Thursday, June 30, 2016

Great News: New Mexico Supreme Court upholds New Mexico assisted suicide law.

Alex Schadenberg
Alex Schadenberg
International Chair - Euthanasia Prevention Coalition

The New Mexico Supreme Court decided in a 5 - 0 decision upheld the New Mexico Court of Appeal decision that assisting a suicide is a crime in New Mexico in Morris v Brandenburg. The Court of Appeal had overturned an activist lower court decision that found a right to assisted suicide in New Mexico. 

The New Mexico Supreme Court decision states (page 2, 3):
the State has legitimate interests in (1) protecting the integrity and ethics of the medical profession; (2) protecting vulnerable groups—including the poor, the elderly, and disabled persons—from the risk of subtle coercion and undue influence in end-of-life situations, including pressures associated with the substantial financial burden of end-of-life health care costs; and (3) protecting against voluntary or involuntary euthanasia because if physician aid in dying is a constitutional right, it must be made available to everyone, even when a duly appointed surrogate makes the decision, and even when the patient is unable to self-administer the life-ending medication. Therefore, we decline to hold that there is an absolute and fundamental constitutional right to a physician’s aid in dying and conclude that Section 30-2-4 is not unconstitutional on its face or as applied to Petitioners in this case.

The original case was partially based on a word game. The original case argued that "aid in dying", which is also known as assisted suicide, is not prohibited by the New Mexico assisted suicide law because "aid in dying" is not assisted suicide. 

The New Mexico Supreme Court decision states (page 14) that according to plain language:
For aid in dying, the lethal dose prescribed by a physician is intended to provide the means for a patient to end his or her own life, which is consistent with how “aiding” has been defined under Section 30-2-4. Therefore, when providing aid in dying, a doctor prescribes a lethal dose of barbiturates for the patient’s use as a means to end his or her own life—conduct clearly encompassed by the plain language of Section 30-2-4.
The original case also argued, that if "aid in dying" is assisted suicide, then the New Mexico assisted suicide law is unconstitutional because it undermines the right to privacy and autonomy. 

The New Mexico Supreme Court decision responded to this claim by examining the US Supreme Court Glucksburg  decision (1997). Glucksburg held that laws prohibiting assisted suicide were not unconstitutional. The New Mexico Supreme Court stated (page 28):
We may diverge from the Glucksberg precedent if we determine that the federal analysis is flawed or that New Mexico has distinct characteristics in the relevant area or that structural differences between our government and the federal government exist. Gomez, 1997-NMSC-006, ¶ 19. For the reasons that follow, we choose not to deviate from either the ultimate holding in Glucksberg or the suggestion that a more particularized showing might prevail.
Further to that the New Mexico Supreme Court decision stated (page 36):
we conclude that there are no distinctive state characteristics with respect to the due process protections of Article II, Section 18 that warrant a departure from the federal analysis holding that physician aid in dying is not a fundamental right.

Finally the court held that the New Mexico assisted suicide law was within the interest of the state. The decision stated (page 55):
We are persuaded that end-of-life decisions are inherently fraught with the potential for abuse and undue influence as evidenced by the protections outlined in the UHCDA and the Pain Relief Act, and therefore the government interests we have identified, similar to those in Glucksberg, are supported by a firm legal rationale.
Therefore the New Mexico Supreme Court in a (5 - 0) decision upheld the state assisted suicide law, they determined that aid in dying is assisted suicide and therefore applies to the state assisted suicide law and that the New Mexico assisted suicide law is not unconstitutional. 

Links to previous articles on the New Mexico Morris v Brandenburg assisted suicide case.

Belgium nursing home ordered to compensate family for refusing to participate in euthanasia.

Alex Schadenberg
International Chair - Euthanasia Prevention Coalition

A civil court in Leuven Belgium ordered a Belgian nursing home to compensate a family because the nursing home refused to participate in euthanasia.

According to the European Institute of Bioethics report, the civil court ordered the Sint Augustinus nursing home to pay 6000 euros to the family of Mariette Buntjens, "for the harm they suffered from having to move their mother so that she could be euthanized".

Mariette Buntjens (74) died by euthanasia in the family home in August 2011. The family claimed that the the nursing home refused to allow doctors to interview their mother at the nursing home for the purpose of euthanasia.

During the trial (May 18, 2016) the nursing home told the court that the conditions for euthanasia were not met and the nursing home claimed that the doctors had not contacted the nursing home medical team for the interview.

Courts should consider the pressure that is exerted on elderly people to die by euthanasia. The Euthanasia Prevention Coalition hopes that the nursing home will appeal the decision.

Forcing euthanasia in Quebec hospitals contravenes patient rights

The Québec government is now insisting that hospitals euthanize people promptly.

MONTREAL, Quebec - June 30, 2016 - PRLog - (Link to the Press Release)

Forcing euthanasia in Quebec hospitals
contravenes patient rights
The Québec government's insistence that hospitals euthanize people in Palliative care units contradicts the medical code of conduct of physicians, who have an obligation to provide the best medical care for their patients. Euthanasia does not meet the standards of best medical care for people who are at the end of life and require palliative care. Despite the Québec law and more recently the Canadian Law, no physician has an obligation to perform euthanasia or assisted suicide. The Québec law requires that the treating physician who receives a request for euthanasia and objects to administering it for personal reasons must refer the request to the medical director of the establishment. Nevertheless the Québec law and Federal law are being challenged in the Québec Superior Court. It is noteworthy that the World Medical Association advises physicians to actively refuse to abide by euthanasia or assisted suicide laws even in jurisdictions where laws have been passed.

Dr Paul Saba
Dr Paul Saba, who is contesting both the Quebec and Canadian euthanasia laws, states that euthanasia and assisted suicide are dangerous and will cause the needless loss of lives of people who may have many years to live. Palliative care is a place where only palliation must be practiced. Patients have a right to be protected and not pressured into ending their lives prematurely. The Québec government is acting recklessly and dangerously in transforming Palliative Care units into euthanasia units. Even the Québec law recognizes a distinction between Palliative care and euthanasia. People who want to live their lives to the end in dignity surrounded by loved ones deserve the respect and support offered by Palliative care units. They have the right not to live in fear of being killed prematurely by a lethal injection. Physicians also have the right to care for their patients according to the highest standards of medical care which includes palliative care but does not include euthanasia.

Dr. Saba questions the true motives of the Québec and Canadian governments. Is the pressure to euthanize due to the lack of health care for its citizens, including the lack of palliative care for those who truly are at the end of life? Is the Québec government creating a false debate in demanding faster access to euthanasia when Quebecers do not have access or prompt enough access to essential services like family physicians, cancer screening and even cancer surgery? Presently 52% of Montrealers cannot be operated within the 4 week window mandated by the government. 900 beds are being closed this summer. Is the government using euthanasia as a means of freeing up more beds? This goes against the will of Quebecers and Canadians as revealed by a recent Angus Reid Poll (April 1 2016). The poll reveals that the majority of Canadians are opposed to physician assisted suicide (PAS) and euthanasia because of lack of health care. Canadians oppose PAS because: "the cost of a patient's care is very expensive to the health care system (79%); "a person has no hope for the future and no meaning to their lives (69%); "a person has multiple health conditions and feels overwhelmed (64%); and "a person's care appears to be a burden to their family (74%)." A slim majority of 55% are in favour of PAS "because Canadians are unable to get access to medical care to treat their pain and suffering."

"This reveals that Quebecers and Canadians want good health care and not euthanasia as the solution for the lack of access to medical care"- states Dr. Paul Saba, a family physician. "Many Canadians wait a long time for: physicians, specialists, screening, testing and treatments. Canadians' access to specialist and primary care is the lowest among 11 comparable countries."

Attorneys Dominique Talarico and Natalia Manole, who represent Dr. Saba in his legal challenge against euthanasia, state that "In the absence of appropriate medical care and services, it is impossible to give a free and informed consent to receive physician-assisted suicide. By not having access to the good care, a person may end his or her life prematurely."

Dr. Paul Saba M.D.


Tuesday, June 28, 2016

Euthanasia and assisted suicide in the Netherlands Belgium and Oregon - a comparative analysis.

Alex Schadenberg
International Chair - Euthanasia Prevention Coalition

An article written by Eveline Dokter and published by news on June 20, 2016 compares the euthanasia and assisted suicide statistics in the Netherlands, Belgium and Oregon. The analysis by Dokter of the Netherlands euthanasia data is more indepth than the Belgian and Oregon data. Dokter reports in her article:
Since the introduction of the Dutch euthanasia law in 2002, the number of notifications for euthanasia nearly tripled. In 2015 doctors in the Netherlands reported 5516 cases of euthanasia or assisted suicide.(1) One of these reports came from the BES islands. In 109 patients dementia formed the basis of the suffering and in 56 patients a psychiatric disorder. Although the reporting rate for euthanasia over the years greatly increased, there is still underreporting. In 1990, doctors reported only 18% of the number of cases, in 2001, 54% and in 2010. 77%. (2) This means that still 914 cases of euthanasia were not reported in 2010.

The analysis by Doktor of the Belgian and Oregon laws is less indepth. For instance she doesn't report on the underreporting of euthanasia in Belgium. The article reports:
In Belgium and the US state of Oregon (assisted suicide) euthanasia is also allowed. In Oregon assisted suicide is allowed in patients with a short life expectancy. People who are not sick but who see their lives as completed are not eligible. Over the years in Oregon, Belgium and the Netherlands until 2014, both the absolute and relative numbers of euthanasia and assisted suicide have increased.(3-8) In 2015, doctors reported 4, 18 and 37 out of 1,000 deaths as euthanasia or assisted suicide. These figures are consistent with the trend previously up to 2012 reported in The Lancet.(9) It is striking that the vast majority of the Belgian euthanasia cases occurred in Flanders. This is probably due to the cultural differences between the Flemish and the Wallonians.(10)
Doktor didn't examine the New England Journal of Medicine (NEJM) published a study on March 19, 2015 showing that 4.6% of all deaths in Flanders (2013) are euthanasia, even though the official data indicates that 2.4% of the deaths are reported as euthanasia indicating that nearly half of all Belgian euthanasia deaths are not reported.

According to the 2015 Oregon death with dignity data summary, of 218 people who received a lethal prescription, the ingestion status was unknown for 43 of the people and 5 of the people who died, no report was submitted, meaning these are possible cases of underreporting.

Dokter provided the following references:
1. Regional assesment committee on euthanasia. 2015, April 2016. Jaarverslag (Yearly report).
3. Yearly reports Death with Dignity Act Oregon, via Public Health Oregon.
4. Death statistics Oregon, via Public Health Oregon.
5. Year reports euthanasia Belgium 2002-2015
6. Death statistics Belgium 2000-2015, Statbel mortalité generale.
7. Regional assessment committee euthanasia, Jaarverslag 2002-2015 (Yearly reports).
8. Death statistics the Netherlands 2000-2015, Statline CBS.
9. Claudia Gamondi et al. Legalisation of assisted suicide: a safeguard to euthanasia? The Lancet, vol 384, 12 juli 2014.

The translation was by Dr J.A. Raymakers

Monday, June 27, 2016

The first legal case to expand euthanasia in Canada.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition.

The BC Civil Liberties Association has wasted no time in launching the first legal challenge to Canada's recently passed euthanasia and assisted suicide law.

Globe and Mail reporter Laura Stone informs us that the BC Civil Liberties Association is launching a court case to "strike down" as unconstitutional the provision in the euthanasia law that states a person's "natural death must be reasonably foreseeable" to qualify for death by lethal injection.

According to the Globe and Mail article:

The British Columbia Civil Liberties Association, along with a woman who suffers from spinal muscular atrophy, a progressive neurodegenerative disease, say they will launch a legal challenge to the government’s new law in Vancouver on Monday. 
The rights group argues that the law, which passed in Parliament 10 days ago, is unconstitutional. 
The Liberal government faced mounting criticism that the law, known as Bill C-14, was too restrictive, due to a provision that says a patient’s natural death must be “reasonably foreseeable” in order to qualify for assisted death. The Senate voted to remove that requirement, but the Liberal government rejected the amendment and the Red Chamber passed the bill with several small changes.

This is the first of many court challenges to Canada's euthanasia and assisted suicide law. The euthanasia lobby are wanting to extend euthanasia to "mature" minors, to people with dementia (through advanced directives) and for people with psychiatric conditions alone.

EPC will examine this legal case and then determine how we will respond.

Friday, June 24, 2016

Wesley J. Smith - Culture of Death: The Age of "Do Harm" Medicine.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition.

In 2001, Wesley Smith published one of the most influential books challenging the culture of death. At that time, EPC sold hundreds of copies of the book. Since then, many people have been waiting for Smith to update his book and now we have it.

Recently released, Wesley Smith has written an excellent defense of traditional ethics in his recent - Culture of Death: The Age of "Do Harm" Medicine. 

The Euthanasia Prevention Coalition (EPC) is selling Culture of Death for $35 (Link) (includes shipping). Indicate that the $35 is for Culture of Death which has 333 pages and is published by Encounter books. 

Wesley Smith was interviewed by Bioedge about the new edition of Culture of Death. Here is some of what he said in the interview:

Smith: There is less respect for human equality and the sanctity of life in healthcare generally, I fear, and not only in the U.S. Indeed, I changed the subtitle of the book to “The Age of ‘Do Harm’ Medicine” because it now grapples with developments outside the United States as well as in my own country. We are all connected, so that what happens in Canada impacts Australia, what happens in the USA can have a pull on South Africa.

I have observed in the 15 years since the first edition of Culture of Death, that throughout the developed world and the West we see a terrible and increasing disrespect for the intrinsic value of the most weak and vulnerable among us. Euthanasia has spread like a stain and grown increasingly toxic. For example, in Belgium medicalized killing is now coupled with organ harvesting—including of the mentally ill. Health care rationing, which is blatant and invidious medical discrimination, is a growing threat. Advocacy continues to discard the dead donor rule in organ transplant medicine, even proposals for the live-harvesting of patients with profound cognitive disabilities.

If there is a “bright spot,” it is to be found among the medical professionals—doctors, nurses, pharmacists, physicians assistants, etc.—who continue to resist these utilitarian bioethical agendas and work in the trenches of clinical medicine with an ongoing commitment to the wellbeing and equal value of all patients.

Wesley J. Smith
It’s a difficult problem. The popular media is increasingly tabloid in its approach to reporting. It is the rare story that informs the general population about the threatening and radical ideas emanating from the academy, in the professional journals, and from among the leaders of the bioethical/medical establishments.

One of the purposes of the book is to help readers be forewarned of the potential threat they or their loved ones could face in a clinical setting—note, I don’t say will, but could—to enable them to mount a defense should an attempt be made to push a vulnerable patient out of the lifeboat.

Ironically, the media can be very helpful in such circumstances, because while the journalistic sector does a terrible job generally of reporting about bioethical issues—and are very boosting of assisted suicide—they often cast klieg lights on individual cases of medical oppression against particular patients, which can personalize the issue in such a way as to gain the attention and sympathy of the general public.

Smith: Assisted suicide and euthanasia are going to continue to be bioethical hot potatoes. Medical futility. Protecting medical conscience rights for health care professionals who wish to adhere to Hippocratic values is going to be huge internationally. I mean, if we are not careful, in 20 years one may not be able to find a doctor who would not be willing to kill you under some circumstances, which I find a very frightening prospect.

The Euthanasia Prevention Coalition is selling - Culture of Death - for a $25 donation  (link) Culture of Death is published by Encounter books and has 333 pages.

Thursday, June 23, 2016

Czech Republic government cabinet rejects euthanasia.

Alex Schadenberg
International Chair - Euthanasia Prevention Coalition

The Prague Daily Monitor reported that the Czech government cabinet rejected, a deputies' bill that would have legalized euthanasia. According to the Daily Monitor: 
the cabinet said it goes counter to the coalition agreement in which the government parties, the Social Democrats (CSSD), ANO and the Christian Democrats (KDU-CSL), pledged not to pass anything that would be incompatible with the protection of life from the conception until its natural end. 
The bill on dignified death has been submitted by six deputies.  
The final decision will be up to parliament. 
Straka Academy
The Daily Monitor published comments on Twitter by Deputy PM Pavel Belobradek (KDU-CSL) and Industry and Trade Minister Jan Mladek (CSSD):

"The bill, if passed, could result in the killing of people," Mladek wrote. 
Agriculture Minister Marian Jurecka (KDU-CSL) wrote that he rejects a simple solution of euthanasia. "I support help, loving care, solidarity and a high-level palliative care, this is a solution," 
According to the Prague Daily Monitor:
The government... believes that it is unsuitable for the Czech Republic to follow the example of the countries where euthanasia is legal, which the authors of the bill suggest. 
"In these countries, cases of clear misuse of euthanasia have been proved, aimed to vacate hospital beds, as well as cases of family members pushing for euthanasia for dubious reasons, and also unpunished cases of the failure to observe the conditions set by law," 
A similar bill on euthanasia, submitted by a senator, was turned down by the Czech upper house in 2008.

Wednesday, June 22, 2016

Ontario physicians who oppose assisted suicide are legally challenging CPSO referral requirement.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

The Coalition for HealthCare and Conscience is seeking a judicial review of the College of Physicians and Surgeons of Ontario (CPSO) policy requiring physicians who oppose euthanasia and assisted suicide, to refer patients to a physician who will kill.

According to the Coalition:
The College of Physicians and Surgeons of Ontario (CSPO) demands that doctors who conscientiously object to assisted suicide refer patients seeking to end their lives to other physicians who will provide the procedure. 
No other foreign jurisdiction that has legalized assisted suicide requires doctors to perform or refer for this procedure. Other provinces have already implemented guidelines to protect doctors who object to providing or referring for assisted suicide.
Larry Worthen, the executive director of the Christian Medical and Dental Society of Canada, and one of the coalition group members stated:
“The current approach of the CPSO demands that doctors set aside their morals and go against their conscience to directly refer for assisted suicide,” 
“In our view, effective referral and participating in assisted suicide are morally and ethically the same thing.”
Three physicians groups are working together to legally challenge the CPSO policy. The Coalition is demanding that the CPSO amend their policy to enable physicians who oppose assisted suicide to continue to practise medicine in Ontario. According to the Coalition:
Protecting conscience rights of health practitioners would require only minor accommodations, such as allowing patients direct access to an assessment or allowing complete transfer of care to another physician. 
A strong majority of Canadians are on side with the coalition’s beliefs on conscience protection. A recent Nanos Research poll found that 75% of Canadians agreed that doctors “should be able to opt out of offering assisted dying,” compared with 21% who disagreed.
Larry Worthen emphasizes that Conscience rights can and must be protected:
“There are ways to respect patients’ wishes while protecting conscience rights,” 
“Not to do so is discrimination against people for their morals and convictions, which are protected in the Canadian Charter of Rights and Freedoms.”
The Coalition for HealthCARE and Conscience represents a group of like-minded organizations, including representing more than 110 healthcare facilities (with almost 18,000 care beds and 60,000 staff) and more than 5,000 physicians across Canada, that are committed to protecting conscience rights for faith-based health practitioners and facilities. We were brought together by a common mission to respect the sanctity of human life, to protect the vulnerable and to promote the ability of individuals and institutions to provide health care without having to compromise their moral convictions.

British Medical Association (BMA) members reject neutrality on assisted suicide.

The following is the report published by the Care Not Killing Alliance on June 21, 2016.

BMA members attending the influential policy-making gathering were asked, in the course of the Medical Ethics debate today (21 June) to consider two motions related to assisted suicide:

Motion 79 (EAST MIDLANDS REGIONAL COUNCIL) That this meeting, with respect to Physician Assisted Dying, notes the recent rejection by Parliaments of efforts to overturn the law on Physician-Assisted Dying and therefore feels that it is not appropriate at this time to debate whether or not to change existing BMA policy.

Motion 80 (SOUTH CENTRAL REGIONAL COUNCIL) That this meeting believes that the BMA should adopt a neutral stance on assisted dying.

115 for 198 against
Several speakers noted that BMA policy exists to represent the views and experience of members, so it was perhaps not entirely surprising that Motion 79, which reflected on MPs' conclusions, was lost - if only by three votes (164-161). Motion 80, however, was rejected after strong speeches by a resounding 198-115 - that's 63% to 37%, or more simply, 2-1. Members wishing to speak on Motion 80 were similarly split, with those opposed to neutrality outnumbering those in favour by 2-1. Thus, the BMA remains opposed to assisted suicide, as it has throughout its history (barring a brief period in 2005-6).

In the few days before the debate, in the time when delegates were packing for, travelling to and beginning to engage with the ARM, 5,000 members of the public thanked the BMA for its long-standing position and urged them to retain this stance. Individual activists made clear its value in their own lives:

@TheBMA Please protect lives and resist neutrality on assisted dying. We look to you for #supportnotsuicide. Thank you. PLS patient. 
— mwenham (@mwenham) June 21, 2016
BMA members voting
Campaigners in favour of assisted suicide - who had driven the calls for change at the ARM after they failed to convince MPs - spoke of a failure by the BMA to allow debate on the subject. Dr Mark Porter, the Chair of Council gave this short shrift. He noted that the debate marked the eighth time in 13 years that the BMA had considered the matter, and stated that 'nobody can credibly say this issue has been suppressed, obfuscated...' Dr Andrew Mowat, who moved Motion 79 went further, describing the constant returns to the issue as a 'neverendum'; Dr Gary Wannan simply mused, 'we've been here before...'

Many doctors spoke to the substance of the case against assisted suicide, especially foreign precedents. Professor the Baroness Finlay and Dr Will Sapwell highlighted, respectively, doctor-shopping and the increasing citation of not wishing to be a burden as a reason for assisted suicide in the US state of Oregon. Dr Sapwell also pointed to extensions of Belgium's euthanasia law, and medical student Heather Davis said that the Netherlands, with a healthcare system much like the UK's, had seen euthanasia numbers rise and eligibility extended as far as a young woman who suffered from PTSD as a result of sexual abuse. Closer to home, Baroness Finlay said that UK doctors were still strongly opposed to actually assisting suicides.

All of this led to a key point, made several times. Ms Davis said that the BMA worked on the basis of evidence, and there was no new evidence to justify a changed stance. Dr Wannan said there was no new evidence - no, repeated opinion polling didn't count. And Professor the Baroness Hollins said that there was no new evidence, and that they must turn their attention to better end of life care. Yorkshire GP Dr Mark Pickering said that doctors must listen to their patients, but must also consider unintended consequences.

Tuesday, June 21, 2016

Popular articles against euthanasia and assisted suicide.

1. Declaration of Hope – Jan 17, 2013.

2. Physician-Assisted Suicide: A Recipe for Elder Abuse and the Illusion of Personal Choice - Feb 17, 2011.

3. A healthy 24 year old Belgian woman is scheduled for euthanasia - June 24, 2015

4. Depressed Belgian woman dies by Euthanasia – Feb 6, 2013.

5. Euthanasia is out-of-control in the Netherlands – Sept 25, 2012.

6. Oregon 2012 assisted suicide statistics: An analysis - Jan 25, 2013

7. Boycott Me Before You - "disability death porn" - May 26, 2016. 

8. 5 reasons why people devalue the elderly – May 25, 2010.

9. Twins euthanized for fear of blindness in Belgium – Jan 14, 2013.

10. Nitschke is promoting Nembutal over the internet – June 22, 2010.

11. Opposing the Supreme Court of Canada assisted death decision - Feb 17, 2015. 

12. Dutch ethicist changed his mind - Assisted Suicide: Don't Go There - July 16, 2014.

13. Emily “Laura” the healthy 24-year-old Belgian woman who was approved for euthanasia, has chosen to live. Nov 12, 2015. 

14. Belgium warns Canada - Medical Assistance in Dying - Don't Go There. April 26, 2016

15. New Jersey Senate may vote on assisted suicide - Dec 16, 2014.

16. Petition: Stop euthanasia Bill in Quebec – May 24, 2014

17. Woman with Anorexia Nervosa dies by euthanasia in Belgium – Feb 10, 2013.

18. Trisomy 18 is not a Death Sentence. The story of Lilliana Dennis – May 29, 2012.

19. Mild stroke led to mother’s forced death by dehydration – Sept 27, 2011.

20. Supreme Court of Canada assisted suicide decision is irresponsible and dangerousFeb 7, 2015.

21. Netherlands 2012 euthanasia report: sharp increase in euthanasia deaths - Sept 24, 2013.

22. Québec's euthanasia Bill 52 is lethal - Dec 12, 2013.

23. A letter of Hope to Laura - July 8, 2015.

24. Botched sex-change operation victim euthanized in Belgium – Oct 1, 2013.

25. Governer Jerry Brown - veto the assisted suicide bill - Sept 17, 2015.

Become a member of the Euthanasia Prevention Coalition ($25) membership.