Be careful about calling it "Death with Dignity."

The following article was written by Barbara Kay and published in the National Post on January 23, 2013 under the titled: Be careful about calling it "Death with Dignity."

Barbara Kay, National Post, January 23, 2013

Barbara Kay

I have always found it odd that the same people who feel the death penalty is barbaric often look benignly on euthanasia. And it does show that words matter. One person’s stark “state killing” is to another, as in Quebec’s pitch to legalize euthanasia, “dying with dignity.” But the final result is still a human being’s life purposefully ended by his fellow human being.

Euthanasia and assisted suicide raise existential moral questions. (Euthanasia is the killing of a patient, for humanitarian reasons, by another person. In cases of assisted suicide, another person provides the patient with the means to kill himself, but does not perform the final lethal act himself.) Yet I find pundits’ discussion around the issue in Canada’s mostly sympathetic mainstream media (including the National Post editorial board) to spring more from vicarious terror of a bad death than critical investigation into assisted suicide/euthanasia as public policy.

Now taken for granted are: the “right” to state-assisted suicide; “dignity” narrowly understood as physical autonomy; “intolerable suffering,” the individual’s to define, the state’s agency in ending to command. None of these assumptions seem self-evident to me.

Also taken for granted: that it is the task of the physician — sworn to heal, relieve suffering and comfort the afflicted — to assist in ending lives. But why doctors, who are passionately divided on the subject? Why not death technicians or even, as one critic sarcastically mused in an October Wall Street Journal op-ed, the police (with a strategically placed loaded gun and instructions on how best to deploy it)?

In fact, most physicians are at odds with public opinion. A 2009 survey in Britain found that while over 80% of the public approved euthanasia, 73% of the members of the British Royal College of Physicians opposed it. In hearings for Quebec’s “Dying with Dignity” Commission, most intervenors rejected euthanasia.

In their report, Quebec’s commissioners boasted of satisfactory fact-finding missions to three European countries where euthanasia is legal. But they did not reveal that euthanization without consent is a growing concern in Belgium; or that in 2009, a UN committee on human rights singled out the Netherlands for its disturbing rates of euthanasia (4,050 in 2010; euthanasia and assisted-suicide rates have jumped 73% in just eight years). Euthanasia opponents also argue that some seniors in euthanasia-legal countries are moving in significant numbers to neighboring non-euthanasia-legal countries, because they fear being pressured to relieve the state or families of the perceived burden they now apparently represent. The reality is that the Quebec commissioners had already made up their minds; they then cherrypicked their data to suit their convictions.

Intractable pain during terminal illness is the issue for most euthanasia proponents. But virtually any pain can be managed, and strictly controlled palliative sedation (which eases passage to, and may hasten death) is already legal in Quebec. Thus, actual pleas for active euthanasia are uncommon. Oncologist Caroline Girouard of the Jewish General Hospital in Montreal testified that “In all my years of practice, I never got one request for euthanasia.”

Hard cases make bad law. Take, for example, the case of the 45-year old identical twin men who were put to death last month in Belgium. The deaf twins were inseparable companions. Upon finding out that they were going blind as well, they concluded that life without the ability to see each other was intolerable. The state concurred.

Such a case has strong emotional appeal to ordinary people who can identify with the mingled physical and psychological trauma the brothers were enduring. But consider an equally plausible hypothetical case of inseparable twin deaf brothers. One of them is struck by lightning and dies. The surviving twin, bereft but otherwise healthy, also feels life without ever “seeing” his brother again is intolerable. Will the state concur and agree to euthanize him? Would you? Since I am not a “progressive,” I would not, but I suspect Belgium would.

Quebec patients already have the right to refuse treatment, withdraw treatment, withhold treatment and request medical assistance in dying. The new law would add one element: active euthanasia, which will effectively suppress interest in enhancing palliative care. There is no dignity in this law. It should be euthanized.

"Death Pact" and the Euthanasia of 45-year old Belgian twins.

Etienne Montero

By Prof. Etienne Montero (University of Namur, Belgium) and President of the European Institute for Bioethics (Brussels Belgium)

Identical twins Eddy and Marc Verbessem were born deaf. Inseparable and single, they had always lived together under the same roof. They were euthanized together at their request on December 14, 2012 in the UZ Brussel (University hospital) in the borough of Jette. They were 45 years old.

Their request for euthanasia was based on a diagnosis of glaucoma, a degenerative condition of the optical nerve which can lead to blindness. According to our information (difficult to verify), they had a genetic anomaly which would progressively but irremediably cause them to go blind. This, together with the idea of loosing their independence, was unbearable for them.

The media presented this as a “first”. There had never been a case of two brothers requesting and being granted joint euthanasia. There had, however, been instances of couples being euthanized together.

Is this a case of infringement of the limits of the law on euthanasia?

Not necessarily. It is quite likely that all the conditions required by the law had been officially met. They no doubt made a voluntary and repeated request, free from any outside pressure. They based their case on an incurable medical condition and unbearable psychological suffering, stemming from the anticipation of future suffering linked to blindness and the loss of autonomy. As for the other necessary conditions, one may suppose that they were also met: various information to be provided, a second medical opinion to be sought, etc.

The twins had not reached the final phase of their illness

The general public, especially abroad, is above all shocked by the fact that the twins had not reached the terminal stage of their illness. It ought, however, to be pointed out that the Belgian law also permits euthanasia when death is not imminent. In this case, two further conditions apply in conjunction with those already mentioned. First of all, another medical opinion has to be sought either from an independent medical practitioner, from a psychiatrist or else a doctor specialized in the pathology in question. In the present instance, a psychiatrist with the medical team which euthanized the twins will probably have been consulted. Subsequently, at least another month of reflection has to pass between the time of the patient’s written request and the act of euthanasia itself.

The rot has set in

Nonetheless, this matter has caused a certain degree of unease. Why? It is as though, imperceptibly, euthanasia has come to represent the most dignified human response to situations of suffering. The Belgian law is designed and has been interpreted in such wide terms that euthanasia and medically-assisted suicide appear acceptable from the moment the interested person has freely formulated his or her request. Euthanasia requires the presence of an incurable disease. Indeed, but the list of incurable conditions is practically unending (diabetes, rheumatism, arthritis, …). The patient has to be able to make a case for unbearable physical or psychological suffering. Indeed, but the notion of psychological suffering is left to the subjective appreciation of the sufferer. Furthermore, as has already been said, euthanasia is permissible even when death is not imminent. All in all, the legal arrangements are practically tailor-made to allow euthanasia in all cases of voluntary and repeated request by all those suffering from various ills, from solitude or from a lack of will to live …. As the threshold of tolerance decreases in the face of illness or suffering, euthanasia does indeed risk becoming mundane, even trivial.

This affair requires our attention because it challenges both medical practice and society to come up with ways of accompanying not only the dying but those who suffer while living their lives.

It must be clear to all of us that we are already witnessing the trivialization of euthanasia in Belgium. The proof of this is that at the time when the law was being debated and was finally passed, a majority of members of Parliament felt that society was not ready to accept the euthanasia of minors and the mentally sick. Today, on the other hand, politicians from various parties consider that the time has come to take this step. In their opinion, the general public is now ready to accept a position it would have disapproved of ten years ago. One cannot, therefore, deny that euthanasia and assisted suicide have indeed been trivialized… Is this really the way in which society intends to deal with the distress and suffering of an ageing population or those who have become vulnerable due to illness or a disability?

Also see: Report “Euthanasia in Belgium : 10 years on” 

and: Belgium twins euthanized out of fear of blindness, what may be next in Belgium.

There is no role for palliative care in providing euthanasia

The following letter was written by Dr. Manuel Borod, the director of Supportive and Palliative Care at the McGill University Health Centre in Montreal Quebec. 

This letter was published in the Montreal Gazette on January 21, 2013 under the title: There is no role for palliative care in providing euthanasia

Re: “End of life rules to be set out in new law” (Gazette, Jan. 16) 

Dr. Manuel Borod

In the reports about the proposed end-of-life legislation, there have been numerous statements that may confuse readers. 

You report that the proposed law would protect the right to refuse treatment, withdraw treatment, withhold treatment, receive palliative care — including the right to receive palliative sedation, and the right to have medical assistance in dying. The first four of these rights are already generally accepted standards of care. 

And a statement describing palliative sedation as “the process of putting a dying patient to sleep, ending feeding and artificial hydration, a procedure that ends in death” is completely misleading and false. Palliative sedation is legal, does not necessarily hasten death (as noted, the patient is dying), and on our palliative care ward, we have very specific policies and follow international guidelines as to when and how to initiate this treatment. 

The only thing new here would be to allow an act that directly causes death, and this is euthanasia. The rest is a smokescreen. 

It is an affront to all those who care for the terminally ill to refer to this act as death with dignity — it is our objective that all our patients die with dignity. It is also misleading to refer to euthanasia as medical or physician aid in dying — once again, all the physicians, nurses, psychologists, social workers, music therapists, occupational therapists, physiotherapists, spiritual care counsellors, pharmacists, dietitians, volunteers and coordinators who work with the dying patient offer aid in dying. 

This has become a political and legal issue, and the lawmakers should call this act what it really is: lawful death or legally acceptable death. 

If the legislators decide to put this act into law, they should also provide for judges and technicians to approve the request and carry out the orders. There is no role for palliative care in providing euthanasia for terminally ill patients. The proposed law calls for improving and expanding the role of palliative care. The opposite will result if palliative care and euthanasia are expected to coexist under the same roof. 

Manuel Borod MDDirector, Division of Supportive and Palliative CareMcGill University Health CentreMontreal

Quebec Euthanasia: Be careful what you wish for!

Alex Schadenberg

By Alex Schadenberg

Executive Director - Euthanasia Prevention Coalition

The Quebec government appears intent on legalizing euthanasia, that they refer to as "assisted death" by defining euthanasia as a form of healthcare.

When analyzing the Quebec Dying with Dignity report and the proposals by the recent Menard report, it appears that Quebec is planning to implement a euthanasia law that mirrors the Belgian law.

Euthanasia is the intentional causing of death, whereby the death occurs directly from that act. Euthanasia has always been defined as part of the Homicide Act in the Criminal Code because, whatever the motive is, euthanasia is an act of killing.

How can killing be defined as a form of healthcare?

By defining euthanasia as a healthcare, access to euthanasia will inevitably be extended to everyone, because everyone is provided given equal access to healthcare. People who want to increase access to euthanasia, in the near future, will employ the equality provision in the Canada's Charter of Rights to convince the courts to logically extend euthanasia. The Quebec government seems to have intentionally defined euthanasia as medical treatment in order to introduce it in a limited form and then let the courts extend it to nearly everyone.

It should concern people that Quebec has chosen to mirror the Belgium euthanasia law. Belgium legalized euthanasia in 2002 and research has found significant abuse primarily related to the imprecise and wide-open definitions that the Belgium law uses.

Three recent studies from the Flanders region of Belgium found that:

1. 32% of all euthanasia deaths were done without explicit request.

2. 47% of all euthanasia deaths were not reported as euthanasia.

3. Nurses are euthanizing their patients, even though the Belgium law limits the act of euthanasia to doctors. 

It is important to note, that even though independent studies have found significant abuses of the Belgium euthanasia law are occurring, not one doctor has been prosecuted in Belgium.

Now the Belgium government is considering changing the euthanasia law to include children and people with dementia/Alzheimer’s. This would once again widen the definitions of who qualifies for euthanasia.

Considering the concerns in Quebec related to the cost containment of healthcare and the concern with medical errors, is it not likely that Quebec will follow the lead of Belgium?

The only way to effectively protect people is by maintaining euthanasia as an illegal act and ensuring the proper care of people with chronic or terminal conditions.

Be careful what you wish for it may become something that you didn’t wish for.

The book by Alex Schadenberg, Exposing Vulnerable People to Euthanasia and Assisted Suicide uncovers data proving that unreported euthanasia deaths and the abuse of the euthanasia laws in jurisdictions, such as Belgium and the Netherlands, where it is legal, uncovers euthanasia deaths without request not only occur but represent a threat to vulnerable patient groups.  

Order the book: Exposing Vulnerable People to Euthanasia and Assisted Suicide.

Calgary Herald: We must all stand against the push for euthanasia

The following Calgary Herald editorial was published in the January 22 edition of the paper under the title: Editorial: We must all stand against the push for Euthanasia.

Editorial: We must all stand against the push for Euthanasia
Calgary Herald - January 22, 2012

Many of Quebec’s politicians seem incapable of taking no for an answer. After losing two votes on separation, the current Quebec provincial government says it will wait for the right timing and “winning conditions” to hold yet another referendum on sovereignty.

Similarly, this minority Parti Quebecois government has vowed to make euthanasia — or doctor assisted suicide — legal in la belle province, in contravention of Canada’s Criminal Code. Premier Pauline Marois says the province will bypass the federal law of the land by declaring assisted suicide a medical procedure, something that falls under provincial jurisdiction.

This comes after former Bloc Quebecois MP Francine Lalonde’s private member’s bill on this issue was resoundingly defeated in the House of Commons by a vote of 228-59 in April 2010. The Supreme Court of Canada rejected legalizing euthanasia in 1993 in its Sue Rodriguez decision and the Special Senate Committee on Euthanasia and Assisted Suicide released a 72-page report called, Of Life and Death, in June 1995 that recommended that voluntary euthanasia remain a criminal offence.

Quebec politicians, however, are intent to not take no for an answer — democracy be damned and the law as well.

As Alex Schadenberg, executive director of the Euthanasia Prevention Coalition, points out, the PQ government is looking for a loophole by defining euthanasia as a form of health care, a tactic that mirrors Belgian law.

Let’s consider what has happened recently in Belgium. Identical twin brothers, Marc and Eddy Verbessem, 45, who were born deaf, were euthanized by a doctor in Antwerp on Dec. 14 after learning that they were gradually going blind.

Neither man was in any pain and they were not facing a painful death or terminal illness. They simply couldn’t stand the idea of not being able to see one another — a daunting thought to be sure. All reasonable people can understand their anguish.

But this is the slippery slope of all of these laws. They start out with strict parameters and end up being widened.

Within days of the twins’ killing, Belgium’s ruling Socialists proposed a legal amendment that would allow the state’s doctors to kill children and Alzheimer’s sufferers.

In other words, they will be changing the current rule that requires consent by the person getting killed. Children and people suffering from Alzheimer’s are not legally able to give consent, for obvious reasons. But this is precisely the kind of diabolical changes that have occurred in the Netherlands, where euthanasia has been practised for decades now, with thousands of examples of people who never provided consent being killed involuntarily by their physicians.

“It should concern people that Quebec has chosen to mirror the Belgium euthanasia law,” says Schadenberg. “Belgium legalized euthanasia in 2002 and research has found significant abuse primarily related to the imprecise and wide-open definitions that the Belgium law uses,” says Schadenberg, who points to three disturbing studies taken in the Flanders region of Belgium.

The studies found in part that:
* 32 per cent of all euthanasia deaths were done without explicit request;
* 47 per cent of all euthanasia deaths were not reported as euthanasia and,
* nurses are euthanizing their patients, even though the Belgium law limits the act of euthanasia to doctors.

“It is important to note, that even though independent studies have found significant abuses of the Belgium euthanasia law are occurring, not one doctor has been prosecuted in Belgium.”

To be clear, euthanasia is the active ending of a human life, ordinarily through lethal injection. It is NOT the removal of life supports on those who are already brain-dead. The latter is simply allowing nature to take its course. That is not what Schadenberg or Canadian law opposes.

Canadians must vehemently oppose these never-ending pushes by Quebec separatists to not just break up this country, but to destroy a tenet of our law that ensures that human life is afforded the weight and importance that it always must.

Legalizing physician-assisted suicide would be dangerous

The following letter was written by Dr. Joe Nemeth, a ER doctor in Montreal Quebec. The letter was published in the Montreal Gazette on January 21 under the title:  Legalizing physician-assisted suicide would be dangerous.

Re: “A creeping culture of death” (Opinion, Jan. 18)

As a short addendum to my colleague Dr. Sherif Emil’s articulate piece, I would also like to weigh in from a perspective different from pediatric surgery, namely seeing the potential “slippery slope” implications of this ruling in the acute care setting.

I am an “ER doc” in the emergency departments of both the Montreal General Hospital and Montreal Children’s Hospital. I wholeheartedly concur with Dr. Emil’s viewpoint regarding the truly destitute state in which we find Quebec health care today and consequently, how this ruling can easily have detrimental ethical and jurisprudential implications. Patients presenting to Emergency with a terminal illness needing to be admitted may be legally coerced to allow for physician assisted suicide to free up hospital beds for those not dying.

Furthermore, it is not difficult to imagine where Emergency docs — already burdened with overwhelming financial and resource pressures — will be encouraged to make physician assisted suicide a practical, cost-cutting “alternative” disposition for those with terminal illness. These sentiments are not outlandish but realistic (see Belgium’s example of physician assisted suicide where what was originally proposed as a solution for extreme cases has become a well-marketed “therapeutic option”).

These are very dangerous waters we may be entering as a society. I call on the government leaders to listen carefully and heed the warning of not the bureaucrats but the MDs who uphold the true essence of physicianship.

Joe Nemeth MD
Montreal

Ménard report (Quebec): Dangerous legal vision and ignorance of medical reality.

Media Release:

Physicians Alliance for the Total Refusal of Euthanasia (Quebec)

January 21, 2012

The Physicians' Alliance for the Total Refusal of Euthanasia (PATRE) deplores the Ménard report's dangerous legal vision and the ignorance of medical reality it reflects. PATRE, which has the signed support of more than 300 leading physicians, urges all Quebecers to become aware of the dangers the report poses to our collective well-being, and to press the opposition majority in the National Assembly to condemn it.

So far more than 1 000 citizens endorse the Physician's Alliance.

Link to the media release.

Support the Physicians' Alliance for the Total Refusal of Euthanasia.

Collectif du Refus Médical de l'Euthanasie 

21 janvier, 2013

Le rapport Ménard: une conception dangereuse du droit et une ignorance de la réalité médicale

À lire sur CNW: http://www.newswire.ca/fr/CNW

Le Collectif des Médecins du Refus Médical de l'Euthanasie (CMRME) déplore la conception dangereuse du droit et l'ignorance de la réalité médicale qui se reflètent dans le rapport Ménard. Le CMRME, appuyé par les plus de 300 médecins qui ont signé son manifeste, exhorte tous les Québécois à prendre conscience des dangers posés par ce rapport pour notre bien-être collectif et à demander à l'opposition (majoritaire à l'Assemblée nationale) de le condamner.

Plus de 1 000 citoyens appuient déjà l'initiative du Collectif de médecins du refus médical de l'euthanasie.

Joignez-vous à nous!
Pour les médecins: www.soignertoujours.com/manifeste/
Pour les citoyens: www.soignertoujours.com/citoyens/

Site Internet: http://www.refusmedical.blogspot.ca/

Quick Facts About Assisted Suicide

Quick Facts About Assisted Suicide

As of January 15, 2013

Prepared by Margaret Dore

1.      Assisted Suicide

Assisted suicide means that someone provides the means and/or information for another person to commit suicide. When a physician is involved, the practice is physician-assisted suicide.(1) 

2.      The Oregon and Washington Laws

In Oregon, physician-assisted suicide was legalized in 1997 via a ballot measure. In Washington State, a similar law was passed via another ballot measure in 2008 and went into effect in 2009.(2) No such law has made it through the scrutiny of a legislature despite more than 100 attempts. 

3.      Patients are Not Necessarily Dying

The Oregon and Washington laws are restricted to patients predicted to have less than six months to live. Such persons are not necessarily dying. Doctors can be wrong.(3) Moreover, treatment can lead to recovery. Consider Jeanette Hall, who was diagnosed with cancer and given six months to a year to live. She was adamant that she would “do” Oregon’s law, but her doctor, Ken Stevens, convinced her to be treated instead. She is alive now, 12 years later.(4)

4.      A Recipe for Elder Abuse

The Washington and Oregon laws are a recipe for elder abuse. The most obvious reason is due to a lack of oversight when the lethal dose is administered. For example, there are no witnesses required at the death; the death occurs in private. With this situation, the opportunity is created for an heir, or for another person who will benefit from the patient’s death, to administer the lethal dose to the patient without his consent. Even if he struggled, who would know?

5.      Empowering the Healthcare System

In Oregon, patients desiring treatment under the Oregon Health Plan have been offered assisted suicide instead.(5)

Oregon's suicide rate, which excludes suicides under its physician-assisted suicide law, has been "increasing significantly" since 2000.(6) Just three years prior, Oregon legalized physician-assisted suicide. This increased suicide rate is consistent with a suicide contagion. In other words, legalizing one type of suicide encouraged other suicides. 

7.      Assisted Suicide is a "Wedge" Issue

In Washington State, there have already been discussions for expansion of assisted suicide to direct euthanasia for non-terminal people. Indeed, last March, there was a column suggesting euthanasia for people unable to afford care, which would be involuntary, right? See Jerry Large, "Planning for old age at a premium," The Seattle Times, 3/8/12 at  ("After Monday's column, . . .  a few [readers] suggested that if you couldn't save enough money to see you through your old age, you shouldn't expect society to bail you out. At least a couple mentioned euthanasia as a solution.")

* Margaret Dore is an attorney in Washington State where assisted suicide is legal. She is also President of Choice is an Illusion, a nonprofit corporation opposed to assisted suicide.  For more information, see: www.margaretdore.com and www.choiceillusion.org 

-----------------
[1]  Compare: American Medical Association, Code of Medical Ethics, Opinion 2.211, available at: http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion2211.page
[2]  The Oregon and Washington laws are similar.  For a short article about Washington’s law, see Margaret K. Dore, "'Death with Dignity': What Do We Advise Our Clients?," King County Bar Association, Bar Bulletin, May 2009, available at: https://www.kcba.org/newsevents/barbulletin/BView.aspx?Month=05&Year=2009&AID=article5.htm
[3]  See e.g., Nina Shapiro, "Terminal Uncertainty: Washington’s new "Death With Dignity" law allows doctors to help people commit suicide­once they’ve determined that the patient has only six months to live. But what if they’re wrong?," 01/14/09, available at: http://www.seattleweekly.com/2009-01-14/news/terminal-uncertainty
[4]  See Jeanette Hall, Letter to the editor, "She pushed for legal right to die, and - thankfully - was rebuffed, Boston Globe, October 4, 2011 ("I am so happy to be alive!), available at: http://www.boston.com/bostonglobe/editorial_opinion/letters/articles/2011/10/04/she_pushed_for_legal_right_to_die_and___thankfully___was_rebuffed/ Kenneth Stevens MD, Letter to the Editor, "Oregon mistake costs lives," The Advocate, the official publication of the Idaho State Bar, Sept. 2010, (scroll down to last letter at: www.margaretdore.com/info/Stevens.pdf).
[5]  See Susan Donaldson James, "Death Drugs Cause Uproar in Oregon," ABC News, August 6, 2008, at: http://abcnews.go.com/Health/story?id=5517492&page=1; "Letter noting assisted suicide raises questions," KATU TV, July 30, 2008, at: http://www.katu.com/news/specialreports/26119539.html; and Ken Stevens, MD, Letter to Editor, "Oregon mistake costs lives," The Advocate, the official publication of the Idaho State Bar, September 2011, to view, scroll down to bottom of second page here:http://www.margaretdore.com/info/September_Letters.pdf
[6]  See "Suicides in Oregon: Trends and Risk Factors," Oregon Department of Human Services, Public Health Division, September 2010, page 6, ("Deaths relating to the death with Dignity Act (physician-assisted suicides) are not classified as suicides by Oregon law and therefore excluded from this report"), available at: http://epcdocuments.files.wordpress.com/2011/10/or_suicide_report_001.pdf. See also Oregon Health Authority, News Release, "Rising suicide rate in Oregon reaches higher than national average," September 9, 2010, ("suicide rates have been increasing significantly since 2000") available at: http://www.oregon.gov/DHS/news/2010news/2010-0909a.pdf

Oregon Assisted Suicide law is unsafe.

The following letter was written by Isaac Jackson, a lawyer in Oregon who has a client who wanted to file a complaint after that persons father died by assisted suicide. The following letter was printed in the  Montana Standard on January 20, 2013 under the title: Oregon Assisted Suicide law is not safe, according to lawyer.

Oregon Assisted Suicide law is not safe according to lawyer.

I am a lawyer in Oregon who specializes in injury claims including wrongful death cases. I understand that Montana will be considering assisted suicide legislation this session. I write to inform your readers that Oregon’s assisted suicide law lacks transparency. Even law enforcement is denied access to information collected by the State. Moreover, this is official state policy.

In 2010, I was retained by a client whose father had died under our assisted-suicide act. Unlike other deaths I have investigated, it was difficult to get basic information.

After I wrote the state epidemiologist, I received a letter from the Attorney General’s Office that the agency charged with collecting assisted-suicide data, the Oregon Health Authority, “may only make public annual statistical information.” The letter also referred me to the Oregon Medical Board and law enforcement.

The Board wrote me that there could be no investigation without an allegation of misconduct against a physician. At my request, a police officer was assigned to the case. Per his confidential report, the Oregon Health Authority would neither confirm nor deny that my client’s father had died under our act. Per the report, the officer did, however, talk to the doctor signing the death certificate who said that he did not know that the death had involved assisted-suicide. The death certificate listed the immediate cause of death as “cancer” and the manner of death as “natural.”

Per the report, the officer also spoke with potential perpetrators who assured him that the death had been voluntary. He closed the case.

This is a link to Oregon’s data release policy as of Jan. 1, that it “will not confirm on a case-by-case basis whether an individual has used, or a provider has been involved, with Death with Dignity.” http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Pages/policy.aspx

Without transparency our law is not safe.

Isaac Jackson
Box 41240
Eugene, Ore.

The Dutch are killing people with Alzheimer's

The following article was written by American bioethicist, Wesley Smith and published on his blog on January 19, 2013 under the title: Let's Find a Way to Kill Alzheimer's Patients.

Wesley Smith, Human Exceptionalism blog, January 19, 2013

Wesley Smith

Don’t anyone tell me that the mercy killing imperative and cost containment aren’t mixed–driven by a pernicious “quality of life” ethic that denigrates and demeans the moral value of the most weak and vulnerable among us.

The Hastings Center Report–the world’s most influential bioethics journal–has a piece pushing euthanasia for Alzheimer’s patients. As I have reported here, Dutch doctors now are allowed to kill Alzheimer’s patients, a matter cheered on by Erik Parens, a senior researcher at the Hastings Center. From, “Alzheimer’s Disease and Personhood:”

As in the United States, the Dutch conversation about assisted suicide emerged primarily in the context of cancer. At least in that context, before acceding to a request for assistance in dying, caregivers must be sure that the person has made a voluntary and carefully considered request, and that her suffering is unbearable and without prospect of improvement. The Dutch have recently been trying to use those criteria in the context of Alzheimer’s disease. Given the wave of Alzheimer’s cases poised to crash onto wealthy countries, along with emerging technology to detect the disease process before symptoms appear, we should be grateful to the Dutch for that attempt.

The guidelines have always been a farce, broken often without significant legal or professional consequence–including infanticide, non voluntary euthanasia, and the killing of the mentally ill and grieving. And note the bottom line: Alzheimer’s patients should be allowed to be euthanized.

But how to get there ethically? Parens finds it odd that we try to apply concepts of consent to kill people no longer capable of consenting, and indeed, who may not be actually suffering. But, Parens concludes, we still have to find a way to justify their killings!

My guess is that it won’t work terribly well to use the cancer criteria in the context of Alzheimer’s disease. My further guess is that, to make headway, we will have to draw on both the “difference” and the “disease” views. How to do that is hardly clear, but that we need to try is.

Those two final sentences tell us what so much about the nature of the bioethics movement. The point isn’t to apply principles to determine the propriety or impropriety of a proposed policy. Rather, the outcome is predetermined and the goal is to find the best way to justify doing what we already want to do.  Or to put it another way, to find the best philosophical means to support the predetermined ends. Reminds me of the Warren Commission Report. 

Legalizing assisted suicide is wrong and dangerous

The following article was written by Dr. Sherif Emil who is a paediatric surgeon at the Montreal Children's Hospital. This article was published in the Montreal Gazette on January 17, 2013 under the title: Legalizing assisted suicide is wrong and dangerous.

By Dr. Sherif Emil, Montreal Gazette, January 17, 2013.

Dr Sherif Emil

At the entry to Paris’s oldest hospital, the Hôtel Dieu, are these words: “To cure occasionally, to relieve often, to comfort always.” Medical historians ascribe this aphorism to Hippocrates, who also gave us our medical oath, an important principle of which is to not kill. And yet a culture of death, frequently disguised as the concept of “dying with dignity,” is creeping into society and becoming increasingly sanctioned by politicians and the medical establishment.

A National Assembly committee held public hearings in 2010-11 and concluded that euthanasia, euphemistically called “medical aid in dying,” should be legal in Quebec. This conclusion came in spite of the fact that two-thirds of the citizens who made presentations to the committee, including myself and many physicians, were opposed to euthanasia.

This week, spurred by a report from a panel of legal experts recommending that terminally ill adult patients be given the right to doctor-assisted suicide, the Quebec government said it will introduce legislation to that effect.

Nowhere is euthanasia more dangerous than here in Quebec. In 2010, the Canadian Medical Association published sobering results of a national survey of Canadians’ attitudes, beliefs and experiences with their health-care system. A large majority of Canadians in every province concluded that the system is broken; but Quebec fared the worst.

As a pediatric surgeon in Montreal, I practise in an environment of constant triage, with decisions every day regarding which patient needs to go first. We do not have enough operating-room resources, intensive-care-unit beds, hospital beds, nurses — and the list goes on. And we are the lucky ones, because we treat children; more resources are available to us than to those who treat adult patients. The situation for my counterparts who treat adults is far worse.

I have experienced the Quebec health-care system over a quarter of a century, first as a medical student in the late 1980s, then as a pediatric-surgical trainee in the late 1990s, and now as a staff pediatric surgeon for the last four years. After I graduated from McGill, I went back to my native California to start my residency, carrying a tremendous pride in the education I had received and holding the environment that I had been trained in as a model for humane and compassionate health care.

Unfortunately, since I have moved back, I have come to learn through my observations as a physician and my experiences as a patient, as well as through being a friend and relative to many patients, that health care in Quebec is in deep crisis. The denial of this crisis by politicians and health-care leaders does not make it any less severe.

The humanity of the health-care system has all but disappeared over the past 25 years. The patient has come to be seen as a burden to the system, rather than the reason for its existence. The resource limitations and senseless governmental macromanagement have destroyed the morale of many who are entrusted to take care of the most vulnerable. The voices of those who want to raise awareness of this decay are often drowned, rather than listened to. Encouraging stories of truly patient and family-centred care are now the exception, not the rule. Is this the type of environment in which we should introduce assisted suicide?

Imagine a patient in his or her final days in such a resource-limited, highly depersonalized system. The patient is requiring large amounts of resources to sustain life. His or her physicians and nurses know that death is imminent, and that it can be hastened by a lethal injection, allowing resources to go to patients who are seen as more worthy. How much dignity will that patient have if he or she chooses to cling to life?

Dr Balfour Mount
The Father of Palliative Medicine
in North America.

Is there a moral dimension to legalized killing? The three guiding principles of medicine are to do no harm, to support and sustain life, and to relieve suffering. It can be argued that legalized euthanasia is consistent with that third principle: relief of suffering. That would be true if there were no alternatives to relieve suffering. But there are, and Quebec has been a leader in this field through the work of palliative-care pioneers like Dr. Balfour Mount and the many disciples who followed him. Palliative care is now available in the home and the hospice, allowing people to die with dignity in the presence of their families and loved ones. Pain medicine has matured into a specialty of its own, and billions of dollars have been invested into finding new treatments and methods to relieve pain and suffering. The armamentarium available to physicians has grown exponentially, and new medical journals are now exclusively dedicated to pain management and palliative care. When pain becomes an argument for ending life, it is the pain that must be killed, not the patient. Legalizing assisted suicide due to poorly treated or untreated pain is no different than legalizing assisted suicide due to poorly treated or untreated depression. It is no coincidence that Dr. Mount, as well as most of his colleagues in palliative care, stand firmly against euthanasia.

As a pediatric surgeon, I am particularly concerned about the fate of children under legalized euthanasia. In Quebec, the age of consent is 14 — the youngest in North America. Will teenagers with terminal cancer or other diseases with a poor prognosis be able to choose to end their lives? Quebec has the highest elective-abortion rate in North America, and one of the highest in the Western world, despite the wide availability of birth control and sex education. It also has one of the highest pregnancy-termination rates for fetuses with congenital defects. Many of these defects are completely treatable, and are associated with excellent prognosis. It is legal in Quebec to terminate a pregnancy, even in the last trimester, when a congenital anomaly is identified. The fetus, who at that point may very well survive birth, is first killed and then delivered. What if parents discover these anomalies after birth, as sometimes occurs? Will they have the legal right to end their newborn’s life?

Dr André Bourque with
Dr. Catherine Dopchie.

The slippery slope is closer than we think. We only have to look at the model the Quebec government is using for its policies on euthanasia: Belgium. Recently Dr. Catherine Dopchie, a Belgian oncologist and director of a palliative-care unit, visited Quebec and spoke to large audiences in Montreal and Quebec City. She described the Pandora’s box that was opened when euthanasia was legalized in Belgium 10 years ago. Out of fear of uncontrolled pain, many patients, their families and physicians don’t even attempt palliative care, and rush toward physician-inflicted death instead, she reported. The field of palliative care is thus compromised, its practitioners having to fight to propose their services to patients before they jump onto the euthanasia bandwagon. A choice for euthanasia becomes the “courageous” thing to do, and subtle or not-so-subtle coercion to make that choice is omnipresent among the elderly and terminally ill, Dr. Dopchie said. What was originally proposed as a solution for extreme cases has become a well-marketed “therapeutic option.”

After her departure from Montreal, we learned that doctors at Brussels University Hospital had euthanized twin brothers, 45 years old, who said they wanted to die because they had been told they were soon to go blind.

The consideration of euthanasia by a society that cannot provide adequate care to its most vulnerable members should be seen as an indictment of that society. Euthanasia is the easier choice for society to make. Mending a broken health-care system that often does not dignify life, long before its end, is the more difficult choice, the one that requires honesty and leadership.

Even with the most advanced medical care, we can still cure occasionally but comfort always. I do not want to practise in a health-care system where we kill occasionally and comfort rarely. For that reason, I have joined other Quebec physicians in a “total refusal of euthanasia” position. You can find out more about our position at caringalways.com.

Disability rights group, Not Dead Yet, comments on the Belgium brothers who were deaf who were euthanized.

The following comment was written by Stephen Drake, the researcher for the disability rights group Not Dead Yet and published on the Not Dead Yet blog on January 15, 2013 under the title: More on Double Euthanasia in Belgium.

Stephen Drake, January 15, 2013

Stephen Drake

The 24+ hours since I posted on the double euthanasia of two deaf men in Belgium has resulted in some developments, varied reactions, and some reflection on my own part. My apologies if this post seems a little scattered – a little like mental  multi-colored pasta thrown against the wall -  but sometimes that’s how my mind works.

First, the National Federation of the Blind (NFB) issued a statement from Dr. Marc Maurer, President of the NFB:

“This disturbing news from Belgium is a stark example of the common, and in this case tragic, misunderstanding of disability and its consequences. Adjustment to any disability is difficult, and deaf-blind people face their own particular challenges, but from at least the time of Helen Keller it has been known that these challenges can be met, and the technology and services available today have vastly improved prospects for the deaf-blind and others with disabilities. That these men wanted to die is tragic; that the state sanctioned and aided their suicide is frightening.”

You can view the entire release and learn more about the NFB here.

At the same time, I’m sure that others have noticed that there are suicides getting a lot of coverage this week. The Pentagon reports that deaths by suicide reached a record number in 2012, with more military deaths occurring due to suicide than from combat. The suicide of programmer/activist/open source advocate Aaron Swartz – apparently overwhelmed by the double effects of depression and what is being called “overreaching” prosecution over his download of millions of journal articles. He was faced with decades in prison and enormous fines.

Read through the comments on any of the countless articles covering these suicide stories and you’ll be hard-pressed to find anyone reacting like this:

• “It’s their body, their choice.”
• “When people decide they need to end it, they should be able to get help to do so.”
• “It’s too bad they had to use violent means – animals can get euthanized; we treat animals better than humans.”

The lack of statements like those struck me because they’re common sentiments expressed in article “comments,” and interactions on Facebook when people react to “double euthanasia” of Marc and Eddy Verbessem, the identical twins whose deaths are still making news.

I think that we don’t see those comments in the cases of Aaron Swartz and the military because those people are valued. I know that euthanasia proponents say that their movement is all about respecting individual choice, but why are the “choices” of  Marc and Eddy Verbessem “respected” while the suicides of military personnel and the suicide of Aaron Swartz are treated as preventable tragedies? The answer, of course, is that euthanasia isn’t about “respect,” but agreeing that another person’s continued existence is pointless.

The animal comparisons always get me. I’ve written before (with Dick Sobsey) about the myths surrounding the “kindness” of pet euthanasia.

What struck me this time was an even deeper disconnect.  Anyone who spends a lot of time on the internet knows that cats are probably the most popular thing in existence. Some of the most popular pictures/videos of cats involve disabled cats – and dogs.  Right now, the most popular cat on the internet seems to be Oskar the Blind Cat:

http://www.youtube.com/watch?feature=player_embedded&v=lNpeTCEPrRk

If you look around, you’ll find stories of a deaf and blind dog rescued from euthanasia and a pet now for seven years and there’s even a story out there about a deaf/blind dog with three legs that rescued his family from a fire.

Oskar has lots of fans. Stories like the ones about the dogs seem to make people just tear up and feel generally inspired.

But two deaf men losing their vision getting “put down”? That evokes shrugs and even applause.

I don’t get it. And I think I’m grateful I don’t.