Profound social change with euthanasia for mental illness.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Dr Ramona Coehlo

An article by Dr Sonu Gaind, Dr Ramona Coehlo, Dr John Maher and Professor Trudo Lemmens challenging Canada's federal government policy to extend euthanasia to people for mental illness alone was published today by Policy Options titled: Missing the mark on a profound social change with MAiD for mental illness.

Gaind, Coehlo, Maher and Lemmens challenge the false statements by Jocelyn Downie, one of the world's leading "academic" pro-euthanasia (MAiD) activist and Mona Gupta, a psychiatrist who has been promoting euthanasia for mental illness alone. Downie and Gupta recently published a response to the Québec Commission report on MAiD, a report that decided not to approve euthanasia for people with mental illness alone.

Dr John Maher

The response by Downie and Gupta titled: Québec's Commission on MAiD misses the mark on mental disorders was published by Policy Options on March 2. Downie and Gupta argue that the Québec Commission on MAiD did not follow the same play book as the rest of Canada by rejecting euthanasia for mental illness alone.

Gaind, Coehlo, Maher and Lemmens state that the federal government rushed through their approval of euthanasia for mental illness without properly considering the unique dangers associated with MAiD for conditions outside of the end-of-life context.

Dr Sonu Gaind

They argue that it is false to claim that permitting euthanasia for mental illness is based on the "right to equality" but rather euthanasia for mental illness undermines equality. They write:

Some who defend the expansive new law invoke the right to equality. Yet, three United Nations rapporteurs and human rights experts, national disability and social justice organizations, Indigenous advocacy groups and leaders and elders, along with hundreds of medical and legal experts have argued that Bill C-7’s removal of the safeguard of “reasonably foreseeable death” for those with disabilities, including mental health disabilities, shows reckless disregard for equal protection of disabled persons against avoidable death.

Trudo Lemmens

Gaind, Coehlo, Maher and Lemmens then reinforce the fact that it is impossible to predict when a mental illness is irremediable, as required by the law. They write:

From the world-renowned CAMH (Centre for Addiction and Mental Health) to the Canadian Association for Suicide Prevention, experts have warned that it is impossible to predict, as per the language of the law, the “irremediability” of mental illness for any individual. Critics say this raises the spectre of people who are not near death, but who have mental illness, being provided physician-assisted death based on unscientific assessments by physicians claiming supposed “irremediability” — at times where they may be suffering despair that is actually resolvable.

Gaind, Coehlo, Maher and Lemmens challenge the concept that a consensus is developing among mental health professionals. They write:

The Canadian Mental Health Association and the Ontario Association for ACT & FACT (experts providing front-line care to those with the most severe mental illnesses) both stand in strong opposition. In a recent survey the overwhelming majority of Ontario psychiatrists who responded said they oppose the sunset clause and MAiD solely on the grounds of mental illness. Gupta and Downie’s article paints a false impression of a “fait accompli” consensus that does not exist.

Gaind, Coehlo, Maher and Lemmens challenge Downie and Gupta who questioned the difference between euthanasia for mental illness and physical illness. They write:

The authors surprisingly criticize as lacking in detail the argument raised by the Quebec commission that “mental disorders have specific characteristics that distinguish them from other illnesses such as cancer or lung and heart disease.” ... Any psychiatrist knows that no other medical illnesses have suicidality as a potential diagnostic criterion. A wealth of evidence shows that people suffering mental illness with related symptoms of despair and hopelessness make different decisions than they otherwise would.

Gaind, Coehlo, Maher and Lemmens recognize that physical conditions may also lead to suicidal ideation, but they argue that it is unethical to offer MAiD while the patient is in a transient state:

Many injuries and physical illnesses are indeed accompanied by temporary depression and suicidal thinking. For example, research demonstrates increased risk of suicide for two years after a spinal cord injury. This suicidality overwhelmingly ends with adaptation and recovery support. Offering death to anyone during a period of transient increased suicidality is, in our view, unethical and violates the standard of medical care by which physicians must abide.

The fact that the newly expanded law may facilitate death in those circumstances of increased suicidal thinking is, in and of itself, problematic. The fact that MAiD for suicidal thinking in those suffering from physical disease is allowed does not make the failure to prevent suicide of people solely on the grounds of mental illness any more acceptable, as Gupta and Downie appear to suggest. Of further concern, they do not mention the fact that those getting MAiD because of mental illness in the few European countries that provide it disproportionately seek relief because of marginalization, including unresolved social suffering and loneliness – problems that are remediable.

Gaind, Coehlo, Maher and Lemmens challenge Downie and Gupta's assertion that treatment that has been ineffective stands in the way of a person's life. They write:

The authors conclude that not giving access to MAiD interferes in the lives of capable adults living with mental disorders, some of whom may have had many years of ineffective treatment. We find it startling to frame suicide prevention as an “interference” in people’s lives, and disturbing that Gupta and Downie do not mention the lack of access to care faced by Canadians suffering from mental illness. The Mental Health Commission of Canada tells us that fewer than one in three adults get the mental health care they need. Only one in five children can access early care that may prevent them from needing many years of professional care later because their diseases were not treated in a timely way. Canadians wait up to five years for specialized tertiary psychiatric care.

In this context, introducing in law a “painless death” through MAiD and ignoring the systemic failures of lack of access to mental health care seems beyond reckless. While this will save money (providing MAiD to non-dying persons with decades left to live is far cheaper than attempting to provide support for dignified living), it will come at the high cost of prematurely ending the lives of those who could possibly have recovered and enjoyed long meaningful lives with family and loved ones.

Gaind, Coehlo, Maher and Lemmens conclude by asserting that euthanasia for mental illness is not about providing a compassionate death but in fact fundamentally denies the right to equal protection for people with mental illness. They state:

Permitting MAiD solely on the grounds of mental illness fundamentally violates the right to equal protection of persons with mental illness against premature death. Gupta and Downie’s strong rejection of the Quebec commission’s recommendation is concerning, particularly when considering how such skewed arguments might influence the soon-to-be released recommendations of Gupta’s federal panel. One member of a mental health advocacy organization has already resigned from Gupta’s panel but this has not been announced by the panel or federal government. None of this bodes well for those of us hoping for a balanced and evidence-based approach.

It must be noted that Mona Gupta is the chair of the federal commission examining the rules for implementing euthanasia for mental illness. Gupta appears to be in a conflict of interest by co-publishing an article opposing the recommendations of the Québec commission, when as chair of the federal committee she is expected to appear be a "neutral."

Dr Sonu Gaind, professor at the University of Toronto, chief of psychiatry and physician chair of the Humber River Hospital MAiD team and former president of the Canadian Psychiatric Association, also co-authored the article.

Assisted suicide lobby admits that assisted suicide for anorexia violates the law.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

In January I wrote an article about assisted suicide for anorexia nervosa. In the article I quoted from a case report published by the ACAMAID, an organization of assisted suicide practitioners who approved assisted suicide for anorexia nervosa by defining the condition as being "terminal." 

An article by Jennifer Brown that was published in the Colorado Sun on March 14 reports on Dr. Jennifer Gaudiani, an internal medicine doctor who specializes in eating disorders and who published a paper on her experience with prescribing assisted suicide for three people with anorexia nervosa. Gaudiani approves assisted suicide for Anorexia Nervosa by falsely defining the condition as terminal.

America's leading assisted suicide lobby group responded to the article in the Colorado Sun by stating that assisted suicide for Anorexia Nervosa is a violation of the assisted suicide laws.

Kevin Dias, the Chief Legal Advocacy Officer for Compassion & Choices response to the Colorado Sun article by stating:

Medical aid-in-dying laws apply only to mentally capable, terminally ill patients with six months or less to live who are able to self-ingest the medication. Any deviation from these requirements violates the law and places physicians, family members and others in regulatory, civil and criminal jeopardy. This law does not and was never intended to apply to a person whose only diagnosis is anorexia nervosa.

The recent Oregon 2021 assisted suicide report also listed Anorexia Nervosa as a reason for assisted suicide.

We know that at least 3 people with anorexia nervosa died by assisted suicide in Colorado and at least 1 person with anorexia nervosa died by assisted suicide in Oregon and there could be many more. 

As stated by Kevin Diaz: 

"Any deviation from these requirements violates the law and places physicians, family members and others in regulatory, civil and criminal jeopardy. This law does not and was never intended to apply to a person whose only diagnosis is anorexia nervosa."

Therefore, is the assisted suicide lobby going to inform authorities of the suicide deaths that have occurred outside of the parameters of the assisted suicide law?

Also, will the assisted suicide lobby stop lying by telling legislators in states that are debating assisted suicide that these laws have never been violated?

On March 22 I published an article examining the research literature concerning anorexia nervosa which clearly concludes that Anorexia Nervosa is not a terminal condition but rather it is a chronic condition.

A study by Kamryn Eddy et al., published in the Journal of Clinical Psychiatry in February 2017 titled: Recovery from Anorexia Nervosa and Bulimia Nervosa at 22 year Follow-Up recognizes that some people with Anorexia Nervosa die from the condition, but the study considers anorexia nervosa to be a chronic condition, not a terminal condition. The study is based on a 22 year follow-up and it concludes that for many people recovery is slow but nearly two-thirds of the participants fully recovered by year 22.

By prescribing lethal drugs for assisted suicide or lethally injecting a person (euthanasia) the clinician is abandoning the patient rather than helping the patient find hope with the potential of long-term recovery. 

Killing the patients abandons the patient and eliminates the prospect of recovery.

Swiss assisted suicide clinic provides death for $11,000.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The shocking news that two healthy American sisters died by assisted suicide in Switzerland is opening new questions about assisted suicide and the Pegasos suicide clinic.

Healthy American sisters die at Swiss suicide clinic (Link).

An article by Ronny Reyes published in the Daily Mail on March 23 explains that Lila Ammouri, a 54 year-old palliative care doctor, and Susan Frazier, a 49-year-old nurse, who were sisters, traveled from Phoenix Arizona to Basel, Switzerland on February 3, and died by assisted suicide on February 11 at the Pegasos suicide clinic. Pegasos is known for providing death for people who are not terminally ill.

Reyes reported that Pegasos charges $11,000 for an assisted suicide.

In order to use Pegasos services, individuals must be members of the organization and pay an annual fee of about $110. Once a member, a person can apply for VAD.

In order to apply for the process, Pegasos needs to know the reason a person is requesting a VAD as well as their current living situation and family background.

Patients must also submit a brief biography, a birth certificate, marriage or divorce certificates, funeral instructions, health reports and proof of residence.

Aside from the membership fee, which could be waived if a patient is already a member of Exit International, the average cost of a VAD with Pegasos is more than $11,000.

Reyes further reported that two healthy American sisters recently died by assisted suicide at the Pegasos suicide clinic. He stated:

A Swiss government source told DailyMail.com that: 'The two American ladies died on February 11.

'They died the same day and the timings were close, if not at the same time.'

The sisters deaths were confirmed by the US consulate on February 18. Their brother Cal, 60, who lives in New York said he only learned of his siblings' passing when contacted by The Independent earlier this week.

In a previous article that was also published by the DailyMail, Reyes reported:

Dr. David Bilgari, a longtime friend of the sisters, said no one had heard from the duo since February 9, four days after they arrived in Switzerland, and that some of their final texts seemed to have been sent by someone else.

Prior to that, Bilgari told Fox 10 that co-workers had been texting them and felt that the person responding was not actually one of the sisters.

'Some of the text communications they had, we are certain they were not from them,' Biglari said. 'They were most likely fabricated with someone else.'

A spokesman for the Basel-Landschaft Public Prosecutor's Office confirmed to The Independent that the sisters had died by suicide 'within the legal framework'.

The concepts of euthanasia and assisted suicide are sold to the culture under the guise of ending suffering. These ladies do not appear to have been sick or suffering but they likely established a suicide pact that was carried-out by the Pegasos assisted suicide clinic.

It is time, once again, to universally reject euthanasia and assisted suicide and to promote a society that cares and not kills its citizens.

‘Healthy’ American Sisters Die at Swiss Suicide Clinic

This article was published by National Review online on March 23, 2022

By Wesley Smith

Article: Swiss suicide clinic provides death for $11,000 (Link).

Repeat after me: Assisted-suicide legalization eventually leads to death on demand.

Oh, you doubt me? That is already the law in Germany thanks to a court ruling creating a constitutional right to a “self determined death,” with help from anyone, at any time, and for any reason.

Now a suicide clinic in Switzerland has committed a joint assisted suicide of apparently healthy sisters from Arizona who flew there secretly to be made dead. From The Independent story:

Sisters Lila Ammouri and Susan Frazier who died by assisted suicide in Switzerland had been healthy and happy prior to their death, their brother says. Cal Ammouri, 60, told The Independent he last spoke to his sisters a few weeks before they travelled to Switzerland on 3 February, and there was no indication they were about to end their lives. He said he had been kept in the dark by US Consular services about the cause of death . . .

Lila Ammouri, 54, a palliative care doctor, and Ms Frazier, 49, a registered nurse, flew from Arizona to Switzerland via Chicago on 3 February without telling friends or family. When they didn’t didn’t show up for work at Aetna Health Insurance on 15 February, colleagues raised the alarm, fearing they may have been kidnapped or held hostage.

Their death was confirmed by the US Consulate in Switzerland on 18 February. Basel-Landschaft Public Prosecutor’s Office spokesman Michael Lutz told The Independent the sisters had died with the help of an assisted suicide organisation.

Always remember that the conjoined mantras, “Strict guidelines protect against abuse,” and, “Assisted suicide is only for the terminally ill,” are utter bunk. Once suicide is redefined as a human right, it becomes increasingly difficult to keep the beast caged.

So, can we finally have an honest debate about this contentious issue? Right. I didn’t think so.

Assisted suicide for anorexia nervosa expands assisted suicide from terminal to chronic conditions.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

In January I wrote an article about assisted suicide for anorexia nervosa. In the article I quoted from a case report published by the ACAMAID, an organization of assisted suicide practitioners who approved assisted suicide for anorexia nervosa by defining the condition as being "terminal." 

An article by Jennifer Brown that was published in the Colorado Sun on March 14 reports on Dr. Jennifer Gaudiani, an internal medicine doctor who specializes in eating disorders and who published a paper on her experience with prescribing assisted suicide for three people with anorexia nervosa.

Gaudiani defines anorexia as a terminally illness. Colorado's assisted suicide law does not permit assisted suicide for chronic or mental illnesses. Gaudiani considers anorexia to be a terminal condition because of the high rate of death among those who struggle with the condition. Brown writes:

In the paper, published in February in the Journal of Eating Disorders, Gaudiani ... writes that, although anorexia doesn’t have delineated levels of severity like cancer, which has stages of progression and a terminal phase, it can be brutally lethal. It is widely believed to have the second-highest mortality rate of all mental illnesses, behind only substance use disorders.

Based on the fact that anorexia has the second-highest mortality rate of all mental illnesses, second to substance use disorder, does that mean that people with substance use disorder also qualify for assisted suicide?

Is anorexia nervosa a terminal or a chronic condition?

A study by Kamryn Eddy et al., published in the Journal of Clinical Psychiatry in February 2017 titled: Recovery from Anorexia Nervosa and Bulimia Nervosa at 22 year Follow-Up recognizes that some people with Anorexia Nervosa die from the condition, but the study considers anorexia nervosa to be a chronic condition, not a terminal condition. The study is based on a 22 year follow-up and it concludes that for many people recovery is slow but nearly two-thirds of the participants fully recovered by year 22.

The study by Eddy is significant as it began in 1987 and followed up the participants at regular intervals including the 9 year interval and the 22 year interval. The study found:

Results:
At 22-year follow-up, 62.8% of participants with anorexia nervosa and 68.2% of participants with bulimia nervosa recovered, compared to 31.4% of participants with anorexia nervosa and 68.2% of participants with bulimia nervosa by 9-year follow-up. Approximately half of those with anorexia nervosa who had not recovered by 9 years progressed to recovery at 22 years. Early recovery was associated with increased likelihood of long-term recovery in anorexia nervosa but not in bulimia nervosa.

Conclusion:
At 22 years, approximately two-thirds of females with anorexia nervosa and bulimia nervosa were recovered. Recovery from bulimia nervosa happened earlier, but recovery from anorexia nervosa continued over the long term, arguing against the implementation of palliative care for most individuals with eating disorders.

There are several significant findings in this study:

1. Recovery from anorexia nervosa was slower than bulimia nervosa. Whereas 31.4% of the participants with anorexia nervosa were fully recovered by year 9 and 62.8% were fully recovered by year 22, with bulimia nervosa 68.2% were fully recovered by year 9 and 68.2% were fully recovered by year 22.

In both anorexia nervosa and bulimia nervosa, some of the participants who had fully recovered by year 9 were no longer fully recovered by year 22, but that also suggests that these are chronic conditions. Anorexia nervosa often requires a longer term treatment commitment to achieve full recovery which also indicates that anorexia nervosa is a chronic condition andnot a terminal condition.

2. The data in the study indicates that of the 246 study participants 18 people were known to have died by the 20 - 25 year interval. There is some missing data since researchers lost contact with 15 of the participants, and 37 participants decided not to continue participating in the study, nonetheless, if anorexia nervosa were a terminal condition the death rate by the 20 - 25 year interval would be much higher. The study does not indicate if all of the 18 participants who were known ot have died, died from the chronic condition or if some died from another cause.

Eddy refers to a study by Hay and colleages who suggested that:

“both the clinician and [chronically ill] patient often share the experience of hopelessness and despair about the likelihood of meaningful change.”

I suggest that feelings of hopelessness and despair are leading assisted suicide clinicians to redefine anorexia nervosa as a terminal illness and thus prescribe death as a treatment.

The recent Oregon 2021 assisted suicide report also listed anorexia as a reason for assisted suicide.

 My earlier comments that assisted suicide for anorexia nervosa is abandonment is supported by the conclusion of the study which states:

Our data indicate that the majority will recover from anorexia nervosa and bulimia nervosa over time. Yet 2 decades of illness represents considerably meaningful life lost, and our findings emphasize the importance of developing interventions to reduce the duration of illness. Our findings that recovery remains possible even after long-term illness argue for active treatment rather than palliative care for most patients. Increased research attention to identifying early predictors, mediators, and moderators of recovery in naturalistic and controlled treatment trials is needed to guide treatment disposition recommendations.

By prescribing lethal drugs for assisted suicide or lethally injecting a person (euthanasia) the clinician is abandoning the patient rather than helping the patient find hope with the potential of long-term recovery.

EPC report: States that are debating assisted suicide in America.

Sara Buscher - Chair, EPC - USA
Alex Schadenberg - Executive Director, Euthanasia Prevention Coalition

The state assisted suicide activity report does not include bills that we are expecting to be introduced in the next few weeks. We will update the report when other assisted suicide bills are introduced or bills are defeated.

States with Bills to Legalize Assisted Suicide that were introduced in 2021.

1. Massachusetts: S. 1384, H. 2381 (introduced in 2021).
2. Delaware: HB 140, introduced June 30, 2021. (carried over to 2022).
3. Minnesota: SF 1352, HF 1358 (carried over to 2022)
4. New York: A 4321, S 6471 (carried over to 2022)
5. Pennsylvania: S.B. 405, HB 1453 (carried over to 2022)
6. North Carolina H 780 (carried over to 2022)
   

States with Bills to Legalize Assisted Suicide that were introduced in 2022.

1. Indiana: HB 1020 referred to Public Health Committee.
2. Kentucky: HB 149 
3. Rhode Island: H. 6600 
4. Virginia: HB 1095, SB668 (Bill defeated in committee).
   
5. Utah: HB 74 
6. Arizona: HB 2762
   
7. New York A00198 Study MAiD if state enacts it.
   
8. Wisconsin SB 1013 died on March 15 when the legislature adjourned.

The assisted suicide lobby have promoted assisted suicide bills in several states but they are focussed on New York, Massachusetts and Connecticut. The Connecticut bill has yet to be introduced.

New York has several bills, including an assisted suicide study bill that was introduced this year.

States With Bills to Expand Existing Assisted Suicide laws in 2022

1. Hawaii: SB 323, SB 839, SD 2, HB 487. Bill passed in the Senate, carried from 2021.
2. Hawaii HB1823, SB2680 Adds physician extenders. Introduced in 2022.
3. Vermont: S.74. Carried from 2021; H 497 changes conscience rights and allows assisted suicide by telemedicine. Introduced in 2022
4. Washington: HB 1141. Bill passed in the House but died when it was not acted on in the Senate.
   

States with Bills to strengthen penalties for Assisted Suicide

1. New York: S. 6140. Prohibits insurance coverage/payment for assisted suicide.
2. New Jersey A1414 upgrade the crimes of coercing a patient to request or forging a request for lethal medication.
3. New Jersey A1415 – Repeals MAiD Act.

Court Cases to legalize or expand Assisted Suicide laws

1. California: Shavelson, M.D. et al v. California Department of Health Care Services, is a challenge in the federal district court to the California assisted suicide law stating that the law must allow euthanasia of people with disabilities who cannot self-administer the lethal drugs.
2. Oregon: Gideonse v. Brown et al. seeks to have residency requirements in state assisted suicide laws declared unconstitutional. Case is in federal Oregon District Court in Portland. This case would potentially extend assisted suicide to all of the USA.
3. Minnesota:Final Exit Network, Inc. v. Stuart, is a challenge in federal court asking it to overturn Minnesota’s law prohibiting assisted suicide.
4. Kligler v. Healy in Supreme Court of Massachusetts to decide if there is a constitutional right to assisted suicide in the state's constitution.
   
5. CMDA v Bonta in California district court challenge to new SB 380 requirements concerning physician conscience rights. SB 380 stated that a request for assisted suicide must be documented by the doctor and counted as the first oral request which is a form of participation.

The Euthanasia Prevention Coalition is very concerned with the direction of the court cases to legalize or expand assisted suicide laws. The Oregon - Gideonse v. Brown et al. case could lead to assisted suicide being done throughout the US via Oregon. Further to that, if an activist judge sides with Shavelson in California, that would allow euthanasia in California, but in reality it could lead to euthanasia in every state that has legalized assisted suicide. EPC-USA is working with a legal team on several of these cases.

Defeated Bills to Legalize Assisted Suicide in 2021 (for reference)

1. Arizona: HB 2254, SB 1775. Bills died in committee with no activity.
2. Connecticut: HB 6425. Bill passed one committee, died in the second committee.
3. Indiana: HB 1074. Bill died in committee with no activity.
4. Iowa: SF 212, HF475. Bills died in committee with no activity.
5. Kansas: HB 2202. Bill died in committee with no activity.
6. Kentucky: HB 506. Bill died in committee with no activity.
7. Nevada: SB 105, AB 351. SB 105 died in committee with no activity. AB 351 was released from one committee and died in another.
8. North Dakota: HB 1415. Bill voted down by the House.
9. Rhode Island: H 5572, S 0775. Bills died in committee with no activity.

We thank the people in every state who have been involved with opposing assisted suicide. We recognize the importance of the disability rights movement and we will help disability rights organizations engage in the assisted suicide debate.

More articles on these topics:

• 2022 Assisted Suicide US predications (Link). 
• The US assisted suicide lobby plans for expanding assisted suicide (Link).
• Assisted suicide deaths are not what you think they are (Link).
  

Italian Senate must defeat Assisted Death bill.

By Jacopo Coghe is a leader of the Italian group Pro-Vita.

Jacopo Coghe

In Italy, euthanasia is a hotly debated topic, and in the last few days the issue has been revamped at the legislative and parliamentary level. 

In the Chamber of Deputies, the Consolidated Act on "Provisions on medically assisted voluntary death" recently passed in the lower house. This legislation provides precisely for the right of a physician to prescribe lethal durgs for "medically assisted death" which is defined by Article 2 as: death caused by an autonomous act by which, as a result of the procedure governed by the rules of this law, your life is ended in a deliberate, dignified and conscious way, with the support and supervision of the National Health Service.

This bill, from the very beginning was opposed by pro-vita because it legalizes killing by euthanasia which is contrary to any form of protection of the most sacred and inviolable good, that being life.

In particular, there are several critical aspects of this text, especially after its approval in the House, which has been revealed only after the vote on the amendments that partially weakened the criteria, such as the amendment that requires a single certification to be eligible for euthanasia and no longer a double medical certification (general practitioner and specialist). Moreover, according to this legislative proposal, there should be no reference to the family and social condition of the person seeking assisted suicide, though these are fundamental elements in everyones life, especially for a person who is sick and possibly terminal.

One of the major critical points is in the preamble of the Consolidated Act, namely the Italian Constitutional Court's judgment no. 242 of 2019, which was the ruling on the so-called "DJ Fabo-Cappato case." The Court urged Italian politics to legislate on the issue. The lawmakers, however, are not legally bound to pass certain regulations. Consequently, the political "race" to legalize assisted suicide at any cost is unjustified, not to say absurd.

The Consolidated Text, which in a few months will reach and be debated by the Senate for the second and final vote, provides another critical "detail" - the definition of irreversible clinical condition. This wording actually serves to extend the right to assisted suicide to an extremely large number of people. The wording of the legislation approves assisted suicide for "irreversible" clinical conditions and many genetic diseases, which make a full return to "normality" impossible, but are a long way from death or dying.

Another legal critical element consists in the lack of room for conscientious objection for physicians who are asked to provide assistance in dying. At first the objection was totally missing from the Consolidated Act, while now it is included, but public health facilities are still required to guarantee the ongoing presence of non-objecting physicians.

On the medical side, there are also broad ethical issues. The legalization of assisted death infringes a millennial moral principle of civilization and medical ethics: "do not kill the innocent" or "do no harm." Moreover, giving doctors the right to prescribe lethal drugs to the sick who question the "good of life" means asserting that their lives are worth "less" than those who are healthy.

In particular, in Italy and especially with this bill, palliative care is not given enough emphasis and is therefore neither guaranteed, supported or even encouraged. This results in the violation of the principle of - caring for the sick. Consequently, as long as all patients do not have effective access to palliative care, there is yet another reason for assisted suicide not to be legalized.