Canada doesn't want to be a 'suicide tourism' destination
North America’s assisted-suicide landscape changed in a profound, historic way on Friday. As NPR reported, that was when Canada’s Senate approved that nation’s new physician-assisted-suicide law. The law was initially brought about by a ruling from Canada’s Supreme Court last year that banned a law against physician-assisted suicide, but left it to the country’s legislature to regulate and determine the scope of the practice.
One interesting aspect of Canada’s version of physician-assisted suicide is that only Canadians are eligible for it. This mirrors how it’s done in the handful of U.S. states where physician-assisted suicide is already legal, which include Washington, Oregon, and Vermont (California’s state legislature approved assisted suicide there recently, but things haven’t been finalized).
Belgium, which enacted its euthanasia law in 2002, is seen as taking one of the most liberal approaches, which has led to some rather strange and heart-wrenching stories. “In 2013, [the famous/infamous Belgian euthanasia physician] Wim Distelmans euthanized a forty-four-year-old transgender man, Nathan Verhelst, because Verhelst was devastated by the failure of his sex-change surgeries; he said that he felt like a monster when he looked in the mirror,” wrote Rachel Aviv in her absolute must-read piece on this subject for The New Yorker a year ago. “‘Farewell, everybody,’ Verhelst said from his hospital bed, seconds before receiving a lethal injection.” More recently, the BBC reported on a Belgian man who wants to end his life because, he says, he can’t live with his pedophilia; the first step of his application was approved. As the BBC noted, “There were 1,807 confirmed cases of euthanasia in 2013, the most recent year for which figures are available.”
There are no easy or obvious answers for any of this, but if you want to know more about how physician-assisted suicide works in Europe, definitely read that New Yorker article or watch VICE’s recent mini-doc, which I mentioned in another recent post on the subject. These controversies are only going to grow more heated.
Terminally ill woman holds party before ending her life
SAN DIEGO — In early July, Betsy Davis emailed her closest friends and relatives to invite them to a two-day party, telling them: "These circumstances are unlike any party you have attended before, requiring emotional stamina, centeredness and openness."
And just one rule: No crying in front of her.
The 41-year-old artist with ALS, or Lou Gehrig's disease, held the gathering to say goodbye before becoming one of the first Californians to take a lethal dose of drugs under the state's new doctor-assisted suicide law for the terminally ill.
"For me and everyone who was invited, it was very challenging to consider, but there was no question that we would be there for her," said Niels Alpert, a cinematographer from New York City.
"The idea to go and spend a beautiful weekend that culminates in their suicide — that is not a normal thing, not a normal, everyday occurrence. In the background of the lovely fun, smiles and laughter that we had that weekend was the knowledge of what was coming."
This July 24, 2016 photo provided by Niels Alpert, Betsy Davis, smiles during a going away party with her family and friends in California
Davis worked out a detailed schedule for the gathering on the weekend of July 23-24, including the precise hour she planned to slip into a coma, and shared her plans with her guests in the invitation.
More than 30 people came to the party at a home with a wraparound porch in the picturesque Southern California mountain town of Ojai, flying in from New York, Chicago and across California.
One woman brought a cello. A man played a harmonica. There were cocktails, pizza from her favorite local joint, and a screening in her room of one of her favorite movies, "The Dance of Reality," based on the life of a Chilean film director.
As the weekend drew to a close, her friends kissed her goodbye, gathered for a photo and left, and Davis was wheeled out to a canopy bed on a hillside, where she took a combination of morphine, pentobarbital and chloral hydrate prescribed by her doctor.
Kelly Davis said she loved her sister's idea for the gathering, which Betsy Davis referred to as a "rebirth."
"Obviously it was hard for me. It's still hard for me," said Davis, who wrote about it for the online news outlet Voice of San Diego. "The worst was needing to leave the room every now and then, because I would get choked up. But people got it. They understood how much she was suffering and that she was fine with her decision. They respected that. They knew she wanted it to be a joyous occasion."
Davis ended her life a little over a month after a California law giving the option to the terminally ill went into effect. Four other states allow doctor-assisted suicide, with Oregon the first in 1997.
Opponents of the law in lobbying against it before state legislators argued that hastening death was morally wrong, that it puts terminally ill patients at risk for coerced death by loved ones and could become a way out for people who are uninsured or fearful of high medical bills.
Marilyn Golden of the Disability Rights Education & Defense Fund, said her heart goes out to anyone dealing with a terminal illness, but "there are still millions of people in California threatened by the danger of this law."
Davis spent months planning her exit, feeling empowered after spending the last three years losing control of her body bit by bit. The painter and performance artist could no longer stand, brush her teeth or scratch an itch. Her caretakers had to translate her slurred speech for others.
"Dear rebirth participants you're all very brave for sending me off on my journey," she wrote in her invitation. "There are no rules. Wear what you want, speak your mind, dance, hop, chant, sing, pray, but do not cry in front of me. OK, one rule."
During the party, old friends reconnected and Davis rolled in and out of the rooms in her electric wheelchair and onto the porch, talking with her guests.
At one point, she invited friends to her room to try on the clothes she had picked out for them. They modeled the outfits to laughter. Guests were also invited to take a "Betsy souvenir" — a painting, beauty product or other memento. Her sister had placed sticky notes on the items, explaining each one's significance.
Wearing a Japanese kimono she bought on a bucket-list trip she took after being diagnosed in 2013, she looked out at her last sunset and took the drugs at 6:45 p.m. with her caretaker, her doctor, her massage therapist and her sister by her side. Four hours later, she died.
Friends said it was the final performance for the artist, who once drew pictures on a stage with whipped cream.
"What Betsy did gave her the most beautiful death that any person could ever wish for," Alpert said. "By taking charge, she turned her departure into a work of art."
Her guests agreed to meet again on her birthday in June to scatter her ashes.
New York, Colorado and the District of Columbia may soon join the handful of states where doctors are allowed to help terminally ill patients die by prescribing a lethal dose of painkillers.
A proposal to allow physician-assisted dying will be on the ballot in Colorado next month. In the District of Columbia, the District Council’s Health and Human Services Committee last week approved a physician-assisted dying bill that the full council could vote on before the end of the year. New York lawmakers, meanwhile, are hopeful that support in the Legislature for aid-in-dying bills will soon overcome opposition from religious leaders and some medical groups.
Victories in the three jurisdictions would galvanize a movement that seeks to give terminally ill Americans a dignified alternative to the dismal choices they face in most of the country. In states where assisted dying is banned, some terminal patients manage to get a lethal dose of drugs from medical professionals under the table, which exposes the health care workers to prosecution. Others are advised to starve themselves to death.
The VSED Exit: A Way to Speed Up Dying, Without Asking Permission
Del Greenfield had endured repeated bouts of cancer over four decades, yet kept working as a peace activist in Portland, Ore., into her 80s. “She was a powerful force,” said her daughter, Bonnie Reagan.
But in 2007, Ms. Greenfield was struggling. She had been her husband’s caregiver until he died that year at 97, never telling her family she was feeling miserable herself. She’d lost much of her hearing. She required supplemental oxygen.
When she fell and broke an arm, “that was the final straw,” her daughter said. “She was a real doer, and she couldn’t function the way she wanted to. Life wasn’t joyful anymore.”
At 91, Ms. Greenfield told her family she was ready to die. She wanted a prescription for lethal drugs, and because she had active cancer, she might have obtained one under Oregon’s Death with Dignity statute for people with terminal illnesses.
Then her son-in-law, a family physician who had written such prescriptions for other patients, explained the somewhat involved process: oral and written requests, a waiting period, two physicians’ assent.
“I don’t have time for that,” Ms. Greenfield objected. “I’m just going to stop eating and drinking.”
In end-of-life circles, this option is called VSED (usually pronounced VEEsed), for voluntarily stopping eating and drinking. It causes death by dehydration, usually within seven to 14 days. To people with serious illnesses who want to hasten their deaths, a small but determined group, VSED can sound like a reasonable exit strategy.
Unlike aid with dying, now legal in five states, it doesn’t require governmental action or physicians’ authorization. Patients don’t need a terminal diagnosis, and they don’t have to prove mental capacity. They do need resolve.
“It’s for strong-willed, independent people with very supportive families,” said Dr. Timothy Quill, a veteran palliative care physician at the University of Rochester Medical Center.
He was speaking at a conference on VSED, billed as the nation’s first, at Seattle University School of Law this month. It drew about 220 participants — physicians and nurses, lawyers, bioethicists, academics of various stripes, theologians, hospice staff. (Disclosure: I was also a speaker, and received an honorarium and some travel costs.)
What the gathering made clear was that much about VSED remains unclear.
Is it legal?
For a mentally competent patient, able to grasp and communicate decisions, probably so, said Thaddeus Pope, director of the Health Law Institute at Mitchell Hamline School of Law in St. Paul, Minn. His research has found no laws expressly prohibiting competent people from VSED, and the right to refuse medical and health care intervention is well established.
Still, he pointed out, “absence of prohibition is not the same as permission.” Health care professionals can be reluctant to become involved, because “they want a green light, and there isn’t one of those for VSED,” he added.
The question grows much murkier for patients with dementia or mental illness who have specified VSED under certain circumstances through advance directives. Several states, including Wisconsin and New York, forbid health care surrogates to stop food and fluids. (Oregon legislators, on the other hand, are considering drafting a bill to allow surrogates to withhold nutrition.)
The question intrigues bioethicists. Can your current competent self cut off nutrition and hydration for your future demented self? In a handful of court decisions, judges have declined to enforce such directives.
Can VSED be comfortable and provide a peaceful death?
“The start of it is generally quite comfortable,” Dr. Quill said he had found, having cared for such patients. The not-eating part comes fairly easily, health professionals say; the seriously ill often lose their appetites anyway.
Coping with thirst can be much more difficult. Yet even sips of water prolong the dying process.
“You want a medical partner to manage your symptoms,” Dr. Quill said. “It’s harder than you think.”
Keeping patients’ mouths moistened and having aggressive pain medication available make a big difference, health professionals say.
At the conference, the Dutch researcher Dr. Eva Bolt presented results from a survey of family physicians in the Netherlands, describing 99 cases of VSED. Their patients (median age: 83) had serious diseases and depended on others for everyday care; three-quarters had life expectancies of less than a year.
In their final three days, their doctors reported, 14 percent suffered pain, and smaller percentages experienced fatigue, impaired cognition, thirst or delirium.
Still, 80 percent of the physicians said the process had unfolded as the patients wanted; only 2 percent said it hadn’t. The median time from the start of their fasts until death was seven days.
Those results mirror a 2003 study of hospice nurses in Oregon who had cared for VSED patients. Rating their deaths on a scale from 0 to 9 (a very good death), the nurses assigned a median score of 8. Nearly all of the patients died within 15 days.
The slower pace of death from fasting, compared with ingesting barbiturates, gives people time to say goodbye and, for the first few days, to change their minds. Several conference speakers described patients who had fasted and stopped a few times before continuing until death.
That’s hard on families and caregivers, though. And slowness won’t benefit people who are dying with severe shortness of breath or pain. “Two weeks is a lifetime in that situation,” Dr. Quill said.
Other obstacles could restrict VSED. A quiet choice in a private home, it could be derailed in nursing homes and assisted living facilities where administrators fear lawsuits or regulatory sanctions. Physicians might decline to participate; home care aides might quit.
Moreover, major religious groups have yet to declare whether they consider VSED an acceptable act of self-determination or a suicide, anathema in most faiths.
Phyllis Shacter and her husband, Alan Alberts, a computer scientist who received a Alzheimer’s disease diagnosis in 2011, had few doubts, however. VSED allowed him to escape the disease that had slowly killed his mother.
No state allows a person with dementia to use a “death with dignity” law, but with support from his wife, doctor and two caregivers, Mr. Alberts, 76, died peacefully at home in 2013 after a nine-day fast.
“I’m glad my husband fulfilled his desire not to live into the final stages of Alzheimer’s,” Ms. Shacter said.
On the other hand, Judith Schwarz, clinical coordinator of End of Life Choices New York, told of an 81-year-old attempting VSED with inadequate pain medication, crying out to his wife at night, “I’m dying of thirst.”
“And of course, he was, but slowly,” Dr. Schwarz said. “This was a horror show.”
Del Greenfield fared better. “She didn’t use any medicines, just some oxygen,” her daughter said. Ms. Greenfield’s children, grandchildren and great-grandchildren came to see her, and “she was completely peaceful, chatting and joking and telling people she loved them.”
She announced that she had one regret. “We all leaned in,” Bonnie Reagan said. “And she said, ‘I wish I’d seen the Rolling Stones the last time they came to Portland.’”
On the fifth day of fasting, “she just fell asleep,” and died about 36 hours later.
DURHAM, N.C. — Out of nowhere, a patient I recently met in my clinic told me, “If my heart stops, doctor, just let me go.”
“Why?” I asked him.
Without hesitating, he replied, “Because there are worse states than death.”
Advances in medical therapies, in addition to their immense benefits, have changed death to dying — from an instantaneous event to a long, drawn-out process. Death is preceded by years of disability, countless procedures and powerful medications. Only one in five patients is able to die at home. These days many patients fear what it takes to live more than death itself.
That may explain why this year, behind the noise of the presidential campaign, the right-to-die movement has made several big legislative advances. In June, California became the fifth and largest state to put an assisted suicide law into effect; this week the District of Columbia Council passed a similar law. And on Tuesday voters in Colorado will decide whether to allow physician-assisted suicide in their state as well.
Yet even as assisted suicide has generated broader support, the group most vehemently opposed to it hasn’t budged: doctors.
That resistance is traditionally couched in doctors’ adherence to our understanding of the Hippocratic oath. But it’s becoming harder for us to know what is meant by “do no harm.” With the amount of respirators and other apparatus at our disposal, it is almost impossible for most patients to die unless doctors’ or patients’ families end life support. The withdrawal of treatment, therefore, is now perhaps the most common way critically ill patients die in the hospital.
While “withdrawal” implies a passive act, terminating artificial support feels decidedly active. Unlike assisted suicide, which requires patients to be screened for depression, patients can ask for treatment withdrawal even if they have major depression or are suicidal. Furthermore, withdrawal decisions are usually made for patients who are so sick that they frequently have no voice in the matter.
Some doctors skirt the question of assisted suicide through opiate prescriptions, which are almost universally prescribed for patients nearing death. Even though these medications can slow down breathing to the point of stoppage, doctors and nurses are very comfortable giving them, knowing that they might hasten a “natural” death.
In extreme cases, when even morphine isn’t enough, patients are given anesthesia to ease their deaths. The last time I administered what is called terminal sedation, another accepted strategy, was in the case of a patient with abdominal cancer whose intestines were perforated and for whom surgery was not an option. The patient, who had been writhing uncontrollably in pain, was finally comfortable. Yet terminal sedation, necessary as it was, felt closer to active euthanasia than assisted suicide would have.
While the way people die has changed, the arguments made against assisted suicide have not. We are warned of a slippery slope, implying that legalization of assisted suicide would eventually lead to eugenic sterilization reminiscent of Nazi Germany. But no such drift has been observed in any of the countries where it has been legalized.
We are cautioned that legalization would put vulnerable populations like the uninsured and the disabled at risk; however, years of data from Oregon demonstrate that the vast majority of patients who opt for it are white, affluent and highly educated.
We are also told that assisted suicide laws will allow doctors and nurses to avoid providing high-quality palliative care to patients, but the data suggests the opposite: A strong argument for legalization is that it sensitizes doctors about ensuring the comfort of patients with terminal illnesses; if suicide is an option, they’ll do what they can to preclude it.
And, again, we are counseled that physicians should do no harm. But medical harm is already one of the leading causes of death — and in any case, isn’t preventing patients from dying on their terms its own form of medical harm?
With the right safeguards in place, assisted suicide can help give terminally ill patients a semblance of control over their lives as disease, disability and the medical machine tries to wrest it away from them. In Oregon, of the exceedingly few patients who have requested a lethal prescription — 1,545 in 18 years — about 35 percent never uses it; for them, it is merely a means to self-affirmation, a reassuring option.
Instead of using our energies to obfuscate and obstruct how patients might want to end their lives when faced with life-limiting disease, we physicians need to reassess how we can help patients achieve their goals when the end is near. We need to be able to offer an option for those who desire assisted suicide, so that they can openly take control of their death.
Instead of seeking guidance from ancient edicts, we need to re-evaluate just what patients face in modern times. Even if it is a course we personally wouldn’t recommend, we should consider allowing it for patients suffering from debilitating disease. How we die has changed tremendously over the past few decades — and so must we.
Haider Javed Warraich, a fellow in cardiovascular medicine at Duke University Medical Center, is the author of the forthcoming book “Modern Death: How Medicine Changed the End of Life.”
Physician Aid in Dying Gains Acceptance in the U.S.
In recent months, this option has become available to a growing number of Americans. Last June, aid-in-dying legislation took effect in California, the most populous state. In November, Colorado voters approved a ballot measure by nearly a two-thirds majority. The District of Columbia Council has passed a similar law, and the mayor quietly signed it last month.
Aid in dying was already legal in Washington, Vermont, Montana and Oregon. So even if the District of Columbia’s law is blocked, as a prominent Republican representative has threatened to do, the country has arrived at a remarkable moment: Close to 20 percent of Americans live in jurisdictions where adults can legally end their lives if they are terminally ill and meet eligibility requirements.
1,300 Canadians have died with medical assistance since legalization — here's one man's story
'I just told him I loved him, held him,' man's husband tells CBC about medically assisted death
On Friday Jan. 6, Rob Rollins and his husband John MacTavish woke up just as they would any other morning. John got his brother Bobby MacTavish, who is unable to speak or walk, ready to go to his day program. But this time, before he left, Bobby spent about an hour with Rollins in his bedroom. The two were saying goodbye.
One of the couple's closest friends, Claire Cowley, soon arrived and sat in the living room with Rollins and MacTavish. The three were chatting "like it was any other morning," MacTavish says. "Which was weird, because I kept looking at the clock, knowing that, you know, the doctor was going to drive in that driveway."
Before the doctor arrived, Rollins, 56, wanted to make sure some practical things were in order.
"[He] tidied up his desk, made sure I knew where things were and gave me the passwords," MacTavish, 54, says. "You know, made sure that I knew how to run the dishwasher."
A nurse from their rural village of Delta, northeast of Kingston, Ont., who had cared for Rollins as he battled throat and neck cancer, arrived at about 10 a.m. and inserted an IV tube into his arm. His family doctor also came, although he wasn't required to, and the group kept chatting.
MacTavish says when the local doctor who would do the final procedure arrived at the house "he talked to Rob to make sure that Rob knew what was happening and still agreeable."
The couple walked down the hallway of their small house and Rollins had a cigarette, while MacTavish held his hand. Then, they came back to the living room.
"He said goodbye to Claire, who's his best friend, to the doctors and the nurse," MacTavish remembers. "We went into the bedroom, he got into bed. I covered him up with his quilt. I laid down beside him. The doctor came in and asked if there was anything we needed to say to each other."
Then, he administered the lethal dose of medication through Rollins's IV tube.
"I just told him I loved him, held him," MacTavish says through tears. "And it was over in about five minutes. Very peaceful."
OAKLAND, Calif. — I WAS leafing through a patient’s chart last year when a colleague tapped me on the shoulder. “I have a patient who is asking about the End of Life Option Act,” he said in a low voice. “Can we even do that here?”
I practice both critical and palliative care medicine at a public hospital in Oakland. In June 2016, our state became the fourth in the nation to allow medical aid in dying for patients suffering from terminal illness. Oregon was the pioneer 20 years ago. Washington and Vermont followed suit more recently. (Colorado voters passed a similar law in November.) Now, five months after the law took effect here in California, I was facing my first request for assistance to shorten the life of a patient.
That week, I was the attending physician on the palliative care service. Since palliative care medicine focuses on the treatment of all forms of suffering in serious illness, my colleague assumed that I would know what to do with this request. I didn’t.
I could see my own discomfort mirrored in his face. “Can you help us with it?” he asked me. “Of course,” I said. Then I felt my stomach lurch.
California’s law permits physicians to prescribe a lethal cocktail to patients who request it and meet certain criteria: They must be adults expected to die within six months who are able to self-administer the drug and retain the mental capacity to make a decision like this.
But that is where the law leaves off. The details of patient selection and protocol, even the composition of the lethal compound, are left to the individual doctor or hospital policy. Our hospital, like many others at that time, was still in the early stages of creating a policy and procedure. To me and many of my colleagues in California, it felt as if the law had passed so quickly that we weren’t fully prepared to deal with it.
The Australian state of Victoria legalises assisted dying
Some 50 bills have been introduced in different Australian states. This is the first to pass
THE quest has failed many times. The past 20 years have seen around 50 attempts to pass laws in different Australian states to allow doctors to help terminally ill people end their lives. All have suffered defeat. But on November 29th Victoria finally made history, when its parliament passed Australia’s first state law to legalise doctor-assisted dying.
The law, which will take effect in 2019, allows people with an advanced, incurable illness to request “assisted dying” if their suffering cannot be relieved “in a manner that the person considers tolerable”. Patients must make three successive requests for such help; doctors are banned from initiating discussion of it as an option. The original bill had proposed limiting eligibility to those who were expected to live no more than a year. Victoria’s lawmakers reduced that to six months, with a few exceptions.
Most earlier attempts to legalise assisted dying were private members’ bills, but the state government proposed this one. Brian Owler, a neurosurgeon advising the government, believes this was crucial to its success. Daniel Andrews, Victoria’s premier, and Jill Hennessy, its health minister, both said that seeing a parent suffer from a debilitating illness had led them to support the law.
Assisted dying is legal only in Colombia, Canada, a few European countries and some American states. Mr Andrews says the new law is the most conservative in the world. Yet it has rankled some other members of his party, Labor. Paul Keating, a former Labor prime minister, says it “stands for everything a truly civil society should stand against”.
It has divided doctors, too. Michael Gannon, head of the Australian Medical Association, a lobby group, says Victoria’s parliament has “changed one of the fundamentals of medical ethics”. Doctors are “concerned about where it might lead”. Mr Owler retorts: “It’s not about doctors. It’s about people who are suffering and dying.” Andrew McGee, a health-law specialist at Queensland University of Technology, thinks Victoria’s law prevailed because the government had embarked earlier on a “thorough” public inquiry that reassured people “this type of regime can succeed.”
Australia has six states and two self-governing territories. The Northern Territory legalised assisted dying 21 years ago. But the national government can overturn territorial legislation, and did so on that occasion within a year. It has no such power over state laws, however. Malcolm Turnbull, Australia’s prime minister, who leads the right-wing Liberal Party, says he would not have voted for Victoria’s law. But Mr Owler is confident it will become a “blueprint” for change elsewhere in Australia.
Guernsey considers whether to legalise assisted dying
Coming out in favour could put the island on course for a constitutional clash with Britain
PEOPLE used to joke, “Welcome to Guernsey, please put your watch back 50 years,” recalls Tony Lee, who moved to the island in the 1970s to work as a doctor. The British crown dependency off the coast of France, formerly part of the ancient duchy of Normandy, is a conservative place (its politics are characterised by “inertia”, notes one politician). Only in 2015 did all shops gain the right to trade on a Sunday, for instance, and its narrow lanes are dotted with churches. All this makes it an unlikely location for the trailblazing introduction of a controversial policy.
Nevertheless, in May the island’s parliament, the States of Deliberation, will vote on whether to legalise assisted dying. If its 40 members come down in favour, a working party would examine issues like whether to restrict the right to those with terminal illnesses, and how doctors’ approval might work, before returning with a fleshed-out proposal in 18 months. Such a vote would set Guernsey on the path to becoming the first place in the British Isles to legalise assisted dying—and, in doing so, raise thorny constitutional questions.
Why David Goodall, 104, Renowned Australian Scientist, Wants to Die
David Goodall, 104, an accomplished Australian scientist, isn’t terminally ill, but he wants to die.
Mr. Goodall says his quality of life has deteriorated so badly that he has no reason to live, and he would like to end his life through assisted suicide. But he can’t do it in his own country, where the practice is banned.
So on Wednesday, he took what was expected to be his last flight, bound for Europe, to accomplish his goal — and his quest has renewed a debate in Australia about the right to end one’s life and what role others should play.
Mr. Goodall left his home in Perth to fly to an assisted-dying agency in Basel, Switzerland, a country where assisted suicide has been allowed for decades.
Though nations like Belgium, Canada, Colombia, Luxembourg and the Netherlands (along with some American states and the District of Columbia) permit euthanasia or assisted suicide, Switzerland is the only country with centers that offer assisted-suicide services to foreigners if the person assisting acts unselfishly.
Was a Scientist’s Death Murder or an ‘Act of Mercy’?
Then, one evening this month, Ms. White was found dead. She was 92. Several days later, her daughter was charged with murdering her.
The accusations have stunned people who knew Ms. White and her family, as well as Bundanoon, the small town where neighbors remembered an attentive daughter who would take her mother to the salon for haircuts and stop in the cafe across the street. Many insist that whatever happened must have been motivated by compassion and love.
“It would have been done as an act of mercy,” said Jenny Goldie, a friend who had known Ms. White for 30 years. “There wouldn’t have been any malice attached to it at all.”
The case has saddened and confused Ms. White’s friends. But it has also tapped into the broader debate in Australia over euthanasia and assisted dying, which has been renewed in recent weeks as Parliament considered a proposal to overturn a two-decade-old ban on the practice in the nation’s territories.
The legislation ultimately failed, but last year, the state of Victoria became the first in Australia to legalize assisted dying, allowing someone with an incurable illness and limited life expectancy to obtain a dose of a lethal drug, and other states are considering their own legislation. (The Victoria law requires that a patient be mentally sound enough to make the request on his or her own, preventing relatives or caretakers from applying on an ill person’s behalf.)
I am not a doctor. I am not very brave. But I want to do what she wants.
Lung cancer is a frightening illness. In its final stages, it can make you feel as though you’re drowning, or suffocating. A formidable pharmacological stew of medications can help to suppress the symptoms, but no pill can take away the pain of waking up each day and remembering all over again that you are about to die.
I know what I’m supposed to do, because she has told me many times. One of the stories passed down as gospel in our tiny family is about how my late father, a doctor, helped his own mother — my grandmother Cecilia, whom I never met — at the end of her life. Her cancer was unbearable. “So he gave her a big dose of morphine to stop the pain,” my mother has always told my brother and me, as if reaching the end of a fairy tale. “It had the side effect of stopping her heart.”
As it happens, I have a big dose of morphine right here in the house. I also have some hefty doses of codeine, Ambien, Haldol and Ativan that I’ve cunningly stockpiled from the hospice service, like a squirrel hoarding for winter. In my top drawer, next to Mom’s passport, are more than 100 micrograms worth of fentanyl patches — enough to kill her and several passers-by.
But I am not a trained assassin. I am not a doctor. I am not very brave. I’m just a person who wants to do the most important thing that her mother has ever asked of her. I’m also a resident of New York State, where assisted suicide is illegal.
British doctors move to end their opposition to assisted dying
But the circumstances have provoked accusations of a stitch-up
IN THE HALF-MILLENNIUM since it was founded the Royal College of Physicians has seen plenty of squabbles, including the storming of its building in the 18th century over its exclusion of non-Oxbridge graduates, and a long battle over whether to admit women (which, after four centuries, it did). The latest row is over one of the most fundamental medical questions of all: should doctors help willing patients to die?
The college is surveying its 35,000 members on whether to back changes to the law on assisted dying, which is illegal in Britain. Five years ago 44% of them voted against and 25% in favour (the rest were neutral). Under the rules then, the plurality of votes against changing the law was enough to carry the day. This time, the college has decided that a supermajority of 60% is needed for either side to win. Since neither the pro nor anti doctors are expected to reach this threshold, the organisation looks likely to default to a neutral stance.
Aid in Dying Soon Will be Available to More Americans. Few Will Choose It.
By October, more than one in five U.S. adults will be able to obtain lethal prescriptions if terminally ill. But for those who try, obstacles remain.
On Aug. 1, New Jersey will become the eighth state to allow doctors to prescribe lethal medication to terminally ill patients who want to end their lives. On Sept. 15, Maine will become the ninth.
So by October, 22 percent of Americans will live in places where residents with six months or less to live can, in theory, exercise some control over the time and manner of their deaths. (The others: Oregon, Washington, Vermont, Montana, California, Colorado and Hawaii, as well as the District of Columbia.)
But while the campaign for aid in dying continues to make gains, supporters are increasingly concerned about what happens after these laws are passed. Many force the dying to navigate an overly complicated process of requests and waiting periods, critics say.
And opt-out provisions — which allow doctors to decline to participate and health care systems to forbid their participation — are restricting access even in some places where aid in dying is legal.
Teen Rape Survivor Who Requested Euthanasia Ends Her Life
Newser — Jenn Gidman
"After years of struggling and fighting, it's over." So reads a Dutch teen's "sad last post" Saturday on her Instagram account, noting she'd stopped eating and drinking and would soon be free from "[unbearable] suffering." The Washington Post reports on the right-to-die case of 17-year-old Noa Pothoven, who suffered from PTSD, depression, and anorexia after being sexually assaulted at age 11, then raped at 14.
Noa's sister confirmed her death Sunday, with the Australian reporting Noa died at her Arnhem home after saying goodbye to family and friends. Noa wrote that her decision wasn't "impulsive," made only "after many conversations and assessments." It's not clear whether Noa had the help of any doctors in dying.
Noa kept her sexual assaults secret for years from her parents out of "fear and shame," per an autobiography she wrote; her mom finally found out what she'd been through when she found goodbye letters Noa had written.
Noa had sought doctors' assistance last year at the Hague's end-of-life clinic, without her parents' knowledge, and was rejected. Her mom and dad had hoped she'd change her mind: Her father told a Dutch paper they wished Noa would "see bright spots [in life] again, perhaps fall in love or learn to discover that life is worth living," per the New York Post. In the Netherlands, which legalized euthanasia in 2001, kids as young as 12 can seek assisted suicide, though until they're 17 they need a parental OK and, like all euthanasia seekers, must demonstrate "hopeless and unbearable suffering." In the US, seven states and the District of Columbia permit assisted suicide, though patients have to take life-ending drugs themselves; New Jersey is set to join that list starting Aug.
This article originally appeared on Newser: Teen Rape Survivor Who Requested Euthanasia Ends Her Life
On assisted suicide, the slope is proving every bit as slippery as feared
When, in 2015, the Supreme Court of Canada struck down the section of the Criminal Code forbidding assisting suicide, it overturned not only the law but its own previous ruling, in the celebrated 1993 case of Sue Rodriguez.
Courts are usually loath to do this: Under the legal doctrine of stare decisis, they are generally bound to follow precedent. However, the court found “the matrix of social and legislative facts” surrounding the 2015 case, known as Carter v. Canada, had changed so dramatically since the Rodriguez case as to justify it in taking the opposite approach.
For whereas the court had been persuaded, in Rodriguez, that an absolute prohibition on the practice was necessary to prevent a more general erosion of the taboo against taking human life, by 2015 it felt confident in setting aside this concern. The potential threat to vulnerable people, whether through error, coercion or systemic prejudice, could be averted by “a carefully designed and monitored system of safeguards.”
Evidence of widespread evasion of such safeguards in Belgium and the Netherlands, where assisted suicide had previously been legalized, was dismissed as “anecdotal,” while the widening of its application in those countries, from the consenting adults originally envisaged, to children and the mentally ill, was waved away as the product of a different “medico-legal culture.” In essence, the court said, it can’t happen here.
This was not just an incidental point. This was central to the court’s reasoning, the thing that allowed it to ignore the precedent set in Rodriguez. Legalizing assisted suicide, relaxing the prohibition in place for centuries in virtually all Western countries, need not open the floodgates, as feared. It could be limited to consenting adults, of sound mind, in the last agonizing stages of a terminal illness – the sorts of people who had come before the court in Carter and Rodriguez, the sorts of cases that had moved the public to support their cause.
Yet here we are, in 2020, considering whether to legalize assisted suicide for non-terminal cases, for the mentally ill, even for children – sorry, “mature minors.” The government has launched a two-week public consultation exercise on these and other issues, with legislation likely to follow later in the year. The slope has in fact proved every bit as slippery as the critics had warned.
Indeed, the court itself began the process. All of the evidence before it had concerned those in unbearable physical pain – and not only pain but incapacity, such as to require the assistance of another to end their lives. The court noted the “cruel choice” faced by those who, while still physically capable of killing themselves at present, might not be so in future, as the disease progressed. Assisted suicide was thus presented as, oddly, a way of prolonging life, rather than shortening it, allowing patients to have others do later what they would otherwise be forced to do themselves, earlier.
And yet in its decision, the court opened the doors to assisted suicide, not merely in cases of physical but also psychological pain. There was no necessity that the illness be terminal, or incapacitating: only that it be a “grievous and irremediable medical condition” that imposed suffering that was “intolerable to the individual.”
Hardly had the decision been issued, moreover, when the clamour went up to further loosen the law. Federal legislation, drafted in response, that included a requirement that the patient’s “natural death has become reasonably foreseeable,” was assailed as unconstitutional, as a Quebec court eventually ruled – the ostensible reason for the current exercise.
But it was always clear that this was just the start: Even as it was presenting the legislation, the Trudeau government signalled its openness to further liberalization. Which is why the coming review will embrace much more than whether the right to assisted suicide should be restricted to the terminally ill.
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It could not be otherwise. Once you have accepted the logic of legalization – that death is no longer to be viewed as a terrible tragedy, something we should wish if possible to prevent, but as a blessing, a release from suffering we should wish to assist – all else follows.
The notion underlying the court’s ruling, that we could erase or elide certain important moral distinctions – between killing yourself, say, and enlisting others to kill you, or between death by natural causes and death by human intervention – while insisting on a host of others, appealing to the unlimited personal autonomy to decide one’s fate on the one hand while hedging it about with all manner of limits on the other, was always bound to collapse on itself.
Was it really to be imagined that we would extend the right to free themselves, or rather have others free them, from intolerable suffering to adults, but would condemn children to years of unendurable pain? Did we honestly think the courts would continue to restrict assisted suicide to those capable of “consenting” to it – as if mere mental incapacity should be any more of a barrier to those in need of its relief than physical?
We may not have fully realized it at the time, but what we were entertaining when we took our first steps down this road was not the legalization of a previously prohibited practice, but the normalization of it. Which is how assisted suicide passed, almost instantaneously, from criminal, to legal, to mandatory – with doctors and hospitals ordered to provide the “service,” or refer patients to others who will, and at public expense.
Which raises a peculiar irony. If the fundamental premise underlying the court’s ruling in Carter, that the fears to which it had deferred in Rodriguez had proved unfounded, has itself proved unfounded; if the limited, exceptional cases it foresaw have already become widespread and unexceptional (more than 4,000 cases of assisted suicide, 1.1 per cent of all deaths, were reported across Canada in 2018, up from roughly 2,500 the previous year), with whatever limits remain likely to be removed; has the “matrix of social and legislative facts” not changed again? Is there not ample cause for the court to revisit Carter, as earlier it revisited Rodriguez?
The fight over medical assistance in dying in one B.C. community is getting ugly
A couple of months ago, Angelina Ireland was invited to speak at the Bringing America Back to Life conference in Cleveland.
It’s billed as one of the largest gatherings of the Christian right in the world. Ms. Ireland, from Delta, B.C., was asked to recount her experiences as the president of a hospice society that has gained notoriety in this country for its efforts to ban medical assistance in dying (MAID) from taking place in its facility.
Ms. Ireland told her mainly U.S. audience that she was arriving with a warning: What was happening in Canada would soon be showing up in their country. “It’s like a contagion.” But first she wanted to clarify her bona fides. “I’m a wife, I’m a mother, I’m a Catholic, I’m pro-life, I’m pro-family and I’m pro-gun.”
A resumé that won a healthy round of applause from the crowd.
I recently watched her nearly hour-long appearance in mid-March on YouTube. It was quite a performance. The picture she painted of life in this country since the government decriminalized medical assistance in dying in 2016 was frightening. Among the things she declared:
That the legislation has ushered in the “dawn of the death industry.” Ms. Ireland defended her stance against MAID by saying she is president of the “Delta Hospice Society, not the Delta Auschwitz Society.” When the B.C. government threatened to strip the society’s funding if it didn’t offer MAID services, she said, it was effectively an order: “Kill or be killed.”
Ms. Ireland also cautioned her audience that this is coming to the U.S., and they need to start developing strategies to fight it “before they compel you to kill your neighbours and your family – because that’s where we are.”
She said there was legislation being drafted that will make MAID available to not just the elderly, but to the disabled, the mentally challenged and children. She offered up the scenario of parents getting a call from a distraught teenager who’d just broken up with her boyfriend wanting to take advantage of MAID. “This is what’s happening now [in Canada],” said Ms. Ireland, who was an unsuccessful candidate for Maxime Bernier’s People’s Party of Canada in the last election. She characterized what was taking place here as “stone-cold communism” and “cultural Marxism.”
When she was asked by someone in the audience what they could do to help, Ms. Ireland said, “The best thing you could do is vote President Trump back in the next election.”
As we say, Ms. Ireland is at the centre of a debate in Delta over a hospice’s right to deny MAID services. She has organized a special meeting of the society next week in the hopes of altering the organization’s constitution to establish it as a Christian-based body. It would have the rejection of MAID entrenched in its bylaws.
Under the language being proposed, any attempt to overturn that bylaw, once passed, would require consent by 100 per cent of the members – a near impossibility as long as the organization has a prominent base of people supporting the mandate being propagated by Ms. Ireland.
Recently, there have been allegations that the current board has been stacking the membership with supporters ahead of the critical June 15 meeting - while denying membership to others who disagree with the direction the society is taking. Ms. Ireland denies this.
What is taking place at the hospice society is simply wrong. The fact is, while it may be a private institution, it was built with money raised from the broader community. It was always intended to meet the needs of those contributors as well. I doubt many donated hoping that one day the society would be taken over by a closed-minded religious element that imposed its Christian canon on the operation.
The province has promised to cut off the $1.5-million in operating funds that go to the Delta Hospice every year if it doesn’t comply with government policy to offer the services of MAID. If the society persists on its present course, the government could move in and close the facility down — it owns the land on which the facility was built.
In some respects, the province must own part of this dispute. The government has offered MAID exemptions to faith-based facilities. This exemption has been linked to the exclusion offered under the federal legislation to doctors who have a “conscientious objection” to participating in the MAID program.
The B.C. government should rethink this policy. It’s one thing to absolve an individual whose conscience won’t allow them to perform a certain procedure. It’s another to give the same pass to a facility that is supposed to serve a broad, polylithic community.
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