Tuesday, January 16, 2018

How does assisting with suicide affect physicians?

This article was published by Mercatornet on January 9, 2018.

Ronald W Pies
By Ronald W Pies

Link to the original article.

When my mother was in her final months, suffering from a heart failure and other problems, she called me to her bedside with a pained expression. She took my hand and asked plaintively, “How do I get out of this mess?”

As a physician, I dreaded the question that might follow: Would I help her end her life by prescribing a lethal drug?

Fortunately for me, my mother tolerated her final weeks at home, with the help of hospice nurses and occasional palliative medication. She never raised the thorny question of what is variously termed “medical aid in dying” or “physician-assisted suicide.”

As a son and family member who has witnessed the difficult final days of parents and loved ones, I can understand why support for MAID/PAS is growing among the general public. But as a physician and medical ethicist, I believe that MAID/PAS flies in the face of a 2,000-year imperative of Hippocratic medicine: “Do no harm to the patient.”

Studies point out that even many doctors who actually participate in MAID/PAS remain uneasy or “conflicted” about it. In this piece, I explore their ambivalence.

Assisted suicides

In discussing end-of-life issues, both the general public and physicians themselves need to distinguish three different approaches.

MAID/PAS involves a physician’s providing the patient with a prescription of a lethal drug that the patient could take anytime to end life. In contrast, active euthanasia or “mercy killing” involves causing the death of a person, typically through a lethal injection given by a physician. Finally, the term “passive euthanasia” refers to hastening the death of a terminally ill person by removing some vital form of support. An example would be disconnecting a respirator.

Increasing international acceptance

In the U.S. some form of legislatively approved MAID/PAS (but not active euthanasia) is legal in five states and the District of Columbia. In my home state – following a passionate debate – the Massachusetts Medical Society recently decided to rescind its long-held opposition to the practice. MMS has taken a position of “neutral engagement,” which it claims will allow it to “serve as a medical and scientific resource … that will support shared decision making between terminally ill patients and their trusted physicians.”

In a few countries, MAID/PAS has grown increasingly common. In Canada, for example, MAID/PAS was legalized in 2016. In Belgium and the Netherlands, both active euthanasia and physician-assisted suicide are permitted by law, even for patients whose illnesses may be treatable, as with major depression; and whose informed consent may be compromised, as in Alzheimer’s disease. In the Netherlands, a proposed “Completed Life Bill” would allow any persons age 75 or over who decide their life is “complete” to be euthanized – even if the person is otherwise healthy.

U.S. physician response

Among U.S. physicians, MAID/PAS remains controversial, but national data point to its increasing acceptance. A report published in December 2016 found 57 percent of doctors agreed that physician-assisted death should be available to the terminally ill – up from 54 percent in 2014 and 46 percent in 2010.

Perhaps this trend is not surprising. After all, what sort of physician would want to deny dying patients the option of ending their suffering and avoiding an agonizing, painful death?

But this question is misleading. Most persons requesting PAS are not actively experiencing extreme suffering or inadequate pain control. Data from the Washington and Oregon PAS programs show that most patients choose PAS because they fear loss of dignity and control over their own lives.

Some physicians feel conflicted

Physicians who carry out assisted suicide have a wide variety of emotional and psychological responses. In a structured, in-depth telephone interview survey of 38 U.S. oncologists who reported participating in euthanasia or PAS, more than half of the physicians received “comfort” from having carried out euthanasia or PAS.

“Comfort” was not explicitly defined, but, for example, these physicians felt that they had helped patients end their lives in the way the patients wished. However, nearly a quarter of the physicians regretted their actions. Another 16 percent reported that the emotional burden of performing euthanasia or PAS adversely affected their medical practice.

For example, one physician felt so “burned out” that he moved from the city in which he was practicing to a small town.

Other data support the observation that MAID/PAS can be emotionally disturbing to the physician.

Kenneth R. Stevens Jr., an emeritus professor at Oregon Health and Science University, reported that for some physicians in Oregon, participation in PAS was very stressful. For example, in 1998, the first year of Oregon’s “Death with Dignity Act,” 14 physicians wrote prescriptions for lethal medications for the 15 patients who died from physician-assisted suicide.

The state’s annual 1998 report observed that:

“For some of these physicians, the process of participating in physician-assisted suicide exacted a large emotional toll, as reflected by such comments as, ‘It was an excruciating thing to do … it made me rethink life’s priorities,’ ‘This was really hard on me, especially being there when he took the pills,’ and ‘This had a tremendous emotional impact.’”
Similarly, reactions among European doctors suggest that PAS and euthanasia often provoke strong negative feelings.

Why the discomfort?

As a physician and medical ethicist, I am opposed to any form of physician assistance with a patient’s suicide. Furthermore, I believe that the term “medical aid in dying” allows physicians to avoid the harsh truth that they are helping patients kill themselves. This is also the view of the very influential American College of Physicians.

I believe that the ambivalence and discomfort experienced by a substantial percentage of PAS-participating physicians is directly connected to the Hippocratic Oath – arguably, the most important foundational document in medical ethics. The Oath clearly states:

“I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect.”
In 5th century BC Greece, Hippocrates was something of a revolutionary in this respect. As the classicist and medical historian, Ludwig Edelstein has pointed out some non-Hippocratic physicians probably did provide poisons to their dying patients, in order to spare them protracted suffering. Hippocrates opposed this practice, though he did not believe that terminally ill patients should be exposed to unnecessary and futile medical treatment.

Palliative care specialist Ira Byock has observed that:

“From its very inception, the profession of medicine has formally prohibited its members from using their special knowledge to cause death or harm to others. This was – and is – a necessary protection so that the power of medicine is not used against vulnerable people.”
Indeed, when patients nearing the end of life express fears of losing control, or being deprived of dignity, compassionate and supportive counseling is called for – not assistance in committing suicide.

To be sure, comprehensive palliative care, including home hospice nursing, should be provided to the subset of terminally ill patients who require pain relief. But as physician and ethicist Leon Kass has put it:

“We must care for the dying, not make them dead.”
Ronald W. Pies, Emeritus Professor of Psychiatry, Lecturer on Bioethics & Humanities at SUNY Upstate Medical University; and Clinical Professor of Psychiatry, Tufts University School of Medicine, Tufts University. This article was originally published on The Conversation. Link to the original article.

Monday, January 15, 2018

29 year-old Dutch woman is scheduled to die by euthanasia for psychiatric reasons.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition


Sign the Letter of Hope to Aurelia.


The Netherlands RTL news published an article on yesterday about a 29 year-old healthy woman who was approved for euthanasia for psychiatric reasons. Her euthanasia death by lethal injection is scheduled for January 26. The article states (google translated):
Sarah has no terminal illness, but knows that she will die in twelve days. Surrounded by friends and in her own bed. She opts for euthanasia because of unbearable and hopeless psychic suffering. "I have been so devoured by my psychiatric disorders that I am completely broken." 
Sarah (not her real name) lives in a small town in the east of the country. She struggles with severe psychological problems from an early age. She has borderline, does self-harm, hears voices, has psychoses and is depressed. She has not wanted to live for years. On New Year's Eve, she received permission for euthanasia after a long trajectory. That will happen on January 26, at two o'clock in the afternoon.
Sarah, whose real name is Aurelia, is a promoter of euthanasia for psychiatric reasons.

The article points to several factors that have led to her seeking death by euthanasia. 


After her first suicide attempt Aurelia lived in a hospital for 2½ years. She was then incarcerated for 2½ years after setting fire to the apartment building that she lived-in. In prison she spent time in an isolation cell. She said that she got worse in prison.

In early 2017, she agreed to try a new treatment, but she was told that her condition was too complicated.

Aurelia - we want you to live. 

At this moment, your life may seem dark and without a future, but we want you to know that there is help and there are people who want to care for you.

Many people have experienced similar pain and struggles and yet life can change and happiness is possible. Making real choices to live sometimes takes courage.


Sign the Letter of Hope to Aurelia.

The article explains the reality of death by euthanasia (google translated):

"I thought it was very intense, they explain how it works, how it works with the drink, how your body responds, and then they tell you that your body and lips are turning blue and what your body is going to do. And then you're dead, but I was shocked by those words, Blue, Death.

In 40 years of terminal care I've never seen unmanageable suffering.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition



The New Zealand Herald published an excellent article, on January 15, by Dr David Richmond in response to an article promoting euthanasia by Dr Havill.

Havill, a former intensive care specialist and a current euthanasia promoter, stated in his article that people are dying cruel and painful deaths that can only be solved by legalizing euthanasia. 
Richmond responds by stating:
In more than 40 years of medical practice as a physician, geriatrician and terminal care manager, I cared for many dying people. My testimony is that I have never seen a person dying with unmanageable suffering.
Richmond then questions the training Havill has received in pain and symptom management. Richmond continues by recognizing the problem of medical errors.
Even with the best of equipment and testing, inaccurate diagnoses and prognoses are surprisingly common. People have already died and many more will do likewise because of mistakes in the euthanasia procedures including diagnosis.
Richmond continues by challenging Havills' assertion that doctors regularly kill patients already.
If rogue doctors are doing what Dr Havill says they are doing while we have laws that provide maximum penalties for killing, imagine what freedom they will arrogate to themselves if the current laws are weakened?
Richmond then refers to studies proving that euthanasia without request regularly occurs in the Netherlands and Belgium.

The death lobby has no problem with hiding or exaggerating the truth to accomplish their goal. Recently a Swedish citizen contacted the Oregon Health Authority and learned that the definition of "terminal illness" in Oregon does not require someone to be "terminally ill" to be approved for assisted suicide. One more deception by the death lobby.

Friday, January 12, 2018

Netherlands Euthanasia "experts" advocate for child euthanasia - with or without consent.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition



The Journal Pediatrics (January 10, 2018) features an "Ethics Round" article titled: Should Pediatric Euthanasia be Legalized?

The Journal article features comments by proponents and opponents of child euthanasia. The article clarifies that, in the Netherlands, euthanasia is a legal option for children (ages 12 - 18) with parental permission and to newborns, based on the Groningen Protocol, who are younger than one. The Journal article states that these deaths are rare.


It is particularly concerning that the Netherlands "experts" Marije Brouwer, Ma, Els Maeckelberghe, PhD, and Eduard Verhagen, MD, JD, PhD, stated:
We would advise the Minister of Health to consider removing age restrictions from both the Euthanasia Regulation and the Groningen Protocol. This would make euthanasia accessible for competent and incompetent children who suffer unbearably when there is no other way to relieve their suffering. It would show trust in mature minors, parents, and doctors to make the right decisions.
Our advice to remove age restrictions is in line with important Dutch values. We believe in self-determination, as manifested by the voluntary request that initiates the procedure, and in the beneficence of physicians to end unbearable suffering when there are no other options. 
We would cautiously remind the Minister that the group of incompetent patients who also might suffer unbearably is not limited to the age of 12 but encompasses patients of all ages.
Brouwer, Maeckelberghe and Verhagen state that euthanasia should be permitted when a person is incompetent to request death by lethal injection and that the decision should be left to the beneficence of physicians. Choice and autonomy were never centrally important, since the law always gave physicians the power to decide. People with disabilities should be concerned when lethal injection can be done based on the beneficence of a physician.

Euthanasia of incompetent people is not new in the Netherlands or Belgium. A recent study published in the New England Journal of Medicine (NEJM) (August 3, 2017) found 431 terminations of life without request in the Netherlands in 2015. Similar studies indicate that euthanasia without consent is even more common in Belgium.

Christopher Kaczor disagreed with Brouwer, Maeckelberghe and Verhagen. Kaczor states that, based on equality. Kaczor states:
Defenders of the Dutch law permitting intentional killing of infants as well as adults and children 12 years of age and older presuppose an empirical claim: killing a person is “the only escape from the situation” of unbearable suffering. This claim is false. 
Current Dutch law does allow for non voluntary euthanasia of infants, an allowance incompatible with the principles of justice because such infants do not consent to have their lives ended. If all persons are to have equal rights and deserve equal protection of the law, then disabled persons (whether they are infants, children, or adults) deserve the same basic protections from intentional homicide.
The Journal article also features comments from long-time euthanasia promoter, Margaret Battin and opposition is expressed by John D. Lantos.

Dutch journalist, Gerbert van Loenen, in his book - Do You Call This A Life? explains that euthanasia without consent based on beneficence, was part of the euthanasia practice, in the Netherlands, from the beginning. van Loenen, in his book, examines the stories and cultural change that led to the legalization and then acceptance of euthanasia in the Netherlands.

Diabetics are eligible for assisted suicide in Oregon - state officials

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition



On Monday the Euthanasia Prevention Coalition reported on an article written by Fabian Stahle, a Swede who opposes euthanasia. Stahle asked the Oregon Health Authority a series of questions. The answers he received confirmed that "terminal disease" has a wider definition, with respect to the assisted suicide act. 

I then wrote this article on Stahle's research: Hidden problems with the Oregon assisted suicide law uncovered.

The Oregon assisted suicide law "restricts" assisted suicide to people with a “terminal disease” defined as an “incurable and irreversible disease that has been medically confirmed and will, within reasonable medical judgment, produce death within six months.”

On Thursday, Bradford Richardson, wrote the article published in the Washington Times:  Diabetics eligible for physician-assisted suicide in Oregon, state officials say. Richardson confirms that diabetics who refuse treatment may qualify for a lethal prescription under the Oregon assisted suicide law.

According to the report by Fabian Stahle, Richardson states:
The report quotes Craig New, a research analyst at the Oregon Health Authority who studies the Death with Dignity Act, confirming that diabetics are eligible for lethal prescriptions if they refuse treatment and receive a terminal diagnosis. 
“The law is best seen as a permissive law, and states only that patients must have a terminal illness with six months or less to live,” Mr. New said. “It does not compel patients to have exhausted all treatment options first, or to continue current treatment. It is up to the patient and doctor to discuss disease and treatment options. But if the patient decides they don’t want treatment, that is their choice.”
Craig New also said patients who cannot afford medical care may qualify for aid in dying.
“I think you could also argue that even if the treatment/medication could actually cure the disease, and the patient cannot pay for the treatment, then the disease remains incurable,” 
The state’s Death with Dignity Act limits aid in dying to those who suffer from a “terminal disease” and receive a prognosis of six months or less to live. Two physicians must sign-off on the diagnosis and confirm that the patient is capable of making the decision to end his life.
Dr William Toffler, the National Director of Physicians for Compassionate Care told Richardson:
there’s nothing in the law to prevent someone with a treatable condition from refusing medical care in order to obtain a terminal diagnosis and lethal prescription. 
“If you’re a diabetic and you get discouraged and depressed and stop taking your insulin, you’re going to die,” 
“Now, if you go to an assisted-suicide doctor and you say, ‘I’ve got problems with kidney failure, I’ve got problem with pain, I want to exercise assisted suicide,’ you just have to find the right doctor.”
Richardson confirms the accuracy of Stahle's report by interviewing Jonathan Modie, lead communications director for the Oregon Health Authority. Modie states:
the Death with Dignity Act is “silent on whether the patient” must exhaust “all treatment options before the prognosis of less than six months to live is made.” 
“The determination on disease treatment — and, if appropriate, end-of-life care options — is made between the patient and his or her physician,”

Mr. Modie said there is no record of someone with a non-terminal, chronic ailment ever taking advantage of the law.
According to the Oregon 2015 Death With Dignity report, Diabetes is listed under "other illnesses" as a reason assisted suicide.

Dr Toffler responds to Modie's remarks by stating: 

there’s no way to know whether abuses are being committed in Oregon, because state record-keeping is insufficiently specific and all source documentation is destroyed after one year. 
“Now, the diabetic patient may have had renal failure and the doctor put down renal failure — they can choose,” 
“It’s kind of subjective what you put on the death certificate. So the Oregon Health Division wouldn’t know. And what’s more, they couldn’t go back and check because they don’t have the records — they’ve destroyed them.”
Richardson concludes his article by quoting from the conclusion of Mr. Stahle: 
Oregon voters were “deceived” when they approved the ballot measure legalizing physician-assisted suicide. 
“Proponents want to sell the Oregon model along with the assurance that medically-assisted suicide only applies to dying patients where all hope is lost. But it is completely misleading,” Mr. Stahle wrote. “Surely vulnerable people in Sweden and all over the world deserve better than laws with such inherent dangers hiding beneath the surface.”
Wesley Smith wrote an article on Fabian Stahle's research titled: Oregon's Permissive Assisted Suicide Regime that was published on National Review online.

Wednesday, January 10, 2018

Euthanasia and Elder Abuse

The following article was published by HOPE Australia on January 9, 2018

Helen Polley
One of the greatest dangers that we face as Australians, now that euthanasia is legalised in Victoria, is making the elderly feel as if they are a burden on society. There is an obsession in our culture with being young, and the older generations can tend to be neglected. The propagation of euthanasia further demeans the value of the lives of elderly Australians. As Senator for Tasmania, Helen Polley stated:

Voluntary euthanasia cannot promote the dignity or humanity of vulnerable older Australians in an environment in which our elderly feel undervalued, ignored and forgotten. Instead, it further will entrench ageist views, desensitise us to euthanasia and ultimately lead to a devaluation of life and premature death.
Elder abuse is a major concern, with a report last year from the Australian Law Reform Commission recommending detailed study into the prevalence of elder abuse in this country. If an individual is unable to take care of themselves, has reduced decision-making capabilities and/or financial management issues, their vulnerability to be pressured into euthanasia by family members or others responsible for their care increases.

Given that there is currently no robust system that has effectively prevented elder abuse, there is no reason to believe that adequate safeguards can be put in place for euthanasia.

Australia has an aging population; by 2050, more than one in four Australians will be 65 or older, and we need to be making good decisions about how we will treat them in their later years.

We say it often, but the truth remains, Australia needs better palliative care. To quote Polley:

If we want to change the culture of dying we should be looking at our end-of-life care system because it’s brimming with untapped potential but significantly underfunded. People should be able to rest assured knowing the end-of-life care and support they deserve will be there for them. We must not let voluntary euthanasia take the attention and resources away from this.
Under no circumstances should an individual feel the need to opt for euthanasia because they don’t have confidence that they will receive adequate end-of-life care.

Tuesday, January 9, 2018

Oregon's Permissive Assisted Suicide Regime

This article was published by National Review online on January 9, 2018

Wesley Smith
By Wesley Smith

The media have always gone along with the nonsense that assisted suicide and euthanasia laws are governed by strict guidelines to prevent abuse. In actuality, the guidelines–such as they are–are merely to give an appearance of control. 

Since the media has no interest in really investigating how these laws work–meaning, they refuse to do their jobs–the truth often comes out via overseas inquiries of investigators from countries considering legalization. Thus, several years ago, a House of Lords commission uncovered that Oregon death bureaucrats destroy all records used to compile their annual reports–meaning that there can be no effective independent inquiry or investigations. The HoL investigators also learned that the oversight agency has no budget or authority to investigate abuses.
Now, a Swedish citizen-investigator named Fabian Stahle sent the Oregon Health Authority questions about how it interprets the law. The candid responses he received from Craig New, Research Analyst, Oregon Health Authority, Center for Public Health Practice, Public Health Division, are worth publicizing. 

For example, New states that the Authority very liberally construes the law in its regulatory approach. From "Oregon Health Authority Reveals Hidden Problems with the Oregon Assisted Suicide Model" (my emphasis): 
The law is best seen as a permissive law, and states only that patients must have a terminal illness with six months or less to live. It does not compel patients to have exhausted all treatment options first, or to continue current treatment. 
Here’s the thing: Assisted suicide was sold to Oregon voters as exactly the opposite–as a very restricted law that would merely serve as a safety valve when nothing else could be done to alleviate suffering. It was always baloney. 

Stahle asked whether someone would live longer than six months could qualify for assisted suicide if they refuse the medical treatments that kept them from dying: 
I sent the following question to the Oregon Health Authority 
(DWDA.INFO@dhsoha.state.or.us):  
1. In the law, “terminal disease” is defined as an incurable and irreversible disease that has been medically confirmed and will, within reasonable medical judgment (in the opinion of the patient’s attending physician and consulting physician), produce death within six months.  
Is this rule interpreted as “without administration of life-sustaining treatment”?  
Craig New, Research Analyst, Oregon Health Authority, Center for Public Health Practice, Public Health Division, answered the question on 4 December, 2017:  
2A. …your interpretation is correct. The question is: should the disease be allowed to take its course, absent further treatment, is the patient likely to die within six months? (Stahle’s emphasis) 
Stahle specifically asked about diabetes that is treatable (emphasis added): 
3. If a patient with a chronic disease (for instance, diabetes) by some reason decides to opt out from the life-sustaining medication/treatment and by doing so is likely to die within 6 months, thereby transforming the chronic disease to a terminal disease—does he/she then become eligible to take use of the act?  
On 6 December, 2017, Craig New gave the following answers to these questions: A. Interesting questions. While this is not addressed specifically in the law, the answer in both cases is yes—those patients would qualify. 
And get this: Stahle asked whether a patient could qualify for assisted suicide even if a cure was available, or the treatment was unaffordable. Answer: Yes! 
In your two examples, both patients would qualify for the DWDA. Patients suffering from any disease (not just those that typically qualify one for the DWDA) may not be able to afford some treatments or medication, and may choose not to pursue some treatments or take some medication for personal reasons…If the patient does not receive treatment or medication (for whatever reason) and is left with a terminal illness, then s/he would qualify for the DWDA.  
I think you could also argue that even if the treatment/medication could actually cure the disease, and the patient cannot pay for the treatment, then the disease remains incurable (emphasis added). 
That means people who could live decades with treatment, can instead receive assisted suicide in some cases. 

Do I detect a yawn? That’s the problem. 

Once people decide being killed/or receiving lethal prescriptions is worth legalizing, they cease caring much about whether the earnestly made promises of protections against abuse are actually fulfilled. 

Caveat emptor!

Monday, January 8, 2018

Jewish Care Home accuses euthanasia doctor of sneaking in and killing a resident.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Louis Brier Care Home
An Orthodox Jewish Care Home filed a complaint against euthanasia doctor, Ellen Wiebe for sneaking into the Home and killing a resident, which is against the policy of the Louis Brier Home in Vancouver.

According to Susan Lazaruk, of the Vancouver Sun, the Jewish Home stated in its complaint that Wiebe's actions were “borderline unethical.” David Kesselman, CEO of the Louis Brier Home stated:
“It was hidden,” 
“There’s no documentation. She came in and I don’t know who you are. You can tell me you’re a physician, you could tell me you’re an astronaut, how do I know?
Kesselman continued:
“Imagine the implications for our staff and our residents and their families,” 
“We have a lot of Holocaust survivors. To have a doctor sneak in and kill someone without telling anyone. They’re going to feel like they’re at risk when you learn someone was sneaking in and killing someone.”
Kesselman explained that Wiebe was well aware of ethics policy of the home:
He said the home has a defined policy devised by an ethics committee that includes allowing its residents to have a MAiD assessment done at the home. But residents are transferred to a health-care facility for the procedure.
Wiebe admitted to sneaking into institutions to do lethally injection. Susan Lazaruk reported:

Proposed Canadian assisted dying regulations overlook many important details

By Taylor Hyatt
Policy Analyst & Outreach Coordinator, Toujours Vivant-Not Dead Yet

Taylor Hyatt
On December 16 – a year and a half after Canada’s assisted suicide legislation came into effect – Health Canada released its first draft regulations for monitoring the practice. Though they were intended to provide “transparency and [foster] public trust,” the draft of these standards came out of a private “pre-regulatory” process led by Health Canada. We have no way to know the other parties involved, nor whether any of them represented the interests and concerns of people with disabilities…and that is the first of many concerns.

  • No mention is made of oversight of the euthanasia process, or enforcement of safeguards.
  • Breaches of the law “are currently, and would remain, under the purview of local law enforcement…” but we don’t know how information about violations would be referred to legal authorities, or what incentives they might be given to investigate and prosecute. We’ve already seen cases in Québec where euthanasia of ineligible people (who were not “at the end of life” or did not have a “grievous and incurable medical condition”) was not pursued. 
  • The regulations do not include a way to verify whether medical practitioners actually file the necessary reports. This will lead to non-reporting of assisted suicide and euthanasia (AS/E), as happens in the BeNeLux countries. Without reports, law enforcement officials will not know who has broken the law. 
  • As well, the regulations make no provision for tracking the outcome when drugs are dispensed for “assisted suicide.” There is nothing to prevent a third party from giving a lethal dose to a person against their will; without a practitioner or other impartial witness, who would know? The states of Washington and Oregon have little “official” documentation of these deaths, but anecdotal evidence (like the story of Thomas Middleton) shows that such fraud and abuse does happen. There is also the possibility that dangerous substances will be left unattended around the house, subject to theft and resale or accidental ingestion by children. 
  • The regulations do not check doctors’ reports of AS/E against all deaths, so as to verify that all “medically-induced” deaths are accounted for. This technique has been the only effective method for alerting researchers to uncounted “medical killing” in other jurisdictions. 
  • Several words and phrases used in the document are either undefined, or create a standard that is not strict enough. These include: 
“…an indication of whether…” may apply to an “either/or” choice (for example, whether a doctor had a relationship with the person before receiving the request for AS/E) or a multiple-choice proposition (which eligibility criteria were assessed and whether the practitioner believed that the patient met each criterion).

“…to the best of the practitioner’s knowledge or belief.” This phrase is often used with regard to the practitioner’s responsibility to gather demographic data or determine eligibility for assisted suicide. It is a very low standard.

“…if known…” Similarly, adding this caveat at the end of requirements related to prescribing drugs for assisted suicide relieves the practitioner of any responsibility to follow up on the prescription and learn the outcome.
  • No safeguards currently exist to prevent a third party from making a request on behalf of a person who has a communication disability, or who is under the influence of the third party. This loophole in the law could have been closed by the regulations. 
  • There is no mechanism to track the participation of assisted suicide advocates in the process of formulating the request and making the eligibility determination. This could cause a variety of problems. First, the potential exists for the advocacy group to persuade the person that AS/E is the best choice, even if the person is ambivalent. Second, the group may be making money for their services through “donations” or “legacies” made by the person. Finally, advocacy organizations’ participation could have an effect on the process: advocates may be asked to act as witnesses to the signing of the application, and practitioners may begin to pass certain tasks (such as communicating information or documenting the process) onto them. 
  • Demographic information collected is insufficient to determine the role of economic factors in a decision to request assisted suicide or euthanasia. (The proposed regulations require authorities to collect information on whether the person lived in an institution or a private residence, the postal code of the residence, their marital status, and their primary occupation while they worked.) The option to declare one’s “place of residence” does not include a choice for long-term hospitalization or for people who are homeless. Household composition and income, home-ownership (or lack thereof), accessibility of the home, personal assistance and/or mental health needs, date of onset of disability, and illness- and disability-related expenses are all economic factors that can affect the person’s decision to request AS/E. 
  • The Minister of Health proposes an online form including multiple choice answers and yes-or-no checkboxes. While these menus may save time in filling out forms, they risk pigeon-holing people and may give an inaccurate picture of those making the request for AS/E. Narrative answers enable practitioners to describe the unique situation of each person. 
  • The regulations seem to allow the reporting obligation to disappear after 90 days if the request does not result in euthanasia. In order to understand the full scope of the AS/E application process, including situations where requests are withdrawn or candidates are deemed ineligible, it is important that all requests be documented, regardless of outcome. 
  • There is no provision for documenting details of euthanasia deaths – for example, time between injections, onset of coma, time between drug administration and death, complications, and what measures are taken to resolve them. 
  • Finally, the regulations do not say how long the data will be kept. In the states of Washington and Oregon, the data on which the annual reports are based are destroyed once the state reports are published. Destroying the data limits the possibility of both in-depth and long-term analysis. 
These regulations were designed to streamline the administrative portion of the process for professionals at the expense of compiling necessary information. Leaving gaps in our knowledge and enforcement of the AS/E program will reduce the efficacy of safeguards and put lives at risk.

Hidden problems with the Oregon assisted suicide law uncovered.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Link to the article by Fabian Stahle: Oregon Health Authority Reveals Hidden Problems with the Oregon Assisted Suicide Model.

Euthanasia and assisted suicide are being promoted world-wide. Recently the Swedish National Council on Medical Ethics published the report, "Assisted death: A Knowledge Compilation."

Fabian Stahle, a Swede who opposes euthanasia, sent EPC an article revealing the hidden problems with the Oregon Assisted Suicide model. 

Stahle read the Swedish report and noticed a quote from Professor Linda Ganzini, from Oregon, who stated that the six-month expected survival time applies, 
“if no treatment is given to slow down the course of the disease”
Stahle responded to this statement by asking the Oregon Health Authority by email if Ganzini’s comment was correct. Stahle asked:
In the law, “terminal disease” is defined as an incurable and irreversible disease that has been medically confirmed and will, within reasonable medical judgment (in the opinion of the patient's attending physician and consulting physician), produce death within six months. 
Is this rule interpreted as ‘without administration of life-sustaining treatment’?”
Craig New analyst for the Oregon Health Authority responded
“. . . your interpretation is correct. The question is: Should the disease be allowed to take its course, absent further treatment, is the patient likely to die within six months?”
This means that the definition of terminal illness, in Oregon, includes people who will become terminally ill if they refuse effective medical treatment or care.

To clarify the response, Stahle followed up by asking the next two questions:

If the doctor suggests, to an eligible patient, a treatment that possibly could a) prolong life, or b) transform a terminal illness to a chronic illness, or c) even cure the disease—and if the patient doesn't give his/her consent to the proposed treatment is he/she still eligible to take use of the Act? 
If a patient with a chronic disease (for instance, diabetes) by some reason decides to opt out from the life-sustaining medication/treatment and by doing so is likely to die within 6 months, thereby transforming the chronic disease to a terminal disease—does he/she then become eligible to take use of the act?
New responded with the following answer:
“Interesting questions. While this is not addressed specifically in the law, the answer in both cases is yes – those patients would qualify.
Craig New confirms that the language in the Oregon assisted suicide law may have deceived people into thinking that the Oregon law is limited to people who are terminally ill.

Fabian Stahle included more detail in his article. Stahle concluded by stating: 
We need to consider the significantly expanded dimensions as to who qualifies for assisted suicide under the Oregon model. It is definitely not the scenario that is being presented in the polls or propaganda by advocates. Proponents want to sell the Oregon model with the assurance that the offer for medically assisted suicide only applies to dying patients where all hope is lost. But it is completely misleading. Sick people in Sweden and elsewhere deserve something better than laws with such inherent dangers beneath the surface.
Link to the article by Fabian Stahle: Oregon Health Authority Reveals Hidden Problems with the Oregon Assisted Suicide Model.

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