the New Atlantis, I wrote about Rosina Kamis, a 41-year-old Toronto woman with fibromyalgia. She chose to die from MAID in part because of her inability to access proper medical care. Before she died, she entrusted her friend James, a former neighbor, to represent her as her power of medical attorney; since her physicians weren’t listening to her, she wanted to see if someone else who has fibromyalgia, as James does, could get her the medical care that she needed. Despite his efforts, James couldn’t help her — and now, after her death, he can’t get the help that he needs. He messaged me months after our first conversation to tell me that he now sees his own future in what happened to Rosina.

James told me that he is living with the specter of an imminent administered death, like Rosina’s. He could decide to stop fighting for the care he needs, too. It seems inevitable. “I’m going to take it one day. That’s how it feels to me. I don’t like that, but to me, the way things are going, this society is really sending us disabled people a message,” James said. “We got that message even before MAID. But now it’s codified into law and there’s these processes and resources to expedite it.”

“I have diagnosed mental-health conditions and I can’t get treatment. I need therapy. My doctor asked me the other day, What do I need? I need therapy. I need a long-term relationship with someone. And she told me, she said, That’s impossible.” Instead, he was sent YouTube videos on how to do stretches. He chuckles.

“I need actual health care,” James said. Eventually, he tells me, he’ll get death care instead.

CAMAP, which sells itself as the experts on MAiD in Canada, received $3.3 million from the Canadian government to develop a curriculum for MAiD clinicians. 

Thank you Alexander Raikin for your research and your continued advocacy for health care not death 'care'.

Canada teaches doctors to become killers

This article was published by National Review Online on September 14, 2023.

Wesley Smith

By Wesley J Smith

The Hippocratic oath explicitly prohibits doctor participation in euthanasia/assisted suicide. But doctors don’t take the great oath anymore, precisely because (in part) it conflicts with modern sensibilities that doctors can be ethical takers of human life.

And this is the result. The Canadian government is teaching doctors to become euthanasia killing specialists. From the Canadian-government press release:

Today, the Honourable Mark Holland, Minister of Health, and the Honourable Ya’ara Saks, Minister of Mental Health and Addictions and Associate Minister of Health, welcomed the release of the Canadian MAiD Curriculum developed by the Canadian Association of MAiD Assessors and Providers (CAMAP). This Curriculum is the first nationally accredited, bilingual MAiD education program available to licensed physicians and nurse practitioners across the country and will help achieve a safe and consistent approach to care.

Since being announced in July 2022, this multi-year project has developed a series of training modules to advise and support clinicians in assessing persons who request MAiD, including those with mental illness, complex chronic conditions, or who are impacted by structural vulnerability, as well as help with the practical application of the MAiD legislative framework. It will be delivered through a combination of online and in-person learning sessions for interested health practitioners, regardless of their level of experience.

And here’s a point to be emphasized — it’s also about killing physically healthy people with mental illnesses:

This is another step in the work by all levels of government to prepare Canada’s health care system for the expiry of the exclusion of MAiD eligibility for people suffering solely from a mental illness on March 17, 2024. The Government of Canada will continue working with provinces and territories (PTs), and health partners to support MAiD practice in Canada, including careful assessment of requests, so that it operates in a consistent and safe manner across the country, recognizing PT differences for health care delivery.

By definition, the concept of “safe” killing is oxymoronic. Euthanasia isn’t medical care. It is homicide.

Somewhere Hippocrates is weeping, but Jack Kevorkian can’t stop smiling. Shame on Canada.

Euthanasia - Popular Culture’s Misrepresentation of Disabled People and the Holocaust

Meghan is an autistic person who is an instructor at E4 Texas - University of Texas (Austin) and an EPC-USA board member.

By Meghan Schrader

Usually, I strongly oppose making comparisons between the United States “aid in dying” movement and the Nazi T4 program. It makes opponents of assisted suicide look paranoid and illogical. Rather than considering the parallels between some of their thinking and the thinking that drove the T4 program, they cite Goodwin’s Law. And, the comparison implies that all of the supporters are evil and want to commit crimes against humanity, which isn’t true. In 2011 I had a pastor who strongly supported assisted suicide because of her work with the terminally ill, and she was not a Nazi. The US movement hasn’t gone as far as Canada’s, and a comparison between it and the Nazi T4 Euthanasia program would strike most people as silly. Most regular people who support it are uninformed and naïve, not evil. And, if the people who truly believed in carefully restricting assisted suicide to terminally ill people and monitoring for abuse remained in charge of society, then we could be sure that US policies would not lead to the human rights abuses we see in Canada.

However, not all US proponents think that way, they would like the United States to be like Canada, and Canada’s program strikes me as being T4 - 2.0. The Canadian government is meeting the needs of people with disabilities with tokenism, and telling them to kill themselves. They’re telling disabled people that it would be a good thing for them to end their lives and give their internal organs to other people. The Canadian media has published treatises celebrating the fact that MAiD will save the Canadian medical system millions of dollars a year. People who support MAiD in Canada point out that no one is literally being strapped to a table and lethally injected, but that’s not the standard that just societies should use to determine whether a policy is benevolent. The Canadian government does not deserve credit for not rounding up unwilling disabled people up and gassing them in a van. 

I think that one of the reasons for the ignorance is how the media portrays euthanasia and the Holocaust. The T4 program is not generally portrayed in movies about the Holocaust, and some movies about the Holocaust present euthanasia and suicide as something people reasonably did to get away from the Nazis. For instance, in Schindler’s List, there’s a scene where the Nazis are about to storm a Jewish hospital, so the hospital staff administers poison to all the patients. It’s strongly implied that the doctors did this to protect them from dying a terrible death at the hands of the Nazis, and that the patients were grateful to the doctors for doing it. In the context of what happened to the disabled in the T4 program, that’s a very problematic way to portray euthanasia in a film about the Holocaust. 

Similarly, I love the film Swing Kids, which portrays the use of American Swing jazz music to resist the Nazis. But, the character I most identity with, a musician who stands up at a music venue and proclaims that he will not play German music anymore because it’s been co-opted by the Nazis, dies by suicide right after that speech. Within the individual narrative itself, it’s strongly implied that he did this to avoid being arrested by the Nazis for his outburst. But, in the context of the T4 program, that scene is deeply problematic. It is again portraying the death of a disabled person as an escape, which is what drove some of the support for euthanasia in Nazi Germany. Moreover, there’s a scene right after the musician’s speech where a Nazi-supporting friend calls him out for his outburst about Germans killing Jews and gypsies. The friend says, “What was that all about, the Jews and the Gypsies? What about the cripples and the retards, you know that’s who you belong with. If I were you, I wouldn’t worry about anybody but myself, because we’re coming after you next.” This is not historically accurate. The medical Holocaust of 300,000 people with disabilities started before the Nazis started to systematically kill people from other identity groups, and the Nazis took a lot of their ideas from the eugenics ideology that was prevalent in the United States in the 1930s.

Hence, I do think that the inaccurate representation of the killing of disabled people during the Holocaust in popular media is undermining people’s ability to recognize parallels between some of the things that the mainstream bioethics movement says about the right to die and violence against disabled people in world history. If people understood this history, they might not think that expansive euthanasia programs, and their precursor, physician assisted suicide, are such a good idea. 

2023 National Conference: Assisted Suicide is Not The Answer. Killing is Not Caring

Our 2023 National Conference Assisted Suicide is Not The Answer. Killing is Not Caring is quickly approaching.

Date:      Saturday October 21, 2023

Time:      9:30 am to 3 pm.

Location: Courtyard by Marriott - 11 Monroe Ave NW Grand Rapids MI.

Registration fee is $30 (in-person and includes lunch). It is free to attend online.

Link to register in-person: Event Bright Link.

Zoom link to register online: Zoom Link.

Speakers include: 

• Wesley Smith, legal consultant - Patients Rights Council
• Genevieve Marnon, Senior Policy Expert - Advocates for Better Care
• Betty Odello, retired nursing professor, President of the Scholl Institute
• Edward Rivet, Policy and Historical Expert on Assisted Suicide in MI 
• Dr Josephine Glaser, doctor in family medicine and EPC-USA board member
• Peter Wolfgang, Executive Director, Family Institute of Connecticut
• Meghan Schrader, Disability rights activist and EPC-USA board member
  
• Alex Schadenberg, Executive Director, Euthanasia Prevention Coalition

Sponsored by the Euthanasia Prevention Coalition, Advocates for Better Care, and the Scholl Institute.

Assisted Suicide is Not The Answer. Killing is Not Caring will train you how to successfully oppose the legalization of assisted suicide in your state. 

Michigan will  likely face a significant legislative push to legalize assisted suicide in 2024.

Please join us.