Death with Dignity – October 2012

Overview of National News – October 2012

(NOTE: For list of articles quoted, go to Categories: Assisted Dying & Euthanasia: Assisted-Death Debate – October 2012)

The major news throughout October has been about the vote in a few days in Massachusetts for a Death With Dignity law, similar to the proven-effective laws in Oregon and Washington. The laws provide similar guidelines and safeguards for those dying patients who want to request a prescription from a physician to hasten their deaths if they decide to and for those physicians who may write the prescriptions.

Is it a perfect law, no. Do some of the opponents have legitimate concerns, certainly. Do they have a right to impose their beliefs on others, no. Is it a work in progress, yes. We need rational debate not fear tactics and threats of being banished to hell to consider all sides of the issue.

I found it interesting that I only came across relevant articles from 12 states and Washington, DC in October. Most articles mentioned the growing debate about the Massachusetts ballot issue to be voted on November 6… however, the one Illinois article discussed the controversy over a proposed  assisted-death bill being introduced in Quebec and the one article from North Carolina had the anti-euthanasia advocate from Canada claiming fraud and abuse at Dignitas in Switzerland. They may be testing the waters.

In Oregon, where the Death with Dignity law has already passed, some of its financially-strapped hospitals are now facing take-over by the Catholic healthcare systems whose execs tell the town folks nothing will change… well, except that abortions (unless to save the life of the mother) and writing prescriptions for a life-ending drug won’t be allowed “on their dime.”

The people of Ashland kicked them out but they continue to target other towns in Oregon and Washington. According to a Catholic Bishop in Wisconsin, supporting a woman’s right to reproductive freedom (abortion); death with dignity (euthanasia); important scientific research (stem cell research); and marriage equality for gay and lesbian citizens are all “intrinsically evil” and, of course, we are all going to hell in a handbasket.

BTW, a gay bashing group from Mississippi sent the opponents of the Death with Dignity law in Massachusetts $250,000 to help them with their campaign. It became a hot news item and they were guilted into sending at least some of it back, although they continue to accept contributions from the Catholic Church (whatever happened to separation between Church and State?) and other dubious supporters for the media blitz this week leading up to voting day.

Unfortunately, it seems their media blitz is working because the gap that according to polls was a slam dunk for passage has been shrinking the past week. Don’t take anything for granted if you want this to pass. Get out and vote, and tell your friends to vote their choice.

It seems that in some states people are beginning to look at this issue and talk amongst themselves about how they want to die when their time comes. If it passes in Massachusetts, some claim it will open the floodgates for other states to get it on the ballot. One writer prophesized: “Coming soon to your state!”

The next states getting close to having a Death with Dignity law on the ballot are New Jersey, Hawaii, Vermont and Texas… and, who knows, maybe even Montana will make it official soon!

People in those other 38 states need to wake up and pay attention not just to what’s happening in Massachusetts, but all over the world on this issue because this is an idea whose time has come. And it’s not going to go quietly away.

Overview of International News – October 2012

In Australia, euthanasia advocate Dr. Philip Nitschke is urging Tasmania’s Upper House MPs to open their minds to what he calls progressive legislation. A discussion paper on legalising voluntary euthanasia is due out in the next few months. A euthanasia bill will have to pass the Upper House before it can go to parliament next year. The issue of gay marriage has only just been dismissed from the Tasmanian Parliament but already Christian groups are preparing for the next moral battle while MLC Paul Harriss has dismissed the debate as a Green-led agenda.

Actor and Bell Shakespeare theatre director John Bell who supports the rights of patients to choose to end their life says it is not a morose or negative cause. ”We’re not about embracing death … we are about celebrating life. Once the quality of life is gone, life is not worth very much,” he said. ”I don’t want to reach that stage of being incontinent, helpless, totally dependent. It’s a dreadful way to end a life that’s been a very happy and blessed one.” John said that often children of parents are particularly torn by how to care for their dying loved one. “They often feel guilty about wanting the parent to go, and therefore not being able to let them go and not knowing how to do it.”

Sarah Edelman, clinical psychologist and vice-president of Dying with Dignity, NSW, says that under current law it is legal to starve oneself to death over several weeks in a hospital bed and to commit suicide using violent means. (In fact, it is difficult to end one’s own life peacefully without appropriate medication or ”insider knowledge”). However, it is illegal to access medical help to die peacefully when faced with intolerable suffering and no prospect of recovery, or when dying is slow, painful and undignified. Politicians should be asked why this is an acceptable state of affairs.

From a woman in Sydney– “Right now there are two people in my life wanting to die. My 19-year-old university student friend Josh made his intentions really, really clear last week. He stood in front of a train. It didn’t kill him and he is vigorously being kept alive in intensive care. My 86-year-old dad, Bob, who lives in an aged care facility, regularly quotes the Ol’ Man River song ‘I’m tired of living, but scared of dying.’ So with all this talk about the possibility of legalising euthanasia, what’s the difference between Josh’s suicide attempt and assisted suicide should my dad Bob want it?

David Leaf, a Dying with Dignity NSW board member, said mounting evidence that supported legalising euthanasia was being ignored. He said assisted dying programs worked, with no evidence of heightened risk for groups considered vulnerable to euthanasia, including the elderly, uninsured, poor, physically disabled and mentally ill.

Dr Leaf criticised Father Brennan and “other Catholic lobbyists” for using emotive terms like “legal killing,” “suicide,” “death by doctor,” and “lethal injection” in their input into the debate. “I’m not anti-Catholic, but I’m anti-bullshit,” Dr Leaf said.

More than 200 Australian doctors have banded together to call for law reform on voluntary euthanasia, but few of them would want to administer a fatal drug dose. “But doctors wouldn’t be administering the drug, because that responsibility could instead lie with the patient who would self-administer the dose, which is what happens in countries where it is legalised,” Dr Marr said.”This is not about the suffering of doctors, it’s about the suffering of the patients and that’s what the doctors signed up to our organisation recognise.”

When the swimming champion Murray Rose died on a quiet Sunday last April, he was at peace. His wife, Jodi, believes palliative care and a supported death at home helped create that peace. “There’s no greater transition than death – and you want it with dignity,” she said. “He loved being at home so I knew in general that if there was any way he could pass away at home that was our ideal scenario. I did not do it alone. I could not have done it alone,” she said. The provision of palliative care in NSW is at a critical juncture: historically underfunded services are struggling to meet increasing demand while federal funding appears to be drying up. The Roses’ experience is unusual in NSW, according to the Palliative Care Plan. One third of people who die of cancer and 90 per cent of those who die predictable deaths from other conditions do not receive palliative care.

And this is one of the problems everywhere it’s being debated. People say palliative care can help relieve the pain and suffering that often comes with the dying process. First, palliative care isn’t available everywhere, in fact hardly anywhere– it’s a new field. Second, there aren’t enough trained medical people to administer and implement palliative care programs to handle the growing need (think Baby Boomers). And third, what is available is expensive and mostly not covered by insurance– including Medicare, which will pay the MD but not the nurses, the social workers, the caregiver assistants, or the chaplains necessary to make it truly a palliative care program.

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In Belgium, deaths from “voluntary euthanasia” are approximated at 2 percent, – 2,000 annually. At a recent conference in Brussels, a Belgian doctor reported that organ transplants are being done on euthanized patients and that Belgium leads in this practice. Dr. Van Raemdonck reported that nine successful lung transplants from “voluntary euthanized” patients have been performed since 2007.

If a person who is an organ donor is brought into the emergency room and declared brain dead, his body can be kept alive by machines until his organs can be harvested. What’s the difference if a person who is dying wants to be euthanized at some point so that his still viable organs can be harvested for transplant? I’m sure there will be outcries from the right that people will want to euthanize granny and sell her lungs when this gets around.

A filmmaker researching a film about dying interviewed two doctors who told him, “Unusually, the Belgian palliative-care movement and right-to-die movement developed alongside each other. Today, following legalisation in 2002, both palliative care and euthanasia are available alongside each other in the mostly Catholic-run public hospitals as part of an integrated system of end-of-life care. Under Belgian law there two key preconditions: incurable illness and unbearable suffering. The euthanasia usually takes place in the presence of friends and family, often accompanied by prayers, music and even champagne.

In the city of Hasselt, Fr Marc Desmet, a kindly palliative-care consultant and Jesuit priest, brought us to meet an older woman, Delphine Van Hoebrock, the evening before she was euthanised. He held her hand gently as he checked whether she had any last doubts. She seemed remarkably certain and sanguine about her choice, although I couldn’t help sensing some loneliness too. It was both emotionally charged and strange to spend time with Delphine on the eve of her chosen death. Heartbreakingly sad also, even though we knew her only fleetingly. Even an assisted death is a sad and lonely affair, it seems, no matter how much it is desired.

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It looks looks Canada is set to become the next country to allow assisted dying. The Quebec legislature passed a report early in October, after two years of work from the Dying With Dignity Committee. The action was part of the Parti Quebecois’ election agenda (Parti Quebecois is the minority government in Quebec at present) and likewise had the backing of the all-party National Assembly committee.  The Liberals have remained silent on the issue.

Nonetheless, the Criminal Code still prohibits medically assisted-suicide. Social services junior minister Véronique Hivon asserts that Quebec can pass the law without the support of Ottawa as “Quebec has jurisdiction over health and also over professional qualifications” which “gives us the confidence to introduce this medical aid in dying in our bill.” The passing of the law will place Canada under the umbrella of other countries who exercise physician assisted-suicide such as Switzerland, Belgium and the Netherlands along with a few American states.

Wanda Morris, Executive Director of Dying With Dignity-Canada, believes Canada has a clean slate where” we can introduce any criteria for eligibility we choose, and we can adopt whatever safeguards we feel are necessary.” Canadians can look to the decision of B.C. Supreme Court Justice Lynn Smith who had access to detailed testimony from both sides, experts from around the world and the results of cross-examinations from both teams of lawyers.

Among her conclusions: there is no slippery slope; the safeguards work. “In my opinion, opponent’s presentation of data from Oregon and Netherlands is generally incomplete, frequently filled with factual inaccuracies and distortions, and often meant to construct a false empirical foundation for what is essentially a moral opposition to the practice of physician-assisted death.”

Ottawa, on the other hand, has filed its arguments in an appeal of a B.C. decision that struck down the prohibition on doctor-assisted suicide, arguing the trial judge was wrong to conclude the law is unconstitutional. In documents filed with the B.C. Court of Appeal, the government says the law reflects a reasonable belief that allowing assisted suicide would put vulnerable people at risk of being coerced or even forced to end their lives. The government says the law reflects Parliament’s desire to discourage and prevent suicide in all cases, and it should be up to lawmakers, not the courts, to decide if that needs to change.

Quebec grassroots group Living with Dignity director Linda Couture expressed alarm at how fast the government is moving, noting the new government hopes to have a bill passed by June next year.

Consistent with Canadian law, most of the country’s medical governing bodies are opposed to assisted death. So taking a principled stand, even within the quiet confidence of colleagues, can trigger career-ending attacks from within.They have to worry as a physician how the public, their patients, and their colleagues are going to view them. Whenever you depart from the traditional viewpoint in medicine, it’s going to be uncomfortable.

Some doctors fear the hot-button issue is drawing focus away from a different, and widely used form of end-of-life care. Dr. Romayne Gallagher works with the palliative care program at Providence Health Care, which aims to alleviate suffering for the dying. However, even though Canada has offered palliative care since 1975, it is still largely unavailable to most Canadians.

So medically assisted death is still not an option in Canada, but it’s  only a matter of time before it is. And we’re talking a few more years, not decades. But Canadians are already finding ways to spare themselves unbearable suffering, because there are organizations out there willing to educate them about the alternatives. And those organizations are watching with interest as several court cases wind their way through the justice system — cases which could turn the tide.

Meg Westley witnessed two people die. One died painfully and slowly of the cancer ravaging her body. Another was relatively well, but decided to hasten his death before Huntington’s disease took its terrible toll. Both, she believes, were abandoned by Canada’s ban on assisted suicide.

“I think it’s barbaric that even though people want to go, we let them suffer on,” said Westley, a University of Waterloo communications professor and president of the right-to-die advocacy group Dying with Dignity. “It is about compassion,” she said. “Give them the assistance so they don’t have to suffer if that’s their choice.”

The wrenching experience was made worse knowing Nagui Morcos died when he still had months, even a couple years of relatively decent health to enjoy with his wife, family and friends. But Morcos knew he could not get the help needed later when he was no longer physically able to end his life on his own. Watching life slip away from this cheerful and passionate man who talked repeatedly of the great moments he would miss reaffirmed the unfairness of Canada’s law against doctor-assisted suicide.

Gloria Taylor, the 64 year-old Okanagan woman who had amyotrophic lateral sclerosis, or Lou Gehrig’s disease and fought to change Canada’s law on assisted dying, died in early October. She was gradually losing control of her muscles and feared dying of the disease. Together with two others, she launched a lawsuit claiming that the Canadian Charter of Rights implied a right to choose the time of her death. Judge Lynn Smith agreed and struck down the law, but suspended her judgement until after the inevitable appeal. However, she did give Ms Taylor a personal exemption from the law, making her the only person in Canada allowed to have recourse to doctor-assisted suicide.The Association says Taylor’s death was sudden: she developed a severe infection resulting from a perforated colon. Given the acute nature of the illness, she did not need to seek the assistance of a physician to end her life.

An Ontario man also with ALS ended his life this month. Part of his final statement reads as a kind of social treatise on the role of government in the final choices of Canadians. “Any liberal, democratic system respectful of human rights should provide for a legal and humane way to exit this life at a time chosen by a rational person and with appropriate safeguards and assistance. Unfortunately, the Government of Canada and Canada’s Supreme Court do no do so. While Canada’s law criminalizing assisted death may have been conceived to protect life, it can have the effect of doing just the opposite. I am now looking for ways to die that I must implement myself, that is while I am still sufficiently strong to take all the necessary steps myself. Having in mind the nature of ALS, this will force me to terminate my life earlier than would otherwise be the case.”

“People are dying too early because of laws against assisted dying. People are killing themselves while they still have the ability to do it.” Wanda Morris, Executive Director of the national organization, Dying With Dignity, advocates with great passion and compassion the urgent need to legalize assisted dying for individuals who have been diagnosed with a terminal illness or a progressive incurable physical illness.

What choices are they left with? With the blasé patter of an airline attendant explaining the protocols of oxygen mask use, the 71-year-old retired librarian removes a microwave bag and pulls it over her head, her face shrouded beneath clear plastic, her features blurring, her graying bun compressed into a soft helmet. Slowly, her fingers begin to pinch a seal around her neck using Velcro strips she attached at the open end of the bag. Her voice muffled and faint, she points to the spot where a tube is to be inserted. “I would probably use helium,” she declares, deadpan. “A few deep breaths and you fade off.”  She is Ruth von Fuchs of the Right to Die Society of Canada who says, “No one wants to die alone. Most just want someone there to hold their hand.” Von Fuchs is a death midwife.

The Social Science Research Laboratory at the University of Saskatchewan – the only facility of its kind in Canada – created the Taking the Pulse survey in its group analysis lab, which includes multiple departments from across the Faculty of Arts and Sciences. Their research found that 59 per cent of Saskatchewanians surveyed believe they should have the option of doctor-assisted suicide when the end is nigh.

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A senate committee in Colombia voted 10-4 to send a proposed measure to regulate euthanasia to the full Senate for consideration. If approved the measure would be sent to the Colombian House of Representatives for a vote.

A representative of the Colombian bishops, Father Pedro Mercado Cepeda, pronounced that “No circumstance can make it legally acceptable to intentionally cause the death of a human being.  The right to life is constitutionally inviolable.”

Now here’s a country where people are lying dead in the streets due to the drug cartels and Father Pedro here is making a moral issue of people who probably have no healthcare to begin with and just want out of the misery of their lives. Take care of the people and stay out of politics Father!

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The Law Commission in India has made a recommendation to the government to initiate measures to enact a comprehensive law on passive euthanasia, subject to certain safeguards. “It’s not objectionable from a legal and constitutional point of view,” the commission, which advises the government on legal issues, said.

Dr. Pallavi A. Roshi says  “This decade has brought a significant change in a doctor’s point of view. Many of us have changed the focus from ‘only care’ to ‘cure and comfort’ to ‘only comfort,’ when cure is impossible. Although doctors should strive to extend life and decrease suffering, they must also accept death as a defining characteristic of life. Sometimes, so-called heroic methods may lead to needless suffering instead of preventing death. So, when the incurability of a disease is confirmed, there begins the journey of palliative care to make the end of life easy, and assuring the patient of a dignified death.”

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From Ireland… Sadly, cases like Jenny Grainger’s, who had to stand by and watch her mother stop eating and drinking to have a better death than she might otherwise have had, are not uncommon. Barbara Grainger (75), who had a motor neuron disease and was a lifelong supporter of euthanasia, told her daughter that she wanted to die and asked for her help. Barbara also wanted the tragic story of her death made public in the hope of helping bring about a change in the law which governs people’s right to choose when and how they die. She wanted to go to Switzerland to Dignitas, but unfortunately she wouldn’t be able to swallow the barbiturate pill given there. So she decided that she would die through a voluntary refusal of food and fluids.

Too often, we see accounts of people travelling abroad to die, or attempting to end their lives at home, sometimes alone to avoid implicating loved ones. For this reason, as well as the many people who suffer unbearably against their wishes, many people in Ireland are campaigning for a change in the law.

One writer says, “if we agree that people like Barbara Grainger  should not have to suffer against her wishes at the end of her life, which the vast majority of us do, then we must continue to fight for a law in the UK which allows dying, competent adults the choice of a peaceful and dignified assisted death. No one should have to contemplate travelling thousands of miles for assistance, or weeks refusing food or water to have what they consider a good death.”

Another writer goes on about all the reasons it’s a bad idea, slippery slope and all, and proclaims– “The vulnerable and sick need support and reassurance they won’t suffer alone. It is sometimes difficult for families to give this support, so there is a duty on society to provide it. The compassionate response to suffering is not to encourage suicide, but to offer the palliative care and psychological support the sick need to help them live.

Perhaps in a perfect world. Once again, I’d ask where is that support? In most cases, it’s either not available or too expensive for the people who need it most. We need to meet people where they are, not in some hoped for future.

“Regardless of their religious or political background, this is an issue which affects everyone and politicians need to take a stand and help bring about the change in the law, which currently robs people of their right to choose,” says Jenny Grainger. She has been inundated with messages of support since she shared the heartbreaking story of how her family stood by her mum when she chose to end her own life through the voluntary refusal of food and fluids. Because she did not have the option of a quick and pain-free death through euthanasia, Barbara lingered for 24 days before her heart finally stopped.

An Irish assisted-suicide campaigner will not face prosecution over his visit to an elderly multiple sclerosis sufferer (MS) who took a fatal overdose to end her life because there is “insufficient evidence.” Tom Curran, who says he will risk up to 14 years in an Irish prison to assist his partner Marie Fleming — also a MS sufferer — to die at a time of her choosing, was interviewed by British police following the death of a wheelchair-bound grandmother of five. Ann Veasey (71) died in August 2011 at her nursing home in Harrogate, North Yorkshire, after she overdosed on pills she had bought online from China.

On the face of it, there is an overwhelming case to permit assisted suicide. For the greater, if not far greater, part, it would apply to people who have lived a life, made it into the upper reaches of the average span, and, were it not for a debilitating condition, would want to cling to life. Why should somebody in that position be held prisoner by nothing more than a societal taboo? Why should that person not be afforded the comfort of knowing that they were ultimately existing on their own terms? On the other hand, there is an argument that any introduction would lead down the slippery slope to elderly people being pressured to consent to their own death.

We live in a society that values choice. We choose our careers, our partners and almost every aspect of our lives. It is then a strange situation that we are ultimately unable to choose the nature of our deaths beyond a small number of options. As the Tony Nicklinson and Marie Fleming cases reach their conclusions in the media and the courts, we may have to reassess this strange paradox and address how we ourselves want to die, on our own terms or on the terms of our final illness?

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From Italy, an online newspaper aimed at providing the last breaking news on welfare policies, an article about the advance of euthanasia in The Netherlands.

Pioneer in Europe, with a law issued in 2002, the Netherlands explicitly guarantee to its citizens the right to interrupt treatment if they want to or can no longer stand their disease. The same right has been then recognized in Belgium, Luxembourg and Switzerland. This latter rejected a few days ago a proposal to ban assisted suicide to foreigners in its territory, thus confirming the outcome of a popular referendum held last year. After all, there is no risk that the country can be invaded by ‘mild death’ tourists: in the last few years, the number of sick persons – mainly from France, Germany and the UK –  emigrating to Switzerland to appeal to the assisted suicide law for a decent and aware end of life (even in the most serious cases of depression) was cut by half.

If in 2006 there were 199 cases of euthanasia among extra-EU citizens, in 2010 this number dropped to 97. Perhaps because, over the years, other European countries have authorized treatment interruption in different ways, while in others euthanasia is still a topic in political and social debate. This is the case of France, where President Hollande announced a palliative care reform last summer. Not the case of Italy, though. “Euthanasia” still remains an unrepeatable word here. Meanwhile, Vatican’s spokespersons in Parliament, probably alarmed by the refusal of any form of therapeutic obstinacy opposed by cardinal Carlo Maria Martini, push for the approval of a law on the living will with dubious constitutional outlines.

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Retired film director Michael Winner has considered ending his life at a euthanasia clinic after doctors told him he has just 18 months to live. The moviemaker from New Zealand, who has battled ill health in recent years, revealed this summer that liver specialists have given him between 18 months and two years and he now admits the prognosis led him to look into the controversial Dignitas institution in Switzerland. The 76-year-old opened up about his research  insisting he was put off by the amount of paperwork required to go through with assisted suicide.

He says, “I checked Dignitas on the computer and you need to go through so much. It’s not a walk-in death. You don’t just go in and say ‘Here I am, do your worst.’ You have to go through a whole series of papers and re-examinations just to die. You have to fill in forms and things and you have to fly there, go back twice…

“I think the idea that people should be able to have an assisted suicide is absolutely highly proper. Why should people elongate life when it’s no good for them? People should have the right to terminate their own life. If you’re dead, you’re dead, so who cares? I’m very happy to snuff it. I’ve had enough time on earth. I’d be happy if someone gave me the plug to pull.”

“If you have the right to die, it’s a completely different feeling than if you do something that is not legal,” Anne Mohrdieck said. “It’s different for me and it’s different for the people around me. It is to die with dignity. “Everyone has different abilities to cope with the suffering. If my ability does not allow me to have a quality of life in any way, and I choose a better option would be to go out … then I’d be enraged if that possibility would be taken from me or wouldn’t be given to me.”
Mary Stewart says euthanasia is just a euphemism for hetero-homicide – getting someone to kill you. After 30 years as a nurse, Mrs Stewart says it will confuse the role of health professionals, who swear an oath to heal and provide comfort.New Zealand medical practitioners anecdotally report having been asked by their patients for assistance in dying gracefully, and many of them have complied. However, rather than following a protocol with built-in safeguards and safety standards, the process is unregulated. For patients and family members who decide to take things into their own hands, the outcome could be devastating.
Advanced care-planning initiatives and advance directives in New Zealand already address patients’ objectives and desires for refusing medical treatment in emergent situations. If those conversations expand to include aid-in-dying options for the terminally ill, then patients have a true grasp of the entire spectrum available to them. Further, it allows family members to discuss options and support each other, rather than have secret conversations and fear of legal prosecution if they follow a loved one’s requests. Medical practitioners have clearly defined processes in place, and medical protocols they must follow to comply with legislation. This protects medical practitioners from having to guess at an appropriate dosage or surmise which drugs to use. The process is defined and has paperwork that shows protocols are followed. There is no legal ramification for following their patient’s wishes. Further, medical practitioners may opt out of the process, which protects their rights to their own personal beliefs about death and dying.
And under the headline of Euthanasia Opens Floodgates of Nastiness— Once assisted suicide becomes legal, anyone old and frail and rich will be expected to do the decent thing by whoever stands to profit from their death. Athinly-disguised legal murder will become routine, especially as lack of respect for the old, and the belief that they don’t have any quality of life anyway, is underscored by the ease with which you can ”help” them die.***From Russia, On the death ofbard Ada Yakusheva– I had heard that Yakusheva was battling cancer, but what I hadn’t realized is that her doctors had denied her pain medication, on the basis of some bureaucratic error. When her relatives confronted them about her suffering, they were curtly told, “everyone suffers.” Only on her final day alive was Yakusheva allowed some dignity and peace. A hospice doctor had her transferred to a palliative care facility. She was given a shot of morphine, curled up, and slept for what was probably the first time in a month. The following morning, Yakusheva passed away peacefully.

The other issue here is, of course, the attitude of the actual doctors. Most are simply not trained to make their patients comfortable. Once it is clear that the patient is dying – a lot of them simply stop caring. And even though palliative care is certainly a major aspect of healthcare in modern Russia, many doctors still resist any urge to call a colleague who works in that field, if only because they don’t want anyone taking over their case. Yakusheva’s doctors went as far as to accuse her relatives of trying to use the dying woman’s condition to score drugs for themselves. The fact that this happened to a well-known personality speaks to the enormity of the problem.

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In Scotland, there is concern that the Swiss assisted-suicide clinic Dignitas helped 217 Britons to die in 10 years. It is understood that the Dignitas Clinic in Switzerland has more than 900 Britons on its books and has ended more than 20 lives a year on average since it was set up ten years ago. The new figures from Dignitas and progress of Ms MacDonald’s latest bill has led anti-assisted suicide campaigners to warn against a change in the law.

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South Africans are discussing how voluntary euthanasia is legal for citizens of Holland and Belgium, and doctor-assisted dying is legal in a few states in the US, and in Switzerland. Lord Joffe is confident it will be legal in the UK in the not too distant future. When asked which he thought was easier — voluntary euthanasia or doctor-assisted dying? He felt it was easier to get someone else to kill you, than to kill yourself. On reflection, the reporter  could only agree. Yet no matter whether it’s voluntary euthanasia or doctor-assisted dying you’re after, the driving force behind legalising it is simply dignity in death.

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According to a new study by the University of Zurich, Switzerland, one in four people who accompany someone to commit assisted suicide suffer massive psychological distress. Researchers at the university spoke to 85 people who went with a family member or close friend to an EXIT euthanasia clinic one to two years after the assisted death of loved ones. A quarter suffered from post traumatic stress disorder while 16 percent had depression. Five percent were found to have long-term grief. The results state that problems can surface 14 to 24 months later and that a death not from natural causes was a heavy burden for those who supported the deceased. Although the research didn’t include a direct comparison with the effects of a natural death on a loved one, the study was compared to others. This showed the researchers that post traumatic stress disorder was more common for people close to an assisted suicide case rather than a natural death.

They don’t mention the other 54% who apparently weren’t heavily burdened or traumatized– and I wouldn’t be surprised to find out that the whole ordeal of having to take one’s dying loved one somewhere to die, as opposed to being in one’s own bed in one’s own home surrounded by loved ones, has a lot to do with the agony of it all.

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Dr. Peter Saunders, a former general surgeon and CEO of Christian Medical Fellowship, a UK-based organization with 4,500 UK doctors and 1,000 medical students as members, says the current British Suicide Act is thereby shown to remain fit for purpose. Through its blanket prohibition on all assistance with suicide, it continues to provide a strong deterrent to the exploitation and abuse of vulnerable people whilst giving both prosecutors and judges discretion in hard cases. It strikes the right balance, is clear and fair and does not need changing. The Swiss vote means that the small number of British people travelling to Switzerland to end their lives will probably continue but we should continue to resist any calls from pressure groups to weaken the law here in the UK.

A poll conducted by Christian Concern surveyed more than 150 MPs across all parties and found that only 29 per cent supported proposals to introduce assisted suicide, whilst 59 per cent were opposed to the move and 12 per cent were undecided. The poll also found that the majority of MPs believe that a change in the law would result in an increase in the number of suicides, and 72 per cent felt that it would place vulnerable people under pressure to end their lives prematurely. Almost 60 per cent were of the opinion that the current economic climate would result in more patients opting for an assisted death to avoid placing a financial burden on family members and carers.

Regarding the case of Tony Nicklinson, who chose to starve himself to death after losing his last appeal for euthanasia in September, a reporter from the Christian Institute wrote: The case of a man who campaigned for doctors to be allowed to kill him will not go to the Court of Appeal, High Court Judges have ruled. Lord Justice Toulson said the case was “plainly a matter for Parliament.” Tony Nicklinson, who suffered from a condition known as ‘locked-in syndrome’, wanted doctors to be able to end his life.

Now judges at the High Court have turned down an application by Jane Nicklinson to be made party to the proceedings. Lord Justice Toulson said: “We do not consider that the proposed appeal has any real prospect of success. Mrs Nicklinson has vowed to appeal the decision. However a second locked-in sufferer, whose case was heard alongside that of Mr Nicklinson, has been given leave to appeal.

Meanwhile, Jane Nicklinson says, “It is not easy to admit feeling relieved that the love of your life, your soul mate, has died.” But that is exactly how Jane Nicklinson feels about husband Tony Nicklinson, the assisted suicide campaigner who died of natural causes six weeks ago. Mrs Nicklinson understands that she might come across as callous or uncaring, especially by those who opposed her family’s very public battle to change the law so that locked-in syndrome sufferer Tony could be legally helped to end his life. But for anyone who has cared for a loved one with an intolerable terminal or degenerative condition, Mrs Nicklinson may just be articulating what many find too difficult to admit.

The widow is expected to call this week for Scotland to become the first part of the UK to change the law on assisted suicide. She will appear at a conference in Edinburgh with the MSP Margo MacDonald, who has already tried and failed to make assisted suicide legal north of the border. The conference will also hear from Ludwig Minelli, founder of Dignitas, the assisted dying organisation in Switzerland. Among Ms MacDonald’s new proposals is a suggestion that a “licensed facilitator”, a so-called “friend at the end”, would have to be present when someone was at the point of ending their own life. The facilitator could be a doctor, social worker, or close friend but not a relative or anyone who stood to gain from the death.

Exactly what I’ve been proposing– Transition Guides, death midwives, doulas. It doesn’t have to be a physician since they are so attached to Hippocrates and don’t understand how important healing of the soul is at the end of life. We need a new specialty and a new perspective about the end of life.

Now doctors have a new worry– Doctors are required to provide access to a patient’s records under the Data Protection Act 1998 if a ‘subject access request’ has been made. However, new GMC draft guidance for fitness-to-practise decision-makers, due to be published later this year, advises it is a criminal offence for doctors to encourage or assist a person to commit or attempt suicide. GPs should explain this to patients when faced with demands for medical records for this purpose, the guidance says. The GMC says that GPs are required to provide medical records under the Data Protection Act. However, if a GP suspects this will be used for the purposes of assisted dying, the GP will be contravening the 1961 Suicide Act by providing the medical records.

Which means if you plan to go to Dignitas, don’t tell your doctor when you ask for your medical records.

Dignitas has seen an average of 18 British citizens coming through its door each year since 2002 and many have chosen to be very open about what compelled them to travel abroad to die. Having control over the timing of their death and avoiding a painful, lingering end have been the over-riding wishes of people like Dr Anne Turner, Peter Smedley and Jackie Meacock as they made their final journey to Zurich. For those who travelled with them, there was always the fear of prosecution but, to date, no-one who accompanied any of the 182 Britons has been prosecuted.

The European Court of Human Rights in Strasbourg last year, ruled that while there is a “Human Right” to suicide, the state has no obligation to provide citizens with the means to commit suicide. Grégor Puppinck, the director of the European Centre for Law and Justice explained, “The Court notes that the vast majority of member States place more weight on the protection of an individual’s life than on the right to end one’s life and concludes that the States have a broad margin of appreciation in that respect.”

During a panel discussion with Human Rights solicitors, Richard Stein observed that the argument that there can never be adequate safeguards to protect the vulnerable  is being used as a “smokescreen”, and, equally, the notion that disabled people cannot exercise their free will to die because it reduces the value of disabled lives is a “hugely patronising” one.

All this reflects a big shift towards secular thinking and individual autonomy as well as growing worries about the medicalised, miserable and costly way of death that awaits many people in rich countries. Assisted suicide typically gains overwhelming public support; legislators, pro-family lobbies, churches and doctors’ groups tend to be more squeamish. They fear that legal, easy-to-get assisted suicide will have dire social and moral effects.

More from Dr. Peter Saunders– Now that the Tony Nicklinson case is over and the next assisted suicide bills (from Falconer in the House of Lords and Macdonald in Scotland) are not to be debated until next year one could be forgiven for thinking that the relentless media pressure for the legalisation of euthanasia might relent for a few weeks. But no – first we have the pronouncements of junior health ministers Norman Lamb and Anna Soubry giving their support for the legalisation of assisted suicide and now the BBC, in its role as cheerleader for assisted suicide, is making an international news story about the fact that it is ten years since the first Briton went to the Dignitas suicide facility in Zurich to kill himself.

As fall-outs between pro-life campaigners go, this one has yet to surface, but it could turn for the worse. The tension is over whether or not the Liverpool Care Pathway (LCP) is being used as a form of euthanasia. In June Dr Patrick Pullicino, a neurologist, claimed that the Pathway was an “assisted death pathway”. According to the doctor, patients are being placed on the LCP without clear evidence that they are close to death, while the sensationalised Daily Mail headline ran: “Top doctor’s chilling claim: The NHS kills off 130,000 elderly patients every year” – where 130,000 is the total number of patients who are put on the LCP out of the 450,000 that are terminally ill. In other words, the majority of people who are close to death are not put on the Pathway.

Since it was rolled out across the country in 2004, it has received three glowing audits, the endorsement of this Government and, just this month, the public support of 20 respected organisations representing millions of patients, carers, doctors and nurses. Yet last week the Association of Palliative Medicine bowed to pressure from a lobby of Roman Catholic doctors, pro-life groups, some media and a small number of distressed and grieving relatives to order a review into the Pathway. Was this a victory for patients’ rights or capitulation to media hysteria and public misunderstanding?

** ** **

This will be the last month I’ll be listing all the articles that come to my email box because it just takes way too much of my time. I will, however, continue to read new articles and contribute to the debate about aid-in-dying from my perspective.

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One comment on “Death with Dignity – October 2012

  1. Pingback: Death with Dignity – October 2012 | Assisted Dying | Scoop.it

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