Amy Hasbrouck: Analysis of Canada’s C-14, Assisted Suicide / Euthanasia Bill

Amy Hasbrouck, assisted suicide, Canada, euthanasia, euthanasia prevention coalition, Our News & Commentary Blog, Toujours Vivant-Not Dead Yet, , , ,

On April 14, 2016, Justin Trudeau’s Liberal government introduced bill C-14 “An Act to Amend the Criminal Code … (Medical Assistance in Dying)” in the house of commons, pursuant to the Canadian Supreme Court’s decision in Carter v. Attorney General of Canada, of February, 2015.

The law will make it legal for a competent adult with a “grievous and irremediable medical condition” to make a voluntary request and give informed consent to receive “medical aid in dying.” In the statute, a “grievous and irremediable medical condition” is defined as a “serious and incurable disease, illness or disability.” The person must be in an “advanced state of irreversible decline in capability” which causes “enduring physical or psychological suffering that is intolerable” and cannot be relieved in a way they find acceptable, and their natural death must be “reasonably foreseeable.” This is not a formal prognosis and sets no specific time limit. However the person must be informed of their reasonably foreseeable natural death.

Eligibility is determined by a doctor or nurse practitioner, with sign-off by a second doctor or nurse practitioner. The onus is on the person to be informed, and no provision is made to ensure communication access. The process by which decisional capacity is determined is not described.

The law allows for either euthanasia (performed by a doctor or nurse practitioner) or assisted suicide (a prescription the person can take at home). It also calls for a 15-day waiting period, unless the medical professional making the eligibility determination decides that the circumstances merit suspension of the waiting period. The application must be made in writing, and signed by two disinterested witnesses. However there is no restriction on who may write and sign the application on behalf of a person who is incapable of writing; thus an heir or employee of a nursing home could fill out the application for a non-verbal person, and their interpretation of the person’s wishes would probably go unquestioned.

The law allows an exemption for any person aiding a medical practitioner for actions in aid of assisted suicide/euthanasia (AS/E). Similarly, “No person commits an offence … if they do anything, at another person’s explicit request, for the purpose of aiding that other person to self-administer a substance that has been prescribed … as part of the provision of medical assistance in dying.” These exemptions apply “even if the person invoking the exemption has a reasonable but mistaken belief about any fact that is an element of the exemption.”

Some additional problems with the law:

  • The “voluntariness” of the request relates only to “external pressure” not psychosocial conditions or “vulnerability.”
  • There is no “vulnerability assessment” provided.
  • There is no prior, external judicial review of the person’s eligibility for AS/E.
  • There is no guarantee of palliative care or home care.
  • There is no right of refusal for clinicians or organizations; no “safe spaces” for patients.
  • (As in Oregon and Washington) lethal drugs left around the house could pose a danger to children or be sold on the street.
  • The data gathering scope and process are not specified.
  • The promises of the bill’s preamble are not fulfilled in the law.

Bill C-14 excludes persons under 18 years of age, and does not allow medical aid in dying by advance directive. The language of “decline in capability” and “reasonably foreseeable” natural death is meant to exclude people whose “suffering” is purely psychological. However the law provides that these three issues will be studied over the next five years to determine if the law should be amended to allow these practices and include these populations.

The bill is expected to go to second reading within the next week, then to the justice committee for hearings. If the bill is not passed by June 6, then the criminal code sections identified in the Carter case will simply cease to be in effect, creating an unstructured “right” to physician assisted death where virtually anything could happen.

The Euthanasia Prevention Coalition is calling upon local groups to organize rallies at the local offices of MPs (Members of Parliament) on April 27, and is planning a major event on June 1 in Ottawa.

NY Independent Living Exec Letter Points To Dangers in Former Insurance Exec’s Assisted Suicide Bill

aid in dying, assisted suicide, Compassion & Choices, letters to the editor, New York, Our News & Commentary Blog, ,

The Albany Times Union just carried a letter by Denise Figueroa, Executive Director of the Independent Living Center of the Hudson Valley, in response to an opinion piece by the Executive Director of the national assisted suicide advocacy group, who is also one of the drafters of the Oregon law upon which the New York bills are closely modeled.  Here’s Ms. Figueroa’s excellent letter, which highlights what many refer to as the “deadly mix” between assisted suicide and a profit driven health care system:

A commentary by Barbara Coombs Lee, head of Compassion & Choices, put forth some confusing and misleading information about a New York assisted suicide proposal and criticized a brain cancer patient leading the fight against it (“Allow terminally ill a peaceful escape,” March 20). Under the proposal, a patient that a doctor has determined has six months or less to live can receive a lethal drug overdose from a pharmacist.

She failed to note in either her background or her piece that she is a former HMO executive. As such, she is very familiar with the business of health insurance and how much these companies have to pay out when someone wants to be treated for their serious disease or disability. Legalizing assisted suicide leaves the doors wide open for health insurance companies to deny coverage of expensive treatments for the terminally ill, in favor of approving the far less expensive lethal drugs for suicide. This horrific danger has already been documented in Oregon where the bill Ms. Coombs Lee authored has been in effect for nearly two decades.

Additionally, she didn’t mention that opposition to assisted suicide is not partisan or ideological. Opponents include the Medical Society of State of New York, the Hospice and Palliative Care Association as well as advocates from disability rights, patients’ rights and suicide prevention communities.

Hopefully, legislators in Albany are getting both sides of the issue.

Denise Figueroa

Executive director, Independent Living Center of the Hudson Valley

[The op-ed to which this letter responds is available only to Times Union subscribers here.]

John Kelly: Assisted Suicide Laws and Bills “Riddled with Falsehoods”

aid in dying, assisted suicide, elder abuse, john kelly, New Hampshire, Our News & Commentary Blog, Second Thoughts, Testimony, , , ,

On March 29, Not Dead Yet New England Regional Coordinator and Second Thoughts Massachusetts Director John Kelly testified against New Hampshire Bill SB426, which would establish an “end-of-life choices study commission.” Using the euphemisms of proponents like Compassion & Choices against the bill, John lists the ways in which the bill is “riddled with falsehoods.”

Excellent opposition testimony was also delivered by doctors Paul Saba and Richard Johnson, and former New Hampshire legislator Nancy Elliott. Below are excerpts from John’s testimony:

Chairman Rowe, Vice-Chairman Hagan, Members of the Committee:

. . . Please reject SB426 because it is riddled with falsehoods. From the words of the commission’s title to its enumerated duties, it’s clear that legalization proponents drafted the bill. It is a stalking horse for the legalization of assisted suicide.

The first falsehood is the phrase “end-of-life.” The committee should know that in current practice, the “end-of-life” is the six-month period following a physician’s terminal diagnosis. Yet of the millions of misdiagnoses every year, many are terminal misdiagnoses. We know this because of the thousands of people who “graduate” from hospice each year. …

Assisted suicide laws turn the best outcome under hospice – proving you weren’t terminal after all – into the worst possible end for people who might live months, years, or decades longer, but are instead persuaded (or coerced) under threat of agonizing death to commit suicide.

There are so many examples of people outliving terminal prognoses, from Ted Kennedy living a year longer than predicted to John Norton of Florence, Mass., who testified before the state legislature that when he was diagnosed with ALS, he would have definitely used assisted suicide were it available. Luckily for John, his family, and everyone who has come to know him, assisted suicide wasn’t state policy, his disease process stopped, and – 60 years later! – he’s urging people to reject these bills. . . .

The second falsehood is illusion of “choices,” the other word in the title of the proposed commission. When people cannot get accurate knowledge about their condition, we cannot speak of “choices.” We also cannot speak of “choices” –

  • When one out of every 10 people over the age of 60 in New Hampshire is estimated to be abused every year, almost always by adult children and caregivers.
  • When someone in line to inherit your estate can help sign you up, pick up the prescription, and then take action against you with no questions asked.
  • When depressed people with a serious illness who mistakenly think that people will be better off without them get told that “feeling like a burden” is a rational reason to kill yourself.
  • When there is no funded homecare, so families worried about the inheritance feel pressure to “choose” assisted suicide. . . .

I was once able-bodied and had an accident, and since then I’ve received many “better dead than disabled” messages, right to my face and through popular culture. My own father wished that I died in the accident. . . .

The third falsehood in this bill is the phrase “aid in dying,” one of Compassion & Choices’ favorite euphemisms for assisted suicide (“Death with Dignity” is the other). It’s not clear exactly what “aid” means. …

“Dying” reflects the fiercely maintained belief of proponents that when people are “reasonably expected” to die within six months, they are in the process of actively dying. …The problem is that this is so often and so clearly untrue. …

[Fourth], according to proponents, … there has never been a case of abuse out in Oregon – that’s right, the first state-run program ever without a case of abuse. The only reason that no abuse is discovered is because the reports are designed that way. The only abuses we know of are ones that somehow make it to the media.

For example, Wendy Melcher died after being given massive doses of barbiturate suppositories by two nurses, one of whom was having an affair with Wendy’s partner. The nurses claimed that Melcher had requested assisted suicide, but there was no doctor’s prescription, Wendy did not self-administer, and the nurses never reported her death to the Oregon Department of Health as an assisted suicide.

Yet instead of referring the nurses to authorities for criminal charges, the state nursing board secretly suspended one nurse’s license for 30 days and placed the other on two years “probation.” It took a reporter’s phone call years later to inform Melcher’s devastated family that she had been killed. It seems that the very existence of the assisted suicide law turned evidence of a serious crime into an excusable mistake. The Portland Tribune editorialized, “If nurses — or anyone else — are willing to go outside the law, then all the protections built into the Death With Dignity Act are for naught.”

The fifth falsehood is that “aid in dying” is not assisted suicide. …

Encouraging assisted suicide for some will encourage suicide for all. Suicide contagion is real. According to the Centers for Disease Control, Oregon’s already high suicide rate has increased much more than the national average; from 1999 until 2010, the rate of increase for people age 35-64 was 49% in Oregon versus 28% nationally. …

The sixth falsehood is that assisted suicide is all about pain and suffering. But the five leading reasons reported by prescribing doctors solely deal with psychosocial distress about disability. First is distress about dependence on other people (“losing autonomy” 92%), second is distress over lost abilities (“less able to engage in activities making life enjoyable” 89%), followed by feelings of shame and perceived/actual loss of social status (“loss of dignity” 79%), distress about needing help with incontinence (“losing control of bodily functions” 50%), and believing that suicide would leave loved ones better off (“burden on family, friends/caregivers” 40%).

Another falsehood is that “choice” belongs only to the individual. It’s a fantasy that other people only want what the individual wants, and completely support whatever the person chooses.

… Here is an example of a man told he was a burden. Oregonian Kathryn Judson wrote of bringing her seriously ill husband to the doctor.

I collapsed in a half-exhausted heap in a chair once I got him into the doctor’s office, relieved that we were going to get badly needed help (or so I thought). To my surprise and horror, during the exam I overheard the doctor giving my husband a sales pitch for assisted suicide. “Think of what it will spare your wife, we need to think of her, “ he said, as a clincher….

The lives of non-“terminal” disabled people share many traits with people requesting assisted suicide, but we reject as bizarre and dangerous the notion that personal dignity is somehow lost through reliance on others, or because we are not continent every hour of every day. That’s why for 40 years the disability rights movement has insisted on funded programs to provide necessary personal care attendant (PCA) services for all disabled people, including people disabled by their serious illness.

Assisted suicide laws set up a two-tier system, under which some people get suicide prevention services while others get suicide assistance. The difference between the two groups would be based on value judgments about so-called “quality of life.” Many of us already get told, straight to our face and through medical hostility, that we might be better off dead. Legalized assisted suicide makes that prejudice official policy.

That’s why every leading national disability rights group that has taken a position on assisted suicide has come out against it.

There is no way to come up with a better bill through the “thoughtful and deliberative” process envisioned by sponsor Senator Dan Feltes.

This study commission would be well replaced by a commission that would investigate how best to “help older people in New Hampshire live well.”

…Reject SB426 because it’s dishonest and dangerous. Thank you.

To read John’s entire testimony, go here.

John Kelly: Not Dead Yet and Second Thoughts make strong showing at Rhode Island hearing

assisted suicide, Autistic Self-Advocacy Network, depression, elder abuse, Our News & Commentary Blog, Rhode Island, Second Thoughts, Second Thoughts Connecticut, , , ,

Chair gives “Not Dead Yet” an “A” for best name of the evening

Disability rights advocates from Rhode Island, Connecticut, and Massachusetts testified on March 24 before the House Health Education and Welfare Committee that it should have “second thoughts” about assisted suicide bill HB 7659. We pitted the harsh realities of assisted suicide laws against the falsehood-packed PR strategy of Compassion & Choices (C & C).

Rhode Island autistic advocate Emily Titon spoke on behalf of Not Dead Yet, Stephen Mendelsohn testified on behalf of Second Thoughts Connecticut, while John Kelly presented on behalf of both Not Dead Yet and Second Thoughts Massachusetts.  The hearing video is available online and these testimonies begin approximately at minute markers 35 and 49.  Written testimony was submitted by Not Dead Yet president and CEO Diane Coleman and Cathy Ludlum of Second Thoughts Connecticut.

At the start of the hearing, Chair Joseph McNamara announced the bill would be sent to study, which he said would keep the bill alive with the possibility of being amended. The reality is that the bill is almost certainly dead, although it could technically be brought forward at any time.

Emily testified that the bill would immediately endanger people experiencing depression, citing the example of Oregonian Michael Freeland, who despite a 43 year history of suicide attempts and depression, easily got a prescription for the lethal drugs.

Against the C & C strategy of presenting personal stories of pain and agony, Emily testified that “What ever else assisted suicide is, it is not about pain. Pain is a medical problem that palliative care can solve.”

The kind of suffering this bill talks about is social and psychological. Doctors report people choosing suicide because of loss of dignity, loss of autonomy, feeling like a burden, and loss of control of bodily functions.

Emily cited the realities of elder abuse, which affects over 20,000 Rhode Islanders over the age of 60. “Only in the fantasy world of the proponents are all families, including the thousands of abusive and dysfunctional ones, happily gathered around the peaceful and willing suicide.”

Stephen Mendelsohn told the committee that “we have crushed these bills in at least nine states this year and the past three years in Connecticut without a single committee vote. “

Stephen said that Connecticut is the first state to recognize explicitly that “assisted suicide is actually a form of lethal discrimination against disabled people.” He read a key finding of the Connecticut Suicide Advisory Board (CTSAB):

Until recently, the CTSAB was considering assisted suicide of the terminally ill as a separate issue from suicide prevention. The active disability community in Connecticut, however, has been vocal on the need for suicide prevention services for people with disabilities. There may be unintended consequences of assisted suicide legislation on people with disabilities. [Disabled scholar William] Peace writes that “Many assume that disability is a fate worse than death. So we admire people with a disability who want to die, and we shake our collective heads in confusion when they want to live.”

Thanks to Second Thoughts Connecticut, one of the Board’s most important recommendations was:

  • Do not “assume” suicide is a “rational” response to disability.

This simple recommendation collapses the house of assisted suicide cards so carefully constructed by the PR machine at Compassion & Choices. C & C has figured that if they terrify enough people of dying in agonizing pain, they may be able to pass the program they wanted all along. And once they establish the goodness of the treatment known as “aid in dying,” they can go about expanding eligibility, step by incremental step. As Not Dead Yet research analyst Stephen Drake has said, once something is defined as a benefit, it can only be extended.

Stephen Mendelsohn catalogs the recent efforts:

Leaders of Compassion & Choices and other “right-to-die” organizations have publicly stated their intent to come back later to expand beyond “six months,” “terminally ill,” and “mentally competent.” At a gathering in Hartford, Connecticut in October 2014, Compassion & Choices president Barbara Coombs Lee declared her support for assisted suicide for people with dementia and cognitive disabilities unable to consent.  CT News Junkie quoted her saying, “It is an issue for another day but is no less compelling.”  Dr. Marcia Angell, leading proponent of the defeated 2012 Massachusetts’ assisted suicide ballot question, wrote in The New York Review of Books that she now favors euthanasia as well as assisted suicide. Last year, Oregon debated legislation (HB 3337) with six co-sponsors that would have extended eligibility for assisted suicide from a six month prognosis to one year.

My testimony started with the fundamental, irrefutable truth of assisted suicide. “This bill is so dangerous because it will cause innocent people, through mistakes and abuse, to lose their lives because doctors are so often wrong about diagnosis and there are so many Rhode Island elders that are abused.” I ridiculed C & C’s promotion of assisted suicide as providing “choice.”

We cannot speak meaningfully about choice when thousands of people graduate from hospice every year. They outlive their six-month diagnosis and what for them is the best possible outcome – graduating from hospice – under this bill, becomes the worst sort of tragedy, in that people will lose their lives when they had months, years, or decades to live.

It seems that everyone knows someone who has been diagnosed terminal and lived longer. Does anyone in this room really think that doctors are infallible?

I said that there could be no choice when one out of every 10 Rhode Island elders are estimated to be abused, when there is no guaranteed funded homecare, so a family has to weigh the inheritance versus care of a family member, and not when the leading reasons cited in Oregon all have to do with disability.

Chair McNamara then started a line of inquiry about our name “Not Dead Yet,”

“Your organization, Not Dead Yet, interesting name.” He was enjoying himself.

“It’s from Monty Python and the Holy Grail,” I called out.

“I love it!,” he roared. “That’s great. That’s great.”

“Bring out your dead.” “But I’m not dead yet.” (I repeated the key lines from the movie scene, in which a man pushes a wheelbarrow through a medieval town during the Black Death, calling “Bring out your dead. Bring out your dead.”)

“Beautiful. Very creative.” McNamara was beaming. “You get an A for the best name of the evening, so far.”

DREDF and NDY Weigh In Against Proposed CA “1-800-KILL_ME” Hotline

assisted suicide, california, dredf, elder abuse, Marilyn Golden, Our News & Commentary Blog, Patients Rights Action Fund, suicide prevention, , ,

[Editor’s Note:  Thanks to the Patients Rights Action Fund for the brilliant “1-800-KILL_ME” label.  It says it all.]

A lead sponsor of the California assisted suicide law has proposed to take the state sponsored program to a whole new level, urging legislators to fund a dedicated phone line to promote – eh, respond to questions about – the assisted suicide process.

Marilyn Golden, Senior Policy Analyst at the Disability Rights Education & Defense Fund, wrote the following pointed introduction to the problems in the proposed bill:

The Disability Rights Education & Defense Fund (DREDF), a national law and policy center on disability civil rights, opposes SB 1002, The End of Life Option Act Dedicated Telephone Number.

This bill is an expansion of the assisted suicide law even before it goes into effect. It’s a way to promote usage of the assisted suicide law. Last year the authors and proponents said this was a private matter solely between doctor and patient. Now the state would play a role in the law’s promotion.

There is no way to limit callers to people who are terminally ill, which is the distinction made in the End of Life Options Act. Anyone could call, including people who are depressed, and people eager to end the life of a family member. Will the state go beyond providing information about the End of Life Options Act? Will it make any referrals? If it refers callers to Compassion & Choices, why not Final Exit Network, which actively assists people to kill themselves without the involvement of a doctor? If the state refers people anywhere, it should be to crisis hotlines, because, again, anyone could be calling, not only people eligible under the Act.

How will state staff respond when a caller says:

  • “My doctor won’t prescribe lethal drugs to me because she says I don’t qualify. Can you tell me who will?”
  • “I am depressed and want to kill myself; what should I do?” Will the state refer the person to a crisis hotline? It should.
  • “I believe my father is being coerced to utilize the End of Life Options Act.” What will the state do? Note that there is no investigative mechanism available to refer callers to. Will it refer callers to law enforcement?
  • “How can I get medicine for pain?” How will the state respond?

To read the whole letter, go here.

NDY picked up the charge, further connecting the dots concerning the dangers of such a hotline and the impossibility of reconciling it with the state’s existing duties to protect its residents:

The push to create this phone line only serves to emphasize how impossible it is to reconcile the new law with the state’s longstanding duties to prevent suicide and enforce laws prohibiting homicide.

There is no way to limit callers to people who are terminally ill, the target population of the End of Life Options Act. Anyone could call, including people who would formerly have been referred to a suicide prevention hotline, or people who want to learn exactly how to get away with ending the life of a family member. The law’s assisted suicide request form, whatever it may be called, provides the perfect alibi, with no further oversight once the lethal drugs are in the home. Any description of the actual provisions of the law that is given by state workers will clarify to the greedy heir of a senior with assets just how easy it would be to use the law’s recipe for abuse and get away with homicide. After all, the victim of any coercion in getting the form signed “to give them peace of mind” will not be around to testify after the drugs are mixed into their food.

To read the whole NDY letter, go here.