Psychiatrists Must Prevent Suicide, Not Provide It

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Psychiatrists Cynthia Geppert, Mark Komrad, Ronald Pies and Annette Hanson are leading voices against the involvement of Psychiatrists in the acts of euthanasia and assisted suicide. 

During the past several months there have been a series of articles and rebuttles between Geppert, Komrad, Pies and Hanson with Drs Kious and Battin. Dr Margaret Battin is a long-time euthanasia activist who has published articles and studies since the 1980's.

The recent rubuttal with Kious and Battin was published in the Psychiatric Times on November 19, 2019. The recent Geppert et al response concerns the following:

Kious and Battin argue that the long-established practice of psychiatrists to make every effort to prevent suicide including the use of involuntary commitment and the relatively new availability of physician aid-in-dying (PAD) create a moral dilemma. Their proposed resolution of the dilemma is to permit psychiatric patients, as well as those with medical illnesses, to access PAD when their suffering is severe and irremediable. Our commentary rejects the fundamental presumption that any physicians, much less psychiatrists, should be involved of the work of killing rather than the calling of healing, among other criticisms.

Cynthia Geppert

Kious and Battin argue that the majority of Americans support assisted suicide, but Geppert et al suggest that polling alone does not determine right or wrong, that in fact a deep analysis of the issue is necessary. Geppert et al argue that the research by the American Medical Association, the World Medical Association and more enables a better understanding of the issues. They state:

This “deep dive” is precisely the process that was brought to bear by the American Medical Association (AMA) and the World Medical Association (WMA) in their recent reexaminations of their ethical opposition to these practices.4 That process was repeated several times at the request of PAS proponents, and each time, though acknowledging the caring intentions on both sides of the issues, these organizations kept coming to the same conclusion—that these practices are “firmly opposed.” Similarly, for the second largest medical organization in the US—the American College of Physicians5—and even for the organization that works professionally in the “end-zone” of life—the International Association for Hospice and Palliative Care6—these and other articulations, are not mere polls. They are robust deliberations by organizations representing physicians and others, whom society is asking to do the killing. Moreover, no medical organization in the US has actually endorsed PAS as a laudable practice so far. At most, those organizations not opposed to PAS have expressed official “neutrality” on this issue.

Kious and Battin argue that Geppert et al hold to a position of essentialism and historicism, which they suggest changes over time. Geppert et al respond:

We now turn to Drs Kious and Battins’ critique of our philosophical position as “essentialism” and “historicism.” If by “essentialism,” they mean that we hold certain medical ethical truths to be constant, enduring, and not “will-o-the-wisp” notions dependent on polls and plebiscites, then, yes—we are guilty of “essentialism.” While we would acknowledge that “evolving social expectations” do have some influence on “what is permissible for physicians,” we would deny that such expectations are infinitely elastic and determinative, vis-à-vis what is ethically permissible. Would the authors change their own position favoring “assisted dying” if new polls showed that most physicians oppose the practice? Or do they base their position in favor of PAS on their own view of what is “essential” to the role of physicians? If we make medical ethics dependent upon polls, we are opening the field to a kind of post-modern relativism that undercuts the very concept of a “profession.” Medical ethics are not a kind of weather vane, changeable with each new poll that comes out! We would argue that PAS is really an outgrowth of, and is contemporaneous with, the consumer movement of the past 50 to 60 years and is therefore an anomaly in the history of medical ethics.7 

Ronald Pies

Geppert et al then defend Hippocratic medicine:

It is not the literal wording of the Hippocratic Oath, but the subsequent development of those values that has provided a moral compass for the medical profession. That growth, intellectually and experientially, resembles, for example, the development of religious values, not confined to, but inspired by the esteemed teachers and holy books of the world’s great religious traditions. These are evolving and venerable moral compasses for covenantal communities. The current Tree of Medicine is rooted in its Hippocratic soil. It has ramified branches of thoughts and values yet embodies a core ethos that has persisted through the rise and fall of many societies.

Annette Hanson

They then challenge the attack that they are simply historicists:

Our colleagues should not so easily dismiss the lessons of history as mere “historicism.” We believe very much in Santayana’s famous wisdom:  “Those who cannot remember the past are condemned to repeat it.” Changing social mores and highly popular notions, championed by celebrities, intellectuals, and policy makers, have swept physicians off their ethical moorings in the past. Consider the historic example of Soviet psychiatry. Civil commitment was used to isolate dissidents, and the doctors went along with it. Physicians, especially psychiatrists, participated with relish in eugenics-inspired forced sterilization programs of the mentally ill in the US.8 There are moral absolutes that our profession should stand up for, in spite of legislative or popular pressure. Public health policy should not be contingent upon popularity. Many popular ideas were proved both wrong and harmful (eg. conversion therapy for homosexuals).

They conclude their rebuttal by referring to anthropologist Margaret Mead:

Anthropologist Margaret Mead presciently warned a physician friend about the social pressure on physicians to kill in the name of mercy, observing that:

The followers of Hippocrates were dedicated completely to life under all circumstances, regardless of rank, age, or intellect—the life of a slave, emperor, foreign man, defective child . . . This is a priceless legacy which we cannot afford to tarnish. But society has repeatedly attempted to make the physician into the killer . . . It is the duty of society to protect the physician from such requests.9

We would do well to heed her warning.

I am sure that this debate will continue. Geppert, Komrad, Pies and Hanson hold to the truth, that physicians must not kill their patients and psychiatrists prevent suicide, not provide it.

Dr Geppert is Professor of Psychiatry and Medicine, and Director of Ethics Education, University of New Mexico School of Medicine; and Ethics Section Editor of Psychiatric Times. Dr Komrad is on the psychiatry faculty of Johns Hopkins, University of Maryland, and Tulane University. Dr Pies is Professor Emeritus of Psychiatry and Lecturer on Bioethics & Humanities, SUNY Upstate Medical University; Clinical Professor of Psychiatry, Tufts University School of Medicine; and Editor-in-Chief Emeritus of Psychiatric Times (2007-2010). Dr Hanson is Director of the Forensic Psychiatry Fellowship at the University of Maryland.
References:

1. Kious BM, Battin MP. Physician Aid-in-Dying and Suicide Prevention in Psychiatry: A Moral Crisis? Am J Bioeth. 2019;19:29-39.

2. Magelssen M, Supphellen M, Nortvedt P, Materstvedt LJ. Attitudes towards assisted dying are influenced by question wording and order: a survey experiment. BMC Med Ethics. 2016;17:24.

3. Dany L, Baumstarck K, Dudoit E, et al. Determinants of favourable opinions about euthanasia in a sample of French physicians. BMC Palliat Care. 2015;14:59.

4. World Medical Association. WMA Declaration on Euthanasia and Physician-Assisted Suicide. https://www.wma.net/policies-post/declaration-on-euthanasia-and-physician-assisted-suicide. Accessed November 7, 2019.

5. Snyder L, Sulmasy DP, Ethics, Human Rights Committee ACoP-ASoIM. Physician-assisted suicide. Ann Intern Med. 2001;135:209-216.

6. De Lima L, Woodruff R, Pettus K, et al. International Association for Hospice and Palliative Care Position Statement: Euthanasia and Physician-Assisted Suicide. J Palliat Med. 2017;20:8-14.

7. Pies RW. Physician-Assisted Suicide and the Rise of the Consumer Movement. Psychiatric Times. 2016;33(8). https://www.psychiatrictimes.com/couch-crisis/physician-assisted-suicide-and-rise-consumer-movement. Accessed November 18, 2019.

8. Dowbiggen I. Keepin America Sane: Psychiatry and Eugenics in the United States and Canada, 1880-1940. New York: Cornell University Press; 2003.

9. Mead M. The Hippocratic Registry of Physicians. https://www.hippocraticregistry.com. Accessed November 18, 2019.

Targeting people with mental illness and dementia for euthanasia.

This article was published by The American Spectator on October 17, 2019

Several countries may be ahead of us in this area, but the U.S. is fast catching up.

Wesley Smith

By Wesley J Smith

A few years ago, a Dutch doctor attended her elderly Alzheimer’s disease patient at a nursing home. The doctor’s purpose wasn’t to examine the patient or prescribe new medicines. Rather, she was there to kill.

While competent, the patient asked to be euthanized when incapacitated, but she also instructed that she be allowed to say when. But before she did that, the doctor and her family decided that her time had come. The doctor drugged the woman’s coffee and, once she was asleep, began the lethal injection procedure. But the patient awakened unexpectedly and fought against being killed. Rather than stopping, the doctor instructed the family to hold the struggling woman down while she completed the homicide.

This would seem to be a clear-cut case of murder. But a judge recently exonerated and praised the doctor for acting in the “best interests” of the patient by merely executing the woman’s previously stated wishes. In other words, the judge essentially ruled that the struggling patient was no longer competent to want to stay alive.

The only unusual aspect of the “Case of the Struggling Alzheimer’s Patient” was the struggle. Even when incompetent and unable to make their own decisions, the law of Netherlands and Belgium allows dementia patients to be killed by doctors if they so order in written advance directives.

Both countries also allow mentally ill patients who ask to die to be euthanized. Such procedures are not rare. According to government statistics, in 2017, Dutch psychiatrists and doctors euthanized 83 mentally ill patients. Sometimes these legal homicides are accompanied by consensual organ harvesting after death. One case — reported in an international transplant medical journal — involved a self-harmer (or “auto-mutilator”) for whom doctors applied the ultimate harm as a “treatment.” Without criticism — or even a moment’s reflection about the moral questions raised by such an act — the medical journal reported approvingly that the lungs of the deceased psychiatric patient were well accepted by their recipients.

The Supreme Court of Switzerland, a country that permits assisted suicide clinics — ruled several years ago that the mentally ill have a constitutional right to access death. Accordingly, there are many verified cases of the non-physically ill being assisted to kill themselves — including an elderly woman who wanted to die because she had lost her looks.

Canada, which recently legalized lethal injection euthanasia for those whose deaths are “reasonably foreseeable,” now is debating expanding the right to be killed to those whose lives are not in danger. Prime Minister Justin Trudeau is on record as favoring liberalization and has stated his government will not appeal a recent court ruling declaring the foreseeable death limitation to be unconstitutionally restrictive and discriminatory.

How far is the expansion likely to go? Many Canadian euthanasia advocates are pushing for revisions that would allow people with mental illnesses and dementia to be killed by doctors in the same manner as now allowed in the Netherlands and Belgium. And here’s some breaking news: the Alzheimer Society of Canada — which is supposed to advocate for the welfare of such patients — has officially endorsed allowing euthanasia by advance directive. This means that even if the incompetent patient is not suffering — perhaps even if he or she expresses no desire to die — their former self’s decision trumps the current self’s needs and desires.

Alan Nichols with his brother.

Meanwhile, there has already been at least one depressed Canadian apparently euthanized at his request even though his death was not foreseeable. The man’s family even begged doctors not to kill him, but to no avail.

What about the U.S.? Would we ever follow such a course? As of now, the nine states and the District of Columbia that have legalized assisted suicide limit access to patients who are terminally ill. But that’s more a political expediency than a principled limitation. Indeed, restricting assisted suicide to the dying is philosophically unsustainable.

Think about it. If the point of allowing suicide by doctor is to eliminate suffering — and if eliminating suffering can include eliminating the sufferer — how can facilitated death be forbidden to patients, such as those with dementia and mental illness, who may suffer far more extremely and for a much longer time than the already dying? It makes no sense.

Despite continuing disapproval of euthanasia for mental illness by the American Psychiatric Association, that point is increasingly being made in the media and professional journals. For example, an article just published in the American Journal of Bioethics argues that since “the suffering associated with mental illness can be as severe, intractable, and prolonged as the suffering due to physical illness,” as a matter of “parity,” in “severe” cases, “PAD” (physician-assisted death) should be made available to mentally ill patients with “decisional capacity” — even when they have “a relatively long expected natural lifespan.” The authors, University of Utah psychiatry professor Brent M. Kious and noted assisted suicide advocate and bioethicist Margaret (Peggy) Battin, go so far as to suggest that “psychiatrists and other mental health professionals” could one day become “gatekeepers for PAD” once “a metric for suffering in both mental and physical illness” is established.

Ponder this for a moment. Instead of being duty-bound to save the lives of all their suicidal patients, mental health professionals would become approvers for and facilitators of self-destruction. That should be unthinkable.

Alas, the first small legal steps toward permitting the demented and mentally ill to access suicide by doctor have already been taken. After California legalized assisted suicide for the terminally ill, the Department of State Hospitals promulgated a regulation requiring that patients who have been involuntarily committed — and who have become terminally ill — be provided access to assisted suicide despite their mental illness. By definition such people are not legally competent, or else why would they be involuntary hospitalized?

Meanwhile, Nevada just enacted a law that allows dementia patients to instruct caregivers to withhold “food and water” once they reach incapacity toward the end that they starve to death. Please note that this first-of-a-kind law isn’t about refusing a feeding tube or preventing force-feeding. Rather, the law (SB 121) permits patients to order their future selves to be refused “food and water” — even if they willingly eat, perhaps even if they ask caregivers for sustenance. That’s homicide by neglect.

Don’t take my word for it. The influential bioethicist Thaddeus Mason Pope wrote about the law:

Even after we stop offering food and fluids, other problems may arise. Most problematically, the patient may make gestures or utterances that seem to contradict her prior instructions [to be starved]. Does such communication revoke the advance directive? A recent court case from the Netherlands suggests the answer is “no.” Once the patient reaches late-stage dementia, she is unable to knowingly and voluntarily revoke decisions she made with capacity. But the answer remains uncertain in the United States.

In other words, Pope believes that a court could one day rule that an advanced dementia patient isn’t “competent” to want to eat.

Of course, the point of such advocacy isn’t really starvation but convincing people to allow intentional overdosing of these vulnerable patients by doctors. After all, if we are going to end their lives, the reasoning goes, we should at least do it humanely. If we accept the propriety of intentionally ending dementia patients’ lives based on their prior instructions, that argument certainly has emotional appeal.

Accelerating advocacy for legalizing euthanasia is pushing us toward making a stark choice. We can decide that assisted suicide is an acceptable response to human suffering, allowing people to die — but also unleashing gravitational forces of logic that will lead inexorably (over time) to a broader killing license, including of the killing of dementia and mentally ill patients as advocated by Kious and Battin. Or, we can focus instead on suicide prevention in all cases. Such caring takes more time, commitment, and resources, but better exemplifies true “compassion,” the root meaning of which, after all, is to “suffer with.”

Kious and Battin are on the mirror opposite side from me in the euthanasia debate, but we agree that there is no such thing as a “little” euthanasia: In for a penny is in for a dollar. Those with eyes to see, let them see.

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

Suicide is not distinct from assisted suicide for psychiatric reasons

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Recent research by Dr Scott Kim et al, examines the position of the American Association of Suicidology (AAS) who claim that there is a clear difference between suicide and assisted suicide.

The American Association of Suicidology accepted the false position of long-time assisted suicide activist Margaret Battin who wrote that suicide and assisted suicide are different acts done for different reasons. Battin is known for producing ideological studies that are not factually based. The assisted suicide lobby knows that assisted suicide becomes socially accepted when it is differentiated from suicide.

The study by Dr Kim, a professor of psychiatry at the University of Michigan and a member of the Department of Bioethics at the National Institute of Health, was published in the Journal of the American Medical Association Psychiatry (JAMA Psychiatry) analyzing the AAS position based on cases of euthanasia for psychiatric reasons in the Netherlands.

Kim suggests that the US states that have legalized assisted suicide claim to exclude assisted suicide for psychiatric reasons, but Kim says:

"it would have been quite understandable if the AAS had limited its statement to PAD for terminal illness especially since the organization is based in the United States (where Psychiatric PAD is not legal) and dedicated to preventing suicides (which occur mostly among persons with mental illness). Yet the AAS statement's support for PAD explicitly includes PAD of all types including PAD for non-terminally persons with psychiatric disorders."

Dr Scott Kim

Kim then challenges the position of the AAS based on their own description of suicide. He writes:

However juxtaposing the AAS statement's descriptions of "suicide in the ordinary, traditional sense" with the existing evidence on psychiatric PAD reveals that the features of persons who die by suicide that are said to distinguish them from persons who seek PAD for terminal illness are, in fact, featured by those who receive psychiatric PAD.

Kim then examines the comments from the AAS based on the reasons people ask for PAD. The research states:

...research shows that these common features of suicide are not only present in psychiatric PAD but are cited as justifications for PAD.

Kim then concludes his research by stating:

"In the debate about psychiatric PAD important considerations are raised by both sides. One of the most concerning is how the practice of psychiatric PAD will affect the longstanding societal commitment to the prevention of suicide. It should give us pause when a leading suicide prevention organization minimizes this problem while ignoring the evidence that psychiatric PAD is difficult to distinguish from suicide. Regardless of one's position on the policy debate, all sides should at least be committed to a more evidence based dialogue."

More articles on this topic:

• Suicide epidemic exasperated by cultural loneliness.
• American Association of Suicidology betrays some suicidal people.
• Margaret Battin's research was false when published in 2007 and remains false today.

Suicide epidemic exacerbated by cultural loneliness.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

The suicide epidemic is once again in the news possibly due to the celebrity suicide deaths of Anthony Bourdain, Kate Spade, and others. There have been many articles published on what may be causing the significant increase in suicide deaths.

The latest research from the Center for Disease Control indicates that between 1999 and 2016, the suicide rate in America increased in every state (except Nevada). Suicide deaths have increased by a staggering 30% in America where in 2016 alone, 45,000 people died by suicide.

After reading many articles and studies on the scourge of suicide, I am further convinced that the causes of suicide are the same or similar reasons why people ask for assisted suicide. Based on their feelings of hopelessness and despair, they feel like they have no other choice.

An article by Ross Douthat in the New York Times Sunday Review (May 18, 2013) concerning loneliness and suicide states:

Right now, the pessimistic scenario seems more plausible. In an essay for The New Republic about the consequences of loneliness for public health, Judith Shulevitz reports that one in three Americans over 45 identifies as chronically lonely, up from just one in five a decade ago. “With baby boomers reaching retirement age at a rate of 10,000 a day,” she notes, “the number of lonely Americans will surely spike.”

The same concerns were expressed by Ben Domenech in an article published in the Federalist (June 11) in commenting about the tragic death of Anthony Bourdain. Domenech states:

The answer is almost assuredly loneliness and depression – both of which Bourdain has talked about in multiple interviews over the years, and since his divorce. Listening to his conversations over the weekend with Marc Maron and David Remnick, it’s barely under the surface of his conversations – and if you’re familiar with his shows, they seem less like advocacy for an approach to life, and more like arguments with himself about the inherent goodness and beauty we can find in the world. 

The disturbing truth we have to recognize is that Bourdain is not alone in his loneliness and depression. We are experiencing an incredible increase in suicide levels according to the latest research from the CDC. From 1999 to 2016, suicide increased in every U.S. state but one (and that one is Nevada, which remains in the top ten states for suicides). It is one of the top ten causes of death and one of only three such causes on the rise. The rise is seen in every age group and across all demographics, but particularly among people who look like Bourdain: 84 percent of suicide victims are white, and roughly 77 percent are men. 

Last month, a CIGNA survey found that loneliness is epidemic, and that the youngest Americans proclaim the highest levels. “One in four Americans (27 percent) rarely or never feel as though there are people who really understand them. Two in five Americans sometimes or always feel that their relationships are not meaningful (43 percent) and that they are isolated from others (43 percent). One in five people report they rarely or never feel close to people (20 percent) or feel like there are people they can talk to (18 percent).

The pro-euthanasia "experts" claim that suicide has nothing to do with assisted suicide. The American Association of Suicidology accepted the false position of long-time assisted suicide activist Margaret Battin who wrote that suicide and assisted suicide are different acts done for different reasons. Battin is known for producing ideological studies that are not factually based. The assisted suicide lobby knows that assisted suicide becomes socially accepted when it is differentiated from suicide.

• Margaret Battin supports child euthanasia.

With 20 years of experience with the issues of euthanasia and assisted suicide I contend that the reasons people die by suicide are the same or similar reasons why people ask for assisted suicide, even when the circumstances differ.

Most people who ask for assisted suicide feel that their life lacks purpose, meaning or hope, they feel that no one cares about them or that they are a burden on others. Physical suffering rarely causes someone to seek a hastened death but loneliness, depression or feelings of hopelessness are primary reasons.

There aren't easy answers, but I contend that a culture can reduce the scourge of suicide and the cultural abandonment associated with assisted suicide, by caring for and being with others at their time of need. It is essential that people who feel that their life lacks value or purpose, or feels that no one cares, is offered purpose, support and genuine hope from their significant community.

The answer is not only talking about it (suicide), the answer is inclusion, caring and being with others as they journey through the difficult times of their lives.

• Elderly Dutch couple. Euthanasia is not the answer.
• Suicide is a symptom of mental illness, not a cure for it.
• Dying alone, the greatest fear.
• Distinguishing between sadness and depression at the end of life.
• Study uncovers problems with euthanasia for psychiatric reasons in the Netherlands.

Behind the Curtain of Assisted Suicide Advocacy

This article was published by First Things on March 16, 2018

Wesley Smith

By Wesley Smith

The United States assisted suicide movement claims that it wants only a limited “reform” of law and medical ethics, restricting what it euphemistically calls “aid in dying” to competent adults with terminal illnesses for whom nothing else can be done to alleviate their suffering. But this claim isn’t true. Currently, no law permitting doctors to write lethal prescriptions mandates any objective medical determination that the patient is actually suffering. Indeed, a 2008 study published in JAMA Internal Medicine found that patients sometimes receive lethal prescriptions even when they are not experiencing serious pain or other noxious symptoms.

The falsity of the “limited license” narrative is further demonstrated by current policies and legislative proposals that are likely to be instituted broadly, should the assisted suicide movement prevail nationally.

Assisted Suicide for the Mentally Incompetent: Legal assisted suicide is supposed to be available only to the mentally competent. But after California legalized doctor-prescribed death, the California State Department of Hospitals promulgated a regulation requiring state mental institutions to facilitate assisted suicides of institutionalized patients who are diagnosed with a terminal illness. As I have written previously, these are often people who have been involuntarily denied their freedom due to diagnosed mental illness, sometimes because of suicidal ideation. They are usually being treated with powerful psychotropic medications. In what universe could they possibly be deemed competent to make a reasoned decision in favor of assisted suicide?

California isn’t alone in opening the door to assisted suicide for the mentally incompetent. A pending bill to legalize assisted suicide in Delaware would allow the “intellectually disabled” who are terminally ill potentially to qualify for lethal prescriptions. Note how HB 160 defines the term:

“Intellectual disability” means a disability, that originated before the age of 18, characterized by significant limitations in both intellectual functioning and in adaptive behavior, which covers many everyday social and practical skills.

Such people can’t legally enter contracts. They can’t control where they live. They would require a guardian’s consent to receive most medical treatments. They can’t consent to getting a tattoo! But these same developmentally disabled people would be able to receive assisted suicide if a licensed clinical social worker wrote a letter to the lethally prescribing doctor confirming “that the patient understands the information provided.”

Expanding Assisted Suicide Beyond the Terminally Ill: The oft-repeated promise that assisted suicide is only for those who are already dying no longer holds overseas. Countries such as the Netherlands, Belgium, Switzerland, and Canada don’t limit assisted suicide and euthanasia to the dying. It’s only logical: If eliminating suffering justifies eliminating the sufferer, there are many people with disabilities, chronic pain, dementia, mental illnesses, and so on who may experience far greater suffering, and for a longer time, than do the terminally ill. It should be no surprise that many countries have steadily expanded their laws’ killable categories over the years—including, in Belgium, joint lethal injections of at least three elderly couples who wanted to die for fear of the future suffering they expected would be caused by widowhood.

Advocacy for loosening the restriction has begun here, too. As the Washington Post recently reported, Oregon legislators are planning a push to eliminate the six-months-to-live rule, and to extend the option of euthanasia to people diagnosed with dementia. True, that bill is opposed by Compassion & Choices; but, at least in part, they oppose it because it “could give ammunition to critics and frustrate their efforts to bring the narrowly defined statute to as many states as possible.” In this regard, it is also worth noting that Compassion & Choices issued a press release applauding Canada’s Supreme Court for granting a very broad legal and positive right to receive euthanasia that extended far beyond the terminally ill—a press release subsequently scrubbed, one suspects, because it revealed how radical the organization’s views really are.

Child euthanasia: Assisted suicide advocates promise to limit medicalized killing to adults. But we have already seen that same promise broken in the Netherlands and Belgium. In the Netherlands, severely disabled and dying babies are subjected to infanticide under the “Groningen Protocol”—a bureaucratic baby euthanasia checklist—and children aged twelve and above can legally be given a lethal jab. Next door in Belgium, there are no age limits! Meanwhile, Canada is beginning to debate whether to expand its euthanasia laws to include at least “mature” children.

Child euthanasia has now received the imprimatur of one of this country’s most prominent euthanasia and assisted suicide advocates, professor and prolific author Margaret P. Battin. She recently wrote in the Dutch medical journal Pediatrics that there are “no good reasons” for failing to expand eligibility for assisted suicide to minors under age twelve, and she believes that many factors favor the expansion—including, notably, “the suffering of parents.” As far as I know, none of her colleagues in the movement have objected to or publicly criticized her radical proposal.

The assisted suicide movement pretends to have a very limited agenda. It pretends to advocate only a minor change—a “safety valve,” as they sometimes call it—in traditional medical ethics and public policy. But advocates sometimes give us glimpses of the more radical and extensive ultimate intentions behind their blithe assurances. For those who have eyes to see, let them see. 

Wesley J. Smith is a senior fellow at the Discovery Institute’s Center on Human Exceptionalism and a consultant to the Patients Rights Council.

Prominent US Bioethicist Supports Child Euthanasia.

This article was published on Wesley Smith's website on March 5, 2018.

Sign the petition: "I Oppose Euthanasia for Children."

By Wesley Smith

The U.S. assisted-suicide movement pretends to want a limited legalization of assisted suicide to competent adults with a terminal illness.

That’s not true. It’s just the expedient to persuade us to accept the premise that suicide or killing is an acceptable solution to human suffering.

If we ever do that — the jury is still out — then, the killing license thereby granted will not only expand way beyond the terminally ill, but will eventually also include children and the incompetent.

The evidence of this isn’t hard to find. Case in point. Pediatrics asked Dutch and American bioethicists whether they would support repealing all age limits for euthanasia in the Netherlands — as the Belgians already have. (Currently, euthanasia in the Netherlands is legal starting at age 12.)

If American advocates were serious about their espoused limits, they would be appalled by the existing Dutch law, and even more so by the Pediatrics hypothetical proposal.

But at least one prominent U.S. proponent — Margaret P. Battin, a favored source on the issue for the New York Times and other mainstream media outlets — is enthusiastically in favor of the Dutch doing away with all euthanasia age limits. From her comment:

I generally support [the] change in Dutch law governing eligibility for euthanasia.‍ Given that euthanasia is currently legal for infants <1 adults="" age="" and="" children="" of="" year="">12 years of age, I believe that opponents would have to show evidence that at least 1 and perhaps many of the following propositions are true if they are to persuade you [a hypothetical Dutch health minister] not to support the change in the law:

Battin lists several propositions, including:

That parents aren’t harmed by seeing their children suffer.

In other words, children should be put out of the parents’ misery:

That pediatricians can’t understand the difference between killing a healthy, curable child and hastening a bad death that is already in progress.

Except that Dutch law does not require a terminal illness to be killed. Indeed, the infanticide-allowing Groningen Protocol — it isn’t technically legal, but is virtually never punished — specifically does not require that the killed baby be otherwise dying. In fact, under the Protocol, serious disabilities justify infanticide.

That allowing this practice would lead to wholesale killing of children from 1 to 12 years of age.

In other words, killing would only be wrong if it amounted to a pogrom against seriously ill or disabled children. Good grief.

That it is always wrong to end a life.‍ (Proponents of this view would need to address situations such as killing in war, killing in self-defense, killing in defense of others, and [more controversially] capital punishment; they would also need to oppose current laws in the Netherlands that allow euthanasia for children <1 adults="" age="" and="" of="" year="">18 years of age.

So, since babies and children age 12 and up can be killed, the Dutch should go all-in. Or to put it another way, once a society starts down Euthanasia Road, there is no stopping.

Battin’s radical proposals aren’t usually made by U.S. assisted-suicide proponents because they know that our society has not completely swallowed the hemlock (as has the Netherlands). If we ever do, we will go exactly to the dark place that country has gone over the last few decades — just as Battin advocates.

It’s a very big deal that a respected Dutch medical journal such as Pediatrics hosted a debate on the ethical propriety of child euthanasia without international criticism. It means that among the medical intelligentsia, child euthanasia has become a respectable proposition.

For those with eyes to see, let them see.

Editor’s Note: This post has been amended since its original publication.

Netherlands Euthanasia "experts" advocate for child euthanasia - with or without consent.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

The Journal Pediatrics (January 10, 2018) features an "Ethics Round" article titled: Should Pediatric Euthanasia be Legalized?

The Journal article features comments by proponents and opponents of child euthanasia. The article clarifies that, in the Netherlands, euthanasia is a legal option for children (ages 12 - 18) with parental permission and to newborns, based on the Groningen Protocol, who are younger than one. The Journal article states that these deaths are rare.

It is particularly concerning that the Netherlands "experts" Marije Brouwer, Ma, Els Maeckelberghe, PhD, and Eduard Verhagen, MD, JD, PhD, stated:

We would advise the Minister of Health to consider removing age restrictions from both the Euthanasia Regulation and the Groningen Protocol. This would make euthanasia accessible for competent and incompetent children who suffer unbearably when there is no other way to relieve their suffering. It would show trust in mature minors, parents, and doctors to make the right decisions.

Our advice to remove age restrictions is in line with important Dutch values. We believe in self-determination, as manifested by the voluntary request that initiates the procedure, and in the beneficence of physicians to end unbearable suffering when there are no other options. 

We would cautiously remind the Minister that the group of incompetent patients who also might suffer unbearably is not limited to the age of 12 but encompasses patients of all ages.

Brouwer, Maeckelberghe and Verhagen state that euthanasia should be permitted when a person is incompetent to request death by lethal injection and that the decision should be left to the beneficence of physicians. Choice and autonomy were never centrally important, since the law always gave physicians the power to decide. People with disabilities should be concerned when lethal injection can be done based on the beneficence of a physician.

Euthanasia of incompetent people is not new in the Netherlands or Belgium. A recent study published in the New England Journal of Medicine (NEJM) (August 3, 2017) found 431 terminations of life without request in the Netherlands in 2015. Similar studies indicate that euthanasia without consent is even more common in Belgium.

Christopher Kaczor disagreed with Brouwer, Maeckelberghe and Verhagen. Kaczor states that, based on equality. Kaczor states:

Defenders of the Dutch law permitting intentional killing of infants as well as adults and children 12 years of age and older presuppose an empirical claim: killing a person is “the only escape from the situation” of unbearable suffering. This claim is false. 

Current Dutch law does allow for non voluntary euthanasia of infants, an allowance incompatible with the principles of justice because such infants do not consent to have their lives ended. If all persons are to have equal rights and deserve equal protection of the law, then disabled persons (whether they are infants, children, or adults) deserve the same basic protections from intentional homicide.

The Journal article also features comments from long-time euthanasia promoter, Margaret Battin and opposition is expressed by John D. Lantos.

Dutch journalist, Gerbert van Loenen, in his book - Do You Call This A Life? explains that euthanasia without consent based on beneficence, was part of the euthanasia practice, in the Netherlands, from the beginning. van Loenen, in his book, examines the stories and cultural change that led to the legalization and then acceptance of euthanasia in the Netherlands.

American Association of Suicidology Betrays some suicidal people.

This article was published by Wesley Smith on November 3, 2017

Wesley Smith

By Wesley J Smith

Assisted suicide advocacy corrupts everything it touches; medical ethics, our views about the worth of the dying–even suicide prevention. 

The latter corruption usually comes in suicide prevention campaigns that ignore assisted suicide advocacy as a cause of some suicides–I believe of some who are not ill as well as those who are. 

But now, the American Association of Suicidology has ideologically determined that when a terminally ill person commits suicide with poison obtained from a doctor’s prescription, it isn’t really suicide. 

The statement gets into different motivations and the like–all of which are highly debatable and refutable–but that would take pages. 

So for here, I want to demonstrate how–a supposedly suicide prevention organization–seems to have begun the process of normalizing suicides of the ill and disabled. From its statement, “Suicide is not the Same as Physician Aid in Dying:” 

Nor does the fact that suicide and PAD [physician aid in dying] are not the same indicate that some cases identified as suicides may not be deaths that have a great deal in common with PAD. especially those in which poor health is a precipitating factor. 

Although such cases are typically labeled ‘suicide’ if the person initiated the causal process leading to death, medical conditions associated with suicide risk in potentially terminal illness—including (among the best studied) cancer, cardiovascular disease, COPD, Huntington’s, HIV/AIDS, multiple sclerosis, ALS, Parkinson’s, renal disease, and Alzheimer’s—may arise from the motivation to avoid a protracted, debilitating, and potentially painful bad death. 

Did you get that? Do you see the game that is afoot? 

The AAS statement is softening the ground for expanding supposedly not suicide “aid in dying” laws to include situations that “have a great deal in common with PAD,” e.g., people with disabilities, chronic illnesses, and progressive conditions. 

Which makes sense since advocates never intended to limit assisted suicide to the terminally ill. Indeed, one of the contact persons on the statement, Margaret P. Battin, has been an advocate for “rational suicide” and euthanasia for decades. Frankly, she has as much business speaking for a suicide prevention organization as I do on behalf of a euthanasia advocacy group. 

And get this: 

While many forms of end-of-life care may be helpful, including palliative and hospice care, a patient’s choice of PAD that satisfies legal criteria is not an appropriate target for “suicide” prevention. 

That’s an utter corruption of hospice philosophy! Indeed, the great Dame Cecily Saunders, who founded hospice, believed that suicide prevention was a key hospice service that protected the equal dignity of her patients. 

Indeed, to assert that the dying (for now)–and eventually sick and disabled patients–don’t deserve the same life-protecting suicide prevention services as other suicidal people is a crass betrayal of those the AAS was created to serve and protect. Shame!