Comments on New England Journal of Medicine Article

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Comments on

New England Journal of Medicine Article

I came across an article in the New England Journal of Medicine offering the scenario of a 72-year old man in the end stages of pancreatic cancer who asks his doctor about assisted dying. The question to the forum is: should it be permitted or not. They provided a professional pro and con opinion then opened it to comments.

Below are quotes from among over 200 comments from physicians, medical students and people like you and me from around the world who endeavor to keep up with the conversation on this issue. Please refer to the article for full details. I did not correct spelling or grammar. I grouped them here by U.S. states,  other countries, and a group of unknown origin, after selecting those I found most interesting on both sides of the debate. I actually found a pretty even split among all the comments on the site, but my sample didn’t end up reflecting that same distribution. I color-coded the first word of each comment I posted to give a quick overview (PRO / CON). My comment is at the end.

UNITED STATES

Physician from Arizona: I was trained to heal and even though I understand the fact that a patient would like to end his/her life with “dignity,” I don’t think I could bring myself together and help them do it.

Physician from California: We have to remember that everybody is the master of his/her own body and choosing the option of dignified death should be the right of the patient and not the physician, lawyer or society at large.

Physician from California: Once the request for hastening dying is balanced against the depression that is intrinsic to the dying process, then the autonomy of the terminally ill cancer sufferer is at the top of the priority chain of ethical principles.

Medical student from California: It is high time that we have an alternative to our inevitable end. We must be entrusted to find a collaborative approach to death as we do with birth. Birth is joyous and assisted. We celebrate it. We welcome it. Death should have its rituals as well. It should be free of fear. It is a very personal choice and a difficult one. It should be honored.

Physician from California: Life is sacred and we must obey the natural law not to kill.

Physician from California: Physicians not only have a right to assist patients with suicide they have a moral duty to do so. The concept is complex and necessary restrictive guidelines need to be in place.

Elder law attorney from Washington, DC: It is the height of unethical behavior for a doctor or relative to substitute his or her opinion of what is best for a dying person’s well being for the patient’s. Using the “art of healing” as a reason to deny a dying person his or her wish is a paternalistic, self-referential shield that fails to engage the patient in his or her life decisions. Patients are not passive recipients of the wisdom of doctors.

Physician from Florida: Today, why are we not lord and masters of our own bodies? Do we belong to the state, or some religious organization? If we do not own and are therefore not able to control our own bodies, who does? Why, legally, does the state have the right to tell us what we can do with our own body, our most precious possession?

Physician from Florida: He is neither suffering nor is he in an unresponsive state (the two specific situations that he did not wish to be in). If by ‘prognosis’ you mean that he understands that there is no cure for his disease, then that realization, by itself, almost certainly does not qualify for life terminating drugs.

Widower from Hawaii: (After declining treatment for pancreatic cancer) With daily visits by an oncologist and surrounded by all 16 family members, aged 3 months to 86, my wife, mentally alert, phoned thanks and good-byes to relatives and close friends around the world. There was no bitterness, no hesitation, never a moment unattended, awake or asleep. She breathed her last in my arms on day 8 and I regard it as our ultimate expression of mutual love in a long life filled with love.

Professor (emerit.) of Surgery from Illinois: Once such a request for help comes from their patients to end their suffering, doctors cannot shy away by cynically claiming, “the last thing” is your problem-not mine. We are in this problem-together!

Physician from Illinois: I am a retired internist. The past 5 years I have had the privilege of being a volunteer at our local hospice. Hospice/palliative care is now able to provide caring and supportive care to the majority of our patients. There is, however, a small minority for whom assisted suicide would be the kindest choice.

Patient from Louisiana: If I experience a complication or progression of my illness that results in a terminal situation, I have made it clear I do not want extraordinary measures made to treat or resuscitate me. If I am suffering and in the terminal phase, I should have the option of physician-assisted suicide or some legal method of obtaining the necessary drugs to end my life. To deny patients this option is an unethical and cruel abuse of our humanity.

Surgeon from Maine: I have argued for assisted euthanasia for many years, including presenting a case at a meeting of the MMS, when they were discussing the issue many years ago, as a delegate from Plymouth, MA.

Physician from Massachusetts: The doctor should not be involved in providing the means. Why not ask the priest or the lawyer to help provide the means?

Physician from U.S.: 78-year old retired general/oncologic surgeon, currently in good health but well aware that a terminal illness like pancreatic cancer could arise at any time. I am the master of my own destiny, I should have the right to choose and would hope that my personal physician could assist me in my choice. I am disappointed that Massachusetts voted not to allow “Death with Dignity.”  I have always felt that the concept of holding out “hope” for terminally ill patients is not only unrealistic but often cruel in not recognizing the reality of ultimate death.

Nurse from Massachusetts: …nurses are the ones who spend more time with them, have an explicit framework to specifically assess and diagnose spiritual distress, changes in role and family processes, and other critical aspects of quality of life, and are far more often present for individual and family at death. Similar polls of nurses are over whelmingly in favor of death with dignity initiatives. It is unfortunate that this debate is so often framed in terms of what physicians want to do. Far better that we all should do what patients ask of us; patient autonomy has always had primacy in nursing practice.

Physician from Michigan: Some physicians feel a heroic obligation to save a life against all odds, to the point not only of futility but absurdity, and in doing so they feel a rewarding sense of accomplishment. They force their beliefs against the wishes of the victim (pardon me, the patient).

Physician from Minnesota: Physicians are highly trained medical professionals who promote and restore human health by diagnosing and treating disease.  When disease-associated pain is present, they alleviate it. Taking a patient’s life only creates pathology it doesn’t treat any disease. It is oxymoronic to see physician-assisted suicide as providing any form of health care. Indeed outside of the privileged doctor-patient relationship such behavior would simply be recognized as homicide.

Physician from Minnesota: No PAS should not be legalized.  I don’t care what kind of consent process or how many behavioural science consultations or screenings you do. We are undoubtedly starting down a slippery slope, especially as we enter into an era of increased regulation and financial constraint.

Physician from New Jersey: As it is my desire to pass gently into the good night when my time is come, if I can assist a fellow human to leave this world gently and by choice when their time is nigh, then I believe it is the moral choice.

Physician from Ohio: When my terminally ill wife with colon cancer indicated she did not want to keep going, her message was conveyed to her hospice caretakers who ensured she would be comfortable. As a physician I personally did not feel comfortable managing a medical situation for which I was not prepared for.

Physician from Oklahoma: Is there a day in the future when people will be asked about their acts or not? In other words, is there “Allah” (God) or not? If you believe in Allah and that there is day of judgment where you will be asked about every single act, word you spoke or listened to, look… then you need to have good answer to why you helped someone kill himself.

Elderly woman from Oregon: I do not think we are puppets of some idea of a supreme being, we rather seem designed to learn and apply knowledge to our individual circumstances, and at near age 86, I hope to choose to end my earth time in dignity with euthanasia under specific circumstances and have outlined those in my directive.

Physician from Oregon: The greatest benefit of the law in Oregon has been its effect in enabling communication. This issue is not simple. The Oregon law does not give Oregonians the “right to die.” But it does give Oregon clinicians and family members the right to assist in their deaths, under carefully prescribed circumstances.

Physician from Pennsylvania: Individual vs Societal Rights. I have never understood how a society that prides itself on self-reliance, individual courage, free will, and the rights of the individual, feels justified in removing these rights from individuals at the end of their lives.

Physician from Pennsylvania: I respect the views, some very eloquently stated, of those selecting option 1. My vote is for option 2.

Physician from Tennessee: Why can’t we accept and recognize that patients have the right to decide when to end their lives with their pain controlled, their dignity preserved and with our support? Why do we abandon our patients and their families in such a difficult times? Properly screened patients (and families) should be allowed to make this decision with the support of a physician who can guide them through the process and relieve them from guilt and remorse.

Physician from Utah: If society deems carefully planned and supervised suicide as an option, why does it have to be PHYSICIAN-assisted? Anyone could be trained to perform this function – certainly it is not part of a physician’s training.

INTERNATIONAL

Physician from Albania: He always asked me whether I can do something else to make his misery go away. I never quite understood what he meant by that until I got a call from the medical examiner. They asked me whether I knew Mr. X and was he one of my patients. I said yes. They told me police had to break into his apartment that day. They found him dead on the floor. He had killed himself using a kitchen knife. He should have had a better option and I should have been a better physician.

Physician from Belgium: With good palliative and terminal care most of these cases can be handled without the need for euthanasia or assisted suicide. We have to introduce the ‘ars moriendi,’ the ‘art’ of dying, facing existential and spiritual problems.

Physician from Brazil: We are doctors not murders. I myself am a religious doctor and I know that lives belong to God. We are living a life that does not belong to us. We are here to proceed the evolution of our Espirits and so are our patients. We do not have the authorization to end someone’s life.

Physician from Brazil: I believe that our society must allow the final expression of free will once the individual is faced with the alternative of avoiding suffering and loss of all his dignity so let the choice for an “ending” according to his moral values be a real one.

Physician from Canada: They would prefer that the patient suffer rather than risk upsetting some abstract and totally subjective set of values. They would hold us all hostage for the sake of their morality. The hypocrisy and sanctimony of their argument is an infinitely greater risk to our freedom than any abstract notion they would force upon us.

Physician from Canada: Listening to a request for death but never carrying it out can be the height of hypocrisy. And individual autonomy is what this question is all about not your book learned ideas of other values and ethics for the collective.

Physician from Canada: This is a personal matter for the individual facing death and has nothing to do with a proper debate on the modern process of death. It is high time to drop the moral blackmail and use of loaded terms such as ‘therapeutic homicide’.

Physician from Canada: Religious dogma of “only God is giving life and only God can take away life” should not be the rational, the actual basis of laws.

Physician from Canada: people with advanced ALS or multiple sclerosis who cannot move more than their eyes often will chose to be disconnected from life support. Some of them would like to have the option of a well performed general anesthesia that would allow them to die comfortably before they reach this advanced stage. Why deny people this option is beyond understanding.

Physician from Canada: We have all watched people suffer and silently wished for the end. Many of us have provided opioids at doses needed for pain control, but that could cause respiratory depression. But we know very well that there is a clear difference between that, and deliberately bringing the end sooner. To raise my hand to kill… never for me, and never (I hope) for my profession.

Physician from Canada: We do not chose to be born. Life happens. I understand that suffering is difficult, distressing and terrible for both the patient and the family. But let’s face it, it’s part of life. NO ONE goes through life without suffering at some point. It is part of being human. Not accepting it seems to be annihilating the core fact of our humanity.

Woman from Canada: A person who dies meets his maker, or so believe most Americans. Our maker has something to say about willfully taking a human life. I do not belong to myself, being created by a higher power, and do not have any inalienable right to determine my death.

Physician from China: Physicians should not be the one to make decision to end a life. But morality is a basic human right and an individual choice. Patients with end stage disease should have the right to die with dignity.

Physician from Dominican Republic: A doctor is a healer not a killer. Death is not part of life because life ends when we died. Living is to watch the sun every morning and the moon every night. A doctor saves the life and the souls of his patients everyday no matter how difficult it is sometimes…

Physician from Egypt: Timing of death is related only to our God. I think we cannot go for helping patients to get suicide, the image of doctor is only to help patients to get better as to improve pain control, relieve symptoms. Practically speaking in this situation of advanced pancreatic cancer, we give strong narcotic with laxatives and usually the survival is very limited to a few weeks maximim.

80-year old man from France: The debate about end of life conditions is nowadays very hot in our country. I strongly believe that the respect of patient’s wishes will not deserve palliative cares, but on the contrary facilitate their development. As wrote Seneque in one of his letter to Lucilius : “the best death is the one I wish”.

Physician from Greece: A colleague once confided softly: “If I am ever in that state, please kill me mercifully.” Recently, Richard Lehman of the BMJ made a bitterly humorous request to be given a strong i.v. anaesthetic and a massive dose of potassium chloride, in case of a massive stroke. Do we as physicians dream of the right to a dignified death for ourselves, but refuse to consider it for our patients? Our ethics have not changed, but medicine has come to a point where we are prolonging wretched conditions of debilitation, humiliation, pain and misery.

Physician from Greece: What constitutes bad medicine, and also fuels the euthanasia argument, is the overaggressive management of advanced cancer with multiple toxic therapies that add only misery to the patient’s last few days/weeks/months. Providing death on request only erodes the status of the medical profession, and is beyond the jurisdiction of medicine.”

Physician from India: A right to die a dignified death by a patient who has fully intact faculties is not an issue to be brushed aside.

Physician from India: I believe life is a gift of God. We have no right to terminate it. We should continuously struggle to minimise the sufferings of our patients and not to indulge in practice of physician-assisted suicide.

Physician from India: The role of the Physician should be just saving life. The patient then has a choice whether to go to the Physician or not and next to the person who could assist him with ending his life (someone whose only training is this and not currently practising any other kind of curative medicine).

Physician from India: I have worked in oncology units and have experienced the pain and sufferings those terminally ill patients undergo. We can have euthanasia with proper regulations in place. We cannot provide any better life to them by any means, so why deny their peaceful termination of their own hopeless journey!

Physician from India: Death is inevitable and is not to be feared and dreaded. We are not in the normal course of life given the luxury of choice as to when and how we die. If given a choice between needless pain and suffering to both the patient and family; the obvious choice is assisted suicide.

Physician from India: I agree with the general principle of physician-assisted suicide. I think doctors who work hard to save a patients life, who have spent time with the patient and have the trust of the patient are in the best position to bear the moral responsibility of taking a patient’s life.

Physician from Italy: Please remember that the Nazi euthanasia program was the foundation of the destruction of the European Jews.

Physician from Italy: The only person who has the right to decide when and how to die is the patient. Religions have nothing to do with it. Our job as physicians does not end when the patient cannot be cured. We must take care of him/her to the end, and that entails also, if the patient so desires, assisting suicide.

Physician from Italy: The choice to kill oneself is the paradigm of a personal choice. As such, it should not involve other persons either relatives or kin. For the same reason physician-assisted suicide should not be done in patients like that described in this case vignette.

Physician from Lebanon: We doctors are born to help those who want to live and not to euthanize those who want to die, that is the dignity of our profession.

Physician from The Netherlands: Discussing the possibility should be legally and professionally obligatory to be one of the “treatment options” right from the first diagnosis! And as such part of palliative care.

Physician from The Netherlands: Banning euthanasia and physician assisted suicide doesn’t mean it never happens. It just means you don’t know how often it happens.

Physician from Pakistan: I understand and accept both points of view. As an oncologist I have spent many a nights fretting and being upset about unnecessary suffering and not being able to make them as comfortable as they should be, but at the same time I do not think I have the courage to knowingly help patients for euthanasia.

Physician from Pakistan: Help patients relieve their sufferings. Dr assisted suicide should be permitted

Student from Peru: When a patient is in the terminal stage in any disease and you as his physician can not give him quality of life then why you have to make him suffer? “Primum non nocere” always… and in this case making him suffer is harming him in spirit.

Physician from Portugal: Medicine is about “healing.” Decisions about suicide at will are not and should never be medicine. If considered a “right” and allowed by society, please create a “legal executioner or hangman” for the job.

Physician from Portugal: The issue of assisted suicide is not a purely medical issue: it involves legal, anthropological, spiritual and ethical issues, which largely exceeds the medical problem. The balance between the safeguarding of life, and mercy and compassion for the suffering often creates gray areas of difficult decision.

Physician from Russian Federation: There is a risk of an abuse of authority if the physician is a maniac or physicians are associated with criminals. Ethical and moral aspects of this issue are very complicated and open to questions.

Physician from Saudi Arabia: Patients with major depressive disorder with suicidal thought and intention are considered in critical state and urgent action is needed to protect them and prevent them from suicidal attempts — so why would we facilitate death in a patient with terminal illness?

Physician from South Africa: Where it is legally authorized, the physician may help those who are in despair to end their lives, if any medical intervention has become futile.

Physician from Spain: Thou shall not kill. Sometimes being a doctor is very difficult. Of course we have to better help the patients when dying and to alleviate them is an essential part of our professional caring. But I strongly feel that to allow killing is a terrible mistake.

Woman from UK: You can privately, quietly, ensure the right dose of the right medication is given with no questions asked. Before you respond from your positions of power and control, please consider what it is like for ordinary people.

Student from UK: Indeed the very idea of a killing doctor almost presents as an oxymoron, however with the training and in-depth understanding that all doctors must possess it seems to me that a doctor is the only humane and realistic choice of assistant to suicide.

UNKNOWN ORIGIN

Physician: When you kill someone you forever remove the virtue of hope, which is so inherent in the work of a physician. When all our drugs and all our armenmentaria are gone, we can always give hope as long as there is life.

Physician: We are doing this everyday through Hospice. We just don’t call it assisted suicide. Terminally ill patients should have the right to choose their end. And helping a patient walk through death’s door with everyone’s consent should be a privilege not denied to their physicians.

Patient: My husband and I have plans to take our lives when we become unable to care for ourselves, mentally or physically. We don’t want to burden our children with our care and believe that the money we would spend on hiring caregivers would be better served paying for our grand children’s education. We are living too long now and the cost/benefit ratio is too low to sustain.

Physician: I favor physician-assisted suicide. It is the ultimate compassionate act in the doctor-patient relationship. To deny it would be to abandon the patient.

Physician: I would hope, that under such or other similar circumstances, I would be given the choice to end the misery. I do not think that anyone else should be able to enforce his/her convictions of prolonging my ordeal for me.

Physician: My father died free of pain (from a recurrent cancer) with the help of a generous dose of morphine from his primary care physician. My mother and I were grateful that he could say goodbye in peace.

Medical student: …listen to what they are saying, analyze if it’s logical. Every case is different. As a doctor, my first duty is to listen to my patient, only he knows his pain and mental anguish. Mr Wallace … fears that such a day would come and wants to opt out of experiencing that condition. I completely understand his fear and respect his wishes. I am okay with assisting him as per his wishes. And I won’t be a murderer if I do so, not in my eyes at least.

Physician: I believe if a person has a terminal illness that causes him/her to suffer, to live an uncomfortable life, the person that is stable should have a decision of life or death … as long as the procedure is assisted by a doctor.

PhD: A person, no matter the age, who is terminally ill should have the right to Death With Dignity and this includes euthanasia

Physician: After practicing as a critical care physician for over 30 years, I am still puzzled as to why is it wrong to assist those who wish to die while in our care? If changes in the practice of medicine now give us the additional responsibility to walk with those on their way to end, we should respectfully perform that task. Not everything we do in medicine is to our liking or edifying. Assisting in a peaceful death may be one of those unpleasant tasks we need to accept reluctantly. I think that is a service to the society.

Physician: Few of us are prepared to swear with a straight face to Apollo, Asclepius, Hygieia, and Panacea, and the ancient oath not only proscribes assisted suicide but also abortion. Likewise some commenters have hearkened to a simplistic version of Judeo-Christian morality and vitalist belief that mere human beings should never weigh in on quality of life or take actions that hasten death. Bottom line is that we must learn more and engage in a more substantive debate of this subject.

Following is my comment– Someone here wrote: We do not choose to be born. Is that a scientific fact?
What if we DO chose to be born… into this body at this time in history on this planet in this country in this community to these parents, into this dysfunctional society, but instead of dying at the end this body’s ability to function we are transformed into our true essence and return home filled with new adventures to tell our loved ones about and lessons learned for the growth of our eternal souls? Then part of healing involves facilitating the soul to exit the body in as peaceful a way as possible by practicing the art of conscious dying, which does not preclude assisted-dying or euthanasia.
This is my understanding of the process after having died and come back to tell about it, and spending the last 40 years studying about it. Actually, we do chose to be born, it’s a great honor and privilege, and when it’s over, it’s great to be going home again. Talk about a paradigm shift!! Hello! The earth is not flat. The planets revolve around the sun. Time to wake up 🙂

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Wrapping up the Massachusetts Death With Dignity Defeat

 sunsetcloudsDeath – the last sleep? No, it is the final awakening.

–Sir Walter Scott

Now that the dust has settled around the Massachusetts ballot initiative for Death with Dignity, and the opposition and the proponents are preparing for the next battles in New Jersey, Connecticut, New Hampshire and Vermont, I’m going to provide excerpts from articles released in November leading up to the vote and its defeat to see what happened.

An interesting thing about this emotional argument is all the different players involved so I’m going to present their perspectives according to the articles leading up to the Massachusetts vote… with the caveat that I’m in favor of a Death with Dignity law but not particularly of the one that was proposed in Massachusetts or the ones that currently exist in Washington and Oregon. I will reserve my opinion for a subsequent blog post. So in alphabetical order–

THE DISABLED COMMUNITY

According to Second Thoughts (People with disabilities opposing the legalization of Assisted Suicide) director John Kelly, the only way for the law to be acceptable to them would be to make the safeguards so exacting that no one could get past them.

• They fear heirs might pressure their relatives to end their life early and with dementia they might relent.

• They stress people with mental illnesses,  including depression, are unable to make these decisions.

• They fear someone putting something into a feeding tube without the person’s knowledge.

• They fear wanton killing of  sick elderly and handicapped, disabled, challenged people as was done in Nazi Germany because they were considered unworthy, too expensive and too much trouble to take care of.

Second Thoughts contends that:

• Assisted suicide is a deadly mix with a profit-driven healthcare system. Pressure to cut costs, delays in treatment and limited coverage for home care can lead patients, families and doctors to choose the cheapest alternative, even if that is assisted suicide.

• Assisted suicide is unnecessary because current law gives every person the right to refuse lifesaving treatment, and to have adequate pain relief, including palliative sedation to die in your sleep. Assisted suicide decreases self-determination by giving doctors and insurers the power not just to cure, but to kill.

• The proposed law is a recipe for elder abuse. An heir can be a witness and help sign someone up, and once a lethal drug is in the home, no one will know how the drug is administered. If the person struggled, who would know?

•A lack of safeguards and oversight in the proposed law puts people at risk of misdiagnosis, deprivation of treatment and economic pressure to choose suicide, while protecting doctors from liability.

  • No mental health evaluation is required for depression or other treatable cause of suicidal feelings.
  • If a doctor refuses lethal drugs, the patient or family simply can—and do—find another doctor (“doctor shopping”).
  • “Terminal condition” and “death within six months” are often misdiagnosed, opening the dangers of assisted suicide to many who are not terminally ill.
  • Nothing in the law can offer protection when family pressures, whether financial or emotional, distort patient choice.
  • The law does not include enforcement provisions, investigation authority, oversight or data verification. The only foolproof safeguard is for the prescribing doctors. The law holds doctors only to a “good faith” standard, which makes any safeguards unenforceable.

• Discrimination: A law that singles out some people (such as old, ill and disabled people) for assisted suicide instead of suicide prevention is not in step with Massachusetts’ progressive tradition as a leader against discrimination.

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A writer commented– “Now is the worst time to perpetuate that death is better than disability.”

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Not Dead Yet Director Diane Coleman praised Second Thoughts Director John Kelly and the Steering committee for inserting the disability rights perspective into the Massachusetts debate. Coleman said Second Thoughts made the difference in preventing assisted suicide from gaining a foothold in the Northeast.

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A woman now confined to a wheelchair because of her MS, which she described as “the slow road to death,” was opposed to voluntary euthanasia until recently. ”As little as five years ago, I really did believe that without safeguards, voluntary euthanasia could be open to the terrible abuse of the elderly and the vulnerable in our society. I felt that quite strongly.” But she had no idea her illness would go into such a steep slide, prompting a ”drastic change in my feelings” about voluntary euthanasia. Now with her new consciousness, she wonders why it is illegal. ”If I’ve got a suffering animal, I won’t hesitate to have them euthanised,” said the keen horsewoman.

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Tony Nicklinson (58), a former soccor player in England, who developed locked-in syndrome following a stroke in 2005 and could only move his eyes, fought for the right to die by doctor-assisted lethal injection.  When his last request was turned down by the High Court in August, he felt his only alternative was to stop eating and drinking thus starving himself to death. Tony developed pneumonia and died a week after the verdict. His wife, Jane, and other people with locked-in syndrome, are continuing to pursue a change in the law to allow euthanasia for people like Tony who are incapable of doing it for themselves and need professional assistance.

THE DYING ONES

These are excerpts from various articles, letters, blogs by people who are or were in the process of dying:

“To end this suffering is not euthanasia. It is a display of pure love and decency for a fellow human through assisted suicide, and an acknowledgment of his own written wishes.”

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“It is not a choice between living and dying, but between different ways of dying.”

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“I don’t know if I’ll use the prescription but I know it’s there, just in case I decide I do. It gives me peace of mind.”

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“It’s not that I’m depressed, I’m just fed up and frustrated,” Ms Harrison (New Zealand) said. “I’ve had such a wonderful life, travelled widely, with glorious memories and now I have no control over my life whatsoever with much worry and anxiety. I am living in such despair. I want to go. I’m quite happy to go. I have no fear of death whatsoever. My one fear is, because I have spent the last 3 years in bed, that I’ll suffer a stroke or other medical disability and my wishes will evaporate with my physical or mental agility. If euthanasia was legal, I could spend more time alive without worrying that I must terminate my life as soon as possible before anything drastic happens.”

Ms Harrison has lived with MS for more than three decades but says the deterioration of her condition in recent years has made life unbearable. Confined to the living room that was once the bustling centre of her family home, she relies on her 26-year-old son, a member of the Army Reserve who is studying for his masters degree, as her primary carer. “All my loves . . . I loved nature, I love books, horseriding. Everything is now lost to me,” she said. “I have to cope daily with double incontinence, gripping spasms and physical and nerve pain, to say the least.”

As a member of Philip Nitschke’s right-to-die group Exit International, Ms Harrison had planned to travel to Dignitas. However, difficulty in obtaining paperwork led to delays and this year she fractured her femur, making the trip impossible .”I wanted to do it properly, to die in the company of friends and with dignity, I didn’t want it to be ‘suicide’,” she said.

EHTICISTS

“While I’m certainly someone who believes in increasing and furthering and advancing patient autonomy, I think that there are a lot of problems with the current ballot initiative. Primarily, the potential problems in having this initiative without any mandate for psychiatric evaluation.”

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“Euthanasia, also known as mercy killing, is the act or practice of deliberately killing a dying individual, who no longer wants to tolerate pain and suffering, in a relatively painless way. Physician assisted suicide, on the other hand, takes direct control out of a doctor’s hands. The doctor presents the patient with the means to end his life. Both issues are extremely controversial in the world of bioethics.” (Bioethicist)

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“The only really difficult ethical question surrounding assisted suicide is how we can ensure that an individual’s desire to end their life is the genuine, settled, free choice of a mentally competent individual. Of course, therefore, there must be safeguards in any future regulation of assisted dying. But as long as stringent safeguards are put in place, it is difficult to see the ethical case against it being provided at all.”

FAMILIES

“Those who have witnessed the agonies of a loved one in the final stages of ALS, MS, cancer, dementia, etc., will tell you that when there is no dignity nor purpose left, then the choice should be the patient’s.”

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I had a million questions about how he expected Ed’s decline to progress and I needed advice regarding the multitude of issues involved in end-of-life care. I wanted to know about ventilators, antibiotics, DNR (do not resuscitate) orders, living wills and so many other things. I also wanted to know how much longer he thought Ed might live, what specifically he might die of, and what signs I should look for that would indicate the end was imminent. And I had a lot of questions about hospice care, including whether I could stop it if I changed my mind later. (He told me I could stop it at any time, for any reason, and that if I changed my mind again, I could resume the services.) The conversation was incredibly stressful. At one point I realized I was holding my breath.

After answering all my questions, Doug looked at me kindly and said, “You know, Marie, the real question for the caregiver is how to help the patient have the highest possible quality of life in the time that is remaining.”That completely changed my thinking about the situation. It gave me a new and positive goal – to bring Ed as much happiness as possible. It led me to think about all the special things I could do for Ed — visiting him more often, taking my little Shih Tzu to see him, having that violinist come back and play another concert, reading to him from the New York Times, and buying him even more of the stuffed animals he loved so much. After that talk, I spent many hours pleasantly thinking up special things to do for and with Ed. Once I got my mind off his looming death, we were able to have a beautiful, pleasurable months-long conclusion of our life together.

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But in focus groups support took a nosedive when participants were told the measure did not require mental health specialists to sign off and did not mandate that family members be notified. When told that one of the common lethal prescriptions required patients to break up 80 to 100 capsules and stir their contents into a drink, support waned. People didn’t find that very dignified.

They also recoiled at the idea that the prescription would be obtained from a local pharmacy and ingested without supervision. As one guy said, ‘So, I’m waiting in line for my Sudafed and some guy waiting in front of me is trying to kill himself?” The research informed a series of powerful ads, including one featuring a pharmacist warning of the dangers and pouring out a bottle of red pills that skittered into a glass dish.“No doctors, no hospitals, just a hundred of these,” the pharmacist in the ad says. And they call that death with dignity?

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Although I asked point blank what to expect, I was told not to worry, mum would simply spend more time asleep and quietly pass away. If only. The weeks over which my mother passed away were a drawn out and traumatic experience that I would not wish on anyone. Several times I tried to get information about what would happen, from all the places you might expect, but none of it cut the mustard. It may be difficult to predict exactly what will happen in individual cases, but we weren’t even told about what might happen and how to prepare for it. Even when it was staring everyone in the face, there was little mention of the elephant in the room. Instead, the stark reality of what was happening was glossed over by those whose honest advice we might have benefited from. I’m sure our family is not alone, and although we may not all want such detail about what happens during death, most of us would admit we need to know it, however hard that might be. Informative conversations about the end of life give patients a better quality of life and help families cope with their bereavement.

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Thomas sat across from me on his sofa, holding his wife’s living will and health care proxy in his hands, still wondering if he chose the right time. Could his wife have changed her mind? Sure, she could have lived weeks or months more, perhaps, but would she have wanted that if she were able to choose?

His wife’s living will did seem to cover such a scenario, though typically such a document applies to a patient who is in a vegetative state rather than one who is conscious and talking (but not making any sense). Hers read: “If I have an incurable, irreversible condition that will cause my death within a relatively short time…I direct the withholding or withdrawal of all treatment, including nutrition and hydration, that only prolongs the process of dying.”

“I was very fortunate to have met Judy,” Thomas said of Schwarz, explaining that she had “held my hand through this process and provided advice that wasn’t coming from anyone else.” Still, Thomas is angry that the American medical system isn’t set up to deal with the complexities of the situation he faced.

“There aren’t a lot of guides for this process,” he said. “You would hope your own physician is [a guide], but they are there to treat you.”

“What am I doing?” she asked my father several times. “Life is not worth anything like this.”

Her hospice nurse was part of a team sent by Hospice and Palliative Care, which also included a doctor, a social worker and a rabbi. I was told when we met last spring that my mom’s quality of life had been deteriorating as April dragged on. She said my mom had told her, “I’m ready.” But my mom knew better than to ask a hospice nurse for help with that task. The goal of hospice is to keep the dying patient as comfortable as possible until death naturally occurs.

The associate chief medical officer told me that if a patient decides on her own to stop nourishment, medicine or machinery, no one will stand in her way.

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For months afterwards, George lay in bed, helpless and wasting away, with 24-hour nurses who washed and fed him and changed his diapers. He was lucid, and asked my mother and her sister to poison him. They told him they couldn’t do that, but my aunt Nina pointed out that his medicine was probably keeping him alive. Ending his life merely by omission hadn’t occurred to him.

“It was humane to put him out of his suffering but done through his choice,” Aunt Nina told me recently. “He certainly acted on that information pretty quickly.”

He died a few days later.

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The week she started hospice care, at the beginning of April 2011, my father contacted them. A few days later, they got a call from the clinical coordinator of Compassion & Choices, who lived nearby on the Upper West Side. She came over and spent a few hours talking with my parents, explaining her organization’s mission and discussing my mother’s illness and the options available. “She was warm and it was personal,” my father said. “She was a professional who is very skilled at dealing with situations like this.”

 The first thing she did was set me straight on the terminology when asked about “assisted suicide.” The term “suicide” has a lot of baggage whether religious, legal or moral, so to call it “assisted suicide” or “euthanasia” is to miss a crucial distinction.

We use the term ‘aid in dying because it more accurately reflects the information and support we provide to terminally ill and suffering clients”—information about how patients might control the circumstances or timing of their death. She went on to say that the motivation for suicide, which often results from mental illness and depression, is another thing entirely. We do not support suicide,” she said, noting the difference between suicide and the “thoughtful and considered decisions” made by some terminally ill patients as a means to avoid further suffering.

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Although Thomas’ wife was concerned about how this decision might affect her family members, it’s what she wanted to do. They got the lethal dose of medicine ready for when she might decide she needed it. But not long after preparing the dose, the cancer spread to her brain and she became unable to make the decision on her own. “So that plan went out the window,” Thomas said.

Even if his wife had been capable of deciding, Thomas wonders whether she would have made the decision to take the lethal dose, after all. “What point have you crossed where you truly don’t want to live in the situation any longer?” he asked. “It sounds more clear-cut when you are talking about it in the abstract than when you’re actually faced with it.”

Nevertheless, in a state of dementia, with hallucinations of snakes, Thomas’ wife was certainly not getting much in the way of dignity or quality of life. So after nearly 44 years of marriage, he decided to stop offering liquid when she stopped asking for it.

“She wasn’t able to consciously express the desire to die,” he said. “I acted on what I believed her wishes would have been.”

It took over a week before she fell into a coma and died.

HOSPICE/PALLIATIVE CARE

Patients would not be required to consult with a palliative care or a hospice expert. Hospice addresses the multifaceted distress that dying patients and their friends and families are experiencing by providing extensive palliative care, expert pain management, and extraordinary social and spiritual supports.  Hospice works with the patient to design a program that is individualized for the patient and provides choice, control and dignity when most needed.  Unlike even a few years ago, appropriate medical care is now able to keep patients comfortable and pain free. When the Oregon law was first passed, hospice care was only a glimmer of what it is today. Even though hospice services are now widely available, they are infrequently accessed.

PROCESS: Before care is provided, hospice staff meets with the patient’s personal physician and a hospice physician to discuss patient history, current physical symptoms, and life expectancy. They then meet with the patient and their family to discuss the services provided, pain and comfort levels, support systems, financial and insurance resources, medications and equipment needs. The patient must have a doctor’s referral to enter into hospice. Medicare covers all services, medications, and equipment related to the illness for patients with a prognosis of 6 months or less. (Source: http://www.hospicefoundation.org)

BENEFITS OF HOSPICE CARE: The use of hospice care can offer benefits to not only patients but their family members and loved ones as well.
1.    For terminally ill patients, the decision to receive hospice or palliative care instead of continued curative treatment can help them avoid the dangers of over-treatment.
2.    Hospice can reduce anxiety in the terminally ill patients as well as their family by helping them achieve some level of acceptance.
3.    Other than the focus on the physical health and comfort of the patients, hospice also focuses on the emotional needs and spiritual well-being of patients and their families.
4.    In-home care from a hospice IDT often means the patient receives greater monitoring than he or she would in a hospital. (Source: http://www.helpguide.org)

HELP FOR FAMILY MEMBERS:  The death of a loved one can be a difficult time and another benefit of hospice care is the support offered to family members after a patient has died. The bereavement support is when the hospice care team works with surviving family members to help them through the grieving process. This can include counselor visits to the family during the first year, support groups, and phone calls or letter contact with the family.

LAWS, COURTS

Sadly, many still believe that those living wills filled out years ago offer us some protection. They do not. We have progressed with the development of representation agreements and advanced directives, but the legal system still hovers threateningly. The author of such a directive – now in no fit state to demand execution of his wishes – must still face each day as a living hell.

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Death With Dignity Act – the state secretary, “This proposed law would allow a physician licensed in Massachusetts to prescribe medication, at a terminally ill patient’s request, to end that patient’s life. To qualify, a patient would have to be an adult resident who (1) is medically determined to be mentally capable of making and communicating health care decisions; (2) has been diagnosed by attending and consulting physicians as having an incurable, irreversible disease that will, within reasonable medical judgment, cause death within six months; and (3) voluntarily expresses a wish to die and has made an informed decision.”

There are, of course, a number of other safeguards built in, such as the need to make the request twice, separated by 15 days, in the presence of witnesses.  However, there could probably be stronger safeguards to protect individuals who are experiencing depression and anxiety, and might have preferable alternatives to physician-assisted death.

If passed on Election Day, physician assisted suicide would become legal under Massachusetts law, effective January 1, 2013. No additional legislative or other approvals would be necessary.  As written, the legislation is poorly written and lacks the basic safeguards against unintended consequences.

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Law is to make sure the assister isn’t prosecuted for helping a terminally ill person who wants to die carry out their wishes– not to determinate rightness or wrongness of the act of helping someone hasten their death. -dg

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In Montana, physician assisted suicide is not explicitly legal, but a state Supreme Court ruling gives legal protection to it.

The Montana Board of Medical Examiners has rejected a request to strike its policy on physician-assisted suicide that opponents criticize as too permissive. The board this year tried to provide some guidance to doctors on the issue that remains unclear in law. The board says it will review complaints on their merits if any are filed against a doctor for providing “aid-in-dying.”

Montanans Against Assisted Suicide says it wants the board to revoke that policy, saying it appears to condone a procedure that they argue is illegal. The board rejected the request on Friday, potentially paving the way for opponents to sue. The Montana Supreme Court in 2009 declared nothing in state law or precedent makes the procedure illegal. The Legislature has been unable to provide any further clarity.

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“Assemblyman John Burzichelli (NJ) introducted a bill modeled on the Death with Dignity Act legislation of Oregon and Washington. It is doctor-assisted suicide, NOT euthanasia. As a humane society we do not force animals to suffer an agonizing death. Why should we not be given the option of having that same right if that is our personal choice?”

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Gov. Peter Shumlin (VT) says he is confident that the Vermont Legislature will pass marijuana decriminalization and Death with Dignity or what opponents call physician-assisted suicide legislation this session.

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In recent years, Compassion & Choices has tried to do something about the shortcomings—or failure, in many opinions—of physicians to guide their patients through the dying process. David C. Leven, a lawyer and the executive director of the organization’s New York affiliate, has led the effort on the legal front.

“Why do you feel the need to urge doctors to diagnose dying?” I asked.

“Nobody tells them to,” he said. “Nobody reimburses you for that diagnosis.”

1997 Supreme Court ruling that individuals have no constitutional right to aid in dying. This ruling left it to states to decide the issue for themselves.

“We are over-treating people at the end of their lives,” Leven said. “People who are dying often suffer unnecessarily because they’re receiving aggressive interventions they may not want and don’t benefit from.”

The solution, in his opinion, is to provide patients with more information so that they can make informed end-of-life decisions that suit their needs. To this end, Leven helped enact New York’s Palliative Care Information Act, which took effect in February 2011. The act requires that doctors provide information and counseling to terminally ill patients who want it—which turns out to be most of them. But it seems that the vast majority of doctors don’t even know about the law. (In the group he spoke to at the hospital on Roosevelt Island, less than a quarter had heard of it.) Another problem is that some doctors may reject a legal mandate that tells them what to do with their patients, which is why the New York State Medical Society opposed the legislation. In Leven’s view, this shouldn’t be an issue because it is supposed to be part of a doctor’s job description.

“Doctors already have an ethical obligation to provide their patients with a diagnosis, prognosis, treatment options, and the risks and benefits of those options so that patients can make informed decisions,” he said.

Leven cited studies showing that a large percentage of doctors don’t have this conversation with their patients or don’t do it well. If they did, patients would be much better off, he said. For instance, when the big picture is explained to them and the options are reviewed, patients typically choose less aggressive treatment and opt more often for  palliative care and quality of life than for extending it. (Gawande made the same point in his New Yorker piece.)

Patients may get referred to hospice care, set up a do-not-resuscitate order, and put other measures in place to make sure that doctors don’t provide treatment against the patient’s wishes. (New York ranks 49th in the country in hospice enrollment.) The result, Leven said, is reduced medical costs, better quality care, and ultimately, a death that is peaceful and dignified; all from a simple conversation between the patient and his doctor.

Dr. Alan B. Astrow, Chief of Hematology and Medical Oncology at Maimonides Medical Center in Brooklyn, said he agrees that it is a doctor’s responsibility to have this talk with patients. But he told me he understands why they often don’t.

“Many doctors avoid having to tell the patient that things are not going well and that the patient is at risk of dying in the near future,” Astrow said. “It’s hard to tell people, and also patients don’t really want to hear that news.”

However, he does not believe that the solution is a statute ordering doctors to do this—a point he made in an article in the New England Journal of Medicine last year. Astrow instead favors “more training in how to discuss end-of-life care issues with patients.” (David Leven agrees that doctors need more training, and is currently working on a bill that would require all healthcare practitioners in New York to get training in pain management and end-of-life care every four years.) Astrow acknowledged, however, that even with training, such care will still be very difficult for doctors. He stressed that he does agree with the goals of the Palliative Care Information Act, which provides a path toward “good medical care,” but he doesn’t think a legal remedy is enough to bring about a change in the overarching medical culture.

Considering that most doctors still don’t know about the Palliative Care Information Act, which isn’t enforced unless specific complaints are made to the New York State Department of Health, Astrow does have a point.

This is why Compassion & Choices, with a national staff of forty, has been trying to pick up the slack, making information available to anyone who needs it. After all, roughly a million and a half Americans die of terminal illness every year.

“Too many people are having bad deaths,” Leven said, “and it’s in some measure because they don’t have all the information they should have.”

NURSES

If ratified, the ANA would join the American Medical Association in saying that the “clinician’s participation in assisted suicide is incompatible with professional role integrity” and that assisted suicide and euthanasia “violate the social contract the professions have with society.”  Both organizations have “vowed to honor the sanctity of life and their duty not to inflict harm.” The document acknowledges the “distress” nurses suffer when asked to participate in active euthanasia and assisted suicide, and asserts that limits to their commitment to the patient’s right to self-determination “do exist.”The nurse is not allowed to “administer the medication that will lead to the end of the patient’s life,” says the draft document.Even in states in which assisted suicide is legal – Oregon, Washington and Montana – the ANA directs nurses to refrain from participation, as doing so would violate The Code of Ethics for Nurses with Interpretive Statements. For anti-euthanasia advocates, there is cause for concern, however, in the section of the document on the “withholding or withdrawal of life-sustaining treatments (WWLST).

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Opponents of the proposal say doctors should never, as a matter of professional ethics, intentionally hasten the death of one of their patients, even one who is terminally ill. The codes of medicine and nursing ethics reject helping patients die.

PHYSICIANS

The AMA “strongly opposes any bill to legalize physician-assisted suicide” because the practice is “fundamentally inconsistent with the physician’s role as healer.”

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A difference between this proposal (called Question 2, which allows for physician-assisted death if a terminal illness is diagnosed with a prognosis of less than six months of survival) and some others is that there is no requirement for evaluation by a psychiatrist for depression before the lethal medication dose is administered. This itself is a fatal flaw.  (written by a psychiatrist)

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On being too aggressive trying to save patient, a doctor said: if you can’t save his life; sometimes, being a good doctor means learning to help people die.

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For Dr. Marcia Angell, a senior lecturer on social medicine at the Medical School and one of the initiative’s major public proponents, this question of autonomy and choice has a clear answer.“It seems to me that this most personal and faithful of decisions belongs with the patients and no one else: not the church, not the Mass. Medical Society, not the state, no one but the patient. And it hurts no one if the patient makes this choice,” she said.

Angell said that the experiences of those who have taken advantage of the law in Oregon shows that the availability of this choice is valuable, even if not used by many.“Good palliative care and assisted suicide—those two things are not mutually exclusive any more than the medical treatment of heart failure and heart transplantation. You use one when the other fails,” Angell said. “Allowing the most desperate of patients to have assisted dying to bring about a slightly faster, more peaceful death, does nothing to the other 99.8 percent of patients.”

“First of all, the totality of suffering at the end of life often involves pain, but it often reflects other reasons as well. For instance, air hunger in someone who has pulmonary disease, or sleeplessness in someone with so-called Lou Gehrig’s disease. So pain control is a major part of palliative care, but palliative care is broader than just pain control. The concept of “total pain” has been in the literature for years. “Total pain” includes physical pain but also involves spiritual or existential pain and psychological burdens. So there’s more to palliative care than pain control, and there’s more to pain than just its intensity.

In the clear majority — in most cases of, say, cancer-related pain — the figure that people quote is from studies applying a very simple three-step ladder that was developed by the World Health Organization: You can control about 90% of the pain in people with cancer. Now, I’m blending together different cancers, different stages and resting pain versus movement pain. But if you were to say: ‘Can you control most people’s pain with simple, non-invasive measures,’ the answer is yes. That’s been studied.

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As for people who have more difficult pain problems despite moving up the medication ladder, by providing a suitable nerve block or infusion, you can probably control the majority of the remainder. So the instances in which you have to choose between the patient’s being awake but in intolerable pain or being deliberately sedated to the point of unresponsiveness are very few.

If you talk to people who work in hospice or palliative care, terminal sedation is uncommon. – It’s wrong to oversimplify this. That’s why, as a program, although we have superb faculty who teach classes about end-of-life and palliative care issues, we’re not saying yes or no on Question 2.

I would say hypothetically, there may be an instance, exceedingly rare, where physician-assisted suicide is warranted. But in practice, in those infrequent instances where pain is hard to control, we now already can offer terminal sedation, where someone can be brought to a restful, sleep-like state by using medications. But even that is uncommon.

Preparing a living will and designating a health proxy before illness strikes or becomes advanced, promotes each person’s working through these issues in a thoughtful, unrushed way.

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Critics say the Death With Dignity Act as written does not provide enough safeguards against mentally ill people securing the drug or prevent patients from being coerced into killing themselves. There are also no rules regarding storage of the lethal pills once they’re brought home.

Furthermore, the Massachusetts Medical Society says that asking doctors to provide lethal drugs is antithetical to what healers stand for and goes against the Hippocratic Oath, a sort of medical code of conduct.

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As a retired clinical psychologist, I must note that there is a vast difference between the depression of a terminally ill patient, who realistically perceives his situation to be hopeless, and a physically healthy patient suffering from clinical depression.

In the case of a physically healthy patient who is clinically depressed, feelings of worthlessness and hopelessness are the product of inaccurate perceptions of self and circumstances — mental distortions produced by the illness itself. For such patients, treatment can produce marked improvement.The same cannot be said for terminally ill patients, whose feelings of hopelessness are, sadly, all too realistic and whose depression is often a normal response to a disheartening reality.

While the “counseling and caring” the doctor recommends can provide comfort to the terminally ill patient, they cannot change the reality of a patient whose quality of life has diminished to the point where each day is another round of frustration and pain, be it physical or emotional.

If I should become terminally ill, I would not want to cede to a third party the right to determine when my life is no longer worth living

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“With proper safeguards, this option is valuable for a very small subset of patients with terminal illnesses that would progress with unbearable physical or psychological suffering. The key is to have the right type of safeguards so only appropriate patients are given this option.”

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The Massachusetts Medical Society officially came out against the measure, arguing that, “the proposed safeguards against abuse are insufficient.” It’s difficult to determine exactly when someone’s six months would begin. More loftily, they reasserted the idea that “physician assisted suicide is fundamentally incompatible with the physician’s role as healer.”

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Assisted dying is best dealt with by preventing it from ever developing in the first place by giving patients the opportunity to talk with their physicians and families about how much care they want and offering them palliative or hospice care before being subjected to needless treatments in the first place. Most physicians and patients and their families would agree with this.

It is not surprising, however, that needless treatment can bring on the serious depression and hopelessness that in some patients can drive the desire for assisted suicide. It is hard, as it should be, and becoming harder all the time because of the rapid advances in medical science to decide when and what kind of treatment is “needless.”

Physicians usually make the judgment after considering all the possibilities that modern medicine can offer and then try to make the best medical and humane judgments, taking into consideration the patient’s prognosis and wishes. But sometimes physicians can be moved by the fear of malpractice suits for not having “done everything” and resort to over-treatment as a solution. This is called defensive medicine. It will continue, however, until the defects in the malpractice system are corrected and physicians are not penalized for using good judgment that is later seized upon as a reason for a malpractice suit.

But insurance plays a significant role in over-treatment as well because it isolates patients and families from the astronomical costs of over-treatment, making it easy for them to demand that “everything be done,” even when it is against the collective judgment of the physicians taking care of the patient. But once the decision to do everything is made, it sets in motion a steady stream of reports from CAT scans and laboratory tests and consultants that often create confusion that worsens patients’ feelings of hopelessness and loss of control.

There is a real danger that the insurance companies’ pressure on doctors to practice “economically” will subtly influence the decisions that patients, their families, and physicians make. Already physicians are under great pressure to practice medicine with severe “cost-saving” restrictions.

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WebMD’s physician web site, recently surveyed 24,000 doctors – When asked if physician-assisted suicide should be allowed in some situations, 47% of doctors said “yes,” 40% said “no,” and 13% said, “It depends.”

RELIGION

Vote NO on Question 2,” reads a sign outside St. Stephen’s Parish in downtown Framingham. The message on a second sign is printed in Spanish. The Roman Catholic Church in recent weeks has spoken out fiercely against the ballot measure to legalize physician-assisted suicide and Catholic groups nationwide have donated most of the $2 million the opposition has raised this election cycle. Cardinal Sean O’Malley of the Archdiocese of Boston last weekend broadcast a special sermon to parishes across the state urging churchgoers to vote no on Question 2. Local parishioners last week said they agree. “It’s taking something that’s out of our control.”

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Rabbi Andrew Vogel said Judaism unlike some other religions doesn’t take a black and white stance. The religion opposes suicide but encourages compassion, he said. He opposes the measure but encouraged Jews to make their own decision.

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The flaws Meade cites include no mandatory family notification – and no mandatory counseling. Her allies include Boston Cardinal Sean O’Malley. In a video homily, posted on the cardinal’s blog, he makes it clear that he wants Catholics to vote no.  O’Malley says “We cannot ignore the impending legalization of physician assisted suicide as if it did not affect us. It would bring spiritual death, a cheapening of human life, the corrupting of the medical profession. PAS means making doctors nurses, pharmacists, friends, and society itself accomplishes in suicide.”

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Rabbi Ronne Friedman of Temple Israel of Boston spoke in favor of the question during his Oct. 5 sermon, and he and four other reform rabbis have released a statement backing the measure.“There are a lot of people who want to know that it would be possible,” Friedman said Sunday in a phone interview. “It’s hard to imagine that level suffering if you’re not in that condition. They want to feel that if it’s intolerable, they have the right and permission to exit on their own terms. Just the knowledge provides a sense of relief.”

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Imam William Suhaib Webb, of the Islamic Society of Boston Cultural Center, said that while the question has not been formally addressed during services, “religiously we’re pretty much in agreement as Muslims” against it.“We believe that every breath is a gift,” Webb said. “Every difficulty through that suffering is a means of purifying into the life thereafter.”

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“It’s the wrong direction to go in,” said Bob Denning, 57, of Boston. Denning said that society was “looking for a quick fix” to suffering and that physician-assisted suicide was “immoral and a crime. The way the law is, it’s actually insulting to humans.”

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The Rev. Walter Kim of Park Street Church, a Protestant church in Boston, said his church recently held a panel discussion on the question, which he opposes.“It’s a moral as well as a political issue,” Kim said. “If we created a culture that really took care of the elderly and gave them vibrant communities, we’d be greatly alleviated. ”The wording of the question “is so problematic it doesn’t enable us to speak with moral clarity,” he said. He added that the lack of safeguards makes it such “that you don’t even have to get to all the moral issues. This ballot is problematic.”

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The Rev. Kazimierz Bem, pastor of the First Church in Marlborough, which is affiliated with the United Church of Christ, preached a sermon against the physician-assisted suicide question on Oct. 21. He said that educating the public was important and that he was moderator of a panel discussion held that same day at the church. Supporters and opponents sat on the panel, he said, but the choice is a clear one.“A person ravaged by disease has no less dignity than Michael Phelps in the swimming pool,” said Bem. “It is not up to us to decide when we go.”

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The widow of Senator Edward Kennedy has joined a line-up of high-profile liberal Catholics opposing a referendum that would permit physician-assisted suicide in the predominantly Democrat state of Massachusetts.Victoria Reggie Kennedy voiced her opposition to physician-assisted suicide in an op-ed article in the Cape Cod Times, saying that Tuesday’s referendum would turn her late husband’s lifelong commitment to health care “on its head by asking us to endorse patient suicide – not patient care – as our public policy for dealing with pain and the financial burdens of care at the end of life.” Mrs Kennedy noted that when her husband was diagnosed with cancer he was given two to four months to live and survived for another 15 months.

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According to financial reports filed with the state, the Archdiocese of Boston and some of its affiliated organizations, such as the Boston Catholic Television Center and St. John’s Seminary, spent at least $2.5 million to defeat the proposed law. He added that the American Principles Project, a national conservative organization, along with one of its founders, added another $500,000 to oppose the initiative.

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In remarks to the assembly earlier in the day, O’Malley thanked his fellow bishops and Catholic organizations for their help in defeating physician-assisted suicide in Massachusetts, which he called a “terrible assault on human life.

”The Catholic church teaches that all life is sacred, from conception to natural death, and that suicide is always objectively wrong, though whether a person bears responsibility for committing suicide depends on his or her psychological and physiological state.

In his remarks, O’Malley pointed to the Netherlands, where doctor-assisted suicide is legal and where a group is now creating mobile teams that will offer euthanasia to patients at home, making lethal drugs more widely available to patients. The United States, O’Malley said, is a long way from that scenario, but only because voters in all but two states have held the line.

“What has put the brakes on the growth of physician-assisted suicide in the US is that more than 20 states have rejected proposed legislation and ballot initiatives,” he said.

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The Archdiocese of Boston led the fight against Question 2, the ballot measure that would have allowed people with less than six months to live to obtain lethal prescriptions. The church helped build a diverse coalition of doctors, hospice workers, and interfaith leaders and helped raise more than $4 million, much of it from Catholic organizations and wealthy donors across the country.

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On Tuesday the Roman Catholic Archdiocese of Boston did something it had not done for a while: It won a major political battle.The archdiocese and other Catholic donors supplied a significant share of the $5 million spent to defeat Ballot Question 2, which would have let terminally ill people obtain a prescription drug to end their lives. But the church did not win the fight alone. By Election Day a large, diverse coalition of opponents had united against the measure, including many Jewish, Christian, and Muslim clergy; palliative care doctors; hospice workers; and pharmacists.

Polls in early October suggested two-thirds of voters supported the ballot question. But on Election Day it failed by 2 points. Opponents outspent proponents by a factor of six.

“Physician-assisted suicide,” Cardinal O’Malley told the assembly, ”presents a moral and ethical threat to society, the medical profession, the disabilities community and the common good. It brings spiritual death, a cheapening of human life, and a corrupting of the medical profession. During the course of preaching and speaking about this issue, I often cited the Hippocratic Oath of ‘do no harm.'”Although the measure to legalize assisted suicide was defeated, the Church is nonetheless called to “become more focused on the fact that we must do more to promote good palliative and hospice care at the end of life.”

“The Church has always been committed to compassionate and dignified end of life care,” he said. “We must work with our hospice care and palliative care communities to continue to provide quality of care for the terminally ill. Fear of tremendous pain is advanced as a reason to support physician-assisted suicide. In almost every instance palliative care can suppress pain.”

The cardinal also reminded the assembly that “people already have the right to refuse burdensome, life-extending treatments. They also have the option of leaving advance directives to determine their care when they are no longer able to express their wishes. The death that results from withholding or withdrawing of life-sustaining treatment has always been separated by a bright line from active measures to cause death.”

“Assisted suicide proponents seek to blur this line,” he said. In preventing this measure from being passed, however, the Massachusetts prelate emphasized the importance of providing pastoral and medical care for terminally patients.

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Some religious groups, of course, have starkly different ideas. The Catholic Church has been vocal in its criticism of assistance in dying and, particularly, of Compassion & Choices. Last year, the United States Conference of Catholic Bishops laid out its official position in a statement. The bishops make a range of well-worn arguments, including the sanctity of the Hippocratic Oath and how “suicidal” people need counseling, confusing the distinction between those who are truly suicidal—who do not want to live—and someone who is terminally ill, who wants to live but chooses to hasten their death because they can’t prevent it. The bishops also argue that allowing people to have a say in how and when they die will inevitably lead to abuse of the practice.

“Taking life in the name of compassion also invites a slippery slope toward ending the lives of people with non-terminal conditions,” the statement said.

RIGHT TO DIE

Death with Dignity 2012, the political action group supporting the measure, staunchly disagrees, saying people deserve to choose how they die.

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Compassion & Choices provides information about end-of-life choices to help patients make informed decisions that reflect their personal values and wishes for care. They don’t provide the means. They don’t administer. They don’t encourage or coerce. They have no agenda other than to provide complete and accurate information about end-of-life options.

*

Final Exit instructs terminally ill people how to end their lives with helium and an “exit mask”—self-acquired and self-administered—and does not pursue legislative reform. The group has run into legal trouble in recent years, notably in Phoenix, Atlanta, and most recently Minnesota, for breaking state laws that prohibit assisting in suicide. Compassion & Choices has so far avoided such problems.

*

“For the past year, the people of Massachusetts participated in an open and honest conversation about allowing terminally-ill patients the choice to end their suffering,” said Compassion & Choices. “The Death with Dignity Act offered the terminally-ill the right to make that decision for themselves, but regrettably, we fell short. Our grassroots campaign was fueled by thousands of people from across this state, but outspent five to one by groups opposed to individual choice.”

The “Death With Dignity Act,” which aimed at allowing a physician licensed in Massachusetts to prescribe medication to a terminally ill patient to end their own life, lost 49% to 51%, according to election results.

In Massachusetts, 1,439,785 voters were against the proposal, while 1,382,651 supported the measure. In Boston, however, voters didn’t share the same sentiment as the rest of the Commonwealth. Hub voters favored the act, with 111,852 of those registered casting a “Yes” vote, compared to 107,377 who voted “No.”

“Even in defeat, the voters of Massachusetts have delivered a call to action that will continue and grow until the terminally-ill have the right to end their suffering,” backers of Question 2 said on Wednesday.

*

Compassion & Choices also debunks misinformation, like the idea that ceasing to eat and drink could be painful. It’s not. Terminally ill people typically don’t have healthy appetites to begin with, so hunger pangs are unlikely. Headaches are common at the beginning, but those pass quickly; thirst or dry mouth is the biggest challenge, but it’s more discomfort than pain, and there are ways to ease it.

“I never tell patients I’m going to help them have a good death,” she said. “What I say is, ‘Let’s work together to have the least bad death possible.’”

RIGHT TO LIFE

Some disability groups and religious organizations believe that the terminally ill who are disabled deserve better palliative care and emotional support rather than a prescription of deadly medicine. They also worry that people may feel compelled or coerced into choosing death because their care is expensive, they see themselves as a burden to others or because relatives are thinking that they do not want to spend the grandchildren’s college tuition to keep grandpop going in a nursing home or ICU. Given the current push to contain medical costs, the biggest fear is that the vulnerable will get the bum’s rush to the hereafter.

*

Few people know that there is not a provision in this ballot language requiring family members to be notified if their loved one decides to take his or her life, that doctors are not present at the end, and that a terminally ill patient can get this prescription filled at the local pharmacy. There is a misguided perception that somehow this all takes place in a medically supervised setting. In reality, there is no tracking of these pills once they are picked up and brought to the person’s home.

*

Patients would not be required to seek psychiatric care before obtaining the lethal drug.  Multiple studies show a connection between a terminal diagnosis and patients developing depression.  As it stands, no mental health professional would be required to be part of the consultative process. I don’t think that the fact that the cardinal is sending out a homily to people is changing poll numbers,” said Mark Horan, spokesman for the Committee Against Physician Assisted Suicide.
Horan said many voters agree the measure has flaws, such as no requirement to notify family members or for psychological counseling.

*

Harvard Right to Life stands for the right to life from conception to natural death,” HLR president Matthew R. Menendez ’14 said. “So it is our view that it is never right to voluntarily end a life, and so in that sense we are opposed to [the Death with Dignity initiative].”

*

Wesley J. Smith of Secondhand Smoke blog says opposition consists of:
•    Disability rights activists who see themselves and the elderly–rightly–as the targets of the movement;
•    Medical professional organizations are overwhelmingly opposed to legalizing assisted suicide.
•    Egalitarian liberals, such as Robert P. Jones, believe that assisted suicide threatens equality.
•    Pro-lifers offer a solid foundation of opposition from which to build a winning coalition.
•    Advocates for the poor who understand that assisted suicide could easily become a form of medical cost containment

*

The landmark 2009 report by MetLife Mature Market Institute describes elder financial abuse as a crime “growing in intensity.” The perpetrators are often family members, some of whom feel themselves “entitled” to the elder’s assets. The report states that they start out with small crimes, such as stealing jewelry and blank checks, before moving on to larger items or coercing elders to sign over the deeds to their homes, change their wills or liquidate their assets. The report states that victims “may even be murdered” by perpetrators.

With legal assisted suicide in Oregon and Washington state, perpetrators are instead able to 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. The elder could be cajoled or coerced into taking the lethal dose, for example, while under the influence of alcohol. The lethal dose could be administered while the elder slept. If he awoke and struggled, who would know?

*

A Boston Globe poll in September showed 68 percent of voters in support and 20 percent opposed. In the end, the margin of defeat was 62,000 votes out of nearly 3 million cast. Some commentators attributed the defeat to prominent opposition by disability activists there who feared pressure to use the law, especially for older people with disabilities. Opposition also included the Massachusetts Medical Society and Senator Ted Kennedy’s widow.

INTERNATIONAL ACTIVITY

AUSTRIA

The Gallup Inc. poll for the Swiss Medical Lawyers Association (SMLA) found that Catholic Austria had the third highest support for the idea of allowing people to decide to take their own lives with 83 per cent in favour. An additional 4 per cent had no opinion and 13 per cent did not agree.

The country which showed the least enthusiasm still also had a majority in favour in Greece where just over half – 52 per cent – agreed assisted suicide should be allowed in some cases such as terminal illness. Support was only stronger in Germany and Spain.

In addition 72 per cent of people in Austria agreed that they could consider using assisted suicide themselves with 18 per cent against the idea, and of these 85 per cent said it should always be carried out with professional assistance in the form of a medically qualified person.

Most Austrians also felt it was wrong that doctors could face prosecution for helping with assisted suicide with 77 per cent calling for it to be lifted against 14 per cent that felt it was right to keep the law in place and 9 per cent that did not know.

Some 27 per cent of Austrians however also admitted that they were worried that they might be put under pressure to choose suicide if it was legalised, saying they saw it as an occasional risk and 7 per cent said they imagined it would be a frequent risk.

AUSTRALIA

Every week about five elderly Australians commit suicide, and euthanasia advocates say most of them hang themselves for lack of a better way to end their pain.

At the same time, keeping people alive with “futile” but expensive treatments in hospitals is both cruel and blowing out health budgets, an intensive care doctor says. “The vast majority is by hanging themselves. The explanation for that is that rope is very easy to get and access to information about how to hang yourself is easy to get … but information about a safe peaceful mediated death is not.

CANADA

Exposing Vulnerable People to Euthanasia and Assisted Suicide by Alex Schadenberg uncovers data from peer reviewed journal articles and studies related to the euthanasia deaths without request, the unreported euthanasia deaths, and the experience of nurses with euthanasia in Belgium. The book also examines the most recent statistics from the Netherlands.

This book exposes how vulnerable patient groups are dying by euthanasia and it also exposes how Justice Smith in the Carter case, the Royal Society of Canada end of life decision making report and the Quebec Commission on Dying with Dignity avoided the truth in order to establish false and dangerous recommendations for the legalization of euthanasia and assisted suicide. “Using already existing studies, Schadenberg has uncovered the shocking truth about euthanasia in Belgium, the lives lost and the deep threat to others. His work demonstrates unequivocally that we must never follow this Belgian pathway to the easy killing of people whose lives are not valued by those who do the killing.”

SOUTH AFRICA

Davison, author of Before We Say Goodbye: Helping my mother die and After We Said Goodbye, was sentenced to five months of house arrest in New Zealand for assisting in the suicide of his terminally ill mother. He returned to South Africa at the end of April. Davison is on the executive committee of DignitySA and they have drafted a policy document that could be used as the basis for a draft bill. The organisation is considering bringing a class action to the Constitutional Court if the bill is not adopted by parliament. They are aiming to legalise euthanasia by the end of next year.

UNITED KINGDOM

An independent review of the controversial palliative care practice known as the Liverpool Care Pathway (LCP) has been announced, many newspapers report.

The LCP is intended to allow people with a terminal illness to die with dignity. But there have been a number of high-profile allegations that people have been placed on the LCP without consent or their friend’s or family’s knowledge.

Concerns have also been raised about hospitals receiving payments for increasing the number of patients who are placed on the LCP.

Care minister Norman Lamb is quoted as saying ‘It is clear that everyone wants their loved ones’ final hours of life to be as pain free and dignified as possible, and the Liverpool Care Pathway is an important part of achieving this aim.’

‘However, as we have seen, there have been too many cases where patients were put on the pathway without a proper explanation or their families being involved. This is simply unacceptable.’

*

Does the cost of applying heroic measures at the end of life exceed the cost of palliative care for 6 months? Can’t be about saving money. In America, nothing happens without a cost-benefit analysis. But the case for a less excruciating death can stand on a more neutral, less disturbing foundation, namely that it is simply a kinder way of death.

*

A Church of England body is opposing changes to a British law on assisted dying, saying it would permit people to actively participate in someone’s death, a move unprecedented since the country’s abolition of capital punishment.

 

NATIONAL/INTERNATIONAL ORGANIZATIONS

Care Not Killing (UK)

Committee Against Physician-Assisted Suicide (US)

Compassion & Choices (US)

Compassion in Dying (UK)

Death with Dignity (US)

Dignitas (Switzerland)

Dignity in Dying (UK)

Dying with Dignity (Canada)

Euthanasia Prevention Coalition (Canada)

Final Exit Network (US)

Healthcare Professionals for Assisted Dying (UK)

Not Dead Yet (US)

Patient Rights Council (US)

Second Thoughts (US)

World Federation of Right to Die Societies (UK) – The World Federation, founded in 1980, consists of 45 right to die organizations from 25 countries. The Federation provides an international link for organizations working to secure or protect the rights of individuals to self-determination at the end of their lives.

BOOKS

How to Die Consciously by Diane Goble – Practical suggestions about how to prepare yourself and your family for your transition whenever/however it happens (because we are all going to die)

Assisted Death Debate – News from May 2012

End-of-Life discussions about Assisted Dying/Suicide/Euthanasia in news articles, blogs, videos from the left, right and center during the month of May 2012. This is a place to find out what’s being talked about around the world as we sort out this highly emotional and controversial issue.

Become informed, open your mind,  join in the discussions. Our leaders need to know what people are thinking and we need to know what our leaders are considering in terms of laws. These are conversations we all need to have!

BLOGS

Dike Drummond, MD: Death with Dignity in the emergency department (5/9/2012)

The Non Sequitur by John Casey: Bad Company (5/5/2012)

The New Old Age Blog: Massachusetts Debates ‘Death With Dignity’ (5/29/2012) –  At the end a rush to the ER (5/6/2012) – Among the very ill confusion about life’s end (4/6/12)

American Medical News (Opinion) – Obstacles in providing end-of-life care (5/7/2012)

Pain Policy & Palliative Care – Relieving the supreme Court’s Pain…  Revisiting the constitutional right to Palliative Care (5/12/2012)

GeriPal – A Geriatrics and Palliative Care Blog: A Thin Reed to Hang On by guest author, Barbara Coombs Lee, President of Compassion & Choices (5/16/2012)

Secondhand Smoke by Wesley J. Smith: Palliative Sedation Not = To Terminal Sedation/Euthanasia  5/18/2012 – Should we kill Alzheimer’s patients? 5/24/2012

Physician-assisted death commercial

Book Recommendation – In Search of Gentle Death: The Fight for Your Right to Die With Dignity by Richard N. Cote

UNITED STATES

(Arizona, California, Connecticut, Georgia, Hawaii, Kansas, Maine, Maryland, Massachusetts, Minnesota, Nebraska, New Mexico, New York, Oregon, Texas, Vermont, Washington)

Arizona

Prescott man kills wife, self, after telling police they planned suicide (The Repubilc 5/4/12) – Police in Prescott say an 88-year-old man killed his wife and them himself after calling 911 and saying both were terminally ill and planned to commit suicide.
Police spokesman Lt. Andy Reinhardt says the man called police at about 8 p.m. Thursday from a medical center parking lot and told dispatchers where they could be found. Arriving officers discovered the man dead of a self-inflicted gunshot wound and his wife severely wounded. She was flown to a Phoenix hospital where she died.
Reinhardt says the couple lived in a nearby assisted living facility and had apparently walked to the medical center where they were found.
The couple were identified as Robert Grossman and his 85-year-old wife Joanne Grossman.

California

92-year-old retired school teacher faces sentencing for selling helium suicide kits (CBS News 5/7/2012) – A 92-year-old retired school teacher who sold $40 helium kits to people who could use it to kill themselves faces sentencing in San Diego for failing to file federal tax returns.
Sharlotte Hydorn faces a maximum term of one year in prison when she is sentenced Monday by U.S. Magistrate Judge Bernard Skomal.
The Spokane, Wash, native began assisting physicians with patient suicides after her husband, Rex, died of colon cancer, said Charles Goldberg, her attorney. Her husband was in “agonizing pain” and did not want to die “filled with tubes in a hospital.”
(more)

Assisted suicide or a show of love? by Tony Perry, Los Angeles Times 5/16/2012 – SAN MARCOS, Calif. —When paramedics arrived at the Purdy home March 20, Margaret was seated in her favorite chair in the living room. The morning sunshine streamed in through a picture window that overlooked a valley. A plastic bag was over her head, tied securely at the neck.
A suicide note in her handwriting was in a folder on her desk, beneath a shelf with books about death and dying. She had written that the pain from her various medical conditions had become unbearable.
Alan Purdy met the paramedics at the door. He said that his 84-year-old wife had taken 30 sleeping pills mixed with applesauce and then suffocated herself.
(more)

Dr. Drew – Is suicide ever OK? – interviews John West, author of The Last Goodnights: Assisting My Parents With Their Suicides (4/2012)

Colorado

Death with dignity: why Coloradans should legalize assisted suicide by Sam Smith, The Catalyst 5/20/2012 – Here in Colorado, we have a statute in place that explicitly criminalizes assisted suicide. Thirty-three other states, from Florida to Alaska, have statutes that do the same. Nine more states, from Vermont to Idaho, criminalize assisted suicide through common law. The other eight states, from North Carolina to Utah, have not criminalized nor legalized assisted suicide.

The fact of the matter is that even if you are against assisted suicide on a religious or moral ground, it should not be up to you what people do with their lives and deaths. People should be able to control their own lives–it’s that simple. Just like abortion is legal and regarded as a matter of choice, assisted suicide should be legal and regarded as a matter of choice.

Some terminally ill patients are allowed to end their lives by refusing medical treatments; in all fairness, those who don’t have that option should be allowed to choose death.

Connecticut

CT Golden Years: Euthanasia, Death Penalty for Connecticut’s Seniors? by Ron Winter (ctwatchdog.com 5/2/2012) – In April Connecticut officially abolished the death penalty for people convicted of murder, making it the 17th US state to do so, even though a majority of state residents wanted to keep it intact.
But as one class of residents gets a reprieve, another class may be vulnerable to continuing efforts across the country to deprive them of life, quite possibly without their knowledge or consent.
(more)

Georgia

Georgia Governor signs ban on assisted suicide by Patrick B. Craine (LifeSiteNews.com 5/2/12) – Georgia Gov. Nathan Deal has signed a bill banning assisted suicide that will now take effect immediately.
The bill, HB 1114 sponsored by Rep. Ed Setzler (District 35), was passed in response to last February’s decision by the Georgia Supreme Court that struck down the state’s previous law that pro-lifers considered weak and ineffective. It had only prevented advertising assisted suicide services, but did not prohibit the procedure itself.
“Stopping the immoral and barbaric practice of killing in the name of compassion is the right thing to do,” said Dan Becker of Georgia Right to Life. “Governor Deal deserves credit for endorsing this measure.”
“Any society that claims to value life cannot justify taking a life lest we risk establishing a public policy with its attendant expectation of a ‘duty to die,’” Becker said. “The Hippocratic Oath says, ‘I will give no deadly medicine to any one if asked, nor suggest any such counsel …’”
“We should instead devote our knowledge and resources to helping people in desperate situations,” he added.

Assisted Suicide Group Indicted (Kennesaw Patch by Gaetana Pipia 5/15/2012) – A Kennesaw man and three other members of the nonprofit Final Exit Network right-to-die group were indicted Friday for their alleged roles in the 2007 suicide of a Minnesota woman, reported Apple Valley Patch.
Thomas “Ted” Goodwin, 65, of Kennesaw and Punta Gorda, FL faces a felony charge of assisting 57-year-old Doreen Dunn to commit suicide and a gross misdemeanor charge of interference with a death scene.
An autopsy initially found that Dunn died of coronary artery disease. But Minnesota authorities reopened their investigation into her death in late 2009 after Georgia officials contacted them about a similar case.
Goodwin was arrested in Georgia in 2009 and accused of assisting in the suicide of a 58-year-old Cumming man, but the charges were dismissed against him and three others in February of this year. Georgia’s Supreme Court cited free speech violations as the basis for its unanimous decision. At the time, Georgia law prohibited advertising assisted suicide services, but not the act of assisted suicide itself.
(more)

Hawaii

Civil Beat Poll – Assisted Suicide Support Strong by Michael Levine (Honolulu Civil Beat 5/4/12) – Hawaii voters support the rights of doctors to help terminally ill patients end their lives by better than a 2-to-1 margin, according to The Civil Beat Poll.
Liberal, well-educated and wealthier voters were most likely to say physician-assisted suicide — also known as “death with dignity” — should be legal, the survey of 1,162 registered voters1 found.
Proponents have argued that death with dignity is already legal in Hawaii. Doctors and have formed an aid-in-dying advisory council and are already offering to help terminally ill patients end their lives.
Past attempts by the Hawaii Legislature to clarify the legal status of assisted suicide have failed. They’ve been opposed primarily by religious groups like the Catholic Church. As of today, death with dignity is legal in Oregon, Washington and Montana.
(For more about the status of aid in dying in Hawaii, read Chad Blair’s two-part interview with Compassion & Choices: A Conversation About Aid In Dying In Hawaii and How Other States Treat Aid In Dying)
Civil Beat asked voters, “Do you believe that doctors should be allowed to help terminally ill patients end their lives?”
(more – lots of charts)

Kansas

Death with dignity by Hilda Enoch, Lawrence 5/1/12 (LJWorld.com) – To the editor: This may be the next needed and, one day in Kansas, protected human right: the right to die with dignity, for those requesting it, physician-assisted dying, an earnest choice between a patient and her/his physician in the privacy of their shared conversations.
The anguish of imposing on one’s loved ones that prolonged period of enduring the suffering and irreversible deterioration of one so well-loved, when it’s against her/his wishes should be finally eliminated, not to mention the costs to the family of those last excruciating months. Shouldn’t such compassion be among the personal choices afforded the person who is dying? It’s her life, isn’t it? Let it end with her personal wishes for a death with dignity and compassion.

Death With Dignity: How Doctors Die (Doctors routinely administer intensive care to patients who say they want it, but many refuse lifesaving treatment themselves. by Ken Murray (Utne Reader May/June 2012) – Doctors die, too. And they don’t die like the rest of us.
Years ago, Charlie, a highly respected orthopedist and a mentor of mine, found a lump in his stomach. He had a surgeon explore the area, and the diagnosis was pancreatic cancer. This surgeon was one of the best in the country. He had even invented a new procedure that could triple a patient’s five-year-survival odds—from 5 percent to 15 percent—albeit with a poor quality of life. Charlie was uninterested. He went home the next day, closed his practice, and never set foot in a hospital again. He focused on spending time with family and feeling as good as possible. Several months later, he died at home. He got no chemotherapy, radiation, or surgical treatment.
(more)

Lousiana

Bill would strengthen La. ban on euthanasia (KATC.com News 5/29/2012) – A bid to strengthen Louisiana’s ban on euthanasia is headed to the governor’s desk after receiving final legislative passage.
The state has a prohibition in criminal law against euthanasia and assisted suicide. The bill (House Bill 1086) by Rep. Alan Seabaugh, R-Shreveport, will add the prohibition to the state’s medical consent law.
Seabaugh’s proposal will spell out that someone authorized to approve medical procedures for another person may not approve any procedure that would be considered assisted suicide. That prohibition also will extend to include surgical or medical treatment for the developmentally disabled or nursing home residents who may be unable to make their own medical decisions.
Gov. Bobby Jindal supports the bill.

Maine

Obama administration is no Third Reich by Maureen Gill, Journal Tribune 5/16/2012) – In Hitler’s Third Reich, euthanasia became a euphemism for the secret, systematic murder of the mentally and physically disabled, and it predated the genocide of the Jews by two years. It was but one of many eugenic measures to secure the “racial purity” of the German nation. The euthanasia program was intended to eliminate what eugenicists considered “life unworthy of life” – individuals whom they believed were genetic and financial burdens to the nation.
Hitler called such people “useless eaters.”
One of the topics I’ve lectured about in the college classroom and public square is whether America’s physician-assisted suicide movement represents a moral slippery slope analogous to Germany’s descent into madness. This is a discussion uniquely suited to my training as a historian with expertise in German fascism and medical ethics. Since passage of the Patient Protection and Affordable Care Act, often called “Obamacare,” such discussions expanded with a plethora of nonsense about “death panels” and rationing. This hyperbole has taken a particularly venal turn since the Department of Health and Human Services initiated efforts to protect women in the workplace from the overreach of their employers, relative to insurance coverage for contraception. President Obama has also been under attack for his administration’s pro-choice stand and defense of same-sex marriage.
(more)

Maryland

Baltimore Doctor Who Helps Terminally Ill Patients End Their Lives Faces New Charges (CBS Baltimore 5/15/2012) – These charges are just the latest legal challenge for the right-to-die movement.
Dr. Lawrence Egbert from Baltimore is the modern-day Jack Kevorkian. He’s been arrested numerous times for illegally assisting in suicides.
Egbert was medical director of the Final Exit Network, a group that offers support and a suicide plan for people suffering from a variety of fatal diseases and conditions. Authorities in Minnesota are the latest to criminally charge the doctor and his colleagues. In 2007, prosecutors say Egbert traveled to the Twin Cities to see a patient.
(more & video interview with Dr. Egbert)

Massachusetts

Physician-Assisted Suicide Ballot Push In Massachusetts by Jessica Pieklo (4/30/12) – This November voters in Massachusetts will do more than just help elect a president. They may get a say on whether or not terminally ill individuals should have the ability to get a fatal prescription and control the terms of their own death.
Patient advocates are pushing a ballot initiative to legalize the practice they call “Death with Dignity,” or more commonly known as physician-assisted suicide. If the measure makes it on the ballot, and if voters approve it, Massachusetts would become the third state, joining Oregon and Washington, where voters have explicitly endorsed it.
(more)

Konchok Rangdrol’s Blog: Support the Massachusetts Death with Dignity Act 5/15/2012

Legal Challenge to Assisted Suicide Initiative! Mass Against Assisted Suicide (5/18/2012) – On Thursday, May 17, 2012, Massachusetts voters including members of the disability rights group Second Thoughts filed a challenge before the Supreme Judicial Court regarding the proposed ballot language for the measure that, if approved, would legalize assisted suicide in the state.
“The ballot language is clearly misleading,” said Second Thoughts director John Kelly of Boston. “We want the voters of Massachusetts to know exactly what they are voting on this November,” he said.

Doctor-prescribed suicide may not bring ‘dignity,’ say workshop presenters by Christopher S. Pineo (PilotCatholicNews.com 5/25/2012) – The realities of physician assisted suicide could reverse social stigmas against suicide, de-personalize care for people facing terminal illness, and create undignified final moments of life. Those points were the focus of the speakers at the Braintree presentation of the Archdiocese of Boston’s educational campaign “Doctor-Prescribed Suicide is Suicide… and suicide is always a tragedy!” Similar education sessions were held through the archdiocese during the month of May.
(more)

Death with Dignity or Murder? Francesca Bastarache interviews Dr. Marcia Angell and Heather Clish  5/24/2012 – Dr. Marcia Angell, former executive editor of the New England Journal of Medicine, now a senior lecturer in social medicine at Harvard Medical School; Time Magazine named her one of the 25 most influential Americans, is a woman on a mission. I assure you. She is NOT amusing herself.  If she has anything to say about it, this fall we will be voting in Massachusetts for the Death With Dignity Act.

Death Panels: Massachusetts is about to approve them by Julia Goralka, The Washington Times Communities 5/29/2012 – I am dying. I don’t have an incurable illness or suicidal thoughts, although with three teenagers those thoughts have flitted through my mind occasionally. At 48, I am not old; I am snuggling nicely into middle age. But make no mistake. I am well aware that I am dying. And so are you.

Minnesota

Minnesota grand jury to review right-to-die case (10tv.com 5/8/2012) – A grand jury is expected to hear evidence this week about the involvement of a national assisted suicide group in the death of a Minnesota woman in 2007.
Apple Valley resident Doreen Dunn, then 57, suffered through a decade of intense, chronic pain before she reached out to the New Jersey-based Final Exit Network. She used helium and a plastic bag to suffocate herself in May 2007, said Robert Rivas, a Florida attorney representing the group. He said he believes four members are now at risk of indictment.
Dakota County Attorney James Backstrom issued a statement Monday confirming his office is investigating Final Exit Network and that he will be convening a grand jury.
(more)

Should assisted suicide be an option for people in chronic, incurable pain? (MPR by Eric Ringham 5/9/2012) – opinions

Minnesota prosecutor obtains grand jury indictment of Final Exit Network and four of its volunteers (5/15/2012) – James Backstrom, the Dakota County prosecutor, called a press conference to deny that he has initiated a war on the right-to-die movement by securing a 17-count indictment against Final Exit Network and four of its volunteers.
As Final Exit Network had predicted, the grant jury handed down the indictment on Friday, May 11, 2012.  But the indictment remained sealed until Monday, when Backstrom called a 3 p.m. press conference to release the indictment and plenty of misinformation about Final Exit Network.
“It is appalling that the government would spend so much of its resources in this political prosecution,” said Final Exit Network’s president, Wendell Stephenson.  “We look forward to an opportunity to bring out the truth about Final Exit Network’s compassionate volunteers in court.”
(more)

Legal fight looms in Apple Valley suicide case by Katie Humphrey, Star Tribune (5/15/2012) – Dakota County Attorney James Backstrom announced Monday that a local grand jury had indicted the Final Exit Network and four of its members on 17 counts of assisting a suicide and interfering with a death scene.
The network faces four counts, two of them felonies. Altogether, the grand jury returned indictments on nine felonies related to assisting in a suicide and eight gross misdemeanors for interference in a death scene.
“If the people of our state wish to authorize assisted suicide, this should be done through clearly defined laws enacted by the Minnesota Legislature with proper restrictions and requirements to ensure the protection of a terminally ill patient and the direct involvement of the patient’s physician and immediate family,” Backstrom said during a news conference at the county law enforcement center in Hastings.
Lawyers for the network and one of the defendants vowed vigorous defenses, starting with a motion to dismiss the case, arguing that the Minnesota law prohibiting assistance of a suicide is overly broad and violates the First Amendment right to free speech.
(more)

Dr. Jon Hallberg: Clearing up confusion about palliative health care – MPR 5/16/2012 – ST. PAUL, Minn. — Palliative care is an approved medical subspecialty that’s present in 85 percent of larger hospitals. But a new survey in the Journal of Palliative Medicine shows that many patients and health care professionals are still confused about the concept. Many even confuse palliative care with euthanasia. (more: transcript & broadcast)

Legal, moral struggles to ‘death with dignity’ (StarTribune Editorial  5/19/2012) – Facing serious illness, most of us don’t want to suffer ourselves or stand by and see another person in pain.
That sentiment is understandable, especially in cases of terminal illness. However, it’s still illegal in most states, including Minnesota, to help someone end their life.
(more)

Nebraska

The Choice of Life or Death (1011now.com 5/14/2012) – Doctor assisted suicide, death by choice or dignified death, whatever you chose to call it, it’s an issue many are fighting for — the freedom to choose when and how you die.
It emerges as the most controversial cultural issue in a recent Gallup Poll. Americans are divided 45% to 48% over whether it is morally acceptable or morally wrong.
One Lincoln couple made that choice.
“It’s going to be a process, but I get it and I am so ok with it and I am happy they are together,” said Kim Miller, the daughter of Carol and Ray Miller.
It’s hard to imagine what it must feel like to lose a parent.
Imagine the heartbreak of losing both your parents at the same time because they took their own lives.
To help you understand why the family is so ok with it, you first have to know the great love story of Ray and Carol Miller.
(more)

New Mexico

Cancer patient joins NM ‘right-to-die’ law fight (NECN.com 5/9/2012) – ALBUQUERQUE, N.M. (AP) — A 48-year-old Santa Fe woman with advanced uterine cancer is joining two doctors in their challenge against a decades-old New Mexico law that prohibits doctors from helping terminally ill patients die.
Aja Riggs publicly announced her decision to join the lawsuit during a news conference Wednesday in Albuquerque.
The lawsuit asks courts to clarify a state law that makes assisted suicide a felony. Lawyers intend to argue that the state law does not legally prohibit doctors from ending the lives of terminally ill patients.
According to the lawsuit, the doctors, both who work at the University of New Mexico Health Science Center, seek to be allowed to prescribe medication to terminally-ill patients who want to end their lives.
The American Civil Liberties Union of New Mexico is helping with the lawsuit.

Some want a choice at the end of the road by Leslie Linthicum, ABQJournal 5/30/2012 –  “I’m actually going to take a pen and write a prescription for something that will end someone’s life.”
That was Katherine Morris, an oncologist and surgeon, facing a documentary filmmaker’s camera and summing up her role in helping an Oregon woman with terminal cancer give herself a lethal dose of barbiturates.
The film, a Sundance Film Festival winner last year, is called “How To Die in Oregon” and it follows Cody Curtis, a 54-year-old woman with advanced liver cancer, as she prepares for and then carries out what is commonly, but inaccurately, called “physician-assisted suicide.”
Morris is at UNM’s Cancer Center now, and she is one of two New Mexico oncologists bringing a lawsuit that asks the court to make a distinction between “assisting suicide,” which is a felony in New Mexico, and a physician “aiding in dying,” which is doing just what Morris did twice in Oregon — prescribing a lethal dose of medicine, usually Seconal pills, to mentally competent patients who are terminally ill and want to choose their time to die.
(more)

New York

New York assisted suicide bull loses support by Hillary Senour, EWTN News, Global Catholic Network 5/27/2012 – A bill that would have helped legalize physician-assisted suicide in the state of New York has lost its only sponsor thanks to the influence of the New York State Catholic Conference.
In early May, director of Pro Life Activities for the Conference, Kathleen Gallagher, met with bill sponsor Assemblyman Eric Stevenson (D-Bronx) and convinced him to remove his support.
(more)

Daunting questions on our fate – Michael Brannigan, timesunion.som 5/31/2012 – Does the case for terminal sedation actually weaken the case against physician-assisted suicide?
Terminal sedation, more clinically referred to as “palliative sedation,” is a legally sanctioned alternative to physician-assisted suicide, a last resort in palliative treatment. It involves inducing and maintaining unconsciousness in a terminally ill patient until the patient dies, and is often accompanied by withholding or withdrawing medical feeding and hydration.
For example, if, in my advanced cancer, I experience intolerable pain, delirium, dyspnea or distress, to alleviate these unmanageable symptoms I let my physician sedate me into unconsciousness until I die. Sort of like undergoing anesthesia before surgery, without waking up.
(more)

Five tips for families facing end-of-life care by Alexandra Sofferlin, Time Healthland (5/31/2012) – In this week’s TIME cover story, “The Long Goodbye”, journalist Joe Klein writes about the loss of his parents. They both suffered from dementia and died within months of each other. Through their end of life, Klein became his parents’ death panel. Video – How to Die
For the many other families facing the same journey, experts’ best advice is to prepare early. As with most difficult transitions, caring for a parent or loved at the end of life is easier if you’ve planned for it. Trying to make the best possible decisions about care often leads to added stress and confusion, especially if your family is already in a difficult situation. “It’s all pre-planning really,” says Malene Smith Davis, CEO of Capital Caring, which provides palliative care and guidance for families. “People really do cope well if they have a conversation about care with their families early. When families don’t have the conversation, that’s when there’s turmoil because no one is prepared and it’s inevitable.”

Oregon

Dragging out death has become an unpleasant societal epidemic by Todd Huffman, OregonLive.com (5/21/2012) – So desperate are we to prolong our curtain calls that hospitalizations during the last six months are rising. The average time spent in hospice and palliative care, which stresses comfort and quality of life once an illness becomes incurable, is falling. The fatally and frightened ill, or their anguished surrogates, are choosing needless medicine over comfort care, compounding and prolonging physical torments beyond any sensible point.
We have become a society that does not allow those who are close to death to die quickly and peacefully.
As a result, people today are actually sicker than ever as they die. Patients agree to treatments in the end more injurious than was their illness. Families push for treatment, only to discover that there are worse things than having someone you love die.
(more)

Texas

Euthanasia is a choice we don’t have yet (The Daily News-Galveston by Pepper Montague 5/9/2012) – In the state of Texas, if we choose, we can be taken off life support, kept out of pain and “allowed” to die, but it is illegal to be “assisted” in dying. There is a problem with that.
(more)

Vermont

Momentum in Montpelier for Death with Dignity Bill by Dick Walters, President Patient Choices at End of Life Vermont (5/3/12) – The majority of Vermonters support the Death with Dignity bill. They can be proud of the progress made in the 2011-12 legislative session toward enactment of this civil right. The issue has gained real momentum in the state capital.
The Death with Dignity bill would give terminally ill patients with fewer than six months to live the option – the choice – to request medication that they would self-administer as a way to control the timing and manner of their death.
(more)

Washington

Wash. Death with Dignity Act annual report released by Dan Thesman (KVEWTV.com 5/2/12) – OLYMPIA– The state’s third annual Death with Dignity Act report released today shows that 103 people requested and received lethal doses of medication in 2011. Since the 2009 law was passed, 255 terminally ill adults have received medication in Washington.
According to the report by the Washington State Department of Health, the 103 prescriptions were written by 80 different physicians and dispensed by 46 different pharmacists. The report covers January 1 to December 31, 2011. Participation increased 16 percent in 2011 from 2010.
(more)

One story behind Washington 2011 Death with Dignity Act Statistics by Colin Fogarty, OPB News 5/2/12) – The latest statistics on Washington’s Death with Dignity Act show a steady increase in the people who have legally ended their lives under the law. Seventy terminally people hastened their deaths in 2011 with the help of a doctor’s prescription. That’s according to a new report out Wednesday from the state Department of Health. Since 2009, a total of 255 terminally ill adults have ended their lives in this way.
Meg Holmes of Seattle held brain cancer at bay for 16 months. Surgeries and radiation couldn’t keep her down. Seven months after an MRI in March, Meg lost her ability to see and move around. And then suddenly… “She told me out of the blue that she had been thinking about the Death with Dignity Act and now that was something she was really interested in,” her husband said.
(more & listen to story)

Access to Aid in Dying Brings Peace of Mind (blog.compassionandchoices.org 5/2/12) – Compassion & Choices of Washington, a nonprofit organization that advocates excellent, patient-centered end-of-life care and stewards Washington’s Death With Dignity Act (DWDA), today responded to the state’s report on its third year of experience with the DWDA. “The report shows patients benefit from the peace of mind and comfort the law provides,” said Robb Miller, the group’s executive director. “The reports required under the DWDA confirm the safety of aid in dying. The law is working as intended and with no unintended consequences.”
The number of written requests, filed with the state under the provisions of the Act, rose only slightly, from 95 in 2010 to 103 in 2011. The number who self-administered medication to achieve a peaceful death in 2011 was 70. Of all the Washingtonians who died in 2011, those who self-administered life-ending medication obtained under the law represent only about 1 in 500.
(more)

INTERNATIONAL

(Argentina, Australia, Belgium, Canada, France, Germany, Ireland, New Zealand, Oman, Scotland, South Africa, Switzerland, United Kingdom)

Argentina

Argentina’s senate votes for “dignified death” law (CBS News 5/10/2012) – BUENOS AIRES, Argentina – Argentina’s senate on Wednesday overwhelmingly approved a “dignified death” law giving terminally ill patients and their families more power to make end-of-life decisions.
The law passed by a vote of 55 to zero, with 17 senators declaring themselves absent. It passed the lower house last year.
Now Argentine families won’t have to struggle to find judges to order doctors to end life-support for people who are dying or in a permanent vegetative state. Getting such approval can be very difficult in many countries, particularly in Latin America, where opposition from the Roman Catholic church still runs strong.
(more)

Australia

Suicide on agenda at forum – SunshineCoastDaily.com.au (5/13/2012) – The Your Death Your Choice community forum will tackle a range of controversial issues when it is hosted by Palliative Care Queensland and Cancer Voices Queensland, two of the state’s leading advocacy bodies for cancer and end of life.
“Queenslanders are suffering more and more because the Queensland Government has no end-of-life policy, and unlike other states, Queensland has no statewide plan for providing palliative care,” said Associate Professor Rohan Vora, president of Palliative Care Queensland.
(more)

Call for action by parliament on euthanasia by Lisa Cox, canberratimes.com.au 5/17/2012) – When he talks about euthanasia, Professor Bob Douglas borrows a line from a former health minister by saying it’s an issue that has politicians ”hiding under their desks”.
Studies have shown that the number of Australians who support voluntary euthanasia is greater than the number that oppose it.
A poll published last year by the Australia Institute put the figure in favour at three in four. Other surveys have had the percentage as high as 85 per cent.But despite the apparent endorsement, there has been no policy change around assisted dying and attempts to have legislation passed have failed.
(more)

Belgium

Euthanasia should also be possible for minors – FlandersNews.be 5/5/2012 – The Flemish socialist lawmakers Marleen Temmerman and Myriam Van Lerberghe want to make euthanasia possible for minors and those suffering from dementia. That’s according to a report in De Standaard. The two politicians are planning to propose a bill by the end of May.
They hope that the time is right to liberalize euthanasia. It should also be allowed for minors, people suffering from dementia or people who are permanently unconscious.
“Society is ready for this”, Ms Temmerman argues. She claims that a big majority of the people agrees with her, especially when a patient previously indicated that he or she would like to escape from this life in these special cases mentioned above.
(more)

Canada

Edmunton

Alzheimer’s and euthanasia by P.J. Cotterill, Edmonton Journal 5/23/2012 – I couldn’t agree more with the Calgary Herald’s editorial that Canada needs to copy the U.S. idea of a national Alzheimer’s plan.
Given Alzheimer’s current incidence and expected increase because of our aging population, we need to pay more attention to this dreadful disease and other forms of dementia.
Because a cure appears distant, however, any national plan should include legalized voluntary euthanasia, allowing those who do not wish to continue living without a functioning brain to die with dignity and less suffering.

Montreal

Term ‘medical aid in dying’ only confuses issue by Eric W. Mauser, Catholic Times Montreal 5/28/2012 – The recommendations of the Select Committee on Dying with Dignity have been tabled and the first round of public consultation concluded, but the most important public debate is yet to take place, according to the English Speaking Catholic Council (ESCC) and like-minded organizations.
The committee’s report recommended expansion of palliative care in Quebec asked the National Assembly to legalize euthanasia and physician assisted suicide, which the report calls “medical aid in dying.”
While there is near unanimous approval for improving palliative care throughout the province, the provisions for “medical aid in dying” are cause for alarm, some groups say.
(more)

Saskatoon

A conversation about medically-assisted suicide at a Saskatoon library – Heads of major Canadian organizations debated the legalization of medically-assisted suicide – Reported by Jared Knoll, CKOM NewsTalk 650 5/3/12) – Saskatoon’s Frances Morrison Library hosted a public debate Thursday night on the legalization of medically-assisted suicide.
Wanda Morris, executive director for Dying with Dignity, faced off against Alex Schadenberg, executive director with the Euthanasia Prevention Coalition.
Morris said that it’s a matter of choice and compassion.
(more)

France

Pope urges France’s Hollande to ‘respect life’ (expatica.com French News 5/16/2012) – Pope Benedict XVI has urged French President Francois Hollande to “respect life” — a reference to abortion and euthanasia, the I.Media news agency for Vatican affairs reported on Wednesday.
The pope congratulated Hollande on his appointment and said he should protect “the dignity of everyone.” The Socialist Hollande supports euthanasia for terminal patients, a stance that is worrying the Catholic Church.
Hollande has also proposed including legally-enshrined principles of secularism in the French constitution.
“I ask God to help you so that, respecting its noble moral and spiritual traditions, your country may continue with courage its efforts to build an ever more just and fraternal society,” the pope said.

Video – Riz Khan: Should assisted suicide be allowed debate (3/9/2012)

Germany

German doctors vote against commercial suicide – BioEdge (May 5, 2012) – Earlier this month the German Medical Association apologized for human rights violations by Nazi doctors and asked for forgiveness from victims and their descendants. It also admitted that “outstanding representatives of renowned academic medical and research institutions” had cooperated in the Holocaust enthusiastically, and not under necessarily under duress from Hitler’s government.
(more)

India

Video – Choosing to Die (India – Nurse Aruna Shaunbaug has been in a vegetative state since she was strangled and sodomized by a disgruntled ward clerk 37 years ago. The Supreme Court rejected a mercy killing plea to end this woman’s life. Children with a debilitating condition with no cure and no money for treatments. Is euthanasia a reasonable request? Cases of active and passive euthanasia (2 parts)

Ireland

Exit International Ireland reports growing interest in assisted suicide by James Fogarty, Medical Independent 5/17/2012 – Three to four Irish people a week contact Exit International, a group campaigning for the legalisation of assisted suicide, according to the group’s Irish spokesperson Tom Curran.
(more)

New Zealand

Man admits helping his wife die by Victoria Robinson, AucklandNow 5/4/12 – An Auckland man has admitted helping his wife die to end her suffering from multiple sclerosis.
Evans James Mott, 61, appeared in Auckland District Court this morning, where his lawyer, Ron Mansfield, entered a guilty plea on his behalf.
No conviction was entered, and Mansfield indicated he would seek a discharge without conviction at sentencing in the High Court.
(more)

Kiwis back euthanasia – by Sarah Harvey (stuff.co.nz 5/5/2012) – New Zealanders are in favour of euthanasia for personal reasons, and often because they don’t want money spent on themselves that could benefit younger, healthier people, a soon-to-be-released study will show.
The University of Auckland study by clinical medical ethics lecturer Phillipa Malpas, to be published in the New Zealand Medical Journal this year, discusses the ethical implications around end-of-life decision-making through a number of interviews with New Zealanders.
Malpas said she interviewed a group of people aged 65 and over who were healthy, and expressed interest in, or were part of, the Voluntary Euthanasia Society.
(more)

Legal euthanasia kills justice for all by John Kleinsman (Sunday Star Times-Opinion 5/5/2012)

The euthanasia debate – DPF’s Kiwiblog 5/6/2012 – If the debate is about how do we make euthanasia safe, rather than does a person have a right to end their own life, then that is a step forward.
We should firstly recognise that we already have unregulated passive euthanasia in New Zealand, where people are allowed to die, even though they could be kept alive. I think there is far greater risk in the status quo, than in legislating the circumstances under which someone’s wishes to die can be implemented with assistance.
(more)

YourNZ – links and news 5/4/2012 – Political and social information and discussions – left, right, out and in centre

The Bioethics Center Blog – If you can tolerate this, then will your granny be next? Colin Gavaghan on New Zealand’s euthanasia debate 5/15/2012

Oman (Sultanate of)

Oman Daily Observer (May 1, 2012) – Fresh Debate by David Barber – The cases of two men charged with helping terminally ill relatives to end their lives have sparked a fresh debate about voluntary euthanasia in New Zealand.
Opposition politician Maryan Street is pushing legislation that would allow a person to help someone end their life without facing criminal charges. Parliament last debated the issue in 2003 after a woman was jailed for 15 months on a charge of attempted murder after her terminally ill mother died.
(more)

Scotland

Dignity in Dying’s response to the Assisted Suicide (Scotland) Bill – 5/5/2012

Call for debate on assisted suicide (heraldscotland.com 5/9/2012) – A woman whose husband has suffered from Alzheimer’s disease for 17 years has called for the debate over the right to die through assisted suicide to include patients with dementia.
Liz Jamieson, whose husband Hugh was diagnosed with the condition in 1995, said patients who are newly diagnosed should be able to decide, with the help of lawyers and relatives, about ending their lives.
(more)

South Africa

Emotional reunion for prof by Daneel Knoetze (DailyNews-South Africa 5/3/12) – Davison also thanked South Africans for the messages of support, especially Archbishop Emeritus Desmond Tutu who sent a letter pleading for leniency to the judge in the case.
“In New Zealand they have a great admiration for Tutu. I have no doubt that I would have served jail time had it not been for his support,” said Davison.
In 2006, Davison gave his 85-year-old mother, Dunedin resident Patricia Davison, a lethal dose of morphine after she tried to starve herself to death.
(more)

Dignity SA petitions for assisted suicide – by Kaylee Kruser, Eye Witness News 5/5/2012 – Cape Town – Non-governmental organization Dignity SA believes terminally ill people should have the right to choose end of their life. The organization started a petition to bring a bill before parliament to legalize assisted dying after the return home of Professor Sean Davidson from serving house arrest in New Zealand after helping his mother die in 2006.

Campaign to legalize assisted suicide in SA – Mail & Guardian News 5/17/2012 – A controversial campaign to legalise doctor-assisted suicide and active euthanasia was launched in Cape Town on Thursday, spearheaded by the Ethics Institute of South Africa (EthicsSA) and Dignity SA.
The launch comes two weeks after the much-publicised return to South Africa of Dignity SA founder Sean Davison, following his five-month house arrest in New Zealand for assisting his aged mother to die.
(more)

Switzerland

Vaud Canton in Switzerland to vote on new step in Right to Die laws – The World Federation of Right to Die Societies (April 30, 2012) – Following the initiative of 3 October 2009 launched by EXIT ADMD Suisse romande,  a vote will be held in the Canton of Vaud on 17 June 2012, hoping to change existing Swiss law in such a way that assistance for suicide will also be allowed in Socio-medical Establishments (so called SME’s), as it is in private homes.
(more)

World-weary Swiss seniors seeks suicide help – The Local-Switzerland’s News in English 5/9/2012 – New figures show that more and more Swiss seniors are taking advantage of assisted suicide even when they do not suffer from any terminal diseases.
The latest reports from Exit, the organization that offers assisted suicide to the Swiss, show that one in every five French speakers and one in every three German speakers opting for assisted suicide are not suffering from a life-threatening illness, newspaper Tribune de Genève reported.
(more)

Switzerland voters rejected ban on assisted suicide for foreigners (jurist.org) – On May 15, 2011, voters in the Swiss city of Zurich rejected a proposed ban on assisted suicide for foreigners as part of a plan to stem the rise of “death tourism,” in which foreigners take advantage of Swiss assisted suicide laws. Assisted suicide has been legal in Switzerland since 1941 and permits a non-physician with no vested interest in a person’s death to provide passive assistance such as prescribing necessary drugs. In 2010, Switzerland’s Federal Council and Federal Department of Justice and Police (FDJP) had introduced legislation establishing stricter rules on assisted suicide based on a consensus of local governments and agencies. UK Director of Public Prosecutions Keir Starmer also published a policy in 2010 outlining public interest considerations against prosecution of those who assist in a suicide including, among other factors, efforts made to dissuade the victim.

Video – The Suicide Tourist (5 parts)

United Kingdom

Patient denied dignified death (itvNews 5/4/12) – The family of a brain tumour patient from Tameside believe he was denied the dignified death he wanted, because medics didn’t turn off an implant designed to keep his heart beating.
Brian Williams, from Hattersley, asked to drift off gently during his final hours at Tameside Hospital. But he’d had a personal defibrillator implanted in his chest for heart problems, years earlier, and it kept shocking him when he was close to death.
(more)

Supporters of euthanasia and abortion ‘use same arguments as the Nazi’s did to promote genocide,’ says Vatican newspaper – Daily Mail Reporter 5/5/2012) – The Vatican’s semi-official newspaper has angered supporters of euthanasia and abortions by suggesting they apply the same justifications that were used by the Nazis to champion their murderous eugenics programme.
(more)

MPS welcomes GMC guidance on assisted suicide but calls for greater clarity – 5/4/2012 – The Medical Protection Society welcomes the General Medical Council’s guidance for its Investigation Committee and case examiners when considering allegations about a doctor’s involvement in assisted suicide, but calls for greater clarity.
Assisted suicide is a complex issue and doctors need clarity, certainty and consistency on their professional and legal responsibilities, when placed in these difficult and emotionally charged situations.
(more)

Assisted suicide law will force chemists from their jobs, says Wirral pharmacist (Diocese of Shrewsbury 5/9/2012) – Rosemary Baker of Hoylake warned pharmacists that they could be ostracised and ultimately driven from their jobs if they refused to dispense lethal drugs needed for assisted suicides if British laws were further weakened by either Parliament or the courts.
Her warning was sounded in a full-page article in the highly-respected Pharmaceutical Journal this week entitled “Stop and think! Are pharmacists really prepared to assist people to die”.

Majority of Ambulance Trusts have polices to ensure patients are not treated or resuscitated against their wishes at the end of life (Compassion in dying 5/24/2012) – Mrs Davis* contacted Compassion in Dying, concerned that her wishes at the end of her life may not be respected by her local ambulance service. Paramedics had told her that they would not take her Advance Decision into account when transporting her, reporting that they would only respond to a Do Not Attempt Resuscitation (DNAR) form signed by her doctor.
(more)

MS sufferer rode wheelchair for two hours to kill herself (The Telegraph 2/24/2012) – The day before Carol Hutchins died, she arrived home in floods of tears after the lever on her buggy had jammed leaving her unable to throw herself over a 3ft fence and into the water.
Determined to end her life, Mrs Hutchins returned to the canal the following day and got the mechanism working to lift the chair above the height of the fence.
(more)

Acutely ill patients prevented from dying with dignity in hospital by Sarah Boseley, The Guardian 5/31/2012 – A third of acutely ill patients in hospital, many of them nearing the end of their lives, are not getting the best care and may be subjected to futile resuscitation attempts that prevent them dying with dignity, according to a new report.
The report, from doctors at the influential national confidential enquiry into perioperative deaths (NCEPOD), paints a disturbing picture. Focusing on patients who suffered cardiac arrest in hospital and were given cardiopulmonary resuscitation (CPR), it finds that less than a third (29%) got good care.
(more)

Video – Euthanasia clarification hearing for Debbie Purdy (10/2/08)
Video – Purdy loses appeal (10/29/08)
Video – Debbie Purdy: I’ve got my life back (7/30/09)