Thursday, October 30, 2008

Lord Joffe to introduce assisted suicide bill

Lord Joffe will once again attempt to legalize assisted suicide in the UK by resurrecting his Assisted Dying for the Terminally Ill Bill that was blocked by the House of Lords two years ago.

This time he plans to use the story of Debbie Purdy to gain support for his cause.

Joffe told The Times that he decided to take action so that family and friends who wished to help to end their loved ones' suffering would know whether or not they were committing an offence.

Joffe also said:
"First we want to get a debate going before we introduce the Bill, so the issue has been explored in the public arena. The introduction of the Bill will be sooner rather than later. It will be a question of when time in the parliamentary calendar can be found to consider a Private Member's Bill."

"The purpose of a Bill is for a change in the law to prevent unnecessary suffering. But we would only be looking at people who are terminally ill."

It is interesting that Joffe is using the Purdy case to promote his efforts to legalize assisted suicide. Purdy is not terminally ill and with good care, she can remain comfortable and live with dignity.

Alison Davis from No Less Human stated that:
If Lord Joffe’s Bill had been law then, I would have qualified for “assisted dying” and I have no doubt whatsoever that I would have requested it.

Leaders of the disability rights movement, such as Davis, recognize that assisted suicide directly threatens their lives due to social attitudes and subtle pressures that exist within society.

Link to article about Alison Davis
http://www.notdeadyetuk.org/alisondavies.php

Lord Joffe is also wanting to appear to be a moderate within the confines of the euthanasia lobby. Joffe's comments at the World Federation of Right to Die Societies Conference in Toronto in 2006 would make you believe that his Bill would be a first measure to legalize assisted suicide. The wording of the previous Bill was based on what the euthanasia lobby believed would be considered acceptable at that time in history.

Link to the article from the Times online:
http://business.timesonline.co.uk:80/tol/business/law/article5042490.ece

Australian government will maintain a national internet filter

The Australian government is implementing a national internet filter to protect its citizens from controversial websites that promote child pornography, certain "adult" content, euthanasia (suicide promotion) and anorexia promotion.

Information about the national internet filter has been revealed by US tech giants Google, Microsoft and Yahoo, and a coalition of human rights and other groups who have unveiled a new code of conduct that is aimed at safeguarding freedom of speech and privacy.

The Australian government passed a law forbidding the distribution of child pornography. The Australian government also passed a law forbidding suicide promoting websites.

The article concerning freedom of speech compares the measures taken by the Australian government to protect its citizens from predatory websites to the internet filters that have been implemented by the Chinese government. This is very inaccurate.

Link to the article from the Australian Herald Sun:
http://www.news.com.au/heraldsun/story/0,21985,24568137-2862,00.html

The fact is that Australia is one of several nations that are attempting to protect vulnerable citizens from suicide promoting websites. Korea, Japan and the UK are also known to be attempting by either by urging internet service providers to voluntarily block these predatory websites or to be moving to interpret the Criminal Code to enable the police to prosecute people who promote suicide via the internet or other communications medium.

I am convinced that blocking suicide promotion websites does not constitute a violation of free speech but rather a reasonable limit in the same way as protecting people from child pornography.

We must remember that people who live with depression and mental illness are often unable to effectively filter out the negative thoughts that are promoted by these websites. They will often commit suicide by following the instructions from these websites.

We need to protect people from the criminally irresponsible who continue to endanger the life and health of others by promoting suicide or suicide methods via the internet.

Link to article on the UK government blocking suicide promoting websites:
http://alexschadenberg.blogspot.com/2008/09/uk-government-to-target-suicide.html

Link to article on the Korean government blocking suicide promoting websites:
http://alexschadenberg.blogspot.com/2008/09/south-korea-takes-measures-to-tackle.html

Link to article on the Japanese government blocking suicide promoting websites:
http://alexschadenberg.blogspot.com/2008/05/japan-looks-to-lower-suicide-rate.html

Margo MacDonald bids to change law on assisted suicide in Scotland

Margo MacDonald MSP announced her intention to bring a Member's Bill to the Scottish Parliament to legalize assisted suicide in Scotland.

MacDonald, a member of the Independent Lothians party, said it should not be a crime to assist the suicide of someone who is suffering from a condition and wants to die.

MacDonald intends to publish a consultation paper by the end of November and will include a wide spectrum of people to discuss the issue.

The detailed proposals of the Bill will be determined by the responses to her consultation paper.

MacDonald, who lives with Parkinson's disease said:
"The politicians have run a mile from this, but they cannot continue to run. I'm not telling them what they have to believe, we all have our own values and beliefs, but they owe it to their constituents to debate the matter."

MacDonald says she has been moved by the case of Dan James (23) a former Rugby player who was paralysed by a training accident and recently died in Switzerland by assisted suicide with his parents accompanying to his death.

MacDonald's announcement specifically followed the decision by the High Court not to guarantee that Debbie Purdy's husband, Omar Puente, would be free from prosecution if he would assist her suicide in Switzerland at the Dignitas Clinic.

The Scottish people need to be aware of how legalizing assisted suicide specifically threatens the lives of people with disabilities and the other vulnerable people in Scotland.

Legalizing assisted suicide creates an inequality in the healthcare system because it allows some people to receive death as the treatment for their condition and others to receive good physical, psychological and social care for the same condition.

It also introduces subtle and overt pressures on people who are living in the most vulnerable time of their lives. Social and economic pressures will often coerce people to "choose" death because they feel they have no other "choice" or to fulfill the wishes of their loved ones or caregivers of the "burden" of care.

Link to the article from the Edinborough Evening News:
http://news.scotsman.com:80/politics/Margo-MacDonald-bids-to-change.4643890.jp

Wednesday, October 29, 2008

Diane Purdy loses assisted suicide case in the UK

Debbie Purdy, who lives with MS, asked the court for clarity concerning the law on assisted suicide in the UK.

Purdy, who has stated that she intends to travel to Switzerland to die by assisted suicide at the Dignitas clinic, is concerned that her husband, Omar Purnte, may be charged with assisting her suicide by participating in her death in Switzerland.

Purdy was granted a judicial review on the grounds that the Director of Public Prosecutions (DPP) had acted illegally by not providing guidance on how decisions on prosecutions are reached.

David Pannick QC - the lawyer for Purdy - said that guidelines already exist for crimes of domestic violence, bad driving and football-related offences.

Pannick argued that Purdy and Puente were entitled to the guidance to enable them to "foresee" if Puente was likely to be prosecuted if he assisted the suicide of his wife.

The two high court justices ruled that the rights of Purdy and her husband have not been infringed and existing guidelines are adequate.

Lord Justice Scott Baker stated:
We cannot leave this case without expressing great sympathy for Ms Purdy, her husband and others in a similar position who wish to know in advance whether they will face prosecution for doing what many would regard as something that the law should permit, namely to help a loved one go abroad to end their suffering when they are unable to do it on their own.

This would involve a change in the law.

The offence of assisted suicide is very widely drawn to cover all manner of different circumstances - only Parliament can change it.

The judge also said that their were reasons why the DPP had produced specific guidelines for other types of crime. The Judge stated:
They concerned "a particular prevalent social problem," were "more easily identifiable," and in those cases "it was clearly imperative that the public should understand the specific criteria that the DPP and crown prosecutors would employ in deciding whether to prosecute them."

The Care Not Killing Alliance in the UK, that is led by Dr. Peter Saunders, responded to the Purdy case by stating:
Assisting in another's suicide is a criminal offence which carries a sentence of up to 14 years imprisonment. The law is very clear on this matter and should not be changed. Changing it to allow assisted suicide would place vulnerable people – the sick, elderly, depressed and disabled – under pressure, whether real or imagined, to request early death. Vulnerable people often feel that they constitute a financial or emotional burden to others and the so-called 'right to die' can so easily become the duty to die. Once a person has been 'helped to die' it is often very difficult to know whether there has been subtle coercion involved from someone who has an interest in a person's death.

Requests like this are thankfully extremely rare and hard cases make bad law. We must not legislate for exceptions and the House of Lords for this reason in 2006 quite rightly rejected Lord Joffe's assisted dying bill. There are over 70,000 people in Britain with multiple sclerosis at present and only a very small number ever request assisted suicide. These requests are virtually never persistent if patients' physical, emotional and spiritual needs are properly addressed. Our key priority must therefore be to make the very best palliative care more widely accessible and to get rid of the postcode lottery of care that currently exists in Britain.

We are concerned about Mrs Purdy's expressed fear of choking to death or experiencing excruciating pain because with good palliative care these fears are quite groundless. The public is being misled over this. There have been great advances in the management of multiple sclerosis which have benefited patients and now mean that many with the disease live an almost normal lifespan. Mrs Purdy has had MS for 13 years already and may have many more years still to live. It is also not at all clear, given the type of illness she has, that she would ever need assistance to end her life, should she be determined to do so. This case has to be seen therefore in the wider context of an ongoing campaign by Dignity in Dying, formerly the Voluntary Euthanasia Society, to change the law.

The key issue here remains whether the law should be changed for the very small number of people who press for assisted suicide. Our view is that in order to protect others from exploitation it should not be.

Link to the response from the Care Not Killing Coalition concerning the Debbie Purdy case:
http://alexschadenberg.blogspot.com/2008/10/debbie-purdy-case.html

Link to the Care Not Killing Alliance website:
http://www.carenotkilling.org.uk/

Purdy has been given permission to appeal the decision. She says she has been left in "a confused mess".

Purdy stated:
I will continue to campaign so that I and others do not have to worry about whether the people we love will face prosecution after we are gone.

The Purdy case is sure to continue.

People with disabilities should be concerned that Purdy may appear to be representing their interests. It is clear that the leadership of the disability rights movement opposes euthanasia and assisted suicide because they are the targeted in society by negative attitudes and social pressures.

People with disabilities really want society to provide them with opportunities to live with dignity. They are not demanding a removal of protections in the law and create an inequality whereby they are subtly and socially pressured to die.

Bryan Ramsey charged with assisted suicide

Bryan Bernard Ramsey was charged with assisted suicide in Union Parish - Framerville La.

Bob Buckley, the Union Parish Sheriff booked Ramsey for helping his 20-year-old housemate kill himself.

Buckley is accused of allegedly putting his hand on the gun but failing to take it from the suicide victim - Tijwan Hendricks.

Ramsey and a female friend were also charged with possessing marijuana and possessing cocaine with intent to distribute it.

Response from the Care Not Killing Alliance to the Debbie Purdy Case

October 29, 2008

Care Not Killing welcomes court decision on Debbie Purdy

The Care Not Killing Alliance has welcomed today's High Court decision not to require the Director of Public Prosecutions to provide information about how decisions to prosecute for assisted suicide are made.

Debbie Purdy, who has multiple sclerosis, had sought a guarantee from the High Court that her husband would not be prosecuted should he accompany her to the Dignitas suicide 'clinic' in Zurich, Switzerland.

Care Not Killing had previously welcomed a full airing of the arguments, but had warned that any loosening of the law to make assisted suicide easier would put vulnerable people at risk and make them susceptible to exploitation and abuse - a view upheld by the House of Lords vote on the Joffe Bill in 2006.

Speaking in reaction to the news of the judgment, Care Not Killing director Dr Saunders said:

We welcome this decision. The current law is very clear and does not require the sort of clarification that has been sought in this case. There has been a huge amount of media interest in this case but the High Court Judges, in giving permission for Debbie Purdy to proceed with the hearing, had made it very clear that they were not giving her any grounds for optimism that her arguments would succeed. We are not surprised that the court found that, in order to protect vulnerable people from exploitation, the current law should be upheld.

Assisting in another's suicide is a criminal offence which carries a sentence of up to 14 years imprisonment. The law is very clear on this matter and should not be changed. Changing it to allow assisted suicide would place vulnerable people – the sick, elderly, depressed and disabled – under pressure, whether real or imagined, to request early death. Vulnerable people often feel that they constitute a financial or emotional burden to others and the so-called 'right to die' can so easily become the duty to die. Once a person has been 'helped to die' it is often very difficult to know whether there has been subtle coercion involved from someone who has an interest in a person's death.

Requests like this are thankfully extremely rare and hard cases make bad law. We must not legislate for exceptions and the House of Lords for this reason in 2006 quite rightly rejected Lord Joffe's assisted dying bill. There are over 70,000 people in Britain with multiple sclerosis at present and only a very small number ever request assisted suicide. These requests are virtually never persistent if patients' physical, emotional and spiritual needs are properly addressed. Our key priority must therefore be to make the very best palliative care more widely accessible and to get rid of the postcode lottery of care that currently exists in Britain.

We are concerned about Mrs Purdy's expressed fear of choking to death or experiencing excruciating pain because with good palliative care these fears are quite groundless. The public is being misled over this. There have been great advances in the management of multiple sclerosis which have benefited patients and now mean that many with the disease live an almost normal lifespan. Mrs Purdy has had MS for 13 years already and may have many more years still to live. It is also not at all clear, given the type of illness she has, that she would ever need assistance to end her life, should she be determined to do so. This case has to be seen therefore in the wider context of an ongoing campaign by Dignity in Dying, formerly the Voluntary Euthanasia Society, to change the law.

The key issue here remains whether the law should be changed for the very small number of people who press for assisted suicide. Our view is that in order to protect others from exploitation it should not be.

Read more: our previous press statement on Debbie Purdy, our media profile and further details about the case.

Notes for Editors
Care Not Killing is a UK-based alliance bringing together around 50 organisations - human rights and disability rights organisations, health care and palliative care groups, faith-based organisations groups - and thousands of concerned individuals.

We have three key aims:

*to promote more and better palliative care;
*to ensure that existing laws against euthanasia and assisted suicide are not weakened or repealed during the lifetime of the current Parliament;
*to inform public opinion further against any weakening of the law.

We seek to attract the broadest support among health care professionals, allied health services and others opposed to euthanasia by campaigning on the basis of powerful arguments underpinned by the latest, well-researched and credible evidence.

Key groups signed up to Care Not Killing include: The Association for Palliative Medicine, the British Council of Disabled People, RADAR, the Christian Medical Fellowship, the Catholic Bishops Conference of England and Wales, the Church of England and the Medical Ethics Alliance.

Monday, October 27, 2008

Coalition Against Assisted Suicide features Barbara Wagner in TV ad

Message from the Coalition Against Assisted Suicide in Washington State:

We urgently need help from across the nation to defeat the assisted suicide initiative here in Washington state. We need to raise money to pay for the final week of media time. Will you match the funds that are pouring into our state from those that support assisted suicide?
Link to the Coalition Against Assisted Suicide donation request form:
https://ssl22.pair.com/stshore/contribute_suicide.html

Click on this link to see the latest Coalition Against Assisted Suicide ad featuring Oregon's Barbara Wagner. It's VERY effective!

Link to the Coalition Against Assisted Suicide website:
http://www.noassistedsuicide.com/

Link to Wesley Smith's blog comment on Barbara Wagner Ad:
http://www.wesleyjsmith.com/blog/2008/10/barbara-wagner-urges-washingtonians-to.html

Dying of hopelessness

Leonard Stern, the Ottawa Citizen's editorial pages editor has written a thought provoking article on the connection of depression to the request for euthanasia or assisted suicide.

Stern begins his article by referring to the fact that the State of Oregon legalized assisted suicide several years ago.

He then states:
For many people, the merits of assisted suicide are self-evident. Who doesn't believe in personal autonomy and the end of suffering? The case for assisted suicide seems all the stronger because those who oppose it tend to invoke religious arguments. Church teachings about the sanctity of life don't resonate very well in public policy debates.

There is, however, a non-religious case to be made against assisted suicide, and it gets stronger the closer one looks at the Oregon experiment, as a team of Oregon psychiatrists recently did. Beginning in 2006, the psychiatrists started interviewing patients who wanted to make use of the assisted suicide legislation. They discovered that one in four patients had undiagnosed clinical depression.

Stern then explains how assisted suicide creates an inequality for people with disabilities. He states:
In most places, people who express a desire to die are evaluated for depression, and receive treatment for it. In places where assisted suicide is practised, such patients might instead receive a fatal dose of barbiturates. The researchers discovered that in 2007, not one "of the people who died by lethal ingestion in Oregon had been evaluated by a psychiatrist or a psychologist."

This secular case against assisted suicide is that assisted suicide discriminates against the sick and disabled. If an able-bodied woman tells her family that she's suicidal, they will surely intervene with psychiatric help. But if a wheelchair-bound woman with Lou Gehrig's disease tells her family the same thing, they might assume, based on social prejudices about disabilities, that the request was a sensible one.

Stern then introduces the case of Daniel James:
Medical ethicists are currently agonizing over the case of Daniel James, a British man who last month killed himself at a Swiss clinic that offers assisted suicide. The case is unsettling for two reasons. First, Mr. James was not suffering a terminal disease. Second, he was 23. The popular image of people who avail themselves of assisted suicide is of very ill senior citizens at the end of life. That was not Mr. James.

Daniel James was a gregarious, burly athlete who last year suffered a terrible injury during a rugby game and was paralyzed from the chest down. Although he could breathe without a ventilator, he couldn't move his limbs. After the accident he tried to kill himself several times but, owing to his disability, was unable to do so. Finally, his parents took him to the clinic in Switzerland. They were with him in the room when the overdose was administered.

By all accounts, Daniel's parents are decent people who were motivated by love. In a statement, his mother talked about how her son had finally been freed from the "prison" he felt his body had become. "What right does any human being have to tell any other that they have to live such a life, filled with terror, discomfort and indignity?" she wrote.

This is heartwrenching. And yet we have to wonder: Daniel said he wanted to die, this is true, but was he instead crying for help, as is the case with so many people -- able-bodied or not -- whose anguish is so great that life seems pointless?

With his injury, Daniel suffered an unspeakable loss -- the loss of the man he once was, and the loss of the man he had planned to be. Because it happened only a year ago, Daniel would still have been in the most intense throes of shock, fear and disorientation that accompany catastrophic misfortune.

Stern then questions whether James was actually depressed:
I'm no expert on the psychology of bereavement, but I suspect that most anyone who suffers a loss of this enormity -- be it the loss of physical independence, the loss of a child, indeed the loss of your future as you envisioned it -- would in the aftermath question the value of living. But experience shows that with time and support, people -- at least some people -- find a way to endure and rebuild.

In her public statement, Daniel's mother acknowledged that "not everyone in Dan's situation would find it as unbearable as Dan." Why is it that Daniel found his situation hopeless and another person with a similar disability might not? One reason might be that Daniel was suffering from profound depression, as would be expected so soon after the accident.

There is a cultural assumption that severe disability is worse than death, and so to Daniel's parents it was completely normal that their 23-year-old son wanted to die. Perhaps they were right. Maybe for Daniel, disability really would have been worse than death. But he should have been given a chance to discover otherwise.

Link to the Ottawa Citizen article:
http://www.canada.com/ottawacitizen/columnists/story.html?id=98cd7c37-2daf-462a-9698-01a775b4a10b

Link to my blog comment on the Ganzini study on depression and assisted suicide in Oregon:
http://alexschadenberg.blogspot.com/2008/10/depression-and-physician-assisted.html

Thursday, October 23, 2008

Spokane VA hospital preventing suicides

What a confusing world we live in.

Information in the Seattle PI explains that the Spokane Veterans Affairs Medical Centre has appointed a suicide prevention coordinator to oversee mandatory suicide prevention training for every employee at the hospital.

There have been six suicide deaths this year alone in that hospital.

I fully endorse the need for a suicide prevention coordinator in hospitals and long-term care facilities to properly care for people who are experiencing depression, mental illness or psychological problems.

But isn't there going to be a problem if Washington State voters decide to support the I-1000 assisted suicide Initiative?

Will the staff of this hospital be forced to abandon a patient who has received a legal lethal dose to their autonomy, even though that person has become depressed and mentally incompetent?

Will legalizing assisted suicide in Washington State not create an inequality among the patients in hospitals, whereby one patient is given the green light to go ahead and ingest a death cocktail while the next patient is discouraged to commit suicide, through the provision of counseling and anti-depressant medications?

If you believe that my concerns are far-fetched then go to the study by Hamilton and Hamilton entitled: Competing Paradigms of Response to Assisted Suicide Requests in Oregon that was published in the American Journal of Psychiatry in June 2005.

In reference to a Mr. A. who was being discharged after being diagnosed with depression and suicidal ideation, Hamilton and Hamilton report:
"The day after discharge, the same psychiatrist who said Mr. A kept the assisted suicide drugs "safely at home" wrote a letter supporting guardianship by saying he "is susceptible to periods of confusion and impaired judgement." He concluded that Mr. A was unable to handle his own affairs and that his cognitive impairments were unlikely to improve. As court records later revealed, his primary care doctor had written a similar letter in which he stated: "I do support guardianship... as I think both his disease process and medications needed to control his level of pain are impairing his judgement and ability to care for himself.

A judge declared Mr. A incompetent to make his own medical decisions and assigned him a temporary guardian. Nevertheless, the assisted suicide drugs remained in his home."


Vote NO to the Washington State I-1000 assisted suicide initiative.

Link to the article in the Seattle PI
http://seattlepi.nwsource.com:80/local/6420ap_wa_va_suicides.html

Homicide-Suicide Statistics shows concerns over mental health awareness and male violence towards women

A recent article published in the Columbus Dispatch concerning statistics and issues related to homicide-suicide confirm the results of a study by Malphurs and Cohen - "A Statewide Case-Control Study of Spousal Homicide-Suicide in Older Persons," that was published in the American Journal of Geriatric Psychiatry (March 2005).

The Malphurs & Cohen study found that 25% of homicide-suicide perpetrators had a history of domestic violence. In the study, all of the perpetrators were men and 40% were care givers for their wives. Furthermore, their study points out that 65% of homicide-suicide perpetrators and 80% of suicides where a man committed suicide alone were men who were depressed before their deaths. All the perpetrators in this study were men who were often described as dominating, controlling individuals. Their research points out that "depression" is prominent in persons of all ages who commit suicide. Their research also points out that most often the perpetrator is the husband and the victim is the wife.

The article in the Columbus Dispatch points to the recent research from the Centers for Disease Control and Prevention in Atlanta that released a report about violent deaths based on statistics from 16 states.

The Centers for Disease Control and Prevention reported:
In the 200 studied cases, a gun was used nearly 90 percent of the time and men almost always were both the suspects and the suicide decedents. About 15 percent of the suspects had a diagnosed mental-health problem; 10 percent of the suspects were receiving treatment.

The highest percentages of both the homicide and suicide victims were between 35 and 44 years old.


Concerns about Homicide-Suicide relate to the issues of euthanasia and assisted suicide based on the false conclusions by some media reporters who state that homicide-suicide deaths are based on a "compassionate" motivation.

When reading the research, one must conclude that the concept of the "compassionate homicide" death is actually a rare occurance, if ever, the reason for the violent acts.

Society needs to recognize that nearly every time these cases are related to mental health concerns or the controlling/abusive actions of the perpetrator spouse towards the other spouse.

Link to the article in the Columbus Dispatch:
http://www.columbusdispatch.com:80/live/content/local_news/stories/2008/10/23/BADSTATS.ART_ART_10-23-08_A1_KGBM6KI.html?sid=101

Tuesday, October 21, 2008

Beware of Mexico drug risks and rip offs

Under the title "Beware of Mexico drug risks and rip offs" it appears that Derek Humphry is warning his fellow euthanasia lobby and activists of the pit-falls and problems with going to Mexico to obtain lethal drugs.

Humphry states:
Now some people who are making the same hunting expedition at veterinary stores are reporting that they failed entirely. Upset and angry, they are embarrassed to give details. "We couldn't find any," they say and slam down the phone.

Unpleasant stories have also emerged of the sales experiences. A few people have taken a taxi in border towns asking the driver to take them to a vet. store. Some stores have window signs saying "Australians served."

While the traveler makes the substance purchase inside, the taxi driver calls friends at the local police, who then wait outside the store. As the customer emerges, the police waiting on the sidewalk accuse him or her of acting illegally(probably untrue) thus they will face arrest unless a bribe is paid.

In fact, he is not discouraging people from going to Mexico but to continue their efforts and to be aware that problems may exist in obtaining lethal drugs.

It should concern everyone that he acknowledges that many of the people who are seeking lethal drugs are mentally ill or unstable but that he doesn't raise concerns about the irresponsible nature of promoting suicide tourism in Mexico.

A few people have travelled from as far as Australia and New Zealand to get the substance for their end of life. And gone home to broadcast the news. For many it's an 'insurance' or escape route much to be desired. Many people with poor mental health are also joining the rush for this elixir of death.

Further, instead of discouraging people with mental illness or at least suggesting that the practise of mentally ill people obtaining lethal substances from Mexico might be viewed negatively by the common citizen, Humphry states:
If a person is still determined to acquire this prized death elixir because of life-threatening illness, they are best to travel to an inland Mexican city to search. Whereas this was highly likely in the past to succeed, there is now no guarantee. Caveat emptor.

Once again, the euthanasia lobby is not about self-deliverance for mentally competent, terminally ill adults, but rather to obtain a universal right to die for all people at the time of their choosing. They are simply not concerned about the duty to die that is imposed upon vulnerable people and they are not concerned about people who are mentally incompetent or depressed following their advice or dying in assisted suicide clinics in Switzerland.

Monday, October 20, 2008

Dying in Dignity leader - Edward Turner questions the assisted suicide death of former Rugby Star - Daniel James

Once again it appears that leaders of the euthanasia lobby group - Dying in Dignity - in the UK have questionned the more radical actions of the world-wide euthanasia lobby.

Last week Philip Nitschke, Australia's Dr. Death, had his appearance at a Irish University cancelled after Dying in Dignity leaders branded his advice as irresponsible and illegal. Nitschke is known for his "peaceful pill" handbook and his suicide promoting and counseling service on the internet.

Today Edward Turner, a trustee of the lobby group Dying in Dignity in the UK, questionned the actions of those who supported Daniel James who travelled to Switzerland to die by assisted suicide at the Swiss Dignitas Assisted Suicide clinic.

Turner stated that while he would like to see a change in UK law to allow 'assisted dying' for terminally ill patients, there was a 'distinction' between those cases and that of Daniel James who whilst paralysed, probably had 'several decades' of life ahead of him.

Turner had accompanied his terminally ill mother to the Swiss Dignitas Clinic. His mother had progressive supranuclear palsy.

Turner was quoted as saying:
"The vast majority of the population wants assisted dying for the terminally ill to be legalised ... but Dan wasn't terminally ill.
Although I advocate assisted dying, I'm basically against assisted suicide."

On the other hand, Baroness Warnock supports the assisted suicide death of Daniel James. She said:
"we had a 'moral obligation to other people to take seriously reached decisions with regard to their own lives equally seriously."

Link to the article on UK's Daily Mail:
http://www.dailymail.co.uk/news/article-1078877/Suicide-rugby-player-decades-live-says-euthanasia-campaigner-mother-died-Swiss-suicide-clinic.html

My thoughts on the case of Daniel James (23) lead me to think about a Canadian hero, Steven Fletcher the member of parliament for Charleswood - St. James - Assiniboia in Winnipeg Manitoba and the current parliamentary secretary to the Minister of Health.


I do not know what Fletcher would say about James's death, but I do know that Fletcher became a complete quadriplegic in 1996, after hitting a moose with his vehicle while travelling to a geological engineering job in northern Manitoba. The accident left him completely paralysed below the neck, and he now requires 24 hour a day attendant care. He was unable to speak for several months, and only regained this ability after a long process of recovery.

A comment in a blog about Daniel James said:
"So Mr James "had decades of life ahead of him" Until you have walked a mile in his shoes how can you know what it feels like to live his life. His parents may suffer a great loss but at least they know they respected his wishes.

Steven Fletcher has lived through similar experiences that Daniel James would have been experiences. He handled the adversity by rising up to become a source of inspiration for people with disabilies.

I also think about my friend Alison Davis, the leader of the group No Less Human in the UK.

Alison was in a similar situation as Daniel James. She wanted to die and attempted to commit suicide. If she had "supportive parents" as James supposedly has, Alison would be dead today. Instead Alison is an active leader of a disability rights group that supports the equality and dignity of people with disabilities and rejects the concept that equality and dignity includes assisted suicide.

James may have also become a great inspiration for others if he had not been abandoned to his supposed wishes.

For more information about Steven Fletcher go to:
http://en.wikipedia.org/wiki/Steven_Fletcher

Friday, October 17, 2008

Death with Dignity or Obscenity?

By Jean Echlin, Nurse Consultant - Palliative Care & Gerontology

To die, to sleep--

To sleep--perchance to dream: ay, there’s the rub,

For in that sleep of death what dreams may come

When we have shuffled off this mortal coil,

Must give us pause.

An excerpt from a monologue in the play "Hamlet" by William Shakespeare



A Sea of Trust?

There is a draconian evil moving aggressively through our culture. It comes in the form of a lethal cult called Compassion & Choices or Death With Dignity. Its leaders and adherents support the cause of euthanasia and assisted suicide which they call "aid-in-dying." Some adherents, who want death on demand, have a strong desire to die at the time of their choosing. However this is a deadly and distorted ideology. Its leaders insist that physicians, nurses or other health care providers prescribe and give lethal injections, provide the gas, or the drugs necessary to kill a person, or give them the means to kill themselves. This may include a plastic "Exit Bag" or simply a plastic garbage bag secured over the face, head and neck in order to dispense with oxygen.

Professional health care relationships with doctors, nurses, patients and family members float on a sea of trust. Asking professional health care providers to kill, or give the means to kill, will destroy this trust relationship. I emphatically believe that we have no right to ask our professional care givers to provide us with death. Neither should our health care providers ever feel obligated to comply with this narcissistic request.

Why do I believe that?

It is against every ethical principle and moral code for healers to intentionally cause the death of their patients. If they do, we in fact should not and could not ever trust them again. How would you know if the person coming into your hospital room with a needle was intent on curing you or killing you?

Currently, thousands of dollars are being collected throughout the U.S. to assist Washington State’s (I-1000) assisted suicide vote that would legalize assisted suicide in the upcoming American election. Unfortunately, many people in our culture have very little understanding of what this will mean in their future, in the future of their parents and the future of their children. Why are these dollars not being used to promote good pain management and excellence in end-of-life care?

What on earth are they thinking?

If you advocate for euthanasia and assisted suicide by voting for decriminalization the following will result. You will have the solid assurance of authorizing the death of you and/or your family members regardless of age or ability to consent.

Take for example, your 78 year-old mother who has been devastated and feels very depressed following the death of her spouse of more than 50 years. She is experiencing difficult symptoms related to a treatable but possibly late stage illness. How will you respond? Is it not in your mother’s best interest to get counseling in an attempt to treat her depression? If your mother should call upon an advocate or member of Compassion & Choices or Dying With Dignity, she would likely be encouraged to take their least dignified way out and "die now." An estimated 73% of all assisted suicide deaths in the State of Oregon, where assisted suicide is legal, are facilitated in some manner by the Compassion & Choices lobby group. When the "Right to Die" lobby and the end-of-life decision maker are the same people, there is no protection for your vulnerable mother.

Another scenario is your 65 year old father with late stage pancreatic cancer. He has been a very productive, healthy man who has chosen to live as long as he can. He refuses to be labeled "terminal." His medical oncologist has advised the use of palliative chemotherapy that is far less toxic than curative chemotherapy. Your father has received the news that his Health Maintenance Organization (HMO) has denied coverage for the chemotherapy. Instead, they offered to pay for him to obtain assisted suicide. He does not have the financial means to pay for this therapy, which his medical oncologist had indicated would give him an extension of life and better quality of life.

Accepting this offer will deny him the civil right to choose life instead of an assisted death. Does this seem fair or reasonable? What would you do in this situation? Could you afford to pay for his chemotherapy to assist in his self-determination to live longer? The less expensive choice of death is coercion to die that in the end leads to a "duty to die."

This happened to Barbara Wagner (54) in Oregon who was denied effective treatment for lung cancer but offered assisted suicide by the Oregon Department of Health. [see "Death drugs cause uproar in Oregon" August 6, 2008 ; http://abcnews.go.com]

Death is not the appropriate solution to pain and suffering, good palliative care is

If we vote to legalize euthanasia or assisted suicide we are giving away our civil rights; in the United States - life, liberty and the pursuit of happiness and in Canada - life, liberty and the security of person. The prophets of the death cult want us to believe death is the logical answer to pain and suffering. They may even see the infliction of death or the provision of assisted suicide as part of the hospice palliative care mission. They pursue their cause like missionaries and zealots proselytizing their gospel of death. Further, mainline media has picked up their cause and preach like the most persuasive evangelicals.

I believe that those medical professionals and organizations choosing to practice or support euthanasia and/or assisted suicide as "mercy killing" should not be providers of hospice palliative care. In addition, they should not be sitting on governing bodies, advisory councils or committees working on developing standards of practice for palliative care that may include assisted suicide as part of the hospice/palliative care continuum. This may mean that parallel programs not inclusive of assisted suicide and euthanasia may need to be developed.

Who is at risk?

If the law is changed to allow euthanasia and assisted suicide, those at highest risk will be:

· Older women (55 and above) or elderly fragile men

· Individuals with physical or mental disabilities

· Partners in scenarios of domestic violence

· Babies and children born with disabilities and birth anomalies

· Persons who are poor and disenfranchised

· Members of minority groups

Jean’s Way

Derek Humphry is the co-founder of the Hemlock Society. In fact, Humphry’s notion of "self-deliverance" was practiced by him in the death of his first wife, Jean. Following her death, Humphry and his second wife Ann wrote the book Jean’s Way. This started Humphry’s rise to power and prestige in the cult of death. Later he participated, with Ann’s help, in procuring the death of his second wife’s parents ….something Ann would later deeply regret.

When Ann developed cancer, Humphry responded by encouraging her to commit suicide. When she decided to seek treatment, he abandoned her. In her book Deadly Compassion, Rita Marker quotes Ann’s last words to Derek Humphry: "What you did – desertion and abandonment and subsequent harassment of a dying woman – is so unspeakable there are no words to describe the horror of it." [excerpt from Ann Humphry’s suicide note].

This begs the question, what is misogyny? Does assisted death really have anything to do with love and compassion or is it often a misogynistic act?

Why Discuss Misogyny?

In our culture misogyny still exists. It would be wise to re-assess the history of misogyny in relation to the advocacy of assisted suicide and euthanasia. If these actions become permissible under the law, women will experience a jolt of reality. Historically, women have been vulnerable to male authority in politics, law, government, religion and medicine. According to Jack Holland in his book entitled Misogyny: The World’s Oldest Prejudice, he reminds us that even in ancient mythology there is much evidence of negative attitudes towards women.

For example, "Zeus created an ‘evil being’ for man’s delight." She was called "Pandora," who was told not to open the box she carried. Disregarding this order, Pandora opened the box, thus releasing every aspect of evil into the world, including sickness, death and old age.

Current misogynistic attitudes exist in all cultures; some worse than others. There are many countries where genital mutilation of girls is carried out. Huge atrocities in trafficking girls and women for prostitution are taking place world-wide. Pornography is a women-children oriented criminal activity occurring in all countries. Because of this on-going unequal status, women are still blamed for all kinds of evil. This places women more at risk than men in our culture of death.

Researchers Malphurs and Cohen published their findings in, "A Statewide Case-Control Study of Spousal Homicide-Suicide in Older Persons." Their study looked at twenty cases of homicide-suicide conducted over a two year period in the state of Florida. Malphurs and Cohen had no interest in euthanasia or assisted suicide and confined their research to mental health studies around issues of suicide and homicide. Their study was published in the American Journal of Geriatric Psychiatry (March 2005).

Their findings illustrated that 25% of homicide-suicide perpetrators had a history of domestic violence. In the study, all of the perpetrators were men and 40% were care givers for their wives. Furthermore, their study points out that 65% of homicide-suicide perpetrators and 80% of suicides where a man committed suicide alone were men who were depressed before their deaths. All the perpetrators in this study were men who were described as dominating, controlling individuals. Their research points out that "depression" is prominent in persons of all ages who commit suicide. Their research also points out that most often the perpetrator is the husband and the victim is the wife.

How often do the media report that: ‘a sad, compassionate husband killed his partner as an ‘act of compassion?’ The poor man could not stand to see his partner suffering. Consequently the overdose of medications or a gunshot to the head was deemed necessary to cause the death of the partner. On the other hand, the death of the partner may also relieve the suffering of the perpetrator.

The cases of Robert Latimer in Saskatchewan and Terri Schiavo in Florida also follow a similar story line and serve as a warning to us all.

What about the State of Oregon?

The data collected in Oregon reveal the harmful consequences for patients. The Oregon "Death with Dignity Act" took effect in 1997. According to researchers Hendin and Foley ["Physician-assisted suicide in Oregon: a medial perspective" see www.michiganlawreview.org/archives/106/8/hendinfoley.pdf], safeguards for the care and protection of terminally ill patients under this law are being circumvented. One of the key problems seems to be the lack of appropriate data collected by the Oregon Public Health Division (OPHD) who are charged with monitoring the law. This organization failed to "ensure that palliative care alternatives to physician assisted suicide (PAS) are made available to patients" and they also failed to protect vulnerable patients by not ensuring that the safeguards are upheld. This study further points out that "the unintended consequences of (a single criterion of 6 months or less to live) is that it enables physicians to assist with suicide without inquiring into the source of the medical, psychological, social and existential concerns that usually underlie the requests for assisted suicide, even though this type of inquiry produces the kind of discussion that often leads to relief for patients and makes assisted suicide seem unnecessary."

The Editorial Board for the largest newspaper in Oregon, The Oregonian, opposes the I-1000 initiative to legalize assisted suicide in Washington State. To quote the Oregonian Editorial Board: "Don’t go there! We won’t be endorsing it. Our fundamental objection is the same as it’s always been – that it’s wrong to use physicians and pharmacists to hasten patients’ deaths."

The Board also objects to the lack of transparency in the Oregon experience. They stated: "Oregon’s physician-assisted suicide program has not been sufficiently transparent. Essentially, a coterie of insiders run the program, with a handful of doctors and others deciding what the public may know. We're aware of no substantiated abuses, but we'd feel more confident with more sunlight on the program."

Physicians are not required to be knowledgeable about the relief of physical and emotional pain and suffering. This situation is shocking and should be unacceptable under the law. The Oregon "Death with Dignity Act" protects doctors much more than patients.

The Netherlands

Of interest are the Dutch government reports about euthanasia and physician assisted suicide (available on the internet www.internationaltaskforce.org/fctholl.htm). The Dutch Reports (Remmelink Reports) that were published in 1990, 1995, 2001 are horrifying. In addition, a study published in the New England Journal of Medicine(May 2007) entitled: "End-of-life Practices in the Netherlands under the Euthanasia Act" states: "in 2005 there were 2,325 euthanasia deaths. There were approximately 100 assisted suicide deaths, and approximately 9,685 deaths related to terminal sedation. There were also 550 deaths without request that were reported". In the previous Dutch Reports these deaths without permission or request were in the range of 1,000 persons per year. These deaths are often imposed by physicians without the knowledge of the patient or family.

The numbers in the Dutch studies do not include the euthanasia deaths of handicapped infants and children or children up to the age of 12 with life-threatening illnesses. This takes place under the recent Groningen protocol. The studies do include patients with mental health/psychiatric problems. Many people oppose the use of euthanasia for mental disabilities simply because these people may be cognitively impaired and unable to understand the consequences of their decisions.

Doctors continue to determine who will live and who will die. Euthanasia is truly out of control in the Netherlands, thus the word "obscenity" in dying comes to mind. Should patients fear going into acute care or long term care institutions? This fear is borne out in the Netherlands where some people carry a card stating their wish not to be euthanized.

Earlier Dutch Reports indicated that doctors deliberately killed approximately 11,800 people each year by euthanasia, assisted suicide or other intentional actions or explicit omissions. The most recent reports would indicate that these numbers have in fact increased.

This is unconscionable in terms of medical practice. Palliative care should be available and used as the compassionate means to care without killing. The Dutch experience is a predictor of what will happen if assisted suicide and euthanasia are introduced into law.

It is noted by Alex Schadenberg, chair of the Euthanasia Prevention Coalition (International), that the decreased incidents of active euthanasia were replaced by the incredible increase in deaths by terminal sedation in the Netherlands.

Palliative Sedation or Terminal Sedation?

It is important to note that there is a difference between "palliative sedation" and "terminal sedation." Unfortunately the literature does not recognize this.

Palliative sedation is medication given to relieve the distress of a terminally ill patient in their last hours or days when other methods of pain management have failed the patient. This only happens in a very low percentage of patients – approximately 2 to 5 percent who have a pain escalation/surge at the very end of life. According to the Journal of Hospice and Palliative Nursing, (2006;8(6):320-327) in the article: "The Process of Palliative Sedation" four criteria should be present:

· Symptoms that are unbearable and unmanageable

· A current do not resuscitate order (DNR) must be in effect

· A terminal diagnosis

· Death must be imminent within hours to days

It would be helpful to have a separate consent for palliative sedation. This would avoid any confusion around treatment plans. The intent of palliative sedation is to provide pain and symptom relief and not to hasten death.

On the other hand, "terminal sedation" as it is practiced in the Netherlands appears to be sedation followed by dehydration with the explicit intention of causing death. One of the most significant findings in current literature indicates that the use of opiates (morphine, hydromorphone, fentanyl, etc.) when properly titrated according to the patient’s pain intensity, do not hasten death. Also, this is one reason narcotics are not the drugs of choice for euthanasia or assisted suicide.

After reviewing current research it is evident that "palliative sedation" and "terminal sedation" need to be clearly defined and differentiated.

What is terminal?

One of the most difficult clinical assessments is the determination of when a human being is actually "terminal." A disease can be labeled terminal at it’s diagnosis as in terminal cancer. This does not mean that a person is imminently dying. In fact the life span may be anywhere from months to years. It is often difficult for the most astute diagnostician to predict the actual end stage or terminal stage of disease. This is true of the major categories of disease such as cardiovascular, neurological, cancer, renal failure, diabetes etc.

How dare we assume that a diagnosis of a life-threatening illness means that a person is "terminal?" One significant lesson learned from the bedside of a patient of mine is: "Do not let anyone label me "terminal." I will tell you when it is my time. Give me a measure of hope and speak to my living!" These were the words spoken by a 38 year old man who desperately wanted to live.

Individuals facing life-threatening disease are usually depressed. Depression is treatable even in late stage disease. Thus, euthanasia and assisted suicide represent a threat to people both needing medical and psychological support for clinical depression.

What is Hospice Palliative Care?

Hospice Palliative Care is the provision of pain and symptom management for individuals experiencing life-threatening, life-limiting, progressive or terminal disease. The cornerstone of excellence in this newer health care reform is the management of pain and other distressing symptoms. A person in pain is unable to focus on anything except their need for pain relief. Having to cry or plead for pain or anxiety medication leaves the patient feeling degraded demoralized and dehumanized. In cases like these their desperation is often distressing enough to make them wish for death. Individuals have the right to appropriate pain and symptom management.

In addition, palliative care focuses on emotional, social and existential suffering. This care may be combined with therapies aimed at reducing or curing the illness or it may be the total focus of care. Grief and bereavement follow-up may be a part of this caring process.

Many therapeutic modes exist to help with the pain experience. These include, but are not limited to, the use of narcotics, nerve blocks, surgery, radiation, chemotherapy, guided imagery and relaxation techniques, therapeutic touch, raikki, hypnosis, music and art therapy.

Programs of hospice palliative care take a multi-disciplinary team approach utilizing the skills of doctors, nurses, chaplains, social workers and physiotherapists, with the added benefit of trained volunteers.

Including these in the care of patient and family can provide enough quality end-of-life support to eliminate the desire for a premature death caused by euthanasia or assisted suicide. For the infrequent situations where pain and anxiety may appear unmanageable, "palliative sedation" may be considered. This is not euthanasia. It is good palliative care. The intention is to relieve pain and suffering, not to hasten death.

Everybody needs to have access to quality end-of-life care through hospice palliative care programs. Further, medical practitioners, nurses, pharmacists and other members of the health care team should keep informed of newer methods of pain and symptom management. This should be a mandatory requirement through the various licensing bodies.

According to Dr. M. Scott Peck in his book, Denial of the Soul: "Failure to treat pain is medical malpractice…. it is one of the worst crimes in medicine today." His words ring true and he too suffered the pain experience.

Hospice Palliative Care – The Great Hope

Today, there is no excuse for any individual, be they adult or infant, to experience an agonizing death. We have an armamentarium of methods and pharmaceuticals (medications) to modify physical pain and death anxiety. Unfortunately, too many of our health care providers, particularly nurses and doctors, are not effectively trained in the principles and practices of this newer health care reform (30 years) called Hospice Palliative Care. Neither are they educated in the newer methods of pain relief for acute, chronic and end-stage disease.

The "death squad mentality" has no place in our health care systems

Doctors and nurses should never be killers. I can only hope there are very few who would consent to provide euthanasia and assisted suicide, but we do not know how many doctors and nurses would provide death if given the opportunity. A 1998 study from Georgetown University’s Center for Clinical Bioethics found a strong link between cost-cutting pressures on physicians and their willingness to prescribe lethal drugs to patients – were it legal to do so. [Sulmasy, Daniel R. et al. "Physician resource use and willingness to participate in assisted suicide", Archive of Internal Medicine, vol. 158, May 11, 1998]

The legalization of euthanasia would remove an individual patient’s autonomy and put it into the hands of professionals with potential control issues; who may be angry, sadistic and abusive. We have all seen colleagues both at the bedside and in health care management who have significant personality flaws, such as no compassion for the pain and suffering of others. These people may often take the law and the lives of others into their own hands. The reality is that individual patients will lose autonomy in the name of autonomy.

Have we learned from the past?

The era prior to Hitler’s reign of horror, should haunt our thinking. Do we want the responsibility of repeating a violation of humanity by our egotistical need to control the time of our death? The doctors in Germany who experimented with various methods of killing people with disabilities (mental or physical) under the eugenic ideology are going to be replaced in history with doctors and nurses of today who are willing to take part in the deadly type of evil called euthanasia and assisted suicide. Professionals who opt to provide death, will be changed…even hardened in their "psyches" treating life and death as meaningless.

A Voice of Experience

With 29 years experience as a palliative care nurse consultant, I have been at the bedside of more than 1,000 dying individuals. It is my learned experience that persons who receive timely, appropriate and expert pain and symptom management, including attention to their significant issues, do not ask for assisted suicide or euthanasia. According to Dr. Neil MacDonald in the Oxford Textbook of Palliative Medicine, proper pain management can actually extend the life span as patients experience improved quality of life. Palliative care is a life-giving therapy not a life-limiting therapy. Dying with dignity can only be achieved with expert hospice palliative care. This is the compassionate choice and should be available for every individual in Canada and the United States, throughout their life span.

Expert hospice palliative care requires a commitment of health care dollars, strong community and institutional and home health care and compassionate support for vulnerable people.

Euthanasia treats people as disposable objects. Everyone should be concerned…. even frightened by the possibilities of euthanasia and assisted suicide changing the value and dignity that is attributed to the dying, chronically ill and people with disabilities. This is especially true in health care systems facing financial and resource cutbacks where death may be seen as more fiscally efficacious than life. A move in the direction of legalizing assisted suicide and euthanasia will eventually herald the holocaust of this millennium

Are you really willing to leave this appalling legacy for the next generation?

Jean Echlin R.N., M.S.N. is a pioneer in Hospice Palliative Care. In 2004, the Ontario Palliative Care Association (OPCA) recognized her 26 year contribution to hospice palliative care by selecting her for the prestigious "Dorothy Ley Award of Excellence" for her part in "fostering the true spirit of Palliative Care in Ontario." Echlin formerly served on faculty, University of Windsor’s Faculty of Nursing, and was director of nursing at Windsor Regional Hospital’s Metropolitan Campus. As coordinator and clinical nurse specialist, then executive director, Jean was instrumental in the development of the Hospice of Windsor & Essex County Inc. which is recognized as exemplary in Canada. In 1988, Jean moved to London, Ontario and established the Palliative Care Consultation Team in the heart of tertiary care at University Hospital, London Health Sciences Centre. She is also recognized as a distinguished public speaker, educator and free-lance writer. Jean is an independent nurse consultant; formerly vice-president Euthanasia Prevention Coalition; serves on the Advisory Council of the deVeber Institute of Bioethics and Social Research; is a member of the Honour Society of Nursing and member Emeritus of the Registered Nurses Association of Ontario.

Tuesday, October 14, 2008

Playing God or Dignified Death.

I find the title of articles about assisted suicide to be interesting at best. The assertion of such a title is that the issue is about religion or a dignified death.

The title of this Blog comment is taken from the article by The Seattle PI reporter - John Iwasaki who wrote about the religious involvement in the Washington State I-1000 assisted suicide Initiative.

What is most important about this article is that it points out that religious people are concerned about the assisted suicide debate in Washington State, but others are also concerned about assisted suicide from a secular point-of-view.

The article states that:
The Washington State Medical Association opposes I-1000, stating that "physician assisted suicide is fundamentally incompatible with the role of physicians as healers." The association also says that recent advances in palliative medicine provide doctor and patients with the ability to control pain and other end-of-life symptoms.

Iwasaki missed the most important group who oppose assisted suicide that being the disability rights community. The disability rights community have been active in opposing the I-1000 assisted suicide Initiative under the leadership of Not Dead Yet - Washington represented by Duane French and Marilyn Golden from the Disability Research Education group.

The disability rights movement recognizes that assisted suicide directly effects the human rights of people with disabilities. The voice of people with disabilities needs to be heard for people in Washington State to understand the real secular and human rights arguements that oppose assisted suicide.

Link to the article in the Seattle PI news:
http://seattlepi.nwsource.com:80/local/383018_suicidefaith13.html

Eluana Englaro case in Italy

The case of Eluana Englaro in Italy will possibly change direction as the health of Eluana worsens.

Eluana has been in coma for 16 years. Beppino Englaro has petitioned the courts in Italy to have his daughters fluids and food removed.

This is a case very similar to the Terri Schiavo case.

This summer a court in Milan granted the request of her father, but prosecutors appealed the decision.

The reality is that if fluids and food were withdrawn from Eluana, the cause of her death would be dehydration. The courts should never allow the direct and intentional killing of a vulnerable person, such as Eluana.

Once we allow the killing of vulnerable people by intentionally dehydration, then the concept of death by injection will only be viewed as a compassionate altenative.

Link to yahoo news article:
http://news.yahoo.com/s/ap/20081011/ap_on_re_eu/eu_italy_right_to_die&printer=1;_ylt=AvPcGr2i6shgjsfPNTrtwLxbbBAF

How did Nitschke test the "peaceful pill?"


Wesley Smith has asked the poignant question: How did Nitschke test the "peaceful pill?"

Go to his blog and read.

Link to Wesley Smith's blog comment:
http://www.wesleyjsmith.com/blog/2008/10/scandal-of-unasked-question-how.html

University cancels euthanasia talk

Philip Nitschke, Australia's Dr. Death, is once again censored for his radical positions.

Nitschke's invitationto speak at a university in Northern Ireland was withdrawn because the university anticipated that he would be promoting suicide or suicide methods during his talk. A university spokeswoman said:
"The Northern Ireland Forum for Ethics in Medicine and Healthcare has withdrawn its invitation to Dr Philip Nitschke to address Forum members in a forthcoming debate. The reported views of Dr Nitschke were not deemed appropriate for this event."

It appears that infighting within the euthanasia lobby may have been responsible for the cancelation of his talk. The article in the UK Press stated:
Dr Nitschke has said he was offering people information to allow them to make choices in their best interest. However, pro-euthanasia campaign group Dignity in Dying branded his advice irresponsible and illegal.

Dr. Tony Calland, the chairman of the British Medical Associations ethics committee stated:
"doctors' organisation didn't support assisted dying. ... the lobby group recognised that there were tragic cases but maintained there were ways of using palliative care to assist people to die with dignity and the minimum of discomfort."

DUP Assembly member Jimmy Spratt said:
Dr Nitschke openly espoused the idea of suicide. He said it was expected he would provide information to students on how to put together a 'suicide kit'.

"Such information can only be to the detriment of the audience and is extremely dangerous," he added.

"For a university to host such an event, where such information is made available, would have been reckless in the extreme."

The reality is that Nitschke and the mainstream euthanasia lobby share the same philosophy and hope for identical "final goals." The only difference is that Dying in Dignity in the UK want to appear to be mainstream and attempt to work within the law and Nitschke looks for ways to go outside the law to achieve the same final goal.

Link to article from the UK Press:
http://ukpress.google.com/article/ALeqM5jm2Pb2hU-jxeJijH3_F6XnfKf9zw

Nitschke launches online euthanasia manual

Philip Nitschke, Australia's Dr. Death, has done it again.

He is now launching an online version of his peacepill pill handbook in order to get around the fact that many nations, including Australia, have declared his book to be illegal to import.

The text of the ebook are also connected to detailed video of how to effectively kill oneself. Methods include use of the drug Nembutal that is obtained from veternary clinics in Mexico and the use of the plastic bag commonly known as an Exit Bag.

Nitschke is moving forward with his online suicide service while at the same time the UK, Japan, South Korea and other nations are attempting to block internet suicide sites due to an increase in suicide rates related to internet suicide promotion.

Nitscke was quoted by the Australian Broadcasting Corporation as saying:
"(The book) will finally make it possible for many elderly people in Australia too frail and elderly to attend an end of life workshop to obtain the material directly and in the privacy of their own home."

Nitschke, who is the maverick Australian leader of Exit International promoted the peaceful pill that allegedly could be available to anyone at anytime.

Several years ago Wesley Smith reported comments by Nitschke in an article titled "Noxious Nitschke" stating that the "peaceful pill" could be available to troubled teens.
Link to article on national review online:
http://www.nationalreview.com/smithw/smith200411150826.asp

I have been stating for a long-time that all western nations need to ban suicide promotion websites in the way we are banning child-pornography websites. Suicide promotion websites, such as the site sponsored by Nitscke, directly threaten the lives of vulnerable people who are often depressed or experiencing mental health issues.

Remember, even though Nitschke is a maverick in the euthanasia lobby he does not represent a different philosophy than that held by the mainstream. The final goal for Dying with Dignity in the Netherlands is the approval of the "Last-Will-Pill".

The only difference between Nitschke and the mainstream euthanasia lobby is the fact that Nitschke will publicly go outside of the law in order to achieve his final goal.

Link to article on Nitschke online euthanasia manual:
http://www.abc.net.au:80/news/stories/2008/10/13/2389521.htm

Links to other articles about Philip Nitschke:
http://alexschadenberg.blogspot.com/2008/08/grieving-family-wants-suicide-book.html

Link to article about the Japanese suicide problem:
http://alexschadenberg.blogspot.com/2008/06/japan-gripped-by-suicide-epidemic.html

Mum steps up war on suicide sites:
http://alexschadenberg.blogspot.com/2008/04/mum-steps-up-war-on-suicide-sites.html

Sunday, October 12, 2008

If Montana Anti-Assisted Suicide Law is Unconstitutional, What Difference Does Terminal Illness Make?

This is a reprint of Wesley Smith's blog commentary on the Montana Court case:

This is all so phony: Compassion and Choices (formerly Hemlock Society) has filed a suit to declare Montana's law prohibiting assisted suicide to be unconstitutional as against Montana's right to privacy. The suit seeks to declare that a terminally ill person has a right to assistance with suicide as a liberty interest, a matter argued in court recently. From the story:

The plaintiffs argue that mentally competent, terminally ill Montanans facing a dying process they find intolerable should be allowed to take prescribed medication to help them die peacefully.

"A mentally competent, terminally ill Montanan should have the right to choose a peaceful death, when confronted by death," said Kathryn Tucker, Compassion and Choices director of legal affairs.
But dying isn't dead, it is an aspect of living, just as there are other aspects of living--unbearable grief, serious disability, chronic illness, loneliness, morbidity in old age, etc.--that people may find intolerable. Thus, if the court rules that an intolerable aspect of living gives rise to a right to facilitated suicide, I don't understand how that liberty can be limited logically to just people who are terminally ill. Indeed, if there is a fundamental right to lethal prescriptions as medical treatment with which the state cannot interfere, how in the world can the state prevent other suffering people from exercising the same right--particularly since non terminal suffering is often far more extended in duration and in the amount of pain caused? This is why Switzerland declared a constitutional right to assisted suicide for the mentally ill: Once the initial premise is accepted, there is no logical way of preventing the entire steak from being consumed.

So we can see that the dying patient is just the point person, the category of suffering persons that many will be willing to accept for the right to suicide, when in reality, these patients are being used to front the broader agenda that can, in time, only lead to a right to be made dead for anyone with a sustained desire to die.

My, we have become a death obsessed culture. The nihilism is so thick you can cut it with a knife.

Hopefully the court will understand that it is a proper purpose of the state to protect everyone from self destruction, not just some people. However it turns out, you will hear about it here.

Link to Wesley Smith's incredible blog comment on the attempt by Compassion and Choices (formerly the Hemlock Society) to strike down Montana's law prohibiting assisted suicide:
http://www.wesleyjsmith.com/blog/2008/10/if-montana-anti-assisted-suicide-law-is.html

Wednesday, October 8, 2008

Response to the Editorial concerning study on: Depression and Physician Assisted Suicide

The recently published study by Ganzini et al shows that 26% of people who took part in this study in Oregon who had requested assisted suicide were experiencing depressive disorders.

The study by Linda Ganzini, Elizabeth R. Goy, and Steven K Dobscha was recently published in the British Medical Journal - BMJ 2008;337;a1682.

I was dismayed by the Editorial that was published in the British Medical Journal - BMJ 2008;337:a1558 written by the Dutch researcher and oncologist Marije L. van der Lee of the Helen Dowling Institute.

van der Lee was the author of the important study that showed that a correlation exists between the incidence of depression with requests for euthanasia in the Netherlands. Euthanasia and Depression: A Prospective Cohort Study Among Terminally Ill Cancer Patients - Journal of Clinical Oncology, Vol 23, No 27 (September 20), 2005: pp. 6607-6612

Based on the Editorial written by van der Lee, it appears that we can expect that the the new response by the euthanasia lobby to the relationship between euthanasia/assisted suicide and depression is to acknowledge that the relationship exists and deny that it is important.

van der Lee writes in the editorial:
Determining whether depression impairs the judgement of a patient requesting assisted suicide is more complex, because depressed patients are not necessarily incompetent. ... Ganzini and colleagues report that only 6% of psychiatrists in Oregon were confident they could adequately determine in a single evaluation whether a psychiatric disorder impaired the judgement of a patient requesting assisted suicide. Doctors who have known their patient for some time can often determine their patient's level of competency. In the Netherlands and Oregon, consultation with a second doctor is already standard procedure, so a psychiatrist should be consulted only when the patient's ability to make a decision is in doubt.

van der Lee is saying that people who are depressed will make requests for euthanasia and assisted suicide but having a depressive disorder does not make the person incompetent. Further to that, van der lee seems to be saying that since there is a requirement of having a second doctor agree to a request for euthanasia or assisted suicide, then the fear of someone who is incompetent dying by lethal injection or ingestion is minimal at best.

In reality van der Lee is simply creating a new paradigm for the fact that their is a direct corelation between people suffering from depression and dying from euthanasia. It is easier to write the concerns off as trivial than recognize the serious problem for what it is.

van der Lee also rejects the concerns of the study that Ganzini acknowledged that stated:
In a study of 290 US forensic psychiatrists, 58% indicated that the presence of major depressive disorder should result in an automatic finding of incompetence for the purpose of obtaining assisted suicide.

Finally van der Lee ignores the fact that last year in Oregon, none of the 49 people who died by assisted suicide were referred for a psychiatric or psychological assessment, even though the Ganzini study notes at least two people who participated in the study were depressed when they died from ingesting lethal drugs. This fact should further concern van der Lee because the van der Lee and Ganzini studies both concluded that 17% of those in the study who died by euthanasia or assisted suicide were depressed. We can assume that in the Netherlands very few people are referred for a psychiatric or psychological assessment before they are injected with death.

This conclusion corelates with the hypothesis that was presented in the van der Lee study which was:
.. we hypothesized that depressed mood would show an inverse association with requests for euthanasia. Our clinical impression was that such requests were well-considered decisions, thoroughly discussed with healthcare workers and family. We thought the patients requesting euthanasia were more accepting their impending death and we therefore expected them to be less depressed. To our surprise, we found that a depressed mood was associated with more requests.


Further to that van der Lee stated in the study:
Opposition stems partly from the perspective of suicide as a symptom of mental illness and the tendency to extend this view of suicide in the physically healthy onto euthanasia and physician-assisted suicide in the terminally ill.


In other words, van der Lee conducted the study that was published by the Journal of Clinical Oncology, Vol 23, No 27 (September 20), 2005: pp. 6607-6612; to counter the opposition to euthanasia that has been expressed concerning vulnerable people with mental illness.

The further concern is whether van der Lee is capable of effectively responding to the Ganzini study.

To read the editorial by van der Lee one may conclude that van der Lee is attempting to cover up the reality of the relationship between depression and euthanasia/assisted suicide rather than analyze the Ganzini findings. We must remain aware of the new directions and verbal gymnastics that the euthanasia lobby incorporates.

The new idea that van der Lee has introduced is that depression is not a reason to not prescribe death for vulnerable patients.

Link to the editorial by van der Lee in the British Medical Journal:
http://www.bmj.com:80/cgi/content/full/337/oct07_2/a1558?eaf

Depression and physician assisted suicide

People in Washington State need to be aware that if the I-1000 assisted suicide Initiative is passed, people who experience depression will not be effectively protected under "Oregon Style" guidelines.

The recently published study by Ganzini et al proves that 26% of people in Oregon who requested assisted suicide were experiencing depressive disorders. Even though many of those people were incompetent or unable to "freely choose" assisted suicide that in fact they were given a prescription for lethal drugs and died by ingesting those drugs.

Linda Ganzini (left)
The study by Linda Ganzini, Elizabeth R. Goy, and Steven K Dobscha - BMJ2008;337;a1682 states in its conclusion:
Our study suggests that most patients who request aid in dying do not have a depressive disorder. However, the current practice of the Death with Dignity Act in Oregon may not adequately protect all mentally ill patients, and increased vigilance and systematic examination for depression among patients who may access legalised aid in dying are needed. Tools for screening for depression such as those used in our study are easy to administer and may help to determine which patients need further evaluation by a mental health professional. Further study is needed to determine the effect of treatment of depression on the choice to hasten death.
What is important about this study is that Ganzini et al do not oppose physician assisted suicide, but are rather concerned about the implications of such a law.

Since the Oregon assisted law was enacted to allow assisted suicide for adults who are competent, terminally ill, and voluntarily choosing to end their life. Therefore this study is important based on the fact that a person who is depressed is usually incompetent or unable to freely choose to end their life.

The Euthanasia Prevention Coalition believes that physician assisted suicide directly threatens the lives of the most vulnerable in our society. That doesn't mean that, when legal, only vulnerable people die by assisted suicide, but rather a vulnerable person, which includes but is not limited to people who are experiencing symptoms of depression, are more likely to die by assisted suicide than the general population of terminally ill people.

Ganzini et al, studied 58 patients in Oregon who requested assisted suicide. Most of these people were dying of cancer or ALS - Lou Gehrig's disease.

Ganzini et al specifically studied patients who had requested assisted suicide:
our surveyed participants had taken active steps to pursue a physician's aid in dying in one of the few jurisdictions where it is legal - all either explicitly requested aid in dying from a physician or contacted Compassion and Choices for information on the Oregon Death with Dignity Act. Before death, almost half had obtained a prescription for a lethal drug under the law.
Of the 58 people who participated in the study, 26% (15) were independently diagnosed with depression.

The study stated:
Among patients who requested a physician's aid in dying, one in four had clinical depression. However, more than three quarters of people who actually received prescription for lethal drugs did not have a depressive disorder. Our findings also indicate that the current practice of legalised aid in dying may allow some potentially ineligible patients to receive a prescription for a lethal drug; two of those who ultimately died by lethal ingestion had depression at the time that they received a prescription for a lethal drug and died by ingestion the drug. A third patient was depressed at the time that she requested a physician's aid in dying and probably received her prescription; she was successfully treated for her depression before she died by lethal ingestion.
Further to the concern in Oregon that people with depressive disorders are dying by assisted suicide Ganzini et al acknowledge that:
In a study of 321 psychiatrists in Oregon only 6% were very confident that in a single evaluation they could adequately determine whether a psychiatric disorder was impairing the judgement of a patient requesting assisted suicide. In a study of 290 US forensic psychiatrists, 58% indicated that the presence of major depressive disorder should result in an automatic finding of incompetence for the purpose of obtaining assisted suicide.
Proponents of assisted suicide will say that since their are safeguards in Oregon that mandate that someone who has a depressive disorder or mental illness must receive a psychiatric or psychological assessment before receiving a prescription for a lethal drug, that these few cases simply represent an oversight by the physician.

The reality is that of the 49 cases of assisted suicide in Oregon last year, none of them were referred for a psychiatric or psychological assessment.

In other words, safeguards in Oregon are either ignored or completely ineffective and Ganzini et al proves it.

Link to the abstract in the British Medical Journal - BMJ 2008;337:a1682:
http://www.bmj.com/cgi/content/abstract/337/oct07_2/a1682?ijkey=bc7d37e92efbfea7ce03a2d59bfd0c8b4623fa04

Link to the article in the Oregon Public Broadcasting - OPB News:
http://news.opb.org/article/3248-new-study-depression-and-assisted-suicide/

Link to the article in the Healthcare Republic:
http://www.healthcarerepublic.com/news/GP/851763/Assisted-suicide-patients-could-treated-depression/