Stop Massachusetts Assisted Suicide Bill

By William Gallerizzo

Sign the petition: Reject Massachusetts Assisted Suicide bill S.1208/H.1926 (Link).

There has been an amended assisted suicide bill introduced in Massachusetts. S.2745 / S.1208.

The Death With Dignity lobby blatantly refuses to accept or to discuss documented evidence from other states and countries showing how legalizing assisted suicide has jeopardized inherent rights of so many others, all in the name of Freedom of Choice. The data that they do present is either nonfactual or inaccurate; as the past and current laws condone inaccuracy and falsification of death certificates. Mathematically data under those conditions cannot be validated. Likewise, they have condoned and supported using social media and other means to slander opponents and silence the truth, in crude and similar fashion to the tactics used by deficient national leadership.

Isn’t this what America is essentially marching about in the streets right now: transparency in government and laws, that no one’s life needs to be jeopardized; that all lives matter without regard to racial difference, religious difference, disability, socio-economic level, or any other man-made political divide. The value of lives should not concern how much money someone has, their status, or how much influence they peddle. Truthfully, the fallacy counter to this fact has existed for some time; but the past three years have seen it to a greater degree during the COVID-19 pandemic.

My own research and that of others have shown at least 8 major issues that make this legislation abusive to the public interest of social justice. Others exist, but these are the most highly impacting. All of these contentions are documented from reliable sources, but DWD considers them insignificant or will not address.

1. The outcome of Euthanasia and Assisted Suicide is to kill other human beings whose lives are not fit to live. The whole basis of eugenics, whether ancient or the present age, is that some people do not deserve to live for no other reason than their very existence.

2. Safeguards are to protect physicians, but offer no safety valves or control for the vulnerable. Even in Netherlands and Oregon where euthanasia has been legal for decades, those most adversely affected and abused are people of color, the disabled, the economically challenged, and the elderly.

3. Assisted suicide is incompatible with the physician’s role as healer. The physician is put in the position of being an executioner, a promoter of death, not a sustainer of health.

4. Advancements in medical technology, elder care, advanced medical care are deemed no longer as necessary. The State of Oregon, once the national leader in hospice and palliative care, now ranks as the 7th worst in the nation.

5. Assisted suicide laws create cultural pressure on doctors who in turn pressure patients, especially when a viable treatment is not locally available. Current laws in Canada prevent conscientious objection on the part of medical personnel and force them to give in to euthanasia and assisted suicide as a standard not an option.

6. Doctors are fallible human beings. Misdiagnosis and faulty analysis for any number of reasons can result in patient premature death. My own disabilities occurred from misdiagnosed injuries, and my own life was saved by a very conscientious and observant physician. Assisted suicide laws increase the probability of unintended mistakes significantly. The end result, more often than not, is premature and needless death.

7. The vocabulary that is often used by advocates of euthanasia uses altered meanings from its common forms. This adds to confusion among the public about the meaning of what these words mean. Although most people have no problem agreeing that they want a peaceful and tranquil death, most find it abhorrent that what they are agreeing to involves a doctor or someone else killing a patient. By definition, compassionate action does not involve acts of overt or covert violence. When patients are influenced, options are reduced. Hence, what they propose is not congruent with reality conditions surrounding end-of-life care. Therefore, what C&C/DWD promote are lies and inaccurate vocabulary which cloud reality from public view.

8. There are no drugs effective to do what advocates claim. Several independent studies in both United States and Great Britain examining all drugs and cocktails used for either Euthanasia and/or Capital Punishment have shown that all have significant failure rates ranging from about 24% to just under 75%. Failure can range from painfully long lingering for hours or even days, to convulsions and severe vomiting. The drugs usually promoted by DWD, secobarbital and pentobarbital, are deemed unsuitable for capital punishment due to excessive and painful failure. More so, it has been shown that dosages of drugs used in anesthesiology require enormously high dosages if used for euthanasia and have significantly higher failure rates above their usual norm in anesthesia. It has also been shown that the use of morphine as pain relief goes through a titration of dosage tolerance in the body, and although it may require increasing dosages to relieve pain, the pain relief is significant and the risk of death caused by the morphine is lower than other drugs. Thus current use of morphine for pain relief does exactly what it is supposed to do; it enables a more pain free and peaceful death from the disease, not an induced death, and little failure leading to prolonged agony.

Sign the petition: Reject Massachusetts Assisted Suicide bill S.1208/H.1926. (Link).

William Orazio Gallerizzo taught Sciences for over 35 years and holds advanced degrees in Education and Natural Sciences (University of Maryland, College Park, MD) and Bioethics (Athenaeum Pontificium Regina Apostolorum, Rome, Italy). Specialized in educational multi-disciplinary integration and critical thinking processes, he has conducted interactive instructional research projects both in the United States and Italy. His primary research work in Bioethics is titled, Euthanasia and Assisted Suicide Trends in the United States.

Dr. Anne Hanson's Testimony Opposing Assisted Suicide

Suicide Contagion; Safeguard Failures; and Implications for the Practice of Psychiatry 

This article was published by Choice is an Illusion.

Anne Hanson MD

The Maryland Psychiatric Society opposes HB 643, the End-of-Life Option Act. Since this bill was first introduced in 2015, the Maryland Psychiatric Society has extensively deliberated the legislation within the organization through several listserv discussions, a member survey, and a four hour pro-con debate sponsored jointly with the Maryland somatic physician's organization, Med Chi. In addition to reviewing the legislation each year, we considered information contained in the American Psychiatric Association's resource document on assisted suicide (APA 2017) and other literature as cited in the references below.

The Maryland Psychiatric Society recognizes that this is a divisive issue and that some of our members disagree with the organization's position. Those members have been encouraged to contact their elected officials to contribute their thoughts and we welcome consideration of both sides of this serious policy.

The Maryland Psychiatric Society maintains its opposition to HB 643. There are three general areas of concern.

1. Suicide Contagion

Promotion of this bill, and assisted suicide laws generally, transmit a dangerous message to vulnerable Maryland citizens. According to the Centers for Disease Control,  at any given point in time 4% of people are experiencing suicidal thoughts. One-sixth of those individuals will attempt suicide (1.4 million Americans), and 3% will die (Shreiber and Culpepper 2020). Translated into Maryland numbers, this means that 242,000 people are presently thinking of killing themselves, 40,333 will attempt suicide, and 1210 will die.

Suicide clusters and contagion are well established phenomena with documented connections to media coverage and publicity (Blasco-Fontecilla 2013). The Centers for Disease Control and the World Health Organization both promulgate guidelines for the media coverage of high profiles suicides (Carmichael 2019). These guidelines advise against the portrayal of self-destruction as a “brave,” or “romantic,” and discourage reports which idealize suicidal behavior. They also caution against explicit discussion of suicide methods. These recommendations were developed in part due to a study which demonstrated that deaths by helium asphyxiation increased by more than 400% in New York following publication of the book Final Exit in 1991 (Marzuk 1993).

Proponents of assisted suicide laws violate these public health recommendations when they describe self-destruction as a “graceful” or “beautiful” expression of personal autonomy (Death With Dignity 2020). To date there have been no well designed studies to clarify the relationship, if any, between adoption of assisted suicide laws and states rates of un-assisted suicide. However, following the highly publicized death of Brittany Maynard in 2014 the number of assisted deaths by lethal medication in Oregon nearly doubled, from 71 in 2013 to 132 in 2015 (Oregon 2015). In a letter to the Colorado Springs Gazette, Dr. Will Johnston documented the case of a young man who was inspired to research suicide methods online after being impressed by, and admiring, Brittany Maynard's suicide video (Johnston 2016).

Here in Maryland, two people with serious mental illness have sought psychiatric help to die on the basis of their mental illness. One was a resident of the Maryland state hospital system and made a request for lethal medication on the day the 2019 bill failed in the Senate (Hanson, personal communication). Another was a resident of the Eastern Shore with schizophrenia who contacted several forensic psychiatrists for a capacity assessment in order to apply for euthanasia in Switzerland (Neghi and Crowley, personal communications).

Adoption of this law carries serious implications for people with mental disorders who would demand equality under the law. People with serious and treatment-resistant eating disorders could qualify, since qualification is based upon prognosis rather than diagnosis.

2. Safeguard Failures

The Maryland Psychiatric Society considers the statutory safeguards to be inadequate. Furthermore, they historically have been ignored without consequences to the negligent physicians.

Between 1998 and 2012 a total of 22 Oregon physicians were referred to the Board of Medical Examiners for non-compliance with the provisions of the Death With Dignity Act. None could be sanctioned due to the “good faith” protections of the law, even when required witness attestations were missing. No attempt has been made by Oregon, or any independent researchers, to document unreported cases in Oregon since the entry into force of the DWDA. The true reporting rate in Oregon is therefore unknown (Lewis 2013).

Similarly, in the first year of the Colorado law all prescribing physicians attested that they followed the law even when 42 cases were missing the consultant's evaluation, 22 had no written request, and nine of 69 cases were not reported at all by the physician (Colorado 2017).

In 2016 the Des Moines Register investigated ten years of data in Washington and Oregon, and found that in 40% of cases the reports were missing key data.

Failure to submit required reports, or to hold physicians accountable for reporting failure, is a substantial weakness of this legislation. Even if all required documents were accounted for, there has been no study to date to confirm the accuracy and specificity of these statutory safeguards.

In Maryland, one physician was even willing to violate our state's criminal prohibition. The late Dr. Lawrence Egbert admitted participation in the assisted suicide deaths, by helium asphyxiation, of six non-terminally ill Maryland residents. Three of those patients had co-existing clinical depression. His actions were discovered purely by accident. He was never charged or prosecuted in Maryland. He admitted in an interview with the Baltimore Sun that he had been involved in 15 suicides in Maryland and 300 nationwide (Dance 2014).

If Maryland is unwilling to enforce criminal prohibitions, the enforcement of statutory safeguards is even less likely. Connecticut's Division of Criminal Justice acknowledged that the statutory construction of their legislation would have prohibited prosecution for murder (Connecticut 2015).

3. Implications for the Practice of Psychiatry

This legislation has the potential to significantly complicate the practice of psychiatry in Maryland, for both the treating clinician and when functioning as an evaluator of decision-making capacity.

This law would carve out a class of people who theoretically could be categorically exempt from emergency evaluation procedures or civil commitment. Given that some individuals live for more than one year after receiving a lethal prescription, and that capacity may deteriorate over that time, it is unclear whether a qualified patient who has lost capacity could be assessed and treated for mental illness under this law.

There is no provision to correct an error if lethal medication is given to a patient who has concealed his or her psychiatric history from a prescribing physician. A treating psychiatrist who discovers an error would have no legal means to take custody of or dispose of the medication given to a patient. There is no procedural mechanism to challenge a faulty or erroneous capacity assessment.

A psychiatrist charged with assessing capacity must also rule out the possibility of coercion. In order to do this, the evaluator must be at liberty to interview any individual with relevant information. Under this law, a coerced individual could refuse permission for the evaluator to speak with anyone who has knowledge of the coercion.

The law allows the patient to ingest the medication at the time and place of his or her choosing. Thus, a participating facility could require an inpatient psychiatric unit to allow ingestion on the ward in violation of ward suicide prevention policies. This would be particularly detrimental on units designed for the treatment of eating disorders or in geriatric units, where it would be most likely to occur. People with mental illness also develop co-occurring serious medical conditions such as diabetes; since the law does not require the patient to accept any treatment, this condition would qualify as “terminal” if the individual refuses insulin (Oregon Health Authority 2018). California's health department regulations mandate that state psychiatric facilities must carry out assisted suicides within their units under certain conditions (9 CCR §4601).

Conclusion

Several additional deficiencies have been identified by other opponent groups, and the Maryland Psychiatric Society endorses these concerns. These include:

1.  No requirement for decisional capacity at the time of ingestion.
2.  No requirement for an independent or law enforcement observer at the time of ingestion.
3.  No mechanism to detect a negligent, incompetent, or malicious prescriber.
4.  The risk to third parties in the home (depressed or mentally ill family members).
5.  Detrimental psychological effects on the involved medical professional.
6.  No requirement for a doctor to notify a power of attorney or guardian that a prescription has been requested.
7.  Potential federal civil rights violations if the eligible person is institutionalized in a correctional facility or state hospital where prevention of suicide is an affirmative obligation.
8.  The lack of mental health screening instruments validated in this population for this purpose.
9.  No mandatory reporting or whistleblower protection for healthcare providers aware of negligent or malicious prescribers

References:

Anfang S et al. APA Resource Document on Physician Assisted Death. American Psychiatric Association 2017.

Blasco-Fontecilla, Hilario. “On Suicide Clusters: More than Contagion.” The Australian and New Zealand Journal of Psychiatry 47, no. 5 (May 2013): 490–91. https://doi.org/10.1177/0004867412465023.

California. Petitions to the Superior Court and Access to the End of Life Option Act. 9 CCR §4601 (2016).

Carmichael, Victoria, and Rob Whitley. “Media Coverage of Robin Williams’ Suicide in the United States: A Contributor to Contagion?” PLOS ONE 14, no. 5 (May 9, 2019): e0216543. https://doi.org/10.1371/journal.pone.0216543.

Colorado End-of-Life Options Act, Year One 2017 Data Summary. Available at: https://drive.google.com/open?id=1kBXgAFzHl6kcfsvtLHfOQ94Unk9mDa-  Accessed February 2, 2020

Connecticut Division of Criminal Justice. Written Testimony Regarding HB7015. 2015. Available at https://www.cga.ct.gov/2015/JUDdata/Tmy/2015HB-07015-R000318-Division%20of%20Criminal%20Justice%20-%20State%20of%20Connecticut-TMY.PDF. Accessed February 4, 2020

Dance, Scott. 2014. “Maryland Strips Doctor of License for Assisting in Six Suicides - Baltimore Sun.” Baltimore Sun, December 30, 2014. https://www.baltimoresun.com/health/bs-hs-suicide-doctor-20141230-story.html.

Death with Dignity National Center. Stories. Available at: https://www.deathwithdignity.org/stories/  Accessed February 2, 2020.

Johnson, Will. 2016 “Brittany Maynard’s Story Sends the Wrong Message to Young People.” Accessed February 2, 2020. https://www.choiceillusioncolorado.org/2016/10/brittany-maynards-story-sends-wrong.html.

Lewis, Penney, and Isra Black. “Reporting and Scrutiny of Reported Cases in Four Jurisdictions Where Assisted Dying Is Lawful: A Review of the Evidence in the Netherlands, Belgium, Oregon and Switzerland.” Med Law Int 13, no. 4 (2013): 221–39.

Marzuk PM, Tardiff K, Hirsch CS, Leon AC, Stajic M, Hartwell N, Portera L (1993) Increase in suicide by asphyxiation in New York city after the publication of Final Exit. N Engl J Med 329:1508–1510.  https://doi.org/10.1056/NEJM199311113292022

Munson, Kyle, and Jason Clayworth. 2016. “Suicide with a Helping Hand Worries Iowans on Both Sides of ‘Right to Die.’” Des Moines Register, November 25, 2016. https://www.desmoinesregister.com/story/news/investigations/2016/11/25/too-weak-kill-herself-assistance-legal/92407392/.

Oregon. Death With Dignity Annual Reports. Available at: https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Pages/ar-index.aspx Accessed February 2, 2020
Oregon Health Authority. 2018. Responses to Fabian Stahle. Available at: https://drive.google.com/file/d/1XopTDjBA2SAVBGBxpDazNN899eTHixSe/view. Accessed February 4, 2020

Shreiber, J, and L Culpepper. 2020. “Suicidal Ideation and Behavior in Adults.” Up-to-Date, January. https://www.uptodate.com/contents/suicidal-ideation-and-behavior-in-adults.

Five Reasons to Oppose Euthanasia and Assisted Suicide

There are many reasons to oppose euthanasia and assisted suicide (also known as assisted death). Here we focus on five key reasons. 

(Link to a printable PDF version of this article)

1. Assisted death should be opposed because it involves causing a person’s death (killing).

Laws permitting assisted death give doctors (and nurse practitioners in Canada) the right to cause a person’s death. Society should never allow one person to legally kill another.

In Canada, the Netherlands, Belgium and Luxembourg, assisted death is done by euthanasia.

Euthanasia is intentionally injecting a person with a combination of lethal drugs. In most countries euthanasia is prohibited under murder or homicide laws.

In the United States and Switzerland, assisted death is done by assisting a person’s suicide. This is when a doctor prescribes a combination of lethal drugs that the person self-ingests.

Euthanasia and assisted suicide involve another person, usually a doctor, who directly kills or is involved with causing the death of another person.

Those who promote assisted death focus on the difficult life conditions that pressure someone to request to die. They argue from a situational ethics’ standpoint to justify killing, an act which is normally considered to be universally wrong.

Assisted death is sold as healthcare. In an interview, psychiatrist and ethicist Mark Komrad said:

“If you were just to replace the image of the needle or the pill with a gun, I think that would make a much more vivid picture of something that would be transculturally wrong.”(1)

People go through difficult physical or psychological conditions, but these human experiences must not be exploited to justify killing. Providing proper care and support is the appropriate response.

2. Assisted death should be opposed because “safeguards” only protect the physician; they do not protect vulnerable people.

Assisted death laws are designed to protect the physician (or another) who is willing to participate. These laws do not provide effective oversight and protection for the person who is being killed. These “safeguards” are designed to sell the legalization of assisted death to politicians who have concerns about killing, but they include exceptions that are wide enough to drive a hearse through.

The State of Oregon was the first jurisdiction to legalize assisted death in 1997.(2) The assisted suicide lobby did not challenge the safeguards in the law because they wanted to convince other jurisdictions that there is no “slippery slope”. However, in 2019, the assisted suicide lobby announced that the problem with assisted suicide laws is the restrictions. That year the Oregon legislature removed the 15-day waiting period.(3)
 
The euthanasia lobby alleges that the Netherlands have not changed their euthanasia law since it was passed in 2002. This is inaccurate: the language of the Netherlands’ euthanasia law has not changed but the interpretation of the law has. The most recent example is the extension of euthanasia to include incompetent people with dementia.(4)

Canada is a prime example of a country where safeguards lack effective definition or meaning. For instance, Canada’s euthanasia law required that a person’s “natural death be reasonably foreseeable”. However, the meaning of this phrase was not defined(5) and, consequently, the application of the law varied. In September 2019, a Québec Superior Court decision struck this phrase from the law.(6)

Canada is also a prime example of how a euthanasia law can incrementally expand. Canada passed its assisted death law in June 2016. In February 2020, Parliament introduced Bill C-7 to expand the law by eliminating the waiting period, permitting euthanasia of an incompetent person who requested an assisted death in advance, and eliminating the terminal illness requirement.(7)

Safeguards in assisted death laws are designed to politically sell killing. These laws protect physicians who are willing to kill; they do not protect those who die from the lethal drugs. 

3. Assisted death should be opposed because it is fundamentally incompatible with the physician’s role as healer.
 
The American Medical Association Code of Ethics Opinion 5.7 (Physician-Assisted Suicide) states that:

…permitting physicians to engage in assisted suicide would ultimately cause more harm than good.

Physician-assisted suicide is fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks.

Instead of engaging in assisted suicide, physicians must aggressively respond to the needs of patients at the end of life.(8)

Assisted death laws are designed to protect physicians who are willing to cause the death of a patient, usually upon request. When the role of a physician changes from healer to killer, it fundamentally changes the physician.

In August 2016, 25-year-old Candice Lewis, who had several medical conditions, was pressured by a doctor to “request” an assisted death while she was in the hospital. Candice’s mother Sheila Elson stated in a CBC News story:

“His words were ‘assisted suicide death was legal in Canada,’” she told CBC. “I was shocked, and said, ‘Well, I’m not really interested,’ and he told me I was being selfish.” 

According to Elson, Lewis was within earshot when the doctor made the comment – which she said was quite traumatic for her daughter to hear.(9)

Sheila said the following in the film Fatal Flaws:

Not once did Candice say to them, “I want to end my life.” The doctor came in the next day after he told me about assisted suicide, stuck his face down in Candice’s and said, “Do you know how sick you are?” When I got his eye contact, we went out in the hallway and I told him, “Don’t you ever pull something like that again.”(10)

The fact that Candice was a person with disabilities should not change the value of her life. How many people are pressured by a medical professional and, unlike Candice, die by assisted death? 

4. Assisted death should be opposed because doctors are fallible; they can make medical errors and misdiagnose conditions.
 
In his article, “Why Getting Medically Misdiagnosed Is More Common Than You May Think,” Brian Mastroianni states that 12 million Americans are affected by medical diagnostic errors each year and an estimated 40,000 to 80,000 people die annually from complications related to misdiagnoses, with a similar number of people experiencing a permanent disability related to misdiagnosis.(11)
 
In April 2013, Pietro D’Amico, a 62-year-old magistrate from Calabria, Italy, died by assisted suicide at a Swiss assisted suicide clinic. His autopsy revealed that he had been medically misdiagnosed.(12)
 
Assisted death is a permanent decision often done when a person fears a painful or difficult death or is experiencing depression or feelings of hopelessness. Once they are dead, it is too late to learn that they were misdiagnosed or living with a treatable condition.

5. Assisted death laws should be opposed because legalization pressures physicians who then pressure patients.
 
What begins as a choice to kill or a choice to die becomes a pressure to kill and a pressure to die.
 
During the debate to legalize euthanasia in Canada, the euthanasia lobby argued that the issue was about choice. The “freedom of choice”: to die by euthanasia, and for a doctor or nurse practitioner to participate.
 
Sadly, Candice Lewis’ story may not be rare.
 
In February 2018, less than two years after Canada legalized assisted death, the Delta Hospice Society (DHS), an independent charitable organization in British Columbia (BC), was ordered by the Fraser Health Authority (FHA) to provide euthanasia.(13) The DHS resisted and continued its good work. In December 2019, the FHA ordered them to provide euthanasia or lose their government funding.(14) The DHS refused to comply with the government’s edict saying that, 

“MAiD is not compatible with the DHS’s purposes stated in the society’s constitution, and therefore, will not be performed at the Irene Thomas Hospice.”(15)

The Canadian Hospice Palliative Care Association and the Canadian Society of Palliative Physicians sent the BC Minister of Health a joint statement saying, 

“…MAiD is not part of hospice palliative care; it is not an ‘extension’ of palliative care nor is it one of the tools ‘in the palliative care basket’”(16) 

The BC Minister of Health responded by ordering the DHS to comply or be taken over by the province in February 2021.(17)
 
Some recent assisted suicide bills in the United States have included a “do or refer” provision.(18) This means that if assisted suicide is legalized, a doctor would not have to prescribe assisted suicide drugs; however, if they received a request for assisted suicide, they would be required to refer the patient to someone who will write the prescription.

In Canada, doctors in Ontario have been ordered by the College of Physicians and Surgeons to do an “effective referral”. This means that the College can punish doctors who refuse to kill and refuse to refer their patients to a doctor who will kill.(19)
 
Advocates of assisted death use the term “freedom of choice” to promote their ideology. This campaign slogan has resulted in medically condoned killing. This ideology has led to a persuasive pressure to die or an edict to kill and is the central part of a cultural campaign to normalize killing.
 
Society must maintain and build on its commitment to caring, not killing.

(Link to a printable PDF version of this article)

Endnotes
1. Dunn, K. (Director). (2018). Fatal Flaws: Legalizing Assisted Death. DunnMedia & Entertainment. [Trailer]. https://www.youtube.com/watch?v=89YQubAyRrI (Dr. Komrad’s statements start at 0:27)
2. Norman-Eady, S. (2002). Office of Legislative Research (OLR) Research Report: Oregon’s Assisted Suicide Law (Report No. 2002-R-0077). Connecticut General Assembly. https://www.cga.ct.gov/2002/rpt/2002-r-0077.htm
3. Callinan, K. (2019, January 1). End-of-Life option laws should avoid needless red tape. McKnight’s LTC News. https://www.mcknights.com/blogs/guest-columns/end-of-life-option-laws-need-compassion/
4. Pieters, J. (2020, April 21). Euthanasia Allowed for Dementia Patients Who Gave Prior Consent: Supreme Court. Netherlands Times. https://nltimes.nl/2020/04/21/euthanasia-allowed-dementia-patients-gave-prior-consent-supremecourt
5. Schadenberg, A. (2016, June 17). Canadian Senate passes euthanasia bill in time for summer break. Euthanasia Prevention Coalition Blog. https://alexschadenberg.blogspot.com/2016/06/canadas-senate-passes-euthanasia-bill.html
6. Marin, S. (2019, September 11). A Quebec court has invalidated parts of the medical aid in dying laws. The Canadian Press. https://montreal.ctvnews.ca/a-quebec-court-has-invalidated-parts-of-the-medical-aid-in-dying-laws-1.4588622
7. Bill C-7, An Act to amend the Criminal Code (medical assistance in dying), First Session, Forty-third Parliament, 68-69 Elizabeth II, 2019-2020. https://www.parl.ca/DocumentViewer/en/43-1/bill/C-7/first-reading
8. Chapter 5: Opinions on Caring for Patients at the End of Life. American Medical Association (AMA) Code of Medical Ethics. https://www.ama-assn.org/system/files/2019-06/code-of-medical-ethics-chapter-5.pdf
9. Bartlett, G. (2017, July 24). Mother says doctor brought up assisted suicide option as sick daughter was within earshot. CBC News. https://www.cbc.ca/news/canada/newfoundland-labrador/doctor-suggested-assisted-suicide-daughter-mother-elson-1.4218669
10. Dunn, K. (Director). (2018). Fatal Flaws Film Clip: “They wanted me to do an assisted suicide death on her.” [Video file]. https://www.youtube.com/watch?v=hB6zt43iCs8
11. Mastroianni, B. (2020, February 22). Why Getting Medically Misdiagnosed Is More Common Than You May Think. Healthline. https://www.healthline.com/healthnews/many-people-experience-getting-misdiagnosed
12. Aided suicide in question after botched diagnosis. (2013, July 11). The Local. https://www.thelocal.ch/20130711/assisted-suicide-in-question-after-botched-diagnosis
13. Fayerman, P. (2018, February 6). Delta hospice rebels against Fraser Health’s mandate to provide medical assistance in dying. Vancouver Sun. https://vancouversun.co/news/local-news/delta-hospice-rebels-against-fraser-healths-mandate-to-provide-medical-assistance-in-dying/
14. Gyarmati, S. (2019, December 7). Fraser Health gives Delta Hospice ‘formal notice of concerns’. Delta Optimist. https://www.delta-optimist.com/news/fraser-health-gives-delta-hospice-formal-notice-of-concerns-1.24029942
15. New Delta Hospice Society board reverses MAiD position. (2019, December 2). Delta Optimist. https://www.deltaoptimist.com/news/new-delta-hospice-society-board-reverses-maid-position-1.24024999
16. Canadian Hospice Palliative Care Association (CHPCA) and Canadian Society of Palliative Care Physicians (CSPCP) Joint Call to Action. (2019, November 27). https://www.chpca.ca/news/chpca-and-cspcp-joint-call-to-action/
17. Gyarmati, S. (2019, December 24). Here’s the deadline given to Delta Hospice. Delta Optimist. https://www.delta-optimist.com/news/here-s-the-deadline-given-to-delta-hospice-1.24041440
18. Murphy, S. (Administrator). (2020, January 14). Indiana assisted suicide bill fails to protect objecting practitioners: Assisted suicide evolves from “assistance” to “medical care”. Protection of Conscience Project. https://www. consciencelaws.org/law/commentary/legal102.aspx
19. Advice to the Profession: Professional Obligations and Human Rights. The College of Physicians and Surgeons of Ontario (CPSO). https://www.cpso.on.ca/Physicians/Policies-Guidance/Policies/Professional-Obligations-and-Human-Rights/Advice-to-the-Profession-Professional-Obligations

Assisted suicide by Zoom

This article was published by First Things on June 5, 2020

*Sign the petition: Healthcare regulations must not permit assisted suicide approvals by telehealth (Link).

By Wesley J Smith

Those who advocate the legalization of physician-assisted suicide always claim that doctor-prescribed death will involve a meticulous process of intimate conversations and hands-on examinations by qualified physicians. They promise that patients who request assisted suicide as a solution to illness or disability will receive a physical to determine the extent of the disease. If declared terminally ill, the patient must next be referred for a second opinion. Only then can the doctor dispense the lethal prescriptions.

But once it’s legal for doctors to prescribe poison, opinions about death and suicide quickly change. Assisted suicide boosters come to see “protections” as unjust “barriers” to attaining a “peaceful death.” This leads to cutting legal corners and breaking public policy promises.

The COVID-19 crisis has provided a pretext for further eroding supposedly ironclad guidelines. When the crisis first hit, assisted suicide advocates wrung their hands because people would be unable to access the medical examinations necessary to obtain doctor-prescribed death. Technology to the rescue! The American Clinicians Academy on Medical Aid in Dying—a newly formed association of doctors who assist suicides—recently published formal guidelines that permit doctors to assist suicides via the Internet. These guidelines state that examination should include a review of medical records and a video meeting via Zoom or Skype. The second opinion can simply be done by phone. This means that assisted suicides will be facilitated by doctors who never actually treated patients for their underlying illness, who may be ignorant of their family situations and personal histories, and who have never met their patients in the flesh.
 

Tele-assisted suicides have already been done. An article published in The Conversation quoted a doctor who quietly began doing streamed suicide consultations years before the COVID pandemic began.

“My patients love telemedicine,” Dr. Carol Parrot, a physician who lives on an island in Washington, told me during a Skype interview in 2018. “They love that they don’t have to get dressed. They don’t have to get into a car and drive 25 miles and meet a new doctor and sit in a waiting room.”

Parrot says she sees 90% of her patients online, visually examining a patient’s symptoms, mobility, affect and breathing. “I can get a great deal of information for how close a patient is to death from a Skype visit,” Parrot explained. “I don’t feel badly at all that I don’t have a stethoscope on their chest.”

Parrot told the interviewer that she “sometimes” consults the suicidal patient’s primary care physician. This means that she sometimes does not even bother to discuss the patient with the medical professional most familiar with the patient’s case. 

*Sign the petition: Healthcare regulations must not permit assisted suicide approvals by telehealth (Link).
 
The dichotomy between advocates’ easy promises and actual practice was apparent long before the COVID crisis. In Oregon, where assisted suicide has been legal since 1994, one of the so-called “protective guidelines” requires doctors to refer patients for psychological “counseling” if the prescribing physician suspects that the patient has a mental condition “causing impaired judgment.” Alas, this supposed protection has proved specious. Few physicians ever make these referrals, and when they do, the resulting consultation is often superficial.

Here’s an example. In 2008, an article in the Michigan Law Review—written by the late suicide expert Herbert Hendin and Kathleen Foley, perhaps the nation’s foremost palliative care doctor—described the assisted suicide of Joan Lucas. Lucas tried to kill herself after being diagnosed with Lou Gehrig’s disease, but failed. She next sought assisted suicide. The death doctor referred her to a psychologist only “to protect my ass.”

The consultation was hardly a professional interaction. From the article:

The doctor and the family found a cooperative psychologist who asked Joan to take the Minnesota Multiphasic Inventory, a standard psychological test. Because it was difficult for Joan to travel to the psychologist’s office, her children read the true-false questions to her at home. The family found the questions funny, and Joan’s daughter described the family as “cracking up” over them. Based on these test results, the psychologist concluded that whatever depression Joan had was directly related to her terminal illness, which he considered a completely normal response.

In other words, the psychologist never personally saw the patient and never considered suicide prevention. As Foley and Hendin wrote, “The psychologist’s report in Joan’s case is particularly disturbing because ‘on the basis of a single questionnaire administered by her family, he was willing to give an opinion that would facilitate ending Joan’s life.’”

Promises were broken in Oregon's very first doctor-prescribed death in 1997. Assisted suicide boosters always depict such deaths as taking place in the context of long-term, caring relationships between doctor and patient. But according to Issues in Law and Medicine, when “Mrs. A” was diagnosed with cancer and asked for assisted suicide, her treating physician refused. So she simply went doctor shopping. A second doctor also declined and diagnosed her as depressed. She then contacted an assisted suicide advocacy organization that referred her to a new doctor—one known to be a proponent of physician-assisted suicide. This doctor gave Mrs. A the deadly injection a mere two and a half weeks after first meeting her.

Even when patients do not qualify legally for doctor-assisted death based on the nature or extent of their illness, advocates for euthanasia and assisted suicide manage to find ways around the diagnostic impediment. Canada permits lethal injection euthanasia only if death is “reasonably foreseeable.” But what about people whose deaths are not foreseeable? No worries—they can receive a lethal jab too. An ethics opinion from the College of Physicians and Surgeons of British Columbia decided that patients who are not eligible under current law for euthanasia can become eligible by starving themselves until they are sufficiently weakened and death becomes “reasonably foreseeable.”

What can we learn from all of this? “Protective guidelines” serve mainly to give a wary society a false sense of security about assisted suicide. But once we accept suicide as an acceptable answer to suffering caused by illness or disability, our attitudes toward death become so warped that obtaining suicide for requesting patients quickly becomes the overriding priority. Over time, practices become progressively unregulated—and nobody much cares.

Because many state legislatures are not in session due to the COVID crisis, attempts to legalize assisted suicide in states like New York, Massachusetts, and Maryland are temporarily paused. But these proposals have not gone away. When the political battle resumes, we will again hear many blithe assurances of strong protections. But history demonstrates that “protections” matter little once it is legal for doctors to help patients kill themselves.
More articles on this topic:

• Stop assisted suicide by telehealth (Link).
• Assisted suicide by telehealth and medical misdiagnosis (Link).

Doctors Now Assist Suicides via Zoom

This article was published by National Review online on June 2, 2020

*Sign the petition: Healthcare regulations must not permit assisted suicide approvals by telehealth (Link).

By Wesley J Smith

We are always told that “strict guidelines will protect against abuse.”

It’s always been baloney. As sold, assisted suicide was supposed to only be engaged between doctors of long-standing and patients well known to the prescriber.

* Stop assisted suicide by telehealth (Link).

That was violated in the very first legal assisted suicide in Oregon. The doctor in that case — referred by an assisted-suicide advocacy organization — only met the patient two weeks before she received her poison pills.

Very quickly, death doctors began to assist the suicides of patients they have never treated. In California, a part-time ER doctor — who spent most recent years as a photojournalist — quickly set up a suicide practice after assisted suicide was legalized. There have also been many cases of oncologists assisting the suicides of ALS patients, and other similar out-of-specialty death facilitations.

Now, death doctors are assisting suicides of patients they may never have met via Zoom and other telehealth — talk about an oxymoron in this circumstance! — means of communication. From, “Dying Virtually,” published in The Conversation:

Parrot says she sees 90% of her patients online, visually examining a patient’s symptoms, mobility, affect and breathing. 

“I can get a great deal of information for how close a patient is to death from a Skype visit,” Parrot explained. “I don’t feel badly at all that I don’t have a stethoscope on their chest.” 

After the initial visit, whether in person or online, aid-in-dying physicians carefully collate their prognosis with the patient’s prior medical records and lab tests. Some also consult the patient’s primary physician.

Did you catch the last bit there? Some “consult” the patient’s primary physician. That also means some don’t. And that means some people are assisted in suicide by doctors they have never met in the flesh and who have never examined them.

This is a breach of all the assuring promises that were made when assisted suicide was legalized. But those promises were never meant to be kept. Only to give false assurance.

It is amazing to me how legalizing assisted suicide transforms peoples’ thinking. Making people dead quickly becomes the overriding imperative and suicide prevention for the seriously ill goes into total eclipse. The easier it is to get people dead, the better.

Those with eyes to see, let them see.

*Sign the petition: Healthcare regulations must not permit assisted suicide approvals by telehealth (Link).

Did the Massachusetts assisted suicide lobby change its tactic or are they just lying?

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Massachusetts legislature

Last Friday, the Massachusetts Joint Committee on Public Health, sadly advanced assisted suicide bills S.1208 and H.1926. I do not think there is time, in this legislative session to pass these bills into law, but the fact that they passed in committee is concerning.

It is also concerning that a commentary that was published in a Massachusetts newspaper causes more confusion as to what assisted suicide is. The article titled: In support of passing death with dignity law states:

There is nothing mandatory in this bill. No doctor may prescribe terminal sedation (my emphasis) requested by a patient unless the patient:
■ is mentally capable, and not suffering from clinical depression or anxiety severe enough to impair his/her judgment;
■ can take the prescribed medication by him or herself;
■ has requested the medication orally and in writing, with two witnesses, one of whom cannot be included in the patient’s will;
■ has met with two physicians and one mental health professional who each attest first to the patient’s understanding and awareness of the full consequences of her/his request, and second to the diagnosis of a terminal illness that will in all likelihood end her/his life within six months.

First, terminal sedation is not assisted suicide. Terminal sedation is a medical act to sedate a person who is experiencing uncontrolled symptoms. Terminal sedation can be abused, by intentionally overdosing or by sedating a person and then dehydrating the person to death, nonetheless terminal sedation is not assisted suicide.

Assisted suicide is to intentionally prescribe lethal drugs, knowing that the person intends to use the lethal drug cocktail to die by suicide.

Is equating terminal sedation with assisted suicide a way to change the way assisted suicide is viewed?

Secondly, people who die by assisted suicide in Oregon, where assisted suicide has been legal for more than 20 years, are rarely sent for a psychological assessment, even though a study found that more than 25% of patients who request assisted suicide are experiencing depression or feelings of hopelessness. 

According to the 2019 Oregon assisted suicide report, that out of 188 reported assisted suicide deaths only one of those people were sent for a psychological assessment.

Finally, the assisted suicide lobby promotes assisted suicide as a "peaceful death." The fact is that many assisted suicide deaths are prolonged and painful deaths.

Legalizing assisted suicide gives doctors who agree to cause the death of patients complete legal protection for doing so.

There are many more problems with assisted suicide. We believe in caring, not killing.

Popular articles opposing euthanasia and assisted suicide.

1. Sick Kids Hospital Toronto will euthanize children with or without parental consent - Oct 10, 2018.

2. Paediatric Palliative Care Symposium and child euthanasia - February 26, 2018.

3. Declaration of Hope – Jan 1, 2016.

4. Fatal Flaws film will change the way you view assisted death - June 8, 2018.

5. Guide to answering the Canadian MAID consultation questionnaire - Jan 15, 2020.

6. Margaret Dore: Assisted Suicide: A Recipe for Elder Abuse and the Illusion of Personal Choice - Feb 17, 2011.

7. Kitty Holman: 5 reasons why people devalue the elderly – May 25, 2010.

8. Healthy 24-year-old Belgian woman who was approved for euthanasia, will live. Nov 12, 2015.

9. Kate Kelly: Mild stroke led to mother’s forced death by dehydration – Sept 27, 2011.

10.  The Euthanasia Deception documentary. - Sept 30, 2016.

11. Healthy 24 year old Belgian woman was scheduled for euthanasia - June 24, 2015.

12. Legalizing euthanasia saves money. Jan 23, 2017.

13. Boycott Me Before You - "disability death porn" - May 26, 2016.

14. Depressed Belgian woman dies by Euthanasia – Feb 6, 2013.

15. Dr's Annette Hanson & Ronald Pies: 12 Myths about Assisted Suicide and Medical Aid in Dying. July 9, 2018.

16. Physically healthy 23-year-old Belgian woman is being considered for euthanasia - October 14, 2019.

17.  Euthanasia is out-of-control in the Netherlands – Sept 25, 2012.

18. Belgian twins euthanized out of fear of blindness. – Jan 14, 2013.

19. Netherlands euthanasia review committee: euthanasia done on a woman with dementia was done in "good faith" -  Jan 28, 2017.

20. Mother upset after doctor urged her to approve assisted death for her daughter with disabilities - July 26, 2017.

21. Assisted suicide law prompts insurance company to deny coverage to terminally ill woman - Oct 20, 2016.

22. Woman who died by euthanasia, may only have had a bladder infection - Nov 14, 2016.

23. Judge upheld decision. Assisted suicide is prohibited in California. May 31, 2018.

24. New Mexico assisted suicide bill is the most extreme bill - Dec 21, 2018.

25. Woman with Anorexia Nervosa dies by euthanasia in Belgium – Feb 10, 2013.

26. 29-year-old healthy Dutch woman died by assisted death for psychiatric reasons. Jan 15, 2018. 

Become a member of the Euthanasia Prevention Coalition ($25) membership.

More important articles:

• Belgian 2018 euthanasia report. A 247% increase since 2010.
• Netherlands 2018 euthanasia report: Deaths are lower, we are concerned about euthanasia for completed life.
• Study: More than 1000 Belgian deaths were hastened without request in 2013.
• Oregon 2019 assisted suicide report. Oregon assisted suicide deaths increase again.
• Washington State, nearly 25% more assisted suicide deaths in 2018.
• California assisted suicide report. 337 reported assisted suicide deaths in 2018.
• Swiss assisted suicide deaths increase by 18% in 2018.
• Canada: Approximately 5000 euthanasia deaths in 2019 and 13,000 since legalization.
• Supreme Court of Canada euthanasia decision was irresponsible and dangerous.
• Ontario: Euthanasia deaths rise quickly with nearly 1800 reported deaths in 2019.
• Quebec euthanasia - Third report, 142 unaccounted deaths.
• Do Not Kill Me: I oppose euthanasia and assisted suicide.
• Exposing Vulnerable People to Euthanasia and Assisted Suicide.