Daily Archives: June 24, 2017

Most NSW doctors and nurses support a controversial medical euthanasia bill headed for Parliament, according to research that could prompt new debateabout the medical fraternity's willingness to accept changes to assisted suicide laws.

A bill, to allow patients to apply for medically assisted euthanasia in specific circumstances when older than 25 (an age when informed consent is deemed reached), will be introduced to the NSW upper house in August for a conscience vote.

About 60 per cent of doctors support the Voluntary Assisted Dying Bill and fewer than 30 per cent oppose it, according to a surveyby market research company Ekas emailed to a database of 4000 NSW doctors it deemed "opinion leaders" and returned by about 500.

A smaller sample of about 100 nurses had support running at 80 per cent in favour of the law reform and opposition at fewer than 10 per cent.

A crowd-funding campaign forAnnie Gabrielides,a motor neurone disease suffererwho has progressively lost her ability to speak and is a euthanasia advocate, paid for the research.

"I'mconsistently hearing from doctors and medical expertsexpressing their sincere support of my campaign, but they're reluctant to speak out," she said.

The results suggest the medical profession and its famously powerful unions, not just Parliament, will be divided when debate on the bill kicks off.

The Australian Medical Association, which opposes changes to euthanasia law, warnedthe research could overstate doctors' support.

"It is likely that doctors with more strongly held opinions are responding to these surveys so caution must be used," AMA NSW president Brad Frankum said.

A national AMA poll of 4000 doctors last year found 50 per cent of doctors believed medical professionals should not be involved in assisted suicide, a spokesman emphasised.

But only slightly less than four in ten said they should, according to a news report.Combined with 12 per cent who neither agreed nor disagreed that left physicians close to evenly splitin some respects.

And anAustralian Doctorpoll of about 370 medicoslast year found about 65 per cent of doctors supported a change to the law on physician-assisted suicide ifstrict conditions, such as patients nearing the end of their lives and suffering "intolerable pain", some of which are mirrored in the NSW proposal, were met. About half told the journal they would be willing to help perform aprocedure.

NSW Nurses and Midwives Association general secretary Brett Holmes said: "The vast majority of nurses support change that enables medically assisted dying. Nurses know patients often choose more drastic means [to medically ending their life] in fear they cannot choose later."

A parliamentary report cited polls from the '90s that found nurses' support for euthanasia reform reached as high as about 75 per cent.

A dozen polls in the past decade hadfound between 75 to 80 per cent of Australians backed medically assisted euthanasia.

Western Sydney anaesthetistAnneJaumeesdoes too after working in palliative care for 15 years: "All their lives they want dignity and patients want that up until the end, too."

The bill is the product of cross-party collaboration and will only allow for applications frompatients expected to die within the coming year and experiencing extreme pain, suffering or incapacitation.

Safeguards proposed included allowing relatives to challenge applications in the Supreme Court,assessmentsby independent doctors and being subject to a 48-hour cooling-off period.

But Maria Cigolionisaid, while proponents arguedthe bill came laden with safeguards, it required no review of what palliative care patients had first sought before applying to end their lives or for alternatives to be suggested.

Overseas safeguards had been loosened so euthanasia could be applied forby people also suffering from psychosocial problems, Dr Cigolioni said.

"Instead of spending money on euthanasia reforms, we should be investing in psychosocial support programs to address suffering."

"People [will hasten the solution of death] when so many other things need to be looked at as the potential cause of that suffering," she said. "Once you change a criminal law [to allow] people to be killed, then [its conditions] can be extended beyond just being terminally ill, [and expand to include] the disabled and the aged and children, as it has in the Netherlands and Belgium."

The state budget last week announced a $100 million increase in funding for palliative care, something experts said would bring levels of NSW services into line with other states.

AMA policy recognises a divergence in doctors' views on euthanasia but it states doctors should not be involved in dispensing treatment that shortens a patient's life.

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Euthanasia survey hints at support from doctors, nurses and division - The Sydney Morning Herald

What do medical students think about euthanasia? A new article in the journal Chest discusses some of the concerns held by the next generation of US medical professionals. The authors of the paper, students from several of the leading medical schools in the country, express grave concerns about the normalisation of euthanasia in end-of-life care.

Commenting on new legislation introduced in US states such as Colorado, the authors remark:

Doctor-patient trust, the authors assert, is founded upon the notion that doctors will commit to doing their best to heal and care for patients and will not intentionally kill those entrusted to their care. The students fear that PAS/E violates the fundamental bond of trust.

Indeed, the authors call upon doctors to return to the original meaning of euthanasia:

The American Medical Student Association currently has a position of conditional support for physician aid in dying.

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Medical students' perspectives on euthanasia - BioEdge

If there is anyone who could be called a patron saint of Dutch euthanasia, it is the psychiatrist Boudewijn Chabot. In 1991 he gave one of his patients, Mrs B, a lethal dose of medication. After accompanying her until she died he reported himself to the police and was subsequently tried. In 1993, the Supreme Court declare that he was guilty of assisting a suicide, but did not punish him and allowed him to keep practicing medicine.

Physically, there was nothing wrong with Mrs B. Nor did she have depression. But her personal life was tragic and Dr Chabot felt that she in a state of existential distress that she should be allowed to die. It was a landmark case in the steady advance towards legalisation in 2002.

That was 25 years ago. Now Dr Chabot looks back and is horrified. Writing in one of the leading Dutch newspapers, NRC Handelsblad, he says that legal safeguards for euthanasia are slowly eroding away and that the law no longer protects people with psychiatric condition and dementia.

The Dutch are complacent about their famous law, he says. But there is no room for complacency.

Under current legislation, euthanasia is only legal if a doctor believes that three conditions have been met: (1) the request must be voluntary and deliberate; (2) there must be unbearable suffering with no hope of improvement; and (3) there must no reasonable alternative to euthanasia.

However, as euthanasia has sunk its roots deeper and deeper into Dutch medicine, the second and third conditions have shrivelled up. Patients define what is unbearable and they define what is a reasonable alternative. Unhappiness can be unbearable and a nursing home may not be a reasonable alternative. So, as one ethicist has observed, requirements (2) and (3) add little to the requirement of a voluntary and thoughtful request. Autonomy has trumped medicine. As a result, the number of euthanasia cases roughly tripled between 2007 and 2016, from 2000 to 6000.

In itself, this does not bother Dr Chabot. After all, he is the Grand Old Man of Dutch euthanasia. He says that he is prepared to accept tens of thousands of euthanasia cases. But he is aghast at the rapid rise in the number of people with psychiatric illness or dementia who have been euthanised:

What does worry me is the increase in the number of times euthanasia was performed on dementia patients, from 12 in 2009 to 141 in 2016, and on chronic psychiatric patients, from 0 to 60. That number is small, one might object. But note the rapid increase of brain diseases such as dementia and chronic psychiatric diseases.More than one hundred thousand patients suffer from these diseases, and their disease can almost never be completely cured.

One sign of the changing times is the rapid expansion of the services of the End of Life Clinic Foundation (Stichting Levenseindekliniek). This organisation offers euthanasia to patients whose own doctors have refused. They never offer to treat the underlying illness, whether it is physical or mental.

By 2015, a quarter of euthanasia cases on demented patients were performed by these doctors; in 2016 it had risen to one third. By 2015, doctors of the End of Life Clinic performed 60 percent of euthanasia cases in chronic psychiatric patients, by 2016 that had increased to 75 percent (46 out of 60 people).

Last year, Dr Chabot points out, doctors from the End of Life Clinic each performed about one euthanasia every month. What happens to doctors for whom a deadly injection becomes a monthly routine? he asks.

Now the End of Life Clinic is recruiting psychiatrists to service the mentally ill and demented. One obvious problem is that there is a shortage of good psychiatric help in the Netherland which tends to take a long time have an effect, in any case because of budget cuts.

Without a therapeutic relationship, by far most psychiatrists cannot reliably determine whether a death wish is a serious, enduring desire. Even within a therapeutic relationship, it remains difficult. But a psychiatrist of the clinic can do so without a therapeutic relationship, with less than ten in-depth conversations? Well

Dr Chabot is deeply sceptical about euthanasia for the demented: we are dealing with a morally problematic act: how do you kill someone who does not understand that he will be killed?.

How? It turns out that sometimes a relative or doctor secretly laces their food or drink with a sedative to make it easier to give them a lethal injection. In one notorious case last year, the sedative didnt work and relatives pinned the terrified woman to the bed while the doctor gave the lethal injection. Dr Chabot was astonished to discover that surreptitious administration of medication has previously occurred, but has never been mentioned in an annual report.

Isnt anyone paying attention to these developments, Dr Chabot asks.

The euthanasia practice is running amok because the legal requirements which doctors can reasonably apply in the context of physically ill people, are being declared equally applicable without limitation in the context of vulnerable patients with incurable brain diseases. In psychiatry, an essential limitation disappeared when the existence of a treatment relationship was no longer required. In the case of dementia, such a restriction disappeared by making the written advance request equivalent to an actual oral request. And lastly, it really went off the tracks when the review committee concealed that incapacitated people were surreptitiously killed.

After surveying the wreckage of the euthanasia law, Dr Chabot concludes bitterly,

I dont see how we can get the genie back in the bottle. It would already mean a lot if wed acknowledge hes out.

Michael Cook is editor of BioEdge. Dr Chabots original article in NRC Handelsblad was translated by Professor Trudo Lemmens, of the University of Toronto Faculty of Law. Excerpts have been republished from his blog with permission.

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A Dutch euthanasia pioneer surveys the wreckage and despairs - BioEdge

A Massachusetts court convicted Michelle Carter of involuntary manslaughter for the death of her boyfriend, Conrad Roy. Roy had obviously been suffering from depression when Carter sent him repeated text messages urging him to go ahead and kill himself. Eventually he complied. He sat in his truck while the cab filled with carbon monoxide. Carters encouragement of Roys suicide, including her instruction to him to get back into his truck, is deplorable. Few would dispute this.

If he had been suffering from metastatic cancer, rather than depression, there are undoubtedly those who would have been praising Carter for her act of compassion. Of course, Carters actions were morally reprehensible, and they would be just as bad had Roy been suffering physically rather than psychologically.

If you agree that Carter lacks moral decency you should take a close look at Connecticut state Rep. Josh Elliott. He has introduced HB 6238, An Act Concerning the Option to Die with Dignity. Elliott, along with his friends at Compassion and Choices, wants to make it legal for Connecticut doctors to prescribe lethal cocktails of medications to patients that are suffering from severe physical pain. Make no mistake; Rep. Elliotts proposal is just as morally corrupt as Carters actions. Physicians helping patients commit suicide, is no better than manipulative, teenaged girls pushing their boyfriends to asphyxiate themselves. Doctors have plenty of means to help patients who are in suffering or in pain. There is no need to engage in euthanasia.

Rep. Elliott should concern himself with our states actual problems, like our current financial situation. Although, if he is like most Democrats, he will probably argue that this bill will help state residents by reducing carbon emissions. Those carbon monoxide suicides really do burn through a lot of fossil fuels.

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Frank J. Mongillo III, M.D.

New Haven

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Letter to the Editor: Connecticut lawmaker wrong to advocate for euthanasia - New Haven Register

Recently the euthanasia lobby attacked Dr Harvey Schipper for comparing assisted dying to the Nazi T-4 euthanasia program. This would not have been a big deal other than that fact that Schipper had been appointed to chair a working group that was to examine Canadas euthanasia law and make recommendations concerning possible extensions to the law.

Catherine Frazee, who is an Officer of the Order of Canada and professor emerita at the Ryerson University School of Disability Studies wrote an article titled: Look into the dark corners of history that was published in the Victoria Times Colonist on June 15. Frazee wrote:

None of Schippers critics disputed the facts upon which his reference was made, nor should they. As historians have chronicled, the Nazi euthanasia program originated when a father in Leipzig petitioned to end the life of his disabled daughter and Adolf Hitler dispatched his personal physician, Karl Brandt, to authorize her death as an act of mercy.

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According to historian Hugh Gallagher, as the story of the little Leipzig girl became known in medical circles, other families sent similar appeals to the Fhrer. It fell to Brandt to make determinations on each of these requests and ultimately to authorize the killing of at least 70,000 people with disabilities pursuant to what the American Holocaust Museum describes as a medically administered program of mercy death.

Frazee then challenges the attack on Schipper:

Schippers recusal as working group chairman will no doubt be applauded by advocates who seek to broaden the availability of assisted death in Canada. Others, such as myself, who know Schipper to be a man of considerable wisdom and integrity, are saddened that the 43-member panel which includes expert advocates on both sides of this debate failed to seize the opportunity to rise above the clamour and reject any suggestion that politics, rather than evidence, would govern their work.

Had they spoken out together, and forcefully, in defence of their colleague, the outcome might have been different.

This is not the first time that a measured and accurate reference to the historical facts of the Nazi euthanasia program has been condemned as strident, distasteful or offensive. It should be the last.

Nothing about medically assisted death is ahistorical. As we review current law and practice, and consider potential expansion to the Criminal Code exemptions that permit Canadian doctors and nurse practitioners to end the lives of certain patients, surely we have the maturity to invite history into the conversation.

Frazee then outlines the reality that people with disabilities have historically faced:

Doctors, at times, have killed. This is fact. Often, when they have killed or harmed, they have not acted alone, but as agents of state authority.

With all of their immense skill and influence, doctors have played indispensable roles in residential schools and asylums in Canada, comfort stations in Southeast Asia, enhanced interrogation facilities at Guantnamo Bay and extermination centres in Nazi Germany.

People with disabilities have suffered violence and harm at the hands of doctors, parents and caregivers. Sometimes, as with Satoshi Uematsu in Sagamihara, Japan, the world has instantly recoiled in horror. Sometimes, as with parent Robert Latimer in Saskatchewan, a court of law might ultimately uphold conviction, but not before public opinion solidifies in support of the perpetrator.

Sometimes, as with Brandt, a nation colludes.

The Nazi Aktion T4 euthanasia program is part of my history as a disabled person. Importantly, its also part of Schippers history as a physician. Those who would forbid us to speak of this history, or police our speech as strident and unwelcome, can only fuel doubt about whether its lessons have been learned.

Frazee concludes by challenging the working groups to examine the extension of euthanasia through the lens of history:

If our federal government is to benefit from the comprehensive reviews it assigned to the Council of Canadian Academies, and if the councils working groups are to gather the evidence Canadians require to guide policy decisions about providing medically assisted death to mature minors, to people with mental illness and to people no longer capable of expressing consent, then the history of euthanasia, and questions arising from the darkest corners of that history, must not be out of bounds.

As Margaret MacMillan, the distinguished Canadian historian, has said: We dont always know best, and the past can remind us of that.

Thank you to Catherine Frazee for setting the record straight.

LifeNews.com Note: Alex Schadenberg is the executive director of the Euthanasia Prevention Coalition and you can read his blog here.

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Disabled Professor: Nazi Euthanasia Program No Different Than Push to Euthanize People Today - LifeNews.com