Prolonged painful assisted suicide deaths and human experiments with new lethal drugs cocktails

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

An article published in the Spring Hill Insider yesterday looks at experiments being done on people to find an effective lethal drug cocktail for assisted suicide. 

The current drug cocktails have caused painful assisted suicide deaths that may take many hours to die.

The article states that assisted suicide researchers are promoting their third generation of lethal drug cocktails. The results of the first two lethal drug cocktails were:

The (first) turned out to be too harsh, burning patients’ mouths and throats, causing some to scream in pain. The second drug mix, used 67 times, has led to deaths that stretched out hours in some patients — and up to 31 hours in one case.

The first two lethal drug cocktail experiments failed to provide a painless, fast death. Remember, these experiments are being done on people.

In February I published the article - assisted dying can cause inhumane deaths based on research by Professor Jaideep Pandit that was published in the British Medical Journal. Pandit researched complications with assisted suicide and capital punishment deaths. The same lethal drugs are used for assisted suicide and capital punishment.

Pandit reports that the complications include:

• difficulty in swallowing the prescribed dose (up to nine per cent) and vomiting in 10 per cent, both of which can prevent proper dosing.
• Re-emergence from a coma occurred in two per cent of cases, with a small number of patients even sitting up during the dying process, the authors said. 
• After oral sedative ingestion, patients usually lose consciousness within five minutes. However, death takes considerably longer. 
• But in a third of cases, death can take up to 30 hours, and some deaths took as many as seven days to occur (four per cent).

It is shocking that New Jersey legalized assisted suicide in March and other states are considering assisted suicide, when people in Oregon are dying long and painful assisted suicide deaths.

The assisted suicide promoters and practitioners developed the lethal drug cocktail by doing human trials rather than animal trials. The team appeared concerned with the lethal efficacy and cost of the lethal drugs as opposed to the possible negative consequences. 

The negative outcomes associated with the lethal drug cocktails and the ethics of human experimentation related to the development of these drugs should cause US government, under the controlled substances act, to stop assisted suicide and prevent human experimentation with these lethal drug cocktails.

The euthanasia lobby is not concerned with a "good" death but rather the cost of the drugs. So much for dying with compassion and dignity.

More articles on this topic:

• What's cruel for incarceration is cruel for the terminally ill. The connection between lethal injection and capital punishment (Link).
• Complications with lethal drugs used for assisted suicide (Link).
• Many assisted suicide deaths are slow and painful (Link).
• Is lethal injection inhumane. Euthanasia execution drug controversy (Link).

Belgian doctor charged with murder in the deaths of 9 patients.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

CHR van Hoei Hospital

On September 24 I reported that a Belgian doctor had been charged with murder in the deaths of four patients in the palliative care department of the CHR van Hoei Hospital.

HLN news has now reported that the doctor lost his contract with the hospital and has been charged with murder in the deaths of five more patients, making it nine total murder charges.

According to HLN news, the physician claims that the deaths were not murder but palliative sedation, more accurately referred to as terminal sedation.

The physician claims that he just wanted to stop the pain and these cases were not euthanasia.

Wim Distlemans

Dr Wim Distelmans, who is co-chair of the Belgian euthanasia control commission and operates a euthanasia clinic, told the Belgian news that palliative sedation is not regulated and occurs 4 times more often in Belgium than euthanasia. Distelmans stated (google translated)

“What happens too often is that doctors dramatically increase the doses of the drugs via the baxter to speed up the end of life. That's hypocritical, because they say to the family, "We just keep him asleep." In fact, such a doctor puts an end to life. You can't even call it euthanasia, because the patient didn't ask for it, "

The intentional overdosing of palliative patients is common and is ethically the same as euthanasia. These cases of terminal sedation represent an abuse of the proper use of sedation. Palliative sedation, when done correctly and ethically, should not cause the death of the patient and should not become confused with murder.

A 2015 Belgian study showed that more than 1000 people died an assisted death without request in 2013. Data, such as this, should create great concern, but in Belgium it has simply been a statistic. This case may begin to deal with the number of intentional deaths without consent occur in Belgium.

I will continue to follow this case. Currently the court is not publishing the facts of around these cases.

U.S. Government Report Shows Hospice Abuse. Sacrificing Patient Care for Profit.

By Mark Hodges.

Groups opposing euthanasia and assisted suicide have been advocates of good hospice care. Stories about hospice abuse have created great concerns as we recognize that good care will reduce the demand for assisted dying while hospice abusive feeds the demand to legalize assisted suicide. Promoters of assisted suicide will often compare hospice care to assisted suicide and refer to hospice abuse to advocate for "more options" at the end of life.

The Trump Department of Health and Human Services’ Inspector General has released two scathing reports concerning the Hospice end-of-life-care industry, with the hope of cleaning up hospice abuse. These reports include stories of maggots in stomach feeding tubes; failing to clean wounds which ultimately became gangrened requiring leg amputations; ignoring pelvic injuries from sexual assault and giving wrong treatment that put patients in the hospital.

The reports specify “significant vulnerabilities” and “deficiencies” which put patients at risk and “jeopardize safety.” Patients were seriously harmed when hospices showed gross negligence or failed to report patient abuse.

Eighty-seven percent of hospices had at least one deficiency. One-third of hospices had complaints filed against them. Over 300 hospices (18%) had at least one “serious” deficiency or at least one “substantiated severe complaint” in 2016 alone. Most of those had a history of deficiencies or substantiated complaints.

Medicare, which pays for almost all hospice treatment, looks to state agencies and accrediting organizations to make sure hospices maintain quality of care for patients. Inspectors review clinical records, visit patients, investigate complaints, and report any deficiencies discovered.

The new government report includes both state and accrediting agencies’ findings. Nearly all hospices were surveyed.

Deficiencies included mismanagement, lack of quality control, improper vetting of staff, inadequate assessments, and poor care planning. As a result, patients suffered.

Horror stories abound. One woman was repeatedly abused by her caregiver/daughter, who literally chained her to her bed, and would “leave her mother in a wheelchair in the bathroom with the lights off and would spray her with water when she called out for help,” according to the government report. Hospice was told of the abuse, but did nothing --not even visit the patient for several weeks.

Another patient had an abusive neighbor, who frequently burst into his apartment “naked, high, and drunk” stealing the patient’s prescriptions. Hospice knew this was going on, yet did nothing to protect the patient, the government reported.

“These hospices did not face serious consequences,” the report says, because Medicare “cannot impose penalties, other than termination, to hold hospices accountable for harming beneficiaries.” Medicare’s only enforcement power is to take the offending hospice out of the Medicare program. It cannot levy fines, or issue sanctions, or close a facility.

One of the report’s recommendations is for Congress to give Medicare “enforcement tools” and “statutory authority...to effectively protect beneficiaries from harm.”

Medicare began dispersing tax dollars for hospice in 1982. As medicine advanced, hospice promised tax savings, with terminal patients cared for at home rather than in hospitals under ever-more-expensive and almost-always-futile medical procedures.

“At the first meetings of our national hospice organization, we were nearly all women, mostly volunteers working on making our communities better,’’ Dr. Joanne Lynn told the Washington Post.

As soon as government money for hospice was unleashed, for-profit companies began invading the industry. For-profit hospices have exploded twice as fast as non-profits.

The industry has quadrupled since 2000. That year, 70 percent of hospices were run by nonprofit organizations or government agencies; by 2012, the percentages were nearly reversed.

Today, hospice cares for more than 1.5 million patients.

“Once Medicare started paying for hospice, it was more men in suits, and the focus shifted to administration and sustainable financing,” Dr. Lynn lamented.

In other words, Big Business horned in, and with it came bottom-line-only concern and its inevitable corruption.

A Washington Post analysis found per-patient profit rose from $353 in 2002 to $1,975 in 2012. A Huffington Post investigation found for-profit hospices charged Medicare nearly 30 percent more per patient than nonprofits.

Medicare doled out $18 billion to hospices in 2017. A company’s profit is capped, on average, at $25,000 a patient.

With that kind of money at stake, sales became a top priority. Hospice salesmen, dubbed “Outreach Specialists,” aggressively sought customers from doctors, hospitals, nursing homes, assisted-living facilities and Meals on Wheels groups. “Community Education Representatives” went to “health fairs” at senior centers with blood pressure testers and pitched families caring for an elderly loved one.

Whistleblowers from leading hospices testified that recruiters were told to stress the urgency of committing to hospice. Bonuses were given to reps who met new patient goals.

It gets worse. Ben Hallman’s 2014 exposé, “How Dying Became A Multibillion-Dollar Industry,” found for-profit hospices pressured staff to illegally enroll unqualified patients, and falsified health records to get more tax dollars. Hospices also illegally-obtained hospital records, submitted insufficient documentation and did not adequately train caregivers.

Hospices even admitted patients who were not dying. The whole idea of hospice is to comfort the terminally ill --rules are two doctors have to certify the patient has only six months to live.

But healthier patients require fewer visits and stay longer, making for-profit companies more money.

“A longer length of stay is going to be more lucrative,” one hospice marketer explained. “If they come in very sick and die right away, it’s difficult to run a business that way.”

Medicare pays by the day, not the visit. Hospice companies can charge the government nearly $200 a day per patient ($6000 a month) for the first 60 days, then about $150 a day --regardless of how much care the patient needs, or how often hospice visits.

“They’re paying for a day of hospice with no accountability for what was done on that day,’’ Icahn School of Medicine Professor Melissa D. Aldridge said, “with a payment mechanism that is completely opaque as to what is being done.’’

Not surprisingly, average length of stay at for-profits is far longer than at non-profits (105 days/69 days).

The number of patients who didn’t die in California hospices jumped 50 percent from 2002 to 2012. At one Mobile AL hospice, 78 percent of “terminal” patients left alive.

A 2014 study found one woman who refused to take her cancer medicine, yet she kept getting better. After a year of hospice, she was finally tested. It turns out she never had cancer.

Multiple allegations from former employees charge hospices with enrolling patients who weren’t terminal --wasting well over $1 billion in tax dollars. Lawsuits also allege that patients received expensive care they didn’t need. The Trump Justice Department has joined several of those lawsuits.

According to the rules as they are now, hospices help determine whether a patient is terminal. At the start, two doctors certify a patient’s diagnosis. But re-approvals are routinely done by hospice physicians.

And corruption is made easy by Medicare’s acceptance of overly vague diagnoses, such as “debility” and “failure to thrive.” Next year, Medicare will prohibit such generalization in primary diagnoses.

“It is important that an initial step toward payment reform be taken as soon as possible,” industry watchdog MedPAC understated to Congress.

Hallman’s six month investigation also revealed over a thousand hospices hadn’t been inspected for more than seven years. The legal minimum was six years, until Congress under the Trump administration increased inspections to every three years.

Additional problems include “rogue” and false front hospices stealing tax dollars. Over billing, patient referral kickbacks, unneeded treatment, charging for therapies never administered, underqualified (lower paid) staff, and other methods of theft plague the industry.

From 2006 to 2014, the U.S. government charged that nearly every major for-profit hospice company committed billing fraud.

And there are even more serious charges.

Deaths from lethal doses of morphine and sedatives while under hospice care were brought to light by Peter Whoriskey in the Washington Post. Patients who were not dying when they started hospice, died from excessive doses of painkillers.

In 2009, the New York Times ran a story about “terminal sedation.” The article explained that a strong sedative, typically lorazepam, and a strong pain killer, typically morphine, are administered by an IV drip until heart rate and breathing are slowed until the patient can no longer eat or drink.

Patient overdosing “can intentionally hasten death,” the NYT article stated. A national survey found 83 percent of doctors said this is ethically permissible.

It is not known how often slow murder under the guise of palliative care is perpetrated. No data is collected about such lethal abuses.
 
Sandra writes, about the death of her father:

“I am absolutely certain that my father died because of the medication he was administered by hospice ...particularly the various forms of morphine he was given... These opioids caused the respiratory failure he went into as soon as hospice administered them to him. He was eligible for hospice with the diagnosis, ‘Failure To Thrive’ and ‘Debility’ after breaking his hip... He was just as alert (after the hip injury) as he had always been until hospice ‘snowed’ him... I didn’t hire hospice to push along my father’s demise.”

The new government report concluded with recommendations to begin righting the hospice industry. The Trump Inspector General urges 

• tighter, more extensive oversight of hospices, 
• changing laws to allow Medicare to enforce violations, and 
• public posting of reports finding deficiencies and violations on Medicare’s website, “Hospice Compare.”  

President Trump’s 2020 budget includes a proposal to allow disclosure of survey reports from accrediting organizations.

The Euthanasia Prevention Coalition believes good hospice care eliminates the falsely-perceived “need” for “mercy killing” (an oxymoron). “The principles and practice of good palliative hospice care already developed and utilized, makes it abundantly clear that there is no need to die in pain, loneliness and anxiety.”

We believe in caring, not killing

But we are deeply concerned about the abuses and fraud that the U.S. government’s new report reveals. “Hospice abuse leads to a greater demand for the legalization of euthanasia and assisted suicide,” EPC Executive Director Alex Schadenberg explained.

We applaud the Trump administration’s Inspector General for a thorough investigation, support its recommendations as a start, and urge the strictest compliance to ethical standards throughout the hospice industry.

The only way to effectively "save hospice" from abuse is to return it to its roots, as expressed by Cicily Saunders. Good caring people who care for the physical, psychological, social and spiritual needs of a person as they approach a natural death.

Assisted Suicide and “Failure of Unconsciousness”

This article was published by Nancy Valko on April 18, 2019

By Nancy Valko

As a nurse, I have seen patients assumed to be unconscious while in a coma or sedated on a ventilator later tell me about some memories and feelings during that time. This is why I always cared for such patients as if they were awake.

Now in a stunning February, 2019 Association of Anaesthetists article titled: “Legal and ethical implications of defining an optimum means of achieving unconsciousness in assisted dying”, a group of international doctors explore the difficulty in ensuring unconsciousness to death in lethal injection capital punishment and assisted suicide/euthanasia. (Note: Since the authors are international, some quoted terms here are spelled differently than here in the US)

• Assisted dying can cause inhumane deaths.
• Is lethal injection inhumane?
• Many assisted suicide deaths are slow and painful.

Believing that “A decision by a society to sanction assisted dying in any form should logically go hand‐in‐hand with defining the acceptable method(s)”, the authors reviewed the methods commonly used and contrast these with an analysis of capital punishment in the US. They “expected that, since a common humane aim is to achieve unconsciousness at the point of death, which then occurs rapidly without pain or distress, there might be a single technique being used.”

They were wrong.

They found that with self-administered lethal overdoses “with death resulting slowly from asphyxia due to cardiorespiratory (heartbeat and breathing) depression”, helium self-suffocation and the Dutch lethal injection that resembles US capital punishment, “there appears to be a relatively high incidence of vomiting (up to 10%), prolongation of death (up to 7 days), and re‐awakening from coma (up to 4%), constituting failure of unconsciousness.” (Emphasis added)

Assisted dying can cause inhumane deaths.

Alex Schadenberg

Executive Director - Euthanasia Prevention Coalition

An article in the Daily Mail by Vanessa Chalmers titled - Assisted Dying can cause inhumane deaths examines the article, by Professor Jaideep Pandit, as reported in the British Medical Journal.

The article explains how death by assisted suicide is often inhumane. Chalmers reports:

Patients are usually given barbiturates – strong sedatives – which knock them out and eventually cause the lungs and heart to stop. 

But the report found complications including difficulty in swallowing the prescribed dose (up to nine per cent) and vomiting in 10 per cent, both of which can prevent proper dosing. 

Re-emergence from a coma occurred in two per cent of cases, with a small number of patients even sitting up during the dying process, the authors said. 

'This raises a concern that some deaths may be inhumane,' the researchers reported in the journal Anaesthesia. 

After oral sedative ingestion, patients usually lose consciousness within five minutes. However, death takes considerably longer.

Death occurs within 90 min in two thirds of cases. 

But in a third of cases, death can take up to 30 hours, and some deaths took as many as seven days to occur (four per cent).

Another concern is that there is no single technique for doing assisted suicide.

'We expected that, since a common humane aim is to achieve unconsciousness at the point of death, which then occurs rapidly without pain or distress, there might be a single technique being used.

'However, the considerable [differences] in methods suggests that an optimum method of achieving unconsciousness remains undefined,' the review said.

'It is striking,' the authors said, 'that the incidence of "failure of unconsciousness" is approximately 190 times higher when it is intended that the patient is unconscious at the time of death, as when it is intended they later awaken and recover after surgery', which occurs approximately one in every 19,000.

We have always known that there are problems with assisted death techniques but the laws are designed to cover-up problems with the law. In every assisted death law the doctor who approves the death, is the same person who participates in the death, is the same person who reports the death. Problems with the law are covered-up by the self-reporting system.

• Is lethal injection inhumane?

Sacrificing Pain Patients to Prevent Opioid Abuse

This article was published by the National Review online on January 23, 2019

By Wesley J Smith

Wesley J Smith

We certainly have an opioid addiction epidemic in this country that requires government action. But I worry that we may sacrifice the legitimate medical needs of patients in severe pain to protect people who abuse these powerful drugs from themselves.

That seems to be happening in California where the medical board has launched aggressive investigations into doctors whose patients died of an overdose — even if the drugs that caused death were not prescribed by that physician. Many doctors worry that this will create a significant chilling effect, leading to legitimate pain patients remaining untreated. From the California Healthline story:

Using terms such as “witch hunt” and “inquisition,” many doctors said the project is leading them or their peers to refuse patients’ requests for painkiller prescriptions — no matter how well documented the need — out of fear their practices will come under disciplinary review. 

The project, first reported by MedPage Today, has struck a nerve among medical associations. Dr. Barbara McAneny, the American Medical Association president and an Albuquerque, N.M., oncologist whose cancer patients sometimes need treatment for acute pain, called the project “terrifying.” She said “it will only discourage doctors from taking care of patients with pain.”… 

The crackdown on doctors has created fear, said Dr. Robert Wailes, a pain medicine specialist in Encinitas and chair of the California Medical Association’s Board of Trustees. “What we’re finding is that more and more primary care doctors are afraid to prescribe and more of those patients are showing up on our doorsteps,” he said.

As I reported here last year, the same chilling phenomenon seems to be happening in Nevada.

This is most unfortunate. Doctors should not be allowed to use their M.D. license as a cover for drug pushing. But responsible physicians should also not be punished for prescribing aggressively when there is no other practical means of providing effective medical relief. Surely, the benefit of the doubt in judging should go to alleviating pain.

And how’s this for a bitter irony? The same California doctors who could face punishment for prescribing pain pills to a patient outside the standard of care, can prescribe opioids to the terminally ill for use in suicide without worry since the only legal standard for death doctors is to act in “good faith.” Good grief, patients who can’t obtain adequate pain medication because of this aggressive enforcement action could conceivably be driven to seek such lethal prescriptions as the only readily available way out of their pain.

Wesley J. Smith is an author and a senior fellow at the Discovery Institute’s Center on Human Exceptionalism