CANADA'S SOLDIERS.... our Jason shares the story....
Jason and Lise our Canadian Warriors 4 our vets... is extraordinary.... when he
started this project.... the bullsheeeeet from the haters gonna hate, hate, hate...
was evil.... so many of us... jumped up... and walked the talk..... 4 our troops who NOT die in Afghanistan...
but died BECAUSE of Afghanistan... God bless our vet... Jason.... and Lise...
still fighting the good fight... love u from old momma Nova...
Soldiers who died by suicide are remembered in Guelph
%2B(1).jpg)
BLOGGED:
BLOGGED
Clara Hughes CANADIAN OLYMPIAN- Finishes Bike Ride -July 3 update-from the mouths of the children- JUNE 26 UPDATE- CANADA DAY'S COMING-JULY 1- GET UR CANADA ON -4 CANADA OLYMPIAN CLARA HUGHES BIG RIDE 4 MENTAL HEALTH FOLKS- send her tweets of support and love- Hey it’s Canada –Mental Health matters. NEWS UPDATES-Teen/Youth/PTSD/Abuse/Bullying stuff /Our Olympian Clara's completes journey 4mentalheal-let's talk-July 1- Clara's in Ottawa CANADA DAY 2014/SEPT 24 NS RCMP- preventing violent encounters -respect homeless and psychiatric problems DO LIST
PTSD
AND
blogged
CANADA MILITARY NEWS: South Pole Wounded Warriors Allied Challenge-Incredible story and victory of 4 counries of Wounded Warriors - Antartica 2 South Pole- Victory run/walk success- in harshest climates- UK/Canada/Australia and USA- The Journey and success proving 2 a billion folks proudly- disabilities are abilities in disguise- did we make u proud- u surely did and do..Environmentalists could NOT make it.... u ran and walked it.... the world rejoiced and Santa and NORAD hugged u along the way.The Journey 2 Victory blogged daily- December 2013/O CANADA TROOPS- we love u so- honour
and then.... horribly ill and aged and in immense pain..... and just tired.....
MY STORY- IMHO
God bless our troops..... many of us Canadians are
concerned and in crisis over the worry and devotion 2 our Canadian troops
coming home wounded- physically and mentally... and way 2 many suicides....
(CHECK OUT NATO NATIONS... AND SEE THE HORRIFIC STATUS ON VETERANS
SUICIDES)..... and then moved over 2
assisted killing of specific persons (regardless of religion) by their
request..... in other words... dying with dignity.....
As an old person... it's been 2 damm hard over the last
few years of people- strangers who have become friends dying horribly and
hard..... my 82 year old mother with the mind stealing disease who could not
feed or clean herself.... this proud woman, whom I called a teenager, because
she kinda was... and at 7 I was the grownup....
MOMA- 82 years old... finally had 2 be placed in a
Toronto hospital (my sainted brother cared 4 her at home... of course she had
no clue who my family was- her sons, her daughters etc.)... In that lonely bustling
noisy loud all hours place- she fell out of bed.... bedsores,,.. little
food little care.... CAUSE THE POOR GET THE 'THROWAWAY' TREATMENT... and we all
know... in our Canada.... tubes everywhere... bruises... the indignity.... the
horrific sight... of a once fiercely proud, workaholic who survived a horrible
childhood and a war... and devastating poverty... 2 raise herself up... and 2
remind us as kids.... Education is the only tool of power.... stay in school or
i'll kill ya....
SHE DIED HARD.... SHE DIED CRUEL... AND SHE DIED IN A
MEAN CRUEL WAY...lived 3 years longer than she should have or wld have wanted 2 with her pride and joy-her dignity.....
... I told my kids.... suicide of brilliant children,
youth and youngbloods and our vets and those suffering tear my heart out....
because damm it... we need their brains, their strong Canadian hears and their
incredible help in our daily lives.....
and for those suffering the horrid evil cruel indignity and/or
unbearable pain - yes, am Roman Catholic.... I see assisted dignity of
dying.... and going 2 a better place....then laying in drool and piss and sheeeet and food tubes and medication and bedsores and screaming.... F**KING LET ME DIE WITH DIGNITY....
Suicide is legal in Canada and Assisted dignity of dying
needs 2 be fully legal as well.... and the decision needs 2 be on ur own
personal terms.... now see how confusing
this is.... we are angry and mourn our troops suffering... often in silence....
with 2 many committing.... and the horrific mean disease and aged who
have lost all dignity- deserving 2 die
on their terms... Anyway... it's out there Canada
... God bless our troops, our Nato troops... and our
Canada... and our beloved Afghanistan with their Good Morning Freedom (Election
April 5, 2014)
- here's some help lines... blogs... and information and
questions- AND YOUTH, TEENS, TWEENS, AND THOSE SERVING AND THOSE HORRIBLY HURT, DEPRESSED AND ANGRY ... please reach out..... Canada is changing and trying 2 be better.... cutting the $$$$$ and getting out 2 the people... please ... we love u.
--------------------
PTSD- This ad just won 'Best Commercial' in The
Netherlands.
PTSD- This is what
WWI and WWII wre like.... the nightmare... no clean water...soap...change of
clothes.... no extra socks... food full of maggots... milk sour... the stink...
the death smell... the fear... and the raw courage... the honour... the
determination.... it's called freedom.... 2day our beautiful Nato troops
bravely tell us about PTSD... and the horror and Olympic Champion Clara Hughes
got so many kids, youth and all 2 open up.... especially our troops helping
each other... now I understand why Uncle Harold would cry over nothing.... would
be playing Sat. nite cards and we would all be making noise... and he would
stop still 4 about 2-3 minutes... then come back 2 us.... why he hugged us kids
so hard... and didn't trust adults... acted way cold and bitter..... why he
cried when a calf was born... when the butterflies and the bees and nature sang
her Canadian songs... look at this picture... let's get down on our knees and
thank them... ensure our troops want 4 nothing.... O Canada... our troops and
our kids matter... imho. hugs and love Old Momma Nova... still here... we got
ur backs ... always.
=====
“When you arise in the morning, think of what a precious
privilege it is to be alive – to breathe, to think, to enjoy, to love”. –
Marcus Aurelius
--------------
our troops..... the pain... the help lines....
Please share
pls share- Know some1 hurting? Sendupthe Count-WWW.MILNET.CA hashtag ?#?sendupthecount? nSOLDIERS4SOLDIERS 18553738387
pls share- Know some1 hurting? Sendupthe Count-WWW.MILNET.CA hashtag ?#?sendupthecount? nSOLDIERS4SOLDIERS 18553738387
--------------
Is someone you know in a crisis or thinking about suicide? We
can help.#VACServices http://ow.ly/D1QXa
BLOGGED:
CANADA
MILITARY NEWS: Feb/Mar2014- Help Lines- SEND UP THE COUNT-
PTSD/SUICIDE/WOUNDED/LOVED/MISSED- Help Lines/Videos/Blogs/Photos
and..
1. Veterans Affairs CA @VeteransENG_CA 1h
Getting help can be the difference between life and death-call 1-800-268-7708 to speak to a mental health professional
Expand
2. Anciens Combattants @VeteransFR_CA 1h
Demander de l’aide pour faire toute la différence. Parlez à un professionnel en santé mentale au 1-800-268-7708
AND..
rVETSMATTER-soldier2soldier VETS CANADA- tollfree phone line, 1-888CAVETS1 (1-888-228-3871) call-in centre that serves the country http://thechronicleherald.ca/opinion/1182731-dunne-a-rescue-mission-for-troubled-vets …
AND..
Soldiers join forces to combat suicide and PTSD
'Send up the count' campaign encourages troops to stay in touch
By James Cudmore, CBC News Posted: Dec 12, 2013 5:11 PM ET Last Updated: Dec 13, 2013 10:14 AM ET
http://www.cbc.ca/news/politics/soldiers-join-forces-to-combat-suicide-and-ptsd-1.2461855
AND..
CANADA- A new toll-free support line, 1-855-373-8387, was launched today, established for soldiers by other soldiers
Canadian Forces ?@CanadianForces 1h
Mental health care is available and recovery possible - listen to your fellow #CAF members tell their stories-http://ow.ly/vf9qS
blogged:
WELCOME 2 CANADA- Come 2 Canada Irish youth- EU Youth-live and work -study- we'd love 2 have u-COME GET UR CANADA ON
http://nova0000scotia.blogspot.ca/2014/03/welcome-2-canada-come-2-canada-irish.html
-
Canadian Forces @CanadianForces 1h
Mental health care is available and recovery possible - listen to your fellow #CAF members tell their stories-http://ow.ly/vf9qS
SEND UP THE COUNT
https://www.facebook.com/photo.php?fbid=10152706405126886&set=pb.627936885.-2207520000.1404387282.&type=3&theater
SOLDIERS OF SUICIDE
https://www.facebook.com/photo.php?fbid=10152706407381886&set=pb.627936885.-2207520000.1404387282.&type=3&theater
CANADIANS REMEMBER
https://www.facebook.com/photo.php?fbid=10152706408566886&set=pb.627936885.-2207520000.1404387282.&type=3&theater
RED FRIDAYS CANADA- TILL THEY ALL COME HOME
https://www.facebook.com/photo.php?fbid=10152703569316886&set=pb.627936885.-2207520000.1404387792.&type=3&theater
HONOUR- OUR- TROOPS-
https://www.facebook.com/photo.php?fbid=10152706406376886&set=pb.627936885.-2207520000.1404387282.&type=3&theater
MONCTON PROUD-
https://www.facebook.com/photo.php?fbid=10152704995466886&set=pb.627936885.-2207520000.1404387426.&type=3&theater
CLARA'S BIG RIDE ACROSS CANADA 2 WAKE UP CANADIANS ON WIPING OUT STIGMA ON MENTAL HEALTH ISSUES- let's talk openly and often..... millions of teens, tweens, kids and youth are stepping up... as are millions and millions who put our troops at the forefront of 'we matter'
https://www.facebook.com/photo.php?fbid=10152704991211886&set=pb.627936885.-2207520000.1404387426.&type=3&theater
AND...
#MilitaryMonday #Veterans #Women change your perception of what a #Veteran looks like @USArmy#SOT #SOV pic.twitter.com/Ujs23JMFdx
Don’t let Washington balance the budget on the backs of those who have served. #CutDebtNotVets
#MilitaryMonday #Veterans #Women change your perception of what a #Veteran looks like @USArmy #SOT #SOV pic.twitter.com/Ujs23JMFdx
Don’t let Washington balance the budget on the backs of those who have served. #CutDebtNotVets
AND..2011
6,000 American troops plus lost 2 suicide......
The Marines - Retired Marine walks 3400 Miles to raise Suicide In USA Military
http://www.youtube.com/watch?v=FTft5GbAGX4
AND...
"A Creed for a Comrade"--In honor of suicide prevention month USA- EVERY MONTH IS SUICIDE PREVENTION MONTH
https://www.youtube.com/watch?v=tzs5V9c_BJk
CANADA- MORE SERVICES-
Is someone you know in a crisis or
thinking about suicide? We can help. #VACServices http://ow.ly/D1QXa
USA-
VETERANS
CRISIS LINE
Voice: (800) 273-8255, press 1
Online chat: veteranscrisisline.net
Text message: 838255
Online chat: veteranscrisisline.net
Text message: 838255
The
Virginian-Pilot November 24, 2014
AND....
AMERICAN VETERANS- when the money comes
first and we all come last- says it straight and true- homeless, broken,
hurting, suicides, wounded...
Hip-Hop - Veteran Theme Song -
"WHY" Soldier Hard
BLOGGED
CANADA MILITARY NEWS- Remembering Halifax
Explosion 1917 and thanking- Boston /also 2 blogs one on special thanks n
journey and 2nd- halifax explosion-noone helped us coloureds- we remember
-thank u
BLOGGED: year 2013
CANADA MILITARY NEWS: Dec 5-6 2013-NOVA
SCOTIA THANKS OUR BOSTON- Halifax Explosion Dec. 6 1917- Canada thanks u- a
beautiful journey of remembrance- of humanity
CANADA- MORE SERVICES-
Is someone you know in a crisis or thinking
about suicide? We can help. #VACServices http://ow.ly/D1QXa
USA-
VETERANS
CRISIS LINE
Voice: (800) 273-8255, press 1
Online chat: veteranscrisisline.net
Text message: 838255
Online chat: veteranscrisisline.net
Text message: 838255
The
Virginian-Pilot November 24, 2014
AND....
AMERICAN VETERANS- when the money comes
first and we all come last- says it straight and true- homeless, broken,
hurting, suicides, wounded...
Hip-Hop - Veteran Theme Song -
"WHY" Soldier Hard
BLOGGED
year 2013
CANADA MILITARY NEWS- Halifax Explosion-
nobody helped the coloureds of NS/White Trash foster kids of WWII/Nova Scotia
our black history- Human Rights and Freedoms in Canada- Nelson Mandela-South
Africa Canada Dec 7 2013
Boston Events November 2014
Top November Things to Do in Boston
- See more at: http://www.boston-discovery-guide.com/boston-events-november.html#sthash.vTf7MEPV.dpuf
-----
HUMOUR.... MIND U A FEW YEARS BACK...
MILLIONS WATCHING THE BACKS OF OUR TROOPS WERE VERY ANGRY....
A Canadian female libertarian wrote a lot
of letters to the Canadian government, complaining about the treatment of
captive insurgents (terrorists) being held in Afghanistan National Correctional
System facilities. She demanded a response to her letter. She received back the
following reply:
National Defense Headquarters
M
Gen George R. Pearkes Bldg.,
15
NT 101 Colonel By Drive Ottawa , ON
K1A 0K2
Canada Dear Concerned Citizen,
Thank you for your recent letter
expressing your profound concern of treatment of the Taliban and Al Qaeda
terrorists captured by Canadian Forces, who were subsequently transferred to
the Afghanistan Government and are currently being held by Afghan officials in
Afghanistan National Correctional System facilities. Our administration takes
these matters seriously and your opinions were heard loud and clear here in
Ottawa . You will be pleased to learn, thanks to the concerns of citizens like
yourself, we are creating a new department here at the Department of National
Defense, to be called 'Liberals Accept Responsibility for Killers' program, or
L.A.R.K. for short.
In
accordance with the guidelines of this new program, we have decided, on a trial
basis, to divert several terrorists and place them in homes of concerned
citizens such as yourself, around the country, under those citizen's personal
care. Your personal detainee has been selected and is scheduled for
transportation under heavily armed guard to your residence in Toronto next
Monday.
Ali Mohammed Ahmed bin Mahmud is your
detainee, and is to be cared for pursuant to the standards you personally
demanded in your letter of complaint. You will be pleased to know that we will
conduct weekly inspections to ensure that your standards of care for Ahmed are commensurate
with your recommendations.
Although Ahmed is a sociopath and extremely
violent, we hope that your sensitivity to what you described as his
'attitudinal problem' will help him overcome those character flaws. Perhaps you
are correct in describing these problems as mere cultural differences. We
understand that you plan to offer counseling and home schooling, however, we
strongly recommend that you hire some assistant caretakers.
Please advise any Jewish friends, neighbors or
relatives about your house guest, as he might get agitated or even violent, but
we are sure you can reason with him. He is also expert at making a wide variety
of explosive devices from common household products, so you may wish to keep
those items locked up, unless in your opinion, this might offend him. Your
adopted terrorist is extremely proficient in hand-to-hand combat and can
extinguish human life with such simple items as a pencil or nail clippers. We
advise that you do not ask him to demonstrate these skills either in your home
or wherever you choose to take him while helping him adjust to life in our
country.
Ahmed will not wish to interact with you or
your daughters except sexually, since he views females as a form of property,
thereby having no rights, including refusal of his sexual demands. This is a
particularly sensitive subject for him.
You also should know that he has shown violent
tendencies around women who fail to comply with the dress code that he will
recommend as more appropriate attire. I'm sure you will come to enjoy the
anonymity offered by the burka over time. Just remember that it is all part of
'respecting his culture and religious beliefs' as described in your letter.
You take good care of Ahmed and remember that
we will try to have a counselor available to help you over any difficulties you
encounter while Ahmed is adjusting to Canadian culture.
Thanks again for your concern. We truly
appreciate it when folks like you keep us informed of the proper way to do our
job and care for our fellow man. Good luck and God bless you.
Cordially,
Gordon O'Connor
Minister of National Defense
----------------------------
THE LETTER- FROM A MOM IN NEWBRUNSWICK
CANADA-
2007
Barbaric Taliban Behead 26, Display
Bodies as Propaganda
CANADIANS ARE VERY SERIOUS ABOUT THEIR
MILITARY, MILITIA, RESERVISTS AND RANGERS..... THE SILENT MAJORITY IS IN THE
MILLIONS.... TAKE THESE 2 LETTERS FROM EVERYDAY FOLK.... when no politician
gave a sheeeet outside petermackay..... imagine the monsters in beautiful cells
with 3 hots and a cot and special ‘diet’... AND OUR Nato kids sleeping in the
freezing cold without food water or a bath???
One Pissed off Canadian Housewife ON
DEVOTION 2 OUR TROOPS... CANADA STYLE
This is very good PLEASE read....
Thought you might like to read this
letter to the editor. Ever notice how some people just seem to know
how to write a letter?
This one surely does!
This was written by a Canadian woman, but oh
how
it
also applies to the U.S.A., U.K. and Australia .
THIS
ONE PACKS A FIRM PUNCH
Written by a housewife in New Brunswick , to
her local newspaper. This is one ticked off
lady...
THE LETTER
"Are we fighting a war on terror or
aren't we? Was
it
or was it not, started by Islamic people who
brought it to our shores on September 11, 2001
and have continually threatened to do so
since?
Were people from all over the world, not
brutally murdered
that day, in downtown Manhattan , across the
Potomac from
the capitol of the USA and in a field in
Pennsylvania?
Did nearly three thousand men, women and
children die a horrible, burning or crushing death that day, or didn't they?
Do
you think I care about four U. S. Marines urinating on some dead Taliban
insurgents?
And I'm supposed to care that a few Taliban
were
claiming to be tortured by a justice system of
a
nation they are fighting against in a brutal
Insurgency.
I'll care about the Koran when the fanatics in
the Middle
East, start caring about the Holy Bible, the
mere belief
of
which, is a crime punishable by beheading in Afghanistan .
I'll care when these thugs tell the world
they are
sorry for hacking off Nick Berg's head, while
Berg
screamed through his gurgling slashed throat.
I'll care when the cowardly so-called
insurgents
in
Afghanistan , come out and fight like men,
instead of disrespecting their own religion by
hiding in Mosques and behind women and
children.
I'll care when the mindless zealots who blow
themselves up in search of Nirvana, care about
the
innocent children within range of their
suicide Bombs.
I'll care when the Canadian media stops
pretending that
their freedom of Speech on stories, is more
important than
the lives of the soldiers on the ground or
their families waiting
at
home, to hear about them when something happens.
In the meantime, when I hear a story
about a
CANADIAN soldier roughing up an Insurgent
terrorist to obtain information, know this:
I
don't care.
When I see a wounded terrorist get shot in the
head when he is told not to move because he
might be booby-trapped, you can take it to the
bank:
I don't care. Shoot him again.
When I hear that a prisoner, who was issued a
Koran and a prayer mat, and fed 'special' food, that is paid for by my tax
dollars, is complaining that his holy book is being 'mishandled,' you can
absolutely believe, in your heart of hearts:
I
don't care.
And oh, by the way, I've noticed that
sometimes
it's spelled 'Koran' and other times 'Quran.'
Well, Jimmy Crack Corn you guessed it.
I don't care!!
If you agree with this viewpoint, pass
this on to
all your E-mail Friends. Sooner or later,
it'll get to
the people responsible for this ridiculous
behavior!
If you don't agree, then by all means hit
the delete
button. Should you choose the latter, then
please don't
complain when more atrocities committed by
radical
Muslims happen here in our great Country! And
may I add:
Some people spend an entire lifetime wondering,
if
during their life on earth, they made a
difference in
the world. But, the Soldiers don't have that
problem.
I
have another quote that I would like to
share AND...I hope you forward All this.
One last thought for the day:
Only five defining forces have ever
offered to die for you:
1. Jesus Christ
2.
The British Soldier.
3.
The Canadian Soldier.
4.
The US Soldier, and
5.
The Australian Soldier
One died for your soul,
the other four, for you and your children's
Freedom.
YOU MIGHT WANT TO PASS THIS ON,
AS
MANY SEEM TO FORGET!
----
VIDEO
Canada Pride
-----------------------
June 22, 2014
Canadian Forces In Afghanistan- FROM OUR
MATTHEW WORTH OF CANADA MILITARY- WITH A SOLDIER'S EYE..... 2 videos- VIDEO 1
A tribute to Canada's 158 Fallen
Soldiers, the thousands of wounded and injured soldiers and all of the Veterans
of the Afghan mission.
* Canadian Forces In Afghanistan, This
Generations War Ends - "Soldiers Eyes" *
Published on 8 May 2014
"Two Part Video" Canadian Armed
Forces In Afghanistan, 2001-2014. A tribute to Canada's 158 fallen soldiers,
the thousands of wounded and injured soldiers and all us Veterans of the Afghan
mission.
Audio/Music (1): "Soldiers
Eyes" - Artist: Jack Savoretti
Audio/music (2): Easy Listening - The
Temperature of the air on the bow of the Kaleetan - Artist: Chris Zabriske
COMMENT;
Very touching love ya Canada!!
Love; Germany
COMMENT:
God bless you guys, we'll never forget
our northern allies. God bless.
COMMENT:
Amazing, god save the queen, and god
bless this nation!
comment:
Beautifully made Matt! Kudos to you! My tears fall & my heart
aches for all the soldiers we have lost in this war. My only consolation is
that these soldiers are buried here, in our Country, unlike all the war dead of
the First World War and many of the Second World War.
------------------
THE MEANING OF TRUE PATRIOT LOVE
FOUNDATION- Helping and understanding
and raising the bar as Canadians 4 our troops...
True Patriot Love Honours Military Members
and Their Families
---------------------
talking mental health-
CANADA STEPS UP...
blogged:
Clara Hughes CANADIAN OLYMPIAN- Finishes Bike Ride -July
3 update-from the mouths of the children- JUNE 26 UPDATE- CANADA DAY'S
COMING-JULY 1- GET UR CANADA ON -4 CANADA OLYMPIAN CLARA HUGHES BIG RIDE 4
MENTAL HEALTH FOLKS- send her tweets of support and love- Hey it’s Canada
–Mental Health matters. NEWS UPDATES-Teen/Youth/PTSD/Abuse/Bullying stuff /Our
Olympian Clara's completes journey 4mentalheal-let's talk-July 1- Clara's in
Ottawa CANADA DAY 2014/SEPT 24 NS RCMP- preventing violent encounters -respect
homeless and psychiatric problems DO LIST
What
is the difference between assisted suicide and aid in dying?
The contrast
between aid in dying, in which a knowledgeable, merciful physician gives his
elderly, dying patient the means to halt end-of-life suffering, and assisted
suicide, in which a malicious predator seeks out and victimizes physically
healthy, mentally ill teens, could not be more clear.
Consider the stark opposites outlined by Dr. James Lieberman:
Consider the stark opposites outlined by Dr. James Lieberman:
·
The
suicidal patient has no terminal illness but wants to die; the aid-in-dying
patient has a terminal illness and wants to live.
·
Suicides
bring shock and tragedy to families and friends; aid-in-dying deaths are
peaceful and supported by loved ones.
·
Suicides
are secretive and often impulsive and violent. Aid in dying is planned; it
changes only the timing of imminent death in a minor way, but adds control in a
major and socially approved way.
·
Suicide
is an expression of despair and futility; aid in dying is an affirmation of a
person’s dignity and rational self-determination.
In short,
suicide is the self-destructive impulse of a person who has every reason and ability
to live. Aid in dying is the self-affirming decision of a person who cannot
choose to live and can only choose the manner of an imminent death.
---------------
International Suicide Hotlines
International
Suicide Hotlines
(Outside of the United States)
(Outside of the United States)
Please click on your country
below:
Canada Suicide Hotlines
Distress Centres Ontario
Ontario
Website: dcontario.org
Ontario
Website: dcontario.org
(DCO) Distress Centre Niagara
Ontario
Hotline: +1 (905) 688 3711
Hotline: 905 734 1212/905 382 0689
Website: dcontario.org
Ontario
Hotline: +1 (905) 688 3711
Hotline: 905 734 1212/905 382 0689
Website: dcontario.org
(DCO) Telecare Distress Centre Brampton
Ontario
Hotline: +1 (905) 459 7777
Website: telecarebrampton.org
Ontario
Hotline: +1 (905) 459 7777
Website: telecarebrampton.org
(DCO) Distress Centre Lanark, Leeds & Grenville
Ontario
Hotline: 1 800 465 4442
Website: dcontario.org
Ontario
Hotline: 1 800 465 4442
Website: dcontario.org
(DCO) Distress Centre Durham
Ontario
Hotline: +1 (905) 433-1121
Website: distresscentredurham.com
Ontario
Hotline: +1 (905) 433-1121
Website: distresscentredurham.com
(DCO) Telecare Distress Centre Etobicoke
Ontario
Hotline: +1(416) 247-5426
Website: webhome.idirect.com/~tdce
Ontario
Hotline: +1(416) 247-5426
Website: webhome.idirect.com/~tdce
(DCO) Distress Line Grey & Bruce
Ontario
Hotline: 1 888 371 8485
Website: dcontario.org
Ontario
Hotline: 1 888 371 8485
Website: dcontario.org
(DCO) Tel-Aide Jewish Distress Centre
Ontario
Hotline: ++ 1 (416) 636-9610
Website: dcontario.org
Ontario
Hotline: ++ 1 (416) 636-9610
Website: dcontario.org
(DCO) Distress Centre Hamilton
Ontario
Hotline: ++ 1 (905) 525-8611
Website: dcontario.org
Ontario
Hotline: ++ 1 (905) 525-8611
Website: dcontario.org
(DCO) Distress Centre London & District
Ontario
Hotline: +1 (519) 667-6711
Website: londondistresscentre.com
Ontario
Hotline: +1 (519) 667-6711
Website: londondistresscentre.com
(DCO) North Halton Distress Centre
Ontario
Hotline: +1 (905) 877-1211
Website: dcontario.org
Ontario
Hotline: +1 (905) 877-1211
Website: dcontario.org
(DCO) Distress Centre Oakville
Ontario
Hotline: +1 (905) 849 4541
Website: distresscentreoakville.com/
Ontario
Hotline: +1 (905) 849 4541
Website: distresscentreoakville.com/
(DCO) Distress Centre Ottawa & Region
Ontario
Hotline: +1 (613) 238 3311
Website: dcottawa.on.ca
Ontario
Hotline: +1 (613) 238 3311
Website: dcottawa.on.ca
(DCO) Tel-Aide Outaouais
Ontario
Hotline: +1 (613) 741 6433
Hotline: 1 800 567 9699
Website: tel-aide-outaouais.org
E-mail Helpline: plume@tel-aide-outaouais.org
Ontario
Hotline: +1 (613) 741 6433
Hotline: 1 800 567 9699
Website: tel-aide-outaouais.org
E-mail Helpline: plume@tel-aide-outaouais.org
(DCO) Distress Centre Peel
Ontario
Hotline: +1 (905) 278 7208
Website: distresscentrepeel.com
Ontario
Hotline: +1 (905) 278 7208
Website: distresscentrepeel.com
(DCO) Distress Centre Sarnia-Lambton
Ontario
Hotline: +1 (519) 336 3000
Website: familycounsellingcentre.ca/home.cfm
Ontario
Hotline: +1 (519) 336 3000
Website: familycounsellingcentre.ca/home.cfm
(DCO) Distress Centres of Toronto
Ontario
Hotline: +1 (416) 408 4357
Website: torontodistresscentre.com
Ontario
Hotline: +1 (416) 408 4357
Website: torontodistresscentre.com
(DCO) Distress Centre Waterloo Region
Ontario
Hotline: +1 (519) 745 1166
Website: cmhawrb.on.ca/distress.htm
Ontario
Hotline: +1 (519) 745 1166
Website: cmhawrb.on.ca/distress.htm
(DCO) Distress Centre Wellington/Dufferin
Ontario
Hotline: +1 (519) 821 3760
Website: dc-wd.org
Ontario
Hotline: +1 (519) 821 3760
Website: dc-wd.org
(DCO) Distress Centre Windsor/Essex
Ontario
Hotline: +1 (519) 256-5000
Website: dcwindsor.com
E-mail Helpline: support@dcwindsor.com
Ontario
Hotline: +1 (519) 256-5000
Website: dcwindsor.com
E-mail Helpline: support@dcwindsor.com
(DCO) Telephone Aid Line Kingston
Ontario
Hotline: +1 (613) 544 1771
Website: http://members.kingston.net/talk
Ontario
Hotline: +1 (613) 544 1771
Website: http://members.kingston.net/talk
Suicide Action Montreal
2345 est. rue Belanger
H2G 1C9
MONTREAL
Quebec
Hotline: (514) 723 4000
Website: suicideactionmontreal.qc.ca
2345 est. rue Belanger
H2G 1C9
MONTREAL
Quebec
Hotline: (514) 723 4000
Website: suicideactionmontreal.qc.ca
Chimo Helpline Inc.
PO Box 1033
NB E3B 5C2
FREDERICTON
Contact by: - Phone
Hotline: Fredericton Area: 450-HELP (4357)
Hotline: Toll free provincial helpline: 1-800-667-5005
PO Box 1033
NB E3B 5C2
FREDERICTON
Contact by: - Phone
Hotline: Fredericton Area: 450-HELP (4357)
Hotline: Toll free provincial helpline: 1-800-667-5005
Distress Line of Southwestern Alberta (Canada)
426 - 6th Street South
T1J 2C9
Lethbridge
Alberta
Contact by: - Phone
Hotline: 403 327 7905
24 Hour service:
426 - 6th Street South
T1J 2C9
Lethbridge
Alberta
Contact by: - Phone
Hotline: 403 327 7905
24 Hour service:
--------------------
ASSISTED SUICIDE - END OF LIFE KILLING BY LAW- GOD UNDERSTANDS.... God understands
I came
across an eloquent blog on Psychology Today recently
written by Ethan Remmel, PhD who's been diagnosed with incurable colon cancer.
A developmental psychologist and associate professor of psychology, he's able
to approach preparing for his death from an analytical yet personal angle. I
heartily recommend that anyone who's interested in end-of-life issues follow
his blog.
A couple
weeks ago, he decided to request medication to hasten his death
under Washington's Death with Dignity Act:
There
are many safeguards on the use of the Act, and I respect those who choose not
to participate, but I respect even more those who enable terminally ill people,
such as me, to maintain some dignity and control at the end of our lives. So I
have the medication now. It is safely locked up. I have not decided if or when
I will use it, but it gives me great relief to know that I have some control
over my dying process. I do not think of using the medication as suicide,
and I don't think others should either. It would be part of a dying process
that has already begun, not of my choice. It would be done in consultation with
my family. It would be done to spare myself and my loved ones unnecessary
suffering. I think it is important to talk about this because I think there is
still some stigma associated with choosing to end one's life, even under these
circumstances. I think open discussion is necessary to overcome this stigma,
and avoid the unnecessary suffering that can result.
Traditional
medical care treats illness as a battle. Living is winning; dying is losing.
But I find this battle metaphor unhelpful in dealing with terminal illness like
mine. Living is not winning if the quality of life is low. And I don't accept
that dying is necessarily losing. I think it is possible to die well, and that
the inevitable end does not have to be considered defeat. I much prefer the
hospice care approach, with the focus on quality of life. I am not trying to
get better or live longer. Those things would be nice, but they're not my goal.
My goal is to feel as good as possible as long as possible.
Not
surprisingly, after openly and honestly writing about his decision to make a
request under Washington's law he received reactions from people reading his
blog, and a couple days later posted this response:
I
have received some feedback on my thoughts about the Death with Dignity Act. As
I said, I have not decided whether to use this option, but I feel strongly that
it should be legally available to mentally competent and terminally ill people
such as myself. As I also said, I do not view it as "suicide"
(although that is a convenient term), because I would not really be choosing
between living and dying. I would be choosing between different ways of dying.
If someone wishes to deny me that choice, it sounds to me like they are saying:
I am willing to risk that your death will be slow and painful. Well, thanks a
lot, that's brave of you.
Couldn't
have said it better myself.
------------------
Difference
between Suicide and Euthanasia
·Key difference:
Suicide is the act of intentionally taking one’s own life. Euthanasia is the
practice of intentionally ending somebody’s life in order to relieve pain and
suffering.
·
According
to Merriam-Webster, suicide is the “act or an instance of taking one's own life
voluntarily and intentionally especially by a person of years of discretion and
of sound mind.” Suicide is derived from the Latin ‘suicidium’, from ‘sui
caedere’, which means “to kill oneself.”
According
to Merriam-Webster, suicide is the “act or an instance of taking one's own life
voluntarily and intentionally especially by a person of years of discretion and
of sound mind.” Suicide is derived from the Latin ‘suicidium’, from ‘sui
caedere’, which means “to kill oneself.”
·Suicide is the act of
intentionally taking one’s own life. It is often committed out of despair, due
to stress factors such as financial difficulties, unhappiness with life or
love. It may also be due to a mental disorder such as depression, bipolar
disorder, schizophrenia, alcoholism, or drug abuse.
·The World Health Organization
(WHO) estimates that it is the 13th leading cause of death worldwide. Over one
million people die by suicide every year. It is estimated that there are yearly
10 to 20 million non-fatal attempted suicides worldwide. It is a leading cause
of death among teenagers and adults under 35. Also, men are three to four times
more likely to attempt suicides than females. There are a number of suicide
prevention helplines and organizations, which aim to help people to deal with
thoughts of suicide and suicidal tendencies.
Merriam-Webster
defines euthanasia as, “the act or practice of killing or permitting the death
of hopelessly sick or injured individuals in a relatively painless way for
reasons of mercy.” Euthanasia is derived from the Greek ‘euthanatos’, from eu
(well or good) + thanatos (death), meaning easy death.
Euthanasia
is basically the practice of intentionally ending a life in order to relieve
them from pain and suffering. It is also often referred to as one’s choice to
live in a dignified manner by many pro-euthanasia activists. Euthanasia can be
categorized in different ways, which include voluntary, non-voluntary, or
involuntary. Voluntary, non-voluntary and involuntary euthanasia can all be
further divided into passive or active euthanasia.
Voluntary
euthanasia is also referred to as "assisted suicide." It is when one
helps somebody who is sick and suffering, to take their own life. Passive
voluntary euthanasia is when one is on life support and asks to be taken off
the life support, so that they may die rather then endure the pain of living.
Passive euthanasia is essentially the withholding of common treatments, such as
antibiotics, which are necessary for the continuance of life. Active voluntary
euthanasia is when a person asks for drugs or supplement to kill themselves, so
that they may not suffer the pain. This is most common in people suffering from
chronic illnesses.
Non-voluntary
euthanasia (sometimes known as mercy killing) is euthanasia conducted where the
explicit consent of the individual concerned is unavailable, such as when the
person is in a persistent vegetative state. In cases of non-voluntary
euthanasia, the family, spouse, or legal representative takes the decision to
take the person off the life support (passive euthanasia) or to give them a
lethal injection to end their life (active euthanasia.)
Involuntary
euthanasia occurs when euthanasia is performed on a person who is able to
provide informed consent, but does not, either because they do not choose to
die, or because they were not asked. In most cases, this is considered as
murder, as the person did not have a choice or knowledge of the ending of their
life.
Both
suicide and euthanasia are controversial topics. Many religions, such as
Christianity, Islam and Judaism, consider suicide and euthanasia as an offense
towards God, as they believe that only God has the right and power to give life
and take it away. Due to this reasoning, suicide is often regarded as a serious
crime, even in modern Western thought. In some countries, a failed suicide
attempt is considered punishable by law. Passive voluntary euthanasia is
considered as legal in some countries and in some US states. These laws were
implemented mainly due to activists protesting a person’s choice to live and
die in dignity. Non-voluntary euthanasia and involuntary euthanasia are illegal
in all countries.
-----------------
Physician-assisted
suicide do-over is a cop-out
Russell
Wangersky Published on February 07, 2015
'Walk the walk, you pompous blowhards'
Russell
Wangersky
The judges
of the Supreme Court of Canada, in their verdict on physician-assisted suicide,
put it succinctly: “It is a crime in Canada to assist another person in ending
her own life. As a result, people who are grievously and irremediably ill
cannot seek a physician’s assistance in dying and may be condemned to a life of
severe and intolerable suffering. A person facing this prospect has two
options: She can take her own life prematurely, often by violent or dangerous
means, or she can suffer until she dies from natural causes. The choice is
cruel.”
Then, the
good judges decided to let that cruelty continue, suspending their judgment for
a year so the federal government can address the issue with new legislation —
making it the latest ideological plaything.
I
certainly applaud the decision wholeheartedly, and agree with the court that
unanimously striking down the law would be unconstitutional. But while I can
understand the court’s desire for practicality, I think the do-over is a
cop-out.
For those
with short memories, the Supreme Court did much the same thing with Canada’s
prostitution laws: Ruled them to be unconstitutional, but allowed the federal
government a year’s grace to come up with new legislation. The government did
exactly that, coming up with seriously flawed new prostitution legislation that
will, in all likelihood, go right back to the Supreme Court.
Legislative
Ping-Pong may be fun for judges and politicians, but the fun goes out of it
entirely when you have to watch your mother slowly and painfully die on the
couch in her living room. (Let me be absolutely clear: When my mother died, I
lived a continent away and bore only a fraction of the burden that my brothers,
and especially my older brother, did.)
But what I
did bear will never leave me.
My mother
was a lively, independent woman in her 70s when she developed liver and brain
cancer. Three months after it was discovered, the disease was literally tearing
her apart. No time for chemotherapy or surgery, no prognosis except death. Not
sick enough for palliative care, too sick for home.
Sometimes,
she thought the British Columbia mountains were drawings put there by hospital
staff. Sometimes, she thought she was in other cities. Sometimes, she got up
from her hospital bed and ran as far as her legs would carry her.
One night,
back at home at around 3 a.m., she started talking to me. I was sitting in a
chair next to where she was lying on the couch. The rest of the house was
quiet, everyone else finally sleeping.
“Call
them, Russ,” she said. “Call them. Call the people who come and pick them up.”
The
ambulance?
“No. Call
them. The people that take you away. They come and pick you up from the curb.
Call them now.”
You know
your parents. You know when they make decisions. She looked straight at me.
“No more.
Had enough. Just end this. You know what I mean. Do it.”
It was a
lesson she had already learned from her father, who had suffered from dementia
and had intended to commit suicide before he was completely ravaged by the
disease. As she told me quite bluntly when I was a teenager, “Our big mistake
was that we took away his gun.”
I had the
medications, I knew exactly what she wanted, but I couldn’t do it. More than
anything else, I couldn’t bring myself to do it wrong.
She stayed
alive, and, just like the court said, it was cruel.
I can’t
write it exactly the way I would say it — the language would be far too foul —
but here goes: Before our federal government spends the next 12 months drafting
new legislation, walk the walk, you pompous blowhards.
Russell
Wangersky is TC Media’s Atlantic regional columnist. He can be reached at russell.wangersky@tc.tc.
His column appears on Tuesdays, Thursdays and Saturdays.
-------------------
Right to Die
FAQs
·
Is it legal in Canada for someone to end their own
life?
Yes,
in 1972 suicide was removed from the criminal code and it has been legal ever
since. It remains illegal for anyone to counsel, aid or abet another person to
end his or her own life.
·
If Canadians already have the right to die, why do
we need medically-assisted dying?
While
we have the right to die, very few of us have the resources to do so
peacefully.
Many
people think they could just end their lives by taking a bottle of Tylenol or
other medication, perhaps washed down with a swig of champagne. The reality is
that taking an over-the-counter medication or most prescription medications,
even in large doses, is unlikely to lead to death. It is much more likely to
lead to brain damage, liver failure or a coma.
Accessible
and effective ways of ending our lives tend to be violent, such as shooting or
hanging. Not only are these traumatic for the survivors, they inevitably end up
by causing the individual to die alone. What's more, most individuals with
terminal or incurable illnesses will not, at the end of their lives, be able to
take their own lives in this manner.
We
believe Canadians should have the right to medically-assisted dying because we
believe individuals should be entitled to a peaceful death - and that no one
should have to die alone.
·
What
is medically assisted dying?
Medically
assisted dying, also called medical aid in dying, is an umbrella term that
refers to an appropriately regulated process whereby a medical professional
actively assists a patient to die.
In all
types of medically assisted dying, a participating physician has a key role to
play in diagnosing the patient's condition and assessing the patient's capacity
to make decisions.
In some
jurisdictions where assisted dying is legal, the physician may write a
prescription for medication which the patient obtains and self-administers.
This remedy, also known as physician assisted suicide, is practiced in Oregon
and Washington State.
Other
jurisdictions allow a doctor, or someone under a doctor's supervision, to
administer life-ending medication at the request of a qualifying patient. This
remedy is also known as voluntary euthanasia. In contrast to self-administered
medication (assisted suicide) voluntary euthanasia allows the patient to
determine the timing of their death, even once they are no longer able to use
their hands or swallow. Voluntary euthanasia is legal in both The Netherlands
and Belgium.
·
Is
this different from euthanasia?
Medically
assisted dying is an umbrella term that covers both patient self-administration
of life-ending medication (physician assisted suicide or PAS) and voluntary euthanasia,
where the patient requests and is given medication administered by a medical
professional to end their life.
For
example, in the Netherlands, where voluntary euthanasia is legal, a patient
will typically gather with their family around them and say good-bye, then a
doctor will administer a shot which will result in their peacefully slipping
into a coma and dying.
Care
needs to be taken to distinguish between the legal practice of voluntary
euthanasia (assistance to die requested by a patient) and non-voluntary
euthanasia (assistance to die without an explicit request by the patient) and
involuntary euthanasia (death without the consent of the patient, also known as
murder).
Advocates
for the right to die support voluntary euthanasia. No jurisdiction has
legalized non-voluntary or involuntary euthanasia.
·
Are
there different types of euthanasia?
Euthanasia
is generally considered to take one of three forms.
The
first is voluntary euthanasia. Many people remember Sue Rodriguez from the
early 1990's; this is what she wanted.
Sue
Rodriguez was a competent and mature adult who was suffering from ALS. She
wanted to die but was unable to take her own life - her disease was advanced
and she no longer had sufficient motor control. In voluntary euthanasia, the
patient is competent, expresses their own wishes - and enlists the support of a
medical professional to carry them out.
This
type of euthanasia is legal in The Netherlands.
The
second type of euthanasia we call pre-planned, and it is sometimes called non-voluntary.
This
refers to euthanasia requested when an individual was competent, but performed
when the patient has lost competence. For example, imagine an individual knows
they are getting Alzheimers' and wants to have their life ended when all
quality is gone.
The
only jurisdiction in the world where pre-planned euthanasia is legal is in The
Netherlands, and then only in very limited circumstances. The patient must have
completed an advance care directive for euthanasia and the doctor must believe
the individual is experiencing intolerable and intractable suffering.
The
final type of euthanasia is involuntary. This is where someone's life is taken
against their will. There is no organization in the world that advocates for
this, nor is there any jurisdiction where it is legal. Irrespective of
choice-in-dying laws, all jurisdictions have murder laws that cover involuntary
euthanasia.
·
Where
is medically assisted dying legal?
Medically
assisted dying is legal in the U.S. states of Oregon, Washington, Vermont,
Montana and New Mexico. It is also legal in Belgium, the Netherlands,
Luxembourg and Switzerland.
·
Can
Canadians travel to these jurisdictions and have assisted dying?
Only in
Switzerland is it legal for non-residents to seek assisted dying. In all other jurisdictions,
only residents can access assisted dying.
·
What
happens in Canada if someone assists someone else to die?
Section
241 of the Canadian criminal code prohibits aiding, abetting or counseling
someone to suicide. Breaking this law carries a maximum sentence of 14 years in
prison.
·
Isn't
there a court challenge being brought right now?
Yes.
The case of Gloria Taylor, also known as the Carter case, has been heard by the
BC Supreme Court (which decided in favour of Gloria Taylor and her
co-plaintiffs) and the BC Court of Appeal (where we await a decision). The
losing side will appeal the decision of the BC Court of Appeal to the Supreme
Court of Canada, so this case has national significance.
For
more information about this cases, see The Court Challenge for the Right to
Die.
·
If
legally assisted dying becomes available, what impact will it have on insurance
policies? They have a clause regarding suicide, will legally aided dying be any
different?
Check
the wording of your individual policy. Most policies have either a one or two
year exclusion for suicide. That means that if the individual has had a policy
in place for longer than that, the manner of death is irrelevant.
In
Oregon, under their Death With Dignity Act, death certificates were initially
filled out to indicate “suicide,” but that practice has since been changed.
Currently, the patient's disease is listed as the cause of death, acknowledging
that it is this underlying disease that is in fact causing the person to hasten
their dying.
If you
have concerns, check your insurance contract and contact your insurance company
directly.
--------------
Ten Reasons to Support
Choice
1.
Palliative care cannot cure all suffering. Palliative care is critical, but alone it is not
enough. In Oregon in 2013 (2012), 86% (97%)[1] of individuals who used that state's dying
with dignity legislation were enrolled in a hospice program. There is some
suffering that only death can end.
2.
Legalizing medically assisted dying is associated with an improvement in end of
life care.
Jurisdictions that have legalized end-of-life choice have seen improvements in
palliative care. Seventy-six percent of Oregon’s physicians reported improving
their knowledge of pain medications “somewhat” or “a great deal” after Oregon’s
“Dying with Dignity” legislation became law, and 30% reported increasing their
referrals to Palliative Care programs[2].
Nurses who were asked to rate doctors on their palliative care skills in Oregon
before and five years after legalization of medically assisted dying noted
significant improvements in care on five of six rated dimensions. The sixth one
was unchanged[3].
3.
Offering medically assisted dying is compassionate. Family members and medical
providers can be deeply traumatized when someone who is suffering greatly begs
for relief when none can be provided. As a compassionate society, we need to
offer information and choices to individuals like Dr.
Don Low, and prevent needless suffering.
4. It
is the will of Canadians.
A recent Angus Reid poll showed that 80%[4]
of Canadians support the right of grievously ill patients to have medical
assistance to die.
5.
Canadians are already allowed to make choices that can end their lives. Every Canadian has the right to
be removed from life support if they choose. By legalizing medically assisted
dying, we would be allowing all dying Canadians to have the same options as
those who depend on machines for survival.
6.
Support for assisted dying has increased in jurisdictions where it has been
legalized. Support
for death with dignity has grown through the years in Oregon, currently 80% of
registered Oregon voters support the law,"— an increase of 20% from the
1997 referendum on this legislation.[5]
Once the choice is legalized, individuals realize that fears raised were
unwarranted and support increases.
7.
Banning medically assisted death does not stop dying Canadians from ending
their lives.
Some terminally-ill Canadians have traveled to Switzerland to receive a
medically assisted death, but the cost of this trip, with associated airfare,
transport and hotel costs, is likely to run somewhere in the range of $20,000 -
$30,000, an amount that is beyond the means of most Canadians. Those who choose
to end their lives in Canada are left to do so without medical assistance,
which can lead to pain and suffering even if the attempt is successful. Others
may choose to end their lives violently[6].
This makes their death horrific not only for themselves, but also for their
families and for emergency responders. Providing a peaceful means of death will
prevent this trauma.
8.
Control gives peace of mind, and sometimes that is all that is needed. Studies have repeatedly shown
that people are healthier[7]
when they know they have control over their lives.
Nagui Morcos ended his life too early because he
knew nobody could help him when he was incapable of ending his life alone. Susan Griffiths went to Switzerland to end her
life while she was still able to travel. She feared that if she waited she
would be unable to make the trip and would end up dying the death she feared.
On the other hand, Gloria Taylor was granted the right to medically assisted
dying by the British Columbia Court of Appeal, but never exercised this right
and died a natural death. Since the Death With Dignity Legislation was
introduced in Oregon, only 61% of patients who received the prescription
actually died from ingesting the medication[8].
If dying Canadians had the right to end their lives in Canada at a time of their choosing, they would have greater peace of mind, and people like Nagui and Susan may choose to die a natural death.
If dying Canadians had the right to end their lives in Canada at a time of their choosing, they would have greater peace of mind, and people like Nagui and Susan may choose to die a natural death.
9.
Legalizing medically assisted dying does not threaten the weak and vulnerable. Right now, some medically
assisted deaths happen without the patient’s explicit consent. Studies in the
Netherlands and Belgium have shown that the rate of these deaths dropped with
the legalization of medically assisted dying. These post-legalization rates of
deaths without explicit consent are also much lower in the Netherlands and in
Belgium than in other jurisdictions studied (Australia and New Zealand) where
assisted death is not legal[9].
Studies from Washington and Oregon show that people who received medically
assisted dying were >95% white and >93% high-school graduates, while only
12% were over age 85 and 2% were uninsured[10].
10.
Medically assisted dying does not compromise the physician-patient
relationship. A
study from Oregon found that doctors who opposed the “Dying with Dignity Act”
were more than twice as likely to report a patient becoming upset or leaving
their practice as a result of their position compared with physicians who
supported the “Dying with Dignity Act”[11].
The same study found that 13% of Oregon doctors were “more supportive” of the
“Dying with Dignity Act” than they were when it initially became law, compared
with only 7% who were less supportive.
[3] Goy, Elizabeth et al, Oregon
hospice nurses and social workers’ assessment of physician progress in
palliative care over the past 5 years, Palliative and Supportive Care, 2003
http://www.ncbi.nlm.nih.gov/pubmed/16594421
[5] http://www.deathwithdignity.org/2013/06/17/peg-sandeen-phd-msw
(Doctoral dissertation of Peg Sandeen)
[8] Since the law was passed in
1997, a total of 1,050 people have had DWDA prescriptions written and
673
patients have died from ingesting medications prescribed under the DWDA http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year15.pdf
page 2
[9] This is a conclusion from a
composite of studies including Chambaere, et al Physician-assisted deaths
under the euthanasia law in Belgium: a population-based survey “In
Belgium…the rate (of LAWER) dropped from 3.2% in 1998 to 1.8% in 2007. In the
Netherlands, the rate dropped slightly after legalization, from 0.7% to
0.4%.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2882449/ The comparative rate
in New Zealand where assisted dying is not legal is 5.6% http://www.ncbi.nlm.nih.gov/pubmed/15280938.
In Australia, “More than a third of surgeons surveyed reported giving drugs
with an intention to hasten death, often in the absence of an explicit request”
per Douglas, et al., The intention to hasten death: a survey of
attitudes and practices of surgeons in Australia. http://www.ncbi.nlm.nih.gov/pubmed/11795535
[10] Loggers, E. T., H. Starks,
et al. (2013). "Implementing a Death with Dignity program at a
comprehensive cancer center." The New England journal of medicine 368(15):
1417-1424.
[11] http://jama.jamanetwork.com/article.aspx?articleid=193817
Table 3. (19/490 = 3.8%, 32/324= 9.9%)
-----------------
Catholic
Killing the Pain, Not the Patient: Pallitive Care vs.
Assisted Suicide
Editor
The Faith Understood
Richard M. Doerflinger and Carlos F. Gomez
From the Jan/Feb 1999 Issue of Lay Witness Magazine
Some time ago an ad appeared in a medical journal
promoting a new pain-killing drug. To emphasize that this new product could
relieve pain without sleepiness or other side effects, the ad began with a
slogan: “Stop the pain. Not the patient.”
The outcome of our society’s debate on physician-assisted
suicide may depend on how well we communicate—and act upon—a similar message.
We are living at a time when some doctors and lawmakers think that the best
solution for some patients’ suffering is to give them lethal drugs for suicide.
Catholics committed to the dignity of each human person must insist: “Kill the
pain. Not the patient.”
It is a compelling message. Some opinion polls show
support for assisted suicide when it is presented as the only relief for a
dying patient in unbearable pain. But when Americans are offered an
alternative, they overwhelmingly say that society should concentrate on
ensuring pain control and compassionate care for such patients—not on helping
them take their lives.
This preference is even stronger among dying patients
themselves. When the medical journal The Lancet reported on interviews with
cancer patients on June 29, 1996, it found that dying patients experiencing
significant pain were more opposed to assisted suicide than the general public.
“Patients with pain do not seem to view euthanasia or
physicianassisted suicide as the appropriate response to poor pain management,”
wrote Dr. Ezekiel Emanuel, a director of the study. “Indeed, oncology patients
in pain may be suspicious that if euthanasia or physician-assisted suicide are
legalized, the medical care system may not focus sufficient resources on
provision of pain relief and palliative care.”
Realizing that assisted suicide is less popular than
improved palliative care, euthanasia advocates have resorted to the claim that
there is really not much difference between the two. Their argument goes like
this:
“Let’s be honest. Doctors commonly practice euthanasia
now, under the guise of pain control. They give dying patients massive doses of
morphine to suppress their breathing, and then call their death a mere ‘side
effect.’ They justify this hypocrisy by invoking an invention of medieval
theologians called ‘the principle of double effect.’ Sometimes they even sedate
these patients into unconsciousness so they can starve them to death. This
‘terminal sedation’ is really slow euthanasia. It would be far more candid as
well as more humane to practice euthanasia openly.”
This argument has appeared in newspaper opinion pieces,
medical journals, and briefs to the U.S. Supreme Court. In 1996, it was even
endorsed to some extent by two federal appeals courts that sought to give
constitutional protection to physician-assisted suicide.
Yet the American medical profession— and the Supreme
Court—rejected this argument. To understand why they were right to do so, we
must explore two realities: the facts about modern pain control, and the
meaning of that so-called medieval invention, the principle of double effect.
The Facts About Pain Control
Many doctors hesitate to give dying patients adequate
pain relief because they fear that high doses of painkillers such as morphine
will suppress the breathing reflex and cause death. Yet we now know that this
fear is based on false assumptions, and on inadequate training of physicians in
pain management techniques. Even among oncologists, who probably deal with more
patients in severe pain, there is too little knowledge of the medically
appropriate use of analgesic drugs.
In reality, a very large dose of morphine may well cause
death—if given to a healthy person who is not in pain and has not received
morphine before. But when administered for pain, such drugs are taken up first
by the patient’s pain receptors. In fact, patients regularly receiving morphine
for pain quickly build up a resistance to side effects far more quickly than to
the drugs’ analgesic effects—so doctors need not hesitate to increase dosages
when needed to relieve pain. The question, “What is the maximum dose of
morphine for a cancer patient in pain?” has one answer: “The dose that will
relieve the pain.” As long as a patient is awake and in pain, the risk of
hastening death by increasing the dose of narcotics is virtually zero.
Unrelieved pain is itself a stimulant, which overwhelms any depressive effects
of narcotics. Patients whose unrelieved pain is distorting the very fabric of
their lives need adequate pain control the way a diabetic needs insulin to
function properly.
Very rarely it may be necessary to induce sleep to
relieve pain and other distress in the final stage of dying. Euthanasia
advocates call this “terminal sedation,” but it is the same kind of sedation
that is sometimes needed to calm distressed or restless patients with
non-terminal conditions. While some terminally ill patients may die under such
sedation, this is generally because they were already at the point of death.
In competent medical hands, sedation for imminently dying
patients is a humane, appropriate, and medically established approach to what
is often called “intractable suffering.” It does not kill the patient, but it
can make his or her suffering bearable. It may also allow a physician the time
to reassess a patient’s pain needs: The terminally ill sedated patient may
later be withdrawn from the sedatives and brought back to consciousness, with
his or her pain under control.
The medical evidence supports these claims. In 1992, the
Journal of the American Medical Association (JAMA) reported on 97 terminally
ill patients who died after life support was withheld or withdrawn. Sixtyeight
of the patients received painkilling drugs or sedatives to relieve pain and
other distress while dying—and they lived longer than the patients who did not
receive drugs. The study found that the dosages of these drugs were chosen to
ensure relief of suffering, not to hasten death.
Only recently has the medical profession begun to
appreciate that unrelieved pain can itself hasten death. It can weaken the
patient, suppress his or her immune system, and induce depression and suicidal
feelings. It can keep patients from living out their lives with dignity, in the
company of their families and friends. So, adequate pain relief can actually
lengthen life. According to a JAMA news item of March 25, 1992, part of modern
medicine’s task may be that of “killing pain before it kills the patient.” Or
as the Catholic Health Association says in its 1993 guide Care of the Dying: A
Catholic Perspective: “Unrelieved agony will shorten a life more surely than
adequate doses of morphine.”
In short, when dosages of painkilling drugs are adjusted
to relieve a patient’s pain, there is little if any risk that they will hasten
death. This fact alone should put to rest the myth that pain control is
euthanasia by another name.
The Principle of Double Effect
What of the rare case when providing pain relief or
sedation does risk hastening death? Is this really the same thing as
deliberately killing a patient?
Centuries of Catholic moral tradition say it is not.
Sometimes it is impossible to achieve some good effect without causing a bad
effect as well. When an act has both a good and a bad effect, we should ask
ourselves whether it meets four criteria.
First, the act itself must be good or at least morally
indifferent; giving medication to relieve pain certainly meets this test.
Second, the good effect must not be attained by means of the bad effect—we
cannot claim, like Jack Kevorkian, that we may deliberately kill suffering
people because once they are dead they can’t suffer. Third, the bad effect must
not be intended; we cannot give pain medication in order to relieve pain and
cause death. Fourth, there must be a serious reason for pursuing the good
effect; it would be irresponsible to risk hastening death to relieve an
ordinary headache.
Taken together, these criteria have become known in
Catholic moral reasoning as the principle of double effect. Euthanasia
supporters like to emphasize the principle’s Catholic origins so they can
dismiss it as an arcane medieval invention. Dr. Timothy Quill, for example, argues
that it should not be used in our pluralistic society because it “originated in
the context of a particular religious tradition” (New England Journal of
Medicine, Dec. 11, 1997).
But one might as well rescind laws against robbing banks
on the grounds that “Thou shalt not steal” comes from a particular religious
tradition. A moment’s reflection will show us that the principle of double
effect is no Catholic peculiarity, but simply good common sense.
When the Ninth Circuit Court of Appeals sought to establish
a “right” to assisted suicide in 1996, its opinion rejected the distinction
between intended and unintended hastening of death. Judge Kleinfeld’s
dissenting opinion used a down-to-earth example to show how wrong the court’s
majority opinion was. “When General Eisenhower ordered American soldiers onto
the beaches of Normandy,” he wrote, “he knew that he was sending many American
soldiers to certain death, despite his best efforts to minimize casualties. His
purpose, though, was to . . . liberate Europe from the Nazis. The majority’s
theory of ethics would imply that this purpose was legally and ethically
indistinguishable from a purpose of killing American soldiers.” Ultimately the
U.S. Supreme Court reversed the appeals court’s decision and upheld the
principle of double effect, citing Judge Kleinfeld’s historical example to
illustrate its moral and legal validity.
Students of Bible history could draw the point out
further. When King David was overcome by desire for the wife of Uriah the
Hittite, he ordered Uriah to the front lines with the express purpose of making
sure he was killed (2 Sam. 11:15-17). That was an act of murder, concealed by
wartime. Anyone who cannot tell the difference between King David’s murderous
plot and General Eisenhower’s decision about D-Day should not be entrusted with
life-and-death decisions!
The importance of intentions in making moral decisions
should be clear to all physicians, who routinely prescribe treatments that may
have negative consequences. If, despite everyone’s best efforts, a patient
stops breathing and dies on the operating table from anesthesia during a
delicate operation, is the surgeon a killer? If so, the medical profession is
filled with “unintentional murders.” A more honest appraisal would be to admit
that human life is fragile, that actions can have unexpected or unintended
consequences, and that human beings—including skilled and ethically responsible
physicians—are fallible.
Are there borderline cases where people’s intentions are
not clear? Are there instances when it is irresponsible to risk hastening death
even as a side effect? Of course. The principle of double effect does not
automatically clarify all questions of intent, and it does not mean that
causing death is justified whenever it is not directly intended. But the
distinction is a useful tool for moral decisions. In modern medicine, quite
literally, we couldn’t live without it.
Assisted Suicide vs. Pain Control
In important ways, assisted suicide and good palliative
care are not only distinct—they are radically opposed to each other. Consider
the following:
Control of pain and suffering eliminates the demand for
assisted suicide. As Dr. Herbert Hendin notes in his 1997 book Seduced by
Death, some terminally ill patients have suicidal thoughts, but “these patients
usually respond well to treatment for depressive illness and pain medication
and are then grateful to be alive.” Such treatment responds to the underlying
reasons why patients ask for death, instead of treating the patient himself as
the problem to be eliminated. When pain control and other care improves,
assisted suicide becomes largely irrelevant.
Assisted suicide undermines good pain management. During
the Supreme Court’s January 1997 oral arguments on its assisted suicide cases,
Justice Stephen Breyer noted a remarkable fact from a report by the British
parliament’s House of Lords: The Netherlands, which has allowed assisted
suicide and euthanasia for years, had only three hospices nationwide, while
Great Britain, which bans these practices, had 185 hospices. He had placed his
finger on one of the most insidious effects of legalization: Once the “quick
and easy” solution of assisted suicide is accepted in a society, doctors lose
the incentive to pursue more difficult but life-affirming ways of truly caring
for patients close to death. The converse is also true: prohibiting assisted
suicide sets a clear limit to doctors’ options so they can commit themselves to
the challenges of accompanying patients through their last days. As one
physician said after years of practicing hospice medicine: “Only because I knew
that I could not and would not kill my patients was I able to enter most fully
and intimately into caring for them as they lay dying” (quoted in Leon Kass,
“Why Doctors Must Not Kill,” Commonweal, Sept. 1992, p. 9).
The assisted suicide movement is willing to discredit
modern pain control to advance its own cause. Euthanasia advocates know that
when they equate assisted suicide and modern pain management, they are not just
elevating the status of assisted suicide. They are also undermining good pain
control among people who oppose direct killing of the innocent. They do not
seem to care that their arguments will make doctors and patients more
distrustful of legitimate practices that can truly help people live with
dignity in their last days.
But others are setting the record straight. In an April
1997 report on constitutional arguments about assisted suicide, the prestigious
New York State Task Force on Life and the Law urged people on all sides of the
assisted suicide issue to keep important distinctions clear. Noting that “many
physicians would sooner give up their allegiance to adequate pain control than
their opposition to assisted suicide and euthanasia,” the Task Force warned
that “characterizing the provision of pain relief as a form of euthanasia may
well lead to an increase in needless suffering at the end of life.”
This warning is even being raised by some who do not
oppose physician-assisted suicide in principle. “Clinicians must believe, to
some degree, in a form of the principle of double effect in order to provide
optimal symptom relief at the end of life,” writes Dr. Howard Brody in the
April 1998 Minnesota Law Review. Dr. Brody does not oppose assisted suicide in
all cases, but he knows that many doctors do—and he knows they will not
practice good palliative care if it is seen as tantamount to euthanasia. “A
serious assault on the logic of the principle of double effect,” he writes,
“could do major violence to the (already reluctant and illinformed) commitment
of most physicians to the goals of palliative care and hospice.”
It is startling that a movement ostensibly dedicated to
the wellbeing of dying patients risks undermining their care to advance its
political goal. What can be said in its defense? That any such adverse effects
on patients are only unintended side effects?
In short, pain control and other elements of palliative
care must be clearly distinguished from intentional killing of patients. In
trying to blur this distinction, euthanasia advocates only show their own
indifference to the goal of promoting better care for dying patients.
In logic and in practice, two very different paths lie
before the medical profession and our society: What Pope John Paul II has
called the “false mercy” of assisted suicide and euthanasia, and the “the way
of love and true mercy” that dedicates us to compassionate care (The Gospel of
Life, nos. 66-67). It is a choice between death and life.
Mr. Doerflinger is associate director for policy
development, secretariat for pro-life activities, National Conference of
Catholic Bishops. Dr. Gomez is the medical director of the palliative care
program at the University of Virginia Health System.
This article was reprinted from Respect Life, Copyright ©
1998, United States Catholic Conference, Inc., Washington, D.C. All rights
reserved.
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Lay Witness Archive
-----------------------
Disability
Perspective
Second Thoughts
People with Disabilities Opposing the Legalization of Assisted Suicide
“We are Massachusetts residents with disabilities who oppose the 2012 state ballot question to legalize assisted suicide. This legislation is dangerous and discriminatory, especially for elders and people with disabilities. We encourage Massachusetts voters to look deeper into the issue – to have Second Thoughts about assisted suicide.”
People with Disabilities Opposing the Legalization of Assisted Suicide
“We are Massachusetts residents with disabilities who oppose the 2012 state ballot question to legalize assisted suicide. This legislation is dangerous and discriminatory, especially for elders and people with disabilities. We encourage Massachusetts voters to look deeper into the issue – to have Second Thoughts about assisted suicide.”
ARTICLES:
“Edmonton reaction mixed to Supreme Court of Canada’s
decision to strike down the ban on assisted suicide in Canada”
(Edmonton Sun — February 6, 2015)
“Back in 2012, parliament gave unanimous consent to the idea of a national suicide prevention strategy and now we say, except people who are incredibly ill or disabled get a right to assisted suicide. Everyone else gets suicide prevention.” said Mark Pickup.
(Edmonton Sun — February 6, 2015)
“Back in 2012, parliament gave unanimous consent to the idea of a national suicide prevention strategy and now we say, except people who are incredibly ill or disabled get a right to assisted suicide. Everyone else gets suicide prevention.” said Mark Pickup.
“Diane Coleman:’s Letter to Some New Jersey Senate
Democrats”
(Not Dead Yet — February 5, 2015)
The idea of mixing a cost-cutting “treatment” such as assisted suicide into a broken, cost-conscious health care system that’s poorly designed to meet dying patient’s needs is dangerous to the thousands of people whose health care costs the most — mainly people living with a disability, the elderly and chronically ill….
When you look at assisted suicide based on one individual, it often looks acceptable. But when you examine how legalization affects the vast majority of us, the dangers to the many far outweigh any alleged benefits to a few.
(Not Dead Yet — February 5, 2015)
The idea of mixing a cost-cutting “treatment” such as assisted suicide into a broken, cost-conscious health care system that’s poorly designed to meet dying patient’s needs is dangerous to the thousands of people whose health care costs the most — mainly people living with a disability, the elderly and chronically ill….
When you look at assisted suicide based on one individual, it often looks acceptable. But when you examine how legalization affects the vast majority of us, the dangers to the many far outweigh any alleged benefits to a few.
“Making lethal, legal”
(Colorado Springs Independent — February 4, 2015)
Carrie Lucas, a juvenile and disability rights attorney who lives in Windsor, is among the opponents. Lucas has muscular dystrophy that began shutting down her muscle function in her teens. Now 43, she is a quadriplegic who needs a ventilator to breathe. Since her disease is terminal, and without assistance she would be within hours of death, Lucas says she’d qualify for assisted suicide under HB 15-1135.
(Colorado Springs Independent — February 4, 2015)
Carrie Lucas, a juvenile and disability rights attorney who lives in Windsor, is among the opponents. Lucas has muscular dystrophy that began shutting down her muscle function in her teens. Now 43, she is a quadriplegic who needs a ventilator to breathe. Since her disease is terminal, and without assistance she would be within hours of death, Lucas says she’d qualify for assisted suicide under HB 15-1135.
“Euthanasia is so accepted that doctors must now justify
prolonging a life”
(National Post — January 28, 2015)
Once “an average Dutchman who thought of euthanasia as one of the crown jewels of our liberal country,” van Loenen became “someone who was shocked by the harsh tone used by the Dutch when they talked about handicapped life.”…One of van Loenen’s settled convictions is that what begins in compassion invariably creeps over to the dark side.
(National Post — January 28, 2015)
Once “an average Dutchman who thought of euthanasia as one of the crown jewels of our liberal country,” van Loenen became “someone who was shocked by the harsh tone used by the Dutch when they talked about handicapped life.”…One of van Loenen’s settled convictions is that what begins in compassion invariably creeps over to the dark side.
“Trapped in His Body for 12 Years, a Man Breaks Free”
(NPR — January 9, 2015)
[A]t age 12, his life took an unexpected turn. He came down with a strange illness….His parents, Rodney and Joan Pistorius, were told that he was as good as not there, a vegetable….He thinks he began to wake up when he was 14 or 15 years old. “I was aware of everything, just like any normal person,” Martin says.
But although he could see and understand everything, he couldn’t move his body.
(NPR — January 9, 2015)
[A]t age 12, his life took an unexpected turn. He came down with a strange illness….His parents, Rodney and Joan Pistorius, were told that he was as good as not there, a vegetable….He thinks he began to wake up when he was 14 or 15 years old. “I was aware of everything, just like any normal person,” Martin says.
But although he could see and understand everything, he couldn’t move his body.
“John Kelly Talks About the Tim Bowers Case”
(Not Dead Yet — December 5, 2014)
Based on this misinformation from doctors, and his and his loved one’s fears about life in a wheelchair, Tim Bowers gave his consent to dying on the first day after his injury. In no way was his decision based on informed consent.
(Not Dead Yet — December 5, 2014)
Based on this misinformation from doctors, and his and his loved one’s fears about life in a wheelchair, Tim Bowers gave his consent to dying on the first day after his injury. In no way was his decision based on informed consent.
“Another View: Disabled have their own beliefs on ‘death
with dignity’”
(Sacramento Bee — November 15, 2014)
The death of Brittany Maynard has generated attention on “death with dignity” and a push to enact laws on physician-assisted suicide in California….Many of us find the concept of “death with dignity” demeaning and devaluing since it implies that your state of being is “undignified.”
(Sacramento Bee — November 15, 2014)
The death of Brittany Maynard has generated attention on “death with dignity” and a push to enact laws on physician-assisted suicide in California….Many of us find the concept of “death with dignity” demeaning and devaluing since it implies that your state of being is “undignified.”
Who’s really hurt by assisted suicide?
(CNN — November 4, 2014)
The idea of mixing a cost-cutting “treatment” such as assisted suicide into a broken, cost-conscious health care system that’s poorly designed to meet dying patients’ needs is dangerous to the thousands of people whose health care costs the most — mainly people living with a disability, the elderly and chronically ill….When you look at assisted suicide based on one individual, it often looks acceptable. But when you examine how legalization affects the vast majority of us — especially the most vulnerable — the dangers to the many far outweigh any alleged benefits to a few.
(CNN — November 4, 2014)
The idea of mixing a cost-cutting “treatment” such as assisted suicide into a broken, cost-conscious health care system that’s poorly designed to meet dying patients’ needs is dangerous to the thousands of people whose health care costs the most — mainly people living with a disability, the elderly and chronically ill….When you look at assisted suicide based on one individual, it often looks acceptable. But when you examine how legalization affects the vast majority of us — especially the most vulnerable — the dangers to the many far outweigh any alleged benefits to a few.
“Assisted suicide is bad medicine”
(Sacramento Bee — November 2, 2014)
Why, when listing opponents, did The Sacramento Bee editorial pushing an assisted-suicide law ignore the disability community? We could be those most affected…. Direct coercion is not even necessary. Denying, of even merely delaying, expensive, life-sustaining treatment can drive patients toward assisted suicide. It is a deadly mix with our cost-driven health care system.
(Sacramento Bee — November 2, 2014)
Why, when listing opponents, did The Sacramento Bee editorial pushing an assisted-suicide law ignore the disability community? We could be those most affected…. Direct coercion is not even necessary. Denying, of even merely delaying, expensive, life-sustaining treatment can drive patients toward assisted suicide. It is a deadly mix with our cost-driven health care system.
“Assisted suicide debate masks disability prejudice”
(Chronicle Herald — Canada — October 14, 2014)
Annual statistics reported by the Oregon Department of Human Services document the three most common reasons for choosing assisted suicide: “concerns about losing autonomy, being less able to engage in activities that make life enjoyable and loss of dignity.”…By sanctioning medical assistance to end a life for these reasons, when physical dependence and limitation are accepted uncritically as reasons to die, disability prejudice is elevated to the level of public policy.
(Chronicle Herald — Canada — October 14, 2014)
Annual statistics reported by the Oregon Department of Human Services document the three most common reasons for choosing assisted suicide: “concerns about losing autonomy, being less able to engage in activities that make life enjoyable and loss of dignity.”…By sanctioning medical assistance to end a life for these reasons, when physical dependence and limitation are accepted uncritically as reasons to die, disability prejudice is elevated to the level of public policy.
“The danger of assisted suicide laws”
(CNN – October 13, 2014)
My heart goes out to Brittany Maynard, who is dying of brain cancer and who wrote last week about her desire for what is often referred to as “death with dignity.”
Yet while I have every sympathy for her situation, it is important to remember that for every case such as this, there are hundreds — or thousands — more people who could be significantly harmed if assisted suicide is legal…At less than $300, assisted suicide is, to put it bluntly, the cheapest treatment for a terminal illness. This means that in places where assisted suicide is legal, coercion is not even necessary. If life-sustaining expansive treatment is denied or even merely delayed, patients will be steered toward assisted suicide, where it is legal.
More on Oregon
(CNN – October 13, 2014)
My heart goes out to Brittany Maynard, who is dying of brain cancer and who wrote last week about her desire for what is often referred to as “death with dignity.”
Yet while I have every sympathy for her situation, it is important to remember that for every case such as this, there are hundreds — or thousands — more people who could be significantly harmed if assisted suicide is legal…At less than $300, assisted suicide is, to put it bluntly, the cheapest treatment for a terminal illness. This means that in places where assisted suicide is legal, coercion is not even necessary. If life-sustaining expansive treatment is denied or even merely delayed, patients will be steered toward assisted suicide, where it is legal.
More on Oregon
“Joan Rivers Will Never be a Carrot”
(National Review Online — September 1, 2014)
We need to stop using the V-word to describe our brothers and sisters with profound cognitive disabilities. That word is just as bigoted as the N-word for people of sub Saharan African descent, the K-word for Jews, or the C-word for women.
(National Review Online — September 1, 2014)
We need to stop using the V-word to describe our brothers and sisters with profound cognitive disabilities. That word is just as bigoted as the N-word for people of sub Saharan African descent, the K-word for Jews, or the C-word for women.
“Living with dignity”
(Saturday Paper — August 16, 2014)
Euthanasia can’t be considered voluntary in a society that stigmatises the disabled, the suffering and the aged.
(Saturday Paper — August 16, 2014)
Euthanasia can’t be considered voluntary in a society that stigmatises the disabled, the suffering and the aged.
“The Progressive Case Against Assisted Suicide”
(Huffington Post — August 4, 2014)
I also reject the attempt by a small group of wealthy elites trying to turn assisted suicide into some right-wing or religious debate….We must all take a skeptical look and acknowledge the role that money and power play in end-of-life decisions, and how assisted suicide is being used by some health care companies and decision-makers to increase their bottom line by denying treatment.
(Huffington Post — August 4, 2014)
I also reject the attempt by a small group of wealthy elites trying to turn assisted suicide into some right-wing or religious debate….We must all take a skeptical look and acknowledge the role that money and power play in end-of-life decisions, and how assisted suicide is being used by some health care companies and decision-makers to increase their bottom line by denying treatment.
“Assisted suicide: Disability groups are opposed”
(Missoulian — August 4, 2014)
[R]eaders need to know that all of the major national disability organizations that have taken a position on the issue oppose legalizing assisted suicide….These organizations view public policy with a deep historical knowledge of how old, ill and disabled people are devalued by society and, too often, even by our own families.
(Missoulian — August 4, 2014)
[R]eaders need to know that all of the major national disability organizations that have taken a position on the issue oppose legalizing assisted suicide….These organizations view public policy with a deep historical knowledge of how old, ill and disabled people are devalued by society and, too often, even by our own families.
“Disabled people like me need help to live, not die”
(The Guardian — July 16, 2014)
I am terrified by Lord Falconer’s assisted dying bill — and so are the doctors who would have to act as suicide judges.
(The Guardian — July 16, 2014)
I am terrified by Lord Falconer’s assisted dying bill — and so are the doctors who would have to act as suicide judges.
“Tanni Grey-Thompson on assisted dying”
(New Statesman — July 15, 2014)
“People come up to me and say ‘I wouldn’t want to live if I was like you.”
(New Statesman — July 15, 2014)
“People come up to me and say ‘I wouldn’t want to live if I was like you.”
“Cuts risk returning disabled to the shadows, says Baroness
Campbell”
(The Telegraph — April 5, 2014)
Jane Campbell has spent the last half century defying the odds. When she was 11 months old, doctors diagnosed her with severe spinal muscular atrophy and told her parents to enjoy what little time she had left…[She] now sits as a crossbencher in the House of Lords as Baroness Campbell of Surbiton. So it should come as no surprise that, in the House of Lords this week, this remarkable fighter positioned herself at the head of the battle to stop the Government cutting the funding that enables her, and around 18,000 of the most severely disabled people in the country, to thrive in their lives and careers.
(The Telegraph — April 5, 2014)
Jane Campbell has spent the last half century defying the odds. When she was 11 months old, doctors diagnosed her with severe spinal muscular atrophy and told her parents to enjoy what little time she had left…[She] now sits as a crossbencher in the House of Lords as Baroness Campbell of Surbiton. So it should come as no surprise that, in the House of Lords this week, this remarkable fighter positioned herself at the head of the battle to stop the Government cutting the funding that enables her, and around 18,000 of the most severely disabled people in the country, to thrive in their lives and careers.
“New Hampshire Assisted Suicide Bill Redefines ‘Terminal
Condition’ Broadly Enough to Make Anyone with a Significant Disability or
Chronic Condition Eligible”
(Not Dead Yet — January 31, 2014)
On the face of it, it’s still a bill that would restrict “eligibility” for getting lethal doses in order to commit suicide to people with “terminal conditions.” But when you get into the actual definition, it’s clear that the sponsors of this bill want “terminal condition” to mean something other than what the rest of us mean.
More on New Hampshire
(Not Dead Yet — January 31, 2014)
On the face of it, it’s still a bill that would restrict “eligibility” for getting lethal doses in order to commit suicide to people with “terminal conditions.” But when you get into the actual definition, it’s clear that the sponsors of this bill want “terminal condition” to mean something other than what the rest of us mean.
More on New Hampshire
“Unconditionally Loving a Human ‘Non-Person’”
(National Review Online — January 25, 2014)
This story is important because it shows a vivid contrast between two approaches dealing with severe human disability….
I am saying it is wrong to treat our cognitively devastated brothers and sisters worse than we ever would animals or criminals through denied sustenance or looking upon them avariciously as a corn crop ripe for the harvest.
(National Review Online — January 25, 2014)
This story is important because it shows a vivid contrast between two approaches dealing with severe human disability….
I am saying it is wrong to treat our cognitively devastated brothers and sisters worse than we ever would animals or criminals through denied sustenance or looking upon them avariciously as a corn crop ripe for the harvest.
“Rhode Island Medical Reporter Quotes Second Thoughts CT
Concerns about MOLST”
(Not Dead Yet — January 23, 2014)
Some people with disabilities fear that MOLST laws, already in place in several states, could result in denial of life-saving treatment to those who want it. Although MOLST is supposed to be voluntary, these activists say some nursing homes have presented it as mandatory. And when emergency personnel see that pink sheet tacked to the wall, will they read all its details or will they assume it means “do not resuscitate?”
(Not Dead Yet — January 23, 2014)
Some people with disabilities fear that MOLST laws, already in place in several states, could result in denial of life-saving treatment to those who want it. Although MOLST is supposed to be voluntary, these activists say some nursing homes have presented it as mandatory. And when emergency personnel see that pink sheet tacked to the wall, will they read all its details or will they assume it means “do not resuscitate?”
“Health Insight: New R.I. law aims to ease final days of
terminally ill”
(Providence Journal — January 19, 2014)
Cathy Ludlum of Second Thoughts Connecticut says that “many people with severe disabilities feel personally threatened” by the law’s definition of “terminal illness” as “an incurable condition that, without the administration of life-sustaining procedures, will, in the opinion of the attending physician, result in death.”
“By definition,” Ludlum said, “we have incurable and irreversible conditions, and many of us use life-sustaining procedures every day of our (hopefully) long lives.”
(Providence Journal — January 19, 2014)
Cathy Ludlum of Second Thoughts Connecticut says that “many people with severe disabilities feel personally threatened” by the law’s definition of “terminal illness” as “an incurable condition that, without the administration of life-sustaining procedures, will, in the opinion of the attending physician, result in death.”
“By definition,” Ludlum said, “we have incurable and irreversible conditions, and many of us use life-sustaining procedures every day of our (hopefully) long lives.”
“John Kelly Talks About the Tim Bowers Case”
(Not Dead Yet — December 5, 2013)
Bowers is the Indiana hunter who was injured in a fall and died the next day when he told doctors to stop life support….I have almost exactly the same injury as Bowers and I know that reliable prognosis requires the passage of time.
(Not Dead Yet — December 5, 2013)
Bowers is the Indiana hunter who was injured in a fall and died the next day when he told doctors to stop life support….I have almost exactly the same injury as Bowers and I know that reliable prognosis requires the passage of time.
“John Kelly Quoted in NPR Thanksgiving Day Article on POLST”
(Not Dead Yet — December 1, 2013)
Some members of the disability community have questioned whether POLST is being too broadly applied. Rather than giving people more control over end-of-life medical care, they say, it could mean interpreting “disabled” to mean “on death’s door.”
More on POLST
(Not Dead Yet — December 1, 2013)
Some members of the disability community have questioned whether POLST is being too broadly applied. Rather than giving people more control over end-of-life medical care, they say, it could mean interpreting “disabled” to mean “on death’s door.”
More on POLST
“Disability Rights Victory in Organ Procurement Protocols…”
(Not Dead Yet — November 14, 2013)
This week the Board of Directors of the Organ Procurement and Transplantation Network (OPTN) adopted a policy that removed two major threats to people with disabilities posed by previous proposals.
More on Oregon Transplant
(Not Dead Yet — November 14, 2013)
This week the Board of Directors of the Organ Procurement and Transplantation Network (OPTN) adopted a policy that removed two major threats to people with disabilities posed by previous proposals.
More on Oregon Transplant
“John Kelly’s Response to IOM Online Survey or ‘We Love Our
Tubes!’”
(Not Dead Yet — November 7, 2013)
Three months ago, my nurse brought me the Massachusetts MOLST form, with its preference for certain treatments in extremis. She had been told that they were to complete these forms with every disabled person she follows.
More on POLST
(Not Dead Yet — November 7, 2013)
Three months ago, my nurse brought me the Massachusetts MOLST form, with its preference for certain treatments in extremis. She had been told that they were to complete these forms with every disabled person she follows.
More on POLST
“Not Dead Yet: ‘Meet our New Regional Director, John Kelly’”
(Not Dead Yet, November 5, 2013)
“I want to introduce myself to the far-flung faithful readers of this blog and all the supporters of Not Dead Yet and our mission to halt the deadly discrimination of legalized assisted suicide and euthanasia.”
(Not Dead Yet, November 5, 2013)
“I want to introduce myself to the far-flung faithful readers of this blog and all the supporters of Not Dead Yet and our mission to halt the deadly discrimination of legalized assisted suicide and euthanasia.”
“Disability — a fate worse than death?”
(The Guardian — October 18, 2013)
As a disabled person, I’m relieved at the defeat of the voluntary assisted dying bill yesterday. Doctors might know about our biology, but it doesn’t mean they know about our lives.
(The Guardian — October 18, 2013)
As a disabled person, I’m relieved at the defeat of the voluntary assisted dying bill yesterday. Doctors might know about our biology, but it doesn’t mean they know about our lives.
“Not Dead Yet UK: “Real Disability Activists and
Masquerades”
(Not Dead Yet — October, 2013)
Have you heard of the new Disabled Activists for Dignity in Dying? And the interesting claim that 75% of disabled people support assisted suicide/euthanasia? Is that true?
(Not Dead Yet — October, 2013)
Have you heard of the new Disabled Activists for Dignity in Dying? And the interesting claim that 75% of disabled people support assisted suicide/euthanasia? Is that true?
“N.J. assisted suicide proposal is a dangerous prescription”
(Trenton Times and NJ.com — August 10, 2013)
When we’re talking about changing public policy that affects the health-care system that we all depend on and the real world of families that are not necessarily all loving and supportive, lawmakers have an obligation to think of everyone, not just those who are safe from the very real risks posed by assisted suicide legislation.
(Trenton Times and NJ.com — August 10, 2013)
When we’re talking about changing public policy that affects the health-care system that we all depend on and the real world of families that are not necessarily all loving and supportive, lawmakers have an obligation to think of everyone, not just those who are safe from the very real risks posed by assisted suicide legislation.
“New York State Lags on Firing Workers Who Abuse Disabled
Patients”
(New York Times — August 8, 2013)
One state worker bit a patient’s ear. Another threatened a co-worker if she called the police. A third left a patient naked and bleeding. A fourth knocked a group home resident out of a chair, hit the resident on the back of the head.
All were found culpable of wrongdoing in internal disciplinary proceedings. But none was fired.
(New York Times — August 8, 2013)
One state worker bit a patient’s ear. Another threatened a co-worker if she called the police. A third left a patient naked and bleeding. A fourth knocked a group home resident out of a chair, hit the resident on the back of the head.
All were found culpable of wrongdoing in internal disciplinary proceedings. But none was fired.
Not Dead Yet comments on POLST
(NDY press release — July 23, 2013)
Not Dead Yet provides video and written comments on POLST to the Institute of Medicine’s Committee on Approaching Death.
“‘How do we know the POLST medical order actually reflects the desires of the individual?’ [We worry] that, depending on how POLSTs are presented, they can make life-sustaining treatments — such as the use of feeding tubes — seem unbearable, even though many disabled people are able to live full lives because of them.”
(NDY press release — July 23, 2013)
Not Dead Yet provides video and written comments on POLST to the Institute of Medicine’s Committee on Approaching Death.
“‘How do we know the POLST medical order actually reflects the desires of the individual?’ [We worry] that, depending on how POLSTs are presented, they can make life-sustaining treatments — such as the use of feeding tubes — seem unbearable, even though many disabled people are able to live full lives because of them.”
“The dangerous ‘help’ of assisted suicide”
(Star Ledger, NJ — July 23, 2013)
People with disabilities and chronic conditions live on the front lines of the health care system that serves (and, sadly, often underserves) dying people. One might view us as the :canaries in the coal mine,” alerting others to dangers we see first.
(Star Ledger, NJ — July 23, 2013)
People with disabilities and chronic conditions live on the front lines of the health care system that serves (and, sadly, often underserves) dying people. One might view us as the :canaries in the coal mine,” alerting others to dangers we see first.
“There Are Sensible Reasons Why Voters Rejected Question 2″
(Boston Globe — July 22, 2013)
Finances will inevitably affect decision-making. Thousands of Massachusetts elders are abused every year, so it’s naive to think that all families are loving and supportive….Dignity does not come at the bottom of a glass of 100 Seconal capsules.
(Boston Globe — July 22, 2013)
Finances will inevitably affect decision-making. Thousands of Massachusetts elders are abused every year, so it’s naive to think that all families are loving and supportive….Dignity does not come at the bottom of a glass of 100 Seconal capsules.
“Assisted suicide fraught with consequences”
(Sacramento Bee — July 14, 2013)
Society must take a critical look at any proposal to legalize assisted suicide. It’s a dangerous Pandora’s box and inevitably reduces patient choice by introducing a plethora of crushing pressures that push seriously ill people and, by extension, some with chronic illness and physical disabilities toward a final, cost-cutting conclusion.
(Sacramento Bee — July 14, 2013)
Society must take a critical look at any proposal to legalize assisted suicide. It’s a dangerous Pandora’s box and inevitably reduces patient choice by introducing a plethora of crushing pressures that push seriously ill people and, by extension, some with chronic illness and physical disabilities toward a final, cost-cutting conclusion.
“Not Dead Yet News & Commentary”
(Not Dead Yet — June 21, 2013)
Overview of disability rights spokesperson concerns about POLST
(Not Dead Yet — June 21, 2013)
Overview of disability rights spokesperson concerns about POLST
“Not Dead Yet Urges Secretary Sibelius and Organ Procurement
and Transplantation Network to Prohibit Organ Procurers from Pressuring Sick or
Injured to Give Up on Living”
(Not Dead Yet press release — June 20, 2013)
(Not Dead Yet press release — June 20, 2013)
“Valuing Everyone, Or Just the Workers?”
(Huffington Post — May 11, 2013)
Disabled children should be euthanised according to Cllr Colin Brewer. According to Baroness Warnock, disabled adults should be euthanasied. Cllr Brewer also spoke about the costs and burden of disabled people….Both Baroness Warnock and Cllr Brewer suggest that disabled people or their parents should consider euthanasia to relieve the cost and burden on families and on the state.
(Huffington Post — May 11, 2013)
Disabled children should be euthanised according to Cllr Colin Brewer. According to Baroness Warnock, disabled adults should be euthanasied. Cllr Brewer also spoke about the costs and burden of disabled people….Both Baroness Warnock and Cllr Brewer suggest that disabled people or their parents should consider euthanasia to relieve the cost and burden on families and on the state.
“Colin Brewer: There is a good argument for
killing some disabled babies”
(Disability News Service — May 10, 2013)
A councillor who won re-election despite having to apologise for suggesting disabled children should be “put down” to save money has told Disability News Service (DNS) he believes there is a good argument for killing some disabled babies.
(Disability News Service — May 10, 2013)
A councillor who won re-election despite having to apologise for suggesting disabled children should be “put down” to save money has told Disability News Service (DNS) he believes there is a good argument for killing some disabled babies.
“Bill allowing doctor-assisted suicide has troubling
aspects”
(Lewiston Sun Journal — April 28, 2013)
For someone dealing with a new diagnosis without proper supports,trying to navigate the bureaucracy while trying to obtain mobility devices or other items critical to daily living, one can see how vulnerable patients may see assisted suicide as an easier choice.
(Lewiston Sun Journal — April 28, 2013)
For someone dealing with a new diagnosis without proper supports,trying to navigate the bureaucracy while trying to obtain mobility devices or other items critical to daily living, one can see how vulnerable patients may see assisted suicide as an easier choice.
“NDY President Diane Coleman Submits Comments on Futile Care
Policies”
(April 22, 2013)
The common thread running through stories we hear is that our lives with disability are seen as less worth living, so much less that health care providers too often think that death is the correct course. They press this viewpoint on us, our families and sometimes even overrule us when we disagree.
(April 22, 2013)
The common thread running through stories we hear is that our lives with disability are seen as less worth living, so much less that health care providers too often think that death is the correct course. They press this viewpoint on us, our families and sometimes even overrule us when we disagree.
Testimony of John B. Kelly of Second Thoughts
before the Vermont House Human Services Committee (April 11, 2013)
“Disabled people may struggle to get specialty care”
(Reuters — March 16, 2013)
A 22-year-old student at Ohio State University in Columbus, she uses an electric wheelchair and finds waiting rooms and examination rooms are often hard to maneuver….Often times, she said she can’t get an appointment at all — because a facility’s entrance has steps, without a ramp or a life.
(Reuters — March 16, 2013)
A 22-year-old student at Ohio State University in Columbus, she uses an electric wheelchair and finds waiting rooms and examination rooms are often hard to maneuver….Often times, she said she can’t get an appointment at all — because a facility’s entrance has steps, without a ramp or a life.
“The Deadly Failure of a Hospital to Follow a Patient’s
Decisions About his Medical Care”
(Disability Rights California — February 2013)
Hospital neglected to provide medical interventions consistent with Mr. turner’s POLST when his physician revised his POLST form to say the opposite of the patient’s expressed wishes to receive life-sustaining treatment.
(Disability Rights California — February 2013)
Hospital neglected to provide medical interventions consistent with Mr. turner’s POLST when his physician revised his POLST form to say the opposite of the patient’s expressed wishes to receive life-sustaining treatment.
“Helen Keller, Anne Sullivan and Assisted Suicide”
(American Spectator — January 17, 2013)
What advice would the young Helen Keller receive if she were alive today?
Helen Keller became both blind and deaf after an illness when she was 19 months. She was taught to communicate at age 7, and she went on, during a long life of 88 years, to contribute to our lives. Apparently no one told the story of Helen Keller to the identical Belgian twin men, age 45, cobblers both, who sought and obtained assisted suicide in Belgium in December.
(American Spectator — January 17, 2013)
What advice would the young Helen Keller receive if she were alive today?
Helen Keller became both blind and deaf after an illness when she was 19 months. She was taught to communicate at age 7, and she went on, during a long life of 88 years, to contribute to our lives. Apparently no one told the story of Helen Keller to the identical Belgian twin men, age 45, cobblers both, who sought and obtained assisted suicide in Belgium in December.
“National Federation of the Blind Comments on Belgian
Euthanasia of Deaf Men Losing Sight”
(NFB — January 15, 2013)
“This disturbing news from Belgium is a stark example of the common, and in this case tragic, misunderstanding of disability and its consequences. Adjustment to any disability is difficult, and deaf-blind people face their own particular challenges but from at least the time of Helen Keller it has been known that these challenges can be met….”
(NFB — January 15, 2013)
“This disturbing news from Belgium is a stark example of the common, and in this case tragic, misunderstanding of disability and its consequences. Adjustment to any disability is difficult, and deaf-blind people face their own particular challenges but from at least the time of Helen Keller it has been known that these challenges can be met….”
“Poll: Twenty Nine Percent Support in Non-Terminal Cases of
Severe Pain, Disability”
(NPR & Truven Health Analytics — December 28, 2012)
Poll included question about whether a physician should be allowed to provide patients or their family members with the means to end the patient’s life if requested by the patient or family.
(NPR & Truven Health Analytics — December 28, 2012)
Poll included question about whether a physician should be allowed to provide patients or their family members with the means to end the patient’s life if requested by the patient or family.
“NDY Activists Leaflet Justice Action Center (NY Law
School)”
(Not Dead Yet — November 19, 2012)
Last Friday, three disability activists in New York City went to the Justice Action Center at the NY Law School to distribute flyers protesting the way in which a symposium on “Freedom of Choice at the End of Life” handled “issues of concern” that people with disabilities have with proponents of assisted suicide (and other “end of life” issues). The “discussion” was relegated to a session about “special people” and the discussion framed by opponents of disability rights advocates and activists.
(Not Dead Yet — November 19, 2012)
Last Friday, three disability activists in New York City went to the Justice Action Center at the NY Law School to distribute flyers protesting the way in which a symposium on “Freedom of Choice at the End of Life” handled “issues of concern” that people with disabilities have with proponents of assisted suicide (and other “end of life” issues). The “discussion” was relegated to a session about “special people” and the discussion framed by opponents of disability rights advocates and activists.
“Bioethicist Endorses Mass. Assisted Suicide Bill in a
Sloppy and Intellectually Lazy Essay”
(Not Dead Yet — November 2, 2012)
The organizations pushing legalization of assisted suicide are sophisticated and well-funded. And, like many advocacy organizations, they are following an incrementalist strategy in terms of their policy goals. Through polling, focus groups and experience, they’ve developed a vocabulary about these topics that draws a favorable response from the public. And, for the moment, the more “respectable” groups are sticking to policy that is allegedly limited to people who are “terminally ill.”
But the signs of more expansive “advocacy” are already in evidence.
(Not Dead Yet — November 2, 2012)
The organizations pushing legalization of assisted suicide are sophisticated and well-funded. And, like many advocacy organizations, they are following an incrementalist strategy in terms of their policy goals. Through polling, focus groups and experience, they’ve developed a vocabulary about these topics that draws a favorable response from the public. And, for the moment, the more “respectable” groups are sticking to policy that is allegedly limited to people who are “terminally ill.”
But the signs of more expansive “advocacy” are already in evidence.
“NY Law School — Justice Action Center’s Upcoming Annual
Justice Symposium Not Fair to Disability Advocates, Let Alone ‘Just’”
(Not Dead Yet — October 24, 2012)
It would be understandable if you thought that this was actually an event planned and presented by Compassion and Choices, with the Justice Action Center merely playing the host. It would be clear because the presence of Compassion and Choices activists dominates this symposium.
(Not Dead Yet — October 24, 2012)
It would be understandable if you thought that this was actually an event planned and presented by Compassion and Choices, with the Justice Action Center merely playing the host. It would be clear because the presence of Compassion and Choices activists dominates this symposium.
“Family of Down’s patient sue hospital over DNR order”
(The Guardian — September 12, 2012)
Relatives allege doctor at NHS hospital in Kent added “do not resuscitate” order to man’s notes on basis of his disability …After he was discharged, a carer unpacking his bag found a DNR form. “It was folded in four in his belongings. She was absolutely horrified, The issue had not been discussed with any relatives at the hospital. X said.
(The Guardian — September 12, 2012)
Relatives allege doctor at NHS hospital in Kent added “do not resuscitate” order to man’s notes on basis of his disability …After he was discharged, a carer unpacking his bag found a DNR form. “It was folded in four in his belongings. She was absolutely horrified, The issue had not been discussed with any relatives at the hospital. X said.
“Conundrum of a Death Foretold”
(New York Times — August 27, 2012)
For some, wheelchairs and prosthetic limbs may seem the very emblem of triumph over life’s vicissitudes. But, for many, those same device are prisons without hope of reprieve, symbols of ailments that preclude the striving for athletic redemtion.
(New York Times — August 27, 2012)
For some, wheelchairs and prosthetic limbs may seem the very emblem of triumph over life’s vicissitudes. But, for many, those same device are prisons without hope of reprieve, symbols of ailments that preclude the striving for athletic redemtion.
“Assisted Suicide Laws Violate the ADA”
(Not Dead Yet — July 25, 2012)
Not Dead Yet has always taken the position that assisted suicide laws violate the ADA by setting up a double standard for how society responds to a person who says they want to commit suicide – some people get suicide prevention and others get suicide assistance, and the difference is the person’s health and disability status.
(Not Dead Yet — July 25, 2012)
Not Dead Yet has always taken the position that assisted suicide laws violate the ADA by setting up a double standard for how society responds to a person who says they want to commit suicide – some people get suicide prevention and others get suicide assistance, and the difference is the person’s health and disability status.
“It’s expensive to support the disabled – suicide kits are $39.95″
(Winnepeg Free Press — July 21, 2012)
Arthur Schafer’s portrayal of comments on the merits of physician-assisted suicide need challenging. Schafer, like many supports of physician-assisted suicide (also known as “doctor-prescribed death”), does not seem to have considered the wider issues facing Canadians with disabilities, including the ongoing social prejudice and discouraging lack of living supports that we encounter on a daily basis.
(Winnepeg Free Press — July 21, 2012)
Arthur Schafer’s portrayal of comments on the merits of physician-assisted suicide need challenging. Schafer, like many supports of physician-assisted suicide (also known as “doctor-prescribed death”), does not seem to have considered the wider issues facing Canadians with disabilities, including the ongoing social prejudice and discouraging lack of living supports that we encounter on a daily basis.
“Disability Discrimination: The Author Responds”
(Hastings Center Bioethics Forum — July 27, 2012)
Worse yet, few scholars have discussed the implications of New York State’s Palliative Care Information Act for people with disability. The law, which went into effect in 2011, requires “physicians and nurse practitioners to offer terminally-ill patients information and counseling concerning palliative care and end of life options.” The hospitalist I met did this — my prognosis was made clear, the range of options discussed…. The problem is, at no point was I terminally ill.
(Hastings Center Bioethics Forum — July 27, 2012)
Worse yet, few scholars have discussed the implications of New York State’s Palliative Care Information Act for people with disability. The law, which went into effect in 2011, requires “physicians and nurse practitioners to offer terminally-ill patients information and counseling concerning palliative care and end of life options.” The hospitalist I met did this — my prognosis was made clear, the range of options discussed…. The problem is, at no point was I terminally ill.
“Comfort Care as Denial of Personhood”
(Hastings Center Report — July-August 2012)
“Many assume that disability is a fate worse than death. So we admire people with disability who want to die, and we shake our collective heads in confusion when they want to live.”
(Hastings Center Report — July-August 2012)
“Many assume that disability is a fate worse than death. So we admire people with disability who want to die, and we shake our collective heads in confusion when they want to live.”
“Disability Discrimination”
(Hastings Center bioethics forum — July 11, 2012)
While he had no illusions about the gravity of his condition William J. Peace was unprepared for what a hospital physician said to him. Peace wrote, “Although not explicitly stated, the message was loud and clear. “I can help you to die peacefully.”
(Hastings Center bioethics forum — July 11, 2012)
While he had no illusions about the gravity of his condition William J. Peace was unprepared for what a hospital physician said to him. Peace wrote, “Although not explicitly stated, the message was loud and clear. “I can help you to die peacefully.”
“Assisted Suicide and Disability: Another Perspective”
(Diane Coleman — American Bar Association; Section of Individual Rights and Responsibilities)
“I don’t want to live like this one more day,” she said firmly. “I’ve had enough.” She had been forced, at 26 to leave her masters program. Her car had been repossessed. Following a miscarriage, her marriage had broken up. Her brother had drowned. And now her mother had been diagnosed with cancer.
(Diane Coleman — American Bar Association; Section of Individual Rights and Responsibilities)
“I don’t want to live like this one more day,” she said firmly. “I’ve had enough.” She had been forced, at 26 to leave her masters program. Her car had been repossessed. Following a miscarriage, her marriage had broken up. Her brother had drowned. And now her mother had been diagnosed with cancer.
“Assisted suicide laws create discriminatory double standard
for who gets suicide and who gets suicide assistance: Not Dead Yet Responds to
Autonomy, Inc.”
Diane Coleman — Disability and Health Journal — 2010)
Diane Coleman — Disability and Health Journal — 2010)
“Key Objections to the Legalization of Assisted Suicide”
(DREDF — Disability Rights Education and Defense Fund)
Ten key objections with links to documentation.
(DREDF — Disability Rights Education and Defense Fund)
Ten key objections with links to documentation.
“Killing us softly: the dangers of legalizing assisted
suicide”
(Marilyn Golden & Tyler Zoanni — Disability and Health Journal – 2010)
Overview of the problems with the legalization of assisted suicide as public policy.
(Marilyn Golden & Tyler Zoanni — Disability and Health Journal – 2010)
Overview of the problems with the legalization of assisted suicide as public policy.
“No. we don’t think our doctors are out to get us:
Responding to the straw man distortions of disability rights arguments against
assisted suicide”
(Carol Gill — Disability and Health Journal – 2010)
The arguments that disability rights advocates present in opposition to legalized assisted suicide are frequently misconstrued in public debate.
(Carol Gill — Disability and Health Journal – 2010)
The arguments that disability rights advocates present in opposition to legalized assisted suicide are frequently misconstrued in public debate.
“Public Health, populations, and lethal ingestion”
(Kirk Allison — Disability and Health Journal — 2010)
In 2008 the American Public Health Association endorsed lethal ingestion as a public health policy as part of “Patients’ Rights to Self-Determination at the end of Life.”
(Kirk Allison — Disability and Health Journal — 2010)
In 2008 the American Public Health Association endorsed lethal ingestion as a public health policy as part of “Patients’ Rights to Self-Determination at the end of Life.”
----------------
Euthanasia &
Assisted Suicide in Canada
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down for articles
Canadian
Supreme Court strikes down law prohibiting assisted suicide
(February 6, 2015)
The Court agreed with a lower court ruling, concluding that the law “deprives a competent adult of such assistance where (1) the person affected clearly consents to the termination of life; and (2) the person has a grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition.”
The decision does not indicate that doctor-prescribed suicide and doctor-administered death would be limited to those who are diagnosed with a terminal illness.
The Court has suspended implementation of its decision for one year.
Text of Court ruling
……………………
(February 6, 2015)
The Court agreed with a lower court ruling, concluding that the law “deprives a competent adult of such assistance where (1) the person affected clearly consents to the termination of life; and (2) the person has a grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition.”
The decision does not indicate that doctor-prescribed suicide and doctor-administered death would be limited to those who are diagnosed with a terminal illness.
The Court has suspended implementation of its decision for one year.
Text of Court ruling
……………………
“Euthanasia Comes to Canada”
(Weekly Standard — February 23, 2015 edition)
This month, the Canadian Supreme Court trampled democratic deliberation by unanimously conjuring a constitutional right to “termination of life” for anyone who has an “irremediable medical condition” and wants to die. Note the scope of the judicial fiat is not limited to the terminally ill: The ruling grants competent adults a right to die is they have an “illness, disease, or disability that causes enduring suffering that is intolerable to the individual “including psychological pain….Hence the court created a right in the Canadian Charter of Rights and Freedoms to Dutch-style active euthanasia.
(Weekly Standard — February 23, 2015 edition)
This month, the Canadian Supreme Court trampled democratic deliberation by unanimously conjuring a constitutional right to “termination of life” for anyone who has an “irremediable medical condition” and wants to die. Note the scope of the judicial fiat is not limited to the terminally ill: The ruling grants competent adults a right to die is they have an “illness, disease, or disability that causes enduring suffering that is intolerable to the individual “including psychological pain….Hence the court created a right in the Canadian Charter of Rights and Freedoms to Dutch-style active euthanasia.
“Landmark Supreme Court ruling favouring ‘death with
dignity’ could become election issue”
(Vancouver Sun — February 6, 2015)
According to the Court, the previous laws [against doctor-prescribed and doctor-administered death] are “of no force or effect to they extent that they prohibit physician-assisted death for a competent adult person.”
A doctor-assisted death should be available to anyone who “clearly consents to the termination of life and has a grievous and irremediable medical condition (including an illness, disease of disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her conditions.” That suffering can be either “physical or psychological,” stated the ruling.
(Vancouver Sun — February 6, 2015)
According to the Court, the previous laws [against doctor-prescribed and doctor-administered death] are “of no force or effect to they extent that they prohibit physician-assisted death for a competent adult person.”
A doctor-assisted death should be available to anyone who “clearly consents to the termination of life and has a grievous and irremediable medical condition (including an illness, disease of disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her conditions.” That suffering can be either “physical or psychological,” stated the ruling.
“Canada to allow doctor-assisted suicide”
(BBC — February 6, 2015)
Canada’s Supreme Court has ruled that doctors may help patients who have severe and incurable medical conditions to die, overturning a 1993 ban.
(BBC — February 6, 2015)
Canada’s Supreme Court has ruled that doctors may help patients who have severe and incurable medical conditions to die, overturning a 1993 ban.
“Quebec’s end-of-life-care law may violate Criminal Code:
Ottawa”
(CBC — June 6, 2014)
Federal government may challenge Quebec’s law allowing physician assisted suicide in court….Justice Minister Peter MacKay’s office said the government believes Quebec has overstepped its bounds with the legislation and believes it violates the Criminal Code — which is Ottawa’s jurisdiction.
(CBC — June 6, 2014)
Federal government may challenge Quebec’s law allowing physician assisted suicide in court….Justice Minister Peter MacKay’s office said the government believes Quebec has overstepped its bounds with the legislation and believes it violates the Criminal Code — which is Ottawa’s jurisdiction.
On June
5, 2014, by a vote of 94 – 22, the Quebec National Assembly passed Bill 52, permitting doctors to administer a
lethal injection to end a patient’s life. (June 5, 2014)
From Sec. 30: “If a physician determines, subsequent to the application of section 29, that medical aid in dying may be administered to a patient requesting it, the physician must administer such aid personally and take care of and stay with the patient until death comes.”
From Sec. 30: “If a physician determines, subsequent to the application of section 29, that medical aid in dying may be administered to a patient requesting it, the physician must administer such aid personally and take care of and stay with the patient until death comes.”
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down for news articles
COURT
CASES……….
February
3, 2014
In Bentley v Maplewood, the B.C. Supreme Court has ruled that Margot Bentley’s spoon feeding is to be continued. Her family had sought to prevent her from eating an drinking.
In Bentley v Maplewood, the B.C. Supreme Court has ruled that Margot Bentley’s spoon feeding is to be continued. Her family had sought to prevent her from eating an drinking.
January
14, 2014
“Canada Supreme Court to revisit decision banning assisted suicide”
(Reuters — January 16, 2014)
The Supreme Court of Canada agreed on Thursday to take another look at a decision it made in 1993 upholding a ban on assisted suicide, setting up a new battle over the right to die.
“Canada Supreme Court to revisit decision banning assisted suicide”
(Reuters — January 16, 2014)
The Supreme Court of Canada agreed on Thursday to take another look at a decision it made in 1993 upholding a ban on assisted suicide, setting up a new battle over the right to die.
November
21, 2013
“No ‘Spoon Feeding!’ Case to BC Supremes”
(National Review Online — November 21, 2013)
At stake is whether a nursing home can be forced to starve a patient to death by withholding spoon feeding. The patient is voluntarily swallowing. No one is forcing food or water down her throat. Spoon Feeding!’ Case to BC Supremes”
“No ‘Spoon Feeding!’ Case to BC Supremes”
(National Review Online — November 21, 2013)
At stake is whether a nursing home can be forced to starve a patient to death by withholding spoon feeding. The patient is voluntarily swallowing. No one is forcing food or water down her throat. Spoon Feeding!’ Case to BC Supremes”
October
18, 2013:
The Supreme Court of Canada dismissed an appeal that would have permitted doctors to end life support for a severely brain-damaged man without the consent of his family or a substitute decision maker.
Judgment in Cuthberton v. Rasouli
The Supreme Court of Canada dismissed an appeal that would have permitted doctors to end life support for a severely brain-damaged man without the consent of his family or a substitute decision maker.
Judgment in Cuthberton v. Rasouli
October
10, 2013:
British Columbia’s Court of Appeal reversed a lower court ruling that said Canada’s assisted-suicide ban violated the charter rights of gravely ill Canadians.
Full text of decision in Carter v. Canada (2013 BCCA 435)
British Columbia’s Court of Appeal reversed a lower court ruling that said Canada’s assisted-suicide ban violated the charter rights of gravely ill Canadians.
Full text of decision in Carter v. Canada (2013 BCCA 435)
June
15, 2012:
British Columbia Supreme Court Judge Lynn Smith ruled against the law forbidding physician-assisted in Canada. In her decision, she upheld a challenge by three plaintiffs stating that the law’s provisions “unjustifiably infringe the equality rights” of one plaintiff and the “the rights to life, liberty and security” of the other two plaintiffs.
An appeal of the decision is expected.
Full text of decision in Carter v. Canada (2012 BCSC 886)
British Columbia Supreme Court Judge Lynn Smith ruled against the law forbidding physician-assisted in Canada. In her decision, she upheld a challenge by three plaintiffs stating that the law’s provisions “unjustifiably infringe the equality rights” of one plaintiff and the “the rights to life, liberty and security” of the other two plaintiffs.
An appeal of the decision is expected.
Full text of decision in Carter v. Canada (2012 BCSC 886)
July
13, 2012:
Justice Minister Rob Nicholson issued a statement, announcing that the federal government will appeal the ruling. According to Nicholson, “The laws surrounding euthanasia and assisted suicide exist to protect all Canadians, including those who are most vulnerable, such as people who are sick or elderly or people with disabilities. The Supreme Court of Canada acknowledged the state interest in protecting human life and upheld the constitutionality of the existing legislation in Rodriguez (1993).”
Justice Minister Rob Nicholson issued a statement, announcing that the federal government will appeal the ruling. According to Nicholson, “The laws surrounding euthanasia and assisted suicide exist to protect all Canadians, including those who are most vulnerable, such as people who are sick or elderly or people with disabilities. The Supreme Court of Canada acknowledged the state interest in protecting human life and upheld the constitutionality of the existing legislation in Rodriguez (1993).”
ARTICLES…………
“Andrew Coyne: With assisted suicide, what begins in
compassion seems to end in eugenics”
(National Post — December 8, 2014)
Much of the discussion of physician-assisted-death in Canada has centered around adult patients capable of making known how they want to end their lives. But Udo Schuklenk, a Queen’s University philosophy professor, argues that in rare cases of severely impaired, deeply suffering newborns, actively causing death is morally acceptable, if still illegal in this country.
(National Post — December 8, 2014)
Much of the discussion of physician-assisted-death in Canada has centered around adult patients capable of making known how they want to end their lives. But Udo Schuklenk, a Queen’s University philosophy professor, argues that in rare cases of severely impaired, deeply suffering newborns, actively causing death is morally acceptable, if still illegal in this country.
“End-of-life debate turns to newborns: ‘Postnatal abortion’
morally acceptable in some cases, ethicist says”
(National Post — December 7, 2014)
Doctors would be justified to end the lives of some terminally impaired newborn babies, says a prominent Canadian bioethicist in a report that pushes the country’s euthanasia debate into new territory….Udo Schuklenk, a queen’s University philosophy professor, argues that in rare cases of severely impaired, deeply suffering newborns, actively causing death is morally acceptable, if still illegal in this country.
(National Post — December 7, 2014)
Doctors would be justified to end the lives of some terminally impaired newborn babies, says a prominent Canadian bioethicist in a report that pushes the country’s euthanasia debate into new territory….Udo Schuklenk, a queen’s University philosophy professor, argues that in rare cases of severely impaired, deeply suffering newborns, actively causing death is morally acceptable, if still illegal in this country.
“Euthanasia would bring injustice to old and disabled”
(Calgary Herald — October 14, 2014)
In the 40 years since palliative care was introduced into Canada, the ability to control pain and other symptoms is improving constantly, although problems of equitable access persist. This is a grave injustice and, many believe, a breach of human rights, but the remedy is not to legalize euthanasia and assisted suicide. It’s to provide the support dying people need.
(Calgary Herald — October 14, 2014)
In the 40 years since palliative care was introduced into Canada, the ability to control pain and other symptoms is improving constantly, although problems of equitable access persist. This is a grave injustice and, many believe, a breach of human rights, but the remedy is not to legalize euthanasia and assisted suicide. It’s to provide the support dying people need.
“N.S. man pleads for euthanasia laws to end sister’s
suffering”
(Atlantic CTV News — June 25, 2014)
A Bedford, N.S. man would like the province to adopt euthanasia laws so he can end the life of his sister who is living with Alzheimer’s.
(Atlantic CTV News — June 25, 2014)
A Bedford, N.S. man would like the province to adopt euthanasia laws so he can end the life of his sister who is living with Alzheimer’s.
“Quebec’s end-of-life-care law may violate Criminal Code:
Ottawa”
(CBC — June 6, 2014)
Federal government may challenge Quebec’s law allowing physician assisted suicide in court….Justice Minister Peter MacKay’s office said the government believes Quebec has overstepped its bounds with the legislation and believes it violates the Criminal Code — which is Ottawa’s jurisdiction.
(CBC — June 6, 2014)
Federal government may challenge Quebec’s law allowing physician assisted suicide in court….Justice Minister Peter MacKay’s office said the government believes Quebec has overstepped its bounds with the legislation and believes it violates the Criminal Code — which is Ottawa’s jurisdiction.
“Saba takes Bill 52 to court”
(The Suburban News — Quebec — June 4, 2014)
While the provincial government is poised to make Bill 52 “Dying with Dignity” a law, Dr. Paul Saba and 48-year old Lisa D’Amico who has been handicapped all her life, are filing a motion of Declaratory Judgment at Montreal’s Superior Court decrying the bill as illegal and illicit.
(The Suburban News — Quebec — June 4, 2014)
While the provincial government is poised to make Bill 52 “Dying with Dignity” a law, Dr. Paul Saba and 48-year old Lisa D’Amico who has been handicapped all her life, are filing a motion of Declaratory Judgment at Montreal’s Superior Court decrying the bill as illegal and illicit.
“Quebec’s legislature unites behind a euthanasia bill that
divides many with debilitating illnesses”
(National Post — May 30, 2014)
Quebec claims jurisdiction over euthanasia on the grounds that it is a medical act, and health is a provincial jurisdiction. However, the federal Criminal Code states, “no person is entitled to consent to have death inflicted on him.”
(National Post — May 30, 2014)
Quebec claims jurisdiction over euthanasia on the grounds that it is a medical act, and health is a provincial jurisdiction. However, the federal Criminal Code states, “no person is entitled to consent to have death inflicted on him.”
“Opponents rally against end-of-life bill”
(CBC Canada — May 24, 2014)
The law would allow some forms of medically assisted death in cases including “incurable serious illness,” advanced states of “irreversible decline in capability,” and “constant and unbearable physical or psychological pain which cannot be relieved in a manner the person deems tolerable.”
A spokesman for the federal justice minister told CBC News that it will be up to the courts to decide if Quebec is acting within the Constitution.
(CBC Canada — May 24, 2014)
The law would allow some forms of medically assisted death in cases including “incurable serious illness,” advanced states of “irreversible decline in capability,” and “constant and unbearable physical or psychological pain which cannot be relieved in a manner the person deems tolerable.”
A spokesman for the federal justice minister told CBC News that it will be up to the courts to decide if Quebec is acting within the Constitution.
“Bill 52 revived by Liberal Government”
(Montreal Gazette — May 22, 2014)
Bill 52 gets around the Criminal Code by treating medical aid to die as a medical issue, within provincial jurisdiction.
(Montreal Gazette — May 22, 2014)
Bill 52 gets around the Criminal Code by treating medical aid to die as a medical issue, within provincial jurisdiction.
“John Alan Lee pushes limits of Canada’s assisted suicide
debate”
(CBC News — May 5. 2014)
A Toronto man’s decision to end his life, simply because he felt it was time to die, has raised questions and concerns among family, friends and experts, some of whom say it could take the assisted suicide debate down a “slippery slope.”
He said he couldn’t enjoy some of his favourite activities anymore; his garden had become overgrown and tangled. His canoe was sitting around unused.
(CBC News — May 5. 2014)
A Toronto man’s decision to end his life, simply because he felt it was time to die, has raised questions and concerns among family, friends and experts, some of whom say it could take the assisted suicide debate down a “slippery slope.”
He said he couldn’t enjoy some of his favourite activities anymore; his garden had become overgrown and tangled. His canoe was sitting around unused.
“Assisted suicide: the issue we can’t afford to get wrong”
(MercatorNet — April 29, 2014)
Globe and Mail columnist Jeffrey Simpson recently wrote a pro-euthanasia column entitled “Assisted suicide – the issue we can’t ignore.” If he’s correct, it’s also the issue where we can’t afford to get our facts wrong. So, looking at his column, where might some people be doing so?
(MercatorNet — April 29, 2014)
Globe and Mail columnist Jeffrey Simpson recently wrote a pro-euthanasia column entitled “Assisted suicide – the issue we can’t ignore.” If he’s correct, it’s also the issue where we can’t afford to get our facts wrong. So, looking at his column, where might some people be doing so?
“Family appeals court ruling that refused to let Margot
Bentley die”
(Vancouver Sun — April 22, 2014)
The family of Margot Bentley, a former nurse with Alzheimer’s, is appealing the B.C. Supreme Court ruling that allowed her Abbotsford nursing home to continue spoon-feeding her.
(Vancouver Sun — April 22, 2014)
The family of Margot Bentley, a former nurse with Alzheimer’s, is appealing the B.C. Supreme Court ruling that allowed her Abbotsford nursing home to continue spoon-feeding her.
“Quebec’s
end-of-life bill faces more hurdles”
(Global News — February 23, 2014)
The Philippe Couillard-led Quebec Liberals last week effectively stopped Bill 52 from passing when they decided against staying late to vote on the bill before members of the National Assembly headed out on a two-week break, arguing there was not enough time to afford the bill the amount of debate it warrants.
(Global News — February 23, 2014)
The Philippe Couillard-led Quebec Liberals last week effectively stopped Bill 52 from passing when they decided against staying late to vote on the bill before members of the National Assembly headed out on a two-week break, arguing there was not enough time to afford the bill the amount of debate it warrants.
“Federal Liberals call for de-criminalization of
physician-assisted death”
(Montreal Gazette — February 23, 2014)
Federal Liberals have passed a controversial resolution calling for the de-criminalization of medically-assisted suicide during their policy convention here Sunday.
Text of resolution
(Montreal Gazette — February 23, 2014)
Federal Liberals have passed a controversial resolution calling for the de-criminalization of medically-assisted suicide during their policy convention here Sunday.
Text of resolution
“Quebec Liberals block passage of end-of-life bill”
(CBC News — February 20, 2014)
The Phillippe Couillard-led Quebec Liberals have blocked the passage of Quebec’s end-of-life legislation, Bill 52, said parliamentary house leader Stephane Bedard…If an election is called, the passage of the end-of-life bill would be paralyzed until an eventual revival by the next government.
(CBC News — February 20, 2014)
The Phillippe Couillard-led Quebec Liberals have blocked the passage of Quebec’s end-of-life legislation, Bill 52, said parliamentary house leader Stephane Bedard…If an election is called, the passage of the end-of-life bill would be paralyzed until an eventual revival by the next government.
“Assisted suicide — what could possibly go wrong?”
(Globe and Mail — Canada — February 20, 2014)
A service launched by a right-to-die group [in the Netherlands] has 30 mobile teams that make house calls to people who want to die but whose family doctors may be unwilling to participate. One of the people its staff put to death was a 63-year-old man who had no friends ot family and couldn’t face the prospect of retirement. Another was a 54-year-old woman with a pathological fear of germs.
(Globe and Mail — Canada — February 20, 2014)
A service launched by a right-to-die group [in the Netherlands] has 30 mobile teams that make house calls to people who want to die but whose family doctors may be unwilling to participate. One of the people its staff put to death was a 63-year-old man who had no friends ot family and couldn’t face the prospect of retirement. Another was a 54-year-old woman with a pathological fear of germs.
“As Quebec set to legalize euthanasia, doctors already
looking to expand who qualifies for lethal injections”
(National Post — Canada — February 13, 2014)
Quebec’s National Assembly is set to begin final adoption next week of a law that will legalize euthanasia in the province.
According to Yyes Robert, secretary of the province’s College of Physicians, “This bill, as it is right now, it’s probably a landmark but surely not the end of the reflection. It’s only a step.”
[Note: The Quebec proposal, Bill 52, is modeled on Belgium's euthanasia law.]
(National Post — Canada — February 13, 2014)
Quebec’s National Assembly is set to begin final adoption next week of a law that will legalize euthanasia in the province.
According to Yyes Robert, secretary of the province’s College of Physicians, “This bill, as it is right now, it’s probably a landmark but surely not the end of the reflection. It’s only a step.”
[Note: The Quebec proposal, Bill 52, is modeled on Belgium's euthanasia law.]
“Court rules 82-year-old Abbotsford Alzheimer’s patient must
be fed in spite of ‘living will’”
(Vancouver Sun — February 3, 2014)
The B.C. Supreme Court ruled Monday that the care and feeding of Margot Bentley must continue. Central to the ruling was determining that Bentley was capable of making the decision to accept food or drink.
In his ruling, Justice Greyell wrote, “I find it significant that Mrs. Bentley indicates preferences for certain flavours and eats different amounts at different times.”
Her family had insisted that she was not capable and that when the care home staff pressed spoonfuls of food against her lips, she was only acting reflexively when she opened her mouth.
Text of ruling in Bentley v Maplewood
(Vancouver Sun — February 3, 2014)
The B.C. Supreme Court ruled Monday that the care and feeding of Margot Bentley must continue. Central to the ruling was determining that Bentley was capable of making the decision to accept food or drink.
In his ruling, Justice Greyell wrote, “I find it significant that Mrs. Bentley indicates preferences for certain flavours and eats different amounts at different times.”
Her family had insisted that she was not capable and that when the care home staff pressed spoonfuls of food against her lips, she was only acting reflexively when she opened her mouth.
Text of ruling in Bentley v Maplewood
“Martinuk: Suicide prevention plans at odds with right to
die”
(Calgary Herald — January 3, 2014)
Prevention is usually a good policy. But I have questions about whether any suicide prevention policy can be successful with Canada’s health-care system and be consistent with other societal messages.
(Calgary Herald — January 3, 2014)
Prevention is usually a good policy. But I have questions about whether any suicide prevention policy can be successful with Canada’s health-care system and be consistent with other societal messages.
“Belgian rapist’s plea for euthanasia stirs debates on
mental health and right to die”
(Globe and Mail — January 1, 2014)
[I]t is also of interest for Canada, where the corrections system struggles similarly with how to best deal with mentally ill inmates. What’s more, Quebec’s legislature is currently debating a right-to-die bill modeled after the Belgian and Dutch voluntary euthanasia laws.
(Globe and Mail — January 1, 2014)
[I]t is also of interest for Canada, where the corrections system struggles similarly with how to best deal with mentally ill inmates. What’s more, Quebec’s legislature is currently debating a right-to-die bill modeled after the Belgian and Dutch voluntary euthanasia laws.
“No ‘Spoon Feeding!’ Case to BC Supremes”
(National Review Online — November 21, 2013)
At stake is whether a nursing home can be forced to starve a patient to death by withholding spoon feeding. The patient is voluntarily swallowing. No one is forcing food or water down her throat.
(National Review Online — November 21, 2013)
At stake is whether a nursing home can be forced to starve a patient to death by withholding spoon feeding. The patient is voluntarily swallowing. No one is forcing food or water down her throat.
“‘Family should decide on life support,’ Canadian Supreme
Court rules in Hassan Rasouli case”
(Courier-Mail — October 19, 2013)
Families and not doctors should decide when life support is turned off, says Canada’s Supreme Court.
(Courier-Mail — October 19, 2013)
Families and not doctors should decide when life support is turned off, says Canada’s Supreme Court.
“Euthanasia puts the elderly at risk”
(Mercatornet — October 28, 2013)
When it comes to euthanasia, the slippery slope aspect of it keeps being swept under the carpet. For me, it is the single most compelling reason not to go forward and here’s why: I have seen the slippery slope played out in the care my mother receives at her nursing home.
(Mercatornet — October 28, 2013)
When it comes to euthanasia, the slippery slope aspect of it keeps being swept under the carpet. For me, it is the single most compelling reason not to go forward and here’s why: I have seen the slippery slope played out in the care my mother receives at her nursing home.
“B.C. Court of Appeal upholds ban on assisted suicide”
(CTV News — October 10, 2013)
The British Columbia Court of Appeal has upheld Canada’s ban on physician-assisted suicide in a split 2-1 decision.
Federal Health Minister Rona Ambrose reiterated Ottawa’s stance on euthanasia last week, saying: “We do not support assisted suicide — that is our government’s clear position.”
(CTV News — October 10, 2013)
The British Columbia Court of Appeal has upheld Canada’s ban on physician-assisted suicide in a split 2-1 decision.
Federal Health Minister Rona Ambrose reiterated Ottawa’s stance on euthanasia last week, saying: “We do not support assisted suicide — that is our government’s clear position.”
“B.C.’s Appeal Court says Canada’s ban on assisted-suicide
is constitutional”
(Calgary Herald — October 10, 2013)
British Columbia’s Court of Appeal has reversed a lower court ruling that said Canada’s assisted-suicide ban violated the charter rights of gravely ill Canadians. Two of the three judges in the split decision ruled that while the law banning assisted suicide has certainly evolved in the last two decades, it hasn’t changed enough to undermine the 1993 decision from the Supreme Court of Canada.
(Calgary Herald — October 10, 2013)
British Columbia’s Court of Appeal has reversed a lower court ruling that said Canada’s assisted-suicide ban violated the charter rights of gravely ill Canadians. Two of the three judges in the split decision ruled that while the law banning assisted suicide has certainly evolved in the last two decades, it hasn’t changed enough to undermine the 1993 decision from the Supreme Court of Canada.
“Help to die? Careful what you ask for”
(Globe and Mail — October 9, 2013)
Only one-third of Quebeckers understand (correctly) that “medical help to die” means active euthanasia: a lethal injection performed by a physician on a patient who requested death. Another third of respondents confuse this procedure with palliative care. And 40 percent confuse it with withdrawing the aggressive life-support techniques that can artificially prolong life.
(Globe and Mail — October 9, 2013)
Only one-third of Quebeckers understand (correctly) that “medical help to die” means active euthanasia: a lethal injection performed by a physician on a patient who requested death. Another third of respondents confuse this procedure with palliative care. And 40 percent confuse it with withdrawing the aggressive life-support techniques that can artificially prolong life.
“Family seeks right to die for dad”
(Windsor Star — August 13, 2013)
William Turner, 69, has advanced Alzheimer’s, heart disease, diabetes…His family wants the nursing home where he lives to stop administering his insulin.
(Windsor Star — August 13, 2013)
William Turner, 69, has advanced Alzheimer’s, heart disease, diabetes…His family wants the nursing home where he lives to stop administering his insulin.
“Nursing Home Won’t Starve Mother — Family Sues”
(National Review — August 8, 2013)
In Canada, a family wants a nursing home to stop spoon feeding their mother because she would not want to be kept alive with Alzheimer’s.
(National Review — August 8, 2013)
In Canada, a family wants a nursing home to stop spoon feeding their mother because she would not want to be kept alive with Alzheimer’s.
“Patient’s family sues B.C. as nursing home keeps her alive
against her wishes”
(Vancouver Sun — August 7, 2013)
The actions of Abbotsford nursing home staff who are spoon-feeding an 82-year-old Alzheimer’s patient — contrary to the wishes she expressed in her living will –constitute battery, a lawsuit by her daughter and husband alleges.
Margot Bentley’s daughter, Katherine Hammond, said she doesn’t visit her mom much anymore.
(Vancouver Sun — August 7, 2013)
The actions of Abbotsford nursing home staff who are spoon-feeding an 82-year-old Alzheimer’s patient — contrary to the wishes she expressed in her living will –constitute battery, a lawsuit by her daughter and husband alleges.
Margot Bentley’s daughter, Katherine Hammond, said she doesn’t visit her mom much anymore.
“Family of B.C. woman ravaged by Alzheimer’s fights to
fulfill her right to die with dignity”
(National Post — July 10, 2013)
In 1991, Margot Bentley drafted a detailed “living will.” She wrote that health care workers were to dispense “no nourishment or liquids” if it was clear she had no chance of recovery.”
According to her daughter, Bentley’s regular spoon-feeding should stop.
(National Post — July 10, 2013)
In 1991, Margot Bentley drafted a detailed “living will.” She wrote that health care workers were to dispense “no nourishment or liquids” if it was clear she had no chance of recovery.”
According to her daughter, Bentley’s regular spoon-feeding should stop.
“Quebec is trying to legalize euthanasia by calling it
something else”
(Globe and Mail — June 19, 2013)
So, you call your pet duck, which lives with you, a dog, because the law prohibits keeping a duck in your apartment, but allows dogs. A court will convict you for breaking the law.
Now, you are the Quebec provincial government and you table a bill in which you call euthanasia, which is prohibited as murder, “medical aid in dying” and claim it is medical treatment….
(Globe and Mail — June 19, 2013)
So, you call your pet duck, which lives with you, a dog, because the law prohibits keeping a duck in your apartment, but allows dogs. A court will convict you for breaking the law.
Now, you are the Quebec provincial government and you table a bill in which you call euthanasia, which is prohibited as murder, “medical aid in dying” and claim it is medical treatment….
“Quebec Euthanasia: Journalism Malpractice 3″
(National Review — June 13,2013)
Paraplegics could most certainly qualify: It could be deemed an “incurable illness” that has led to “irreversible decline in capability” and which causes “unbearable physical or psychological pain” that cannot be relieved “in a manner the person deems tolerable.”
(National Review — June 13,2013)
Paraplegics could most certainly qualify: It could be deemed an “incurable illness” that has led to “irreversible decline in capability” and which causes “unbearable physical or psychological pain” that cannot be relieved “in a manner the person deems tolerable.”
“Govt Funded Euthanasia Coming to Quebec?”
(National Review — June 12, 2013)
It would require that all “institutions,” e.g., hospitals, nursing homes, and residential care facilities “provide” terminal sedation or euthanasia which are included in the bill’s definition of the term, “end of life care.”
(National Review — June 12, 2013)
It would require that all “institutions,” e.g., hospitals, nursing homes, and residential care facilities “provide” terminal sedation or euthanasia which are included in the bill’s definition of the term, “end of life care.”
“Whose Life Is It Anyway?”
(National Review — June 3, 2013)
Futile Care Theory is as much about money as it is about benefiting the patient. It is also about honoring the subjective views of doctors and care givers — even at the expense of rejecting a patient’s specific request for efficacious treatment, that is, treatment that would or could achieve the desire medical result of extending the patient’s life.
(National Review — June 3, 2013)
Futile Care Theory is as much about money as it is about benefiting the patient. It is also about honoring the subjective views of doctors and care givers — even at the expense of rejecting a patient’s specific request for efficacious treatment, that is, treatment that would or could achieve the desire medical result of extending the patient’s life.
“Pro Suicide Advocacy in Globe and Mail“
(National review — March 2, 2013)
A woman committed suicide and it is depicted in the press as a positive — “on her own terms.” And note, she was not terminally ill, the usual excuse for supporting suicide….Suicide is being transformed into a human rights before our very eyes. But if it’s a “right” that means for any one and any reason:
Death on demand. Reader take warning!
(National review — March 2, 2013)
A woman committed suicide and it is depicted in the press as a positive — “on her own terms.” And note, she was not terminally ill, the usual excuse for supporting suicide….Suicide is being transformed into a human rights before our very eyes. But if it’s a “right” that means for any one and any reason:
Death on demand. Reader take warning!
“Some Quebec doctors resisting drive for euthanasia”
(BioEdge — February 22, 2013)
Some Quebec doctors are beginning to fight back against a drive for legalised euthanasia. Earlier this week, Physicians Alliance for the Total Refusal of Euthanasia (PATRE) organised a conference to influence an upcoming debate in the province’s parliament. Most of PATRE’s 317 member doctors hail from Quebec.
(BioEdge — February 22, 2013)
Some Quebec doctors are beginning to fight back against a drive for legalised euthanasia. Earlier this week, Physicians Alliance for the Total Refusal of Euthanasia (PATRE) organised a conference to influence an upcoming debate in the province’s parliament. Most of PATRE’s 317 member doctors hail from Quebec.
“Corbella: Untruths used to push for euthanasia law”
(Calgary Herald — February 15, 2013)
The case of Ruth Goodman is a perfect example of how confused, illogical uniformed and sometimes untruthful many proponents of euthanasia or physician-assisted suicide are. Goodman killed herself on Feb. 2 with no assistance, at the age of 91 in her Vancouver home, in a bid to change physician assisted suicide laws….[E]veryone already can make “this choice.” It’s not illegal to kill yourself.
(Calgary Herald — February 15, 2013)
The case of Ruth Goodman is a perfect example of how confused, illogical uniformed and sometimes untruthful many proponents of euthanasia or physician-assisted suicide are. Goodman killed herself on Feb. 2 with no assistance, at the age of 91 in her Vancouver home, in a bid to change physician assisted suicide laws….[E]veryone already can make “this choice.” It’s not illegal to kill yourself.
“Quebec’s Doctors to Become Killers?”
(National Review — February 7, 2013)
Quebec is about to make a major push to legalize euthanasia based on the recommendations of a commission. The commission’s recommendations include: “We propose that this option take the form of ‘medical aid in dying’. This assistance involves an act performed by a physician in a medical setting following a free and informed request made by the patient himself.”
(National Review — February 7, 2013)
Quebec is about to make a major push to legalize euthanasia based on the recommendations of a commission. The commission’s recommendations include: “We propose that this option take the form of ‘medical aid in dying’. This assistance involves an act performed by a physician in a medical setting following a free and informed request made by the patient himself.”
“A Life Interrupted: Hassan Rasouli’s journey from an earache to a high-stakes battle over end-of-life
decisions“
(Informer — Toronto, CA — November 27. 2012
….The Rasoulis were stunned. Hassan had been a health, vigorous man. He had walked into non-emergency surgery under his own volition and caught a bug from the hospital, and now the same hospital was saying they wanted to let him die?
(Informer — Toronto, CA — November 27. 2012
….The Rasoulis were stunned. Hassan had been a health, vigorous man. He had walked into non-emergency surgery under his own volition and caught a bug from the hospital, and now the same hospital was saying they wanted to let him die?
“Family to take end-of-life fight to Supreme Court of
Canada”
(CTV TV — November 19, 2012)
The family first began to see signs of improvement in January 2011, saying Rasouli was tracking their movements with his eyes, and even got to the point where he could give a thumbs-up. In their submission to the SCOC, doctors at Sunnybrook said protracted end-of-life care is a massive drain on the entire medical system, arguing that physicians should have the right to decide when life support is halted.
(CTV TV — November 19, 2012)
The family first began to see signs of improvement in January 2011, saying Rasouli was tracking their movements with his eyes, and even got to the point where he could give a thumbs-up. In their submission to the SCOC, doctors at Sunnybrook said protracted end-of-life care is a massive drain on the entire medical system, arguing that physicians should have the right to decide when life support is halted.
“Death’s midwife helps terminally ill Canadians end their
lives”
(The Star – Toronto — October 21, 2012)
Reaching beneath a desk in her home office, Ruth von Fuchs pulls out a white plastic box containing a collection of tubes, valves and microwave turkey roasting bags.
This is her death kit.
(The Star – Toronto — October 21, 2012)
Reaching beneath a desk in her home office, Ruth von Fuchs pulls out a white plastic box containing a collection of tubes, valves and microwave turkey roasting bags.
This is her death kit.
“Quebec to legalize doctor-assisted suicide”
(CJAD Radio — October 4, 2012)
Quebec’s new government plans to table legislation legalizing doctor-assisted suicide by this spring. According to social services junior minister Veronique Hivon, patients should only have access to the service if they are adult Quebec residents with a serious and incurable illness, and have given their express written consent.
(CJAD Radio — October 4, 2012)
Quebec’s new government plans to table legislation legalizing doctor-assisted suicide by this spring. According to social services junior minister Veronique Hivon, patients should only have access to the service if they are adult Quebec residents with a serious and incurable illness, and have given their express written consent.
Quebec has
no power over the criminal code, which forbids doctor-assisted suicide.
However, Hivon is arguing that Quebec will be able to pass this law without
Ottowa. “Quebec has jurisdiction over health and also over professional
qualifications,” she says. “So this gives us the confidence to introduce this
medical aid in dying in our bill.”
“Report: Canadian health care spending unsustainable”
(Daily Caller — July 24, 2012)
Single-payer health care, once lauded by President Barack Obama for its ability to keep health care expenditures down by rationing care, has become prohibitively expensive and inefficient in Canada, according to a new study.
(Daily Caller — July 24, 2012)
Single-payer health care, once lauded by President Barack Obama for its ability to keep health care expenditures down by rationing care, has become prohibitively expensive and inefficient in Canada, according to a new study.
“It’s expensive to support the disabled — suicide kits are
$39.95″
(Winnepeg Free Press — July 21, 2012)
Arthur Schafer’s portrayal of comments on the merits of physician-assisted suicide need challenging. Schafer, like many supporters of physician-assisted suicide (also known as “doctor-prescribed death”), does not seem to have considered the wider issues facing Canadians with disabilities, including the ongoing social prejudice and discouraging lack of living supports that we encounter on a daily basis.
(Winnepeg Free Press — July 21, 2012)
Arthur Schafer’s portrayal of comments on the merits of physician-assisted suicide need challenging. Schafer, like many supporters of physician-assisted suicide (also known as “doctor-prescribed death”), does not seem to have considered the wider issues facing Canadians with disabilities, including the ongoing social prejudice and discouraging lack of living supports that we encounter on a daily basis.
“Assisted-suicide ruling to be appealed by Ottawa”
(CBC News — July 13, 2012)
The federal government will appeal last month’s ruling by the British Columbia Supreme Court that partially struck down Canada’s ban on assisted suicide, Justice Minister Bob Nicholson says.
In a statement, Nicholson said, “The Supreme Court of Canada acknowledged the state interest in protecting human life and upheld the constitutionality of the existing legislation in Rodriguez (1993). In April 2010, a large majority of parliamentarians voted not to change these laws…
(CBC News — July 13, 2012)
The federal government will appeal last month’s ruling by the British Columbia Supreme Court that partially struck down Canada’s ban on assisted suicide, Justice Minister Bob Nicholson says.
In a statement, Nicholson said, “The Supreme Court of Canada acknowledged the state interest in protecting human life and upheld the constitutionality of the existing legislation in Rodriguez (1993). In April 2010, a large majority of parliamentarians voted not to change these laws…
“Down a dangerous path”
(The Progress — June 28, 2012)
One person’s right can become another person’s obligation. When patients have the right to choose euthanasia, this sends an implicit message that some lives aren’t worth living. Frail elderly, handicapped, and cancer patients can easily perceive that society doesn’t want them around, when they can instead choose to “die with dignity.” It is a short step from believing that they can choose dying to believing that they should choose dying.
(The Progress — June 28, 2012)
One person’s right can become another person’s obligation. When patients have the right to choose euthanasia, this sends an implicit message that some lives aren’t worth living. Frail elderly, handicapped, and cancer patients can easily perceive that society doesn’t want them around, when they can instead choose to “die with dignity.” It is a short step from believing that they can choose dying to believing that they should choose dying.
“Is Medically Assisted Death an Individual Right”
(Psych Central — June 27, 2012)
Advocates argue that medically assisted death is a patient’s right. It should therefore be considered as an end-of-life option rather than a criminal act.
“Many physicians and patients will find this a shocking prospect to consider,” write Drs. Ken Flegal and John Fletcher. “Frail, dependent patients often feel a burden to their families or caregivers, and the unspoken possibility of a quick resolution to their predicament may complicate an already stressful situation,” they write.
(Psych Central — June 27, 2012)
Advocates argue that medically assisted death is a patient’s right. It should therefore be considered as an end-of-life option rather than a criminal act.
“Many physicians and patients will find this a shocking prospect to consider,” write Drs. Ken Flegal and John Fletcher. “Frail, dependent patients often feel a burden to their families or caregivers, and the unspoken possibility of a quick resolution to their predicament may complicate an already stressful situation,” they write.
“Choosing when and how to die: Are we ready to perform
therapeutic homicide?”
(Canadian Medical Association Journal — June 25, 2012)
Removing the legal barrier to ending another’s life may ensure the self-dignity of those who wish to die, but may distress and remove the self-dignity of more people who wish to live.
(Canadian Medical Association Journal — June 25, 2012)
Removing the legal barrier to ending another’s life may ensure the self-dignity of those who wish to die, but may distress and remove the self-dignity of more people who wish to live.
“How do we want our great-great-grandchildren to die?”
(Mercator.net — June 17, 2012)
How do we want our great-great-grandchildren to die? This is probably the most important question of all. And if we legalize assisted suicide/euthanasia what kind of society will they live in and what will be its shared values?
(Mercator.net — June 17, 2012)
How do we want our great-great-grandchildren to die? This is probably the most important question of all. And if we legalize assisted suicide/euthanasia what kind of society will they live in and what will be its shared values?
“Not Dead Yet Responds to Quebec Commission Report on ‘Dying
with Dignity’”
(Not Dead Yet blog — March 26, 2012)
The highlight of the report is 24 recommendations that include “medically-assisted death” as an “option for care.” The report indicates that individuals with such conditions as ALS, Multiple Sclerosis and Muscular Dystrophy, where people can live many satisfying and productive years, even after “advanced deterioration of their capacities” would be eligible for euthanasia.
(Not Dead Yet blog — March 26, 2012)
The highlight of the report is 24 recommendations that include “medically-assisted death” as an “option for care.” The report indicates that individuals with such conditions as ALS, Multiple Sclerosis and Muscular Dystrophy, where people can live many satisfying and productive years, even after “advanced deterioration of their capacities” would be eligible for euthanasia.
“Haunting right-to-die case weighs on judges’ minds, 18 years
on”
(The Globe and Mail — December 16, 2011)
Jack Major can still see the silent ranks of disabled people, their wheelchairs ringing the Supreme Court of Canada as a courtroom full of lawyers debated the assisted suicide law in 1993….Eighteen years later, the polarizing question is heading back to the top court.
(The Globe and Mail — December 16, 2011)
Jack Major can still see the silent ranks of disabled people, their wheelchairs ringing the Supreme Court of Canada as a courtroom full of lawyers debated the assisted suicide law in 1993….Eighteen years later, the polarizing question is heading back to the top court.
“B.C. right-to-die group launches court challenge”
(CTV BC Canada– August 1, 2011)
Much has changed in the 18 years since Canada’s high court refused Sue Rodriguez the legal right to assisted suicide. For that reason, the Farewell Foundation For The Right to Die will be renewing the court battle around “self-chosen death.”
(CTV BC Canada– August 1, 2011)
Much has changed in the 18 years since Canada’s high court refused Sue Rodriguez the legal right to assisted suicide. For that reason, the Farewell Foundation For The Right to Die will be renewing the court battle around “self-chosen death.”
Canadian government sued over assisted-suicide law
(Courthouse News, Vancouver, BC — April 29, 2011)
For the second time in a month people have sued the Canadian government, seeking to overturn the criminal prohibition on doctor-assisted suicide. A married couple say they fear prosecution for helping the wife’s mother end her life in Switzerland and a doctor says he would be willing to provide the service.
(Courthouse News, Vancouver, BC — April 29, 2011)
For the second time in a month people have sued the Canadian government, seeking to overturn the criminal prohibition on doctor-assisted suicide. A married couple say they fear prosecution for helping the wife’s mother end her life in Switzerland and a doctor says he would be willing to provide the service.
“Assisted Death, Palliative Care and Human Rights”
( Medical News Today – - February 1, 2011 )
The issues of assisted suicide and palliative care in Canada should be discussed in the context of human rights according to a commentary in the Canadian Medical Association Journal…”The equalization of palliative care must occur before legalization of assisted suicide, otherwise there runs the very real risk that a decision to request assisted death is not fully consenting because of the lack of meaningful choices in the ability to alleviate pain and distress.”
( Medical News Today – - February 1, 2011 )
The issues of assisted suicide and palliative care in Canada should be discussed in the context of human rights according to a commentary in the Canadian Medical Association Journal…”The equalization of palliative care must occur before legalization of assisted suicide, otherwise there runs the very real risk that a decision to request assisted death is not fully consenting because of the lack of meaningful choices in the ability to alleviate pain and distress.”
Euthanasia & Assisted Suicide in Canada: Chronology 1983
through 2010
(National Library of Canada — October 15, 2011)
(National Library of Canada — October 15, 2011)
In
Canada, Francine LaLonde has often introduced assisted suicide bills. Her
2009-2010 bill, C-384, if passed, would have amended the Criminal
Code to permit a doctor to assist a patient’s suicide if the patient was EITHER
(A) in severe physical or mental pain, or (B) is terminally ill. The bill
failed.
“Euthanasia is about killing, not the ‘right to die with
dignity’”
( Examiner - Canada – December 1, 2009 )
Assisted-suicide bill debate is delayed until February 2010.
( Examiner - Canada – December 1, 2009 )
Assisted-suicide bill debate is delayed until February 2010.
“Killing without mercy,” (Calgary Herald,
5/8/08)
Canadian lawmaker plans to introduce her euthanasia and assisted-suicide bill again.
Canadian lawmaker plans to introduce her euthanasia and assisted-suicide bill again.
“What if we could choose our time to die?” (Montreal Gazette, 1/7/08)
“It seems that no regulation can control euthanasia once the legal ban has been lifted.
“It seems that no regulation can control euthanasia once the legal ban has been lifted.
2005
Bill to permit assisted suicide fails.
On June 15, 2005, Francine Lalonde, a lawmaker from La Pointe-de-l’Ile, introduced Bill C-407. The measure would have permitted a medical practitioner or someone assisted by a medical practitioner to aid another person to die if that person has a terminal illness or is experiencing severe physical or mental pain and “appears to be lucid” when he/she requests death. The measure failed to gain support.
Text of C-407
On June 15, 2005, Francine Lalonde, a lawmaker from La Pointe-de-l’Ile, introduced Bill C-407. The measure would have permitted a medical practitioner or someone assisted by a medical practitioner to aid another person to die if that person has a terminal illness or is experiencing severe physical or mental pain and “appears to be lucid” when he/she requests death. The measure failed to gain support.
Text of C-407
CANADIAN
SUPREME COURT ASSISTED SUICIDE DECISIONS
Rodriguez v. British Columbia (1993)
Regina v. Latimer(Appeal, 1997)
Regina v. Latimer (Appeal decision, 2001)
Rodriguez v. British Columbia (1993)
Regina v. Latimer(Appeal, 1997)
Regina v. Latimer (Appeal decision, 2001)
Justice
Minister declares he will not support C-407 (10/13/05)
The following message was sent from Paul Macklin, M.P to Liberal Assistants: РLiberal Members/D̩put̩s on October 13, 2005:
The following message was sent from Paul Macklin, M.P to Liberal Assistants: РLiberal Members/D̩put̩s on October 13, 2005:
Dear
Colleagues,
There has
been increased reporting by media lately on the subject matter of Euthanasia
and Assisted Suicide – due in part to Francine Lalonde’s Private member’s Bill,
C-407, and in part to some cases before the courts.
To provide
you with the latest information, please find attached our position paper on
Bill C-407. Please be advised that Bill C-407 is tentatively scheduled for its
first hour of debate on October 31st.
If you
require further information, please do not hesitate to contact the Minister’s
office at 992-4621.
Sincerely,
Hon. Paul
Macklin, P.C., M.P.
Parliamentary Secretary to the Minister of Justice and Attorney General of Canada
Parliamentary Secretary to the Minister of Justice and Attorney General of Canada
Position
Paper
BILL C-407
An Act to amend the Criminal Code (right to die with dignity)
Francine Lalonde (Bloc Québécois)
BILL C-407
An Act to amend the Criminal Code (right to die with dignity)
Francine Lalonde (Bloc Québécois)
Minister’s
Position: The
Minister of Justice will not be supporting the bill.
Factual
Summary of the Bill:
Bill C-407
proposes to amend the Criminal Code to permit assistance in dying under
certain conditions.
Key
features of the bill:
The bill
seeks to permit assisted suicide and euthanasia, in both cases provided the
conditions described below are met.
The bill
would not only apply to terminally-ill patients, but also to persons who suffer
from severe physical or mental pain with no prospect of relief (neither
physical nor mental pain is defined).
The aider
could be either a medical practitioner or someone who is assisted by a medical
practitioner.
The Bill’s
prescribed conditions included in the bill somewhat temper its potential scope
as the require that the person wishing assistance in dying: must be 18 years of
age andor older; over, be either terminally ill or suffering from severe
physical or mental pain with no prospect of relief,; make two requests, ast
least 10 days apart, while “appearing to be lucid,” to a doctor or aider,; and
must also designate someone who will act on his or her behalf vis-Ã -vis the
doctor or aider should he or she become mentally incapacitated. Under the Bill,
tThe “aider”: must be either a medical practitioner or someone who is assisted
by a medical practitioner,; must have received confirmation of the diagnosis
from another doctor, or from two doctors if the aider is not a doctor,; must be
a member of, or assisted by, a provincial health services team,; must act in
the manner requested by the person wishing to die,; and must provide the
coroner with the confirmation of diagnosis.
Assessment:
It is
expected that this bill will raise considerable public attention and
controversy as it touches upon such profound issues as life and death, which
for many involves religious beliefs.
The Bill
has far-reaching implications in the manner in which it alters the current
state of the law and in the way it will impact on medical ethics and practice.
The Bill also appears to exceed the parameters of current public views. While
many Canadians may not disapprove of permitting those who suffer from severe
physical pain with no prospect of relief to access assistance in dying, few
would tolerate the idea of allowing those who suffer from severe mental pain
with no prospect of relief to have the same access to assisted death. As
“mental pain” is not defined in the Bill, such common conditions as chronic
depression could potentially qualify as “mental pain”. This particular aspect
of the proposal, combined with such vague terms as “while appearing to be
lucid” as the requisite criterion for providing consent, raise concerns with
respect to s. 7 and s. 15 of the Charter. The recognized medical and
legal standard for providing a free and informed consent is not reflected in
Bill C-407.
In order
to guard against the potential to move towards what is often described as the
“slippery slope” in facilitating the unwanted death of elderly, physically or
mentally vulnerable persons, a very stringent regime would have to be
introduced, and Bill C-407 falls short of accomplishing this. For example, Bill
C-407 lacks an appropriate oversight mechanism to guard against abuses. The
Bill does not require detailed reporting or establish a committee to review
reports as is found in comparable legislation implemented in Oregon, the
Netherlands and Belgium, nor does the Bill does address how to deal with cases
of abuse, e.g. by creating a specific offence.
The Bill
also addresses matters that fall within provincial/territorial responsibilities
for the delivery of health care services and the medical profession, and
provincial legislation that deals with substitute decision makers. Extensive
consultations with interested groups, including the medical profession, and
Canadians in general should be undertaken by Parliament before it considers a
specific legislative proposal, although Parliament did examine these issues in
detail in 1994 and 1995 in the context of the study conducted by the Special
Senate Committee on Euthanasia and Assisted Suicide. It should be noted that
the majority recommended that theCriminal Code offence of assisted
suicide should remain intact.
------------
Frequently Asked
Questions
Euthanasia
and Assisted Suicide: Frequently Asked Questions
by
Rita L. Marker and Kathi Hamlon
One of the
most important public policy debates today surrounds the issues of euthanasia
and assisted suicide. The outcome of that debate will profoundly affect family
relationships, interaction between doctors and patients, and concepts of basic
ethical behavior. With so much at stake, more is needed than a duel of one-liners,
slogans and sound bites.
The
following answers to frequently asked questions are designed as starting points
for considering the issues. For more detailed information see the documented,
in-depth material available at this web site.
1.
Where are euthanasia and assisted suicide legal?
Oregon,
Washington, Montana, the Netherlands, Belgium and Luxembourg are the only
jurisdictions in the world where laws specifically permit euthanasia or
assisted suicide.
Note: On May 20, 2013, doctor-prescribed suicide became a legal “medical treatment” in Vermont. For information on that law, see Vermont.
Note: On May 20, 2013, doctor-prescribed suicide became a legal “medical treatment” in Vermont. For information on that law, see Vermont.
Oregon and
Washington passed laws and Montana’s Supreme Court determined that assisted
suicide is a medical treatment.(1) The Netherlands, Belgium and Luxembourg
permit both euthanasia and assisted suicide. Although euthanasia and assisted
suicide are illegal in Switzerland, assisted suicide is penalized only if it is
carried out “from selfish motives.”(2)
In 1995
Australia’s Northern Territory approved a euthanasia bill.(3) It went into
effect in 1996 but was overturned by the Australian Parliament in 1997. Also,
in 1997, Colombia’s Supreme Court ruled that penalties for mercy killing should
be removed.(4) However the ruling does not go into effect until guidelines are
approved by the Colombian Congress.
2. What
is the difference between euthanasia and assisted suicide?
One way to
distinguish them is to look at the last act – the act without which death would
not occur.
Using this
distinction, if a third party performs the last act that intentionally causes a
patient’s death, euthanasia has occurred. For example, giving a patient a
lethal injection or putting a plastic bag over her head to suffocate her would be
considered euthanasia.
On the
other hand, if the person who dies performs the last act, assisted suicide has
taken place. Thus it would be assisted suicide if a person swallows an overdose
of drugs that has been provided by a doctor for the purpose of causing death.
It would also be assisted suicide if a patient pushes a switch to trigger a
fatal injection after the doctor has inserted an intravenous needle into the
patient’s vein.
3.
Doesn’t modern technology keep people alive who would have died in the past?
Modern
medicine has definitely lengthened life spans. A century ago, high blood
pressure, pneumonia, appendicitis, and diabetes likely meant death, often
accompanied by excruciating pain. Women had shorter life expectancies than men
since many died in childbirth. Antibiotics, immunizations, modern surgery and
many of today’s routine therapies or medications were unknown then.
4.
Should people be forced to stay alive?
No. A lot
of people think that euthanasia or assisted suicide is needed so patients won’t
be forced to remain alive by being “hooked up” to machines. But the law already
permits patients or their surrogates to withhold or withdraw unwanted medical
treatment even if that increases the likelihood that the patient will die.
Thus, no one needs to be hooked up to machines against their will.
Neither
the law nor medical ethics requires that “everything be done” to keep a person
alive. Insistence, against the patient’s wishes, that death be postponed by
every means available is contrary to law and practice. It is also cruel and
inhumane.
There
comes a time when continued attempts to cure are not compassionate, wise, or
medically sound. That’s when hospice, including in-home hospice care, can be of
great help. That is the time when all efforts should be directed to making the
patient’s remaining time comfortable. Then, all interventions should be
directed to alleviating pain and other symptoms as well as to providing
emotional and spiritual support for both the patient and the patient’s loved
ones.
5. Does
the government have the right to make people suffer?
Absolutely
not. Likewise, the government should not have the right to give one group of
people (e.g. doctors) the power to kill another group of people (e.g. their
patients).
Activists
often claim that laws against euthanasia and assisted suicide are government
mandated suffering. But this claim would be similar to saying that laws against
selling contaminated food are government mandated starvation.
Laws
against euthanasia and assisted suicide are in place to prevent abuse and to
protect people from unscrupulous doctors and others. They are not, and never
have been, intended to make anyone suffer.
6. But
shouldn’t people have the right to commit suicide?
People do
have the power to commit suicide. Worldwide, about a million people commit
suicide annually.(5) Suicide and attempted suicide are not criminalized. Each
and every year, in the United States alone, there are 1.6 times as many
suicides as there are homicides.(6) And, internationally, suicide is one of the
three leading causes of death among people ages 15-34. (7)
Suicide is
an all too common tragic, individual act. Indeed, in 1999, the Surgeon General
of the United States launched a campaign to reduce the rate of suicide.(8)
Euthanasia
and assisted suicide are not private acts. Rather, they involve one person
facilitating the death of another. This is a matter of very public concern
since it can lead to tremendous abuse, exploitation and erosion of care for the
most vulnerable people among us.
Euthanasia
and assisted suicide are not about giving rights to the person who dies but,
instead, they are about changing public policy so that doctors or others can
directly and intentionally end or participate in ending another person’s life.
Euthanasia and assisted suicide are not about the right to die. They are about
the right to kill.
7.
Isn’t “kill” too strong a word for euthanasia and assisted suicide?
No. The
word “kill” means “to cause the death of.”(9)
In 1989, a
group of physicians published a report in the New England Journal of Medicine
in which they concluded that it would be morally acceptable for doctors to give
patients suicide information and a prescription for deadly drugs so they can
kill themselves.(10) Dr. Ronald Cranford, one of the authors of the report,
publicly acknowledged that this was “the same as killing the patient.”(11)
While
changes in laws have transformed euthanasia and/or assisted suicide from crimes
into “medical treatments” in Oregon, Washington, Belgium and the Netherlands,
the reality has not changed – patients are being killed.
Proponents
of euthanasia and assisted suicide often use euphemisms like “deliverance,”
“death with dignity,” “aid-in-dying” and “gentle landing.” If a proposed change
in public policy has to be promoted with euphemisms, this may be due to the
fact that the use of accurate, descriptive language would make its chilling
reality too obvious.
8.
Wouldn’t euthanasia or assisted suicide only be available to people who are
terminally ill?
No. There
are two problems here – the definition of “terminal” and the changes that have
already taken place to extend euthanasia or assisted suicide to those who
aren’t “terminally ill.”
“Terminal”
There are
many definitions for the word “terminal.” For example, Jack Kevorkian who
participated in the deaths of more than 130 people before he was convicted of
murder said that a terminal illness was “any disease that curtails life even
for a day.”(12) Dutch psychiatrist Dr. Boudewijn Chabot who provided a fatal
dose of drugs to a depressed, but physically healthy, woman, stated that
“persistently suicidal patients are, indeed, terminal.”(13)
Oregon’s
and Washington’s assisted-suicide laws defines “terminal” as a condition which
will “within reasonable medical judgment, produce death within six months.”(14)
A prognosis of six month to live is also the basis upon which patients qualify
for hospice coverage under Medicare.(15) However, federal officials note that
about 10% of patients live longer than the anticipated six-month life
expectancy.(16)
The use of
a six-month prognosis to qualify a patient for assisted suicide or euthanasia
was challenged in the World Federation of Right to Die Societies’ newsletter as
well:
The
six-month standard “not only calls on doctors to make an unreliable prediction,
but prescribes a pointless time limit: The longer the life expectancy the
greater the patient’s suffering. The essential elements for legislation are
that the condition is irremediable by medical treatment and the suffering is
intolerable to the patient.”(17)
The Dutch
who describe “terminal” as a “concrete expectancy of death,” have made no
attempt to predict when that concrete expectancy will be fulfilled.(18) Even a
Dutch physician who has carried out euthanasia is reluctant to say how long the
patient might have lived otherwise since “any estimate of the extent of
shortening of life can only be very general” and this has no “absolute
value.”(19)
Not
“Terminal”
The idea
that euthanasia and assisted suicide should only be practiced if a patient has
a terminal condition has never been accepted in the Netherlands.(20) Under both
the previous guidelines and the new law in the Netherlands, unbearable
suffering of either a physical or mental nature has been the factor that
qualifies one for induced death.(21)
It appears
that not even the prerequisite of subjective unbearable suffering will be
maintained for much longer. Discussion now centers on whether assisted suicide
should be available to elderly people who are healthy but “tired of life.”
Dutch Minister of Justice Els Borst has said, “I am not against it if it can be
carefully controlled so that only those people of advanced age who are tired of
life can use it.”(22)
Assisted
suicide for non-terminally ill patients has also been advocated repeatedly in
the United States.
In 1994,
the influential New England Journal of Medicine published an article
recommending legalization that would permit assisted suicide not only for
individuals who have terminal conditions but also for those with “incurable
debilitating illnesses.” (23)
Likewise,
the Hemlock Society (now called Compassion & Choices), citing the fact that
many people fear becoming a burden, has publicly supported a man’s legal
attempt to “empower his wife to have a doctor end his life by lethal injection,
without criminal liability, should he be stricken by a debilitating
illness.”(24)
Within two
years after the passage of Oregon’s assisted suicide law, a model law was
drafted that would have given doctors the right to provide assisted suicide if
“the patient has a terminal illness or an intractable and unbearable
illness.”(25)
A 1995
article in the journal, Suicide and Life-Threatening Behavior, concluded that
suicide is a rational choice for those with “hopeless conditions.” As defined,
“Hopeless conditions include, but are not necessarily limited to terminal
illnesses, severe physical and/or psychological pain, physically or mentally
debilitating and/or deteriorating conditions, or quality of life no longer
acceptable to the individual.”(26)
In a May
1996 speech to the prestigious American Psychiatric Association, George Delury
– who portrayed himself as a loving husband who “helped” his non-terminally ill
wife die (27) – suggested that “hopelessly ill people or people past age sixty
just apply for a license to die.” He said that such a license should be granted
without examination by doctors.(28)
At a 1998
international meeting held in Zurich, Switzerland, right-to-die activists
issued a declaration calling for the availability of assisted suicide and
euthanasia for those suffering “severe and enduring distress.”(29)
A failed
proposal in South Australia would have made euthanasia and assisted suicide
available to those who are “hopelessly ill.” According to the “Dignity in Dying
Bill 2001″:
“A
person is hopelessly ill if the person has an injury or illness
(a) that will result, or has resulted, in serious mental impairment or permanent deprivation or consciousness; or
(b) that seriously and irreversibly impairs the person’s quality of life so that life has become intolerable to that person.”(30)
(a) that will result, or has resulted, in serious mental impairment or permanent deprivation or consciousness; or
(b) that seriously and irreversibly impairs the person’s quality of life so that life has become intolerable to that person.”(30)
9.
Wouldn’t euthanasia and assisted suicide only be at a patient’s request?
No. As one
of their major goals, euthanasia proponents seek to have euthanasia and
assisted suicide considered “medical treatment.” If one accepts the notion that
euthanasia or assisted suicide is a good medical treatment, then it would not
only be inappropriate, but discriminatory, to deny this good treatment to a
person solely because that person is too young or mentally incapacitated to
request it.
In the
United States, a surrogate’s decision is often treated, for legal purposes, as
if the patient had made it. That means that, if euthanasia is legal, a court
challenge could result in a finding that a surrogate could make a request for
death on behalf of a child or an adult who doesn’t have decision-making
capacity.
In the
Netherlands, a 1990 government sponsored survey found that .8% of all deaths in
the Netherlands were euthanasia deaths that occurred without a request from the
patient.(31) And in a 1995 study, Dutch doctors reported ending the lives of
948 patients without their request.(32)
Suppose,
however that surrogates were not permitted to choose death for another and that
doctors did not end patients’ lives without their request. The fact still
remains that subtle, even unintended, pressure would still be unavoidable.
Such was
the case with an elderly woman who died under Oregon’s assisted suicide law:
Kate
Cheney, 85, reportedly had been suffering from early dementia. After she was
diagnosed with cancer, her own physician declined to provide a lethal
prescription for her. Counseling was sought to determine if she was capable of
making health care decisions.
A
psychiatrist found that Mrs. Cheney was not eligible for assisted suicide since
she was not explicitly pushing for it, her daughter seemed to be coaching her
to do so, and she couldn’t remember important names and details of even a
recent hospital stay.
Mrs.
Cheney was then taken to a psychologist who said she was competent but possibly
under the influence of her daughter who was “somewhat coercive.” Finally, a
managed care ethicist who was overseeing her case determined that she was
qualified for assisted suicide, and the lethal drugs were prescribed.(33)
10.
Could euthanasia or assisted suicide be used as a means of health care cost
containment?
Yes.
Perhaps one of the most important developments in recent years is the
increasing emphasis placed on health care providers to contain costs. In such a
climate, euthanasia or assisted suicide certainly could become a means of cost
containment.
These
implications were acknowledged during a historic argument before the U.S.
Supreme Court. Arguing against assisted suicide, acting solicitor general
Walter Dellinger said, “The least costly treatment for any illness is lethal
medication.”(34)
In the United States alone, millions of people have no medical insurance and studies have shown that the elderly, the poor and minorities are often denied access to needed treatment or pain control.(35) Doctors are being pressured by HMOs to reduce care; “futile care guidelines” are being instituted, enabling health facilities to deny necessary and wanted interventions; and health care providers are often likely to benefit financially from providing less, rather than more, care for their patients.(36)
In the United States alone, millions of people have no medical insurance and studies have shown that the elderly, the poor and minorities are often denied access to needed treatment or pain control.(35) Doctors are being pressured by HMOs to reduce care; “futile care guidelines” are being instituted, enabling health facilities to deny necessary and wanted interventions; and health care providers are often likely to benefit financially from providing less, rather than more, care for their patients.(36)
In Oregon,
some patients have been told by their health insurance provider that a costly
drug prescribed by a doctor to treat the patient’s illness would not be covered
but inexpensive lethal drugs for assisted suicide would be. (37) See: “Oregon’s Suicidal Approach to Health Care”
Canadians
are faced with such long delays getting treatment in the country’s overcrowded
health care system that the Canadian government has contracted for Canadians to
be treated out of the country. (38)
Many
British doctors and nurses have concluded that the only way to secure the
future of the National Health Service (NHS) is to make more treatments
available only to those who can pay privately for them. (39) And a survey by
the Nuffield Trust and the nurses’ magazine, Nursing Times, found that the NHS
is failing to care adequately for hundreds of thousands of patients who die each
year, many without proper care or pain relief.(40)
Savings to
governments could become a consideration. Drugs for assisted suicide cost about
$75 to $100, making them far less expensive than providing medical care. This
could fill the void from cutbacks for treatment and care with the “treatment”
of death.
For
example, the Oregon Medicaid program pays for assisted suicide for poor
residents as a means of “comfort care.” (41) In addition, spokespersons for
non-governmental health insurance plans have said the coverage of assisted
suicide is “no different than any other covered prescription.” (42)
Legalized
euthanasia or assisted suicide raises the potential for a profoundly dangerous
situation in which the “choice” of assisted suicide or euthanasia is the only
affordable option for some people.
11.
Certainly people wouldn’t be forced into euthanasia or assisted suicide, would
they?
Oregon’s
and Washington’s assisted-suicide laws do not allow anyone to “coerce” or use
“undue influence” to obtain a request for assisted suicide. (43) However, there
is absolutely nothing in the Oregon and Washington laws to prevent HMOs,
managed care companies, doctors or anyone else from suggesting, encouraging,
offering, or bringing up assisted suicide with a patient who has not asked
about it.
Emotional,
financial and psychological pressures could become overpowering for depressed
or dependent people. If the choice of euthanasia or assisted suicide is
considered as good as a decision to receive care, some people will feel guilty
for not choosing death.
The
concern about “being a burden” could serve as a powerful force that could
influence the decision. The tenth annual report on deaths under the Oregon
assisted-suicide law illustrates this. In 45% of the deaths reported during
2007, fear of being a burden was expressed as a reason for requesting assisted
suicide. (44)
Even the
smallest gesture could create a gentle nudge into the grave. Such was evidenced
in greeting cards sold at a national conference of the Hemlock Society.
According
to the conference program, the cards were designed to be given to those who are
terminally ill. One card in particular exemplified the core of the movement
that would remove the last shred of hope remaining to a person faced with a
life-threatening illness. It carried the message, “I learned you’ll be leaving
us soon.” (45)
12.
Wouldn’t legalized euthanasia and assisted suicide make certain that patients
can die peacefully, surrounded by their families and doctors, instead of being
suffocated by plastic bags or gassed to death with helium or carbon monoxide?
No.
Legalizing euthanasia and assisted suicide only legitimizes the use of plastic
bags and toxic gasses to kill vulnerable people.
For
example, immediately following the passage of Oregon’s assisted-suicide law,
some who favor euthanasia and assisted suicide said the new law would permit
the types of activities carried out by Jack Kevorkian. (46) Others said pills
could lead to complications and only a lethal injection or suffocation with a
plastic bag could ensure death. (47)
Official
reports in Oregon have not provided information on problems and complications
associated with assisted-suicide deaths. If it were not for occasional news
reports and inadvertent disclosures, assisted-suicide in Oregon would seem
problem free. However, two particularly troubling accounts have shattered that
image:
·
After
Patrick Matheny received his lethal dose of drugs from the Oregon Health
Sciences University via Federal Express, he delayed taking them for four months.
On the day of his death, he experienced difficulty.His brother-in-law, Joe
Hayes, said he had to “help” Matheny die. According to Hayes, “It doesn’t go
smoothly for everyone. For Pat, it was a huge problem. It would not have worked
without help.” (48)
·
Another
assisted suicide that went awry was disclosed by attorney Cynthia Barrett, an
assisted suicide supporter, in December 1999 during a class at Portland
Community College titled, “Physician Assisted Suicide: Counseling
Patients/Clients.” According to Barrett, “The man was at home. There was no
doctor there,” she said.”After he took it [the drug overdose], he began to have
some physical symptoms. The symptoms were hard for his wife to handle. Well,
she [the wife] called 911. The guy ended up being taken by 911 to a local
Portland hospital. Revived. In the middle of it. And taken to a local nursing
facility. I don’t know if he went back home. He died shortly – some period of
time after that time.” (49)
During the
campaign to legalize euthanasia in Australia’s Northern Territory, supporters
painted pictures of a calm, peaceful death with the patient surrounded by loved
ones. The Australian law (50) (which was later overturned (51)) legalized both
euthanasia and assisted suicide.
Draft
guidelines for its implementation recommended that family members should be
warned that they may wish to leave the room when the patient is being killed
since the death may be very unpleasant to observe. (Lethal injections often
cause violent convulsions and muscle spasms. (52)
Although
euthanasia and assisted suicide remained technically illegal in the Netherlands
until 2001, for many years the Royal Dutch Association of Pharmacy has provided
prescribing guidelines to prevent problems and to increase the efficiency of
euthanasia and assisted suicide. Yet there are still a number of complications
and problems reported with such deaths. (53)
Even Dutch
euthanasia activists acknowledge these difficulties, stating in their own
euthanasia society publication that, in one out of five cases of euthanasia or
medically-assisted suicide, there are problems or complications. (54)
13.
Since euthanasia and assisted suicide take place anyway, isn’t it better to
legalize them so they’ll be practiced under careful guidelines and so that
doctors will have to report these activities?
That
sounds good but it doesn’t work. Physicians who do not follow the “guidelines”
will not report and, even when a physician does report information, there is no
way to know if it is accurate or complete.
For example,
the Oregon law requires the Oregon Health Division (OHD) to collect information
and publish an annual statistical report about assisted-suicide deaths. (55)
However, the law contains no penalties for health care providers who fail to
report information to the OHD. Moreover, the OHD has no regulatory authority or
resources to ensure submission of information to its office. (56)
Thus, all
information contained in the OHD’s official reports is that which has been
provided by the physicians who prescribed the lethal drugs and only that which
the physicians choose to provide.
The OHD
even admitted that reporting physicians may have fabricated their versions of
the circumstances surrounding the prescriptions written for patients. “For that
matter, the entire account could have been a cock-and-bull story. We assume,
however, that physicians were their usual careful and accurate selves” (57)
when providing information.
Furthermore,
even if every physician reported each case and did so accurately, there would
be no way to determine whether the deaths were accompanied with problems and
complications since the Oregon law does not require that a physician be present
when the patient dies. According to the tenth annual report issued by OHD,
physicians were present at only 22% of reported deaths during 2007. (58)
In the
Netherlands, prior to enactment of the 2001 law, physicians were assured that
they would not be prosecuted for euthanasia or assisted suicide as long as they
followed guidelines and filed a report after the patient’s death. However,
official surveys of Dutch doctors, in which physicians were granted both
immunity and anonymity, revealed that only 41% of euthanasia and
assisted-suicide deaths were reported. (59)
Cases
which failed to meet practice guidelines were most likely to go unreported.
(60)
14.
Isn’t euthanasia or assisted suicide sometimes the only way to relieve
excruciating pain?
Quite the
contrary. Euthanasia activists exploit the natural fear people have of
suffering and dying. They often claim that, without euthanasia or assisted
suicide, people will be forced to endure unbearable pain:
During a
radio debate, T. Patrick Hill (who was then an official of Choice in Dying and
later served on the board of directors of the New York Citizens’ Committee on
Health Care Decisions) stated that continuing to prohibit euthanasia would, in
some circumstances, “abandon the patient to a horrifying death.” (61)
Hill
acknowledged that “even under the best circumstances active euthanasia is
indeed a troubling issue.” But he said, “I do think there are very restricted
circumstances where, in fact, it is the more humane thing to do rather than not
to do. Because, not to do it would, as I say, be to abandon the patient to
unbearable suffering, whether emotional suffering or physical suffering.” (62)
Such
irresponsible claims fail to recognize that virtually all pain can be
eliminated or that – in those rare cases where it can’t be totally eliminated –
it can be reduced significantly if proper treatment is provided.
It is a
national and international scandal that so many people do not get adequate pain
control. But killing is not the answer to that scandal. The solution is to
mandate better education of health care professionals on these crucial issues,
to expand access to health care, and to inform patients about their rights as
consumers.
In 2002,
the International Task Force published an important book, Power over Pain,
which is an incredibly valuable tool for people to use in obtaining the pain
relief they need.
Everyone –
whether a person with a life-threatening illness or a chronic condition – has
the right to pain relief. With modern advances in pain control, no patient
should ever be in excruciating pain. However most doctors have never had a
course in pain management so they’re unaware of what to do.
If a
patient who is under a doctor’s care is in excruciating pain, there’s
definitely a need to find a different doctor. But that doctor should be one who
will control the pain, not one who will kill the patient.
There are
board certified specialists in pain management who can not only help alleviate
physical pain but who are also skilled in providing necessary support to deal
with emotional suffering and depression that often accompany physical pain.
15.
Isn’t opposition to euthanasia and assisted suicide just an attempt to impose
religious beliefs on others?
No.
Right-to-die leaders have attempted for a long time to make it seem that anyone
against euthanasia or assisted suicide is trying to impose his or her religion
on others. But that’s not the case.
People on
both sides of the euthanasia and assisted suicide controversies claim
membership in religious denominations. There are also individuals on both sides
who claim no religious affiliation at all. But it’s even more important to
realize that these are not religious issues, nor should this be a religious
debate.
The debate
over euthanasia and assisted suicide is about public policy and the law.
The fact
that the religious convictions of some people parallel what has been
long-standing public policy does not disqualify them from taking a stand on an
issue.
For
example, there are laws that prohibit sales clerks from stealing company
profits. Although these laws coincide with religious beliefs, it would be
absurd to suggest that such laws should be eliminated. And it would be equally
ridiculous to say that a person who has religious opposition to it shouldn’t be
able to support laws against stealing.
Similarly,
the fact that the religious convictions of some euthanasia and assisted-suicide
opponents parallel what has been long-standing public policy does not
disqualify them from taking a stand on the issues.
Throughout
all of modern history, laws have prohibited mercy killing. The need for such
laws has been, and should continue to be, debated on the basis of public
policy. And people of any or no religious belief should have the right to be
involved in that debate.
In
Washington state, where an attempt to legalize euthanasia and assisted suicide
by voter initiative in 1991 failed, polls taken within days of the vote
indicated that fewer than ten percent of those who opposed the measure had done
so for religious reasons. (63)
Voter
initiatives have also failed in California, (64), Michigan (65) and Maine. (66)
All failed following significant organized opposition from a coalition of
groups including medical societies, nursing groups, hospice associations, civil
rights groups and major state newspapers.
16.
Where does the main support for euthanasia and assisted suicide come from?
The most
visible and vocal proponents of euthanasia and assisted suicide are
right-to-die organizations made up of committed activists who seek to change
the laws. But, they are only able to pursue their agenda because of funding
from a handful of extremely generous sources.
Far from
reflecting any grassroots desire, the push for legalization of euthanasia and
assisted suicide is a “top down” creation where the few seek to change the laws
that affect everyone. (67)
17.
Since suicide isn’t against the law, why should it be illegal to help someone
commit suicide?
Neither
suicide nor attempted suicide is criminalized anywhere in the United States or
in many other countries. This is not because of any “right” to suicide. When
penalties against attempted suicide were removed, legal scholars made it clear
that this was not done for the purpose of permitting suicide. Instead it was
intended to prevent suicide. Penalties were removed so people could seek help
in dealing with the problems they’re facing without risk of being prosecuted if
it were discovered that they had attempted suicide.
Just as
current public policy does not grant a “right” to be killed to a person who is
suicidal because of a lost business, neither should it permit people to be
killed because they are in despair over their physical or emotional condition.
With legalized euthanasia or assisted suicide, condemned killers would have
more rights to have their lives protected than would vulnerable people who
could be pressured and exploited into what amounts to capital punishment for
the “crime” of being sick, old, disabled or dependent.
Endnotes:
1.
Oregon’s “Death with Dignity Act” (ORS 127.800-897) passed in November 1994 and
went into effect in 1997. See additional information on Assisted Suicide in Oregon. Washington approved
the Washington “Death with Dignity Act” on Nov. 4, 2008. See additional
information on Washington. On December 31, 2009, the Montana Supreme Court
determined that physicians could assist patients in ending their lives with a
lethal dose of drugs. See additional information on Montana.
2.
Although both euthanasia and assisted suicide had been widely practiced in the
Netherlands, they remained technically illegal until passage of a bill for the
“Review of cases of termination of life on request and assistance with suicide”
was approved in April 2001. See additional information on Holland. Belgium’s law was passed on May 16,
2002. Swiss law states, “Whoever, from selfish motives, induces another to
commit suicide or assists him therein shall be punished, if the suicide was
successful or attempted, by confinement in a penitentiary for not more than
five years or by imprisonment.” [Article 115 of the Penal Code] [emphasis
added]
3. “Rights
of the Terminally Ill Act,” Northern Territory of Australia (1996).
4.
Republic of Colombia Constitutional Court, Sentence # c-239/97, Ref. Expedient
# D-1490, May 20, 1997.
5. World
Health Organization, 2009.
6. In
2005, suicide took the lives of more than 32,000 people – 1.6 times as many as
died from homicide. National Center for Health Statistics Center for Disease
Control, 2009.
7. World
Health Organization, 2009 .
8. U.S.
Public Health Service, “The Surgeon General’s Call to Action to Prevent
Suicide,” Washington,DC, 1999.
9.
Merriam-Webster OnLine (2008).
10. Sidney
H. Wanzer, M.D. et al., “The Physician’s Responsibility toward Hopelessly Ill
Patients: A Second Look,” 320 The New England Journal of Medicine (March 30,
1989), p. 848.
11.
MacNeil/Lehrer NewsHour, PBS, March 30, 1989.
12. “‘Dr.
Death:’ No law is needed on euthanasia,” USA Today, October 28, 1992, p. 6A.
Kevorkian’s attorney, Geoffrey Feiger said, “Any disease that curtails
life-span is terminal.” Geoffrey Fieger, Letter to the Editor, Detroit Free
Press, December 11, 1990.
13. “CQ
Interview: Arlene Judith Klotzko and Dr. Boudewijn Chabot Discuss Assisted
Suicide in the Absence of Somatic Illness,” 4 Cambridge Quarterly of Healthcare
Ethics (1995), p. 243. A case was brought against Chabot for the 1991 death. On
June 21, 1994, the Supreme Court of the Netherlands ruled that Chabot was
guilty but that he would not be punished. The “Chabot case” is widely perceived
as having expanded the Dutch guidelines for euthanasia and assisted suicide to
include physically healthy psychiatric patients.
14. Oregon
“Death with Dignity Act” [ORS 127.800 §1.01 (12)] and Washington “Death with
Dignity Act [Initiative 1000, § 1, (13)].
15. Jane
Cys, “HCFA won’t punish doctors for long-living hospice patients,” American
Medical News, October 9, 2000.
16. Ibid.
17. Eric
Gargett, “Changing the Law in South Australia,” World Right-to-Die Newsletter,
May 2001, p. 3. (The World Right-to-Die Newsletter is a publication of the
World Federation of Right to Die Societies.)
18. Paul
J. van der Maas et al., II Euthanasia and Other Medical Decisions Concerning
the End of Life, (English Translation, the Remmelink Report) (Elvesier 1992),
p. 23.
19. Ibid.,
pp. 23-24.
20. John
Griffiths, Alex Bood, Hellen Weyers, Euthanasia and Law in the Netherlands,
(Amsterdam University Press, 1998), p. 295.
21. For
full discussion and documentation of the law and practice of euthanasia and
assisted suicide in the Netherlands, see
http:www.internationaltaskforce/holland.htm.
22.
Margaret Oostvenn, “Ik kan me goed voorstellen dat artsen stervenshulp niet
melden,” NRC Handelsblad, April 1, 2001.
23.
Franklin G. Miller, Timothy E. Quill, Howard Brody, et al., “Sounding Board:
Regulating Physician-Assisted Death,” 331 New England Journal of Medicine,
(July 14, 1994), p. 120.
24.
Hemlock Society Press Release, “Hemlock Society Comments on Judge’s
Right-to-Die Bid,” December 31, 1998.
25.
Charles H. Baron, Clyde Bergstresser, Dan W. Brock, et al., “Statute: A Model
State Act to Authorize and Regulate Physician-Assisted Suicide.” 33 Harvard
Journal on Legislation, (1996), p. 26. (Emphasis added.)
26. James
L. Werth and Debra C. Cobia, “Empirically Based Criteria for Rational Suicide:
A Survey of Psychotherapists,” 25 Suicide and Life Threatening Behavior,
(1995), p. 238. (Emphasis added.)
27.
Although Delury originally claimed that his wife had died of a pill overdose,
he later admitted that, after giving her a drug laced drink, he put two plastic
bags over her head, secured them with a ribbon around her neck and watched as
her breathing slowly stopped. [Seth Gitell, "Delury Put Bag over Lebov's
Head during Course of 'Assisted Suicide,'" Forward, May 9, 1997, p. 1;
Thomas Maier, "State Probes Suicide Memoir: Attorney general to test
book's profits under Son of Sam law," Newsday, June 19, 1997; Dateline
NBC, June 30, 1997.] See additional information on Delury.
28.
Transcript of May 7, 1996 taped presentation at American Psychiatric
Association Annual Meeting, Tapes number 96APA-S52A and 96APA-S52B, “Assisted
Suicide Discussed, Part 1″ and Assisted Suicide Discussed, Part 2,” produced
for APA by Mobiltape Co., Inc.
29.
“Zurich Declaration on Assisted Dying,” signed on October 14, 1998 at the 12th
International Conference of the World Federation of Right to Die Societies,
held on October 12-15, 1998 in Zurich, Switzerland. For the full text, see
Zurich Declaration. Among the signers were Richard MacDonald, M.D., Medical
Director of the Hemlock Society; Australian physician Philip Nitschke; and
British Dr. Michael Irwin of the United Kingdom.
30.
“Dignity in Dying Bill 2001,” South Australian Parliament, introduced on March
14, 2001 by Australian Democrats state deputy leader Sandra Kanck. (Emphasis
added.) Kanck acknowledged that the bill was drafted in large part by the South
Australian Voluntary Euthanasia Society (SAVES). [Extract from Hansard,
Legislative Council, 14 March 2001.
31.
Medical Decisions About the End of Life, I. Report of the Committee to Study
the Medical Practice Concerning Euthanasia. (Volume 1 of 2), (The Hague,
September 19, 1991) p. 15. (Also known as the “Remmelink Report.”)
32.
Herbert Hendin, “Physician-Assisted Suicide and Euthanasia in the Netherlands:
Lessons from the Dutch,” 277 Journal of the American Medical Association, (June
4, 1997), p. 1720-1722
33. Erin
Barnett, “A family struggle: Is Mom capable of choosing to die?” Oregonian,
October 17, 1999. See additional information on Kate Cheney.
34.
Transcript of Oral Arguments before the U.S. Supreme Court in Washington v.
Glucksberg, (No. 96-110), 143 Chicago Daily Law Bulletin (January 10, 1997), p.
2.
35. See:
“Ethnicity and Analgesic Practice,” 34 Annals of Emergency Medicine (January
2000), pp. 11-16; Sheryl Stolberg, “Study Finds Pain of Oldest Is Ignored in
Nursing Homes,” New York Times, June 17, 1998; “Management of Pain in Elderly Patients
with Cancer,” 279 Journal of the American Medical Association, (1998), pp.
1877-1882; Charles Cleeland et al., “Pain and Treatment of Pain in Minority
Patients with Cancer,” 127 Annals of Internal Medicine (1997), pp. 813-816; and
American College of Physicians & American Society of Internal Medicine,
“Report: No Health insurance? It’s Enough to Make You Sick – Scientific
Research Linking the Lack of Health Coverage to Poor Health,” (November 30,
1990).
36. For a
thorough discussion of the changes that are taking place in the delivery of
health care, see: Wesley J. Smith, Culture of Death: The Assault on Medical
Ethics in America, (Encounter Books 2000).
37. KATU
TV, Portland, OR; July 31, 2008.
38.
“Clinic gets contract to treat Canadian patients,” Associated Press, January
23, 2000.
39.
“Rationing ‘only option’ for NHS,” BBC New Online, February 7, 2001. .
40.
Lorraine Fraser, “NHS patients ‘die without proper care or pain relief,’”
Electronic Telegraph (London), May 27, 2001. .
41. Erin
Barnett, “Suicide coverage passes review,” Oregonian, April 26, 1999.
42. Dan
Postrel, “State could cover assisted suicide,” Statesman-Journal (Salem, OR),
December 1, 1994.
43. Oregon
“Death with Dignity Act” [ORS 127.890 §4.02 (2)] and Washington “Death with
Dignity Act [Initiative 1000, § 20, (2)].
44. Death
with Dignity Act: Annual Report, Year 10(March 2008), Table 1.
45. The
greeting card was from “Grief Songs” Greeting Cards. It was described on the
program and purchased at “Reforming the Law: The 5th National Conference on
Voluntary Euthanasia,” sponsored by the National Hemlock Society and the Metro
Denver Hemlock Society, November 15 and 16, 1991 in Denver, Colorado. Card on
file at International Task Force office.
46.
“Oregon’s Assisted Suicide Law,” ABC News Nightline, December 7, 1994. Geoffrey
Fieger (Jack Kevorkian’s attorney) and Dr. Peter Goodwin (medical director for
Compassion in Dying, advisory board member of Hemlock, professor at Oregon
Health Sciences University, and a principal proponent of Oregon’s assisted
suicide law) both agreed that the Oregon law would permit use of an assisted
suicide device such as that developed by Jack Kevorkian. Kevorkian’s device,
used in most of the known deaths in which he participated, resulted in the
victim’s death by carbon monoxide poisoning.
47. Derek
Humphry (co-founder of the Hemlock Society and author of the suicide manual,
Final Exit), Letter to the Editor, New York Times, December 3, 1994 and Mark
O’Keefe, “Dutch researcher warns of lingering deaths,” The Sunday Oregonian,
December 4, 1994.
48. Erin
Barnett, “Dilemma of Assisted Suicide: When?” Oregonian, January 17, 1999 and
Erin Barnett, “Man with ALS makes up his mind to die,” Oregonian, March 11,
1999.
For more
information on Matheny, see Oregon death.
49.
Catherine Hamilton, “The Oregon Report: What’s Hiding behind the Numbers?”
Brainstorm, March 2000. Accessed at http://www.brainstorm.com. Hamilton was present
at the class which she audiotaped. The revelations made at the class were also
discussed on Portland’s KXL Radio and in the Oregonian. [David Reinhard,
"The pills don't kill: The case, First of two parts, Oregonian, March 23,
2000 and David Reinhard, "The pills don't kill: The case, Second of two
parts," Oregonian, March 26, 2000.] For more information on 911 call case,
see third case.
50.
“Rights of the Terminally Ill Act,” Northern Territory of Australia (1996).
51. Karen
Middleton, “Right-to-die law overruled,” The Age (Australia), March 25, 1997.
52. “Rights
of the Terminally Ill Regulations,” Northern Territory of Australia (1996);
Maria Ceresa, “Euthanasia may be agonising to watch: guidelines,” Australian,
March 22, 1996; Gail Alcorn, “Spasms warning on mercy killings,” Sydney Morning
Herald, March 22, 1996; Geoffrey Lee Martin, “’22 steps’ to legalised
euthanasia,” Electronic Telegraph, May 27, 1996.
53.
Johanna H. Groenewoud, et al., “Clinical Problems with the Performance of
Euthanasia and Physician-Assisted Suicide in the Netherlands,” 342 New England
Journal of Medicine (February 24, 2000), pp. 553-555.
54.
Beatrijs Trip, “Summary of Interview with former professor of pharmacology and
hospital doctor, Dr. Jan Glerum,” from “Relevant,” Volume 26, Number 3, July
2000, posted on World Federation of Right to Die Societies web site . Dr.
Glerum is described in the summary as a pharmacist and hospital doctor who “was
often involved with euthanasia and in the attempts of people to kill
themselves.”
55. Oregon
“Death with Dignity Act,” (ORS 127.865 §3.11).
56. Linda
Prager, “Details emerge on Oregon’s first assisted suicides,” American Medical
News, September 7, 1998.
57. Oregon
Health Division, CD Summary, (March 16, 1999), p. 2.
58. Death
with Dignity Act: Annual Report, Year Ten (March 2008), Table 1.
59. G. van
der Wal, P. J. van der Maas, J. M. Bosma, et al., “Evaluation of the
notification procedure for physician-assisted deaths in the Netherlands,” 335
New England Journal of Medicine (November 28, 1996), p. 1706.
60. Ibid.,
p. 1710.
61.
Transcript from audio tape of “On Target,” WVON Radio (Chicago). Debate between
Rita Marker and T. Patrick Hill, September 26, 1993.
62. Ibid.
63.
Tracking polls on Initiative 119, conducted by Hebert Research, October 31,
1991, and within one week following the November 5, 1991 vote. Five days before
the vote only 9.7 percent of those opposing the measure cited religious reasons
for their opposition. Following the measure’s defeat, individuals who had
previously indicated support for Initiative 119 were again surveyed. Of these
previous supporters, 15 percent subsequently opposed the initiative. Religious
reasons accounted for only 6.1 percent of this eventual opposition.
64.
California’s Death with Dignity Initiative (Proposition 161, 1992).
65.
Michigan’s assisted suicide initiative (Proposal B, 1998).
66. Maine
“Death with Dignity Act” (Question 1, 2000).
67. For a
discussion of this phenomenon, see: R. Marker, “Dying for the Cause: foundation
funding for the ‘right-to-die’ movement,” Philanthropy (January/February 2001),
pp. 26-29.
January
2010
---------------
Assisted Suicide
& Death with Dignity: Past, Present & Future
Table
of Contents
http://www.patientsrightscouncil.org/site/rpt2005-part1/Oldest
U.S. euthanasia organization calls it quits (view)
http://www.patientsrightscouncil.org/site/rpt2005-part1/Euthanasia
Society of America (view)
Spin off: Euthanasia Educational Council (view)
New names: Society for the Right to Die and Concern for Dying (view)
Reunification: Choice in Dying (view)
A kinder gentler image: Partnership for Caring (view)
Last Acts as the last act (view)
Spin off: Euthanasia Educational Council (view)
New names: Society for the Right to Die and Concern for Dying (view)
Reunification: Choice in Dying (view)
A kinder gentler image: Partnership for Caring (view)
Last Acts as the last act (view)
From
“Hemlock” to “Compassion and Choices” (view)
http://www.patientsrightscouncil.org/site/rpt2005-part1/Hemlock
(view)
Spin off: Americans against Human Suffering (view)
ERGO formed (view)
Another spin off: Compassion in Dying (view)
Expectations of success (view)
Hemlock undergoes another “makeover” (view)
Caring Friends program (view)
New name: End-of-Life Choices (view)
Unification: Compassion and Choices (view)
Exits (view)
Spin off: Americans against Human Suffering (view)
ERGO formed (view)
Another spin off: Compassion in Dying (view)
Expectations of success (view)
Hemlock undergoes another “makeover” (view)
Caring Friends program (view)
New name: End-of-Life Choices (view)
Unification: Compassion and Choices (view)
Exits (view)
Final Exit
Network (view)
http://www.patientsrightscouncil.org/site/rpt2005-part1/Death
with Dignity National Center (view)
http://www.patientsrightscouncil.org/site/rpt2005-part2/Polls:
Measurement or manipulation (view)
Oregon as a model (view)
Oregon as a model (view)
http://www.patientsrightscouncil.org/site/rpt2005-part2/Official
reports do not tell the whole story (view)
Other troubling aspects of Oregon’s law (view)
Other troubling aspects of Oregon’s law (view)
http://www.patientsrightscouncil.org/site/rpt2005-part3/Death
by Laptop (view)
“You don’t need a doctor” (view)
“You don’t need a doctor” (view)
The
Netherlands (view)
http://www.patientsrightscouncil.org/site/rpt2005-part3/Dutch
physicians led the way (view)
Euthanasia and assisted suicide legalized (view)
Euthanasia and assisted suicide legalized (view)
Belgium (view)
http://www.patientsrightscouncil.org/site/rpt2005-part3/Other
Countries (view)
-------------------
Euthanasia,
Assisted Suicide & Health Care Decisions – Part 1
Euthanasia,
Assisted Suicide & Health Care Decisions:
Protecting Yourself & Your Family
Protecting Yourself & Your Family
Table of Contents | Part 1 | Part 2
INTRODUCTION
The words
“euthanasia” and “assisted suicide” are often used interchangeably. However,
they are different and, in the law, they are treated differently. In this
report, “euthanasia” is defined as intentionally, knowingly and directly acting
to cause the death of another person (e.g., giving a lethal injection).
“Assisted suicide” is defined as intentionally, knowingly and directly
providing the means of death to another person so that the person can use that
means to commit suicide (e.g., providing a prescription for a lethal dose of
drugs).
Part I of
this report discusses the reasons used by activists to promote changes in the
law; the contradictions that the actual proposals have with those reasons; and
the logical progression that occurs when euthanasia and assisted suicide are
transformed into medical treatments. It explores the failure of so-called
safeguards and outlines the impact that euthanasia and assisted suicide have on
families and society in general.
Withholding
and withdrawing medical treatment and care are not legally considered
euthanasia or assisted suicide. Withholding or withdrawing food and fluids is
considered acceptable removal of a “medical treatment.”
Part II of
this report includes information about practical ways to protect oneself and
loved ones during any time of incapacity and a discussion of some of the
policies that have led to patients being denied care that they or their
decision-makers have requested. It concludes with an examination of the ethical
distinction between treatment and care.
PART I
EUTHANASIA
& ASSISTED SUICIDE
MOVING THE
BOUNDARIES
In 2002,
the International Task Force report, “Assisted Suicide: Not for Adults Only?”
(1) discussed euthanasia and assisted suicide for children and teens. At that
time, such concerns were largely considered outside the realm of possibility.
Then, as
now, assisted-suicide advocates claimed that they were only trying to offer
compassionate options for competent, terminally ill adults who were suffering
unbearably. By and large, their claims went unchallenged.
A crack in
that carefully honed image appeared in 2004 when the “Groningen Protocol”
elicited worldwide outrage. The primary purpose of that protocol – formulated
by doctors at the Groningen Academic Hospital in the Netherlands – was to
legally and professionally protect Dutch doctors who kill severely disabled
newborns. (2)
While
euthanasia for infants (infanticide) was not new, widespread discussion of it
was. Dutch doctors were now explaining that it was a necessary part of
pediatric care.
Also in
2004, Holland’s most prestigious medical society (KNMG) urged the Health
Ministry to set up a board to review euthanasia for people who had “no free
will,” including children and individuals with mental retardation or severe brain
damage following accidents. (3)
At first,
it seemed that these revelations would be harmful to the euthanasia movement,
but the opposite was true.
Why?
Awareness
of infanticide and euthanasia deaths of other incompetent patients moved the
boundaries.
Prior to
the widespread realization that involuntary euthanasia was taking place,
advocacy of assisted suicide for those who request it seemed to be on one end
of the spectrum. Opposition to it was on the other end.
Now, the
practice of involuntary euthanasia took its place as one extreme, opposition to
it as the other extreme, and assisted suicide for terminally ill competent
adults appeared to be in the “moderate middle” – a very advantageous political
position – and expansion of the practice to others had entered the realm of
respectable debate.
This
repositioning has become a tool in the assisted-suicide arsenal. In May 2006,
an assisted-suicide bill, patterned after Oregon’s law permitting assisted
suicide, failed to gain approval in the British Parliament. The bill’s
supporters immediately declared that they would reintroduce it during the next
parliamentary session.
Within two
weeks, Professor Len Doyal – a former member of the British Medical
Association’s ethics committee who is considered one of England’s leading
experts on medical ethics – called for doctors to be able to end the lives of
some patients “swiftly, humanely and without guilt,” even without the patient’s
consent. (4) Doyal’s proposal was widely reported and, undoubtedly, when the
next assisted-suicide bill is introduced in England, a measure that would
permit assisted suicide only for consenting adults will appear less radical
than it might have seemed prior to Doyal’s suggestion.
Currently,
euthanasia is a medical treatment in the Netherlands and Belgium. Assisted
suicide is a medical treatment in the Netherlands, Belgium and Oregon. Their
advocates erroneously portray both practices as personal, private acts.
However, legalization is not about the private and the personal. It is about public
policy, and it affects ethics, medicine, law, families and children.
A
FAMILY AFFAIR
In
December 2005, ABC News’ World News Tonight reported, “Anita and Frank go often
to the burial place of their daughter Chanou…. Chanou died when, with her
parents’ consent, doctors gave her a lethal dose of morphine…. ‘I’m convinced
that if we meet again somewhere in heaven,’ her father said, ‘she’ll tell us we
reached the most perfect solution.’”(5)
The report
about the six-month-old Dutch child’s death was introduced as a report on the
“debate over euthanizing infants.” A Dutch legislator who agrees that doctors
who intentionally end their tiny patients’ lives should not be prosecuted said,
“I’m certainly pro-life. But I’m also a human being. I think when there is
extreme, unbearable suffering, then there can be extreme relief.” (6)
Gone was
the previous year’s outrage over the Groningen Protocols. Infanticide had
entered the realm of respectable debate in the mainstream media. The message
given to viewers was that loving parents, compassionate doctors and caring
legislators favor infanticide. It left the impression that opposing such a
death would be cold, unfeeling and, perhaps, intentionally cruel.
In Oregon,
some assisted-suicide deaths have become family or social events.
Oregon’s
law does not require family members to know that a loved one is planning to
commit suicide with a doctor’s help. (7) Thus, the first knowledge of those
plans could come when a family member finds the body. However, as two news
features illustrate, some Oregonians who die from assisted suicide make it a
teachable moment for children or a party event for friends and family.
According
to the Mail Tribune (Medford, Oregon), on a sunny afternoon, Joan Lucas rode
around looking at houses, then she sat in a park eating an ice cream cone. A
few hours later, she committed suicide with a prescribed deadly drug overdose.
“Grandchildren were made to understand that Grandma Joan would be going away
soon. Those who were old enough to understand were told what was happening.” (8
Did these
children learn from Grandma Joan that suicide is a good thing?
UCLA’s
student newspaper, the Daily Bruin, carried an article favoring assisted
suicide. It described how Karen Janoch who committed suicide under the Oregon
law, sent invitations for her suicide to about two dozen of her closest friends
and family. The invitation read, “You are invited to attend the actual ending
of my life.” (9) At the same time California’s legislature was considering an
assisted-suicide bill that was virtually identical to Oregon’s law, UCLA
students learned that suicide can be the occasion for a party.
In Oregon,
assisted suicide has gone from the appalling to the appealing, from the tragic
to the banal.
During the
last half of 2005 and the first half of 2006, bills to legalize assisted
suicide were under consideration in various states and countries including, but
not limited to, Canada, Great Britain, California, Hawaii, Vermont, and
Washington. All had met failure by the end of June 2006. But plans to
reintroduce them with some cosmetic changes are currently underway. A brief
examination of arguments used to promote them illustrates the “small world”
nature of assisted-suicide advocacy.
TWO
PILLARS OF ADVOCACY
Wherever
an assisted-suicide measure is proposed, proponents’ arguments and strategies
are similar. Invariably, promotion rests on two pillars: autonomy and the
elimination of suffering.
Autonomy
Autonomy
(independence and the right of self-determination) is certainly valued in modern
society and patients do, and should, have the right to accept or reject medical
treatment. However, those who favor assisted suicide claim that autonomy
extends to the right of a patient to decide when, where, how and why to die as
the following examples illustrate.
During
debate over an assisted-suicide measure then pending before the British
Parliament, proponents emphasized personal choice. The bill, titled “The
Assisted Dying for the Terminally Ill Bill,” was introduced by Lord Joel Joffe.
Dr. Margaret Branthwaite, a physician, barrister and former head of England’s
Voluntary Euthanasia Society (recently renamed Dignity in Dying (10)), called
for passage of the Joffe bill in an article in the British Medical Journal. “As
a matter of principle,” she wrote, “it reinforces current trends towards
greater respect for personal autonomy.” (11)
The focus
on autonomy was also reflected in remarks about a plan to introduce an
assisted-suicide initiative in Washington. Booth Gardner, former governor of
Washington, said he plans to promote the initiative because it should be his
decision when and how he dies. He told the Seattle Post-Intelligencer, “When I
go, I want to decide.” (12)
The
rationale is that when, where, why and how one dies should be a matter of self-determination,
a matter of independent choice, and a matter of personal autonomy.
Elimination
of suffering
The second
pillar of assisted-suicide advocacy is elimination of suffering. During each
and every attempt to permit euthanasia and assisted suicide, its advocates
stress that ending suffering justifies legalization of the practices.
California
Assemblywoman Patty Berg, the co-sponsor of California’s euphemistically named
“Compassionate Choices Act,” (13) said the assisted-suicide measure was
necessary so that people would have the comfort of knowing “they could escape
unbearable suffering if that were to occur.” (14)
In an
opinion piece supporting the failed 1998 assisted-suicide initiative in
Michigan, a spokesperson for those favoring the measure wrote that the patients
“targeted” by the proposal were those who were “tortured by the unbearable
suffering of a slow and agonizing death.” (15)
In the
United Kingdom, Lord Joffe said his bill would enable those who are “suffering
unbearably” to get medical assistance to die. (16) Testimony before the British
House of Lords Select Committee studying the bill noted that, where “assisted
dying” has been legalized, it has done so “as a response to patients who were
suffering.” (17)
The
centerpiece of the 1994 Measure 16 campaign that resulted in Oregon’s
assisted-suicide law was a television commercial featuring Patti Rosen.
Describing her daughter who had cancer, Rosen said, “The pain was so great that
she couldn’t bear to be touched…. Measure 16 would have allowed my daughter to
die with dignity.” (18)
When an
assisted-suicide proposal that later failed was being considered by the
Hawaiian legislature in 2002, a public relations consultant who was working on
behalf of the bill, e-mailed a template for use in written or oral testimony.
The template suggested inclusion of the phrases “agonizingly painful,” “pain
was uncontrollable,” and “pain beyond my understanding.” (19)
During
consideration of an assisted-suicide bill in Vermont, the state’s former
governor Philip Hoff said, “The last thing I would want in this world is to be
around and be in pain, and have no quality of life, and be a burden to my
family and others.” (20) Dick Walters, chairman of Death with Dignity Vermont,
said the proposal would permit a person to “peacefully end suffering and hasten
death.” (21)
Thus, the
rationale given by euthanasia and assisted-suicide proponents for legalization
always includes autonomy and/or elimination of suffering. However, the laws
they propose actually contradict this rationale.
CONTRADICTIONS
When
proposed, laws such as those now in existence in Oregon and similar measures
introduced elsewhere include conditions or requirements limiting assisted
suicide to certain groups of “qualified patients.” A patient qualified to
receive the treatment of assisted suicide must be an adult who is capable of
making decisions and must be diagnosed with a terminal condition.
If one
accepts the premise that assisted suicide is a good medical treatment that
should be permitted on the basis of personal autonomy or elimination of
suffering, other questions must be raised.
If the
reason for permitting assisted suicide is autonomy, why should assisted suicide
be limited to the terminally ill?
Does one’s
autonomy depend upon a doctor’s diagnosis (or misdiagnosis) of a terminal
illness? If a person is not terminally ill, but is suffering – whether
physically, psychologically or emotionally – why isn’t it up to that person to
decide when, why and how to die? Does a person only have autonomy if he or she
has a particular condition or illness? Is autonomy a basis for the law?
If
assisted suicide is a good and acceptable medical treatment for the purpose of
ending suffering, why should it be limited to adults who are capable of
decision-making?
Isn’t it
both discriminatory and cruel to deny that good and acceptable medical
treatment to a child or an incompetent adult? Why is a medical treatment that
has been deemed appropriate to end suffering available to an 18-year-old, but
not to a 16-year-old or 17-year-old? Why is a person only eligible to have his
or her suffering ended if he or she has reached an arbitrary age?
And, what
of the adult who never was, or no longer is, capable of decision-making? Should
that person be denied medical treatment that ends suffering? Are euthanasia and
assisted-suicide laws based on the need to eliminate suffering, or not?
Establishing
arbitrary requirements that must be met prior to qualifying for the medical
treatment of euthanasia or assisted suicide does, without doubt, contradict the
two pillars on which justification for the practices is based.
The
question then must be asked: Why are those arbitrary requirements included in
Oregon’s law and other similar proposals? The answer is simple. After a series
of defeats, euthanasia and assisted-suicide proponents learned that they had to
propose laws that appeared palatable.
In April
2005, Lord Joffe, the British bill’s sponsor, acknowledged that his bill was
intended to be only the first step. During hearings regarding the measure, he
said that “this is the first stage” and went on to explain that “one should go
forward in incremental stages. I believe that this bill should initially be
limited….” (22)
He
repeated his remarks a year later when discussing hearings about his bill. “I
can assure you that I would prefer that the [proposed] law did apply to
patients who were younger and who were not terminally ill but who were
suffering unbearable,” he said and added, “I believe that this bill should
initially be limited.” (23)
STEP-BY-STEP
APPROACH
Proposals
for euthanasia and assisted suicide have always emanated from advocacy groups,
not from any grassroots desire. Those groups learned that attempting to go too
far, too fast, leads to certain defeat.
After many
failed attempts, most recently those in the early 90s in Washington and
California – when ballot initiatives that would have permitted both euthanasia
by lethal injection and assisted suicide by lethal prescription were
resoundingly defeated – “death with dignity” activists changed their strategy.
They decided to take a step-by-step approach, proposing an
assisted-suicide-only bill which, when passed, would serve as a model for
subsequent laws. Only after several such laws were passed, would they begin to
expand them. That was the strategy that led to Oregon’s Measure 16, the “Oregon
Death with Dignity Act.”
Those who
were most involved in the successful Oregon strategy were not new to the scene.
Cheryl K.
Smith, who wrote the first draft of Oregon’s law, had served as a special
counsel to the political action group Oregon Right to Die (ORD). Smith had been
the National Hemlock Society’s legal advisor after her graduation from law
school in 1989 and had been a top aide to Hemlock’s co-founder, Derek Humphry.
While a student at the University of Iowa College of Law, Smith helped draft a
“Model Aid-in-Dying Act” that provided for children’s lives to be terminated
either at their own request or, if under 6 years of age, by parental request.
(24)
Barbara
Coombs Lee was Measure 16’s chief petitioner. At the time, she was a vice
president for a large Oregon managed care program. After the law’s passage, she
took over the leadership of Compassion in Dying. (25) [Note: In early 2005,
Compassion in Dying merged with the Hemlock Society. The combined organization
is now called Compassion and Choices.]
Coombs
Lee’s promotion of assisted suicide and euthanasia began prior to her
involvement with the Death with Dignity Act. As a legislative aide to Oregon
Senator Frank Roberts in 1991, she worked on Senate Bill 114 that would have
permitted euthanasia on request of a patient and, if the patient was not
competent, a designated representative would have been authorized to request
the patient’s death. (26)
Upon
passage of the Oregon law in 1994, many assisted-suicide supporters were
certain that other states would immediately fall in line. However, that did not
occur. Between 1994 and mid-2006, assisted-suicide measures were introduced in
state after state.(27) Each and every proposal failed. All of the proposals
were assisted-suicide-only bills and, with one exception, (28) every one was
virtually identical to the Oregon law.
Among
supporters of assisted suicide and euthanasia, though, the Oregon law is seen
as the model for success and is referred to in debates about assisted suicide
throughout the world. For that reason, a careful examination of the Oregon
experience is vital to understanding the problems with legalized assisted
suicide.
OREGON
Under
Oregon’s law permitting physician-assisted suicide, the Oregon Department of
Human Services (DHS) – previously called the Oregon Health Division (OHD) – is
required to collect information, review a sample of cases and publish a yearly
statistical report. (29)
However,
due to major flaws in the law and the state’s reporting system, there is no way
to know for sure how many or under what circumstances patients have died from
physician-assisted suicide. Statistics from official reports are particularly
questionable and have left some observers skeptical about their validity.
For
example, when a similar proposal was under consideration in the British
Parliament, members of a House of Lords Committee traveled to Oregon seeking
information regarding Oregon’s law for use in their deliberations. The public
and press were not present during the closed-door hearings. However, the House
of Lords published the committee’s proceedings in three lengthy volumes, which
included the exact wording of questions and answers.
After
hearing witnesses claim that there have been no complications associated with
more than 200 assisted-suicide deaths, committee member Lord McColl of Dulwich,
a surgeon, said, “If any surgeon or physician had told me that he did 200
procedures without any complications, I knew that he possibly needed counseling
and had no insight. We come here and I am told there are no complications.
There is something strange going on.” (30)
The
following includes statistical data from official reports and other published
information dealing with troubling aspects of the practice of assisted suicide
in Oregon. Statements from the 744-page second volume of the House of Lords
committee proceedings are also included. None of the included statements from
the committee hearings were made by opponents of Oregon’s law.
OFFICIAL
REPORTS
Assisted-suicide
deaths reported during the first eight years
Official
Reports: 246
Actual Number: Unknown
Actual Number: Unknown
The latest
annual report indicates that reported assisted-suicide deaths have increased by
more than 230% since the first year of legal assisted suicide in Oregon. (31)
The numbers, however, could be far greater. From the time the law went into
effect, Oregon officials in charge of formulating annual reports have conceded
“there’s no way to know if additional deaths went unreported” because Oregon
DHS “has no regulatory authority or resources to ensure compliance with the
law.” (32)
The DHS
has to rely on the word of doctors who prescribe the lethal drugs. (33)
Referring to physicians’ reports, the reporting division admitted: “For that
matter the entire account [received from a prescribing doctor] could have been
a cock-and-bull story. We assume, however, that physicians were their usual
careful and accurate selves.” (34)
The
Death with Dignity law contains no penalties for doctors who do not report
prescribing lethal doses for the purpose of suicide.
Complications
occurring during assisted suicide
Official
Reports: 13 (12 instances of vomiting & one patient who did not die from
lethal dose.)
lethal dose.)
Actual
number: Unknown
Prescribing
doctors may not know about all complications since, over the course of eight
years, physicians who prescribed the lethal drugs for assisted suicide were
present at only 19.5% of reported deaths. (35) Information they provide might
come from secondhand accounts of those present at the deaths (36) or may be
based on guesswork.
When asked
if there is any systematic way of finding out and recording complications, Dr.
Katrina Hedberg who was a lead author of most of Oregon’s official reports
said, “Not other than asking physicians.” (37) She acknowledged that “after
they write the prescription, the physician may not keep track of the patient.”
(38) Dr. Melvin Kohn, a lead author of the eighth annual report, noted that, in
every case that they hear about, “it is the self-report, if you will, of the
physician involved.” (39)
Complications
contained in news reports are not included in official reports
Patrick
Matheny received his lethal prescription from Oregon Health Science University
via Federal Express. He had difficulty when he tried to take the drugs four
months later. His brother-in-law, Joe Hayes, said he had to “help” Matheny die.
According to Hayes, “It doesn’t go smoothly for everyone. For Pat it was a huge
problem. It would have not worked without help.” (40) The annual report did not
make note of this situation.
Speaking
at Portland Community College, pro-assisted-suicide attorney Cynthia Barrett
described a botched assisted suicide. “The man was at home. There was no doctor
there,” she said. “After he took it [the lethal dose], he began to have some
physical symptoms. The symptoms were hard for his wife to handle. Well, she
called 911. The guy ended up being taken by 911 to a local Portland hospital.
Revived. In the middle of it. And taken to a local nursing facility. I don’t
know if he went back home. He died shortly – some…period of time after that….”
(41)
Overdoses
of barbiturates are known to cause vomiting as a person begins to lose
consciousness. The patient then inhales the vomit. In other cases, panic, feelings
of terror and assaultive behavior can occur from the drug-induced confusion.
(42) But Barrett would not say exactly which symptoms had taken place in this
instance. She has refused any further discussion of the case.
Complications
are not investigated
David
Prueitt took the prescribed lethal dose in the presence of his family and
members of Compassion & Choices. After being unconscious for 65 hours, he
awoke. It was only after his family told the media about the botched assisted
suicide that Compassion & Choices publicly acknowledged the case. (43) DHS
issued a release saying it “has no authority to investigate individual Death
with Dignity cases.” (44)
Referring
to DHS’s ability to look into complications, Dr. Hedberg explained that “we are
not given the resources to investigate” and “not only do we not have the
resources to do it, but we do not have any legal authority to insert
ourselves.” (45)
David
Hopkins, Data Analyst for the Eighth Annual Report, said, “We do not report to
the Board of Medical Examiners if complications occur; no, it is not required
by law and it is not part of our duty.” (46)
Jim
Kronenberg, the Oregon Medical Associations’ (OMA) Chief Operating Officer,
explained that “the way the law is set up there is really no way to determine
that [complications occurred] unless there is some kind of disaster.”
“[P]ersonally I have never had a report where there was a true disaster,” he
said. “Certainly that does not mean that you should infer there has not been, I
just do not know.” (47)
In the
Netherlands, assisted-suicide complications and problems are not uncommon. One
Dutch study found that, because of problems or complications, doctors in the
Netherlands felt compelled to intervene (by giving a lethal injection) in 18%
of cases.(48)
This
led Dr. Sherwin Nuland of Yale University School of Medicine to question the
credibility of Oregon’s lack of reported complications. Nuland, who favors
physician-assisted suicide, noted that the Dutch have had years of practice to
learn ways to overcome complications, yet complications are still reported.
“The Dutch findings seem more credible [than the Oregon reports],” he wrote.
(49)
Assisted-suicide
deaths of patients with impaired judgment
Official
Reports: 0 (Official reports do not contain this category.)
Actual number: Unknown
Actual number: Unknown
Under the
assisted-suicide law, depressed or mentally ill patients can receive assisted
suicide if they do not have “impaired judgment.” (50) Concerning the decision
to refer for a psychological evaluation, Dr. Kohn said, “According to the law,
it’s up to the docs’ discretion.” (51) During the last year for which reports
are available, only 5% of patients were referred for a psychological evaluation
or counseling before receiving a prescription for assisted suicide. (52)
Even if a
patient is competent when the prescription is written, that may not be the case
when the lethal drugs are taken. Dr. Hedberg acknowledged that there is no
assessment of patients after the prescribing is completed. “Our job is to make
sure that all the steps happened up to the point the prescription was written,”
(53) she said. “In fact, after they write the prescription, the physician may
not keep track of that patient…. [T]he law itself only provides for writing the
prescription, not what happens afterwards.” (54)
Kate
Cheney, 85, died of assisted suicide under Oregon’s law even though she
reportedly was suffering from early dementia. Her own physician declined to
provide the lethal prescription. When counseling to determine her capacity was
sought, a psychiatrist determined that she was not eligible for assisted
suicide since she was not explicitly seeking it, and her daughter seemed to be
coaching her to do so. She was then taken to a psychologist who determined that
she was competent, but possibly under the influence of her daughter who was
“somewhat coercive.” Finally, a managed care ethicist who was overseeing her
case determined that she was qualified for assisted suicide and the drugs were
prescribed. (55)
Assisted-suicide
deaths of depressed patients
Official
Reports: 0 (Official reports do not contain this category.)
Actual number: Unknown
Actual number: Unknown
The first
known assisted-suicide death under the Oregon law was that of a woman in her
mid-eighties who had been battling breast cancer for twenty-two years. Two
doctors, including her own physician who believed that her request was due to
depression, refused to prescribe the lethal drugs. Then Compassion in Dying
(CID), now called Compassion and Choices, became involved. Dr. Peter Goodwin,
who was then the medical director of CID, (56) determined that she was an
“appropriate candidate” for death and referred her to a doctor who provided the
lethal prescription. In an audiotape, made two days before her death and played
at a CID press conference, the woman said, “I will be relieved of all the
stress I have.” (57)
In 2001,
Dr. Peter Reagan, an assisted-suicide advocate affiliated with CID, gave
Michael Freeland a prescription for lethal drugs under Oregon’s law. Freeland,
64, had a 43-year history of acute depression and suicide attempts. However,
when Freeland and his daughter went to see Dr. Reagan about arranging a legal
assisted suicide, Dr. Reagan said he didn’t think that a psychiatric
consultation was “necessary.” (58)
Assisted-suicide
requests based on financial concerns
Official
Reports: 7
Actual number: Unknown
Actual number: Unknown
Data about
reasons for requests is based on prescribing doctors’ understanding of
patients’ motivations. It is possible that financial concerns were much greater
than reported. According to official reports, 36.5% of patients whose deaths
were reported were on Medicare (for senior citizens) or Medicaid (for the poor)
and an additional 1% had no insurance. (59)
After the
second annual report, official reports have not differentiated between Medicare
and Medicaid patients dying from assisted suicide.
Patients
who received lethal dose more than 6 months before death
Official
Reports: 2 or 4 (After the 2nd year, official reports stopped including this
category.)
Actual number: Unknown
Actual number: Unknown
Lethal
prescriptions under Oregon’s law are supposed to be limited to patients who
have a life expectancy of six months or less. (60)
One
patient was still alive 17 months after the lethal drugs were prescribed, (61)
and, during the first two years of the law’s implementation, at least one
lethal dose was prescribed more than eight months before the patient took it.
(62) The DHS is not authorized to investigate how physicians determine their
patients’ diagnoses or life expectancies. (63)
According
to the OMA’s Chief Operating Officer, Jim Kronenberg, most physicians have told
him that trying to predict that a patient has less than six months to live “is
a stretch.” “Two hours, a day, yes, but six months is difficult to do,” he
explained. (64)
Dr. Peter
Rasmussen, an advisory board member of the Oregon chapter of C & C, (65)
has been involved in Oregon assisted-suicide deaths numbering in double digits.
He said life expectancy predictions for a person entering the final phase of
life are inaccurate. He dismissed this as unimportant, saying, “Admittedly, we
are inaccurate in prognosticating the time of death under those circumstances,
we can easily be 100 percent off, but I do not think that is a problem. If we
say a patient has six months to live and we are off by 100 percent and it is
really three months or even twelve months, I do not think the patient is harmed
in any way….” (66)
Shortest
length of time reported for prescribing doctor-patient relationship
Official
Reports: Less than one week
Actual Number: Unknown
Actual Number: Unknown
Oregon’s
assisted-suicide law requires that at least two weeks elapse between the
patient’s first and last requests for lethal drugs. (67) Yet, for the third
through the eighth years, the doctor-patient relationship in some reported
assisted-suicide cases was under one week. (68) Thus, official reports indicate
that either some physicians are not complying with the two-week requirement or
they step in to write an assisted-suicide prescription after other physicians
refused.
First
physician asked agreed to write prescription
Official
Reports: 27 (41%) in the first three years. (After the 3rd year, official
reports stopped including this category.)
Actual
number: Unknown
A New
England Journal of Medicine article noted that “many patients who sought
assistance with suicide had to ask more than one physician for a prescription
for lethal medication.” (69) Patients or their families can “doctor shop” until
a willing physician is found.
There is
no way to know, however, why the previous physicians refused to lethally
prescribe (i.e., the patient was not terminally ill, had impaired judgment,
etc.) since non-prescribing physicians are not interviewed for the official
state reports. The only physicians interviewed for official reports are those
who actually wrote lethal drug prescriptions for patients. (70)
OTHER
TROUBLING ASPECTS of ASSISTED SUICIDE in OREGON
No way
to track the drugs once they are received
“[W]e do
not have a way to track if there was a big bottle [of lethal drugs] sitting in
somebody’s medicine cabinet and they died whether or not somebody else chose to
use
it,” explained Dr. Hedberg. (71)
it,” explained Dr. Hedberg. (71)
Self-administration
is very broadly interpreted
Dr.
Rasmussen explained that, in one case, he opened 90 capsules – a lethal dose –
of barbiturates and poured the white powder into a bowl of chocolate pudding.
He gave the mixture to the woman’s son who spooned the mixture into his
mother’s mouth. Another son gave her sips of water to wash the solution down.
The woman died twelve hours later. (72) (Because the woman performed the last
action – swallowing – that led to her death, the act was technically assisted
suicide, not euthanasia.)
According
to Sue Davidson of the Oregon Nurses Association (ONA), a 2002 survey found
that nurses were very actively involved in the process and that “some indicated
that they had assisted [patients] in the taking of it [the lethal dose].” (73)
Lethal
drugs do not need to be taken orally
Barbara
Glidewell who educates Oregon Health & Science University (OHSU) patients
and their families about “the need for a dying plan and to rehearse the plan”
(74) said that patients who cannot swallow would “need to have an NG tube or G
tube placement.” (75) Then, they could “express the medication through a large
bore syringe that would go into their G tube.” (76)
Oregon’s
2005 Guidebook for Health Care Professionals states, “It remains unclear
whether the Oregon Death with Dignity Act allows an attending physician to
prescribe an injectable drug for the patient to self-administer for the purpose
of ending life.” (77)
Discussing
a case in which a man said he helped his brother-in-law take the prescribed
drugs, Dr. Hedberg said, “[W]e do not know exactly how he helped this person
swallow, whether it was putting a feed tube down or whatever, but he was not
prosecuted….” (78)
“Safeguards”
are disregarded but no one is disciplined
Referring
to assisted-suicide cases that were in violation of the law – where only one of
the required two witnesses signed the request or where doctors prescribed the
lethal drugs without waiting for 15 days as the law requires – Dr. Hedberg
said, “[T]here have been a number over the years.” (79)
Kathleen
Haley, Executive Director of the Oregon Board of Medical Examiners, said four
such cases, one involving multiple patients, (80) were reported to the Board of
Medical Examiners. This resulted in issuance of two “letters of concern” that
are considered “letters of advice.” She explained that the letters “are not
public and they are not official disciplinary actions.” (81)
Records
used in annual reports are destroyed
Dr.
Hedberg said, “After we issue the annual report, we destroy the records.” (82)
Thus, there is no way to track if the same physicians have violated the law
during more than one year.
HMOs
are facilitating assisted suicide
The
unwillingness of many physicians to write lethal prescriptions led one HMO to
issue a plea for physicians to facilitate assisted suicide.
On August
6, 2002, Administrator Robert Richardson, MD, of Oregon’s Kaiser Permanente
sent an e-mail to doctors affiliated with Kaiser, asking doctors to contact him
if they were willing to act as the “attending physician” for patients
requesting assisted suicide. According to the message, the HMO needed more
willing physicians because “Recently our ethics service had a situation where
no attending MD could be found to assist an eligible member in implementing the
law for three weeks….” (83)
Gregory
Hamilton, MD, a Portland psychiatrist pointed out that the Kaiser message
caused concern for several reasons. “This is what we’ve been worried about:
Assisted suicide would be administered through HMOs and by organizations with a
financial stake in providing the cheapest care possible,” he said. Furthermore,
despite promoters’ claims that assisted suicide would be strictly between
patients and their long time, trusted doctors, the overt recruitment of
physicians to prescribe the lethal drugs indicated that those claims were not
accurate. Instead, “if someone wants assisted suicide, they go to an
assisted-suicide doctor – not their regular doctor.” (84)
Kaiser’s
Northwest Regional Medical Director Allan Weiland, MD, called Dr. Hamilton’s
comments “ludicrous and insulting.” (85) But it appears that Dr. Hamilton was
correct, as the involvement of an assisted-suicide advocacy group indicates.
Assisted-suicide
advocacy group facilitates most of Oregon’s assisted suicides
If a
physician opposes assisted suicide or believes the patient does not qualify
under the law, C & C or its predecessor organizations has often arranged
the death.
Dr. Peter
Goodwin, the group’s former medical director said that about 75% of those who
died using Oregon’s assisted-suicide law through the end of 2002 did so with
the organization’s assistance. (86)
During the
2003 calendar year, the organization was involved in 79% of assisted-suicide
deaths. (87)
According
to Dr. Elizabeth Goy of OHSU, Compassion in Dying (now called Compassion and
Choices (88)) sees “almost 90 percent of requesting Oregonians….” (89)
Barbara
Farmer of the Visiting Nurses Association said, if a person’s own doctor
doesn’t want to participate, “we have advised them to work with Compassion in
Dying….” (90)
The
state pays for assisted-suicide drugs for the poor
Oregon’s
Medicaid program pays for assisted suicide (91) but not for many other medical
interventions that patients need and want.
Ann
Jackson, Executive Director and primary spokesperson of the Oregon Hospice
Association, explained, “The State of Oregon, under the Oregon Health Plan,
will buy the medications…. The drugs are very inexpensive.” (92)
No
family notification required before a doctor helps a loved one commit suicide
Family
notification is only recommended, but not required, under Oregon’s
assisted-suicide law. (93) The first time that a family learns that a loved one
was considering suicide could be after the death has occurred.
Prescribing
doctors decide what “residency” means
Under
Oregon’s law, a patient must be a resident of Oregon. Residence can be
demonstrated by means that include, but are not limited to, a driver’s license
or a voter registration. (94)
According
to Dr. Hedberg, “It is up to the doctor to decide” whether the person is a
resident. There is no time element during which one must have lived in Oregon.
“If somebody really wanted to participate, they could move from their home
state,” she said. “I do not think it happens very much….” (95)
Pain
control has become increasingly inadequate in Oregon
As of
2004, nurses reported that the inadequacy of meeting patients’ pain needs had
increased “up to 50 percent even though the emphasis on pain management has
remained the same or is slightly more vigorous…. Most of the small hospitals in
the state do not have pain consultation teams at all,” said a spokesperson for
the Oregon Nurses Association. (96)
As
other states and countries consider Oregon-type laws, it remains to be seen
whether decision-makers will rely on the deceptively rosy picture painted by
assisted-suicide supporters – or on the reality of the Oregon experience.
OPPOSING
EUTHANASIA & ASSISTED SUICIDE EFFORTS
It is important
to be concerned about assisted suicide and euthanasia. But concern alone
doesn’t protect anyone. Tragically, some people worry about the dangers and
assume that either there is nothing they can do or that they don’t have the
time to get involved in effectively opposing those seeking death on demand.
There is,
however, much that can be done by everyone, no matter what one’s age,
occupation or financial ability may be. The following are some concrete
suggestions.
As already
discussed, assisted-suicide laws have been and will continue to be proposed
throughout the country, using two prime avenues – ballot initiatives and
legislative proposals.
No matter
which of those two avenues may be taken, effective advocacy of one’s position
can include the following:
Be
informed. Nothing destroys credibility more than having the facts wrong. Be
able to cite your source for any information.
Keep to
the issue. There are many other “hot button” issues that one may feel
passionate about. But, when discussing assisted suicide, keep the focus on
assisted suicide. Don’t be sidetracked to other issues. Don’t be tempted to
compare assisted suicide to other issues.
Write
letters to the editor of your local newspaper. Keep the letters short and to
the point. (The “Letters to the Editor” section of any newspaper is one of the
most-read sections, only behind the sports page and advice columns.)
Always ask
yourself three questions:
1. Who am
I trying to reach? Know your “audience.” Is it a neighbor, family member,
legislator, large gathering or general reader of the local newspaper?
2. What am
I trying to accomplish? Specifically, what is my one goal in saying or writing
this?
3. Will
what I am planning to say or write reach the person or persons I’m attempting
to reach and will it accomplish what I’m trying to accomplish?
Recognize
that your views are important. Your personal views, shared with clarity and
respect, can have a far greater impact on those you know than anything an
outside “expert” may say.
Become
involved. Be active in neighborhood, community, professional, church and/or
political activities if possible. If you are already taking part in such
activities, you will have far greater influence when speaking about assisted
suicide because you will have established relationships. People will know you
as a friend and colleague.
Don’t take
anyone’s viewpoint for granted. When the issue is assisted suicide, one cannot
predict another’s stance on the topic based on political or religious
affiliations, nor can one’s view regarding assisted suicide be predicted based
on a position related to other issues such as abortion, capital punishment,
etc.
Legislative
proposals
If an
assisted-suicide measure is proposed in the state legislature, the best thing
to do is to elect lawmakers who share your viewpoint about assisted suicide.
This means finding out where candidates stand on the issue. If you are pleased
with the position taken by a candidate, donate to the campaign or volunteer to
work on the campaign, even if it is only to make a few phone calls on the
candidate’s behalf.
Then,
continue to maintain contact with your elected officials after they get into
office. If you have established some type of relationship with your elected
official or with his or her staff, it is far more likely that your voice will
be heard when a really important issue comes up.
If an
assisted-suicide measure is pending, don’t wait until it is almost time for a
vote to contact your elected official. Generally, by the time a measure gets to
a vote, minds are made up. This is not to say that testifying at hearings about
a measure is useless, but it is far easier to change minds before that point.
Remember
that short personal letters are far more effective than petitions or
form letters. Some suggestions:
Keep letters
short (ideally one page long). A multi-page, single spaced letter filled with
underlining shouts, “Ignore me.” That type of letter may get a form letter in
response, but it’s only effect will be to alert office staff to ignore the next
letter or message from the sender.
Be
accurate. Make sure you can back up everything you write.
Say “thank
you.” Occasionally send a letter thanking your elected official for a
particular position or vote that he/she has taken.
Be
respectful but firm. Recognize that a lawmaker may, at first, favor a
particular proposal that you know is dangerous. His or her intent may be good.
But that good intent will not protect people from the sometimes deadly content
of a measure. Gently point out the problems in the bill. Be clear, concise,
brief, and respectful.
Use
correct terminology. Remember the definitions of euthanasia and assisted
suicide explained at the beginning of this report.
Note: The
ITF is not a lobbying organization so it does not contact legislators seeking
to influence their votes. However, the ITF does analyze pending
assisted-suicide bills. A selected point from such an analysis can be used in a
letter or message to a lawmaker. Remember, you – as someone who votes for the
lawmaker – will have far more influence on an elected official than any outside
organization or expert.
Voter
initiative or referendum
If a
proposal will be decided by a direct vote of the people, either through a
referendum or an initiative, the voters – you, your friends, family, neighbors
and colleagues – will be deciding whether the crime of assisted suicide will
become a “medical treatment” in your state.
There are
many effective ways to help others understand the danger of such a proposal.
The following ideas are only a few such ways:
Before such
a measure is actually scheduled for the ballot, begin to discuss assisted
suicide with others.
If you are
a member of a church, professional or civic organization, become involved in
the program committee. If you have suggested other speakers who have been
interesting, your suggestion to schedule a speaker who will discuss assisted
suicide is more likely to be accepted. (You may even decide that you will offer
to be the speaker for the topic.)
If you
belong to an organization that frequently or occasionally adopts resolutions
supporting or opposing pending legislation, draft a simple resolution
supporting your position on assisted suicide. Line up support for it among
others in the organization before proposing it. If your resolution passes, make
certain that your organization issues a press release announcing the
resolution.
Assisted
suicide and euthanasia do, indeed, pose a great threat to families and to all
of society. But, with the exception of Oregon, the Netherlands and Belgium,
attempts to legalize them have been unsuccessful.
Unfortunately,
there are other threats to vulnerable individuals. Those threats and the ways
to protect oneself and one’s loved ones are addressed in Part II of this
report.
Endnotes
for Part I:
1. Some
portions of Assisted Suicide: Not for Adults Only? are included in this report.
For entire text, see Not for Adults Only.
2. “20
October 2004, Pediatricians and child neurologists of the Groningen Academic
Hospital find that in very extraordinary cases doctors must have the possibility
of ending the life of young children…. Groningen pediatricians in the past
years have developed a protocol that can serve as a guideline in cases of the
active ending of life. The protocol serves as guarantee for careful action and
makes the manner of work of the medical treatment team transparent and
testable.” English translation from “Protocol waarborgt zorgvuldigheid bij
levenseinde kind” 29 October 2004, accessed at: http://www.azg.nl/azg/nl/nieuwa/persberichten/43604.
3. Toby
Sterling, “Netherlands hospital says it has euthanized 4 gravely ill babies,”
San Francisco Chronicle, Dec. 1, 2004.
4.
“‘Legalise euthanasia’ says expert,” BBC News, June 8, 2006.
5. “Baby
Euthanasia,” ABC News’ World News Tonight Transcript, Dec. 4, 2005.
6. Ibid.
7. Family
notification is only recommended, but not required, under Oregon’s
assisted-suicide law. ORS 127.835 §3.05.
8. Bill
Kettler, “Family lives through emotions of mother’s assisted suicide,” Mail
Tribune (Medford, OR), July 7, 2000.
9. Jason
O’Bryan, “Right to die must be legalized, protected,” The Daily Bruin Online,
Jan. 20, 2006.
10. The
new name was approved by the VES in 2005 and went into effect in January 2006.
The British organization followed the lead of U.S. and Australian euthanasia
and assisted-suicide groups that have also changed their names to portray a
more appealing image. For more information on the name changes.
11. M.A.
Branthwaite, “Time for change,” British Medical Journal, vol. 331 (Sept. 24,
2005), p. 681.
12. David
Ammons, “Former governor says he’ll offer ‘assisted death’ measure,” Seattle
Post-Intelligencer, Feb. 7, 2006.
13. “The
Compassionate Choices Act” (AB 651) failed on June 27, 2006. For information on
the bill and the campaign waged by both proponents and opponents, see: cal.htm.
14. “Right
to die — a just choice or are we failing the ailing?” San Francisco Chronicle,
Feb. 20, 2005.
15. Robert
G. Faber, “Vote yes on Proposal B: Patients need right to choose,” Jackson
Citizen Patriot (Jackson, MI), Oct. 25, 1998.
16. Clare
Dyer, “Lords back bill to legalise assisted suicide,” British Medical Journal,
vol. 331 (Nov. 19, 2005), p. 1160.
17. I.G.
Finlay, V.J. Wheatley, C. Izdebski, “The House of Lords Select Committee on the
Assisted Dying for the Terminally Ill Bill: implications for specialist
palliative care,” Palliative Medicine, vol. 19 (Sept. 2005), p. 445.
18. Full
text of ad from “Analyzing the Ads,” Oregonian, Oct. 14, 1994. Much of Rosen’s
account about Jody’s death was found to be fabricated. See : “Assisted Suicide:
The Continuing Debate”
19.
Message titled, “Death with Dignity Hearing Info,” from Scott Foster of Scott
Foster & Associates to right-to-die mailing list, Feb. 21, 2002.
20. “Crowd
packs ‘death with dignity’ hearing,” Rutland Herald, Apr. 13, 2005.
21. Dick
Walters, “Death with Dignity,” Letters to the Editor, Burlington Free Press,
Apr. 12, 2005.
22. House
of Lords Select Committee on the Assisted Dying for the Terminally Ill Bill,
Assisted Dying for the Terminally Ill Bill [HL] Volume II: Evidence. Apr. 4,
2005, question 89. (Emphasis added.)
Proceedings
of the committee hearings were published in two volumes.
Available
at: http://www.publications.parliament.uk/pa/ld200405/ldselect/ldasdy/86/86ii.pdf
(last accessed Feb. 23, 2006).
23. Daniel
Foggo, “Chain of suicide clinics planned,” Sunday Times (London), Apr. 16,
2006.
24. Craig
A. Brandt et al, “Model Aid-in-Dying Act,” 75 Iowa Law Review (1989-90), pp.
125-215.
25. Linda
Rockey, “A Call for Compassion: Nurse Leads Fight for Physician-Assisted
Suicide,” Chicago Tribune, Feb. 8, 1998; Tom Bates, “Chief petitioner answers
questions on Measure 16,” Sunday Oregonian, Nov. 27, 1994; Elise Chidley, “PA
Heads Right to Die Group,” PA Today (professional journal for physician’s
assistants), March 21, 1997, p. 8.
26. Diane
Gianelli, “Oregon bill would allow euthanasia,” American Medical News, Apr. 1,
1991 and Tom Bates, “Chief petitioner answers questions on Measure 16,” Sunday
Oregonian, Nov. 27, 1994.
27.
Listing and description of failed assisted-suicide proposals.
28.
Michigan’s 1998 “Terminally Ill Patient’s Right to End Unbearable Pain or
Suffering,” also known as “Proposal B,” was a 12,000 word voter initiative that
confused even its supporters. The initiative failed by 71% to 29%.
29. ORS
127.865 §3.11.
30. Supra
note 22. Remarks by Lord McColl of Dulwich, HL, p. 334, question 956. (Emphasis
added.)
31. DHS,
“Eighth Annual Report on Oregon’s Death with Dignity Act,” March 9, 2006 (http://egov.oregon.gov/DHS/ph/pas/docs/year8.pdf).
32. Linda
Prager, “Details emerge on Oregon’s first assisted suicides,” American Medical
News, Sept. 7, 1998. (Emphasis added.)
33. Joe
Rojas-Burke, “Suicide critics say lack of problems in Oregon is odd,”
Oregonian, Feb. 24, 2000.
34. Oregon
Health Division, CD Summary, vol. 48, no. 6 (March 16, 1999), p. 2 (http://www.ohd.hr.state.or.us/chs/pas/pascdsm2.htm).
35. Supra
note 31, p. 23. The annual report states that the presence of the attending
physician in the 48 out of 246 reported deaths is 28%, however the calculation
is mathematically inaccurate. The correct calculation is 19.5%.
36. DHS,
“Fifth Annual Report on Oregon’s Death with Dignity Act,” March 6, 2003, p. 9 (http://www.ohd.hr.state.or.us/chs/pas/year5/ar-index.cfm).
37. Supra
note 22. Testimony of Katrina Hedberg, p. 263, question 597.
38. Ibid.,
p. 259, question 567.
39. Ibid.
Testimony of Melvin Kohn, p. 263, question 598.
40. Erin
Hoover, “Dilemma of assisted suicide: When?” Oregonian, Jan. 17, 1999 and Erin
Hoover, “Man with ALS makes up his mind to die,” Oregonian, March 11, 1999.
41. Audio
tape on file with author. Also see Catherine Hamilton, “The Oregon Report:
What’s Hiding behind the Numbers?” Brainstorm, March 2000 (http://www.brainstormnw.com);
David Reinhard, “The pills don’t kill: The case, First of two parts,”
Oregonian, March 23, 2000 and David Reinhard, “The pills don’t kill: The
cover-up, Second of two parts,” Oregonian, March 26, 2000.
42.
Johanna H. Groenewoud et al, “Clinical Problems with the Performance of
Euthanasia and Physician-Assisted Suicide in the Netherlands,” 342 New England
Journal of Medicine (Feb. 24, 2000), pp. 553-555.
43.
Associated Press, “Assisted suicide attempt fails,” March 4, 2005.
44. DHS
news release, “No authority to investigate Death with Dignity case, DHS says,”
March 4, 2005.
45. Supra
note 22. Testimony of Katrina Hedberg, p. 266, question 615.
46. Ibid.
Testimony of David Hopkins, pp. 259-260, question 568.
47. Ibid.
Testimony of Jim Kronenberg, p. 347, question 1035.
48. Supra
note 42.
49.
Sherwin Nuland, “Physician-Assisted Suicide and Euthanasia in Practice,” 342
New England Journal of Medicine (Feb. 24, 2000), pp. 583-584.
50. ORS
127.825 §3.03.
51. Andis
Robeznieks, “Assisted-suicide numbers in Oregon,” American Medical News, Apr.
5, 2004.
52. Supra
note 31, p. 23, Table 4. (Emphasis added.)
53. Supra
note 22. Testimony of Katrina Hedberg, p. 259, question 566. (Emphasis added.)
54. Ibid.,
p. 259, question 567. (Emphasis added.)
55. Erin
Barnett, “A family struggle: Is Mom capable of choosing to die?” Oregonian,
Oct. 17, 1999.
56. Peter
Goodwin was an Associate Professor (now professor emeritus) in the Department
of Family Medicine at the Oregon Health Science University in Portland, Oregon
and was Chair of Oregon Right to Die during the campaign to pass Oregon’s
assisted-suicide law. He had been active in the Hemlock Society. Speaking at a
1993 Hemlock conference in Orlando, Florida, he explained that he favored both
the lethal injection and assisted suicide, but he realized that most people
were not yet ready to accept the former so incremental steps would need to be
taken.
57. Erin
Hoover and Gail Hill, “Two die using suicide law; Woman on tape says she looks
forward to relief,” Oregonian, March 26, 1998; Kim Murphy, “Death Called 1st
under Oregon’s New Suicide Law,” Los Angeles Times, March 26, 1998; and Diane
Gianelli, “Praise, criticism follow Oregon’s first reported assisted suicides,”
American Medical News, Apr. 13, 1998.
58. N.
Gregory Hamilton, M.D. and Catherine Hamilton, M.A., “Competing Paradigms of
Responding to Assisted-Suicide Requests in Oregon: Case Report,” presented at
the American Psychiatric Association Annual Meeting, New York, New York, May 6,
2004 (http://www.pccef.oorg/articles/art28.htm).
59. Supra
note 31, p. 23, Table 4.
60. ORS
127.800 §1.01(12), ORS 127.815 §3.01 (a), and ORS 127.820 §3.02.
61. Supra
note 58.
62.
Department of Human Services (DHS), Oregon Health Division (OHD), “Oregon’s
Death with Dignity Act: The Second Year’s Experience,” Feb. 23, 2000, Table 2 (http://www.ohd.hr.state.or.us/chs/pas
/year2/ar-index.cfm).
63.
Katrina Hedberg et al, Letter to the editor in response to “The Oregon Report:
Neutrality at OHD?” Hastings Center Report, January-February 2000, p. 4.
64. Supra
note 22. Testimony of Jim Kronenberg, p. 351, question 1054.
65.
Compassion and Choices of Oregon web site (http://www.compassionoforegon.org)
last accessed March 6, 2006.
66. Supra
note 22. Testimony of Peter Rasmussen, p. 312, question 842. (Emphasis added.)
67. ORS 127.840
§3.06 and ORS 127.850 §3.08.
68. Supra
note 31, p. 24, Table 4.
69. Amy
Sullivan, Katrina Hedberg, David Fleming, “Legalized Physician-Assisted Suicide
in Oregon – The Second Year,” 342 New England Journal of Medicine (Feb. 24,
2000), p. 603.
70. Supra
note 31, p. 9.
71. Supra
note 22. Testimony of Katrina Hedberg, p. 262, question 591.
72.
Jennifer Page, “A Death in Oregon: One Doctor’s Story,” Washington Post, Nov.
3, 1999.
73. Supra
note 22. Testimony of Sue Davidson, pp. 352-353, question 1058.
74. Ibid.
Letter from Barbara Glidewell, included in testimony transcript, p. 268, number
3.
75. Ibid.,
p. 270, question 623.
76. Ibid.,
p. 275, question 653.
77. “The
Oregon Death with Dignity Act: A Guidebook for Health Care Professionals,”
(2005), developed by The Task Force to Improve the Care of Terminally-Ill
Oregonians, convened by The Center for Ethics in Health Care, Oregon Health
& Science University; Chapter 10, Pharmacists and Pharmacy-Related Issues,
p. 4. Available at: http://www.ohsu.edu/ethics/guidebook/chapter10.pdf.
(Last accessed Feb. 23, 2006.) The guidebook notes, “The Act specifically
states: ‘Nothing in ORS 127.800 to 127.897 shall be construed to authorize a
physician or any other person to end a patient’s life by lethal injection….’”
[Chapter 10, p. 4. (Emphasis added.)] It does not specifically state that a
patient cannot end his or her own life by lethal injection.
78. Supra
note 22. Testimony of Katrina Hedberg, p. 267, question 621.
79. Ibid.,
p. 257, question 555.
80. Ibid.
Testimony of Kathleen Haley, p. 323, question 889.
81.Ibid.,
p. 323, question 892.
82. Ibid.
Testimony of Katrina Hedberg, p. 262, question 592.
83. Andis
Robeznieks, “HMO query reignites assisted-suicide controversy,” American
Medical News, Sept. 9, 2002.
84. Ibid.
85. Ibid.
86.
Transcript of tape of Peter Goodwin, “Oregon” Jan. 11, 2003, presented at 13th
National Hemlock Biennial Conference, “Charting a New Course, Building on a
Solid Foundation, Imagining a Brighter Future for America’s Terminally Ill,”
Jan. 9-12, 2003, Bahia Resort Hotel, San Diego California.
87.
“Compassion in Dying of Oregon Summary of Hastened Deaths,” Data attached to
Compassion in Dying of Oregon’s IRS Form 990 for 2003.
88. The
co-director of Compassion and Choices was the chief petitioner for the Oregon
law. Compassion and Choices spearheaded California’s failed legislative measure
– the “Compassionate Choices Act” (AB 651) modeled on Oregon’s law.
89. Supra
note 22. Testimony of Elizabeth Goy, p. 291, question 768. (Goy is an assistant
professor, Dept. of Psychiatry, School of Medicine, OHSU, and has worked with
Linda Ganzini in formulating results of surveys dealing with Oregon’s law.)
90. Ibid.
Testimony of Barbara Farmer, p. 302, question 794. (Farmer is Director, Home
Care and Manager for Legacy VNA Hospice, part of the Visiting Nurse Association
and the Legacy Health System.)
91. Erin
Hoover Barnett, “Suicide coverage passes review,” Oregonian, Apr. 26, 1999.
92. Supra
note 22. Testimony of Ann Jackson, p. 307, question 819. (Jackson is Executive
Director and Chief Executive, Oregon Hospice Association. She is also the
primary spokesperson for OHA and Oregon hospices about the Oregon law.)
93. ORS
127.835 §3.05.
94. ORS
127.860 §3.10.
95. Supra
note 22. Testimony of Katrina Hedberg, p. 267, question 620. (Emphasis added.)
96. Ibid.
Testimony of Sue Davidson, pp. 357-358, question 1098.
12/06
Back to
Table of Contents
-----------------
What people
close to death say about euthanasia and assisted suicide: a qualitative study
This
article has been cited by other articles in PMC.
Abstract
Objective
To explore
the experiences of people with a “terminal illness”, focusing on the patients'
perspective of euthanasia and assisted suicide.
Method
A
qualitative study using narrative interviews was conducted throughout the UK.
The views of the 18 people who discussed euthanasia and assisted suicide were
explored. These were drawn from a maximum variation sample, who said that they
had a “terminal” illness, malignant or non‐malignant.
Results
That UK
law should be changed to allow assisted suicide or voluntary euthanasia was
felt strongly by most people. Those who had seen others die were particularly
convinced that this should be a right. Some had multiple reasons, including
pain and anticipated pain, fear of indignity, loss of control and cognitive
impairment. Those who did not want to be a burden also had other reasons for
wanting euthanasia. Suicide was contemplated by a few, who would have preferred
a change in the law to allow them to end their lives with medical help and in
the company of family or friends. The few who opposed a change in UK law, or
who felt ambivalent, focused on involuntary euthanasia, cited religious reasons
or worried that new legislation might be open to abuse.
Conclusion
Qualitative
research conducted on people who know they are nearing death is an important
addition to the international debate on euthanasia and assisted suicide. Those
who had seen others die were particularly convinced that the law should be
changed to allow assisted death.
The
Netherlands and Belgium permit euthanasia performed by a doctor, and define it
as the act, undertaken by a third party, which intentionally ends a person's
life at his or her request. Doctor‐assisted
suicide is legal in The Netherlands, Belgium and Oregon. Assisted suicide, with
or without the involvement of a doctor, is legal in Switzerland. In Australia,
the Northern Territory approved euthanasia in 1995, but in 1997 this bill was
overturned by parliament.
In the UK,
the issue of euthanasia has been widely debated since the 1870s,1 and many argue that the
question of the right to die has become one of the most important in
contemporary ethics.2
A House of Lords select committee recently produced a report on Joel Joffe's
Assisted Dying for the Terminally Ill Bill, and recommended that, in future,
assisted suicide and voluntary euthanasia be debated separately, allowing the
possibility of a change in the law for one but not the other.3 Lord Joffe has since redrafted his bill,
which had its formal first reading in November 2005.
Euthanasia
in the UK is illegal, but the application of the law is not always clear. For
example, although doctors in the UK are not allowed to give treatment that
causes death, doctors can withhold artificial nutrition and hydration (defined
by the British Medical Association as “life‐prolonging treatments”) if they
believe that this would be in the patient's “best interests”. In the absence of
consensus, any decision must be authorised by a court, but the meaning of “best
interests” can be controversial. Giving food and drink to the sick has long
been used to symbolise “compassionate care”,4 and some may regard the withdrawal of
food and water, as in the Tony Bland case,i as a form of involuntary
euthanasia or even murder.5,6 Thus, the law seems to
be inconsistent.7
It forbids doctors to give a patient a lethal injection at his or her request,
but permits a court to authorise death by starvation without such a request.
The UK law
on assisted suicide has also been described as “contradictory, confusing and
opaque”.8 What
counts as assistance in suicide in “mercy‐killing
cases” seems to be rather arbitrary. In 1989, a couple were convicted because
they sat and watched their daughter (who had motor neurone disease) commit
suicide and die of an overdose, but in 2005 Graham Lawson was not prosecuted
after he comforted his sister, who had multiple sclerosis, during a 26‐h suicide ordeal. She finally
killed herself with a plastic bag. The Director of Public Prosecutions
continues to consider cases individually. Under the Suicide Act 1961 section 2
(4), no prosecution for the offence of assisted suicide can take place without
the consent of the Director of Public Prosecutions. He will exercise his
discretion only after a suicide has taken place; therefore, no prospective
guidance can be given to people.9
Previously,
attitudes to euthanasia and assisted suicide were examined mainly from the
perspectives of politicians, ethicists, health professionals and the general
public.10,11,12
A few studies tried to capture the patients' perspective indirectly—for
example, Seale and Addington‐Hall13 found that a quarter
of bereaved respondents would have preferred an earlier death, and examined the
reasons, but they did not interview the people who were dying. Little is known
about euthanasia or assisted suicide from the patients' point of view.14 We explore these
issues from the perspectives of people who knew they were terminally ill.
Method
With the
approval of the ethics committee, we invited people living in the UK to
participate in a study on the experience of “living with a terminal illness”.
Interviews were contributed to the website, DIPEx (Personal Experiences of
Health and Illness; www.dipex.org).15 We interviewed 41
people who said that they had a terminal illness. We aimed for a sample with
maximum variation, including younger and older people from various social
backgrounds, with malignant and non‐malignant
disease (table 11).16
The sample included people who had attended a hospice for day care and others
who had spent a few weeks in a hospice or nursing home. Some people were
recruited through general practitioners, hospice staff and Macmillan nurses.
Long discussions (to explain the study) were held with health professionals,
who then approached suitable patients with full information. Patients returned
a reply slip to the research team if they wished to participate. Other people
volunteered after reading about DIPEx in a national newspaper, through support
groups or during a conference about palliative care that included patients.
Table
1Characteristics of 18 people who discussed euthanasia or assisted suicide,
drawn from a larger sample of 41 people interviewed about terminal illness
The interviews
Most
people were interviewed in their homes during 2003 and 2004 by a sociologist
and asked to talk about their recent experience of illness. Some were
interviewed twice, usually because of fatigue. All interviews were audiotaped
and lasted 1–2?h. Rather than use a structured approach, we conducted narrative
interviews, which were led by respondents. A few people themselves raised the
subject of suicide, euthanasia or assisted suicide, which became a high profile
issue in the media during the fieldwork. It was considered to be unethical to
press respondents to talk about the subject, but in some cases the researchers
judged that they could invite respondents to comment on the euthanasia debate.
In some interviews the subject was initially raised during a break for rest or
cup of tea (it is sometimes easier to raise a sensitive subject “off tape” in a
more informal atmosphere) and then repeated as part of the taped interview. The
subject was not always raised because it became apparent during the interviews
that some respondents did not think they were dying (even though they had said
they had a terminal illness and had volunteered for the study), and it did not
seem appropriate at the time. Eighteen people discussed these topics, some
briefly and others at some length.
Analysis
Two
members of the research team, both medical sociologists, read and re?read the
data and constructed a coding frame. Data analysis included examining expected
themes such as pain and emergent themes, including suicide and assisted death,
across the whole dataset and in the context of each person's interview. The
method of constant comparisons was used to ensure that all perspectives were
included in the analysis.17
QSR N5 (a qualitative data?indexing package; QSR International Pty, Melbourne,
Australia) facilitated the analysis.18 AC and SZ regularly discussed coding and
interpretation of results (for more details on methods, see www.dipex.org/methodology.aspx).
Results
Arguments supporting voluntary
euthanasia or assisted suicide
Pool5 found that “control
over the time and manner of death” was a central theme in requests for
euthanasia in a Dutch hospital. Some people we interviewed also mentioned a
need to control events, but had further reasons for wanting a change in the
law. For example, a young woman with chronic obstructive lung disease said that
without a change in the law she may commit suicide alone. She was in great
pain, and could not find a place in a hospice. Throughout the interview she
said she wanted to be in control and emphasised her right to choose:
R:
I myself want to be in control as long as I can, I don't want doctors and
nurses controlling me (…) I'm on morphine, I get a lot of breakthrough pain, when
I get to the pitch where I really can't cope with anything any more, where my
quality of life is totally gone, I will tell my husband I want a really good
day out with the kids which is when he'll know that when I go to bed that night
I won't wake up the next morning.
I:
Because you're going to take control?
R:
Yes.
I:
Have you talked to anyone else about that?
R:
Yes, I've talked to my GP about it. He wishes I lived in another country
because that decision would be helped. (…)
I:
And if you were in control of legislation what would you say should happen?
R:
(…) I think that you have to really look into it seriously, whether this is the
right thing for the right person because I think there is the risk it might be
abused. But with myself, if the legislation was there then it would be nicer
for me, so I'm not on my own, which I know I will be because I don't want any
of the family here when it happens.
I:
Why don't you want anyone with you?
R:
Because I don't want them involved, I don't want them to get in trouble. (…) In
other countries, (…) I believe now, you're allowed to choose when you die so
you've still got your dignity. This country we don't allow it; (…) if anybody
helps us they lock them up, which is wrong. You've taken away that person's
dignity and nobody should have the right to do that. We should all have the
right to choose when we die and how we die (LD25).
She
believes that without a change in UK law she would have to die alone to protect
her family from prosecution for their involvement in assisted suicide. She also
notes the difference made by personal involvement:
I
think the government has got to seriously take it on board, and I realise that
it's a very dangerous subject, and it's a very dangerous area, but in the right
situation it's needed (…). I think if some of these ministers and politicians
who are against euthanasia, I sometimes wonder, if it was their life or their
wife or mother, how they'd feel then (LD25).
One
argument against euthanasia has been that good palliative care should control
symptoms, including pain and depression, and therefore people who consider
ending their lives may change their minds when symptoms are properly
controlled. Although most patients do have a pain?free death, however, a few do
not. Sometimes analgesia is insufficient without side effects such as sedation,
nausea and confusion.19
Some respondents mentioned uncontrolled pain:
R:
Sometimes I am in that much pain that all I want to do is put myself on my bed
and go to sleep but I can't sleep because the pain keeps me awake (…). I feel
sad and angry that at the dawn of the 21st century they're able to talk on
television about taking photographs and soil samples of Mars but they can't
give me something that will keep me awake, lucid and to be a useful member of
society and kill the pain at the same time (LD09).
This man
had searched the internet to find out how to commit suicide. He said that he
would not do this without talking it through with his fiancée. He was against
euthanasia but for assisted suicide:
R:
The people that have motor neurone disease, the people that have MS and are in
excruciating pain, a lot worse than the pain that I have, they should be able,
in conjunction with their partner [our emphasis], to decide that enough
is enough and that they should be able to take their own life (LD09).
The
hospice movement exists to deliver outstanding care to dying patients and does
so.20 But
research suggests that hospice care does not stem the wishes of a notable
minority for euthanasia. Seale and Addington?Hall21 interviewed relatives and acquaintances
of those who had died and found that respondents for hospice patients were more
likely than respondents for those who had not received hospice care to believe
that an earlier death would have been better, even after controlling for levels
of distress and dependency among those who were dying. The authors suggest that
this may be either because hospice care is geared to helping patients express
their fears and exercise choice or because people (and their relatives) who
accept hospice care may be predisposed to consider the benefits of an earlier
death. But other reasons may also contribute. One woman we interviewed said
that she would welcome euthanasia or assisted suicide because of what she saw
on a shared ward:
R:
I spent a month in the hospice, (…) just unfortunately probably nine different
ladies came into the ward and died (…). So I have seen what happens at the end
and if I could avoid it happening to me I would, simple as that. (…). It was
really bad luck because I've seen it first hand whereas in the past I could
only guess at I suppose what it could be like at the end, and it's not a
pleasant prospect and if I could just take enough of something to put myself to
sleep for good, I would happily do it and [um]. If somebody wants, you know
wanted to help me, if somebody was brave enough to help me, I'd be grateful to
them. It's almost a nonsense we can't decide what to do with our life at the
end, isn't it? Why should a judge be able to say, no, I can't kill myself if I
want to? (LD02).
In the
1970s Murray Parkes22
interviewed surviving spouses, and asked how their husbands and wives had felt
about other people's deaths in St Christopher's Hospice. Of these, 15 (44%)
respondents said that their spouse had realised that a death had occurred but
most were apparently not upset. More recently, however, Lawton23 observed patients in a hospice who had
unpleasant symptoms that could not be successfully treated or controlled, and
who sometimes requested euthanasia or refused food and drink to hasten death.
She noted that other patients in the ward, like the woman just quoted, were
very distressed by what they saw and smelt.23
Another
woman with metastatic kidney cancer, whom we interviewed, had seen her mother
die a painful, undignified death, and hoped that the law would be changed
before she died. She too was worried by the possibility of an incontinent,
“unbounded” body:23
R:
It would be a comfort to me to think that when I've come to a point where I'm
clearly dying, you know there is no further treatment available for me and if I
am in lots of discomfort, I would like to be able to say, “Can you get my kids
to come and see me,” and maybe, I don't know, my friend, that's a minister or
whatever and say goodbye. And then [er] you know can you just do what has to be
done, give me an overdose of morphine or whatever it is. Because actually my
Mum was in hospital for about three months before she died. And she had sort of
raging osteoporosis having taken lots of steroids for another condition. And
she was in terrible pain and she had made a living will actually. [Um] And they
had to give her so much morphine in the last few weeks, to be honest she was
talking rubbish and coming up with ideas. She told us there was something she
wanted to tell me and that she had murdered twelve children. And I said, “Oh
Mum, you know that is your mind playing tricks because of the drugs. You
haven't murdered anybody”. But she still insisted that she had. And I just wish
that she could have gone a month or two earlier before she went through all
that indignity that is dying really. [um] And I would feel the same about
myself (…). I just think that when you've come to that stage, only you know
when that is, how bad that has to be, you don't need to go through the physical
indignities of throwing up, being smelly, being incontinent, whatever it might
be (LD17).
Others
have noted that when death approaches, people still wish to remain physically
independent.13,24 A man with progressive
multiple sclerosis hated being dependent on his wife and wanted the option of
euthanasia. He had run a nursing home and had seen others die in great pain. At
times he suffered from excruciating pain himself, and he dreaded cognitive
impairment:
R:
I have a strong opinion about that [euthanasia]. First of all I believe that it
is everybody's right to die as it is their right to live (…). Now I would like
to think that if something happens to me [so] that I become completely
incapable of enjoying life then I would want someone to do to me what they
would do to any ordinary animal. They would if it was a dog and it was
suffering and in pain and couldn't be a dog anymore, you would say, “Oh pity”,
and you would take the dog to the vet. I would hope that I could be taken to a
doctor or the doctor would come to me, or would be allowed to and would be able
to just put me to sleep, because I think life is only tolerable if you're alive
(…). What I am saying is for me if I have a stroke that leaves me paralysed,
leaves me brain dead, then I don't want to live like that, I don't and why
should I? (…) I've seen people who you could show a mirror and they would say,
“Who's that?” and they don't know who it is, but the soul has gone as far as
I'm concerned if that's what happens. I don't want to be like that (LD27).
That some
people will feel undervalued and obliged to end their lives to reduce the cost
to others is a concern. Two people we interviewed said that they did not want
to be a burden to others, an important finding, but this was not the only reason
they wanted the option of euthanasia. For example, one woman knew a man with
dementia. Having seen his wife struggling to cope, she said she did not want to
“lumber” herself with anyone or with any institution. But she was also
concerned about pain:
If
your usefulness has gone out of life I can't see the point in delaying things.
And certainly if you are in a vegetative state there is none, I don't know how
anyone can justify it (…). I know one lady who is determined to go on looking
after her husband, and in the eleven years since he was diagnosed with
Alzheimer's, he got to the stage where he was blind, dumb, and she thought
deaf, and she was still pushing food in one end and collecting it the other. He
wasn't alive he was existing (…) God forbid that I ever got to that (…). I
don't want to lumber myself on anyone, or any institution for that matter (…)
but if I ever get to the stage of having the pain which I'd had in the past
without my husband and without my children really needing me, (…) I think the
plastic bag might just come in use. Back to euthanasia, I would much prefer it
if someone would say, “Well, we'll just do it for you calmly and quietly”. I
don't see any point in continuing when there is no purpose in life (LD 22).
A woman
with motor neurone disease worried about the cost of care, but also strongly
favoured euthanasia because she had seen her husband suffer:
R:
I said the same when my lovely husband was ill, if I could have given him a
tablet I would have done. But that isn't possible (…). If your GP or someone
can't do it [assist with suicide or euthanasia] or wouldn't do it, I respect
them but I think somewhere along the line someone should help you. What is the
point? You're suffering unnecessarily and the cost is, you can end up with the
cost, the costs are astronomical and there's no point because there's no end to
it.
I:
In some countries, I think in Scandinavia, it's different, isn't it?
R:
Yes, and Holland there is. My grandson lives in Holland so I know.
I:
Why do you think it's happened in those countries and not in ours?
R:
Because we so drag our feet here, that's why. I mean it's all judgement by
people who are able?bodied and they don't have a clue.
I:
So if the people who are in your situation could be asked their opinion, do you
think a lot of people would think like yourself?
R:
I don't know, I really don't know. But I'm only speaking for me and I saw my
own husband suffer unnecessarily for an end that was inevitable anyway. And to
me that is evil or at least cruel (LD34).
Among
these interviews with people who were themselves facing death, those who spoke
most passionately about the need for a change in the law were those who had
also seen others die.
Arguments against a change in UK law
A few
people opposed a change in UK law (or were ambivalent), who represent negative
cases in the analysis.25
Apart from three people who appeared to be discussing involuntary euthanasia,
one said that people should trust God and that good could come out of suffering,
and another was anxious that people might ask for assisted suicide to help
carers rather than themselves. Others, who overall were in favour of
euthanasia, feared that any new legislation may be misused. For example, a man
with oesophageal cancer said that he would welcome euthanasia for himself, but
hesitated to recommend it as national policy:
R:
I would like an easy death and from that point of view I think I would welcome
euthanasia. Having said that I see all the complications of it, and people who
are at a stage of illness where they can't speak for themselves, a possibility
of somebody wanting to get rid of their relatives, that makes me very nervous,
so although on the one hand I would like to see it to help me, I'm very
hesitant about it.
I:
As a national policy.
R:
As a national policy (…). Yet on the other hand there was um, Dianne [Dianne
Pretty, who took her case to the European court] isn't it, with motor neurone
disease, and that poor women obviously wanted to die and nobody would do
anything about it. It's a conflict, I don't know, I can't deal with it, I don't
know how you sort it out (LD21).
Others
shared concerns about the potential for abuse, but concluded that each case
should be judged on its own merit:
The
thing that would concern me very much is the abuse of it [euthanasia]. It could
be used in the wrong way, and therefore requires a lot of careful thought (…) I
think you've got to judge each case on its own merit actually, and the people
involved (LD31).
Discussion
Our study
is important because it draws on accounts of patients who knew that they would
probably die soon of either cancer or non?malignant disease (table 11).).
Most previous qualitative research designed to understand the dying process has
been based on the views of patients with cancer or those of patients dying of
AIDS.14,26 When examining the views of those with
HIV?1 or AIDS, Lavery et al26
found that people desired euthanasia or assisted suicide because of
disintegration or loss of community. Our participants did not mention loss of
community as a reason for desiring euthanasia or assisted suicide, perhaps
because they did not have diseases as highly stigmatised as AIDS. But they gave
many other reasons for wanting the option of ending their lives. They often had
multiple reasons for wanting a change in the law, including the right to choose
when to end their own life, pain, anticipated pain, cognitive impairment, fear
of indignity, fear of loss of control and concern that they may be a physical
or financial burden on others. Some regretted that they may have to die alone
if suicide became their only legal option.
Only a few
people opposed a change in UK law, mainly it seems because they were discussing
involuntary rather than voluntary euthanasia. Some were ambivalent about a
change in the law that would allow voluntary euthanasia because they feared
that a new law may be misused. It is important, however, to note that this was
not a numerically representative sample and that interviews were led by the
patient's story, not by a set of questions from the researcher. The appropriate
emphasis for the findings is therefore the range of perspectives and the
characteristics and experiences of people who held different views and not the
numbers of people who were for or against euthanasia.
The method
was appropriate to the aim of the study but it had some limitations. The
interviewer did not define exactly what she meant by euthanasia when she
introduced the subject herself, which led to confusion in some cases. One
person, for example, mentioned Harold Shipman, and evidently thought that the
interviewer was talking about involuntary euthanasia or murder. Also, some
respondents may have had strong views but felt unable to introduce the topic
themselves. Although we aimed for a maximum variation sample, we interviewed
few manual workers and the two from minority ethnic groups did not discuss the
subject. It is extremely hard to recruit patients who are dying for any type of
research. Family members may resent precious time and energy being spent on
work that will not give a chance of a cure.27 Health professionals can also be very
protective of their patients and may not facilitate recruitment.28 Seale and
Addington?Hall13
found that social class and religious denomination did not greatly influence
people's views about euthanasia, but they interviewed few people of
non?Christian faiths. If we had interviewed more people from minority groups
with other religious views, we may have heard additional arguments. Numbers of
people interviewed in qualitative studies are necessarily small; so entire
studies may be needed to explore the subject of euthanasia and assisted suicide
from the perspective of the various minority ethnic groups in the UK.29
Most
people in our study were interviewed only once. Some of those who expressed
strong views, either for or against the option of euthanasia or assisted death,
may have changed their views as their illness progressed. Also, the comments
some people made about euthanasia or assisted dying, or the lack of comment in
other accounts, may have been influenced by a need to project a particular
moral stance, by current media debates, or by the palliative care argument that
better end of life care would reduce the need for euthanasia.
Of course
it is important to provide more resources to help all patients die with dignity
in a setting of their choice.20
But, some reason that even with the best palliative care there may be a case
for euthanasia or assisted suicide in certain situations,30 and that without new legislation,
euthanasia and assisted suicide will simply be driven underground.11
In the UK,
the law on euthanasia and assisted suicide certainly needs clarification, and
perhaps even change. Our respondents spoke powerfully, some thinking about
their own deaths, and others recalling the deaths of other people, which
fuelled their criticism of the current UK law. In many parts of the world, the
intense controversy about euthanasia and assisted suicide persists.31,32,33
We believe that these accounts of ordinary people who are facing death should
inform current debate in the UK and elsewhere, but there is still a need for
more research that includes patients' views of these important issues.
Acknowledgements
We thank
the men and women who contributed the interviews; Audrey Chamberlain, who
conducted most of the interviews; those who helped to recruit volunteers; the
members of our advisory panel; and The Gatsby Charitable Foundation for funding
the work. We also thank Clive Seale, Emmie Arnold, Emily Jackson and John
Coggon for valuable comments on an earlier draft of this manuscript. We also
thank Cancer Research UK for a personal award to SZ.
Footnotes
iAiredale NHS Trust v Bland
(1993) AC 789.
Competing
interests: AM and AH are cofounders of DIPEx (www.dipex.org) and all authors are on the DIPEx
steering group. This does not, however, represent a conflict of interest for
this paper.
Ethics
approval: Eastern MREC, House No 1, Papworth Hospital NHS Trust, Papworth
Everard, Cambridge CB3 8RE, UK, approved the protocol.
Written consent:
All the patients quoted in this manuscript gave written consent to use their
interviews in publications, education, lectures and broadcasting.
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31. Quill
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2004. 3502029–2032.2032 [PubMed]
32.
Twisselmann B. “Right to die”: summary of responses [letter]. BMJ 2005. 3301398
33. Fraser
S, Walters J. Death—whose decision? Euthanasia and the terminally ill. J Med
Ethics 2000. 26121–125.125 [PMC free article] [PubMed]
-------------
Assisted dying overseas
A number
of countries have passed laws to provide terminally ill people with the choice
an assisted death, within legal safeguards. These safeguards have protected
vulnerable people [1] whilst ensuring that terminally ill patients do not have
to suffer unnecessarily against their wishes. The law Dignity in Dying proposes
is very similar to the law currently in place on Oregon in the USA.
The Oregon
Death with Dignity Act has been in place for 17 years. It gives terminally ill,
mentally competent people the option of an assisted death. Recent research from
the Journal of Medical Ethics concluded that in Oregon there is no evidence of
abuse or the so-called ‘slippery slope’.
The
numbers using the Act to die are low and steady – and in 17 years just 752
people have been assisted to die, but many more have taken comfort from knowing
the option is there.
The latest
report (available here) demonstrates both the compassionate
benefits to patients and the success of the legal safeguards in
providing protection for vulnerable people.
Washington (USA)
Washington
state voted in favour of an assisted dying law modelled on the Oregon
legislation (the vote took place alongside the presidential election November
2008).
58% of
Washingtonians voted in favour of a change in the law in a voter initiative –
the law will not come into effect instantaneously, and may face challenges (as
the Oregon law did when it was endorsed in a similar voter initiative).
·
In
2013, of patients who request assisted dying: 91% report concerns about loss of
autonomy, 79% concerns about loss of dignity and 89% reported concerns about
loss of ability to participate in activities that make life enjoyable. These
are comparable to Oregon.
·
Approximately
80% have cancer and 10-15% a neuro-degenerative illness such as MND.
·
In
2013, 86 percent were enrolled in hospice care when they ingested the
medication.
·
All
these figures are comparable to those in Oregon.
To view
the latest report – click here.
Vermont (USA)
Assisted
dying has been legal in Vermont since May of 2013. The Vermont law is very
similar to the laws in Oregon and Washington, and Vermont is the first state to
have passed an assisted dying law through the legislative process (rather than
a public vote).
Assisted dying and palliative care
working together
Research
shows that in the countries where assisted dying has been legalised, palliative
care is making great steps forward whilst working alongside the assisted dying
laws.
In the
state of Oregon is consistently found to provide among the best palliative care
in the USA. Currently, 90% of those who receive prescriptions under assisted
dying legislation in Oregon receive hospice care [2]. Furthermore, health
professionals’ skills, knowledge and communication with dying patients have
improved in places with assisted dying legislation [3]. Experiences in other
countries demonstrates that assisted dying legislation can clearly work
alongside established health care methods and systems [4].
Laws allowing direct medical help to die
in Europe
The Netherlands
Patients
who have an incurable condition, face unbearable suffering and are mentally
competent may be eligible for voluntary euthanasia or assisted dying.
There are
about 3,500 cases of assisted dying or voluntary euthanasia a year.
Since the
legislation has been in place rates of non-voluntary euthanasia (i.e. doctors
actively ending patients’ lives without having been asked by them to do so)
decreased from 0.8% of all deaths in 1991 (1,000 deaths) to 0.4% in 2005 (550
deaths).
Belgium
The
Belgian Act on Euthanasia was passed in May 2002. The law allows adults who are
in a “futile medical condition of constant and unbearable physical or mental
suffering that cannot be alleviated” to request voluntary euthanasia.
Luxembourg
In
February 2008, the Luxembourg Parliament approved a Law on the Right to Die
with Dignity. This allows a person who is suffering unbearably from an illness,
and is mentally competent, to request medical assistance to die.
Assisted suicide in Switzerland
Voluntary
euthanasia is forbidden in Switzerland. However, Article 115 of the Swiss Penal
Code exempts people who assist someone to commit suicide, if they act with
entirely honorable motives.
Footnotes
1.
Independent research has found no evidence to justify the grave concerns about
the negative impact of assisted dying legislation on potentially vulnerable
groups. Researchers carefully examined data from Oregon and the Netherlands and
assessed the use of assisted dying legislation for a number of potentially
vulnerable groups. The researchers concluded there was no evidence to support
claims that assisted dying legislation would have a negative impact on these
people – Margaret P Battin, Agnes van der Heide, Linda Ganzini, Gerrit van der
Wal, Bregje D Onwuteaka-Philipsen, ‘Legal physician-assisted dying in Oregon
and the Netherlands: evidence concerning the impact on patients in vulnerable
groups’, Journal of Medical Ethics 2007; 33:591-597
2. Annual
Report on Oregon’s Death with Dignity Act, Department of Human Services, March
2007
3. Ganzini
et al, ‘Oregon Physician’s attitudes about and experiences with end-of-life
care since the passage of the Oregon Death with Dignity Act’, JAMA, 285;18, May
9 2001, 2363-2369. Goy et al, ‘Oregon hospice nurses and social workers’
assessment of physician progress in palliative care over the past 5 years’,
Palliative and Supportive Care 2003, 1, 215-219
4.
Bernheim et al, ‘Development of palliative care and legalisation of euthanasia:
antagonism or synergy?’, BMJ 2008, 336: 864-867
--------------------
Euthanasia and Assisted Suicide:
International Experiences
Julia
Nicol, Marlisa Tiedemann, Dominique Valiquet
Legal and Social Affairs Division
8 April 2011
Revised 25 October 2013
Legal and Social Affairs Division
8 April 2011
Revised 25 October 2013
Contents
·
1
Introduction
·
2.1.3.1
Georgia
·
2.1.3.2
Minnesota
·
2.1.3.3
Arizona
·
2.1.4
Some Other Recent American Cases
·
2.6
Other State Initiatives
·
3
United Kingdom
·
3.1
England and Wales
·
3.2
Northern Ireland
·
3.3
Scotland
·
4
The Netherlands
·
4.1
Development of the Law
·
4.2
Current State of the Law
·
5
Australia
·
6
Belgium
·
7
Switzerland
·
8
France
·
9
Luxembourg
·
10
Colombia
·
Notes
1 Introduction
Over the
last few decades, movements have arisen in a number of jurisdictions in favour
of the legalization of physician-assisted suicide and, in some cases,
euthanasia. At the same time, there continues to be vocal opposition to the
elimination of criminal sanctions for individuals who either assist in or cause
the death of a person who has requested that his or her life be terminated.
Although there are many possible definitions of euthanasia and assisted
suicide, this paper uses the following:
·
“Euthanasia”
is the deliberate act undertaken by one person with the intention of ending the
life of another person in order to relieve that person’s suffering.
·
“Assisted
suicide” is the act of intentionally killing oneself with the assistance of
another person who provides the knowledge, means or both.1
This paper
reviews developments in jurisdictions that already permit physician-assisted
suicide or euthanasia (or both) in certain contexts, as well as developments in
some jurisdictions that appear to be moving toward greater acceptance of these
practices.2 An appendix at
the end of this paper provides an overview, in chart format, of the current
legal status of euthanasia and assisted suicide in various jurisdictions. Note
that in Canada, both euthanasia and assisted suicide are illegal.3
2 The United States
To date,
Oregon, Washington State and Vermont are the only states that have passed laws
explicitly permitting some form of physician-assisted suicide. In addition,
Montana’s Supreme Court concluded that doctors could use the defence of consent
to protect themselves, if certain conditions are met, should they be prosecuted
for assisting a suicide.4
There is little case law in the United States relating to state laws that
permit physician-assisted suicide; most case law relating to this issue
addresses state laws that explicitly prohibit the practice.
2.1 Challenges to State Laws that
Prohibit Physician-Assisted Suicide
The
majority of American states have laws explicitly prohibiting assisted suicide,
while some rely on common-law crimes, which have developed through judicial
decision-making, to prohibit the practice. No American state has legalized
euthanasia. The prosecution of cases of euthanasia is addressed through regular
homicide laws.5
2.1.1
Washington and New York State Laws Prohibiting Assisted Suicide Upheld
On 1
October 1996, the Supreme Court of the United States agreed to hear an appeal
of two Court of Appeal rulings from the states of Washington and New York,
which had concluded that laws prohibiting physician-assisted suicide in those
states were unconstitutional. The Supreme Court had previously refused to hear
an appeal of a Michigan State Court decision that upheld a Michigan law
prohibiting assisted suicide. The law had been passed after high-profile
advocate Dr. Jack Kevorkian began his campaign of assisting terminally ill
people to die.
On 26 June
1997, the Supreme Court reversed both decisions and upheld the Washington and
New York statutes prohibiting assisted suicide. Since that decision, the
appellate courts of other states such as Alaska and Colorado have also upheld
laws criminalizing assisted suicide, concluding that they do not violate the
states’ respective constitutions.6
While the courts have found that these statutes are constitutional, this does
not mean that a law permitting assisted suicide would automatically be found
unconstitutional. Oregon, Washington State and Vermont have passed such laws.
Oregon’s laws were challenged but eventually upheld in the courts (see section
2.2.2, “Legal Challenges to the Death with Dignity Act”).
2.1.2
Defence of Consent for Doctors in Montana
In October
2007, in another challenge to laws against assisted suicide, two terminally ill
patients, four doctors and a patients’ rights organization in Montana brought a
lawsuit before the District Court claiming the “right to die with dignity.”
They alleged that the “application of Montana homicide statutes to physicians
who provide aid in dying to mentally competent, terminally ill patients”
contravened Article 2 of the state constitution, which protects the right to
privacy and human dignity. The District Court, the court where the lawsuit was
initiated, concluded that the constitutional protection of these rights
included the right for competent, terminally ill patients to die with dignity.
In turn, this right was found to include protection from prosecution for a
physician who might assist such a patient.7
The
Montana government appealed the decision to the Montana Supreme Court, which
decided the case without addressing the constitutional question. The majority
of the Court concluded in its December 2009 judgment that doctors could use the
existing defence of consent, if charged with homicide for assisting a mentally
competent, terminally ill patient to commit suicide.8 The consent defence allows a defendant to argue
that the victim consented to the act that the defendant committed, and that the
defendant should thus not be convicted.9
In this way, where the patient is mentally competent and terminally ill,
physicians who prescribe medication so that a patient may commit suicide have a
defence against homicide charges in Montana. Non-physicians may not benefit
from the same protections, since the December 2009 decision only addressed the
situation of doctors.10
Though the
decision provided a defence for doctors in the state, it did not outline any
procedures, standards or safeguards. In Montana, the practice of assisting a
suicide is not regulated in any way, unlike in Washington, Oregon and Vermont
where safeguards are outlined in the legislation on assisted suicide. Montana
House Bill 505, which proposed to overturn the state Supreme Court decision and
make assisted suicide illegal in Montana, was defeated by the state Senate in
April 2013.11 Montana Senate
Bill 220, which would have legalized assisted suicide and provided a framework
to regulate the practice, was defeated the same month.12
2.1.3
Constitutional Challenges by Final Exit Network
2.1.3.1 Georgia
In 2008, a
terminally ill patient died in Georgia, allegedly with the assistance of the
Final Exit Network (FEN), a right-to-die organization. FEN, along with four of
its members – Thomas (Ted) Goodwin, Dr. Lawrence Egbert, Nicholas Sheridan and
Claire Blehr – were charged with assisting John Celmer to commit suicide and
other related charges after Mr. Celmer’s death.
To be
convicted of the crime of assisting a suicide, Georgia’s statute required a
public advertising of assisted suicide, or a public offer to assist in the act,
as an element of the crime. Assisted suicide was legal as long as it remained a
private matter.13 The
accused challenged the constitutionality of the law, based on both the federal
and state constitutions, arguing a number of issues, including a violation of
the right to free speech because of the public advertising element of the
crime. On 6 February 2012, the Supreme Court of Georgia (the state’s highest
appellate court) found that the statute restricted free speech and was
unconstitutional under both the United States and Georgia constitutions. The
charges against all of the accused were dismissed. In response, the state
legislature passed legislation on 29 March 2012 criminalizing assisted suicide.
The new legislation eliminates the advertising element of the offence but also
narrows the scope of the assisted suicide provisions.14
2.1.3.2 Minnesota
As a
result of the investigation in Georgia, information came to light that a woman
in Minnesota, Doreen Dunn, may also have been assisted by FEN members in
committing suicide in 2007. FEN and four of its members, including two of the
accused in the Georgia case (Mr. Goodwin and Dr. Egbert), were charged with
various offences, including assisting a suicide.15
The
accused challenged Minnesota’s law on assisted suicide on grounds similar to
those of the Georgia challenge. The law criminalizes “advis[ing],
encourag[ing], or assist[ing] another in taking the other’s own life.” In
September 2013, in an unpublished decision that is not binding in future cases,
the State of Minnesota Court of Appeals found that the prohibitions on advising
and encouraging unjustifiably infringed on free speech and were overbroad. The
case will be sent back for a retrial on the charges of assisting a suicide.
Media reports state that the Dakota County Attorney (Minnesota) plans to appeal
the decision.16
That
decision appears to contradict an earlier State of Minnesota Court of Appeals
decision which concluded that the same statute was constitutional. In
that case, a former nurse, William Melchert-Dinkel, had communicated over the
Internet and encouraged a Briton and a Canadian to kill themselves. His
motivation appears to have been entirely different from that of the individuals
in FEN, as he wanted to watch the suicides and pretended also to be suicidal.
The Court of Appeals concluded that the type of speech used by Melchert-Dinkel
was not protected speech and that the statute was neither overbroad nor vague.
That case is before the state’s Supreme Court.17
2.1.3.3 Arizona
Another
case involving four FEN members, including Dr. Lawrence D. Egbert, resulted in
pleas to misdemeanours (minor charges) for two of the defendants. A jury
exonerated Dr. Egbert in 2011 and could come to no conclusion with respect to
the final defendant, who later pleaded guilty to a misdemeanour rather than
face a retrial.18
2.1.4
Some Other Recent American Cases
In
Connecticut, two doctors initiated a lawsuit similar to the one undertaken in
Montana. They challenged the state law on assisted suicide, but not in relation
to any specific patients. The Connecticut Superior Court, in its June 2010
decision, dismissed the case. It found that determining whether doctors should
be allowed to assist patients to commit suicide is an issue for the Connecticut
legislature rather than the courts.19
Two
doctors and a woman with advanced ovarian cancer launched a challenge of New
Mexico’s law against physicians assisting terminally ill patients to commit
suicide in March 2012. The matter is scheduled to be heard in December 2013.
The plaintiffs argue that the state’s law against assisted suicide does not
encompass a situation where a physician provides a prescription to a mentally
competent, terminally ill person. They have also made constitutional arguments.
If they win their case, it could have ramifications for other states with
similarly written legislation.20
2.2 Oregon’s Death with Dignity Act
2.2.1
Requirements under the Death with Dignity Act
In
November 1994, Oregon voters passed Measure 16, a legislative proposal that had
been put to a referendum and that allows terminally ill adult residents of
Oregon, with a prognosis of less than six months to live, to obtain a prescription
for medication for the purpose of committing suicide. Before a physician can
issue such a prescription, certain conditions have to be met. For example:
·
The
patient has to make two oral requests at least 15 days apart and one written
request for medication. The written request must be signed before two witnesses
and criteria are outlined in the law regulating who may be witnesses.
Forty-eight hours must elapse between the written request and the provision of
a prescription.
·
A
second medical opinion is required.
·
The
patient has to be capable, meaning that
in
the opinion of a court or in the opinion of the patient’s attending physician
or consulting physician, psychiatrist or psychologist, a patient has the
ability to make and communicate health care decisions to health care providers,
including communication through persons familiar with the patient’s manner of
communicating if those persons are available.21
·
If
either of the physicians is of the opinion that a patient’s judgment may be
impaired by a psychiatric or psychological disorder or depression, the
physician must refer the patient for counselling and cannot prescribe
medication to end the patient’s life until it is determined that the patient’s
judgment is not impaired.
·
The
physician must verify that the patient is making an informed decision, which is
defined in the statute as a decision based on an appreciation of the relevant
facts and made after the patient has been fully informed by the attending
physician of:
·
his
or her medical diagnosis and prognosis;
·
the
potential risks associated with taking the medication to be prescribed;
·
the
probable result of taking the medication to be prescribed; and
·
the
feasible alternatives, including, but not limited to, comfort care, hospice
care and pain control.22
·
The
physician must request that the patient inform his/her next of kin of his/her
request for a prescription, though the physician cannot obligate an individual
to do so.
Details
must be included in the patient’s medical record concerning the requests,
diagnosis, prognosis, any counselling that occurred and the doctor’s offers to
rescind the request. Doctors also have reporting obligations to Oregon’s
Department of Human Services once a prescription is written.23
2.2.2
Legal Challenges to the Death with Dignity Act
A legal
challenge to the legislation prevented the proclamation of Measure 16 until the
end of 1997. The Oregon legislature then voted to have another referendum on
the law, in which Oregon voters reaffirmed their support by a 60% majority and
the Act came into effect in November 1997.24
Opponents
of the Death with Dignity Act quickly began lobbying for federal
intervention against the state initiative. They initially appeared
unsuccessful, but with a change in government at the federal level in 2001, an
Interpretive Rule was issued to clarify the legal situation in federal law for
doctors who might assist a patient to commit suicide. The Interpretive Rule
stated that physicians who prescribed, dispensed or administered federally
controlled substances to assist a suicide would be violating the federal Controlled
Substances Act.25
However, in January 2006, the Supreme Court of the United States in Gonzales
v. Oregon ruled that the Interpretive Rule was invalid because it went
beyond the federal Attorney General’s authority under the Controlled
Substances Act.26
2.2.3
Death with Dignity Act Annual Reports
The Death
with Dignity Act requires Oregon’s Department of Human Services to annually
review and report on information collected in accordance with the Act. Table 1
highlights some statistics that reports have provided since the legislation
came into force.
Table 1
– Annual Statistics Relating to Oregon’s Death with Dignity Act,
1998–2012
Year
|
Reported Prescriptions Written
for Medication to Commit Suicide
|
Reported Deaths by Ingestion of
the Prescribed Medicationa
|
Reported Deaths by
Physician-Assisted Suicide per 1,000 Deaths
|
1998
|
24
|
16
|
0.55
|
1999
|
33
|
27
|
0.92
|
2000
|
39
|
27
|
0.91
|
2001
|
44
|
21
|
0.71
|
2002
|
58
|
38
|
1.22
|
2003
|
68
|
42
|
1.36
|
2004
|
60
|
37
|
1.23
|
2005
|
65
|
38
|
1.2b
|
2006
|
65
|
46
|
1.47
|
2007
|
85
|
49
|
1.56
|
2008
|
88
|
60
|
1.94
|
2009
|
95
|
59
|
1.93
|
2010
|
97
|
65
|
2.09
|
2011
|
114
|
71
|
2.25
|
2012
|
115
|
77
|
2.35
|
Notes:
a. The
Oregon Department of Human Services reports also note cases where the status of
individuals who received a prescription is unknown. Return to table 1
b. The
figure of 1.2 deaths due to physician-assisted suicide for every 1,000 deaths
in 2005 is an estimate only, though the annual report for 2005 does not explain
why. See Oregon Department of Human Services, Office of Disease Prevention and
Epidemiology, Eighth Annual
Report on Oregon’s Death with Dignity Act 
(184.37
kB, 24 pages), Portland, Oregon, 9 March 2006. Return to table 1
(184.37
kB, 24 pages), Portland, Oregon, 9 March 2006. Return to table 1
Sources: Oregon Department of Human
Services, Prescription History
– Oregon Death with Dignity Act (53.08
kB, 1 page), 1998–2012; and Oregon Health Authority, “Death with Dignity Act Annual Reports”
(1998–2012).
(53.08
kB, 1 page), 1998–2012; and Oregon Health Authority, “Death with Dignity Act Annual Reports”
(1998–2012).
Though the
number of prescriptions written and deaths due to ingestion have increased
almost every year since the law was passed, relatively few prescriptions have
been written considering that almost four million people live in Oregon. The
number of deaths by physician-assisted suicide out of all deaths was a little
more than two of every 1,000 deaths in Oregon in 2012.
The annual
reports provide aggregate statistics about who is choosing assisted suicide:
·
52%
were men;
·
69%
were 65 or older;
·
98%
were white;
·
45%
had a baccalaureate degree or higher;
·
90%
were enrolled in hospice care and 95% died at home;
·
65%
had private health insurance and 34% had some form of government health
insurance; and
·
80%
had cancer.
The three
most common reasons for choosing assisted suicide were concerns about losing
autonomy, being less able to engage in activities that make life enjoyable and
loss of dignity.27
2.3 Washington State’s Death with
Dignity Act
The State
of Washington passed its Death with Dignity Act by referendum on 4
November 2008 and it came into force on 5 March 2009.28 The law is based on the law in Oregon and
includes reporting requirements, with the Washington State Department of Health
playing a collection and monitoring role similar to Oregon’s Department of
Human Services.29 Table 2
highlights some statistics that reports have provided since the legislation
came into force.
Table 2
– Annual Statistics Relating to Washington State’s Death with Dignity Act,
2009–2012a
Year
|
Reported Prescriptions Written
for Medication to Commit Suicide
|
Reported Deaths of “Death with
Dignity Participants” (individuals who had received a prescription)
|
2009b
|
63
|
36
|
2010
|
87
|
51
|
2011
|
103
|
101
|
2012
|
121
|
83
|
Notes:
a. The
statistics in the Washington State Department of Health annual reports about
the people who died due to assisted suicide differ from those in the Oregon Department
of Human Services reports, summarized in Table 1. In its total, Washington
includes both individuals who died due to ingestion of the prescribed
medication and individuals with a prescription but who died due to other
reasons, such as terminal illness. Oregon’s statistics relate only to deaths
due to ingestion of the prescribed medication. However, the demographic profile
of the individuals involved is similar. The reports for both states also note
cases where the status of individuals who received a prescription is unknown. Return to table 2
b. The
numbers for 2009 represent the period beginning 5 March 2009 with the entry
into force of the law. Return to table
2
Sources: Washington State Department of
Health, Death with Dignity
Act (annual reports, 2009–2012).
2.4 Concerns with the Laws in Oregon and
Washington State
A number
of concerns have been raised with respect to Oregon’s Death with Dignity Act,
as well as with Washington’s similar law. Some commentators and organizations
that oppose assisted suicide fear that it will be seen by insurers as an
economically attractive alternative, in contrast to costly life-sustaining care
for the terminally ill. Fox News and other media have reported that, for
reasons of cost, Oregon’s Medicaid has refused to cover patients’ access to
life-sustaining but non-curative cancer treatment because it would not cure their
cancer – even though the treatment could prolong and improve the quality of the
patients’ lives. (Medicaid is state-funded health care for low income
residents.) However, the patients were reportedly told at the same time that
the program would cover comfort care, including the cost of the prescription
for medication to commit suicide, if they wanted assistance in ending their
lives.30 Nonetheless,
Oregon’s 2012 annual report on the state’s Death with Dignity Act
reports that only 2.7% of those who died between 1998 and 2012 after ingesting
the prescribed medication had concerns about the financial implications of
treatment when they decided to seek assistance to commit suicide.31 In Washington, the figure was 5% in 2012 and
4% in 2011.32
According
to Oregon’s 2012 annual report, 39% of individuals who died between 1998 and
2012 after ingesting the prescribed medication were concerned about becoming a
burden at the end of their life.33
In Washington State, 63% of those who ingested the medication in 2012 and 54%
of those who did in 2011 voiced such concerns.34 Because a doctor does not need to be present
at the time of death, some commentators worry about the risk of abuse if
individuals are pressured or forced to take the medicine. Other concerns
include inadequate identification and referral for mental health issues prior
to issuing a prescription, under-reporting by doctors, lack of sanctions for
those who do not comply with the legal requirements and lack of enforcement
mechanisms to ensure compliance with the law.35
2.5 Vermont’s Act Relating to Patient
Choice and Control at End of Life
On 20 May
2013, Vermont’s Governor Peter Shumlin signed the Patient Choice at End of Life
Bill into law. This is the first law permitting physician-assisted suicide to
be passed by a legislature in the United States; the Oregon and Washington laws
were passed by referendum. This law is modelled on Oregon’s law. However, the
provision outlining requirements similar to Oregon’s will expire on 1 July
2016. After that date, the requirements change, and a person expected to die
within six months would potentially be able to get a prescription after a
single consultation with a doctor.36
2.6 Other State Initiatives
Since
1991, four proposals to legalize euthanasia and/or assisted suicide by
referendum (including an earlier one in Washington State) have been defeated.
Since 1994, 135 bills have been proposed on the topic in 27 states, with only
the Vermont law being passed.37
Massachusetts recently held a referendum in which voters rejected an attempt to
legalize physician-assisted suicide in that state by a very small margin.38 In addition to the
legislature of Montana, which is mentioned above, a number of state
legislatures dealt with assisted suicide bills in 2013, including the
legislatures of the following states:
·
Connecticut
(House Bill 6645, House Bill 6217, Senate Bill 48 and Senate Bill 229), Hawaii
(House Bill 606) and Maine (Legislative Document 1065), though all of these
initiatives were defeated; and
·
Kansas
(House Bill 2068 and House Bill 2108), Massachusetts (House Bill 1998), New
Jersey (Assembly Bill 3328 and Senate Bill 2259) and Pennsylvania (Senate Bill
1032), where initiatives were still before the respective state legislatures at
the time of writing.
3 United Kingdom
3.1 England and Wales
End-of-life
decisions have caused considerable controversy in the United Kingdom (U.K.).
Euthanasia is unlawful throughout the U.K. While assisted suicide also remains
illegal, a person assisting will not necessarily be prosecuted, as a result of
developments discussed in this section.
The
European Court of Human Rights heard the case of Diane Pretty on 19 March 2002.
Ms. Pretty, who was paralyzed from the neck down as a result of a motor neuron
disease (a neurological disorder), had unsuccessfully sought assurances from
the Director of Public Prosecutions (DPP) that her husband would not be
prosecuted if he assisted her suicide. The Court found that the DPP’s refusal
of her request and the U.K.’s prohibition of assisted suicide did not infringe
on any of her rights under the Council of Europe’s European Convention on
Human Rights.39
In March
2004, Lord Joel Joffe introduced the Assisted Dying for the Terminally Ill Bill
in the House of Lords, and a Select Committee was established to review the
bill in November of the same year. The bill was similar to the Oregon Death
with Dignity Act in many ways. Lord Joffe’s bill differed, however, in one
major respect from the Oregon model, in that it not only allowed a physician to
provide a patient with the means to end his or her life (assisted suicide), but
also allowed the physician to end the life of a patient who was physically
unable to do so himself or herself (euthanasia). The bill also differed from
the Death with Dignity Act by requiring that a patient who makes a
declaration seeking assisted suicide do so in front of a solicitor who, in
order to witness the declaration, must find the patient to be of sound mind and
be satisfied that the patient understands the effect of the declaration. The
Assisted Dying for the Terminally Ill Bill also contained a clause preventing a
physician with a conscientious objection from being obligated to participate in
an assisted death.
The Select
Committee released its report on the bill in March 2005 and, while noting that
there was insufficient time to proceed with the bill in that session, made a
number of recommendations with respect to any similar bills that might be
introduced at a later date. For example, a new bill should draw a clear
distinction between assisted suicide and euthanasia. Also, such legislation
should spell out what actions a physician may or may not take in assisting a
suicide or in administering euthanasia.40
The committee report was debated in the House of Lords in October 2005. A
subsequent bill introduced by Lord Joffe was effectively defeated by the House
of Lords on 12 May 2006.
In the
mid-2000s, Debbie Purdy, who suffered from multiple sclerosis, made it known
that she wanted to obtain the assistance of a Swiss clinic to end her life. She
was afraid, however, that her husband, Omar Puente, would be prosecuted in the
U.K. if he accompanied her to Switzerland. She wanted to determine the DPP’s
official policy in this regard, and clarify whether it was legal under British
law for a British citizen to assist someone to commit suicide in a country like
Switzerland where assisted suicide is legal.
The House
of Lords concluded that the DPP should be required to make the policy public.41 A final policy, published in
February 2010, states clearly that assisted suicide remains a criminal offence.
However, it outlines a two stage process to determine whether charges will be
brought: first, it must be determined if there is sufficient evidence of an
offence having been committed and, second, it must be decided whether a
prosecution is in the public interest. Specific factors, such as whether the
person who committed suicide clearly stated the intention to do so and the
motivation of the person who assisted, are to be considered.42
In
September 2010, a non-governmental Commission on Assisted Dying was set up to
study the issue of assistance in dying. Lord Charles Falconer acted as the
Chair.43 The commission
concluded in its 2011 report that assisted suicide should be legalized in
England and Wales, though it outlined recommendations for improved health and
social services as well as for eligibility criteria to ensure sufficient
safeguards are in place to protect vulnerable individuals.44 Critics allege that the report was flawed
because the commission’s funders and a majority of the commissioners supported
changing the law prior to the commission starting its work. Critics also stated
that groups on the other side of the debate were excluded and/or refused to
take part.45
On 16 May
2013, Lord Falconer introduced a new bill in the House of Lords to legalize
physician-assisted suicide (not euthanasia). The bill is quite similar to those
in Oregon and Washington State, though there are some differences. A doctor or
a nurse authorized to do so may go so far as to assist an individual in
ingesting or self administering the drug, though the final act of taking the
medicine must be completed by the patient. The assisting health professional
must remain near the patient until they either die or decide not to administer
the medicine.46
In a July
2013 decision, the England and Wales Court of Appeal (Civil Division) rejected
a challenge to the country’s laws on assisted suicide and euthanasia. Tony
Nicklinson and an individual known as AM, both of whom were paralyzed, had
initiated the case, with another plaintiff, Paul Lamb, joining later (Mr. Lamb
was also paralyzed). When Mr. Nicklinson died shortly after a lower level court
decision came out, his wife also became a plaintiff. The Court of Appeal
refused to create a common-law defence of necessity for individuals charged for
committing euthanasia or assisting a suicide. However, the Court found that the
DPP policy mentioned above was not sufficiently clear for individuals in all
situations to have a good understanding of whether they would be prosecuted for
assisting a suicide. This was found to be a violation of section 8 of the European
Convention on Human Rights.47
3.2 Northern Ireland
The DPP’s
jurisdiction is limited to England and Wales, but Northern Ireland has a
similar policy, developed in collaboration with the DPP.48
3.3 Scotland
Scotland
does not have a statutory offence of assisted suicide as do England, Wales and
Northern Ireland. Depending on the facts, a case of assisted suicide might be
addressed through homicide laws.49
In an attempt to eliminate this risk, Margo MacDonald, an independent member of
Parliament living with Parkinson’s disease, introduced a bill in the Scottish
Parliament in 2010 that would have legalized assisted suicide. According to the
website of the Scottish Parliament, “Parliament disagreed to the general
principles of the Bill,” so the bill was defeated on 1 December 2010.50 Ms. MacDonald has begun the
process to introduce another bill to legalize assisted suicide.51
4 The Netherlands
4.1 Development of the Law
Traditionally,
euthanasia was prohibited under the Dutch penal code, which states that anyone
who terminates the life of another person at that person’s explicit request is
guilty of a criminal offence. Nonetheless, those who practised euthanasia in
the Netherlands were not prosecuted as long as they followed certain
guidelines. The guidelines were developed through a series of court decisions
in which physicians who had been charged with practising euthanasia were found
not to be criminally liable. Under the guidelines, all of the following
requirements had to be met:
·
The
patient must repeatedly and explicitly express the desire to die.
·
The
patient’s decision must be well-informed, free and enduring.
·
The
patient must be suffering from severe physical or mental pain with no prospect
of relief (but need not be terminally ill).
·
All
other options for care must have been exhausted (so that euthanasia is a last
resort), or the patient must have refused other available options.
·
The
euthanasia must be carried out by a qualified physician.
·
The
physician must consult at least one other physician (and may also consult other
health care professionals).
·
The
physician must inform the local coroner that the euthanasia has been carried
out.
In
February 1993, the Netherlands passed legislation on the reporting procedure
for euthanasia. Although it did not legalize euthanasia, the legislation
provided a defence to physicians who followed certain guidelines. In effect,
this provided doctors with protection from prosecution.
In 1994,
the Supreme Court of the Netherlands decided the controversial Chabot case,
finding Dr. Boudewijn Chabot technically guilty of assisting a suicide. Dr.
Chabot’s patient, 50 year old Hilly Bosscher, had simply not wished to live
because of a violent marriage, the death of two sons and 20 years of
depression. After working with the patient for some time and believing the
situation to be hopeless, Dr. Chabot considered that the lesser evil would be
to provide his patient with the means to commit suicide painlessly and with as
little violence as possible.
The
Supreme Court accepted the principle that assisted suicide could be justifiable
in cases where, although no physical illness was present, the patient was
experiencing intense emotional or mental suffering. However, the Court found
that Dr. Chabot had violated procedural requirements. Nonetheless, the Court
declined to impose a penalty on Dr. Chabot. The issue of assisting a suicide in
order to relieve non-somatic (non-physical) suffering remains a contentious
one.
With
respect to infants, in 1995, Dutch courts dealt with two separate but similar
cases in which doctors had ended the lives of severely disabled infants, both
of whom were in pain and were not expected to survive their first year. In each
case, the doctor had acted at the explicit request of the child’s parents. The
courts concluded that the doctors had met the requirements of good medical
practice in those cases.52
In 2004, some doctors and the district attorney in Groningen, Netherlands,
developed a protocol to identify when euthanasia of infants is appropriate. The
Groningen Protocol has been ratified by the National Association of Pediatricians,
and doctors who respect the protocol’s requirements appear not to be prosecuted
in the Netherlands, though the protocol is not an actual law.53 The Royal Dutch Medical Association is
reportedly advising that a new test be established to determine when euthanasia
of a newborn is allowed. It recommends that a factor for consideration in such
cases be the anguish of the parents watching their baby suffer.54
4.2 Current State of the Law
In August
1999, the Minister of Justice and the Minister of Health tabled a legislative
proposal in the House of Representatives – the lower house of Parliament –
legalizing euthanasia and assisted suicide as long as certain conditions are
met. The bill was passed by the House of Representatives on 28 November 2000 by
a vote of 104 to 50 and by the Senate on 10 April 2001 by a vote of 46 to 28.55
The new
statutory provisions make no substantive change to the grounds on which
euthanasia and assisted suicide are permitted based on the case law, but do
spell out in more detail the existing criteria for due care. The physician
must:
·
be
satisfied that the patient’s request is voluntary and well considered;
·
be
satisfied that the patient’s suffering is unbearable and that there is no
prospect of improvement (not necessarily a terminal illness);
·
inform
the patient of his or her situation and further prognosis;
·
discuss
the situation with the patient and come to the joint conclusion that there is
no other reasonable solution;
·
consult
at least one other physician with no connection to the case, who must then see
the patient and state in writing that the attending physician has satisfied the
criteria for due care; and
·
exercise
due medical care and attention in terminating the patient’s life or assisting
in his or her suicide.
Individuals
may write an advance directive outlining the circumstances in which they would
want euthanasia to be performed. Physicians must report cases to a regional
review committee. That committee decides by a majority whether the criteria
were respected. It refers cases where one of the criteria is not met to the
Public Prosecution Service and the Health Care Inspectorate.56
The most
controversial aspect of the legislation was a proposal that children as young
as 12 be permitted to request euthanasia or assisted suicide. However, the
legislation as passed follows the Netherlands’ Medical Treatment Contracts
Act, and parental consent is required for persons under the age of 16. In
principle, 16- and 17 year olds can decide for themselves, but their parents
must always be involved in the discussion.
In June
2004, an article in the medical journal The Lancet suggested that the
strict regulations governing euthanasia in the Netherlands might be loosened,
in part because of a concern that they might be causing under-reporting. The
situation with respect to persons with Alzheimer’s disease or other
non-terminal illnesses remains somewhat contentious. There has also been some
discussion in the Netherlands of allowing euthanasia and/or assisted suicide
for people who are simply “tired of life.”57 In 1998 (before the current law was in place),
a doctor assisted an 86 year old former senator who had no physical or
psychiatric illness or disorder to die because he no longer wanted to live. At
the appellate level, the doctor was found guilty of assisting a suicide since
he had not respected the requirements set out in the case law, though he received
no punishment because, as was reported in a January 2003 British Medical
Journal article, “he had acted out of great concern for his patient.”58
4.3 Statistics and Reviews of the System
Most cases
of reported deaths by euthanasia and assisted suicide involve individuals
suffering from cancer. There have been significant increases in reported deaths
by euthanasia and/or assisted suicide in recent years (as high as 19% between
2009 and 2010). Though regional review committees have been examining the
reasons for these increases, they have not come to any clear conclusions as to
whether there has been an increase in euthanasia and/or assisted suicide or
whether doctors are simply reporting more often, given that reporting had not
been universal in the past. Multiple reviews and studies of the system, both
official and independent, have been undertaken in recent years.59 Table 3 highlights some statistics that
reports have provided in recent years.
Table 3
– Annual Statistics Regarding the Netherlands’ Law Relating to Euthanasia and
Assisted Suicide, 2003–2011
Year
|
Reported Deaths by Euthanasia
|
Reported Deaths by Assisted
Suicide
|
Reported Deaths by a
Combination of Euthanasia and Assisted Suicide
|
2003
|
1,626
|
148
|
41
|
2004
|
1,714
|
141
|
31
|
2005
|
1,765
|
143
|
25
|
2006
|
1,765
|
132
|
26
|
2007
|
1,923
|
167
|
30
|
2008
|
2,146
|
152
|
33
|
2009
|
2,443
|
156
|
37
|
2010
|
2,910
|
182
|
44
|
2011
|
3,446
|
196
|
53
|
Sources: Annual reports published by
regional euthanasia review committees, including the following: Annual Report 2011
(919.79
kB, 36 pages), The Hague, August 2012; Annual Report 2010
(1,013.17
kB, 34 pages), The Hague, August 2011; Annual Report 2009
(884.42
kB, 29 pages), The Hague, May 2010; 2008 annual report
(126.50
kB, 36 pages), The Hague, April 2009; 2007 annual report
(273.88
kB, 37 pages), The Hague, April 2008; 2006 annual report
(288.15
kB, 45 pages), Arnhem, (The Netherlands), May 2007; 2005 annual report
(299.55
kB, 30 pages), Arnhem, April 2006; 2004 annual report
(267.86
kB, 24 pages), Arnhem, March 2005; and 2003 annual report
(245.92
kB, 22 pages), Arnhem, September 2004.
(919.79
kB, 36 pages), The Hague, August 2012; Annual Report 2010
(1,013.17
kB, 34 pages), The Hague, August 2011; Annual Report 2009
(884.42
kB, 29 pages), The Hague, May 2010; 2008 annual report
(126.50
kB, 36 pages), The Hague, April 2009; 2007 annual report
(273.88
kB, 37 pages), The Hague, April 2008; 2006 annual report
(288.15
kB, 45 pages), Arnhem, (The Netherlands), May 2007; 2005 annual report
(299.55
kB, 30 pages), Arnhem, April 2006; 2004 annual report
(267.86
kB, 24 pages), Arnhem, March 2005; and 2003 annual report
(245.92
kB, 22 pages), Arnhem, September 2004.
5 Australia
5.1 The Northern Territory’s Rights of
the Terminally Ill Bill
In
February 1995, the Chief Minister of the Northern Territory of Australia
introduced a private member’s bill, the Rights of the Terminally Ill Bill
(1995) (NT), in the territory’s Legislative Assembly. The bill was intended to
provide a terminally ill person with the right to request assistance from a
medically qualified person in voluntarily terminating his or her life. A Select
Committee on Euthanasia was established to study the bill and report back to
the Legislative Assembly. In May 1995, after more than 50 amendments had been
made to the original bill, the Legislative Assembly passed the legislation by
15 votes to 10.
The bill
created considerable controversy, both within Australia and internationally.
There were calls for its repeal, and for the Governor-General of Australia to
disallow it under the Northern Territory (Self-Government) Act, 1978;
however, the administrator of the Northern Territory assented to the Act in
June 1995, and to regulations under the Act in June 1996. These came into
effect, with the Act itself, on 1 July 1996. The Northern Territory thus became
the first jurisdiction in the world to legalize physician-assisted suicide and
euthanasia.
Between May
1995, when the bill was passed, and July 1996, when it came into force, the
Northern Territory Legislative Assembly passed further amendments to the
legislation whereby the number of doctors to be involved was increased from two
to three, one of whom must be a qualified psychiatrist and another a specialist
in the patient’s illness. The Rights of the Terminally Ill Act 1995 (NT)
included many administrative safeguards as well as numerous references to
treatment and levels of suffering “acceptable to the patient.”
In an
attempt to prevent the bill from becoming law, the president of the Northern
Territory Branch of the Australian Medical Association, Dr. Christopher Wake,
and an Aboriginal leader, Reverend Dr. Djiniyini Gondarra, challenged its
validity. One of the grounds for challenging the bill was that the exercise of
legislative power by the legislative assembly is constrained by an obligation
to protect an inalienable “right to life” that is deeply rooted in the
democratic system of government and in the common law. By a two-to-one
majority, the Supreme Court of the Northern Territory upheld the legislation,
stating that it need not decide whether the legislation infringed any
fundamental right because, in the absence of a constitutionally enshrined Bill
of Rights, that issue was “ethical, moral or political,” rather than legal, in
nature.
Some
critics had argued that the amended bill was too cumbersome to be workable, but
in late September 1996, a Darwin resident became the first person to use the
new legislation successfully. As a result, controversy erupted again. The
patient had suffered from prostate cancer for five years and, according to
press reports, the lethal injection was triggered by a laptop computer through
which the patient confirmed his wish to die. (According to a 27 July 1996 Chicago
Tribune article, special computer software activated a syringe filled with
pentobarbital sodium and a muscle relaxant. The syringe featured an intravenous
line to the patient and a cable to the laptop.) Three other people used the
provisions of the Act before it was soon overruled by the national Parliament.
Under
Section 122 of the Australian Constitution, the Commonwealth Parliament has a
plenary power to pass legislation overriding any territorial law. In September
1996, Kevin Andrews, a government backbencher, introduced a private member’s
bill to overturn the Northern Territory’s euthanasia law. The bill, the Euthanasia
Laws Act 1997, was passed in the House of Representatives on 9 December
1996 and in the Senate on 24 March 1997, meaning that the Rights of the
Terminally Ill Act 1995 (NT) was no longer of any force or effect.
Since
2007, senators have introduced a number of bills in the Commonwealth Senate
(national level) to repeal the Euthanasia Laws Act 1997. To date, none
of the bills have passed.60
5.2 Other Legislative Proposals
In recent
years, there have been numerous legislative proposals relating to euthanasia at
the state level, with all states except Queensland considering the issue. A
bill introduced in New South Wales was defeated in May 2013.61 A bill in South Australia was postponed at
second reading in March 2013. In Tasmania, the premier and the leader of the
Greens political party published a consultation document in February 2013 and
introduced a private member’s bill, the Voluntary Assisted Dying Bill,
in September 2013. The bill failed to pass when put to a vote in October 2013
(the vote was 11 to 13).62
As of October 2013, none of the various legislative initiatives across the
country had passed.
6 Belgium
Belgium
legalized euthanasia in 2002.63
Unlike the law in the Netherlands, the Belgian Act does not regulate assisted
suicide;64 it regulates only
euthanasia, which it defines as an act of a third party that intentionally ends
the life of another person at that person’s request. Anyone who has reached the
age of majority (18 years) or is an emancipated minor (by marriage or court
order), is mentally capable and is conscious may make a request if they have an
incurable condition that results in constant and unbearable physical or
psychiatric suffering.65 The
legislation established conditions that must be met by both the person seeking
euthanasia and the physician who performs it. The physician is required to fill
out a registration form each time he or she performs euthanasia; this form is
then reviewed by a commission whose role it is to determine whether the
euthanasia was performed in accordance with the conditions and procedures of
the legislation. If two thirds of the commission members are of the opinion
that the conditions were not fulfilled, the case is referred to the public prosecutor.
Individuals can make an advance directive expressing their desire to be
euthanized as long as certain conditions are met when the time arrives, such as
loss of consciousness by an individual. Table 4 highlights some statistics that
reports have provided since the legislation came into force.
Table 4
– Annual Statistics Concerning Belgium’s Law Relating to Euthanasia,
2002–2011
Year
|
Reported Deaths by Euthanasia
|
Deaths by Euthanasia
per 1,000 Deaths |
22
Sept. 2002–31 Dec. 2003
(approximately 15 months) |
259
|
2
|
2004
|
349
|
3.6
(2004–2005 average)
|
2005
|
393
|
3.6
(2004–2005 average)
|
2006
|
429
|
4.4
(2006–2007 average)
|
2007
|
495
|
4.4
(2006–2007 average)
|
2008
|
704
|
7
(2008–2009 average)
|
2009
|
822
|
7
(2008–2009 average)
|
2010
|
953
|
10
(2010–2011 average)
|
2011
|
1,133
|
10
(2010–2011 average)
|
Sources: Belgium, Santé publique,
Sécurité de la chaîne alimentaire et Environnement, Biannual reports on the Loi relative à la
euthanasie, 2004–2012.
A number
of bills proposing to amend Belgium’s euthanasia law were before the country’s
federal legislature as of October 2013. A few of the bills sought to expand
access to euthanasia to all minors and individuals suffering from dementia.
Others seek to legalize assisted suicide and to require greater consideration
of palliative care alternatives to euthanasia. News reports state that
legislators have agreed to pass amendments to allow minors to request
euthanasia if certain conditions are met.66
7 Switzerland
Article
114 of the Swiss Penal Code prohibits euthanasia, although the crime has
a lesser sentence than other acts deemed homicide; murder carries a mandatory
minimum sentence of five years’ imprisonment, for example, while Article 114
provides that an individual who kills a person for compassionate reasons on the
basis of that person’s serious request will be fined or sentenced to a maximum
term of imprisonment of three years. Assisted suicide is addressed in Article
115, which provides that someone who, for selfish reasons, incites someone to
commit suicide or assists a suicide will be fined or sentenced to a maximum
term of imprisonment of five years. Thus, it is implicit that assisted suicide
is permitted if the person assisting the suicide does so for unselfish reasons.
Since Article 115 does not explicitly regulate assisted suicide for unselfish
reasons, the Penal Code does not require that a physician be the person to
assist a suicide, nor does it require the involvement of any physician
whatsoever, which is a significant departure from legislation in other
countries where assisted suicide is permitted.67
Assisted
suicide is also not limited to those with a terminal illness or to Swiss
residents. Switzerland has become a popular destination for foreigners,
predominantly Europeans, seeking assistance in committing suicide.68 For example, on 1 March 2011, Nan Maitland, an
84 year old British advocate for assisted suicide, went to a Swiss clinic to
receive assistance in committing suicide. Ms. Maitland had arthritis but was
not terminally ill and simply wanted to avoid a long decline as she got older.69 Canadian Kathleen Carter
went to Switzerland in 2010 to end her life. She suffered from spinal stenosis,
a compression of the spinal cord or spinal nerve roots that was painful but not
fatal. A daughter and son-in-law of Ms. Carter are plaintiffs in litigation to
legalize assisted suicide in British Columbia.70 Susan Griffiths, a Canadian with multiple
system atrophy, also went to Switzerland to end her life in April 2013.
In July
2008, the Swiss government called on the Department of Justice and the federal
police to prepare a report on the necessity of updating the rules on assisted
suicide. That report, as well as consultations undertaken in 2009 and 2010,
concentrated primarily on two options: either to provide a more detailed
legislative framework to regulate assisted suicide or to prohibit organizations
that provide assistance to commit suicide altogether.71 In the end, there was no consensus on the best
course of action and the Swiss Federal Council decided not to make any changes
to the law.72 Referendums in
Zurich to ban assisted suicide or at least to impose a residency requirement
also failed to pass.73
In January
2011, the European Court of Human Rights held that no violation of the European
Convention on Human Rights’protections of private life occurred when a
Swiss man was unable to obtain a lethal substance that was available only by
prescription. Ernst G. Haas, who suffers from serious bipolar affective
disorder, had attempted suicide twice and had been unsuccessful in getting a
psychiatrist to prescribe a lethal dose of a drug for him. He had also
unsuccessfully sought permission from federal and cantonal authorities to
receive such a dose without a prescription and had appealed those decisions in
the Swiss courts before turning to the European Court. The Court recognized his
right to decide to end his own life as protected under the right to privacy in
section 8 of the Convention, but concluded that the state has no obligation to
assist someone to access such a drug without a prescription. The Grand Chamber
of the European Court of Human Rights refused to hear an appeal.74
In May
2013, the European Court of Human Rights heard another case from Switzerland.
This time, the case was brought by Alda Gross, who was in her 70s when the case
started and, though not ill, did not want to experience the continued decline
in mental and physical health that can come with age. She had repeatedly
expressed the will to die over a number of years. However, doctors were
unwilling to provide a prescription for a lethal substance due to concerns that
this would violate professional ethics or lead to prosecution. A split
four-to-three decision by the Court distinguished the question at issue from
that in the Haas case. The Court in the Gross case concluded that the lack of
clear, legally binding guidelines in Switzerland resulted in a lack of clarity
as to the extent of Gross’s right to obtain a lethal drug prescription to
commit suicide. As a result, this was a violation of the right to privacy under
section 8 of the European Convention on Human Rights. The Court left it
up to the Swiss authorities to develop the necessary guidelines to remedy the
violation of section 8.75
8 France
In France,
Health Minister Philippe Douste-Blazy reopened the euthanasia debate in an
interview published in the newspaper Le Figaro in August 2004. He called
for a law that would ensure the right to die in dignity, but ruled out the
legalization of euthanasia. He suggested that a draft law defining the legal
options for terminally ill patients would be placed before the National
Assembly before the end of the year. In April 2005, amendments to France’s Public
Health Code relating to end-of-life care were approved by the French
Senate.76 The legislation
does not address either assisted suicide or euthanasia; rather, it addresses
the cessation of treatment and the prescribing of pain medication in
circumstances where such action might shorten a patient’s life.
In March
2008, a court in Dijon turned down a request by Chantal Sébire, who was
suffering from a rare form of cancer, to take a lethal dose of barbiturates
under the supervision of a doctor. According to the court, such a request was
not permitted under the 2005 legislation. Ms. Sébire was found dead in her
apartment soon after the decision, apparently after taking barbiturates. No one
has been charged for involvement in her death.77
A few
years ago, the French Senate’s Committee on Social Affairs studied three
similar bills proposed by three different parties on the topic of medical
assistance to commit suicide, from which it proposed the development of a
single bill. However, on 25 January 2011, the Senate rejected the proposal.78
In the
2012 elections, one of presidential candidate François Hollande’s campaign
promises was to introduce legislation on the topic of assisted dying. After
being elected, President Hollande commissioned a report on the topic. The
report, published in December 2012, notes that French law is silent with
respect to assisted suicide, neither making it an offence nor regulating the
practice of assisted suicide.79
France’s national ethics committee also published its opinion on the topic in
July 2013 at the request of the president. The committee could not come to a
unanimous conclusion on recommendations with respect to euthanasia or assisted
suicide, with the majority recommending no changes to the status quo.80 Nonetheless, media reports
state that the president plans to introduce legislation before the end of 2013,
though the content of such a law remains to be seen.
9 Luxembourg
Luxembourg
is the most recent country to have passed a law legalizing euthanasia and
assisted suicide (in 2008). Conditions similar to those in the Netherlands are
set out in the legislation, the Loi du 16 mars 2009 sur l’euthanasie et
l’assistance au suicide.81
There are some differences, including the age at which a person may request
euthanasia. In Luxembourg, an individual must be at least 18, the age of
majority.
The Act
was passed in December 2008 and came into force in March 2009, though not
without some controversy.82
Luxembourg is a constitutional monarchy, and the country’s monarch, the Grand
Duke Henri, planned to veto the law for reasons of conscience as a Catholic. In
response, Parliament amended the Constitution to reduce the Grand Duke’s powers
from approving laws to simply signing them.83
One
incident of euthanasia was declared in 2009, four were declared in 2010, five
were declared in 2011 and nine were declared in 2012.84
10 Colombia
In
Colombia, euthanasia is a criminal offence, but the maximum sentence for it is
less than that for homicide. In a 1997 case, an individual initiated a
constitutional challenge to this sentencing distinction based on the rights to
life and equality. One argument was that individuals convicted of euthanasia
should not benefit from a lower maximum sentence. Colombia’s highest court, the
Constitutional Court, rejected the constitutional challenge, concluding that a
doctor could not be prosecuted for euthanasia for assisting an individual in
ending his or her life where the person had a terminal illness and had
consented. Nonetheless, “mercy killing” remains a crime in Colombia if those
conditions are not met.85
The judgment also urged legislative action in this area, but it seems that
legislative efforts have not been successful to date as the issue is quite
contentious in the predominantly Catholic country.86
Notes
Library of
Parliament Background Papers provide in-depth studies of policy
issues. They feature historical background, current information and references,
and many anticipate the emergence of the issues they examine. They are prepared
by the Parliamentary Information and Research Service, which carries out
research for and provides information and analysis to parliamentarians and
Senate and House of Commons committees and parliamentary associations in an
objective, impartial manner. [ Return
to text ]
Martha
Butler et al., Euthanasia and
Assisted Suicide in Canada
2013-07-26 ·
Paul Russell, the leader of HOPE Australia, has been very effective at
explaining to Australians why euthanasia and assisted suicide are not
safe.
6 Feb 2015 ... Assisted death The story
behind the CMA's overwhelming change on ... Video: Reversal of assisted suicide ban gives people 'choice': advocate
... The court decision puts Canada in the company of a small group of countries
such as Belgium – and .... Company's goal is to make robots do your dirty work ...
Oct 30, 2005 ... FOUR DIFFERENCES BETWEEN MERCY-KILLING &
MERCIFUL DEATH. SYNOPSIS: The advent of medical technology that can keep a
body ...
... Palliative
Care vs Assisted Suicide ... resorted to the claim that there is really
not much difference between the ... a choice between death and
...
-----------------
BLOGGED:
HOMELESS HARLEY LAWRENCE OF NOVA SCOTIA- MURDERED DOWN ON
MAIN- We must do better Nova Scotia- Canada- we just must- tears and prayers -a
little good news-MAY 2014- CATCHING MONSTERS CAUGHT- HEALING GARDEN BUILT IN
BERWICK NS-honour/June 28 2014- Another beloved Homeless Man savaged in Halifax
Nova Scotia- LET'S FIX THIS- GOD'S WATCHING AND LOSING FAITH IN US /25 Famous
people who were Homeless 2/ OPEN ARMS KENTVILLE- WHY AREN'T U OPENED 4 OUR
BELOVED HOMELESS?? -Sept 24- AWESOME SHARE NS RCMP - RCMP NOVA SCOTIA SHARED
THIS AWESOME RESPECT 4 HOMELESS AND PSYCHIATRIC -mental health or addiction
PROBLEMS- 2do list
Finally- an Oscar show 4GROWNUPSONLY- brilliant and wonderful-
lik Academy Awds used 2b...thx https://www.facebook.com/photo.php?fbid=10153166144526886&set=a.10152685943101886.1073741826.627936885&type=1&theater
GLORY, GLORY HALLELUJAH - u raise humanity up
John Legend & Common performance Glory - Oscars 2015
| FULL VIDEO HD
SIDEBAR-
A great great tragedy..... the beautiful glorious Islam
culture being butchered by ISIS....
Iraq, the
cradle of civilization, the birthplace of agriculture and writing and the home
of the Sumerian, Akkadian, Assyrian, Babylonian and Arab civilizations had
never witnessed such an assault on its rich cultural heritage since the Mongol
era in the Middle Ages.
ISIS Burns
8000 Rare Books and Manuscripts in Mosul
----------
LOGGED/BLOGGED/BLOGSPOT BLOGSPOT
CANADA HISTORY AND WHITE SLAVERY- WHITE SERVITUDE
(Indentured Servant)…Iran’s vicious cruelty (SHAME ON USA) against citizen….
NEDAS….. black Muslim slavery/ Jon Stewart’s Rosewater and why it matters… AND
THEN THEY CAME 4 ME…..Baha’i-To Light A Candle- and Education is NOT a
Crime….#1BRising- why we are still here- Zahra Kazemi, Canadian Iranian
Journalist raped, tortured beaten 2 death 4 taking pictures of Evin
Prison/#Free Rafi- Saudi Arabia / Mohamed Nadel Fahmy- Canadian Egyptian (bring
him home 2 Canada now/ so tired of global politicans (all) selling humanity’s
soul at the cost of our troops and everyday folks 4 UN $$$greed and war/EDWARD
SNOWDEN WINS AN OSCAR
BLOGGED:
CANADA history of White Slavery/Muslim Slavery of Black
Muslims/NEDA- Iran Zahra Kazemi and Nedas/ Baha’is –Jon Stewart’s ROSEWATER…
and Education is not a crime/Edward Snowden wins Oscar/Bring Mohamed Fahmy
home2 Canada/#FreeRafi
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