Quebec proposes that its Doctors be forced to become Killlers

Wesley Smith

The following two articles were written by Wesley J. Smith and published February 7, 2013 on his Human Exceptionalism blog under the titles: Quebec Doctors to become Killers?. and Quebec Doctors forced into Homicide?

Article 1: Quebec Doctors to become Killers?.

By Wesley J Smith, February 7, 2012

Quebec

Quebec is about to make a major push to legalize euthanasia based on the recommendations of a commission. I have now had a chance to read the report, and it is pushing Quebec (and thence, Canada) toward a Belgium style culture of death.

Here’s an overview: “First, the euphemism “aid in dying” means active killing by doctors: From the Select Committee Dying With Dignity Report recommendations:

We propose that this option take the form of “medical aid in dying”. This assistance involves an act performed by a physician in a medical setting following a free and informed request made by the patient himself.

Second, the categories of the killable are broad and wide enough to drive a hearse through:

•The person is suffering from a serious, incurable disease;  

•The person is in an advanced state of weakening capacities, with no chance of improvement; 

•The person has constant and unbearable physical or psychological suffering that cannot be eased under conditions he or she deems tolerable.

Consider: “serious and incurable disease” isn’t a synonym for “terminal disease.” Despite the dicta from the committee that this should be reserved for end of life situations, that is not the wording of the recommendation. Hence, diabetes could qualify in this definition, say, when the patient loses a foot or begins to have vision issues. MS would apply. Serious arthritis. HIV as it turns to AIDS, etc.

The “no chance of improvement” criterion is also a misnomer in most cases, if literally applied. People often go into unexpected improvements of health even when they are unquestionably terminally ill. Some, even get kicked out of hospice because they stop dying. Others have their symptoms effectively palliated. Still others overcome their depression about wanting to die sooner rather than later, and are glad to be alive–if they have the chance to get there

The recommendations would allow doctors to kill incompetent patients who had signed an advance kill directive:

The Committee recommends that relevant legislation be amended to recognize that an adult with the capacity to consent is entitled to give an advance directive for medical aid in dying in the event that he becomes irreversibly unconscious, based on the current state of medical science.

This means that an incompetent patient who might not want to die today, could be killed anyway because he thought he would in the past and because his doctor thinks he should.

Quebec wants to lead Canada off the moral cliff already leaped off of by Belgium, the Netherlands, and Switzerland.  It is a radical province growing increasingly so. I hope there are enough people remaining in the French-speaking province who still believe in Hippocratic values and the intrinsic dignity of human life to hold the death agenda at bay.

Article 2: Quebec Doctors may be forced into Homicide.

Wesley Smith

By Wesley J. Smith, February 7, 2013

No one should be forced to kill or participate in killing. 

But if a recommendation of a Quebec euthanasia commission to legalize doctor-administered death are followed (discussed in more detail here) every Quebec physician will be conscripted to participate in homicide as a condition of practicing medicine.  From the “Dying with Dignity” Commission recommendation:

By definition, medical aid in dying could only be provided by a physician. Under their codes of ethics, physicians and nurses are entitled to conscientious objection, meaning they can refuse to perform an act that goes against their values. Of course, physicians and nurses will retain this right where medical aid in dying is concerned. However, a doctor who refuses to provide medical aid in dying for reasons of conscience will have the duty to help his patient find anotherwho is prepared to do so, as quickly as possible

That would make every doctor in Quebec a potential accomplice in homicide.

Think of it this way: If a hit man were approached by a man to kill his wife, but the murderer didn’t kill women, so instead, referred the husband to a killer he knew would kill females, the original killer would be complicit, indeed, an accomplice in the woman’s murder–even if he didn’t personally pull the trigger. That is akin to what the above recommendation would require of all doctors if it becomes law–forced participation in homicide.

Such a conscience-obliterating law already exists in Victoria, Australia, regarding abortion. (When I traveled the country in 2010 on a speaking tour, I met doctors who moved from their homes to other provinces rather than risk becoming complicit.) The Dutch Medical Association (KNMG) also has issued a similar ethics opinion.

It is a very sad day when doctors must participate in killing as a condition of practicing medicine. But then, we shouldn’t be surprised. The culture of death brooks no dissent. 

Depressed woman dies by euthanasia in Belgium.

Professor Tom Mortier

This article was written by Tom Mortier and published on February 4, 2013 by Mercator.net under the title: How my mother died.

A mentally-ill Belgian woman sought euthanasia to escape her problems. The doctors told her, sure, why not?

How my mother died

Since 2002 a law was passed in Belgium that allowed people to be euthanised when they were suffering intractable and unbearable pain. Today euthanasia is more often granted to people suffering from mental illnesses like chronic depression, schizophrenia, chronic anorexia nervosa and borderline personality disorder, etc.

The law requires that a patient’s free decision has to be established before medical doctors can give the lethal injections.

My mother suffered from chronic depression. Two years ago she broke off all contact with me. In April 2012 she was euthanased at the hospital of Vrije Universiteit Brussel (the Free University of Brussels).

I was not involved in the decision-making process and the doctor who gave her the injection never contacted me.

Since then, my life has changed considerably. Up until now, I am still trying to understand how it is possible for euthanasia to be performed on physically healthy people without even contacting their children. The spokesman of the university hospital told me that everything happened according to my mother’s “free choice”. After my mother’s death, I talked to the doctor who gave her the injection and he told me that he was “absolutely certain” my mother didn’t want to live anymore.

The death of my mother has triggered a lot of questions. How is it possible that people can be euthanised in Belgium without close family or friends being contacted? Why does my country give medical doctors the exclusive power to decide over life and death? How do we judge what “unbearable suffering” is? What are the criteria to decide what “unbearable suffering” is? Can we rely on such a judgment for a mentally ill person?

After all, can a mentally ill person make a “free choice”? Why didn’t the doctors try to arrange a meeting between our mother and her children? How can a medical doctor be “absolutely certain” that his/her patient doesn’t want to live anymore? Why can’t we bear to see people suffering?

Some doctors at the Vrije Universiteit Brussel believe that euthanasia should be offered to anyone who wishes to end his/her life because of unbearable and meaningless suffering. All objections and restraints from the community are regarded as immoral and unjustifiable. These doctors are nowadays even discussing euthanasia for people suffering from autism and youngsters who are suicidal.

What scares me is that these doctors also seem to be controlling the Belgium media. Is this the society we want to evolve to? Are we going to control suicides in the nearby future by putting people out of their misery before they can do it themselves -- instead of investing in mental health and palliative care?

I believe that the appeal to “free choice” is becoming a dogma of convenience. We are rapidly changing into a society of absolute loneliness where we don’t want to take care of each other any more. And when we suffer, we ask our doctors to kill us, breaking fundamental biological and human laws. However, by doing this, we create new and insoluble problems.

Therefore, we really should rethink what we believe in. 

Is it life or is it death?

Tom Mortier PhD lectures in chemistry at Leuven University College. This article was written with the assistance of Dr Steven Bieseman and Professor Emeritus Herman De Dijn. It was originally published in the Belgian medical journal Artsenkrant.

Oregon assisted suicide deaths hit record high

In response by the announcement by UK assisted suicide activist, Lord Falconer, Dr. Peter Saunders from the Care Not Killing Alliance in the UK wrote the following article that he published on his blog on February 2, 2013 under the title: Warning sounded to UK as Oregon assisted suicide deaths hit record high. It is worth noting that this article represents a warning to the UK as well as the rest of the world.

By Dr. Peter Saunders, the campaign director for the Care Not Killing Alliance.

Dr. Peter Saunders 

Lord Falconer has just announced that he is about to introduce a new bill into the House of Lords to legalise assisted suicide along the lines of the Oregon model – assisted suicide for mentally competent adults who have less than six months to live.

Members of the House of Lords should note that statistics released just last month (full report here) show that the number of assisted suicide prescriptions and deaths in Oregon, once again, increased in 2012 and has now reached an all-time high. 

Falconer’s bill, however, only requires a twelve month life expectancy and so is thereby even more liberal than Oregon’s. 

There were 59 assisted suicide deaths in Oregon in 2009, 65 in 2010, 71 in 2011 and 77 in 2012; a 30% increase overall in just four years. 

The number of prescriptions for assisted suicide was 95 in 2009, 97 in 2010, 114 in 2011 and 115 in 2012; 115 in 2012; a 21% increase since 2009.

Overall assisted suicides have gone from 16 in 1998 to 77 in 2012, an overall increase of 381% (see chart above).

This pattern of incremental extension is similar to that seen in the Netherlands and Switzerland, other countries that have changed the law.

A major factor fuelling this increase is suicide contagion - the so-called Werther effect. This is particularly dangerous when assisted suicides are backed by celebrities as they are here and given high media profile as they are frequently by the BBC. 

The Oregon numbers may not seem large but we need to remember that Oregon has a very small population relative to the UK and that they may well be an underestimate as they are based on physicians' self-reporting. 

But for argument's sake let's simply take them at face value. How would they then translate to Britain?

Back in 2006, and based on Oregon’s total of 38 assisted suicide deaths in 2005, the House of Lords calculated that with an Oregon-type law we would have about 650 cases of assisted suicide a year in Britain. 

But as the numbers in Oregon have since doubled to 77 the UK equivalent would now be 1,300. With Falconer’s more liberal interpretation of what constitutes ‘terminally ill’ the numbers here would be expected to be higher still.

Currently assisted suicide is illegal here and we see only 15-20 Britons going to Dignitas in Switzerland to die each year.

We should learn from the Oregon experience and be resisting these moves. 

Any change in the law to allow assisted suicide (a form of euthanasia) would inevitably place pressure on vulnerable people to end their lives so as not to be a burden on others and these pressures would be particularly acutely felt at a time of economic recession when many families are struggling to make ends meet and health budgets are being slashed. 

And once legalised there will inevitably be incremental extension as we have seen in Oregon, Switzerland and the Netherlands. Legalisation leads to normalisation.

Currently only two US states, Oregon and Washington, have legalised assisted suicide, each on the basis of a referendum. 

By contrast whenever a bill has been brought before a US state parliament it has been defeated. This has happened over 120 times in the last 20 years. 

Thirty-four states prohibit assisted suicide outright. Massachusetts and six other states have banned it through legal precedent.

It is often argued by the pro-euthanasia lobby that opposition to the legalisation of assisted suicide is largely faith-based. But this is not true.

In Massachusetts, a left leaning Democrat state which rejected assisted suicide in a referendum last year, the opposition of doctors and disabled people has been very significant indeed. 

This is because one of the most powerful arguments against it is public safety – any change in the law will put pressure on vulnerable people to end their lives and no law can be adequately safeguarded against abuse.

I have previously blogged about the shroud of secrecy which surrounds assisted suicide practice in Oregon, the worrying trends in neighbouring Washington state, which enacted a similar law more recently and the way the Oregon law steers people toward suicide. 

Also deeply concerning are reports of depressed patients being killed without being treated, doctor shopping, deaths taking place without witnesses present (raising questions about elder abuse) and the fact that 44 of the 77 who died last year (57%) said that they were concerned about being a burden on family, friends and caregivers. 

The lessons are clear. Let’s not go there.

Physician-assisted suicide runs risk of invisible coercion

The following letter was written by Cort Freeman and published in the Montana Standard on January 28, 2012 under the title: Physician-assisted suicide runs risk of invisible coercion.

Physician-assisted suicide runs risk of invisible coercion. 

Ben Mattlin writes in The New York Times on Oct. 31, 2012, that he counts himself as a pro-choice liberal who ought to support physician-assisted suicide, but as a lifelong disabled person, he cannot.  

Physician-assisted suicide is a person swallowing a lethal drug prescribed by a doctor. With plenty of room for abuse, Mattlin says, it’s a bad idea.

In Montana, the issue of physician-assisted suicide has been kicked around in the Legislature and in the courts, including the Montana Supreme Court, resulting in a mixed message that needs clarity. This Legislature will try again. 

Here’s Mattlin: “My problem, ultimately, is this: I’ve lived so close to death for so long that I know how thin and porous the border between coercion and free choice is, how easy it is for someone to inadvertently influence you to feel devalued and hopeless — to pressure you ever so slightly but decidedly into being ‘reasonable’ to unburdening others, to ‘letting go.’” 

He goes on to say that, while the push for physician-assisted suicide comes from many who have seen a loved one suffer, supporters of it can’t truly conceive of the many “subtle forces — invariably well-meaning, kindhearted, even gentle, yet as persuasive as a tsunami — that emerge when your physical autonomy is hopelessly compromised.” 

Mattlin was born with spinal muscular atrophy. He has never walked, stood, or had much use of his hands. Half of babies with this condition die within two years. Today, Mattlin, almost 50, is a husband, father, journalist and author. 

When a hospital blunder compromised his heath further, doctors questioned whether his life was worth saving. Mattlin writes, “They didn’t know about my family, my career, my aspirations.” His wife rescued him. 

From this he learned how easy it is to be perceived as someone whose quality of life is untenable and how this becomes one of many invisible forces of coercion. Others include, “that certain look of exhaustion in a loved one’s eyes, or the way nurses or friends sigh in your presence while you are zoned out in a hospital bed.” 

Mattlin writes that this can cast a dangerous cloud of depression upon even the most cheery of optimists. He says, “advocates of Death with Dignity laws who say that patients themselves should decide whether to live or die are fantasizing. We are inexorably affected by our immediate environment. The deck is stacked.” 

Cort Freeman2950 Bayard St.Butte

When it comes to the ‘right-to-die’ debate, I choose the right to live.

The following article was written by Gwyneth Edwards and published in the Montreal Gazette on February 2, 2013 under the title: When it comes to the 'right to die' debate, I choose the right to live.

Gwyneth Edwards, Montreal Gazette - February 2, 2013

The recent letters to the editor and Opinion articles on the subject of euthanasia have been met with silence by my husband, Marc. His mother died recently and, with the tragedy still fresh in our minds, discussions are limited. But we can no longer watch the Opinion pages fill up with support for the “right to die” without telling how his mother’s life came to an end.

Marc’s mother raised eight children on a farm in Mercier. Her husband worked the land by day and was a supervisor at a local factory by night. She ran the household and, after her husband’s death, helped her eldest son run the farm. So when Marc’s mother went into the hospital this past July with a clogged bronchiole tube, we thought nothing of it. Yes, she had emphysema, but her underlying strength and will to live were never in doubt. She would live forever, we all thought. Her only fear was death itself.

After a few weeks in the hospital, concern grew. There was some discussion of stomach problems. Surgery was scheduled for a routine procedure. The routine, however, soon became the complicated. Marc’s mom was unable to keep food down. An intestinal feeding tube was inserted, followed by a few more failed attempts at swallowing. Her physician suggested that the feeding tube would remain indefinitely and that she might never eat again, but she could live this way for years.

The family was stunned. The surgeon claimed that the operation had been a success, while the physician claimed a brain “malfunction.” Although family members were confused, they worked toward getting Mom better, so that one day the “malfunctioning” brain would once again function, swallowing would return and home she would go. But in the meantime the physician — the one whom Marc’s mother saw as being second only to God himself — explained that some people who are on a feeding tube choose to die. This same physician, we learned, believed in the right to die, and was a proponent of dying with dignity.

From that moment on, my mother-in-law sat in her hospital bed with little emotional support outside of the struggling efforts of her children, who spent most of their time trying to find a way to get her out. While a social worker sought out a long-term-care facility, the hospital staff cared for her by administering pain relief upon request. The children argued against the morphine, but Mom, the staff indicated, was lucid enough to decide on her own.

So over the course of a few months, Marc’s mom was given morphine throughout the day, whenever she asked. Slowly but surely she fell into an abysmal depression and lost her will to live. She missed her home, her children, and the life that she had known for 79 years.

In late December she pulled her feeding tube out twice within three days (yet did not remember doing so). Eventually, when it was to be inserted once again, she refused and said that she wanted to die. The children fought back: the tube was working and the emphysema was under control; she just had to wait for a bed. But no agreement was reached. Just before Christmas, the family left the hospital, thinking all would be resolved once the holidays had passed.

On Christmas Day, we found Marc’s mother almost lifeless in her hospital bed. The intravenous had been removed and she could barely speak. Marc fed her chocolate, which she eagerly accepted and successfully swallowed, and we waited to meet with the physician. But the following day Marc and his siblings learned that Mom had started to die from the moment she removed the feeding tube a week earlier.

Three days after Christmas, and 10 from the day she first pulled out the feeding tube, Marc’s mom died. One son never made it to the hospital in time, while many of the other children, holding out false hope, never took the time to say goodbye.

As she died, Marc’s mom did not receive any pain medication; she was unable to request it. Near the end of her life, she was free of drugs, food and water. Marc is convinced that she died in peace. But he is also convinced that she didn’t have to die at all.

Marc and I are most definitely on the “right to live” side of the equation, where we firmly believe the entire medical profession should sit.

Gwyneth Edwards is a PhD candidate at the John Molson School of Business. She lives in Kirkland with her husband and two children.

Quebec Assisted Suicide advocate, Ginette Leblanc, dies of natural causes.

Ginette Leblanc

Ginette Leblanc, the woman who launched the court case in Quebec to strike down Canada's assisted suicide law, died of natural causes in her 50th year.

The Euthanasia Prevention Coalition offers condolences to the family of Ginette Leblanc as they grieve her loss.

Leblanc, who was living with ALS, hired a high profile recently retired human rights lawyer, René Duval, to challenge Canada's assisted suicide law. The case that was filed on October 31, 2011 claimed that Canada's assisted suicide law was unconstitutional. The case was scheduled to be heard in Trois Rivières Quebec from March 25 - 28, 2013.


The Toronto Sun reported Duval to have stated on Saturday that:

"Due to Leblanc's death the case is now closed"

The Leblanc case was nearly identical to the Rodriquez case that the Supreme Court of Canada decided in 1993 by a 5 - 4 margin that Canada's assisted suicide law was not unconstitutional.

However, Duval added a clause to the case that would have quietly legalized euthanasia in Canada.  The Leblanc case in Quebec.

Recently the Quebec government published the Menard report that established the direction that the Quebec government appears to be going in order to decriminalize euthanasia.

Quebec citizens should be very concerned that their government appears to be intent on decriminalizing along the lines of the "Belgian model."

When analysing the Belgian model of euthanasia it is clear that the definitions that are used and the system that is in place has led to significant abuses of euthanasia. 

EPC warns Quebecers to be careful for what you wish for.


The Carter case in British Columbia will be heard in Vancouver by the BC Court of Appeal from March 4 - 8, 2013. Let's hope that the BC Court of Appeal will strike down the disturbing decision by Justice Smith in the Carter case.

Gloria Taylor, the plaintiff in the Carter case in BC, who also lived with ALS, also died of natural causes in early October, even though Justice Smith had granted Taylor a constitutional exemption to die by euthanasia.

The Euthanasia Prevention Coalition launched the Declaration of Hope as a positive response to the human issues that lead to people requesting euthanasia or assisted suicide.

Testimony of Ira Byock, MD to Vermont Senate Committee on Health and Welfare Hearing on End of Life Choices

The following is a blogpost by Stephen Drake, the research analyst for Not Dead Yet that was posted on January 31, 2013 under the title: Vermont: Testimony of Ira Byock, MD to Vermont Senate Committee on Health and Welfare Hearing on End of Life Choices.

By Stephen Drake - January 31, 2013

Anyone who has read this blog regularly knows that we hold Ira Byock in high regard.  That’s why we nominated him to the IOM’s Committee on Transforming End-of-Life-care.

Earlier today, Ira Byock gave testimony to the Vermont Senate Committee on Health and Welfare’s Hearing on End of Life Choices (that means it’s a hearing on legislation to legalize assisted suicide).

Below is the written testimony, which is similar to his verbal testimony:

State of Vermont
Senate Committee on Health and Welfare
Hearing on End of Life Choices
January 31, 2013
Testimony of Ira Byock, M.D.

Chairman Ayer, and Members of the Committee. Thank you for allowing me to
come before you this morning.

Dr. Ira Byock

I am Dr. Ira Byock. I am a practicing palliative care physician and direct the palliative care program at Dartmouth-Hitchcock Medical Center in Lebanon, NH. I am a professor in the Department of Medicine at the Geisel School of Medicine at Dartmouth.

I give testimony today as an individual, not on behalf of any institution or organization.

I have an active Vermont medical license and although I live and practice in New Hampshire, as many as 40% of the patients I and our team serves live in The Green Mountain State.

My clinical experience of over 30 years of practice informs my approach to care for people through the end of life. Of course, my personal understanding of society and my political beliefs also influence my testimony today. I am a proud lifelong social and political progressive. I support universal health care, disability rights, voting rights, women’s rights, Planned Parenthood, gay marriage, alternative energy, nuclear disarmament and gun control.

Proponents assert that the death with dignity bill is about an individual’s right to
die. To political progressives, this is an attractive approach. What could be more personal than a right to control one’s own body?

As a physician I have devoted myself to advocating for the rights and wellbeing
of seriously ill and dying people and their families. If legalizing physician -assisted suicide represented an authentic extension of personal freedoms, I would be an ardent advocate. In reality, giving doctors the authority to write lethal prescriptions represents acquiescence to well-documented social failures and unmet needs of ill people and their families. While masquerading as progressive politics – “the right to die” is an effective slogan – legalizing physician-assisted suicide is regressive social policy.

Lawyers and legislators will recognize that no right to suicide can be found in any social compact; not in the Magna Charta, the Declaration of Independence or the U.S. Constitution. The United States was founded on certain unalienable Rights, “that among these are Life, Liberty and the pursuit of Happiness.”

Consistent with these rights, I believe that there is a right to basic health care,
including palliative and hospice care when someone has a life-threatening
condition and complex needs. Thanks to Governor and this legislature, Vermont
has made important strides toward improving health care for the residents of the state. I applaud and support your efforts. However, we have a long way to go
toward achieving the goal of honoring this right for all seriously ill Vermonters.

Responding to Suffering

One thing on which good people on both sides of this issue agree is that far too
many people suffer needlessly as they approach the end of life.

If I thought lethal prescriptions were necessary to alleviate suffering I would
support them. In 34 years of practice, I have never abandoned a patient to die in
uncontrolled pain and have never needed to hasten a patient’s death. Alleviating
suffering is different from eliminating the sufferer. Allowing a person to die gently is importantly different from actively ending the person’s life.

The real question for this Committee – and by extension for all us – is how can
we take the best care possible of seriously ill Vermonters and the families who
love and care for them?

The Role of Doctors and Health Care Professionals

The health care system and health professionals in general, and doctors in
particular, have important roles to play.

The ancient professions developed as repositories of specialized expertise and
services to members of society. From antiquity, the medical profession was
developed to protect, save or sustain life, and to enhance quality of life, including alleviating suffering.

Today, America’s health care system is really a disease treatment system. We
have more power to diagnose and treat disease and to save and extend life than
ever before in human history. Until the latter part of the 20th Century, people with conditions such as kidney failure or heart failure died abruptly but today they may live for many years – for most of the time quite well. Throughout history, cancer was a brief illness. We are now able to cure nearly 60% of cancers and many cancers we cannot also become conditions that people can live with, often for many months if not years.

For all the progress and power of medicine, we have yet to make even one person immortal. Instead we have invented chronic illness and we have
inadvertently made dying much harder than it used to be – or needs to be. I’m proud of being a doctor, but it is undeniable that our health care system, including many of my fellow doctors, are not caring well for dying people. It is not because doctors are callous or insensitive to people’s suffering. As a medical educator, I can say that despite modest improvements in medical school curriculum, in our zeal to fight disease, we are neglecting to train doctors to care well for the people living with disease. Stated differently: We are still setting new doctors up to fail, not just themselves, but also their patients and, collectively, the very society that trains and pays them. Hospice and palliative medicine are given short shrift in medical training. Only small amounts of curricular time are devoted to symptom management, communication, and the ethics of decision-making. Little if any time is invested in teaching young doctors how to counsel patients and families who are living with life-limiting illness. Less time still is spent building skills of working in teams with hospice and palliative care clinicians or of coordinating care for patients. We teach minutia of biochemical pathways, but not eligibility criteria for accessing vital services such as home health and hospice.

Persistent Health Care Deficiencies

Vermont is rightly proud of the health care that it provides to residents. But as
this Committee knows, serious challenges remain.

Few of Vermont’s hospitals have palliative care services, including most of the
critical access hospitals that serve small communities in this state. And in those
hospitals where palliative care does exist, it is typically a threadbare service that
leaves many patients and families with unmet palliative needs.

Hospice penetration among Medicare enrollees in Vermont has improved slightly in recent years, but lags far below the national average. Nationally, in 2010, 63% of Medicare beneficiaries who died had hospice care, but in Vermont only 36% of Medicare patients received hospice care before they died.

When the Medicare Hospice Benefit was established by Congress in the early 1980s, it was intended to be available for the last 6 months of people’s lives. But
median length of hospice service nationally is just 19 days before death, despite
perennial efforts to educate doctors and the public to access hospice earlier.

Under regulatory scrutiny from Medicare, patients who are admitted to hospice
have to continue to decline or they risk being discharged from hospice care. Of
course, although hospice care rarely cures anyone, it often makes people’s conditions better. Indeed, in 2010, over 10% of hospice patients in Vermont were discharged from hospice because they were not dying quickly enough. 

Vermont’s hospice programs are also challenged by their small sizes and geography, including our rural roads, northern weather and long distances between patients. Hospices in rural communities often have difficulty incorporating the rapid advances in the field of hospice and palliative care. As a practicing physician, I often encounter hospice programs in our region which cannot accept patients whose treatment plans include medically administered
nutritional support, injectable medications for pain or other symptoms, or IV fluids for comfort, or wound care with vacuum dressings.

The medical directors of many hospice programs in the state typically work for
hospice only a few hours a week – it is a community service rather than a vocation for most. Few hospice medical directors are specialists in the way we think of specialists in cardiology, oncology, or critical care. When a hospice medical director is out of town or otherwise unavailable, medical supervision for hospice patients and after hours calls typically reverts to each patient’s own primary physician or that physician’s associates. But those physicians may have no interest or expertise in this realm of practice. So specialty level care for pain or other symptoms, counseling and family support becomes unavailable.

In addition to the discomforts and exhaustion of illness, seriously ill people often suffer from a sense of being a burden to those they love. That is one of the main reasons that people in Oregon request lethal prescriptions under that state’s Death With Dignity Act.

In America today – including in Vermont – we inadvertently make that burden
heavier than it needs to be. In the fight against disease, cost is no concern, but our system pauperizes of people for being seriously ill and not dying quickly
enough. Inadequate staffing in assisted living and long-term care makes frail
elders feel undignified, often because there is simply no one to answer the bell
when someone’s grandmother or grandfather needs help in getting to the bathroom.

Dying will always be hard, but it doesn’t have to be this hard.

Reasons for Limiting a Doctor’s Role

There are limits to a doctor’s role. From earliest beginnings of the profession of
medicine, society gave physicians special authority and privileges – to touch
people in intimate ways and talk about highly personal matters that would
otherwise be inappropriate. Correspondingly, society imposed clear limitations
on a doctor’s role. Chief among them was the principle that doctors must not kill
patients.

This prohibition extends beyond assisting in suicide or performing euthanasia.
Doctors are disallowed by the profession from participating in capital punishment, even in jurisdictions in which it is legal and court ordered. Similarly, doctors must not participate in torture or “forcible interrogation”, even when police or military authorities order us to do so. These proscriptions were not put in place to protect the sensibilities of practitioners, but to protect the public and vulnerable people from misuse of medical power.

Those in favor of legalizing physician-assisted suicide point out that many people want to be comfortable AND alert and interactive to the very end. It’s true that while I can assure people of being reasonably comfortable as they take their last breaths, the “cost” of comfort may well require them to be sleepy.

Proponents suggest that having to be sedated and having to be turned and cleaned by others is an assault to a person’s dignity. But this notion of dignity
seems self-fulfilling, setting the bar for dignity so high that few people at the far
end of life will qualify.

People who are seriously ill should not have to die with their boots or their makeup on to feel dignified. They already ARE dignified. This is a settled matter
of social ethics. In 1948 United Nations Universal Declaration of Human Rights
begins with the stipulation:

“Whereas recognition of the inherent dignity and of the equal and
inalienable rights of all members of the human family is the foundation of
freedom, justice and peace in the world.”

If dignity is an inherent feature of human life, our collective responsibility is to
care for one another in ways that allow people who are aged, ill or otherwise frail
to see their inherent dignity reflected in our eyes. Each of us, as members of
society, should expect that degree of sensitivity from the doctors, nurses and
others who are caring for our loved ones – our mothers, fathers, grandparents,
spouses, siblings, children and friends.

The Power of Words

It is not my place to judge the suicide of any individual. Suicide may be a
personal and private act. But physician-assisted suicide involves two people, one of whom was trained and licensed by society and is compensated by society.
The legalization of physician-assisted suicide is social policy.

Recognizing the serious deficiencies of care and family support that continue to
plague incurably ill people and their families, the drift toward embracing physician-assisted suicide feels Orwellian. George Orwell understood the power of language to reshape moral thought.

Today we know that branding matters. That is why the Hemlock Society morphed into Compassion and Choices, which promotes “death with dignity” and objects to the word “suicide,” preferring “aid-in-dying” or “self-deliverance” or “hastenings.” These terms sound benign, but the undisguised act they describe remains a morally primitive, socially regressive, response to basic human needs.

Proponents of adopting an Oregon-style act in Vermont emphasize safeguards in the law and assert that Oregon’s experience proves that worries about a slippery slope are unfounded. However, a recent PBS Frontline documentary, The Suicide Plan, shows unambiguously that the leaders of Compassion and Choices and the Final Exit Network truly believe that the right to self-deliverance must not be abridged, nor should it be dependent on physical ailments or the willingness of a prescribing doctor. (www.pbs.org/wgbh/pages/frontline/suicide-plan/) The filmmakers did not take sides, adopting an unblinking approach to the topic. I encourage any legislator who feels drawn to vote for legalizing physician assisted suicide to see this documentary.

Suspicion of Hospice and Palliative Care

Although the hearings this week respond to citizens who support legalizing physician-assisted suicide, there is a significant portion of the public who worry that they or their relatives’ or friends’ lives might be prematurely shortened by doctors. I am not aware of any formal surveys or studies, but both as a doctor and as someone who talks with the lay audiences about these issues on a regular basis, I would estimate that 25% or more of the public would have difficulty distinguishing between hastening death and hospice and palliative care.

Some people worry that palliative care is a euphemism for euthanasia. In my experience such fears are more common among people with long-standing disabilities, people of color, and self-identified social conservatives. In a single day at the hospital recently, I encountered two separate families who were hesitant to allow me to consult on their loved one’s care. In each case, they
wanted to know how palliative care was different from Jack Kevorkian or
euthanasia.

The inflammatory characterizations of advance care planning discussions with one’s doctor as “death panels” and accusations of “killing granny” were entirely unfounded, and yet have left a lasting impression. Although the large majority of social conservatives applaud and support hospice and palliative care programs and professionals, a vitriolic fringe accuses our field, along with medical ethicists, of promoting a “culture of death” and representing “stealth  euthanasia.” I would simply ignore such nonsense, were it not for the tangible consequences it has in sewing suspicion and limiting my and my colleagues ability to serve people who need our help.

Hospice and palliative care professionals feel responsible for serving all of the population of our region. Many people will not allow us to care for their mother or father if they think we might surreptitiously end their loved one’s life. Therefore, it is essential to reaffirm the distinction between hastening death and allowing people to die gently with medical competence, social support, tenderness and love.

A Progressive Agenda to Improve Care and Quality of Life

An authentically progressive agenda for improving the way we die would include the state of Vermont making use of the Medicare waiver mechanism within the state’s health plan to dissolve the arbitrary requirement that incurably ill people give up treatment for their disease to receive hospice care for their comfort and quality of life and support for their families.

The Vermont legislature could preserve the dignity of frail elders and physically ill and dependent people by ensuring that there sufficient staff in long-term care facilities to answer the bell when Vermont’s mothers or fathers, grandmothers or grandfathers, need help in getting to the bathroom. Nothing assaults an ill or demented person’s dignity more than being unable to get help when needed.

It is past time for every state legislature to insist that every medical student receives adequate training and passes competency tests in basic palliative care knowledge and in the skills required for effective symptom management, communication, shared decision-making, and counseling related to serious illness and dying – skills that too many physicians lack today.

Summary and Conclusion

Despite all the collective efforts of Vermont’s health care community and
government, including this body – and the significant incremental progress being made – we are failing people who are facing the end of life and those who love and care for them.

The bills being considered would not address the root causes of suffering. Nothing in an Oregon-style Death With Dignity Act would change serious curriculum deficiencies or ameliorate the impact they have on the public health. It would simply give licensed physicians in this state authority to write lethal prescriptions – nothing more.

Nothing in the legislation would protect a terminally ill Vermonters who legally obtains a lethal prescription from being denied hospice care because he wants to continue disease treatments, nor from being subsequently discharged from hospice care if his condition slightly improves. The message from state and
federal government will be clear: We may not be able to afford hospice care for
you, but your legal right to “self-deliverance” remains available.

The day after the new law took effect, hospice length of service would still be shrinking, hospice would still have limited ability to serve people undergoing active treatments. Staffing in long-term care would still be woefully inadequate. And we would still be graduating and licensing new physicians who have been inadequately trained and are demonstrably unprepared to care well for dying patients.

Rather than representing an extension of our rights, granting physicians the authority to write lethal prescriptions feels like capitulation to our failures. We are better than that. 

Physician-assisted suicide is not a right; it is a wrong.