Swedish Citizen Unmasks a Main Physician-assisted Suicide Propaganda Point

Oregon, the first US state to legalize physician-assisted suicide, is routinely promoted by advocates as having the model law for assisted suicide. Now the debate has come to Sweden.

The Swedish National Council of Medical Ethics, an advisory board to the Swedish government and parliament, published a November 20, 2017 report, Assisted Death: A Knowledge Compilation” (an English translation is coming) “to promote a more fact-based debate on assisted dying” and states that the Council “does not take a stand on assisted dying in the report”.

However, Fabian Stahle, a Swedish private citizen who read the report, found a problem.

In his article “Oregon Health Authority Reveals Hidden Problems with the Oregon Assisted Suicide Model” , he notes that:

“As a basis for their reassurance of no slippery slope in the Oregon model, the authors of the Swedish report note that there is one question that is ‘the crucial issue’: is anyone with a non-terminal, chronic disease granted medical assisted death?” (Emphasis in original)

But Mr. Stahle notes that the report says elsewhere that the six-month limit on expected survival time applies, “if no treatment is given to slow down the course of the disease” (Emphasis in original)  and thus “might complicate the the whole idea that the law only applied to the ‘untreatable’ sick where nothing could be expected to extend life beyond six months”.

So Mr. Stahle says he did his own investigation by contacting the Oregon Health Authority himself.  Craig New, Research Analyst with the Oregon Health Authority  replied and told him that:

“…your interpretation is correct: The question is: should the disease be allowed to take its course, absent further treatment, is the patient likely to die within six months” (Emphasis added)

Fabian Stahle went further by asking if the doctor suggests to a eligible patient a treatment that possibly could prolong life or transform a terminal illness to a chronic illness or even cure the disease but the patient refuses, would that patient still be eligible for physician-assisted suicide.

He gave the example of a patient with a chronic disease like diabetes who refuses life-sustaining medication/treatment and becomes likely to die within 6 months and asked if that person would be eligible for assisted suicide.

Oregon’s Mr. New answered yes and that if the patient does not want treatment, that would also be their choice-along with the choice for assisted suicide.

As Fabian Stahle observes, this “allows a sanctioned path to suicide, aided by a physician, for anyone with a chronic illness who is likely to die within six months if they chose to stop treatment.” (Emphasis in original)

Fabian Stahle then asked about patients with a chronic disease whose health insurance company is not willing to pay for the treatment/medication.

Oregon’s Mr. New responded that:

“I think you could also argue that even if the treatment/medication could actually cure the disease, and the patient cannot pay for the treatment, then the disease remains incurable.” (Emphasis added)

And thus the patient is considered eligible for assisted suicide under Oregon’s law. This is especially outrageous.

THE BOTTOM LINE

Unfortunately, much of the public just accepts the Compassion and Choices propaganda that physician-assisted suicide is a safe “choice” with strict regulations for terminally and incurably ill people who are going to die soon anyway. Unfortunately, a mostly sympathetic mainstream media concurs and portrays assisted suicide as a “humane” last resort for extreme cases.

But now, Fabian Stahle, a Swedish private citizen, has done what few people do today even with such a life and death issue: He actually investigated the topic and contacted the Oregon Health Authority to clarify what “terminal” and “incurable” really legally means in Oregon’s “model” law.

Of course, there are many other problems with physician-assisted laws but Mr. Stahle focused on the one cited by the Swedish National Council of Medical Ethics as ‘the crucial issue’: is anyone with a non-terminal, chronic disease granted medical assisted death?”

Mr. Stahle is right to question this. The latest Oregon report on their assisted suicide law shows a range of diseases from cancer to undefined “other illnesses” as well as 43 people whose “ingestion status” of the prescribed overdose is unknown and obviously not followed up to see if or when they died.

Having written medical news analysis articles in the past for a national newspaper, I am appalled by the routine lack of investigative interest in life or death issues like assisted suicide from today’s mainstream media. The public needs and deserves better.

I wish Fabian Stahle was eligible for a Pulitzer Prize.

“MAID” in Laval, Canada

The December 2017 issue of the Canadian medical journal Le Specialiste contains a fascinating but disturbing English language article “First Results from a Unique Study” on pages 36-40.

2015 was the year when the MAID (medical aid in dying, aka physician assisted suicide and even lethal injections in Quebec) Act  took effect. The article is about physicians and MAID in the city of Laval in Quebec, Canada that has a population of about 435,000.

The study made news when it reported that after 18 months, conscientious objections from physicians against providing MAID were far more frequent than anticipated. Prior to the law, 48% of doctors said they would participate, 30% with conditions and only 28% said they would never participate.

Afterwards, 77% of the physicians getting MAID requests refused to actively participate, all of them using the conscientious objection clause, even though the study claimed the majority (72%) were in favor of MAID with only 13% of the doctors neutral or ambivalent.

The most common reason given for refusal was “too much of an emotional burden to bear, followed by a perception of lack of clinical expertise, and a fear of being stigmatized by peers or by people in general for participating.”

Other reasons included not adding to an “already heavy clinical burden”, MAID being “a very time-consuming process” and “medical legal concerns”.

The seemingly obvious takeaway from these surprising refusals is that participating in the killing of patients is much harder in reality than approving gauzy claims of just relieving suffering.

CRITICISM OF “CONSCIENTIOUS OBJECTION”

However, the authors did another study “to explore what ‘conscientious objection’ meant to these (refusing) physicians.” Although less than half of the refusing doctors participated in this second study, the authors conclude that legal “conscientious objection” is mostly being used for “reasons other than moral or religious grounds”. They contend that reasons like “high emotional burden, a perception of incompetence to perform the procedure and time constraints” do not meet the classic definition of conscientious objection on moral or religious grounds. They also worry that with the currently low physician participation in MAID, there is a “risk of a looming crisis in access to timely MAID services”.

The authors cite arguments by those who oppose conscientious objection that the authors consider “just as valid” as arguments in favor of conscientious objection:

1. “Consequences for patients” leading to denial of access or delay in treatment.

2.  “Costs for healthcare systems: while the possibility of referring the patient to a colleague exists, this can generate additional costs and prove to be less efficient.” (Note that Canada has a government-controlled health care system.)

3. “A heavy burden on the shoulders of a reduced number of physicians who accept to perform” certain acts.

4.”The importance of professionalism” which means “caring for patients, no matter the type of care required”.

CONCLUSION

These  two studies have important implications regarding conscience rights for all health care providers, even those outside the MAID policies in Quebec.

Just last April, the very influential Dr. Ezekiel Emanuel co-wrote in the New England Journal of Medicine article “Physicians, Not Conscripts-Conscientious Objection in Health Care” that:

“Health care professionals who conscientiously object to professionally contested interventions may avoid participating  in them directly, but, as with military conscientious objectors, who are required to perform alternative service, they cannot completely absent themselves from providing  these  servicesConscientious objection still requires conveying accurate  information  and  providing  timely  referrals to ensure patients receive care.

and

“Health care professionals who are unwilling to accept these limits have two choices: select an area of medicine, such as radiology, that will not put them in situations that conflict with their personal morality or, if there is no such area, leave the profession. “ (All emphasis added)

It is ironic how deliberate death decisions defended on the basis of “choice” can easily become “no choice” for those health care professionals dedicated to really caring for patients instead of killing them.

And all of us-whether we are patients or health care professionals-must understand that legalizing physician-assisted suicide inevitably leads to further erosion of medical ethics and thus crucial protections for ourselves, our loved ones and society.

 

Six Things You Need to Know about Physician-Assisted Suicide

This article was originally published in The Public Discourse on December 19, 2017

Six Things You Need to Know about Physician-Assisted Suicide

Pull quote: Is the real healthcare crisis not enough physician assisted suicide laws? Or
is it the staggering and increasing number of people losing their battles
with mental illness and committing suicide?

It has been twenty years since Oregon’s physician-assisted suicide law took
effect after a public referendum. Since then, four other states have
legalized physician-assisted suicide.

Polls seem to show strong public support for physician-assisted suicide. They ask questions like this one from a  2017 Gallup poll: “When a person has a disease that cannot be cured and is living in severe pain, do you think doctors should or should
not be allowed by law to assist the patient to commit suicide if the patient
requests it?”

Unfortunately, most people have only a vague idea about what such laws
actually say and do. Here are six things you must know before you decide
whether to support or oppose physician-assisted suicide.

1. Pain or any other suffering is not a requirement for a person seeking
assisted suicide; “a disease that cannot be cured” can include manageable
conditions like diabetes as well as terminal illnesses like cancer.

None of the US laws are restricted to patients experiencing pain, which can
be addressed in ways that do not deliberately kill the patient. In 2016, for
example, almost half of patients using assisted suicide in Oregon cited their reason for seeking death as “Burden on family, friends/caregivers” while just 35 percent cited “Inadequate pain control or concern about it.”

2. Medical professionals participating in physician-assisted suicide are
immune from accountability and standards of due care.

“No person shall be subject to civil or criminal liability or professional
disciplinary action for participating in good faith compliance with”
Oregon’s law. Thus any licensed doctor (or other healthcare provider), with
or without experience and regardless of his or her medical specialty, can
write a lethal overdose prescription for a patient as long as he or she
claims to be in “good faith compliance.” As a legal standard, this test is
effectively meaningless, because it relies only on the physician’s word.

The physician is not required to be-and often is not-the patient’s primary
care doctor. Many physicians do not want to be involved in this process,
according to “Compassion & Choices,” an organization that promotes the legalization of physician-assisted suicide throughout the United States. When one doctor (or many) conclude that it would be irresponsible to give a lethal overdose to a patient, such
organizations encourage patients to find a doctor with lower standards.

No other medical intervention has such immunity protection from lawsuits or
criminal investigation. In addition, no other medical intervention is so
devoid of standards for the clinical expertise or education required of the
physician involved.

3. Physician-assisted suicide does not involve the stringent documentation
and oversight required for other medical interventions.

In all jurisdictions where physician-assisted suicide is allowed, to
prescribe a lethal overdose the doctor need only fill out the required state
forms that include a consultation with a second physician who agrees.
Neither doctor is required to have a professional relationship with the
patient before the physician-assisted suicide request.

Documentation of physician-assisted suicides relies on doctors’
self-reporting. There is no requirement that the actual taking of the lethal
overdose be witnessed by a medical professional or anyone else. This means
that there is no safeguard against medical complications, coercion by family
members, or other problems.

The Oregon law also specifies that, “Except as otherwise required by law, the information collected shall not be a public record and my not be made available for inspection by the public”, after which the original forms are destroyed.

Unfortunately, the immunity protections and secrecy surrounding even the minimal self-reporting in state-level assisted-suicide laws eliminate the possibility of future potential lawsuits or prosecutions for abuse. They keep alive the myth that there are strong safeguards in the law that eliminate problems like coercion or elder abuse.

4. The cause of death must be falsified.

States with physician-assisted suicide laws require that the cause of death is reported as death from an underlying condition rather than the lethal overdose, supposedly to ensure the patient’s privacy. But this clearly violates the standards set for coroners
and medical examiners by the Centers for Disease Control. Those standards require accuracy in determination of death because “The death certificate is the source for
State and national mortality and is used to determine which medical conditions receive research and development funding, to set public health goals, and to measure health status at local, State, national, and international levels.”

Falsified death certificates also quietly function to smooth over any problems with life insurance policies that have suicide clauses denying death benefits if the insured commits suicide within two years of taking out a policy. And since doctors are only required to “recommend that the patient notify next of kin” about the plan for assisted suicide, the rest of the patient’s family may never know the real cause of death. This means that they are also deprived of the chance to reassure their loved ones of their
support and willingness to help take care of them until their natural death.

5. Assisted suicide laws promote discrimination against suicidal people.

The usual standards for caring for a suicidal person include intensive management to prevent suicide attempts. These are changed in physician-assisted suicide: “If, in the opinion of the attending physician or the consulting physician, a patient may be suffering from a psychiatric or psychological disorder or depression causing impaired judgment, either physician shall refer the patient for counseling.” Only the evaluation of a patient’s competence, not the diagnosable mental disorders that afflict more than 90 percent of people who die by suicide, is required . It is shocking that only 3.8 percent of those seeking physician-assisted suicide in Oregon were referred for psychiatric
evaluation in 2016. Patients with dementia and with clinical depression that had existed for years before they contracted a physical illness have died under the Oregon law.

6. Suicide is contagious.

A 2015 article in the Southern Medical Journal titled “How Does Legalization of
Physician-Assisted Suicide Affect Rates of Suicide?” studied Oregon’s and Washington’s rates of non-assisted suicide after assisted suicide laws were passed. Despite claims that assisted suicide laws would reduce other suicides or only substitute for them, the authors reached the disturbing conclusion that “Rather, the introduction of PAS (physician assisted suicide) seemingly induces more self-inflicted deaths than it inhibits.”

This does not surprise me. In 2009 my thirty-year-old, physically healthy daughter Marie died by suicide. She killed herself using a technique she learned after visiting assisted suicide/suicide websites and reading Final Exit (1991) by Derek Humphry, founder of the Hemlock Society (an organization that merged with another group to form Compassion & Choices). The medical examiner called her suicide “textbook Final Exit.”

Adding to our family’s pain, at least two people close to Marie became suicidal not long after her suicide. Luckily, they were saved, but suicide contagion, better known as “copycat suicide,” is a well-documented phenomenon. Often media coverage or publicity around one death can encourage other vulnerable people to commit suicide.

According to the Centers for Disease Control and Prevention, suicide rates have been
increasing since 2000 after decades of decline. Suicide is now the tenth leading cause of death in the United States, with more than 44,000 people dying by suicide every year. Suicide costs society over $56 billion a year in combined medical- and work-loss costs, not to mention the enormous toll suicide takes on family and friends. Oregon’s suicide rate is more than 40 percent higher than the national average.

Is the real healthcare crisis not enough physician-assisted suicide laws? Or is it the staggering and increasing number of people losing their battles with mental illness and committing suicide?

No matter what Compassion & Choices says, physician-assisted suicide is not a civil right or just one of an assortment of morally neutral end-of-life options. It’s time to stand up and fight to keep the medical profession from abandoning its most fundamental ethical principles.

Nancy Valko, RN, ALNC, is a longtime writer and speaker on medical ethics issues who recently retired from critical care nursing to devote more time to consulting and volunteer work. She is also a spokesperson for the National Association of Pro-Life Nurses.

[Non-text portions of this message have been removed]

Minding Your Medications, Especially When You are Older

When I first started out as a nurse in the late 1960s, I saw several patients admitted to determine why they had “mental status changes”, such as confusion. One of my first duties on admission was to make a list of medications the patient was taking.

I was alarmed to find some of these patients, usually elderly, were taking a large number of medications and some were similar and/or had potential interactions with other medications. When I first brought this to the attention of a doctor, he was skeptical until he read one of the patients’ lists.

The result was that he reevaluated every medication and temporarily stopped all medications that were not crucial. When the patient rapidly improved and went home with a much reduced list of medications, he and I shared this with other doctors and many other such patients then rapidly improved.

However, according to a December 12, 2017 article from Kaiser Health News titled “An Overlooked Epidemic: Older Americans Taking Too Many Unneeded Drugs”, such problems with medications continue to exist in our fast-paced health care system and older people continue to be especially at risk.

As the article states:

At least 15 percent of seniors seeking care annually from doctors or hospitals have suffered a medication problem; in half of these cases, the problem is believed to be potentially preventable. Studies have linked polypharmacy (multiple medications) to unnecessary death. Older patients, who have greater difficulty metabolizing medicines, are more likely to suffer dizziness, confusion and falls. And the side effects of drugs are frequently misinterpreted as a new problem, triggering more prescriptions, a process known as a prescribing cascade.

The glide path to overuse can be gradual: A patient taking a drug to lower blood pressure develops swollen ankles, so a doctor prescribes a diuretic. The diuretic causes a potassium deficiency, resulting in a medicine to treat low potassium. But that triggers nausea, which is treated with another drug, which causes confusion, which in turn is treated with more medication.

For many patients, problems arise when they are discharged from the hospital on a host of new medications, layered on top of old ones.” (Emphasis added)

Some doctors are now trying to combat the problem through education  about “deprescribing” — systematically discontinuing medicines that are inappropriate, duplicative or unnecessary.

I saw this problem recently in my own family when one of my older but still vigorous relatives in remission from cancer suddenly started to deteriorate. At first, her daughter thought the cancer had come back but the tests were negative.

The mystery was solved when it was discovered that my relative’s ophthalmologist (eye doctor) changed her eye drops for glaucoma but, unfortunately, the new medication also contained some of the same drug she was using for her heart condition.  When the medications were adjusted, my relative was back to normal within a short time.

MY RECOMMENDATIONS FOR MEDICATION USE AT ANY AGE

1. Keep an updated list of all medications you take-including supplements like vitamins and over the counter medications-with you or a family member. Make sure all of your doctors have this list.

2. Especially if you take several prescription medications, don’t be afraid to ask your doctor if you still need all your current medications. With pain medication, especially narcotics, ask about how long you should use them and if or when you should start using over the counter pain medicine instead.

3. Ask about all your medications’ intended purpose and side effects  so you can recognize a potential problem.

4. If possible, use one pharmacy so that all your medications will be listed in one place and possible interactions can potentially be picked up.

5. Feel free to ask the pharmacist questions about your medications, even after you have already filled and started the prescription. They are there to help and medication is their specialty. You can even ask them how to safely dispose of older or narcotic medications you no longer need. Personally, I use a pharmacy that is open 24 hours a day.

I hope these tips will be helpful to you and your loved ones!

 

Compassion and Choices Celebrates as the Massachusetts Medical Society Becomes the 10th State Medical Association to Succumb to the Physician-assisted Suicide Agenda

In 1980, the Hemlock Society (now known as Compassion and Choices) was formed to  work for the legalization of physician-assisted suicide by proposing state legislative bills, voter initiatives and public advocacy.

These efforts failed until finally in May 1994, the Oregon Medical Association changed its position opposing physician-assisted suicide to neutrality.

Six months later, Oregon voters approved the very first US physician-assisted suicide law 51% to 49%.

Not surprisingly, now the Oregon Medical Association “supports the position that ‘death with dignity’ (aka physician-assisted suicide) is part of the doctor-patient relationship”.

Obviously, the neutrality of the medical association was a big factor in getting the first physician-assisted suicide law passed in the U.S. as well as its eventual integration into Oregon’s health care system.

Now, Compassion and Choices, the now well-funded promoter of assisted suicide and other death “choices”, is celebrating that:

“The Massachusetts Medical Society is the 10th American Medical Association chapter that has dropped its opposition to medical aid in dying and adopted a neutral stance on the practice, including nine of them in the last two years. The others are the California Medical Association in 2015, Colorado Medical Society in 2016, Maryland State Medical Society in 2016, Medical Society of the District of Columbia in 2016, Maine Medical Association in 2017, Minnesota Medical Association in 2017, Nevada State Medical Association in 2017, Oregon Medical Association in 1997 and Vermont in 2017.” (Emphasis added)

And that:

“Massachusetts’ ‘neutral engagement’ position is even better than a simply neutral position,” said Rebecca Thoman, M.D., campaign manager for Doctors for Dignity for Compassion & Choices. “It means if Massachusetts enacts a medical aid-in-dying law, the medical society will offer education and guidance to physicians who want to incorporate medical aid in dying into their practices.” (Emphasis added)

Ironically, as the Boston Globe reported in January 2017,:

“The vote before the Massachusetts Medical Society was whether to approve a survey — just a survey — of members’ attitudes toward “medical aid in dying.” …

In the end, the policy-making body decisively endorsed the survey and approved $25,000 to fund it — a sign that the Massachusetts Medical Society may be reconsidering its historic rejection of what it has called “physician-assisted suicide.’’ It comes as this movement to give terminally ill patients an option to end their life at a time of their choosing is gaining traction, propelled in part by some physicians’ groups dropping their longstanding opposition. (Emphasis added)

The surveys were ultimately sent to 25,000 doctors but only 12 to 13 percent were returned. Of those returned, approximately 60 percent of respondents wanted the medical society to rescind its opposition to physician-assisted suicide, while 40 percent wanted to keep the policy.

The most fundamental medical ethic of not killing or helping patients kill themselves must not be reduced to a popularity contest.

If this radical change in medical ethics results in the Massachusetts legislature legalizing physician-assisted suicide or by yet another voter referendum, the Compassion and Choices agenda to legalize assisted suicide throughout the U.S. will continue to accelerate to the detriment of the health care system, ethical health care providers and all medically vulnerable people.

Killing with Love?

Two disturbing news items in the UK recently caught my eye. Both involved actions considered criminal in the past, but now reconsidered as acts of love. Unfortunately, we have had similar cases here in the US.

MAN WON’T GO TO PRISON AFTER KILLING HIS DIABETIC FATHER WITH AN OVERDOSE OF MORPHINE

In a November 17, 2017 UK Telegraph article, a 59 year old chemist named Bipin Desai, admitted pouring morphine into his father’s fruit smoothie and then injecting the diabetic father with insulin. The judge directed the jury to find Mr. Desai not guilty of murder but rather of assisted suicide.

The judge told Mr. Desai that:

“Your acts of assistance were acts of pure compassion and mercy. Your father had a solid and firm wish to die. For him, being assisted to die would be fulfilling his wish of going to heaven to see his wife and being put out of his misery.”

Ironically, the father was not even terminally ill but rather “he had just had enough of life and there are no real authorities who deal with that situation.” (Emphasis added)

Mr. Desai was allowed to go free with a suspended nine month prison sentence for assisting his father’s suicide and told by the judge:

“You are free to now go with your family and start the process of rebuilding your life.”

And apparently still able to be an heir.

MOM WINS $12 MILLION IN WRONGFUL BIRTH LAWSUIT, SHE WISHES HER SON WAS NEVER BORN

Omodele Meadows of the UK was given $12 million dollars for the “wrongful birth” of her now 6 year old son Adejuwon.

Four years before she became pregnant, Ms. Meadows had a test to see if she had the gene linked to hemophilia because a relative had a child with the condition. Ms. Meadow’s test mistakenly showed that she did not have the gene.

After her son was born and found to have both hemophilia and autism (a condition that has no prenatal test, at least for now), she sued the doctor who gave her the results. Ms Meadows claimed that if she knew she had the gene for hemophilia, she would have had her son prenatally tested and aborted him.

The judge wrote:

It cannot be easy for any mother to contend bluntly that her child should not have been born. ‘Her love for her son shone through from her written statements. ‘She had specifically sought to avoid bringing a child with hemophilia into the world, knowing the suffering that condition causes.” (Emphasis added)

The judge added that Ms. Meadows now loves her son dearly and had only brought the claim “to provide a better life for her son”.

Did anyone wonder what Baby Adejuwon will think if or when he finds out about the circumstances of his mother’s case?

CONCLUSION

Before the legalization of abortion and euthanasia, we had consensus that killing a person because he or she was ill or disabled was absolutely wrong and unjust.

Now we are urged to accept that killing can be a loving act and should not be criminalized. And, if a diagnostic mistake is made and an abortion avoided, parents who would have aborted should be compensated, even richly.

What does that tell people who are ill or who have disabilities as well as all of us who lovingly care for these people? What does this do to our laws, ideals and attitudes?

In our hearts, we all really know that caring for lives, not killing, is the right thing to do. When we insist on ignoring this truth, tragedies like these two cases will not only continue but also devolve into terrible social, medical and legal policies that will affect us all if we do not speak out now.

A Thanksgiving Story

This fall, an expectant mother from a small town in Missouri found out that her son had spina bifida, a condition where the spinal column does not close all the way during the baby’s development. This can cause a range of serious, even life-threatening problems such as nerve damage, paralysis and fluid buildup around the brain.

In the past, babies with this condition were operated on soon after birth but in the last few years, intrauterine (inside the womb) surgery was developed to treat the baby before birth to get the best possible outcome for the baby. In an October 23, 2017 New York Times article about one such surgery, the doctors claimed that the optimal time for this surgery is 24 to 26 weeks.

Although many women tragically abort their babies with spina bifida, this brave expectant mother wanted for this surgery for her son. The surgery was scheduled at a large medical center in St. Louis.

Hearing about this, a call was put out to the St. Louis pro-life community to help this mom. One person donated an apartment near the medical center for her before the surgery because she was on bed rest and afterwards for recovery.  Many people made meals and helped in other ways.

Mother and baby are now doing well and we are all praying for an uneventful final weeks of pregnancy and a safe delivery.

Especially at Thanksgiving, we give thanks for the blessings we enjoy. Perhaps we should also give thanks that we have such wonderful, selfless people like those in this story!

“When Dying (by Physician-assisted Suicide) Becomes Unaffordable”

Although physician-assisted suicide is consistently portrayed in major media as just a matter of taking some pills and peacefully going to sleep and die, a November 9, 2017 article titled “When Dying Becomes Unaffordable” in Medscape (a free subscription resource for medical professionals) describes a very different and alarming scenario.

This article by Roxanne Nelson, RN BSN is primarily about outrage over pharmaceutical companies drastically raising the price for secobarbital, the most commonly used sedative drug dosage prescribed for physician-assisted suicide, from less than $200 to $3000 or higher. However, the article also reveals little-known problems with the oral overdoses themselves, the ironic connection with capital punishment, the rise of lethal injections in other countries and the expected increase in the assisted suicide business.

PROBLEMS WITH ORAL OVERDOSES

Physician-assisted suicide laws are silent on the actual drugs and dosages prescribed but taking the lethal overdose is not an easy matter, according to this article.

For the most commonly used drug secobarbital, a person has “to dismantle 100 capsules to obtain powder to mix into a lethal brew, a process that takes about 1 person-hour of effort“,  “generally mixed with juice of a sweet substance to mask the bitter taste” and “consumed at one time”. (Emphasis added) And, although unmentioned in the article, Oregon’s 2016 data summary on their physician-assisted suicide law reported that the minutes between ingesting the drugs prescribed and death ranged from 7 minutes to 9 hours. But even this related to documentation received on only 25 patients out of the 133 patients taking the overdose last year. The other 108 patients are listed as “information unknown” about the time between overdose and death.

According to the article, the second most commonly used sedative drug oral pentobarbital became unavailable in 2015, in part due to “the uncanny and uncomfortable parallel between executions and PAD (‘physician-assisted dying’, more accurately known as physician-assisted suicide)”. The intravenous form of this drug is used in lethal injection executions and the growing opposition to capital punishment along with limited therapeutic uses may have resulted in oral pentobarbital products “voluntarily withdrawn or discontinued by the manufacturers” and no longer available in the US.

According to the article, physicians in Washington have tried two cheaper and available assisted suicide “cocktails” (the article’s term) containing overdoses of two cardiac drugs, morphine and a sedative after finding that just an alcohol and sleeping pills combination made patients complain of a “burning sensation”.

The first lethal “cocktail” trial called DDMP resulted in 20% of patients taking longer than 4 hours to die but a stronger “cocktail” called DDMP2  is now said to kill the majority of patients within 2 hours.

So far the new lethal “cocktail has been given to about 60 patients and, with 10 more cases, the doctors intend to submit an article on their findings.

LETHAL INJECTION ASSISTED SUICIDE

Ms. Nelson also writes positively about other countries like Canada, Belgium, Luxembourg, and the Netherlands that use lethal injections to allow “more leeway and options as to the selection of drugs, cost, and mode of delivery.”

And, at least in Ontario, patients prefer the injection:

“For example, in Ontario, Canada ― a country where patients have a choice ― there have been very few cases of self-administration, less than 1%, according to James Downar, MD, CM, MHSc, a critical care and palliative care physician at the University Health Network in Toronto.”

And

“There is a strong desire to avoid the oral route here, given the failure rate,” (All emphasis added)

“NUMBERS ARE SMALL BUT SLATED TO GROW”

In this chilling final section of the article, Ms. Nelson predicts that with the recent passage of California’s physician-assisted suicide law in 2015 and more states considering such laws, “the number of individuals choosing this option will be significantly higher.”

And she concludes with this ominous prediction:

“As more laws are passed across the United States, the need for an effective and affordable medication or drug combination becomes increasingly imperative. Even if covered by insurance, artificially inflated drug costs place a burden on the healthcare system and on society in general, so a safe and inexpensive option would benefit everyone.

Currently, unless the generic and widely available drugs used in DDMP2 fall victim to price gouging or some other unforeseen issue, it appears that a viable option has become available.” (Emphasis added)

CONCLUSION

People, sick or healthy, have been dying by self-inflicted suicide since time began but we never encouraged or approved it until the last 25 years. Having medical professionals involved does not make suicide better.

We don’t solve problems by helping people kill themselves and if we don’t reject physician-assisted suicide, we will inevitably find ourselves-like Canada and other countries-expanding to lethal injections and other groups of people who are judged “better off dead”.

This is truly what we cannot afford.

Defending Physician-assisted Suicide

In a recent letter to the editor in the Wall Street Journal,  Dr. David Grube, national medical director of Compassion and Choices, defended physician-assisted suicide by stating:

“I knew that the people who requested it didn’t want to end their life. They loved life but realized they had an incurable, terminal disease and didn’t want to suffer needlessly as the inevitable end of life approached.

The proof is that more than one-third of terminally ill Oregonians who obtain the medication never take it, but they get great comfort in knowing they have access to it if they need it, which helps them suffer less.” (Emphasis added)

Is this really the crucial argument to upend our medical and legal ethics to legalize physician-assisted suicide?

Especially when more than 33% of people approved for assisted suicide don’t use the lethal overdose prescriptions, this should be a wake-up call for assisted suicide activists as well as suicide prevention groups and the rest of society.

As a former oncology (cancer) and hospice nurse who cared for many terminally ill patients including relatives over decades, I encouraged my patients and family members to talk about all their concerns. I found very few who wanted to end their lives out of fear of future suffering. I  reassured my patients and relatives that we would make them as comfortable as possible and support them until their natural death. Not one died by suicide and all died with true dignity.

But this was before physician-assisted suicide began to be legalized, glamorized and  promoted by activists, especially through sympathetic media outlets.

WHERE IS THE FOLLOW UP ON THE PATIENTS WHO DON’T TAKE THE LETHAL OVERDOSE?

What happened to these patients who decided not to take the lethal overdose? Did they unexpectedly improve or find their symptoms adequately treated? Was the terminal diagnosis wrong? Did they find the physical, emotional and spiritual support to continue living?

Unfortunately, those writing state assisted suicide reports are apparently not interested in this important information that could help save other lives.

WHAT HAPPENS TO THE UNUSED LETHAL OVERDOSE?

Another concern is what happens to the lethal overdose that the patient does not take?

In any home health situation, every unused dose of a controlled medication must be accounted for and disposed of carefully. We know how important it is to keep such medication out of a child’s reach or from misuse by a family member or friend. Keeping overdoses for possible future ingestion is obviously dangerous, especially when our nation is in the middle of an opioid crisis that now kills almost 100 Americans every day.

However when it comes to unused lethal overdoses in assisted suicide, Death with Dignity’s advice is that:

“Anyone who chooses not to ingest a prescribed dose or anyone in possession of any portion of the unused dose must dispose of the dose in a legal manner as determined by the federal Drug Enforcement Agency or their state laws, if any.”

CONCLUSION

When even assisted suicide supporters admit data suggests that the “distress prompting patients to request these lethal medications primarily stems from their fear over losing control at the end of life” but claim that the more than 33% who don’t take the prescribed lethal overdose should still have it to supposedly “get great comfort in knowing they have access to it if they need it”,  physician-assisted suicide is further exposed as a terrible response to human fear and despair.

As our National Association of Pro-life Nurses states, patients need us to take their hands, not their lives.

 

The Changing Rules for Organ Donation

BACKGROUND

Whether we are renewing our driver’s licenses, reading the news or watching TV, it’s almost impossible to miss the campaign to persuade us to sign an organ donation card.

But do we really know what we are signing?

While internet organ donor registration sites like Donate Life America and organdonor.gov still maintain that vital organs can only be harvested (the technical term for removal) after brain death (a controversial issue itself ), a whole new category of organ donors initially called NHBD (non-heart beating organ donors) and later changed to DCD (donation after cardiac death) was added in the 1990s.  This new pool of organ donors are patients who are severely brain-injured but not brain dead, on ventilators (breathing machines) and considered hopeless in terms of survival or predicted “quality of life”.

Organs from these patients are taken when families agree to stop the ventilator and allow doctors to take the person to an operating room where the patient’s organs are removed when (or if) the patient’s heartbeat and breathing stops for 2-5 minutes within a 1-2 hour time frame. If the patient does not die within the time frame, the transplant is cancelled because the organs are potentially damaged and the patient is then returned to a room to die without further treatment.

At first, there was some criticism of DCD on legal, medical and ethical grounds, especially after a 1997 segment of the TV show “60 Minutes” exposed the case of a young gunshot victim whose organs were taken by DCD but the medical examiner who conducted the autopsy said he believed the injury was survivable.

Nevertheless, this new kind of organ donation was deemed ethically acceptable in 2000 by the US Institutes of Medicine while unfortunately also finding “opinion is divided on the option of non-heart-beating donation for the patient who is ventilator dependent but conscious and who wants to stop life-sustaining treatment.

As of 2015, DCD comprised 8.9 percent of all transplants in the US but the procedure is still little-known to the public.

THE DEAD DONOR RULE AND IMMINENT DEATH DONATION

In 2016, UNOS (United Network for Organ Sharing), the organization that manages the nation’s organ transplant system under contract with the federal government, issued its decision on Imminent Death Donation, a policy that would take DCD a step farther to become virtual organ donor euthanasia.

Because “a substantial minority” of DCD donors fail to die fast enough in the 1-2 hour time frame for organ donation, UNOS was considering re-framing the issue as “the recovery of a living donor organ immediately prior to an impending and planned withdrawal of ventilator support expected to result in the patient’s death” to ensure better quality organs and avoid an unsuccessful procedure. (Emphasis added)

Not only would this language change DCD donors from dead donors to living donors, but this also effectively destroys the definition of Dead Donor Rule that states:

“The dead donor rule is an ethical norm that has been formulated in at least two ways: (1) organ donors must be dead before procurement of organs begins; (2) organ procurement itself must not cause the death of the donor. (Emphasis in original)

Although living organ donation can be ethical when a healthy person freely decides to donate an organ like one kidney to someone who has lost kidney function, this imminent death donation is entirely different because the donor’s organ is taken before a planned and expected death.

Writing in a 2013 New England Journal of Medicine article “The Dead-Donor Rule and the Future of Organ Donation”, a group of prominent doctors gave this rationale for abandoning the dead donor rule:

“Respect for autonomy requires that people be given choices in the circumstances of their dying, including donating organs. Nonmaleficence requires protecting patients from harm. Accordingly, patients should be permitted to donate vital organs except in circumstances in which doing so would harm them; and they would not be harmed when their death was imminent owing to a decision to stop life support. That patients be dead before their organs are recovered is not a foundational ethical requirement.” (Emphasis added)

The following year, a polling study in the Journal of Medical Ethics concluded that  the American public is “largely in support of organ removal even though it causes death in this scenario.” (Emphasis added)

CONSEQUENCES

Although UNOS ultimately decided to shelve last year’s proposal to approve Imminent Death Donation “because of its potential risks at this time, due to a lack of community support and substantial challenges to implementation”, that decision may only be temporary:

“In the future, it may be possible to adequately address those challenges through additional research or careful policy development or revision.”

However, apparently no bad ethical idea ever really dies when it comes to increasing the number of organs to transplant and now UNOS is currently considering “Living Organ Donation by Persons with Certain Fatal Diseases who Meet the Criteria to be Living Organ Donors”.

Thanks to the disability advocacy group Not Dead Yet (NDY), I was recently alerted to this new  proposed organ donation policy change and read UNOS’ public comment proposal that describes such patients as having “a progressive, incurable, chronic disease that is fatal and will ultimately be terminal” and gives examples like Alzheimer’s and Multiple Sclerosis.

In its statement opposing the policy change, NDY points out:

“Yet the Committee seems to want to create a special subgroup of living donors to whom the normal rules governing living donations do not apply and whose deaths are of less concern than the deaths of other donors because these living donors are presumably anticipated to die soon anyway. The recommendations would promote overt and lethal discrimination between donors based on disability and perceived health status…

One example of the Committee’s biased double standard is while OPTN policy is not to accept persons as living donors if they show evidence of suicidality, it urges an exception for people with certain fatal diseases so as not to preclude people with plans for assisted suicide (where legal) from first undergoing a living organ donation. (pg. 10) Surely, public confidence in the organ procurement system will not be enhanced by any policy proposal that hints toward a future in which organ euthanasia is accepted and promoted.” (Emphasis added)

CONCLUSION

Unfortunately, the short time frame for public comments on this new policy is now closed and UNOS apparently does not send out alerts to the general public. Also, to the detriment of the public, the media tends to publicize feel-good stories about donation rather than explore controversial policies.

Personally, I am for ethical donation of organs and tissues. Years ago, I volunteered to donate a kidney to a friend and our youngest grandson was saved in 2013 by an adult stem cell transplant.

But I do not have an organ donor card nor encourage others to sign one because I believe that standard organ donor cards give too little information for truly informed consent. Instead, my family knows that I am willing to donate tissues like corneas that can be ethically donated after natural death and will only agree to that donation.

The bottom line is that what we don’t know-or allowed to know-can indeed hurt us, especially when it comes to organ donation. We need to demand transparency and information before such policies are quietly implemented.