Study: Legalizing euthanasia saves money.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

The Canadian Medical Association Journal (CMAJ) published a study by Aaron J. Trachtenberg MD DPhil, Braden Manns MD MSc titled: Cost analysis of medical assistance in dying,

The researchers found that the Canadian healthcare system will save between 34.7 and 138.8 million dollars per year, depending on the number of euthanasia deaths. Canada has a universal healthcare system, whereby the financial cost for healthcare is primarily covered by the government.

The cost savings were assessed based on a Netherlands study estimating the number of weeks that lives were shortening by euthanasia, multiplied by the average cost of care for a person nearing death, and multiplied by the likely number of euthanasia deaths in Canada. The study also considered the cost of the euthanasia procedure and potential variable costs related to patients using palliative care.

The researchers emphasize that they are not encouraging people to die by euthanasia, but in fact, this type of research creates social pressure for people to die by euthanasia.

First: Associating euthanasia with medical cost savings creates a belief that euthanasia is a social good. People who feel that their life has lost value may now consider it altruistic to "choose" to die by euthanasia.

"I will give back to society by having my life ended and save money."

I fear that the social pressure to save money and provide a greater access to organs for donation will become the ultimate form of social responsibility.

Second: Associating euthanasia with medical savings creates pressure on people who choose to live until they die. 

"How dare you choose to live. You are costing society money."

By promoting the concept that euthanasia saves money coupled with the media stories and TV shows, such as Mary Kills People, creates a new powerful social pressure to die.

Last weekend I was invited to speak to a group in a small Ontario community. After my presentation a man told me that he supported euthanasia based on his experience with his mother-in-law who lived the last few months of her life, after having a stroke, lacking awareness. He asked me, what was the purpose for her life? He then said: how much did her care cost the government?

I responded by saying:

I guess euthanasia is not about "choice" or "autonomy," she was unable to choose, but rather killing people at the most vulnerable time of life.

During Canada's euthanasia debate very few people were speaking about the fact that Canada's health care system is facing a financial crunch. The reality is that killing people is cheaper than caring for them.

The authors of this study suggest that the financial savings gained from premature deaths by euthanasia could be re-invested into palliative care. 

The authors of this study are naive. The more that people die prematurely by lethal injection, the less demand will exist for palliative care.

Dead people don't need palliative care.

British Psychiatrist approves six dementia patients deaths at Swiss suicide clinics

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

The Daily Mail news reported that a British Psychiatrist, who had lost his medical license, approved the assisted suicide deaths of six people with dementia.

Sanchez Manning reported that Colin Brewer, who is no longer permitted to practice medicine, told the Daily Mail that he had done mental capacity tests on six people with dementia, before approving their suicide deaths in Switzerland. None of the six people were terminally ill.

Baroness Ilora Finlay

Baroness Ilora Finlay, one of Britain’s most eminent end-of-life doctors and an opponent of legalising assisted suicide, told the Daily Mail:

‘You don’t know how the disease [dementia] might or might not progress. 

‘Some people may be frightened and may be in despair. 

‘But if you assist their suicide you cut their life off by months or years when they may never have gone on to experience more severe forms of the disease.’

Alistair Thompson, a spokesman for the group Care Not Killing, added:

‘A lot of people fear that when there is a care crisis within the NHS there will be more pressure on people who are elderly and frail to think about ending their lives.’

The Daily mail article reported that:

Brewer ran an addiction clinic in London before he was struck off in 2006 by the General Medical Council after a patient for whom he had prescribed drugs died. 

He can see and assess patients offering non-medical services as long as he makes clear that he is not on the medical register.

Yesterday, after speaking to a group, one of the attendees told me that he supported euthanasia for incompetent people. He said that when his mother-in-law was nearing death, she became unaware of her surroundings. He asked me, what was the purpose of her life? and then he said - How much money did it cost the government to care for her?

I responded by saying: 

sadly, your comments tell me that history may repeat itself.

Killing is never the solution to human problems. 
We support caring options, not killing.

Promoting assisted suicide: A form of coercion.

The Victoria Times Colonist printed this excellent letter on January 19 by Paul Jungwirth

Noreen Campbell chose to end her life by means of physician-assisted suicide, as was her right under Canada’s new law. 

Since that law was passed, more than 744 people have also chosen to end their life this way. 

But apparently Campbell’s dying wish was that even more people would avail themselves of this new right. 

She wanted her story about ending her life to “open the door for others” and “draw attention to the gaps she saw in the process,” because, as a member of the assisted-suicide advocacy group Dying with Dignity, she felt the law doesn’t go far enough. 

The ease with which she embraces killing as a good solution to suffering is simply appalling. 

Her opinions about why people should go the same route as she did contributes nothing new to this discussion — it’s all about fearmongering and undermining people’s expectations about what palliative care can achieve. 

According to her, taking a lethal injection is preferable to the alternatives, and promoting this idea is an insidious form of coercion that will only result in more needless premature deaths, and an increasingly callous approach to people who might be suffering near the end of life. 

Paul Jungwirth 

Burnaby BC

Previous article on this topic: How many people have died by euthanasia in Canada?

I'm terminally ill and the euthanasia debate scares me.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Julie Morgan

New South Wales Australia will soon be debating the legalization of euthanasia. At least one terminally ill woman, Julie Morgan, says that the euthanasia debate worries and scares her on several levels.

Morgan, in her article published in the Sydney Morning Herald says that her experiece with fighting cancer for four years has enabled her to understand and oppose euthanasia:

the past four years have given me a unique window into the complexity of death and dying, of living and loving, and of holding on and letting go.

Morgan first explains her personal life experience:

The doctors have told me I have a few months to live. The cancer that began in my breast four years ago has spread to my spine, ribs, hips and, more significantly, to my lungs. The surgeries, extensive chemotherapy, and radiation that I went through back then, plus the on-going hormone therapy, didn't do the trick. And so now, in my mid 50's, I'm terminally ill. It often doesn't seem real, yet it is. But there's so much more that I want to do – I am not ready to go!

Morgan expressed why the euthanasia debate scares her:

The debate worries and scares me on several levels. Fortunately we just don't go around killing each other any more, so the notion that it's a person's "free choice" to die just doesn't make sense. Recognising the full scope of human dignity, we stopped capital punishment a long time ago. Now bringing in legislation that allows a group of experts to determine who can "legally" die, seems a retrograde move. Intellectually, that worries me. And once the legislation has been approved, experience tells us that it is likely to grow exponentially. I can imagine a time when particularly frail and vulnerable people will succumb to the thought that it might be best for their families and for society in general for them to let go and die – they will agree to something because they think they ought to. That scares me.

Morgan concludes her article by defining what true death with dignity is:

I have always been an extremely private person, so the thought that my increasingly frail body will need intimate help does not thrill me. But just as I cared for and loved my friend in all her messiness and fragility, I will have to let others care for and love me in the same way. There is nothing undignified about that. So my experience of being a primary carer tells me that as I'm dying, the presence of people who have the emotional capacity to sit with me during long hours, who have the strength to continually stroke my arm, to bring me cups of water in the night, to tell me that they love me and to stay with me even if it seems that I am no longer present to them is of beyond measure. I'm sure that I will know their voices, and that I will know their touch. So as the doctors relieve my physical pain, I trust that my family and friends will abide with me so that just as I have lived, so will I die, with integrity and grace.

In November 2016, South Australia debated and defeated a euthanasia bill and the Australian Medical Association re-affirmed its opposition to euthanasia and assisted suicide.

Paul Russell and Hope Australia have once again prepared an effective opposition to the proposed euthanasia legislation. Thank you Julie for expressing your real fears about euthanasia.

How many people have died by euthanasia in Canada?

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

The Globe and Mail published an article by Kelly Grant featuring a BC couple who wanted to die by euthanasia together, but ended up dying by euthanasia four days apart.

I had hoped that the pro-euthanasia propaganda media articles would lessen now that euthanasia is legal in Canada, but in fact the media continues to ramp up the propaganda.

Nonetheless, the Globe and Mail article states that at least 784 people have died by euthanasia in Canada since June 2016.

On December 29, I reported on a CTV News article stating there were at least 744 people who died by euthanasia since June.

Both articles clearly state that there could be more and both articles use data from a Québec report that was published more than two months ago, on November 1.

I believe that the number of euthanasia deaths will continuously increase as long as the media continues to publish articles promoting euthanasia and assisted suicide.

Comparing the data from the Dec 29 CTV news article to the Jan 18 Globe and Mail (G & M) article:

• BC 154 (CTV)  -  195 (G & M),
• Alberta 63 (CTV)  -  71 (G & M),
• Saskatchewan 8 (CTV)  -  11 (G & M),
• Manitoba 18 (CTV)  -  32 (G & M),
• Ontario estimated 180 (CTV)  -  200 estimated (G & M)
• Québec 300 estimated (CTV)  -  262 (data based on November 1 report) (G & M)
• Nova Scotia 16 (CTV)  -  16 (G & M),
• Newfoundland and Labrador 4 (CTV)  -  4 (G & M),
• New Brunswick 0 (CTV)  -  0 (G & M),
• Prince Edward Island 0 (CTV)  -  0 (G & M),
• Northwest Territory 0 (CTV)  -  0 (G & M),
• Yukon Territory 1 (CTV)  -  1 (G & M),
• Nunavut did not release data (CTV)  -  0 in Nunavut (G & M), 

The Globe and Mail report has under-estimated the number of euthanasia deaths in Québec.

Further to that, the government monitors "assisted death" with a self-reporting system. The reporting system requires the doctor or nurse practitioner who carries out the euthanasia to also report the death. 

The Netherlands and Belgium also employ a self-reporting system to collect data on euthanasia. Based on studies, it is estimated that (20% - 23%) of all euthanasia deaths in the Netherlands are not reported and more than 40% of the euthanasia deaths in Belgium are not reported. Underreporting of assisted suicide also occurs in Oregon and Washington State.

The only way to uncover abuse of the euthanasia law is through family and friends who are willing to share their story. Several stories have already been uncovered.

If you are willing to share information about the euthanasia death of a family member or friend please call Compassionate Community Care at: 1-855-675-8749.

EPC looking for a story for our next documentary. If you seriously considered dying by euthanasia or assisted suicide or felt pressured toward an assisted death, please call us at: 1-877-439-3348.

Canadian bioethicists call for organ donation euthanasia.

This article was written by Michael Cook and published by MercatorNet on January 16, 2017

By Michael Cook

Well, well, that didn’t take long, did it? Euthanasia became legal in Canada in June and by December Quebec bioethicists had already published an article in the Journal of Medical Ethics calling for organ donation after euthanasia. In fact, they were reflecting the positive opinions of the both the Quebec government and of Transplant Quebec, the professional association of transplant surgeons

The authors, Julie Allard and Marie-Chantal Fortin, bioethicists at the University of Montreal, argue that their proposal is a kind of homage to autonomy:

“MAID (medical aid in dying) has the potential to provide additional organs available for transplantation. Accepting to procure organ donation after MAID is a way to respect the autonomy of patients, for whom organ donation is an important value. Organ donation after MAID would be ethically acceptable if the patient who has offered to donate is competent and not under any external pressure to choose MAID or organ donation”.

However, they insist that the decision to donate should be separate from the decision to be euthanized. They point out that such a policy could have a negative impact upon the public’s perception of organ donation, so they urge that further studies be done.

Not very publicized, but pre-dating the publication of the JME article, are position statements from Transplant Quebec (no link available) and an ethics committee of the Quebec government. The latter stated on May 11 that:

Considering that a request for medical help in dying is a right, that organ donation is socially acceptable and it is an express request of the patient, and considering that the Commission [Commission de l'éthique en science et en technologie] has always praised organ donation in preceding position statements, the Commission recommends that all the institutions responsible set in place the necessary conditions for making these two requirements compatible.

Allard and Fortin contend that organ donation euthanasia will always be a rare option, because most patients who request euthanasia are dying of cancer, which would normally make them unsuitable as an organ donor.

As a policy, it has only been rolled out in Belgium and the Netherlands. Between 2005 and 2015, 21 Belgians donated organs following euthanasia. The Dutch lag behind, but so far 15 patients have asked to donate organs following euthanasia.

What is the ethical reasoning behind such a procedure? It is based upon respect for the patients’ autonomy.

Several countries, including Canada and the USA, believe that a person who is able to give free and informed consent (or refuse such consent) is entitled to decide what will happen to his or her body.

Allard and Fortin acknowledge that there might be some ethical complications. Patients might feel that they are a burden and could only be useful if they were to give their organs. This would constitute a subtle form of coercion. However, Allard and Fortin are confident that this can be overcome.

It will be difficult to disentangle patients' motivations for requesting MAID, but the complete separation of the two decisional processes should help to ensure that the MAID request is motivated by unbearable suffering, as required by law, and not by the feeling that one's value is limited to one's organs.

Of all the bad ideas associated with euthanasia, this must be one of the worst. The potential for exploiting vulnerable people is immense. Imagine that you have recently become a quadriplegic after a motorcycle accident. You are lonely, frustrated, discouraged; you think that life has no meaning, that you are a useless encumbrance on your family and society. You don’t believe the doctors who insist that paraplegics can and do live fulfilling and happy lives.

One day, from your hospital bed you see a TV program in which a transplant surgeon praises the unforgettable generosity of So-and-so whose life was not worth living but found a way to give life to others, etc, etc. Wouldn't you think of ringing up the doctor and asking him how to go about it?

It could get even worse. What if organ donation organisations promoted an standard advance directive which instructs your next-of-kin to arrange for organ donation euthanasia if you become seriously demented? There is no reason why this could not happen. In Belgium, demented people can be euthanized and organs are being accepted, even from elderly people. That would clean out the nursing homes and shorten the kidney waiting list.

How is Canada going to stop this from happening?

Michael Cook is editor of MercatorNet. An earlier version of this article was published in BioEdge, which he also edits.

Fighting assisted suicide in your state.

2017 will be an active year for those who protect people from assisted suicide.

EPC - USA has organized an Assisted Suicide Training Session to provide you with the tools to fight assisted suicide in your state.

The assisted suicide lobby has identified at least 26 states where they plan to introduce bills or launch a court case to legalize assisted suicide in America.

The states include: Arizona, Connecticut, Delaware, Hawaii, Indiana, Iowa, Kansas, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Hampshire, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, South Dakota, Tennessee, and Utah. 

There will also be a federal debate as to whether the District of Columbia assisted suicide law will be overturned.

The event begins at 6 pm until 9 pm and is followed by the screening of the Euthanasia Deception documentary.

We have limited seating. To book your seat at this event. (Link).

Ontario nurse faces six more charges. Is legalizing euthanasia more dangerous?

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Elizabeth Wettlaufer (October 25)

On October 25, 2016, EPC reported that Elizabeth Wettlaufer, 49, a nurse from Woodstock, was charged with 8 counts of first degree murder in what is being defined as possibly the worst case of a seriel killer in Canadian history. 

EPC responded to this news by demanding an in-depth investigation into care homes in Canada, especially now that euthanasia is legal.

Wettlaufer is now facing six more changes related to the abuse of patients in Woodstock and Paris Ontario.

It is important to note that Wetlauffer's alleged acts of murder were not uncovered by an investigation or by "quality control" but rather by a tip received by Wettlaufer's psychiatrist.

Further to that, on December 7. the London Free Press reported that Susan Muzylowsky, a nurse who worked at the Mount Hope Centre for Long Term Care in London ON confessed to charges of professional misconduct relating to 19 patients.

As Executive Director of the Euthanasia Prevention Coalition, I regularly receive calls from people who believe that their loved one was prematurely killed or neglected in a hospital or nursing home. These cases are frustrating because, based on privacy, it is nearly impossible to prove that such an act has occurred and the financial and personal costs associated with gaining justice is prohibitive.

I am convinced that Elizabeth Wettlaufer is one of many "care-givers" who have caused the death, neglected or abused patients in care homes. In fact, I am convinced that if an honest, third-party, in-depth investigation was done into the care of vulnerable persons in Canada that a significant number of horrific cases would be uncovered.

Now that euthanasia is legal in Canada, should you be concerned?

There is no effective oversight of the euthanasia law. If a person dies by euthanasia, the reporting procedure requires the doctor or nurse practitioner who did the lethal injection to submit a report to the authorities. Therefore, the person who causes the death is required to self-report of the death. There is no effective oversight of the law.

Further to that, the flawed language in Canada's euthanasia law provides legal immunity to anyone who participates, in any way, in an act of euthanasia or assisted suicide. The law states:

Section 241(3): No person is a party to an offence under paragraph (1)(b) if they do anything for the purpose of aiding a medical practitioner or nurse practitioner to provide a person with medical assistance in dying in accordance with section 241.‍2.

No other jurisdiction in the world provides this level of blanket immunity for euthanasia.

Legalizing euthanasia in Canada has given medical professionals the ability to cover up acts of murder, abuse, negligence or medical error.

Finland set to debate euthanasia

This article was written by Paul Russell, the Director of HOPE Australia, and published by HOPE Australia on December 31, 2016.

By Paul Russell

A citizen's initiative to raise the issue of euthanasia in the Finnish Parliament (Eduskunta) has passed the requisite 50,000 signatories required to trigger a parliamentary debate.

As in many countries, Finland has been dicing with euthanasia for some years now. The pro-euthanasia lobby, Exitus has been active since the early 1990s. As in many countries, the notional public support for euthanasia is above the two-thirds mark. Support amongst the nations doctors has also been steadily increasing in recent years with support and oppose numbers in the medical profession both at 46% in 2014.

As with all Finnish Citizen's Initiatives, the 'Euthanasia initiative includes a prescription of the form of the Bill to be debated. The presented model is for euthanasia for people experiencing an 'incurable fatal disease, and death takes place in the near future'. The registered signatories now exceed 62,000 which should ensure that, after exclusion checks, that a formal bill is developed and that the parliament is compelled to move to a vote.

The sponsor for the initiative is former Finnish MP, Esko Olavi Seppänen. Seppänen, a member of the Left Alliance Party and earlier the Finnish Communist Party, he was also a Member of the European Parliament from 1996 to 2009 as a Member of the European United Left/Nordic Green Left (GUE/NGL).

The Finnish Medical Association is opposed to the initiative. Association head Heikki Palve said that the majority of palliative care doctors working with dying patients object to legalising euthanasia. A 2010 survey of doctors attitudes found that, in their opinion, more training on palliative care would diminish requests for active euthanasia and improve physicians’ skills in dealing with the difficult challenges faced in end-of-life situations and care.

Timo Soini, the chairperson of the Finns Party, has confirmed his intention to vote against the citizens' initiative to legalise euthanasia in Finland. Finns is the second largest party in the four-party governing coalition in Finland and has a socially conservative base. Amongst its coalition partners both the National Coalition and the Centre Party hold within their ranks notional majorities of socially conservative MPs.

It is not clear at this time when a bill will be tabled for debate.

Congress will vote to protect people from assisted suicide in DC.

Alex Schadenberg

Executive Director - Euthanasia Prevention Coalition

Congressman Jason Chaffetz

The Washington Post reported on January 10th that Congressman Jason Chaffetz (R-Utah) the chairman of the House Oversight and Government Reform Committee that oversees District affairs told reporters that he intends to stop the DC assisted suicide bill. Chaffetz stated that he:

fundamentally disagrees with the bill

District of Columbia Mayor Muriel Bowser signed the assisted suicide bill on December 19. The US Congress has 30 working days to vote NO to assisted suicide in DC.

Petition: I support H.J. Res 27 to reject the DC assisted suicide act.

The Washington Examiner reported that:

It is not clear if Congress will approve the legislation. It has blocked D.C. legislation before, most recently the city's recreational marijuana law. Under the Constitution, Congress has to sign off on all D.C. laws.

EPC - USA President, Nancy Elliott stated:

Rep. Jason Chaffetz is doing the right thing. Assisted Suicide is dangerous public policy, preying on people who are not necessarily dying, such as diabetics and is open to elder abuse, disabled abuse, death because of wrong diagnosis, suicide steering and suicide contagion. Having this law in our nations' capital is a black eye on our country.

Petition: I support H.J. Res 27 to reject the DC assisted suicide act.

Contact your representative.

Massachusetts Judge urged to dismiss assisted suicide court case.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

In late October 2016, two doctors filed a court case challenging the Massachusetts assisted suicide law in order to give them the right to prescribe lethal drugs for assisted suicide.

Patricia Wen of the Boston Globe reported, on January 9, that Attorney General Maura Healey and Cape & Islands District Attorney Michael O’Keefe urged the judge to dismiss the case based on the principle that issues, such as assisted suicide, are properly decided by the legislature and not the court.

Dr Roger Kligler, who has metastic prostate cancer, is the plaintiff in the case and Dr. Alan Steinbach, also from Cape Cod, is willing to prescribe lethal drugs to Kligler or others who, if proven mentally sound, want to die due to their terminally ill state. Dr Kligler has not been deemed to be terminally ill. 

Kligler and Steinbach are acting on behalf of the suicide lobby group, Compassion & Choices.

According to the Boston Globe article, O'Keefe told the judge that:

he is “very sympathetic” to patients like Kligler, but that the doctor is making his petition “to the wrong branch of government.”

Compassion & Choices failed in New Mexico, Connecticut, Tennesee, California and New York with similar court cases.

The Massachussets Superior Court should reject this case and honor the results of the voter initiative whereby Massachusetts residents rejected assisted suicide in 2012.

Outgoing Vermont Governor Peter Shumlin’s Father’s Death was an Assisted Suicide

This article was published by True Dignity Vermont on January 6, 2017.

Peter Shumlin, the outgoing governor of Vermont, fought hard to legalize assisted suicide in the state; so it was no surprise when he listed it among other “accomplishments” in his farewell speech this week. A big surprise, however, came when the governor revealed that his own father died from assisted suicide. (Link to Youtube video) comments begin at minute 54:50.

Bristling with pride, Shumlin said that never in his wildest dreams did he imagine that his own father would die in this way. In May of 2011, however, True Dignity commented on a speech he made at a VT showing of the film “How to Die in Oregon”. The speech can be viewed at (Link to youtube video) comments begin at Minute 1:40. Speaking about how much he hoped VT would enact legal assisted suicide, he actually used his parents as illustrations of why he felt legalization was important.

Here, in italics are our comments at the time:

We were offended by the governor’s filmed jokes about how his apparently healthy but aged parents haven’t responded as he would have liked to his attempts to have “the conversation” to plan for their dying (in the video the audience laughs when he says he asked where they planned to be in ten years). 

… We need….to fight against the seduction of his not so soothing words about how Vermonters “take care of each other”, when he speaks words like these in the context of a conversation about assisted suicide.

In 2017 we are even more offended than we were in 2011. It is hard to believe that any governor would brag about facilitating a single suicide in his state. It is even harder to hear that governor brag about facilitating the suicide of his own parent.

Back in 2011, we were sorry for and feared for Peter Shumlin’s parents. It is self-evident to us that any suggestion that suicide is a viable end of life option for another person is itself pressure and can never be anything else If we heard the words Shumlin spoke in 2011 from one of our adult children, we would feel pressured, and we would not forget. No act done under pressure, even the most well-meaning pressure, is ever completely free.

We hope one day to live again in a state in which the sick and elderly are legally protected from such pressure, however well-meaning or inadvertent. Our new governor, Phil Scott, voted against legal assisted suicide when it was passed in 2013. Let’s ask him to work for its repeal now. Contact information will follow in the coming weeks.

Ontario "assisted dying" legislation (Bill 84) lacks any effective oversight of the law.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

On June 17 the Canadian government passed Bill C-14, a bill that legalized euthanasia and assisted suicide. Bill C-14 used imprecise language, double messages, and lacked a mechanism for effective oversight of the law.

I concluded my article on Bill C-14 by stating:

"I cannot understand why people are not concerned about the implications of the language of Bill C-14."

On Dec 7, the Ontario government introduced Bill 84 to reconcile the laws and procedures in Ontario with the new federal law.

We are very disappointed with Bill 84 with its lack of effective oversight of the law. Euthanasia and assisted suicide cause the death of a person, an act that cannot be reversed. Effective oversight of the law should be paramount. Bill 84 states:

Medical assistance in dying 10.1 (1) Where a person dies as a result of medical assistance in dying, the physician or nurse practitioner who provided the medical assistance in dying shall give notice of the death to a coroner and, if the coroner is of the opinion that the death ought to be investigated, the coroner shall investigate the circumstances of the death and if, as a result of the investigation, the coroner is of the opinion that an inquest ought to be held, the coroner shall hold an inquest upon the body. 

Requirements re giving of notice(2) The physician or nurse practitioner who provided the medical assistance in dying shall provide the coroner with any information about the facts and circumstances relating to the death that the coroner considers necessary to form an opinion about whether the death ought to be investigated, and any other person who has knowledge of the death shall provide such information on the request of the coroner.

Therefore the physician or nurse practitioner who "medically assist the death" of a person is required to self-report the act to the coroner. Systems of self-reporting do not provide effective oversight of the law.

Based on Bill 84, a physician or nurse practitioner who does not fulfill the requirements of the law will also self-report the act. People do not self report abuse of the law.

A study from Belgium, which also has a self-reporting system, found that more than 1000 assisted deaths occured without request in 2013.

Further to that Bill 84 provides legal immunity to anyone who participates in "medical assistance in dying." Bill 84 states:

Immunity, MAID
13.8 (1) No action or other proceeding for damages shall be instituted against a physician or nurse practitioner or any other person assisting him or her for any act done or omitted in good faith in the performance or intended performance of medical assistance in dying. 

Exception
(2) Subsection (1) does not apply to an action or proceeding that is based upon the alleged negligence of a physician, nurse practitioner or other person.

The exception to complete legal immunity lacks any significant legal oversight because all of the information concerning the act is self-reported by the person who does the act.

Society needs to wake up and become committed to caring for people, not killing them.

Ontario residents must contact their MPP and tell them to oppose Bill 84.

Removing Life-Support is NOT euthanasia.

This article was published by National Review online on January 4, 2017.

Wesley Smith

By Wesley Smith

Stopping life support so natural death can come is a normal part of health care. We all have the right to refuse medical interventions even if it is likely to lead to death. As the great late bioethicist Paul Ramsey put it when he led the movement in to obtain that right, not forcing tubes and drugs into an unwilling person is to treat the “patient as a person.” 

Moreover, in the 1976 Karen Ann Quinlan case, New Jersey’s Supreme Court ruled that removing a respirator at the request of an unconscious patient’s parents is not killing. It is notable that after her respirator was removed, Quinlan lived another ten years. 

As they always do, the euthanasia movement attempted to harness the right to refuse treatment and morph it into a right to be made dead. That gambit was refused unanimously by the U.S. Supreme Court in 1997 (Vacco v Quill). There are factual and moral distinctions between dying after refusing life support–such patients don’t always die and the death is natural–and giving a patient poison to make her dead. 

Now, Dave Adox, a New Jersey man dying of ALS wants to remove his ventilator so that he can die. That’s his right. 

But he wants to do it in a hospital so he can donate his organs. Hospital lawyers are saying no, worried that it might be construed as an assisted suicide. From the MedCity News story:

University Hospital has declined several requests for comment, but Bach said the hospital’s attorneys were concerned about liability.  

“The legal issue is: What is euthanasia?” Bach explained. “Are you killing a patient by taking him off a respirator that’s keeping him alive?” 

But that’s a long settled question under the law. It isn’t. 

The lawyers are clearly squeamish because of the organ donation request. That is the real concern, not that the death would be euthanasia. 

They have a point. Adox’s case represents an expansion of what is known as “donation after cardiac death” (DCD) protocol, during which life support is removed, and then three minutes after death cardiac arrest, death is declared and the organs are procured. 

Such protocols are controversial for several reasons too lengthy to get into here. But if performed properly, they are definitely legal. 

When that protocol was first developed, bioethicists promised it would be strictly limited to people with catastrophic brain damage. Of course, such public policy promises are made to be broken, the assurances given merely to convince a wary public to go along. That is why bioethicists promising strict guidelines should never be believed. 

The principle should be judged, not the promised strict limitations that soon evaporate. 

This case represents just such an expansion. But the principle is sound. 

I see no reason to preclude Adox from being an organ donor. His disease is at a very advanced stage when refusing life-extending treatment is common and uncontroversial. He has a right to refuse treatment. He is not being killed for organs. 

But if he doesn’t die after the ventilator is removed, no action should be taken to make his heart stop. That would cross the crucial line into killing for organs–as happens in Belgium and the Netherlands–which would violate the law and crucial moral principles that vital organ donors be dead before their gift of life is received.

Belgian Euthanasia Commission - Can we still ask questions?

This article was published by Euthanasia Stop in Belgium on January 3, 2017.

With regard to euthanasia, Belgium plays a pioneering role, but that isn't to say that everything is in perfect order, says a group of ethicists and doctors.

The Federal Commission for the Control and Evaluation of Euthanasia ('La Commission fédérale de Contrôle et d'Évaluation de l'Euthanasie'; CFCEE) recently published its biannual report. Here we shall take the liberty of offering some criticism.

In recent years; anyone criticising an aspect of the practice of euthanasia is generally accused of being fundamentally against it. For our part, we don't object to the principle against euthanasia, but we think that it has become a taboo in Belgium to even mention the problems related to its practice, and this development worries us. Here we will present just three problems, with the objective of stimulating a constructive debate with all those that are open to it.

The figures

The CFCEE's reports only reflect the officially reported instances of euthanasia. According to the Commission, 1.8% of all deaths which occurred in Belgium in the 2014-15 period were due to euthanasia.

However, according to the research group 'Zorg Rond het Levenseinde' (ZRL) ("End of Life"), a partnership between VUB and UGent, in 2013 euthanasia already represented 4.6% of all deaths in Flanders alone. The lower rate in French-Speaking Belgium has certainly had the effect of lowering the national percentage. These studies are only estimates (the credible interval applied in this study was 95%, indicating at least 3%), but you could equally conclude that at least one case of euthanasia in three wasn't reported! According to ZRL's study, this can be explained in the large part by the fact that doctors themselves don't classify cases before them as euthanasia. Often, it is an act of sedation, requested by the patient to the doctor, but really with the intention to shorten their life.

Such cases should fall under the law decriminalising euthanasia.

Since the ZRL group's studies are published in reference medical journals, it is disappointing to read that the Commission can't evaluate the proportion of the number of reported euthanasia cases compared to the number of cases of euthanasia actually carried out.

It is of course not the Commission's fault that so many doctors aren't reporting cases of euthanasia, but what is unintelligible is that the Commission does not condemn this. In its information brochure, the Commission did not mention that when high doses of morphine and sedatives are administered at the patient's request in order to shorten their lives, this constitutes euthanasia, which must be reported. However, in reality, such reporting hardly ever occurs. More and more doctors are also openly making it known that they refuse to report euthanasia. If doctors do not fulfil their obligation to fill in an official declaration, serious monitoring of the practice of euthanasia is impossible. Again, it is up to the Commission to condemn this. It is also disgraceful that Belgian legislation does not provide for sanctions in the case of doctors not reporting these instances.

Is the second doctor independent?

Another problem concerns the quality of registration documents.

One in four reports is clearly incomplete. And yet the Commission states that "the quality of the registration documents has been improved significantly since the previous report". We must therefore wonder what the 'quality' level was in the past. There is also the question of whether the registration document is clear enough to ensure that a large number of doctors are willing to complete it seriously.

The registration document in the Netherlands is much better in several respects. The doctor is not anonymous, for example, and the opinions of the medical advisors must be attached. In Belgium however, it suffices for the doctor carrying out the euthanasia to themselves draw up a summary of the opinions given by the medical advisors, who will therefore remain anonymous.

It was because of this anonymity, held dear by Belgium, that there was at least one case of euthanasia in which the practicing doctor and the doctor consulted for advice were brothers (one of whom is also a member of the Commission). This was revealed by a judgement by the Louvain Court of First Instance (DS 30th June and DS 8th July). Nevertheless, the Commission approved this case of euthanasia, which was clearly illegal (the second doctor having to be independent regarding to the first one, and in this case, there was a family link (brothers) between the two doctors). In the Netherlands, such a situation would not have gone unnoticed.

The Commission as a Court

The role that the Commission grants itself is also problematic. The Commission states that "in some cases, one or another of the procedural requirements isn't duly respected, but the Commission approved it anyway, after being fully assured that essential substantive conditions of the law had been properly adhered to".

From reading this, one cannot dispense with the idea that the Commission sometimes gives itself the rights of a 'court': As such, it approves cases of euthanasia in which one or more procedural requirements haven't been satisfied, since in its opinion, the 'essential' conditions have been respected.

Yet the law gave the Commission the task of examining if the 'conditions' specified by the law on euthanasia were fulfilled, and the legislator makes no distinction between the 'essential substantive conditions' and the other conditions. According to the law, the Commission (with a two thirds majority) transfers the case to a public prosecutor if the legal conditions are not adhered to. The Commission must of course be able to seek clarification from the doctors, to eliminate vagueness and ambiguity which could lead to misinterpretation. But in no case can it rule that the non-respect of certain conditions poses no problem.

Moreover, the Commission has already interpreted the law on various occasions thus acting as a 'legislator'. Here are two examples:

(1) Shortly after the law was adopted, the Commission stated that the law authorised medically assisted suicide, whereas the law in fact provides exclusively for euthanasia, defined as "an act carried out by a third party, which intentionally ends a person's life, at the latter's request"

(2) Recently, it was added to the registration document that the request for euthanasia remains valid for the duration of the time necessary to carry out the act of euthanasia, even if the patient loses consciousness after making the request. This means that, in such a case, at the moment of euthanizing, the doctor can no longer ensure that the patient still wishes to be euthanised.

This element, added to the registration form, is contrary to the rule (which in practise, is always considered as paramount) which states that the patient, up until the last moment, is still able to refuse, and that the doctor is able to obtain this confirmation from the patient. We are not saying that there isn't an argument in favour of these two examples. But what we are challenging however, is that the Commission clearly allowed itself to broaden the scope of the law. We are grateful to the authors of the latest report for their hard work. Nevertheless, the legislator engraved strict conditions in a text of criminal law, and we believe that this report should give rise to a debate on the work which still remains to be done to ensure that this law is respected, and if necessary, adapted.

Signed by Kasper Raus (UZ Gent; Ghent Bioethics Institute, UGent; VUBUGent End of Life Research Group (Zorg Rond het Levenseinde)), Sigrid Sterckx (Ghent Bioethics Institute UGent; VUBUGent End of Life Research Group (Zorg Rond het Levenseinde), Marc Desmet (Jessa Ziekenhuis Hasselt Palliative Care Service), Ignaas Devisch (General Practitioner and Front Line Health Care Doctor, UGent), Farah Focquaert (Ghent Bioethics Institute, UGent), An Haekens (Lead Physician at Alexianen Zorggroep Tienen), Gert Huysmans (President of the Federation of Palliative Care in Flanders (Federatie Palliatieve Zorg Vlaanderen)), Jo Lisaerde (Academic Centre for Family Medicine (Academisch Centrum voor Huisartsgeneeskund), KULeuven), Senne Mullie (Honorary President of the Federation of Palliative Care in Flanders), Herman Nys (Distinguished Professor in Medical Law, KU Leuven), Guido Pennings (Head of Ghent Bioethics Institute, UGent), Veerle Provoost (Ghent Bioethics Institute, UGent), An Ravelingien (Ethica, AZ Delta Roeselare), Paul Schotsmans (Distinguished bioethics professor, KU Leuven), Joris Vandenberghe (UZ Leuven in the University's Physicatric Cetnre, KULeuven), Paul Vanden Berghe (Head of the Federation of Palliative Care in Flanders), Nele Van Den Noortgate (Head of the Geriatric Service, UZ Gent), Bert Vanderhaegen (Senior Chaplain, UZ Gent)

Free translation of the opinion piece published in De Standaard 15/11/2016

European Court of Human Rights Judge: "There is no right to suicide or to assisted suicide"

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Justice De Gaetano

The Times of Malta published a New Year's interview by Matthew Xuereb, with Chief Justice emeritas Vincent De Gaetano, of the European Court of Human Rights in Malta.

Xuereb asked Justice De Gaetano a question concerning euthanasia, assisted suicide and the Vincent Lambert case. Justice De Gaetano responded by stating:

One cannot do justice in a few words to a very complex legal and moral issue. Euthanasia, however much one tries to hedge the definition, flies in the face of human dignity. 

There is no right to suicide or to assisted suicide under the convention and no positive obligation to provide such.

Vincent Lambert

The Lambert case concerned the withdrawal of fluids and food from Vincent Lambert, who was incompetent to make medical decisions and whose wishes were unknown. Justice De Gaetano responded to this issue by stating:

In Lambert, the main issue was different, namely whether, in the absence of a clear indication of the patient’s will, ordinary care by way of food and hydration could be withdrawn. It was a form of disguised euthanasia.

The legalization of euthanasia and assisted suicide does not provide individual rights but it gives doctors, or others, the right in law to cause your death.

Three arrested in New York death of ventilator dependent resident.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

The Attorney General of New York, Eric Schneiderman, announced the arrest of two registered nurses and a certified nurses aid in connection with the death of an 81 year-old ventilator dependent resident of the A. Holly Patterson Extended Care Facility in Uniondale.

According to the December 28th press release from the AG:

The resident, whose identity is being kept confidential, lived on a specialized ventilator unit at the facility. She required a mechanical ventilator to breathe and was entirely dependent on the nursing staff; the resident passed away after the defendants failed to respond to the ventilator alarms. If convicted, the defendants, none of whom still work at the facility, each face up to seven years in prison. 

“These allegations paint a picture of blatant neglect that ultimately resulted in the death of a patient,” 

“My office will always hold accountable those medical professionals and others who knowingly ignore a patient’s basic needs or recklessly place any nursing home resident in a life-threatening situation.”

The media release described the case:

The complaint alleges that on the morning of December 20, 2015, the resident–who was wheelchair bound and ventilator dependent–became disconnected from her ventilator. The resident was unable to breathe without the assistance of her mechanical ventilator. A visual and audible alarm was immediately triggered which notified nursing staff on the floor that this resident was in an emergency, life-threatening situation. 

Sijimole Reji, Annieamma Augustine and Martine Morland were at the nursing station near the resident’s room when the alarm sounded throughout the unit. All nursing staff who work on the ventilator unit at A. Holly Patterson Extended Care Facility are required to immediately respond to resident ventilator alarms. These three defendants–Reji, Augustine and Morland–ignored the emergency ventilator alarm for more than nine minutes and failed to provide any assistance to the resident who languished without oxygen. 

Eventually, when staff entered her room, they discovered that the resident was unresponsive and unconscious. The resident was transported from A. Holly Patterson Extended Care Facility to Nassau University Medical Center, where she died the following day, December 21, 2015.

Deaths and abuse in care homes is not uncommon. Recently a nurse was charged in the deaths of eight people who lived in care homes in Woodstock and London Ontario.

The victim's life was in the hands of her care-givers. It is not realistic to expect that people in society who disdain the lives of people with disabilities, won't also consider their life as not worth living. Data from Belgium shows that a significant number of lives are ended each year without request. Usually these people are incompetent or completely dependent on their care-givers.