When the right to die becomes a duty to die.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition.

Euthanasia and assisted suicide are currently being debated in England, Scotland, Ireland, Jersey and the Isle of Man. Each jurisdiction is debating a different proposal.

Sonia Sodha

Sonia Sodha wrote an excellent opinion column that was published in the Guardian on April 7, 2024. Sodha wonder who will step in to save the most at risk? and she states: Proponents of legalising assisted dying are right to stop and think of the possible unintended consequences. Sodha explains:

It’s rare to get a politician who openly admits they are torn on an issue, but in recent days there have been two striking examples. First, Wes Streeting, Labour’s shadow health secretary, admitted that though he voted to legalise assisted dying a few years ago, he feels conflicted. Then Nicola Sturgeon, former Scottish first minister, wrote a piece saying that, with new Scottish legislation on the table, the reservations she expected to subside are becoming stronger.

Sodha also supported euthanasia but has now changed her position. Sodha explains:

A decade ago, I would have supported assisted dying out of a respect for personal autonomy and a desire to alleviate suffering. Today, I understand these objectives are not standalone but need to be weighed against the impact on those for whom an abstract liberal notion like autonomy is highly simplistic, and the state-sanctioned wrongful deaths that seem to me impossible to avoid.

Sodha further explains why she now opposes euthanasia:

The first prompt for my reappraisal has been my evolving understanding of the complexity of relationships. We are not all autonomous islands floating in a sea of humanity; we are highly influenced by each other and by cultural norms. Writing about domestic abuse has opened my eyes to the extent that coercively controlling relationships drive people to do things because others want them to. Of course there will be women who get a terminal diagnosis, whose partners have been emotionally abusive to them for years – telling them their life isn’t worth living – who will come under intolerable pressure to opt for assisted dying. How can we ignore that around a third of female suicides are thought to be related to intimate partner abuse? Or that some men who violently kill their sick wives rely on defences such as “mercy killing” and “suicide pacts”, sometimes very effectively? Even the fact that men are much more likely than women to leave their partners after a terminal diagnosis feels salient to understanding the gendered implications.

Sodha explains how the risk of coercion is a wider issue:

The risk of coercion goes beyond intimate partners in a society riven with ageism and anti-disability prejudice; what happened to older people in care homes during Covid is just one example. More than a fifth of people over 65 have experienced physical, emotional, financial or sexual abuse. There are relatives who will find ways – perhaps quite subtly, even unintentionally – of hinting to people with a terminal diagnosis who need round-the-clock care that they should opt for assisted dying. How would that make you feel? Almost half of people who chose assisted death in Oregon in 2022 cited concern about being a burden.

Then there is the internal pressure that arises from some feeling that they ought to do it to save relatives difficulty and financial consequences: where the right to die becomes the duty to die. That message will be reinforced at a societal level; Times columnist Matthew Parris recently argued in a widely condemned column that assisted dying could help address the cost of an ageing population; that there are those willing to be honest about this should give serious pause for thought. Moreover, palliative care doctors talk about how the wish to die is not stable, and often abates in terminally ill patients in the wake of an initial diagnosis, and can be affected by depression, which is hard to diagnose.

Sodha then refers to the International evidence with legalised euthanasia.

The most cited example is Canada, where a limited form of medical assistance in dying (MAiD) was legalised in 2016 for people with “grievous and irremediable medical conditions” with assurances about its narrow scope. Today, that definition has been interpreted to include a person with severe sensitivities to chemicals unable to access appropriate housing from the state, and there have been reports of officials promoting assisted dying to people with disabilities applying for government assistance and medical professionals trying to coerce people into it. A parliamentary committee has recommended MAiD should be extended to some sick children and it is set to be expanded to people with chronic mental illness. In the Netherlands, euthanasia is an option for people who are autistic and lonely and is about to be extended to children of all ages. In Oregon, where the law has remained more stable, terminal conditions today include arthritis and anorexia.

Sodha comments on the House of Lords debate that assured people that safeguards can be maintained. Sodha writes:

Medical professionals are not trained in or necessarily any good at detecting coercive control; judges will have limited evidence to make their own call. In the family courts, judges can fail to detect coercive control even when confronted with detailed evidence about intra-familial relationships. Narcissistic abusers can be highly adept at fooling professionals. What level of outside influence is considered too much, how is it measured, and how sure must a judge be, given life and death is at stake, surely rendering the balance of probability evidentiary threshold usually applied in the family courts inappropriate?

Sadha criticized the House of Lords debate by writing:

In the House of Lords debate, there was a marked failure to engage with these detailed concerns. Some claimed there is no evidence of problems abroad, as if coercively influenced wrongful deaths would magically reveal themselves after the fact. One only need look at the fight to reveal the true number of hidden homicides of women by their abusers to understand the naivety in that and, in somewhere like Oregon, the system is simply not set up to catch wrongful deaths. With brutal utilitarian honesty, former supreme court president Lord Neuberger acknowledged there would be abuses, but argued the benefits for those acting autonomously would outweigh them.

Sodha concludes by challenging politicians to examine the complexity of the issue. She writes:

We live in a social media-driven world characterised by excessive moral certainty, in which powerful individual stories that invoke strong emotions can dominate the discourse to the detriment of the voiceless. There is a real risk that a law gets passed without any of these devastating concerns being addressed. Assisted dying is not a right-left issue, but it garners more support from MPs on the left, including Keir Starmer, and a Labour government might feel under pressure to introduce big reforms that don’t cost money given its self-imposed fiscal constraints. That is why voices like Streeting’s and Sturgeon’s are so important; we desperately need politicians willing to acknowledge that assisted dying is one of the most complex and fraught ethical questions they will ever be asked to confront.

More articles on this topic:

• Warning to Ireland. If euthanasia is legalized as a cure for suffering, then suffering people will be "cured" by euthanasia! (Link). 
• Autistic healthy 28-year-old Dutch woman scheduled to die by euthanasia (Link). 
• Netherlands 2023 euthanasia report. A 23% increase in euthanasia for psychological suffering (Link).

Normalizing assisted suicide will lead to a "Duty to Die."

This article was published by National Review online on April 2, 2024.

By Wesley J Smith

Euthanasia isn’t really about compassion but fear of decline and a loathing of dependency — and of those experiencing them.

That nasty truth has become abundantly clear with a new column published in the Times of London in which former Tory MP Matthew Parris argues that euthanasia/assisted suicide should not only be permitted — but encouraged. In “We Can’t Afford a Taboo on Assisted Dying,” he writes (my emphasis):

I can’t dispute the objectors’ belief that once assisted dying becomes normalized we will become more apt to ask yourselves for how much longer we can justify the struggle.

The word “justify” is telling. It does not only concern the suffering of the person who is ill, disabled, or elderly but the suffering that person is supposedly causing to family and society. Parris believes that, eventually, for such a person to continue to live will be considered unjustifiable:

Is life still giving us more pleasure than pain? How much is all this costing relatives and the health service? How much of a burden are we placing on those who love us? How much of a burden are we placing on ourselves? . . .

If assisted dying becomes common and widely accepted, hundreds of thousands — perhaps millions — will consider choosing this road when the time comes, and in some cases, even ask themselves whether it would be selfish not to. . . .

Within a decade or more [assisted suicide] will be seen as a normal road for many to take, and be considered socially responsible –– and even, finally, urged upon people.

In other words, the creation of a “duty to die.” Come on, Granny! Time to swallow the pills. We need your money to send Junior to college.

Parris sees the future as a war between the old and sick and the young and healthy based on the cost of caring for people with dementia, disabilities, and serious illnesses:

This [resource] imbalance helps explain the government’s desperate reliance on immigration — to the rage of electorates who won’t face the fundamental question: how are our economies going to pay for the ruinously expensive overhang that dare not speak its name: old age and infirmity?

Does everyone who supports euthanasia/assisted suicide desire this end? Of course not. But Parris’s logic is impeccable. Regardless of people’s intentions, these are exactly the consequences to which the right to die juggernaut will lead if general society buys his argument.

Parris’s piece clearly lays out the policy and moral issues that we should be debating, rather than the phony-baloney assertions that assisted suicide is only for the terminally ill for whom nothing else can be done to alleviate suffering. That is not true, and indeed, such proposals are merely stations on the way to creating a crassly abandoning society in which the weakest and most vulnerable among us become a killable caste.

 

You Don’t Want to be a Burden, Do You?

This article was written and published by Nancy Valko on April 26, 2018.

Nancy Valko

By Nancy Valko

An April 13, 2018 USA Today op-ed titled “Make an End-of-life plan or Lose your Money and Choices in your Dying Days” by Hattie Bryant begins with the statement “End-of-life care can bankrupt your family and rob you of choices. End the denial about dying. Make a plan in case you end up seriously ill and frail.” (Emphasis added)

Ms. Bryant is very upfront about using the economic argument about aging and the enormous toll it can take financially and personally on the family as well as medical costs. She states that “in 2011, Medicare spent $554 billion and 28%, or about $170 billion, on patients’ last six months of life. After $170 billion is spent, those patients are still dead.”

Her solution is a new kind of economic advance directive she developed (and is selling as a book titled “I’ll Have It My Way: Taking Control of End-of-Life Decisions“ ) “that deals with how you want your funds spent when you are seriously ill or frail.” (All emphasis added)

Should We Have A “Duty To Die”?

Back in 1984, Governor Richard Lamm of Colorado found himself in the middle of a firestorm of outrage when, as the New York Times reported, “Governor Lamm Asserts Elderly, If Very Ill, Have a ‘Duty to Die”.

Here is an excerpt from the article:

“Elderly people who are terminally ill have a ''duty to die and get out of the way'' instead of trying to prolong their lives by artificial means, Gov. Richard D. Lamm of Colorado said Tuesday.

People who die without having life artificially extended are similar to ''leaves falling off a tree and forming humus for the other plants to grow up,'' the Governor told a meeting of the Colorado Health Lawyers Association at St. Joseph's Hospital.

''You've got a duty to die and get out of the way,'' said the 48-year-old Governor. ''Let the other society, our kids, build a reasonable life.''

This philosophy was echoed in 2014 by one of the architects of Obamacare, Dr. Ezekiel J. Emanuel, when he wrote “Why I Hope to Die at 75-An argument that society and families—and you—will be better off if nature takes its course swiftly and promptly” for The Atlantic Magazine.

At age 57 at the time, Dr. Emanuel states that while death is a loss, there “is a simple truth that many of us seem to resist: living too long is also a loss” that “renders many of us, if not disabled, then faltering and declining, a state that may not be worse than death but is nonetheless deprived. It robs us of our creativity and ability to contribute to work, society, the world. It transforms how people experience us, relate to us, and, most important, remember us. We are no longer remembered as vibrant and engaged but as feeble, ineffectual, even pathetic.” (Emphasis added)

He states that he will stop trying to prolong his own life by age 75.

Conclusion

Helping to care for many terminally ill or seriously disabled relatives, friends and patients of all ages for many decades both professionally and personally, I have a different perspective.

We are all born dependent on others for care and many of us need at least some help from others at the end of our lives. This can be hard at times-as even parents of newborns will attest-but the rewards are great both for the helper and the person being helped.

I remember when my mother with Alzheimer’s and terminal thyroid cancer was dying in 1988. It wasn’t the most convenient time for us, to say the least. I was a suddenly single parent with three young children and financially struggling. My mother no longer recognized me but, as I told a friend, the most important issue was that I recognized her. As a family, we did what was medically reasonable for my mother to help her without either prolonging or hastening her dying.

Taking care of my mother was a wonderful, if occasionally difficult, experience and I am grateful that we were able to keep her at home almost to the very end.

The final result was that my mother was kept safe, comfortable and loved. Her funeral was truly a celebration of her life and my children learned an important lesson about the circle of life and taking care of each other. We still talk fondly about their time helping with grandma, even after 30 years.

When I made out my own advance directive, I made sure that it was as protective as possible against a hastened death. I don’t fear death. I do fear the bio-ethicists and others who use economics and fear to push especially older people into prematurely signing away their rights to even basic care and what this does to our society.

What about assisted suicide's impact on those left behind?

The following article was published in the Montreal Gazette on March 9, 2015.

By Derek Miedema:

“No man is an island” said John Donne. We are not only radical individuals. Our lives and our deaths have profound consequences for those we love and those who love us. How we die is not solely our domain, but touches families, friends and our communities.

The makeshift roadside memorials and ghost bikes chained to light posts on busy city corners remind us that how one leaves the world lingers long after the last breath. Suffering does not end at death — not for those left behind.

When the Supreme Court of Canada struck down the prohibition on euthanasia and assisted suicide in the name of personal autonomy, it did not address the suffering of grieving families. In fact, the court’s decision last month introduced further tensions within families with a suffering loved one.

Assisted suicide adds a whole new dimension to the dying process for families and friends of the seriously ill. Choosing whether or not to kill yourself could never be described as simple. Take this example from Washington State: Attorney Margaret Dore recounts the story of a client in the state of Washington where assisted suicide has been legal since 2009. The client found herself caught in a family feud over whether or not her ailing father should take a prescribed lethal dose to kill himself. The adult daughter was distraught and the family divided. Worse still, her father lived his final months caught in the middle, unsure whether he should kill himself or not.

In situations like this, the dying family member can feel like a burden on his loved ones. The sad reality is this: The option of assisted suicide transforms the feeling of being a burden into consideration of a duty to die.

Sometimes, that duty to die can be imposed by someone outside the family, leaving individuals and family members to defend their right to life.

Last year, my own twin brother, severely handicapped from birth, was admitted to his local hospital with pneumonia. A family member stayed by his side, but during a few hours that he was alone, a purple bracelet appeared on his arm. Since the medical staff wouldn’t volunteer what it meant, my mother inquired about it, and was told it indicated a “do not resuscitate” order. My severely handicapped brother can’t speak and eats through g-tube. His doctors, without input from our family, labelled him better off dead than suffering from pneumonia. The possibility that my brother could be left to die in a hospital terrifies my family. It complicates caring for and protecting him.

Right to die becomes a duty to die.

This article was originally published on July 23, 2014 in the Lethbridge Herald.

Focus should be on caring not killing

By Mark Penninga

Recently Mr. John Warren, vice chair of the organization Dying with Dignity, made the argument in this paper that the Supreme Court’s upcoming decision about assisted suicide will determine who owns your life – “you or the state.”

He referenced Sue Rodriguez who suffered from ALS and pleaded for the right to have a doctor end her life. Although she lost her case in a 1993 decision of the Supreme Court, Mr. Warren argues that public opinion has changed dramatically since then.

I hope we can all agree that we have a moral obligation to dig deeper than shifting public opinion. It is not enough to reduce this issue to emotional stories or catch-phrases like “dying with dignity.”

Will legalizing euthanasia or assisted suicide mean that you “own your life”? This is an example of how right-to-be-killed advocates twist the facts to appear reasonable and compassionate. But not even “Dying with Dignity” would be willing to apply this logic consistently. Nobody in this case would advocate for an unrestricted right to die. If a 12-year-old victim of bullying requests suicide, we all would agree that her family and the rest of society better be there to care for her and address the bullying, not give her a lethal injection. Even if Canada becomes the most permissive nation in the world when it comes to euthanasia, there will still be some elites, be they judges, lawyers, politicians or doctors, who get to decide who “owns their life.”

What is often ignored is that as soon as assisted suicide or euthanasia are legalized, the right to life that everyone is supposed to possess moves from objective to subjective. That means that instead of having dignity and worth simply because we are human, we now have to prove our worth to an ever-changing standard that is imposed on us. That hardly sounds dignified.

In a country where assisted suicide is legal, a 70-year-old who has been diagnosed with dementia has to explicitly or implicitly prove to those around her why she should stay alive. She has to justify her continued existence at a time when she feels most vulnerable. A right to die quickly turns into an obligation to die.

One has only to look at the places in the world where euthanasia was legalized to see evidence of this subjective standard. In the Netherlands and Belgium it took very little time for their “strict” euthanasia laws to change and now even include children and infants. Think for a moment of what it means to tell an eight-year-old that they have a right to die! A Canadian Medical Association Journal study also found that close to a third of the euthanasia deaths in one region of Belgium were done without consent.

So much for owning your own life. Euthanasia and assisted suicide doesn’t give you ownership of your life. It takes life away, sometimes even without your consent.

Declaration of Hope: Opposing assisted suicide.

Sign the Declaration of Hope.

We believe that legalizing assisted suicide is bad public policy and should be rejected by every State legislature.

Legalizing assisted suicide enables one citizen to be directly and intentionally involved with causing the suicide death of another citizen. America must not allow its citizens to be involved with causing the death of other Americans. We understand that the most tragic cases will dominate the public discussion, but the issues must be considered based on how it will affect society as a whole.

Assisted suicide is not a socially acceptable response to terminal or incurable illness or chronic conditions. Legalizing assisted suicide may result in some people feeling pressured and thereby considering themselves or their loved ones as ‘better-off-dead’. Some people will feel obliged to justify why they want to continue medical treatment. For many, including attending physicians, assisted suicide would become the unspoken, but ever present, question resulting in a subtle, negative change to the doctor-patient relationship. Will this result in a “duty to die”?

The government must not place the lives of citizens at risk. Legislators need to apply the precautionary principle: the higher the risk – the higher the burden of proof on those proposing legislation. The risk of abuse cannot be eliminated.

Assisted suicide poses a threat to the equality of persons. The lives of some in our community will be considered — “not worth living”. Among those at greatest risk are the elderly, the lonely, those living with disabilities, those experiencing chronic illness and those with limited access to good medical care. Laws that prohibit assisted suicide protect every Americans equally.

Older people are not a problem to be rid of — they’re a generation to be honored and cared for. Elder Abuse has become a significant problem in America. We cannot ignore the possibility that dependent elderly people may be coerced into assisted suicide. We cannot put older Americans at risk by creating new paths to elder abuse.

Legalizing assisted suicide is a recipe for abuse. So-called ‘safeguards’ are an illusion because they are unable to prevent the potential for coercion and abuse.

Every American should have access to quality pain control — no matter where they live. Pain control and palliative medicine should be given a higher priority in medical training so that every American can benefit.

Being involved in one’s health care plan and making informed choices are vitally important to a patient’s sense of well-being. Assisted suicide would weaken the autonomy of patients, reducing their choices about their care and symptom management. Assisted suicide could be increasingly adopted as the easier option to the exclusion of genuine patient centered care.

We firmly oppose assisted suicide legislation. 

Sign the Declaration of Hope.

* Declaration of Hope - Canada.

'Death with Dignity' claims another victim

This article was written by Paul McHugh, a former psychiatrist in chief at Johns Hopkins Hospital. This article was printed on page A13 of the US edition of the Wall Street Journal on May 25, 2013

Now Vermont has joined the misguided movement toward assisted suicide.

Paul McHugh

By Paul McHugh, Wall Street Journal, May 25, 2013

Nearly 30 years ago, Arnold Schwarzenegger's "Terminator" character made famous the phrase "I'll be back," the implacable cyborg assassin's response to a setback. Today, similarly relentless terminators are among us, also with a deadly mission: to move America toward acceptance of physician-assisted suicide.

On Monday, the terminators gained a victory when Vermont Gov. Peter Shumlin signed into law the "Patient Choice and Control at End of Life Act." The bill had been passed by the state legislature the week before without consulting the electorate, possibly because the lawmakers had seen what happened last fall next door in Massachusetts, where voters rejected a similar initiative. Now Vermont doctors will be able to prescribe lethal medication to patients as the state joins Oregon, Washington and Montana in supporting the practice. (Assisted suicide is technically prohibited in Montana)

Hippocratic Oath

So the terminators are back. The reasons for opposing them and opposing physician-assisted suicide never went away. The reasons have been with us since ancient Greek doctors wrote in the Hippocratic oath that "I will neither give a deadly drug to anybody if asked for it nor will I make a suggestion to that effect." The oath is a central tenet in the profession of medicine, and it has remained so for centuries.

Dr. Leon Kass, in a brilliant essay on the Hippocratic oath in his 1985 book "Toward a More Natural Science," explains why this has been true. Medicine and surgery, he says, are not simply biological procedures but expressions, in action, of a profession given to helping nature in perpetuating and enhancing human life. "The doctor is the cooperative ally of nature," Dr. Kass writes, "not its master." It shouldn't need saying, but the exercises of healing people and killing people are opposed to one another.

Traditionally the public rests its trust in doctors on this understanding of medicine. Doctors occasionally remind the public of it when they explain why they do not participate in capital punishment or bear arms in military service.

But the terminators who champion physician-assisted suicide propose that, as seen in intensive-care units, contemporary medicine prolongs unnecessary suffering.

As a psychiatrist, I work with doctors on such units, and I can testify that all of them realize that human life itself is limited in duration and scope. These doctors regularly consider just how far they should go in sustaining a hope for recovery—cooperating with nature's resilience in treating advancing disease. They also consider when prolonging a futile effort should be replaced by comforting the person as his life naturally comes to an end. The judgment is delicate, though, and most families are justified in leaving it to skilled physicians.

Another argument for physician-assisted suicide is that many patients with cancer live too long in pain. The suffering could be reduced if their legitimate wish for death were fulfilled. These are the arguments pressed by Dr. Timothy Quill and many in the Oregon "death with dignity" group.

Dr. Kathleen Foley

But scientific publications from oncologists such as Kathleen Foley, who studies patients with painful cancers, reveal that, quite to the contrary, most cancer patients want help with the pain so they can continue to live. Suicide is mentioned only by those patients with serious but treatable depressive illness, or by those who are overwhelmed by confusion about matters such as their burden on loved ones and their therapeutic options. These patients are relieved when their doctors attend to the sources of their psychological distress and correct them.

In the nearly two decades that Oregon has permitted physician-assisted suicide, I became suspicious that just such depressed and confused patients number large among those who ask for and take life-ending poisons. Why suspicious? Because the law does not demand a psychiatric assessment before they take the fatal step.
Yet all efforts by psychiatrists anxious to read the medical charts of these patients after their deaths have been thwarted by the champions of their suicides, who have shrouded the patients' mental states in secrecy by raising the "privacy privilege." I believe that these doctors are killing patients of the sort that I help every day.

And then there is this talk about "death with dignity," as the Oregon and Washington laws are titled. Surely what we want is "life with dignity." Seeking life, we're ready to endure much in order to keep it going. Think of the life-saving and life-preserving colonoscopy—all dignity drops with your trousers.

The advance of the hospice movement has made a shambles of the terminators' insistence that medicine prolongs suffering and denies dignity. The doctors, nurses and social workers committed to hospice care demonstrate how an alliance with nature at life's end plays out in just the way that the medical profession intends. As hospice ways become more familiar, the public can overcome the fears that the terminators used to win over the Vermont legislature.

For you see, the terminators ultimately are not merely interested in killing people who are suffering the throes of a final illness. They have even others in mind, as history tells us. The drive to allow doctors to "assist" in suicide is not recent. Its roots are in the Progressive era of the early 20th century, when many Americans placed utter confidence in reform and in technocratic elites. Then the enthusiasts for euthanasia lined up with those clamoring for government intervention in the name of eugenics and population control.

Across the decades, Americans have fought off such dire temptations with reasoned arguments about the nature of medicine. Despite Vermont's unfortunate decision, Americans elsewhere likely will continue to defeat physician-assisted suicide at the ballot box and in the statehouse. But the enemies of life are terminators—they'll be back.


Dr. McHugh, former psychiatrist in chief at Johns Hopkins Hospital, is the author of "Try to Remember: Psychiatry's Clash Over Meaning, Memory, and Mind" (Dana Press, 2008).

True Dignity Vermont overwhelms opposition at Senate committee hearing.

The following message is from True Dignity Vermont about the recent hearing on assisted suicide in Vermont.

Opponents of assisted suicide hugely outnumbered proponents at tonight's public hearing before the Vermont Senate Judiciary and Health and Welfare committees. 

Three board members of True dignity got two minutes each to speak, as did many other opponents. The common theme was that legalizing assisted suicide would have unintended consequences such as suicide contagion, elder abuse, the perception by sick people of a duty to die, expansion to euthanasia, expansion to the non terminally ill and the incompetent, and a fundamental and corrupting change in the way both patients and doctors view the practice of medicine.

The proponents did not even try to respond to these concerns. Some actually reinforced them by saying things such as "If I were facing Alzheimer's I would want to have the option of death with dignity.". This is either ignorance or a dead giveaway that the proponents will push for the expansion of assisted suicide to people who are either more than six months from death or incompetent, since that expansion would be necessary to include Alzheimer's patients, who become incompetent earlier than six months before death.

Peter Shumlin, the governor of Vermont, has been pushing for the legalization of assisted suicide throughout his political career. Vermont has faced continuous attempts to legalize assisted suicide over the past several years.

For more information go to: Vermont Governor commits to legalizing assisted suicide, again. 

Netherlands Churches express concern over assisted suicide proposal

An article in the Netherlands paper Reformatorisch Dagblad entitled: Churches express concern about the initiative on Free Will, concerns a joint letter written to the Government house in the Netherlands concerning proposals to allow assisted suicide for people who are “tired of living.”

The letter to the government was sent on behalf of seven denominations of various Reformed Churches in the Netherlands.

The church leaders point out in their letter to the government that the current initiative by the Dutch Euthanasia Society (NVVE) is much wider than the current euthanasia law that was passed in 2002. This new proposal would approve assisted suicide for people who have passed the age 70 years and who are not living with a medical condition related to hopeless and unbearable suffering. The person requests assisted suicide is simply “tired of living.”

The church leaders reminded the government of their call to protect human life. The letter stated that: The protective value of life is a central value, even when life is marked by ill health. The churches emphasized that society is better served by valuing people at every age, instead of legalizing assisted suicide.
Insurmountable objections can be raised against the initiative of "Free Will." The letter stated: Life is not available to man, but has received from God. Therefore we believe it is not lawful to hasten the death for ourselves or for our others.

The letter was also concerned with the psychological pressure that be placed upon many people who are over 70 who want to live. The authors warned that it should not be underestimated how these people will be made to think that they are a burden to their families. The churches were also concerned about the moral pressure on those caring or nursing older people who may be called to assist a suicide.

The Netherlands euthanasia society (NVVE), is preparing advance directives, that will include the request for assisted suicide for "tired of living."

Canadians want good end-of-life care, not euthanasia or assisted suicide.

A recent Environics Research Group poll focussed on Canadian attitudes towards euthanasia. The poll was part of the Environics Research Group Omnibus survey that asks questions to 2000 participants from across Canada.

The poll found that:

* 66% of Canadians want the government to place a greater priority on improved access to palliative care. What was important about this result is that a majority of people in every region or political affiliation wanted the Provincial and Federal governments to place a greater priority on access to palliative care.

* 76% of Canadians expressed concern that elderly persons in abusive situations would be pressured to consent to euthanasia. The Canadian government has made elder abuse prevention a national priority. The poll found that Canadians are concerned about elder abuse and that they recognize that people who are experiencing elder abuse are vulnerable to being pressured into consenting to euthanasia, if it were legal. It is interesting to note that Conservatives were more likely to be concerned about elder abuse than other political affiliations. 

* 74% of Canadians are concerned that, if legal, people with disabilities, people who are sick or elderly would be euthanized without consent. 

* 82% of Canadians oppose the legalization of euthanasia, when the person does not give their consent. 

Politicians should take notice, especially since the Netherlands is now openly supporting euthanasia for people with dementia and they have allowed euthanasia on children born with disabilities, under the Groningen Protocol. It is also important to note that a study published in May 2010, on the practice of euthanasia in Belgium found that 32% of all euthanasia deaths were without explicit request or consent.

It is interesting that in Quebec, where the government established a commission to examine the issue of euthanasia, the poll found that:

* 67% want the government to place a greater priority on improved access to palliative care. 

* 76% were concerned the elderly persons in abusive situations would be pressured to consent to euthanasia. 

* 74% were concerned that, if legal, people with disabilities, or people who are sick or elderly would be euthanized without consent. 

* 79% oppose the legalization of euthanasia, when the person does not give their consent.

Canadians are concerned, that if euthanasia is legalized, vulnerable Canadians, such as those experiencing elder abuse and people with disabilities will be pressured to consent or euthanized without consent.

A Disability Perspective on Euthanasia

Erik Leipoldt sent me the following statement from Australia:

Australia is facing a tsunami of euthanasia Bills. The first to come up is the Criminal Law Consolidation (Medical - Defences) - End Of Life Arrangements Bill 2011 in South Australia.

A comprehensive Disability Position Statement On Euthanasia and Physician-Assisted Suicide was developed by a group of people who have direct experience of living with disability or chronic illness in their lives.

Please read and support the statement by leaving a comment. See the Statement here (I have reprinted the statement in full): http://proliving.blogspot.com/2011/03/disability-position-statement-on.html.

Disability Position Statement on 
Euthanasia and Physician-assisted suicide in Australia - March, 2011

• We are Australians who live with a disability (1) or chronic illness, directly, and/or by our close involvement with people with disabilities/chronic illness, as family, friend or ally.

• We are concerned that euthanasia and physician-assisted suicide (PAS) (2) legislation may be introduced in this country that allows the intentional shortening of life, including on grounds that life with disability is not worth living.

• We oppose the introduction of euthanasia and physician assisted suicide legislation because it is inherently wrong to end a life in answer to suffering (3). This is especially so in absence of the many things we, as a rich society, can do to alleviate suffering.

• We believe that much ‘suffering’ is not primarily caused by a person’s disability or medical condition. It often arises from inadequate care and support, contributing to requests for euthanasia or PAS.

• We believe that state-sanctioned euthanasia and physician-assisted suicide poses great risks to life and well-being of people with disabilities, in particular to highly vulnerable (4) disabled people. It would undermine any social climate of support and life-giving values that they need to live good lives.

• It is a matter of social justice for the status of people with disabilities in our society to be duly considered in this matter (5).

Yes to good quality care and support

No to euthanasia and physician assisted suicide.

Pro-Living calls for…

A halt to introduction of euthanasia and physician-assisted suicide Bills and the development of social policy that:

• Meaningfully supports people with disabilities and those who assist them, to live good lives (6) in the community, where good quality community, health and palliative care service is widely available;

• Affirms disability as a normal part of life in all its diversity;

• Affirms the human worth of people with disabilities as equal to all other human beings;

• Recognises their real needs, takes responsibility for meeting them, does so competently, and in participation with the focal person with a disability, to the fullest extent.

Pro-Living Endorses…

• The Palliative Care Australia Position Statement on Euthanasia and Physician-assisted Suicide (7) with the proviso that acquiring any disability does not of itself indicate “an approaching end of life”.

• The Australian Disability Strategy’s (2011) stated intent of full inclusion of people with disabilities into society, based on the UN Convention on the Rights of Persons with Disabilities. However, ProLiving believes that the acknowledgement of people with disabilities as interdependent should be a guiding principle, rather than regard pursuit of independence as primary.

Pro-Living Believes…

The role of quality disability support is critical

Much community interest in voluntary euthanasia involves fear of pain and suffering, especially that of “loss of dignity” through increased dependence on others, sometimes through the most basic of assistance, such as with toileting, showering and dressing. Where good quality support is provided, many people with disabilities live well with those realities on a daily basis (8). We are not claiming that therefore everyone should do likewise. We merely point to the fact that good quality care is a potent remedy against suffering and fears of suffering and preserves dignity. It contributes to a civil society where those who embody fears about aspects of life, such as fragility, loss of personal control and dependence, are treated as inherently worthy.

Fear of disability may lead to euthanasia

Because of the existence of such fears in our community, and the generally low social worth accorded to people with disabilities, life with disability is easily conflated with that of meaningless, and unbearable suffering. A low ‘quality of life’ is often assigned to living with a disability. This perception makes them vulnerable to being viewed as eligible for euthanasia and physician-assisted suicide, rather than call for good care and support.

Fear of inadequate care and support underlies some euthanasia requests

Fears of a presently inadequate care and support environment, for example ‘ending up in a nursing home’, or ‘stuck on a tube’, also underlie community support for laws that allow the intentional ending of life under such circumstances. The causes of these realistic fears are human-made. They must be addressed at that level by attention to the development of widely available, quality care and support.

About access to quality care and support

We acknowledge that in an imperfect world there may never be enough care and support to address all suffering. At the same time we assert that our wealthy country can and ought to do much more in offering quality care and support than it presently does. By this we do not primarily mean providing more money. We aim for the development, in genuine participation with disabled people and their supporters, of the best possible quality approaches to meeting their needs. Without such quality, and available support in place, it is irresponsible to legislate for euthanasia and PAS as we presently do not attend to all the reasons for people requesting euthanasia. "Unrelievable suffering?"

There are no effective safeguards against abuse of legalized euthanasia and PAS

Long accepted and legal euthanasia practice in the Netherlands (9) and in Oregon (10), as well as more recently in Belgium (11), give no reason for confidence in believing that euthanasia and physician assisted suicide can be properly regulated. To the contrary, they show the inevitability of a widening of eligibility criteria for assisted death beyond terminal illness, beyond ‘pain’, and beyond the person’s own autonomous request. Assisted by expert advice, parliamentary inquiries in the UK, Canada and US have all concluded that effective safeguards are not possible (12).

So-called ‘narrow’ euthanasia Bills, focused on terminal illness and pain, are no safeguard. They are merely a foot in the door to wider criteria, prompted by inevitable calls for additional ‘suffering’ to be treated with ending of life, as the many attempts for such widely constructed Bills show (13).

Illegal euthanasia is no rationale for legalization

Undoubtedly illegal intentional ending of life where life is considered not worth living in our healthcare institutions is happening today (14). We believe that the answer to this situation is to pay attention to better quality and safeguards in care, and safeguards against abuse, not to sanction medically assisted suicide by legalising it.

Changing the doctor-patient relationship

If choosing to have medical assistance to end one's life becomes a legal option it will have to presented as an option to people with chronic illness or disability who meet the requirements, as their right. Such an offer from health professionals would dramatically change the doctor-patient relationship and our dependence on their medical support in living our lives in good health. Many people with disabilities also depend on doctors for many social benefits, allowances and subsidies, where doctors are gatekeepers. Given research, showing a high level of negative attitudes towards disability, the roles of healer, gatekeeper and life terminator provide such tensions and conflicts of interest that the doctor-patient relationship is severely eroded by it. This further adds to a high vulnerability of people with disabilities.

Putting us out of our misery

Under a requirement of being offered euthanasia, as a legal option, our lives as disabled people would be contingent on our will to keep living in the face of the possibility that carers and family members may be thinking that we should take the option available, and our fear that we should put ourselves out of their misery in having to cope with us.

Euthanasia undermines civil society

Huge and unprecedented social, environmental and economic changes are upon us, in the form of the effects of climate change. In a society under pressure, where the response to suffering is sanctioned as killing the sufferer, presently highly vulnerable people are increasingly at risk of being treated as cumbersome, unproductive burdens, beginning with a reduction in their entitlements from the public purse, and ending with an obligation to remove themselves from the planet. On the other hand, a truly caring society, with an eye for the realities of dependence, fragility, and limitations in life, will be inclusive and socially sustainable.

Equal human worth

All people with disabilities are equally worthy to any other human being, possessing a meaningful and purposeful life by virtue of their own potential to grow as a human being, whether or not the nature and rate of that growth or its potential can be readily discerned. They should be treated accordingly, in the best spirit of care.

Disability is a normal part of life

Disability is inherent in the diverse experience of the human condition. Anyone of us appear on a scale from dependent to ‘independent’, rational to non-rational, able to less-able at any one time in our lives. A pro-living disability perspective on euthanasia is therefore relevant, and of value to all.

Autonomy, choice and independence

Much of the euthanasia debate revolves around rights to exercising personal choice. While it is true that people with disabilities are trying to rise up from very low levels of personal autonomy and choice, it is quite another thing to let respect for these principles decide in favour of euthanasia. Especially when they are being denied autonomy and life choices in a range of important areas. Many people with disabilities need better and real choices about needs like health, accommodation and work: a better life balance in other words. Independent living in disability means living in an ordinary home, with support, in a community: enjoying relationships, not being isolated. Many people with disabilities are limited in their capacity to be an autonomous human being because of cognitive impairments or mental illness. This renders autonomy a principle of limited value in euthanasia. It also means that such people with disabilities, who are thus impaired in judgment, are vulnerable to involuntary or nonvoluntary euthanasia by those who want to address suffering through euthanasia in a broad sense. Autonomy, like independence, is actually an illusion in the lives of many people with disabilities (15).

Engagement, not polls

Currently the debate is driven by polls that ask quick, simplistic questions on complex issues, involving end of life support. Disability, as is death, dying and responses to them, are mostly poorly understood by the community (16). A variety of ways of engaging with those realities must be explored, in the interests of a meaningful debate and ongoing safeguard to human wellbeing. No legislation should be passed on uninformed, uneducated assumptions.

Some context

While some progress has been made, a broadly socially devalued status for people with disabilities in Australia exists. This has resulted in their exclusion from many pursuits that are regarded as normal in our country. These include activities that people in the community typically do, for example, work, attend school and university, participate in social activities, maintain familial relationships, live in regular housing, and use public transport. Those whose impairments raise the greatest challenges to participating in these ways, such as some with significant mental illness, cognitive impairment and dementia, are among those with the highest vulnerability to abuse and covert life-ending now. Under any euthanasia law they would be more so, sooner or later.

Aside from vulnerability through their exclusion, people with disabilities are among groups in Australian society that are highly vulnerable to isolation, neglect and abuse. Negative assumptions about (people with) disability are endemic. Hate crimes against them continue (17). Their voice is rarely heard and good disability advocacy is under-supported. Many lack the adequate care and support needed for them to live good lives and reflect their human worth as equal to anyone else. The Commonwealth Government’s Shut Out report (2010) (18) for example found 56% of its respondents revealed disability support services themselves presented “barriers” in their lives. Many are still excluded from work, often cannot get good support and live in poverty.

More than half the submissions received (56 per cent) identified exclusion and negative social attitudes as critical issues. People with disabilities and their families, friends and carers reported daily instances of being segregated, excluded, marginalised and ignored. At best they reported being treated as different. At worst they reported experiencing exclusion and abuse, and being the subject of fear, ignorance and prejudice.

(Shut Out report (2010), p.7)

Proponents of euthanasia and physician-assisted suicide often characterise disability experience as unbearable suffering and a burden that should by extension be eligible for treatment by euthanasia (19). Where people with disabilities do suffer, this is often the result of their social exclusion and inadequate care and support. Their suffering is not primarily, or inherently found in the nature of their impairments, as it is often misrepresented. Such realities make people with disabilities highly vulnerable to effects of legalized euthanasia (20).

Impairment is a normal part of the human condition. Currently some one in five Australians has some sort of disability. This means not only that anyone is prone to acquire a disability at any time but that those factors that are part of disability experience are equally valid for any of us.

Until Australians are assured of the best palliative care, community services and advocacy, we will not truly know the extent to which suffering can be relieved.

...the lives of many people with disabilities are awful. (...) Only when we improve the quality of the lives of those people will we be able to ascertain whether they want euthanasia because they think life with a disability is worthless or because they think it is awful (Parsons & Newell, 1996, p. 54 , reporting Ann McDonald’s view on euthanasia. Anne lived in appalling institutionalised conditions as a child with disability).

We have reason to fear that a medical view of disability still persists (21), while that same medical, and allied, professions are often gatekeepers to disability entitlements and play a central role in euthanasia. At the same time there is evidence of substantial emotional and psychological damage to doctors themselves when participating in euthanasia (22). This is not a sign of a socially ‘good’ practice.

A growing application of market-economics to community services reduces the notion of heightened vulnerability of many people with disabilities, as arising in significant part from effects of negative attitudes, to one of ‘market failure’. This concept results in values-free financial and managerial remedies to such failure, letting those in charge off the hook in addressing attitudinal causes and quality in service. A business-like focus on effectiveness and efficiency in meeting ‘demand’, results in cost-benefit analysis of service where genuine needs are not necessarily met.

A joining of a medical view of disability and a market view of life are serious threats to the lives and wellbeing of people with disabilities, when they not meet a medical benchmark of ‘quality of life’, or the primarily valued status of contributor to the economy.

An ageing population, increase in disability, and over population are developing as significant problems. So are the emerging social, environmental and economic effects of climate change. We have reason to fear that in a culture that accepts euthanasia and PAS as legitimate responses to suffering, such developments will put further pressures on good care, support and rights to life of such people as ‘unproductive burdens.’ (23)

Our society is at a crossroads in deciding whether to emphasize our culture as one that cares, or kills.

Reference Points

Making statements about end of life issues carries responsibility. ProLiving therefore makes every effort to support its arguments with evidence - something too often lacking in the high emotions involved in this debate. While the issues are seldom black and white and involve personal values, empirical and anecdotal information does help. The reference points provided here are not intended as exhaustive.

1 We understand ‘disability’ as created from the interactions of impairments (physical, cognitive, mental, sensory), social and personal values and attitudes and environmental barriers. This understanding is compatible with view of disability taken in the UN Convention on the Rights of Persons With Disabilities (UNCRPD).

Furthermore we not orthodox on a particular ‘correct’ term describing people who are disabled in the above described interactions. We use “people with disabilities”, “disabled people” and “people with disability” interchangeably in this position paper. They are not pejorative and everyone knows what they mean.

2 “Euthanasia” and “physician assisted suicide” can be treated as having distinct meanings but can also be used interchangeably. Either can be done or facilitated by a medical doctor, allied health professionals, like nurses, or family members. Furthermore one could describe sub categories of active or inactive, voluntary, involuntary or non-voluntary euthanasia, where it usually, but not necessarily carried out by a physician, whether one terminally ill or not. The term “mercy killing” is also used.

In this position paper, euthanasia and physician assisted suicide are both covered by this definition:

An intervention or non-intervention by one person, to end the life of another person, who is terminally ill, for the purpose of relieving suffering, with the intent of causing the death of the other person, except where the primary intent is either to provide treatment necessary for the relief of pain or other symptoms of serious physical distress, or non-provision or withdrawal of treatment is justified, in particular, because there is a valid refusal of treatment or the treatment is futile. Somerville, M.A. (1993). The song of death: The lyrics of euthanasia. Reprinted from The Journal of Contemporary Health, Law and Policy, 9, 10–76.

3 Euthanasia is usually proposed as an act to address suffering. Such suffering can be identified as pain, futile medical interventions, fear of loss of dignity, existential pain or even being ‘tired of life.’ Whereas euthanasia proponents may use disability experience as suffering which warrants a right to euthanasia, the vast majority of people with disabilities see their experience as just a part of the variety of life. That experience does not call for euthanasia but for good support.

4 All human beings are vulnerable. A bus could hit, illness could strike. One might be sacked. People with disability are often much more vulnerable to ill effects on their health, personal safety, employment, housing, through combined effects of impairment, social attitudes and environmental barriers. This follows from adopting the above-described definition of disability. A large body of research exists, describing their grossly disproportionate collective experience of exclusion, abuse, neglect, poverty, ill-health and incarceration. Whereas “dependent” or “vulnerable” is at times used as a pejorative label, heightened vulnerability for disabled people is a fact of life and should be understood for its causes. Any pejorative use should be addressed at the level of those using it in this way.

See Joan Hume's (1996) Disability, Feminism and Eugenics: Who has the right to decide who should or should not inhabit the world?

5 See inter alia UNCDPR article 10, “Right to life”:

States Parties reaffirm that every human being has the inherent right to life and shall take all necessary measures to ensure its effective enjoyment by persons with disabilities on an equal basis with others.

6 A ‘good life’ for people with disabilities means having opportunities in being supported towards achieving one’s individual potential to be the best one can be and to minimize harm to the person. This includes being part of a community or communities, involving a sense of belonging and contribution, living, working and playing - being fully welcomed - alongside everyone else. A good life is not a segregated and congregated life.

7 Position Statement on Euthanasia and Physician-assisted Suicide. Palliative Care Australia , accessed February 2011.

8 Gill,G. (2001). Divided understandings: The social experience of disability. In Albrecht,G,L.,Seelman,K,D., & Bury, (Eds.). Handbook of disability studies. Thousand Oaks, CA: Sage Publications.

See also Rapley,M. (2003). Quality of life research: a critical introduction. Sage Publications. London.

9 See comments expressing concern of The United Nations Covenant on Civil and Political Rights Concluding observations of the Human Rights Committee : Netherlands. (2001). Inter alia, about inability to regulate euthanasia, euthanasia for newborns and children.

Furthermore, Dutch regulations have gradually widened to include people who are mentally ill, have beginning dementia, are newborn babies with disabilities and extended a right to euthanasia from age 12. Now a large citizens initiative around a right to euthanasia when ‘tired of life’ from age 70, is pushing the boundaries even further.

See Jochemsen,H. (2007). Recent developments in the euthanasia debate in the Netherlands. ;Ms Els Borst, the Minister responsible for euthanasia supports a ‘tired of life’ rationale: Dutch Minister favours suicide pill

Jochemsen,H.; Keown,J. (1999). Voluntary euthanasia under control? Further empirical evidence from The Netherlands. Journal of Medical Ethics, 25,1, 16-21. This study concluded that voluntary euthanasia in the Netherlands remains beyond effective control.

Around 1,000 cases of nonvoluntary euthanasia, through not being competent to consent, were reported in the first two government reports on euthanasia in 1991 and 1995. The government’s third report made it clear that it was the patient’s responsibility to make an advance direction NOT to have euthanasia, in the event of suffering and being incompetent. See The Linacre Centre for Healthcare Ethics (2004). Submission to the House of Lords Select Committee on the Assisted Dying for the Terminally Ill Bill.

Buiting,H., van Delden,J., Onwuteaka-Philpsen,B., Rietjens,J., Rurup,M, van Tol,D., Gevers,J., van der Maas,P, & van der Heide,A. (2009). Reporting of euthanasia and physician-assisted suicide in the Netherlands: descriptive study. BMC Medical Ethics 2009, 10:18.

This 2009 study concluded that “The information [Dutch doctors performing euthanasia] provide is in most cases sufficient to enable adequate review.” It also reports:

63% physicians mentioned 'other aspects'; these included increased dependency (28%), deterioration (15%) and more rare aspects (16%), such as loneliness, being a burden to relatives and being mentally exhausted. Physicians most often based the 'hopelessness' of the suffering upon the "absence of treatment alternatives" (32%), "absence of curative treatment alternatives" (28%), or "absence of treatment alternatives to relieve the patient's symptoms", or combinations of these (14%).

10 Hendin,H; Foley, K. (2008). Physician-assisted suicide in Oregon: A medical perspective. Michigan Law Review, 106,8. This study found that legally mandated safeguards were being circumvented, causing harm to patients.

Eleven years of assisted suicide in Oregon. Patients Rights Council. A comprehensive analysis of implementation of Oregon’s Death With Dignity Act (1997), showing many flaws.

11 Cohen-Almagor,R. (2009). Law, ethics and medicine Belgian euthanasia law: a critical analysis. J Med Ethics 2009;35:436-439 Found concerns with the Belgian euthanasia law itself and about potential abuse.

http://www.deredactie.be/cm/vrtnieuws.english/mediatheek_en/1.990035

Inghelbrecht, E, Bilsen,J., Mortier, F., Deliens, L.(2010). The role of nurses in physician-assisted deaths in Belgium. Canadian Medical association Journal, 182,9. This study highlight the role of nurses in administering life-ending drugs and warns of the nursing profession’s illegal practice in going beyond the boundaries of the profession, including through direct involvement in euthanasia without an explicit request from the patient, and in which close to half of all nurses in this study involving 1678 Belgium nurses.

Until death do us part... not. Presented as "taboo-breaking", Belgium couples are having euthanasia together. Reported on March 30, 2011, an 84-year old terminally ill man and his 78-year old non-terminally ill wife (she had arthritis), met all the Belgium euthanasia criteria and had euthanasia done together. The wife simply did not want to to on without her spouse. See video here. It was the first time that such joint euthanasia had been openly acknowledged in funeral notices but joint euthanasia by Belgium couples is reportedly not uncommon. Like Dutch provisions, three doctors had assessed the joint request and judged it as within the law, which, also like Dutch law, does not require terminal illness as a criterion.

12 The UK House of Lords Select Committee, which stated in 1993, in the context of the Bland case:

We do not think it is possible to set secure limits on voluntary euthanasia. It would be impossible to frame safeguards against non-voluntary euthanasia if voluntary euthanasia were to be legalised. It would be next to impossible to ensure that all acts of euthanasia were truly voluntary, and that any liberalisation of the law was not abused. Moreover, to create an exception to the general prohibition of intentional killing would inevitably open the way to its further erosion, whether by design, by inadvertence, or by the human tendency to test the limits of any regulation. These dangers are such that we believe that any decriminalisation of voluntary euthanasia would give rise to more and more grave problems than those it sought to address.

The Senate of Canada established a Special Committee to study the issues of euthanasia and assisted suicide and reached similar conclusions in 1994 on the same grounds and so did the New York State Task Force on Life and the Law.

13 For example the so-called “Parnell” Bill introduced in the South Australian Parliament in 2010, expressly allowed euthanasia for persons “suffering” from a disability. Leipoldt, 2010. Euthanasia in Australia: Raising a disability voice. Australian Policy Online.

Like wise the “Rights Of The Terminally Ill Act” (1998) had inadequate safeguards. (Keown, J. (2002). Euthanasia , ethics and public policy: An argument against legalization. Cambridge University Press.)

14 Magnussen (2002). Angels of death: Exploring the euthanasia underground. Yale University Press.

15 Sobsey,R. (1994). An Illusion of Autonomy: Questioning Physician-Assisted Suicide and Euthanasia

16 Kopp,S.W. (2009). The influence of death attitudes and knowledge of end of life options on attitudes towards physician-assisted suicide. Omega (Westport). 58(4)299-311.

Aranda.S, O,Connor.M (1995). Euthanasia, nursing and care of the dying: rethinking Kuhse and Singer. Australian nursing Journal,3,18-121.

Webster, J., & Kristjanson, L. (2002). But isn‘t it depressing: The vitality of palliative care. Journal of Palliative Care,18(1), 144-150.

17 Sherry, M. (2000.). Hate crimes against people with disabilities. School of social work. University of Queensland. Accessed Oct 25, 2010.

18 Shut Out: The Experience of People with Disabilities and their Families in Australia, 2010. National Disability Strategy Consultation Report prepared by the National People with Disabilities and Carer Council. FAHCSIA10307.0908.

19 Leipoldt, 2010. Euthanasia in Australia: Raising a disability voice. Australian Policy Online.

20 Fitzgerald,J. (1999).Values in End-of-Life Decision-Making: Some Implications for People with Disability. Accessed 05 Nov 2010.

21 Hubbard,S.(2004). Disability studies and health care curriculum: The great divide. Journal of Allied Health, 33(3),184-8.

Byron,M., Cockshott,Z., Brownett,H.& Ramkalawan,T. (2005). What does ‘disability’ mean for medical students? An exploration of the words medical students associated with the term ‘disability.’ Medical education 39:176-183.

Dixon,D.P. (2008). Informed consent or institutionalized eugenics? How the medical

profession encourages Abortion of fetuses with Down Syndrome. Issues in Law &

Medicine.24.

22 Stevens, Jr, Kenneth, R. (2006). Emotional and Psychological Effects of Physician-Assisted Suicide and Euthanasia on Participating Physicians. Issues in Law & Medicine, 3, 187-200.p

23 Herman Daly is a professor of economics and past World Bank economist. John Cobb is a professor of philosophy and theology. As one strategy to reduce excess of births over deaths in answer to the overpopulation problem, they proposed a right to die for older people. Of course, the incidence of disability is high in old age, and like in disability, a sense of meaning in old age has been eroded. When meaning in the lives of vulnerable people is questioned, a perceived suffering from old age or disability, can lead to the concept of their lives as worthless and disposable. We should also ask, is a ‘right to die’ here a front for the greater good of society? They wrote:

Older people should have the right to die on their own terms. A major dread of the elderly is that they will be kept alive at great expense to society and with much trouble to their children long after their lives have ceased to have any meaning for themselves and for others. This is, on any large scale, a problem brought about by the triumphs of modern medicine. The proper response cannot be found in ancient religious texts that came out of a very different social and demographic situation. Society is beginning to take a few tentative steps toward releasing doctors from the need to take extreme measures in preserving the life of one who wants to die we hope that with due caution it will go considerably further. Quite apart from any general demographic considerations, a proper respect for human freedom and the needs of the elderly should grant them the right to die and aid them in implementing their decision. In a world where population presses upon ecological limits, there are additional reasons to take these humane steps. (p.250). Daly, H.E., Cobb, J,B. (1989). For the common good. Redirecting the economy toward community, the environment and a sustainable future. Beacon Press. Boston.

Another warning on a slippery slope from Pieter Admiraal, a former Dutch anesthetist, who became one of Holland's leading campaigners for euthanasia. He said:

In 50 years time, you will see euthanasia accepted all over the world. It will be used with patients suffering from Alzheimer's who are otherwise kept alive for five or ten years. The time will come when we say that this costs money, and if you are demented for one year, we will kill you. I see it not as the answer to the growing elderly population but as the exercise of the right of self-determination.

Reported in an excellent article by Ruth Limkin (2008). Living with Dignity. Eureka Street