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Update 2009-2
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Undercover sting operation exposes the
assisted-suicide group Final Exit Network
On February 25, 2009, the
organization Final Exit Network (FEN) made headlines across
the country. But, it was not good news for the group. Four
of its key members had been arrested as a result of an
undercover sting operation conducted by the Georgia Bureau
of Investigation (GBI). Mainstream media called the
organization a "suicide ring" and law enforcement's
investigation in nine states a "raid" and a "bust"-much to
the dismay of FEN faithful, who view themselves as
compassionate, volunteer "exit guides" out to help their
fellow members with "intolerable medical conditions" commit
suicide. [FEN Press Release, 2/26/09]
According to the GBI, former FEN president Ted Goodwin, 63,
and Georgia resident Claire Blehr, 76, both exit guides,
assisted the June 2008 suicide of John Celmer, 58, a throat
and oral cancer patient who had undergone two recent
reconstructive surgeries and was, at the time of his death,
cancer-free. Goodwin and Blehr, along with Maryland
residents Dr. Lawrence Egbert, 81, and Nicolas Sheridan, 60,
were arrested in connection with Celmer's death and charged
with assisted suicide (a felony in Georgia), tampering with
evidence, and racketeering in violation of the Georgia RICO
Act. [GBI Press Release, 2/25/09] Dr. Egbert, FEN's medical
director, had approved Celmer's suicide request, as he had
all the estimated 130-plus FEN suicide deaths over the past
four years since the group was formed. [Atlanta
Journal-Constitution, 3/8/09]
Another FEN death under investigation is the April 2007
suicide of Jana Van Voorhis, 58, a Phoenix, Arizona, woman
with a long history of mental illness and imagined physical
ailments. Dr. Egbert and FEN's medical evaluation committee
declared her eligible for their death service after only
speaking with her by phone. [Phoenix New Times, 8/23/07;
2/25/09]
The suicide process
The GBI's investigation
revealed the process FEN uses for suicides. After paying a
$50 FEN membership fee and applying for suicide assistance,
the member is visited by an exit guide, who instructs the
member to buy two helium canisters and a clear plastic "Exit
Bag" customized with tubing to connect to the helium tanks.
On the day of the scheduled suicide, the member is visited
by both the exit guide and a senior exit guide who explains
the details involved in bringing about the member's death.
After the member is dead, the exit guides remove all
evidence from the scene and make it look as though the
member died naturally. [GBI Press Release, 2/25/09; AP,
3/2/09] "It's grotesque," said ITF Executive Director Rita
Marker. "There's no dignity in getting a plastic bag over
your head." [LA Times, 2/27/09]
Key in the case against the 3,000-member FEN will be
testimony by the GBI undercover agent who infiltrated the
organization by claiming to have pancreatic cancer (a claim,
the GBI said, FEN accepted without requesting confirmation).
[Atlanta Journal-Constitution, 2/25/09] When senior
exit guide Ted Goodwin demonstrated what would happen after
the agent put the plastic bag over his head, "[Goodwin] got
on top of him and held his hands down," explained GBI
spokesperson John Bankhead. "[He] firmly held his hands down
so he couldn't move." This action, Bankhead said, would have
prevented the agent from removing the bag during an actual
suicide if he had changed his mind. In the Celmer case, for
which Goodwin and Blehr have been charged, both exit guides
admitted they held Celmer's hands down. [NBC News 11,
2/27/09; NY Times, 3/11/09]
FEN's new president, Jerry Dincin, denied the allegation
that exit guides restrain the hands of soon-to-be dead
members. While he admits that holding hands is a part of the
assisted-suicide process, he said exit guides do it "in the
way that you would a frightened child, to calm them." But
FEN's own "First Responder Information" form reportedly
outlines why exit guides might want to firmly hold a
member's hands down: once the process starts, if the flow of
helium is interrupted, severe brain damage could result-and
they would have a botched suicide on their hands. [Sunday
Paper (Atlanta), 3/29/09]
Compassions & Choices tries to distance itself from FEN
In an article written shortly
after the FEN arrests, Barbara Coombs Lee, head of the
assisted-suicide advocacy group Compassion & Choices (C&C),
went to great lengths to distance her group from FEN.
"Compassion & Choices has no affiliation with FEN," she
wrote. [Huffington Post, 2/27/09]
But both groups have a lot in common. Both are Hemlock
Society spin-off groups; both offer "aid-in-dying" or
"self-deliverance" services (euphemisms for assisted
suicide) to those who live where assisted suicide is not
legal; both are members of the World Federation of Right to
Die Societies; and, despite C&C's claims to the contrary,
both have the same goal: death on demand for anyone claiming
to be suffering. [Stanton J. Price, "Different
assisted-suicide groups, one goal," LA Times, 3/27/09
Montana & Washington providers say no to PAS
In an attempt to pick up where
Montana District Court Judge Dorothy McCarter left off in
her broad ruling legalizing physician-assisted suicide
(PAS), newly elected Representative Dick Barrett
(D-Missoula) has drafted a bill-entitled the Montana Death
with Dignity Act (LC 1818)-intended to establish rules and
regulations for the newly legalized practice. The draft
bill, not yet officially introduced, is patterned after
Oregon's 10-year-old assisted-suicide law, the original
Death with Dignity Act (DWDA).
The Montana draft bill, however, differs from Oregon's law
in one significant area. Oregon's law requires a waiting
period of at least 15 days between the patient's first oral
request for PAS and the doctor's writing of the prescription
for lethal drugs. [OR DWDA, ORS 127.850 §3.08] The Montana
bill would greatly speed up the process by requiring only a
48-hour wait between the first request and the issuance of
the prescription. [MT LC 1818, Sec. 6 (1)]
Shortly after Judge McCarter's ruling last December,
Compassion & Choices' legal director, Kathryn Tucker, laid
the groundwork for Montana's "token" waiting period.
Speaking on Spokane Public Radio, she said that Montana
would have more freedom regarding PAS than Oregon. "In
Oregon there's a minimum 15-day waiting period. That
provision very possibly would not survive constitutional
scrutiny because it would be unduly burdensome," she
explained. [OR Public Broadcasting, 12/9/08]
Annual report shows Oregon set new assisted-suicide records
in 2008
According to the Oregon
Department of Human Services' newly released statistical
report on physician-assisted suicide (PAS) deaths in 2008, a
record high 88 prescriptions for lethal drugs were written
by a record-setting 59 doctors. Of those patients who
received prescriptions, 60 took the drugs and died-a record
high for the 11 years that Oregon's PAS practice has been
legal. The total number of reported PAS deaths in Oregon
since the Death with Dignity law was enacted in 1997 is now
401. [OPHD, 11th Annual Report on Oregon's Death with
Dignity Act, 3/3/09;
http://www.oregon.gov/DHS/ph/pas/ar-index.shtml.]
The 2008 report set yet another record-this one for brevity.
It consists of only a two-page "Summary" and one table,
two-and-a-half pages long. By contrast, the 2004 report was
25 pages long. "It appears that the more PAS deaths there
are, the shorter and more incomplete the state's report is
for that year," observed Kathi Hamlon, an ITF policy
analyst.
The data used in Oregon's annual PAS reports is obtained
almost exclusively from the very doctors who provided the
lethal drug prescriptions to patients. Since Oregon's law
does not give the state any authority or resources to
investigate PAS cases, there is no way to know whether
additional cases went unreported or whether the reports
provided by the participating doctors were even accurate.
While doctors are required by law to report their PAS cases
to the state, there is no penalty if they neglect to do so.
According to George Eighmey, executive director of the
assisted-suicide advocacy group Compassion & Choices of
Oregon (C&C-O), his organization facilitated the deaths of
88% (53 out of 60) of the PAS patients who died in 2008. [Oregonian,
3/4/09] As the self-proclaimed "steward" of the
assisted-suicide law, C&C-O maintains a network of willing
PAS-prescribing doctors and tight control over just what
information is released to the public. This fact prompted
the Oregonian's editorial board to recently opine,
"Essentially, a coterie of insiders run the [PAS] program,
with a handful of doctors and others deciding what the
public may know…." [Oregonian, 9/20/08]
The 11-year chart on Oregon PAS practice lists some of the
categories contained in the PAS annual reports over the past
eleven years and the corresponding statistics for each
category. Of particular note is the extraordinarily low
number of PAS-requesting patients who were referred for a
psychological evaluation. In 2007, not one of the 49
patients who died was referred for an evaluation. In 2008,
only two patients (3.3%) out of the 60 who died were
evaluated. The overall, eleven-year total for psychological
evaluations was only 38 (9.6%) out of the 401 who died.
Studies shed light on PAS practice
The fact that PAS doctors are
generally not questioning the state of mind of their
death-requesting patients flies in the face of a recent
Oregon Health & Science University (OHSU) study that found
that one in four PAS patients is likely to be clinically
depressed. (See ITF Update, 2008,
No. 4. p. 2.) Researchers concluded that Oregon's PAS
law "may fail to protect some patients whose choices are
influenced by depression…." [Ganzini et al., British
Medical Journal, 10/8/08]
Another OHSU study, published in March of this year, found
that patients who request assisted suicide do so, not
because of their current physical symptoms or quality of
life, but because of their fears regarding possible
suffering in the future. Researchers concluded,
At the time they express
initial interest in PAD [physician-assisted death],
Oregonians are motivated by worries about future
physical discomfort and losses of autonomy and function.
When confronted with a request for PAD, health care
providers should first work to bolster the patient's
sense of control and to educate and reassure the patient
regarding management of future symptoms. [Ganzini et
al., Archives of Internal Medicine, 3/9/09]
In other words, Oregon doctors
should first address PAS patients' fears before writing them
off with a lethal prescription.
Status of state assisted-suicide bills in the US
This year, Oregon-style bills
to legalize assisted suicide have been introduced in
Connecticut (Raised Bill 1138), Hawaii (HB 806),
Massachusetts (HB 1468), New Hampshire (HB 304), New Mexico
(HB 814), and Pennsylvania (SB 404). In Montana, a draft of
an assisted-suicide bill (LC 1818) surfaced early this year,
but was never introduced in the legislature.
Thus far, assisted-suicide advocates have not had much to
cheer about. The Connecticut, Hawaii, and New Mexico bills
have all failed to get the support needed to advance in the
legislature. New Hampshire's bill, which significantly
expanded the boundaries of Oregon's PAS law, has been
retained in the House Judiciary Committee. It will likely be
studied and revised, but is not expected to come up for a
vote until January 2010, at the earliest.
The only bills still pending are in Massachusetts and
Pennsylvania. However, the Pennsylvania bill's sponsor said
the bill is a long way from passage, and she doesn't expect
it to be heard in a committee until next year. [WFMZ-TV,
4/10/09]
Meanwhile, in Montana, an appeal of a District Court judge's
ruling legalizing assisted suicide is pending before the
Montana Supreme Court.
Dignitas head: Death on demand saves money
Ludwig Minelli, founder and
director of the Swiss suicide clinic Dignitas, recently told
BBC Radio that assisted suicide is a human right that should
be available "on demand" to anyone who has the capacity to
choose it. Moreover, he said, it could save Britain's
National Health Service "huge costs" resulting from botched
suicide attempts. "In many, many cases, [those attempting
suicide] are terribly hurt afterwards, sometimes you have to
put them in institutions for 50 years, very costly." [BBC,
4/2/09; Daily Mail, 4/8/09]
Minelli touted suicide as "a marvelous possibility given to
a human being." "Suicide is a very good possibility to
escape a situation which you can't alter," he explained.
[Telegraph, 4/2/09]
Dignitas has facilitated the deaths of approximately 1,000
clients worldwide, more than 100 of those from Britain.
Minelli admits that Dignitas helps the mentally ill-even
those with schizophrenia and bipolar disorders-to die. As a
result, Swiss psychiatrists refuse to work with Dignitas, so
Minelli allows patients to provide their own mental
assessment papers. [Times (London), 4/3/09]
Now Minelli plans to test the legality of aiding the suicide
of a healthy Canadian woman whose husband is terminally ill.
The couple told Minelli that they want to die together at
his clinic. [BBC, 4/2/09]
Currently, Swiss authorities are investigating Minelli, who
reportedly has become a millionaire, for profiting from
Dignitas deaths. Swiss law allows assisted suicide only if
it's done without selfish motives. The clinic is also under
investigation for dumping the ashes of about 300 clients
into Lake Zurich. [Telegraph, 1/7/09; Times,
10/25/08]
Luxembourg legalizes euthanasia
Following the Netherlands and
Belgium, Luxembourg has become the third country in Europe
to legalize both euthanasia and assisted suicide. The new
law, which took effect on April 1, grants doctors legal
immunity from "penal sanctions" and civil lawsuits if they
directly kill or assist the suicide of a patient with a
"grave and incurable condition," who has repeatedly asked to
die. The doctor must first consult another physician to
verify the patient's condition.
Luxembourg's Grand Duke Henri had refused to sign the
euthanasia bill into law-a requirement mandated by the
nation's constitution. Parliamentary supporters were so
intent on legalizing euthanasia, that they passed a
constitutional amendment to eliminate that requirement and
reduce the monarch's power. [Brit. Med. Journal,
3/24/09]
News Briefs
from home and abroad
• A new "conscience
rule"-promulgated by the Bush administration and
issued by the US Department of Health & Human Services (HHS)
- took effect in January 2009. It's intent was to
protect the right of health care workers to refuse to engage
in medical procedures and treatments that they considered to
be ethically or morally objectionable. No one has been more
opposed to the new rule than assisted-suicide advocate
Barbara Coombs Lee, executive director of Compassion
& Choices (C&C). She has repeatedly called upon the new
Obama administration to overturn the "meddlesome"
rule that, she said, encourages "healthcare workers to
obstruct needed treatment considered offensive to their
personal beliefs." (Apparently, she considers assisted
suicide a "needed treatment.") "I'm determined," she wrote,
"to continue blogging about the issue until it is repealed."
[C&C Blog, 2/11/09]
On February 27, the Obama administration (via HHS) issued a
notice that it intends to rescind the conscience rule. [NY
Times, 2/28/09] During the subsequent public comment
period, ITF Associate Director Wesley J. Smith
submitted his assessment of the conscience rule to HHS and
urged that it be revised, not revoked. He wrote that the
rule should:
• protect
medical professionals against being discriminated in
their employment because they refuse to take a human
life;
• distinguish
between elective and non-elective (i.e., life saving)
medical procedures, with greater worker protection for
not participating in objectionable elective procedures;
• insure that
conscience guarantees apply only when a procedure or
treatment is objectionable, and not used to discriminate
against certain patients;
• establish
that conscience protection is given to only bona fide
health care professionals, such as nurses, physicians
and pharmacists. [Smith, Comment to Proposed Rule, AB
49, 4/2/09]
The administration's final
determination on the conscience rule is pending.
•
Few places in the world have been as deeply embroiled
in the debate over assisted suicide as the UK. One
reason is that over 100 Britons have committed suicide at
the Swiss assisted-suicide clinic, Dignitas.
Assisted-suicide advocates in Britain-with a lot of
help from the media-have been persistently in the news,
calling for Parliament to legalize the practice so
that patients won't have to travel to Switzerland to die,
and family and friends won't face prosecution if they go
with them. To that end, former British Health Secretary
Patricia Hewitt, with the support of 100 members of
Parliament (MPs), introduced an amendment to the
Government's Coroners & Justice Bill to protect those
who accompany loved ones to the Swiss death clinic-even
though there have been no prosecutions in relation to any of
the 100-plus Dignitas deaths of British citizens. Hewitt
admitted that her amendment was only the first step in a
larger campaign to legalize assisted suicide and establish
local suicide clinics in the UK. [Sky News, 3/20/09;
Times, 3/20/09; Daily Mail, 3/21/09; Mirror,
3/21/09] But, on March 23, despite all the media hype, the
expected debate on Hewitt's amendment in the House of
Commons never happened. The session time ran out before
the MPs could address the issue. Assisted-suicide proponents
were outraged, but said they are hopeful the amendment will
be taken up later in the House of Lords. [Telegraph,
3/23/09]
•
In Scotland, the push for legalized assisted
suicide is being championed by Scottish Parliament
member (MSP) Margo MacDonald. MacDonald, who has
Parkinson's disease, hopes to introduce her "End of
Life Choices (Scotland) Bill" later this year, but she
needs to get 18 MSPs to support the bill before she can do
so. Thus far, just 12 have endorsed the measure. In an
attempt to garner more support, MacDonald requested input
from fellow MSPs and the public, which resulted in her
narrowing the categories of patients eligible for an induced
death. As it now stands, there are three categories: (1)
those who are terminally ill; (2) those with progressive or
degenerative conditions, like Parkinson's; and (3) those who
are totally dependent on others because of trauma from
crashes or sports injuries. [Scotsman, 3/25/09;
BBC, 3/25/09; Herald, 3/26/09]
•
A survey of 3,733 physicians practicing in the UK,
found that two-thirds opposed the legalization of euthanasia
and physician-assisted suicide. Of those opposed, 61%
indicated their opposition without qualification. According
to the study, published in the journal Palliative
Medicine, only 9% of doctors felt certain that
practitioners should be permitted to end patients' lives if
they had incurable and painful illnesses. It also revealed
that palliative care specialists were the group most opposed
to both induced death practices, followed by doctors
specializing in elder care-the two specialties with the most
experience with dying patients. [Seale, Palliative
Medicine, 3/25/09]
•
The chairman of Belgium's euthanasia commission,
Wim Distelmans, wants to change the country's euthanasia
law so that the elderly who are tired of living can be
euthanized, even if they are not ill or suffering
unbearably. He said that seniors have to endure many things,
like poor hearing, poor verbal skills, and dependence on
others. "Put together, this could amount to unbearable
suffering," Distelmans explained. "I don't believe it's
wrong to request euthanasia in such situations." He made
these comments in connection with the case of Amelie Van
Esbeen, 93, whose request for euthanasia was granted
after she went on a 10-day hunger strike and doctor shopped
until she found one willing to euthanize her. Her regular
doctor had refused her request because she was not
terminally ill and did not experience unbearable,
intractable pain or suffering as stipulated by law.
Approximately 2,700 people have been euthanized since
Belgium legalized the practice in 2002. [Expatica,
3/24/09; 4/3/09]
•
A court in Hamburg has ruled that Germany's
Dr. Death, former justice minister Roger Kusch,
can no longer assist suicides for financial gain. Kusch, who
charged over $10,000 for how-to-commit-suicide advice, has
helped three women and two men die. None were terminally
ill. [British Medical Journal, 2/18/09] After the
court ruling, Kusch closed down his suicide service. [Hamburger
Morgen Post, 2/21/09]
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