euthanasia

CALIFORNIA GOVERNOR SIGNS ASSISTED SUICIDE BILL AND MY 1996 ARTICLE “NO BLANK BULLETS”

nancyvalko assisted suicide, conscience rights, euthanasia, medical ethics

USA Today article: Calif. governor signs assisted suicide bill

Comment: Note the quote about why Governor Brown signed this bill after it was defeated 4 times in committee with weeks of deliberation: “In the end, I was left to reflect on what I would want in the face of my own death,” the governor wrote. “I do not know what I would do if I were dying in prolonged and excruciating pain. I am certain, however, that it would be a comfort to be able to consider the options afforded by this bill. And I wouldn’t deny that right to others.”

Unfortunately, it seems too many people base their judgements about physician-assisted suicide based on possible future self-interest rather than what the bill allows-medicalized killing by suicide-instead of the terrible consequences on people at risk, medical ethics and society.

Almost 20 years ago and before Oregon implemented its physician-assisted suicide law, I wrote the following commentary for the January-March 1996 edition of the Patients Rights Council newsletter. I believe it is just as valid today.

No Blank Bullets

Ready… aim… fire!

All the B-movie scenes I watched as a child flashed through my mind when I heard that a convicted murderer had been recently executed by firing squad. My visceral reaction was to cringe, instantly imagining the terror of being blindfolded and waiting for the bullets to hit. What I couldn’t imagine, though, were the feelings of being one of the men called to pick up and aim a piece of cold, hard steel at another human being. Would the man cope by pretending it was just another round of target practice? Would he try to remember the details of the murders and the tears of the victims’ families to muster the outrage that such crimes call for? What did he feel after the execution — sadness or satisfaction?

I was not surprised to later learn that one of the firing squad guns contained only blank bullets. In such circumstances, it is sensible to protect each executioner from the certain knowledge that he personally ended another’s life. In the more common lethal injection executions, the process is said to include at least two people and two buttons to start the process. Again, the procedure for legally terminating another life tries to protect those whom society asks to perform the awful task.

It is ironic, therefore, that society is considering the addition of yet another kind of execution to the legal list — assisted suicide — but this time without the blank bullets.

Few people would seriously consider legalizing relative– or family-assisted suicide. The inherent dangers of this type of private killing are much too obvious. Thus, the goal must be physician-assisted suicide or, more accurately, health care professional-assisted suicide, since nurses also must necessarily be involved when the assisted suicide occurs in a health facility or home health situation. We doctors and nurses are the ones society is now considering asking to perform the act of terminating lives, but unlike the firing squad or the lethal injection team, we will know and have to live with the certain knowledge that we caused death.

It is doubly ironic that when a convicted murderer tries to discourage efforts by lawyers to stop his or her execution, this is considered as a sign of stress or mental disorder, while a sick person’s willingness to die is considered an understandable and even courageous decision! How do we reconcile the two views that killing is the ultimate punishment for a convicted murderer and, at the same time, the ultimate blessing for an innocent dying or disabled person?

Both the American Medical Association and the American Nurses Association have recently issued strong statements against assisted suicide and euthanasia. While acknowledging the very real deficiencies too often found in care at the end of life, these organizations call for more education and access to help instead of the simple but dangerous option of killing terminally-ill or severely-disabled people or helping such people kill themselves. It is eminently logical that our concern for life should not be limited to just the curable.

And, although some polls show that a significant number of doctors and nurses, like the general public, say they could support assisted suicide in a hypothetical case, when faced with the realities and ramifications of legalizing the practice, most express deep concerns and fears regarding its implementation.

Society has long insisted that health care professionals adhere to the highest standards of ethics as a form of protection for society. The vulnerability of a sick person and the inability of society to monitor every health care decision or action are powerful motivators to enforce such standards. For thousands of years doctors (and nurses) have embraced the Hippocratic standard that “I will give no deadly medicine to any one, nor suggest any such counsel.” Should the bright line doctors and nurses themselves have drawn to separate killing from caring now be erased by legislators or judges?

As a nurse, I am willing to do anything for my patients — except kill them. In my work with the terminally ill, I have been struck by how rarely these people say something like, “I want to end my life.” And the few who do express such thoughts are visibly relieved when their concerns and fears are addressed and dealt with instead of finding support for the suicide option. I have yet to see such a patient go on to commit suicide.

This should not be surprising. Think about it. All of us have had at least fleeting thoughts of suicide in a time of crisis. Imagine how we would feel if we confided this to a close friend or relative who replied, “You’re right. I can’t see any other way out either.” Would we consider this reply as compassionate or, instead, desperately discouraging? The terminally-ill or disabled person is no different from the rest of us in this respect.

I often wonder if right-to-die supporters really expect us doctors and nurses to be able to assist the suicide of one patient and then go on to care for a similar patient who wants to live without this having an effect on our ethics or our empathy. Do they really want to risk more Jack Kevorkians setting their own standards of who should live and who should die?

The excuse that the only real issue is the patient’s choice would be cold comfort to us doctors and nurses when we have to go home and face the fact that we helped kill another human being or had to remain silently powerless while some of us legally participated. There will be no blank bullets then for us — or for society.

How NOT To Prevent Assisted Suicide On World Suicide Prevention Day

nancyvalko assisted suicide, disability, euthanasia

HOW NOT TO PREVENT ASSISTED SUICIDE ON WORLD SUICIDE PREVENTION DAY

Today is World Suicide Prevention Day and this week is the US National Suicide Prevention Week.

.According to the International Association for Suicide Prevention:

“We may not be able to pinpoint the exact figure, but we do know that each individual suicide is a tragic loss of life. It is hard to imagine the extreme psychological pain that leads someone to decide that suicide is the only course of action. Reaching out to someone who is struggling can make a difference.” (emphasis added)

All aspects of suicide, suicide prevention and the groups at risk are addressed by these organizations. Yet on the topic of preventing physician assisted suicide, there is only silence.

If indeed some suicides should be considered acceptable or even worthy, I have some suggestions on how NOT to prevent assisted suicide:

1. Change the terminology. Call your organization “Compassion and Choices” rather than The Euthanasia Society of America. Insist that physician assisted suicide now be called “death with dignity”, “aid in dying” or some other term that eliminates the word “suicide.”  Glamorize assisted suicide as “heroic” and “altruistic”. Refuse to even acknowledge the existence of suicide contagion and its devastating effects on surviving friends and families. Insist that only terminally ill people with 6 months to live and are in unendurable pain are eligible despite the evidence.

2. Change strategies as necessary. If most people in a state like California will not vote to legalize assisted suicide, find a judge to rule that a ban on assisted suicide is unconstitutional and hope that this will lead to a new US Supreme Court decision. Lobby professional health care organizations like the AMA, ANA and American Academy of Hospice and Palliative Medicine to take at least a neutral position on assisted suicide because some of their members are in favor of assisted suicide. Encourage articles in journals like Psychology Today promoting the idea of “rational suicide”. Promote positive statements on assisted suicide from celebrities like Hugh Grant, Dr. Mehmet Oz and Stephen Hawking.

3. Demonize the opposition. Call them “religious extremists” who are against individual choice and freedom. Accuse them of actually wanting people to endure needless suffering. Tell health care professionals that their conscience rights  are merely a right to ” to exercise their idiosyncratic convictions at the expense of patient care”.  Ignore disability organizations like Not Dead Yet.

4. Manage negative facts to persuade the media and thus the public to support assisted suicide. Publicize tragic stories like Brittany Maynard’s to raise even more money to legalize assisted suicide everywhere. Dismiss  or downplay stories about coercion, euthanasia on demand in European countries, ethical palliative and hospice care  and criticism of so-called “safeguards” and self-reported state statistics.

5. Most of all, ignore the lethal consequences of physician assisted suicide on individuals, health care itself and society.

New Doctor-Assisted Suicide Bill Introduced in California After Prior Bill and 2 Court Challenges Fail

nancyvalko assisted suicide, euthanasia, medical ethics

Last October when Compassion and Choices (the former Hemlock Society) rolled out Brittany Maynard’s tragic assisted suicide story along with the establishment of a Brittany Maynard Fund to raise money to legalize doctor-assisted suicide throughout the US, the group was confident that this would be the tipping point in a movement that had stalled in other states.

The state of California was considered a sure thing for doctor-assisted suicide especially because Brittany Maynard and her family left California which had repeatedly rejected doctor-assisted suicide for Oregon, the first state to legalize such suicides. Nevertheless, People magazine and other mainstream media praised Ms. Maynard “heroism” in supporting doctor-assisted suicide and touted the “success” of such laws in the few states that had legalized it.

However, efforts to pass Senate Bill 128 failed in the California legislature this summer after efforts by disability, pro-life and other organizations to educate both legislators and the public about the dangers of doctor-assisted suicide.

Undaunted, Compassion and Choices then supported efforts to reverse the ban against assisted suicide with lawsuits filed by several terminally ill patients in two courts. However both courts, one in San Francisco and one in San Diego,  refused to overturn California’s ban on assisted suicide.

The well-funded pro-assisted suicide groups are nothing if not tenacious so it should not be a surprise that they have now unveiled a “new” and “improved”  doctor-assisted suicide bill called AB 15 End of Life Option Act with more so-called “safeguards”.

The reassurance of safeguards are critical to the selling of doctor-assisted suicide to a public understandably squeamish about allowing doctors to help some people to kill themselves.

 WHAT SAFEGUARDS?

There have been many articles about the problems with these alleged safeguards but they are rarely covered in mainstream media articles. The latest and one of the best is then August 15, 2015 US Conference of Catholic Bishops’ paper titled  “Assisted Suicide Laws in Oregon and Washington: What Safeguards?”,

For example, here is a portion of the paper that gives the real facts behind the alleged psychological counseling safeguard:

Despite medical literature on the frequent role of depression and other psychological problemsin choices for suicide, the prescribing doctor (and the doctor he selects to give a second opinion)are free to decide whether or not to refer suicidal patients for any psychological counseling.Even if such counseling is provided, its goal is to determine that the patient is not suffering from“a psychiatric or psychological disorder or depression causing impaired judgment.” Ore. Rev.Stat. 127.825; Rev. Code Wash. 70.245.060. The doctors or counselor can decide that, since depression is “a completely normal response” to terminal illness, the depressed patient’s judgment is not impaired…..
From 1998 to 2012, on average only 6.2% of patients who died under the Act in Oregon were referred for counseling to check for “impaired judgment.” Of 108 patients who died under the (Oregon) Act in 2007 and 2009, none was referred for psychological evaluation. In Washington, only 4% of patients are known to have been referred for such counseling in 2014 (six of the 167 who died from any cause after receiving the prescription); the state does not report whether any of those who actually ingested the lethal drugs had been referred for counseling.
 In another section, the paper relates what happened with an Oregon physician despite the alleged safeguard that an assisted suicide request must come from a competent, terminally ill person:
An Oregon emergency room physician was asked by a woman to end the life of her mother who was unconscious from a stroke. He tried to stop her breathing or heartbeat in several ways,finally giving a lethal dose of a paralyzing drug to the older woman who died minutes later. The state board of medical examiners reprimanded the doctor but he faced no criminal charges for this direct killing–which news reports called a case of “assisted suicide”–and he later resumed medical practice.

WHY SHOULD WE CARE?

Unfortunately, even my home state of Missouri which has laws against assisted suicide had a case similar to the one referenced here about the Oregon physician who gave a lethal overdose. This 2001 Missouri case involved a nurse. The nurse gave a lethal overdose without a doctor’s order to a patient who had a stroke the day before but wouldn’t stop breathing when taken off a ventilator. After the patient’s son voiced support for the nurse, she was only sentenced to 5 years’ probation.

The point is that when so-called “safeguards” are accepted (and routinely ignored) in states that do have legalized doctor-assisted suicide amid an aggressive national campaign to legalize doctor-assisted suicide as a civil right, there has been a chilling effect on prosecutors and juries even in other states that have rejected assisted suicide as long as “compassion” is given as the reason for ending life.

Ominously, in other countries like Belgium and Holland, the practice of doctor-assisted suicide for the terminally ill adult has  evolved over the years to now include children, people with mental illness and even people who are only “tired of life.”

Are we willing to risk a similar fate here?