The Atlantic Boosts Assisted-Suicide Doctors, Pushes Euthanasia

This article was published by National Review online on March 3, 2021

By Wesley J Smith

The media love to boost assisted suicide. They laud people who commit it — witness their swoon over the late Brittany Maynard — and the doctors who are willing to lethally prescribe or give lethal injections.

Now, The Atlantic goes there bigly, describing the experiences of two California doctors who assist suicides. But I want to focus on one: Lonny Shavelson, whose excesses and assisted-suicide enthusiasms I have been writing about for years.

Shavelson was a part-time ER doc and photo journalist. Fascinated with assisted suicide, he wrote a journalistic book about the subject called A Chosen Death. Decades later, when assisted suicide was legalized in California, he went into business, helping to kill people for $3,000.

Of course, the media has gone gaga for him. In the Atlantic piece, byline Katie Engelhart, the scribe mentions Shavelson’s book and the heart-rending situations he reported. But she leaves the most important story out — Shavelson’s witnessing the murder of a disabled man who changed his mind about wanting to die. From A Chosen Death:

His good hand flew up to tear off the plastic bag. Sarah’s hand caught Gene’s at the wrist and held it. His body thrust upwards. She pulled his arm away and lay across Gene’s shoulders. Sarah rocked back and forth, pinning him down, her fingers twisting the bag to seal it tight at his neck as she repeated, “the light, Gene, go toward the light.” Gene’s body pushed against Sarah’s. Then he stopped moving.

Not only did Shavelson not try to stop “Sarah” — a pseudonym for someone described as a Hemlock Society chapter head — but he never called the police about the killing. Rather, he describes just sitting there watching, wringing his hands. (If you want to read that description from Shavelson’s book, hit this link.)

The guidelines are supposed to protect against abuse. But even though Shavelson does not treat his “patients” — his is strictly a suicide “practice” — and even though he is not board certified in treating illnesses such as cancer or ALS, and even though he barely knows the people who come to him, he colors outside the lines: From “I’m the Doctor Who is Here to Help You Die:”

One man had terminal cancer but said he wanted to die now for financial reasons. He was a Vietnam War vet, he said, and he couldn’t stop thinking about the Agent Orange attacks. He wanted all his savings to go to Vietnamese victims—not to pay his way through some awful American nursing home. Another had ALS and didn’t want to lose her mobility. She “hated her disability and she died early,” Shavelson said. “She was still walking.”

Sometimes, Shavelson felt like he was refining the eligibility rules as he went. What if, for instance, a 103-year-old wanted to die but didn’t have a specific illness or condition? Could you assume that he had just six months left to live? Sure, Shavelson thought, as long as he scored high enough on a “frailty index” test.

Swell.

He also circumvented the self-administration requirement of the law:

Soon, he was delivering the drugs directly into feeding tubes, when patients had them. He would load the medication into a plastic syringe and then hand the plunger to the patient, who would press down on it to “self-administer” and “ingest” the drugs. Sometimes, if a patient was weak, Shavelson would hold the plunger himself and place the patient’s hand on top of his. “If I feel you pushing on my hand,” he would say, “we will push together.” These were legal deaths. And often lovely deaths. But in a way, the whole thing was ridiculous.

Later, Shavelson started administering the drugs rectally for patients with disturbed intestinal systems.

Englehart reports on Shavelson getting final consent for an assisted suicide from a cancer patient. See if you can see what is wrong with this picture.

“What are you dying from?” Shavelson asked. Then again, louder.

“I’d like to know myself,” Bradshaw said.

“Dad, you have to be serious,” Marc said. Bradshaw said nothing for a while and then recalled that something was wrong with his prostate.

“Okay,” Shavelson said, smiling, “We have a bit of paperwork to do.” Bradshaw groaned. “As you can imagine, the state of California doesn’t let you die easily.”

Shavelson held up a document. “This little paper here is called the ‘Final Attestation.’ The state of California wants you to sign, to say that you are taking a medication that will make you die.” Bradshaw closed his eyes.

“Dad,” Marc urged. “Dad, you have to stay awake for a few minutes … Daddy, you need to sign, right?”

“Dad,” Cheryl said. “Sign your name.”

Bradshaw opened his eyes and signed.

Did the man even know what he was signing? How could Shavelson give him a poisonous brew when Bradshaw appeared to be following his children’s orders?

The entire piece is actually a criticism of assisted-suicide guidelines and a pitch for lethal-injection euthanasia:

In other countries, I knew, none of this would be happening: the juice, the labored sips, the shaking hands. But in America, doctors were in a special bind. In almost every place where assisted death is legal, such as Canada and Belgium, euthanasia is also legal. This means that patients can choose between two kinds of dying: a drinkable solution or an injection, delivered by doctors. Patients almost always choose the injection. They want their doctors to take care of things. Also, the shots are straightforward and quick and always work. No stress about mixing the solution. No chance of vomiting or waking up, which can happen, albeit very rarely, with the liquid drinks.

All in all, a splendid dark example of how the media is continually pushing euthanasia and assisted suicide. No opponents’ voices allowed and no doubts about the agenda entertained.

The article says Shavelson is quitting his suicide practice. Good. Go back to taking photographs, death doctor!

Assisted suicide deaths may not be quick or peaceful.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition.

When debating assisted suicide, legislators and voters assume that an assisted death is quick and peaceful. This is important because people often support assisted suicide based on fear of a painful death.

The theory is not the same as the reality.

What is not known is that assisted suicide activists have been experimenting for several years with lethal drug cocktails on people approved for assisted suicide.

According to an article by Lisa Krieger published by the Medical Xpress:

When Californians passed the medical aid-in-dying law - inspired by Oakland's Brittany Maynard, San Mateo's Jennifer Glass and others who sought to end their suffering from cancer - voters assumed it promised them a neat Shakespearean-styled ending, like Romeo's quick poisoning in Verona. That was the goal, but it didn't always happen.

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

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

But what is not said in the article is that assisted suicide promoters and practitioners are developing new lethal drug cocktails through human trials rather than animal trials. The human experimentation is ethically questionable and should be investigated by the Food and Drug Administration.

Furthermore, the doctors, who are doing the experiments, may have consent to assist a person's death but have they obtained consent to use experimental drug cocktails in the process? 

Krieger explains that these experiments are not new:

When aid-in-dying was first passed in Oregon in 1997, patients were given secobarbital, sold under the brand name Seconal. It induces deep sleep, then a coma that is so deep that the brain no longer drives respiration.

But that drug wasn't consistently quick. Then it became prohibitively expensive, finally unavailable.

To replace Seconal, the doctors invented a three-drug cocktail - a painkiller, sedative and a heart-slowing agent - based on their experiences with overdose deaths. They later added another cardiac drug. But problems remained.

The assisted suicide lobby is not honest about the fact that many assisted suicide deaths are slow and painful. The design of the law enables doctors to cover-up the reality.

A Daily Mail article by Vanessa Chalmers titled - Assisted Dying can cause inhumane deaths examined an article, by Professor Jaideep Pandit, as reported in the British Medical Journal. The article explains how death by assisted suicide is often inhumane. 

Chalmers reported:

Patients are usually given barbiturates – strong sedatives – which knock them out and eventually cause the lungs and heart to stop. 

But the report found complications including difficulty in swallowing the prescribed dose (up to nine per cent) and vomiting in 10 per cent, both of which can prevent proper dosing. 

Re-emergence from a coma occurred in two per cent of cases, with a small number of patients even sitting up during the dying process, the authors said.  

'This raises a concern that some deaths may be inhumane,' the researchers reported in the journal Anaesthesia. 

After oral sedative ingestion, patients usually lose consciousness within five minutes. However, death takes considerably longer. 

Death occurs within 90 min in two thirds of cases. 

But in a third of cases, death can take up to 30 hours, and some deaths took as many as seven days to occur (four per cent).

Before legalizing assisted suicide, legislators and voters need to know how it is done, the negative consequences associated with these drugs and the ethics related to the development and use of these drugs.

Assisted suicide deaths can be slow and painful.

More articles on this topic:

• Is death by euthanasia similar to drowning?(Link)
• Do euthanasia drugs cause a painful death? (Link).
• Death may take hours (Link).
• The connection between lethal injection and capital punishment (Link). 
• Complications with lethal drugs used for assisted suicide (Link).
• Many assisted suicide deaths are slow and painful (Link).
• Is lethal injection inhumane? Euthanasia execution drug controversy (Link).

Natalie Harp was urged to request assisted suicide in California.

This article was published by the American Spectator on August 26, 2020.

Natalie Harp is living proof of the importance of the “right to try.”

Natalie Harp

By Wesley Smith

The threat of assisted suicide is a portentous issue of our day that many politicians pretend isn’t there. Republicans, in particular, have tended to hide under their desks about it. That may be because the question of legalizing doctor-prescribed death and/or euthanasia doesn’t usually make pollsters’ lists of issues that drive people to the polls, and the media enjoy depicting opponents of assisted suicide legalization as people who want others to suffer.

Ignoring this issue is not the kind of leadership that our country needs. Indeed, the question of whether or not to allow killing to become an acceptable answer to human suffering could not be more important, both culturally and morally.

When we accept assisted suicide, we are not really being compassionate, but rather are tacitly validating surrender to darkness. But by opposing the “give them the pills” expedient (that’s what it really is), and instead committing unequivocally to caring for the terminally ill with loving concern, we can insure that dying people are not made to feel like burdens or allowed to believe we will allow them to wallow in misery. In doing so, we value their equality and uphold the intrinsic dignity of their lives.

That’s a difficult message to communicate in our soundbite culture — particularly when so much communication these days is mere emoting. Indeed, most depictions of assisted suicide in the media and popular culture extol people who commit suicide as empowered and “dying on their own terms.” For example, who hasn’t seen the image of the late Brittany Maynard photographed with a cute puppy when the media reports on an assisted suicide? Maynard was made an A-list celebrity by the media back in 2014 when, tragically diagnosed with terminal brain cancer, she began campaigning to legalize doctor-prescribed death. CNN even named her one of 2014’s “extraordinary persons,” simply because she killed herself — with no real reportage about how the symptoms and difficulties of dying from brain cancer can be ameliorated with proper medical care. In fact, when the palliative care expert Ira Byock was interviewed on national television about that potential, he was castigated for interfering with Maynard’s “choice.”

With that kind of propaganda machine pushing assisted suicide, perhaps we can understand why Republicans have never brought it up at their national convention. That changed Monday night. Natalie Harp — who has survived diagnosed terminal bone cancer — proved that hope can be found even in situations seemingly bereft of anything but tragedy. From her speech:

The Democrats love to talk about health care being a human right. But a right to what? Well, I’ll tell you. To them, it’s a right to marijuana, opioids, and the right to die with “dignity” — a politically correct way of saying … assisted suicide.

Harp was not saying palliation is a bad thing. Nobody would. Pain and symptom control is an essential component of contemporary medicine that everyone should support. But she was warning us that these important medical fields should not be treated as a metaphorical elephant’s graveyard where people are sent to die.

In her speech, Harp identified a real problem powerfully and succinctly:

I was told I was a burden to my family and to my country — and that by choosing to die early, I’d actually be saving the lives of others by preserving resources for them rather than wasting them on a lost cause like myself.

Can you imagine the pain of that? Can you imagine how such treatment could induce one to want to commit assisted suicide, whether for fear of symptoms or worries about being a burden?

Harp saved her life with the new “right-to-try” law that permits terminally ill people to access treatments not yet approved by the FDA. The experimental care worked, allowing her to appear on national television to tell the tale.

But one can imagine a different scenario. Depressed and dejected, told there is no hope, she could have requested poison pills — unaware that a different choice would bring continued life. And a doctor — so compassionately — acquiesces in the death.

By the way, such “the patient didn’t die as expected” scenarios happen sometimes in situations that do not involve right-to-try. I experienced such a case as a hospice volunteer.

When I first met Ernie, an elderly man expected to die of congestive heart failure, he fell into my arms, crying, “I want to die! I want to die! I want to die!” When I asked him why, he said he worried about burdening his son. I assured him that wasn’t true and notified the care team about Ernie’s deep depression so they could intervene with social and mental health services.

About three months later, I lost Ernie — not because he died, but because his health had so unexpectedly improved that he was kicked out of hospice care!

If assisted suicide had been available in California at that time — as it is today — I believe Ernie would have asked for the poison pills, he was in such despair over his situation. Look at what he would have missed — and no one would have ever known. In this regard, it is worth noting that the humorist Art Buchwald was placed in hospice care with kidney failure. He too eventually left hospice and lived long enough after that to write his last book.

That isn’t the usual course for most hospice patients, of course. But that fact doesn’t justify assisted suicide either. Hospice help patients in their last stage of life live well and with great quality. Indeed, it is something of a hospice cliché that patients tell caregivers they would not have missed their final weeks and months in hospice for anything. A few of my patients told that to me too.

By allowing Harp to walk where Republicans usually fear to tread, the Trump campaign has done a big favor to the most weak, vulnerable, and, too often, abandoned among us. Harp’s advocacy to never give up on patients, to embrace care and not killing, has opened the door to explore these issues in greater depth going forward. Thank you, Natalie Harp!

Award-winning author Wesley J. Smith is chairman of the Discovery Institute’s Center on Human Exceptionalism and a consultant to the Patients Rights Council.

Dr. Anne Hanson's Testimony Opposing Assisted Suicide

Suicide Contagion; Safeguard Failures; and Implications for the Practice of Psychiatry 

This article was published by Choice is an Illusion.

Anne Hanson MD

The Maryland Psychiatric Society opposes HB 643, the End-of-Life Option Act. Since this bill was first introduced in 2015, the Maryland Psychiatric Society has extensively deliberated the legislation within the organization through several listserv discussions, a member survey, and a four hour pro-con debate sponsored jointly with the Maryland somatic physician's organization, Med Chi. In addition to reviewing the legislation each year, we considered information contained in the American Psychiatric Association's resource document on assisted suicide (APA 2017) and other literature as cited in the references below.

The Maryland Psychiatric Society recognizes that this is a divisive issue and that some of our members disagree with the organization's position. Those members have been encouraged to contact their elected officials to contribute their thoughts and we welcome consideration of both sides of this serious policy.

The Maryland Psychiatric Society maintains its opposition to HB 643. There are three general areas of concern.

1. Suicide Contagion

Promotion of this bill, and assisted suicide laws generally, transmit a dangerous message to vulnerable Maryland citizens. According to the Centers for Disease Control,  at any given point in time 4% of people are experiencing suicidal thoughts. One-sixth of those individuals will attempt suicide (1.4 million Americans), and 3% will die (Shreiber and Culpepper 2020). Translated into Maryland numbers, this means that 242,000 people are presently thinking of killing themselves, 40,333 will attempt suicide, and 1210 will die.

Suicide clusters and contagion are well established phenomena with documented connections to media coverage and publicity (Blasco-Fontecilla 2013). The Centers for Disease Control and the World Health Organization both promulgate guidelines for the media coverage of high profiles suicides (Carmichael 2019). These guidelines advise against the portrayal of self-destruction as a “brave,” or “romantic,” and discourage reports which idealize suicidal behavior. They also caution against explicit discussion of suicide methods. These recommendations were developed in part due to a study which demonstrated that deaths by helium asphyxiation increased by more than 400% in New York following publication of the book Final Exit in 1991 (Marzuk 1993).

Proponents of assisted suicide laws violate these public health recommendations when they describe self-destruction as a “graceful” or “beautiful” expression of personal autonomy (Death With Dignity 2020). To date there have been no well designed studies to clarify the relationship, if any, between adoption of assisted suicide laws and states rates of un-assisted suicide. However, following the highly publicized death of Brittany Maynard in 2014 the number of assisted deaths by lethal medication in Oregon nearly doubled, from 71 in 2013 to 132 in 2015 (Oregon 2015). In a letter to the Colorado Springs Gazette, Dr. Will Johnston documented the case of a young man who was inspired to research suicide methods online after being impressed by, and admiring, Brittany Maynard's suicide video (Johnston 2016).

Here in Maryland, two people with serious mental illness have sought psychiatric help to die on the basis of their mental illness. One was a resident of the Maryland state hospital system and made a request for lethal medication on the day the 2019 bill failed in the Senate (Hanson, personal communication). Another was a resident of the Eastern Shore with schizophrenia who contacted several forensic psychiatrists for a capacity assessment in order to apply for euthanasia in Switzerland (Neghi and Crowley, personal communications).

Adoption of this law carries serious implications for people with mental disorders who would demand equality under the law. People with serious and treatment-resistant eating disorders could qualify, since qualification is based upon prognosis rather than diagnosis.

2. Safeguard Failures

The Maryland Psychiatric Society considers the statutory safeguards to be inadequate. Furthermore, they historically have been ignored without consequences to the negligent physicians.

Between 1998 and 2012 a total of 22 Oregon physicians were referred to the Board of Medical Examiners for non-compliance with the provisions of the Death With Dignity Act. None could be sanctioned due to the “good faith” protections of the law, even when required witness attestations were missing. No attempt has been made by Oregon, or any independent researchers, to document unreported cases in Oregon since the entry into force of the DWDA. The true reporting rate in Oregon is therefore unknown (Lewis 2013).

Similarly, in the first year of the Colorado law all prescribing physicians attested that they followed the law even when 42 cases were missing the consultant's evaluation, 22 had no written request, and nine of 69 cases were not reported at all by the physician (Colorado 2017).

In 2016 the Des Moines Register investigated ten years of data in Washington and Oregon, and found that in 40% of cases the reports were missing key data.

Failure to submit required reports, or to hold physicians accountable for reporting failure, is a substantial weakness of this legislation. Even if all required documents were accounted for, there has been no study to date to confirm the accuracy and specificity of these statutory safeguards.

In Maryland, one physician was even willing to violate our state's criminal prohibition. The late Dr. Lawrence Egbert admitted participation in the assisted suicide deaths, by helium asphyxiation, of six non-terminally ill Maryland residents. Three of those patients had co-existing clinical depression. His actions were discovered purely by accident. He was never charged or prosecuted in Maryland. He admitted in an interview with the Baltimore Sun that he had been involved in 15 suicides in Maryland and 300 nationwide (Dance 2014).

If Maryland is unwilling to enforce criminal prohibitions, the enforcement of statutory safeguards is even less likely. Connecticut's Division of Criminal Justice acknowledged that the statutory construction of their legislation would have prohibited prosecution for murder (Connecticut 2015).

3. Implications for the Practice of Psychiatry

This legislation has the potential to significantly complicate the practice of psychiatry in Maryland, for both the treating clinician and when functioning as an evaluator of decision-making capacity.

This law would carve out a class of people who theoretically could be categorically exempt from emergency evaluation procedures or civil commitment. Given that some individuals live for more than one year after receiving a lethal prescription, and that capacity may deteriorate over that time, it is unclear whether a qualified patient who has lost capacity could be assessed and treated for mental illness under this law.

There is no provision to correct an error if lethal medication is given to a patient who has concealed his or her psychiatric history from a prescribing physician. A treating psychiatrist who discovers an error would have no legal means to take custody of or dispose of the medication given to a patient. There is no procedural mechanism to challenge a faulty or erroneous capacity assessment.

A psychiatrist charged with assessing capacity must also rule out the possibility of coercion. In order to do this, the evaluator must be at liberty to interview any individual with relevant information. Under this law, a coerced individual could refuse permission for the evaluator to speak with anyone who has knowledge of the coercion.

The law allows the patient to ingest the medication at the time and place of his or her choosing. Thus, a participating facility could require an inpatient psychiatric unit to allow ingestion on the ward in violation of ward suicide prevention policies. This would be particularly detrimental on units designed for the treatment of eating disorders or in geriatric units, where it would be most likely to occur. People with mental illness also develop co-occurring serious medical conditions such as diabetes; since the law does not require the patient to accept any treatment, this condition would qualify as “terminal” if the individual refuses insulin (Oregon Health Authority 2018). California's health department regulations mandate that state psychiatric facilities must carry out assisted suicides within their units under certain conditions (9 CCR §4601).

Conclusion

Several additional deficiencies have been identified by other opponent groups, and the Maryland Psychiatric Society endorses these concerns. These include:

1.  No requirement for decisional capacity at the time of ingestion.
2.  No requirement for an independent or law enforcement observer at the time of ingestion.
3.  No mechanism to detect a negligent, incompetent, or malicious prescriber.
4.  The risk to third parties in the home (depressed or mentally ill family members).
5.  Detrimental psychological effects on the involved medical professional.
6.  No requirement for a doctor to notify a power of attorney or guardian that a prescription has been requested.
7.  Potential federal civil rights violations if the eligible person is institutionalized in a correctional facility or state hospital where prevention of suicide is an affirmative obligation.
8.  The lack of mental health screening instruments validated in this population for this purpose.
9.  No mandatory reporting or whistleblower protection for healthcare providers aware of negligent or malicious prescribers

References:

Anfang S et al. APA Resource Document on Physician Assisted Death. American Psychiatric Association 2017.

Blasco-Fontecilla, Hilario. “On Suicide Clusters: More than Contagion.” The Australian and New Zealand Journal of Psychiatry 47, no. 5 (May 2013): 490–91. https://doi.org/10.1177/0004867412465023.

California. Petitions to the Superior Court and Access to the End of Life Option Act. 9 CCR §4601 (2016).

Carmichael, Victoria, and Rob Whitley. “Media Coverage of Robin Williams’ Suicide in the United States: A Contributor to Contagion?” PLOS ONE 14, no. 5 (May 9, 2019): e0216543. https://doi.org/10.1371/journal.pone.0216543.

Colorado End-of-Life Options Act, Year One 2017 Data Summary. Available at: https://drive.google.com/open?id=1kBXgAFzHl6kcfsvtLHfOQ94Unk9mDa-  Accessed February 2, 2020

Connecticut Division of Criminal Justice. Written Testimony Regarding HB7015. 2015. Available at https://www.cga.ct.gov/2015/JUDdata/Tmy/2015HB-07015-R000318-Division%20of%20Criminal%20Justice%20-%20State%20of%20Connecticut-TMY.PDF. Accessed February 4, 2020

Dance, Scott. 2014. “Maryland Strips Doctor of License for Assisting in Six Suicides - Baltimore Sun.” Baltimore Sun, December 30, 2014. https://www.baltimoresun.com/health/bs-hs-suicide-doctor-20141230-story.html.

Death with Dignity National Center. Stories. Available at: https://www.deathwithdignity.org/stories/  Accessed February 2, 2020.

Johnson, Will. 2016 “Brittany Maynard’s Story Sends the Wrong Message to Young People.” Accessed February 2, 2020. https://www.choiceillusioncolorado.org/2016/10/brittany-maynards-story-sends-wrong.html.

Lewis, Penney, and Isra Black. “Reporting and Scrutiny of Reported Cases in Four Jurisdictions Where Assisted Dying Is Lawful: A Review of the Evidence in the Netherlands, Belgium, Oregon and Switzerland.” Med Law Int 13, no. 4 (2013): 221–39.

Marzuk PM, Tardiff K, Hirsch CS, Leon AC, Stajic M, Hartwell N, Portera L (1993) Increase in suicide by asphyxiation in New York city after the publication of Final Exit. N Engl J Med 329:1508–1510.  https://doi.org/10.1056/NEJM199311113292022

Munson, Kyle, and Jason Clayworth. 2016. “Suicide with a Helping Hand Worries Iowans on Both Sides of ‘Right to Die.’” Des Moines Register, November 25, 2016. https://www.desmoinesregister.com/story/news/investigations/2016/11/25/too-weak-kill-herself-assistance-legal/92407392/.

Oregon. Death With Dignity Annual Reports. Available at: https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Pages/ar-index.aspx Accessed February 2, 2020
Oregon Health Authority. 2018. Responses to Fabian Stahle. Available at: https://drive.google.com/file/d/1XopTDjBA2SAVBGBxpDazNN899eTHixSe/view. Accessed February 4, 2020

Shreiber, J, and L Culpepper. 2020. “Suicidal Ideation and Behavior in Adults.” Up-to-Date, January. https://www.uptodate.com/contents/suicidal-ideation-and-behavior-in-adults.

Oregon assisted suicide lobby wants to expand the assisted suicide law.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

I have always said that the Oregon assisted suicide law was designed to extend suicide by physicians to other states. The assisted suicide lobby controlled the law and maintained the lie that there were no problems with the law. I knew that eventually they would decided to expand the provisions of the law.

Recently, the leader of C & C, formerly the Hemlock Society, outlined their commitment to eliminate provisions in the assisted suicide laws.

This year, the assisted suicide lobby is proposing Brittany's Bill in the Oregon legislature. I have not seen the particulars but the website from the assisted suicide lobby group states:

Brittany's Bill is a new bill that will be introduced in the 2019 Oregon Legislative Session. It's purpose is to expand the current Death with Dignity Law. The end result will be to change the eligibility of people who can take advantage of this choice. Currently, only patients diagnosed with a terminal illness and a life expectancy of six months are eligible. Brittany's Bill will expand the eligibility to any patient with an incurable disease or experiencing unbearable pain.

An article by Bruce Yelle, the director of the lobby group, end-of-life choices, published in the Register Guard states:

In the upcoming 2019 Oregon Legislative session there will be bills, including one called Brittany’s Bill, introduced in both the Senate and House health committees to expand Oregonians’ end-of-life choices. 

In the article Yelle makes reference to people:

• who have become incompetent and therefore cannot access assisted suicide;
• who do not meet the six month prognosis requirement, a provision that is fatally flawed already;

Expansive assisted suicide bills that lack clear definitions are the new normal. For instance that New Mexico assisted suicide bill is the most radical bill that I have ever seen.

A new era in the assisted suicide debate in America has begun.

Prevention Is the Right Answer to Assisted-Suicide Requests

This article was published by the National Review online on October 8, 2018.

Wesley Smith

By Wesley Smith

We only seek to prevent some suicides these days. If a suicidal person lives in a state where assisted suicide is legal, and is qualified to receive prescribed poison with which to overdose, they will probably never receive prevention interventions.

That’s an abandonment. In Scientific American, Michael Shermer reviews a book about suicide and describes how prevention can benefit any suicidal person. From, “Why Do People Kill Themselves?” (my emphasis):

Like most human behavior, suicide is a multicausal act. Teasing out the strongest predictive variables is difficult, particularly because such internal cognitive states may not be accessible even to the person experiencing them. We cannot perceive the neurochemical workings of our brain, so internal processes are typically attributed to external sources. Even those who experience suicidal ideation may not understand why or even if and when ideation might turn into action.

This observation is reinforced by Ralph Lewis, a psychiatrist at the University of Toronto, who works with cancer patients and others facing death, whom I interviewed for my Science Salon podcast about his book Finding Purpose in a Godless World (Prometheus Books, 2018). “A lot of people who are clinically depressed will think that the reason they’re feeling that way is because of an existential crisis about the meaning of life or that it’s because of such and such a relational event that happened,” Lewis says. “But that’s people’s own subjective attribution when in fact they may be depressed for reasons they don’t understand.” In his clinical practice, for example, he notes, “I’ve seen many cases where these existential crises practically evaporated under the influence of an antidepressant.”

Assisted suicide advocates claim this has nothing to do with their cause because the terminally ill just don’t want to die in agony.

But that’s more fear mongering to win a political debate than reality. The actual reasons people commit assisted suicide or ask for euthanasia–verified from the published statistics from Oregon, Netherlands, and elsewhere–usually has little to do with physical pain. Rather, people ask for suicide help because of existential issues, such as fears of being a burden or being remembered poorly by their loved ones after going through a natural dying process (one of Brittany Maynard’s two primary reasons for wanting to die).

Don’t get me wrong: These are crucial issues that should be taken very seriously. The good news is that they can often be remedied:

In consulting suicide attempt survivors, Lewis remarks, “They say, ‘I don’t know what came over me. I don’t know what I was thinking.’ This is why suicide prevention is so important: because people can be very persuasive in arguing why they believe life—their life—is not worth living. And yet the situation looks radically different months later, sometimes because of an antidepressant, sometimes because of a change in circumstances, sometimes just a mysterious change of mind.”

Exactly. I have met such people who would be qualified for assisted suicide. Indeed, my last hospice patient (I was a volunteer) died peacefully in his sleep of ALS. When I first met Bob, he described being suicidal and wanting to go to Kevorkian (this was in the 90s). His family refused to cooperate and he was so glad! He told me that after some months of just wanting to be dead (because he could not properly support his family anymore and felt abandoned by his priest), that he had “come out of the fog” (his words). He later wrote about how the assisted suicide movement corroded his morale and was harmful to the wellbeing of terminally ill people. Please read it here.

When we accede to an assisted suicide request of a person with a terminal illness, we send the insidious message: “Of course you want to die. I would too in your place.” That’s potentially devastating. And families dragged into the death spiral may support their loved one’s suicidal wishes thinking they are being supportive–when they are unintentionally confirming the patient’s worst fears and unaware that with proper care, their loved one could, one day, be thankful they did not commit suicide.

In Oregon, Other Suicides Have Increased with the Legalization of Assisted Suicide

The following article was published by Choice Is An Illusion Montana. (shortened version).

Margaret Dore

By Margaret Dore Esq

Since the passage of Oregon’s law allowing physician-assisted suicide, other suicides in Oregon have steadily increased. This is consistent with a suicide contagion in which the legalization of physician-assisted suicides has encouraged other suicides. In Oregon, the financial and emotional impacts of suicide on family members and the broader community are devastating and long-lasting.[1]

A.  Suicide is Contagious 

It is well known that suicide is contagious. A famous example is Marilyn Monroe.[2] Her widely reported suicide was followed by “a spate of suicides.”[3]

With the understanding that suicide is contagious, groups such as the National Institute of Mental Health and the World Health Organization have developed guidelines for the responsible reporting of suicide, to prevent contagion. Key points include that the risk of additional suicides increases:

[W]hen the story explicitly describes the suicide method, uses dramatic/graphic headlines or images, and repeated/extensive coverage sensationalizes or glamorizes a death.[4] 

B. Assisted Suicide in Oregon

In Oregon, prominent cases of physician-assisted suicide include Lovelle Svart and Brittany Maynard.

Lovelle Svart died in 2007.[5] The Oregonian, which is Oregon’s largest paper, violated the recommended guidelines for the responsible reporting of suicide by explicitly describing her suicide method and by employing “dramatic/graphic images.” Indeed, visitors to the paper’s website were invited “to hear and see when Lovelle swallowed the fatal dose.”[6] Today, ten years later, there are still photos of her online, lying in bed, dying.[7]

Brittany Maynard reportedly died from physician-assisted suicide in Oregon, on November 1, 2014. Contrary to the recommended guidelines, there was “repeated/extensive coverage” in multiple media, worldwide.[8] This coverage is ongoing, albeit on a smaller and less intense scale.

C. The Young Man Wanted to Die Like Brittany Maynard

A month after Ms. Maynard’s death, Dr. Will Johnston was presented with a twenty year old patient during an emergency appointment.[9] The young man, who had been brought in by his mother, was physically healthy, but had been acting oddly and talking about death.[10]

Dr. Johnston asked the young man if he had a plan.[11] The young man said "yes," that he had watched a video about Ms. Maynard.[12] He said that he was very impressed with her and that he identified with her and that he thought it was a good idea for him to die like her.[13] He also told Dr. Johnston that after watching the video he had been surfing the internet looking for suicide drugs.[14] Dr. Johnston’s declaration states:

He was actively suicidal and agreed to go to the hospital, where he stayed for five weeks until it was determined that he was sufficiently safe from self-harm to go home.[15]

The young man had wanted to die like Brittany Maynard.

D. In Oregon, Other Suicides Have Increased with Legalization of Assisted Suicide

Oregon government reports show the following positive correlation between the legalization of physician-assisted suicide and an increase in other suicides.  Per the reports:

• Oregon legalized physician-assisted suicide “in late 1997.”[16]
• By 2000, Oregon’s conventional suicide rate was "increasing significantly."[17]
• By 2007, Oregon's conventional suicide rate was 35% above the national average.[18]
• By 2010, Oregon's conventional suicide rate was 41% above the national average.[19]
• By 2012, Oregon's conventional suicide rate was 42% above the national average.[20]
• By 2014, Oregon's conventional suicide rate was 43.1% higher than the national average.[21]
  

 

E. The Financial and Emotional Cost of Suicide in Oregon 

Oregon’s report for 2012 describes the cost of suicide as “enormous.” The report states:

Suicide is the second leading cause of death among Oregonians aged 15 to 34 years, and the eighth leading cause of death among all ages in Oregon. The cost of suicide is enormous. In 201[2] alone, self-inflicted injury hospitalization charges in Oregon exceeded $54 million; and the estimate of total lifetime cost of suicide in Oregon was over $677 million. The loss to families and communities broadens the impact of each death. (footnotes omitted).[22]

Footnotes:

[1]  Shen X., Millet L., Suicides in Oregon: Trends and Associated Factors. 2003-2012, Oregon Health Authority, Portland Oregon, p.3, Executive Summary. 

[2]  Margot Sanger-Katz, “The Science Behind Suicide Contagion,” The New York Times, August 13, 2014.

[3]  Id.

[4]  "Recommendations for Reporting on Suicide,” The National Institute of Mental Health. See also “Preventing Suicide: A Resource for Media Professionals,” World Health Organization, at http://www.who.int/mental_health/prevention/suicide/resource_media.pdf.

[5]  Ed Madrid, “Lovelle Svart, 1945 - 2007, The Oregonian, September 28, 2007. 

[6]  Id.

[7]  The still shots at this link, are still up today, July 7, 2017.

[8]  The worldwide coverage of Ms. Maynard in multiple media started with an exclusive cover story in People Magazine. Other coverage has included TV, radio, print, web and social media.

[9]  Declaration of Williard Johnston, MD, May 24, 2015. 

[10]  Id.

[11]  Id.

[12]  Id.

[13]  Id.

[14]  Id.

[15]  Id.

[16]  Oregon's Death with Dignity report for 2016, p. 4, first line. 

[17]  Oregon Health Authority News Release, September 9, 2010, at https://choiceisanillusion.files.wordpress.com/2017/07/news-release-09-09-10.pdf ("After decreasing in the 1990s, suicide rates have been increasing significantly since 2000").  

[18]  Suicides in Oregon: Trend and Risk Factors, issued September 2010 (data through 2007). 

[19]  Suicides in Oregon: Trends and Risk Factors, 2012 Report (data through 2010). 
[20]  Suicides in Oregon: Trends and Associated Factors, 2003-2012 (data through 2012). 
[21] Oregon Vital Statistics Report 2015 (data through 2014;
at page 6-26, third full paragraph)

[22]  See https://choiceisanillusion.files.wordpress.com/2017/07/suicides-in-oregon-2003-2012-p-6.pdf  

Logan Paul and the Suicide Contagion effect

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Newsweek recently published an excellent article by Joseph Frankel concerning the suicide contagion effect. The article is based on the video that Logan Paul posted on Youtube that showed the body of a Japanese man who died by suicide. The video achieved 6 million views before Youtube removed the posting. The Newsweek article examines the question: Is Suicide Contagious?

Sign the Euthanasia Prevention Coalition petition: Tell CBC to stop producing one-sided propaganda programs on assisted death (Link).

According to Frankel, the suicide contagion effect has been proven by many studies.

“Even though people do still wonder how a behavior as serious as suicide can be contagious, there are consistent results from so many studies that indicate that following a media story, suicide rates go up,” Madelyn Gould, an epidemiologist at Columbia University who studies suicide risk and prevention, told Newsweek. Gould also points out this is "far from the first example of the dangers of amplifying stories of suicide." 

And it’s far from the first time that media outlets have had to reckon with the question of suicide contagion: the phenomenon of increased risk of suicide after exposure to suicide, including depictions of or reporting on suicide in the media. Last May, the Netflix series 13 Reasons Why featured a graphic scene depicting a character’s suicide. The show sparked several articles examining whether the series would stoke the effect, along with a research study in JAMA Internal Medicine showing Google searches for terms related to suicidal thoughts spiked after the show’s release.

Frankel explains the history of the suicide contagion effect:

The 1772 novel The Sorrows of Young Werther tells the story of a young man who kills himself after a failed romance. It was reportedly banned in several cities for fear that young people in Europe, many of whom mimicked the protagonist’s style of dress, would take their own lives as well. This phenomenon has been dubbed the Werther effect, a term that researchers have adopted over a century after the book’s publication. 

The Werther effect is a touchstone in research and writing about suicide. But, researchers have also found a flipside in the the “Papageno effect”: reported stories that focus on people who have suicidal thoughts, and ultimately find ways of coping and surviving were associated with a decrease in the suicide rate.

After almost 20 years of experience with the assisted suicide issue, I am convinced that media articles promoting assisted suicide has an assisted suicide contagion effect. Studies and research appears to agree with this assertion. Dr Will Johnston reported that his patient became suicidal after watching the Brittany Maynard video.

Frankel states, in the article, that the media is responsible for reporting in a manner that prevents harm and he refers to the Austrian reporting guidelines but he does not refer to the World Health Organization guidelines for reporting on suicide.

Clearly the way suicide and assisted suicide is reported effects the public.

• CBC airs propaganda programs promoting assisted death.
• Liberal MP - Robert-Falcon Ouellette will vote against euthanasia bill.
• Why on earth is anyone surprised by the rise in US suicides. Advertising works. 
• Brittany Maynard story: a suicide contagion.

I’m dying of brain cancer. I prepared to end my life. Then I kept living.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

The Washington Post published an interesting article on September 27 about a man who was diagnosed with an aggressive brain tumor, similar to Brittany Maynard, and who planned to die by assisted suicide, but has kept on living.

Jeffrey Davitz, a scientist and silicon valley entrepreneur, was diagnosed in April 2015 a lethal and aggressive brain tumor, a brainstem glioblastoma multiforme in an advanced stage. At that time he was given, at most, six months to live with treatment.

Davitz explains that he supported assisted suicide during the California assisted suicide debate and he was planning to die by assisted suicide. He decided to accept treatment with the hope of living a little longer, while expecting that he would eventually die by assisted suicide. But then he started feeling better. Davitz states:

Jeffrey Davitz

As I waited for the (assisted suicide) law to go into effect, I began to feel some creeping uncertainty about my decision to die. There were things I still wanted to do, like see my daughter’s high school graduation. I was ready to go, I thought, and yet I was conflicted. 

Then a peculiar thing happened: I started to get better. 

... I noticed that I was getting stronger: I had been almost bedridden in the early stages of my illness, too weak to walk. But my strength began to return, and as it did, I felt the dizziness that had come with the diagnosis recede. I regained my balance. Strange symptoms, such as a weird full-body buzz that had begun when I lowered my head, also faded away. Soon, I was having somewhat normal days, doing some professional things, socializing and exercising. 

I was an unusual hospice member — eventually the program kicked me out, designating me a “hospice graduate,” a label that I still find funny. I celebrated my brother’s 60th birthday with him, attended my daughter’s graduation, saw my parents hit their 72nd wedding anniversary and fell into a kind of life pattern.

My MRIs reflected this. The tumor stopped its relentless advance, and there were even signs of some retreat. My most recent image, in May, surprised my doctors, who saw signs not of the expected encroachment but of a slowing and even dormant process. 

I’ve now lived longer and better than anybody had projected. Suddenly, it’s hard to see self-termination in quite the same way. I could have missed all this.

One of the many flaws with legalizing assisted suicide is that it causes people who have many quality months and sometimes years to live to have their lives ended.

Davitz has not changed his mind about assisted suicide but he concludes by recognizing his internal conflict with assisted suicide. He states:

Sometimes, I wonder: Would dying have been a good choice anyway? In my case, and not speaking generally, the answer is: of course not. I had a surprising, profoundly unlikely path that has led to love and work of special kinds. I got some good luck in the midst of the bad luck, and I have had a great few years — in some peculiar way the ideal life. Not without pain and difficulties, but also with moments of transcendence. 

... But I am not trying to find my way to clear, simple feelings anymore. Instead, long beyond what was expected, I am simply living.

When assisted suicide is legal the decision is influenced by the doctor who has gained the right in law to cause death. 

This may have been a very different story if, from the beginning, his friends, family and medical care-givers said to him, I will not be involved with killing you, but I will ensure that you are properly cared for and that you do not suffer.

Many people fear a bad death and fear suffering, but legalizing assisted suicide is not about gaining a "right to die", but rather it is about giving someone else the right to end my life.