Tuesday, September 1, 2015

Mixed signals from the Netherlands and Belgium about euthanasia.

This first appeared at bioedge.org and is reprinted with permission.

By Michael Cook

There is good news and bad news about euthanasia from the Netherlands and Belgium in JAMA Internal Medicine earlier this month. But which is which depends on which side of the fence you sit.

From the Netherlands comes a report about how a euthanasia clinic which handled people whose regular doctor had rejected their request for euthanasia. The staff of the Levenseindekliniek are clearly more committed to euthanasia than the general run of Dutch doctors. However, they still turned away nearly half of the requests for euthanasia and physician-assisted suicide, mostly because these patients only had psychological suffering or were tired of living.

The clinic has a reputation for aggressively pushing euthanasia. Of the 162 patients it euthanized in 2012, the year of study, 8.2% were suffering from a psychological or psychiatric ailment and 7% were “tired of life.” It has a growing fleet of mobile vans (about 40 at the moment) which buzz around the countryside assessing patient’s requests for euthanasia. Nevertheless, it “granted fewer requests for euthanasia and physician-assisted suicide than are granted in the Netherlands on the whole.”

So the report – which was funded by the end-of-life clinic — paints a picture of moderation and sound judgment on the part of euthanasia doctors.

From Flanders, the Dutch-speaking region of Belgium, comes a different picture. Belgium legalized euthanasia in 2002. Between 2007 and 2013, the prevalence of euthanasia there rose from 1.9% to 4.6% of all deaths. One in every 20 deaths is by euthanasia nowadays. The Flemish authors attempt to explain this enormous change in social mores.

First, they argue that “values of autonomy and self-determination” have become more important for the Flemish. And approval of euthanasia continues to rise, perhaps with the help of very positive reporting in the media.

The second reason is that doctors are more willing to perform euthanasia. Like their fellow citizens, they esteem autonomy, but they also are confident that they will not be prosecuted. Euthanasia is treated “as part of the palliative care continuum, as formally expressed in a position statement from the Federation of Palliative Care Flanders.”

American observers were alarmed by this new data. “As the number of overall deaths like this becomes more frequent than 1 in 20, say, I think red flags really need to be raised,” the author of a commentary in the same issue, Dr. Barron Lerner told Reuters [1]
“Most of us were trained to never condone speeding death at all,” he added. 
“To the degree that some physicians are comfortable doing so, they will be in cases in which someone has an intractable physical suffering that will only persist or get worse; it is quite a leap for most of us to also see psychological suffering as a valid reason for speeding death.”
[1] Dr. Lerner and bioethicist Arthur Caplan wrote a commentary for JAMA Internal medicine titled “Euthanasia in Belgium and the NetherlandsOn a Slippery Slope?” [http://archinte.jamanetwork.com/article.aspx?articleid=2426425].

Monday, August 31, 2015

Political Risks and Rewards for Legislators Associated with Assisted Suicide.

Dear Honorable Members of the California Assembly,

Dr Jacqueline Harvey
y name is Dr. Jacqueline Harvey and I write today to share new and vital evidence from my latest study, "Assisted Suicide: Political Risks and Rewards for Legislators Associated with Votes to Legalize vs. Maintain the Status Quo" that will help inform your vote on ABX2-15. This paper was submitted for the 2016 Western Political Science Association in San Diego and is the first analysis of the political risks and rewards for lawmakers attributed to their vote for or against assisted suicide. It examines the fate of lawmakers in Vermont who passed the first and only assisted suicide bill Act 39 in 2013. By contrasting each lawmakers vote on Act 39 with 2014 election results as well as the subsequent voting records on assisted suicide for each office, the study indicates that lawmakers who voted to monumentally change the status quo on an issue as contentious as assisted suicide faced confirmed risks with no rewards. 

Consider the following findings:
  • There was a statistically significant higher incidence of losing re-election attributed to a pro-assisted suicide vote (r=.176) but no risk/losses attributed to an anti-assisted vote. 
  • Lawmakers who voted in favor of assisted suicide lost their re-election campaigns more than twice as often as those who chose to maintain the status quo, seven vs. three (n=10) 
  • Voting against assisted suicide was not a factor that contributed to any of the 3 losses. 
  • Voting in favor of assisted suicide was a factor in six out of seven failed campaigns, and was only ruled out in one case. 
  • In every case where assisted suicide was a variable in re-election, 100% of those who lost re-election were in favor of assisted suicide. 
  • In all six cases where assisted suicide was a factor, 100% of those who lost re-election were succeeded by legislators who voted to repeal Act 39. 
  • Democrats comprised 100% of losses where assisted suicide was a factor and all were replaced by Republicans. 
  • Neither party suffered a single loss due to a vote against Act 39, a total of 30 Democrats and 34 Republicans who voted against Act 39 and none of those who sought re-election lost to a pro-assisted suicide challenger. 
  • Controlling for party-affiliation confirmed that there was no political benefit for voting in favor or opposed to Act 39. In the four out of ten cases where the candidates' position on assisted suicide was ruled out as a contributing factor in their loss, the two instances that include one vote in favor and one opposed both, which indicate voters did not choose a lawmaker over the challenger as a reward for their previous vote on assisted suicide. 
  • The author of Act 39 was not rewarded with re-election for passing the first assisted suicide bill but unseated after six years in office by a candidate who voted to repeal Act 39. 
The implications of these findings for you in regard to ABX2-15 is that the perceived support that passed Act 39 did not endure to the ballot box. Voters certainly do not reward their elected officials for supporting assisted suicide and potentially vote against them in retribution. Please consider this evidence when choosing if this issue, which already lacks public support, is worth the risks that you could face by offering your support.

Jacqueline C. Harvey, Ph.D.
Political Science, Department of Social Science

Thursday, August 27, 2015

National Post: Assisted Suicide, respect the conscience rights of all

Alex Schadenberg
By Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Yesterday, delegates at the Canadian Medical Association (CMA) annual meeting rejected a motion (79%) to respect the conscience rights of physicians who oppose euthanasia and assisted suicide. 

The CMA has not announced its final policy yet but many physicians want nothing to do with killing their patients by euthanasia or assisted suicide, even after the Surpreme Court struck down Canada's assisted suicide law and gave parliament 12 months to legislate on the issue.

Today, the National Post published an editorial titled: On physician-assisted suicide, respect the conscience rights of all. The National Post first examined the position of physicians.

According to a poll of 1,047 doctors by the Canadian Medical Association (CMA), released as part of the organization’s annual general meeting in Halifax, 63 per cent would refuse to provide so-called “medical aid in dying.” 29 per cent said they would consider killing a patient upon request, with 19 per cent saying that they “would be willing to help end the life of a patient whose suffering was psychological, not physical.” 
The results suggest there remains strong opposition to assisted suicide among the membership of the CMA, which until recently was officially opposed to a loosening of anti-euthanasia laws in any form. At the same time, it suggests there are enough doctors willing to aid a patient to commit suicide to serve the demand. Unfortunately, that is not enough to settle the matter of just when and how physicians will be involved.
The National Post editorial then examines the effect on physicians:
Put yourself in the position of a doctor who believes euthanasia to be a deep moral wrong. This is not an antiquated or otherwise-dismissible position. The legalization of physician-assisted suicide is a revolution in medicine, which turns the role of doctors as a provider of care on its head and intrudes upon the Hippocratic Oath’s instruction to “not play at God.” It violates the traditional conception of medicine, beseeching the physician to do no harm. It is a new and relatively unchartered territory — altogether so here in Canada. It is imperative that the conscience rights of all be protected. 
Any doctor should have the right to say, “I want nothing to do with this.” While this would obviously not allow him or her to interfere in the decision of another doctor to help a patient commit suicide, the conscientiously objecting doctor should equally be under no obligation to abet the killing of a patient in any way, whether directly or by referral to another doctor. 
The Supreme Court’s finding ... means there are limits on how far Parliament can restrict the practice. It does not — and should not — imply an obligation upon all doctors to participate in the new assisted-suicide regime.
The National Post ends the editorial by urging parliament to recognize conscience rights.
As the CMA poll suggests, there remains considerable hesitation on the part of Canada’s physicians to jump on the euthanasia bandwagon. Accordingly, Parliament’s new law should be explicit in affording the utmost protection to doctors who do not wish to participate in this new and morally troubling enterprise.
The Euthanasia Prevention Coalition recognizes that if euthanasia and assisted suicide become legal, the only way to protect people is by protecting the conscience rights of physicians.

When physicians have the right to say - I will not kill you - then they also have the right to say - I will protect you in your time of need.

Wednesday, August 26, 2015

Canadian Medical Association rejects conscience rights for physicians with regard to euthanasia.

Alex Schadenberg
By Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The Canadian Medical Association (CMA) voted to rejected a motion that would protect the conscience rights of physicians who refuse to refer patients to die by euthanasia at their annual General Council meeting today in Halifax.

A media release from the CMA today stated:

Conscientious objection was a contentious issue, with 79% of delegates voting against a motion to support conscientious objectors who refuse to refer patients for medical aid in dying. 
"What we expect from physicians, at a minimum, is that they provide further information to patients on all the options including the spectrum of end-of-life care and … how to access those services," CMA Vice President of Medical Professionalism Dr. Jeff Blackmer told reporters at a press conference Aug. 26.
Yesterday, the CMA released the data from an online consultation of 1407 members which found that 63% would refuse to assist the death of their patients, 29% would assisted the death of their patients upon request and 8% were unsure.

But only 29% of the physicians who would refuse to lethally inject their patients would also refuse to refer patients to their death.

The Globe and Mail quoted Dr Jennifer Tong of Vancouver who warned:
“coercing physicians against their conscience” would damage patient-doctor relations and push some out of the profession.
The Euthanasia Prevention Coalition recognizes that if euthanasia and assisted suicide become legal, the only way to protect people is by protecting the conscience rights of physicians. 

When physicians have the right to say - I will not kill you - then they also have the right to say - I will protect you in your time of need.

Family challenges $1.8 million Will bequest to euthanasia group, after their father died by suicide.

By Alex Schadenberg
Alex Schadenberg
International Chair, Euthanasia Prevention Coalition

The family of a man, who died by suicide are challenging their father's Will that gave $1.8 million to Philip Nitschke and his euthanasia lobby group, Exit International.

According to the Herald Sun William O’Brien’s children Gai and Brett challenged the 89-year-old’s will after he took his own life last year. The Herald Sun reported Philip Nitschke, the founder of Exit International, as saying:
Mr O’Brien believed that every elderly person, terminally ill or not, should have that choice. 
the legal challenge was “very surprising” given Mr O’Brien felt that he had provided for his children “very adequately”, and the directions for his estate should be respected by the court.
According to the Herald Sun Mr O'Brien died in July 2014 even though he was reportedly in good health. The Herald Sun also reported that O'Brien left $5000 to each of his surviving children.

Dying With Dignity Canada received almost 24% of their income in 2014 from bequests.

Tuesday, August 25, 2015

63% of Canadian physicians will refuse to assist their patients suicide.

Alex Schadenberg
By Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Today, the Canadian Medical Association (CMA) released to the media the results of their online survey of members. The survey that was based on responses from 1407 CMA members found that 63% would refuse to assist the death of their patients, 29% said that they would assisted the death of their patients upon request and 8% were unsure.

For those who would assist the death of their patients, 43% would do so for non-terminal patients and 19% would do so for patients who live with psychological suffering.

The Supreme Court of Canada decision defined Assisted Death to include euthanasia (lethal injection) and assisted suicide (prescribing a lethal dose).

Dr Sheila Harding
Saskatoon hematologist Dr Sheila Harding strongly opposes assisted death. CBC news reported Harding as saying:

"I feel strongly that hastening death is not part of medicine. I think it eviscerates what medicine is intended to be. I think that asking physicians to be killers is contrary to the very core of medicine,"
Physicians conscience rights.

According to the Globe and Mail, 75% of the CMA conference delegates agreed that:
physicians should provide information to patients on all end-of-life options available to them but should not be obliged to refer.
The Globe and Mail article quoted Dr. Jennifer Tong of Vancouver who warned: 
“coercing physicians against their conscience” would damage patient-doctor relations and push some out of the profession.
Dr. Jeff Blackmer, vice president of medical professionalism with the CMA stated:
"No physician should be forced to participate against their conscience," 
"But there's disagreement about what this means."
29% of the physicians who refuse to kill their patients are also opposed to having anything to do with assisted death, while the others were either unsure or willing to refer their patient to another physician or administrator in some manner.

The Euthanasia Prevention Coalition recognizes that if euthanasia and assisted suicide become legal, that the only way to protect people is by protecting the conscience rights of physicians. 

When physicians have the right to say - I will not kill you - then they also have the right to say - I will protect you in your time of need.

New Euthanasia Push in Tasmania

This article was published on the HOPE Australia website on August 25, 2015

Paul Russell and
Alex Schadenberg outside
Tasmanian Parliament.
By Paul Russell, Director of Hope Australia

News today that the Tasmanian State Conference of the Australian Labor Party endorsed a motion in support of a push for euthanasia has reignited the issue in the island state.

Euthanasia was last debated in Tasmania on the 17th of October 2013 when the Voluntary Assisted Dying Bill was defeated 13 votes to 11 in the State's Lower House. Since that time, the State Election has changed the make up of the chamber offering, perhaps, the mover of the last bill, Lara Giddings MP, some hope that this time the outcome might be different.

The ALP motion - now part of the party's Tasmanian platform - is subject to the normal provision of a conscience vote and is, we understand, not binding upon State ALP Members of Parliament.

However, as noted in The Examiner, the three new members on the government benches for the Liberal Party are holding their cards close and claiming, at this time, to be 'openminded' on the subject.

Readers should note that, in 2013, Lara Giddings was Premier which provided her with additional control over the debate process. This time around she is a Shadow Minister on the opposition benches.

Time will tell. The Examiner reports that Lara Giddings will be looking to introduce her bill later this year.

Euthanasia at the Heart of the Federal Election

While the federal election campaign is in full swing, the question of Euthanasia is beginning to make its way among major election issues in healthcare. Indeed, the next federal government will have the mandate to enact a law before February 6 in response to the Supreme Court’s judgment on "medical assistance in dying."

To stimulate discussions, the Ontario Ministry of Health has announced the creation of a second Expert Advisory Group in addition to the Federal External Panel set up by the federal government shortly before the dissolution of Parliament.

Composed of 11 provinces and territories, this new advisory group, led by Ontario, will too be responsible for providing advices on the development of policies, practices and protective measures to be taken with the legalization of assisted suicide on their respective territories. Several experts are featuring on its board, namely Maureen Taylor, Jocelyn Downie and Arthur Schaefer are well known pro-Euthanasia activists.

Since each election campaign launches political parties in a race for votes, candidates for the next government will be forced to gauge public opinion in order to establish their position on this social issue. It is therefore crucial that everyone takes part in the debate by answering the online survey of the Provincial-Territorial Expert Advisory Group, as well as the online consultation of the Federal External Panel.

We also strongly encourage you to take advantage of this key moment in our democracy to contact your candidates and discuss with them about issues regarding Euthanasia and assisted suicide, in particular their social impact on families and caregivers and the measures to be taken to protect vulnerable people.

Living with Dignity, the Physicians’ Alliance against Euthanasia and the Euthanasia Prevention Coalition are stressing the importance of expressing yourself in the polls, especially during electoral period. By doing so, you add weight to the experts’ recommendations in order to contain the excesses that the law on Euthanasia and assisted suicide will generate in a few months.

Monday, August 24, 2015

Final Exit Network found guilty for assisting the suicide of Minnesota woman.

Alex Schadenberg
By Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

A Minnesota Judge applied the maximum sentence to the Final Exit Network (FEN) for their role in assisting the suicide of Doreen Dunn (57) in 2007, after a jury found the Final Exit Network guilty last May.

The Star Tribune reported that:

During the trial, prosecutors argued that the group gave Doreen Dunn, of Apple Valley, a “blueprint” for ending her life and made efforts to conceal her suicide from family and authorities by removing the equipment she used. 
Criminal cases against Final Exit Network coordinator Roberta Massey, of Bear, Del., and the group’s medical director, Lawrence Egbert, 87, of Baltimore, are still pending. 
Another defendant, Jerry Dincin, died and charges against Thomas Goodwin were dismissed in 2013. 

According to a LaCrosse Tribune article:
Dakota County prosecutor Elizabeth Swank told jurors that the evidence showed that two members of Final Exit Network went to Dunn's home in Apple Valley to assist her suicide. They then removed the equipment that she used for suicide so that it appeared she had died of natural causes. 
Dunn's husband of 29 years arrived home on May 30, 2007, to find her dead on the couch. Swank said Dunn had a blanket pulled up to her neck with her hands folded on her chest. 
Swank said that despite Dunn's pain and depression, she had no life-threatening illness and her family was puzzled by her death. There were good things happening in her life: Her daughter who had been in Africa for about a year was coming home the next day and her son's fiancee was scheduled to give birth that week. However, her husband was also planning to move out, the prosecutor said.
John Celmer
Judge Christian Wilton senteced FEN to the maximum sentence by ordering that they pay a $30,000 fine plus $3000 towards the funeral cost.

FEN has been prosecuted for assisting several suicides. In Georgia, John Celmer, who was depressed after recovering from cancer, died after FEN assisted his suicide. Celmer's widow Susan Celmer, testified against FEN. 

Last year Larry Egbert, the medical director FEN, lost his medical license in Maryland.

The continual expansion of euthanasia in the Netherlands and Belgium.

Alex Schadenberg
By Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The Washington Post published a very well researched article by Charles Lane on August 19, 2015 titled: Europe's sinister expansion of euthanasia. This same article was republished in the National Post and several other major newspapers.

Lane examined the date from the recent research concerning the Belgian euthanasia law. I have written similar articles, but to his credit, Lane has been published by major newspapers.

Lane first examines the data from a Study: concerning 100 requests for euthanasia for psychiatric reasons in Belgium. Lane remarks that:

Between October 2007 and December 2011, 100 people went to a clinic in Belgium’s Dutch-speaking region with depression, or schizophrenia, or, in several cases, Asperger’s syndrome, seeking euthanasia. The doctors, satisfied that 48 of the patients were in earnest, and that their conditions were “untreatable” and “unbearable,” offered them lethal injection; 35 went through with it. 
These facts come not from a police report but an article by one of the clinic’s psychiatrists, Lieve Thienpont, in the British journal BMJ Open. All was perfectly legal under Belgium’s 2002 euthanasia statute, which applies not only to terminal physical illness, still the vast majority of cases, but also to an apparently growing minority of psychological ones. Official figures show nine cases of euthanasia due to “neuropsychiatric” disorders in the two-year period 2004-2005; in 2012-2013, the number had risen to 120, or 4 percent of the total.
Charles Lane
Lane then examines the data from a study concerning the: First Year of the End-of-Life Clinic for Physician-Assisted Dying in the Netherlands. Lane states that:

... the Netherlands, which decriminalized euthanasia in 2002, right-to-die activists opened a clinic in March 2012 to “help” people turned down for lethal injections by their regular physicians. In the next 12 months, the clinic approved euthanasia for six psychiatric patients, plus 11 people whose only recorded complaint was being “tired of living,” according to a report in the Aug. 10 issue of JAMA Internal Medicine. 
If you find this sinister, I agree. Bioethicists Barron H. Lerner and Arthur L. Caplan, who reviewed the data from the Low Countries in JAMA Internal Medicine, observe that the reports “seem to validate concerns about where these practices might lead.”\
Lane emphasizes that the Belgian study admits that decisions for euthanasia are based on undefined criteria:
Thienpont acknowledges that “the concept of ‘unbearable suffering’ has not yet been defined adequately” and that “there are no guidelines for the management of euthanasia requests on grounds of mental suffering in Belgium.” 
Yet she and her colleagues continue to put the mentally ill to death, insisting that they are respecting their wishes — though, as she writes, “further studies are recommended.”
Frank van den Bleeken
Lane then uses the example of Frank van den Bleeken, the Belgian prisoner who was serving a life sentence for murdering and raping. van den Bleeken was approved for lethal injection for reasons of psychological suffering because he considered living in prison for the rest of his life was too great a level of suffering. Lane states:

Thienpont’s co-author Wim Distelmans, a leading advocate of euthanasia, has ended the life of a 44-year-old who was anguished, but not terminally ill, due to a botched sex-change operation. Distelmans also put to death identical 45-year-old deaf twins who said they lost the will to live upon learning they would eventually go blind. 
Frank van den Bleeken, imprisoned for 30 years for rape and murder, sought euthanasia from Distelmans, citing his incurable violent impulses and the misery of life behind bars. Belgian officials and Distelmans initially agreed; a lethal injection the murderer might have gotten as punishment in the United States would be supplied as therapy in anti-death penalty Europe. 
In January, however, Distelmans backed out just before the scheduled procedure — there was still hope for van den Bleeken to get treatment at a facility in the Netherlands, he said. 
Distelmans faced little accountability either way. The body empowered to scrutinize his actions, after the fact, was Belgium’s Euthanasia Control and Evaluation Commission — of which he is co-chairman. It has reviewed thousands of cases since 2002 but referred exactly none to law enforcement.
Lane ends the article by quoting from the Lerner and Caplan commentary:
The “very worrisome” trends in Europe “should give us pause” about where the “assisted dying” movement might lead in this country, Lerner and Caplan write. 
To be sure, by authorizing doctors to administer lethal drugs, in terminal and non-terminal cases, the Benelux countries go far beyond laws in Oregon and four other states, which permit physicians to prescribe, not administer, a fatal dose — and only in cases of terminal physical illness.
Charles Lane has done his homework. Euthanasia has gone through multiple extensions. The types of euthanasia deaths that are happening in the Netherlands and Belgium would have been considered abuses of the law, if they had occured in the first years.