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August 2013

More of our elderly are giving up on life

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NZ Herald 28 August 2013
Old people are at high risk of suicide as they try to cope with living on the pension and fewer social interactions, a Wairarapa advocate for the elderly says.
The comments follow the release of provisional annual suicide figures which showed the nation’s highest rate of suicide was among men aged over 85.
The figures, released this week, were for the year ending in June.
The Wellington coronial office dealt with 58 suicides in the last year, up from 48 the year before and 52 in 2010/2011.
The Wellington office covers Wellington, Kapiti, Lower Hutt, Masterton, Porirua, Upper Hutt and Chatham Islands.
Separate figures for Wairarapa were unavailable.
Wairarapa Age Concern manager Charlie Fairbrother said elderly people were a high-risk group.
http://www.nzherald.co.nz/wairarapa-times-age/news/article.cfm?c_id=1503414&objectid=11115314

Experts ponder euthanasia link in old-age suicide rate

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Stuff co.nz 27 August 2013
Elderly men are taking their lives at a high rate, and the chief coroner has raised the possibility of a link with euthanasia.
Suicide figures published yesterday highlighted the lack of information about people who died through euthanasia, which was illegal in New Zealand, chief coroner Judge Neil MacLean said.
“Euthanasia is suicide – we don’t go into details about the euthanasia rate.”
The figures show that, in the past year, men aged 85 or older were more likely to take their own lives than any other group.
Judge MacLean said more research was needed into elderly suicides. “Is it in rest homes, in the community, in hospitals?”
He said the research was necessary even though those aged 85 and older made up only a small proportion of the 541 people who killed themselves last year. Nine men in that age group took their lives in the 12 months to June 30, pushing their suicide rate to 31 per 100,000 people.
Older women were far less likely to commit suicide, with only three taking their lives last year.
http://www.stuff.co.nz/national/health/9089423/Experts-ponder-euthanasia-link-in-old-age-suicide-rate

Hospice Care

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Hospice Care
by Carrie Gordon Earll
CitizenLink.com
Hospice provides support and care for persons in the last phases of incurable diseases so that they may live as fully and comfortably as possible. Recognizing death as part of the normal process of living, hospice focuses on maintaining the quality of remaining life, neither hastening nor postponing the inevitable.
Hospice exists in the hope and belief that through appropriate care–and the promotion of a caring community sensitive to their needs–patients and their families may be free to attain a degree of mental and spiritual preparation for death that is satisfactory to them.
A hospice program provides comforting care to terminally-ill.
Patients and supportive services to patients, their families, and significant others 24 hours a day, seven days a week, in both home and facility settings. Physical, social, emotional, and spiritual care are provided during the last stages of illness, the dying process, and bereavement by a medically directed interdisciplinary team consisting of patients, families, professionals, and volunteers.
When a family member or caregiver contacts a hospice, the director of the center will call the patient’s doctor to verify his condition. If all information is accurate, the hospice will proceed with care for the patient. In any case, patients must have a terminal diagnosis to receive hospice care. In some instances, an individual who has no family will desire hospice care. In this situation, the hospice has two options:

  • If the patient is able-bodied and independent, the hospice will treat the patient in the home.
  • If the patient is bed-ridden, the hospice will send them to a hospice-operated, in-patient facility, or work with a nearby nursing home or hospital on a contractual basis to care for the patient. When home care is unavailable, hospices try to provide as close to a home-like setting as possible for the patient.

The Hospice Care Approach
The primary goal of hospice care is to manage or control pain and alleviate the fears most commonly associated for a person with a terminal illness. In fact, the patient is involved in the decision-making process for choosing how they would like to be treated for their pain. In the majority of cases, most medication is given orally to avoid the discomfort injections would cause the patients. Some of the fears hospice care addresses include:

  • Fear of pain related to the illness
  • Fear of becoming a burden to the family
  • Fear of financing the cost of a terminal illness

The hospice team of doctors, nurses, psychologists, spiritual counselors, and volunteers provide such everyday support services as administering medication, lending equipment, shopping, cleaning, and running errands for the patient. The hospice staff can be reached 24 hours a day and will visit a patient when needed, whether night or day.
Availability of Hospice Care
Those seeking hospice care for a friend or relative can find a listing in their local telephone directory’s yellow pages. However, most people find out about a particular hospice through a friend, neighbor, or family member who has experienced hospice care.
How Hospice Prepares the Family
Hospice care does not only care for the individual, but for the family, as well. Here are some of the ways hospices help the families care for patients in the homes:

  • The hospice staff walks through the realistic needs of the patient, such as a hospital bed, commode chair, or walker. The hospice also tries to fulfill the heartfelt needs of the patient, no matter how big or small.
  • Hospice nurses serve as go-betweens for the patient and his or her doctor. The hospice also teaches the family how to administer pain medications. Patients aren’t required to make office visits.
  • The hospice instructs the family that taking care of the patient must be a team effort among all family members.
  • The hospice team encourages the family to surround themselves with a network of support from friends and church members.
  • The hospice encourages the family to reminisce and take time out for light-hearted moments with the patient. The family is also urged to express their true feelings about what is happening.
  • The hospice doctor instructs the family how to react (i.e., who to call first) when the person passes away, as well as what the patient will look like. This training with the family leaves the family with a sense of empowerment.  Volunteers work with the family to give them breaks and to run errands for the family or the patient. Volunteers also offer companionship to the patient, especially if they are in a facility.
  • The hospice also helps the family plan the funeral (which volunteers and staff members often attend), sends cards and letters, and offers continuing psychological and spiritual counsel to the family for as long as needed.

The Cost of Hospice Care
Hospice care is the most cost-effective way of caring for a terminally-ill person. In the U.S., the approximate estimated cost for hospital care is $1,756 per day, $284 per day at nursing facilities, and averages about $100 per day for at-home hospice care and $200 per day in a private facility. Hospice care is covered under Medicare, Medicaid (in some states), most private-insurance groups, and HMOs. Families may be asked to meet some uncovered costs. However, hospices rarely, if ever, turn down patients for financial reasons. Public and community support through donations, grants, memorial gifts and fund-raising events assist to help cover the cost of care.
How You Can Get Involved
Volunteers are a hospice’s life-blood and keep the facility running in an efficient, caring manner. To become involved with hospice care:

  • Contact your local hospice and find out how you can become a volunteer. Volunteers are fully trained by the hospice.
  • Or, if you know a patient in your church, business, or neighborhood, you can assist the patient and their family on your own.

Other Practical Suggestions

  • Listen
  • Pray
  • Write letters or thank you notes for the patient
  • Bake cookies for visitors
  • Prepare a basket of teas and coffees
  • Buy and/or wrap Christmas and birthday gifts
  • Run errands
  • Do the laundry and dishes
  • Clean or vacuum the house
  • Provide a meal
  • Help take care of the lawn and weed flower beds
  • Help write the patient’s memoirs
  • Send flowers
  • Read to the patient
  • Visit the patient to relieve care-giver

This page was originally posted on December 16, 2003.
Carrie Gordon Earll is the Senior Policy Analyst for Bioethics at CitizenLink (an affiliate of Focus on the Family) and a fellow with the Center for Bioethics and Human Dignity.

What You Need to Know About Terri Schiavo

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What You Need to Know About Terri Schiavo
by Carrie Gordon Earll
CitizenLink.com

Terri Schiavo’s fight for life was widely publicized in the media but do you know the facts?
Terri Schindler Schiavo died on March 31, 2005 after 13 days of court-ordered dehydration. She was a 41-year-old disabled Florida woman at the center of an ongoing legal dispute between her estranged husband, Michael, and her parents. Here is part of her story written in the present tense before her death:
In 1990 at 26-years of age, Terri collapsed in her home when her heart temporarily stopped, cutting off oxygen to her brain and leaving her severely brain damaged.
Terri is not dying or terminally ill; she is not brain-dead or in a coma. She is an otherwise healthy mentally disabled woman. The diagnosis that she is in a “vegetative state” is disputed by many medical experts, including neurologists. Some neurologists believe it’s possible that Terri is in a “minimally conscious state” (MCS)— a neurological diagnostic criteria first defined in 2002.1  Researchers are beginning to test this criteria against that of “persistent vegetative state” (PVS) with other patients. 2
Terri breathes on her own without the aid of a ventilator. Her only dependency is on a feeding tube into her stomach for liquids and nourishment.3   She swallows her own saliva, a fact that leads some experts in speech pathology to believe that with sufficient time and therapy, she could regain her ability to swallow fluids by mouth.4   As recently as 1997, nursing staff who cared for Terri testified that she could swallow fluids and Jello-O, follow people with her eyes and even speak. 5
Barbara Weller, an attorney for Terri’s parents, has posted narratives on the Internet describing her recent visits with Terri. During these visits, Weller witnessed purposeful interaction between Terri, her parents and other visitors. 6
At the time of her collapse, Terri did not have a written advance medical directive. Since her disability, medical decisions have been made by her husband, Michael Schiavo.
Michael Schiavo won a medical malpractice case on Terri’s behalf in 1992, pledging to use the money for Terri’s rehabilitation and care for the rest of her natural life. 7   The court awarded more than $1 million: $300,000 directly to Michael for his loss and additionally, more than $700,000 for Terri’s care. 8   Terri’s parents, Bob and Mary Schindler, claim that prior to the settlement a neurologist recommended progressive therapy for Terri and that Michael agreed to provide such therapy, only to deny it and confine Terri to a nursing home after receiving the jury award. 9
It was after the settlement that Michael first claimed that Terri had previously stated that she didn’t want to be kept alive by artificial means — a statement he never mentioned during the malpractice trial. 10
As guardian, Michael Schiavo controls the $700,000-plus trust fund awarded for Terri’s care. 11 As of fall of 2003, Michael Schiavo’s attorneys reported that the trust fund was down to $50,000, with more than $430,000 going to “pay for court costs associated with her husband’s legal battle to remove his wife’s feeding tube.” 12   Meanwhile, Medicaid helps to pay Terri’s $5,000-a-month nursing costs at a hospice in Pinellas Park, Florida. 13
Since 1995, Michael Schiavo has lived with a girlfriend, Jodi Centonze, with whom he has two children. 14  Michael remained legally married to Terri, as well as her guardian, until her death.  (Then, he married Centonze.)
In 1998, Michael Schiavo petitioned the court to have Terri’s feeding tube removed.
Terri’s parents have offered to take care of Terri at their own expense, allowing Michael to keep all money remaining in the trust fund.  Michael Schiavo refused, insisting that Terri die from dehydration.
Florida Sixth Judicial Circuit Judge George Greer set Friday, March 18 at 1:00 p.m. EST as “date and time” certain to remove Terri’s feeding tube — an act that will cause the painful death of an otherwise healthy disabled person whose body processes and benefits from the nutrients and fluids she receives daily.
TIMELINE: 15
On February 25, 1990, 26-year-old Terri Schindler Schiavo collapsed in her home when her heart temporarily stopped, cutting off oxygen to her brain and leaving her severely brain injured.
In November 1992, her husband, Michael, won a medical malpractice lawsuit after claiming that doctors failed to diagnose the chemical imbalance that caused the heart attack. The court awarded approximately $1 million in damages with $300,000 to Michael for his loss and another $700,000 to Michael for Terri’s guardianship and care.
In July 1993, Terri’s parents, Bob and Mary Schindler, petition the court to have Michael removed as Terri’s guardian — a request that is denied in August 2001.
In May 1998, Michael Schiavo petitions the court to have Terri’s feeding tube removed, claiming that Terri told him that she did not want life-sustaining intervention in the event of her incapacitation.
In February 2000, Florida Circuit Judge George W. Greer rules that the feeding tube can be removed.
After several court appeals, it is removed on April 24, 2001. Two days later, Florida Circuit Judge Frank Quesada orders doctors to reinsert Terri’s feeding tube.
In October, 2001, the Florida 2nd District Court of Appeals indefinitely delays the removal of Terri’s feeding tube pending the examination of Terri by five physicians: two selected by Michael, two by the Schindler’s and one by the court. The two doctors selected by Terri’s parents tell the court that she can recover; the remaining three stated that she is in a vegetative state with no hope of recovery. The following month, Judge Greer again orders the feeding tube to be removed again. More court appeals follow.
On October 15, 2003, Terri’s feeding tube is removed for a second time.  It is later reinserted.
October 20-21, 2003: the Florida State Legislature passed legislation (dubbed “Terri’s Law”) allowing Governor Jeb Bush to intervene, ordering the reinsertion of Terri’s feeding tube — six days after it was removed.
May 6, 2004 — January 24, 2005: Various courts, including the Florida Supreme Court, strike down “Terri’s Law” as unconstitutional; the U.S. Supreme Court refuses to hear the case.
March 2005: Members of the U.S. Congress and the Florida State Legislature introduce legislation to intervene on behalf of Terri and other medically vulnerable patients.
March 18, 2005: Terri feeding tube is removed for the third and final time. That same evening, Congress passes “Terri’s Law II”  authorizing Terri’s parents to seek federal court review of whether her federal rights were protected. Over the next week, both the U.S. District Court and the U.S. Supreme Court declined to intervene on Terri’s behalf.
On March 31, at approximately 9:05 am, after almost 14 days without nutrition or hydration, Terri Schindler Schiavo dies from severe dehydration.
This page was originally posted on March 7, 2005.
Carrie Gordon Earll is the Senior Policy Analyst for Bioethics at CitizenLink (an affiliate of Focus on the Family) and a fellow with the Center for Bioethics and Human Dignity.
________________________________________
1 Affidavit of Neurologist Beatrice C. Engstrand, M.D., March 3, 2005; Affidavit of Neurologist Jacob Green, M.D., February 22, 2005; Affidavit of Neurologist Lawrence Huntoon, M.D., March 3, 2005. Some affidavits may be accessed on-line at www.terrisfight.org 2 J.T. Giacino, et al., “The minimally conscious state: Definition and diagnostic criteria,” Neurology, February 2002; 58: 349-353; Melanie Boly, et al., “Auditory Processing in Severely Brain Injured Patients,” Archives of Neurology, February 2004, 61:233-238. 3Abby Goodnough, “Governor of Florida orders woman fed in right-to-die case,” The New York Times, October 22, 2003. 4Affidavit of Speech Language Pathologist Sarah Green Mele, July 25, 2003; Affidavit of Carolyn Heron, M.D., March 3, 2005; Affidavit of Neurologist Beatrice C. Engstrand, M.D., March 3, 2005; Affidavit of Speech and Language Pathologist Jill Joyce, PhD, March 3, 2005. Some affidavits may be accessed on-line at www.terrisfight.org 5Affidavits of Certified Nursing Assistant Heidi Law, September 1, 2003; Registered Nurse Carla Sauer Iyer, September 1, 2003. 6Narrative by Barbara Weller on visit with Terri December 24, 2004; Narrative by Barbara Weller on visit with Terri February 24, 2005. 7Vickie Chachere, “Michael Schiavo says money, activists motivate in-laws,” Associated Press, October 28, 2003. 8Patrick Kampert, “Parents or husband: Who decides?; Courts to choose victor in battle over woman’s life,” Chicago Tribune, October 12, 2003. 9Interview with Robert and Mary Schindler, Larry King Live, September 27, 2004. 10Kampert, Associated Press. 11Hugo Kugiya, “Decision for Death; Florida woman’s feeding tube pulled after court okays action, Newsday, October 16, 2003. 12William R. Levesque, “Schiavo’s husband says he’ll fight back,” St. Petersburg Times, October 24, 2003; Chris Gray, “Both sides in Schiavo fight point to control of money,” Philadelphia Inquirer, October 29, 2003. 13Mary McFachlin, “Schiavo case a growing legal, moral morass,” Palm Beach Post, October 26, 2003; Levesque, St. Petersburg Times. 14Rich McKay and Maya Bell, “How to deal with Terri Schiavo’s tragedy splits family,” Orlando Sentinel, October 26, 2003; Warren Richey, “Can state intervene in medical decisions?” Christian Science Monitor, August 3, 2004. 15With assistance from “Key Dates in the life of Terri Schiavo,” Associated Press, January 24, 2005.

Physician-Assisted Suicide: The Stories Behind the Issue

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Physician-Assisted Suicide: The Stories Behind the Issue
by Carrie Gordon Earll
CitizenLink.com

Supporters of physician-assisted suicide often tell emotive stories of terminally ill patients who ask a doctor to help them die. These stories communicate that an early, premeditated death is the best, and perhaps the only option for the patient. However, a growing number of medical professionals who work with dying patients are speaking out to dispute this perception that early death is the best solution.
Consider these statements:
“If we treat their depression and we treat their pain, I’ve never had a patient who wanted to die.” —Dr. William Wood, clinical director of the Winship Cancer Center at Emory University in Atlanta, Time April 15, 1996 pg. 82
“In my clinical practice, I have been asked by suffering patients to aid them in death because of severe pain. I have had the opportunity to see these requests for aid in death fade with adequate pain control, psychological support, provision of family support, and with the promise that their symptoms would be controlled throughout the dying process.”
Kathleen Foley, MD serves as Chief of the Pain Service at Memorial Sloan-Kettering Cancer Center in New York City and as director of the World Health Organization Collaborating Center for Cancer Pain Research and Education. In April of 1996, Dr. Foley made the preceding statement before the Judiciary Subcommittee on the Constitution in Washington D.C., a Congressional subcommittee investigating physician-assisted suicide.
“There is a legacy that reverberates beyond a last breath, depending on how, one way or another, those last days were faced. I treated a young man with AIDS who begged for me to help him die. His religiously fundamentalist family was appalled with him. So much was unspoken, unsettled. Gradually the hospice team was able to bring them together, and to see that father gently bathing his son was nothing short of a miracle. Just think about that for a moment. It’s all right there, the moment of truth. This man died in peace, and his family will always know they had loved him, something that wouldn’t have happened if I or some other doctor had listened to his request to die.”
—Montana hospice physician Ira Byock as published in The New York Times Magazine, July 21, 1996
“We already know enough now to manage virtually all cases of malignant pain successfully. The widely held belief that pain can be relieved only by doses of morphine so high as to render the patient a zombie is a pernicious myth.”
—Eric Chevlen, MD, Director of Palliative Care at St. Elizabeth Health Center, Youngstown, Ohio. Excerpted from Chevlen’s article entitled “Mock Medicine, Mock Law” published in First Things, June/July 1996 p. 17
“I’ve taken care of 2,000 people who’ve died in my care. I only had two patients out of that whole group who, in a system of good care, where they could count on their nurses and doctors, still wanted to have that option.” —Gerontologist Dr. Joanne Lynn during a panel discussion in WETA-TV’s “Who Plays God?” broadcast, May 3, 1996.
“A few years ago, a young professional in his early 30’s who had acute myelocytic leukemia was referred to me for consultation. With medical treatment, he was given a 25 percent chance of survival; without it, he was told, he would die in a few months.
“His immediate reaction was a desperate preoccupation with suicide and a request for support in carrying it out. he was worried about becoming dependent and feared both the symptoms of his disease and the side effects of treatment. His anxieties about the painful circumstances that would surround his death were not irrational, but all his fears about dying amplified them.
“Many patients and physicians displace anxieties about death onto the circumstances of dying – pain, dependence, loss of dignity, the unpleasant side effects resulting from medical treatment. Once the young man and I could talk about the possibility or likelihood of his dying – what separation from his family and the destruction of his body meant to him – his desperation subsided. He accepted medical treatment and used the remaining months of his life to become closer to his wife and parents. Two days before he died, he talked about what he would have missed without the opportunity for a loving parting.”
—Psychiatrist Dr. Herbert Hendin, Executive Director of the American Suicide Foundation. This statement is an excerpt from Lifesavers, a quarterly newsletter of the American Suicide Foundation, Spring 1995. Carrie Gordon Earll is the Senior Policy Analyst for Bioethics at CitizenLink (an affliate of Focus on the Family) and a fellow with the Center for Bioethics and Human Dignity.
http://www.citizenlink.com/2010/06/18/euthanasia-the-stories-behind-the-issue/

The Dutch Disaster

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The Dutch Disaster
by Carrie Gordon Earll
CitizenLink.com

Euthanasia advocates argue that strict guidelines will protect the dependent, disabled and elderly from family members or medical professionals who deem their lives are no longer worth living. These “right to die” supporters point to Holland, where physicians have practiced physician-assisted suicide and euthanasia for more than two decades.
While euthanasia and assisted suicide remain illegal in Holland, doctors are free to engage in such practices without prosecution if they follow specific guidelines. Among others, these parameters require that the patient be competent, voluntarily repeating the request for death and experiencing unbearable suffering from an irreversible illness.1
However, two Dutch studies, conducted in 1990 and 1995 found that doctors in the Netherlands practiced euthanasia apart from these guidelines. These studies substantiate the suspicion that granting physicians the legal liberty to intentionally bring about the death of a patient could result in people being killed who did not ask to die.
The studies make a distinction between two forms of euthanasia: euthanasia — the intentional killing of a patient by the direct intervention of a physician at the patient’s explicit request, and ending life without the explicit request of the patient — the intentional killing of a patient by the direct intervention of a physician without the patient’s explicit request. An analysis of deaths in both categories reveals that 31 percent of cases in 1990, and 22.5 percent in 1995 involved patients who did not give their explicit consent to be killed.2
Dutch physicians have also extended the practice of euthanasia to include comatose patients, handicapped infants and healthy but depressed adults. In 1996, a Dutch court found a physician guilty of euthanizing a comatose patient at the request of the patient’s family. Although the court determined the patient was not suffering and did not ask to die, the doctor was not punished.3
In April 1995, Dutch physician Henk Prins was convicted of giving a lethal injection to Rianne Quirine Kunst, a baby born with a partly formed brain and spina bifida. The court refused to punish Prins.4 Likewise, though psychiatrist Boudewijn Chabot was found guilty in 1994 of prescribing a fatal dose of sleeping pills for Hilly Bosscher, who was suffering from depression, Chabot was not penalized.5 That same year, the Dutch Supreme Court ruled physician-assisted suicide might be acceptable for patients with unbearable suffering but no physical illness. A 1996 survey of Dutch psychiatrists found 64 percent of those responding “thought physician-assisted suicide for psychiatric patients could be acceptable.”6
As the Dutch experience demonstrates, euthanasia does not remain limited to competent, terminally ill adults who choose to end their own lives. Furthermore, guidelines have proven to be no protection for Holland’s disabled, depressed or elderly citizens. In fact, involuntary euthanasia has become so prevalent that many Dutch citizens carry “Life Passports,” cards that state they do not want so-called “physician aid-in-dying” if they are hospitalized.7
Analysis of Dutch Euthanasia Studies
The studies were conducted in 1990 and 1995. Methods included surveys of and interviews with Dutch physicians as well as analysis of Dutch death certificates listing the cause of death. The 1990 study is often referred to as the Remmelink Report, named after the government representative who chaired a national commission formed to examine medical decisions at the end of life. In the Netherlands, physicians are able to engage in the practices of both euthanasia and physician-assisted suicide, generally without fear of prosecution. However, the two Dutch studies indicate that, on the average, euthanasia is practiced 10 times more frequently than physician-assisted suicide (PAS).
Table 1: Comparison of euthanasia and physician-assisted suicide deaths (% in total deaths):
1990– Euthanasia (1.8%), PAS (0.2%), Ratio 9:1 1995– Euthanasia (2.4%), PAS (0.2%), Ratio 12:1 Average: 10.5
(Percentages used in this analysis are based on the total number of deaths in the Netherlands in the year: 128,786 deaths in 1990 and 135,546 deaths in 1995.)
The Dutch studies make a distinction between two forms of euthanasia: euthanasia — the intentional killing of a patient by the direct intervention of a physician at the patient’s explicit request and ending life without the explicit request of the patient or ELWERP — the intentional killing of a patient by the direct intervention of a physician without the patient’s explicit request. Based on these definitions, the studies document the following number of deaths:
Table 2: Analysis of euthanasia deaths with and without explicit request (% of total deaths):
Method of death 1990 Euthanasia (with request) 2318 (1.8%) ELWERP (without request) 1030 (0.8%) TOTAL 3348
1995 Euthanasia (with request) 3253 (2.4%) ELWERP (without request) 948 (0.7%) TOTAL 4201
(Percentages used in this analysis are based on the total number of deaths in the Netherlands in the year: 128,786 deaths in 1990 and 135,546 deaths in 1995.) These numbers reveal that, of all euthanasia deaths (3348 and 4201, respectively), 30.76 percent in 1990 and 22.56 percent in 1995 involved patients who did not give their explicit consent to be killed.
Sources:
1990 study: van der Maas, P.J., van Delden, J.J.M., Pijenborg, L. (1992). Euthanasia and other medical decisions concerning the end of life: An investigation performed upon request of the Commission of Inquiry into the medical practice concerning euthanasia. Amsterdam: Elsevier Science Publishers. (p. 178, 181-182).
1995 study: van der Maas, P.J., van der Wal, G., Haverkate, I., et al. (1996). Euthanasia, physician-assisted suicide, and other medical practices involving the end of life in the Netherlands, 1990-1995. New England Journal of Medicine, 335, 1699-1705.


1Carlos Gomez, Regulating Death, (New York: Free Press, 1991), p. 32; “The Dutch Guidelines: How a Nation Tolerates Euthanasia,” Newsday, January 6, 1997, p. A6 2P. J. van der Maas, J.J.M. van Delden and L. Pijenborg, Euthanasia and other Medical Decisions Concerning the End of Life: An Investigation Performed Upon Request of the Commission of Inquiry into the Medical Practice Concerning Euthanasia, (Amsterdam: Elsevier Science Publishers, 1992) p. 178-179, 181-182; P.J. van der Maas, G. van der Wal, I. Haverkate, C.L.M et al.,(1996). Euthanasia, physician-assisted suicide, and other medical practices involving the end of life in the Netherlands, 1990-1995. New England Journal of Medicine, 335, p. 1700-1701 3“The Dutch Guidelines,” Newsday, 1997, p. A6 4 “Doctor Freed in ‘Justified’ Mercy Killing,” Chicago Tribune, April 27, 1995, p. N21; “Murder Charge Proved Against Euthanasia Doctor, but Case Dismissed,” Associated Press, April 27, 1995 5 “Doctor Unpunished for Dutch Suicide,” New York Times, June 22, 1994, p. 10A 6 J.H. Groenewoud, P.J. van der Maas, G. van der Wal, et al., Physician-assisted death in psychiatric practice in the Netherlands. New England Journal of Medicine, 336, p. 1796 7 “Dutch Death,” Oregonian, January 8, 1995, p. 17A

This article was originally posted in June 1996.
Carrie Gordon Earll is the Senior Policy Analyst for Bioethics at CitizenLink (an affiliate of Focus on the Family) and a fellow with the Center for Bioethics and Human Dignity.
http://www.citizenlink.com/2010/07/12/the-dutch-disaster/

Physician-Assisted Suicide and Euthanasia

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Physician-Assisted Suicide and Euthanasia
by Carrie Gordon Earll
CitizenLink.com

Should physicians be granted the power to intentionally end the lives of their patients? Recent proposals to legalize physician-assisted suicide have raised this question and triggered intense legal, medical and social debate.
For some individuals, the debate is fueled by their fear that medical technology may someday keep them alive past the time of natural death. However, this concern is unfounded for mentally competent adults who have a legal right to refuse or stop any medical treatment. It is also important to recognize that today’s health care climate lends itself more to undertreatment than overtreatment.
However, the present debate is not about refusing treatment or taking extraordinary measures. The issue is whether physicians should be allowed to intentionally kill their patients, either by providing the means of death or ending the patient’s life by the doctor’s hands. There is a tremendous distinction between allowing someone to die naturally when medical technology cannot stop the dying process and causing someone to die through assisted suicide or euthanasia. The question is one of intent: Is the intention to cause the death of the patient?
The terms “physician-assisted suicide” and “euthanasia” are often used interchangeably. However, the distinctions are significant. The act of physician-assisted suicide involves a medical doctor who provides a patient the means to kill him or herself, usually by an overdose of prescription medication.
Meanwhile, euthanasia involves the intentional killing of a patient by the direct intervention of a physician or another party, ostensibly for the good of the patient or others. The most common form of euthanasia is lethal injection. Euthanasia can be voluntary (at the patient’s request), nonvoluntary (without the knowledge or consent of the patient) or involuntary (against his or her wishes).
Legal Status
Euthanasia is illegal in the United States. Physician-assisted suicide is illegal by statute or common law in most states. Oregon and Washington State allow physician-assisted suicide.  Montana law may provide a defense for a doctor charged with such an action.
In 1997, the U.S. Supreme Court ruled that there is no federal constitutional right to physician-assisted suicide. However, the decision does not address individual state constitutions, which could be interpreted by other courts to include a state right to physician-assisted suicide.
Many state legislatures have tackled this issue in recent years, with more than 25 rejecting bills to legalize physician-assisted suicide and nearly a dozen states adopting new laws to ban it. No state legislature has voted to legalize physician-assisted suicide.
Oregon approved a ballot initiative to legalize physician-assisted suicide in 1994 and reaffirmed the vote in 1997. Five other attempts to legalize physician-assisted suicide (or euthanasia) through ballot initiative (California in 1988 and 1992, Washington State in 1991, Michigan in 1998, and Maine in 2000) all failed.
In 2008, Washington State approved physician-assisted suicide by ballot measure.  In Montana, a 2009 state Supreme Court ruling did not legalize physician-assisted suicide but rather may provide a defense for a physician charged with homicide involving a patient.
Stories Behind the Issue
Supporters often use emotional stories of terminally ill patients suffering in the final days of life to justify legalizing physician-assisted suicide. These stories communicate that an early, premeditated death is the best, and perhaps the only, option for the patient. However, a growing number of medical professionals who work with dying patients are speaking out to dispute this perception. Consider the following statements:
If we treat their depression and we treat their pain, I’ve never had a patient who wanted to die.
William Wood, M.D., clinical director of the Winship Cancer Center at Emory University in Atlanta, as published in Time, April 15, 1996, p. 82.
I simply have never seen a case nor heard of a colleague’s case where it (physician-assisted suicide) was necessary. If there is such a request, it is always dropped when quality care is rendered.
Linda Emanuel, M.D., Ph.D., director of the American Medical Association’s Institute on Ethics, as published in “The New Pro-Lifers,” The New York Times Magazine, July 21, 1996.
In my clinical practice, I have been asked by suffering patients to aid them in death because of severe pain. I have had the opportunity to see these requests for aid in death fade with adequate pain control, psychological support, provision of family support, and with the promise that their symptoms would be controlled throughout the dying process.
Kathleen Foley, M.D., chief of pain service at Memorial Sloan-Kettering Cancer Center in New York City, as part of her testimony before the House Judiciary Subcommittee on the Constitution, Washington D.C., April, 1996.
  Reasons to Oppose Physician-Assisted Suicide
There are many reasons for opposing attempts to legalize such actions. Here are a few:

  • Acceptance of physician-assisted suicide sends the message that some lives are not worth living.

Social acceptance of physician-assisted suicide tells elderly, disabled and dependent citizens that their lives are not valuable. Doctors who list death by assisted suicide among the medical options for a terminally or chronically ill patient communicate hopelessness, not compassion.

  • The practice of physician-assisted suicide creates a duty to die.

Escalating health-care costs, coupled with a growing elderly population, set the stage for an American culture eager to embrace alternatives to expensive, long-term medical care. The so-called “right to die” may soon become the “duty to die” as our senior, disabled and depressed family members are pressured or coerced into ending their lives. Death may become a reasonable substitute to treatment and care as medical costs continue to rise.

  • There are better medical alternatives.

Terminally ill patients do not need to suffer a painful death. Today’s pain management techniques can provide relief for up to 95 percent of patients, thus offering true death with dignity.1, 2, 3 In addition, these same techniques can lessen pain and other symptoms for all patients. Another alternative is palliative care through hospice, which addresses the physical, emotional and spiritual needs of dying patients and their families.

  • Physician-assisted suicide ignores what may be a legitimate cry for help.

Suicidal thoughts often indicate the presence of severe depression. A study of terminally ill hospice patients found only those diagnosed with depression considered suicide or wished death would come early. Patients who were not depressed did not want to die.4 Depression can and should be treated.

  • Physician-assisted suicide gives too much power to doctors.

Assisted suicide does not give the patient autonomy. It gives the power to the doctor. The doctor essentially decides if you live or die, and doctors can make mistakes. Consider a survey of Oregon physicians published in the February 1, 1996, issue of New England Journal of Medicine. Researchers found one half of the physicians responding were not confident they could predict that a patient had less than six months to live. One third were not certain they could recognize depression in a patient asking for a lethal dose of medication. Yet, these are the same doctors who, under Oregon’s law legalizing physician-assisted suicide, are allowed to assist in a patient’s death if they can recognize depression and predict patient death within six months.

  • The practice of physician-assisted suicide threatens to destroy the delicate trust relationship between doctor and patient.

Every day patients demonstrate their faith in the medical profession by taking medications and agreeing to treatment on the advice of their physicians. Patients trust that the physicians’ actions are in their best interest with the goal of protecting life. Physician-assisted suicide endangers this trust relationship.

  • Physician-assisted suicide opens the door to euthanasia abuses.

Allowing physicians to cross the line into killing does not stop with willing patients who request it. A case in point is in The Netherlands where doctors have practiced physician-assisted suicide and euthanasia for more than a decade. Two Dutch government reports, conducted in 1990 and 1995, found that, on average, 26 percent of euthanasia deaths in Holland were “without the explicit consent of the patient.” In 1995, 21 percent of the patients who were killed without consent were competent.5, 6
Dutch physicians have also extended the practice of euthanasia to include comatose patients, handicapped infants and healthy but depressed adults. In 1996, a Dutch court found a physician guilty of euthanizing a comatose patient at the request of the patient’s family. Although the court determined the patient was not suffering and did not ask to die, the doctor was not punished.7
In 1995, Dutch physician Henk Prins was convicted of giving a lethal injection to a baby born with a partly formed brain and Spina bifida. The court refused to punish Prins.8 Likewise, though psychiatrist Boudewijn Chabot was found guilty in 1994 of prescribing a fatal dose of sleeping pills for a woman who was suffering from depression, Chabot was not penalized.9 That same year, the Dutch Supreme Court ruled that physician-assisted suicide might be acceptable for patients with unbearable suffering but no physical illness. A 1996 survey of Dutch psychiatrists found 64 percent of those responding “thought physician-assisted suicide for psychiatric patients could be acceptable.”10


1K.M. Foley, “The Treatment of Cancer Pain,” The New England Journal of Medicine (1985): 313, pp. 84-95. 2I.R. Byock, “Kevorkian: Right Problem, Wrong Solution” [Letter to the Editor], The Washington Post, January 1994, p. A23. 3D. Colburn, “Assisted Suicide: Doctors, Ethicists Examine the Issues of Pain Control, Comfort Care and Ending Life,” The Washington Post, 14 September 1993, p. Z7. 4S. Barakat, J.H. Brown, P. Henteleff, C.J. Rowe, “Is It Normal for Terminally Ill Patients to Desire Death?” American Journal of Psychiatry (1986): 143:2, pp. 208-211. 5P.J. Van Der Maas, J.J.M. Van Delden, L. Pijenborg, Euthanasia and Other Medical Decisions Concerning the End of Life (Amsterdam: Elsevier Science Publishers, 1992), pp. 73, 75, 181-182. 6P.J. Van Der Maas, G. Van Der Wal, I. Haverkate, et al. “Euthanasia, Physician Assisted Suicide, and Other Medical Practices Involving the End of Life in the Netherlands, 1990-1995,” New England Journal of Medicine (1996): 335, pp. 1699-1705. 7“The Dutch Guidelines,” Newsday, 1997, p. A6. 8“Doctor Freed in ‘Justified’ Mercy Killing,” Chicago Tribune, 27 April 1995, p. N21; “Murder Charge Proved Against Euthanasia Doctor, but Case Dismissed,” Associated Press, 27 April 1995. 9“Doctor Unpunished for Dutch Suicide,” New York Times, 22 June 1994, p. 10A. 10J.H. Groenewoud, P.J. Van der Maas, G. Van Der Wal, et al., “Physician-Assisted Death in Psychiatric Practice in the Netherlands,” New England Journal of Medicine(1997): 336, p.1796.
This article was originally posted in June 1996.

Carrie Gordon Earll is the Senior Policy Analyst for Bioethics at CitizenLink (an affiliate of Focus on the Family) and a fellow with the Center for Bioethics and Human Dignity.
http://www.citizenlink.com/2010/07/12/physician-assisted-suicide-and-euthanasia-2/

Euthanasia bill close to MP's heart

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Stuff.co 12 August 2013
People who have been self-determining, autonomous adults throughout their lives should have every right to choose when their time is up, MP Maryan Street says.
Along with Waikato’s Voluntary Euthanasia Society, Ms Street travelled to New Plymouth yesterday to speak about her End of Life Choice Bill, which is in Parliament’s ballot box.
Support towards the bill appeared strong in New Plymouth, with more than 50 people, young and old, turning out to listen and express their views.
Only one attendee, with Christian views, stood up to express his disagreement with the document.
The bill proposes euthanasia be open to people with terminal illness likely to cause death within 12 months, or to people with an irreversible physical or mental condition that renders their life unbearable – by their own assessment.
Ms Street, a former New Plymouth Girls’ High School student, said the topic of euthanasia was a growing issue that had continued to generate much interest over the years.
Similar bills have been through Parliament twice before.
In 1995, one was defeated 61-29, while in 2003 another missed out by two votes.
http://www.stuff.co.nz/taranaki-daily-news/news/9029192/Euthanasia-bill-close-to-MPs-heart

Very few doctors in Canada would kill a patient by euthanasia

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National Right To Life News 5 August 2013
What do we know about the willingness of Canadian physicians to participate in euthanasia? Here are two authoritative polls.
An article published earlier this year by Postmedia News reported on a survey by the Canadian Medical Association (CMA) that found very few Canadian doctors are willing to kill a patient by euthanasia, if requested.
The survey was done in response to the Carter case in BC that seeks to legalize euthanasia and assisted suicide in Canada, and Quebec Bill 52 that would legalize euthanasia in Quebec.
The CMA defines euthanasia as:
“knowingly and intentionally performing an act that is explicitly intended to end another person’s life” in cases of incurable illness “and the act is undertaken with empathy and compassion.”
Canada’s criminal code prohibits euthanasia and assisted suicide, making it an offence to counsel or assist someone to commit suicide, or agree to be put to death. The CMA opposes euthanasia and medically assisted suicide in a 2007 policy.
The July 2011 CMA online survey that was completed by 2,125 Canadian doctors is considered accurate within plus or minus 2.1% 19 times out of 20. The CMA survey found that:
44% would refuse a request to assist a death,
26% were unsure how they would respond to a request,
16% would assist a death,
15% refused to answer the question while
16% stated that they were asked to assist a death within the past 5 years.
A similar survey by the Canadian Society of Palliative Care Physicians (CSPCP) published in November 2010 found that of the CSPCP members who responded to the survey, the overwhelming majority–88%–were opposed to the legalization of euthanasia while 80% were opposed to the legalization of assisted suicide.
The CSPCP survey also found that 90% of responding members would not be willing to participate in the act of euthanasia while 83% of responding members would not be willing to assist a suicide.
http://www.nationalrighttolifenews.org/news/2013/08/very-few-doctors-in-canada-would-kill-a-patient-by-euthanasia/#.UgLRBtSN2Um