Biden’s Suicide Prevention Day Proclamation Fails to Repudiate Assisted Suicide

This article was published by National Review online on September 10, 2021

Wesley Smith

By Wesley J Smith 

Yesterday was World Suicide Prevention Day. You didn’t hear about it? If so, that’s pretty typical, which is why I call this annual event, “Invisible Suicide Prevention Day.”

Once again, the obligatory official proclamations didn’t mention that suicide is now promoted widely in the media, popular culture, and by political activists seeking to legalize so-called “death with dignity” or “aid in dying.”

These euphemisms seek to convince people that committing suicide because of serious illness or disability, is not really suicide. But that’s a sophistic advocacy trope. Suicide is the act of self-killing. The reason for killing oneself has nothing to do with the nature of what was done. In other words, suicide is suicide is suicide.

A truly effective suicide prevention strategy must seek to prevent all suicides, which would require repudiating the pro-some-suicides messaging of the assisted suicide/euthanasia movement. Instead, prevention proclamations ignore the issue — perhaps for fear of being controversial — which undercuts most prevention efforts’ general effectiveness.

Joe Biden’s proclamation is no exception. First, it points out the extent of the suicide crisis. From "A Proclamation on World Suicide Prevention Day 2021":

In 2019, suicide was the 10th leading cause of death in the United States, and the second leading cause of death for young people between the ages of 10 and 34. And that was before the COVID-19 pandemic compounded, for many, feelings of isolation, exhaustion, and economic and public health-related anxieties. Increased rates of depression have sparked concern that we will see a further increase in suicide rates.

And note, since the laws legalizing assisted suicide dishonestly redefine those deaths as not being suicides, the actual number of suicide deaths in the U.S. is hundreds higher than the official national count.

The proclamation barely mentions serious illness as a suicide cause:

My Administration is committed to treating suicide as the public health problem it is and helping to address the underlying risk factors for suicide. . . . While there is no one cause of suicide, we know there are many factors that increase a person’s risk for suicide, including the loss of a job; serious illness; and financial, criminal, legal, and relationship problems.

And of course the official pabulum makes no mention that laws allowing facilitated suicide impede the effective prevention of those suicides and insidiously sends a wider nihilistic message that self-killing as an acceptable answer to suffering.

We already know where this ideology ultimately leads. Germany’s highest constitutional court declared a fundamental right to commit suicide, have help in so doing, and to assist in suicide if requested — without regard to the whys or reasons. Just wanting to die is all that matters.

That’s death on demand folks, which makes effective suicide prevention a truly Sisyphean endeavor. If we truly want to prevent suicide, we must reject the suicide-promotion movement, because that’s what euthanasia advocacy really is. Until we do, prevention proclamations are just so much window dressing.

The Treasure of Palliative Care – a video series

The Treasure of Palliative Care - a video series Link to the PDF English version.

Press Release

The Treasure of Palliative Care – a video series

There is always a better option than euthanasia

A Quebec perspective for a better understanding of palliative care

Montréal, CANADA – September 9, 2021 – The Living with Dignity citizen network (LWD), founded in 2010 in advance of the debate on the issue of "dying with dignity" in Quebec, is officially launching The Treasure of Palliative Care video series today.

Since 2015, the Canadian province has been the first jurisdiction in the world to propose euthanasia as end-of-life care, known as medical assistance in dying. "In this context, a Quebec perspective on the many benefits of palliative care is particularly pertinent and we wanted to share it internationally. It is becoming increasingly clear to us that there is always a better option than euthanasia," said LWD’s president Alex King.

Produced in English and French, the 10-minute video The Treasure of Palliative Care answers six essential questions to help you better understand this form of care whose name "palliative" was coined in Montreal in 1973 by Dr. Balfour Mount. In addition to the brief answers provided by two Quebec experts in the field, Dr. Golda Tradounsky and Dr. Patrick Vinay, six additional videos explore the following questions in greater depth:  

• Is palliative care only for people dying of cancer? 
• Where can we receive palliative care? 
• Does palliative care hasten death? 
• Does morphine cause death? 
• Should pain be part of the end of life?  
• Is medical assistance in dying (term used in Canada for euthanasia) part of palliative care?

Directed by Bruno Olivier and hosted in English by Angela Barrett and in French by Claudette Lambert, The Treasure of Palliative Care is available on the LWD Facebook page as of today (https://www.facebook.com/vivredignite/videos/560224695177761) as well as on YouTube via the https://vivredignite.org/treasure page.

A pre-launch of the video took place during the summer vacations on the occasion of LWD's participation in the Select Committee on the Evolution of the Act Respecting End-of-Life Care on August 9, 2021. This Quebec parliamentary commission is studying the potential extension of medical assistance dying (1) to people who have a mental illness as their only medical problem or (2) to those in a situation of incapacity (caused by a neurodegenerative disease such as Alzheimer’s) who have previously signed advance directives. For full details on LWD's participation in this committee, visit https://vivredignite.org/lwd-select-committee-2021.

The Living with Dignity citizen network is active on the following social networks:
Twitter https://twitter.com/Vivredignite
Facebook https://www.facebook.com/vivredignite
LinkedIn https://www.linkedin.com/company/vivredignite
YouTube https://www.youtube.com/channel/UCh3NsKMNpDum-RyhWSV4WzQ

Living with Dignity is a Quebec non-profit citizen network with no religious or political affiliation. Its mission is to promote the protection of the life and inherent dignity of people made vulnerable by sickness, old age or disability, by ensuring an end to their lives that is natural and respectful of the person and their dignity, through compassionate accompaniment.

-30-

To request an interview with a member of the LWD team.

Jasmin Lemieux-Lefebvre
Coordinator, Living with Dignity
info@vivredignite.org

Doctors (world-wide) are being invited to sign this open letter: Doctors Want No Part in Euthanasia and Assisted Suicide.

An open letter from doctors around the world to medical ethicists and lawmakers

Link for doctors to sign the open letter (Link).

Doctors Want No Part in Euthanasia and Assisted Suicide

Euthanasia and Assisted Suicide are not part of Medicine

As medical doctors, we are committed to supporting people to both live and die with dignity and comfort.

We are determined that state-of-the-art care should be available for people who are dying and also for people suffering from chronic disease, disability or mental illness.

We believe that universal and equitable access to effective pain and symptom management, including mental healthcare and palliative care, is a fundamental human right.

We fully support the right of a person with decision-making capacity to decline a treatment offered to them.

We support clinicians and patients agreeing to withdraw or withhold burdensome and ineffective treatment in favour of supportive and palliative care.

We believe that doctors have the training and skill to promote and maintain a caring doctor-patient relationship.

It is our view that skilful and effective pain management neither requires nor uses lethal doses of drugs.

We believe neither assisted suicide nor euthanasia is a medical procedure. Doctors should play no role in the regulation, or practice, of euthanasia and assisted suicide.

We are especially concerned with protecting vulnerable people who can feel they have become a burden to others, and we are committed to supporting those who find their own life situations a heavy burden.

We endorse the views of Medical Associations around the world which hold that physician assisted suicide and euthanasia are unethical, even if they are made legal.

“Leave doctors to focus on advocating for patients – to cure sometimes, to relieve often and to comfort always.”

Join us

If you are a registered doctor and would like to add your name to this Open Letter, complete the form below. These details are required to confirm that you are a medical doctor.

Declaration of good faith and disclaimer

The organisers have sought, and continue to seek, support for this open letter from currently practicing medical doctors within participating countries, and every reasonable effort is made to verify that they hold a valid practicing certificate or licence. The list of supporting doctors is published in good faith with a commitment to correct any errors, but the organisers disclaim any liability for published names found to be ineligible.

Link for doctors to sign the open letter (Link).

Euthanasia and assisted suicide: the illusion of autonomy.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Dr Ole Harling

The British Medical Journal (BMJ) published an excellent essay - Euthanasia and assisted dying: the illusion of autonomy written by Dr Ole Hartling, a Danish physician for more than 30 years and a past Chair of the Danish Council of Ethics. Hartling examines the arguements in favour of euthanasia and assisted suicide with the intent of creating "a little doubt" in the minds of those who absolutely favour legalization. Hartling primarily examines the concept of autonomy.

Hartling begins with his premise:

I question whether self-determination is genuinely possible when choosing your own death. In my book, I explain that the choice will always be made in the context of a non-autonomous assessment of your quality of life—that is, an assessment outside your control.

Hartling differentiates autonomous decisions in relation to dying as compared to other autonomous decisions. He writes:

Decisions about your own death are not made in normal day-to-day contexts. The wish to die arises against a backdrop: of desperation, a feeling of hopelessness, possibly a feeling of being superfluous. Otherwise, the wish would not be there. Thus, it is under these circumstances that the right to self-determination is exercised and the decision is made. Such a situation is a fragile basis for autonomy and an even more fragile basis for decision making. The choice regarding your own death is therefore completely different from most other choices usually associated with the concept of autonomy.

Hartling comments on why a "choice" to die can translate into a "duty to die." He states:

But if a law on assisted dying gives the patient a right to die, that right may turn into a duty to die. How autonomously can the weakest people act when the world around them deems their ill, dependent, and pained quality of life as beyond recovery?

He refers to this situation as the "prison of freedom." He continues by commenting on internalised external pressure. He states:

French bioethicist Emmanuel Hirsch states that individual autonomy can be an illusion. The theologian Nigel Biggar quotes Hirsch saying that a patient “may truly want to die, but this desire is not the fruit of his freedom alone, it may be—and most often is—the translation of the attitude of those around him, if not of society as a whole which no longer believes in the value of his life and signals this to him in all sorts of ways.

Hartling then writes about the concept that assisted death is actually about the end of autonomy. The "choice" of an assisted death is an act that ends autonomy. He then comments on the limit of autonomy by stating:

However, a patient’s autonomy means that he or she has the right to decline any treatment. It does not entail a right to have any treatment the patient might wish for. Patients do not have the right to demand treatment that signifies another’s duty to fulfil that right. If that were so, autonomy would be the same as “autocracy”—rule of the self over others.

Hartling argues that assisted death requires a binding agreement between two people, one who wants to be killed or assisted in death and another who will do the act. Hartling states that society only condones exemptions to the killing ban based on war and self-defense.

Hartling then comments on the valuation of a life that occurs when assisted dying is legalized. The decision is not only about autonomy but it includes a decision by a medical professional that as to whether a person's life is worth preserving.

Hartling ends his essay by commenting on the concept that assisted dying relieves suffering. He states:

If a competent and legally capable person must have the option of voluntarily choosing assisted dying in the event of unbearable suffering, why does suffering have to be a requirement? The answer is straightforward: our concepts of assisted dying imply that compassion must form a crucial aspect of the decision—mercy killing and compassionate killing are synonyms. But this leads instantly to the question of why we should not also perform assisted dying on people who are not in a position to ask for it themselves but are also suffering.

This is exactly the debate that is happening in Canada and other nations that have legalized euthanasia. The arguement is that someone who is incapable of asking for death should also be allowed to die to avoid suffering, especially if they had previously stated that they would not want to live in this way. The problem being, the person cannot ask for it themselves so they lose the right to change their mind. Hartling continues:

Some people find the reasoning unproblematic. It stands to reason that relieving suffering is a duty after all. But in this context it is not unproblematic, because it effectively shifts the focus from the autonomy claimed. According to prevailing ideas about autonomy, patients initially evaluate their quality of life themselves, but ultimately it is those around them who end up gauging that quality and the value of their life. That is to say, the justification for assisted dying is borne on the premise that certain lives are not worth living rather than the presence of a request. The whole point is that in the process, respect for the right to self-determination becomes relative.

Hartling completes his article by focusing on compassion and care and not killing.

Autonomy is largely an illusion in the case of assisted dying. A patient overwhelmed by suffering may be more in need of compassion, care, and love than of a kind offer to help end his or her life. It is not a question of whether people have a right to say that they are unworthy. It is a question of whether they have a right to be believed when saying it.

Hopefully many people will read share Dr Ole Harling's essay.

Talking to Strangers: What We Should Know About Talking to People We Don’t Know

Review by Bill Murphy

Malcolm Gladwell, Talking to Strangers; What We Should Know About Talking to People We Don’t Know, Little, Brown and Company, 2019 

In 2016, in small town Texas, Officer Brian Encinia pulled over a young black woman, Sandra Bland, for a minor traffic infraction. The interaction becomes heated and Sandra is incarcerated. Three days later, she is dead in her jail-cell.

Malcolm Gladwell examines this case in light of ways we commonly mis-interpret strangers. “[We] are struggling to understand each other through multiple layers of translators. Talking to Strangers is about why we are so bad at the act of translation.” Can we do better than settle for simplistic conclusions of racism or blaming the victim? Can our response be more robust than ‘We will try to do better next time.’ Gladwell introduces the Sandra Bland affair at the start of Talking to Strangers. He returns to the investigation at the end of the book, to address these questions.

Malcolm Gladwell is a Canadian writer whose books often examine research in the fields of social science and psychology. In Talking to Strangers Gladwell considers assumptions we tend to make about people that we do not know and the consequences these assumptions have when we interpret events and social behavior.

He describes a number of high-profile cases related to spying, lie-detection, foreign affairs, interrogation, suicide, criminal behavior and policing. Gladwell considers the cases in light of research. The conclusions can be surprising, complex and at odds with colloquial wisdom.

Research contends that our ability to read peoples’ intentions is more unreliable than we assume, even for professionals like law enforcement officers. The Truth-Default Theory of psychologist Tim Levine proposes a strong natural bias to believe the ‘normal’ explanation of an event. These two mistakes we make with strangers can become a crisis “when we do not understand the importance of the context in which the stranger is operating.”

The concept of context may be particularly relevant to end-of-life issues. Gladwell does an extensive review of the dynamics of suicide. The concept of ‘coupling’ is informative with regard to MAID. (Medical Assistance in Dying)

It is often assumed that if a person is suicidal, they will find some way to end their life. However, research by Ronald Clarke in 1988 suggests that suicide is commonly ‘coupled’ with a method of suicide. Suicide is more than the act of depressed people. “It’s the act of depressed people at a particular moment of extreme vulnerability and in combination with a particular, readily available lethal means.” 

Suicide follows vulnerability and availability. Gladwell reviews the example of suicide by gas as the common method of choice in Britain before 1960s. In a ten-year period, as a wholesale transition was made from 'town gas' to the less lethal 'natural gas' in Britain, the suicide rate plunged, with no corresponding up-take of other methods of suicide.

The context of vulnerability and lethal means is further supported in a study by Richard Seiden in 1978. He followed up on 515 people who had tried to jump off the Golden Gate Bridge but had been restrained. Only 25 of the 515 went on to die by suicide in some other way.

For EPC readers, Talking to Strangers offers insights and evidenced-based dynamics around the issues of suicide (and euthanasia). The average coffee-house debate of end-of-life issues (and criminal events) can be simplistic to the point of outright misunderstanding. Neither does his research exempt professionals from being victims of common false assumptions and mis-conceptions. The book fairly screams ‘caution’ when assessing requests for euthanasia. To accept such requests at face-value defies professional and scientific responsibility.

When considering a MAID request, consideration of the client's context is necessary, in addition to the expressed request by the client. The author made an interesting comment about coupling of the act of suicide with the method of suicide of American poet, Anne Sexton. Gladwell opines “Don’t look at the stranger and jump to conclusions. Look at the stranger's world."

The euthanasia lobby is promoting suicide?

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

While reading an article published by the Cal-Alumni Association that was promoting the expansion of the California assisted suicide law I wondered: Why does the death lobby get away with promoting suicide?

The article focused on stories of people who died by suicide / assisted suicide. I was shocked by the descriptions and lionizing of the deaths.

I regularly read articles about euthanasia and assisted suicide but I clearly felt that this article was not only promoting the expansion of assisted suicide but it was also irresponsible in how it described the deaths and applauded those who died.

The World Health Organization published a resource for media professionals with protocols for responsible reporting of suicide deaths to prevent suicide and suicide contagion. The quick reference in the WHO media guidelines for preventing suicide states:

• Take the opportunity to educate the public about suicide,
• Avoid language which sensationalizes or normalizes suicide, or presents it as a solution to problems,
• Avoid prominent placement and undue repetition of stories about suicide,
• Avoid explicit description of the method used in a completed or attempted suicide,
• Avoid providing detailed information about the site of a completed or attempted suicide,
• Word headlines carefully,
• Exercise caution in using photographs or video footage,
• Take particular care in reporting celebrity suicides,
• Show due consideration for people bereaved by suicide,
• Provide information about where to seek help,
• Recognize that media professionals themselves may be affected by stories about suicide

Clearly a story describing how Debra and Lillian ended their lives with clear descriptions of the methods used to die not only normalizes assisted suicide but it will lead to more suicide, the suicide contagion effect.

The data shows that where euthanasia or assisted suicide have been legalized that the suicide rates increase (Link).

Further to that, the story promotes the radical assisted suicide group, the Final Exit Network. Without trying to provide too much negative information, the Final Exit network assisted Lillian's suicide. The article states:

Lillian was not ill, at least not terminally, but she was old. She had lived a full and creative life, but was no longer the person she used to be, or wanted to be, or wanted her friends and family to see. She was certain about that.

The article that I am refering to is only one of many irresponsible articles that appear to be promoting assisted suicide or the expansion of these laws while in fact they are promoting suicide, whether they are assisted or not, and denigrating the life of people with disabilities or the elderly.

The claim that this is all about freedom of speech is important, but all freedoms have limits based on our responsibility to others.

I believe in a society that upholds the value of living with disabilities, respecting the lives and experience of elderly people and upholding the equality of every human being. 

Suicide promotion articles and the philosophy of the Final Exit Network is oriented towards abandoning people to death.

101 euthanasia deaths in 6 months in Victoria Australia.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Kaitlyn Offer reported for Australia's AAP that there were 101 assisted deaths in the first 6 months of 2021. Nine were administered by a medical practitioner (euthanasia) and 92 were self-administered (assisted suicide). There were 94 assisted deaths in the last 6 months of 2020.

The report indicated that 132 lethal doses were obtained in the first 6 months of 2020, meaning that many of these people will die in the second half of 2021.

There is already pressure to expand Victoria's euthanasia law.

Offer stated that the euthanasia report highlighted that the legislation prevented consultations happening via telehealth, describing it as undermining quality of care and lacking compassion.

Offer also reported that the inaugural chair of Victoria's Voluntary Assisted Dying Review Board, Betty King, is stepping down from the role.

According to the data, from legalization (June 19, 2019) to June 30, 2021, there have been 325 deaths by Victoria Australia's euthanasia law with 276 dying by assisted suicide and 46 dying by euthanasia.

For more information about the Victoria Australia euthanasia law go to the Australian Care Alliance website (Link).

Bioethicists joust over Canada’s ‘Medical Aid in Dying’ euthanasia law

This article was published by Bioedge on August 29, 2021.

Michael Cook

By Michael Cook, Editor of Bioedge

The debate in Canada over euthanasia and assisted suicide – or, as it is called there, Medical Assistance in Dying (MAiD) – will have a huge impact upon developments elsewhere in the Anglosphere. As two of Canada’s stalwart defenders of MAiD, Jocelyn Downie and Udo Schuklenk, pointed out in a recent article in the Journal of Medical Ethics, “other countries will confront the same questions if they contemplate changing their assisted dying law”.

This makes their pushback against critics of MAiD even more interesting. (Schuklenk, by the way, is a trenchant opponent of conscientious objection over abortion and euthanasia. He has even proposed that medical schools screen out potential objectors.)

The two bioethicists home in on two weighty criticisms of Canada’s MAiD regime: “social determinants of health” and slippery slopes. “Social determinants of health” is a WHO term for the non-medical factors which influence health outcomes – which range from racism to disability and mental illness to unemployment.

They argue that it is discriminatory to deny people with mental illness and disability access to MAiD. Patient rights would be sacrificed on the altar of paternalism.

As for the slippery slope argument, they dismiss it as illusory.

The change from Carter to C-14 moved Canada in a more restrictive direction. The entire scene is that Canada has not become more permissive as between the Supreme Court of Canada decision in Carter and Bill C-7. Rather, there was a period during which Canada had an unconstitutional tightening of the eligibility criteria. Canada is simply back where the Supreme Court of Canada put it through Carter.

This sets the scene for a vigorous response in the JME from another Canadian academic, Tom Koch, of the University of British Columbia.

He says that the “social determinants of health” argument remains valid. “Inadequate control of pain and control of other symptoms was a rationale in over half of all MAID cases. This outcome reflects the limited number of palliative and rehabilitative physicians in Canada.” In his view, the availability of MAiD means that bioethicists and others no longer feel the moral urgency of clamouring for more and better palliative care.

As for the slippery slope argument, Koch simply points to the numbers.

An expanding class of persons eligible for MAID has resulted in an exponential increase in the number of reported cases. Total reported cases of MAID across Canada increased from 1018 in 2016 to 21,589 in 2020. This is by definition the slippery slope: a relaxation of requirements resulted in an expanding class of eligible persons and an ever increasing number of medically induced deaths.

Michael Cook is editor of BioEdge

Queensland Australia Euthanasia Bill fails to protect from involuntary death

This article was published by the Australian Care Alliance on September 1, 2021.

To read the full submission by the Australian Care Alliance (Link).

In a legal analysis of Queensland's Voluntary Assisted Dying Bill 2021 presented to the Australian Care Alliance, Paul Santamaria QC concluded that if enacted it would manifestly fail to protect vulnerable Queenslanders from being led into a death "not by a genuine exercise of personal autonomy, but rather because they feel pressured to agree – or, worse, are actually unaware of the nature of the process being undertaken 'for' them".

In the Bill as designed, the risk scenarios of patients who do not possess sufficient decision-making capacity or who are not acting voluntarily are manifest.

Nothing in this Bill ought encourage diligent parliamentarians to believe that prosecution for unlawful conduct which has caused the death of vulnerable Queenslanders is other than the stuff of dreams.

The protections much vaunted by the proponents of the Bill are only paper thin, wallpaper as it were, to assuage concerns of the parliamentary middle ground and to garner their support which is necessary to secure its passage into law. To the extent that the Bill confers protection on anyone, ironically, the Bill protects those who may honour the law in its breach and not its observance, such is the lack of any effective sanctions for breach.

The critical discretions under the Bill – for example, as to whether the patient has a terminal illness, is suffering intolerably on account of that illness, has requisite decision-making capacity, whether their decision is voluntary, and their consent is informed as to the nature and finality of the consequences of their action – all of these conditions are evaluated by [two] medical practitioners.

The Bill does not require them to know the patient or to have had any prior consultative relationship with the patient. The Bill does not require the doctors to be specialist or experienced in the illness or disease from which the person is suffering.

Given the presence of unacceptable elder abuse within the community, and the recognition that undue influence and coercion may be expected unless regulated, the acid is on the parliament to ensure that its protective function delivers safeguards that are watertight. Not as good as we can get – but watertight.

High-sounding phrases like “voluntary”, “no coercion”, “no undue influence” and the like promise much but deliver little. It is not realistic for two doctors, who may know nothing about the patient, the patient’s personality, family relationships or the possibility of past and present elder abuse by family members of the patient to arrive at a sufficiently informed decision on a sometimes vexing matter that, when before the courts, takes a significant period of time to determine safely.

It requires little imagination to know that there is little prospect that the doctor will become aware of circumstances that indicate a patient’s decision is involuntary.

The vice of the Bill in this regard is that any breach of statutory obligation will not be detected. Because death is “privatised” by the Bill, there is no realistic prospect that the death of a patient by unlawful conduct will ever be detected, let alone the subject of punitive sanction.

So far as the State has any involvement in the process, it is confined to checking that the paperwork has been correctly completed by the participants each of whom is working to the same end– that is, that all the boxes on the forms have been ticked, literally. Notice that the Bill reveals a stick only when a doctor is to file the paperwork. The State has no interest, let alone duty, in inquiring into the circumstances in which the paperwork has been prepared.

The Australian Care Alliance submission on the Bill may be read here.

The Dissenting Reports opposing the Bill by Dr Mark Robinson MP may be read here and that by Mr Stephen Andrew MP read here.

Debate on the Bill may take place in the Queensland Parliament in the sitting week beginning Tuesday 14 September.