Canadian Anestesiologists warn: Assisted Death is not simple.

By Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Dr Cheryl Mack

An article by Sharon Kirkey and published in today's National Post reports on an article published in the Canadian Journal of Anestesia outlining the problem with and reactions to the drugs that are used for euthanasia and assisted suicide. Kirkey reports:

Canada’s anesthesiologists, doctors who work every day with some of the drugs commonly used in euthanasia and assisted suicide, are warning hastened death may not always result in a peaceful exit. 

They say patients could experience convulsions, or a longer-than-expected “time to death,” or “awakenings” while the fatal cocktail of drugs take effect. 

Some are even questioning whether they — or any other doctor — ought to be involved at all, and recommend the task be left instead to “euthanists” or some other group.

Kirkey continues her article with her information from her interview with Dr Cheryl Mack, one of the authors of the article:

Mack, chair of the clinical ethics committee for University of Alberta hospitals, said she and her co-author don’t object, in principle, to a “rational” suicide. “But that’s assuming, of course, we can distinguish between what is a rational suicide, and what is an irrational one.”

... Patients can respond to drugs differently and in unanticipated ways. Dosing is based on careful titration and monitoring of the patient, she said. “We can foresee potential complications.”

For example, with assisted suicide, where the doctor prescribes a fatal drug overdose the patient takes himself, “depending on what kind of safeguards are in place, and who’s present, you can have reactions to overdose — convulsions, vomiting, aspirations,” Mack said. “We could actually have patients incurring harm that they may not have anticipated.”

Kirkey then examines her article by looking at the reality of euthanasia:

During surgery, “We take a lot of care with our monitoring and our assessment of the patient to judge depths of anesthesia,” Mack said. But if an error is made during euthanasia — and the muscle relaxant injected before the person is in a coma deep enough to prevent feeling the effects — he or she could die by suffocation while paralyzed, but conscious.

Guidelines for doctors in Quebec, where the first deaths from euthanasia have been reported since the act became legal in that province in December, state that while the risk of loss of consciousness being “inadequate” or too brief is low, the drugs may be less effective if the IV catheter isn’t inserted properly, or the drugs injected too slowly.

“The other concern is, how do you establish a standard of care for assisted death? How do you judge competency?” Mack said. She performs hundreds of anesthesia procedures a year to maintain her competency. “What would that look like for assisted death?”

If Canada follows the experience in the Netherlands, where euthanasia and assisted suicide make up about three per cent of total yearly deaths, deaths from “PAD” — physician-assisted death — could number more than 7,000 a year in Canada, Ottawa anesthesiologist Dr. Miriam Mottiar estimates.

“I think a lot of people feel uneasy with the entire concept of this,” said Dr. Susan O’Leary, president of the Canadian Anesthesiologists’ Society. “This is not what we intended when we became anesthesiologists.”

Alex Schadenberg

The Supreme Court of Canada, in my opinion, made their decision based on a philosophical point of view, rather than legal and human realities.

Not only will there be problems with the use of the euthanasia "drug cocktail" but, if the experience with euthanasia in Belgium and the Netherlands is examined, we will also expect there to be significant abuse of the euthanasia law.

Legalizing euthanasia gives physicians the legal right to kill you. Not only are the drugs that are employed in the act a problem, but also, the act itself should never be accepted because it permits killing people at their most vulnerable time of their life.

Why Physicians Should Oppose Assisted Suicide

By Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

The Journal of the American Medical Association (JAMA), in its current edition, published a series of articles concerning palliative care, end-of-life treatment and assisted suicide.

Dr. Y Tony Yang and Dr. Farr A Curlin offered their insights as to Why physicians should oppose assisted suicide. Dr. Yang is affiliated with George Mason University and Dr. Curlin is affiliated with Duke University.

In their article, Yang and Curlin focus on why people ask for assisted suicide and why physicians should not support or participate in assisted suicide. They begin their article with the following:

That we are debating this question of whether physician-assisted suicide is ever justifiable shows how far medicine has shifted toward redefining the role of the physician. If the medical profession accepts physician-assisted suicide, it will be declaring decisively that "physicians" are mere providers of services to be guided only by the desires of the individual patient, the will of the state or other third parties, and what that law allows.

They continue by examining the difference between palliative care and assisted suicide:

While acknowledging that death may come sooner as a side effect of palliation, physicians pledge never to intentionally hasten the patients' death. ... Yet with physician-assisted suicide, the physician is to disregard what is perhaps the most universal moral injunction - do not kill (emphasis is mine) - and wrtie a lethal prescription with the express intent of helping patients kill themselves.

Yang and Curlin then explain why people in Oregon ask for assisted suicide:

Evidence, nevertheless, indicates that calls for physician-assisted suicide are not mainly driven by the experience of pain or other refractory symptoms. ... reports from Oregon that found patients requesting physician-assisted suicide reported being concerned about "losing autonomy" (91.5%), being "less able to engage in activities making life enjoyable" (88.7%), "loss of dignity" (79.3%), "losing control of bodily functions" (50.1%) and being a "burden on family, friends/caregivers" (40%). Only 1 in 4 (24.7%) even reported "concern about" inadequate pain control.

They continue by examining what options already exist for patients and what assisted suicide actually represents:

Patients already have the right to refuse life-sustaining treatment. They have the right to proportionate palliation, even if death is hastened as a side effect. They also have the liberty to end their lives by all manner of methods that do not involve physicians. With respect to physician-assisted suicide, the "right to die" is a euphemism for the putative "right to have a physician help me kill myself." (emphasis is mine)

The writers then examine the issue of the trust relationship between patients and physicians:

"Physician-assisted suicide is fundamentally inconsistent with the physician's professional role." (emphasis is mine) If the physician were solely service providers who accomodated the self-determining choices of patients, then physician-assisted suicide would be logical, if assisted suicide were justified. ... Rather the physicians professional role is to attend to those who are sick and debilitated ... There would be no profession of medicine but for human beings' shared vulnerability to illness. There can be no practise of medicine if patients do not trust physicians to care for them when they cannot care for themselves.

Yang and Curlin continue by showing how the physicians role extends in society:

And herein is the conflict. Insofar as physicians enjoy societal trust, it is because since Hippocrates, physicians have maintained solidarity with those who are sick and disabled, seeking only to heal and refusing to use their skills and powers to do harm. This is why Doctors Without Borders treats injured Taliban soldiers. It is why physicians have refused to participate in capital punishment, or to be active combatants, or to cooperate with torture. It is why physicians have refused to help patients commit suicide.

They then re-examine the trust relationship between patients and physicians:

The boundary against intentionally causing the patient's death, however, gives patients a reason to trust physicians while also giving physicians the freedom needed to perform their duties and responsibilities... Rather than posing an obstacle to compassionate care, this boundary creates a space in which physicians can act freely and decisively to palliate distressing symptoms. (emphasis is mine) Without this commitment, patients have good reason to be concerned that morphine that leads to sedation is dosed not in proportion to the pain but in an effort to hasten death.

Yang and Curlin conclude:

In sum, physician-assisted suicide is never justifiable. It is never justifiable because it always violates the injunction not to kill. It is never justifiable because it unjustly patronizes the desires of the few who request physician-assisted suicide over the needs of the much larger number larger number... Physician-assisted suicide contradicts the physician's professional role and undermines the distinctive solidarity with those whose health is diminished that makes the practise of medicine possible. ... physicians should oppose the legalization of physician-assisted suicide and steadfastly refuse to condone or participate in it.

JAMA simultaneously published an opposing point of view titled: Responding to patients requesting Physician Assisted Death.

Lewis: Four months is not enough for a debate on euthanasia.

By Charles Lewis

Just like everyone who has taken a role in trying to combat euthanasia, I am well aware of the poll numbers on societal support for government-sponsored killing. But numbers, no matter how high, lay flat on a page. They carry no emotion and nor do they reveal the depth of support. Someone's "yes" may be weaker than another person's "yes."

I got a real taste of what real enthusiastic support for assisted suicide sounds and feels like. 

Last week, Bill Maher, the most obnoxious liberal talk show host in history of media, was interviewing California's Deputy-Governor, Gavin Newsom. Newsom, a Democrat, is tall, boyish and handsome with a full head of dark hair. He already has said he'll runs for governor and do not be surprised if his name pops up shortly after that as a likely presidential candidate. He is Kennedyesque, as Americans like to say.

Maher's interview was more of a love in. He and Newsom share the same views on a host of issues, including easy access to abortion, limiting carbon dioxide emissions and, as it turns out, assisted suicide. Newsom listed his government's accomplishments to which the audience responded with polite applause to every item ticked off. But they saved their most explosive applause for when Newsom noted legalized assisted suicide as one of those achievements.

It is not a surprise that those sitting in the studio to watch Maher lean left. Nor is it a surprise that Maher and his audience support assisted suicide — though I will never understand why legalized assisted suicide became such an American liberal project.

In the past, American liberals were an important driver of such things as civil rights, equal protection under the law, fair hiring, equal work for equal pay and voting rights for the country's black citizens, the right to health care. Most will agree that these causes were justified and life affirming.

But now the liberal banner has turned from life affirming to life ending. Newsom grinned when the audience thundered its support for killing patients. What was he grinning about? Should not someone with an ounce of morality still feel some regret about taking the life of anyone, especially someone who is innocent? Perhaps a good man might have frowned, and silenced the audience with a wave of his hand. He might have said this is nothing to celebrate. He might have added: The taking of a life is always tragic. He could have made the case that assisted suicide is an awful but needed response to what he sees as a tragic situation. Finally, he could have gone out of his way to assure his audience that he and his government would ensure that the new law be used only in the most extreme situations.

I would not have become a supporter of assisted suicide if he followed my fantasy script but at least I might have been assured that this misguided legislation was at least approached with the care and gravitas it deserves. But no: The Maher audience became a rally for death.

It is important to keep this in mind as we come down the stretch in Canada. The court gave our Liberal government a four month extension to come up with new legislation that reflects the court's Feb. 6 2015 decision to strike down the nation's ban on euthanasia.

Four months is not enough. It is not enough for debate and not enough so every Canadian gets to here a full debate on the issue — something that amazingly enough has not yet happened. But perhaps the supporters of euthanasia in Canada are as enthusiastic as their like-mined brothers and sisters in California. If that turns out to be the case, then God save us.

Charlie Lewis was a journalist for 33 years and a former columnist with the National Post.

Previous article by Charles Lewis:

• Opinion: No cooperation with killers in euthanasia and assisted suicide.

Canadian Doctors Abject Surrender to Euthanasia

This article was published by Wesley Smith on his blog on January 17, 2016.

Wesley Smith

By Wesley Smith

The complete and abject acquiescence of the Canadian medical establishment to their Supreme Court’s order transforming doctors from healers into killers is both disheartening and astonishing. 

One of the most radical transformations in the role of the doctor in medical history is moving forward with such enthusiasm, that doctors appear to be on the verge of allowing patients to tell them when a diagnosable medical condition is “grievous” and “irremediable,”–meaning that even if re-mediating treatment is available and the patient doesn’t want it, they can be killed. 

And all doctors will have to be complicit–either by doing the deed or being a death doctor pimp by finding one who they know will. 

Look at what the head of Nova Scotia’s College of Physicians and Surgeons has to say about that. From the Herald News story: 

Grant said a grievous and irremediable medical condition is subjective and “viewed through the lens of the patient.”  “It is the patient’s subjective experience that determines whether the condition is grievous,” he said. “It is the patient’s subjective decision as to whether the condition is irremediable to treatments that the patient would be willing to go through.”  

He acknowledged that this is an area of great uncertainty for doctors. “These are words that we don’t use very often in medicine — grievous and irremediable — and we’re now being tasked to participate in a decision of enormous consequence that hinges on those words.”  

While no doctor can be compelled to assist in a patient’s death, the draft document says an effort should be made to refer a patient to a willing doctor. 

During World War II, the Nazi occupiers tried to force Netherlander physicians to become death doctors and participate in that country’s euthanasia policies. Those courageous doctors refused and engaged in total noncooperation. Some were sent to concentration camps, from whence some did not return. But the peaceful civil disobedience won the day–against Nazis! 

What would those heroes think of the Canadian medical establishment? Disgusted and ashamed.

The Supreme Court of Canada gave a four month extension, it exempted Québec and it granted Superior Court judges the right to approve deaths.

By Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

On February 6, 2015, the Supreme Court struck down Canada's assisted suicide law and it employed language that permits euthanasia in its irresponsible and dangerous decision. The Supreme Court gave parliament 12 months to legislate on the issues.

On January 11, 2016 the Supreme Court heard a request from the Federal government for a six month extension to legislate on euthanasia and assisted suicide in Canada. The Federal government suggested that Québec should be exempted from the extension to allow them to institute their own euthanasia law.

Today the Supreme Court decided to grant the Federal government a four month extension to legislate on the issues of euthanasia and assisted suicide, they agreed to exempt Québec from the extension and based on national "fairness" they have enabled Canadians to petition the Superior Court for approval to die by lethal injection. If governments do not legislate on the issues within four months, Canada's assisted suicide law (Section 241b) will be null and void leaving no protection in law for Canadians.

The Superior Court is instructed to approve assisted death based on Section 127 of the Carter decision which stated:

a competent adult person who (1) clearly consents to the termination of life; and (2) has a grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition. “Irremediable”, it should be added, does not require the patient to undertake treatments that are not acceptable to the individual. The scope of this declaration is intended to respond to the factual circumstances in this case. We make no pronouncement on other situations where physician-assisted dying may be sought.

When reading the Carter decision you will notice that these terms have not been defined.

The Euthanasia Prevention Coalition is concerned that it is not possible to devise and pass effective legislation on euthanasia and assisted suicide within four months. We are further concerned that Superior Court judges will be given the right to approve lethal injections without proper definitions and effective parameters around their decisions.

First euthanasia death in Québec.

By Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

This is a very sad announcement. According to the media, Québec had its first euthanasia death in the the national capital region. Québec has defined euthanasia as a form of healthcare. 

The article by Simon Boivin that was published in LaPresse reported (google translated):

"There was a request that was made and where end of life care was provided, have gone to the end," says Annie Ouellet, spokesperson CIUSSS Capitale-Nationale. "And there is a second application that is being evaluated." 

In the case of the patient to whom the protocol was applied in full, the assisted dying has not been given at home, but in an establishment of CIUSSS, added the spokesman.

...The person must be of age, able to consent to care, suffering from a serious and incurable illness and experiencing constant and unbearable physical and psychological suffering.

Only a doctor has the right to inject a lethal dose to a patient, after having obtained the independent opinion of a second doctor in meeting the conditions to be met.A doctor can refuse to offer assistance to die, but the institution that hiring should meet the demand of the patient.

EPC urges the doctors to treat patients with excellent pain and symptom management and not lethal injection.

On December 1, Québec Superior Court Justice Michel Pinsonneault correctly prevented the Québec euthanasia law from coming into effect until the federal government amended the Criminal Code provisions prohibiting euthanasia. On December 22, the Quebec Court of Appeal overturned the Pinsoneault decision.

Canada has a disturbing constitutional situation. The federal Criminal Code prohibits euthanasia and Québec is being allowed to ignore the law.

New York State Assisted Suicide and Euthanasia Bills Are a Recipe for Elder Abuse

TUESDAY, JANUARY 12, 2016

FOR IMMEDIATE RELEASE

Margaret Dore

Dore: "Even if you like the concept of assisted suicide and euthanasia, the proposed New York bills have it all wrong.”

Contact: Margaret Dore (206) 697-1217Albany, NY 
Attorney Margaret Dore, president of Choice is an Illusion, which has fought assisted suicide legalization efforts in many states and now New York State, made the following statement in connection with a legislative lobby day for proposed bills, which seek to legalize assisted suicide and euthanasia.

"There are bills pending before the New York State Legislature, which seek to legalize physician-assisted suicide, assisted suicide and euthanasia as those terms are traditionally defined," said Dore. "The bills are described as 'aid in dying,' but their reach is not limited to dying people. 'Eligible' persons may have years, even decades, to live."

Dore said, "The bills are a recipe for elder abuse. The patient's heir, who will financially benefit from the patient's death, is allowed to actively participate in signing the patient up for the lethal dose. There is no oversight over administration." Dore elaborated, "No doctor, not even a witness, is required to be present at the death. Even if the patient struggled, who would know? The bills create the perfect crime." 

The New York bills seek to legalize assisted suicide and euthanasia for people who are "terminal," which is defined as a doctor’s prediction of less than six months to live. In real life, such persons can have years, even decades, to live.

“Doctors can be wrong about life expectancy, sometimes way wrong," Dore said. "This is due to actual mistakes: They evaluated another patient’s test results. More typically, however, doctors are wrong because predicting life expectancy is not an exact science. A few years ago, I was picked up at the airport by a man who at age 18 had been diagnosed with ALS and given 3 to 5 years to live, at which time he was predicted to die by paralysis. The diagnosis had been confirmed by the Mayo Clinic. When he picked me up, he was 74 years old. The disease progression had stopped on its own.”

“If any of the New York bills become law, there will be new lethal paths of elder abuse, which will be legally sanctioned," said Dore. "People with years, even decades to live, will be encouraged to throw away their lives. Even if you like the concept of assisted suicide and euthanasia, the proposed New York bills have it all wrong.”

For more information, see:
1. Memo from Margaret Dore, Esq., MBA, to Members of the New York State Assembly and Senate Health Committees, January 9, 2016, available at: (link)  See back up documentation at: (link).

2.  Margaret K. Dore, "'Death with Dignity': What Do We Advise Our Clients?," King County Bar Association, Bar Bulletin, May 2009 (link).

3.  Nina Shapiro, "Terminal Uncertainty: Washington’s new "Death With Dignity" law allows doctors to help people commit suicide­once they’ve determined that the patient has only six months to live. But what if they’re wrong?" Seattle Weekly, 01/14/09, available at: (link).

Assisted Suicide Bill Dies in New Jersey Senate

An important victory that bolsters opposition nationwide

For Immediate Release - January 12, 2016

Contact Tim Rosales at: 929-244-3297

Trenton, NJ - “The New Jersey Alliance Against Doctor-Prescribed Suicide applauds the New Jersey Senate for recognizing the dangers to older people and those with disabilities and allowing S 382, legislation to legalize assisted suicide, to die without a vote on the floor of the Senate,” stated Kate Blisard of Not Dead Yet. “People are surprised to learn that all major national disability groups that have taken a position on the issue oppose the legalization of assisted suicide because the dangers of misdiagnosis, coercion and abuse put us at great risk.”   

“A bi-partisan group of New Jersey Senators took the time to listen to the disability-rights community and to understand why it is important that doctor-prescribed suicide not become law in New Jersey,” continued Democratic Senator Peter Barnes. “It became clear that this bill would have a detrimental impact on vulnerable populations and expose them to abuse, coercion and possible denial of health care because it costs more than suicide drugs. While the bill's few, vocal supporters educated legislators as to their personal concerns, it became clear that there are other solutions than doctor-prescribed suicide to address end-of-life pain.  For that reason, there was never a groundswell of support for this bill and, on balance, we heard from many more voices opposed to this bill.”

The New Jersey Alliance exposed the following flaws in S 382:

• No requirement of mental health evaluation or pain relief consultation.
• Permits an heir to witness a death request.
• Requires no oversight on whether the patient was willing to take the lethal drugs.
• No requirement that a medical person be present to supervise the ingestion of lethal drugs. 
• Allows a third party familiar with how the patient communicates to make the death request. 
  • Permits lethal drugs to remain in a patient’s home without securing them.
  • Relies on the inaccurate premise that a doctor can predict death within six months.
  • No distinction as to whether the death prediction is with or without treatment of the patient.
  • No required notification of family members.
  • Immunizes from prosecution anyone participating in administering lethal drugs,  even if their participation was coercive and out of self-interest
  • Falsely certifies the cause of death.

The New Jersey Alliance Against Doctor-Prescribed Suicide is a broadly-based, diverse coalition of organizations strongly opposed to the legalization of assisted suicide. 

Euthanasia declaration fails at European parliament.

By Alex Schadenberg
Euthanasia Prevention Coalition - International Chair

European Parliament

A declaration at the European Parliament that supported euthanasia failed to garner support.

The Declaration on the dignity at the end of life was signed by 95 MEP's in three months. The declaration that was sponsored by Elena Valenciano from Spain, required the support of 751 MEP's.

The Declaration called on the European Commission and the Council to identify best practices across the European Union with regard to the provision of end-of-life health services and to facilitate the exchange of those practices between EU countries, which appears innocuous except that the declaration also supported euthanasia by stating that the right to life also constitutes a right to die.

Empirical evidence indicates that euthanasia and assisted suicide laws are abused.

By Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

A recent article by Stuart Chambers that was published on January 5 in the Ottawa Citizen claims that: 

It was a bitter pill to swallow for secular prohibitionists when large-scale abuses against vulnerable populations failed to materialize in those jurisdictions.

Chambers argues that there is only anecdotal abuse of euthanasia and assisted suicide and only religious arguments oppose euthanasia and assisted suicide ignoring the disability rights movement and the position of Not Dead Yet.

Chambers ignores the data from study that was published in the NEJM on March 19, 2015 on the experience with euthanasia in the Flanders region of Belgium. 

The study examined 3751 deaths in the first six months of 2013 in the Flanders region of Belgium and concluded that 1.7% of all deaths were hastened without request representing more than 1000 deaths yearly. The study also determined that euthanasia represents 4.6% of all deaths but the official Belgian reports indicate that euthanasia represents 2.4% of all deaths, meaning that almost half of all assisted deaths went unreported, a clear abuse of the Belgian law.

Chambers also ignored the data concerning the Washington State assisted suicide law.

The 2014 Washington State assisted suicide report states that 176 lethal prescriptions were received, 126 people died by assisted suicide, 17 deaths were from other causes, 6 people remained alive and 27 deaths were from unknown causes. The report states that the ingestion status of the 27 deaths from unknown causes is unknown and the lethal prescription is unaccounted. What kind of oversight is that?

For the purpose of brevity, this article only examines a few key points. It should be a bitter pill to swallow for Chambers that my response did not require anecdotal evidence.

Charles Lewis: No cooperation with killers in euthanasia and assisted suicide.

By Charles Lewis

The fight against legalized assisted suicide and euthanasia is not getting any simpler. I sense from having spoken to a wide range of those who oppose euthanasia that people are splitting into two camps.

One camp says we must get involved with the process of creating a safe euthanasia law. They say if we stay on the sidelines we will have no chance to influence the outcome. On some level I can see how this would seem to make sense: Given the odds of stopping the legalization of euthanasia is becoming smaller by the day why not at least try to make it as safe as possible? Why not try to ensure the process has enough checks and hurdles that only a rare few can ever access euthanasia? This all makes sense except for the fact it is fatally flawed.

In almost every case where euthanasia or assisted suicide has had time to put down legal roots it grows. At first the law is narrowly applied and then it becomes wider. It starts with those with fatal diseases who are in unremitting pain... and then suddenly it opens its doors to those with chronic pain, psychological pain or those who simply have decided that life itself is a pain. Worse, none are required to seek out treatment as an alternative. Even in the case of fatal diseases, euthanasia cuts short what may have been good years without pain to be enjoyed. I am constantly amazed at the number of people who now beat cancer or live well even years after they were supposed to have died.

The other camp, the camp I am in and those who I most admire are part of, says no cooperation with killers. Imagine if euthanasia becomes legal. Anyone who assisted the government will be, in some way complicit. Even when people complain about how the law has become more deadly than what they pushed for, the government can say: "You had your chance. We let you help. You are as culpable as we are."

It is an understatement to say that the road myself and allies have taken is harder. Anyone who calls our route a long shot or even naive is not wrong. Yet, history is peppered with long shots that succeeded beyond anyone's wildest imagination. Think of the Jewish people after the Second World War. The psychological devastation should have left survivors as lifelong psychiatric patients. Instead three years later Israel was created. Who could have predicted that?

Finally, standing up for the right thing is never wrong. It is more important than winning or losing. Remember, this battle will go on even if euthanasia becomes legal. I for one would rather fight it with clean hands.

Charles Lewis was a journalist for 33 years and a former writer for the National Post.

• Netherlands 2014 euthanasia report: another 10% increase.
• Assisted suicide increased by 44% - Oregon 2014 assisted suicide report.
• Washington State 2014 assisted suicide report - no information on 27 deaths.
• More than 1000 Belgian deaths were hastened without request in 2013.

The Netherlands approves euthanasia for severe dementia.

By Alex Schadenberg
International Chair - Euthanasia Prevention Coalition

The Netherlands government has decided to extend euthanasia to people with dementia who are incompetent to request death by lethal injection, if the person requested euthanasia while still competent. 

The 2014 Netherlands euthanasia statistics state that out of 5306 euthanasia deaths; 81 people were lethally injected for dementia and 41 people died by euthanasia for psychiatric reasons.

To lethally inject a person who is unable to request death undermines the "safeguard" of consent. Even if the person, while competent, requested euthanasia for dementia, now the person is unable to change their mind.

Since the person is incompetent to request death by lethal injection, the new "guide" undermines the safeguard requiring a clear request. Who will decide when the lethal injection should be done? Will it be determined that some lives are not worth living? 

The new guide appears to be designed to protect doctors who were already killing people with dementia. 

On January 7, 2016, the Netherlands Times reported:

The Ministries of Public Health and Security and Justice updated their “guide” on euthanasia to give people suffering from severe dementia the option of euthanasia, even if they are unable to express the wish themselves. This is only possible if the patient wrote a declaration with his wish for euthanasia while he was still clearheaded, broadcaster NOS reports. 

The new guide states that patients with severe dementia often do not seem to be suffering unbearably under their dementia, but they do suffer under the physical conditions that go along with it, such as severe anxiety and pain. “In those cases a doctor may give euthanasia, even if a patient can not make it clear in words or gesture. But there has to be a written request for euthanasia, that the patient drew up earlier.” 

The guide was updated to take away the uncertainty about the possibilities for euthanasia in dementia patients. According to the guide, doctors have given euthanasia to dementia patients with a previously written request a few times before. But if it is unclear whether such a request still exist at a time that a patient is unable to express himself, chances are that the doctor will not carry out euthanasia. 

The guide includes a manual for drafting a euthanasia declaration.

The Dutch Medical Association stated, a few days earlier, that doctors are not required to participate in euthanasia.

Dutch doctors have the right to refuse to participate in euthanasia

By Alex Schadenberg
International Chair - Euthanasia Prevention Coalition

The Dutch Medical Federation (KNMG) has affirmed the conscience rights of doctors to refuse to participate in euthanasia. The DutchNews.NL reported:

Dutch doctors must retain the right to refuse to help their patients to die, the doctors’ federation KNMG has told the NRC. While most doctors back euthanasia, or assisted dying, they should never be compelled to cooperate, Rutger Jan van der Gaag is quoted as saying. Euthanasia should not be something that can be forced on doctors, he said. 

‘The doctor is currently an important safety catch who makes sure that reasonable alternatives [to euthanasia] are not ignored and that the drugs are not misused,’ Van der Gaag told the NRC.

Update: Ontario court decision forces doctors to refer their patients to death.

Québec doctors have been told that they must refer their patient to die by euthanasia, even if they oppose euthanasia. The Physicians Alliance Against Euthanasia are fighting this decree.

Doctors in Ontario have also been told that they will have to refer their patients to death. Medical groups in Canada need to recognize that the Netherlands is not forcing doctors to kill, why are conscience rights in Canada not also being respected?

Protect physicians conscience rights in Canada at: http://www.canadiansforconscience.ca/

Québec physicians group opposes referring patients for euthanasia.

Scientific Objection to Dr. Yves Robert’s Editorial

[“Referring the patient’s request to a health care professional who would follow through with it would then seem the ultimate compromise, respecting patient’s and physician’s rights.”][1] Dr. Yves Robert, Le Collège, November 10, 2015

Dr Robert,

The above statement that you made as Secretary of the Collège des médecins du Québec is absolutely false.

First, let’s recall this excerpt, from of the Superior Court ruling (par. 97): “The lawyer of the Attorney General of Canada also expressed her concern about article 31 of an Act respecting end-of-life care, obliging physicians who do not want to grant a request for physician-assisted dying, to participate, despite their objection, in the process of finding a willing physician. She sees in this fact itself an indication that even a physician, conscientious objector, would inevitably become involved in a process leading to the commission of a criminal act under the current state of the law”.

This summarizes without ambiguity the thoughts of the Attorney General of Canada and the Quebec Superior Court concerning your “ultimate compromise” on the subject of conscientious objection, also shared by the Collège des médecins du Québec.

This form of collaboration in killing a patient, with all due respect, is not the ultimate compromise. It is an obligation to collaborate — which can be experienced by a physician as complicity in an act he considers to be harmful to his patient, irrelevant whether the act is criminal or not (the crime evoked here only compounds the insult of the obligation).

As for me, I want to continue to offer care to my patient; not sever the relationship. I simply refuse to cause his death. What will you do against my medical judgment?

If you suspend me, you are the one severing the care relationship by depriving a patient of his physician, whereas I am willing to continue caring for him. I do not consider sending my patient to be killed as providing care because… to be killed is not a treatment, neither for me, nor for the overwhelming majority of physicians and medical associations all over the world. This then is a question of medical obligation, because I apply the international norm, while the Collège has decided unilaterally to disagree.

The issue here is much more a question of scientific objection than an objection of conscience because the purpose is to apply the international norms and standards the Collège decided to disagree with.

Given that most physicians will never agree to stop preventing suicide among their patients, we cannot compel them to stop this prevention because their medical judgement and expertise—that they have applied for years—tells them not to do it. Simply put, preventing suicide remains good medicine.

Likewise, a hospital director cannot force me to perform surgery on my patient if my medical opinion tells me the surgery would be harmful. It does not mean that I sever the professional relationship with my patient, only that I exercise my profession with my judgement and my competence, which means to say that I am not a simple technician who will only serve to be “someone else’s hands.”

In the same way, no patient can force me to perform surgery that I consider bad or harmful, and it is understood that the minimum degree of professional consistency would prevent me from referring him to someone who would perform it in my place. I would simply tell him that it is not recommended, and he would be free to go elsewhere. If however, I were to transfer him to a colleague or health care professional knowing that the procedure I consider harmful will be conducted, it would be as though I performed it through the hands of another.

The Collège needs to recognize this logical response from physicians (palliative and other) who do not want to collaborate in paving the way toward the medically assisted death of their patients. These physicians, who are neither fanatical nor arrogant, see this intention of the state (and of the Collège) to impose on them a forced collaboration like an abuse of authority. The use of the term “ultimate compromise,” in this context, sounds a lot like “this is my final offer.” That, would sooner be called an ultimatum—and the Attorney General of Canada did well to note the real intention behind the words.

In conclusion, if the Collège hopes to avoid unjust and unnecessary confrontation with qualified and attentive physicians of integrity, it should find a way not to compel them to assist in the death of their patients against their medical judgement and their professional conscience.

Even if the new exception measures (not to read “rule”) that will soon be established in the Canadian Criminal Code allows for euthanasia or assisted suicide under certain conditions, you must remember that forcing physicians to refer—moreover to threaten them—is a sure-fire way to cause unnecessary and damaging battles for all, to cause division and spoil the collegial environment in our hospitals.

If, one day, euthanasia or assisted suicide are decriminalized, a true compromise—one that would respect everyone’s autonomy — would be something like this: let patients carry out their own wishes by putting a voluntary system in place, forcing no participants to act against their will—neither their doctors nor anyone else involved.

Marc Beauchamp, MD, FRCSC, orthopedic surgeon, Montreal


With the support of the undersigned:

Canada's healthcare system in an unenviable disrepair, a broken palliative care system and now Euthanasia?

By Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

On December 30, Canada's National Post published two articles concerning Canada's healthcare system. 

An article by Kristy Kirkup explains how the euthanasia debate has exposed a "dark secret" that Canada's palliative care system is inadequate while the article by Brian Rotenberg asks Canadians to examine what medical services should continue to be paid for by the government.

Together, these articles should caution Canadians and urge governments, at all levels, to reject the legalization of euthanasia and assisted suicide.

The first article is based on a soon-to-be released report by Gabriel Miller, the public issues director with the Canadian Cancer Society. Miller is hoping that the euthanasia debate will lead to a greater commitment to palliative care across Canada. Kirkup reports:

“There are thousands of terminally ill Canadians who are not getting the right kind of care,” Miller said. “That’s causing patients and families unnecessary suffering and it is costing the health-care system precious resources.” 

Miller is urging the federal Liberal government, along with its provincial and territorial counterparts, to capitalize on the chance to ensure Canadians have universal access to better, affordable end-of-life care.

“We finally have a moment to pull this problem out of the shadows and solve it,” he said. 

“That’s the importance of the broader debate that’s unfolding right now. It is a chance to confront a broken system for end-of-life care and make a lasting reform.”

The second is an opinion article written by Rotenberg who is an expert advisor with the Evidence Network. Rotenberg states that Canadians will need to make hard choices:

All across Canada, provincial governments are grappling with ever-growing health-care demands, in the face of shrinking resources. Our enviable publicly funded health system is now in a downward spiral of unenviable disrepair. As patients are becoming more knowledgeable about their own care, and as doctors develop a wider array of options available to treat diseases, the costs are increasing. 

The truth is that we can’t have it all. Both the physicians who deliver care and the patients who receive it need to start considering how best to manage the limited resources in our publicly funded health-care system.

The paradox is clear. Even if there is political goodwill, governments, at all levels cannot fix the "broken end-of-life care system" in a healthcare system that is "in a downward spiral of unenviable disrepair."

On February 6, 2014; the Supreme Court struck down Canada's laws that protected people from euthanasia and assisted suicide. 

At sometime in the future, will Canadians feel obligated to "choose" to die?

Governments, at all levels, must reject the legalization of euthanasia and assisted suicide and recognize it as a pandora's box that cannot be controlled, especially within our "broken end-of-life care system that is within our healthcare system that is in unenviable disrepair.

Battle lines drawn in Belgium over euthanasia and conscience rights.

This article was published by HOPE Australia on January 2, 2016.

Paul Russell

By Paul Russell 

Director: Hope Australia

Family set to sue over ‘non-euthanasia’ in Catholic aged care home.

Over recent weeks the issue of conscientious objection, or the ‘conscience clause’ in the Belgian euthanasia law has been brought into the spotlight by the assertion by the newArchbishop of Mechelen-Brussels, Jozef De Kesel, that he has the right to refuse Catholic hospitals and aged care facilities to co-operate with euthanasia.

Euthanasia advocates both in academia and in the medical profession have bristled at the suggestion that institutions might say ‘non’ with many displaying a distinct and disturbing lack of understanding about the status of the 14 year old statute that allows doctors to kill their patients.

The Belgian law clearly provides a conscientious ‘out’ for doctors and others assisting in a euthanasia but it is otherwise silent about institutions. Some suggest that the extension to institutions such as a church ae implied while others suggest, dubiously to my thinking, that the silence suggests otherwise.

While, initially at least, this seemed like very much like an academic exercise with no-one really expecting the new bishop to force a show down. But a showdown was already in the making.

Various Belgian news outlets, today, are running with a story about a refusal by a Catholic nursing home to allow a doctor onto their premises to perform euthanasia. According to reports, the 74-year-old woman was terminally ill with metastatic cancer and living in the St. Augustine residential care centre in Diest.

The process of requesting euthanasia began in 2011 and progressed for six months before St. Augustine’s management refused access supposedly only days before the euthanasia was to take place. The various stories do not say whether or not the facility was formally aware of the process, however the family of the woman say that, after initially believing that the matter was simply a misunderstanding, they arranged for the woman to be transported to a private residence where the death took place. The family are claiming that the facility caused additional psychological and physical suffering for their mother.

The matter is listed to be heard in a civic court in Leuven in April – four and a half years after the death and after the matter had already been postponed twice before; why, we are not told.

I smell a rat. This issue precedes the current controversy but it does not take a cynic to question why, all-of-a-sudden, a matter that has twice been suspended over a death that took place over four years ago where the woman got what she wanted, is suddenly before the media and the courts?

If that were not enough to have any conspiracy theorist salivating, the lawyer for the woman’s family, Sylvie Tack, has a longstanding professional relationship to Belgian euthanasia supremo, Wim Distelmans and his Life Ending Information Network (LEIF) being lecturer, speaker and part of their peer review panel. Not a ‘hanging-offence’ certainly, but enough to question which was the horse and which the cart.

Overall, it may well be that Archbishop De Kesel was well aware of this pending case when he made his pre-Christmas declaration. If so, then full marks to him. As we observed earlier, it seems likely now that the courts may well determine the interpretation of Article 14 of the Belgian law.

It does not seem likely that the complaint by the woman’s family is principally about her treatment or any recompense or restitution for ‘suffering or loss’. As their lawyer told De Morgen: "The new Act states that doctors and staff who are involved in the euthanasia, can have conscientious objection. But the health care institution itself should not interfere with it themselves."

Make no mistake: if ever there was going to be a test case, this is it. Rightly or wrongly, Belgian’s euthanasia supremos have always seen the Catholic Church and its influence as the last bulwark standing against them. I have heard them say as much personally. Perhaps, ironically, they also see Catholicism as the last voice of conscience – to which they clearly object.

Declaration of Hope

(Sign the Declaration of Hope)

We believe that legalizing euthanasia and/or assisted suicide is bad public policy.

To legalize euthanasia and/or assisted suicide enables one person to directly and intentionally cause the death or to be involved with causing the death of another person. It is not safe to allow anyone to be involved with causing death of other people. We understand that the most tragic cases will dominate the public discussion, but the issues must be considered based on how it will affect society as a whole.

Euthanasia and assisted suicide is not an acceptable response to terminal or incurable illness or chronic conditions. Changing the law may result in some people feeling pressured and thereby consider themselves or their loved ones as ‘better-off-dead’.  Some people will feel obliged to justify why they want to continue treatment. For many, including attending physicians, euthanasia and assisted suicide would become the unspoken, but ever present, question resulting in a subtle, negative change to the doctor-patient relationship. Will this result in a “duty to die” or even a "duty to kill"?

Euthanasia and assisted suicide pose a threat to the equality of every person. The lives of some in people will be considered — “not worth living”. Among those at greatest risk are the elderly, the lonely, those living with disabilities, those experiencing chronic illness and those with limited access to good medical care. Maintaining laws against euthanasia and assisted suicide provide equal protection.

Older people are not a problem to be rid of — they’re a generation to be honored and cared for. Elder Abuse has become a significant societal scourge. We cannot ignore the possibility that dependent elderly people may be coerced into euthanasia or assisted suicide. We cannot put older people at risk by creating new paths to elder abuse.

We must not place the lives of people at risk. Legislators need to apply the precautionary principle: the higher the risk – the higher the burden of proof on those proposing legislation. The risk of abuse cannot be eliminated.

Legalizing euthanasia and/or assisted suicide is a recipe for abuse. So-called ‘safeguards’ are an illusion because they are unable to prevent the potential for coercion and abuse.

All people should have access to quality pain control — no matter where they live. Pain control and palliative medicine should be given a higher priority in medical training so that everyone can benefit.

Being involved in one’s health care plan and making informed choices are vitally important to a patient’s sense of well being. Euthanasia and assisted suicide weakens the autonomy of patients, reducing their choices about their care and symptom management. Euthanasia and assisted suicide may be increasingly adopted as the easier option to the exclusion of genuine patient centered care.

We firmly oppose euthanasia and assisted suicide.

(Sign the Declaration of Hope)

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The American Declaration of Hope.