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December 2015

New palliative guidelines a great step in positive direction

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Lecretia Seales’ husband backs palliative care guidance but says more needed
Stuff co.nz 23 December 2015
The husband of Lecretia Seales says new palliative care guidelines are a positive step but will not do enough to help some dying patients like his late wife.
The guidance Te Ara Whakapiri: Principles and guidance for the last days of life released by the Government on Monday outlines how health professionals should care for patients at the end of their lives.
Health Minister Jonathan Coleman said it was important that Kiwis could access “quality, personalised and compassionate palliative care”, with around 17,000 adults and their families using the services in 2015.
Coleman said the new guidance placed a greater focus on developing individual care plans, as well as “clear and respectful” communication.
“This guidance has been designed to help ensure consistent and quality care is provided for New Zealanders, whether they are in a hospice, aged residential care, hospital or their own home.”
The guidance was developed after public consultation and had been endorsed by the key organisations involved with palliative care, including the Australia and New Zealand Society of Palliative Medicine, Palliative Care Nurses New Zealand and Hospice New Zealand.
http://www.stuff.co.nz/dominion-post/news/politics/75407054/Lecretia-Seales-husband-backs-palliative-care-guidance-but-says-more-needed

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Killing Isn’t Caring

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Focus on the Family December 2015
For the past 36 years, I have lived and practiced in the state of Oregon. For half that time, there was never any doubt about my role as a physician: It was to strive to cure. Failing cure, I would strive to always comfort and care—never kill.
At my medical school graduation, I recited the Hippocratic Oath, which includes the clear statement to avoid doing harm—”I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect.”
Since Oregon voters rejected this foundational principle with the passage of assisted suicide 20 years ago, there has been a profound shift in the public’s attitude toward medical care—a corruption of the Hippocratic tradition, new fear and secrecy and a fixation on death as the solution to suffering. By the end of this calendar year, almost a thousand Oregonians will have taken their own lives by ingesting massive overdoses of prescription drugs. While only some doctors participate directly, all Oregon physicians are now licensed to help patients kill themselves.

False Claims and Secrecy

Promoters of assisted suicide prefer euphemisms—”death with dignity” or “choice in dying”—and point to Oregon as a model for spreading assisted suicide to other states. They claim Oregon’s safeguards work and there have been no problems. This is not true. Their use of euphemisms and repetition of false claims cannot hide the reality.
In truth, there is a shroud of secrecy enveloping the practice. Doctors do not accurately report the actual manner of death on the death certificate. Instead, they are required by state law to fabricate the cause of death stating that the cause is “natural” rather than suicide.
In fact, in late 1997, just before assisted suicide was about to be implemented, the legislature introduced a system using two different death certificates (one that is public with no medical information and a separate one that is never made public). Thus, it’s impossible for anyone outside of the Oregon Health Division (OHD) to track the statistics.
What little tracking is done is only by second- (or even third-) hand reporting by doctors who are rarely actually present when the overdose is taken. There is never any review or verification of the details provided. Even this questionable identifying data is deliberately destroyed by the OHD after a tally is made. Where else in the medical profession are records deliberately destroyed?
Also concerning are the regular notices I receive from the state Medicaid program saying it won’t cover many important services and drugs for my patients—even some pain medications—but it will pay for physician-assisted suicide. Supporters claim this gives patients choice. What sort of a choice is it when life is expensive but death is free?
I have seen firsthand how the law has changed the relationship between doctors and patients, some of whom now fear that they are being steered toward assisted suicide.
In one such case, a patient with bladder cancer contacted me. She was concerned that her oncologist might be one of the “death doctors,” and questioned his motives. Her concern grew after she obtained a second opinion from another oncologist who was more positive about her prognosis and treatment options. Whichever of the two was correct, such fears were never an issue before assisted suicide passed.
In another case, a colleague who enthusiastically adopted the practice gave advice to a cancer patient over the telephone. Without ever examining her or referring her to a pain management specialist, he concluded she was a good candidate for ending her own life. He then “helped” her contact an organization promoting assisted suicide. Within a few months, she was dead of an overdose.

The Message Behind the Words

Since doctor-assisted suicide has become an option, I have had scores of patients discuss it with me in my practice. Most of them didn’t have a terminal diagnosis.
One of the first people to ask me about it was a patient with a progressive form of multiple sclerosis (MS). He was in a wheelchair yet lived a very active life. In fact, he was a general contractor and quite productive. I asked how MS had impacted his life. He acknowledged that it was a major challenge, and then said if it got much worse, he might want to “just end it.”
“It sounds like you are telling me this because you might ultimately want assistance with your own suicide if things got worse,” I said. He nodded, and seemed relieved that I understood what he was saying.
I told him that I could readily understand his fear and his frustration—even his belief that physician-assisted suicide might be a good option. At the same time, I told him that should he become sicker or weaker, I would work to give him the best care and support available. I told him no matter how debilitated he might become, that—at least to me—his life was, and would always be, inherently valuable. As such, I would not recommend, nor could I participate, in his suicide. He simply said, “Thank you.”
The truth is that we are not islands. How a physician responds to a patient’s request has a profound effect not only on that patient’s choices, but also on his view of himself and his inherent worth.
When a patient says, “I want to die,” it may simply mean, “I feel useless.” When a patient says, “I don’t want to be a burden,” it may really be a question: “Am I a burden?” When a patient says, “I’ve lived a long life already,” he may really be saying, “I’m tired. I’m afraid I can’t keep going.”
And when a patient says, “I might as well be dead,” she may really be saying, “No one cares about me.”
How one responds is critical. Such patients deserve our support and love, not a doctor acting as a veritable vending machine.

Irrational Conclusions

Under Oregon’s law, a patient can request lethal drugs only if he has a terminal illness and less than six months to live. However, doctors are unable to predict the course of an illness six months out, and many patients given such prognoses live full, rewarding lives long past six months.
The law requires that patients be referred for psychological examination if the doctor suspects they have depression or mental illness. Yet last year, only three of the 105 patients who took their lives with a doctor’s help were referred for psychological exams.
A study published in the British Medical Journal in 2008 examined 58 Oregonians who sought information on assisted suicide. Of them, 26 percent met the criteria for depressive disorder, and 22 percent for anxiety disorder. Three of the depressed individuals received and ingested the lethal drugs, dying within two months of being interviewed. The study’s authors concluded that Oregon’s law “may not adequately protect all mentally ill patients.”
Indeed. How could doctors not recognize such individuals as depressed? After all, the prevalence of depression in the general population is at least double this rate, according to the National Institute for Mental Health. Given the reality that a life is literally on the line, shouldn’t doctors be even more vigilant to avoid assisted suicide in patients with a highly treatable condition?
In reality, some doctors have little formal training or practice in recognizing psychiatric needs. Sadly, some doctors (even some psychiatrists) see suicidal depression as “rational.”
They believe actively ending a patient’s life live is not only acceptable under some circumstances, but good. They have come to believe the solution to some suffering is ending the life of the sufferer.
In fact, former Tufts University Dean Dr. Louis Lasagna has created a “Modern Version” of the Hippocratic Oath, which states: “If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty.”
Astonishingly, the next line of this modern version is “Above all, I must not play at God.”
Can you believe it? A doctor embraces the power and “awesome responsibility” to decide to “take a life” and yet also maintains the position that he or she won’t “play at God.”
Sadly, all doctors in Oregon have been empowered by the state to end the lives of their patients. After receiving the label of “terminal,” all a patient needs to do is ask. Then the doctor can decide if his life is worth living.

Unexpected Joy

For me, all of these issues surrounding end-of-life care have become very personal. Last year my wife, Marlene, died of cancer. We had been married for 40 years. The final five years, we both knew she would inevitably die. At one point, doctors told her she would only live for three to nine months—yet she lived almost four times that long.
While I treasure all our years together, the last five were among the best. There was great suffering, but also great joy in the many special moments that we and our seven children shared together—moments that became all the more treasured the closer we came to the end of her life. I wouldn’t trade a nanosecond of them. She died peacefully and naturally at home, surrounded by family and friends. She didn’t take an overdose, yet her death and life had great dignity.
While assisted suicide was legalized in 1994, it will always be unethical—because any doctor who assists in a suicide has an inherent conflict of interest. Knowing this, I carefully chose a palliative care specialist for Marlene—he or she had to be a doctor who respected the value of my wife’s life in all of it stages, regardless of prognosis and her progressive weakness and debility.
While most states have appropriately rejected assisted suicide thus far, special-interest groups will try to expand it soon. Today four states—California, Oregon, Vermont and Washington—have passed assisted-suicide legislation either by ballot or legislative action. Since a single judge in Montana ruled that the state constitution doesn’t prohibit assisted suicide, some doctors have begun to prescribe lethal doses to some patients there, too. In 2015, promoters of assisted suicide have begun efforts to enact legislation in more than two dozen states.
While there is growing resistance movement that includes disability-rights activists, palliative care specialists, oncologists and many major medical organizations, more is needed if we are to avoid becoming a culture of death. Everyone who recognizes the inherent value of all human life must continue to actively pray and actively oppose any and all efforts to legalize the situational killing of patients by doctors.
Doctors should care—not kill.
http://www.focusonthefamily.com/socialissues/citizen-magazine/killing-isnt-caring?utm_source=nl_thrivingvalues&utm_medium=email&utm_campaign=301005&refcd=301005&crmlink=content-on

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Belgium experts ask for end to euthanasia based on mental health problems

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Flanders Today 10 December 2015
Euthanasia should no longer be carried out on the basis of psychological suffering alone, according to 65 Belgian psychiatrists, psychologists and professors in an op-ed published by De Morgen this week.
On average, 2,000 people a year in Belgium choose to end their lives through euthanasia. Most are terminally ill, but about 3% of them request the procedure because of unbearable psychological suffering. In the past two years, there were about 100 such cases.
The experts said they were “alarmed by the trivialisation” of the option. It cannot be objectively determined whether psychological suffering is incurable, they wrote, and pointed out that feelings of despair are typical of depression.

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Wim Distelmans, palliative health-care professor at the Free University of Brussels (VUB) and president of the Federal Euthanasia Commission, emphasised that the option is only available to those who have chronic and serious mental health problems. “It is only for those who have tried different medications, therapies and therapists for many years,” he said, adding that some patients, knowing they can turn to euthanasia if necessary, have found the strength to carry on.
Distelmans has received support from political parties Open-Vld and SP.A. Open-Vld president Gwendolyn Rutten told Radio 1 that the measure is not available to just anyone who suffers from depression.
http://www.flanderstoday.eu/innovation/experts-ask-end-euthanasia-based-mental-health-problems
Euthanasia-Free NZ 8 December 2015
Open letter
Remove euthanasia on the ground of purely psychological suffering from the law
Death as therapy? 
We, representatives of various relevant occupational groups, are alarmed about the increasing trivializing of euthanasia on the ground of psychological suffering only.
For the first time since the law was put into effect in 2002, a decision to allow euthanasia – the case of De Moor / Van Hoey – has been challenged by the evaluation committee and forwarded to the judiciary. The Australian broadcaster SBS made a documentary about this euthanasia case and the conversations between the patient and the doctor. The Economist also published a poignant video report (24 and Ready to Die) on a 24-year-old young lady from Bruges who was granted euthanasia on grounds of psychological suffering, but ultimately declined its execution.
In our open letter in the Artsenkrant “Doctors’ Newspaper” (September 2015) we noted the legal uncertainty of a doctor approving euthanasia based solely on psychological suffering. In this opinion piece we want to draw attention to its specific problematic character, and in particular the fact that it’s impossible to objectify the hopelessness of psychological suffering.
One would expect that this incurability is founded on indications of for example, organic injury or tissue damage – in other words, factors that are independent of what is subjectively felt and thought about the illness. Such objectification is problematic in relation to psychological suffering.
Let’s be clear: psychological suffering is real and can be at least as severe as physical suffering. However, specific to mental suffering is the fact that you can rely only on the word of the sufferer to estimate it. And this is a good thing, because he or she is the only one who knows how much it hurts at that moment. At that moment… because when we suffer psychologically, we are often convinced that no other future is possible anymore. It is often precisely this thought that pushes a person into an abyss, because as long as there is perspective, a person can usually tolerate much.
We see that some who are at first declared incurably ill, eventually abandon the notion of euthanasia because new perspectives appeared. In a paradoxical way, this proves that the illness cannot be called incurable.
http://www.euthanasiadebate.org.nz/belgium-experts-call-for-a-removal-of-euthanasia-on-the-grounds-of-psychological-suffering/
Thanks to Renee Joubert from Euthanasia-Free NZ for translating the document     facebook_icon twitter follow us

Group encouraging doctors to sign letter against assisted suicide

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NZ Herald 9 December 2015
A group opposed to euthanasia is encouraging more doctors to sign a new open letter objecting to assisted suicide.
But the MP backing a bid to legalise euthanasia says his bill is solid, and claimed the loud objections of some doctors were hypocritical and detached from public opinion.
The Care Alliance, which opposes euthanasia, said one its trustees, Dr Sinead Donelly, launched the online letter to send a message to lawmakers.
The letter claimed to have attracted the support of 40 doctors by mid-afternoon.
“We believe that crossing the line to intentionally assist a person to die would fundamentally weaken the doctor-patient relationship, which is based on trust and respect,” the letter stated.
“We are especially concerned with protecting vulnerable people who can feel they have become a burden to others, and we are committed to supporting those who find their own life situations a heavy burden.”
The letter invoked the position statements of the World Medical Association and New Zealand Medical Association (NZMA).
NZMA chairman Stephen Child said the association was not aware of the letter being published. However, the NZMA’s position statement on euthanasia was recently reviewed and was consistent with the tenor of the open letter.
In its position statement, the NZMA opposed euthanasia but supported the concept of “death with dignity and comfort”.
“Euthanasia, that is the act of deliberately ending the life of a patient, even at the patient’s request or at the request of close relatives, is unethical.”
Yet the NZMA supported the right of patients to decline treatment, or request pain relief. It also supported the right of access to appropriate palliative care.

Doctors want no part in assisted suicide    

We endorse the views of the World Medical Association and the New Zealand Medical Association that physician assisted suicide and euthanasia are unethical, even if they were made legal. 
We are committed to the concept of death with dignity and comfort, including the provision of effective pain relief and excellence in palliative care.
We uphold the right of patients to decline treatment, as set out in the NZ Code of Health and Disability Services Consumers’ Rights.
We know that the proper provision of pain relief, even if it may unintentionally  hasten the death of the patient, is ethical and legal.  Equally the withdrawal or withholding of futile treatment in favour of palliative care is ethical and legal.
We believe that crossing the line to intentionally assist a person to die would fundamentally weaken the doctor-patient relationship which is based on trust and respect.
We are especially concerned with protecting vulnerable people who can feel they have become a burden to others, and we are committed to supporting those who find their own life situations a heavy burden.
Doctors are not necessary in the regulation or practice of assisted suicide.  They are included only to provide a cloak of medical legitimacy.  Leave doctors to focus on saving lives and providing real care to the dying.
TO SIGN THIS LETTTER, GO TO http://doctorssayno.nz/ 
http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=11558573

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End of life Choices Bill Or Please Don’t Kill Anyone

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Commentary – John Fox
To begin with I should say two things; first, this is not abstract for me. I live with a mild form of cerebral palsy and various associated problems including spastic hemiplegia. I know from first-hand experience how hard it is to be physically vulnerable, to lose control of one’s own body, how hard it can be to depend on other people. From this angle I have every human sympathy with Lecretia Seales and others like her who show to us how real, ugly and frightening death can be. Like everyone with a functional pulse I recognise how hard and difficult this issue is. Advancing medical technology means the debate about ‘the good death’ will not go away.
But secondly, I also know some other things from the same experience. I’d like to share with you why I believe the so-called “choice in dying” bill should not proceed, in fact I want to put it in the waste-paper basket. I say this because for me, this issue is not abstract. When talking about the deaths of people who are sick, terminally ill and disabled, I am not able to forget that we are discussing my life and my death.
One of my first memories is hospital, and especially the crippling sense of vulnerability of a sick four-year-old. I was having corrective surgery and it came time to remove the casts around my feet. My parents tried to distract me while the doctor advanced on me with a blade to cut the cast. I still remember the sense of utter helplessness I felt. The only thing that made feeling this vulnerable okay was my belief that the doctor was here to help me. That I could trust the nurse and the medical professionals. I’ve been in many hospitals since. Every time I lie flat for an x-ray or have my scar tissue mobilised I trust the doctors, their good intentions, their competence, their care. The euthanasia bill strikes at the root of the doctor-patient relationship by making doctors an instrument to kill, not cure. For every articulate (but I think misguided) patient like Lecretia Seales, there are many more who are vulnerable, persuadable or unsure. To use the trust and professional skills special to doctors to enable patients to be killed, even at their own request, is a betrayal of the doctor-patient relationship and the Hippocratic oath: first, do no harm.
I understand, I think, what it is like to feel useless and tortured by your own life. I walk into the pharmacy and the pharmacist says “hello John, is it the usual?”. The ‘usual’ includes fairly high-strength pain meds, drugs to put me to sleep, drugs to wake me up again, and drugs to make life tolerable while I’m awake. There are days when my feet refuse to work, when I fall and have to get scraped off the footpath, when I lie awake, staring at the ceiling wondering what use my life is. But that is not all I have. As my friends and family remind me regularly, even if I am no use to the economy and even little use to myself, I am valuable to them simply by existing.
If a healthy and able bodied 32 year-old went to the doctor tomorrow and asked to die, there would be severe concern. The doctor would ask questions about the context of his life, his relational support, what it is that makes his life no longer worth living. The doctor’s first concern would be to get him to see the bigger picture, the interconnectedness and belonging we share as human beings and members of the human family. Give that 32 year-old a terminal illness or like me, an incurable disability, and in some jurisdictions death becomes thinkable, even allegedly the best option. I don’t know what to call that, other than fear of disability. As modern western people we pride ourselves on our autonomy, our power, our capacity. It is one of our deepest and most unspoken fears – the fear of disability, disfigurement, loss of control and death. It is for this reason that for instance the large majority of down-syndrome children never arrive. It is for this reason that we shy away from the mentally ill, the elderly, and the sick hoping that if we crowd them away, we will not become like them. If we pride ourselves on being an inclusive society, a fair society and a society of solidarity we must change and confront this fear. It is at the moment of death we can measure the practical charity of our society. In our country palliative care is patchy. It took me six months to access pain services in our largest city – thank God I don’t live in the Northern Territory. There are also multiple reports of the abuse and neglect of the elderly in rest homes. I argue that we must uphold solidarity with disabled people. We must insist on our connectedness as well as our autonomy. We must remind even those tempted to forget that quote “each of us is willed, each of us is loved, each of us is necessary”. We have rightly abandoned the asylum mentality of the 1970s. Let us make another step and declare, as our law already does, we are all in this together. The euthanasia bill creates a category of people who are killable. That is wrong.
I know slippery slope arguments get bad press coming somewhere around that old chestnut “will somebody think of the children?”. In this case, I think a slippery slope argument can be justified, but rather, I chose a different one. Once you have created the category, whether it is terminally ill people, incurable, or simply people who wish to die, the category will inevitably creep. Unless parliament were to pass a law setting out the medical details of everyone who wishes to die and naming them one by one, the category is bound to be and become broader than intended. The DPB was once an emergency benefit for battered wives. The abortion law was intended for the rare hard case. And welfare was created as a supplement to work. What we see in all three examples is the phenomenon I talk about; not so much slippery slope, but category creep. The law becomes broader than intended, then easily expandable, then a rule, in spite of safe-guards. The only way to stop category creep is not to create the category in the first place.
I know from experience, both mine and other peoples’, what disability looks like. I have also seen death, and the process leading up to it. They expose the deepest questions of the human soul and make concrete the challenge we too often ignore: the challenge to care. It is this challenge I wish to leave you with. Whether it is the elderly, the disabled, the young or the unborn, New Zealand faces a choice. We can rise to our best selves: fair, decent, brave and compassionate, or push the red button and sweep up the mess. For me and the many disabled people who think as I do (although not all) we hope that we will be wise enough, kind enough and gutsy enough to choose the first option. Maintain our dignity. Put the bill in the bin.
Reprinted with Permission of Author

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Woman, 50, granted right to die after complaining she's 'lost her sparkle'

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ITV News 2 December 2015
A judge has granted a 50-year-old woman who fears being “poor, ugly or old” the right to die after she complained she had “lost her sparkle”.
The woman, known only as C, destroyed her kidneys after trying to kill herself by taking an overdose when she found out she had breast cancer.
As a result she needs dialysis but refuses to undergo further treatment even though there is a high chance she will live.

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One of her daughters told the Court of Protection the most important thing to her mother, who was described as “impulsive” and “self-centred”, was her “sparkly lifestyle”.
A judge was asked by King’s College Hospital NHS Trust to decide if C had the mental capacity to refuse treatment.
And in a controversial decision, which Mr Justice MacDonald said many people may be “horrified” by, he ruled in her favour.
http://www.itv.com/news/2015-12-02/woman-50-granted-right-to-die-after-complaining-shes-lost-her-sparkle/

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The insane message legalizing ‘death with dignity’ sends to the suicidal

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LifeSiteNews 16 November 2015
I’d like the defenders of euthanasia and so-called “death with dignity” to explain something to me. How is the legalization and relentless promotion of “assisted suicide” not the “glorification of suicide”?
I’m tired of all of transparently mindless babble about how “assisted suicide” is not a slippery slope. The phrase itself screams with denial: “Wanna kill yourself? Here, let us help you with that.” When helping people kill themselves is referred to as “end-of-life care” rather than “accomplice to murder,” who will be picking up the phone at the other end of the suicide prevention hot line?
Here’s the thing. I know many people who struggle with depression. I would wager that everyone does. If we’re honest, we can admit that many people who struggle with mental illness would, in a particularly black moment, consider suicide if it was easily available and relatively painless. That is the reason the number one cause of death by gun in Canada is suicide—because many people who would not have ordinarily taken their own lives do so in a fit of palpable darkness.
The idea that our government, our health care system, our society, would send such mixed signals to those contemplating suicide is criminally negligent and outright disgusting. Suicide is never the answer, campaigners used to say. Now, I suppose, they’ll have to qualify. Suicide is never the answer—except sometimes. It’s complicated!
That’s already happening.

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Consider Laura, a healthy 24-year-old from Belgium. Doctors recently approved her request for euthanasia, because she had “suicidal thoughts.” The solution to suicidal thoughts is now suicide, apparently. One of Laura’s friends, who was also suicidal, had died by euthanasia some time previously.
The story hasn’t caused much of a stir, though. Five people a day die by euthanasia in Belgium, and reports have emerged that many elderly people are increasingly being killed without their consent, like aging house pets being put to sleep. For some reason, we’ve managed to abolish the death penalty for rapists and serial killers but approved the needle for the old, the sick, and the depressed.
And then there is the Netherlands, where a report noted that a minimum of 50% of those killed by euthanasia were suffering from depression at the time. The Dutch researchers didn’t find this a big deal, stating that there was no reason to believe that the death requests by these people were not thought through properly, as if requesting death was not in and of itself a sign of warped thought processes.
This is not some conspiracy theory, either. In 2013 the Dutch Health Minister Edith Schippers admitted that there had been at least 45 “psychiatric euthanasia deaths” in that year alone.
The impact of families can be tragic, as Tom Mortier can attest. He filed a lawsuit with the European Court of Human Rights to challenge Belgium’s euthanasia laws after doctors killed his mother because of “untreatable depression”—and nothing else. The heart-broken Mortier, who wasn’t even contacted by anyone, said his mother was depressed because of a recent break-up—and the doctors who killed her didn’t even have any psychiatric qualifications.
https://www.lifesitenews.com/blogs/how-is-assisted-suicide-anything-other-than-the-glorification-of-suicide

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