Connecticut: Superior Court Judge Dismisses Suit by Assisted Suicide Advocates

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Good news from Connecticut – Superior Court Judge Julia Aurigemma has dismissed the case brought by two doctors – with heavy assistance by Compassion & Choices (C&C) – which sought to decriminalize physician-assisted suicide through the courts.

Specifically, C&C, in a bold move, sought to have the court sanction “aid in dying” as a separate entity from “assisted suicide” – and therefore exempt from any laws against assisting in a suicide.

Judge Aurigemma didn’t buy it.  In fact, she put the phrase “aid in dying” in quotes – every time she used it – in her long memorandum dismissing the case.  I read this as a “hint” that she’s not viewing the term as a legitimate one. Aurigemma also rejected the argument that this kind of policy should be implemented through the courts – it’s exactly the kind of public policy that legislatures should be in charge of.

Here is a description of her analysis from the Hartfort-Courant:

The matter raises public policy concerns that the legislature is “uniquely positioned” to evaluate, Aurigemma wrote. Some of the concerns she listed echoed those raised by advocates for people with disabilities, who sought to intervene in the case, and argued that granting the doctors’ request could be dangerous to people with severe disabilities.

Among the concerns:

•Would physician-assisted suicide threaten the most vulnerable people in society? If so, how could they be protected from pressure or coercion?
•Would it shift doctors’ and insurers’ focus away from treating depression and providing pain control and palliative care?
•Would allowing doctors to help patients die erode patient trust in the doctor’s role as a healer?
•Would it open the door to the possibility of involuntary euthanasia?

“The legislature is the most appropriate body to evaluate these important questions as well as a host of other complex issues,” Aurigemma wrote.

I suspect this won’t be the end of C&C’s efforts in Connecticut.  But for now, it’s a real setback for them and a time for a short celebration for those of us who continue to fight these efforts. –Stephen Drake

betancourt v. trinitas, futility, litigation, new jersey, Our News & Commentary Blog, thaddeus pope

Today’s edition of the Wall Street Journal has a very good article on the Betancourt v. Trinitas case in New Jersey.  (All of the previous posts on the case can be found by accessing this link)

Suzanne Sataline provides the best summary of the issues in the case – as argued by stakeholders on both sides.  Here is a brief summary of what happened to Ruben Betancourt from Sataline’s article “Court Weighs Death Decision“:

Trinitas Regional Medical Center in Elizabeth argues that Mr. Betancourt was in a persistent vegetative state and that giving further care was unwarranted and unethical, prolonging a painful death. The hospital is appealing a lower-court judgment from 2009 that ordered Trinitas to provide life-saving treatment to the patient.

Mr. Betancourt died in May 2009, a year before the appellate judges heard arguments. While his care decisions may now be academic, legal observers say they expect the court to rule in the closely watched case because New Jersey courts have not shied from such debates, which have become more common across the country.

Not Dead Yet, along with other disability rights groups, filed an amicus brief in the case. NDY is referenced in the article, along with other significant players on both sides:

Several organizations have weighed in on the fight. The New Jersey Hospital Association and the Medical Society of New Jersey argued that families have no constitutional right to demand end-of-life care and that hospitals have a duty to conserve their limited resources for all patients.

Not Dead Yet, a disability-rights organization based in Rochester, N.Y., backs the family, saying it fears that a decision in favor of Trinitas could mean that a hospital would have the power to overrule a patient’s directive. Thaddeus Pope, a professor at Widener University School of Law in Wilmington, Del., filed a brief in support of the family, saying that the hospitals are seeking too much ultimate authority.

This is probably the most even-handed media treatment of the case that has appeared in print.  I’m told that Ms. Sataline spent a significant amount of time making sure she had a complete understanding of the facts of the case.

More later on this case – either on developments or on other commentary about it.  –Stephen Drake

Not Dead Yet UK Launches “The Resistance Campaign”

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(The picture at the right is of disability activists in the UK. Most in the picture are using wheelchairs.  Several are holding signs.  There are two signs that can be read.  One says “You cut our money – you cut our lifeline;” and the other says “Increased poverty/Increased disability”).

Not Dead Yet UK has launched “The Resistance Campaign,” urging all Members of Parliament (MPs) to sign on to the ‘Resistance’ Charter 2010 – protecting the lives of disabled and terminally ill people.

Key points from the charter:

· A recognition that disabled and terminally ill people should have the same legal protection as everyone else
· A commitment to support disabled and terminally ill constituents to access the health, social and other services that they need
· A commitment to oppose any change to the current law, which makes assisted suicide illegal.

 The campaign has gotten coverage on the BBC, The Guardian, and Public Service.

Here’s an excerpt from Jane Campbell’s column about the campaign in The Guardian:

Disabled and terminally ill people have had to deal with fear, prejudice and discrimination since the beginning of time. Our lives have been devalued by statements such as “he/she’d be better off dead”. In recent years, calls for a change to the law prohibiting assisted suicide have grown louder and more frequent. They capitalise on fear. Fear of pain, fear of loss of dignity, fear of being a burden. And, yes, fear of witnessing those fears being felt by those we know and love. The solution offered to the fear of disability and illness is final: suicide.

Yet suicide is not well thought of in our society. It is “committed” by the mentally ill and those unable to face the future. In both cases, society does all that it can to prevent suicidal thoughts being enacted. Life is too precious to be solely entrusted to individual action. That society is willing to protect us, even from ourselves in times of personal crisis, defines our – and its – humanity.

However, those seeking a change to the law on assisted suicide say such ideals have no place when considering severely disabled and terminally ill people. Such lives, it seems, are not so precious: ending them prematurely should be a matter of individual choice. Perversely, if you can take your own life without assistance, society generally strives to protect you; but, if assistance to die is needed, they argue, it should be provided. The option to choose the time of one’s death is to be reserved for those for whom assistance is required.

No equality there. Yet many see this as irrefutably logical and compassionate.

We here in the US applaud our brothers and sisters in the UK for continuing to present a powerful resistance to policies that endorse the ideas that disabled people are better off dead, as good as dead – and cheaper if we’re dead. –Stephen Drake

Disability and Ethics Conference This Weekend – Low Expectations Based on Past Performance

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On July 13, 2006, about 40 disability activists protested a bioethics conference in Albany, NY.  The picture above shows 7 of the protesters (there were about 40 in total) who successfully invaded the conference, holding signs and chanting “Nothing About Us Without Us!”

Here’s an excerpt from our flyer for the protest:

Disability activists are calling the Alden March Bioethics Institute’s Conference on “Bioethics in a Divided Democracy” a sham and a further effort to make sure that other stakeholders get shut out of important public policy debates.  The conference brings together bioethicists from the “right” and “left”.  The protest has been organized by Not Dead Yet, a national disability rights group that organizes for the disability community to oppose legalized euthanasia, assisted suicide and other forms of medical killing.

“We’re calling this conference a sham for a number of reasons,” says Stephen Drake, research analyst for Not Dead Yet.  “First, an important agenda that all participants in this conference share is to keep other stakeholders out of policy debates and protect their roles as the sole ‘experts’ on public policies affecting people with disabilities and the rest of the American public.  Second, it’s clear that many of the players in this  conference are working to keep our democracy a ‘divided’ one.  Organizer Glenn McGee takes a blatantly partisan approach in his bioethics advocacy.  His definition of ‘progressive’ appears to be to marginalize, exclude and sling mud at minorities who disagree with him, rather than engage them in meaningful debate.  The ‘frame’ of this conference advances that agenda for him.”

Disability activists point out that they have plenty of grievances with both ends of the ideological spectrum.  Conservatives claiming to respect life have attempted to cut off Medicaid payments for feeding tubes in both Missouri and Florida.  So-called, “progressives” have been advancing “futile care” statutes, which hospitals use to deny care to patients who they think are “too disabled” to benefit, even when that treatment is demanded by the family or the individual herself.  Glenn McGee has found new allies in Compassion & Choices, whose main mission is to legalize assisted suicide in this country.  The group’s latest “victory” was to lobby successfully for a statute in Colorado that gives medical professionals blanket immunity from manslaughter charges as long as an individual who has died in their care consented to palliative care.

Imagine my reaction – four years later – when I saw the following conference announcement:

Disability and Ethics through the Life Cycle: Cases, Controversies, & Finding Common Ground, May 21-22, 2010, Union College, Schenectady, NY

Despite a common interest in facilitating good medical care, bioethicists and members of the disability rights community sometimes differ in their approach to issues arising in the bio-medical settings, especially on such polarizing issues as abortion and physician-assisted suicide. Focusing on these polarizing issues, however, distracts attention from other ethical issues that affect people with disabilities in biomedical contexts. This conference will offer a forum for bioethicists, disability-rights advocates, and other stakeholders with a different focus for discussing these issues by viewing disability from a life -cycle perspective. People confront disability through the life cycle: infancy, childhood, reproductive years, middle age, and old age. At each age they confront situations with ethical dimensions that present them, their families, and their caregivers and biomedical researchers with ethical challenges. This conference is designed to promote interdisciplinary conversations about these less frequently discussed ethical issues. (Emphasis added.)

Two other things about the announcement and paper solicitation.  It states that “no papers on prenatal issues or assisted suicide will be considered.”  The second item of note is that one of the main sponsors is the Albany Law School, which means many of the same players from the 2006 Albany bioethics conference are involved in the planning and framing of the event.

There were and are a number of disturbing aspects of this announcement.  The suggestion that abortion has been a divisive issue between the bioethics community and the disability community is a gross distortion at best.  To the extent that prenatal issues have been discussed by disability scholars (and NDY has never taken part in these discussions in any way), the focus has been on prenatal screening and selective abortion for reason of future disability.  The criticisms don’t generally translate into suggestions for radical public policy changes.

As to assisted suicide, one would think from the description that there’s been a rich dialog between bioethicists and disability advocates.  If there has been such a discussion, I sure missed it.  It also seems to imply a coherent position on the part of mainstream bioethicists in support of assisted suicide – something that always got vehemently denied when we suggested that was the case.

Overall, though, is the glaring sense of entitlement that assumes the right to set the parameters regarding what topics are acceptable to discuss – especially insulting when directed at a group of people generally excluded and derided in your profession.

A couple of weeks after this announcement came out, Diane Coleman, NDY’s founder and president, received an invitation to to be a plenary speaker at this conference that seeks – according to its title – to find “common ground.”

Give me a break.

First of all, there have been several single-shot events by different entities over the years that accomplished nothing – except perhaps for the bioethicists who sponsored the events to pat themselves on the back for their one-time exercise in inclusion.  And, having done that, return to exclusion as a matter of standard operating procedure.

Mark Kuczewski, one of the plenary speakers, organized one such event at the Neiswanger Institute for Bioethics and Public Policy.  Kuczewski organized a conference around the topic of ethics and disability in 2001.  How did it go?  Well, there’s been no communication between NDY or other disability activists with Kuczewski and the Institute since then, but he has continued to write about disability, in a way that seeks to carve out a space for himself as some kind of arbiter in determining what is reasonable in the criticism of disability activists and which points can be safely ignored.  This is more or less what he did in a 2003 article written with Kristi Kirschner in the journal Theoretical Medicine.  One especially telling aspect of that article is when they wrote that activists had “found a manifesto in Wesley Smith’s book, The Culture of Death.”  It’s a deliberate and marginalizing image to put activists in a wagon pulled by someone else’s horse.

Another prominent participant in this event is Alicia Ouellette.  If you check out the link, her publications and presentations show she had developed an aggressive “interest” in disability and “end of life” – the latter a term she uses frequently without ever really defining.  I first noticed Ouellette when she seemed to show precognitive ability when she wrote an entry on the bioethics blog titled “Important End-of-Life Case in Massachusetts Reaches Critical Point.” The entry was about Haleigh Poutre, an abused 11-year-old girl who was beaten so badly she went into a deep coma.  At the time of Ouellette’s blog entry, the MA Supreme Court hadn’t rendered a verdict to the challenge of treatment removal on the part of her adoptive stepfather, who no doubt sought to beat a murder rap.  Nevertheless, her situation was referred to as an “end of life” case by Ouellette.  And Ouellette didn’t find it worth revisiting the subject two months later – after the judge had sanctioned Haleigh’s right to die a “dignified” death, she began to come out of the coma and is alert and doing well at last report.

Writing in the Oregon Law Review in 2006, Ouellette wrote out her analysis on “Disability and the End of Life.”  In the paper, she accuses activists of conflating disability and terminal illness.  Leaving a debunking of this aside, I think it’s worth noting that neither Ouellette nor other mainstream bioethicists have attacked the Final Exit Network or Compassion & Choices for their very blatant – and successful – maneuvers to conflate terminal illness and disability (and voluntary vs. involuntary, for that matter).  This article is a goldmine of ad hominem attacks and selective storytelling.  She makes sure to tie disability activists to religious political groups in relation to Schiavo, but also fails to mention the twenty or so national disability groups that expressed concerns over Schiavo’s situation and what it meant about dismantled protections for people under guardianship.  She “tells the story” of Elizabeth Bouvia, but without relating the personal events in her life that might have led any young woman into a downward slump.  She talks briefly about Larry McAfee but fails to credit disability advocates as the ones who got him what he wanted in order to live – a place to live outside of an institution. (CORRECTION: I have reread the article in question and Ouellette does indeed relate several personal losses and setbacks in Bouvia’s life cited by disability activists.  Later, though, she apparently gives them short shrift by referring to the “power of choice” – implying giving Bouvia an opportunity to die with medical assistance empowered her to live.)

Ouellette gets to do a session with another bioethicist describing the “diverging perspectives” between her community and ours on “classical cases” – Bouvia among them.  Evidently, the nondisabled bioethicists get to give both their take on these stories as well as ours.  It’s a clear message of just whose perspectives and interpretations count – and whose don’t.  Who speaks matters.

Similarly, Ouellette, along with Robert Baker – provides a closing and commentary at the end of the conference.  That tells us in advance whose evaluation of the issues really matters.

I could go on for quite awhile with a “rogue’s gallery” in terms of this conference, but even I’m getting tired of reading this right now.

If you get the idea that I’m not really thrilled about going to this, you’d be right.  Aside from Neiswanger and this event, the Hasting Center, The Center for Practical Bioethics, and a couple of others have hosted little “events” mingling us common folks with the bioethicists.  They produced no results, no follow-up.  Zip.

Unfortunately, I have to be there.  Believe me, this is not my idea of a great or productive weekend by a longshot.

If the past is any good indicator of the future, that is what this will be.  One more entity that can pat itself on the back for a moment of inclusiveness – and go back to the real business of marginalizing disability advocates and activists.  They’ll co-opt those things that they approve of and attempt to understand how better to undermine us in the future.

The reality is that this “discourse” around bioethics is more than just an exchange of philosophies, ideas, and experiences.  At the core, this is a political struggle over public policy – a struggle between those who have power and seek to hold onto it and those directly affected by the policies who want to take power,

And no one knows it better than the bioethicists who are hosting this event.

Just to be clear – I don’t think that the real “goal” is to find “common ground” – the goal is to use this to further bolster the dominance of bioethicists in public policy discussions.  I don’t believe it – I’ve seen too much of this kind of stuff before.

Fool me once, shame on you.  Fool me 4 or 5 times — someone give me a swift kick in the head to remind me never to fall for it again.  –Stephen Drake

Connecticut: Assisted Suicide Advocates Attempt to Exploit Tragic Murder-Suicide

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On Monday of this week (May 10), there was one of those all-too-familiar tragedies that appear in the news on a regular basis.  In the one of the earliest and most comprehensive articles covering the story, reporter Ann DeMatteo wrote an article titled “North Haven deaths believed to be murder-suicide“:

NORTH HAVEN — A well-known town family is suffering its second tragedy in a decade following the death of a husband and wife in what police believe was a murder-suicide.Life was never the same for Thomas and Joan Vanacore of 2 Pleasant Drive after the Sept. 11, 2001, death of their son, Edward Vanacore, 29, who worked at the World Trade Center. More recently, Thomas Vanacore was being treated for a late-stage cancer, and his wife had Alzheimer’s disease.

Police received a 911 call about 3:30 p.m. Monday when a visiting nurse known to the couple reported the shooting. The nurse had received permission to run an errand, and returned to find the scene. Her name was not released, and she declined to be interviewed.

According to Capt. James Merrithew, the Vanacores were found by authorities in an enclosed porch at the rear of the house. Joan Vanacore, 70, was found dead when paramedics and police arrived. Thomas Vanacore, 73, was taken to Yale-New Haven Hospital where he died.  Early indications are that Thomas Vanacore shot his wife and then himself, police said.

(That early assumption has been pretty well upheld and is believed to be the case.)

North Haven is in Connecticut, where Compassion & Choices (C&C) – the largest and most aggressive advocacy group for legalization of assisted suicide – is currently pursuing a legal gambit to decriminalize doctors giving suicide assistance to patients diagnosed as “terminally ill” in Blick v. Division of Criminal Justice.

The spinmeisters at C&C just couldn’t let a perfectly good tragedy go unexploited.

On Wednesday, May 12th, the organization issued a press release saying that this case “highlights a need for aid in dying.”:

PORTLAND, OR – Compassion & Choices, the nation’s largest advocate for end-of-life care and choices, responded to the tragic deaths in North Haven,Connecticut, described as “a murder-suicide,” of 73 year-old Thomas Vanacoreand 70-year-old Joan Vanacore on Monday, May 10. The tragedy could andshould have been avoided. Thomas Vanacore was reportedly dying of throat cancer and his wife Joan of Alzheimer’s disease. Thomas is reported to have shothis wife and then himself to death. (Emphasis added.)

****

The Vanacores should have been able to turn to their physician if they found their dying processes to be unbearable and request a prescription for medication they could consume to bring about a peaceful death. This option, known as aid in dying, is openly available in Oregon, Washington and Montana. A pending lawsuit in Connecticut asks the court to find that Connecticut law does not outlaw the practice. In Blick v. Connecticut the Connecticut Superior Court is asked to recognize that when a dying patient consumes medication prescribed for the purpose of bringing about a peaceful death that this is not “suicide” and a physician who provides such a patient with that prescription is not within reach of a Connecticut law that makes a crime of assisting another person to “commit suicide.” Medical and mental health professionals recognize that suicide and the choice of a dying patient for a peaceful death are starkly and fundamentallydifferent. (Emphasis added.)

If you’re hearing a loud noise right now, it’s probably a bullshit alarm going off.  There’s more:

Kathryn Tucker, co-counsel to the physician plaintiffs in the Blick case, and Director of Legal Affairs for Compassion & Choices, said, “It is tragic to hear of dying patients resorting to the horrific violence of death by gunshot, and here it is compounded by the tragedy of the husband first shooting his wife and then himself. Dying patients in Connecticut should be able to turn to their physicians and discuss all end-of-life options, including aid in dying. If the patient feels that the burden of suffering imposed by the dying process is too great to bear, he or she should be able to choose aid in dying, and have the option to die at home, in familiar surroundings, with family present at the bedside, in a peaceful, dignified manner. (Emphasis added.)

Why is this bullshit?

Two reasons:

I’ve read all the press coverage concerning the deaths of the Vanacores.  Not one single article claims that Joan Vanacore was “dying” of Alzheimer’s disease.  Alzheimer’s can only be considered “terminal” in the final stages – a stage at which the person isn’t legally competent to request help in comitting suicide.  While she apparently wasn’t in the most advanced stages of Alzheimer’s, Joan Vanacore had apparently reached a point where she wouldn’t have been considered legally competent to make a life-and-death decision, according to her son:

John Vanacore, of North Haven said he doesn’t believe his parents conspired to end their lives, as his mother “wasn’t cognizant enough” to make such a decision, but that his father was thinking about others in the family. “My father was very private, but I feel he felt he was dying and didn’t want to have her be a burden on anyone,” he said.

So that’s the second reason: Competence. C&C pays lip service to the principle of limiting legalization of assisted suicide only to those people who are diagnosed as “terminal” (expected to live no longer than 6 months) and who are mentally competent to make the request.  Joan Vanacore wasn’t “dying” and she wasn’t regarded as “competent.”

Is C&C suggesting that legalization would somehow have made it possible for John Vanacore to discuss his wish to end his wife’s life with a doctor?

There are only two ways I can think of right now to interpret this cynical exploitation of a tragic situation:

1. C&C is testing the limits of the public’s gullibility.  They might be emboldened right now, seeing how the Final Exit Network – with its “open door” policy of suicide assistance to nonterminal old, ill and disabled people have gotten a sympathetic free ride in the press – and in many cases misreport the group as “aiding” people with “terminal illnesses.”  They might also have been pleasantly surprised at how the combined marketing efforts of HBO and CNN have repackaged Jack Kevorkian – from a lawless creepy ghoul to an eccentric champion for the terminally ill.  So maybe they’re keeping they’re fingers crossed that maybe the public really is too stupid to notice that the person who was killed wasn’t dying and didn’t ask to die.

2. It’s also possible that C&C is testing the waters with this release.  Anyone familiar with the passions of assisted suicide/euthanasia activists knows that the “terminally ill” limitation being promoted at present is just the first step in an incrementalist strategy.  Most of the supporters of assisted suicide and euthanasia want much broader “elegibility” – similar to the expansive eligibility in the Netherlands and Switzerland.

Time will tell.  I’m hoping that the public really isn’t as gullible as C&C seems to think.

In any case, after this latest gambit by the organization, C&C will now be referred to on this blog as “Conflation & Con jobs.”  They’ve earned the name.  –Stephen Drake