Aid in Dying on Network TV.

Barbara Coombs Lee, Gary Blick and Stewart Lane will be on Anderson Cooper 360 tonight. The email from Compassion and Choices where Coombs Lee is president:

While still taboo for many families, increasingly our nation is engaging in a thoughtful, often difficult, dialogue about end-of-life choice. This shift is evidenced by the vigor and reach of public discussion surrounding this weekend's release of You Don't Know Jack, an HBO film about the life of Dr. Jack Kevorkian.

The truth is, many dying patients suffer, even with adequate care and pain management. Others fear that their pain will become unbearable. Unable to talk openly with their physicians about a range of legal, safe, peaceful options to ease a painful dying process, desperate patients look to guns and other violent options to end their lives. Or they ask physicians to work secretly outside the law.

Compassion & Choices advocates that all mentally competent, terminally ill patients should have a full range of end-of-life choices, including aggressive pain and symptom management, palliative sedation, voluntarily stopping eating and drinking, forgoing life-extending interventions and aid in dying.

You may be interested in watching CNN's Anderson Cooper 360 tonight where I was invited to be the voice of Compassion & Choices' supporters in a conversation about our landmark Blick v. Connecticut case. We represent two physicians, Gary Blick and Ron Levine, who are asking a Connecticut court to rule that the state's assisted-suicide statute does not reach their conduct in providing aid in dying to their terminally ill patients. Joined on Anderson Cooper 360 by Dr. Gary Blick and his patient Stewart Lane, I asserted that without a rational public discussion that includes aid in dying as a medical standard of care, covert aid in dying would continue.

Dr. Kevorkian recognized this need, and drew the national and international spotlight to the desperation of patients whose current legal choices are inadequate. His actions raised public awareness and highlighted major public policy problems. As in every movement for social change, there are provocateurs and persuaders.

Compassion & Choices works within the law, using education and advocacy to advance a vision where all Americans can live and die as free people, in dignity and according to their own values. We believe patients should be able to talk with their physicians about legal, safe, peaceful options for easing a painful dying process

Connecticut Seeks to Define Assisted Suicide.

On Monday the Connecticut courts began examination of the laws forbidding assisted suicide. A case that seeks to determine aid in dying as separate from assisted suicide has been brought by two doctors in that state:

On Monday, judges will begin deciding what suicide means or dismiss the case on whether state law applies to doctors who help terminally ill patients die.

Two doctors and end-of-life advocates filed a lawsuit filed to get some clarification on the state's ban on assisted suicide and hope it prevent second-degree manslaughter charges for doctors who prescribe medication to help patients end their own lives, the New Haven Register reports.

Fairfield doctors Gary Blick and Ronald Levine regularly care for the dying, according to court papers and said they said fear of being prosecuted stopped the doctors from giving dying patients medications that would aid a peaceful death.

Compassionate Choices is also part of the lawsuit, siding with the doctors.

The state is working to convince the judge that the issue of assisted suicide is best left to the legislature. It's the same route the Montana state attorney took in that case last year.

More info From the Hartford Courant.

WTIC provides some background on the suit, noting the involvement of the Connecticut Catholic Conference:

Separately, the Connecticut Catholic Conference asked the judge to become a party to the lawsuit. The judge has yet to rule on that request.

Connecticut Catholic Conference lawyer Lorinda Coon said the lawsuit is a backdoor effort to legalize doctor-assisted suicide in Connecticut.

The Catholic Church opposes suicide.

From the Christian site LifeNews, an interesting quote from Perry Zinn-Rowthorn, associate attorney general, that points to the religious opposition against aid in dying, linking it to abortion. As well, the site calls the doctors pro-euthanasia:

Zinn-Rowthorn also pointed to a measure in the state legislature that attempted to legalize abortion that had 14 pages of regulations and safeguards and warned that overturning the assisted suicide ban would lead to a free-for-all targeting the terminally ill and elderly.

"We don't have any of those safeguards," he said, according to the newspaper. "It would be dangerous, from a public health policy (standpoint), to issue this type of sweeping public policy change by declaration."

Attorney Daniel Krisch represented the pro-euthanasia doctors and argued the state should allow people to make their own decision about whether to get help from a physician to kill themselves using lethal drugs.

"Judges aren't supposed to legislate ... are we really asking the court to do that here?" the judge asked Krisch.

But by far the most interesting aspect of this suit is the way the Connecticut Catholic Conference is trying to work as co-defendents of the suit by petitioning to team up with the state. The church has a new boldness since their successful efforts during the summer to pass the Stupak amendment. In other areas around the country, they continue to fight patients' rights by taking over hospitals and ending reproductive services.

These and other instances of increased Catholic conservatism are strongly contrasted against their challenges last week, noted by Elissa Lerner at TheRevealer.

This motion to intervene has yet to be decided on but you can read the motion here.

And you can find all the briefs and additional information about the suit here.

Aid in Dying in Connecticut.

On the heels of the Montana Supreme Court's decision on New Year's eve that nothing in the state laws prevent the use of aid in dying comes a court case in Connecticut which challenges an aged statute that prohibits "assisted suicide."

The plaintiffs will argue that the right for a terminal, mentally sound patient to receive a lethal prescription from their doctor which they may choose to take is not "assisted suicide" but aid in dying.

The Connecticut Law Tribune writes a good summary of the case, although I wish they had distinguished the difference being made between the two terms and that aid in dying is a choice elected by the patient and self-administered:

Aid In Dying

Dennis C. is 72 and suffering from terminal lung cancer. Chemotherapy and radiation have had little effect. When not inundated with morphine or other drugs, he is in great pain.

Dennis’s doctor is a highly regarded Connecticut internist. He has watched this disease take over Dennis’s life. Yesterday, Dennis asked his doctor if he could give him something to help him die. What can his doctor legally do?

A law passed some 40 years ago states that any person who “intentionally causes or aids another person, other than by force, duress or deception, to commit suicide” is guilty of second-degree manslaughter. There is no exception for doctors.

End of story? Maybe not. Two doctors are asking a Connecticut court to rule that this statute does not necessarily prohibit “aid in dying...a recognized term of medical art,” which “may, in the professional judgment of a physician, be a medically and ethically appropriate course of treatment.”

Despite the “assisted suicide” prohibition in the Connecticut law, it is today generally accepted that a “living will” may direct a physician to withhold procedures “that would serve only to artificially prolong the dying process” and may provide that the patient “be permitted to die naturally” with only those medicines or procedures that provide comfort or alleviate pain.

Connecticut law permits doctors to follow these directives for patients in a “terminal condition.” It defines that as “an incurable or irreversible medical condition” which, in the opinion of the attending physician, “will result in death within a relatively short time period.”

Using such a definition, how different, ethically, would it be to allow a patient to further direct the use of affirmative medical procedures that would, in fact, hasten the dying process?

Whether a Connecticut court feels free to recognize an exception for “aid in dying” or simply concludes that it must follow the literal language of the assisted suicide statute remains to be seen. Should it make a difference to the court that the legislature has, in fact, confronted the issue before and refused to amend the statute? Would it be appropriate for the court to approve an exception by reasoning that if the legislature strongly objected to the judicial gloss, it could easily amend the current statute to specifically deny such an exemption or further define its permissible use?

In the event the court believes it cannot recognize a physician’s “aid to dying” as not covered by the assisted suicide statute, the legislature should itself re-examine the restrictions imposed by this statute. How might it be useful to do so?

Here is a short list of some of the many issues that the court and the legislature should consider, and some possible responses:

• What category of doctors should be allowed to decide whether to carry out a patient’s aid-in-dying request?

The doctor making the decision should be one of the treating physicians. If there are any circumstances that might compromise the decision of a treating physician, then another physician in the same specialty should be so authorized.

• When and how should the patient’s aid-in-dying request be legally recognized?

If legally competent, the patient should be able to make such a request either in a living will or through a health care representative at a later time if duly witnessed. In the absence of either the spouse or other relatives should only be allowed to request an aid-in-dying treatment under very controlled circumstances. This topic warrants another editorial.

• What other safeguards need to be provided?

A “terminally ill” patient needs to be defined, probably in terms of the current language used for living wills.

Today, doctors regularly make medical decisions based on reasonable probability. Physicians treating very ill patients are perfectly capable of determining whether patients knowingly seeking an aid to dying are “terminally ill.” Physicians having doubts can always seek a second opinion. The point is that it is in the patient’s interests, and in society’s interests, to provide trained doctors with a legally permissible means of helping terminally ill patients die with dignity, whether through affirmative or passive means. •

Connecticut Court Case: Distinguishing Between "Aid in Dying" and Assisted Suicide.

Kevin B. O'Reilly posts a story at AmericanMedicalNews about the pending court case in Connecticut regarding aid in dying:

Gary Blick, MD, an HIV/AIDS specialist in Norwalk, Conn., and Ronald M. Levine, MD, an internist in Greenwich, Conn., in October filed a legal challenge to the state's assisted-suicide statute, saying the threat of punishment prevents them from prescribing lethal doses of medication

Dr. Blick said that since he started practicing in 1987, he has received numerous requests for lethal prescriptions from terminally ill patients with "agonizing pain" and poor quality of life. "I always tell them I can't do that -- I could be tried for manslaughter."

"For anyone who is terminally ill, who is mentally competent, for whom we know there's no hope, who has lost quality of life and is in chronic pain, we can help them to die with dignity," said Dr. Blick, medical and research director of the HIV/AIDS clinic Circle Medical. "That's what we call aid in dying. This is not assisted suicide."

The distinction between "aid in dying," also called Death with Dignity where legal in Washington and Oregon, and assisted suicide, a prosecutable act, is one that anti-choice advocates are working to prevent. O'Reilly quotes "pro-life" advocate Wesley J. Smith:

"The argument is to replace assisted suicide with a euphemistic advocacy term in the statute," said Wesley J. Smith, senior fellow in human rights and bioethics at the Discovery Institute, a conservative think tank. "It's an amazing and hubristic idea."

By hubristic, we can assume that Smith finds the idea of an individual controlling their last days and weeks in order to escape suffering an affront to either God, the state or the medical profession. His position assumes that an individual is not entitled to oversee and determine the care of their own body, dignity, or quality of life. And considering that most hospitals and hospice facilities already practice Continuous Deep Sedation to alleviate pain until death, without patient consent or the strict regulations determined by the Death with Dignity law, the concept is hardly amazing.

Yet, the nature of the two acts, aiding a mentally competent, terminally ill patient - who is going to soon die - to choose their time and manner of death is not the same as assisting someone physically healthy to end their life.

As we wait for the Montana Supreme Court to deliver a decision on Baxter v Montana and watch the New Hampshire legislature draft a Death with Dignity bill, the case in Connecticut will teach us much about how aid in dying translates under that state's constitution.

On Figs, Baloney, Consistency and Post-Modernism.

In a post on the 6th at FirstThings, Wesley J. Smith gets riled by the case in Connecticut, brought by two doctors, that challenges the constitutionality of assisted suicide. It's a post about definitions.

He calls inconsistent the efforts by advocates to, by court or by legislation, legalize assisted suicide. (See my little bit earlier today about majority rule and minority rights.) Then he gets damn wacky with talk of euphemisms, gobbledygook, and post-modernism.

By conflating suicide and assisted suicide (and claiming that depression is the cause and hospice is the answer, see other posts), Smith fails to address the real cause behind the movement to legalize aid in dying: personal choice. Who owns suffering? Not the patient, according to Smith, because personal suffering is, well, just narrative.

(Incidentally, Smith is all for condemning democratic vote when it doesn't serve his purposes.)

The assisted suicide movement doesn’t give a fig about consistency. If people attack legalized suicide, they pound the podium and assert that we must respect state’s rights. But when states refuse to legalize assisted suicide–as in Montana–they file lawsuits hoping an activist judge will find a heretofore unheard of “right” to assisted suicide.

**

It’s really not hard: Suicide is knowingly taking action to kill yourself, in this case, taking an overdose of drugs with the intent to die. Assisted suicide is providing the means or otherwise assisting that action, in this case, prescribing sufficient drugs to kill the patient in the knowledge that suicide is the patient’s intent. It isn’t prescribing drugs for a legitimate medical purpose, such as treating pain.

“Aid in dying” is just a gobbledygook euphemistic advocacy term that pretends terminally ill people can’t commit suicide. In other words, it is postmodernism run amok in that it would disregard facts and sacrifice accurate definitions on the altar of personal narrative. So, if I give someone dying of cancer a gun, load it, cock it, and help them point it at their head knowing they will pull the trigger, I have only aided in their dying? That’s nuts. People like Tucker will say, but that’s violent, so it is suicide. Baloney. The principle doesn’t change if a doctor is prescribing a poisonous overdose or I am helping someone shoot themselves.

Blick v Connecticut

A new case in Connecticut has been filed by doctors Gary Blick and Ron Levine, "asking a Connecticut court to rule that the state assisted suicide statute does not reach their conduct in providing aid in dying."

Get all the news on the case, view the press conference, and watch for updates at Compassion & Choices.