Monday, March 30, 2015

Clear rules and consequences needed around end-of-life decision making.

This article was published by Advocate Daily on March 30, 2015.
Hugh Scher
Top British Columbia courts have made it clear that oral nutrition should not be considered health care or medical treatment and instead be seen as basic personal care and support. But, how the directive will be applied and enforced across Canada remains to be seen, says Toronto health and human rights lawyer Hugh Scher.
In Bentley v. Maplewood Seniors Care Society 2015 BCCA 91, the British Columbia Court of Appeal dismissed a request from the family of an 83-year-old woman that their mother no longer be given nourishment or liquids by staff members at the nursing home where she resides.
Justice Mary Newbury agreed with a lower court judge, ruling that the woman, who has advanced Alzheimer’s disease, is exercising her consent when she opens her mouth to accept food and water, despite her family’s position that it was her wish while she was mentally capable that she not be fed in her current condition.
The Euthanasia Prevention Coalition and the Euthanasia Prevention Coalition – BC, represented by Scher and Geoff Cowper QC, were intervenors in the case at trial and on appeal.
“I recognize the terribly difficult situation in which Mrs. Bentley’s family find themselves and I appreciate the disappointment they must feel in being unable to comply with what they believe to have been her wishes and what they believe still to be her wishes,” writes Newbury. 
“It is a grave thing, however, to ask or instruct caregivers to stand by and watch a patient starve to death. It should come as no surprise that a court of law will be assiduous in seeking to ascertain and give effect to the wishes of the patient in the ‘here and now’, even in the face of prior directives, whether clear or not," says the decision.
The coalition also advanced its position at the Supreme Court of British Columbia, which previously ruled that oral nutrition should not be considered health care or medical treatment, but rather seen as basic personal care and support. The court found the woman is capable of making the decision to accept oral nutrition and hydration and is “providing her consent through her behaviour when she accepts nourishment and liquids.”
The case has seen national media attention, with Scher appearing on outlets including Global NewsCTV and Lawyers Weekly, and he says with the appeal concluded, it’s time to look forward at how the ruling will take shape across the country.
“The first step is going to be to determine how the ruling in Bentley, which determines that regular feeding and regular hydration represent basic personal support and not health care or medical treatment, is applied across the country,” says Scher. 
We know there are people in nursing homes across the land, including Ontario, where it’s an open question whether doctors are following that protocol. Families may be making requests of doctors to stop these measures of basic food and drink in a way that may be contrary to the law.”
There are a number of international policies and provisions in places such as the U.S. and Scotland, says Scher, that also consider foods and fluids to be personal support and not health care, but the issue now is how to determine whether the rules are being respected.

Friday, March 27, 2015

John Kelly and Alex Schadenberg on Radio Sputnik's “Brave New World”

John Kelly
This article was published by Not Dead Yet on March 27 2015.

Alex Schadenberg
At the end of February, John Kelly, the New England Regional Director of Not Yet Dead and Alex Schadenberg, Executive Director of the Euthanasia Prevention Coalition, were guests on “Brave New World,” a show on Radio Sputnik. Also on the show was Gert Huysmans, the President of the Federation of Palliative care of Flanders (Belgium). John Harrison is the host of the show.

According to John Kelly, this show was better venue than he is used to – venues in which news hosts are often openly hostile to any opponent of legalized assisted suicide and euthanasia. John said (and the show recording and transcript confirm this) “he (Harrison) gave each of the participants a chance to describe the situation in our own country, thereby giving us a chance to make our points without being asked the “what do you say to Brittany Maynard” type of gotcha question. When he asked me the devils advocate question it was about a person with a disability, not someone “about to die in pain” or some such nonsense.”

Here are a couple of excerpts:
Gert Huysmans: What you mentioned in Flanders and in Belgium, euthanasia is not a right. You have the right to request for euthanasia, and that’s a world of difference. So it’s not that you have the right to choose your moment of dying with euthanasia. You have to follow certain conditions that are mentioned in the law. You have to have unbearable suffering caused by a disease or an accident, and the physician you request your euthanasia [from] should have the internal persuasion that euthanasia is the only proper solution for your problems and in some cases and in some circumstances euthanasia is acceptable, but it is not a right as such.
And, as news of the law’s actual application has shown, practice is only as narrow as the broadest comfort zone of any given individual physician.

John talks about the long-term resistance to “right to die” laws from the disability community:

JK: We in the United States, the disability rights movement have fought [for] a generation against the arrogance being displayed by the doctor, where the doctors can presume to judge the quality of life, and when it is correct to end it. We have a history of being judged to not have high quality of lives, and whenever suffering is the subjective criterion for deciding who gets to die, people with disabilities will always be the ones who are targeted.
This show is an excellent one. I encourage readers to listen to the show or to read the transcript.

Safeguards do little to control euthanasia in Belgium.

This article was published on March 27 by OneNewsNow.

Alex Schadenberg
Promised safeguards and controls for euthanasia and doctor assisted-suicide in Belgium apparently aren't working, according to the latest study.

In 2007, a study was conducted in Belgium, and figures released in the most recent examination of the practice from 2013 still show it is problematic. Alex Schadenberg of the Euthanasia Prevention Coalition tells OneNewsNow experts researched over 3,700 deaths.

“And in that data they learned that 4.6 percent of all the deaths were euthanasia, which is significant and huge,” he explains. “On top of that, they found that 1.7 percent of all deaths were what they call 'hastened deaths without request.'”
In other words, doctors or nurses decided to kill an ailing person who had not requested euthanasia.

According to Schadenberg, the absence of estimates on unreported cases is glaringly apparent. He says the practice is so out of control that even people suffering depression are assisted to die.

“So the fact is that there is a serious problem, and the Belgium government needs to stop it,” he tells OneNewsNow. “The problem with euthanasia right off the bat is once you allow someone else to cause your death, once you allow in law that someone else can kill you, the one question remaining is for what reason? And when they are promoting this to people they always say, Oh, but we will have safeguards.”
But Schadenberg says the regulations are neither safe nor do they guard against abuse. He says that's also true in states in America where assisted suicide has been legalized.

Thursday, March 26, 2015

Feeding Tubes and Futility in Texas.

We Can End the End-of-Life Impasse in the Texas Legislature.
Dr Jacqueline Harvey
By Jacqueline C. Harvey, Ph.D . 

After five consecutive sessions of bitter battles over end-of-life bills, the Texas Legislature is finally poised to pass the first reform to the Texas Advance Directives Act (TADA) in twelve years. An issue that created uncanny adversaries out of natural allies and equally odd bedfellows has finally found common ground in H.B. 3074: an act that simply prohibits doctor-imposed euthanasia by starvation and dehydration. Since H.B. 3074 includes only those provisions and language that all major organizations are on record as having deemed acceptable in previous legislative sessions, there is finally hope of ending the end-of-life impasse in the Texas Capitol.

Many people are surprised to learn that Texas law allows physicians to forcibly remove a feeding tube against the will of the patient and their family. In fact, there is a greater legal penalty for failing to feed or water an animal than for a hospital to deny a human being food and water through a tube. This is because there is no penalty whatsoever for a healthcare provider who wishes to deny artificially administered nutrition and hydration (ANH). According to Texas Health and Safety Code, “every living dumb creature” is legally entitled to access to suitable food and water. Denying an animal food and water, such as a case this January in San Antonio, is punishable by civil fines up to $10,000 and criminal penalties up to two years in jail per offense. Yet Texas law allows health care providers to forcibly deny food and water from human beings - what they would not be able to legally do to their pet cat. And healthcare providers are immune from civil and criminal penalties deny of food and water to human beings as long as they follow the current statutory process which is sorely lacking in safeguards. Therefore while it is surprising that Texas is the only state law that explicitly mentions food and water delivered artificially for the purpose of completely permitting its forced denial (six other states mention ANH explicitly for the opposite purpose, to limit or prohibit its refusal), it is not at all surprising that the issue of protecting a patient’s right to food and water is perhaps the one point of consensus across all major stakeholders.

H.B. 3074 is the first TADA reform bill to include only this provision that is agreed upon across all major players in previous legislative sessions. Texas Alliance for Life and Texas Right to Life have each previously sponsored broad and ambitious bills to either preserve but reform the current law (Texas Alliance for Life’s position) or overturn it altogether as Texas Right to Life aims to do. Prior to H.B. 3074, bills filed by major advocacy organizations have often included ANH, but also a host of other provisions that were so contentious and unacceptable to other organizations each bill ultimately died, and this mutually-agreed-upon and vital reform always died along with it. The 2011 and 2013 sessions present a prime example where both organizations filed complicated, contentious opposing bills, both of which would have protected a patient’s right to food and water but each bill also included provisions that other groups saw as contrary to their goals. Both bills were ultimately defeated and neither group was able to achieve protections for patients at risk of forced starvation and dehydration- a mutual goal that could have been met through a third, narrow bill like H.B. 3074. H.B. 3074 focuses on what unites the organizations involved rather than what divides them.

H.B. 3074 is progress that is pre-negotiated and pre-approved. It is not a fertile springboard for negotiations on an area of mutual agreement. Rather it is the culmination of years of previous negotiations on bill that all came too late, either due to the complex nature of rival bills, the controversy involved or even both. On the contrary, H.B. 3074 is not just simple and an area of agreement, moreover, it is has already been negotiated. since Texas Alliance for Life and Texas Right to Life (along with their allies) were able to agree on language in 2007 with C.S.S.B. 439. 

The language from C.S.S.B. 439 is strikingly similar to H.B. 3074 which states, “except that artificially administered nutrition and hydration must be provided unless, based on reasonable medical judgment, providing artificially administered nutrition and hydration would: 
  1. hasten the patient's death; 
  2. seriously exacerbate other major medical problems not outweighed by the benefit of the provision of the treatment; 
  3. result in substantial irremediable physical pain, suffering, or discomfort not outweighed by the benefit of the provision of the treatment; 
  4. be medically ineffective; or 
  5. be contrary to the patient's clearly stated desire not to receive artificially administered nutrition or hydration.” 

Doctor Death Nightmare

Published on March 24.

By Deborah Rankin

Margaret Somerville
A law professor at McGill University says that a recent decision of the Supreme Court of Canada overturning the ban on assisted-suicide and euthanasia is a "nightmare" and "full of errors". Margaret Somerville, the Founding Director of the Centre for Medicine, Ethics and Law at McGill made these remarks recently to a rapt audience at a public forum organized by the Newman Centre for Catholic students and faculty.

She said that the SCC decision goes farther than simply striking down the ban against aiding someone to commit suicide, permitting euthanasia by physicians in certain circumstances, while cautioning that the ruling is unclear in this regard.

In physician assisted-suicide the doctor prescribes drugs that the patient takes, whereas in euthanasia the doctor administers a lethal injection - in either scenario, ostensibly at the patient's request. However, in jurisdictions where assisted-suicide has been legalized, there are multiple examples of abuse with people being euthanized without their consent.

This is especially true in the case of children and incompetent adults who can't give informed-consent: for example, the Groningen Protocol of the Netherlands permits so-called "voluntary euthanasia" of babies at the parents' request. Pro-euthanasia advocates refer to this gruesome practice as "post-birth abortion" while opponents say that it is really a form of "closet eugenics" - if the child is born with congenital defects the parents can request euthanasia on the pretext of preventing the child from suffering.

Wednesday, March 25, 2015

The Atlantic - Pushing Killing for Organs

This article was published on Wesley Smith's blog on March 24, 2015.
Wesley Smith
By Wesley Smith

I have repeatedly warned about articles published in medical and bioethics journals advocating killing the profoundly disabled or dying for their organs. 

The assault on the “dead donor rule” has now filtered down to the popular media. The Atlantic has an article advocating that dying patients be killed for their organs rather than having to actually, you know, die first. From, “As They Lay Dying:” 
A more useful ethical standard could involve the idea of “imminent death.” Once a person with a terminal disease reaches a point when only extraordinary measures will delay death; when use (or continued use) of these measures is incompatible with what he considers a reasonable quality of life; and when he therefore decides to stop aggressive care, knowing that this will, in relatively short order, mean the end of his life, we might say that death is “imminent.”  
If medical guidelines could be revised to let people facing imminent death donate vital organs under general anesthesia, we could provide patients and families a middle ground—a way of avoiding futile medical care, while also honoring life by preventing the deaths of other critically ill people.  
Moreover, healthy people could incorporate this imminent-death standard into advance directives for their end-of-life care. They could determine the conditions under which they would want care withdrawn, and whether they were willing to have it withdrawn in an operating room, under anesthesia, with subsequent removal of their organs. 

There’s a name for that: Homicide. Doctors should never be killers, even for a “beneficial” purpose.

Monday, March 23, 2015

Almost half of the Belgian euthanasia deaths may not have been reported in 2013.

By Alex Schadenberg
International Chair - Euthanasia Prevention Coalition

The New England Journal of Medicine (NEJM) published  a new study concerning the Belgium euthanasia experience titled: Recent Trends in Euthanasia and Other End-of-Life Practices in Belgium.

Similar to previous studies, researchers sent a four page questionnaire to 6188 physicians who had certified death certificates in the first half of 2013 in Flanders Belgium. The study received a 60.6% response rate with 3751 returned questionnaires. The data represents about 6% of all deaths.

The data indicates that:

1. 4.6% of all deaths were euthanasia.
2. .05% of all deaths were assisted suicide.
3. 76.8% of the requests for euthanasia or assisted suicide were granted.
4. 1.7% of all deaths were hastened without explicit request.
The data did not include information concerning the number of unreported euthanasia deaths.

With help from a researcher in Belgium I learned that in 2013 there were 61,621 deaths in Flanders Belgium. Since the data from the 3751 questionnaires indicated that 4.6% of all deaths were euthanasia, therefore there may have been as many as 2834 assisted deaths in Flanders in 2013.

Since the official Belgian euthanasia report stated that there were 1807 reported euthanasia deaths in Belgium, of which, 1454 were from the Flanders region, therefore about 1380 assisted deaths may not have been reported in Flanders Belgium in 2013. 

This means that almost half of all euthanasia deaths may not have been reported in Flanders in 2013.

The study also found that 1.7% of all deaths were hastened without explicit request. Since there were 61,621 deaths in Flanders, therefore about 1047 deaths may have been hastened without explicit request in Flanders Belgium in 2013.

The recent Supreme Court of Canada assisted death decision suggested that abuse of euthanasia laws in other jurisdictions was only anecdotal. Canada needs a Royal Commission to set the record straight. 

Euthanasia is out-of-control in Belgium.

To learn more about the abuse and extension of euthanasia in the Netherlands and Belgium purchase my book: Exposing Vulnerable People to Euthanasia and Assisted Suicide.

Chilean girl who asked for euthanasia, changes her mind.

Alex Schadenberg
Euthanasia Prevention Coalition

Valentina Maureira
A 14-year-old Chilean girl, who asked the Chilean President, to allow her to die by euthanasia, has now changed her mind and wants to live.

Valentina Maureira, who lives with Cystic Fibrosis, created a youtube video last month asking the Chilean President, Michelle Bachelet, to allow her to die by euthanasia. Valentina got the idea from the Brittany Maynard assisted suicide campaign.

On February 28 President Bachelet met with Valentina. Presidential spokesman Alvaro Elizalde stated that 'it's impossible not to be overcome by emotion with the girl's request, it's impossible to grant her wish,' because it's not allowed under Chilean law.

Valentina has changed her mind after meeting with a family from Argentina.

Maribel Oviedo
Valentina's father said that his daughter was moved by a visit from a Argentina family, whose children also have Cystic Fibrosis.

He said Valentina was given hope by meeting someone who had survived beyond age 20 with the disease.

Maribel Oviedo and her father Ernesto traveled to Santiago to 'convey a message of hope.'

Maribel, 22, watched her sister Marisol die of cystic fibrosis in 2013. Mirabel received a lung transplant in 2012 and told Valentina that she now lives a normal life.

Mirabel offered to go to a doctor's appointment with her because she wanted to encourage her to live.

Valentina's story is emotionally charged. If Valentina had died by euthanasia, her options, potential treatment and opportunity to change her mind would have ended.

Now Valentina has hope.

Sunday, March 22, 2015

The 2015 HOPE International Symposium on Euthanasia and Assisted Suicide.

The Fourth International Symposium on Euthanasia and Assisted Suicide is hosted by HOPE Australia on May 22 - 23, 2015 at the Rydges Hotel South Park in Adelaide South Australia.

Register for the 2015 HOPE International Symposium.

The 2015 HOPE International Symposium is hosted by HOPE Australia, and co-sponsored by the Euthanasia Prevention Coalition - International, Euthanasia-Free New Zealand, the disability rights group - Lives Worth Living, and Doctors Opposed to Euthanasia.

Renee Joubert
The speakers include:

  • Alex Schadenberg, Executive Director, Euthanasia Prevention Coalition (EPC) and Chair, EPC - International,
  • Paul Russell, Director, HOPE Australia and Vice Chair, EPC - International,
  • Renee Joubert, Director, Euthanasia-Free New Zealand,
  • Craig Wallace, Convenor, Lives Worth Living, a network of people with disabilities,
  • Nic Steenhout, Director, Vivre dans la dignité Quebec.
  • Nic Steenhout
    Henk Reitsma, Board member, EPC - International and an expert on the Netherlands Euthanasia statistics.
  • Tom Mortier, Chemistry professor in Belgium. His depresed mother died by euthanasia in 2012. 
  • Professor Theo Boer, former member of a Dutch Euthanasia Regional Review Committee.
  • Nancy Elliott, Board member, EPC - International and a past three term New Hampshire state representative.
  • Sue Hanson, co-chair NSW Agency for Clinical Innovation - Palliative Care Network
  • Dr Paul Dunne, a leading Palliative Care Medical Specialist in Australia.
  • Brendan Malone, from New Zealand, is a dynamic speaker on youth, culture and media.
This is the first International Symposium hosted in the southern hemisphere by EPC - International. Previous symposia were held in Toronto, Washington, Vancouver, Edinburgh.

Saturday, March 21, 2015

Euthanasia doctor justifies death for depressed people.

By Alex Schadenberg
International Chair - Euthanasia Prevention Coalition

Godelieva De Troyer died by euthanasia in 2012.
An interview with Wim Distelmans, the chairman for the federal euthanasia commission in Belgium, was published in HLN.BE   (google translated) on March 15. where Distelmans explains that there were 50 - 60 psychiatric patients who died by euthanasia in 2013 - 2014. Distelmans states:

"It is a small group, 50 to 60 patients. But it is not a negligible number:. 2 to 3 percent of the 1,924 people who were euthanized last year."
Distelmans then states:
"usually they are not old, but they suffer long. They do not belong in this world, they think.."
Distelmans promotes euthanasia for depressed people. He states (google translated):
"Manic-depressive patients are in their manic moments capable of the most improbable things, They spend their bank loot, for weeks at a five-star lodge, buy several cars one day. At that stage they are not competent. But in moments of depression they by their exhaustion come back to the baseline and are indeed competent. Then they can for instance say, "I live for thirty years crazy highs and lows, I've tried everything to break that infernal cycle Now that I'm back on the baseline, and I know that I have a couple of weeks left, back I for a dip in the depth or a jump in height. " These are people who are eligible for euthanasia."
Once euthanasia has become an acceptable solution to human suffering the only question that remains is what conditions will death become the solution for life.

Lethal injections for people with psychiatric conditions is based on a false compassion. Distelmans appears to be reacting to his fear of living with chronic depression.