Daily Archives: October 31, 2019

A group of US-based researchers have published a detailed review of Dutch cases of euthanasia for patients with dementia. Their findings show that euthanasia doctors in many cases read in what they think an incapacitated patient would say about receiving assistance in dying.

The study was published in August in the American Journal of Gereatric Psychiatry and reviewed 75 case reports submitted to the Dutch euthanasia review committees between 2011 and 2018. 59 of the cases involved a concurrent request for euthanasia and 16 were based on an advanced care directive.

Concerning the concurrent requests, the study authors state that in some of these cases, the patients past conversations were used to confirm competence to request [euthanasia/assisted suicide]. That is, the validity of a patients decision was determined with reference to past statements rather than standard competency tests.

The authors provide an example from a 2014 case report where the physician stated:

[the] patient was not competent at [the time of her evaluation] but she had been until recently. Her desire for euthanasia had been so consistent lately that the reduced competence should not be a stumbling block....

The Dutch regional euthanasia review committees appear to condone this approach, having stated that patients can be competent even when they are unable to present supporting arguments for their request.

The study authors, however, claim that this approach could be problematic as it is based on the potentially confusing process of trying to verify and interpret a patients past statements about euthanasia. It also runs afoul of the idea of informed consent, asvalid consent had not been obtained from many of the patients who were euthanised.

The study authors, furthermore,found significant problems with euthanasia advance care directives. The authors write that advance euthanasia directives often included trigger criteria that could make their implementation difficult, such as losing her dignity.

Furthermore, even when a clearer trigger criterion (e.g., admission to a nursing home) is met, advance euthanasia directives only speak to the voluntary and well-considered criterion and the physicians must still assess the patient is experiencing unbearable suffering. Indeed, the euthanasia review committees have stated that admission to a nursing home is insufficient to meet the unbearable suffering criterion in Dutch euthanasia law.

Xavier Symons is deputy editor of BioEdge

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Researchers cast spotlight on euthanasia for dementia in the Netherlands - BioEdge

The World Medical Association (WMA) has reaffirmed its long-standing policy of opposition to euthanasia and physician-assisted suicide.

After an intensive process of consultation with physicians and non physicians around the world, the WMA at its annual Assembly in Tbilisi, Georgia, adopted a revised Declaration on Euthanasia and Physician-Assisted Suicide.

This states: "The WMA reiterates its strong commitment to the principles of medical ethics and that utmost respect has to be maintained for human life. Therefore, the WMA is firmly opposed to euthanasia and physician-assisted suicide."

It adds: "No physician should be forced to participate in euthanasia or assisted suicide, nor should any physician be obliged to make referral decisions to this end.

"Separately, the physician who respects the basic right of the patient to decline medical treatment does not act unethically in forgoing or withholding unwanted care, even if respecting such a wish results in the death of the patient."

The revised Declaration defines euthanasia as "a physician deliberately administering a lethal substance or carrying out an intervention to cause the death of a patient with decision-making capacity at the patients own voluntary request."

It says that physician-assisted suicide "refers to cases in which, at the voluntary request of a patient with decision-making capacity, a physician deliberately enables a patient to end his or her own life by prescribing or providing medical substances with the intent to bring about death."

WMA Chair Dr. Frank Ulrich Montgomery said: Having held consultative conferences involving every continent in the world, we believe that this revised wording is in accord with the views of most physicians worldwide."

* World Medical Associationhttps://www.wma.net/

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World Medical Association reaffirms opposition to euthanasia and physician-assisted suicide - Ekklesia

By Peter Wilson*

Analysis: MPs vote to hold a referendum on voluntary euthanasia, the government strikes a deal with farmers and the Greens change their minds on counter-terrorism legislation.

Politicians in the news this week included clockwise from top left: Louisa Wall, Mark Patterson, Andrew Little and Scott Simpson. Photo: RNZ

MPs voted 63-57 on Wednesday to hold a referendum on David Seymour's End of Life Choice Bill after NZ First left them with no choice but to hand the decision to the voters.

The voluntary euthanasia bill still has to pass its third reading, and if it does, the referendum on whether it should become law will be held at the same time as next year's general election.

It will almost certainly get through. The bill had solid majorities on its first and second readings - 76-44 and 70-50 - and is now assured of NZ First's backing.

During Wednesday's debate NZ First's Mark Patterson laid his party's position on the line - all nine MPs would vote against the bill at its third reading unless Parliament agreed to put it to a referendum.

Many of the bill's supporters opposed a referendum but felt they couldn't risk it being defeated if they ignored NZ First's ultimatum. One was Prime Minister Jacinda Ardern, who said on Monday she would consider supporting a referendum if that was the only way to get the bill through. On Wednesday she voted in favour.

Labour MP Willie Jackson agonised over it and finally decided: "I don't want to be the one vote that stops it all".

Labour MP Willie Jackson voted in favour of the End of Life Choice Bill at its second reading in Parliament. Photo: RNZ / DOM THOMAS

His caucus colleague, Louisa Wall, couldn't bring herself to vote for a referendum. "My principles will not let me vote for a referendum - even if it means the bill fails," she said.

Mr Patterson explained his party's stance as "a matter of absolute principle". It was a familiar tactic from NZ First, which also insisted on holding a referendum on the legalisation of cannabis.

It means voters will be faced with two referenda on election day next year as well as having to choose the government.

The Dominion Post sees that as a problem. "This is a crowded menu of hotly disputed moral and social issues," the paper said in an editorial today. "The danger for the government is that its attempts to explain a first term that has so far failed to dazzle the wider voting public will be drowned out by conservative lobbyists and single-issue interest groups, as well as a National opposition embracing a populist mode and an NZ First that will be desperate to amplify differences between itself and Labour."

The government announced yesterday it had struck a deal with farmers that means they have until 2025 to work out a pricing mechanism for greenhouse gas emissions. They will work with the government on that, as well as on finding ways to reduce on-farm emissions.

Environmentalists accused ministers of giving in to the farming lobby, and the agreement is well short of Labour's pre-election pledge to bring agriculture into the Emissions Trading Scheme.

If the pricing mechanism can be successfully worked out, separate from the ETS, the farmers won't have to go into the scheme at all.

But there is a stick as well as a carrot in the government's approach. If they don't do enough to reduce emissions they could be pulled into the ETS in 2022. The government doesn't want to do that and it's unlikely to happen, but the message is clear - there's no time to waste.

Ms Ardern sold the deal as a win-win "historic consensus" and NZ First leader Winston Peters said his party had listened to the farmers. So far, he hasn't claimed all the credit.

All 11 agricultural sector groups support the agreement and it has important implications for the government's re-election chances. National had been getting ready to grab rural votes on the back of farmer discontent with the government's climate change policies, and that has been swept away.

The opposition didn't seem to know how it should react. It couldn't attack the government for reaching an agreement favoured by farmers and it couldn't say the terms were unfair. So it has decided to wait and see the fine print in the legislation that will be brought to Parliament before deciding what to do about it.

Climate change spokesperson Scott Simpson said the government had kicked for touch, but he was pleased to see it was finally beginning to deal with farmers instead of dealing to farmers.

The bill will set out the timeline and carry a provision that farmers will be taxed on their emissions if the 2025 deadline for a pricing mechanism isn't achieved.

Prime Minister Jacinda Ardern is hailing the government's deal with farmers as a "historic consensus" while National is biding its time until it sees the fine print of the legislation. Photo: RNZ / Dom Thomas

Another deal struck this week ended Justice Minister Andrew Little's dependence on National to get his counter-terrorism bill through Parliament, which he hadn't liked at all.

The Greens had said they would vote against it and National was demanding changes in return for its support - Mr Little said he was being "dicked around" by the opposition.

So he negotiated with the Greens and gained their backing in return for assurances that human rights would be recognised in the way the bill's measures were implemented.

The bill strengthens police powers to deal with returning foreign fighters, and National believes it doesn't go far enough.

The last-minute deal with the Greens gave Mr Little the numbers he needed and the bill passed its first reading 64-52.

*Peter Wilson is a life member of Parliament's press gallery, 22 years as NZPA's political editor and seven as parliamentary bureau chief for NZ Newswire.

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Week in politics: Voters will get the final say on voluntary euthanasia - RNZ

The Minister of Justice has plans in place to combat misinformation and manipulation in any campaigns leading up to, potentially, two divisive referendums at next year's election.

Justice Minister Andrew Little Photo: RNZ / Rebekah Parsons-King

That includes a special team within the Ministry of Justice to direct people to information aimed to be as accurate and neutral as possible, and to be on the look-out for any attempts to deliberately mislead the public.

It's the first time core public servants have taken on this role, and they'll have to walk a tightrope between providing credible public information and getting drawn into any partisan debates.

Voters will not only have to choose the government come 2020, but will also have their say on legalising recreational cannabis, and potentially, voluntary euthanasia.

The latter still has to pass its final reading on 13 November. If it does the referendum will be held.

Minister of Justice Andrew Little said the Electoral Commission would look after the nuts and bolts of running the referendums, whereas the justice team would manage the public information, websites, and respond to public queries.

The team would also have a monitoring role, he said.

"That if someone claims to have a highly authoritative piece of research - it is that, not some sort of highly partisan, highly sceptical or dubious piece of information," Mr Little said.

The Electoral Commission would also keep watch so people did not go "so far wide of the mark" that it crossed over into "misinformation".

The debate was prone to "fairly emotional and irrational responses" but should focus on "real facts, real issues" and in the end the electorate would make its choice, Mr Little said.

Officials operate under strict public sector rules that require them to be politically neutral and non-partisan.

Nick Smith. Photo: RNZ / Alexander Robertson

National MP Nick Smith questioned the ability of justice officials to be able to stay within those rules, saying for the most part the government wanted voluntary euthanasia to become law.

"It's really inappropriate for the justice ministry to have this role ... when the Cabinet manual and the State Services Commission is very clear they are there to follow the instructions of the minister and deliver government policy."

Mr Little acknowledged it would be "a very difficult balancing act" for public servants to avoid being seen as pushing one side or the other or being drawn into the debate.

"I think they are very alert to that, I think we have a very good culture in our state sector ... those in this unit in justice providing this oversight are totally aware of how they may be drawn in to answering questions and queries - I'm totally confident they will discharge their public service responsibilities with great care," he said.

The sponsor of the End of Life Choice Bill, ACT leader David Seymour, put his trust in the "wisdom of crowds" to identify misinformation or manipulation when they saw it.

"A massive information campaign, or should I say misinformation campaign, has failed to shift public opinion."

Part of that was many people based their views on personal experience, said Mr Seymour.

"They've seen bad death, and they've said 'when my time comes that's not for me, I want choice' ... it's very difficult to overturn people's heartfelt feelings with Facebook advertising."

Vocal opponent and National MP Maggie Barry said she was still hopeful the Bill would fail its third reading, as many MPs still held concerns about the lack of safeguards.

If the referendum did go ahead, she and others with similar views would continue to point out what they saw as the "dangers of the Bill and its flaws" so people could make an informed decision.

She hoped any election year debate would be conducted in a "civilised way".

An MP's job was to stand up for what they believed, but also to act with sensitivity, Ms Barry said.

"And I don't think either side has exactly covered itself with glory, upon occasion, but that said it's important everyone realises how important this issue is and we get a formula whereby the public can have as thorough as view of this legislation as possible."

But Dr Smith said the name of the legislation was in itself a form of misinformation.

"The 'End of Life' phrase makes it more acceptable to pass ... 'choice' has got a nice, fuzzy feel about it but if you talk about, actually, providing injections of poisons to kill people, you get a very different response."

Mr Little said government websites would feature what he described as "independently prepared information relevant to the issues".

Part of the advertising and marketing campaign would be directing people to those sites.

The government would be "looking out carefully" for signs social media or other platforms were being used to mislead people as had happened in political campaigns overseas, Mr Little said.

"There will be some things claimed in each case that will be highly questionable and and it's a question that in the course of the debate that stuff gets called out, and we do our best to keep the debate clean."

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Plans to combat misinformation in election-year referendum debates - RNZ

Joe Biden speaks at the Iowa Federation of Labor Convention in Altoona, Iowa, August 21, 2019.(Gage Skidmore)

Father Ryan Hilderbrand of Huntingburg, Ind., has a useful thread explaining why Joe Biden was barred from receiving the Eucharist at a South Carolina church on Sunday:

This is formally explicated in the 1983 Code of Canon Law, which states at Can. 915:

Those upon whom the penalty of excommunication orinterdict has been imposed ordeclared, and others who obstinately persist in manifest gravesin, are not to beadmittedtoholycommunion.

Not all of the clergy agreed with Fr. Hilderbrand, however. Jesuit Father James Martin tweeted:

Surely Fr. Martin does not mean to suggest that support for the death penalty for heinous criminals a practice the Catholic Church has supported (and enacted!) in various moments in its history is comparable to supporting the slaughter of unborn children. Neither, one imagines, could he possibly be suggesting that excessive use of air conditioning, or failing to recycle plastic goods, as outlined in Pope Franciss environmental encyclical Laudato Si, are acts of similar moral gravity as a politician publicly supporting abortion rights.

Surely thats not what he means. Right?

Fr. Martin would do well to consider the words of Pope Emeritus Benedict XVI:

Not all moral issues have the same moral weight as abortion and euthanasia. For example, if a Catholic were to be at odds with the Holy Father on the application of capital punishment or on the decision to wage war, he would not for that reason be considered unworthy to present himself to receive Holy Communion. While the Church exhorts civil authorities to seek peace, not war, and to exercise discretion and mercy in imposing punishment on criminals, it may still be permissible to take up arms to repel an aggressor or to have recourse to capital punishment. There may be a legitimate diversity of opinion even among Catholics about waging war and applying the death penalty, but not however with regard to abortion and euthanasia.

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Should Biden Have Been Denied the Eucharist? - National Review

Secretary for Administration and Justice Sonia Chan (center)

The Municipal Affairs Bureau (IAM) will make euthanizing animals its last resort used to prevent animal disease, the bureaus representatives remarked during yesterdays Legislative Assembly (AL) plenary session.

Secretary for Administration and Justice Sonia Chan and the IAMs representatives presented the veterinary disease prevention bill at the AL yesterday. The bill, which was passed in general terms, suggested that the IAM authorize the right to euthanize animals when necessary.

Lawmakers, including Agnes Lam and Sulu Sou, voiced their concerns about euthanasia. The lawmakers mainly asked about the governments measures in strictly implementing the law when animals must be euthanized. Compensating concerned parties after euthanasia was also proposed by lawmaker Leong Sun Iok.

Sulu Sou proposed the government establish laws to regulate vet clinics and vets. Other lawmakers wondered whether the government has already had discussions with animal protection groups and whether or not the governments proposal is supported by these groups.

Replying to the lawmakers questions, Sonia Chan said that the local government is drafting a law bill on vet clinics. She acknowledged the importance of managing and accrediting the sector.

Chan noted that vet clinics must report to the IAM when they record an animal disease case. Animal owners are also obliged to make sure their sick animals receive medical treatment.

Generally speaking, animals received by the IAM will first be sent for isolated observation. During the observation period, the IAM will closely monitor the animals health and other conditions. The IAM will also provide medical treatment to the animals. Euthanasia will be the IAMs last option.

Regarding compensation to interested parties in the animal business, IAM President Jos Tavares said that the bureau provides subsidies to the parties instead of compensation, which means that the money given, while representing a financial loss, is not governmental compensation but a form of help given to the concerned parties.

He also explained that the IAM has detected sick animals in the past, and that some were euthanized, though not killed in a brutal manner.

Lawmaker Mak Soi Kun then indicated that he wishes the government to handle the stray animal problem in Coloane. In his opinion, Coloane has an excessive number of stray animals, in particular stray dogs, which pose a danger to the public.

Many residents have told me that there are increasingly more stray dogs, said Mak.

Replying to Maks comment, the IAM representative said that when stray dogs do not carry diseases, they are passed to local communities for re-homing.

In recent years, on average, the IAM only registered a single-digit number of illegally imported animals.

Besides the animal disease prevention bill, the amendment of the stamp tax bill was generally passed at the Legislative Assembly (AL) yesterday as well. The bill proposed a four- to 10-fold penalty for tax evasion and tax avoidance.

Secretary for Economy and Finance Lionel Leong explained that, in some cases, buildings consisting of small shops engaged in tax evasion and tax avoidance behaviors that caused unfairness to small shops operating inside the buildings premises.

Currently, the penalty for tax evasion and tax avoidance for stamp tax is between 100 patacas and 10,000 patacas, respectively. The government holds that the current amount is rather small compared to penalties related to other taxes, such as the tourism tax.

The amendment mainly proposed simplifying tax payment procedures and increasing the aforementioned penalty.

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Legislative Assembly | Euthanizing animals to be last resort to prevent disease spread - Macau Daily Times