Update 071, Volume 28, Number 4 (2014-4)

Update 2014 – 4
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Dutch euthanasia expert: “We were wrong—terribly wrong, in fact”

A Dutch expert on euthanasia has not only stopped supporting the death practice and the euthanasia law for which he campaigned, but he has made the reasons for his about-face public—something usually frowned upon in Dutch circles.

Professor Theo Boer held a unique position for seeing how the country’s euthanasia/assisted-suicide law, enacted in 2002, actually worked. For nine years, Boer, a medical ethicist, was a member of one of five Dutch regional review committees charged with investigating all reported euthanasia and assisted-suicide deaths for the government to see if each case complied with the law.

In an article Boer submitted to London’s Daily Mail—in the hope of persuading Britain’s House of Lords not to pass an assisted-suicide law (see p. 6)—Boer said he and his colleagues were “terribly wrong” when they concluded five years after the Dutch euthanasia law took effect that there was no “slippery slope” associated with that law. Starting in 2008, the numbers of induced deaths began increasing 15% each year. By 2012, the euthanasia review committees recorded 4,188 deaths (compared to 1,882 in 2002), and Boer expects the reported annual death count to reach 6,000 this year or next year at the latest.

“Euthanasia is on the way to become a ‘default’ mode of dying for cancer patients,” he wrote, and there’s been a sharp increase in the deaths of people with psychiatric illnesses or dementia, and those simply suffering from grief, loneliness, or age. “Some of these patients could have lived for years or decades,” he explained.

There have been other undeniable signs of a serious ethical slide due to the law. One example he cites is the “End of Life Clinic,” established by the Dutch Right to Die Society (NVVE) that sends out teams of euthanasia doctors to end the lives of those who have been denied an induced death by their own doctors. These mobile doctors, Boer wrote, do not have an established relationship with patients, having only seen them three times before terminating those patients’ lives. NVVE is also relentlessly campaigning for a “lethal pill” for anyone over 70 years of age.

According to Boer, the Dutch law “sees assisted suicide and euthanasiaas the exception,” but “public opinion is shifting towards considering them rights, with corresponding duties on doctors to act.” A new law being drafted would place added pressure on doctors who refuse a death request to refer the patient to a “willing doctor.” “Not even the Review Committees, despite hard and conscientious work, have been able to halt these developments,” Boer wrote.

Finally, Boer implored Britain’s Parliament not to pass the assisted-suicide bill currently being considered before looking closely at the Dutch experience, suggesting that “the mere existence of such a law is an invitation to see assisted suicide and euthanasia as a normality instead of a last resort.” “Once the genie is out of the bottle,” he wrote, “it is not likely to ever go back in again.”  [Boer, “Don’t make our mistake,” Daily Mail, 7/9/14]


Quebec legalizes euthanasia; one lawsuit filed—so far

Quebec, Canada’s largest and arguably most politically liberal province, has become the only jurisdiction in North America to ever legalize euthanasia.

Earlier this year, Bill 52, An Act Respecting End-of-Life Care, technically died when the Quebec National Assembly failed to vote on it in February before the Assembly recessed and a new election was scheduled. But after the National Assembly reconvened with a new government installed, the bill was resurrected and passed easily on June 5 by a vote of 94 to 22.  It is due to take effect 18 months after passage.

The new law permits both direct euthanasia and doctor-assisted suicide without ever using those terms. Instead, the terms are replaced by the euphemism “medical aid-in-dying” in an attempt by drafters to redefine those death-inducing actions as medical treatment, thereby circumventing Canada’s Criminal Code that clearly makes both euthanasia and assisted suicide punishable crimes. It was a clever ploy because, in Canada, the federal government has jurisdiction over criminal matters, but the provinces have jurisdiction over health care.

While it is likely that the federal government will challenge Quebec’s law in court, no action has been taken as of this writing. A Justice Ministry spokeswoman did state, “It is our government’s position that the Criminal Code provisions prohibiting assisted suicide and euthanasia are constitutionally valid, and in place to protect all persons.…” [Globe & Mail, 6/5/14]

Meanwhile, a recent court challenge has been filed in Quebec Superior Court arguing that the law violates the Criminal Code and both Quebec’s and Canada’s Charter of Rights & Freedoms. [Digital Journal, 7/17/14]

Compassion & Choices wants to be the only
assisted-suicide drug dealer in the US

 Compassion & Choices (C&C), the national assisted-suicide activist group, has proposed that it join the lethal drug trade as the only US distributor of pentobarbital, the assisted-suicide drug of choice. In May, Drs. Nancy Crumpacker and Peter Reagan, C&C’s former and present medical directors, met with the Oregon Board of Pharmacy (OBP) to discuss a serious problem facing assisted-suicide patients in Oregon and Washington (as well as Vermont): Pentobarbital, brand name Nembutal, is no longer available in the US.

The drug is a casualty of death penalty opposition, with the European Union banning the export of drugs used in US executions. US compounding pharmacies—which get raw materials from manufacturers to make drugs that are not available—have also been forced to stop supplying the drug due to the death penalty controversy.

According to Gary Miner, the OBP’s compliance director, Drs. Crumpacker and Reagan proposed C&C’s solution to the problem: if an Oregon compounding pharmacy were allowed to get the raw materials and make pentobarbital, C&C would distribute the drug. Miner said he did not see any legal reason why C&C’s plan would not work.

Secobarbital is the second-best assisted-suicide drug, but it also is becoming scarce and is five times more expensive than pentobarbital—a high price often prohibitive for patients. C&C of Washington is helping that state’s assisted-suicide patients pay for the drug.

C&C has been extremely quiet about the lethal drug problem because of concerns over the bad publicity hampering its efforts to legalize doctor-prescribed suicide in states across the country. [Willamette Week, 5/21/14; Real Change News 6/18/14; KIRO TV, 6/27/14]

Massachusetts General issues DNR orders
without patient or surrogate consent

According to a study presented at the May 2014 American Thoracic Society International Conference in San Diego, Massachusetts General Hospital’s ethics committee has had a policy allowing unilateral do-not-resuscitate (DNR) orders since 2006. These orders, as defined by the study’s authors, are “a specific type of medical futility decision in which clinicians withhold advanced cardiopulmonary resuscitation (CPR) in the event of cardiopulmonary arrest despite objections of patients or their surrogates.” (Emphasis added.)

Researchers studied all the ethics committee’s consults involving DNR conflicts between doctors and their patients or the patients’ surrogate decision makers since 2006. There were 147 cases where there was conflict over intensity of treatment and DNR status. The ethics committee recommended a unilateral DNR order 35% of the time. That recommendation was implemented in 83% of those cases.

The study found that a patient’s age, gender, and functional status prior to being hospitalized were “not associated” with a unilateral DNR recommendation, but non-white patients and “patients judged to have end stage conditions” were more likely to have a unilateral DNR recommended by the committee. Researchers also found that patients who actually were issued unilateral DNRs were more likely to die in the hospital. [Medical Futility Blogspot, 5/11/14]

PRC consultant Wesley J. Smith called the Massachusetts General policy “a medical tyranny.”

New Jersey bill pulled before Assembly floor vote

A New Jersey bill to legalize doctor-prescribed suicide—that appeared to be on the fast-tract for passage in the State Assembly—was suddenly pulled from the docket just prior to a scheduled full-Assembly vote on June 26.

Assemblyman John Burzichelli pulled his bill, called the “Aid in Dying for the Terminally Ill Act,” because it lacked the votes needed to pass it. “It continues to be a work in progress,” he said, adding that he hopes to bring it before the full Assembly after the legislature’s summer recess ends in September, giving him more time to assuage legislators’ “genuine” concerns regarding the bill. [Star-Ledger, 6/26/14]

But that will likely be more difficult than Burzichelli is letting on. Marilyn Golden of the Disability Rights Education & Defense Fund said, “The bill was shown to be extremely controversial. It has bipartisan opposition and is widely opposed by a diversity of groups, including the disability community.”

Drawing from his experience working with opposition coalitions in New Hampshire, Massachusetts, and Connecticut to defeat similar measures, John Kelly, regional coordinator for the national disability rights group Not Dead Yet, said that changing legislators’ minds will be difficult for Burzichelli. “The more legislators learn about the details, the more they turn against an assisted-suicide bill,” he said. One of the biggest concerns people have, according to Not Dead Yet President Diane Coleman, “is that no law can prevent assisted suicide coercion behind closed doors.” [PRWeb, 6/27/14]

The bill’s supporters, however, were hopeful that they would succeed in the full Assembly after the bill was passed by the Assembly Health & Senior Services Committee along party lines on June 5. But even supporters recognize that successfully getting the measure passed into law is currently highly unlikely. No action has been taken on the Senate version of the bill, which is languishing in the Senate Health Committee, and Gov. Chris Christie has stated on a number of occasions that he strongly opposes the measure.

Washington #1 in assisted-suicide percentage rise

A hallmark of legalized euthanasia and assisted suicide is the ever increasing number of reported cases annually. While it was disturbing that Washington State—after only four years of legalized doctor-prescribed suicide practice—surpassed Oregon’s mounting assisted-suicide body count in 2012, the latest Washington report on 2013 assisted-suicide cases shows a 37% increase in reported assisted deaths over the previous year. It is the largest percentage increase of any jurisdiction worldwide that has legalized euthanasia and/or assisted suicide and makes statistical reports on those deaths available to the public—including the Netherlands and Belgium.

According to the latest figures issued by the Washington State Department of Health (WSDH), there were 159 doctor-assisted suicide cases in 2013 as opposed to 116 such cases in 2012. The vast majority (96%) of the 159 who died lived in the western part of the state (west of the Cascade Mountains). The ages of all the assisted-suicide patients ranged from 29 to 95 years. Cancer was the most frequently cited illness (77%). Ninety-seven percent (97%) of those who died were white, non-Hispanic; 52% were married; and 76% had at least some college education.  For most (86%), their only insurance was Medicare or Medicaid.

As in Oregon, only a small fraction of Washington patients who requested assisted suicide were referred for a psychiatric or psychological evaluation—just 6 (4%) in 2013 and 3 (3%) in 2012. Also, concern or fear over pain was not the reason most patients wanted to die. Fears over loss of autonomy, inability to enjoy activities, loss of dignity, and being a burden topped the list.

In the 2013 report, the WSDH indicated that 173 prescriptions for lethal drugs were issued by 89 different doctors. The state received confirmation that, of the 159 known to have died, 119 took the lethal drugs and 29 did not, but died of other causes. In the remaining 14 cases, the state has no clue whether or not the patient actually ingested the drugs. The “dead or alive” status for an additional 14 patients is also unknown. In only two of the reported 159 deaths was the doctor who prescribed the lethal drugs actually present when the patient took those drugs. [Washington State Department of Health, 2013 Death with Dignity Act Report, 6/4/14]

No conscience against prescribed suicide allowed
by Wesley J. Smith

I am sensing some exhaustion among those who resist the culture of death, almost as if some people are saying, “Do what you want. Just leave me alone.”

But they won’t leave you alone—at least not if you are in the medical professions. To the contrary, an advocacy drive has begun to require all doctors, nurses, pharmacists, and others in the medical sector to participate in the active killing of patients.

Take Washington, where the state chapter of the ACLU is trolling for clients to sue health care providers who have refused for reasons of religious conscience to participate in life-taking actions. Thus, the group’s website asks to “hear the stories” of people “denied… end-of-life services by a religiously based medical facility,” because, “the ACLU believes that everyone in Washington has the right to receive health care that is not restricted by the religious beliefs of others.”

Apparently to the ACLU, “the right to receive health care” means forcing medical professionals to participate in assisted suicide, which is legal in Washington. According to the group’s website, the services that medical providers and facilities should never restrict or deny to patients include:

  • Information about Washington’s Death with Dignity Act;
  • Referral to support organizations or cooperating providers to assist a patient in using Washington’s Death with Dignity Act;
  • Allow medical providers to participate in Washington’s Death with Dignity Act…
  • Palliative care/nursing support for patients who choose to stop eating and drinking to allow natural death [e.g., participation in suicide by starvation, not a natural death].

What was that about “stop eating and drinking”? It’s the newest form of suicide promoted by the euthanasia/assisted-suicide movement known as “voluntarily stopping eating and drinking” (VSED), by which people starve themselves to death with the help of medical professionals to palliate the awful symptoms.

Some health care facilities refuse to cooperate or permit such suicides to take place on their premises, so apparently the ACLU wants to force them to allow it. Illustrating how adamant death-purveyors are, there is growing advocacy to force nursing homes to starve people with Alzheimer’s to death if they so requested it in an advance directive—even if they willingly accept spoon feeding and water! In fact, the first lawsuit seeking to force a nursing home to starve an Alzheimer’s patient has already been filed in Canada.

Meanwhile, all doctors are forced to cooperate with euthanasia under the law just enacted in Quebec legalizing lethal injections, called euphemistically in the statute, “medical aid-in-dying.”  Under the law, if a qualified patient asks a Quebec doctor for euthanasia and that doctor has a conscience objection to killing, he or she must refer the case to a supervisor or another doctor who has no compunction about euthanasia. In other words, every doctor in Quebec must be complicit in doctor-administered death as the price paid for practicing medicine.

Advocates often try to frame the issue of medicalized killing as “choice.” But increasingly they assert that medical professionals should not have a choice about whether to participate in such killing. Indeed, activists ultimately want to force those with religious or conscience objections to violate the Hippocratic Oath’s proscription on euthanasia and assisted suicide or get out of medicine: No conscience allowed!

Wesley J. Smith, J.D. is a consultant for the Patients Rights Council as well as the Center for Bioethics and Culture, and a senior fellow at the Discovery Institute’s Center on Human Exceptionalism.

“Aid-in-dying”:  States should beware
By Rita L. Marker

Since 1992, California has defeated seven attempts to let doctors prescribe or administer deadly drugs.  Now, once again, it appears that the state will be targeted by those seeking to dismantle the legal barriers that prevent physicians from having such power.

Those seeking to transform the crime of assisted suicide into a medical treatment use soothing labels such as “aid-in-dying” or “death with dignity” for the lethal practice and claim it would be carried out under careful safeguards.

Sounds good—at first. But there’s more to the story. There are locations in this and other countries that can provide us with vital information on what happens when the barriers are taken down—places where doctors are now permitted to prescribe and/or administer an intentionally lethal dose of drugs.

In the Netherlands and Belgium where tolerance reigns supreme, the public is beginning to have second thoughts. Holland’s recent establishment of mobile euthanasia clinics and calls by its proponents to expand eligibility for euthanasia and assisted suicide to anyone over 70 years-old, regardless of physical or mental condition, has shown that things are spinning out of control.

In Belgium, lawmakers extended the law so that physicians can administer lethal injections to children upon request and with parental agreement.  According to that law, death-inducing actions taken by physicians can be subject to post-mortem investigation by a special committee to ensure compliance with the law.

Yet, this seeming supervision would be comical if it were not so tragic. You see, the chair of that review committee is a physician who has administered lethal injections to at least five people under conditions that shocked and outraged even the law’s supporters. Those recent cases involved two hearing-impaired, middle-aged men who were losing their sight; a person depressed over a botched sex change procedure; and two physically healthy women who were clinically depressed, one of whom had never been treated for her depression.

A perfect example of the fox watching the hen house!

It would be easy to dismiss this as something happening only in Europe.  We could erroneously assume that there’s careful oversight of assisted suicide in this country. But we’d be wrong.

Oregon doctors have had the right to prescribe suicide for sixteen years, and its advocates claim that the state’s official annual reports prove the law is working well.

But there’s more to that story as well.

While Oregon’s official reports indicate that the assisted-suicide law is virtually problem free, the information upon which those reports are based is submitted by the very      physicians who have written the prescriptions for lethal drugs that caused the patients’ deaths. And what they submit may or may not be true.

Those responsible for issuing Oregon’s official annual reports have acknowledged from the very beginning that the reports may not be accurate or complete. Referring to        information submitted by the prescribing doctors, the Oregon Health Division’s first official summary stated, “The entire account [given by reporting doctors] may be a cock and bull story. We assume, however, that physicians were their usual careful and accurate selves.” [“A Year of Dignified Death,” CD Summary, 3/16/99]  Furthermore, Oregon’s assisted-suicide law gives the state absolutely no authority or funding to investigate assisted-suicide deaths.

As a result, reliance on claims that the Oregon law is working well and is free of abuse is fraught with peril.

There’s one aspect of doctor-prescribed suicide that we should all be able to agree upon: Once legalized, it’s the cheapest form of “medical treatment” available.

At a time of spiraling healthcare costs and increased control of our health care decisions by insurance companies and the government, we have to wonder how long it is before life-prolonging treatments that patients want and need aren’t covered by insurance—but doctor-prescribed  suicide is. That has already happened in Oregon to cancer patients like   Barbara Wagner and Randy Stroup. They were informed by the Oregon Medicaid program that the treatment that had been prescribed by their respective doctors would not be covered, but prescribed fatal drugs and services would.

Even those who support the concept of assisted suicide are reluctant to embrace it when they ask themselves one very important question:  If doctor-prescribed suicide is considered a medical treatment, do we trust profit-driven insurance companies and government bureaucrats to do the right thing—or the cheap thing?

California has wisely chosen to maintain the barriers preventing doctors from obtaining power to prescribe assisted suicide.

Wouldn’t it be wise to heed the words of G. K. Chesterton, “Don’t ever take a fence down until you know the reason it was put up”?

Rita L. Marker , J.D., is executive director of the Patients Rights Council.  She is a member of the California Bar Association, the District of Columbia Bar Association, and is admitted to practice before the U.S. Supreme Court.

UK: Two landmark court rulings address euthanasia and DNR orders

…Aiding those seriously disabled to end their lives

The British Supreme Court has dismissed an appeal, brought by Paul Lamb and the widow of Tony Nicklinson, claiming that the law against euthanasia and assisted suicide violates the right of the disabled to respect for private and family life under Article 8 of the European Convention of Human Rights (ECHR). Lamb is paralyzed as a result of a car accident and Nicklinson had “locked-in syndrome”—neither physically able to end their lives without direct assistance. The Court held that, while it had the constitutional authority to rule on whether the law violates Article 8, Parliament is better situated to make such an assessment. [Supreme Court, Nicklinson v. Ministry of Justice, 6/25/14]

DNR orders and patient rights

The Court of Appeals in London has ruled that doctors have a legal duty to first consult with and then inform patients or theirfamilies if a do-not-resuscitate (DNR) order will be placed in a patient’s medical records. Not to do so would violate a patient’s rights to physical integrity and autonomy protected by Article 8 of the ECHR. Justice Lord Dyson, who authored the ruling, wrote, “…since a [DNR] decision is one which will potentially deprive the patient of life-saving treatment, there should be a presumption in favour of patient involvement. There needs to be convincing reasons not to involve the patient.” [Court of Appeals, Tracey v. Cambridge Unit Hospital NHS Foundation Trust, 6/17/14]

The case, which had been rejected by a lower court, was brought by the family of Janet Tracey, 69, who had been diagnosed with lung cancer and subsequently suffered a broken neck in a car accident. Tracey’s daughter found the DNR order in her mother’s hospital records, placed there without her mother’s or the family’s knowledge and against her mother’s wishes.

British House of Lords debates Oregon-like, assisted-suicide bill

The long-awaited debate on an Oregon-style, assisted-suicide bill, originally introduced in 2013, was held in the British House of Lords on July 18. After a marathon 9 hours and 43 minutes, with 133 speakers stating their positions, the Lords proved to be evenly divided on the bill. They opted to allow the measure to proceed to the committee stage where it will be further scrutinized and where amendments—including “wrecking” ones aimed at killing the bill—can be proposed.

The bill, titled the “Assisted Dying Bill,” was introduced by veteran euthanasia proponent Lord Charles Falconer. The right-to-die group Dignity in Dying waged a huge media campaign featuring celebrities and emotional stories of hard cases in the months and weeks prior to the debate.

But, despite all the publicity, the bill has little chance of clearing its remaining hurdles. Even if it were to eventually pass in the House of Lords, the lower house of Parliament, the House of Commons, would have no time to consider the measure before a scheduled General Election in May 2015, effectively killing the bill. [BMJ, 7/21/14; Press Association, 7/19/14]

News briefs for home & abroad

LouisianaLouisiana has enacted a law meant to prevent what has occurred in Oregon, where the state’s health insurance program rations medical care by denying payment for certain drugs, chemotherapy, and other needed treatments that doctors have prescribed for their terminally ill patients. The cases of cancer patients Barbara Wagner and Randy Stroup are examples of what happens under Oregon’s rationing policy. The Oregon Medicaid program denied both patients coverage for prescribed cancer treatments but offered to pay for the drugs and services needed for their assisted-suicide deaths. “We think it particularly cruel,” said Pete Martinez, director of state governmental affairs for the Pharmaceutical Research & Manufacturers Association. “The Oregon policy should not take root in Louisiana,” he added. Under the Louisiana law, medical insurers—including HMOs, governmental and private insurers—cannot deny prescribed medical care to patients because of their life expectancy or terminal condition. [Act No. 541, enacted 6/5/14; The Advocate, 4/3/14]

VermontMay 20, 2014 marked the first year anniversary of the enactment of Vermont’s permissive doctor-prescribed suicide law, referred to as the “Patient Choice and Control at the End of Life Act” or Act 39. During that year, no patient who qualified for an assisted suicide ingested lethal drugs. According to the state health department, only two patients requested and received prescriptions for those drugs, and neither one took them. They both died of natural causes. [Burlington Free Press, 5/19/14]  Perhaps in response to the lack of patients opting for prescribed-suicide, Compassion & Choices, formerly the Hemlock Society, has hired a new Vermont director to travel around the state promoting the law, encouraging patient participation, and generally getting people to feel comfortable with assisted suicide. [Vermont Alliance for Ethical Healthcare, Press Release, 5/19/14]

Australia:  The Medical Board of Australia (MBA) has finally taken formal action against euthanasia promoter Dr. Philip Nitschke, otherwise known as “Dr. Death.” At a late-night emergency session on July 23, the MBA suspended Nitschke’s license to practice medicine “in order to keep the public safe, while other investigations or processes continue.” [MBA, Media Statement, 7/24/14]

The MBA began its investigation of Nitschke after the Australian Broadcast Company (ABC) reported on the death of Nigel Brayley, 45, a physically healthy man who committed suicide after communicating—both by e-mail and in person—with Nitschke and his organization, Exit International. Brayley, from Perth, was deeply depressed over the recent loss of his job and the fact that he was being investigated by police for the murder of his wife in 2011. He had joined Nitschke’s organization and had illegally obtained the drug Nitschke recommends for a “peaceful death.” Knowing that Brayley was depressed and intended to end his life, Nitschke did nothing to discourage him or refer him for professional help. “If a 45-year-old comes to a rational decision to end his life, researches it in the way he does, meticulously, and decides that… now is the time I wish to end my life, they should be supported,” Nitschke told ABC. “And we did support him in that.” [ABC News, 7/5/14]

But it was news of two other suicides of healthy, young males, ages 25 and 26,that likely sealed Nitschke’s fate with the MBA. Both had been in contact with Exit International. The mother of the 26 year-old called what Exit did to her son “death coaching.” Commenting on Nitschke’s license suspension, Dr. Andrew Miller, of the Western Australia chapter of the Australian Medical Association, said, “Our profession is relieved to be rid of him and wish to assure the community we will always help those with treatable illnesses to recover and live.” [The Australian, 7/25/14]

Lithuania:  The new Lithuanian Health Minister, Rimantė Šalaŝevičiūtė, just began her new job in early July but is already causing controversy in the country. She has backed open discussion of euthanasia legalization and told reporters that, since Lithuania is not a welfare state with palliative care available to all citizens, euthanasia could be an option for those who do not want to torment their family members with having to watch them suffer. She also said that euthanasia for children, which was recently approved in Belgium, might be something Lithuania should consider after it’s publically debated. But the new minister is likely to run into strong opposition to her euthanasia proposals from many Lithuanian doctors. [Delfi, 7/24/14;  Bioedge, 7/26/14]

StudyIn a letter published in the medical journal The Lancet, five academics from universities in Switzerland and the UK opined that legalized assisted suicide, if it is regulated, is a safeguard against rising euthanasia rates. They came to this novel—if not questionable—conclusion after reviewing statistics from countries that have legalized assisted suicide and/or euthanasia. “[T]o legalize only assisted suicide (with clear procedural rules) but not euthanasia seems to limit the number of hastened deaths and their increase over time,” they wrote. Why? Because patients overwhelmingly prefer having a doctor kill them over killing themselves. Without the euthanasia option, there are fewer “hastened deaths”—except in unregulated Switzerland. [The Lancet, 7/12/14]