Update 042: Volume 21, Number 3 (2007)

New euthanasia/assisted-suicide study draws international criticism

It was a study with a purpose: to discredit the safety, abuse, and “slippery slope” arguments which have so successfully prevented the spread of legalized euthanasia and assisted suicide to targeted jurisdictions in the U.S. and abroad.

Assisted-suicide advocates who embraced the study’s findings—like Compassion & Choices legal director Kathryn Tucker—touted it as definitive proof that legalized euthanasia and assisted suicide are safe practices for even vulnerable members of society. “It’s the most pre-eminent examination of the data with the slippery slope question in mind,” she told reporters, who were all too willing to accept her statement and the study’s conclusions at face value. [Salt Lake Tribune, 9/27/07]

Opponents questioned the validity and integrity of the study. ITF legal consultant Wesley J. Smith wrote that it was biased and “demonstrates the vapidity of ‘scientific studies.’”[www.wesleyjsmith.com/blog, 9/27/07] Canada’s Euthanasia Prevention Coalition director Alex Schadenberg called it outright “propaganda.” [Canadian Press, 9/30/07] Dr. Peter Saunders, head of the British group Care Not Killing, warned that the study was a ploy to get support for legalized euthanasia in the U.K., [Christian Today, 9/28/07] while disability rights activist Stephen Drake, head research analyst for Not Dead Yet, labeled the data used in the study “soft data” and “non-verifiable” because it is based on information that “doctors choose to admit.” Drake also said the study’s lead author uses “research for political purposes.” [NDY News & Commentary Blog, 10/1/07]

The study

The study, published in the British Journal of Medical Ethics, found that, where euthanasia and assisted-suicide are already legal, “there is no current evidence for the claim that legalised PAS [physician-assisted suicide] or euthanasia will have disproportionate impact on patients in vulnerable groups.” Researchers identified 10 groups as “vulnerable”: the elderly, women, the poor, the uninsured, those with “low educational status,” the physically disabled or chronically ill, minors, those with psychiatric illnesses including depression, racial or ethnic minorities, and AIDS patients. The study found that only those in the AIDS group had a “heightened risk” for induced deaths. [Battin et al., “Legal physician-assisted dying in Oregon and the Netherlands: Evidence concerning the impact on patients in ‘vulnerable groups,’” Journal of Medical Ethics, October 2007, p. 591. Hereafter cited as Battin.]

Questionable data

Researchers examined data from two jurisdictions where euthanasia and/or PAS are legal, namely Oregon and the Netherlands. With regard to Oregon, where only PAS is legal, researchers focused primarily on data from the state’s 2006 annual PAS report and three additional surveys of doctors and hospice professionals, which, researchers said, “have not uncovered extralegal or unreported cases.” [Battin, p. 592] But, the primary source—the 2006 annual report, issued on March 8, 2007—was so abridged that it consisted of only a one-and-a-half page summary, a chart, and two tables. Astonishingly, some of the statistical totals for the eight prior years of Oregon PAS practice were changed in the 2006 report without any explanation as to why the figures were retrospectively altered. [See “Ninth Annual Report on Oregon’s Death with Dignity Act,” 3/8/07, at www.oregon.gov/DHS/ph/pas/ar-index.shtml]

The Oregon Department of Human Services (ODHS), the agency responsible for issuing the annual reports, has acknowledged multiple times that it has no way of knowing if the data provided by the doctors is accurate or complete. The ODHS also has admitted that the state has no clue how many PAS cases go unreported and has no authority under the state’s PAS law to investigate doctor non-compliance. [See “Nine Years of Assisted Suicide in Oregon” at www.internationaltaskforce.org/orrpt9.htm]

With regard to the Netherlands, where both euthanasia and assisted suicide are legal, researchers took most of their data from a 2005 study, published in 2007 in the New England Journal of Medicine. [Battin, p. 592] That study found there was “a modest decrease” in the number of both euthanasia and PAS deaths after both practices were formally legalized in 2002. However, the number of involuntary euthanasia deaths—defined as “the ending of life without an explicit request by the patient”—remained steady and occurred at a rate four-times that of PAS deaths. Moreover, the study found that the number of “terminal sedation” cases—an imposed “deep sedation” usually used in conjunction with the withholding of all food and fluids, resulting in the patient’s death—rose significantly. Even though Dutch researchers acknowledged that euthanasia and PAS deaths were “to some extent” replaced by terminal sedation deaths, the latter type of deaths were not included in the overall number of euthanasia deaths cited in the study and, in actual practice, were not subject to control by the national euthanasia review committees. The study also indicated that, in 2005, Dutch doctors neglected to report euthanasia/PAS deaths as required by law 20% of the time. [van der Heide et al., “End-of-Life Practices in the Netherlands under the Euthanasia Act,” NEJM, 5/10/07; DutchNews.nl, 5/10/07]

Questionable conclusions

The new risk assessment study based on the Oregon and Dutch data asked the question, “Are the lives of people in vulnerable groups more frequently ended with a physician’s assistance than those of other, less vulnerable people?” Often the study’s answers and conclusions seem superficial and tailored to a specific outcome.

For example, researchers based their findings strictly on the number of deaths in each group, not on whether those individual patients had actually experienced pressure to end their lives. Case in point: researchers found that seven Oregon patients with either no health insurance or whose insurance status was unknown had died as a result of PAS. Taking seven as a relatively small number, researchers concluded that PAS posed no heightened risk to Oregon’s uninsured patients. [Battin, p. 594] So even if all seven patients had actually been coerced into opting for an early death, that number of patients did not constitute a “disproportionate” risk.

Researcher also determined that patients with psychiatric illness, including depression, experienced no heightened risk of an induced death. Incredibly, they reached that conclusion even after acknowledging the data they used was “inferential or partly contested”; that not all patients who requested suicide assistance were evaluated by mental health professionals; that “many cases of depression are missed” by doctors (and, therefore, not part of the data used for their study); and that it’s possible that patients without depression when they received lethal prescriptions were actually suffering from depression when they took the fatal drugs. [Battin, p. 596]

A case of bias

What is not mentioned in the study is that the lead author, University of Utah philosophy professor Margaret Pabst Battin, is a longtime euthanasia and assisted suicide advocate dating back to the early 1980s when she called suicide advocacy “humanitarian.” In 1985, she told attendees of a Hemlock Society conference that those most vulnerable to the pressure to request euthanasia or commit suicide would be people who have been least self-determining in their lives, like women who have taken care of the needs of their families. But, even if there are undue pressures for some, she said, “the fact that people will have a choice is the most important thing.” In 1987, she told the Washington Times that suicide assistance may be warranted for financially-strapped elderly. [Marker, Deadly Compassion, 1993, p. 150] Currently, Battin is on the advisory board of the Death with Dignity National Center, an organization that promotes Oregon-style PAS.

Case highlights ethical erosion of assisted suicide

The family of Oregon software engineer Wendy Melcher had no idea that four days before her death in 2005 two nurses gave her huge overdoses of morphine and phenobarbital with the intention of ending her life. For the last two years, family members thought Melcher died as a direct result of her underlying condition, neck and throat cancer.

The only reason relatives now know the truth is that a newspaper reporter from the weekly Portland Tribune contacted them in June 2007 regarding a new state investigation into possible criminal charges related to Melcher’s death—a probe ordered by Governor Ted Kulongoski after a former employee of the Oregon State Board of Nursing (OSBN) notified him of the board’s questionable handling of the case.

Board’s inaction

According to Tribune articles, published on July 6, 2007, the OSBN knew about the case shortly after Melcher’s death on August 23, 2005, but took over a year to conduct an investigation. Even after the board determined that the two nurses in question did, in fact, intentionally give Melcher the drug overdoses, it did not report either nurse to state authorities for a warranted criminal investigation. The nurses—Rebecca Cain, an R.N. from Providence St. Vincent Hospice who was assigned to Melcher, and Diana Corson, a nurse practitioner not associated with the hospice who took an unofficial interest in the case as a friend-of-a-friend of Melcher’s—were, instead, allowed to keep their nursing licenses. The only sanctions imposed by the OSBN were a two-year probation for Cain and a 30-day license suspension for Corson. Cain could continue nursing; Corson could resume practicing after the 30-day suspension.

The board concluded that Cain and Corson participated in a suicide plan, a plan the nurses claim Melcher helped devise. They administered the drug overdoses without notifying Melcher’s physician, who had no knowledge of any purported assisted-suicide request or plan—a clear violation of Oregon’s physician-assisted suicide (PAS) law.

Reportedly, OSBN documents indicate that Cain told investigators that she had “administered excessive morphine because she believed [Melcher] to be in uncontrollable pain.” But, records also show that Cain recorded no mention of Melcher’s intolerable pain prior to August 19, 2005, the day she administered the morphine overdose. It is normally standard hospice practice to monitor and document a patient’s ongoing pain level in the medical record and notify the hospice pain management team so that the patient’s pain can be controlled. Cain did none of those things. Nor did she get an order from Melcher’s doctor for any change to the pain medications Melcher was already getting.

Cain told the OSBN that Melcher had previously asked her if she was eligible for PAS, and Cain said no because she could not swallow the lethal drugs and her life expectancy might not be long enough to go through the death request process mandated by the law. She did not inform her supervisor or Melcher’s doctor about the PAS request, another violation of standard hospice practice in Oregon.

OSBN documents also reveal that Corson, the second nurse, admitted she had written Melcher’s suicide plan on a “communication board” in the patient’s home and, on August 19, shoved 10 phenobarbital suppositories into Melcher “as quickly as she could, one right after the other.” According to her attorney, Corson gave Melcher the phenobarbital overdose to call attention to her pain. “My client did not give her a lethal dose of anything. She didn’t believe it would kill [Melcher], but she believed it would get everybody’s attention. This is something Wendy [Melcher] wanted to do.” “She just wouldn’t die,” he added, “and she was in a tremendous amount of pain and was suffering.”


Tricia Howe, the patient’s daughter who was with Melcher as long as seven hours a day in the weeks before her death, does not believe the nurses’ claims that Melcher’s pain was “uncontrollable” or that Melcher wanted to die the way the nurses say. A family spokeswoman said that Melcher had previously talked to Howe about PAS and would have told her about any suicide plan.

According to the Tribune, medical experts who reviewed the OSBN documents agreed that there was no reason for Melcher to suffer great pain while in hospice. If she was, then the nurses, especially Cain, should have taken the necessary steps to report that to the hospice team and Melcher’s doctor, not give her a massive overdose.

Commenting on this case, Dr. Bill Toffler, a professor at Oregon Health & Science University and national director of Physicians for Compassionate Care, said, “This is not pain relief….They knew what they were doing was wrong. Otherwise why wouldn’t they talk to the doctor?” Toffler, an opponent of Oregon’s PAS law, attributes what happened in the Melcher case to the effects of legalized assisted suicide. “This is the slippery slope. It’s not theoretical. It’s very real,” he said. “We’ve deformed consciousness,” he explained. “We’ve embraced in our state the message that some lives aren’t worth living.” [Portland Tribune, 7/6/07]

The case prompted the Tribune editors to write, “If nurses—or anyone else—are willing to go outside the law, then all the protections built into the Death With Dignity Act [Oregon’s PAS law] are for naught.” [Editorial, “Another case for nursing reform,” Portland Tribune, 7/10/07]

Editor’s note: After the Portland Tribune broke this story, the Oregon Department of Administrative Services (DAS) issued a scathing investigative report on, among other things, the OSBN’s propensity for protecting its members at the expense of public safety and its failure to refer criminal activity to law enforcement. [ODAS, “Oregon State Board of Nursing Management Review and Assessment,” 8/27/07]

Oregon has “serious problem with suicide”

“We have a serious problem with suicide in Oregon,” declared Dr. Mel Kohn, Oregon Department of Health Services’ top epidemiologist and principal author of the newly released report, “Violent Deaths in Oregon: 2005.”

According to that report, suicide accounted for 74% of all violent deaths in 2005, beating the number of homicides—the second highest cause of violent death—at a rate of 5-to-1. Those suicide figures do not include the number of legal assisted suicides under the Oregon Death with Dignity law.

The overall rate of suicide increased with age, with the rate for Oregonians 65 and over being 78% higher than the national average. More than 50% of those who committed suicide were seriously depressed. [ODHS, “Violent Deaths in Oregon: 2005”; Oregonian, 9/18/07]

Nationally, while the elderly are most at risk for suicide, they are the least targeted group for suicide prevention programs because of scarce funding and the notion that depression is a normal part of growing old. [AP, 9/19/07]

Final Exit Network’s “exit guides” involved in Phoenix death

On April 12, 2007, Phoenix resident Jana Van Voorhis died after opening the valve of a helium canister and placing a plastic “hood” with tubing linked to the canister securely around her head. Her family had no idea that she even contemplated ending her life.

Overseeing Van Voorhis’ suicide were two “exit guides” from the Final Exit Network (FEN), a group of right-to-die volunteers who prefer the vision and policies of the now defunct National Hemlock Society over those of its more prominent spin-off group Compassion & Choices (C&C). C&C’s current goal is to change state laws to allow physician-assisted suicide for the terminally ill. FEN, on the other hand, feels that legislative change will take too long, and those really suffering from any “incurable condition” need help “NOW” to “hasten their deaths.” [www.finalexitnetwork.org]

FEN determined that Van Voorhis, 58, was one of those non-terminally ill yet incurable sufferers. But, if FEN had only contacted her family, the exit guides would have been told that any physical ailments Van Voorhis had were more imaginary than real. According to her sister, Viki Thomas, “She called her doctors constantly with lists of aches and pains,” so much so that one doctor “fired” her as his patient, saying, “I will no longer be your doctor.” He wrote in his notes that Van Voorhis “believes she has holes in her belly, feet, and liver.”

Since her high school days, when she was first admitted to a psychiatric hospital, Van Voorhis had a long history of serious mental illness and therapy to combat that illness. Last year her psychiatrist, Dr. Michael Fermo, noted in her medical record that she “had been increasingly becoming psychotic, claiming the roof rats have been overtaking her home, sneaking into her house, and attacking her.”

Van Voorhis was very close to her family, and those closest to her insist that, if they had known, they would have done anything to stop her suicide. “If the Final Exit Network had gotten ahold of me, I would have called Jana and gotten right over there,” explained her sister. “Sure, she had problems. But she was alive, and now she’s not.”

But Wye Hale-Rowe, the FEN senior exit guide assigned to assist in Van Voorhis’ suicide, told a reporter that she doesn’t think Van Voorhis was seriously mentally ill. “Jana was in the throes of what we call existential suffering,” she said. “Even though their physical pain may be managed, just being alive is a burden.” Apparently, Hale-Rowe made that assessment after spending only a short time with Van Voorhis: during an hour-long practice suicide run through earlier on the day Van Voorhis died and then a few minutes right before she inhaled the lethal gas for real.

The second exit guide, Frank Langsner, spent more time with Van Voorhis than did Hale-Rowe, but still did not have any better assessment of Van Voorhis’ actual mental or physical condition. During a June 6 police interview, Langsner emphasized Van Voorhis’ physical “illnesses,” which included, he said, lung and back pain, a lesion on her liver, possible breast cancer, and other serious problems.

Langsner also told police that to help people end their lives successfully, “You help get them in a frame of mind that they want to do it.” If that reported quote is accurate, it may be legally damaging to Langsner if he and Wye-Rowe are prosecuted for assisting Van Voorhis’ suicide, a crime in Arizona.

FEN has retained two Phoenix attorneys to represent Hale-Rowe and Langsner. But not all the blame for Van Voorhis’ tragic death rests with the two exit guides. In the weeks prior to her death, Van Voorhis spoke by phone to FEN’s medical evaluation committee. Apparently, they passed her as a suitable candidate for a FEN-style death. [Phoenix New Times, 8/23/07]

Compassion & Choices establishes 1-800 suicide-aid line in California

Frustrated after years of defeated attempts to legalize assisted suicide in California, the Oregon-based advocacy group Compassion & Choices (C&C) has launched a 1-800 suicide-aid service comprised of volunteers and a handful of clergy from various denominations, all trained by C&C to explain end-of-life “options” to terminally-ill patients and their families. Included in those options is “aid-in-dying,” the euphemism for assisted suicide. [Sacramento Bee, 9/17/07]

In September C&C held press conferences in Sacramento, San Francisco, Los Angeles, and San Diego churches as part of their public relations spin that truly compassionate clergy support their new “End-of Life Consultation” service—a spin intended to counter the Catholic Church’s strong opposition to assisted suicide. [San Diego Union-Tribune, 9/18/07]

“This effort to put a clerical collar on Dr. Kevorkian only makes assisted suicide creepier,” said Tim Rosales, spokesperson for the coalition Californians Against Assisted Suicide. [CA-AAS Press Release, 9/18/07]

The strategy of setting up suicide assistance after defeated attempts to legalize the practice is nothing new. When a euthanasia/assisted-suicide initiative was defeated in Washington State in 1991, C&C’s predecessor, Compassion-in-Dying, was formed to do precisely what C&C wants done in California. The now defunct Hemlock Society followed suit with its suicide-aid group, “Caring Friends”—now called the Final Exit Network’s “Exit Guide Program.” (See above article.)

Fate of U.S. minister rests on extradition hearing in Irish assisted-suicide case

The persistence of Irish authorities handling the assisted-suicide death of Rosemary Toole is beginning to pay off. In May 2004, they issued an arrest warrant for George Exoo, an American Unitarian minister and euthanasia advocate who admitted he was present when Toole died in Dublin on January 25, 2002. In June of 2004, the Irish Republic formally requested that the United States extradite Exoo back to Ireland to stand trial for that country’s first known assisted suicide, a felony punishable by up to 14 years in jail. But, it was not until June 25, 2007—over 5 years after Toole’s death—that Exoo was finally arrested by FBI agents at his home in Beckley, West Virginia.

The right-to-die connection

The 49-year-old Toole, whose formal name was Rosemary Elizabeth Toole-Gilhooley, had a long history of severe depression and had attempted suicide twice before. Married two times, both unsuccessfully, she had no children and, by all reports, was profoundly lonely.

Her father, Owen Toole, said his daughter often talked about suicide with people from around the world. She had even posted a message on Derek Humphry’s Right-to-Die E-mail List Service saying that assisted suicide should be available to those who are mentally ill because “brain torture is worse than physical torture.” [Right-to-Die List Service, 8/26/01] Humphry, the co-founder of the Hemlock Society and author of the suicide manual Final Exit, had reportedly sold Toole a copy of his book, but told an Irish reporter, “I never encouraged her to commit suicide.” [Irish Examiner, 2/1/02] Toole used the precise method—barbiturate overdose, plastic bag, and helium gas—outlined in Humphry’s book to end her life.

Toole had also contacted Libby Wilson, a retired doctor and head of the Scottish right-to-die group Friends at the End (FATE), for suicide help. Wilson refused because FATE only assists those with physical illnesses. As to why Toole was seeking suicide help from others, Wilson concluded, “I think she was very, very lonely. She did not want to be alone.” [Irish Times, 2/3/02]

After her death, authorities combed through the e-mail messages on her computer and found that Toole had contacted Evelyn Martens of the Right-to-Die Network of Canada to purchase an “Exit Bag,” a customized plastic bag with tubing designed to connect to a helium canister. It was Martens who referred Toole to Exoo because he had a history of traveling to foreign countries to assist suicides. [Vancouver Sun, 1/28/03] Exoo and his live-in partner Thomas McGurrin had founded a suicide assistance organization called “Compassionate Chaplaincy.”

Irish police were able to retrieve four revealing e-mail messages between Exoo and Toole from her computer:

November 23, 2001 – I will work with you. Please tell be [sic] when you would like the CC to come?” – Signed: “George Exoo, Compassionate Chaplaincy Fnd.”

December 10, 2001 – Dear Reverend George, I am very anxious to know did you receive AIB [Allied Irish Banks] draft for U.S. $1,250 being the first moiety [sic] due to you the same sum due again on your arrival. Please email me if you can. I will phone you later on anyway. Kindest regards, Rosemary.”

January 1, 2002 – Dear Reverend George, Thank you so much for coming and arriving on the 22nd of January 2002. PLEASE COME… I will have the rest of the money with me. I have deleted all messages I ever sent to you and you to me from the computer and they are in one file which I will give to you when I meet you to destroy.”

January 20, 2002 – Re: Dignity… See you shortly.” – Signed: “George and Thomas” [Formal complaint against George Exoo filed in U.S. District Court, Beckley WV, on 6/22/07, as reported in the Charleston Gazette, 6/27/07]

Date with death

As promised, Exoo and McGurrin met Toole for the first time at the Dublin Airport on January 22. She rented a car, and, for two days, the trio had great fun touring Ireland and researching McGurrin’s ancestry. Witnesses at a bar in County Mayo recalled that Toole, Exoo, and McGurrin partied for four hours on January 24, the night before she died. According to one patron, “They were laughing and joking from the minute they came in.” [The Mirror, 2/5/02]

On January 25, the day she died, the three went to a Dublin apartment Toole had rented for the occasion. In an attempt to establish that Toole was acting rationally, Exoo reportedly asked her, “Are you really sure you want to do this? You’re so cheerful.” Toole, he said, replied, “Yes, I really have enjoyed these two days with you, but I will be miserable.” [The Mirror, 2/5/02] Exoo claimed that he was well qualified to assess Toole’s state of mind even though he had no medical or psychological training. [Irish Times, 2/3/02] He also said that Toole had convinced him that she had an incurable brain disorder. According to the complaint filed by federal prosecutors in West Virginia, Toole had a condition that caused swelling in her head, but she was not terminally ill. [AP, 6/27/07]

According to 2002 newspaper accounts, Exoo had brought with him equipment to use for Toole’s assisted suicide, and both he and McGurrin had helped set it up. They also admitted going through five practice sessions before the real suicide. [Sunday Independent (Ireland), 2/3/02; Irish Independent, 2/6/02] Exoo now denies doing anything overt in relation to Toole’s death. According to the current Compassionate Chaplaincy web site, Exoo and McGurrin were present only to “make a final assessment of her case, assure that she had assembled the needed [death inducing] supplies, and provide a compassionate presence and pray with her as she made her transition to the Other Side.” [compassionate- chaplaincy.com]

But soon after her death, Exoo told the press he had actively urged Toole to hurry up the suicide process. “The last thing she did before she pulled down the [Exit] bag was take one last toke on the cigarette,” he revealed. “I said, ‘OK, Rosemary, time to put the cigarette down, if you don’t mind.'” [Charleston Gazette, 2/2/02; The Observer, 2/3/02] She followed his direction, and the suicide process continued. It is this admission by Exoo that is key to the criminal case against him. As the formal complaint states, “by telling her it was time to extinguish her last cigarette that he aided and abetted and counseled the suicide of Rosemary Toole.” [Charleston Gazette, 6/27/07]

Extradition hearing

A three-hour hearing on whether Exoo would be extradited to Ireland was held on August 17, 2007. Calling the case “simply extraordinary,” U.S. District Court Magistrate Judge Clarke VanDervort declined to issue an immediate ruling. “I don’t see being anywhere near reaching a conclusion in a week or two,” he said after hearing the arguments for and against extradition. Whichever way the judge rules, it will be precedent setting because no one has ever been extradited for the crime of assisted suicide before.

The case deals with complicated issues of international law. For example, Exoo’s attorney, federal public defender Edward Weis, argued that, according to the extradition treaty between the U.S. and Ireland, the offense committed must be a federal felony in both countries. While it definitely is in Ireland, Weis said, assisted suicide is not a federal crime in the U.S., nor is it a crime in the state of West Virginia. [Editor’s Note: Assisted suicide is a crime in West Virginia under common law.]

Arguing on behalf of the Republic of Ireland, Assistant U.S. Attorney Philip Wright countered Weis’ claim by arguing that extradition treaties must be given the broadest possible interpretation, and that the preponderance of states in the U.S.—up to 42—consider assisted suicide a felony.

In the end, the judge concluded, “It’s going to take a considerable effort on my part, in my chambers, to reach a correct decision.” [AP, 8/17/07; Sunday Gazette Mail, 8/18/07]

Transplant surgeon charged with hastening death to retrieve organs

San Francisco transplant surgeon Hootan Roozrokh, 33, has been charged with attempting to hasten the death of Ruben Navarro, 25, in order to harvest his organs. Navarro, who was on life support, had a rare degenerative condition and was diagnosed with irreversible brain damage, but he was not brain dead, a usual requirement for organ retrieval. On February 6, 2006, when the decision was made to remove Navarro from a ventilator, Roozrokh and a lesser experienced doctor from the California Transplant Donor Network flew down to a San Luis Obispo hospital with the intention of procuring Navarro’s organs after his heart stopped beating.

What happened next, witnesses said, was in violation of both state law and federal protocols. Roozrokh, who should not have even been in the same room with Navarro before he was declared dead, essentially took over and ordered the ventilator removed. When the patient didn’t stop breathing on his own, Roozrokh ordered a nurse to give Navarro excessively high doses of morphine and Ativan. In addition, Roozrokh injected Betadine, a topical antiseptic, into Navarro’s feeding tube. But Navarro still didn’t die until eight hours later, rendering his organs unusable. Roozrokh has pleaded not guilty to two of the three criminal charges against him. A hearing is scheduled for October 29. [San Luis Obispo Tribune, 8/5/07, 9/13/07; LA Times, 9/12/07; KSBY News, 9/12/07]

Vatican issues definitive answers to food and fluids questions

On August 1, 2007, Cardinal William Levada, head of the Vatican Congregation for the Doctrine of the Faith, issued answers to questions submitted by the U.S. Conference of Catholic Bishops concerning the ethics of withdrawing or withholding tube-provided nutrition and hydration, particularly in regard to “vegetative state” patients.

The answers, which were approved by Pope Benedict XVI, were unambiguous. “The administration of food and water even by artificial means is, in principle, an ordinary and proportionate means of preserving life,” Cardinal Levada wrote. “It is, therefore, obligatory to the extent to which, and for as long as, it is shown to accomplish its proper finality, which is the hydration and nourishment of the patient.”

In response to the question whether tube feeding can be discontinued if “competent physicians judge with moral certainty that the patient will never recover consciousness,” the cardinal wrote, “No. A patient in a ‘permanent vegetative state’ is a person with fundamental human dignity and must, therefore, receive ordinary and proportionate care which includes, in principle, the administration of water and food even by artificial means.” [Congregation for the Doctrine of the Faith, “Responses to Certain Questions of the United States Conference of Catholic Bishops Concerning Artificial Nutrition and Hydration,” 8/1/07]

News notes . . .

After eight years of using two flats in a residential block of Zurich as a place where 700 people, mostly foreigners, came to die, the Swiss assisted-suicide group Dignitas was finally evicted in July, the result of years of complaints from residents who had to endure a parade of corpses in the halls and elevators. But the rejection didn’t stop there. After Dignitas leased another apartment in a Zurich suburb, residents again complained, and the group was ordered to stop using the apartment for deaths. Dignitas ignored the order, so the locks were changed, barring entry to the group’s death facilitators. Desperate, Dignitas took up residence in an industrial area near Zurich, but authorities demanded a special permit, so Dignitas was out again. Finally, Dignitas set up shop in a hotel room, but, after hotel management learned that a German man was helped to die there, the owner vowed to sue Dignitas, calling what the group did a “disgrace.” “I’ve never had the wool pulled over my eyes like this before,” he explained. [Guardian, 7/13/07; Reuters, 9/26/07; Agence France Presse, 10/1/07; SwissInfo, 10/4/07]

Earlier this year, Zurich’s senior prosecutor Andreas Brunner called for the Swiss government to create tougher regulations and oversight for groups like Dignitas. He said new evidence has been uncovered that indicates some of the foreigners being helped to die were simply depressed and not suffering from intractable pain. [Sunday Telegraph (London), 3/6/07]

Recent studies on depression shed new light on the detrimental effect it has on human life. A study in the July issue of the American Journal of Psychiatry found that, for the more than 109,000 patients studied, suicide attempts fell by at least 50% within the first month after depression treatment (medication, psychotherapy, or both) was initiated, and declined steadily as time went by. [Science Daily, 7/2/07; HealthDay Reporter, 7/2/07]

Another global study by the World Health Organization, published in the September 8, 2007 issue of the British journal The Lancet, found that, compared to other chronic physical conditions—like angina, asthma, and diabetes—depression causes the most decline in health. That is particularly the case if the depressed person is suffering from other illnesses. “Having depression over and above a physical illness significantly worsens health even further,” explained lead WHO researcher Dr. Somnath Chatterji. “Being sad is bad for your health.” [Reuters, 9/7/07; HealthDay Reporter, 9/7/07]

Australia’s “Dr. Death,” Dr. Philip Nitschke, is now touting a new, simplified, do-it-yourself method for making a barbiturate-based “Peaceful Pill” to end lives. The new “Single Shot” or “Coffee Pot” method employs a converted espresso coffee pot that can exert high pressure and heat to produce a barbiturate “soluble sodium salt.” According to Nitschke, the method can be used in “any average kitchen.” Of course, the home-made barbiturate hasn’t as yet been tested “to establish exact composition and degree of contamination.” But that didn’t stop Nitschke from making a short film about the method—entitled The Single Shot—and posting it on-line at YouTube.com. [e-Deliverance (Nitschke’s newsletter), 8-9/07]

On July 24, 2007, a New Orleans grand jury decided not to indict Dr. Anna Pou, the ear, nose, and throat cancer specialist who had been charged with second-degree murder in the deaths of four acute-care patients stranded at Memorial Medical Center during the horrific aftermath of hurricane Katrina in 2005. The two nurses arrested with Pou, Lori Budo and Cheri Landry, had previously been granted immunity from prosecution in exchange for their grand jury testimony against Pou. New Orleans District Attorney Eddie Jordan said the grand jury concluded that “no crime had been committed.” “I think justice has been served after due process,” he added. But Dr. Arthur Caplan, the University of Pennsylvania bioethicist asked by the Louisiana attorney general to review the facts in the case, said, “[M]y conclusion is that the deaths…are all cases of active euthanasia.” “Each person died with massive doses of narcotic drugs in their bodies.” [Reuters, 7/24/07; BioEdge 263, 8/29/07]

New studies clearly show the necessity for “extreme caution” regarding decisions to withhold or withdraw life-sustaining treatment, including food and fluids, from patients diagnosed as being in a permanent or persistent vegetative state (PVS). One study, conducted by Belgian research teams and presented in June at the 17th Meeting of the European Neurological Society, found that 40% of PVS patients studied were misdiagnosed, a figure consistent with much earlier studies in the U.S. and U.K. The misdiagnosed patients were actually in a minimally conscious state (MCS), meaning they had a higher level of awareness than true PVS patients and a much better “chance of recovering a significant portion of their faculties.” Researchers concluded, “The results show a strong tendency to underestimate levels of consciousness in brain injury patients.” A separate study covering a five-year span of data, conducted at the University of Liège in Belgium, found over half of the patients originally thought to be PVS ended up leaving the hospital intensive care unit with some degree of recovered consciousness. In 59% of those cases, patients had “recovered to the point where they could obey commands.” [News-Medical.net, 6/20/07]

Gulf War veteran Jesse Ramirez, 36, suffered sever brain injuries, a broken neck, punctured lung, broken ribs, and a fractured face when his SUV crashed and rolled over on May 30. Less than two weeks later, his wife, Rebecca, ordered his feeding tube removed and had him moved from the hospital to a hospice. Reportedly, doctors had told his wife that he would likely be blind and remain in a permanent vegetative state. She told the local paper she did not want her husband to live if he could not care for himself. [Arizona Republic, 6/14/07; Arizona Daily Star, 6/15/07]

But Ramirez’s family took the case to court. Maricopa County (AZ) Superior Court Judge Paul Katz ordered Ramirez’s tube feeding reinstated and appointed a guardian ad litem to act on his behalf. On June 27, the Arizona Republic reported that Ramirez was not only alive and conscious, but he could “hug and kiss, nod his head, answer yes and no questions, give a thumbs-up sign, and sit in a chair.” The article also said that Jesse was ready to move to a rehabilitation facility and family members had reached a settlement transferring Jesse’s care decisions to a court-appointed guardian. [Arizona Republic, 6/27/07]