California doctor faces up to 10 years in prison for fraudulently diagnosing his patients as terminal

Did any of Dr Victor Contreras's patients fraudulently die by assisted suicide? 

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Holly Vossel reported for The Hospice News on July 26 that a hospice physician in California faces up to 10 years in prison for defrauding the Medicare system by falsely claiming that his patients were terminal and thus qualifying them under Medicare for hospice. Vossel reported:

Two years following his arrest, Dr. Victor Contreras, 68, recently pled guilty to one count of health care fraud. Contreras served as a physician for two Pasadena-based providers, Saint Mariam Hospice Inc. and Arcadia Hospice Provider Inc.

Contreras defrauded Medicare of nearly $4 million in false and fraudulent hospice claims from July 2016 to February 2019, according to the plea agreement. U.S. District Judge André Birotte Jr. has scheduled a sentencing hearing for October 25, with Contreras facing a maximum of 10 years in federal prison.

“Contreras falsely stated on claims forms that patients had terminal illnesses to make them eligible for hospice services covered by Medicare, typically adopting diagnoses provided to him by hospice employees whether or not they were true,” the U.S. Department of Justice Attorney’s Office in the Central District of California indicated in a statement. “Contreras did so even though he was not the patients’ primary care physician and had not spoken to those primary care physicians about the patients’ conditions.”

This issue is significant for several reasons. 

The authorities are concerned with approximately $30 million in Medicare fraud. 

I am concerned with the ease of falsely declaring patients terminal considering that the same criteria for qualifying for hospice care also qualifies a patient for assisted suicide in California. Did any of Contreras's patients fraudulently die by assisted suicide?

Vossel also reported for The Hospice News that:

Arcadia Hospice Provider submitted false Medicare claims to the tune of $23 million. Meanwhile, St. Mariam Hospice submitted nearly $13.5 million in false claims. Contreras was allegedly involved in roughly $5.1 million of these, according to the Justice Department.

Additional charges were issued to medical industry marketer Callie Jean Black, 65, who allegedly recruited patients for the hospice companies in exchange for illegal kickbacks, the Justice Department reported. Black was also arrested in 2022 and has pleaded not guilty to the charges. A sentencing trial is scheduled for October 15.

The charges also included the owner of the two hospice companies, Juanita Antenor, 61, who remains at large. Authorities have not been able to locate Antenor throughout the two-year investigation. The Justice Department believed Antenor could have relocated to the Philippines as of 2022, though nothing has been publicly confirmed.

The Euthanasia Prevention Coalition demands an audit of the medical records for people who have been approved for assisted suicide in California.

Further to that, we recognize that if such levels of Medicare fraud and falsely diagnosing people as terminal is possible in California, then it must also be possible in all American jurisdictions and even Canada.

Laws that permit the killing of people by assisted suicide can be abused but with assisted suicide, the outcome is death.

New Report On Elder Abuse In Australia: Implications For Euthanasia.

This article was published by the Australian Care Alliance on January 12, 2022.

A new report on elder abuse in Australia by L. Qu and colleagues - National Elder Abuse Prevalence Study: Final Report - released in December 2021 points to the prevalence of elder abuse and explains some of the risk factors and the common characteristics of perpetrators.

This information needs to inform any discussion of the risks to elderly people of legalising euthanasia and assistance to suicide, including risks arising from inheritance impatient adult children; psychological and physical abuse from adult children and intimate partners; social isolation and loneliness; failure to report abuse to professionals, including GPs; and the ineffective responses even when abuse is reported to professionals.

Proponents of legalised euthanasia or assistance to suicide who dismiss the risk of elder abuse in this context are naïve, disingenuous or simply so focused on demanding their “right to die” that they are prepared to ignore this risk.

As Dr Henry Marsh, a British neurosurgeon and proponent of legalising assisted suicide and euthanasia, has said "Even if a few grannies get bullied into [suicide], isn’t that the price worth paying for all the people who could die with dignity?"

Relevantly, this report found that:

The estimate for the prevalence of elder abuse among community dwelling people aged 65 and older in Australia is 14.8%, based on findings from the SOP. This estimate is based on experiences reported in the past year in the survey. The most common form of abuse is psychological abuse (11.7%). Neglect is the next most common abuse subtype at 2.9%. For the other subtypes, prevalence rates are 2.1% for financial abuse, 1.8% for physical abuse and 1% for sexual abuse. (page 2)

Each of these abuse types is relevant for assessing the safety of a law that allows a lethal poison to be prescribed and suppled to an elderly person to be used to end the person's life.

Adult children were most likely to commit financial, physical, and psychological abuse. Sons were almost twice as likely as daughters to commit financial abuse. Adult children were on par with intimate partners as perpetrators of neglect. Intimate partners also featured commonly as perpetrators of physical, psychological, and sexual abuse.

perpetrators were reported to have … and financial problems (nearly one in five). The most common problems associated with financial abuse were financial problems.

Inheritance impatience was a characteristic of 19.1% of abusers in Queensland in 2018/19. (page 2)

Elderly people prescribed and supplied with a lethal poison may be at risk from adult children and intimate partners perpetrating financial, physical and psychological abuse – including seeking to hasten the death of the person for financial benefit; bullying or nagging the person to ingest the poison; physically forcing the person to ingest the poison.

Most laws (including all such laws in Australia and the United States) permitting assistance to suicide provide no protections whatsoever once the lethal poison is prescribed and supplied.

people with poorer health were more likely than those with better health to report experiencing elder abuse. Having a disability was associated with a higher likelihood of experiencing elder abuse. Low social support and lack of social contact were associated with a higher likelihood of experiencing elder abuse (page 2)

There is a correlation between all abuse subtypes and low social support (including social isolation and loneliness). (page 61)

A low sense of social support is the highest risk factor for physical abuse (30.4%) and the second highest risk factor for financial abuse (29.8%). (page 66)

There is also a correlation between isolation and loneliness and requests for euthanasia. For example, the Sixth annual report for Quebec reported that for April 2020-March 2021, 24% of people gave as a reason for wishing to have their life ended by a lethal injection experiencing “isolation or loneliness”.

Where older people sought professional help, they were more likely to turn to the helping professions, medical professionals such as GPs and nurses … Notably, of those older people who reported taking action, substantial minorities considered these actions were ineffective. Responses indicating actions were ineffective were highest for financial abuse (over one third) (page 3)

This confirms the concern that there is no guarantee that medical practitioners assessing those who request euthanasia or assistance to suicide for "voluntariness" will adequately identify or respond to the presence of, or the risk of, financial, psychological or physical abuse playing a role in a person’s request for a lethal poison to end their life or the actual ingestion of such a poison if prescribed and supplied for self-administration.

For example, the section of the mandatory training in Victoria for participating medical practitioners dealing with assessing voluntariness, including the absence of coercion takes just over 5 minutes to complete including a 2 minute 20 second video and slides which take a further 2 minutes 50 seconds to read.

Given what this latest report on elder abuse confirms about its prevalence and the failure of professionals including GPs and other health professionals to adequately identify and respond to it there are no grounds for assuming that the provisions of any law permitting euthanasia or assistance to suicide are adequate to prevent wrongful deaths by elder abuse by pressure to request or ingest a lethal poison.

Simply chanting “choice” as a mantra does not address this real and substantive risk of lethal elder abuse.

Québec Doctor testifies that some Covid patients were euthanized rather than treated.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition.

A Québec inquest into Covid related deaths has uncovered more disturbing facts. In September I published an article from the testimony of an auxilary nurse claiming that many of the COVID 19 nursing home deaths were caused by abuse and neglect.

A Québec doctor told the inquest into Covid related deaths that many treatable patients actually died by euthanasia.

An article by Clara Descurninges for The Canadian Press reported on the testimony from Dr Vinh-Kim Nguyen who worked in the emergency room at the Jewish General Hospital during the first wave of the COVID-19 pandemic. Dr. Nguyen who had previously managed the Ebola pandemic for Doctors Without Borders told the inquiry that:

Patients who arrived from CHSLDs with heavy cases of COVID-19 were, according to him, “surprisingly well after a day or two of infusions or oxygen”. "By hydrating these patients, they recovered very easily,"

Dr Nguyen was sent to CHSLDs to work with their COVID-19 patients. Dr Nguyen testified that he found himself in a very different situation. Descurninges states:

Wanting to transfer patients to the hospital, he quickly discovered "the many obstacles" put in his way, while public health guidelines recommended keeping residents there.

For patients stuck in CHSLDs, the only measures available were often end-of-life respiratory distress protocols, or strong cocktails of drugs used to reduce suffering, he testified. “These are protocols that lead to death. […] It was in fact euthanasia,” he insisted.

“What really traumatized me was that I saw patients who didn't have to go there, they could have been treated."

Duscurninges also reported on the testimony from Dr. Réjean Hébert who told the inquest that 10% of patients at CHSLDs died of COVID-19 during this period. Dr Hébert is a specialist in gerontology and a professor in health policy evaluation at the University of Montreal testified that these deaths represented a "massacre" by "systematic ageism."

Dr Hébert referred to the management of healthcare in Québec as "administrative monsters" with reference to what he referred to as the six hierarchical levels of management.

The Québec inquest was established to investigate why from February 25 - July 11, 2020, Quebecers aged 70 and over accounted for 92% of deaths from COVID-19.

I have written several articles concerning COVID-19 deaths. I believe that with varying degrees, the same abuse neglect and euthanasia that occurred in Québec COVID-19 deaths also happened in other jurisdictions. The only difference is that Québec has established an inquest into these COVID-19 related deaths.

Further articles on this topic:

• Canada's claim to value seniors and disabled people rings false during COVID-19 pandemic (Link). 
• 43% of US COVID-19 deaths were nursing home residents (Link). 
• Stealth euthanasia: How many seniors with COVID-19 were killed? (Link). 
• 81% of Canada's COVID-19 deaths were long-term care residents (Link).
  

Exposing abuse of the Oregon assisted suicide law. Two doctors accused of alleged abuse of the Oregon assisted suicide law.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

The recently released 2018 DWD assisted suicide statistics indicated that two physicians were referred to the Oregon Medical Board for failure to comply with the assisted suicide law. 

The assisted suicide report does not indicate what they were accused of doing or not doing and it does not provide references for the alleged abuse of the law.

Order the pamphlet - Shedding light on assisted suicide in America.

This is a significant issue considering the number of states that are debating legislation to legalize assisted suicide under the guise that there have been no problems in Oregon.

A search of the Oregon Medical Board disciplinary actions on September 15, 2018, Dr Rose Kenny was disciplined by the Medical Board. The order from the meeting states:

3.1 Licensee must not prescribe or manage the prescriptions for any medication for any patient enrolled in hospice care, 

3.2 Licensee must not prescribe or manage the prescriptions for any medication for any patient requesting Death with Dignity.

The Oregon Medical Board states that the matter is under investigation and it does not provide information concerning the reason for the order.

The minutes of the meeting of the Oregon Medical Board (October 4, 5, 2018) indicates that the Board approved the notice of complaint and proposed disciplinary action based on the possible violation of the Medical Practice Act as well as violations of the Oregon Death with Dignity Act.

Since the Oregon Death with Dignity Act concerns prescribing lethal drugs to intentionally cause death, it appears that Dr Kenny has been treated leniently, especially since this is not the first time she has been brought before the Oregon Medical Board.

An internet search found the article: Redmond doctor avoids losing license despite complaints that was written by Tara Bannow and published in The Bulletin on October 7, 2016. The article explains the agreement between Dr Kenny and the Oregon Medical Board. Kenny kept her medical license by accepting an $8500 fine and five years probation. The article in The Bulletin  states:

Kenny escaped what could have been much harsher punishment: She faced losing her license and a $10,000 fine. 

Since Dr Kenny agreed to a five year probation in 2016 and is now being disciplined for allegedly abusing the assisted suicide law, her medical license should have been suspended until the investigation is complete.

Defining assisted suicide within the framework of medical treatment means that abuse of the law is not brought before a court, even though the death of a patient has occurred. It is easier to hide assisted suicide abuse within a medical framework as compared to a legal framework.

Finally, the assisted suicide law was designed to cover-up abuse. The Oregon law has a self-reporting system requiring the physician who prescribes the lethal drugs to also be the physician who submits the report, after the death. Physicians will not self-report abuse of the law.

I have not found information about the second physician mentioned in the report. If anyone has references to the second physician please contact me at: alex@epcc.ca

Nurse found guilty of professional misconduct for complaining about the care of her grandfather.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

It is shocking that the Saskatchewan Registered Nurses Association found Carolyn Strom, a registered nurse, guilty of professional misconduct after complaining on her facebook page about the care her grandfather received in palliative care.

The hospital stated that an investigation was done into the complaints. Link to the discipline committee report.

On October 25 I wrote about Elizabeth Wetlauffer, who is a nurse that was charged with 8 counts of murder at care homes in Woodstock and London Ontario. EPC reacted to this news by demanding an in-depth investigation be done into murders at care homes in Ontario.

Yesterday the Ontario Provincial Police (OPP) announced that they are investigating two more suspicious deaths that may be connected to Wetlauffer.

Wetlauffer's acts of alleged murder were not uncovered by an investigation or by "quality control" but rather by comments Wetlauffer made to a psychiatrist.

Two days ago the London Free Press reported that Susan Muzylowsky, a nurse who worked at the Mount Hope Centre for Long Term Care in London Ontario confessed to charges of professional misconduct relating to 19 patients. According to the London Free Press:

Prescribed pain medications were routinely withheld, residents were handled roughly, verbally demeaned and sexually mocked, and some were sexually abused on more than one occasion, according to the investigation report released Wednesday.

In this case, incidents of abuse were reported to the registered nurse in charge of the shift but supervisors failed to follow policy and report the incidents to the leadership at Mount Hope or the Ministry of Health. The Free Press stated that the Ministry of Health reported that:

During their investigation, inspectors interviewed a personal care provider who had reported incidents involving Muzylowsky to registered nurses in the hopes “something would happen.” 

“What was happening was what I was afraid of, I was telling and nothing was happening.” The worker said she was “afraid to go to management and nothing would be done, I still had to report to her,” the inspection report said. 

One of the registered nurses who received the allegations of abuse and neglect of residents stated “we kept quiet about it and we should not have.”

In other words the incidents were reported, but not reported to authorities and Muzlowsky continued to abuse.

Instead of disciplining Strom, the Saskatchewan Minstry of Health needs to examine whether or not Strom's complaint was valid.

Now that euthanasia is legal in Canada, do these stories make you feel protected?

California assisted suicide Bill ABX2-15 - Vote NO.

Margaret Dore, a Washington State lawyer, published this article opposing California assisted suicide bill ABX2-15 after she attended a recent committee hearing. Her response was published on the California Against Assisted Suicide website on September 9, 2015. 

Margaret Dore

1. New Mexico no longer allows physician-assisted suicide.

2. Under ABX2-15, requiring the patient to meet alone with the doctor as a protection against undue influence, is not necessarily a safeguard. See § 443.5(a)(4). Consider, for example, if the doctor, himself or herself, has an interest in seeing the patient gone. For example, if the doctor botched the patient’s case and wants to eliminate the liability by eliminating the patient.

3. ABX2-15 protects patients by providing that doctors may be sanctioned by their licensing board or agency. See § 443.16(c). Doctors, however, are notoriously bad at policing themselves. For an extreme example, there is the case of Michael Swango MD, who thrill-killed his patients. When hospital administrators became aware of a potential problem, they simply let him go, leaving him free to get another job and start killing again. (Information Link)

4. Under ABX2-15, a bad doctor like Swango would be additionally aided by "blanket immunity." See Committee Staff Analysis for the Assembly Committee on Public Health and Developmental Services, p. 17 (“the bill provides blanket immunity for health care providers ... even in instances where their actions are grossly negligent”).

5. There is already a problem with hospice and palliative care programs over-reaching and killing non-dying patients. See e.g., Peter Whoriskey, “As More Hospices Enroll Patients who Aren't Dying, Questions About Lethal Doses Arise,” Washington Post, August 21, 2014, (Link to the article). See also The Kaiser Papers, regarding California cases (Link to the article) If you can’t control the abuse now, why would you give doctors even more power to take away patient choice?

6. Dogs who are euthanized do not get to choose; people are already having the same problem with euthanasia not actually legal. Please vote “No” on ABX2-15.

Margaret Dore, Esq., MBA
Law Offices of Margaret K. Dore, P.S.
Choice Illusion, a non-profit corporation
www.margaretdore.com
www.choiceillusion.org

John Kelly: Second Thoughts Against California Assisted Suicide Bill.

This letter was published by California Against Assisted Suicide on September 7, 2015.

John Kelly is the Director of the
disability rights group, Second Thoughts.

Assemblymember:

I hope you will have second thoughts about legalizing assisted suicide in California. Now especially that the California Medical Association secured the removal of any liability clause from  AB2x 15, in the words of the committee staff’s analysis (see page 17), “wanton misconduct” and “gross negligence” will go unpunished.

The replacement clause, that professional licensing boards “may sanction” professional misconduct, is toothless. As we have seen across society, self-interested institutions cannot be trusted to police themselves. Please see the case of Wendy Melcher, who was illegally injected with lethal drugs by two Oregon nurses, completely outside the scope of the law. The nurses were not referred for prosecution, but were secretly dealt with by the state nursing board. The nurses continue to practice today. 

In important ways assisted suicide laws are like death penalty laws: innocent people inevitably lose their lives. A strong consensus is now emerging against the death penalty because mistakes (witness misidentification, false confession) and abuse of the system (prosecutorial and police misconduct) lead to wrongful convictions and executions.

Mistakes and abuse in the medical system are common. People who are misdiagnosed (see John Norton), people who would respond to more treatment ( Jeanette Hall), or who would live years longer  (some participants in Oregon have lived almost 3 years after being judged “terminal”) will be led to tragically “choose” death. Assisted suicide programs have offered lethal drugs to patients with severe depression (Michael Freeland) and to people denied treatment (Barbara Wagner). And because not all families are loving or financially secure, innocent people will be bullied or worse by abusive families and beneficiaries.

Just like the death penalty, assisted suicide exacerbates existing inequalities across race and class. It has been shown repeatedly that patients of color receive substandard, often deadly lack of medical care, and are the targets of educational campaigns to give up on treatment. Distrust of the medical system is widespread among more vulnerable populations. It’s no surprise that people of color (and poorer people generally) oppose legalized assisted suicide (Pew Research Center on End-Of-Life). The 4 most Latino cities in Massachusetts (Lawrence, Holyoke, Chelsea, and Springfield) voted heavily against the 2012 assisted suicide ballot measure. And as the Oregon and Washington statistics reveal, there is been almost no participation in the program outside of non-Hispanic whites.

Barbara Wagner

Cost savings are a major driver of today’s end-of-life policy recommendations, as Barbara Wagner learned to her horror. We poorer people and disabled people are already under increasing pressure to refuse life-saving treatment (even antibiotics or temporary ventilation). For people who are often viewed as “better off dead,” assisted suicide will become a recommended option.

Proponents of “aid in dying” have compelling individual stories, but represent a more well-to-do, better educated and whiter portion of the general population.  One social group’s particular views on end of life dignity should not be imposed on such a diverse state as California.

Please think about the profound social implications of enshrining in policy the belief that sometimes it is more dignified, more respectable, to die early. Rather than aid in dying, please focus on aid in living and ending the vast inequalities that are distorting our society.

John B. Kelly
Director
Second Thoughts Massachusettswww.second-thoughts.org

Warning — Hospice Abuse Can Kill You.

Hospice abuse can be euthanasia without consent. The Euthanasia Prevention Coalition (EPC) supports good hospice care, but we are also extremely concerned about hospice abuse. Good hospice care leads to less support for euthanasia and assisted suicide while hospice abuse leads to a greater demand for the legalization of euthanasia and assisted suicide.

By Sara Buscher, an attorney from Appleton Wisconsin. She was elected to leadership positions in Elder Law and in Civil Rights Law, working as an advocate on behalf of people with disabilities and the elderly.

Bud Coffey with his sister.

What do Bud Coffey, Jim Carlen, Roseann Gillespie and Beverly Garguilo have in common? Their deaths from apparently lethal doses of morphine and sedatives while in hospice. These cases are described in a Washington Post exposé by award-winning investigative journalist Peter Whoriskey.[1] They were not dying nor in extreme pain when they enrolled in hospice, but were given excessive doses of painkillers, dying a few days or weeks later.

So how does it work? A 2009 front page New York Times article explained that a strong sedative, typically lorazepam, and a strong pain killer, typically morphine, are supplied drip by drip through an IV until heart rate and breathing are slowed to the point of making it impossible to eat or drink.[2] “In so doing, it can intentionally hasten death.” This practice goes by various names, including “terminal sedation”, “palliative sedation” and “slow euthanasia.” An earlier national survey found 83% of doctors said it is ethically permissible.[3]

The Washington Post article reports on complaints from around the country illustrating the potential dangers of hospice for patients who are not near death, but who are prescribed lethal doses. Yet no data is collected about such abuses.

The article explains that as the hospice industry has grown, more are enrolling patients who aren’t close to death. Lawsuits have sought to recover more than $1 billion in federal money from hospices who have “fraudulently” billed Medicare for these patients. To qualify for Medicare hospice payments, patients must be certified as having terminal conditions likely to lead to death in six months.

Medicare tracks the number of patients who leave hospice alive as a check on honest enrollment practices. The proportion of “hospice survivors” has increased to the point where some experts believe hospices are deliberately enrolling patients who aren’t dying. They can collect $155 a day ($4,650 a month), without visiting them at home. At hundreds of U.S. hospices, more than one in three patients were released alive, according to a new study funded by Medicare. A “hospice survivor profiled in the article refused to take the drugs while she got better. She was finally given a blood test that proved she did not have cancer, but only after spending a year of her life in hospice.

Sadly, Bud Coffey’s family realized too late that the drugs they were giving him per hospice directions had likely ended his life.

Whether patients are nearing death with a terminal condition or not, EPC opposes the intentional ending of peoples lives with lethal doses. Families and patients should avoid inappropriate hospice enrollment. If a hospice is willing to falsify records to get paid by Medicare, in the US, that hospice is more likely to engage in other unethical practices.

Mothers death provided painful example of need to stop assisted suicide.

The following letter was published online by the Montana Missoulian on August 5, 2014.

By Gail Bell - Bozeman Montana

The July 25 guest column by Sara Myers and Dustin Hankinson begins with a discussion of pain, “great pain,” specifically. The paragraph goes on to use the phrase “great pain” to justify “death with dignity,” meaning assisted suicide and euthanasia.

With their column, I couldn’t help but think of my mother’s last years and the decision of others that it was time for her to die. Pain was used as a justification for increases in her medication – to get the job done. This happened three times before she finally died in the hospital on Sept. 6, 2010. The coroner’s report, case No. 100906, lists the cause of death as congestive heart failure with oxygen deprivation and “fentanyl therapy.” The manner of death is listed as “accident.”

Fentanyl is reported “to be 80 to 200 times as potent as morphine.” It’s also well known that fentanyl patch problems cause overdoses, injuries and deaths (Link to article). A 100 mcg/hour fentanyl patch has a range within 24 hours of 1.9-3.8 ng/mL. Mom’s death result was 2.7 ng/mL on/or about 48 hours.

A complaint was filed by me with the Montana Board of Medical Examiners, No. 2012-069-MED. The screening panel dismissed the complaint with prejudice, which means that the board may not consider the complaint in the future.

Since then, I have talked with other people who have had similar experiences involving the death of a family member via a medical overdose. (Link to article).

The column by Myers and Hankinson states, “I believe one should have control of one’s life including its ending.“

I agree with that statement. However, my mother did not have that control. Others dictated for her. 

Please rethink legalizing assisted suicide and euthanasia so that we do not give others even more power to kill.

Assisted suicide has devalued the lives of the elderly in Washington State.

The following letter was printed online by the Revalli Republic news in Montana.

I am a high-school student in Washington state, where assisted suicide is legal. I want to become a doctor. My mother is a caregiver. Sometimes I help her with her clients.

I am writing to tell you about how older people are at risk in Washington, from doctors and hospitals. I will also talk about how attitudes about older people have changed for the worse. This is especially true since our assisted suicide law was passed in 2008.

I grew up in an adult family home. An adult family home is a small elder care facility located in a residential home. The caregivers live in the home with the clients.

My parents and two of my brothers lived in the home. With the clients there, it was like having six grandparents at once. It was a very happy environment.

This was true for the clients too, no matter what their condition was or how long they had to live. My mom could make them happy even when they were dying. The clients’ family members were supportive and seemed happy too, and never suggested that one of the clients should die.

Today, in 2014, we no longer live in an adult family home. My mother is a caregiver for private clients. She also now fears for her clients, especially in the hospital. She is afraid that the hospital will begin “comfort care” (that’s morphine) and her patient will suddenly die. This has already happened. She tries to never leave her patients alone in the hospital. Either she or a family member will be there.

She has also had one client where a family member wanted the client to do the assisted suicide.

In short, older people are no longer valued as they were before.

I hope that you will not follow our path.

Elizabeth Poiana,

Issaquah, Washington

Assisted suicide full of dangers.

The following article was written by Marilyn Golden and published in the Albuquerque Journal on January 18, 2014.

By Marilyn Golden - Senior Policy Analyst, Disability Rights Education and Defense Fund

Marilyn Golden

With the stroke of a pen, a New Mexico judge unraveled some of the most basic protections people in our state have when facing serious illness or disability.

This week, Judge Nan G. Nash of the Second District Court in Albuquerque ruled that the health care system and those entrusted to deliver medical care cannot be prosecuted for prescribing a lethal prescription overdose for the purposes of assisting in the suicide of someone with serious disease or disability.

This ruling tears away at the fabric of what those of us in the disability rights movement have been working to improve: a health care system free to deal with each individual uniquely rather than as a line-item on an accounting ledger, the elimination of abuse and coercion by those seeking to profit or take advantage of someone during a difficult time, and the illusion that individuals with a severe illness or disability should be measured by a flawed societal definition of quality of life.

Nash’s ruling codifies the idea that some lives are not worth living and they should have the option, if not the duty, to “choose” a premature death via a doctor’s prescription pad.

This turn of events in states like New Mexico and Oregon is a frightening prospect for persons living with a disability. If the practice of assisted suicide becomes normalized, what real choice is there for those of us who can cost the most to care for, and need assistance by equipment, specialized vehicles and personal aides to perform daily tasks?

Such was the choice given in the now infamous case of Barbara Wagner in Oregon.

Oregon’s assisted suicide law passed in 1998 and has been widely scrutinized by those in the medical community, disability rights advocates and ethicists who have noted many examples of unreported problems and complications with the law, generally only brought to light through investigative reporting or personal testimonies.

Barbara Wagner

Wagner was an Oregon retiree diagnosed with lung cancer. During the course of her treatment, her physician recommended particular chemotherapy, but within weeks, she received a notice from her insurer that they would not cover the life-saving treatment. However, they would pay for assisted suicide.

Some may believe that an aging grandmother who contracted lung cancer and is in an advanced stage has the obligation, for the good of the herd, to request a lethal prescription and go quietly into the night. We foresee very dangerous social ramifications, as disability and disease are further quantified.

As we work towards world-class health care and access for all, the legalization of assisted suicide is a move toward health care quality and access for only the select.

Further, legalization of assisted suicide does not account for the pressures or coercion from family members or others. While we may think coercion or pressure to die would never happen in our family or acquaintance circle, that cannot be said of every family, and unfortunately, statistics on elder abuse show that ulterior motives can often arise.

In fact, the laws that apply in Oregon and now New Mexico only say that a person must be of a sound mental state when the lethal dose is prescribed. There is no safeguard for an individual’s mental state when the prescription is administered or ingested.

The fact is, even those individuals facing the very end of life have multiple options offered by palliative and hospice care that make assisted suicide unnecessary, such as palliative sedation, where sufficient medication can be provided to render the patient unconscious, if necessary, until he or she passes peacefully.

Assisted suicide is a dangerous across-the-board health care policy, particularly for those of us that live with disability and serious disease on a daily basis. Nash seems to have ignored all the dangers posed to the disability community and seriously ill when the ruling was issued.

We hope New Mexico Attorney General Gary King will stand with the disability rights community and appeal this decision.

The Disability Rights Education and Defense Fund is a leading national civil rights law and policy center whose mission is to advance the civil and human rights of people with disabilities.

Is the Belgian Euthanasia Control and Evaluation Commission a Sham?

This article was published in Dutch by the Belgian Medical Newspaper (www.artsenkrant.com) and in French by “Le Journal du Médecin” on December 20, 2013.

By Dr. Georges Casteur and Dr. Sc. Tom Mortier

Abstract: The Belgian Euthanasia Commission for monitoring and evaluation has no oversight function. It only has an administrative function.

The Belgian Euthanasia Control and Evaluation Commission, more commonly called the Euthanasia Commission was established by the Belgian 2002 Euthanasia Act. This committee has as its main task to ensure an after-the-fact application of the law by the doctors who practice euthanasia.

The physician must complete after each act of euthanasia a document consisting of two parts. The first part contains specific information such as the name of the patient and the physician consulted. This document is confidential and the Euthanasia Commission does not have access to it at first.

The second component is anonymous and contains diagnostic and other circumstances that led to euthanasia. It is only in case of doubt that the committee may decide by a simple majority to consult the first part. The Euthanasia Commission can, by a two-thirds majority, decide to refer the case to the prosecutor.

Since 2002, over 8,000 cases of euthanasia have been recorded. Those cases reported to the Euthanasia Commission were “controlled” as “anonymous” as described above. However these “two words” deserve reflection.

In 11 years, no case has been referred to the prosecutor for reasons that are inherent in the law itself:

• every physician knows how to complete the second part of the document, to not get into trouble;• there are operational issues with the Euthanasia Commission that several recent events have shown.

Some registration documents concerning acts of euthanasia were performed by the President of the Euthanasia Commission himself, and other members of this commission appear to be in a conflict of interest. For example, the President of the Euthanasia Commission practiced on September 30 2013, under the gaze of cameras, euthanasia in a transsexual, who became depressed after surgery for sex reassignment. This file was publicized in the extreme and has been submitted by this same President to the Euthanasia Commission. However, the President nevertheless stated publicly that this act fits perfectly within the statutory criteria of the law. How could the members of the Euthanasia Commission possibly still oppose this case when their President already played publicly the judge and the executioner?

Moreover, this same president said in front of the cameras that he already has practiced euthanasia on foreigners who had found their way to our country for a lethal injection.

To what extent will the members of this committee oppose such abuses?

Is it surprising that the impartiality of the commission, as required by law, is in doubt?

How can this Committee accept as its president a man who presents himself in the media as a judge and a jury?

Should we wonder why no file has been referred for prosecution so far?

We come to the conclusion that even the most strict application of the law to prevent abuses doesn’t work. Therefore, the Euthanasia Commission has no control function at all, but only an administrative record function!

When even the president of the Euthanasia Committee is profiling himself openly as a judge and a jury, it seems all the more important that the operation and the impartiality of this commission is severely questioned. It is high time to consider a solution such as a before the act control commission or the replacement of the Euthanasia Commission by a panel of judges, advised by doctors if necessary.

Dr. Georges Casteur, General Practitioner, Ostend

Dr. Sc. Tom Mortier, The Department of Health and Technology, Leuven University College

Links to similar articles:

● Québec's bill 52 and the Belgium euthanasia law are not safe.

● Euthanasia in Belgium: Safeguards and controls do not work.

● Belgium's experience with euthanasia teaches that safeguards are an illusion.

● Members of the Belgian Euthanasia Commission appear to be in a conflict of interest.

Quebec: Be Careful with Euthanasia

The following letter was published in the National Post on August 21, 2013.

Margaret Somerville

By Margaret Somerville

Re: Euthanasia May Land On Doctors’ Agenda, Aug. 17.

This story notes that the Canadian Medical Association’s policy opposing euthanasia and doctor-assisted suicide has “not [been] updated since 2007,” implying it needs updating. But a six-year timespan is minuscule for a policy that dates back nearly 2,500 years.

Morphine being administered “to control terminal pain” is proffered as an example of euthanasia “already [being] practiced.” But this is not euthanasia. Moreover, properly chosen and titrated pain management does relieve pain and does not kill people, contrary to popular belief.

The concept of “dying healthy” is, to say the least, puzzling — if you are healthy, you don’t die. That leads to Quebec’s Bill 52, which would allow “medically assisted death” (euthanasia). This story refers to “dying” people having access to euthanasia, but it would not be limited to them. Rather, it would include those who “suffer from an incurable serious illness; suffer from an advanced state of irreversible decline in capability; and suffer from constant and unbearable physical or psychological pain which cannot be relieved in a manner the person deems tolerable.” In short, people who are not terminally ill or mentally, but not physically, ill, could have access to euthanasia. Many disabled, old, frail and vulnerable people would fulfill these criteria.

Margaret Somerville, McGill Centre for Medicine, Ethics and Law, Montreal.

Don't give doctors euthanasia powers.

Yesterday, the National Post published an edited version of my letter that they titled: Don't give doctors euthanasia powers. 

My letter responded to the article: That terrifies us: Canadian doctors get virtually no training on handling a patients desire to die.

Alex Schadenberg

Don't give doctors euthanasia powers.

By Alex Schadenberg

Executive Director, Euthanasia Prevention Coalition

This article notes that "Most doctors finish their degrees ... with virtually no instruction on how to deal with death generally, let alone patients who ask for help with suicide." 

I believe that between the lines, this article is suggesting that if euthanasia were legal, end-of-life care would improve. Instead, legalizing euthanasia in Canada would give physicians the right, in law, to cause the death of their patients by lethal injection.

The article focuses on a few bad cases while suggesting that good end-of-life care can lead to a good death. 

When euthanasia becomes part of a medical system it leads to new ethical problems and unlike most medical errors, the abuse of euthanasia causes death.

In Belgium, where euthanasia is legal, independent studies have found that 32% of assisted deaths are done without request. These deaths are hidden from the statistics since another study found that 47% of the assisted deaths were not reported.

Considering all the difficulties that we are experiencing within Canada's medical system, do we really want our doctors to gain the right, in law, to cause our death?