By Mark Hodges.
Groups opposing euthanasia and assisted suicide have been advocates of good hospice care. Stories about hospice abuse have created great concerns as we recognize that good care will reduce the demand for assisted dying while hospice abusive feeds the demand to legalize assisted suicide. Promoters of assisted suicide will often compare hospice care to assisted suicide and refer to hospice abuse to advocate for "more options" at the end of life.
The Trump Department of Health and Human Services’ Inspector General has released two scathing reports concerning the Hospice end-of-life-care industry, with the hope of cleaning up hospice abuse. These reports include stories of maggots in stomach feeding tubes; failing to clean wounds which ultimately became gangrened requiring leg amputations; ignoring pelvic injuries from sexual assault and giving wrong treatment that put patients in the hospital.
The reports specify “significant vulnerabilities” and “deficiencies” which put patients at risk and “jeopardize safety.” Patients were seriously harmed when hospices showed gross negligence or failed to report patient abuse.
Eighty-seven percent of hospices had at least one deficiency. One-third of hospices had complaints filed against them. Over 300 hospices (18%) had at least one “serious” deficiency or at least one “substantiated severe complaint” in 2016 alone. Most of those had a history of deficiencies or substantiated complaints.
Medicare, which pays for almost all hospice treatment, looks to state agencies and accrediting organizations to make sure hospices maintain quality of care for patients. Inspectors review clinical records, visit patients, investigate complaints, and report any deficiencies discovered.
The new government report includes both state and accrediting agencies’ findings. Nearly all hospices were surveyed.
Deficiencies included mismanagement, lack of quality control, improper vetting of staff, inadequate assessments, and poor care planning. As a result, patients suffered.
Horror stories abound. One woman was repeatedly abused by her caregiver/daughter, who literally chained her to her bed, and would “leave her mother in a wheelchair in the bathroom with the lights off and would spray her with water when she called out for help,” according to the government report. Hospice was told of the abuse, but did nothing --not even visit the patient for several weeks.
Another patient had an abusive neighbor, who frequently burst into his apartment “naked, high, and drunk” stealing the patient’s prescriptions. Hospice knew this was going on, yet did nothing to protect the patient, the government reported.
“These hospices did not face serious consequences,” the report says, because Medicare “cannot impose penalties, other than termination, to hold hospices accountable for harming beneficiaries.” Medicare’s only enforcement power is to take the offending hospice out of the Medicare program. It cannot levy fines, or issue sanctions, or close a facility.
One of the report’s recommendations is for Congress to give Medicare “enforcement tools” and “statutory authority...to effectively protect beneficiaries from harm.”
Medicare began dispersing tax dollars for hospice in 1982. As medicine advanced, hospice promised tax savings, with terminal patients cared for at home rather than in hospitals under ever-more-expensive and almost-always-futile medical procedures.
“At the first meetings of our national hospice organization, we were nearly all women, mostly volunteers working on making our communities better,’’ Dr. Joanne Lynn told the Washington Post.
As soon as government money for hospice was unleashed, for-profit companies began invading the industry. For-profit hospices have exploded twice as fast as non-profits.
The industry has quadrupled since 2000. That year, 70 percent of hospices were run by nonprofit organizations or government agencies; by 2012, the percentages were nearly reversed.
Today, hospice cares for more than 1.5 million patients.
“Once Medicare started paying for hospice, it was more men in suits, and the focus shifted to administration and sustainable financing,” Dr. Lynn lamented.
In other words, Big Business horned in, and with it came bottom-line-only concern and its inevitable corruption.
A Washington Post analysis found per-patient profit rose from $353 in 2002 to $1,975 in 2012. A Huffington Post investigation found for-profit hospices charged Medicare nearly 30 percent more per patient than nonprofits.
Medicare doled out $18 billion to hospices in 2017. A company’s profit is capped, on average, at $25,000 a patient.
With that kind of money at stake, sales became a top priority. Hospice salesmen, dubbed “Outreach Specialists,” aggressively sought customers from doctors, hospitals, nursing homes, assisted-living facilities and Meals on Wheels groups. “Community Education Representatives” went to “health fairs” at senior centers with blood pressure testers and pitched families caring for an elderly loved one.
Whistleblowers from leading hospices testified that recruiters were told to stress the urgency of committing to hospice. Bonuses were given to reps who met new patient goals.
It gets worse. Ben Hallman’s 2014 exposé, “How Dying Became A Multibillion-Dollar Industry,” found for-profit hospices pressured staff to illegally enroll unqualified patients, and falsified health records to get more tax dollars. Hospices also illegally-obtained hospital records, submitted insufficient documentation and did not adequately train caregivers.
Hospices even admitted patients who were not dying. The whole idea of hospice is to comfort the terminally ill --rules are two doctors have to certify the patient has only six months to live.
But healthier patients require fewer visits and stay longer, making for-profit companies more money.
“A longer length of stay is going to be more lucrative,” one hospice marketer explained. “If they come in very sick and die right away, it’s difficult to run a business that way.”
Medicare pays by the day, not the visit. Hospice companies can charge the government nearly $200 a day per patient ($6000 a month) for the first 60 days, then about $150 a day --regardless of how much care the patient needs, or how often hospice visits.
“They’re paying for a day of hospice with no accountability for what was done on that day,’’ Icahn School of Medicine Professor Melissa D. Aldridge said, “with a payment mechanism that is completely opaque as to what is being done.’’
Not surprisingly, average length of stay at for-profits is far longer than at non-profits (105 days/69 days).
The number of patients who didn’t die in California hospices jumped 50 percent from 2002 to 2012. At one Mobile AL hospice, 78 percent of “terminal” patients left alive.
A 2014 study found one woman who refused to take her cancer medicine, yet she kept getting better. After a year of hospice, she was finally tested. It turns out she never had cancer.
Multiple allegations from former employees charge hospices with enrolling patients who weren’t terminal --wasting well over $1 billion in tax dollars. Lawsuits also allege that patients received expensive care they didn’t need. The Trump Justice Department has joined several of those lawsuits.
According to the rules as they are now, hospices help determine whether a patient is terminal. At the start, two doctors certify a patient’s diagnosis. But re-approvals are routinely done by hospice physicians.
And corruption is made easy by Medicare’s acceptance of overly vague diagnoses, such as “debility” and “failure to thrive.” Next year, Medicare will prohibit such generalization in primary diagnoses.
“It is important that an initial step toward payment reform be taken as soon as possible,” industry watchdog MedPAC understated to Congress.
Hallman’s six month investigation also revealed over a thousand hospices hadn’t been inspected for more than seven years. The legal minimum was six years, until Congress under the Trump administration increased inspections to every three years.
Additional problems include “rogue” and false front hospices stealing tax dollars. Over billing, patient referral kickbacks, unneeded treatment, charging for therapies never administered, underqualified (lower paid) staff, and other methods of theft plague the industry.
From 2006 to 2014, the U.S. government charged that nearly every major for-profit hospice company committed billing fraud.
And there are even more serious charges.
Deaths from lethal doses of morphine and sedatives while under hospice care were brought to light by Peter Whoriskey in the Washington Post. Patients who were not dying when they started hospice, died from excessive doses of painkillers.
In 2009, the New York Times ran a story about “terminal sedation.” The article explained that a strong sedative, typically lorazepam, and a strong pain killer, typically morphine, are administered by an IV drip until heart rate and breathing are slowed until the patient can no longer eat or drink.
Patient overdosing “can intentionally hasten death,” the NYT article stated. A national survey found 83 percent of doctors said this is ethically permissible.
It is not known how often slow murder under the guise of palliative care is perpetrated. No data is collected about such lethal abuses.
Sandra writes, about the death of her father:
“I am absolutely certain that my father died because of the medication he was administered by hospice ...particularly the various forms of morphine he was given... These opioids caused the respiratory failure he went into as soon as hospice administered them to him. He was eligible for hospice with the diagnosis, ‘Failure To Thrive’ and ‘Debility’ after breaking his hip... He was just as alert (after the hip injury) as he had always been until hospice ‘snowed’ him... I didn’t hire hospice to push along my father’s demise.”
The new government report concluded with recommendations to begin righting the hospice industry. The Trump Inspector General urges
- tighter, more extensive oversight of hospices,
- changing laws to allow Medicare to enforce violations, and
- public posting of reports finding deficiencies and violations on Medicare’s website, “Hospice Compare.”
President Trump’s 2020 budget includes a proposal to allow disclosure of survey reports from accrediting organizations.
The Euthanasia Prevention Coalition believes good hospice care eliminates the falsely-perceived “need” for “mercy killing” (an oxymoron). “The principles and practice of good palliative hospice care already developed and utilized, makes it abundantly clear that there is no need to die in pain, loneliness and anxiety.”
We believe in caring, not killing
But we are deeply concerned about the abuses and fraud that the U.S. government’s new report reveals. “Hospice abuse leads to a greater demand for the legalization of euthanasia and assisted suicide,” EPC Executive Director Alex Schadenberg explained.
We applaud the Trump administration’s Inspector General for a thorough investigation, support its recommendations as a start, and urge the strictest compliance to ethical standards throughout the hospice industry.
The only way to effectively "save hospice" from abuse is to return it to its roots, as expressed by Cicily Saunders. Good caring people who care for the physical, psychological, social and spiritual needs of a person as they approach a natural death.
By Mark Hodges (EPC Researcher)
In a culture of death, British doctors destroy chance for life.
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| Tafida Raqeeb |
Such is the case right now for Tafida Raqeeb, who is dying in a London hospital because her doctors refuse to release her to where she could be cured.
The little five year-old has a rare and fatal blood vessel condition called “arteriovenous malformation.” Specialists in Italy have expertise in treating that very condition, but the Royal London Hospital is keeping Tafida literally imprisoned in their facility.
Sign the citizengo petition to let Tafida go and get the care that she needs. (Link).
The Giannina Gaslini Institute in Genoa has assembled a medical team for Tafida, and is in contact with her doctors in London. The Sun quotes the Institute’s Italian doctors as predicting, “There is a good chance she will emerge from the coma she is in.”
Yogi Amin, a human rights lawyer representing Tafida, assured decision-makers that:
“there is no evidence that Tafida will be harmed during transit or abroad, and her loving parents should have a legal right to elect to transfer their daughter to another hospital for private medical care.”
Still, the UK hospital refuses to even let Tafida’s parents take her for a potential healing in Italy at their own expense.
In fact, the Sun reports that the British doctors are suing to pull the plug on Tafida, saying, “It would be better for her to be left to die.”
And a totally separate lawsuit by Barts NHS Trust seeks to give hospitals the legal right to cut off all medical care if a patient in Tafida’s condition gets worse.
But Tafida’s parents, Shelina and Mohammed, have taken their fight for their daughter’s life to the High Court.
European Union law and Human Rights attorney Jason Coppel QC charged that Tafida’s “confinement is against her will.” He emphasized the key point, that “Her parents are the sole people who currently have the legal right to make decisions for her.”
Despite Tafida’s life or death condition, Justice MacDonald delayed making any decision until the Fall. He only said he will hear both the parents’ and the hospital’s sides in September.
But time is of the essence. Ron Liddle of the Sun opined,
“I can understand doctors telling Mohammed and Shelina there is nothing more that they can do for their little girl. What is beyond belief — beyond imagination — is that they would insist on keeping the child there to die when there is genuine hope she might be cured.”
Little stated,
“I am not a medical expert, ...but I do know that if there is hope for Tafida, the longer they wait to treat her, the less likely there will be a good outcome.”
Tafida’s case is similar to the case of two-year-old Alfie Evans. Alfie had a GABA-transaminase deficiency, and his mom and dad wanted to take him to Vatican-owned Bambino Gesù hospital for experimental treatment. That facility in Rome was ready and waiting to care for Alfie.
But Liverpool’s Alder Hey hospital refused to release Alfie.
Attorney Coppel (who now represents Tafida) argued in Alfie’s last chance attempt --after his doctors had his ventilator unplugged for two days-- to get Alfie to specialists at Bambino Gesù. At the time, Alfie was breathing on his own and could have made the trip to Rome.
But the judge ruled against parental rights, and little Alfie languished three more days in Liverpool’s Alder Hey hospital until he died.
Similarly, nearly one-year-old Charlie Gard was diagnosed with Mitochondrial DNA depletion syndrome, and his mom and dad sought to get him to the United States for experimental treatment.
British doctors sued to unplug Charlie’s breathing machine so he would die, instead of releasing Charlie to his parents in the hopes that he might be helped by American specialists.
New York’s Presbyterian Hospital was ready for Charlie (as was Bambino Gesù in Rome), but British judges blocked Charlie’s parents, and he quickly died after his air was cut off.
It seemed to many that the Brits --both physicians and judges-- had stepped over the line from “doing no harm” to denying potentially beneficial treatment based on futile care theory.
Another child, eight-year-old Ashya King, was in Southampton suffering from a brain tumor. His parents were concerned about his treatment, and wanted to take him for proton therapy elsewhere.
When the hospital refused to acknowledge parental rights and release Ashya, Brett and Naghemeh King snuck their son out of the hospital --making them fugitives for the sake of their son’s life.
A European continent-wide manhunt was launched against Ashya’s parents. They were finally apprehended in Spain.
But their little Ashya was given treatment --which is what the now "criminal" parents were seeking all along.
The illegally-sought treatment cured Ashya. Today Ashya is cancer-free, with no brain damage from his now non-existent tumor.
The Sun’s Ron Little reported.
“The parents were right. The doctors were horribly wrong,” “Our medical professionals are, by and large, brilliant. But there is sometimes a grotesque arrogance and pigheadedness about them.”
The Anglican church also hasn’t helped. Bishop John Sherrington of Westminster said he would pray for Tafida, but he offered no support for Tafida’s life or for her parents’ heartbreaking plight.
Sherrington even equated the hospital’s lawsuit for Tafida’s death with her parents’ fight for her life. “I hope that all due weight will be given to the wishes of her parents, while also respecting the clinical judgment of the doctors caring for her,” he hopelessly and irreconcilably stated. “Those of us not in possession of all the relevant information might best be reserved in our judgment.”
In Italy, life-support is not withdrawn from children unless they are declared “brain-dead.” Tafida is not “brain-dead,” and may be able to make it --as long as doctors do not unplug her ventilator-- until her preliminary hearing in September.
By Mark Hodges (EPC Researcher)
“This is for all the lonely people, thinking that life has passed them by: Don’t Give Up...” sang the pop group America in their 1974 number five hit song. Today, however, more and more doctors say to lonely people, “If you think life has passed you by, we’ll help kill you.”
As we get older, it is normal to have regrets, or miss the exuberance of youth. The elderly can often experience reflective, sometimes melancholy moods. With age come various physical limitations and pains.
It often takes a loss of our youthful self-reliance to foster introspection necessary to recognize the most important things in life. “Teach me to number my days,” says the ancient proverb, “that I may gain a heart of wisdom.”
But today, instead of addressing the stages of life and its challenges, more and more doctors, where euthanasia is legal, are willing to end life --for no physical reason.
Alex Schadenberg of the Euthanasia Prevention Coalition explained.
“I have significant experience with people as they approach death, and it is natural to become unsure, or to feel your life has lost purpose, or to be depressed, or have feelings of loneliness. These are normal feelings,”
“The sad reality with euthanasia and assisted suicide is that these normal feelings, once killing is legal, can become a death request, rather than a normal process of being human.”
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| Charles Bentz |
Oregon Dr. Charles Bentz is just one example among many. His patient, an avid outdoorsman, was diagnosed with cancer, and became depressed. Dr. Bentz’ was asked to approve the assisted suicide death of his patient.
“I said, ‘Wait a minute... What’s going on? Let’s talk about this,” Dr. Bentz recounted. But his colleague “must have found someone else, because two weeks later his patient was dead from an overdose of a medication.”
“So my colleague saw a patient with depression, but instead of addressing his depression, she gave him the means to kill himself.”
Dr. Bentz’ experience is not unique.
In the Netherlands, a woman in her twenties suffering from post-traumatic stress was given a lethal injection –despite her documented improvement after therapy. Doctors even admitted that a request for death could be really a cry for help. The woman’s therapy “was temporarily partially successful,” yet she was killed anyway.
Another healthy woman was euthanized because she and her deceased husband had agreed not to go on living after one of them died. She was granted a lethal injection, even though she “did not feel depressed at all. She ate, drank and slept well. She followed the news and undertook activities.”
In 2014, a healthy Italian woman was killed at a Swiss suicide clinic because she was depressed over how she looked.
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| Rosie DiManno |
The Toronto Star’s Rosie DiManno explains what happens when someone falls into dark despair.
“The ‘black dog’ clinical depression…locks on with pit bull jaws. And you forget that it will pass or at least abate. In the moment, it feels unendurable. Sometimes, you want to die.”
DiManno reasons that clinical depression clouds one’s thinking, and therefore depressed patients should not be candidates for assisted suicide. She says:
“Descending into that dark place where hopelessness – and psychical fatigue, really, just so damn tired of misery – renders rational thought impossible”
Enabling suicide is the opposite of medical treatment. All the more so for depressed patients. DiManno criticizes Belgium and the Netherlands –which now kill non-terminal people suffering from “incurable distress”— as “knocking off the depressed, because that’s what they want, as if the deeply disconsolate can possibly make an informed decision.”
“Among those “approved’’ for death have been people with autism, anorexia, borderline personality disorder, chronic fatigue syndrome, partial paralysis, manic depression, Alzheimer’s and a 24-year-old transgender man devastated by the failure of a sex-change surgery. None of these patients was dying. They just feel real bad… They were morbidly disconsolate and frail of mind. Which is a far sight from terminally ill and dying.”
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| Senator Denise Batters |
Canada also legalized euthanasia for “psychological suffering.” Canadian Senator Denise Batters, whose husband died by suicide, spoke against assisted suicide for depression.
“The committee did not require that illness be terminal or life-threatening. It included psychological suffering as grounds for physician-assisted death — without any requirement to consult a psychiatrist. It even recommended extending physician-assisted suicide to…those under 18.”
The New York Times ran an article pointing out that,
“According to psychiatric experts, the vast majority of people requesting suicide are suffering from treatable depression, and no longer want to kill themselves once their underlying depression is resolved.”
“Once the depression lifts and people can think more clearly, the therapists say, those who were determined to kill themselves are thankful to be alive, despite their pain or grim prognosis.”
Senator Batters argued.
“The preservation of hope for mentally ill people is absolutely paramount,”
“Those who endure psychological suffering need our support, our resources and our promise that we will never give up on them, even when they can see no other option but to give up on themselves.”
An analysis of Maine’s new so-called “Death With Dignity” law noted that
“severely depressed or mentally ill patients can receive assisted suicide without having any form of counseling.”
Indeed, there is nothing in existing Maine law (or Oregon, Washington, or Vermont law) that requires doctors to refer patients to a therapist in order to screen for treatable depression or mental illness before enabling their suicide.
Society’s response to depression in the elderly or in youth or for people with disabilities must not be to enable their death, but to reach out to them on a personal level, and connect them to people and activities that restore a sense of being loved and wanted.
Instead, the number of suicides keeps growing, along with the rising rates of depression. Our Western culture canonizing individualism only exacerbates the depression epidemic.
The Center for Disease Control documented that between 1999 and 2016, the suicide rate in America increased in every state (except Nevada, which remained in the top ten states for suicide).
Judith Shulevitz in The New Republic reports that one in three Americans over 45 identifies as chronically lonely. One survey found:
“One in four Americans (27 percent) rarely or never feels as though there are people who really understand them. Two in five Americans…feel 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).”
Signs of depression include feelings of helplessness or hopelessness, a loss of interest in daily activities, and a loss of energy. A severely depressed person my also idealize suicide by talking about self-harm, becoming pre-occupied with death, or saying things like “everyone would be better off without me.”
Schadenberg reveals
“Society 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 their life lacks value or purpose, or feel no one cares, are offered purpose, support and genuine hope from their significant community.”
Schadenberg concludes.
“Suicide is a symptom of mental illness, not a cure for it,”
“The answer is not only talking about it, the answer is inclusion, caring and being with others as they journey through the difficult times of their lives.”
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| Tom Mortier |
Tom Mortier, who wasn’t informed of his mother’s death until the day after a doctor killed her for being depressed commented
“The big problem in our society is that we have apparently lost the meaning of taking care of each other,”
Professor Gregory Crawford of the Australasian Chapter of Palliative Medicine for the Royal Australian College of Physicians emphasized that people asking to die often need to be diagnosed and treated for depression. He relayed an example of one of his terminal patients who wanted to die. He treated her for severe depression by changing her medication, and
“She made a miraculous improvement, both physically and psychologically. She improved and lived for another 12 months. She had serious, progressive disease but her physical function and her ability to interact and live improved. She went off on a holiday, achieved some other things on her wish list and made lots of other nice memories for her family. She died at home, supported by our palliative care.”
Crawford concluded.
“It showed me that sometimes the symptoms of impending death and the symptoms of advanced depression can look very much the same,”
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| Andrew Lawton |
Another example is Canadian media personality Andrew Lawton. He shared.
“Nearly seven years ago I overdosed on dozens of pills — causing multiple cardiac arrests and weeks in hospital on life support,”
“Everything from the method to the date and time was meticulously thought out... I’m sure I could have sold my own suicide given how convinced I was that it was the right call. That wouldn’t have made it any less flawed a conclusion.”
Lawton continued
“Suicidal people are irrational... This is true even when decisions appear to be made through logic and reason.”
“I appeared normal, despite not thinking normally. I saw suicide as the answer to pain I was convinced wouldn’t abate. I had tried myriad therapies, medications, and treatment throughout my years-long battle with depression. By the time I tried to pull the plug on my own existence, none had made an impact.”
After Lawton’s nearly successful suicide attempt, his attitude changed. Healing didn’t happen overnight, he says, and his circumstances didn’t change -- “but my outlook did.”
“In 2010, no one could have told me happiness was possible. Today, I am married to the love of my life, working in a successful career, and able to look forward each day — all just a few years after I signed my own death warrant.”
People who are depressed are in the middle of, as Alcoholics Anonymous puts it, “stinking thinking.” They need help out of their depression, not the enabling and furthering of their mental darkness by assisted death.
Senator Batters points out the fallacy in suicide as a treatment for depression. She argues
“Physical and psychological illnesses are (not) the same,”“Psychological suffering on its own is not terminal. It is usually treatable.”
“Mental and physical illness can’t be lumped into one category,”
“When illness is in the mind, rather than the body, it calls any decision into question — an irreversible one all the more so.”
“Delivering the means to suicide straight into the hands of mentally ill individuals directly contradicts the suicide prevention standard in the mental health field.”
Lawton concludes.
“The role of health-care practitioners is…not to enable one’s disordered thinking by killing them,”
“State-sanctioned death doesn’t help the mentally ill — it robs them of a chance for healing.”
Another problem with legalizing suicide for depressed people is there is no legal standard for “unbearable suffering” or “incurable depression.”
A major study published in the Journal of the American Medical Association Psychiatry concluded, “There is no evidence base to operationalize ‘unbearable suffering,’ there are no prospective studies of decision-making capacity in persons seeking EAS for psychiatric reasons, and the prognosis of patients labeled as ‘treatment-resistant depression’ varies considerably, depending on the population and the kind of treatments they receive.”
The British Medical Journal also published a study which concluded, “‘Unbearable suffering’ has not yet been defined adequately.”
“People ask for euthanasia because they have lost hope. They may be in depression or experiencing distress, darkened by their reality, and feel that life has lost its purpose or value,”
“In the past, doctors took this request to die as a cry for help, and they tried to find out what their patient needs to weather his or her overwhelming difficulty… I want a physician who will protect my life when I’m going through my deepest darkest times. When I’m going through that physical, psychological, emotional, or existential distress and I’m so darkened that I can’t see beyond my own difficulty, I need a physician who will say ‘no’ to me and will care for me, not kill me.”
Assisted suicide and euthanasia are not about freedom for the sufferer; it’s about abandoning the patient –particularly patients in despair.
By Mark Hodges (EPC researcher)
The Canadian Parliament is debating whether doctors may follow their vow and conviction to “do no harm,” or if government can force them to violate their most sacred and deeply held belief against euthanasia (lethal injection).
On the crucial conscience rights issue, the United States is only a step behind Canada, and may be closing in fast.
Saskatchewan MP David Anderson sponsored the Conscience Rights protection bill (C-418) that will determine whether conscientious objecting physicians will leave their profession, or forced to be complicit with killing.
Over the past decade, a debate has arisen over “competing rights,” namely, the fundamental right of physicians and other citizens to practice with integrity and conscience, versus a new “right” of patients to be euthanized upon request, regardless of their doctor’s convictions.
Assisted suicide advocates in both Canada and the U.S. say doctors’ rights must be overridden or compromised in favor of the "right to die". In 2016, the Canadian Medical Association voted against physicians’ conscience rights by a margin of 71 percent.
Conscience supporters say assisted suicide is not healthcare, and it is a doctor’s right to refuse to kill his/her patients, or refuse to prescribe lethal medication, and refuse to refer or be complicit with the act.
After Canada’s Supreme Court decriminalized euthanasia in 2015, the College of Physicians and Surgeons of Ontario promoted what they called a “compromise” which did not require doctors to lethally inject patients but it required doctors who objected to refer their patients to a death doctor.
This stripping of individual conscience rights is spreading to the United States. Proposed assisted suicide bills in Massachusetts, Minnesota, New Mexico, and Wisconsin included clauses to force objecting physicians to refer for suicide.
Belgium is following Ontario by pressuring all physicians regardless of conviction to refer for death by euthanasia.
Last year, the Ontario Court of Appeal upheld the College’s coercion, admitting that physicians’ rights were indeed “infringed” by the policy, but the infringement is reasonable in a democratic society. In an unprecedented ruling against Charter rights, the court institutionalized a “limit” on fundamental freedoms in the name of “ensuring access” to death “care.”
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| Alex Schadenberg |
The Euthanasia Prevention Coalition criticized the decision as no “compromise” at all. Alex Schadenberg stated that facilitating suicide makes one complicit in the act. He said:
“If it’s wrong to do the act, then it’s also wrong to send a patient to somebody else who will do the act,”
Ethicist Dr. Edmund Pelligrino explained that referring is participation. He reasoned.
“Formal cooperation is absolutely and always, forbidden. ...This is the case when the physician shares the evil intent, partakes directly and freely, or in any way facilitates an intrinsically evil act like…assisted suicide.”
Pro-assisted suicide politicians and doctors in the U.S. have begun to accuse physicians who refuse to practice assisted suicide of “abandoning patients.” Ironically, even ethicists in professional journal articles have called refusal to refer for death “a toxic form of patient abandonment.”
Alex Schadenberg disagree's, in life-or-death terms.
“People ask for euthanasia because they have lost hope. They may be in depression or experiencing distress, darkened by their reality, and feel that life has lost its purpose or value. In the past, doctors took this request to die as a cry for help, and they tried to find out what their patient needs to weather his or her overwhelming difficulty. The conscientious physician isn’t abandoning his or her patient, they’re caring for that person.”
Conscience advocates add that this is as much an issue of patients’ rights as it is of physicians’ rights.
“Physician conscience rights are important for physicians, but they are more important for protecting patients,”
Schadenberg pointed out, saying that conscience rights are central to protecting patients when they are most vulnerable.
“I want a physician who will protect my life when I’m going through my deepest darkest times. When I’m going through that physical, psychological, emotional, or existential distress and I’m so darkened that I can’t see beyond my own difficulty, I need a physician who will say ‘no’ to me and will care for me, not kill me.”
Schadenberg concludes that denying conscience rights to physicians actually denies patients their right to live.
Conscience rights are not just for the religious; there are clear secular reasons to object to assisted suicide. First of all, suicide devalues human life.
The American College of Physicians stated in 2001.
“Both society in general and the medical profession in particular have important duties to safeguard the value of human life,”
“This duty applies especially to the most vulnerable members of society.”
A second conviction against assisted suicide is that, with modern medicine and advances in palliative care, pain can be managed.
The Canadian Society of Palliative Care Physicians issued a statement against assisted euthanasia that emphasized palliative care’s mission is
“to help patients live as fully as possible until their natural death. Palliative care strives to reduce suffering, not to intentionally end life... The Canadian public must be able to continue to trust that the principles of palliative care remain focused on effective symptom management and psychological, social, and spiritual interventions to help people live as well as they can until their natural death.”
Janice Strukoff of the Delta hospice spoke out against a 2018 edict by the Fraser Health Authority in British Columbia ordering healthcare facilities --including hospices-- to participate in Medical Aid in Dying (euthanasia).
“Hospice palliative care is not about hastening death, and we object to the bullying currently taking place in B.C.”
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| Dr Neil Hilliard |
The medical director of Fraser Health Palliative Care, Dr Neil Hilliard, resigned over the edict. He stated.
“Providing euthanasia or physician-assisted suicide is not in accordance with palliative care, (which) ‘affirms life and regards dying as a normal process,’”
A third argument against assisted suicide is that physician-complicit killing destroys the doctor-patient trust to heal and do no harm.
“Legalizing euthanasia or physician-assisted suicide would have a profound and detrimental effect on the doctor–patient relationship,”
The British Medical Association stated just sixteen years ago (2003).
“It would be unacceptable to put vulnerable people in the position of feeling they had to consider precipitating the end of their lives.”
A fourth argument comes from the experience of states and countries where assisted suicide and euthanasia are legal. History proves that once euthanasia is accepted, limitations on candidates diminish and authorized applications expand.
Examples of the limits on euthanasia eroding are happening now. Since legalizing assisted suicide, the Oregon Health Authority changed the definition of “terminal illness” from its universally-understood meaning of “incurable and irreversible fatal disease” to include treatable medical conditions if a patient refuses to take his or her medicine.
Another example of expansion is the several assisted suicide bills debated in the Oregon legislature. One redefines “self-administer” so that the suicidal patient can legally be killed (commit “suicide”) by someone else. Another bill lengthens the necessary prognosis of six months to live. Another enables a pro-suicide doctor to wave the 15 day waiting period. Another widens “terminal” to include any medical condition that ultimately could “substantially contribute to a patient’s death.”
Some euthanasia activists go so far as to elevate the “right to die” to a “duty to die” for patients whose care “costs” too much for their families or for society at large.
In a speech to the Health Lawyers Association, then-Colorado Governor
Richard Lamm stated in 1984 that the terminal elderly have “a duty to
die and get out of the way,” because giving them health care would turn
the U.S. into a “second-rate economic nation.” Time, the Washington
Post, and the New York Times reported his remarks favorably.
It must be noted that this callous, purely economic reasoning is precisely the attitude that led pre-Nazi Germany to “dispose” of human “life devoid of value.”
Dr. Leo Alexander, a Boston psychologist and the American psychiatric representative to the Nuremberg trials, explained that the foundations of genocide lie in euthanasia. Dr. Alexander wrote in the New England Journal of Medicine in 1949:
“The beginnings were at first merely a subtle shift of emphasis in the basic attitudes of physicians in the 1920s. It started with the acceptance of the attitude, basic in the euthanasia movement, that there is such a thing as a life not worthy to be lived,”
“This attitude in its early stages concerned itself merely with the severely and chronically sick, (then)...the socially unproductive, the ideologically unwanted, the racially unwanted, and finally all non-Germans. But it is important to realize the infinitely small wedged-in lever from which the entire mindset received its impetus was the attitude toward the non-rehabilitable sick.”
Summarizing reasons to oppose euthanasia, a 2012 statement from the Ethics, Professionalism and Human Rights Committee of the American College of Physicians read,
“Making physician-assisted suicide legal raised serious ethical, clinical and social concerns and that the practice might undermine patient trust; distract from reform in end-of-life care; and be used in vulnerable patients, including those who are poor, are disabled, or are unable to speak for themselves or minority groups who have experienced discrimination.”
These reasons show that physicians’ right to refuse to prescribe death is not necessarily based on faith, but grounded in foundational understandings about humanity and healthcare.
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| David Anderson MP |
Physicians leaving medicine is just what is happening in Canada. MP David Anderson testified.
“I have spoken to doctors who feel overt pressure to leave family medicine because of their conscientious beliefs,”
“I have heard of palliative care doctors in Ontario who have stopped practicing altogether. Nurses who feel increasingly bullied are choosing to shift their focus or retire early. I have had personal conversations with people who work in old folks’ homes who explain they do not want to participate in this but are increasingly feeling pressured to do so.”
The effect of Canada’s euthanasia law is to force euthanasia objectors out of their chosen practice, or out of healthcare altogether. In May of this year, the Court of Appeal for Ontario brazenly exposed that effect as intended, actually advising conscientious medical workers to find a job where assisting suicide would not be required.
Anderson lashed out against the court’s insulting advice, calling it
“incredibly demeaning to those men and women who have gone through years of training.”
“They are being punished for holding that level of dignity, respect and honor for their patients.”
Anderson continued:
“We have such a shortage of physicians and medical services,”
“Particularly in rural areas, there is an increasing lack of physicians in an increasingly challenged medical system... The answer does not have to be to do it, find someone else to do it or get out of medicine.”
Fortunately, a flickering spark of common sense has been ignited in various places, and we must fan that into a flame.
The U.S. State Department report on international freedoms singled out
a growing trend of prospective healthcare professionals whose potential
is destroyed by a lack of conscience rights.
“Medical and nursing
students...expressed their reluctance to enter the health care field as a
whole, and particularly specialties...where their objections
to…euthanasia might not be respected.”
The Trump administration has officially noted Canada’s trashing of doctors’ conscience rights. Last year, U.S. Secretary of State Mike Pompeo released a report pointing out that Canada’s “regulations requiring doctors to refer patients seeking assisted death...constituted facilitation and violated constitutional guarantees of freedom of conscience and religion.”
Earlier this year, the Trump Department of Health and Human Services (HHS) reversed Obama rules and mandated conscience protections
“for physicians, pharmacists, nurses, teachers, students, and faith-based charities,” exempting them from “having to provide, participate in, pay for, provide coverage of, or refer for, services such as...assisted suicide.”
HHS regulations now protect healthcare entities that object to
“assisted suicide, euthanasia, or mercy killing” from “being required to perform, participate in, pay for, provide coverage for, counsel or refer for...euthanasia.”
Freedom of conscience “is the bedrock of American life,” President Donald Trump proclaimed.
The new HHS rules specifically include as unlawful discrimination:
“being steered away from a career in obstetrics, family medicine, or geriatric medicine, when one has a religious or moral objection to...physician-assisted suicide or euthanasia.”
Roger Severino, director of HHS’s Office for Civil Rights, elaborated,
“This rule ensures that healthcare entities and professionals won’t be bullied out of the healthcare field because they decline to participate in actions that violate their conscience, including the taking of human life.”
Besides the current U.S. administration, there are other glimmers of hope. Last year the Norwegian Supreme Court handed down a landmark conscience rights ruling supporting a Polish physician who was fired for following her conscience not to kill.
In Canada, the province of Manitoba passed conscience rights legislation in 2017 allowing doctors to opt out of killing. MP David Anderson told Parliament.
“The example of the province of Manitoba...shows there does not need to be compulsion in the medical system when it comes to this issue,”
“Why would one try to force people into doing what they believe to be wrong?”
David Anderson’s bill (C-418) has enabled debate in the Canadian Parliament. He told Parliament Bill C-418 would:
“provides the teeth” that the current law lacks. “make it an offence to intimidate” a healthcare worker “to take part, directly or indirectly, in the provision of physician-assisted suicide.” It would also stop hospitals and employers from firing healthcare workers who opt out of assisting in a patient’s suicide.
It is said, “Where the battle rages, loyalty is proved.” The fight for conscience rights is immediate and intense, and the outcome is in question not only for Canada, but the U.S. and the rest of the civilized world.
