The problems with Canada's MAiD policy.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

...is medical assistance in dying really a choice, or is it coercion?

Jeremy Appel, who does not oppose the concept of euthanasia, has written an article that was published by Jacobin.com on January 8 titled: The Problems with Canada's Medical Assistance in Dying Policy. Appel begins his article by stating:

Canada’s Medical Assistance in Dying program seemed like a step forward for choice and dignity. But it is beginning to look like a dystopian end run around the cost of providing social welfare that can beat back the deprivations that make life unbearable.

Appel follows that by stating:

But the legalization of MAiD has brought to the fore some disturbing moral calculations, particularly with its expansion in 2019 to include individuals whose deaths aren’t “reasonably foreseeable.” This change opened the floodgates for people with disabilities to apply to die rather than survive on meager benefits.

I’ve come to realize that euthanasia in Canada represents the cynical endgame of social provisioning within the brutal logic of late-stage capitalism — we’ll starve you of the funding you need to live a dignified life, demand you pay back pandemic aid you applied for in good faith, and if you don’t like it, well, why don’t you just kill yourself?

The problem with my previous perspective was that it held individual choices as sacrosanct. But people don’t make individual decisions in a vacuum. They’re the product of social circumstances, which are often out of their control.

Appel is acknowledging that individual choice has not worked out with the issue of euthanasia because decisions to be killed are based on social circumstances.

Appel explains that there are endless examples of people with disabilities who were offered euthanasia as an alternative to living a life of pain and exclusion. And with the impending expansion of MAiD to include people with mental illnesses, the problem is only going to get worse. He continues:

At least four veterans suffering from post-traumatic stress have been offered MAiD, including one instance where a caseworker told a veteran that MAiD is a preferable alternative to “blowing your brains out against the wall.” Mark Meincke, a veteran of the Princess Patricia’s Canadian Light Infantry who on his podcast spoke to the veteran who was offered MAiD, told the House of Commons Standing Committee on Veterans Affairs that the individual in question had never even contemplated suicide. He just wanted help dealing with his PTSD and other ailments.

“He expressed to me that things were sunshine and roses prior to this phone call, he was feeling good about life,” Meincke told the committee.

“Post phone call, he left the country, because he was devastated by that call.

He continues with the story of Christine Gauthier:

In another instance, retired corporal Christine Gauthier, who is paraplegic and competed for Canada at the 2016 Rio de Janeiro Paralympics and the Invictus Games, was offered assisted suicide, with Veterans Affairs offering to provide her with the necessary equipment.

Gauthier had been fighting for five years to have Veterans Affairs provide her with a wheelchair ramp. They wouldn’t provide the ramp, but they would give her the means to end her life.

He quotes Brennan Leffler and Marianne Dimain who were published in the Globe and Mail as stating:

“How poverty, not pain, is driving Canadians with disabilities to consider medically-assisted death,” notes the “excruciating cycle of poverty” that leads disabled people to choose assisted death, rather than live a life filled with barriers to their existence. “The numbers are grim,”

Joannie Cowie

Leffler and Dimain explain that according to Statistics Canada (2017), 25% of people with disabilities are living in poverty. Appel then quotes Joannie Cowie who lives in poverty, has multiple disabilities, and is considering death by euthanasia as stating:

“People with disabilities have been put on the backburner and nobody gives a damn about them,” she told Global. “I’ve cried a lot at night. I usually stay up a lot of the night. I pray. I pray a lot.”

Alan Nichols with his brother.

Appel further explains the problem by telling the story of Alan Nichols.

The case of Alan Nichols demonstrates how uncomfortably permissive Canada’s euthanasia framework is. Nichols, who suffered from depression, was hospitalized in June 2019 over fears he was suicidal. Upon hospitalization he asked his brother Gary to “bust him out” as soon as possible.

A month later, Nichols successfully applied for MAiD, not for depression, which is not yet legal, but for hearing loss, which occurred as a result of brain surgery when he was twelve.

His family, who filed a police report and notified health authorities, said that there was no way that he was eligible for MAiD, arguing that he had refused to take his meds and use his cochlear implants, which would have helped his hearing.

“Alan was basically put to death,” Gary Nichols said.

Sean Tagert with his son.

Sean Tagert died by euthanasia in August 2019 and left behind his 11-year-old son rather than be institutionalized. Appel writes:

While his condition required him to receive twenty-four-hour care, the government would only provide funding for sixteen hours, forcing him to pay $263.50 a day for the remaining eight hours.

He called the option of institutionalization, as opposed to fully funded care, a “death sentence.”

Roger Foley

Another story is that of Roger Foley, who has fought to live. Appel explains:

Roger Foley, who was hospitalized with a degenerative brain disorder in London, Ontario, began surreptitiously recording his conversations with hospital workers who offered him euthanasia unprompted.

In one recording, the hospital’s director of ethics told him continuing care would cost “north of $1,500 a day,” the Associated Press reported, which he correctly regarded as coercive.

Appel asks the question based on people with disabilities who are living in poverty - is medical assistance in dying really a choice, or is it coercion? Appel quotes Dr. Naheed Dosani, a palliative care physician in Toronto who told Global news:

Combined with COVID policies that have consigned disabled and immunocompromised people to a life of perpetual self-isolation, a lack of funding for people on disability assistance makes MAiD an increasingly palatable solution to ending their suffering. In this context, the cavalier way in which MAiD has been implemented in Canada serves as a form of eugenics, where only the able-bodied survive.

Appel explains that Canada has fewer safeguards than other jurisdictions. In some jurisdictions doctors must exhaust medical treatment options before approving euthanasia. In Victoria Australia only the patient can bring up the option of euthanasia.

Appel loses his appeal by completing his article with the following statements:

I still believe it’s cruel to refuse MAiD for people on the verge of death, with no prospects for recovery. But it’s even crueler to offer death as an alternative to a properly funded social support system.

We’ve let the MAiD genie out of its bottle. There’s no going back. We must ensure that our health care systems have sufficient resources to guarantee everyone, regardless of ability or mental health, a dignified existence.

The genie may be out of the bottle but as Gordon Friesen, who lives with disability, recently wrote:

Poverty high-lights the problem of euthanasia in a particularly graphic way. But poverty is not the cause of this problem (and even doing away with poverty, entirely, would in no way solve it). For as long as there is legal euthanasia based on medical criteria, there will be discriminatory eligibility, and discriminatory death.

Most importantly: The shortest road to solving the euthanasia problem is to seek legislative initiatives narrowly designed to restrict this practice, or to remove it entirely.

Unlike Appel I recognize that the horrifying Canadian stories of euthanasia for poverty, homelessness, and a lack of medical treatment are the result of legalizing euthanasia. That as Friesen also stated: euthanasia is abhorrent on its own!

Poverty and euthanasia has created public interest but euthanasia is abhorrent on its own.

Gordon Friesen

by Gordon Friesen, EPC President

A welcome revival of interest in the euthanasia question.

For a brief space, it seemed that the euthanasia question had been settled; people had lost interest in arguing the issue. Not even the enlargements of C-7 [i]were enough to overcome that inertia.

In recent months, however, "Medical Assistance in Dying", has returned painfully to the public mind.[ii] Stories abound of horrible examples and unintended consequences.[iii] [iv] Canadian soldiers offered MAID for PTSD;[v] patients bullied to accept MAID;[vi] [vii] even choosing MAID to avoid disabled homelessness.[viii] These terrible anecdotes caught public attention as no amount of argument had succeeded in doing before.

Our magic bullet misses the mark

Unfortunately, however, the running battle of policy debate is a dynamic one of trial and error, where adversaries rapidly adapt to counter the successes of their opponents.

In this case, it was not long before euthanasia enthusiasts had found the means to nullify our disabled poverty narrative. Speaking of presentations by pro-euthanasia professionals, a recent New Atlantis Article states:[ix]

"Gibb-Carsley and Kevin Reel do not present euthanasia driven by poverty as a problem for MAID. Actually, they suggest, it presents an opportunity to highlight the real problem: the inadequacy of the welfare state.

It’s as if the situation offers a silver lining. Reel excitedly talks about the problem as an “extraordinary lever” to lobby for improved welfare."

In other words; Kumbaya! We all agree that there are "structural inequities". We all want improved welfare supports. We are on the same team! We are reading from the same page! "But it doesn’t mean that we should be sheltering people from the option of having an assisted death"

And how must we respond?

It is simply necessary for us to recall, that it is not poverty which makes euthanasia abhorrent: euthanasia is abhorrent on its own!

The definition of "Medical Assistance in Dying" tells us that it is appropriate for some people to die by lethal injection; but only for these, and for no one else.

We must never tire of repeating that this definition creates a terrible discriminatory burden.

It also follows that some poor people are accordingly eligible for euthanasia. And it is inevitable that some of these privileged few will indeed choose to die, not because of the medical reasons which render them eligible, but because they are poor.

Yet contrary to what our opponents allege, it is not poverty that we must blame. At least not in this context. The problem of poverty is always present. Poor people suffer. Poor people die of suicide. In the worst of cases, poor people die of poverty itself.

However, ONLY SOME PEOPLE (whether they be poor or not) are eligible to be put down by lethal injection, like dogs at the vet.

The bottom line

Poverty high-lights the problem of euthanasia in a particularly graphic way. But poverty is not the cause of this problem (and even doing away with poverty, entirely, would in no way solve it). For as long as there is legal euthanasia based on medical criteria, there will be discriminatory eligibility, and discriminatory death.

Most importantly: The shortest road to solving the euthanasia problem is to seek legislative initiatives narrowly designed to restrict this practice, or to remove it entirely.

Stories of euthanasia and poverty will help us to that end. But we must refuse to confound the immediate tragedy of euthanasia (and its very realistic solutions) with greater social narratives of a much more complex, and uncertain nature.

Gordon Friesen is a disabled individual who has followed the assisted death debate closely since the early 1990s.

[i] Friesen, G. March 22, 2021, Beyond C-7 and death on demand -- competent choice is the new frontier, or death with no demand, (Link).

[ii] Coelho R., Lemmens T., Gaind K. S., Maher J. Normalizing Death as “Treatment” in Canada: Whose Suicides do we Prevent, and Whose do we Abet?. World Medical Journal. 2022;70(3):27-35. (Link).

[iii] Favaro A. Woman with chemical sensitivities chose medically- assisted death after failed bid to get better housing CTV. 2022 (Link) accessed December 23, 2022

[iv] Daflos P. Police investigation, public outcry following B.C. woman’s medically assisted death CTV. 2022 (Link) accessed December 23, 2022

[v] Veterans offerred maid for PTSD (Link) accessed December 23, 2022

[vi] Roger Foley STANDING COMMITTEE ON JUSTICE AND HUMAN RIGHTS TUESDAY, NOVEMBER 10, 2020 (Link) (intervention at 11:10) accessed December 23, 2022

[vii] Geoff Bartlett · CBC News · Jul 24, 2017 Mother says doctor brought up assisted suicide option as sick daughter was within earshot (Link) accesed December 23, 2022

[viii] LEWIS PENNOCK, DAILYMAIL.COM, 9 December 2022 'I don't want to die, but I don't want to be homeless': Canadian man, 65, has a doctor's approval for euthanasia despite admitting becoming POOR is a main reason he's applying to die (Link) accessed December 23, 2022 (Video Link)

[ix] Alexander Raikin, “No Other Options,” The New Atlantis, Number 71, Winter 2023, pp. 3–24; (Link) accessed January 10, 2023

A woman asks for help. She doesn't want to die by euthanasia.

Dear Friends 

Last week, a supportive group received a heart rendering email from a 38 year-old woman in Winnipeg considering MAiD. She gave permission to share part of her email with you.

“I am seriously considering the right to MAID. I am writing as a last resort before doing so. I live with a vision impairment and mental health concerns. Even before the pandemic, I had no or little access to the system.

I tried to go through employment programs, who refused to put in the extra effort to get someone with my disabilities hired. For years, I was bounced back between physical disability employment agencies and mental health programs and on mental health meds that had hard side effects. The worst was nausea and exhaustion which made it extremely difficult to work.

Often I found myself on EI or EIA, only to be told I'm lazy and try harder with no or little or irrelevant help. The advice I was given from many therapists was to not ask friends and family for help but go to the system for resources. If I was in dire straits, maybe get my act together. I found very little compassion.

The only way was to leave the system altogether and find my way on my own. I did find work and connections. However, times are getting tough and people are offended by me asking them for help, considering me as a "burden."

As for friends, I understand people have work and families. It crushes me that there are many others, alone, contemplating suicide, with no supports, abandoned by family and friends and brushed off, told to "Be independent," "Figure it out," etc.

How can seniors and people with disabilities and vulnerable people connect? How can all the lonely people get together and support each other? Why is helping others so offensive?”

I am so ashamed of this situation. I don’t want to want attention, I just need prayers and really really desire safe, affordable, accessible housing. I want to have healthy relationships where there is mutuality.”

This woman was reaching out for help and personal support. She doesn't want to die by euthanasia but she feels like a burden. Her plea for help is not uncommon. It is our goal to help people, like this woman, to live.

Canadian Disability groups tell members that they will not offer euthanasia.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

An excellent article by Tristan Hopper was published in the National Post on January 5 titled: Disability groups now assuring members they won't recommend euthanasia (MAiD).

Hopper reports on a growing coalition of disability and human rights groups that are saying that Canada's euthanasia law has gone to far. The groups are also assuring their members that they will not suggest or refer any of them for euthanasia. Hopper writes:

A growing coalition of disability and mental health groups have begun openly advocating against Canada’s liberalized MAID (medical assistance in dying) regime, including posting signs assuring patients that they will not recommend them for assisted suicide.

“This organization will not recommend, suggest or refer anyone to Medical Assistance in Dying as an alternative to assisting in obtaining necessary supports and services you require,” reads a sign recently circulated on social media by the group Disability Without Poverty.

The sign was accompanied by a note urging other health-related organizations to pledge never to recommend MAID as a solution to poverty “no matter what some would have you believe.”

The New Brunswick Coalition of Persons With Disabilities posted a sign directed at its members reading “you are safe with us” and promising not to pursue assisted death as an alternative to “speaking out for necessary supports and services you require.” This sign is now being shared by other disability rights groups.

A letter was signed by more than 50 disability and human rights groups to Justice Minister David Lametti urging him to dial back Canada’s MAID regime lest it continue “euthanizing people with disabilities who are not terminally ill.”. Hopper quotes from the letter:

“We know, as do you, that the existing law is not working and has not worked, and that people with disabilities have been dying due to their life circumstances and oppression,” added the letter, which was endorsed by groups ranging from Spinal Cord Injury Canada to the Stratford, Ont.-based Community Food Centre.

Even Simons euthanasia commercial re-enforces the failure of euthanasia. Hopper explains:

This was true even of Jennyfer Hatch, who was featured in a pro-euthanasia video entitled All is Beauty commissioned by the Canadian clothing retailer Simons. After the video’s release, CTV released an interview with Hatch showing that she had opted for MAID only after years of failing to secure care for Ehlers-Danlos syndrome, a rare disease that strikes the body’s connective tissues.

Hopper reminds us how Canadian veterans have been urged towards euthanasia:

In November, a House of Commons committee heard of five Canadian Armed Forces veterans who were counselled to seek MAID after approaching Veterans Affairs to seek assistance on conditions including PTSD. In one of those cases, the veteran acted on the recommendation and died by assisted suicide before the hearing was convened.

Doctors that provide euthanasia denied approving it for poverty but Hopper explains the reality:

Although representatives of the MAID doctor community have said publicly that nobody is getting approved for assisted death due to housing, internal documents from the Canadian Association of MAID Assessors and Providers show that members are indeed encountering patients who cite poverty as the primary driver for their wish to die.

The disability community predicted that this would happen. Hopper concludes.

In Feb. 2021, the United Nations’ special rapporteur on disability rights openly condemned Canada’s liberalization of MAID. “From a disability rights perspective, there is a grave concern that, if assisted dying is made available to all persons with a health condition or impairment … a social assumption might follow (or be subtly reinforced) that it is better to be dead than to live with a disability,” wrote Special Rapporteur Gerald Quinn.

Links to more stories of the euthanasia experience in Canada:

• No other options: An exposé on euthanasia in Canada (Link).
• Toronto Star: We need to put the brakes on euthanasia (Link).
• Globe and Mail: No to euthanasia for mental disorders (Link).
  
• Veterans affairs worker advocates euthanasia for PTSD (Link).
• Canadian man claims that he was pressured to request euthanasia (Link).
  
• Why did they kill my brother (Link).
  
• Manitoba woman died by euthanasia based on inadequate home care (Link).
• Quebec man seeks euthanasia based on changes to home care (Link). 
• Alberta man requests euthanasia based on poverty (Link).
• Ontario man approved for euthanasia because he can't get medical treatment (Link).
• Shopping for doctor death in Canada (Link).
• Gwen is seeking euthanasia because she can't access medical treatment (Link).
• Euthanasia for disability and poverty (Link).
• Euthanasia for Long Covid and poverty (Link).
• Canada's MAiD law is the most permissive in the world. (Link).

Wisconsin woman charged with using euthanasia drugs in alleged attempted homicide of husband.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Amanda Chapin

A Wisconsin woman has been charged with attempted first-degree homicide for allegedly poisoning her husband three times with veterinary euthanasia drugs.

A January 5, 2023 Associated Press story explained that Amanda Chapin (50) was charged for allegedly attempting to poison her husband, Gary Chapin (70), a veterinarian. The story states:

According to a criminal complaint, the couple got married in March. Following the wedding, Amanda Chapin forged the signature of one of her husband’s children on a power-of-attorney document, then demanded her husband amend his house deed so she would get the home if he died. The complaint says she poisoned her husband for the first time less than three weeks after the quit claim deed on the house was authorized.

The third time he drank the allegedly poisoned coffee, in early August, he fell into a coma that lasted for four days, the complaint said. Blood work showed barbiturates in his system came from drugs he used to euthanize animals.

Gary Chapin’s son subsequently filed a restraining order against Amanda Chapin on his father’s behalf, and Gary Chapin has filed for divorce, according to online court records.

I also published an article on a case in Colorado where a man accidentally ingested lethal assisted suicide drugs. As much as this story concerns an alleged attempted homicide, the story proves how euthanasia drugs can be used for homicide.

Similar recent stories:

• Netherlands man arrested for selling suicide powder resulting in at least 4 deaths (Link).
• Father of 19-year-old who died by suicide powder wants it banned (Link).
• Australian woman charged with killing her millionaire boyfriend (Link).
  

Lethal assisted suicide drugs were accidentally ingested in Colorado.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

I was cleaning up my emails and found a report that was published in the Journal of Emergency Medical Services on November 29, 2022 titled: Death with Dignty: When the Medical Aid in Dying cocktail gets into the Wrong Hands. 

The report concerns an emergency whereby a 35-year-old man in Colorado self-administered part of a lethal cocktail of assisted suicide drugs. The report states:

Ambulance 64 is dispatched to a 35-year-old male with possible alcohol overdose. Upon arrival, the crew is directed to a back bedroom where they find two fully clothed males with their legs hanging off a bed. One is elderly, the other is middle aged. Both are unconscious and unresponsive with shallow respirations. A bystander hands a medicine bottle to the attending paramedic frantically saying, “They drank this! They drank this!” The bottle contains digoxin 100 mg, diazepam 1,000 mg, morphine 15,000 mg, amitriptyline 8,000 mg and phenobarbital 5,000 mg. She remarks that the older man “should be dead” and the younger one “should be alive.”

The bystander states that the older man is a “death with dignity” patient who invited loved ones to be present while he consumed the MAID medication. After his first swallow, he remarked, “Man that burns!” The younger man said, “Let me see,” and then also took a swallow. The attending paramedic directs rescuers to begin ventilating the younger man while requesting evidence of advance directives for the older man. Care was not rendered to the death with dignity patient because he had a valid Medical Orders for Scope of Treatment (MOST) form stating he wanted no lifesaving measures performed on him. The medication bottle was prescribed to the patient. Hospice was contacted to verify he was a terminally ill patient of theirs. Medical control was also contacted for a consult because this was not a typical call.

The younger male patient is found to be atraumatic. His skin signs were significant for cyanosis but otherwise warm and dry. Pupils were constricted, equal and reactive. Without ventilations, his respiratory effort is 6; Sp02 was 72%. The patient is placed on a cardiac monitor and the heart rate is recorded at 144 bpm, blood pressure is auscultated and found to be 134/96 mmHg. Blood glucose is 172 mg/dl. Intravenous access is achieved with a 16-gauge catheter placed in his right external jugular vein. After there is no change in the patient’s presentation following Narcan 2 mg via IV, he is endotracheal intubated. End tidal carbon dioxide is then measured at 56 mmHg. The receiving facility is notified that a patient with a massive polypharmacy ingestion is en route.

...This challenging case is an excellent illustration of the importance of prehospital providers to have an understanding of end-of-life-care as it pertains to advanced directives and to be aware they may practice in an area where they encounter patients who may be in a MAID program. In this case, the paramedic had to juggle a complicated scene with two potential patients who both were near death. Education regarding such programs should be a priority to EMS agencies, as is how to handle instances where family members are requesting that no resuscitation be attempted and either advance directives are not in place, or copies of them cannot be located.

The report continues with information about the recovery of the man who self-administered the lethal cocktail without legal permission and it then concludes:

Should accidental ingestion occur, care is mainly supportive. The patient should be placed on a cardiac monitor and have a 12-lead rhythm strip to evaluate for QRS prolongation and consideration of sodium bicarbonate administration. Continuous pulse oximetry monitoring and assisting ventilation as necessary is indicated. If necessary, placement of advanced airway with assisted ventilations with BVM and confirmation by end-tidal CO2 is appropriate. Intravenous or intraosseous access should be obtained and intravenous fluids can be administered if the patient is hypotensive. Naloxone can be trialed, although may not have much effect given the high dose of opiates in the compound. Consideration may be made for transport to an ECMO capable facility.

The US states that have legalized assisted suicide have done so in a completely irresponsible manner. Prescribing a lethal cocktail of drugs for suicide is always ethically wrong, but to do so without monitoring is irresponsible.

Is it possible that a grand child could find the lethal assisted suicide cocktail by the bed side or in the medicine cabinet? What happens to the lethal drugs that are not consumed?

The concept of freedom to choose to die is a lie. People don't ask for a lethal drug cocktail to express their freedom but rather it is a reaction to a social abandonment that has left them feeling that there is no hope, purpose or value to continuing life.

Letter from Canada's Disability groups opposing (MAiD) euthanasia for mental illness.

The following letter was signed by more than 50 organizations and sent to Justice Minister David Lametti, Prime Minister Justin Trudeau, Opposition Leader Pierre Poilievre, Leader of the NDP Jasmeet Singh, Leader of the Bloc Québécois Yves-Francois Blanchet, and Elizabeth May, Leader of the Green Party.

Dear Minister David Lametti,

We, the undersigned disability and human rights organizations are writing to express our concern and opposition to the legalization of Medical Assistance in Dying (MAiD) for mental illness and to the already-legal practise of euthanizing people with disabilities who are not terminally ill.

The legalization of MAiD for mental illness is a discriminatory process that is made worse by systematic poverty, a national housing crisis, and inadequate access to support in the community. We know, as do you, that the existing law is not working and has not worked, and that people with disabilities have been dying by MAiD due to their life circumstances and oppression. To legalize MAiD for mental illness would pour gas on a fire that is already out of control.

Over two million Canadians over the age of 15 have a mental health-related disability. The majority are women, non binary, and gender non-conforming people. Four out of five have at least one other type of disability. The majority have experienced assault. Persons living in poverty and those who are homeless are over-represented, as are indigenous people who, as noted in both Expert Panel's reports, have not been meaningfully consulted or engaged in relation to MAiD.

As a country we cannot provide state-assisted death to people who are not terminally ill, without ensuring a legislated right to a decent life for all. The current MAiD law has chipped away at the constitutional protections of Canadians. The very existence of the current law is a threat to the lives of people with disabilities and their families.

We call on the government to take the necessary steps to not just delay MAiD for mental illness but to fully roll back the sunset clause and to repeal track two MAiD (for persons not terminally ill) as introduced under Bill C-7. We cannot allow systematic discrimination of this magnitude and risk to continue. The government's ill-considered, trial-and-error experiment on the lives of persons with disabilities is failing. It is time to ensure protection for all, including people with disabilities.

Thank you for considering our concerns, and we expect to see meaningful action taken on this critical issue.

Sincerely,

Signed by 53 disability and human rights organizations.

Are people who are declared Brain Dead - always dead?

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Brain death is a controversial topic. Many people have received a life-saving organ donation from a person who was declared brain dead. This article does not question organ donation but it does question whether determinations of brain death are always accurate and whether changes to brain death determinations will cause further controversy. There have been several cases of people declared brain dead who were not brain dead. 

I am concerned that the Uniform Law Commission, which writes model laws in the US, are debating amendments to the Uniform Determination of Death Act (UDDA) which will make it easier to declare someone brain dead. Sara Buscher, a lawyer and past-chair of EPC-USA states in her recent article:

The current uniform act has been adopted in some version by all 50 states says:

“An individual who has sustained either (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead. A determination of death must be made in accordance with accepted medical standards.”

Reasons offered for seeking changes to the existing UDDA include:

• Eliminating lawsuits by family members, especially by parents of children declared brain dead.
• Making it easier to ration medical care, especially Intensive Care Unit beds.
• Making somewhat more organs available for transplant.

A recent article by Dr Heidi Klessig that was published by the American Thinker stated:

"In response to a number of recent lawsuits related to brain death determination," the American Academy of Neurology has proposed a revision to the UDDA, the RUDDA. The revisions to the UDDA are not inconsequential.

The first change would seek to replace the term irreversible in the standards with the term permanent. At first glance, this may not seem like much of a change, but the definitions make a difference. "Irreversible" is commonly held to mean "not capable of being reversed." The term permanent is being offered as meaning that "no attempt will be made to reverse the situation." So, because doctors are not going to attempt to correct the patient's problem, it now becomes "permanent."

By changing the term irreversible to permanent it means that people with treatable conditions will not be treated. Klessig continues:

The second change would narrow down the definition of brain death from "the entire brain" to just selected functions of the brain stem that can easily be tested at the bedside. This change recognizes that current practice does not test all functions of the entire brain, since most people diagnosed as brain-dead still have a functioning hypothalamus, a part of the brain. Many also still have electrical activity on electroencephalogram (EEG), which is one of the reasons that EEG testing as a requirement for a brain death diagnosis was dropped in the 1970s.

The third change would standardize the brainstem testing protocol. The current UDDA states only that "[a] determination of death must be made in accordance with accepted medical standards." Since the standard isn't defined, every medical center decides for itself which brainstem tests are performed. This has aided lawyers suing on behalf of patients declared as brain-dead by introducing doubt as to the validity of the brain death testing at one center compared to another.

The fourth change would eliminate the necessity for obtaining consent prior to testing for brain death. The apnea test for brain death disconnects patients from their ventilator for 6–8 minutes to see if they will breathe independently. This test has absolutely no value for the brain-injured patient and can only cause harm to a patient not yet declared brain-dead. When the ventilator is disconnected, rising levels of carbon dioxide in the blood cause intracranial pressure to rise, further damaging the brain. It is like making a heart attack patient with chest pain run on a treadmill. The test can only make the patient worse and only serves the interests of the transplant industry.

Under the current UDDA there have been cases of people who were declared brain dead who were not brain dead. For instance, a BBC news story published on April 25, 2022 told the story of Lewis Roberts. 

Lewis Roberts with his sister.

Roberts, who was 18, was struck by a van in March 2021. A BBC story reported:

At one point the family was told he had suffered a brain-stem death but hours before surgery to donate his organs, he began to breathe on his own.

His case has led to reviews in the way head injury patients are treated.

Jade Roberts, his sister, said: "They said that Lewis had passed away, his brain-stem was dead... and there was nothing more they could do."

Because his family had agreed to donate his organs, his life support machine was kept on and he showed signs of life when he squeezed his sister's hand.

...University Hospitals of North Midlands NHS Trust, where Mr Roberts was treated, said national clinical guidelines were strictly followed when he was declared brain-stem dead.

Kaleb being held by his mother.

According to a Daily Mail story that was written by Vanessa Chalmers and published on December 10, 2018, a baby that was declared brain dead and whose life support was removed survived. Chalmers states:

A baby boy who was given no chance of survival after being declared brain dead miraculously survived after his life support was switched off.

Kaleb Crook, now 15 months old, astounded doctors when he continued to breathe on his own and squeezed his mother's finger. 

His parents, Becki and Phil Crook, had said their final goodbyes to their ten-day-old son, who was brain damaged due to oxygen deprivation.

The Daily Mail story focused on the fact that Kaleb was going to have his first Christmas at home at 15 months of age.

This is a life and death issue.

The stakes are high. When a person is declared brain dead they are legally dead. The body is often kept alive for the purpose of organ donation but if the family does not consent to organ donation then life-sustaining treatment is ceased. Either way, a false diagnosis of brain death effectively means death.

The Uniform Determination of Death Act was established to determine when a person is brain dead. I am very concerned with the direction of the proposed amendments to the UDDA which will make it easier to determine brain death.

My primary concerns relate to changes in definitions that will lower the standard for determining brain death, the attempt to eliminate the influence of family or the power of attorney for health care from providing consent.

I recognize that almost everyone declared brain dead does not recover but there are factors that make this a reality. Since brain death determinations lead to organ donation or a withdrawal of life-sustaining measures, therefore a determination of brain death, when the person isn't brain dead, will almost certainly result in death.

France's Council of State rejects assisted suicide.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Paris Protest against euthanasia (2014)

The highest administrative court in France, on December 29, 2022; rejected a challenge to France's law by Switzerland's Dignitas assisted suicide group. Dignitas is committed to legalizing assisted suicide in other jurisdictions.

According to CNE news:

The organisation (Dignitas) had asked the French Prime Minister and Minister of Health to modify the regulations concerning poisonous substances. It wanted an exception for their use for suicide. However, as the Prime Minister and the Minister of Health refused to do so, Dignitas took them to court. The organisation believed that the refusal was an infringement on the constitution that safeguards the dignity of individuals. The Council of State rejected the request in 2021 already, but Dignitas continued to launch requests.

Now, the Council of State has ruled that European Law does not recognise the right to die with dignity, and thus, France is not obliged to establish a regulation that legalises assisted suicide.

The assisted suicide debate is not settled in France.

In September, France's President Emmanuel Macron stated that he wants to legalize euthanasia. An Associated Press article reported that Macron said in a written statement that a body composed of citizens will work on the issue in the coming months in coordination with health care workers, while local debates are to be organized in French regions.

France's citizen convention began it's deliberations in December.

Lethal Non-Compliance with Washington’s “Death with Dignity Act”

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Richard Doerflinger has written an indepth investigative report: Lethal Non-Compliance with Washington's "Death with Dignity Act". 

In his report Doerflinger examines the recent Washington state assisted suicide reports and proves that a significant number assisted suicide deaths were non-compliant with the law. Doerflinger's report was published by the Charlotte Lozier Institute on December 20, 2022.

Those who follow the Euthanasia Prevention Coalition know that I have written about the non-compliance with assisted suicide in Oregon. My report on the 2021 assisted suicide deaths in Oregon points out:

According to the 2021 Oregon assisted suicide report.

• There were 238 reported assisted suicide deaths.
• There were 383 lethal prescriptions written which is up from 373 in 2020.
• 20 of the deaths, the lethal drugs were prescribed in previous years.
• 2 people were referred for a psychiatric evaluation.
• 1 person ingested the assisted suicide drugs but did not die.
• 106 people received lethal prescriptions, but their "ingestion" status is unknown.

In Oregon, in 2021, there were 106 people who received a lethal prescription but their "ingestion" status is unknown. Some of these people may have died by assisted suicide but no report was submitted.

The possible under-reporting of assisted suicide has been increasing in Oregon. In 2020 there were 80 people who received lethal prescriptions but their "ingestion" status was unknown and in 2019 there were 58.

In his investigative report, Doerflinger uncovers possible under-reporting of assisted suicide and non-compliance with the assisted suicide act in Washington state.

Doerflinger's investigative report states:

The reports state that 299 participants received the lethal medication in 2019, 340 in 2020, and 400 in 2021. At least 291 patients died from the lethal drugs in 2021 — the highest number of cases ever reported by the state, and eight times as many as in 2009, the year the law took effect. Forty-four patients died of other causes, and another 52 died but the Department says it does not know whether this was from ingesting the drugs. This means that at least 44 lethal overdose prescriptions, and potentially as many as 96, were not ingested by the patient and their whereabouts are unknown. The Department does not claim that any patient was referred for a psychological evaluation in these years.

Most disturbing, however, is the admission by these reports that in many cases the legally required forms were never submitted by physicians.

For the 400 participants who received the lethal dose in 2021, missing required documentation includes:

-46 written and witnessed requests from patients
-35 attending physician compliance forms
-47 consulting physician compliance forms
-20 pharmacy dispensing forms
-39 after-death reporting forms*

Doerflinger further establishes a table of non-compliant assisted suicide reports and shows that non-compliance has existed since assisted suicide was legalized in 2009 and the percentage of non-compliance with the law has dramatically increased in the past 3 years.

Further to proving non-compliance with the law, Doerflinger proves that non-compliance is criminal. Doerflinger proves that the statutes prohibiting assisting a suicide remain in Washington state's laws, but an exception to those laws was created when assisted suicide was legalized.

Doerflinger states:

In short, if a physician prescribes or provides a drug overdose so a patient can take his or her own life, but does not comply with the DWDA’s requirements, the physician’s actions do not fulfill a legitimate medical purpose and are not lawful. That physician can be prosecuted for promoting a suicide attempt or committing a controlled substances homicide.

The question is - will the authorities prosecute the violators of the law?

Read the full investigative report: Lethal Non-Compliance with Washington's "Death With Dignity Act" (Article Link).