Response to the editorial concerning study on: Depression and Physician Assisted Suicide

By Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Alex Schadenberg

The recently published study by Ganzini et al shows that 26% of people who took part in this study in Oregon who had requested assisted suicide were experiencing depressive disorders.

The study by Linda Ganzini, Elizabeth R. Goy, and Steven K Dobscha was recently published in the British Medical Journal - BMJ 2008;337;a1682.

I was dismayed by the Editorial that was published in the British Medical Journal - BMJ 2008;337:a1558 written by the Dutch researcher and oncologist Marije L. van der Lee of the Helen Dowling Institute.

van der Lee was the author of the important study that showed that a correlation exists between the incidence of depression with requests for euthanasia in the Netherlands. Euthanasia and Depression: A Prospective Cohort Study Among Terminally Ill Cancer Patients - Journal of Clinical Oncology, Vol 23, No 27 (September 20), 2005: pp. 6607-6612

Based on the Editorial written by van der Lee, it appears that we can expect that the the new response by the euthanasia lobby to the relationship between euthanasia/assisted suicide and depression is to acknowledge that the relationship exists and deny that it is important.

van der Lee writes in the editorial:

Determining whether depression impairs the judgement of a patient requesting assisted suicide is more complex, because depressed patients are not necessarily incompetent. ... Ganzini and colleagues report that only 6% of psychiatrists in Oregon were confident they could adequately determine in a single evaluation whether a psychiatric disorder impaired the judgement of a patient requesting assisted suicide. Doctors who have known their patient for some time can often determine their patient's level of competency. In the Netherlands and Oregon, consultation with a second doctor is already standard procedure, so a psychiatrist should be consulted only when the patient's ability to make a decision is in doubt.

van der Lee is saying that people who are depressed will make requests for euthanasia and assisted suicide but having a depressive disorder does not make the person incompetent. Further to that, van der lee seems to be saying that since there is a requirement of having a second doctor agree to a request for euthanasia or assisted suicide, then the fear of someone who is incompetent dying by lethal injection or ingestion is minimal at best.

In reality van der Lee is simply creating a new paradigm for the fact that their is a direct corelation between people suffering from depression and dying from euthanasia. It is easier to write the concerns off as trivial than recognize the serious problem for what it is.

van der Lee also rejects the concerns of the study that Ganzini acknowledged that stated:

In a study of 290 US forensic psychiatrists, 58% indicated that the presence of major depressive disorder should result in an automatic finding of incompetence for the purpose of obtaining assisted suicide.

Finally van der Lee ignores the fact that last year in Oregon, none of the 49 people who died by assisted suicide were referred for a psychiatric or psychological assessment, even though the Ganzini study notes at least two people who participated in the study were depressed when they died from ingesting lethal drugs. This fact should further concern van der Lee because the van der Lee and Ganzini studies both concluded that 17% of those in the study who died by euthanasia or assisted suicide were depressed. We can assume that in the Netherlands very few people are referred for a psychiatric or psychological assessment before they are injected with death.

This conclusion corelates with the hypothesis that was presented in the van der Lee study which was:

.. we hypothesized that depressed mood would show an inverse association with requests for euthanasia. Our clinical impression was that such requests were well-considered decisions, thoroughly discussed with healthcare workers and family. We thought the patients requesting euthanasia were more accepting their impending death and we therefore expected them to be less depressed. To our surprise, we found that a depressed mood was associated with more requests.

Further to that van der Lee stated in the study:

Opposition stems partly from the perspective of suicide as a symptom of mental illness and the tendency to extend this view of suicide in the physically healthy onto euthanasia and physician-assisted suicide in the terminally ill.

In other words, van der Lee conducted the study that was published by the Journal of Clinical Oncology, Vol 23, No 27 (September 20), 2005: pp. 6607-6612; to counter the opposition to euthanasia that has been expressed concerning vulnerable people with mental illness.

The further concern is whether van der Lee is capable of effectively responding to the Ganzini study.

The editorial by van der Lee suggests that she is attempting to cover up the reality of the relationship between depression and euthanasia rather than analyze the Ganzini findings. We must need to be aware of the new directions and verbal gymnastics that the euthanasia lobby incorporates.

van der Lee has introduced the concept that depressed people can be prescribe death by assisted suicide.

Link to the editorial by van der Lee in the British Medical Journal: (Link)

Study: Depression and assisted suicide in Oregon.

By Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

People in Washington State need to be aware that if the assisted suicide initiative is passed, people who experience depression will not be protected by "Oregon Style" assisted suicide guidelines.

A recently published study by Ganzini et al found that 15 of 58 (26%) of people who requested assisted suicide in Oregon were experiencing depressive disorders. Even though many of those people were incompetent or unable to "freely choose" assisted suicide, they were given a prescription for lethal drugs and died by assisted suicide.


The study by Linda Ganzini, Elizabeth R. Goy, and Steven K Dobscha - BMJ2008;337;a1682 states in its conclusion:

Linda Ganzini (left)

Our study suggests that most patients who request aid in dying do not have a depressive disorder. However, the current practice of the Death with Dignity Act in Oregon may not adequately protect all mentally ill patients, and increased vigilance and systematic examination for depression among patients who may access legalised aid in dying are needed. Tools for screening for depression such as those used in our study are easy to administer and may help to determine which patients need further evaluation by a mental health professional. Further study is needed to determine the effect of treatment of depression on the choice to hasten death.

Ganzini et al, studied 58 patients in Oregon who requested assisted suicide. Most of these people were dying of cancer or ALS - Lou Gehrig's disease.

Ganzini et al specifically studied patients who had requested assisted suicide:

our surveyed participants had taken active steps to pursue a physician's aid in dying in one of the few jurisdictions where it is legal - all either explicitly requested aid in dying from a physician or contacted Compassion and Choices for information on the Oregon Death with Dignity Act. Before death, almost half had obtained a prescription for a lethal drug under the law.

Of the 58 people who participated in the study, 26% (15) were independently diagnosed with depression. The study stated:

Among patients who requested a physician's aid in dying, one in four had clinical depression. However, more than three quarters of people who actually received prescription for lethal drugs did not have a depressive disorder. Our findings also indicate that the current practice of legalised aid in dying may allow some potentially ineligible patients to receive a prescription for a lethal drug; two of those who ultimately died by lethal ingestion had depression at the time that they received a prescription for a lethal drug and died by ingestion the drug. A third patient was depressed at the time that she requested a physician's aid in dying and probably received her prescription; she was successfully treated for her depression before she died by lethal ingestion.

Further to the concern in Oregon that people with depressive disorders are dying by assisted suicide Ganzini et al acknowledge that:

In a study of 321 psychiatrists in Oregon only 6% were very confident that in a single evaluation they could adequately determine whether a psychiatric disorder was impairing the judgement of a patient requesting assisted suicide. In a study of 290 US forensic psychiatrists, 58% indicated that the presence of major depressive disorder should result in an automatic finding of incompetence for the purpose of obtaining assisted suicide.

Proponents of assisted suicide will say that since their are safeguards in Oregon that mandate that someone who has a depressive disorder or mental illness must receive a psychiatric or psychological assessment before receiving a prescription for a lethal drug, that these few cases simply represent an oversight by the physician.

The reality is that of the 49 cases of assisted suicide in Oregon, last year, not one of the people who died by assisted suicide were referred for a psychiatric or psychological assessment.

Ganzini supports assisted suicide and is researching the implications of the assisted suicide law.

This study proves that safeguards in Oregon are either ignored or ineffective.

The Euthanasia Prevention Coalition recognizes that assisted suicide threatens the lives of people at the most vulnerable time of their life.

• Link to the abstract in the British Medical Journal - BMJ 2008;337:a1682: (Link)
• Link to the article in the Oregon Public Broadcasting - OPB News: (Link)
• Link to the article in the Healthcare Republic: (Link).

Minimally conscious patients can still feel pain

A study that has been published in the November edition of the Lancet Neurology suggests that minimally conscious patients can feel pain.

The article written by Dr Steven Laureys, Coma Science Group, Cyclotron Research Center and Department of Neurology, University of Liege, Belgium, and colleagues compared brain activity following electrical stimulation of the median nerve in five MCS patients (aged 18–74 years) with 15 controls (aged 19–64 years) and 15 PVS patients (aged 18–75 years). They looked at the areas of the brain responsible for pain sensation (the cortical pain matrix), including the thalamus, the primary somatosensory cortex and the insular, frontoparietal and anterior cingulate cortices.

The researchers found that none of these areas of the brain was less activated in MCS patients than in controls, and in MCS patients the cortical pain matrix was significantly more active than in PVS patients.

MCS patients also showed better ‘connectivity’ between different brain regions responsible for pain than did PVS patients.

The authors conclude: “These findings might be objective evidence of a potential pain perception capacity in patients in MCS, which supports the idea that these patients need painkilling treatment.”

This study should also concern us knowing that many experts believed that Terri Schiavo was not in a PVS state but rather in a Minimally Conscious State. This would mean that she suffered incredible pain before succumbing to death by dehydration.

Link to the article in Science Now:
http://sciencenow.sciencemag.org:80/cgi/content/full/2008/1009/1?eaf

Link to the article in On Medica news:
http://www.onmedica.com:80/NewsArticle.aspx?id=7a7a9a4c-d4e6-4ae3-9c3e-9ef4191a9e71

Are doctors redefining life and death?

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

A recent article written by William Saletan that was published in the Washington Post asks the question whether doctors are redefining death in order to make more organs available for organ donation.

I have written about this topic before and I have quoted Wesley Smith on this topic. I agree that the urge to change our definition of death in order to increase the availability of organs for organ donation will only undermine the concept of organ donation within society.

Saletan is writing about the recent New England Journal of Medicine article about the direction of the Children's Hospital in Denver who are now declaring children dead after 75 seconds of heart failure, rather than waiting the conventional 5 minutes.

Since death is defined as the irreversible stoppage of the heart, therefore declaring someone dead after 75 seconds in order to remove the heart of the child may represent a redefination of death, since the heart can resume beating and has been known to do so after 75 seconds.

Saletan explains the issue this way:

How can we get more organs? By redefining death. First we coined "brain death," which let us take organs from people on ventilators. Then we proposed organ retrieval even if non-conscious brain functions persisted. Now we have "donation after cardiac death," the rule applied in Denver, which permits the harvesting based on heart, rather than brain, stoppage.

Saleton then quotes ethicist Robert Troug who actually supports the Denver protocol:

This redefinition of death has gone too far. Let's accept that we're taking organs from living people and causing death in the process. Troug believes this is ethical as long as the patient has "devastating neurologic injury" and has provided, through advance directive or a surrogate, informed consent to be terminated this way. We already let surrogates authorize removal of life support, he noted.

Further Troug stated:"

The public will accept the new policy since surveys suggest we're not hung up on whether the donor is dead.

In other words Troug is saying that we have already redefined death. He believes its time to simply allow the removal of organs from people who have consented to the act or who have provided consent through a surrogate decision maker or power of attorney who would have legal authority to make such decisions.

This sounds very familiar to the reasoning behind euthanasia and assisted suicide and the arguement about who should make these decisions. There is no concern about whether or not doctors should be healers who abstain from killing, and no real concern about the plight of the vulnerable in society who lack social, economic or cultural support.

Saletan asks some very important questions:

How devastating does the injury have to be? If death is vulnerable to redefinition, isn't "devastating" even more so? The same can be asked of "futility," the standard used by the Denver team to select donors. Is it safe to base lethal decisions on the ebb and flow of public opinion, particularly when the same surveys show confusion about death standards? And can termination decisions really be insulated from pressures to donate? Even if each family makes its own choice, aren't we loosening standards for termination precisely to get more organs?

As the culture of death continues to permeate every corner of medical ethics we need to recognize the importance of push back. Simply informing the public of the ethical problems that are on the way won't slow their progression. There needs to be a more organized push that is orchestrated on the medical institutions, the intellectual research and publications and the government bodies that oversea standards.

We cannot simply make commentary about the culture of death, we must oppose it.

Link to the article in the Washington Post:
http://www.washingtonpost.com/wp-dyn/content/article/2008/10/03/AR2008100301974.html

Link to the previous comments by myself on the Troug and Miller article in the New England Journal of Medicine:
http://alexschadenberg.blogspot.com/2008/08/dead-donor-rule-and-organ.html

Link to blog article about Wesley Smith's response to the Children's Hospital in Denver cardiac death protocol:
http://alexschadenberg.blogspot.com/2008/08/undermining-public-trust-in-organ.html

I-1000 Assisted Suicide Initiative is fatally flawed

This is a reprint of the original article found at:
http://www.heraldnet.com/article/20081005/OPINION03/710059966
INITIATIVE 1000

Assisted suicide initiative is fatally flawed

By Chris Carlson

Voters should reject Initiative 1000 when they mark ballots this fall. I-1000 is poor public policy and contains flaws that endanger us all.

When you read the fine print in I-1000, you will see it contains no real safeguards:

There is no requirement a spouse or family be notified. It is reasonable to imagine an understandably depressed and confused patient opting for the "quick exit" approach without family support.

There is no requirement the death be witnessed. It is possible someone could force feed the lethal dose to the patient. An undetectable crime is committed and the initiative provides the perfect alibi for the perpetrator.

I-1000 contains no mandatory requirement the patient receive a psychological examination. Suicidal tendencies are a cry for help and unmistakable signs of depression. Most frequently, when depression is treated, suicidal thoughts disappear. Society should be providing safe harbors for people nearing the end of their lives, not "quick exits."

With I-1000 the act of assisted suicide is shrouded in secrecy. No opportunity exists for third party review of circumstances surrounding the patient's death. Patient records are sealed and all interested parties are prohibited from viewing the records. There's neither accountability nor transparency.

The doctor signing the death certificate is required to cover-up the lethal drug overdose. According to Section X of Initiative 1000, the underlying illness must be listed on the death certificate. Doctors have objected strongly to this requirement that they falsify the death certificate. In fact, the Washington State Medical Association, along with nurses and hospice workers, oppose Initiative 1000.

The initiative allows one of the two witnesses in the request for assisted suicide to be an heir. This contravenes existing law dealing with wills and estates. It creates the distinct possibility of a relative with ulterior, self-benefitting motives coercing the patient to commit assisted suicide.

I-1000 isn't about end-of-life options. I-1000 contains the distinct probability that the decision to commit assisted suicide will not be yours at all. Safeguards are all but nonexistent.

Advanced directives for health care will no longer be deemed legally sufficient. The doctor-patient relationship of trust and the collaborative process between doctor, patient and family are destroyed.

Insurance, health care and government bureaucrats will be complicit in deciding who lives and who dies.

Oregon is the one state where assisted suicide has been legalized. In Oregon, some cancer patients have received notification from the state health insurance plan that their chemotherapy will not be covered, but that assisted suicide is fully covered. If Initiative 1000 becomes law, low-income people in Washington could face the same devastating health care cost containment.

I-1000 is about the choices others will have over you. It is about shifting public perception and changing public policy. Why should the many who accept the fact that life runs a natural course of events risk putting the government into end-of-life issues just so the few can feel good about committing suicide via a lethal dose of barbiturates?

In our broken health care system, doctors are offered incentives for implementing measures that save profit-driven insurance companies money.

Coercion comes in many forms and is interpreted by patients in many ways. Patients view doctors as authority figures. Hearing the option of assisted suicide from their doctor, patients may very well interpret it as an obligation to commit assisted suicide.

This initiative is not about pain. Current and continuing advances in palliative medicine make almost all patient pain manageable.

Make no mistake, I-1000 is really about profit and power. Derek Humphrey, co-founder of the Hemlock Society, has said: "Euthanasia and physician assisted suicide will inevitably prevail in our society because they make economic sense!"

If you don't want corporations, the government and others intruding into this most private and personal end-of-life affair, vote no on 1000.

Chris Carlson is chairman of the Coalition Against Assisted Suicide. Visit www.noassistedsuicide.com.

Rita Marker responds to Baroness Warnock on assisted suicide

This article was originally published by the American Thinker.

An Open Letter to Baroness Warnock on Assisted Suicide
By Rita L. Marker - October 04, 2008

Dear Baroness,

Your recent interview on a duty to die certainly caused a stir when you said you hope people will soon be licensed to "put down" those who are unable to look after themselves. To hear the fuss from commentators around the world, one would think you'd never expressed that idea before. But I imagine few people read about a lecture you gave at Giggleswick School in 1990 where you said virtually the same thing. Truth be told, when I first read the account of that lecture in the Craven Herald and Pioneer, I thought it was a very bad joke. Maybe that was due, in part, to the name of the school. Not being a Brit, I didn't realize what a prestigious institution it is. Still, I thought it was a bit radical to suggest that some people were "quite unambiguously entitled to end the life of those whose life chances are seen as very poor."

I can see now that you really meant it then and that you haven't budged in your stance. However, in your latest call for designated death deciders you really went over the top when you pointed out that it would save money for the National Health Service. And you hurt your own cause.

Quite frankly, Baroness, it's time to face the fact that it has been eighteen years since you first voiced your proposal in an open forum and you're no closer now than you were then to achieving your goal. If you want to succeed, you really must change your approach.

You may want to consider following a model that seems to be working here "across the pond."

That model is from Oregon. It started with a proposal much like yours. In 1991, Senator Frank Roberts sponsored a measure (SB 1191) to permit "aid-in-dying," defined as "a medical procedure" performed by a physician "to end the life of a patient in a dignified, painless and humane manner." Of course, it meant killing the patient with a lethal injection but, you'll note, that the soft phrase, "aid-in-dying," was used. That's an important point since words like "euthanasia," "assisted suicide" or, as you say, "put others down" really turn people off.

Senator Roberts' legislative aide was Barbara Coombs Lee. (Keep that name in mind, Baroness. You really do want to emulate what she has done over the years.) Lee worked to gain approval for the proposal. But, despite the euphemistic phrases and Lee's hard work, the measure failed. It had several fatal flaws that made it unpalatable.

First, the printed version of the bill noted that it was sponsored "at the request of the Hemlock Society," making it far too clear that a special interest euthanasia advocacy group was behind it. Second, it went too far, too fast. It provided that an individual could give another person the right to "instruct my physician to provide assistance in ending my life in a painless, dignified and humane manner if I have a fatal disease such as advanced Alzheimer's disease that makes me unable to speak intelligibly...."

Sound familiar to you? It should, since it's exactly what you're calling for.

But, at the time, it was just too much for people in Oregon to swallow.

The backers of the measure could have just kept proposing the same bill over and over, but they didn't. Unlike your, dare I say, stubborn insistence on pushing for everything at once, assisted-suicide and euthanasia activists here learned from their failure. They realized they had to change their image from that of Hemlockian activism to one of compassionate concern.

The players didn't change, but the script did. Three years after Roberts' euthanasia-for-Alzheimer's-patients bill failed, Barbara Coombs Lee became the chief petitioner for Measure 16, Oregon's "Death with Dignity Act." By then she was vice president of a fast-growing managed care company and was working with Compassion in Dying (a spin-off of the Hemlock Society.) Unlike the earlier legislative measure, this one went directly to the voters. It was a scaled back proposal, permitting assisted suicide only (not euthanasia by lethal injection). And it didn't make any provisions for a third party to request an incompetent patient's death. Additionally, politically savvy campaigners made sure that the chilling name, "Hemlock," was no longer attached to the push to legalize assisted suicide.

Another twist was added as well. During the campaign prior to the vote, proponents of the assisted-suicide bill played on Oregon's anti-Catholic biases. They deluged the airwaves, telling voters that the Catholic Church was behind all opposition to the bill and that one religion was trying to deny dying patients the right to choose death with dignity.

The strategy worked. Oregon's "Death with Dignity Act" passed by a vote of 51 - 49% in November 1994 and went into effect three years later.

Baroness, can you see how this process works?

It's really quite simple.

Remember, you need to take things step-by-step; use carefully-chosen, comforting words to describe what you are proposing and find a bête noire (such as the Catholic Church or evangelical Christians). Above all, you must be ready to make changes if something isn't working.

When Oregon's assisted-suicide law passed, those who share your views thought they would rapidly achieve similar victories, but that didn't happen. In fact, in the ensuing years, Oregon-style laws were proposed in twenty-three states (multiple times in some of those states). Yet, each and every one of them failed.

That didn't stop your U.S. counterparts. They forged ahead. They solidified their organizational structure, changing their name to Compassion & Choices (by merging the Hemlock Society and Compassion in Dying). And, most important, they collected "proof" that Oregon's law is working well.

Under Oregon's law, doctors who prescribe lethal drugs for patients must file reports with the state and, then, that information is used to formulate official annual reports. And, since Compassion & Choices has arranged and participated in 75% of the state's assisted-suicide deaths, it has maintained control of most information contained in annual reports. (Oregon officials acknowledge that there is no way to verify whether the self-reporting by assisted-suicide-prescribing doctors is accurate or complete.) All that can be claimed with certainty, is that, after ten years of assisted suicide in Oregon, there have now been ten annual official reports which are, at best, questionable. Nonetheless, this "proof" has become the most powerful tool for those who share your views. They've been able to claim that there have been absolutely no problems or abuses.

Baroness, you might think the Oregon statistics are not relevant to your efforts in Britain but, I assure you, those figures have and will continue to be an important part of the arsenal of anyone, anywhere, who is promoting assisted suicide and euthanasia.

If you are wondering whether your statements - which have, until now, been counterproductive - have somehow disqualified you from being effective in the future, I want to reassure you.

The same people who have previously failed can be very effective as long as they change their words and strategy. Their experience with the 1991 euthanasia-for-Alzheimers'-patients proposal in Oregon did not require its early supporters to bow out of the action.

For example, a few weeks ago, just as you were making your counterproductive "putting people down" statement, your far more savvy American counterparts - who are currently engaged in an assisted-suicide initiative campaign in Washington State (I-1000) - were pointing at Oregon as a model of compassion and choice. In a letter to the editor of the Seattle Post-Intelligencer, former Oregon governor Barbara Roberts assured Washingtonians that "I-1000 is not a slippery slope." Roberts is the widow of Senator Frank Roberts who, you recall, introduced the failed euthanasia-for-Alzheimers-patients measure.

Omitted from her letter was any mention of the fact that, in Oregon, some patients are now being told that their health care plan will pay for assisted suicide, but not for life-saving treatment that their doctors prescribe.

You see, Baroness, once an assisted-suicide law is passed, it can be used to save money. But Roberts is smart enough to know that mentioning the cost containment aspect would cause Washington voters recoil from an Oregon-style assisted suicide law. Instead, she painted the Oregon experience with rosy hues, describing "beautiful accounts of compassion, sharing, dignity and gentle exits."

It should come as no surprise that she also failed to mention Barbara Coombs Lee's leadership in the Washington effort, even though Lee is the current president of Compassion & Choices, which has poured hundreds of thousands of dollars into the Washington State effort. In a recent letter to supporters, Lee wrote, "Very soon - with your help, Washington State could be the next to pass an Oregon-style aid-in-dying law."

By now you should realize that Lee has been very effective in the years since she first worked on a proposal that mirrored yours. And, Baroness, you can also be effective. All you need to do is remember a few crucial points:

* Be very careful with language. Use soothing phrases.
* Don't try to achieve your entire goal at one time. Use a step-by-step approach.
* Manufacture statistics. Use them to bolster your claims, whatever they are.
* Portray any opposition as "anti-choice religious zealots."
* Keep all focus on the current proposal. Never discuss your plans for expansion.
* Always portray your motivation as caring and compassionate. Never, ever, let anyone know that you see legalized assisted suicide and euthanasia as a means of cost containment.
If you follow these few simple steps, you could be well on your way to achieving your end goal. You might want to reflect on the sentiments expressed by Booth Gardner, the former governor of Washington State and the principle spokesperson for the current Washington campaign. In December 2007, Gardner was interviewed by The New York Times Magazine. According to that article:

Gardner's campaign is a compromise; he sees it as a first step. If he can sway Washington to embrace a restrictive law, then other states will follow. And gradually, he says, the nation's resistance will subside, the culture will shift and laws with more latitude will be passed...."

In closing, Baroness, I hope this advice has given you some guidance in how you can be more effective.

However, more than that, I hope those who read this advice will see you as an ethics guru, grown arrogant by too much deference, whose agenda is a cold, cruel dismissal of the lives of those who are most vulnerable. Furthermore, I hope they will recognize that Washington's assisted-suicide proposal and Oregon's law are rooted in the same mentality.

Rita L. Marker

Rita L. Marker is an attorney and executive director of the International Task Force on Euthanasia and Assisted Suicide.

Debbie Purdy - Assisted Suicide UK law review

Dignity in Dying campaigner Debbie Purdy has progressive multiple sclerosis. She may at some stage wish to receive assisted suicide and wants her husband Omar to be immune from prosecution in the UK should he accompany her to Dignitas, the Swiss assisted suicide clinic. Her campaign bears striking similarities to that of the late Diane Pretty. Dignity in Dying is the leading euthanasia lobby group in the UK.

The Care Not Killing Alliance in the UK stated that they:

welcome a full airing of the arguments, but they warned that legalising assisted suicide would put vulnerable people at risk and make them susceptible to exploitation and abuse - a view upheld by the House of Lords vote on the Joffe Bill in 2006.

Care Not Killing's campaign director Dr Peter Saunders stated his concerns in this manner:

We welcome this opportunity to revisit the arguments and are confident that the court will find that, in order to protect vulnerable people from exploitation, the current law should be upheld.

Assisting in another's suicide is a criminal offence which carries a sentence of up to 14 years imprisonment. The law is very clear on this matter and should not be changed. Changing it to allow assisted suicide would place vulnerable people – the sick, elderly, depressed and disabled – under pressure, whether real or imagined, to request early death. Vulnerable people often feel that they constitute a financial or emotional burden to others and the so-called 'right to die' can so easily become the duty to die. Once a person has been 'helped to die' it is often very difficult to know whether there has been subtle coercion involved from someone who has an interest in a person's death.

Requests like this are thankfully extremely rare and hard cases make bad law. We must not legislate for exceptions and the House of Lords for this reason in 2006 quite rightly rejected Lord Joffe's assisted dying bill. There are over 70,000 people in Britain with multiple sclerosis at present and only a very small number ever request assisted suicide. These requests are virtually never persistent if patients' physical, emotional and spiritual needs are properly addressed. Our key priority must therefore be to make the very best palliative care more widely accessible and to get rid of the postcode lottery of care that currently exists in Britain.

We are concerned about Mrs Purdy's expressed fear of choking to death or experiencing excruciating pain because with good palliative care these fears are quite groundless with multiple sclerosis. The public is being misled over this. There have been great advances in the management of multiple sclerosis which have benefited patients and now mean that many with the disease live an almost normal lifespan. Mrs Purdy has had MS for 13 years already and may have many more years still to live. It is also not at all clear, given the type of illness she has, that she would ever need assistance to end her life, should she be determined to do so. This case has to be seen therefore in the wider context of an ongoing campaign by Dignity in Dying, formerly the Voluntary Euthanasia Society, to change the law.

The key issue here remains whether the law should be changed for the very small number of people who press for assisted suicide. Our view is that in order to protect others from exploitation it should not be.

Link to the comments by the Care Not Killing Alliance:
http://www.carenotkilling.org.uk/?show=443

Washington State Medical Association stongly opposes Initiative 1000

From the brochure produced by the Washington State Medical Association the physicians group makes it very clear that they oppose the I-1000 Initiative to legalize assisted suicide in their state.

The brochure titled: The Washington State Medical Association strongly opposes Initiative 1000 - I-1000 is not the answer.

The brochure states:
The WSMA believes physician assisted suicide is fundamentally incompatible with the role of physicians as healers. Patients put trust in physicians and that bond of trust would be irrevocably harmed by the provisions of this dangerous initiative.

Under the title - Patients Deserve Quality End of Life Care, the brochure states:
Requests for physician-assisted suicide are a signal that a patient's needs are unmet. Many patients are fearful about the choices they and their families will face a the end of life.

Significant advances in palliative medicine in recent years now provide doctors and patients the ability to control pain and other symptoms at the end of life. No one should feel forced to choose suicide for fear that good medical care is not available.

The citizens of Washington State need to heed the warning from the Washington State Medical Association. Why would a person suggest that physicians should be legally involved with assisted suicide when they themselves believe that it is wrong.

The brochure features a big check mark and the statement.
Vote NO on I-1000 this November.

Link to the brochure by the Washington State Medical Association:
http://www.wsma.org/files/Downloads/PatientResources/I-1000_brochure.pdf

Angel of Death and her Supervisor

Two nurses were indicted in April for causing the death of five patients at the McHenry County Nursing Home in 2006 in Woodstock Illinois.

From the article in the Chicago Tribune:

Marty Himebaugh, a Lake in the Hills resident and a licensed practical nurse, was charged with four counts of criminal neglect of a long-term care resident, one count of obtaining morphine by fraud, and one count of unlawful distribution of a controlled substance.

Penny Whitlock, a former director of nursing at the facility and a Woodstock city resident, was charged with five counts of criminal neglect of a long-term care resident and two counts of obstructing justice.

Both women have pleaded not guilty in McHenry County Circuit Court.

The Chicago Tribune article also stated:

A supervisor allegedly told a nurse, "I do not care if you play the angel of death, just don't let me know about it," the report says.

"She won't make it through the day," the report says the nurse told a co-worker, referring to a restless patient. "I made sure of that."

The Department of Public Health report also refers to a 56-year-old man with Down syndrome who died in April 2006 and quotes a nurse telling a co-worker: "Those people aren't meant to live that long. They are meant to die in their teens and I'm going to help him along."

Chicago Tribune article:
http://www.chicagotribune.com/news/local/chi-nurse-deaths-web-26-sep26,0,6187039.story

At the time that the indictments were announced, prosecutors said they did not believe there was enough evidence to prove that any of the patients were killed.

Dick Sobsey, director of the John Dossetor Health Ethics Centre, Dobsey stated in his blog:

In my opinion, if the statements made by these nurses can be verified, the nurse who is alleged to have killed these patients should be charged with attempted murder or murder or both. If it can be shown that the medication overdoses cuased the death, the charge should be murder. If, as is often the case for debilitated patients, the overdose cannot be shown to be the cause of death, the charge should be attempted murder.

Link to Dick Sobsey's blog comment:
http://icad.wordpress.com:80/2008/09/30/angel-of-death-and-her-supervisor/

Initiative 1000 Opponents Debut Actor Martin Sheen in Commercials

FOR IMMEDIATE RELEASE
September 29, 2008

Olympia---Today, the Coalition Against Assisted Suicide announced it has started a $750,000 broadcast advertising campaign, featuring actor Martin Sheen. Sheen agreed to help publicize the dangers of Initiative 1000, the assisted suicide measure on the November ballot in Washington State.

"Martin Sheen is an outstanding actor and a person of impeccable integrity. His tireless efforts to help low income people across the country and his concern for vulnerable populations have earned him the reputation of a man who is compassionate and walks his talk," said Coalition Chair, Chris Carlson. "We are happy to add his distinguished voice to the growing chorus of people opposed to assisted suicide being legalized in Washington."

Carlson reported radio ads are beginning today (Monday, September 29), with television ads to begin on October 1st in the Seattle, Spokane, Yakima and Tri-Cities markets.

For his part, Sheen was eager to make a statement against assisted suicide.

"I try to work when I'm not on the screen to help improve conditions for the most vulnerable people in our country -- low wage workers, immigrants, the disabled and the poor," Sheen said. "We have a health care system where the more money you have, the better medical care you receive. Initiative 1000 is a dangerous idea -- because so many people do not have the money necessary to get the care they need. When I heard about Initiative 1000, I wanted to help stop it before it harms people who are at risk."

"Assisted suicide and a for-profit health care system are a lethal mixture," Carlson said. "As a society, we should be focusing more on creating safe harbors for people truly in need at the end of their life, not providing quick fixes like suicide." He added, "In Oregon, where assisted suicide is legal, some cancer patients have already been denied treatment and steered towards assisted suicide."

"The proponents have often suggested that assisted suicide is favored by good Democrats, liberals and progressives but that's just not the case," Carlson said. "I'm a Democrat, Martin Sheen is a Democrat, and many people opposed to I-1000 are progressives —- and that's why we're opposed; we don't want vulnerable people harmed, nor do we believe doctors should be asked to encourage people to end their lives prematurely."

Sheen is best known for his Emmy-award winning role in the drama "West Wing" where he played a Democratic president, and for many movie roles including "Apocalypse Now," "The American President," and "The Departed."

"It is absolutely crucial that voters understand the very real implications of I-1000. Most people in Washington don't even know that I-1000 is on the ballot this November, and ballots will be mailed in the next three weeks. Martin Sheen is a man of intelligence, integrity, character, and compassion, and we are grateful that he is lending his support to the effort to educate the public now about why Initiative 1000 is a truly flawed initiative and a dangerous social policy," said Eileen Geller, R.N., B.S.N., the Coalition's campaign coordinator.

According to Geller, the ads point out some of the little known, major flaws of the proposed law:

* Spouses and family members do not need to be told before — or after — a loved one is given lethal drugs.
* Persons suffering from depression can be given a lethal overdose without any psychological counseling or treatment — nothing in the Initiative requires an assessment of potential depression by a qualified professional.
* Health care insurers and HMO's could exploit I-1000 to save costs, since a bottle of lethal drugs costs far less than other end-of-life care.
* Heirs to a patient’s estate are allowed to participate in the assisted suicide and to witness the request for lethal drugs. This would contravene existing practice governing wills and estates, a scenario that worries law enforcement because of the real potential for abuse.

Geller noted that the Coalition Against Assisted suicide is working hard to raise more money to fund an even larger media buy, but the Coalition still expects to be outspent at least three-to-one by proponents of physician assisted suicide.

Copies of the ads can be found at www.noassistedsuicide.com/ads.html

Do the Demented Have a Duty to Die?

Last week the famous UK ethicist, Lady Warnock, stated to a Church of Scotland that people who have dementia/alzheimer's disease have a duty to die.

Ken Connor, the chairman of the board for the Center for a Just Society, wrote an excellent, Christian response to Lady Warnock's idea of the "Duty to Die".

Please link to his article. It is worth reading.

Link to the article by Ken Connor:
http://www.centerforajustsociety.org/press/article.asp?pr=3956

Nobody has a duty to die.

The title of this article would appear to come from a person who opposes euthanasia and assisted suicide. But rather it comes from the Right to Die lobby who are busy doing damage control after Lady Warnock, the esteemed British ethicist stated that people with dementia had a duty to die.

Warnock stated in an article in the Church of Scotland Magazine - Life and Work:

"I'm absolutely, fully in agreement with the argument that if pain is insufferable, then someone should be given help to die, but I feel there's a wider argument that if somebody absolutely, desperately wants to die because they're a burden to their family, or the state, then I think they too should be allowed to die."

Sarah Wootten, a leader of the Dying in Dignity euthanasia lobby group tries to distance herself from Warnock's comments by stating:

"Baroness Warnock is right on her first point. Terminally ill adults in unbearable suffering should be able to choose when and where they die, within strict legal safeguards. However, she is very wrong on her second point - absolutely no one has a duty to die."

Wootten leaves out of her article Warnock's strongest comments which were:

"If you've an advance directive, appointing someone else to act on your behalf, if you become incapacitated, then I think there is a hope that your advocate may say that you would not wish to live in this condition so please try to help her die."

In other words, even if you are incapable of making the decision, someone else should be allowed to make the decision to end your life. Therefore the "duty to die" should also be a "duty to kill"

Link to blog entry concerning Lady Warnock's comments:
http://alexschadenberg.blogspot.com/2008/09/dementia-sufferers-may-have-duty-to-die.html

Wootten further distances herself from Warnock's comments by stating:
"Of course, some will disagree - those who seek to impose their own beliefs on others and those who do not think we go far enough (read in Warnock). However, Dying in Dignity's position is clear. When even the best end-of-life care cannot allow all terminally ill people to avoid suffering they feel is unbearable, it is sadly inevitable that some of them will resort to traveling abroad to die, botched suicide attempts and "mercy killings". This situation is simply wrong: we need regulation at the end of life that allows choice while protecting vulnerable people."

Link to the article in the Guardian:
http://www.guardian.co.uk/commentisfree/2008/sep/28/socialcare.health
Nicely said Sarah, but where euthanasia is legal and regulated, such as in the Netherlands and Belgium, there are a significant number of cases of abuses and a significant problem with under-reporting of deaths.

In the New England Journal of Medicine study of euthanasia in the Netherlands in 2005 they found that 550 deaths that year in the Netherlands were people who did not request death or indicate any form of consent.

What Wootton and other leaders in the euthanasia lobby tend to ignore is the fact that these decisions cannot be effectively regulated because these are decisions that are made behind closed doors, with family members and medical professionals who have their own personal set of values. Many people believe that an imposed death is the most caring act one can offer for a loved one in their final days.

The only assurance that will ever protect vulnerable people is to always offer the best and most appropriate CARE and to never KILL.

Link to the New England Journal of Medicine article on End-of-life practises in the Netherlands - 2005:
http://content.nejm.org/cgi/reprint/356/19/1957.pdf

Bioethics Blog Defends Warnock's Call for Killing of People with Dementia

Stephen Drake, the masterful research director for Not Dead Yet discovered that the blog for the American Journal of Bioethics featured an entry by Summer Johnson Ph.D., who came out supporting Warnock's call to euthanize people with dementia.

Link to the Not Dead Yet blog:
http://notdeadyetnewscommentary.blogspot.com/2008/09/bioethics-blog-defends-warnocks-call.html

On September 19, I reported on this blog that Baroness Warnock(84), a leading ethicist in the UK was suggesting that people with dementia had a duty to die.
Link to my blog entry:
http://alexschadenberg.blogspot.com/2008/09/dementia-sufferers-may-have-duty-to-die.html

Many people reacted by thinking these were just a few comments by a demented old woman, but in fact these are mainstream views among the euthanasia lobby who are busy planning for a day where they can obtain the "last-will-pill" or the "peaceful pill" and help mother out-of-her misery.

In case you think that Summer Johnson (pictured above) is possibly another thinker that is part of an extreme fringe, then just look at her bio:

Summer Johnson Ph.D. is the director of the Ethics in Novel Technologies, Research, and Innovation (ENTRI) program of the Alden March Bioethics Institute and a tenure-track Assistant Professor of Medicine. She is also the Director of Graduate Studies at AMBI at Albany Medical School.

Her bio goes on and is very impressive.

Thank you Summer Johnson for proving that Warnock is not alone.

The real question is: What are we going to do about this?

Oregon Death with Dignity Political Action Fund donating up to $1 million to Washington Yes on 1000 Campaign

Dear Friends:

I have just come across this message (below) from the Oregon Death with Dignity Political Action Fund promising to empty their coffers by matching all further donations to the Yeson1000 campaign in Washington State - up to $1 million. They also elude to the fact that all donations of $5000 or more must be received by October 13.

I wish the Euthanasia Prevention Coalition could make a similar financial commitment, but unlike the euthanasia lobby, we lack the donors with deep pockets.

Nonetheless, you can make a difference. We cannot allow the euthanasia lobby to brainwash the public by running television commercials without a counter-point-of-view.

We absolutely need people and organizations, like yourselves, to give to the Washington Coalition Against Assisted Suicide. I am not a great begger for money but there has never been a more important time, than today, to make a large donation to stop the forward progression of the culture of death.

Just 3 days ago the Oregonian newspaper editorial board (the largest newspaper in Oregon) stated that they are opposed to the I-1000 assisted suicide initiative in Washington State. You can link to the article from the Oregonian by going to my blog at: http://alexschadenberg.blogspot.com/2008/09/oregonian-editorial-board-opposes.html

If Washington State passes the I-1000 assisted suicide initiative then their will be a wild-fire response of new initiatives to legalize assisted suicide everywhere. Our leaders are already discussing the need to establish coalitions in states throughout the US to organize an effective response to the impending initiatives.

Please give generously to the Coalition Against Assisted Suicide.

Contact them at: Coalition Against Assisted Suicide, P.O. Box 11794, Olympia Washington, 98508, Phone (206) 337-2091 or go to: https://ssl22.pair.com/stshore/contribute_suicide.html

Thank you for your generous response.

Alex Schadenberg
Euthanasia Prevention Coalition
Call: 1-877-439-3348
email: info@epcc.ca

P.S. Please read the message from The Oregon Death with Dignity Political Action Fund that is reprinted below.


Washington Campaign Enters Final Weeks

The Oregon Death with Dignity Political Action Fund is leading efforts to raise $1M to ensure passage of the Washington Death with Dignity initiative this November.

We are entering the most critical time for the Washington campaign. We are working on the final push to raise enough money to purchase television commercials to counter our opponents' lies in the media.

In every past Death with Dignity campaign, our opponents, including the Catholic Church, have funneled hundreds of thousands of dollars in last-minute donations into efforts to defeat us on Election Day. They have used this money to spread scare tactics and lies. In order to win, we have to successfully counter these ads with the truth about I-1000 and our experience with Oregon's Death with Dignity law.

So far, we have experienced phenomenal success. Every piece of the campaign has fallen into place, and we are on the brink of victory on November 4. We exceeded the number of signatures required to be included on the ballot by 100,000. We have three former Washington governors endorsing the Death with Dignity initiative. We have endorsements from nine different editorial boards, including the biggest newspaper in the state. We can see a win!

We are asking you today to meet our challenge of raising $1M for the Washington campaign. The Oregon Death with Dignity Political Action Fund has agreed to empty our coffers and incur a substantial financial loss in order to assure success for this campaign. This campaign is so important to our organization that we are willing to go broke trying to win it!

We originally donated $315,000 in seed money to the campaign. And we are now prepared to contribute an additional $500,000 in matching funds for every donation received by the campaign to reach the $1M goal. Your gift will have double the impact!

Campaign finance laws in Washington state require that all donations over $5,000 be made by October 13. We have very little time. Please show your support today by making a secure, on-line donation directly to the Yes on I-1000 campaign.

The time is now to catapult the Death with Dignity movement forward. The power is yours to make this happen.

Thank you.
Sincerely, All of us at the Oregon Death with Dignity Political Action Fund

New Diagnostic Techniques to Reduce Forty Percent PVS Misdiagnosis

Wesley Smith has written a blog about a report in the Times of London (England) that explained how a new diagnostic technique may reduce the level of misdiagnosis of Persistent Vegetative State (PVS) by 40 percent.

For those who thought that Terri Schiavo was in a PVS state, the question you should ask is: Are You Sure?

I remember a presentation that I heard in March 2004 at the Congress on: Life-Sustaining Treatments and Vegetative State that was organized by the Pontifical Academy for Life. The presentation was by the author of a study that concluded that more than 40 percent of people diagnosed as PVS were misdiagnosed.

The presentation effected me because the author of the study explained that in the UK someone can be dehydrated to death if they are diagnosed as PVS. The concern was that the person be properly diagnosed to avoid dehydrating people that could be rehabilitated.

Link to the Blog
http://www.wesleyjsmith.com/blog/2008/09/new-diagnostic-techniques-to-reduce.html

Link to the original article:
http://www.timesonline.co.uk:80/tol/life_and_style/health/article3004892.ece

Link to the Andrews study on misdiagnosis of PVS:
http://www.bmj.com/cgi/content/full/313/7048/13

The Oregonian Editorial Board opposes Washington State I-1000 assisted suicide initiative

The Editorial Board for the largest newspaper in Oregon opposes the I-1000 initiative to legalize assisted suicide in Washington State.

The Oregonian Editorial Board states under the headline: Washington state's assisted-suicide measure: Don't go there that

Still, even though Washington's initiative closely parallels Oregon's law, we won't be endorsing it.

Our fundamental objection is the same it has always been -- that's it's wrong to use physicians and pharmacists to hasten patients' deaths.

The Oregonian bases their opposition to the I-1000 assisted suicide initiative on Oregon's mixed experience with assisted suicide. The article states:

On the plus side, the law has not created a tidal wave of assisted suicide since its enactment in 1997. Only 341 (reported) patients, 86 percent of them with terminal cancer, have died under its provisions. More than a third of those who have obtained lethal prescriptions never used them.

It's also true that the law is popular, twice winning voter approval, and that vigorous public debate over it has led to much-improved end-of-life care in Oregon. The state is recognized today as the national leader in providing access to palliative medicine and pain treatment.
(Alex's comment - Oregon is not a leader in palliative care, even though the euthanasia lobby claims that they are)

The Oregon experience, however, has brought similar reform in many other states, including Washington, where most physicians don't want to write prescriptions to hasten patients' deaths. An argument can be made that Oregon's influence has already improved end-of-life care in Washington so much that the new law is not needed
(Alex's comment - There has been an improvement in palliative care throughtout North America. There is no proof that this improvement is related to the Assisted Suicide law in Oregon.)

On the negative side, Oregon's physician-assisted suicide program has not been sufficiently transparent. Essentially, a coterie of insiders run the program, with a handful of doctors and others deciding what the public may know. We're aware of no substantiated abuses, but we'd feel more confident with more sunlight on the program.

The article concluded by stating:

We defended Oregon's right to this law when it was under attack by the Bush administration, and we have taken sharp issue with claims that the worst fears about the program have been borne out. But our basic unease with physician-assisted suicide has not changed, and we cannot exhort Washington voters to take the same path.

Link to the Oregonian Editorial Board position:
http://www.oregonlive.com:80/opinion/index.ssf/2008/09/washington_states_assistedsuic.html

Dementia sufferers may have a 'duty to die'

By Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Baroness Warnock

Baroness Warnock (84), a veteran UK government advisor and one of Britains leading moral philosophers recently stated in a interview with the Church of Scotland's magazine - Life and Work that:

Elderly people suffering from dementia should consider ending their lives because they are a burden on the National Health System (NHS) and their families.

Warnock said:

Pensioners in mental decline are "wasting people's lives" because of the care they require and should be allowed to opt for euthanasia even if they are not in pain.

She insisted that there was "nothing wrong" with people being helped to die for the sake of their loved ones or society.

She hoped people will soon be "licensed to put others down" if they are unable to look after themselves.

The article in the Telegraph stated that:

Recent figures show there are 700,000 people with degenerative diseases such as Alzheimer's in Britain. By 2026 experts predict there will be one million dementia sufferers in the country, costing the NHS an estimated 35 billion pounds a year.

The article also stated that:

Last year the Mental Capacity Act came into effect (UK) that gives legal force to "living wills", so patients can appoint an "attorney" to tell doctors when their food and water should be removed.

Warnock also stated that:

"I'm absolutely, fully in agreement that if pain is insufferable, then someone should be given help to die, but I feel there's a wider argument that if somebody absolutely, desperately wants to die because they're a burden to their family, or the state, then I think they should be allowed to die."

"Actually I've just written an article called 'A Duty tod Die?' for a Norwegian periodical. I wrote it really suggesting that there's nothing wrong with feeling you ought to do so for the sake of others as well as yourself."

"If you've an advance directive, appointing someone else to act on your behalf, if you become incapacitated, then I think there is a hope that your advocate may say that you would not wish to live in this condition so please try to help her die."

The article quoted Neil Hunt, the chief executive of the Alzheimer's Society, who said:

"I am shocked and amazed that Baroness Warnock could disregard the value of the lives of people with dementia so callously.

With the right care, a person can have good quality of life very late in to dementia. To suggest that people with dementia shouldn't be entitled to that quality of life or that they should feel that they have some sort of duty to kill themselves is nothing short of barbaric."

The euthanasia lobby has always sold their goals within the framework of suffering, terminally ill people who make a free choice to die. They are a movement that rarely reveal their real goals.

Dr. Philip Nitschke - Australia's Dr. Death, hopes to distribute a "peaceful pill" that would be available to anyone who is tired of living. Nitschke stated several years agon in an interview with the National Review that the "peaceful pill" would be available to troubled teens.

Previous blog entry:
http://alexschadenberg.blogspot.com/2008/05/alleged-suicide-job-shocks-campaigners.html

Dying With Dignity in the Netherlands (NVVE) has made it very clear in their newsletters that their final goal is the "last will pill" that could be taken by anyone who is tired of living.

At the World Federation of Right to Die conference in September 2006 in Toronto, Dr. Rob Jonquiére, the CEO of the NVVE stated that the actions of the radical side of the right to die movement was holding politicians back from supporting the "last will pill".

The NVVE is also working on establishing euthanasia as a human right.

A previous blog entry
http://alexschadenberg.blogspot.com/search/label/Last-will-pill

The next time you are affected by the sales pitch by the euthanasia lobby remember. The end game will be a universal right to die for the competent, a duty to die for the incompetent, and a social pressure on people with disabilities and the elderly to take the "last will/peaceful pill".

The voters in Washington State need to read the comments by Baroness Warnock, Philip Nitscke, the NVVE in the Netherlands and Ludwig Minelli in Switzerland. They need to understand that assisted suicide will not stop with the Initiative 1000 campaign, even Booth Gardner has stated that the I-1000 initiative is only the beginning because voters will not accept more at this time.

Link to the article in the Telegraph:
http://www.telegraph.co.uk:80/news/uknews/2983652/Baroness-Warnock-Dementia-sufferers-may-have-a-duty-to-die.html