assisted suicide

Urgent: Will Congress Stop the Washington D.C. Assisted Suicide Law in Time? Write Now!

nancyvalko assisted suicide, Compassion & Choices, law, medical ethics, Uncategorized

Washington D.C. Mayor Muriel Bowser  quietly signed an assisted suicide bill into law on December 19, 2016 after a majority of the city council voted for it.

Under the U.S. Constitution, the Congress has exclusive legislative authority over the District of Columbia. Congress has just 30 legislative days to review a law of the District of Columbia once it is passed by the city government. Resolutions of disapproval must be passed by both houses and be signed by the president to block a D.C. law.

In a race against time, the first step  to block the assisted suicide law was taken January 12, 2017 by Sen. James Lankford (R-Okla.) who introduced introducing a resolution in the Senate that opposes D.C.’s  “Death With Dignity Act”.

A companion resolution was introduced in the House by Rep. Brad Wenstrup (R-Ohio) and Rep. Jason Chaffetz (R-Utah) also said that he would push to block the law.

COMPASSION AND CHOICES HAS ALREADY STARTED A LETTER WRITING CAMPAIGN TO LEGALIZE ASSISTED SUICIDE IN WASHINGTON, D.C.

In a message to assisted suicide supporters, Compassion and Choices claims that “more than 2400 supporters” have “sent more than 7,000 messages to members of Congress”.  The organization also emphasizes “the importance of including your personal testimony” as “often the most effective way to change the minds of lawmakers”.

HOW TO CONTACT YOUR CONGRESSMAN OR CONGRESSWOMAN TO OPPOSE  ASSISTED SUICIDE IN WASHINGTON, D.C.

The National Right to Life Committee has a website link   to “Nullify District of Columbia Assisted Suicide Law” to contact your Senators and a separate link to contact your House representative(s). Enter your zip code in the box provided and you will be taken to a list of your congresspersons and a form you fill out to send an email to those representatives or senators with your comments.

HOW TO WRITE COMMENTS

Keep your comments respectful  and address the points that most move you. If you have a personal story about why you are against assisted suicide, write it as clearly and concisely as possible.

PROBLEMS WITH THE ASSISTED SUICIDE BILL

While many legislators (as well as the public) are persuaded by the “safeguards” to support assisted suicide laws, the Washington D.C. bill has many of the same problems with “safeguards” that other assisted suicide bills have. (For example, see my blogs “The slippery Slope-Tactics in the Assisted Suicide Movement” and “Pain and ‘Choice’“.)

In the D.C. assisted suicide law, such problems include:

1.The extraordinary immunity protections against civil, criminal liability or professional  disciplinary actions for doctors who participate in “good faith compliance” with the law.

2. Protection from life or annuity insurance problems due to suicide (“Neither may a qualified patient’s at of ingesting a covered medication have an effect upon a life, health, accident, insurance, or annuity policy”)

3. Minimal reporting requirements and secrecy in public records (“The Department will generate and make available to the public an annual statistical record of information collected”) Emphasis added.

4. Require mental health evaluation only for the purpose of determining if the person is mentally capable to make the decision to end his or her life. (“‘Counseling’ means one or more consultations as necessary between a state licensed psychiatrist or psychologist  and a patient for the purpose of determining that the patient is capable and not suffering from a psychiatric or psychological disorder or depression causing impaired judgment.”)

CONCLUSION

There are many reasons to oppose legalizing assisted suicide including risk for elder abuse, discrimination against people with disabilities and/or terminal or chronic conditions, the destruction of the most basic rule of medical ethics to not kill patients or help them kill themselves, suicide contagion, etc.

Assisted suicide, legalized and approved by society, is a manifestation of despair and abandonment-not empowerment. We cannot afford to be bystanders while others like Compassion and Choices continue to demand that we all accept legalized assisted suicide as a constitutional and civil right.

The Slippery Slope-Tactics in the Assisted Suicide Movement

nancyvalko assisted suicide, brain injury, Compassion & Choices, euthanasia, food and water, medical ethics

I first saw this tactic  in the mid-1980s when Missouri was considering a “living will” law to allow a person to refuse “death prolonging procedures” if a person became terminally ill and unable to speak for himself or herself.  Some of us warned about a broader agenda, citing court cases involving feeding tubes and seriously brain-injured but non-terminally ill patients like Paul Brophy and Claire Conroy in New Jersey and Massachusetts . In  response, “right to die” activists (as they were known then) added the ”safeguard” of not allowing the withholding of food and water to the Missouri law  and the bill was passed.

Not surprisingly, Missouri soon faced the Nancy Cruzan case  involving the withdrawal of a feeding tube from a non-terminally ill young woman in a so-called “persistent vegetative state”.  Soon after that,  a Missouri Designated Health Care Decision Maker Act was passed that would allow a person to designate someone to make health care decisions (or a relative if there is no document) including withholding or withdrawing of feeding tubes when the person was incapacitated whether or not they were terminally ill or even in a so-called “vegetative state”.

Now, over 30 years later, we have legalized physician-assisted suicide in several states and the District of Columbia and the former “right to die” groups are now known as Compassion and Choices.

TODAY’S SLIPPERY SLOPE TACTICS

In a December 2016 commentary article titled “End of Life Liberty in DC” for a publication supported by the University of Pittsburgh School of Law, lawyer and long-time assisted suicide activist Kathryn L. Tucker surprisingly criticizes the new assisted suicide law quietly signed into law by the mayor of Washington, DC. this month.

While most people might believe that passage of yet another assisted suicide law would be cause for celebration for assisted suicide activists, Ms. Tucker is unhappy with the so-called “safeguards” in the DC law-just as “right to die” activists were with Missouri’s “living will” law.

Ms. Tucker now complains about the “many burdens and restrictions imposed” by these “safeguards” which, ironically, are added by assisted suicide activists themselves when they  “routinely face arguments of insufficient ‘safeguards’”.  Ms. Tucker lists some of these so-called “burdens and restrictions”:

  • Patients electing AID (aid in dying, the activists preferred term for physician-assisted suicide) must make at least three requests, two oral and one written.
  • The requests must be witnessed.
  • A second opinion confirming diagnosis and prognosis is required.
  • A mental health specialist must be consulted if the attending or consulting physician has concerns regarding the patient’s ability to make an informed decision.
  • A minimum fifteen-day waiting period must elapse between the two oral requests.
  • Physicians must collect and report a vast amount of demographic data on who chooses AID and why.

Ms. Tucker claims these so-called burdens and restrictions “impose heavy governmental intrusion into the practice of medicine, which is concerning because it creates barriers to patient access and to physician participation.” (Emphasis added)

Instead, Ms. Tucker proposes another, more expansive statute without the usual so-called “safeguards” that would provide:

a clear safe harbor (i.e. immunity) for physicians to practice aid in dying in conformity with standard of care. This reflected a positive step in the direction of normalizing AID within the practice of medicine. Medicine is not routinely governed by statute but, rather, by the type of care that a competent health care professional would render in similar circumstances —referred to as standard of care or best practice. (Emphasis added)

In other words, Ms. Tucker is proposing a policy that makes assisted suicide simply normal medical care with special protections against criminal, civil or disciplinary actions for doctors who participate even though such immunity is not given for other medical practices.

CONCLUSION

Ms. Tucker and other are deadly serious about this. When Vermont passed its assisted suicide law in 2013, the law contained a “sunset” provision that would end “nearly all regulation” after the first three years. Fortunately, this was repealed in 2015.

However, assisted suicide activists will not give up on this as Compassion and Choices makes clear:

We firmly believe — and experience demonstrates — that working within healthcare systems to normalize medical aid in dying will ensure fewer people suffer at the end of their life. (Emphasis added)

As Ms. Tucker demonstrates, assisted suicide advocates will promise anything to get assisted suicide laws passed but it appears that they will never be satisfied until assisted suicide becomes a private and unfettered practice using well-funded groups like Compassion and Choices as the potentially taxpayer-funded “experts” in charge of policies, referrals, training and education.

Pain and “Choice”

nancyvalko assisted suicide, Compassion & Choices, euthanasia, Kevorkian, law, medical ethics

It was 1969 and I was fresh out of nursing school when I was assigned to a patient I will call “Jenny” who was thirty two years old and imminently dying of cancer. She was curled up in her bed, sobbing in pain and even moaned “just kill me.” The small dose of Demerol I injected into her almost non-existent buttocks every four hours “as needed” was not helping. I reassured Jenny that I was immediately calling the doctor and we would get her more comfortable.

However, I was shocked when the doctor said no to increasing or changing her medication. He said that he didn’t want her to get addicted! I told him exactly what Jenny said and also that she was obviously very close to death so addiction would not be a problem. The doctor repeated his no and hung up on me.

I went to my head nurse and told her what happened but she told me I had to follow the doctor’s order. Eventually, I went up the chain of command to the assistant director of nursing and finally the Chief of the Medical Staff. The verdict came down and I was threatened with immediate termination if I gave the next dose of Demerol even a few minutes early.

I refused to abandon Jenny so for the next two days before she died, I spent my time after my shift sitting with her for hours until she fell asleep. I gave her whatever food or drink she wanted. I stroked her back, held her hand and told stories and jokes. I asked her about her life. I did everything I could think of to distract her from her pain and make her feel better. It seemed to help, although not enough for me. I cried for Jenny all the way home.

And I was angry. I resolved that I would never watch a patient needlessly suffer like that again.

So I educated myself by reading everything I could about pain medicine and side effects. I also pestered doctors who were great at pain control to teach me about the management, precautions and rationale of effective pain management. I used that knowledge to advocate and help manage my patients’ pain as well as educating others.

I was delighted to see pain management become a major priority in healthcare and even called “the fifth vital sign” to be evaluated on every patient. I saw new developments like nerve blocks, new drugs and regimens to control pain and other techniques evolve as well as other measures to control symptoms like nausea, breathlessness and anxiety. Now we also have nutritional, psychological and other support for people with terminal illnesses and their families.

Best of all was that I never again saw another patient suffer like Jenny despite my working in areas such as ICU, oncology (cancer) and hospice.

TWENTY-FOUR YEARS LATER

When my oldest daughter was 14, she attended a public high school where the science teacher unexpectedly started praising the infamous Dr. Jack Kevorkian and his public campaign for legalized assisted suicide and euthanasia.  Kevorkian’s first reported victim was Janet Adkins, a 54 year old woman with Alzheimer’s in no reported physical pain who was hooked up to a  “death machine” in the back of a rusty van. Mrs. Adkins was just the first of as many as 130 Kevorkian victims, many if not most of whom were later found to have no terminal illness. Kevorkian escaped prosecution-even after he harvested a victim’s organs and offered them for transplant-until the TV show 60 Minutes aired Kevorkian’s videotape showing him giving a lethal injection to a man with ALS (Lou Gehrig’s disease). Shockingly, Kevorkian served only 8 years in prison before he was paroled and eventually became a media celebrity peddling assisted suicide and euthanasia.

My daughter, who never before showed any interest in my speaking and writing on the topic of assisted suicide, now stood up and peppered her teacher with facts about Kevorkian. The teacher asked her where she learned her information and she answered “From my mom who is a cancer nurse”.

Sarcastically, he responded “So your mother wants to watch people suffer?” My daughter responded “No, my mother just refuses to kill her patients!” End of discussion.

CONCLUSION

But not the end of the story. Tragically, we now have legalized assisted suicide in several states and serious efforts  to expand it to include people without physical pain but with conditions like Alzheimer’s, mental illness or other psychological distress as well as even children.

As Wesley Smith recently and astutely observed :

 Moreover, the statistics from Oregon and elsewhere show that very few people commit assisted suicide due to physical suffering. Rather, the issues are predominately existential, such as fears of being a burden or losing dignity

The public is being duped by groups like Compassion and Choices that campaign for legalized assisted suicide on the alleged basis of strict criteria for mentally competent, terminally ill adults in unbearable physical pain to freely choose physician-assisted suicide with (unenforceable) “safeguards”.

The emerging situation throughout the world is more like Kevorkian’s dream of unfettered and universal access to medical termination of the lives of “expendable” people. How much easier is that when people with expensive mental health problems, serious illnesses or disabilities can be encouraged to “choose” to be killed?

How Secrecy and Immunity Destroy “Safeguards” in Assisted Suicide Laws

nancyvalko assisted suicide, Compassion & Choices, conscience rights, law, medical ethics, nursing, suicide

Finally this November, a mainstream media source, the Des Moines Register, investigated some of the problems with legalized physician-assisted suicide in other states such as complications during the process, prolonged deaths,  non-existent or incomplete data in assisted suicide and even the “disputed meaning of ‘self-administer’” of the lethal overdose. This is crucial since Iowa is considering an assisted suicide bill in the legislature.

However, the Register’s reporting ignored one of the most dangerous legal problems in assisted suicide laws: immunity for doctors from “civil or criminal liability or professional disciplinary action for participating in good faith compliance” with the assisted suicide law.  In addition, the secrecy and often yearly destruction of even the minimal information self-reported by the doctors as well as  falsified death certificates listing such deaths as natural effectively destroys any pretense of an enforceable law.

This has made enforcement of so-called “safeguards” virtually impossible in states with legalized assisted suicide and affects even a state like my home state of Missouri that has a  law with penalties to prohibit assisted suicide.

THE MISSOURI EXPERIENCE

Missouri’s law against assisted suicide states:

A person commits the crime of voluntary manslaughter if he knowingly assists another in the commission of self-murder.
Mo. Rev. Stat. § 565.023.1

Yet despite years of failure, the pro-assisted suicide forces are again trying this year to get the standard assisted suicide bill passed in the Missouri legislature.

However, enforcement of the current Missouri law has been problematic. In the only case involving a health care professional, just a five years probation plea agreement was reached before a trial despite a nurse admitting she killed the patient, not assisting a suicide.

In 2001, Daillyn Pavia, RN  faced murder charges after she admitted giving a lethal dose of morphine to a new patient who had just had a stroke and was taken off life support.  According to police, Pavia admitted to co-workers that she had “without authorization and within a half-an-hour of taking charge of Julia Dawson as her patient … intentionally (given) Ms. Dawson 15 times the maximum dosage of morphine that had been prescribed” as well as Propofol, a strong sedative, that was not prescribed. The victim’s son defended the nurse’s action, saying it was done out of compassion and should not be prosecuted.

In 2003, 2 years later, nurse Pavia pleaded guilty to voluntary manslaughter and was sentenced to 5 years probation.  Nurse Pavia did not show up at a hearing before the Missouri State Board of Nursing which noted that Pavia was placed “on five years of supervised probation with the special condition that she surrender her nursing license.”

(Ironically, this decision followed on the heels of the decision not to prosecute Dr. Lloyd Thompson, then head of the Vermont Medical Society, for intentionally giving a paralyzing, “life ending drug” to an elderly woman with terminal cancer whose breathing machine had been removed. The family opposed prosecuting the doctor. Instead Thompson was reprimanded by the Vermont Medical Practice Board that required a monitoring and review of his care of all terminally ill patients.  10 years later, Vermont became the third state to legalize physician-assisted suicide.)

I could find only two other cases of people being charged with assisting a suicide in Missouri. One occurred in 1996 when Velma Howard, a woman with ALS died of suffocation in a motel with family members who admitted giving her sleeping medication, alcohol and a plastic bag. The prosecuting attorney later dropped charges against the family members.

The Jacob Runge assisted suicide case in 2010  resulted in a jury acquitting a young man who provided a gun to his emotionally disturbed friend in a self-described mutual suicide pact but said he could not go through with killing himself.

FALLOUT AND CONSEQUENCES

The fallout from these cases, like many others around the country, show that if someone-even a doctor or nurse-claims that they acted out of “mercy” it is unlikely that a person will face more than a slap on the wrist for ending or helping to end an ill or troubled person’s life.

In addition for those of us who are ethical and conscientious nurses, we feel the chilling effect discouraging us from even reporting other health care providers like nurse Pavia in such cases since we may face repercussions ourselves, including firing. There are apparently no real whistleblower protections for nurses (and thus the public) in such cases, especially since these cases routinely garner much media and public sympathy for the perpetrators and routinely result in minimal if any penalties. Conscience rights may not be enough to protect our patients and ourselves.

As a 2014 Medscape (password protected) article titled “Should Nurses Blow the Whistle or Just Keep Quiet?   by a nurse/lawyer author explains with regard to patient safety violations (which, of course, should include reporting the killing of a patient) :

Am I recommending that nurses adopt the “see nothing, hear nothing, speak nothing” attitude? No. I am saying that under current law, it is safer for a nurse not to report than to report. That surprises me, and it may be right- or wrong-minded, but it’s the way it is. (Emphasis added.)

This is exactly what pro-assisted suicide groups like Compassion and Choices could have hoped for when they fashioned the immunity protections and the secrecy of even the minimal self-reporting standards in their assisted suicide laws. Eliminating the possibility of future potential lawsuits or prosecutions is what keeps their myth of “no problems, no abuses” alive.

Unfortunately, that is also what puts all of us and our loved ones at risk, especially when we are at our most vulnerable. With legalized assisted suicide laws now quickly expanding to other states, we must step up our efforts to educate the public and fight against the well-funded and relentless Compassion and Choices machine.

And there is one significant effort that any of us can do.  Consider asking your own doctor or health care provider where he or she stands on assisted suicide and feel free to state your position. If your doctor is in favor of assisted suicide, you might want to consider asking for a referral to another doctor who refuses to provide assisted suicide. The life you save may be your own.

High Priority: Public Comments Needed on ANA’s New Draft Position Paper on Denying Food and Water

nancyvalko assisted suicide, conscience rights, end-of-life, law, medical ethics, nursing, terninal/palliative sedation

Although the American Nurses Association (ANA) claims it represents the over 3 million US nurses, only a tiny fraction of nurses actually belong. ANA does not give out the actual number of members. I used to belong both my state nursing organization as well as the ANA to try to uphold good nursing ethics and conscience rights for nurses. I finally gave up when my state organization would not address even the conscience rights of nurses in the Nancy Cruzan feeding tube case. I gave up on the ANA when I discovered that the ANA opposed a ban on partial birth abortion without notifying its membership. I only found this out when I watched a TV show on politics mentioning the ANA position. I called the ANA public relations department myself to protest both their position and not notifying members like me and resigned.

Yesterday, I received a call from a nurse in another state who sent me the website for public comments due by 5 pm ET 12/1/2016 about a proposed new ANA position on nutrition and hydration at the end of life.

The proposed position paper is 9 pages long and I sent the following comments with the referenced lines as requested. It would have taken me many pages to address all the issues:

Lines 18-24.  In the past, the hospice principle of never prolonging or hastening death at the end of life was paramount. Now, this has been subjugated to a legalized autonomy (even when exercised by a third party) to decide when to hasten death.

However, nurses are professionals whose integrity depends on proper respect for their conscience rights, especially when it comes to decisions about hastening death.  This concern is absent in this draft.

We do have such a provision in Missouri law that states:

Missouri Revised Statutes
Section 404.872.1

Refusal to honor health care decision, discrimination prohibited, when.

404.872. No physician, nurse, or other individual who is a health care provider or an employee of a health care facility shall be discharged or otherwise discriminated against in his employment or employment application for refusing to honor a health care decision withholding or withdrawing life-sustaining treatment if such refusal is based upon the individual’s religious beliefs, or sincerely held moral convictions.

(L. 1992 S.B. 573 & 634 § 7)

Line 88: There is no definition of “severe neurological conditions”.
Line 90 on “Dementia, recognized as a terminal illness associated with anorexia and cachexia”.  As a former hospice nurse and caregiver for my mother until her death as well as a volunteer for people with dementia, this is an alarming and potentially dangerous assertion. No one should have to die by dehydration and indeed many people with dementia can be spoon-fed like my mother until natural death. I have likewise seen several people begging for food or water but denied because of a decision not to place a feeding tube or spoon feed.

Lines 101-104. VSED as described is really assisted suicide and implicitly changes ANA opposition to medically assisted suicide.

Also, in a New York Times article in October titled “The VSED Exit: A Way to Speed Up Dying, Without Asking Permission”, Dr. Timothy Quill (past president of the AAPHM and the doctor arguing for the constitutionality of assisted suicide in the 1997 Vacco v Quill US Supreme Court case) was quoted as claiming that while VSED is “generally quite comfortable at the beginning”, he also states that “You want a medical partner to manage your symptoms,” because “It’s harder than you think.”

How hard?

In 2000, Quill and Dr. Ira Byock (a palliative care doctor who speaks against legalizing physician-assisted suicide while also supporting VSED and terminal sedation) wrote an article titled “Responding to Intractable Terminal Suffering: The Role of Terminal Sedation and Voluntary Refusal of Food and Fluids” . The patient was a doctor who wanted to die before his symptoms became worse. He was given a morphine drip that had to be increased to total unconsciousness on day 10 because he became “confused and agitated and began having hallucinations”.

Lines 114-115 cite “Psychological, spiritual, or existential suffering, as well as physical suffering” but only say that “Symptom control is imperative” rather than oppose participation in VSED  for people who are not even terminally ill.

Lines 149-150 state that “Decisions about accepting or forgoing nutrition and hydration will be honored including those decisions about artificially delivered nutrition as well as VSED”. This blanket statement destroys the conscience rights of nurses as well as our duty to advocate for our patients’ best interests. (Emphasis added)

Ironically, the ANA’s 2010 position paper on reproductive rights (i.e. abortion) states that:

“Also,nurses have the right to refuse to participate in a particular case on ethical grounds. However, if a client’s life is in jeopardy, nurses are obligated to provide for the client’s safety and to avoid abandonment.” (Emphasis added) Apparently, the ANA is proposing that the right to refuse to participate ends when the death of the patient is deliberately intended.

CONCLUSION

Just this week, it was reported that a union for Australian nurses is backing voluntary euthanasia. The Australian Nursing and Midwifery Federation (SA branch) is even partnering with other Compassion and Choices-style groups in Australia to pass a voluntary euthanasia bill. This could well be our future here in the US if we do not respond.

As nurses and citizens, we need to fight for truly patient-safe health care by responding to groups like the ANA through comments sections like the one above (which ends December 1) and in the media. We must also support and insist on ethical health care providers for ourselves and our loved ones as well as protecting our patients. As much as we can, we can also help state and national organizations that fight against euthanasia.

Especially if you are a nurse, consider joining the National Association of Pro-Life Nurses and following our Facebook page.

Our profession, our patients and even our nation are at stake!

 

 

Oh, Colorado!

nancyvalko assisted suicide, Compassion & Choices, conscience rights, euthanasia, law, medical ethics, Uncategorized

Of course, the big news from the national voting last week was the stunning election of Donald Trump as president. But  barely mentioned by the media except for its passage was  Colorado’s Proposition 106 “End of Life Options Act initiative which won by a 65% to 35% popular vote. Now five states have formally legalized physician assisted suicide. Montana had a court ruling that state physician-assisted suicide is not “against public policy” but no law legalizing assisted suicide has been passed.

I remember going to Colorado about 20 years ago to speak against an assisted suicide bill in the state legislature. Enthusiasm was high and the assisted suicide bill was subsequently voted down in the legislature. But, as in other states including my own Missouri, the assisted suicide proponents never stopped pushing their agenda over and over again.

With their efforts often stymied in state legislatures after robust debate and testimony, well-funded groups like Compassion and Choices turn to the promotion of state initiatives. Colorado now joins Oregon and Washington State in legalizing assisted suicide by popular vote.

However, with groups like Compassion and Choices trying to normalize assisted suicide as just another valid medical decision, medical groups increasingly intimidated into neutrality and an almost entirely sympathetic mainstream media holding up Brittany Maynard as the ultimate poster child, the average person is easily persuaded to not look too closely  at the reality of assisted suicide.

For example, here is just the title of the Colorado ballot measure. There is also a much longer ballot summary and a link to the full proposed law.

“Shall there be a change to the Colorado revised statutes to permit any mentally capable adult Colorado resident who has a medical prognosis of death by terminal illness within six months to receive a prescription from a willing licensed physician for medication that can be self-administered to bring about death; and in connection therewith, requiring two licensed physicians to confirm the medical prognosis, that the terminally-ill patient has received information about other care and treatment options, and that the patient is making a voluntary and informed decision in requesting the medication; requiring evaluation by a licensed mental health professional if either physician believes the patient may not be mentally capable; granting immunity from civil and criminal liability and professional discipline to any person who in good faith assists in providing access to or is present when a patient self-administers the medication; and establishing criminal penalties for persons who knowingly violate statutes relating to the request for the medication?”

But what might have happened if this alternative language was used?

Should Colorado change the Colorado revised statues to permit a licensed doctor of any specialty in conjunction with a similar doctor to write a prescription for a lethal overdose to cause death for any adult resident that the doctors expect to die within 6 months; require mental health evaluation only for the purpose of determining if the person is mentally capable to make the decision to end his or her life; grant immunity for the doctors and others from civil or criminal penalty as long as they claim “good faith” intentions; require that the death certificate falsely state the cause of death as a natural medical condition instead of the lethal overdose; prohibit life insurance policies from being affected by a request for a legal lethal overdose and prohibit  public information about such lethal overdoses except a yearly statistical report as reported by the doctors involved? (Emphasis added)

Of course, we will never know.

But when we allow medical/legal protections and standards to be suspended for some suicidal people considered expendable based on an estimated prognosis and personal fear of even potential pain and/or dependence,  we will inevitably see the pool of potential victims of medical termination expand and lethal injections accepted, as is already  happening in Canada, the Netherlands, Belgium and Switzerland.

Just as bad, we will also be creating a class of medical serial terminators immune from any real oversight and accountability while penalizing ethical health care providers who refuse to participate or refer.

New York Times Article, Dr. Timothy Quill Promote Physician-Assisted Suicide by Starvation and Dehydration

nancyvalko assisted suicide, Compassion & Choices, end-of-life, euthanasia, law, medical ethics

Physician-assisted suicide is not just about someone taking a lethal overdose of medicine prescribed by a doctor. For many years, Compassion and Choices, the former and more appropriately named Hemlock Society) has also promoted VSED (voluntary stopping of eating and drinking) as just other end of life option they insist is legal in all states, even those without an assisted suicide law.

Now in a disturbing new New York Times article  “The VSED Exit: A Way to Speed Up Dying, Without Asking Permission” , columnist Paula Span (who admits that she was “also a speaker, and received an honorarium and some travel costs.”) writes about conference on VSED, “billed as the nation’s first, at Seattle University School of Law which drew about 220 participants — physicians and nurses, lawyers, bioethicists, academics of various stripes, theologians, hospice staff.” In her article, Ms. Span acknowledges that VSED “causes death by dehydration, usually within seven to 14 days.” (Emphasis added)

Thus, VSED death is no more “natural” than physician-assisted suicide by lethal overdose. It just takes longer.

One of the featured speakers was Dr. Timothy Quill, described as “a veteran palliative care physician at the University of Rochester Medical Center.” Unmentioned is that Dr. Quill is a long-time activist for physician-assisted suicide and 2012 president of the American Academy of Palliative and Hospice Medicine which is now “neutral” on assisted suicide. He was also the respondent in the 1997 US Supreme Court Case Vacco v Quill arguing for the constitutional right to physician-assisted suicide.

VSED AS A “REASONABLE” OPTION FOR “PEOPLE WITH SERIOUS ILLNESSES WHO WANT TO HASTEN THEIR DEATHS”

Although Dr. Quill claims that VSED is “generally quite comfortable at the beginning”, he also states that “You want a medical partner to manage your symptoms,” because “It’s harder than you think.”

How hard?

In 2000, Quill and Dr. Ira Byock (a palliative care doctor who speaks against legalizing physician-assisted suicide while also supporting VSED and terminal sedation) wrote an article titled “Responding to Intractable Terminal Suffering: The Role of Terminal Sedation and Voluntary Refusal of Food and Fluids”.

In the article, they wrote about the case of BG, a radiology doctor with an eventually fatal brain tumor, who “did not want to die but was fearful of becoming physically dependent and intellectually impaired.”

As they wrote: “BG stopped eating and drinking. The initial week was physically comfortable and personally meaningful.” However, “On day 10, BG became confused and agitated and began having hallucinations. The peace and comfort that he and his family had achieved began to unravel.”

His intravenous morphine drip to control his headaches was increased to cause terminal sedation and he died.

Byock and Quill conclude that   “Medicine cannot sanitize dying or provide perfect solutions for all clinical dilemmas. When unacceptable suffering persists despite standard palliative measures, terminal sedation and voluntary refusal of food and fluids are imperfect but useful last-resort options that can be openly pursued.” (Emphasis added).

THERE ARE NO RELIGIOUS OBJECTIONS TO VSED?

In her article, Ms. Span makes an effort to make VSED sound morally and ethically acceptable when she states:

“Moreover, major religious groups have yet to declare whether they consider VSED an acceptable act of self-determination or a suicide, anathema in most faiths.”

Actually, many people-religious and non-religious- as well as disability groups like Not Dead Yet have objected to VSED.

And for Catholics, the Vatican Charter for Health Care Workers specifically states :

“The administration of food and liquids, even artificially, is part of the normal treatment always due to the patient when this is not burdensome for him: their undue suspension could be real and properly so-called euthanasia.” (Emphasis added)

In addition, the Charter also addresses the concept of terminal sedation:

“Sometimes the systematic use of narcotics which reduce the consciousness of the patient is a cloak for the frequently unconscious wish of the health care worker to discontinue relating to the dying person. In this case it is not so much the alleviation of the patient’s suffering that is sought as the convenience of those in attendance. The dying person is deprived of the possibility of ‘living his own life’, by reducing him to a state of unconsciousness unworthy of a human being. This is why the administration of narcotics for the sole purpose of depriving the dying person of a conscious end is ‘a truly deplorable practice’.” (Emphasis added)

EXPANDING VSED

As Ms. Span observes there are “obstacles” still to overcome in the quest for universal acceptance of VSED including whether people with dementia can “pre-choose” VSED by request or “living will”  while still well.  Another issue includes legal cases where even non-terminal residents or their relatives sue to make nursing homes stop even spoon-feeding.

The Compassion and Choices death machine rolls on and in many different directions but the goal remains death on demand. Apathy is not an option.

Is Compassion and Choices Aiming to Become the “Planned Parenthood” of Euthanasia?

nancyvalko advance directives, assisted suicide, Compassion & Choices, education, end-of-life, law, medical ethics

With over $22 million in 2015 net assets,  a 4 star rating from Charity Navigator, enthusiastic media coverage and a new  “Federal Policy Agenda for 2016 and Beyond” , Compassion and Choices increasingly appears to be following in the 4 star, politically and media supported, $1.3 billion dollar revenue ($528 million in government taxpayer funding) steps of the Planned Parenthood Federation of America.

While Compassion and Choices claims that it just “works to improve care and expand choice at the end of life”, it also admits that “We employ  educational training programs, media outreach and online and print publications to change healthcare practice, inform policy-makers, influence public opinion and empower individuals.” (Emphasis added)

THE PALLIATIVE AND HOSPICE CONNECTION

Compassion and Choices has worked for decades not only to legalize physician-assisted suicide in every state but also to normalize and integrate physician-assisted suicide into medical practice and reaches out to established medical groups like the American Academy of Palliative and Hospice Medicine (AAPHM).

Currently, Oregon reports that 92.2% of its physician-assisted suicides were enrolled in hospice care and in Washington state,  93% of its assisted suicides “were assisted by an EOLWA (End of Life Washington) volunteers”. 

Compassion and Choices also supports two other “legal” options for assisted suicide in states that haven’t passed physician-assisted suicide laws. One is “voluntary stopping of eating and drinking (VSED)” and the other is “palliative sedation-Sometimes called terminal sedation”. Significantly, the recommendations include the admission that “VSED includes pain and symptom management” and “Palliative sedation must be medically managed by a healthcare provider”. Thus the need to influence and train hospice and palliative care providers.

No wonder Compassion and Choices lists as one of its accomplishments that it:

Pioneered the medical model of aid in dying that helps ensure that doctors can ethically practice aid in dying in an open, legitimate and accessible way, and integrates the option into patients’ end-of-life care. The culmination of that work was the publication of clinical criteria in the Journal of Palliative Medicine in December 2015. (Emphasis added)

The first line of this article “Clinical Criteria for Physician Aid in Dying” (their preferred name for physician-assisted suicide) is:

“More than 20 years ago, even before voters in Oregon had enacted the first aid in dying (AID) statute in the United States, Timothy Quill and colleagues proposed clinical criteria AID.”  (Emphasis added)

Timothy Quill, MD was the 2012 president and recipient of the Visionary award  of the American Academy of Palliative and Hospice Medicine. Dr. Quill also was the respondent in the 1997 US Supreme Court case Vacco v Quill arguing for physician-assisted suicide as a constitutional right. He lost unanimously then.

Now, Compassion & Choices’ website has a video presentation based on this article  titled  “Understand the Clinical Practice of Aid in Dying”  for doctors and other clinicians. The presentation even offers continuing medical education credits.

This would not be possible if the AAPHM had not changed its position on assisted suicide from opposition to “studied neutrality”, a position that the American Medical Association itself is now considering.

WHERE THE MONEY AND POWER IS

Compassion and Choices now has its “Federal Policy Agenda / 2016 & Beyond”.

The priorities on its agenda include:

“Establish federal payment for palliative care consultations provided by trained palliative care professionals who will advocate for and support the values and choices of the patient….”  (Emphasis added)

Also included are “Professional Education and Development” training programs for doctors and other providers “in discussing terminal prognoses and death” and  “Policies and Payment Systems” to change medical policies and payments to a “a value-based healthcare payment system” that will “(e)ncourage Congress to direct CMS (the Centers for Medicare and Medicaid Services) and other federal agencies” to withhold   “appropriations or other funds”  for treatment that was “provided but (deemed) unwanted”.

This last provision reinforces the fear many healthcare providers already have that, if in doubt, it is safer not to treat a person rather than treat him or her in hope of a good result because of potential lawsuits or reimbursement problems.

Also a priority is “Public Education and Engagement”.  Compassion and Choices bemoans that one survey showed “22 percent of those aged 75 and older had neither written down nor talked to someone about their treatment preferences at the end of life.”

So naturally Compassion and Choices recommended strengthening the Centers for Medicare and Medicaid Services’ proposal to “reimburse doctors for communicating with patients about whether and how they would want to be kept alive if they become too sick to speak for themselves.”  This of course involves “living wills” and other advance directives that give people a list of some medical treatments or care to automatically refuse by a check mark. Unfortunately but tellingly, these directives include no explanation of the treatments themselves or their risks and benefits which is crucial for the informed consent or refusal required if the person was making the decision while fully conscious.

CONCLUSION

Compassion and Choices has been very involved in many legal cases about assisted suicide including the 1997 US Supreme Court’s Vacco v Quill decision finding no constitutional right to physician-assisted suicide. Undeterred, the organization continues to push for legalization of assisted suicide by fighting state by state while hoping for a possible future US Supreme Court decision that, like Canada’s in 2015, would legalize medically assisted suicide throughout the country.

In the meantime, if Compassion and Choices federal policy agenda is successful, they stand to benefit from a potential windfall of government taxpayer funding to provide their currently  “free consultation, planning resources, referrals and guidance”

As an article by Ashton Ellis has astutely observed ,

“The effort by pro-euthanasia group Compassion & Choices to use Brittany Maynard’s story to push physician-assisted suicide is part of a larger strategy. When talking about end-of-life issues, a strategically crafted frame points to only one logical conclusion: I’d rather be dead.”

Neutrality Kills

nancyvalko assisted suicide, Compassion & Choices, conscience rights, law, medical ethics, nursing

In 1997, Oregon became the first state to pass a physician-assisted suicide law. This came after the Oregon Medical Association changed its position from opposition to neutrality. 21 years later and after multiple failed attempts, the California state legislature approved the latest physician-assisted suicide law after the California Medical Association changed its opposition to neutrality.

The message sent-and received- was that if doctors themselves don’t strongly oppose physician-assisted suicide laws, why should the public?

Now the American Medical Association is set to reconsider changing its traditional opposition to assisted suicide to neutrality. This would be another, even more far-reaching disaster in terms of national impact.

For years, the euthanasia/assisted suicide activists of Compassion & Choices have successfully lobbied groups like the California Medical Association, the American Public Health Association, The American College of Legal Medicine, American Medical Student Association and American Medical Women’s Association and The American Academy of Hospice and Palliative Medicine to support legalized physician-assisted suicide or at least take a “neutral” position.

As a former home health and hospice nurse, I am particularly outraged that the latest organization to crumble to Compassion & Choices is the Visiting Nurses Associations of America.

According to its website, Compassion & Choices says that the VNNA had Compassion & Choices as part of the their Public Policy Leadership Conference “where they discussed their federal agenda for 2016 and the important role that members of the VNAA play in end-of-life care.”

With millions of dollars from donors to advance its agenda, a supportive media that ignores dangerous facts, popular ethicists who change positions with the polls and a legal system that has helped to undermine protections for the medically vulnerable, it may seem that Compassion & Choices is getting closer to achieving its goal of forcing doctors and nurses to supply medically assisted death on demand.

For example, a 2014 survey of over 21,000 American and European doctors responding to an ethics survey conducted by Medscape (a password-protected website for medical professionals) showed that-for the first time-a majority of doctors polled supported assisted suicide.

However, here are a few ways any of us can help turn around this dire situation:

  •  Educate yourself on the facts and consider joining others to publicly oppose medically assisted suicide/euthanasia in our courts, legislatures and media outlets.
  • Demand that suicide prevention and treatment must be made available to all, not just the young and physically healthy.
  • Ask your health care professionals about their position on assisted suicide/euthanasia and support only health care providers who will not assist suicide or refer for it.
  • Discover and reach out to at risk individuals and their families who may be in your neighborhood or church. Loneliness and isolation can be debilitating.
  • Consider volunteering at a local nursing home or facility. Some churches have even started programs to encourage church members to visit one hour, once a week with one patient.

None of us can afford to be neutral- or silent-when it comes to this life or death issue.

Assisted Suicide and the Psychiatrist

nancyvalko assisted suicide, euthanasia, law, medical ethics

When a person is suicidal, it is standard to get a psychiatric or psychological evaluation to help treat the suicidal person-except in states that have physician-assisted suicide laws. In those states when a suicidal person wants assisted suicide, there is only a so-called “safeguard” that leaves it up to the opinion of the assisted suicide doctor as to whether or not such an evaluation is necessary.

Not surprisingly, very few such consultations are done since assisted suicide advocates insist that suicide is rational when a person is terminally or incurably ill.

But even if such an evaluation is done, would it be done according to the same standards as the evaluation of a suicidal person not seeking medically assisted suicide?

In my opinion, probably not.

PSYCHIATRIC AMBIVALENCE

In a recent Psychiatric Times article “Death and the Psychiatrist”,  editorial board member and ethics writer Dr. H. Steven Moffic struggles with the topic of medically assisted suicide:

The role of the psychiatrist is generally to determine whether psychiatric illness is contributing to the decision to die. The assumption is that the mental illness is treatable if it is diagnosed. Another related role is to assess competence to make a decision.

However, data indicate that psychiatrists are seldom called in by other physicians when they should be. Moreover, in the Netherlands and Belgium, physicians can now be called on to help mentally ill patients die.2 (Emphasis added)

Dr. Moffic goes on to note that:

Polls indicate that like the public, physicians and psychiatrists have mixed and ambivalent opinions about euthanasia, and—for moral reasons—few of us want any involvement.5” (Emphasis added)

And:

There are obvious financial considerations as Baby Boomers age and become ill. End-of-life medical costs are high and physician-assisted suicide offers a cheap, quick solution to conserve health care resources. (We in psychiatry know this all too well, since we were an early target of for-profit managed care cost savings.)13 (Emphasis added)

Yet he concludes:

Beyond the personal, what do I believe professionally about euthanasia? I lean toward the AMA position—that physician-assisted death could take us too far away from our healing role. Perhaps, though, a special cadre of physicians can be trained and dedicated to this role. (Emphasis added)

However, ambivalence does nothing to  stop or even limit medicalized suicide.

CONCLUSION

The traditional Hippocratic Oath was routinely taken by graduating medical students and promoted the standard of incorruptible virtue in the practice of medicine.  In the 1960s, that began to change and new Oaths were promoted as more up to date and relevant.

Significantly, one of the first parts of the Hippocratic Oath to be eliminated was:

I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan; and similarly I will not give a woman a pessary to cause an abortion. (Emphasis added)

Now we have medicalized deaths actually promoted as civil rights.

Without strong ethical standards, enforceable laws and honorable health care providers,  how can we be expected to just automatically trust our health care system?