Aid in Dying in Massachusetts

It's no surprise that the Massachusetts Medical Society has affirmed it's stance on opposition to aid in dying. The Dignity 2012 campaign which has put aid in dying on the ballot next year is receiving a lot of attention and I expect the MMS was under pressure to reassert their position. The Boston Globe article is interesting for one point, however: the announcement was made without MMS polling it's members. In other words, the decision was made by leadership. I suspect that, like most medical societies in the US, leaders feel that coming out in support of aid in dying is still too nuanced a position and one that continues to undermine faith in doctors if publicly stated. Yet, the double effect, a practice that allows a doctor to give a patient a lethal dose of medicine so long as the intent is to keep the patient comfortable, even if it kills them, is still upheld across the country. Between aid in dying and the double effect, one has to ask, where is the bright line? At public perception, apparently.

The National Catholic Register also weighs in this week on Dignity 2012, outlining for readers what the Catholic Church is doing in that state to combat legalization (and neglecting to count Montana as one of the states where it is legal). Most of the article's quotes from Catholic leadership echo last June's announcement by the Catholic Church of a new campaign to fight aid in dying. A clip from the article:

In Masses geared to area legal and medical professionals, Cardinal Seán O’Malley has taken the opportunity to speak out forcefully against the initiative.

“We hope that the citizens of the commonwealth will not be seduced by the language, ‘dignity, mercy, compassion,’ which are used to disguise the sheer brutality of helping someone to kill themselves,” said the archbishop of Boston at the Red Mass on Sept. 18.

Stephen Crawford, communications director for Dignity 2012, the supporting group of the initiative, thinks the “people of Massachusetts are ready for the discussion on this issue.”

Janet Benestad, chairwoman of a Boston archdiocesan steering committee on physician-assisted suicide, said that a group of about 12 people, some with connections to Harvard Medical School and the New England Journal of Medicine, were able to get an initiative petition certified by the Massachusetts attorney general on Sept. 7.

Supporters of the petition then had to gather 68,911 signatures for it to be considered by the state Legislature. Brian McNiff, a spokesman for the Secretary of the Commonwealth of Massachusetts, said as the Register went to press Dec. 8 that the group had filed over 80,000 signatures but that his office still had to count and verify them.

Peter McNulty of the Massachusetts Catholic Conference said that “the bishops are very much concerned with this issue,” and a steering committee has been formed to recommend a course of action. The conference is the public-policy arm of the state’s bishops and represents the four dioceses in the commonwealth.

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.

BBC's Pro-Death Propaganda

A BBC special by the renowned British author Terry Pratchett has caused a stir in the UK. Shown Monday night, "Terry Pratchett: Choosing to Die," included footage of a patient ingesting lethal medication and dying in a Dignitas clinic in Switzerland, where aid in dying is legal. Nearly 900 viewers contacted BBC to complain. The show caused a furor that reached the state level; several peers are accusing the station of taking a side in the aid in dying debate, one of the more contentious issues in Britain at the moment. Aid in dying is not legal in the UK. Terry Pratchett, diagnosed with Alzheimer's, is a vocal advocate for the right to die.

Last year Kier Starmer, the Director of Public Prosecutions, ruled that it was legal to assist a patient in their death, a decision that was the result of a court case brought by multiple sclerosis sufferer, Debbie Purdy, in 2009. Purdy asked the courts to allow her partner Omar Puente to assist her travel to Switzerland when she decided to end her life -- without risking court action when he returned.

(h/t Mrak)

So Long, Jack.

Jack Kevorkian is dead at the age of 83. News came in yesterday and it's taken me a little while to sum up what, if anything, I have to say about it. The media's dream, the assisted suicide movement's nightmare, Kevorkian cornered the national conversation about death. And it's hard to knock anyone who gets us talking about death. As I often write, we're in a national (and international) health care crisis. The world's population is quickly growing older, subject to medical systems and structures that are woefully unprepared for the increasing needs of this population. Our national economy will shortly be brought to a halt if meaningful health care reform isn't enacted. (No, I don't mean Obamacare. I mean real reform.) And increasingly, elders are not dying the way they want to.

While Kevorkian brought this conversation to prime time -- and everybody has an opinion on Jack Kevorkian -- and while he did it without the horrifying saccharine sweet sentimentality that impedes the meaningfulness of such conversations, he erred by allowing himself to be portrayed as a cantankerous clown. He was too easy to paint as a quack, a cantankerous fanatic obsessed with death. If there's anything I've learned in my modest time writing about death (and religion), it's that tone and sound bites have more impact than facts. In a society that packs death off to nursing homes and hospitals, we desperately can't afford dismiss-able spokesmen who allow media to relegate the conversation to spectacle.

And there's no doubt that Kevorkian became a spectacle. Patients' rights don't mean much when reduced to snuff clips on 60 Minutes. So while I strongly believe in choice at the end of life -- and sympathize strongly with Kevorkian's mission -- and while we've seen three states adopt rational, helpful laws regarding patient's rights at the end of life since Kevorkian's rise to prominence, I don't think that the life and times of Dr. Death Kevorkian has really moved the nation or the assisted suicide movement ahead in the necessary grapple that is our impending health care crisis.

Still, may he rest in peace.

More on Kevorkian's death: From his Royal Oak neighbors. From Janice Van Dyck at HuffPo's Healthy Living. Icky monomaniacal Wesley Smith at National Review. Jeff Gerritt at Detroit Free Press. Tami Abdollah at AP gets it mostly wrong. Another AP story calls Kevorkian "audacious." UK's conservative BioEdge calls Kevorkian a "suicide hero." Christian Post focuses on Kevorkian's dismissal of religion. Religion Dispatches' Susan Henking gets stuck in the nomenclature, picks out how various religions discuss suicide (and cites Durkheim!) and divides the landscapes into two erroneously-named sides, "the right-to-life" and "right-to-death" movements.

Assisted Suicide Bill Defeated in South Australia

South Australia's Parliament defeated a bill that would have amended an existing law to allow assisted suicide. While it's estimated that 80% of voters favor the amendment, parliament rejected it. From The Sydney Morning Herald:

But Family First MLC Dennis Hood said the bill was "dangerous" and he was relieved it was defeated.

"Parliament has spoken loud and clear. Voluntary euthanasia for SA has been soundly defeated and should be moved off the agenda," he said.

"I am grateful that members listened to my concerns and made the decision on conscience to oppose the bill."

Mr Hood said the bill would have allowed euthanasia for patients that did not have a terminal illness, left psychological referral of patients as an option only and offered a "toothless" Voluntary Euthanasia Board to oversee the practice.

In September this year, Ms Key announced she would introduce the bill into parliament's lower house while Greens upper house MP Mark Parnell will put the identical bill to the Legislative Council.

Mr Parnell had similar legislation defeated in the upper house last year.

At the time, Ms Key said it was time for the SA parliament to catch up with public opinion.

"Over 80 per cent of Australians support the right of the terminally ill and others living in intolerable pain and suffering to seek the assistance of a doctor to end their own lives at a time and in the circumstances of their choosing," she said.

Mr Parnell said the bill required a patient to be examined by two doctors, including at least one specialist and oversight by a Voluntary euthanasia Board.

But influential Port Pirie Catholic bishop Gregory O'Kelly was among vocal opponents of the plan, blaming the recent rise of minor political parties for "pushing death.

"It is a sadness that the first moves around our nation under our new political arrangement seem to be a promotion of death and abuse of marriage," he said in September.

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

The Implosion Cometh, OR, It's Only Fear-Mongering if it Contradicts Your Ideology.

The fight for quality health care has been framed by conservatives (with time-honed fear of government programs and ideological adherence to "pro-life" but futile care policies) as an either/or financial and "sanctity of life" apocalypse. Either we as a society recognize "human exceptionalism," a term bandied by the likes of Wesley J. Smith and meant to codify a "pro- life" ideology that means, particularly regarding end of life care, irrational expenditure for treatments that do nothing to cure or extend life or -- and here's the implosion scenario used -- we start killing the vulnerable.

What a tragic debacle that will cause suffering beyond comprehension. And this is is the milieu in which legalizing assisted suicide is being seriously contemplated! Unbelievable.

It's a black-and-white view of a much more complicated challenge faced by westernized countries the world over, one that does little to problem-solve loss of patient autonomy, the impossible rising cost of health care, discrimination in health care delivery, lack of corporate regulation, nor the very necessary discussion of death and palliative care that desperately needs to take place. But, as you'll notice in the comments to WJS's fear-mongering post and as I mentioned at the beginning, there are political and ideological objectives that are met by fanning fear among the elderly, disabled, and poor. Smith and others are willing to call recognition of a crisis fear-mongering when it contradicts their objectives.

Regarding climate change, another challenge with political and ideological framing but one that pitted "alarmists" against climate change deniers, Ross Douthat writes today at the New York Times:

The Seventies were a great decade for apocalyptic enthusiasms, and none was more potent than the fear that human population growth had outstripped the earth's carrying capacity. According to a chorus of credentialed alarmists, the world was entering an age of sweeping famines, crippling energy shortages, and looming civilizational collapse.

It was not lost on conservatives that this analysis led inexorably to left-wing policy prescriptions -- a government-run energy sector at home, and population control for the teeming masses overseas.

Social conservatives and libertarians, the two wings of the American right, found common ground resisting these prescriptions.

I quote Douthat, though I dislike his politics greatly and find his own prescription for climate change -- do nothing and see what happens -- to be terribly irresponsible, because he makes an important point.

Social conservatives and libertarians are denying on-the-ground facts regarding delivery of health care (and climate change) not because they don't think we need to solve the problem but because the only viable solutions belong to the opposing political party.

An interesting bit about this post: I came to the Smith hand-wringing post via a fundraising email from the activist organization founded by Terri Schiavo's family, dedicated to legislating that patients like Schiavo not be removed from life support.

Knowing the Facts

Two True/Slant journalists are having a back-and-forth about the "right to die." The first, Ethan Epstein, has just learned about the Hemlock Society and basically says that if people want to end their lives, let them go at it. What legalizing AS would do is allow doctors to kill patients.

It's a juvenile argument that anyone following the conversation could debunk any number of ways: suicide is not assisted suicide, many suffering patients don't want to end their lives violently (guns, etc.), our medical system has developed in such a way that patients are subjected to futile, life-prolonging care that they would never have agreed to had they been informed and prepared, artificial life-sustaining methods of keeping patients alive are hard to end once they are begun, and doctors provide their patients with the means (like a gun seller does, like a Henkle knife sales man does, like a hardware salesman when he sells a rope does). The patient must self-administer any lethal medication. Humans don't have a right to die, he says. Geesh. Want me to go on?

He's got no history on the issue, no life experience of it (apparently), and no knowledge of the current bioethical or political debate.

His colleague, Sahil Kapur, weighs in and debunks Epstein's "logic." It will be fun to watch this dialogue if it continues.

Tasmanian Devils.

If you want a rational voice on end of life care and law, I can recommend some others than Wesley J. Smith who makes his money from the ultra-conservative Discovery Institute and books, blogs and articles (for the likes of National Review and First Things) on nebulous, bible-esque stuff like the "sanctity of life" and the "slippery slope" and the "culture of death" that's out to kill, you know, any body it can. The underlying groan of Smith's writing is anti-"socialist" -- whatever that means -- and yet strangely all for government telling us when and where we can die. It's an odd, potent mix of narrative that, thanks to a host of popular (but not truly populist) politicians and media celebrities, has tea party (hence, well-funded think tank) legs at the moment.

Australia has been debating assisted suicide for a while. Never one to lose a chance at the limelight, Smith's decided to weight in. From ABC News Australia:

Wesley Smith has been brought to Australia by the Right to Life lobby group to lobby in Tasmania, Queensland, Victoria, New South Wales, and Western Australia.

Mr Smith says Tasmanian politicians' backing for a private member's bill could end in a voluntary euthanasia law that will lead to a broader range of people being eligible for assisted suicide.

He says that in Belgium and the Netherlands legislation has been gradually eased to allow sick babies, people with mental illness and healthy spouses of terminally ill people to be euthanised.

Mr Smith says there can be no legislative roadblocks to restrict who would be eligible for assisted suicide.

"Once you accept the precepts of assisted suicide, that suffering is a just cause for helping someone to end their life, it's not going to remain restricted," he said.

"That's the argument I think we should have as a society."

In other words, Smith's not interested in dialogue, he's already laid out his argument and expects others -- despite the horrors of end of life care, four decades of technical advancements that have changed the definition of death, rampant futile care, and failing health systems across the globe -- like the Australian government to toe his line.

We can say that Smith has a right to his opinion here in the U.S. -- the First Amendment exists for a vital reason -- but he must adhere to facts, an area where he prefers to move quick and loose. But playing the ambassador to other countries, even at the invitation of religious groups that espouse broad imposition of ideological medicine on all citizens, is really offensive. Particularly when he purports to be an expert, touting the horrors of the Netherlands' and Belgium's laws and health care systems. From a man who still claims Terri Schiavo was murdered. His broad-strokes, black and white approach to bioethics is embarrassing. His use of the controversial subject and the politically, ideologically motivated "right to life" organizations to get the limelight is irresponsible. Take the "Made in America" sticker off that export.

Dying at Home in the UK

Britain's Health Secretary, Andrew Lansley, has announced that more people should be allowed to die at home, a phrasing that gets at the challenges of end of life care, from The Telegraph:

Speaking at the International Carers Conference in Leeds, he said: “Having a terminal illness is a very distressing time for individuals and their families. People should be able to choose where they are cared for – most would choose to be cared for at home, surrounded by their friends and family – and be certain that the care they receive will be of the highest quality.

“This review will look at how we better deploy the money we spend on palliative care – so those in need are better supported. We intend that whatever care patients choose will meet their needs and wishes.”

In the U.S., as I've written before, about 80% wish to die at home but only about 20% do. I've been interested to see how attention to end of life care changes when the issue of assisted suicide (in all it's nomenclature) is discussed. Britain has been in the midst of a public discussion of end of life care, assisted suicide and the legal challenges of such laws thanks to the Purdy case last summer. I wonder if this elevated level of awareness there has had any effect on Lansley and the proposed study?

Dying to Avoid the Death Tax

James Parke at Colorado Planning and State Probate Blog writes this in response to yesterday's Wall Street Journal article, "Too Rich to Live":

As a refresher, there is currently no estate tax in 2010. Thus, if a person dies this year, they can pass an unlimited amount of wealth to their heirs without paying a dollar of federal estate taxes. In 2011, however, the estate tax reappears with a top marginal rate of 55% and an exemption of $1M. For example, if a person worth $20M died on December 31, 2010, they would not pay any federal estate taxes. If that same person lived a few hours longer, and died on January 1, 2011, they would pay almost $10.5M in federal estate taxes. Seems a little arbitrary, doesn't it?

People have been speculating for years about the perverse incentive that this creates for wealthy people and their families. Will this result in a string of suicides? Or even worse, homicides? Until recently, I thought that these speculations were simply ridiculous hyperbole masked as legal analysis. The Wall Street Journal has taken this discussion to a new level by listing jurisdictions that offer physician assisted suicide. The one thing that kept going through my mind as I read this article is: are you serious? Why would they go through the trouble of doing that research and publishing that information? It almost seems like they are encouraging this ridiculous behavior.

Of course the WSJ is the paper of money and inherently conservative but before they give the partial details that get Parke upset, they make the obvious point:

Of course, there is a "death incentive" whenever Congress raises the estate tax. But it hasn't happened in decades; the top rate has held steady or fallen since 1942, according to tax historian Joseph Thorndike of Tax Analysts, a nonprofit group.

How is it that the inheritance tax has remained steady for 68 years? A concerted, organized and devious effort by conservatives to brand it the "death tax," thanks to Frank Luntz, get-one-over-on-the-people-for-the-sake-of-the-stinky-rich extraordinaire. (In part, Luntz is also responsible for the horrendous health care bill we've got. All that socialism talk, death panel stuff can be traced back to him.)

Disparaging taxes is easy. Nobody wants to pay more than they have to. But that's only part of the story -- the part that the WSJ, folks like Luntz, and, well, the wealthy, have worked to spread. The wealth disparity in the US -- and the world -- is greater than it has ever been. If the poor were poor because they just didn't care to earn money -- as if that desire to be rich were golden! -- then we'd have another issue altogether. But wealth disparity is created by taking advantage of the disadvantaged. Shaming project-born children, giving them futile educations, keeping them out of college. Allowing corporations to treat their low income workers any way they want. Preventing restructuring of health care. Spending more on infrastructure in wealthy areas than elsewhere. We've got a national system of keeping the down down. Any time you hear entitlements, socialism, natural law, and the like, pay attention to who is saying it and what privilege they're speaking from. Those that have wealth have employed our American mythology to make sure they keep it. And yet, greater equality means a brighter future for the nation.

And that's why the estate tax has remained unchanged for so long. Common Americans were hoodwinked into believing that the increase of death taxes would grossly affect them. And yet, I'd like to see the numbers on how many Americans are going to suffer unsurmountable penalties. The WSJ uses the case of an estate worth 50 Million to demonstrate the taxes cost. How many U.S. estates are worth that? Why doesn't it give us real statistics on how many Americans have 1 million and do the math from there? Because the WSJ -- and Parke -- have a clientelle to protect. And its most likely not me or you.

To Parke's other point: that the WSJ is irresponsible to publish information regarding legal assisted suicide. Pure rubbish. There are currently three states and the battle in those states was so pronounced that residents and their lawyers and doctors couldn't have missed it. Instead he should be concerned for the end of life tragedies that abound because of lack of health care, poor finances, few resources and abuse in the U.S. Assisted suicide laws make states accountable for their ill and elderly. And besides, it's a hell of a lot easier to buy a gun than to get a lethal dose of anything from your physician. Parke's is a moot point, misdirected.

In fact, because of the sad economic state of the U.S. right now, this is probably the best time to reinstate the inheritance tax. I can think of some other policies we could change too.

Portland Doctor's License Suspended

Stuart Weisberg, a Portland Psychiatrist who planned to open an assisted suicide clinic, has had his license suspended.

Wesley J. Smith on the matter.

Compassion & Choice's response to the license suspension:

Compassion & Choices today responded to the Oregon Medical Board’s suspension of Dr. Stuart G. Weisberg’s medical license. Dr. Weisberg had proposed to open a private, for-profit facility to offer physician aid in dying.

Patient safety, ensured by precautions in the Death with Dignity Act (DWDA) would have prevented Dr. Weisberg, a psychiatrist, from serving as an attending (prescribing) physician, “the physician who has primary responsibility for the care of the patient and treatment of the patient’s terminal disease.” Neither could he have been a consulting physician, “qualified by specialty or experience to make a professional diagnosis and prognosis regarding the patient’s disease.”ORS 127.800 s.1.01. A psychiatrist does not have the expertise necessary to treat or diagnose a terminal illness.

“Law enforcement and professional oversight are in place to ensure no individual tries to practice outside the law or established standard of practice,” said Barbara Coombs Lee, President of Compassion & Choices. “The Oregon Medical Board made the right move suspending Dr. Weisberg’s license for past violations improperly prescribing drugs. Additional safeguards would have prevented him from prescribing under the DWDA.”

”We understand a proposal like this attracts attention,” said Coombs Lee, “but aid in dying is legal in Oregon. It is part of the standard of practice along with other end-of-life care options. After twelve years, the DWDA is working as the voters of Oregon intended. Individuals can take control of their dying if suffering becomes intolerable. They usually choose to do so among the people they love in their own homes. Oregonians don’t need and don’t seem to much want the kind of setting Dr. Weisberg proposed. The rest of what he proposed to offer is illegal.”

Germany, Latest Country to Wrestle with Assisted Suicide

From Deutsche Welle:

Germany's highest criminal court has ruled that passive assisted suicide is legal if the patient has explicitly decreed his or her wish that treatment used to keep the patient alive should be terminated.

"Turning off a ventilator or cutting a feeding tube fall under the category of permissable forms of terminating treatment," judge Ruth Rissing van Saan said.

The ruling by the Federal Court of Justice refers to a case involving Erika Kuellmer, a then terminally-ill patient in her seventies, who had been in a coma for five years. Prior to becoming unconscious, she indicated to her daughter that she would not want to be kept alive should she fall into a coma.

On the advice of her solicitor Wolfgang Putz, who specializes in medical law, the daughter tried to help her die by cutting the tube that was feeding her mother. But staff at the care home intervened and the patient survived another two weeks before dying a natural death.

Reports from the Annual Catholic Health Association Assembly

I wasn't able to attend because I'm not a CHA member and, for some reason, couldn't muster up a sponsor, but the reports are now coming in from the event which was held on the 13th through the 15th of this month in Denver.

From U.S. Catholic, an article about the assisted suicide panel:

Proponents of assisted suicide are using the U.S. church's own revised ethical directives as "propaganda to promote" their cause, a physician and Franciscan brother told a workshop at the Catholic Health Association convention June 14.

Compassion & Choices, a national organization created from the merger of the former Hemlock Society and Compassion in Dying in 2005, is telling people that the "Ethical and Religious Directives for Catholic Health Care Services" now require that "everyone will have a feeding tube rammed down their throat" at Catholic health facilities, said Franciscan Brother Daniel P. Sulmasy.

Brother Sulmasy, a medical doctor who also holds a doctorate in philosophy, is a professor of medicine and ethics at the University of Chicago. He was joined by two other speakers in a panel discussion on "Responding to the Advance of the Physician-Assisted Suicide Agenda" at the CHA convention in Denver.

"Assisted suicide is bad ethics, bad medicine and bad public policy," he told the session. "If it wasn't for that, I'd be all for it."

Reviewing the various efforts to make assisted suicide legal beyond Oregon and Washington states, Brother Sulmasy said that although most efforts have been in the courts or state legislatures, Compassion & Choices also has been conducting a public relations campaign that misrepresents the Catholic directives on withdrawal of food and water that were revised in 2009.

Who Wants To Die? Belgium and Junk Studies.

Fox news and other outlets are reporting that Belgium, long the recipient of scorn for being one of the few nations where assisted suicide is legal, is killing the dying. A survey (of some sort) was conducted of (a very limited number of) nurses on how often they euthanized (however you wish to define that term, type of drug insignificant) a patient (their health status not included in the article) without the patient's consent (written? verbal? what about the family's or the doctors?).

It's the perfect proof of a slippery slope! Give that "culture of death" an inch and it will take your mama!

From the story at Fox:

In interviews with 248 nurses, a fifth admitted they had taken part in a euthanasia procedure based on the “assumption” that the patient wanted to die. Almost half of the nurses confessed to “terminations without request or consent.”

Sure it sounds terrible and scary. Fifty nurses running around offing patients whenever they feel like it, often doing it for the doctor who couldn't be bothered. And what's a vulnerable patient to do when they can't protect themselves and they don't want to die?

I expect it's all rubbish. Britain and Canada, where the primary stories come from, are in the midst of a harsh and unsavory battle over the legalization of assisted suicide. Any story that starts off using the term euthanasia, even one that is about a country in europe, without first clarifying the terms is coming already from a particular position on the issue. Neither article has a link to the original study, nor the name of the study organization - it could have been conducted by the Catholic Church for all we know.

Two of the story versions (here's a British one) quote Peter Saunders of Care Not Killing, an "anti-euthanasia" organization. In both, nothing is said about how the study was conducted, nor is there a description of what is meant by euthanasia. Were the nurses all clear in their answers and using the same definitions? What kinds of hospitals did the nurses work in? From what regions? How old were they? How long had they been nursing? What is consent? Were they trained in palliative care? Do they think that morphine ends lives?

Unfortunately, these types of unsubstantiated stories still move emotions. Just read the comment sections on any of them.

The Case for Suffering.

Here are two interesting clips: one a heartbreaking story from a New Haven, Connecticut newspaper about the experience of a dying friend; the other a article on a talk given by Margaret Somerville on why aid in dying should remain illegal in Canada. What I'm contrasting in these two clips is the way suffering is discussed, the value placed on it, and the religious ideas that inform our justifications of suffering.

The so-called murder-suicide of a North Haven couple suffering from Alzheimer’s and cancer touches me, not only sympathetically, but personally. I have a longtime friend who, as I write, is facing a prolonged dying in "the American way."

She is a virtual prisoner of what, echoing President Dwight D. Eisenhower, one might call "the medical-religious complex."

Certainly, there are reasons to hold life sacred and to beware the institutionalization of death-dealing. Counterweighing these is the respect due to an individual’s autonomy in matters of ultimate value, especially the quality of one’s own life and death.

My friend has led an active, meaningful life, but now finds herself unable even to read, or to take pleasure in personal company, or to get out of her hospice bed, because of both the pain of her illness and the grogginess induced by the drugs used to combat her pain. While everyone caring for her is well-intentioned, the fact is, as she just put it to me, "I want this to be over yesterday."

AND #2:

Arguments against euthanasia are complex and far more difficult to make, she said.

"Today, the argument for euthanasia is the easiest to make," she said, noting the concern for the autonomous individual. "It's my right, my body. The individual has the right to choose death."

The arguments against euthanasia concern its effects on institutions, such as the health care system, hospitals, doctors and society as a whole, she said.

People often argue that we are merciful to dogs by euthanizing them, so why shouldn't we do the same for human beings, she said. "We're not dogs!"

Somerville said one of the biggest challenges is to argue there is something special about human beings without using religious reasons.

Traditional religion used to serve as a way of putting talk of death into a context of eternity, she said. "It is very difficult to justify suffering without some form of religious argument."

Bioethics and the Worst Case Scenario

BioEdge has an interview with George J. Annas, author of the new Worst Case Bioethics: Death, Disaster and Public Health. Here's a clip:

BioEdge: Worst case scenarios aren’t exclusively bioethical – the Y2K bug springs to mind – so is there something in our culture which encourages us to frame the future as Doomsday? Is it the legacy of the Cold War and mutually assured destruction, or something deeper?

GJA: It has to do with our deep fear of death. The first sentence of the book is, “Death is almost everyone’s personal worst case scenario.” This, in turn, makes “saving lives” a universal justification for action—both in medicine and in government. Mostly, we deal with our mortality by denial, by not dealing with it. We simply put our faith in modern medicine and scientific progress that somehow we will be provided with new technologies that will permit us to postpone death indefinitely—or at least for a long time. In effect, we fight worst case scenarios by imagining best case scenarios.

BioEdge: What are the effects of US health policy moving away from public health to public security?

GJA: US health policy has never been based on public health and population-based prevention—but rather on individuals and treatment of their illnesses and injuries, at least those who can afford to pay. To the extent that concerns over bioterrorist attacks and pandemic flu and SARS have commanded attention and at least some resources on public health, we have been responding by adopting a military national security model – complete with public health officials in military uniforms. This has encouraged our government to predictably concentrate on 19th century interventions like mandatory vaccinations and quarantine when an epidemic threatens, rather than scientific information, and at least some public health officials still expect Americans to simply “follow orders” in a public health emergency rather than make informed decisions. This is delusional.

Euthanasia and Islam.

At Irtiqa, Nidhal Guessoum is guest posting about euthanasia. It's a two-parter and a quick read:

Part 1 - a discussion of "You Don't Know Jack"

Part 2 - a discussion of euthanasia (or assisted suicide, death with dignity, aid in dying) and Islam

Read these two excerpts, below, and tell me if they don't sound like the Catholic positions, the first espoused by the USCCB (those experiencing pain should be taught to understand the Christian concept of redemptive suffering) and the second by the Catholic Health Association. In other words, the theological and the practical:

I was also pleasantly surprised to find that an Islamic Code of Medical Ethics had been produced in 1981 in the First International Conference on Islamic Medicine held in Kuwait, and in it euthanasia was addressed quite squarely. Among the relevant pronouncements, however, one finds: “The claim of killing for painful hopeless illness is also refuted, for there is no human pain that cannot be largely conquered by medication or by suitable neurosurgery...”; “A physician should not take an active part in terminating the life of a patient, even if it is at his or her guardian’s request, and even if the reason is severe deformity; a hopeless, incurable disease; or severe, unbearable pain that cannot be alleviated by the usual pain killers. The physician should urge his patient to endure and remind him of the reward of those who tolerate their suffering.”

Finally, in an interesting recent article published in an Iranian journal of medicine, Aramesh and Shadi (2007) present the orthodox views of Islamic scholars (Shiite and Sunni), but at the very end try to show some “flexibility” by pointing to two instances where “passive assistance in allowing a terminally ill patient to die” would be permissible under Islamic law: (a) “administering analgesic agents that might shorten the patient’s life, with the purpose of relieving the physical pain or mental distress”; (b) “withdrawing futile treatment on the basis of informed consent (of the immediate family members who act on the professional advice of the physicians in charge of the case), allowing death to take its natural course.”

Ebay Ends "Murderabilia" Sale of Kevorkian's Van.

Ah well. Ebay has ended the timely sale of Jack Kevorkian's van.

HBO Airs Kevorkian Movie on Saturday.

And the media is abuzz with news about the movie. Here are some clips:

From conservative Human Events:

It’s not hard to guess where the folks behind the new biopic of Dr. Jack Kevorkian stand on the topic of physician-assisted suicide

HBO’s “You Don’t Know Jack,” debuting at 9 p.m. EST April 24 on HBO, recalls the later years of the man known by many as Dr. Death.

The network’s original content routinely leans left, sometimes only by a matter of degrees (“The Trials of Ted Haggard“), other times without check (“Recount”).

So expecting a fair and balanced debate on assisted suicides from the critically hailed cable channel seems unwise.

You Don't Know Jack isn't a "news story" on Fox. It's a movie. I don't think fair and balanced was one of the mandates. But clearly, because the movie purports to make Kevorkian a human being, opponents are claiming -- and they may be right, I haven't seen it yet -- that assisted suicide is made warm and fuzzy. Well, so is unwanted pregnancy, poverty, working 80 hours a week, dying in war or dying in a hospital in pain....

Final Exit Network, in a press release about the movie, gets one thing right:

Advances made in medicine over the last 50 years have been astonishing. Thanks to sophisticated new technologies and treatments, diseases once considered death sentences are now manageable conditions. The progress is often, however, a mixed blessing. Doctors' once-revered vow to keep patients alive - no matter what - often results not in extending life but extending death. Perpetuating "life" in a nightmare of powerlessness, constant pain, social isolation, and mental deterioration is tantamount to torture.

This is what the Kevorkian movie should have us talking about. And why it is so easy to paint Kevorkian as either a saint or a killer because he chose to address these issues.

From the Star Phoenix:

When he was writing the screenplay for the HBO biographical TV movie You Don't Know Jack -- about the right-to-die activist who famously, and infamously, championed the right of terminal patients to die by physician-assisted suicide -- Mazer says the last thing he wanted to do was fall into the old TV trap of cliches.

Mazer wrote his screenplay long before he learned Al Pacino would be cast to play the Michigan pathologist who would earn the nickname "Dr. Death."

Kevorkian famously served eight years in prison for second-degree murder after video of him administering a lethal injection was shown during a 60 Minutes interview with Mike Wallace in November 1998.

"We didn't set out to do a movie about assisted suicide," Mazer explained. "It is a movie about Jack Kevorkian." And Jack Kevorkian is a much more complicated person than the public picture suggests, Mazer said.

Avoiding the trap of cliches. And finding out more about Kevorkian.

If I get a chance to watch the HBO premier on Saturday I'll come back with my own review.