Monday, September 29, 2014

‘Rational suicide’ and capital punishment: Australia’s ‘doctor death’ feeds his own cult

By Dr Kevin Fitzpatrick OBE, 
Director, Euthanasia Prevention Coalition, International and a leader of Not Dead Yet UK

Kevin Fitzpatrick
he idea of a ‘rational’ suicide is, to Philip Nitschke, mere ‘common sense’. It is a seductive idea – as so many of his pronouncements can be to an unreflective audience – it contains dangerous elisions that serve his purposes and try to bury serious, thoughtful objections. His recent comments follow Belgium’s decision to euthanize one of its prisoners, a serial rapist/murderer.

Counting suicide as a rational act is shallow and self-serving; if people buy the idea from him, then he stands to sell more of his death-kits, take the media limelight for those who kill themselves following his advice, sell more places at his death seminars and sell membership subscriptions to his organisation – make no mistake, Nitschke enjoys his notoriety built from the despair of others, but he makes money too, on their backs already strained to the point of terminal desolation.

Counting euthanasia of convicted serial killers as rational is the kind of easy extension he makes without drawing breath One response to his remark about a mass murderer of 35 people, is to wonder what the families of his victims make of ‘releasing’ him through euthanasia, and indeed, what they think of Nitschke for proffering the idea. Some of them, like one family member of a victim of the Belgian rapist/murderer, might prefer that he ‘rot’ in prison.

Whatever we might make of that, it is a serious response - not to be glossed over or ignored completely, not even counted as something to be considered. Do victims’ families deserve Nitschke’s further deep insults?

Netherland 2013 euthanasia report - 15% increase, euthanasia for psychiatric problems and dementia.

By Alex Schadenberg
International Chair - Euthanasia Prevention Coalition.

The 2013 Netherlands euthanasia report was released today indicating a 15% increase of reported euthanasia deaths. There were also 42 euthanasia deaths for people with psychiatric problems and 97 euthanasia deaths for people with dementia.

The 2013 report indicated that there were 4829 reported euthanasia deaths which was up from 4188 in 2012. As bad as it is, the reported euthanasia deaths do not include the unreported euthanasia deaths.

The five year Netherlands euthanasia Lancet study indicated that in 2010, 23% of all euthanasia deaths went unreported in the Netherlands, which was up from 20% in 2005. The under-reporting of euthanasia in the Netherlands represents (20% - 23%) of all euthanasia deaths. It is likely that the actual number of euthanasia deaths is (965 - 1100) deaths higher.

The number of reported euthanasia deaths in the Netherlands is continually increasing. There was a 15% increase in 2013, 13% in 2012, 18% in 2011, 19% in 2010. Further to that:
Theo Boer, a Dutch ethicist who had been a 9 year member of a euthanasia regional review committee recently wrote an article explaining why he has changed his mind and now opposes euthanasia. He explained how the Netherlands law has expanded its reasons for euthanasia and how the number of euthanasia deaths was constantly increasing turning euthanasia into a perceived right rather than an exception.

The reasons for euthanasia continues to expand in the Netherlands. For instance:

EPC predicted that there would be a continuous increase in the number and reasons for euthanasia after the Netherlands euthanasia lobby launched six mobile euthanasia teams.

The mobile euthanasia teams claimed that they would fill the "unmet demand" for euthanasia for people with chronic depression (mental pain), people with disabilities, people with dementia and loneliness, and for those whose request for euthanasia was declined by their physician.

Dutch ethicist, Theo Boer, stated in his recent article that: 

I used to be a supporter of legislation. But now, with twelve years of experience, I take a different view. 
Once the genie is out of the bottle, it is not likely to ever go back in again.
We need to heed the warning from Theo Boer. 
We need to reject killing people by euthanasia and assisted suicide.

Sunday, September 28, 2014

Australia's Dr Death - Philip Nitschke - is being investigated in 20 deaths.

Alex  Schadenberg
By Alex Schadenberg
International Chair - Euthanasia Prevention Coalition

The Sydney Morning Herald is reported that Philip Nitschke, Australia's Dr Death, is being investigated in the deaths of up to 20 people with investigations occurring in every Australia State. 

At the same time, Nitschke is promoting, online, updates to his suicide manual and he has launched a website in German to promote his suicide manuals and devices.

Paul Russell, the founder of HOPE Australia, is calling for a national inquiry into the suicide industry  established by Philip Nitschke.

Warning - If you are having suicidal thoughts please seek help. Your Life Counts.

The latest inquiries into the suicide business by euthanasia lobbyist, Philip Nitschke began in early July when the media reported that Nitschke was being questioned in the death of a healthy depressed man. Australia's ABC news reported that Nitschke admitted to being involved in the death:

In emails obtained by the ABC, Mr Brayley admitted to Dr Nitschke he was not "supporting a terminal medical illness", but said he was "suffering". 
Now Dr Nitschke is being accused of moving into uncharted territory by agreeing to assist Mr Brayley despite knowing he was not terminally ill. 
AUDIO: Listen to PM's report (PM) 
"If a 45-year-old comes to a rational decision to end his life, researches it in the way he does, meticulously, and decides that ... now is the time I wish to end my life, they should be supported. And we did support him in that," he said.

The Sydney Morning Herald article reported that Nitschke is being investigated by the Victoria police in the death of Ross Currie (55) who died on May 25. The article states that police have emails between Currie and Nitschke with respect to Nitschke's Max Dog Brewing company, a company that sells and distributes Nitrogen inhalent equipment for the purpose of causing death by asphyxiation, under the guise of beer brewing equipment. 

The article also reports that there are 5 complaints being investigated by the Australian Medical Board including one by Paul Russell, the Director of HOPE Australia, and another by the mother of a 26 year-old depressed son who died by suicide allegedly with connections to Nitschke. The article stated:
A Melbourne woman, Judith Taylor, who complained to the board after her 26-year-old son, Lucas, committed suicide using ... after buying Dr Nitschke's euthanasia book, The ... Handbook. She is understood to have claimed that an online forum curated by Exit International encouraged her son to take his life.
The Euthanasia Prevention Coalition supports HOPE Australia's call for a national inquiry into the suicide industry that has been created by Philip Nitschke.

Saturday, September 27, 2014

Physician-Assisted Suicide: A Clinicians Perspective

This article was published by Medscape Internal Medicine on September 25, 2014.

Joshua M Hauser MD

Joshua Hauser
Listening to Patient's Wishes

"When a horse breaks his leg, they put him down; why can't you do that to me?" The patient who asked me this recently is a 76-year-old man dying of gastric cancer who had pain from pressure ulcers he developed as he became increasingly debilitated and had no one to help get him out of bed. He also had haunting memories of caring for his parents as they died in pain decades ago. I explored how he was suffering; I suggested what we could do for his pain and what resources we might be able to gather to help him at home. I listened as he told me about his time with his parents. He was not satisfied.

And I left our interaction wondering what we would do next to help him. Two days later, we had a family meeting with his closest relatives, a niece and a nephew, and I asked how he was feeling about our conversation and wanting us to help him die. "Oh, that was just then. I feel OK now." I asked whether it was the pain medications or the newly developed plans for a nursing facility. "No, just not feeling that way anymore," he told me.

A second patient was a woman in her 40s who was dying of lymphoma. She was not dying as fast as she wanted to and requested our help in hastening her death. Evaluations ensued by our palliative care service, our psychiatry service, the ethics service, and multiple chaplains and she persisted in this desire. We all thought we had ideas about how to address her suffering; none were effective. Finally, after several days of intensive pain control and continued conversations, her desire for hastened death waned.

What made the difference? I asked her afterwards. The difference was, she told me, the result of the "sitter" who was called in because of caregivers' concerns—not about physician-assisted suicide, but because of worries about the patient's risk for "traditional" suicide.

Why did the sitter make a difference? Because, the patient told me, "she just sat there," "she read to me," and "she went and got me something to eat." What could be simpler? The patient proceeded to have several more months with her family.

Responding to Wishes for Hastened Death

Dying is unpredictable. These cases represent two phenomena which I believe are common in our care of dying patients: (1) how rapidly patients' wishes for hastened death can change; and (2) the unpredictability of the interventions that we use to address these wishes. Sometimes, despite all of the remarkable advances in palliative care that we have had over these past decades, we may not even know which specific intervention has made a difference.

I say this not to suggest that we abandon our attention to the core principles and interventions of palliative care used to combat the many forms of suffering that might affect patients, but because I believe we must redouble our efforts. We might not know which intervention is making a difference, so we owe it to ourselves and to our patients and their families to listen to their suffering, understand it as best as we can, identify what we cannot understand, and intervene in whatever way we can.

And as we do that, we must realize that wishes may change. Having patience with the possibility of wishes changing is difficult for us as clinicians who deeply desire to help and improve a patient's experience. It is even more difficult for the patient who is suffering. And yet, because many of us in palliative care have seen patients' desires change, patience is necessary.

Responding to Wishes for Hastened Death

Risks of physician-assisted dying. I have never practiced in a setting where physician-assisted dying has been legal, but even with safeguards that exist where it is legal, I worry that its availability could undermine this fickleness of patients' desires and short-circuit this observation about the unpredictability of interventions. I fear that even with the most altruistic of intentions, its availability would compromise the hard work of attending to suffering and the non-abandonment that is fundamental to palliative care.

For clinicians of all specialties, physician-assisted dying represents the ultimate measure of patient suffering and the ultimate challenge to our personal values as physicians. But whether we are the most passionate advocates for physician-assisted dying or its staunchest opponents, it is ultimately what the request represents for a patient that must be our focus. It is likely that those of us in palliative care witness patient requests for hastened death more often, but whether one practices in oncology, primary care, hospital medicine, cardiology, or many other specialties, we will confront patients who explicitly or implicitly want our help in hastening their death.

First and foremost, we must see a request as an alarm that a patient's suffering is out of control. Second, it should prompt us to explore with that patient and his family how he is suffering and its physical, psychological, social, spiritual, and existential sources. Third, it should lead us to interventions in these domains of symptom control and of psychological, social, and spiritual suffering.

We cannot be so presumptuous as to believe that we can solve each of these sources of suffering, but I know that we can bear witness in the deepest medical and human sense. And so a fourth step of non-abandonment is one that will allow space—for the unexpected sitter or the change of mind that cannot be predicted.

I won't assist in euthanasia again.

By Alex Schadenberg
International Chair - Euthanasia Prevention Coalition

Sean Davidon, who was previously convicted in New Zealand for assisting his mother’s death, last week he admitted to assisting a South African quadriplegic man to commit suicide, is now saying that he will never assist in euthanasia again.

Davidson, who should be investigated for his part in the death of Anrich Burger, a man who became a quadriplegic in 2005 after a car accident.

Davidson told the South African media today that:

“Anrich Burger was a very close friend. I wouldn't want to ever go through that again. It was very stressful”
Davidson's comments may be related to the fact that he is promoting a bill in the South African parliament to legalize assisted suicide. Davidson's actions may lead to criminal charges but may also lead to politicians reject the assisted suicide bill.

Kevin Fitzpatrick
Dr Kevin Fitzpatrick, the EPC - International Director and disability activist responded to the death of Burger by writing:

When a person with disabilities has pain, and distress about his work, his own patients’ welfare, and asks a doctor to help him commit suicide. If the doctor says ‘Let’s look at your pain management – let’s get you working again the way you’d like - you h 
ave so much to give these online patients seeking help’? That leads to a belief that life is worth living. 
But if a doctor responds: Well of course not. ‘You want to die? Yes of course I’ll help you’ – simple, eh? That leads to a belief that the person is better off dead.
Last weekend, Davidson was chosen to become a member of the international board of the euthanasia lobby.

Children arrange parents' joint euthanasia.

This article published on Wesley Smith's blog on September 26, 2014.

By Wesley Smith

Wesley Smith
If this doesn’t scare you, nothing will.

A doctor has agreed to murder/euthanize a healthy elderly Belgian couple who don’t want ever to live apart–and their three children approve. One even procured the death doctor. From the Daily Mail story:

Their son, John Paul, 55, approached their doctor to request their euthanasia – which was legalised in Belgium in 2002 – but the doctor refused because there were no grounds for it. John Paul found another doctor willing to perform the killings in an unnamed hospital in Flanders, the Dutch-speaking part of Belgium in which 82 per cent of euthanasia cases are performed. 
Francis said he and Anne were grateful for the arrangement. ‘Without our son and our daughter, it would never have succeeded,’ he said. ‘We are not sad, we are happy,’ he continued. ‘When we were told we could leave life together smoothly we were on a little cloud. It was as if we had spent all that time in a tunnel and suddenly we came into the light again.’ 
The couple’s daughter has remarked that her parents are talking about their deaths as eagerly as if they were planning a holiday. John Paul said the double euthanasia of his parents was the ‘best solution’. ‘If one of them should die, who would remain would be so sad and totally dependent on us,’ he said. ‘It would be impossible for us to come here every day, take care of our father or our mother.’
Imagine knowing your children don’t want you depending on them–because that is really what is being said.

If I told my mother I supported her euthanasia at 97, it would make her want to kill herself! Good grief.

The story is wrong that this would be the first joint euthanasia in Belgium of elderly couples – which I have covered here at HE at least twice before. It has also happened in Switzerland.

But that’s the way euthanasia rolls. Culture of death, Wesley? What culture of death?

Thursday, September 25, 2014

Assisted Suicide as “Last Resort” Fantasy

This article was published on September 25 on Wesley Smith's blog.

Wesley Smith
By Wesley Smith

Many supporters of assisted suicide are well-meaning, really thinking that it would only be done in the proverbial “last resort” scenario. But that’s a fantasy, as we will discuss below.

The bioethicist, Art Caplan, is one such last resortist. He used to oppose assisted suicide but now believes it can work under “strict guidelines”–such as waiting periods and terminal illness–and then, only as a last resort. From his, Physician-Assisted Suicide: Only as a Last Resort, published on Medscape:
The other restriction I would look for with respect to assisted suicide is to first offer people palliative care, hospice — options that do not involve taking the person’s life. If they say, “I’m in pain”; if they say, “I’m spiritually upset,” then we ought to try to address that first before we say, “Here’s a pill; goodbye.” 
It does seem to me that good palliative care and good hospice care are crucial as fundamental components of what assisted suicide should be about. We do not want to encourage people toward assisted suicide. We may want to include it as an option but absolutely the option of last resort… 
Assisted suicide may work but only with adequate protections, adequate controls, adequate oversight, and adequate regulation to make sure that people do not think, “I better do this because I am a burden to others” or “I am going to do this because nothing else out there can help me with my pain, suffering, or depression.” Those are not adequate ethical circumstances to support someone ending his or her own life.
Sorry. Assisted suicide is never practiced only as a “last resort.” Consider: