Canada Revisits Aid in Dying

A wheelchair bound Canadian grandmother, Gloria Taylor, who has Lou Gherig's disease has asked the British Columbia Supreme Court to allow her doctors to give her a lethal dose of medication so that she can end her life. The decision is expected next year and lawyers predict that the case will be taken to the Canadian Supreme Court. This rather standard article from the AP has a paragraph that caught my attention:

In the latest case now unfolding, Taylor's lead lawyer, civil liberties defender Joe Arvay, argued to the court that assisted suicides were taking place despite the ban, a practice he likened to the illegal "back-alley abortions" of the past.

I've been urging women's rights advocates in the US to pay closer attention to the opposition to certain medical services and treatments. Often those who oppose abortion--"pro-life" and "family and marriage" groups and the Catholic Church, among others--also oppose the legalization of aid in dying. Shame often functions to keep proponents of such services quiet. And yet, abortion and aid in dying have taken place for as long as humans have existed. How they are provided and regulated is perhaps the paramount question for society; they are issues that test our humanity and require us to reckon with a new definition of life and death created by modern medicine.

Canada's Debate

The government of Quebec has designated six months for debate of a proposed assisted suicide law. A series of panels are being held to allow doctors, family members, and the dying to tell their stories. In an article for Canada's CBCNews, Lorna Dueck writes the following:

For centuries, Christianity has been prime source material for teaching how to love and care for family and strangers in pain.

Of course we need to be honest with those looking to our distinct truth and what we mean by hope.

For two millennia we Christians have said that this body on Earth is but a shadow of the future self that God has waiting for us after death and we need to regain our practice of how to explain and engage that truth with the reality of dying.

That belief helps us understand that there is no purpose to keeping Grandma, son, daughter or self clinging to life support when a greater beauty comes next.

In debates such as this, how great is our loss if we withdraw the contribution of faith from our collective education and view only individualism as the better way to face the perils of death.

As surely as we wrestle through the physical steps of death, particularly on an issue as fraught with emotion as euthanasia, so will we need to come to terms with the spiritual journey.

Read more: http://www.cbc.ca/canada/story/2010/11/24/f-vp-dueck-euthanasia.html#ixzz16j1OtJnw

Canada Votes Down C-384; It's a Good Story.

After months of discussion -- or rather exaggeration, noise, name-calling and fear mongering -- Canada finally voted down C-384 in a vote that wasn't even close; the bill would have made aid in dying legal there. Here's a clip from CBC:

The House of Commons has rejected a Bloc Québécois MP’s legislation to permit assisted suicide in Canada under strict conditions.

Bill C-384 was defeated Wednesday afternoon on second reading by a 228-59 margin.

The bill would have allowed doctors to avoid murder and manslaughter charges for helping terminally ill people or those in severe chronic pain to die.

Francine Lalonde, an east Montreal member of Parliament, introduced the measure. It was supported by most of her caucus and a sprinkling of MPs from the Liberals, Conservatives and NDP, because party leaders allowed a free vote.

The bill stipulated that a physician could help someone to "die with dignity" provided nine conditions were met, including that the person was 18 or older, suffered from a terminal illness or unrelenting physical or mental pain, had made two written requests to die at least 10 days apart, and had their diagnosis confirmed by a second doctor.

Lalonde — who has faced death during recent struggles with cancer — said it's time to allow terminally ill people in intolerable pain to die gently in a manner of their own choosing.

But MPs were concerned it would take the country down a "slippery slope" in which severely disabled or dying people could be euthanized without their consent.

Junior cabinet minister Steven Fletcher, who has quadriplegia, abstained even though he supports the principle of allowing individuals to choose to die with dignity

He said Lalonde's bill was "flawed," arguing it could relieve the pressure on society to provide the level of social and health support required to make severely injured or ill patients want to live.

I can understand the strong reaction, both here in the US and in Canada (and elsewhere around the world where aid in dying is discussed), simply because how it is discussed is often full of fact-less speculation. Oregon has taught us that end of life care improves when aid in dying is legalized and the population goes through a rigorous debate on end of life care. We've also learned that fears of coercion and abuse are unfounded. But when the issue is framed as the government killing people -- without an understanding of how lives end now, in this decade, in the path of aggressive and futile care -- aid in dying (or euthanasia or assisted suicide) sounds scary.

This may seem unrelated and tangential, but I heard a bit of an interview with Alabama Senator Jeff Sessions yesterday on NPR. Melissa Block was asking the republican what the meeting with Obama that morning on selecting a new Supreme Court justice had been like and what he, as ranking minority member of the Judiciary committee, would find acceptable in a candidate. Sessions said:

I would like to see a nominee who is committed to faithfully following the Constitution as it is written and that understands that they are not empowered to consult polling data or social conditions as they interpret the existing words of our constitution.

Of course I'll have more to say about (the impossible) literal interpretation of the Constitution over at my other home, TheRevealer.org, but in this instance my point is that we live in an era where facts, statistics, social conditions and life as people are living it have much less influence on discussions of policy, rights, freedoms, and services than they should. (See debate over abortion.) Chalk it up to compelling story-telling -- and opponents of aid in dying have a good story! -- but also to the movement away from intellectual, lengthy, detailed, fact-based discourse in our public square regarding policy issues, law and society. I can accept opposition to aid in dying, but only when it comes from a real place. That services for the dying will be eroded by it's legalization is unfounded.

Because the story of killing a dying patient is so compelling and frightening, it's easy to get away from the facts of how we die today. Particularly when the story is being told via a blasted email or a network news clip that lasts 30 seconds. Sessions and others make no excuse for wishing to adhere to an idea of law or what they call "tradition." Most of us who write about the health care system, futile care, and end of life circumstances understand that those ideas and that tradition are fabricated.

In Support of Suffering.

Canada will discuss C-384, a bill to legalize assisted suicide there, in May. In today's Hamilton Spectator, Paul Kokolksi writes against the bill, citing the same arguments that we hear here in the US. My least favorite argument is that which endorses end of life suffering - in line with the theological concept of redemptive suffering espoused by the Catholic church, that the more pain we feel, the closer we are to God.

For all of the talk about a "slippery slope" with our "culture of death," I find there too is a slippery slope to the acceptance of suffering. We have the ability to relieve suffering for the dying but suffering brings us closer to God. We have the ability to relieve poverty, inequality, racism, hunger, abuse, injustice...but suffering brings us closer to God? If the concept of redemptive suffering prevents us from relieving suffering for the sake of converting those in pain, we have reduced our moral imperative as humans to a mission for the church. I can't think of a less humane premise than this.

Here's a clip:

Our present culture tends to consider suffering the epitome of evil. In such a culture there is a great temptation to resolve the problem of suffering by eliminating it at the root, by hastening death so that it occurs at the moment considered most suitable. True compassion leads to sharing another's pain; it does not kill the person whose suffering we cannot bear.

The pleas of the gravely ill who sometimes request death should not be understood as implying a true desire for euthanasia; in fact, it is almost always a case of an anguished plea for help and love. Intentionally causing one's own death, or suicide, is a rejection of God's sovereignty and loving plan. It is a refusal of love for self, the denial of a natural instinct to live, a flight from the duties of justice and charity owed to one's neighbour and to society.

No one should be allowed to permit in any way the killing of an innocent human being, whether a fetus or an embryo, an infant or an adult, an old person, or one suffering from an incurable disease, or a person who is dying. The moment a positive law deprives a category of human beings of the protection which civil legislation ought to accord them, the state is denying the equality of all before the law.

In the Netherlands, a policy originally encompassing only persistent requests for death from hopelessly suffering and dying patients has steadily expanded so that physicians have been allowed to kill patients who were physically healthy and handicapped children who never asked for death.

The Netherlands stands as a stark reminder of the slippery slope leading from supposedly limited killing to a broader culture of death.

There exists in contemporary culture a certain Promethean attitude which leads people to think that they can control life and death by taking the decisions about them into their own hands. What really happens in this case is that the individual is overcome and crushed by a death deprived of any prospect of meaning or hope. What any sick person needs, besides medical care, is love -- the human and supernatural warmth provided by those close to him such as family, nurses and doctors.

Working for Disability Rights and End of Life Rights.

Oh, I'm under fire again. This time mostly from Canadians, likely because the euthanasia bill C-384 is back in debate this week. Opponents are lashing out, even across the border. And at me for what I would consider an incredibly benign post that is all history of disability rights in Canada. Geesh.

I don't know the Canadian bill intimately, admittedly, though I have had interaction with Alex Schadenberg of the Canadian Euthanasia Prevention Coalition. I think he seems like an alright guy with a poorly-defined mission. His work is predicated on legislating his idea (of life) and death that is no longer valid and has been rapidly changing for the past 40 years. I admit that medical advancement has muddied that definition, he does not. "Go get-em" he says to Stephen at Not Dead Yet. I'm -em.

Not Dead Yet caught up with my Vancouver Sun link and dug around til they found the last time they (and "pro-lifer" Jill Stanek) wagged their fingers at me. Stephen posits that supporting Death with Dignity (the aid in dying bills in Oregon and Washington, as I do) means that I'm out to kill the disabled because, um, allowing terminally ill patients, who I admit can be classified as disabled because of their illnesses, to decide when and where to end their lives means that I have some deep-seated intent to start killing anyone that looks at me askance.

I don't mean to be flip about this, nor evasive. I've been accused of not addressing disability rights in my advocacy for end of life rights. I haven't because, while I understand the justified fear that the disabled have of state laws, and of society's and the medical profession's discrimination, I find the definition of "terminal" to not include someone in a wheelchair.

When you're accustomed to systemic discrimination, seeing your fellow-travelers is sometimes difficult. I'm advocating for patients' rights - and that means the right of every one of us, regardless of our color, class, gender, education, or functionality, to make our own medical decisions. The legalization of Death with Dignity in Washington and Oregon doesn't in any way cheapen or make vulnerable the lives of any member of society.

Yet this is the case that many make, out of fear, out of mis-directed self-defense, or out of lack of information regarding the end of life experience and the DwD laws. And this was the case that Bad Cripple made at his site yesterday, oddly lumping me with every person who's ever offended or misunderstood him:

As for the first example, I have news for Neumann: if I have learned anything in the last thirty years of using a wheelchair it is that all people with a disability are not valued to some degree. There is no slippery slope involved. Just ask any paralyzed person or anyone with a disability. Better yet go to a school board meeting and listen to one and all cluck about the need for equal access and then vote down the need for that expensive elevator or lift on the school bus. There is no over reaction here . Indeed, if disability activists are guilty of anything I would argue we are too passive. We need to be more vigorous in asserting our inalienable rights as citizens.

Comparing murder to depriving the disabled of school buses is over-reaction. Again, I agree that our society should work much harder to accommodate the disabled, to wipe away prejudices. Anything less than equality for the disabled is discrimination, plain and simple. But claiming that every supporter of Death with Dignity is out to end the lives of every disabled person is over-the-top.

As for the second example, I doubt Neumann goes through the same mental gymnastics or experience the fear people with a disability do when they go to the doctors office or hospital. Perhaps Neumann can appreciate the difference between the terminally ill and disabled but I assure you most people, doctors included, do not. How else do I explain comments made to me such as "I would be rather be dead than use a wheelchair" or "Are you sure you wish to receive medical treatment" or "How longe have you suffered paralysis?" A clear message is being sent and it is not positive. Indeed, it is deadly and with the right spin can be lethal in some circumstances. My existence is open to question, my life less valuable. This is not paranoia but rather a social fact.

I didn't make those comments, nor would I. I believe that a disabled person has the same rights to be informed of their medical status and options as anyone else. But fear of a law that applies to terminal patients and working to oppose the rights of the dying does not protect the disabled from prejudice. BadCripple's existence should never be open to question! His life is never valueless. Hideous discrimination does exist. This we must work to end.

Sacrificing the rights of some for the fears of others never works. Or every black man with a bandana on his head and his hand in his pocked would be jailed away from every prejudiced little old lady who thought he was out for her purse. In other words, fear is powerful and often justified but it cannot be used to sanction the innocent acts of others.

Somehow I doubt anyone has openly questioned the value of Nuemann's existence or asked her if she really wished to receive medical treatment. Frankly I do not want Nuemann's sympathy or anyone else's for that matter. What I want is support; support for my civil rights. That support starts at the beginning, middle and end of life. I have not had that support from anyone aside from my family, friends and doctor or two. What an indictment on society. How can something as unimportant as the ability to walk have such profound social consequences. Worse yet when I assert my rights I get called "paranoid" by people like Nuemann with a political goal--the legalization of assisted suicide. This is depressing to me and I sincerely doubt I can sway the views of people such as Nuemann. Hence this why I write more about disability rights than the politics of assisted suicide.

Asserting one's rights is not what I was calling paranoid; working to end the rights of others in order to assert oneself is reactionary. I may not be in a wheelchair but I will always support civil rights, equality and autonomy for those who are. I may not understand the kind of discrimination the disabled receive but I do know what it's like to have others legislate me out of my own health care decisions.

And here's the reply I posted at Bad Cripple, below. It's sparked a lot of productive conversation. You can read the other comments here.

My advocacy is for patients' rights. I don't know what it's like to be in a wheel chair, nor what it's like to be black or gay or old and feeble. But as a woman, I know what it's like to have my decisions about my health impeded by the government, society, and other groups. I'm not writing to offer sympathy but empathy, that quality that binds advocates to their objective of protecting individual rights in health care delivery.

What you and I disagree on is the definition of death. Until about 40 years ago, death meant the almost simultaneous cessation of breathing, heart beat and brain function. But not so today.

With respirators and defibrillators we can sustain the first two indefinitely. CPR, 911, paramedics can make our hearts beat and our lungs breath. This is a brilliant thing; yet only 15% survive resuscitation to leave the hospital.

My point is that we have the technology to sustain life but also prolong death. And so the definition of death has changed; natural death is less and less common as we are given feeding tubes, respirators, pace-makers and increased artificial means of maintaining the body. In a world where something like 75% of society says it would like to die at home, 80% die in facilities.

What does this have to do with disability? We will all be disabled at some point. By age, by disease, by other health issues. But we all deserve the ability to make our medical choices. It is this ability - this right - that I advocate for.

What Not Dead Yet, Alex Schadenberg at Euthanasia Prevention Coalition and you miss in my writing is my support for Death with Dignity as legalized in Oregon and Washington (US). DwD involves only the terminally ill with 6 months to live, of sound mind, getting a prescription from their doctor that allows them to choose when and where they die. They are dying of their disease. They are not suicidal.

This is not at all different from a family member honoring one's advance directive to remove a respirator or forgo a feeding tube, nor from a patient's choice to end experimental treatments for cancer. It is a choice for as natural a death as we can have. It is a choice to not lie in a hospital, fully sedated for the remaining 6 weeks of life.

We, as members of developed countries where life-prolonging treatments can simply keep us "alive" for longer than God's planned, must now legally struggle with this new definition of death. And we must do so in a way that honors every patient's choice. Regardless of their race, economics, age, or medical condition.

This is my advocacy: To end futile, unwanted care which prolongs suffering; to educate patients' on what their rights are; and to work to help all of us plan for the end of life so that the decisions are in our hands.

In my work for patients' rights, I'm more of a fellow traveler than, unfortunately, you realize.

A Look At Disability Rights In North America.

Journalist Douglas Todd writes for The Vancouver Sun today about the changing landscape of disability rights in North America. The article has a great little history on the disability rights movement and notes the challenges that the disabled still have in asserting their equal rights in society. Here's a clip:

Even though Stainton said Canada has lost its place as a world leader in disability rights, the movement has challenged all of us on a number of charged philosophical and political fronts.

With differing degrees of success, disability-rights advocates have urged Canadians and others to:

- Change the way we talk about and understand disabled people.

- Stop stigmatizing people with disabilities.

- Spend tax dollars on including the disabled in all facets of life.

- Force employers to accommodate people with disabilities.

- Oppose voluntary assisted suicide for those with severe disabilities.

- Respond to the connection between disability and poverty.

- Not forget the disabled in developing countries.

snip

A more crucial emphasis for disabled-rights proponents, perhaps, has been on the need to make a firm distinction between the "medical" and "social" models of disability.

The "medical" model, said campaigners, came out of science in the early 20th century. It was individualistic. The medical model acts as if a person's disability, whether a missing limb or paraplegia, is medical "damage," which places the disabled person outside human normalcy.

In response, advocates of the "social model" of disability have been arguing since the 1970s that the problem for people with disabilities is not that they're in a wheelchair, without a limb or blind.

It is that society doesn't accommodate them, whether with disabled-only parking or books in braille.

With the discussion thus shifting to communal rights for the disabled, people in Canada and much of the Western world began to put their emphasis on reducing social barriers to access and inclusion.

The complex debate over disability models continues to boil, as governments, businesses and employers in the industrialized world are increasingly compelled to do everything they can to accommodate disabled men and women.

Given that the Canadian Charter of Rights forbids any form of "discrimination" on the basis of "physical disability," is there any limit to how far an organization must go to include a person who is visually impaired, in a wheelchair or without a limb?

Even while governments and businesses are being pressed by legislation to include disabled people in every aspect of life, Stainton said courts have been ruling there are financial limits to consider in providing "reasonable accommodation."

snip

The battle for disabled rights has had other unpredicted twists and turns.

One of them is over the so-called "right to die." As advocates for the disabled have continued battling for recognition, they have clashed with people who want laws in Canada and the U.S. permitting assisted suicide for those with severe disabilities and terminal conditions.

Even though polls show the majority of Canadians support regulated euthanasia, disability rights activists have strongly lobbied politicians to make sure no one, regardless of the severity of their disability, should be able to choose an assisted suicide.

In this increasingly bitter debate, disabled activists claim legalizing assisted suicide would be an ethical "slippery slope" that would lead to all disabled people, no matter the degree of their impairment, being devalued as human beings.

In turn, advocates for assisted suicide maintain the arguments of disabled-rights activists are a misplaced over-reaction to their proposals.

Canadian Poll on "Euthanasia" Contested.

While a new poll by Angus Reid shows that a majority of Quebec and BC residents support "euthanasia" policies, the poll is contested by disability and "pro-life" groups who say that the general public does not properly address disability and end of life issues.

I post this article (best when contrasted with last week's Angus Reid poll of the US) because of a comment, bolded below, by the pollster. It seems, he says, that where the euthanasia debate is greatest - in the news, as in Quebec - people are more willing to support it. This is substantial in a number of ways: does more information regarding end of life care, palliative care, and aid in dying change opinions toward favorable?

Catch the comments if you want to hear more about how the general public articulates support for "euthanasia" laws.

From the Globe and Mail:

The online survey compiled the opinions of 1,003 Canadian adults, with Quebec and B.C. showing the highest support for euthanasia, respectively.

Nationally, 85 per cent of Canadian respondents believe legalizing euthanasia would allow an opportunity for suffering people to ease their pain, in addition to establishing clearer regulations for doctors with end-of-life decisions.

Further, two-thirds of Canadians agreed that legalizing euthanasia would not send the message that the lives of the sick or disabled are less valuable.

Jaideep Mukerji, public affairs vice president for Angus Reid, said the differences amongst the provinces showed interesting variations. “In Quebec, where there is a much stronger political debate surrounding euthanasia, it was interesting to note that the poll indicated that the provincial result was nearly 10 points higher than the national average,” he said.

Cheryl M. Eckstein is an anti-euthanasia activist and president of the Euthanasia Prevention Coalition. Despite her status as a chronic pain patient, which went undiagnosed for months, Eckstein remains a staunch opponent to assisted suicide. She believes the latest poll revealed a lack of public understanding on the topic of euthanasia.

“There isn't a lot of information about what is euthanasia,” she said. “Some people don't really understand what it is. They think euthanasia is the same as pulling the plug.”

Regardless of public misconceptions, the poll established that 50 per cent of British Columbians agree there should be no penalty applied to a parent found guilty of assisting the death of a terminally ill child, whereas only a third of Ontarians and Albertans felt the same way. Currently in Canada, it is a crime to counsel or aid someone with suicide, punishable by a 14-year prison sentence.

Baby Isaiah: Is Futile Care for the Living or the Dying?

Medical advancements have pushed us into a climate where anything that can be done for a dying patient often is done, and just as often without the patient's consent. What specific care a patient may wish is often not documented properly - all care scenarios are difficult to anticipate - or family members or hospitals may disagree with that wish. Grief is a powerful force; our desire to hold onto the beloved sometimes supplants what is best for the beloved.

The result is what is called "futile care": medical treatments that do nothing to improve a patient's condition and often inflict undue stress and suffering on the patient but that offer hope to the family and those involved in the process.

Alex Schadenberg at Canada's Euthanasia Prevention Coalition summarizes a recent case in that country that addresses futile care and - I think - asks us to consider whom that futile care benefits:

Baby Isaiah was born with the umbilical cord around his neck after a 40 labour in Alberta. He was not breathing when he was born but was revived and sent to the Stollery Children's hospital in Edmonton Alberta.

After approximately 90 days of receiving care, the parents of Baby Isaiah - Rebecca and Isaac May, were told that the hospital would withdraw the ventilator from Baby Isaiah.

The parents went to court to request another 90 days of care to give Baby Isaiah a chance to further improve. When speaking with Rebecca May, she made it very clear that they hoped to be able to bring Isaiah home and care for him. She understood that Isaiah may not survive very long and if he survived, that he may be profoundly disabled, but she was willing to care for him and love him, no matter what happened.

The Euthanasia Prevention Coalition has supported the wish of the May family to give Baby Isaiah a chance to improve to the point where they could bring him home.

While Schadenberg has properly and adequately explained that removing Isaiah from artificial life support would not be "euthanasia," he and his organization have strongly backed the May family in their fight against the hospital, citing the "precedent" that the case sets.

Like many other organizations around the world, Schadenberg and others have highly publicized Baby Isaiah's "struggle" as a "pro-life" cause. Schadenberg explains why:

Modern bioethics has bought into futile care theory. Futile care theory originally focussed on withdrawing treatment when it became futile, burdensome and ineffective. Over the past decade, and more, futile care theory now focusses on withdrawing effective treatment from patients that are deemed to be futile.

The ventilator is effectively providing oxygen for Baby Isaiah, who is growing and physiologically thriving with the care. The hospital and the physician view Baby Isaiah as being futile and believe that they are wasting the resource of the ventilator on a futile patient.

If the May family loses this court case consider where the issue may go next. People with alzheimers or dementia, people with profound disabilities, and more.

Next consider how such a legal precedent could be used if euthanasia ever became legal in Canada.

Schadenberg and others have tacked the term "theory" onto the end of futile care, a rhetorical calculation that has effectively been used to conflat the definition of scientific theory (set of principles that explain natural phenomena) with a theory in everyday life (a guess) - made popular in regards to evolution.

As Susan Jacoby writes, "The popular 'just a theory' argument rests not only on religious faith but on our national indifference to the specific meanings of words in specific contexts."

With this distortion, "pro-life" groups can debunk medical (and any other) science when they like in lieu of hope for a miracle from God. And indeed, medical science is not foolproof any more than the human body is uncomplicated. (Schadenberg's explanation is fraught with other exaggerations and assumptions as well: futile care is really necessary care, viable patients are removed from necessary care, Baby Isaiah is "thriving," removing one patient from artificial life support threatens other patients....)

But the real point of this post is this: Whom does futile care serve?

A clue may reside in a recent quote by Bobby Schindler, brother of Terri Schiavo and founder, with his parents, of the Terri Schindler Schiavo Foundation, dedicated to a Catholic, "pro-life" agenda of "protecting" those who have suffered severe disabilities from removal of artificial life support. Schindler stated regarding caring for those like his sister:

"They allow us to show our compassion, our love. I believe that they are blessings.

“And if you talk to families that are caring for people like my sister, they look at their loved one as a blessing – to be in this position of having to care for them – because they are completely vulnerable to us."

There's something inherently subversive about loving someone because they are completely vulnerable to you, about prolonging the life of a body for one's own redemptive sacrifice and subsequent "blessing." Schindler slips in "having to care" as an indication that the choice is not ours but presumably God's.

The foundation of this desire to love the vulnerable is, of course, compassion. But also, as medical ethics works to guide us through questions of artificial life support, I believe, it is also one of theological purpose. The "pro-life" stance that all life is sacred is on the face very noble and just. Not until applied to real life examples does the protection of that "sanctity" at all costs exemplify discrimination: opposition to contraception, women's and patient's rights, and to the wishes of the dying. It is in that opposition that the suffering of the other is imposed for the sake of one's own redemption. When "having to care" for a vulnerable person, God teaches us the benefits of unrequited love, of suffering, of patience.

I'm not able to speak specifically to the May's decision. I don't know their purpose. But when the private struggle of an infant is prolonged and made an example of vulnerability, an example of God's plan, a cause for hope of miracles and a case against some hypothetical "slippery slope" preying on the terminal, the disabled, the elderly, the compassion for a brain-dead child and their family is lost and subverted. They've become a cause, an argument against science and a justification for futile care.

That our lives are redeemed by suffering, that we are made better, indeed won to the bossom of Christ, by our pain, grief, and abject self-sacrifice is strongly entrenched in fundamental religious ideas - those currently and strongly espoused by the Catholic and Fundamentalist organizations that comprise the current "pro-life" movement.

Caring for the "least of these" should not demand prolonging their lives at all cost so that we can love unconditionally, so that we can suffer in that caring process in order to be closer to God. Somewhere in the argument the ability to accept death and the innate course of human life must figure. Our redemption must not feed on the suffering of others.

Anabaptist Conscientious Objection in Toronto.

From CNW Group, an update on the Canadian case about conscientious objection:

Mennonite Central Committee Canada (MCCC) and Canadian Friends Service Committee (CFSC) (Quakers) express disappointment that the Federal Court of Appeal (FCA) has rejected a request to intervene in an appeal by US war resister Jeremy Hinzman.Hinzman and family applied for permanent resident status in Canada on humanitarian and compassionate grounds, but their application was rejected. An upcoming appeal to the FCA will focus on whether punishment for desertion from the military - if it was motivated by a "deeply held" objection to war - could amount to "undue hardship" for the purpose of a humanitarian and compassionate application.The FCA refused CFSC-MCCC's intervention stating that they weren't directly affected by the issue, wouldn't provide a "fresh perspective", and that the Hinzmans' legal counsel could raise relevant concerns.Jane Orion Smith, General Secretary of CFSC, said, "The Court's decision is profoundly disappointing. Quakers and Mennonites, the core base of historic peace churches, have a unique and influential role in establishing rights for conscientious objectors over several centuries in Canada and internationally. During conscription, most of our members sought exemption as conscientious objectors. Conscientious objection is an issue of the present, not just history. Jeremy Hinzman and his family are an active part of the Toronto Quaker Meeting. Despite this setback, we will continue to educate and advocate for the realization of this much misunderstood right which is protected in domestic and international law."CFSC and MCCC argued that because Jeremy Hinzman's conscientious objection is rooted in his freedom of religion (and conscience), there should be a different test for assessing his punishment for holding those beliefs. It should not have to amount to "undue or disproportionate" hardship. Any hardship for his beliefs could potentially breach his religious rights, and the immigration officer deciding his case had to consider his case in light of these rights.Tim Wichert of Jackman & Associates, counsel for CFSC and MCCC, says: "The Federal Court has specifically said that the issue of conscientious objection still raises a host of outstanding questions, begging for resolution. Because of their extensive experience with this issue, we argued that Quakers and Mennonites had a unique perspective to offer."For further information: Tim Wichert (counsel), (905) 932-8914 or (416) 653-9900 ext 228; Jane Orion Smith (CFSC), (416) 920-5213 or (416) 356-5213

Judge Says "Clean Needle" Program Like Palliative Care.

Via the Washington Post, a Canadian judge has compared the first-of-its-kind, threatened "clean needle" program in BC to palliative care. The pertinent quote is in the last paragraph of the excerpt below.

I'm a strong believer in clean needle programs that recognize and address addicts' suffering and vulnerability to disease - without shaming or blaming the victims. I also think palliative care shouldn't be a marginalized field of medical practice. Yet the specialty is demeaned as "rationed" medicine or only for those who have given up on life (much like hospice!)

Apt comparison? Inviting dispersions? What do you think?

British Columbia's top court on Friday rejected an attempt by the Canadian government to close North America's first safe injection site for drug users.

The site, where people can inject illegal drugs with clean needles under a nurse's supervision, has operated since 2003 under a temporary exemption. It was opened as part of a harm-reduction plan to tackle an epidemic of HIV-AIDS and drug overdose deaths.

The exemption was scheduled to end in 2008, but a trial court allowed it to remain open. The Conservative government appealed Justice Ian Pitfield's ruling last year that allowed Insite, as the site is known, a constitutional exemption from Canadian drug laws.

In the May 2008 ruling, Pitfield said Insite - operated by the Portland Hotel Society in conjunction with the Vancouver Coastal Health Authority - provided important health care resources to addicts.

The British Columbia Court of Appeal rejected the federal government's bid to overturn the lower court's ruling that said Insite provided a needed medical service.

The three-member appeals court panel, which was split in its ruling, said Insite is a health facility and falls under provincial and not federal Canadian jurisdiction.

"Like palliative care, it is a form of harm reduction with benefits for both the patient and the community," said Justice Carol Huddart in the split decision. "The lure of safe injection gets those addicts into Insite so health care may be delivered."

Margaret Somerville on Patient Dignity and Suffering.

Margaret Somerville, an opponent of aid in dying, writes for today's Globe and Mail some great things about how to help dying patients in pain feel as though they still control their lives.

While I agree with much of what she writes, her disingenuous digs at "euthanasia" ring hollow and unjustified in the context of the article. Patient dignity and control is not negated by aid in dying, when provided in the context of strict laws, but in particular terminal cases enabled by it. But the Canadians have their own culture war over "euthanasia" waging. Somerville has an ideology to enforce; unfortunately that's made an interesting and beneficial story into a piece of advocacy work, undermined by a position that she espouses but doesn't back up with fact.

Euthanasia is proposed by its advocates as an appropriate response to pain and suffering, precisely because, they argue, it gives patients ultimate control over what happens to them. But if, for ethical and practical reasons, we believe (as I do) that legalizing euthanasia is a very bad idea, what else can we do to reduce the suffering of seriously ill and dying people?

First, everyone has a right to all necessary pain-relief treatment: We must kill the pain, not the person with the pain. To unreasonably leave someone in pain is a breach of a fundamental human right and a breach of trust.

Trust in one's caregivers is very important in reducing suffering. In the past 30 or so years, we have changed from blind trust – “trust me because I know what's best for you” – to earned trust – “I will show you can trust me and will earn your trust.”

Earned trust requires honesty, and shared information and decision-making, all of which increase the patient's sense of control, thereby reducing suffering. When it's not possible for the patient to be in control, honouring the patient's trust becomes even more important.

We have medicalized, depersonalized, dehumanized and technologized death – and, as a result, dying people suffer intense premortem loneliness. We need to recognize and address that loneliness. Euthanasia is a medical technological response to suffering and death. But in a caring, ethical society, the answer to loneliness and abandonment is not a lethal injection.

We need to understand what seriously ill or dying people require to feel respected. Harvey Chochinov, a Manitoba psychiatrist who specializes in the care of terminally ill people, and his colleagues have developed a treatment they call “dignity therapy.” They identified the elements that contribute to dying people's suffering and designed interventions to counteract these elements. Hope, for instance, is very important in reducing suffering. It requires having a sense of connection to the future. We can give people “mini-hopes” – things to look forward to – even when a long-term future is not possible.

Rom Houben and the Evolution of Uplift.

Alex Schadenberg of Canada's Euthanasia Prevention Coalition has a great run-down of the evolution of the uplifting but inaccurate story of Rom Houben, the "locked in" patient "discovered" and now talking about the horror of his 23 years alone.

The story resonated for me because a lot of "pro-life" folks jumped on the story as strange vindication for the death of Terri Schiavo who was removed from artificial nutrition and hydration after a years long court battle and media blitz. See, "pro-lifers" said, maybe the persistent vegetative state diagnosis is wrong sometimes. I never bought the parallel and I still don't.

But the Houben story had emotional legs that it marathon-ed across all sorts of media outlets. Those who oppose aid in dying (strange because the DwD laws, in the US at least, only pertain to patients capable of ingesting the medicine on their own and only those with terminal diagnoses) worked the story into justification for their position.

The Terri Schiavo case - and the Rom Houben case - have zilch to do with aid in dying. US law has long determined that families may choose to remove their brain dead loved ones from artificial life support. Or with an advance directive, patients may do so themselves in advance.

But read Schadenberg's summary. I'm glad he has it up; it speaks to EPCs commitment to using the facts, discerning what's best for patients, and not chasing after ideological and emotional stories for political gain. At least today, with this post.

Alex Schadenberg Get All Riled Up Over an Ad.

A few days ago I posted about the ad campaign in Canada, where a huge brawl is taking place over the legalization of assisted suicide. The campaign is a series of plaque-like stickers on park benches with fictional stories about painful deaths. It is meant to bring awareness to how we die and it has garnered a lot of attention. It was created by two advertising executives who are trying to raise awareness for a series of end of life issue including aid in dying and living wills.

Now check out what Alex Schadenberg, the executive director of Canada's Euthanasia Prevention Coalition is ranting regarding the use of terms and their definitions regarding end of life care:

One of the promoters of this euthanasia campaign (under the title - Greywizard) accused me (in this blog) of trying to rewrite the english language. This person was insistent that he was right and I was wrong. The fact is that the Dignity in Death website that was developed by this person is wrong and irresponsibly misleading.

Greywizard also attempted to discredit me by calling me religious. Instead of dealing with the arguement Greywizard preferred to discredit me by accusing me of being religious. But euthanasia and assisted suicide are not religious issues but rather public safety issues.

Euthanasia is prosecuted under Section 222 of the Criminal Code (homicide) and Bill C-384, the bill that is being debated in parliament to legalize euthanasia and assisted suicide, would legalize euthanasia by amending section 222 of the criminal code.

The advertising specialists who are promoting the euthanasia campaign stated to the Toronto Star:

"We've both seen cases where passive euthanasia is the right thing to do."

Just because two advertising specialists want to call witholding or withdrawing life-sustaining medical treatment euthanasia, doesn't mean that it is euthanasia. This is irresponsible because it is often necessary to withdraw life-sustaining treatment to allow natural death to occur. If good people who oppose euthanasia are falsely convinced that this action is euthanasia, they will refuse and create medical problems.

The issue of euthanasia is very serious. When someone directly and intentionally causes the death of another person, (euthanasia) for any reason, the person dies. This is an irrevocable decision.

To create false sympathy by using fictional stories is irresponsible. The ad campaign attempts to create a situation where people will believe that unless we legalize assisted suicide, people will suffer when they are dying.

It is not necessary to give physicians the right to directly and intentionally cause the death of their patients in order to prevent suffering. What we need to do is improve access and the availability to excellent care in Canada.

Advertising specialists need to maintain a level of ethics. The fact that these park bench stickers have fictional stories about a serious issue and they have website information that connects people to false and misleading information should be dealt with by advertising standards ethics.

As I stated in the Toronto Star article:

Alex Schadenberg, executive director of Canada's Euthanasia Prevention Coalition, agrees that the stories created by McKay and Manson "are very compelling" but calls their website "misleading and inaccurate.

"No one wants to see people suffering in the way they describe," but the pair confuse euthanasia, the debate on whether doctors should be able to actually take a life, with being able to request that a doctor withhold treatment so the disease takes its course, Schadenberg says.

In conclusion, it is interesting that the advertising specialists are now saying that they are promoting living wills. I guess a good technique of dealing with criticism is to change the issue. The advertising campaign doesn't actually promote living wills but rather it promotes euthanasia and assisted suicide.

Let's hope society will reject these advertising specialists for there false representation of a very serious and socially contentious issue.

Compassion at the end of life - and choice in how one dies - is a slippery subject to term and define for both opponents of aid in dying and proponents. Schadenberg prefers cut and dried ideas of death. A lethal prescription is in his mind - and essential to the purpose of his organization - distinctly different from, say, denial of treatment or removal from treatment. Or use of the double effect, as according to the Catholic church and doctors (to avoid prosecution) is really sedating a person to death in order to relieve pain. So long as the purpose is said to be relief of pain, the responsible party is not guilty of aid in dying.

See what I'm getting at? Ethics demark no clear line between alleviation of suffering and hastening death, or removing treatment, or denying treatment. What is best for the patient - as the patient decides - is what the doctor is there to do. And it should be what society is here to do.

The pending case in Connecticut will ask the courts to decide that aid in dying is not assisted suicide, a prosecutable offense, because the patient does it himself. Talk about out-defining the opponent!

Regarding the campaign, I imagine Schadenberg is bent because he has noticed how effective it has been. It is emotionally moving and demands a strong response to the suffering of patients.

The creators were wise to use fictional stories. Using the real name and situation of a patient would betray that individual's privacy. The use of fictitious characters really bothers Schadenberg though (and he strangely seems to equate fiction with "not serious") and I can understand why.

For decades, anti-aid in dying advocates have continued to betray a patient's privacy in end of life decisions. In fact, the entire premise of their fight is based on their assertion that they know what is best for a dying patient than the patient or his doctor do. Yes, these groups will claim that they are working for the individual's best interests, but when that means asserting rights over another's health care decisions, it's a false claim.

I really suspect Schadenberg's just sorry that he's not the big voice in the media getting to frame the issue, as he typically tries to be.