Assisted suicide makes good economic sense, argue academics

This article was published by Bioedge on March 15, 2020

Michael Cook

By Michael Cook, the editor of BioEdge

A new study in the journal Clinical Ethics claims that permitting assisted dying would substantially benefit both those seeking assisted suicide and the public.

Two Scottish academics, Dr David Shaw of the Universities of Basel and Maastricht, and Professor Alec Morton of the University of Strathclyde, posit three economic arguments: the cost to terminally-ill patients of a poor quality of life, the cost of care that could be better used elsewhere and potential benefits to organ donation (PDF here).

Dr Shaw, the lead author, said: “Some people might suggest that it is callous to consider assisted dying from the perspective of resource management; these are real people with real lives. This criticism is misplaced. Part of the motivation for our argument is precisely that these are real people with real lives who wish to avoid suffering.

The first argument is that it enables consenting patients to avoid negative ‘quality-adjusted life years’ (QALYS).

QALYs are a measurement of disease burden which encompasses the quality and quantity of life lived which is used by health professionals to determine the value of health outcomes.

Second, resources consumed by patients who are denied assisted dying could instead be used to provide additional QALYs for patients elsewhere who wish to continue living and improve their quality of life.

Third, organ donation may provide an additional source of QALYs in this context.

The authors argue that, together, the avoidance of negative QALYs and gain in positive QALYs suggests permitting assisted dying would substantially benefit both the small population that seeks assisted suicide and the larger general population.

They argue that denying assisted dying is a lose-lose situation for all patients.

In the paper the authors write:

“Quality-adjusted life years have been used for decades in healthcare allocation decision-making.

“By combining quality of life and mortality into one metric, they enable quantification of the medical gains and losses and relative financial costs of a vast diversity of treatments and interventions, in turn enabling these different treatments to be compared against each other and funding decisions to be made.

“Organ donation could also benefit because there are several reasons why donation after assisted dying is better from a clinical and economic perspective.

“First, if patients are denied assisted dying, organ function will gradually deteriorate until they die naturally, meaning that transplantation is less likely to be successful. Second, patients who choose assisted dying have to go through a lengthy process, and organ donation can be easily integrated into that process, non-coercively, decreasing the risk that family members will attempt to overrule donation, which often occurs when a patient dies in a way that is not planned.

“The legal arrangements for assisted dying vary widely from country to country, and if the UK was to legalise assisted dying (presumably in the form of assisted suicide) the calculations here could be made more precise based on the specifics of the approach under consideration. Nevertheless, our paper shows in general that denying dying plausibly imposes great costs on both patients who wish to die and those who do not.

“However, our argument is not that legalisation of assisted dying should be primarily based on economic arguments; these are supplemental facts that should not be neglected. Legalising assisted dying in the UK is likely to yield a substantial increase in QALYs across the patient population as a whole.”

Dr Gordon Macdonald

Dr Gordon Macdonald, of the lobby group Care Not Killing, which opposes assisted suicide, said: “This report is highly disturbing. It highlights the dangers of legalising euthanasia. Very quickly the argument moves from that of personal autonomy to doctors and nurses making value judgments about the quality of other people’s lives while seeking to save money and tackle so-called ‘bed blocking’ in health services.”

Michael Cook is editor of BioEdge

Canadian doctor: Kids benefit from seeing euthanasia.

This article was published by Mercatornet on March 2, 2020.

By Michael Cook

Michael Cook

Bedside gatherings at Canadian euthanasia deaths are normally an adults-only affair. Of course we’re not privy to most of them, but occasionally a journalist describes the last moments of an elderly man or woman in a magazine feature. Sometimes there’s a party, glasses of champagne, hilarity -- until the doctor arrives. The friends and relatives gather around the bed while the doctor administers a lethal injection.

In fact, most of these deaths are of people well over 65. Very few are of an age to be leaving youngsters behind. It is their children or grown grandchildren who are with them in their last moments.

What about people with young children? One experienced MAiD doctor suggests that young children will benefit from becoming involved.

In a blog entry at a University of British Columbia site, Dr Susan Woolhouse, who has been involved in some 70 “assisted deaths”, says “instinct told me that involving children in the MAID process of their loved one was possibly one of the most important and therapeutic experiences for a child. My past experiences during my palliative care rotations reassured me that children could benefit from bearing witness to a loved one’s death. Why would MAID be any different?”

She gives some tips about how to explain the process of dying to young children:

Assuming that children are given honest, compassionate and non-judgmental information about MAID, there is no reason to think that witnessing a medically assisted death cannot be integrate as a normal part of the end of life journey for their loved one. If the adults surrounding them normalize MAID, so will the children.

“These conversations can easily be had with children as young as 4,” she says.

Dr Woolhouse estimates that between 6 and 7 percent of MAiD deaths are of people under 55. As the numbers grow, “this will result in more children being impacted by the assisted death of a loved one.”

This is how she would explain euthanasia to a child:

“In Canada, when someone has an illness that will cause their body to die, they can wait for this to happen or they can ask a doctor help. The doctor or nurse uses a medication that stops the body from working and causes the body to die. This is done in a way that isn’t painful … 

“I am going to give your [loved one] medication over a period of about ten minutes. This medication will make her very look very tired and then she will very quickly go into a coma. This means that she will no longer be able to hear, see or feel any pain. You might hear strange breathing sounds, however these do not cause her any pain. Her skin will get colder and maybe even change colour. She will stop moving her body. Her heart will eventually stop beating and this means that her body has died. When a body dies, it can no longer see, feel pain, or hear. It can’t ever be fixed.”

I wonder if a child will find this explanation convincing. The doctor will not be around to answer her questions as she becomes a teenager, a young adult, and a parent. One researcher found that, years afterwards, some children still described the death of a pet as “the worst day of their lives.” How much worse will it feel to remember the day that your mother or father was put down?

Dr Woolhouse’s brief essay leaves some questions up in the air. The obvious question is “where is Dad now?” She can’t offer the child the comfort of an afterlife. Dad isn’t anywhere anymore; he’s just dead.

In her description of her hypothetical patient’s last hours, it’s clear that he is not suffering unbearably, at least at that moment. Why, the child is bound to ask, did Dad want to leave me? Why did he choose to die and leave me an orphan?

But Dr Woolhouse is right about one thing: if you want to normalise euthanasia, what better marketing device could there be than photos of little kids watching her give a lethal injection?

Michael Cook is editor of MercatorNet

Competing reports on euthanasia for mental illness.

This article was published by BioEdge on February 16, 2020

Michael Cook

By Michael Cook

The Provincial and Federal governments in Canada need to amend their euthanasia laws quickly. They have to meet a March 2020 deadline set last year by Quebec Superior Court Justice Baudouin who ruled that it was unconstitutional to deny Canadians the right to die unless their deaths were “reasonably foreseeable”.

Amongst other issues, lawmakers need to determine whether people with mental illness will be able to access euthanasia, or Medical Assistance in Dying (MAiD), as it is called in Canada.

In every jurisdiction where euthanasia has been legalised, this is a fiercely debated topic. There is no doubt that mental illness causes great suffering. But even supporters of euthanasia are divided on whether it is unbearable and whether it is incurable.

It comes as no surprise, then, that Canadians have two acronym-rich reports to digest about euthanasia and mental illness. Or, for more precision, medical assistance in dying as it relates to cases where a mental disorder is the sole underlying medical condition -- MAiD for MD-SUMC.

The first was published by the Institute for Research on Public Policy (IRPP) and was written by “the Halifax Group”, eight academics on the Council of Canadian Academies (CCA) expert panel on MAiD. Its best-known member is Jocelyn Downie, a legal expert.

They contend that persons with MD-SUMC should not be excluded from accessing MAiD, provided that their decision is “well thought out and not impulsive”. They also insist that legislation should not require their decision to be “non-ambivalent”. In other words, even if people are torn between competing values (such as desiring death but not wanting to leave their children), they can still make a rational decision.

Admittedly, there is a danger of “over-inclusion” – allowing people to access MAiD whose suffering could be alleviated. But they feel that this risk can be minimized by providing better mental health services.

The second report argues that Canada is on the way to becoming “the most permissive jurisdiction in the world for MAiD, with the fewest safeguards against unwanted deaths”. It was written by the Expert Advisory Group (EAG) on MAiD, a group of Canadian and international experts, plus people with lived experience of mental illness.

The EAG’s core recommendation is that:

“determinations of irremediability and irreversible decline cannot be made for mental illnesses at this time, and therefore applications for MAiD for the sole underlying medical condition of a mental disorder cannot fulfill MAiD eligibility requirements”. 

“The risk of providing MAiD for mental illnesses, while being unable to predict irremediability of mental illnesses, is obvious,” they argue. “Non‐dying people who would have improved will be assisted to die prematurely.”

It also recommends two other conditions: non-ambivalence about a MAiD decision and “lack of a reasonable alternative”.

The EAG authors insist that their approach is evidence-based and that the Halifax Group’s report does not represent a consensus of medical opinion. In fact, they say that “surveys of mental health providers show that while most (72%) do support MAiD in general, most do not support MAiD for mental illnesses (only 29% in support)”. They also criticise the competing report for failing to include authors with lived experience of mental illness.

Michael Cook is editor of BioEdge

Belgian trial draws curtain from dark back-story to euthanasia death

This article was published by Mercatornet on January 27, 2020.

By Michael Cook

The criminal trial of three Belgian doctors for assisting in an allegedly illegal euthanasia of a woman in 2010 is under way. It is the first time that doctors have been charged with an unlawful death since the legalisation of euthanasia in 2002. The accused have been named in the media: the doctor who administered the lethal injection, Joris van Hove; the general practitioner, Frank de Greef; and the psychiatrist, Godelieve Thienpont.

• Three Belgian doctors go on trial in the euthanasia death of a woman diagnosed as autistic (Link).
  

Tine Nys (center) with her sisters.

The parents and two sisters of Tine Nys have succeeded, after nine years of harassing the bureaucracy, in having charges laid. The prosecution alleges that the defendants did not follow the prescribed guidelines for euthanasia in Belgium. Tine was 38 when she died, surrounded by her family, in 2010. The doctors aver that she was suffering from a “serious and incurable disorder”. In her case, it was said to be unbearable psychological suffering.

A few intriguing facts have emerged.

The portrait of Tine Nys grew sadder with the testimony of each witness. She had been estranged from her family for years. She experienced violence in her relationships, she had an abortion, she had worked as a prostitute. “Everything in her life was a failure,” said Dr Thienpont, who diagnosed her as autistic not long before the death. (Dr Thienpont is Belgium's leading psychiatric euthanasia doctor).

The main lawyer for the parents and two sisters of Tine was forced to step down over a clear conflict of interest. The head of Belgium’s euthanasia evaluation commission, Wim Distelmans, revealed that Fernand Keuleneer had been a non-voting member of the commission when her case was examined. It's puzzling how a lawyer could possibly believe that this was acceptable. Mr Keuleneer has since been replaced by another lawyer, Joris Van Cauter.

How the doctors broke the Belgian euthanasia law became clearer. Tine had asked Dr de Greef for a letter authorising euthanasia, but he refused. So she went to LEIF, a euthanasia group which supplies euthanasia doctors, and found Dr van Hove. Dr van Hove dropped by Dr de Greef on the evening of April 27, 2010 at 8pm and asked him to sign a paper. Apparently de Greef misunderstood what he was signing, because he claimed to have been aghast when he learned that Tine had been euthanised shortly after the visit.

This occasioned two breaches of the conditions which shield doctors from prosecution for murder in Belgium. First, Dr van Hove had falsely listed Dr de Greef as the first doctor confirming that Tine was eligible for euthanasia. Second, the paperwork arrived at the euthanasia commission nearly four weeks late.

This worries euthanasia doctors. One told the Belgian newspaper De Morgen, “As a doctor, will you still run the risk of performing euthanasia if you know that with that you run the risk of being prosecuted for premeditated murder? Just because your euthanasia certificate did not arrive at the committee within four days?"

Dr Joris van Hove’s seamy background was highlighted in the media coverage. He has been in court before over offenses like drink driving and forgery. In 2017 he was convicted of molesting young male patients. Was his troubled background the reason why he had turned his hand to euthanasia? (On that fateful evening he had to rush off to do another euthanasia after Tine Nys.) Perhaps more testimony will shed light on this. The Dutch medical council has begun disciplinary proceedings against him.

Dr van Hove admitted that he had never done a euthanasia for psychological suffering before and that he had been clumsy. He had not completed his “end of life” training and he failed to administer the lethal injection properly. He did not have a stand for the infusion and the bag plopped onto Tine’s face as she was saying goodbye to her family. He neglected to bring a blank death certificate. It was like asking Mr Bean to perform euthanasia.

However, Dr van Hove told the court that the euthanasia procedure had been carried out within the law. He protested that the very fact that the case had reached the stage of prosecution was a victory for the “hidden agenda” of the Catholic Church.

The general practitioner, Dr Frank de Greef, painted himself as the victim of a charming but manipulative young woman and her angry relatives. When she was diagnosed as autistic by Dr Thienpont, he was thunderstruck. “When I saw that diagnosis, I thought: What kind of stupid person have I been? Look at its history, everything could be explained by that autism. Tine was engaging and intellectual, but also manipulative and looking for conflict."

The trial continues.

Michael Cook is editor of BioEdge.

‘The last frontier in prison reform’: assisted suicide?

This article was published by Bioedge on July 21, 2019

Michael Cook

By Michael Cook

Activist Philip Nitschke once described euthanasia as the “last frontier in prison reform”. His idea has still not caught on. A Belgian prisoner was allowed to take advantage of euthanasia, but it never happened. But the idea refuses to die.

The author of an article in latest issue of the Journal of Criminal Law and Criminology argues that assisted suicide should be allowed in American prisons.

Kathleen S. Messinger observes that assisted suicide is becoming increasingly acceptable in the US. “The autonomy, self-determination, and pain that a terminally ill patient may feel justifies the decision to die with dignity.” Why shouldn’t terminally-ill prisoners be given the same opportunity?

This is a violation of the Constitution’s prohibition on cruel and unusual punishment because it is unnecessarily punitive and exacerbates the pain of individuals already suffering. When the state strips individuals of their freedom and denies them their ability to “provide for their own needs,” the government has an affirmative duty to provide for the inmate. Regardless of how we morally feel about aid in dying as an option, and perhaps believe that those incarcerated deserve to suffer, the state must fulfill its obligation to provide for aid in dying because anything less is “incompatible with the concept of human dignity . . . .”

The question is particularly relevant now as prisons are filling up with more and more elderly inmates. By 2030, over 55s will make up a third of American inmates. Some have dementia and no longer even remember why they were incarcerated. A 2017 report warned that the US was moving towards an “Elder Incarceration Crisis.” 

Messinger says that “prisons are overcrowded, underfunded, and ill-equipped to support terminally ill and aging inmates”. Perhaps assisted suicide and/or euthanasia would help governments to reduce costs and improve conditions.

Belgian man asks for euthanasia because he cannot afford medication

This article was published by Bioedge on July 13, 2019.

By Michael Cook

A Belgian man with a serious degenerative blood disease has told the media that he has applied for euthanasia because he cannot afford the expensive medication he needs to live a normal life.

Christophe (no surname was given) has four children, aged 4 to 10, but he separated from his partner two years ago. He is living alone and can no longer work. When his children visit on the weekends, his parents need to accompany them in case he falls or faints.

He suffers from a rare disorder, paroxysmal nocturnal hemoglobinuria, which destroys red blood cells. Patients have a life expectancy of 10 to 20 years from the time of diagnosis. Christophe is constantly fatigued, falls, and suffers from breathlessness and swollen glands.

PNH is rare, with an annual rate of 1 to 2 cases per million and there are only two known treatments: a bone marrow transplant and a drug called Eculizumab (or Soliris) which costs US$500,000 annually. None of Christophe’s relatives are a good match for a transplant and he cannot afford Eculizumab, even with help of Belgium’s healthcare system.

He began thinking about euthanasia three years ago. A year ago, he started doing the paperwork. "I sleep all the time, that's why I'm waiting for euthanasia, I'm waiting for the answer ... because if I can only live like this ... like a vegetable," he told the Belgian outlet RTL.

Michael Cook is editor of BioEdge

‘Tsunami’ of elderly and euthanasia are not a good mix, say Queensland doctors

This article was published by Bioedge on July 6, 2019

By Michael Cook

With a “tsunami” of elderly patients with severe health problems approaching, Australians should not be legalising euthanasia, a senior doctor has told the Queensland Parliament. It could increase the pressure on vulnerable older people who feel they are a "burden" on others to do away with themselves, said Dr Chrys Pulle, on behalf of the Australian New Zealand Society of Geriatric Medicine Queensland.

“There [are] risks of voluntary and involuntary euthanasia on patients with cognitive impairment, dementia, delirium or reduced capacity; adverse effects on the funding for palliative care services and research; changing the concept of doctors being treaters and life savers and healers." 

"We need education for the wider public, as well as older people, about what expectations we're likely to face once we've been diagnosed with a chronic neurodegenerative disease, or chronic pain condition," he said. "No one wants to be that patient in the dementia ward that's agitated. It's not what their loved one wants. And oftentimes that reflects the wish to end somebody's life."

The head of the Australian Medical Association Queensland ethic committee, Dr Chris Moy said voluntary euthanasia could lead to unintended consequences.

"You're opening up the issue of value of life, that's not just from other people imposing their values of life onto individuals, which is a problem, but the second part is individuals starting to value their lives in a different way as well. It may not just be elderly, there are disabled, there are children, you're opening it up."

A committee of the Queensland Parliament is conducting a year-long inquiry into voluntary assisted dying, palliative care and aged care issues.

Belgian tug-of-war over euthanasia for mental illness and dementia

This article was published by Mercatornet on May 13, 2019

By Michael Cook:

Wim Distelmans

Belgium’s leading advocate for euthanasia liberalisation is campaigning vigorously for euthanasia for people with dementia. According to the current euthanasia law, patients are only eligible if they are fully aware and competent. This can lead to distressing situations and must change, says Professor Wim Distelmans.

Distelmans is chairman of Belgium’s chairman of the Federal Euthanasia Commission, the body which assesses whether euthanasia cases have been carried out legally. But he is also the chairman of LEIF (the Life End Information Forum), Belgium’s leading end-of-life lobby.

LEIF has organised an online petition which has been signed by scores of well-known academics, journalists and politicians as well as thousands of others. LEIF has also posted three heart-tugging videos of people with dementia putting the case for euthanasia.

Distelmans asks on the LEIF website:

“What are they waiting for to give priority to this basic human and patient right on the political agenda? After all, no one is obliged to euthanize or to implement it, not even in the proposed amendment to the law. But one can avoid a lot of situations that are considered 'degrading' by those involved by making the prior directive also applicable to those who suffer from dementia or other incapacity.”

However, at the same time and moving in the opposite direction, the Belgian medical association has implemented a far more restrictive policy on euthanasia for psychiatric patients. This is a very significant shift in policy. Some supporters of the country’s euthanasia law differ on the wisdom of making a liberal law even more liberal.

Belgium’s euthanasia law says that the treating doctor must seek advice from two other doctors, including at least one psychiatrist who is not the treating psychiatrist. But the new guidelines from the Orde van Artsen set down that the treating doctor should consult not just one but two independent psychiatrists who should meet face-to-face to discuss the case. This new standard is far more demanding. According to an April 29 directive:

the doctor considering euthanasia in psychiatric patients should go one step further and physically meet with the two psychiatrists. A physical meeting results in an interdisciplinary collaboration where every doctor explains his views as objectively as possible. The doctors should prepare a joint report and come to a joint decision, without being required to agree on everything. 

It is recommended that this physical consultation involves all healthcare providers who are in regular contact with the psychiatric patient. In addition to the nursing team, it is recommended that the psychologists and psychotherapists who help realize the care process are also involved in the consultation.

Theoretically, this implies that a doctor could be sanctioned by the Orde van Artsen over a euthanasia which was perfectly legal.

My feeling, for what it's worth, is that Belgium will keep relaxing its 2002 law until it becomes effectively euthanasia on demand. Doctors will end up becoming mere suicide enablers.

There may be one way to stop this juggernaut, or at least to slow it down. And that is to dismiss the chairman of the Federal Euthanasia Commission, Dr Wim Distelmans. This gentleman is not only the senior regulator of euthanasia in Belgium. He is also a media star as the chief spokesman for the right to die and one of the main practitioners of euthanasia (he also operates the euthanasia clinic). In other countries, this would be regarded as an egregious conflict of interest.

A new chairman who is not immersed in the world of Belgian euthanasia politics would be in a better position to identify abuses and refer doctors who fail to comply with the law to the public prosecutor.

Michael Cook is editor of MercatorNet

What happened to do no harm? Protecting you from medical homicide.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

I just re-published the excellent article concerning the involuntary euthanasia deaths at Mount Carmel hospitals in Ohio. (Link to the article).

It is shocking that 34 people are known to have died after allegedly receiving an intentional lethal overdose of painkillers from Dr William Husel. Husel had his medical license suspended and he was fired from the hospital, while 20 other hospital employees have been suspended. 

Last night I received a call from a physician who was seeking advice about launching a criminal case into the death a close family member. The cover-up for the death started immediately and no one would have suspected anything if this doctor didn't arrive the afternoon before the death and start asking questions about the lethal levels of drugs that the family member was administered.

We spoke for a long time about his frustration about the lack of response from the local police. We have referred him to an excellent lawyer.

It is not easy to bring medical homicide cases forward. Usually the victim's family do not have a medical background and only suspect that something wrong occurred while the police view medical homicide complaints as "medical error" cases or simply as not in their jurisdiction.

We hope that this case will go forward since the plaintiff is an experienced physician and the circumstances are similar to Ohio.

Become a member of the Euthanasia Prevention Coalition (membership) or make a (donation) to enable us to help you in your time of need.

• More than 1000 Belgian deaths were hastened without request in 2013 (Link).
• 431 deaths without request in the Netherlands in 2015 (Link).
• 456 patients killed in a British hospital (Link).

34 elderly people are dead. Why the silence?

This article was published by Mercatornet on February 12, 2019

Michael Cook

By Michael Cook

Abuse of the vulnerable and elderly is a vile crime. That’s why the alleged rape of a 29-year-old woman in a Phoenix, Arizona, healthcare facility made news around the world when she gave birth to a baby boy. The New York Times ran at least four articles on the stomach-churning scandal.

Intentionally ending of a patient's life, more than medical error.

But, astonishingly, the involuntary euthanasia of possibly as many as 34 elderly patients in two Catholic hospitals in the city of Columbus has been almost ignored outside of Ohio.

According to Mount Carmel Health System, one of its doctors, William Husel, ordered overdoses of powerful painkillers for at least 34 near-death patients — 33 at Mount Carmel West in Franklinton and one at Mount Carmel St. Ann’s in Westerville. All of the 34 died, although six may not have died because of the painkillers.

No charges have been laid, but the State Medical Board has suspended Husel’s licence and Mount Carmel has fired him. Twenty employees, including pharmacists and nurses, have been suspended.

Lawsuits are also being filed by relatives of one of the deceased patients. One of them cited Husel, the hospital, an unnamed pharmacist and an unnamed nurse in the death of 79-year-old Janet Kavanaugh.

A "grossly inappropriate dose was either ordered negligently and not properly reviewed, or was intentionally prescribed by Defendant Husel for the purposes of hastening the termination of Janet Kavanaugh’s life," the lawsuit says.

“The pharmacist has an obligation to question an order, and the nurse has an obligation to question the order as well,” said the lawyer for Mrs Kavanaugh’s family. “All of those safeguards were overridden or ignored. It’s like nothing I’ve ever seen.”

According to The Columbus Dispatch:

Staff members who worked in the ICU in the past five years said Husel often would give emergency orders for the powerful opioid fentanyl or some other painkiller. Those emergency orders, meant to be used in certain urgent situations, would allow him to bypass a pharmacist’s pre-approval, giving the medical staff access to drugs stored in a Pyxis machine, or secure cabinet, on the ICU floor.

Husel sometimes would tell families agonizing over removing a loved one from a ventilator that he would ease the patient’s suffering with pain medication, but he didn’t tell the families he was prescribing potentially lethal dosages, family members said.

“Regardless of the reason the actions were taken, we take responsibility for the fact that the processes in place were not sufficient to prevent these actions from happening,” Mount Carmel President and CEO Ed Lamb declared in a video statement.

Police are investigating the alleged crimes, but no one has been arrested yet. If the deaths are proven, it will be one of the worst instances of an “angel of mercy” in the United States. In Europe, there are nurses and doctors who have been convicted of killing dozens of patients.

Why have the leading American media ignored the case? Perhaps because no one has been arrested yet. Perhaps because the facts are murky at the moment. But perhaps because the pro-euthanasia paradigm is that doctors won’t commit involuntary euthanasia – they will always have the best interests of autonomous patients at heart. But this is obviously not true – just read up on British GP Dr Harold Shipman – and when assisted suicide and euthanasia are legalised, who will be able to tell the difference between the voluntary and involuntary euthanasia of a dying patient?

Michael Cook is editor of MercatorNet.

Quebec euthanasia deaths increase by 75%

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Caroline Touzin reported for Le Press that the recent Quebec government euthanasia report indicates that the number of euthanasia deaths are increasing quickly.

Quebec legalized euthanasia in December 2015, while the rest of Canada legalized euthanasia in June 2016.

According to Touzin the recent government report stated that there were 1664 reported euthanasia deaths between December, 2015 and March 31, 2018. 

It is concerning that 1493 reports were received and yet 1664 euthanasia deaths were reported by institutions. Therefore 171 euthanasia deaths were not reported representing more than 10% of the deaths.

A report compiled by the Sean Murphy for the Protection of Conscience Project indicated that there were 454 reported Quebec euthanasia deaths in 2016 and 757 in 2017. He stated that in 2017 1.2% of all deaths were by euthanasia (lethal injection) representing a 67% increase from the number of euthanasia deaths in 2016.

According to an article by Michael Cook for Bioedge there were 845 reported euthanasia deaths for the 9 months from July 2017 to March 2018, compared to 638 for the 12 months from July 2016 to June 2017 representing a 75% increase.

Cook also reported that the recent government euthanasia report states that doctors are often not following the law. According to Cook:

The latest report indicates that 10% of the reported euthanasia deaths were not administered according to the letter of the law. Either the paperwork was incomplete or the law had apparently been broken. The corresponding figure for the previous period was 8%. The report stresses, however, that the “great majority” of the euthanasia deaths were administered according to the law.

Abuse of the law is not new. Last year, Amy Hasbrouck, the EPC President and a Quebec disability rights leader, examined the Quebec government report and reported that:

• Confusion and inconsistency exists between euthanasia figures offered by the various sources; the “number of forms received and examined“ by the commission, the reports of the institutions, and the reports from the Collège des médecins du Québec.
• A 5% or 7% error rate (with 3% undetermined) would not be acceptable where lives depended on the effective application of safeguards (e.g. the airline industry).  
• The three cases in which the safeguards were clearly violated (two where the person did not have a “serious and incurable illness” and one where the person was not at the “end of life”) were not addressed as the crimes that they are.

Similar problems exist in the Netherlands, where a study found that in 2015, 23% of the assisted deaths were not reported and 431 assisted deaths were done without explicit consent.

The Quebec government does report more information than Canada's federal government about the euthanasia practice.

• Euthanasia increases by 30% in Canada.

Architects of Victoria Australia's euthanasia law publish ‘manual’ on how to push legislation through

This article was published by bioedge on December 1, 2018

By Michael Cook

Victoria Parliament

One year ago, in December 2017, the Australian state of Victoria legalised euthanasia and assisted suicide. This has given new heart to supporters in other states who have been lobbying for years for the “right-to-die”.
 

The Australian Healthcare Review has just published a review of how supporters were able to break the log-jam in Victoria – essentially a how-to manual for activists written by the government’s former Ministerial Advisory Panel, the brain trust for the process.

Here are a few of the elements which the authors highlight in their article.

1. Victoria passed a Charter of Human Rights in 2006. Its emphasis on autonomy helped to enable passage of a law decriminalising abortion in 2008 and then last year’s euthanasia legislation.

2. Victoria’s Labor government, headed by Premier Daniel Andrews, supported the legislation, although it was eventually decided on a conscience vote. A report from the parliament’s Legal and Social Issues Committee endorsed it. “Government support was essential,” report the authors.

3. As members of its Ministerial Advisory Panel (MAP), the government appointed seven men and women with distinguished professional qualifications, all supporters of a change in the law. The chair, Brian Owler, was a former federal president of the Australian Medical Association.

4. The MAP had extensive discussions with stakeholders in legalised euthanasia, such as health professionals and administrators, legal groups, medical colleges, nursing and allied health groups, consumer and carer groups and mental health providers. Consultative workshops were held throughout Victoria.

5. The support of the Department of Health and Human Services was essential to the process. It provided expert legal and political advice, and administrative support. The Health Minister dedicated “significant departmental resources required, for the process of consultation to develop a high-quality bill.”

6. Skillful media management ensured that messaging was “consistent and accurate”. The members of the MAP were given media training. Journalists were given extensive briefings at each major step “to ensure that the public messaging of a complex model containing strict criteria was clear and that the work was reported accurately. In addition, different lobby groups undertook public campaigns to engage the media and the general public, as well as to directly lobby politicians, which was helpful in balancing the differing arguments.”

The authors conclude that: “This process has been a tangible example of democracy at work at a time when many may feel cynical about political processes.”

It would be interesting to read an account of how the legislation passed from the point of view of its opponents.

Internet scammers make money claiming to sell suicide drugs

This article was published by BioEdge on December 1, 2018.

By Michael Cook:

Internet scammers are using fake endorsements from well-known euthanasia campaigners to bilk gullible people. According to Derek Humphry, founder of the Hemlock Society:

“At any one time there are at least 40 web sites offering to sell the drug Nembutal without the need for a doctor’s prescription. None are known to be reliable. Not only are they fraudulent but sometimes pretend to be part of genuine right-to-die organizations like ERGO or EXIT.

“The latest impersonator has stolen the colored banner and logo from ERGO’s web site. They repeat the words ‘Euthanasia World Directory – Web Site of Hemlock Society Founder Derek Humphry’ at the top of their web site.”

Mr Humphry says that the scammers charge US$500 to $700 for enough Nembutal to end life. “A favorite trick of some thieves is to deliver honestly on a couple of orders, gain a good reputation, then when thousands of dollars roll in, fail to respond and close down the web site.” However, says Mr Humphry, whose blog describes him as “serving the rights of competent, terminally ill adults for 30 years”, neither ERGO nor EXIT sells drugs. They only offer “quality advice” on how to kill people who want to die.

More articles on this topic:

• Exoo, Exit, Derek Humphry and assisted suicide.
• 'I made it look like they died in their sleep.'

Swiss doctors go head-to-head over liberal assisted suicide guidelines.

This article was published by Bioedge on October 28, 2018

By Michael Cook

The Federation of Swiss Medical Doctors (FMH) has refused to include in its code of ethics new guidelines on end-of-life care proposed developed by the Swiss Academy of Medical Sciences (SAMS). These provide that a physician may practice assisted suicide for patients presenting with "unbearable suffering" related to the symptoms of an incurable disease or disability. Until now, the patient had to have a terminal illness.

The FMH believes that unbearable suffering is too vague as a criterion. Michel Matter, a FMH vice president, gave the example of a bipolar patient. "When she is in a low phase, such a person would fulfil this condition of unbearable suffering, but not when she is in a high phase." For him, doctors must protect the most vulnerable patients and whose situation is not always clear. "By defending the weakest, the FMH is in step with society," he concluded.

Samia Hurst, of the University of Geneva, who participated in the development of the guidelines, criticised the decision of the FMH. "This test of unbearable suffering is found in many jurisdictions about voluntary death.” She added that "Physicians already practice assisted suicide outside end-of-life situations (for example, by accompanying, for example, elderly people with multiple pathologies). The new directives of the SAMS frame these situations, while the old ones did not. "

Laying the groundwork for child euthanasia in Canada.

The following article was published by BioEdge on September 22, 2018.

Michael Cook

By Michael Cook:
 
Euthanasia, or “medical aid in dying”, was authorised by Canada’s Supreme Court in June 2016. It was a controversial decision and the controversy is far from over. Three issues were left hanging: euthanasia for “mature minors”, euthanasia for people with mental illness, and advance directives for euthanasia. The government asked the Council of Canadian Academies to produce a report on these issues by December this year.

Euthanasia for mature minors is a particularly sticky issue. In the Journal of Medical Ethics, several Canadian paediatricians and bioethicists construct an argument supporting it.

First of all, they frame euthanasia (MAID) a part of a continuum of palliative care.

it is wrong to force a person to live in circumstances of unendurable and irremediable suffering and ... the wishes of capable patients should be respected within legal limits, especially in such an intimate matter as how they choose to die. Persons, in other words, have a right to life, not a duty to live ...

If MAID is essentially a normal medical procedure, it follows that there is no need for “special procedures for managing communication, confidentiality and capacity assessment”.

One consequence of this is that doctors should be proactive in suggesting euthanasia to children for they have an obligation to inform patients of their healthcare options.

What about a young person’s capacity for consent? In Ontario, “young people can be and are found capable of making their own medical decisions, even when those decisions may result in their death”. This is not universally accepted in Canada, so it may be necessary to tweak the law.

How about the role of parents? What if a young person requests MAID but their parents object? The authors argue that if a young person is capable of making their own medical decisions, there is no reason why parents have to be informed. “If we regard MAID as practically and ethically equivalent to other medical decisions that result in the end of life, then confidentiality regarding MAID should be managed in this same way.”

How should hospitals manage their public relations? Permitting child euthanasia is sure to be extremely controversial so they need to reduce the social stigma. The authors propose HIV/AIDS as a model:

If we take the HIV model as our strategy for publicly messaging MAID, we would proceed by providing MAID in a matter-of-fact way that may, over time, reduce the social burden both on patients seeking this procedure and clinicians providing it.

• Paediatric Palliative Care Symposium and child euthanasia.

20% of End-of-life medical decisions made without cancer patients consent in Belgium.

10% of Flemish (Belgium) cancer patients die by euthanasia.

The following article was published by Bioedge on April 8, 2018.

Michael Cook

By Michael Cook

A survey of end-of-life decisions for cancer patients involving Flemish physicians has found that in 10.4% of the cases, there was euthanasia or physician-assisted suicide and life shortening without explicit patient request in 1.8%.

The results were published in the British Journal of Cancer and were based on a survey of physicians in Flanders, Belgium, in 2013. The percentages are based, not on cancer deaths, but on the number of end-of-life decisions for the patients. The classification system may seem a bit odd to non-specialists. If the drugs were given with the explicit intention of hastening death, the decision was termed “euthanasia” if “someone other than the patient at the patient ’s explicit request had administered the drugs”; physician-assisted suicide if “drugs had been prescribed or supplied and self-administered”; and “life abbreviation without explicit patient request” if there had been no explicit request from the patient.

The reasons for an end-of-life decision included (along with other motives) the “wish of the family” (28%) and an “unbearable situation for relatives” (12.4%).

Since cancer is the disease most often mentioned as a trigger for a euthanasia request, it is not surprising that requests for euthanasia are higher amongst cancer patients. The authors believe that “in Belgium assisted dying has clearly become a part of medical practice in the care of cancer patients and that the various disciplines of oncology need to be trained in dealing with euthanasia requests”.

The 1.8% of deaths which occurred without explicit request should not alarm anyone about “slippery slopes”, the authors believe. The proportion of such deaths has remained constant ever since euthanasia was legalised in 2002.

However, somewhat confusingly, the authors note that “decision-making took place without the patient’s input in almost 20% of the cases”. These decisions were not necessarily euthanasia; they could have been withholding treatment or aggressive pain relief. But as the authors note, it is still unethical.

Canadian prisoner dies by euthanasia.

This article was published by Mercatornet on March 5, 2018

Michael Cook

By Michael Cook.

Not too long ago, a request by a Belgian prisoner for euthanasia made international headlines -- even though he was not permitted to take advantage of the legislation.

But in a measure of how enthusiastically Canada has embraced euthanasia, one prisoner has already been killed under its Medical Aid in Dying (MAID) law, and three others have been approved. According to a report in CBC News, the death took place in a hospital outside of the prison, under the supervision of two correctional officers. It seems to have slipped under the radar of the ever-vigilant journalist of the Canadian media -- even though it could be a world first.

Correctional Service Canada (CSC) told CBC News that it had, to date, received eight requests for MAID.

CSC is now permitted to organise MAID in a community hospital — but it can also take place in a penitentiary regional hospital or treatment centre in exceptional circumstances and at the request of the inmate. The procedures for prisoner all all set out in a set of detailed guidelines.

Correctional Investigator Ivan Zinger criticised the possibility of inmates being euthanised in a prison in a letter to the CSC head:

"Practically and perceptually, I simply can not imagine a scenario where it would be considered acceptable to allow an external provider to carry out a MAID procedure in a federal penitentiary,"

Zinger said that MAID should occur only outside prisons. A prohibition on MAID within prisons would protect the integrity of the system now and in the future, when eligibility for assisted death could expand to prisoners suffering from acute psychiatric illnesses – and in prisons there are a number of these.

You wonder where the logic of personal autonomy will end. Prisoners must be the amongst most vulnerable people of all possible candidates for euthanasia. Their surroundings seem purpose-made to inspire despair and promote groupthink. Their custodians benefit from their deaths by cutting costs. They are already being punished by restricting the exercise of their autonomy. It seems perverse to allow them to choose death when they cannot even choose their favourite TV program.

Michael Cook is editor of MercatorNet

Canadian court tells doctors they must refer for euthanasia. Will they be hounded out of their profession?

This article was published by Mercatornet on February 2, 2018

By Michael Cook, editor of Mercatornet.

For years bioethicists of a utilitarian cast have argued that conscientious objection has no place in medicine. Now Canadian courts are beginning to put their stamp of approval on the extinction of doctors’ right to refuse to kill their patients.

The Superior Court of Justice Division Court of Ontario ruled this week that if doctors are unwilling to perform legal actions, they should find another job.

A group of five doctors and three professional organizations were contesting a policy issued by Ontario’s medical regulator, the College of Physicians and Surgeons of Ontario (CPSO), arguing it infringed their right to freedom of religion and conscience under Canada’s Charter of Rights and Freedoms.

However, Justice Herman J. Wilton-Siegel wrote on behalf of a three-member panel:

“the applicants do not have a common law right or a property right to practise medicine, much less a constitutionally protected right."

“Those who enjoy the benefits of a licence to practise a regulated profession must expect to be subject to regulatory requirements that focus on the public interest, rather than the interests of the professionals themselves.”

At issue is the policy of “effective referral”. A doctor who objects to participating in euthanasia cannot be forced to do it. But he is expected to pass the patient to another doctor who will. The CPSO argues that effective referral is necessary “to protect the public, prevent harm to patients and facilitate access to care for patients in our multicultural, multifaith society, by guiding all physicians on how to uphold their professional and ethical obligations of non-abandonment and of patient-centred care within the context of Ontario’s public health-care system.”

Without the policy of effective referral, equitable access would be "compromised or sacrificed, in a variety of circumstances, more often than not involving vulnerable members of our society at the time of requesting services," Justice Herman Wilton-Siegel wrote. People in remote communities might request euthanasia. If their doctor refused, they might suffer needlessly and taxpayers would have to foot the bill to subsidise the refusnik’s conscience.

It is remarkable how closely Justice Wilton-Siegel’s text hews to the arguments of bioethicists who have been chipping away at the right to conscientious objection for years.

In 2005 American legal scholar Alta Charo described conscientious objection as “an unfettered right to personal autonomy while holding monopolistic control over a public good ... an abuse of the public trust—all the worse if it is not in fact a personal act of conscience but, rather, an attempt at cultural conquest’.

In 2006 Oxford’s Julian Savulescu argued in the BMJ that “when conscientious objection compromises the quality, efficiency, or equitable delivery of a service, it should not be tolerated”.

More recently, Canadian bioethicist Udo Schuklenk and a colleague contended in the BMJ that:

“If at any given time a doctor is unable to continue practicing due to their—ultimately arbitrary—conscience views, nothing would stop them from leaving the profession and taking up a different vocation. This happens across industries and professions very frequently. Professionals can be expected to take responsibility for the voluntary choices they make.”

Responding to the ruling, Larry Worthen, executive director of the Christian Medical and Dental Society of Canada, said: “We heard from our members and other doctors with conscientious objections over and over again that they felt referral made them complicit and that they wouldn’t be able to live with themselves or stay in the profession if effective referral is still required.”

The case is sure to be appealed, but if the doctors championing conscientious objection fail, the consequences will be dire.

Throughout Canada, doctors would be required to refer for euthanasia. If they refuse, they will be hounded out of their profession, or, at best, shunted into specialties where the question will not arise, like pathology or dermatology.

This ruling shows how quickly tolerance vanishes after euthanasia has been legalised. In the Carter decision which legalised it, Canada’s Supreme Court explicitly stated that legalizing euthanasia did not entail a duty on the part of physicians to provide it. Now, however, 18 months and more than a thousand death after legalisation, conscientious objection is at risk.

It also shows how vulnerable religious-based arguments can be. The plaintiffs contended that referring patients violated their right to religious freedom. While this is true, is this the main ground for conscientious objection? As several doctors pointed out in the Canadian Medical Association Journal last year, “Insofar as all refusals of therapy are ultimately justified by the ethical belief that the goal of therapy is to provide benefit and avoid harm, all treatment refusals are matters of conscience.”

Michael Cook is editor of MercatorNet.