International Task Force
on Euthanasia and Assisted Suicide
Update
Year 2004, Volume 18, Number 1
| Assisted-suicide advocates lose
another The assisted-suicide advocacy group End of Life Choices (formerly the Hemlock Society) used the Arizona House of Representatives this year to debut its new model bill called the "Patients' Comfort and Control Act" (PCCA). Rep. Linda Lopez, who sponsored the bill, told reporters that the PCCA does not go as far as the Oregon law, which allows physician-assisted suicide. [Tucson Weekly, 1/8/04] In truth, her bill would legalize PAS just like the Oregon law. Lopez’s deceptive comment was straight from End of Life Choice’s (EOLC) strategy plan. At the Hemlock Society's 13th Biennial Conference held in San Diego in January 2003, public relation experts hired by the group unveiled the PCCA, then in draft form. The new spin was to emphasize that people themselves should be in charge of controlling their own pain and suffering—even to the point of causing death—by executing a new advance health care directive called "Advance Directive for Control of Suffering." According to Hemlock’s experts, the PCCA "will be very difficult for the federal government to block. The rights given a patient under the law are very close to those granted physicians under the double effect doctrine. Efforts to limit the rights granted by this bill would be forced to focus directly on the concept of patient control, the area in which we are strongest." [Hemlock Society, "Empowering People to Preserve the Dignity of Life: A New Roadmap," p. 1] While the PCCA’s benign language may make it appear safe and comforting, it is not. There is no requirement that deaths pursuant to this bill be reported to the state or anywhere else for oversight, nor is there any requirement for psychiatric or psychological evaluation if the patient is depressed or has other mental conditions. The risks to the elderly, the disabled, and the chronically ill still exist. To EOLC’s dismay, House Health Committee Chair Deb Gullen refused to even hear the PCCA this session, effectively killing the measure. She based her decision in part on the fact that AZ Medical Association opposed it. Theoretically, the PCCA could still be incorporated into another Senate bill this session, but that is unlikely. For the last three years, right-to-diers held high hopes for Hawaii to be the next state to legalize PAS. In 2003, the Hawaii Death with Dignity Act, modeled after Oregon’s law, died in committee. The 2002 version passed the House but was defeated in the Senate by a vote of 14-11. This year, the House Judiciary Committee voted 10-5 for the measure, but when the bill went to the House floor, the Democratic leadership withdrew it without taking a vote. They said there were not enough votes to pass it, and people were uncomfortable with the issue in an election year. [Star Bulletin, 3/10/04; AP, 3/10/04] The Vermont Nurses Association and the Vermont Coalition for Disability Rights (representing 26 Vermont groups) also took strong stands against the bill. This and the fact that the governor would likely veto the bill prompted the chairs of both the House and Senate Health & Welfare committees to refuse to hear the measure. [Rutland Herald, 12/3/03, 1/7/04] Another measure patterned after Oregon’s law, titled "Fagan’s Death with Dignity Bill" after an attorney who committed suicide last year, never got out of the starting gate. The bill, authored by Sen. Keith Goodenough, died quickly on 2/12/04, when the Senate voted 19-8 against it even being introduced. "The Wyoming Legislature is not on the cutting edge of progressive social issues," Goodenough said. [Casper Star-Tribune, 1/22/04] Oregon’s reported assisted-suicide According to the latest report, 42 Oregonians "ingested" lethal drugs prescribed by physicians and died in 2003, up from 38 in 2002 and 16 in 1998. The total number of reported deaths over the last six years is 171. [ODHS, Sixth Annual Report on Oregon’s Death with Dignity Act, 3/10/04, p.4. Hereafter cited as Report.] Forty-two (42) physicians wrote 67 lethal drug prescriptions in 2003, continuing the steady increase over the six-year period. Thirty-nine (39) of those prescription recipients took the drugs and died in 2003. Of the remaining 28 patients who opted not to take the drugs, 18 died from their illnesses, and 10 were still alive by year’s end (12/31/03). Noteworthy is the fact that, among the 42 patients who died in 2003, two had received their lethal prescriptions in 2002, and one had obtained the prescription in 2001. [Report, p. 11] The DWDA requires that, in order for a patient to qualify for assisted suicide, he/she must have a life expectancy of six months or less, confirmed by the lethally prescribing doctor and the consulting doctor. Obviously, that prognosis for at least three patients was grossly inaccurate, yet the ODHS neglected to list these three cases as not complying with the law. The only non-compliance case listed had to do with the law’s provisions regarding signature witnessing on the assisted-suicide request form, and even then the ODHS categorized it as only a "possible non-compliance." [Report, p.13] In 2003, 37 assisted-suicide patients (88%) took lethal doses of pentobarbital, 4 (10%) ingested secobarbital, and 1 (2%) used a combination of secobarbital and amobarbital (Tuinal). [Report, p.13] The DWDA allows the patient to "self-administer" the fatal drug, but expressly prohibits lethal injections. [Report, p.7]Yet, according to Dr. Kenneth Stevens, head of radiation oncology at Oregon Health & Science University and president of Physicians for Compassionate Care, "Pentobarbital is available only as an injectable liquid, the same formulation used to euthanize animals." "It is manufactured to be used as an injection, although it could be ingested by mouth or given as an IV infusion," he explained. "The state agency [ODHS] responsible for reporting on assisted suicide is neither aware that the injectable form of pentobarbital was used in 2003, nor is it aware how it was used." [Oregonian, 3/12/04] A 2/17/04 letter from the ODHS to Dr. Stevens backs up his claim: "Although we collect data on the type and amount of medication, we don’t collect this information about its form."As in previous years, the 2003 ODHS report contains the disclaimer that its data "do not include patients and physicians who may act outside of the provisions of the DWDA." [Report, p.15] In other words, the agency required by the DWDA "to collect information regarding compliance with the Act," does not fulfill that mandate. [Report, p.4; emphasis added] While assisted-suicide doctors are required to report each case to the state, the ODHS has no authority to enforce that reporting requirement, and the law does not penalize doctors who do not comply. There is no reason for a doctor to incriminate himself by reporting a case that does not comply with the law. Consequently, the ODHS reports are incomplete at best, and inaccurate at worst.The only way ODHS identifies patients is if the doctor or pharmacist reports the lethal prescription. The actual patients are never interviewed, their qualifications for assisted death are never verified by ODHS, nor are family members or others close to the patient interviewed. The state bases all its data on statements made by the lethally-prescribing physician, who is not even required to be present when the fatal drugs are taken. [Report, p.9] In 2003, lethally prescribing doctors were present for just 12 assisted-suicide deaths (29%). For the remaining 30 (67%), the doctor-provided data was based on second and third hand accounts from those who were present, if, indeed, anyone was. [Report, p.13] In one reported case, the patient drank half of the lethal prescription, and 30 seconds later regurgitated one-third of what was ingested. The patient kept down only about one-third of the lethal dose and lived for 48 hours. "Yet, patients surviving beyond six hours are unlikely to die from the short-acting barbiturate," noted Dr. Stevens. "What was the true cause of death? Where is the so-called death with dignity?" Stevens added. [Oregonian, 3/12/04] Another reason for concern is that, in 2003, only 2 patients (5%) were referred for a psychological evaluation. [Report, p.11] Independent studies have found that depression is commonly not recognized by doctors and is most often a factor in suicide.Oregon’s suicide drug of choice neither According to an Oregon pharmacist, who asked to remain anonymous, when patients commit physician-assisted suicide Oregon style, "their final act can’t be pleasant." She made this comment to a Eugene, OR, newspaper reporter shortly after filling a lethal prescription of the liquid barbiturate pentobarbital (brand name: Nembutal) for a cancer patient. "It has no syrup in it because it was meant to be injected, not taken orally," the pharmacist explained. It tastes horrible, she added, very acrid and salty. But Oregon’s permissive assisted-suicide law prohibits injections, and pentobarbital is the death-producing drug of choice because it’s quick and almost foolproof, advocates claim. Used as a sedative or for seizure control, the usual dose of Nembutal is 20 milligrams three to four times daily. Sometimes a patient will take one 100 milligram dose to aid sleep. To produce death in an assisted suicide, the patient must swallow at least 9,000 milligrams—approximately 7 fluid ounces—within one to two minutes. ["A final prescription," Register-Guard (Eugene, OR), 8/17/03] George Eighmey, head of the assisted-suicide advocacy group Compassion in Dying, blames the cost hike on supply and demand. Since newer drugs with fewer side effects have replaced barbiturates like Nembutal, less is being manufactured, resulting in higher prices per dose. ["Cost per dose of lethal drug increases," Register-Guard, 8/17/03] CID maintains network of willing PAS doctors and pharmacists Of the 42 Oregon patients who reportedly died last year from physician-assisted suicide (PAS), 33 (79%) were counseled and aided by the assisted-suicide advocacy group Compassion in Dying (CID). [Oregonian, 3/10/04] CID maintains a list of Oregon doctors and pharmacists willing to participate in the assisted-suicide deaths of patients. According to CID head George Eighmey, by 2003, the group had identified about 400 doctors in the state willing to give medical opinions or write prescriptions for lethal drug doses. The list of Oregon pharmacists willing to fill those prescriptions number around 25. [Register-Guard, 8/17/03] Since the assisted-suicide law was enacted in 1997, 171 deaths have been reported, with the highest number of lethally-prescribing doctors (42) reported in 2003. The actual number, however, is likely higher since there are no penalties for not reporting assisted suicides to the state. The existence of CID’s network of assisted-suicide physicians confirms that the law’s "safeguards" are illusory and concerns about "doctor shopping" are real. If a patient’s primary physician rightly determines that the patient does not qualify for PAS under the law (i.e., not mentally competent), those wanting the patient’s death need only contact CID for referrals to any number of willing doctors. CID Foundation president Barbara Coombs
Lee recently told supporters, "Compassion counsels people throughout the nation, but
only in Oregon is [PAS] legal…." [Lee, E-mail Message to Supporters of
Compassion, 3/11/04] Disabled man in UK fears for his life Burke’s fears are not unrealistic. Britain’s health care guidelines stress certain patients’ rights to refuse life-sustaining treatment, not their rights to continued life. On behalf of himself and other disabled patients, Burke filed a suit in Britain’s High Court challenging the General Medical Council’s (GMC) ethical guidelines that authorize a doctor to withhold or withdraw life-sustaining treatment, specifically nutrition and hydration, based on his or her assessment of the patient’s "best interests." The GMC policy mirrors earlier guidelines issued by the British Medical Association (BMA). Referring to the process of consulting those close to an incompetent patient regarding treatment decisions, the BMA holds, "The views of people close to an adult patient carry no legal weight….[I]t is essential that those consulted are absolutely clear that, ultimately, the treatment decision is not their right or their responsibility….The decision will be made by the clinician in charge of the patient’s care on the basis of what he or she considers will benefit the patient." [BMA, "Withholding and Withdrawing Life-prolonging Medical Treatment: Guidance for Decision Making," Part 3C, Sec. 18.3, 4/24/01] Another BMA policy declaration states, "The BMA does not believe that it is appropriate to prolong life at all costs, with no regard to its quality or the burdens of treatment." ["End of Life Decisions," June 2000, emphasis added] "What I am frightened of most," Burke explained, "is that there will come a time when I have lost the capacity to communicate but am aware that the hospital had decided to stop feeding me." "Once they withdraw artificial nutrition," he said, "it will take between two and three weeks for me to die. I will be lying there in great distress but unable to tell anyone that I want to live." [Independent, 2/26/04] Burke’s legal counsel argued in court that the GMC guidelines violated Burke’s "right to life" under Article 2 of the European Convention on Human Rights. The GMC countered that the guidelines have been misinterpreted and there are no grounds for the court to intervene. The judge said he would hand down his ruling "in due course." [Press Association News, 2/26/04 & 3/1/04] In 1998, David—who was born with hydrocephalus, is virtually blind, and has spastic quadriplegia and severe learning disabilities—had a respiratory infection that likely required the temporary use of a ventilator and/or possible resuscitation. Instead, doctors placed a "Do Not Resuscitate" (DNR) order in the boy’s medical records against his mother’s order to the contrary. They also decided to limit David’s "treatment" to the drug diamorphine which could further depress David’s respiration. Again, the doctors dismissed the mother’s pleas to stop giving her son the drug. When David’s condition deteriorated further, she told the doctors that she wanted to take David home. The doctors alerted the police, and she was warned that she would be arrested if she tried. When other family members demanded that the drug be stopped, doctors said they would, but only if the family agreed to the DNR order. A fight broke out, and three of the relatives were arrested and later jailed. But, during the commotion, David’s mother revived him, and then brought the boy home. He’s now 17 years-old. When Ms. Glass filed a complaint with the GMC—whose website states, "Our job is to protect patients"—the group ruled that the doctors had not acted inappropriately and that their treatment choice was justified. She took her case to Britain’s High Court, but Justice Scott Baker concluded that the court should not intervene because the crisis was over and David was no longer a patient in that hospital. The Court of Appeal concurred. Determined to continue her fight for justice, Ms. Glass brought the case to The
European Court of Human Rights. The seven-judge court found that the hospital and its
doctors breached David’s right to respect for his private life and his right to
physical integrity under article 8 of the European Convention on Human Rights. [BBC,
3/9/04, 4/22/99; Guardian, 3/10/04; British Medical Journal, 3/20/04] Pope speaks out on PVS and food & fluids On March 20, Pope John Paul II addressed experts from around the world attending the International Congress on Life-Sustaining Treatments and Vegetative State. His points were clear. The word "vegetative" is demeaning, the pontiff said, and he had "the duty to reaffirm strongly that the intrinsic value and personal dignity of every human being do not change….A man, even if seriously ill or disabled in the exercise of his highest functions, is and always will be a man, and he will never become a ‘vegetable’ or an ‘animal.’" "The sick person in a vegetative state, awaiting recovery or a natural end, still has the right to basic health care (nutrition, hydration, cleanliness, warmth, etc)," the pope explained. "I should like particularly to underline how the administration of water and food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act." "Death by starvation or dehydration is the only possible outcome as a result of their withdrawal," the pope emphasized. If it is "done knowingly and willingly," it is truly "euthanasia by omission." [Pope’s Address, official English trans., 3/20/04] Editor’s note: There will be more on the pope’s address in the next Update.
Euthanasia bill studied in House of Lords The latest version of the British "Assisted Dying for the Terminally Ill Bill" was submitted to the House of Lords by Lord Joel Joffe on 1/15/04. On 3/11/04, the bill passed its first hurdle and was sent to a select committee for detailed study. The process could take up to two years. The new bill seemingly limits "assisted dying" to only terminally-ill patients who can self-administer the lethal drugs. However, if the patient is not able to do so, the bill allows doctors to give a lethal injection. According to Junior Health Minister Lord Warner, the Lords have no plans to change current laws banning euthanasia. [BBC, 3/10/04; Guardian, 3/11/04] Meanwhile, the Liberal Democrats have voted overwhelmingly to include euthanasia legalization as part of their official policy. They also embraced a plan to lower the legal age for teens to view pornography in sex
shops from 18 to 16. Reportedly, public cries of outrage and condemnation resulted. [Telegraph,
3/21/04] Euthanasia advocate found guilty in NZ It wasn’t until three years later—when Martin wrote her book To Die Like a Dog, describing how she tried to "help" her mother die by injecting her with 60mg of morphine—that authorities had enough evidence to charge her. Martin denied the charge, but prosecutor Andrew Cameron told the court that she
couldn’t say she didn’t intend to kill her mother while also campaigning
vigorously to legalize euthanasia. Martin’s sister, Louise Britton, said she just
wanted Martin to stop "using" their mother to promote euthanasia. Martin’s
sentencing is scheduled for April 30. [AAP, 3/31/04; NZ Herald, 3/31/04; CNSNews, 4/1/04; Dominion
Post, 4/2/04] Swiss medical advisory group reverses assisted-suicide policy The Swiss Academy of Medical Sciences (SAMS) announced on 2/5/04 that doctors can participate in the suicides of terminally-ill patients as long as they follow "strict" directives. This is a significant departure from the academy’s prior position of being firmly opposed to all forms of induced death practices. "We still state that assisted suicide is not part of normal medical practice, but we add that there are situations where assisted suicide can be comprehensible," explained Werner Stauffacher, SAMS president. "So it’s no longer a complete ‘no.’" The advisory group—consisting of doctors, care givers, and legal workers—said that Swiss authorities should respect doctors’ decisions to prescribe intentionally lethal drugs to terminally-ill patients (physician-assisted suicide). The group, however, indicated that it still opposes the practice of doctors directly administering the fatal drugs to patients (euthanasia), which is currently illegal in Switzerland. Using the same rationalization employed by the Dutch, SAMS’ announcement emphasized that doctors should follow strict guidelines before assisting a patient’s suicide. Among those are:
SAMS’ recommendations will be reviewed by Swiss doctors. A set of new guidelines are expected by the end of this year. "We want to avoid doctors, who are close to their patients, having to send them to
organizations offering assisted suicide, which we consider [to] go against medical
values," Stauffacher said. Switzerland already has the highest assisted-suicide rate
in Europe. [SwissInfo, 2/5/04; UPI, 2/5/04] Swiss prosecutor moves to outlaw "suicide tourism" Zurich’s public prosecutor, Andreas Brunner, is drafting legislation to prohibit assisted-suicide groups from providing their services to foreigners. Dignitas accepts a wide variety of suicidal people: those terminally ill, chronically ill, and those with mental afflictions like Alzheimer’s disease and depression. Minelli says that he believes suicide is a basic human right. Recently, a case involving a suicide assister pouring a lethal drink down a chronically-ill man’s throat was made public. Prosecutor Brunner commented that this case greatly stretched existing laws. "Can we—in this case—still say the person who wanted to attempt suicide carried it out himself?" "How can you be absolutely sure that the person wanted to die at that time," added Brunner. "People are only here for one day before they die. We know nothing about them and we can’t say they had a long-term desire to end their lives." Brunner decided to draft the new legislation after the Swiss Justice Ministry refused
to deal with the issue until 2007. While being described in the media as a "vocal
opponent of assisted suicide," Brunner said that, if it has to occur, there should be
strict oversight, and it should be limited to only Swiss residents. Provisions
in the proposed measure include: Brunner’s measure would apply only to the Zurich area. Minelli has threatened to
challenge it in Federal Court. [SwissInfo, 2/27/04; Scotland on Sunday, 2/29/04; Daily
Post, 1/20/04] Belgium’s first year of legalized euthanasia practice reveals alarming facts and even more disturbing recommendations. While the "official" report on euthanasia implementation is expected sometime in 2004, the Federal Ministry for Public Health released some data last November. Among that data: there were 203 recorded euthanasia deaths in the first year of legalization (9/23/02-9/23/03). [Belgian Expatica.com, 11/25/03] Meanwhile, Belgium’s Federal Health Ministry is looking into how
the Netherlands informs patients and doctors about euthanasia practices. Other remedies
include streamlining the compliance regulations and making the reporting forms simpler.
[Belgian Expatica.com, 11/25/03] Council of Europe defers euthanasia debate After postponing scheduled debates on euthanasia three times in the last six months, the Parliamentary Assembly of the Council of Europe (COE) placed the euthanasia issue on the provisional agenda for its Paris meeting on April 26-30, 2004. The COE, which consists of 313 officials from 45 member states, has put off the debate because of strong ethical and cultural differences among its member countries regarding euthanasia and its possible legalization. Latin and Eastern European countries have voiced more concerns and opposition to the practice than Northern European nations. A proposal by Swiss parliamentarian Dick Marty to give euthanizing doctors legal immunity has been rejected twice by the COE’s Parliamentary Assembly. [www.coe.int; SwissInfo, 2/5/04] Latest on the Terri Schiavo Case Once again, Florida Circuit Judge George Greer has ruled against the parents of Terri Schiavo, the cognitively disabled woman whose estranged husband, Michael, wants dead. Her parents, Bob and Mary Schindler, filed a contempt motion against Michael for not complying with an earlier ruling ordering him to inform the Schindlers about any significant change in Terri’s medical condition. In a sworn affidavit, Mary Schindler, recounted that medical staff feared retaliation and job loss if they gave the Schindlers information on Terri’s condition against Michael’s standing orders. In his 3/29/04 ruling, Judge Greer denied the contempt motion and said Mary Schindler’s affidavit testimony was based on hearsay and not admissible. (See www.terrisfight.org for Greer’s ruling.) On the same day, Michael’s lawyer issued a press release alleging that five hypodermic needle puncture wounds were discovered on Terri’s arms after her parents visited her for 45 minutes. The statement went on to say, "A forensics team has examined the crime scene, the Clearwater Police are investigating." [Felos, Press Release, 3/29/04] The Schindlers denied the allegation, saying that when they left Terri’s room she was fine. After toxicology tests proved negative, police said there was no indication of any crime. [Tampa Tribune, 3/31/04] Back | Home | Contact | Search | Site Map International Task Force on Euthanasia and Assisted Suicide Copyright © 1996 - 2004, International Task Force. All Rights Reserved. |