Tuesday, June 28, 2016

Euthanasia and assisted suicide in the Netherlands Belgium and Oregon - a comparative analysis.

Alex Schadenberg
International Chair - Euthanasia Prevention Coalition

An article written by Eveline Dokter and published by ntvg.nl news on June 20, 2016 compares the euthanasia and assisted suicide statistics in the Netherlands, Belgium and Oregon. The analysis by Dokter of the Netherlands euthanasia data is more indepth than the Belgian and Oregon data. Dokter reports in her article:
Since the introduction of the Dutch euthanasia law in 2002, the number of notifications for euthanasia nearly tripled. In 2015 doctors in the Netherlands reported 5516 cases of euthanasia or assisted suicide.(1) One of these reports came from the BES islands. In 109 patients dementia formed the basis of the suffering and in 56 patients a psychiatric disorder. Although the reporting rate for euthanasia over the years greatly increased, there is still underreporting. In 1990, doctors reported only 18% of the number of cases, in 2001, 54% and in 2010. 77%. (2) This means that still 914 cases of euthanasia were not reported in 2010.

The analysis by Doktor of the Belgian and Oregon laws is less indepth. For instance she doesn't report on the underreporting of euthanasia in Belgium. The article reports:
In Belgium and the US state of Oregon (assisted suicide) euthanasia is also allowed. In Oregon assisted suicide is allowed in patients with a short life expectancy. People who are not sick but who see their lives as completed are not eligible. Over the years in Oregon, Belgium and the Netherlands until 2014, both the absolute and relative numbers of euthanasia and assisted suicide have increased.(3-8) In 2015, doctors reported 4, 18 and 37 out of 1,000 deaths as euthanasia or assisted suicide. These figures are consistent with the trend previously up to 2012 reported in The Lancet.(9) It is striking that the vast majority of the Belgian euthanasia cases occurred in Flanders. This is probably due to the cultural differences between the Flemish and the Wallonians.(10)
Doktor didn't examine the New England Journal of Medicine (NEJM) published a study on March 19, 2015 showing that 4.6% of all deaths in Flanders (2013) are euthanasia, even though the official data indicates that 2.4% of the deaths are reported as euthanasia indicating that nearly half of all Belgian euthanasia deaths are not reported.

According to the 2015 Oregon death with dignity data summary, of 218 people who received a lethal prescription, the ingestion status was unknown for 43 of the people and 5 of the people who died, no report was submitted, meaning these are possible cases of underreporting.

Dokter provided the following references:
1. Regional assesment committee on euthanasia. 2015, April 2016. Jaarverslag (Yearly report).
3. Yearly reports Death with Dignity Act Oregon, via Public Health Oregon.
4. Death statistics Oregon, via Public Health Oregon.
5. Year reports euthanasia Belgium 2002-2015 http://leif.be/professionele-info/rapporten/.
6. Death statistics Belgium 2000-2015, Statbel mortalité generale.
7. Regional assessment committee euthanasia, Jaarverslag 2002-2015 (Yearly reports).
8. Death statistics the Netherlands 2000-2015, Statline CBS.
9. Claudia Gamondi et al. Legalisation of assisted suicide: a safeguard to euthanasia? The Lancet, vol 384, 12 juli 2014.

The translation was by Dr J.A. Raymakers

Monday, June 27, 2016

The first legal case to expand euthanasia in Canada.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition.

The BC Civil Liberties Association has wasted no time in launching the first legal challenge to Canada's recently passed euthanasia and assisted suicide law.

Globe and Mail reporter Laura Stone informs us that the BC Civil Liberties Association is launching a court case to "strike down" as unconstitutional the provision in the euthanasia law that states a person's "natural death must be reasonably foreseeable" to qualify for death by lethal injection.

According to the Globe and Mail article:

The British Columbia Civil Liberties Association, along with a woman who suffers from spinal muscular atrophy, a progressive neurodegenerative disease, say they will launch a legal challenge to the government’s new law in Vancouver on Monday. 
The rights group argues that the law, which passed in Parliament 10 days ago, is unconstitutional. 
The Liberal government faced mounting criticism that the law, known as Bill C-14, was too restrictive, due to a provision that says a patient’s natural death must be “reasonably foreseeable” in order to qualify for assisted death. The Senate voted to remove that requirement, but the Liberal government rejected the amendment and the Red Chamber passed the bill with several small changes.

This is the first of many court challenges to Canada's euthanasia and assisted suicide law. The euthanasia lobby are wanting to extend euthanasia to "mature" minors, to people with dementia (through advanced directives) and for people with psychiatric conditions alone.

EPC will examine this legal case and then determine how we will respond.

Friday, June 24, 2016

Wesley J. Smith - Culture of Death: The Age of "Do Harm" Medicine.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition.

In 2001, Wesley Smith published one of the most influential books challenging the culture of death. At that time, EPC sold hundreds of copies of the book. Since then, many people have been waiting for Smith to update his book and now we have it.

Recently released, Wesley Smith has written an excellent defense of traditional ethics in his recent - Culture of Death: The Age of "Do Harm" Medicine. 

The Euthanasia Prevention Coalition (EPC) is selling Culture of Death for $35 (Link) (includes shipping). Indicate that the $35 is for Culture of Death which has 333 pages and is published by Encounter books. 

Wesley Smith was interviewed by Bioedge about the new edition of Culture of Death. Here is some of what he said in the interview:

Smith: There is less respect for human equality and the sanctity of life in healthcare generally, I fear, and not only in the U.S. Indeed, I changed the subtitle of the book to “The Age of ‘Do Harm’ Medicine” because it now grapples with developments outside the United States as well as in my own country. We are all connected, so that what happens in Canada impacts Australia, what happens in the USA can have a pull on South Africa.

I have observed in the 15 years since the first edition of Culture of Death, that throughout the developed world and the West we see a terrible and increasing disrespect for the intrinsic value of the most weak and vulnerable among us. Euthanasia has spread like a stain and grown increasingly toxic. For example, in Belgium medicalized killing is now coupled with organ harvesting—including of the mentally ill. Health care rationing, which is blatant and invidious medical discrimination, is a growing threat. Advocacy continues to discard the dead donor rule in organ transplant medicine, even proposals for the live-harvesting of patients with profound cognitive disabilities.

If there is a “bright spot,” it is to be found among the medical professionals—doctors, nurses, pharmacists, physicians assistants, etc.—who continue to resist these utilitarian bioethical agendas and work in the trenches of clinical medicine with an ongoing commitment to the wellbeing and equal value of all patients.

Wesley J. Smith
It’s a difficult problem. The popular media is increasingly tabloid in its approach to reporting. It is the rare story that informs the general population about the threatening and radical ideas emanating from the academy, in the professional journals, and from among the leaders of the bioethical/medical establishments.

One of the purposes of the book is to help readers be forewarned of the potential threat they or their loved ones could face in a clinical setting—note, I don’t say will, but could—to enable them to mount a defense should an attempt be made to push a vulnerable patient out of the lifeboat.

Ironically, the media can be very helpful in such circumstances, because while the journalistic sector does a terrible job generally of reporting about bioethical issues—and are very boosting of assisted suicide—they often cast klieg lights on individual cases of medical oppression against particular patients, which can personalize the issue in such a way as to gain the attention and sympathy of the general public.

Smith: Assisted suicide and euthanasia are going to continue to be bioethical hot potatoes. Medical futility. Protecting medical conscience rights for health care professionals who wish to adhere to Hippocratic values is going to be huge internationally. I mean, if we are not careful, in 20 years one may not be able to find a doctor who would not be willing to kill you under some circumstances, which I find a very frightening prospect.

The Euthanasia Prevention Coalition is selling - Culture of Death - for a $25 donation  (link) Culture of Death is published by Encounter books and has 333 pages.

Thursday, June 23, 2016

Czech Republic government cabinet rejects euthanasia.

Alex Schadenberg
International Chair - Euthanasia Prevention Coalition

The Prague Daily Monitor reported that the Czech government cabinet rejected, a deputies' bill that would have legalized euthanasia. According to the Daily Monitor: 
the cabinet said it goes counter to the coalition agreement in which the government parties, the Social Democrats (CSSD), ANO and the Christian Democrats (KDU-CSL), pledged not to pass anything that would be incompatible with the protection of life from the conception until its natural end. 
The bill on dignified death has been submitted by six deputies.  
The final decision will be up to parliament. 
Straka Academy
The Daily Monitor published comments on Twitter by Deputy PM Pavel Belobradek (KDU-CSL) and Industry and Trade Minister Jan Mladek (CSSD):

"The bill, if passed, could result in the killing of people," Mladek wrote. 
Agriculture Minister Marian Jurecka (KDU-CSL) wrote that he rejects a simple solution of euthanasia. "I support help, loving care, solidarity and a high-level palliative care, this is a solution," 
According to the Prague Daily Monitor:
The government... believes that it is unsuitable for the Czech Republic to follow the example of the countries where euthanasia is legal, which the authors of the bill suggest. 
"In these countries, cases of clear misuse of euthanasia have been proved, aimed to vacate hospital beds, as well as cases of family members pushing for euthanasia for dubious reasons, and also unpunished cases of the failure to observe the conditions set by law," 
A similar bill on euthanasia, submitted by a senator, was turned down by the Czech upper house in 2008.

Wednesday, June 22, 2016

Ontario physicians who oppose assisted suicide are legally challenging CPSO referral requirement.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

The Coalition for HealthCare and Conscience is seeking a judicial review of the College of Physicians and Surgeons of Ontario (CPSO) policy requiring physicians who oppose euthanasia and assisted suicide, to refer patients to a physician who will kill.

According to the Coalition:
The College of Physicians and Surgeons of Ontario (CSPO) demands that doctors who conscientiously object to assisted suicide refer patients seeking to end their lives to other physicians who will provide the procedure. 
No other foreign jurisdiction that has legalized assisted suicide requires doctors to perform or refer for this procedure. Other provinces have already implemented guidelines to protect doctors who object to providing or referring for assisted suicide.
Larry Worthen, the executive director of the Christian Medical and Dental Society of Canada, and one of the coalition group members stated:
“The current approach of the CPSO demands that doctors set aside their morals and go against their conscience to directly refer for assisted suicide,” 
“In our view, effective referral and participating in assisted suicide are morally and ethically the same thing.”
Three physicians groups are working together to legally challenge the CPSO policy. The Coalition is demanding that the CPSO amend their policy to enable physicians who oppose assisted suicide to continue to practise medicine in Ontario. According to the Coalition:
Protecting conscience rights of health practitioners would require only minor accommodations, such as allowing patients direct access to an assessment or allowing complete transfer of care to another physician. 
A strong majority of Canadians are on side with the coalition’s beliefs on conscience protection. A recent Nanos Research poll found that 75% of Canadians agreed that doctors “should be able to opt out of offering assisted dying,” compared with 21% who disagreed.
Larry Worthen emphasizes that Conscience rights can and must be protected:
“There are ways to respect patients’ wishes while protecting conscience rights,” 
“Not to do so is discrimination against people for their morals and convictions, which are protected in the Canadian Charter of Rights and Freedoms.”
The Coalition for HealthCARE and Conscience represents a group of like-minded organizations, including representing more than 110 healthcare facilities (with almost 18,000 care beds and 60,000 staff) and more than 5,000 physicians across Canada, that are committed to protecting conscience rights for faith-based health practitioners and facilities. We were brought together by a common mission to respect the sanctity of human life, to protect the vulnerable and to promote the ability of individuals and institutions to provide health care without having to compromise their moral convictions.

British Medical Association (BMA) members reject neutrality on assisted suicide.

The following is the report published by the Care Not Killing Alliance on June 21, 2016.

BMA members attending the influential policy-making gathering were asked, in the course of the Medical Ethics debate today (21 June) to consider two motions related to assisted suicide:

Motion 79 (EAST MIDLANDS REGIONAL COUNCIL) That this meeting, with respect to Physician Assisted Dying, notes the recent rejection by Parliaments of efforts to overturn the law on Physician-Assisted Dying and therefore feels that it is not appropriate at this time to debate whether or not to change existing BMA policy.

Motion 80 (SOUTH CENTRAL REGIONAL COUNCIL) That this meeting believes that the BMA should adopt a neutral stance on assisted dying.

115 for 198 against
Several speakers noted that BMA policy exists to represent the views and experience of members, so it was perhaps not entirely surprising that Motion 79, which reflected on MPs' conclusions, was lost - if only by three votes (164-161). Motion 80, however, was rejected after strong speeches by a resounding 198-115 - that's 63% to 37%, or more simply, 2-1. Members wishing to speak on Motion 80 were similarly split, with those opposed to neutrality outnumbering those in favour by 2-1. Thus, the BMA remains opposed to assisted suicide, as it has throughout its history (barring a brief period in 2005-6).

In the few days before the debate, in the time when delegates were packing for, travelling to and beginning to engage with the ARM, 5,000 members of the public thanked the BMA for its long-standing position and urged them to retain this stance. Individual activists made clear its value in their own lives:

@TheBMA Please protect lives and resist neutrality on assisted dying. We look to you for #supportnotsuicide. Thank you. PLS patient. 
— mwenham (@mwenham) June 21, 2016
BMA members voting
Campaigners in favour of assisted suicide - who had driven the calls for change at the ARM after they failed to convince MPs - spoke of a failure by the BMA to allow debate on the subject. Dr Mark Porter, the Chair of Council gave this short shrift. He noted that the debate marked the eighth time in 13 years that the BMA had considered the matter, and stated that 'nobody can credibly say this issue has been suppressed, obfuscated...' Dr Andrew Mowat, who moved Motion 79 went further, describing the constant returns to the issue as a 'neverendum'; Dr Gary Wannan simply mused, 'we've been here before...'

Many doctors spoke to the substance of the case against assisted suicide, especially foreign precedents. Professor the Baroness Finlay and Dr Will Sapwell highlighted, respectively, doctor-shopping and the increasing citation of not wishing to be a burden as a reason for assisted suicide in the US state of Oregon. Dr Sapwell also pointed to extensions of Belgium's euthanasia law, and medical student Heather Davis said that the Netherlands, with a healthcare system much like the UK's, had seen euthanasia numbers rise and eligibility extended as far as a young woman who suffered from PTSD as a result of sexual abuse. Closer to home, Baroness Finlay said that UK doctors were still strongly opposed to actually assisting suicides.

All of this led to a key point, made several times. Ms Davis said that the BMA worked on the basis of evidence, and there was no new evidence to justify a changed stance. Dr Wannan said there was no new evidence - no, repeated opinion polling didn't count. And Professor the Baroness Hollins said that there was no new evidence, and that they must turn their attention to better end of life care. Yorkshire GP Dr Mark Pickering said that doctors must listen to their patients, but must also consider unintended consequences.

Tuesday, June 21, 2016

Popular articles against euthanasia and assisted suicide.

1. Declaration of Hope – Jan 17, 2013.

2. Physician-Assisted Suicide: A Recipe for Elder Abuse and the Illusion of Personal Choice - Feb 17, 2011.

3. A healthy 24 year old Belgian woman is scheduled for euthanasia - June 24, 2015

4. Depressed Belgian woman dies by Euthanasia – Feb 6, 2013.

5. Euthanasia is out-of-control in the Netherlands – Sept 25, 2012.

6. Oregon 2012 assisted suicide statistics: An analysis - Jan 25, 2013

7. Boycott Me Before You - "disability death porn" - May 26, 2016. 

8. 5 reasons why people devalue the elderly – May 25, 2010.

9. Twins euthanized for fear of blindness in Belgium – Jan 14, 2013.

10. Nitschke is promoting Nembutal over the internet – June 22, 2010.

11. Opposing the Supreme Court of Canada assisted death decision - Feb 17, 2015. 

12. Dutch ethicist changed his mind - Assisted Suicide: Don't Go There - July 16, 2014.

13. Emily “Laura” the healthy 24-year-old Belgian woman who was approved for euthanasia, has chosen to live. Nov 12, 2015. 

14. Belgium warns Canada - Medical Assistance in Dying - Don't Go There. April 26, 2016

15. New Jersey Senate may vote on assisted suicide - Dec 16, 2014.

16. Petition: Stop euthanasia Bill in Quebec – May 24, 2014

17. Woman with Anorexia Nervosa dies by euthanasia in Belgium – Feb 10, 2013.

18. Trisomy 18 is not a Death Sentence. The story of Lilliana Dennis – May 29, 2012.

19. Mild stroke led to mother’s forced death by dehydration – Sept 27, 2011.

20. Supreme Court of Canada assisted suicide decision is irresponsible and dangerousFeb 7, 2015.

21. Netherlands 2012 euthanasia report: sharp increase in euthanasia deaths - Sept 24, 2013.

22. Québec's euthanasia Bill 52 is lethal - Dec 12, 2013.

23. A letter of Hope to Laura - July 8, 2015.

24. Botched sex-change operation victim euthanized in Belgium – Oct 1, 2013.

25. Governer Jerry Brown - veto the assisted suicide bill - Sept 17, 2015.

Become a member of the Euthanasia Prevention Coalition ($25) membership.

British Medical Association (BMA) rejects push to go neutral on assisted suicide by 2 to 1 majority

Peter Saunders
This article was published on Peter Saunders blog on June 21, 2016.
By Dr Peter Saunders

Today the Annual Representative Meeting (ARM) of the British Medical Association (BMA) in Belfast voted against going neutral on assisted suicide by a two to one majority (see detail here).

Delegates rejected motion 80, ‘that this meeting believes that the BMA should adopt a neutral stance on assisted dying’, by 198 to 115 (63% to 37%).

The debate took place after a previous motion affirming that ‘it is not appropriate at this time to debate whether or not to change existing BMA policy’ was defeated by 164 to 160.

The BMA, the UK doctors’ trade union, has been opposed to the legalisation of assisted suicide and euthanasia for every year of its history with the exception of 2005-6 when it was neutral for just twelve months.

‘that... the BMA should adopt a
neutral stance on assisted dying’
Fifteen doctors spoke during an impassioned debate on the two motions but the final vote was decisive, and reflected the 65% opposition to legalising assisted suicide shown in most opinion polls.

Dr Mark Porter, the Chair of BMA Council, noted that the debate marked the eighth time in 13 years that the BMA had considered the matter, and stated that ‘nobody can credibly say this issue has been suppressed or obfuscated’. Dr Andrew Mowat, who moved Motion 79, went further, describing the constant returns to the issue as a ‘neverendum’; Dr Gary Wannan simply mused, ‘we’ve been here before...’

(There is no such thing as neutrality with assisted suicide.)

The Royal College of Physicians, Royal College of General Practitioners and British Geriatrics Society are all officially opposed to a change in the law along with 82% of Association for Palliative Medicine members. Amongst all doctors, this latter group carries the greatest weight in this debate due to their understanding of the vulnerability of dying patients and their knowledge of treatments to alleviate their symptoms.

British parliaments have consistently resisted any move to legalise any form of assisted suicide or euthanasia. There have been a dozen unsuccessful attempts in the last twelve years. Last year the Marris Bill in the House of Commons and the Harvie Bill in the Scottish Parliament were defeated by 330-118 and 82-36 respectively.

Assisted suicide and euthanasia are contrary to all historic codes of medical ethics, including the Hippocratic Oath, the Declaration of Geneva, the International Code of Medical Ethics and the Statement of Marbella.

Neutrality on this particular issue would have given assisted suicide a status that no other issue enjoys. Doctors, quite understandably, are strongly opinionated and also have a responsibility to lead. The BMA is a democratic body which takes clear positions on a whole variety of health and health-related issues.

Furthermore, to drop medical opposition to the legalisation of assisted suicide and euthanasia at a time of economic austerity would have been highly dangerous. Many families and the NHS itself are under huge financial strain and the pressure vulnerable people might face to end their lives so as not to be a financial (or emotional) burden on others is potentially immense.

In rejecting an attempt to move it neutral at its ARM in 2012 the BMA said that neutrality was the worst of all positions. This was based on bitter experience. When the BMA took a neutral position for a year in 2005/2006 we saw huge pressure to change the law by way of the Joffe Bill. Throughout that crucial debate, which had the potential of changing the shape of medicine in this country, the BMA was forced to remain silent and took no part in the debate. Were it to go neutral again it would be similarly gagged and doctors would have no collective voice.

Going neutral would also have played into the hands of a longstanding campaign led by a small pressure group with a strong political agenda.

Healthcare Professionals for Assisted Dying (HPAD), which is affiliated to the pressure group ‘Dignity in Dying’ (formerly the Voluntary Euthanasia Society), at last count had just over 500 supporters, representing fewer than 0.25% of Britain’s 240,000 doctors.

Instead the BMA ARM wisely gave short shrift to this latest neutrality proposal and signalled by the margin of defeat that this matter should now be settled for the foreseeable future.

Disability author angry over association with Me Before You movie.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

EW News reported that Francesco Clark, an ambassador for the Christopher and Dana Reeves Foundation and an entrepreneur who founded a skincare line for people with disabilities, is angry that his memoir, Walking Papers, is referenced in the film Me Before You

Walking Papers tells the story of Clark's life after he experienced an accident in his early 20's that resulting in him living with quadriplegia.

EW News reported Clark as saying:

“I’ve worked tirelessly to show people that being quadriplegic isn’t the end of your life, it’s another beginning,” 
“While I am by no means taking a stance on the issue of assisted suicide, I feel compelled to express that I am angry to be unwittingly associated with a storyline that suggests the only option for those who sustain injuries like mine is death.”
Francesco Clark
Clark distanced himself from the movie:
“I had no involvement in the making of this movie, and am in fact saddened by the association,” 
“I will continue to spread a message of positivity and hope for those who have experienced spinal cord injuries, either directly or as a loved one. I am a prime example, along with many others, that life does not just ‘go on,’ it gets better and better with each day.”
The disability community has protested Me Before You throughout the world.

Monday, June 20, 2016

There is no such thing as neutrality with assisted suicide.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

The assisted suicide lobby is once again pressuring medical association's to become neutral on assisted suicide.

Last Monday, the American Medical Association (AMA) reacted to pressure from the Oregon Medical Association, to change the AMA stance on assisted suicide to neutral (Resolution 015) by establishing a Study on aid in dying.

Tomorrow, the British Medical Association (BMA) will vote on two motions

The first motion (79 on the agenda): affirms that: ‘it is not appropriate at this time to debate whether or not to change existing BMA policy’.

If the first motion is not passed they will debate a second motion (80) which states: ‘that this meeting believes that the BMA should adopt a neutral stance on assisted dying’.

Physicians need to recognize that neutrality on euthanasia or assisted suicide does not exist. Either you support physicians lethally injecting patients (euthanasia) or writing prescriptions for lethal drugs (assisted suicide) or you don't.

Further to that, if euthanasia or assisted suicide become legal, physicians are pressured to participate.

In Belgium, physicians do not have to inject or refer their patients to a physician who will inject their patient, but physicians who are unwilling to refer patients are pressured to do so. A recent bill in the Belgian legislature would require physicians to refer for euthanasia.

For instance, the Ontario College of Physicians and Surgeons have rejected conscience rights and decided that physicians don't have to lethally inject their patients, but they are required to "effectively refer" their patients to someone who will kill their patient.

Neutrality is only a stepping stone to legalization.

The assisted suicide lobby knows that the two most influential bodies of opposition to assisted suicide are the disability community and the medical community. If one or both of those communities become neutral, the odds of legalizing these acts substantially increase.

Whether a physician opposes or supports assisted suicide, it is never an issue of neutrality, and if it becomes legal, there is always pressure to participate in acts that cause death.