Hawaii Medical Association Opposes Physician-Assisted Suicide

The following article was written by Christopher Flanders and published on December 5, 2012 in the Honolulu Civil Beat under the title: Hawaii Medical Association Opposes Physician-Assisted Suicide.

Assisted Suicide is being pushed in Hawaii by Compassion & Choices (C & C), the lobby group that promotes assisted suicide. C & C has falsely claimed that assisted suicide is legal in Hawaii. We expect C & C to, once again, attempt to legalize assisted suicide in the Hawaii legislature this year.

Hawaii Medical Association Opposes Physician Assisted Suicide

By Christopher Flanders, Honolulu Civil Beat - December 5, 2012.

On October 5, Civil Beat ran a piece favorable to euthanasia activism by Chad Blair entitled “ New Aid-in-Dying Service Gets Inquiries.” At the end of the article, Civil Beat asks readers to respond to the question, “Is the aid-in-dying movement a humane approach to a difficult subject, or is it a violation of ethical standards?” I wish to respond on behalf of the Hawaii Medical Association.

Serving Hawaii since 1856, the Hawaii Medical Association (HMA) is a voluntary, professional membership organization for physicians, resident physicians, and medical students in the state of Hawaii. HMA is dedicated to serving physicians, their patients, and the community through representation, advocacy, and public service. HMA is part of the American Medical Association (AMA) and is the parent organization for Hawaii's five component medical societies that operate independently, but in a network with the HMA in all four counties in the State of Hawaii.

In the last several decades, medical technology has made tremendous advances in saving and extending lives. As a result, life expectancy has increased dramatically.

The Hawaii Medical Association, along with the American Medical Association, oppose any bill to legalize physician-assisted suicide or death. We believe physician-assisted suicide to be unethical and fundamentally inconsistent with the pledge all physicians take to devote themselves to healing and life.

The issue of physician-assisted suicide is a highly charged and emotional issue. Often times, there is confusion as to the distinction between withholding or withdrawing treatment and assisted suicide. There is a critical difference, both ethically and in practice, between a patient’s right to refuse unwanted medical treatment and active medical intervention which brings about death.

The AMA Board of Trustees Report (#48) issued in 1996 articulates well the HMA’s views on this issue. It states:

Physicians, by nature of their calling, have compassion for those who suffer pain and indignity at the end of life. Instead of assisting those patients in committing suicide, this compassion and respect for patient dignity instills a demand on the profession to focus on the quality of care at the end of life….the cost to society of physician-assisted suicide is simply too high. The physician’s primary obligation is to advocate for the individual patient. At the end of life, this means that the physician must strive to understand and assist patients with various and unique existential, psychological and physiological factors that play out over the course of end-of-life care. Permitting physician involvement in assisted suicide would impose a significant and irreversible course change in the patient/physician relationship.

HMA continues to hold to these timeless principles today.

There are preferable alternatives to end-of-life care rather than helping patients to kill themselves. We believe that the emerging specialties of geriatric and palliative medicine are leading physicians toward a role that improves care for their patients. This research, education and training of physicians and caregivers about palliative care are making great strides in Hawaii. The focus of public-policy decisions should be on increasing access to compassionate and palliative care.

The words of ethicist Hans Jonas summarize well the consequences of embarking upon the dangerous path of legalized physician-assisted suicide: “The role of taker of life must never be assigned to a physician; in any case, the law must never permit him to perform it, for this would jeopardize and perhaps destroy the physician’s role in society. A patient must never have to suspect that his physician might become his executioner. (Hastings Center Report, Vol 25, No 7 – Special Issue 1995).

About the author: Christopher Flanders is the executive director of the Hawaii Medical Association. He is a neuropathologist, trained at the University of Texas Health Science Center at San Antonio.

Sunnybrook doctors' ability to cut off life support goes to Supreme Court of Canada

The following article was written by Sun Newspaper Columnist, Michele Mandel and published in the Toronto Sun on December 7, 2012 under the title: Sunnybrook doctors' ability to cut off life support goes to Supreme Court of Canada.

The Euthanasia Prevention Coalition had intervener standing in the Rasouli case at the Ontario Court of Appeal and we have intervener standing in the Rasouli case at the Supreme Court of Canada. The Euthanasia Prevention Coalition hopes that the Supreme Court of Canada essentially upholds the decision of the Ontario Court of Appeal.

The Euthanasia Prevention Coalition opposes giving doctors the right to unilaterally withdraw life-sustaining treatment from patients without consent and we are concerned about how the term "medical treatment" is defined, especially since the euthanasia lobby is attempting to have euthanasia defined as a form of "medical treatment" in Canada.

Sunnybrook doctors' ability to cut off life support goes to Supreme Court of Canada.

By Michele Mandel - Toronto Sun, December 7, 2012

Many of us will spend our final days in a cold hospital bed, dependant on expensive medical care to keep us alive.

But who will ultimately decide when our time has come? Will it be our Maker or hospital accountants? Will physicians be able to unilaterally withdraw treatment when they decide further care is futile? Or will the final decision remain with the patient and their family?

Who gets to decide who lives and who dies?

Supreme Court of Canada

On Monday, the Supreme Court of Canada will wade into that ethical minefield as two doctors from Sunnybrook hospital seek to unilaterally pull the plug on a patient they’ve decided no longer medically benefits from being on a mechanical ventilator.

No matter what the family wants.

The case surrounds Hassan Rasouli, a 60-year-old retired mechanical engineer and devout Shia Muslim. He’s been on life support at Sunnybrook since October 2010 after contracting bacterial meningitis in the hospital following successful surgery for a benign brain tumour.

The once vibrant father of two, newly arrived from Iran, slipped into a coma and after six weeks, his medical team announced to his family that there was no hope and they would be removing his ventilator and feeding tube the next day.

A doctor herself in her native Iran, his wife Parichehr Salasel stood in front of Rasouli’s bed and told them that they’d have to kill her first.

“In the view of Shia Muslims, life is sacred. A person is entitled to remain alive until all signs of life are gone. Preventable death must be prevented,” the family says in their factum.

When doctors and families can’t agree, such end-of-life disputes usually proceed to the Consent and Capacity Board (CCB) where an independent expert panel mediates on what should be done. Instead, the critical care doctors at Sunnybrook went to court to insist that they didn’t need consent to withdraw futile medical treatment.

So far, the judges have ruled against them. Last year, the Ontario Court of Appeal upheld a lower court ruling that found the physicians needed to obtain the family’s permission or refer the case to the CCB. But the Sunnybrook doctors pressed on and appealed to the Supreme Court, determined to have a definitive legal answer to a debate that will only grow as the population ages and more expensive medical machinery exists to keep people alive almost indefinitely. “If the Court of Appeal’s decision stands, patients and their surrogates will be legally entitled to insist upon receiving an array of futile treatments.”

In the meantime, Rasouli defied his doctors and actually began to improve. As his devoted family remained at his bedside, talking to him, reading to him, convinced that he was still there, he began to respond. He was able to catch balls when gently tossed into his hands, give a thumbs up or peace sign when requested, track them with their eyes. A neurologist confirmed his slight progress and upgraded him to “minimally conscious” (MCS) from his previous vegetative state. Patients in MCS have a 33% chance of making a marked recovery.

Still, the Supreme Court refused the family’s application to quash the doctors’ case.

The Sunnybrook physicians insist Rasouli is only exhibiting reflexes. “It is clear that Mr. Rasouli’s family loves him very much, and that they desperately wanted to believe that he was conscious and improving. Unfortunately, it is also clear this coloured their interpretation of his behaviour,” they say in their factum.

“The purpose of critical care medicine, including life-support measures, is to support the patient long enough to allow recovery from a reversible illness. Where, as in Mr. Rasouli’s case, there is no reversible illness from which he can or will recover, life-support serves no medical purpose.”

But it is not that clear cut or definitive. This is a family who believes there is still hope and the life of a vulnerable man hangs in the balance. And perhaps, one day, ours as well.

“It is not a matter of medical judgment that people need food, water and air,” Rasouli’s family argues. “Patients, patients’ families and the public at large are entitled to reassurance that physicians are not hastening their patients’ preventable death without consent or oversight,”

Assisted Suicide leaves no room for doctors' errors

The following letter was written by Jerry & Dora Jacobson and printed today in the Ravalli Republic newspaper in Montana under the title: Assisted Suicide leaves no room for doctors' errors or erroneous prognostications.

Jeanette Hall's letter ("Assisted suicide prompts some terminally ill patients to give up on life prematurely"), about how she would have died from assisted suicide if her doctor hadn't talked her out of it, hit a nerve. Her stated motivation was that she had been diagnosed with cancer and given six months to a year to live. That was 12 years ago.

Doctors do not know the future. They are often wrong. Indeed, this has happened twice in my family.

The first time was with my father. At age 66, he collapsed as he was leaving a doctor's appointment in the hospital at Glasgow. A week or so later his doctor recommended that we "pull the plug." I instead moved my father to another hospital. He fully recovered and lived nine more years. The doctor was wrong.

The second time was with me. When I was 62 years old, I was paralyzed due to a disease and put on a respirator. After four months, my doctors offered to take me off the respirator. They said that there was no chance of recovery. They said that if I lived, I would always be respirator dependent and a quadriplegic. Instead, I eventually lost my paralysis and even went back to work. My doctors, excellent doctors with years of experience, were wrong. It is now 14 years later.

Proponents of assisted suicide sometimes claim that assisted suicide is no different than pulling the plug. This is untrue. When you pull the plug, the patient doesn't necessarily die. If the patient does die, he or she dies due to his or her illness, not a lethal overdose.

I hope that we can keep assisted suicide out of Montana.

Jerry and Dora Lou Jacobson,
Glasgow Montana

Book release: Exposing Vulnerable People to Euthanasia and Assisted Suicide.

Order copies of Exposing Vulnerable People to Euthanasia and Assisted Suicide.

The book – Exposing Vulnerable People to Euthanasia and Assisted Suicide by Alex Schadenberg is available for orders.

Exposing Vulnerable People uncovers data from journal articles and studies concerning the practice of euthanasia and assisted suicide in Belgium and the Netherlands. 

Exposing Vulnerable People examines the data concerning: euthanasia deaths without request, unreported euthanasia deaths, and the experience of nurses with euthanasia in Belgium. The book also examines the most recent statistics concerning the practice of euthanasia in the Netherlands.

Exposing Vulnerable People exposes how vulnerable patient groups are dying by euthanasia without request and it proves that these deaths go undetected because the doctors are not reporting the deaths as a euthanasia death.

Alex Schadenberg

Exposing Vulnerable People also exposes how Justice Smith, in the Carter case in British Columbia, the Royal Society of Canada End-of-Life Decision Making report, and the Quebec Commission on Dying with Dignity avoided the truth in order to establish false and dangerous recommendations for the legalization of euthanasia and assisted suicide in Canada.

These false and misleading reports are being used in other jurisdiction to support the legalization of Euthanasia and Assisted Suicide.

Order - Exposing Vulnerable People from the Euthanasia Prevention Coalition for: $20 for one book, $50 for 3 books, $100 for 8 books, or $200 for 20 books. (prices include the cost of shipping) 

Order Exposing Vulnerable People by calling the office at: 1-877-439-3348 or email: info@epcc.ca. You can pay for the book online at: LINK.

The digital version is now available. Order it by email at: info@epcc.ca and then pay online at: LINK.

Nancy Elliott

Nancy Elliott, the former three term representative of the New Hampshire legislature and a member of the Euthanasia Prevention Coalition - International leadership team stated:

"Alex Schadenberg's book "Exposing Vulnerable People" is a powerful tool. The way he takes dry statistics and weaves them into the chilling realities that they are, is exceptional. His technique of reinforcing the statistics gives the reader a real working knowledge of the facts by the time he had finished this book. Definitely worth reading."

André Bourque

Dr. André Bourque, (RIP) the founding President of Vivre dans la Dignité (Living with Dignity) in Quebec stated:

“The Quebec Commission on Dying with Dignity has in its 2012 report recommended the introduction of euthanasia, while stating that they had reviewed the literature on the euthanasia experience in Belgium and Holland, and could not find any clear evidence of abuses or of any drift. Alex Schadenberg sets the record straight on what they should have read or may have purposefully ignored.”

Paul Russell, the founder of HOPE Australia, stated:

“Alex Schadenberg has done the debate on euthanasia & assisted suicide a great service in this comprehensive work. His thorough-going analysis of the available studies concerning the Netherlands and Belgium  demand a response from those who support euthanasia & assisted suicide. This work supports empirically the observation that no legislation can ever protect all citizens from the possibility of abuse. For legislators and commentators alike, this is a must read.”

 Michael van der Mast, Cry for life, the Netherlands stated:

My friend was diagnosed with pancreas cancer in 2011. When the time came he had to face the inevitable news that further medical treatment was meaningless, he was cared for by his wife surrounded by his family. In that time he had to turn down three independent euthanasia suggestions by his attending physicians. The suggestions were against our liberal euthanasia laws. It proves our societies are indeed on "a slippery slope" as argumented in this study; it’s high time to wake up, we may already have passed the point of no return.

Schadenberg conclusive remark therefore should be taken seriously.

Dr. Kevin Fitzpatrick
Director of EPC - Europe

Kevin Fitzpatrick, the director of the Euthanasia Prevention Coalition - Europe and a leader of Not Dead Yet UK stated:

"Using already existing studies, Schadenberg has uncovered the shocking truth about euthanasia in Belgium, the lives lost and the deep threat to others. His work demonstrates unequivocally that we must never follow this Belgian pathway to the easy killing of people whose lives are not valued by those who do the killing."

Since being published, Exposing Vulnerable People to Euthanasia and Assisted Suicide has received orders from across the world.

Order copies of Exposing Vulnerable People to Euthanasia and Assisted Suicide.

Investigation into the Liverpool Pathway.

The following article was written by Dr. Peter Saunders, the Campaign Director for the Care Not KIlling Alliance - UK that was published on his blog under the title: Investigation into the Liverpool Pathway: An update.

I think that the Liverpool Pathway is a strong argument for opposing euthanasia and assisted suicide. As Dr. Saunders states: 

"If everyone followed the very clear guidelines issued by those overseeing the LCP’s implementation I doubt that we would be having the current discussion"

If doctors in the UK won't follow the Liverpool Care Pathway guidelines, then what makes them think they will follow the guidelines that would be developed concerning, if legalized, euthanasia and assisted suicide.

Investigation into the Liverpool Pathway: An Update. 


Dr. Peter Saunders, Campaign Director - Care NOT Killing Alliance UK - December 2, 2012

Peter Saunders

On Monday 26 November, Care Minister Norman Lamb MP (pictured) convened roundtable talks with parliamentarians, doctors and patients' representatives to discuss the controversial Liverpool Care Pathway (LCP).

During the meeting, which I attended, the Minister announced a far-reaching review to consider the various issues raised, with an independent chair. 

The review will consider the findings of three existing reviews being conducted by the Association of Palliative Medicine ('on the implementation of the pathway and the experience of professionals'), Dying Matters ('on the experience of the patient and their loved ones') and the End of Life Care Strategy ('on complaints surrounding the LCP and end of life care in hospitals'). 

The announcement has understandably received widespread media attention (BBC, Telegraph,Guardian, Mail). 

The LCP has been the subject of criticism but has been defended by over twenty leading healthcare organisations and a group of more than 1,000 doctors. One testimony that has drawn a lot of attention is that of Dr Kate Granger, who as a terminally ill cancer patient and geriatric consultant has knowledge of both ends of this issue.

I have previously blogged extensively on the LCP and welcomed the investigation. 

Currently about 80,000 patients per year have been supported by the LCP and there is no doubt that it has hugely improved the care of many thousands of patients in the last hours and days of life. 

Furthermore the fact that most patients are dying within 33 hours of being placed upon it tells us that they are dying not from dehydration but from their underlying conditions. People usually take 10-20 days to die from dehydration and patients in the last hours or days of life often do not utilise fluids well and have no desire to drink.

However, the LCP has also come under justified criticism for its inappropriate use in some patients who are not imminently dying, its use by junior staff who have not been adequately trained or supervised and the fact that some relatives have not been informed that their loved ones have been placed on it. 

Case reports of patients being on the pathway for up to two weeks before dying, or recovering and living for months after being taken off it after protests by relatives have been particularly disturbing. 

If everyone followed the very clear guidelines issued by those overseeing the LCP’s implementation I doubt that we would be having the current discussion. 

However it is clear that in some care homes and district hospitals implementation has been sub-optimal. 

In order to iron out the abuses several measures need to be implemented: 

1. It should be made absolutely clear that no one who is not imminently dying within hours, or at most two or three days, should be placed on the LCP and anyone placed on it who shows improvement should be taken off it. These assessments should be made by senior clinicians. 

2. No one should be placed on the LCP without it being discussed with the relative or carer (although the latter do not need to give consent) 

3. Every patient placed on the LCP must be regularly monitored and reassessed by a multidisciplinary team. 

4. The present documentation is far too complex and needs to be simplified and standardised so that those implementing it can easily follow the guidelines and supervisors can easily tell what is going on with each patient.

5. Training and supervision of those using the pathway needs to be standardised and improved and formal training should be required before any healthcare professional is able to use it. 

6. An annual audit needs to be carried out and all suboptimal use identified promptly acted upon. 

7. Non-clinical priorities in the use of the pathway, especially financial priorities, must be eradicated and every patient treated solely according to their need. In this connection it would be far better to link CQUIN payments to staff training in the use of the pathway rather than numbers of patients placed on the pathway. 

8.Communication to relatives both by health professionals and organisations involved in LCP implementation needs to be substantially improved. 

9.Those misusing the LCP should be quickly identified and in the case of abuse reported to the appropriate authorities (General Medical Council or Nurses and Midwifery Council). 

Every airline accident should make our next air trip safer. In the same way every abuse or misuse of the LCP should mean that the same mistake never occurs again. 

We await the result of the investigation with great interest.

Why opinion polls supporting euthanasia are inaccurate.

The following article was written by Dr. Peter Saunders and published on his blog on December 1, 2012 under the title: Why opinion polls supporting euthanasia are a waste of space. The article was reprinted in full.

Peter Saunders

By Peter Saunders, Campaign Director - Care Not Killing Alliance - UK.

The Daily Mail is today running a story titled ‘Majority of Brits want assisted suicide legalised as new poll reveals strong support for change in the law across Europe’.

The headline is based on the findings of a new survey, carried out on behalf of the Swiss Medical Lawyers Association (SMLA), which apparently found that large majorities in the twelve west European countries involved supported ‘the right of people to choose when and how they die’.

Nearly three quarters of British people are said to be in favour of legalising assisted suicide and across Europe two-thirds to three-quarters of respondents said they could imagine opting for assisted suicide themselves if they suffered from an incurable illness, serious disability or uncontrollable pain (more detail here). 

The SMLA, according to Reuters, have concluded that ‘in practically all European countries, many signs indicate that the prevailing legal system no longer reflects the will of large parts of the population on this issue’. They argue that the results of their poll ‘should allow politicians to take democratic principles into account when considering legislation on these issues’.

The underlying assumption is that any practice that most people support in opinion polls should be legalised. 

But it’s not actually as simple as all that.

Support for assisted suicide, or any other form of euthanasia, is generally reflex rather than considered. Most opinion poll research consists to a large extent of knee-jerk answers to emotive - and often leading - questions. If people are asked if they would like help to die comfortably should they be terminally ill and with intractable pain it is not surprising that the vast majority answer yes. It is more surprising that anyone says no.

If such questions are asked, as they usually are just after some high profile case has been in the news, so-called ‘assisted dying’ will inevitably get the sympathy vote. And in a climate of continued high profile cases, as we have here, this 'support' will be maintained.

And yet when a specific change in the law is considered by parliamentarians in the cool light of day they almost invariably say no. 

This is because support for legalisation is uninformed. Most people have little understanding of the complexities and dangers in legalising assisted suicide or euthanasia and are ignorant of what has happened when it has been legalised elsewhere.

But public opinion changes when the dangers are pointed out. In the state of Massachusetts support for the legalisation of assisted suicide fell from 69% to 49% in just four weeks prior to the US Election, meaning that a measure everyone predicted would fly through in a liberal democratic state foundered at the finish line once the arguments against were properly aired. 

Worldwide, informed politicians, regardless of party background, largely reject it. Three attempts in UK parliaments to change the law in the last six years have all been defeated by large majorities over concerns about public safety. Over 120 attempts to change the law through US state parliaments since 1990 have all similarly failed. 

Apparent support for legalisation is also uncommitted. Legalizing assisted suicide is just not high on most people’s ‘to do list’. We don’t see people marching in the streets for a change in the law and serious petitions gain very little support. I doubt that ‘assisted dying’ would feature in the vast majority of people’s top 20 issues that they wanted parliament to do something about. 

Rather legalisation is the obsession of a very small, well-financed liberal elite, bolstered by a group of celebrities flocking to what they perceive to be a popular cause and furnished with a ready-made information conduit to the liberal press.

In my experience most of those in favour tend to be the ‘worried well’, especially the wealthy worried well who fear dependence and are terrified about the dying process. By contrast people with disabilities or terminal illness very rarely even wish to discuss it, either because they have experienced what good care can offer, or they have adapted to their disability or illness.

Apparent support is finally unconvincing. Most people answering polling questions are also in favour of bringing back the death penalty, but a recent campaign to get parliament to consider it which was given high prominence by the BBC and championed by one of Britain’s most popular bloggers could only muster 26,000 signatures. 

Moreover, if capital punishment were ever to reach parliament it would be defeated because of the fear that one innocent person might be condemned to death. A similar fear that vulnerable people might ‘choose’ to end their lives if assisted suicide were ever legalised similarly gives politicians pause for thought.

This is why we see lobby organisations like Dignity in Dying (formerly the Voluntary Euthanasia Society) relying on reflex opinion polls, high profile hard cases and celebrity endorsement rather than petitions, because if they tried the latter it would demonstrate just how weak their grass-roots support base really is.

Opposition to the legalisation of assisted suicide is by contrast diverse and broad-based. In Massachusetts the recent measure was defeated by a coalition of unlikely bedfellows: doctors, disability rights groups, egalitarian liberals, prolife groups, charities for the aged, advocates for the poor who saw legalisation as an invitation for cost containment, faith groups and ordinary people of all faiths and none. 

The bottom line is that advocates for assisted suicide face a tough battle because there remains sufficient support for traditional values in Britain and because liberals are divided on the issue. 

Montana has not legalized assisted suicide

The following letter was written by Dr. David W. Hafer and published in the Billings Gazette in Montana on December 2, 2012 under the title: Montana has not legalized assisted suicide.

Montana has not legalized Assisted Suicide 

A recent AP article which appeared Nov. 16 in most major newspapers in our state incorrectly stated that Montana is the third state to allow assisted suicide, along with Washington and Oregon. Attorneys Greg Jackson and Matt Bowman did an extensive analysis of the case and concluded it "did not legalize assisted suicide and it continues to carry both criminal and civil liability for any doctor, institution, or lay person involved." The Montana Lawyer, the official publication of the Montana State Bar concluded the issue is open to argument, confirming that the Legislature needs to clarify the issue this coming session. 

Your readership needs to know that there are problems inherent in passing a law that would allow a physician to kill their patient. People need to understand that we are talking about a physician writing a prescription for the express purpose of one taking their own life. The very oath that physicians take in stepping into this profession states that they "shall do no harm." Their purpose is to cure, to heal, to provide comfort and care at the end of life, but not to aid in facilitating the end of that life through active means. 

Physicians are fallible human beings and often are wrong in their prognosis concerning how long a patient will survive their illness. Often, it is depression that prompts one to think that life is not worth living or perhaps the feeling that because of their illness they are a burden to their family. The whole matter is a recipe for elder abuse. 

I appreciate the opportunity to set the record straight and hope that The Gazette will continue to report on this vital topic. 

David W Hafer, DDS, MS
Dayton

Margaret Somerville says: Euthanasia ruling is convoluted and skewed.

On November 22, Margaret Somerville spoke at the University of Toronto on behalf of the deVeber Institute on the issue of euthanasia and assisted suicide. Somerville focused on the one-sided skewed and convoluted decision by Justice Smith in the Carter decision in BC.

The following article was written by Michael Swan and published in the December 2 edition of the Catholic Register in Toronto under the title: Euthanasia ruling, convoluted skewed.

By Michael Swan, Catholic Register - December 2


With respect, Justice Lynn Smith of the British Columbia Supreme Court of Justice is dead wrong, Margaret Somerville told about 300 people gathered at Toronto’s University of St. Michael’s College Nov. 22.

Margaret Somerville

The McGill University law professor and bioethicist picked apart the 137,000 words of the B.C. judge’s June 15 decision striking down the law against assisted suicide in the Carter case. That case has been kicked up to the B.C. Court of Appeal and will almost certainly wind up in front of the Supreme Court of Canada.

The judge ruled that the prohibition of physician-assisted suicide under Canada’s Criminal Code infringe upon the rights of the disabled and on Canadians’ right to life, liberty and security of the person.

Somerville turned her legal mind to the judge’s use of the terms “Right to life,” “Respect for life,” “Inviolability of life,” “Protection of life,” “Sanctity of life” and “Quality of life” in her decision.

Smith ruled that the Charter of Rights and Freedoms’ guarantee of the right to life is violated by a law which denies citizens access to physician-assisted suicide. She reasons that a seriously ill patient who is determined to commit suicide would have to kill themselves before becoming too sick or frail to successfully commit self-murder alone. However, if physician-assisted suicide were available, patients could rely on doctors to kill them and therefore wait longer before committing suicide. By Smith’s reasoning, patients would live longer if they could order their doctors to kill them.

Somerville called the reasoning convoluted and skewed. The problem is that the judge considers only individual rights and not the effect on society as a whole.

Euthanasia is a “social act,” Somerville said, where “medical personnel are licensed and compensated by the state to take life.”

While Justice Smith seems to assume that personal autonomy is the value which trumps all others, society has rights too, said Somerville.

“The strongest case against euthanasia is what it is going to do to society,” she said.

Somerville has made similar arguments against legalizing physician-assisted suicide before, but Jean Echlin, University of Windsor lecturer and palliative care nurse consultant, still felt she had to be there to hear the secular champion of life issues speak.

Jean Echlin

“She inspires me,” said Echlin. “I love her inspirational message. It just kind of flows.

Echlin particularly wanted to hear Somerville pick apart the Carter judgment, which she believes does not line up with her bedside experience as a palliative care nurse.

Though official statistics claim 30 per cent of Canadians have access to palliative care at the end of life, Echlin believes it can’t be more than 20 per cent. To hear Somerville argue there can be no such thing as informed consent to euthanasia when other options are not available and pain is not well managed gave Echlin the satisfaction of hearing a respected legal scholar explain something she knows from experience.

For student Safina Allidina, an intern at the deVeber Institute, which sponsored Somerville’s lecture, learning from the McGill professor how euthanasia has escalated in European countries, where it was first envisioned as a rare event in need of legal protection, was eye-opening.

“I didn’t realize how extreme it has gotten in the Netherlands,” Allidina said.

Somerville outlined the program of Dutch doctors in specially equipped minivans who now make house calls to euthanize patients at home.

Sunnybrook Hospital’s Dr. Lucas Vivas felt he had to be there for Somerville’s talk.

“It’s a pressing issue in our field,” he said.

Vivas daily passes by Hassan Rasouli’s bed, though he’s not involved in the man’s care. Rasouli’s family has insisted he should remain on life support against the advice of Sunnybrook doctors, who believe there is no reasonable hope of recovery for the patient who has been in either a persistent vegetative state or minimally conscious since October 2010. The Rasouli family will argue before the Supreme Court of Canada Dec. 10 that he should remain on life support.

For Vivas the central question in end-of-life debates is sanctity of life.

“If there is no sanctity of life a lot of this is moot,” he said.

But in a secular society we have to decide what sanctity means for people who do not accept religious arguments, he said.

Though many polls show a majority of Canadians in favour of legalized physician-assisted suicide, the question has been framed in terms that make it seem cruel to force people to live on in pain, said Somerville. Nor is polling an appropriate way to determine how we care for the dying.

“Just because a majority votes for something doesn’t make it ethically acceptable or legally acceptable,” said Somerville.

Canada has to solve the legal and ethical problem of end-of-life care in ways that accord with the country’s deeper values and not simple economics or convenience, she argued.

“It’s how we treat dying people that will tell us the ethical tone of society.”

Abuse of Liverpool Pathway extends to dehydrating newborns with disabilities

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The Liverpool Pathway is a guideline in the UK that doctors follow to ensure that people who are nearing death receive good pain and symptom management. There have been several studies and many articles, over the past few months, concerning the abuse of the Liverpool Pathway. The Liverpool Pathway is abused when doctors decide to place a patient, who is not otherwise dying on the Liverpool Pathway or when a doctor decided to the abuse the Liverpool Pathway to cause death.

An article last June suggested that patients that are difficult to manage were being put on the Liverpool Pathway to die prematurely. An article published in October emphasized how the UK was planning to tighten the guidelines for the Liverpool Pathway to ensure that people are not by euthanasia by dehydration.

An article that was written by Sue Reid and Simon Caldwell and published on November 28 in the Daily  Mail newspaper in the UK under the title: Now Sick Babies go on Death Pathway: Doctor's haunting testimony reveals how children are put on end-of-life plan explains how babies with disabilities were intentionally killed through the abuse of the Liverpool Pathway. The article stated:

Sick children are being discharged from NHS hospitals to die at home or in hospices on controversial ‘death pathways’. 

Until now, end of life regime the Liverpool Care Pathway was thought to have involved only elderly and terminally-ill adults. 

But the Mail can reveal the practice of withdrawing food and fluid by tube is being used on young patients as well as severely disabled newborn babies.

The article then uncovers a report in a medical journal that reports that a physician admitted to withdrawing fluids from at least 10 babies. The article stated:

One doctor has admitted starving and dehydrating ten babies to death in the neonatal unit of one hospital alone. 

Writing in a leading medical journal, the physician revealed the process can take an average of ten days during which a  baby becomes ‘smaller and shrunken’. 

‘Parents and care teams are unprepared for the sometimes severe changes that they will witness in the child’s physical appearance as severe dehydration ensues. 

‘I know, as they cannot, the unique horror of witnessing a child become smaller and shrunken, as the only route out of a life that has become excruciating to the patient or to the parents who love their baby.’ 

According to the BMJ article, the doctor involved had presided over ten such deaths in just one hospital neonatal unit. 

In a response to the article, Dr Laura de Rooy, a consultant neonatologist at St George’s Hospital NHS Trust in London writing on the BMJ website, said: ‘It is a huge supposition to think they do not feel hunger or thirst.’ 

Clearly the report is referring to an abuse of the Pathway that fits the description of euthanasia by dehydration, often referred to as slow euthanasia. Euthanasia by dehydration occurs when a person, who is not otherwise dying, is intentionally dehydrated to death. The abuse of the Liverpool Pathway is very similar to the use of the Groningen Protocol in the Netherlands.

The Liverpool Pathway is undergoing an investigation and a possible revision. The article informs us about the history of the Liverpool Pathway. The article states:

The LCP was devised by the Marie Curie Palliative Care Institute in Liverpool for care of dying adult patients more than a decade ago. It has since been developed, with paediatric staff at Alder Hey Hospital, to cover children. Parents have to agree to their child going on the death pathway, often being told by doctors it is in the child’s ‘best interests’ because their survival is ‘futile’.

The article then informs us that Bernadette Lloyd, hospice paediatric nurse has officially criticised the use of the Liverpool Pathway for children. The article states:

She said: ‘The parents feel coerced, at a very traumatic time, into agreeing that this is correct for their child whom they are told by doctors has only has a few days to live. It is very difficult to predict death. I have seen a “reasonable” number of children recover after being taken off the pathway. 

‘I have also seen children die in terrible thirst because fluids are withdrawn from them until they die. 

‘I witnessed a 14 year-old boy with cancer die with his tongue stuck to the roof of his mouth when doctors refused to give him liquids by tube. His death was agonising for him, and for us nurses to watch. This is euthanasia by the backdoor.’

The article also reports that:

Teresa Lynch, of protest group Medical Ethics Alliance, said: ‘There are big questions to be answered about how our sick children are dying.’

Hopefully the investigations into the Liverpool Pathway in the UK will also effect the care of people, whether they be adults or children, world-wide. The clear abuse of palliative care that is occurring in the UK is also happening throughout the world.

Historically, the T4 German euthanasia program began the same way in 1939. Children with disabilities were first dehydrated to death, and then they were injected, and then they were gassed. 

In case you are wondering, legalizing euthanasia does not stop the abuse.

Legal assisted suicide Orwellian and discriminatory

The following letter was written by Dr. Carley Robertson and published on November 28, 2012 in the Ravalli Republic under the title: Legal assisted suicide Orwellian and discriminatory.

I am confused by the ongoing dispute about whether we should legalize assisted suicide in Montana. I am a medical doctor whose patients include incarcerated persons. Law enforcement, jails and prisons are mandated to monitor for signs of depression and suicidal ideation, and to identify, intervene and/or initiate treatment. We are told that our failure to do so would be a significant breach of an inmate’s civil rights. Yet according to proponents of assisted suicide, patients also have a right to receive a doctor’s assistance with the suicide. This makes no sense. 

On the one hand, you have a group of people (prisoners) who suffer from situational depression due to their circumstances. Suicide attempts in this population are not rare. On the other hand, you have a group of people (persons diagnosed with a terminal diagnosis) who suffer from situational depression due to their circumstances. Why is one group entitled to protection and the other is not? Is it because with the second group, you call it “aid in dying” because people are dying anyway? They may not be dying anyway. Doctors diagnoses can be wrong. I have seen patients in my own practice live longer than expected. What about an older inmate? Would he be entitled to protection or a lethal dose? This all strikes me as very Orwellian and also discriminatory to people labelled terminal. I thought freedom from discrimination was a constitutional right. 

I have seen suicidal people get better and rebuild lives that looked pretty grim. I do not agree that doctors or anyone else should be steering people to suicide in Montana. I hope that our legislature will clarify once and for all that assisted suicide is not legal in Montana. 

Carley C. RobertsonHavre