Posted: Wed Sep 03, 2003 2:32 am Post subject: Euthanasia
In my work I have come across certain ethical issues of which I am curious whether they are or are not allowed and why this is the case. These issues are first of all euthanasia. I live in a country where it has been recently legalised. This does not imply killing people, but peacefully ending the life of a person who is not going to get better, who is in a great deal of unbearable pain and who has made this request being sound of mind. Naturally there are other requirements, but I will leave these aside for now. I am aware that the Qu'ran says that we cannot take the life of another (i.e. euthanasia) and that we cannot take our own lives (i.e. physician-assisted suicide). There are some texts and people who suggest that the more we suffer in the here and now, the more we will be rewarded in the afterlife.
Now, before you reply that killing is wrong, I would like you to first ask yourselves where the line is. If someone has been hit by a car, and all that is keeping him alive is a ventilator and artificial supplies of food and drink, is he still alive? Is his spirit still in his body? For if it wasn't for modern medicine, he would have passed away. Is it therefore wrong to turn of the machines and let him die? Another example is someone who has an uncurable illness and is in a great deal of pain. If he receives painkillers to help control the pain, but knows that these painkillers will end his life sooner, is this wrong? Because these are also forms of euthanasia although in different countries they have different names.
I wonder if there have ever been made farmans on this issue.
If doctors who won't kill are 'wicked,' the world is sick
By Licia Corbella, Calgary HeraldJanuary 10, 2009
Talk about Orwellian. A woman described as a "leading expert in ethics" has declared that doctors who refuse to kill their patients are "genuinely wicked." I'm not making this up.
Mary Warnock, a British baroness told the Northern Ireland Forum for Ethics in Medicine and Healthcare this past Monday, that doctors who refuse to break their Hippocratic oath are evil.
It seems that virtually every day, I read another story that proves the world--and what is accepted as good and true --is being turned on its head.
Referring to terminally ill patients who make a written request to be killed when they reach a certain point in their illness, Warnock said: "There are doctors, we know, who don't pay any attention (to those written wishes to be killed).
"But that seems to me a genuinely wicked thing to do--to disregard what somebody had quite explicitly said, that he wants to die . . . "
This is the same old bird (she's 84) who argued that people who have dementia or Alzheimer's disease have a "duty to die" because they are a burden to society and their families.
"If you're demented, you're wasting people's lives--your family's lives--and you're wasting the resources of the National Health Service," she said a few months ago.
There was a time when such statements would be described as wicked and the orator as well.
But in Warnock's twisted world of "ethics," doctors who kill are righteous and doctors who refuse to kill are villainous.
Black is white, white is black and wrong is right. Murder is merciful and compassionate care, cruel. Somewhere out there, George Orwell is saying, "I told you so."
In her Jan. 5 speech, Warnock dismisses the idea that murdering the elderly and "demented" will not lead to a slippery slope of killing infants, depressed teens and others.
But that is precisely what is happening in Holland, where euthanasia has been practised since 1980 and has been fully legal since 2002.
Currently, infants born with defects are often killed by their doctor, with or without the parents' permission, not that permission makes it any more acceptable.
That's not just a slippery slope, it's Mount Everest in a blizzard.
The language surrounding euthanasia is necessarily softened by its proponents, calling the active killing of another human being, mercy killing, dying with dignity and choice. But what actually has been shown to happen in places that embrace legalized euthanasia is the antithesis of choice.
In a government study in the Netherlands, called Medical Decisions about the End of Life, it was found that in 1990 alone 1,031 patients were actively killed by their doctor without their request and of those people, 14 per cent were fully competent, 72 per cent had never expressed that they wanted their lives ended and in eight per cent of the cases, doctors performed "involuntary euthanasia" even though they believed other options were available.
Similar subsequent studies found similar outcomes.
So, this form of "choice" actually leads to thousands of people never being able to make a choice--ever again.
Even some staunch proponents of euthanasia say Holland is an extreme example. Much better to look to Oregon, where physician assisted suicide (PAS) has been legal since 1997.
But in the reports published annually by the state, it's evident that choice is compromised in Oregon too.
In 1998, 12 per cent of PAS patients in Oregon said they chose this irreversible course of action because they didn't want to burden their family. That rose to 26 per cent in 1999, 42 per cent in 2005 and 45 per cent in 2007, the last year figures are available. If that were a company's bottom line, champagne corks would be popping!
In other words, for the infirm and disabled, the right to die quickly becomes the duty to die. Wanting to live despite being frail or ill increasingly is viewed as selfish in places where euthanasia is the law.
That's not empowerment, it's coercion, guilt for living, pressure to die.
According to Belfast's daily paper, The News Letter, after Warnock spoke in the debate --which was ironically held in a local church, one of the members of the audience, Avril Robb, a lawyer and a member of the Medical Legal Society, said she had cared for her parents through their terminal illnesses and stated: "I do know that the last months were very precious."
That is what many who spend time caring for a dying parent, child or spouse says about a loved one's last days and months. Their vulnerability causes all emotional walls to tumble down and petty problems to vanish.
A nurse friend of mine who works in palliative care but had also spent years helping to bring babies into the world says: "I'm convinced that dying can be a more blessed a time than birth."
That may sound counterintuitive, but compared to saying that refusing to kill is wicked, it's much easier to believe.
Don't follow Oregon's lead--say no to assisted suicide
By Dr. Charles Bentz, Calgary HeraldJanuary 17, 2009 3:01 AM
I am an internal medicine doctor, practising in Oregon, where assisted suicide is legal and would like to commend the Jan. 10 column by Licia Corbella, entitled: "If doctors who won't kill are 'wicked,' the world is sick.' "
I would also like to share a story about one of my patients.
I was caring for a 76-year-old man who came in with a sore on his arm.
The sore was ultimately diagnosed as a malignant melanoma, and I referred him to two cancer specialists for evaluation and therapy.
I had known this patient and his wife for more than a decade. He was an avid hiker, a popular hobby here in Oregon. As he went through his therapy, he became less able to do this activity, becoming depressed, which was documented in his chart.
During this time, my patient expressed a wish for doctor-assisted suicide to one of the cancer specialists.
Rather than taking the time and effort to address the question of depression, or ask me to talk with him as his primary care physician and as someone who knew him, the specialist called me and asked me to be the "second opinion" for his suicide.
She told me that barbiturate overdoses "work very well" for patients like this, and that she had done this many times before.
I told her that assisted suicide was not appropriate for this patient and that I did NOT concur.
I was very concerned about my patient's mental state, and I told her that addressing his underlying issues would be better than simply giving him a lethal prescription.
Unfortunately, my concerns were ignored, and approximately two weeks later my patient was dead from an overdose prescribed by this doctor.
His death certificate, filled out by this doctor, listed the cause of death as melanoma.
The public record is not accurate.
My patient did not die from his cancer, but at the hands of a once-trusted colleague.
This experience has affected me, my practice, and my understanding of what it means to be a physician.
What happened to this patient, who was weak and vulnerable, raises several important questions that I have had to answer, and that Canadian citizens should also consider: - If assisted suicide is made legal in Canada, will you be able to trust your doctors to give you and your family members the best care? I referred my patient to specialty care, to a doctor I trusted, and the outcome turned out to be fatal. - How will financial issues affect your choices? In Oregon, patients under the Oregon Health Plan have been denied coverage for treatment and offered coverage for suicide instead, which saves the plan money. See KATU TV story and video at http://www.katu.com/home/video/26119539.html (about Barbara Wagner). Do you want this to be your choice? - If your doctors favour assisted suicide, will they let you know about all possible options or will they simply encourage you to kill yourself?
Suicidal ideation is interpreted as a cry for help. In Oregon, the only help my patient received was a lethal prescription, intended to kill him.
To the citizens of Canada, is this where you want to go? Please learn the real lesson from Oregon.
Despite all of the so-called safeguards in our assisted suicide law, numerous instances of coercion, inappropriate selection, botched attempts, and active euthanasia have been documented in the public record.
Protect your health care. Don't let legalized assisted suicide come to Canada.
Charles J. Bentz, Md, FaCP, is a CliniCal assoCiate ProFessor oF MediCine, division oF General MediCine and GeriatriCs at oreGon health & sCienCes University, Portland, ore.
Betty Coumbias does not need assistance to die. She needs help to learn how to go on living.
The elderly Vancouver woman wants to create a suicide pact with a new twist --assisted suicide for her husband, George, who has heart disease, and for herself as well because she doesn't want to live without him. Dignitas, an assisted-suicide advocacy group based in Switzerland, plans to approach state government officials in Zurich and possibly seek a court ruling to determine the legality of doctors administering lethal drugs to healthy people who don't want to live any longer.
The prevailing ethos in civilized society is that people who want to commit suicide are in dire need of help. They need counselling, and they need the comfort and sympathy of others. Reaching out to help those who are so profoundly depressed and miserable that suicide seems the only way to escape from their pain, is a hallmark of this ethos, which speaks to an unshakable belief in the sanctity of human life. It must not be eroded, for then all human life is immeasurably cheapened and easily accorded the same level of disposability as that of thousands of unwanted dogs and cats euthanized daily be-cause there is no one to love and care for them.
Widowhood is a terrifying and depressing prospect, but the bereaved need assistance in journeying through the grief process, not help in killing themselves.
Assisted suicide is always a wrong moral path down which to walk, whether one is ill, or in good health, as Betty Coumbias is.The oxymoronically named Dignitas is not about dignity at all, for dignity entails learning how to go on with life after loss and rediscovering the joy of living. To argue that dignity is re-ally about a quick and easy launch pad into the terrible permanence of death reduces dying to just another lifestyle choice.
It is telling that, during what hospice personnel call "active dying," the person in whom the process is taking place fights death at many levels. So hardwired is the human organism to go on living that the heart will pump harder to force sinking blood pressure levels back up to normal. The inevitable process of death is marked by such brave little last-ditch efforts on the body's part to rally.
If the human body is not prepared to succumb so easily, then the human ethos that underpins our attitudes toward life and death must not succumb to the blandishments of those who believe that the suicidal should be helped to die, instead of being helped to live.
Bloc Quebecois MP Francine Lalonde is at it again. Her very own neverendum has returned like a bad case of acid reflux.
No, I'm not referring to her aspiration for Quebec to separate from the rest of Canada. Lalonde's second favourite neverendum is far more serious to the well-being of us all. On Wednesday, Lalonde resurrected for the third time her private member's bill for doctors to kill you without penalty, should you request she or he do so, even though both the Supreme Court of Canada and a Canadian Senate committee has rejected legalizing euthanasia. Lalonde's private member's bill is benignly called Bill C-384.
This is what Lalonde said in the House on Wednesday: "The time has come for this Parliament to find a way to decriminalize medical assistance in dying, which is of such vital importance to those whose suffering can no longer be relieved except by this ultimate compassion."
She goes on to say that in recent years three countries in Europe and two U.S. states have enacted legislation which allows physicians to help a patient die.
In her speech, Lalonde says these jurisdictions allow physicians "under certain circumstances--the express request of terminally ill patients being one of them --to help certain persons die." It's strange, though, because that's not what her proposed legislation actually says. Bill C-384 will make it legal for physicians to kill anyone 18 or older who "continues, after trying or expressly refusing the appropriate treatments available, to experience severe physical or mental pain without any prospect of relief."
When proponents of euthanasia speak, they refer almost exclusively to elderly terminally ill people in excruciating pain being the recipients of, as Lalonde called it, "ultimate compassion."
But when you read the small print, her bill includes depressed 18-year-olds who refuse "appropriate treatments" like say, refusing to take their Prozac. So killing off depressed teens who refuse their meds is now "ultimate compassion."The euphemism is nauseating.
In her comments before the House, Lalonde stated: "Serious research . . . clearly shows that the greatest fear expressed in this Parliament some years ago, abuses and the hypothetical slippery slope, has not in any way become reality."
That statement isn't just inaccurate, it's a lie and Lalonde knows it because I told her about reports that show the slippery slope back in 2005 and I taped the phone call in which she listened to facts from those reports which I read to her and faxed to her office.
The Netherlands has been practising the killing of patients for about 30 years. It was made legal on April 1, 2002. Euthanasia in the Netherlands started out as "mercy killing" only for terminally ill, elderly people with full mental faculty who repeatedly ask for death. Now in the Netherlands, anyone over the age of 16, suffering from mental anguish, can seek physician-assisted suicide. What's more, now mildly deformed infants are being killed in the Netherlands.
In a March 2005 New England Journal of Medicine report called The Groningen Protocol, it is revealed that babies born with spina bifida, cleft palate and other abnormalities are being killed by Dutch physicians.
Imperfect babies are being killed and Lalonde says there's no slippery slope? That's not a slippery slope --it's a vertical skating rink.
Consider the case of British Columbia couple George and Betty Coumbias, both 73. George is ill with serious heart disease and is seeking to be killed in Switzerland at a clinic called Dignitas. Betty is perfectly healthy, but she has decided she wants them to kill her at the same time as her husband, and this clinic is seriously considering it. More slipping and sliding going on here.
So, what's the problem, proponents of euthanasia ask? It's their life and they should be free to choose when to end it and how. Proponents of euthanasia always argue it doesn't hurt anyone else. But again, that's not what the scientific studies show.
According to a 1991 Dutch report called Medical Decisions About the End of Life, by Prof. J. Remmelink, attorney general of the High Council of the Netherlands, in 1990 alone 1,031 people were killed by their physicians without their consent or knowledge. What I don't understand is how this fact alone doesn't stop the push for euthanasia cold. Of those 1,031 people murdered against their will, 14 per cent were fully competent and 72 per cent never expressed the will to be killed. In other words, those patients were given no choice then or ever again. That could be you or your teenager or your infant should Lalonde's bill become law.
Numerous other reports in the Netherlands made similar hair-raising findings. In 1995, 950 people were killed without their consent or "choice," and in 2005 (the most recent report in the Netherlands) 550 people were killed by their doctors without request or consent.
That's what happens when euthanasia is entrenched in a society. Call your MP and demand that he or she oppose this evil bill.
Death a certainty, not a right
Calgary HeraldJuly 18, 2009
The Quebec College of Physicians is taking the country down a dangerous path by reopening the often murky debate about euthanasia. It wants to recommend it be considered appropriate care in some instances.
Euthanasia is never appropriate.
The college is referring to the common practice of treating terminally ill patients with painkillers, to manage their suffering. Physicians constantly adjust and increase the morphine required, and sometimes the analgesic is what kills the patient, not the disease. But is this euthanasia? The Quebec doctors want to argue: Yes.
"The question here is to decide whether a drop in dosage or an increase in dosage constitutes a criminal act," says college secretary Yves Robert. "We may go as far as to recommend that in certain cases where the pain is unbearable, the amount of analgesic required could correspond to a form of euthanasia."
It's curious the college wants to go down this road, considering physicians make these decisions daily without fear of criminal charges. They do not need it spelled out in the Criminal Code.
This is an attempt to bridge the huge chasm between passive and active euthanasia. There is a difference; one allows nature to take its course, the other deliberately takes a life that someone -- in this case, a doctor--has deemed is no longer valuable.
To amend the Criminal Code in this way, would be to legitimize a form of euthanasia, setting a precedent that could be extended well beyond terminally ill patients.
The move could lead to an "end of life" policy adopted by the Quebec government. If that happens, it may only be a matter of time before that role would be expanded to include voluntary assisted suicide.
In Oregon, residents are prescribed a fatal dose of medication if they have a disease expected to kill them within six months. Yet, a lot can change in six months.
Take HIV/AIDS, which was once a death sentence, but is now something people live with as they would a chronic illness, thanks to advances in medications.
Physicians are not infallible. They have been known to make mistakes, or diagnose someone with a terminal illness, only to be proven wrong and witness a so-called miraculous recovery.
If Quebec physicians are so concerned about making their patients' final days as comfortable as possible, they should advocate for better palliative care programs. With good pain and symptom control, the desire for euthanasia, from a patient's perspective, diminishes drastically. Yet most people die without ever seeing a palliative care provider. And without palliative care, pain and symptom control cannot be optimized.
Quebec physicians should be helping their patients live as comfortably and fully as possible, until they take their last breaths, and not a second sooner.
By Bishop Fred Henry, For The Calgary HeraldJuly 28, 2009
On May 13 Francine Lalonde, a member of parliament with the Bloc Quebecois, introduced her private member's Bill C-384, An Act to amend the Criminal Code (right to die with dignity), to legalize euthanasia and physician-assisted suicide in Canada.
The issue is one of pressing interest and concern but also widespread confusion.
A major cause of the confusion is what George Orwell, in his essay, Politics and the English Language, calls the language of "euphemisms, question-begging and sheer cloudy vagueness." Some of the language being used in the euthanasia debate appears "designed to makes lies sound truthful and murder acceptable, and give an appearance of solidity to pure wind."
The rhetoric of "choice," "aid-indying," "compassion," "a new medical treatment," "self-determination," "autonomy," and "death with dignity" tend to cover up the reality that euthanasia is a deliberate act undertaken by one individual with the intention and result of ending the life of another to relieve that person's suffering. Assisted suicide is the act of killing oneself with the assistance of another who provides the knowledge, means or both.
This proposed legislation would reverse the reigning medical ethic which for more than two millenniums has insisted that doctors must heal and never kill. Legalizing physician assisted suicide would irreparably damage the doctor-patient relationship. The patient's trust in the doctor's wholehearted devotion to the patient's best interests will be hard to sustain once doctors are licensed to kill. Furthermore, such legislation would put undue stress on the conscience of the physician pressured by patients and others to take part in killing.
The unmistakable issue is the intentional killing of a human being. It has nothing to do with natural death or dignity, and everything to do with killing. We are NOT discussing letting someone die.
Euthanasia is NOT respecting a patient's refusal of treatment at any time in the course of treatment. Medical tradition and practice clearly distinguish between refusal of medical intervention and intentionally causing death by euthanasia.
Euthanasia is NOT discontinuing treatment when it serves no therapeutic purpose or the patient requests treatment to cease; nor is it abstaining from medically futile treatment.
All treatments that impose undue burdens on the patient without overriding benefits or that simply provide no benefits may justifiably be withheld or withdrawn. In making such decisions, the judgment is about the worth of treatment, not about the worth of lives. The provision of adequate medicines to control pain is not euthanasia. The administration of high doses of painkillers and sedatives to terminally ill patients may lead to a shortening of their lives. It is, however, morally acceptable to administer such drugs in doses which are linked to their painkilling or sedative effects, and not to the termination of life. It is not correct to call this "euthanasia" because there is no intention to shorten the patient's life.
Those favouring assisted-suicide have not given adequate attention to palliative care. The goal of palliative care is to give comfort and thereby enable the dying to live while dying. Letting life ebb away can in no way be equated with active euthanasia. Allowing to die is a world removed from giving a lethal injection.
Palliative care also aims at lessening or managing the suffering of terminal patients. Often they feel helpless, lonely, in the way, and a burden to others. With empathy, comfort care, and affirmation, palliative caregivers accompany patients in their suffering and by their kindness and compassion help the patient maintain a sense of worth and a feeling of belonging, and move from depression to hope.
The legislation of aid-indying would pose a threat to the elderly, the infirm, handicapped newborns and to all members of society who are unable to look after their own best interests. This kind of legislation says to them: "you're not important; you're not needed; in fact, you are a burden to others."
Canadian citizens should be assured that their dignity at every stage of life is recognized by government as important. They must be reassured by government that their needs will be met humanely. They must be shown true compassion in the care they receive from society, not through death-dealing, but by being looked after in a life-giving way.
As Canadians, we all have a duty to speak up for the rights and dignity of every citizen. In short, it is Bill C-384 that must die!
Euthanasia is a licence to kill
By David Warren, The Ottawa Citizen
August 1, 2009
The word "euthanasia" was designed from the beginning as a euphemism --as an attempt to draw the happy face over a profoundly ugly thing, and thereby slide over the moral depths--in the pioneering days of eugenics. The purpose of euphemism is to decorate a lie.
"Self-murder" was the word for killing yourself in several European languages (in German, for instance, Selbstmorder); and in English and the Romance languages the word "suicide" is just self-murder from the Latin (sui+caedere).
Of course, killing someone else is not suicide. That is murder, plain and simple, in all European languages --or at best "accessory to murder" in legalese, which was punished as murder until (figuratively) the day before yesterday. It didn't matter if he wanted to die.
That suicide is the ultimate subjective act, and thus, in effect, the final act of narcissism, was among the striking observations of Tomas Garrigue Masaryk. He was the 20th-century Czech thinker and statesman whose 1881 book Suicide and the Meaning of Civilization laid the foundation for much later social thought.
It was Masaryk's thesis that suicide rates, already at historical highs, and climbing, in the more industrially advanced parts of Europe by the 1880s, would continue to rise through the decades ahead, with decreasing religiosity and increasing modernization. He predicted that this trend would spread to regions yet untouched, as the symptoms of modernity reached them.
This was not so much a question of religious denomination, as of religious practice. There would be a rough, inverse correlation between church attendance and the suicide rate. Later statistical studies have borne this out, and Masaryk thus stands among the few sociologists whose work retains any empirical value.
Masaryk grasped the difference between depression and hopelessness, which we like to slur over today. Depression only makes one accident-prone; the real self-killer is the absence of hope for the future. This is a distinction that has been vindicated in psychiatric studies of the dying; it points directly to a dimension of human life that is irreducibly moral and religious.
Masaryk's book is much deeper and more comprehensive than Le suicide (1897), by Emile Durkheim --still presented as the standard classic on its subject to sociology majors, who will never hear of Masaryk. This is partly because of Masaryk's "unmodern" audacity, in showing that the phenomena of suicide are moral and religious, as opposed to natural. People kill themselves for all sorts of stated reasons, but what goads one man to suicide goads another to renewed life, and the only sound predictor is religious formation.
Loss of religious belief, and what is more significant, religious practice--for beliefs mean little when not put into practice; words mean little without deeds --was the true common factor. Life lost meaning once religion was abandoned.
We have lost our historical sense as well as our religion, and it is hard for us to appreciate today the longer historical trends that Masaryk was examining. We have the impression that the Christian religion was still going strong in the 1950s, and that something happened in the 1960s--the sexual revolution, or whatever--to change all that. No.
To a longer view there is not much to choose between those decades. In the English-speaking world, the outward "loss of faith" is an event that began among Victorian liberal elites. That in turn was preceded by the religious desiccation of the 18th-century; which had its roots in the Protestant Reformation, etc. History does not arrange itself in hermetic periods.
We face today not a continuing revolution in morals and manners, dating from the 1960s, but the last whanks of a revolution wrought centuries ago. Masaryk was looking at the fallout from "the Enlightenment," in the broadest possible sense. He foresaw much by penetrating beneath shorter-term trends, and by wrestling directly with core moral and philosophical concepts.
The many symptoms of civilizational decay that lay partly concealed beneath the surface of society only recently came into full view, in the open pornography, the open nihilism, the despairing flippancy, visible throughout our contemporary public life. But the pond was long draining, and it is only now we see fish flopping in the mud.
Euthanasia is the final "life issue," the clincher for what the last pope called "the culture of death." Even when legalizing abortion, we agreed only to the slaughter of human beings we could not see. It was still possible to look away, to pretend we were not killing "real people," only "potential people."
But when we embrace so-called "mercy killing," we embrace slaughter not only for the sick and old, but ultimately, the "option" of easy suicide for ourselves. It will be hard to go lower.
David Warren is a columnist With The Ottawa Citizen.
Last week, Debbie Purdy, a British multiple sclerosis sufferer, secured what those promoting assisted suicide see as a useful victory. Asked to rule on Great Britain's assisted-suicide law -- specifically whether her husband could face charges if he accompanied her to a Swiss euthanasia clinic and was with her as she died--the law lords agreed the law was opaque, and required Westminster to clarify it.
The next day, a private member's bill was proposed to allow terminally ill Britons to end their lives without leaving the country, or criminalizing those who aid them.
Those who fear euthanasia, may take comfort from the bill's slender chance of ever receiving parliamentary time.
Still, these events further illustrate how radical social change, in whatever sphere of human activity it is forced, relies on two things:Clever exploitation of sympathetic but marginal circumstances, and our monstrous capacity to deny the long-term implications of small changes to address them --as in, "What slippery slope? That would never happen."
Sadly, "that" often happens exactly as pessimists say. Against contemporary consensus, revolutions have been snatched from moderates, by bloodier men. War came to Europe despite assurances that concessions to Hitler meant it never would. Suffice to say skilful activists find incrementalism a powerful lever in sowing doubt and creating conditions for a dam-bursting moment of transition.
Purdy, after all, is an extremely sympathetic case. No decent person can fail to sympathize with the fears and apprehensions of a woman facing a protracted and potentially painful death. Right-to-die advocates know this, and use it. And, without appealing to a faith not universally shared, how do life's defenders rebut the arguments of fairness, and that this woman's life is hers to dispose?
Typically, by suggesting such cases are the thin end of a wedge: If physician assisted suicide is permitted to desperately ill people, it will eventually be available for the merely depressed, commonplace for the suffering, and a danger to the dependent elderly whose continued existence violates the right of their children to a convenient life, (secured by their inheritance).
Never happen? It already does, in Holland.
It is salutary to reflect that revolutionaries from Cromwell through Robespierre, to the tyrants of the early 20th century and the abortion activists of the 1970s have in common that for their new and perfected world orders to flourish, somebody --the Stuarts, the aristocracy, class enemies, the Jews, the unborn-- must die. The assisted-suicide movement is but the latest such culture of death: If it has its way, an unwilling generation will pay with their lives for the noble principle of choice, sure as slopes are slippery.
Perhaps the British will see this: When they clarify their law, Purdy may not like it.
However, Canada should take no comfort from that. Activists merely wait for the next good case, and this country has its own peculiar philosophical vulnerability, the charter right to equality. In 1993, the Supreme Court of Canada rejected the contention laws against assisted suicide were discriminatory, but nobody should assume it would do so again. The Constitution is, after all, "a living tree" supposed in judicial circles to evolve with public opinion. Contra the bromide that such a thing could never happen here, it is entirely possible that it might.
The clarity actually required, here and in Great Britain, is that life is sacred and vulnerable. When it is depreciated in one law, it is depreciated in all.
That is, as the right to die is conceded to someone eagerly desiring it, a death sentence is quietly pronounced on someone else clinging to life.
September 7, 2009
A More Perfect Death
By ROSS DOUTHAT
As if there weren’t enough end-of-life anxieties floating around the health care debate, the Montana Supreme Court has chosen this month to weigh whether their state should join nearby Oregon and Washington in endorsing physician-assisted suicide.
What’s at stake is the right to voluntary euthanasia, not the sort of involuntary plug-pulling that some Republicans have claimed is concealed in the finer print of the current health care reform proposals. But you don’t have to share Sarah Palin’s death panel fears to see perils lurking at the intersection of physician-assisted suicide and health care reform.
Consider the words of a prominent oncologist, bioethicist and health care wonk, critiquing assisted suicide in 1997, just before a Supreme Court ruling on the issue. “Once legalized,” this writer warned in the pages of The Atlantic, “euthanasia would become routine. Over time doctors would become comfortable giving injections to end life and Americans would become comfortable having euthanasia as an option.” From there, it would be an easy slide to euthanizing the incompetent: “Comfort would make us want to extend the option to others who, in society’s view, are suffering and leading purposeless lives.”
Comfort — and budgetary constraints. Euthanasia would be much more likely to pass from an exception to a rule, the bioethicist argued, “in the context of demographic and budgetary pressures on Social Security and Medicare as the Baby Boom generation begins to retire, around 2010.”
In the great health care debate of 2009, that’s the kind of argument you’d expect to hear from a Republican politician. But the words were actually written by Ezekiel Emanuel, a health-care advisor at the Office of Management and Budget, and the brother of Rahm Emanuel, the White House Chief of Staff.
Ironically, Dr. Emanuel now stands accused of favoring some sort of death panels himself, thanks in part to a paper he recently co-authored, which argues that the scarcest medical resources (emergency vaccines, say, or donated organs) should be provided to younger, healthier patients before they’re given to the aged and infirm. His critics have seized on the paper to suggest that Emanuel — and by extension, the Obama administration — might support applying age and health-based rationing to medical treatment in general.
Yet the conservatives pillorying him, unjustly , as a “deadly doctor” could just as easily be quoting him. Twelve years later, Emanuel’s Atlantic essay remains a lucid case for the existence of a slippery slope, especially under government-managed health care, to some sort of death-by-bureaucrat.
Just because Ezekiel Emanuel and Sarah Palin agree that a slope exists, however, doesn’t mean that America will slip down it.
In a more cost-conscious culture, there’s no question that physician-assisted suicide could lead to a particularly sinister form of rationing. The European experience offers plenty of cautionary tales — from the spread of less-than-voluntary euthanasia in the suicide-accepting Netherlands, to the recent controversy over Great Britain’s “Liverpool Care Pathway,” whose supposedly-merciful approach to dying patients may involve withdrawing care before their death is actually certain.
But the American way of death is different. Our move toward physician-assisted suicide springs from the same quest for mastery over mortality that leads us to spend nearly twice as much on health care as any other developed nation. And our instincts run so strongly toward unlimited spending that it’s much easier to imagine the government going bankrupt paying for extreme life-saving procedures than it is to imagine a suddenly cost-conscious bureaucracy pressuring doctors to administer lethal overdoses.
It sounds paradoxical to link the desire for unlimited medical treatment to the desire for physician-assisted suicide. But the idea that there’s a right to the most expensive health care while you want to be alive isn’t all that different, in a sense, from the idea that there’s a right to swiftly die once life doesn’t seem worth living.
In each case, the goal is perfect autonomy, perfect control, and absolute freedom of choice. And in each case, the alternative approach — one that emphasizes the limits of human agency, and the importance of humility in the face of death’s mysteries — doesn’t mesh with our national DNA.
There are many good reasons to oppose assisted suicide. It transforms a healing profession into a killing profession. It encourages relatives to see a loved one’s slow death as a problem to be solved, rather than a trial to be accepted. And as Emanuel noted in his 1997 essay, its “beneficiaries” are far more likely to be suffering from psychological distress than unbearable physical pain.
But in the profligate, Promethean United States, it probably won’t lead to rationing-by-euthanasia. It’s just as likely to become one more “intervention” that we insist every health insurance plan should cover — on our way, perhaps, to a rendezvous with fiscal suicide.
Euthanasia damages trust in doctors
October 17, 2009
It should be disturbing news to Quebecers that 75 per cent of medical specialists in that province would probably be in favour of legalizing euthanasia, according to a survey of its members done by the Quebec Federation of Medical Specialists. Nothing could be more calculated to destroy the trust in their physicians that patients should by rights be able to have than the knowledge that a given doctor looks favourably on euthanasia.
The organization clarified the results of the survey by stating that it refers to euthanasia "within a clearly defined legislative limit." There is no such thing, and both doctors and patients are fooling themselves if they think there is. The compendium of illness is so vast and the ways a single malady can affect different people so varied that it is impossible for any issue this serious to be so black and white that it can be clearly defined by legislation. Health-care providers always work in shades of grey, due simply to the diversity of the patient population they're caring for.
And unless a patient is aware that his or her doctor is adamantly opposed to euthanasia, confidence in that doctor will be eroded. No patient can then be sure that a doctor has saving lives in mind when giving advice on such things as drug dosages for pain or sedation for someone hospitalized with a serious illness. Nor will patients be any longer confident that a doctor looking after them when they are unconscious has not written them off as candidates for euthanasia when discussing care and treatment plans with their families. Loved ones may find themselves agreeing to levels of drug administration for a sick family member, for example, which they don't have the medical expertise to challenge, and are not even in an emotional state to begin to do so.
Euthanasia should and must remain outlawed in Canada, despite the leanings of the QFMS, and despite Bill C-384, which proposes legalizing euthanasia and is in second reading in Parliament. Patients have an inviolable right to trust that their doctor is doing everything possible to help them live. A favourable feeling among doctors toward euthanasia is the farthest thing possible from the Hippocratic oath, which states: "I will do no harm or injustice to (my patients) . . . I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan . . . "
Test these bioethicists for consciousness
By Naomi Lakritz, Calgary Herald
November 29, 2009
It's said that where there's life, there's hope. It also seems that where there's life, there's someone ready to devalue it.
Last week, the world heard about the case of Rom Houben, a 46-year-old Brussels man who spent more than two decades living the nightmare of a medical misdiagnosis. Paralyzed in an auto accident, Houben was thought to be in a persistent vegetative state until three years ago when scans showed that his cerebral cortex--the part of the brain scientists say governs thought, language and other higher functions --was active. It turned out that Houben had been fully aware all those years, but trapped in his paralyzed body, he was unable to let doctors know.
This should be happy news, especially because in the three years since Houben's true diagnosis of locked-in syndrome was made, he has learned to communicate with the help of an aide and a special keyboard and computer. But it has dealt a severe blow to those who set themselves up to judge the quality and value of the lives of others, because it puts paid to their cherished notions about euthanasia and that oxymoronic phrase, "right to die." That term is often slyly used as though it meant the right of the disabled individual in question, when actually it means someone else's right to decide the disabled person should die.
So roaring back they came, the dissenters, ready to denounce Houben's restored communication ability as a mere parlour trick. I'm not sure what satisfaction they get from savaging this helpless man's accomplishments, but then I don't presume to pass judgment on the level of sentience at which they function, as they have passed judgment on Houben's.
Houben is so lucky to have a wise, compassionate doctor like neurologist Steven Laureys caring for him. In an interview Friday with newscientist.com,Laureys said, "What is happening now is very regrettable. I feel sorry for Rom and about what some people have written on the Net. He knows what people are saying, and one can only try to imagine what he has already been through. . . . He is again being treated as if 'it is impossible, he cannot be a cognitive being.' "
Indeed, some cretins posting online dismissed Houben as a "fraud," a "hoax" and a "poor stiff."
Laureys added, "We don't have the neural correlate of consciousness. However, there is a whole literature on the brain's metabolic activity in the vegetative state and on its activity when it is functioning normally."
Consciousness is the ultimate mystery of human existence. How dare anyone make dismissive assumptions about the state of Houben's consciousness and self-awareness? There is simply no ruling out the possibility that apart from the known physical functions of the brain, something else is the seat of consciousness. Call it the mind, call it the soul--we have no way of knowing anyone else's depth of experience of cognition, regardless of how disabled they appear outwardly.
Arthur Caplan, a professor of bioethics professor at the University of Pennsylvania, dismisses Houben's communication as "Ouija board stuff" and says the things Houben communicates are not natural for someone who has suffered an injury like his. If anything, it is the bioethics profs who appear to be the soulless ones. Listen to what bioethicist Jacob Appel wrote, which was posted Tuesday on www.huffingtonpost.com:"Conservative activists may attempt to use his tragedy as an argument against withdrawing care from those believed to be persistently comatose. However . . . these calamities may instead offer a compelling argument for withdrawing such care. In fact, such circumstances might present the rare occasions when active euthanasia is morally justified without overt consent."
In other words, it might be OK to kill Houben because others think he'd be better off dead. Never mind what he thinks. To use the euphemism "active euthanasia"-- why not just call it murder?--in the same sentence as "morally justified" is absolutely appalling.
"Keep in mind," Appel continues, "that patients like this have no guarantee that their consciousness will ever be discovered."
Appel says "no conscious individual should ever be euthanized against his wishes . . . " but then he suggests that where no wishes have been expressed, a sort of referendum could be held for the public to decide what the "default" position should be--life or death-- "or we could even conclude that some forms of suffering are so horrific that a few patients may have to die against their preferences so that others will not have to undergo years of unremitting psychological agony."
God help us if health care ever reaches that state of moral degradation.
As for letting patients like Houben live, "we should recognize that such a policy is neither obvious nor intuitive," Appel writes.
He's quite wrong there. Such a policy is not only obvious and intuitive, it is the only moral choice there is.
Compassion not at core of euthanasia debate
By Jim Mahony, For The Calgary Herald
December 12, 2009
As people across Canada line up for flu shots, their Members of Parliament are considering a more chilling issue: legalized euthanasia. And while there is every indication that Bill C-384, Bloc MP Francine Lalonde's 'right-to-die' bill, will itself die an early death, it raises issues about compassion that must be faced down, sooner or later.
If there is any doubt about the issue's importance, it was brought home by a recent poll of Quebec doctors which Canada's euthanasia advocates -- and some journalists -- have greeted as if it were a clear call for legalized euthanasia by the province's medical profession. In fact, the survey by the Quebec Federation of Medical Specialists was anything but, as even a brief review will make clear.
While 74 per cent of federation members who responded would "certainly or probably" favour a legal framework for euthanasia in Canada, those who say the poll is evidence of majority support for euthanasia overlook a critical point. Of the federation's more than 8,000 members, just 23 per cent, or less than one in four responded to the poll. That's hardly a ringing endorsement, and it conveniently leaves out the 6,000 Quebec specialists who didn't voice their views one way or the other.
Equally important, federation members make up only about half of Quebec's roughly 16,000 doctors, some 8,200 of whom are family physicians and general practitioners (i. e., non-specialists). Most of these doctors belong to another professional group which notably has not weighed in on the euthanasia debate. Let's not generalize about medical opinion until all physicians' groups have spoken.
Far from heralding any sea-change in Canadian society, the federation's poll is more likely evidence that a minority of Quebec specialists -- those endorsing euthanasia -- are trying to get a jump on their more Hippocratic colleagues in the public debate on this topic. On that score, it's worth noting that the Canadian Medical Association, a much larger, national physicians' group, has made very clear that it does not support euthanasia, a point which Canada's euthanasia-boosters have somehow overlooked.
In the end, the debate over euthanasia will not be won or lost by opinion polls, but through a reasoned public discussion. Moral values are naturally part of that dialogue because many faiths, including Christianity, view killing -- the taking of innocent life -- as morally wrong. Yet, euthanasia-boosters bridle at any talk of killing, preferring to chant the "right to die" mantra. That only confuses the issue. One Quebec doctor offers a more reasoned view.
"To give the right to die to the patient, you must give a right to kill to the physician," Andre Bourque, head of family medicine at the University of Montreal, told the CBC in October. If there is any doubt about what euthanasia proponents are asking for, Bourque's comment makes it clear. It is about killing, not dying.
Since Bill C-384 was tabled in Ottawa, it's also about one MP asking Parliament to give Canada's doctors the legal right to kill. Thirty years ago, there would have been little debate on this issue, because so few Canadians would entertain the notion of euthanasia. Only since society has largely sidelined religious belief have some of its "thinkers" discarded traditional morality, including much of the value usually accorded human life.
Of all things, belief in God may be the best indicator of one's views on euthanasia. Very few believers endorse it. Yet, among atheists, who recognize few laws higher than the state, support for euthanasia is common. After all, they believe no one will ultimately be around to enforce the rules, whether here or in the hereafter. With that mindset, anything goes -- that, at least is the logic.
In fairness, some people view euthanasia as the answer to the problem of suffering. Society wants a quick fix, especially for suffering among the dying, terminally ill and elderly. Yet, how often need it be said that we do not show compassion by killing, but by journeying with the sufferer? Arguably, there is no quick fix for any complex problem, least of all this one.
If Canada legalizes euthanasia, it will go swiftly from being a society that brings compassion to the suffering to one that merely executes them, albeit in a clinical setting. Euthanasia advocates say unspecified "safeguards" will ensure that only the willing will be killed. Yet, safeguards had no such effect in the Netherlands, where cases of involuntary euthanasia (i. e., without consent) are well documented. The Remmelink report made that clear.
Canada should think twice before going down the road of imposed death, but so should doctors. Whenever talk of legalizing euthanasia arises, ethicists ask how it would affect the often fragile trust that exists between patient and doctor. "A physician is there to support, comfort (and) heal," says Dr. Bourque. "The minute you give him the right to kill, you have changed something in the relationship."
That's an understatement. The tradition of the physician as healer is long-standing and ancient. Patients have for centuries looked to their doctors for help, healing and relief, never for death. Arguably, the success of any treatment depends on the continuance of that trust. How long will it survive, if doctors are given the right to kill?
A journalist and former Calgary lawyer, Jim Mahony writes about healthca reethicsandend-oflife issues from a Catholic perspective.
In my first-ever column on euthanasia, I wrote about Frances and Ken. Fifteen years later, their stories remain far more compelling than my words in showing us what happens to individuals when society promotes life -- or death -- as a virtue.
The story of Frances appeared in Newsweek. On her 76th birthday, she wrote, "unassisted and by my own free will, I have chosen to take my final passage. I am still in control . . . this act is not one of suicide . . ." She then took an overdose of sleeping pills, tied a plastic bag over her head and committed suicide.
Why? She had no terminal illness. But she idolized Dr. Jack Kevorkian and possessed numerous well-worn publications from the Hemlock Society, as well as a suicide file. She spent the last years of her life focused on death and, according to her friend, "held a schoolgirl's romanticism about suicide, seeing it as noble and an act of strength."
When society promotes suicide as a virtue and the ultimate act of autonomy, lonely and vulnerable people like Frances are the first casualties.
Yet, last week it was reported that healthy, elderly people in the Netherlands who are "tired of living" could soon be allowed to end their lives with a lethal injection. In fact, the very helpful Right to Die group has suggested there's no need for the medical community to be involved in this death project and has proposed that non-medical staff be trained to administer the injection.
In Holland, inhabitants of nursing homes already fear for their lives and the possibility of "involuntary" euthanasia, while the depressed, the terminally ill, the not-so terminally ill and young ballerinas with arthritic toes all pride themselves in their right to voluntarily purchase this eternal one-way ticket.
In December, the health minister who led Holland's euthanasia bill into law admitted some regrets. Medical care for the terminally ill has declined and she believes it was a mistake to listen first to "the political and societal demand in favour of euthanasia."
In spite of what we now know about Holland, Bloc MP Francine Lalonde continues to envision this kind of a society for Canada. This week, she once again introduced a private member's bill to give medical doctors the right to directly and intentionally cause the death of a patient -- if the patient "appears to be lucid" and has chronic physical or mental pain (i. e. depression) or is terminally ill. She told Parliament, "We should not refuse them the right to die with dignity."
A November 2009 Environics poll showed that 61 per cent of Canadians apparently agree with Lalonde. But even though they may support legalized euthanasia, they still have a host of concerns about the consequences. Between 55 to 72 per cent of those who supported euthanasia still worried that a "significant number" of people could be put to death against their wishes (data from Holland broadly supports this concern). In addition, a large majority of those who showed tentative support for euthanasia believe we should place a greater priority on palliative and hospice care than euthanasia. In other words, Canadians are just as concerned with helping people live as helping them die.
That brings us to Ken, a 48-year-old Montreal poet who suffered from a rare, paralyzing form of Parkinson's disease. As his condition worsened, he repeatedly asked his friend for right-to-die literature and a lethal supply of sleeping pills. Then, one day, instead of saying "help me die," Ken began to ask his friend to "help me live."
According to Ken, "Life is beautiful and I haven't lost my appetite for life. I have proved the doctors wrong about my capacity to live, despite the disease, for years and years. But if I do not get help, I cannot continue to survive."
Ken then became a well-known advocate for home care in Quebec. Instead of using his final years to contemplate suicide, he used them to make life better for those with terminal illness.
There will be increasing pressure to legalize euthanasia as our population ages and a generation that has led a life of convenience comes to terms with death. Society must now choose. Will we focus on better palliative care or euthanasia? Will our nation promote life or death? Will Canadians help people live or help them die?
Last year, the radio host Diane Rehm watched in agony as her husband, John, starved to death over the course of 10 days.
Severely crippled by Parkinson’s disease, his only option for ending the suffering was to stop eating and drinking. Physicians in most states, including Maryland, where he lived, are barred from helping terminally ill patients who want to die in a dignified way.
“He was a brilliant man, just brilliant,” Ms. Rehm said in an interview. “For him to go out that way, not being able to do anything for himself, was an insufferable indignity.”
Ms. Rehm, whose current affairs talk show at WAMU is distributed by NPR, the public radio network, has brought a strong and poignant voice to a debate gaining attention in state legislatures around the country.
Currently, only Oregon, Washington, Vermont, New Mexico and Montana allow health care providers, under strict guidelines, to hasten the death of terminally ill patients who wish to spare themselves and their loved ones from the final, crippling stages of deteriorating health. Lawmakers in 15 other states and the District of Columbia have introduced so-called aid in dying bills in recent months to make such a humane option available to millions of Americans at a time when the nation’s population of older adults is growing.
The impetus for many of the bills was the widely publicized story of Brittany Maynard, a 29-year-old woman from California who moved to Oregon, after learning in the spring of 2014 that she had incurable brain cancer, so she could die on her own terms. The nonprofit organization Compassion & Choices, which has worked closely with Ms. Maynard’s relatives and with Ms. Rehm, has played a leading role in getting state lawmakers to introduce bills.
The right-to-die movement has strong opponents, including the Catholic Church, which opposes any form of suicide. Meanwhile, some medical professionals argue that the practice is at odds with their mission as healers and worry that it could be abused. Unfortunately, many Americans associate the issue with Dr. Jack Kevorkian, a notorious advocate of assisted suicide who was convicted in 1999 of murder and who aided dozens of patients, many of whom were not terminally ill, in ending their lives.
As local lawmakers around the country debate the bills, they should consider how successfully and responsibly the law has been carried out in Oregon. The state’s Death With Dignity Act, which went into effect in 1997, gives doctors the right to prescribe a lethal dose of medication to patients who are terminally ill and who have been advised of their alternatives, such as hospice care. The law provides layers of safeguards to ensure proper diagnosis of the disease, determine a patient’s competency to make the decision, and protect against coercion. Last year, 105 patients in Oregon, a record high, died after receiving a lethal dose of medication.
Health care providers in states where assisted suicide is illegal face wrenching choices when dying patients ask them for help. In one case, prosecutors in Pennsylvania perversely charged Barbara Mancini, a nurse, with assisting a suicide for handing a bottle of morphine in February 2013 to her 93-year-old father, who was in hospice care. A judge dismissed the case the following year.
Some doctors caught in these painful situations end up handing patients lethal doses of painkillers with a wink and a nod, right-to-die activists say. But these unregulated practices put patients and doctors on dangerous terrain. “Making a secret process transparent makes it safer,” Barbara Coombs Lee, the president of Compassion & Choices, said in an interview. Ms. Rehm said she and her husband had long agreed they would help each other die if either was in growing distress from a terminal illness. Her inability to help him die humanely is a situation no spouse should have to face.
“There was no question but that I would support him and honor whatever choice he would make,” she said. “As painful as it was, it was his wish.”
There is much confusion around this issue among patients and their families, and unfortunately among physicians as well. Which form is the right one? Who should have a copy?
An advance directive — each state has its own — is indeed an important legal document. Like any insurance policy, it is intended to prepare its owners in advance for difficult times. All responsible homeowners buy home insurance even though they will rarely, if ever, use it. But although everyone will eventually confront the end of life, their own and probably that of one or more loved ones, only about 20 percent of people complete an advance directive.
And even when they do, there is no set of clear and sequential instructions for I.C.U. doctors like me to follow. An advance directive is too reductionist to possibly do that. The human body and its workings are too unpredictable to plan for all possible eventualities. And then there are the myriad other factors: psychological, familial and spiritual considerations.
The advance directive should be seen as a conversation starter, an idea generator, a philosophical tool. It is a guide for your loved ones to work with your doctors and make decisions that are based on your goals and values as the situation unfolds. Its purpose is to chart the broad strokes, to delineate the guiding principles.
But it simply cannot be a detailed list of dos and don’ts.
The form asks that you choose between two general approaches to treatment — to prolong life or not to prolong life. There will be no confusion if you choose the first option — physicians’ default setting is to pursue every reasonable treatment, often until death. The problem is for those who would choose the latter.
Although the choice not to prolong life includes clarifying sentences — if the likely risks and burdens of treatment would outweigh the expected benefits, or if I become unconscious and, to a realistic degree of medical certainty, will not regain consciousness, or if I have an incurable and irreversible condition that will result in my death in a relatively short time — those conditions remain very subjective and can leave decision makers and doctors stumped. What does a relatively short time mean? Four days on a ventilator for someone with terminal cancer in excruciating pain might be a fate worse than death. But for someone else it might be a bridge to another six months of good life.
The patient was terminally ill. He had decided to end his life under his state’s “death with dignity” law, and his doctor prescribed the medication he would use to do it. But his death was unexpectedly delayed because he drank a large soda before taking the medication — an ordinarily lethal dose — and it apparently interfered with the drug’s absorption. I’ve been told that patients who want to die are now warned not to drink carbonated beverages before or after taking the medication.
In another situation, a physician assisting in a death for the first time prescribed less than the recommended dose of the lethal drug. Although the patient died, it might have been otherwise. And an A.L.S. patient who requested the prescription from his physician met one criterion (having a terminal illness) but not the second (prognosis of six months to live). These are just some of the unexpected wrinkles that have come up in the still-new world of physician-assisted death.
Providing the means for immediate death is contrary to the long history of medicine, where the primary intent has been to work for the patient’s survival. As a bioethicist in Washington, one of the five states that have legalized this, I find that for doctors, having the opportunity to help a patient die may resolve certain ethical issues but raises many others. It is especially important to consider these now, as many states are considering legislation on this practice.
A photo of Brittany Maynard, a terminally ill woman who moved from California to Oregon last year to legally end her life, rested on the dais as California lawmakers discussed a bill on medical aid in dying on March 25.Credit Rich Pedroncelli/Associated Press
Medical aid in dying is now allowed in Oregon, Washington and Vermont by legislation and in Montana and New Mexico through court decisions. The laws provide direction and protection for those involved. For example, in Oregon, Washington and Vermont, when terminally ill patients request physician assistance in dying, it is not considered suicide, and the death certificate notes the underlying illness as the cause of death.
In Washington State, two doctors must verify that the patient is competent, suffering from a terminal illness and that death is expected within six months. The request must be made and confirmed by a second request after a 15-day waiting period. The process requires a doctor who is willing to write the prescription and a pharmacist who is willing to fill it. The patient must have the capacity to take the prescription independently; that is, it must not be administered by another party.
Once a patient has the medication, he or she may decide when or whether to take it. Many patients have delayed taking the medication for weeks as they assessed when the timing was right. Most patients are not in a hurry to die. Some die of their diseases, never taking the medication. Surviving family members usually say that such patients felt a great sense of comfort in knowing they had the means to bring about their death if their suffering intensified. Many were willing to accept a certain level of pain as long as they were able to relate to loved ones and find at least a minimal level of satisfaction in living.
Legally, the act of aiding or abetting the death of another has been considered a felony. Ethically, physician assistance in the death of a patient has been contrary to the precepts of bioethics, and in earlier times physicians took an oath that they would not provide any deadly substance to patients. The passage of this law in 2008 in Washington has opened a new window on this practice and served as a reminder to physicians that many feel we are not doing a good enough job in caring for the dying by providing excellent palliative care at the end of life.
This is a new day for physicians. As one physician friend said: “I voted for this law when it was on the ballot, in principle, it seemed like a good idea. I never imagined that one of my patients would ask me to write a lethal prescription and participate in their decision to die.” Another doctor mused: “All of my training was to provide medications with the intent of curing illness or relieving pain. Writing a lethal prescription has a different intent.” Some physicians have examined their consciences and decided that they will not participate. Some health care organizations have decided to “opt out,” usually for religious reasons, and have established policies forbidding any employee of the institution from participating in physician assisted dying. Others have opted in.
Imagine, however, that a physician has decided to assist patients in situations deemed appropriate. When a patient makes a request for aid in dying, how should that conversation go? Is the patient driven by unreasonable fears or by discomforts that could be resolved through excellent palliative care? The request should trigger a careful discussion. These questions were not covered in medical school or resident training. To whom should one turn for this information?
If a decision is made to assist the patient, what happens next? Secobarbital — or seconal — is currently the most widely used prescription. Patients are advised to open the capsules and mix the powder with sweetened applesauce or a drink. There are a handful of cases where patients have regurgitated part of the medication, so an antiemetic should be taken first. The patient usually loses consciousness within moments of taking the medication, and death follows quickly. Physicians who prescribe medication in death with dignity cases usually seem to want to fly below the radar, avoiding publicity; they do not want to become known as “Dr. Death.” Given the desire for anonymity, there is little in the way of support from colleagues. I have recently met privately with two groups of physicians in the state, at their request, to discuss such issues and to provide support in the face of these complexities.
If other states pass death with dignity laws, learning from Washington State’s experience, they should require that the Department of Health provide standardized information to assist physicians. Additionally, professional support groups providing a neutral source of information and guidance for participating physicians should be offered. Even then, doctors will continue to struggle with their role in the process. As one physician I know put it, “a prognosis of six months or less is the same criterion for participation in hospice as it is for participation in physician-assisted death under the Death With Dignity Act — but I worry a lot more about the accuracy of the prognosis if a patient requests a prescription for a lethal dose of medication.”
Thomas R. McCormick is a senior lecturer emeritus in the Department of Medical History and Ethics at the University of Washington School of Medicine.
Doctors will be more and more confronted to asituations where they have to make a decision on helping or not a patient die. The AKU is preparing them for those decisions since a long time with a course on medical ethics. I hope more Universities across the world will follow suit with this kind of courses that should be made compulsory.
When I was preparing my will, the notary made me sign a paper which defined the person/persons that will be able to take those kind of decision on my behalf if I become incapable of taking decisions. I though that was the right thing to do. Why put the doctors in uncomfortable position where they are asked to make decisions on behalf of their patient.
Is not stopping medication and stopping treatment of a terminally ill patient, a form of passive euthanasia?
Doctors will be more and more confronted to asituations where they have to make a decision on helping or not a patient die. The AKU is preparing them for those decisions since a long time with a course on medical ethics. I hope more Universities across the world will follow suit with this kind of courses that should be made compulsory.
I don't think a solution has been found yet nor is there a simple one for this issue. However MHI has expressed the need to address such issues at the AKU in the coming decades as per statement below made at the McMaster Convocation May 15, 1987:
"Professional standards and assumptions can provide a form of intolerance, pride and myopia as intractable as the rigidities of traditional societies. As you know far better than I, science alone will not give us much guidance on when to prolong human life and whether to intervene in its creation.
The industrialized world only rather recently has rediscovered that these questions engage not merely professional ethics and standards; they touch the deeply held convictions of a Judeo-Christian tradition, an idea of humanity that has challenged the prophets and philosophers for thousands of years. Nations cannot assign these issues to a priesthood of scientists; they require the resources of the human spirit as well as the mind. The Islamic world is dealing with these questions on two fronts simultaneously; first, in the reintroduction of science and its sceptical world view that it is not part of current tradition; second, Islamic societies are redicovering the importance of the modern, secular world of their Islamic ethical underpinning. Is it any surprise that there is soul-searching and social upheaval, but also intellectual vitality and tumult, among the people of the Islamic world?
My message to all graduating doctors, nurses and health workers, then, is that the world needs your professionalism. But it also needs your imagination, your energy, and an abiding humility and curiosity about the human beings you serve - and about those subtle, deep, non-material forces that motivate them. During its first hundred years McMaster has shown an exceptional ability to ask new questions about old issues, and to ask the old - ethical - questions about new issues. Is this restlessness, this continually renewed freshness of intellectual approach, not the sign of a great institution? Surely it is. Nowhere has this been clearer than in McMaster's health sciences.
Science is a wonderful, powerful tool and research budgets are essential. But science is only the beginning in the new age we are entering. My hope is that, in Islamic Pakistan, The Aga Khan University and Hospital can make progress in developing new models. Islam does not perceive the world as two separate domains of mind and spirit, science and belief. Science and the search for knowledge are an expression of man's designated role in the universe, but they do not define that role totally. Surely there is no more worthy area in which East and West can work, to bond these two aspects of man's understanding, than the field of health sciences that our graduates enter this evening. The world is an infinitely exciting place. You have been wonderfully trained. I congratulate you and urge you to move forward with all reason, imagination, and human understanding. Thank You."
Healthy 24-year-old granted right to die in Belgium
Doctors in Belgium are granting a 24-year-old woman who is suffering from depression but is otherwise healthy the right to die as she qualifies for euthanasia under the Belgian law, even though she does not have a terminal or life-threatening illness.
The 24-year-old woman, known simply as Laura, has been given the go-ahead by health professionals in Belgium to receive a lethal injection after spending both her childhood and adult life suffering from "suicidal thoughts", she told local Belgian media.
Laura has been a patient of a psychiatric institution since the age of 21 and says she has previously tried to kill herself on several occasions. She told journalists: "Death feels to me not as a choice. If I had a choice, I would choose a bearable life, but I have done everything and that was unsuccessful." The date of Laura's death is yet to be decided.
Belgium passed a law to legalise euthanasia in 2002, the second country in the world to do so after the Netherlands. The law states that Belgian doctors can "help patients" to end their lives if they freely express a wish to die because they are suffering from intractable and unbearable pain.
Dr Marc Van Hoey, a general practitioner and president of the Right to Die Association in northern Belgium, is a vocal supporter of the legislation. Van Hoey told the Independent newspaper that he believes that sometimes euthanasia is the kindest option. "I've seen quite a lot of persons dying in - how do you say in proper English - agony?" Van Hoey said. "I never saw that when I gave someone euthanasia he or she asked for."
Over the past few years there has been a sharp increase in the number of euthanasia cases in Belgium. In 2013, there were 1,807 deaths recorded compared with 1,432 in 2012. More than half of last year's cases were patients aged 70 and over but there are increasing numbers of young people requesting to die legally, with the majority citing depression as their "intractable and unbearable pain."
However, not everyone is in favour of the law. Carine Brochier, a project manager with the Brussels-based European Institute of Bioethics, tells Newsweek that she believes too many people are dying as a result of Belgium's liberalised euthanasia laws.
She argues that many people who experience psychological suffering and treatable mental illnesses may be wrongly given the go ahead for euthanasia because "there is absolutely no way for healthcare professionals to measure another person's mental suffering to decide if they should receive euthanasia."
"Euthanasia is not the answer to all human suffering," Brochier continues. "We need to develop better palliative care for people," something she believes Belgium is not currently doing.
Earlier this year in February, the parliament in Belgium passed a bill also allowing euthanasia for terminally ill children without any age limit, by 86 votes to 44. The vote makes it the first country in the world to have legalised euthanasia without an age limit.
In the Netherlands, the first country to legalize euthanasia, sick children are allowed to request it, but only if they are 12 years or older.
As of June 2015, euthanasia is legal in the Netherlands, Belgium, Colombia and Luxembourg.
SACRAMENTO — In a landmark victory for supporters of assisted suicide, the California State Legislature on Friday gave its final approval to a bill that would allow doctors to help terminally ill people end their lives.
Four states — Oregon, Washington, Montana and Vermont — already allow physicians to prescribe life-ending medication to some patients. The California bill, which passed Friday in the State Senate by a vote of 23 to 14, will now go to Gov. Jerry Brown, who will roughly triple access to doctor-assisted suicide across the country if he signs it. Mr. Brown has given little indication of his intentions.
"In spite of the bill’s provision about coercion, Dr. Aaron Kheriaty, director of the medical ethics program at the University of California, Irvine, School of Medicine, said that low-income and underinsured patients would inevitably feel pressure from family members to end their own lives in some cases, when the cost of continued treatment would be astronomical compared with the cost of a few lethal pills.
He pointed to a case in Oregon involving Barbara Wagner, a cancer patient who said that her insurance plan had refused to cover an expensive treatment but did offer to pay for “physician aid in dying.”"
Quebec province is introducing Euthanasia under Doctor supervision. It required Quebec Residency as the province does not want to encourage Euthanasia Tourism.
The doctor will be free to refuse. There are conditions also as it is not Euthanasia for all, what is proposed is Euthanasia with the consent of the patient for terminally il, when suffering is increasing everyday and is unbearable and death is inevitable in a short time because of the disease.
This has created a debate on the ethics of Euthanasia...
As I rushed through the hospital lobby on my way to the intensive care unit, I saw the palliative care team speaking to a young woman in a wheelchair. She was beautiful, her cheeks full and round, her mouth in a constant soft smile as she spoke. She sat regally in her chair, the red of her sweatshirt anchoring my eyes in the dim hospital lobby. She was such a vision of beauty and health that it took me a second to realize that her right leg was amputated below the knee.
One of my colleagues smiled in introduction and gestured ceremoniously to the patient. “Dr. Zitter, you remember Michelle Moore.” My mind grappled for traction. I recognized the name (which I’ve replaced with a pseudonym to protect her privacy), but her face drew a blank. “I believe that you took care of Michelle in the I.C.U. when she first came to the hospital last year.” And then it came to me: When I had known this woman, she had been covered by so many tubes and wires, I could barely make out her face.
As the treating doctor for this critically ill patient, I had been sure she would die. And I was wrong. Her very presence in the lobby felt like a reprimand.
As Nicholas Christakis describes in his book “Death Foretold,” doctors are significantly more likely to overestimate a patient’s life expectancy than to underestimate it. And not just by a little. According to a large study he conducted in 2000, they overestimated survival by a factor of five. In that vein, it is the rare case where I feel confident that an outcome will be bad and the patient proves me wrong.
Michelle’s heart valve had become infected from a batch of bacteria-laden heroin. These delicate valves act as a backstop for the heart, preventing blood from flowing backward. In Michelle’s case, a critical valve was caked with pus and a cabbage-like mass clung to it like a rider on a rodeo horse. The majority of blood flowed backward with every contraction of her heart, instead of toward her oxygen-starved organs, and her blood pressure was critically low.
In addition to compromising her blood flow, the heaving vegetation had been steadily showering drops of pus downstream, to any location where blood flowed. Pus had woven into her muscle fibers, her kidney, her liver, and lodged into the distal regions of her extremities. Her hands and feet were so chock-full of it that they were beginning to die. But her brain, the control center of life, was our biggest concern. The CT scan showed that it was saturated throughout with fine pustules and inflammation, severe enough in some parts to have caused bleeding into its delicate tissues. The neurologists met with the family to break the bad news that significant recovery was extremely unlikely.
I, too, spent numerous hours with her family, providing support and information, and transmitting my increasing concern that she would not recover. We were approaching the two-week mark of her hospitalization, the point at which we become concerned that continuing pressure from the breathing tube can break down the delicate tissues of the throat and airway. A solution is to sew the breathing tube directly into the neck at the level of the Adam’s apple, a procedure called a tracheostomy or trach, to more safely continue to provide support from the breathing machine.
Although the procedure itself is not significantly risky, its implications are serious. Unlike the temporary breathing tube of the first two weeks, a trach does not expire. And therefore, while it may serve as a bridge to improvement, it may also function as a tomb for one who does not improve.
I use this two-week decision point as an opportunity to reassess goals of care with the family. Is it time to focus on comfort more than the prolongation of life? Or not? By that time, I have gathered more data, observed the trajectory of the illness, and have a clearer view of where things are heading. If recovery, or even improvement, doesn’t seem likely, families may decide to remove the temporary breathing tube and allow their loved one’s body to die. Many families elect to place the trach despite a poor prognosis, but I feel it is my role to enable them to opt out of the default decision to prolong life, so common in our nation’s I.C.U.s.
I presented Michelle’s mother with both options: Withdraw the breathing tube and allow her to die, or replace it with a trach and keep her on machines. When they asked me what I would do if this were my family member, I said I probably would not perform a tracheostomy. Still, her mother, a religious woman, decided she would hold out for a miracle. And so against my better judgment, we trached her.
For the first several months of her hospitalization, she was cited as a sad case of nonbeneficial life prolongation, with extensive nursing needs and continued medical setbacks. But one day a colleague said to me: “Hey, did you hear that Michelle Moore woke up?” I looked up, incredulous. “No, I’m serious,” she continued. “Dr. Rodriguez was standing next to her bed and she said hello.” I was stunned and thrilled.
Her unexpected turnaround began to affect our hospital culture. “Remember that patient with the valve infection?” became a common refrain for doctors considering whether to break bad news. What if they were wrong?
I had delivered bad news to Michelle’s family several times. I had presented them with the option of disconnecting her from the breathing machine. Their belief in miracles had kept her alive. And now she was here in our hospital lobby thanking me for all I had done for her. I wondered whether I would ever be able to give a family bad news again.
Before we parted, I hugged her and almost wept with joy. Yet as I walked away, I was overcome by a cloud of apprehension. Should I have kept my doubts to myself? Was it wrong to consider stopping the full-court press?
But over the course of that week some clarity returned. In my 25 years of experience with thousands of patients, I can count miraculous cases like Michelle’s on one hand. Numerous doctors besides me had been convinced she would die, or at least be severely brain damaged if she were to survive. And that consensus of thought is something I believe that families do deserve to hear.
The fact is, there are two types of risk in cases like these. One risk is that a patient will be deprived of the chance at a miracle. But the far more likely risk is that a patient with no chance of recovery will become permanently attached to machinery designed to automate breathing and feeding, and spend the rest of her life in a nursing home, being washed by strangers, enduring infections and skin breakdown, family visits ebbing because it’s simply too painful. Survey after survey shows that most people would never choose this path.
A friend used the analogy of a lottery. Why not go for it? Even if there is only a chance in a million, isn’t it worth trying? My response to this question is as follows. Are you, as a future patient, and future surrogate of loved ones, willing to take the risk of being on the other side of Michelle’s odds? This is where the lottery analogy falls away completely. It’s not $5 on the line. It’s everything.
For the sake of my future patients, I must remember that miracles are just that… miracles.
Jessica Nutik Zitter, a critical care and palliative care physician at Highland Hospital in Oakland, Calif., is writing a book about end-of-life issues.
Religious leaders call for better palliative care as assisted dying debate heats up
Religious leaders from several faiths are calling on Canadian lawmakers to improve palliative care and respect human life as the contentious debate over doctor-assisted dying heats up.
The Canadian Conference of Catholic Bishops and the Evangelical Fellowship of Canada, along with other faith leaders, held a joint news conference on Parliament Hill to release a declaration physician-assisted death.
The statement has been endorsed by more than 30 Christian denominations, as well as Jewish and Muslim leaders from across the country. It calls for more palliative care, as well as "respect for the dignity of the human person, human solidarity and psychological, spiritual and emotional support as the only ethical and moral response in end of life care."
In a unanimous landmark ruling on Feb. 6, 2015, the Supreme Court of Canada struck down the ban on physician-assisted dying, on the grounds that it violated Canadians' Charter rights. Justices gave the federal and provincial governments 12 months to prepare for the decision to come into effect.
The College of Physicians and Surgeons of Manitoba says in its draft statement on physician-assisted dying that two physicians have to participate to process of a patient's request for help in ending his or her life. (Reuters)
This week, CBC News reported the incoming Liberal government is considering asking the Supreme Court for a six-month extension to draft new laws.
The Conservatives had set up an independent panel this summer to hear from Canadians. Work was suspended during the three-month election campaign.
Dr. Cindy Forbes, the new president of the Canadian Medical Association, appeared before the panel last week and requested federal leadership on the issue.
"What we're hoping is that there will be a national approach to this so that there wouldn't be a patchwork of different legislation across the country, so that it wouldn't matter where you live in Canada the regulations, the process and the service would be similar and access would be similar right across the country," she told CBC News.
The CMA has done its own consultations on this issue. Forbes said at first doctors were divided about whether or not they should be allowed to help a terminally ill patient end his or her life.
Since the Supreme Court ruled, Forbes said, the conversation has changed.
"How should this occur? What about physicians who wish to participate — are they protected? And what about the physicians who would not wish to participate due to issues of conscience?" Those are the kinds of questions doctors are asking now, Forbes said.
Defeated Conservative MP Steven Fletcher had his own private member's bill on the issue, and has long been an advocate for physician-assisted dying.
He would prefer the federal government let the provinces deal with the issue going forward.
"I'm not sure what kind of legislation the government could bring forward. What the Supreme Court did was, when they made their decision, they took the meat of my private member's bill and put it into their decision. So the framework, the boundaries are already in place," Fletcher said.
Fletcher said all political parties dodged this issue in any kind of detail in the election campaign.
Prime Minister-designate Justin Trudeau is expected to ask the Supreme Court of Canada for a six-month extension to craft new laws around physician-assisted dying. (Sean Kilpatrick/Canadian Press)
"Politicians are terrible at making laws that deal with morality, particularly telling cognitive adults what they can or can not do," he said.
But, he added, he heard from many voters about their support for physician-assisted dying, and he believes the political tone will change going forward, not because it's a new government, but because of what Canadians are telling their politicians.
"The people who went door knocking in the last three months would have heard about this on their doorstep. And what people would say, in my experience was, the vast majority were in favour of physician-assisted death with the appropriate caveats," Fletcher said.
It has been 15 years since my mother called and asked, “Do you have some time at the end of July or the beginning of August? Your father and I have decided to kill ourselves and we would like you to come and find our bodies.”
My parents, who lived in England, were Czech refugees from the Holocaust. My father, a 26-year-old newly minted lawyer, escaped deportation in 1939 by walking across the border from his native Czechoslovakia into Poland, with England as his goal. My mother’s parents put her on a train in Prague, with Shanghai as her eventual destination. She was 18.
My mother’s parents died in Lodz and Auschwitz. My father told me that his father had committed suicide during the transport of Jews from Ostrava to Nisko in 1939. This information might have come from his mother, who was deported to Minsk and murdered there in 1942.
During the early years of World War II, chance and good fortune brought both my parents to London, where they met and married in 1945. Within a couple of years, they had established themselves as an academic couple with two children and started to make their way up the social and economic ladder. Their careers were distinguished, with honors and privileges bestowed by their adopted country.
They had made it clear for as long as I can remember that, because of the deaths of all four of their parents in the Holocaust, their lives were their own, to continue or end as they saw fit and whenever they saw fit. They had even made a pact wherein, if one of them died, the other need stay alive for only six months before taking his or her own life, if that life proved unbearable.
My mother’s health began to fail in 2000 and, with her phone call from England, it was clear that my parents had abandoned their pact and were planning to end their lives together.
In answer to my mother’s macabre question, I said, “I can come to England on the night that you kill yourselves and then come to the house with a doctor and the police, if that is what you want.” But, no, that was not what my mother wanted.
“We would like you to come and say goodbye to us, to go to London for the day, and then to return alone to find our bodies.” I’m not that tough; I could not agree to do that. So my mother said that they would make other arrangements.
A few weeks later, in mid-August, a doctor was called to their house and found my parents dead, with garbage bags tied over their heads and pillows resting on their suffocated faces. She also found a statement of their intent to kill themselves.
In October, the coroner ruled, “I have to be sure beyond reasonable doubt that both these persons intended to take their own lives. They have done so, I am sure.”
We shall all die and most of us want some control over the manner of our dying. Some want to be sure that they will be able to kill themselves; some want the right to assisted suicide if they are unable to kill themselves; some want purely palliative care; and some want every possible medical intervention.
I hope, too, to have some control over my dying and I am repelled neither by the idea of suicide nor by the idea of assisted suicide. However, my experience with my parents’ deaths gives me pause.
Since my parents’ deaths, many of my friends have seen their parents die in the hospital or under hospice care. I envy all these friends. Their parents brought them into this world and they were there for their parents when their parents left this world. By depriving me of this filial role, my parents rejected me more forcefully than they could possibly have understood — or, maybe, they just did not care. Or was their request that I be the one to find their bodies an indication of their great love for me? This is a question that I can never answer.
Most of the time, I do not think of my parents’ deaths. But they are a result of the Holocaust as surely as the deaths of my grandparents. And it is at the most inopportune times, when I am worried about my own health, that I have to confront all six deaths. When a physician asks for my family history, I have to say, “My grandparents perished as Jews in the Holocaust; my father died, according to his autopsy, in perfect health; and my parents killed themselves.”
Sherwin Nuland, the author of “How We Die,” taught me that one cannot control how one dies but one can have some control over how one lives. But I wonder how much control I shall have over my own death and, more profoundly, how much control is best for me and, even more important, for my children and grandchildren. It is my descendants, after all, who will be dealing with the manner and consequences of my death when I am gone.
Ann M. Altman is a scientist, a writer and a political adviser.
Archbishop of Toronto speaks out against assisted dying
'It is never justified' for doctors to kill, Cardinal Thomas Collins tells area Catholics
A cardinal's statement on assisted dying was read and shown by video today in more than 200 Catholic churches across the Archdiocese of Toronto.
In the statement, the Archbishop of Toronto, Cardinal Thomas Collins, calls on the federal government to protect the vulnerable and those who care for them.
"Dying is simply not the same as being killed," Collins said in the video, which the Archdiocese posted earlier this week to YouTube.
- Assisted dying much more complex when it comes to mentally ill: experts
"We are grateful for physicians and nurses and others who offer medical assistance to patients who are dying. But it is never justified for them to kill."
Justin Trudeau Seeks to Legalize Assisted Suicide in Canada
OTTAWA — The government of Prime Minister Justin Trudeau introduced legislation on Thursday to legalize physician-assisted suicide for Canadians with a “serious and incurable illness,” which has brought them “enduring physical or psychological suffering.”
The proposed law limits physician-assisted suicides to citizens and residents who are eligible to participate in the national health care system, an effort to prevent a surge in medical tourism among the dying from other countries.
If the bill passes, Canada will join a group of countries that permit some form of assisted suicide, including Belgium, the Netherlands, Switzerland and Germany. Assisted suicide is legal in only a few American states, including Oregon and Vermont.
Under Canada’s proposed law, people who have a serious medical condition and want to die will be able to commit suicide with medication provided by their doctors or have a doctor or nurse practitioner administer the dose for them. Family members and friends will be allowed to assist patients with their death, and social workers and pharmacists will be permitted to participate in the process.
The legislation is the latest step in a decades-long and frequently emotional debate in Canada about the rights and protections of patients with serious medical conditions who might seek to end their lives.
The legislation is expected to pass, given the Liberal Party’s strong majority in the House of Commons. However, the government has promised to further study the issue after the law’s passage and may make changes to the system.
Prime Minister Justin Trudeau of Canada has said his support for doctor-assisted death was informed by the last days of his father, former Prime Minister Pierre Elliott Trudeau. Credit Alice Chiche/Agence France-Presse — Getty Images
“For some, medical assistance in dying will be troubling,” Jody Wilson-Raybould, the justice minister, said at a news conference on Thursday. “For others, this legislation will not go far enough.”
The bill would allow consenting adults “capable of making decisions with respect to their health” to choose to end their own lives or seek assistance in doing so from their doctors. A physician must decide that “natural death has become reasonably foreseeable, taking into account all of their medical circumstances.”
Officials said that a patient does not have to have a terminal condition, citing the example of someone with an immune system deficiency which leaves them vulnerable to lethal infections.
Two independent physicians must agree and the patient must wait 15 days before moving to end his or her life, though the bill would allow for that waiting period to be shortened under certain circumstances.
Doctors will not be required to help people die, but they must refer patients to another physician if they have an objection to participating.
“I’ve seen people die well and I’ve seen people die in misery,” Dr. Jane Philpott, the health minister who is also a family physician, told reporters on Thursday after the bill was introduced. “I want Canadians to have access to the best care possible.”
The government’s proposal is more restrictive than some proponents of legal assisted suicide had sought. It does not include provisions for minors who may be capable of making decisions about their own medical care to choose to end their lives, nor does it allow for people in the early stages of illnesses like dementia to request an assisted death while they are still competent.
"Since 2014, aid-in-dying bills have been introduced in at least 26 states and Washington, D.C. While it’s important to provide a humane option to the dying, it’s also essential that lawmakers focus on the need to provide broader access to palliative and hospice care so that terminal patients do not choose death because pain relief is unaffordable. They must ensure that doctors be trained in prescribing life-ending medication and must encourage professional groups to offer education and support for those who want to provide such aid. And they should make funding available to study the effect of these laws."
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