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Margaret Dore: (New Jersey) Euthanasia Act "Must Be Set Aside"

Fri, 2020-03-27 16:26
This article was published by Choice is an Illusion on March 27, 2020.

Margaret DoreOn March 24, 2020, a hearing was held in Glassman v Grewal, a lawsuit, which seeks to invalidate New Jersey's euthanasia law, formally known as the "Medical Aid in Dying for the Terminally Ill Act."

The specific matter before the court was a motion to dismiss brought by the defendant, New Jersey Attorney General, Gurbir S. Grewal.

The plaintiff, Joseph Glassman, represented by E. David Smith, opposed the motion, as did Margaret Dore, president of Choice is an Illusion, representing herself as amicus curiae.

Dore, who had filed both an amicus brief and a reply brief, argued that the Act must be set aside pursuant to the New Jersey Constitution. Her arguments largely tracked her reply brief, a portion of which is set forth below.

The Court took the matter under advisement.

* * *

Reply Brief Excerpt (web version):

B. The Act’s Title Is Misleading and Therefore Unconstitutional

The Act’s title, the “Medical Aid in Dying For the Terminally Ill Act,” implies that the Act is limited to the “dying” and the “terminally ill.”[6] As described in Dore’s amicus brief, the Act also applies to people with years or decades to live.[7] For this reason alone, the title is misleading and therefore unconstitutional. The Act must be set aside.

C. Contrary to the Attorney General, the Act Allows Euthanasia

Euthanasia as traditionally defined is the administration of a lethal agent by another person.[8] The Attorney General claims that the Act does not allow euthanasia.[9] This claim is wrong for the following reasons:

1. The Act’s name means euthanasia The Act’s name, “Medical Aid in Dying for the Terminally Ill Act,” contains the phrase “Aid in Dying.”

Aid in Dying is a traditional euphemism for active euthanasia. See, for example: Craig A. Brandt, Model Aid-in-Dying Act, Iowa Law Review, 1989 (“Subject: Active Euthanasia ....”)[10]

For this reason alone, the Act allows euthanasia.

2. The Act allows euthanasia as traditionally defined The Act refers to the lethal dose as “medication.”[11] Generally accepted medical practice allows other people, including doctors and adult children, to administer medication.[12]

If the medication administered is a lethal dose, this is euthanasia as traditionally defined.

3. The Act does not require self-administration. The ADA would trump any such requirement Nothing in the Act says that self-administration is required.[13] If it were, the Americans with Disability Act [ADA] would trump the requirement to allow euthanasia for people unable to self-administer.[14] For this reason also, the Act allows euthanasia as traditionally defined.

D. Voluntariness Is Not Assured

The Attorney General claims that the Act is “strictly voluntary” for patients, which is not true.[15] As previously discussed in Dore’s amicus brief, a more obvious reason is the Act’s complete lack of oversight at the death.[16] If the patient objected or even struggled, who would know?

E. Purported Patient Protections Are Illusory

The Act sets forth patient protections, including a formal application process to obtain the lethal dose.[17] Per the Act, the attending physician:
shall ensure that all appropriate steps are carried out in accordance with the provisions of [the Act] before writing a prescription for [the lethal dose].[18] The Act does not define “accordance.”[19] Dictionary definitions include “in the spirit of,” meaning “in thought or intention.”[20] With these definitions, the physician’s mere thought or intention to comply with patient protections is good enough. Actual compliance is not required. Purported patient protections are illusory.

F. Deaths in Accordance With the Act Are “Natural” as a Matter of Law.

1. Action taken in accordance with the Act is not suicide or homicide The Act states:
Any action taken in accordance with the provisions of [the Act] shall not constitute ... suicide ... or homicide under any law of this State.[21]
2. The Act requires deaths to be reported as “natural” In New Jersey, death certificates have five categories for reporting the manner of death, four of which are substantive: (1) natural; (2) accident; (3) suicide; and (4) homicide.[22] The fifth category is “undetermined.”[23]

As noted in the preceding section, a death occurring in accordance with the Act does not constitute suicide or homicide under any law of the State. The death is also not an accident due its having been an intended event. This leaves “natural.” Deaths occurring pursuant to the Act are natural as a matter of law.

G. Dr. Shipman and the Call for Death Certificate Reform

Per a 2005 article in the UK’s Guardian newspaper, there was a public inquiry regarding Dr. Harold Shipman, ... determining that he had “killed at least 250 of his patients over 23 years.”[24] The inquiry also found:
that by issuing death certificates stating natural causes, the serial killer [Shipman] was able to evade investigation by coroners. (Emphasis added).[25] Per a subsequent article in 2015, proposed reforms included having a medical examiner review death certificates, so as to improve patient safety.[26] The New Jersey Act has instead moved in the opposite direction to require that deaths be reported as natural. Doctors and other perpetrators have been enabled to kill under mandatory legal cover.

H. The Act Renders New Jersey Residents Sitting Ducks to Their Heirs and Other Predators

New Jersey’s slayer statute prevents a killer from inheriting from his or her victim. The statute states:
[A]n individual who is responsible for the intentional killing of the decedent forfeits [his or her inheritance].”[27] The rational is that a criminal should not be allowed to benefit from his or her crime.[28]

Under the Act, however, a person who intentionally kills another person is allowed to inherit. This is due to the deaths being certified as natural. With the passage of the Act, New Jersey residents with money, meaning the middle class and above, have been rendered sitting ducks to their heirs and other predators.

Footnotes:
....

[6] The Act, N.J.S.A. 26:16-1, attached in the appendix at p. A-2.
[7] Dore’s Amicus Brief, dated 12/19/19, Section IX, pp. 6 to 8.
[8] AMA Code of Medical Ethics Opinion, 5.8, in the appendix at page A-17. (“Euthanasia is the administration of a lethal agent by another person....”).
[9] The Attorney General’s letter brief, dated February 4, 2020, page 8, states:
Dore’s argument that the Act violates the single object rule is premised on her misstatement that the Act permits involuntary participation and euthanasia. (Emphasis added). [10] Georgetown University information pages, summarizing the Brandt and CeloCruz articles, in the appendix at pages A-18 and A-19.
[11] The Act, attached in the appendix, at pages A-2 through A-16, referring to the lethal dose as medication throughout its text.
[12] Dr. Kenneth Stevens states:
Generally accepted medical practice allows a doctor, or a person acting under the direction of a doctor, to administer prescription drugs to a patient.
Common examples of persons acting under the direction of a doctor, include: ... adult children who act under the direction of a doctor to administer drugs to their parents in a home setting. Declaration of Kenneth Stevens, MD, attached in the appendix at pp. A-20 to A-22, quote at page A-22, ¶ 10 (spacing changed).
[13] See the Act in its entirety, attached in the appendix, at pp. A-2 through A-16.
[14] Dore’s Amicus Brief, pp. 10-11.
[15] The Attorney General‘s letter brief, dated February 4, 2020, page 8.
[16] See the Act in its entirety, in the appendix at pp. A-2 to A-16.
[17] The Act, in the appendix at pp. A-4 through A-8.
[18] Id., in the appendix, at page A-5.
[19] See the Act in its entirety, in the appendix, at pp. A-2 through A-16.
[20] Definitions attached in the appendix at pp. A-24 and A-25.
[21] The Act, C.26:16-17.a.(2), attached in the appendix at page A-10.
[22] Andrew L. Falzon, MD, and Sindy M. Paul, MPH, “Death Investigation and Certification in New Jersey,” MD Advisor, a journal for the New Jersey medical community, 2016. (Attached in the appendix at page A-25)
[23] Id.
[24] David Batty, “Q & A: Harold Shipman,” The Guardian, 08/25/05, at https://www.theguardian.com/society/2005/aug/25/health.shipman. (Attached in the appendix at pages at A-26 to A-28).
[25] Id., attached at A-28.
[26] Press Association, “Death Certificate Reform Delays ‘Incomprehensible,” The Guardian, January 21, 2015, attached in the appendix at A-29 to A-30.
[27] NJ Rev Stat § 3B:7-1.1, attached in the appendix at pages A-31 and A-32.
[28] Cf. Ilene S. Cooper and Jaclene D'Agostino, "Forfeiture and New York's 'Slayer Rule', NYSBA Journal, March/April 2015
Categories: Discussion

Death doctors using Covid-19 crisis to permit "aid-in-dying" via telehealth.

Thu, 2020-03-26 16:06
Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The assisted suicide lobby are actively promoting the approval of assisted suicide and euthanasia via telehealth. The death lobby are using the coronavirus to achieve two main goals, that being, allowing the approval of lethal prescriptions via telemedicine or telehealth and the expansion of assisted suicide to include euthanasia.

According a committee of the newly formed American Clinicians Academy on Medical Aid in Dying, (death doctors) (chaired by Lonny Shavelson, a California doctor who only offers death) the coronavirus crisis requires allowing approvals by telehealth. The committee stated:
In light of the coronavirus crisis, a committee has been convened to establish recommendations pertaining to the use of telemedicine to evaluate patients’ requests to consider medical aid in dying. (See below for members of the policy committee.)

For the purposes of this policy statement, “telemedicine” and/or “telehealth” refers to a visual and verbal patient contact by electronic means, without an in-person visit. Long before the onset of the coronavirus pandemic, many established aid-in-dying clinicians used telemedicine visits to evaluate select aspects of terminally ill patients’ requests to consider medical aid in dying. Given the need to limit in-person contacts to decrease the speed of contagion of coronavirus, an increased use of telemedicine for select aspects of aid-in-dying evaluations and care is recommended.The committee of death doctors concluded:
The Committee concludes that there is nothing inherent in an aid-in-dying request that prohibits or discourages the use of telemedicine.
The death doctors are using the coronavirus to achieve their goal and they have no intention of going back to examining patients, once the coronavirus crisis passes. 

It is important to recognize the language used by the death doctors. "Medical Aid in Dying" (MAiD) is a term that is used by the death lobby for euthanasia and assisted suicide. The American death lobby are trying to extend assisted suicide legislation to include euthanasia or lethal injection. Most new assisted suicide bills are not what they appear to be.

Recently I reported that another death lobby group was using the coronavirus to promote assisted suicide via telehealth.

This is not a new plan. The 2019 New Mexico assisted suicide bill included a telehealth provision and a recent bill to expand assisted suicide in Hawaii includes a telehealth provision.State regulators should not take this group seriously. These are death doctors promoting more death. In the case of Shavelson, he does not provide medical treatment only death.
Categories: Discussion

Washington State assisted suicide group - death may take hours.

Wed, 2020-03-25 17:04
Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

A Washington State assisted suicide lobby group is informing its "clients" that death by assisted suicide may take many hours. In their document, Death with Dignity - Preparing for the last day, End of Life Washington states:
Every individual is different and time to death after taking the medication varies greatly depending on the person’s physical condition and ability to absorb the medication. Be assured that once the person is in a coma (generally within 5-10 minutes of taking the life-ending medication), they will be in a peaceful place and not experience any suffering. If they do not die as soon as expected, do not panic. There is little that can be done except to wait. Caregivers may administer any of the medications in a hospice kit, if one is available, in response to any symptoms that ordinarily would be treated.

It may be helpful to consider the additional hours as a time for a vigil, which often occurs during the last hours of a person’s life during a natural death. The Washington State 2018 assisted suicide report indicated that of the 203 reported assisted suicide deaths that there were 8 reported complications in 2018, likely related to the new DDMA and DDMP2 lethal drug cocktails. Also, 62 deaths reportedly took more than 90 minutes with the time of death ranging from 7 minutes to 30 hours.

The Oregon 2019 assisted suicide report states that the time of death ranged from 1 minute to 47 hours but the report didn't indicate how many people died more than 90 minutes after taking the lethal drugs.
The fact that assisted suicide deaths can take many hours is directly related to the new lethal drug cocktails that have been developed to enable a cheaper way to kill.

These lethal drug cocktails were developed through human experimentation. The results of the first two failed lethal drug trials were:
The (first) turned out to be too harsh, burning patients’ mouths and throats, causing some to scream in pain. The second drug mix, used 67 times, has led to deaths that stretched out hours in some patients — and up to 31 hours in one case.In February 2019 I published the article - assisted dying can cause inhumane deaths based on research by Professor Jaideep Pandit that was published in the British Medical Journal. Pandit researched complications with assisted suicide and capital punishment deaths and indicates that the complications include:
  • difficulty in swallowing the prescribed dose (up to nine per cent) and vomiting in 10 per cent, both of which can prevent proper dosing.
  • Re-emergence from a coma occurred in two per cent of cases, with a small number of patients even sitting up during the dying process, the authors said. 
  • After oral sedative ingestion, patients usually lose consciousness within five minutes. However, death takes considerably longer. 
  • But in a third of cases, death can take up to 30 hours,
The negative outcomes associated with the lethal drug cocktails and the ethics of human experimentation related to the development of these drugs should be investigated by the US government, based on the controlled substances act.
Categories: Discussion

Lethal Drugs Used For Assisted Suicide and Complications for Patients.

Tue, 2020-03-24 19:42
The Patients Rights Action Fund published the following information.
 
Warning: If you are experiencing suicidal thoughts, do not read this article but call: 1-800-273 (talk) 8255.

Article: Lethal drug cocktails experimented on humans (Link).

Seconal (Secobarbital)
  • A 90-100 pill dosage of Seconal (secobarbital) was widely used for assisted suicides for many years until it became too costly and in 2019 became unavailable for this use. [1]
Phenobarbital
  • To replace Seconal, proponents of assisted suicide began experimenting with combinations of drugs to induce death. One of the drug combinations used is a mixture consisting of phenobarbital, chloral hydrate and morphine sulfate. The patient mixes the powder with water, alcohol, applesauce or juice. This drug combination lowered the cost to $400-$500. 
  • In Oregon, the phenobarbital combination was used to cause the death of 65 patients. For those cases for which data on time to death after ingestion were reported, patients experienced death from 20 minutes to 72 hours. [2]
DDMP 1; DDMP2
  • Increasingly, experimentation began with other new drug cocktails. A combination using DDP (diazepam, morphine sulfate and propranolol) took a patient 18 hours to die so 10 mg. of digoxin was added to the mix to create DDMP 1. The digoxin dosage was subsequently increased to 15 mg. to form DDMP 2. [3] 
  • Researchers have described DDMP 2 as “blue-whale-sized doses…..And the mixture tastes extremely bitter. ‘Imagine taking two bottles of aspirin, crushing it up, and mixing it in less than half a cup of water or juice.’” [4]  
  • In Oregon, DDMP 1 and DDMP 2 accounted for 239 deaths through 2019. For those cases for which data on time to death after ingestion were reported, patients experienced death from a range of 5 minutes to 47 hours. Two patients regained consciousness after ingesting the drugs.[5] “The median time until death was longer for the DDMP2 compound (120 min) than for secobarbital (25 min)…”[6] The drug cocktail is taken in liquid form and is ingested orally or through a tube.
DDMA 
  • In 2019, DDMA was introduced which is a combination of diazepam, digoxin, morphine sulfate and amitriptyline. In Oregon, DDMA was used for 87 patients and for those cases for which data on time to death after ingestion were reported, the time to achieve death ranged from one minute to 19 hours. [7]
Morphine Sulphate 
General Complications From Lethal Drugs Used In Assisted Suicide Deaths
  • Experimenting with combinations of drugs is “research” which has not been approved by any ethics review committee like an "Institutional Review Board" (IRB), which appears to violate research ethics standards. 
  • According to The Atlantic: “No medical association oversees aid in dying, and no government committee helps fund the research…The doctors’ work {to experiment with drugs which kill patients} has taken place on the margins of traditional science. Despite their principled intentions, it’s a part of medicine that’s still practiced in the shadows.”[10]  
  • According to Kaiser Health News: “The first Seconal alternative turned out to be too harsh, burning patients’ mouths and throats, causing some to scream in pain.”[11] “The second drug mix, used 67 times, has led to deaths that stretched out hours in some patients – and up to 31 hours in one case…the next longest 29 hours, the third longest 16 hours and some 8 hours in length.”[12]
  •  According to the New England Journal of Medicine: “One in five Dutch patients using standard barbiturates to kill themselves experienced complications including vomiting, inability to finish the medication, longer than expected time to die, failure to induce coma, and awakening from coma.” [13]  
  • According to Anaesthesia: “However, for all these forms of assisted dying, there appears to be a relatively high incidence of vomiting (up to 10%), prolongation of death (up to 7 days), and re-awakening from coma (up to 4%), constituting failure of unconsciousness. This raises a concern that some deaths may be inhumane…”[14]
  •  According to the British Medical Journal: “Complications related to assisted dying methods were found to include difficulty in swallowing the prescribed dose (≤9%), a relatively high incidence of vomiting (≤10%), prolongation of death (by as much as seven days in ≤4%), and failure to induce coma, where patients re-awoke and even sat up (≤1.3%). ‘This raises a concern that some deaths may be inhumane,’ the researchers said. They had expected to find a single technique being used but said that ‘the considerable heterogeneity in methods suggests that an optimum method of achieving unconsciousness remains undefined.’” [15]

1. http://www.medscape.com/viewarticle/869023?src=emailthis#vp_2 https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year22.pdf, page 7

2. https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year22.pdf, page 16

3. https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year21.pdf, page 15

4. https://www.theatlantic.com/health/archive/2019/01/medical-aid-in-dying-medications/580591/

5. https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year22.pdf, page 16

6. https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year21.pdf, page 7

7. https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year22.pdfm , page 16

8. https://www.doh.wa.gov/Portals/1/Documents/Pubs/422-109-DeathWithDignityAct2017.pdf, page 9

9. https://www.doh.wa.gov/Portals/1/Documents/Pubs/422-109-DeathWithDignityAct2017.pdf, page 10

10. https://www.theatlantic.com/health/archive/2019/01/medical-aid-in-dying-medications/580591/

11. Kaiser Health News, “Docs in Northwest Tweak Aid-In-Dying Drugs to Prevent Prolonged Deaths”, February 21, 2017

12. Kaiser Health News, “Docs in Northwest Tweak Aid-In-Dying Drugs to Prevent Prolonged Deaths”, February 21, 2017

13. Groenewoud, J.H., van der Heide, A., Onwuteaka-Philipsen, B.D., Willems, D.L., et al. (2000). Clinical Problems with the Performance of Euthanasia and Physician-Assisted Suicide in the Netherlands. The New England Journal of Medicine, 342, 551-556.
 
14. Sinmyee, S., Pandit, V.J., Pascual, J.M., Dahan, A., Heidegger, T., et al. (2019). Legal and ethical implications of defining an optimum means of achieving unconsciousness in assisted dying. Anaesthesia, 74,557-559.

15. Torjesen, Ingrid. (2019) Assisted dying methods can lead to “inhumane” deaths. British Medical Journal. 364:1797 doi: 10.1136/bmj.1797
Categories: Discussion

Dr Sonu Gaind: Canadian Psychiatric Association (CPA) position on euthanasia for psychiatric reasons is embarrassing

Mon, 2020-03-23 16:27
Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Dr Sonu GaindDr. K. Sonu Gaind is an associate professor of psychiatry at the University of Toronto, a past president of the Canadian Psychiatric Association (CPA) and a member of the Council of Canadian Academies expert advisory group on MAiD responds in the CanadianHealthcareNetwork.ca to the new position of the CPA supporting euthanasia.

Dr Gaind was the president of the (CPA) at the time of the Carter Supreme Court of Canada euthanasia decision. In response to the Supreme Court decision, the CPA held a task force, developed guidelines and provided evidence based guidance to policy makers, committees and government committee's on euthanasia for psychiatric conditions.

Based on his expertise, Gaind was appointed as a member of the Council of Canadian Academies expert advisory group on MAiD. In his recent article: I wish I didn't have to write this Gaind expresses his embarrassment by the new position by the CPA that that supports euthanasia for people with psychiatric conditions.

Gaind explains that the CPA research directly affected Canada's euthanasia legislation, he wrote:In the end, the federal government heeded the advice of the CPA, and in Bill C-14 indicated that further study was required to assess the appropriateness of permitting MAiD for the sole condition of mental illness. Following the implementation of C-14, the federal government tasked the Council of Canadian Academies (CCA) with undertaking further study on three issues related to MAiD, including the issue of sole criterion mental illness applications. Unrelated to my CPA roles, I sat as an expert on the CCA panel on mental illness and further studied the issue. Gaind comments on his personal position on MAiD:When I started all this, as CPA president in late 2015, I entered with an open mind and as neutrally as I could, both to respect my role as representing not just myself but all CPA members, and also on a personal level I did not want any pre-judgements to form my opinion without understanding the various issues and evidence. I am not a conscientious objector to MAiD in general, and in fact am physician chair of our hospital MAiD group, overseeing all the MAiD cases we undertake. However, after this extensive period of review, it is clear to me now that expanding MAiD for sole criterion mental illness would not be safe in the current context.Gaind comments on how the euthanasia expansion advocates ignore a basic point of the law.Expansion advocates often focus overly narrowly on issues they label as “patient autonomy” (even there the focus is on a narrow concept of what autonomy is, rarely acknowledging relational autonomy or other concepts beyond autonomy being what one individual is asking for at one point in time). However, they gloss over the simplest yet most crucial fallacy regarding potentially providing MAiD for mental illnesses. Our current MAiD framework is supposed to be for irremediable conditions. As I’ve written previously in Medical Post and elsewhere, and as CAMH has concluded, irremediability cannot be predicted for mental illnesses at this time. This is presented clearly following extensive evidence-based review in the recent Expert Advisory Group on MAiD report at www.eagmaid.org.

So, if patients with sole criterion mental illness receive MAiD, they are not getting it for a predictably irremediable condition, as they would be if they had ALS, cancer, or other medical conditions with known pathophysiology. They would be getting MAiD because society has agreed they had suffered enough, but they could get better. To me, it is discriminatory to expose those with mental illness to death based on assessors’ personal views and arbitrary opinions of irremediability, when the evidence tells us we cannot predict irremediability in mental illness.Gaind then suggests that the new CPA euthanasia policy was developed in secrecy. He states:...Many colleagues with senior positions in CPA leadership roles were unaware of any work CPA was continuing to do on this file (myself included, having completed my term and rotating off the board in September 2019). Despite having been chair of the sunset time-limited CPA task force on MAiD, and an expert on the CCA panel, CPA had not engaged me or any colleagues I know of with expertise in the area to assist with the file. Of more concern, since the 2016 CPA member survey done by the previous time-limited task force on MAiD, which showed only approximately 30% of Canadian psychiatrists supported MAiD for mental illness, there had been no subsequent engagement of general membership regarding their views as issues evolved.

Knowing that the six-month period after the Truchon ruling was coming up in March, and that federal government reviews were intended to start in summer 2020, I contacted the CPA CEO in mid-February to provide CPA with relevant informational updates, and to ask what the CPA was doing on this file given imminent policy changes. Other than a polite response from the CEO over a week later acknowledging receipt of my message, no information was forthcoming (other than confirmation that no-one representing CPA even phoned in on the national, open teleconference lines providing technical briefings on Bill C-7 on February 24).Gaind continues on the new CPA position statement: Imagine my surprise when, this past Friday, March 13, the CPA released a so-called Position Statement on Medical Assistance in Dying developed by the CPA Professional Standards and Practice (PSP) Committee. From a process point of view, this raised significant concerns, given the complete lack of member engagement on this issue preceding this statement. The PSP is a generic (i.e., not MAiD-specific) committee of several members (seven). It is unclear whether any additional expertise in the area of MAiD and mental illness was even sought through this process. If it was, it was certainly a well-kept secret from many of us who are CPA members.

Process aside, if such a Position Statement actually provided evidence-based guidance, it could still be of value. Unfortunately, not only does the PSP Position Statement fail to provide any evidence-based guidance regarding MAiD and mental illness, at this critical time when policies are being set, the Statement is actually, in my opinion, damaging and dangerous.Dr Gaind explains his criticism of the CPA position statement:The bulk of the one page (if you remove author affiliations) PSP Statement, consisting of five points, makes ‘apple pie’ comments referring to “having working knowledge of legislation,” being “mindful of the medical ethical principles as they relate to MAiD,” being “rigorous in conducting capacity assessments,” and providing information even if choosing to not be involved with provision of MAiD. It also makes a statement that “patients with a psychiatric illness should not be discriminated against solely on the basis of their disability, and should have available the same options regarding MAiD as available to all patients.” That’s it. No actual guidance on what any of that means. And quite remarkably for a Position Statement issued by a national expert professional medical association, after there have been years of focused review and study on the issue (for example, the CCA Panel Reports, and numerous and ongoing other national and international literature references), there is not a single reference to any citation regarding mental illness and MAiD, capacity or decision making, suffering, or above all, irremediability. Again remarkably for a psychiatric association, the three only citations are to Bill C-14 and the Carter and Truchon rulings.Dr Graind continues on why the new position is dangerous:Had the PSP Position Statement simply been unhelpful, I would not have written this piece. Unfortunately, beyond being unhelpful, the Statement is dangerous. While the comment that patients with mental illness should not be discriminated against is self-evident, it is far from evident what CPA is actually saying with that comment. Does this mean that it would be discriminatory to not provide MAiD to patients with sole criterion mental illness? Or does this mean that it would be discriminatory to provide MAiD in such situations, since it would expose patients to arbitrary and unscientific determinations of irremediability that cannot be predicted? Again, remarkably for a psychiatric association, the PSP Position Statement never even once addresses or comments on the issue of predicting irremediability in mental illnesses.

Even worse than taking a position, the CPA has chosen to attempt to say nothing on this issue—and in doing so, in this politicized debate CPA has opened the door to dangerous and arbitrary interpretations of what this position statement actually means (perhaps fittingly, if they have also opened the door to expose patients to dangerous and arbitrary determinations of irremediability of mental illness that cannot be scientifically made). Dr Gaind states that the CPA position on euthanasia for psychiatric reasons is embarrassing:As a past president and current Distinguished Fellow of the CPA, it pains me to write this piece. I know how thoughtful, considered and hardworking all elected CPA Board members are. Many are my friends. However, my obligation to all our patients, and to what our members should expect of a member association, must outweigh these feelings. Through the process and content of this PSP Position Statement, by failing to engage or be respectful of its own members, by failing to even try to address any evidence-based recommendations and being silent on key issues needing guidance regarding mental illness and MAiD at this crucial time, the CPA has failed its members and our patients in its role as a national professional member association, and has in fact abrogated its role and lost any moral authority in this important issue.

Today, I am embarrassed to be a CPA member.More information on this topic:
Categories: Discussion

Schadenberg: Study encourages euthanasia.

Mon, 2020-03-23 14:52
This article was published by OneNewsNow on March 23, 2020 (edited).
Will governments with legalized euthanasia require it for the common good?Alex SchadenbergAlex Schadenberg of the Euthanasia Prevention Coalition tells OneNewsNow two Scottish doctors have published "Cost analysis of medical assistance in dying" a previous study in the Canadian Medical Association Journal looked at medical aid in dying in Canada.
"They are arguing that assisted suicide saves money for the healthcare system, but it also provides more organs for organ donations; therefore, we should be doing this. We should be encouraging this," Schadenberg relays. "They continued throughout this study to say that we're not actually promoting euthanasia, but of course … it's a lie.”That reminds him of the 1920 book, Allowing the Destruction of Life Unworthy of Life, that doctors of Hitler's time were required to read. It promoted and justified euthanizing people with disabilities, for the "common good."
"It's very similar, actually, because it's justifying these things based on cost and based on efficacy to the nation, meaning that, you know, you're going to get a lot more healthy organs out of this if you allow this, so this is a good thing to do also," Schadenberg poses.But he is concerned that that philosophy is leading society down the path to forced euthanasia -- killing people in the name of compassion when it really just means saving money and benefiting others with their organs.
Further information:
Categories: Discussion

Assisted Suicide lobby is using Covid 19 virus to promote assisting suicides via telehealth.

Fri, 2020-03-20 16:48
Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The death lobby is promoting the approval of assisted suicide and prescribing of lethal drugs via telehealth. This means that a person could be approved for death by lethal drugs, without being examined or even meeting the death perscribing doctor.

Today's fundraising email from Kim Callinan, the President of an assisted suicide lobby group, states that the current Covid-19 crisis provides new opportunity for assisted suicide. She writes:
As always, we are responding quickly to the needs and opportunities of the times. As the workforce grapples with the pandemic, telehealth is gaining prominence as a critical mode of delivering medical care. This provides a unique opportunity to make sure health systems and doctors are using telehealth, where appropriate, for patients trying to access end-of-life care options. These efforts should improve access to medical aid in dying in the short and long-term.This is not a new plan. The 2019 New Mexico assisted suicide bill included a telehealth provision and the recent bills to expand assisted suicide in Hawaii include a telehealth provision.

Let's think this through. A person with difficult health issues who feels like on burden on others, or experiencing depression or existential distress, could be assessed, via telehealth, and prescribed lethal drugs for suicide.


The death lobby focuses on facilitating death and protecting doctors who are willing to be involved with killing their patients. They are not concerned with protecting people.


For more information read the articles:  
 
Categories: Discussion

Covid-19 reveals a deadly failure of priorities.

Fri, 2020-03-20 13:00
This article was published by the disability rights group, Not Dead Yet on March 17, 2020

Diane ColemanBy Diane Coleman
President and CEO of Not Dead Yet

With the looming and imminent threat of insufficient hospital and ICU beds, medical equipment and healthcare staff, I found myself recalling an old favorite TV show from my college years. MASH (mobile army surgical hospital) created both comedy and drama around the reality of having three operating room beds in an army tent on the war front in South Korea. Triage was part of the routine, determining who gets on the operating table first, and who gets the best surgeon (Hawkeye) of the four in the unit. Now and then, when the frontlines had faced a heavy attack and massive casualties poured in, the plot explicitly focused on triage situations. Hawkeye always struggled to do the right thing.

COVID-19 is leading to more and more news reports on the fast approaching reality that the demand for hospital beds and ventilators will exceed supply. New York’s Governor Cuomo was carried on MSNBC yesterday and today, discussing this crisis.

A few years ago, NDY’s research analyst, Stephen Drake (aka my husband, now retired), reviewed New York’s Ventilator Allocation Guidelines, released in 2015. The pandemic guidelines operate on the principles of triage.
The primary goal of the Guidelines is to save the most lives in an influenza pandemic where there are a limited number of available ventilators. To accomplish this goal, patients for whom ventilator therapy would most likely be lifesaving are prioritized. The Guidelines define survival by examining a patient’s short-term likelihood of surviving the acute medical episode and not by focusing on whether the patient may survive a given illness or disease in the longterm (e.g., years after the pandemic). Patients with the highest probability of mortality without medical intervention, along with patients with the smallest probability of mortality with medical intervention, have the lowest level of access to ventilator therapy. Thus, patients who are most likely to survive without the ventilator, together with patients who will most likely survive with ventilator therapy, increase the overall number of survivors. Within the hospital environment, ventilators would be allocated and, if necessary, re-allocated as the pandemic proceeds. Importantly, the guidelines state:
In its consideration to protect vulnerable populations, i.e., ventilator-dependent chronic care patients, the Task Force determined that these individuals are subject to the clinical ventilator allocation protocol only if they arrive at an acute care facility for treatment.It would be helpful if disability advocates determine whether similar guidelines exist in their state and, specifically, what they say, in order to inform their communities and ensure that individuals who use breathing support can make the best decisions for themselves if they get sick. (In my opinion, I should not go to an acute care facility if I get sick.)

It’s hard to disagree with the principle of maximizing the number of pandemic survivors but, nonetheless, a few things need to be said.

First, COVID-19 is not the only cause of the shortages we face. I’m on a New York Medicaid advocacy listserv in which one member quoted Judy Wessler, former head of the NY Commission on the Public’s Health System:
Let’s Remember That Since At Least 2006 There Has Been A Tremendous Push In New York State To Close Hospital Beds And Consolidate Hospitals. We Used To Have 4 Beds Per 1,000 And Now We Have Something Like 2.8 Beds Per 1,000. So Now We Have To Play Catch-Up. Wessler was also quoted in a NY Post article entitled New York has thrown away 20,000 hospital beds, complicating coronavirus fight.

How many states have taken similar steps as they offload their healthcare responsibilities, letting managed care take over and allowing that industry to suck up around 20% of our healthcare dollars and put profits over people? So our shortage of beds and ventilators is not just caused by COVID-19 but also by unacceptable political and fiscal decisions made largely under the public radar.

Second, how will the idealized triage principles be implemented in practice? The NY guidelines call for a triage committee. It will not be the attending doctor. I don’t think we can count on the committee being composed only of doctors like the caring Hawkeye Pierce. And there will be a time crunch. The situation invites biases like ableism and racism to creep in.

Third, we already know that healthcare resources are denied based on disability bias under futility policies, denial of transplants and other practices reported in the National Council on Disability’s bioethics series. In this crisis, further devaluation of our lives is a real threat.

Not Dead Yet was among many organizations that signed onto a National Disability Rights Call To Action on March 3rd. We are all are trying to impress upon policymakers that our lives are valuable. We are not worth-less and we are not expendable!

This pandemic resource shortage will touch people who previously felt safe from healthcare rationing. How we treat people in need is a reflection of the priorities of the policymakers we elect. All too often, the voices of people with disabilities and other justice communities have been drowned out. Perhaps the unnecessary loss of life from this pandemic due to healthcare capacity limits will cause others to join with us in re-evaluating the priorities that got us here.
Categories: Discussion

Canada's newest euthanasia push is insane

Thu, 2020-03-19 16:25
This was published by OneNewsNow on March 19, 2020


Canada is mirroring Europe in its embrace of euthanasia thanks to the country’s psychiatrists approving of euthanizing their own patients.

Millions of people turn to professional help to deal with depression, suicidal thoughts, and other challenging problems, but the Canadian Psychiatric Association calls it discriminatory if the country’s current law prohibits their patients from ending their own lives.
Article: Canadian Psychiatric Association approves euthanasia (Link).
Article: Canadian psychiatrists: Refusing euthanasia for the mentally ill is discrimination (Link).Alex SchadenbergAlex Schadenberg of the Euthanasia Prevention Coalition says Canadian officials have created a “set of principles” for doctors to follow.
“But right off the bat this is the wrong idea,” he warns. “Psychiatrists are supposed to be caring for people with mental illness, supposed to be caring for people who have suicidal ideation, not killing them.”He credits the American Psychiatric Association for making it clear that doctors should not be involved in killing those in their care.
“I'll go one step further: In Canada, you have a situation where capital punishment is not permitted, so right off the bat physicians traditionally do not participate in capital punishment because they believe it's wrong for a physician to do so,” Schadenberg observes. “And here you will now have psychiatrists involved in euthanasia"
Categories: Discussion

Euthanasia clinic shuts down amid Coronaviris Crisis.

Wed, 2020-03-18 19:33
Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Kevin Dunn filming Fatal Flaws at the euthanasia clinicThe Netherlands euthanasia clinic has temporarily shut-down amid the Coronavirus crisis. This is the euthanasia clinic that reported euthanasia requests, in 2019, were up by 22% and euthanasia deaths increased to 992 from 727 in 2018. This is also the euthanasia clinic that specializes in euthanasia for psychiatric reasons and euthanasia for people with dementia or questionable competency.

The announcement from the euthanasia clinic (google translated) follows:
Corona crisis hits Euthanasia Expertise Center

The Corona crisis also affects the assistance of the Euthanasia Expertise Center. In the interest of public health, our patients, their loved ones and employees of the expertise center, it is no longer responsible to continue our current care provision.

Euthanasia expertise center temporarily will not accept new patients; clients are requested to submit their request at a later date. In addition, the care for current patients of the Euthanasia Expertise Center is suspended. Existing processes are put on hold and resumed at a later date. If euthanasia has already been agreed or promised, euthanasia can continue on condition that the group of attendees is limited to those who are absolutely necessary. Urgent case histories of current patients from the center of expertise are also dealt with, as long as a doctor and nurse are available for this. This concerns case histories of terminal patients or patients where there is an important risk that the ability to exercise will be compromised.

Unavoidable
Helping people, especially patients who turn to us in extreme need, is in the DNA of the doctors and nurses of the Euthanasia Expertise Center. The above measures are difficult for the employees. However, special circumstances force us to take these inevitable steps. However harsh: euthanasia care cannot be identified as a top priority in health care. The risk of infection is high and the expertise center employs ambulatory doctors and nurses who also work elsewhere. For example, they are general practitioners or work in the intensive care unit of a hospital. Other healthcare providers are retired and themselves fall under the definition of the group of "vulnerable".

Euthanasia consultants
The measures apply until April 6. The government's date is leading for the Euthanasia Expertise Center. Our euthanasia consultants continue to provide (general practitioner) doctors in the Netherlands with telephone support.EPC has not obtained the 2019 Netherlands euthanasia report, but the 2018 Netherlands euthanasia report indicated that euthanasia had slightly dropped in 2018, likely because of the court case related to the incompetent woman who died by euthanasia, even though she had resisted

In the Netherlands there were 6126 reported euthanasia deaths in 2018. In 2018, the statistics included a new category where 205 people died by euthanasia based on: multiple problems derived from the aging process. I consider this category as an acceptance, in part, of euthanasia for "completed life".
Categories: Discussion

Assisted suicide for mental illness: Why safeguards won't work.

Wed, 2020-03-18 14:32
Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Dr John MaherImpact Ethics published the most recent article by the renowned psychiatrist, Dr John Maher, who argues that euthanasia for mental illness should not be permitted and safeguards will not work.

Last month Dr Maher was published by CBC News explaining why legalizing (MAiD) for mental illness was misguided.

Maher explains that there are limits to individual autonomy and for good reason. He states:
MAiD advocates sing a siren song of absolute individual autonomy. It is claimed: i) the state should not interfere with a capable person’s choice to complete suicide, and; ii) the state should help with such suicides since people are entitled to services (i.e. MAiD) that other (dying) citizens already receive. But, caring societies have long held that respecting autonomous choice has its limits, especially with: brain malformation, damage, or disease; childhood; and harm to self or others.Maher outlines four key reasons why safeguards concerning MAiD for mental illness won't work. He states:
1. Review of the assisted suicide requests by two (or more) independent psychiatrists (preferably with special expertise in the salient psychiatric disorder). Whether for or against assisted suicide for mental illness it is clear that intact decisional capacity is necessary for providing informed consent for MAiD. Note, however, that if a psychiatrist does not know the patient over the long term, and is not within a functional therapeutic relationship, it can be very difficult to assess decisional capacity accurately. Patients commonly “hold it together” during the snapshot afforded by a 1-2 hour capacity assessment by an independent psychiatrist, even against a hidden backdrop of profound decisional impairment. “Ruling out” who should not be eligible for MAiD is easy (with extreme psychosis, for example). “Ruling in” is fraught with clinician-to-clinician variability and value judgements. Inter-rater capacity assessment reliability is only 65%. The presumption that all psychiatrists can sort out these grey areas with aplomb is naïve. Capacity assessments require training, experience, and sophisticated craft knowledge. This variability means there is a significant risk that many patients will be judged to qualify for MAiD when they actually lack the capacity to consent to it. Of greater concern are the psychiatrists who would be willing to kill a lot of patients in the name of compassion. The experience of the Benelux countries unequivocally illustrates pro-suicide biases among a small number of psychiatrists whom patients actively seek out to get the suicide outcome they desire. The risk with this group of psychiatrists is, again, the over-use of MAiD in cases where patients should be considered ineligible. 2. Require that the patient accept more or different treatment, and simultaneously impose a time delay (e.g. 6 months) before fulfilling the assisted suicide request to allow time for further reflection, added support provision, or to see if the different treatment approach reduces suffering. Standard psychiatric treatment protocols are not of short duration (months to years), and entail multiple treatment trials. The requirement that the patient have an “irremediable medical condition”, as specified by existing MAiD legislation, means the patient has already been receiving longer term treatment that she or he considers inadequate. This supposed safeguard would not filter out anyone who should be ineligible for MAiD, since everyone with a serious psychiatric condition that has yet to be remedied (even when ultimately remediable) will meet this point-in-time requirement. 3. Require an eligibility criterion of a “non-ambivalent decision”. Unwavering certainty would self-evidently be a minimum legal requirement for any provision of MAiD. But a sustained and clear wish to die does not mean it is a rational wish. For example, the wish might arise out of depression-induced despair. Some propose watering this requirement down to a “well-considered decision”. This weaker position has questionable grounding in the realities of brain science, decisional variability, and the profound messiness engendered by hopelessness, cognitive distortions, and suicidal symptomatology. A person may have arrived at a “well-considered decision” even while beset with one or more of these symptoms. 4. Require a “lack of a reasonable treatment alternative” criterion. What counts as “reasonable” depends on the perspective. A psychiatrist may believe that there is a reasonable treatment alternative, while the patient does not want that treatment. In such a situation, would the patient be denied MAiD? Probably not, given that current MAiD legislation protects patient treatment refusals. And so, some people who could get better will die.Maher concludes his article by stating that their is a lack of availability of effective mental health care and allowing euthanasia (MAiD) for people with mental illness is a failure of the governments duty to care.

John Maher is an assertive community treatment (ACT) psychiatrist, President of the Ontario Association for ACT and FACT, and Editor-in-Chief of the Journal of Ethics in Mental Health
Categories: Discussion

Euthanasia saves money and provides more organs for donation.

Mon, 2020-03-16 22:19
Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition


Canada legalized euthanasia on June 17, 2016. On January 23, 2017, the Canadian Medical Association Journal (CMAJ) published a study by Aaron J. Trachtenberg MD DPhil, Braden Manns MD MSc titled: Cost analysis of medical assistance in dying.
 
The researchers in that study found that Canada's healthcare system would save between 34.7 - 138.8 million dollars per year, depending on the number of euthanasia deaths, now that euthanasia was legal. Canada has a universal healthcare system, where the financial cost for healthcare is primarily paid by governments.
 
In Canada there were 5000 euthanasia deaths in 2019 and 13,000 since legalization. I suggest that the higher estimates by Trachtenberg and Manns were probably more accurate.
 
The Journal of Clinical Ethics recently published a study by Scottish researchers David Shaw and Alec Morton titled: Counting the cost of denying assisted dying. The authors argue:
First: permitting assisted dying allows consenting patients to avoid negative quality-adjusted life years, enabling avoidance of suffering. Second: the resources consumed by patients who are denied assisted dying could instead be used to provide additional (positive) quality-adjusted life years for patients elsewhere in the healthcare system who wish to continue living and to improve their quality of life. Third: Organ donation may be an additional potential source of quality-adjusted life years in this context.
The authors use the term assisted death to refer to both euthanasia, which is done by lethal injection, and assisted suicide, which is done by providing a lethal prescription that a person "self administers."

The authors suggest that people who are denied an assisted death should be compensated. They state:
Competent adults may claim that their life is not worth living and that they wish their life to end. Such claims must be investigated sympathetically. If the claims persist despite optimum care and in the absence of depression healthcare professionals must find ways to compensate such patients for the fact that society has denied them the means to exercise their autonomy. How patients could or should be compensated has not been determined.
In their analysis, the researchers examine "positive" gains if assisted death is legalized in relation to a persons QALY (Quality Adjusted Life Year). They suggest that a nations QALY is improved because some health conditions are worse than death. They state:
Most health states are preferable to death, and so attract a quality of life score which is greater than zero, indicating that life in that health state is preferable to no life at all... However, some limited literature has examined the value of health states worse than death.
The authors are arguing that when assisted death is legal it actually improves the QALY of a nation because some lives are worse than death.

Similar arguments were made by Karl Binding and Alfred Hoche in their book: Allowing the Destruction of Unworthy Life: Its Extent and Form. This is the book that led to the Nazi euthanasia program and it was based on very similar arguements to Shaw and Morton.

The authors then assess the financial savings by legalizing assisted death. The authors are very precise in their financial calculations by stating:
What quantity of resources might be saved from legalising assisted dying? It is possible to get a rough sense of the magnitude. Many patients who seek assisted dying are suffering from cancer (e.g. around two-thirds in the Netherlands) and Round et al. estimate that 12 months of care for a cancer patient at the end of life costs £9914, including health, social, charity and informal care. If only one-third of these costs could be saved through assisted dying, at the UK level, this would translate to £74m in the high scenario and £7.4m in the low scenario.
Finally the authors assess the issue of organ donation and assisted dying. They state:
Allowing patients to access assisted dying enables many of them to become organ donors. Despite the assumption that donation is not possible after assisted suicide or euthanasia, in many countries, this is a reality for patients.
They continue
First, if patients are denied assisted dying, organ function will gradually deteriorate until they die naturally, meaning that transplantation is less likely to be successful. Second, patients who choose assisted dying have to go through a lengthy process, and organ donation can be easily integrated into that process (non-coercively), decreasing the risk that family members will attempt to overrule donation, which often occurs when a patient dies in a way that is not planned. Finally, because of the planned nature of the death, it is even possible that a tissue match could be found before the organs are explanted. For all these reasons, enabling assisted dying could also enable an additional, highly beneficial source of organs for transplantation.Organs obtained from euthanasia are healthier because the donor didn't experience the dying process. These arguements also justify euthanasia by organ donation. Why kill a person and then remove the organs when you can remove the organs which kills the person?

The authors argue that they are not promoting assisted dying but only analyzing the cost benefits associated with assisted dying and the benefits and improves access to healthy organs for donation. This is not true.

First, they argue in the study that people who are denied an assisted death should be financially or otherwise compensated. In otherwords, the authors begin with a concept that people not only have a "right to die" but society has a "duty to kill them".

Secondly they are undermining the cultural reality that many people feel like a burdon on society. The arguement that some people are better off dead than living with certain health conditions reinforces this ideology.

For those who are not aware, you need to read the book: Allowing the Destruction of Unworthy Life: Its Extent and Form. This is the book that led to the Nazi euthanasia program and this is what Shaw and Morton's arguements support.

Ideas have consequences. Yes, euthanasia and assisted suicide are financially cheaper to the healthcare system than living, but legalizing assisted death changes the way society views human life. Society will change overtime and soon the "right to die" becomes the "Duty to Die" especially when the analysis is based on the utilitarian concept of the greatest "happiness for all".

Categories: Discussion

Canada Psychiatrists: Refusing Euthanasia for Mentally Ill Is ‘Discrimination’

Mon, 2020-03-16 18:00
This article was published by National Review online on March 16, 2020.

Wesley SmithBy Wesley Smith

Dedicated psychiatrists are often the only defense between patients with serious mental illness and suicide. But legalizing euthanasia shifts thinking 180 degrees because suicide has been redefined as health care and a right. Hence, protections — such as barring administered death to the mentally ill — soon come to be seen as obstacles.

That has happened in Canada, where the government is erasing its weak provision that death must be “reasonably foreseeable” requirement to qualify for killing. Once that provision is repealed, psychiatric conditions diagnosed “irremediable” could qualify for death.

This is the context in which the Canadian Psychiatric Association has warned the government not to “discriminate” against the mentally ill by barring them from lethal jabs when the law is changed. From the Association’s Position Statement (my emphasis):
2. Patients with a psychiatric illness should not be discriminated against solely on the basis of their disability, and should have available the same options regarding MAiD [medical assistance in dying, i.e., euthanasia] as available to all patients.

3. Psychiatrists will be mindful of the medical ethical principles as they relate to MAiD. They should not allow personal opinion or bias to sway patients who wish to consider MAiD as an option for addressing irremediable conditions.

4. While psychiatrists may choose not to be involved with the provision of MAiD, patients requesting MAiD must be provided with information regarding available MAiD resources and the referral process…

The CPA will continue to protect the rights and interests of patients with psychiatric conditions at all times, and with particular attention to the issues of decisional capacity, informed consent and irremediable conditions in the legislation and evolving landscape of MAiD. The CPA will advocate for the inclusion of appropriate safeguards in processes, protocols, procedures and legislation pertaining to provision of MAiD. So last line of defense protecting the mentally ill against suicide will be required by their Association’s ethics rules to cooperate in the very act they were once duty-bound to prevent, and indeed, participate in the euthanasia of eligible psychiatric patients by providing information about the process, and either killing them or referring them to a doctor who will. And they are not allowed to try to talk patients out of dying because that would be “bias.”
Categories: Discussion

Assisted suicide makes good economic sense, argue academics

Mon, 2020-03-16 15:42
This article was published by Bioedge on March 15, 2020


Michael CookBy Michael Cook, the editor of BioEdge

A new study in the journal Clinical Ethics claims that permitting assisted dying would substantially benefit both those seeking assisted suicide and the public.

Two Scottish academics, Dr David Shaw of the Universities of Basel and Maastricht, and Professor Alec Morton of the University of Strathclyde, posit three economic arguments: the cost to terminally-ill patients of a poor quality of life, the cost of care that could be better used elsewhere and potential benefits to organ donation (PDF here).

Dr Shaw, the lead author, said: “Some people might suggest that it is callous to consider assisted dying from the perspective of resource management; these are real people with real lives. This criticism is misplaced. Part of the motivation for our argument is precisely that these are real people with real lives who wish to avoid suffering.

The first argument is that it enables consenting patients to avoid negative ‘quality-adjusted life years’ (QALYS).

QALYs are a measurement of disease burden which encompasses the quality and quantity of life lived which is used by health professionals to determine the value of health outcomes.

Second, resources consumed by patients who are denied assisted dying could instead be used to provide additional QALYs for patients elsewhere who wish to continue living and improve their quality of life.

Third, organ donation may provide an additional source of QALYs in this context.

The authors argue that, together, the avoidance of negative QALYs and gain in positive QALYs suggests permitting assisted dying would substantially benefit both the small population that seeks assisted suicide and the larger general population.

They argue that denying assisted dying is a lose-lose situation for all patients.

In the paper the authors write:
“Quality-adjusted life years have been used for decades in healthcare allocation decision-making.

“By combining quality of life and mortality into one metric, they enable quantification of the medical gains and losses and relative financial costs of a vast diversity of treatments and interventions, in turn enabling these different treatments to be compared against each other and funding decisions to be made.

“Organ donation could also benefit because there are several reasons why donation after assisted dying is better from a clinical and economic perspective.

“First, if patients are denied assisted dying, organ function will gradually deteriorate until they die naturally, meaning that transplantation is less likely to be successful. Second, patients who choose assisted dying have to go through a lengthy process, and organ donation can be easily integrated into that process, non-coercively, decreasing the risk that family members will attempt to overrule donation, which often occurs when a patient dies in a way that is not planned.

“The legal arrangements for assisted dying vary widely from country to country, and if the UK was to legalise assisted dying (presumably in the form of assisted suicide) the calculations here could be made more precise based on the specifics of the approach under consideration. Nevertheless, our paper shows in general that denying dying plausibly imposes great costs on both patients who wish to die and those who do not.

“However, our argument is not that legalisation of assisted dying should be primarily based on economic arguments; these are supplemental facts that should not be neglected. Legalising assisted dying in the UK is likely to yield a substantial increase in QALYs across the patient population as a whole.”
Dr Gordon MacdonaldDr Gordon Macdonald, of the lobby group Care Not Killing, which opposes assisted suicide, said: “This report is highly disturbing. It highlights the dangers of legalising euthanasia. Very quickly the argument moves from that of personal autonomy to doctors and nurses making value judgments about the quality of other people’s lives while seeking to save money and tackle so-called ‘bed blocking’ in health services.”

Michael Cook is editor of BioEdge
Categories: Discussion

Assisted suicide law makes abuse possible

Fri, 2020-03-13 20:28
This article was written by Charlie Butts and published by OneNewsNow on March 12, 2020

Oregon has released its stats on assisted suicide – and it's raising the concern of an expert who opposes the practice and has argued the two-decades-old law that made it legal actually enables those who would abuse the law.
Article: Oregon assisted suicide deaths increase again in 2019 (Link).
The state enacted its "Death with Dignity Act" in 1997. The figures for 2019 indicate the state logged 188 reported assisted suicide deaths; that compares to 178 in 2018 (see chart). Alex Schadenberg of the Euthanasia Prevention Coalition explains to OneNewsNow that the amount of time until death occurred after ingesting lethal drugs ranged from one minute to almost two days.
"When someone ingested the lethal drugs, it took 47 hours to die," he states. "… Imagine being a family member watching your loved one lay there for 47 hours as they die. I don't think that's what you call a 'death with dignity' any way you look at it."
Alex SchadenbergThe state admits it doesn't know the ingestion status of 58 people last year who had prescriptions and did die. That was up from 43 in 2018. According to Schadenberg, "some or all" of those deaths may represent unreported assisted deaths.

The EPC spokesman points out another piece of data that concerns him.
"The [2019] data show that someone died 1,503 days [more than four years] after requesting assisted suicide," he shares. "So, 1,503 days is obviously a lot more than six months, [and] the law says you have to be six months from death [to obtain a prescription] – and we always knew that the six-month thing was hard to determine [that someone will die within] six months."
Two Oregon doctors who administered prescriptions for suicide were sent before the disciplinary board. One in 2018 lost his license to prescribe any medication to anybody. Another in 2019 remains unidentified, but the Euthanasia Prevention Coalition is searching for information on the allegations and any action taken.

EPC has argued in the past that Oregon's assisted suicide law is designed to deceive and cover up abuse of the law. The yearly DWD reports, the group states, are based on data from the physicians who prescribe and carry out the assisted suicide death.
"The data is not independently verified," reports EPC. "Therefore, we don't know if the information from these reports is accurate or if abuse of the law occurs …. Since doctors rarely self-report abuse of the law or even self-report controversial decisions … the law enable[s] a cover-up of any and all concerns."
Categories: Discussion

Canadian Psychiatric Association approves euthanasia.

Fri, 2020-03-13 17:17
Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition
 

The Canadian Psychiatric Association has moved from a position that was negative to euthanasia and assisted suicide to one that is supportive. This is the position of the American Psychiatric Association.

The new position of the the Canadian Psychiatric Association’s Professional Standards and Practice Committee, that was approved by the Board of Directors on February 10, 2020 states:
Canadian psychiatrists will ensure that: 1. They have a working knowledge of legislation that will potentially impact their patients with respect to MAiD, and shall take it into consideration during clinical encounters where this issue may arise. 2. Patients with a psychiatric illness should not be discriminated against solely on the basis of their disability, and should have available the same options regarding MAiD as available to all patients. 3. Psychiatrists will be mindful of the medical ethical principles as they relate to MAiD. They should not allow personal opinion or bias to sway patients who wish to consider MAiD as an option for addressing irremediable conditions. 4. While psychiatrists may choose not to be involved with the provision of MAiD, patients requesting MAiD must be provided with information regarding available MAiD resources and the referral process. 5. Psychiatrists who assess eligibility for MAiD are expected to be rigorous in conducting capacity assessments and identifying symptoms of mental disorder that are likely to affect decision-making. The CPA will continue to protect the rights and interests of patients with psychiatric conditions at all times, and with particular attention to the issues of decisional capacity, informed consent and irremediable conditions in the legislation and evolving landscape of MAiD. The CPA will advocate for the inclusion of appropriate safeguards in processes, protocols, procedures and legislation pertaining to provision of MAiD.
References
1. Parliament of Canada. An act to amend the criminal code and to make related amendments to other acts (medical assistance in dying) [Internet]. Canada; 2016. [Cited 2020 Feb 03]. Available from: http://www.parl.gc.ca/HousePublications/Publication.aspx?Language=E&Mode=1&DocId=8384014.
2. Carter v. Canada 2015 SCC 5 [2015] 1. R.C.S. 331.
3. Truchon c. Procureur général du Canada, 2019, QCCS 3792.Psychiatrists should not ever be involved with killing their patients. If you consider the nature and condition of many patients that psychiatrists are helping, killing should be viewed as antithetical to their care. 

I am concerned about the good psychiatrists who I have come to know who believe that killing is not a medical treatment for psychiatric treatment. Where are we going?


Categories: Discussion

Portugeese collect 76,000 signatures against euthanasia. Portugeese Communists oppose euthanasia.

Fri, 2020-03-13 15:15
Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition


Last month I reported that Portugal may soon legalize doctors killing their patients by lethal injection.

On February 20, the Portuguese Parliament voted on five proposals to legalize euthanasia. All of the proposals passed, even though two years ago, similar proposals were defeated. The Portuguese government will now propose a single bill for parliament.
 
Groups opposing euthanasia started a massive signature petition campaign to urge the government to approve a Portugeese referendum on euthanasia. The Portugeese government requires 60,000 signatures before considering a referendum, but organizers have stated that they have collected more than 76,000 signatures and more are expected. The government would still need to approve the referendum.

The Portugeese Communist Party restated their opposition to euthanasia. Here is their position:
1. The debate over the legalization of the possibility of provoking an early death is not the discussion about hypothetical options or individual considerations of each person facing the circumstances of their own death. Rather, it’s a discussion of political options of reinforced complexity and with deep social, behavioral and ethical implications.

The legalization of euthanasia cannot be presented as a matter of choice or individual consideration. To inscribe in the Law the right to kill or to kill oneself is not a sign of progress but a step towards civilizational regression, with deep social, behavioral and ethical implications that question central elements of a society that is guided by humanistic and solidarity values.

The PCP rejects the idea that dignity of life is guaranteed by the legal consecration of the right to an early death.

The PCP's opposition to euthanasia has its foundation in the preservation of life, in calling for technical and scientific advances (including in medicine) to ensure the increase in life expectancy and not to shorten it, in the dignification of life while alive. It is this consideration of the intrinsic value of life that must prevail and not that of valuing human life in terms of its usefulness, economic interests or questionable standards of social dignity.

2. The invocation of extreme cases, to justify the legalization of the Right to an Early Death, presenting it as an act of dignity, is not the way of dealing with the necessary reflection. In some cases, it can express judgments motivated by its own experience, individual conceptions that must be respected, but it is also, for some of its promoters, a search of protagonism and promotional political agendas.

Today, science already has resources that, if used and accessible, allow to reduce or eliminate physical and psychological suffering. In matters that have to do with the fate of his life, each citizen now has legal instruments (of which the “living will” is an example, respecting its limits) and sovereignty in his individual decision regarding medical abstinence (no one can be forced to undergo certain treatments against their will). Medical practice guarantees no artificial extension of life, respecting death as a natural process, refusing to delay it through therapeutic obstinacy. There is a substantial difference between artificially maintaining life or deliberately anticipating death, between decreasing or eliminating suffering from illness or precipitating the end of life.

3. In a context in which the value of human life is often relativized due to criteria of social utility, economic interests, family responsibilities and costs or public spending, the legalization of the provocation of an early death would add a new dimension of problems.

It would immediately contribute to the consolidation of the political and social options that lead to this devaluation of human life and would introduce a relevant social problem resulting from the pressure of referral for the early death of all those to whom society refuses to answer and support its situation of special frailty or need. Furthermore, the legalization of this possibility would further limit the conditions for the State to promote, in the field of mental health, the fight against suicide.

4. The principle of equality implies that the same social dignity is recognized for all, and it is not legitimate to interpret that a person “with permanent injury or incurable disease” or “in extreme suffering” is diminished by such a circumstance in the dignity of his life. And even more that this same dignity is invoked to enshrine in law the right to death, based on a law of the Republic.

Life is not worthy only when (and while) it can be lived in the full use of physical and mental capacities and faculties and society must ensure the conditions for a dignified life in all stages of the human journey, from the least autonomous (be it childhood or old age) to those with greater autonomy; in the presence of healthy conditions or illness; within the framework of the full integrity of physical, motor or intellectual faculties or of a more or less profound disability, be it congenital or supervening.

What is needed is that the advancement and civilizational progress and the increase in life expectancy resulting from scientific evolution are called upon to guarantee a life with dignified material conditions in all its phases.

5. The PCP affirms its opposition to legislation that institutionalizes the provocation of an early death in whatever form it takes - at the request in the form of assisted suicide or euthanasia -, as well as possible proposals for referenda on the matter.

The PCP will continue to fight for the implementation, in a political and legislative level, of measures that respond to the full needs of users of the National Health Service, namely in the reinforcement of serious investment in palliative care, including home care; guaranteeing the right of everyone to refuse to undergo certain treatments; ensuring that medical practice does not artificially prolong life; in the development, improvement and right of access for everyone to use the resources that science can make available, in order to guarantee to everyone, up to the limit of life, the dignity due to each human being.

6. This is the profoundly humanistic conception of life that the PCP defends and that its political project of social progress embodies. A conception that does not give up on life, that fights for decent living conditions for all and demands policies that guarantee them from the start by the material conditions necessary in life, at work and in society.

Faced with the problems of human suffering, illness, disability or incapacity, the solution is not to make society less responsible by promoting the early death of people in these circumstances, but rather to social progress in order to ensure conditions for a dignified life, mobilizing all social means and capacities, science and technology to overcome suffering and disease and ensure social inclusion and family support.

The preservation of human life, and not the abandonment of life, is a heritage that integrates real humanism - and not proclaiming - that the PCP assumes in principles and in the struggle.

Categories: Discussion

Massachusetts assisted suicide bill permits euthanasia.

Tue, 2020-03-10 14:29
This is the article that the Boston Globe refused to print.

Massachusetts Legislature.As advocates for people at the most vulnerable time of their life, we are deeply troubled by two so-called “aid in dying” bills, now before the Massachusetts legislature [1]. 

Currently the two bills (S.1208 and H. 1926) would open the door not only to physician-assisted suicide (PAS), but also to euthanasia—sometimes called “mercy killing.” Unlike PAS, which involves a person self-administering a lethal, prescribed “drug cocktail”, euthanasia involves another person’s administering the lethal drugs.

Both bills state that “A terminally ill patient may voluntarily make an oral request for aid in dying and a prescription for medication that the patient can choose to self-administer…”. However, “self-administer” is defined as “a qualified patient’s act of ingesting” the lethal medication. This definition does not prevent another person from administering the lethal dose that the person then "ingests." Moreover, the bills require no medical oversight of the “act of ingesting”, which may be subject to family pressures; and which sometimes results in prolonged death (24 hours or more), nausea, vomiting, gasping, and awakening from unconsciousness.[2]

Neither PAS nor euthanasia is permitted under Massachusetts current statute Ch. 201D §12). [3] In January, the Suffolk Superior Court ruled that the Commonwealth's laws and constitution do not guarantee a right to physician-assisted suicide, and PAS was rejected in a 2012 state referendum. The legislature should now reject these two dangerous bills.

Ronald W. Pies, MD
Clinical Professor of Psychiatry,
Tufts University School of Medicine

Alex Schadenberg

Executive Director, Euthanasia Prevention Coalition

References:

1 https://www.deathwithdignity.org/wp-content/uploads/2015/10/2019-MA-S1208.pdf

2 https://www.mdmag.com/medical-news/twelve-myths-concerning-medical-aid-in-dying-or-physicianassisted-suicide

3 https://statelaws.findlaw.com/massachusetts-law/massachusetts-euthanasia-laws.html
Categories: Discussion

Press Release: A growing number of Canadian physicians are being bullied to participate in MAiD.

Tue, 2020-03-10 01:15
PRESS RELEASE Alert from a growing number of Canadian physicians “We are being bullied to participate in Medical Assistance in Dying” 
Montréal, March 9, 2020 - The Physicians’ Alliance against Euthanasia has received reports that unwilling physicians are being pressured and bullied to participate in Medical Assistance in Dying (MAiD): euphemism for euthanasia and assisted suicide. Fearing reprisals, physicians have asked that no information that could identify them be disclosed.

The pressure has been intense for many physicians, especially amongst palliative specialists, some leaving their profession even before this latest development. Descriptions were made of toxic practice environments and fear of discipline by medical regulators.“The anxiety, fear, and sadness surrounding my work bled into my family life, and I ultimately felt that I could not manage practicing palliative care at this stage of my life.”
(Former palliative care physician, March 2020)In different locations across Canada over the last months there has been a change in certain hospital MAiD policies. The change seems intended to provoke crisis or confrontation: to force objecting physicians to facilitate MAiD, or to have to refuse — and face contrived allegations of “obstructing access.” Reports consistently focus on the MAiD providers refusing to accept full responsibility for the death of the patient and forcing other physicians to share responsibility for the death. If the physician asks to withdraw from care and allow the MAiD provider to take over as before, the MAiD provider resists assuming the natural pattern of care.

The reports we are hearing from distressed physicians describe deliberate disruption of arrangements that were previously working satisfactorily and that had permitted patients to have access to MAiD while still allowing for conscience objectors to not be involved in facilitating the patient’s death. This bullying and betrayal of collegial relationships can poison practice environments and compromise patient care. Such behavior should not be tolerated by health care administrators in Canada.

Canadian physicians having similar stories of bullying are encouraged to contact the Physicians’ Alliance by email: info@collectifmedecins.org.

Contact:
Charmine Francis
Coordinator
438-938-9410
info@collectifmedecins.org
Categories: Discussion

Oregon assisted suicide deaths increase again in 2019

Mon, 2020-03-09 20:05
Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition


The 2019 Oregon assisted suicide report indicates that the number of assisted suicide deaths is up in 2019 over  2018 Oregon assisted suicide report. As with prior years, the report implies that the deaths were voluntary (self-administered), but the information in the report does not address that subject.

According to the 2019 Oregon assisted suicide report.
  • There were 188 reported assisted suicide deaths up from 178 in 2018.
  • 18 of the deaths, the lethal drugs were prescribed in previous years.
  • 1 patient was referred for a psychological or psychiatric evaluation.
  • 1 physicians was referred to the Oregon Medical Board for failure to comply with the law.
  • The time of death ranged from 1 minute to 47 hours.
  • In 2019 one person died 1503 days (more than 4 years) after requesting assisted suicide.
  • 58 people received lethal prescriptions, but their "ingestion" status is unknown.
  • There were 290 lethal prescriptions written, up from 249 in 2018.
*Order the pamphlet - Shedding light on assisted suicide in America.There are more assisted suicide deaths.
According to the 2019 Oregon report, the ingestion status was unknown in 58 deaths. The 2018 report stated that 168 people died by assisted suicide and the ingestion status was unknown in 43 deaths. The 2019 report was amended to state that 178 people died by assisted suicide in 2018.
When the ingestion status is unknown, it is possible that the person died by assisted suicide. Some or all of these deaths may represent unreported assisted deaths.
Expansion of assisted suicide.
Oregon Governor Kate Brown, in July 2019, signing Bill SB 0579 into law. This bill, essentially, eliminates the 15 day assisted suicide waiting period. This expansion of assisted suicide allows a person who is approved for assisted suicide to die within days, and if depressed, the patient loses the opportunity to change their mind.
Assisted suicide drug experimentation.
An article published in the Spring Hill Insider looks at experiments being done on people to find an effective lethal drug cocktail for assisted suicide. 
The current drug cocktails have caused painful assisted suicide deaths that may take many hours to die.

The article states that assisted suicide researchers are promoting their third generation of lethal drug cocktails. The results of the first two lethal drug cocktails were:The (first) turned out to be too harsh, burning patients’ mouths and throats, causing some to scream in pain. The second drug mix, used 67 times, has led to deaths that stretched out hours in some patients — and up to 31 hours in one case.These are unethical human experiments.
Oregon Health authority has an expanded definition of terminal.
In December 2017, Fabian Stahle, a Swedish researcher who is concerned about assisted suicide, communicated by email with a representative of the Oregon Health Authority.Stahle confirmed that the definition of terminal illness, used by the Oregon Health Authority includes people who may become terminally ill if they refuse effective medical treatment.The responses to Stahle from the Oregon Health Authority also confirmed that there is no effective oversight of the Oregon assisted suicide law. The yearly Oregon DWD reports are based on data from the physicians who prescribe and carry-out the assisted suicide death and the data is not independently verified. Therefore, we don't know if the information from these reports is accurate or if abuse of the law occurs.
Categories: Discussion

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