Thursday, February 24, 2011

'I am racked by guilt'


Canadians will once again begin a national debate on euthanasia based on the case of Stephan Bolton who yesterday admitted to intentionally killing his wife, Barbara, with a lethal cocktail of pain killers.

Stephan Bolton went into the RCMP yesterday to confess that he intentionally gave his wife, who had stage 4 breast cancer, a lethal cocktail of morphine and Nozinan. He told the RCMP that he had not discussed euthanasia with his wife and he was confessing to the crime because he felt "racked by guilt"

He stated:
"It's been over a month. Over that month I tried to live with it and I just can't - not without being told by (some) authority that what I did wasn't wrong"
The RCMP stated in their media release:
Queens County RCMP Investigating Possible Homicide

February 24, 2011, Liverpool, Nova Scotia....Members of the Royal Canadian Mounted Police (RCMP), Queens County Detachment, are investigating a possible homicide. On February 23, 2011, at 11:00 a.m. a 56 year-old man walked into the Queens County RCMP Detachment to confess his involvement in the death of a 59-year old woman. The RCMP Southwest Nova Major Crime Unit along with Queens County RCMP Detachment are in the preliminary stages of their investigation.

The suspect is currently in custody as the investigation continues. Further investigation is required to determine if charges will be laid. The investigators are treating this as a very serious incident.
Bolton said that his wife was not suffering physical pain but that she was very depressed.

Euthanasia is an act that is prosecuted as a homicide in the Criminal Code. To legalize euthanasia would mean, giving one person the right to directly and intentionaly cause the death of another person.

Canada needs to maintain our laws prohibiting euthanasia to protect people from others who, like Bolton, may decide to ease their own pain by taking the life of another person.

I have great concern about how we care for people with cancer, about how we provide end-of-life care for Canadians, about how we support the families, but Canada needs to recognize that the concept of legalizing euthanasia threatens the lives of vulnerable Canadians.

The article in the Nova Scotia Chronicle Herald sated:
Stephan Bolton got into his white taxi late Wednesday morning with a heavy heart.

He pulled out of the driveway in front of the pale green mobile home where he had lived with his late wife, Barbara, her black Dodge SX 2.0 still in the driveway, promoting her photography business in pink letters.

Bolton drove the few minutes to the Queens RCMP detachment on the other side of Liverpool to tell police he had played a role in his terminally ill wife’s death last month.

But before he did that, Bolton telephoned The Chronicle Herald to explain that he wanted to go public to spur much-needed public debate about the issue of euthanasia.

“I don’t have an agenda. I have a guilty conscience,” he said.

And then he told this newspaper what he said he did.

It was Jan. 22.

His wife, 59, was suffering with Stage 4 breast cancer and in palliative care, with Bolton her primary caregiver.

One Liverpool resident who asked not to be named said it was well known in the community that Barbara was very ill and in great distress.

Stephan Bolton said his wife had, at most, a couple of months to live.

While she wasn’t in terrible pain, Bolton told The Herald his wife was very depressed. He said he gave her a lethal injection of two medications — morphine and Nozinan — and was taking the drugs to the detachment with him.

They had not discussed the possibility of euthanasia, he said, or did he ask Barbara if she wanted the lethal injections.

His wife’s suffering ended that January day. Bolton’s did not.

He said he has been haunted by his actions.

“It’s been over a month. Over that month, I tried to live with it and I just can’t — not without being told by (some) authority that what I did wasn’t wrong. I am racked by guilt and have to somehow resolve it.”

Bolton said he has discussed the issue with people but has gained no sense of relief or well being.

“I can’t resolve it through more discussion. I am not happy (with turning myself in), but you have to weigh things and sometimes happiness is not the most important thing.”

Cpl. Grant Webber, a detachment spokesman, confirmed a 56-year-old man turned himself in to the RCMP office at 11 a.m. to confess to “a possible homicide.”

“At this time, no charges have been laid,” Webber said in an interview late Wednesday afternoon.

The officer would not name the man because he had not been charged, but he did say the man would be held in the detachment overnight.

Bolton’s white taxi was in the detachment most of the day but was gone by late afternoon.

The man who was being questioned by police did speak with a Nova Scotia Legal Aid lawyer. Johnette Royer left the detachment by a side entrance shortly before 5 p.m. but declined to give an interview.

Earlier in the day, Bolton told this newspaper that he does not want to be a poster boy for euthanasia, but he does believe public debate is in order.

“It’s time we decided these issues (and they are) not swept under the carpet.”

He said he wants to take responsibility for his actions and will accept the outcome if he is charged.

Webber said officers with the Southwest Nova major crime unit and the Queens RCMP detachment are investigating.

“Further investigation is required to determine if charges will be laid,” he said in a news release. “The investigators are treating this as a very serious incident.”

In addition to her husband, Barbara Jollimore-Bolton is survived by her parents, three adult children and seven grandchildren.

She was described in her obituary as “a passionate, free spirit who loved to travel, loved the outdoors and loved to laugh.”

She was well known in the community, owning a cab company called B.J.’s Taxi and a photography business.

“Best described as a strong woman, her fiery personality and enduring sense of humour will be missed by all those she encountered,” the obituary said.

Saturday, February 19, 2011

Save baby Joseph Maraachli vigil - Monday at 9 AM

On Thursday, I wrote a comment about the decision by the Ontario Superior Court to withdraw the ventilator from 13 month old, Joseph Maraachli. This is not a case of euthanasia but it is an injustice that will effect Ontario citizens because the Judge decided that the decision of the doctors and the hospital is upheld against the reasonable decision of the family.

All the family is wanting to do is bring Joseph home so that he can die in the care of his family.

A group of people who are supporting the Maraachli family are having a vigil for Baby Joseph and his family starting at 9 am on Monday, February 21, at the corner of Wellington and Commissioners in London Ontario (near the hospital).

Link to the Save baby Joseph facebook page: http://www.facebook.com/#!/pages/Save-baby-Joseph/142316562497565

Thursday, February 17, 2011

Windsor couple's appeal dismissed to bring baby home

An article by Sonja Puzic in the Windsor Star announced that the Ontario Superior court has decided that the breathing tube that is keeping 13 month old Joseph Maraachli alive will be removed on Monday, February 21; against the wishes of his family.

The case is not about the right to withdraw life-sustaining medical treatment. Link to my previous article.

Victoria Hospital (London Health Sciences Centre) and the family agree that Joseph is dying. The family wants a tracheotomy to be done to allow Joseph to be brought home where he would die in the care of his family.

We must be clear, this is not a case of euthanasia but rather a case of who has the right to decide to make end-of-life decisions.

I really can't understand why the court denied the family the opportunity to bring their child home to allow him to die in their care. I also can't understand why Victoria Hospital in London Ontario would be so heartless as to force this family, who are grieving, to go through the emotional and financial stress of going through the courts in order to be allowed to take their terminally ill child home to die in their arms?

I can't understand how the court would think that "justice" has been done, when a hospital has employed a high priced legal team to fight against a family who are relying on legal aid to defend their rights. This is not only a case of David vs Goliath, but in this case, the court is the second Goliath.

Finally, the decision may have been acceptable, if the Judge had decided that, if another physician was willing to do the tracheotomy, that then it should be done. The reality is that you cannot force a doctor to do a tracheotomy against their conscience.

Once again, if it becomes accepted that decisions by a hospital or medical team supersede that of the power of attorney, then everyone needs to be concerned.

The article stated:

Baby's breathing tube to be removed Monday

A Superior Court judge in London has dismissed a Windsor couple’s appeal of a decision to have their dying baby’s breathing tube removed in hospital instead of allowing the child to spend his last days at home.

Moe Maraachli and Sana Nader took their battle with London doctors to court in hopes their one-year-old son Joseph, who has a severe neurological condition, would be able to die at home, surrounded by family.

The couple appealed a Jan. 26 ruling by the Consent and Capacity Board of Ontario, an independent body that deals with matters under the Health Care Consent Act, which sided with the doctors, agreeing that Joseph’s breathing tube should be removed.

An emotional Justice Helen Rady said Thursday the board’s decision was reasonable, tearing up as she delivered her decision about an hour after the lawyers made their arguments in court.

Joseph’s breathing tube is to be removed by 10 a.m. Monday.

“I do my best for my baby. My son is not a criminal ... to just let him die,” Moe Maraachli said through tears outside the courtroom. “They are taking my baby away from me.”

Maraachli said he didn’t know how he will tell his wife Sana, who was too upset to sit through the day’s court proceedings, about the judge’s decision. He couldn’t think about how he would explain the situation to the couple’s older child, seven-year-old Ali.

Maraachli and Nader lost a daughter nine years ago to a condition nearly identical to Joseph’s.

Joseph has been at London’s Victoria Hospital since October, suffering from severe and progressively deteriorating neurological problems.

His brain is losing function and he can’t breathe on his own or swallow.

After a battery of tests and various examinations, specialists in London concluded that Joseph has no prospect of recovery and is in a persistent vegetative state.

But Joseph’s parents insisted the baby responds to their voices and touch and has been growing over the course of his hospital stay. They wanted doctors to perform a tracheotomy — opening a direct airway through an incision in the trachea — and let them take Joseph home to die.

Doctors refused to perform the procedure because it’s too risky.

The craziest quote in the article is the final quote
Doctors refused to perform the procedure (tracheotomy) because it's too risky.

Why is it too risky, the child is supposedly dying anyway, and after they remove the breathing tube, the child will supposedly die anyway. So what's at issue?

I am convinced that this case is really about deciding who has the power to make end-of-life decisions. The court aooears to be suggesting that the Hospital and the doctors have the power to make end-of-life decisions, even when it is against the reasonable wishes of the family. If this is the case, then the people of Ontario better be ready, because this is worse than supposed death panels.

Physician-Assisted Suicide: A Recipe for Elder Abuse and the Illusion of Personal Choice

Link to the original article:


Margaret Dore
By: Margaret K. Dore, Esq.
"Elders and people with disabilities are, as a group, at high risk for violence, abuse and exploitation."
Vermont Center for Crime Victim Services[1]
Introduction

In 2009, a legislative proposal to legalize physician-assisted suicide in Vermont was introduced, but not brought to a vote.[2] The proposal was modeled on Oregon’s assisted suicide act.[3] Oregon is one of just two states where assisted suicide is legal. In Vermont, proponents have indicated that they will be backing a similar proposal in the 2011 legislative session.[4]

Physician-Assisted Suicide

The American Medical Association (AMA) defines physician-assisted suicide as follows: “Physician-assisted suicide occurs when a physician facilitates a patient’s death by providing the necessary means and/or information to enable the patient to perform the life-ending act (e.g., the physician provides sleeping pills and information about the lethal dose, while aware that the patient may commit suicide).”[5]

The AMA rejects assisted suicide.[6] Assisted suicide is also opposed by disability rights groups such as the Disability Rights Education and Defense Fund, and Not Dead Yet.[7]

Most States and Canada Do Not Allow Assisted Suicide

The vast majority of states to consider assisted suicide, have rejected it.[8] In 2010, New Hampshire and Canada rejected it by wide margins.[9] In Vermont, legislative proposals to enact assisted suicide have failed multiple times.[10]

There are just two states where assisted suicide is legal: Oregon and Washington. These states have acts that give doctors and others immunity from criminal and civil liability.[11] In Montana, there is a court decision that gives doctors a potential defense to criminal prosecution, but does not legalize assisted suicide by giving doctors and others criminal and civil immunity.[12]

The Oregon and Washington Acts

Oregon’s act was passed via a ballot initiative and went into effect in 1997.[13] Washington’s act was passed via another initiative and went into effect in 2009.[14] Washington’s act is modeled on Oregon’s act.[15]

In both states, voters were promised that assisted suicide would assure their choice over the manner and timing of their deaths.[16] Both the Oregon and Washington acts, however, have significant gaps so that such choice is not assured. For example, neither act requires witnesses at the death.[17] Without disinterested witnesses, the opportunity is created for someone else to administer the lethal dose to the person without his consent. Even if he struggled, who would know?

Oregon and Washington are also “Don’t Ask, Don’t Tell” states. Required official forms and reports do not ask about or report on whether the person who died consented to administration of the lethal dose.[18] Consent at the time of death is also not required by the language of the acts themselves.[19] Without the right to consent at the time of administration, the claimed control over the manner and timing of death is an illusion. Once again and contrary to marketing rhetoric, choice is not assured.

The Vermont Proposal

In 2009, the proposal to legalize assisted suicide in Vermont consisted of two identical bills: Senate Bill S.144 and House Bill H.455.[20] As in Oregon and Washington, proponents claimed that choice would be assured.[21] This choice was, however, not assured. Like Oregon and Washington, the proposal lacked witnesses at the death.[22] The proposal also failed to require consent when the lethal dose was administered.[23] Two of the proposal’s other gaps are discussed below.

“Self-administer”

The Vermont proposal stated that a person “may request medication to be self-administered for the purpose of hastening his or her death.”[24] There was, however, no language stating that administration "must" be by self-administration.[25] This left the door open to someone else administering it. Without a clear right to self-administration, the person’s ability to choose the manner and timing of death was not assured.[26]

Interested parties

The Vermont proposal had an application process to obtain the lethal dose, which included a written request form with two required witnesses.[27] The witnesses were not allowed to be interested parties, such as a beneficiary of the patient’s will who would benefit financially from the death.[28] The proposal did not, however, prohibit interested persons from procuring the patient’s signature.[29] An example of procurement would be: providing the lethal dose request form; recruiting the witnesses; and supervising the signing.

In the context of signing a will, a beneficiary’s procurement of the will is a “suspicious circumstance,” capable of supporting a presumption of undue influence. The Vermont Supreme Court in Estate of Raedel states: “[I]n cases of suspicious circumstances, usually ‘the beneficiary has procured the will to be made or has advised as to its provisions.’”[30]

Other states have similar laws. Burns v. Kabboul, a Pennsylvania case, states: “It will weigh heavily against the proponent [of the will] on the issue of undue influence when the proponent was … present at [its] dictation … ”[31] The Vermont proposal's lethal dose request process, which allowed interested parties to procure the person's signature on the lethal dose request form, did not promote choice. It invited coercion.

Not Necessarily Dying

The Vermont proposal applied to “terminal” patients, defined as having no more than six months to live.[32] Such persons are not necessarily dying. Doctor prognoses can be wrong.[33] Moreover, treatment can lead to recovery. Oregon resident, Jeanette Hall, who was diagnosed with cancer and told that she had six months to a year to live, states:
I wanted to do our law and I wanted my doctor to help me. Instead, he encouraged me to not give up and ultimately I decided to fight. I had both chemotherapy and radiation … It is now nearly 10 years later. If my doctor had believed in assisted suicide, I would be dead.[34]
Expanded Definitions of “Terminal”

In other states, proponents of assisted suicide have proposed expanded definitions of terminal for the purpose of assisted suicide. If these definitions would be enacted in Vermont in 2011, assisted suicide would apply to people who are clearly not dying. Consider, for example, an Oregon style bill introduced in New Hampshire in 2009 and defeated in 2010.[35] When originally introduced, it contained the following definition of “terminal condition”:
XIII. “Terminal condition” means an incurable and irreversible condition, for the end stage of which there is no known treatment which will alter its course to death, and which, in the opinion of the attending physician and consulting physician competent in that disease category, will result in premature death.[36]
Stephen Drake, of the disability rights group Not Dead Yet, explains the definition’s significance, as follows:
“[T]erminality is defined as having a condition that is irreversible and will result in a premature death. My partner [a wheelchair user] would fit that definition. Many people I work with also fit the definition. None of them are dying.”[37]
In Montana, Compassion & Choices, a suicide proponent, proposed this definition of “terminally ill adult patient”: “[An adult] who has an incurable or irreversible condition that, without the administration of life-sustaining treatment, will, in the opinion of his or her attending physician, result in death within a relatively short time.”[38] Attorney Theresa Schrempp and doctor Richard Wonderly provide this analysis:
[The] definition is broad enough to include an 18 year old who is insulin dependent or dependent on kidney dialysis, or a young adult with stable HIV/AIDS. Each of these patients could live for decades with appropriate medical treatment. Yet, they are “terminally ill” according to the definition promoted by [Compassion & Choices].[39]
Not Personal Choice

Once a person is labeled “terminal,” the argument can be made that his or her treatment should be denied in favor of someone more deserving.[40] This has happened in Oregon, where persons labeled “terminal” have not only been denied coverage for treatment, they have been offered coverage for suicide instead.[41] The most well-known case involves Barbara Wagner, who had lung cancer.[42] The Oregon Health Plan refused to pay for a drug to possibly prolong her life and offered to pay for her suicide instead.[43]

After Wagner’s death, Compassion & Choices’s president, Barbara Coombs Lee, published an editorial arguing against Wagner’s choice to try and beat her cancer.[44] Coombs Lee also defended the Oregon Health Plan and argued for a public policy change to discourage people from seeking cures.[45]

The editorial, combined with Compassion & Choices’ expanded definitions of terminal, provides a glimpse into that organization’s true agenda: it is not the promotion of personal choice. Indeed, the opposite would appear to be true.

A Bipartisan Vote Defeats Assisted Suicide

In January 2010, the Oregon-style New Hampshire bill discussed above was defeated in the New Hampshire House of Representatives, 242 to 113.[46] New Hampshire Representative Nancy Elliott states: “[M]any legislators who initially thought that they were for the act became uncomfortable when they studied it further."[47] At that time, the New Hampshire House of Representatives was controlled by the Democratic Party.[48] The vote to defeat assisted suicide was bipartisan.[49]

Legalization Will Create New Paths of Abuse

In Vermont, there are an estimated 3,750 cases of violence and abuse against elders each year.[50] Nationwide, elder financial abuse is a crime growing in intensity, with perpetrators often family members, but also strangers and new “best friends.”[51] Victims are even murdered for their funds.[52]

Elder abuse is often difficult to detect. This is largely due to the unwillingness of victims to report. “Shame, dependence on the abuser, fear of retribution, and isolation from the community are significant obstacles that discourage elders from reporting … ”[53]

In Vermont, preventing abuse of vulnerable adults, including the elderly, is official state policy.[54] If assisted suicide would be legalized via an Oregon-style act, the gaps would create new paths of abuse against the elderly, which is contrary to that policy. Moreover, some gaps cannot be filled. Representative Elliott states: “[Assisted suicide] acts empower heirs and others to pressure and abuse older people to cut short their lives. This is especially an issue when the older person has money. There is no assisted suicide bill that you can write to correct this huge problem.”[55]

People With Disabilities

In Oregon and Washington, the prescribing doctor is required to complete a reporting form after the person’s death.[56] In both states, this form includes a check-the-box question listing seven “concerns” to justify the lethal dose request.[57] These concerns include: “loss of dignity,” “loss of autonomy,” and “decreasing ability to participate in activities that made life enjoyable.”[58]

Each year, Oregon and Washington each issue a report based on the information provided.[59] In 2010, William J. Peace wrote this response to Washington’s first report, regarding its devaluation of people with disabilities. He stated:
I am a professional writer who has been paralyzed since I was 18 years old … I cannot walk and hence have lost some individual autonomy. In the estimation of many that can walk, my existence is not dignified. There are activities I once enjoyed that I can no longer do … But my life does have value and I am chilled to the bone by … [the report that] has the not-so-subtle implication that my life, and the lives of others like me, do not.[60]
In Vermont, adults with physical disabilities are “vulnerable adults” entitled to protection under Vermont’s Adult Protective Services Statute.[61] To enact an Oregon-style law would devalue such persons and would be counter to the intent of that statute to protect people with disabilities.[62]

The Oregon Suicide Statistics

Oregon’s suicide rate, which excludes suicide under Oregon’s assisted suicide act, is 35% higher than the national average.[63] This rate has been “increasing significantly since 2000.”[64] Just three years prior, in 1997, Oregon legalized assisted suicide.[65] There is at least a statistical correlation between these two events.

Regardless, how can Oregon or Vermont credibly tell its citizens that "suicide is not the answer" when it also tells them that suicide is “death with dignity?” In Vermont, preventing suicide is official state policy.[66] Vermont should not enact a proposal that contradicts this policy.

Conclusion

Legalization of assisted suicide is a recipe for elder abuse. It devalues people with disabilities. Its promise of individual choice is an illusion. Vermont has repeatedly rejected assisted suicide. Don’t make Oregon and Washington’s mistake.

Margaret K. Dore, Esq., is an elder law/appellate attorney in Washington state, where assisted suicide is legal. She has been licensed to practice law since 1986. She is a former Law Clerk to the Washington State Supreme Court for then Chief Justice Vernon Pearson. She is a former Law Clerk to the Washington State Court of Appeals to Judge John A. Petrich. She is a former Chair of the Elder Law Committee of the American Bar Association Family Law Section. She is admitted to practice in the United States Supreme Court, the Ninth Circuit Court of Appeals, the United States District Court of Western Washington and the State of Washington. For more information, see www.margaretdore.com.

End Notes:
[1] Elder Abuse Public Education Campaign, Vermont Center for Crime Victim Services, at http://www.ccvs.state.vt.us/pub_ed/index.html (last visited Dec. 24, 2010).
[2] The Vermont proposal consisted of two identical bills: Senate Bill S.144 and House Bill H.455, http://www.leg.state.vt.us/docs/2010/bills/Intro/S-144.pdf (last visited Dec. 24, 2010) and http://www.leg.state.vt.us/docs/2010/bills/Intro/H-455.pdf (last visited Dec. 24, 2010).
[3] S.144 and H.455 had the same basic structure as Oregon’s act. See Or. Rev. Stat. § 127.800-.995, http://www.oregon.gov/DHS/ph/pas/ors.shtml (last visited Dec. 24, 2010). The two Vermont bills also contained findings regarding Oregon’s assisted suicide act. See S.144 & H.455, Sec.1.
[4] See, e.g., www.patientchoices.org (last visited Dec. 24, 2010).
[5] A.M.A. Code of Medical Ethics, Opinion 2.211, http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion2211.shtml (last visited Dec. 24, 2010).
[6] Id.
[7] See http://www.dredf.org/assisted_suicide/index.shtml (last visited Dec. 24, 2010) and www.notdeadyet.org (last visited Dec. 24, 2010).
[8] Int’l Task Force on Euthanasia & Assisted Suicide, Attempts to Legalize Euthanasia/Assisted Suicide in the United States (2009), http://www.internationaltaskforce.org/pdf/200906_attempts_to_legalize_assisted_suicide.pdf (“Between January 1994 and June 2009, there were 113 legislative proposals in 24 states. All were either defeated, tabled for the session, or languished with no action taken.”) (last visited Dec. 24, 2010).
[9] On January 13, 2010, the New Hampshire House of Representatives defeated an Oregon-style assisted suicide act, 242 to 113. See New Hampshire House Record, No. 9, January 13, 2010 regarding HB 304, at http://www.gencourt.state.nh.us/house/caljourns/journals/2010/houjou2010_09.html (last visited Nov. 4 2010). On April 21, 2010, the Canadian Parliament defeated a bill that would have legalized assisted suicide, 228 to 59. See Canadian government website at http://bit.ly/Official_Report_C-384 (last visited October 22, 2010) and How’d They Vote: Bill C-384, at http://howdtheyvote.ca/bill.php?id=2053 (last visited Nov. 4, 2010).
[10] Int’l Task Force, supra at note 8, Vermont’s Assisted Suicide Proposal, http://www.internationaltaskforce.org/vermont.htm (listing failed bills) (last visited Dec. 24, 2010).
[11] See Or. Rev. Stat. § 127.800-.995; Wash. Rev. Code Ann. § 70.245.010-904 (2009).
[12] See, e.g., Greg Jackson & Matt Bowman, Analysis of Implications of the Baxter Case on Potential Criminal Liability, for the Montana Family Foundation (April 2010), at http://www.montanafamily.org/portfolio/pdfs/Baxter_Decision_Analysis_v2.pdf (last visited Dec. 24, 2010).
[13] Oregon’s act was passed as Ballot Measure 16 in 1994 and went into effect in 1997. See Death With Dignity Act, at http://www.oregon.gov/DHS/ph/pas/ors.shtml (last visited Dec. 24, 2010).
[14] See Wash. Rev. Code Ann. § 70.245.903. Washington’s assisted suicide act was passed as Initiative 1000 on November 4, 2008, and went into effect on March 5, 2009. See Center for Health Statistics, Death with Dignity Act, http://www.doh.wa.gov/dwda/default.htm (last visited Dec. 24, 2010). The full text of the Act is available at http://apps.leg.wa.gov/RCW/default.aspx?cite=70.245 (last visited Dec. 24, 2010).
[15] Cf. Or. Rev. Stat. § 127.800-.995 and Wash. Rev.Code Ann. § 70.245.010-904.
[16] See, e.g., Margaret Dore, 'Death with Dignity': A Recipe for Elder Abuse and Homicide (Albeit not by Name), 11 Marq. Elder's Advisor 387, 387 (2010), at http://www.margaretdore.com/pdf/Dore-Elder-Abuse_001.pdf (last visited Dec. 24, 2010).
[17] Or. Rev. Stat. § 127.800-.995; Wash. Rev. Code Ann. § 70.245.010-904.
[18] Id. See also all official forms and reports for both the Oregon and Washington acts, which can be viewed at http://www.oregon.gov/DHS/ph/pas/index.shtml/shtml and http://www.doh.wa.gov/dwda/.
[19] Both the Oregon and Washington acts require that a determination of whether a patient is acting “voluntarily” be made in conjunction with the lethal dose request, not later at the time of administration. See Wash Rev. Code Ann. §§ 70.245.020(1), 70.245.030(1), 70.245.040(1)(a)(d), 70.245.050, 70.245.120(3)(4), 70.245.220; Or. Rev. Stat. §§ 127.805 § 2.01(1), 127.810 § 2.02(1), 127.815 § 3.01(1)(a)(d), 127.820 § 3.02, 127.855 § 3.09(3), 127.855 § 3.09(4), 127.897 § 6.01.
[20] See supra at note 2.
[21] See, e.g., www.patientchoices.org (stating that the 2009 bills will “[a]ssure that mentally-competent persons who are terminally ill have the right to choose the manner and timing of death”) (last visited Dec. 24, 2010).
[22] See S.144 and H.455 in their entirety, supra at note 2.
[23] S.144 and H.455's provisions requiring that a determination be made of whether a patient is acting “voluntarily” or “free from duress or undue influence” are in conjunction with the lethal dose request, not later at the time of administration. See S.144 and H.455 at §§ 5281(a)(1), (c); 5282(1)(C), (4); 5283; 5289(a)(4); and 5296.
[24] S.144 and H.455 at § 5281(a)(1).
[25] See S.144 and H.455 in their entirety.
[26] In Washington’s act, “self-administer” is a specially defined term that allows someone else to administer the lethal dose. See Margaret K. Dore, Death with Dignity: What Do We Tell Our Clients?, Wash. St. B. Ass’n B. News, July 2009, at http://wsba.org/media/publications/barnews/jul-09+deathwithdignity.htm (last visited Dec. 24, 2010).
[27] See S.144 and H.455 at §§ 5281(c) & 5296.
[28] Id.
[29] See S.144 and H.455 in their entirety.
[30] 152 Vt. 478, 483-4, 568 A.2d 331 (1989).
[31]. 595 A.2d 1153, 1163 (Pa. Super. Ct. 1991).
[32] S.144 and H.455 at § 5280(11).
[33] Nina Shapiro, Terminal Uncertainty, Seattle Weekly, Jan. 14, 2009, at www.seattleweekly.com/2009-01-14/news/terminal-uncertainty (Last visited August 8, 2010).
[34] Jeanette Hall, Letter to the Editor, Second life, Missoula Independent, June 17, 2010. Author confirmed accuracy with both Ms. Hall and her doctor.
[35] New Hampshire House Record, regarding HB 304, supra at note 9 (“This bill is modeled on the Oregon death with dignity law”).
[36] New Hampshire Bill, H.B. 304-L:2, XIII.
[37] Stephen Drake, New Hampshire Poised to Redefine “Terminally Ill” to PWDs and Others for Assisted Suicide Eligibility, Jan. 30, 2009, http://notdeadyetnewscommentary.blogspot.com/2009/01/new-hampshire-poised-to-redefine.html. Drake’s partner is Diane Coleman, founder of the disability rights organization, Not Dead Yet, who uses a wheelchair.
[38] Plaintiffs’ Responses to State of Montana’s First Discovery Requests, Answer No. 4, Baxter v. Montana, No 2007-787 (Mont. 1st Dist., May 16, 2008), at http://www.margaretdore.com/pdf/C&C_Defines_Terminality.pdf.
[39] Letter from Richard Wonderly, MD, and Theresa Schrempp, Esq., to Alex Schadenberg, Executive Director of the Euthanasia Prevention Coalition, Oct. 22, 2009, http://www.euthanasia prevention.on.ca/ConnMemo02.pdf.
[40] Id.
[41] Id.; Susan Donaldson James, Death Drugs Cause Uproar in Oregon 1, ABC News, Aug. 6, 2008, http://www.abcnews.go.com/Health/Story?id=5517492&page= (last visited Aug. 9, 2010); video transcript of Barbara Wagner, http://www.katu.com/news/26119539.html?video=YHI&t=a (last visited Aug. 8, 2010).
[42] Id.
[43] Id.
[44] Barbara Coombs Lee, Sensationalizing a sad case cheats the public of sound debate, The Oregonian, Nov. 29, 2008, http://www.margaretdore.com/pdf/Coombs_Lee_against_Wagner.pdf.
[45] Id. She stated: “The burning health policy question is whether we inadvertently encourage patients to act against their own self interest, chase an unattainable dream of cure, and foreclose the path of acceptance that curative care has been exhausted … Such encouragement serves neither patients, families, nor the public.”
[46] See New Hampshire House Record, regarding HB 304, supra notes 9 & 35.
[47] Nancy Elliott, Letter to the Editor, Right to Die is Prescription for Abuse, Hartford Courant, May 28, 2010, http://articles.courant.com/2010-05-28/news/hc-elliott-letter-suicide-0528-20100528_1_new-hampshire-abuse-prescription (last visited Nov. 4, 2010).
[48] See New Hampshire website, http://www.gencourt.state.nh.us/house/abouthouse/leadership.htm (“Democrat Mary Jane Wallner … serves as Majority Leader”) (last visited Nov. 4, 2010).
[49] See e-mail message from New Hampshire General Court Staff with vote breakdown by party; a “yea” vote is a vote to defeat the bill: 242 yeas (100 Democrats; 142 Republicans); 113 nays (93 Democrats; 20 Republicans). (On file with author).
[50] Elder Abuse Public Education Campaign, supra note 1.
[51] See MetLife Mature Market Institute, Broken Trust: Elders, Family and Finances, A Study on Elder Abuse Prevention, March 2009, at http://www.metlife.com/assets/cao/mmi/publications/studies/mmi-study-broken-trust-elders-family-finances.pdf (last visited October 22, 2010); Miriam Hernandez, ‘Black Widows’ in court for homeless murders, March 18, 2008, ABC Local, http://abclocal.go.com/kabc/story?section=news/local&id=6027370 (last visited October 2, 2010) (elderly homeless men killed as part of an insurance scam); and People v. Rutterschmidt, 98 Cal.Rptr.3rd 390 (2009), rev. granted; issues limited, 102 Cal.Rptr.3d (2009) (regarding this same case).
[52] See MetLife, supra note 51, at 24; and People v. Stuart, 67 Cal. Rptr. 3d 129, 143 (where daughter killed her mother with a pillow, “financial considerations [are] an all too common motivation for killing someone … ”).
[53] Elder Abuse Public Education Campaign, supra note 1.
[54] See, e.g., Vermont Adult Protective Services Statute, “Reports of Abuse, Neglect and Exploitation of Vulnerable Adults,” 33 V.S.A. § 6902(14)(D)(defining a “[v]ulnerable adult" as a person 18 years of age or older who “is impaired due to … infirmities of aging …” ).
[55] Elliott, supra note 47.
[56] See “Oregon Death with Dignity Act Attending Physician Follow-up Form” at http://www.oregon.gov/DHS/ph/pas/docs/mdintdat.pdf (last visited Dec. 24, 2010) and Washington “Attending Physician’s After Death Reporting Form,” at http://www.doh.wa.gov/dwda/forms/AfterDeathReportingForm.pdf (last visited Dec. 24, 2010).
[57] Oregon form, supra note 56, Question # 15; Washington form, supra note 56, Question # 7.
[58] Id .
[59] Washington’s Report for 2009 can be viewed at http://www.doh.wa.gov/dwda/forms/DWDA_2009.pdf (page 7 summarizes the “concerns”).
[60] William J. Peace, Letter to the editor, sent to the Seattle Times, March 7, 2010 (copy on file with author). The letter was originally written as a blog post. See William J. Peace, Assisted Suicide in Washington: The Death Toll 36, Bad Cripple, March 6, 2010, http://badcripple.blogspot.com/2010/03/assisted-suicide-in-washington-death.html (last visited January 1, 2011).
[61] Tit. 33, ch. 69. See also 33 V.S.A. § 6902(14)(D) (defining a “[v]ulnerable adult” as a person 18 years of age or older who is “impaired due to … a physical … disability”).
[62] See 33 V.S.A. § 6901 (“The purpose of this chapter us to: protect vulnerable adults … ”).
[63] Oregon Health Authority, News Release, Rising suicide rate in Oregon reaches higher than national average, Sept. 9, 2010, at http://www.oregon.gov/DHS/news/2010news/2010-0909a.pdf (Last visited October 13, 2010). An assisted suicide under Oregon’s assisted suicide law is not tallied as a “suicide.” See Or. Rev. Stat. 127.880 § 3.14 (“Actions taken in accordance with ORS 127.800 to 127.897 [the Oregon Death With Dignity Act] shall not, for any purpose, constitute suicide … under the law”).
[64] Oregon Health Authority, Rising suicide rate, supra note 63.
[65] See 2009 Annual Report, Oregon’s Death with Dignity Act, http://www.oregon.gov/DHS/ph/pas/docs/year12.pdf , page 2 ("since the law was passed in 1997) (Last visited October 14, 2010).
[66] See, e.g., 18 V.S.A. § 7101(17)(defining a “person in need of treatment” in terms of "a person who has threatened or attempted suicide") and 28 V.S.A. § 907(6)(G) (regarding training of medical and correctional staff in “[s]uicide potential and prevention”).

Wednesday, February 16, 2011

Alleged internet suicide predator pleads not guilty in the death of Nadia Kajouji, but waves his right to a trial.

Mark Drybrough
William Melchert-Dinkel (48), the former Minnesota nurse, has waved his right to a trail, but also pled not guilty to assisting the suicides of Canadian teen Nadia Kajouji (18), and Mark Drybrough (32) of Coventry England.

Nadia Kajouji
Melchert-Dinkel failed to get the charge of assisted suicide dropped when a Minnesota judge refused to accept the arguement that this was a case of freedom of speech.

Melchert-Dinkel has admitted to being involved in the deaths of Carlton University student Nadia Kajouji and Mark Drybrough from the UK, but he has pled not guilty to assisting their suicide deaths.

Instead of facing a three week trial, Melchert-Dinkel has decided to opt for a rarely used Minnesota provision that gives the judge seven days to review the case and then the judge decides whether or not he is guilty of the crime.

The following is the article in the Ottawa Citizen by Lee Greenberg:

Melchert-Dinkel
Nurse waives right to trial in suicide case

The trial of a Minnesota nurse accused of assisted suicide in the death of a Carleton University student took another unexpected turn Tuesday, when William Melchert-Dinkel announced he will waive his right to a trial.

Melchert-Dinkel, who has admitted to prowling online suicide chat rooms and coercing depressed people into killing themselves, was scheduled to appear at a three-week trial in April.

Instead, he is employing a rarely used Minnesota legal provision. A judge will Thursday review the prosecution’s case against Melchert-Dinkel and decide within seven days whether the 48 year old Minnesotan is guilty of two counts of assisted suicide.

By entering the unusual motion, known as a Lothenbach plea, Melchert-Dinkel waives his right to cross-examine prosecution witnesses, to compel his own witnesses to testify and his right to testify on his own behalf.

He is still nevertheless pleading not guilty.
“We neither think witnesses are necessary nor do we think a trial in any way benefits my client,” said Terry Watkins, Melchert-Dinkel’s lawyer.

“There’s not a disagreement basically with the facts in this case so a trial based on stipulated facts would be much more efficient and much more effective and would be in the best interests of both my client and the government.”
Melchert-Dinkel, a father of two teenage daughters, lives in the picturesque town of Faribault, Minnesota, about an hour south of Minneapolis. State authorities began investigating the troubled former nurse after a British grandmother complained in 2008 he was encouraging depressed online chatroom participants into suicide.

Celia Blay pointed Minnesota police to the case of Mark Drybrough, a 32-year old Briton, who hanged himself in 2005 after corresponding with Melchert-Dinkel.

Police later learned of the 2008 suicide of Nadia Kajouji, a Brampton teen and first-year Carleton University student who was befriended by Melchert-Dinkel and coaxed into a false suicide pact. The aging, overweight man was posing as a 20-something woman when he asked Kajouji to kill herself in front of a webcam while he watched.
“If you go ... any kind of home improvement store — get yellow nylon rope about eight feet or about 3.5 meters and about one-inch thick or about three centimetres that is all you need and look around apartment for somewhere to hang from,” he told Nadia during one chat session. “I can help you with the cam when you need to.”
When he learned of a police investigation into the issue, Melchert-Dinkel checked into a state hospital and claimed to be suffering from an “addiction” to suicide chat rooms.

He told police he formed “10 or 11” false suicide pacts with people over the world and compared his preoccupation with hunting human game, telling detectives he enjoyed “the thrill of the chase.”

Ottawa police told Kajouji’s mother they decided against charging Melchert-Dinkel because there was no evidence he directly caused her suicide.

That decision perplexed legal scholars, who said Canada’s suicide provision does not require such causality.

Minnesota police says the charges are the first in recent memory. State law punishes anyone who “intentionally advises, encourages, or assists” suicide with up to 15 years imprisonment and up to a $30,000 fine.

Links to information about the Melchert-Dinkel case.

Bill to clarify that assisted suicide is prohibited in Idaho unanimously passes in the Idaho Senate Affairs Committee.

The bill to clearly define assisted suicide as prohibited in Idaho has unanimously passed in the Idaho Senate Affairs Committee.

The Idaho Spokesman Review stated:
Legislation to outlaw physician-assisted suicide in Idaho has cleared the Senate State Affairs Committee, which just voted to send SB 1070 to the full Senate with a recommendation that it pass. The bill was sponsored by pro-life groups who worked with the Idaho Medical Association, in order to protect physicians making appropriate patient-care decisions for dying patients or following those patients' living wills or advance care directives.

Ken McClure, IMA lobbyist, told the committee, “Under current law, it is not at all clear whether assisted suicide is a crime or not.” It's not currently a part of Idaho's standards for patient care, he said, and doctors don't want it to be. “This law gives a physician the assurance that if proper medical care is being given, he or she is safe from prosecution,” McClure told the senators.

The bill makes it a felony to assist in a suicide, plus revokes the licenses of physicians who do so. It also authorizes court injunctions against anyone “reasonably believed to be about to violate” the new law.

Interesting Op-ed by PR Guy for Hawaii Death with Dignity Society

Stephen Drake, the research analyst for the disability rights group Not Dead Yet has done a great analysis of the recent comments by Scott Foster, the communications director for the Hawaii Death with Dignity group. Drake always does a great analysis, and he always looks into the archives for more information.

Drakes comment is work reading.

Interesting Op-ed by PR Guy for Hawaii Death with Dignity Society

Well, whatever else you can say about Scott Foster, Communication Director at the Hawaii Death with Dignity Society, he churns out an op-ed pretty quickly. Like lots of communications folks, he regurgitates stuff he's written elsewhere, but every once in awhile he introduces some new gem and there are several items of interest in his op-ed in the Star Advertiser after the defeat of the assisted suicide bill last week.

Foster wants a "better" debate - an ironic request from an assisted suicide zealot who exploited the tragic attempted murder-suicide in late 2009. Robert Yagi attempted to kill his wife with a flare gun loaded with shotgun shells. It was unsuccessful. However, Yagi succeeded in killing himself a short time later when police sent him home after being charged with attempted murder, left alone in his home. Like "Conflation and Con Jobs," Foster jumped on this incident to promote legalized assisted suicide, making the bizarre case that an attempted murder of a woman who didn't want to die somehow would have been prevented by a "death with dignity." Draw that reasoning up on a chalkboard and it would have a striking similarity to some of Glenn Beck's exercises in fantastical "logic."

The first "gem" in Foster's op-ed is that he comes very close to "speaking" Derek Humphry's "unspoken argument" - that an aging population and rising health care costs are powerful hidden motivations in supporting assisted suicide. Here's what Foster says:

I remain convinced that the well-organized opposition to DwD legislation in Hawaii and elsewhere is more about money and God than about our solving the many challenges associated with an aging population, the resulting end-of-life issues, or the out-of-control cost of health care in our state and nation. If you wonder where all that money is going, according to the U.S. Department of Health & Human Services Office of Research, Development, and Information: "Medicare provides 64 percent of total health expenditures for beneficiaries in their last year of life ..." and the numbers for private insurance and out-of-pocket expenditures are similar. Despite the smoke and mirror arguments about "compassion," as it is, there's big money in death for many in the health care industry and DwD seems to threaten the status quo. (Emphasis added.)

It's fascinating, really. If you read that carefully, what Foster is saying is "assisted suicide will save money." After you look beyond "the smoke and mirror arguments about 'compassion'" (to use Foster's words) you see what Foster and the rest are really betting on.

Another interesting aspect of this op-ed is his attack on the chair of the Committee that held the hearings on the assisted suicide bill. Pro-assisted suicide advocates normally portray physicians as absolutely trustworthy professionals who would never abuse or expand killing beyond what an assisted suicide statue allows. That doesn't mean that Foster wants one to run a hearing on assisted suicide:

It is also clear that an M.D. should not be chairing health committees. It's an inherent conflict of interest.

There's a contradiction there - trust a doc with your life but not your legislation? Seriously, though, I doubt that Foster would object to the hearing being chaired by a pro-euthanasia doctor.

For anyone interested, there's been a fairly heated exchange between myself and another commenter at the newspaper site. I wouldn't be surprised if the other person was Foster himself, since he or she uses the same tired old arguments and fantasy scenarios about husbands who murder their wives.

Check out the comments in the Star Advertiser.

Tuesday, February 15, 2011

Physician-Assisted Suicide: A Recipe for Elder Abuse and the Illusion of Personal Choice

Margaret Dore
The Vermont Bar Journal (Winter 2011 edition) has just published an article by Margaret Dore, the former chair of the Elder Law Committee of the American Bar Association Family Law Section.

The article titled: Physician-Assisted Suicide: A Recipe for Elder Abuse and the Illusion of Personal Choice is concerned with the dangerous nature of laws legalizing assisted suicide in general, while analysing the legislative issues with the previous bills that have been presented in Vermont and other jurisdictions.

This article is the result of significant research by Margaret Dore and will be viewed a key article opposing the legalization of assisted suicide anywhere.


Dore concludes the article by stating:
Legalization of assisted suicide is a recipe for elder abuse. It devalues people with disabilities. Its promise of individual choice is an illusion. ... Don't make Oregon and Washington States mistake.
Link to the original article.

Link to Margaret Dore's website.

Link to the "Choice" Is An Illusion website.

Assisted Suicide is Not Legal in Montana; Clarification Needed

The Montanans Against Assisted Suicide and for Living with Dignity put an important update on their website concerning the status of Senator Hinkle's Bill SB 116, the Elder Abuse Prevention Act. There is confusion in Montana related to the Montana Supreme Court - Baxter decision, which did not legalize assisted suicide but gave physicians, if prosecuted, a potential defense of consent.

Please read the update:

On February 10, 2010, the Senate Judiciary Committee defeated and tabled SB 167, which would have legalized physician-assisted suicide in Montana. Despite this defeat, some assisted suicide proponents are encouraging doctors and others to engage in assisting and/or causing suicide, claiming that the practice is legal under Baxter v. State.

Under Baxter, doctors are given a potential defense to a homicide charge, which may or may not succeed. Baxter did not overrule prior case law imposing civil liability for doctors and others who cause another person’s suicide, typically in a hospital or jail setting. Under Baxter, doctors and others can still be held criminally and civilly liable for causing another person’s suicide.

Historically, the movement to legalize assisted suicide and euthanasia has had a eugenic component, which seems to be the case here. Legalization is, regardless, a recipe for elder abuse, which Baxter completely overlooked. Baxter also overlooked statistics from Oregon showing a positive correlation between legalization of assisted suicide and an increased rate of other violent suicides. Montana already has one of the highest suicide rates in the country. Montana does not need even more suicide.

Senator Hinkle’s bill, SB 116, is a short simple bill that seeks to return Montana to the status quo of 47 other states in which assisted suicide is clearly not allowed. SB 116 is needed because, with Baxter, the law is convoluted; Montanans, especially our older citizens, are not protected.

References:
The Hinkle Report: Link
SB 116 at a glance: Link Elder Abuse At a Glance

Monday, February 14, 2011

Why Safe Voluntary Euthanasia is a Myth

The following article is written by Australian Dr. Brian Pollard who is a retired anaesthetist and palliative care physician, who founded and directed the first full-time palliative care service in a teaching hospital in Sydney Australia at Concord Hospital in 1982 and directed it for five years. He is author of The Challenge of Euthanasia (Little Hills Press, 1994).

The article was printed in Quadrant online:

Why Safe Voluntary Euthanasia is a Myth

The criminal law in Australia holds that the intentional taking of human life is a major criminal offence. This accords with the United Nations Universal Declaration of Human Rights, to which Australia is a signatory, which declares that the right to the integrity of every person’s life is equal, inherent, inviolable, inalienable and should be protected by law.

Since the intentional taking of human life is the specific aim of every euthanasia law, such a law would be unique in the following critically important ways:

• it would intend to subvert the existing law
• it would fail to respect the principle that all are equal before the law
• it would fail to respect the principle that all human lives have equal value, and
• it would attempt to gain legal recognition for the concept of life not worth living.

This would present an impossible task, if honesty were to prevail. It would have to rely on such things as asserted but non-existent human rights, shades of deceit, inexact definitions and words or clauses allowing loose interpretations, rather than objectivity and precision.

The push for legalised medically assisted death in Australia has now increased to the point where bills are before several state parliaments and another is before the Commonwealth parliament to reverse the previous overturning of the Northern Territory legislation. I have analysed most of the previous failed bills and noted their weaknesses. Rather than debate the pros and cons of the social role of euthanasia, I believe that MPs, who have sole responsibility for making safe laws, should direct their attention to ensuring that draft euthanasia bills cannot imperil the lives of innocent people who do not wish to die.

It is evident that the authors of those bills have not read any of the extensive literature on this subject because they invariably include, as so-called safeguards, provisions which are known not to work in practice. A common feature of those who advocate euthanasia bills is their touching faith that certain things will happen, just because the draft prescribes them. If that were true, no crime would ever be committed because all crime is currently forbidden by some law.

In 1958, Yale Kamisar, an American professor of law in this field, wrote a seminal paper in which he listed these basic difficulties: ensuring that the person’s choice was free and adequately informed; physician error or abuse; difficult relationships between patients and their families and between doctors and their patients; difficulty in quarantining voluntary euthanasia from non-voluntary; and risks resulting from this overt breach of the traditional universal law protecting all innocent human life. All these problems still exist and others have been added, such as the critical role of depression in decision-making and the evolution in the moral basis for requesting death from the relief of severe suffering in the terminally ill to reliance on respect for personal autonomy. Some of these will be discussed below.

Definitions are often vague or at odds with ordinary meanings. For example, in place of “terminal illness” one may find “incurable illness”. Many illnesses are literally incurable but do not necessarily cause death or shorten life. Pain and suffering are both highly subjective experiences; neither can be measured or compared between persons, while suffering is often due to social causes rather than medical. According to the drafts, both have to be simply accepted as the person describes them, even when this may raise serious doubt. And, as most now allow, if the symptoms are said to make life “intolerable”, even though it is recognised that what one person finds intolerable others can bear, that claim has only to be made to be incontestable. The situation then will have become virtually one of death on demand.

All bills require the doctor to be “satisfied” that the patient’s request was freely made, though no one could ever know with certainty about coercion from sources of which he was totally unaware. But would coercion be likely? Brian Burdekin, a former Human Rights Commissioner, reported that in his experience, “The most vulnerable were the most likely to be abused and the most likely to be coerced.” Subtle degrees of coercion would be almost impossible to detect.

If a well person asks for death he will be referred for counselling. If a sick person asks, he is as likely to be supported in his “exercise of personal autonomy”. And what of autonomy in the presence of severe illness, especially terminal illness, with its frequent association with depression and unrelieved pain, which powerfully hinder careful evaluation of issues? More importantly, no matter what the patient decides, in every case it will be the doctor’s decision that determines whether euthanasia actually proceeds. Leon Kass, a lawyer and prolific author in this area, wrote that, in view of the totality of the impediments to clear reasoning in such patients, “the ideal of rational autonomy, so beloved of bioethicists and legal theorists, rarely obtains in actual medical practice”.

Doctors are experienced in persuading patients to follow their legitimate advice concerning treatment options, to the point where some have been heard to say, “I can get my patients to do anything I want.” Their power, relative to that of the patient, is large even when there is no intention to manipulate. Euthanasia draft bills require doctors to inform patients about the medical details of their illness and future alternatives. Since such discussions will usually occur in private, one could never know whether such information was accurate, adequate, non-coercive and impartial. If the doctor’s personal view was that euthanasia was appropriate for a patient, we may be sure some would not be deterred from advocating it.

A lot of publicity has lately been given to the fact that some 85 per cent of respondents to opinion polls favour legalised euthanasia. This refers to the Morgan poll which has been using this question for many years: “If a hopelessly ill patient in great pain with absolutely no chance of recovering asks for a lethal dose, so as not to wake again, should the doctor be allowed to give the lethal dose or not?” It is not hard to see why many respondents, whose understanding of the complex matter of euthanasia is unknown, might agree to such an emotionally charged question. Given that repeated polls have shown that most Australian doctors have not received adequate training in palliative care, and sometimes none at all, should anyone be surprised that too often pain is poorly managed? Against that background, the poll question may be truthfully reworded, “If a doctor is so negligent as to leave his patient in pain, severe enough to drive him to ask to be killed, should the doctor be able to compound his negligence by killing the patient, instead of seeking expert help?” The community would be appalled to know how few doctors who must care for dying patients are able to deal with severe pain effectively. The only remedy for this situation will be to introduce mandatory levels of competence in palliative care training in all medical schools. In the meantime, legalising euthanasia will lead inevitably to many needless deaths. Australia has about half the palliative care specialists it needs, all of whom are in cities or big towns.

Too often, draft bills for euthanasia only require the doctor to obtain expert psychiatric advice if he “suspects” the patient is “not of sound mind”, that is, has impairment of competence, which is not the key issue. The literature of psychiatry contains abundant evidence that the sustained wish to die is associated, in a large number of the seriously ill, with depression, which alters mood and inhibits the ability to reason coherently. Not to require consultation by a psychiatrist experienced in the treatment of dying patients whenever a sustained wish to die is encountered, is a negligent omission, especially as such depression is often difficult to diagnose. A published retrospective review of the Northern Territory legislation in its short life showed that relevant psychiatric evidence had been withheld and treatable depression was missed in four of the seven patients whose lives were taken under its provisions. The demoralising combination of depression or despair, anxiety and fear associated with a desire to die, can usually be treated with a mix of empathy, psychotherapy and medication.

The usual superficial approach to this problem is in stark contrast to the following advice from expert psychiatrists: “No request for hastened death can be understood without first attempting to understand the psychological landscape within which the request arises.” One advised, “Never kill yourself when you are suicidal—you are not yourself then.” Accordingly, it has been suggested that the need for better training in the detection of profound psychological disturbance in these patients is as great as that for the relief of severe pain. Even in the Netherlands, there is awareness of past failings, as the former health minister from 1994 to 2002, Mrs Borst-Eilers, commented in 2009, “The government’s move [to legalise euthanasia] was a mistake, we should have first focused on palliative care.”

Wherever voluntary euthanasia is practised, legally or not, non-voluntary is also found, including in Australia. Many find this difficult to credit because, whatever their failings, doctors surely would not take life without any request. In fact, they do it because it seems logical. Once euthanasia for patients who are suffering and ask to be killed is regarded as providing them with a benefit, it will appear, at least to some, that it would be wrong to withhold that benefit from others who suffer as much, but who, for some reason, cannot ask. In their eyes, this would be a matter of compassion. Because the same rationale can be the justification for euthanasia for both groups, the extension of one to the other must be regarded as inevitable and so will be uncontrollable. The Dutch have long since given up trying to prevent non-voluntary euthanasia.

Bills require the doctor to notify the coroner, following euthanasia. Since he will be its sole author, the chief actor and the sole survivor of the event, what chance is there that the doctor will include anything he would not wish the coroner to know?

Some may have found the earlier reference to deceit too strong, but it was not. At length, the draft bill must somehow directly confront the present law which outlaws euthanasia. So, the doctor is required by the bills to certify the death as due to the underlying illness, that is, to lie (though falsifying a death certificate is currently a punishable offence), and the death is not to be regarded, for the purposes of the Act, as any form of homicide, even though it was unquestionably homicide. Truth must yield to weasel words for these bills to succeed.

After euthanasia, the doctor may not be subject to any civil or criminal action, nor to any penalty or loss of privilege by any professional body. With only a few exceptions, medical associations throughout the world hold that euthanasia is forbidden to doctors because it is unethical, that is, morally wrong. Australian state governments establish boards and tribunals to regulate medical practice and they all regard medical life-taking as deserving of deregistration because those doctors are no longer fit to practise, on ethical grounds. These clauses in the bills are included without the consent or authority of the regulators, who regard them as necessary to protect patients against attacks on their lives, in recognition of their genuine human rights. Just now, when it is being more widely recognised that there is a need for more emphasis on ethics in many areas of moral significance, the supporters of euthanasia want to dispense with them altogether. It may be wondered what benefits the community can expect to gain from having unethical doctors.

When all euthanasia draft bills so far put before state parliaments over many years are reviewed, it can be observed that they go to extreme lengths to shield the doctor from the effects of current law, no matter what he or she may have done negligently or by omission, while including many opportunities for endangering the lives of patients who did not want their life ended. In justice, it is the vulnerable who need protection, not the powerful. This danger is exactly what all the large committees of inquiry into the consequences of legalising euthanasia have predicted in their published reports, even those which included some members who were in favour of euthanasia. No other reasoned conclusion was available to them after extensive oral and written evidence had been taken from a wide range of community and professional sources. Every law to permit euthanasia will be inherently and unavoidably unsafe.

Sunday, February 13, 2011

Assisted suicide: Annual report raises more questions than answers

Dr. Kenneth Stevens, the leader of physicians for Compassionate Care in Oregon, wrote a Guest Column that was printed in Oregon Live on Friday, February 11, 2011

Dr Stevens examines the Annual Report on assisted suicide by the Oregon Public Health Division and he explains that their are more questions than answers concerning the assisted suicide statute in Oregon.

The Column states:
The doctor-assisted suicide information released by the Oregon Public Health Division for the past year raises more questions than answers.

Why was the report compiled and released before all of the information for the year was available? All prior years' reports were released in March, allowing sufficient time for the receipt of information from prescribing doctors for the prior year. Although the new report lists 65 deaths, there are likely to be others who died of doctor-assisted suicide in 2010 for whom the prescribing doctors' reports had not been received as of Jan. 7.

The report mentions that there is no further information about 15 patients who had received prescriptions under the law in 2010. Why was the report prepared and released so hastily rather than with more accurate and complete information?

The report did reveal, however, that two patients who attempted to take the supposedly lethal drugs did not die. The reports' sparse information states that one person regained consciousness within 24 hours and died of the underlying illness five days later, a second person regained consciousness three days after ingestion of the drugs and died of the underlying illness three months later. Vomiting was reported in both people. These drugs are not easy to take and swallow; they are very bitter and foul-tasting.

Why did the report not provide more information regarding these two unsuccessful suicides? Why did the report fail to detail why these two people chose not to repeat the overdose?

Perhaps the two patients found the experience less pleasant than promoters of doctor-assisted suicide led them to believe. The individuals and their family and friends probably had a harrowing time dealing with those unsuccessful suicides.

It seems strange to live in a society where a failed suicide is considered to be unsuccessful and an accomplished suicide is considered a success.

Why did only one of the 65 people reported to have taken their lives with the drugs have a psychiatric or psychological referral? Researchers at Oregon Health & Sciences University reported in 2008 that 25 percent of patients requesting doctor-assisted suicide were considered to be depressed. There continues to be no protection for depressed patients in the process.

Why, according to the state's report, was a doctor present for only six people when the drugs were taken and when death occurred? Why are Oregon's doctors distancing themselves from the final fatal act? Is it because of the significant personal emotional toil that occurs when doctors prescribe lethal drugs?

The report lists that there was "unknown information" for 50 to 70 percent of deaths for the following categories: whether the doctor was present when the drugs were ingested, if there were complications, if emergency services were called, and the time between ingestion to unconsciousness and to death.

When such a substantial proportion of important information is unknown and with much incomplete information, how are we to know what is really happening with doctor-assisted suicide in Oregon?

The state's report appears to be perfunctory and does little to relieve the concerns regarding the dangers of doctor-assisted suicide in Oregon.

Kenneth R. Stevens is a Sherwood physician.

Thursday, February 10, 2011

Bill to legalize assisted suicide defeated in the Montana Judiciary Committee

Congratulations to everyone who worked in coalition to successfully defeat Senator Anders Blewett's bill SB 167 by a vote of 7 - 5 in the Montana Senate Judiciary Committee. SB 167 would have legalized assisted suicide in Montana.

Senator Greg Hinkle's - Elder Abuse Prevention Act - Bill SB 116, will reverse the Baxter court decision and prohibit assisted suicide in Montana will go to a vote soon.

I was told that the majority of the Montana Senators oppose assisted suicide, but many of them are unsure of where Montana citizens stand on the issue of assisted suicide.

A few Montana Senators have suggested that they oppose assisted suicide but thought that it was acceptable to maintain the status quo.

The fact is that the Status quo is unacceptable because Compassion & Choices, formerly the Hemlock Society, has been lying to Montana physicians by stating that they could prescribe a lethal dose for their patients without fear of prosecution. In other words, because Compassion & Choices is encouraging doctors to take the law in their own hands, that it is absolutely necessary for Montana legislators to support Senator Hinkle's Bill SB 116.

Finally, the news article from CNBC suggested that the Montana Governor may not sign the Hinkle bill into law. The fact is that everytime the Governor usurps the role of the House and Senate, he does so at a political cost. Bill SB 116 needs to be supported in order to protect Montana citizens from elder abuse.

The Montanans against Assisted Suicide and for Living with Dignity are working to get more people to write letters and call their Legislators.

A pro-assisted suicide article entitled: Bill to set rules for doc-assisted suicide fails was published today on CNBC

Now that the Blewett bill has been defeated in Montana, and a similar bill was also unanimously defeated in the Senate Health Committee in Hawaii last week, with a focused hard working effort, it is likely that the bills to legalize assisted suicide in New Hampshire and Vermont will likely also be defeated this Spring.

Wednesday, February 9, 2011

Euthanasia and Assisted suicide debate in Quebec

Deborah Gyapong has written an update concerning the euthanasia debate in Quebec. Gyapong, who writes for the Canadian Catholic News, interviewed Linda Couture, the director of Vivre dans la Dignite (Living with Dignity). Couture has done an excellent job at building a coalition against euthanasia and assisted suicide in Quebec.

The reality is that the Quebec government committee continues to favour presentations that support euthanasia, even though the majority of the presentations have opposed euthanasia.

By the way, it appears that the Quebec committee is thinking about turning a blind-eye to euthanasia by establishing guidelines that will favour Belgium style Euthanasia. Couture is correct when she states that the people of Quebec really don't support euthanasia.

The article by Deborah Gyapong stated:

Quebec holds hearings on assisted suicide during “Suicide Prevention Week”

­As Quebec marked Suicide Prevention Week (Jan 30­ - Feb 5), the Select Committee on Dying with Dignity held hearings here testing support for legalized euthanasia and assisted suicide.

The irony did not escape Linda Couture, who directs Living with Dignity, a grassroots, non-religious organization that has been monitoring the hearings as the committee travels across Quebec. Living with Dignity is also marshaling opposition from a wide range of groups and individuals to any changes to the law or its enforcement.

On Jan 30, Couture had received a copy of a press release from Marguerite Blais, the Quebec minister responsible for seniors, who kicked of Suicide Prevention Week by expressing alarm over the high rates of suicide among the elderly and criticizing the belief that suicide is a normal response to growing older.

Couture said Blais has made as eloquent a plea as any she has heard that suicide is never a normal or acceptable response to age or illness.

“How could a medicalized suicide be acceptable?” Couture asked. “There’s something missing. I don’t get it.”

The Select Committee composed of Members of Quebec’s National Assembly (MNAs) has been holding public hearings in cities across Quebec since September. Couture said she has attended most of them. The committee wraps up its hearings at the end of February and will then work on a written report.

On Feb 1, Ottawa Hospital Palliative Care chief Dr. Jose Pereira told the committee that legalized euthanasia and assisted suicide “places people at risk.”

“In Oregon, for example, where depression has to be excluded, we know that people with a depression are more likely to ask for assisted suicide or euthanasia,” he said. “That's very well-known.”

He added that in Oregon, one in six people who received assisted suicide were found to have untreated depression.

“My brother-in-law committed suicide last year, and it was a very difficult time for our family,” he said. “And, looking back, we feel it was a depression that wasn't treated. And, so, people with depression do ask for assisted suicide and do commit suicide.”

Pereira, who has worked in Switzerland where assisted suicide is allowed, said he observed the rules change over time. At first assisted suicide was only supposed to apply to those who are terminally ill, at the end of life and suffering.

Yet within two years, there was a campaign to allow assisted suicide for those “in long-term care facilities and nursing homes, for people who were elderly and felt that they didn't want to live anymore.”

Joan Lusignan, a private citizen in her eighties, testified the Special Committee had her worried. “What will our children and future generations think of a government that on one hand spends large sums of our money and effort to help prevent the escalating rate of suicides among young people in Quebec, but at the same time allows other people to help them commit suicide?”

The problem of suicide doesn’t just affect one person, it haunts the whole family for generations,” she said.

Couture said she is worried about how political the process has become. She noted how the MNAs tend to zero in on the five or six hard cases of individuals whose stories seem to recur over and over at the hearings.

“They really get stuck on the individual stories, the exceptions,” Couture said. “We don’t build a law on exceptions like that. We can’t afford to do that.”

Most of the MNAs’ questions, especially for those who identified themselves as religious, raised the hard cases of those suffering from terminal illness who clearly want death.

They asked why they think they can impose their religious views on others who disagree.

Couture said that line of questioning is typical.

There have been 300 or so testimonies presented to the Select Committee so far. Most of them---about 80 per cent---have been made by individuals. The rest are have been made on behalf of groups. Couture estimates they have been about two to one against legalizing euthanasia or assisted suicide.

But reports have said the presentations are about 50/50, she said.

The committee has also said it is not numbers they are interested so much as the “quality” or the emotional appeal of the presentation, especially from individual citizens, Couture said.

Yet emotionally touching stories of those who pitched in as a family to take care of dying parents and spouses “don’t seem to touch them,” she said.

The process has been set up to test the tolerance level for assisted suicide in those exceptional cases, said Couture, but she warned the province better “think twice” about introducing a new bureaucracy that might require two doctors signing off to kill patients when “one million people like me don’t have a family doctor.”

The province did not expect the level of response, she said. If politicians go ahead and “smuggle” in euthanasia and assisted suicide under euphemism like “medical aid in dying” she believes Quebeckers will find it unacceptable and rise up.