Friday, March 16, 2018

Behind the Curtain of Assisted Suicide Advocacy

This article was published by First Things on March 16, 2018

Wesley Smith
By Wesley Smith


The United States assisted suicide movement claims that it wants only a limited “reform” of law and medical ethics, restricting what it euphemistically calls “aid in dying” to competent adults with terminal illnesses for whom nothing else can be done to alleviate their suffering. But this claim isn’t true. Currently, no law permitting doctors to write lethal prescriptions mandates any objective medical determination that the patient is actually suffering. Indeed, a 2008 study published in JAMA Internal Medicine found that patients sometimes receive lethal prescriptions even when they are not experiencing serious pain or other noxious symptoms.

The falsity of the “limited license” narrative is further demonstrated by current policies and legislative proposals that are likely to be instituted broadly, should the assisted suicide movement prevail nationally.

Assisted Suicide for the Mentally Incompetent: Legal assisted suicide is supposed to be available only to the mentally competent. But after California legalized doctor-prescribed death, the California State Department of Hospitals promulgated a regulation requiring state mental institutions to facilitate assisted suicides of institutionalized patients who are diagnosed with a terminal illness. As I have written previously, these are often people who have been involuntarily denied their freedom due to diagnosed mental illness, sometimes because of suicidal ideation. They are usually being treated with powerful psychotropic medications. In what universe could they possibly be deemed competent to make a reasoned decision in favor of assisted suicide?

California isn’t alone in opening the door to assisted suicide for the mentally incompetent. A pending bill to legalize assisted suicide in Delaware would allow the “intellectually disabled” who are terminally ill potentially to qualify for lethal prescriptions. Note how HB 160 defines the term:
“Intellectual disability” means a disability, that originated before the age of 18, characterized by significant limitations in both intellectual functioning and in adaptive behavior, which covers many everyday social and practical skills.
Such people can’t legally enter contracts. They can’t control where they live. They would require a guardian’s consent to receive most medical treatments. They can’t consent to getting a tattoo! But these same developmentally disabled people would be able to receive assisted suicide if a licensed clinical social worker wrote a letter to the lethally prescribing doctor confirming “that the patient understands the information provided.”

Expanding Assisted Suicide Beyond the Terminally Ill: The oft-repeated promise that assisted suicide is only for those who are already dying no longer holds overseas. Countries such as the Netherlands, Belgium, Switzerland, and Canada don’t limit assisted suicide and euthanasia to the dying. It’s only logical: If eliminating suffering justifies eliminating the sufferer, there are many people with disabilities, chronic pain, dementia, mental illnesses, and so on who may experience far greater suffering, and for a longer time, than do the terminally ill. It should be no surprise that many countries have steadily expanded their laws’ killable categories over the years—including, in Belgium, joint lethal injections of at least three elderly couples who wanted to die for fear of the future suffering they expected would be caused by widowhood.

Advocacy for loosening the restriction has begun here, too. As the Washington Post recently reported, Oregon legislators are planning a push to eliminate the six-months-to-live rule, and to extend the option of euthanasia to people diagnosed with dementia. True, that bill is opposed by Compassion & Choices; but, at least in part, they oppose it because it “could give ammunition to critics and frustrate their efforts to bring the narrowly defined statute to as many states as possible.” In this regard, it is also worth noting that Compassion & Choices issued a press release applauding Canada’s Supreme Court for granting a very broad legal and positive right to receive euthanasia that extended far beyond the terminally ill—a press release subsequently scrubbed, one suspects, because it revealed how radical the organization’s views really are.

Child euthanasia: Assisted suicide advocates promise to limit medicalized killing to adults. But we have already seen that same promise broken in the Netherlands and Belgium. In the Netherlands, severely disabled and dying babies are subjected to infanticide under the “Groningen Protocol”—a bureaucratic baby euthanasia checklist—and children aged twelve and above can legally be given a lethal jab. Next door in Belgium, there are no age limits! Meanwhile, Canada is beginning to debate whether to expand its euthanasia laws to include at least “mature” children.

Child euthanasia has now received the imprimatur of one of this country’s most prominent euthanasia and assisted suicide advocates, professor and prolific author Margaret P. Battin. She recently wrote in the Dutch medical journal Pediatrics that there are “no good reasons” for failing to expand eligibility for assisted suicide to minors under age twelve, and she believes that many factors favor the expansion—including, notably, “the suffering of parents.” As far as I know, none of her colleagues in the movement have objected to or publicly criticized her radical proposal.

The assisted suicide movement pretends to have a very limited agenda. It pretends to advocate only a minor change—a “safety valve,” as they sometimes call it—in traditional medical ethics and public policy. But advocates sometimes give us glimpses of the more radical and extensive ultimate intentions behind their blithe assurances. For those who have eyes to see, let them see. 


Wesley J. Smith is a senior fellow at the Discovery Institute’s Center on Human Exceptionalism and a consultant to the Patients Rights Council.

Netherlands breaking records by killing its own.

This interview was published by OneNewsNow on March 16, 2018

Alex Schadenberg
The Netherlands has released an annual report on euthanasia deaths but an advocate against euthanasia says the numbers deserve scrutiny.

There were more than 6,500 deaths in 2017, an increase of eight percent over 2016, but Alex Schadenberg of the Euthanasia Prevention Coalition says a previous study suggests that 23 percent of patients killed by a doctor are not reported.

One reason for the increase, he observes, might be expanding the allowances for euthanasia, including mental patients who don't have a terminal condition.

"Often they have actually no medical condition causing their death," says Schadenberg, "but they have psychiatric distress and most of those deaths are caused by the euthanasia clinic." 
The numbers are likely to rise even more if euthanasia of disabled children is legalized but Schadenberg says even that allowance is not the sole reason if future data shows more dead people. 
"So you have this constant increase because what was once considered an exceptional case, or out of the ordinary, has become the ordinary," he says. "And the more the culture moves in that direction, the more euthanasia deaths you're going to have."

Monday, March 12, 2018

Public prosecutor investigates euthanasia deaths in the Netherlands

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition


The DutchNL news reported that the regional euthanasia review committee's annual report was released indicating that the number of assisted deaths increased by another 8% to 6585 assisted deaths were reported in 2017.
The DutchNL news, indicated that the number of assisted deaths for dementia or psychiatric reasons also increased in 2017, with 169 people dying by euthanasia for dementia (3 were advanced dementia) and 83 people dying by euthanasia for psychiatric reasons.

The report also indicated that there were 4 deaths being investigated by the public prosecution service. The Guardian news reported the following:

The four cases being investigated have been referred to the prosecutor’s office by regional euthanasia committees, which monitor the system and alleged they had found problems. The cases were then found to warrant criminal investigation. 
Two deaths being examined by the prosecutor in Noord-Holland province involve a doctor employed by Levenseindekliniek, an end of life clinic. 
It is claimed that a 67-year-old woman, who lacked the capacity to express her own will because of Alzheimer’s, was euthanised in May last year despite the physician being unable to ascertain whether the request for death was voluntary and deliberate. 
In a second case, an 84-year-old woman was euthanised last June after claiming her life was “hopeless” because of several physical illnesses. It has been suggested that this was not sufficiently proven to be case.

The public prosecutor in Oost-Nederland is also investigating the euthanasia of a 72-year-old woman last April who had metastasised cancer but lapsed into a coma, leaving the physician unable to ascertain that the decision for euthanasia was voluntary and well-considered, the review committee said. 
In the fourth case, which is being investigated in The Hague, a euthanasia request from an 84-year-old woman was granted in February last year after the patient complained that her freedom of movement had been “very much restricted” by pulmonary emphysema. It has been claimed the physician concluded too easily that the suffering of the patient was hopeless.
The DutchNL article indicated that 12 of the euthanasia deaths were questionable:
Twelve cases were labeled by the monitoring committee as not being carefully carried out – these were mainly problems with medical care or not having an independent second opinion.
The New England Journal of Medicine (NEJM) (August 3, 2017) published a Netherlands study titled:End-of-Life Decisions in the Netherlands over 25 years.

Netherlands euthanasia study uncovers abuse of the law. The study indicates that in 2015 there were 7254 assisted deaths (6672 euthanasia deaths, 150 assisted suicide deaths, 431 terminations of life without request) in the Netherlands.



A woman in the Netherlands was interviewed for the upcoming Fatal Flaws Film explaining how her mother died by euthanasia without request.

The Netherlands euthanasia law uses a voluntary self-reporting system, meaning the doctor who lethally injects the patient also submits the report. Since doctors do not self-report abuse of the law, therefore the law enables doctors to cover-up "abuse" of the law. The 431 terminations of life without request are usually not reported.

John Kelly: Incredible presentation explaining why the disability community opposes assisted suicide.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition.

John Kelly, the New England Regional Director for the disability rights group, Not Dead Yet and the leader of Second Thoughts Massachusetts made an incredible presentation to the National Academies of Sciences, Engineering and Medicine (Health and Medicine division).

Kelly spoke at the workshop - Physician-Assisted Death: Scanning the Landscape and Potential Approaches.

Kelly's presentation is less than 17 minutes and yet he thoroughly explains why assisted suicide should not be legalized and why assisted suicide threatens the lives of people with disabilities, and others. 


I encourage everyone to watch this presentation.

Previous articles by John Kelly:

Wednesday, March 7, 2018

Netherlands 2017 euthanasia deaths increase by another 8%

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition


The DutchNL news is reporting that the regional euthanasia review committee's annual report was released indicating that 6585 assisted deaths were reported in 2017, increasing by 8% from 6091 reported assisted deaths in 2016.
According to the DutchNL news, the number of assisted deaths for dementia or psychiatric reasons also increased in 2017, with 169 people dying by euthanasia for dementia (3 were advanced dementia) and 83 people dying by euthanasia for psychiatric reasons.  

In 2016 there were 141 people who died by euthanasia based on dementia, up from 109 in 2015 and 60 people who died by euthanasia for psychiatric reasons, up from 56 in 2015. 

The DutchNL article indicated that 12 of the euthanasia deaths were questionable:
Twelve cases were labeled by the monitoring committee as not being carefully carried out – these were mainly problems with medical care or not having an independent second opinion.
The Netherlands euthanasia review committees are lying when they state that nearly all of the deaths are done according to the law. The fact is that they simply do not know how many assisted deaths occur outside of the law.

The New England Journal of Medicine (NEJM) (August 3, 2017) published a Netherlands study titled: End-of-Life Decisions in the Netherlands over 25 years.
The study indicates that in 2015 there were 7254 assisted deaths (6672 euthanasia deaths, 150 assisted suicide deaths, 431 terminations of life without request) in the Netherlands.

A woman in the Netherlands was interviewed for the upcoming Fatal Flaws Film  explaining how her mother died by euthanasia without request.



Since the Netherlands 2015 euthanasia report indicated that there were 5561 reported assisted deaths in 2015 and yet the data from the study indicated that there were 7254 assisted deaths in 2015. Therefore, based on the data from the study, 1693 (23%) of the assisted deaths were not reported.

The Netherlands euthanasia law uses a voluntary self-reporting system, meaning the doctor who lethally injects the patient also submits the report. Since doctors do not self-report abuse of the law, therefore the law enables doctors to cover-up "abuse" of the law. The 431 terminations of life without request are usually not reported.

Due to the design of the Netherlands law, it is impossible to know how many people actually die by an assisted death in the Netherlands. Sadly the Belgian and Canadian euthanasia laws contain the same Fatal Flaws as the Netherlands law.

Important articles on euthanasia in the Netherlands (2017):

Assisted suicide in Oregon: The reality.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition


The Lozier institute has published a thorough analysis of the reality of assisted suicide in Oregon by Richard Doerflinger based on the Oregon Health Authorities 2017 assisted suicide report.
Doerflinger, who is an associate scholar with the Charlotte Lozier Institute and a Public Policy Fellow at the University of Notre Dame’s Center for Ethics and Culture, examines the report based on key themes.

He first examines the problem with uncovering abuse of the law.

Physicians, witnesses, and others involved in the process need not comply objectively with the law’s requirements, but only show “good faith” compliance, exempting physicians from their usual obligation not to be negligent. The prescribing physicians need not refer a patient for psychological evaluation even in a clear case of clinical depression — such referral is required only if the doctors think the patient’s depression causes “impaired judgment.” So if they agree with the patient’s judgment that he or she is better off dead, there is no referral. 
the Oregon system is tailor-made to conceal, not reveal, abuses. The physicians involved in prescribing the drugs are the only people allowed to file reports on these cases. The Oregon Health Authority itself says it has no legal warrant to do anything but take this self-reporting at face value. If other doctors found that the patient is not eligible for assisted suicide, patient or family can simply keep trying other doctors until they find one ardently committed enough to assisted suicide to sign the forms – and it is only that last doctor who files a report. So the very cases that most cry out for investigation – in which other doctors had concluded that this patient is not eligible to receive lethal drugs – are those in which the only report is most likely submitted by ideologically committed physicians inclined to ignore or conceal problems. Those physicians are then told by the state to falsify the death certificate, listing the underlying illness as cause of death, so there will be no autopsy or independent scrutiny. And after filing an annual report from which all identifying information has been removed, the state destroys the original reports.
As I have always stated, the Oregon assisted suicide law is designed to protect physicians who are willing to prescribe lethal drugs.

He then examines the data in the 2017 assisted suicide report:
In 2017, there were 218 lethal prescriptions written and 143 patients died from these drugs. The annual increase in deaths has accelerated in the last four years, with almost twice as many assisted suicides in 2017 (143) as in 2013 (73). 
Fourteen of the 2017 deaths were from drugs prescribed in previous years. So of the 218 prescriptions filled in 2017, as many as 89 lethal barbiturate overdoses (with instructions on how to use them to take a life) are in the population, and the state that authorized their distribution has no idea what became of them. In all, 1,967 lethal prescriptions have been written and at least 1,275 patients have died from these drugs, leaving a total of 692 lethal overdoses unaccounted for.
He then examines the issue of mental health and assisted suicide:
From 1998 to 2012, only 6% of patients on average were referred for evaluation; this went down to just under 4% in 2013-2016, then 3.5% in 2017. The state has not cited a single case out of 1,275 in which a patient was found ineligible for assisted suicide because an evaluation found depression or other mental condition impairing judgment. 
...The essential question, then, is this: What checks are there against depression or other mental condition, misuse of the drugs by others with their own agendas, subtle or overt coercion, etc., at the time of death? 
The answer is: There aren’t any.
He then examines the oversight of the Oregon assisted suicide act:
The only person who can report on the circumstances at that time is the prescribing physician, and that person was only present 16% of the time in 2017 (an average of 15% for all years). In past years, a health care provider other than the prescribing physician was present 27% of the time on average; in 2017 that is down to 13%. Thus in 2017 no health care provider was present 71% of the time. 
Since the prescribing doctor, who is required to self-report the act, is rarely present at the death, therefore there is little to no oversight of the law.
Doerflinger then examined the definition of “Incurable and irreversible” terminal illness in the Oregon law based on the recent research by a Swedish investigator who communicated with the Oregon Health Authority. Doerflinger states:
Fabian Stahle, a Swedish investigator who contacted a state health official in Oregon to clarify how the phrase “terminal disease” is interpreted by those who monitor the law’s implementation. He found that patients are eligible for assisted suicide if the two doctors think they are likely to die in six months without any treatment — even if they could have been cured by treatment, or could live for years or decades if treated. If the patient refuses potentially curative treatment (as a suicidally depressed patient, for example, may well do), or treatment is denied by someone else like the physician or a health insurance company, that patient becomes “terminal” and can receive lethal drugs. Essentially you are terminal if, by withholding treatment, you can be made terminal.
He then uncovers further issues with the terminal definition:
Overall, the time from first request for the drugs, to death from those drugs, has been as long as 1,009 days (over five times the projected life expectancy); in 2017 it was as long as 603 days. 
In 2017, some 77% of the patients had various forms of cancer. Others had chronic conditions with a less predictable trajectory toward death, such as cardiac and respiratory conditions found in many seniors, neurological conditions like ALS (Lou Gehrig’s disease), and even metabolic conditions like diabetes. In 2016 the list included “benign and uncertain” growths; overall, three patients have been found eligible for the lethal drugs although doctors listed no illness at all.
The next question that he examined was the issue of uncontrolled pain.
The reality is that pain, or even concern about future pain, ranks low on the reasons that patients cite for getting the lethal drugs. In 2017, only 21% cited this concern (compared to an average of 26% in past years). The most common reasons are being “less able to engage in activities making life enjoyable” (88%), “losing autonomy” (87%), and “loss of dignity” (67%), all of which could be cited by someone with a chronic illness or long-term disability that is not terminal. The most significant change is that in 2017, some 55% of patients (compared to an average of 42% in past years) say they are obtaining the lethal dose because they are a “burden on family, friends or caregivers” – a feeling easily communicated to patients by those other parties, and by the existence of a government policy singling them out for “assistance” in suicide.
Further to that he examined the problems with assisted suicide's
In 2017, at least two patients had seizures after ingesting the drugs. Overall, at least 25 patients (including one in 2017 and three in 2016) regurgitated some of the dose, and seven overall have regained consciousness and died later of natural causes. (Interestingly, there is no record of anyone choosing to go through this a second time.) For 638 patients, 101 of them in 2017, it is not known whether such complications occurred, presumably because the prescribing physician who filed the report was not present. The time period from ingesting the drugs to death is unknown in most cases; in the 40 cases where it is known in 2017, patients took as long as 21 hours to die, compared to nine hours in 2016, with an overall maximum of 101 hours (over four days). In 2017 it took as long as four hours for the patient to lose consciousness, compared to a maximum of one hour previously; this figure is not known for 105 of the 143 patients in 2017.
Finally he examined the issue of medical treatment options:
One significant change: In 2017, only 31% of the patients had private health insurance (compared to 54% in 2016), and 68% had only governmental insurance such as Medicaid and/or Medicare (compared to 45% the previous year). This is troubling in light of Oregon’s Medicaid rationing plan, which has been known to deny potentially life-prolonging treatment to patients while highlighting the availability of assisted suicide. 
Not that private health insurance is a guarantee against rationing. In 2017, Nevada physician Brian Callister revealed that he had sought approval from insurance companies in Oregon and California (the latter also having an Oregon-style law) for two patients he thought could be cured by a treatment available in those states – in both cases, he says, the companies refused coverage for the treatment but suggested that he consider assisted suicide.
Richard Doerflinger concluded his article by stating:
This is the updated reality of physician-assisted suicide in the state whose law is seen as a model for the nation. Chronically ill seniors, potentially victims of untreated depression and the impression that they have become a “burden” on others, are nudged to a premature death that may be more gruesome than they’ve been led to believe, with no one usually present at the time of death to check whether they are competent, badgered by others, or overtly coerced toward that death. This is what has become known as “death with dignity” in Oregon, and advocates are working to spread it to far more states.
Clearly, the theory of assisted suicide in Oregon and the reality are very different.

Nancy Elliott testimony to the Connecticut Public Health Committee. "Assisted suicide is bad public policy."

Nancy Elliott's testimony to the Connecticut Public Health Committee.

Dear Committee Member,

Nancy Elliott
This is my testimony opposing the intent of assisted suicide bill HB 5417. 


I am Nancy Elliott. I am a former 3 term New Hampshire State Representative and the Chair of Euthanasia Prevention Coalition USA
 

The three groups that are the target for assisted suicide are the sick, the elderly and the disabled. While there are many other problems with this kind of law, I am going to focus in on these three today.
 

It is said this is only for the sick and dying. One of the biggest problems is people who qualify for assisted suicide are not necessarily dying. Think of a 21-year-old otherwise healthy insulin dependent diabetic. He qualifies if he rejects his insulin. This would be the same for many other people with serious conditions, who take prescription medications. What about all the curable cancers? They qualify. What about the 5% of incorrect medical diagnosis? With Assisted Suicide on the table these mistakes can be deadly.
 

I was at an oral submission on assisted suicide in Massachusetts a few years back when a gentleman named John Norton gave evidence, that as a young man he was diagnosed with ALS. He stated that had assisted suicide been legal at that time he would have used it. A few years in, the disease’s progression just stopped. Now in his late 70’s he stated he has had a great life with children and a grandchild. With assisted suicide on the table he would have lost all of that.
 

Steering is a big deal with all three of the groups that I mentioned. At that same Massachusetts proceeding, a doctor stated that assisted suicide laws were something he was in favor of. He continued with his points and ended by saying that he felt it was the responsibility for a good doctor “to guide people to make the right choice”. I do not think he intended to say that, but is there any doubt that this pro suicide doctor would try to persuade his patients to follow his wishes concerning their assisted suicide.
 

These laws are abusive in their very nature. To suggest to someone that they should kill themselves is abuse. My husband was terminally ill and I went to a lot of doctor appointments with him. If medical personnel were to suggest assisted suicide to him, he would have been devastated. While he never would have done that, it would be like saying to him, "You are worthless and should die." That is abuse! The proponents say that would never happen, but that did happen to an Oregon woman named Kathryn Judson. She had gone to a doctor’s appointment with her seriously ill husband and feeling exhausted she sunk into a chair where she overheard the doctor pitching assisted suicide to her husband with the clincher, “Think of your wife.” They left and never went back. The husband went on to live another five years.

Next seniors are at risk and very easily fall victim to coercion as the process is very open to that. In most states, heirs can be there for the request and even speak. Anyone can pick up the lethal dose. Once in the house all oversight is gone, there is no witness required at the death. Even if they struggled who would know. If that is not enough, the death certificate is falsified to reflect a natural death. All the information is sealed and unavailable to the public. Even if someone suspected foul play, the death certificate says no crime here. Taking advantage of seniors is epidemic in the States. Look at the case of Thomas Middleton. He made Tami Sawyer his trustee and moved into her home. Within a month he was dead by Oregon’s assisted suicide law. Two days after his death Ms. Sawyer listed his house and sold it and deposited the money into three companies she owned with her husband. We will never know if or how much coercion or foul play took place in that case.

Finally those with a disability are at risk. Most people that “qualify” for assisted suicide at that point in their life have a disability. Many with long term disabilities and have been labeled as terminal all their lives. Without meds, treatments, and assistance they would not survive. This is about disability. If you have a disability you are encouraged to give up and commit suicide. If, on the other hand, you are young and healthy, you are given suicide prevention counseling. This is discrimination against people with disabilities. Why should they trust that they will not be coerced into assisted suicide, when they are already discouraged to seek treatments and are not treated fairly? When you think about it this is a law that is written just for them. It is a “special” carve out, for the sick, elderly and disabled.

In closing, I just want to add that assisted suicide has been rejected in over 100 legislative, ballot initiative and judicial attempts in the USA, including my state New Hampshire. The more it is studied the more uncomfortable people become with it.

Thank you for the opportunity to address this bill. Please reject HB 5417. It is bad public policy.

Nancy Elliott
Chair - Euthanasia Prevention Coalition - USA

Tuesday, March 6, 2018

Second Thoughts Connecticut Opposes Assisted Suicide HB 5417

This message was sent by the disability rights group, Second Thoughts Connecticut to the members of the Connecticut Public Health Committee,

Cathy Ludlum
Dear Members of the Public Health Committee,

With all due respect, and on behalf of our members at Second Thoughts Connecticut, we are writing to express our outrage that yet another bill to legalize assisted suicide is being raised this year.

Similar bills were raised in 2013, 2014, and 2015. Each one resulted in a grueling 12-15 hour hearing, putting great stress on legislators, the public, and especially on disabled people like ourselves, many of whom find it hard to travel and stay out for hours at a time.

Not only were these bills pulled each year before the JF deadline, but each time they were pulled earlier in the process, indicating that whatever support the concept may have had in 2013 had eroded.

Stephen Mendolsohn
This is not surprising. Initially, people often think that assisting someone to die is the compassionate course. Once they read the bill, consider its implementation, and understand the discrimination it entails, support drops. They have second thoughts.

It’s bad enough to have to go through this ordeal all over again. We were shocked to see that HB 5417 (An Act Concerning End-Of-Life Care) is exactly identical to HB 7015, which was heard in 2015. The only things that have been changed are the title and the effective date. All of the testimony opposing the 2015 bill is still relevant. If there are no new ideas, and none of our previous concerns have been addressed, why would the outcome be any different?

Furthermore, this bill deals with life and death. It was not taken seriously enough to draft a new bill, or even remove the reference in Section 18 to the Office of Protection and Advocacy for Persons with Disabilities, which no longer exists. How much thought was put into the impact this legislation would have on our well-being?

We urge you to withdraw HB 5417. There is nothing new here, and this concept has failed to pass a single committee in three consecutive years. In baseball, after you strike out three times, you sit down for a while.

Thank you.

Cathy Ludlum and Stephen Mendelsohn
Second Thoughts Connecticut
Website: https://sites.google.com/site/secondthoughtsconnecticut/
Facebook: https://www.facebook.com/SecondThoughtsConnecticut/
Twitter: https://twitter.com/2ndThoughtsCT

Monday, March 5, 2018

Prominent US Bioethicist Supports Child Euthanasia.

This article was published on Wesley Smith's website on March 5, 2018.

Sign the petition: "I Oppose Euthanasia for Children."


By Wesley Smith

The U.S. assisted-suicide movement pretends to want a limited legalization of assisted suicide to competent adults with a terminal illness.

That’s not true. It’s just the expedient to persuade us to accept the premise that suicide or killing is an acceptable solution to human suffering.

If we ever do that — the jury is still out — then, the killing license thereby granted will not only expand way beyond the terminally ill, but will eventually also include children and the incompetent.

The evidence of this isn’t hard to find. Case in point. Pediatrics asked Dutch and American bioethicists whether they would support repealing all age limits for euthanasia in the Netherlands — as the Belgians already have. (Currently, euthanasia in the Netherlands is legal starting at age 12.)

If American advocates were serious about their espoused limits, they would be appalled by the existing Dutch law, and even more so by the Pediatrics hypothetical proposal.

But at least one prominent U.S. proponent — Margaret P. Battin, a favored source on the issue for the New York Times and other mainstream media outlets — is enthusiastically in favor of the Dutch doing away with all euthanasia age limits. From her comment:

I generally support [the] change in Dutch law governing eligibility for euthanasia.‍ Given that euthanasia is currently legal for infants <1 adults="" age="" and="" children="" of="" year="">12 years of age, I believe that opponents would have to show evidence that at least 1 and perhaps many of the following propositions are true if they are to persuade you [a hypothetical Dutch health minister] not to support the change in the law:
Battin lists several propositions, including:
That parents aren’t harmed by seeing their children suffer.
In other words, children should be put out of the parents’ misery:
That pediatricians can’t understand the difference between killing a healthy, curable child and hastening a bad death that is already in progress.
Except that Dutch law does not require a terminal illness to be killed. Indeed, the infanticide-allowing Groningen Protocol — it isn’t technically legal, but is virtually never punished — specifically does not require that the killed baby be otherwise dying. In fact, under the Protocol, serious disabilities justify infanticide.
That allowing this practice would lead to wholesale killing of children from 1 to 12 years of age.
In other words, killing would only be wrong if it amounted to a pogrom against seriously ill or disabled children. Good grief.
That it is always wrong to end a life.‍ (Proponents of this view would need to address situations such as killing in war, killing in self-defense, killing in defense of others, and [more controversially] capital punishment; they would also need to oppose current laws in the Netherlands that allow euthanasia for children <1 adults="" age="" and="" of="" year="">18 years of age.
So, since babies and children age 12 and up can be killed, the Dutch should go all-in. Or to put it another way, once a society starts down Euthanasia Road, there is no stopping.

Battin’s radical proposals aren’t usually made by U.S. assisted-suicide proponents because they know that our society has not completely swallowed the hemlock (as has the Netherlands). If we ever do, we will go exactly to the dark place that country has gone over the last few decades — just as Battin advocates.

It’s a very big deal that a respected Dutch medical journal such as Pediatrics hosted a debate on the ethical propriety of child euthanasia without international criticism. It means that among the medical intelligentsia, child euthanasia has become a respectable proposition.

For those with eyes to see, let them see.

Editor’s Note: This post has been amended since its original publication.

Canadian prisoner dies by euthanasia.

This article was published by Mercatornet on March 5, 2018

Michael Cook
By Michael Cook.

Not too long ago, a request by a Belgian prisoner for euthanasia made international headlines -- even though he was not permitted to take advantage of the legislation.

But in a measure of how enthusiastically Canada has embraced euthanasia, one prisoner has already been killed under its Medical Aid in Dying (MAID) law, and three others have been approved. According to a report in CBC News, the death took place in a hospital outside of the prison, under the supervision of two correctional officers. It seems to have slipped under the radar of the ever-vigilant journalist of the Canadian media -- even though it could be a world first.

Correctional Service Canada (CSC) told CBC News that it had, to date, received eight requests for MAID.

CSC is now permitted to organise MAID in a community hospital — but it can also take place in a penitentiary regional hospital or treatment centre in exceptional circumstances and at the request of the inmate. The procedures for prisoner all all set out in a set of detailed guidelines.

Correctional Investigator Ivan Zinger criticised the possibility of inmates being euthanised in a prison in a letter to the CSC head:
"Practically and perceptually, I simply can not imagine a scenario where it would be considered acceptable to allow an external provider to carry out a MAID procedure in a federal penitentiary,"
Zinger said that MAID should occur only outside prisons. A prohibition on MAID within prisons would protect the integrity of the system now and in the future, when eligibility for assisted death could expand to prisoners suffering from acute psychiatric illnesses – and in prisons there are a number of these.

You wonder where the logic of personal autonomy will end. Prisoners must be the amongst most vulnerable people of all possible candidates for euthanasia. Their surroundings seem purpose-made to inspire despair and promote groupthink. Their custodians benefit from their deaths by cutting costs. They are already being punished by restricting the exercise of their autonomy. It seems perverse to allow them to choose death when they cannot even choose their favourite TV program.

Michael Cook is editor of MercatorNet

Friday, March 2, 2018

Canadian doctors - Obliged to Kill

This article was published in the Weekly Standard on March 2, 2018

Wesley Smith
By Wesley Smith

A court in Ontario, Canada, has ruled that a patient’s desire to be euthanized trumps a doctor’s conscientious objection. Doctors there now face the cruel choice between complicity in what they consider a grievous wrong—killing a sick or disabled patient—and the very real prospect of legal or professional sanction.

A little background: In 2015, the Supreme Court of Canada conjured a right to lethal-injection euthanasia for anyone with a medically diagnosable condition that causes irremediable suffering—as defined by the patient. No matter if palliative interventions could significantly reduce painful symptoms, if the patient would rather die, it’s the patient’s right to be killed. Parliament then kowtowed to the court and legalized euthanasia across Canada. Since each province administers the country’s socialized single-payer health-care system within its bounds, each provincial parliament also passed laws to accommodate euthanasia’s legalization.

Not surprisingly, that raised the thorny question of what is often called “medical conscience,” most acutely for Christian doctors as well as those who take seriously the Hippocratic oath, which prohibits doctors from participating in a patient’s suicide. These conscientious objectors demanded the right not to kill patients or to be obliged to “refer” patients to a doctor who will. Most provinces accommodated dissenting doctors by creating lists of practitioners willing to participate in what is euphemistically termed MAID (medical assistance in dying).

But Ontario refused that accommodation. Instead, its euthanasia law requires physicians asked by a legally qualified patient either to do the deed personally or make an “effective referral” to a “non-objecting available and accessible physician, nurse practitioner, or agency .  .  . in a timely manner.”

A group of physicians sued to be exempted from the requirement, arguing rightly that the euthanize-or-refer requirement is a violation of their Charter-protected right (akin to a constitutional right) to “freedom of conscience and religion.”

Unfortunately, the reviewing court acknowledged that while forced referral does indeed “infringe the rights of religious freedom .  .  . guaranteed under the Charter,” this enumerated right must nonetheless take a back seat to the court-invented right of “equitable access to such medical services as are legally available in Ontario,” which the court deemed a “natural corollary of the right of each individual to life, liberty, and the security of the person.” Penumbras, meet emanations.



And if physicians don’t want to commit what they consider a cardinal sin, being complicit in a homicide? The court bluntly ruled: “It would appear that, for these [objecting] physicians, the principal, if not the only, means of addressing their concerns would be a change in the nature of their practice if they intend to continue practicing medicine in Ontario.” In other words, a Catholic oncologist with years of advanced training and experience should stop treating cancer patients and become a podiatrist. (An appeal is expected.)

This isn’t just about Canada. Powerful political and professional forces are pushing to impose the same policy here. The ACLU has repeatedly sued Catholic hospitals for refusing to violate the church’s moral teaching around issues such as abortion and sterilization. Prominent bioethicists have argued in the world’s most prestigious medical and bioethical professional journals that doctors have no right to refuse to provide lawful but morally contentious medical procedures unless they procure another doctor willing to do as requested. Indeed, the eminent doctor and ethicist Ezekiel Emanuel argued in a coauthored piece published by the New England Journal of Medicine that every physician is ethically required to participate in a patient’s legal medical request if the service is not controversial among the professional establishment—explicitly including abortion. If doctors don’t like it? Ezekiel was as blunt as the Canadian court:

Health care professionals who are unwilling to accept these limits have two choices: select an area of medicine, such as radiology, that will not put them in situations that conflict with their personal morality or, if there is no such area, leave the profession.

Thursday, March 1, 2018

Dr Mark Komrad: Submission to New Zealand government committee

The submission by Dr Mark Komrad to the New Zealand Parliamentary Committee examining euthanasia and assisted suicide.

Dr Mark Komrad
Dr Mark Komrad I am submitting feedback to the New Zealand Parliament’s End of Life Bill. I am a psychiatrist and a medical ethicist in Baltimore, Maryland, USA on the faculty of Psychiatry at Johns Hopkins, University of Maryland, and the Sheppard Pratt Health Systems who has been engaged in the issue of assisted suicide and euthanasia, particularly in the case of psychiatric patients, in the U.S., Canada, and Europe.


  • An important assumption underlying such assisted dying legislation is that physician-administered death is the only escape from unbearable suffering. This is not consistent with state-of-the-art palliative care, which includes a number of techniques, including but not limited to “terminal sedation,” in which consciousness is suppressed to the point where suffering is not experienced. Though there may be an increased risk of death from such a procedure, that is not the intention of the procedure. This and many other measures are quite effective at relieving suffering in a dignified and compassionate manner. If we kill patients as a means of relieving suffering, it undermines the entire enterprise of palliative care and will short circuit access, willingness, and even resources available for palliative care. This has happened in Belgium, where palliative care nurses are actually resigning, with the complaint that palliative care facilities are becoming “houses of euthanasia.” [https://tinyurl.com/y7kdh9ab , Caldwell, S. “Palliative care nurses quit ‘houses of euthanasia’” Catholic Herald, 18 Jan 2018] 
  • The deep and millennia-old value that is “professed” by the profession of Medicine is to not kill in the name of healing. This was the unique feature of the very foundation of Medicine by Hippocrates, who made trainees swear an oath that they would “give no man a poison, nor counsel anyone else to do so.” This Hippocratic Oath is so core and fundamental to the ethos of medicine that it is still recited at medical school graduations to this day. Just as the teachings of Jesus were the foundational root out of which the mighty tree of Christianity grew, with all of its core value systems, this Hippocratic ethos was the root out of which the tree of Medicine has grown, and it is intimate to its fundamental substance as a profession. Although there is arguably a continuum between the role of “bringer of comfort” and “bringer of death,” society has a vested interest in maintaining the role of physicians as the “bringers of comfort.” Maintaining the “sterile field” in which physicians bring comfort, without deliberately killing, is crucial to the doctor - patient relationship. This is vital to how a physician thinks through possible options, the degree of devotion to helping the patient, and the willingness to sustain a field of support for a suffering patient. Compassion means “to suffer with.” Allowing doctors to kill patients can increase the unconscious temptation for doctors to avoid their venerable, age-old devotion to “suffering with.” 
  • No country that has experimented with medically assisted dying has been able to hold the practice to patients at the end of life. None. That is the intention with which it begins. The living laboratories of The Netherlands and Belgium, which have had over 15 years of experience with this since their law was struck, have seen an inexorable slope. It began with those who are terminally-ill, by the nature of their illness. It progressed to those who produced a terminal condition by refusing chronic life-sustaining treatment (i.e. insulin). Then it slipped to the chronically and non terminally ill; then to the removal of distinctions between mental and physical suffering (thus opening the door to psychiatric conditions and unbearable lifestyles); then to those who are merely “tired of living” or feel they have a “completed life;” then to proxy consent for euthanasia of the incompetent, children, people on life support, and people suffering from dementia — by family members; then to “mercy killing” of those without capacity, by doctors who are unable to find consenting family members. Now there is the push for over-the-counter suicide pills in the Netherlands. Each of these steps has been widely documented. 
  • Shifting suicide from a freedom to a right is a profound shift for any society. When suicide is made a right, rather than a freedom, it implies that there is a duty to enable people to fulfill that right. That means setting up a class of human beings who now has a duty to help people fulfill the right to suicide. Whoever has that duty is now vested with the mantel of “compassion,” “virtue,” and “healing” in the act of killing, however well-intentioned. The now-regretful pioneer of euthanasia in The Netherlands, Doudewijn Chabot M.D., seeing society’s inability to constrain euthanasia to its originally legislated applications has noted, “a culture has emerged in which performing euthanasia is considered to be virtuous behavior.” This is not only true for doctors, but this sense of virtue is also bestowed on those who choose assisted suicide. They are cast as heroic and noble, while those who continue to suffer are seen as partially responsible for their own continued suffering, because they rejected the death solution. There are widespread anecdotes of this attitude towards the chronically suffering, developing in Belgium, which I discovered in my research. 
  • There is much evidence for “suicide contagion” as a consequence of ordinary suicide. Several studies in the U.S. and in the Netherlands have shown that the introduction of physician assisted suicide has not only failed to curb the “natural” suicide rate, but has also been associated with an acceleration of that rate. Whether there is a cause and effect relationship is still unknown. Assisted suicide has certainly done nothing to curtail “natural” suicide. However, there is an extraordinary dissonance in a society that engages in public health measures and messages to prevent suicide, while simultaneously designating a “special privilige” to certain groups to not just permit suicide, but to help provide for and abet that goal—by the same professionals (physicians) who are otherwise engaged in thwarting suicide in others. 
  • Suicidal thinking is a very reliable indicator of a treatable psychiatric condition. Many medical conditions, particularly degenerative ones, are known to be highly associated with clinical depression, as part of the diseases themselves—independent of the degree of impairment (i.e. not just a result of “demoralization”). Research from Oregon shows that clinical depression is commonly missed by physicians who write assisted suicide prescriptions [missed up to 26% of the time: Ganzini, et al, Prevalence of depression and anxiety in patients requesting physicians’ aid in dying: cross sectional survey British Medical Journal 2008; 337 :a1682]. This is congruent with extensive literature showing that clinical depression is missed in about 1/3 of patients by primary care physicians. There is also literature showing that psychiatric treatment aborts suicidal wishes in a large proportion of people with terminal illness [Liebenluft, et. al “The Suicidal, Terminally Ill Patient with Depression” Psychosomatics, 29 (4), 379]. As elsewhere in the world, the proposed New Zealand law makes psychiatric evaluation optional, as part of the evaluation for medical ending of life. The evaluating physician personally determines the need for psychiatric evaluation. If such a referral is made, it is largely limited to assessment of capacity, and it carries no mandated psychiatric treatment attempt to qualify for assisted dying. In addition, even if there is psychiatric evaluation, a patient can refuse to give access to collateral records or informants to enable a fully accurate assessment. 
  • Reports from the Oregon Health Authority [https://tinyurl.com/ybyh9w63, “Oregon Death with Dignity Act: Data Summary, Oregon Health Authority, Public Health Division, 2016] demonstrate that the primary reason people request physician assisted suicide is psychiatric: fear, hopelessness, despair, anxiety, and inability to conceive of how they will cope as their illness progresses. These are much more commonly motivating factors (90% of the time) for assisted suicide than actual physical pain or current debilitation. It is fear of the future. Often these emotions are in the setting of complex family dynamics, abandonment, impoverishment, and a wide variety of other psychosocial stresses that affect coping ability. These are common, fundamental psychiatric issues, and addressing them lies within the skill set of mental health professionals—independent of any particular psychiatric diagnosis. It is vital to not bypass state-of-the-art means of addressing these concerns with mental health care, rather than providing a civilization-changing shortcut to medically provisioned suicide in the face of these existential distresses. Of all kinds of health care however, mental health care is often the least accessible, due to stigma as well as comparatively underfunded resources. So these factors facilitate a path of lesser-resistance, should the assisted suicide option be opened. This puts those who are more emotionally vulnerable and most in need of mental health care at risk of short-circuiting mental health treatment. 
Also, see my complete lecture on this issue at:  https://tinyurl.com/yboe394m