EPC-USA's Broad Coalition Participated in the American Academy of Family Physicians conference.

Colleen E. Barry

The cost to attend medical conferences is prohibitive. Consider donating to the EPC - USA (Donation Link).

The American Academy of Family Physicians (AAFP) FUTURE conference held from July 31 - August 2 in brought together medical students and residents from across the nation with family medicine leaders, residency programs and potential employers for three days of family medicine exploration + celebration." Event. Euthanasia Prevention Coalition (EPC) - USA had an Honor and opportunity to participate in the "AAFPFUTURE" Conference. 

Part of EPC-USAs' goals are to educate the public along with professionals on issues related to euthanasia, assisted suicide and their effect on society. We provided educational materials, discussions. Assisted Suicide is fundamentally incompatible with the physician’s role as healer. EPC-USA recognizes that Doctors are the original opponents of assisted suicide.

EPC-USA was grateful with the many discussions as well as a great amount of basic information given to participants, including resources and follow up material from Dr. Sharon Quick, President of "Physicians for Compassionate Care educational Foundation". Dr. Quick has expressed that: 

“A death request is often a plea for help, but legalizing assisted suicide may allow an option to die to transform into a duty to die.”

EPC-USA was able to educate Medical Students and a broad coalition of doctors, medical professionals and attorneys about people who have experienced the direct threat of assisted suicide against themselves or a family member. EPC-USA shared the history of Disability groups such as Not Dead Yet, Second Thoughts and DREDF (Disability Rights Education & Defense Fund), just to name a few who have been at the fore front to stop assisted suicide. 

A monumental past leader of DREDF, Marilyn Golden stated: 

“If these bills pass, some people’s lives will be ended without their consent, through mistakes and abuse.” “No safeguards have ever been enacted or proposed that can prevent this outcome, which can never be undone.”

EPC-USA was able too share the many successes when state coalitions encompassing a broad variety of individuals and groups led their state legislators to understand their concern and opposition to assisted suicide. 

One of EPC-USA’s missions is to combat the growing acceptance of assisted suicide through advocacy and education. The broad variety of individuals and groups includes progressive's as well as conservatives, includes a disability and human justice-based movement to prevent the legalization of assisted suicide and euthanasia and to end these practices where they exist. Assisted suicide cuts to the heart of what kind of society we want to live in.

Discussions with conference participants included physicians explaining that their care of patients, must establish a physician-patient relationship based on mutual trust and respect to be able to render the best care to their patients. Not assisted suicide. 

Many Medical students and residents were very appreciative to see EPC-USA's booth and expressed the concerns that they have with assisted suicide. These medical students expressed their goal of caring for many patients throughout their lives, extending through to their last days of life.

There were residents, medical students and physicians that were surprised to see our booth and expressed confusion. It was a great opportunity for EPC-USA to share basic information, discussion and provide resources from others doctors that have actively taken a stand to help society realize the problems with assisted suicide. These doctors explain that assisted suicide is Not a Therapy or a Solution.

EPC-USA professionals in attendance were so successful that we ran out of educational material and resources including a the story of a doctor working with a patient that qualified for assisted suicide. The doctor knew that the patient was caught up in the hype of the newly passed assisted suicide law in Oregon and was depressed by a new prognosis. The doctor guided the patient out of out the depression. The patient is still alive and well today. EPC-USA also ran out of educational material on a list of coercion and complications cases that is provided by a disability rights group.

Assisted Suicide is not a type of medical treatment. And affects the nature of medical treatment in our society.

Our table at the American Academy of Family Physicians (AAFP) FUTURE conference was an incredible success.

The cost to attend medical conferences is prohibitive. Donate to the Euthanasia Prevention Coalition (EPC) - USA (Donation Link).

Colleen Barry is a nurse and the Chair of the Euthanasia Prevention Coalition (EPC) - USA

Physicians group urges New York Governor to veto assisted suicide bill.

Dear Governor Hochul,

My name is Dr Sharon Quick and I am President of Physicians for Compassionate Care Education Foundation (PCCEF), an organization without religious or political affiliation that advocates for the vulnerable at end of life. I have expertise in pediatric anesthesia, critical care, and medical ethics. We oppose A 136. Please veto this poorly constructed bill.

Summary: A 136, like other medically-assisted suicide laws, inevitably violates (rather than upholds) patient autonomy; creates (based on subjective, often inaccurate, criteria) a class of marginalized patients with the disability of terminal illness from whom the standard of medical care can be withheld; allows lethal drugs to unnecessarily substitute for good palliative care and pain control; disproportionately preys on those with mental health problems and disabilities; and destroys the foundation of medical ethics, creating distrust among patients and the health care profession. In addition, A 136 is the most radical policy in the country because it has no waiting period for obtaining lethal drugs. It also has no residency requirement which could turn New York into an international assisted suicide tourism destination for one-stop lethal drug prescriptions. Will New York citizens have to pay for funerals and/or transport of bodies back to their home states and countries? The bill makes no provision for the fact that out-of-state citizens or non-citizens may be pressured to take lethal drugs immediately and they are not required to make funeral and burial arrangements.

1. Pain should never be a reason to seek lethal drugs. Complaints of excessive symptoms indicate doctors lack palliative care knowledge, such as when to refer to pain management specialists. Lethal drugs should never be a solution for lack of education. In addition, those in significant pain lack capacity to consent for lethal drugs. Instead, improve palliative care access and expertise, which has been assessed as likely insufficient to meet the needs of New York.1 There is evidence that minorities, the uninsured, those on Medicaid, and those living in disadvantaged communities may encounter barriers to receiving palliative care.2 It would be a tragedy for these under served populations if this legislation made lethal prescriptions more accessible than palliative care.

2. This bill has no waiting period to obtain lethal drugs; no other law is so rash. Immediate death does not give adequate time for appropriate discussion and interventions for vulnerable patients who make rash decisions out of fear, depression, embarrassment, subtle pressure by a tired caregiver who makes them feel like a burden, or other reversible or transient concerns. Such patients often change their minds and no longer want to hasten death.

3. Physicians may be wrong about a patient’s prognosis, and they often miss depression and compromised decision-making capacity. Patients in WA and OR have died up to 5 years beyond their original “terminal” diagnosis and receipt of lethal drugs. Neither mental health status nor capacity are required to be assessed immediately before a patient ingests lethal drugs, which could be years after initial assessment; there is no guarantee that patients are not compromised at that time.

4. Lethal drugs are not a proportionate means of achieving palliative care goals but devalue vulnerable patients in a way that violates the very goals palliative care aims to achieve. Assisted suicide is abandonment, not health care, and is not part of palliative medicine. Lethal cocktails are bitter-tasting, sometimes mouth-burning liquids, and patients must ice their mouths with popsicles and take anti-emetics just to get them down. Risks include nausea, vomiting, aspiration, seizures, and not dying. Palliative care can do far better.

5. Lethal drug prescriptions undermine autonomy and discriminate against the disability community. Requests for lethal drugs are not primarily for pain but because of depression and/or psychological responses to disabilities developed during terminal illness--which is itself a disability by both social security and ADA criteria. This bill grants new choices and power to doctors, not patients, allowing them to treat patients unequally, subjectively placing them into either (1) a protected group (getting standard mental health care) or (2) a marginalized group with the disability of terminal illness (who can be abandoned to lethal drugs). This discriminates against the disability community and undermines autonomy by violating equality of persons. New York does not need a two-tiered health system that devalues those with the disability of terminal illness.

6. The slippery slope is real. Patients with depression and those with non-terminal diagnoses of anorexia, hernia, arthritis, and “medical complications” have received lethal drugs. Hundreds of doctors’ and patients’ consent forms are missing in Washington and Colorado.

a. In 2023, Oregonian Cody Sontag decided to avoid advanced dementia by killing herself via voluntarily stopping eating and drinking (called VSED). An Oregon doctor declared her “terminally ill” due to dehydration from VSED. He waived the waiting period, prescribed lethal drugs immediately, and Cody died from them.(3) Dehydration is not “incurable” or “irreversible,” as legally required. How many others with non-terminal diagnoses have used VSED to access lethal drugs? No one—least of all physicians whom the vulnerable must be able to trust—should be granted god-like powers to decide which disabilities make life worthless, prey on those who lack capacity, and assist with termination of those so judged.

7. There is no mechanism to enforce the law or detect abuse, which is perhaps why no sanctions have been reported. The design of this bill, like other assisted suicide laws, is a set-up for undetected elder abuse, coercion, or murder, given neither capacity re-evaluation nor the presence a neutral party are required when patients ingest lethal drugs (sometimes weeks, months, or years after initial evaluation).

8. Doctors often devalue those with disabilities. Protect the medical profession from acting on that bias by not granting them power to assist the suicides of patients disabled by terminal illness—especially a bill that has no more oversight than Oregon, where physicians are not disciplined for ending the lives of those with non-terminal illness (like Cody).

9. Protect the medical profession from distrust, both between patients and their doctors and among doctors. Patients in the northwest who are opposed to assisted suicide now have legitimate fears that doctors might overlook depression or compromised capacity, devalue them, and prescribe lethal drugs if they request hastened death while depressed or in a moment of vulnerable weakness. A death request is often a plea for help, and people often change their minds about hastening death with time, treatment, and support. Dr. Bentz lost trust in colleagues after referring a patient to an oncologist who, over Dr. Bentz’ objections, gave lethal drugs to his patient instead of treating his depression.

10. This bill contains potential conscience violations for physicians and health care employers:

a. Requires falsifying the death certificate, naming the underlying disease as the cause, rather than the actual cause of death—lethal drugs (p. 12, lines 12-14)

b. It is unclear whether an objecting health care employer can prohibit physician employees from providing information about lethal drug provision or referring patients for them, or whether objecting physicians could be forced to inform or refer for this process, both of which would violate their conscience for participation in an unethical practice that is not medical care.

11. Finally, participants do not need to be New York residents, which may allow persons out-of-state (or country) to obtain lethal drugs. These patients may not receive adequate evaluation, especially of capacity and lack of coercion, by New York physicians who may not know them well. Non-residents would be pressured to take the lethal drugs immediately in New York to avoid legal complications from ingestion in their home state/country, when many patients hold on to the drugs for weeks, months, and even years, and some never take them. New York may become an international assisted suicide tourism destination.

Please veto A 136. I am happy to answer any questions you may have.

Sincerely,
Sharon Quick, MD, MA (Bioethics)
President, Physicians for Compassionate Care Education Foundation (PCCEF)

P.O. Box 7122 Bonney Lake WA 98491 Tel: 253-501-7011 or info@pccef.org, www.pccef.org

1. CAPC. Palliative Care in New York. 2025. (Link)
2. Chambers B. How to Increase Awareness and Reduce Gaps in Palliative Care for MinoritiesJuly 9, 2020. (Link) (accessed 9-22-2024).
3. Pope TM, Brodoff L. Medical aid in dying to avoid late-stage dementia. Journal of the American Geriatrics Society 2024: 1-7. (Link).

Testimony of Dr Sharon Quick: In opposition to New York assisted suicide bill.

Testimony of Sharon Quick, MD, MA (Bioethics)

President, Physicians for Compassionate Care Education (PCCEF)

In opposition to New York A 136 June 8, 2024

I am President of Physicians for Compassionate Care Education Foundation (PCCEF), an organization without religious or political affiliation that advocates for the vulnerable at end of life. I have expertise in pediatric anesthesia, critical care, and medical ethics. We oppose A 136.

Summary: A 136, like other medically-assisted suicide laws, inevitably violates (rather than upholds) patient autonomy; creates (based on subjective, often inaccurate, criteria) a class of marginalized patients with the disability of terminal illness from whom the standard of medical care can be withheld; allows lethal drugs to unnecessarily substitute for good palliative care and pain control; disproportionately preys on those with mental health problems and disabilities; and destroys the foundation of medical ethics, creating distrust among patients and the health care profession. In addition, A 136 is the most radical policy in the country because it has no waiting period for obtaining lethal drugs.

1. Pain should never be a reason to seek lethal drugs. Complaints of excessive symptoms indicate doctors lack palliative care knowledge, such as when to refer to pain management specialists. Lethal drugs should never be a solution for lack of education. In addition, those in significant pain lack capacity to consent for lethal drugs. Instead, improve palliative care access and expertise, which has been assessed as likely insufficient to meet the needs of New York.(1) There is evidence that minorities, the uninsured, those on Medicaid, and those living in disadvantaged communities may encounter barriers to receiving palliative care.(2) It would be a tragedy for these under served populations if this legislation made lethal prescriptions more accessible than palliative care.

2. This bill has no waiting period to obtain lethal drugs; no other law is so rash. Immediate death does not give adequate time for appropriate discussion and interventions for vulnerable patients who make rash decisions out of fear, depression, embarrassment, subtle pressure by a tired caregiver who makes them feel like a burden, or other reversible or transient concerns. Such patients often change their minds and no longer want to hasten death. Terminal illness is highly associated with depression, and suicidal thinking is highest when cancer is first diagnosed and becomes less frequent as time goes on and patients get support.

3. Physicians may be wrong about a patient’s prognosis, and they often miss depression and compromised decision-making capacity. Patients in WA and OR have died up to 5 years beyond their original “terminal” diagnosis and receipt of lethal drugs. Neither mental health status nor capacity are required to be assessed immediately before a patient ingests lethal drugs, which could be years after initial assessment; there is no guarantee that patients are not compromised at that time. 

4. Lethal drugs are not a proportionate means of achieving palliative care goals but devalue vulnerable patients in a way that violates the very goals palliative care aims to achieve. Assisted suicide is abandonment, not health care, and is not part of palliative medicine. Lethal cocktails are bitter-tasting, sometimes mouth-burning liquids, and patients must ice their mouths with popsicles and take anti-emetics just to get them down. Risks include nausea, vomiting, aspiration, seizures, and not dying. Palliative care can do far better.

5. Lethal drug prescriptions undermine autonomy and discriminate against the disability community. Requests for lethal drugs are not primarily for pain but because of concerns of losing autonomy or abilities or feeling like a burden. These may be symptoms of depression and are usually psychological responses to disabilities developed during terminal illness--which is itself a disability by both social security and ADA criteria. This bill grants new choices and power to health practitioners, not patients, allowing them to treat patients unequally, subjectively placing them into either (1) a protected group (getting standard mental health care) or (2) a marginalized group with the disability of terminal illness (who can be abandoned to lethal drugs). This discriminates against the disability community and undermines autonomy by violating equality of persons. New York does not need a two-tiered health system that devalues those with the disability of terminal illness. 

6. The slippery slope is real. Patients with depression and those with non-terminal diagnoses of anorexia, hernia, arthritis, and “medical complications” have received lethal drugs. Hundreds of doctors’ and patients’ consent forms are missing in Washington and Colorado.

a. In 2023, a dementia diagnosis led Cody Sontag to voluntarily stopping eating and drinking (called VSED) to kill herself. An Oregon doctor said dehydration from VSED would soon cause death; he waived the waiting period, prescribed lethal drugs, and Cody died from them.(3) Dehydration is not “incurable” or “irreversible,” as legally required. How many others with non-terminal diagnoses have used VSED to access lethal drugs? No one—least of all physicians whom the vulnerable must be able to trust—should be granted god-like powers to decide which disabilities make life worthless, prey on those who lack capacity, and assist with termination of those so judged.

7. There is no mechanism to enforce the law or detect abuse, which is perhaps why no sanctions have been reported. The design of this bill, like other assisted suicide laws, is a set-up for undetected elder abuse, coercion, or murder, given neither capacity re-evaluation nor the presence a neutral party are required when patients ingest lethal drugs (sometimes weeks, months, or years after initial evaluation).

8. Doctors often devalue those with disabilities. Protect the medical profession from acting on that bias by not granting them power to assist the suicides of patients disabled by terminal illness—especially a law with so little oversight that physicians are not disciplined for ending the lives of those with non-terminal illness (like Cody).

9. Protect the medical profession from distrust, both between patients and their doctors and among doctors. Patients in the northwest who are opposed to assisted suicide now have legitimate fears that doctors might overlook depression or compromised capacity, devalue them, and prescribe lethal drugs if they request hastened death while depressed or in a moment of vulnerable weakness. A death request is often a plea for help, and people often change their minds about hastening death with time, treatment, and support. Dr. Bentz lost trust in colleagues after referring a patient to an oncologist who, over Dr. Bentz’ objections, gave lethal drugs to his patient instead of treating his depression.

10. This bill contains potential conscience violations for physicians and health care employers:

a. Requires falsifying the death certificate, naming the underlying disease as the cause, rather than the actual cause of death—lethal drugs (p. 12, lines 12-14)
b. It is unclear whether an objecting health care employer can prohibit physician employees from providing information about lethal drug provision or referring patients for them, both of which would violate their conscience as participation in an unethical practice that is not medical care.
c. It is unclear whether objecting physicians could be forced to inform or refer for this process in violation of their conscience.

11. Finally, participants do not need to be New York residents, which may allow out-of-state residents to obtain lethal drugs. These participants may not receive adequate evaluation, especially of capacity and lack of coercion, by New York physicians who may not know them well. Because non-residents would be forced to take the lethal drugs in New York, it may pressure patients to take the lethal drugs immediately, when many patients hold on to the drugs for weeks, months, and even years, and some decide never to take them. Given the number of people who travel to New York from around the world, this may make New York an international assisted suicide tourism destination.

Please vote no on A 136. I am happy to answer any questions you may have.

Sincerely,
Sharon Quick, MD, MA (Bioethics)
President, Physicians for Compassionate Care Education Foundation (PCCEF)

1. CAPC. Palliative Care in New York. 2025. (Link).
2. Chambers B. How to Increase Awareness and Reduce Gaps in Palliative Care for Minorities July 9, 2020. (Link) (accessed 9-22-2024).
3. Pope TM, Brodoff L. Medical aid in dying to avoid late-stage dementia. Journal of the American Geriatrics Society 2024: 1-7. (Link).

Physicians for Compassionate Care Testimony against Oregon Assisted Suicide Law expansion bill.

Testimony in opposition to Oregon SB 1003
Sharon Quick, MD, MA (Bioethics)
President, Physicians for Compassionate Care Education Foundation
Expertise: Pediatric Anesthesiology/Critical Care, Medical Ethics
Senate Rules Committee June 2, 2025

I am Dr. Sharon Quick, President of the Physicians for Compassionate Care Education Foundation (PCCEF), an organization without religious or political affiliation. We advocate for the vulnerable terminally ill, promoting good palliative care. I have expertise in pediatric anesthesiology, critical care, and medical ethics. We oppose SB 1003-A Engrossed. Please see the following reasons for our opposition.

1. Reducing the waiting period to 7 days from 15 days (p. 5, lines 27-31, 40-43) does not allow adequate time to fully assess a patient who may be suffering from complex emotional/mental health/existential problems that can worsen physical pain. Mental health problems and deficits in decision-making capacity are common in the terminally ill but often missed by physicians. This bill devalues vulnerable patients suffering from disabilities—such as mental health problems, lack of capacity, psychological distress over loss of function—that will not be uncovered due to inadequate time for assessment. Nor is there time for patients to change their minds, which they often do.

a. It is unclear why there is a need to reduce the waiting period. No dying patient should have unbearable pain. Such a complaint indicates the clinician lacks knowledge about the management of complex pain—an unawareness that is far too common. Lethal drugs are a poor solution for lack of education of clinicians. Furthermore, patients in significant pain have compromised capacity to choose, invalidating consent for lethal drugs.
b. Lethal drugs do not guarantee a peaceful death; there are many contraindications and side effects to these mouth-burning, experimental concoctions. Palliative care can ensure a peaceful death to a far greater degree than lethal drugs.

2. There are good medical reasons to DISALLOW lethal drugs the closer a patient gets to death, but this bill authorizes the opposite (waiving the waiting period for patients close to death)—and allows this difficult determination by one clinician, without any defined expertise, and without a second opinion. (p. 5, lines 44-45 to p. 6, lines 1-4) PATIENTS WITHIN A WEEK OF DEATH USUALLY HAVE COMPROMISED MENTAL CAPACITY AND INABILITY TO INGEST LIQUIDS, MAKING CONSENT UNLIKELY AND INGESTION DANGEROUS.

3. Shortening and/or eliminating the waiting period provide a mechanism for anyone, whether terminally ill or not, to access lethal drugs through voluntarily stopping eating and drinking (VSED). This is happening in OR, but physicians have not been sanctioned for this abuse.

a. Voluntarily stopping eating and drinking (VSED) has been used as a “bridge” to prescription of lethal drugs in Oregon. In 2023, Oregon resident Cody Sontag, decided to commit suicide via VSED to prevent her dementia from advancing. On her fifth day of VSED, a physician assessed Cody as “terminally ill” due to dehydration, and a consulting physician concurred through telehealth. The physician determined that Cody would die within 15 days and waived her waiting period; she died by lethal drug ingestion 2 days later. This action is in clear violation of Oregon’s law which defines terminal illness as an “incurable and irreversible disease.” Dehydration is neither incurable nor irreversible, nor is it a “disease.” Additionally, dehydration reduces cognition, and this is worsened by a baseline of dementia; it is unlikely that Cody had sufficient decision-making capacity to make her consent valid. VSED could potentially be used in this way for any adult for any reason. In 2024, 179 patients (29% of those who received lethal drug prescriptions) had their waiting periods waived. How many of these patients had an induced “bridge” to lethal prescriptions like Cody? No one, including physicians, should be granted god-like powers to decide which disabilities make life worthless and to assist with termination of those so judged.

4. The bill removes the requirement for the second opinion to include evaluating patient capacity, absence of coercion, and a fully informed decision. (p. 3, lines 42-43; p. 4, lines 35-40) These are potentially more difficult assessments than determining the presence of a terminal disease, and a second opinion should be mandatory for those assessments.

5. Requiring health care facilities and hospice programs to publicly disclose their positions on participation in assisted suicide may be a conscience violation. Assisted suicide is not considered a medical procedure but unethical patient abandonment by most physicians and health care practitioners in the world. Requiring health care facilities or programs to make statements about their degree of involvement with it has the effect of making those facilities appear to agree that assisted suicide is a medical practice, even when they do not agree that it is. This is a conscience violation.

6. Changing the word “physician” to “practitioner” is confusing and unnecessary if only physicians are allowed to prescribe lethal drugs. The obvious reason for this word change is to set the stage to allow non-physicians, such as nurse practitioners or physician assistants to prescribe lethal drugs by a simple definition change of “practitioner” in line 42 on page 2 (p. 2, Sec. 3, lines 8-9, 15-17, 42). Vulnerable patients wanting to hasten death with lethal drugs risk their lives on the decisions made--they deserve the highest level of expertise from physicians. Reasons to not open the door to non-physicians:

a. Proponents have stated that rural areas lack physicians willing to prescribe lethal drugs, and advocate allowing non-physicians to participate to expand access in these areas. However, both rural access to palliative care and the number of palliative care prescribers are estimated to be insufficient to meet Oregon’s needs.1 It is a disservice to patients to potentially make lethal drugs more accessible than palliative care.
b. Medicare requires that a physician, not other types of clinicians, certify that a patient is terminally ill for hospice admission.
    i. Although physicians are frequently wrong about a 6-months prognosis, there is evidence that physicians are more accurate than nurses in prognoses.
    ii. Physicians often miss depression2 and deficits in decision-making capacity3; those with lesser qualifications should not make such judgments.
    iii. The training of physician assistants (PAs) is insufficient in end-of-life care, evaluating a patient’s decision-making capacity, determining prognosis for terminal illness, or deciding that death is imminent.4

7. Given the current abuse of Oregon’s law, allowing it to function as a mechanism for termination of people who may not be terminally ill or may be under coercion, please oppose SB 1003, which drops further safeguards. Instead, perhaps further safeguards and better oversight need to be put in place.

a. VSED, as described in #3 above, is being used as a way for non-terminally ill patients to obtain lethal drug prescriptions.
b. In Oregon, patients are getting lethal prescriptions for diagnoses of anorexia, hernia, and arthritis (Oregon 2021 Data Summary, p. 14, footnote 3)—diagnoses that are not terminal by themselves—but there is no process for challenging physician actions. Oregon, California, and Colorado have unethically provided lethal drugs to patients with eating disorders.
c. Thomas Middleton, a terminally ill Oregon resident, moved in with the trustee of his estate and then died by physician-assisted suicide in 2008. The trustee sold his house and deposited the money in her account; she was arrested on theft and criminal mistreatment charges, but whether physicians had inappropriately prescribed lethal drugs (by not properly investigating coercion) was never investigated.

NOTES
1. Only 40% of rural and 32% of suburban areas have access to hospital-based palliative care—numbers which are below both the national and Pacific region averages. (Link)
2. Oregon patients with depression have died from lethal prescriptions. Ganzini, L., E. R. Goy, and S. K. Dobscha. "Prevalence of Depression and Anxiety in Patients Requesting Physicians' Aid in Dying: Cross Sectional Survey." Bmj 337 (2008): a1682.
3. One study found that about 90% of cancer patients had deficits on some subscale of decision-making capacity, but the majority of physicians missed these deficits. Kolva, E., B. Rosenfeld, and R. Saracino. "Assessing the Decision-Making Capacity of Terminally Ill Patients with Cancer." Am J Geriatr Psychiatry 26, no. 5 (May 2018): 523-531. (Link).
4. As of 2023 only 227 PAs (0.2%) in the nation had specialty training in hospice and palliative care. This bill does not distinguish between PAs with experience/expertise and those without. (Link), p. 6

Assisted Suicide destroys Hope.

This opinion article was published by the Fayette Tribune on October 10, 2024

Vote YES on West Virginia Amendment 1 for protection from assisted suicide (Link).

Pat McGeehan

By Pat McGeehan

For every one suicide in our country, there are an estimated 25 non-fatal suicide attempts. (McIntosh, J.L. (for the American Association of Suicidology). (2009). U.S.A. suicide 2006: Official final data. Washington, DC: American Association of Suicidology, dated April 19, 2009, downloaded from http://www.suicidology.org.)

The vast majority of people who survive suicide do not attempt to kill themselves again: “nine out of ten people who attempt suicide and survive will not go on to die by suicide at a later date.” (Owens D, Horrocks J, and House A. Fatal and non-fatal repetition of self-harm: systematic review. British Journal of Psychiatry. 2002;181:193-199. Emphasis added.)

Suicide attempts don’t simply seek out death. They give expression to misery. They cry out for help. They seek an end, not to life, but to suffering, shame, and depression. By bringing these buried miseries into the light, suicide attempts often motivate the loving intervention of family, friends, neighbors, and the medical community. In the vast majority of suicide attempts, it is life, and not death, that has the final word.

It is baseless and unintelligent to imagine that an attempt at medically-assisted suicide is not as much a cry for help as any other suicide attempt. When a loved one expresses a desire to kill themselves, we are counseled to restrict their access to “lethal means” — to hide medication and move firearms out of the house. But, in places like California, if that same loved one would kill themselves by medically-assisted suicide, an incredibly “lethal means” — a cocktail of poisons, sedatives, and painkillers known as DDMA or DDMP — is mailed to their home.

Unlike every other form of suicide — in which the desire to live and the desire to die are so obviously at war in the individual — medically-assisted suicide is presumed to be a rational, unchanging choice. This is foolish. Consider Michael Freeman, whose story was recorded by the National Council on Disability:

At age 62, Michael Freeland had a 43-year medical history of significant depression and suicide attempts. After receiving a diagnosis of terminal lung cancer, he requested assisted suicide. Dr. Peter Reagan, an assisted suicide advocate who was associated with the group Compassion in Dying (later renamed Compassion & Choices), a leading pro-assisted suicide organization, prescribed lethal drugs to Michael Freeland...Freeland then made a telephone call to Physicians for Compassionate Care (PCC), a medical group dedicated to improving the care of seriously ill people without resorting to assisted suicide. The call was answered by a PCC volunteer who was trained in counseling people with serious illness. With encouragement from a doctor recommended by PCC, Freeland underwent chemotherapy and radiation treatment, which alleviated his cancer symptoms significantly. PCC volunteers arranged for him to receive adequate pain care, other appropriate medication, and 24-hour attendant services. A PCC volunteer stayed in touch with him to offer encouragement, as did some old friends, who began to visit him daily. He also received assistance to resolve other health and personal problems. With this multifaceted assistance, his suffering abated, as did his wish to take lethal drugs. He was able to fully reconcile with his daughter, who had been estranged from him during certain periods. In the end, he lived 2 years post-diagnosis; he eventually died of natural causes. (“The Danger of Assisted Suicide Laws: Part of the Bioethics and Disability Series” by The National Council on Disability, October 9, 2019)

Michael’s story shows that the attempt at medically-assisted suicide follows the same path as other suicide attempts: An ambivalent desire that does not end in death but in the intervention of friends and caregivers who reaffirm that life is worth living. But what if Michael’s desire to live became conscious and decisive, not after the appointment prescribing him poison pills, but after swallowing them?

Within suicide states, physicians help sick people to kill themselves in a way that ensures that their suicide attempt will not be the occasion of any positive, life-affirming change. The poisons commonly used in medically-assisted suicides are maximally lethal. Survival is not an option. Through the intervention of bad laws and spineless medical practitioners, suicide attempts “become” what they rarely otherwise are: Irreversible decisions with no other goal besides death.

...It is easy to imagine that no one regrets medically-assisted suicide — its victims are all dead! It is easy to imagine that medically-assisted suicide is an unchanging and unambivalent decision rather than a cry for help — suicide states like Oregon are not required to keep any record of the time between the ingestion of poison pills and death (Worthington A, Finlay I, Regnard C. Efficacy and safety of drugs used for ‘assisted dying.’ Br Med Bull. 2022 Jul 9;142(1):15-22. doi: 10.1093/bmb/ldac009. PMID: 35512347), records concerning complications are quickly destroyed, and “this destruction of essential data makes it impossible to carry out retrospective analysis of Oregon’s assisted deaths” (Regnard C, Worthington A, Finlay I, Oregon Death with Dignity Act access: 25 year analysis BMJ Supportive & Palliative Care Published Online First: 03 October 2023. doi: 10.1136/spcare-2023-004292).

Likewise, it is easy to imagine that those who attempt medically-assisted suicide are clear-headed individuals, rather than people suffering underlying causes of hopelessness and neglect. The trend, in suicide states, is to meet the request for suicide with great haste (Oregon has seen “a reduction in the length of the physician-patient relationship from 18 weeks in 2010 to 5 weeks in 2022”), to refer those requesting suicide to a willing physician, and decidedly not to investigate the possibility that the person requesting medically-assisted suicide might be depressed — “the proportion referred for psychiatric assessment remains low (1%)” (Ibid). Unwilling to listen to a cry for help, medical practitioners in suicide states are increasingly unable to recognize it when it is made in the form of a request for medically-assisted suicide.

We’re not like that in West Virginia. Here, when the sick, disabled, or ill express a desire to kill themselves, we do not ignore everything we know about suicide and prescribe them poison any more than we hand them a loaded gun. We help. Our mothers and fathers can trust a physician in West Virginia with what afflictions and depressions trouble them, and their physician will not repay their trust by recommending their death. This is a confidence we cannot take for granted. Without vigorously rejecting medically-assisted suicide, the future chosen by Canada — where medically-assisted suicide is the fifth leading cause of death — could well become our own.

That’s why it is vital to vote for Amendment One this November. It protects our state from medically-assisted suicide and the culture of indifference and carelessness that it promotes. It affirms the goodness of suicide prevention. And it sends a clear and confident message that West Virginia is not a state of despair, but of hope.

Pat McGeehan is a six-term state delegate from Hancock County. A graduate of the U.S. Air Force Academy, he serves as the dean of a private school in the Northern Panhandle. Pat resides with his daughter Kennedy in Chester.

Reject Washington State assisted suicide expansion bill. Overall patient safety more than cosmetic need

This article was published by The Spokesman Review on March 24, 2023.

Dr Sharon Quick

Dr Sharon Quick

How important is patient safety? Two Washington state bills pertaining to elective medical treatments have opposing views.

ESSB 5050 wisely requires breast implant information prior to surgical consent because women believe time and information are lacking to make informed decisions. Risks include device failure, cosmetic problems, diseases and cancer. The bill supports the current standard, which includes four meetings with health professionals and signing over 20 documents two weeks prior to surgery.

By contrast, ESSB 5179 demolishes safeguards for the terminally ill to obtain lethal prescriptions. It chops the waiting period for lethal drugs from 15 to seven days and allows: nurse practitioners and physician assistants to determine eligibility and write lethal prescriptions; less qualified practitioners to perform mental health evaluations; consent form completion before two practitioners have agreed; mailing lethal drugs; and an indirect supervisory role between the two evaluating practitioners that compromises the integrity of the second opinion. The waiting period may start before either practitioner has evaluated the patient, making same-day death possible.

How can one bill require extensive consent processes for a cosmetic medical procedure with mostly risks that aren’t life-threatening, while another bill limits the consent process and diminishes safeguards for a procedure intended to cause immediate death? The difference in treatment unfairly disregards patient safety in one group of people, the terminally ill. The proposals in ESSB 5179 ignore palliative care possibilities, current deficiencies in safeguards and the vulnerability of terminally ill patients.

Proponents of ESSB 5179 suggest that shortening the waiting period to obtain lethal drugs is needed to end “intractable” pain. Two problems arise with this argument. First, pain is not “intractable.” Multiple medications, nerve blocks and other interventions including pain management consultation make end-of-life care effective in managing pain and other symptoms. Temporary sedation can eliminate symptoms in rare cases where usual measures are inadequate. Though studies show that some doctors lack knowledge about palliative care possibilities, lethal drugs should never be a solution for lack of education. Secondly, patients in significant pain cannot provide valid consent for lethal drugs.

Some want to rush lethal drugs to patients nearing death so they can die in the manner theychoose. However, hallmark symptoms for patients approaching death include brain dysfunction and the inability to ingest liquids. As a result, lethal prescriptions would be dangerous and consent invalid at this time.

Of the 2,704 patients who have received lethal drugs since 2009 in Washington, 476 physicians ’forms and 264 patient consent forms are missing from the Washington Department of Health records. The problem seems to be worsening, as about half of the legally required missing forms are from the last three years in which reports are available. Why does this bill propose to further reduce safeguards when hundreds of Washington residents have received lethal drugs without documentation of consent or a terminal diagnosis?

A wish to die requires thorough evaluation. It is often a plea for help or assurance of self-value in the face of new disabilities. The terminally ill frequently have a compromised capacity to choose,with good/bad days, declining cognition, depression, coercion risk, etc. If such deficits are not recognized and a request for lethal drugs fulfilled, then that person’s autonomy is violated. Such vulnerable patients risk ingesting lethal drugs, not realizing that with time and support they may not want to hasten death. Depression and impaired capacity to choose often go unrecognized by doctors. Evidence suggests depressed patients are getting lethal drugs. Allowing providers with less expertise to prescribe lethal drugs will worsen this.

The terminally ill need loving care, not abandonment to a lethal prescription. Without an adequate waiting period or sufficient provider expertise, patients are deprived of proper evaluation, treatment and time for mind changes. While ESSB 5050 rightly prioritizes safety and time for decision-making, ESSB 5179 exhibits reckless disregard for patient safety–violating the coremedical ethic to do no harm. Why are we discriminating against the terminally ill? Do disabilities make their lives less valuable?

Sharon Quick, M.D., M.A. (Bioethics) is president of Physicians for Compassionate Care Education Foundation. She is a retired pediatric anesthesiologist/critical care physician residing in Bonney Lake, Washington.

Doctors (world-wide) are being invited to sign this open letter: Doctors Want No Part in Euthanasia and Assisted Suicide.

An open letter from doctors around the world to medical ethicists and lawmakers

Link for doctors to sign the open letter (Link).

Doctors Want No Part in Euthanasia and Assisted Suicide

Euthanasia and Assisted Suicide are not part of Medicine

As medical doctors, we are committed to supporting people to both live and die with dignity and comfort.

We are determined that state-of-the-art care should be available for people who are dying and also for people suffering from chronic disease, disability or mental illness.

We believe that universal and equitable access to effective pain and symptom management, including mental healthcare and palliative care, is a fundamental human right.

We fully support the right of a person with decision-making capacity to decline a treatment offered to them.

We support clinicians and patients agreeing to withdraw or withhold burdensome and ineffective treatment in favour of supportive and palliative care.

We believe that doctors have the training and skill to promote and maintain a caring doctor-patient relationship.

It is our view that skilful and effective pain management neither requires nor uses lethal doses of drugs.

We believe neither assisted suicide nor euthanasia is a medical procedure. Doctors should play no role in the regulation, or practice, of euthanasia and assisted suicide.

We are especially concerned with protecting vulnerable people who can feel they have become a burden to others, and we are committed to supporting those who find their own life situations a heavy burden.

We endorse the views of Medical Associations around the world which hold that physician assisted suicide and euthanasia are unethical, even if they are made legal.

“Leave doctors to focus on advocating for patients – to cure sometimes, to relieve often and to comfort always.”

Join us

If you are a registered doctor and would like to add your name to this Open Letter, complete the form below. These details are required to confirm that you are a medical doctor.

Declaration of good faith and disclaimer

The organisers have sought, and continue to seek, support for this open letter from currently practicing medical doctors within participating countries, and every reasonable effort is made to verify that they hold a valid practicing certificate or licence. The list of supporting doctors is published in good faith with a commitment to correct any errors, but the organisers disclaim any liability for published names found to be ineligible.

Link for doctors to sign the open letter (Link).

Do not follow Oregon’s example. It is dangerous for patients and society. Vote No to Connecticut Bill 6425.

State of Connecticut General Assembly Committee on Public Health

Vote NO on Bill No. 6425, An Act Concerning Aid in Dying for Terminally Ill Patients

Dr Kenneth Stevens

Testimony of Dr. Kenneth R. Stevens, Jr., MD,
Professor Emeritus, Radiation Oncology, Oregon Health & Science University, Portland, OR

February 24, 2021

To Members of the Committee on Public Health,

I have been a cancer doctor in the practice of Radiation Oncology for 52 years in Oregon, treating cancer patients from 1969 to 2019.

I have studied and closely followed the implementation of Oregon’s assisted-suicide law since its passage in 1994. I have also continued to teach and practice medicine in a society where there exists such a law, taking note of its tragic results. The more I have learned and witnessed, the more I realize the significant harm and danger of assisted suicide to the vulnerably ill and to society. The following includes some of those harms and dangers.

There has been a profound negative shift in attitude towards terminally ill patients in Oregon. The commitment to care has become a commitment to the option of killing. There has been a distinct change of attitude in society and in members of the medical profession to patients who are terminally ill and eligible for assisted suicide. There is reduced incentive to evaluate and provide for the palliative care needs of patients who are eligible for assisted suicide. The legalization of assisted suicide results in a deterioration of caring for patients’ medical needs and symptoms.

Oregon’s assisted suicide law is not necessarily for only patients who are dying. Many who request/use the law are not dying already. The mere presence of legal assisted suicide steers patients to suicide.

As in Oregon, Bill 6425 supposedly applies to patients predicted to have less than six months to live. In 2000, I had a cancer patient named Jeanette Hall. She was referred to me with an inoperable low rectal cancer. She plainly told me that she did not want to be treated, and that she was going to “do” our law, i.e., end her life with a lethal dose of barbiturates. She had voted for the law and it was a very much settled decision for her. Her referring surgeon, who had determined that her cancer was inoperable, informed her that without treatment (radiation & chemotherapy) that she had a six month to one year life expectancy, so she qualified for Oregon’s assisted suicide law. Patients refusing appropriate treatment may be deemed “terminal” under current interpretation of the Oregon law. After consulting with her, I informed her that her cancer was treatable with chemotherapy and radiation and her prospects were good. She was not interested in treatment. She had made up her mind, but she continued to see me. On the third or fourth visit, I asked her about her family and learned that she had a son in his late 20s. I asked her how he would feel if she went through with her plan. Shortly after that, she agreed to be treated, the cancer melted away, and she is alive and active today. Twenty years later, she says “It’s great to be alive”. For her, the mere presence of legal assisted suicide had steered her to suicide. An 18-year-old girl with insulin-dependent diabetes would be eligible, if she stopped taking life-sustaining insulin.

Pain is not the issue. It is very significant that there are many cases of assisted suicide being used to address psychological and social concerns, but it is very rare for assisted suicide to be used in the case of actual untreatable pain.

Depressed people are dying from assisted suicide in Oregon. In 2008, researchers at Oregon Health & Science University reported 25% of terminally ill patients pursuing assisted suicide in Oregon met criteria for depression.  Yet, the Oregon Health Department annual reports for the years 2018 and 2019 reported that only 1% (4 of 366) of patients dying from assisted suicide had a psychiatric evaluation. Your bill dangerously permits social workers to evaluate patients’ mental status.

There is no real monitoring of Oregon’s assisted suicides. When David Prueitt’s failed suicide was made public in 2005, the Department of Health Services (DHS) publicly stated that they had “no authority to investigate individual Death with Dignity cases. The state law authorizing physician-assisted suicide neither requires of authorizes investigations by DHS.”

We are dependent on self-reporting by doctors, and in in most cases the prescribing doctor is not present when the drugs are taken.

There are financial and societal dangers that assisted suicide may be pressured as a cost savings. The Oregon Health Plan (Medicaid) pays for assisted suicide and does not pay for some cancer treatment to extend life. In 2008, cancer patients Barbara Wagner and Randy Shoup received letters from the Oregon Health Plan that the Plan would not pay for beneficial chemotherapy, but would pay for [among other things] physician-assisted suicide. Ms. Wagner’s comment to the media was “they will pay for me to die, but won’t pay for me to live.” 

Oregon’s regular suicide rate has increased since the legalization of assisted suicide. According to the U.S. Center for Disease Control (CDC), Oregon had the 2nd highest suicide rate in the U.S. for the years 1999-2010.

I urge you to vote no on this bill. Do not follow Oregon’s example. It is dangerous for patients and society.

Thank you,
Dr. Kenneth R. Stevens, Jr., M.D.

Doctors say No to Washington state assisted suicide expansion bill HB 1141.

No on Washington state HB 1141,

by Kenneth R. Stevens, Jr., MD,

Professor Emeritus & former Chair Department of Radiation Oncology,

Oregon Health & Science University.

President, Physicians for Compassionate Care Education Foundation, pccef.org

When the citizens of Washington state voted in 2008 in favor of Initiative 1000, Washington’s Death with Dignity Act, they did it with the understanding that there were “safeguards” in the new law.

HB 1141 seeks to remove some of those safeguards.

1) It removes the safeguard that only medical physicians can be both the attending and consulting physicians. It expands qualifications to those with lesser medical expertise. That was not the intent of the original I-1000 initiative.

2) Instead of evaluation by mental health professionals, such as psychiatrists and psychologists, it expands the law to include mental evaluation by others with lesser credentials. That was not the intent of I-1000

3) It removes the 15-day and the 72-hour waiting periods. I-1000 and the current law allowed for this time period for the person to really understand and reflect on the decision to end their life by lethal drugs. This bill will remove that protection promised in I-1000. If passed this bill would permit a person to receive lethal drugs and end their life on the same day that they have made a decision to use the law! That was not the intent of I-1000.

4) It reduces the security of delivery of the lethal drugs by permitting delivery by expanding the type of delivery. This is dangerous.

If these changes, which remove some safeguards in the law, had been in the original initiative petition, I doubt that the voters of Washington state would have approved. They would not have voted to legalize assisted suicide in Washington state in 2008.

Eliminating safeguards will eliminate vulnerable people!

The following link tells of my patient, Jeanette Hall, who requested lethal drugs in 2000, and who is grateful to still be alive 20 years later. (Link).

I urge Washington state legislators to not remove “safeguards” from the Washington “Death with Dignity Act”.