Euthanasia and Assisted Suicide: What in the World is Going On?

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Euthanasia and assisted suicide are legal in a few jurisdictions in the world, but most countries have rejected their legalization.

Most recently, legislation to legalize euthanasia and/or assisted suicide has been rejected in France, Israel, England, Scotland, Australia, Canada, Bulgaria, etc. In the U.S., where there have been well over 100 legislative proposals to legalize physician-assisted suicide (PAS) since 1994, California, Hawaii, New Hampshire, Vermont, Connecticut, and more have recently rejected it. (1)

In the United States, assisted suicide was legalized by voter initiatives in Oregon in 1994 and Washington State in 2008. (2) A 2009 Montana Supreme Court ruling did not legalize assisted suicide but it did create a potential defense, based on consent of the patient, for physicians who are prosecuted for assisted suicide. In 2011, a bill to prohibit PAS and a bill to create regulations for PAS were both introduced in the MT legislature. Neither bill had enough votes for passage. (3)

In May 1995, Australia’s northern territory became the first jurisdiction in the world to legalize euthanasia. The law went into effect in June 1996 but was overturned by the Australian government in March 1997. (4)

The Netherlands officially legalized euthanasia and assisted suicide in April 2002. Previous to that, the Dutch Courts approved the practice of euthanasia and assisted suicide. Some people suggest that there are no problems with the Dutch euthanasia law, but in fact there is significant abuse and the slippery slope has been very steep. (5)

In the beginning, the Dutch euthanasia law applied only to people who were terminally ill and suffering uncontrolled pain. Now the law applies to people with physical and mental pain, people with chronic conditions, infants with disabilities (Groningen Protocol), people with dementia or Alzheimer’s, and the current push is to allow euthanasia for people who are 70 years old and “tired of living.” (6) The most recent Dutch government study found that every year there are approximately 550 intentionally caused deaths without request or consent and approximately 20% of euthanasia deaths are not reported. (7)

In Belgium, euthanasia was legalized in 2003. Recent studies have revealed significant abuses of euthanasia and signs that it is “out-of-control.” Independent studies, published in May 2010, looked at the practice of euthanasia in the Flanders region. They revealed that 32% of the euthanasia deaths in that region were done without request or consent (8) and that 45% of all euthanasia deaths done by nurses in Belgium are without request or consent. (9) Another highly disturbing study published in October 2010 found that nearly half of the euthanasia deaths in the Flanders region are not reported and that “controversial” euthanasia deaths are usually not reported. Under-reporting explains why the “official” Belgium government report suggests that few if any problems exist. (10)

When looking at the studies concerning euthanasia in the Netherlands and Belgium, one must conclude that choice and autonomy (self-determination) are only the sales slogans for gaining societal acceptance of euthanasia; that in fact euthanasia has become a way to eliminate human lives deemed, by others, to be not worth living. (11)

Much research proves a direct connection between depression and requests for euthanasia or assisted suicide. Published in 2005, a study by a Dutch doctor who supports euthanasia found that people who had cancer were 4.1 times more likely to request euthanasia if they were depressed or experiencing feelings of hopelessness. (12) A similar study in Oregon, published in 2008, found that 26% of the people who requested euthanasia were depressed or experiencing feelings of hopelessness. The Oregon PAS law has a “supposed” safeguard that requires physicians to refer for psychological assessment anyone who requests assisted suicide and has signs of depression. (13) Nevertheless, of 124 people who died by assisted suicide in Oregon (2009 and 2010), only one was sent for a psychiatric or psychological assessment. (14) Yes, depressed people in Oregon are dying by assisted suicide.

Then there is the growing scourge of elder abuse in our culture. Legalizing euthanasia or assisted suicide creates new paths of abuse. Elder abuse is rarely reported because it is most often perpetrated by a person upon whom the victim is dependent. In the same way, a vulnerable person who is experiencing abuse can be steered to suicide when the law allows doctors to prescribe death. (15)

The euthanasia lobby promotes death on demand based on choice and autonomy. (16) This is an illusion. The legalization of euthanasia and assisted suicide does not give you the “right to die.” It gives another person, usually a physician, the right to intentionally and directly cause your death.

Bulgarian Parliament Committee resolutely rejects euthanasia bill

The Health Committee of the Bulgarian Parliament has overwhelmingly rejected a proposed bill to legalize euthanasia. The bill was tabled last week by socialist MP Lyuben Kornezov.

An article that was published today by the Novite.com news agency stated:

The committee voted with 12 members against and 1 abstention, with Kornezov's fellow MPs from the Bulgarian Socialist Party also being widely against.

Vanyo Sharkov and Hasan Ademov from arch-rivals rightist Blue Coalition and ethnic Turkish Movement for Rights and Freedoms united in an all-out rejection of euthanasia as going against the principles of beneficence in medicine.

Ruling center-right GERB party Djema Grozdanova said that euthanasia could be introduced only after an extensive and deep debate within the whole society, something which has not happened in Bulgaria.

Socialist Yanaki Stoilov argued that euthanasia could be introduced only in a country where the health system is at a sufficiently high level, which he saw as plainly not being the case in Bulgaria.

Kornezov defended his legislative proposal, arguing for the right to die with dignity, and defending it as a case of well-doing in extreme cases.

Committe MPs nevertheless were firmly against the bill and went on to reject it.

Euthanasia is falsely sold to society as a "freedom of choice". In fact, legalizing euthanasia does not grant an individual freedom but rather it gives doctors the right to lethally inject their patients.

Euthanasia and assisted suicide threaten the most vulnerable in society by enabling family members and medical care givers to steer people towards death by lethal dose.

The Health Committee of the Bulgarian parliament has made the right decision.

A Response to The Nation: Legal Assisted Suicide is a Recipe for Abuse; Health Care Providers are Empowered to Steer Patients to Suicide

By Margaret Dore, an attorney in Washington State who specializes in issues related to elder abuse. Link to her website.

Yesterday, NPR and The Nation featured a pro-assisted suicide commentary by Ann Neumann. [The Nation: Keeping the Right to Die Alive].(1) Her commentary overlooked gaps in the Oregon and Washington assisted-suicide laws. She uncritically accepted Compassion & Choices marketing claims that it promotes patient choice for "terminal" patients. This blog post presents the other side.

A Recipe for Abuse
Physician-assisted suicide laws in Oregon and Washington have gaps that put patients at risk.(2) The most obvious gap is a lack of witnesses at the death.(3) Without disinterested witnesses, the opportunity is created for someone else to administer the lethal dose to the patient against his will. Even if the patient struggled, who would know?

Barbara Coombs Lee is a Former "Managed Care Executive"

Neumann's commentary describes Compassion & Choices and its president, Barbara Coombs Lee, as promoters of patient choice.(4) Compassion & Choices is the former Hemlock Society.(5) It advocates for legal physician-assisted suicide, which it terms "aid-in-dying."

In 2008, Oregon resident Barbara Wagner wanted treatment for cancer.(6) The Oregon Health Plan (Medicare) offered her assisted-suicide instead.(7) After Wagner’s death, Barbara Coombs Lee wrote an criticizing Wagner for her choice to be treated.(8) Coombs Lee also defended the Oregon Health Plan, which had steered Wagner to suicide.(9)

Perhaps not a coincidence, Coombs Lee is a former "managed care executive."(10) She argued against Barbara Wagner's choice.

Ending Lives

Compassion & Choices advocates for assisted suicide for "terminally ill adult patients," which as defined by Compassion & Choices would include young people with "decades" to live. This is what Compassion & Choices proposed in Montana in 2009. See pages 1 to 3 at - link.

In Oregon and Washington, terminal is defined in terms of having less than six months to live. Even then, the people at issue are not necessarily dying. This is the point of a 2009 article from Washington State: Patients can live years beyond expectations.(11)

With the topic of "aid in dying," the people at issue are not necessarily dying. They may have years or even decades to live. For these people, Compassion & Choices' advocacy is about ending their lives.

Fighting Back
In 2010, Compassion & Choices claimed that assisted suicide was legal in Idaho. A former Chief Justice of the Idaho Supreme Court denounced the claim as "false."(12) In 2011, the Idaho legislature enacted a statute to strengthen Idaho’s law against causing or aiding a suicide.(13)

In 2011, proposed assisted suicide bills failed in Montana, Hawaii and New Hampshire.(14) In New Hampshire, the Committee report to defeat the bill stated:

"This bill is a recipe for . . . abuse. The committee also recognizes that doctors’ diagnoses and predictions may be incorrect; numerous cases exist where people have lived far beyond their doctor’s predictions, some of them having been cured from their terminal disease. . . .This bill represents bad policy and practice . . ."

House Journal, Vol. 33, No. 28, p. 883-885.

Conclusion

The claim that legal assisted suicide promotes patient choice is marketing rhetoric. These laws are a recipe for abuse. They empower health care providers to steer patients to suicide. They encourage citizens to cut short their lives. Don’t be fooled.

Link to the original article.

A summary: To Live Each Day with Dignity

The US Conference of Catholic Bishops (USCCB) approved a statement on assisted suicide at their recent meeting. The Euthanasia Prevention Coalition (EPC)recognizes that people oppose assisted suicide for varying reasons and many of these reasons were well explained by the Bishops document: To Live Each Day with Dignity.

The Californians Against Assisted Suicide commented on the USCCB statement by stating:
Californians Against Assisted Suicide coalition member Marilyn Golden, policy analyst for the Disability Rights, Education and Defense Fund, found areas of agreement with the United States Council of Catholic Bishops' recent public policy statement on the dangers of assisted suicide legalization, including:

• The danger to people with depression,
• The concerns of the disability community,
• The significant and dangerous lack of scrutiny and oversight where assisted suicide is legal,
• The potential for undue influence by others,
• The significant ambiguity in the definitions of terminal illness,
• The significant risk to the very people supposedly served: people with serious illness, and
• The importance of continuing improvement in palliative care.

Golden states:

"It is critical that society gains a greater awareness about these concerns."

After reading To Live Each Day with Dignity, EPC decided it would be important to highlight some of its important points.

The document frames the societal response to assisted suicide in the context of the proper response by society to the legitimate fear that an individual has in relation to human difficulties at the most vulnerable time of their life.

The document responds to the concerns of people by breaking it down into specific issues.

The document responds to the question of freedom by pointing out that often people who ask for a lethal dose are doing so as a response to depression or mental illness. The document states that:

“However, suicidal persons become increasingly incapable of appreciating options for dealing with these problems, suffering from a kind of tunnel vision that sees relief in death. They need help to be freed from their suicidal thoughts through counseling and support and, when necessary and helpful, medication.”

The document acknowledges the weak attempts by the assisted suicide lobby to ‘safeguard’ people with depression or mental illness from assisted suicide by stating:

“Many such proposals permit—but do not require—an evaluation for mental illness or depression before lethal drugs are prescribed. In practice such evaluations are rare, and even a finding of mental illness or depression does not necessarily prevent prescribing the drugs (lethal dose). No evaluation is done at the time the drugs are actually taken.”

“In Oregon and Washington, for example, all reporting is done solely by the physician who prescribes lethal drugs. Once they are prescribed, the law requires no assessment of whether people are acting freely, whether they are influenced by others who have financial or other motives for ensuring their death, or even whether others actually administer the drugs. Here the line between assisted suicide and homicide becomes blurred.”

The document concludes the section by stating:

“People who request death are vulnerable. They need care and protection. To offer them lethal drugs is a victory not for freedom but for the worst form of neglect. Such abandonment is especially irresponsible when society is increasingly aware of elder abuse and other forms of mistreatment and exploitation of vulnerable persons.”

The next part of the document focuses on how legalizing assisted suicide devalues the lives groups of people, including people with disabilities. The document states:

“Legalization proposals generally… define a class of people whose suicides may be facilitated rather than prevented. … Many people with chronic illnesses, or disabilities—who could live a long time if they receive basic care—may be swept up in such a definition (terminal illness).”

“By rescinding legal protection for the lives of one group of people, the government implicitly communicates the message … that they may be better off dead. Thus the bias of too many able-bodied people against the value of life for someone with an illness or disability is embodied in official policy.”

The conclusion to this section can be summed up this way:

“Those who choose to live may then be seen as selfish or irrational, as a needless burden on others, and even be encouraged to view themselves that way.”

“Many people with illnesses and disabilities who struggle against great odds for their genuine rights … are deservedly suspicious when the freedom society most eagerly offers them is the “freedom” to take their lives.”

The third part of the document focuses on how assisted suicide threatens authentic human freedom. The comments can be summed up in this way:

“in countries that have used the idea of personal autonomy to justify assisted suicide and euthanasia, physicians have moved on to take the lives of adults who never asked to die, and newborn children who have no choice in the matter. They have developed their own concept of a “life not worth living” that has little to do with the choice of the patient.”

To Live Each Day with Dignity then examines the essence of compassion. The document states:

“True compassion alleviates suffering while maintaining solidarity with those who suffer. It does not put lethal drugs in their hands and abandon them to their suicidal impulses, or to the self-serving motives of others who may want them dead. It helps vulnerable people with their problems instead of treating them as the problem.”

False compassion run amok leads to a “slippery slope.” The document states:

“Dutch doctors, who once limited euthanasia to terminally ill people, now provide lethal drugs to people with chronic illnesses and disabilities, mental illness and even melancholy. … the physicians who has begun to offer death as a solution for some illnesses is tempted to view it as the answer for an ever-broader range of problems.”

“This agenda actually risks adding to the suffering of seriously ill people. Their worst suffering is often not physical pain, which can often be alleviated with competent medical care, but feelings of isolation and hopelessness.”

“Even health care providers’ ability and willingness to provide palliative care such as effective pain management can be undermined by authorizing assisted suicide. … Government programs and private insurers may even limit support for care that could extend life, while emphasizing the “cost-effective” solution of a doctor prescribed death.”

The document ends by emphasizing that there is A Better Way to deal with the problems that naturally exist within the human condition.

The Better Way includes:

1. Society should embrace “the way of love and true mercy” by surrounding people in need with love, support and companionship, providing the assistance needed to ease their physical, emotional and spiritual suffering.
2. There is no requirement to prolong life by using medical treatments that are ineffective or truly burdensome.
3. We must not deprive people who are suffering the necessary pain medications out of a concern related to side-effects or the possible shortening of life. Providing effective pain relief will not generally shorten life and when provided will alleviate the fear and desperation that may lead to a person considering suicide.
4. Effective palliative care provides time for people to devote their attention to the unfinished business in their lives. This time is not useless or meaningless.

The document concludes by encouraging Catholics to join with other concerned people, including disability rights advocates, charitable organizations, and medical professionals to defend the dignity of people with serious illnesses and disabilities and to promote life-affirming solutions to human problems and hardships. The claim of a “quick fix” by lethal overdose is not a substitute for a caring community.

The document then challenges Catholic people to build a caring society. It states:

“The choices we make together now will decide whether this is the kind of caring society we will leave to future generations.”

The Euthanasia Prevention Coalition calls on everyone of good will to recognize how choice is really an illusion.

Legalizing euthanasia will give doctors the right to prescribe death for their patients. It will not grant a right to die, but rather a right to be killed.

Dr. Clare Walker states: Unofficial euthanasia is practiced in the UK

The problem of covert euthanasia has been asserted by Dr. Clare Walker, The President of the Catholic Medical Association in the UK, recently stated that:

"euthanasia is being widely practiced in the NHS in an official way."

Dr. Walker explained that:

"she is regularly contacted by distressed healthcare professionals and managers who describe their experience of witnessing repeated instances of unofficial active euthanasia in their local areas"

She stated:

The standards of medical ethics and of interpretation of existing legislation appears to vary greatly around the country and from one organization to the next, even in the same local area.

Whether active euthanasia is actually widespread is unknown and anecdotal at best, but the reality is that the Euthanasia Prevention Coalition regularly receives phone calls and emails from family members and friends of people whose medical care-givers appear to be intentionally causing their death. Many of these cases are concerned family members reacting to end of life decisions that are made because the person is actually dying, whereas, sometimes these cases appear to be euthanasia.

Dr. Walker made reference to the application of the Liverpool Care Pathway (LCP) that was developed by the Royal Liverpool Hospital and the Marie Curie hospice in the 1990's.

The LCP is a set of criteria that is used to withdraw Life-Sustaining Treatment and a philosophy for the application of palliative care. There have been reports that indicate people, who were not otherwise dying, being dehydrated to death based on the LCP.

Concerning the LCP, Walker stated:

"If it is used out of context, then it could be used to the detriment of patients e.g. a patient comes into a resuscitation baby and it is not always clear if a condition is acute and can be treated."

Walker reported on a recent survey that was done by a colleague that examined crematorium records. The survey found that 23% of all deaths, in one city, of people who were put on the LCP that there had been no definite diagnosis at any stage.

Walker does not blame the LCP for what appears to be abuses that is causing death, but rather she blames the application of the LCP.

For instance, it is euthanasia to intentionally cause a persons death by dehydration, when that person is not otherwise dying. This is how Terri Schiavo died. It is not euthanasia to withhold hydration and nutrition (H & N) from a person who is actively dying and/or unable to assimilate H & N. That person is actually dying and the provision of H & N provides little to no benefit and may cause suffering.

Walker stated:

"The problems come when an idol is made of the protocols. It is the same story with anything if you make an idol of it you lose common sense and critical faculties."

She referred to this problem as

“tick box itus.”

If Walkers assessment is correct, most of these deaths are not euthanasia but rather medical malpractice or deaths related to physician error.

Gordon Macdonald of the Care Not Killing Alliance in the UK questioned that covert euthanasia is widespread in the UK. Macdonald stated that:

"Of course we share concerns over abuses,” he said. “Anecdotally we hear stories of certain care homes with questionable practices but generally we would not accept it’s widespread."

Walker may be understating the problem with LCP. She is correct to state that when protocols are abused, that it can result in the death of a person, who may have recovered with proper treatment. But the LCP does not prevent doctors from intentionally dehydrating people to death who are not otherwise dying.

Many physicians do not share Walker’s ethical principles and may use LCP as a protocol to intentionally and directly cause death (euthanasia) rather than unintentionally causing death out of a lack of proper training.

We must not to overstate the problem of covert euthanasia, as the euthanasia lobby does in order to promote euthanasia, and yet at the same time we must be vigilant to protect vulnerable people from backdoor euthanasia.

Physician-Assisted Suicide: A Recipe for Elder Abuse and the Illusion of Personal Choice

Link to the original article:



Margaret Dore

By: Margaret K. Dore, Esq.

"Elders and people with disabilities are, as a group, at high risk for violence, abuse and exploitation."
Vermont Center for Crime Victim Services[1]

Introduction

In 2009, a legislative proposal to legalize physician-assisted suicide in Vermont was introduced, but not brought to a vote.[2] The proposal was modeled on Oregon’s assisted suicide act.[3] Oregon is one of just two states where assisted suicide is legal. In Vermont, proponents have indicated that they will be backing a similar proposal in the 2011 legislative session.[4]

Physician-Assisted Suicide

The American Medical Association (AMA) defines physician-assisted suicide as follows: “Physician-assisted suicide occurs when a physician facilitates a patient’s death by providing the necessary means and/or information to enable the patient to perform the life-ending act (e.g., the physician provides sleeping pills and information about the lethal dose, while aware that the patient may commit suicide).”[5]

The AMA rejects assisted suicide.[6] Assisted suicide is also opposed by disability rights groups such as the Disability Rights Education and Defense Fund, and Not Dead Yet.[7]

Most States and Canada Do Not Allow Assisted Suicide

The vast majority of states to consider assisted suicide, have rejected it.[8] In 2010, New Hampshire and Canada rejected it by wide margins.[9] In Vermont, legislative proposals to enact assisted suicide have failed multiple times.[10]

There are just two states where assisted suicide is legal: Oregon and Washington. These states have acts that give doctors and others immunity from criminal and civil liability.[11] In Montana, there is a court decision that gives doctors a potential defense to criminal prosecution, but does not legalize assisted suicide by giving doctors and others criminal and civil immunity.[12]

The Oregon and Washington Acts

Oregon’s act was passed via a ballot initiative and went into effect in 1997.[13] Washington’s act was passed via another initiative and went into effect in 2009.[14] Washington’s act is modeled on Oregon’s act.[15]

In both states, voters were promised that assisted suicide would assure their choice over the manner and timing of their deaths.[16] Both the Oregon and Washington acts, however, have significant gaps so that such choice is not assured. For example, neither act requires witnesses at the death.[17] Without disinterested witnesses, the opportunity is created for someone else to administer the lethal dose to the person without his consent. Even if he struggled, who would know?

Oregon and Washington are also “Don’t Ask, Don’t Tell” states. Required official forms and reports do not ask about or report on whether the person who died consented to administration of the lethal dose.[18] Consent at the time of death is also not required by the language of the acts themselves.[19] Without the right to consent at the time of administration, the claimed control over the manner and timing of death is an illusion. Once again and contrary to marketing rhetoric, choice is not assured.

The Vermont Proposal

In 2009, the proposal to legalize assisted suicide in Vermont consisted of two identical bills: Senate Bill S.144 and House Bill H.455.[20] As in Oregon and Washington, proponents claimed that choice would be assured.[21] This choice was, however, not assured. Like Oregon and Washington, the proposal lacked witnesses at the death.[22] The proposal also failed to require consent when the lethal dose was administered.[23] Two of the proposal’s other gaps are discussed below.

“Self-administer”

The Vermont proposal stated that a person “may request medication to be self-administered for the purpose of hastening his or her death.”[24] There was, however, no language stating that administration "must" be by self-administration.[25] This left the door open to someone else administering it. Without a clear right to self-administration, the person’s ability to choose the manner and timing of death was not assured.[26]

Interested parties

The Vermont proposal had an application process to obtain the lethal dose, which included a written request form with two required witnesses.[27] The witnesses were not allowed to be interested parties, such as a beneficiary of the patient’s will who would benefit financially from the death.[28] The proposal did not, however, prohibit interested persons from procuring the patient’s signature.[29] An example of procurement would be: providing the lethal dose request form; recruiting the witnesses; and supervising the signing.

In the context of signing a will, a beneficiary’s procurement of the will is a “suspicious circumstance,” capable of supporting a presumption of undue influence. The Vermont Supreme Court in Estate of Raedel states: “[I]n cases of suspicious circumstances, usually ‘the beneficiary has procured the will to be made or has advised as to its provisions.’”[30]

Other states have similar laws. Burns v. Kabboul, a Pennsylvania case, states: “It will weigh heavily against the proponent [of the will] on the issue of undue influence when the proponent was … present at [its] dictation … ”[31] The Vermont proposal's lethal dose request process, which allowed interested parties to procure the person's signature on the lethal dose request form, did not promote choice. It invited coercion.

Not Necessarily Dying

The Vermont proposal applied to “terminal” patients, defined as having no more than six months to live.[32] Such persons are not necessarily dying. Doctor prognoses can be wrong.[33] Moreover, treatment can lead to recovery. Oregon resident, Jeanette Hall, who was diagnosed with cancer and told that she had six months to a year to live, states:

I wanted to do our law and I wanted my doctor to help me. Instead, he encouraged me to not give up and ultimately I decided to fight. I had both chemotherapy and radiation … It is now nearly 10 years later. If my doctor had believed in assisted suicide, I would be dead.[34]

Expanded Definitions of “Terminal”

In other states, proponents of assisted suicide have proposed expanded definitions of terminal for the purpose of assisted suicide. If these definitions would be enacted in Vermont in 2011, assisted suicide would apply to people who are clearly not dying. Consider, for example, an Oregon style bill introduced in New Hampshire in 2009 and defeated in 2010.[35] When originally introduced, it contained the following definition of “terminal condition”:

XIII. “Terminal condition” means an incurable and irreversible condition, for the end stage of which there is no known treatment which will alter its course to death, and which, in the opinion of the attending physician and consulting physician competent in that disease category, will result in premature death.[36]

Stephen Drake, of the disability rights group Not Dead Yet, explains the definition’s significance, as follows:

“[T]erminality is defined as having a condition that is irreversible and will result in a premature death. My partner [a wheelchair user] would fit that definition. Many people I work with also fit the definition. None of them are dying.”[37]

In Montana, Compassion & Choices, a suicide proponent, proposed this definition of “terminally ill adult patient”: “[An adult] who has an incurable or irreversible condition that, without the administration of life-sustaining treatment, will, in the opinion of his or her attending physician, result in death within a relatively short time.”[38] Attorney Theresa Schrempp and doctor Richard Wonderly provide this analysis:

[The] definition is broad enough to include an 18 year old who is insulin dependent or dependent on kidney dialysis, or a young adult with stable HIV/AIDS. Each of these patients could live for decades with appropriate medical treatment. Yet, they are “terminally ill” according to the definition promoted by [Compassion & Choices].[39]

Not Personal Choice

Once a person is labeled “terminal,” the argument can be made that his or her treatment should be denied in favor of someone more deserving.[40] This has happened in Oregon, where persons labeled “terminal” have not only been denied coverage for treatment, they have been offered coverage for suicide instead.[41] The most well-known case involves Barbara Wagner, who had lung cancer.[42] The Oregon Health Plan refused to pay for a drug to possibly prolong her life and offered to pay for her suicide instead.[43]

After Wagner’s death, Compassion & Choices’s president, Barbara Coombs Lee, published an editorial arguing against Wagner’s choice to try and beat her cancer.[44] Coombs Lee also defended the Oregon Health Plan and argued for a public policy change to discourage people from seeking cures.[45]

The editorial, combined with Compassion & Choices’ expanded definitions of terminal, provides a glimpse into that organization’s true agenda: it is not the promotion of personal choice. Indeed, the opposite would appear to be true.

A Bipartisan Vote Defeats Assisted Suicide

In January 2010, the Oregon-style New Hampshire bill discussed above was defeated in the New Hampshire House of Representatives, 242 to 113.[46] New Hampshire Representative Nancy Elliott states: “[M]any legislators who initially thought that they were for the act became uncomfortable when they studied it further."[47] At that time, the New Hampshire House of Representatives was controlled by the Democratic Party.[48] The vote to defeat assisted suicide was bipartisan.[49]

Legalization Will Create New Paths of Abuse

In Vermont, there are an estimated 3,750 cases of violence and abuse against elders each year.[50] Nationwide, elder financial abuse is a crime growing in intensity, with perpetrators often family members, but also strangers and new “best friends.”[51] Victims are even murdered for their funds.[52]

Elder abuse is often difficult to detect. This is largely due to the unwillingness of victims to report. “Shame, dependence on the abuser, fear of retribution, and isolation from the community are significant obstacles that discourage elders from reporting … ”[53]

In Vermont, preventing abuse of vulnerable adults, including the elderly, is official state policy.[54] If assisted suicide would be legalized via an Oregon-style act, the gaps would create new paths of abuse against the elderly, which is contrary to that policy. Moreover, some gaps cannot be filled. Representative Elliott states: “[Assisted suicide] acts empower heirs and others to pressure and abuse older people to cut short their lives. This is especially an issue when the older person has money. There is no assisted suicide bill that you can write to correct this huge problem.”[55]

People With Disabilities

In Oregon and Washington, the prescribing doctor is required to complete a reporting form after the person’s death.[56] In both states, this form includes a check-the-box question listing seven “concerns” to justify the lethal dose request.[57] These concerns include: “loss of dignity,” “loss of autonomy,” and “decreasing ability to participate in activities that made life enjoyable.”[58]

Each year, Oregon and Washington each issue a report based on the information provided.[59] In 2010, William J. Peace wrote this response to Washington’s first report, regarding its devaluation of people with disabilities. He stated:

I am a professional writer who has been paralyzed since I was 18 years old … I cannot walk and hence have lost some individual autonomy. In the estimation of many that can walk, my existence is not dignified. There are activities I once enjoyed that I can no longer do … But my life does have value and I am chilled to the bone by … [the report that] has the not-so-subtle implication that my life, and the lives of others like me, do not.[60]

In Vermont, adults with physical disabilities are “vulnerable adults” entitled to protection under Vermont’s Adult Protective Services Statute.[61] To enact an Oregon-style law would devalue such persons and would be counter to the intent of that statute to protect people with disabilities.[62]

The Oregon Suicide Statistics

Oregon’s suicide rate, which excludes suicide under Oregon’s assisted suicide act, is 35% higher than the national average.[63] This rate has been “increasing significantly since 2000.”[64] Just three years prior, in 1997, Oregon legalized assisted suicide.[65] There is at least a statistical correlation between these two events.

Regardless, how can Oregon or Vermont credibly tell its citizens that "suicide is not the answer" when it also tells them that suicide is “death with dignity?” In Vermont, preventing suicide is official state policy.[66] Vermont should not enact a proposal that contradicts this policy.

Conclusion

Legalization of assisted suicide is a recipe for elder abuse. It devalues people with disabilities. Its promise of individual choice is an illusion. Vermont has repeatedly rejected assisted suicide. Don’t make Oregon and Washington’s mistake.

Margaret K. Dore, Esq., is an elder law/appellate attorney in Washington state, where assisted suicide is legal. She has been licensed to practice law since 1986. She is a former Law Clerk to the Washington State Supreme Court for then Chief Justice Vernon Pearson. She is a former Law Clerk to the Washington State Court of Appeals to Judge John A. Petrich. She is a former Chair of the Elder Law Committee of the American Bar Association Family Law Section. She is admitted to practice in the United States Supreme Court, the Ninth Circuit Court of Appeals, the United States District Court of Western Washington and the State of Washington. For more information, see www.margaretdore.com.

End Notes:
[1] Elder Abuse Public Education Campaign, Vermont Center for Crime Victim Services, at http://www.ccvs.state.vt.us/pub_ed/index.html (last visited Dec. 24, 2010).
[2] The Vermont proposal consisted of two identical bills: Senate Bill S.144 and House Bill H.455, http://www.leg.state.vt.us/docs/2010/bills/Intro/S-144.pdf (last visited Dec. 24, 2010) and http://www.leg.state.vt.us/docs/2010/bills/Intro/H-455.pdf (last visited Dec. 24, 2010).
[3] S.144 and H.455 had the same basic structure as Oregon’s act. See Or. Rev. Stat. § 127.800-.995, http://www.oregon.gov/DHS/ph/pas/ors.shtml (last visited Dec. 24, 2010). The two Vermont bills also contained findings regarding Oregon’s assisted suicide act. See S.144 & H.455, Sec.1.
[4] See, e.g., www.patientchoices.org (last visited Dec. 24, 2010).
[5] A.M.A. Code of Medical Ethics, Opinion 2.211, http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion2211.shtml (last visited Dec. 24, 2010).
[6] Id.
[7] See http://www.dredf.org/assisted_suicide/index.shtml (last visited Dec. 24, 2010) and www.notdeadyet.org (last visited Dec. 24, 2010).
[8] Int’l Task Force on Euthanasia & Assisted Suicide, Attempts to Legalize Euthanasia/Assisted Suicide in the United States (2009), http://www.internationaltaskforce.org/pdf/200906_attempts_to_legalize_assisted_suicide.pdf (“Between January 1994 and June 2009, there were 113 legislative proposals in 24 states. All were either defeated, tabled for the session, or languished with no action taken.”) (last visited Dec. 24, 2010).
[9] On January 13, 2010, the New Hampshire House of Representatives defeated an Oregon-style assisted suicide act, 242 to 113. See New Hampshire House Record, No. 9, January 13, 2010 regarding HB 304, at http://www.gencourt.state.nh.us/house/caljourns/journals/2010/houjou2010_09.html (last visited Nov. 4 2010). On April 21, 2010, the Canadian Parliament defeated a bill that would have legalized assisted suicide, 228 to 59. See Canadian government website at http://bit.ly/Official_Report_C-384 (last visited October 22, 2010) and How’d They Vote: Bill C-384, at http://howdtheyvote.ca/bill.php?id=2053 (last visited Nov. 4, 2010).
[10] Int’l Task Force, supra at note 8, Vermont’s Assisted Suicide Proposal, http://www.internationaltaskforce.org/vermont.htm (listing failed bills) (last visited Dec. 24, 2010).
[11] See Or. Rev. Stat. § 127.800-.995; Wash. Rev. Code Ann. § 70.245.010-904 (2009).
[12] See, e.g., Greg Jackson & Matt Bowman, Analysis of Implications of the Baxter Case on Potential Criminal Liability, for the Montana Family Foundation (April 2010), at http://www.montanafamily.org/portfolio/pdfs/Baxter_Decision_Analysis_v2.pdf (last visited Dec. 24, 2010).
[13] Oregon’s act was passed as Ballot Measure 16 in 1994 and went into effect in 1997. See Death With Dignity Act, at http://www.oregon.gov/DHS/ph/pas/ors.shtml (last visited Dec. 24, 2010).
[14] See Wash. Rev. Code Ann. § 70.245.903. Washington’s assisted suicide act was passed as Initiative 1000 on November 4, 2008, and went into effect on March 5, 2009. See Center for Health Statistics, Death with Dignity Act, http://www.doh.wa.gov/dwda/default.htm (last visited Dec. 24, 2010). The full text of the Act is available at http://apps.leg.wa.gov/RCW/default.aspx?cite=70.245 (last visited Dec. 24, 2010).
[15] Cf. Or. Rev. Stat. § 127.800-.995 and Wash. Rev.Code Ann. § 70.245.010-904.
[16] See, e.g., Margaret Dore, 'Death with Dignity': A Recipe for Elder Abuse and Homicide (Albeit not by Name), 11 Marq. Elder's Advisor 387, 387 (2010), at http://www.margaretdore.com/pdf/Dore-Elder-Abuse_001.pdf (last visited Dec. 24, 2010).
[17] Or. Rev. Stat. § 127.800-.995; Wash. Rev. Code Ann. § 70.245.010-904.
[18] Id. See also all official forms and reports for both the Oregon and Washington acts, which can be viewed at http://www.oregon.gov/DHS/ph/pas/index.shtml/shtml and http://www.doh.wa.gov/dwda/.
[19] Both the Oregon and Washington acts require that a determination of whether a patient is acting “voluntarily” be made in conjunction with the lethal dose request, not later at the time of administration. See Wash Rev. Code Ann. §§ 70.245.020(1), 70.245.030(1), 70.245.040(1)(a)(d), 70.245.050, 70.245.120(3)(4), 70.245.220; Or. Rev. Stat. §§ 127.805 § 2.01(1), 127.810 § 2.02(1), 127.815 § 3.01(1)(a)(d), 127.820 § 3.02, 127.855 § 3.09(3), 127.855 § 3.09(4), 127.897 § 6.01.
[20] See supra at note 2.
[21] See, e.g., www.patientchoices.org (stating that the 2009 bills will “[a]ssure that mentally-competent persons who are terminally ill have the right to choose the manner and timing of death”) (last visited Dec. 24, 2010).
[22] See S.144 and H.455 in their entirety, supra at note 2.
[23] S.144 and H.455's provisions requiring that a determination be made of whether a patient is acting “voluntarily” or “free from duress or undue influence” are in conjunction with the lethal dose request, not later at the time of administration. See S.144 and H.455 at §§ 5281(a)(1), (c); 5282(1)(C), (4); 5283; 5289(a)(4); and 5296.
[24] S.144 and H.455 at § 5281(a)(1).
[25] See S.144 and H.455 in their entirety.
[26] In Washington’s act, “self-administer” is a specially defined term that allows someone else to administer the lethal dose. See Margaret K. Dore, Death with Dignity: What Do We Tell Our Clients?, Wash. St. B. Ass’n B. News, July 2009, at http://wsba.org/media/publications/barnews/jul-09+deathwithdignity.htm (last visited Dec. 24, 2010).
[27] See S.144 and H.455 at §§ 5281(c) & 5296.
[28] Id.
[29] See S.144 and H.455 in their entirety.
[30] 152 Vt. 478, 483-4, 568 A.2d 331 (1989).
[31]. 595 A.2d 1153, 1163 (Pa. Super. Ct. 1991).
[32] S.144 and H.455 at § 5280(11).
[33] Nina Shapiro, Terminal Uncertainty, Seattle Weekly, Jan. 14, 2009, at www.seattleweekly.com/2009-01-14/news/terminal-uncertainty (Last visited August 8, 2010).
[34] Jeanette Hall, Letter to the Editor, Second life, Missoula Independent, June 17, 2010. Author confirmed accuracy with both Ms. Hall and her doctor.
[35] New Hampshire House Record, regarding HB 304, supra at note 9 (“This bill is modeled on the Oregon death with dignity law”).
[36] New Hampshire Bill, H.B. 304-L:2, XIII.
[37] Stephen Drake, New Hampshire Poised to Redefine “Terminally Ill” to PWDs and Others for Assisted Suicide Eligibility, Jan. 30, 2009, http://notdeadyetnewscommentary.blogspot.com/2009/01/new-hampshire-poised-to-redefine.html. Drake’s partner is Diane Coleman, founder of the disability rights organization, Not Dead Yet, who uses a wheelchair.
[38] Plaintiffs’ Responses to State of Montana’s First Discovery Requests, Answer No. 4, Baxter v. Montana, No 2007-787 (Mont. 1st Dist., May 16, 2008), at http://www.margaretdore.com/pdf/C&C_Defines_Terminality.pdf.
[39] Letter from Richard Wonderly, MD, and Theresa Schrempp, Esq., to Alex Schadenberg, Executive Director of the Euthanasia Prevention Coalition, Oct. 22, 2009, http://www.euthanasia prevention.on.ca/ConnMemo02.pdf.
[40] Id.
[41] Id.; Susan Donaldson James, Death Drugs Cause Uproar in Oregon 1, ABC News, Aug. 6, 2008, http://www.abcnews.go.com/Health/Story?id=5517492&page= (last visited Aug. 9, 2010); video transcript of Barbara Wagner, http://www.katu.com/news/26119539.html?video=YHI&t=a (last visited Aug. 8, 2010).
[42] Id.
[43] Id.
[44] Barbara Coombs Lee, Sensationalizing a sad case cheats the public of sound debate, The Oregonian, Nov. 29, 2008, http://www.margaretdore.com/pdf/Coombs_Lee_against_Wagner.pdf.
[45] Id. She stated: “The burning health policy question is whether we inadvertently encourage patients to act against their own self interest, chase an unattainable dream of cure, and foreclose the path of acceptance that curative care has been exhausted … Such encouragement serves neither patients, families, nor the public.”
[46] See New Hampshire House Record, regarding HB 304, supra notes 9 & 35.
[47] Nancy Elliott, Letter to the Editor, Right to Die is Prescription for Abuse, Hartford Courant, May 28, 2010, http://articles.courant.com/2010-05-28/news/hc-elliott-letter-suicide-0528-20100528_1_new-hampshire-abuse-prescription (last visited Nov. 4, 2010).
[48] See New Hampshire website, http://www.gencourt.state.nh.us/house/abouthouse/leadership.htm (“Democrat Mary Jane Wallner … serves as Majority Leader”) (last visited Nov. 4, 2010).
[49] See e-mail message from New Hampshire General Court Staff with vote breakdown by party; a “yea” vote is a vote to defeat the bill: 242 yeas (100 Democrats; 142 Republicans); 113 nays (93 Democrats; 20 Republicans). (On file with author).
[50] Elder Abuse Public Education Campaign, supra note 1.
[51] See MetLife Mature Market Institute, Broken Trust: Elders, Family and Finances, A Study on Elder Abuse Prevention, March 2009, at http://www.metlife.com/assets/cao/mmi/publications/studies/mmi-study-broken-trust-elders-family-finances.pdf (last visited October 22, 2010); Miriam Hernandez, ‘Black Widows’ in court for homeless murders, March 18, 2008, ABC Local, http://abclocal.go.com/kabc/story?section=news/local&id=6027370 (last visited October 2, 2010) (elderly homeless men killed as part of an insurance scam); and People v. Rutterschmidt, 98 Cal.Rptr.3rd 390 (2009), rev. granted; issues limited, 102 Cal.Rptr.3d (2009) (regarding this same case).
[52] See MetLife, supra note 51, at 24; and People v. Stuart, 67 Cal. Rptr. 3d 129, 143 (where daughter killed her mother with a pillow, “financial considerations [are] an all too common motivation for killing someone … ”).
[53] Elder Abuse Public Education Campaign, supra note 1.
[54] See, e.g., Vermont Adult Protective Services Statute, “Reports of Abuse, Neglect and Exploitation of Vulnerable Adults,” 33 V.S.A. § 6902(14)(D)(defining a “[v]ulnerable adult" as a person 18 years of age or older who “is impaired due to … infirmities of aging …” ).
[55] Elliott, supra note 47.
[56] See “Oregon Death with Dignity Act Attending Physician Follow-up Form” at http://www.oregon.gov/DHS/ph/pas/docs/mdintdat.pdf (last visited Dec. 24, 2010) and Washington “Attending Physician’s After Death Reporting Form,” at http://www.doh.wa.gov/dwda/forms/AfterDeathReportingForm.pdf (last visited Dec. 24, 2010).
[57] Oregon form, supra note 56, Question # 15; Washington form, supra note 56, Question # 7.
[58] Id .
[59] Washington’s Report for 2009 can be viewed at http://www.doh.wa.gov/dwda/forms/DWDA_2009.pdf (page 7 summarizes the “concerns”).
[60] William J. Peace, Letter to the editor, sent to the Seattle Times, March 7, 2010 (copy on file with author). The letter was originally written as a blog post. See William J. Peace, Assisted Suicide in Washington: The Death Toll 36, Bad Cripple, March 6, 2010, http://badcripple.blogspot.com/2010/03/assisted-suicide-in-washington-death.html (last visited January 1, 2011).
[61] Tit. 33, ch. 69. See also 33 V.S.A. § 6902(14)(D) (defining a “[v]ulnerable adult” as a person 18 years of age or older who is “impaired due to … a physical … disability”).
[62] See 33 V.S.A. § 6901 (“The purpose of this chapter us to: protect vulnerable adults … ”).
[63] Oregon Health Authority, News Release, Rising suicide rate in Oregon reaches higher than national average, Sept. 9, 2010, at http://www.oregon.gov/DHS/news/2010news/2010-0909a.pdf (Last visited October 13, 2010). An assisted suicide under Oregon’s assisted suicide law is not tallied as a “suicide.” See Or. Rev. Stat. 127.880 § 3.14 (“Actions taken in accordance with ORS 127.800 to 127.897 [the Oregon Death With Dignity Act] shall not, for any purpose, constitute suicide … under the law”).
[64] Oregon Health Authority, Rising suicide rate, supra note 63.
[65] See 2009 Annual Report, Oregon’s Death with Dignity Act, http://www.oregon.gov/DHS/ph/pas/docs/year12.pdf , page 2 ("since the law was passed in 1997) (Last visited October 14, 2010).
[66] See, e.g., 18 V.S.A. § 7101(17)(defining a “person in need of treatment” in terms of "a person who has threatened or attempted suicide") and 28 V.S.A. § 907(6)(G) (regarding training of medical and correctional staff in “[s]uicide potential and prevention”).

Why Safe Voluntary Euthanasia is a Myth

The following article is written by Australian Dr. Brian Pollard who is a retired anaesthetist and palliative care physician, who founded and directed the first full-time palliative care service in a teaching hospital in Sydney Australia at Concord Hospital in 1982 and directed it for five years. He is author of The Challenge of Euthanasia (Little Hills Press, 1994).

The article was printed in Quadrant online:

Why Safe Voluntary Euthanasia is a Myth

The criminal law in Australia holds that the intentional taking of human life is a major criminal offence. This accords with the United Nations Universal Declaration of Human Rights, to which Australia is a signatory, which declares that the right to the integrity of every person’s life is equal, inherent, inviolable, inalienable and should be protected by law.

Since the intentional taking of human life is the specific aim of every euthanasia law, such a law would be unique in the following critically important ways:

• it would intend to subvert the existing law
• it would fail to respect the principle that all are equal before the law
• it would fail to respect the principle that all human lives have equal value, and
• it would attempt to gain legal recognition for the concept of life not worth living.

This would present an impossible task, if honesty were to prevail. It would have to rely on such things as asserted but non-existent human rights, shades of deceit, inexact definitions and words or clauses allowing loose interpretations, rather than objectivity and precision.

The push for legalised medically assisted death in Australia has now increased to the point where bills are before several state parliaments and another is before the Commonwealth parliament to reverse the previous overturning of the Northern Territory legislation. I have analysed most of the previous failed bills and noted their weaknesses. Rather than debate the pros and cons of the social role of euthanasia, I believe that MPs, who have sole responsibility for making safe laws, should direct their attention to ensuring that draft euthanasia bills cannot imperil the lives of innocent people who do not wish to die.

It is evident that the authors of those bills have not read any of the extensive literature on this subject because they invariably include, as so-called safeguards, provisions which are known not to work in practice. A common feature of those who advocate euthanasia bills is their touching faith that certain things will happen, just because the draft prescribes them. If that were true, no crime would ever be committed because all crime is currently forbidden by some law.

In 1958, Yale Kamisar, an American professor of law in this field, wrote a seminal paper in which he listed these basic difficulties: ensuring that the person’s choice was free and adequately informed; physician error or abuse; difficult relationships between patients and their families and between doctors and their patients; difficulty in quarantining voluntary euthanasia from non-voluntary; and risks resulting from this overt breach of the traditional universal law protecting all innocent human life. All these problems still exist and others have been added, such as the critical role of depression in decision-making and the evolution in the moral basis for requesting death from the relief of severe suffering in the terminally ill to reliance on respect for personal autonomy. Some of these will be discussed below.

Definitions are often vague or at odds with ordinary meanings. For example, in place of “terminal illness” one may find “incurable illness”. Many illnesses are literally incurable but do not necessarily cause death or shorten life. Pain and suffering are both highly subjective experiences; neither can be measured or compared between persons, while suffering is often due to social causes rather than medical. According to the drafts, both have to be simply accepted as the person describes them, even when this may raise serious doubt. And, as most now allow, if the symptoms are said to make life “intolerable”, even though it is recognised that what one person finds intolerable others can bear, that claim has only to be made to be incontestable. The situation then will have become virtually one of death on demand.

All bills require the doctor to be “satisfied” that the patient’s request was freely made, though no one could ever know with certainty about coercion from sources of which he was totally unaware. But would coercion be likely? Brian Burdekin, a former Human Rights Commissioner, reported that in his experience, “The most vulnerable were the most likely to be abused and the most likely to be coerced.” Subtle degrees of coercion would be almost impossible to detect.

If a well person asks for death he will be referred for counselling. If a sick person asks, he is as likely to be supported in his “exercise of personal autonomy”. And what of autonomy in the presence of severe illness, especially terminal illness, with its frequent association with depression and unrelieved pain, which powerfully hinder careful evaluation of issues? More importantly, no matter what the patient decides, in every case it will be the doctor’s decision that determines whether euthanasia actually proceeds. Leon Kass, a lawyer and prolific author in this area, wrote that, in view of the totality of the impediments to clear reasoning in such patients, “the ideal of rational autonomy, so beloved of bioethicists and legal theorists, rarely obtains in actual medical practice”.

Doctors are experienced in persuading patients to follow their legitimate advice concerning treatment options, to the point where some have been heard to say, “I can get my patients to do anything I want.” Their power, relative to that of the patient, is large even when there is no intention to manipulate. Euthanasia draft bills require doctors to inform patients about the medical details of their illness and future alternatives. Since such discussions will usually occur in private, one could never know whether such information was accurate, adequate, non-coercive and impartial. If the doctor’s personal view was that euthanasia was appropriate for a patient, we may be sure some would not be deterred from advocating it.

A lot of publicity has lately been given to the fact that some 85 per cent of respondents to opinion polls favour legalised euthanasia. This refers to the Morgan poll which has been using this question for many years: “If a hopelessly ill patient in great pain with absolutely no chance of recovering asks for a lethal dose, so as not to wake again, should the doctor be allowed to give the lethal dose or not?” It is not hard to see why many respondents, whose understanding of the complex matter of euthanasia is unknown, might agree to such an emotionally charged question. Given that repeated polls have shown that most Australian doctors have not received adequate training in palliative care, and sometimes none at all, should anyone be surprised that too often pain is poorly managed? Against that background, the poll question may be truthfully reworded, “If a doctor is so negligent as to leave his patient in pain, severe enough to drive him to ask to be killed, should the doctor be able to compound his negligence by killing the patient, instead of seeking expert help?” The community would be appalled to know how few doctors who must care for dying patients are able to deal with severe pain effectively. The only remedy for this situation will be to introduce mandatory levels of competence in palliative care training in all medical schools. In the meantime, legalising euthanasia will lead inevitably to many needless deaths. Australia has about half the palliative care specialists it needs, all of whom are in cities or big towns.

Too often, draft bills for euthanasia only require the doctor to obtain expert psychiatric advice if he “suspects” the patient is “not of sound mind”, that is, has impairment of competence, which is not the key issue. The literature of psychiatry contains abundant evidence that the sustained wish to die is associated, in a large number of the seriously ill, with depression, which alters mood and inhibits the ability to reason coherently. Not to require consultation by a psychiatrist experienced in the treatment of dying patients whenever a sustained wish to die is encountered, is a negligent omission, especially as such depression is often difficult to diagnose. A published retrospective review of the Northern Territory legislation in its short life showed that relevant psychiatric evidence had been withheld and treatable depression was missed in four of the seven patients whose lives were taken under its provisions. The demoralising combination of depression or despair, anxiety and fear associated with a desire to die, can usually be treated with a mix of empathy, psychotherapy and medication.

The usual superficial approach to this problem is in stark contrast to the following advice from expert psychiatrists: “No request for hastened death can be understood without first attempting to understand the psychological landscape within which the request arises.” One advised, “Never kill yourself when you are suicidal—you are not yourself then.” Accordingly, it has been suggested that the need for better training in the detection of profound psychological disturbance in these patients is as great as that for the relief of severe pain. Even in the Netherlands, there is awareness of past failings, as the former health minister from 1994 to 2002, Mrs Borst-Eilers, commented in 2009, “The government’s move [to legalise euthanasia] was a mistake, we should have first focused on palliative care.”

Wherever voluntary euthanasia is practised, legally or not, non-voluntary is also found, including in Australia. Many find this difficult to credit because, whatever their failings, doctors surely would not take life without any request. In fact, they do it because it seems logical. Once euthanasia for patients who are suffering and ask to be killed is regarded as providing them with a benefit, it will appear, at least to some, that it would be wrong to withhold that benefit from others who suffer as much, but who, for some reason, cannot ask. In their eyes, this would be a matter of compassion. Because the same rationale can be the justification for euthanasia for both groups, the extension of one to the other must be regarded as inevitable and so will be uncontrollable. The Dutch have long since given up trying to prevent non-voluntary euthanasia.

Bills require the doctor to notify the coroner, following euthanasia. Since he will be its sole author, the chief actor and the sole survivor of the event, what chance is there that the doctor will include anything he would not wish the coroner to know?

Some may have found the earlier reference to deceit too strong, but it was not. At length, the draft bill must somehow directly confront the present law which outlaws euthanasia. So, the doctor is required by the bills to certify the death as due to the underlying illness, that is, to lie (though falsifying a death certificate is currently a punishable offence), and the death is not to be regarded, for the purposes of the Act, as any form of homicide, even though it was unquestionably homicide. Truth must yield to weasel words for these bills to succeed.

After euthanasia, the doctor may not be subject to any civil or criminal action, nor to any penalty or loss of privilege by any professional body. With only a few exceptions, medical associations throughout the world hold that euthanasia is forbidden to doctors because it is unethical, that is, morally wrong. Australian state governments establish boards and tribunals to regulate medical practice and they all regard medical life-taking as deserving of deregistration because those doctors are no longer fit to practise, on ethical grounds. These clauses in the bills are included without the consent or authority of the regulators, who regard them as necessary to protect patients against attacks on their lives, in recognition of their genuine human rights. Just now, when it is being more widely recognised that there is a need for more emphasis on ethics in many areas of moral significance, the supporters of euthanasia want to dispense with them altogether. It may be wondered what benefits the community can expect to gain from having unethical doctors.

When all euthanasia draft bills so far put before state parliaments over many years are reviewed, it can be observed that they go to extreme lengths to shield the doctor from the effects of current law, no matter what he or she may have done negligently or by omission, while including many opportunities for endangering the lives of patients who did not want their life ended. In justice, it is the vulnerable who need protection, not the powerful. This danger is exactly what all the large committees of inquiry into the consequences of legalising euthanasia have predicted in their published reports, even those which included some members who were in favour of euthanasia. No other reasoned conclusion was available to them after extensive oral and written evidence had been taken from a wide range of community and professional sources. Every law to permit euthanasia will be inherently and unavoidably unsafe.

Remains found in hospital graveyard in Austria, likely victims of the euthanasia program

An article written by Kate Connolly and published in the Guardian newspaper in the UK on January 4, 2011; explains that a mass grave was found by an Austrian hospital which is likely where the victims of euthanasia were buried.

The Tyrol Psychiatric Institute has recently uncovered records and a mass grave that indicates that approximately 220 people were killed by euthanasia between 1942 - 1945 at this institution in Austria.

It is significant that Oliver Seifert, an historian, told a press conference that many questions remained unanswered. He article reported:

"At this stage we can't say that all 220 people were victims of the Nazi euthanasia programme but one of the central questions we will be looking into is how they died," he said.

He added that his discovery of the documents, during a reorganisation of the hospital archives, showed the death rate of patients at Hall went up considerably towards the end of the war, despite the fact that the institution was not officially part of the Nazis' euthanasia programme, under which tens of thousands of people with disabilities were killed. The graves may throw light on the way in which euthanasia as a policy was decentralised and, even without orders from on high, became systematic in many psychiatric institutions across the Third Reich whose head doctors bought into the Nazi belief that people with mental disorders were unworthy of life.

Even though this institution was not part of the T4 euthanasia programme, that in fact doctors and possibly administrators took it upon themselves to kill people with disabilities.

People say, don't bring up the Nazi doctors, they were forced to kill people by a criminal regime.

The fact is that the doctors at this institution and many other institutions were not forced to kill people, but chose to do it because they believed that these people were "better off dead."

The article continued by quoting Seifert. It stated:

"We know that murder was actively carried out at other psychiatric institutions, by overdosing patients, neglect or undernourishment," Seifert said.

Until now there had been no official documentation supporting the idea that patients at Hall, which still operates as a psychiatric institution, had been murdered, although at least 360 patients from Hall are believed to have been taken to other institutions to be killed.

In other words, directly and intentionally killing people by neglect (abuse) or undernourishment was an accepted method to kill people within the Nazi regime. Now we do the same but we call it withdrawing medical treatment. Consider the cases of Terri Schiavo or Pastor Joshua Mayundi.

The article concluded by explaining that:

A commission has been given two years to investigate. Excavation of the graves is to start in March, by which time the area's snow should have melted.

Scientists will study each of the bodies in an attempt to ascertain their identities and causes of death.

The hospital launched a global appeal for those who believe their relatives might be among the victims to contact them. It also called for witnesses to come forward with any information that might help.

"Every memory has the potential to help us in researching the history of this cemetery," a spokesman said.

Many people will tell you that society wouldn't do these horrific crimes today. There is only one way to protect people from similar crimes and that is by maintaining a social and legal prohibition on euthanasia and assisted suicide.

I must admit that today the euthanasia lobby is more sophisticated. They use the illusion of choice to sell an imposed death on society. The fact is that choice is an illusion.

Consider the recent reports concerning euthanasia in Belgium that found that 32% of all euthanasia deaths were done without explicit request or consent and that nearly half of all euthanasia deaths were not reported.

Consider the Groningan Protocol in the Netherlands which authorizes the euthanasia death of children born with disabilities.

The more things change the more they stay the same.

Choice is an illusion.