Thursday, August 27, 2015

National Post: Assisted Suicide, respect the conscience rights of all

Alex Schadenberg
By Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Yesterday, delegates at the Canadian Medical Association (CMA) annual meeting rejected a motion (79%) to respect the conscience rights of physicians who oppose euthanasia and assisted suicide. 

The CMA has not announced its final policy yet but many physicians want nothing to do with killing their patients by euthanasia or assisted suicide, even after the Surpreme Court struck down Canada's assisted suicide law and gave parliament 12 months to legislate on the issue.

Today, the National Post published an editorial titled: On physician-assisted suicide, respect the conscience rights of all. The National Post first examined the position of physicians.

According to a poll of 1,047 doctors by the Canadian Medical Association (CMA), released as part of the organization’s annual general meeting in Halifax, 63 per cent would refuse to provide so-called “medical aid in dying.” 29 per cent said they would consider killing a patient upon request, with 19 per cent saying that they “would be willing to help end the life of a patient whose suffering was psychological, not physical.” 
The results suggest there remains strong opposition to assisted suicide among the membership of the CMA, which until recently was officially opposed to a loosening of anti-euthanasia laws in any form. At the same time, it suggests there are enough doctors willing to aid a patient to commit suicide to serve the demand. Unfortunately, that is not enough to settle the matter of just when and how physicians will be involved.
The National Post editorial then examines the effect on physicians:
Put yourself in the position of a doctor who believes euthanasia to be a deep moral wrong. This is not an antiquated or otherwise-dismissible position. The legalization of physician-assisted suicide is a revolution in medicine, which turns the role of doctors as a provider of care on its head and intrudes upon the Hippocratic Oath’s instruction to “not play at God.” It violates the traditional conception of medicine, beseeching the physician to do no harm. It is a new and relatively unchartered territory — altogether so here in Canada. It is imperative that the conscience rights of all be protected. 
Any doctor should have the right to say, “I want nothing to do with this.” While this would obviously not allow him or her to interfere in the decision of another doctor to help a patient commit suicide, the conscientiously objecting doctor should equally be under no obligation to abet the killing of a patient in any way, whether directly or by referral to another doctor. 
The Supreme Court’s finding ... means there are limits on how far Parliament can restrict the practice. It does not — and should not — imply an obligation upon all doctors to participate in the new assisted-suicide regime.
The National Post ends the editorial by urging parliament to recognize conscience rights.
As the CMA poll suggests, there remains considerable hesitation on the part of Canada’s physicians to jump on the euthanasia bandwagon. Accordingly, Parliament’s new law should be explicit in affording the utmost protection to doctors who do not wish to participate in this new and morally troubling enterprise.
The Euthanasia Prevention Coalition recognizes that if euthanasia and assisted suicide become legal, the only way to protect people is by protecting the conscience rights of physicians.

When physicians have the right to say - I will not kill you - then they also have the right to say - I will protect you in your time of need.

Wednesday, August 26, 2015

Canadian Medical Association rejects conscience rights for physicians with regard to euthanasia.

Alex Schadenberg
By Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The Canadian Medical Association (CMA) voted to rejected a motion that would protect the conscience rights of physicians who refuse to refer patients to die by euthanasia at their annual General Council meeting today in Halifax.

A media release from the CMA today stated:

Conscientious objection was a contentious issue, with 79% of delegates voting against a motion to support conscientious objectors who refuse to refer patients for medical aid in dying. 
"What we expect from physicians, at a minimum, is that they provide further information to patients on all the options including the spectrum of end-of-life care and … how to access those services," CMA Vice President of Medical Professionalism Dr. Jeff Blackmer told reporters at a press conference Aug. 26.
Yesterday, the CMA released the data from an online consultation of 1407 members which found that 63% would refuse to assist the death of their patients, 29% would assisted the death of their patients upon request and 8% were unsure.

But only 29% of the physicians who would refuse to lethally inject their patients would also refuse to refer patients to their death.

The Globe and Mail quoted Dr Jennifer Tong of Vancouver who warned:
“coercing physicians against their conscience” would damage patient-doctor relations and push some out of the profession.
The Euthanasia Prevention Coalition recognizes that if euthanasia and assisted suicide become legal, the only way to protect people is by protecting the conscience rights of physicians. 

When physicians have the right to say - I will not kill you - then they also have the right to say - I will protect you in your time of need.

Family challenges $1.8 million Will bequest to euthanasia group, after their father died by suicide.

By Alex Schadenberg
Alex Schadenberg
International Chair, Euthanasia Prevention Coalition

The family of a man, who died by suicide are challenging their father's Will that gave $1.8 million to Philip Nitschke and his euthanasia lobby group, Exit International.

According to the Herald Sun William O’Brien’s children Gai and Brett challenged the 89-year-old’s will after he took his own life last year. The Herald Sun reported Philip Nitschke, the founder of Exit International, as saying:
Mr O’Brien believed that every elderly person, terminally ill or not, should have that choice. 
the legal challenge was “very surprising” given Mr O’Brien felt that he had provided for his children “very adequately”, and the directions for his estate should be respected by the court.
According to the Herald Sun Mr O'Brien died in July 2014 even though he was reportedly in good health. The Herald Sun also reported that O'Brien left $5000 to each of his surviving children.

Dying With Dignity Canada received almost 24% of their income in 2014 from bequests.

Tuesday, August 25, 2015

63% of Canadian physicians will refuse to assist their patients suicide.

Alex Schadenberg
By Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Today, the Canadian Medical Association (CMA) released to the media the results of their online survey of members. The survey that was based on responses from 1407 CMA members found that 63% would refuse to assist the death of their patients, 29% said that they would assisted the death of their patients upon request and 8% were unsure.

For those who would assist the death of their patients, 43% would do so for non-terminal patients and 19% would do so for patients who live with psychological suffering.

The Supreme Court of Canada decision defined Assisted Death to include euthanasia (lethal injection) and assisted suicide (prescribing a lethal dose).

Dr Sheila Harding
Saskatoon hematologist Dr Sheila Harding strongly opposes assisted death. CBC news reported Harding as saying:

"I feel strongly that hastening death is not part of medicine. I think it eviscerates what medicine is intended to be. I think that asking physicians to be killers is contrary to the very core of medicine,"
Physicians conscience rights.

According to the Globe and Mail, 75% of the CMA conference delegates agreed that:
physicians should provide information to patients on all end-of-life options available to them but should not be obliged to refer.
The Globe and Mail article quoted Dr. Jennifer Tong of Vancouver who warned: 
“coercing physicians against their conscience” would damage patient-doctor relations and push some out of the profession.
Dr. Jeff Blackmer, vice president of medical professionalism with the CMA stated:
"No physician should be forced to participate against their conscience," 
"But there's disagreement about what this means."
29% of the physicians who refuse to kill their patients are also opposed to having anything to do with assisted death, while the others were either unsure or willing to refer their patient to another physician or administrator in some manner.

The Euthanasia Prevention Coalition recognizes that if euthanasia and assisted suicide become legal, that the only way to protect people is by protecting the conscience rights of physicians. 

When physicians have the right to say - I will not kill you - then they also have the right to say - I will protect you in your time of need.

New Euthanasia Push in Tasmania

This article was published on the HOPE Australia website on August 25, 2015

Paul Russell and
Alex Schadenberg outside
Tasmanian Parliament.
By Paul Russell, Director of Hope Australia

News today that the Tasmanian State Conference of the Australian Labor Party endorsed a motion in support of a push for euthanasia has reignited the issue in the island state.

Euthanasia was last debated in Tasmania on the 17th of October 2013 when the Voluntary Assisted Dying Bill was defeated 13 votes to 11 in the State's Lower House. Since that time, the State Election has changed the make up of the chamber offering, perhaps, the mover of the last bill, Lara Giddings MP, some hope that this time the outcome might be different.

The ALP motion - now part of the party's Tasmanian platform - is subject to the normal provision of a conscience vote and is, we understand, not binding upon State ALP Members of Parliament.

However, as noted in The Examiner, the three new members on the government benches for the Liberal Party are holding their cards close and claiming, at this time, to be 'openminded' on the subject.

Readers should note that, in 2013, Lara Giddings was Premier which provided her with additional control over the debate process. This time around she is a Shadow Minister on the opposition benches.

Time will tell. The Examiner reports that Lara Giddings will be looking to introduce her bill later this year.

Euthanasia at the Heart of the Federal Election

While the federal election campaign is in full swing, the question of Euthanasia is beginning to make its way among major election issues in healthcare. Indeed, the next federal government will have the mandate to enact a law before February 6 in response to the Supreme Court’s judgment on "medical assistance in dying."

To stimulate discussions, the Ontario Ministry of Health has announced the creation of a second Expert Advisory Group in addition to the Federal External Panel set up by the federal government shortly before the dissolution of Parliament.

Composed of 11 provinces and territories, this new advisory group, led by Ontario, will too be responsible for providing advices on the development of policies, practices and protective measures to be taken with the legalization of assisted suicide on their respective territories. Several experts are featuring on its board, namely Maureen Taylor, Jocelyn Downie and Arthur Schaefer are well known pro-Euthanasia activists.

Since each election campaign launches political parties in a race for votes, candidates for the next government will be forced to gauge public opinion in order to establish their position on this social issue. It is therefore crucial that everyone takes part in the debate by answering the online survey of the Provincial-Territorial Expert Advisory Group, as well as the online consultation of the Federal External Panel.

We also strongly encourage you to take advantage of this key moment in our democracy to contact your candidates and discuss with them about issues regarding Euthanasia and assisted suicide, in particular their social impact on families and caregivers and the measures to be taken to protect vulnerable people.

Living with Dignity, the Physicians’ Alliance against Euthanasia and the Euthanasia Prevention Coalition are stressing the importance of expressing yourself in the polls, especially during electoral period. By doing so, you add weight to the experts’ recommendations in order to contain the excesses that the law on Euthanasia and assisted suicide will generate in a few months.

Monday, August 24, 2015

Final Exit Network found guilty for assisting the suicide of Minnesota woman.

Alex Schadenberg
By Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

A Minnesota Judge applied the maximum sentence to the Final Exit Network (FEN) for their role in assisting the suicide of Doreen Dunn (57) in 2007, after a jury found the Final Exit Network guilty last May.

The Star Tribune reported that:

During the trial, prosecutors argued that the group gave Doreen Dunn, of Apple Valley, a “blueprint” for ending her life and made efforts to conceal her suicide from family and authorities by removing the equipment she used. 
Criminal cases against Final Exit Network coordinator Roberta Massey, of Bear, Del., and the group’s medical director, Lawrence Egbert, 87, of Baltimore, are still pending. 
Another defendant, Jerry Dincin, died and charges against Thomas Goodwin were dismissed in 2013. 

According to a LaCrosse Tribune article:
Dakota County prosecutor Elizabeth Swank told jurors that the evidence showed that two members of Final Exit Network went to Dunn's home in Apple Valley to assist her suicide. They then removed the equipment that she used for suicide so that it appeared she had died of natural causes. 
Dunn's husband of 29 years arrived home on May 30, 2007, to find her dead on the couch. Swank said Dunn had a blanket pulled up to her neck with her hands folded on her chest. 
Swank said that despite Dunn's pain and depression, she had no life-threatening illness and her family was puzzled by her death. There were good things happening in her life: Her daughter who had been in Africa for about a year was coming home the next day and her son's fiancee was scheduled to give birth that week. However, her husband was also planning to move out, the prosecutor said.
John Celmer
Judge Christian Wilton senteced FEN to the maximum sentence by ordering that they pay a $30,000 fine plus $3000 towards the funeral cost.

FEN has been prosecuted for assisting several suicides. In Georgia, John Celmer, who was depressed after recovering from cancer, died after FEN assisted his suicide. Celmer's widow Susan Celmer, testified against FEN. 

Last year Larry Egbert, the medical director FEN, lost his medical license in Maryland.

The continual expansion of euthanasia in the Netherlands and Belgium.

Alex Schadenberg
By Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The Washington Post published a very well researched article by Charles Lane on August 19, 2015 titled: Europe's sinister expansion of euthanasia. This same article was republished in the National Post and several other major newspapers.

Lane examined the date from the recent research concerning the Belgian euthanasia law. I have written similar articles, but to his credit, Lane has been published by major newspapers.

Lane first examines the data from a Study: concerning 100 requests for euthanasia for psychiatric reasons in Belgium. Lane remarks that:

Between October 2007 and December 2011, 100 people went to a clinic in Belgium’s Dutch-speaking region with depression, or schizophrenia, or, in several cases, Asperger’s syndrome, seeking euthanasia. The doctors, satisfied that 48 of the patients were in earnest, and that their conditions were “untreatable” and “unbearable,” offered them lethal injection; 35 went through with it. 
These facts come not from a police report but an article by one of the clinic’s psychiatrists, Lieve Thienpont, in the British journal BMJ Open. All was perfectly legal under Belgium’s 2002 euthanasia statute, which applies not only to terminal physical illness, still the vast majority of cases, but also to an apparently growing minority of psychological ones. Official figures show nine cases of euthanasia due to “neuropsychiatric” disorders in the two-year period 2004-2005; in 2012-2013, the number had risen to 120, or 4 percent of the total.
Charles Lane
Lane then examines the data from a study concerning the: First Year of the End-of-Life Clinic for Physician-Assisted Dying in the Netherlands. Lane states that:

... the Netherlands, which decriminalized euthanasia in 2002, right-to-die activists opened a clinic in March 2012 to “help” people turned down for lethal injections by their regular physicians. In the next 12 months, the clinic approved euthanasia for six psychiatric patients, plus 11 people whose only recorded complaint was being “tired of living,” according to a report in the Aug. 10 issue of JAMA Internal Medicine. 
If you find this sinister, I agree. Bioethicists Barron H. Lerner and Arthur L. Caplan, who reviewed the data from the Low Countries in JAMA Internal Medicine, observe that the reports “seem to validate concerns about where these practices might lead.”\
Lane emphasizes that the Belgian study admits that decisions for euthanasia are based on undefined criteria:
Thienpont acknowledges that “the concept of ‘unbearable suffering’ has not yet been defined adequately” and that “there are no guidelines for the management of euthanasia requests on grounds of mental suffering in Belgium.” 
Yet she and her colleagues continue to put the mentally ill to death, insisting that they are respecting their wishes — though, as she writes, “further studies are recommended.”
Frank van den Bleeken
Lane then uses the example of Frank van den Bleeken, the Belgian prisoner who was serving a life sentence for murdering and raping. van den Bleeken was approved for lethal injection for reasons of psychological suffering because he considered living in prison for the rest of his life was too great a level of suffering. Lane states:

Thienpont’s co-author Wim Distelmans, a leading advocate of euthanasia, has ended the life of a 44-year-old who was anguished, but not terminally ill, due to a botched sex-change operation. Distelmans also put to death identical 45-year-old deaf twins who said they lost the will to live upon learning they would eventually go blind. 
Frank van den Bleeken, imprisoned for 30 years for rape and murder, sought euthanasia from Distelmans, citing his incurable violent impulses and the misery of life behind bars. Belgian officials and Distelmans initially agreed; a lethal injection the murderer might have gotten as punishment in the United States would be supplied as therapy in anti-death penalty Europe. 
In January, however, Distelmans backed out just before the scheduled procedure — there was still hope for van den Bleeken to get treatment at a facility in the Netherlands, he said. 
Distelmans faced little accountability either way. The body empowered to scrutinize his actions, after the fact, was Belgium’s Euthanasia Control and Evaluation Commission — of which he is co-chairman. It has reviewed thousands of cases since 2002 but referred exactly none to law enforcement.
Lane ends the article by quoting from the Lerner and Caplan commentary:
The “very worrisome” trends in Europe “should give us pause” about where the “assisted dying” movement might lead in this country, Lerner and Caplan write. 
To be sure, by authorizing doctors to administer lethal drugs, in terminal and non-terminal cases, the Benelux countries go far beyond laws in Oregon and four other states, which permit physicians to prescribe, not administer, a fatal dose — and only in cases of terminal physical illness.
Charles Lane has done his homework. Euthanasia has gone through multiple extensions. The types of euthanasia deaths that are happening in the Netherlands and Belgium would have been considered abuses of the law, if they had occured in the first years.

Friday, August 21, 2015

Euthanasia decisions are the hardest

This column was published by the Toronto Sun on August 20, 2015.

Farzana Hassan
y columnist Farzana Hassan

Euthanasia is about intention.

A doctor who is reluctant to perform an assisted suicide but refers a patient to someone else prepared to do it, is on the same moral ground as a doctor who willingly participates.

The Supreme Court of Canada’s decision in February which struck down the ban on euthanasia prompted the Conservative government to form a commission on euthanasia last month.

One of the issues under debate is whether doctors should be compelled to perform assisted suicides on terminally ill patients.

In fact, it is absolutely crucial to determine who can influence the decision of carrying out a physician-assisted suicide.

The ethical and legal issues are complex.

Even deciding on a useful definition of “terminally ill” is a minefield, and that’s just the start.

Medical diagnosis and prognosis are inexact sciences, and mistakes in them often occur in Canada’s healthcare system.

Quebec’s Bill 52 right-to-die legislation, which has already passed, has been interpreted to mean the following:

To qualify as a terminal illness it must be incurable and serious; it must have caused an advanced and irreversible decline in bodily function; the person requesting the procedure must be in unbearable and constant pain, both physical and mental; the patient must be an adult, mentally sound enough to give credible consent.

As an extra safeguard, Quebec requires doctors and patients to get second opinions.

An independent commission composed of doctors, jurists, ethicists and ordinary citizens will oversee the process for reaching such decisions.

All the ground work seems to have been covered here.

Suitable patients will be only those who are the truly terminally ill and anguished patients who can no longer live with their situation.

Given this, it almost seems humane to grant their wish of dying with dignity.

But do measures like this adequately address the concerns of doctors who object?

The large number of Canadian physicians reluctant to perform assisted suicides throws doubt on the practicality of such a policy.

Prominent Quebec bioethicist David Roy has noted that: “Killing the pain is the point, not killing the patient.”

He has also asked: “Should we socially and legally (put) this power to administer death to patients into the hands of physicians, who are relatively inept at communicating with suffering and dying people?”

I have stated the reasons for my unease about euthanasia previously.

My biggest concern is that suicide is self-evidently an irreversible decision for a patient to make.

Medical advances that could directly impact on a patient’s decision to take his or her life may be unlikely, but they are possible.

A disease that is “incurable” today may have a breakthrough in treatment tomorrow.

Recently, for example, researchers at Thomas Jefferson University discovered that blocking certain types of proteins in the brain may allow them to administer drugs that can inhibit Lou Gehrig’s disease (ALS) a debilitating illness.

It is hard to imagine an issue more likely to provoke polarized and heated arguments than euthanasia.

Any law which tries to define its limits will face challenges not just from doctors, who are on the front lines of medical care, but from all sections of society.

The debate is much wider than the example of any single case.

No law is likely to be fair and comprehensive enough that it will address all concerns about allowing euthanasia as one humane option in genuinely dire cases.

Thursday, August 20, 2015

New Mexico Supreme Court asked to hear assisted suicide decision.

Alex Schadenberg
By Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

On August 11, the New Mexico Court of Appeals handed a defeat to the right-to-die movement by reversing an activist lower-court ruling that legalized assisted suicide. In overturning the lower court decision, the Court of Appeals upheld the assisted suicide law in New Mexico.

Yesterday the assisted suicide lobby appealed the Court of Appeals decision to the New Mexico Supreme Court.

The case argued that "aid in dying", which is also known as assisted suicide, is not prohibited by the New Mexico assisted suicide law because "aid in dying" is not assisted suicide.

The case argued, that if "aid in dying" is assisted suicide, then the New Mexico assisted suicide law is unconstitutional because it undermines the right to privacy and autonomy.
But, Aid in dying is assisted suicide and assisted suicide does not constitute medical treatment. Therefore prohibiting assisted suicide does not undermine the right to privacy or autonomy.

The case originally concerned Aja Riggs, a woman with uterine cancer, who said that she wanted to die by assisted suicide, and two doctors who were willing to prescribe lethal drugs. Riggs told the Albuqueque journal last December that she is now in remission. She is fortunate that the court did not give her an exemption to die by assisted suicide.

Since Riggs is in remission, the suicide lobby amended their claim. Now the case is based on Susan Brown, who has terminal cancer and David Bradley, who lives with ALS.

A similar case was dismissed by the Connecticut court in 2010.