Euthanasia versus Plagiarism at the World Medical Association

Last week, the Canadian Medical Association (CMA) decided to withdraw its membership from the World Medical Association after a controversy related to euthanasia and plagiarism.

Dr Mark Komrad

Dr Mark Komrad, a psychiatrist and professor at John's Hopkins University, wrote a commentary on the drama titled: Euthanasia vs Plagiarism published in the Psychiatric Times on October 10, 2018. The Psychiatric Times considered the commentary as a follow-up to Komrad's article published online on October 3, 2018: An Open Letter to Representatives of the World Medical Association.

Komrad wrote: 

A remarkable drama occurred at the World Medical Association (WMA) last week. The events were not just dramatic; they took a bizarre turn. I am an Associate Member of the WMA. As I shared with you in an earlier commentary, an initiative was mounted by the Canadian Medical Association (CMA) and the Royal Dutch Medical Association at the WMA’s semi-annual meeting in Reykjavik to dilute the WMA’s strong language against assisted suicide and euthanasia in their ethics code. This language currently reads:

Physician-assisted suicide, like euthanasia, is unethical and must be condemned by the medical profession. Where the assistance of the physician is intentionally and deliberately directed at enabling an individual to end his or her own life, the physician acts unethically.1

These two national delegations, representing countries where medical euthanasia is legal, appear to have attempted to move the WMA towards a more neutral position. In Canada, euthanasia is a legal option for some patients whose death is “in the reasonably foreseeable future”—which is undefined. In Ontario Province, there have been maneuvers both by government and medical societies to condemn and make illegal refusing to refer patients for euthanasia by physician conscientious objectors. In the Netherlands, even non-terminal chronic conditions like psychiatric disorders, could be eligible, and there is even political pressure to remove medical criteria and open euthanasia by physicians for those who feel “tired of living” or that their life is “complete.” Both countries were looking to the WMA to begin normalizing their remarkably advancing moral wavefronts by moving the fulcrum of world medical ethics.2

At the meeting, Dutch and Canadian delegations withdrew their aggressive proposals at the last minute. However, the German delegation instead proposed a potential compromise in the code’s language. This includes changing the term “physician-assisted suicide” to “physician-assisted death” and changing “unethical and must be condemned” to “physicians should not engage” in these activities. Yet, they also proposed language protecting “conscience rights” for conscientious objectors. However, there was apparently overwhelming opposition to even this “compromise” change in language among the majority of national delegations to the WMA. (Curiously, the Belgian delegation was silent and did not stand up with the Dutch on their initiative, even though their laws and practices are very similar to those in the Netherlands.) Now, the WMA has agreed to call for written opinions from all delegates on this “compromise” proposal of the Germans, to be assembled for their Spring 2019 meeting.

Now for the bizarre part. One can assume that having seen their initiative miss the mark, the CMA delegation discovered that incoming WMA President Dr Leonid Eidelman’s inaugural speech had some passages identical to a previous inaugural speech and some material on the web. They called for his resignation. Dr Eidelman, himself surprised, apologized and said that English was his 4th language and that he had actually hired a speechwriter to draft the speech. So, he was unaware of this sloppy preparation by the speechwriter. The CMA delegates declared this to be the “apex” of unethical behavior and called for his resignation. Not a single country’s delegation supported that call (including the Netherlands) and so they promptly walked out, and resigned Canada from the WMA.

Psychiatrists are familiar with the phenomenon of projection. Could the CMA be projecting a shadow of guilt regarding the remarkable and undoubtedly difficult practice of their members who are euthanizing patients? This shadow seems cast onto such a comparatively puny ethical misstep (inadvertent plagiarism), which is a mere “tempest in a teapot” by comparison.. Yet, the CMA leadership supporting their country’s euthanasia practices feel that their position on euthanasia is ethically justified.3 So, from their vantage point, where they may feel they are on higher moral ground than the WMA which condemns euthanasia, the CMA condemns the WMA President’s sloppiness as the very “apex” of unethical behavior.4 The “primary gain?” The CMA can feel more “comfortable“ not abiding by the WMA’s ethics code, since they no longer belong.

What does the resignation of the CMA from the WMA teach us? “Doctors killing patients is OK. But copying small parts of speeches is real evil—so evil in fact that it merits leaving the international community of medicine.” 

References: 

1. World Medical Association. WMA Statement on Physician-Assisted Suicide. https://www.wma.net/policies-post/wma-resolution-on-euthanasia. Accessed October 10, 2018.
2. Schadenberg A. Canadian and Dutch Medical Associations pressure World Medical Association to change policy opposing euthanasia. Euthanasia Prevention Coalition. September 6, 2018. http://alexschadenberg.blogspot.com/2018/09/canadian-and-dutch-medical-associations.html. Accessed October 10, 2018.
3. Blackmer J. Dr. Blackmer blog response. April 30, 2018. Physicians’ Alliance against Euthanasia. https://collectifmedecins.org/en/dr-blackmer-blog-response. Accessed October 10, 2018.
4. Rizza A. Canadian Medical Association resigns from world body amid plagiarism accusations. The Toronto Star. October 6, 2018. https://www.thestar.com/news/canada/2018/10/06/canadian-medical-association-resigns-from-world-body-amid-plagiarism-accusations.html. Accessed October 10, 2018.

Dr Mark Komrad has published several excellent articles on euthanasia and assisted suicide. Previous article by Dr Komrad:

Canadian Association of Retired Persons is pressuring governments to force medical institutions to kill.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

The Canadian Association of Retired Persons (CARP) released its policy platform for the 2019 Federal election. 

CARP is focusing on 19 areas for action including pressuring the government to force every medical institution that receives government funding to provide euthanasia, also known as Medical Assistance in Dying (MAiD).

The CARP "Exceptional Health Care" policy includes to:  Make Accessible End-of-Life Care a Right (page 21 of the platform). 

This platform statement first demands palliative care for everyone:

Make access to palliative care a right so that all Canadians can access it regardless of where they live or receive care, including rural, remote and indigenous communities.

The platform then demands that all publicly funded medical institutions provide euthanasia:

Ensure access to medical assistance in dying (euthanasia) is provided at publicly-funded institutions and available to Canadians regardless of where they live or receive care.

By demanding that every funded medical institution provide euthanasia they are then demanding that every religiously affiliated, every palliative care and every long-term care medical institution provide euthanasia.

Promoting euthanasia is not new for CARP.

Wanda Morris

CARP officially became a pro-euthanasia advocacy group in January 2016 when CARP fired Susan Eng, the long-time Executive VP of CARP. Moses Znaimer, the President of CARP, disagreed with Eng's neutral position on euthanasia. Znaimer then hired Wanda Morris, the CEO of the euthanasia lobby group - Dying with Dignity to replace Eng.

In July 2018, Wanda Morris, the current Executive VP of CARP, published an article attacking palliative care institutions and services refusing to provide euthanasia. Morris argued that euthanasia respects the Hippocratic tradition and argued that refusing to do euthanasia causes harm to patients.

Sick Kids Hospital Toronto will euthanize children with or without parental consent.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

A recent report from the Hospital for Sick Children in Toronto states that they are not only ready to do euthanasia on children but their policy states that a child should be able to die by euthanasia without the consent or knowledge of the parents.

Sign the petition: I Oppose Euthanasia for Children.
Download the petition to the House of Commons and collect signatures opposing child euthanasia. (Petition Link)

According to an article by Sharon Kirkey for Sun Media, the Hospital for Sick Children in Toronto published their policy on euthanasia and assisted suicide as a report in the recent Journal of Medical Ethics. According to Kirkey:

The Sick Kids’ working group says the hospital has willing doctors who could “safely and effectively” perform euthanasia for terminally ill youth 18 and older who meet the criteria as set out in federal law, and that it would be “antithetical” to its philosophy of care to have to transfer these patients to a strange and unfamiliar adult hospital. But it is a suggestion that euthanasia might one day take place without the involvement of parents that has provoked fresh controversy in the assisted-death debate.

Who does the Hospital for Sick Children believe that euthanasia can be safe and effective for?

Kirkey explains that the ethicists at the Children's Hospital believe that there is no difference between killing someone and letting them die. Clearly there is a difference between allowing a natural death and actually causing the death of a person. By blurring clear distinctions ethicists minimize the ethical problems associated with doctors killing their patients. Kirkey reports:

The working group said it wasn’t convinced that there is a meaningful difference for the patient “between being consensually assisted in dying (in the case of MAID) and being consensually allowed to die (in the case of refusing life-sustaining interventions).”

Sick Children's hospital is planning to apply the same policy for mature minors as they have for young adults. Kirkey explains that most Canadian provinces allow mature minors to make decisions about their own care, including withdrawing or withholding life support. She explains that in Ontario a minor can provide consent for treatment or withdrawal of treatment if they understand the “reasonably foreseeable consequences” of their decision. The Sick Kids' hospital stated that they encourage minors to involve their families in medical decisions. 

Kirkey explains that the Hospitals for Sick Children is suggesting that children could decide to die by euthanasia without the consent of the parents:

The draft policy argues the same rules should apply to MAID since there is no meaningful ethical or practical distinction from the patient’s perspective between assisted dying and other procedures that result in the end of a life, such as palliative sedation (where people sleep until they die) or withdrawing or withholding life-sustaining treatments.

Kirkey explains that the Sick Kids Hospital paper came out just ahead of the report by The Canadian Council of Academies that will make recommendations in December concerning the extension of euthanasia to mature minors. The same group is examining the extension of euthanasia to cases of mental illness alone, as well as incompetent people who requested euthanasia within an “advance directive”.

• Is child euthanasia next in Canada?
• Sign the petition: I Oppose Euthanasia for Children.
• Paediatric Palliative Care Symposium and child euthanasia in Canada.

Grief and suffering associated with death by euthanasia.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

I received a call from a woman who was seeking help to deal with the grief associated with the euthanasia death of her grandfather. 

Her grandfather's death was approved by two doctors in-spite of the fact that he was not dying. He requested euthanasia because his health conditions led him to become disabled. 

She offered to care for her grandfather, but he refused.

I am not a medical professional, but grief after the death of a family member is normal. If her grandfather had died by suicide or homicide grief counselors would treat her pain and suffering in a serious manner. Since her grandfather died by euthanasia (a legal homicide) she was told that "it was his choice" and "if she loved him she would be supportive."

She sought help from counselors but they refused to speak about euthanasia.

She told me that no one was willing to help her deal with her grief and suffering because her grandfather died by euthanasia and that she is expected to "be happy for him."

I asked her to write about her experience. There are no easy answers to extreme grief, but to write it out and acknowledge her pain may bring some healing. I also told her that she can talk to me about it. I do not claim to be a counselor but I understand her pain.

Her grandfather died by a legal killing and whether he asked for it or not, her grandfather was abandoned. He felt that his life was not worth living and two doctors not only agreed they lethally injected him. They couldn't use the excuse that he was dying anyway, in his case they must have thought that they wouldn't want to live like him either.

This call was likely the first of many calls we will receive from people seeking help in dealing with grief associated with euthanasia. Our culture has decided that killing people by euthanasia, at the most vulnerable time of life, is not only an acceptable answer to difficult human experiences, but our culture has also decided that everyone should support these decisions and there is something wrong with you if you don't.

The grief that she is experiencing is normal. She truly loved her grandfather.

Study uncovers questionable Hospice care and financial fraud in the US.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

From its inception, the Euthanasia Prevention Coalition (EPC) has promoted good hospice and palliative care. One of the founding purposes of EPC is:

To promote improvement in the quality and availability of hospice/palliative care, and effective methods of controlling pain and suffering.

Debate about the Palliative Care and Hospice Education Training Act (PCHETA), S. 693 / H.R. 1676, has grown since the Association of American Physicians and Surgeons opposed the legislation.

The EPC promotes good hospice and palliative care and we urge that physicians and nurses be properly trained in pain and symptom management. It is a tragedy when a person seeks out death by lethal drugs (assisted suicide) because they have not received effective care.

Concerns about the S.693/H.R 1676 stem from two main concerns: the lack of clear definitions in the bill and the abuse of hospice/palliative care.

The lack of clear definitions is important since a goal of the assisted suicide lobby is to normalize assisted suicide by infiltrating palliative care. The abuse of hospice/palliative care creates significant concern since S.693/H.R 1676 provides millions of dollars for hospice/palliative care services.

A few months ago, the US Department of Health & Human Services - Office of Inspector General issued a report titled: Vulnerabilities in the Medicare Hospice Program Affect Quality Care and Program Integrity: An OIG Portfolio. The study found:

Hospice care can provide great comfort to beneficiaries and their families and caregivers at the end of a beneficiary's life. Hospice use has grown steadily over the past decade, with Medicare paying $16.7 billion for this care in 2016. It is an increasingly important benefit for the Medicare population; 1.4 million beneficiaries received hospice care in 2016. 

However, OIG has identified vulnerabilities in the program. OIG found that hospices do not always provide needed services to beneficiaries and sometimes provide poor quality care. In some cases, hospices were not able to effectively manage symptoms or medications, leaving beneficiaries in unnecessary pain for many days. 

OIG also found that beneficiaries and their families and caregivers do not receive crucial information to make informed decisions about their care. Further, hospices' inappropriate billing costs Medicare hundreds of millions of dollars. This includes billing for an expensive level of care when the beneficiary does not need it. Also, a number of fraud schemes in hospice care negatively affect beneficiaries and the program. Some fraud schemes involve enrolling beneficiaries who are not eligible for hospice care, while other schemes involve billing for services never provided. 

Lastly, the current payment system creates incentives for hospices to minimize their services and seek beneficiaries who have uncomplicated needs. A hospice is paid for every day a beneficiary is in its care, regardless of the quantity or quality of services provided on that day. While CMS made some changes to payments, the underlying structure of the payment system remains unchanged.

For the sake of the patients and care-givers and to protect the culture from the promotion of assisted suicide, concerns about the delivery of hospice/palliative care need to be repaired. It is not acceptable that people who are seeking pain and symptom management not receive it and that financial fraud be connected to the care of people while they are at a vulnerable time of their life.

EPC supports excellent pain and symptom management becoming mainstream in providing medical treatment rather it becoming the domain of specialists. People want to die at home and not within institutions who are making huge profits.

Prevention Is the Right Answer to Assisted-Suicide Requests

This article was published by the National Review online on October 8, 2018.

Wesley Smith

By Wesley Smith

We only seek to prevent some suicides these days. If a suicidal person lives in a state where assisted suicide is legal, and is qualified to receive prescribed poison with which to overdose, they will probably never receive prevention interventions.

That’s an abandonment. In Scientific American, Michael Shermer reviews a book about suicide and describes how prevention can benefit any suicidal person. From, “Why Do People Kill Themselves?” (my emphasis):

Like most human behavior, suicide is a multicausal act. Teasing out the strongest predictive variables is difficult, particularly because such internal cognitive states may not be accessible even to the person experiencing them. We cannot perceive the neurochemical workings of our brain, so internal processes are typically attributed to external sources. Even those who experience suicidal ideation may not understand why or even if and when ideation might turn into action.

This observation is reinforced by Ralph Lewis, a psychiatrist at the University of Toronto, who works with cancer patients and others facing death, whom I interviewed for my Science Salon podcast about his book Finding Purpose in a Godless World (Prometheus Books, 2018). “A lot of people who are clinically depressed will think that the reason they’re feeling that way is because of an existential crisis about the meaning of life or that it’s because of such and such a relational event that happened,” Lewis says. “But that’s people’s own subjective attribution when in fact they may be depressed for reasons they don’t understand.” In his clinical practice, for example, he notes, “I’ve seen many cases where these existential crises practically evaporated under the influence of an antidepressant.”

Assisted suicide advocates claim this has nothing to do with their cause because the terminally ill just don’t want to die in agony.

But that’s more fear mongering to win a political debate than reality. The actual reasons people commit assisted suicide or ask for euthanasia–verified from the published statistics from Oregon, Netherlands, and elsewhere–usually has little to do with physical pain. Rather, people ask for suicide help because of existential issues, such as fears of being a burden or being remembered poorly by their loved ones after going through a natural dying process (one of Brittany Maynard’s two primary reasons for wanting to die).

Don’t get me wrong: These are crucial issues that should be taken very seriously. The good news is that they can often be remedied:

In consulting suicide attempt survivors, Lewis remarks, “They say, ‘I don’t know what came over me. I don’t know what I was thinking.’ This is why suicide prevention is so important: because people can be very persuasive in arguing why they believe life—their life—is not worth living. And yet the situation looks radically different months later, sometimes because of an antidepressant, sometimes because of a change in circumstances, sometimes just a mysterious change of mind.”

Exactly. I have met such people who would be qualified for assisted suicide. Indeed, my last hospice patient (I was a volunteer) died peacefully in his sleep of ALS. When I first met Bob, he described being suicidal and wanting to go to Kevorkian (this was in the 90s). His family refused to cooperate and he was so glad! He told me that after some months of just wanting to be dead (because he could not properly support his family anymore and felt abandoned by his priest), that he had “come out of the fog” (his words). He later wrote about how the assisted suicide movement corroded his morale and was harmful to the wellbeing of terminally ill people. Please read it here.

When we accede to an assisted suicide request of a person with a terminal illness, we send the insidious message: “Of course you want to die. I would too in your place.” That’s potentially devastating. And families dragged into the death spiral may support their loved one’s suicidal wishes thinking they are being supportive–when they are unintentionally confirming the patient’s worst fears and unaware that with proper care, their loved one could, one day, be thankful they did not commit suicide.

Australian man killed his wife and called it a mercy killing - Judge calls it murder.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

An Australian man who pled guilty to murder in the death of his wife, claiming that the act was part of a suicide pact that he had with his wife. The Judge decided that this was an act of murder and not mercy.

Victoria Laurie, the Senior reporter for the Australian, reported that Justice Bruno Fiannaca sentenced Kevin John Keith (71) to 10 years imprisonment before parole in the death of his wife Kerrie Anne. The article reported:

During the trial, Keath’s lawyer Karen Farley QC had told the Supreme Court it was her client’s “only and deepest” regret that he had not fulfilled the agreement with his wife to kill himself.

Instead, Mr Keath drove to a nearby town and confessed to police on the night of the killing, saying he was “guilty as sin.” Keath told police he had not killed himself because he wanted to ensure his wife’s body was treated with dignity.

Mrs Keath had left a suicide note saying the couple had a suicide pact and after “dispatching” her, her husband was going to kill himself “as a loving act” to her. The couple had made a suicide pact after they lost a large sum of money from a bad investment.

Justice Fiannaca told Mr. Keath that he had a duty to look after his wife, not to kill her. The article reports that Justice Finnaca responded to the Mercy Killing plea in this manner:

the question of euthanasia “is a vexed question in society.” ... that Keath had repeatedly stated that he had not wanted to become bankrupt and live on in a flat on a pension, or rely on his son for help.

The judge noted that his wife had “wished to die and she wished for you to take her life…Notwithstanding that, you have no right to take her life.”

“It would be very sad indictment on our society if one sought to justify a killing …to avoid a lifestyle that is seen to be intolerable,”

Justice Fiannaca referred to it as an act of murder, not mercy. 

Report: Euthanasia without consent of Dutch woman with dementia

Richard Egan wrote the following summary of the report from the Regional Disciplinary Court for Healthcare that was issued in the Hague on July 24, 2018.

By Richard Egan (with the Australian Care Alliance)

In Case 2016-85 the Review Committees found that a doctor had not acted with due diligence in administering euthanasia to a woman with Alzheimer’s disease. The woman had made a general reference in a living will to wanting euthanasia at the “right time”. At the time the doctor euthanased her she was incompetent to voluntarily request it.

Article: Netherlands review committee examined case of euthanasia without request of woman with dementia.

The doctor put medication in her coffee to reduce her consciousness deliberately so as to avoid her resisting being given drugs by injection. Nonetheless she physically struggled against the administration of an intravenous lethal injection. She was physically restrained by family members while the doctor completed the administration of the lethal drugs.[1]

A criminal investigation into this case commenced in September 2017 but has not yet concluded.[2]

Article: Dutch Minister of Health comments on forced euthanasia.

On June 13, 2018 the Regional Disciplinary Court for Healthcare in The Hague considered a complaint against the doctor brought by the Inspectorate for Health Care and Youth. The decision was published on July 24, 2018.[3] The Court found that the written declaration of intent was not sufficiently clear to justify euthanasia in this case. It also found that the doctor should have tried to discuss the execution of euthanasia with the patient beforehand.

“In view of the irreversibility of termination of life and the ethical aspects connected with the deliberate ending of the life of a fellow human being, a written euthanasia declaration must be unambiguous, not needing any further interpretation.”

The Court did not completely rule out that ambiguities in a written declaration of intent could be removed (even in the case of a demented patient) if a patient is later unambiguous, consistent and tenacious (verbally or non-verbally) in his statements about wanting death. However, with this patient this was not the case because she sometimes said she wanted to die and sometimes not. Despite its finding that the doctor had seriously breached the requirements for euthanasia it only imposed a reprimand on the doctor. This was said to be sufficient because the doctor had cooperated in the process (she actually tried to get the complaint dismissed on procedural grounds) and also because a criminal investigation was still under way.

Article: Dutch doctor reprimanded for euthanasia without consent of woman with dementia who resisted.

[1] Regionale Toetsingscommissies Euthanasie, Jaarverslag 2016, p. 54-58 https://www.euthanasiecommissie.nl/binaries/euthanasiecommissie/documenten/jaarverslagen/2016/april/12/jaarverslag-2016/RTE_jaarverslag2016.pdf

[2] https://www.om.nl/onderwerpen/euthanasie/beslissingen-college/@100430/investigation-into/

[3] https://www.tuchtcollege-gezondheidszorg.nl/binaries/tuchtcolleges-gezondheidszorg/documenten/publicaties/documentatie-procedures/uitspraken/uitspraken-van-persberichten/beslissing-euthanasie-bij-dementie/2018-033bes.pdf

No to suicide prevention discrimination.

This article was published by Nancy Valko on October 4, 2018.

Nancy Valko

By Nancy Valko

When I was asked by my late daughter Marie’s best friend to join her on a family and friends fundraising walk for suicide prevention last Sunday, I hesitated.

I was in the process of reading yet another disturbing article about assisted suicide, this time a Journal of Clinical Psychiatry article titled “Working with Decisionally Capable Patients Who Are Determined to End Their Own Lives” and I found it outrageous that the suicide prevention groups I know exclude potential physician-assisted suicide victims.

As a nurse, I have personally and professionally cared for many suicidal people over decades including some who were terminally ill. To my knowledge, none of these people went on to die by suicide except one-my own daughter.

Almost nine years ago, my 30 year old daughter Marie died by suicide using an assisted suicide technique she found after searching suicide and assisted suicide websites and reading assisted suicide supporter Derek Humphry’s book “Final Exit”.

Marie was a wonderful woman who achieved a degree in engineering despite struggling off and on with substance abuse and thoughts of suicide for 16 years. She was in an outpatient behavioral health program at the time of her suicide. Her suicide was my worst fear and it devastated all of us in the family as well as her friends. Two people close to Marie also became suicidal after her death but were fortunately saved.

For years before and after Marie’s death, I have written and spoken to groups around the country about the legal and ethical problems with assisted suicide as well as suicide contagion and media reporting guidelines for suicide.

So it was with mixed feelings that I participated in the suicide prevention walk but now I am glad I did.

“Working With Decisionally Capable Patients Who Are Determined To End Their Own Lives”

I finally finished reading this article after the walk and found that while the authors of this Journal of Clinical Psychiatry article insist that they are only discussing “decisionally capable” people with “advanced medical illness”, they write:

“The 24% increase in US suicide rates from 1999 to 2014 has led to greater efforts to identify, prevent, and intervene in situations associated with suicidality. While the desire to kill oneself is not synonymous with a mental illness, 80%–90% of completed suicides are associated with a mental disorder, most commonly depression. Understandably, psychiatrists and other clinicians face strong moral, cultural, and professional pressures to do everything possible to avert suicide. Hidden within these statistics are unknown numbers of individuals determined to end their lives, often in the context of a life-limiting physical illness, who have no mental disorder or who, despite having a mental disorder, were nevertheless seemingly rational and decisionally capable and in whom the mental disorder did not seem to influence the desire to hasten death.”

Tragically, the authors also state:

“In reviewing the either sparse or dated literature in this field, surveys from the United States and Canada support that most psychiatrists believe that PAD (physician aid in dying, a euphemism for assisted suicide) should be legal and is ethical in some cases and that they might want the option for themselves.”

And

“Although we see ‘assisted death’ as an option of last resort, we instead ask whether on certain occasions psychiatrists might appropriately not seek to prevent selected decisionally capable individuals from ending their own lives.” (All emphasis added)

This flies in the face of long-standing professional suicide prevention and treatment principles.

Notably, the article ends with an addendum, the 2017 Statement of the American Association of Suicidology (AAS): “Suicide is not the same as ‘Physician Aid in Dying’”

That concludes:

“In general, suicide and physician aid in dying are conceptually, medically, and legally different phenomena, with an undetermined amount of overlap between these two categories” but “Such deaths should not be considered to be cases of suicide and are therefore a matter outside the central focus of the AAS.” (Emphasis added)

Why I am glad I went on the Suicide Prevention Walk

The Sunday walk was sponsored by the American Foundation for Suicide Prevention (AFSP), a group that I discovered states it is trying to “Develop an updated AFSP policy position on assisted death (other common terms include physician assisted suicide or Death with Dignity Laws)”

The next day, I was able to contact a policy person at their Washington, DC office and, unlike other suicide prevention group representatives I have contacted in the past, I found this woman surprisingly interested and receptive to the idea that we should not discriminate against certain people when it comes to suicide prevention and treatment. She even asked for my contact information.

Of course, the AFSP may decide to exclude potential assisted suicide victims like other organizations have done but at least I tried and that’s the best tribute I can give to my daughter now.

Assisted suicide is the wrong prescription.

Dr. Joseph Marine, an associate professor of medicine at Johns Hopkins University wrote an article that was published by Realhealth.com on September 20, 2018. Dr Marine gave five reasons why assisted suicide is the wrong prescription. Here is what he wrote:

1. PAS is unethical for doctors and nurses and is not medical care. The Oath of Hippocrates, from over 2400 years ago, states that “neither will I administer a deadly drug to anybody when asked to do so, nor will I suggest such a course.” In modern times, most major medical organizations, including the AMA, the American College of Physicians, the American Nurses Association, the National Hospice and Palliative Care Organization, and the World Medical Association, have agreed and issued statements opposing PAS. PAS has no basis in medical science or tradition, no peer-reviewed guidelines or standards of care. No one would consider giving patients cyanide tablets or carbon monoxide to be medical care. Neither is misusing dangerous controlled drugs as poisons.

2. The supposed “safeguards” in PAS laws are an illusion. They include no requirement for psychiatric evaluation or for witnesses to the consumption of the lethal overdose, no medical examiner inquests, no independent safety monitoring board, and no mandatory routine audits of records and documentation. There is no requirement that the prescribing physician has a meaningful long-term patient-physician relationship with the patient seeking assisted suicide and physicians are immunized from ordinary negligence. Additionally, all medical records and documents connected to the provision of assisted suicide are protected from legal discovery or subpoena, ensuring that no investigation is ever likely to take place.

3. Abuses of PAS laws are already occurring in the U.S. Despite the extraordinary legal protections given to PAS practitioners and the lack of meaningful oversight, cases in the U.S. have been documented where PAS drugs have been given to patients with severe depression and dementia, and at the urging of relatives rather than a patient’s independent request. We know that patients in Oregon have been given PAS drugs and lived for years afterwards, when the law requires a six month prognosis. In addition, there are reports that health insurance companies have denied patients investigational therapies while offering to pay for PAS drugs. Documents from the Oregon PAS program also show that patients may take as long as four days to die after ingesting PAS drugs. For 80 percent of patients, it is unknown if complications occurred (because of lack of medical witnesses). Doctors experimenting with novel PAS drug cocktails in Washington State caused some patients to “scream in pain” before dying.

4. PAS is unnecessary. Patients may already decline any and all medical care that they do not want, and can encode their wishes in advance directives, to be overseen by designated and empowered health-care proxies. Palliative care, hospice care, and pain management programs have made enormous stride in the past decades, and almost all pain and distress at the very end of life can be treated with medications. Moreover, the great majority of patients do not seek PAS because of pain (less than 25 percent in Oregon). Rather, loss of autonomy and fear of being a burden on others are the dominant reasons.

5. The vast majority of doctors in the U.S. will not practice PAS. In Oregon, all suicide prescriptions are written by only 2–3 percent of the state’s doctors, and the average duration of the doctor-patient relationship is only three months, indicating that patients’ personal physicians are rarely providing these prescriptions. In Washington DC, nearly one year after legalization of PAS, only two out of 11,000 licensed physicians (0.02 percent) have registered to participate. These facts indicate that the vast majority of U.S. physicians recognize that PAS is wrong and that physicians who practice PAS may not be trusted by patients with their lives and their health.

Assisted suicide is dangerous and unnecessary, and will permanently damage the integrity of and public trust in the health professions and the health-care system. What is more, there has never been a time in human history when assisted suicide and euthanasia have been less needed. Palliative care, hospice care, and pain management programs are what physicians and legislatures should be promoting — not assisted suicide.

Dr. Joseph E. Marine is a member of the American Medical Association and an associate professor of medicine at Johns Hopkins University.

Music as Therapy in Assisted Dying?

By Kevin Dunn
Co-Producer of Fatal Flaws and the Euthanasia Deception documentary.

The effects of assisted dying laws on the culture continue to astound me. Recently, I spoke with a music therapist who was looking for my perspectives on Canada’s Medical Aid in Dying Law (MAiD) as I have just finished my second film on the subject. 

Kristen Morrow

Kristen Morrow, MTA is a conscientious objector who will be part of an upcoming forum in Vancouver, entitled “Responding to Change: Music Therapy Perspectives on Navigating Assisted Suicide” . Kristen will be presenting alongside another therapist who used music therapy in a MAiD procedure. Together they will discuss the ethical ramifications of their profession becoming more involved with this “new and controversial aspect of the healthcare system”. The session will be one of many presented at the Music Therapy Association of British Columbia’s annual conference. She says depending on the response to the forum, the conversation may move to a national level.

I suppose this resonated with me so powerfully because I am a musician myself. Music has always been an integral part of my life. I have always used this gift to bring joy, hope – and where I can, bring healing to others.

I want to say at the onset that my heart breaks for people whose circumstances have led them to a place where they feel that an assisted death is their only option. I’ve interviewed people in these situations. I have spoken to them just weeks before their euthanasia. I still grieve for their demise. It touches me to the very core.

The Canadian Music Therapy Association defines the profession as “a discipline in which credentialed professionals use music purposefully within therapeutic relationships to support development, health, and well-being.”

While I understand why music therapists want to have this discussion in light of our new law, I believe Kristen is rightly concerned about her profession’s complicity with the ideology of assisted dying. Like sedatives which are given to calm the patient before a lethal injection or medication, music therapy is now being proposed as a complimentary comfort and relaxation tool in the process. Some may take no issue with this. Others do. Kristen says she got into this profession to use music as a vehicle for healing and now she may be asked to use her gift to comfort – be complicit – in a suicide. An assisted suicide yes, but still suicide.

Let’s put aside various legal criteria for an assisted death for a moment. After all, it’s a moving target in most countries and the language is extremely broad and subjective. Canada is no exception. Incremental extensions and exceptions to the law are commonplace in various countries. Now, people non-terminal conditions (like blindness), chronic illness, mental illness, even children and babies are now ‘qualifying’ in some countries. Canada’s criteria continues to be challenged.

Another consideration is the ‘completed life’ bill in the Netherlands, where, if passed, would allow otherwise healthy people to ask for euthanasia if they feel their ‘life is complete’ or no longer worth living. Even the most staunch supporters of euthanasia feel the genie has left the bottle and are speaking out about this “worrisome culture shift”.

It seems to me that once society accepts that life is no longer worth living in certain situations – and that ethos has been enshrined in law, we are all left to deal with the fall out. The ripple effect continues for decades, perhaps centuries. Society’s vulnerable are the first to suffer. Patients demand their ‘right to die’ while doctors in Ontario are now forced to ‘do or refer’ — or risk losing their licence, violating their very right of freedom of conscience. How long before this applies to others who refuse to participate on grounds of conscience – nurses, nurse practitioners, support staff, pharmacists, psychologists — music therapists like Kristen?

Most baby boomers in North America will remember a time when the very idea of euthanasia for people was so foreign, so unthinkable that its very application was relegated to disturbing news stories or science fiction movies.

Soylent Green

When I heard more about music therapy being considered as part of the assisted death procedure, I couldn’t help but think of the scene in the post-apocalyptic, dystopian movie Soylent Green starring Charlton Heston. Depressed and disgusted by the depravity of the world, an elderly police analyst (played by Edward G. Robinson) enters a government clinic to obtain an assisted suicide. While registering, the clerk asks him what kind of music he would like to hear while as the procedure takes place. He asks for classical. Light classical. He asks that the music be be played for a full 20 minutes until he dies. Sure enough, when he enters the room, his requested music is played through the speakers and delightful imagery is projected on screens around him. As he lay on his pre-arranged death bed, two assistants, dressed like angels give him the drink that will end his life. The music intensifies until he succumbs to the lethal medication. While the actual plot of the movie is quite far-fetched, the atmosphere in which people are euthanized is quite chilling, especially in light of these modern day discussions and rapid extensions to the law. Coincidentally, the movie is set in the year 2022.

Kevin Dunn

During the filming of my film Fatal Flaws, my crew and I visited an actual ‘end of life clinic’ in the Netherlands. The clinic, which operates independently, is set up for people whose own GP will not grant their request for euthanasia. It’s not really a clinic per se, rather a consultation facility where, if the patient qualifies, doctors will travel to their home to carry out the euthanasia request. I was told by the director of the clinic that approximately one third of the patients who apply, end up qualifying for euthanasia.

Since the law was passed in Canada, over 3,000 people have chosen an assisted death. In 2018 alone, we are witnessing a 30% jump in MAiD procedures. This increase will no doubt have an effect on access and less restrictive laws. Sadly, this leaves many vulnerable people in an extremely precarious position. Depression, fear of loss of autonomy, fear of becoming a burden, the draining of finances are the top rationale which affect he choices people make in ending their lives early. I wonder. As more people and professions fall in line with this philosophy, how much more will the pressure be on any of us to ‘opt in’ when we are at the lowest point in our lives. And just like planning funerals, people who qualify for an assisted death are now planning not only who will surround them at the end – but what kind of atmosphere they wish while the procedure is taking place. One has to ask, where is all of this leading us?

Power of Music

In the painting entitled “Power of Music” by Louis Gallait we see a brother and sister resting before an old tomb. The brother is attempting to comfort his sibling by playing the violin, and she has fallen into a deep sleep, “oblivious of all grief, mental and physical”.

I can imagine what happens in the scene later on. The sister would have woken up, consoled and rejuvenated by the power of music. Alternatively, when music therapy is used as a comfort tool in euthanasia procedures, there is no hopeful conclusion. Only death.

I join my voice with Kristen when I say that pandora’s box in this case is wide open and that music therapy should never enter in. Rather, let us use this great gift of music – and our own gift of presence – to be the reason for someone’s tomorrow, no matter how challenging those ‘tomorrows’ may be.
 
Kevin Dunn is a respected Canadian filmmaker, guest speaker and president of DunnMedia. His recent work “Fatal Flaws: Legalizing Assisted Death” looks at the effects of these laws on the culture in four different countries. His first film on the subject is “The Euthanasia Deception” . He can be reached at www.dunnmedia.ca

Canadian Medical Association withdraws motion at World Medical Association Meeting supporting euthanasia -- for now.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

The Canadian (CMA) and Dutch (KNMG) Medical Associations are pressuring the World Medical Association (WMA) to change its position opposing euthanasia and assisted suicide. 

The CMA and KNMG brought a motion to the (WMA) meeting in Iceland (October 2 - 4), calling on the WMA to become neutral on doctors killing their patients by euthanasia or assisting a suicide.

Delegates attending the WMA meeting in Iceland have stated that the CMA and KNMG motion was withdrawn due to a lack of international support.

The Euthanasia Prevention Coalition expects that the CMA and KNMG will regroup and try again in the near future.

The WMA Declaration on Euthanasia and WMA Statement on Physician Assisted Suicide state:

‘Euthanasia, that is the act of deliberately ending the life of a patient, even at the patient’s own request or at the request of close relatives, is unethical’. 

‘Physician assisted suicide, like euthanasia, is unethical and must be condemned by the medical profession. Where the assistance of the physician is intentionally and deliberately directed at enabling an individual to end his or her own life, the physician acts unethically’.

The August edition of the World Medical Association Journal provided an analysis of the four meetings held by the WMA concerning its position on euthanasia and assisted suicide. The WMA regional meetings concluded that very few delegates world-wide supported a change in the positions on assisted death and nearly all of the medical associations agree that euthanasia and assisted suicide are unethical.

Recently, seven Canadian physicians wrote an article that was published in the current World Medical Association Journal (WMJ) titled: Euthanasia in Canada: a Cautionary Tale  concerning their experience with euthanasia and assisted suicide in Canada. Dr Mark Komrad, a leading psychiatrist, wrote an Open Letter to Representatives of the World Medical Association explaining the American Psychiatric Association position on euthanasia and assisted suicide that was published in the Psychiatric Times.