EPC - USA Statement to the New York Legislature in opposition to Assisted Suicicde

RE: Euthanasia Prevention Coalition-USA Statement in STRONG OPPOSITION to A995A Assisted Suicide-also known as “Medical Aid in Dying”

Dear ...

Please let A995A die this session. Assisted suicide proponents are trying to sell you a "pig in a poke". It's not about pain or a quick, peaceful death. It spawns more suicides and provides less healthcare. EPC-USA's physicians and disability advocates express strong opposition to assisted suicide.

“Medical aid in dying" is not healthcare and will exacerbate systemic inequities faced by people with disabilities and people from other marginalized communities. Assisted suicide combined with a broken healthcare and home care system is a deadly mix for people who are economically poor, lonely, vulnerable, elderly, disabled, and historically marginalized in the healthcare system.

The Euthanasia Prevention Coalition USA supports public policy that promotes positive measures to improve the quality of life of people living with a terminal illness and their families; we oppose euthanasia and assisted suicide. We are disability advocates, lawyers, doctors, nurses and politicians.

Any safeguards are part of a deliberate bait-and-switch tactic by assisted suicide advocates to get a bill passed and then come back to amend it by gutting those safeguards.

• Amy Pauline recently stated. At an event promoting A995A and S2445A , “We've been criticized by some organizations that actually want an expansion …. but we've held firm because we want to get this passed first.” (starting at 18:40).(1)
• J.M. Sorrell, Executive Director of Massachusetts Death with Dignity, who was quoted on a similar bill saying, “Once you get something passed, you can always work on amendments later.”(2)

Since 2020, there have been seven amendments to such laws across five states: in Oregon in 2020 and 2023; in Vermont 2022, and 2023; in California in 2022; in Washington in 2023; and in Hawaii in 2023 and an amendment has been introduced in New Jersey. All these changes expand access, for example, waive waiting times, allow nurses to prescribe the lethal medication, or drop residency requirements.(3)

It’s Not about Pain 

Dr. Lonny Shavelson, a California assisted suicide provider says promoting “aid in dying” as avoiding pain is a political sales pitch. See webinar(4) minutes 25:24-27:53. He says people choose assisted suicide because they are low energy or afraid of losing control.

It’s Not about a Peaceful or Quick Death 

Dr. Shavelson says the idea that assisted suicide creates a peaceful beautiful death is another myth. See webinar(5) minutes 37:35-41:00. Some people may suffer prolonged and difficult deaths from the experimental lethal drug cocktails.

Insurance Companies Use Assisted Suicide to Deny Curative Life-Saving Treatment 

Assisted suicide exacerbates the systemic problems patients face when seeking care for terminal illnesses. Dr. Brian Callister(6) of Nevada says he was stunned when insurance would not cover life saving treatment for his patients who were transferring to California and Oregon, but offered to pay for Assisted Suicide instead.

Assisted Suicide Spawns More Suicides and Attempted Suicides. 

Assisted suicide advocacy has already exacerbated the suicide crisis among people with disabilities. Disabled people have a higher rate of suicide than the general population and people are more likely to approve of suicide if the victim is disabled.(7) Worse, in 2023, the American Association of Suicidology (AAS) had to retract its 2017 statement that “Medical Aid in Dying” was not suicide, after it was used to justify expanding assisted suicide and euthanasia to disabled Canadians over the objection of the Canadian Association for Suicide Prevention.(8)

Moreover, a 2019 report found teen suicides in California increased by 34%(9)  since that state legalized Assisted Suicide in 2016. Oregon’s youth suicides increased 79.3% from 2000 to 2018.(10) Research about completed suicides in four states that legalized Assisted Suicide (Oregon, Washington, Vermont and Montana) found it was associated with at least a 6.3% increase in the rate of all suicide deaths.(11)

The Marginalized understand this will be used to provide them with poorer care. Even with insurance, people of color get poorer hospital care and pain relief. According to a New York Times article,(12) people of color disproportionately died of COVID-19. (article)Medical prejudices and neglect result in racial disparities in diagnosis and treatment of diabetes, cancer, and heart trouble. COVID-19 has killed Black, Indigenous, and People of Color (BIPOC) at a much higher rate than Whites.(13)

There Are Very Clear Cases of Abuse 

The Disability Rights Education and Defense Fund (DREDF) has cataloged a long list of abuse cases.(14) Moreover, a doctor suggested assisted suicide to her anorexic patients and helped them carry it out. Compassion and Choices has acknowledged this abuse of the law, yet repeatedly asserts that the law has never been abused.(15)(16)

EPC-USA's physicians remind us that Assisted Suicide laws exacerbate systematic inequalities that disabled people experience in the medical sphere. A "Federal study found that the nation's assisted suicide laws are rife with dangers to people with disabilities".(17)

EPC-USA’s physicians remind us that Physicians, clinicians, insurance companies, and healthcare systems are fallible. Misdiagnoses and unreliable terminal prognoses are documented by the cases of: Jeanette Hall,(18) John Norton,(19) and Rahamim Melamed-Cohen.(20) More and more diagnoses qualify for Assisted Suicide. As mentioned, the latest effort to stretch “terminally ill” treats anorexia as a qualifying terminal disease.

In 2021, the NY based United Nations Special Rapporteur on the Rights of People with Disabilities asserted that all assisted suicide laws violate its Convention On The Rights of People with Disabilities.(21)

As the cheapest state-sponsored “treatment,” assisted suicide diminishes patient choice and takes away patient autonomy. Assisted suicide combined with a broken health care and home care system is a deadly mix for people who are economically poor, lonely, vulnerable, elderly, disabled, and historically marginalized in the US healthcare system.

We urge you to allow A995A to die this session because exacerbating systemic social inequalities so that the proponents can plan their deaths is unwise and unjust.

Sincerely,

Colleen E. Barry, Chairperson
Josephine L.A. Glaser, MD.,FAAFP
Meghan Schrader
Kenneth Stevens, MD
William Toffler, MD
Gordon Friesen
Alex Schadenberg

Euthanasia Prevention Coalition USA, EPC_USA@yahoo.com

End Notes

1. Amy Pauline recently stated. At an event promoting A995A and S2445A , “We've been criticized by some organizations that actually want an expansion …. but we've held firm because we want to get this passed first.” (starting at 18:40) (Link).

2. Comerford to reintroduce medical aid-in-dying bill in wake of court decision (Link).

3. Journal of Medical Ethics. Twenty five years (Link).

4. COMPLETED LIFE APRIL 2021 LUNCH HOUR WITH LONNY SHAVELSON (Link).

5. COMPLETED LIFE APRIL 2021 LUNCH HOUR WITH LONNY SHAVELSON (Link).

6. Insurance companies denied treatment to patients, offered to pay for assisted suicide, doctor claims - Washington Times (Link).

7. Is suicide an option?: The impact of disability on suicide acceptability in the context of depression, suicidality, and demographic factors. (Link).

8. Statement on recent MAiD Developments. (Link) (Link).  

9. New health report for California shows 34% increase in teen suicide (Link).

10. National Vital Statistics Report. Suicide Rates Among... (Link).

11. How Does Legalization of Physician-Assisted Suicide Affect Rates of Suicide? (Link).

12. The Never-Ending Mistreatment of Black Patients (Link).

13. One Man's COVID-19 Death Raises The Worst Fears Of Many People With Disabilities (Link).

14. Some Oregon and Washington State Assisted Suicide Abuses and Complications (Link).

15. Terminal Anorexia Is Dangerous Justification for Aid in Dying (Link).

16. (Link).

17. The impact of disability on suicide acceptability (Link).

18. Jeannette Hall on dying well (Link).

19. Affidavit of John Norton (Link).

20. Twelve years after contracting Lou Gehrigs disease, Dr. Rahamim Melamed-Cohen (Link).

21. Disability is not a reason to sanction medically assisted dying – UN experts (Link).

A New Assisted Suicide Organization Arises

This article was published on March 13, 2023 on Nancy Valko's blog.

Nancy Valko

By Nancy Valko

In my June, 2016 blog “Tolerating Evil”, I wrote:

“(A) few days after California’s new assisted suicide law took effect, one doctor immediately opened up a dedicated assisted suicide clinic in San Francisco.

Dr. Lonny Shavelson, 64 and a long-time supporter of physician-assisted suicide, was an emergency room doctor for 29 year and then spend 7 years at an Oakland clinic for immigrants and refugees before taking a 2 year break.

His new assisted suicide business could be quite lucrative. Although Medicare will not pay for assisted suicide costs, Shavelson said he will charge $200 for an initial patient evaluation. If the patient is deemed qualified under California law, Shavelson said he would charge another $1800 for more visits, evaluations and legal forms.

Lonny Shavelson

Shavelson defends his business by claiming that: 

“..the demand (for assisted suicide) is so high, that the only compassionate thing to do would be to bring it above ground and regulate it.”

Now, a new medical group called American Clinicians Academy on Medical Aid in Dying has been formed with a Board of Directors and Advisors and chaired by the same Dr. Lonny Shavelson.

The board of this organization includes a Nursing Coordinator, Director of End-of-Life Doula Education, a Volunteer Systems Advisor, as well as Hospice and Palliative Care Advisors including chaplains, nurses and social workers. There is also an “Aid in Dying Ethics Consultation Service”, ethicist, lawyer and pharmacists. An Investigations and Data Collection group is also included as well as State Liaisons in various states.

Also included is Resident Training and Education, Patient Liaisons and Volunteers, Chaplains and End-of-Life Spiritual Advisors, a legal advisor/ethicist, and a member of the San Francisco/Marin Medical Society with a Master’s in Public Health degree.

The American Clinicians Academy on Medical Aid along with the older Death with Dignity organization just had their second conference February 17-18 in Portland Oregon and provided “13 continuing education units for doctors and nurses” and 10 for social workers.

The conference included presentations like “ Some Myths about Aid in Dying”, “State Differences — Present and Future Legal Considerations”, “Hospices and Aid in Dying — A land of many journeys”, “Prognostic Dilemmas in Aid in Dying”, “Medical Aid in Dying for ALS: Navigating Complexities from Prognosis to Ingestion” and “Clinician Attendance on the Aid-in-Dying day — Doctors, nurses, volunteers, end-of-life doulas, hospice staff” and “Socially-Challenging Settings and Circumstances — homeless and impoverished; family conflicts; skilled nursing and long-term care facilities” and “Medically Challenging Cases: Complex gut function; Self-administration by oral, rectal, PEG and ostomy routes” presented by Dr. Shavelson himself. (All emphasis added)

The first National Clinicians Conference on Medical Aid in Dying occurred in 2020 at UC Berkley in California. It was sponsored by groups like UC Davis Health, Mission Hospice and Home Care, the San Francisco Marin Medical Society and the Center for Bioethics and Humanities at the University of Colorado that promotes “Research at the Intersection of Bioethics and Policy for Persons with Disability” (emphasis added) among other groups.

Apparently, Compassion and Choices now has some competition in the relentless campaign to legalize and normalize medically assisted suicide in every US state.

Compassion and Choices

Now, Compassion and Choices has a new “Federal Advocacy and Policy-Bringing the voice of the terminally ill to Capitol Hill“ that:

“advances federal legislation and regulatory change focused on:

• Strengthening and expanding the full spectrum of end-of-life care such as advance care planning, hospice care, and palliative care, while protecting end-of-life options and patient autonomy from federal efforts to weaken or overturn federal and state laws.
  

• Addressing disparities in end-of-life care for historically disadvantaged populations and advancing healthcare equity at life’s end.
  

• Expanding professional end-of-life care education, training and development for all healthcare professionals.
  

• Preventing healthcare entities from disregarding patient values and preferences by refusing care due to their ethical directives and policy-based restrictions. (All emphasis added)”

Compassion and Choices strongly opposes the “Assisted Suicide Funding Restrictions Act (ASFRA) (seeking repeal)” that:

“Prohibits the use of federal funds to provide or pay for any healthcare item or service or health benefit coverage for the purpose of causing, or assisting to cause, the death of any individual.” as well as “Seeking to permanently vacate the proposed rule, “Protecting Statutory Conscience Rights In Health Care (83 FR 3880),” from the U.S. Department of Health and Human Services, which attempted to allow medical providers expanded exemptions from critical healthcare services beyond what the law currently allows.”

Compassion and Choices also supports effort to “Establish Comprehensive Telehealth Reform” and also ominously, the Palliative Care and Hospice Education Act (PCHETA)

Conclusion

In 2018, I wrote the blog “Beware the New Palliative Care and Hospice Education and Training Act” (PCHETA)” about Senate Bill 693.

A similar bill had already passed in the House and this Senate bill was also expected.

As I wrote then:

“As an RN with decades of nursing experience in hospice, oncology (cancer) and critical care, I have been involved with many end-of-life situations. I am an enthusiastic supporter of ethical palliative and hospice care which is indeed wonderful for patients of any age and their families.

Unfortunately, there is a growing trend towards calling unethical practices ‘palliative’ or ‘hospice’ care.”

And we certainly should not be allocating federal dollars for this.

But, despite the enormous push for the PCHETA, it never passed.

There was great opposition by American Association of Physicians and Surgeons, the National Association of Pro-life Nurses , Sara Buscher, a retired attorney and CPA was the  chair of the Euthanasia Prevention Coalition – USA. who advocates for the elderly and disabled , the Healthcare Advocacy and Leadership Organization (HALO) and others.

Now, Compassion and Choices is working hard again to get PCHETA passed to “increase the number of faculty at accredited healthcare programs” and “promote increased education and research in Palliative Care and Hospice care.” (All emphasis added)

If groups promoting medically assisted suicide throughout the US are successful in taking over the ethics education of our health care professionals, eliminating conscience rights for healthcare providers and institutions, continue to dismantle so-called legal safeguards called “obstacles” and allow the same poor oversight and documentation found in Oregon, the first state to legalize assisted suicide, we will see the inevitable and inexorable expansion of medically assisted suicide that we are now seeing in Canada.

We need to demand the highest ethical standards in healthcare to protect ourselves, our healthcare institutions and the most vulnerable among us who need hope and help-not medically assisted suicide. 

California Judge dismisses case to permit euthanasia within assisted suicide law.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

On December 7, 2022 Justice Vince Chhabria, US District Judge in California approved a motion to dismiss a court case by Dr Lonny Shavelson (supported by the assisted suicide lobby group Compassion and Choices) to extend the California assisted suicide law (end-of-life options act) to include euthanasia. The case is called Shavelson v Bonta. 

Euthanasia is an act of injecting a lethal drug cocktail to cause death. Assisted suicide is an act of prescribing the same lethal drug cocktail but the person self-administers.

Shavelson's attempt to get the court to extend California's assisted suicide law to include euthanasia was rejected on June 22, 2022. The current decision was a response to Shavelson's attempt to amend the case.

Justice Chhabria approved the motion to dismiss the case and stated that any further amendment to the case would be futile. Chhabria wrote:

It seems unlikely that that the plaintiffs could adequately allege (and ultimately demonstrate) standing under this alternative reading of the requested accommodation if given another attempt. But even if they did, the Court would dismiss the lawsuit on the merits. Setting aside the assistance prohibition would cross the sharp line drawn by the California Legislature between assisted suicide and euthanasia, and thus would fundamentally alter the nature of the program for the same basic reasons discussed in the prior ruling. Shavelson, 2022 WL 2234973. And that dismissal would be with prejudice, given the number of chances the plaintiffs have now had to state a claim.

The dismissal for lack of jurisdiction is therefore without leave to amend—it is clear by now that further amendment would be futile.

On June 23, 2022, Chhabria rejected the argument by Shavelson that euthanasia needed to be an accomodation when a person is unable to self-administer. According to Maria Dinzeo who reported on June 22 for the Court House News Service:

A federal judge said he cannot allow an Americans with Disabilities Act carveout to California’s assisted suicide law that would let doctors assist people too weak or disabled to ingest end-of-life medication, finding that such a provision would “fundamentally alter” the law from conferring the ability to take your own life to having a doctor do it for you.

I published an article on August 30, 2021 explaining that Shavelson had challenged the state assisted suicide act to permit euthanasia. The case argued that some people with disabilities, when approved for assisted suicide, are unable to self-administer the lethal drugs. Shavelson argued that based on the Americans with Disabilities Act, the court must permit euthanasia (doctor administered death) in these cases.

On September 13, 2021 I wrote that the California court must reject the challenge to the state assisted suicide act based on (among other reasons): 

• The Supreme Court, in Glucksberg, recognized that there is no right to assisted suicide and it recognized that one state interests in prohibiting assisted suicide was the prevention of euthanasia. This court case specifically seeks to permit euthanasia.  
• There is no right to assisted suicide, therefore there is no obligation to amend the "perceived" inequality within the state assisted suicide law.
• Permitting euthanasia is not an extension of the state assisted suicide law but rather it required the court to legislate the legalization of euthanasia, which is a form of homicide.

Thankfully Chhabria was not willing to legislate from the bench. I predict that the attempt to expand state assisted suicide laws to include death by lethal injection (euthanasia) has only begun. It is likely that Shavelson will appeal the decision.

Article promotes legalizing euthanasia in America.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

An opinion article by Alison McCook published by the Philadelphia Inquirer promotes the legalization of euthanasia and assisted suicide in Pennsylvania. McCook is an assistant opinion editor at The Inquirer.

McCook writes about the death of her mother in 2007 by ALS and asks the question - Why is assisted suicide not legal in Pennsylvania? The article is well crafted but this article is designed to legalize assisted suicide and euthanasia which is the new goal of the American death lobby.

What is the difference between euthanasia and assisted suicide?

With assisted suicide two medical practitioners approve a person's request to die, the primary practitioner writes the prescription for the lethal drug cocktail. The person receives and consumes the lethal drug cocktail and dies by assisted suicide. Assisting a suicide is currently legal in 10 states.

With euthanasia, two medical practitioners approve a person's request to die, the primary practitioner then lethally injects the person with a lethal drug cocktail. Lethal injection is currently defined as homicide in all 50 states. The death lobby is now working to expand assisted suicide laws to euthanasia.

McCook makes her case for euthanasia by writing:

Even if Pennsylvania manages to pass a medical aid-in-dying law, it would be flawed, along with all the other aid-in-dying laws on the books in other states, because these laws require that patients give themselves lethal medication. By the time my mother was ready to die, she would have likely been too paralyzed to do this. There’s a whole class of patients who are terminally ill and cannot ingest the medication without assistance. Our laws, as written, leave them behind.

McCook is arguing that legalizing assisted suicide leaves out a group of people who are not capable of self-administering the lethal drugs. This argument assumes that there is nothing wrong with killing people, which is what euthanasia does, but in fact, without going into details, people with ALS are dying by assisted suicide since the term self-administer is loosely defined.

This article shows us the direction of the death lobby in America. Historically, they started with trying to legalize euthanasia but failed. In 1994 Oregon passed its assisted suicide voter initiative because they limited the act to assisted suicide. Now the death lobby is working to expand their assisted suicide laws to euthanasia.

The good news is that their first attempt in California has failed. In June 2022 a California federal judge rejected a case designed to permit euthanasia within California's assisted suicide act. Lonny Shavelson, a doctor that solely focuses on assisted suicide argued that the state's assisted suicide law discriminated against people who had difficulty self-ingesting lethal assisted suicide drugs and to remedy the situation the state needed to permit euthanasia (lethal injection) in those cases. (Link to the decision). The Judge decided that legalizing euthanasia would not extend the state assisted suicide law but fundamentally altered it.

The American death lobby lost their first battle in legalizing euthanasia in America but clearly their goal is to continue this battle.

Opposing euthanasia is most effective when we all it what it is, that being homicide/murder. It is never a good or a safe idea to give doctors the right in law to kill you.

Link to my previous articles about the California court case (Link 1) (Link 2).

Response: “Neurologic Diseases and MAiD” in The American Journal of Bioethics

This article was published by Not Dead Yet on August 30, 2022.

Jules Good writes in response to “Neurologic Diseases and MAiD: Aid-In-Dying Laws Create an Underclass of Patients Based on Disability” by Lonny Shavelson, Thaddeus M. Pope, Margaret Pabst Battin, Alicia Oulette & Benzi Kluger, published in The American Journal of Bioethics 16 August 2022:

Jules Good

Legal assisted suicide puts disabled people in danger of being killed on the basis of disability alone. This is especially true when assisted suicide laws allow someone other than the patient to administer the drug. The authors claim that denying someone euthanasia is an ADA violation. Their argument is that getting assistance in administering the lethal drug should be seen as a “reasonable accommodation” used to allow someone without the physical capacity to take the drug access to assisted suicide. The provision of the ADA cited in the article to support this claim states that “No qualified individual with a disability shall…be excluded from participation in or be denied the benefits of services, programs, or activities of a public entity, or be subjected to discrimination by any such entity” when reasonable accommodation can be provided.”

There is a much more compelling case for invoking the ADA here that focuses less on making it easier for disabled people to die and more on making it easier for us to live life on our own terms. In places where assisted suicide is legal, disabled people who wish to die (some actually terminal, some not) are given the tools to do so, while nondisabled people who wish to die are given access to mental health resources. Is being coerced toward “choosing” death really an example of disabled people accessing the “benefits of services, programs, or activities of a public entity”? Is being denied mental health treatment because our lives are seen as less valuable than the lives of nondisabled people not a more pressing example of the ADA being violated?

Thaddeus Pope, co-author of the article, has himself admitted that he sees having a disability, and not exclusively a “terminal” prognosis, as an acceptable reason for someone to be permitted to die by assisted suicide. We reject this notion. True healthcare includes treatment and resources that allow someone to live with as little pain and with as much independence as possible. Legal assisted suicide, which, on a systemic level, results in the premature and unnecessary deaths of our community members, is not a “service, program, or activity” that disabled people “benefit” from. This is a blatant misuse of the ADA.

It is clear that the authors of this article are out of touch with the core tenets of disability justice, which state in part that we have a responsibility to keep each other safe. Policies that champion the desires of individuals over the safety and vitality of the most marginalized disabled people are not grounded in a true disability justice framework. Disabled people do not need more help dying. Crisis standards of care in the face of COVID-19 that deprioritize us for treatment, our profit-driven healthcare system that regularly denies care to those who need it most, and a general societal attitude that people are “better off dead than disabled” make death more accessible to us than life. The ADA, while imperfect, was passed because the disabled community worked to ensure that the inherent value of our lives would be recognized in the eyes of the law. It should not be used to further jeopardize the safety of the most vulnerable members of our community.

California 2021 assisted suicide report. 486 "reported" deaths.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition.

The 2021 California assisted suicide report indicates that there were 486 reported assisted suicide deaths and 772 lethal cocktail prescriptions written. The report also states that 130 people who were approved for assisted suicide died from their underlying illness or other causes and 194 people received a lethal drug cocktail but their ingestion status is unknown.

When the ingestion status is unknown, the California Department of Public Health knows that the person received a lethal drug cocktail but they do not know whether or not the person died by assisted suicide.

The 2020 California assisted suicide report stated that there were 435 reported assisted suicide deaths with 164 people whose ingestion status was unknown. The 2021 California assisted suicide report amended the 2020 data stating that there were 495 reported assisted suicide deaths up from 435 in 2020. Last year I estimated that the actual number of assisted suicide deaths may be 500. I was close. In 2020 at least 60 of the 164 people whose ingestion status was unknown, died by assisted suicide.

How many of the 194 people whose ingestion status is unknown in 2021 died by assisted suicide? I estimate that next years report will state that there were 550 reported assisted suicide deaths.

Under-reporting and abuse of the law is covered-up by the reporting system. The California assisted suicide data comes from the reports submitted by the assisted suicide doctors. Since this is a self-reporting system, it is impossible to know when a doctor does not send in a report or abuses the law.

Order the pamphlet - Shedding light on assisted suicide in America. 

The data indicates that of the 486 reported assisted suicide deaths, 416 (85.6%) were white, 34 (7%) were Asian, 25 (5.1%) were Hispanic and 4 (.8%) were Black. 

The 2020 California population census indicates that: 39% are Hispanic, 35% are White, 15% are Asian and 5% are Black.

Clearly, assisted suicide is an issue of white privilege.

In 2021 California legislators expanded the assisted suicide law by passing Bill SB 380 which:

• Reduced the mandatory 15-day waiting period between the two oral requests to 48 hours. 
• Forced doctors who oppose assisted suicide to refer the person who requests assisted suicide.  
• Eliminated the original law’s sunset clause, which eliminated the requirement to review the law.

In response to passing of Bill SB 380, a group of California Doctors who oppose assisted suicide have launched a court case to protect their conscience rights (Link to article). The conscience rights case has yet to be heard.

Recently a California federal judge rejected a case designed to permit euthanasia within California's assisted suicide act (Link to article). Dr Lonny Shavelson, who solely focuses on assisted suicide, and Sandra Morris, who lives with ALS, argued that the state's assisted suicide law discriminated against people who had difficulty self-ingesting the lethal assisted suicide drugs and to remedy the situation the state needed to permit euthanasia (lethal injection) in those cases. (Link to the decision)

Justice Chhabria rejected Shavelson's challenge to the law stating that permitting euthanasia was not an extension to the current law but rather it would fundamentally alter the law (Link to article).

Judge rejects challenge to legalize euthanasia within California assisted suicide law.

Alex Schadenberg

Executive Director, Euthanasia Prevention Coalition

A California federal judge rejected a case designed to permit euthanasia within California's assisted suicide act. Lonny Shavelson, a doctor that solely focuses on assisted suicide and Sandra Morris, who lives with ALS, argued that the state's assisted suicide law discriminated against people who had difficulty self-ingesting the lethal assisted suicide drugs and to remedy the situation the state needed to permit euthanasia (lethal injection) in those cases. (Link to the decision)

Maria Dinzeo reported on June 22 for the Court House News Service that:

A federal judge said he cannot allow an Americans with Disabilities Act carveout to California’s assisted suicide law that would let doctors assist people too weak or disabled to ingest end-of-life medication, finding that such a provision would “fundamentally alter” the law from conferring the ability to take your own life to having a doctor do it for you.

Dinzeo stated that Justice Chhabria rejected Shavelson's challenge. Dinzeo wrote:

Chhabria ruled the case could not proceed on the theory that it violates the ADA because the accommodation they seek would cross the boundary created by the End of Life Option Act, “from the ability to end your own life to the ability to have someone else end it for you.”

Chhabria wrote, “Such an accommodation would ‘compromise' the essential nature of the act, and would therefore fundamentally alter the program.’”

The judge said the law’s self-administration requirement is the “final safeguard” to ensure the act remains voluntary.

“A person seeking to end their life pursuant to the act can opt out at any point — after requesting or receiving the prescription, after the drugs are in their hand, after the feeding tube has been installed, after saying goodbye,” he wrote. “The accommodation that the plaintiffs seek would significantly undermine these protections by opening a window during which there would be no way of knowing whether the patient had changed their mind.”

On September 13, 2021 I wrote that the federal judge must reject the challenge to the state assisted suicide act based on the following rationale: 

1. There is no right to assisted suicide; therefore, there is no legal requirement to amend the perceived inequality within the state-assisted suicide law.
2. The Supreme Court, in Glucksberg, recognized that there is no right to assisted suicide and it recognized that one state interest in prohibiting assisted suicide was the prevention of euthanasia. This court case specifically seeks to permit euthanasia.
3. Permitting euthanasia is not an extension of the state-assisted suicide law, but rather, it requires the court to legislate a new law, that being the legalization of euthanasia, which is a form of homicide.

Link to my previous articles about this court case (Link 1) (Link 2).

EPC - USA Testimony opposing Connecticut Assisted Suicide Bill.

February 21, 2022

Mary Daugherty Abrams and Jonathan Steinberg, Co-Chairs and Members Connecticut Public Health Committee

Link to the letter (Link).

RE: Testimony Opposing S.B. 88, An Act Concerning Aid in Dying for Terminally Ill Patients

Dear Co-Chairs and Members:

The Euthanasia Prevention Coalition USA opposes euthanasia and assisted suicide, instead supporting positive measures to improve peoples’ quality of life which also helps their families. We are aging and disability advocates, lawyers, doctors, nurses and politicians.

We are asking you to let SB 88 die in your committee. You will hear several of the more obvious concerns about Assisted Suicide from other opponents. I will focus on these issues about Assisted Suicide that you may not otherwise hear.

• The Bill allows Assisted Suicide with elastic and meaningless “safeguards.”
• Assisted Suicide is not about pain or receiving a peaceful death; both are myths.
• Assisted Suicide spawns more suicides and attempted suicides.
• Insurance companies use Assisted Suicide to deny coverage for curative life-saving treatments, offering to pay for Assisted Suicide instead. This raises equity concerns.

The Bill allows Assisted Suicide with elastic and meaningless “safeguards.”

Connecticut criminalizes aiding a person to commit suicide, which is classified as 2nd degree manslaughter. CGS § 53a-56. S.B.88 at Sec. 12(d) removes criminal prosecution under CGS § 53a-56 for anyone self administering a lethal prescription under the “aid in dying” law. Thus, it is clear the bill is allowing assisting a person to commit suicide whatever pretty euphemism is created by marketing consultants to make it sound better.

Dr. Diane E. Meier, best known as the founder of Mt. Sinai’s Center to Advance Palliative Care, and a one-time proponent of Assisted Suicide years ago, recently said safeguards go up in smoke once the law allows it:

All the heartfelt adherence to restrictions that are announced when you first get the public [or Legislature] to vote in favor of this go up in smoke once the practice is validated. …It’s a dangerous path to go down with the claim that it is all about respect for autonomy, when the real drivers are getting rid of a painful and expensive burden on society.

S.B. 88 allows the prescription of a lethal dose to people who are terminally ill, with a 6 month prognosis, and who can self-administer by ingesting. No safeguards or witnesses are required at the time of ingestion regardless of the person’s mental state or ability to self-administer. I will briefly touch on this.

People qualify as terminally ill despite being able to live for years with treatment. Some of the diagnoses that qualify are infectious disease, gastrointestinal disease, diabetes, arthritis, sclerosis, stenosis, and musculoskeletal system disorders. The latest effort to stretch “terminally ill” treats anorexia as a qualifying terminal disease.

Here’s how one doctor describes self-administration in his practice:

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.”

It’s Not about Pain or a Peaceful Death; Both are Myths

Dr. Lonny Shavelson’s practice is limited to providing only Assisted Suicide. He now consults and educates other physicians who are willing to kill. He says:

promoting “aid in dying” as avoiding pain is a political sales pitch. See webinar minutes 25:24-27:53.

In his experience, people choose Assisted Suicide because they are low energy or afraid of losing control. He says Oregon’s data is consistent with his experience. The Oregon data show most people choose Assisted Suicide because of a decreasing ability to participate in enjoyable activities (94%), loss of autonomy (93%) and loss of dignity (72%), not fear of pain and suffering.

Dr. Shavelson says another myth is that Assisted Suicide creates a peaceful beautiful death. Actually, it does not change what happens during dying. It simply makes it faster. People gasp for air, change colors, sweat, twitch, have seizures and sometimes vomit. See webinar minutes 37:35-41:00.

For many years, fatal quantities of barbiturates were prescribed to carry out Assisted Suicide. These drugs cause the lungs to fill with fluids like drowning. When these drugs became expensive, Assisted Suicide doctors experimented on people with other drug cocktails, some of which burned people’s throats causing them to scream in pain and extended the dying process by more than 3 hours and as much as 31 hours.

Assisted Suicide Spawns More Suicides and Attempted Suicides.

If you enact S.B. 88, more people will die by suicide and more will attempt suicide. This is the collateral damage caused by suicide contagion when Assisted Suicide is legalized. If you do so, you send a message that suicide is an acceptable solution to problems. Publicity about suicide leads to more suicides; this is called suicide contagion. Legalizing Assisted Suicide is linked to suicide contagion.

Legalization of Assisted Suicide especially impacts youths. A 2019 report found teen suicides in California increased by 34% since that state legalized Assisted Suicide in 2016. Oregon’s youth suicides increased 79.3% from 2000 to 2018. Research about completed suicides in four states that legalized Assisted Suicide (Oregon, Washington, Vermont and Montana) found it was associated with at least a 6.3% increase in the rate of all suicide deaths. For every person who dies by suicide, another 30 attempt suicide.

So let’s apply this to Connecticut which now has a low suicide rate compared to other states. In 2020, 359 people died by suicide in Connecticut. A 6.3% increase will add 22 suicides if S.B. 88 is enacted. For each one of these 22 suicides, another 30 or 660 people will attempt suicide; some of them will become permanently disabled.

Insurance Companies Use Assisted Suicide to Deny Curative Life-Saving Treatment

Insurers stop covering certain treatments due to the availability of Assisted Suicide. Dr. Brian Callister of Nevada says he was stunned when insurance would not cover life saving treatment for his patients who were transferring to California and Oregon, but offered to pay for Assisted Suicide instead. These were people who could be cured with the denied treatment rather than being rendered terminal. In effect, Assisted Suicide is being used to shunt people off the curative, restorative medicine track, especially if they cannot afford to pay for treatments out of pocket, just like Dr. Diane Meier said.

There also equity concerns. People of color get this. Even with insurance, people of color get poorer hospital care and pain relief according to a New York Times article. They are disproportionately dying of COVID-19. So, it is unsurprising that Black and Latin0 people oppose Assisted Suicide by 2-1 margins‒ “… the voting results from [Massachusetts] Ballot Question 2 in 2012 show Assisted Suicide pits wealthier, whiter districts against those with poorer people and people of color according to Second Thoughts – Massachusetts. The same is likely true in Connecticut.

In closing, I urge you to consider the heartache for families whose members are impacted by suicide contagion and the loss of insurance coverage for curable treatments that would follow enactment of S.B. 88 which also contributes to inequity for people of color. If you weigh that against the so-called benefits of Assisted Suicide which are myths, you will let S.B. 88 die in your committee.

Sincerely,

Sara Buscher, Chair
Euthanasia Prevention Coalition USA

Is an assisted death 'quick and painless'?

This article was published by Mercatornot on November 1, 2021.

Michael Cook

By Michael Cook

Campaigners for 'assisted dying' paint a rosy picture of a gentle, easy death. It doesn't always happen that way.

Similar article: Assisted suicide is neither painles nor dignified (Link).

The marketing strategy of right-to-die organisations has not changed much over the past 150 years. In 1872 a British writer, Samuel D. Williams, wrote a book advocating the use of the novel anaesthetic chloroform to give patients “a quick and painless death”. In 1931 the British eugenicist Dr Killick Millard proposed legalisation of euthanasia “to substitute for the slow and painful death a quick and painless one”.

Now that legalisation has arrived, however, doctors have realised that a Q&P death is easier said than done.

Writing in a recent issue of The Spectator (UK), Dr Joel Zivot, a Georgia physician, expresses his doubts about whether lethal medications are the way forward. He studied the autopsy reports of more than 200 prisoners executed with lethal injections and found that many may have died in great pain.

“The death penalty is not the same as assisted dying, of course. Executions are meant to be punishment; euthanasia is about relief from suffering. Yet for both euthanasia and executions, paralytic drugs are used. These drugs, given in high enough doses, mean that a patient cannot move a muscle, cannot express any outward or visible sign of pain. But that doesn’t mean that he or she is free from suffering.”

Dr Zivot believes that pentobarbital, which, it seems, is used in Oregon in 4 out of 5 assisted suicides, caused pulmonary oedema – the lungs fill with liquid secretions and the person can die in agony. “Advocates of assisted dying owe a duty to the public to be truthful about the details of killing and dying. People who want to die deserve to know that they may end up drowning, not just falling asleep,” he writes.

Nor is death necessarily quick.

In Oregon, where statistics are gathered about the mode of death, the median time to death throughout the 23 years of the Act is 30 minutes but the maximum time is 4 days and 8 hours. The median time for people to fall unconscious is 5 minutes, the maximum is 6 hours.

At least in the United States, doctors who participate in assisted suicides are aware of these issues. Dr Lonny Shavelson, a California physician who specialises in this novel field, has helped to organise the American Clinicians Academy on Medical Aid in Dying. This provides a forum for doctors to establish a best-practice for helping people to die.

It turns out that the very diseases from which the patients suffer can make the drugs less effective. Dr Shavelson spoke with Medical Xpress last year about some of the difficulties:

“Shavelson and [his colleague retired anesthesiologist Dr Carol] Parrot have identified which patients are more likely to linger, and can recommend adjustments. People with gastrointestinal cancer, for example, don’t absorb the drugs as well. Former opiate users often have resistance to some of the drugs. Young people and athletes tend to have stronger hearts and can survive longer with low respiration rates.

“We’re learning. Hypothesis, data and confirmation. This is what science is,” he said. “Our job is to stop the heart; that’s what they want us to do.”

His learning curve is rather ghoulish. He sits at the bedside of the person whom he is assisting to die with a clip board, noting the drugs, the dosages, oxygen levels, heartbeat, and breathing. Another California doctor says that he is grateful for Shavelson’s work. “It’s really helpful to have someone actually studying the utility of what it is we’re doing. So much of what we’re doing has arisen empirically. He’s collected such great data. Patients want a medication that is effective. They want a swift, peaceful death.”

Medical Xpress explains that “[Shavelson’s] pharmacologic findings, shared with clinicians nationwide, are dramatically reducing the incidence of long, lingering and wrenching deaths.”

Whoa!

What is this business of reducing the number of “long, lingering and wrenching deaths”? These have never been mentioned by “assisted dying” campaigners. What’s the point of changing the law so that a few cancer patients will escape a “long, lingering and wrenching” death at the expense of others who are going to experience it in the very process of assisted dying?

Little has been written about this issue – but enough to set the alarm bells ringing. A scoping review of “assisted dying” in Canada (MAID) published in BMJ Open last year found that complications “that may cause patient, family and provider distress” could be common.

“Of the 163 reports found, 40 described outcomes and complications in MAID provision. For intravenous administration, complications included difficulty in obtaining or maintaining intravenous access, the patient dying too slowly or not dying, patient dying too quickly, difficulty in pushing a large syringe, pain on injection, need for a backup kit and inappropriate drugs given. For oral administration, complications included prolonged duration of the dying process, vomiting, myoclonus/seizures, poor taste of the cocktail and the need for intravenous backup.”

And an Irish pharmacist stated bluntly in the BMJ in January that: “The process of assisted suicide and/or euthanasia cannot guarantee a peaceful, pain free, dignified death.”

Let’s be honest about “assisted dying”. Patients might die swiftly and painlessly. They might not. If it’s a game of roulette, is “assisted dying” really a compassionate option?

EPC - USA letter opposing Massachusetts assisted suicide bills.

Joanne M. Comerford, Chair and Members Joint Committee on Public Health

RE: H2381/S1384, O'Day and Mahoney/Comerford, an Act relative to end of life options; legalizing Assisted Suicide

Dear Chairperson and Members:

The Euthanasia Prevention Coalition USA opposes euthanasia and assisted suicide, instead supporting positive measures to improve peoples’ quality of life which also helps their families. We are aging and disability advocates, lawyers, doctors, nurses and politicians.

We are asking you to let H2381/S1384 die in your committee. You will hear several of the more obvious concerns about Assisted Suicide from other opponents. I will focus on these issues about Assisted Suicide that you may not otherwise hear.

• Assisted Suicide is not about pain or a peaceful death; both are myths.
• Assisted Suicide caters to the privileged.
• Insurance companies use Assisted Suicide to deny coverage for curative life-saving treatments, offering to pay for Assisted Suicide instead.
• People of color opposed Assisted Suicide by 2-1 margins on your 2012 ballot measure.
  

It’s Not about Pain or a Peaceful Death; Both are Myths.

Dr. Lonny Shavelson who exclusively practices in providing California’s Medical Aid in Dying (a name used for Assisted Suicide) says promoting it as avoiding pain is a political sales pitch. See webinar minutes 25:24 - 27:53. In his experience, people choose Assisted Suicide because they are low energy or afraid of losing control. He says Oregon’s data is consistent with his experience. The Oregon data show most people choose Assisted Suicide because of a decreasing ability to participate in enjoyable activities (94%), loss of autonomy (93%) and loss of dignity (72%), not fear of pain and suffering.

Dr. Shavelson says another myth is that Assisted Suicide creates a peaceful beautiful death. Actually, it does not change what happens during dying. It simply makes it faster. People gasp for air, change colors, sweat, twitch, have seizures and sometimes vomit which is why he puts them into a coma first. See webinar minutes 37:35 - 41:00. Most people who die under these laws do not have a medical person present, (two-thirds in Oregon). Either way, the family will experience this.

For many years, fatal quantities of barbiturates were prescribed to carry out Assisted Suicide. These drugs cause the lungs to fill with fluids like drowning. When these drugs became expensive, Assisted Suicide doctors experimented on people with other drug cocktails, some of which burned people’s throats causing them to scream in pain and extended the dying process by more than 3 hours and as much as 31 hours.

Assisted Suicide Caters to the Privileged

Assisted Suicide laws like the End of Life Options Act are used primarily by privileged white people. Oregon’s last report says 96.5% of those using the Oregon law in the past twenty-three years were white. Massachusetts is already in the top ten states with increasing youth suicides, positioning your state for more if you enact the End of Life Options Act. Your Office of the Child Advocate found concerning suicide trends among younger Black children, LGBTQ, Native American and Hispanic youth in Massachusetts.

More youth will commit or attempt suicide, especially youth of color, if you pass the End of Life Options Act. In so doing, you send the message that suicide is an acceptable solution to problems. Publicity about suicide leads to more suicides; this is called suicide contagion. Legalizing Assisted Suicide is linked to suicide contagion. Suicide contagion especially impacts youth of color. All of this is more fully explained below.

Publicity about the details of how to commit suicide or that normalizes suicide makes suicide contagious. In 2017 when Netflix released 13 Reasons Why, the story of a 17 year old girl’s suicide and its aftermath, teen female suicides went up by 21.7% (95% CI, 7.3%-36.2). For every person who dies by suicide, another 30 attempt suicide. This particularly impacts teens and adolescents. Because youth are far more likely to attempt than commit suicide, the medical costs for this group can be significant, especially for those who become disabled. Those less financially well off are impacted: 28.4% of medical costs for suicide and attempts are paid by Medicaid; another 24.8% are incurred by the uninsured.

Legalization of Assisted Suicide contributes to suicide contagion, again especially impacting youths. A 2019 report found teen suicides in California increased by 34% since that state legalized Assisted Suicide in 2016. Oregon’s youth suicides increased 79.3% from 2000 to 2018. Research about completed suicides in four states that legalized Assisted Suicide (Oregon, Washington, Vermont and Montana) found it was associated with at least a 6.3% increase in the rate of all suicide deaths. The study reported:

“PAS [Physician Assisted Suicide] is associated with an 8.9% increase in total suicide rates (including assisted suicides), an effect that is strongly statistically significant (95% confidence interval [CI] 6.6%-1.2%). Once we control for a range of demographic and socioeconomic factors, PAS is estimated to increase rates by 11.79% (95% CI 9.3%-14.1%). When we include state-specific time trends, the estimated increase is 6.3% (95% CI 2.7%-9.9%).”

Black and Hispanic youth are particularly impacted. The Congressional Black Caucus calls suicides by Black youth a crisis. Nationally, Black youth under age 13 are twice as likely to die by suicide than their white peers. From 1991-2017, attempted suicides by Black adolescents (boys and girls) rose 73%, while injuries from those attempts rose 122% for the boys. From 2000 to 2015, the suicide rate among Hispanic females rose by 50% overall while increasing nearly 100% among young Hispanic women. Adolescent Hispanic girls attempt suicide at much higher rates than Black or non-Hispanic white girls.

Insurance Companies Use Assisted Suicide to Deny Curative Life-Saving Treatment Insurers stop covering certain treatments due to the availability of Assisted Suicide. Dr. Brian Callister of Nevada says he was stunned when insurance would not cover life saving treatment for his patients who were transferring to California and Oregon, but offered to pay for Assisted Suicide instead. These were people who could be cured with the denied treatment rather than being rendered terminal. In effect, Assisted Suicide is being used to shunt people off the curative, restorative medicine track, especially if they cannot afford to pay for treatments out of pocket.

People of color get this. Even with insurance, people of color get poorer hospital care and pain relief according to a New York Times article. They are disproportionately dying of COVID-19. So, it is unsurprising that Black and Latinx people oppose Assisted Suicide by 2-1 margins‒ “… the voting results from [Massachusetts] Ballot Question 2 in 2012 show Assisted Suicide pits wealthier, whiter districts against those with poorer people and people of color according to Second Thoughts – Massachusetts. 

In closing, I urge you to consider the heartache for families who lose their youth to suicide and the loss of insurance coverage for curable treatments that would follow enactment of these bills, both of which contribute to inequity for people of color. If you weigh that against the so-called benefits of Assisted Suicide which Dr. Shavelson says are myths, you will let the End of Life Options Act die in your committee. 

Sincerely,

Sara Buscher, Chair
Euthanasia Prevention Coalition USA
EPC_USA@yahoo.com

California judge rejects preliminary injunction to permit euthanasia within the California assisted suicide act.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

A California federal judge has rejected a preliminary injunction asking the court to permit euthanasia within the state assisted suicide act. Link to the court decision (Link).

On August 30 I wrote an article about the California court case to permit euthanasia within the state assisted suicide act. The case argued that some people with disabilities, who are approved for assisted suicide, are unable to self-administer the lethal drugs. Therefore, based on the Americans with Disabilities Act, the court must permit euthanasia (doctor administered death) in these cases.

On September 13 I wrote that the California court must reject the challenge to the state assisted suicide act based on (among other reasons): 

1. There is no right to assisted suicide, therefore there is no legal requirement to amend the perceived inequality within the state assisted suicide law. 
2. The Supreme Court, in Glucksberg, recognized that there is no right to assisted suicide and it recognized that one state interests in prohibiting assisted suicide was the prevention of euthanasia. This court case specifically seeks to permit euthanasia.  
3. Permitting euthanasia is not an extension of the state assisted suicide law but rather it requires the court to legislate a new law, that being legalizing euthanasia, which is a form of homicide.

On September 20 Justice Vince Chhabria of the United States District Court Northern District Of California rejected a preliminary injunction to permit death by lethal injection (euthanasia) for the plaintiffs. Justice Chhabria stated:

The plaintiffs' ADA claim does not raise a serious legal question, because it seems clear (at least on this record) that the plaintiffs are seeking a modification that would compromise the essential nature of California's program.

Justice Chhabria also makes a clear distinction between euthanasia and assisted suicide by stating:

And most relevant here, the Legislature drew a clear line between assisted suicide and euthanasia, providing that a terminally ill person cannot obtain a prescription unless they can administer the medication themselves and specifying that there is no immunity from criminal or civil liability for someone who administers the medication to a terminally ill person.

Justice Chhabria concludes his decision by stating:

In short, the line between assisted suicide and euthanasia is a significant one. See Washington v. Glucksberg... (1997). It is unlikely that the ADA could be reasonably contrued as requiring a state to cross the line to euthanasia merely because the state has chosen to authorize assisted suicide. Requiring the State of California to cross the line here would likely compromise the essential nature of the end-of-life program it created.

Link to the court decision (Link).

Link to my previous articles about this court case (Link 1) (Link 2).