Ronald W. Pies, MD testimony opposing Massachusetts assisted suicide bill.

This testimoney was sent to the Euthanasia Prevention Coalition with permission to publish.

Dr Ronald Pies

Written Testimony of Ronald W. Pies, MD

Massachusetts psychiatric physician and medical ethicist

In opposition to H. 2505/S.1486 MASSACHUSETTS END OF LIFE OPTIONS ACT

Submitted to Massachusetts Joint Committee on Public Health - March 29, 2025

Dear Committee Members:

As a Massachusetts psychiatrist and medical ethicist, I write in firm opposition to H.2505/S.1486 MASSACHUSETTS END OF LIFE OPTIONS ACT—bills that would effectively legalize physician-assisted suicide (PAS) in Massachusetts. 

First, it is important to note the profound ethical problems inherent in the practice of PAS, misleadingly called “aid in dying” in some contexts. (PAS does not “aid” the natural dying process; rather, it terminates dying by terminating the patient, via provision of lethal drugs). The American Medical Association; the American Psychiatric Association; the American College of Physicians; and the National Council on Disability have all rejected physician-assisted suicide. [1] Neither the Massachusetts constitution nor the U.S. Constitution contains a right to assisted suicide; therefore, no individual has the right to authorize another to kill him or her in violation of federal and state criminal laws. (Washington v. Glucksberg, 521 U.S. 702, 735 (1997). Instead, Massachusetts has an unqualified interest in the preservation of human life. Furthermore, in the Massachusetts case of Kligler v. Att’y Gen., 491 Mass. 38, 70 (2022), the court rejected claims that a person has a “right” to assisted suicide. The court found no basis to “conclude that physician-assisted suicide ranks among those fundamental rights protected by the Massachusetts Declaration of Rights.”

Contrary to popular misconceptions, the vast majority of persons requesting PAS are not in the grip of severe, intractable pain and suffering [2]. As data from Oregon have shown, the most common reasons for requesting medical aid in dying were fears regarding loss of autonomy (97.2%), inability to engage in enjoyable activities (88.9%), and loss of dignity (75.0%) [3] These understandable fears are best dealt with via empathic, face-to-face counseling and psychotherapy—not with the ingestion of poison.

Furthermore, a peaceful death is by no means guaranteed using current methods of PAS, as a recent piece by Lo pointed out: 

“Physicians who support PAD need to consider how to address the potential for adverse outcomes, including longer time to death than expected (up to 24 hours or more), awakening from unconsciousness, nausea, vomiting, and gasping.” [4] 

Data collected between 1998 and 2015 showed that the time between ingestion of lethal drugs and death ranged from 1 minute to more than 4 days. During this same period (1998-2015), 27 cases (out of 994) involved difficulty ingesting or regurgitating the drugs, and there were 6 known instances in which patients regained consciousness after ingesting the drugs. However, it is difficult to know the actual rate of drug-induced complications, because in the majority (54%) of cases between 1998 and 2015, no health care professional was present to attend and observe the patient’s death [5].

This last point highlights an additional ethical flaw in so-called “end of life options” bills, including H. 2505/S.1486: they do not require the presence of a physician or other medical personnel at the time the patient ingests the lethal drugs. In addition to denying the patient medical oversight of the suicide, this amounts to abandonment on the part of the physician who authorized the assisted suicide. To compound the ethical lapse, the physician is then permitted to falsify the cause of the patient’s death; i.e., “The attending physician may sign the patient's death certificate which shall list the underlying terminal disease as the cause of death” (lines 195-196 H. 2505/S.1486 ). This is plainly fraudulent, unethical, and inimical to research aimed at tracking the natural course of terminal illnesses.

A major failing of this bill is its ambiguity regarding the concept of “terminal illness.” The bill defines “Terminally ill”, as “having a terminal illness or condition which can reasonably be expected to cause death within 6 months, whether or not treatment is provided.” [italics added]. The phrase “whether or not treatment is provided” is vague and indecipherable. Does this mean that if a patient with, say, type 1 diabetes or anorexia nervosa refuses evidence-based treatment—and thus, is likely to die within 6 months—the patient nevertheless meets the criterion for “terminal illness”? Would a patient with a potentially fatal but treatable infectious disease who refuses treatment be classified as “terminally ill?” Such an interpretation radically distorts the historical meaning of the term “terminally ill.” Moreover, in practice, there are significant limitations in a physician’s ability to predict patient outcomes; this is true even for end-of-life physician specialists. For example, in a study of 364 doctors who provided survival estimates for 468 terminally ill patients, only 20% of predictions were accurate.[6]

Psychiatric and Medico-legal Considerations

As a psychiatrist, I find the bill’s safeguards against missing underlying psychiatric illness—which may compromise informed consent—woefully inadequate. Yes, the bill does mandate (section 8) that:

“…An attending physician shall refer a patient who has requested medical aid in dying medication under this chapter to counseling to determine that the patient is not suffering from a psychiatric or psychological disorder or depression causing impaired judgment. The licensed mental health care professional shall review the medical history of the patient relevant to the patient’s current mental health and then shall submit a final written report to the attending physician.”

However, the bill defines licensed mental health professional very broadly, as “…a treatment provider who is a psychiatrist, psychologist, psychiatric social worker or psychiatric nurse and others who by virtue of education, credentials and experience are permitted by law to evaluate and care for the mental health needs of patients.” In what is literally a life-or-death determination, it is far from clear that the average “mental health professional” possesses the requisite skill set to assess mental capacity in the setting of terminal illness—an assessment that would challenge the skills of even a forensic psychiatrist.

Furthermore, there is no requirement in the bill for psychological evaluation at or very near the actual time of lethal drug ingestion, despite the fact that the patient’s mental status and mental capacity may fluctuate from day to day or week to week, in the course of a terminal illness. In addition, it seems that the bill would permit evaluation and “counseling” of the patient without even a face-to-face meeting; i.e., the process could be conducted via “telemedicine”—to my knowledge, a completely untested method of determining mental capacity or providing counseling in the context of a terminal illness.

Finally, there are no well-defined procedures specified in the bill by which any unused lethal drugs would be located and disposed of, in the event the patient elects not to ingest them. The bill merely states, “Any medical aid in dying medication dispensed under this chapter that was not self-administered shall be disposed of by lawful means. The medication dispenser shall be responsible for informing the individual collecting the medication what disposal by lawful means entails.” This says nothing about when the unused medication shall be disposed of—a day after the patient decides not to ingest it? A week? A month? What about the risk that in the interim, a family member—perhaps a young child—will happen upon the lethal medication and ingest it? A recent report in the Journal of Emergency Medical Services reveals that this possibility is not merely theoretical. [7] Do Massachusetts physicians really want to assume medico-legal liability in such a scenario? The bills as written are an invitation to litigation.

Conclusion

End-of-life care deserves far better than effectively handing terminally ill patients a bottle of lethal drugs—a practice that flies in the face of more than two millennia of Hippocratic medical practice. As Dr. John R. Peteet and I have argued, physician-assisted suicide will lead to “distorting the physician’s role; cheapening individual life; and abandoning the most vulnerable people” at their time of most urgent need. Surely as a society we can do better, by providing optimal, accessible psychiatric and palliative care. [8] As physician and medical ethicist Dr. Leon Kass eloquently put it,

“The legalization of physician-assisted suicide [perverts] the medical profession by transforming the healer of human beings into a technical dispenser of death. For over two millennia the medical ethic . . . has held as an inviolable rule, “Doctors must not kill.” The venerable Hippocratic Oath clearly rules out physician-assisted suicide. Without this taboo, medicine ceases to be a trustworthy and ethical profession. . . . We need to care for the dying, not make them dead.” [9]

Respectfully,

Ronald W. Pies, MD ronwpies@gmail.com
Professor Emeritus of Psychiatry
Lecturer on Bioethics & Humanities
SUNY Upstate Medical University;
Clinical Professor Emeritus of Psychiatry
Tufts University School of Medicine

References

1. Snyder Sulmasy L, Mueller PS; Ethics, Professionalism and Human Rights Committee of the American College of Physicians. Ethics and the Legalization of Physician-Assisted Suicide: An American College of Physicians Position Paper. Ann Intern Med. 2017 Oct 17;167(8):576-578. doi: 10.7326/M17-0938. Epub 2017 Sep 19. PMID: 28975242.

2. https://www.hcplive.com/view/twelve-myths-concerning-medical-aid-in-dying-or-physicianassisted-suicide

3. Loggers ET, Starks H, Shannon-Dudley M, Back AL, Appelbaum FR, Stewart FM. Implementing a Death with Dignity program at a comprehensive cancer center. N Engl J Med. 2013;368(15):1417-1424. doi: 10.1056/NEJMsa1213398

4. Lo B. Beyond legalization - dilemmas physicians confront regarding aid in dying. N Engl J Med. 2018;378(22):2060-2062. doi: 10.1056/NEJMp1802218.

5. Oregon Health Authority, Public Health Division, Center for Health Statistics. Oregon Death With Dignity Act: data summary 2016. oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year19.pdf. Published February 10, 2107. Accessed June 6, 2018.

6. Nicholas A. Christakis, Extent and Determinants of Error in Doctors’ Prognoses in Terminally Ill Patients: Prospective Cohort Study, 7233 THE BMJ 469, 469-73 (2000).]

7. Death with Dignity: When the Medical Aid in Dying Cocktail Gets into the Wrong Hands. https://www.jems.com/patient-care/death-with-dignity-when-the-medical-aid-in-dying-cocktail-gets-into-the-wrong-hands

8. https://www.telegram.com/story/opinion/columns/2023/01/29/dr-john-peteet-and-dr-ronald-pies-oppose-physician-assisted-death/69831539007/

9. Kass LR. Dehumanization Triumphant. 1996. See: https://www.psychiatrictimes.com/view/deferring-mastery-death-hippocrates-judge-gorsuch-and-autonomy-fallacy

Anita Cameron: Don’t Be Fooled, Assisted Suicide IS Suicide

The following article was published by Not Dead Yet on September 25, 2023.

By Anita Cameron

Suicide is devastating. Take it from someone who has lost dear friends to it. It’s an especially difficult death for families to deal with. Loved ones often feel guilt, wondering was there anything they could have done to prevent it. I, too, felt that horror and guilt after learning that a close friend had died by suicide hours after visiting me. 

September is National Suicide Prevention Month. The Centers for Disease Control and Prevention reports that suicide is a serious public health issue whose rates have increased approximately 36% between 2000–2021. It reports that suicide was responsible for 48,183 deaths in 2021.

Many resources exist to inform the public about suicide – what it is, it’s impact on the country and on certain communities, the signs to watch for and how to prevent it – but no resource addresses the state sanctioned suicide masquerading as health care, that proponents call medical aid in dying, but opponents call by its true name: assisted suicide. 

Assisted suicide is a practice legal in 10 states and the District of Columbia, where a doctor, or in some states, a physician assistant, writes a prescription for a lethal drug that terminally ill patients – those with six months or less, to live – fill and subsequently take. No doctor or witness is required to be present, so no one would know if the medication was purposely taken or if the person was coerced or convinced to do so. 

Proponents say that this is not suicide, but the Oxford Dictionary of English lists the definition of suicide as “the action of killing oneself intentionally.” Proponents refuse to call assisted suicide what it actually is, probably due to the stigma associated with suicide. One can call it all kinds of fancy terms that hide the truth, but don’t be fooled – assisted suicide IS suicide.

Though assisted suicide is supposedly only for those who are terminally ill, it’s hard to predict that, so doctors often make mistakes. There are countless stories of people living years or even decades beyond their doctors’ predictions. 

Assisted suicide creates a two-tiered system where younger, healthier folks expressing thoughts of harming themselves are more likely to get mental health treatment whether they want it or not, while disabled people, who often lack access to such care, are more likely to have suicidal feelings rationalized, so are less likely to receive mental health treatment. 

This is especially important when someone is diagnosed with a terminal illness. It’s normal to become depressed after such a diagnosis. Mental health counseling, along with other services and supports should be offered from the beginning and tailored to meet the person’s changing needs. 

Proponents rename assisted suicide as “aid in dying” so it sounds like end of life care. However, it is not. End of life care is all of the services and supports, including pain management, that a person needs to be as comfortable as possible while the dying process takes place naturally. Assisted suicide is just that – suicide. Death. No care. 

It’s said that access to housing, healthcare, clean water and food security is suicide prevention. Getting rid of assisted suicide as public policy is also suicide prevention.

Good Old News: In Early 2023, Suicidology Group Withdrew Statement on Assisted Suicide

This article was published by Not Dead Yet on July 10, 2023.

In October 2017, the American Association of Suicidology (AAS) issued a Statement announcing that physician assisted suicide is not “suicide”. The Executive Summary states:

“The American Association of Suicidology recognizes that the practice of physician aid in dying, also called physician assisted suicide, Death with Dignity, and medical aid in dying, is distinct from the behavior that has been traditionally and ordinarily described as ‘suicide,’ the tragic event our organization works so hard to prevent. Although there may be overlap between the two categories, legal physician assisted deaths should not be considered cases of suicide and are therefore a matter outside the central focus of AAS.”

At their annual conference held seven months later, disability activists protested the Statement and distributed a leaflet to conference attendees, many of whom were previously unaware of the Statement.

In early 2023, according to an online AAS posting, the Statement was “retired.” Disability activist Meghan Schrader discussed the original Statement and its retirement in her recent article published in the Euthanasia Prevention Coalition blog, which criticizes Thaddeus Pope and others who favor expanding eligibility for assisted suicide to include disabled people without a “terminal” prognosis. The following is the relevant excerpt from her article:

The disabled community is reaping the consequences of a society that is so apathetic toward disabled people’s basic needs that it can’t even be bothered to provide us with suicide prevention. We are dirt.

…All self-respecting suicide prevention advocates and organizations really need to do some honest and humble reflection on their silence regarding assisted suicide. Not saying anything while people like [Thaddeus] Pope shamelessly sell suicide to the disabled community communicates that suicide prevention is for ablebodied, neurotypical people. The Canadian Association for Suicide Prevention strongly opposed extending assisted suicide to the disabled community in 2021, but their opposition came too late to prevent the law change.

Indeed, the American Association of Suicidology’s 2017 statement about “medical aid in dying” being different from suicide had tragic consequences for the disabled community. Regrettably the board had somehow fallen under the influence of assisted suicide advocate, academic Margaret Battin, and its statement about PAS has repeatedly been used to justify PAS in all sorts of different contexts. The 2019 Truchon court decision in Québec which extended euthanasia to people with disabilities, cited the AAS’s statement to support its judgment that “MAiD” for disabled people was not suicide.

The AAS had made that statement in the context of physician assisted suicide for people with terminal illnesses, but in the end, the organization’s intentions did not matter. Its statement that some suicides weren’t suicides was used to cause multiple disabled Canadian’s suicides.

To its credit, the AAS became apprised of the genie it had let out of the bottle, and it retracted its statement about PAS not being suicide in 2023. Now the assisted suicide movement has no scientific basis for its assertions that PAS is not suicide. (Link to article)

Montana Bill (SB 210) prohibits assisted suicide.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Over the past few years Montanans have had a confusing situation concerning assisted suicide. 

In 2009, the Baxter court decision declared that Montanans had a right to assisted suicide. The Baxter decision was appealed to the Montana Supreme Court where it was decided that Montanans do not have a right to assisted suicide but the Court found a defense of consent. Therefore, if a Montana physician assists a suicide the physician must prove that there was consent.

Physician-Assisted Suicide is not legal in Montana.

State Senator Carl Glimm

Since the Montana Supreme Court decision, the assisted suicide lobby has claimed that assisted suicide is legal in Montana. Even though assisted suicide is technically prohibited, Montanans have been dying by assisted suicide.

In 2023, Montana State Senator, Carl Glimm has introduced Bill SB 210 to reverse the effect of the Montana Supreme Court decision by clarifying that consent is not a defense for homicide or assisted suicide.

Bill (SB 210) to reverse Baxter and prohibit assisted suicide will be heard by the Senate Judiciary Committee on Feb 1. Written testimony supporting SB 210 must be submitted by February 1 at: (Link).

SB 210 states:

3 (a) For the purposes of subsection (2)(d), physician aid in dying is against public policy, and a patient's consent to physician aid in dying is not a defense to a charge of homicide against the aiding physician.

3 (b) (1) For the purposes of this subsection (3), "physician aid in dying" means an act by a physician of purposefully prescribing a lethal dose of medication to a patient that the patient may self-administer to end the patient's life.

3 (b) (ii) The term does not include an act of withholding or withdrawing a life-sustaining treatment or procedure authorized pursuant to Title 50, chapter 9 or 10."

SB 210 effectively closes the loophole and prevents assisted suicide in Montana.

Written testimony supporting SB 210 must be submitted by February 1 at: (Link).

Lethal assisted suicide drugs were accidentally ingested in Colorado.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

I was cleaning up my emails and found a report that was published in the Journal of Emergency Medical Services on November 29, 2022 titled: Death with Dignty: When the Medical Aid in Dying cocktail gets into the Wrong Hands. 

The report concerns an emergency whereby a 35-year-old man in Colorado self-administered part of a lethal cocktail of assisted suicide drugs. The report states:

Ambulance 64 is dispatched to a 35-year-old male with possible alcohol overdose. Upon arrival, the crew is directed to a back bedroom where they find two fully clothed males with their legs hanging off a bed. One is elderly, the other is middle aged. Both are unconscious and unresponsive with shallow respirations. A bystander hands a medicine bottle to the attending paramedic frantically saying, “They drank this! They drank this!” The bottle contains digoxin 100 mg, diazepam 1,000 mg, morphine 15,000 mg, amitriptyline 8,000 mg and phenobarbital 5,000 mg. She remarks that the older man “should be dead” and the younger one “should be alive.”

The bystander states that the older man is a “death with dignity” patient who invited loved ones to be present while he consumed the MAID medication. After his first swallow, he remarked, “Man that burns!” The younger man said, “Let me see,” and then also took a swallow. The attending paramedic directs rescuers to begin ventilating the younger man while requesting evidence of advance directives for the older man. Care was not rendered to the death with dignity patient because he had a valid Medical Orders for Scope of Treatment (MOST) form stating he wanted no lifesaving measures performed on him. The medication bottle was prescribed to the patient. Hospice was contacted to verify he was a terminally ill patient of theirs. Medical control was also contacted for a consult because this was not a typical call.

The younger male patient is found to be atraumatic. His skin signs were significant for cyanosis but otherwise warm and dry. Pupils were constricted, equal and reactive. Without ventilations, his respiratory effort is 6; Sp02 was 72%. The patient is placed on a cardiac monitor and the heart rate is recorded at 144 bpm, blood pressure is auscultated and found to be 134/96 mmHg. Blood glucose is 172 mg/dl. Intravenous access is achieved with a 16-gauge catheter placed in his right external jugular vein. After there is no change in the patient’s presentation following Narcan 2 mg via IV, he is endotracheal intubated. End tidal carbon dioxide is then measured at 56 mmHg. The receiving facility is notified that a patient with a massive polypharmacy ingestion is en route.

...This challenging case is an excellent illustration of the importance of prehospital providers to have an understanding of end-of-life-care as it pertains to advanced directives and to be aware they may practice in an area where they encounter patients who may be in a MAID program. In this case, the paramedic had to juggle a complicated scene with two potential patients who both were near death. Education regarding such programs should be a priority to EMS agencies, as is how to handle instances where family members are requesting that no resuscitation be attempted and either advance directives are not in place, or copies of them cannot be located.

The report continues with information about the recovery of the man who self-administered the lethal cocktail without legal permission and it then concludes:

Should accidental ingestion occur, care is mainly supportive. The patient should be placed on a cardiac monitor and have a 12-lead rhythm strip to evaluate for QRS prolongation and consideration of sodium bicarbonate administration. Continuous pulse oximetry monitoring and assisting ventilation as necessary is indicated. If necessary, placement of advanced airway with assisted ventilations with BVM and confirmation by end-tidal CO2 is appropriate. Intravenous or intraosseous access should be obtained and intravenous fluids can be administered if the patient is hypotensive. Naloxone can be trialed, although may not have much effect given the high dose of opiates in the compound. Consideration may be made for transport to an ECMO capable facility.

The US states that have legalized assisted suicide have done so in a completely irresponsible manner. Prescribing a lethal cocktail of drugs for suicide is always ethically wrong, but to do so without monitoring is irresponsible.

Is it possible that a grand child could find the lethal assisted suicide cocktail by the bed side or in the medicine cabinet? What happens to the lethal drugs that are not consumed?

The concept of freedom to choose to die is a lie. People don't ask for a lethal drug cocktail to express their freedom but rather it is a reaction to a social abandonment that has left them feeling that there is no hope, purpose or value to continuing life.

Euphemisms mask the true nature of assisted suicide and euthanasia

This article was written by Noreen O'Carroll and published by Mercatornet on January 19, 2022. This article was originally published in the Summer issue of the Irish journal Studies.

By Noreen O'Carroll

Disguising the true meaning of words is a powerful weapon in the "right to die" armoury

The lower house of the Irish Parliament, the Dáil Éireann is currently considering the “Dying with Dignity Bill 2020”. The most striking feature of this bill is that it does not mention the words “assisted suicide” or “euthanasia” in any of its qualifying criteria or provisions but instead uses expressions and phrases such “assistance in dying”; “the prescription of substances which can be orally ingested”; “prescribing and providing the means of self-administration”; and “the substance or substances may be administered”.

Language matters. It can persuade us to buy products when they are labelled and packaged attractively. It can also shape people’s attitudes and approaches to controversial issues and questions. Assisted suicide and euthanasia are labelled and packaged attractively in the Dying with Dignity Bill through the use of euphemistic terms that obscure important ethical and empirical distinctions. But they are very influential in swaying public opinion in favour of assisted suicide and euthanasia.

Euphemisms designate something unpleasant by a milder term. In the bill euphemisms operate by dissociating language from the experience of reality and putting something illusory in its place instead.

What’s in a name?

This can be seen in the title and provisions of the bill. The title is quite misleading. By using the euphemism “dying with dignity” it dissociates the choice to take one’s life intentionally, or have one’s life ended deliberately by a healthcare professional, from the experience of “suicide” or “euthanasia”, which is what the bill’s provisions are about.

This is a cause of considerable distress to all who have lost a loved one who died naturally with dignity, because it implies that a death with dignity is only achieved by assisted suicide or euthanasia.

It has been suggested that the rationale for using euphemistic language in the bill is to better reflect the wishes of patients with terminal illness whose desire is for a death with dignity. However, legislation doesn’t apply to patients only; it also affects others – doctors, nurses, families, communities and society as a whole.

A more linguistically appropriate title for the bill is, arguably, the “Assisted Suicide and Euthanasia Bill”.

The provision for assisted suicide in Section 11 of the bill is expressed in language stating that a medical practitioner may prescribe or provide a substance or substances which can be orally ingested or self-administered by a person; or prepare a device which will enable that person to self-administer the medicine, “with the purpose of enabling that person to end his or her own life”.

The euphemisms “orally ingesting” and “self-administration” dissociate the idea from the reality of the experience of committing suicide by ingesting or self-administering lethal medication prescribed or provided by a doctor or nurse; the definition of terms in Part 1 of the bill states that an “assisting healthcare professional means a registered medical practitioner or a registered nurse who has been authorised by the attending medical practitioner to deliver any substance or substances prescribed”. In this situation, the patient is the direct causal agent ending his or her own life.

Absent words

The absence of the words “suicide” and “assisted suicide” is striking. The provision for euthanasia in Section 11 of the bill is also expressed euphemistically, stating that in the case that it is not possible for a person to self-administer, “then the substance or substances may be administered” – and this too is qualified by the phrase “with the intention of enabling the person to end his or her own life”.

This is less than honest. Obviously, if the patient is unable to self-administer and the substances may be administered, then clearly someone else is involved. Who? The identity of the healthcare professional who euthanises the patient is disclosed in Section 11 (6) as either “the attending medical practitioner or the assisting healthcare professional”, who can be either a doctor or a nurse. The doctor or nurse is legally obliged to remain with the person “until the person has self-administered the substance or substances or have it or them administered”. This situation is one where the doctor or nurse is the direct causal agent who ends the patient’s life.

Couched in euphemistic language, this is euthanasia and specifically voluntary euthanasia when it is done at the request of the patient. The idea conveyed in the words “the attending medical practitioner or assisting healthcare professional must remain with the person until the person has self-administered the substance or substances or have it or them administered” (my emphasis) is dissociated from the experience it is intended to convey – of one’s life being ended deliberately through the administration of a lethal substance by a doctor or a nurse. The absence of the words “euthanasia” and “voluntary euthanasia” is striking.

Conscientious objection

The provision for conscientious objection in Section 13 of the bill obliges medical practitioners who do not want to participate in ending the life of a patient to make arrangements “for the transfer of care” of the patient to another medical practitioner.

“The transfer of care” is a euphemism for compelling a doctor who does not want to co-operate in ending a patient’s life intentionally to send the patient to another doctor who will do so. This is a travesty of genuine conscientious objection, because it compels doctors to be complicit in acts they believe to be morally wrong and unjustifiable.

When is suicide not suicide?

When he introduced the bill in the Dáil, Mr Kenny argued that “assisted dying” should not be conflated with suicide and that a terminally ill, mentally competent patient who wants to end their life is not suicidal. He said: “I take exception to conflating this with suicide. People with a terminal illness are not suicidal”.

At the second stage, when the government proposed referring the Dying with Dignity Bill 2020 to a special Oireachtas committee to consider the legislation and report back within a year, he referred to “assisted suicide” but that it was irresponsible to conflate assisted dying with suicide, which had very different connotations.

However, it is a distortion of language to suggest that someone who takes their own life with assistance from a doctor is not suicidal.

The word “suicide” means to kill oneself, derived from Latin, sui (of oneself), and caedo (to kill). The words infanticide, homicide, parricide and gendercide derive from the same root. To suggest that someone is not committing suicide when they take their own life with assistance from a doctor flies in the face of the word’s meaning.

Ireland has a national suicide prevention strategy, Connecting for Life, published jointly by the Department of Health, the HSE, the National Suicide Prevention Office and Health Ireland. This defines the word “suicide” and its cognates in fidelity to its root meaning of “to kill oneself”: “Suicide is death resulting from an intentional, self-inflicted act”. The foreword to the strategy states: “Suicide prevention is everybody’s concern. This national strategy sets out what we must do as a government and society to protect and save lives. Since suicide is a ‘whole-of-society’ issue, we’re taking a ‘whole-of-government’ approach….”

One wonders whether the 81 TDs who voted to progress the Dying with Dignity Bill 2020 have ever heard of, or read, Ireland’s national suicide prevention strategy.

Remarkably, in his Dáil speech Mr Kenny did not make any reference to the bill’s provision for voluntary euthanasia. Yet there is a world of difference between a person committing suicide with assistance from a doctor or nurse, and that person having his or her life ended by a doctor or nurse following a request to do so. The World Medical Association defines the former as “assisted suicide” and the latter as “voluntary euthanasia”.

The use of euphemistic language in the Dying with Dignity Bill 2020 is in line with what is happening in other jurisdictions.

In the United States, where assisted suicide has been legalised in some individual states, the legislation is given titles such as Death with Dignity Act (Oregon, Washington State, Washington DC, and Maine); Patient Choice and Control at the End of Life (Vermont); End of Life Option Act (California), Our Care Our Choice Act (Hawaii); Aid in Dying for the Terminally Ill Act (New Jersey). In Canada the criminal code was amended to include “Medical Assistance in Dying (MAID)”, legalising assisted suicide and euthanasia. In Australia the states of Victoria, Western Australia and Tasmania have all passed Voluntary Assisted Dying laws making assisted suicide and euthanasia available.

Dr Noreen O’Carroll is a lecturer in medical ethics at RCSI University of Medicine and Health Sciences.

New York Bill S6140 would prohibit funding assisted suicide

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition.

While New York has companion Bills A4321 and S6471 to legalize assisted suicide and New York has Bill A198, to study assisted suicide, New York also has Bill S6140 to prohibit funding assisted suicide.

Bill S6140 is sponsored by New York State Senator Phil Boyle. The bill is known as:

AN ACT to amend the insurance law, in relation to prohibiting insurance coverage for physician assisted suicide.

To keep it simple, S6140 prohibits state funding for assisted suicide, prohibits any policy of group or blanket accident and health insurance coverage, and prohibits any funding for medical expense indemnity corporation, hospital service corporation or health service corporation for assisted suicide.

Senator Boyle defines physician-assisted suicide and aid-in-dying prescription drugs as:

For purposes of this subsection "physician-assisted suicide" shall mean voluntary termination of one's own life by administration of a lethal substance with the direct or indirect assistance of a physician and "aid-in-dying prescription drug" shall mean a drug determined and prescribed by a physician which an individual may choose to self-administer to bring about his or her death.

The Euthanasia Prevention Coalition urges the New York State Legislature to reject assisted suicide, nonetheless, Bill S6140 does not imply that assisted suicide will become legal but rather that it should not be funded by the state government or by any form of insurance.

Separating myth and reality in aid in dying

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

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

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

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

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

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

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

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

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

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

Rhetoric: The law has safeguards that will prevent abuses.  

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

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

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

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

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

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

Council of Canadians with Disabilities Denounces Trudeau Government's Re-Introduction of Un-amended Bill C-7 on Medical Aid in Dying as “Head-in-the Sand Mentality” that Endangers the Lives of Canadians with Disabilities

Media Release

Winnipeg – October 5, 2020 – The Council of Canadians with Disabilities (CCD), a national disability rights organization, is vehemently denouncing the Trudeau government’s re-introduction of Bill C-7, a bill which extends access to Medical Aid in Dying to people who are experiencing intolerable suffering as a result of illness or disability, but whose death is not reasonably foreseeable. The bill was first introduced in early February, before the COVID-19 pandemic hit Canada.

“The COVID-19 pandemic has clearly revealed the ableism that is rampant in Canada’s healthcare system, as well as in Canadian society as a whole.” says Dr. Heidi Janz, Chair of the CCD’s Ending-of-Life Ethics Committee. She explains that “Ableism can be defined as the discrimination and social prejudice against people with disabilities based on the belief that typical abilities are superior. Like racism and sexism, ableism classifies entire groups of people as ‘less than,’ and perpetuates harmful stereotypes, misconceptions, and generalizations about people with disabilities.”

“Over the past five months, we’ve seen not only the introduction of critical care triage protocols which identify the pre-existence of a disability as an exclusion criterion for critical care, in the event that rationing of resources, such as ventilators, becomes necessary due to overwhelming demand; we’ve also seen elderly and disabled people who fall ill being left to die in nursing homes and never sent for medical care in hospitals,” Janz explains. “At the same time, we’re hearing provinces like Alberta and Ontario threaten to severely cut—or even outright end—the income support programs that people with disabilities rely on to survive. All of this means that people with disabilities are more marginalized during these pandemic times than they have been at any other time in Canada’s history.”

“With such evidence of systemic discrimination against people with disabilities mounting daily, the Trudeau government’s decision to move forward with this bill without adding safeguards to prevent marginalized Canadians from being driven to seek assistance to die because they cannot get assistance to live is evidence of a head-in-the-sand mentality that endangers the lives of Canadians with disabilities,” Janz says.

The Council of Canadians with Disabilities is urgently calling on the Trudeau government to withdraw Bill C-7 and replace it with a new bill that strikes a more careful balance between autonomy rights and equality rights for people with disabilities. Such a Bill would need to follow the judicial directive in the Carter ruling, which called for “a carefully-designed system” that “imposes stringent limits” that are “scrupulously monitored and enforced.”

"The government seems committed to spending time, energy and resources to helping us die sooner. What we truly need are resources to live with dignity in the community. This means having income above the poverty line, access to community resources like home care and attendant services and access to quality palliative care -- should the need arise," said Tracy Odell, President of Citizens With Disabilities - Ontario and 2nd Vice-Chair of CCD.

"Canada should show its resolve to be a 'kinder and gentler' nation. We do this through active support of our human rights recognized by the United Nation Convention on the Rights of People with Disabilities; not by expediting people's death -- especially when our so-called 'choice' for an early death arises from fear of loneliness, neglect and shortage of help to live with dignity at home."

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FOR FURTHER INFORMATION, CONTACT:

Dr. Heidi Janz
hjanz@ualberta.ca

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Communiqué de presse

LE CONSEIL DES CANADIENS AVEC DÉFICIENCES DÉNONCE LA REMISE EN VIGUEUR DU PROJET DE LOI C-7 NON MODIFIÉ SUR L’AIDE MÉDICALE À MOURIR: AVEC CETTE «POLITIQUE DE L’AUTRUCHE», LE GOUVERNEMENT TRUDEAU MET EN DANGER LA VIE DES CANADIENS EN SITUATION DE HANDICAP.

Winnipeg – 5 octobre 2020 – Le Conseil des Canadiens avec déficiences (CCD), organisation nationale de défense des droits des personnes handicapées, dénonce la remise en vigueur fédérale du projet de loi C-7, qui élargit l’accès de l’aide médicale à mourir aux personnes subissant d’intolérables souffrances suite à une maladie ou un handicap mais dont la mort n’est pas raisonnablement prévisible. Ce projet de loi est entré en vigueur au début février, avant que la pandémie de la COVID-19 ne frappe le Canada.

«La COVID-19 a nettement révélé le capacitisme endémique dans le système de soins de santé du Canada ainsi que dans la société canadienne en général, a déclaré la Dre Heidi Janz, présidente du Comité d’éthique en fin de vie du CCD. Le capacitisme, explique-t-elle, peut-être défini comme la discrimination et le préjudice social basés sur la supériorité soutenue des capacités typiques et exercés à l’égard des personnes handicapées. À l’instar du racisme et du sexisme, le capacitisme catégorise des groupes complets de personnes comme des «êtres inférieurs » et perpétue les dangereux stéréotypes, malentendus et généralisations appliqués aux personnes en situation de handicap.»

«Depuis les cinq derniers mois, nous avons vu apparaitre, en soins intensifs, des protocoles de triage stipulant que la préexistence d’une déficience serait considérée comme un critère d’exclusion au cas où une rationalisation des ressources, notamment les respirateurs, s’avèrerait nécessaire suite à une demande excessive. Nous avons également vu dans des centres de soins de longue durée, des personnes âgées et des personnes handicapées tomber malades, ne jamais être hospitalisées et être abandonnées jusqu’à la mort, a souligné Mme Janz. Et en même temps, nous apprenons que des provinces comme l’Alberta et l’Ontario menacent de couper – et voire même de supprimer carrément – des programmes de soutien du revenu dont dépendent les personnes handicapées pour survivre. Ce qui signifie que pendant cette pandémie, les personnes handicapées ont été plus marginalisées qu’à n’importe quelle époque de l’histoire du Canada.»

Devant cette preuve manifeste de la progression quotidienne de la discrimination systémique à l’égard des personnes en situation de handicap, la décision du gouvernement Trudeau de remettre la loi en vigueur sans ajouter des mesures de sauvegarde pour protéger les Canadiens marginalisés incapables d’obtenir le soutien requis, contre toute incitation vers l’aide à mourir, cette décision n’est qu’une politique de l’autruche, un aveuglement qui met en danger la vie des Canadiennes et des Canadiens en situation de handicap, a ajouté Mme Janz.»

Le Conseil des Canadiens avec déficiences prie instamment le gouvernement Trudeau d’abroger le projet de loi C-7 et de le remplacer par une loi instaurant un juste équilibre entre les droits à l’autonomie et les droits à l’égalité des personnes handicapées. Une telle loi se conformerait aux directives judiciaires stipulées dans le jugement Carter, à savoir «les risques doivent être réduits par un système soigneusement conçu imposant des limites strictes scrupuleusement surveillées et mises en application.»

«Le gouvernement semble vouloir consacrer son temps, son énergie et ses ressources à accélérer notre mort. Nous avons vraiment besoin de ressources pour vivre en toute dignité dans la communauté. Ce qui implique un revenu supérieur au seuil de la pauvreté, l’accès à des ressources communautaires comme les soins à domicile et les services d’auxiliaires et l’accès à des soins palliatifs de qualité, le cas échéant, a déclaré Tracy Odell, présidente de Citizens With Disabilities, Ontario et 2ème vice-présidente du CCD.»

«Le Canada doit afficher sa volonté d’être un pays « plus généreux et plus compatissant.» À cette fin, il devra activement appuyer nos droits reconnus par la Convention des Nations Unies relative aux droits des personnes handicapées, et non pas accélérer notre mort – surtout quand le soi-disant choix pour une mort prématurée est fondé sur la peur de la solitude, la négligence et le manque de soutien pour vivre dignement chez soi.»

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POUR PLUS D’INFORMATIONS, CONTACTER :

Dre Heidi Janz
hjanz@ualberta.ca