Update 027: Volume 17, Number 1 (2003)

Special report

The fight to save Terri Schiavo’s life

It’s not a new story: family members’ battling in court over whether a brain-damaged relative should be starved and dehydrated to death. But the fact that this scenario has been played out before in no way diminishes the significant danger the current Terri Schiavo case poses to all cognitively disabled patients.

In the past, these Update pages have reported on two other similar cases—the Robert Wendland and the Michael Martin court battles. [See Wendland: Update, 11-12/97; 2001, #1; 2002, #1. Martin: Update, 5-6/93; 9-10/93; 7-8/94; 9-10/95.] Both the Wendland case in California and the Martin case in Michigan dealt with wives wanting to withdraw food and fluids from their brain-damaged husbands, while mothers and sisters fought to save their sons/brothers’ lives. Neither man was in a persistent or permanent vegetative state. Both could respond to simple commands. Ultimately, the judges in these cases, while sympathetic to the wives’ arguments, found no clear and convincing evidence to support the spouses’ claims that their husbands would not want to continue living. Given that lack of evidence, the judges expressed their desire to err, if necessary, on the side of life, and, consequently, ordered that tube-provided food and fluids be maintained.

In Terri Schiavo’s case, it’s her husband who wants her life ended, and, thus far, the judge responsible for hearing this case has shown no inclination to “err” on the side of life.


It is not clear what exactly caused Terri to collapse on February 25, 1990. What is clear is that the oxygen supply to her brain was cut off, leaving her permanently brain damaged. The most common theory is that, at the age of 26, Terri had a heart attack brought on by a low potassium level caused by an eating disorder. Another more recent theory suggests she may have suffered a serious neck injury.

Terri’s husband, Michael Schiavo, a respiratory therapist and nurse, recounted that he had awakened at 5 a.m. and saw Terri collapse to the floor. Her heart had stopped beating, and her brain was without oxygen for about five minutes. [St. Petersburg Times, 1/30/00]

Almost three years later, a jury awarded Terri approximately $700,000 for her on-going medical care in a malpractice suit filed by Michael against her doctor. The case rested on the fact that her gynecologist neglected to diagnose her low potassium level even after having her blood tested. The same jury also awarded $300,000 to Michael for loss of companionship.

Ironically, during that trial Michael’s attorney, Glenn Woodworth, showed a video of Terri, and argued that, even though she was in a “vegetative state,” “you can tell she has some sense of her predicament.” He also pointed out to the jury that “[on the film] she knows her husband and looks into his eyes.” [St. Petersburg Times, 11/12/92, 1/25/00]

But not long after the successful malpractice suit, Michael, Terri’s legal guardian, decided it was time to take her off life support and refuse antibiotics for infection. Since Terri was not on a ventilator or any other high-tech life support system, that meant withdrawing all her tube-provided food and fluids. The result: certain death by dehydration within one to two weeks. Terri’s parents, Robert and Mary Schindler, vehemently opposed Michael’s decision.

Michael & the Schindlers go to court

The battle over Terri’s care, or lack of it, ended up in the courtroom of Pinellas County Circuit Court Judge George Greer, who conducted a hearing in January 2000. Michael sought the court’s permission to stop Terri’s tube feeding, arguing that, prior to her brain damage, Terri had told him that she would not want to be kept on life support. Terri’s parents said that Michael never mentioned that Terri didn’t want life support until after the malpractice settlement and that, with further treatment, her condition could improve.

Judge Greer appointed attorney Richard Pearse, Jr., to study the case and recommend a solution. Pearse’s report questioned Michael’s credibility, pointing out that he had stopped pursuing treatment for Terri only after the malpractice award. If Terri died, Pearse concluded, Michael would inherit the $700,000 and be legally free to marry a woman he‘d been engaged to for four years. If he divorced Terri, he would lose any claim to the $700,000. Michael’s attorney, George Felos, countered that Pearse was personally biased against the removal of feeding tubes and that the reason Michael had not filed for divorce was that he didn’t want the Schindlers to have the authority to keep Terri on life support. [St. Petersburg Times, 1/26/00]

On February 11, 2000, Judge Greer ruled that—in spite of the fact that Terri left no written evidence or advance directive indicating a wish to forego life support—Michael could order all food and fluids withheld from Terri starting on March 12. Greer later changed the target date until after the Schindlers had exhausted all appeals.

Litigation nightmare

Since Judge Greer’s ruling, the Schindlers’ determination to save their daughter’s life has been matched at every step by Michael’s resolve to end her life. Each appeal filed by the Schindlers was met with petitions and appeals by Michael. And it soon became apparent that Judge Greer’s bias was clearly with Michael. (See the Timeline on page 2 for details.)

A bright point for the Schindlers during this litigation nightmare came on October 17, 2001, when the 2nd District Court of Appeals approved their request to have Terri examined by independent doctors and ordered Judge Greer to hold an evidentiary hearing on the doctors’ findings. Michael’s subsequent appeals to stop the medical exams were denied by the Appellate Court on November 1, 2001, and by the Florida Supreme Court on March 14, 2002. At issue then and now is whether Terri is truly in a persistent vegetative state (PVS). If she isn’t, according to Florida law, she cannot be starved and dehydrated to death. [www.terrisfight.org; World Net Daily, 11/1/02]

The hearing

The Appellate Court authorized that five medical experts—two selected by Michael, two by the Schindlers, and one by Judge Greer—examine Terri to determine her condition and whether any treatment would be of benefit. It had been quite a while since she had received any treatment, and, according to the Schindlers, she had regressed significantlly. Prior to 1993, Terri was in rehabilitation and had improved to the point of being able to say “yes,” “no,” and “stop that.” But that was the year Michael stopped her therapy and began moving her to different facilties, finally placing her in a hospice for dying patients. “She hasn’t had her teeth cleaned in 10 years, a mammogram, or therapy,” her father explained. “She was thrown into a room and left to die.” [World Net Daily, 12/1/02; Courier Times, 10/6/02]

On the first day of the hearing, the court viewed a recent videotape of Terri in which she smiled when she heard her mother’s voice, reacted when she saw her mother, and even followed a doctor’s instruction to open and close her eyes and to turn her head in specific directions. [Palm Beach Post, 10/13/02] Video clips of Terri’s clear interaction with her mother were later shown on WFTS, the ABC News affiliate in Tampa, prompting the news anchor to say on the air, “I guess it seems a matter of semantics, but it doesn’t look like a coma.” [S. Drake, Not Dead Yet Server List, 10/14/02]

Yet despite the video, the two doctors solicited by Michael and his attorney, George Felos, a euthanasia advocate, testified that Terri was PVS and there was no hope of improvement. The two physicians chosen by the Schindlers concluded that Terri was not PVS and could still improve with treatment. As expected, the tie breaker, the neurologist appointed by Judge Greer, sided with Michael.

One of Michael’s “experts” was Ronald Cranford, a Minnesota neurologist who makes it his business to testify at high profile “right to die” cases, always in support of death. He even refers to himself as “Dr. Humane Death.” In addition to testifying that Terri was PVS—and discounting Terri’s interaction with her mother on the video as an “involuntary subcortical response,” not recognition—Cranford also told the court that PVS patients and the unconscious in general lack “personhood” and consequently have no constitutional rights. [Naples Daily News, 10/22/02; World Net Daily, 11/1/02; Ragged Edge Online, Issue 6, 2002]

Judge Greer issues death sentence

There wasn’t much about this latest hearing that was surprising, and that includes the judge’s ruling. On November 22, 2002, Judge Greer once again ordered that all Terri’s food and fluids be withdrawn. “Viewing all the evidence as a whole,” the Judge wrote, “and acknowledging that medicine is not a precise science, the court finds that the credible evidence overwhelmingly supports the view that Terry [sic] Schiavo remains in a persistent vegetative state.” [Order, Schiavo v. Schindler, No. 90-2908-GD-003 (FL. Cir. Ct. Nov. 22, 2002)] In his ruling, Judge Greer set Terri’s execution date: January 3, 2003, at 3:00 p.m. He later stayed that date, saying that Terri needed to be kept alive until the Appellate Court reviews the Schindlers’ appeal. [AP, 12/13/02; CNN, 12/13/02] Oral arguments for that appeal are scheduled for April 4, 2003.

Question of abuse surfaces

During the hearing, one of the doctors testified that Terri had a “suspiciously rigid neck,” and that the only other time he had seen this in a cardiac arrest patient was in a case of an attempted strangulation. This testimony prompted Pat Anderson, the Schindlers’ attorney, to reexamine Terri’s medical records. Among those records was a report on a total-body scan performed on Terri in 1991, 13 months after she collapsed. The scan showed that Terri had fractures of the first lumbar vertebra as well as several thoracic vertebrae, fractures of both sacroiliac joints and both knees and ankles, multiple rib fractures, and a compression fracture of her thigh. Doctors who reviewed the scan and the report concluded that she had a history of severe physical abuse. “Somebody worked her over real good,” one physician said. Terri’s records also indicate that her progress in rehabilitation was hampered by “ossification” or “bone matter that forms around fractures,” which indicates that the fractures were not fresh. [World Net Daily, 11/13/02; Tampa Tribune, 11/13/02; St. Petersburg Times, 11/13/02]

Judge Greer denied Anderson’s motion to allow discovery of this body-scan evidence during the hearing. His denial will be one of the issues before the Appellate Court. [www.terrisfight.org] Michael’s attorney called Anderson’s motion “garbage,” calling it “rife with unattributed hearsay, rank innuendo and libel.” [World Net Daily, 11/14/02]

But during the January 2000 hearing, Terri’s friend and co-worker testified that she frequently saw bruises on Terri and that Terri had said they were from her husband “pinching her.” The friend also said that Terri and Michael had had a violent argument on the day Terri collapsed and that she had tried to convince Terri not to stay home that night. Terri ignored her friend’s advice. [World Net Daily, 11/13/02]

What concerns Anderson and the Schindlers is the fact that, just prior to this latest hearing, Michael filed a petition requesting that the malpractice settlement money reserved for Terri’s care be used to pre-pay her cremation and burial costs. [World Net Daily, 11/1/02] Judge Greer granted the petition, a clear indication of his bias in this case. But, for the Schindlers, the request for a quick cremation coupled with the allegation of abuse “raises many doubts as to what really happened” the night Terri collapsed. [www.terrisfight.org]

And, as for the $700,000 awarded to Terri for her long-term care, it’s almost gone. That’s how Michael has paid for all the legal costs he’s incurred trying to end Terri’s life. [AP, 11/16/02; World Net Daily, 11/1/02; Ragged Edge Online, Issue 6, 2002]

The Terri Schiavo Case Timeline 2000 – Present2000 – Present

Sources: www.terrisfight.org, court records, and news accounts


Countries clamp down on assisted-suicide trade

In recent months, three countries have taken legal action against assisted-suicide advocates and their wares:


Irish authorities have announced plans to begin extradition proceedings against American Unitarian minister George Exoo and Canadian assisted-suicide advocate Evelyn Martens for their involvement in the January 26, 2002, death of 49-year-old Rosemary Toole in Dublin.

Aiding and abetting a suicide is illegal under Ireland’s Criminal Law (Suicide) Act of 1993 and carries a 14-year prison sentence. [Irish Examiner, 2/4/02]

When Toole’s body was found, her head was covered with a plastic “Exit Bag” secured tightly around her neck, and a tube from a helium canister was inserted so that she could breathe in concentrated, lethal levels of the gas. It was a classic assisted-suicide scene, straight off the pages of the suicide manual Final Exit by euthanasia guru Derek Humphry, who reportedly had sold a copy of the book to Toole. (See Update, 2002, #1, p. 5.)

Even though Toole’s death was Ireland’s first known assisted suicide, it didn’t take long for Irish police to find out who the “assisters” were. After examining her phone records and computer e-mail messages, police confirmed that Exoo and his live-in companion Thomas McGurrin had traveled from Beckley, West Virginia, to Dublin where they met Toole at the airport. For the next few days, the trio rented a car and took a sightseeing trip to the western part of Ireland so that McGurrin could trace his family’s roots.

Toole paid each man over $3,000 for travel expenses, then brought them to an apartment she had rented to end her life. [London Telegraph, 2/2/03]

Exoo and McGurrin run a small death assistance organization called “Compassionate Chaplaincy” out of their West Virginia home and are known within right-to-die circles for their willingness to travel outside the U.S. Neither has had formal medical training. When asked last year how he determines whether a person is truly terminally or hopelessly ill, Exoo replied, “I have to say it’s intuitive. That doesn’t satisfy a lot of people, but I can tell if a person is a crazy and not logical.” [RTE News, 2/5/02 ]

But Toole had a long history of mental illness and acute depression. Reportedly, she had two unsuccessful marriages, no children, was very lonely, had attempted suicide before, and spoke of doing it again. She was not physically ill, a fact verified by her family. But Exoo insists Toole was terminally ill. “She had reported to me that she had a build-up of something or other in her brain,” he explained. “The doctors were unable to control it… She had gone through hell and there was no relief for her.” [The Observer, 1/26/03]

Exoo and McGurrin admit that they helped Toole set up the suicide equipment and that they instructed her through five practice sessions. They also acknowledge that they were present when she died. But it was Toole, they say, who obtained the pills, the bag, and the helium on her own. [Irish Examiner, 2/4/02]

By his own account, Exoo actively urged Toole to hurry up the suicide process. “The last thing she did before she pulled down the bag was take one last toke on the cigarette. I said, ‘OK, Rosemary, time to put the cigarette down, if you don’t mind.’” [The Observer, 2/3/02; Irish Examiner, 2/4/02]

By tracing Toole’s e-mail, detectives were able to establish that she had contacted Evelyn Martens in Victoria, Canada, to request a plastic bag that she could use to end her life. In turn, Martens, a member of the Right to Die Network of Canada, sold the customized Exit Bag to Toole and finalized the transaction via the Internet. It’s believed that Martens is the woman who referred Toole to Exoo. [Vancouver Sun, 1/28/03]

The International Task Force (ITF) has obtained an Exit Bag and its accompanying instructions from the Canadian group. On a sheet titled, “Deployment of an ‘Exit Bag for Helium,’” it states, “[W]e strongly recommend the presence of a field-worker from either Hemlock’s Caring Friends program, or Compassionate Chaplaincy (based in West Virginia).” (Underlined emphasis added.)

According to Royal Canadian Mounted Police Sgt. Derek Crawford, Marten’s involvement with Toole went beyond e-mail messages. “I couldn’t comment on knowing totally, but there’s certainly more information than that, that I’m aware of.” He acknowledged that the RCMP has been assisting Dublin detectives by providing information on Martens and the Right to Die Network. “They’re looking at the possibililty of numerous other offenses involving her or potentially other people affiliated with her and that organization,” Crawford said.[Vancouver Sun, 1/28/03]


In addition to possible extradition to Ireland, Evelyn Martens faces charges in Canada on two counts of assisting suicide and two counts of counseling to commit suicide. Like in Ireland, aiding and abetting a suicide in Canada carries a maximum sentence of 14 years in prison.

Martens, 71, was arrested shortly after the assisted-suicide death of former nun Monique Charest, 64, on June 26, 2002. She is also charged with an earlier assisted death, that of Vancouver teacher Leyanne Burchell, 53, on January 7, 2002. A pre-liminary hearing to determine if there was sufficient evidence to bind Martens over for trial was scheduled for two days last November, but the prosecution was granted more time since there will probably be more than 30 witnesses called. Authorities are reviewing records of all sudden deaths in British Columbia for the last five years. The hearing was scheduled to resume on February 5th. The court has placed a publication ban on all testimony and evidence until the trial. [Vancouver Sun, 6/29/02, 1/28/03; Cowichan News Leader, 11/19/02; Times Colonist, 7/14/02]

When Martens was arrested, police went to her home and confiscated all suicide equipment, including Exit Bags, helium canisters, and tubing. They also discovered that John Hofsess, founder of the Right to Die Network, had his office in her home. Hofsess recently told those present at the Hemlock Society’s national conference that police had cleaned out his office, taking everything. [13th National Hemlock Biennial Conference, San Diego, CA, 1/12/03]

A second British Columbia woman has also been charged with assisting a suicide. A preliminary hearing last December found that there was sufficient evidence to indict Julianne Zsiros for the death of Linda Whetung, 50, who died of carbon monoxide fumes on March 18, 2001. Zsiros, 38, is accused of counseling as well as aiding and abetting a suicide. Her trial is scheduled for April 7th and is expected to last three weeks. [Times Colonist, 11/22/02, 12/6/02] It is not clear whether Zsiros and Martens are connected in any way.


On January 9, 2003—when Dr. Philip Nitschke arrived at Sydney’s airport and boarded the plane that was to take him and his latest death-producing device to the U.S.—he was met by Australian customs agents who promptly confiscated the devise. They also took a set of Exit-type bags that Nitschke had designed after customs officials cut off the supply from Canada’s Right to Die Network. (See Update, 2002, #3, p. 7.)

“They were waiting for me,” Nitschke told reporters. “It’s clear. We’d been quite public about bringing the machine to the U.S. to demonstrate it.” “I’m very angry about it,” he said. [AP, 1/13/03]

Custom agents told Nitschke, dubbed Australia’s Dr. Death, that his new machine and Exit Bags could not leave the country because of a newly amended law, the Prohibited Export Act, which now prohibits the exportation of items dealing with suicide. [news.com.au, 1/11/03; Sydney Morning Herald, 1/11/03]

Nitschke was scheduled to unveil his device, called the COGen machine, at the national Hemlock Society conference on January 12 in San Diego, CA. Nitschke obtained funding from Hemlock USA to develop the COGen, which consists of a small canister, an intravenous drip bag, and nasal tubing. Chemicals in the canister produce deadly carbon monoxide, which is inhaled through the nasal tube.

“It has all the essential elements of being simple, transportable and the patients use it themselves,” explained Derek Humphry, Hemlock founder and author of the how-to book Final Exit. “This type of machine cuts out the legal risk,” he added. [AP, 1/13/03] Nitschke told cheering conference attendees, “You don’t need a doctor! You can die without one!” He further touted, “This may be an answer for terminal [sic] ill people who want a peaceful death….” [BBC, 1/13/03]

It is interesting to note that California, the state hosting the Hemlock conference, has a law prohibiting the use of carbon monoxide gas to euthanize animals. The law was enacted in 2000 because carbon monoxide deaths are considered inhumane and cruel to animals. [California Penal Code §597u (2003); Wisconsin AG Connection, 1/16/03]

Australia’s Dr. Death

Supported by the Hemlock Society USA

There is an old folk wisdom: “You are known by the company you keep.” As is true of most folk wisdom, the saying has much to recommend it. To use an extreme example, if you hung out with and financially supported a known terrorist, most people would reasonably think that you were a terrorist too.

Which brings to mind the Hemlock Society of the United States, perhaps the world’s largest assisted-suicide advocacy group. No, they are not terrorists. But the organization’s close association with and financial support for Australian suicide fanatic Dr. Philip Nitschke exposes how radical Hemlock really is.

For those who haven’t heard of him, Nitschke is the Australian Jack Kevorkian. (The murderer Kevorkian is another Hemlock favorite despite his oft-stated goal of using assisted suicide to open the doors to “obitiatry,” e.g., medical experimentation on people being euthanized.) While Nitschke doesn’t publicly assist suicides and dump the bodies of victims at local hospitals the way Kevorkian did, he does travel Australia and New Zealand giving well publicized how-to-commit-suicide classes. He also manufactures plastic suicide bags—”the Exit Bag”— for distribution to members of an Australian euthanasia advocacy group. Nitschke also hopes to purchase a suicide death ship to take past the Great Barrier Reef into international waters where he would engage in the mass euthanasia of sick and disabled people who wanted to die.

As surreal and macabre as all of this may sound, it is actually pretty conventional assisted-suicide-advocacy fare. What makes Nitschke stand out from the pack is his desire to give troubled teenagers access to a suicide concoction—the so-called “peaceful pill”—that Nitschke is formulating from generally available household products.

Nitschke’s promotion of suicide for troubled teens first came to light in a 2001 interview on National Review Online. At one point, NRO’s Kathryn Jean Lopez asked Nitschke who would qualify for access to his suicide pill. His response was as chilling in its candor as it was for its utter disregard for the value of human life:

This difficult question I will answer in two parts. My personal position is that if we believe that there is a right to life, and then we must accept that people have a right to dispose of that life whenever they want…. I do not believe that telling people they have a right to life while denying them the means, manner, or information necessary for them to give this life away has any ethical consistency. So all people qualify, not just those with the training, knowledge, or resources to find out how to ‘give away’ their life. And someone needs to provide this knowledge, training, or resource necessary to anyone who wants it, including the depressed, the elderly bereaved, the troubled teen. If we are to remain consistent and we believe that the individual has the right to dispose of their life, we should not erect artificial barriers in the way of subgroups that don’t meet our criteria.

In other words, assisted suicide should not be restricted to one “subgroup” of people with terminal illnesses.

“This would mean,” Nitschke continued, “that the so-called peaceful pill should be available in the supermarkets so that those old enough to understand death could obtain death peacefully at the time of their choosing.” (Emphasis added.)

Does Nitschke really believe this? Surely, some might say, he misspoke under the pressure of a microphone-in-the-face style interview.

But that excuse won’t fly. This particular Q&A was done via e-mail — so Nitschke had all the time he needed to write and edit his responses to NRO’s questions. Nitschke wrote those words because he deeply believes them.

Nitschke’s actions match his advocacy. He is currently hip deep in a heated controversy surrounding the suicide of an Australian woman named Nancy Crick. Crick became famous in Australia when she announced publicly that she was under the care of Nitschke and was planning her suicide, because, she and Nitschke said, she was dying from terminal cancer. That put the Australian media into an American-style feeding frenzy, which became white-hot, when, after months of equivocating, she finally killed herself in front of a group of awestruck euthanasia advocates who actually applauded when she took the pills. (Nitschke, fearing jail, left Crick’s side before she did the deed.)

Then came the autopsy. Oops. It turned out that Crick was not dying from cancer. Moreover, Nitschke soon admitted that he and Crick both knew that she wasn’t terminally ill. However, rather than being repentant or embarrassed that he had supported Crick’s suicide desire even though he knew she wasn’t dying, Nitschke argued that her non-terminal condition was “irrelevant” because she was “hopelessly ill” with a painful digestive problem. Only later did he halfheartedly apologize for lying to the media.

How is Hemlock involved in this madness? The organization has paid Nitschke tens of thousands of dollars to develop the “peaceful pill.” Moreover, despite his outspoken advocacy for making the peaceful pill available to troubled teens and in supermarkets, Hemlock recently invited Nitschke to present “What’s New in Hastening the Dying Process” at their January National Convention in San Diego, Calif.

Clearly, the Hemlock Society likes Philip Nitschke.

This did not surprise those of us who pay close attention to Hemlock Society advocacy. In recent years, the organization’s publicly stated beliefs have become increasingly Nitschke-like. For example, little noticed by the media, the Hemlock Society of the United States recently announced that it no longer wants to restrict the legalization of assisted suicide to people with terminal illnesses. Rather, it now urges that assisted suicide be available legally to people who are not dying, specifically to the “hopelessly ill,” that is, to people like Nancy Crick.

Hemlock’s leaders have privately expressed such beliefs for years. Thus, in 1998, Dr. Richard McDonald, Hemlock’s medical director, joined Nitschke and other assisted-suicide physician ideologues in signing the “Zurich Declaration on Assisted Dying.” Meant more for private rather than public consumption, the Zurich Declaration called for the legalization of assisted suicide “for all competent adults suffering severe and enduring distress.” This comes very close to Nitschke’s death-on-demand philosophy. No wonder Hemlock loves Nitschke.

Yes, we are known by the company we keep. Through their moral and financial support of the odious Philip Nitschke, the Hemlock Society has revealed its true colors. Society should judge the organization and its advocacy, accordingly.

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 11/26/02 and is reprinted here with the author’s permission.

Swiss assisted-suicide group attracts foreign, vulnerable patients

Switzerland, once known in the tourism business for its spectacular alpine landscape, precision timepieces, and chocolate, has a new claim to fame as the world’s death mecca. After the BBC aired an investigative report on the assisted-suicide group Dignitas last August, physically and mentally vulnerable patients have been lining up for a one-way trip to Zurich. (See Update, 2002, #3, p. 1.)

One such desperate patient, 74-year-old Reginald Crew from the U.K., died on 1/27/03 in the presence of his wife, daughter, and a TV film crew from the “Tonight” show on ITV1. Crew, who had motor neurone disease (ALS), had been telling the media of his plan to seek out Dignitas’ services weeks before he actually did. It cost him £46 to become a Dignitas member, a requirement for death eligibility. He blamed the U.K.’s law banning euthanasia and assisted suicide for forcing him to seek out Dignitas. “I don’t want to go on living like this,” he told the BBC. “I have had enough. I’d like to go tomorrow—I’m that desperate.” [BBC, 1/2/03]

Winifred, Crew’s wife and caregiver, also had had enough. “I have come to the stage now where life is so bad that, even if they put me in prison when I come back, I don’t care, because I can’t stand it any more.” [Daily Post, 12/31/02]

Crew was the second Briton to kill himself in the apartment Dignitas uses for deaths. The first was a 77-year-old cancer patient who wanted to remain anonymous. He died on 10/23/02. [The Observer, 11/3/02]

According to Dignitas director Ludwig Minelli, a Swiss lawyer, his group’s services include 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. 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. Minelli readily admits that Dignitas will accept people who are terminally ill, have Alzheimer’s disease, are depressed, or have other forms of mental illness. He claims that Dignitas has assisted the suicides of 146 people over the last four year. [London Telegraph, 8/13/02; Copenhagen Post, 1/31/03]

While Swiss law does not formally legalize assisted suicide, the practice is not prosecuted as long as the assister’s motive is unselfish. It does not require the involvement of a doctor or that the patient be terminally ill. [British Medical Journal, 2/1/03, pp. 271-273]

Back in the U.K., authorities are grappling with whether Crew’s wife and the TV crew who filmed his final hours should be prosecuted under the 1961 Suicide Act, which carries a maximum 14-year sentence. [Liverpool.co.uk, 1/14/03]

Anticipating future legal problems, Britian’s Medical Defence Union (MDU) issued a warning to doctors that they could be liable under British law if they assist or advise a patient regarding suicide. According to MDU’s medical/legal advisor Dr. John Gilberthorpe, “We are advising our members that providing advice which could help a person to end their life in such a way, could result in an investigation for ‘aiding, abetting, counseling, or procuring’ a suicide in the U.K., even if the act took place in another country.” “The law in the U.K. is very clear: it does not allow assisted suicide,” he said. [MDU Press Release, 1/22/03]

A recent confidential poll, taken after Crew’s death by the physicians’ information service Medix UK, found that 45% of the British doctors who responded were against any change in the law to permit assisted suicide, 34% favored such a change, and 21% were unsure. [British Medical Journal, 2/1/03, p. 242]

Currently, more than a dozen British patients are planning to fly to Zurich in the coming months to die with Dignitas’ help. [The Observer, 1/26/03] This prospect has alarmed many members of parliament. According to MP Nigel Waterson, right-to-die proponents use fear to advance their cause. “[T]hey present a case giving no real choice and instead give the impression that either cancer sufferers die in agony or choose euthanasia, or that motor neurone disease patients will die in unrelieved pain by choking and suffocating unless they choose euthanasia. Both concepts bear no truth in relation to modern medicine and hospice care.” [Eastbourne News, 1/2/03]

Britain is not the only country concerned about its citizens going to Zurich to die. In the week after Denmark’s TV2 aired a documentary on Dignitas, 20 Danish patients put their names on a Dignitas waiting list. A Copenhagen newspaper reported that the “suicide clinic has provoked massive resistance and staunch criticism all over Europe.” The chairman of Denmark’s National Ethics Council, Ole Hartling, “blasted” Dignitas, saying that “even a half-sanctioned offer of euthanasia can induce individuals to suicide who never would have taken that step on their own.” [Copenhagen Post, 1/31/03]

Dignitas has even alarmed the Swiss parliament, where there is a move to ban “suicide tourism” and to place tougher bans on assisted suicide. “Tourists come at lunchtime and by the afternoon they are dead,” said MP Dorle Vallender. “This is not an image we want of our country and legal system.” [Time, 10/14/02]

Doctors found to take DNR orders too far

A study recently published in the Journal of the American Geriatric Society found that the presence of a do-not-resuscitate (DNR) order may affect the overall level of care a doctor provides for a patient.

A DNR order is meant to inform a medical staff that a particular patient does not wish to undergo cardiopulmonary resuscitation (CPR) in the event of cardiac arrest. The order does not apply to any other treatment or intervention.

But researchers, Dr. Mary Catherine Beach of Baltimore’s Johns Hopkins University School of Medicine and Dr. R. Sean Morrison of New York’s Mount Sinai School of Medicine, found that doctors were more apt to withhold from patients other treatments not covered by a DNR order.

“The results support the hypothesis that, when presented with identical patient scenarios, physicians will withhold treatments other that CPR for patients with DNR orders,” the researchers wrote. “Based solely on the presence of a DNR order, physicians are less likely to agree to initiate procedures ranging from complex therapies, such a ICU transfer, to simpler interventions, such as blood transfusions.”

Answering their own question— “Why are DNR orders so broadly interpreted?”—the researchers concluded, “Patients with DNR orders are often quite ill, and physicians may assume, that because these patients have already chosen to have one life-prolonging treatment withheld, they would wish to have other life-prolonging treatments withheld, if given the choice. Yet patients may resonably wish only to avoid CPR but still be interested in pursuing a variety of other therapies in order to live as long as possible.” [Emphasis added.]

Researchers also noted, “[E]ven hospital DNR policies have been shown to be confused about the scope of a DNR order.” [Beach and Morrison, “The Effects of Do-Not-Resuscitate Orders on Physician Decision-Making,” Journal of the American Geriatric Society, December 2002, pp. 2057-2061]

News Notes

Round 2 in the legislature’s battle over assisted suicide has begun in Hawaii. Last year, a bill to legalize the practice was narrowly defeated by a final vote of 14-11. This year, the Hawaiian Death with Dignity Act has once again been introduced in the Senate and has been embraced by Hawaii’s Women’s Caucus as a priority issue. This group is a coalition of over 200 private and professional organizations. The state’s new governor, Linda Lingle, has said she opposes assisted suicide and would veto the bill unless there is overwhelming support for it in the legislature. [Star Bulletin, 1/24/03]

The newly formed Death with Dignity Vermont (DWDV) has legislators in both state houses poised to introduce their Vermont Death with Dignity Act, a clone of Oregon’s law According to a DWDV spokesman, they are optimistic about their chances of passing the bills given the financial support they have received from the Hemlock Society USA. [13th National Hemlock Biennial Conference, San Diego, CA, 1/10/03]

There will be more on Vermont and Hawaii as well as a special report on the Hemlock Society’s national conference in the next Update.

French nurse Christine Malevre has been sentenced to 10 years in prison for the murder of six patients at Francois-Quesnay Hospital outside of Paris. She claimed she was merely ending patients’ suffering. Psychiatrists who had examined her reported that she had a “morbid fascination with illness” and was fully aware of her actions. A lawyer for three of the victims’ families expressed outrage over the 10-year sentence. “If Christine Malevre had been tried for killing [six] people in good health, we’d be far from 10 years and closer to life in prison. [BBC, 2/1/03]