Update 026: Volume 16, Number 3 (2002)

Media reports false as briefs are filed in
Oregon v. Ashcroft appeal

When the federal government recently submitted its brief in support of Attorney General John Ashcroft’s directive that doctors who intentionally prescribe controlled substances for assisted suicide violate federal law, many major media services were less than accurate in their reporting.

ABC News, for example, ran an Associated Press report stating, “The Bush administration asked a federal appeals court to strike down Oregon’s assisted-suicide law as counter to U.S. drug law.” [ABC News, 9/23/02] CBS News took the same spin, reporting that the federal government filed its brief supporting the Ashcroft ruling “in an effort to strike down the only such law in the nation.” [CBS News, 9/23/02] The Oregonian, Oregon’s largest newspaper, ran an article stating, “Attorney General John Ashcroft renewed the federal government’s attack on Oregon’s physician-assisted suicide law….” [Oregonian, 9/24/02] Even Reuters, a major international wire service, reported, “The U.S. Justice Department challenged Oregon’s assisted suicide law, asking an appeals court to strike down the first-in-the-nation measure….” [Reuters.com, 9/23/02]

International Task Force (ITF) legal consultant Wesley J. Smith called the media’s spin “utterly and factually wrong.” “The federal government has never asked any court anywhere to strike down Oregon’s assisted-suicide law,” Smith said. ITF Executive Director Rita Marker agreed. “Oregon’s claim that the Ashcroft directive would nullify Oregon’s law is patently false,” she explained. “Although this case will be decided within the context of assisted suicide, it is not about whether Oregon may permit the practice of assisted suicide within its borders. It is about whether a state can prevent the federal government from interpreting its own regulations.”


Last November, Attorney General Ashcroft issued an interpretive ruling stating that, under the federal Controlled Substances Act (CSA), “assisting suicide is not a ‘legitimate medical purpose’” and that “prescribing, dispensing, or administering federally controlled substances to assist suicide violates the CSA.” [Ashcroft, “Dispensing of Controlled Substances to Assist Suicide,” 11/6/01, p. 1]

Since barbiturates, controlled substances under federal law, are the drugs of choice for inducing deaths in Oregon, the state along with assisted-suicide advocates petitioned the U.S. District Court in Oregon to issue a restraining order barring the implementation of Ashcroft’s ruling. Federal District Judge Robert E. Jones not only issued the requested injunction barring DEA action against Oregon doctors who prescribe barbiturates to intentionally cause death, but he also ruled that it is up to individual states to decide what is “legitimate” medical practice within their borders. He found that neither the CSA nor the U.S. Department of Justice (USDOJ), was ever intended to establish “a national medical practice or act as a national medical board.” The USDOJ appealed Jones’ ruling to the Ninth Circuit Court of Appeals in San Francisco. (See Update, 2002, #1 and Update, 2002, #2)

Federal government submits “Brief for Appellants”

In its 43-page brief, filed with the Ninth Circuit, the USDOJ argued:

Judge Jones’ District Court “lacked jurisdiction to review the Attorney General’s interpretive rule.” Federal law requires that any judicial review of an attorney general’s interpretive rule be conducted by a U.S. Court of Appeals, not a District Court. [Brief for Appellants, Oregon v. Ashcroft, U.S. 9th Cir. Ct. of Appeals, No. 02-35587, p. 14-16. Hereafter cited as Appellant Brief.]

The CSA prohibits doctors from prescribing controlled substances unless it is for a “legitimate medical purpose.” Attorney General Ashcroft correctly determined that assisting a suicide is not a legitimate medical purpose, a determination supported by the CSA’s wording, by ordinary English usage, and “by centuries of almost uniform opposition to the practice of assisted suicide,” all of which “demonstrate that medicine involves the practice of healing, not killing.” [Appellant Brief, pp. 11, 14-22]

Federal law governs questions of medical purpose legitimacy under the CSA. Otherwise, the application of federal law would vary from state to state. The CSA “makes clear that the question of what constitutes a legitimate medical purpose…and its implementing regulations must be determined under a uniform federal standard.” “Legislative history confirms that Congress intended for the legitimate medical purpose requirement to operate independently of state law.” [Appellant Brief, pp. 12, 23-24]

ITF files brief in support of Ashcroft’s ruling

The ITF has submitted an amicus curiae brief to the Ninth Circuit Court of Appeals in support of Ashcroft’s directive. Among its many points, the ITF brief demonstrates why the Ashcroft ruling does not overturn Oregon’s Death with Dignity law (ODWDA).

Despite claims by the media, assisted-suicide advocates, and Judge Jones in his ruling, there is nothing in Ashcroft’s directive which would nullify the ODWDA or preempt provisions in that law.

“The Ashcroft Directive does not prevent physicians from engaging in the act of physician-assisted suicide under the ODWDA. They may still write prescriptions for medication for the purpose of enabling patients to commit suicide. The Ashcroft Directive only addresses the means, by stating that practitioners may not use their federal registrations to prescribe federally-controlled substances for the purpose of causing drug-induced deaths.” [ITF Amicus Curiae Brief, Oregon v. Ashcroft, U.S. 9th Cir. Ct. of Appeals, pp. 13-14. Hereafter cited as ITF Brief.]

Moreover, the ITF Brief argues,

“Although all federally controlled substances are prescription drugs, not all prescription medications are federally controlled substances. A federal registration is only required to dispense prescription medications that are federally controlled substances. The Ashcroft Directives applies only to those prescription drugs for which a federally issued license is necessary and only to those drugs when they are prescribed for the purpose of enabling a patient to commit suicide.” [ITF Brief, p. 14]

The ITF Brief holds that Judge Jones erred in his ruling when he concluded that the U.S. Attorney General lacked the authority to determine that prescribing controlled substances for assisted suicide is not a legitimate medical purpose under the CSA. To the argument that Ashcroft’s directive oversteps his authority and usurps a state’s right to regulate the practice of medicine, the ITF brief states,

“Attorney General Ashcroft’s Directive does not address the matter of whether assisted suicide may be considered a ‘legitimate medical practice’ under Oregon law. Instead, it deals solely with whether using a federal registration to prescribe federally controlled substances to cause drug-induced death serves a ‘legitimate medical purpose’ under DEA regulations.” [ITF Brief, p. 3]

Death Tourism: One-way trip to Switzerland

A Swiss right-to-die group is offering assisted suicide to foreign patients seeking to end their lives. The group, Dignitas, operates out of Zurich and claims to have already assisted in 109 deaths.

An investigation conducted by the BBC, which was aired on 8/12/02, revealed that Dignitas provides foreign nationals with a Swiss doctor who, after seeing the patient only once, will supply the lethal drugs if it appears that the patient’s death wish is the result of a “rational” decision. In Switzerland, only one doctor is needed to approve a candidate for assisted suicide. Once the deadly drugs have been supplied, Dignitas then provides the patient with a small apartment in Zurich for his or her death. The lethal drugs are prepared by a volunteer nurse; two witnesses are present for each death; and the local authorities are notified.

While there is nothing in Swiss law which formally legalizes assisted suicide, the practice is tolerated if the suicidal person self-administers the lethal drugs and the person’s suicide decision is deemed rational.

Dignitas director Ludwig Minelli, a Swiss lawyer, explained that his organization will accept people who are terminally ill, have Alzheimer’s disease, are depressed, or have other forms of mental illness. Accepting patients in the last three categories puts into serious question the “rational” death wish requirement.

According to Andreas Brunner, Zurich’s chief prosecutor, “Some people have insufficient doctors’ records, insufficient documentation, and we must ask whether they were capable of making a rational decision to die. Sometimes it’s impossible to be sure.” “Some arrive one day and die the next,” he added. “We can’t always check whether their wish to die has been a long-term one or just a phase they’re going through.”

“What we are doing is a friendly act,” Minelli argued. “The patient always makes the last act—swallowing the drug or opening a valve of a drip himself—so we have never had a problem with the police.” “Between the first contact and death it can take several weeks,” added Minelli, “but in the most severe cases for patients in the final stages of a terminal illness it can happen much quicker.” For the person thought to be mentally competent, the entire death process can occur within 12 hours of his or her arrival in Zurich.

Minelli pointed out that Dignitas does not charge for its death services because making a profit from assisted suicide is illegal in Switzerland. What he does charge is a £10 ($15US, EUR 16) membership fee and accepts donations. According to Minelli, his group just wants to help anybody “who is looking for a place to put his body.” The actual cost, however, for anyone planning to use Dignitas’ services can run as high as £800 ($1,2445US, EUR 1,263), and that does not include traveling costs to Zurich and costs to return the body to the person’s native country. Most want to be cremated and have their ashes sent to relatives. Some just want to be buried anonymously in a Zurich cemetery.

Swiss authorities have voiced alarm at the rise in Dignitas’ membership, which last year reached 1,620. Of those who have died thus far, 61 were from Germany, 37 from Switzerland, 5 from France, 2 from Austria, 1 from Italy, 1 from the Netherlands, 1 from Spain, and 1 from the U.S.

Chief Prosecutor Brunner told reporters that Dignitas was giving Switzerland a bad name. “We are very concerned about suicide tourism which is not in our interests at all,” he said. Furthermore, he noted, each assisted suicide ends up costing Swiss taxpayers up to 9,230 Swiss Francs (£4,000, $6,221US, EUR 6,301) in inspection fees.

Other Swiss euthanasia groups limit their clientele to Swiss citizens. But Minelli sees a need for extending death services beyond Swiss borders. “You must understand that you can no longer commit suicide today by swallowing pills,” he said. “They are made today so they are no longer necessarily lethal when taken in heavy doses.” Dignitas, he added, can ensure a certain death.

But Zurich ethicist Professor Oswald Ultz is critical of Dignitas. “It’s a very strange occurrence that someone wants to help to kill people,” he told a reporter from National Public Radio (NPR). “They count their efficiency by the body count. It’s the ultimate execution of power over someone else. And I think that’s quite a pathology. And, therefore, many of these people should have psychological or psychiatric help,” he explained.

[BBC, Newsnight, 8/12/02; BBC, “The Swiss way of death,” 8/12/02; Daily Telegraph, 8/13/02, 8/25/02, 9/14/02; Mail & Guardian Online, 9/4/02; The Sunday Scotsman, 8/25/02; Reuters Health, 9/13/02; Transcript, All Things Considered, NPR, 9/17/02 ]

Suicide aid advocates prepare for legal battle

As soon as Attorney General John Ashcroft issued his ruling last November that doctors who prescribe controlled substances for assisted suicide violate federal law, pro-assisted-suicide groups began mobilizing.

The Hemlock Society launched its campaign to denounce what it called the “Ashcroft Decree.” In addition to a letter writing and petition campaign, Hemlock organized a Washington D.C. press conference and newspaper ads to announce “the most ambitious initiative in its history: overturning Attorney General John Ashcroft’s assisted-death ruling and making dying-with-dignity part of the national political dialogue in America.” Hemlock also acknowledged that because of its members and donors, it “has the power and the will to make sure the Attorney General knows he cannot deny end-of-life choice and expect to get away with it without a fight.” [www.hemlock.org, “Hemlock Launches Bid Against Ashcroft Decree,” 11/25/01]

The Compassion in Dying Federation (CIDF), a legal force backing Oregon’s suit against Ashcroft’s ruling, has been busy preparing for a legal battle that is likely to go all the way to the U.S. Supreme Court. According to its recent newsletter, CIDF has been soliciting and coordinating amici curiae briefs to better advance their cause. Groups that have indicated their support against Ashcroft include the Amer. Geriatrics Society, the Society of General Internal Medicine, California Medical Assoc., and Amer. College of Legal Medicine. [CIDF, Connections, Summer 2002, pp. 1-2]

Groups who have submitted briefs in support of Ashcroft’s ruling include the ITF, Physicians for Compassionate Care, Not Dead Yet, American Center for Law & Justice, and U.S. Senators.

Two studies published on assisted suicide in Oregon

A study published in the Journal of the American Medical Association (JAMA), entitled “Responding to Requests for Physician-Assisted Suicide,” found that patients who initially consider physician-assisted suicide (PAS) are most often exploring their end of life options and that nine out of 10 patients who actually request PAS do not end up taking the lethal drugs their doctors prescribed.

“If we had 1,000 people known to have terminal illness, 100 would talk to their family about it [PAS],” explained the study’s co-author, Susan Tolle, M.D. “Only 10 of those would actually ask their doctor for physician-assisted suicide, and one of them would take a [lethal] prescription and end their life.”

The data strongly suggests that, when patients initially ask about PAS, it usually is not a request for induced death. “It may be a signal,” Tolle said. “It really isn’t to be taken at face value, but as a call for exploration of the patient’s motivations for asking.” Often times, the motivations can include the fear of being a burden to others and the loss of autonomy or control. [American Medical News, 7/29/02]

The study found that “most patients’ desires for PAS diminish as their underlying concerns are identified and addressed.” Doctors should try to identify patients’ fears by taking the time to talk to them about, among other things, their concerns and expectations, their pain and physical symptoms, their family situation, their sense of meaning, and any symptoms of depression. “When this approach is taken, suffering can be optimally alleviated and, in almost all cases, the patient’s wishes can be met without PAS.” [Bascom & Tolle, “Responding to Requests for Physician-Assisted Suicide,” JAMA, 7/3/02. pp. 91-99]

Another study recently published in the New England Journal of Medicine (NEJM) surveyed 397 Oregon hospice nurses and social workers by mail about their experiences with hospice patients who ask for assisted suicide.

The majority of those surveyed indicated that patients who obtained a prescription for lethal drugs were more afraid of losing control over the circumstances of death than other hospice patients. In addition to the loss of control, other reasons patients gave for requesting PAS were “a desire to die at home, the belief that continuing to live was pointless, and being ready to die.” [Ganzini et al., “Experiences of Oregon Nurses and Social Workers with Hospice Patients Who Requested Assistance with Suicide,” NEJM, 8/22/02, pp. 582-588]

“Patients make the choice to request assisted suicide because they want to control the timing and manner of their death,” observed lead author Linda Ganzini, M.D., director of the Palliative Care Fellowship at the Portland VA Medical Center and psychiatry professor at Oregon Health and Science University School of Medicine. “It’s surprising how we found so little variation with regard to this characteristic, almost as if the nurses and social workers were all seeing the same patient,” she added. “The clear message is that we need to study what control means to people who are dying.” [Mail Tribune, 8/22/02]

The findings of this study differ somewhat from the four annual PAS reports issued by the Oregon Dept. of Human Services, which were based exclusively on information and observations provided by the doctors who wrote lethal prescription for patients.

Doctors of Death:
Kaiser solicits its doctors to kill

Wesley J. Smith

When liberals ask me why they should oppose physician-assisted suicide (PAS), I always reply, “I can summarize a big reason in just three letters: HMO.”

That always raises an eyebrow. Liberals hate HMOs.

Then I ask, “Do you know how much it costs for the drugs used in an assisted suicide?” They usually shake their heads, no. Answering my own question, I say, “About forty bucks,” adding, “Since HMOs make money by cutting costs, and it could cost $40,000 (or more) to provide suicidal patients with proper care so that they don’t want assisted suicide, the economic force of gravity is obvious.” More often than not, my liberal interlocutor will say, “Gee, I never thought about that before,” and agree that the HMO factor is a very serious problem confronting the assisted-suicide movement.

Most people haven’t yet made the money connection between assisted suicide and the increasing strains on health-care budgets. That may be because reporters, who are usually eager to expose potential financial conflicts of interest in other public-policy issues, tend to be blind to the economic stakes involved in the assisted-suicide controversy. They prefer to see it as a matter of “choice,” or of “compassion,” or of modernism-versus-religion. Yet, the realization that assisted suicide will, in the end, be largely about money, is becoming increasingly difficult to ignore.

Take Oregon, where assisted suicide is legal. While the assisted-suicide law does not compel any doctor or HMO to participate in the self-destruction of patients, only Catholic HMOs have said no. Indeed, Kaiser/Permanente Northwest’s doctors are known to have written lethal prescriptions under the Oregon law.

But now, Kaiser isn’t merely permitting doctors to assist in patient suicides, it is actively soliciting its doctors to participate in the deadly practice. As revealed by the anti-assisted-suicide medical group Physicians for Compassionate Care, a Kaiser executive recently e-mailed a memo to more than 800 Kaiser doctors soliciting PAS-doctor volunteers.

The memo reveals that to the apparent chagrin of Kaiser, but to their physicians’ credit, few plan doctors are willing to participate in the killing of their own patients. Hence, the executive urges any Kaiser doctor willing to “act as Attending Physician under the [assisted suicide] law for YOUR patients” and doctors willing to act as “Attending Physician under the law for members who ARE NOT your patients” to contact “Marcia L. Liberson or Robert H. Richardson, MD, KPNW Ethics Services.” (Emphasis in the memo.) Since “attending physicians” write the lethal prescriptions under the Oregon law, Kaiser is apparently willing to permit its doctors to write lethal prescriptions for patients they have not treated.

For opponents of assisted suicide who are closely following events in Oregon, Robert Richardson is already notorious as the HMO administrator who green-lighted the assisted suicide of Kate Cheney. Cheney, as reported by the Oregonian, was a terminal cancer patient who was probably suffering from dementia when she asked for a lethal prescription, raising serious and significant questions about her mental competence. Rather than prescribe lethal drugs, her doctor referred her to a psychiatrist who reported that “she does not seem to be explicitly pushing for this.” He also determined that she did not have the “very high capacity required to weigh options about assisted suicide.” Accordingly, the psychiatrist nixed the lethal prescription.

Advocates of legalized assisted suicide might, at this point, smile happily and say that this is the way the law is supposed to operate: a vulnerable and perhaps incompetent woman’s life had been protected. But proving that “protective guidelines” don’t really protect, that wasn’t the end of Cheney’s story. Her daughter insisted that Kaiser permit another psychiatric opinion. Kaiser agreed to the request.

This time, the consultation was a clinical psychologist rather than an M.D. psychiatrist. Like the first report, the psychologist found that Cheney had significant memory problems. For example, she could not recall when she had been diagnosed with terminal cancer. The psychologist also worried that Cheney’s decision to die “may be influenced by her family’s wishes.” Still, despite these reservations, the psychologist determined that Cheney was competent to commit suicide.

The final decision to approve the assisted suicide was made by Richardson. Despite two mental-health professionals’ significant concerns about Cheney’s mental state and the potential that familial pressure was involved in her decision, after he interviewed Cheney, Richardson approved the writing of a lethal prescription.

It is worth noting that Cheney did not take the poison pills right away. Her assisted suicide took place only after she was sent to a nursing home for a week. Tellingly, she took the pills on the very day of her return home. No doctor was present. Nor was her mental status assessed at that time. That is because under the Oregon law, once the prescription is written, death doctors need have no more to do with the suicidal patient.

When the Cheney case became public, Richardson angrily claimed that his decision had nothing to do with money. And, to be fair, there is no doubt that, if the relatively few people reported as committing assisted suicide so far in Oregon is correct, Kaiser and other participating HMOs have not yet saved a great deal of money by agreeing to facilitate the assisted suicides of their terminally ill members. But if the reluctance of good doctors such as those currently refusing to participate in-patient self-killing at Kaiser is ever overcome, the financial facts could change. Indeed, if assisted suicide ever became nationalized and a routine “medical treatment,” significant money could be saved — and hence made — by the HMO industry from the hastened deaths of their patients.

This is the view of none other than assisted-suicide guru Derek Humphry, cofounder of the Hemlock Society and a heavy lifter in support of the Oregon law. Humphry now claims that money is the “unspoken argument” in favor of legalizing assisted suicide. Specifically, in his most recent book Freedom to Die, co-authored with Mary Clement, the authors write that “the hastened demise of people with only a short time left would free resources for others,” an amount they predict could run into the “hundreds of billions of dollars.” Moreover, the authors claim that “economic necessity” is the ultimate force driving the assisted-suicide movement, to the point that it “is the main answer to the question [about legalizing PAS], ‘Why Now?'”

Logic is certainly on their side. With the advent of managed care, profits in health care increasingly come from cutting costs. With assisted suicides costing such little money, what “treatment” could be more cost effective than assisted suicide? And since it is a well-known human failing that our values often follow our pocketbooks, ignoring the significant financial stakes involved in the assisted-suicide debate is to overlook a crucial part of the story.

Wesley J. Smith is an attorney for the International Task Force and the author of Culture of Death: The Assault on Medical Ethics in America (Encounter Books, 2000) and Forced Exit: The Slippery Slope from Assisted Suicide to Legalized Murder (Times Books, 1997). He is also the co-author, with Eric Chevlen, M.D., of Power over Pain: How to Get the Pain Control You Need (International Task Force, 2002). His article was originally published by National Review Online on 8/19/02 and is reprinted here with the author’s permission.

Belgium claims first death under newly
enacted euthanasia law

Belgium has claimed its first euthanasia death, just one week after the new law decriminalizing euthanasia went into effect on 9/23/02. Mario Verstraete, 39, who worked on the campaign to make euthanasia legal, had multiple sclerosis for ten years, and stated several months ago that he wanted his life terminated once the law was enacted. He died by lethal injection on 9/30/02.

Belgium is the second European country this year to put into force a permissive euthanasia/assisted suicide law. The Belgian Parliament passed the law last May by a vote of 86-51, shortly after the Dutch government put its new euthanasia law into effect on April 1, 2002. (See Update, 2002, #1 and Update 2002, #2.)

But, for those in charge of implementing the Belgian law, the effective date came a bit too soon. “The law became effective today, but it’s not yet applicable,” a Health Ministry spokeswoman told the press. A permanent committee set up by the government to monitor euthanasia deaths had not yet met. As a result, the forms that doctors would need to fill out for each euthanasia death were still not approved.

Apparently some sort of form was available for Verstraete’s death because the government’s oversight committee announced that it would meet the day after Verstraete’s demise “to decide whether it would approve of the death’s registration documents.” As is the case with the Dutch euthanasia law and Oregon’s assisted-suicide law, any official review of the facts and forms pertaining to a euthanasia death only occurs after the patient is dead and there is no recourse to help or save the patient. Under the Belgian law, the patient need not be terminally ill, but must have a hopeless condition with chronic or unbearable suffering, which can be either physical or psychological in nature. [Reuters, 9/23/02, 9/25/02; ABC News Online, 9/24/02, expatica.com, 9/24/02, 10/9/02; London Daily Telegraph, 9/22/02]

Nitschke “forced” to create own suicide bag after
ITF interview stops supply from Canada

Dr. Philip Nitschke, Australia’s Jack Kevorkian, was not at all happy last year when ITF’s legal consultant, Wesley J. Smith, told the press about a specially designed plastic suicide bag that was being imported from Canada for use by suicidal Australians. The “Exit Bag,” as it is called, features terrycloth and felt padding at the neck for comfort and a Velcro fastener to insure asphyxiation

After Smith, who was on a speaking tour in Australia, mentioned the bag in a talk, he was contacted by Australia’s national newspaper The Australian for an interview. The paper then ran the story on the front page, along with a picture of Smith holding an actual Exit Bag, which he had obtained by mail with no questions asked. [The Australian, 8/20/01. p.1]

Readers were outraged, but none more than Australia’s Justice and Customs officer Chris Ellison, who called for an investigation. As a result, the Right to Die Network of Canada, who developed the Exit Bag, stopped its shipments to Australia.

Nitschke now claims that, because the government, he’s been “forced” to develop a suicide bag for Australians. At a press conference he scheduled in Brisbane to unveil the new Exit Bag, Nitschke said that over 150 bags have already been ordered out of the first run of 500. “People don’t want to put bags over their heads,” Nitschke said. “But we have governments, state and federal, that have painted people into desperate corners and desperate people do desperate things.” Queensland Premier Peter Beattie told the state parliament that Nitschke’s newest attention getter, the bag, was “distasteful in the extreme.” [news.com.au, 8/20/02; The Courier-Mail, 8/21/02, 8/20/02; The Australian, 8/22/02, 8/21/02]

Meanwhile, Nitschke is waging another battle as well. After he orchestrated the death of cancer-free Nancy Crick last May (see Update, 2002, #2), authorities seized computers and documents from his two homes as part of their investigation of Crick’s death. Nitschke has now filed suit to have everything returned. [The Border Mail, 9/3/02]

New Dutch government to review euthanasia law

The new coalition government in the Netherlands has announced plans to “review” that country’s permissive euthanasia law. The law, which took effect on 4/1/02, requires that euthanasia doctors terminate patients’ lives or assist in their suicides “with due care,” in a medically appropriate fashion. The law transformed what the Dutch Penal Code called the crimes of euthanasia and assisted suicide into legal medical treatments. (See Update, 2002, #1 for more on the law.)

Last May, the Dutch elected the first center-right government in 25 years. Officially sworn in on 7/22/02, the new coalition government is comprised of representatives from the Christian Democratic Alliance, the Liberal Party (VVD), and the recently formed List Party.

As part of its 45-page policy reform plan, the new government has targeted the euthanasia law for reevaluation. The new prime minister, Jan Peter Balkenende, has stated that he does not favor euthanasia.

It remains to be seen whether the new government will take any action after the law is reviewed. [AP, 7/22/02; BBC, 7/4/02; The Guardian, 7/5/02; The Straits Times, 7/7/02]

World Medical Association condemns euthanasia

The World Medical Association (WMA) has adopted a resolution which condemns euthanasia and urges all physicians and medical associations not to engage in the practice “even if national law allows it.”

The new resolution reaffirms the WMA’s prior policy positions that voluntary euthanasia goes against “basic ethical principles of medical practice” and “must be condemned by the medical profession..” It was approved last year after a heated debate among the WMA’s 18-member council, with the Netherlands being the only member to vote against it.

According to member council chairman Randolph Smoak, it was “very clear that nations around the world represented here are unequivocally opposed to euthanasia with one exception.” Reports from the council meeting indicate that representatives from the Royal Dutch Medical Association had an “unpleasant experience” and were very upset when the Dutch euthanasia policy was compared to “practices from the Third Reich.” The Dutch, however, vowed not to leave WMA, and are planning to lobby for a new debate in the future. [British Medical Journal, 9/28/02, p. 675]

Guernsey Parliament votes to study euthanasia

The Parliament of the English Channel island of Guernsey has voted 38-17 in favor of an “investigation” into the issue of euthanasia. The vote is significant because parliament members were instructed not to vote for the investigation unless they were in favor of changing the law to permit euthanasia. While the parliament has the power to enact laws for Guernsey and other Channel islands as well, a change in the euthanasia law would have to be approved by the U.K.’s Privy Council. [BBC News, 9/27/02; London Daily Telegraph, 9/27/02]

Doctor survives coma, sues hospital for advising
family to withhold food & fluids

A Scottish doctor is suing a Dundee hospital for £100,000 for hastily diagnosing her as being in a persistent vegetative state (PVS) and for advising her family to withdraw her food and fluids.

“I’m very deeply disturbed by what goes on at present,” explained 46 year-old Dr. Fiona Smith, a general practioner. “I think the expression ’vegetative state’ is loosely used. This is me, somebody who was NOT dying, and yet was, to a certain extent, condemned to death, given a hopeless prognosis,”

Seven years ago Dr. Smith, her husband (also a physician), and their three children were in a car crash while on vacation in France. Her husband was killed, and she was left brain damaged. She remained in a coma for three months. The children were not badly injured.

The French brain specialists who initially cared for her told her family that, with proper care, she would regain consciousness in three to four months. But when she was returned to Scotland, experts at Dundee Royal Infirmary dashed her family’s hopes by diagnosing her as PVS with little or no chance of recovery. They began suggesting that the family should consider stopping her feeding and hydration and let her die. The doctors stood by their prognosis despite a nurse’s statement that twice Dr. Smith opened her mouth when asked so that her teeth could be brushed.

Remembering the French doctors’ promising prognosis, Dr. Smith’s family moved her to another hospital, where she was given more stimulation and physiotherapy, was dressed daily, and was transported to the TV lounge with other patients. Immediately she showed signs of improvement. Less than three weeks later, she regained consciousness.

“I truly feel that if my family had not been so well informed and so confident about challenging the views of the medics that I might not be here to share whatever comes with them,” Dr. Smith said.

“On a personal front, that makes me angry,” she added, “but the bigger issue here is the fact that in years to come, other patients will be as vulnerable as I was. They might not have any family, or their family might be in awe of doctors and feel that they cannot be challenged. I want to make sure they do everything they can for those patients because I don’t believe they did it for me.”

PVS is often misdiagnosed. A 1996 study reported in the British Medical Journal found that 43% of patients diagnosed as being in a persistent or permanent vegetative state were found to have been misdiagnosed by their physicians. (See Update, 7-9/96, p.10.) Another study, this one in the U.S., found that 38% of patients diagnosed as PVS were not vegetative at all. (See Update, 3-4/94, p.3.)

Dr. Smith is most concerned that Scotland’s “Adults with Incapacity Act,” passed in 2000, gives doctors too much power over incompetent patients. (See Update, 2000, #1.) “The law says while relatives can have an opinion, it’s doctors that have the power to withdraw treatment,” she said.

[The Scotsman, 9/5/02, 9/6/02; BBC, “Back from the Dead,” Frontline Scotland, 11/21/00]

British doctors reaffirm assisted-suicide stance

The British Medical Association (BMA) has rejected a motion to amend the country’s 1961 Suicide Act to permit the assisted deaths of “mentally competent individuals who wish to take their own lives but are physically incapable of so doing.”

The motion was proposed by Dr. Alex Freeman, a general practitioner, as a response to the high profile Diane Pretty and Ms. B court cases. Pretty had motor neuron disease (ALS) and wanted the courts to allow her husband to assist her suicide. Ms. B, who was paralyzed from the neck down, petitioned the court to establish that she was mentally competent to refuse unwanted medical treatment, a long-held right under British law. While Ms. B’s request was met with court approval, Pretty’s case was not. Both Britain’s High Court and the House of Lords as well as the European Court of Human Rights rejected her claim that the U.K.’s ban on assisted suicide violated her basic human rights. (See Update, 2002, #1 and Update 2002, #2 .)

At its annual meeting in July, the BMA’s representatives voted 96 to 82 that it was not “necessary and desirable” to change the law. [British Medical Journal, 7/13/02:66; health-news.co.uk, 7/4/02; Wales.co.uk, 7/5/05]

Assisted-suicide petition presented to Tony Blair

Brian Pretty, along with four patients, went to 10 Downing Street to present British Prime Minister Tony Blair with a petition signed by 40,000 assisted-suicide supporters and an additional 10,000 names collected over the Internet. “We are calling for Tony Blair to listen to the people who are asking for a change in the law,” Pretty told reporters. The Voluntary Euthanasia Society claimed that the 10,000 names it gathered off of the Internet is the largest on-line petition ever presented to the prime minister. To date, there has been no official statement from Blair’s office.

Pretty is the husband of Diane Pretty, the woman with motor neuron disease (ALS) who unsuccessfully took her request to have her husband assist her suicide all the way to European Court of Human Rights. She died naturally and peacefully on May 11, 2002, while under the care of a hospice close to her home. [BBC, 9/22/02; Ananova, 9/23/02; Daily Telegraph, 9/23/02]

Book Review

The Case against Assisted Suicide:
For the Right to End-of-Life Care
Kathleen Foley and Herbert Hendin, Eds.
Johns Hopkins University Press, 2002,
371 pages, $49.95.

Reviewed by Rita Marker

Anyone who is looking for a comprehensive text about assisted suicide will find it in The Case against Assisted Suicide: For the Right to End-of-Life Care, edited by Kathleen Foley, M.D., and Herbert Hendin, M.D.

The book, which provides clear and impeccably documented information, is divided into four parts. The first deals with autonomy, compassion and rational suicide. The second with practice versus theory. The fourth and final section discusses a better way—hospice and compassionate care rather than assisted suicide—of helping patients. It is, however, the third section, titled “Practice versus Theory,” that is filled with alarming facts that everyone who is concerned about assisted suicide will find most helpful when discussing or debating the topic.

Contributions to that section address the reality of assisted suicide and euthanasia in the Netherlands, Oregon and Australia. Sections by the editors and by Gregory Hamilton, M.D., an Oregon psychiatrist, describe the culture of silence that has developed in Oregon, effectively preventing any accurate reporting related to coercion, complications or even accuracy of diagnosis. Readers will find that managed care and politically active pro-assisted suicide groups are playing the lead role in facilitating assisted suicide deaths.

For those interested in Dutch euthanasia, the chapter by Zbigniew Zylicz, M.D. provides a thorough discussion of the practice of euthanasia in the Netherlands, including the characteristics of those requesting and those providing euthanasia. Zylicz lays out the case showing how euthanasia and assisted suicide undermine effective palliative care. David W. Kissame, an Australian psychiatrist and palliative care physician chronicles the bizarre activities in 1996-1997 during the nine month period in which euthanasia and assisted suicide were legal in Australia.

This book is not only a “must read.” It is also a “must have.” All who are concerned about assisted suicide and all who are dedicated to seeing to it that patients have truly compassionate end-of-life care would do well to have this book on their own bookshelves.

News note….

Lawyers for Jack Kevorkian have filed a petition with the U.S. Supreme Court in a last-ditch effort to overturn the death doctor’s 1998 second-degree murder conviction. Kevorkian is currently into the fourth year of a 10-25 year sentence for the video-taped death of Thomas Youk. Youk had Lou Gehrig’s disease (ALS), and his death was shown on the CBS show 60 Minutes with euthanasia supporter Mike Wallace hosting the segment.

Mayer Morganroth, Kevorkian’s attorney, argued that the Oakland County assistant prosecutor who originally tried the case violated Kevorkian’s Fifth Amendment right to not to testify. According to Morganroth, “The prosecutor on 14 times told the jury that Dr. Kevorkian could have taken the stand and testified.” Furthermore, Morganroth claimed, the conviction should be overturned because Kevorkian, who insisted on acting as his own attorney, had ineffective legal representation during the trial

In the Supreme Court petition Morganroth also argues that the Michigan Court of Appeals erred when it found that it was not up to the court to determine if there is a constitutionally protected right for individuals to be free of unbearable pain and suffering. That, the court ruled, was up to the legislature. [Detroit News, 7/18/02; UPI, 7/18/02] It is not likely that the U.S. Supreme Court will hear Kevorkian’s case.