Euthanasia bill defeated in South Australia, euthanasia lobby suggests another bill next year

The Parnell/Key euthanasia bill was defeated in the South Australian legislature on Wednesday, November 24, by the voice vote. Parnell pulled the bill from receiving a final vote but admitted that the bill was probably going to be defeated by a vote of 12 to 9.

After the bill was defeated it was suggested that another bill will be brought before the legislature next year.

This is a significant victory.

Last year a similar bill was defeated by a vote of 11 to 9. Since then, South Australia had elections that resulted in 3 of the 11 members who opposed euthanasia being defeated. It was significant that two more Liberal members moved to oppose the bill.

An article by Michael Cook stated:

Liberal Jing Lee, a swinging voter, was not convinced either. "There are many problems with this Bill," she said. "What I am afraid of is voluntary euthanasia will inevitably mean in some cases involuntary euthanasia."

Family First MLC Dennis Hood argued that the bill had too many loopholes. He claimed that it allowed euthanasia for patients without a terminal illness and allowed people to take out life insurance policies shortly before undergoing euthanasia. Referral to psychiatrists was only optional in the bill and the proposed Voluntary Euthanasia Board was “toothless”. “This was a dangerous proposal and I’m glad it is off the table now so that we can get on with serious business for South Australia,” said Mr Hood.

An article by Sarah Martin that was published in Adelaide Now stated:

The Bill, prepared by Greens MLC Mark Parnell and ALP backbencher Steph Key, was defeated "on the voices" and did not go to a vote after debate indicated it would be defeated.

Mr Parnell said some key members had expressed in-principle support for voluntary euthanasia which had "left the door open" for future legislation.

"Of course we are disappointed the Bill didn't pass the Upper House last night, but this by no means is the end of the debate," he said.

"The Bill Steph Key and I have introduced is still very much alive in the Lower House (and) it's time for the Lower House to start doing some heavy lifting on this issue."

The debate lasted several hours, with about 12 members indicating they would vote against the Bill.

Euthanasia advocate Philip Nitschke said the defeat of the Bill was a "significant setback".

"Unless there are some lessons learnt from this experience and changes made, it is hard to hold out much hope for the voluntary euthanasia legislation to be presented to the SA Lower House next year."

The group HOPE (saying no to euthanasia) needs to be congratulated for the defeat of the bill. HOPE organized an effective opposition and lobbying campaign to defeat the bill.

Thank you to Paul Russell and the team at HOPE. http://www.noeuthanasia.org.au/

Analysis of the South Australia euthanasia bills

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

On Wednesday, November 24, 2010; there will be a debate and vote on the Parnell/Key euthanasia bills in South Australia. These bills are identical, one being in the upper house and one in the lower house.

The Parnell/Key bills are deceptively titled: Consent to Medical Treatment and Palliative Care (End of Life Arrangements) Amendment Bill 2010. What these bills do is they legalize euthanasia in South Australia by amending the Consent to Medical Treatment and Palliative Care Act 1995.

Legalizing euthanasia means that the law will allow a physician to directly and intentionally cause the death of their patient. These Acts are designed to determine the conditions to allow an act, that is currently recognized as homicide.

These bills are so cumbersome that a physician will likely need to consult a lawyer, or the euthanasia lobby, before deciding to lethally inject a person.

It is possible that the euthanasia lobby intended these bills to be complicated to ensure that physicians would need to consult them on the workings of the law.

Even the rules that are prescribed in the bill related to the establishment of a “Euthanasia Board” are cumbersome.

Definitions are everything.

The bills allows a lethal injection to be given to (35) (1):

(a) an adult person who is in the terminal phase of a terminal illness. The words terminal phase and terminal illness are not defined.

(b) An adult person who is suffering from an illness, injury or other medical condition (other than mental illness within the meaning of the Mental Health Act 2009) that irreversibly impairs the person’s quality of life so that lie has become intolerable to that person.

Section (b) essentially applies to anyone who has a significant physical disability or a long-term chronic condition.

Many people live with an illness, injury or other medical condition that irreversibly impairs the person’s “quality of life”. But when did society decide that people who live with disabilities or chronic conditions are better off dead?

Does this bill limit euthanasia to the “free choice” of a person?.

The bill states that if the physician suspects that the person is not of sound mind, or possible under some form of duress that the physician must obtain a certificate from a psychiatrist before being allowed to lethally inject the person.

This is a similar provision to the assisted suicide statute in Oregon. In the first year of the Oregon assisted suicide law, 11 of 24 people were sent for a psychiatric assessment. In 2009, 0 of 59 people who died by assisted suicide were sent for a psychiatric assessment.

An independent study by Linda Ganzini that was published in 2008 found that 15 of 58 people (26%) who had requested assisted suicide were depressed or experiencing feelings of hopelessness. BMA 2008, 337: a. 1682.

“Safeguards” to prevent people who are depressed from dying from euthanasia are only as good as the people who operate the law. Most physicians are not experts in depression or mental illness, therefore the “safeguard” will be rarely, if ever, applied.

These bills would allow someone, to request in advance of a possible medical condition, that a lethal injection be done , while in a possible future state of health.

The purpose for this section of the bill is to give physicians the right to lethally inject people who have Alzheimer disease or dementia. If people in South Australia are encouraged to sign advanced directives for euthanasia, this would eliminate many people when they are expensive to care for and when their lives are considered not worth living.

In Conclusion:
The South Australia bill is written in a cumbersome fashion to make it appear to protect vulnerable people from euthanasia. The bill states that it is about voluntary euthanasia.

By reading the bill it becomes clear that the purpose of the bill is to eliminate the lives of people with disabilities or long-term chronic conditions. The bill is not limited to terminal illness and further, it doesn’t even effectively define terminal illness.

Therefore the cumbersome nature of the bill is either a smoke screen to convince the public that the bill will ensure public safety, which it doesn’t, while it allows wide definitions to ensure that people who are expensive to care for can be lethally injected.

Once again, the cumbersome nature of the bill will also play into the hands of the euthanasia lobby. In Oregon, the 2009 stats indicate that 57 of 59 assisted suicide deaths were facilitated by Compassion & Choices, formerly the Hemlock society. This means that the euthanasia lobby has become responsible for facilitating the law. The same would be true in South Australia.

Members of the South Australian parliament need to reject these bills and re-commit themselves to providing effective care for all of their citizens and not lethal injections for people with disabilities and chronic conditions.

Alex Schadenberg
Euthanasia Prevention Coalition
euthanasiaprevention@on.aibn.com

Homicide or Mercy Killing?

Alex Schadenberg

By Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

The New York Daily News is reporting on a very sad case of homicide, whereby an elderly man shot his wife, reportedly based on compassion.

The daughter of the couple was reported by the newspaper as stating:

"It was a mercy killing," 

"Her mind was gone."

These cases need to be reported very carefully by the media. We do not know the actual intention of the spouse who is the perpetrator.

Research indicates that often a older person who kills their spouse has a history of abuse, has a controlling personality, or is experiencing depression or mental illness. Sadly these acts are almost always done by men.

A recent study entitled: Domestic Homicide and Homicide-Suicide: The Older Offender that was researched by Dominique Bourget and published in the Journal of the American Academy of Psychiatry and the Law 38:3:305-311 (2010) found that a disturbing trend exists in Spousal homicide cases among older persons.

The study found:

Most homicides committed by offenders aged 65 and older occur in a domestic context. In Canada, incidence rates of family homicide against people in this age group have increased in recent years, with spouses or ex-spouses accused in 42 percent of deaths of older women and 25 percent of deaths of older men. Most of the perpetrators of spousal homicide (77%) were close in age to their spouses. This finding differs from results in U.S. studies that indicate that female spousal homicide victims are usually younger than the perpetrators, and that the risk of homicide victimization increases as the age difference between spouses increases.

A history of domestic violence is a major risk factor for spousal homicide for female and male victims of any age. Lethal violence is often a result of long-term abusive behavior by a man against his female partner, and some women kill their intimate partners in a severe reaction to longstanding abuse. Spousal violence often continues into old age. In the past decade in Canada, 37 percent of older adults accused of spousal homicide had past incidents of domestic violence. Older male spousal homicide victims were more likely than older female homicide victims to have a history of domestic violence against the accused. While this finding is consistent with those in previous research that indicate a continuation of spousal violence into old age, it is important to note that the perpetrators of previous domestic violence cannot be established from available police reports. It should also be noted that, for various reasons, the prevalence of domestic violence is likely to be higher than reports indicate and that the apparent association with spousal homicide would therefore also be under-reported.

The study continues by promoting the high rate of mental illness among older persons who are prosecuted for homicide. The study states:

In an investigation of psychiatric characteristics of older offenders (65 and older) who had been referred to a medium-security forensic unit in the London area over a 13-year period, Tomar et al. identified diagnoses of schizophrenia and dementia in three of four homicide perpetrators who had offended after the age of 65. Coid et al. recorded index offenses and lifetime diagnoses of mental disorder in 52 older offenders (aged 60 and older) admitted to seven secure forensic psychiatric services in the United Kingdom over a seven-year period. The investigators found that schizophrenia, other delusional disorders, organic brain syndrome, and depressive disorder were the most prevalent lifetime diagnoses for the offenders, most of whom (82%) had committed homicide or attempted homicide. Link to study.

When reading these very disturbing facts it becomes abundantly clear that when a spouse of many years murders their spouse, even when the spouse who died was ill, one should never conclude that the action was based on a "compassionate" homicide.

It is better to speak about the sad reality of the story and not draw conclusions, especially conclusions that suggest that these acts would not occur if euthanasia or assisted suicide were legalized.

Link to a previous article on this topic.

Montana Supreme Court did not legalize assisted suicide.

A recent article that was written by William L. Saunders and published by Engage was wrongly titled: The Montana Supreme Court Legalizes Assisted Suicide, in fact argues that the Montana Supreme Court did not actually legalize assisted suicide.

Saunders points out that:

In Baxter v. State, decided December 31, 2009, the Montana Supreme Court did not "constitutionalize" a "right to die" as the lower court had done (Judge Dorothy McCarter). Rather, the court held that physicians who prescribe lethal drugs upon the request of their patients are not subject to criminal liability under the "consent defense" to Montana's homicide law. Thus technically the court did not "legalize" assisted suicide; rather, someone who assists a suicide simply has a "defense" to homicide.

Link to article.

Melchert-Dinkel pleads not guilty to encouraging suicide

An article in the AOL news article by Hugh Collins, a few days ago, reported that William Melchert-Dinkel has pled not guilty of encouraging suicide in the deaths of Nadia Kajouji, the Carlton University student in Ottawa Canada, who died by suicide in March 2008 and Mark Drybrough, of Coventry England, who died in 2005.

The article stated:

Prosecutors in Rice County, Minn., say that Merchert-Dinkel posed as a female nurse on Internet chat rooms and gave Kajouji and Drybrough advice on how they could best kill themselves. He entered his not guilty plea Friday.

If found guilty, Melchert-Dinkel, who is now a truck driver, could face 15 years in prison, QMI Agency said.

Using online names such as "Cami" and "Li Dao," Melchert-Dinkel allegedly discussed techniques for suicide and even offered to enter into a suicide pact with Kajouji to strengthen her resolve.

Melchert-Dinkel admitted to entering into suicide pacts with about 10 people. He believes that five of these people went on to kill themselves.

Melchert-Dinkel's lawyer failed to have the case dismissed based on communication via the internet being protected as free speech. Judge Thomas Neuville disagreed.

Melchert-Dinkel's lawyer is now attempting to have the case dismissed because the deaths did not take place in the United States.

The article states that:

District Judge Thomas Neuville will take the matter under advisement on Dec. 13. He will then have 60 days to make a decision.

The article stated that:

In one Internet chat, "Li Dao" (Melchert-Dinkel) offered Drybrough advice on how to hang himself without attaching the rope to the ceiling.

Police in Britain and the United States examined Drybrough's computer and determined that he had sought advice online on how to kill himself, Prosecutors say this advice came from Melchert-Dinkel's computer.

Marc kajouji, Nadia's brother stated in the article:

Surprisingly, I don't spend much time worrying what happens to Melchert-Dinkel. I spend my time thinking about how I can help others prevent suicide from hitting their family.

William Melchert-Dinkel needs to be prosecuted for steering vulnerable depressed people toward suicide.

Dying man opposes South Australia Euthanasia Bill

Dear Mr Premier,

Re: Voluntary Euthanasia Bill 2010

I write this letter to you my own name only and not in the name of my institute, of any Government Committees in which I am involved, or of any organisation. I write because what happens in South Australia on this matter will affect all Australians, particularly those who, like me, meet the requirements of the Bill.

Relevant to this matter is the fact that I am dealing with my own terminal illness (combination of renal failure, advanced ischaemic heart disease and Rheumatoid auto-immune disease) and am dependant on haemodialysis and palliative care. I have undergone 15 angioplasty procedures and the placement of eight stents to attempt to recover some blood flow after the failure of coronary bypass surgery. The last such procedure was unsuccessful as the blocked artery could not be accessed. The Rheumatoid disease causes chronic pleuropericarditis. I mention these matters only to establish that I am no stranger to suffering and disability, and am well aware of the limitations of palliative care. It is particularly difficult to control chronic pain because the effectiveness of most forms of pain relief is of limited duration, given the development of therapeutic tolerance. I have reached the limits of what palliative care can offer.

I cannot speak for all people who suffer from illness and disability, but think I can speak more credibly about suffering, illness and disability than those people who advocate for euthanasia presenting an ideological view of suffering and disability. Facing illness and disability takes courage and we do not need those euthanasia advocates to tell us that we are so lacking dignity and have such a poor quality of life that our lives are not worth living.

Professionally, I have been involved with issues to do with the care of the terminally ill for many years, having been Australia’s first hospital ethicist, twenty-eight years ago, at St Vincent’s Hospital, Melbourne, where I was also Director of Bioethics for a period of eight years.

Since then I have been a consultant ethicist in private practice and have taught ethics in the medical faculties of the University of Melbourne and Monash University, before taking my current position at the John Paul II Institute. The Institute is associated with the Lateran University in Rome and is a registered Higher Education Provider in Australian offering accredited specialist graduate courses in Bioethics and in Theological Studies in Marriage and Family.

Also relevant is that recently I had the experience of chairing a National Health and Medical Research Council (NHMRC) Working Committee preparing guidelines for the care of people in an unresponsive state or a minimally responsive state and receiving a large number of public submissions on that topic. The topic is closely related to the topic of your enquiry. The strength of submissions from people who care daily for Australia’s most dependant and needy individuals was overwhelming and I highly recommend that you read the public submissions on the NHMRC’s web-site or at least read the NHMRC Ethical Guidelines for the Care of People in an Unresponsive State or a Minimally Responsive State (2008). Importantly, the guidelines provide a careful analysis of the way in which care decisions may be made so as to preserve respect for the dignity and worth of people who are so profoundly disabled and to provide care for the families and others who care for people with PCU or MRS.

I have also had a long-term association with a home hospice service that serves the eastern area of Melbourne. I would like to record my own view that it would not benefit seriously ill South Australians, particularly those who are terminally ill and suffering intractably, if the Voluntary Euthanasia Bill became law. The current legal situation in South Australia, while not perfect, does provide a measure of protection against the terminally ill being regarded as a burden. As a chronically ill person I know well what it is to feel that one is a burden to others, to both family and community, how isolating illness and disability can be, and how difficult it is to maintain hope in the circumstances of illness, disability and severe pain, especially chronic pain.

For several years, until I objected, I received from my health insurer a letter that tells me how much it costs the fund to maintain my health care. I dreaded receiving that letter and the psychological reasoning that would seem to have motivated it. Each year I was reminded how much of a burden I am to my community. The fear of being a burden is a major risk to the survival of those who are chronically ill. If euthanasia were lawful, that sense of burden would be greatly increased for there would be even greater moral pressure to relinquish one’s hold on a burdensome life. Seriously ill people do not need euthanasia. We need better provision of palliative care services aimed at managing symptoms and maximising function, especially as we approach death. Rather than help to die, the cause of dignity would be more greatly helped if more was done to help people live more fully with the dying process.

The proposal to make provision for a terminally person who is suffering to request, and a doctor to provide, assistance to die makes it less likely that adequate efforts will be made to make better provision for palliative care services. Legalised euthanasia would give those responsible for funding and providing palliative care a political “out” in that respect.

In Australia, too little is done to make adequate palliative care available to those who need it:

• Current entry requirements for palliative care usually exclude people with chronic pain and is often limited to people who are in the last stage of cancer with a prognosis of less than eight weeks;
• The pharmaceutical subsidies for the more effective forms of pain relief are often restricted to cancer patients;
• People living outside major cities have little access to palliative care facilities.
• Few doctors are adequately trained to provide palliative care.
• Such palliative care services as exist are chronically underfunded and struggle to provide the complex range of services that are needed to assist a person to live with pain and disability.
• Most pain clinics are over subscribed and have long waiting lists. For people who are left suffering, such waiting is unconscionable.

Medical research in this area indicates that the desire for euthanasia is not confined to physical or psychosocial concerns relating to advanced disease, but incorporates hidden existential yearnings for connectedness, care and respect, understood within the context of the patient’s lived experience. Euthanasia requests cannot be taken at face value but require in-depth exploration of their covert meaning, in order to ensure that the patients’ needs are being addressed adequately. In Australia, what is needed is often not available or not available in time. It is distressing to note that in the US State of Oregon in 2009, none of the patients who were lawfully killed at their own request were referred for formal psychiatric or psychological evaluation. It is also distressing to note that two thirds of people lawfully killed under euthanasia laws, in those jurisdictions that permit it, are women.

If euthanasia is a legitimate option with a determined structure, such as was the case in the Northern Territory for a brief period, and is now proposed for South Australia, then life for the chronically seriously ill would become contingent upon maintaining a desire to continue in the face of being classified as a burden to others. Essentially the Bill involves setting up a category for people whose lives may be deliberately ended. Their protected status as a member of the South Australian and Australian communities depends on a contingency. Passage of the Bill would imply that our community considers that our continued survival depends on us not succumbing to the effects of pain and suffering, depends on us not losing hope.

I ask simply that the committee find in favour of the status quo in this respect. We need protection and encouragement from our community, we do not need this form of discrimination. Far from protecting the dignity of those who are seriously ill and suffering, the Bill would undermine dignity by undermining our sense of individual worth as a person, no matter our suffering and disability.

It should also be noted that of the seven deaths that happened under the terms of the Rights of the Terminally Act in the Northern Territory that permitted euthanasia, four did not actually meet the criteria . The legislation was manifestly unsafe and I would argue that legislation that permits euthanasia could never be made safe for those of us who have serious chronic illnesses, because the essence of such legislation is to make respect for our lives contingent upon the strength of our will to survive. Such legislation depends on each of us, who have a serious illness and are suffering, not losing hope. If euthanasia is lawful then the question about whether our lives are overly burdensome will be in not only our minds, but the minds of those health professionals and those family members on whose support and encouragement we depend. The mere existence of the option will affect attitudes to our care, and hence our own willingness to continue.

That desire to live is often tenuous in the face of suffering and in the face of the burden our illnesses impose on others, our families and the wider community. You would gain nothing worthwhile for us by supporting the legalisation of deliberately ending the life of those who request death. Such requests warrant a response in solidarity from our community, a response that seeks to give us more support and better care, rather than termination of both life and care.

I note that the Bill has some safeguards including:

• REQUIREMENTS for two doctors, including a specialist, to examine the person making the request.
• DEMANDING a psychiatrist be consulted if either doctor believes the person is not of sound mind or acting under “undue influence”.
• CREATING a Voluntary Euthanasia Board with powers to intervene if any relevant medical practitioner believes a request for euthanasia should not be granted.
• There will be strict obligations on witnesses, jail terms of up to 20 years for misleading statements, and a ban on for-profit centres and the promotion of voluntary euthanasia by insurance companies

However there are many problems with the Bill, in summary:

• The Bill has a very wide scope, it affects not just those who are imminently dying. The definition of “terminal illness” includes people who may be months or years away from their illness causing death. As a person whose life depends on extraordinary care, including haemodialysis for four x four hour sessions each week, on that basis alone, I fit the description. I also have severe angina throughout those sessions, caused by the haemodynamics of the treatment and my own compromised coronary flows, and I have many other episodes of pain throughout the day, including waking at night in pain. Whether that is a profound level of pain and/or distress depends on the support that I receive from those close to me, as much as it depends on my own will. That euthanasia is not offered to me is important to that response. People who are ill and disabled need that support and encouragement and the knowledge that those around them value them.
• The Bill has not been generated by a broad-based enquiry that took into account the interests of all South Australians, and especially those with chronic or terminal illness. It is a narrow approach that excludes the provision of adequate care and support for those in need, and appears to be more a matter of ideology than a genuine attempt to respond to the range of matters that affect us.
• The Bill would expect the doctors involved to prescribe a drug not for legitimate purposes that define the medical vocation, such as the care of the patient or the treatment of illness, but to intentionally and actively intervene to end the life of the patient. In that respect, the Bill is not supported by the Australian Medical Association or any of the medical Colleges. The AMA’s policy on euthanasia is to “strongly oppose any bill to legalize physician-assisted suicide or euthanasia, as these practices are fundamentally inconsistent with the physician’s role as healer” .
• The Bill has not been supported by organizations and institutions directly involved in aged care, the care of the dying or the care of those with chronic illness. Those involved in the day to day care are generally not in favour of being given the capacity to end the lives of those they care for.
• The Bill would not benefit South Australians who suffer from chronic illnesses. Instead it would make protection of their lives dependant on the strength of their will to continue. The fear of being a burden is a major risk to the survival of those who are chronically ill. If euthanasia were lawful, that sense of burden would be greatly increased for there would be even greater moral pressure to relinquish one’s hold on a burdensome life and to remove that burden from the lives of others.
• The Bill is based on a notion of unbearable pain. A major part of pain experience and our capacity to tolerate it is what is sometimes called “existential pain”. Pain of an existential nature arises usually from loneliness and a lack of sense of self worth. The option of euthanasia provides an out for families and carers, and the fact that the option exists would be likely to make someone who had a burdensome illness feel even less valued and increase the likelihood that they would choose death over dying alone or being a burden to others. Serious illness and dying are times when a person needs the support of others so that others can share empathy with that person . The possibility of opting instead for a fatal prescription would cast a shadow over those relationships and would be likely to undermine the person’s wish to be wanted and valued.
• Pain and suffering are complex involving physical, psychological, emotional and spiritual elements. Palliative care seeks to address the needs of those who are suffering in a multi-disciplinary way that reflects the many elements involved . Crucial to good palliative care is the support of the patients socially, emotionally and spiritually. It is not simply a matter of relieving physical pain. For those who continue to live with a burdensome illness, the option of euthanasia would undermine one of the essential elements of good pain relief, the notion that the person is supported, loved and wanted.
• In other places, such as the United Kingdom, for instance, which have adopted very liberal policies on other social policies, such as reproductive technology, gay unions and abortion, the Parliaments have strongly opposed euthanasia because euthanasia cannot be made safe for people who are seriously ill and thus vulnerable. It is worth noting that jurisdictions such as the Netherlands and Belgium that legalised euthanasia, lacked the availability of the kind of palliative care services that developed in the UK.
• Euthanasia law cannot be made safe. The Northern Territory briefly had similar law. As discussed above, several of those for whom the legislation was implemented did not in fact meet the criteria of the Act despite the safeguards. This is reflected also in the Dutch experience where much larger numbers than were expected have been subject to the law, raising human rights concerns, see United Nations’ concern below.
• Euthanasia is contrary to the International Human rights instruments. When the Human Rights Committee of the United Nations considered a euthanasia law enacted in the Netherlands to codify what had become euthanasia practice, the Committee said that where a State party seeks to relax legal protection with respect to an act deliberately intended to put an end to human life, the Committee believes that the International Covenant on Civil and Political Rights obliges it to apply the most rigorous scrutiny to determine whether the State party’s obligations to ensure the right to life are being complied with (articles 2 and 6 of the Covenant). The Committee expressed the concerns that the new Act (in the Netherland) contains a number of conditions under which the physician is not punishable when he or she terminates the life of a person, inter alia at the “voluntary and well-considered request” of the patient in a situation of “unbearable suffering” offering “no prospect of improvement” and “no other reasonable solution”. The Committee also expressed concern lest such a system may fail to detect and prevent situations where undue pressure could lead to these criteria being circumvented. The Committee was also concerned that, with the passage of time, such a practice may lead to routinization and insensitivity to the strict application of the requirements in a way not anticipated. The Committee learnt with unease that under the present legal system more than 2,000 cases of euthanasia and assisted suicide (or a combination of both) were reported to the Netherlands’ review committee in the year 2000 and that the review committee came to a negative assessment only in three cases. The large numbers involved raise doubts whether the present system is only being used in extreme cases in which all the substantive conditions are scrupulously maintained.

I would welcome the opportunity to discuss this letter and the matters raised by the Voluntary Euthanasia Bill 2010 further.

Yours sincerely,
Assoc Prof Nicholas Tonti-Filippini PhD

Link to the original article.

Euthanasia poll, What do the people of Quebec really want?

By Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

CBC News is running an online poll connected to an article that is titled: Euthanasia: Should it be legalized?

When you scroll down a little on the screen you will notice on the right hand side thepoll asks the question - Do you support the legalization of euthanasia? Link to online poll.

The CBC is reporting the results of a poll that was conducted from November 5 - 15, 2010 and commissioned by the CBC and Radio-Canada. The poll suggests that 83% of the people in Quebec want euthanasia legalized.

The reality about polling is that the results are determined by the question.

A recent Environics research group poll that was conducted between September 15 - 22, 2010 of 2025 Canadians that included a sample size of 500 people from Quebec. That poll found that 69% of the people in supported the legalization of euthanasia.

What do Quebecers actually want?

The Environics poll asked several questions to determine what Canadians actually were concerned about and the poll found.

The poll found that:

63% of Canadians and (75%) of Quebecers were concerned that elderly people would feel pressured to accept euthanasia to reduce the cost of health care.

78% of Canadians and (81%) of Quebecers were concerned that a significant number of sick, disabled or elderly persons being euthanized without their consent.

71% of Canadians and (60%) of Quebecers stated the government needs to improve palliative and hospice care rather than legalize euthanasia.

59% supported legalizing euthanasia, with only 22% strongly supporting. Support was highest in Quebec at (69%) and lowest in Saskatchewan/Manitoba 49%. Since last year, support dropped in Quebec by (6%) and dropped in Montreal by (15%).

Quebecers actually want.

Quebecers want the government to improve end-of-life care, rather than legalize euthanasia.

Quebecers are concerned that people will feel pressured to accept euthanasia in order to reduce health care costs.

Quebecers are concerned, that if euthanasia were legal, a significant number of people would be euthanized without consent. This is a well-founded concern. A study that was published in the CMAJ (May, 2010) found that 32% of assisted deaths in the Flanders region of Belgium were done without explicit request or consent.

The Quebec government should not be trying find a way to legalize euthanasia through the back-door, but rather to improve end-of-life care.

Contact Alex Schadenberg at the Euthanasia Prevention Coalition - toll free: 1-877-439-3348 or info@epcc.ca

Compassionate Care

Jean Echlin, the past VP of the Euthanasia Prevention Coalition and a former executive director of the Hospice of Windsor, sent in an article that was published in the Windsor Star concerning the Parliamentary Committee on Palliative and Compassionate Care.

The article is reprinted below:

Compassionate Care

Jean Echlin, Special to The Windsor Star - November 13, 2010

In April 2010, a new federal parliamentary group was formed. This followed the stunning defeat of Bill C-384, which sought to change Canada's Criminal Code to allow euthanasia and assisted suicide.

Thanks to the vision of some members of Parliament who voted against the bill, a non-partisan, multi-party group called "the Parliamentary Committee on Palliative and Compassionate Care (PCPCC) began deliberations.

The Committee is co-chaired by Windsor-Tecumseh MP Joe Comartin (NDP) and NDP Justice Critic; Scarborough Southwest MP Michelle Simson (Lib); Kitchener-Conestoga MP Harold Albrecht (CPC); founding members, MP Frank Valeriote; MP Kelly Block; and more than 50 MP members, with varying degrees of involvement.

A four-pronged approach developed by PCPCC includes: promotion of the need for palliative care for all Canadians facing end-of-life issues such as pain and symptom management; implications of an on-going mental health crisis and suicide prevention; elder abuse, including lack of compassionate care; and issues encountered by persons with disabilities.

Broad consultations are taking place in every region of Canada concerning present levels of care available to an ageing society and a critical nationwide shortage of expertise and resources in the field of palliative, hospice, home-care and mental health.

As a member of the Advisory Council of The deVeber Institute for Bioethics and Social Research's, Toronto, I attended the PCPCC's hearing, in the West Block of the federal Parliament Buildings on October 19.

The deVeber Institute's submission "Proposal for Integrated Palliative Care" was addressed by Dr. L.L. (Barrie) deVeber, founding director of The Institute and myself. The paper points out the need for education in palliative, end-of-life care for all healthcare providers and earlier patient referrals to palliative care specialists.

The existence of the Parliamentary Committee on Palliative and Compassionate Care brings attention to the complex and multi-faceted needs of many Canadians facing the issues and often the chaos associated with acute and chronic pain, debilitating and late stage illness.

Many programs involved with hospice palliative care and pain management exist in Canada, however are accessible to only a small percentage of the population needing these services.

The utilization and effectiveness of these programs make it abundantly clear that there is no need for Canadians to spend much of their lives immobilized by chronic pain or to die in pain, loneliness, anxiety and bereft of dignity. We must keep pushing for appropriate, knowledgeable and compassionate care regardless of a person's diagnosis, (physical or mental illness), age, gender, culture or religious persuasion.

Personally, I am in awe of the enormity of work this parliamentary committee has undertaken. Their commitment to this effort in addition to their parliamentary and constituency workloads is highly commendable. Further, these parliamentarians are showing exemplary non-partisan collaboration in addressing these fundamental issues. It is hoped that this Committee will be a model for future governmental cross-party endeavours.

A favourite proverb: "Do not withhold good from those who deserve it, when it is in your power to act."

Jean Echlin lives in Windsor and is an independent nurse consultant in palliative care and gerontology.

Look beyond the suffering

Alison Davis, the inspired leader of the disability right group - No Less Human in the UK, recently sent a letter that was published in the Herald newspaper in UK.

Davis was responding to Mary Warnock's comments concerning the supposed "safeguards" that would be part of a bill to legalize euthanasia and/or assisted suicide.

Warnock is the same person who suggested in September 2008 that people with dementia may have a 'duty to die'.

Alison Davis wrote:

Mary Warnock makes a fundamental mistake when she suggests that so long as a bill legalising euthanasia/assisted suicide has sufficient “safeguards”, sick and disabled people need not worry that they will be first in the line of candidates for the lethal dose (Why sometimes it’s rational to choose death, Opinion, October 24). There is a more basic problem than relying on “safeguards” which, of course, would be written by the very people who want to legally hasten the end of some people’s lives.

Typical “safeguards” state that the person requesting death must be terminally ill or have an incurable disability; they must be adult, suffering “unbearably and unrelievably” and, crucially,the “choice” must be entirely theirs. All well and good, one might think (that is, if one were not a member of any of those categories).

Let us now consider a person who qualifies under all these “safeguards”.

She has an incurable disability which entails using a wheelchair full time, and her condition is degenerating. It is causing extreme physical pain which the best efforts of many teams of doctors have been unable to alleviate. Her doctors think her life expectancy is very short. An intelligent adult (with a university degree), she says repeatedly, to anyone who will listen, that she wants to die. Feeling unheard by those who could “help” her, she seriously attempts suicide several times, and is saved only by friends. She is furious when she comes around to find herself still in this world.

Legalising euthanasia/assisted suicide would seem to be a boon for a patient like this.

Ten years on, the woman is still disabled, still uses a wheelchair, still has extreme pain. She has moved to a different area where local doctors conclude that since she has lasted 10 years, the prognosis of a very short lifespan must have been wrong. The big change, however, is that she no longer wants to die. She has found that she can use her talents to help others, even more vulnerable than herself, to live and to have better lives than they otherwise would. Fast forward a further 15 years and she is still alive, more determined than ever to live whatever life she has left to the full.

Would the Warnocks of this world agree to add a waiting time – 10 or 20 years – to any bill they draw up, in case of a change of mind? Because human beings are fallible, because life can be good even with great pain, because nobody knows when doctors’ prognoses will be wrong, it is sheer folly to legalise assisted suicide for one group of people because they suffer in certain ways, while spending large amounts of money on “suicide prevention programmes” to prevent the suicides of others who suffer in a different way.

You will have guessed, I’m sure, that I am the woman who wanted to die for 10 years, is still alive today, and who still wants to live. If I had died 25 years ago, I would have missed the best years of my life. Mary Warnock’s mistake is that she seems unable to look past the suffering to see the person, a sad afflication indeed.

Alison Davis - Dorset

Everyone who knows and loves Alison is happy that she is alive. She is truly an inspiring woman.

A Life Beyond Reason

Many people will tell you about a book that you must read or a movie that you must see. The following article is, without a question, an article that you must read. It may be one of the most profound articles about the disability perspective that I have ever read.

Thank you Chris and August Gabbard.

A Life Beyond Reason

By Chris Gabbard

My son, August, has a number of quirks that distinguish him from the typically developing 10-year-old. He lives with cerebral palsy, is a spastic quadriplegic, has cortical visual impairment (meaning he is legally blind), is completely nonverbal and cognitively disabled, has a microcephalic head, and must wear a diaper. Moreover, he is immobile—he can't crawl or scoot around or hold himself up or even sit in a chair without being strapped in it. If someone were to put him on the floor and leave him there, he would be in the same location hours later, give or take a foot.

At home, in the eyes of my wife, Ilene; our 7-year-old daughter, Clio; and me, he seems merely a little eccentric, possessor of a few odd quirks, as I said. We don't think of him as being different; he is August, just another member of an already quirky family. Although he cannot play with his sister, she loves him. Without being prompted, she recently made pipe-cleaner wheelchairs for her dolls and rendered her wooden doll house ADA-compliant by retrofitting it with ramps. Now the dolls wheel freely in and out. For family bike rides, we have a specially built bicycle with a Tumble Forms chair attached to the front for him to ride in. I feed August his meals (he cannot feed himself), change his diapers, place him in the supersize jogger when I go running, and put him to bed. He and I have a good relationship: He laughs at my attempts at humor, which consist of making odd sounds or putting him face-up on the rug, holding his feet and legs up high, and rocking him swiftly back and forth. He seems to enjoy my company, and I most certainly enjoy his.

Outside of our home, my wife and I and Clio are constantly reminded of how unusual August must appear to other people. He elicits responses ranging from aversion to "the stare." We understand that his drooling stems from his cerebral palsy—the spasticity in the muscles of the mouth prevents him from being able to control saliva. No connection exists between mental disability and drooling, but, in the public imagination, this association has long been established.

In the eyes of some, August fits stereotypical images such as the comic-strip character Zippy the Pinhead. Yet likening my son, and other people who have microcephalic heads, to Zippy is about as relevant as likening African-Americans to blackface caricatures. In the eyes of others, August resembles Terri Schiavo, who, for the secular-educated, triggers the fearful response of "better off dead than disabled." Many such well-meaning people would like to put an end to August's suffering, but they do not stop to consider whether he actually is suffering. At times he is uncomfortable, yes, but the only real pain here seems to be the pain of those who cannot bear the thought that people like August exist. For many of those folks, someone with August's caliber of cognitive and physical disability raises the question of where humanity leaves off and animality begins. But that animal-human divide is spurious, a faulty either-or.

And then there are the Christians, who see in August a child of God. Given the educated alternative I just sketched out, that response seems a relief. Here in the South, they come up and say "God bless!," to which, depending on the occasion and the person, I sometimes respond, "This is my beloved son, in whom I am well pleased."

For almost everyone, August signifies one of the great tragedies that can befall a family.

After his birth, we ourselves lived in the tragic mode, but we soon grew tired of it. August brings us joy, as does his sister. Admittedly, the parenting commitment takes time from my career. And caring for August requires more time than does attending to Clio. Because August is a spastic quadriplegic, he requires the consuming regimen of daily full-body care.

Each morning I lift him from his bed, put him on a table, change his

diaper, and wash and dress him. Next I carry him up to the breakfast room, strap him into his wheelchair, hand-feed him breakfast, wash his hands and face, brush his teeth, wheel him out to the van, and drive him to his school. On regular school days, this morning preparation can take up to two hours to perform. In the late afternoon and evenings, I follow a similar routine: I drive through heavy traffic from campus to the only after-school facility in Jacksonville, Fla., equipped to handle children like August. Once there, I lift him into the van, bring him home, hand-feed him dinner (his food must be puréed and otherwise specially prepared so that he won't choke on it), find something to occupy him after dinner, and finally prepare him for bed. All of this activity takes two to three hours.

Often in the evenings, my wife and I hire people to help us so that we can get our work done and take care of our daughter. However, we cannot just hire the 15-year-old down the street to babysit: To take care of August properly, a caregiver requires at least a week of training. On my campus we have had good luck finding nursing and physical-therapy students, but we must pay more than the customary $7 an hour.

On the days that I teach and August's school is out of session, or his after-school facility shuts down, my wife and I must scramble to cover him. We cannot afford for my wife, a self-employed physical therapist and Pilates instructor, to give up a day of patients and clients. Other types of day-care facilities and the usual programs for typically developing 10-year-olds cannot accommodate a boy with spastic quadriplegia. I used to take him with me to the university, but he has now grown too large for that, and besides, he can be temperamentally unpredictable, making teaching difficult.

Just recently our family experienced an additional ripple of difficulty. My wife suffered a herniated disk in her neck, brought on in part by lifting August. An artificial disk was inserted, and, once she is fully recovered, the new disk will limit her to lifting no more than 50 pounds. Unfortunately, August now weighs at least 70. Because we moved from San Francisco to Jacksonville so that I could take my tenure-track job, we have no family in the vicinity to help us. Even worse, we have no rich uncles. As a result, almost all of the caregiving responsibilities have fallen on me. My wife and I have plans—but at present not the money—to remedy the situation: Procure a lift (for inside the home) as well as a van with a wheelchair ramp. (Yes, August has a state Medicaid waiver, and we have health insurance through my university, but when we make requests for his needs, the wheels turn slowly and sometimes not at all.)

In the meantime, I cannot leave the house for more than about eight hours at a time. Every day, morning and evening, I must be on hand to perform the routines. In sum, I cannot travel at all, even overnight. Hence, in the near future, I do not foresee going to conferences, traveling to do research, or applying for those tempting academic opportunities that entail going abroad, or, for that matter, going anywhere. In a sense, I am as stranded as Robinson Crusoe on his island. Just a few weeks ago someone in the university offered me an additional job with a small pay increase. However, the job required spending three days' training in Orlando, so I had to turn it down.

While August has limited what I can accomplish in my academic career, he also has broadened my teaching and scholarship. In order to explain how he has done so, I have to go back to my grade-school years, in Palo Alto, Calif. For the most part, I was a good student and a nice boy—nice, that is, except when I was bullying Peter, the lone kid in the class who had learning disabilities. Perceiving him to be the bearer of stigma, my fellows and I trailed after Peter, calling him idiot, moron, imbecile, stupid, and cretin. Our Lord of the Flies vitriol at least respected the boundary of not physically harming him, though our psychological abuse must have damaged him.

As I grew older, I was inspired by Socrates' statement that "the unexamined life is not worth living." Similarly, Aristotle's dictum that man is the animal having "logos," the power of reasoning, impressed me. The notion that the human being is a rational animal made sense, and I internalized it as a basic assumption, as I did Socrates' pronouncement. At San Francisco State University, I became intrigued by the Enlightenment. John Locke, David Hume, and Immanuel Kant fascinated me. Who would not want to be enlightened? Who in his or her right mind would choose in favor of a benighted past of superstition, ignorance, and blind faith in custom? I put my faith in reason. Eventually I obtained my doctorate at Stanford in 18th-century British literature—the age of reason: Anne Finch, Alexander Pope, Jonathan Swift, Samuel Johnson.

In sum, I grew up prizing intellectual aptitude—not that I am a candidate for Mensa—and detesting "poor mental function." Perhaps what helped make me revere intelligence was growing up in Palo Alto, with Stanford less than half a mile away and a number of Nobel Prize winners and famous and wealthy technology innovators all around me. People in my immediate vicinity had good brains, and that meant money, respect, and international influence.

Given, then, my nearly metaphysical attachment to intelligence, imagine my surprise when in March 1999, at my first child's birth, he failed to breathe and consequently suffered severe brain damage. The delivery was taking place at a prestigious teaching hospital, one that, I later learned, was attempting to reduce the number of Caesarean sections because a belief had emerged that American medicine was relying too heavily on the procedure.

Peter Singer

After his birth, as I entered the intensive-care nursery, I was deeply ambivalent, having been persuaded by the Princeton philosopher Peter Singer's advocacy of expanding reproductive choice to include infanticide. But there was my son, asleep or unconscious, on a ventilator, motionless under a heat lamp, tubes and wires everywhere, monitors alongside his steel and transparent-plastic crib. What most stirred me was the way he resembled me. Nothing had prepared me for this, the shock of recognition, for he was the boy in my own baby pictures, the image of me when I was an infant.

Eight months after the birth, a doctor commented, after viewing the results of a CT scan, that his brain looked like "Swiss cheese," it was so full of dead patches.

So from the start, I had to wrestle with the reality of his condition. Martin Luther held the opinion that, because a child such as August was a "changeling"—merely a mass of flesh, a massa carnis, with no soul—he should be drowned. And Singer reasonably would maintain that my son would not qualify as a "person," because he would have no consciousness of himself in time and space.

Days later, at the hospital consult, the doctors tried to explain what had gone awry but without yielding any information that might provide a basis for a malpractice suit. Because nothing significant was disclosed, my wife and I secured a lawyer to find out what had happened. A medical expert reviewing the records reported back that malpractice had occurred. In the meantime, we had discovered that the expense of caring for August over his lifetime would very likely exceed hundreds of thousands of dollars—a van with a lift, a lift in the house, thousands of hours of attendant care, lost wages, etc., all on the salaries of an educator and a physical therapist. Then the first lawyer mysteriously dropped out, and lawyer after lawyer looked over the records and passed on the case: A series of serious medical misjudgments had been made, but no single "smoking gun" instance of malpractice, certain to convince a jury, was likely to turn up.

My son's birth initially cast me into a wilderness of perplexity, doubt, and discontent. This was part of my wife's and my tragic mode. My formerly complacent assumptions began coming apart, and over the next few years they crumbled. I had seen the dark side of medicine—the quintessence of the Enlightenment—and firm ground slipped out from under me. Then came the culmination of the Terri Schiavo case, six years to the month after August's birth. That a Florida court would order the deliberate starvation and dehydration of a woman whose mental disability differed not that much from my son's struck me as what Gayatri Spivak terms "an enabling violation." Schiavo's death served as a turning point for me, and new interests, beliefs, and curiosities began to coalesce.

In my teaching and scholarship, I now interrogate some of the ideas that once informed my assumptions, and the questions that I ask fit awkwardly into the academic landscape. Is it really true that the unexamined life is not worth living? And is it accurate to say that only the possession of logos qualifies an entity for human status?

For me, Socrates' and Aristotle's monumental truths gave way to questions for which I still do not have answers. And yet I concluded that Martin Luther was wrong. I arrived at sufficient resolution to join a disability-rights group called Not Dead Yet and to pass out leaflets on its behalf when Singer spoke on my campus.

I do not know how far I wish to go in demystifying logos. After all, I would not want to encourage my students to make unintelligent choices, leave their potential unexplored, or write irrational essays. What I do want to do, though, is bring forward to my students, colleagues, and readers what should have been obvious to me all along: namely, that the Peters and Augusts of the world are as much members of our human tribe as any of us are.

Especially in an academic environment that rewards being smart, how do I broach the idea that people with intellectual disabilities are fully equal? We academics advance in our careers by demonstrating how clever we can be, and because so much depends on flaunting intelligence, it is harder for us than for most people to steer clear of prejudice. In posing my awkward questions, I have focused on teaching literature and disability-studies courses and writing articles that examine the rhetoric and representation of intellectual disability.

My commitment to bringing cognitive disability into the foreground in the humanities can be glimpsed in the way I teach Toni Morrison's short story, "Recitatif." I teach it every chance I get. Over all, the story illustrates how irrational frustration can well up even in sympathetic characters, compelling them to seek scapegoats. This story helped me begin to understand how my own troubles at home many years ago played a part in my abusive actions toward Peter. If I did not have August in my life, I probably never would have reconsidered my behavior toward Peter, or read Morrison's story carefully, let alone begun to teach it.

To admit how August has changed me is not to assert that what he has given me compensates for what he, my wife, my daughter, and I have lost on account of the poor decisions made by the hospital where he was born. There is no getting back what we have lost. Compensation is just a trope, and belief in compensation is as superstitious as belief in the medieval notion of correspondences. Besides, nothing can compensate for what all of us have had to give up. It would be better for everyone if August could run around and shout intelligible language.

And I agree with Rabbi Harold Kushner when he writes and talks about bad things happening to good people: August's disability does not form a part of "God's plan" and does not serve as a tool for God to teach me or anyone else wisdom. What kind of a God would it be, anyway, to deprive my boy of speech and movement just to instruct me? A cruel and arbitrary God. August's disabilities are not a blessing; but neither are they a divine curse. To traffic in a cosmic economy of blessings and curses is to revert to an ancient prejudice. Indeed, even though August's disabilities offer ample opportunity for public interpretation, they do not mean anything at all in and of themselves—they have no intrinsic significance. They simply are what they are.

That is not to deny that August, along with my daughter and my wife, is the most amazing and wonderful thing that has ever happened to me, for he has allowed me an additional opportunity to profoundly love another human being. A person such as Peter Singer well may conclude, reasonably, that I have become overpowered by parental sentiment. So be it. I can live with that. There are limits to reason.

Chris Gabbard is an associate professor of English at the University of North Florida. This essay is from Papa, PhD: Essays on Fatherhood by Men in the Academy, published this month by Rutgers University Press.

Dylan Campbell, 12, is cognitively disabled since December, family sues health authority

The story of Dylan Campbell was reported on CBC today, after his parents sued the Winnipeg Health Authority for negligence causing Dylan to lose cognitive awareness. The CBC article states:

The family of a Manitoba boy left brain damaged a few days after having his tonsils removed at a Winnipeg hospital is suing the Winnipeg Regional Heath Authority.

The family of Dylan Campbell, now 12, has filed a statement of claim on the boy's behalf against the WRHA and several employees of the Health Sciences Centre.

The family is suing for undisclosed financial compensation and the costs of future medical care for the boy, who has been in a "persistent vegetative state" since December, according to court documents.

Campbell had the routine tonsillectomy in November 2009 and was released. Five days later, his mother rushed him back to hospital after he started coughing up blood.

He suffered a heart attack, leading to "irreversible" brain damage and his current condition, according to court documents.

Waited in ER for too long:
Dylan has been on life support since then, dependent on caregivers. He is now living at St. Amant Centre, a long-term-care facility in Winnipeg.

The family is alleging negligence led to his condition, claiming the amount of time Dylan waited in the emergency room to be readmitted was a factor.

There was an "inordinate and unacceptable" delay before he was triaged and treated upon his return, according to the lawsuit.

The WRHA declined to comment when contacted Tuesday.

The allegations contained in the statement of claim have not been proven in court and no trial date has been set.

The WRHA has not yet filed a statement of defence.

Lawyer Bob Tapper said Dylan's family is devastated by the boy's condition.

"I mean, it's a tragic case, a despicably tragic case," he said.

"How often do you see a 12-year-old boy go for something so innocuous as a tonsillectomy … and end up in a persistent vegetative state. I mean, it's awful," he said.

We hope that the Health Authorities and Dylan's family will continue to care for Dylan, inspite of his devastating condition.

Judge refuses to dismiss case against Melchert-Dinkel

An Associated Press article written by Amy Forliti, is reporting that Judge Thomas Neuville has refused to dismiss the case against William Melchert-Dinkel, the Minnesota nurse who admitted to encouraging Carlton University student, Nadia Kajouji (18) and Mark Drybrough (32) of Coventry England, to commit suicide. He is also allegedly involved with encouraging and or counseling at least three other people to suicide.

Melchert-Dinkel's lawyer has claimed that freedom of speech protects the acts of encouraging or counseling suicide via the internet. It appears that sanity is prevailing.

The article from the Associated Press:
Minn. judge refuses to dismiss aided suicide case

A Minnesota judge ruled Tuesday that the case against a former nurse who allegedly sought out depressed people in Internet chat rooms and encouraged them to kill themselves won't be dismissed on free speech grounds.

William Melchert-Dinkel, 48, of Faribault, is charged with two counts of aiding suicide in the deaths of an English man and a Canadian woman.

His attorney had asked that the case be dismissed, saying Melchert-Dinkel's conversations involved protected speech. Rice County District Judge Thomas Neuville disagreed in a 21-page ruling, saying speech that aids the suicide of another is not protected by the First Amendment.

The judge also said Minnesota law makes it a crime to participate in speech that intentionally advises, encourages, or aids another in taking his or her own life. And, the judge wrote, the courts have ruled that speech that constitutes aiding and abetting criminal conduct is not protected.

"Thus, speech that directly encourages and imminently incites the act of suicide ... falls outside the protection of the First Amendment," Neuville wrote.

Rice County Attorney Paul Beaumaster argued Melchert-Dinkel was obsessed with suicide and hanging and cruised the Internet for potential victims. When he found them, he posed as a female nurse, feigned compassion and offered step-by-step instructions on how they could kill themselves. Melchert-Dinkel also entered phony suicide pacts, Beaumaster said.

Melchert-Dinkel was charged in April with two counts of aiding suicide in the 2005 hanging death of Mark Drybrough, 32, of Conventry, England, and the 2008 drowning of Nadia Kajouji, 18, of Brampton, Ontario.

Beaumaster said in earlier court documents that Melchert-Dinkel admitted participating in online chats with at least 15 to 20 people about suicide and entering into fake suicide pacts with about 10 people, five of whom Melchert-Dinkel believed killed themselves.

The prosecutor said Tuesday that he is pleased with the judge's ruling and is preparing for trial. The next court hearing is set for Nov. 19. A plea is expected to be formally entered then.

Melchert-Dinkel's attorney, Terry Watkins, said he hadn't read the judge's ruling and had no immediate comment. He said nothing has changed, and he is anticipating his client will plead not guilty.

Watkins also had asked that the case be dismissed because of a lack of probable cause and because the state's aiding suicide law is too vague. Neuville denied those requests as well.