Tuesday, March 3, 2015

Appeal dismissed in BC normal feeding case.

This article was published by Advocate Daily on March 3, 2015.
Hugh Scher

By Hugh Scher, EPC Legal Counsel

The British Columbia Court of Appeal has dismissed a request from the family of an 83-year-old woman that their mother no longer be given nourishment or liquids by staff members at the nursing home where she resides, says Toronto health and human rights lawyer Hugh Scher.

In Bentley v. Maplewood Seniors Care Society 2015 BCCA 91, Justice Mary Newbury agreed with a lower court judge, ruling that the woman, who has advanced Alzheimer’s disease, is exercising her consent when she opens her mouth to accept food and water, despite her family’s position that it was her wish while she was mentally capable that she not be fed in her current condition.

The Euthanasia Prevention Coalition (EPC) and EPC – BC, represented by Scher and Geoff Cowper QC, were intervenors in the case at trial and on appeal.
“I recognize the terribly difficult situation in which Mrs. Bentley’s family find themselves and I appreciate the disappointment they must feel in being unable to comply with what they believe to have been her wishes and what they believe still to be her wishes,” writes Newbury. 
“It is a grave thing, however, to ask or instruct caregivers to stand by and watch a patient starve to death. It should come as no surprise that a court of law will be assiduous in seeking to ascertain and give effect to the wishes of the patient in the ‘here and now’, even in the face of prior directives, whether clear or not," says the decision.
The coalition also advanced its position at the Supreme Court of British Columbia, which previously ruled that oral nutrition should not be considered health care or medical treatment, but rather seen as basic personal care and support. The court found the woman is capable of making the decision to accept oral nutrition and hydration and is “providing her consent through her behaviour when she accepts nourishment and liquids.”

The Supreme Court ruled spoon-feeding is “a form of personal care, not health care,” and “withdrawing oral nutrition and hydration for an adult that is not capable of making that decision would constitute neglect within the meaning of the Adult Guardianship Act.”

The woman had prepared advance directive documents, but the Supreme Court considered them invalid due to lack of clarity and contradictions in the wishes.

The case is one of several examples of end-of-life care issues stirring up heated debates across Canada, says Scher, who appeared at the Supreme Court of Canada on behalf of the  coalition in Carter v. Canada (Attorney General), 2015 SCC 5 in the fall.

Links to more information about the Bentley case:

For more information contact:
Hugh Scher, EPC legal counsel (Toronto): 416-816-6115 or hugh@sdlaw.ca

Oregon debating bill to expand assisted suicide.

By Alex Schadenberg
International Chair - Euthanasia Prevention Coalition

An Oregon, assisted suicide Bill HB 3337 is being debated in the State House to expand the assisted suicide law.

Currently people in Oregon are eligible to die by assisted suicide if they are defined as terminally ill. The assisted suicide act states:
“Terminal disease” means an incurable and irreversible disease that has been medically confirmed and will, within reasonable medical judgment, [produce] result in death within [six months].
Bill HB 3337 will expand the definition to 12 months.

Jeannette Hall lives in Oregon and was diagnosed as terminally ill with a 6 - 12 month prognosis in 2000. She asked for assisted suicide but is alive today because her physician didn't abandon her by prescribing a lethal dose, but rather provided medical treatment. Hall is happy to be alive today.

The 2014 Oregon assisted suicide report indicates a 44% increase in assisted suicide deaths and a 48% increase in the number of lethal prescriptions. In 2014, at least one person who died by assisted suicide obtained the lethal dose in 2012, (439 days before death) even though the law requires the person to be within 6 months of death.

In 2014, Assisted suicide's in Oregon increased in numbers, conditions and demographics.

  • 105 assisted suicide deaths in 2014 up from 73 in 2013. (44% increase).
  • 155 prescriptions for suicide in 2014 up from 105 in 2013. (48% increase).
In previous years almost 80% of the assisted deaths, were cancer related. In 2014, 68% had cancer with "other illnesses" increasing to 8.6% (9 deaths). Other illnesses included diabetes.

Oregon did not previously attempt to expand the assisted suicide law because the assisted suicide lobby was trying to first expand the number of states that permit assisted suicide.

In Oregon, the doctor who prescribes suicide self-reports the assisted suicide death after the person has died. Since doctors do not self-report abuse of the law and since the doctor is rarely at the death, therefore we have no idea if the assisted suicide death was voluntary and we have no idea if the person who died was mentally competent, depressed or coerced.

The lack of oversight reveals concerns that elders, who are being abused, people with depression or incompetent may be dying by assisted suicide.

Disability advocate: Supreme court is wrong on assisted suicide.

This letter was published in the Hamilton Spectator on March 3, 2015.

By Steven Passmore

As a person living with a disability, I am deeply concerned with the Supreme Court of Canada ruling, which struck down Canada's laws protecting me from assisted suicide. As a non-elected body, the Supreme Court has made a bad decision which will negatively affect all 35 million Canadians.

We are a nation that prides itself on democracy. In April, 2010, Parliament defeated an assisted suicide bill by a vote of 228 to 59. That was a pretty strong consensus. Nine Supreme Court Justices should not be able to overrule 308 members of parliament (MPs).

In Canada, does democracy still rule?

The Supreme Court of Canada has overstepped its mandate; the justices should have upheld the law and not struck down our current law. I would urge Parliament to use the notwithstanding clause to overrule the Supreme Court of Canada's decision on the basis of democracy.

Steven Passmore, Hamilton, Advocate for Persons with Disabilities and Board Member of Euthanasia Prevention Coalition

The case of a BC woman who is being fed normally, to be decided today.

 By Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

The Euthanasia Prevention Coalition (EPC) hopes that the BC Court of Appeal will dismiss the case of a BC woman, who is living with dementia and being fed normally. Mrs. Bentley is not being fed by a feeding tube, she is being fed orally and continues to swallow normally. 

On February 3, 2014; Justice Greyall of the BC Supreme Court decided that Normal Feeding is basic personal care and not medical treatment in the Bentley case. The court recognized that there is an obligation to provide basic personal care, whereas medical treatment is optional.

EPC intervened in this case because we agree that normal feeding by spoon and cup to be basic normal care. Mrs. Bentley willing eats and swallows normally. The decision by Justice Greyall was correct. EPC also recognizes that people who require assisted feeding will be negatively affected if Greyall's decision is overturned.

The Bentley family argued that Justice Greyall erred in his decision. They stated that normal feeding by spoon and cup is a form of medical treatment and Mrs Bentley's is being fed against her prior wishes which they define as "assault and battery."

The family wants normal feeding to be discontinued. Mrs Bentley would die from dehydration.

In August 2013, the family of Mrs Bentley launched a lawsuit against Fraser Health and the BC government ordering that feeding by spoon and cup be discontinued. The Bentley family defined normal feeding as medical treatment.

It is interesting that, in August 2013, the Bentley family claimed that Mrs Bentley was living with "end stage" dementia and yet in December 2014 she continues to be fed normally.

For more information contact:
Hugh Scher, EPC legal counsel (Toronto): 416-816-6115 or hugh@sdlaw.ca
Dr Will Johnston, Chair EPC - BC (Vancouver): 604-220-2042 or willjohnston@shaw.ca
Alex Schadenberg, EPC Executive Director (London): 519-851-1434 or info@epcc.ca

Monday, March 2, 2015

Ontario Physicians want conscience rights protected.

By Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

The College of Physicians and Surgeons of Ontario (CPSO) on February 20 ended their consultation on the issue of conscience rights for physicians.

The CPSO has been suggesting that physicians will not be required to assist the death of their patients but that they will be required to refer their patients to a physician who will assist the death.

The CPSO had an online poll asking: Do you think a physician should be allowed to refuse to provide a patient with a treatment or procedure because it conflicts with the physician's religious or moral beliefs? 

The CPSO published the results of the online poll. Out of 32,912 respondents, 25,230 (77%) agreed that the conscience rights of physician should be protected.

Physicians are demanding that their conscience rights continue to be protected by the CPSO. These physicians consider assisted death to be not part of health care.

Physicians should not be required to lethal inject, assist the suicide, or refer a patient a physician or an agency for the purpose of causing or assisting death.

Connecticut should again reject assisted suicide bill

The following column was written by Paul Choiniere and published on March 1, 2015 in The Day

By Paul Choiniere

You have to give the group Compassion & Choices high marks for persistence. Despite little progress, for the third straight legislative session they are back in Connecticut, asking the General Assembly to pass a law that would allow doctors to prescribe medications that terminally ill patients could use to commit suicide.

I know the group doesn't like that ugly word and you won't find it in any of Compassion & Choices press releases or guest commentaries. Instead there are references to "aid in dying," "death with dignity" and "end-of-life choices."

But what they are talking about is the state sanctioning suicide: "The act of taking one's own life voluntarily and intentionally."

The assisted suicide bills did not get to the floor for a vote in 2013 or 2014, but as I wrote a year ago, the group sees Connecticut as a progressive state that can eventually be persuaded to see the issue as a matter of individual choice - the choice in the organization's words to "have the best death possible."

It is an issue that generates strong and emotional opinions on both sides. Compassion & Choices garnered much media attention last year, and certainly won some converts, with the moving story of 29-year-old Californian Brittany Maynard, who utilized the Oregon law to take her life before her brain cancer became severely debilitating.

This is a movement more imposed on Connecticut than generated from the grassroots. C&C has also launched campaigns in New Jersey, Massachusetts, Colorado and California. Vermont and Washington, as well as Oregon, already allow doctor-assisted suicide in cases of terminal illness.

As proposed in Connecticut, a person with a few months to live, and who is becoming increasingly incapacitated and dependent on others and wants to avoid suffering, can obtain medication to commit suicide at a time of his or her choosing. In the parlance of the movement, they can choose to "die with dignity."

I remain convinced such a law is not needed and would take society down a troubling ethical path.

What message does it send to and about severely disabled people to contend it is undignified to need the assistance of others? When government gives the OK through law that expediting death can be the best option, it can apply subtle pressure on the dying - who may worry they are a financial and emotional burden on family - to "just get it over with."

Sunday, March 1, 2015

Maggie Karner: Assisted Suicide Would Undermine My Cancer Battle

Maggie Karner, who is living with the same medical condition as Brittany Maynard had, wrote an article that was published in the Hartford Courant titled: Suicide Option Would Undermine My Cancer Battle. Karner, who lives in Bristol Connecticut opposes assisted suicide and the assisted suicide bill that is being debated in the Connecticut legislature.
Maggie Karner in Hawaii in 2009

Karner first comments on assisted suicide and her medical condition:
I have been diagnosed with a terminal brain cancer — a glioblastoma. Because of my diagnosis, I would likely be eligible for the state's help to commit suicide under a bill before the General Assembly — and that is terrifying. 
Like many Connecticut residents, I have wondered whether I would want my doctor to offer suicide as a treatment for deadly cancer. The out-of-state proponents of the bill regarding physician-assisted suicide suggest having the ability to end your life legally is comforting. But I can tell you from personal experience that it is nearly as troubling as the cancer itself. 
You see, I get strength and comfort from the knowledge that nobody is going to give up on me — medically, psychologically or holistically. Right now, I have the firm support of the state and my fellow citizens in my desire to live — no matter the cost or burden. If that were to change, the tiny knowledge that I might be straining my family, friends, doctors or community resources unnecessarily would be a heavy burden. The constant "option" for suicide would wear at my resolve and I fear, become an unspoken "duty" for me and others.
Maggie then comments on the Oregon assisted suicide law:
In Oregon, where assisted suicide is legal, the top reasons people give for wanting a deadly prescription are fear of losing autonomy (91.5 percent), fear of being less able to engage in activities (88.7 percent) and fear of loss of dignity (79.3 percent). These are not good enough reasons to upend the medical axiom of "first, do no harm."
Karner then comments on the Connecticut situation:
In 2014, Connecticut legislators enacted a pilot program regarding medical orders at the end of life. These forms, given to medical and hospital personnel, declare in advance the level of intervention a person wants when receiving emergency or end of life care. To build on these efforts and provide laws that will actually help the most people, our legislators should increase awareness and access to hospice and palliative care, double funding for home health care and their aides (more jobs!) and require mandatory training for doctors on pain management techniques. 
These measures would help many more hundreds and thousands of Connecticut people rather than undercutting the care and security of people like me who are fighting for their lives.
Karner concludes her article by arguing for compassionate care and not assisted suicide.

Friday, February 27, 2015

“New Scientist” Reporter Goes Over Oregon Assisted Suicide Data with NDY’s Diane Coleman

This article was published by Not Dead Yet on February 26, 2015.

Diane Coleman

By Stephen Drake, researcher for Not Dead Yet.

A newly-published article in New Scientist includes a section in which reporter Clare Wilson reports on actual Oregon data on assisted suicide after a go-through with NDY CEO and founder Diane Coleman. It’s rare – almost unheard of – for a reporter to go into this kind of detail on assisted suicide in Oregon. The same is true of bioethicists weighing in on the topic. Here’s the section of the article dealing with data in "2015 a watershed year for assisted suicide in the US":
Diane Coleman, head of advocacy group Not Dead Yet, which opposes assisted suicide, says the Oregon Health Authority’s annual reports on the practice show the law there isn’t working as intended. She points to the motives people gave for choosing this option. According to the latest figures, released on 12 February, only a third of people who took a prescribed lethal dose of medication in 2014 cited pain or fear of pain as one of the reasons for doing so. 
Supporters of assisted suicide often cite pain as a primary reason why people should have the legal right to die. But the state’s report showed that people’s concerns tended toward loss of autonomy (91 per cent), loss of dignity (71 per cent) or being a burden on their family (40 per cent). Coleman is particularly concerned that people are choosing assisted suicide because they feel they are a burden. “To me that feels more like a duty to die than a choice to die,” she says. 
What’s more, according to the data available for Oregon, some people waited longer than six months between asking for the overdose and taking it. It isn’t stated how many times this happened, but at least some people lived a few years after obtaining the drugs. Coleman is concerned that this means people are being accepted for assisted suicide who don’t meet the criteria of having less than six months to live. “Those people were not actually terminally ill,” she says.

Tuesday, February 24, 2015

One third of Dutch doctors would euthanize people with mental illness.

By Alex Schadenberg
International Chair - Euthanasia Prevention Coalition

A study concerning the euthanasia practise in the Netherlands that was published in the Journal of Medical Ethics on February 18 found that 34% of Dutch doctors will consider euthanizing a person who is either mentally ill, living with dementia or "tired of living." This recent study proves that euthanasia is expanding and is contagious.

The researchers sent a questionnaire to 2269 eligible doctors with 1456 completing the questionnaire, a 64% response rate.

The results of the questionnaire indicated that 34% of Dutch doctors would consider euthanasia for a person with mental illness, dementia or who claims to be "tired of living."

When examining the data further, the study of doctors in the Netherlands indicates that: 

  • 40% would lethally inject someone who is living with early stages of dementia, 
  • 33% would approve of euthanasia for someone in the late stages of dementia, 
  • 27% would euthanize a person who is "tired of living" if they had other conditions,
  • 18% would lethally inject a person who claims to be simply "tired of living."
The data confirms the trend found in the Dutch annual euthanasia reports. The 2013 annual report showed a 15% increase in the number of assisted deaths to 4829 reported deaths. A disturbing statistic in the report is that 42 people with “psychiatric problems” up from 14 in 2012 and 97 people with dementia up from 42 in 2012 died by euthanasia in 2013. It is predicted that about 6000 people died by euthanasia in the Netherlands in 2014 which is up from 2636 reported euthanasia deaths 5 years earlier in 2009.

As concerning as the Dutch euthanasia statistics are, it is important to note that a Lancet study concerning the Dutch euthanasia practice in 2010 found that 23% of the assisted deaths were not reported and 310 assisted deaths were done without request.

Lawmakers shouldn't legalize assisted suicide

The following letter was written by Louis C. Breschi and published in the Baltimore Sun on February 23, 2015. This letter is worth considering in any jurisdiction.

As a practicing physician, I was disappointed to read about the proposed physician-assisted suicide legislation in Maryland ("Dying former official a focus of Maryland assisted suicide bill," Feb. 14).

The article ignores the serious flaws in the legislation, while not giving credit to the broad range of groups and individuals who are actively opposing the bill.

There are numerous reasons to oppose this legislation, and they aren't just issues raised by religious or disability groups.

To begin, the bill does not require a patient to receive a psychiatric evaluation before receiving the lethal medication. Further, the legislation only applies to those who have been diagnosed with a terminal illness and six months or less to live.

To illustrate the inaccuracy of a six-month terminal estimate, a family friend this week was "discharged" from home hospice care because he was eating well, gaining well and felt better. Physicians' prognoses for longevity are just that — general estimates that may or may not apply to individual cases.

Finally, no doctor or nurse is present when the lethal dose is taken. Patients must take up to 100 pills in order for the medication to be lethal — drugs they will pick up at the local pharmacy.

In some cases patients will ingest a lethal dose of a drug but fail to absorb most of the medication, causing acute intestinal distress and bodily discomfort. This is hardly death with dignity.

Unlike many bills considered by the General Assembly, this one literally is a matter of life and death. I can't imagine how legislators could pass something that could cause preventable deaths, especially when this is the first time such a bill has been considered.

Louis C. Breschi, Towson