Euthanasia lobby confirms elder abuse risk – but doesn’t seem to care

This article was published by Mercatornet on September 5, 2017

Paul Russell

By Paul Russell - The director of HOPE Australia

The Netherlands legalised both euthanasia and assisted suicide in 2002. The data shows an overwhelming preference for euthanasia. In 2015, there were 6672 euthanasia deaths and only 150 assisted suicide deaths; the total comprising at least 4.5% of all deaths.

In recent years the discussion about ‘life ending actions’ has turned to assisted suicide for ‘completed life’; where a person over a certain age may declare that they wish to end their lives even though they may have no serious medical issues.

Debate has raged back and forth on this new development for some years. An expert committee recommended that changes to the law not proceed, but there remains support from within government and some of the minor parties.

Reports in 2016 suggested that the government had drafted legislation. Health Minister, Edith Schippers, has said that "because the wish for a self-chosen end of life primarily occurs in the elderly, the new system will be limited to them”. The lower age limit is rather arbitrary with debate ranging from 60 to 70 years of age.

Legislation is expected to be introduced in late 2017. It is expected to take the form of a new law rather than an amendment. This seems to be because the existing provisions require medical opinion and support whereas this new form of assisted suicide may have more in common with the mail or online order system made notorious by the Australian activist Dr Philip Nitschke and his organisation, Exit International.

But this is not the first time that such a move has been put forward. As with all of these debates, there’s a long lead-in time while the discussion of the agenda looks to forge a beachhead of public opinion.

In 1991, Dutch Supreme Court Judge, Huib Drion, argued for “The self-chosen end for old people,” over the age of 75. He suggested a two-stage process where a person would self-administer a substance that would have no immediate effect that could be followed up later by the second stage substance that would react with the first and bring about death by suicide. The idea became known as “the Drion Pill” though no such pill was ever developed.

The publication of his paper in a newspaper, NRC Handelsblad, in 1991, sparked a significant controversy with letters of support for many weeks and Drion receiving a great deal of public attention.

The World Federation of Right to Die Societies (WFRTDS) also picked up on the idea as did its Dutch counterpart the Dutch Right to Die society (NVVE) and the former Dutch health minister Els Borst who was instrumental in the introduction of the 2002 euthanasia law.

In 2003, the WFRTDS adopted a name change to their policy support for Drion’s idea, calling it, instead, “The Last Will Pill” and noting that the resonance of the use of Drion’s name limited the association of the idea to the elderly. WFRTDS sees its application more broadly than that.

Both Drion and the WFRTDS are clear in the distinction between the practice of euthanasia in Holland and this new proposal.

The rhetoric is eerily similar to Nitschke and Exit: current euthanasia and assisted suicide laws are medical models that only partially give voice to autonomy. As NVVE chief executive officer Rob Jonquière, pointed out: 

“People want the right to choose to end their life independent of doctors or illness.”

This independence from any medical model has implications. As observed already, there are similarities in the proposals to the modus operandi of Exit and Philip Nitschke.

Another Dutch right-to-die club, The Co-operative Last Will, are also pushing this barrow. They seem willing to sail close to the edges of the law in advocacy and information in a similar way to Exit. They are promoting “a new drug” but refuse to identify it.

“The stuff is legally available and deadly in pure form. It has already been used by people who wanted to commit self-exploitation. There have also been several murders committed by the means.”

This is dangerous talk. As we have seen with the Nitschke methods, people who are not otherwise ill and people who suffered depressive illnesses have been caught up in the hype with devastating personal and family consequences. The reference to murders is chilling: clearly people have been tricked into consuming the drug.

Again, like Nitschke (who once said: “There will be some casualties…”), The Co-operative Last Will organisation is frank about the possible collateral damage:

“The Cooperative Last Will and its members (3,500 people) point out the existence and functioning of the new drug. The club realizes that it involves the risks. An extreme consequence could be that children give the means to their old and wealthy parents because they want to claim their inheritance.

"That kind of criticism is to be expected. But the sale of rope is also not forbidden, and so people rob themselves of life, "says a spokeswoman.” (Emphasis added)

A glib retort and hardly apposite. Robbing oneself of life is suicide – elder abuse to death is murder. But who would ever know.

But collateral damage it will be. Far from stopping Dutch “right-to-die” types in their tracks, such an acknowledgement seems more about deflecting criticism than it is about protecting Dutch citizens from abuse.

One wonders if the Zeitgeist had not been infected this past 20 years and more with the Dutch strain of the euthanasia virus if there might have been more pause for thought. Given that Drion’s infamous idea predates Dutch euthanasia by a full decade; perhaps not!

Paul Russell is director of HOPE: preventing euthanasia & assisted suicide, which is based in Australia.

Australian Assisted Suicide Plan: Only the Beginning.

This article was published by HOPE Australia on July 26, 2017

By Paul Russell

The Director of HOPE Australia.

Don’t look to the starting point; look at the finish line.

The ubiquitous figure of Philip Nitschke and his death peddling organisation, Exit, are never far from the news.

Though eschewed by many on the pro-euthanasia movement, Nitschke does do straight-talking well when he exposes the ultimate end of the supposedly limited (Victorian Premier said: conservative) regimens such as that to come before Victoria.

In recent days two of his members have said in the press that the Andrews Victorian model simply doesn’t go far enough, but is a ‘good first step’.

In 2010 in the Western Australian debate, mover of the bill, The Hon Robin Chapple, told the local pro-euthanasia lobby that he knew his restricted bill wouldn’t please everyone but that it was a ‘good start’.

In New Zealand in 2013, mover of the bill, Maryan Street, responding to a question about the possibility of euthanasia for terminally ill children said:

"Application for children with terminal illness was a bridge too far in my view at this time. That might be something that may happen in the future, but not now."

In the Canadian debate, euthanasia for children, people with dementia and mental illness were excluded from the bill even though the mandate from the Supreme Court in the Carter case suggested inclusion. The government needed to get the bill through and decided to ‘investigate’ these possibilities later.

The Victorian Ministerial Advisory Panel also wrestled with where to set the initial ‘pitch’.

So what’s this all about?

It is a sales pitch, without question. It is all about securing 50% plus one of the votes in the deliberative chambers of parliament.

Once the door is open, as Director of the European Bioethics Institute based in Brussels, Carine Brochier, observed, ‘it will go wider and wider.’

Assisted Suicide – Is It All About The Money?

The following article was published by Hope Australia on July 20, 2017.

Paul Russell

By Paul Russell - the Director of Hope Australia

CEO of St Vincent’s Hospital network, Toby Hall must have been wondering at all the fuss over a simple observation in a recent article in The Australian about his network stating its blanket refusal to cooperate with assisted suicide should Victoria pass the Andrews’ Government mooted legislation.

I have written previously about the Greens’ Party spokesperson, Colleen Hartland calling for the government to review St Vincent’s funding as a response. A veiled threat if ever there was one. Surely the mantras of tolerance and diversity are broad enough to include a health service that has a conscientious objection? Maybe not.

But the most scathing criticism of Hall’s comments came from journalist Andrew Denton; also on the pages of The Australian. Denton was responding to the following statement in the original article:

“St Vincent’s Health Australia chief executive Toby Hall said the Andrews government’s proposed “conservative” euthanasia model was flawed and vulnerable patients would be put at risk by the proposed legislative changes, which he described as a “cheap economic way out”. 

“He accused the government of taking the cheaper option to “give someone a drug and kill them” rather than providing sufficient palliative care for the majority of Victoria’s terminally ill.”

But rather than providing any concrete evidence to support his criticism of Hall’s comments, Denton simply asserts that, “It is both incorrect and highly insensitive to the reality of how Victorians are dying” and then moves on. That is, except for this curious claim:

But by palliative care’s own admission all the resources in the world aren’t going to help them deal with all pain and suffering. It is not medically possible. And until we find a cure for cancer, MND and other diseases, this is unlikely to change.

The first statement seems to be a paraphrase that is, at the very least, debatable – depending on what one might take to be the precise meaning of each of its phrases. The second is redundant – if there were no difficult diseases there would clearly be little if any difficulty in managing symptoms.

But there’s a bigger picture here that Hall was alluding to, made abundantly clear by the call this week by Palliative Care Victoria for an additional $65M in funding in the state to help meet the need and to fill the service delivery and educational gaps. This follows closely upon the New South Wales Government recently committing $100M towards regional and rural palliative care services in that state.

The reality is that, in spite of Australia’s Palliative Care Services being ranked second in the world behind Britain, there are still service gaps and funding shortfalls. In that context and for some, the supposed ‘choice’ of assisted suicide is, in reality, no choice at all.

This is also true when you consider that in a landmark study by the Grattan Institute a few years ago confirmed that something like 70% of Australians expressed a deep desire to die at home when only 14% of people were actually able to exercise that choice.

So if you live in rural or remote parts of Australia not only will you likely not be able to die at home, but the services you receive could be well below Australian standards or you may need to choose between dying in a regional hospital that may not be able to meet your needs or being transferred to a big city hospital with all of the attendant dislocation. Perhaps assisted suicide becomes a more pressing option when other legitimate choices are limited. Hardly fair is it?

In spite of the need for increased funding for palliative care and end of life care being recognised in the Victorian Auditor General in 2015, the End of Life Choices Inquiry in 2016 and by the Productivity Commission this year, there was no additional funding for such services in the recent Victorian State Budget.

Yet, according to Palliative Care Victoria:

"Currently 55% of Victorian palliative care services report that they are unable to meet the current demand for palliative care. At least 26% of Victorians who die are missing out on the benefits of palliative care, according to the international measures of population need for palliative care."

They further note that there has been no nett increase in palliative care funding from the government since 2014.

Does this sound like a government that has a handle on its agenda? Surely, if they were serious about ‘choice’ as a value in promoting assisted suicide they would have increased funding in the last budget a few months ago; even if only to make the point that they take end of life care seriously.

No doubt they will point to the mooted lead in period until their assisted suicide regime becomes active. But Palliative Care Victoria’s plaintive cry for support won’t fix the gaps overnight. As Liz Carr told Victorian Parliamentarians a few months ago – fix the first 48 recommendations of the Parliamentary Inquiry Report before you tackle number 49 (the suicide recommendation).

Without such funding the CEO of St Vincent’s assertion of assisted suicide may be seen by bean counters as a ‘cheap way out’ has a ring of authenticity.

In Canada, less than a year after the Quebec and Ottawa government's legalised forms of euthanasia and assisted suicide, a research paper entitled: Cost analysis of medical assistance in dying in Canada appeared in the Canadian Medical Journal (CMAJ). It found that "Medical assistance in dying could reduce annual health care spending across Canada by between $34.7 million and $138.8 million." The bean counters must have been in seventh heaven.

The authors summarized: "Our analyses suggest that the savings will almost certainly exceed the costs associated with offering medical assistance in dying to patients across the country, and that the inclusion of medical assistance in dying in the services covered by universal health care will not increase health care spending, but rather will release funds to be reinvested elsewhere." Adding lamely: "We are not suggesting medical assistance in dying as a measure to cut costs." Really?

Daniel Fleming took up the 'economic argument' on the pages of the ABC's Religion and Ethics website, citing the Canadian study:

"Soon after the legislation was introduced in Canada, the above mentioned study was undertaken which had the object of demonstrating the savings to Canadian tax-payers as a result of the legislation. At this point in time, such savings might be considered an ancillary purpose to the explicit purpose of providing PAS-E (Euthanasia and Physician Assisted Suicide). However, they reveal important facts: end-of-life care is expensive, and it is not impossible to imagine a government or healthcare organisation which needs to face this fact during a hard budget agreeing to focus more attention on the cheaper options of PAS-E than on other forms of end-of-life care, an approach which has already been suggested by one of the world's leading economists."

Even the famous Dutch euthanasia enthusiast, Dr. Boudewijn Chabot recently lamented the effect of financial considerations in relation to euthanasia for psychiatric reasons in his own country:

"Ever since budget cuts turned chronic psychiatry into a diagnosis-prescription business, good treatment has become scarce."

Fleming warned in conclusion:

"These are uncomfortable considerations, and they take the debate outside of its typical contours which consider the suffering of an individual and sometimes their family, and whether or not it is right for that person to end their own life with medical assistance. That debate still needs to be had. However we land there, it is crucial to remember that the debate takes place in an ideological context, and if or when the legislation is enacted it will be done in a way that takes it beyond the intent of those proposing it, and into the realm of the value set of capitalism. Any legislation or major social interventions has social consequences beyond its original purpose."

There’s always the money question just as there will always be people who are at risk under any form of legislation. There are winners and losers in all of these debates.

Even Premier Andrews, now the prime mover in the assisted suicide agenda, once noted the money question, as Fairfax media reporter, Farah Tomazin noted last December:

Andrews' resistance was not based on faith, he explained, but from his stint as health minister under the Brumby government. It was during that time the Labor MP saw firsthand the incessant demand for hospital beds in an overstretched system and became increasingly concerned that "these laws might see a rationing of precious health dollars".

Andrews may have changed his mind to support assisted suicide, but his observations about the health system and the temptation to cut and/or limit budgets remains.

What Boudewijn Chabot teaches us about euthanasia.

This article was published by HOPE Australia on June 26, 2017

Paul Russell

By Paul Russell, the director of HOPE Australia

Dr. Boudewijn Chabot is a retired Dutch psychiatrist and psychotherapist. In 1993 he was charged with having assisted in the suicide of a healthy 50-year-old Dutch woman, Hilly Bosscher, in 1991. Bosscher had lost two sons in the previous five years; six months apart. One had committed suicide; the other had died of cancer. Both were in their early twenties. Her grief did not abate; she wanted to die and to 'to lie in between the graves of her two sons'.

The Independent reported at the time that:

"Dr Chabot, now 53, originally trained as a GP before specialising in psychiatry. It was not until he had spent more than 12 years in psychiatric practice that he decided to see patients who had contacted the Dutch Society for Voluntary Euthanasia (NVVE), desperately wanting to die. He has said that he got in touch with the NVVE in order to 'offer my services in difficult cases'. It had been reported that the organisation was unable to find psychiatrists who did not utterly oppose the patient's wish to die."

At that time acts of euthanasia and assisted suicide were not legal but allowed under certain circumstances via court precedents stretching back to 1973 and the Postma case. The "Termination of Life on Request and Assisted Suicide (Review Procedures) Act" would not become law until 2002.

Chabot was tried and acquitted in a lower court. The prosecution appealed to the Supreme Court where a guilty verdict was returned but no punishment was applied. Up until this time euthanasia and assisted suicide cases were not considered lawful without the presence of 'unacceptable suffering' that was defined as physical. The standard defence of necessity or 'force majeure' did not apply to Chabot.

As Wesley Smith reported, this was a 'show trial' and there was never any intention to punish Chabot but, rather allow the case to set a new legal precedent.

Following the Supreme Court decision in November 1993 the Royal Dutch Medical Association (KNMG) amended its 1984 guidelines to include the possibility that there may be cases where 'it is merciful, such as if a patient has serious psychiatric problems and has no prospect of improvement'.

From The Independent:

"Chabot was put in contact with his patient through the NVVE in the summer of 1991. Two months of intensive consultations followed, during which he tried to find a way into her 'closed world of suicide'. She had planned to take her own life since the death of her second son earlier that year and had bought a plot of four graves, two for her sons, one for herself and another for her estranged husband. A suicide attempt the night of her second son's death failed."

Chabot also consulted with other psychiatric professionals; though none reportedly examined the woman. According to Chabot, he suggested that she try anti-depressants, but she refused both the medication and an entrance into a therapeutic community.

The Chabot case opened the door to euthanasia and assisted suicide for psychiatric reasons. This is a classic case of 'bracket creep' or incremental extension. The recent interim report of the Victorian Ministerial Advisory Panel notes well that in their consultations there are those who have argued for a different 'starting point' that is much broader in application that parameters suggested by the earlier Parliamentary Committee report.

One way or another, such extension is inevitable.

But Chabot offers us another consideration both in the 1993 case and his recent lament about the application of the Dutch law published in NRC Handelsblad on June 16, 2017.

Chabot is severe in his criticisms of the developments in the application of the Dutch law in recent years. He's not at all concerned about the skyrocketing numbers of deaths ("In the last ten years, the number of euthanasia reports has increased from two thousand to six thousand per year.") but rather the changes that have seen the 'due care criteria' morph in ways that suggest that euthanasia and assisted suicide 'on demand' is now the prevailing paradigm.

"To understand what has gone wrong, the reader must know the three most important “due care criteria” of the law. There must be: 1) a voluntary and deliberate request; 2. unbearable suffering without prospect of improvement; 3. No reasonable alternative to euthanasia. 

"The second and third requirements are closely linked because if another solution, such as specialist palliative care, is indicated, the suffering is not without prospect of improvement. If the patient refuses that option, the physician will not be convinced of the “unbearable” nature of the suffering and will not provide euthanasia. 

"At least as important is what is not in the law. There is no requirement that the disease has to be physical, and the doctor need not have a treatment relationship with the patient."

Chabot's concerns are well founded. They relate to the subjective nature of 'unbearable suffering' and the reality that the term 'no reasonable alternative' has also become entirely subjective. He does not note the irony that this was precisely the situation with Hilly Bosscher more than 30 years ago: there were alternative treatments available that she refused and her suffering was clearly unbearable to her.

The Victorian Parliamentary Committee suggested a framework for assisted suicide and euthanasia with certain qualifying criteria. They included:

– is at the end of their life (final weeks or months of life)– is suffering from a serious and incurable condition that is causing enduring and unbearable suffering that cannot be relieved in a manner the person deems tolerable (so similar to the Dutch Due Care criteria #2 & #3)

The Interim Report of the Victorian Ministerial Advisory Panel suggested the possibility that 'final weeks or months of life' could be determined formally as a prognosis of either 6 or 12 months to live. At no time has there been any suggestion that a person who 'qualifies' need to have first exhausted any reasonable treatment options. That stands to reason in as much as no-one can be forced to accept any treatment offered. But I wonder if the public sees it that way.

Chabot laments:

"Once upon a time, moving to a nursing home or receiving treatment with some medication was still considered a “reasonable alternative” for euthanasia. At least it had to be tried. Many doctors now accept that a patient can refuse a reasonable alternative and that this does not create a barrier for euthanasia. That brake has now also disappeared."

That description would seem to be the starting point in the proposed Victorian regime. Any thought in the mind of the public that a death by assisted suicide or euthanasia would be a 'last resort' option only, cannot be sustained.

The same applies to the role of the psychiatrist. Chabot is concerned that in a majority of the notified cases of euthanasia for psychiatric reasons were 'executed' by the Dutch End-of-Life Clinic:

"What happens to doctors for whom a deadly injection becomes a monthly routine? They are surely well-intended, but do they also realize how they are fanning a smoldering fire that can become a blaze because they fuel the death wish of vulnerable people who are still trying to live with their disabilities? 

"The End of Life Clinic is now actively recruiting psychiatrists. It justifies this by pointing to the long waiting list. Their task: relieving the unbearable and unrelievable suffering from psychiatric patients through euthanasia. Every time the Clinic is in the news, a wave of depressed patients whose treatments are allegedly exhausted but many of whom have never been properly treated report to the Clinic. Ever since budget cuts turned chronic psychiatry into a diagnosis-prescription business, good treatment has become scarce. 

"The newly recruited psychiatrists won’t need to enter into a treatment relation with the patient. The evaluation committee has accepted that in the case of severe physical illnesses. Now it has also applied this to incurable brain diseases—without discussing it with members of the psychiatric profession by the way."

Will the same be said of the Victorian regime? Will the role of psychiatry be reduced to a 'diagnosis-prescription' type business where the therapeutic role of the profession is ignored or, at least, only given lip service?

That was precisely what occurred during the time that euthanasia was legal in the Northern Territory in the mid-1990s. The Lancet report on the four deaths that occurred under the short-lived regime showed scant regard for the law and the role of the psychiatrist was seen as just another hoop to jump through or tick on a list of checkboxes.

The Victoria Branch of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) noted similar concerns in their submission to the Victorian Ministerial Advisory Panel:

"The VIC Branch also notes that, due to the often rapidly changing manifestations of mental illness, proper assessments are best undertaken by clinicians with the benefit of extended interactions over a significant period of time with the individual in question. As such, the views of psychiatrists and/or other mental health professionals with established therapeutic relationships with individuals seeking voluntary assisted dying (sic) should be sought wherever possible."

Yet the thrust in terms of the law proposed for Victoria seems likely to only require a psychiatric evaluation for the sake of concerns about capacity and not necessarily about suicidal ideation or the presence of psychiatric illness (though that may be implied). Moreover, as the RANZCP report also notes, there remains a significant risk that the treating doctor and the second confirming doctor may miss signs of psychiatric concern:

"In situations where a patient has a terminal condition causing enduring and unbearable suffering, there is a risk that symptoms of mental ill health may be mistaken by a doctor not trained in psychiatry for an 'understandable' reaction to their condition. Furthermore, traumatic brain injury, addiction issues, dementia and delirium may all confound assessments of capacity and non-psychiatrically trained doctors 'are not well placed to recognise the presence of these conditions in the medically ill population'."

This raises serious questions about the mechanism that supposedly 'protects' people who are vulnerable. If neither of the two assessing doctors suspect a psychiatric issue, nothing more is done.

Will the final recommendation due to be made to Premier Daniel Andrews at the end of July include a requirement that a psychiatric evaluation takes place in a therapeutic context? This would imply a relationship over time that seeks a remedy to the presenting psychiatric issues. But time may well be short. Or will this all fall back on self-determination, as it did in the Chabot case, and an acceptance that, even though the patient may have therapeutic options available - both psychiatric and medical - that refusal of any or all treatment is a fast track to suicide?

"In psychiatry, an essential limitation disappeared when the existence of a treatment relationship was no longer required." Chabot.

The outcome is grave and irreversible. The Andrews government has been talking into an echo chamber, yet most Victorians will likely be unaware of the proposal and even less aware of how any proposed law might operate. The idea that assisted suicide and euthanasia are a 'last-resort-only' option; that people would need to at least try 'reasonable' options, has never really been the case yet is likely to be the general public view.

With thanks to Professor Trudo Lemmens for the English translation of the recent Chabot article.

Elder abuse is a clear and present danger in the euthanasia debate.

This article was published by Mercatornet on June 15, 2017.

Paul Russell

By Paul Russell - the director of HOPE Australia

June 15 is World Elder Abuse Awareness Day. Timed to coincide with this international day, the Australian Law Reform Commission has released its final report into a long-running inquiry on Elder Abuse and the Law.

Running to 432 pages, the report takes a comprehensive look at the legal landscape across Australia and argues for a comprehensive nation-wide approach to tackling Elder Abuse. While looking mainly at the law, it also looks at abuse in Aged Care settings and argues for an overhaul of staffing, staff training, recruitment and mandatory reporting type structures to protect people.

The report also looks at training for lawyers and medical professionals.

What is elder abuse?

The World Health Organisation describes Elder Abuse as: ‘a single, or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person’

It is recognized to 'take various forms, such as physical abuse, psychological or emotional abuse, financial abuse, sexual abuse, and neglect. The World Health Organization has estimated that the prevalence rate of elder abuse in high-or middle-income countries ranges from 2% to 14% of people usually defined as 'over the age of 60 or 65 years'.

The WHO also noted that research in other predominantly high-income countries has found ‘wide variation in rates of abuse in the preceding 12 months among adults aged over 60 years, ranging from 0.8% in Spain and 2.6% in the United Kingdom to upwards of 18% in Israel, 23.8% in Austria and 32% in Belgium’.

Whether there is a connection between the extremely high rate of Elder Abuse in Belgium and the existence of their euthanasia regime can only be guessed at, though intuitively one could easily develop a 'best guess' argument based on culture alone.

The report notes that 'vulnerability' to such abuse is not necessarily related to the age of the person. However, the effects of aging, broadly understood, can make our elders vulnerable to such abuse. There is also a connection to disability as noted in the report:

"While older people should not be considered vulnerable merely because of their age, some factors commonly associated with age can make certain older people more vulnerable to abuse. Disability, for example, is more common among older people. More than 80% of people aged 85 years or over have some disability. While fewer than one in 20 Australians under 55 years have ‘severe or profound core activity limitations’, almost one-third of people aged 75 years or over have such limitations." The authors go on to add: "Vulnerability does not only stem from intrinsic factors such as health, but also from social or structural factors, like isolation and community attitudes such as ageism. All of these factors contribute to elder abuse."

We have discussed ageism before in terms of the dominant meme that elderly people are 'burdens'. Similar observations can be made in respect to 'ableism' and disability.

By way of explanation - a simple anecdote:

Dr. Kevin Fitzpatrick OBE and I shared a podium in Ireland a few years ago. Kevin became a paraplegic after an incident 40 years previous. He asked the audience to imagine that he and I separately visit our doctor; both of us displaying suicidal tendencies. Kevin observed that, in my case, I would be offered all sorts of support and interventions under suicide prevention strategies. In his case (as had been his experience) he said that the doctor would say that they understood why he wanted to kill himself because he had such a difficult life.

As Liz Carr recently observed, treating each of us differently based on disability is scary in terms of assisted suicide and euthanasia and is one of the reasons why many people living with disability do not want such laws. They already experience discrimination in medical care and recognise the potential that such discrimination will also be present in discussions on this subject.

Orwellian Bill due to be introduced in New South Wales Australia in August preceded by 'group think'

This article was published on the HOPE Australia website on June 12, 2017.

Paul Russell

By Paul Russell, the director of HOPE Australia.

A draft bill is currently being circulated for comment and consultation in New South Wales. A consultation is being conducted by the 'NSW Parliamentary Working Group on Assisted Dying'. Although this sounds rather official, essentially the members of this group are simply a common interest group of MPs within the parliament.

Not only is this 'working group' not an official organ of the parliament, the consultation itself holds no official status either. You've probably guessed; the members who will oversee the consultation are also the members of the working group!

Like the Ministerial Advisory Panel in Victoria, submissions will be kept in confidence and not published and there will be no consultations with the public; only community information sessions.

So, good people of New South Wales! Do you think, after all of this takes place, that you'll feel like you've been consulted; that those charged with the grave task of chin rubbing, head scratching and deliberating over clauses in the bill will have taken an objective and hard-headed look at the draft? Will the bill be the most comprehensive and safe ever?

If you think that - then I've a bridge you might want to buy!

No, this is just another long-winded attempt to buy the public confidence on an issue that they (the public) are decidedly uncomfortable about.

And what of this 'draft' bill? No point wasting ink on analysing clauses at the moment; that can wait until the bill is tabled in parliament. Apart from the novel lower age limitation of 25 years, it looks most like almost any other bill we've seen over the last decade and more. This despite the parliamentary group claiming to have 'consulted extensively since 2015 with key stakeholder organisations and parliamentarians in NSW on the Bill'. But, maybe they did consult and maybe there are simply just very few ways of couching doctor killing and assisting in suicide in legal terms.

But just for once I'd like to see a bill that used the proper terminology. Not here. 'Assisted Dying' is the latest 'group think' catch phrase. And even though the bill describes both euthanasia and assisted suicide, apparently 'assisted dying' is not the same as euthanasia and assisted suicide simply doesn't rate a mention. From their 'Overview' statement:

"Patients may self-administer, or be assisted by their medical practitioners or a nominated person to administer, a lethal substance (as prescribed by regulations) to end their lives, after having gone through the required process outlined in the Bill." 

And then this gem: "The Voluntary Assisted Dying Bill 2017 (NSW) is a Bill that provides for physician-assisted dying, not voluntary euthanasia." 

"Physician-assisted dying involves a medical practitioner making a substance available to an eligible patient (after having gone through a process) which the patient then uses to end their lives at a time and place of their choosing. [ed. assisted suicide: assistance to self-administer] The patient is in control at all stages of the process. Whereas voluntary euthanasia involves, in all cases, a medical practitioner carrying out a patient’s request to end their life up until the point of death." [ed. euthanasia: administration by a third party as in 'assisted by their medical practitioners or a nominated person to administer'].

This really is despicable. It's one thing to develop talking points for a bill. At a stretch one might want to concede that there may be some legitimacy to a consultation that is not consultative and where the inputs (submissions) will not be able to be perused against the outputs (the final bill). But hiding the essence of the program in saccharine sweet euphemisms and then denying any relationship at all to the actual outcome is contemptuous of the New South Wales Parliament and the good people of that state.

Perhaps I shouldn't be too harsh given that Victoria is holding to precisely the same line with the endorsement of the Premier and Health Minister and Tasmania and South Australia saw similar levels of subterfuge in recent bills. It is as if there's some kind of new orthodoxy that demands slavish adherence; where the truth itself is a heresy.

Last time the New South Wales Parliament devoted time to assisted suicide and euthanasia the bill failed at second reading in the Upper House by a vote of 23 to 13 in 2013. There have been a number of changes in the Legislative Council since then, creating some uncertainty about the possible outcome of this bill, should it be debated.

Euthanasia: Truth is the first casualty

This article was written by Paul Russell and published on the HOPE website on May 18. 

Paul Russell

By Paul Russell

Euphemisms have consequences.

The Victorian Ministerial Advisory Panel charged by Premier Daniel Andrews with the task of developing a safe way to kill people and to help them to suicide, released its interim report yesterday.

Set up in December last year the 'expert panel' has conducted state-wide hearings and accepted submissions on precisely how to make a safe law.

The Panel's introductory discussion paper made it perfectly clear that their job was not to consider the ethical/moral concerns: "The purpose of this consultation is to ensure that parliament may debate the merits of voluntary assisted dying through well-informed and workable legislation."

How that outcome could be considered as 'values-neutral' is beyond comprehension. Any proposition that has supposedly been vetted and designed through what I am sure will be described as a 'lengthy and thorough process' would seem to have the 'tick of approval'. The 'merit' is loaded into the outcome as Health Minister, Jill Hennessy confirmed today:

“We have the very best medical and legal experts working on this to make sure that when the time comes, everyone in the Victorian parliament has the information, and assurances they need to make an informed decision about this important issue.”

In the 64 pages and in 29,143 words, the interim report uses the word euthanasia only once - and that in a quotation from a submission. Assisted Suicide is mentioned three times - again, only from quotations and suicide (separately); well, that's where matters become more interesting again.

"Some denominational submissions suggested it should not be called ‘voluntary assisted dying’ because it would obscure the role of medical practitioners in aiding suicide."

Why the mention of 'denominational'? In all of the quotes from various submissions and testimony, no mention is made about the name of the individual or organisation (given only a number), what is it about this reference that requires an identifier? It is difficult to come to any other conclusion than to observe that by the use of 'denominational' the report seeks to dismiss the concerns as being a 'religious objection' only.

The very next sentence amplifies the subterfuge:

"An alternative view was expressed that the language of suicide should not be conflated with voluntary assisted dying because of the person’s proximity to death due to illness."

Who expressed that view? Suicide is suicide; no amount of qualification changes that. But here's where the euphemism becomes really useful: Read the quote again and substitute 'suicide' for 'voluntary assisted dying' and the reasons for its use become clear. This is double-speak.

If any more proof was needed, the next occasion that the 'S' word appears is in the context of a discussion about record keeping and monitoring:

"It was noted that if information about those whose request was denied was linked to other data such as suicides, it would provide a greater understanding of how the framework was operating."

So, if a person gets access to the law, then it's 'voluntary assisted dying'; if they fail to qualify for some reason and end their life by other means it can be called suicide. The premise here, of course, is that 'assisted dying' will reduce the incidence of other forms of suicide. This has proven not to be the case in Oregon and any expectation that it might be the case in Victoria is supposition at best.

There's more! In a discussion about legal liability it is noted that, 'acting outside the proposed legislation, such as aiding and abetting suicide, would still be a criminal offence.'

Indeed. The death might be by precisely the same method under precisely the same conditions - even with full consent - yet if one condition identified in the law is not met, then it is assisted suicide! You couldn't make this stuff up!

But the final mention of 'suicide' is really where obfuscation and euphemisms are so blatantly evident:

"Life insurance 

"The impact of the listed cause of death on insurance eligibility was also highlighted in forums and submissions. It was noted that there should be no loss of insurance benefits as a result of exclusion clauses for suicide. This was one of the reasons many considered that voluntary assisted dying should not be listed on a death certificate. Others were of the view that it was clearly the underlying terminal illness or disease that was the cause of death so there should be no issues with insurance."

Like many other bills we've seen in Australia, this proposition would legislate further obfuscation and would make liars out of doctors by forcing them to falsify the cause of death. Insurance industry bodies have railed against this kind of inclusion previously and for good reason. They raised the same concerns in The Australian today. It opens up the possibility of someone signing up for a life insurance policy only months before their suicide for the benefit of their estate with a minimum of paid premiums. Think of the possibilities of 'inheritance impatience', otherwise known as Elder Abuse.

Further obfuscation came via Victorian Greens MLC, Colleen Hartland in the same article:

“It is the issue around ­insurance, and the reality is that the cancer or the neurological disease is what killed them, they have just allowed to die a bit ­earlier,” she said.

What kind of policy outcome are Victorians likely to gain from all of this if their elected representatives and appointed officials can't get past the fabricated expressions of the death dealing lobby?

Buddha is often quoted as having said that, "Three things cannot be long hidden: the sun, the moon and the truth." He never visited Victoria.

The final report is said to be due at the end of July.

Victoria Australia: Extending euthanasia, even before the bill is written.

This article was published by HOPE Australia on their website on May 5, 2017.

Paul Russell

By Paul Russell

Anyone looking at the experience in Canada since euthanasia and assisted suicide laws came into force last year, should be struck by the moves to extend the law so soon after they had been passed. After all, when you look to Belgium and Holland and even Oregon USA, the moves to expand their laws and/or the application of their laws has taken some time to develop.

There are many reasons why the European and Oregon situations have taken time to see the various incremental legal and effective interpretational changes gather momentum. In Belgium and Holland the statutes were written in very broad terms relating to unbearable and irretrievable suffering. While the understanding at the time of their debates focussed on euthanasia as a 'last resort' option for people in the last stages of a terminal illness, the wording never restricted application in that way.

In the last five years and more there has been a continual pushing at the edges of the community understanding of the breadth of the law. Euthanasia for tinnitus, for blindness, for psychological suffering, for the accrual of minor complaints associated with old age, for fear of entering a nursing home - all unthinkable in the beginning. Add to that the 2013 statute amendment to include children in Belgium and the current discussion in Holland in respect to assisted suicide for people over 70 years of age who are simply 'tired of life', and one can legitimately wonder where it will all stop.

As Dutch journalist, Gerbert van Loenen once observed:

“Making euthanasia and physician-assisted suicide legal started a development we did not foresee. The old limit ‘thou shalt not kill’ was abandoned, a new limit is yet to be found.”

Canada seems bent on catching up with the Benelux countries at some pace.

In Victoria, Australia, there also seems to be something of a rush.

A Ministerial Advisory Panel charged with the role of consulting about how to make assisted suicide safe, is due to provide an interim report to Premier Daniel Andrews any day now. The final report is due in July and legislation is slated for the second half of this year.

The Panel's reference was the Legal and Social Issues Committee of the Victorian Parliament report in the matter of the 'Inquiry into End of Life Choices' that was finalised in mid-2016.

Recommendation 49 of that report called upon the Victorian Parliament to legislate assisted suicide for people, “suffering from a serious and incurable condition which is causing enduring and unbearable suffering” and that these persons must be “at the end of life (final weeks or months of life)”.

So, not necessarily but most likely a terminal illness but still only for those at the very end or, as the Dutch talked about: a 'last resort' option.

Politically this makes sense. The game, if I can call it that, is to gain 50% plus one support in the two chambers of parliament. The logic is, of course, that it is the first hurdle that is the hardest. Better to get something on the statute books rather than risking yet another loss from trying for too much.

In September last year, Victorian Health Minister, Jill Hennessy warned pro-euthanasia advocates not to be too greedy:

“Politicians need to ask themselves: is it about being pure or is it about saying ‘let’s get the best result we can’?”

This warning did not stop Victorian euthanasia supporter, Dr Rodney Syme from entering the debate immediately arguing for an expansion of eligibility to include "neurological failure, such as multiple sclerosis, motor neurone disease and Parkinson's disease, who have progressive diseases, and those with profound stroke or high quadriplegia who have a static condition, may have an ill-defined trajectory to death, and while suffering unbearably, may be discriminated against by narrow legislation." It is precisely the same sort of argument that could (and will) be made for a later amendment if Syme does not get his way. Think about that.

Indeed, everyone knows that later extension is a possibility via an amendment bill. Euthanasia for children was originally considered for the first Belgian debate. Trudo Lemmens relates that, ‘children were explicitly excluded from the ambit of the original law because “it was deemed so controversial that including it may have threatened approval of the Euthanasia Bill.”’

Back in Victoria, there have been a few 'leaks' about the possible direction the Panel's report might take. One article pointed to a plan not to provide effective conscience protections for doctors.

Today we are told that the Panel will recommend a prognisis-based qualifier:

But the advisory panel wants to extend the timeline and the government is believed to be considering three options: 24 months, 12 months or six months.

It is mere speculation on my part, but it would seem that this kind of qualifier might be a compromise position between the Parliamentary Inquiry's recommendation and the agitation of the likes of Syme. Either way, it is much broader than the original “at the end of life (final weeks or months of life)”.

This leaves many questions unanswered: Does this call into question the judgement of the members of the Parliamentary Committee? Is it now considered that the Victorian public are open to this kind of extension where those who submitted to the Parliamentary Inquiry were clearly not? Will the members of the Parliamentary Committee rebuke the Panel for their extension?

Lack of answers aside, the idea of incremental extension is now out in the open for all to see. No Victorian MP can ignore it. They now need to question, not whether the model presented satisfies their judgement on a set of limits, but that their vote in support of any framework will most certainly provide precursory endorsement and impetus to later extension.

Dutch Health Minister, Edith Schippers, speaking enthusiastically about euthanasia recently, confirmed: "One thing is certain: on euthanasia and assisted suicide, we will never be finished."

The Panel's interim report is likely to be made public in the next few weeks.

The Dutch concern with international scrutiny of euthanasia law.

Paul Russell published this article on the Hope Australia website on April 25 under the title: The Dutch Mouse that Roared.

Paul Russell

Paul Russell, the Director of Hope Australia.

Public challenges to the zeitgeist on euthanasia are rare in the Netherlands. The practice of deliberately killing patients in Holland has a long history reaching back more than thirty years. The Dutch, like their Belgian neighbours, have grown used to the idea. Promotion of the practice through sympathetic propaganda on prime time television and even a euthanasia film festival a few years ago have served the agenda to normalise the practice.

This has lead some commentators to suggest that everything is going just fine and dandy in the Low Countries, supposing that the cultural acceptance of euthanasia is a sign that the practice is entirely under control. The lack of political opposition has been cited by the likes of Peter Singer in an attempt to confirm this. This is thinking in a bubble: it ignores the realities that what is legal becomes broadly accepted as being moral and that repeal or reform is incredibly difficult in such circumstances.

But opposition does exist and has always existed. Principally held by disenfranchised voices, there is nevertheless significant disquiet in many quarters; exemplified by the public declarations of people like Professor Theo Boer who once supported the Dutch law but has changed his mind under close observation of developments in recent years.

One would think that, in such circumstances and in a society noted for its tolerance, that the occasional roar of a mouse against the zeitgeist would be simply noted and then largely ignored. Not so if the recent declarations by the Reformed Political Party (SGP) at their annual convention are anything to go by.

The SGP is Holland's oldest political party. Confessionally Calvinist, they have been a consistent yet very small player in the Dutch Parliament currently holding three seats in the Dutch House of Representatives (out of 150) and being one of thirteen parties in that chamber.

At their national convention this week in Hoevelaken, party leader, Kees van der Staaij, took the SGP's longstanding opposition to Dutch Euthanasia Laws to a new level. Van der Staaij wants to fuel the international concern about Dutch euthanasia through the production of an English language documentary on Dutch euthanasia practice so as to engage the international anglophone media.

"Van der Staaij says people are shocked abroad when he says that it is used in the Netherlands (for) euthanasia on people with mental illness and dementia. He also claims that this happens "without being able to explain at the time that they really want, and without a court is involved." (see, for example, the recent Dutch nursing home dementia case)

The Dutch Euthanasia organisation NVVE are not amused. But instead of ignoring the SGP commentary - as would any rational organisation confident of its position and confident that such a call would simply fade into obscurity - the NVVE and others have fought back in the media. Is there something to hide here? Is the NVVE cultural reign on shaky ground?

The NVVE railed against the SGP in the Dutch media claiming that they are putting Dutch euthanasia policy in a 'deliberately bad light'. Full marks there. Spokesperson, Dick Bosscher cited support from 'sister' organisations around the globe to somehow claim that the international opinion of the Dutch death regime is somehow positive.

Another commentator, Rik de Jong, claimed that van der Staaij had 'crossed a line' by seeking to expose the Dutch regime internationally. Somehow, according to de Jong, it is acceptable for the SGP to hold a Christian perspective on the issue and to make a 'constructive contribution' to debate; but clearly not to rattle the cage internationally: keep 'the opinion of foreign conservatives outside'!

So what's the problem? If everything is above board, if there are no problems, if there are no abuses, surely there is a robust defence of the Dutch euthanasia laws from within the polity and the public that can stand such scrutiny?

Maybe not!

• Netherlands 2016 euthanasia deaths increased by 10% again.
• Netherlands review committee says that forced euthanasia of woman with dementia was done in "good faith".

Nitschke encouraged Adam Maier-Clayton suicide.

This article was originally published by Hope Australia on April 22, 2017.

Paul Russell

By Paul Russell

Anyone who has ever sat on an awards committee knows well that there are standards to be met. Make the award too easy to attain or provide it to someone who has not met the criteria and the currency of the award is diminished. Raise the bar too high and no-one applies.

At Exit International they must have ridiculously low standards. Exit boss and former medical doctor, Philip Nitschke recently awarded his so-called 'Peaceful Pill Prize' to an elderly Australian couple essentially because the woman concerned recently cried a patronising 'bullshit' at Professor Margaret Somerville on an Australian National current affairs program.

Nitschke claimed that Mr & Mrs Fellows' comments were 'forthright' and 'a significant contribution to the Australian Euthanasia debate'. Crass and undignified more like it!

There was a time when everyone understood that to raise one's voice or to swear in the context of a debate was to lose the argument. Maybe not so much nowadays; after all, the show's presenter, Tony Jones said that the 'bullshit' comment was 'refreshing' which seemed to me, at the time, to be a ringing endorsement of Mrs Fellows' sentiment.

Nitschke's endowment upon the Fellows', it seems, was no accident either. He admits that the couple are members of his Exit organisation and exemplars, one suspects, of Exit's new militant wing, Exit Action. Is it just me or does anyone else reason that Exit is synonymous with militancy; so why the need for tautology? If the Fellows' have set the standard perhaps we can expect more of this revolting behaviour as other card-carrying Nitschke-ites vie for the same prize.

So, what do the Fellow's gain for their inglorious moment? Steak Knives? Champaign perhaps? No. 'Two redeemable vouchers for 12mg packages of pure sodium pentobarbital (nembutal).' I suppose an alternative might have been a lifetime membership, but I digress.

The award ceremony will surely raise the interest of Border Protection & Customs Police. But, of course, Nitschke's not stupid: "As possession of this drug in Australia is illegal, the details of the delivery of the prize will be kept confidential. Delivery will be by unconventional means" said Nitschke. He added that the prize would amount to a 'safety net' for the Fellows - how bizzarre.

The Fellows, by their own admission are not unwell but simply don't want to live in a nursing facility in their decrepitude. None of us does, really, let's be honest. That's an issue that many of us will face; but few, I suspect would want to try to foister upon society a euthanasia regime with all its attendant and irretrievable risks simply for the sake of getting our own way. That's tyranny clothed as autonomy.

The Fellows may not have thought that through. Maybe they are unaware of the trail of grief created by Nitschke's 'collateral damage' in the deaths of young people via Exit methods; young men like Lucas Taylor, for example.

But people who are used to getting their own way don't necessarily consider much else in the drive for autonomy. The well, well-off but worried have a very blinkered view re-enforced by the Nitschke mantra of rationality.

Such was the assurance given by Exit's youngest member-now-statistic, Adam Maier-Clayton who died by suicide recently in Canada. 27 year old Maier-Clayton had some significant mental health issues yet claimed to be entirely 'rational'.

According to one report, he suffered anxiety, mood disorder and obsessive compulsive disorder and tried all sorts of remedies and relief to no avail; difficulties that should not be discounted. He spent the last few months campaigning for the inclusion of mental illness within the scope of Canada's new death legislation, arguing that it is not only those who are near death suffer refractory symptoms.

In January he posted a picture of himself wearing an Exit T Shirt with an image of Nitschke emblazened across it, saying that he was, 'rocking his Exit International Official membership' adding that he felt that he was 'absurdly rational' and should not be excluded from Canada's death laws.

Notwithstanding Mrs Fellows' expletive, just because someone can engage in a process of thought does not necessarily make them truly rational. It is not necessarily thought processes that suffer through depression, unremitting pain and the like; it is, in my own experience, the connection with others that diminishes - the threads that bind us to each other. In other words, the context of one's life can seem strangely distant. Blurred by pain, remove the context of care, of family of future from the equation and thought - even seemingly rational thoughts - and logic becomes an untrustworth guide.

So explained columnist, Andrew Lawton recently in the Canadian Global News:

"This idea that suicide is dignified and painless is a dangerous one. Take it from someone who tried and failed. 

"Nearly seven years ago I overdosed on dozens of pills — causing multiple cardiac arrests and weeks in hospital on life support. 

"I survived, but only narrowly so. 

"Everything from the method to the date and time was meticulously thought out. 

"I picked the day because I didn’t have any other appointments scheduled — as though missing a meeting would have been the only problem with my plan any other day. 

"Suicidal people are irrational. This is true even when decisions appear to be made through logic and reason. 

"I saw suicide as the answer to pain I was convinced wouldn’t abate. 

"It wasn’t just about picking the easy way out of an unpleasant situation — it was the only way. I saw no way my life would improve. 

"Spoiler alert: it did. 

"Like Maier-Clayton, I had tried myriad therapies, medications, and treatment throughout my years-long battle with depression. By the time I tried to pull the plug on my own existence, none had made an impact. 

"But after the attempt, that changed. Healing didn’t happen overnight, but things that hadn’t worked previously showed positive results. 

"My circumstances didn’t change, but my outlook did."

It must surely be amongst the very last things that a society would want to have to someone like Nitschke telling suicidal people that their desire for death is 'rational'. It's an endorsement. Like euthanasia & assisted suicide, it runs counter to suicide prevention.

Likewise, telling those who understandably fear their demise that they have a 'way out', that, effectively, they don't need to address their fears nor find a path through them to a fulfilling life inspite of them, is reckless.

But these are precisely the messages that euthanasia and assisted suicide laws send - with the added weight of government approval. We need to learn not to reward bad behaviours and bad ideas.

Dutch nursing home death – more excuses, more killing

This article was originally published on January 29, 2017 on the HOPE Australia website.

Paul Russell

By Paul Russell, the director of HOPE Australia.

Once you create a situation at law where killing of another person is allowed in certain circumstances, not only will the circumstances in which such killing is endorsed or allowed change over time, but the boundaries, however originally drawn, will be entirely ineffective in providing moral, legal and ethical guidance and restraint.

In Belgium and The Netherlands in the thousands of euthanasia deaths since their laws came into being in 2002 few cases have ever been referred by the review systems to justice for further scrutiny. In Belgium that number is one; one case only. …

According to a multiplicity of reports, an un-named woman–an octogenarian living in a nursing home and experiencing dementia– was euthanized against her will. She had made a comment in her advanced directive that she would like euthanasia “when I myself find it the right time.”

The woman had been a resident in the nursing home for only seven weeks. During that time she was noted as being ‘frightened and angry’ wandering the halls of the facility at night and missing her family. This, the nursing home doctor concluded, meant that she was suffering unbearably. She assessed that the woman was no longer mentally competent and accepted that the written declaration she had made earlier in her advanced directive was an acceptable request for euthanasia.

The Dutch Law allows for a request for euthanasia in an advanced directive to be acted upon after the satisfaction of all the other qualifying criteria. The law considers such a written statement as a ‘well considered request for euthanasia’. How it can be known for certain that, at the time the request was written down, that the person understood fully the nature of their request is never explained.

Compounding the problem, the woman’s expression of intent in her directive was not clear and should not have been accepted as an advance request according to the Dutch Euthanasia Commission. She had written, concerning euthanasia, that she wanted it, “when I myself find it the right time.” At the very least, this expression suggests that the woman wanted to approach the matter when she thought it was appropriate, implying that her own capacity to make a contemporary decision was important to her. Paradoxically, the doctor’s determination that capacity had been lost should have rendered her statement null.

Various media reports point out that the woman was provided with a sedative in her coffee ‘to calm the woman down’. She was unaware that the sedative had been provided. The Trouw newspaper’s editorial discussed the issue of the provision of a pre-euthanasia sedative without the person’s knowledge, pointing to a recent case where a similar sedative was provided without consent in a bowl of apple sauce. They note that the Dutch Euthanasia Review Commission rightly considers such behavior as ‘deceptive’.

The Trouw editor concluded that the problem was really that the coffee-carried dose was too low. Why? Because the woman resisted when later the doctor moved to apply the lethal dose via syringe. The NLTimes described it this way:

‘But when the infusion was inserted she “pulled back”, and while the doctor injected the euthanasia agent, she moved as if to get up. The doctor decided to continue while family members held the patient down. The woman died shortly afterwards.’

According to the UK Mirror, this story came to light via a report prepared by a Dutch Coroner for review by the Dutch Euthanasia Regional Review Committee. The Mirror says that the woman had said clearly several times “I don’t want to die” in the days before her death.

The Euthanasia Review Committee is charged with reviewing the file and making a recommendation that would need to be endorsed by a second review committee.

The Mirror concludes:

“The committee concluded though the doctor had acted in good faith, she should have stopped when the patient resisted. 

“Committee spokesman Jacob Kohnstamm added he was in favour of the case going to court: “Not to punish the doctor, but to get judicial clarity over what powers a doctor has when it comes to the euthanasia of patients suffering from severe dementia.” 

“The committee’s recommendations are now reportedly being considered by prosecutors and health officials.” …

Euthanasia or assisted suicide laws create an exception to the laws prohibiting homicide if certain criteria are observed. They were not observed in these cases, therefore the exception should not be applied. In Holland it would seem that ‘good faith’ is enough to be let off with a little less than a slap on the wrist. But deciding what is and is not an act in ‘good faith’ is a tricky business. A wrongful death – even in ‘good faith’ is still a homicide and not simply a misdemeanor.

It may be that this situation is being used deliberately to further the current debate on euthanasia and dementia and euthanasia and ‘tired of life’. It may be that the doctor was lax in her application to the paperwork; a simple mistake. But it just may be about a death outside of the confines set by the parliament – deliberately or otherwise – a homicide.

Whatever the outcome, what is abundantly clear is that once we create legal excuses for killing there will be more excuses and more killing.

• Netherlands euthanasia review committee says euthanasia without consent on woman with dementia was done in 'good faith.'