NY Association on Independent Living Opposes Assisted Suicide Bill A2383A

The following article was published by Not Dead Yet on April 23, 2018.

Testimony of Mel Tanzman on Behalf of NY Association on Independent Living Opposing Assisted Suicide Bill A2383A (April 20, 2018)

Testimony to the New York State Assembly Health Committee on the Death with Dignity Act

Hello and thank you for the opportunity to testify here today. The New York Association on Independent Living (NYAIL) is strongly opposed to A.2383A, known as the Medical Aid in Dying Act, which would legalize physician assisted suicide in New York State.

A major concern for people with disabilities is that assisted suicide reinforces negative perceptions about being disabled and the idea our lives are not worth living. Fears of becoming disabled and facing functional loss, whether the cause is injury or illness, are often reported by doctors as reasons patients request assisted suicide in states where it is legal. Oregon released data from 2017 which showed that the top three end-of-life concerns cited by Oregon patients requesting suicide pills had nothing to do with physical pain and suffering. These concerns were: decreasing ability to participate in enjoyable activities; loss of autonomy; and loss of dignity (1). The disability community strongly opposes the belief that requiring the assistance of another individual for activities of daily living, such as dressing, bathing and toileting, is undignified or a legitimate reason for New York State to legalize physician assisted suicide.

Most people become disabled toward the end of their life. The disability community understands that becoming disabled and losing the ability to do things like walk, dress or go to the bathroom independently is very difficult and causes depression. Yet, this law does not have adequate safe guards to ensure people are not seeking this option due to depression or other concerns which can be addressed. Though frequently insist that as a key safeguard, depressed people are ineligible, psychological supporters of the proposed legislation screenings are not required, leaving it to a physician to determine whether someone requires a psychological evaluation.

In Oregon, Michael Freeland was a 64 year old man with a 43-year medical history of acute depression and suicide attempts (2). Yet, the doctor he consulted with when seeking assisted suicide medication said he didn’t think that a psychiatric consultation was “necessary.” In fact, Oregon’s statistics for the years 2011 – 2014 show that each year, only 3% of patients (or fewer) were referred for psychological evaluation or counseling before receiving their prescriptions for lethal drugs. The proposed Medical Aid in Dying Act only mandates an attending physician refer the patient for a mental health screening if they lack the capacity to make the decision.

If you are still wondering why the disability community is so opposed to legalizing physician assisted suicide, consider the reports that came out of Oregon in January. Oregon state officials have confirmed that people with chronic conditions like Diabetes are eligible for physician assisted suicide if they stop treatment (3). According to Craig New, a Research Analyst for the Oregon Health Authority, who studies the Death with Dignity Act “The law is best seen as a permissive law, and states only that patients must have a terminal illness with six months or less to live. It does not compel patients to have exhausted all treatment options first, or to continue current treatment. It is up to the patient and doctor to discuss disease and treatment options. But if the patient decides they don’t want treatment, that is their choice.” New goes onto say that if a patient can’t afford treatment, then they can be considered terminal under the law as well. Diabetes and many other chronic diseases can be treated and allow people to live long lives. This interpretation creates a serious danger for people with disabilities and chronic conditions. Oregon’s law allows people with disabilities who could otherwise seek treatment to kill themselves with the help of a doctor. There are no safeguards in the proposed legislation to ensure this is not permitted in New York.

NYAIL is also concerned about the deadly mix between our profit-driven health care system and legalizing assisted suicide, which will be the cheapest so-called treatment. Direct coercion is not even necessary. If insurers deny, or even merely delay, expensive live-saving treatment, the person will be steered toward assisted suicide. Take Barbara Wagner and Randy Stroup: two Oregon residents who had cancer. Both Wagner and Stroup were prescribed treatments, but their health plans denied the prescribed treatment, offering physician assisted suicide as an alternative (4). What happened to these patients underscores the danger of legalizing assisted suicide in the context of our broken U.S. health care system.

Proponents of physician assisted suicide often argue that this option is necessary to prevent suffering at the end of life. This is not the case as there are alternative options to prevent suffering. It is already legal in New York for individuals to refuse life-sustaining treatment at any time, and to create an advance directive to cease treatment under any circumstance they choose if they are no longer able to make and communicate decisions. Palliative care is available and can provide pain relief to ensure a person is not in pain, even in those rare cases in which total palliative sedation is required. Unfortunately, medical schools do not mandate their students learn about end of life options and so may not be educating their patients on all their options. New York should invest in educating the community about these options and focus on promoting and expanding palliative care so that it is an available option to anyone facing a painful illness. What happened to these patients underscores the danger of legalizing assisted suicide in the context of our broken U.S. health care system.

People vastly prefer to live and die in their homes, as opposed to a hospital. Unfortunately, hospice is not always an available option for people facing terminal illness, and is severely underutilized in New York State, which is 48 among the states in using hospice services. There are barriers for people who live in assisted living facilities from getting hospice services. There are also barriers to people receiving home care once on hospice. The State should focus on addressing these barriers rather than on legalizing physician assisted suicide.

Finally, the disability community is deeply concerned about coercion and abuse. The proposed legislation is based on the laws in Washington and Oregon, which have proven to have ineffectual safeguards against abuse. One upsetting example from Oregon is Kate Chaney, an 85-year-old woman with dementia who died by assisted suicide (5). She first approached her physician, who would not prescribe her the lethal prescription. She then went to a second doctor, who ordered a psychiatric evaluation, which found that Cheney lacked “the very high level of capacity required to weigh options about assisted suicide.” Cheney’s request was denied, and it has been reported that her daughter “became angry.” A second evaluation was then done with another psychologist, who insisted on doing the evaluation with Chaney alone. Disturbingly, the psychologist deemed Cheney competent while still noting that her “choices may be influenced by her family’s wishes and her daughter, Erika, may be somewhat coercive.” Cheney soon took the drugs and died, but only after spending a week in a nursing home. This is a very disturbing example of doctor shopping and the lack of safe guards in place in Oregon.

A.2383/S.3151A does not prevent a coercive family member or caregiver from doctor shopping with the individual to find a physician who will provide the fatal drug, such as in the case of Kate Chaney. There is nothing in the proposed legislation that would prevent an abusive caregiver or family member from steering the individual toward physician assisted suicide, witnessing the request form, picking up the lethal dose, and even administering the drug. Because no independent witness is required at the death, there is no assurance of self- administration or even consent.

For all of the reasons above, we strongly urge the Assembly’s Health Committee not to pass this dangerous legislation.

Respectfully submitted,

Mel Tanzman
Executive Director of Westchester Disabled on the Move NYAIL Board Member and Health Committee Chair

1 Oregon Death With Dignity Act: 2015 Data Summary

2 Gregory Hamilton, M.D. and Catherine Hamilton, M.A., Competing Paradigms of Responding to Assisted-Suicide Requests in Oregon: Case Report, presented at the American Psychiatric Association Annual Meeting, New York, New York, May 6, 2004.

3 Bradford Richardson, Diabetics eligible for physician-assisted suicide in Oregon, state officials say, The Washington Times, January 11, 2018.

4 Kenneth R. Stevens, Jr., M.D., Oregon Rationing Cancer Treatment But Offering Assisted Suicide to Cancer Patients—Paying to Die But Not to Live, Physicians for Compassionate Care Educational Foundation, June 6, 2008, (accessed July 9, 2009).

5 DHS news release, “No authority to investigate Death with Dignity case, DHS says,” March 4, 2005.

Oregon Health Plan – Medicaid, Rationing of Care for Patients with Cancer Changes in Eligibility Criteria over the years from 1994 to 2018

This article explains how the Oregon Health Plan rations care for patients with cancer.

Dr Kenneth Stevens

By Kenneth R. Stevens, Jr., MD 

April 15, 2018

The Oregon Health Plan (Medicaid) uses a Prioritized List of Health Services (Link) established by the state Health Services Commission in determining what diagnoses, conditions and treatments will be covered. The Oregon Health Plan (OHP) was established in 1994.

It is currently under the Oregon Health Authority (OHA).

The OHP Guidelines for patients with serious illness have changed over the years.

During its early years (1994 to about 2008-2009), one of its guidelines was: 

“It is the intent of the Commission to not cover diagnostic or curative care for the primary illness or care focused on active treatment of the primary illness which are intended to prolong life or alter disease progression for patients with a 5% chance of a 5 year survival.”

This was the criteria used to deny Barbara Wagner of Springfield, Oregon from receiving chemotherapy for her recurrent lung cancer.

Barbara Wagner’s story: 

Barbara Wagner of Springfield, Oregon, a 64-year old great-grandmother was diagnosed with lung cancer in about 2006. Her cancer was initially treated with chemotherapy and radiation, and she went into remission. In early May 2008, a CT scan revealed her cancer was back and her cancer physician prescribed Tarceva (brand name erlotinib) a pill taken once a day for the purpose of slowing the cancer growth and extending her life. Studies show the drug provides a 30% increased median survival for patients with advanced lung cancer. One-year-survival rate for patients who took Tarceva increased by more than 45% compared to patients who took a placebo. She was on the Oregon Health Plan (Medicaid) and was notified in May 2008 that the OHP would not cover the beneficial chemotherapy treatment, “but that it would cover palliative, or comfort care, including, if she chose, doctor-assisted suicide.”

She said she was devastated when she found that the Oregon Health Plan wouldn’t cover the cancer medication prescribed by her oncologist. “I think it’s messed up,” Wagner told the reporter, bursting into tears. (“A Gift of Treatment – When the Oregon Health Plan fails to cover a cancer drug, the drugmaker steps in” by Tim Christie, June 3, 2008, The Register-Guard Newspaper, Eugene, Oregon.) 

She was particularly upset because the letter of denial said that doctor-assisted suicide would be covered! “To say to someone, we’ll pay for you to die, but not pay for you to live, it’s cruel,” she said. “I get angry. Who do they think they are?”

Barbara Wagner

Having been given no help or hope from the State of Oregon, her oncologist appealed to Genentech, the company that markets Tarceva in the United States, to cover Wagner’s medication. On Monday, June 2, she got the call from Genentech that they would cover the drug for a year, at which time she could re-apply. She was expecting delivery of the drug on June 3. “It’s fantastic”, she said, “I can’t wait to start the medication.” Ultimately, the drug company demonstrated more concern about Barbara’ continued survival than did the state of Oregon.

Mrs. Wagner died a few months later.

The Oregon Health Plan later changed the guidelines for patients like Barbara Wagner.

The guidelines for the January 1, 2010 OHP Prioritized List (revised 7-21-10) states:

Guideline Note 12. Treatment Of Cancer With Little Or No Benefit Near The End Of Life.

All patients receiving end of life care, either with the intent to prolong survival or with the intent to palliate symptoms, should have/be engaged with palliative care providers (for example, have a palliative care consult or be enrolled in a palliative care program).

Treatment with intent to prolong survival is not a covered service for patients with any of the following:

• Median survival of less than 6 months with or without treatment, as supported by the best available published evidence. 
• Median survival with treatment of 6-12 months when the treatment is expected to improve median survival by less than 50%, as supported by the best available published evidence.
• Median survival with treatment of more than 12 months when the treatment is expected to improve median survival by less than 30%, as supported by the best available published evidence.
• Eastern Co-operative Oncology Group (ECOG) performance score of 3 or higher 

The Health Services Commission is reluctant to place a strict $/QALY (quality adjusted life-year) or $/LYS (life-year saved) requirement on end-of-life treatments, as such measurements are only approximations and cannot take into account all of the merits of an individual case. However, cost must be taken into consideration when considering treatment options near the end of life. For example, in no instance can it justified to spend $100,000 in public resources to increase an individual’s expected survival by three months when hundreds of thousands of Oregonians are without any form of health insurance.

Treatment with the goal to palliate is addressed in Statement of Intent 1, Palliative Care.

The most recent guideline 3-22-2018 states:

Guideline Note 12, Treatment Of Cancer With Little Or No Benefit 

Cancer is a complex group of diseases with treatments that vary depending on the specific subtype of cancer and the patient’s unique medical and social situation. Goals of appropriate cancer therapy can vary from intent to cure, disease burden reduction, disease stabilization and control of symptoms. Cancer care must always take place in the context of the patient’s support systems, overall heath, and core values. Patients should have access to appropriate peer-reviewed clinical trials of cancer therapies. A comprehensive multidisciplinary approach to treatment should be offered including palliative care services (see Statement Of Intent 1, Palliative Care).

Treatment with intent to prolong survival is not a covered service for patients who have progressive metastatic cancer with:

A) Severe co-morbidities unrelated to the cancer that result in significant impairment in two or more major organ systems which would affect efficacy and/or toxicity of therapy; OR
B) A continued decline in spite of best available therapy with a non reversible Karnofsky Performance Status or Palliative Performance score of 3 or higher which are not due to a pre-existing disability.

Treatment with intent to relieve symptoms or improve quality of life are covered as defined in Statement Of Intent 1, Palliative Care:

Examples include: 

A) Single-dose radiation therapy for painful bone metastases with the intent to relieve pain and improve quality of life.

B) Surgical decompression for malignant bowel obstruction.

C) Medication therapy such as chemotherapy with low toxicity/low side effect agents with the goal to decrease pain from bulky disease or other identified complications. Cost of chemotherapy and alternative medication(s) should be considered.

To quality for treatment coverage, the cancer patient must have a documented discussion about treatment goals, treatment prognosis and the side effects, and knowledge of the realistic expectations of treatment efficacy. This discussion may take place with the patient’s oncologist, primary care provider, or other health care provider, but preferably in a collaborative interdisciplinary care coordination discussion. Treatment must be provided via evidence-driven pathways (such as NCCN, ASCO, ASH, SBMT, or NIH Guidelines) when available.

Nevada doctor: Insurance companies are denying treatment to patients and offering to pay for assisted suicide.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

According to an article by Bradford Richardson that was published in the Washington Times on May 31, 2017, a Nevada physician is reporting that in states where assisted suicide is legal, insurance companies are denying treatment for patients but offering to pay for assisted suicide. Youtube video of Brian Callister telling his story.

The Washington Times article stated:

Brian Callister, associate professor of internal medicine at the University of Nevada, said he tried to transfer two patients to California and Oregon for procedures not performed at his hospital. Representatives from two different insurance companies denied those transfer requests by phone, he said. 

“And in both cases, the insurance medical director said to me, ‘Brian, we’re not going to cover that procedure or the transfer, but would you consider assisted suicide?’ ” Dr. Callister told The Washington Times. 

The phone calls took place last year within the span of a month, Dr. Callister said. He said he did nothing to prompt the suggestion in either case.
The patients were not terminal, but “would have become terminal without the procedures.” 

“It was estimated that their chance for cure — cure, not just adding time — of about 50 percent in one case and 70 percent in the other case,” Dr. Callister said.

Several years ago Oregon residents Barbara Wagner and Randy Stroup were denied medical treatment but offered assisted suicide.

Legalizing assisted suicide is not about patient choice or autonomy, but rather it gives physicians and others the right in law to be directly involved with causing your death.

California Assisted suicide law prompts insurance company to deny coverage to terminally ill woman

Stephanie Packer

Alex Schadenberg

Executive Director - Euthanasia Prevention Coalition

The Washington Times reported that the California Assisted-suicide law prompted an insurance company to deny coverage to a terminally ill California woman.

Insurers use assisted suicide law to deny treatment for terminally ill patients.

Bradford Richardson, from the Washington Times reported that Stephanie Packer, a wife and mother of four who was diagnosed with a terminal form of scleroderma, said that her insurance company initially indicated it would pay for her to switch her chemotherapy drug based on the recommendation of her doctors but shortly after the California assisted suicide law went into effect, her insurance company denied her treatment.

Richardson reported Packer as saying:

“And when the law was passed, it was a week later I received a letter in the mail saying they were going to deny coverage for the chemotherapy that we were asking for,” 

She said she called her insurance company to find out why her coverage had been denied. On the call, she also asked whether suicide pills were covered under her plan. 

“And she says, ‘Yes, we do provide that to our patients, and you would only have to pay $1.20 for the medication,’”Mrs. Packer said.

Stephanie Packer believes that legalizing assisted suicide creates an incentive for insurance companies to deny terminally ill people coverage. Packer stated:

“As soon as this law was passed — and you see it everywhere, when these laws are passed — patients fighting for a longer life end up getting denied treatment, because this will always be the cheapest option,” 

Attitude have also changed in her support group:

After the right-to-die movement began garnering national attention, Mrs. Packer said she noticed a change in tone at her support groups for terminally ill patients. While the meetings were formerly positive and encouraging, she said the specter of suicide now hangs above them like a dark cloud. 

“And people, once they became depressed, it became negative, and it started consuming people,” she said in the video. “And then they said, ‘You know what? I wish I could just end it.’ “

Stephanie Parker is not the first person to be denied chemotherapy but offered assisted suicide. Several years ago Barbara Wagner and Randy Stroup, in Oregon, were denied medical treatment but offered assisted suicide.

John Kelly’s Testimony Opposing New Jersey Assisted Suicide Bill A2451

This article was published on the Not Dead Yet website on September 6, 2016.

[Editor’s Note: John Kelly lived in New Jersey in his younger years and traveled back there to testify on October 6, 2016 in opposition to the latest assisted suicide bill, A2451. His oral testimony is below, and his full written testimony is here.]

Chair Burzichelli, Vice Chair Lagana, Members of the Committee:

John Kelly testifying in Connecticut.

My name is John Kelly, and I am the New England Regional Director for Not Dead Yet, the national disability rights group that has long opposed euthanasia and assisted suicide. I am also the director of Second Thoughts Massachusetts, Not Dead Yet’s Massachusetts affiliate.

We are concerned that this bill is before the Appropriations Committee. It suggests that cost-containment really is a major factor behind the push for assisted suicide laws. So when in the state of Oregon, Barbara Wagner and Randy Stroup received letters from Oregon Medicaid denying coverage for prescribed chemotherapy. The letters did, however, offer to cover the negligible cost of assisted suicide. Because assisted suicide will always be the cheapest treatment, its availability will inevitably affect medical decision-making. This will actually end up constraining choice.

A2451 threatens you, every single resident of New Jersey, because all of us are vulnerable to misdiagnosis. “Terminally ill” is defined as:

“Terminally ill” means that the patient is in the terminal stage of an irreversibly fatal illness, disease, or condition with a prognosis, based upon reasonable medical certainty, of a life expectancy of six months or less.”

When it comes to life and death, there is no such thing as “reasonable medical certainty.” Of the millions of misdiagnoses every year, many are terminal misdiagnoses. We know this because of the thousands of people who “graduate” from hospice each year. Every year in Oregon, people have lived longer than their six-month terminal diagnosis.

John Kelly with Amy Hasbrouck

Every year in New Jersey, it is estimated that 1/10 people over the age of 60 are abused, almost always by adult children and caregivers. Although “self administration” is touted as one of the key “safeguards”, in about half of Oregon program deaths, there is no evidence of consent or self-administration in the death. If the drugs were administered by others without consent, no one would know. The request form constitutes a virtual blanket of legal immunity covering all participants in the process.

Assisted suicide laws inevitably take the lives of innocent people through mistakes, coercion, and abuse. Please reject this bill.

“60 Minutes” - and the selling of assisted Suicide

This article was published by Nancy Valko on her website on March 16, 2016

Nancy Valko

By Nancy Valko

In the March 13, 2016 TV “60 Minutes” segment titled “Aid in Dying” (re-titled: “Should the terminally ill control how they die?” in the online transcript, the vaunted investigative news show crossed the line from presenting facts to enthusiastic advocacy.

The stage was set when medical correspondent Dr. John LaPook, an internist and son-in-law of liberal activist Norman Lear, opened the segment by stating:

This is not euthanasia, when a doctor gives a patient a lethal injection. That’s illegal in all 50 states. Aid-in-dying, or what opponents call “assisted suicide”and supporters call “death with dignity,” relies on people taking the medication themselves. Oregon became the first state to legalize it 18 years ago, but because a nurse or doctor is rarely present, it’s remained mostly a private affair, practiced behind closed doors. We wanted to hear from patients and family members who’ve experienced it and are fighting to make it legal nationwide.

If you go to the link for the transcript, you will also see “related videos” with segment extras not included on the TV show.

One titled “ethical concerns” is an interview with Dr. Katrina Hedberg, state epidemiologist of the Oregon Public Health Division, to discuss “ethical concerns raised by her state sanctioning aid-in-dying”. Not surprisingly, Dr. Hedberg strenuously denies that assisted suicide is a danger for the “disenfranchised” or for medical economic or family burden reasons. Instead, she says “the opposite has happened” despite cases like Barbara Wagner’s.

In the segment extra “How does the medicine work?”, the assisted suicide doctor explains that the medicine simply just “shuts off the brain” starting “at the top” where consciousness is and then goes to “the bottom” of the brain where heartbeat and breathing occur. Not a very accurate or scientific explanation but designed to reassure the public.

I

Dr William Toffler

n the televised segment, there was only a very short interview with Dr. William Toffler, National Director of Physicians for Compassionate Care but only identified by Dr. LaPook as a doctor “who’s taken care of terminally ill patients for 40 years” and whose wife died of cancer in comfort and without physician-assisted suicide. Dr. Toffler’s practical and ethical concerns were ignored or dismissed by Dr. LaPook.

The rest of the segment involved interviews with people fighting for physician-assisted suicide for themselves or a relative and an assisted suicide doctor. The usual lethal overdose drug and the method for using it for suicide were described in detail.

John Kelly: Second Thoughts Against California Assisted Suicide Bill.

This letter was published by California Against Assisted Suicide on September 7, 2015.

John Kelly is the Director of the
disability rights group, Second Thoughts.

Assemblymember:

I hope you will have second thoughts about legalizing assisted suicide in California. Now especially that the California Medical Association secured the removal of any liability clause from  AB2x 15, in the words of the committee staff’s analysis (see page 17), “wanton misconduct” and “gross negligence” will go unpunished.

The replacement clause, that professional licensing boards “may sanction” professional misconduct, is toothless. As we have seen across society, self-interested institutions cannot be trusted to police themselves. Please see the case of Wendy Melcher, who was illegally injected with lethal drugs by two Oregon nurses, completely outside the scope of the law. The nurses were not referred for prosecution, but were secretly dealt with by the state nursing board. The nurses continue to practice today. 

In important ways assisted suicide laws are like death penalty laws: innocent people inevitably lose their lives. A strong consensus is now emerging against the death penalty because mistakes (witness misidentification, false confession) and abuse of the system (prosecutorial and police misconduct) lead to wrongful convictions and executions.

Mistakes and abuse in the medical system are common. People who are misdiagnosed (see John Norton), people who would respond to more treatment ( Jeanette Hall), or who would live years longer  (some participants in Oregon have lived almost 3 years after being judged “terminal”) will be led to tragically “choose” death. Assisted suicide programs have offered lethal drugs to patients with severe depression (Michael Freeland) and to people denied treatment (Barbara Wagner). And because not all families are loving or financially secure, innocent people will be bullied or worse by abusive families and beneficiaries.

Just like the death penalty, assisted suicide exacerbates existing inequalities across race and class. It has been shown repeatedly that patients of color receive substandard, often deadly lack of medical care, and are the targets of educational campaigns to give up on treatment. Distrust of the medical system is widespread among more vulnerable populations. It’s no surprise that people of color (and poorer people generally) oppose legalized assisted suicide (Pew Research Center on End-Of-Life). The 4 most Latino cities in Massachusetts (Lawrence, Holyoke, Chelsea, and Springfield) voted heavily against the 2012 assisted suicide ballot measure. And as the Oregon and Washington statistics reveal, there is been almost no participation in the program outside of non-Hispanic whites.

Barbara Wagner

Cost savings are a major driver of today’s end-of-life policy recommendations, as Barbara Wagner learned to her horror. We poorer people and disabled people are already under increasing pressure to refuse life-saving treatment (even antibiotics or temporary ventilation). For people who are often viewed as “better off dead,” assisted suicide will become a recommended option.

Proponents of “aid in dying” have compelling individual stories, but represent a more well-to-do, better educated and whiter portion of the general population.  One social group’s particular views on end of life dignity should not be imposed on such a diverse state as California.

Please think about the profound social implications of enshrining in policy the belief that sometimes it is more dignified, more respectable, to die early. Rather than aid in dying, please focus on aid in living and ending the vast inequalities that are distorting our society.

John B. Kelly
Director
Second Thoughts Massachusettswww.second-thoughts.org

Assisted suicide, "some people's lives will be ended without consent, through mistakes and abuse."

By Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Liz Carr

Liz Carr is an actress and disability campaigner in the UK. Carr is a spokesperson for Not Dead Yet UK

ITV news published an article on August 14 by Liz Carr.

Carr explains that she is not religious and she is not "anti-choice," but she works with Not Dead Yet to oppose the legalization of assisted suicide. She explains:

We believe that if the Assisted Dying Bill passes, that some people’s lives will be ended without their consent, through mistakes and abuse. 

No safeguards have ever been enacted or proposed that can prevent this outcome – which can never be undone. The only guaranteed safeguard is to not legalise assisted suicide. 

And we’re not alone in thinking this.

She explains that no organisations of disabled people support assisted suicide and most doctors oppose it. This is important to her.

As someone who has spent a lot of her life needing extensive health care, I am relieved to hear this. I wouldn’t be alive without the NHS but I recognise that it is currently understaffed and under resourced. Against a backdrop of longer shifts, difficulty in obtaining appointments and the rationing of certain treatments, should we really be pushing further pressures onto our reluctant doctors?

Liz Carr at a suicide clinic
in Switzerland.

Carr continues by explaining that the assisted suicide bill that will be debated in the British parliament is based on the Oregon assisted suicide law. She says:

We’re told there’s been no problems with this law but that is to ignore the experiences of Barbara Wagner and Randy Stroup. Both Oregonians with terminal cancer, their life extending drugs were denied to them based on cost. Instead, they were offered a range of choices, including cheaper drugs to enable them to end their life. 

If you think this wouldn’t happen in England, it already is. Changes to England’s Cancer Drugs Fund mean that from April 2015, new cancer patients have been denied a number of expensive treatments that were previously available on the NHS. The fund normally supports palliative treatment, enabling people with metastatic cancers to access drugs that can add several months to their lives. From April however, only people who are already on the treatments in question will receive them whilst new patients will no longer be eligible.

Carr then challenges the concept that legalizing assisted suicide provides choice.

So when supporters of these bills say they’re about individual choice, I have to disagree. They offer one particular choice - physician assisted suicide. People do have other choices at the end of their lives, like palliative and hospice care, yet these choices are currently being denied to people. 

In a recent survey of attitudes to dying, two-thirds said they would prefer to die at home yet the UK still has some of the highest rates of hospital death among older people in Europe.

Carr supports the assisted suicide law.

Supporters of assisted suicide will tell you that the current law is broken but the current law is exactly where it needs to be when the consequences of making a mistake would be murder. 

Safety of the many has to overrule the desires of the few. What is broken, however, are the social and health care support systems which are currently failing us all, both during and at the end of our lives.

Denied the support to live – or die - with dignity, is it any surprise that people feel they have no choice but to end their lives? What terminally ill and disabled people need is an Assisted Living not an Assisted Dying Bill.

She concludes that legalising medically assisted suicide is not the solution.

• Summary of Liz Carr's speech at Not Dead Yet UK rally.

Follow the Money: Oregon pays for assisted suicide but not suicide prevention for adults.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Wesley Smith

Bioethicist, lawyer and cultural commentator, Wesley Smith, examines the Oregon policy of paying for assisted suicide in an article that was published, today, in the Weekly Standard.

In his article, Smith first comments on the celebration of Brittany Maynard's death, that became a massive campaign by the assisted suicide lobby, as compared to the near silence surrounding the life and death of Lauren Hill, who had the same condition but choose to live, continue to play basketball on her college team and raise money to fight cancer.

Smith examines the policies that have led to 859 Oregonians dying by assisted suicide, a state that also has the second highest "other suicide" rate that is 41% higher than the national average. Smith states:

A government’s priorities dictate its spending choices. Oregon uses federal and state money for youth suicide prevention. But even though one in five suicides in Oregon occurs among “older adults,” the anti-assisted-suicide Physicians for Compassionate Care found that the Oregon Health Authority does not fund adult suicide prevention services. As an OHA bureaucrat responded when answering an inquiry from a state legislator, “Staff resources to work on older adult suicide development have not been developed in OHA.” 

In contrast, Oregon does fund assisted suicides under Medicaid, using state funds (federal Medicaid dollars cannot legally pay for assisted suicide). So Oregon taxpayers pay the costs of terminally ill adults seeking death, but no state funds are dispensed to prevent adults from killing themselves. 

Not only that, but Medicaid is explicitly rationed under Oregon law. As one example, some poor patients with late-stage cancer are denied life-extending (as opposed to curative) chemotherapies, but assisted suicide is never rationed. Indeed, readers might recall that Barbara Wagner and Randy Stroup​—​two terminally ill cancer patients​—​were denied Medicaid coverage for chemotherapy in 2008, but told in their rejection letters that the state would fund their suicides.

In fact, the Oregon Health Authority has explicitly stated that assisted suicide is "covered" for the poor. Smith quotes:

It is the intent of the Commission that services under [the Oregon Death with Dignity Act] be covered for those that wish to avail themselves to those serv­ices. Such services include but are not limited to attending physician visits, consulting physician confirmation, mental health evaluation and counseling, and prescription medications.

As Smith says, the message is obvious:

No poor Oregonian will ever be rationed out of assisted suicide​—​after all, what “end of life treatment” could be more cost effective? The message is unequivocal: The state will always pay the tab of the poor wanting to kill themselves, but will not necessarily pay for their fight to remain alive.

Smith concludes his article by re-stating Oregon's spending priorities:

Asked about Oregon’s funding priorities, oncologist Dr. Kenneth Stevens, president of Physicians for Compassionate Care, lamented, “You would think with the concern about the state’s high geriatric suicide rate and the similar crisis among military veterans, the state would fund suicide prevention for adults and the elderly.” 

That would be true in an anti-suicide culture. But that isn’t Oregon. By following the money, we can see what the state cares most about: facilitating some​—​rather than preventing all​—​adult suicides.

The Oregon suicide rate has experienced a steady increase since 2000 and last year alone, Oregon assisted suicide rate increased by 44%.

• Oregon's suicide rate continues to increase faster than the national average.
• Assisted suicide and the suicide contagion effect.
• Assisted suicide increased by 44% in Oregon - 2014 assisted suicide report.

Euthanasia is contagious.

By Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Newsweek published an extensive article titled: Dying Dutch. The article focuses on stories supporting euthanasia and assisted suicide and information from people like Theo Boer, who, for nine years was a member of a Euthanasia Evaluation Committee but now opposes it, because euthanasia in the Netherlands has become out-of-control.

Under the heading - Death is Contagious, The Newsweek article reports:

In the first few years after the Netherlands decriminalized euthanasia in 2002, the number of cases declined. Then, in 2007, the statistics began a steady climb, an average jump of 15 percent a year...

Theo Boer, the ethicist, has some theories. Once a supporter of euthanasia, he’s now one of its most vocal critics. Among the reasons for the euthanasia boom, Boer suggests, is propaganda. Over the past decade, he says, Dutch journalist Gerbert van Loenen has been tracking a series of documentary films that depict euthanasia in a wholly positive light. “They do ask certain questions,” Boer says. “But they systematically ignore most critical questions, so that the general public is presented with an opinion that is completely good, and has no risks. This is contagious.”

Theo Boer

The number of deaths and the reasons for euthanasia is growing.

Another key factor: It’s getting easier each year to qualify for euthanasia. In the beginning, most of those eligible were terminally ill. Now doctors are helping people die if they no longer want to bear depression, autism, blindness or even being dependent on the care of others. “There are increasing numbers of double euthanasia—one of the partners is terminal and the other partner is care-dependent, they don’t want to live alone,” says Boer. One in 10 of the past 500 dossiers he has read contains some reference to “loneliness,” he adds. “Those are the cases where I have become increasingly uneasy.” 

The numbers support Boer. In 2012, 13 patients were euthanized after convincing a doctor they were suffering unbearably from mental illnesses ranging from depression to schizophrenia. The following year, the figure more than tripled, to 44. The number of patients with dementia who killed themselves grew from 43 in 2012 to 97 in 2013. “I’m afraid,” Boer says, “the situation in the Netherlands is out of control.” 

In 2005, lawmakers decriminalized another form of euthanasia—for babies. ...

Nancy Elliott writes to New Jersey Senators concerning assisted suicide.

Dear Senator __________

Nancy Elliott

My name is Nancy Elliott and I am a Team Leader with Euthanasia Prevention Coalition, International. I am a former three term New Hampshire State Representative. I served on the Judiciary Committee, which is where I was first exposed to Assisted Suicide Legislation.

Early this spring our Democrat led House soundly rejected HB1325, a similar bill to yours by a vote of 219 to 66. Many expected this bill to pass, but Legislators, some who thought they were for this bill, became uncomfortable as they were educated in the kinds of harm this legislation could cause.

Many of you have been led to believe that it is imperative that you pass this legislation to help people like the young woman from Oregon who recently took her own life. Her situation was sad, but as legislators, you know that to make laws for a small select few is bad law. While this might help someone face a bleak future, it will hurt many more. We must look at the big picture.

In New Hampshire legislators were particularly concerned with the aspect of Elder Abuse. I am sure you have heard much on this, but the fact is that our bill and A2270 doesn't require a witness at the death. Once the person requests Assisted Suicide, they have put everyone on notice, if anything happens to me, don't ask any questions. If the person is given the lethal dose against their will, who would know. There is no witness at the death. This is a prescription for Elder Abuse especially if the person has money. This troubled our Legislators.

Oregon Oncologist Speaks of the Tragedy of Physician-Assisted Suicide

By Kenneth R. Stevens Jr. · November 4, 2014

Lauren Hill

(Lauren Hill, has been diagnosed with an inoperable brain tumor and has been given only a few months to live. She just played in the opening basketball game at Mt. St. Joseph University.)

Physician-assisted suicide has recently been in the media because of Brittany Maynard, diagnosed with a brain tumor earlier this year, who came to Oregon and died of suicide from an overdose of barbiturates on November 1, 2014. The assisted suicide proponent organization, Compassion & Choices (former Hemlock Society), has orchestrated and centered a skillful media campaign about her story to promote further legalization of physician-assisted suicide.

She was attractive, young, recently married, and diagnosed with a malignant brain tumor. Even though she was very functional and able to travel to the Grand Canyon in recent weeks, she ended her life prematurely a few days ago with the drug overdose.

My 47-year experience caring for patients with cancer in Oregon has been rich with experiences with patients. Since Oregon’s assisted suicide law was passed by voters in 1994, I have studied the law and its effects and led efforts to fight it.

Brittany Maynard’s story is currently in the news, but there are other stories regarding assisted suicide in Oregon.

I first became involved with assisted-suicide in 1982, shortly before my 39-year old wife died of cancer in the brain. We had just made what would be her last visit with her doctor. As we were leaving the office, he said that he could provide her with an extra-large dose of pain medication. She said she did not need it because her pain was under control. As I helped her to the car, she said “Ken, he wants me to kill myself.” She had suffered a lot over the prior 18 months, but her doctor’s statement caused the most suffering to her. It devastated her that her doctor, her trusted doctor, would suggest that she kill herself. Two weeks later she peacefully died in our home without pain, and with dignity. We treasured all of our time together, even to the natural end of her life on earth.

Assisted Suicide is bad medicine.

This article was published in the Sacramento Bee on November 1, 2014

By Marilyn Golden 

Marilyn Golden

Why, when listing opponents, did The Sacramento Bee editorial pushing an assisted-suicide law ignore the disability community? (“Give the dying the right to pick how and when to die”: Editorials, Oct. 26) We could be those most affected.

As a disability-rights advocate and person living with a disability, I know our concerns aren’t just “fear-mongering.” Rather, legalizing assisted-suicide is a direct threat to our community as well as to the elderly, people with chronic illness and others marginalized by society.

The Oregon assisted-suicide experiment has major problems.

When Oregonian Barbara Wagner was prescribed chemotherapy for aggressive lung cancer, the Oregon health plan refused to cover it. They offered, instead, among other things, to pay for her assisted suicide. Randy Stroup, another Oregonian with cancer, received a similar denial. Is there any wonder why? Treating people with terminal or chronic illness is expensive. At roughly $300, assisted suicide is the cheapest “treatment.”

Direct coercion is not even necessary. Denying, or even merely delaying, expensive, life-sustaining treatment can drive patients toward assisted suicide. It is a deadly mix with our cost-driven health care system.

This is partly why every major disability organization taking a position opposes legalizing assisted suicide.

Assisted suicide laws are more dangerous than people acknowledge

This article was published by NewJersey.com on October 31, 2014

John Kelly

By John B Kelly - the New England regional director for Not Dead Yet, a grassroots disability group opposed to the legalization of assisted suicide.

The media is flush with the sympathetic story of Brittany Maynard, the 29-year-old newlywed with aggressive brain cancer. Her video advocating expanded assisted suicide laws has been seen millions of times, prompting another push in the State Assembly to pass an assisted suicide bill.

When the focus is on an individual, assisted suicide can sound good – who’s against compassion or relieving suffering? But a closer look reveals that assisted suicide puts vulnerable people in mortal danger. The more people learn about the real-world implications of these bills, the more they oppose them. (Our group takes its name – Second Thoughts – from this fact). Last year, the Legislatures of New Hampshire, Massachusetts and Connecticut rejected assisted suicide bills.

The simple truth is that not all families are loving. Elder abuse is a nationally recognized epidemic. Every year, New Jersey elders suffer an estimated 175,000 cases of reported and unreported abuse, most by adult children and caregivers. Financial gain or emotional relief creates motives for steering someone toward death. The two witnesses to the death request could be an heir and the heir’s accomplice. Once the lethal prescription leaves the pharmacy, there is no further supervision and no independent witness required at the death to ensure that the lethal dose is self-administered.

Depressed people will be harmed. Under Oregon’s program, Michael Freeland obtained a lethal prescription for his terminal diagnosis, despite a 43-year history of severe depression, suicide attempts and paranoia. The prescribing doctor said a psychological consult was not “necessary.” When Freeland received volunteer suicide prevention services, he was able to reconcile with his estranged daughter and lived two years post-diagnosis. Oregon’s statistics for the last four years show that only 2 percent of patients are being referred for psychological evaluations.

The Danger of Assisted Suicide laws.

The following article was written by Marilyn Golden and published by CNN on October 13. Golden is a senior policy analyst with the Disability Rights Education and Defense Fund (DREDF). The views expressed are her own.

Marilyn Golden

By Marilyn Golden

My heart goes out to Brittany Maynard, who is dying of brain cancer and who wrote last week about her desire for what is often referred to as "death with dignity."

Yet while I have every sympathy for her situation, it is important to remember that for every case such as this, there are hundreds -- or thousands -- more people who could be significantly harmed if assisted suicide is legal.

The legalization of assisted suicide always appears acceptable when the focus is solely on an individual. But it is important to remember that doing so would have repercussions across all of society, and would put many people at risk of immense harm. After all, not every terminal prognosis is correct, and not everyone has a loving husband, family or support system.

As an advocate working on behalf of disability rights for 37 years, and as someone who uses a wheelchair, I am all too familiar with the explicit and implicit pressures faced by people living with chronic or serious disability or disease. But the reality is that legalizing assisted suicide is a deadly mix with the broken, profit-driven health care system we have in the United States

At less than $300, assisted suicide is, to put it bluntly, the cheapest treatment for a terminal illness. This means that in places where assisted suicide is legal, coercion is not even necessary. If life-sustaining expensive treatment is denied or even merely delayed, patients will be steered toward assisted suicide, where it is legal.

This problem applies to government-funded health care as well.

Barbara Wagner

In 2008, came the story that Barbara Wagner, a Springfield, Oregon, woman diagnosed with lung cancer and prescribed a chemotherapy drug by her personal physician, had reportedly received a letter from the Oregon Health Plan stating that her chemotherapy treatment would not be covered. She said she was told that instead, they would pay for, among other things, her assisted suicide.

"To say to someone: "We'll pay for you to die, but not for you to live" -- it's cruel," she said.

Another Oregon resident, 53-year-old Randy Stroup, was diagnosed with prostate cancer. Like Wagner, Stroup was reportedly denied approval of his prescribed chemotherapy treatment and instead offered coverage for assisted suicide.

Meanwhile, where assisted suicide is legal, an heir or abusive caregiver may steer someone towards assisted suicide, witness the request, pick up the lethal dose, and even give the drug -- no witnesses are required at the death, so who would know? This can occur despite the fact that diagnoses of terminal illness are often wrong, leading people to give up on treatment and lose good years of their lives.

Assisted suicide is not legal in Montana, not the answer.

Link to the hand-out of this article that can be used in your community.

The following article was published by the Missoulian Newspaper on August 21, 2014.

Guest column by BRADLEY WILLIAMS

I take exception to the opinion by two members of the former Hemlock Society, now known as “Compassion & Choices.” The opinion of July 25 implies that assisted suicide is legal in Montana, which is not true.

I am the president of Montanans Against Assisted Suicide. We are in litigation against the Montana Medical Examiners Board. As part of that litigation, we got the board to remove a position paper from its website implying that assisted suicide is legal. Assisted suicide is not legal.

The “treatment” of suicide

As part of our litigation with the board, we also obtained an affidavit from Dr. Ken Stevens, of Oregon, which is one of the few states in which assisted suicide is legal. His affidavit describes how, in Oregon, that state’s Medicaid program uses legal assisted suicide to steer patients to suicide. This is through coverage incentives. The program will not necessarily cover a treatment to cure a disease or to extend a patient’s life. The program will cover the patient’s suicide. In other words, with legal assisted suicide, desired treatments are displaced with the “treatment” of suicide.

Backing the establishment

The former Hemlock Society, Compassion & Choices, touts itself as the great promoter of individual choice. But if you take a closer look, its actual mission is to back the medical-government establishment.

Barbara Wagner

Consider the well-publicized case of Oregon cancer patient Barbara Wagner. In 2008, Oregon’s Medicaid program declined to cover “Tarceva,” a cancer drug recommended by her doctor, and offered to cover her suicide instead, terming it “aid in dying.” Wagner was devastated.

“It was horrible,” Wagner told ABCNews.com. "I got a letter in the mail that basically said if you want to take the pills, we will help you get that from the doctor and we will stand there and watch you die. But we won't give you the medication to live."

The drug’s manufacturer subsequently gave Tarceva to Wagner without charge. She, nonetheless, died a short time later.

I recently asked Stevens about Tarceva. He told me that some of his patients had taken it and that for some of them it was beneficial. This was in terms of survival and better quality of life. He also told me that it can be difficult to know how a particular cancer patient will do on a particular cancer drug. He said that there are always some patients who live longer than expected, sometimes 10 or even 20 years longer, depending on the type of cancer. He said, “This is because there are always some people who beat the odds.” Barbara Wagner had wanted to be one of those people.

After Wagner’s death, Compassion & Choices stepped forward to show its true colors. Specifically, its president, Barbara Coombs Lee, published an opinion in Oregon’s largest paper taking issue with Wagner’s choice to try and live. Coombs Lee argued that Wagner should have instead given up hope and accepted her pending death. But, this was not Wagner’s choice.

In a KATU TV interview Wagner had said: 

“I’m not ready, I’m not ready to die ... I’ve got things I’d still like to do.”

A public policy to discourage cures

Coombs Lee’s opinion piece also argued for a public policy change to discourage people from seeking cures. This would presumably be through coverage incentives. For example, she said: “The burning public policy question is whether we inadvertently encourage patients to act against their own self-interest, chase an unattainable dream of cure, and foreclose the path of acceptance that curative care has been exhausted.”

Coombs Lee is a former “managed care executive.”

Your choice is not assured by their legislation. Don’t be fooled by their double-speak.