Update 043: Volume 22, Number 1 (2008)

Physician-assisted suicide initiative filed in Washington State

A measure to legalize physician-assisted suicide (PAS) has been officially filed in Washington State. On January 9, 2008, former governor Booth Gardner, the chief spokesman for the initiative, filed the “Washington Death with Dignity Act” at the state capitol flanked by members of the PAS advocacy group Compassion & Choices of Washington (formerly the Hemlock Society). Advocates have until July 3 to garner 224,880 valid voter signatures in support of Initiative 1000 to place it on the November 2008 ballot. To become law, the measure would then need a simple majority vote of the people.

This is not the first PAS initiative Washington voters have had to consider. In 1991, voters defeated Initiative 119, a measure which would have legalized both PAS (where a doctor prescribes lethal drugs for the patient to self-administer) and euthanasia (where a doctor administers fatal drugs to the patient, usually by lethal injection).

Patterned after Oregon’s PAS law

This time, right-to-diers are modeling the initiative after Oregon’s permissive PAS-only law in the hope that voters will be more amenable to its passage. They claim the Oregon law, which went into effect in 1997, has proven that PAS can be practiced without abuses and without the “slippery slope” effect of expanding the categories of patients eligible for death.

Gardner, however, would like to have state-sanctioned assisted suicide available to anyone with an incurable illness and a significantly diminished quality of life. [The Herald (Everett, WA), 1/10/08] “I wish we could do a more liberal law, but we’re going to pattern it after the Oregon law because it passed,” he explained. “We’re not going to go farther than that now.” [Bergner, “Death in the Family,” NY Times Magazine, 12/2/07, p. 60. Hereafter cited as NYT Mag.]

Gardner: Profile of the spokesman

Gardner is a formidable spokesman for the campaign to legalize PAS. In addition to enjoying continued statewide popularity stemming from his years as governor, he has Parkinson’s Disease, a fact that could ramp up voter sympathy for his cause—even though Gardner would not be eligible for assisted suicide under the terms of the initiative, since Parkinson’s Disease is not considered a terminal condition.

After filing the initiative, Gardner told reporters that his motives were altruistic. “I want to give terminally ill, mentally competent adults the peace of mind to make end of life decisions with dignity and autonomy,” he said. The way to do that, he explained, is to provide them with the means to end their lives, if they so choose. [Press Conference, 1/9/08]

But a recent New York Times Magazine feature article on Gardner and his campaign revealed another possible motivation. According to Gardner’s son Doug—who is opposed to the PAS initiative—his father is driven, not by a “principled belief” in the measure, but “by an attempt to place himself, one last time, at the center of the public’s attention.” Gardner lent credence to his son’s claim when he admitted in the same article, “I want to be involved in public life. I was looking for an issue, and this one fell in my lap.” [NYT Mag, pp. 40 & 78]

Gardner, who struggles with depression, maintains that personal control and autonomy are of utmost importance to him, telling one reporter that he could even be considered a “control freak.” [Spokesman-Review (Spokane), 1/9/08; Crosscut (Seattle), 1/8/08] The campaign slogan he uses when promoting the initiative is “My life, my death, my control.” In reference to his father’s emphasis on autonomy, Doug Gardner observed, “Autonomy is all about I, me, I, me, I, me.” [NYT Mag, p. 78]

The campaign: A war of words

As has been the case in recent, failed attempts to pass PAS bills in California and Vermont, assisted-suicide advocates in Washington are playing a semantics game to soften opposition to their initiative. Since their polling clearly showed that the word “suicide” does not elicit a favorable response from the public, advocates decided the term “physician-assisted suicide” had to go. During the proponents’ first press conference, Compassion & Choices board member Arline Hinckley explained their rationale for using terms like “hasten death” and “aid in dying” instead of “suicide,” which, she said, “implies violence, mental instability, or a love-struck teenager whose romance went awry. It’s an irrational act by an otherwise healthy person.” On the other hand, she said, “hastening death” is a “very well thought-out, very rational decision by someone who would rather live if their physical circumstances were different.” [Seattle Times, 1/9/08]

Duane French, founding member of the disability rights group Not Dead Yet of Washington, says PAS advocates are attempting to rewrite the dictionary. “Suicide, if you look up the definition in Webster’s, is someone taking their own life,” he explained. “And when you ingest a lethal dose of medication, that is taking your own life.” [Crosscut (Seattle), 1/11/08] Oregon internist Dr. Charles Bentz agrees, calling advocates’ substituted terms for “suicide” euphemisms for situational killing. Bentz, the head of Physicians for Compassionate Care, explained, “For people who are suicidal at the end of life—and there are reasons—having assisted suicide as an option shortcuts appropriate medical care. Instead of getting treatment for depression, they get a lethal prescription.” The battle over terms and definitions is tremendously important, Bentz concluded. “If Compassion & Choices of Washington wins the battle of language, it will have won.” [The Oregonian, 1/10/08]

The opposition

But a strong, broad-based, opposition coalition has formed in Washington to fight Compassion & Choices’ attempt at verbal engineering and educate voters about the initiative’s inherent dangers. Members of Washington’s Coalition Against Assisted Suicide include doctors, nurses, hospice workers, people with disabilities, minorities, religious groups, and politicians. Medical groups strongly opposed to the initiative include the Washington State Medical Association, the Washington Hospice and Palliative Care Organization, and the Washington State Hospital Association. [CAAS Press Release, 1/8/08. See www.noassistedsuicide.com]

Dangers unique to Washington

A recent Washington court ruling could affect the initiative’s age requirement if the measure were to pass. The case involved 14-year-old cancer patient Dennis Lindberg, a Jehovah’s Witness, who refused blood transfusions to save his life. Over the objections of his parents and doctors, a Washington Superior Court judge ruled that the teen had the right to make this medical decision and forego the transfusions even if it meant he would die—which he did just hours after the judge issued his decision. [In re The Dependency of: Dennis Lindberg, No. 07-7-00779-3, slip op. (Super. Ct. Wash. Nov. 28, 2007)] If 14 year-olds now have the right to make their own life and death medical decisions, it would follow that, if legalized, the Washington Death with Dignity Act’s 18 or older age restriction could be struck down, expanding the right to assisted suicide to terminally-ill adolescents.

Also, legalized PAS coupled with an intense push to cut state health care costs creates a dangerous environment for those unable to afford treatment. According to a state report, the rising “financial burden of the uninsured” is threatening the “health security” of all residents. [WA Insurance Commissioner, Press Release, 12/12/07] The temptation, if PAS is legal, is to view a cheap lethal prescription as the solution to everyone’s fiscal problems.

Montana suit claims PAS a constitutional right

A lawsuit filed last October against the state of Montana and its attorney general seeks to transform the crime of assisted suicide into a right guaranteed under the state’s constitution.

The complaint—filed in Lewis and Clark County Judicial Court on behalf of two terminally-ill men, four Missoula doctors, and the physician-assisted suicide (PAS) advocacy organization Compassion & Choices—seeks “declaratory judgment and injunctive relief” to exempt doctors who provide patients with lethal drugs from existing state homicide laws. Physician “aid-in-dying,” the suit claims, is a right under the Montana Constitution, which is the only state constitution in the country to guarantee a right to dignity in addition to privacy. [Baxter v. Montana, Complaint, 10/18/07]

The section of the constitution addressing “individual dignity” does not explicitly include a right to die or assisted suicide. It simply states, “The dignity of the human being is inviolable. No person shall be denied the equal protection of the laws. No state nor any person, firm, corporation, or institution shall discriminate against any person in the exercise of his civil or political rights on account of race, color, sex, culture, social origin or condition, or political or religious ideas.” [Montana State Constitution, Article II, Section 4]

Attorney Mark Connell, who filed the suit, and Compassion & Choices’ legal director Kathryn Tucker, who is helping Connell, want the court to establish a constitutionally protected right to assisted suicide, making the prosecution of doctors involved in assisted-suicide cases unconstitutional. “The key question is who should decide,” Connell said, “the patient, in consultation with their doctor, or the government, through the application of criminal law?” Bozeman Daily Chronicle, 10/19/07; KTVQ News, 10/19/07]

Tucker, who spearheaded two unsuccessful, assisted-suicide state law challenges all the way to the U.S. Supreme Court in 1997—Washington v. Glucksberg and Vacco v. Quill (NY)—laid the groundwork for the Montana challenge in an article published in the Summer 2007 issue of the Montana Law Review. In that article, Tucker cites the 1999 abortion case Armstrong v. State of Montana as having “significant ramifications” for the individual’s right to assisted suicide. Interjecting direct quotes from the court’s majority ruling, Tucker wrote that the Montana Constitution’s privacy clause

…broadly guarantees each individual the right “to make medical judgments affecting her or his bodily integrity and health…free from the interference of the government.” The court further held that the state constitutional right of individual privacy “requires the government to leave us alone in all these most personal and private matters.” [Tucker, “Privacy and Dignity at the End of Life: Protecting the Right of Montanans to Choose Aid in Dying,” Montana Law Review, Summer 2007, p. 320]

What Tucker doesn’t mention is that two of the judges on the panel, including the chief justice, strongly objected to the opinion’s overly broad scope, warning that it could affect issues, such as physician-assisted suicide, that were not litigated in the case. As ITF attorney Wesley J. Smith observed at the time,

If the ruling means that virtually anything goes medically in Montana so long as a patient requests it and a health care professional is willing to provide it, then patients can ask doctors to kill them for organ-donation purposes, parents or guardians can secure the killing of disabled infants, and people can volunteer to be experimented on in dangerous ways that are currently illegal, all this as a result not of a considered decision by the people of Montana but of a little-noticed ruling by the state supreme court. [Smith, “Is Bioethics Ethical?” The Weekly Standard, 4/3/00]

Smith recently pointed out that much of the “ludicrously broad” ruling could be “legitimately dismissed” by current courts as dicta, meaning it was simply judges’ opinions and “not binding since the parameters of acceptable action by medical practitioners was never at issue in the Armstrong litigation.” “Still,” he said, “the [current] case is certainly no sure thing—either way.” [“Suing for the Right to Assisted Suicide,” www.wesleyjsmith.com, 10/18/07]

The campaign to make suicide a medical treatment
Rita L. Marker

Imagine that you are standing in line at your supermarket pharmacy. As you wait to pick up your prescription, you overhear the pharmacist explaining to the person ahead of you. “To induce death, mix all of this into a sweet beverage and drink it very quickly.”

Unimaginable? No. That type of prescription is currently permitted in Oregon.

In 1994, Oregon passed an assisted-suicide law, transforming the crime of assisted suicide into a “medical treatment.” Since then, proposals patterned on Oregon’s law have been introduced in 22 states—in many, multiple times—but not one has passed. Now, with a planned 2008 ballot initiative in Washington State, assisted-suicide activists hope to break the logjam.

Spearheaded by the euphemistically named Compassion & Choices (formerly known as the Hemlock Society), steps are being taken to achieve a win in Washington and propel that victory into states across the country.

To achieve their goal, they’ve taken a number of steps. Recognizing that all social engineering is preceded by verbal engineering, they’ve sanitized the language. The “s-word” is out. No longer do proponents refer to “physician-assisted suicide.” Now it’s called “physician-assisted death,” “aid-in-dying” or “death with dignity.” They’ve formed a political action committee called the “It’s My Decision Committee.” They’ve started raising funds for the anticipated multi-million dollar campaign. And they’ve selected a primary spokesperson.

For a number of reasons, former two-term governor Booth Gardner was tapped to be the public face of the campaign. Although he has been out of office for over a decade, he remains exceptionally popular in the state. Gardner has pledged significant funding for it. (He is heir to the vast Weyerhauser fortune.) On top of that, he has Parkinson’s Disease, adding the “Michael J. Fox effect,” which could make opposition to his plea for the assisted suicide appear mean spirited.

Assisted-suicide advocates plan to lull the public into accepting their proposal by claiming that it will give terminally ill adults the right to request “medication to end suffering” in accord with strict safeguards. They further claim that the practice will require careful reporting to add transparency and prevent abuse.

Oregon will be the centerpiece of the campaign.

Assisted-suicide activists use questionable studies about Oregon’s law to bolster their claims that assisted suicide has been “working well in Oregon.” For example, a recent study by University of Utah philosophy professor Margaret Pabst Battin purported to prove Oregon’s law does not have a disproportionate impact on vulnerable people. The study, published in the Journal of Medical Ethics, received widespread attention in the media. However, Battin is a longstanding pro-assisted-suicide activist who, as early as 1981 called on suicide prevention programs to adopt a more “humane” approach by cooperating with suicide advocacy groups. Currently she serves on the advisory board of the Death with Dignity National Center, an Oregon-based group that helps coordinate support for legalizing assisted suicide in other states. (That information was conveniently omitted from any identifying information in the Journal.)

In addition, assisted-suicide advocates claim that official reports on Oregon’s law demonstrate that it has been free of problems. However, that claim cannot be verified. Consider the following:

All information in official reports is provided by those who carry out assisted suicide.

Under Oregon’s law, doctors participating in assisted suicide must file reports with the state. The doctor first helps the person commit suicide and, afterwards, reports that his or her actions complied with the law. Then, that information is used to formulate the state’s annual reports. But, according to American Medical News, Oregon officials in charge of issuing the reports have conceded that “there’s no way to know if additional deaths went unreported.”

Several years ago, members of a British House of Lords Committee traveled to Oregon seeking information regarding Oregon’s law for use in their deliberations about a similar proposal that was under consideration in Parliament. They held closed door hearings where authors of Oregon’s official reports and physicians who carry out assisted suicide were surprisingly candid — perhaps because they assumed that their testimony, buried in Parliament’s transcript of the hearings, would go unnoticed.

Dr. Melvin Kohn, a lead author of several official reports, said that information received from doctors “is a self-report, if you will, of the physician involved.” Furthermore, there are no penalties for non-reporting.

Complications or other problems associated with assisted suicide are almost impossible to determine.

When Dr. Katrina Hedberg, who also has headed up formulation of official reports, was asked by the British Committee if there is a systematic way of finding out and recording complications, she said, “Not other than asking physicians.” Yet, even if they were inclined to report complications, physicians may not be aware of them since “after they write the prescription, the physician may not keep track of the patient.” According to the last official report, physicians who prescribed the drugs for assisted suicide were present at only 21.5% of reported deaths. Therefore, any information they provide might come from secondhand accounts or may be based on guesswork.

The state does not have any authority to verify if reports made by assisted-suicide providers are accurate or complete. It also does not have the authority or the funding to track complications or abuse.

Dr. Hedberg told the British Committee, “Not only do we not have the resources to do it, but we do not have any legal authority to insert ourselves.”

Records used in annual reports are destroyed.

According to Dr. Hedberg, “After we issue the annual report, we destroy the records.” Therefore, there is no way to reexamine information if questions or concerns about an assisted-suicide death arise later.

Assisted-suicide advocates also claim that Oregon’s law has safeguards to protect patients, but they’ve contradicted their own claims.

The waiting period between requests for assisted suicide and provision of the lethal prescription was based on political strategy, not patient protection.

Oregon’s law requires a fifteen-day waiting period between the first request and the provision of drugs for suicide. Kathryn Tucker, legal counsel of Compassion & Choices, addressing a conference soon after Oregon’s law went into effect, admitted that the waiting period was included to assure passage of the law. Referring to the waiting period, she explained that, after failing in several states, their strategy evolved:

“In my view, the Oregon measure, in some sense, became overly restrictive. It has a fifteen-day waiting period. And my own view of the federal constitutional claim is that a fifteen-day waiting period would be struck down immediately as unduly burdensome. As we’ve seen in the reproductive rights context, you can’t have a waiting period of that kind of duration. But in the legislative forum, to pass, you need to have measures that convince people that it’s suitably protective so you see a fifteen-day waiting period.”

The required life expectancy of six months or less is both disingenuous and disregarded.

Oregon’s law requires that patients be diagnosed with a life expectancy of six months or less before they are eligible for assisted suicide. However, a physician who has been involved in Oregon assisted-suicide deaths numbering in double digits said that such life expectancy predictions are inaccurate. Dr. Peter Rasmussen, an advisory board member for Compassion & Choices of Oregon, dismissed the need for an accurate prognosis of life expectancy. He told the British Committee:

“Admittedly, we are inaccurate in prognosticating the time of death under those circumstances. We can easily be 100 percent off, but I do not think that is a problem. 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 twelve months, I do not think the patient is harmed in any way….”

A doctor can help a mentally ill or depressed patient commit suicide.

Under Oregon’s assisted-suicide law, a depressed or mentally ill patient can receive assisted suicide if the doctor believes the patient’s judgment is not impaired. According to the last official Oregon report, physicians reported referring only 4% of assisted-suicide patients for psychological or psychiatric evaluation.

Assisted-suicide proponents also claim that the practice would never be expanded to anyone who is not terminally ill. However, in unguarded moments, they have often acknowledged that Oregon is only the “first step” toward death on demand. Nonetheless, they’ve been careful to keep those plans under wraps — until now.

To their dismay, Booth Gardner has let the cat out of the bag. According to the December 2, 2007 New York Times Magazine cover story, “Death in the Family,” about Gardner’s campaign for assisted suicide,

“Gardner wants a law that would permit lethal prescriptions for people whose suffering is unbearable, a standard that can seem no standard at all; a standard that prevails in the Netherlands, the Western nation that has been boldest about legalizing aid in dying; a standard that elevates subjective experience over objective appraisal and that could engage the government and the medical profession in the administration of widespread suicide…. Gardner’s campaign is a compromise; he sees it as a first step. If he can sway Washington to embrace a restrictive law, then other states will follow. And gradually, he says, the nation’s resistance will subside, the culture will shift and laws with more latitude will be passed…”

Compassion & Choices and other activists are none too happy about Gardner’s candor. They’ll desperately attempt to downplay any references to potential expansion of assisted suicide – until, as Gardner described, other states have joined Oregon and the nation’s resistance has subsided.

Their success in achieving that goal will depend on keeping people ignorant of their agenda. Their failure depends upon an informed, concerned and involved public.

Tempted to dismiss what’s happening in Oregon? Wondering how Oregon-type laws in other states would affect you or your loved ones? Consider this:

A doctor can prescribe a lethal dose of drugs to a person whose family may be totally unaware that a loved one is contemplating assisted suicide.

Schools can inform students that assisted suicide is an acceptable medical choice.

Medical students can be taught how to prescribe deadly drugs for patients to use to commit suicide.

Insurance companies and state Medicaid can pay for assisted suicide, while denying coverage for wanted and needed medical care.

All of that is permitted in Oregon and could, if not effectively opposed, be coming soon to your state.

No matter where we live, we are all Washingtonians for the next year. The outcome of its 2008 assisted-suicide voter initiative will affect everyone in every state.

Rita L. Marker is an attorney and executive director of the International Task Force on Euthanasia and Assisted Suicide.

New assisted-suicide bills introduced in Arizona & Wisconsin

Arizona and Wisconsin are two states where one or two legislators have repeatedly sponsored bills to legalize assisted suicide in the hope of wearing down strong legislative opposition over time.

For the sixth consecutive year, Arizona Rep. Linda Lopez (D-Tucson) has introduced her bill modeled on Oregon’s assisted-suicide law. Only her first year’s bill got an informational hearing before it died. Subsequent versions of the bill never even got that. Her new 2008 bill (HB 2387) will likely follow suit, even though, for the first time, it has the support of the Senate Health Committee chair Carolyn Allen (R-Scottsdale). [Arizona Republic, 1/24/08; East Valley Tribune, 1/21/08]

Wisconsin Sen. Fred Risser and Rep. Frank Boyle surpass Lopez in tenacity. 2008 marks the 16th year they have sponsored an assisted-suicide bill and the first time in ten years their bill got a hearing. Senate Bill 151, another clone of the Oregon law, was heard before the Senate Public Health Committee on January 23, 2008. [AP, 1/23/08] Among those asked to testify against the measure was ITF Executive Director Rita Marker, who told the committee that 22 states have considered virtually identical measures and rejected all of them. “I would ask that Wisconsin consider following their lead,” she said.

Sen. Risser told the press that his bill likely will not pass, but vowed to keep sponsoring PAS bills until one does. [The Daily Page, 1/29/08]

Two European assisted-suicide advocates resort to Kevorkian-style tactics

Two assisted-suicide proponents in Europe have recently engaged in tactics reminiscent of those pioneered by Michigan’s “Dr. Death,” Jack Kevorkian, in the early 1990s.

In September, Dr. Roger Kusch—a former senator in Hamburg, Germany, and current head of the new party “Homeland Hamburg”—unveiled the prototype of his new suicide device to residents of a local nursing home. According to one critic, the death-producing device is Kusch’s solution to “the suffering of the elderly brought about by cuts in health care.” [World Socialist Web Site, 9/15/07] In addition to nursing homes, Kusch plans to make his device available to hospices and hospitals. [CWNews.com, 9/13/07]

Like Kevorkian’s first suicide machine, the “Mercitron,” Kusch’s device uses lethal intravenous substances that the person wishing to die purportedly controls by simply pressing a little green button. This feature, he claims, makes the device’s use legal by circumventing Germany’s law banning anyone from actively assisting another’s suicide. While Kusch’s version consists of only a two-step delivery system (glucose solution followed by a liquid anesthetic overdose) and Kevorkian’s made-from-scraps contraption used a three-step process (saline solution, a barbiturate, then potassium chloride), the intended and achievable outcome of both is death.

According to a message on euthanasia guru Derek Humphry’s right-to-die news list service, Kusch’s suicide device “will be operational” in early 2008, “but organization and administrative details have not been made public.” Part of the plan, however, is “to make maximum use of retired physicians, as the retirees can continue to write the necessary prescriptions without fear of losing their license to practice.” [ERGO right-to-die news list, 9/9/07]

Ludwig Minelli, founder and director of the controversial Swiss assisted-suicide organization Dignitas, created an uproar when word leaked out in November that he had arranged for two German men to die in their vehicles in a wooded area parking lot outside of Zurich. Reportedly, Minelli had earlier provided a lethal overdose to a German woman who died in her car parked in front of Minelli’s house in Maur, Switzerland—the same town where the two men died. According to the publication Die Welt, Minelli’s damage-control spin on the car deaths is that Dignitas respects its clients’ wishes to die where they want, even on a park bench. [Die Welt, 11/12/07] But Minelli has had to resort to the “death on wheels” service because Dignitas has been repeatedly evicted from rented apartments, hotel rooms, and commercial properties throughout the Zurich area. [Daily Mail (London), 11/8/07; Telegraph (London), 11/9/07]

Minelli has the same problem that Kevorkian had. Both men serviced people who lived far away, so the clients’ homes were not available for the deaths. Kevorkian opted to use his rusty old Volkswagen van for his earliest victims’ deaths. Minelli is following Kevorkian’s example.

Dignitas’ motto is “Dignity in life, dignity in death.” But Maur undertaker Urs Gerber found little dignity in the group’s recent vehicle deaths because of what he called the “undignified surrounding conditions.” In addition to the disrespect shown to people relegated to dying in cars, Gerber said there is absolutely no dignity when he has to pull the bodies out of the car and stretch them out on the ground. [Earthtimes.org, 11/8/07]

Swiss hospitals allow on-site assisted suicides
amid calls for cost-saving health care rationing

In November, Swiss university hospitals in Bern, Lausanne, and Geneva publicly admitted that assisted suicides have taken place on their premises. Earlier this year, the Swiss Academy of Medical Sciences (SAMS) ruled that the country’s hospitals could independently decide whether or not to permit the practice. Now, the majority of hospitals have adopted assisted-suicide guidelines that require patients to be assessed for mental competence and establish designated hospital committees to approve death requests on an individual basis. In addition, an assisted suicide can only take place in the hospital if it is not possible to move the patient back home or to another setting. [British Medical Journal, 11/24/07]

Because Swiss law does not require physicians to participate in or oversee assisted-suicide deaths, the right-to-die advocacy groups EXIT and Dignitas have provided assisted-suicide services and lethal drug overdoses to people in their homes or in rented quarters. The medical profession, as such, had generally kept its distance from the controversial death-producing practice. But now, with assisted suicides taking place within hospital settings, the practice is transformed into an accepted “medical treatment.”

This comes at a time when continually rising health care costs are causing Swiss doctors to ration patients’ needed, but often expensive, medical treatment. According to the findings of a recent SAMS study, two-thirds of doctors surveyed admitted that, due to cost, they had not performed medical tests that otherwise would have been beneficial to patients.

It’s a practice that has been done largely in secret because doctors know Swiss patients would strongly object if they knew treatment was being denied. SAMS President Peter Suter explained, “There’s a risk that [patients] won’t understand the reason and would feel they are the victim of an injustice, and that there’s a disparity in terms of treatment compared with other people suffering illnesses.” To make the rationing “pill” go down easier for patients, SAMS has asked both federal and local health authorities to adopt guidelines for doctors to use in determining whether treatments should be denied and, if so, to what extent. Then, Suter said, “[T]he patient will not feel discriminated against and as a consequence will accept it more easily if a treatment is withheld.” [SwissInfo, 9/14/07]

But, treatment rationing and assisted suicide form a deadly combination. Lower costs could be viewed as a societal good, tempting doctors to offer inexpensive, lethal drug overdoses to costly patients instead of needed care.

Editor’s Note: In Switzerland, assisted suicide is not legal. However, it is penalized only if done “from selfish motives.” [Swiss Penal Code art. 115] This results in de facto legalization, since aiding a suicide is not punishable as long as the motives for doing it are deemed altruistic.

News notes . . .

On February 1, 2008, a new policy statement issued by Canada’s College of Physicians & Surgeons of Manitoba on the withholding and withdrawing of life-sustaining treatment took effect. It is binding on all Manitoba physicians. Essentially, the 15-page policy says that, while a patient or his or her duly-appointed health care proxy has the right to “participate” in decisions concerning whether life-sustaining medical treatment is withheld or withdrawn, it is the doctor who has the final say. A close family member has no legal authority to make decisions regarding the provision of life-supporting treatment unless that relative was officially authorized as a proxy by the patient or appointed by a court. If patients do not recover to a point where they are aware of themselves, the environment, and their existence, then life-sustaining treatment is deemed futile and not in the patient’s best interest. [CPSM, “Withholding and Withdrawing Life-Sustaining Treatment,” No. 1602, 2/1/08]

The new policy was issued just weeks after a Winnipeg family got a temporary restraining order barring a local hospital from disconnecting their father’s ventilator and withholding his food and fluids. In December, doctors argued that the 84-year-old, brain-injured man showed no improvement after four weeks in intensive care. The father, Samuel Golubchuk, still had brain function, and stopping his treatment would violate his Orthodox Jewish beliefs, his family said. The judge who issued the temporary injunction has yet to rule on whether he will make it permanent. The father has since shown signs of improvement. Reportedly, he is awake and has on occasion interacted with people. [Canadian Press, 12/11/07; National Post, 12/11/07; Jerusalem Post, 1/6/08; Winnipeg Free Press, 1/31/08] (There will be more on this case in the next Update.)

The Swiss assisted-suicide group Dignitas and its German branch Dignitate have announced plans to carry out an assisted-suicide test case in Germany where the induced-death practice is illegal. Dignitate deputy director Uwe-Christian Arnold, a physician, told the German media that his group’s intention is to set a legal precedent by testing the law. “We are looking to set a test case because it is not clear whether a person can be prosecuted if they do not go to the aid of a person who is dying,” he explained. When asked if assisted suicide can be abused, Arnold said, “Of course, it is open to abuse. But this argument is not a good one. Every area in life is open to abuse.” [Deutsche Welle, 11/23/07] Dignitas director Ludwig Minelli said they are prepared to take the case to the German Federal Court of Justice. “It is not right that Germany forces its seriously ill patients to leave their beds instead of us being able to come to them,” he said. [Reuters, 11/17/07]

The Dutch right-to-die organization NVVE has posted an article on its website saying research shows over 4,000 people in the Netherlands “take matters in their own hands” and die by “auto-euthanasia,” usually by ingesting a drug overdose or foregoing food and fluids. According to the article, euthanasia advocate Bert Keizer, a doctor, commented that he is “satisfied with the sense of autonomy displayed by these resourceful individuals, especially since it seems likely that many did not fit all criteria for legal euthanasia.” The article went on to say, “Half of the subjects did not even discuss euthanasia with their doctors.” [NVVE, RELEVANT Magazine, 8/07]

A bill that would have established criteria for euthanasia practice in Colombia has died in the Columbian Senate. The bill, which was supported by the government but lacked votes in the senate, would have allowed relatives to decide if a family member should be euthanized. [Spero Forum. 10/9/07; CNA, 11/5/07]

Indian Parliament member C. K. Chandrappan has introduced the Euthanasia (Permissions and Regulation) Bill, 2007 that allows a broad range of patients to qualify for life termination based on their functional inabilities. “[A] person who’s completely invalid and/or is bedridden or who cannot carry out his daily chores without regular assistance,” the bill states, “can either himself or through persons authorized by him have the option to file an application for euthanasia….” Bill proponent Dr. B. K. Rao, of the Sir Ganga Ram Hospital in New Delhi, explained, “If it is established that the treatment is proving to be futile, euthanasia is a practical option for lessening the misery of patients.” But Legal Aid Services chairman Geehanath Ganguly opposes the bill, arguing, “This bill, if it came to pass, will abuse more than be of any use.” [Telegraph (Calcutta), 11/28/07]

Australia’s “Dr. Death,” Philip Nitschke, was arrested and detained for over two hours at the Auckland airport for having two copies of his Peaceful Pill Handbook in his luggage. The book, which instructs readers how to commit suicide and get away with crimes relating to assisted suicides, has been banned in both Australia and New Zealand. The books were confiscated along with a coffee pot that has been modified to produce homemade barbiturates for suicides. A video of elderly people describing the “coffee pot” method, titled Single Shot, was also in Nitschke’s possession, along with a second video, Doing It with Betty, demonstrating how to use a plastic oven bag to end a life. [Dominion Post, 2/1/08; AAP, 1/28/08, 1/31/08]

A US federal judge has denied Ireland’s request to extradite George Exoo to stand trial for the 2002 assisted-suicide death of Rosemary Toole. The judge ruled that the stipulations in the US/Ireland extradition treaty were not met. [WV Gazette, 10/27/07; Post & Courier, 10/27/07]