Dr. Anne Hanson's Testimony Opposing Assisted Suicide

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

This article was published by Choice is an Illusion.

Anne Hanson MD

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

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

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

1. Suicide Contagion

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

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

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

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

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

2. Safeguard Failures

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

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

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

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

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

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

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

3. Implications for the Practice of Psychiatry

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

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

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

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

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

Conclusion

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

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

References:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Queensland Australia report approves euthanasia with a condition that will cause death some day

Published by the Australian Care Alliance on April 1, 2020.

Queensland Australia Parliament

Legalising euthanasia for any Queensland adult with a medical condition that two doctors or nurses think “will cause death” someday has been recommended by a parliamentary committee.

The Health, Communities, Disability Services and Domestic and Family Violence Prevention Committee of the Queensland Parliament has, in a report tabled on 31 March 2020, recommended that:

“the Queensland Government use the well-considered draft legislation submitted to the inquiry by Professors Lindy Willmott and Ben White as the basis for a legislative scheme for voluntary assisted dying.”

That draft legislation would legalise euthanasia and assisted suicide for any person over 18 years of age, with “an incurable, advanced and progressive medical condition that” two doctors say “will cause death”.

The Committee recommended also allowing two registered nurses to make the eligibility assessment and one of the nurses to administer the lethal poison to kill the person.

Unlike the Victorian or Western Australian laws the draft legislation would require a registered medical practitioner to be present if the prescribed lethal substance is self-administered.

There would, however, be no requirement for the medical practitioner (or nurse) to remain with the person after the lethal poison is administered either by the person or by the medical practitioner or nurse.

Interestingly, Willmott and White note:

Given that where choice is available, practitioner administration [i.e. euthanasia] is overwhelmingly chosen, these disadvantages [the inconvenience of requiring a medical practitioner to be present] are only likely to arise in the small number of voluntary assisted dying cases where a person specifically wants to self-administer [assisted suicide].

Section 10 of the draft legislation makes it clear that whether a person’s medical condition will cause the person’s death is to be determined by reference to available medical treatment that is acceptable to the person. This means, for example, that any insulin dependent diabetic would qualify simply by deciding no longer to take insulin.

The section also makes it clear that the suffering element is purely subjective and could be limited to existential suffering (such as feeling like a burden on others).

The draft legislation would require a medical practitioner with a conscientious objection to euthanasia to refer the person to a medical practitioner willing to perform it.

Like the laws in Victoria and Western Australia, the draft legislation would allow both an initial and final request for euthanasia to be made by a gesture.

Rejecting evidence presented by the Australian Care Alliance (see p. 22-24) about suicide contagion where assisted suicide has been legalised the Committee claims that:

temporary suicidal ideation is quite distinct from an enduring, considered and rational decision to end one’s life in the face of unbearable suffering. Given this distinction, the committee considers that a decision to legislate for the introduction of voluntary assisted dying [euthanasia and assisted suicide] is not inconsistent with suicide prevention campaigns and messaging.

The Committee does recommend adding a provision to the draft legislation that only the person may instigate a discussion about euthanasia or assisted suicide.

The Committee suggests that further consideration be given as to whether euthanasia by advanced directive should also be allowed.

The Greens member of the Committee, Mr Michael Berkman, favours the use of advanced directives as well as allowing children to request euthanasia.

The two LNP members of the Committee rejected the key recommendation:

This recommendation is not supported with any written assessment of the document. As the Report does not show the Committee undertook a detailed analysis it is very difficult to conclude that the “draft legislation” is “well considered.” There is also no evidence in the Report that the Bill was disseminated to stakeholders nor detailed evidence taken from them including professional bodies as to whether or not the Bill should be put forward as “draft legislation”. This is a fundamental breach of any Committee’s obligation. If it is to recommend a Bill, then the Report should and must provide a rigorous assessment undertaken with all stakeholders.

It seems unlikely that any Bill would be introduced before the Queensland State election which is due on 31 October 2020.

The Premier's office has said that Premier Annastacia Palaszczuk's focus was "100 per cent on the state's response to COVID-19".

Webinar: Disability Rights Opposition to Assisted Suicide laws.

Announcing!

Webinar: Disability Rights Opposition
To Assisted Suicide Laws

Wednesday, October 30, 2019, 
3:00-4:30 pm Eastern Time

REGISTER HERE!

What Will You Gain By Attending:

• Familiarity with the key issues, arguments and common questions
• Materials that explain, detail, and document individual cases of assisted suicide problems and abuses
• Understanding what disability has to do with assisted suicide

Speakers:

• Anita Cameron, Director of Minority Outreach, Not Dead Yet
• Diane Coleman, President/CEO, Not Dead Yet
• Marilyn Golden, Senior Policy Analyst, Disability Rights Education & Defense Fund
• John Kelly, Director, Second Thoughts Massachusetts

Topics Include:

• What is Assisted Suicide?
• What’s disability got to do with it?
• Deadly mix between assisted suicide & pressures to cut healthcare costs
• Elder and disability abuse; effects on other constituencies
• Palliative care and palliative sedation can address pain
• Failure of so-called “safeguards”
• Minimal data and fatally flawed oversight, no investigation of abuse
• Suicide contagion
• What’s happening in Canada and other countries?
• Take action!

REGISTER HERE

For More Information: mgolden@dredf.org

Canadian euthanasia party propaganda story.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

The other day I published an article about a Seattle assisted suicide party propaganda story. One of our supporters sent me the link to a Canadian euthanasia party propaganda story, a story that I did not write about when it was first published.

Similar to the Seattle story, the Canadian story is designed to promote MAiD (euthanasia) and break-down social barriers towards euthanasia.

The story by Susie Adelson was published by Toronto Life features Adelson's grand mother, Sonia Goodman (88). 

Goodman visits Sunnybrook hospital in pain and with sepsis and tells the medical team that she wants them to end her life. Adelson writes:

At first, the doctors suggested palliative care, but she was adamant: no more surgeries, no more drugs, not even antibiotics. She had watched her friends pass away and my mother suffer, and she didn’t want to go through that. Neither did I: seeing my mom languish in a hospital bed for months left me anxious and terrified of death.

Adelson is concerned that her grandmother would languish in a hospital bed for months. Clearly this statement is designed to cause fear but it indicates that she is not terminally ill.
 
There is more to the story. The woman does not appear to be terminally ill - "natural death is not reasonably forseeable" but demands and receives death by lethal injection.

The article raises a concern with the social approval of elder suicide. When the doctors decided that she was qualified to die, the decision seems based on her age (88). The fact that she demands to die seems very similar to suicide. When did approving suicide based on age become acceptable?

Adelson then builds the propaganda by emphasizing how they all shared a celebration drink and spoke about their memories of Goodman. Adelson writes:

Relishing the spotlight, she encouraged us to go around the room and share our memories of her. She was delighted when person after person remarked on her glamour. When it was my turn, I thanked her for giving me my mother—and for her advice to never leave the house without a coat of lipstick. She laughed, and I held her hand. When it was time, we raised our Dixie cups: “To Yaya!”

We all want the focus to be on us in our final days, but it doesn't require a lethal injection to make it happen.

The euthanasia lobby is promoting death. As I stated in my response to the Seattle article - assisted suicide was once an avant garde concept, now normalizing assisted suicide is really another propaganda tool.

Its time for real journalism with real life, juxtaposing stories, complicated reality, and not propaganda.

Seattle assisted suicide party propaganda.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition
 

The following story may seem like a plot from a bad horror film, but it is simply another assisted suicide propaganda story.

The Associated Press (AP) published an article by Gene Johnson about an assisted suicide party in Seattle. The story is designed to make you open to assisted suicide, but this story leads to questions about assisted suicide and why AP decided to publish assisted suicide propaganda.

*Washington State: Nearly 25% more assisted deaths in 2018.

The AP story, concerns Robert Fuller (75) who planned his suicide party and this story gives Fuller his 15 minutes of fame.

The story goes something like this, Fuller, who is a nominal Catholic, marries his male partner, Reese Baxter, in the morning. He then moves down to the common room, in his seniors building, to greet friends, well wishers and later that afternoon he injects a fatal drug cocktail into his feeding tube and dies.

* Order the Fatal Flaws film from the Euthanasia Prevention Coalition and see the other side of the story (Link).

It appears that Fuller may have had a life-long problem with suicidal ideation.

When Fuller was 8 his Aunt died by a suicide drowning in the Merrimack river. Johnson states that seeing her body began Fuller's long relationship with death. According to Johnson, Fuller stated:

"If life gets painful, you go to the Merrimack River."

Johnson describes how Fuller survived a suicide attempt in 1975. His marriage ended after telling his wife that he was gay and he was drinking too much.

Johnson writes that as a nurse in the 1980's, Fuller cared for people with HIV. Fuller admits to intentionally killing a patient, with a drug overdose, to "end his battle" with AIDS.

Johnson also writes that Fuller intentionally lived a risky sexual life-style in the 80's, a lifestyle that verged on suicidal. Johnson quotes Fuller as saying:

"I think I wanted to get AIDS,"

"All my friends were dying."

When Fuller was sought assisted suicide, were his suicidal tendencies examined? It is difficult to differentiate between a "rational" wish to die and suicidal ideation.

To offer the other side of the issue, Johnson publishes a few quotes from bioethicist Wesley Smith, who opposes assisted suicide. Smith states:

to allow people to hasten their deaths represents an abandonment, a signal to the terminally ill that their lives are not worth living, he said.

"We should be very concerned that we are normalizing suicide in our society, especially at the very time during which, practically out of the other side of our mouth, we are saying suicide is an epidemic," Smith said.

I think that Smith, hit the nail on the head, but the article contradicts Smith's comments, and continues with its suicide contagion narrative to explain that Fuller rejected treatment and "chose death" but not until he lived out a few "bucket list" experiences.

The article undermines the Catholic Church. Fuller attended a Catholic parish where the priest and many parishioners appear accepting of death by assisted suicide. The parish priest even had a group of children bless Fuller at his final mass before his death. (Link to the Archdiocese of Seattle statement)

Finally the article describes the "death midwife" participation and how his death was without complications. Data shows that many people who die by assisted suicide do not experience a death without pain, suffering and complications.
 
Why am I writing about the AP propaganda article?

I guess I am giving this propaganda article attention. Yes, this is a pro-assisted suicide article designed to undermine opposition to doctor prescribed suicide.
 

Johnson seems to have little concern about how glorifying suicide leads to a suicide contagion effect. 

Popularizing assisted suicide is not about creating awareness but providing new customers for the assisted suicide death business.
 
The article admits that suicide was a integral part of Fuller's life experience. What effect do these articles have on other wounded individuals who are scarred by their suicide experiences or suicide attempts. Society must not trivialize suicide as it deeply effects a person's inner most being.

Finally, did AP have to gain by promoting assisted suicide. Assisted suicide was once an avant garde concept, now normalizing assisted suicide is another political propaganda tool.

Its time for the media to provide real journalism with real life, juxtaposing stories, complicated reality, and not propaganda.

Order the Fatal Flaws film from the Euthanasia Prevention Coalition and see the other side of the story (Link).

Massachusetts to debate suicide coercion bill "Conrad's law"

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Conrad Roy

Massachusetts State Senator Barry Finegold and Representative Natalie Higgins are introducing Conrad's Law, a bill to deter suicide coercion.

Lauren Fox reporting for The Boston Globe stated that the bill is named for Conrad Roy who died in July 2014 after his girlfriend, Michelle Carter, pressured him through text messages and phone calls to carry out his suicide.

Conrad's law punishes those who coerce others into committing or attempting to commit suicide, with punishment of up to five years in prison. This bill does not apply to assisted suicide, which is illegal in Massachusetts.

Lauren Fox reported Lynn Roy, Conrad's mother as saying: 

she was honored to support the legislation, called “Conrad’s Law.” 

“Before my son passed, I was excited about so much,” she said. Still, she had never said “I’m friggin’ excited” about anything until she learned the anti-suicide measure was moving forward. 

“My heart is so full,” she said. “And I’m so proud of my son.”

CBS Boston reported Lynn Roy as saying that this is the first time she has felt joy since the death of her son. Roy stated:

“My son was the most kind, warm, compassionate person,” she said. “By passing Conrad’s Law, I truly believe this is the perfect way to honor him.”

Conrad's father told The Boston Globe that he hopes that:

“this bill helps saves some lives and just puts some more awareness out there about suicide and about bullying.”

Fox reported that Carter was convicted, in 2017, of involuntary manslaughter in Roy’s death. Earlier this month, Carter’s lawyers petitioned the US Supreme Court to review the case. 

Suicide lobby operates comprehensive suicide information website.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Several days ago I published an article titled: Assisted dying can cause inhumane deaths. This article explains the research by Professor Jaideep Pandit that was published in the British Medical Journal.

While doing further research on the suicide lobby's involvement with developing suicide drug cocktails I came across a website that appears to be operated by the suicide lobby providing detailed suicide information, similar to the book that is sold by euthanasia campaigner Philip Nitschke.

It shocks me that anyone who does a google search will come across suicide websites that only require you to link to the qualifier, 18 or older to enter the site.

I think this is crazy.

I live in a country where the suicide rate continues to increase. My country legalized euthanasia and assisted suicide under the term MAiD. We deny that this will increase our suicide rate. Websites that provides all the necessary instructions for my self-destruction are easy to find.

People consider suicide when they are at the lowest time of their life, when they are emotionally and psychologically in the darkest place. These sites enable suicide.

I have provided too much information already.

Truchon, Gladu and the euthanasia of people who are not terminally ill

This article was published on February 7, 2019.

By Dr Catherine Ferrier

President, Physicians Alliance Against Euthanasia

In recent issues of this Newsletter we have considered the dangers of different ongoing schemes for enlarging the qualifying criteria for euthanasia, to include people with dementia (by advance directive), “mature” minors (with or without parental consent or knowledge) and those for whom psychiatric illness is the sole underlying condition.

Unfortunately, by virtue of a challenge currently undertaken by Mr. Jean Truchon and Ms. Nicole Gladu before the Québec Superior Court, there is now something quantitatively much worse on the table: euthanasia for people who are not at the “end of life” (as required by the Quebec law) or for whom, contrary to what Canadian law requires, “natural death is not reasonably foreseeable”. In other words, doctors may soon be asked to “medically” kill people who are not dying.

It is evident that to permit this would allow the phenomenon to assume proportions many times that of the original context of “unbearable suffering at the end of life”. Therefore, whatever dangers were first invoked in that discussion must now be multiplied a hundredfold.

Unfortunately, the plaintiffs and their counsel do not admit that any such dangers exist. Increased suicide, for example, is impossible in their world because “Medical aid in dying” is never suicide, by definition (although any qualified and suicidal patient would have the absolute right to die using a compliant doctor in the place of poison or gun). Moreover, no matter how many “vulnerable” persons were to die for the wrong reasons, that too is irrelevant, because Mr. Truchon and Ms. Gladu are not vulnerable. And in the myopic priorities of the petitioners: if even one, single, non-vulnerable ill or disabled person wishes to die, then society has a sacred duty to provide that death, even if it means completely transforming medical culture, regardless of what mayhem may ensue.

The law, however, must not uncritically endorse the perspective of any one stakeholder. The law has a duty to balance competing interests.

Jean Truchon & Nicole Gladu

These conflicting interests and the balancing function of the law were sharply illustrated on the first day of hearings by the presence of two severely disabled individuals, vehemently opposed to the demands of Mr. Truchon and Ms. Gladu, and determined to defend their own rights: not the right to benefit from a discriminatory exception to our criminal code which would allow their deaths; but the right to an equal and non-discriminatory application of existing law to prevent those deaths.

For that is what the law against assisted suicide does: it prevents deaths. Before the Carter decision and Bill C-14, it provided this protection to everyone; and even since the law was adopted, it has still protected those who are not at the end of life; but if the Truchon-Gladu challenge prevails, the entire population of chronically ill and disabled individuals will be stripped of such protection. And that is horribly wrong.

It has been reported that Mr. Truchon and Ms. Gladu’s counsel summarily rejected any notion of lost protection, using what has so often been accepted as an unassailable argument: “each one may choose”. But if apparent choice were sufficient protection from the dangers of assisted suicide, why do we still have a law at all? Why do “normal” people still require protection? The answer is obvious: Because the existing law does in fact provide real protection for the general population. And non-suicidal people who are ill or disabled (whether “vulnerable” or not), naturally resent this attempt to deprive them of their right to equal treatment before the law.

This is not different from many regulations in existence, such as, for example, those requiring doors to close off open elevator shafts (in spite of the fact that people may simply “choose” not to jump). We recognize that people can fall down the shaft by accident; or that in a period of existential weakness they might regrettably decide to jump; and yes, they may even be pushed. Doors prevent such tragedies. And so do our laws against assisted suicide.

Here, then, fundamentally, are the two sides to this issue: There are people who seek an exceptional “right” to jump, with the help of the medical profession; and there are those, every bit as qualified for that proposed exemption, who wish to benefit from the same level of protection accorded to every other citizen.

How, then, can we decide between these two competing and mutually exclusive views?

1. The number of suicidal people like Mr. Truchon and Ms. Gladu is greatly inferior to those in similar circumstances who wish to continue living.
2. It is impossible that people with the intellectual resources and networking skills of the non-vulnerable Mr. Truchon and Ms. Gladu can be prevented from dying if they really want to. Many thousands of Canadians commit suicide each year, and it is estimated that hundreds are assisted to do so. What Mr. Truchon and Mme Gladu risk, then, is not a requirement to live, but simply that society will not arrange for their deaths.
3. Should Mr. Truchon and Ms. Gladu win, others, who will inevitably and regrettably succumb to the open elevator shaft of missing protection, will lose their lives. Our choice, therefore, is between providing a more convenient death for a few, or protection of ongoing life for many more.
4. Fair minded people must realize the reality of intimidation, coercion – or even mere suggestion – originating from overwrought family, overburdened caregivers, and yes, perhaps blatantly greedy heirs; recognize also the danger of passing self-doubt, or existential despair, translated into state-sanctioned, medicalized suicide. We believe that what the legislators considered an acceptable weight of tragedy, in a compromise involving only those wishing to die more quickly and less painfully at the very end of life, should certainly be considered unacceptable when applied to the much larger population of those with non-terminal illness and disability.
5. Law is a framework under which we live. The benefits of law should be maximized for those who are alive – and for those who wish to go on living.

From these several facts, we arrive naturally at the conclusion that the existing law (bad as it may be) should remain as it is without further expansion. Mr. Truchon and Ms. Gladu will die, as all people die, and probably much sooner, by their own hand or by the hand of others.

But when they leave this world, they must not be permitted to bequeath to us a framework that works to the detriment of those who have chosen to remain behind.

Make euthanasia unimaginable.

Sincerely,
Catherine Ferrier
President, Physician Alliance Against Euthanasia.

Capital Punishment vs Assisted Suicide

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Dr Kevin Hay

Dr Kevin Hay, who is a family physician in Alberta, wrote an excellent op-ed titled: It's illogical to ban capital punishment but allow doctor-assisted death that was published on November 28, 2018.

What is most interesting about the article are the comparisons that Hay makes between capital punishment and assisted suicide. Hay wrote:

So is it contradictory for a society to embrace voluntary euthanasia while banning the death penalty? (MAID in Canada is overwhelmingly by voluntary euthanasia rather than the optional assisted suicide). To answer that question we need to take those arguments used to decry capital punishment and apply them to MAID. 

Capital punishment can kill the innocent. Euthanasia can kill the coerced and the incompetent. Both capital punishment and euthanasia are irreversible once enacted in error. Capital punishment is morally wrong because of the intrinsic value of human life; so, too, is euthanasia. 

Capital punishment brutalizes the prisoner, the executioner, society-at-large, the law and human rights. The requirements for MAID can brutalize a suffering patient (e.g. if death is not “immediately foreseeable,” MAID should be refused). After providing euthanasia, some doctors in Ontario “found themselves overwhelmed by the act of killing another human being.” Euthanasia can have devastating effects on friends and family, especially young children. Only a handful of countries allow a citizen to demand death at the hands of another citizen. Most countries believe that the state-sanctioned killing of a citizen is wrong. Rights are universal; if one person has the right to die, then we all have the right to die. 

Capital punishment is cheaper than life imprisonment. MAID is vastly cheaper than treatment or palliative care. It’s barbaric to promote cost reduction through the killing of the sick. (Note the case of 42-year-old Roger Foley in Ontario.)
The death penalty is unique as a punishment. Euthanasia is unique as a “treatment.”
In the U.S., the death penalty is applied unfairly across capital cases. No one can truly ascertain that some MAID applicants — and not others — “deserve” death. 

Capital punishment fails to deter serious crime and can martyr a terrorist. The glamourization of MAID in the media can cause suicide contagion — the Werther Effect. 

The mentally ill offender should be treated, not put to death. Civilized societies strive to prevent suicide in the mentally ill — not collude with delusions. 

The death penalty is inhumane (even by lethal injection, as reported in the Lancet in 2005). There is potential for difficulty with the administration of euthanasia. 

Capital punishment is unnecessary, especially with life imprisonment without parole. Autonomy allows a person to refuse care — that doesn’t commit the state to provide death at the hand of another citizen. 

Misguided compassion has blinded sympathetic people (including the Supreme Court of Canada) to the similarities between voluntary euthanasia and the death penalty. Logical consistency requires a society to have both or neither.

Hay makes it very clear, it's inconsistent to legalize assisted suicide and to outlaw capital punishment. In fact, when the Supreme Court of Canada (45 years ago) rejected capital punishment, they stated that is was inhumane to ask someone to inflict death on another person. I think the Supreme Court of Canada is inconsistent and Dr Kevin Hay is consistent.

• World Medical Association: Physicians must not be complicit with capital punishment.
• Is lethal injection inhumane?
• Killing by lethal injection. A psychological torment.
• Banned execution drug is used for euthanasia in Belgium.

The deadly advocacy of assisted suicide in Washington DC

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Dr G Kevin Donovan 

The Washington Times published an excellent analysis of the assisted suicide legislation in Washington DC by G. Kevin Donovan, a physician and director of the Pellegrino Center for Clinical Bioethics and professor at Georgetown University Medical Center.

Donovan is responding to public service announcements in Washington DC promoting assisted suicide. Donovan states:

It is no wonder that the assisted-suicide lobby has resorted to such tactics — this dangerous public policy is so unpopular here that in the first year after the District of Columbia enacted a law to allow assisted suicide, not one person killed themselves with a doctor’s help, as the new law sanctions. In fact, during that time only two out of nearly 11,000 licensed D.C. physicians were willing to participate, and just one hospital cleared doctors to be involved.

People in Washington DC clearly do not want assisted suicide. Donovan then explains how legalizing assisted suicide leads to discrimination for people in vulnerable conditions.

Despite so-called safeguards, the D.C. assisted-suicide bill fails to adequately protect the most vulnerable in society. The poor, people of advanced years, persons with disabilities, both physical and developmental, and people who experience depression all find themselves at a much higher risk of being placed, even against their will, in that “second class” of people who do not receive the equal protection of suicide prevention. 

This type of discrimination is a reality in places where assisted suicide is legal. We know because in Oregon (oregon.gov), where assisted suicide was legalized 20 years ago, feeling like a burden is among the top end-of-life concerns of people who asked for lethal drugs. Making suicide available to people who require significant care and resources conveys that dependency and the need for care is burdensome, perhaps even revolting.

Donovan continues by outlining the other negative effects associated with assisted suicide.

Assisted suicide also breaks down the patient-physician relationship. With these laws, a doctor is legally forbidden from listing suicide as the cause of death on the death certificate. Not only does that require a falsehood, it makes oversight nearly impossible and accurate disease data a thing of the past. These laws do precious little for patients, but they do ensure that doctors cannot be sued or subjected to criminal penalties when acting “in good faith” within this law. 

For centuries, a physician’s primary focus has been to cure and comfort. Assisted suicide is an aberration that distorts that focus, medicalizing suicide. The result is a breach of trust between physician and patient — and the real risk that normalizing suicide will lead to “suicide contagion” in others. There is no mystery behind why physicians in Washington are not lining up to participate: It undermines their credibility and runs contrary to their role as healer. And physicians should be wary of promoting suicide for any reason among their patients. More doctors themselves die of suicide than in any other profession.

Donovan concludes by challenging the suicide lobby from promoting assisted suicide rather than suicide prevention, patient's rights and protection of the vulnerable.

• NO DC assisted suicide deaths in the first year after legalization. DC doctors don't support assisted suicide.

No to suicide prevention discrimination.

This article was published by Nancy Valko on October 4, 2018.

Nancy Valko

By Nancy Valko

When I was asked by my late daughter Marie’s best friend to join her on a family and friends fundraising walk for suicide prevention last Sunday, I hesitated.

I was in the process of reading yet another disturbing article about assisted suicide, this time a Journal of Clinical Psychiatry article titled “Working with Decisionally Capable Patients Who Are Determined to End Their Own Lives” and I found it outrageous that the suicide prevention groups I know exclude potential physician-assisted suicide victims.

As a nurse, I have personally and professionally cared for many suicidal people over decades including some who were terminally ill. To my knowledge, none of these people went on to die by suicide except one-my own daughter.

Almost nine years ago, my 30 year old daughter Marie died by suicide using an assisted suicide technique she found after searching suicide and assisted suicide websites and reading assisted suicide supporter Derek Humphry’s book “Final Exit”.

Marie was a wonderful woman who achieved a degree in engineering despite struggling off and on with substance abuse and thoughts of suicide for 16 years. She was in an outpatient behavioral health program at the time of her suicide. Her suicide was my worst fear and it devastated all of us in the family as well as her friends. Two people close to Marie also became suicidal after her death but were fortunately saved.

For years before and after Marie’s death, I have written and spoken to groups around the country about the legal and ethical problems with assisted suicide as well as suicide contagion and media reporting guidelines for suicide.

So it was with mixed feelings that I participated in the suicide prevention walk but now I am glad I did.

“Working With Decisionally Capable Patients Who Are Determined To End Their Own Lives”

I finally finished reading this article after the walk and found that while the authors of this Journal of Clinical Psychiatry article insist that they are only discussing “decisionally capable” people with “advanced medical illness”, they write:

“The 24% increase in US suicide rates from 1999 to 2014 has led to greater efforts to identify, prevent, and intervene in situations associated with suicidality. While the desire to kill oneself is not synonymous with a mental illness, 80%–90% of completed suicides are associated with a mental disorder, most commonly depression. Understandably, psychiatrists and other clinicians face strong moral, cultural, and professional pressures to do everything possible to avert suicide. Hidden within these statistics are unknown numbers of individuals determined to end their lives, often in the context of a life-limiting physical illness, who have no mental disorder or who, despite having a mental disorder, were nevertheless seemingly rational and decisionally capable and in whom the mental disorder did not seem to influence the desire to hasten death.”

Tragically, the authors also state:

“In reviewing the either sparse or dated literature in this field, surveys from the United States and Canada support that most psychiatrists believe that PAD (physician aid in dying, a euphemism for assisted suicide) should be legal and is ethical in some cases and that they might want the option for themselves.”

And

“Although we see ‘assisted death’ as an option of last resort, we instead ask whether on certain occasions psychiatrists might appropriately not seek to prevent selected decisionally capable individuals from ending their own lives.” (All emphasis added)

This flies in the face of long-standing professional suicide prevention and treatment principles.

Notably, the article ends with an addendum, the 2017 Statement of the American Association of Suicidology (AAS): “Suicide is not the same as ‘Physician Aid in Dying’”

That concludes:

“In general, suicide and physician aid in dying are conceptually, medically, and legally different phenomena, with an undetermined amount of overlap between these two categories” but “Such deaths should not be considered to be cases of suicide and are therefore a matter outside the central focus of the AAS.” (Emphasis added)

Why I am glad I went on the Suicide Prevention Walk

The Sunday walk was sponsored by the American Foundation for Suicide Prevention (AFSP), a group that I discovered states it is trying to “Develop an updated AFSP policy position on assisted death (other common terms include physician assisted suicide or Death with Dignity Laws)”

The next day, I was able to contact a policy person at their Washington, DC office and, unlike other suicide prevention group representatives I have contacted in the past, I found this woman surprisingly interested and receptive to the idea that we should not discriminate against certain people when it comes to suicide prevention and treatment. She even asked for my contact information.

Of course, the AFSP may decide to exclude potential assisted suicide victims like other organizations have done but at least I tried and that’s the best tribute I can give to my daughter now.

Promoting ‘Rational’ Elder Suicide

This article was published by National Review online on September 6, 2018.

Wesley Smith

By Wesley Smith

September 10 is World Suicide Prevention Day. I used to call the annual event “Invisible Suicide Prevention Day” because it is so often ignored in major media.

But perhaps we should change that name to “World Prevent Just Some Suicides Day.” A mere five days prior to the big event, two columns were published in major newspapers that, at the very least, present elder suicide in a sympathetic light or, one could even say, praise it with faint damnation.

The first is from the New York Times by “The New Old Age” columnist Paula Span. In “A Debate Over ‘Rational Suicide,'” Span seems sympathetic to the argument that we should empower some elderly people to kill themselves. Oh sure, she expresses concerns — an elderly suicidal person could be mentally ill, the slippery slope, etc. — but her prime focus is supportive, unsurprising as she has also been favorably disposed toward suicide-by-self-starvation for seniors. From her essay:

The size of the baby boomer cohort, with the drive for autonomy that has characterized its members, means that doctors expect more of their older patients to contemplate controlling the time and manner of their deaths.

Not all of them are depressed or otherwise impaired in judgment. “Perhaps you feel your life is on a downhill course,” said Dena Davis, a bioethicist at Lehigh University who has written about what she calls “pre-emptive suicide.”

“You’ve completed the things you wanted to do. You see life’s satisfactions getting smaller and the burdens getting larger — that’s true for a lot of us as our bodies start breaking down.”

At that point, “it might be rational to end your life,” Dr. Davis continued . . . “We ought to start having conversations that challenge the taboo” of suicide, she said.

However heated the arguments become, as religious groups and disability activists and right-to-die proponents weigh in, there’s agreement on that point, at least. Reflexively negative reactions to an older person’s mere mention of suicide — Don’t say that! — shut down dialogue.

This is more that a mere “taboo.” Social disapproval of suicide is important and rational. It saves lives.

True, a “Don’t say that!” response isn’t helpful. But unequivocal loving and empathetic suicide-prevention efforts are. In all cases! That’s not the same as “dialogue.” It is treatment.

Meanwhile, in the Orange County Register, columnist David Whiting depicts elder suicide as a matter of “taking control” and “reasoned suicide.” His mother overdosed on animal sedatives obtained from Mexico — a suicide method pushed by the odious Australian suicide fanatic, Phillip Nitschke. Only she apparently found out where and how to obtain the poison in the New York Times.

From “Some Aging Seniors Are Stretching the Legal Bounds of Death with Dignity by Taking Control of their End of Life“:

Along with an unknown number of other seniors, Alice Whiting made her way to Tijuana and bought a bottle of veterinary pentobarbital, the gold standard of poisons, the same brew that has been used in putting convicts to death.

With a little sleuthing, I discovered that she found her “where and how” in a 2008 New York Times article that is more “how to” than necessary.

Rather than being upset with the Times for giving his mother a map to obtain lethal pills, Whiting seems supportive of his mother’s suicide:

Me? I wish I could have dinner with Mom tonight, and I don’t subscribe to what I consider Mom’s early death.

But I do subscribe to the idea that we should be allowed to control our end of life. Moreover, I subscribe to shedding light on something in the shadows.

But he isn’t just shedding light. Whiting does not advocate increased vigilance over the mental health of our elders or improved efforts to combat elder suicide. Rather, he concludes on a suicide-positive note:

Two months later, my father asks for every detail about his wife’s death. It becomes painfully clear he has struggled for weeks to understand what happened.

We talk for a very long time. I conclude, “Mom went out exactly the way she wanted and she loved you very much.” Dad smiles.

Experts and medical journals state risk factors for suicide include depression, bipolar disorder, schizophrenia, personality disorders and substance abuse.

But they don’t mention anything about aging or a reasoned life lived in full.

This is very dangerous stuff for the elderly and indeed, any suicidal person struggling to remain on earth.

Suicide is contagious. That is why the World Health Association has warned the media against publishing articles that sympathetically depict suicide, describing the methods used in detail, or otherwise presenting it in a positive light. That caveat is increasingly ignored, as in these cases.

Let’s hope World Suicide Prevention Day advocates explicitly for the lives of our elders, no exceptions. And let’s hope the Times and other media pay as much attention to prevention efforts as they do to the promotion of some suicides.