Euthanasia in the Netherlands, Ten Years On

Oy, what a crappy article. From the stock syringe image to the "two sides to every story" to the Nazi references, Marco Hochqemuth hits all the typical buttons on this brief piece about how the Netherlands led with same-sex marriage and other nations followed but only two have adopted assisted suicide since the Netherlands did 10 years ago. Sans the religion quotes, it's one of the more cliched articles I've seen in a while.

Read more on the 10th anniversary here.

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.”

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.

Massachusetts and the Tactics of "Pro-Life" Groups.

Marie Sturgis of Massachusetts for Life talks to super-conservative LifeNews about the new bill being discussed in that state that would make Massachusetts the fourth state in the U.S. to legalize aid in dying (also known as, tellingly by particular constituents, assisted suicide, "euthanasia," or Death with Dignity, the latter the name of the bills in Oregon and Washington).

There are a couple of things in this clip from the article that are worth noticing because they represent the "pro-life" attack on aid in dying the world over:

1. The unfounded claim that aid in dying is a "systematic devaluation of human life." Why allowing a patient who is determined to die (by two doctors) within the next six months and found to be mentally sound the right to die as they wish devalues life is unsubstantiated by any statistics - particularly those facts and statistics coming out of Oregon where aid in dying has been legal since 1998. What is unanswered by these claims is the question of how? The claim sounds true enough when unexamined: "killing" is never right or moral or just. And yet the absolutism fails to take in special situations and and personal choice.

2. Aid in dying "brings on sadness and sorrow." No studies have ever shown that the family members of those who choose aid in dying suffering more than those who die what "pro-life" groups call a "natural death" (largely a misnomer considered how we primarily die of fatal diseases in the current era of modern medicine, hooked up to machines, in a medical facility). Nor are there statistics that show the dying patient suffers more: in fact, the option of aid in dying often gives dying patients a calm that allows them to approach the end of their lives with peace.

The only exception to this is suicide by violent, undocumented, unregulated measures, often perpetrated by a suffering person due to mental instability or the feeling of lack of choices. Aid in dying, in these ways (mental stability, when all medical options are exhausted, under the guidance of a doctor) is not considered suicide legally. Patients' who select it are already sentenced to death by their terminal disease. Neither are they "giving up on life." They have tried all the known medical options to survive.

3. The way that William Stearn's comments regarding the need for strict regulations are twisted below betrays the right's inability to enter into the necessary nuance of the discussion regarding end of life care. For decades, they have (successfully) portrayed - not only to themselves but to the uneducated, inexperienced public - that any challenge to the state, the church or the medical industry about how we die is immoral and nothing less than "unsavory," "culture of death" factions "preying" on "the vulnerable." The whole of the Right's argument is based on the "immoral" desire to "kill" by aid in dying advocates, yet this argument does not hold up when you examine the desire for the latter to strictly regulate the practice - to the benefit of patients' rights.

To enforce this inaccurate view, the Right has cultivated disability activist supporters. More on use of "vulnerability of the disabled" will come from me as time goes on.

“Once we cross the line and we enter into the realm of the assisted suicide, we all become vulnerable,” Sturgis said. “It begins the systematic devaluation of human life.”

“No society should ever approve to take their own lives, whether it is using a doctor to help them or doing it themselves,” said Sturgis. “This is not death with dignity – it’s a situation that brings on sadness and sorrow.”

Rep. Louis Kafka, a Democrat, is the sponsor of H 1468 would allow patients medically determined to have less than six months to live to request that their doctor prescribe drugs that would kill them.

But even one supporter of the proposal, William Stearns, who said he lost his mother, father and sister to terminal illnesses, said some terminal patients are not able to provide proper consent for an assisted suicide.

He also worried that patients who receive the lethal drugs could accidentally leave them someplace where children or other people could get access to them.

Eileen Lipkind of Stoughton testified for the bill and said her husband, Al Lipkin, asked Kafka to file the bill before he died of stomach cancer.

But disabled people opposed the measure during the Judiciary Committee hearing, including Denise Karuth of Florence -- who is wheelchair bound.

“People ask me, ‘Why would a disability activist be opposed to this?’ ” said Karuth, according to the Milford Daily News. “The movement is based on the fear of loss of control.”

The newspaper said Karuth believes "such a law would make people with disabilities feel like they should die if they couldn't pay their health insurance or were suffering from abuses."

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.

"Pro-Life" Groups Focus on Aid in Dying.

It was predictable: state-level "pro-life" groups are working to focus their awareness efforts on end of life issues. The ubiquitous Wesley J. Smith was in Vermont for the annual National Right to Life rally this week to help attendees focus their efforts on aid in dying.

From the Times Argus; the article is a look at how these groups are approaching patients' rights and end of life care without any knowledge of the dying process and an un-nuanced approach to that ill-defined term "life." And the article is so fawning, it hardly counts as reporting.

Allowing doctors or other medical professionals to legally end the lives of patients is a radical, "culture-changing" shift in American society that, once begun, can lead to unintended and horrible actions.

A nationally known speaker, Wesley J. Smith, issued that warning in Montpelier on Saturday to the roughly 400 people who packed the Statehouse during the annual Vermont Right to Life rally.

"When we're talking about assisted suicide, we're talking about something that is really a culture-changing agenda," Smith told the crowd. "I mean, think about the potential impact on how we view each other as human beings."

Smith, who is a lawyer, bioethicist and writer whose articles frequently appear in well-established conservative journals such as National Review and The Weekly Standard, gave an impassioned speech to the rally-goers, who ranged from young children to senior citizens.

Smith sprinkled his speech with stories from Oregon and the Netherlands, places that already have approved assisted suicide. His message was that even though most legislation allowing the practice limits it to the terminally ill, it quickly – and logically – begins to include people in all types of pain.

"Once you accept the premise that ending life intentionally through artificial means is an acceptable answer to a problem of human suffering, how do you leave it to the terminally ill?" Smith asked.

The answer is that once legal, it's not limited to the terminally ill, Smith said.

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.

Once and For All: Aid in Dying in Montana.

I've been enthusiastic about the recent decision by the Montana Supreme Court to allow aid in dying, making Montana the third state in the US to legalize aid in dying. But in truth, the decision gave the Montana Supreme Court only a cameo role in what will prove to be a much longer contentious fight for terminal patients' rights.

The court could have said that aid in dying was constitutional. It did not. It said that there was nothing in the states constitution or laws that prevented aid in dying, almost inviting the legislature, decidedly anti-choice despite public opinion to the contrary, to step in with laws that, as the President of Montana Family Foundation puts it, will end aid in dying "once and for all."

Jeff Laszloffy, president of the Montana Family Foundation, said the battle for life isn't over yet.

"It's up to us now to go into the next legislative session and put a statute in place that completely and once and for all bans physician-assisted suicide in the state of Montana," he said.

Now the question remains to be asked: is aid in dying the same as physician assisted suicide as the "pro-life" religious groups claim?

Palliative Doctors Question Accuracy of Palliative Care Media Coverage.

I've been adamant about my enthusiasm regarding the New York Times recent Months to Live series basically because the subject of end of life care sees so little attention from mainstream media. The recent article on questioning the Dartmouth study was a bummer because it failed to address the primary issues of end of life care and chose to work with the sensationalization and questioning of studies. But I thought the palliative sedation article by Anemona Hartocollis was a great example of a journalist getting access to end of life situations, patients, doctors, and family members.

PalliMed, one stellar blog that you should be reading, has a run-down of the palliative article that gives us an insider's take on the reporting that Hartocollis did. And the analysis hits exactly the challenges of reporting on such taboo subjects, on gaining access for such reporting, and on how difficult it is for reporters to get technical and emotional reporting right.

I take this all as a great reminder, as a journalist working on a project about end of life care, that nuance is a difficult thing to capture and that while grabbing and keeping readers is important, paramount is the service of education and dispelling sensationalism.

PalliMed's Drew Rosielle writes:

This Sunday's New YorkTimes had a front page/below the fold article on 'palliative sedation' (which as of last night was still the #1 most emailed article according to their website). It is a long, confusing article, & I'm still trying to figure out what I think of it. Like most newspaper articles about things like this it gets some things it gets spot on, while others I found deeply troubling.

And lists the issues he has with the article:

Aspects which troubled me:

• There is no mention of the (yes incredibly preliminary and by no means rigorous) investigations into PS practices which do not suggest it frequently hastens death (see for instance here: I by no means think this is any sort of definitive evidence, but it's an indication that people are beginning to try to answer these questions and thus far are not coming up with much to suggest current sedating practices hasten death).
• The article associates PS with rationing care at the end of life (ie clinicians being urged to hasten things along with PS to save money etc.). It does this by essentially saying 'boy PS could be used this way' then notes that no one thinks it is - but this is a sort of journalistic guilt by association (bringing it up then shooting it down) even if there is no one anywhere who thinks this is a significant problem.
• Every time it mentions sodium thiopental it notes it is also used as part of a lethal injection cocktail. Nice. So is potassium chloride, one of the most widely prescribed and used meds out there, but who's counting.
  
• One of the photos is of a patient who is described as resisting a DNR order for sometime, who at some point prior to her death agrees to it. They have a photo of her signing her DNR order - in the photo her doctor is actually holding the patient's hand with the pen in it (as if to steady it, etc.) - but given the overall tone of the article the (usually slumbering) paranoid part of me wondered if that image was deliberately chosen to suggest the patient was pressured into signing it against her better judgment, etc.
• There is no presentation of any patients for whom sedation (whether CDS or not) is seen as a good, welcomed thing (by either the patient or family). For every patient discussed in the article their sedation was presented as emotionally fraught, troubling to either the patient, or the family, or even the clinicians. As I mention above, this is absolutely fair, but in my experience it's just as common for family members to greet the mention of deliberate sedation with relief and gratitude: 'thank you for not letting my love one die suffering like they have been,' etc. I scanned some of the comments online and many of them spoke positively about sedation (either 'I'm glad the doctors did it so my loved one didn't die in pain' or 'When I'm dying I hope someone is willing to make me comfortable even if it means this') - it's too bad the article didn't present this perspective.

The National Hospice and Palliative Care Organization (NHPCO) also takes on the article (mentioned in PalliMed's comments), discussing the mixed feelings palliative and hospice practitioners have about such reporting. They are pleased that dialogue is being started; they worry that the direction the dialogue takes may not be wholly accurate because of lack of knowledge, disclusion of information, or misleading opinions of journalists:

Whenever the media focuses on issues involving end-of-life care, there are sure to be different points of view, nowhere is this better understood than within the hospice and palliative care provider community. When such an article appears in the press, there is always value in the conversations that follow among individuals and families, and between healthcare providers.

That said, there is concern regarding The New York Times article by Anemona Hartcollis, “Hard Choices for a Comfortable Death: Sedation”(12/26/09). While the large majority of the nearly 500 responses posted to the New York Times Web site in response to this article reflect favorably on hospice care and the personal experiences of many readers, there is concern that others may draw inaccurate conclusions about hospice and care of the dying.

As Ms. Hartcollis points out, intractable pain at the end of life is never a simple issue. A decision to use sedation near the end of life should be made carefully and thoughtfully, with adequate support from knowledgeable and skilled healthcare providers.

Research showing that patients at the very end of life who receive palliative sedation do not die more quickly than patients who are not sedated has been published in such peer reviewed professional journals as Annals of Oncology, Journal of Palliative Medicine, Journal of Pain and Symptom Management, Archives of Internal Medicine, and Palliative Medicine. (A bibliography of these articles is available from NHPCO.)

And they clarify a few issues from the article:

Hospice typically involves a wide range of interventions to control physical suffering in addition to meeting the emotional, spiritual, and social needs of the patient and family. Provided by an interdisciplinary team of professionals, hospice services can include counseling, complementary therapy (such as massage, music, and physical therapy), and medications. In the vast majority of cases, a combination of medical and non-medical therapies can reduce physical suffering to a level that is comfortable for the patient.

On the rare occasion when treatments for pain or other forms of physical suffering are not able to help the patient reach an acceptable level of comfort, hospice providers may discuss the option of palliative sedation. The benefits and risks should be discussed carefully with the patient and his or her family. The patient and family are always at the heart of all decisions that are made and every patient’s care plan is individualized and unique to him or her.

NHPCO—in alignment with the world's leading experts on palliative sedation—believes that palliative sedation should be used only when other therapies that do not compromise patient consciousness have failed.

Above all, any discussion about sedation should begin early. Rushed decisions by patients and families in crisis are often not ideal. Instead, patients are best able to make decisions when they have time to discuss and reflect. Advance care planning and good hospice care should therefore pay attention to patients' goals and fears about suffering, and should anticipate the need for sedation so that decisions can be made with the care that they require.

The NY Times article makes reference to the term “slow euthanasia.” Palliative sedation is medically, ethically, and legally separate from euthanasia. It is not administered with the intent to cause death; it is not administered with the foreseen outcome of causing death; and, when administered successfully, it does not cause death.

The National Hospice and Palliative Care Organization along with the American Medical Association, the American Association of Hospice and Palliative Medicine, and the United States Supreme Court believes that palliative sedation can be a safe and appropriate intervention at the end of life. Importantly, NHPCO does not believe—nor do any of the aforementioned institutions—that palliative sedation, when practiced safely by qualified clinicians using evidence-based protocols, is a form of “slow euthanasia” or euthanasia of any kind.

The Definition of Palliative Sedation.

The New York Times printed an article yesterday on the contentious use of palliative sedation. It's by the fantastic Anemona Hartocollis who has been writing about end of life care for over a year now. From the article:

Among those choices is terminal sedation, a treatment that is already widely used, even as it vexes families and a profession whose paramount rule is to do no harm.

Doctors who perform it say it is based on carefully thought-out ethical principles in which the goal is never to end someone’s life, but only to make the patient more comfortable.

But the possibility that the process might speed death has some experts contending that the practice is, in the words of one much-debated paper, a form of “slow euthanasia,” and that doctors who say otherwise are fooling themselves and their patients.

There is little information about how many patients are terminally sedated, and under what circumstances — estimates have ranged from 2 percent of terminal patients to more than 50 percent. (Doctors are often reluctant to discuss particular cases out of fear that their intentions will be misunderstood.)

While there are universally accepted protocols for treating conditions like flu and diabetes, this is not as true for the management of people’s last weeks, days and hours. Indeed, a review of a decade of medical literature on terminal sedation and interviews with palliative care doctors suggest that there is less than unanimity on which drugs are appropriate to use or even on the precise definition of terminal sedation.

Discussions between doctors and dying patients’ families can be spare, even cryptic. In half a dozen end-of-life consultations attended by a reporter over the last year, even the most forthright doctors and nurses did little more than hint at what the drugs could do. Afterward, some families said they were surprised their loved ones died so quickly, and wondered if the drugs had played a role.

Whether the patients would have lived a few days longer is one of the more prickly unknowns in palliative medicine. Still, most families felt they and the doctors had done the right thing.

Wesley J. Smith has of course weighed in on the article to try to clarify some of Hartocollis' grey areas. He does so because he (and most doctors and the US Conference of Catholic Bishops) support what is called the "double effect," the use of sedation until death in order to alleviate suffering but not hasten death, but strongly work to distinguish it from "euthanasia" or, well, hastening death. As Smith writes:

First, it shouldn’t be called terminal sedation because death isn’t the intent. The words we use matter in this debate. Second, I don’t know of any palliative expert that opposes sedation as a last resort legitimate medical tool. Indeed, if properly applied based on otherwise uncontrollable symptoms, palliative sedation isn’t slow motion euthanasia because the issue isn’t whether life is “shortened.” The issue is whether the physical suffering of the patient could not otherwise be alleviated. If not, and sedation is applied, then if death comes sooner–and as the article points out, there is usually little way to tell–it is a side effect of a legitimate treatment.

In this regard, it is important to remember that any medical treatment can have a lethal side effect. That isn’t the same thing as mercy killing. Consider: Sometimes patients die earlier than they would otherwise have during surgery intended to save life. That is no more euthanasia than dying from legitimately applied pain control

Criticisms of legitimately applied palliative sedation, as mentioned above, may be based on a vitalistic notion that anything that results in an earlier death is killing. But as noted above, that clearly isn’t true. Perhaps, more often, it is intended to blur the lines between euthanasia and palliation, to make the former easier to justify politically.

Among the intentional line blurrers is the assisted suicide advocacy organization Compassion and Choices–formerly the Hemlock Society–that clearly has ambitions to become the Planned Parenthood of death. C & C was the moving force behind pernicious legislation in California two years ago–AB 2747–that as originally written would have given a legal right to patients with one year or less to live to demand sedation and withdrawal of food and fluids–without regard to whether their symptoms warranted such radical action–so that death would be caused by dehydration. (That part of the bill was defeated.)

In fact, the lawyer for Robert Baxter argued before the Montana Supreme Court on September 2nd in an appeal case to determine the constitutionality of aid in dying that there was no "bright line" between palliative sedation and aid in dying. The only differences are the documentation required of aid in dying (or Death with Dignity in Washington and Oregon where it is legal) and the "intention of the doctor."

It is this intention that Smith and others wish to judge as part of "the culture of death" or the "double effect," one of the other. From Hartocollis, it becomes quite clear that doctors wish only to prevent suffering.

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.

DeMint and the "Pro-Life" Agenda.

Check out this interview with Senator Jim DeMint on what the health care bill will cover. He rings the "euthanasia"/assisted suicide bell and talks about the "animosity" this administration shows to a "pro-life" agenda.

His logic would be just fine if there were some facts behind it. His willingness to compromise human rights of his constituents and all Americans is stunning. And religious. And the nonchalance he takes with my reproductives rights should be shaming. He's not speaking for his wife and daughters who have the ability to no manage their health in a way that opposes their conscience. He wants to tell all others what to believe and how to act.

The very simple premise here is this: DeMint and fellow "pro-life" individuals, Senators, Representatives, and activists, claim religious freedom and moral superiority (see the interview at Religion Dispatches today on moral talk) and they want us all to be subject to them.

He assumes that because the "pro-life" segment of society is unwilling to stop at anything less than their moral/religious line, that the Democrats are too. I very much wish he were right.

Justifying the "Bright Line" between the Double Effect and Assisted Suicide.

The University of Toronto Students for Life have been hosting a blog series on euthanasia and assisted suicide in the wake of a visit from Alex Schadenberg, Executive Director of Canada's Euthanasia Prevention Coalition. Here's the lastest, a look at the difference between refusal of treatment and the "double effect."

The USCCB recently changed its directive on refusal of treatment to not include artificial nutrition and hydration, now considered "obligatory" care and not subject to removal, thus rendering advance directives at all 600 Catholic hospitals moot.

“Living is not an obligation. I don’t want to die hooked up to a bunch of machines or forced to stay alive when I know it’s time to pass on.”

There is no legal obligation to receive treatment in Canada. A competent patient or the proxy of an incompetent patient has the legal power to accept or refuse any treatment, or ask that it be discontinued.

Many people don’t understand what euthanasia is. The refusal of treatment is not euthanasia or assisted suicide. It’s the refusal of treatment. That’s a right we affirm; this argument misunderstands the pro-life position.

The withdrawal or withholding of extraordinary or disproportionate treatment, when its burdens outweigh its benefit, is not euthanasia because the intention is not to cause death but to allow the person to die naturally; in euthanasia the intention is to cause death – the patient does not die naturally but rather is killed by another human being before his or her time.

A means/ends/consequence breakdown is useful here. In euthanasia and assisted suicide, the goalmay be to end a patient’s suffering, but a patient’s death is directly sought as the means of ending that suffering. Death is a desired consequence of the act. But when refusing treatment, death is anunintended foreseen consequence. The intent is to refuse treatment, to alleviate pain or undue burden, and the result is that the disease or natural ailment then takes its toll. The ailment causes death, not the act of any person.

It’s the difference between killing someone, and letting nature take its course.

When disproportionate treatment is withdrawn or withheld, the cause of death is the underlying disease or condition; in euthanasia the cause of death is the lethal injection, pill or other means used. There is a great difference between allowing to die and making die.

It’s good practice responding to these points before reading ahead…

Artificial nutrition and hydration are considered ordinary care – not treatment – and must, in principle, be given to the patient. Food and water are basic necessities of life which do not treat any specific condition. A person should never die because they have been deprived of nutrition and hydration. However in certain circumstances, such as near the end of life, the body may not be able to assimilate food and water or the procedures used can be too burdensome to continue. In these situations, artificial nutrition and hydration can be discontinued.

An important qualifier: starving someone to death is not the same thing as refusing treatment (but for exceptional circumstances near the end of life).