What is the Good of Euthanasia? Part IV: What it means to present euthanasia as "medical care"

Gordon Friesen

By Gordon Friesen,
EPC Board Member.

To put it simply: to claim that euthanasia is medical care, is to say that euthanasia is "good" in a way that society can agree upon.

Of course there IS no agreement on the medical status of euthanasia. And this article could easily have been written, as many more worthy articles have been, on the theme of exactly WHY euthanasia is NOT good medicine. Moreover this mere observation (that so many doctors continue to name euthanasia as medically unethical) would seem to fatally challenge the medical pretension, precisely because the kind of objective consensus required, to make such a claim, does not in fact exist.

However, I would like to skip over this argument for the time being, in order to pass directly to a description of the theoretical and practical effects of actually accepting a true medical premise for euthanasia. And the reason why that step has become so unfortunately necessary, is because the practice of euthanasia is, indeed, already universally justified, in Canada, as medical care. Therefore, we will simply assume that euthanasia IS (good) medicine, and show where that (most questionable) assumption has (and will) lead us.

Morals and science: intuitive right and wrong, versus empirical fact

To begin with, the introduction of medical ethics to justify euthanasia is, itself, a sort of intellectual end-run, around the common-language notions of right and wrong. People did not (and do not) agree on the moral status of euthanasia. Substituting medical  authority, however, would seem to promise that the passionate conflict of moral opinion might be overcome by the impersonal proof of science.

Once again : there are powerful arguments as to why there can be no way for scientific evidence to determine primary questions of medical ethics, any more than those of common morality. However, the whole point of an appeal to science is to establish beyond discussion that certain things are either true or false (right or wrong), and this simple trick, of conflating utterly different things (science and morals) has been used, in this case, to create the illusion of a logical, dispassionate, consensus around the medical justification of euthanasia, where in fact no such thing exists. And yet such is the legal and clinical situation, in Canada, as we find it today!

Medical indications, treatment, and repeatability

To the extent that medicine is a science, prescribed treatments are supposed to apply to defined indications in a reliably repeatable manner. In other words, applying pressure on a bleeding wound will (observably) reduce blood loss and contribute to the survival of the patient. Therefore, in the presence of bleeding, pressure is applied.

Moreover, from the moment that euthanasia is considered as medical treatment, some clinical equation of this kind must be available to explain its use: In situation A, euthanasia is applied, reliably producing result B.

Now for euthanasia, the result is absolutely reliable. The person will die. Therefore, in the same way we say that reducing bleeding is desirable in certain clinical conditions, we must also be willing to say that death is desirable in others. Not that death might be desirable. Nor that death is desirable if, and only if, the patient desires it. No! Because the whole point of clinical science is objectivity and observable fact. Thus, by choosing this method of conceptualizing euthanasia, we are agreeing, at the outset, to accept that in certain clinical conditions, the patient SHOULD be dead, and it is the doctor's duty to kill them. 

Prescription and consent

Current best practice in clinical medicine assumes that the doctor, more than anyone else, knows what is medically required. It is the doctor, from his or her depth of knowledge and experience, who will arrive at a proposition of treatment which will then be explained to the patient. The patient has the perfect right to decline any treatment, of course, including euthanasia. However, in order to submit to treatment, the patient need only consent. And that consent can be of the most passive and minimal kind. For in practice, anything less than actual, definite refusal of care is deemed as consent.

And that is not all, for pressure is applied to the wounds of bleeding patients whether they are capable of consent or no. For in the absence of ability to consent, that consent will routinely be assumed, in keeping with established protocols of shared and substituted decision-making authority. Clearly, if euthanasia is justified as medical treatment, prescribed in response to objectively identified conditions, then that which is medically good for capable patients can not possibly be denied to the incapable. And therefore, even if present legal forms lag behind the logical conclusions of our argument, we can confidently expect that all sorts of incapable patients will indeed be euthanized (in fact already are), and that the law will be adjusted accordingly (exactly as Bill C-7 adjusted the voluntary limits of euthanasia by removing the illogical requirement that patients actually be dying before they were offered assistance in doing so). For in perfectly rational terms: just as fairness in euthanasia, by choice, requires that anybody be able to choose to die in this manner, so, also, euthanasia as medical treatment does not require that patients be able to choose at all.

Once again, I am fully aware that many will find these notions abhorrent, as do I. I do, however, feel it is useful to point out that this is indeed the conceptual structure that will be (is being, has already been) built upon the now standard assertion that euthanasia is medical care.

What are the clinical indications for euthanasia as medical treatment?

This, clearly, is where that fatal absurdity, which we simply chose to avoid at the outset (concerning the impossibility of pretending there might be an objective justification for euthanasia), must inevitably raise its ugly head once more. For if euthanasia is a medical treatment prescribed in response to objectively recognizable conditions, then what, exactly, ARE those conditions? To be charitable, let us simply say, that in a situation like our present, where a third of Canadian doctors still believe euthanasia is unethical under any circumstances (whatsoever), there can not possibly be a shared consensus as to which clinical conditions objectively indicate the use of euthanasia. In other words, there can be no clarity at all comparable to that surrounding typical (we might say legitimate) medical treatments, like the earlier bleeding wound example.

And yet, because our lawmakers have already decreed that the medical justification for euthanasia will indeed be employed; and because any medical justification requires that some objective indications for the use of euthanasia must exist: what, we must ask, will these be?

Apparently, since there is no collective agreement, we must rely on the individual wisdom, of the individual doctor, in each particular case.

The duty of the doctor and the prerogative of the patient

It is the duty of the doctor to make the best proposition, of clinical care, of which he is professionally capable. There are criteria for which patients may legally be euthanized, but these are not medical criteria, and most if not all doctors would agree that it would be absurd to claim that all patients fulfilling said criteria should be killed. However, the individual doctor is allowed to prescribe euthanasia for any patient within that group. And legally prescribed euthanasia is deemed to be ethical medical care. Therefore, from the moment that ANY doctor prescribes euthanasia for ANY eligible patient, the medical indications to which he was then responding would henceforth serve as a hallowed precedent for the general application of euthanasia to any similar case (and that, with a particularly significant impact, where patient consent is not an issue, due to incapacity).

The eligible patient, on the other hand, has the virtual right to demand euthanasia, such that, even if a doctor is unwilling, that doctor is bound to find another who is. Therefore, it is simply assumed that, should a patient be eligible, a doctor can, indeed, be found, who will declare the procedure ethical. 

The combination of these two principles moreover -- of a patients unfettered choice, and/or a doctor's unfettered ability to prescribe (within the limits of what are now the most broad and vague criteria possible) -- would suggest that no matter how absurd the idea might still appear (that ALL seriously ill or disabled people SHOULD be killed) this really does appear to be the final definition (of objective medical indication for euthanasia), towards which our present practice will logically lead. 

To resume: real objective medical indications cannot be defined for euthanasia.

Legal criteria, however, can be created at the stroke of a pen! And since treating euthanasia as ethical medical care positively demands objective indications: it would seem inevitable that the fraudulent substitution, of medical ethics for common morality, would also entail the subsequent fraudulent substitution, of arbitrary legal eligibility criteria, for actual medical indications.

Incredibly, the clinical application of these principles will now only depend on the personal discretion (subjective caprice) of each individual doctor.

Patient beware!

Gordon Friesen, Montreal, November 19, 2021

http://www.euthanasiediscussion.net/     (français)

http://euthanasiadiscussion.com/      (english site in development)

http://hopeandfree.com/        (personal philosophical musings)

Is death becoming an industry in Canada?

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

An article by Lee Harding that was published on November 14 by the Epoch Times interviews Amy Hasbrouck from Toujour Vivant - Not Dead Yet, Angelina Ireland from the Delta Hospice Society and myself concerning the direction of euthanasia (MAiD) in Canada.

Alex Schadenberg

Harding begins by stating that the Québec euthanasia data was released on October 20 showing that the number of MAiD deaths increased by 37% to 2426 (April 1, 2020 - March 31, 2021) representing 3.3% of all deaths. Harding asks why the numbers of euthanasia deaths is increasing so quickly. Among other things, I told Harding:

“In the discussion leading up to Bill C-7, all of the cultural taboos about killing people with disabilities or extending this (MAiD) to people with mental health issues and things like that, it was breaking down the negativity or the concept of maybe it’s not a good idea to do this to anyone for any reason,”

“The more we talk about it, the more it will happen. The more people will promote it, the more people will think it’s fine and the more people will die this way. … In a sense, death is becoming an industry. The fact is that all these things have moved our social mores.”

I then spoke about a call that I received from a woman who was upset that her husband had asked to die by euthanasia.

“She’s calling me up all upset, saying, ‘My husband would have never supported this, never. What’s happening?’ And we had a long discussion. She found out that the one nurse in palliative care had spoken to him for two hours in the middle of the night, convincing him that it was the right thing to do,”

“They say this is all about freedom and choice and autonomy, and yet you’re getting calls like this.

Angelina Ireland

Harding also interviewed Angelina Ireland, the President of the Delta Hospice Society, an organization that lost government funding because it refused to participate in euthanasia. Ireland said:

“They can kill you at your home, the hospital, long-term care facility, hospice, and now the funeral home. But if one actually wants to live—that’s a lot more difficult. With the firing of thousands of health-care workers across Canada, we cannot so easily access even routine surgeries and tests for our own well-being. Where are the priorities?”

Harding then spoke to Amy Hasbrouck who is a disability leader in Canada. Hasbrouck says:

The Truchon decision in Quebec in September 2019 legalized euthanasia for the disabled across Canada, a decision Hasbrouck believes did more to devalue people with disabling health conditions than empower them.

“The judge, basically, instead of saying, ‘You’re right. That’s the problem of our public policies and the way we treat disabled people. We need to do things differently,’ she said, ‘Oh, yes. You’re right. You should have the right to be killed by the state because, of course, you wouldn’t want to go into a nursing home,”

“So the judge’s solution was, they would be better off dead.

Amy Hasbrouck

Hasbrouck commented on Jonathon Marchand, a Quebec City man with muscular dystrophy camped outside the Legislative assembly in a make-shift cage to protest his confinement to a nursing home, rather than enabling him to live independently with supports. Hasbrouck says:

“Quebec resisted and dragged their feet. And ultimately, they allowed Jonathan to create a program for himself, but they refused to extend the pilot project to other people. … [Yet] it costs less for somebody to live in the community than for the person that lives in an institution,”

“It became much more apparent during the COVID pandemic that society in general considered disabled people [and the elderly in nursing homes] as a disposable population. Those are trends that we have seen most recently that are very worrisome.”

Hasbrouck is decrying the fact that people are not being offered choices to live, but they are being told that they have a choice to die. In other words, people are considered better off dead.

NSW Australia Parliament debates 'assisted dying.'

This article was published by Bioedge on November 13, 2021

New South Wales Parliament

By Michael Cook

On Friday the Parliament of the Australian state of New South Wales began its debate on the controversial bill to legalise “voluntary assisted dying”. The outcome is still uncertain, but more speakers supported the bill on the first day than opposed it.

The debate was respectful but most of the MPs brought emotional stories of the deaths of loved ones to the attention of the house. Arguments ranged from “The Voluntary Assisted Dying Bill 2021 is the most heinous piece of legislation ever introduced to this Parliament” (Dr Hugh McDermott) to “The bill offers a safe framework for patients whose death is imminent and whose pain and suffering has become unbearable to end that suffering at a time of their choosing” (Sonya Hornery).

Even if the bill passes in the Lower House, it is unlikely that it will become law this year. Before the Upper House votes, it will study the report of a committee which is currently gathering evidence.

Below are excerpts from the Premier, Dominic Perrottet, and the Leader of the Opposition, Chris Minns.

The Premier told the House that his own grandmother is dying at the moment from cancer and is in considerable pain. Nonetheless he said:

A strong society protects and cherishes its most fragile members. This debate today is not about the details of the bill that is in front of us. It is not about the strengths or weaknesses of the safeguards, or the rights of medical practitioners, or the technicalities of who qualifies and who does not. It is so much bigger than all of that. This debate is fundamentally about how we treat that precious thing called human life. Our answer to that question defines what kind of society we will be. This bill at its heart enshrines a new principle—that we can intentionally help terminate the lives of certain people to end their suffering.

Make no mistake, this is a culture-changing decision. Once we accept the principle of this bill, we cross a line and nothing will be the same as we will have started to define the value of life. It turns on its head a bedrock of our ethics—that we help, not hurt; that we offer hope, not harm. That is why every single member of this place needs to think very carefully about the ramifications of this bill because no safeguard can stand in the way of the fundamental shift we are contemplating here. [Former Prime Minister] Paul Keating called this our threshold moment “an unacceptable departure in our approach to human existence”.

Chris Minns acknowledged that his point of view is not popular in his own Labor Party. However, he felt that legalisation is simply too dangerous:

I am not convinced that any legislation can prevent an individual choosing to die in response to pressure, coercion or duress caused by others. No legislation, even one crafted with the best of intentions like this bill, can prescribe against the conduct of people with bad intentions. Once we provide access to a voluntary assisted death, it is inevitable that some people will act to pressure another to end their life. That pressure may be overt. It may be the demand of an estranged child or a plea for respite from a dearly loved partner. It may be subtle, a suggestion, a hint, an overheard conversation or it may be deduced without a word being spoken by a vulnerable person watching the impact their illness is having on others who they love. The risk of those situations occurring is not far-fetched or exaggerated. In fact, that risk is acknowledged in the bill on the very first page.

Article: New South Wales euthanasia bill temporarily stopped (Link).

Assisted-Suicide Mendacity: Today’s ‘Strict Protections’ Become Tomorrow’s Unjust ‘Barriers’

This article was published by National Review online on November 13, 2021.

Wesley Smith

By Wesley J Smith

When assisted-suicide mongers promise strict guidelines to protect against abuse, rest assured, it’s nothing but a con. It won’t take long before these same advocates denigrate the very “protections” they promoted as “barriers” or “obstacles” to a good death.

Article: Assisted suicide lobby challenges Oregon assisted suicide residency requirement (Link)

Assisted-suicide-movement camp followers in the media eagerly promote the new message without a mention that they also pushed the “strict guidelines against abuse” trope. Latest example, Paula Span’s “New Old Age” column in the assisted-suicide-friendly New York Times. From, “For Terminal Patients, the Barrier to Aid in Dying Can Be a State Line:”

Five years ago, Dr. Nicholas Gideonse spoke with an older man who had received a terminal cancer diagnosis and was hoping to use Oregon’s medical aid-in-dying law.

Oregon’s Death With Dignity Act, in effect since 1997, permits doctors, after a complex process of requests and waiting periods, to prescribe lethal medication for dying patients to self-ingest.

The nonprofit group End of Life Choices Oregon had referred the man to Dr. Gideonse, a primary care doctor at Oregon Health & Science University and a hospice medical director, who had already helped many patients use the law.

But this time he could not. “I’m really sorry,” he told the man on the phone. “I’m not going to be able to help you with this.” Oregon’s law — and all the laws that permit medical aid in dying in 10 states and in Washington, D.C. — has residency requirements. This man would have qualified — except for that fact he lived in nearby Washington State.

A few points. Washington legalized assisted suicide in 2009. The moment I read that, I suspected that the man’s own doctor refused to facilitate his suicide and so he went doctor shopping with the assistance of an assisted-suicide advocacy group, a common occurrence. Sure enough:

Although Washington has its own aid-in-dying law, its southwestern region has few providers who can help patients use it.

They “can,” but won’t, might be better stated. At least some doctors still believe in the Hippocratic Oath and understand that prescribing poison is antithetical to a doctor’s professional obligations to patients.

When Measure 16 was promoted to legalize assisted suicide, advocates assured voters that the residency requirement was an important protection against suicide tourism — as now happens in Switzerland. But now that Oregonians accept prescribed death, residency is an unconstitutional obstacle! The death doctor is suing:

Last month Dr. Gideonse, backed by pro bono lawyers and Compassion & Choices, an advocacy group for expanding end-of-life options, filed a federal lawsuit claiming that the residency requirement for Oregon’s aid-in-dying law is unconstitutional. “I realized how important this could be for patients seeking access,” he said.

The lawsuit is one of several legal and legislative efforts around the country to reduce the requirements that patients must contend with in order to receive aid in dying. In some states, lawmakers have already broadened the types of health care providers that can participate, or have shortened waiting periods or allowed waivers.

“I think of it as MAID 2.0,” said Thaddeus Pope, an end-of-life bioethicist at Mitchell Hamline School of Law who tracks such actions, referring to the acronym for medical aid in dying. “We found out there’s an access problem.” He added, “We set all these safeguards and eligibility requirements and they locked a lot of people out.”

Oh, baloney. This was the plan all along.

I hope people understand that assisted suicide is not about “terminal illness.” That “protection” is just the entry point, a tactic to convince people to swallow the hemlock. Once the poison is in the cultural bloodstream, the terminal-illness requirement will be deemed an obstacle, and the law will be continually expanded over time — just as they have just in the last year or so in Canada, California, Hawaii, and Oregon. The pattern is more predictable than Biden’s statements being clarified by his press secretary.

So, support assisted suicide, if you must. But do it with a full understanding of the consequences. Don’t lie to yourself that there will be only a tiny change in medical ethics and societal morality. In the end, there is no such thing as just “a little assisted suicide.” The ultimate destination is death on demand — a nihilistic mindset that Germany already reached.

We will too, eventually, unless we refuse to swallow the poison.

Protecting People from Euthanasia in Canada

Register for the next Euthanasia Prevention Coalition (EPC) webinar - Protecting People from Euthanasia in Canada on Wednesday, December 1, 2021 at 7 pm (EST) for 1 hour.

Advance registration is required using the following (registration link). 

The webinar will feature an informative presentation by Alex Schadenberg, EPC - Executive Director and Kathy Matusiak Costa with Compassionate Community Care.

Alex will provide an update on what is happening in Canada, explaining the outcome of Bill C-7, discussing our concerns with the "Special Joint Committee on Medical Assistance in Dying" that is examining further expansions of euthanasia in Canada, and discussing our concerns with the "Expert panel on MAiD and mental illness" which is devising euthanasia for mental illness protocols.

Alex will also discuss the current situation with the Delta Hospice Society and how euthanasia is changing palliative care. He will then discuss a series of recent stories on how euthanasia is affecting people in Canada.

Kathy will discuss the Compassionate Community Care (CCC) visitor training program including the My Story and Advocacy sections of the program and the importance (CCC).

We will complete the webinar by focusing on why you should be concerned and Protecting People from Euthanasia followed by a question and answer session.

Wednesday, December 1, 2021 at 7 pm (EST) for 1 hour.

Advance registration is required using the following (registration link).

Massachusetts Supreme Court to hear assisted suicide case.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

In January 2020 the assisted suicide lobby appealed a Massachusetts Superior court decision which found that there was no right to assisted suicide. 

A few weeks ago, the Massachusetts Supreme Court agreed to hear the case in February 2022. 

The case concerns Dr Roger Kligler, who is living with prostate cancer and seeking death by assisted suicide and Dr Alan Schoenberg, who stated that he is willing to prescribe lethal drugs for Kligler to die by assisted suicide. 

Kligler and Schoenberg are arguing that criminally prosecuting a doctor for prescribing lethal drugs for assisted suicide to a competent terminally ill person is illegal under the Massachusetts state constitution.

At the time, of the lower court hearing, the Massachusetts Attorney General argued that this is a legislative not a judicial issue. 

The Massachusetts lower court decision found that there is no right to assisted suicide and it recognized the difficulty in accurate patient assessment to approve assisted suicide, which is an irreversible decision. The court challenged the concept that assisted suicide is a form of medical treatment and pointed out that even in Oregon the oversight of the law is questionable at best.

In its decision, the lower court explained why the Massachusetts prohibition on assisted suicide meets the rational basis for both due process and equal protection. Starting on Page 20 of the decision, the court gave clear reasons why assisted suicide should not be legalized.

This case is attempting to overturn the US Supreme Court Glucksberg decision which found that there was no right to assisted suicide but a State had the right to legislate on the issue.

EPC-USA is planning to present an Amicus brief to the Massachusetts Supreme Court in this case.

Kligler, who claimed to be terminally ill when launching the case in 2016 remains alive today.

Opposing The Palliative Care and Hospice Education and Training Act (2021)

House RCP 117–17 (10-28-2021) of H.R. 5376, BUILD BACK BETTER ACT, §§ 31007-31011

Position Statement

The EPC - USA opposes assisted suicide and euthanasia. This bill would  federally fund training in how to assist a suicide (an option within palliative care) and promote it. We support hospice and palliative care that mitigates distressing symptoms, relieves pain and maintains function. We support helping patients live well without placing them at risk of abuse, serious harm and hastened deaths. Until dangerous and unsafe palliative and hospice care can be identified in time to protect patients, the federal government should not be promoting it.

Talking Points

The bill would federally fund medical training in how to assist a suicide (an option within palliative care(1)) and the promotion of assisted suicide as palliative care. The Assisted Suicide Funding Restriction Act only forbids federal funding of providing or obtaining assisted suicide.

The bill would extend palliative care provided by hospice (69% of hospices own palliative care programs(2)) and by health insurers to non-dying patients, federally fund medical education and direct HHS how to “sell” palliative care to the public. The bill has no enforcement mechanisms.

    1. Hospice, a palliative care program, is plagued by fraud and poor quality care leading to serious harm and deaths, while wasting hundreds of millions of federal dollars.

Federal juries found the medical directors and a nurse from Novus Health Services guilty of Medicare fraud close to $40 million along with the director who told nurses to make patients “go bye-bye” with overdoses of drugs like morphine.(3) All of them are facing lengthy prison sentences.

Federal investigators found hospices enrolling patients who are not terminally ill, without their knowledge or under false pretenses, providing poor quality care, and inappropriately billing Medicare hundreds of millions of dollars.(4)

Eighty percent of hospices had deficiencies that pose risks to beneficiaries; 20% had deficiencies jeopardizing patients’ health and safety or substantially limiting their ability to provide adequate care.(5) The bill does not address this.

    2. Palliative care programs are used to enroll more patients in hospices earlier,(6) even if clinically inappropriate,(7) to make more money.

“Palliative care is for all individuals with serious illness who face heightened risks of crisis hospitalization and preventable spending” per the Center to Advance Palliative Care.(8)

Health insurers (e.g. Anthem and Humana) are running palliative care programs. Anthem owns the Aspire palliative care company which uses a Google funded algorithm to target people for palliative care.(9) Humana is running a palliative program where people who sign up are enrolling in hospice with curative care that automatically ends after 31 days.(10)

The Senate Finance Committee says 16% of hospice enrollees got care from either a private equity owned or publicly traded hospice company in 2019; care quality in for-profits is concerning.(11)

Research of care in private equity owned nursing homes found a 10% increase in mortality and a 11% increase in taxpayer spending, while Medicare compliance declined.(12)

    3. Enactment of the PCHETA bill could erase federal fraud recoveries, rewarding those who game the system.

The HHS Office of Inspector General says hospices are defrauding Medicare of hundreds of millions of dollars by enrolling people who are not terminal and then billing at the highest rates.(13)

Most hospice settlements listed on the Fraud in Healthcare site are for enrolling ineligible people.(14)

    4. Palliative care is often a dangerous pathway to death for people not otherwise dying who could have years to live.

Palliative care leads to the deaths of people who were not otherwise dying; typically by indifferently assessing people as terminal and providing them “comfort care” where they are heavily sedated, overdosed on pain killers and denied food and water so the prognosis becomes self-fulfilling.

Clinical practices in palliative medicine regularly result in shortening lives.(15) In one study, 39% of physicians and nurses said they intended to shorten lives with drugs and treatment withdrawals.(16) A survey of over 800 hospice and palliative care physicians revealed 45% would sedate patients who were not actively dying to unconsciousness and then withhold food and fluids until they died, as a “best practice.”(17) One-fourth of them said it did not matter how long the patient had to live. Id.

These practices are so prevalent that they were described by the Washington Post in a 2014 series,(18) identified as a serious problem by Duke University professor Farr Curlin, M.D.in 2015,(19) and identified as a patient safety problem by the Agency for Healthcare Research and Quality in 2017.(20)
 

1. Delaware HB 140 says medical aid in dying (a euphemism for assisted suicide) is a palliative care option. (Link) see also (Link). 
2. (Link). 
3. (Link); (Link). 
4. (Link to the complete report)
5.  (Link to the complete report). 
6. (Link to the article) calling palliative care a loss leader for hospice providers. A loss leader is a service sold below cost to attract customers who will then buy more profitable services. www.businessdictionary.com/definition/loss-leader.html 
7. See notes 3and 5. 
8. (Link) 
9. (Link to the Anthem companies) (Article about Aspire Health). 
10. (Link to article); (Link to document) 
11. (Link to document) 
12. (Link to article) 
13. See note 4. 
14. (Link). 
15.  Rietjens JA et al., Physician reports of terminal sedation… Ann Intern Med 2004;141:178-185.
16. Cohen L, et al., Accusations of Murder and Euthanasia in End of Life Care, J Pall Med 2005.8.1096 at 1102. See note 15 at 1099. 
17. Plots created by Sahr N, Ph.D from data reported on in Maiser S et al., A Survey of Hospice and Palliative Care Clinicians' Experiences and Attitudes Regarding the Use of Palliative Sedation, J Pall Med 2017 Sep;20(9):915-92. 
18. Peter Whoriskey, As More Hospices Enroll Patients Who Aren’t Dying, Questions about Lethal Doses Arise, Washington Post, August 21, 2014 (Link).
    
19. Farr A. Curlin, M.D., Hospice and Palliative Medicine’s Attempt at an Art of Dying, chapter 4 in Dying in the Twenty-First Century, edited by Lydia Dugdale, MD, MIT Press 2015 at pages 47-8. 
20. Palliative-Care-Comfort-vs-Harm (Link) published November 2017.
    

Portugal passes euthanasia bill. Urge President de Sousa to veto the bill.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Portugal's parliament has once again passed a bill to legalize euthanasia. This is the second euthanasia bill this year to be passed by Portugal's parliament. 

On January 29, Portugal's parliament passed its first euthanasia bill, but the language of the bill was very imprecise.

On February 19, President Marcelo de Sousa decided not to sign the bill into law but instead to refer the bill to the Constitutional court for evaluation. President de Sousa stated that he thought that the bill was: 

"excessively imprecise," potentially creating a situation of "legal uncertainty."

On March 15, Portugal's Constitutional court rejected the euthanasia bill. The Portuguese American Journal reported that the Constitutional court decided:

“the law is imprecise in identifying the circumstances under which those procedures can occur.” The court stated the law must be “clear, precise, clearly envisioned and controllable.” The law lacks the “indispensable rigor.”

Once again, President de Sousa can sign the bill into law or he can refer the bill to the Constitutional court for evaluation.

Please send a message to President de Sousa, urging him to veto the bill. (Link to send a message to President de Sousa).

DW.com reported that the new bill changed the language of the bill claiming to fulfill the requirements of the Constitutional court. DW.com reported:

The rephrasing of the bill clarified the "imprecise" definition for when euthanasia would be possible after the Constitutional Court found that the bill's previous reference to "a definitive injury of extreme seriousness in accordance with scientific consensus" lacked "indispensable rigor."

The new version of the bill, which passed Friday, said euthanasia could be possible in cases of "serious injury, definitive and amply disabling, which makes a person dependent on others or on technology to undertake elementary tasks of daily life," and where there is "very high certainty or probability that such limitations endure over time without the possibility of cure or significant improvement."

Clearly this new bill focuses on euthanasia for people with disabilities.

In July, 2020 I reported that the Portuguese Medical Association informed the government that they will not permit doctors to participate on the euthanasia commission (the commission to approve euthanasia). At the same time, a group of 15 law professors, including Professor Jorge Miranda, known as the father of Portugal's Constitution, stated that the euthanasia bills are unconstitutional.

According to DW.com, Portugal's parliament was criticised for passing a euthanasia bill while not being able to pass it's budget. Since Portugal's parliament is unable to pass its budget, the government will have an election in January.

Portugal needs to care for and not kill its citizens.

(Link to send a message to President de Sousa).

Study shows negative impact of MAID on palliative care in Canada

This article was published by Dying Will on November 3, 2021.

A study conducted by a group of physicians in Canada reveals the detrimental impact that the legalisation of assisted dying has on palliative care.

In their 2020 qualitative study, Matthews and Colleagues interviewed palliative care physicians and nurses who practiced in healthcare settings where patients could access Medical Assistance in Dying (MAiD) in Southern Ontario. Their findings conclude the negative impact that MAID has on palliative care in Canada:

1. All clinicians spoke about a conflict between maintaining Medical Assistance in Dying eligibility and effective symptom control. Clinicians felt they must withhold symptom control medications that could cause sedation or confusion and therefor jeopardise MAID eligibility, even if the medication could significantly alleviate their patient’s pain. This difficulty in providing optimal symptoms management created by the Medical Assistance in Dying legislation resulted in increased providers and patients’ distress. 
2. Many clinicians described the prevalence of ethical and moral dilemmas regarding the appropriateness of certain discussions regarding MAID with their patients, such as introducing MAID to patients who did not initiate these requests. Clinicians were concerned that introducing the topic of Medical Assistance in Dying might be misinterpreted as an invitation to request for it, and may add to the burden of vulnerable patients and erode families’ trust. Participants also described challenging conversations around supporting patients and resolving tension with families around Medical Assistance in Dying.
   
3. Medical Assistance in Dying has a significant emotional and personal impact on palliative care providers. Many of the clinicians described a large emotional toll created by exposure to Medical Assistance in Dying. 
4. Medical Assistance in Dying changes the patient palliative care provider relationship. The clinicians described how patients thought that palliative care included assisted death, which complicated their relationships with these patients. Further, clinicians with moral or religious objections to Medical Assistance in Dying described substantial challenges with building trust with patients pursuing assisted death. 
5. The clinicians felt that the providing of assisted suicide led to more palliative care resources being dedicated to assisted deaths that would have otherwise been allocated to palliative care.
   

This study should serve as a warning to the UK as Parliament debates the legalisation of assisted suicide. If Canada serves as any example, the implementation of assisted suicide will have a profound negative impact on palliative care.