Update 036: Volume 20, Number 2 (2006)

ITF director debates euthanasia in Ireland

On January 18, 2006, the historically renowned Trinity College Dublin Debating Society (the oldest debating society in the world, established in 1770) hosted a debate on the proposition “That This House Would Legalize Euthanasia.” The event was filmed for a Canadian documentary on the ongoing controversy over Oregon’s law allowing physician-assisted suicide (PAS).

Of the four invited euthanasia experts, attorney Ludwig Minelli spoke first. His Swiss organization, Dignitas, has facilitated the deaths of well over 450 people, mostly foreigners. Minelli told the audience that the quality of people’s lives is important, and being able to end your life if the quality is no longer acceptable is a human right. Suicide is a major social problem, he added, and society should accept it “and not say suicide should not be.” Suicidal people should have a safe place to go without fear, where they can be assisted. “You do not leave for a long journey without having consulted a travel agent,” he told the audience.

The second debater was Father Kevin Doran, secretary of the Irish Bishops Conference on Bioethics. He countered that dramatic statements—like, “I wish I were dead”—should not be taken literally. Instead, it likely means that individuals feel they cannot go on living in their present situations. A caring society, Doran explained, works to remove the person’s physical or emotional pain, as in the case of palliative care.

Next up was Margaret Branthwaite, a doctor, barrister, and former chairman of England’s Voluntary Euthanasia Society (now called Dignity in Dying). She argued that what society needs are laws like Lord Joel Joffe’s PAS bill, currently under consideration in the British Parliament.

“There are patients for whom death is preferable to life,” she said. “Who are we to countermand their [death] decisions.” Using Oregon and the Netherlands as examples, Branthwaite said that euthanasia does not adversely affect society. She claimed that 80% of the public favors euthanasia, so it’s only a matter of time before it’s legalized.

Attorney and author Rita L. Marker, executive director of the International Task Force on Euthanasia & Assisted Suicide, pointed to the fact that PAS isn’t about private choice, but rather a radical change in public policy. Quoting a British Medical Journal article by Branthwaite that named autonomy and the elimination of suffering as the goals of euthanasia, Marker showed that the PAS bills that Branthwaite supports actually contradict those laudable goals by limiting PAS to competent, terminally-ill adults. “Why would a patient only have autonomy if they were terminally ill?” she asked. The Dutch experience—where euthanasia is now performed on infants and children under 12—proves that euthanasia cannot be limited.

Following the arguments, a vote was taken. Doran and Marker’s side won the debate, and the proposition to legalize euthanasia was defeated.

[See Ireland for more information.]

Supreme Court ruling no endorsement of
Oregon’s assisted suicide law

The ink on the U.S. Supreme Court’s decision in Gonzales v. Oregon was barely dry before some news rooms across the country heralded the ruling with headlines like, “Justices back Oregon suicide law,” and even “Supreme Court upholds physician-assisted suicide.” But the headlines were wrong.

The scope of the 6 to 3 ruling, handed down on January 17, 2006, was exceedingly narrow and in no way endorsed physician-assisted suicide (PAS) as desirable public policy or the Oregon Death with Dignity Act (ODWDA) as constitutional law. Instead, the high court’s majority ruling focused on procedural technicalities, finding that former Attorney General John Ashcroft exceeded both his authority and his expertise when he issued his “Interpretive Rule” that the use of federally controlled drugs—namely barbiturates—to intentionally cause patients’ deaths violated the Controlled Substances Act (CSA), as enacted by Congress in 1970 and amended in 1984. In other words, Ashcroft didn’t go about arriving at his conclusion in the right way.

Ashcroft released his determination in 2001, four years after Oregon enacted the only permissive PAS law in the country. He did so after consulting with the U.S. Office of Legal Counsel and conducting a review of legal precedents. Ultimately, he determined that the practice of assisted suicide was not a medically “legitimate” use of barbiturates under the federal CSA and that doctors who prescribe, dispense, or administer those controlled drugs to assist suicide risk losing their federally-issued prescribing licenses. [Ashcroft, “Dispensing of Controlled Substances to Assist Suicide,” 11/6/01, p. 1. Hereafter cited as Rule.]

The majority ruling

The majority ruling, written by Justice Anthony Kennedy, acknowledged that Ashcroft’s determination regarding the illegitimacy of assisted suicide as a medical practice was “reasonable,” based on “the teachings of Hippocrates, the positions of prominent medical organizations, the Federal Government, and the judgment of the 49 States that have not legalized physician-assisted suicide….” However, the attorney general “is not authorized to make a rule declaring illegitimate a medical standard for care and treatment of patients that is specifically authorized under state law.” [Gonzales v. Oregon, 546 U.S. 04-623 (2006), slip op. pp. 11 & 26. Hereafter cited as Majority.]

According to the majority, the attorney general does not have “the sole delegated authority under the CSA.” “He must instead,” Kennedy wrote, “share it with, and in some respects defer to the Secretary [of Health & Human Services], whose functions are likewise delineated and confined by the statute…. [T]he Secretary’s recommendations on scientific and medical matters bind the Attorney General.” [Majority, p. 18] Furthermore, the federal government’s argument—that Ashcroft’s determination was a “legal one and not a medical one”—was without merit. “[T]he authority claimed by the Attorney General” the majority held, “is both beyond his expertise and incongruous with the statutory purposes and design.” [Majority, slip op., p. 20]

The dissents

There were two dissenting opinions, one written by Justice Antonin Scalia (with Chief Justice John Roberts and Justice Clarence Thomas signing on) and one by Justice Thomas alone.

Scalia, whose dissent was almost as long as the Kennedy’s opinion, countered the majority’s technical and procedural arguments point by point. Referring to Ashcroft’s Interpretive Rule as “The Directive,” Scalia wrote, “In sum, the Directive’s construction of ‘legitimate medical purpose’ is a perfectly valid agency interpretation of its own regulation; and if not that, a perfectly valid agency interpretation of the statute [CSA].” Moreover, Scalia held, “If the term ‘legitimate medical purpose’ has any meaning, it surely excludes the prescription of drugs to produce death.” [Gonzales v. Oregon, 546 U.S. 04-623 (2006) (Scalia, J., dissenting), slip op., pp. 10 & 25. Hereafter cited as Scalia Dissent.]

According to Scalia, Congress explicitly authorized the attorney general “to promulgate rules and regulations… relating to the registration and control of the manufacture, distribution, and dispensing of controlled substances….” [Scalia Dissent, slip op., p. 20]

Addressing the majority’s contention that the Secretary of Health & Human Services has exclusive authority over scientific and medical determinations, Scalia wrote, “…Congress granted the Secretary specifically defined authority in the areas of scheduling [drugs] and addiction treatment, without otherwise mentioning him in the registration provisions” related to the federal licensing of doctors to prescribe controlled substances. Therefore, it is “perfectly consistent with an intelligent ‘design of the statute’ to give the Nation’s chief law enforcement official, not its chief health official, broad discretion” over the registration and deregistration of doctors. That “no more depends” on a medical judgment “than does the legitimacy of polygamy or eugenic infanticide.” [Scalia Dissent, slip op., pp. 22-23]

Justice Thomas’ concise dissent centered on the contradictory findings in both Gonzales v. Oregon and the 2005 Supreme Court ruling in Gonzales v. Raich, dealing with the CSA and a California law legalizing marijuana for medical use. Thomas pointed out the obvious: “[A] majority of this Court (a mere seven months ago) determined that the CSA effectively invalidated California’s law because ‘the CSA is a comprehensive regulatory regime specifically designed to regulate which controlled substances can be utilized for medicinal purposes, and in what manner.’” “Today,” Thomas wrote, “the majority beats a hasty retreat from these conclusions.” [Gonzales v. Oregon, 546 U.S. 04-623 (2006) (Thomas, J., dissenting), slip op., p. 1]

Congress has power to act

Nothing in the court’s majority ruling in the Oregon case precludes action on the part of Congress to either amend the CSA to clearly address the assisted-suicide issue or to pass a new statute prohibiting the practice.

Assisted-suicide advocates use
high court ruling to advance cause

As soon as the Supreme Court issued its ruling in Gonzales v. Oregon, assisted-suicide proponents spun it as an outright endorsement of their efforts to legalize the practice in targeted states.

It only took them days in Hawaii to get three new physician-assisted suicide (PAS) bills introduced in the legislature—two of which actually cite Gonzales v. Oregon in their preambles as paving the way for passage. Despite the spin, it is unlikely that any of the bills will go very far this election year.

California and Vermont also have active PAS bills in their legislatures. The “California Compassionate Choices Act” is a hold-over from last year. When faced with sure defeat in the Assembly, the bill’s authors slyly gutted a bill already in the liberal Senate and amended it with the Assembly bill’s PAS wording. That bill will be heard in the Senate Judiciary Committee this spring. Vermont’s bill is also scheduled for a hearing soon, but it’s passage is unlikely this year.

In Washington State, just weeks after the court’s ruling, former Gov. Booth Gardner announced plans to spearhead a 2008 voter initiative drive to legalize both euthanasia and Oregon-style PAS in that state. [AP, 2/7/06]

Oregon issues 2005 PAS report

On March 9, 2006, the Oregon Department of Human Services (ODHS) released its eighth annual report on physician-assisted suicide (PAS) deaths in 2005 under Oregon’s Death with Dignity Act (DWDA). As was the case with all previous reports, this latest accounting covers only the PAS deaths that were reported to the state by the very doctors who supplied lethal drug overdoses to patients. The ODHS acknowledges that their data “do not include patients and physicians who may act outside the provisions of the DWDA.” [“Eighth Annual Report on Oregon’s Death with Dignity Act,” 3/9/06, p. 15; hereafter cited as PAS Report] The ODHS’s data is obtained from physician and pharmacy reports, physician interviews, and death certificates. Patients are never interviewed prior to their deaths. [PAS Report, p. 9]

In 2005, a total of 38 patients reportedly ingested prescribed lethal drugs and died. Thirty-nine (39) doctors wrote 64 prescriptions for lethal doses of barbiturates. Of those who received the 64 prescriptions, 32 took the drugs and died in 2005. Of the remaining 32 patients who did not take the drugs, 15 died naturally of their illnesses, while 17 were still alive on December 31, 2005. Six additional patients, who had been prescribed barbiturate overdoses in 2004, died in 2005—bringing the total number of reported deaths to 38. [PAS Report, p. 13] Only 2 PAS patients had been referred for a psychiatric evaluation, and in just 8 cases the prescribing doctor was present when the patient died. [PAS Report, p. 23]

In addition, there were only three “complication” cases listed in the report: two patients regurgitated some of the lethal dose, but still died; in the other case, the patient did not die. [PAS Report, p. 5] David E. Prueitt woke up three days after taking his lethal dose of barbiturates asking, “What the hell happened? Why am I not dead?” His family leaked his botched suicide to the Oregonian newspaper, prompting some to question whether his case would have ever surfaced otherwise. [Oregonian,3/4/05]

The accuracy of the ODHS’ reports has been seriously questioned in the past because of the lack of data on clinical problems or complications. In 2004, Jim Kronenberg, of the Oregon Medical Association, told a British House of Lords Committee investigating the DWDA, “[T]he way the law is set up, there is really no way to determine that [complications occurred].” Lord McColl, a surgeon, found the lack of reported complications disturbing. “We come here and I am told there are no complications,” he remarked. “There is something strange going on.” [House of Lords Report, “Assisted Dying for the Terminally Ill Bill,” Vol. II: Evidence, 4/4/05, pp. 334 & 347. Hereafter cited as HL.]

Dr. Katrina Hedberg, the lead author of most of Oregon’s official reports, told the House of Lords committee that, after the fatal drug overdose is prescribed by the doctor, there is no tracking of the patient to see if there were any problems. “Our job is to make sure that all the steps happened up to the point the prescription was written,” she revealed. “In fact, after they write the prescription, the physician may not keep track of the patient…. [T]he law itself only provides for writing the prescription, not what happens afterwards.” Hedberg also explained, “[W]e do not have a way to track if there was a big bottle [of lethal drugs] sitting in somebody’s medicine cabinet and they died, whether or not somebody else chose to use it.” [HL, pp. 259 & 262; emphasis added]

Hedberg admitted there have been “a number of cases over the years” where the PAS law’s provisions have been violated, but the ODHS was “not given the resources to investigate” and “we do not have any legal authority to insert ourselves.” [HL, p. 266] Even in the few cases where the ODHS reported doctors to the state board of medical examiners for violating the law’s safeguards, no disciplinary action was taken. [HL, p. 323]

One of the law’s requirements is that the patient have six months or less to live, a difficult prognosis to determine. Dr. Peter Rasmussen, an oncologist who has assisted in numerous PAS deaths, told the British committee that predicting patient’s life expectancy is often “inaccurate.” “If we say a patient has six months to live and we are off by 100 percent and it is really three months or even 12 months, I do not think the patient is harmed in any way….” [HL, p. 312] More information from British House of Lords Committee Report.
Eight Years of Oregon’s Official Statistics

Documents reportedly point to Katrina euthanasia deaths

As reported in the last issue of the Update, Louisiana authorities have been investigating whether severely ill patients at New Orleans Memorial Hospital were euthanized after the devastation caused by hurricane Katrina last year. While the probe is still ongoing with no official findings released as yet, National Public Radio (NPR) aired a report on February 16, 2006, regarding its review of “secret court documents” related to that investigation that strongly suggest such deaths actually did occur.

According to NPR reporter Carrie Kahn, four key witnesses heard discussions at the hospital that the decision had been made to actively end the lives of some of the patients with lethal doses of painkillers. None of the witnesses, however, knew who had ultimately made that decision.

The patients targeted for death were on the seventh floor of the hospital, a floor leased out to LifeCare Hospitals, which provided long-term patient care. Angela McManus’s mother, 78 year-old Wilda, was on that floor. McManus stayed with her mother during and after the hurricane, but nurses eventually asked her to go down to the first floor so she could be evacuated. Her mother, she was told, would be evacuated with the other seventh floor patients by helicopter.

The situation at the hospital was horrendous: no power, the stench of sewers backing up everywhere, temperatures inside over 100 degrees, and patients in severe distress. When McManus reached the first floor, she could hear gunshots outside, as looters and others stormed the hospital for drugs and what some perceived as safety from the flood. “So they boarded the doors up, and we were in there, just smothering all night long,” she said.

The following morning, McManus learned that her mother was still on the seventh floor, and had obviously not been evacuated. Rushing to her mother’s side, she overheard nurses saying that LifeCare’s patients with “do not resuscitate” (DNR) orders would not be evacuated. She “frantically tried to rescind her mother’s DNR order, to no avail.” When she was ordered by police to leave the seventh floor for the final time, only eight of LifeCare’s 24 patients, including her mother, remained alive.

NPR reported that, subsequently, “LifeCare’s pharmacy director, the director of physical medicine and an assistant administrator [said] they were told that the evacuation plan for the seventh floor was to ‘not leave any living patients behind,’ and that, ‘a lethal dose would be administered.” Later, the pharmacy director recalled that Dr. Anna Pou, a head and neck surgeon, and two nurses told him that the decision had been made to euthanize LifeCare’s patients. NPR said that the court documents do not indicate who actually gave that order.

The unnamed pharmacy director also said that Dr. Pou showed him a large pack of morphine vials, and that, before he was evacuated, he saw her and the two nurses entering the rooms of the remaining seventh floor patients. Nowhere in the documents, according to NPR, “does anyone confirm seeing doctors or nurses administering lethal doses of morphine.” [NPR News, “All Things Considered,” 2/16/06]

Another Memorial Hospital physician, Dr. Bryant King told CNN last year, that a conversation allegedly occurred between a Memorial Medical Center administrator and a female doctor discussing the need to euthanize some patients. King said that, about three hours later, he spied Dr. Pou with “a handful of syringes.” He did not know what they contained. [CNN, 10/13/05 & 12/22/05]

The state Attorney General’s office has subpoenaed over 70 witnesses and accumulated volumes of evidence. As yet, no charges have been filed. While toxicology tests were ordered on a number of LifeCare’s patients, New Orleans coroner, Frank Minyard, said the tests may not be accurate given the fact that the bodies were not taken from the hospital until two weeks after the hurricane and were badly decomposed. Meanwhile, Angela McManus wants answers about her mother’s death and has retained an attorney to investigate it. [NPR News, 2/16/06]

Even though Haleigh Poutre is conscious, she’s not necessarily safe.

by Wesley J. Smith

In the court (and courts) of life and death, a little 11-year-old Massachusetts girl named Haleigh Poutre could be the next Terri Schiavo. For those who have not heard the tragic story, Haleigh was beaten nearly to death last September, allegedly by her adoptive mother and stepfather. The beating left her unconscious and barely clinging to life.

Within a week or so of the beating, most of her doctors had written her off. They apparently told Haleigh’s court-appointed representative and the Department of Social Services (DSS) that she was “virtually brain dead.” The DSS quickly went to court seeking permission to remove her respirator and feeding tube. The court agreed, a decision affirmed recently by the supreme court of Massachusetts.

And so, no doubt with the best of intentions, a little girl who had already suffered so much was stripped by the Commonwealth of Massachusetts of even the chance to fight to stay alive. If she didn’t stop breathing when the respirator was removed, which doctors expected, she would slowly dehydrate to death.

Close call

Then came the unexpected: Before “pulling the plug” on Haleigh, Harry Spence, the head of DSS, decided to visit her. He was stunned. Rather than finding a little girl with “not a chance” of recovery, as doctors had described Haleigh’s condition to him (as reported by the Boston Globe), Haleigh was conscious. She was able to give Spence a yellow block when asked to by a social worker and respond to other simple requests.

Laudably, Spence immediately called off the dehydration. Haleigh is now off her respirator and breathing on her own. She has been transferred out of the hospital and is currently being treated in a rehabilitation center.

Lest anyone think that Haleigh’s apparent consciousness protects her from suffering the fate of Terri Schiavo, who was ordered dehydrated by a Florida court based, in part, on a finding that she was unconscious, think again. In most states, exhibiting consciousness is not a defense against dehydration for profoundly impaired patients. Indeed, cognitively disabled people who are conscious are commonly dehydrated throughout the country. So long as no family member objects, the practice is deemed medically routine.

How can this be? The simple answer is that tube-supplied food and water — often called “artificial nutrition and hydration” (ANH) — has been defined in law and in medical ethics as a medical treatment. This means that it can be refused or withdrawn just like, say, antibiotics, kidney dialysis, chemotherapy, surgery, blood pressure medicine, or any other form of medical care. Indeed, removing ANH has come to be seen widely in medicine and bioethics as an “ethical” way to end the lives of cognitively disabled, “biologically tenacious” patients (as one prominent bioethicist once described disabled people like Terri Schiavo and Haleigh Poutre), without resorting to active euthanasia.

Defining dehydratable people

It wasn’t always so. It used to be thought of as unthinkable to remove a feeding tube. Then, as bioethicists and others among the medical intelligentsia began to worry about the cost of caring for dependent people and the growing number of our elderly — and as personal autonomy increasingly became a driving force in medical ethics — some looked for a way to shorten the lives of the most marginal people without violating the law or radically distorting traditional medical values. Removing tubes providing food and fluids was seen as the answer. After all, it was argued, use of a feeding tube requires a relatively minor medical procedure. Moreover, the nutrition provided the patient is not steak and potatoes, but a liquid formula prepared under medical auspices so as to ease digestion. There can also be complications such as diarrhea and infection.

Having reached consensus on the matter, the bioethics movement mounted a deliberate and energetic campaign during the 1980s to change the classification of ANH from humane care, which can’t be withdrawn, to medical treatment, which can. The first people targeted for potential dehydration were the persistently unconscious or elderly with pronounced morbidity. Thus, bioethics pioneer Daniel Callahan wrote in the October 1983. Hastings Center Report, “Given the increasingly large pool of superannuated, chronically ill, physically marginalized elderly it [a denial of ANH] could well become the non treatment of choice.”

In March 1986, the American Medical Association Council on Ethical and Judicial Affairs, responsible for deliberating upon and issuing ethics opinions for the AMA, legitimized dehydration when it issued the following statement: Although a physician “should never intentionally cause death,” it was ethical to terminate life-support treatment, even if:

…death is not imminent but a patient’s coma is beyond doubt irreversible and there are adequate safeguards to confirm the accuracy of the diagnosis and with the concurrence of those who have responsibility for the care of the patient…. Life-prolonging medical treatment includes medication and artificially or technologically supplied respiration, nutrition and hydration.

There it was: Food and fluids provided by a feeding tube were officially deemed a medical treatment by the nation’s foremost medical association, meaning that withdrawing them was deemed the same as turning off a respirator or stopping kidney dialysis.

As often happens in bioethics, once the medical intelligentsia reached consensus, their opinion quickly became law. Thus, in 1990, the Supreme Court of the United States issued its decision in Cruzan v. Director, Missouri Department of Health, which upheld Missouri’s law allowing for the removal of life-sustaining treatment from a person, provided there was “clear and convincing evidence” that the person would not have wanted to live. Unfortunately, the Court also agreed that tube-supplied food and fluids is a form of medical treatment that can be withdrawn like any other form of treatment. (This is often erroneously called the “right to die.”) With the seeming imprimatur of the Supreme Court, all 50 states soon passed statutes permitting the withholding and withdrawal of tube-supplied sustenance — even when the decision was made by a third party.

With that principle established, what did unconsciousness have to do with it? Not a thing. It didn’t take long for the American Medical Association to broaden the categories of dehydratable people. Thus, in 1994, a brief eight years after its first ethics opinion classifying tube feeding as medical treatment that could be withdrawn only when the patient was “beyond doubt” permanently unconscious, the AMA proclaimed it “not unethical” to withdraw ANH “even if the patient is not terminally ill or permanently unconscious.” And that’s where the matter stands today.

But that doesn’t make it right. Don’t get me wrong: People can and should be able to refuse unwanted ANH for themselves, either directly or in a written advance medical directive. But it seems to me that given the certainty of death when denying a patient sustenance — and in light of the profound symbolism of refusing to provide even nourishment — a different standard should apply when third parties seek to refuse tube-supplied food and water on behalf of another.

In such cases, medically inappropriate ANH — such as when the actively dying body can no longer assimilate sustenance — should be able to be refused as other forms of care. But when the decision is a value judgment that a person’s life isn’t worth living because of disability or perceived “quality of life,” then the decision to dehydrate should be considerably constrained.

Which brings us back to poor Haleigh Poutre: Until and unless ANH is recognized as a unique category of care to be governed by its own rules for determining when and whether sustenance can be withheld or withdrawn, Haleigh remains very much at risk. After all, her doctors could still conclude that she will not improve. They could still recommend to the DSS that her food and fluids be withheld lest she grow up profoundly disabled. Her court-appointed representatives could once again agree that an early death is better than a longer disabled life and ask the courts to sanction her dehydration. The juvenile court could promptly hold a new hearing in which the judge would undoubtedly be told by a bevy of “expert witness” bioethicists that dehydrating this child to death would be ethical and morally appropriate even though she is conscious. The court could still order her to die slowly, over two weeks, of dehydration despite her being awake and aware. And the supreme court of Massachusetts could still give final approval to the decision. Such is the sad state of medical ethics and the law in the United States of America.


Wesley J. Smith is a lawyer for the International Task Force on Euthanasia and Assisted Suicide, a senior fellow at the Discovery Institute, and a special consultant to the Center for Bioethics and Culture. His web site is www.wesleyjsmith.com. An earlier version of this article appeared in National Review, 2/1/06.

Editor’s update on Haleigh Poutre:

On January 18, 2006, the day after the Massachusetts Supreme Court upheld a lower court ruling approving the removal of life support (specifically, the ventilator and tube feeding and hydration) from Haleigh Poutre, the now 12 year-old began to breathe on her own and respond to commands.

A tragic victim of cruel abuse allegedly at the hands of her adoptive mother and stepfather, Haleigh was hospitalized last September with cuts, bruises, burns, broken teeth, and a damaged brain stem. Within days, her doctors, the state DSS, and the courts appeared bent on Haleigh’s death, labeling the child “vegetative” with no hope for a “meaningful recovery.” The only reason Haleigh is alive today is due to her stepfather—who would have faced murder charges if the child had died—and his appeal of the lower court ruling clearing the way for life support removal from Haleigh. His likely self-serving appeal bought time for Haleigh to improve.

That improvement resulted in Haleigh being transferred from Baystate Medical Center to Franciscan Hospital for Children in Boston, a facility specializing in pediatric rehabilitation, where she is receiving physical, occupational, and speech therapy. She can now appropriately indicate yes and no to questions, grasp particular objects when asked, communicate with her hands, and eat scrambled eggs. [Boston Herald, 2/11/06, 2/10/06, 2/7/06, 2/1/06; Boston Globe, 3/5/06, 2/12/06, 2/7/06, 1/30/06]

But, her case is cloaked in secrecy. The DSS refuses to release updates on her condition citing an ongoing state investigation of its handling of her case. [Boston Globe, 3/5/06, 2/12/06; The Republican, 2/7/06]

International news notes . . .

Australia’s Dr. Death, Dr. Philip Nitschke, said he is “disappointed” by the recent ruling handed down by the New Zealand Medical Council that he was practicing medicine without a license or an “annual practicing certificate” when he conducted his infamous euthanasia workshops in three New Zealand cities in January. It is during these workshops that Nitschke instructs attendees on ways to make their own lethal “peaceful pill” so that authorities would find it difficult to prosecute them. Suicide assistance is illegal in New Zealand. [New Zealand Herald, 2/21/06; Dominion Post, 2/21/06]

Nitschke had moved his euthanasia-promoting operation—including his group, EXIT, his web site, and all his death-producing gadgets—to New Zealand because Australia banned last January most of what Nitschke and EXIT do. At that time, he said, “The climate is a lot less oppressive in New Zealand.” [Sydney Morning Herald, 11/28/05]

The NZ Medical Council has referred his case to the country’s Ministry of Health for possible action. Nitschke could face a criminal charge carrying up to three months in jail and a $10,000 fine. [ABC Online, 2/20/06; Radio New Zealand, 2/21/06]

In 2005, there were 400 cases of euthanasia reported in Belgium. That is double the number of deaths reported in 2002 when the practice was legalized. The increase is allegedly due to doctors in Flanders, the predominately Dutch section of Belgium, where 80 percent of euthanasia deaths occur. Brussels Free University professor Wim Distelmans said that is because “Flemish doctors have the support of a good network, namely the Life Ending Information Forum.” But Distelmans also acknowledged that, while 400 deaths were reported last year, the vast majority of euthanasia cases go unreported by doctors. In fact, the actual number of cases “is about five times higher than the official figures,” he said. [Expatica, 2/7/06; UPI, 2/7/06]

Belgian authorities are investigating Dr. Marc Cosyns, a GP and lecturer on end-of-life issues at the University of Ghent, who admittedly euthanized 87-year-old Suzanne Roegiest, a dementia patient. Cosyns openly discussed her death in an article published in the medical magazine Huisarts (2/6-7/06). He wrote that the woman had asked, in a lucid moment, to be allowed to die, so, in January, he gave her an overdose of barbiturates in a drink. Cosyns intentionally violated Belgium’s euthanasia law—that mandates that patients be fully competent in order to request death—because he wanted to reignite the controversy over extending euthanasia to dementia patients and children. [British Medical Journal, 2/18/06]

The government of Cambodia has deported an American for running two web sites that promoted the country as an ideal place to commit suicide. “You’re going to die anyway,” the web sites touted, “so why not Cambodia?” In 2003, Roger Graham, 57, went to Cambodia from Paradise, CA, where he had founded the Assisted Euthanasia Society of Paradise. Residing in the province of Kampot, he owned and operated a coffee and internet café. His suicide advocacy came to the attention of the Cambodian government when a British woman, Kim Walton, committed suicide last September after being lured to Kampot by Graham’s website. In November, Kampot Province Governor Puth Chandarith sued Graham for defaming the province’s reputation. [ABC News, 3/4/06; Agence France Presse, 3/4/06; Reuters, 11/9/05]

Zhao Gongmin, a research fellow at the Chinese Academy of Social Sciences, has asked for legal permission to conduct euthanasia experiments in certain areas of China. “I think it is only a matter of time for euthanasia to become legal,” he said. “Therefore, we should first allow some experiments on the local level for the purpose of accumulating experience.” [Xinhua News Agency, 3/6/06]

Canadian Senator Sharon Carstairs, once a strong supporter of attempts to legalize euthanasia and assisted suicide in Canada, appears to have changed her mind for now. On March 3, 2006, speaking on the state of palliative care at the end of life, Carstairs told those gathered at the University of Toronto, “Canada is not ready for a debate on assisted suicide or euthanasia.” “Unless every single Canadian can be guaranteed quality end-of-life care in which they have a legitimate choice to make,” she said, “then I would suggest that we cannot start that other debate. We aren’t there yet. We are a long way from being there yet.” When asked about those who wish to commit suicide, Carstairs replied that she would ask them about their needs. “People fear unbearable pain and loss of personal dignity,” she explained. “Is it because we have made them feel undignified? It is a dreadful societal failure when someone feels the need to commit suicide.” [Memo from Alex Schadenberg, executive director of Canada’s Euthanasia Prevention Coalition, 3/8/06]