Canada: How Death Care is pushing out Health Care

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Alexander Raikin has written another excellent exposé on Canada's euthanasia regime published in the National Review on September 14, 2023 entitled: How Death Care pushed out Health Care. 

Raikin's previous article: No other options: An exposé on euthanasia in Canada, published by the New Atlantis on December 16, 2022, provides important insights into Canada's euthanasia law.

Raikin focuses on proceedings from the Canadian Association of MAiD Assessors and Providers (CAMAP), training seminars and interviews with patients and doctors concerning death 'care'. 

CAMAP is an independent organization funded by Canada's federal government to train doctors and nurse practitioners on how to euthanize (kill) patients (MAiD).

A panel at the CAMAP training seminar explained how "strict" the law is:

On the same day that a patient enters into an optional written agreement with only one of his or her two MAID assessors — even if it is unsigned, without any witnesses, and with no family members having been informed — the clinician can administer the lethal injection without asking for the final consent of the patient.

Quoting from a CAMAP training seminar, Raikin writes:

"Next question is from Debbie," the moderator of a discussion on medical decision-making capacity said to her fellow physicians. “How would folks interpret someone who has lost capacity with a waiver in place and is now delirious, shouting, pulling their arm away as one tries to insert the IV to provide MAID?”

The question is important because the patient is clearly unable to consent and is showing signs of resisting. 

The Moderator, Dr Ellen Wiebe, possibly Canada's most prolific euthanasia doctor, responds to the question by stating:

“I’m guessing I would bring in one of their other providers, you know, palliative care or, or whatever, and get them sedated. But what would you say?”

First to speak is Jim MacLean, who claims that he has performed more than 75 “provisions” since MAID expanded to include non-dying patients. “I don’t think I have any great thoughts on this one.” Wiebe laughed. “Everyone’s different. I mean, you try to deal with the situation. Calm the room down. See what you can achieve through conversation and calmness.”

Chantal Perrot is the co-chairman of a clinician advisory council for Canada’s largest pro-MAID lobby group. She described herself to a parliamentary committee as someone who has “cared for hundreds of patients . . . as they navigated the MAID process.” Responding to Wiebe, she said, “That’s a question. If they’re sedated, then have we sedated them into being accepting of MAID? You know, that’s a whole other question.”

Kevin Reel, a senior ethicist at Sunnybrook Hospital in Toronto and former president of the Canadian Bioethics Society, answers in part with another question: “If what we’re doing by trying to honour the waiver is reducing distress for the patient and also for maybe even the family around them, would it be acceptable to do something similarly covert to keep them from reacting in that way?”

Reel continues, “That might be a way around it, but — ” before being interrupted by MacLean, whose new answer takes the question from the hypothetical to the actual and clarifies what he meant by “conversation and calmness”: “One waiver I did use, the patient was a little agitated. So we did give her some subcutaneous hydromorphone” — an opiate ordinarily used for acute-pain control instead of sedation — “before I did the MAID, did the provision. So we did, we did use it in that situation and it was very helpful.”

“Good,” the moderator says, before moving on to the next question. 

No one on the panel or audience objects.

Raikin explains:

The asterisk in the law is that the agreement is in place only as long as the patient “does not demonstrate, by words, sounds or gestures, refusal,” or “resistance to its administration.” If this demonstration is “involuntary” and “made in response to contact,” the death of the patient may still proceed. But consent is a spectrum, and patients with delirium can flicker between having capacity and not; patients can also change their minds about dying at the hands of their physician or nurse.

The recording from an October 2021 training session documents the use of sedation to obtain consent. 

Raikin explains the importance of the use of sedation to obtain consent for death:

At the core of death care is the presumption that safeguards work and that consent, the most important safeguard, prevents death care from slipping into rampant homicide or suicide contagion. Instead, it is turning into the end of medicine.

Raikin provides examples of the use of sedation to gain consent for death:

In Belgium last year, after a lethal injection failed to kill a 36-year-old woman with terminal cancer, the presiding physician smothered her with a pillow. In New Zealand and Canada, suicidal patients seeking medical care for suicide prevention were prompted to consider assisted suicide instead.

In the Netherlands, a similar story of a physician sedating her patient into accepting euthanasia led to the first criminal trial of a euthanasia physician. She was acquitted. The judges said, “We believe that given the deeply demented condition of the patient the doctor did not need to verify her wish for euthanasia,” even though the patient repeatedly attempted to fight off her physician.

I have written previously about how a failed suicide attempt in Canada was completed through euthanasia, despite concerns of illegality by physicians involved with CAMAP, an organization that has held internal seminars on patients requesting euthanasia because of poverty, lack of medical care, homelessness, and credit-card debt.

Raikin quotes Michel Bureau, head of the Commission sur les soins de fin de vie (Commission on end-of-life care), the independent monitoring agency for MAID in Quebec who told the Canadian Press news agency this summer:

“We’re now no longer dealing with an exceptional treatment, but a treatment that is very frequent.”

In every jurisdiction that has legalized assisted suicide, the number of deaths have ballooned and "safeguards" have been rescinded. Raikin writes:

In California, the number of assisted suicides last year increased by more than 63 percent. In Canada, the number of deaths by euthanasia is on track to increase more than 13-fold in just the first seven years of the practice’s legalization. Belgium has seen a more than twelvefold increase since 2003. In Switzerland, which legalized assisted suicide in 1941, the number of such suicides has doubled every five years since 1999.

Raikin gives examples of deaths that are outside of the law:

A sibling found out that his brother’s MAID paperwork in British Columbia listed only “hearing loss” as his qualifying condition. In the Netherlands, dozens of patients qualified for euthanasia only because of autism. In Canada, “advanced age” helps qualify patients to die, even though Quebec cautions that to rely on it as the sole criterion is illegal. Young patients have died through euthanasia in Belgium for a range of reasons, including a botched sex change, sexual exploitation by a psychiatrist, unresolved post-traumatic stress disorder after a terrorist attack, and again, this time in twins, hearing loss.

Last year the Swiss Medical Association saw a need to issue a statement reminding physicians, for the first time, that “assisted suicide for healthy persons is not medically and ethically justifiable.” The agency responsible for monitoring assisted suicides in Quebec issued a similar reminder over the summer.

Raikin quotes bioethicist Leon Kass, who warns that if the value of a human being is considered subjective, invariably the right to die metamorphoses into the duty to die.

Raikin explains the planning and goals of CAMAP:

In 2018, at CAMAP’s annual conference, the leading death-care practitioners gamed out their plan. It was nothing short of prescient. Many speakers, such as the CEO of Dying with Dignity, stressed that MAID is a “political issue” and that it would require “the political will to speak out against Catholic institutions around MAID.” Moreover, as some panelists insisted, it was important for practitioners to “recognize the harm to vulnerable populations that comes with the assertion of freedom of religion.”

 In comparison, MAID was “sacred.” One speaker implored non-MAID clinicians “to keep the spirit of MAID intact.”

Just two years into Canada’s euthanasia experiment, physicians were busy laying plans for how to expand euthanasia to children, especially Indigenous children, since they “are considered wise because they are closest to the ancestors.”

Raikin explains how CAMAP promotes euthanasia for poverty:

Senior CAMAP leadership has repeatedly denied that patients are receiving euthanasia primarily because of poverty. Yet in 2018, it devoted an entire panel to “providing MAID to vulnerable, Indigenous, homeless, and frail elderly populations.” Panelists described how they could “help to empower vulnerable populations” by helping “patients fight for options that would allow them to have access to MAID” — in other words, to help find “what supports” patients might need to die instead of to live.

“I have a First Nation patient who meets all the criteria for MAID, but much of their suffering is due to a life lived in poverty,” one panelist said. “If I could change their social determinants of health, their situation might improve.” Even a hypothetical example of a patient with “fixed delusions that are causing him severe suffering” was deemed potentially eligible because “it doesn’t matter what he wants [MAID] for.”

Stefanie Green, the leader of  CAMAP, advocated that opposition by hospices to euthanasia will be overcome. Raikin quotes Green as stating:

“Over time, perhaps ten years from now, I think this conversation will happen again. If we push it now too hard and too fast, I think that will put more wedges in.”

CAMAP’s strategy has already succeeded. In 2017, Vancouver Island had a Catholic hospital and four hospice beds. Now as a consequence of a public campaign by death-care advocates, there are no remaining “MAID-free” spaces on the island.

In 2021, Vancouver Island had the highest euthanasia rate in Canada. 

Raikin discusses the cases of several Catholic hospitals that have been taken over by the Australian government in order to provide access to death services. 

Raikin writes of the doctors who object to euthanasia and are being forced out of medicine:

Helen Lord, one of the nine palliative specialists in Tasmania, retired once                "death care" began.

“I know I actually can’t kill someone, I can’t do it.  

“I said I’m not going to have any part of this. It’s not medicine. It’s just not what we do. . . . Half of the people who came into [my] palliative care were scared that they were going to be euthanized.”

When Lord spoke out against euthanasia she was accused of being a right-wing Evangelical, which she is not. Lord does believe that "life is precious" and "time is precious."

Félix Pageau, a geriatrician practicing in Quebec, testified to a national parliamentary committee in Ottawa that in his opinion as a physician, based on research, Canada was not ready to expand MAID to advanced dementia. For this, he said, a colleague in his home hospital “filed a complaint to the Collège des médecins” saying he “lied” to the committee. The Collège decided to “open an inquiry, even though they don’t have jurisdiction over testimony at the federal [level] or in the Parliament.” The investigation became an ordeal — and an expensive one, since Pageau needed to hire a lawyer. Pageau in his parliamentary testimony was exercising his free-speech rights. Eventually, the Collège ruled that it did not have jurisdiction, but the point was made.

Raikin continues:

Another physician, a former director of a palliative clinic in Canada, told me, “I had to leave a job that I loved” because “the MAID situation” made it “just too difficult to practice medicine here.” After she spoke up publicly to urge that MAID and palliative care be separate, she was constantly harassed; her email was flooded with dozens of gory images. Another palliative-care physician told me that he started his own small clinic rather than stay at the hospital where he practiced. “Physicians that go against the narrative are sanctioned,” he said. “They’re marginalized. It’s hard. It’s risky.”

Dr David D’Souza and Dr Mark D'Souza are physicians in Ontario:

“I think already there’s a lot of abuse going on, and I’m seeing it in my own practice,” including when families pressure loved ones to die so that estates or insurance payouts become available sooner. “It’s making me think twice about whether I should be continuing in geriatric care.” His brother, Mark, also a physician, left palliative care entirely. “We’re literally doing harm even though it’s under the guise of compassion,” Mark said.

Raikin states: 

The effect of legalizing death care is not just the hostile takeover of medicine. It hurts those who are the most vulnerable, those who want not to die but to be helped to live.

Gabrielle Peters, a disabled writer and policy analyst in Canada, told Raikin that it is essential that there are MAiD free places in Canadian healthcare. Raikin interviewed Rachel, who lives with chronic pain, PTSD and depression.

Rachel, a woman with a condition that causes chronic pain, told me about the difficulties of the past year. “Every day was really hard to stay alive,” she told me. “I really felt like I was dead.” She also suffers from major depression and has a history of PTSD from childhood abuse. “If I said that I wanted to die or that I couldn’t hack it anymore” when she spoke with health-care practitioners before MAID was legalized, “I was met with, ‘Here’s some coping skills and let’s talk about it,’ and various forms of therapy and resources being brought to bear.”

Once her condition qualified for MAID, in 2021, she began to notice a trend. “I would call the crisis line, the suicide crisis line. Many of these mental-health professionals, their advice would be to go look up Dying with Dignity’s website.” She tried to get help for thoughts of suicide, and instead she was being offered advice for how to die from assisted suicide.

“I have been afraid, you know, over this last couple of years to go to just my local hospital, because I was afraid that if any doctor either brought up MAID themselves or met my kind of ambivalent desire for MAID, all I needed was a push and I would be dead right now.”

Rachel found help at the Centre for Addiction and Mental Health (CAMH), Canada’s largest mental-health teaching hospital, located in Toronto. 

Raikin writes:

Its policy is that no CAMH clinicians can provide MAID on site. She felt that she had found a MAID-free space that could treat her illnesses. (CAMH is yet to release a statement on whether its MAID policy will change when, in six months, MAID will be expanded to include mental illnesses.)

Rachel decided to risk everything. With her meager savings from her disability benefits, she purchased a one-way, long-distance bus ticket, not knowing whether she would be admitted to the hospital or instead end up homeless.
“I literally just presented myself at the CAMH ER,” she said. “Part of the reason I felt safe to go to CAMH is just because I knew that they do not endorse MAID for mental illness. They’re pretty strict on that.” In a sense, Rachel lucked out. Despite the usual long wait times at Canadian emergency rooms, especially for psychiatric illnesses, her poor condition meant that her case was triaged to the front of the queue. She soon discovered how MAID was viewed by doctors at the center. “On the psych ward at CAMH, my psychiatrist was terrified — terrified,” Rachel said, carefully enunciating every syllable, “that I would talk about MAID on the floor with the other patients. She was terrified of suicide contagion.”

Over the span of weeks, Rachel began to recover. She was finally put on a new form of pain control; her depression improved. But the most important change at CAMH was that, finally, she felt listened to. “Sometimes, all you need is someone to come alongside you. And just help you cope through the everyday,” she said. “Whether it’s a doctor or just the person who is walking alongside me while I’m in a lot of pain. It may not change how much pain I actually have. But it sure makes a big difference to how much I suffer from that pain.”

Rachel is now happily back home. “I have no intention of using MAID. I have 100 percent turned away from it. Only because I had health care. All I needed was health care and pain care.”

Raikin recounts his previous article about Rosina Kamis, who died by euthanasia and her friend James, who has a similar medical situation:

In the first story that I wrote about death care, “No Other Options,” published in the New Atlantis, I wrote about Rosina Kamis, a 41-year-old Toronto woman with fibromyalgia. She chose to die from MAID in part because of her inability to access proper medical care. Before she died, she entrusted her friend James, a former neighbor, to represent her as her power of medical attorney; since her physicians weren’t listening to her, she wanted to see if someone else who has fibromyalgia, as James does, could get her the medical care that she needed. Despite his efforts, James couldn’t help her — and now, after her death, he can’t get the help that he needs. He messaged me months after our first conversation to tell me that he now sees his own future in what happened to Rosina.

James told me that he is living with the specter of an imminent administered death, like Rosina’s. He could decide to stop fighting for the care he needs, too. It seems inevitable. “I’m going to take it one day. That’s how it feels to me. I don’t like that, but to me, the way things are going, this society is really sending us disabled people a message,” James said. “We got that message even before MAID. But now it’s codified into law and there’s these processes and resources to expedite it.”

“I have diagnosed mental-health conditions and I can’t get treatment. I need therapy. My doctor asked me the other day, What do I need? I need therapy. I need a long-term relationship with someone. And she told me, she said, That’s impossible.” Instead, he was sent YouTube videos on how to do stretches. He chuckles.

“I need actual health care,” James said. Eventually, he tells me, he’ll get death care instead.

CAMAP, which sells itself as the experts on MAiD in Canada, received $3.3 million from the Canadian government to develop a curriculum for MAiD clinicians.

Thank you Alexander Raikin for your research and your continued advocacy for health care not death 'care'.

Canada teaches doctors to become killers

This article was published by National Review Online on September 14, 2023.

Wesley Smith

By Wesley J Smith

The Hippocratic oath explicitly prohibits doctor participation in euthanasia/assisted suicide. But doctors don’t take the great oath anymore, precisely because (in part) it conflicts with modern sensibilities that doctors can be ethical takers of human life.

And this is the result. The Canadian government is teaching doctors to become euthanasia killing specialists. From the Canadian-government press release:

Today, the Honourable Mark Holland, Minister of Health, and the Honourable Ya’ara Saks, Minister of Mental Health and Addictions and Associate Minister of Health, welcomed the release of the Canadian MAiD Curriculum developed by the Canadian Association of MAiD Assessors and Providers (CAMAP). This Curriculum is the first nationally accredited, bilingual MAiD education program available to licensed physicians and nurse practitioners across the country and will help achieve a safe and consistent approach to care.

Since being announced in July 2022, this multi-year project has developed a series of training modules to advise and support clinicians in assessing persons who request MAiD, including those with mental illness, complex chronic conditions, or who are impacted by structural vulnerability, as well as help with the practical application of the MAiD legislative framework. It will be delivered through a combination of online and in-person learning sessions for interested health practitioners, regardless of their level of experience.

And here’s a point to be emphasized — it’s also about killing physically healthy people with mental illnesses:

This is another step in the work by all levels of government to prepare Canada’s health care system for the expiry of the exclusion of MAiD eligibility for people suffering solely from a mental illness on March 17, 2024. The Government of Canada will continue working with provinces and territories (PTs), and health partners to support MAiD practice in Canada, including careful assessment of requests, so that it operates in a consistent and safe manner across the country, recognizing PT differences for health care delivery.

By definition, the concept of “safe” killing is oxymoronic. Euthanasia isn’t medical care. It is homicide.

Somewhere Hippocrates is weeping, but Jack Kevorkian can’t stop smiling. Shame on Canada.

Euthanasia - Popular Culture’s Misrepresentation of Disabled People and the Holocaust

Meghan is an autistic person who is an instructor at E4 Texas - University of Texas (Austin) and an EPC-USA board member.

By Meghan Schrader

Usually, I strongly oppose making comparisons between the United States “aid in dying” movement and the Nazi T4 program. It makes opponents of assisted suicide look paranoid and illogical. Rather than considering the parallels between some of their thinking and the thinking that drove the T4 program, they cite Goodwin’s Law. And, the comparison implies that all of the supporters are evil and want to commit crimes against humanity, which isn’t true. In 2011 I had a pastor who strongly supported assisted suicide because of her work with the terminally ill, and she was not a Nazi. The US movement hasn’t gone as far as Canada’s, and a comparison between it and the Nazi T4 Euthanasia program would strike most people as silly. Most regular people who support it are uninformed and naïve, not evil. And, if the people who truly believed in carefully restricting assisted suicide to terminally ill people and monitoring for abuse remained in charge of society, then we could be sure that US policies would not lead to the human rights abuses we see in Canada.

However, not all US proponents think that way, they would like the United States to be like Canada, and Canada’s program strikes me as being T4 - 2.0. The Canadian government is meeting the needs of people with disabilities with tokenism, and telling them to kill themselves. They’re telling disabled people that it would be a good thing for them to end their lives and give their internal organs to other people. The Canadian media has published treatises celebrating the fact that MAiD will save the Canadian medical system millions of dollars a year. People who support MAiD in Canada point out that no one is literally being strapped to a table and lethally injected, but that’s not the standard that just societies should use to determine whether a policy is benevolent. The Canadian government does not deserve credit for not rounding up unwilling disabled people up and gassing them in a van. 

I think that one of the reasons for the ignorance is how the media portrays euthanasia and the Holocaust. The T4 program is not generally portrayed in movies about the Holocaust, and some movies about the Holocaust present euthanasia and suicide as something people reasonably did to get away from the Nazis. For instance, in Schindler’s List, there’s a scene where the Nazis are about to storm a Jewish hospital, so the hospital staff administers poison to all the patients. It’s strongly implied that the doctors did this to protect them from dying a terrible death at the hands of the Nazis, and that the patients were grateful to the doctors for doing it. In the context of what happened to the disabled in the T4 program, that’s a very problematic way to portray euthanasia in a film about the Holocaust. 

Similarly, I love the film Swing Kids, which portrays the use of American Swing jazz music to resist the Nazis. But, the character I most identity with, a musician who stands up at a music venue and proclaims that he will not play German music anymore because it’s been co-opted by the Nazis, dies by suicide right after that speech. Within the individual narrative itself, it’s strongly implied that he did this to avoid being arrested by the Nazis for his outburst. But, in the context of the T4 program, that scene is deeply problematic. It is again portraying the death of a disabled person as an escape, which is what drove some of the support for euthanasia in Nazi Germany. Moreover, there’s a scene right after the musician’s speech where a Nazi-supporting friend calls him out for his outburst about Germans killing Jews and gypsies. The friend says, “What was that all about, the Jews and the Gypsies? What about the cripples and the retards, you know that’s who you belong with. If I were you, I wouldn’t worry about anybody but myself, because we’re coming after you next.” This is not historically accurate. The medical Holocaust of 300,000 people with disabilities started before the Nazis started to systematically kill people from other identity groups, and the Nazis took a lot of their ideas from the eugenics ideology that was prevalent in the United States in the 1930s.

Hence, I do think that the inaccurate representation of the killing of disabled people during the Holocaust in popular media is undermining people’s ability to recognize parallels between some of the things that the mainstream bioethics movement says about the right to die and violence against disabled people in world history. If people understood this history, they might not think that expansive euthanasia programs, and their precursor, physician assisted suicide, are such a good idea. 

Berlin Memorial to the victims murdered by the T4 Euthanasia Program

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

While in Berlin Germany to speak at a conference about euthanasia, I went to the Euthanasia Memorial located at Tiergartenstraße 4, directly beside the Berliner Philharmonie and across from Tiergarten park.

The explanation of the T4 Euthanasia Program from the memorial is striking considering the countries that have legalized euthanasia and the fact that the German government is now debating assisted suicide. 

People living in jurisdictions that have legalized euthanasia and/or assisted suicide should shudder at the historical past, especially knowing how modern euthanasia programs are being medicalised.

The euthanasia lobby will argue that the (T4) Euthanasia Program did not give people the "choice" to die, whereas the modern programs are based on choice and autonomy. When we consider the legal language within our modern euthanasia laws, choice and autonomy are lacking. These laws give doctors and nurses the right in law to kill you. Read on and ask yourself - "Is history repeating itself?"

I have reproduced most of the text from the monument below:

Tiergartenstraße 4

From 1940 to 1945, this (Euthanasia Memorial) was the location of the head-quarters for the National Socialists' mass murder of people with mental disabilities or illnesses. The organization was housed in a villa in Tiergartenstraße 4. The crimes planned here were called "Aktion T4" after this address.

After 1945, knowledge of the suffering and death of the victims was suppressed. Only since the 1980's has a plaque and a sculpture at this historical site commemorated the patients murdered in institutional settings. In 2007, Berlin citizens began to campaign for an appropriate memorial site. The German parliament granted this wish in November 2011.

The Path to the Euthanasia Killings:

Long before 1933 "active euthanasia" (Greek for a good death) was being discussed for incurable patients, institutionalised patients in need of care, and babies born with disabilities. Eugenics or "racial hygiene" theories developed in the 19th Century provided the basis for debates.

In 1933, the National Socialist regime issued a "Law for the Prevention of Genetically Diseased Offspring." It allowed forced sterilisation. It also indirectly called into question the right to life of human beings with psychiatric illnesses and mental or physical disabilities.

The lawyer Karl Binding (1841 - 1920) and the psychiatrist Alfred Hoche (1865 - 1943) not only demanded a "right to die" for the terminally ill but also the killing of "incurable idiots" and the "mentally dead" in institutions.

The National Socialist regime used films, magazines, posters and even school education to warn people of the "economic burden" that the "idiots" and "insane" supposedly posed to the population.

The Murder of Patients (1939 - 1945):

Shortly after the war begin in 1939, the SS murdered thousands of German and Polish psychiatric patients in occupied Poland. At the same time, the murder of at least 5,000 children and adolescents with mental and physical disabilities began in Germany under the assumed name of the "Reich Committee for the Scientific Registering of Serious Hereditary and Congenital Illnesses."

From 1939 - 1941, institutionalized patients were the target of the murder campaign organised at Tiergartenstraße 4, the so called Aktion T4. About 70,000 people were asphyxiated by gas in killing centres. At a later stage, the "T4" staff also killed about 20,000 concentration camp prisoners in these centres. Even after the centrally managed "Aktion T-4" was shut down in August 1941, the murders continued: doctors and nurses killed about 90,000 more institutionalised patients through deliberate neglect, starvation, and with drugs.

The Families of the Victims and Public Response:

The victims of the "euthanasia" crimes came from all walks of life. The murders could not be covered up entirely. The frequent reports of deaths led to suspicion among family members. Nevertheless, some accepted the killings or even advocated them, but there was also resistance.

At the beginning of "Aktion T4" obituaries reporting cases of sudden death began to mount up; from Spring 1941 it was no longer permitted to print them.

The deportations and rumours about the murder of patients led, in 1940, to protests in Vienna. Anna Wodl, whose son Alfred was killed in a "children's ward for expert care" a year later, took part in the protests.

Only a few representatives of the Judiciary and the Church opposed "euthanasia". In August 1941, a sermon given by the Bishop of Munster, Clemens August von Galen (1878 - 1946), led to the cancellation of the centralised campaign of murder.

In a sermon that was secretly circulated on leaflets, Bishop Graf von Galen denounced the "euthanasia" murders in early August 1941. The sermon caused great unrest among the population.

Selections in the Psychiatric Institutions:

From 1933, the authorities radically intensified the austerity measures that had already been initiated in the Weimer Republic's psychiatric hospitals.

"Incurable" patients and those "unfit" for work were particularly affected. For example, the state of Saxony introduced a nutritionally deficient diet for non-working institution residents in 1938.

"Aktion T4" then took the step of systematically murdering institutionalised patients who were unfit to work, in need of a lot of care or held to be "troublesome". The doctors in the institutions were involved in the crimes: they completed the registration forms that were used to select the "euthanasia" victims.

Under National Socialism, the patient's ability to work in the institution became the key to their survival; "useless eaters" were murdered.

Tiergartenstrasse 4 - The Administrative Headquarters:

In October 1939, in a document backdated to the beginning of the war, Hitler gave his escort surgeon Karl Brandt and the head of the Chancellery of the Fuhrer, Philipp Bouhler, the authority to grant supposedly incurable patients a "mercy death."

Under the Chancellery of the Fuhrer, which was directly subordinated to Adolf Hitler, doctors and administrative staff at Tiergartenstrasse 4 began to organise the registration and selection of institutionalised patients and their transportation to the killing centres in 1940. Specially created administrative machinery was intended to ensure that everything ran smoothly and the mass murders were kept confidential. When "Aktion T4" was cancelled due to protests, the headquarters tried to take charge of the murders carried out by drugs, and continued recording patients with registration forms. The perpetrators made use of a bureaucratic and dehumanising language.

The "Aktion T4" staff in Berlin drew up patient transfer lists and used buses belonging to the fake company "Charitable Ambulance Services" to take patients to the killing centres set up for mass murder of patients.

Mass Murder in the Gas Chambers:

Gas chamber "shower"

On the basis of such registration forms that were sent to all psychiatric institutions, four medical experts decided whether patients would die (red plus sign) or survive (blue minus sign).The murder of the patients was carried out systematically. For this purpose, the "T4" organisation set up a total of six killing centres in Germany. The "T4" staff often initially grouped patients together in intermediate institutions for a few weeks before transferring them to one of these killing centres. This served the purpose of concealment and allowed each murder facility to adapt to the existing "killing capacity" at that time.

Usually patients were asphyxiated in the gas chambers using carbon monoxide on the day they arrived at the "euthanasia" institutions. Their bodies were burned.

"Every time a transport had arrived, you could see a big black cloud of smoke shortly afterwards, reported Karl Schuhmann (1921 - 2000), a local resident who secretly photographed the Hartheim Killing centre.

Perpetrators - Accessories - Profiteers:

In the Berlin "T4" head office and in the institutions where people were killed by gas, around 500 people were directly involved in the organisation and operation of "Aktion T4". The judiciary covered up the murder campaign.

Many doctors were involved out of careerism, out of conviction or due to their blind acceptance of authority. In their view, healing and annihilation belonged together. As experts, they selected the victims; in the killing centres, they turned on the gas tap, in the psychiatric institutions, they murdered patients with drugs or let the inhabitants starve. They conducted experiments on patients or research on the brains of the victims. Nursing staff helped the doctors with the "Aktion T4."

The Charitable Foundation for Curative and Institutional Care was one of four cover organisations that concealed the murder of patients. One of its tasks was to staff the "T4" programme.

Hadamar

In order to kill people with gas, the "T4" organisation had five psychiatric facilities (Hadamar, Grafeneck, Bernburg, Pirna-Sonnenstein, Hartheim) and a former prison (Brandenburg der Havel) converted into killing centres.

The "T4" staff feigned a normal admission procedure for the patients when they arrived at the killing facilities and then led them into a gas chamber disguised as a shower room. There they were killed.

The 'victims' families were informed of the death of their relatives with so-called letters of condolence. These contained false information about the cause, date and place of death.

Euthanasia and the Holocaust:

The first systematic mass murder of Jews in Germany took place as part of "Aktion T4."

In 1940, nearly all Jewish psychiatric patients were killed because of their "race". When the "euthanasia" killings were extended to concentration camp prisoners ("Aktion 14f13") in 1941, the doctors deliberately selected Jewish inmates.

The "T4" staff continued their crimes in the German extermination camps in the east. Thus around 120 "T4" men were involved in "Operation Reinhardt" in the occupied Polish territories, during which at least 1.6 million Jews were murdered.

The commandants of Belzec, Sobibor and Treblinka were members of "T4." The "T4" driver and "corpse burner", Lorenz Hackenholt, played a major role in the construction of the gas chambers at Belzec.

Dealing with the Euthanasia Crimes:

After the war ended, the Psychiatric patients continued to face discrimination; eugenic ideas persisted. The situation only began to improve in the 1970's. In the "euthanasia" trials, only a few offenders were given severe sentences. Most of the doctors involved were never called to account.

Karl Brandt and Viktor Brack, two of the main men responsible for the "euthanasia" murders were sentenced to death at the Nuremberg Doctors' Trial in 1947.

The medical director of the "T4" organisation, Herman Paul Nitscke (1876 - 1948), was sentenced to death by the district court in Dresden for his part in the "euthanasia" crimes and executed in 1948.

Friederike Pusch (1905 - 1980), a doctor in the State Hospital of Brandenburg-Gorden, was involved in the "euthanasia" crimes, but allowed to continue working undisturbed as a psychiatrist in Germany, despite incriminating witness statements.

As the office manager at Tiergartenstraße 4, Friederich Tillmann (1903 - 1964), was in charge of administering the programme of murder. The criminal proceedings initiated against him in 1960 were dropped after his death.

The brain researcher, Julius Hallervorden (1882 - 1965), used at least 700 brains of "euthanasia" victims for his research, the results of which he published without hesitation even after 1945.

Dr. Adolf Wahlmann (1876 - 1956), the head of the Hadamar killing centre from 1942, was found guilty of mass killings and initially sentenced to death, but was released from prison in 1952. The male nurse Karl Willig (1894 - 1946), was sentenced to death for the murder of forced labourers and executed in 1946.

When it was revealed in 2000 that Jussuf Ibrahim (1877 - 1953) had, as the head of the University Children's Hospital in Jena, personally proposed children for "euthanasia" in 1943 and 1944, many Jena residents came to the defence of the town's honorary citizen and "Honoured Doctor of the People" of the GDR.

Even as late as 1964, Werner Catel (1894 - 1981) the head of the "children's ward for expert care" at the Children's University Hospital in Leipzig and a "Reich Committee" expert, was still demanding that "idiot children" be "released from their misfortune".

1987 saw the foundation of the "Federation of the People Damaged by Euthanasia and who Underwent Compulsory Sterilisation." The German Parliament outlawed the forced sterilisation law in 2007.

Marianjoy Rehabilitation Hospital position on assisted suicide

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Conclusion

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

Northwestern Medicine Marianjoy Rehabilitation Hospital - Wheaton Illinois.
Ethics Committee

Assisted Suicide: A perverse disincentive in health care

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

By Michelle de Boer
Protect Children's Lives

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

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

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

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

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

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

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

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

Assisted suicide laws violate the Americans with Disabilities Act

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

Lisa Blumberg

By Lisa Blumberg

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

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

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

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

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

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

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

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

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

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

As one mother has written lovingly of her daughter:

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

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

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