EPC - USA focuses on defeating New York assisted suicide bill.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The assisted suicide debate is growing in New York and EPC-USA has been instrumental in holding back the tide. The assisted suicide lobby is becoming more extreme as Assisted suicide lobby members in New York were arrested for disorderly conduct on Tuesday May 21 as they conducted a civil disobedience protest in the New York Assembly. Clearly the assisted suicide lobby is becoming desperate as assisted suicide Bill A995 and S2445 does not have the necessary support to bring it to a vote.

A recent New York Times article by Erin Nolan and Grace Ashford stated that:

Roughly a decade has passed since the first medical aid in dying bill was introduced in Albany, and it has yet to reach the floor for a vote.

But the proposal has gained momentum this year, because of endorsements from groups like the Medical Society of the State of New York, a trade group of roughly 20,000 doctors, and the efforts of activists like Dr. Netherland, who has a Ph.D. in medical sociology and was diagnosed with Stage 4 breast cancer last year.

Colleen Barry in NY

Some of the concerns of the Euthanasia Prevention Coalition were acknowledged by Nolan and Ashord:

Opponents worry that some patients might choose to end their lives based on an inaccurate prognosis or after being pressured to do so. And while the current bill is restricted to terminally ill people, they worry that lawmakers could expand eligibility for medical aid in dying after any initial legislation is passed.

“Even if there is just one case of abuse or coercion, or even if there is just one mistake, that is a dead person,” said Colleen Barry, a nurse and board member of Euthanasia Prevention Coalition USA.

Nolan and Ashford recognize that the American Medical Association opposes assisted suicide and defines it as “​​fundamentally incompatible with the physician’s role as healer.” but the article, which is supportive of assisted suicide, emphasizes that the New York Medical Association has now endorsed the assisted suicide bill.

We knew that the New York assisted suicide lobby was in trouble last December, when Assemblywoman Amy Paulin, who is the sponsor of Assembly Bill A0995 stated on a video (starting at 18:40) that 'they need to get the assisted suicide bill passed first and then amend it later.'

Paulin, who has sponsored the New York assisted suicide bill since 2016, crafted the assisted suicide bill to appear to be tighter than previous bills. She acknowledges that once legalized she will push to have the legislation expanded.

Nearly every state that has legalized assisted suicide have also expanded their legislation.

EPC continues to actively oppose assisted suicide in New York.

American Medical Association retains opposition to assisted suicide

This article was published by National Review online on Nov 14, 2023.

By Wesley J Smith

Wesley Smith

I am a frequent critic of the medical establishment. But not this time. It didn’t make much news, but the American Medical Association had another vote to repeal its existing policy against assisted suicide, and for the fourth time — good on them — the delegates refused to budge.

The current policy remains in place, which states in part:

Euthanasia is fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks.

Euthanasia could readily be extended to incompetent patients and other vulnerable populations.

The involvement of physicians in euthanasia heightens the significance of its ethical prohibition. The physician who performs euthanasia assumes unique responsibility for the act of ending the patient’s life.

Instead of engaging in euthanasia, physicians must aggressively respond to the needs of patients at the end of life. Physicians:
(a) Should not abandon a patient once it is determined that a cure is impossible.
(b) Must respect patient autonomy.
(c) Must provide good communication and emotional support.
(d) Must provide appropriate comfort care and adequate pain control.

The AMA also refused to change the descriptive and accurate term “assisted suicide” to the euphemistic “medical aid in dying.”

Article: American Medical Association maintains opposition to assisted suicide (Link). 

American Medical Association maintains opposition to assisted suicide

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Great news: The American Medical Association (AMA) upheld their opposition to assisted suicide and euthanasia.

This is a huge win as AMA delegates voted down the attempt to change the code of ethics to support or become neutral on assisted suicide and they voted down the attempt to change terminology from assisted suicide to Medical Aid in Dying (MAiD). 

The take home message is that medical professionals, young physicians and medical students must be involved in the AMA.

On October 10, the Euthanasia Prevention Coalition (EPC) were the first group to report that the AMA would be debating their policies on assisted suicide and euthanasia at the AMA House of Delegates interim meeting in Maryland (November 10 - 14, 2023).

50 draft resolutions were proposed with two of the draft resolutions dealing with assisted suicide and euthanasia.

• Resolution 4 proposed to change the position of the AMA from opposition to supporting (Resolution Link).
• Resolution 5 was for the AMA to adopt a neutral stance. (Resolution Link).

Resolution 4 would have  removed the AMA statement on not performing euthanasia or participating in assisted suicide. Both resolutions proposed to change the terminology from Physician-Assisted Suicide to Medical Aid in Dying (MAiD). The term Medical Aid in Dying includes assisted suicide and euthanasia.

Thank you to the many medical professionals who responded to the alert and worked to defeat Resolutions 4 and 5.

American Medical Association (AMA) is debating assisted suicide and euthanasia.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The American Medical Association Policy 5.7 on assisted suicide currently states:

Physician-assisted suicide is fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks.

Instead of engaging in assisted suicide, physicians must aggressively respond to the needs of patients at the end of life.

Physicians:

• Should not abandon a patient once it is determined that cure is impossible.
• Must respe∘ct patient autonomy.
• Must provide good communication and emotional support.
• Must provide appropriate comfort care and adequate pain control.

At the Interim meeting of the AMA House of Delegates on November 10 - 14, 2023 in Maryland, 50 draft resolutions will be debated. Two of the draft resolutions will concern assisted suicide and euthanasia.

• Resolution 4 is to change the position of the AMA on Medical Aid in Dying (Resolution Link).
• Resolution 5 is for the AMA to adopt a neutral stance on Medical Aid in Dying (Resolution Link).

It is important to note that Resolution 4 would remove the AMA statement on not performing euthanasia or participating in assisted suicide:

Physicians must not perform euthanasia or participate in assisted suicide. A more careful examination of the issue is necessary. Support, comfort, respect for patient autonomy, good communication, and adequate pain control may decrease dramatically the public demand for euthanasia and assisted suicide. In certain carefully defined circumstances, it would be humane to recognize that death is certain and suffering is great. However, the societal risks of involving physicians in medical interventions to cause patients' deaths is too great in this culture to condone euthanasia or physician- assisted suicide at this time.

Both resolutions use the term Medical Aid in Dying (MAiD) rather than Physician Assisted Suicide. The term Medical Aid in Dying is not limited to assisted suicide, it also includes euthanasia. The assisted suicide lobby wants to legalize euthanasia (medical homicide) in America.

Both resolutions need to be vigorously opposed. The assisted suicide lobby likely introduced both resolutions to create the impression that Resolution 5 (adopting a neutral stance on Medical Aid in Dying) is a compromise resolution, whereas, both resolutions will effectively lead to the same outcome.

Normalizing Organ Harvesting after Euthanasia.

This article was published in the National Review online on May 26, 2021

Wesley Smith

By Wesley J Smith

In 1993, my first ever anti-euthanasia column warned in Newsweek that once euthanasia became accepted widely, it would be followed by organ harvesting “as a plum to society.” By now, you know how that story goes. I was accused of alarmism, slippery-slope advocacy, conspiracy theories, etc., etc. And, as these kind of stories nearly always end, it came to be — in Canada, Netherlands, and Belgium, with more likely to follow over time.

Now, organ harvesting after euthanasia has become so normalized within the medical intellegentsia, that an American Medical Association publication, JAMA Surgery, had a letter debate — not about the propriety of killing and harvesting, but about whether the kill should begin at home or in a hospital.

Two doctors say that “organ donation after euthanasia starting at home” (ODEH) is the way to go:

The patient is only sedated at home, which marks the start of euthanasia in legal terms but is medically only intended to remove consciousness while vital functions are maintained and secured. Coma induction and the start of the agonal phase [killing] subsequently take place in the intensive care unit after farewells at home and transportation [to the hospital].

Their debaters says, no, start the homicides in the hospital:

A guideline for ODEH should be developed, including instructions for physicians on how to act if the condition of the patient deteriorates during transport. In the ODEH case presented by Mulder and Sonneveld, noradrena line was given to maintain adequate blood pressure during transport to the hospital. This could be interpreted as violation of an important principle of organ donation after euthanasia, namely that the euthanasia and organ donation should be at all times handled as 2 separate entities.

No one says — don’t do it!

But I will. Some of these patients (in Belgium and Netherlands) are not physically sick, but mentally ill. Believing that their deaths are more valuable than their lives — because of the lives potentially saved by their organs — could easily become the tipping point for some of these anguished patients to decide to be killed. Note: These are people who would otherwise live for years.

In other words, organ donation could be an inducement to euthanasia. That could also be true of disabled patients who are the other prime cadre of ODE targets because they have “good organs.”

Moreover, in Ontario, Canada, the organ donation society is told in advance by doctors of a planned euthanasia, and representatives call the patient/family to ask for their organs! It’s almost out of a Monty Python skit, “Hello, can we have your liver?”

No, of course suicide prevention is not offered! That might get in the way of suffering people agreeing to be transformed into so many natural resources.

Five Reasons to Oppose Euthanasia and Assisted Suicide

There are many reasons to oppose euthanasia and assisted suicide (also known as Assisted Death or MAiD). Here we focus on five key reasons. 

(Link to a printable PDF version of this article)

1. Assisted death should be opposed because it involves causing a person’s death (killing).

Laws permitting MAiD give medical practitioners the right to cause a person’s death. Society should never allow one person to legally kill another.

In Canada, the Netherlands, Belgium and Luxembourg, assisted death is done by euthanasia.

Euthanasia is intentionally injecting a person with a combination of lethal drugs. In most countries euthanasia is prohibited under murder or homicide laws.

In the United States and Switzerland, assisted death is done by assisting a person’s suicide. This is when a doctor prescribes a combination of lethal drugs that the person self-ingests.

Euthanasia and assisted suicide involve another person, usually a doctor, who directly kills or is involved with causing the death of another person.

Those who promote assisted death focus on the difficult life conditions that lead to someone to requesting death. They argue from a situational ethics’ standpoint to justify killing, an act which is normally considered to be universally wrong.

Assisted death is sold as healthcare. In an interview, psychiatrist and ethicist Mark Komrad said:

“If you were just to replace the image of the needle or the pill with a gun, I think that would make a much more vivid picture of something that would be transculturally wrong.”(1)

People go through difficult physical or psychological conditions but these human experiences must not be exploited to justify killing. Providing proper care and support is the appropriate response.

2. Assisted death should be opposed because “safeguards” only protect the medical practitioner; they do not protect vulnerable people.

Assisted death laws are designed to protect the medical practitioner who is willing to cause death. These laws do not provide effective oversight and protection for the person who is being killed. These “safeguards” are designed to sell the legalization of assisted death to politicians who have concerns about killing, but they include exceptions that are wide enough to drive a hearse through.

The State of Oregon was the first jurisdiction to legalize assisted death in 1997.(2) The assisted suicide lobby did not reduce the safeguards in the law because they wanted to convince other jurisdictions that there is no “slippery slope”. However, in 2019, the assisted suicide lobby announced that the problem with assisted suicide laws is the restrictions. That year the Oregon legislature removed the 15-day waiting period.(3)
 
The euthanasia lobby alleges that the Netherlands have not changed their euthanasia law since it was passed in 2002. This is inaccurate: the language of the Netherlands’ euthanasia law has not changed but the interpretation of the law has changed. The most recent example is the extension of euthanasia to include incompetent people with dementia.(4)

Canada is a prime example of a country where safeguards lack effective definition or meaning. For instance, Canada’s euthanasia law required that a person’s “natural death be reasonably foreseeable”. However, the meaning of this phrase was not defined(5) and, consequently, the application of the law varied. In September 2019, a Québec Superior Court decision struck this requirement from the law.(6)

Canada is also a prime example of how a euthanasia law incrementally expands. Canada passed its assisted death law in June 2016. In February 2020, Parliament introduced Bill C-7 to expand the law by eliminating the waiting period, permitting euthanasia of an incompetent person who requested an assisted death in advance, and eliminating the terminal illness requirement.(7)

Safeguards in assisted death laws are designed to politically sell killing. These laws protect medical practitioners who are willing to kill; they do not protect those who die from the lethal drugs. 

3. Assisted death should be opposed because it is fundamentally incompatible with the physician’s role as healer.
 
The American Medical Association Code of Ethics Opinion 5.7 (Physician-Assisted Suicide) states that:

…permitting physicians to engage in assisted suicide would ultimately cause more harm than good.

Physician-assisted suicide is fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks.

Instead of engaging in assisted suicide, physicians must aggressively respond to the needs of patients at the end of life.(8)

Assisted death laws are designed to protect medical practitioners who are willing to cause the death of a patient. When the role of a physician changes from healer to killer, it fundamentally changes the physician.

In August 2016, 25-year-old Candice Lewis, who had several medical conditions, was pressured by a doctor to “request” an assisted death while she was in the hospital. Candice’s mother Sheila Elson stated in a CBC News story:

“His words were ‘assisted suicide death was legal in Canada,’” she told CBC. “I was shocked, and said, ‘Well, I’m not really interested,’ and he told me I was being selfish.” 

According to Elson, Lewis was within earshot when the doctor made the comment – which she said was quite traumatic for her daughter to hear.(9)

Sheila said the following in the film Fatal Flaws:

Not once did Candice say to them, “I want to end my life.” The doctor came in the next day after he told me about assisted suicide, stuck his face down in Candice’s and said, “Do you know how sick you are?” When I got his eye contact, we went out in the hallway and I told him, “Don’t you ever pull something like that again.”(10)

The fact that Candice was a person with disabilities should not change the value of her life. How many people are pressured by a medical professional and, unlike Candice, die by assisted death? 

4. Assisted death should be opposed because doctors are fallible; they can make medical errors and misdiagnose conditions.
 
In his article, “Why Getting Medically Misdiagnosed Is More Common Than You May Think,” Brian Mastroianni states that 12 million Americans are affected by medical diagnostic errors each year and an estimated 40,000 to 80,000 people die annually from complications related to misdiagnoses, with a similar number of people experiencing a permanent disability related to misdiagnosis.(11)
 
In April 2013, Pietro D’Amico, a 62-year-old magistrate from Calabria, Italy, died by assisted suicide at a Swiss assisted suicide clinic. His autopsy revealed that he had been medically misdiagnosed.(12)
 
Assisted death is a permanent decision often done when a person fears a painful or difficult death or is experiencing depression or feelings of hopelessness. Once they are dead, it is too late to learn that they were misdiagnosed or living with a treatable condition.

5. Assisted death laws should be opposed because legalization pressures physicians who then pressure patients.
 
What begins as a choice to kill or to die becomes a pressure to kill and a pressure to die.
 
During the debate to legalize euthanasia in Canada the euthanasia lobby argued that the issue was about choice. The “freedom of choice”: to die by euthanasia, and for a doctor or nurse practitioner to participate.
 
Sadly, Candice Lewis’ story may not be rare.
 
In February 2018, less than two years after Canada legalized assisted death the Delta Hospice Society (DHS), an independent charitable organization in British Columbia (BC), was ordered by the Fraser Health Authority (FHA) to provide euthanasia.(13) The DHS resisted and continued its good work. In December 2019, the FHA ordered the DHS to provide euthanasia or lose their government funding.(14) The DHS refused to comply with the government’s edict saying that, 

“MAiD is not compatible with the DHS’s purposes stated in the society’s constitution, and therefore, will not be performed at the Irene Thomas Hospice.”(15)

The Canadian Hospice Palliative Care Association and the Canadian Society of Palliative Physicians sent the BC Minister of Health a joint statement saying, 

“…MAiD is not part of hospice palliative care; it is not an ‘extension’ of palliative care nor is it one of the tools ‘in the palliative care basket’”(16) 

The BC Minister of Health responded by ordering the DHS to comply or be taken over by the province in February 2021.(17)
 
Recent assisted suicide bills in the United States have included a “do or refer” provision.(18) This means that if assisted suicide is legalized, a doctor would not have to prescribe assisted suicide drugs; however, if they received a request for assisted suicide, they would be required to refer the patient to someone who will write the prescription.

Doctors in Ontario Canada have been ordered by the College of Physicians and Surgeons to do an “effective referral”. This means that the College can punish doctors who refuse to kill and refuse to refer their patients to a doctor who will kill.(19)
 
Advocates of assisted death use the term “freedom of choice” to promote their ideology. This campaign slogan has resulted in medically condoned killing, persuasive pressure to die and an edict to kill by some medical organizations is a central part of a cultural campaign to normalize killing.
 
Society must maintain and build on its commitment to caring, not killing.

(Link to a printable PDF version of this article)

Endnotes
1. Dunn, K. (Director). (2018). Fatal Flaws: Legalizing Assisted Death. DunnMedia & Entertainment. [Trailer]. https://www.youtube.com/watch?v=89YQubAyRrI (Dr. Komrad’s statements start at 0:27)
2. Norman-Eady, S. (2002). Office of Legislative Research (OLR) Research Report: Oregon’s Assisted Suicide Law (Report No. 2002-R-0077). Connecticut General Assembly. https://www.cga.ct.gov/2002/rpt/2002-r-0077.htm
3. Callinan, K. (2019, January 1). End-of-Life option laws should avoid needless red tape. McKnight’s LTC News. https://www.mcknights.com/blogs/guest-columns/end-of-life-option-laws-need-compassion/
4. Pieters, J. (2020, April 21). Euthanasia Allowed for Dementia Patients Who Gave Prior Consent: Supreme Court. Netherlands Times. https://nltimes.nl/2020/04/21/euthanasia-allowed-dementia-patients-gave-prior-consent-supremecourt
5. Schadenberg, A. (2016, June 17). Canadian Senate passes euthanasia bill in time for summer break. Euthanasia Prevention Coalition Blog. https://alexschadenberg.blogspot.com/2016/06/canadas-senate-passes-euthanasia-bill.html
6. Marin, S. (2019, September 11). A Quebec court has invalidated parts of the medical aid in dying laws. The Canadian Press. https://montreal.ctvnews.ca/a-quebec-court-has-invalidated-parts-of-the-medical-aid-in-dying-laws-1.4588622
7. Bill C-7, An Act to amend the Criminal Code (medical assistance in dying), First Session, Forty-third Parliament, 68-69 Elizabeth II, 2019-2020. https://www.parl.ca/DocumentViewer/en/43-1/bill/C-7/first-reading
8. Chapter 5: Opinions on Caring for Patients at the End of Life. American Medical Association (AMA) Code of Medical Ethics. https://www.ama-assn.org/system/files/2019-06/code-of-medical-ethics-chapter-5.pdf
9. Bartlett, G. (2017, July 24). Mother says doctor brought up assisted suicide option as sick daughter was within earshot. CBC News. https://www.cbc.ca/news/canada/newfoundland-labrador/doctor-suggested-assisted-suicide-daughter-mother-elson-1.4218669
10. Dunn, K. (Director). (2018). Fatal Flaws Film Clip: “They wanted me to do an assisted suicide death on her.” [Video file]. https://www.youtube.com/watch?v=hB6zt43iCs8
11. Mastroianni, B. (2020, February 22). Why Getting Medically Misdiagnosed Is More Common Than You May Think. Healthline. https://www.healthline.com/healthnews/many-people-experience-getting-misdiagnosed
12. Aided suicide in question after botched diagnosis. (2013, July 11). The Local. https://www.thelocal.ch/20130711/assisted-suicide-in-question-after-botched-diagnosis
13. Fayerman, P. (2018, February 6). Delta hospice rebels against Fraser Health’s mandate to provide medical assistance in dying. Vancouver Sun. https://vancouversun.co/news/local-news/delta-hospice-rebels-against-fraser-healths-mandate-to-provide-medical-assistance-in-dying/
14. Gyarmati, S. (2019, December 7). Fraser Health gives Delta Hospice ‘formal notice of concerns’. Delta Optimist. https://www.delta-optimist.com/news/fraser-health-gives-delta-hospice-formal-notice-of-concerns-1.24029942
15. New Delta Hospice Society board reverses MAiD position. (2019, December 2). Delta Optimist. https://www.deltaoptimist.com/news/new-delta-hospice-society-board-reverses-maid-position-1.24024999
16. Canadian Hospice Palliative Care Association (CHPCA) and Canadian Society of Palliative Care Physicians (CSPCP) Joint Call to Action. (2019, November 27). https://www.chpca.ca/news/chpca-and-cspcp-joint-call-to-action/
17. Gyarmati, S. (2019, December 24). Here’s the deadline given to Delta Hospice. Delta Optimist. https://www.delta-optimist.com/news/here-s-the-deadline-given-to-delta-hospice-1.24041440
18. Murphy, S. (Administrator). (2020, January 14). Indiana assisted suicide bill fails to protect objecting practitioners: Assisted suicide evolves from “assistance” to “medical care”. Protection of Conscience Project. https://www. consciencelaws.org/law/commentary/legal102.aspx
19. Advice to the Profession: Professional Obligations and Human Rights. The College of Physicians and Surgeons of Ontario (CPSO). https://www.cpso.on.ca/Physicians/Policies-Guidance/Policies/Professional-Obligations-and-Human-Rights/Advice-to-the-Profession-Professional-Obligations

Reject Massachusetts End of Life Option Act

This article written by Margaret Dore and published by Choice is an Illusion.

Sign the petition: Reject Massachusetts Assisted Suicide bill S.1208/H.1926. (Link).

There has been an amended assisted suicide bill introduced in Massachusetts. S.2745 / S.1208.

I. Introduction

I am an attorney in Washington State where assisted suicide is legal.[1] The proposed bills seek to legalize “aid in dying,” a traditional euphemism for active euthanasia and physician-assisted suicide.[2]

Most states reject these practices.[3] Other states have strengthened their laws against them.[4] If enacted, the bills will apply to people with years or decades to live. Individuals with money, meaning the middle class and above, will be especially at risk. I urge you to reject the proposed bills.

II. Definitions (Traditional)

A. Physician-Assisted Suicide, Assisted Suicide and Euthanasia

The American Medical Association defines physician-suicide as occurring when “a physician facilitates a patient’s death by providing the necessary means and/or information to enable the patient to perform the life-ending act.”[5] For example:

[T]he physician provides sleeping pills and information about the lethal dose, while aware that the patient may commit suicide.[6] Assisted suicide is a general term in which an assisting person is not necessarily a physician. Euthanasia is the administration of a lethal agent by another person.[7]

B. Withholding or Withdrawing Treatment

Withholding or withdrawing treatment (“pulling the plug”) is not euthanasia if the purpose is to remove burdensome treatment, as opposed to an intent to kill the patient. More importantly, the individual will not necessarily die. Consider this quote from Washington State regarding a man removed from a ventilator:

[I]nstead of dying as expected, [he] slowly began to get better.[8] 

III. Assisting Persons Can Have an Agenda

Persons assisting a suicide or euthanasia can have an agenda. Consider Tammy Sawyer, trustee for Thomas Middleton in Oregon. Two days after his death by legal assisted suicide, she sold his home and deposited the proceeds into bank accounts for her own benefit.[9] Consider also Graham Morant, convicted of counseling his wife to kill herself in Australia, to get the life insurance.[10] The Court found:

[Y]ou counselled and aided your wife to kill herself because you wanted ... the 1.4 million.[11] Medical professionals too can have an agenda. New York physician, Michael Swango, got a thrill from killing his patients.[12] Consider also Harold Shipman, a doctor in the UK, who not only killed his patients, but stole from them and in one case made himself a beneficiary of the patient’s will.[13]

IV. Patients will have Years or Decades to Live

The bills apply to persons who are “terminally ill,” which is defined as an illness or condition expected to cause death within six months.[14] Such persons may in fact have years or decades to live. This is true due to actual mistakes (the test results got switched) and because predicting life expectancy is not an exact science.[15]

Indeed, doctors can sometimes be very wrong. Consider John Norton, who testified before this body in 2012. Diagnosed with ALS at age 18, he was told that he would get progressively worse (be paralyzed) and die in three to five years.[16] Instead, the disease progression stopped on its own. His affidavit states:

If assisted suicide or euthanasia had been available to me in the 1950's, I would have missed the bulk of my life and my life yet to come.[17] 

V. How The Bills Work

The bills have an application process to obtain the lethal dose, which includes a lethal dose request form. Once the lethal dose is issued by the pharmacy, there is no oversight. No doctor, not even a witness, is required to be present at the death.[18]

VI. The Bills are Stacked Against the Individual

Proponents claim that bill passage will assure individual choice, which is not true. See below.

A. Patient Protections will not be Enforceable

The bills set forth multiple patient protections, for example, that the attending physician “shall” refer the patient to another physician prior to prescribing the lethal dose.[19] The bills also say that actions are to be carried out in “accordance” with the bills.[20]

The bills do not define “accordance.”[21] Dictionary definitions include “in the spirit of,” meaning in thought or intention.[22] In other words, a mere thought or intention to comply is good enough. The protections will not be enforceable.

B. The Bills will Allow Other People to Communicate on the Patient’s Behalf
.
The bills describe patients as being “capable.”[23] This is a specially defined term, in which other people will be allowed to communicate on the patient’s behalf during the lethal dose request process, as long as the communicating people are “familiar with the patient’s manner of communicating.” The bills state:

"Capable” means having the capacity to make informed, complex health care decisions; understand the consequences of those decisions; and to communicate them to health care providers, including communication through individuals familiar with the patient’s manner of communicating if those persons are available. (Emphasis added).[24]

 Being familiar with a patient’s manner of communicating is an extremely low standard for something so important. Consider, for example, a doctor’s assistant who is familiar with the patient’s manner of communicating in Spanish, but she, herself, does not understand Spanish. That, however, would be good enough for her to communicate on his behalf during the lethal dose request process. The patient would not be in control of his fate.

C. “Even if the Patient Struggled, Who Would Know?”

The bills have no required oversight over administration of the lethal dose.[25] In addition, the drugs used are water and alcohol soluble, such that they can be injected into a sleeping or restrained person without consent.[26] Alex Schadenberg, Executive Director for the Euthanasia Prevention Coalition, puts it this way:

With assisted suicide laws in Washington and Oregon [and with the proposed bills], perpetrators can . . . take a “legal” route, by getting an elder to sign a lethal dose request. Once the prescription is filled, there is no supervision over administration. Even if a patient struggled, “who would know?” (Emphasis added).[27] 

VII. The Bills Will Allow Euthanasia as Traditionally Defined

The bills state that patients may choose to “self-administer” the lethal dose.[28] This is a specially defined term, which paradoxically allows other people to administer the lethal dose to the patient. The bills state:

"Self-administer” means a qualified patient’s act of ingesting medication [the lethal dose] ....(Emphasis added)[29] 

The bills do not define “ingest.”[30] Dictionary definitions include:

[T]o take (food, drugs, etc.) into the body, as by swallowing, inhaling, or absorbing.” (Emphasis added).[31] 

With these definitions, someone else putting the lethal dose in a patient’s mouth qualifies as self-administration if the patient swallows the lethal dose, i.e., ingests it. Someone else placing a medication patch on the patient’s arm will similarly qualify as self-administration because the patient will then be “absorbing” the dose, i.e., “ingesting” it. Gas administration initiated by another person will also qualify because the patient will be “inhaling” the dose, i.e., ingesting it. With self-administer defined as mere ingesting, someone else is allowed to administer the lethal dose to the patient, which is euthanasia as traditionally defined.

VIII. Legally, Deaths Will Be Due to a Terminal Disease, not Euthanasia or Homicide

The bills require deaths via the lethal dose to be listed on the patient’s death certificate as caused by a terminal disease, not euthanasia or homicide. The bills state:

The attending physician may sign the patient’s death certificate which shall list the underling terminal disease as the cause of death. (Emphasis added).[32]
[and]

Actions taken by health care providers and patient advocates supporting a qualified patient exercising his or her rights pursuant to this chapter, including being present when the patient self-administers medication, shall not for any purpose, constitute elder abuse, neglect, assisted suicide, mercy killing [euthanasia] or homicide under any civil or criminal law or for purposes of professional disciplinary action. (Emphasis added).[33] 

IX. Death Certificates Will Report Deaths as “Natural”

Massachusetts’ death certificates have seven categories for reporting the manner of death, five of which are substantive: natural cause; accident; homicide; suicide and therapeutic complication.[34]

As noted in the previous section, euthanasia deaths will be reported as caused by a terminal disease, not euthanasia or homicide. The death is also not an accident due its being intentionally performed; it is not suicide due to it’s being performed by another person; it is not a therapeutic complication. This leaves “Natural.”

With this situation, the manner of death for a traditional euthanasia must be reported on the death certificate as Natural. The significance is that doing so will create a legal inability to prosecute for murder. The official legal manner of death will be natural, not homicide, as a matter of law. The bills will create a perfect crime.

X. Dr. Shipman and the Call for Death Certificate Reform

Per a 2005 article in the UK’s The Guardian newspaper, there was a public inquiry regarding Dr. Shipman’s conduct, which determined that he had “killed at least 250 of his patients over 23 years.”[35] The inquiry also found:

that by issuing death certificates stating natural causes, the serial killer [Shipman] was able to evade investigation by coroners.[36] Per a subsequent article in 2015, proposed reforms included having a medical examiner review death certificates, so as to improve patient safety.[37] Instead, the instant bills move in the opposite direction to require a legal coverup in which doctors and other perpetrators will be empowered to kill with impunity.

XI. Perpetrators will be Allowed to Inherit

Slayer statutes block persons from receiving an inheritance when they murder a person from whom they stand to inherit.”[38] The rational is simple.[39] No one should financially benefit from his or her own crime.”[40]

In Massachusetts, the slayer statute applies when there is a murder conviction for homicide. Actions taken pursuant to the bills, however, are not homicide.[41] Again, the bills state:

Actions taken by health care providers and patient advocates supporting a qualified patient exercising his or her rights pursuant to this chapter, including being present when the patient self-administers medication, shall not for any purpose, constitute elder abuse, neglect, assisted suicide, mercy killing [euthanasia] or homicide under any civil or criminal law or for purposes of professional disciplinary action. (Emphasis added).[42]

With this situation, the slayer statute will not apply to deaths pursuant to the bills because legally there will be no homicide, and therefore no murder. It won’t matter that the lethal dose was administered to the decedent against his or her will or that he or she was tricked into taking it. Perpetrators will be allowed to inherit.

XII. Participants will be Traumatized

A. The Swiss Study: Physician-Assisted Suicide can be Traumatic for Family Members

A European research study addressed trauma suffered by persons who witnessed legal physician-assisted suicide in Switzerland.[43] The study found that one out of five family members or friends present at an assisted suicide was traumatized. These people, 

experienced full or sub-threshold PTSD [Post Traumatic Stress Disorder] related to the loss of a close person through assisted suicide.[44] 

B. My Clients Suffered Trauma in Oregon and Washington State

I have had two cases where my clients and their family members suffered severe emotional trauma due to legal assisted suicide. One case was in Oregon, the other case was in Washington State.

In the first case, one side of the family wanted the father/patient to take the lethal dose, while the other side did not. The father spent the last months of his life caught in the middle and torn over whether or not he should kill himself. My client, his adult daughter, was severely traumatized. The father did not take the lethal dose and died a natural death.

In the other case, it’s not clear that administration of the lethal dose was voluntary. My client, although he was not present, was severely affected by the incident and also by the sudden loss of his father.

XII. Conclusion

If enacted, the bills will apply to people with years or decades to live. Some assisting persons, including doctors and family members, will have an agenda, with the more obvious reasons being inheritance and life insurance, but also, as in the case of Dr. Swango, the thrill of seeing someone die.

The bills’ lack of required oversight at the death, coupled with the mandatory falsification of the death certificate will provide cover for murder and create a perfect crime. Families and individuals will be traumatized.

I urge you to vote “No” on H. 1926 and S. 1208. 

Click here to view pdf version.
 
Margaret Dore, Esq., MBA
Law Offices of Margaret K Dore, P.S.
Choice is an Illusion, a nonprofit corporation
www.margaretdore.com
www.choiceillusion.org
Footnotes:

[1] A copy of my bio is in the appendix, at page A-1.
[2] Craig A. Brandt, Model Aid-in-Dying Act, Iowa Law Review,
1989 Oct; 75(1): 125-215, (“Subject: Active Euthanasia ....”); and
Maria T. CeloCruz, “Aid-in-Dying: Should We Decriminalize
Physician-Assisted Suicide and Physician-Committed Euthanasia?,”
summary pages, in the appendix, at A-2 & A-2A.
[3] Patient’s Rights Council, “Assisted Suicide Laws in the United States,”
http://www.patientsrightscouncil.org/site/assisted-suicide-state-laws/
[4] In the last nine years, at least eight states have strengthened their laws against assisted suicide and/or euthanasia. These states include: Alabama, Arizona, Georgia, Idaho, Louisiana, New Mexico, Ohio and Utah. See backup documentation in in the appendix, at pages A-3 to A-7. See also https://www.choiceillusionnewmexico.org/2016/07/new-mexico-upholds-assisted-suicide.html (regarding a New Mexico Supreme Court decision overruling legal assisted suicide); http://codes.ohio.gov/orc/3795 (regarding Ohio’s statute) and https://le.utah.gov/~2018/bills/static/HB0086.html (regarding Utah bill).
[5] The AMA Code of Medical Ethics, Opinion 5.7, in the appendix, page A-8.
[6] Id.
[7] Opinion 5.8, “Euthanasia,” attached in the appendix, at page A-9.
[8] Nina Shapiro, “Terminal Uncertainty: Washington’s new ‘Death With Dignity’ law allows doctors to help people commit suicide—once they’ve determined that the patient has only six months to live. But what if they’re wrong?,” Seattle Weekly, 01/13/09, attached in the appendix, at pp. A-10 to A-12; quote at A-12.
[9] "Sawyer Arraigned on State Fraud Charges," KTVZ.COM, 08/16/16, attached in the in the appendix, at page A-13.
[10] R v Morant [2018] QSC 251, Order, 11/02/18, excerpts in the appendix, at pp. A-14 and A-15. Full opinion available here: https://archive.sclqld.org.au/qjudgment/2018/QSC18-251.pdf
[11] Morant opinion, ¶ 78, attached in the appendix, at A-15.
[12] Charlie Leduff, “Prosecutors Say Doctor Killed to Feel a Thrill,” The New York Times, 09/07/00, attached in the appendix, at pages A-16 to A-18, https://choiceisanillusion.files.wordpress.com/2019/03/ny-times-killed-to-feel-a-thrill-1.pdf (“Basically, Dr. Swango liked to kill people. By his own admission in his diary, he killed because it thrilled him.”) See also: CBSNEWS.COM STAFF, “Life in Jail for Poison Doctor,” 07/12/00, https://www.cbsnews.com/news/life-in-jail-for-poison-doctor
[13] David Batty, “Q & A: Harold Shipman,” The Guardian, 08/25/05, at https://www.theguardian.com/society/2005/aug/25/health.shipman. (Attached in the appendix, at A-19 to A-21). See also Fiona Guy, “Healthcare Serial Killers: Doctors and Nurses Who Kill,” Crime Traveler, (2015, Sept 09), available at https://choiceisanillusion.files.wordpress.com/2019/03/doctors-and-nurses-who-kill.pdf
[14] The bills state:
“Terminally ill" means having a terminal illness or condition which can reasonably be expected to cause death within 6 months, whether or not treatment is provided. H. 1926 and S. 1208, lines 78 to 79. A copy of H. 1926 is in the appendix, at pages A-22 to A-38.
[15] See: Jessica Firger, “12 Million Americans Misdiagnosed Each Year,” CBS NEWS, April 17, 2014, attached in the appendix, at A-39; and Nina Shapiro, “Terminal Uncertainty ...,” supra, excerpts attached hereto in the appendix, at A-10 to A-12.
[16] Affidavit of John Norton, attached in the appendix, at A-40 to A-42.
[17] Id., ¶ 5.
[18] See the bills in their entirety, which are currently identical. Bill H. 1926 is attached in in the appendix, at pages A-22 to A-38.
[19] The bills, § 6, lines 151 to 179, attached in in the appendix, at A-30 & A-31.
[20] The bills state:
(1) The attending physician shall: ...
(k) ensure that all appropriate steps are carried out in accordance with this chapter before writing a prescription for medication for a qualified patient .... (Emphasis added). The bills, line 152, and lines 178 to 179, attached in the appendix, at A-30 and A-31.
[21] See the bills in their entirety.
[22] Definitions attached in the appendix, at pages A-45 to A-46.
[23] The bills, § 1, lines 14-17. (Attached in the appendix, at A-23).
[24] Id.
[25] See the bills in their entirety.
[26] In Oregon and Washington State, reported drugs include Secobarbital, Pentobarbital, Phenobarbital and Morphine Sulfate, which are water and/or alcohol soluble. See excerpts from Oregon’s and Washington’s annual reports, in in the appendix, at pp. A-43 and A-44. See also http://www.drugs.com/pr/seconal-sodium.html, http://www.drugs.com/pro/nembutal.html and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2977013
[27] Alex Schadenberg, Letter to the Editor, “Elder abuse a growing problem,” The Advocate, Official Publication of the Idaho State Bar, October 2010.
[28] The bills, Section 1, line 10, attached in the appendix, at A-22
[29] Id., lines 76 to 77.
[30] See the bills in their entirety.
[31] Attached in the appendix, at A-47.
[32] The bills, §6(2), lines 189 to 190, attached in the appendix, at A-32.
[33] The bills, lines 252 to 256.
[34] See Massachusetts “Death Certificate Medical Certifier Worksheet,” attached in the appendix, at A-48.
[35] David Batty, attached in the appendix, at A-19.
[36] Id., attached hereto at A-21.
[37] Press Association, “Death Certificate Reform Delays ‘Incomprehensible,” The Guardian, January 21, 2015, attached in the appendix, at A-49 to A-50.
[38] Cushing and Dolan, PC, Attorneys at Law, “What are Slayer Statutes,” January 28, 2015, in the appendix, at A-51 to A-52.
[39] Ilene S. Cooper and Jaclene D’Agostino, Forfeiture and New York’s “Slayer Rule,” NYSBA Journal, March/April 2015, attached in the appendix, at A-55.
[40] Id.
[41] Cushing and Dolan, in the appendix, at A-52. See also “Taking from deceased victim’s estate prohibited,” attached in the appendix, at A-53. The bar to inheritance applies “only to murder in the first degree, murder in the second degree or manslaughter.”
[42] The bills, lines 252 to 256.
[43] “Death by request in Switzerland: Post-traumatic stress disorder and complicated grief after witnessing assisted suicide,” B. Wagner, J. Muller, A. Maercker; European Psychiatry 27 (2012) 542-546, available at http://choiceisanillusion.files.wordpress.com/2012/10/family-members-traumatized-eur-psych-2012.pdf (Cover page attached in the appendix, at A-56).
[44] Id.

Indiana assisted suicide bill fails to protect objecting practitioners

This article was published by the Protection of Conscience Project on January 16, 2020

Assisted suicide evolves from "assistance" to "medical care" 

Affirmation has serious consequences for objecting Indiana physicians

By Sean Murphy

Introduction

On 7 January, 2020, Representative Matt Pierce introduced HB1020: End of life options in the Indiana General Assembly.1 HB1020 is the fourth assisted suicide bill introduced by Pierce since 2017; three previous bills died in committee without hearings.2,3,4,5,6 Parts of HB1020 relevant to protection of conscience are reproduced on the Project website.7
 
Overview

The bill permits physician assisted suicide for Indiana residents 18 years of age and older who have been diagnosed with a terminal illness likely to cause death within six months. Candidates must be competent to make health care decisions and must apply in writing for a lethal prescription; the application must be witnessed by two independent witnesses. Lethal medication can be prescribed or dispensed by an attending physician after a fifteen day waiting period if the patient is acting voluntarily and making an informed decision.

Neither the attending physician nor any other person need be present when the lethal medication is taken, though the attending physician must tell the patient that someone else should be present. The lethal medication must be self-administered. If the medication does not cause death, no one is authorized to kill the patient. 

HB1020 imposes obligations upon "attending physicians"8 and "consulting physicians"9 and it assumes the cooperation of pharmacists in dispensing lethal medication. There is some ambiguity in the description of what is expected of attending physicians. Section 4(a)(13) makes provision or prescription of lethal medication an absolute obligation if all of the conditions specified in the bill are met (". . .the attending physician shall. . ."). On the other hand, Section 4(c) seems to leave some discretion to the attending physician to refuse, even if the conditions are met (". . . the attending physician may . . ."). A later protective provision indicates that an attending physician can refuse, but the ambiguity in the wording of Section 4 remains.

Protective provisions: biased, insufficient and conflicting

The bill makes no reference to freedom of conscience or religion, but Section 12 offers some protection for "health care providers."

Under Section 12(d) a hospital (health care provider) can prohibit physicians (individual health care providers) from participating in assisted suicide on its premises, and, provided it has notified them in advance, can take action against those who defy the prohibition. This would seem to be broad enough to include a prohibition against assessing patients and arranging for assisted suicide elsewhere.

However, Section 12(e) pits health care "facilities" against health care "providers." A facility cannot prevent a physician from "providing services consistent with the applicable standard of medical care." This includes at least providing information about assisted suicide, being present at a suicide, and referring a patient for assisted suicide. What is not clear is whether or not this includes doing so on the facility's premises, notwithstanding a facility prohibition of participation in assisted suicide.

Unfortunately, HB1020 does not explain the distinction between a health care "provider" and a health care "facility." And while the Indiana Code defines both terms, it offers three different definitions of "health care facility"10 and five differing and very lengthy definitions of "health care provider."11 The latter can include individuals (thus covering attending physicians) but also health facilities and incorporated entities. This further complicates interpretation of Section 12(e).

Section 12(a) provides immunity against professional, criminal and civil liability, but only for those who prescribe or dispense assisted suicide medication or are present when it is taken. Those who refuse are unprotected. The bias in favour of assisted suicide practitioners and disadvantage imposed upon those unwilling to provide the service is obvious.

Section 12(b) protects both health care providers who participate and those who refuse to participate in assisted suicide against private disciplinary or punitive actions by professional associations, organizations and other health care providers. It offers the same protection for health care providers who provide "scientific and accurate information" about the service - but not those who refuse to do so.

Section 12(c) states that a health care provider cannot be required to participate in "the dispensing or providing of medication", but this does not clearly protect objecting physicians from demands that they do everything but dispense or prescribe lethal drugs.
Assisted suicide evolves from "assistance" to "medical care"

In 2017, HB1561 Section 12(a) described participation in assisted suicide as "provid[ing] assistance in the completion of a request for medication." It granted professional, civil and criminal immunity to those providing "assistance."

The following year, HB1157 Section 12(a) used the same phrase to describe participation. It conferred immunity upon those providing such "care."

In 2019, HB1184 Section 12(a) evolved further, so that participation in assisted suicide is described in HB1020 as the provision of "medical care," including prescribing or dispensing lethal medication and being present at a patient's suicide. The addition of Section 12(e) in HB1020 reflects and reinforces this evolution when it refers to participation in assisted suicide that conforms to "the applicable standard of medical care."

Now, in 2019 the American Medical Association (AMA) reaffirmed its rejection euthanasia and assisted suicide as contrary to medical ethics,12 so the AMA would presumable reject the bill's supposition that there can be a "medical standard of care" for either procedure. In this respect, the author of HB1020 may be looking to a future in which a medical standard of care is developed as a result of the legalization of physician assisted suicide.

When assisted suicide becomes "medical care"  

Seven Canadian physicians have described what that future looks like.

"For refusing to collaborate in killing our patients," they write, "many of us now risk discipline and expulsion from the medical profession," are accused of human rights violations and "even called bigots."13

How did this come about?

An important part of the explanation is the Canadian Medical Association's (CMA) classification of assisted suicide and euthanasia as "therapeutic service[s]"14 and "legally permissible medical service[s]."15

Since there is no dispute that physicians have a professional obligation to provide or arrange for therapeutic medical services for their patients, the change in CMA policy implicitly made participation normative for the medical profession (and, by extension, for other health care workers and institutions). From that perspective, as the Canadian physicians note, refusing to provide or arrange for euthanasia and assisted suicide services for legally eligible patients "became an exception requiring justification or excuse." Hence, discussion in Canada is now largely about "whether or under what circumstances physicians and institutions should be allowed to refuse to provide or collaborate in homicide and suicide."13

The seven Canadian physicians authors can't be dismissed as outlying cranks. Almost 60 Canadian physicians from across the country endorsed the article, which appeared in the World Medical Association's professional journal. Signatories included a Canadian Medical Hall of Fame member known as the father of palliative care in North America,16,17 a member of an expert advisory group on euthanasia and assisted suicide convened by Canadian provinces and territories,18 and a regional director of palliative care who resigned when a health authority demanded that objecting hospices permit euthanasia and assisted suicide on their premises.19

Thus, in the long term, statutory affirmation that assisted suicide is not only permitted but is a form of "medical care" would likely have serious adverse consequences for objecting Indiana physicians.

Notes

1. US, HB 1020, End of life options, 121st Gen Assembly, 2nd Reg Sess, Ind, 2020 [Internet]. Indianapolis: Indiana General Assembly; 2020 Jan 7 [cited 2020 Jan 14].

2. US, HB 1561, End of life options, 120th Gen Assembly, 1st Reg Sess, Ind, 2017 [Internet]. Indianapolis: Indiana General Assembly; 2017 Jan 23 [cited 2020 Jan 14].

3. US, HB 1157, End of life options, 120th Gen Assembly, 2nd Reg Sess, Ind, 2018 [Internet]. Indianapolis: Indiana General Assembly; 2018 Jul 1 [cited 2020 Jan 14].

4. US, HB 1184, End of life options, 121st Gen Assembly, 1st Reg Sess, Ind, 2019 [Internet]. Indianapolis: Indiana General Assembly; 2019 Jul 1 [cited 2020 Jan 14].

5. Hussein F. Indiana lawmaker proposes assisted suicide bill. Indianapolis Star [Internet]. 2018 Jan 4 [cited 2020 Jan 14].

6. Arthur V. Assisted suicide legislation stalls in Indiana. Today's Catholic (Fort Wayne, IN) [Internet]. 2019 Apr 4 [cited 2020 Jan 14].

7. Indiana: House Bill 1020 (2020): End of life options [Internet]. Powell River (BC): Protection of Conscience Project; 2020 Jan 14 [cited 2020 Jan 14].

8. "'Attending physician' means the licensed physician who has the primary responsibility for the treatment and care of the patient. For purposes of IC 16-36-5, the term includes a physician licensed in another state." IN Code § 16-18-2-29 (2018) [Internet]. Mountainview, CA: Justia [cited 2020 Jan 14].

9. The term is undefined, so it appears to refer to any licensed physician.

10. For "health care facility" see IN Code § 16-18-2-161 (2018) [Internet]. Mountainview, CA: Justia [cited 2020 Jan 14].

11. For "health care provider" see IN Code § 16-18-2-163 (2018) [Internet]. Mountainview, CA: Justia [cited 2020 Jan 14]

12. Frellick M. AMA Reaffirms Stance Against Physician-Aided Death. Medscape [Internet]. 2019 Jun 11 [cited 2020 Jan 14].

13. Leiva R, Cottle MM, Ferrier C, Harding SR, Lau T, Scott JF. Euthanasia in Canada: A Cautionary Tale. WMJ 2018 Sep [cited 2020 Jan 14]; 64:3 17-23.

14. Doctor-assisted suicide a therapeutic service, says Canadian Medical Association [Internet]. CBC News; 2015 Feb 06 [cited 2020 Jan 14]. Emphasis added.

15. CMA Policy: Medical Assistance in Dying [Internet]. Canadian Medical Association; 2017 May [cited 2020 Jan 14]. Emphasis added.

16. (Dr. Balfour Mount). Phillips D. Balfour Mount [Internet]. Montreal (Quebec): McGill University; 2016 May 03 [cited 2020 Jan 14].

17. The Canadian Medical Hall of Fame. Dr. Balfour Mount, 2018 Inductee [Internet]. [cited 2020 Jan 14].

18. (Dr. Nuala Kenny). Provincial-Territorial Expert Advisory Group on Physician-Assisted Dying. Final Report [Internet]. Toronto (Ont): Government of Ontario, Ministry of Health and Long Term Care; 2015 Nov 30 [cited 2020 Jan 14].

19. (Dr. Dr. Neil Hilliard). Fayerman P. Delta hospice rebels against Fraser Health's mandate to provide medical assistance in dying [Internet]. Vancouver Sun; 2018 Feb 06 [2020 Jan 14].