Connecticut: No Appeal in ‘Aid in Dying’ Case

assisted suicide, Compassion & Choices, Conflation and Con jobs, Connecticut, court decisions, litigation, Our News & Commentary Blog

Good news and appropriate headline from the Hartford Courant:

No Appeal in ‘Aid in Dying’ Case

I’d like to think that the editors at the paper used the scare quotes on purpose.  Superior Court Judge Julia Aurigemma consistently framed the term that way in her decision to dismiss the case.  The article gives an indication of why it’s extremely appropriate in covering this case:

The plaintiffs in a lawsuit aimed at making it legal for doctors to help terminally ill patients end their lives will not appeal a judge’s decision to dismiss the case.

Fairfield County physicians Gary Blick and Ronald Levine filed the lawsuit last year asking the court to declare that a state law against assisting suicide would not apply to doctors who prescribed lethal medication to mentally competent, terminally ill patients who asked for it. Doing so would not be suicide, their lawsuit argued, but “aid in dying.”

In response,  Judge Aurigemma used the term “aid in dying” every time she used in her long memorandum dismissing the case.  In essence, Aurigemma ruled that the legislature had visited the issue of physician-assisted suicide a number of times – and had never passed an exemption.  The term ‘aid in dying’ was treated by the judge – rightly – as having no legitimacy, since it was in fact just a substitute term for an issue the legislature had already visited under a more established name.

More from the article:

In a statement Thursday, Kathryn Tucker, an attorney for the plaintiffs, said the decision not to appeal was based on Connecticut’s “unusually strict” sovereign immunity laws.

“But the question posed in this case remains,” said Tucker, legal director of Compassion & Choices, a national end-of-life-care advocacy group that backed the lawsuit. “It is essential for Connecticut physicians to know whether providing aid in dying subjects them to criminal prosecution. At present, patients are unsure if they will be able to access aid in dying should they confront an unbearable dying process.”

A couple of things on this ‘spin’ from the organization I tend to think of as “Conflation & Con Jobs”:

I doubt that Connecticut is “unusually strict” when it comes to sovereign immunity.  Most states have measures of immunity in place.  My guess is that they wrote this off since pretty much every argument they made was written off – including their attempt at a judicial sanction of “aid in dying” as a legitimate and distinct type of medical “care.”

C&C attorney Kathryn Tucker says it’s “essential” for physicians and patients to know if handing out lethal prescriptions to patients for the purpose of suicide will subject them to prosecution.  This is pure posturing on Tucker’s part.  The court gave her the answer to that question – physicians can be prosecuted in those circumstances.

Get real.  Not liking the answer is NOT the same as “not knowing.”  –Stephen Drake

Widow Files Wrongful Death Lawsuit Against Final Exit Members in Georgia

crime and punishment, cults, final exit network, litigation, Our News & Commentary Blog, wrongful death

Billboards or no, troubles continue to mount for the Final Exit Network (FEN):

From blogger Greg Land –

Widow sues ‘Final Exit Network’ over its role in husband’s death:

10:07 am, June 23rd, 2010
 
The widow of a Forsyth County man who died two years ago with the assistance of the Final Action Network, an assisted suicide organization, has filed a wrongful death and negligence suit against the group and four members already facing criminal charges that they helped John D. Celmer, 54, commit suicide with the aid of an “exit hood” connected to a helium tank.

The individual defendants—co-founder Thomas Goodwin of Kennesaw, Claire Blehr of Atlanta, and Lawrence Egbert and Nicholas A. Sheridan, both of Baltimore, Md.—were indicted by a Forsyth County grand jury in March on charges of assisting a suicide, tampering with evidence and racketeering in connection with Celmer’s death.

The civil complaint, filed last week on in Fulton County Superior Court by S. Fenn Little Jr. of Little, Crumley & Chambliss on behalf of Susan Celmer, says that her husband’s cancer was in remission in April 2008 when he contacted the Final Exit Network to inquire about its “exit guide” services. Celmer provided his medical records and filled out a questionnaire and other documents, it says, and on June 19, 2008, defendants Blehr and Goodwin went to Celmer’s home and helped him place the hood over his head, holding his hands as he inhaled the helium and remaining for about 15 minutes “to confirm Celmer was dead.”

The suit says Celmer’s prognosis for recovery was “excellent” at the time of his death, and seeks damages for the value of his life, the loss of companionship for his widow, and punitive damages.

Effort to reach Blehr’s attorney, Robert Rubin of Decatur’s Peters Rubin & Reynolds, was not immediately successful.

The zealots at FEN will probably attempt to describe this as “persecution” and part of a “witch hunt.”  Looks like a widow seeking justice to me.  –Stephen Drake

Reporter Succeeds in Getting Two Suicide Prevention Organizations to Comment on Final Exit Network Billboard!

assisted suicide, International Association of Suicide Prevention, lanny berman, media coverage, Our News & Commentary Blog, San Francisco Suicide Prevention, suicide prevention

Regular readers of this blog might remember that last September – during Suicide Prevention Week – this blog blasted suicide prevention organizations for their silence on all the positive press coverage of the Final Exit Network (FEN).  The coverage included approval of suicides for people who are old, ill or disabled. For good measure, virtually every story on FEN included the organizations website – where people could get information and contact people who would affirm their desire to off themselves as “rational.”

What we concluded was that Suicide Prevention Week didn’t apply to people who are old, ill or physically disabled:

Specifically, there is an appalling lack of voiced concern over the promotion of suicide in the populations of old, ill and physically disabled people. For the first few months of this year, there was nationwide coverage of the Final Exit Network – an organization that supports and facilitates the suicides of people with nonterminal disabilities and chronic conditions. Over the course of many months, stories appearing in countless outlets included the URL for the Final Exit Network in their stories. The website provided information on obtaining suicide instructional materials and how to get involved with the Final Exit Network. Most of the articles treated the Network and its “work” sympathetically.

In case you’re wondering, suicide prevention groups do get involved in media issues. The American Foundation for Suicide Prevention and the Suicide and Mental Health Association International both have sections devoted to media issues. Except for a brief mention of suicide increases related to publication of Derek Humphry’s book, Final Exit, there is no acknowledgment that the suicides of old, ill and physically disabled people are being facilitated and then covered in a way that legitimizes them in the press.

Well, things are looking up, a little.

The Bay Citizen “was founded in 2010 as a nonprofit, nonpartisan news organization dedicated to fact-based, independent reporting on civic and community issues in the San Francisco Bay Area.” (This all sounded familiar so I did a quick check of the likeliest source and found that the Chicago Reader‘s Michael Miner wrote about The Bay Citizen just about a month ago.)

Given the dismal and consistent silence of suicide prevention organizations over the past year, I was extremely surprised when I read the headline of the latest story on FEN’s billboards.  Senior writer Katharine Mieszowski wrote the story that broke new ground in coverage of FEN and assisted suicide.  The title that caught my eye was “Suicide-Prevention Experts Decry Ad,” with a subtitle that suggests the billboard could send the wrong message to those who are suicidal. 

Here’s an excerpt from the story about reactions to the billboard and FEN:

“This is irresponsible and downright dangerous; it is the equivalent of handing a gun to someone who is suicidal,” wrote Lanny Berman, president of the International Association of Suicide Prevention, in an email. “This message, communicated to thousands of vulnerable individuals, suffering from psychic and or physical pain that is treatable, invites a tragic and final solution to problems that most often can be solved with proper evaluation and treatment.”

 These are strong words – and I’m grateful for them.  Berman doesn’t seem to be aware, though, that this message has been conveyed through countless op-eds and news articles over the past year, all carrying contact information for the FEN.  And the message those suffering from “psychic or physical pain” when they contact a representative of FEN is the same that is on the billboard.

The representative of a local suicide prevention organization seems to be totally clueless as the scope of FEN’s activities and who they think should be facilitated in commiting suicide:

“Regardless of what someone might feel about assisted suicide, I feel the message behind this billboard is confusing and dangerous,” wrote David Paisley, deputy director of San Francisco Suicide Prevention, in an email.

“It assumes people will understand that it is a billboard about assisted suicide or they will go to the website,” he wrote. “In reality, most people who see the billboard from the street or car will not go to the website, but are left with a message that could be interpreted very tragically by someone in crisis and acting impulsively.”

Paisley seems to be suffering from severe ignorance in regard to just what FEN will be telling people when they call.  Does he really think that FEN exists to talk old, ill and disabled people out of killing themselves???

Finally, a representative of FEN has the final word – and that final word from Frank Kavanaugh is a lie – a big one:

“We don’t even think that what we do is suicide,” said Kavanaugh. “What we’re about is assistance in dying. We’re dealing with mentally competent people who are rational. People who are suicidal are severely depressed, psychotic, acting impulsively. We would never touch anybody in that kind of a situation.”

That is total crap.  The case in Arizona – in which two FEN members have already entered into plea bargain agreements – involve their facilitation of the suicide of a woman who had no serious physical illness at all, but who had a long history of emotional problems.

Kudo to Ms. Mieszowski.  Out of all the reporters who have covered FEN, she is the only one to have contacted suicide prevention organizations for comment – or at least the first one who has gotten a reply. 

My advice to Lanny Berman and David Paisley: Start learning more about FEN.  This isn’t about a “mixed message” or hitting the wrong target audience.  Here’s a quote from a message left by FEN board member Bob Levine on the article on the Arizona case linked above:

We think every adult, mentally competent person has the right to end their life on their own terms. We think it is an inherent human right. The prosecutor obviously does not believe this and because of his beliefs he is using his police powers to do so.

Well, there’s also the issue of the family complaining to police about the death of the Arizona woman, which they viewed as a tragedy rather than an exercise of her rights.  The police are concerned with several activities of FEN they allege – removing the helium tank and mask after death and generally cleaning the scene, reducing the ambiguity the woman felt about actually commiting suicide, and the suggestion that they might have held her hands to prevent her “accidentally” removing the plastic bag off her face.

In any case, Levine didn’t really mean “every adult” – it’s pretty clear that a person has to be old, ill or disabled to be considered by them.

The question I have is this:

Is this the first word from suicide prevention organizations on this matter – or is it the last one?  In other words, will they finally break their silence and actually act like the lives of old, ill and disabled people matter to them?  Or will they retreat into their previous silence – and abandonment – of this group of people?

Many of us would like to know.  –Stephen Drake

Final Exit Network Starts Billboard Campaign

assisted suicide, Compassion & Choices, Conflation and Con jobs, final exit network, media coverage, media issues, Our News & Commentary Blog

Many readers of this blog are probably already aware that the Final Exit Network (FEN) has put up a promotional billboard in San Francisco.  The group promises to erect more in New Jersey and Florida. 

There hasn’t been a great deal of attention paid to the group and the billboard as of yet, but what little there is shows clearly the advantage FEN has in managing the information about themselves, as can be seen in this SFGate blog entry:

According to its site, FEN provides support, information and counseling, and doesn’t physically help people end their lives. But authorities believe the group played an active role in the death of a cancer-stricken man in Georgia and have charged four network members with assisted suicide, evidence-tampering and racketeering, reports Time. They were indicted by a grand jury in April.

 Interestingly, the blog links to a story in the last sentence of this paragraph that gives a lot more detail – and contradicts the claims made by FEN that are otherwise unchallenged in this report.  Here’s an excerpt from the MSNBC article in the link above, referring to two of the defendants in the Georgia case, Thomas Goodwin and Clair Blehr:

Goodwin and Blehr were with Celmer when he died, each holding one of his hands, according to court records. Afterward, investigators said they removed a helium tank and hood Celmer wore to help him suffocate. Investigators say Egbert and Sheridan evaluated him before his death and gave the OK for his suicide.

FEN members also cleaned up the scene, removing the helium tank, plastic hood, etc.  As for “holding” hands, the allegations of the Georgia Bureau of Investigation are stronger than that:

The death had been planned for months, authorities say. Two helium tanks were purchased, along with an “exit bag,” or hood to be placed over the suicidal man’s head.

Thomas “Ted” Goodwin, 63, formerly of Kennesaw, and Claire Blehr, 76, of Atlanta, would observe the death of the man they were told suffered from pancreatic cancer. In truth, the man was a Georgia Bureau of Investigation agent conducting a sting operation at a residence in Dawson County.

On Wednesday, authorities say, Goodwin walked the undercover agent through the steps that would have killed him. He demonstrated how he would hold down the undercover agent’s hands to prohibit him from removing the “exit bag.” (Emphasis added.)

I’ll be writing more about FEN, and some reactions (past and present) from different parties and what it can tell us about the broader “right to die” movement. I think we’re getting to the point where groups like “Conflation & Con Jobs” AKA “Compassion and Choices” can’t accuse us of being fearmongers when we accuse their movement of following “incrementalist” or “slippery slope” strategies.  –Stephen Drake

New Guidelines for Determining Brain Death – But Will Hospitals Actually Follow Them?

"end of life", brain death, organ donation, Our News & Commentary Blog, policy, reality check, safeguards

From USA Today – “When is someone brain dead? Experts revise guidelines“:

Determining brain death is a complex process that requires dozens of tests to make sure doctors come to the correct conclusion.
With that goal in mind, the American Academy of Neurology has issued new guidelines — an update of guidelines first written 15 years ago — that call on doctors to conduct a lengthy examination, including following a step-by-step checklist of some 25 tests and criteria that must be met before a person can be considered brain dead.
The goal of the guidelines is to remove some of the guess work and variability among doctors in their procedure for declaring brain death, which previous research has found to be a problem, said guidelines co-author Dr. Panayiotis Varelas, director of the Neuro-Intensive Care Service at Henry Ford Hospital in Detroit.
According to the U.S. Uniform Determination of Death Act, brain death occurs when a person permanently stops breathing, the heart stops beating and “all functions of the entire brain, including the brain stem” cease.
While no one disagreed with that description, a 2008 study that included 41 of the nation’s top hospitals found widespread and worrisome variability in how doctors and hospitals were determining who met the criteria, said Varelas, co-author of the 2008 review.

Dr. James Bernat elaborated on the findings of the 2008 review, the implications and the intent of the new guidelines.

Dr. James Bernat, a professor of neurology and medicine at Dartmouth Medical School, said the new guidelines will help to remove some of the variability in how doctors determine brain death.
“The 2008 study disclosed rather surprising and disturbing variations in determining brain death, and in some cases there were practices that were just plain wrong,” Bernat said.
The main risk is that a patient will be declared brain dead who really isn’t, Bernat said.
“The authors of this (new) study are experts in their field and have done an evidence-based, authoritative review,” Bernat said. “They are saying, ‘This is the way it ought to be done.’ The goal is to improve the uniformity and the quality of neurological practice.”

Maybe I’m missing something, but I don’t see how this will have a great impact on current practices.  These new guidelines are recommended guidelines, just like the old ones. In fact, when I read the 2008 study, it seemed clear to me that the biggest problem wasn’t a lack of specificity in the guidelines, but a virtual guarantee of widely varying practices built into the Uniform Determination of Death Act. Here’s a relevant excerpt from the abstract of the study:

In accordance with the Uniform Determination of Death Act, guidelines for brain death determination are developed at an institutional level, potentially leading to variability of practice.

So, again, unless I am missing something, individual hospitals still get to set their own practice standards in making a determination of brain death.  I don’t see them hopping up and embracing the new, detailed standards here, frankly.  From what I can see, the trend has been for hospitals to move toward standards that broaden the types of medical professionals that can make the determination, as was recently done in Virginia in a way that makes it possible to have a determination made without the involvement of a physician in a neurologically-related specialty. In the link above discussing Virginia, there is also information on a 2006 attempt by medical organizations in New Jersey to expand the range of professionals allowed to make a determination of brain death and dropping the two-physician requirement at the same time.

It seems – and not for any sinister reasons – that hospitals want to be able to make those determinations more quickly and with which ever medical professional is handiest.  They’re looking to save money and time – and time may be important when organ donation is a consideration.

I don’t see how – unless the Uniform Determination of Death Act is rewritten – these new guidelines will have much impact, especially since even one of the authors seems to be engaging in a bit of denial over what the widely varying practices have meant in life-and-death terms:

“We found no credible report of anyone who was brain dead and who woke up and survived,” Varelas said.

I have two issues with this statement.  First of all, any individual who is being evaluated for brain death is obviously in dire straits.  It’s highly unlikely that many would survive the removal of life support, even if they were capable of recovery – and obviously those who might have gotten falsely diagnosed as “brain dead” who were organ donors had no chance to recover at all.

Which brings me to the second issue.  In 2008, 21-year-old Zack Dunlap was determined to be brain dead in an Oklahoma hospital following an ATV accident.  As luck would have it, one of the two friends who accompanied him to be prepped for organ donation had some medical training – and got a “feeling” that Dunlap didn’t look “ready.”  The friend did some simple test for reactions to scraping his skin – and got them.  Organ harvesting was called off and he was evaluated further.  Dunlap eventually made close to a full recovery.

I don’t know what to make of the statement Varelas made.  The report on Dunlap was very credible.  Maybe Varelas would claim that Dunlap was never really brain-dead, so he doesn’t count.  That would be beside the point, though.

Because no matter how thoroughly or sloppily the determination was made, once Zack Dunlap was declared “brain dead,” he was corpse in the eyes of the State of Oklahoma.  And he stayed a corpse until the hospital realized it made a mistake (although they called it a “miracle” rather than a “mistake”).

So – someone tell me, please.  What good are the new guidelines if hospitals don’t have to follow them? –Stephen Drake