Dutch Parliament votes to legalize euthanasia
While euthanasia and assisted suicide have been openly tolerated in the Netherlands since 1973, both practices are technically criminal acts under Dutch Penal Code Articles 293 and 294—even if the doctors ended patients’ lives according to government-approved guidelines. On 11/28/00, however, the Dutch Parliament’s Lower House, by a vote of 104-40, passed a bill to officially make both practices legal under certain conditions. The bill still must be approved by Parliament’s Upper House, but passage in the Senate is considered a mere formality. The new law is expected to take effect early next year, making the Netherlands the only country in the world to formally legalize premeditated, doctor-induced death.
According to IAETF Executive Director Rita Marker, passing such a law sends a dangerous message “telling people that if it’s legal, it’s right.” “It will be like giving the Good Housekeeping Seal of Approval,” she told the media. “What is currently a crime will be transformed into medical treatment.” [AP, 11/28/00; BBC News, 11/28/00; CNN.com, 11/28/00]
The euthanasia measure, referred to by the Dutch government as “Review of Cases of Termination of Life on Request and Assistance with Suicide,” was sponsored by both the Minister of Justice, Benk Korthals, and the Minister of Health, Dr. Els Borst. The plan to formally legalize both euthanasia and assisted suicide was part of a coalition agreement forged by Labor and Liberal parties prior to the formation of the present government.
What the new law entails
The measure would add a provision to the existing Dutch Criminal Code so that euthanasia and assisted suicide “would not be treated as a criminal offence if carried out by a physician and certain criteria of due care have been fulfilled.” [Dutch Ministry of Justice Press Release, 11/28/00. Hereafter cited as MOJ Press Release.]
Also, the new law will simply codify the existing way euthanasia and assisted suicide are supposed to be practiced. Essentially, the seemingly “strict” guidelines that the Dutch government adopted in 1993 have been reformulated and retitled “the criteria of due care.” The criteria stipulate that any doctor performing euthanasia or participating in a suicide must:
- “be convinced that the patient’s request was voluntary and well-considered”;
- “be convinced that the patient was facing unremitting and unbearable suffering”;
- “have advised the patient concerning the latter’s situation and prospects”;
- “have reached the firm conclusion together with the patient that there was no reasonable alternative solution to the patient’s situation”;
- “have consulted at least one other independent physician, who has examined the patient and has formed a judgment concerning the requirements of due care as set out above”;
- “have carried out the termination of life in a medically appropriate manner.” [MOJ Press Release]
Patients who qualify for an induced death need not be terminally ill.
By slightly altering the euthanasia reporting process, the government hopes to further remove the criminal stigma from both induced-death practices. Currently, if a doctor has terminated a patient’s life, the doctor is required to notify the local coroner and report the circumstances of the death to one of five regional review committees. The committee, comprised of at least one lawyer, doctor, and ethicist, must then submit a report to the Public Prosecution Service for final review, even if the doctor followed all the established guidelines.
Under the new law, the regional review committee is obligated to report a euthanasia or assisted suicide death to the Public Prosecution Service only if the committee thinks that the doctor did not comply with the criteria of due care. If the committee feels that the doctor acted appropriately, then the “case is closed,” and no report to the Prosecution Service is required. [MOJ Press Release; CNN.com, 11/28/00]
Reporting: Problematic
Under both the existing and new law reporting requirements, doctors are not obligated to report patient killings until after the patient is dead.
Moreover, by eliminating the prosecutorial review of all cases, the government hopes to lessen doctors’ fears of possible prosecutions and encourage more doctors to actually report induced deaths. Reporting noncompliance is a major problem for the government. A Dutch study, published in 1996, found that the majority of Dutch doctors (59%) do not report voluntary euthanasia and assisted-suicide deaths, and cases of involuntary euthanasia (without patients’ knowledge or consent) are rarely if ever reported. [van der Wal et al., “Evaluation of the Notification Procedure for Physician-Assisted Death in the Netherlands,” New England Journal of Medicine (NEJM), 11/28/96:1706-1707]
It is not surprising that Dutch physicians do not report involuntary euthanasia cases. Such deaths are a blatant violation of the very first euthanasia guideline and should be prosecuted as a criminal act under both the existing and new law guideline scheme. Given the fact that Dutch physicians have rarely been prosecuted for guideline violations and that no doctor has ever been imprisoned or substantially penalized for noncompliance, it would seem that physicians’ fears of legal ramifications are misplaced.
Still, the termination of life without consent is common. Data from the 1991 government-sponsored Remmelink Report clearly indicated that the majority of all euthanasia deaths in the Netherlands are involuntary. [Medical Decisions About the End of Life, vol. 1, The Hague, 9/19/91:72]
In a more recent Dutch study, researchers found that 55% of the Dutch doctors interviewed in 1995 indicated that “they had ended a patient’s life without his or her explicit request” or “they had never done so but that they could conceive of a situation in which they would.” [van der Maas et al., “Euthanasia, Physician-Assisted Suicide, and Other Medical Practices Involving the End of Life in the Netherlands, 1990-1995,” NEJM, 11/28/96:1701]
Yet, according to Health Minister Els Borst, who drafted the new law, “Doctors should not be treated as criminals.” “[The law] will create security for doctors and patients alike,” he explained. “Something as serious as ending one’s life deserves openness.” [AP, 11/29/00]
Just how “open” euthanasia and assisted suicide practice will be is questionable. Like Oregon’s assisted suicide law, the new Dutch measure mandates that annual reports be published. In Oregon, those reports are issued by the state Health Division, and the data has been sketchy and incomplete due in large part to physician non-reporting and inflated privacy concerns.
According to the new Dutch law, the regional review committees are supposed to “publish annual reports which provide as much information as possible—whilst preserving anonymity—concerning the way in which they have tested actual cases against the criteria of due care.” [MOJ Press Release] But, like in Oregon, if Dutch doctors do not report the deaths, including the involuntary euthanasia cases, and if privacy concerns outweigh justice for vulnerable patients, the committee reports will be skewed and not a true picture of Dutch medicalized killing.
Euthanasia for minors
Generally, it has been the contention of the government and medical establishment that minors should also have the right to request euthanasia. Children with terminal illnesses, proponents argue, are often more mature than many adults, and they deserve the right to have their suffering ended.
When the new euthanasia law was originally proposed, it contained a provision allowing minors 12 and over to request and obtain an assisted death, even if their parents objected. Because of intense criticism both nationally and internationally, that provision was amended. As passed by the Lower House, the measure now stipulates that children age 12 through 15 can still be euthanized or assisted in suicide, but the consent of at least one parent or guardian is required. Minors 16 or 17 years-old can decide to have their lives ended without parental consent. [MOJ Press Release; Time Europe, 11/28/00]
Euthanasia advance directives
One of the most dangerous provisions of the new law is the sanctioning of advance directives authorizing euthanasia and assisted suicide. The law expressly validates written declarations—signed by patients long before the onset of incompetence—regarding their “termination of life” wishes. These declarations would give doctors the right to decide whether patients’ lives should be terminated if they become unable to make decisions for themselves. [MOJ. Press Release; AP, 11/28/00]
Reaction
Not surprisingly, reactions to the Lower House’s passage of the euthanasia bill has been strong and varied. German Justice Minister Chert Dauber-Melvin is highly critical of the bill’s passage. “Germany will never legalize euthanasia,” the minister said. “I see this law as breaching a taboo.” Germany is especially sensitive to the euthanasia mentality, given Hitler’s systematic extermination of children and adults considered physically or mentally disabled. “Everyone has the right to die naturally,” explained the minister, who is a patron of Germany’s hospice programs. “It is not a doctor’s job to judge whose life is worth saving and whose is not.” [Reuters, 11/30/00]
The Council of Europe also expressed vehement opposition to the measure, stating that it violates Article 2 of the European Convention on Human Rights which mandates that no individual should be intentionally deprived of life unless that person has been convicted of a crime serious enough to impose the death penalty. Council spokesman Edeltraud Gatterer called on the Dutch Senate to defeat the bill when it comes up for the final vote. [Australian Broadcasting Corp., 11/30/00]
Euthanasia proponents are using the bill’s passage to promote legalization internationally. In Canada, long-time euthanasia supporter MP Svend Robinson announced he would introduce a new bill early next year requiring that the House of Commons study Dutch euthanasia practice and make recommendations for changes in Canadian law. [Globe and Mail, 11/29/00] In South Australia, MP Sandra Kanck indicated that she too would introduce a euthanasia bill in that state’s parliament early next year. [South China Morning Post, 12/1/00] Immediately after the Dutch bill passed the Lower House, Australia’s Dr. Death, Philip Nitschke, told a New South Wales parliamentary forum that voluntary euthanasia should be included in a NSW bill of rights. [Sydney Morning Herald, 11/29/00] In England, Voluntary Euthanasia Society head Malcolm Hurwitt told reporters that the Dutch vote “removes many of the arguments against euthanasia here.” [U.K. Yahoo! News, 11/28/00]
Next: Those “suffering from life”
The passage of the euthanasia bill was actively promoted by the Dutch Voluntary Euthanasia Society (DVES). While pleased overall by the measure’s provisions, the DVES said it did not get everything it wanted, specifically the killing of people who are simply tired of living. “We think that if you are old, you have no family near, and you are really suffering from life then it [euthanasia] should be possible.” said DVES spokesperson Walburg de Jong. “We have to start this discussion, but we say, let’s get this first part passed because it will also help a lot of people.” [CNN.com, 11/24/00]
But the Dutch are already beyond the “discussion” stage. A month before the Lower House debated the new euthanasia law, a Dutch court ruled that Dr. Philip Sutorius was medically justified when he helped 86-year-old Edward Brongersma commit suicide. Brongersma was not physically ill or in pain. He had said that he was simply “tired of life” and his aging “hopeless existence.” While the government has warded off most public criticism by appealing this court ruling and claiming that the new euthanasia law would never allow doctors to kill patients like Brongersma, the government’s own prosecution sought only a token 3-month suspended sentence for the doctor. [British Med. Journal, 11/11/00:1174]
As observed in a Wall Street Journal Europe editorial, “there is a slippery slope here.” “If we someday find ourselves as callous toward human life as were the ancient Romans, it may be remembered that it all began in the name of compassion with a people who tended toward ‘progressive’ ideas, the Dutch.” [Editorial, WSJ Europe, 12/1/00]
Maine voters reject “Death with Dignity” Referendum
On November 7, 2000, Maine voters joined ranks with those in Washington State, California, and Michigan by defeating a ballot measure that would have legalized assisted suicide.
The measure, the Maine Death with Dignity Act (MDWDA), was placed on the ballot as Question 1: “Should a terminally ill adult who is of sound mind be allowed to ask for and receive a doctor’s help to die?” The voters responded: 51% no, 49% yes.
The Oregon Experience
The MDWDA’s defeat was essentially a rejection of Oregon’s way of dealing with end-of-life difficulties—sanctioned killing. Oregon is the only state which has legalized assisted suicide, despite similar attempts in approximately 15 other states—most often in state legislatures—since Oregon embraced the practice. Maine was one of those states. In fact, its legislature soundly rejected assisted-suicide bills four times, the last time being earlier thisyear before the MDWDA was placed on the ballot.
But in spite of those legislative defeats, national right-to-die advocates targeted Maine as a state likely to advance their cause. “The demographics of Maine are very much like those of Oregon,” explained Rita Marker, IAETF’s executive director, “It’s clear that the poor and minorities, for example, really oppose [assisted suicide]. You don’t have to deal with that population in Maine, just as you didn’t in Oregon,” she said. “Maine is also an inexpensive and small media market,” Marker added. “They felt they could control their message.” [Wall Street Journal, 11/10/00]
It was clear from the start that the message was “Follow Oregon.” The MDWDA was closely modeled after the Oregon law, which also bears the title “Death with Dignity Act.” At various stages throughout the campaign, numerous Oregonians either endorsed the measure in writing or actually went to Maine to support the legalization effort. Among those were Oregon’s chief epidemiologist Dr. Katrina Hedberg, co-author of Oregon’s two annual assisted-suicide reports, both favoring the practice; Ann Jackson, executive director of the Oregon Hospice Association; Eli Stutsman, Oregon lawyer and long-time right-to-die activist; Barbara Coombs Lee, chief author of the Oregon law and executive director of the assisted-suicide advocacy group Compassion in Dying Federation; and Barbara Roberts, former governor of Oregon.
“We’ve looked to Oregon a lot in this campaign to talk to people about what’s happened there,” said Kate Roberts, director of Mainers for Death with Dignity, later called “Yes on 1.” “The Oregon experience is the only real solid information about how this law might work.” [Statesman Journal (Salem, OR), 11/5/00]
Opposition coalition formed
While the pro-assisted suicide camp was relying heavily on its collaboration with Oregon’s key players to sell the MDWDA, an impressive, broad-based coalition was forming in opposition to the measure. Groups representing various aspects of the medical profession, patients’ rights, disability rights, ethical issues, and respect life concerns all banded together to form Maine Citizens Against the Dangers of Physician-Assisted Suicide, later referred to as “No on 1.”
Included among those groups were Maine Developmental Disabilities Council, Maine Medical Association, Maine Hospice Council, Maine Chapter of Not Dead Yet, Maine Hospital Association, Alpha-One, Maine Osteopathic Association, Maine Psychiatric Association, Maine Society of Anesthesiologists, Maine Medical Directors Association, Catholic Diocese of Portland, Organization of Maine Nursing Executives, and the Maine Chapter of the American Cancer Society.
Loss a matter of message, not money
After their campaigns in Washington, California, and Michigan, assisted-suicide advocates blamed their losses on the fact that each time their opponents had more money with which to work. In Maine, that was not the case. In fact, data released the week before the election by the Maine Commission on Governmental Ethics and Election Practices showed that Yes on 1 had raised a total of $1.6 million (the vast majority of which came from outside Maine), whereas No on 1 collected only about $957,474. [Bangor Daily News, 11/8/00. See also Update, 2000, No. 2.)
Money was not the reason the MDWDA lost. According to Maine pollster Patrick Murphy, president of Strategic Marketing Services, the No on 1 campaign had “superior advertising and hit home their message better than their opponents by creating doubts in people’s minds.” [Sun-Journal (Lewiston, ME), 11/14/00]
The No on 1 ads were so effective that the Yes on 1 camp enlisted the aid of Oregon’s present governor, John Kitzhaber, a former emergency room physician, to appear in a TV ad countering one of the No on 1 ads featuring Oregon physician Thomas Reardon. Reardon, immediate past president of the American Medical Association, stated in the ad that doctors in Oregon “can prescribe 60 to 100 pills” to assist a suicide, that disturbing complications can cause family members to panic and call 911, and that lethal prescriptions can be sent in the mail—all assertions the coalition could back up with documentation. The ad concluded with Reardon saying, “And I don’t want Maine to make the same mistake we made.” [Transcript, No on 1 Ad, “Same Mistake”] In the Kitzhaber ad, the governor declared that he wanted to “set the record straight” about the Oregon law. “Here’s the truth,” he said, “It’s working well.” [Register Guard, 10/28/00]
Barbara Coombs Lee was also recruited to defend the Oregon law and to counter the Reardon ad. She told reporters that the ad contained false information, like the reference to the 60 to 100 pills in a lethal prescription. She said that Reardon was wrong because the barbiturates used to kill patients do not come in pill form but rather in capsules that can be opened to place the contents in liquid. [Kennebec Journal, 10/25/00] Both Kitzhaber and Lee insisted that no assisted-suicide under the Oregon law had ever resulted in complications warranting a 911 call, despite the fact that just such a case was the subject of a 2-part article by columnist David Reinhard published in Oregon’s largest newspaper, The Oregonian. [Oregonian, 3/23/00 & 3/26/00. See also, Update, 2000, No. 1.)
Polls tell the story
The progressive decline in support for the MDWDA was a direct indication of just how effective the No on 1’s efforts were in educating Maine voters about the dangers and abuses inherent in assisted-suicide practice. In August 2000, polls showed that 71% of Mainers supported the MDWDA. [Portland Press Herald, 8/24/00] By the end of September, support dropped to 67%. [Bangor Daily News, 9/27/00] In mid-October, support tumbled to only 54%, with a further decline by the end of October to 52%. [Press Herald, 10/18/00 & 10/30/00] When voters actually cast their votes on November 7, support was down to 49%.
“The more we tell the truth about Question 1,” said No on 1 spokesperson Dr. Laurel Coleman, “the less people like the proposed law.” [No on 1 Press Release, 10/24/00]
“The gut reaction is to like the idea of ‘death with dignity,’” explained IAETF’s Rita Marker. “But as people begin to take a closer look within the context of health care today—managed care, the need to save money, how cost-effectiveness will play a part—opinion starts to change.” [Wall Street Journal, 11/10/00]
Research in Review
Oncologists’ support for physician-assisted suicide & euthanasia drops dramatically
Between 1994 and 1998, support among America’s cancer specialists for physician-assisted suicide declined more than 50% and support for euthanasia plummeted by almost 75%, according to a recent survey published in the Annals of Internal Medicine.
The study—conducted in 1998 by researchers from Maryland, Colorado, Massachusetts, New York, Texas, and Tennessee—surveyed 3,299 members of the American Society of Clinical Oncology (ASCO) regarding their attitudes and practices with respect to assisted suicide and euthanasia. It is the largest study ever conducted on the subject.
Researchers, led by Dr. Ezekiel Emanuel from the National Institutes of Health, found that only 22.5% supported “physician-assisted suicide for a terminally ill patient with prostate cancer who had unremitting pain despite optimal pain management,” while 6.5% favored euthanasia for such a patient. Moreover, fewer that 16% (15.6%) expressed a willingness to engage in assisted suicide, and only 2% said they would be willing to euthanize the patient.
When the findings were compared to a similar study conducted by Dr. Emanuel in 1994, researchers discovered that “support for euthanasia and physician-assisted suicide has decreased substantially.” Using the same “prototypical case of the terminally ill patients with unremitting pain,” they found that support for assisted suicide dropped by half, from 45.5% in 1994 to 22.5% in the current study. Euthanasia support fell by nearly 75%, from 22.7% in 1994 to only 6.5% in the new survey.
Equally significant are the findings that (1) doctors who had received better training in end-of-life care were less likely to engage in assisted suicide or euthanasia, and (2) physicians who were unable to obtain adequate care for their cancer patients were more likely to favor both practices. [E.J. Emanuel et al., “Attitudes and Practices of U.S. Oncologists regarding Euthanasia and Physician-Assisted Suicide,” Annals of Internal Medicine, 10/1/00:527-532]
“These study results underscore the need for physician education of optimal pain and palliative care practices,” explained researcher Dr. Robert J. Mayer from the Dana-Farber Cancer Institute “Physicians who are better informed about end-of-life issues feel less need to use euthanasia and physician-assisted suicide.” [ASCO Press Release, 10/2/00]
Terminally ill seldom consider assisted suicide or euthanasia for themselves
While 60% of terminally ill patients in a recent study indicated support for euthanasia and assisted suicide in a hypothetical case, only 10% said that they had seriously considered the induced-death practices for themselves. The study—published in the 11/15/00 issue of the Journal of the American Medical Association (JAMA) as one of a series of articles and commentaries on end-of-life care—presents the first research to actually track over a period of time terminally ill patients’ attitudes and desires regarding euthanasia and assisted suicide.
Between March 1996 and July 1997, researchers surveyed 988 terminally ill patients and 893 patient-designated primary caregivers. The data revealed that psychological factors, such as depression and the patients’ sense that they were no longer appreciated, were the most significant factors associated with patients’ considering and planning euthanasia or assisted suicide deaths. Those who reported that they had more pain or required substantial care were also more likely to consider having their lives ended, and their caregivers were more likely to support a decision for euthanasia or assisted suicide. In contrast, the majority (89.6%) of terminally ill patients who did not personally consider either practice were less likely to have depressive symptoms and more likely to feel appreciated, be 65 or over, African American, and religious.
Researchers also noted, “While a majority [60.2%] of those surveyed find euthanasia acceptable for terminally ill patients with unremitting pain, less than a third support it when the patient desires it because of fear of being a burden on the family.” Furthermore, the study’s authors observed that there appears to be “a tension between attitudes and practices, between the reason people find euthanasia and PAS [assisted suicide] acceptable—predominantly pain—and the main factor motivating interest in euthanasia or PAS—patient depression.”
In addition, researchers found that the patients’ personal considerations of euthanasia and assisted suicide were significantly unstable. More than 50% of the patients who initially expressed interest in ending their lives later changed their minds, and some of those who had not considered these induced-death practices at the initial interview began to do so. “Depressive symptoms and dyspnea were associated with this instability,” researchers wrote. “This suggests that when physicians are confronted by a patient’s request for euthanasia or PAS, they should attend to the possibility of depression and other psychological stressors,” they concluded. [E.J. Emanuel, D.L. Fairclough, & L.L. Emanuel, “Attitudes and Desires Related to Euthanasia and Physician-Assisted Suicide Among Terminally Ill Patients and Their Caregivers,” JAMA, 11/15/00:2460-2468]
Editor’s notes:
- Two of the three co-authors of this study were the husband and wife team Drs. Ezekiel Emanuel and Linda Emanuel. Ezekiel Emanuel was also lead author of the study (reported on page 5) showing a dramatic drop in support for assisted suicide and euthanasia among cancer specialists trained in end-of-life care. Apparently upset by both studies’ published findings, euthanasia and suicide guru Derek Humphry wrote to fellow right-to-diers, “Thus we should not let academics like the Emmanuels [sic] make a reputation out of trumpeting that hastened death is no longer necessary so long as there is palliative care, and groups like Hemlock etc. are now superfluous. They apparently give little or no consideration to quality of life, which is uppermost in most of our minds.” [D. Humphry, right-to-die e-mail list, 11/15/00]
- Regarding the researchers’ recommendation that physicians should take steps to determine if patients who request euthanasia or assisted suicide are depressed or are under other “psychological stressors,” it is interesting to note that during the first two years under Oregon’s permissive assisted-suicide law, less than 35% (15 out of 43) of the patients who received lethal prescriptions were referred for a psychiatric or psychological consultation. [Oregon Health Division, “Oregon’s Death with Dignity Act: The Second Year’s Experience,” Table 2, 2/23/00]
- The mental assessment rate is even lower in the Netherlands where only 3% of all those euthanized or assisted in suicide receive professional mental health evaluations. According to Dr. Linda Ganzini, director of geriatric psychiatry at the Veteran’s Affairs Medical Center in Portland, OR, “[S]tudies of dying cancer patients reveal that between 59-100% of patients wanting hastened death have major depressive disorder.” “Depressed people,” she explained, “often focus on the worst possible outcomes and are impaired by apathy, pessimism, and low self-esteem.” “The experience of palliative care psychiatrists is that depression treatment is effective in terminally ill patients,” Ganzini wrote. [L. Ganzini, “Commentary: Assessment of Clinical Depression in Patients Who Request Physician-Assisted Death,” Journal of Pain & Symptom Management, June 2000, pp. 474-478]
Vast majority of Jack Kevorkian’s “patients” had no terminal illness
A study of 69 of Jack Kevorkian’s assisted-suicide deaths from 1990 to 1998 revealed that only 25% involved people with a terminal condition, meaning they had less than six months to live. Of the 69 people whose lives Kevorkian claimed, five were found to have no “anatomical disease” whatsoever upon autopsy.
These findings, which were published as a letter in the New England Journal of Medicine, were the result of a two-year clinical analysis, conducted by psychologists from the University of South Florida, of data from the Oakland County, Michigan, medical examiner’s office . Since autopsy procedures can vary among counties, Kevorkian-related deaths outside of Oakland County were excluded from the study. Kevorkian has claimed to have participated in about 130 deaths.
Researchers found that in 72% of the cases the individual had experienced a recent decline in health, a factor which could have precipitated their desire to die. Seventy-one percent (71%) were women’ and most of the 69 were either divorced, widowed, or had never married. Thirty-five percent (35%) were experiencing pain, and 13% exhibited symptoms of depression. “Altogether,” researchers concluded, “our findings underscore the vulnerability of women and groups of men (i.e., those not married and those coping with serious illness) to physician-assisted suicide and euthanasia….” [L. Roscoe, L.J. Dragovic, D. Cohen, “Dr. Jack Kevorkian and Cases of Euthanasia is Oakland County, Michigan, 1990-1998,” NEJM, 12/7/00]
“Kevorkian attracted a group of people who were desperate and depressed and didn’t have the support systems to deal with their suffering,” observed Dr. Donna Cohen, who co-authored the analysis. “The issue isn’t about the right for someone to die. It’s the issue of the standards of practice that create safeguards for individuals who aren’t getting proper care, support and counseling,” she added. “We can do better as a society than to just kill people.”
“This is a catastrophe,” remarked co-author Dr. L.J. Dragovic, Oakland County’s chief medical examiner. “Five of those individuals just died in vain because they were led to believe that it was the only solution for their problems.” [Globe and Mail, 12/7/00]
“[Kevorkian’s] been touted as a hero by so many, yet he did this,” said Diane Coleman, president and founder of the disability rights group Not Dead Yet. “He robbed many disabled women and others of their lives by responding to their despair in a way society would never respond if they were not disabled women.” [St. Petersburg Times, 12/8/00]
WORLD FOCUS
AUSTRALIA
Home-grown poisons to be tested in secret lab
Euthanasia activists in Australia have announced plans to set up a secret laboratory to test the effectiveness of common weeds to kill patients. Leading this project is Dr. Philip Nitschke, the doctor responsible for the deaths of 4 patients under the now defunct Northern Territory law legalizing euthanasia. After that law was overturned by Australia’s national parliament, Nitschke began holding how-to euthanasia clinics throughout the country. He is also developing a suicide tent designed to remove oxygen from the air to cause one or more individuals to suffocate to death.
Reportedly, Nitschke and his fellow activists have raised A$40,000 (Australian dollars) and they expect another A$60,000 from foreign sources. If the underground lab is established, suicidal patients would be able to send in plant samples to be tested for lethal effects.
Hemlock, the weed responsible for Socrates’ death in 399 bc, will be one of the first plants tested. As Nitschke has pointed out, it is not illegal to grow hemlock, and it is a common weed all across Australia.
Nitschke also said that he didn’t believe people would use the lab to establish the best substances to use to murder someone or to commit suicide because of depression or any non-medical reason. He said that if a person wanted to murder someone, they wouldn’t want to wait for the lab to suggest a “peaceful way” to do it. [South China Morning Post, 10/24/00; Herald Sun, 10/23/00; Courier Mail, 9/28/00] (See “News Notes” in this Update for more on Nitschke.)
Charges in euthanasia case dropped
Last February, just two hours after cancer patient Freeda Hayes told her doctor and her brother and sister that she wanted to die, her wish was granted in the form of a fatal mixture of drugs. The trio was subsequently charged with murder. An autopsy confirmed that Hayes’ death was not from natural causes and that one of the lethal drugs contained in her blood stream was a paralyzing agent to prevent her breathing. Her doctor, Daryl Alan Stephens, was accused of actually giving her the lethal injection. “Whatever his motivation may have been,” said Prosecutor David Dempster, “there can only be one intention—the intention to kill.” But, despite the facts of the case, Perth Magistrate Jeremy Packington dropped all the charges, saying the case was based on circumstantial evidence. [The Age, 11/28/00; Sydney Morning Herald, 11/30/00]
BELGIUM
Doctors kill one in 10 Belgians
According to a recent survey conducted by researchers from the Free University Brussels and Ghent University, more than one in ten deaths in Belgium are the result of doctors actively ending patients’ lives. Euthanasia is illegal in Belgium, though the country’s parliament has been debating a proposal to legalize the practice. (See Update, 2000, No. 1, p. 8.)
Researchers studied deaths in Belgium’s northern region which occurred during the first four months of 1998. After extrapolating the data from those deaths to estimate likely causes of death for an entire year, they found that more than three in every 100 deaths patients had been given lethal injections without the patient’s’ request or permission. In 5.8% of the cases treatment was withheld expressly for the purpose of ending the patient’s life. [BBC News, 11/24/00; CNN.com, 11/24/00]
GREAT BRITAIN
Brain-dead organ donors should receive painkillers
Britain’s top anesthetists have called for certified brain-dead organ donors to be given painkilling drugs to insure that the patient does not experience pain when the organs are harvested. An editorial that appeared in Anaesthesia, the journal of the Royal College of Anaesthetists, said that anesthetics should routinely be given to a beating-heart, brainstem-dead patient during surgery to remove the person’s heart, lung, liver, and pancreas.
If these patients are not sedated, it is common for there to be disturbing and dramatic responses from the donor’s body. “Nurses get really, really upset,” explained Philip Keep, a consultant anesthetist from the Norfolk and Norwich hospital. “You stick the knife in and the pulse and blood pressure shoot up,” he said “If you don’t give anything at all, the patient will start moving and wriggling around and it’s impossible to do the operation.”
The authors of the editorial, Basil Matta and Peter Young, concluded, “Death is not an event but a process and our limited understanding of the process should demand caution before assuming that anesthesia in not required.”
But John Evans, founder of the vBritish Organ Donor Society, called the editorial “very unsettling” for donors’ families and feared that it would deter organ donations. “The sooner we scotch the thought of pain and the person being alive in any sense of the word then the better.” [BBC News, 8/19/00; Scripps Howard News Service, 8/21/00]
High Court rules removing food & fluids not a violation of Human Rights Act
British High Court Judge Dame Elizabeth Butler-Sloss has ruled that the right-to-life provision in Britain’s newly enacted Human Rights Act does not affect a doctor’s right to withhold or withdraw tube feeding from patients thought to be in a permanent vegetative state (PVS).
The new Human Rights Act incorporates the provisions of the European Convention on Human Rights into British law. The cases before the British High Court purportedly involved two articles from the Act—Article 2, stating “Everyone’s right to life shall be protected by law,” and Article 3, banning “inhuman and degrading treatment.”
The cases in question involved two women referred to only by their initials. Mrs. M, 49, reportedly has been PVS for three years as a result of an anesthesia accident that occurred during surgery. Ms. H, 36 and an epileptic, has been only “near-PVS” (she responds to external stimuli) since last January when she went into cardiac arrest.
The families of both women want their feeding stopped. John Grace, the lawyer arguing for the withdrawal of tube-feeding on behalf of the two hospital trusts caring for the women, described PVS in court as “a twilight zone of suspended animation where death commences whilst life continues. A living death.”
Initially it was reported that the Official Solicitor representing the two women was expected to argue that withholding their tube-feeding would violate their right to life. However, during the hearing, Official Solicitor Ben Emmerson agreed with the opposing lawyer, John Grace, that the existing nutrition and hydration guidelines established seven years ago by the House of Lords—allowing the starvation and dehydration of Tony Bland, a young man brain-damaged during a soccer riot—were compatible with Article 2 of the Human Rights Act.
Judge Butler-Sloss agreed and so ruled. [British Medical Journal, 10/14/00; London Times, 10/2/00; Ananova, 10/6/00, 10/5/00]
SWITZERLAND
Zurich allows assisted suicide in homes for the elderly
The city of Zurich has issued a directive sanctioning assisted suicide for elderly people in residence homes. The man behind this new directive is Robert Neukomm, head of the Zurich Health Department, which maintains control of elderly residence homes in the city.
Until the directive was issued on October 26, 2000, members representing pro-euthanasia organizations, such as EXIT, were not allowed to enter the homes. Suicide of any type was strictly prohibited on the premises. Now access is allowed at the elderly resident’s request. “In a changed society, which places high value on the right to self-determination, there is no longer room for such prohibitions,” Neukomm said.
According to a message sent over the right-to-die e-mail list by a Swiss EXIT board member, there are guidelines regulating assisted suicide practice in the residence homes:
- The elderly person no longer has a private home, and the person’s room in the residence is considered his or her “private sphere.”
- The person must be competent and state a wish to die on several occasions.
- Nurses and resident home staff are not allowed to participate in the death, but they are allowed to be present.
- If the competence of the patient is questionable, the case should be referred to an ethics committee for final determination.
- A physician is not to be involved in the assisted suicide; the assistance is to be provided by EXIT or other such group. (That way the policy of no physician-assisted suicide is officially maintained.)
- All other options, including palliative care are to be exhausted.
- Assisted suicide is not allowed in hospitals. [Dr. Harri Wettstein, right-to-die e-mail list, 10/30/00]
Neukomm issued the new assisted-suicide directive even though he has admitted that such suicide decisions are often the result of severe depression.
Dr. Albert Wettstein, head of a group of municipal doctors, said “Only 1.1% of the residents…have expressed the wish to commit suicide.” His fear now is that the new directive will encourage suicides and will be a “first step” toward active euthanasia—which is officially illegal in Switzerland. [Zenit News Agency, 10/29/00]
NEWS NOTES
In a recent fundraising effort for his euthanasia advocacy group, ERGO!, Derek Humphry, author of the how-to suicide manual, Final Exit, indicated that the right-to-die movement’s progress has definitely been impeded. “With the election defeat in Maine last month, and the fate of the Oregon law hanging in the balance,” Humphry wrote, “can anyone doubt that SELF-DELIVERANCE from an unbearable terminal illness must, for years to come, be handled without doctors? There is no progress in Britain, Australia, Canada, or the USA.” [Humphry, right-to-die e-mail list, 12/8/00]
On 11/14/00, the Alaska Supreme Court heard oral arguments in Sampson & Doe v. State of Alaska, the lawsuit brought by the Oregon-based Compassion in Dying Federation (CIDF) challenging Alaska’s assisted-suicide ban on the grounds that it violates the state constitution. A ruling from the high court is not expected for about six months. [AP, 11/15/00]
Last year, Alaskan Superior Court Judge Eric Sanders ruled against CIDF, finding that the state’s assisted-suicide law does not violate the liberty, equal protection, and right to privacy clauses contained in Alaska’s Constitution. CIDF appealed that decision to the Alaska Supreme Court. (See Update, July-Sept., 1999.)
During oral arguments before the state’s highest court, Assistant Attorney General Eric Johnson told the justices that terminally-ill adults considering assisted suicide could be under social pressures and could be coerced into making that decision. He also argued that to legalize assisted suicide implies that the lives of those disabled by terminal illness are undignified and of less value. “We as a society value equality,” he said, “and that means valuing disabled lives [the same] as others. You can’t discount a life just because you have” a short time left.
CIDF lead lawyer Kathryn Tucker and co-counsel Robert Wagstaff dismissed Johnson’s arguments. Wagstaff said that assisted suicide would be limited to terminally ill, mentally competent adults. “It does not include the disabled,” he added. [Anchorage Daily News, 11/15/00]
Members of the disability rights group Not Dead Yet attended the oral arguments. The group is well known for its opposition to assisted suicide. [AP, 11/15/00]
On 12/6/00, the American Medical Association House of Delegates voted overwhelmingly to defeat a resolution asking the AMA to withdraw its support of the Pain Relief Promotion Act (PRPA). The PRPA, which has already passed in the House of Representatives and is currently in the Senate, would amend the federal Controlled Substances Act of 1970 (CSA) to establish, for the first time, that aggressive pain management is a “legitimate medical purpose” for the use of drugs regulated under the CSA. It would also allocate $5 million for pain control research grants and for the creation of needed pain management education programs for doctors and other health care professionals.
But the PRPA provision that has been most controversial is the prohibition against using federally controlled drugs to intentionally end patients’ lives—a practice allowed under Oregon’s assisted suicide law. If the PRPA passes Oregon doctors could no longer prescribe lethal doses of barbiturates, the drugs of choice for assisted suicides.
By rejecting Resolution 214, “Opposition to the Pain Relief Act,” the AMA delegates reaffirmed the association’s overwhelming support of the PRPA. According to Dr. Gregory Hamilton, head of Physicians for Compassionate Care, “It is more important than ever that Congress pass and President Clinton sign the enlightened Pain Relief Promotion Act, which has bipartisan support and is supported by the majority of congressional members in both chambers. Patients need improved pain treatment and palliative care, not assisted suicide.” [PCC Press Release, 12/6/00]
Australian euthanasia activist Dr. Philip Nitschke and two other supporters have written a letter to President Bill Clinton asking him to pardon Jack Kevorkian. Kevorkian is currently serving a 10 to 25-year sentence for the death of Thomas Youk, which Kevorkian videotaped and was later aired on CBS’s 60 Minutes.
“We are writing to you, a leader of a democracy, to ask that you, as president, demand that Dr. Kevorkian be given a pardon and released from prison,” Nitschke et al. wrote. “We… beg you to exercise your authority and have Dr. Kevorkian restored to his rightful place in society—as a leader and a hero of reform.” [AAP, 11/27/00]
Thus far, there has been no public response from President Clinton.
