Marianjoy Rehabilitation Hospital position on assisted suicide

The following position statement was published by the Marianjoy community in Wheaton, Illinois. (Link to the position statement).

The Marianjoy community has been committed to advocacy for people with disabilities since its founding. It is from this lens that we are requesting that Northwestern Medicine take an official stance against physician assisted suicide/medical aid in dying before the Illinois state legislature reviews proposed legislation in late September or early October 2023. The reasons for this request are summarized in an attached document prepared by the National Council on Disabilities (NCD) in 2019.

The NCD, founded in 1984, is comprised of presidentially and congressionally appointed Council Members who are the federal voice for the over 61 million Americans with disabilities across the country. NCD has long opposed assisted suicide laws. In 1997, after a thorough review of the forms of discrimination against people with disabilities experienced in American society, the NCD issued a document entitled Assisted Suicide: A Disability Perspective, opposing legalization of assisted suicide, concluding that the evidence indicated that the interests of the few people who would benefit from assisted suicide were “heavily outweighed by the probability that any law, procedures, and standards that can be imposed to regulate physician-assisted suicide will be misapplied to unnecessarily end the lives of people with disabilities”. In 2019 an updated full report was prepared which confirmed the prior study’s conclusions.

On the basis of all of this evidence, Instead of legalizing assisted suicide, the Marianjoy community joins the NCD in calling for a comprehensive, fully-funded, system of assistive living services for people with disabilities.

A copy of the full 2019 report is attached, but in summary, the NCD’s recent research reveals extensive significant and dangerous policy and procedural flaws in existing and proposed laws which have become ever-more apparent over the almost 30 years since Oregon legalized assisted suicide in 1994.

Dr. Lisa Lezzoni, with Harvard Medical School and her colleagues, published a study in Health Affairs in February 2021, which found that over 82% physicians nationwide view people with significant disabilities as having a low quality of life. An October 2022 follow-up study conducted by Dr. Lezzoni and her colleagues, also published in Health Affairs documented conversations with physicians under the cloak of anonymity wherein they revealed their preference not to treat people with disabilities; admitting sending them to cattle processing plants, supermarkets, zoos and grain elevator facilities to get weighed; and telling people with disabilities that their practices are closed and not accepting new patients, when in fact they are open and accepting new patients, but not those with disabilities.

Diane Coleman, president and founder of Not Dead Yet, a grassroots disability organization opposed to legalizing assisted suicide, noted that the public image of severe disability as a fate worse than death . . . become[s] grounds for carving out a deadly exception to longstanding laws and public policies about suicide [prevention] services.

Legalizing assisted suicide means that some people who say they want to die will receive suicide intervention, while others will receive suicide assistance. The difference between these two groups of people will be their health or disability status, leading to a two-tiered system that results in death to the socially devalued group.

In addition, studies show an increased rate of general suicide in states where assisted suicide is legal. In Oregon, government reports show a statistical correlation between assisted suicide under the Oregon law and an increase in other suicides. Before Oregon legalized assisted suicide, its suicide rate was similar to the national average. Yet by 2010, Oregon’s suicide rate was 41 percent above the national average, and 16 in states overall, assisted suicide laws are associated, on average, with a 6 percent increase in a state’s total suicide rate.

The NCD also examined information from 20 years of annual reports from Oregon’s experience with their law and found many disturbing trends. Of note, the top five reasons doctors give for their patients’ assisted suicide requests are not pain or fear of future pain—that alone is noteworthy—but psychological issues that are all-too-familiar to the disability community: “loss of autonomy” (95.5 percent), “less able to engage in activities” (94.6 percent), “loss of dignity” (87.4 percent), “losing control of bodily functions” (56.5 percent), and “burden on others” (51.9 percent).

These “reasons” are not directly gathered from the individuals themselves, but are gathered from proxies (their doctors) after assisted suicides have already occurred, which means there is no way of validating the reports, which could be a source of error. The mere fact that the reporting forms include these particular check boxes as options to express one’s reasons means that they were viewed as acceptable from the beginning of the laws’ implementation, and yet they are all uninformed expressions of common disability-related experiences. By rendering them acceptable explanations for requesting assistance in one’s suicide, these laws are communicating dangerous, discrimination-filled messages to people with disabilities and the public that common disability experiences, like requiring assistance with personal care activities, are understandable and acceptable grounds for ending one’s life. There is a clear double standard in suicide prevention efforts where people with disabilities are not referred for mental health treatment when seeking assisted suicide, while people without disabilities receive such referrals.

Article: Study finds assisted suicide laws ripe with dangers to people with disabilities (Link).

The recent NCD report further points out: Assisted suicide laws contain provisions intended to safeguard patients from problems or abuse. However, research for this report showed that these provisions are ineffective, and often fail to protect patients in a variety of ways, including:

• Insurers have denied expensive, life-sustaining medical treatment but offered to subsidize lethal drugs, potentially leading patients toward hastening their own deaths.
• Misdiagnoses of terminal disease can cause frightened patients to hasten their deaths.
• People with the disability of depression are subject to harm where assisted suicide is legal.
• Demoralization in people with disabilities is often based on internalized oppression, such as being conditioned to regard help as undignified and burdensome, or to regard disability as an inherent impediment to quality of life. Demoralization can also result from the lack of options that people depend on. These problems can lead patients toward hastening their deaths—and doctors who conflate disability with terminal illness or poor quality of life are ready to help them. Moreover, most health professionals lack training and experience in working with people with disabilities, so they don’t know how to recognize and intervene in this type of demoralization.
• Financial and emotional pressures can distort patient choice.
• Assisted suicide laws apply the lowest culpability standard possible to doctors, medical staff, and all other involved parties, that of a good-faith belief that the law is being followed, which creates the potential for abuse.
• There is a substantial lack of data about assisted suicide, due not to lack of research, but to unnecessarily strict privacy and confidentiality provisions in assisted suicide laws.
• Where assisted suicide is legal, states have no means of investigating mistakes and abuse, nor even a complaint mechanism for the public to report suspected problems.
• Assisted suicide laws require no evidence of consent when the lethal drugs are administered.
• Trends show that the minimal amount of data collection that was mandated by earlier state laws is decreasing over time as some newer states adopt less restrictive assisted suicide laws.

Although the slippery slope has been described as a fallacious argument, the history of such laws here in the United States and around the world actually prove that it is true.

Conclusion

Instead of legalizing assisted suicide, the Marianjoy community joins the National Council on Disabilities in calling for a comprehensive, fully-funded, system of assistive living services for people with disabilities, that medical providers inform patients seeking assisted suicide of these supports; and that medical providers receive training in disability competency and disability-risk factors for suicide

Northwestern Medicine Marianjoy Rehabilitation Hospital - Wheaton Illinois.
Ethics Committee

Assisted Suicide: A perverse disincentive in health care

This article was published by the Protect Children's Lives website.

By Michelle de Boer
Protect Children's Lives

Medically assisted suicide has become a controversial issue in Canada and other countries, as it raises moral and ethical questions about the right to die. While it may seem like a humane solution for those suffering from unbearable pain and terminal illness, there is a growing concern about the unintended consequences of this practice on the public health care system.

One of the most concerning issues is the creation of a perverse disincentive in health care, where death may be chosen as a cost-saving measure instead of providing necessary treatments and support. With the rising cost of health care and an aging population, some experts believe that medically assisted suicide could become an attractive option for healthcare providers struggling to balance the demands of cost-effectiveness and patient care.

For example, patients who are diagnosed with a terminal illness and require expensive treatments, such as cancer or a chronic condition, may be presented with assisted suicide as a way to end their suffering and save the healthcare system the cost of their care. This creates a situation where death becomes an option instead of life, and patients are forced to choose between their dignity and their right to receive proper care.

Moreover, the trend of medically assisted suicide also has a chilling effect on end-of-life care, as it shifts the focus from providing palliative care and support to patients and their families to the more cost-effective option of death. This not only undermines the core values of the health care system, but it also has severe implications for the quality of life of patients who are facing their final days.

In conclusion, while medically assisted suicide may seem like a solution to the growing concerns about end-of-life care and the rising cost of health care, it creates a disturbing disincentive in the public health care system, where death is chosen over life, and patients are denied the care and support they deserve. We must address this issue and find ways to ensure that all patients receive the best possible care and support, regardless of their health status or financial situation.

This is a call to action for all concerned citizens and healthcare providers to participate in the «Protect Children’s Lives Initiatives Against Child Euthanasia». Our responsibility is to ensure that children, the most vulnerable members of our society, are protected from the dangers of medically assisted suicide.

We must work together to raise awareness about the severe implications of this practice on children’s health and well-being and to promote alternative solutions that respect the dignity and rights of all patients, regardless of their age or health status. Through advocacy, education, or community outreach, we can make a difference in the lives of children facing life-threatening illnesses and conditions.

Join us in our efforts to protect children’s lives and ensure they receive the best care and support. Your voice, your support, and your commitment can make a difference. Together, we can make sure that the next generation grows up in a world where life is valued and where everyone has the right to receive proper care and support.

Assisted suicide laws violate the Americans with Disabilities Act

This opinion article was published by Newsweek on September 11, 2023.

Lisa Blumberg

By Lisa Blumberg

This summer, disability rights advocates sued California over its so-called End of Life Options Act. Under the 2016 law, assisted suicide is available to persons deemed terminally ill with less than six months to live. But, as argued in the lawsuit, the act violates the legal rights of disabled Californians and worsens the dehumanization they already face.

California residents Lonnie VanHook and Ingrid Tischer know the problem firsthand. VanHook and Tischer have significant disabilities that would be fatal without medical management. Both have struggled to get medical care and in-home support. They believe they have encountered discrimination in hospitals due to their disabilities, and in VanHook's case, also for being Black. Both have heard suggestions that their quality of life is unacceptable. Tischer describes a doctor's refusal to get her into rehabilitation after pneumonia as a "solid gut punch." Both have had bouts of depression, anxiety and thoughts of ending it all. They are fearful that if they become suicidal, they will not be given the suicide prevention services available to the general California public but instead be approved for a lethal drug prescription.

Amid existing health care disparities, assisted suicide, although ostensibly voluntary, imperils the ill and disabled. A law enabling it is discriminatory because it carves out an arbitrary health-related exception to the state's policy of deterring suicide attempts. Four disability rights groups have joined VanHook and Tischer in filing a federal lawsuit alleging that California's End of Life Option Act violates the Americans with Disabilities Act (ADA), Section 504 of the Rehabilitation Act, and the equal protection and due process clauses of the 14th Amendment of the U.S. Constitution.

Terminally ill persons have impairments that impact daily life activities and so are protected under the ADA. People typically request lethal prescriptions due to a perceived lessening of autonomy, or feelings of being a burden. One study indicates that a fear of going into a nursing home is much more likely than pain to fuel a desire to hasten death. These are not uniquely end-of-life concerns. These are the solvable concerns of people who want to control their lives but need kinds of help that others currently do not.

VanHook's and Tischer's fear about the blurring of the line between terminal illness and chronic conditions that are life threatening without treatment is well founded. In states where assisted suicide is legal, persons have been deemed eligible based on conditions like diabetes, arthritis, and anorexia.

Knowledge gaps may play some role in a person not being offered certain services. For example, a provider may not be fully aware how often suicide ideation occurs among people with Parkinson's disease and that care should include a psychiatric component.

But there is more at play. In a study of doctors' perceptions of disabled people, 82.4 percent of the doctors surveyed felt that people with a disability have a worse quality of life than others. Such attitudes appear to contribute to the health care disparities such individuals experience. Bias may cause doctors to assume that the intrinsic nature of a person's physical condition, rather than treatable depression, is fueling a desire to die.

Assisted suicide can hardly be called a "choice," as proponents do, when people do not have access to necessities such as home health aides or breathing support, or persons they trust are giving them cues that living is no longer a good option. Such "steering" is part of a pattern of devaluation and discrimination that pushes people to despairingly believe that their only option is assisted suicide.

If the California law is found to be invalid, so can the assisted suicide laws in the few other states that have them. Should any further state enact such a statute, they will be similarly embroiled in controversy.

Beyond the legalities though, we should focus less on perceptions of personal limitations and more on human aspirations.

As one mother has written lovingly of her daughter:

She did not want to die, contrary to the fallacy, seemingly held by some of our doctors that the will to live might fade as her prospects dimmed. Even when cancer robbed her of so much personal agency, of moments of dignity, eventually of her mobility and even, frustratingly, some of her precious words, she did not want to leave this world behind.

Neither do most of us—if we can get the help we need.

Lisa Blumberg is a Connecticut-based writer, lawyer, and disability rights advocate.The views expressed in this article are the writer's own.

Conservative Party of Canada passes Policy 908 opposing expansion of euthanasia

Dear Friends:

We have incredible news. 

The Conservative Party of Canada overwhelmingly passed Policy 908 at their Convention (September 7 - 9, 2023) in Quebec City, a resolution that opposes the expansion of euthanasia to people with psychological suffering, to minors, to people who are not competent and their opposition to euthanasia for people who are not terminally ill.

Policy 908 stated the following:

In principle, the Conservative Party opposes euthanasia and assisted suicide. Furthermore, we oppose the extension of euthanasia and assisted suicide (MAID) to minors, to people who are not competent, people who live with psychological suffering (mental illness), and people not terminally ill (their natural death is not reasonably foreseeable).

We oppose MAID for people living with disabilities or mental illness seeking to die based on poverty, homelessness or inability to receive medical treatment. Euthanasia must not be an abandonment of people living with genuine needs.

The Euthanasia Prevention Coalition was involved with the development and promotion of Policy 908. In a letter that we sent to Conservative Members of Parliament we stated:

Bill C-7, in March 2021, approved MAiD for mental illness alone with a two year moratorium. This Spring Bill C-39 extended the moratorium on MAiD for mental illness to March 17, 2023. On Wednesday May 17, 2024, Bill C-314, a bill sponsored by Hon. Ed Fast MP (Abbotsford CPC), received it’s first hour of debate. C-314 would once again prevent MAiD for mental illness.

Recently Kathrin Mentler went to the Assessment Centre at Vancouver General Hospital for help as she was experiencing suicidal ideation. While being assessed the counsellor asked her if she had considered Medical Assistance in Dying. Mentler told the media that she was shocked and sickened that she was given recommendations on how to kill herself.

A report from the Special Joint Committee on Medical Assistance in Dying (AMAD) that was tabled in the House of Commons on February 15, 2023 calling for a drastic expansion of (MAiD). The report recommended that "mature minors" and patients with dementia should be permitted to make advanced requests for MAiD by advanced directive.

We need you to help slow the growth and normalization of MAiD in Canada.

Enough is enough. Death-care for some is not a substitute for healthcare for all.

The Euthanasia Prevention Coalition offers our gratitute to the original sponsors of Policy 908 and all of the delegates and Members of Parliament who worked to get it overwhelmingly passed at the Policy Convention. Now it needs to be implemented.

Questioning a medical euthanasia mandate in the UK

By Gordon Friesen
President, Euthanasia Prevention Coalition

An interesting pro-euthanasia article was published in the British Medical Journal on August 29, 2023 titled, "Breaching the stalemate on assisted dying: it’s time to move beyond a medicalised approach" by Nancy Preston, Sheila Payne, and Suzanne Ost.

According to the authors, British attempts at legalizing euthanasia have encountered an unyielding obstacle in the medical system:

"Despite growing legal and medical support for assisted dying, many healthcare professionals do not want to be directly involved."

In fact, we might add: this wildly underestimates the problem. Where euthanasia is actually practised, only about 10% of doctors will do more than one or two (before quietly dropping the issue). 70% will never do even one. And the real volume is carried by only a handful of hardcore zealots.

It is this problem, then, of medical rejection, which is standing in the path of decriminalization in the UK. And the solution suggested by the authors (in order to "Breach the Stalemate" as their title promises) would be a "de-medicalised approach".

We cannot overestimate the importance of such a statement from an apparently pro-euthanasia source. For as noted in the article "debate about whether assisted dying is morally justified tends to assume that, were it legalised, it would be part of healthcare".

Again I would say more: the primary difficulty of passing off assisted death as a moral act, at all, depends upon transferring the debate to the grounds of medical ethics. And yet everybody knows, from the start, that doctors do not consider euthanasia to be ethical. The entire scheme, therefore, actually depends upon legislation (as in Canada) over-ruling doctors in their own domain. In that way, the moral debate is deviously settled through reliance on an illegitimate ethical support, gained from medicine, effectively at political gun point.

For even a small number of euthanasia supporters to retreat from that position represents a major victory for euthanasia opponents.

Reality is setting in.

The reasons given for contemplating a "civil" (rather than a "medical") regime of assisted death are described as follows:

• Doctors do not want to be personally involved.
• Pharmacists do not want to provide drugs. 
• Hospitals would rather discharge the patient than permit the procedure.
• Relatives report difficulties in navigating healthcare systems to find participating doctors.
  

The general portrait painted in these lines, is that of a sullen medical industry, passively resisting the unwanted euthanasia mandate in any way that it can. And the solution of the authors is simple: if institutional medicine does not want to work with us, let us work with those who do.

Non-profits and lobby groups.

It is an open secret, in Canada, that the fastest way to die is not to contact some random doctor, or hospital. The fastest route is by contacting the euthanasia lobby, or a to contact the CAMAP. Either of these will immediately hook you up with professionals whose favourite word is "yes".

In other words, even where euthanasia is already legally imposed upon all medical professionals and institutions, it is still the euthanasia movement, itself, which operates the most efficient pipe-line to death.

Why, do the authors ask, should policy engineers continue needlessly pushing on a string?

There is a problem with trust in the profession and in the public health system.

The authors, identify significant positive benefits which are associated with keeping assisted death out of public system responsibility.

• Reporting and safeguards are more meaningful because the Government is not reporting on itself.
• Attending doctors are not forced to espouse values which are foreign to them (and conscience thus becomes a non-issue) 
• Patients are better able to maintain trust in both individual doctors and the Public Health system.
  

In this list of benefits, we sadly see a corresponding admission of present harms in the actual Canadian regime, where patient trust has definitely been undermined in the new environment; harm indeed, endured by the entire medical industry, patients and professionals, in order to execute an ideological program of suicidal choice.

Moreover, if we are to believe the authors, that massive vandalism has been practised for no reason at all (or was simply factored in, in countries such as mine, as the price of getting over the first political hump of decriminalizing assisted death).

In any case, if the UK debate on assisted death were to take the turn suggested in this article, it would be wonderful news for euthanasia opponents.

As the authors state: 

"The possibility of situating assisted dying outside healthcare would significantly reposition the debate."

Indeed it would! And it would re-calibrate the issue accordingly.

Belgian doctor "completes" euthanasia with a pillow

This article was published by National Review online on September 9, 2023.

By Wesley J Smith

Euthanasia is not the practice of medicine. It just puts a “medical” patina on homicide.

Proof of point: When a doctor tried to lethally inject a patient at her request and she didn’t die, he smothered her with a pillow. From the Daily Telegraph New Zealand story:

A terminally ill Belgian woman was ‘euthanized’ by suffocation with a pillow by a doctor after lethal drugs she requested to be administered to her to voluntarily end her life proved to be insufficient, according to reports by Belgian media . . . When the cocktail of drugs failed to have the desired effect, the doctor allegedly used a pillow to suffocate the woman to end her life. A post mortem examination showed signs of suffocation, 7sur7 reported.

An expert on medicalized killing is unhappy with the means of death:

“What happened is not euthanasia,” Belgian politician and doctor Jacques Brotchi said to RTL Info. “Such a definition of this terrible situation devalues the gesture of euthanasia, which accompanies a person to the end without pain.”

No, it is precisely euthanasia — which is, after all, solely about making the patient dead. The use of “medications” and the doctor’s presence is just a veneer that hides the harsh truth of what is being done.

Apparently, the family plans to sue.

Renaud Molders-Pierre, a lawyer representing the family, said that the bereaved are not demanding “heavy sanctions” but added that “if rules exist, it is so that sick rooms do not turn into crime scenes where anything can be done.”

Frankly, this is nonsensical. Why should the killing be considered “medicine” if she died by a lethal jab and a “crime scene” if by suffocation? The point was to end her suffering by making her dead, and that deed was accomplished.

(Another version of the story states that nurses did the smothering after the doctor failed to palliatively sedate the patient, which is different from euthanasia. If so, that would be murder under the law, since the patient did not ask to be killed. Intriguingly, no criminal charges have apparently been filed even though the killing took place in 2022, which — in and of itself — tells us all we need to know about how the culture of death distorts ethical thinking.)

Canadian euthanasia stories influence international debate

The Care Not Killing Alliance UK shared the following message with their supporters as they fight to prevent the legalization of euthanasia in the UK.

This weekend, The Telegraph published an interview with Canadian veteran and Paralympian Christine Gauthier.

‘Ms Gauthier, who requires a wheelchair because of irreversible injuries from her time in the military, said after initially submitting her request for… disabled equipment in 2018, in 2022 a [Veterans Affairs Canada] employee “called me to make a point of where we’re at [with the lift]”.

‘She continued: “And I said, I just can’t keep going like this. I can’t keep living like this. Like, this has to be done. This has to be resolved.”

‘“And the person stated, ‘You know, Madame Gauthier, if you really feel you can’t go on like this, if you feel that you can’t do it anymore, you know, you have the right to die?’”’

Lawmakers, opinion-formers and the general public need to hear (and heed) such cautionary tales. 

The Care Not Killing Alliance message continued:

‘Increasingly, we are hearing appalling stories from Canada of those who are poor or disadvantaged being offered medical assistance in dying rather than proper health or social care. In the case of Roger Foley he was offered euthanasia whilst being told his care was costing over Canadian $1,500 a day.

‘Assisted suicide and euthanasia corrupt the healthcare system, putting pressure on people to end their lives so as not to be a burden on family, friends or care services. If Scotland were to have a Swiss-type assisted suicide system, hundreds of people a year would be dying prematurely owing to financial or other pressures or because of undiagnosed or untreated clinical depression.’

When Australian assisted suicide extremist Philip Nitschke announced that his 3D-printed suicide pods would be ready for use within a year, Gordon told the Daily Mail:

‘The development of personal gas chambers marks a new low in the debate about whether or not to kill people via assisted suicide and euthanasia.

‘What is equally risible is the claim that these will give people a quick pain free death, as this was exactly what was said about the use of death row drugs in the handful of places that have introduced assisted suicide or euthanasia.’

The Euthanasia Prevention Coalition fights the legalization of euthanasia and assisted suicide around the world. Care Not Killing Alliance UK is instrumental in preventing the legalization of euthanasia and/or assisted suicide in the UK.

Help us fight this battle. Become or renew your membership in the Euthanasia Prevention Coalition today. (EPC Membership Link).

You are not alone. Life-Protecting Power of Attorney for Personal Care can save your life

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Recently, someone asked me:

"Will a Power of Attorney for Personal Care document protect me from euthanasia when I can't speak for myself?"

EPC updated the Life Protecting Power of Attorney for Personal Care when euthanasia and assisted suicide was legalized in Canada. It will protect your life.

The Life-Protecting Power of Attorney for Personal Care is available in multiple formats: a general Canadian version, a British Columbia version, and two different American versions.

$10 is an inexpensive investment to protect your life.

EPC sells the Life Protecting Power of Attorney for Personal Care for $10 + taxes.

The Life Protecting Power of Attorney for Personal Care:

- ensures that your Power of Attorney will have the ability to uphold your values 

- protects you from euthanasia and assisted suicide

- defines the treatment decisions that you want in the event that you are unable to make decisions for yourself

The Life Protecting Power of Attorney gives you peace of mind that you are not alone. 

Euthanasia Prevention Coalition will help you if your expressed wishes are ignored or if a hospital or doctor pressures to impose decisions upon you.

To make a donation, or to order the Life Protecting Power of Attorney, (Information Link):

call: 1-877-439-3348 

email: info@epcc.ca

EPC works with Compassionate Community Care (CCC) to offer practical advice and support when you or a loved one are faced with difficult medical care decisions, or if you are concerned that a friend or a loved one is being denied basic care or has died by euthanasia.

Contact CCC at: 1-855-675-8749.