The story of Edwarda O'Bara, a story of love and commitment

An article written by Wayne Drash for CNN and published on December 23 recounts the love of a mother and family for their daughter and sister who lived in a comatose condition for 42 years. The article that was titled: Comatose since Christmas 1969: A tale of unconditional love and miracles focuses on the life and love of the O'Bara family for Edwarda who went into diabetic shock on January 3, 1970 and became comatose.

Family and friends, Edwarda's 51st birthday.

Edwarda was cared for, around the clock at home, by her mother Kathryn (Kaye) until she died in March 2008 and more recently she was cared for by her younger sister Colleen until Edwarda recently died on November 21, 2012.

This is a difficult story to consider outside of the concept of the love of a person for another person or in this case, for their child or sister.

The story of unconditional love for Edwarda includes religious overtones that many people would immediately reject. It is true that religious experiences are private and personal.  The greatest miracle was the care, love and  commitment that the O'Bara family provided Edwarda. 

It is wrong that some people have suggested that the family was somehow causing Edwarda to suffer. This is a story of love and commitment.

It is particularly distressing that the Hemlock Society thought that it was part of their mandate to try to convince the O'Bara family to stop caring for Edwarda. The story states:

"The Hemlock Society phoned often, pleading with the mother to let her daughter die. The day after Christmas in 1981 someone called to say he was going to put Edwarda out of her misery. A few hours later three bullets were fired into the home. No one was hurt."

Colleen caring for her sister Edwarda

Why would the Hemlock Society care that Edwarda's family were willing to love and care for her. Wasn't it their choice? The family cared for Edwarda, they weren't harming her.

The Hemlock Society changed its name to Compassion & Choices a few years ago.

In 1970, when Edwarda became Comatose, there was very little knowledge about the awareness of a person who is considered Persistent Vegetative State or Comatose. Today, researchers are learning a lot more about these conditions.

The story quotes Stephen Mayer, a professor of neurology and neurological surgery at Columbia University, who has treated many comatose patients over the years. The story states

"He says new research suggests that patients in persistent vegetative states may perceive what's around them in a way that doctors didn't previously understand. 

"The best evidence of that are people who don't follow commands and appear to be vegetative, but after several years they wake up and start following commands," says Mayer. 

Mayer, who did not treat Edwarda, says it's possible "she was perceiving what was going on around her to some extent over those 40 years, but not really able to communicate to us in a way that we can believe. And maybe the daily contact, the voices, the touches with her loved ones gave her reason to live." 

"One thing I've learned over the years as somebody who treats people in a coma and tries to save them," he says, "is there's something very important about human contact with the people that bring meaning to your life, your loved ones."

A mother caring for her daughter.

Kathryn believed that to the fullest.

The love and commitment to care for Edwarda was a counter-cultural message that needs to be upheld as an example of the true dignity of human beings. I would rather live in a world that is willing to care for its most vulnerable members than a world that views its most vulnerable members as expendable.

The O'Bara family went above and beyond what was required or expected of them. 

Their love and commitment should be celebrated and emulated.

Nitschke is importing death cannisters.

The following article was written by Paul Russell, the founder and leader of HOPE Australia, and published on his blog on December 19 under the title: Importing Death Cannisters, legal or not?.

The article concerns a TV news current affairs program that focused on the new suicide device that was developed by Philip Nitschke under the guise of the Max Dog brewing company. The comment by Paul Russell follows:

Importing Death Cannisters, legal or not?

Paul Russell

Last Tuesday night December 18 the ABC's National Current Affairs program, The 7:30 Report, ran a story on Dr. Nitschke and his promotion of nitrogen for suicide. 

Link to The 7:30 Report program. 

For the first time, he admitted that he imports the nitrogen canisters from China and the report said that he did so through the company, Max Dog Brewing which is wholly owned by Dr. Nitschke through another company, Northern Analytics P/L.

In the report, Nitschke suggests that brewing is the reason for the imports of nitrogen and that people might choose to use it for other purposes as well. The ABC seem to have swallowed that assertion uncritically.

It's really hard to take this seriously; as is the image of Nitschke sitting in the back of a van in a North Sydney car park awaiting his customers.

Nitrogen is used in some brewing processes, certainly; but most home brewers would not use this method of providing the bubbles in their favourite brew. But why the need for a front company and why the need for the brewing facade?

Perhaps Australian Customs Laws and Regulations might have something to do with it:

CUSTOMS (PROHIBITED IMPORTS) REGULATIONS 1956 - REG 3AA

Importation of devices and documents relating to suicide

(1) The importation of a device designed or customised to be used by a person to commit suicide, or to be used by a person to assist another person to commit suicide, is prohibited absolutely.

(2)  The importation of the following documents is prohibited absolutely:

(a)  a document that promotes the use of a device mentioned in subregulation (1);

(b) a document that counsels or incites a person to commit suicide using one of those devices;

(c)  a document that instructs a person how to commit suicide using one of those devices.

These Regulations seem open to interpretation, who knows. But what we do know, from Nitschke's own words is that he has another order of 100 canisters on the way.

How do we know who turns on the tap?

This is the big question here. If there's a debate in a parliament on euthanasia or assisted suicide MPs have to grapple with the issue of public safety: are the 'safeguards' really safe? Does the bill protect people at risk?

But here there's no such protection, no public scrutiny and no accountability. As I said in the interview, we should really be concerned about Elder Abuse - there's no way of telling whether or not an abusive relative ordered the kit and turned on the tap. There's no way of guaranteeing that a troubled teenager didn't order a kit or 'borrow' one from a relative or friend.

This is reckless behaviour.

Assisted Suicide's dangerous illusion of control

The following article was written by Dr Will Johnston, the chair of the Euthanasia Prevention Coalition of BC and published in the Calgary Herald on December 19, 2012 under the title: Assisted Suicide's dangerous illusion of control.

By Will Johnston - Calgary Herald, December 19, 2012

Will Johnston

The daughters are beside themselves. One sat in my office recently, telling me about her father’s trips to the bank that are draining his savings. He gets angry when his daughters challenge him.

The money — thousands of dollars, slowly saved from a meagre pension and needed for his care — seems to be going to a recently acquired girlfriend some years younger than himself. He speaks almost no English. The situation was detected by chance when a daughter gave him a ride to the bank and saw his bank book.

Some time ago, I performed a competency assessment on a socially isolated older person who had been placed in a nursing home. An unrelated neighbour had listed the person’s home for sale and was receiving inquiries before a relative became aware.

On another occasion, an older woman had adequate resources to stay in her attractive home and employ a live-in caregiver. A family member, an heir and beneficiary, arranged to have her met at her door by an ambulance crew with a gurney. She was told that if she did not co-operate, the police would be called. She submitted and was transported to a dingy nursing home that she described as a prison. Her home was sold.

A colleague recalls being on duty in an emergency room several years ago when an older bachelor came in desperately ill and confused, accompanied by his niece and nephew.

“He’s had a good life. He wouldn’t want any treatment,” his only relatives (and presumably heirs) attested. With ordinary care and rehydration, the older man walked out of hospital a week later.

Each of these scenarios is different, and none of them grace a research paper, but all of them are the real face of elder abuse. I could list 10 more from my own experience. Government of Canada policy recognizes the epidemic of elder abuse and the unusual difficulty of detecting it, often because the victim resists the revelation of abuse.

I routinely see people induced to do things and accept arrangements that are contrary to their own interests. People can be surprisingly naive.

High profile assisted suicide cases might at first seem to be about another kind of person, a sophisticated and clear-minded sort, immune to undue influence. I suggest that this presumption is also naive.

We all take our cues from those around us. It only takes a few words to promote suicide. If the law is changed, an obligation to mention the legal fact of assisted suicide will be created. Some patients will experience even the most perfunctory acknowledgment of assisted suicide as an inducement to it.

If state-sanctioned suicide becomes part of the atmosphere in our hospitals, a presumption in that direction will be created. I predict the same erosion of medical diligence that many of us on the front lines have already watched happen when caregivers choose to see a patient as having finished all useful life. How much more will this be the case when the patient’s present fear and loss of hope feed smoothly into an official assisted-suicide regime?

Some people would throw away months or years of life, and some would miss good medical care or medical advances they would have wanted to enjoy. Consider the case of Jeanette Hall, who wanted to use Oregon’s assisted suicide law and is grateful, 12 years later, that her doctor directed her toward treatment rather than suicide.

One of Dr. Ken Stevens’ Oregonian patients was not so lucky — part way into his cancer treatment, he became despondent and was given suicide pills by another doctor.

I know someone, happy to be alive, who had alarming symptoms and a clear diagnosis of Lou Gehrig’s disease more than a decade ago. The symptoms inexplicably resolved. Huntington’s disease, a factor in a recent high-profile suicide in Toronto, moved closer to a treatment recently in a stem cell experiment.

If a legal assisted suicide offer is always dangling, variations in the competence and diligence of doctors create arbitrary forces that move choice and control to others, not the patient.

When you or your loved one goes to the hospital, you need to be able to trust that an assisted-suicide-minded doctor or nurse will not be steering you or them toward death. People can be offered the illusion of control and autonomy when the choices are really being shaped by others.

When empowered medical personnel — and right-to-die activists — choose their own opinions about your quality of life, and have been given constitutional protection to counsel, facilitate and steer you toward suicide, you and your loved ones will not be safe.

The choices created by legal assisted suicide may end up being someone else’s, not yours. The speculative legal changes being offered are dangerous and irresponsible. Parliament rejected them firmly two years ago. We will all be safer if our courts do the same.

Photograph by Ami Sanyal

Dr. Will Johnston is chair of the Euthanasia Prevention Coalition of BC.

© Copyright (c) The Calgary Herald

France may allow assisted suicide.

An article published today in the Connexion, France's English newspaper states that Assisted Suicide may be allowed in France. 

The article concerns the report from the Comité Consultatif National d'Ethique in France that examined the issues of euthanasia and assisted suicide and concluded that assisted suicide may be legalized but stated that euthanasia is: 

“a radical medical gesture” that crossed “a forbidden barrier” – and was both impractical and immoral

The report 'severely criticised current medical care of terminally-ill patients in France and called for the development of better palliative care regimes' and it emphasized the moral use of palliative sedation rather than euthanasia or assisted suicide.

The Euthanasia Prevention Coalition (EPC) recognizes the difference between euthanasia and assisted suicide as being somewhat distinctive but both decisions threaten the lives of people who are already devalued or considered by many to have lives that are not worth living.

Euthanasia is when someone directly and intentionally causes the death of another person, usually by lethal injection, and it is considered a form of homicide.

Assisted suicide is when someone is directly and intentionally involved with causing the death of another person, usually by lethal dose. Assisted suicide is to aid, encourage or counsel suicide.

Euthanasia and assisted suicide both involve giving the right to one group of people to directly and intentionally cause the death or be involved with causing the death of another person.

Society should never give one human being the right in law to cause the death of another human being. The act cannot be safe and it will be abused, it cannot be effectively controlled and it cannot be separated from the attitude of the person who is causing or involved with causing the death of the other, such as negative attitudes towards people with disabilities or those with Alzheimer's or chronic disabling conditions.

Further to that, legalizing euthanasia or assisted suicide gives the power over life and death to physicians. This is a power that should never be exercised by one person over another person.

Paris Protest

EPC calls on all people of good will to strongly protest and to oppose any attempt to give others the right to cause death by euthanasia or assisted suicide. 

The article stated that:

the Comité Consultatif National d'Ethique would be asked to look at the report and advise on putting it into practice with a view to a law before parliament in June 2013.

Read the pdf of the report on the Elysee website. 

Belgium considering euthanasia for children and people with alzheimer's

The AAP news published an article today stating that the Belgium government is considering changes to their euthanasia law that would enable doctors to cause death by euthanasia of children and people with Alzheimer's or dementia.

The proposed changes to the euthanasia law in Belgium must be strongly challenged, especially since a recent 10 year review of the Belgium euthanasia law indicates that euthanasia is out-of-control in Belgium.

The Belgium Euthanasia model is in serious need of review, not expansion. The Belgium Euthanasia Model:
* The reporting process in Belgium does not protect vulnerable patients. The patient is dead before the report is submitted (after the death reporting). A study that was published in the BMJ - Nov 2010 found that 47% of the euthanasia deaths in the Flanders region of Belgium were not reported.

* A study published in the CMAJ - June 2010 found that 32% of the euthanasia deaths in the Flanders region of Belgium were done without request or consent.

* There are no reports of doctors who were prosecuted in Belgium for ignoring the safeguards.

* Belgium requires doctors to approve and carry-out euthanasia. It is illegal for nurses to euthanize a patient in Belgium. A study published in the CMAJ - June 2010 found that 45% of the euthanasia deaths done by nurses were done without request or consent.

Belgium does not protect vulnerable people from euthanasia.

The AAP article stated:

The proposed changes to the law were submitted to parliament Tuesday by the Socialist party and are likely to be approved by other parties, although no date has yet been put forward for a parliamentary debate. 

"The idea is to update the law to take better account of dramatic situations and extremely harrowing cases we must find a response to," party leader Thierry Giet said. 

The draft legislation calls for "the law to be extended to minors if they are capable of discernment or affected by an incurable illness or suffering that we cannot alleviate." 

Belgium was the second country in the world after the Netherlands to legalise euthanasia in 2002 but it applies only to people over the age of 18. 

Socialist Senator Philippe Mahoux, who helped draft the proposed changes, said there had been cases of adolescents who "had the capacity to decide" their future. 

He said parliamentarians would also consider extended mercy-killing to people suffering from Alzheimer's-type illnesses. 

Euthanasia was allowed to an Alzheimer's patient for the first time in the Netherlands last year. 

In Belgium, some 1,133 cases - mostly for terminal cancer - were recorded in 2011, about one percent of all deaths in the country, according to official figures. 

A seriously ill prisoner serving a long jail sentence this year became the first inmate to die under Belgium's euthanasia laws.

Link to my blog article concerning 23% of assisted deaths in the Netherlands not being reported.

It is important to note that the article states that there were 1133 reported cases of euthanasia in 2011 and yet studies indicate that up to 47% of all euthanasia deaths go unreported.

The book, Exposing Vulnerable People to Euthanasia and Assisted Suicide uncovers the data proving that unreported euthanasia deaths and the abuse of the euthanasia laws in jurisdictions where it is legal, such as euthanasia deaths without request, not only occurs but represents a threat to vulnerable patients.  

Order the book: Exposing Vulnerable People to Euthanasia and Assisted Suicide. Link.

No euthanasia, but possibly assisted suicide in France.

A article written by Angela Diffley and published today in the European news RFI English stated that the soon to be released French commission report on euthanasia and assisted suicide will recommend that euthanasia remain illegal but assisted suicide be allowed for progressive incurable illnesses.

François Hollande spoke about legalizing euthanasia during the election and soon after the election he established this commission on euthanasia and assisted suicide in France.

Many of these reports and examinations concerning assisted death base limit their research to the data on the reported assisted deaths in jurisdictions where it is legal. Therefore the unreported assisted deaths are not considered within these studies.

The recent meta-analysis of the 2010 data concerning assisted deaths in the Netherlands found that 23% of the "assisted deaths" were not reported. A recent study concerning the practice of assisted deaths in the Flanders region of Belgium found that 47% of the "assisted deaths" were not reported.

These reports indicate that the reported assisted deaths usually follow the guidelines in the law while the unreported assisted deaths usually do not follow the guidelines in the law.

Further to that, these reports have found that the demographic group for people who die by an unreported assisted death tend to be patients who are over the age of 80, die in a hospital, and were incompetent to make decisions for themselves. This represents a "vulnerable patient group" who have lost their life in a manner that is illegal and yet unprotected.

It is also important to note that in every jurisdiction where an assisted death has been legalized, the data from the reported assisted deaths comes from the doctor who carried-out the assisted death. 

The data from Belgium indicates that doctors do not report abuses of the law and doctors do not self-report abuses of the law. The data from the official reports do not indicate that abuses occur because they are simply not being reported.

Protest against euthanasia in France

The Euthanasia Prevention Coalition will work with the groups who oppose the legalization of euthanasia and assisted suicide. To legalize assisted suicide for any reason, will change the belief that it is always wrong to allow people, in society, to kill other people in society. 

Once assisted suicide is legalized, the social question moves from - is it right to kill people in society to in what circumstances is it right to kill people in society.

There must be a line in the law that it is always wrong to kill a human being.

The article from the European news RFI, English stated:

François Hollande

A report commissioned by French president François Hollande, to be made public on Tuesday, will recommend that euthanasia remain illegal in France, while leaving the door open to assisted suicide. 

Professor Didier Sicard concludes after his study of the issue, that assisted suicide could be considered in certain cases of progressive incurable illnesses. 

Under current French legislation, enshrined in the 2005 so-called Leonetti Law, it is illegal to give patients medication which will kill them, but legal to administer pain relief, which might have the side effect of shortening life. 

Opposition UMP Parliamentarian Jean Leonetti, largely responsible for the existing law, welcomed the new report’s conclusion to maintain France’s ban on euthanasia, and suggested that there was no need for any change in legislation.

He said that the details of the 2005 law were often not understood and that the law was not always applied. 

He declared that he himself did not favour allowing assisted suicide, as legalised in the US state of Oregon, because it would “break society’s solidarity with the most vulnerable” 

But in an interview with French radio station Europe 1, Marie Humbert, who helped her tetraplegic son to die in a widely publicised case in 2003, said she was “enormously disappointed” with the recommendations of the new report.

She said she knew of many mothers who had helped their children to die, with the unofficial help of sympathetic doctors, and that it was a very difficult secret for them to bear. 

The report is critical of doctors on the issue of pain relief, and condemns a culture which it says focuses on treatment and does not sufficiently emphasize efforts to reduce suffering, despite the existence of effective drugs. 

The authors also say that doctors sometimes appear deaf to the distress and wishes of patients, and they recommend that palliative care should form part of all medical training.

The book, Exposing Vulnerable People to Euthanasia and Assisted Suicide uncovers the data proving that unreported euthanasia deaths and the abuse of the euthanasia laws in jurisdictions where it is legal, such as euthanasia deaths without request, not only occurs but represents a threat to vulnerable patients.  

Order the book: Exposing Vulnerable People to Euthanasia and Assisted Suicide. Link.

Irish court case seeks to legalize assisted suicide.

The Euthanasia Prevention Coalition (EPC) is very concerned about the recent court case in Ireland that seeks to legalize assisted suicide. 

The Irish assisted suicide case was launched by Marie Fleming, the wife of Exit International leader Tom Curran. She is challenging the Irish law that protects people from assisted suicide.

Fleming, who lives with MS, is arguing that the ban on assisted suicide will force her to die an undignified death. She is asking the court to allow her husband, Tom Curran, the right to assist her death without fear of prosecution.

An expert witness, Dr Tony O'Brien, a palliative care physician at Cork University hospital told the court that legalizing assisted suicide in Ireland would "muddy the waters" and it could put pressure on vulnerable people to end their lives. Professor Robert George from the  Guys hospital in London England warned the court about the practice of euthanasia and assisted suicide in the Netherlands.

The RTE News in Ireland reported on December 13 the following:

An expert in palliative care has told the High Court that changing the law on assisted suicide could put pressure on vulnerable people to end their lives.  

Dr Tony O’Brien, a palliative care consultant, was giving evidence in the case of Marie Fleming, the Wicklow woman who has taken a landmark case challenging the criminal law on assisted suicide.  

Dr O‘Brien said a removal of the absolute ban on helping someone to end their life would "muddy the waters". 

He said he was fearful it could make people feel they were a burden on relatives, leading them to decide they wanted to end their lives.  

Dr O'Brien said if a person had a right to choose their time of death and should there be a corresponding obligation on a physician to enable them to do so would cause him great alarm and would be entirely inappropriate. 

Dr O'Brien then explained that, when properly used palliative care provides relief to human suffering, not death. He said:

Dr O‘Brien said palliative care when properly used was designed to enhance the life of patients and not to render them comatose, as had been suggested during the case.  

He said it would be wrong to suggest there was "a pill for every ill" but palliative care treated the whole person and not just a condition or disease.

O'Brien then challenged the comments by American euthanasia promoter, Margaret Battin who compared palliative care to assisted suicide. O'Brien stated:

He denied that it was a common occurrence that the administration of pain killing medication towards the end of life often had the "double effect" of shortening life. 

He said attempts to link palliative care to physician assisted suicide was misleading. This simply does not happen, he said. He said: "You could kill someone with morphine but it is difficult to do so because of the dosages involved. It is much easier to kill someone with paracetamol."  

Dr O’Brien also said he was deeply concerned to hear of the pain and suffering being endured by Marie Fleming. He felt adequate palliative care could help to relieve this and would meet the needs expressed by Ms Fleming in her evidence.  

He also disagreed with a witness for the plaintiff that hydration and nutrition were routinely withheld from palliative care patients towards the end of life, causing them to die from dehydration or starvation.  

He said decisions about hydration and nutrition were separate clinical decisions, which were not connected.  

Dr O’Brien said at times it may be more burdensome on a patient to administer fluids towards the very end of life and the decision would be made on a burden to benefit ratio.

The court then heard from Professor Robert George, who is an English palliative care consultant who was reported to have stated:

... changing the law on assisted suicide would be a reclassification of a form of killing.  

He said there was a concern about the idea of creating a "slippery slope" to euthanasia in that "once the ending of life is viewed to be the best option the landscape would be changed completely".  

He said it started as voluntary euthanasia in the Netherlands and then became non-voluntary for those for whom it was presumed to be in their best interest, then it moved to people with psychiatric disorders.  

Questions would then be asked who needs it and who does not and why could it not be done for children.  

Prof George said killing people as a treatment or a solution would change society, making it a much more hazardous one.  

Risks to vulnerable people would be high and could not be monitored adequately, he said.  

There is a claim that euthanasia and assisted suicide were different things but he did not agree.

EPC is very concerned about the push to legalize assisted suicide in Ireland. We recognize that the Irish case was based on the Carter case in BC, a case that has been appealed by Justice Minister, Hon Rob Nicholson and will be heard from March 4 - 8, 2013 in Vancouver.

The Euthanasia Prevention Coalition have been granted intervener standing in the appeal of the Carter case in British Columbia.

Assisted Suicide: Strengthen the law against it.

The following letter was written by Ruth Plesner from Victor Montana and published yesterday in the Ravalli Republic newspaper in Montana. I like this letter because it is simple and to the point. 

Ruth's letter follows a great format for writing letters to newspapers. The letter follows.

Assisted Suicide: Strengthen law against it.

I have several concerns about the practice of assisted suicide, which is currently legal in only two states (Washington and Oregon).

1. The potential for elder abuse is very real. Patients in Oregon with a “terminally ill” diagnosis have been refused treatment and steered toward assisted suicide. Patients can be pressured by a relative, who can even administer the dose.
2. A “terminally ill” diagnosis can be wrong. Some patients recover with treatment and may live a long time.
3. Montana already has a high suicide rate and state policy is directed at lowering that rate. Suicide rates have increased in Oregon.

Please tell your legislators to clarify and strengthen our law against assisted suicide.

Ruth Plesner, Victor

Expert in Irish Assisted Suicide case claims that no abuse of vulnerable people occurs.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Marie Fleming, the wife of Exit International leader Tom Curran, is challenging the Irish law that protects people from assisted suicide.

Fleming, who lives with MS, is arguing that the ban on assisted suicide will force her to die an undignified death. She is asking the court to allow her husband, Tom Curran, the right to assist her suicide without fear of prosecution.

Similar to the Carter and Leblanc cases in Canada Fleming is basing her case on the concept that the law discriminates against people with disabilities who are unable to commit suicide without assistance.

An article published in the RTE News in Ireland on December 11, 2012 stated that Professor Margaret Battin, from the University of Utah, claimed that: 

"there was no evidence from studies in the US and the Netherlands that legalised assisted suicide led to abuse of vulnerable people such as the elderly, poor or disabled."

Margaret Battin

A similar article published in the Independent on December 12 stated that Margaret Battin stated that: 

"laws providing for assisted suicide did not lead to unlawful practices affecting vulnerable people. 

In areas where assisted suicide was permitted, a range of conditions and safeguards were applied, said Prof Battin of the University of Utah. 

She agreed there had been objections to her findings but did not believe any of those "hold adequate water".

Margaret Battin has been promoting euthanasia and assisted suicide for at least 30 years. She is not a neutral expert but a euthanasia apologist.

Battin bases her data on the reported cases of euthanasia and assisted suicide in jurisdictions where it is legal and she ignores the data concerning the unreported euthanasia deaths in the Netherlands and Belgium.

By analysing the data from three studies on the practice of euthanasia in Belgium (Physician-assisted deaths under the euthanasia law in Belgium: a population-based survey - CMAJ June 15, 2010, The role of nurses in physician-assisted deaths in Belgium - CMAJ June 15, 2010,Reporting of euthanasia in medical practice in Flanders Belgium: cross sectional analysis of reported and unreported cases - BMJ November, 2010) and the most recent major study on the practice of euthanasia and assisted suicide in the Netherlands (Trends in end-of-life practices before and after the enactment of the euthanasia law in the Netherlands from 1990 to 2010: a repeated cross-sectional survey - Lancet July 2012) we learn that the practice of euthanasia is often abused and the euthanasia law is often ignored.

These four studies indicate that:

1. 32% of the euthanasia deaths are done without explicit request in the Flanders region of Belgium. 

2. We learn that nurses are carrying-out euthanasia deaths in Belgium, even though it is illegal for nurses to do euthanasia. 

3. 47% of the euthanasia deaths in the Flanders region of Belgium are not reported and 23% of the euthanasia deaths in the Netherlands are not reported as euthanasia.

A further analysis of these four peer reviewed studies indicates that:

1. When a physician reports a euthanasia death, as euthanasia, the physician usually follows the rules that are outlined by the law.

2. When a physician does not report a euthanasia death, the physician usually does not follow the rules that are outlined by the law.

3. The reasons for not reporting a euthanasia death, include the following: to avoid the administrative burden, the legal due requirements were not met or to avoid possible legal consequences. Often the physician never intended to report the death as euthanasia.

4. When a euthanasia death is not reported in Belgium, or done without explicit request the patient is more likely to be over the age of 80, die in a hospital, and is often incompetent to consent to the act. The same demographic is also over represented when a euthanasia death is done by a nurse in Belgium. Euthanasia deaths that are done without explicit request, that are unreported, or that are done by nurses fit the same demographic group. 

This demographic group "fits the description of a 'vulnerable' patient group" who have died by euthanasia without request.

5. Euthanasia deaths that are done by nurses in Belgium are not legal but occur. These deaths are usually done by order of a physician, but sometimes they are done without consulting a physician. These deaths are usually done by intentional opioid overdose, even though sometimes they are done by neuromuscular relaxants. Nurses who had previously been involved with a euthanasia death and male nurses were far more likely to carry-out euthanasia in Belgium.

Battin did agree that some studies may indicate that depressed people are dying by assisted suicide in Oregon. Battin stated: 

Oregon Death With Dignity Act may not adequately protect patients with mental illness or depression which in some cases may be missed or overlooked.

However she said she noted the word "may".

Battin may have forgotten about a study by her friend, Oregon researcher Linda Ganzini, that was published in 2008. Ganzini studied 58 people who requested assisted suicide in Oregon. Ganzini found that 15 of 58 participants in her study were either depressed or experiencing feelings of extreme hopelessness. Of the 58 participants in her study, 18 died by assisted suicide with 3 of the assisted suicide deaths being persons who Ganzini found had questionable competency due to their depression/feelings of hopelessness.

A similar study from the Netherlands that was published in 2005 found that people who showed signs of depression or exhibited "extreme feelings of hopelessness" were 4.1 times more likely to request euthanasia.

Margaret Battin needs to answer the question, whose findings do not "hold adequate water?"

Meanwhile the Irish government argued that there is no "right to suicide" in Ireland and legalizing assisted suicide will negatively effect certain vulnerable groups.

A similar court case was recently heard in the UK concerning Tony Nicklinson who was living with Locked-in-Syndrome. The three judges on the High Court in the UK decided in the Nicklinson/Martin case that the issues of euthanasia and assisted suicide should be decided by parliament and not the courts.