Monday, July 25, 2016

California assisted suicide law is unconstitutional... Killling is never medical care.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Dr Philip Dreisbach is one of six physicians who joined with the American Academy of Medical Ethics to legally challenge the California assisted suicide law has written an important article that was published in the Wall Street on July 24, 2016 titled: Why are they trying to make us kill our patients.

Dreisbach explains why the California assisted suicide law is unconstitutional:
I am an oncologist/hematologist who has been practicing in California, primarily at Eisenhower Medical Center in Rancho Mirage, for 39 years. It has been my privilege to have treated and cared for more than 16,000 patients with cancer or blood diseases and to have provided pain relief and comfort for the dying. 
... Our state’s physician-assisted suicide law instantly removes penal-code protections from a vulnerable segment of the population deemed “terminally ill.” The law allows anyone labeled as terminally ill to request assisted suicide—but it also accepts heirs and the owners of caregiving facilities to formally witness such requests, even though the probate code does not even accept “interested” parties as witnesses to a will. 
The law does not require an attending physician to refer the patient for psychological assessment. It thus does not allow for screening for possible coercion, or for underlying mental conditions that could be behind the suicide request—unless the patient has signs of mental problems, which may not be visible to a suicide-specialist doctor they may not even know. In these and other ways, the law devastates elder-abuse law and mental-health legal protections, and it deprives those labeled as terminally ill of equal-protection rights that all other Americans enjoy. 
All of us in the practice of cancer care have seen patients, diagnosed with so-called terminal illness, who have experienced a marvelous remission of disease. Very little is absolute—except death itself.
Dr Philip Dreisbach
reisbach explaines why doctors should not assist in killing of their patients:
Killing is never medical care. There is no circumstance when any compassionate, competent physician would prescribe a deadly drug to any patient. If “medical practice” has any meaning, it definitely does not include using drugs to willfully kill a patient or for a physician and pharmacist to supply a lethal drug so that a patient can kill himself. 
The American Medical Association has spoken for all physicians by stating: “Physician-assisted suicide is fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks.” 
The irony here is that the medical community has strongly objected to facilitating the death of felons on death row, but that same medical community is now expected to help kill the innocent.
Dreisbach comments on the experience of Dr William Toffler, from Oregon, where assisted suicide has been legal since 1998:
... Dr. William Toffler, a distinguished professor of family medicine at Oregon Health & Science University in Portland, Ore., testified before Congress in 2015 about abuses of the law and about the state health department’s negligence. “There is a shroud of secrecy enveloping the practice,” he said. “Doctors engaging in this practice are required by state law to fabricate the cause of death stating that the cause is ‘natural’ rather than suicide.” 
As the law took effect, Dr. Toffler noted, “the Oregon legislature implemented a system of two different death certificates—one that is public with no medical information and a separate one that is never made public. Thus, review and tracking of physician-assisted suicide deaths by anyone outside of the Oregon Health Division is impossible.”
Dreisbach concludes his article by confirming why the California assisted suicide law is unconstitutional:
Equal protection is not a mindless bumper-sticker slogan. It is a pillar of state and federal constitutions and must not be corrupted. Under the law, equal protection must apply not only to the healthy and able but to the most vulnerable—the unhealthy, the disabled, the elderly—and all who might fall victim to those peddling physician-assisted killing.
Several weeks ago the California assisted suicide law was also denounced by the Disability Rights Education and Defense Fund (DREDF).

Wednesday, July 20, 2016

Court case filed to protect Vermont physicians and patients from coercion in assisted suicide.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition.

The Alliance Defending Freedom (ADF) has filed a lawsuit to protect the conscience rights of healthcare professionals in Vermont and prevent physicians and patients from being coerced into assisted suicide.

According to the ADF media release the case was filed on July 19 in federal court on behalf of health care professionals in Vermont who refuse to refer their patients for death by assisted suicide and against the officials in the Vermont Board of Medical Practice and the Office of Professional Regulation.

The ADF Senior Counsel Steven H. Aden states in the media release:

“The government shouldn’t be telling health care professionals that they must violate their medical ethics in order to practice medicine,” 
“... The state has no authority to order them to act contrary to that sincere and time-honored conviction.”

The Vermont assisted suicide law requires physicians to inform patients about all palliative care options. The ADF states that the Vermont Department of Health expanded the definition of palliative care to include assisted suicide. The ADF release quotes a Vermont Department of Health document that states:
“Do doctors have to tell patients about this option? Under Act 39 and the Patient’s Bill of Rights, a patient has the right to be informed of all options for care and treatment in order to make a fully-informed choice. If a doctor is unwilling to inform a patient, he or she must make a referral or otherwise arrange for the patient to receive all relevant information.”
The complaint filed as Vermont Alliance for Ethical Healthcare v. Hoser states:
This is nothing but the redefinition of ‘palliative care’ to mean providing assisted suicide, an intolerable position for Plaintiffs and other conscientious physicians and healthcare professionals." 
“Plaintiffs, state and national associations of conscientious healthcare professionals whose personal and professional ethics oppose the practice of assisted suicide, bring this action on behalf of their members against the operation of Act 39 to force them to counsel and/or refer for the practice.”
A similar case was filed in Canada by physicians in Ontario who are being coerced by the Ontario College of Physicians and Surgeons to refer patients to die by euthanasia or assisted suicide, even if the physician morally or ethically opposes killing patients.

Tuesday, July 19, 2016

Malta rejects euthanasia and proposes living wills.

Alex Schadenberg
International Chair - Euthanasia Prevention Coalition

Last week, the Maltese government rejected euthanasia and decided to codify "living wills." The Malta Independent news published a statement from government Chairperson, Professor Arnold Cassola.
"A 'biological will' would allow a person, when still in full possession of one's intellectual faculties, to declare what kind of treatment to accept and whether to prolong or not in an artificial way - through the use of machines or other artificial systems - a life that would otherwise have naturally come to an end. The standards of palliative care should also be looked into to guarantee dignified end-of-life care for everyone." 
“Whilst AD does not agree with the termination of life through euthanasia, it is in favour of the drawing up of 'living wills' or 'biological wills.’”
It is good that the Maltese parliament debated the issue of euthanasia honestly by recognizing that euthanasia constitutes the termination of a human life.

Accidental dog euthanasia, Illegal euthanasia at animal service, should humans be concerned?

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Everyday I receive euthansia news updates from a google alert. Usually there are stories about euthanasia of animals as part of the alert. Most of the animal euthanasia stories concern a change of rules for euthanasia or an announcement that an animal shelter is lessening or eliminating euthanasia.

Recently there have been several interesting stories about animal euthanasia that made me think. Could this also happen to humans?

The first story concerns a dog that was accidentally euthanized after staff at the Contra Costa Animal Services failed to follow protocols.

According to the article in the East Bay Times Barbie was accidentally euthanized based on a communication error. Animal Services Director Beth Ward stated:
...her agency had agreed to perform surgery on Barbie before transferring her. When a staff member went looking for Barbie to prep for surgery, it was discovered that the dog had been put down. 
Barbie was getting picked up to get a biopsy done on a mammary gland mass, when it was discovered she was mistakenly euthanized, said Melissa Farley Law, the dog adoption coordinator at Petaluma Pet Pals, which had found a foster family to care for Barbie. 
She still wants to know whether staff who made the mistakes are being held accountable.
Pietro D'Amico
In April 2013, Pietro D'Amico died at a Swiss assisted suicide clinic, after receiving a wrong diagnosis. An article published in Switzerland's english news service, The Local, stated:
... his family's lawyer Michele Roccisano told Italian newspaper Corriere della Sera. 
An autopsy carried out by the University of Basel’s Institute of Forensic Medicine found that D’Amico was not suffering from a life-threatening illness at the time of his death. 
Roccisano has called on the Italian and Swiss authorities to examine D’Amico’s medical records to determine what went wrong.
Did the D'Amico family ever find out what went wrong?

The next article concerned the resignation of the Louisville Metro Animal Services Director, Jessica Montgomery, who had illegally euthanized a dog. According to the Insider Louisville news Montgomery was not certified to do euthanasia.

A study published published in the NEJM in March 2015 on the experience with euthanasia in the Flanders region of Belgium indicates that approximately 1000 Belgian deaths were hastened without explicit request in 2013. A similar study that was published in the CMAJ in May 2010 found a nearly identical percentage of Belgian deaths that were hastened without explicit request in 2007.

The final article concerned grieving that many people experience after the euthanasia death of a pet. According to the Long Beach Post:
The loss of a pet is sometimes not appreciated by those who have had no similar experiences or can’t relate to a pet as a loved one. When a loss happens, there are steps to deal with the pain. The first thing to realize is that your feelings of grief and sadness are real.
Tom Mortier's depressed mother died by euthanasia in April 2012. Mortier was completely shocked and traumatized by her euthanasia death.

Society has long understood that there are abuses of euthanasia related to animals. Should humans not also be concerned?

Wednesday, July 13, 2016

Utah's assisted suicide bill encourages people with years to live to throw away their lives

1001 4th Avenue, Suite 4400
Seattle WA 98154

Wednesday, July 13, 2016


Dore: "Utah’s assisted suicide bill, if enacted, will allow the perfect crime. The law will encourage people with years to live to throw away their lives."
Contact: Margaret Dore (206) 697-1217

Salt Lake City, UT -- Attorney Margaret Dore, president of Choice is an Illusion, which has fought assisted suicide legalization efforts in many states, and now Utah, made the following statement in connection with a bill pending before the Utah Legislature. (HB 264).

“The bill has an application process to obtain the lethal dose,” said Dore. “The process includes a written lethal dose request form with two required witnesses. One of the witnesses is allowed to be the patient’s heir who will financially benefit from the patient’s death.”

"A central problem with the bill is that a person assisting a suicide can have his or her own agenda," Dore said. "For example, if the person will financially benefit from the patient's death due to an inheritance, he or she will have a potential motivation to be sure that the death goes through. This may or may not be consistent with the patient's choice."

"This central problem is exacerbated by bill provisions that strip away existing patient rights. Dore explained, "Under current Utah law, patients have a right to informed consent regarding treatment alternatives. Under the proposed bill, patients instead have the right to an 'informed decision,’ which limits their right to information. More to the point, they have no right to be told about alternatives for cure or to extend life."

Dore said, "Another problem is that the bills allow someone else to speak for the patient during the lethal dose request process." Dore elaborated, "There is no requirement that speaking person be the patient's designated agent, for example, through a power of attorney. The person is merely required to be 'familiar with the patient's manner of communicating,' for example, that the patient communicates with a stutter. This is obviously not a sufficient standard for a life and death decision."

“After the lethal dose is issued by the pharmacy, there is no oversight,” Dore said. “No doctor, not even a witness, is required to be present at the death. This creates the opportunity for someone else to administer the lethal dose to the patient without his or her consent. If the patient objected or even struggled, who would know? The bill allows the perfect crime."

"The bill seeks to legalize assisted suicide for people who are 'terminal,' which is defined as a doctor's prediction of less than six months to live," Dore said. "In real life, such persons can have years, even decades, to live. This is due to actual mistakes: The doctor evaluated another patient's test results. More typically, doctors are wrong because predicting life expectancy is not an exact science."

Dore concluded, "Utah’s assisted suicide bill, if enacted, will allow the perfect crime. The law will encourage people with years to live to throw away their lives."


For more information:

1. Legal/policy analysis of HB 264, which can be viewed at these links:

2. Margaret K. Dore, "'Death with Dignity': What Do We Advise Our Clients?," King County Bar Association, Bar Bulletin, May 2009,
3. Nina Shapiro, "Terminal Uncertainty: Washington’s new "Death With Dignity" law allows doctors to help people commit suicide-once they’ve determined that the patient has only six months to live. But what if they’re wrong?" Seattle Weekly, 01/14/09, available at:

Choice Is An Illusion is a human rights organization, working to keep assisted suicide and euthanasia out of your state, and out of your life

Tuesday, July 12, 2016

Assisted Dying: What can we learn from places where it is legal.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Baroness Ilora Finlay
Professor Ilora Finlay wrote an excellent article that was published in the Guardian today titled: Assisted Dying: What can the UK learn from places where it is legal.

Last year the British parliament overwhelmingly defeated an assisted suicide bill. Finlay responded to the push to legalize assisted suicide with this article. 

Finlay first analyzes the Oregon experience with assisted suicide. She writes:
In 1997 the US state of Oregon licensed doctors to supply lethal drugs to terminally-ill patients who met certain conditions – that they had less than six months to live, had mental capacity and were acting voluntarily. 
Up to 2013 there was a steady overall upward trend in the numbers of such assisted suicide deaths. But from 2013 there has been a marked upturn. The two years 2014 and 2015 saw an 80% increase in deaths of this nature: there are now more than eight times the number than when the law came into force. 
There are other concerns too. There is “doctor shopping”, whereby people whose doctors won’t participate in assisted dying (and two out of three won’t) seek lethal drugs from other doctors who are willing but have never met them before and know nothing about them beyond case notes. One such doctor issued no less than 27 prescriptions for lethal drugs in 2015 alone. 
Prognosis of terminal illness is fraught with difficulty. The reports from Oregon illustrate this. They show that some people who had been supplied with lethal drugs on the basis of a prognosis of six months or less lived for up to three years before taking them. How long they might otherwise have lived is anybody’s guess.
Baroness Finlay then looks at the experience with assisted dying in the Netherlands.
What of the Netherlands? Their 2002 legislation also permits physician-administered euthanasia – where a doctor injects lethal drugs (coma-inducing drugs plus, often, a paralysing agent to cause death by asphyxia). The Netherlands’ assisted death rate also rose modestly at first before turning sharply upwards. Last year euthanasia or assisted dying accounted for one in 26 of all deaths in the Netherlands: that’s the equivalent of over 20,000 deaths annually in the UK. 
The Dutch official reports also reveal legislative drift. Increasing numbers of people were euthanised last year because of psychiatric illness (56 cases) or dementia (109 cases). In 2015 euthanasia was administered to a young woman suffering from post-traumatic stress disorder and anorexia nervosa who had been sexually abused as a child. Dutch campaigners want to make suicide drugs available to people who aren’t ill at all, just tired of life.

Dutch legislators simply didn’t envisage this in 2001 when they enacted the Termination of Life on Request and Assisted Suicide Act – a title that is at least upfront and honest and avoids the sugar-coated euphemisms (like assisted dying) that are used here to cloak the realities.
Professor Finlay finishes by stating:
... Campaigners in the UK claim they only want Oregon-style physician-assisted dying for the terminally ill. But such criteria are purely arbitrary and contain within themselves the seeds of their own expansion. ... The limited criteria we are seeing look more like an unpacking of assisted dying in an attempt to get it through the door of a skeptical parliament. If we are wise, we will learn from the experience of others rather than from our own mistakes.

Ilora Finlay is professor of palliative medicine at Cardiff University and has taught end-of-life care internationally. She is a crossbench Peer in the House of Lords; her private member’s Access to Palliative Care Bill is before parliament. She co-chairs the independent think-tank Living and Dying Well.

Monday, July 11, 2016

Québec: 166 euthanasia deaths since December.

Amy Hasbrouck
Director: Toujours Vivant - Not Dead Yet

According to an article in Le Devoir published on July 6, 2016, there have been 252 requests for euthanasia in Québec since December 10, 2015, and 166 people died by euthanasia. Another 249 people were given terminal palliative sedation.

A similar article from Radio Canada published on the Huffington Post Québec website on the same day put the figures somewhat lower. The Radio Canada report said that 128 people have been euthanized, while 200 people requested the procedure. Radio Canada did not mention a figure for terminal palliative sedation. The Commission on End-Of-Life Care has not issued an official report on the number of euthanasia procedures; their report is expected in September.

The statistics were compiled by each publication from information on the websites of hospitals throughout Québec. Each media outlet has interpreted the statistics according to its own position on the issue. While Radio Canada’s article is relatively neutral, the piece in Le Devoir implies that people’s rights are being violated if they die before the eligibility evaluation process is completed and euthanasia can be administered.

The figures speak for themselves

According to a compilation of all the reports submitted by Quebec hospitals conducted by Le Devoir, 252 people asked for medical help to die since 10 December, and 166 received it.

In almost 34% of cases, 85 patients, medical aid in dying was not given, confirming the trend highlighted in June by Le Devoir, with partial data. In 16 cases, patients changed their minds during the process, which represents less than 7% of total applications and a fifth of requests for euthanasia not administered.

In only 27 cases, or nearly 11% of total requests, euthanasia was refused because patients did not meet the criteria of the law. Recall that the patient must be an adult and able to consent to care and be end of life. [They must also have] an incurable and serious disease, the patient should experience a "advanced and irreversible" decline in his capabilities, and experience "constant, unbearable physical or mental suffering that can not be appeased in conditions deemed tolerable."

A marginal demand

Analysis of the reports on assistance to die also shows that during the same period, 249 people received terminal palliative sedation – a procedure that puts the patient in an irreversible coma leading to death – or roughly the same number as those who requested medical help to die. Overall, aid in dying so far remained marginal: it accounts for only 0.6% of the total number of palliative care reported by institutions in this first report.

Of the total deaths expected in six months, aid in dying would represent less than 5 deaths in 1000 up to now, if we extrapolate from the data provided by the Institut de la statistique du Québec (ISQ) that shows 65,000 deaths in 2015. According to the Ministry of Health, the proportion of requests for aid in dying account for about 2% of deaths in countries that have passed laws authorizing this end of life care.

Switzerland needs to improve palliative care.

Alex Schadenberg
International Chair - Euthanasia Prevention Coalition

Editor in chief: Larissa Bieler
Today's editorial supports better palliative care in Switzerland where assisted suicide has become common. Editor, Larissa Bieler, examines the human reality in relation to assisted suicide as compared to palliative care and states:
The final act in assisted suicide ... is the taking of a lethal substance. It needs the patient’s active involvement. Or to put it another way: it’s a suicide for which the patient requires medical help to prepare. 
... Palliative care seeks to give some transparency to the issues of confronting death and the wish to die. It also aims to remove the taboos. There is an alternative. Suicide can be a long-term burden for loved ones and end up being an extremely ambivalent act for the patient. Do I want to go or not? 
... many terminally ill people are hit by the end of life question when they are in their prime. At that moment, the patient’s wishes are affected by many different influences such as other people’s opinions, or by values, beliefs and religion. Fear can also be a factor. Hence it is important to take time to recognise what people want in order to appreciate the full complexity of each individual’s fate. 
Palliative care is no panacea but it does allow an enlightened society to have a transparent discussion about death. ...In this moment of total dependence though, there are more humane ways to die than downing a cup of poison and simply fulfilling a desire for autonomy. If the absolute autonomy of our existence comes down to suicide, if the absolute ideal is to kill yourself, then this needs to be called into question, also in Switzerland. Assisted suicide must not simply become a routine affair.
The editorial supports assisted suicide, but it questions whether death by poison is part of an enlightened society.

Cognitively disabled French man threatened with death by dehydration.

Alex Schadenberg
International Chair - Euthanasia Prevention Coalition

Vincent Lambert with his mother.
The Vincent Lambert case in Reims France may be changing direction after the court appointed Vincent's wife, Rachel Lambert, as his primary guardian.

Vincent Lambert became cognitively disabled in a motorcycle accident injury in 2008. His wife unsuccessfully petitioned the court to have all treatment and care ceased including food and water. Lambert's parents want their son transferred to a rehabilitation center.

Alliance Vita expressed concern in their July 8 press release:
It should be noted that one of the major issues involved in this decision is not only for continuing or discontinuing artificial nutrition and hydration, allowing Vincent Lambert to continue living despite his heavy dependency and his poorly-relating state, it is now also a question of which Medical Center will care for him. Vincent’s parents have requested for him to be admitted to a center specialized for patients in “poorly-relating and neuro-vegetative states”. This would allow Vincent to benefit from physical therapy, occupational therapy and have outdoor access for fresh air that he has been deprived of for years.
To intentionally withdraw fluids from a person who is not otherwise dying is a form of euthanasia by omission because the person directly and intentionally dies from dehydration and not from a medical condition.

Previous articles concerning the Vincent Lambert case.

Sunday, July 10, 2016

Canada: Assisted suicide for psychiatric patients.

This article was published by Nancy Valko on her blog on July 3, 2016.

Nancy Valko
By Nancy Valko

My first husband and the father of my children was a caring man and dedicated psychiatrist who himself eventually became disabled by mental illness. Early in our marriage, I helped him write his medical journal articles and we planned to eventually include me in his psychiatric practice to work with the families of his patients. As a nurse, I always believed that families were ideally the best support system for patients and our goal was to improve the care and outcomes of people with mental illness.

Tragically, my husband’s mental illness worsened despite intensive treatment. He ultimately abandoned our family and lived the next 26 years in and out of hospitals and assisted living places before he died of natural causes in 2014.

Thus I have a unique perspective on the legal, medical and personal aspects of mental illness.

At one point, a family member sympathetically suggested that it might be better for everyone if he committed suicide. I was horrified. You don’t give up on sick people and I told this person that I would do anything in my power to stop him if he tried to kill himself. Suicide would be the ultimate tragedy.

Canada and Its New Assisted Suicide Law

In February 2015, the Canadian Supreme Court ruled unanimously in the Carter v. Canada case to legalize physician-assisted suicide for competent, consenting adults whose suffering is due to a “grievous and irremediable” medical condition and gave Parliament a year to develop a regulatory regime along these “parameters.”

The Parliamentary Special Joint Committee on Physician-Assisted “Dying” suggested that the “grievous and irremediable” criterion includes nonterminal medical conditions, including psychiatric disorders.

The federal government’s Bill C-14, on the other hand, defined “grievous and irremediable” as an “advanced state of irreversible decline in capabilities” in a person for whom “natural death has become reasonably foreseeable.” The Senate ultimately passed the bill but the controversy about assisted suicide for psychiatric patients is still raging.

In a June 21, 2016 commentary in the Canadian Medical Association Journal “Should assisted dying for psychiatric disorders be legalized in Canada?”, authors Scott Y.H. Kim MD PhD and Trudo Lemmens LLM DCL warn against this.

As they note:

In Belgium and the Netherlands, medical assistance in dying has been provided to people with chronic schizophrenia, post traumatic stress disorder, severe eating disorders, autism, personality disorders and even prolonged grief.
The authors conclude that:
Because of the necessarily broad criteria used to regulate assisted dying (in Canada), legalizing the practice for psychiatric conditions will likely place already vulnerable patients at risk of premature death.
However, others like Belgium psychiatrist Joris Vandenberghe, MD, PhD disagree:
“I think the current approach taken by the Canadian government is a bit too strict because it doesn’t fully recognize the enormous impact that psychiatric disorders can have on patients,” Dr Vandenberghe told Medscape Medical News. (Emphasis added)
However, even Dr. Vandenberghe recognizes the problems while still calling for more “safeguards”:
“I am generally not opposed to our euthanasia legislation and agree that patients suffering from psychiatric conditions should not be excluded from our legislation. However, extra precautions are urgently needed. 
“I’m not happy with the way things work here [in Belgium]. Sometimes euthanasia is used with insufficient reluctance on the part of the healthcare professionals involved. We’re missing opportunities for treatment, and we need more safeguards,” said Dr. Vandenberghe. 
So for me, the answer lies in a thorough evaluation of a patient prior to euthanasia. There really is no time pressure in psychiatric disorders, and if you have a multidisciplinary committee involved in the evaluation, you can take care of lot of the concerns we now have about euthanasia in the setting of psychiatric illness.”
The reality is that very few psychological or psychiatric referrals are even now made for anyone considering assisted suicide either in the US or in Europe. The answer is not more “safeguards” for assisted suicide practitioners to disregard while enjoying virtual legal immunity but rather an emphatic “No!” from the public as well the legal and medical systems. We also need an unbiased media to publicly expose the real facts about legalized medical killing.