Update 039: Volume 20, Number 5 (2006)

U.K. doctors’ group wants debate on the killing of disabled newborns

Citing concerns that “a very disabled child can mean a disabled family,” Britain’s Royal College of Obstetricians and Gynaecologists (RCOG) has called for the medical profession to openly consider allowing active euthanasia for seriously ill or disabled newborns.

The RCOG stated its position in a response to an inquiry on the treatment of premature newborns conducted by the Nuffield Council on Bioethics, a group that offers ethical guidelines for medical professionals. The Council created a Working Party in October 2004 “to consider the ethical, social, legal and economic issues” involved with sustaining the lives of “extremely premature or critically ill babies.” [www.nuffieldbioethics.org] (See next article for information on the Council’s findings.)

“We would like the Working Party to consider the wider issues of support and information for parents,” wrote RCOG Ethics Committee chair Dr. Susan Bewley, “and to think more radically about non-resuscitation, withdrawal of treatment decisions, the best-interests test and active euthanasia as they are means of widening management options available to the sickest of newborns.” [“Response of the Ethics Committee of the Royal College of Obstetricians and Gynaecologists to Nuffield Council on Bioethics consultation document, The ethics of prolonging life in fetuses and the newborn,” 7/11/05, p. 1; hereafter cited as RCOG.]

Dr. Bewley pointed out that premature newborns may not be the only infants who could benefit from a hastened death. “Concerns about suffering might equally lead to a positive argument for resuscitation limits of the extremely premature infant, or to intentional assisted dying (as nationally, many more babies are affected and may be suffering from multiple, repetitive and invasive neonatal treatments).” [RCOG, p. 3] Furthermore, “[i]f life-shortening and deliberate interventions to kill infants were available, they might have an impact on obstetric decision making, even preventing some late abortions, as some parents would be more confident about continuing a pregnancy and taking a risk on outcome.” [RCOG. P. 8]

Considerations regarding the appropriateness of treatment for severely or even moderately disabled newborns should go beyond the infant’s interests to include his or her impact on the family, the RCOG argued.

[I]f a mother really knew the real, life-long costs of caring for such a baby, and also knew that the chances of the central or local government paying anything near enough to cover such costs are very low, perhaps she might feel differently about aggressive resuscitation and treatment of her premature baby. Perhaps, her doctors might as well. Bringing up a very damaged baby, without nearly enough help, and to such a very uncertain future, would profoundly affect her life and her partner’s and her other children’s. [RCOG, p. 11]

Another serious cost concern, Dr. Bewley wrote, involves the fact that these disabled or severely ill babies turn into “bed blockers” when their needed treatment takes weeks or months. “Some weight should be given to economic considerations as there is a real issue in neonatal units of ‘bed blocking’ whereby women have to be transferred in labour to other units compromising both her and her babies’ care.” [RCOG, p. 11]

The RCOG is not the only British medical association that has questioned the use of intensive care for very premature babies. Sir Alan Craft, president of the Royal College of Paediatrics, said earlier this year, “Many paediatricians would be in favour of adopting the Dutch model of no active intervention for these very little babies.” [Sunday Times, 3/26/06] The Dutch refuse to resuscitate any baby under 25 gestational weeks of age. Last year, they went beyond “letting” newborns die and adopted guidelines for actively killing those considered severely disabled.

But Dr. John Wyatt, a neonatologist at London’s University College Hospital said that, once doctors decide whether a life is worth living, “it changes medicine into a form of social engineering where the aim is to maximize the benefit to society and minimize those who are perceived as worthless.” [Sunday Times (London), 11/5/06]

Alison Davis of the British disability rights group No Less Human was horrified by the RCOG’s comments on killing disabled newborns. “Deliberate killing on grounds of disability is always wrong regardless of the age or status of the victim,” she said. “Disabled people, particularly those with conditions regarded as ‘severe,’ will be both appalled and afraid by the RCOG’s call. [Spero News, 11/7/06]

British bioethics council issues blanket guidelines on premature babies

After a two-year inquiry into the issue of life-saving treatment for premature infants, the Nuffield Council on Bioethics, a British group which examines ethical questions resulting from medical advances, has issued practice guidelines on the provision of such treatment based upon the gestational age of premature newborns.

While the Council “unreservedly” rejected active euthanasia for very premature infants—as proposed by the Royal College of Obstetricians and Gynaecologists (see previous article)—the council’s guidelines are still controversial.

Contained in a 246-page report which was released on November 16, 2006, the guidelines state that no baby born prematurely at 22 weeks or less should be resuscitated, and any attempt to do so “should only take place within a clinical research study.” The reason for the prohibition is that only 1% of these babies will survive long enough to leave the hospital, and their risk for severe disability is high. Babies born at 24 to 25 weeks of gestation, on the other hand, have better odds and should receive life-saving treatment. For those born at 23 to 24 weeks, treatment decisions should be up to the parents. Most of the time, however, decision-making power rests with doctors; parental decisions are only given “some weight in any relevant deliberations.” [Nuffield Council on Bioethics, Critical care decisions in fetal and neonatal medicine: ethical issues, 11/16/06, pp. xvii, xxi, 155-157]

Data from the EPICure Study, a British follow-up study of babies born at 25 weeks or less, sheds some light on possible disability outcomes for preemies. At two-and-a-half-years postpartum, the study found that 50% had no disabilities, 25% had some level of disability, and 25% were severely disabled. At six years postpartum, the physical disability rates were: 31% had no problems, 13% had moderate disability, 11% had severe disability, 11% had mild neurological problems, 4% had mild hearing loss, and 30% needed glasses. The findings prompted one of the study’s authors to say that “the majority of children do not have a serious physical disability… and despite the high incidence of learning difficulties, half are doing reasonably well and keeping up with their classmates.” [Univ. of Nottingham, Press Release on EPICure Study, 1/6/05]

The British Medical Association criticized the Council’s blanket guidelines, saying, “Each case should be considered on its merits and its own context. We therefore cannot agree with stringent cut-off points for treatment.” The Church of England, the Catholic Church, and disability rights groups shared the BMA’s criticism. [Norfolk Eastern Daily Press, 11/16/06; Joint Statement, Anglican Bishop of Southwark and Catholic Archbishop of Cardiff, 11/15/06]

Oregon plays word games with assisted suicide

Ever since Oregon’s Death with Dignity Act (DWDA) was enacted in October 1997, the Oregon Department of Human Services (ODHS) has used the term “physician-assisted suicide” when it referred to the legalized practice of doctors intentionally prescribing lethal drugs for terminally-ill patients. As the entity charged with compiling annual assisted–suicide statistics, the ODHS used the term on its official web site, in its press releases, and in each of the eight annual reports it has issued since 1999.

But that will no longer be the case—not after Compassion & Choices (C&C), the advocacy group involved with most of the state’s assisted-suicide deaths, reportedly brought its lawyers to a meeting with ODHS officials and argued that the state’s usage of the term “physician-assisted suicide” (PAS) actually violated the DWDA. [AMNews, 11/6/06] They pointed out that the law, which C&C leadership helped write, states, “Actions taken in accordance with [the DWDA] shall not, for any purpose, constitute suicide, assisted suicide, mercy killing or homicide, under the law.” [DWDA, §127.880 s.3.14]

In a letter to ODHS officials dated 8/22/06, C&C called the term “physician-assisted suicide” “value-laden and negatively biased language that perpetuates misunderstanding of Oregon law and policy” and implies that a crime has been committed since aiding the suicide of anyone other than a terminally-ill person remains a felony under Oregon law. Those patients contemplating assisted suicide, C&C argued, find the word “suicide” offensive. [Register-Guard [Eugene], 10/23/06; Statesman Journal, 10/17/06]

But, if all that is true, why did C&C wait almost 10 years to challenge the ODHS over its use of “assisted suicide”? The answer lies in recent polling.

Frustrated by its inability over the last decade to get a state other than Oregon to pass an assisted-suicide law, C&C turned to polling to see how they could tweak their sales pitch so that voters and legislators would be more apt to approve an assisted-suicide measure. In 2005, public opinion researcher David Binder was hired to test California voters’ reactions to right-to-die terminology. He found that respondents had a very negative reaction to the term “assisted suicide.” [Californians for Compassionate Choices Press Kit, 9/28/05]

A Gallup Poll earlier last year also found that the word “suicide” negatively impacted efforts to legalize assisted suicide. When asked if they thought “doctors should be allowed by law to end the patient’s life by some painless means if the patient and his family request it,” respondents said “yes” 75% of the time. But when asked if doctors should “assist the patient to commit suicide,” support dropped to only 58%. [Gallup News Service, 5/17/05]

Since C&C activists use the Oregon DWDA as the model for legislation in other states, they needed to get the ODHS to stop using “assisted suicide,” especially on its easily accessible web site. Otherwise it would be extremely difficult for activists to convince legislators and voters in those states that all they wanted to legalize was “aid-in-dying,” “directed dying,” or “assisted dying”—C&C’s deceptive terms of choice.

Initially, ODHS officials agreed to change all their “physician-assisted suicide” references to “physician-assisted death,” but, within one day, canned that term after PAS opponents objected to the change. They finally decided to refer to the practice as “death with dignity” and call patients who commit suicide by ingesting a legally prescribed drug overdose as “persons who use the Oregon Death with Dignity Act.” C&C called the change “a major leap forward in clarifying the public’s perception of the distinction between suicide and a terminally ill patient’s choice for a peaceful and dignified death.” [compassionandchoices.org, Top Stories, 10/23/06]

But Derek Humphry, co-founder of the Hemlock Society (the group from which C&C evolved), is highly critical of the ODHS’ choice of euphemisms. “‘Physician’ means a licensed M.D.; ‘assisted’ means helping; and ‘suicide’ means deliberately ending life,” he recently wrote. “The department’s cop-out choice of words, ‘death with dignity,’ is wildly ambiguous and means anything you want. Let’s stick to the English language and in this matter call a spade a spade.” [Letter to the Editor, Register-Guard, 11/7/06]

Study finds cancer patients more than twice as likely to commit suicide

A study of American cancer patients—published in the October 19, 2006, edition of the Annals of Oncology—found that these patients have a 2 to 2½ times greater risk of ending their lives compared to the general public.

Dr. Wayne S. Kendal, a Canadian radiation oncologist from the Ottawa Hospital Regional Cancer Center, analyzed 1.3 million cases of individuals with invasive cancers who were diagnosed between 1973 and 2001. Of those, a total of 1,307 males (19 out of every 1,000 male cancer patients) and 265 females (four out of every 1,000 female cancer patients) committed suicide.

The patients with the highest suicide risk were males with “head and neck cancer or myeloma, advanced disease, little social or cultural support, and limited treatment options.” Those with the least degree of risk were African-American females with “colorectal or cervical cancer, localized disease, and living with [a] spouse.” Males were found to have almost five times the risk for suicide than the female patients studied.

Other factors contributing to suicide ideation included metastatic disease at diagnosis, contraindicated surgery and other treatments, high-grade tumors, and cancers of the head, neck, lungs, bronchus, bladder, and esophagus.

The study also found that married patients exhibited a lower risk of suicide.

“Overall,” Dr. Kendal wrote, “it would seem plausible to conclude that depression played a likely role in many of the suicides from the study population.”

“Oncologists and allied health professionals should be aware of the potential for suicide in cancer patients,” Dr. Kendal concluded, especially since “every year in America, about 1.4 million new cancers will be diagnosed, 570,000 persons will die of cancer, and another 1,700 persons with cancer will commit suicide.” [Kendal, “Suicide and cancer: a gender-comparative study,” Annals of Oncology, 10/19/06]

“I wanted to raise awareness among caregivers who are looking after cancer patients… for the risk of suicide in all cancer patients,” Dr. Kendal told the press. “I have had patients who I believe have committed suicide, and I really wasn’t astute to picking it up.” [Reuters, 10/19/06]

Dignitas moves to offer depressed suicide aid

Dignitas, the Swiss group that has assisted the suicides of 619 of its Swiss and foreign members since 1998, has petitioned the Swiss Supreme Court to permit it to facilitate the deaths of those deemed chronically depressed or mentally ill.

Dignitas founder Ludwig Minelli, a human rights lawyer, views assisted suicide as a basic human right that should be available to those with chronic mental illness. The petition, which was scheduled to be heard by the Swiss high court on October 27, involves a Swiss man with bipolar disorder, also called manic depressive disorder, who lives abroad. As yet, the court has not issued a ruling in the matter.

Minelli spoke about the case during a September speech to Liberal Democrats attending a conference in Brighton, England. “We should see in principle suicide as a marvelous possibility given to human beings because they have a conscience,” he said. “If you accept the idea of personal autonomy, you can’t make conditions that only terminally ill people should have this right.” “We should accept generally,” he continued, “the right of a human being to say, ‘Right, I would like to end my life,’ without any pre-condition, as long as this person has capacity of discernment.”

Labeled the “suicide missionary” by the London Times, Minelli said that he would take the court case all the way to the European high court, if necessary. “I tell [Dignitas] members suffering from mental illnesses: I am fighting for your freedom,” he explained.

When asked if there were any suicidal people he would refuse to help die, he replied, “I would never say no. I would say perhaps.” [London Times, 9/20/06, 9/21/06, 9/22/06; Daily Post, 9/21/06; BBC News, 9/20/06; Independent, 9/21/06]

Dutch film aims to make
euthanasia decisions easier…and sooner

Too many Dutch doctors are dragging their feet when it comes to euthanasia requests, according to Rob Jonquière, a former general practitioner and current director of the Dutch Society for a Voluntary Ending of Life.

Each year, he said, hundreds of doctors either delay euthanasia too long, use morphine to put the patient into a coma (called “terminal sedation”), or just ignore a patient’s request for an induced death. He estimates that there could be thousands of unfulfilled requests annually.

Jonquière said euthanasia decisions are some of the most difficult Dutch doctors make. “It affects doctors professionally and personally and makes unbelievable demands,” he explained.

To make the euthanasia decision easier, Jonquière has made a film for doctors and patients, entitled Letting Him Down. It consists of scenes depicting right and wrong ways to handle patients’ death requests. In one scene, a grieving widow blames the doctor for her husband’s “terrible” death. The doctor had never acted on her husband’s euthanasia request which had been first submitted to the doctor 10 years earlier.

“We want to show that euthanasia should be a process begun before there is any suggestion of a malignant disease,” Jonquière said, “a path that both patient and doctor must take while continuing to communicate.” [British Medical Journal, 9/9/06]

Euthanasia death toll spikes in Belgium

According to the commission which oversees legalized euthanasia practice in Belgium, there were 742 euthanasia deaths, 31 per month, in 2004 and 2005. Thus far, for the first part of 2006, the rate has increased to 37 euthanasia deaths a month. That is a significant jump from 2002 (the year euthanasia was legalized) and 2003 when statistics showed that 17 people a month were euthanized.

The commission concluded that, despite the jump in deaths, euthanasia is limited to the very few, accounting for only three to four deaths per 1,000. But, with Belgium’s overall death rate at 10.27 per 1,000, the number of euthanasia deaths is not insignificant.

The rise in euthanasia practice, the commission explained, is because of the increased dissemination of information on the subject, not a change in the public’s attitude. There was “no wave of euthanasia,” they concluded, nor was there any indication that Belgium became a tourist death destination. As the Belgian newspaper Le Soir put it, “Doctors did not become old-people murderers.”

The statistics for 2004 and 2005, however, showed that 49 percent of euthanized patients were elderly.

In addition, cancer patients accounted for 83 percent of euthanasia cases, with men opting for a hastened death more often than women. In only 39 percent of the cases, euthanasia occurred in the patient’s home.

A mere 14 percent of the official euthanasia declarations signed by patients were in French, indicating that the majority of patients requesting death are from the Dutch-speaking regions of the country. [Agence France Presse, 11/11/06; Expatica, 11/9/06]

Experimenting with live patients
Some experts approve of using “vegetative” human subjects

By Wesley J. Smith

In the new novel “Hunters of Dune,” biotechnologists of the future create “ghoulas”—clones made from the dead—in breeding contraptions known as “axlotl tanks.” About 100 pages into the novel, the reader is shocked to learn that axlotl tanks are really unconscious women whose bodies have been expropriated to serve the greater good as so many gestating vats.

Happily, “Hunters of Dune” is science fiction. In the real world, we have a higher sense of morality and ethics. We would never use catastrophically disabled human beings so crassly. We understand that treating people as mere things violates the intrinsic dignity of the individual and the equal moral worth of all human life.

Well, most of us do.

Unfortunately, many bioethicists would feel right at home in a world in which unconscious people are converted into mere biological machines. Indeed, some of our most prominent bioethical and philosophical thinkers have published articles in the world’s most respected medical and bioethical journals proposing that unconscious patients (those diagnosed as in a persistent vegetative state) be used both as vital organ donors and the subjects of human medical experimentation.

Those we would exploit, we must first dehumanize. A favored proposal for stripping these vulnerable patients of their humanity is to redefine a diagnosis of persistent vegetative state into the legal equivalent of death—even if the “dead” patient breathes without assistance.

“The essence of human existence,” the influential Georgetown University bioethicist Robert Veatch wrote several years ago in the Journal of Clinical Ethics, “is the presence of integrated mind and body…. For the human to exist in any legal, moral or socially significant sense, these two features must be present.” And, since those diagnosed as vegetative are thought to be unaware, according to Veatch and many of his colleagues, they are merely “respiring cadavers” who could even be buried except that it “is simply unaesthetic to bury someone while still breathing.”

The proposed redefinition of these living patients into dead, albeit breathing, bodies is intended to pave the way for using them as so many organ farms.

A 1996 article in the British medical journal Lancet put it this way: “If the legal definition of death were to be changed to include comprehensive irreversible loss of higher brain function, it would be possible to take the life of a patient (or more accurately to stop the heart, since the patient would be defined as dead) by a ‘lethal’ injection and then remove the organs needed for transplantation, subject to the usual criteria for consent.”

More recently, the notion that the bodies of persistent vegetative patients should be exploitable has been extended to the realm of cutting-edge medical research—perhaps for the purpose of using these profoundly disabled people in place of primates or other animals.

Illustrating how respectable these radical views have become among the medical intelligentsia, articles and letters published during the past two years in the Journal of Medical Ethics have gone so far as urging that vegetative patients be used to test the safety of “xenotransplantation,” that is, of transplanting animal (usually pig) organs into humans.

The usual ethical approach in medical research is to complete animal testing and then cautiously move into human trials with patients who could conceivably benefit from the experimental drug or procedure. But some bioethicists worry about the social, personal and sexual contacts of early pig organ recipients allowing a porcine virus to cross the species boundary and setting off a pandemic.

But quarantining pig organ recipients is seen as violating their personal autonomy. The proposed “ethical” remedy for this conundrum is to use persistent vegetative bodies in place of patients who actually need new organs in early xenotransplantation experiments.

“If it can be agreed upon that PVS bodies can be regarded as dead,” Belgian professor An Ravelingien and several co-authors wrote in 2004, “then experimenting on them is legitimate under the same conditions as experiments on cadavers,” so long as they consented to be used in this fashion prior to their impairment. To illustrate the extent to which these bioethicists dehumanize people diagnosed as PVS, Ravelingien asserts that “living cadavers” in persistent vegetative state should not be called “patients” because that wrongly humanizes them and “impedes the discussion.”

This year, Heather Draper, a bioethicist from Birmingham, England, took Ravelingien’s argument one step further: “My own view is that people in a PVS are still alive,” she wrote. But this seemingly obvious observation should not, in Draper’s view, preclude these helpless patients from being used in animal organ transplant experiments. “I see no objection in principle to the proposal that competent people can decide, in advance, to participate in research when they become incompetent.”

Nor, apparently, would Draper limit such human experimentation to those believed to be unconscious. “Helping others by taking part in clinical research is undoubtedly a good way to live out what may be years in a PVS or other less-compromised states,” she writes.

Consider the kind of scenario this advocacy contemplates: Alice, a woman in her late 20s, nearly drowns. Aggressive CPR restarts her heart but she remains unresponsive for six months. Doctors tell her husband Jack she is in a persistent vegetative state—and although the diagnosis is difficult to make with certainty and is often wrong—they conclude she will never awaken.

Since the law now considers a persistent vegetative state the same as being dead, the state issues a death certificate. Jack assures doctors that Alice wanted her body used for science if she ever died or became profoundly incapacitated. Accordingly, her “breathing cadaver” is transferred from a nursing home to a major organ transplant center. Soon, her kidneys are removed for transplantation into renal patients. Doctors then implant pig kidneys. Alice survives the surgery and continues to breathe on her own. She lives for years in isolation as researchers continually test for dangerous porcine viral infections. When the experiment concludes, Alice is lethally injected—which is not considered euthanasia because she is already legally dead— and her remains are cremated.

It’s an ugly picture, and it is important to emphasize that transplant surgeons do not currently harvest the organs of vegetative patients, nor do medical researchers use these most vulnerable people in unethical medical experiments. But if we want to keep it that way, we will have to make it unequivocally clear to the bioethicists and our lawmakers that patients diagnosed with persistent vegetative state are people, too. It’s wrong to reduce them into the nonfictional equivalents of axlotl tanks.

Wesley J. Smith is an attorney for the International Task Force on Euthanasia and Assisted Suicide, a special consultant to the Center for Bioethics and Culture, and is a senior fellow at the Discovery Institute. His article originally appeared in the San Francisco Chronicle on October 22, 2006, and is reprinted here with the author’s permission. Mr. Smith’s web site can be accessed at www.wesleyjsmith.com

Computerized brain connections show better
quality of life in ALS patients

Research, recently published in the journal Psychophysiology, sheds new light on the condition known as the completely locked-in state (CLIS), a state where the patient’s total lack of muscle control makes communication virtually impossible. Patients totally paralyzed with advanced ALS (Lou Gehrig’s disease) are among the patients considered to be in CLIS. ALS is a motor disease which progressively destroys the peripheral and central motor system in the body.

German researcher Niels Birbaumer, from the University of Tübingen, found that when brain-computer interfaces (BCIs) are used before the patient goes into the CLIS state, the patient can learn to communicate using the electronic device and continue that skill in the CLIS state. BCIs use activity in the brain to communicate by means of external devices like computers.

One of Dr. Birbaumer’s most significant findings was that the ALS patients studied rated their quality of life far better than their caretakers or family members did, even when the patient was completely paralyzed and on a respirator. He also found that “only 9% of the patients showed long episodes of depression, most of them in the time period following the diagnosis and a period of weeks after tracheostomy.” “In fact,” he wrote, “they are in a much better mood than psychiatrically depressed patients without any life-threatening bodily disease.”

According to Dr. Birbaumer, most ALS patients choose not to have artificial respiration or feeding and then die of respiratory problems. They are often pressured into foregoing such treatment by doctors and family members who think their quality of life is too low for such measures. In the Netherlands and Belgium where euthanasia is legal, very few patients choose to continue life. “The facts on end-of-life issues and quality of life,” Dr. Birbaumer concluded, “do not support hastened death decision in ALS….” [Birbaumer, “Breaking the silence: Brain-computer interfaces (BCI) for communication and motor control,” Psychophysiology, 43 (2006), 517-532]

News notes . . .

At its biennial conference held in Toronto, Canada, in September, the World Federation of Right to Die Societies—an umbrella group consisting of 38 right-to-die organizations from 23 countries—reaffirmed its “Manifesto.” Originally debuted at its previous meeting in Tokyo in 2004, the document declares that everyone has the “right to die with dignity, meaning in peace and without suffering” and that “the manner and time of dying should be left to the decision of the individual.” Usually people presume that these “rights” apply only to those who are terminally ill, with six months or less to live. But they would be wrong. Instead, the Manifesto says, “all competent adults” who suffer “from incurable illnesses” have the “intrinsic human” right to be euthanized or assisted in committing suicide. “Incurable” does not necessarily mean “terminal.” Incurable diseases can include even common conditions like arthritis or diabetes.

There is renewed talk of legalizing euthanasia in Australia. Former Northern Territory chief minister Marshall Perron—whose Rights of the Terminally Ill Bill in 1996 made the Northern Territory the first jurisdiction in the world to formally legalize euthanasia, only to be overturned months later by Australia’s federal Parliament—has backed the plans of Senator Amanda Vanstone to push for euthanasia laws both on the federal level and in individual states. Vanstone is the most powerful woman in the Federal Cabinet. Both Perron and Vanstone were key speakers at a 9/22/06 rally in Sydney to commemorate the death of Bob Dent, the first of four people to die under the Northern Territory euthanasia law before it was overturned. [Northern Territory News, 9/17/06]

Meanwhile, down in South Australia, state Parliament member Bob Such is putting the final touches on a new bill to legalize euthanasia, his sixth attempt to change the law since 1995. [Sydney Morning Herald, 11/14/06]

Australia’s renegade “Dr. Death,” Philip Nitschke, continues to be in the news. Upon his return from the World Federation of Right to Die Societies’ meeting in Toronto, Australian customs officials at the Brisbane Airport seized 45 copies of his new book, The Peaceful Pill Handbook, which contains instructions on how ordinary people can make their very own “suicide pill.” Officials said the book was an incitement to suicide. [ABC News, 9/22/06]

While Nitschke seems to relish provoking authorities by testing legal limits, he usually avoids situations where he personally would be as risk for prosecution. In September he arranged a trip for himself and 12 elderly Australians to travel to Mexico to buy bottles of the barbiturate Nembutal, a drug banned for human consumption in Australia and an item classified as a prohibited import. The drug, however, is #1 on Nitschke’s best-drug-for-human-euthanasia list, and, since it is only allowed to put down animals, he routinely recommends that people make friends with veterinarians in order to obtain access to the drug. But, that’s easier said than done. Hence, the trip to Mexico. When the time came to return to Australia, the elderly people successfully smuggled in their bottles of the drug. Nitschke, however, decided to dump his bottles before going through customs, saying it was “too risky.” He later made light of the incident to the press: “We’re talking 80-year-olds, and the general feeling amongst them is ‘if I get caught, what the hell.’” [The Sunday Mail (Adelaide), 9/24/06]

There have been numerous accounts from those who have escaped from North Korea that disabled babies are being routinely killed soon after birth and pregnant women whose babies are suspected of having Chinese fathers are being subjected to forced abortions. Escapees say that this selective killing is part Kim Jong-il’s policy of racial purity and supremacy. Ri Kwang-chol, a North Korean doctor who escaped last year, recently told a forum in the southern city of Seoul, “There are no people with physical defects in North Korea.” He said that medical staff kill disabled newborns and bury them quickly. Other witnesses said that they saw infants being thrown into boxes with plastic sheeting and left to die. After two days, two of the babies were still blinking, so a guard beat them with forceps. The aid organization Médecins Sans Frontières left the country in 1998 after the government refused to let the group enter the “9-27 camps,” where disabled and ill children were being dumped. [The Sunday Times (London), 10/15/06]

In a landmark ruling, a British judge has ordered that a 53-year-old woman, diagnosed as being in a persistent vegetative state (PVS) for three years, be given a sleeping pill before any decision can be made regarding her family’s petition to have her food and fluids withheld.

As reported previously in the Update (see Update, vol. 20, no. 3), there have been documented cases where PVS patients have awakened suddenly after being given the sleeping medication Zolpidem (brand name Ambien). In the cases involving three South African patients, published in the medical journal NeuroRehabilitation, each patient awakened about 20 minutes after the drug was given and remained conscience for approximately four hours. A second dose was then given, allowing each patient eight hours a day to interact with their families and caregivers.

In England, senior family court judge Sir Mark Potter heard testimony from Professor Keith Andrews, an expert in PVS from London’s Royal Hospital for Neuro-Disability, before ruling that the sleeping pill therapy should be tried before he issues any final determination on whether or not the woman should be denied nutrition and hydration. The family of the unnamed woman, who had suffered a massive stroke in 2003, objected to the judge’s ruling, saying that she should be allowed to die because she would not want to live aware of her disabilities. [The Times (London), 11/20/06; The Guardian (London), 11/20/06]

But Sienie Englebrecht, the mother of one of the South African patients, said, “They [the family] cannot let her die when there’s still hope.” Englebrecht’s son, Louis Viljoen, has been taking Zolpidem for seven years in decreasing dosages. It has enabled him to undergo rehabilitation therapy, so he continues to improve. “He is getting better and better every day,” his mother said. “To me, it is a miracle. It is an eye opener for people that have suffered brain damage.” [The Telegraph (London), 11/21/06]