Pauline Interviews Near-Death Experiencer Diane Goble

Diane Goble, MS, CCHt

Author, Educator, Spiritual Counselor, Hypnotherapist, Transition Guide

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talks about her near-death experience while drowning and the after-effects

with Pauline (March 2015) in Sisters, Oregon

Part One (14:32)

Part Two (10.03)

Part Three (11:32)

For more information, go to BeyondtheVeil.net

9780963860651-Perfect.indd

Available at amazon.com and bookstores everywhere

Near-Death Experiencer Shares Secrets from Beyond the Veil

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Search “Diane Goble” in your device’s ebook store or Google “ebooks by Diane Goble”

or read a sample and purchase directly from publisher (click on title below)

Watch for a New Smashwords Discount Coupon every month

Reincarnation and the Evolution of Consciousness (2013) – 16,000 words – $1.99

Author reading Chapter “The Challenge of Being Fully Human

Author on BlogTalkRadio with Pamela Edmunds’ Bridge Between Two Worlds – 2/12/14

Author on BlogTalkRadio with Pamela Cummins’ The Love Channel Show – 4/15/14

The Path to Peace & Joy (2013) – 15,290 words – $1.99

Author reading Chapter “Chakras

How to Die Consciously: Secrets from Beyond the Veil (2011) – 52,520 words – $2.99

Author reading Chapter “End of Life Conversations

Conversations with a Near-Death Experiencer – Book 1 (2010) – 95,840 words – $3.99

*** MARCH SPECIAL “50% Off” – Use code FJ47W at check out ***

More Conversations with a Near-Death Experiencer – Book 2 (2010) – 70,340 words – $2.99

*** MARCH SPECIAL “50% Off” – Use code ZQ22G at check out ***

Sitting in the Lotus Blossom (2010) – 64,100 words – $2.99

Author reading Chapter “The Wounded Planet

• • • • • • •

The following CDs are suggested in some of Diane’s ebooks

Vocals by Diane Goble • Music by Shapeshifter

Sample and downloads available by clicking on links below

happinessCDHappiness Journey (download) – $1.99

lotusmeditationLotus Meditation (download) – $1.99

Relax1-4Relax2-4Relaxation Exercise 1 & 2 (downloads) – $3.99

ClearingPastCDClearing the Past (download) – $1.99


Film can start “The Conversation” about end-of-life

I wrote this column which was published in my local newspaper, The Nugget on 12/10/2014, after viewing the beautiful, award-winning documentary “Final Pose,” about a local yoga teacher who developed cancer and in the end decided to use Oregon’s Death with Dignity Act.

I attended the screening of “Final Pose,” an award-winning BendFilm 2014 documentary directed by Karen Mellberg of Bend at The Belfry last week. The film concerns the end-of-life journey of Sisters yogi Myra Lani Fisher through her own voice and was filmed during the last few weeks of her life as she was preparing to use Oregon’s Death with Dignity (DWD) Act.

I didn’t know Myra and only learned about her a few weeks before she transitioned. I wish I could have had a conversation with this very strong woman to learn how she processed her decision to choose this end of life option. Because this is what I do– help people have these conversations about death and dying so they can make informed choices, have discussions among their family members, and fill out the necessary paperwork so their last wishes will be carried out. It probably wouldn’t surprise you that most people find it difficult to even contemplate their own death, much less plan for it.

I spoke with a number of people that night who had no idea this information was available or even that Oregon has had a DWD law since 1997. Very few have talked to their doctor about anything to do with their own death and not many knew about the process one has to go through to request the option. This can be a daunting task for anyone, especially for those who wait until the last possible minute to even try to find information. Just having to make the request twice 15 days apart, much less trying to find a physician who will write a prescription and a pharmacist who will fill it, can take time and perseverance– this where CompassionandChoices.org can help.

It’s certainly not a fit for everybody as one’s dying process isn’t always a terrible ordeal, but for some people, it is… with some diseases, especially certain cancers such as Lani suffered with, it can be excruciatingly painful in spite of the availability of morphine through hospice services. Certainly palliative pain management is helpful for a lot of people, but it’s not universally available, not everybody benefits equally and an individual’s suffering is intangible.

For those who die slowly over a long period of time, especially in their 80s and 90s, continuing to be kept alive only to continue suffering even without pain can be unbearable to some and these patients often beg to die, beg their loved ones to kill them; some take matters into their own hands.

Voluntary Stop Eating and Drinking (VSED) is often the only sanctioned option a person has if they are not terminal (diagnosed with 6 months or less to live), have a degenerative disease or mental problem or are frail elderly. I’ve seen VSED go well for some people and others not so much. We don’t have a perfect system for helping people to die well yet. Medical students are finally starting to receive some training in end of life care and things are slowly beginning to change. Insurance coverage is a whole other issue.

Those who end up in hospitals trying one more resuscitation, one more invasive procedure, one more experimental treatment, often end up on life support beyond what they would have wanted– just because they were too afraid to have the conversation and make some informed decisions about what treatments they would want and not want at the end of their lives. This agony extends to the family and leaves them traumatized for years over whether they did the right thing because they always thought there would be more time and suddenly there is none.

Yes, there are religious objections, and fears of wantonly offing the disabled, the elderly, the vulnerable who are unable to speak for themselves, which is why we need solid laws to prevent coercion and forced extermination. Seventeen years of experience has shown the Oregon DWD Act to be effective and only used by a small percentage of people. And only a small percentage of the people who request their prescription actually fill it, and an even smaller percentage actually end up taking it.

The recent case of Brittany Maynard, a 29-year old woman with incurable brain cancer, a prognosis of a only a few months to live, and the likelihood of an agonizing dying process, has kickstarted the conversation around the country about our right to choose to die on our own terms. She moved to Oregon from California where there is no legal option for aid-in-dying and ended her life last month with the help of Compassion & Choices by self-administering the medication on the day she chose at home in her own bed with her husband and her mother by her side. Isn’t this the way we all want to go?

So now we have this beautiful documentary, a gift from Myra Lani Fisher and Karen Mellberg, about the beauty of life in our own death to give each of us the courage to have those hard conversations we don’t want to have with ourselves or with our families, but which we must… because suddenly there may be no more time.

The boundaries that divide Life and Death are at best shadowy and vague.

Who shall say where the one ends and where the other begins?

~Edgar Allen Poe

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Having “The Conversation” about End of Life Healthcare Planning

The Nugget, Sisters, Oregon – October 15, 2014

Having “The Conversation”

By Diane Goble

Ever since Ben Franklin warned us, “If you fail to plan, you are planning to fail,” we’ve been diligently planning for everything — college, career path, marriage, children, home buying, vacations, retirement — everything, that is except our inevitable end of life. We don’t want to think about that so we tend to ignore it or postpone dealing with it, often until it’s too late. We live in the state of denial that keeps us oblivious to the unthinkable fact that this day could be our last on earth.

Hopefully that’s not true for you this day, but statistically, in this country, 1 person dies every 3 seconds, approximately 6800 of us every day, 2,468,435 every year. Most people die from health-related conditions, including (in order) heart disease, cancer, chronic respiratory diseases (COPD) and stroke. Accidents are next down the list. All of these are, to some degree, preventable, treatable, manageable, mitigated by medical care and healthy lifestyle changes, and most of us will survive to live the life we planned to a ripe old age.

And that’s part of the problem. Health care has improved, we’re making progress with many cancers, we’ve recognized the problem of obesity and we’re eating healthier and exercising more so we’re living longer but we’re getting diseases now that people didn’t use to get because they died at earlier ages — Alzheimer’s Disease, in particular, but also emphysema, COPD, Parkinson’s Disease, and diabetes. And with the aging Boomer population, we wonder will there be rationing of medical services.

The health care system has us focused on treatments that almost kill us in order to make us better so we can live longer and get more diseases for them to treat. At the same time there are more people in need of care, there are also fewer doctors and medical services are stretched thin.

And within this maelstrom of activity is the elephant in the room. At some point, we are all going to die — but no one wants to admit it or talk about it and certainly know one wants to plan for it. We always think there will be more time.

This is a quote from this correspondent’s soon to be released book on amazon.com, Beyond the Veil: Our Journey Home, from a woman named Kathy who shared her experience of not planning ahead:

While we had gradually acknowledged to each other that he might not make it, we’d never really accepted it or talked about what it meant. I always thought we’d have a period of time when he was in hospice care when we would talk more and say our goodbyes. While I, and my kids, said lots of goodbyes and I love yous while he was in a coma, he was never able to communicate with us again. I still replay those last few days over and over and wonder how we didn’t know he was so close to the end and wonder if he knew.

There is a lesson in this: to say the things we want to say while we can – and it illustrates why it is so important to plan for the end of our lives, not just for our selves, but for our loved ones as well. We won’t know how we are going to die, where we will be when it happens, who will be with us or if we will be alone, but we can make our choices known about how we want to be treated at that crucial time, which will guide our loved ones to follow our wishes.

We do have some options and they are more likely to be honored if we have discussed them with our family members and doctors, appointed a healthcare representative who supports our wishes through our Advance Healthcare Directive so physicians will know what we want and don’t want if it comes down to that. The biggest hurdle is sitting down to have the conversation.

Realize that this is not a one-time conversation. It may occur in bits and pieces — a question at the dinner table, a comment during a TV program or news story, a shared article from a magazine, a book, a website, a post on Facebook. Over time and with new information or health concerns, you may change your mind several times.

You may have a conversation with your doctor or a clergy member that provides some new insight or clarifies your values. After seeing what another family went through, you may decide you do or don’t want that to happen to you. Visiting a friend in hospice care may change you mind about how soon you would want to bring hospice services into your life or the life of a family member. Advance Healthcare Directives are changeable and should be reviewed every 5 years or as you health changes.

No matter how old you are — and perhaps this is something everyone should do when they first get their driver’s license because those are extremely vulnerable years for accidents — no matter what your health status is, the time to have these important conversations is when you are healthy and mentally competent to make decisions. By the time you are in an ambulance, in the ER, or on your deathbed, it is too late. Leaving it to your distraught family members to decide what you would want during dire circumstances is setting them up for unending grief and trauma over whether they did they right thing — no matter what they did or didn’t do.

Fortunately, right here in Sisters, there are several people, including Kelsey Collins, Sue Stafford, myself and others, who are available to help people sort through the information about Medicare, home health care, palliative care, hospice services, Advance Healthcare Directives, POLST and Oregon’s Death with Dignity Act. Talk to your doctor, talk to your spiritual adviser and by all means, talk with your family about your last wishes — then you don’t have to think about it anymore!

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A Peaceful Death with Dignity

I’d like to express my appreciation to Brittany Maynard for going public with her decision to exercise her Death with Dignity option in Oregon because it will bring this conversation to the family dinner table where it belongs. Of course I’m sad she has this terrible condition, but if she can make something positive out of a bad situation, which she is by raising awareness, it gives hope to many people who want the same thing– if my death is inevitable, let it be peaceful and on my own terms.

This is what I encourage people to do on a daily basis through my writings and “Having The Conversation over Coffee and Cake” gatherings. I don’t encourage Death with Dignity, but I’m not afraid to address it as an option and provide resources, such as Compassion & Choices, if people want to consider it. This is a truly personal decision that should be between a terminally ill patient and those in his or her inner circle and it’s a shame the Maynard family has to be exposed to the vitriol that permeates Internet over their personal decision to allow Brittany to have a peaceful death with dignity. It’s as if  everybody suddenly noticed there’s an elephant in the room.

Those among us who think we have a right to an opinion about how any person decides he or she wants his/her death to be should be thinking about how they want the end of their lives to be, not someone they don’t even know. If, for whatever reason you think, having control over one’s own death at the end of life, is wrong then do it your way, whatever that is – and let me do it my way. Don’t force your views on me because you think you have all the right answers and I won’t interfere with your decisions about how you choose to experience your last days. And I’m referring here to people who have been given 6 months or less to survive a terminal illness, are in intractable pain or unbearable agony or suffering, and choose not to prolong their life.

That choice is still limited by the ability to self-administer the medication and therein lies the crux of the problem. If the person waits too long and loses decision-making abilities, or there is a sudden change in health that precludes swallowing or self-administering the medication, or if the person makes the request too late for all the paperwork to be completed, there are complications. This is where the law comes in. We can’t have people recklessly giving vulnerable people life-ending medications, or physicians or insurance companies or the government deciding when life no longer has value.

The law that was passed in Oregon takes into account the legal aspects of the issue to the extent that we can protect the vulnerable and protect physicians, hospice workers, pharmacists and families, from prosecution for helping a dying person carry out their wishes for a peaceful ending to their physical existence. This law has stood the test of time with no slippery slope or mass extinction for 17 years and is the basis for the laws passed in Washington, Vermont, and pending a vote in several other states.

Studies among physicians reveal a majority of physicians would refuse treatment and consider Death with Dignity for themselves, but they would suggest continuing treatments to their patients. They have the hypocrisy to claim that an oath written 2500 years ago by people who believed the earth was flat, and gods and goddesses ruled over humanity, told them to do no harm and give no poison. What really is the harm if the person is dying and is in considerable pain?

Which leads us to consider religious views that claim God said this or that, or a Jesus or a Mohammed said this or that, and believe that their holy book or their dogma is the one and only truth – and that it applies to the rest of us. And many people don’t believe… that there is even a God or a Jesus or a Mohammed to have a say so in the matter. Then we have many ethical atheists who think we only have one life and have no right to end it on our own terms.

We live in a world where millions of people die every day, often sick, hungry, dehydrated, neglected or savagely beaten, enslaved, decapitated, electrocuted, eviscerated, drowned, bombed, burned alive, as if they were meaningless cockroaches. But suddenly we become concerned and know what’s best for some poor person who has been suffering terribly with some dreadful disease or condition, and only asks for a peaceful death with dignity in the privacy of their own bedrooms, surrounded by their loved ones.

I hope Brittany Maynard’s plight will be an awakening to all you who have doubts about what is the right thing to for you in a situation like she is facing and begin to see that death is a sacred journey into whatever comes next. We will all go through it, we need to recognize that it is a graduation, not the end of our journey.

The message from my near-death experience is that We Don’t Die! Death of the body is not the end of life – life goes on and there is so much more to look forward to beyond the veil of illusion.

Peace & Joy!

Diane

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Planning Your Assisted-Suicide

I live in Oregon so I can legally request the

Death With Dignity option

at the time I deem appropriate if I choose, so I’ve thought about what medical treatments and interventions I would or wouldn’t accept and how I would want to die if this or that happens to my body and/or mind, whenever it happens.

I’ve been involved with this issue long enough (see article)– I was a hospice volunteer off and on for over 20 years, I’ve sat with numerous people and their families as they lay dying, I’ve been a caregiver and a counselor to the dying, I had a near-death experience 40 years ago (see article)– and I understand more about death and dying than most people who try not to think about it at all.

Most folks have opinions related to self-preservation, love of family and their life, or religious dogma, but a narrow perspective of the whole issue. So I’m just going to think out loud here to give others some food for thought… with the caveat that you continue this conversation with someone immediately after reading this and get to work on your own Advanced Healthcare Directive.

I’m 70+ so there’s that. Having seen first hand and studied what happens to the body and the mind of the majority of people as they age, I acknowledge my personal limits. Knowing my body and what I’ve done to it and for it, I’m hoping to live healthy to at least 75 but no longer than 80. Closer to 75, more likely. Beyond 80 things seem to fall apart more rapidly and sitting in front of a TV all day in an assisted living home with a bunch of other half comatose people is not something I could take for more than a minute. Lying in a  hospital bed staring at the ceiling with no hope of ever getting up again would be intolerable.

Now I know there are some 90-year olds still driving and playing golf or milking the cows and tilling the fields,  but that’s not me. There are also some 60-year old, overweight couch potatoes, who can hardly walk from the couch to the refrigerator any more.They’re on multiple medications with multiple side effects and are mostly miserable most of the time.

One’s past habits and lifestyle have a lot to say about how fit we will be in our old age, and we should be aware of our genes and our base lines so we can keep track of our physical health as we age. If you’re 40 and have diabetes, you’re not likely to make it to experience much of old age. If you haven’t cared about your health during your life, you’re not likely to have a healthy older age.

Of course one can always get hit by a bus or have a heart attack or get shot by a wacko on his own suicide mission. Personally if I’m too far gone and it would take too much or too long to restore me to a reasonable state of health, I would opt not to be resuscitated in the first place.

Certainly cracking open my rib cage, cutting off any limbs or hooking my body up to artificial life support are completely off the table. I want not to live without full use of my limbs or cognitive processes so don’t even think about it. If my heart stops, let me be. If I come back on my own, this time, I’ll talk about it. If my mind starts to disappear, you can bet I’ll be working on my suicide plan, physician-assisted or not, before I forget who my loved ones are.

So you have this pain or these symptoms you’ve been ignoring but it’s suddenly gotten worse and you can’t do things you used to be able to do so you finally go to a doctor and they run a bunch of tests and tell you that you have cancer of the blahblah and they’re going to have to take out your blahblah and then you’ll have to have radiation and chemo and then maybe you’ll have a few good months left but every case is different and they just know you’re going to beat this so here, sign these papers and let’s get started.

And you go… WTF? Because you never thought about it before, never allowed yourself to think it might happen to you or someone you love. You didn’t hear a word the doctor said after “cancer.” Your mind went blank and you felt like the elevator just dropped 20 floors in a second.

You are now spinning out of control but your doctor has moved on to the next patient to give him or her the same devastating news and you’re left to gather your wits and find your way home to tell your loved ones… but the only word that comes out of your mouth is… cancer or brain tumor or kidney failure or multiple sclerosis. Suddenly you’re a dead man walking.

You’ve never thought about it before? Never asked anyone what their thoughts are? Never asked someone who is dying what they think about? Would you want everything done? Do you even know what “everything” means? How much of you abilities are you wiling to do without just to see the next football game on TV?

You suddenly black out and wake up hooked up to machines in an ICU, paralyzed so you don’t try to rip out the tubes and  lines, surrounded by strangers with masks on looking down at you and one of them says sprightly, “Welcome back, Mr. Jones. We thought we’d lost you.”

And you’re thinking, “OMG, I was having this wonderful out-of-body experience. I was surrounded by loving beings of light and you brought me back to this? I’ll kill everyone of you!” But you can’t speak, you can’t move. Those people out there think you’re not aware, but you’re aware of everything, you just can’t do anything about it.

You’re wishing you had written that Advanced Healthcare Directive indicating you wanted no extraordinary measures to keep you alive if you were in this unfathomable condition. Unless you have a few lucid moments to state otherwise or can at least blink your eyes if asked, it is now beyond your control. You could end up a living, breathing vegetable for years.

If one is born disabled or becomes disabled through accident or illness, there is a whole added dimension to thoughts about one’s death. Depending on how dependent you are on others for care and whether you are able to communicate or are even aware of what’s happening, decisions are difficult, riddled with guilt and fear, no one ever sure they did the right thing. If you could convey your wishes, what would they be?

Assisted dying is not an option under the current laws unless you can self-administer. It has been tested by brave people with ALS and MS in the U.S. and foreign courts but euthanasia, which allows a physician to administer a life-ending drug to a person who is unable to self-administer because of their disability, is considered murder and many people fear that is opening assisted dying up to a slippery slope that could lead to the wholesale killing of the most vulnerable among us– the elderly, the disabled, the mentally ill, the poor.

Instead of showing compassion for those who are wrestling with these very personal decisions, some groups of religious protestors and bio-ethicists use fear and scare tactics, dredging up images from the Holocaust and other genocides, or hellfire and eternal damnation, to keep everyone from having control of how they end their own lives. These moral absolutists feel they are right and everyone else is wrong, and they have to protect us wayward relativists from ourselves as if we had no values. We do, just not the same as theirs.

I value human life as part of our eternal spiritual journey, I just don’t believe in the sanctity of life as the right to lifers do. Theirs is a religion based on fear and a judgmental god. I believe our Free Will gives us the right to determine when the quality of our life has fallen below our level of tolerance; that we should have the right to decide when it’s our time to die, and be able to ask our doctor to help us by giving us a prescription that will allow us to chose the time and circumstances of our own death.

Physicians, pharmacists and hospitals who provide a public benefit to a diverse society cannot impose their personal religious beliefs or moral values on patients at the end of their lives any more than at any other time in their lives. They work for us, we hire them… they are not the boss of us!

The alternative, if one is able, may be to blow your brains out or jump off a bridge or throw yourself in front of a train. What a mess! How much more peaceful and spiritual to take a pill and just go to sleep. Would you rather your family watch you suffer or allow you to die in peace? How much better for your family to be by your side instead of you having to go off like an animal to die alone.

A good way to count oneself down is to make a list of 100 things you do every day and cross items off as you can’t do them anymore until you’re down to the last 5 or 10 or 20, wherever you draw the line, then call your doctor for your prescription, pick it up when you are ready, gather your family together to say your goodbyes and have a final toast to your good death and peaceful journey home.

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How we die – Dr. Sherwin Nuland died

Dr. Sherwin Nuland, surgeon, bioethicist and author of the book “How We Die,” died last week. He was 83 years old and died from prostate cancer. He felt it was important to describe in his book how we die, physically and mentally, from cancer, heart disease, Alzheimer’s, and other common illnesses so we could have frank discussions with our doctor to help us deal with those aspects of illness and death that frighten us the most.

His first patient as a med student in a hospital ER died suddenly from a heart attack. He experienced the death of many family members including his mother when he was 11, and was with his father and his brother when they took their last breaths as they died from colon cancer. As a physician, he observed the process toward death of many of his patients in many different ways.

He wrote that death with dignity is a myth and while we would all like to die a good death, it rarely happens that way. Most of the time, patients suffer interminably, often prolonged by aggressive treatments, visits to the ICU, or futile treatments, through pain, humiliation and lack of control. Even under the best of care, the dying process, especially a prolonged dying process, can be agonizing for both the dying person and the family.

As a hospice volunteer for many years, I witnessed a number of deaths and been told about many others by volunteers, nurses and chaplains in support groups. Enough to agree with Dr. Nuland that we don’t always get what we ask for in that regard and when it does happen, it’s just a  coincidence.

More likely, we will be completely helpless or barely coherent and things will go on behind our backs without our knowledge or understanding by people who say they have our best interests at heart. We may want to die at home in our own bed surrounded by family but it’s more likely the last thing we’ll see will look more like a scene from a horror movie in a bright, sterile torture chamber.

Doctors will tell patients and families what they think they want to hear, that there is always something that can be done, that there’s always hope that the next treatment will be the one. Families tell their dying loved ones half truths to protect them, make promises they can’t keep, pretend everything is going well when it isn’t, avoid conversations about how they want to die until it is too late. Everyone follows the philosophy, as Dr. Nuland said he did for so long, that anything is better than death.

911 is called, CPR is administered, ribs are broken, tubes are inserted, bodies are bruised, invasive procedures performed. Maybe patients are put on ventilators and paralyzed so they don’t fight the restraints that bind them to keep their bodies alive. They know everything that is going on but they can’t do anything about it. They are trapped in a private hell while decisions about how to prolong life are debated in the hallways. Their death is terribly, terribly difficult and is the usual outcome of all this activity. Statistically, only a small percentage of these patients make it out of the hospital alive after this frightening experience. An even smaller percentage survive for more than a few months.

What gets taken away from the terminally ill or elderly patient is the opportunity to be at home surrounded by their loved ones during the last few weeks or months as the body shuts down naturally and the person adjusts to letting go. They lose the time to make amends and reconcile their lives, to say their goodbyes and fulfill their bucket lists.

This is what Dr. Nuland came to understand through the deaths of his patients and family members and why he wrote his book to help people make informed decisions about their preferences for end of life care, including when to stop aggressive, invasive treatments and accept pain management for the remainder of one’s life.

During his lifetime, hospice and palliative care have evolved to assume a bigger role in the care of terminally ill patients to keep people out of the ICU and allow them to die a good death at home surrounded by their family. It’s not available everywhere yet. Budget cuts are a problem. And it doesn’t work well for everyone. But it is bringing the business of dying back into the family and changing the practice of medicine at the end of life. Healing doesn’t necessarily mean curing the disease.

Dr. Nuland realized it’s not true that anything is better than death and, for many people, what they would have to go though in order to come out the other side alive is simply not worth the pain and effort for the short reprieve. He came to recognize that death is part of the life cycle and to redefine hope as the belief that something meaningful will happen, that we lived a life that meant something to others and will be renewed through others whose lives we touched.

Although Dr. Nuland wasn’t a proponent of physician-assisted dying, he was a strong advocate for end of life planning, including having The Conversation among family members, appointing a healthcare representative with the authority to speak for you if you become unable to communicate, and filling out an Advanced Healthcare Directive to assure your end of life wishes are carried out.

Being proactive doesn’t mean you are giving up or are by any means ready to die. The Conversation ideally should take place long before anyone is even sick or turns 65 because life can change on a dime and suddenly there is no time. Decisions have to be made immediately, no discussion.

If there has been no conversation and there is no Advance Healthcare Directive, the family is put under greater stress by being forced to make healthcare decisions for you without knowing what you might have wanted. As Dr. Nuland wrote doing everything may not always be the best choice. The question is where do you draw the line for your self? Next– tell someone!

Next month, April 16th, is National Healthcare Decisions Day, download Advanced Healthcare Directive forms by state for everyone in your family.

Get some tools and advice about having The Conversation with your family or with your neighbors, groups, organizations.

Become informed about Death With Dignity laws in your state; download forms from Compassion & Choices

Prepare your self mentally, emotionally and spiritually for your death whenever, however it happens – How to Die Consciously by Diane Goble

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The Slippery Slope of Physician Assisted Dying/Suicide

Sisters Sunset 8/21/13

I’ve been reading (pro and con) articles, blogs, opinions, press releases, news stories, surveys, law suits, legislation, etc. about Death With Dignity Laws and the attempts to pass them from all over the world for the past year and as a result of all I’ve learned I’ve come to the conclusion that there is a slippery slope when it comes to physician assisted dying. In all of the states in the U.S., Canada and other countries where such laws have been passed (in no particular order):

1. There is an increase in palliative and hospice care, and services have expanded and improved to include transitions

2. Medical students are now being trained in pain management and end or life care

3. More doctors are having conversations at the request of their patients about end-of-life care, regardless of whether they get paid

4. More people are having conversations with their families about what they want at the end of their lives

5. More people are talking about death and dying as if it is part of life not as a tragic event nobody wants to think about or plan for

6. More people are getting to die at home in their own warm bed surrounded by their family as they wish instead of in a cold, impersonal ICU hooked up to machines and tubes, surrounded by strangers who wear masks

7. More people are dying peacefully rather than being scared to death about death

8. More people are filling out Advance Healthcare Directives

9. More people are working on their Bucket List, reconciling their lives, asking forgiveness, expressing gratitude, and preparing themselves mentally, emotionally and spiritually for their journey out of their body

9. More emergency room physicians are complying with Advance Healthcare Directives and life or death situations are handled the way even the unresponsive patient wants not the way protocol dictates

10. More people are filling out POLST (physician Orders for Life-Sustaining Treatment) forms with their primary physician and are being spared drastic resuscitation measures they don’t want at end of life

11. More chronically disabled people are expressing optimism that they will have more control over their end of life decisions

12. More people are meditating, eating healthier and exercising to improve the quality of the rest of their lives instead of subjecting themselves to invasive life-prolonging, often futile, medical treatments in their last days

13. Fewer people are accumulating huge medical bills at end of life for unwanted invasive medical procedures

14. Fewer dying people are resorting to drastic, messy, inept suicide attempts or homicide/suicide acts that often end in failure and horror for the whole family

15. Physicians are accepting responsibility for being with their patients until the end of their lives instead of abandoning them when there is nothing more they can do medically or when the patient decides to stop medical treatment but wants to continue to be monitored

16. Fewer people are trying impose their morals and values on other people about their end of life choices

17. More people who are near death are requesting assistance from their physicians in case their dying process becomes unbearable… fewer of them actually take the medication because palliative and hospice care are keeping them comfortable longer and allowing more people to experience a more peaceful transition

Good laws need to be written to protect physicians from prosecution and the dying from being killed against their will while allowing release from their body by their consent.

We have to guard against extremes but abide by reason and compassion.

Physicians, Nurses & Pharmacists and Assisted Dying

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Physicians, Nurses, Pharmacists & Assisted Dying

Trying to come up with a Death with Dignity law that will cover all the contingencies and please all the stakeholders is next to impossible, but it is a process and we have to start somewhere. My interest is in encouraging the discussion so the best laws will be written to protect all of us while giving us the freedom to make our own healthcare choices.

The laws in Oregon and Washington are showing that fears of wholesale murder haven’t materialized. Old people are not lining up along the highways at the state line to be killed. The slippery slope is holding. But there are still issues that need to be addressed to improve the law and stop the legal battles that only hurt the patients while filling the pockets of lawyers and the media.

Physicians have been polled in states where the law has been brought to the attention of the voters and a good many of them don’t want to participate. If a patient asked, they would say no.

Some claim allegiance to an oath written around 400 BC, 100 years after Hippocratesdeath, during a time when citizens were being fed to lions and butchered in the streets, that says Primum non nocere (Latin for “First, do no harm”). Actually it didn’t quite say that originally, but “I will keep them from harm and injustice.” I don’t think that has the same meaning today.

It’s hard to believe 2400 years later that an educated person would swear an oath to Apollo Physician, Asclepius, Hygieia, Panacea, and all the gods and goddess… of the Greco-Roman pantheon (at which time it was believed the earth was flat and all else was on a dome that revolved around it). No wonder they came to have a God-complex!

Hippocrates was considered the father of medicine during the time the Roman Empire was at war with just about everyone else as they conquered the lands around the Mediterranean. He was the first to recognize that illnesses come from natural causes and were not punishment from the gods, and he promoted natural healing and disapproved of the use of potent drugs. At the time, dissection was taboo in Greece so he didn’t know much about anatomy or how symptoms related to disease.  Their values and lives were quite different and more people died violent deaths than suffered debilitating and long-term chronic diseases like people today face. Then, 40 was old.

The truth is most medical school graduates today either don’t swear any kind of oath or use a more modern version, but let’s consider do no harm. Some synonyms for “harm”– (deliberately inflicted) hurt, pain, trauma; also wrong, wickedness, iniquity, sin. So it seems physicians don’t consider it harmful to allow a patient to suffer in agony for days or weeks as they are dying, but they do consider it harmful to end a dying person’s suffering by hastening his or her impending and inevitable death by a few days when that is what the person wishes.

Seems to me forcing patients to stay alive for more torture and medical insults is deliberately inflicted hurt, pain and trauma. A sin? Oh, please, save us from the beliefs of people who seek to impose the will of their imaginary gods and goddesses on the rest of us.

So apparently, according to some, helping to relieve someone, who is in the process of dying, from unbearable suffering or pain is doing harm. Really? Have you ever sat with a loved one who is dying that way, begging to die, begging for that little pill to set them free?  (See my article “The Right to Die” [1979])

The other part of the oath some physicians invoke states: I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect.So when Socrates, considered the wisest man in Greece at this same time, was sentenced to death for speaking his mind, he gladly accepted the hemlock and his death rather than face exile. I wonder what Hippocrates thought about that. And here we are today debating about whether a person can choose to die or not when faced with death. Is one right and one wrong or are both right and the law should allow for individual choice?

The Hippocratic Oath also states To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art – if they desire to learn it – without fee and covenant; to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken an oath according to the medical law, but to no one else. So it’s a paternalistic, sexist document– and when was the last time anyone saw a physician who didn’t charge fees?

I don’t think we should throw the baby out with the bath water but can we get over this Hippocratic Oath defense and get practical? This is 2013, laws (and oaths) need to be relevant to the times and we need to get up to speed.

People who are conscious as they are slowly dying often see their loved ones waiting for them on the other side (read any books by Dr. Elisabeth Kubler-Ross). They’ve been traveling back and forth, out of their body, between one world and another, for days or weeks and are excited about going home.  One’s final struggle is between wanting to stay and wanting to go. Some refuse to give up and fight to the end, and that is their choice; however when one is ready to go, when one requests it, let them go. The end is the same. It’s what’s in between that needs to be addressed.

Seems to me cruel and unusual punishment to force dying people to stay alive when they are ready to go, and it’s not just about pain relief. Some religious people believe suffering is part of life and seem to imply the more one suffers, the better. They believe in the “sanctity” of human life because they believe there is only one life. What if they are wrong… like the Greeks and Romans were wrong concerning Zeus and Juno and their brood?

As long as we identify with our body, we want to stay in it but once we realize we are more than our body, that we are spiritual beings temporarily living as humans in a physical world, we get the whole picture and realize that we don’t die when our bodies die…that our conscious awareness continues after our bodies give out. We just wake up, step out and move on.

My feeling is that to be done compassionately, and to dispel many of the concerns brought up by other stakeholders, a physician should be committed to his or her patients until the end. That means if a patient declines further medical treatment and requests assistance with dying, a physician should rightly be at the bedside supporting, informing, preparing, administering and monitoring until that patient expires.

I’ve read about doctors who abandon their patients to hospice when they think there’s nothing more to be done. This could be expected of surgeons whose forte is surgery, who see patients as organs or diseases, but greater compassion is expected of primary care physicians who may know the family as well as his or her patients.

Palliative care and hospice care should be given as options from the beginning of the diagnostic process and offered as a choice along with invasive options,  drug therapies and clinical trials. Patients don’t seem to realize they can opt for no treatment or to stop treatment at any time. Doctors don’t bring these issues up unless patients ask when they are uncomfortable talking about death as if it meant giving up.

There’s concern about the accuracy of a “6 months to live” prognosis. Hospice patients often outlive their 6 months because they get so much comfort and attention from the highly compassionate hospice caregivers that they live longer. Instead of spending one’s last months having more surgeries, more treatments, more side effects from drugs, more pain and suffering only to die hooked up in the ICU, patients could have the opportunity to have well thought out end-of-life conversations with their families. They may get palliative care so they are pain-free and able to fill out Advance Healthcare Directives, complete their bucket list, write their memoirs, wrap up unfinished business, complete their life review and give away treasures to family before transitioning to hospice care where they get to say goodbye to loved ones and have a going away party before they pass peacefully (with or without assistance).

When doctors treat their patients holistically, there’s still a lot that can be done when it comes to healing body-mind and soul. Physicians generally just haven’t been taught how to deal with death with their patients. There were no courses in med school until recently due to all this controversy, but lately things are changing and new physicians are finding courses available to help them relate to their patients as people and understand death as merely a transformation of energy. In my opinion, those who have already graduated need some continuing education classes.

Do I think “physicians” are the ones who should ultimately fill this role? Not necessarily. As I just mentioned, they’re not trained for it and it doesn’t fit their mindset. The whole physician-training process needs to include dying in a holistic healthcare continuum for their attitude to change. MDs may be the only ones who are permitted to prescribe the medication, but a newly-designated medical specialist (e.g. MD or RN with PhD in Thanatology) could be at the bedside to protect the patient’s interests following certain guidelines and carry out his or her end-of-life wishes for a quick and peaceful release.

This way, someone capable would be at the bedside if anything goes wrong (e.g. patient falls asleep before ingesting all meds, patient throws up meds, something goes wrong with an IV line), as well as pronounce the patient and sign the necessary paperwork. Just as it takes great compassion to be with the dying as a hospice nurse but not all nurses have the passion to become hospice nurses, only certain physicians will have the sensitivity necessary to assist patients who request assistance with a quick and peaceful pre-planned death.

They may be those women and men who realize death of the body is just a transition, a transformation of energy from one state to another with continuation of consciousness, and that assisting the dying to have a peaceful and meaningful experience helps to heal the soul as it is leaving the body.

Polls show that a lot of nurses are opposed to participating as well. Back before the November election in Massachusetts last year, an organization of nurses put out a statement of opposition to passage of the Death with Dignity Act. Hospice nurses who are more attuned to the needs of the dying could develop a transition guide specialty, but they would have to shift their mindset beyond only stopping eating and drinking being acceptable. It’s OK for a person to starve to death over a week or two along with their other ailments, aches and pains as they are dying? It’s OK to pump them full of morphine so they are comatose for days? It’s OK to force people to live but not OK to allow them a peaceful passing? It’s not OK to be OK with dying and wanting to speed up the process if one is dying anyway? Hmmmmm….

There’s a wonderful book by two hospice nurses, Peggy Callanan and Nancy Kelly, Final Gifts: Understanding the Special Awareness, Needs, and Communications of the Dying, in which they talk about their experiences at the bedsides of hundreds of people as they were dying. They describe how wonderful and how terrible it can be for the dying and for the families in different circumstances. For some people, they say “I’m going now,” close their eyes and take their last breath.  For some, it’s like a fight to the finish to rip the soul out of the body. We don’t know how it will be when it’s our time, but those who have gotten their prescription say they take comfort in knowing that they have the option if they decide to exercise their desire for death with dignity. It doesn’t mean they will, in fact, most do not. Some have a peaceful death without it. Some wait too long and are not able to take it without assistance.

The other issue that comes up here is euthanasia, which means a physician or another person administers the lethal dose either by mouth or injection. This is where it gets tricky with the law because it’s considered murder to kill another person. It’s not illegal to commit suicide, but no one can legally help you do it. You don’t want your relatives to be put in prison for helping you out but you may be incapable of doing it yourself. That whole thing with Final Exit and the helium bag over the head– it’s just insane that a person should be forced to resort to such measures, but it’s got to be better than blowing one’s brains out.

For people facing Alzheimer’s, should they be eligible for a dignified, peaceful death before succumbing to the agony of losing their mind? For someone dealing with MS or ALS or locked-in syndrome, should they be eligible for assistance if they decide they want out of their progressively worsening condition? I don’t think people should be required to live that way if they don’t want to… whatever their reasons. If they’re OK with it, fine… live on.  I certainly don’t believe in wholesale killing of the elderly and disabled, and am fully aware of Hitler and others like him, which is why I believe we need good laws to protect the vulnerable but still allow freedom of choice. This is still America, not Nazi Germany.

As for people in a vegetative coma, if it were me… just shoot me now! But I stress the importance of filling out Advance Healthcare Directives at an early age because you never know what accident, medical procedure or infection might suddenly put you there and leave your loved ones with gut-wrenching decisions about the care of your body because they don’t know what you would have wanted or some well-meaning organization steps in and decides you must be kept alive because you might wake up 20 years from now… and some people do, and loved ones tend to hold out for that hope. You need to decide how long to wait before it’s OK with you to pull the plug.

Perhaps we need a new definition of murder? My dictionary says– “the unlawful premeditated killing of one human being by another.” Could we just add— without consent? So if a person consents to euthanasia, it wouldn’t be unlawful. Or if the definition exempted ending of life under the care of a physician at patient’s request. It just seems to me that a simple injection would be easier on a person than swallowing all those pills now required for the process and that a responsible person should be there to make sure all goes well, no mistakes, no question the person made his or her own decision willingly, and that the death was peaceful. And who else’s business is it besides a patient and his/her doctor any way? This paternalism is getting really boring.

Another voice is the pharmacist. Now some of them are citing religious or moral values that say assisted-suicide is murder and we’re not going to dispense these prescriptions so people can kill themselves. I don’t know that they have a right to question a physician’s judgment or not fill a prescription. They fill all those prescriptions for psychotropic drugs so many people are hooked on without question turning us into a nation of prescription drug addicts who often overdose, but someone who wants out early at the end of their life must be denied because some pharmacist doesn’t think it’s right or it goes against his beliefs. I don’t think so.

They dying patients are the ones who suffer when these people force their judgments and beliefs on vulnerable people who just want control over their own lives and a peaceful death. Religious organizations and moral absolutists pour money into negative propaganda to scare people into thinking someone wants to make it easy to kill off old, sick and disabled people thereby denying the rights of dying people who are capable of making their own end-of-life decisions. They squash support for personal freedom in healthcare instead of funding educational programs to help people make informed decisions about their end-of-life healthcare options. They have their priorities backwards. Help to strengthen the law to protect the vulnerable but don’t force your beliefs and opinions on people you don’t even know.

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COMING NEXT: Discussion about The New England Journal of Medicine open forum about whether physician-assisted suicide should be permitted or not in a particular case scenario.

Assisted-Death Debate – October 2012 – News and Blogs from Around the World

End-of-Life discussions about Assisted Dying/Suicide/Euthanasia in news articles, blogs, videos from the left, right and center during the month of October 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. Don’t be swayed by emotional euphemisms or dysphemisms, or religious dogma. 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! The end result should be reasonable laws that protect the vulnerable yet allow self-determination at the end of life for those who want the option of assistance.

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)

Health Talk Online (UK)

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.

BLOGS

Death with Dignity National Center – Living with Dying – This Week in the Movement
October 5
October 12
October 19
October 26

Poll: What do you think of assisted suicide?

Conservative Christians are implacable opponents of assisted dying– Choice in Dying: Arguing for the right to die and against the religious obstruction of that right

Significant stress after witnessing assisted suicide – BioEdge (10/5/12)

Physician-Assisted Suicide: Why Medical Ethics Must Sometimes Trump the Patient’s Choice by Ronald Pies, MD, PsychCentral.com (October 2012)

Three MDs weigh in on assisted suicide – Not Dead Yet (10/6/12)

Margaret Morganroth Gullette on the vote for physician-assisted dying – The Chicago Blog by Kristie McQuire (10/22/12)

Hard decisions in the ICU – New Old Age by Paula Span (10/24/12)

Death with Dignity in Massachusetts by Lauren Mackler, Huffington Post Blog (10/23/12)

How we die– the most important issue we never talk about – Conservative Home (10/24/12)

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… someday)

Death and Dignity: Making Choices and Taking Charge by Tim Quill – Just having this option is valuable for the sense of peace it provides to suffering patients

No One Has to Die Alone: Preparing for a Meaningful Death by Lani Leary – Practical skills, vocabulary, and insights needed to truly address the needs of a dying loved one while caring for yourself through the process

Voicing My Choices by Lori Wiener, PhD – New guide helps seriously ill teens and young adults talk about their needs

After We Said Goodbye by Sean Davison – his arrest, trial and sentencing and the dramatic events that followed after taking the most fateful decision of his life

BROADCASTS

Death on Demand – OnPoint with Tom Ashbrook discussing Massachusetts’ Death with Dignity law with Barbara Coombs Lee, president of Compassion & Choices, Edward Lowenstein, professor of anesthesia and professor of medical ethics, and Michael Grodin, director of the Medical Ethics and Human Rights Programs

When prolonging death seems worse that death – NPR Fresh Aire – Compassion & Choices is an organization that helps terminally ill patients and their families make informed and thoughtful end-of-life decisions to hasten a patient’s death. These decisions are not made impulsively, Schwarz tells Fresh Air‘s Terry Gross. “Nobody makes this choice unless the burdens of living have so consistently, day after day, outweighed all benefit.”

On Doctor-Assisted Suicide, Stances Rooted in Experiences – WBUR, Boston’s NPR – All Things Considered host Sacha Pfeiffer speaks with Dr. Marcia Angell and John Kelly about their very personal reasons for their stances.

About 57 per cent of people either strongly or somewhat agree that it should be a right, according to the University of Saskatchewan’s Taking the Pulse survey. (more)

Doctor-assisted suicide should be allowed, pollsters told – CBC.ca – A majority of Saskatchewan people believe people with terminal illnesses should be able to legally access doctor-assisted suicide, a new poll says.

JOURNAL ARTICLES

Euthanasia: from ethical debate to clinical reality by Thierry Berghmans and Dominique Lossignol, European Respiratory Journal (Octobr 2012) – While it may only be the third-leading neoplasm worldwide, lung cancer is the first cause of death by cancer in males and one of the first in females in industrialised countries. Overall, cure rate is only 10–15% and the majority of patients, most of whom are diagnosed at an advanced stage and will ultimately die from lung cancer progression or related complications. During the last few decades, palliative care has become a central element of the therapeutic approach to terminally ill cancer patients. Palliative care aims to improve quality of life and control symptoms but has no role in hastening death, although palliative care specialists can be involved in the end-of-life decision process when euthanasia or physician-assisted suicide are considered.

Attitudes Toward Assisted Suicide and Life-Prolonging Measures in Swiss ALS Patients and their Caregivers – Frontiers in Psychology for Clinical Settings (October) – Conclusion: A liberal legal setting does not necessarily promote the wish for AS. However, the desire to discuss AS is prevalent in ALS patients. There is a higher level of suffering and loneliness on the caregivers’ side.

Physician-assisted dying by Sandy Buchman, MD, Canadian Family Physician (October) – The trend to PAD (which encompasses physician-assisted suicide and euthanasia) is occurring worldwide. In 2007, 76% of Canadians agreed that people with incurable disease have the right to die, and in 2010, 67% supported the legalization of euthanasia.The Collège des médecins du Québec, the Royal Society of Canada Expert Panel, and the Quebec National Assembly have all proposed legislative reforms that would permit PAD. Other health care organizations have published papers examining the issue. It is now time for the CFPC to bring the specific perspective of Canada’s FPs to the table.

Redefining Physician’s Role in Assisted Dying by Julian Prokopetz, BA and Lia Lehmann, MD, PhD in New England Journal of Medicine (July) – We believe there is a compelling case for legalizing assisted dying, but assisted dying need not be physician-assisted.

Under the DWDA, the patient’s physician prescribes lethal medication after confirming the prognosis and elucidating the alternatives for treatment and palliative care. In theory, however, the prescription need not come from the physician. Prognosis and treatment options are part of standard clinical discussions, so if a physician certifies that information in writing, patients could conceivably go to an independent authority to obtain the prescription.

MAGAZINE ARTICLES

Assisted suicide: Over my dead body – The Economist (10/20/12) – Helping the terminally ill to die, once taboo, is gaining acceptance

Physician-Assisted Suicide is not Progressive by Ira Byock, director of palliative care at Dartmouth-Hitchcock Medical Center in The Atlantic (10/25/12)

SEMINARS

Compassion in Dying Seminar: Shared decision making at end of life (UK-September 20) – from both the patient and healthcare professional perspective. Findings from research which examined choice and control with a terminal illness, how patients make decisions and the role of healthcare professionals in this process were presented. Alongside this an example of how end-of-life care preferences are recorded electronically to ensure that healthcare professionals can access them was discussed. (audio recordings are available) (more)

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UNITED STATES

(News this month from California, DC, Hawaii, Illinois, Iowa, Kansas, Massachusetts, Mississippi, New Jersey, New York, North Carolina, Oregon, Wisconsin)

CALIFORNIA

Michael Winner researching assisted suicide by hollywood.com (10/4/12) – He says, “I checked Dignitas on the computer and you need to go through so much. It’s not a walk-in death. You don’t just go in and say ‘Here I am, do your worst.’ You have to go through a whole series of papers and re-examinations just to die. You have to fill in forms and things and you have to fly there, go back twice… (more)

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D.C.

Radical hate group joins opponents of Death with Dignity by Peg Sandeen, Death with Dignity National Center (10/18/12) – Opponents of Death with Dignity in Massachusetts used this hate money to launch and seed their campaign, providing them with critical resources to build the infrastructure of a political campaign. After they were caught publicly with the money, they sent back a portion of it, but not all of it. And, the unanswered question is “why are these groups involved in the Death with Dignity issue at all?” (more)

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What’s airing on Pro-Life Perspective Today? “Combating Euthanasia,” Part 2 by Carol Tobias, NRLC President & Pro-Life Perspective Host, National Right to Life News Today (10/19/12) – The trends in medical practice, in the courts, and in the legislatures, have been all too clear.  The assumptions of 30 years ago, that the presumption in all medical cases is for life, has been virtually reversed. Advocates of euthanasia began in the 1970s by building on an almost universally accepted premised that, in the absence of truly exceptional circumstances, a competent adult may accept or reject any medical treatment.  Rooted in the doctrine of informed consent and long accepted by common law, this principle became the starting point for their efforts. (more)

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Euthanasia was the right decision for my wife by Mars Kramer, Washington Post (10/22/12) – But we live in the Netherlands, and here is where our story becomes a little different. When people become as ill as my wife, with no prospect of cure and only pain and exhaustion in the offing, it is quite legal to end one’s life by voluntary euthanasia.

We set the date for Tuesday at 3 p.m. Our children assembled in the sitting room and I was in the bedroom, with the doctor and a nurse. Mathilde had had a bad night, distraught and unable to sleep, and the doctor had come to give her morphine.

But now she was awake and fully conscious of her condition. To the nurse she said, “I am ready” and to me, “I am not afraid.” I sat on one side of the bed and took her hand, and the doctor, at the other side, gave her the first injection.

She immediately fell asleep, snoring loudly. The doctor gave her a second injection, and the snoring stopped. She had died. It was all over in a couple of minutes. (more)

Responses to article

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HAWAII

New Aid-in-Dying Service Getting Inquiries by Chad Blair, Honolulu Civil Beat (10/5/12) – The group said the new Hawaii data is consistent with data from Oregon, where “one in six terminally ill Oregonians talks with their family about aid in dying. One in 50 talks with their doctor. In the end, one in 500 ingests life-ending medication.” (more)

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ILLINOIS

Allowing ‘medical aid in dying’ means euthanasia for Quebec by Deborah Gyapong, U.S. Catholic (10/16/12) – Parti Quebecois junior social services minister Veronique Hivon said she hoped to introduce legislation soon to help people who face unbearable end-of-life suffering.

Though euthanasia and assisted suicide are illegal under the jurisdiction of Canada’s Criminal Code, Hivon said health is a provincial matter. The province could also direct crown prosecutors not to prosecute cases of assisted death that fall under the guidelines for “medical aid in dying,” she said.

But Linda Couture, director of the Quebec grassroots group Living with Dignity, said using health care and directing prosecutors in this manner bring “euthanasia through the back door.”

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IOWA

Legalize Euthanasia by Ian Timberlake, Iowa State Daily (10/18/12) – It seems like another needless form of government control on its citizens, arguably unconstitutional as early as the Preamble. This is a freedom I wish to have, and should the conditions arise (knock on wood), I will be one of the many seniors who illegally commits suicide because their state won’t entitle them to a dignified death. Euthanasia will never become obligatory, and it is absolutely not a method to “snuff out” the country’s disabled and elderly as Iowa’s Right to Life organization claims. (more)

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KANSAS

Physician-assisted suicide up for vote in Mass.– WIBW (10/28/12) – A September Suffolk University/7 NEWS poll found 64 percent of likely Massachusetts voters support the initiative.

The initiative stems from a ballot petition filed by Boston-based Dignity 2012 and a terminally ill Stoughton, Mass. man’s 2009 attempt to get a similar bill passed in the state legislature. Lawmakers didn’t take action, and Al Lipkind died of stomach cancer that year, according to CBS Boston.

Supporters, primarily patients’ rights groups, say the bill has effective safeguards, including prohibiting doctors from prescribing the drugs to depressed patients.

Religious, medical and disability rights groups are fighting the measure, saying it’s open to manipulation and relies on diagnoses that may be wrong. They’ve raised more than $1.6 million so far, compared with nearly $500,000 for supporters, mostly patients’ rights and AIDS groups, according to CBS Boston. (more)

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MASSACHUSETTS

A Method for Dying with Dignity by Dr. Marcia Angell,  former editor-in-chief of New England Journal of Medicine, senior lecturer in social medicine at Harvard Medical School, bostonglobe.com – Opinion (9/29/12) – Unfortunately, the Massachusetts Medical Society officially opposes the Act because it believes it is “inconsistent with the physician’s role as healer,” in the words of its past president. But this isn’t about physicians or their self-image; it’s about patients — specifically patients for whom healing is no longer possible. They, not physicians, are the ones to say when their suffering is no longer bearable, and individual physicians (many of whom disagree with the position of the medical society) should be able to honor their wishes. Why should anyone — the state, the medical profession or anyone else — presume to tell someone how much suffering they must endure as their life is ending? We respect people’s right to self-determination when they’re healthy. That shouldn’t be denied to them when they’re dying. (more)

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Physician-Assisted Suicide Town Forum – (10/3/12) – Hosted by Cardinal Sean O’Malley

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Residents divided over ‘Death with Dignity’ ballot question– Wicked Local Marblehead (10/4/12) – Former Marblehead resident Dr. Tim Quill said just having this option is valuable for the sense of peace it provides to suffering patients.

“There are two groups of patients for whom this is really important,” said Quill. “The bigger group of people who are quite sick may worry about what might happen if their pain gets really bad and want to have a choice if their suffering gets out of hand. For most of those people, palliative care is pretty affective at relieving suffering, and it works most of the time. So those people don’t need this option. But there will be a small amount of cases where this doesn’t work sufficiently, and suffering is more extreme.”

Having this option is also important, according to Quill, in that it brings these conversations out into the open between loved ones and doctors. Otherwise, the patient may take matters into his own hands. (more)

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Massachusetts weighs ballot measure allowing doctor-assisted suicides– Fox News (10/5/12) – In 2010, a Boston doctor diagnosed Heather Clish’s father with brain cancer, giving him only six months to live. Lee Johnson didn’t want to suffer and decided to end his life.”It was very important to him to die with grace amid all the indignities that he was enduring,” Heather said, as she walked along the Boston Common. “It was important to him to control that process of dying.”However, the state of Massachusetts does not give the dying that much control — barring all forms of doctor-assisted suicide.

Clish explained that her father was forced to travel back to his home in Oregon where euthanasia is legal.

“It was a decision I respected,” she said. (more)

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Say no to doc-aided suicide by Henry C. Luthin, Boston Herald (10/6/12) – The Catholic Lawyers’ Guild, which annually sponsors the Red Mass to invoke God’s blessing on the legal profession and the courts at the start of the judicial year, this year also joins with many in the medical and disabilities communities in the fight against ballot Question 2, which would add physician-assisted suicide to the statutes of the commonwealth.The act purports to give terminally ill adults, who have been determined to have less than six months to live and who are residents of the commonwealth, the right to request a lethal prescription for medication to end their life in what proponents call “a humane and dignified manner.” What on the surface appears to be a good and compassionate law to help end suffering in fact is poorly written, confusing, and a flawed ballot initiative.No one disputes the need to alleviate the suffering of those who are terminally ill, and hospice and palliative care programs have alleviated pain and suffering. (more)
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Vote for Death with Dignity by Harvey Silvergate and Juliana Devries, bostonherald.com (10/6/12) – In his 1869 masterpiece “On Liberty,” John Stuart Mill called this “self-regarding” conduct and wrote that citizens should have “perfect freedom, legal and social” to do as they wish with themselves “and stand the consequences.” Only when individual choices significantly and negatively affect others, such as producing second-hand smoke in enclosed areas or driving drunk, do we normally turn to prohibition. (more)

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Ballot question sparks debate about assisted suicide by Laura Krantz, MetroWest Daily News (10/7/12) – Should dying people be allowed to kill themselves?

Question 2 on next month’s ballot is simple, but perhaps not easy to answer.

Voters next month will decide whether Massachusetts physicians should be allowed to prescribe medication that will end the life of a terminally ill patient. (more)

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Ballot question sparks debate about assisted suicide by Laura Krantz, MetroWest Daily News (10/7/12) – Reading resident Heather Clish has a unique connection to the Oregon law. Her father, an Oregon resident, was visiting her in Massachusetts when he was diagnosed with brain cancer. She watched his health plummet as the cancer ravaged both sides of his brain, becoming inoperable. He began receiving palliative care, Clish said, but couldn’t bear to lose the fierce independence he had cultivated since childhood. “It was this line, a personal line that he had crossed in how he wanted to live the last, be able to live, the last days of his life,” Clish said. She picked up the prescription for her father at the pharmacy and he took it a month later, surrounded by his three daughters and holding his wife in his arms.” It was peaceful, it was loving, it was warm,” she said.

But not everyone agrees physicians should be able to prescribe a drug intended only for suicide. (more)

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Catholics donate to anti-assisted suicide group by Laura Krantz, MetroWest Daily News (10/8/12) – The anti-Question 2 group so far has raised $1.3 million and spent $878,000, according to the state’s Office of Campaign and Political Finance.

The $250,000 contribution from St. John’s Seminary Corporation makes up more than half of the $432,000 the committee reported raising in the last two weeks of September. It also received $150,000 from the Knights of Columbus, which also donated $200,000 this summer.

Despite their strong finances, recent polls have suggested Massachusetts voters support the ballot question.

Dignity 2012, the main group supporting the question, reported raising $28,000 in the same two-week period. (more)

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Opponents gather support to fight assisted suicide ballot question by Chris Burrell, The Patriot Ledger (10/11/12) – With three statewide polls showing strong support for a ballot question that would make Massachusetts only the third state in the nation that specifically allows some terminally ill people to obtain a prescription for life-ending drugs, a well-funded opposition is striking back. Arguing that the measure is poorly written, lacks safeguards and ignores advances in palliative care for the dying, the main opposition group is gathering support from associations of physicians, nurses, hospice workers and people with disabilities. (more)
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The right to choose: Physician-assisted suicide by Sephora Marie Borges, The Torch (10/12/12) – The point of Question 2 is to alleviate that suffering – to give patients and their families the option to not have to endure that suffering to the bitter, imminent end.The fact is this happens whether people like it or not. There have been plenty of stories and cases about terminally ill patients requesting their physicians to administer lethal drugs, and their physicians being so moved by the immense pain and suffering their patients have endured, they’ve gone ahead and done so.Of course, it’s mostly had to be done in secret – so why not bring it out into the open now? Why not attach some legal parameters to it so it can’t be abused, and allow patients to die on their own terms without physicians risking their livelihoods just because they wanted to fulfill a sick person’s dying wish.Moreover, it’s hard to discern why Question 2 is that much different from people who sign “Do Not Resuscitate” – or DNR – orders. (more)*
Controlling the quality of dying by Marjorie Arons-Barron, Wicked Local Newton (10/15/12) – For me, if I am at the end and suffering unendurably, with that suffering only going to get worse, I want that pill on my night table.  I may, in the end, choose not to use it, but I want the option to die a more humane and dignified death. (more)

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Physician-Assisted Suicide on the Massachusetts Ballot by Rich Barlow. BU Today (10/15/12) – Marcia Angell (MED’67), a senior lecturer in social medicine at Harvard Medical School and a former editor of the New England Journal of Medicine, was the first person to sign the petition putting the issue on the ballot. She will explain her support for the law today at noon, when she gives the ninth annual Pike Lecture on Health Law at the School of Law. The lecture commemorates N. Neal Pike (LAW’37), a lawyer and activist for people with disabilities. (more)

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Question 2 sponsors say measure isn’t ‘assisted suicide’ by Lane Lambert (10/16/12) – “This is not about life versus death,” Dr. Marcia Angell of Dignity 2012 said Tuesday in a Patriot Ledger editorial board interview. “This is about the manner of death.” (more)

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Voting on Question 2– The Journal Staff, Lynn Journal (10/16/12) – Question 2 is not a battle for medical ethicists and philosophers. It is a battle for voters to determine whether or not assisted suicide should be allowed in the state of Massachusetts. Make sure you vote.This is an important question that goes to the very depths of our beliefs. (more)

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Dying with Dignity: Massachusetts to vote on medically assisted dying on 6th November (10/16/12) – Angell said the safeguards are there, including a state drug tracking law that will go in effect in January 2013. But she said the key issue is, “Who gets to decide, the patient or someone else? ”She said the ballot measure is aimed at providing a voluntary choice for a limited number of terminally ill persons who are in pain that palliative or hospice care can’t relieve, and who doctors say have mental competence to choose to end their life.“The loss of dignity is often harder to relieve than the pain,” Angell said. “They know they’re dying.” (more)
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Millions spent in fight over MA Assisted-suicide law– golocalworester.com (10/18/12) – A survey of 1,051 likely Massachusetts voters conducted by Public Policy Polling earlier this month found that 56 percent of Bay Staters said they would vote yes on Question 2 if the election were today, while 30 percent said they would vote no and 14 percent said they were undecided. With less than three weeks until Election Day, groups on both sides of the issue are working to get their message out and move those numbers decisively in one direction or the other. The five main organizations have combined to spend nearly $1.5 million advocating for or against the measure, according to reports filed with the state’s Office of Campaign and Political Finance, with plenty more still in the bank. (more)
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Daughter: Parents’ suicide highlights a need for assisted suicide by Lexi Salazar (10/19/12) – Van Dorn is the daughter of Adm. Chester Nimitz Jr., a U.S. Navy veteran who served in two wars and was the son of the commander of the U.S. Navy in the Pacific during World War II. She said her parents feared reaching a stage of helplessness and not being able to take action to end their lives when they wanted to.“It would have given them huge peace of mind to know that when things got worse they could choose to end things,” she said.Van Dorn supports Question 2, the so-called Death with Dignity initiative on the Nov. 6 ballot. (more)*Death on Demand – the Law in Oregon, on Ballot in Massachusetts, a Hot Radio Show– SeniorJournal.com (10/19/12) – “It is to be hoped that the current wave of liberalization will continue, for those who suffer at the end of their lives have been too long denied the right to an easeful death,” says the Economist.“Death comes in many ways. Some beautiful. Some terrible. For some, unbearable,” says radio commentator Ashbrook, whose show is heard mostly on National Public Radio (NPR).

“Some states have voted to let doctors help ease the way. The language itself is a battlefield: right to die, ‘death with dignity,’ assisted suicide,” he says about the show. (more)

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‘Ethically, is this right for doctors to do?’ Help a terminal patient die? by Carey Goldberg, Boston’s NPR News (10/19/12) – (audio) Ravi Parikh, a fourth-year student at Harvard Medical School, faced conflicting messages.

The American Medical Association, which he belongs to, and the Massachusetts Medical Society oppose Question 2, the measure on next month’s state ballot that would allow terminally ill patients to ask a doctor to prescribe them life-ending drugs.

In contrast, The American Medical Student Association, which he also belongs to, supports it.

Ravi faced conflict within as well. He’d applied to medical school for the usual reason — to heal patients, as spelled out in the Hippocratic oath — not to help them die.

But his medical education introduced him to the complexities of modern American dying. (more)

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What about do no harm?: Globe columnist on assisted suicide– Boston Catholic Insider (10/20/12) – If Hippocrates, the “father of Western medicine,” were alive today, would he favor Question 2, the Massachusetts ballot initiative to authorize doctor-prescribed suicide?

Presumably not: The celebrated code of medical ethics that bears his name, which physicians for centuries took an oath to uphold, flatly forbids assisted suicide. “I will not give a lethal drug to anyone if I am asked,” the Hippocratic oath avows, “nor will I advise such a plan.” (more)

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Letter: On physician-assisted suicide by Mary Louise C. Ashur MD, Associate Professor & Clinical Instructor – The Daily Free Press – The Independent Student Newspaper at Boston University (10/20/12) – What is the true motivation for the Question 2 ballot initiative? Question 2 is thinly veiled to look like an act to alleviate suffering and promote self-determination. But to promote “suicide” – the taking of one’s own life, a lonely act for a vulnerable soul, is a sad commentary for a civilized society. Really, Question 2 simply devalues human suffering. It abhors the natural human life by promoting premature death. Question 2 undermines the work of a physician – to care for patients from birth to natural death. The Massachusetts Medical Society wants Question 2 defeated. As a doctor and 27 years witness to the courage and dignity of people as they live and die, I too urge the defeat of Question 2. (more)

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Mass. voters consider physician-assisted suicide – modernhealthcare.com (10/20/12) – Leaders on opposite sides of Massachusetts’ right to die debate are fighting for the same reason: Both have watched loved ones receive fatal diagnoses.

Dr. Marcia Angell supports the initiative. Her father shot himself to death rather than die from metastatic prostate cancer in 1988. She believes he would’ve lived longer and not turned to a pistol had assisted suicide been available.

Rosanne Bacon Meade’s sister-in-law is still fighting cancer, 18 months after doctors gave her three months to live. She opposes the measure, saying diagnoses are often wrong. (more)

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Question 2: Bay state voters soon to decide matter of life and death by Kait Taylor and Sean Leonard, The Daily Item (10/23/12) – Representatives of both sides of Question 2 visited The Daily Item last week in separate editorial board meetings to express their views. (more)
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Waltham mayor, councilors say they will all vote ‘no’ to physician-assisted suicide ballot question by Jaclyn Reiss, boston.com (10/24/12) – LeBlanc said in the statement that she felt the law has limitations, and that she was troubled that the ballot question has not been debated.

However, a group called the Massachusetts Death with Dignity Coalition supports the bill, citing a patient’s right to die on his or her own terms and at home.

The coalition writes on their website that the change would have 16 different safeguards, including approvals from two doctors and a 15-day waiting period in between seeing the physicians.

The coalition also says that the same law has been in place for 15 years in Oregon, and four years in the state of Washington. In each state, 60 terminally ill patients decided to utilize the law each year, and careful tracking of the law has found “not a single instance of abuse over the past 15 years.” (more)

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Donato: Vote No on Assisted Suicide by Jarret Bencks, patch.com (10/25/12) – “Regardless of where a person stands on the issue of physician-assisted suicide, Question 2 – as designed – contains serious flaws, such the lack of a psychiatric evaluation and no family notification,” Donato said in a written statement. “For these reasons and others, I encourage the voters of Medford and Malden to reject Question 2 on November 6.” (more)

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Share the Story Behind Your Opinion– Here’s Mine by Carey Goldberg, WBUR, Boston’s NPR Radio (10/25/12) – And here’s what I thought: I bet just about every one of the people on either side of the issue has a story. They’ve witnessed a death, and that experience influenced their opinion. So here’s an open invitation: Won’t you share your story in the Comments section below?

Here’s mine: (more)

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Pharmacists group opposes ballot question 2 – MetroWest Daily News (10/25/12) – The Western Massachusetts Pharmacists Association Thursday announced their opposition to ballot question two, which would legalize physician assisted suicide.
“As pharmacists, our goal is to help people – Question 2 would undermine that,” (more)

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Death with Dignity a compassionate outlet for suffering by Bryan Goodchild, U Of Mass Medical School (10/26/12) – David Clive, MD,  professor of medicine, answers questions about Death with Dignity (video)

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HMS Panel Considers “Death with Dignity” Ballot Question by Victoria Zhuang, The Harvard Crimson (10/26/12) – Lachlan Forrow, the director of ethics and palliative care programs at Beth Israel Deaconess Medical Center, posed a philosophical question to his audience on prescribing medication to end life: “Who has the right to tell anybody how to die?”At Thursday afternoon’s public forum at the Harvard Medical School, this question was more than abstract. A panel composed of two medical and two legal experts explained the issues surrounding Question 2 on this November’s general election ballot for Massachusetts, known as the “Death With Dignity” Initiative. (more)
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Reader endorses ‘Death with Dignity’ ballot question – Canton Citizen Newspaper (10/27/12)  Dear Editor:

Believing that only an informed electorate can govern themselves properly, the Canton Council on Aging sponsored a forum on the all-important last event of our lives: the act of dying.

As is true for most laws, this one would require some fine tuning, but the evolved citizens of Oregon and Washington have had remarkable success (i.e., no abuse) with their Death with Dignity laws. Only 596 patients have availed themselves of this right since 1997, showing that its use is only one more choice of many ways to end life. The scarcity of the law’s use is not the reason it should not be provided. If only one man speaks the truth, it is still the truth even if a world of people believe otherwise. (more)

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Kennedy fights assisted suicide effort by Cynthia Mccormick, Cape Cod Times (10/27/12) – Kennedy takes issue with the ballot question’s specification that it apply to those with a life expectancy of six months or less.”When my husband was first diagnosed with cancer, he was told he had only two to four months to live, that he’d never get back to the United States Senate, that he should get his affairs in order, kiss his wife, love his family and get ready to die,” she writes. “But that prognosis was wrong. Teddy lived 15 more productive months.””When the end finally did come — natural death with dignity — my husband was home, attended by his doctor, surrounded by family and our priest.”Heather Clish of Reading said her father died of the same brain cancer in the spring of 2011 — and his experience is leading her to support Question 2.”His doctors explained all of his treatment and end-of-life care options, but he knew about the death with dignity law in his home state of Oregon,” Clish wrote in an email Friday.”He treated his illness for as long as he could, but as his decline progressed, he decided to choose death with dignity,” Clish said. “The decision he made wasn’t easy, but it was his.”Clish said Massachusetts voters need to allow the terminally ill to make the choice for themselves. It’s a private decision and government shouldn’t be involved, she said. (more)*2012 Initiatives: Euthanasia & Recreational Marijuana on the Ballot by Gabriel Legend, Gather.com (10/27/12) – 2012 is a year for unusual ballot measures it seems, with one state voting to pass a measure for physician assisted suicides. The euthanasia initiative will be voted on November 6th in the state of Massachusetts, and is officially called the Death with Dignity Initiative. While this may seem reprehensible to some, the ballot measure does not mean that a patient or family member is required to choose this option if they are suffering from an illness or disease. It simply means that they will have that option to choose from. (more)

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Assisted suicide on the ballot: Beyond Fear Tactics – Mortal Matters/Dr. Lachlan Forrow on end-of-life wishes (10/28/12) – I have serious misgivings about whether a ballot initiative is the best way for the people of Massachusetts to make decisions about profound, complex moral issues. My misgivings are especially great when, as I believe is true of Question 2 next Tuesday, many people are going to have to cast their vote without having had the time, opportunity, or help they needed to develop a clear and accurate understanding of what those issues are.

I am further distressed that too many of the ads, op-eds, and advocacy emails that I have seen — from both sides — seem to me to present seriously distorted, irresponsibly exaggerated claims that are designed to frighten you into voting one way or the other. If I didn’t know better, I would be more frightened than ever about myself or a loved one ever having a so-called “terminal illness”. (more)

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There’s no ‘dignity’ in suicide by Tom Driscoll, MetroWest Daily News (10/28/12) – It is argued that Question 2 advances “dignity” and “personal choice” and yet I read the law in detail and what I come away with is the procedural aspect of it all. Requisite clinical prognoses, signatures witnessed by disinterested parties, waiting periods and asking to be asked all over again. What’s being described isn’t so much enabled free choice for individuals and their families as exhaustive protocol for the medical profession to follow, not so much about the dying and their dignity as the practice of dispensing deadly medicine and the concomitant exposures and liabilities. (more)

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Life and death issue emotional by Bronislas B. Kush, Worcester Telegram (10/28/12) – Much of the discussion about physician assisted suicide revolves around moral, religious, ethical and legal questions.

Individuals on both sides of the question acknowledge the Massachusetts vote is an important one, given that approval of the measure may spawn more aggressive efforts elsewhere.

Interestingly, the Bay State’s religious community is divided on the issue.

For example, the Catholic Church, which is the most powerful and the most influential religious organization in Massachusetts, has been working hard to defeat the measure.

However, other groups, such as the Massachusetts Council of Churches, a partnership of about 17 Orthodox and Protestant denominations, is not taking a position on the referendum because there is no clear consensus of its membership.

Spokesmen for some of the religious organizations privately note that life should be cherished but that it is difficult to outright dismiss the arguments made by the terminally ill and their families. (more)

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Bishop attacks Question 2  by Richard Duckett, Worcester Telegram (10/28/12) – A pastoral letter written by Bishop Robert J. McManus expressing his objections to Question 2 on the Nov. 6 Massachusetts ballot will be read by priests in churches at all Masses in the Worcester Roman Catholic Diocese next weekend.

Speaking yesterday at a conference at Assumption College titled “To Live Each Day With Dignity,” Bishop McManus called Question 2 “poorly written, deliberately confusing, and morally flawed.” (more)

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State Rep. Scaccia Opposed to Question 2 -by Daivd Ertischek, Roslindale.Patch.com (10/29/12) – “As vice-chair of the Joint Committee on Mental Health and Substance Abuse, I am deeply concerned with Question 2 and, specifically, its lacking of a psychiatric evaluation for terminally ill patients,” said Scaccia, D-Readville. “Quality mental health must be ensured for all citizens throughout the Commonwealth and, as it stands, Question 2 undermines that effort through its lack of necessary safeguards.” (more)

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Local legislators say ‘No on 2’ by Monique Scott, The Milford Daily News (10/29/12) – State Sen. Richard Moore, D–Uxbridge, chairman of the Joint Committee on Health Care Financing, said the bill is “deeply flawed” because it allows patients to choose to end their lives without notifying family members.

Moore’s other concerns include that a physician is not required to be present when a patient is taking life-ending medication. Also, a patient, he said, could miscalculate the dosage and not end his life, possibly causing more pain to himself.

State Rep. Kevin Kuros, R-Uxbridge, said he opposes Question 2 because without a physician present, life-ending drugs could fall into the wrong hands.

“The number one place where teens get prescription drugs to experiment with is from their home medicine chest,” Kuros said. “I fear the very real possibility of a patient being prescribed the drugs, picking up the prescription, and then changing their mind, leaving the drugs in their home and not under a physician’s supervision. It is a tragic accident waiting to happen.” (more)

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Why a leading end-of-life specialist opposes assisted-suicide by Dr. Ira Byock in Common Health (10/29/12) – We’ll still be teaching more obstetrics than hospice and palliative care to every medical student. We’ll still be graduating more doctors who have never been trained to have these conversations or in ways to help people sort through their unfinished business. But, those doctors will now have the authority to write lethal prescriptions.

This does not seem like progress to me. (more)

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Massachusetts Vote May Change How the Nation Dies by Lewis M. Cohen, Slate Magazine (10/29/12) – This Election Day, Massachusetts is poised to approve the Death With Dignity Act. “Death with dignity” is a modernized, sanitized, politically palatable term that replaces the now-antiquated expression “physician-assisted suicide.” Four polls conducted in the past couple of months have shown strong support for the ballot question, although a well-funded media blitz by the opposition is kicking in during the final several weeks and may influence voter opinions. (more)

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Advocates for ballot question on assisted suicide pledge more ads by Laura Krantz, Milford Daily News (10/30/12) – Responding to news Tuesday about a new swell of opposition to the ballot question on assisted suicide, advocates pledged more advertising in the final week of the campaign.

The Suffolk/7News poll of 600 likely voters released today shows support for the question has shrunk from 64 percent six weeks ago to 47 percent.

“Regrettably, voters are facing a barrage of negative advertising financed by radical, out-of-state fringe groups, who are willing to say anything to defeat Question 2,” Crawford said.

The Archdiocese of Boston lately has become one of the most outspoken opponents to the measure, issuing a special sermon this week against the question. (more)

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What Physician-Assisted Suicide Means to You by Grace Ross, GoLocal Wocester (10/30/12) – There’s a misnomer on the ballot for November 6th called “Physician-assisted suicide.” My image that I just played out of physician assistance doesn’t even begin to apply to the law that has been proposed.  There’s so much wriggle-room in this law that you could drive a truck through it. (more)

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MISSISSIPPI

Is it morally wrong to take a life? Not so, say ethicists – OneNewsNow. – Read the latest from Answers in Genesis and the Creation Museum examining news from the biblical viewpoint. (more)

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NEW JERSEY

New Jersey legislator introduces assisted suicide bill by Alex Schadenberg, LifeSiteNews (9/28/12) – On September 27, New Jersey Assemblyman, John J. Burzichelli, introduced what he refers to as the “New Jersey Death with Dignity Act,” a bill that is a “Oregon Style” assisted suicide bill.

This bill is designed to be debated and voted on by the legislature and, if passed, to bypass the governor and go before the voters as a ballot question in the next election.

Burzichelli, a Democrat, stated about Assembly Bill A3328 that: “It’s not a Dr. Kevorkian bill where someone who’s 45 years of age who’s depressed and lost their job decides they don’t want to live and wants to call someone to assist them in suicide. This bill is very narrow.” (more)

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Begin debate on end of life – Asbury Park Press (10/1/12) – Assemblyman John Burzichelli, D-Gloucester, recently introduced New Jersey Death with Dignity Act (A-3328) would grant doctors in the Garden State the right to prescribe lethal doses of drugs to willing patients who have less than six months to live and don’t want to spend their last days suffering and in pain.
What right should government have to dictate to people of sound mind who are slowly and painfully dying the terms of their death and bar them from seeking a doctor’s aid in making a personal medical decision?It is perfectly reasonable to look at this issue and see righteousness on both sides. (more)

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New bill could make assisted suicide legal in New Jersey by Myles Collier, Christian Post (10/1/12) – Conservative and religious leaders are raising concern over a newly introduced bill in the New Jersey state legislature that would make assisted suicide legal.

Bill A3328, also known as the New Jersey “Death with Dignity Act” was introduced in the New Jersey state legislature last week by Assemblyman John Burzichelli and is seeking voter approval to legalize physician-assisted suicide. (more)

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Sane discussion on right to die, freedom needed now by Bob Ingle, Vineland Daily Journal (10/7/12) – Mention “assisted suicide” and images of Dr. Jack Kevorkian come to mind; he’s the pathologist said to have helped at least 130 people commit suicide in the 1990s, saying “death is not a crime,” although he served eight years in prison for second-degree murder. Credit him with starting a national conversation about end-of-life issues and patient rights that continues.It has to come to New Jersey in a direct way. Assemblyman John Burzichelli, D-3, has introduced the New Jersey Death with Dignity Act (A-3328) that would grant physicians the right to prescribe lethal doses of drugs to willing patients with less than six months to live. (more)

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NEW YORK

Cancer patient fights for right to die – WABC News (10/4/12)

How to Die by Bill Keller, The Opinion Pages, NY Times (10/8/12) – good comment section

Why Doctors Die Differently by Dr. Ken Murray, The Wall Street Journal – In a survey of 765 doctors, they found that 64% had created an advanced directive—specifying what steps should and should not be taken to save their lives should they become incapacitated. That compares to only about 20% for the general public. (As one might expect, older doctors are more likely than younger doctors to have made “arrangements,” as shown in a study by Paula Lester and others.) (more)

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What does the Catholic Church teach about end of life care? The Deacon’s Bench, Greg Kandra (10/8/12) – Keller makes it sound, predictably, like the Catholic Church is cruel and inhumane—opposed to the kind of palliative end-of-life treatment his father-in-law received.  But Church teaching is far more nuanced. Below is a clear description from the National Catholic Bioethics Center.  The center has been endorsed by the last two popes, and the esteemed Fr. Tadeusz Pacholczyk serves as its Director of Education and Ethicist. Part of its guidelines state: (more)

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Letters: Deciding when to end life support – NY Times (10/14/12) – Response to How to Die by Bill Keller (10/8/12)

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Four Myths About Doctor-Assisted Suicide by Ezekeil J. Emanuel, New York Times: Opinionator (10/27/12) – Unfortunately, like so many health care questions, the debate about physician-assisted suicide is confused, characterized by four major falsehoods:

Pain, Advanced Technology, Mass Appeal, A Good Death (more)

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Suicide the ‘New Norm’ for Dying?– Human Exceptionalism: Life and Dignity with Wesley J. Smith, National Review Online (10/30/12) – Yet, here in the USA, we are supposed to believe the death agenda is just a teensy-weensy, itty-bitty, miniscule adjustment in medical norms.

Baloney. Assisted suicide advocates are just following the well-worn path of cultural transforming campaigns; insist that there should be little fuss about a minor change about which we need to “have a conversation”–until the radicals control the castle walls. Then the hammer comes down, the minor change grows exponentially, and the conversation is stifled. (more)

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NORTH CAROLINA

Swiss Parliment votes against regulating assisted suicide groups by Cassie Fiano – LiveActionNews/Human Rights (10/1/12) – Currently, there is zero legislation for Swiss assisted suicide clinics. Alex Schadenberg, executive director of the Euthanasia Prevention Coalition, pointed out that there have been allegations of abuse and fraud, as well as a lack of concern for vulnerable people, raised about the assisted suicide clinic Dignitas. (Dignitas is the only clinic which allows foreign tourists to kill themselves.) And for Dignitas, assisted suicide is a multi-million-dollar business. (more)

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OREGON

Hospital officials explain Dignity choice– Ashland Daily Tidings (10/5/10) – Dignity Health was formerly known as Catholic Health Care West until Jan. 23, when it changed its name and its affiliation with the Catholic Church. Since the change, the hospital system is no longer a sponsored ministry of the church, but a self-governing, nonprofit health care system.

However, because 25 of Dignity’s 40 hospitals remain Catholic-affiliated, its non-Catholic hospitals are still barred from performing direct abortions, in vitro fertilization or prescribing aid-in-dying medication. They are not, however, required to force lifesaving treatment on a patient who refuses it.

Many Ashland residents have expressed concern over Dignity Health’s stance against the Oregon Death with Dignity Act, its banning of direct abortions, and the loss of local control if a partnership is formed. (more)

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Worries over abortion, assisted suicide scuttle takeover of Ashland hospital– Oregonlive.com (10/30/12/) – Early this month, Mark Marchetti, the hospital’s chief executive officer, said the hospital could be closed in a year if it remains independent, and the former board chairman, Dr. Doug Diehl, testified in October that it had four to six months of operating cash left unless it trimmed services.

The Ashland hospital has said its size puts it at a disadvantage against larger hospitals in Medford, and it’s squeezed by unreimbursed costs of treating Medicare and Medicaid patients.

Some community members raised concerns that Dignity Health would restrict women’s reproductive services and the rights of dying patients to get lethal prescriptions to end their lives under Oregon law.

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WISCONSIN

Catholic Bishop: Democrats support evil, will go to hell by Michael Stone, examiner.com (10/27/12) – In the letter, dated Wednesday, October 24, Bishop Ricken claims supporting a woman’s right to reproductive freedom (abortion); death with dignity (euthanasia); important scientific research (stem cell research); and marriage equality for gay and lesbian citizens are all “intrinsically evil.” (more)

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INTERNATIONAL

(News updates from Australia, Belgium, Canada, India, Ireland, Italy, New Zealand, Russia, Scotland, South Africa, Switzerland, United Kingdom)

AUSTRALIA

Nitschke urges open mind on euthanasia bill – ABC News (AU) – (10/2/12) – Euthanasia advocate doctor Philip Nitschke is urging Tasmania’s Upper House MPs to open their minds to what he calls progressive legislation. (more)

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Anti-euthanasia battle stepping up– ABC News (10/8/12) – The issue of gay marriage has only just been dismissed from the Tasmanian Parliament but already Christian groups are preparing for the next moral battle.

A discussion paper on legalising voluntary euthanasia is due out in the next few months.

The euthanasia bill is due before parliament next year but will have to pass the Upper House.

MLC Paul Harriss has dismissed the debate as a Green-led agenda. (more)

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Bell backs campaign to legalise euthanasia by Josephine Tovey, Sydney Morning Herald (10/22/12) – Supporting the rights of patients to choose to end their life is not a morose or negative cause, the actor and Bell Shakespeare theatre director John Bell says.

”We’re not about embracing death … we are about celebrating life. Once the quality of life is gone, life is not worth very much,” he said. (more)

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Time for politicians to recognise the right to die with dignity by Sarah Edelman, clinical psychologist and vice-president of Dying with Dignity, NSW – Brisbane Times (10/22/12) – Under current law it is legal to starve oneself to death over several weeks in a hospital bed and to commit suicide using violent means. (In fact, it is difficult to end one’s own life peacefully without appropriate medication or ”insider knowledge”). However, it is illegal to access medical help to die peacefully when faced with intolerable suffering and no prospect of recovery, or when dying is slow, painful and undignified.Politicians should be asked why this is an acceptable state of affairs. (more)
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Death is so personal it can’t be politicised by Julie Fewster, Sydney Morning Herald (10/23/12) – Right now there are two people in my life wanting to die. My 19-year-old university student friend Josh made his intentions really, really clear last week. He stood in front of a train. It didn’t kill him and he is vigorously being kept alive in intensive care. My 86-year-old dad, Bob, who lives in an aged care facility, regularly quotes the Ol’ Man River song “I’m tired of living, but scared of dying.”So with all this talk about the possibility of legalising euthanasia, what’s the difference between Josh’s suicide attempt and assisted suicide should my dad Bob want it? (more)
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Dying with Dignity by Amy Taylor-Kabbaz, ABC Online (10/22/12) – While the NSW Greens are planning to introduce a bill to the NSW Parliament early next year, a newspoll for Dying with Dignity NSW found that eighty-three percent of people in NSW supported legalising voluntary euthanasia. Including John Bell.”I don’t want to reach that stage of being incontinent, helpless, totally dependent,” John told Adam.”It’s a dreadful way to end a life that’s been a very happy and blessed one.”John said that often children of parents are particularly torn by how to care for their dying loved one.”They often feel guilty about wanting the parent to go, and therefore not being able to let them go and not knowing how to do it.” (more)*Doctor slams ‘arrogance’ on euthanasia by Melissa Davey, The Sydney Morning Herald (10/24/12) – The views on euthanasia held by the Prime Minister, Julia Gillard, and the NSW Premier, Barry O’Farrell, are ”supremely arrogant”, says a leading Sydney primary care physician.David Leaf, a Dying with Dignity NSW board member, said mounting evidence that supported legalising euthanasia was being ignored. He said assisted dying programs worked, with no evidence of heightened risk for groups considered vulnerable to euthanasia, including the elderly, uninsured, poor, physically disabled and mentally ill.

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

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GPs reluctant to euthanise patients by Melissa Davey, Brisbane Time (10/25/12) – More than 200 Australian doctors have banded together to call for law reform on voluntary euthanasia, but few of them would want to administer a fatal drug dose, the organisation’s spokesman says.
‘But doctors wouldn’t be administering the drug, because that responsibility could instead lie with the patient who would self-administer the dose, which is what happens in countries where it is legalised,” Dr Marr said.”This is not about the suffering of doctors, it’s about the suffering of the patients and that’s what the doctors signed up to our organisation recognise.” (more)
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There’s no greater transition that death, and you want it with dignity by Amy Corderoy, Sydney Morning Herald (10/27/12) – When the swimming champion Murray Rose died on a quiet Sunday last April, he was at peace.His wife, Jodi, believes palliative care and a supported death at home helped create that peace.”There’s no greater transition than death – and you want it with dignity,” she said. “He loved being at home so I knew in general that if there was any way he could pass away at home that was our ideal scenario.”

“I did not do it alone. I could not have done it alone,” she said.

The provision of palliative care in NSW is at a critical juncture: historically underfunded services are struggling to meet increasing demand while federal funding appears to be drying up.

The Roses’ experience is unusual in NSW, according to the Palliative Care Plan. One third of people who die of cancer and 90 per cent of those who die predictable deaths from other conditions do not receive palliative care. (more)

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Let’s put legalised euthanasia issue down by Piers Akerman, The Sunday Telegraph (10/28/12) – Reasonable adults would like to learn more about euthanasia and about any potential legislation before debate begins in state parliament. Blind compassion encapsulated in slick sloganeering should not dictate the discussion but such strategies are the norm with The Greens _ and the left in general.There are many complex questions to be answered before any legislation can be drafted, not least being who should decide when someone who has expressed a desire to be euthanised is actually to be killed.What protections will there be for the sufferer who may well decide that, despite increasing debilitation and decreased quality of life, living is still a better option than death? (more)

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BELGIUM

Doctor Admits Euthanasia Patients’ Organs Harvested by Lisa Correnti , LifeNews.com (10/12/12) – Deaths from “voluntary euthanasia” in Belgium are approximated at 2 percent, – 2,000 annually. At a recent conference in Brussels, a Belgian doctor reported that organ transplants are being done on euthanized patients and that Belgium leads in this practice. (more)

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CANADA

Assisted-suicide advocate’s resolve bolstered by terminally ill friend’s early death – MetroNews.ca (10/1/12) – The wrenching experience was made worse knowing Morcos died when he still had months, even a couple years of relatively decent health to enjoy with his wife, family and friends. But Morcos knew he could not get the help needed later when he was no longer physically able to end his life on his own.

“He knew what he was giving up and he had to give it up too soon and that was heartbreaking to me,” Westley said.

Watching life slip away from this cheerful and passionate man who talked repeatedly of the great moments he would miss reaffirmed for Westley the unfairness of Canada’s law against doctor-assisted suicide. (more)

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Quebec to legalize doctor-assisted suicide– CJAD News (10/4/12) – “We really feel that it is necessary to put forward such a possibility for people who, at the end of their life, are suffering in an unbearable manner,” says social services junior minister Véronique Hivon.

She says the idea was part of the Parti Quebecois’ election platform, and was also recommended by an all-party National Assembly committee last spring.

She says her bill will be based on that committee’s report. It’s guidelines said patients should only have access to the service if they are adult Quebec residents with a serious and incurable illness, and have given their express written consent. (more)

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Quebec to Pass MD-Assisted Suicide Law – Jobs & Hire (10/5/12) – The Quebec legislature passed the report Thursday, after two years of work from the Dying With Dignity Committee. The action was part of the Parti Quebecois’ election agenda (Parti Quebecois is the minority government in Quebec at present) and likewise had the backing of the all-party National Assembly committee.  The Liberals have remained silent on the issue.

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

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Woman who fought to change Canada’s law on assisted suicide has died – CKNW News Talk 980 (10/5/12) – The BC Civil Liberties Association says Gloria Taylor, the 64 year-old Okanagan woman who fought to change Canada’s law on assisted dying, died yesterday.
She was the Association’s lead plaintiff in its “death with dignity” lawsuit.
BC Supreme Court had granted Taylor a personal exemption allowing her the right to seek a physician-assisted death.
The Association says Taylor’s death was sudden: she developed a severe infection resulting from a perforated colon.
Given the acute nature of the illness, the Association says she did not need to seek the assistance of a physician to end her life. (more)

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Assisted-suicide activist Gloria Taylor dies from infection by Wendy Stueck and Rob Mickleburgh, The Globe and Mail (10/5/12) – In the end, she didn’t exercise the right for which she fought, and won, in court – the right to have a doctor’s help when she decided it was time to end her life.

But when Gloria Taylor died on Thursday, she did so on her own terms.

“It was very unexpected and it was sudden, but in the end, Gloria had the good death she so dearly wanted,” Grace Pastine, litigation director for the B.C. Civil Liberties Association, said Friday in an interview. (more)

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Safeguard precedents prove Canada is ready for euthanasia by Wanda Morris Executive Director, Dying With Dignity Canada – Vancouver Sun (10/6/12) – In Canada, we have a clean slate, we can introduce any criteria for eligibility we choose, and we can adopt whatever safeguards we feel are necessary.

If they have any further doubts, Canadians can look to the decision of B.C. Supreme Court Justice Lynn Smith. She had access to detailed testimony from both sides, experts from around the world and the results of cross-examinations from both teams of lawyers.

Among her conclusions: there is no slippery slope; the safeguards work. In her own words:

“In my opinion, opponent’s presentation of data from Oregon and Netherlands is generally incomplete, frequently filled with factual inaccuracies and distortions, and often meant to construct a false empirical foundation for what is essentially a moral opposition to the practice of physician-assisted death.” (more)

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Focus on palliative care, not suicide: doctor– CTVNews.ca (10/10/12) – A landmark case on doctor-assisted suicide is heading to the B.C. Appeals Court in March, but some doctors fear the hot-button issue is drawing focus away from a different, and widely used form of end-of-life care.

Dr. Romayne Gallagher works with the palliative care program at Providence Health Care, which aims to alleviate suffering for the dying. (more)

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Canadian assisted suicide activist dies of natural causes by Michael Cook, BioEthics (10/11/12) – The woman at the centre of Canada’s move towards assisted suicide died of natural causes last week before taking advantage of an exemption from the law granted by a judge in British Columbia.Gloria Taylor, 64, suffered from amyotrophic lateral sclerosis, or Lou Gehrig’s disease. She was gradually losing control of her muscles and feared dying of the disease. Together with two others, she launched a lawsuit claiming that the Canadian Charter of Rights implied a right to choose the time of her death. Judge Lynn Smith agreed and struck down the law, but suspended her judgement until after the inevitable appeal. However, she did give Ms Taylor a personal exemption from the law, making her the only person in Canada allowed to have recourse to doctor-assisted suicide. (more)
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Inside Gloria Taylor’s battle for the right to die– CBC.ca (10/12/12) – Four days after B.C. grandmother Gloria Taylor was diagnosed with Lou Gehrig’s disease, she crafted Plan B — an arrangement for someone to help her die.The crusader for physician-assisted death, who later became the only Canadian to win the legal right to get a doctor’s help to die and put the issue back in the national spotlight, didn’t need the plan in the end. Taylor, 64, died last Thursday of an infection caused by a perforated colon. (more)
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A matter of time by Pam Frampton, The Telegram (10/13/12) – Medically assisted death is still not an option in Canada, but it’s  only a matter of time before it is. And we’re talking a few more years, not decades.But Canadians are already finding ways to spare themselves unbearable suffering, because there are organizations out there willing to educate them about the alternatives. And those organizations are watching with interest as several court cases wind their way through the justice system — cases which could turn the tide. (more)
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Assisted Dying Timeline  – 1990-2012 – cbc.ca (10/17/12) – June 4, 1990 – Dr. Jack Kevorkian assists Janet Adkins in her death, using his “suicide machine.” Adkins was suffering from Alzheimer’s disease. (more)
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PQ’s ‘medical aid in dying’ sugarcoats euthanasia, foes say by Deborah Gyapong, The Catholic Register (10/18/12) – Quebec grassroots group Living with Dignity director Linda Couture expressed alarm at how fast the government is moving, noting the new government hopes to have a bill passed by June next year.In early October, radio station CJAD reported Parti Quebecois junior social services minister Veronique Hivon hoped to introduce legislation soon to help people who face unbearable end-of-life suffering. Though euthanasia and assisted suicide are both illegal in Canada’s Criminal Code, and under federal jurisdiction, Hivon said health is a provincial matter. The province could also direct Crown prosecutors not to prosecute cases that fall under the guidelines for medical aid in dying, she said.Couture said using health care and directing prosecutors in this manner is bringing in “euthanasia through the back door” while hiding behind a vague, nice-sounding phrase. (more)
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Death’s midwife helps terminally-ill Canadians end their lives– by Robert Cribb, thestar.com (10/21/12) – With the blasé patter of an airline attendant explaining the protocols of oxygen mask use, the 71-year-old retired librarian removes a microwave bag and pulls it over her head, her face shrouded beneath clear plastic, her features blurring, her graying bun compressed into a soft helmet.Slowly, her fingers begin to pinch a seal around her neck using Velcro strips she attached at the open end of the bag.Her voice muffled and faint, she points to the spot where a tube is to be inserted.“I would probably use helium,” she declares, deadpan. “A few deep breaths and you fade off.”Von Fuchs is death’s midwife. (more)
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2012 Atkinson Series: Life or Death: Who Chooses?– thestar.com – various articles
*Assisted suicide too risky, allowing it demeans value of life, federal gov’t says– Vancouver Sun (10/25/12) – The government says the law reflects Parliament’s desire to discourage and prevent suicide in all cases, and it should be up to lawmakers, not the courts, to decide if that needs to change. (more)

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Sask. support for assisted suicide by Janet French, Regina Leader-Post (10/25/12) – The Social Science Research Laboratory at the University of Saskatchewan – the only facility of its kind in Canada – created the Taking the Pulse survey in its group analysis lab, which includes multiple departments from across the Faculty of Arts and Sciences. Their research found that 59 per cent of Saskatchewanians surveyed believe they should have the option of doctor-assisted suicide when the end is nigh. (more)
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Physician-Assisted Suicide Remains Illegal in Canada by Robert Cribb, thestar.com (10/26/12) – But even emotional support for a patient taking his life is a rare public admission for a doctor in Canada, where a code of silence around such conversations is firmly entrenched in the medical profession.Consistent with Canadian law, most of the country’s medical governing bodies are opposed to assisted death. So taking a principled stand, even within the quiet confidence of colleagues, can trigger career-ending attacks from within.“You have to worry as a physician how the public, your patients, and your colleagues are going to view you,” Cohen says. “Are you really going to have the opportunity to defend yourself and are your views going to be respected? Whenever you depart from the traditional viewpoint in medicine, it’s somewhat uncomfortable.” (more)
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Ontario man with ALS ends his life with his loved ones by Robert Cribb, Toronto Star (10/26/12) – Part of his final statement reads as a kind of social treatise on the role of government in the final choices of Canadians.“Any liberal, democratic system respectful of human rights should provide for a legal and humane way to exit this life at a time chosen by a rational person and with appropriate safeguards and assistance,” it says. “Unfortunately, the Government of Canada and Canada’s Supreme Court do no do so.”While Canada’s law criminalizing assisted death may have been conceived to protect life, it can have the effect of doing just the opposite, he wrote.“I am now looking for ways to die that I must implement myself, that is while I am still sufficiently strong to take all the necessary steps myself. Having in mind the nature of ALS, this will force me to terminate my life earlier than would otherwise be the case.” (more)
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Canadian Government submits brief why law against assisted suicide should stand by Alex Schadenberg, executive director Euthanasia Prevention Coalition – National Right to Life News (10/26/12) – Ottawa is defending the law that prohibits assisted suicide as it appeals a decision from a British Columbia court, which concluded it is unconstitutional to prevent the sick and dying from asking a doctor to help them end their lives.The government argues in court documents that allowing any form of assisted suicide creates the possibility that people with disabilities, the elderly and the terminally ill could be coerced to end their lives or do so in moments of depression and despair, even if better days may be ahead.“It [the current law’s purpose] is to protect the vulnerable, who might be induced in moments of weakness to commit suicide,” the government says in a 54-page legal argument filed with the B.C. Court of Appeal.“And it is a reflection of the state’s policy that the inherent value of all human life should not be depreciated by allowing one person to take another’s life … It also discourages everyone, even the terminally ill, from choosing death over life.” (more)

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When Living Does More Harm Than Dying by Steffanie Petroni, Local2 (10/29/12)  – “People are dying too early because of laws against assisted dying. People are killing themselves while they still have the ability to do it.” Wanda Morris, Executive Director of the national organization, Dying With Dignity, advocates with great passion and compassion the urgent need to legalize assisted dying for individuals who have been diagnosed with a terminal illness or a progressive incurable physical illness. (more)

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COLUMBIA

Columbian bishops say nothing justifies legalizing euthanasia– DFW Catholic (10/11/12) – A representative of the Colombian bishops, Father Pedro Mercado Cepeda, has rejected recent efforts by a group of lawmakers to legalize euthanasia in the country.

“No circumstance can make it legally acceptable to intentionally cause the death of a human being.  The right to life is constitutionally inviolable,” he wrote in column published by local newspaper El Espectador.

On Oct. 8, a senate committee in Colombia voted 10-4 to send a proposed measure to regulate euthanasia to the full Senate for consideration. If approved the measure would be sent to the Colombian House of Representatives for a vote. (more)

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INDIA

Passive euthanasia gets law panel push– Hindustan Times (10/4/12) – The Law Commission has made a recommendation to the government to initiate measures to enact a comprehensive law on passive euthanasia, subject to certain safeguards. “It’s not objectionable from a legal and constitutional point of view,” the commission, which advises the government on legal issues, said. (more)

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Aiming for dignity in death by Dr. Pallavi A. Roshi, Deccan Herald (10/6/12) – This decade has brought a significant change in a doctor’s point of view. Many of us have changed the focus from ‘only care’ to ‘cure and comfort’ to ‘only comfort,’ when cure is impossible.

Although doctors should strive to extend life and decrease suffering, they must also accept death as a defining characteristic of life. Sometimes, so-called heroic methods may lead to needless suffering instead of preventing death. So, when the incurability of a disease is confirmed, there begins the journey of palliative care to make the end of life easy, and assuring the patient of a dignified death. (more)

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Euthanasia: Mercy killing or murder? – NDTV debate (10/7/12)

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IRELAND

There are no easy answers in matter of life and death – Belfast Telegraph (10/4/12) – The moving story of Jenny Grainger who helped her mum take her life has reignited the assisted suicide debate. Here campaigners for and against have their say– (more)

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The Gloria Taylor Case– Irish Medical Times (10/4/12) – Taylor was concerned that her condition would reach a stage where she would not be in a position to end her own life without assistance and that she would be left to die in circumstances which would be “painful, frightening and repugnant to her”.

She brought proceedings in the Supreme Court of British Columbia in which she sought the right to be allowed to die by way of physician-assisted suicide. (more)

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Nolan Show tackles assisted dying again – Humani: The Humanist (10/4/12/) – Jenny Grainger, who helped her mother Barbara to take her own life, told her story on The Nolan Show on BBC1 Northern Ireland on Wednesday 3rd October. In the Belfast Telegraphshe has called on Northern Ireland’s politicians to relax the laws on assisted suicide.The Lisburn life coach bravely highlighted the story of how her mother suffered an agonisingly slow death by refusing food and water as the only legal way to end her own life following a motor neurone disease diagnosis.Barbara (75), who was a lifelong supporter of euthanasia, told her daughter that she wanted to die and asked for her help. She wanted to go to Switzerland to Dignitas, but unfortunately she wouldn’t be able to swallow the barbiturate pill given there. So she decided that she would die through a voluntary refusal of food and fluids.Barbara also wanted the tragic story of her death made public in the hope of helping bring about a change in the law which governs people’s right to choose when and how they die. (more)
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Now MLAs must act on helping loved ones to die with dignity by Stephanie Bell, Belfast Telegraph (10/4/12) – “Regardless of their religious or political background, this is an issue which affects everyone and politicians need to take a stand and help bring about the change in the law, which currently robs people of their right to choose.”

Jenny has been inundated with messages of support since she shared the heartbreaking story of how her family stood by her mum when she chose to end her own life through the voluntary refusal of food and fluids.

Because she did not have the option of a quick and pain-free death through euthanasia, Barbara lingered for 24 days before her heart finally stopped. (more)

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Jenny’s story demands we open debate on euthanasia– Belfast Telegraph (10/6/12) – It was a sunny Saturday in late September of the Millennium year when my mother moved on. I do not know the time of my going but, if I am lucky enough to live into my 80s or indeed 90s and the prospect of losing my dignity to pain and pumps stares me in the face, I know what I want.

Hopefully, by then, we will have grown up enough to stop skirting around the most life-changing moment in our lives after our birth.

Our death – and the manner of our going. (more)

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When a loved one wants to die by Allen Gilsenan, Irish Times (10/13/12) – Unusually, the Belgian palliative-care movement and right-to-die movement developed alongside each other. Today, following legalisation in 2002, both palliative care and euthanasia are available alongside each other in the mostly Catholic-run public hospitals as part of an integrated system of end-of-life care.Under Belgian law there two key preconditions: incurable illness and unbearable suffering. The euthanasia usually takes place in the presence of friends and family, often accompanied by prayers, music and even champagne.In the city of Hasselt Fr Marc Desmet, a kindly palliative-care consultant and Jesuit priest, brought us to meet an older woman, Delphine Van Hoebrock, the evening before she was euthanised. He held her hand gently as he checked whether she had any last doubts. (more)
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Right-to-die campaigner won’t face charges over suicide by Dearbhail McDonald, Legal Editor, Independent.ie  (10/16/12) – An Irish assisted-suicide campaigner will not face prosecution over his visit to an elderly multiple sclerosis sufferer (MS) who took a fatal overdose to end her life because there is “insufficient evidence”.Tom Curran, who says he will risk up to 14 years in an Irish prison to assist his partner Marie Fleming — also a MS sufferer — to die at a time of her choosing, was interviewed by British police following the death of a wheelchair-bound grandmother of five. Ann Veasey (71) died in August 2011 at her nursing home in Harrogate, North Yorkshire, after she overdosed on pills she had bought online from China.  (more)
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Time for live debate on assisted suicide by Michael Clifford, Irish Examiner (10/20/12) – On the face of it, there is an overwhelming case to permit assisted suicide. For the greater, if not far greater, part, it would apply to people who have lived a life, made it into the upper reaches of the average span, and, were it not for a debilitating condition, would want to cling to life. Why should somebody in that position be held prisoner by nothing more than a societal taboo? Why should that person not be afforded the comfort of knowing that they were ultimately exiting on their own terms?On the other hand, there is an argument that any introduction would lead down the slippery slope to elderly people being pressurised to consent to their own death. (more)
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On whose terms should we die? by Daniel O’Reilly, The University Times (10/28/12) – We live in a society that values choice. We choose our careers, our partners and almost every aspect of our lives. It is then a strange situation that we are ultimately unable to choose the nature of our deaths beyond a small number of options. As the Tony Nicklinson and Marie Fleming cases reach their conclusions in the media and the courts, we may have to reassess this strange paradox and address how we ourselves want to die, on our own terms or on the terms of our final illness? (more)

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ITALY

The advance of euthanasia in The Netherlands by Valentina Ascione, west-info.eu (10/3/12) – Not the case of Italy, though. “Euthanasia” still remains an unrepeatable word here. (more)

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NEW ZEALAND

Michael Winner researching assisted suicide – 3news.co.nz (10/5/12) – Retired director Michael Winner has considered ending his life at a euthanasia clinic after doctors told him he has just 18 months to live.

The moviemaker, who has battled ill health in recent years, revealed this summer that liver specialists have given him between 18 months and two years and he now admits the prognosis led him to look into the controversial Dignitas institution in Switzerland.

The 76-year-old opened up about his research in a new interview with Britain’s The Times newspaper, insisting he was put off by the amount of paperwork required to go through with assisted suicide. (more)

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The right to die – yes or no by Aaron von Delden, Wanganui Chronicle (10/6/12) – “If you have the right to die, it’s a completely different feeling than if you do something that is not legal,” Anne Mohrdieck said. “It’s different for me and it’s different for the people around me. It is to die with dignity.

“Everyone has different abilities to cope with the suffering. If my ability does not allow me to have a quality of life in any way, and I choose a better option would be to go out … then I’d be enraged if that possibility would be taken from me or wouldn’t be given to me.”

MARY Stewart says euthanasia is just a euphemism for hetero-homicide – getting someone to kill you.

After 30 years as a nurse, Mrs Stewart says it will confuse the role of health professionals, who swear an oath to heal and provide comfort. (more)

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Euthanasia law nothing to fear by Yvonne Shaw, Southland Times (10/17/12) – New Zealand medical practitioners anecdotally report having been asked by their patients for assistance in dying gracefully, and many of them have complied. However, rather than following a protocol with built-in safeguards and safety standards, the process is unregulated. For patients and family members who decide to take things into their own hands, the outcome could be devastating.

When aid-in-dying laws support the rights of patients, the whole of society is protected, according to the Death with Dignity National Centre in Oregon, United States. For instance, patients and their families have a clear understanding of all of their options through carefully guided conversations with their medical practitioners. Advanced care-planning initiatives and advance directives in New Zealand already address patients’ objectives and desires for refusing medical treatment in emergent situations.

If those conversations expand to include aid-in-dying options for the terminally ill, then patients have a true grasp of the entire spectrum available to them.

Further, it allows family members to discuss options and support each other, rather than have secret conversations and fear of legal prosecution if they follow a loved one’s requests.

Medical practitioners have clearly defined processes in place, and medical protocols they must follow to comply with legislation. This protects medical practitioners from having to guess at an appropriate dosage or surmise which drugs to use. The process is defined and has paperwork that shows protocols are followed.

There is no legal ramification for following their patient’s wishes. Further, medical practitioners may opt out of the process, which protects their rights to their own personal beliefs about death and dying. (more)

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Euthanasia opens floodgates of nastiness by Rosemary McCloud, The Dominion Post (10/31/12) – Once assisted suicide becomes legal, anyone old and frail and rich will be expected to do the decent thing by whoever stands to profit from their death.

A thinly-disguised legal murder will become routine, especially as lack of respect for the old, and the belief that they don’t have any quality of life anyway, is underscored by the ease with which you can ”help” them die. (more)

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RUSSIA

Trendwatcher: Is Dignity in Death Too Much to Ask? by Natalia Antonova, RIA Novosti (10/8/12) – The other issue here is, of course, the attitude of the actual doctors. Most are simply not trained to make their patients comfortable. Once it is clear that the patient is dying – a lot of them simply stop caring. And even though palliative care is certainly a major aspect of healthcare in modern Russia, many doctors still resist any urge to call a colleague who works in that field, if only because they don’t want anyone taking over their case.

Yakusheva’s doctors went as far as accuse her relatives of trying to use the dying woman’s condition to score drugs for themselves. The fact that this happened to a well-known personality speaks to the enormity of the problem. (more)

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SCOTLAND

Swiss assisted-suicide clinic Dignitas helped 217 Britons to die in 10 years by David Maddox Scotsman (10/25/12) – It is understood that the Dignitas Clinic in Switzerland has more than 900 Britons on its books and has ended more than 20 lives a year on average since it was set up ten years ago.

The new figures from Dignitas and progress of Ms MacDonald’s latest bill has led anti-assisted suicide campaigners to warn against a change in the law. (more)

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SOUTH AFRICA

Finding a path to dignity in death by Marika Sboros, BDlive.co.za (10/3/12) – Voluntary euthanasia is legal in Holland and Belgium (only for citizens). Doctor-assisted dying is legal in a few states in the US, and in Switzerland. Lord Joffe is confident it will be legal in the UK in the not too distant future.

I asked which he thought was easier — voluntary euthanasia or doctor-assisted dying. He felt it was easier to get someone else to kill you, than to kill yourself. On reflection, I could only agree.

Yet no matter whether it’s voluntary euthanasia or doctor-assisted dying you’re after, the driving force behind legalising it is simply dignity in death. (more)

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SWITZERLAND

Study: Assisted suicide helpers distressed– World Radio Switzerland (10/4/12) – One in four people who accompany someone to commit assisted suicide suffer massive psychological distress, according to a new study by the University of Zurich.

Researchers at the university spoke to 85 people who went with a family member or close friend to an EXIT euthanasia clinic.

A quarter suffered from post traumatic stress disorder while 16 percent had depression. Five percent were found to have long-term grief.

The interviews were carried out one to two years after the assisted death of loved ones.

The results state that problems can surface 14 to 24 months later and that a death not from natural causes was a heavy burden for those who supported the deceased. (more)

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UNITED KINGDOM

Husband died in wife’s arms in Assisted Suicide at Switzerland’s Digitas– this is Hull and East Riding (10/2/12) – “All Patrick wanted was to die in his garden that he cherished so much,” she said.

“Instead, he was forced to travel to a foreign place with no meaning to him. He had always said to me he wanted to die in ‘Blighty’.”

After suffering such heartache, Anne is now backing calls for Britain to introduce powers allowing people with terminal illnesses to be able to take their own lives. (more)

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Editor’s Viewpoint: Assisted Suicide Laws Need Debate– Belfast Telegraph (10/2/12) – The 24 days that she took to die were a terrible ordeal for both her and family. It was not a clean, clinical alternative to her illness and near the end the family had to beg medical professionals to administer painkilling injections to ease her suffering from the effects of profound dehydration. Some people might wonder if her choice of the way to die was not just as bad as letting the disease take its course.

While the family stood by their mother’s decision, their dilemma was compounded by the legal issues which surround assisted suicide. Assisted suicide is illegal in the UK. (more)

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Trickle of British suicide cases to Dignitas continues as Swiss vote for status quo by Dr. Peter Saunders, National Right to Life News Today (10/2/12) – The British Suicide Act is thereby shown to remain fit for purpose. Through its blanket prohibition on all assistance with suicide, it continues to provide a strong deterrent to the exploitation and abuse of vulnerable people whilst giving both prosecutors and judges discretion in hard cases. It strikes the right balance, is clear and fair and does not need changing.
The Swiss vote means that the small number of British people travelling to Switzerland to end their lives will probably continue but we should continue to resist any calls from pressure groups to weaken the law here in the UK. (more)
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Majority of MPs oppose assisted suicide– Christian Telegraph (10/3/12) – The poll, which surveyed more than 150 MPs across all parties, found that only 29 per cent supported proposals to introduce assisted suicide, whilst 59 per cent were opposed to the move and 12 per cent were undecided.The poll also found that the majority of MPs believe that a change in the law would result in an increase in the number of suicides, and 72 per felt that it would place vulnerable people under pressure to end their lives prematurely.Almost 60 per cent were of the opinion that the current economic climate would result in more patients opting for an assisted death to avoid placing a financial burden on family members and carers. (more)
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Judges reject bid to appeal verdict of euthanasia case – The Christian Institute (10/5/12) – The case of a man who campaigned for doctors to be allowed to kill him will not go to the Court of Appeal, High Court Judges have ruled.Lord Justice Toulson said the case was “plainly a matter for Parliament”.Tony Nicklinson, who suffered from a condition known as ‘locked-in syndrome’, wanted doctors to be able to end his life.Now judges at the High Court have turned down an application by Jane Nicklinson to be made party to the proceedings.Lord Justice Toulson said: “We do not consider that the proposed appeal has any real prospect of success.Mrs Nicklinson has vowed to appeal the decision.However a second locked-in sufferer, whose case was heard alongside that of Mr Nicklinson, has been given leave to appeal.(more)
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Jane Nicklinson: ‘I can’t deny it. It’s nice to be able to go out when I want to’ by Nina Lakhani, The Independent (10/8/12) – It is not easy to admit feeling relieved that the love of your life, your soul mate, has died. But that is exactly how Jane Nicklinson feels about husband Tony Nicklinson, the assisted suicide campaigner who died of natural causes six weeks ago.Mrs Nicklinson understands that she might come across as callous or uncaring, especially by those who opposed her family’s very public battle to change the law so that locked-in syndrome sufferer Tony could be legally helped to end his life. But for anyone who has cared for a loved one with an intolerable terminal or degenerative condition, Mrs Nicklinson may just be articulating what many find too difficult to admit. (more)
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No one has the moral right to take a life– This is Plymouth (10/8/12) – The European Court of Human Rights in Strasbourg last year, ruled that while there is a “Human Right” to suicide, the state has no obligation to provide citizens with the means to commit suicide. Grégor Puppinck, the director of the European Centre for Law and Justice explained, “The Court notes that the vast majority of member States place more weight on the protection of an individual’s life than on the right to end one’s life and concludes that the States have a broad margin of appreciation in that respect.” (more)

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NHS: 150 patients die from starvation and dehydration on wards by Hannah Osbourne,  IBTimes.co.uk (10/8/12) – More than 150 patients in England and Wales either starved to death or died from dehydration in 2011, according to new figures from the Office for National Statistics.The figures show that 111 patients died from dehydration, and another 43 from malnutrition. Hundreds more were either starving or dehydrated when they died.The number of people who had dehydration and malnutrition mentioned recorded on their death certificate was 669 and 291 respectively.The ONS figures also showed that eight people starved to death in care homes. Twenty-one died from dehydration. (more)
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Dignity, Death and Deprivation of Liberty: Human Rights in the Court of Protectionby Rosalind English, UK Human Rights Blog (10/12/12) – Richard Stein observed that the argument that there can never be adequate safeguards to protect the vulnerable  is being used as a “smokescreen”, and, equally, the notion that disabled people cannot exercise their free will to die because it reduces the value of disabled lives is a “hugely patronising” one. (more)
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A pathway to euthanasia? Family revive father doctors ruled wasn’t worth saving by John Stevens, Daily Mail (10/12/12) – It involves withdrawing treatment and the heavy sedation of a patient and removal of tubes providing food and fluid in the last 24 hours of their life.Devised in the 1990s as a means of easing pain for the dying, it has been in widespread use in the NHS in recent years.However, critics claim it is increasingly being applied to patients without their families’ knowledge and when they still have a chance of recovery. (more)
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Over My Dead Body – The Economist (10/20/12) – All this reflects a big shift towards secular thinking and individual autonomy as well as growing worries about the medicalised, miserable and costly way of death that awaits many people in rich countries. Assisted suicide typically gains overwhelming public support; legislators, pro-family lobbies, churches and doctors’ groups tend to be more squeamish. They fear that legal, easy-to-get assisted suicide will have dire social and moral effects. (more)
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Assisted suicide: 10 years of dying at Dignitas by Phillipa Roxbury, BBCNews (10/20/12) – Dignitas has seen an average of 18 British citizens coming through its door each year since 2002 and many have chosen to be very open about what compelled them to travel abroad to die.Having control over the timing of their death and avoiding a painful, lingering end have been the over-riding wishes of people like Dr Anne Turner, Peter Smedley and Jackie Meacock as they made their final journey to Zurich.For those who travelled with them, there was always the fear of prosecution but, to date, no-one who accompanied any of the 182 Britons has been prosecuted. (more)

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Switzerland: 750% increase in Assisted Suicides since 1998 by Dr. Peter Saunders, a doctor and the CEO of Christian Medical Fellowship, a British organization with 4,500 doctors and 1,000 medical students as members; member of Care Not Killing Alliance – LifeNews.com (10/25/12) – Now that the Tony Nicklinson case is over and the next assisted suicide bills (from Falconer in the House of Lords and Macdonald in Scotland) are not to be debated until next year one could be forgiven for thinking that the relentless media pressure for the legalisation of euthanasia might relent for a few weeks.

But no – first we have the pronouncements of junior health ministers Norman Lamb and Anna Soubry giving their support for the legalisation of assisted suicide and now the BBC, in its role as cheerleader for assisted suicide, is making an international news story about the fact that it is ten years since the first Briton went to the Dignitas suicide facility in Zurich to kill himself. (more)

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GPs asked to provide patients with medical reports for Dignitas by Madlen Davies, pulsetoday.co.uk (10/25/12) – Doctors are required to provide access to a patient’s records under the Data Protection Act 1998 if a ‘subject access request’ has been made.

However, new GMC draft guidance for fitness-to-practise decision-makers, due to be published later this year, advises it is a criminal offence for doctors to encourage or assist a person to commit or attempt suicide.

GPs should explain this to patients when faced with demands for medical records for this purpose, the guidance says.

The GMC told Pulse that GPs are required to provide medical records under the Data Protection Act. However, if a GP suspects this will be used for the purposes of assisted dying, the GP will be contravening the 1961 Suicide Act by providing the medical records. (more)

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I’m not sorry… it’s what he wanted– BBC Radio News (10/25/12) – It is ten years since the first British person chose to travel to Switzerland and end their life with the help of the Swiss Dignitas organisation since then 217 British people have used its assisted-dying services.

Today programme presenter Evan Davis spoke to Win Crew, whose husband Reg was the second British person to commit assisted suicide at Dignitas.

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The Liverpool Care Pathway and its discontents by Sebastian Tarwater, Christian Today (10/27/12) – As fall-outs between pro-life campaigners go, this one has yet to surface, but it could turn for the worse. The tension is over whether or not the Liverpool Care Pathway (LCP) is being used as a form of euthanasia.

In June Dr Patrick Pullicino, a neurologist, claimed that the Pathway was an “assisted death pathway”. According to the doctor, patients are being placed on the LCP without clear evidence that they are close to death, while the sensationalised Daily Mail headline ran: “Top doctor’s chilling claim: The NHS kills off 130,000 elderly patients every year” – where 130,000 is the total number of patients who are put on the LCP out of the 450,000 that are terminally ill. In other words, the majority of people who are close to death are not put on the Pathway. (more)

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THIS IS THE PATH TO DEATH, PEOPLE by Camilla Tominey , Express.co.uk (10/28/12) – Since it was rolled out across the country in 2004, it has received three glowing audits, the endorsement of this Government and, just this month, the public support of 20 respected organisations representing millions of patients, carers, doctors and nurses.

Yet last week the Association of Palliative Medicine bowed to pressure from a lobby of Roman Catholic doctors, pro-life groups, some media and a small number of distressed and grieving relatives to order a review into the Pathway.

Was this a victory for patients’ rights or capitulation to media hysteria and public misunderstanding? (more)

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Tony Nicklinson’s widow to call for Scotland to legalise assisted suicide by Auslan Cramb, Telegraph.co.uk (10/30/12) – The widow of the right-to-die campaigner Tony Nicklinson is expected to call this week for Scotland to become the first part of the UK to change the law on assisted suicide.

Jane Nicklinson, 56, will appear at a conference in Edinburgh with the MSP Margo MacDonald, who has already tried and failed to make assisted suicide legal north of the border.

The conference on Friday will also hear from Ludwig Minelli, founder of Dignitas, the assisted dying organisation in Switzerland.

Among Ms MacDonald’s new proposals is a suggestion that a “licensed facilitator”, a so-called “friend at the end”, would have to be present when someone was at the point of ending their own life.

The facilitator could be a doctor, social worker, or close friend but not a relative or anyone who stood to gain from the death. (more)

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