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Dutch euthanasia getting so out of hand that even assisted-death docs want to hit the brakes

by Doug Mainwaring, Life Site, 5 July 2017

Mr Mainwaring considers why 200 Dutch doctors took out an advertisement in a major newspaper to declare “[Assisted suicide] for someone who cannot confirm he wants to die? No, we will not do that. Our moral reluctance to end the life of a defenseless man is too great.”

The doctors, many of whom currently serve as assisted-suicide providers, are objecting to the unchecked growth of euthanasia in their country, where people who have reduced mental capacity due to dementia are being euthanised.

Current law allows doctors to euthanize without verbal consent if a written declaration of will has been provided in advance. In addition, a doctor has to also first determine that the patient is undergoing unbearable suffering. But with reduced mental capacity, patients are often unable to confirm that their former request to be euthanized — executed perhaps years earlier — is still valid.

Alarm bells began to sound for these doctors a few years ago when an elderly woman was euthanized against her will.  

The 80-year-old suffered from dementia. She had allegedly earlier requested to be euthanized when “the time was right” but in her last days expressed her desire to continue living.

Despite changing her mind about ending her life, her doctor put a sedative in the her coffee. When that wasn’t enough, the doctor enlisted the help of family members to hold down the struggling, objecting patient so that she could administer the lethal injection.

In 2016, the Dutch doctor was cleared of wrongdoing by a euthanasia oversight panel. The chairman of that panel expressed hope that the case will go to court – not so the doctor can be prosecuted but so a court can set a precedent on how far doctors may go in such cases.

The Netherlands appears to be going the way of nearby Belgium. In 2009, 12 patients with dementia were euthanized. In 2016, there 141 cases reported. And for those with psychiatric illness, there were no cases in 2009 but 60 in 2016.  

Boudewijn Chabot, a psychogeriatrician and prominent euthanasia supporter, said in June that things are “getting out of hand.” He continued, “[L]ook at the rapid increase … The financial gutting of the healthcare sector has particularly harmed the quality of life of these types of patients. It’s logical to conclude that euthanasia is going to skyrocket.”

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10 Questions for David Seymour: #6

by Care Alliance, 18 July 2017

Click here to view the 10 Questions For David Seymour website, with questions (and answers!) being added between 12 July and 25 July.

#6 How do you prevent subtle coercion of older people?

 

Conclusion: It will not be possible to prevent or even detect subtle coercion of older people. Large numbers (in the Auckland area more than 50%) of our elders in New Zealand are already lonely, itself a form of systemic coercion, while significant and growing numbers report being coerced by, or not trusting, family members.

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10 Questions for David Seymour: #5

by Care Alliance, 18 July 2017

Click here to view the 10 Questions For David Seymour website, with questions (and answers!) being added between 12 July and 25 July.

#5 What is the error rate of medical diagnosis?

  • The diagnosis is wrong 10–15% of the time.” A diverse range of research into this issue over the past several decades suggests that this range is very much on target (p.1).
  • Winters, Bradford et al (2012, p. 894) note, in a paper published in the British Medical Journal, that 28% of autopsies report at least one misdiagnosis. An autopsy-confirmed study of 500 cases between 1959 and 1999/2000 (2012, p. 159) showed that in spite of the progress in diagnostic technology, the rate of false-positive diagnoses (people falsely diagnosed as having a particular condition) increased between 1959 and 1999/2000 from 7% to 15%.
  • A study of doctors’ prognoses (the medical prediction of the course of a disease over time) for terminally Ill patients found that only 20% of predictions were accurate – that is, within 33% of actual survival time.
  • To qualify for assisted suicide under Oregon’s “Death With Dignity Act” a doctor needs to determine that a person will die within six months, the same provision found in David Seymour’s Bill. In Oregon, the range of days between request and death over the period 1998-2015 is 14 to 1009 days (p.11). This means that at least one person judged eligible for assisted suicide on the basis they would die within six months survived for 2 years and 9 months.

 

Conclusion: Medical diagnosis is widely accepted as being wrong in at least 10-15% of cases and medical prognoses are inaccurate up to 80% of the time. Under the Bill that David Seymour has drafted, significant numbers of patients could decide to end their lives in error because of a misdiagnosis, and doctors would be asked to make claims about a patient’s prognosis which they cannot possibly substantiate with a high degree of accuracy. 

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Woman, 77, with osteoarthritis approved for euthanasia in Canada

by Mia de Graaf, Daily Mail, 28 June 2017

Ms de Graaf reports on a Canadian court case in which ‘AB’, a 77-year old woman with osteoarthritis, asked for euthanasia.

Although Canada legalized assisted dying last year for people enduring unbearable suffering, two doctors refused to administer lethal drugs since they feared being charged with murder because her illness is not terminal.

But on Monday, a judge declared AB’s doctor could legally assist her in dying – and chided the doctors for ‘apprehensive misunderstanding’ of the law.

Superior Court Justice Paul Perell told the courtroom in Toronto that a patient’s death does not have to be imminent, and their condition does not have to be terminal.

Rather, he said, the patient qualifies for medically assisted dying if their death ‘has become reasonably foreseeable’, and that their remaining years would be marred by suffering.  

Andrew Faith, the lawyer who represented AB, acknowledged that ‘no one knows what it means’.

‘We are all on the trajectory towards death from the moment we’re born,’ he said. ‘But this is about how death has “become” reasonably foreseeable.’ 

Faith said he believes the phrase is likely unconstitutional, and a high profile case – Lamb vs Canada – is under way to decide whether or not it should be scrapped. 

For now, Faith said, he hopes the case will allow his client to be treated as she wishes, and set a precedent for other patients and doctors in similar legal conundrums.

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10 Questions For David Seymour: #4

by Care Alliance, 17 July 2017

Click here to view the 10 Questions For David Seymour website, with questions (and answers!) being added between 12 July and 25 July.

#4 How many deaths per year from this bill?

 

  • The Netherlands requirements concerning eligibility for euthanasia are very similar to those in David Seymour’s Bill. We would therefore expect that based on current Netherlands statistics, there would be around 1,200 deaths per year in NZ under this Bill.
  • In the Netherlands (and 2016), Belgium and Oregon, the numbers of cases of euthanasia/assisted suicide have increased consistently since the practice was legalised. We should expect the same pattern to occur in New Zealand were we to legalise either of these practices.

 

Conclusion: Current figures from the Netherlands indicate we can expect about 1,200 deaths per year in New Zealand from euthanasia and assisted suicide under David Seymour’s Bill.

Overseas experience indicates that arguments supporting euthanasia and assisted suicide are initially based on relief of suffering for a small number of ‘extreme’ cases. Once the practice becomes legal, however, the arguments have shifted toward ‘rights’ and ‘choice’ and the categories have broadened. This has meant that the numbers of deaths continue to rise significantly.

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10 Questions For David Seymour: #3

by Care Alliance, 14 July 2017

Click here to view the 10 Questions For David Seymour website, with questions (and answers!) being added between 12 July and 25 July.

 

#3 Why involve doctors? Why not lawyers?

  • The New Zealand Medical Association Position Statement on Euthanasia states: “Euthanasia, that is the act of deliberately ending the life of a patient, even at the patient’s request or at the request of close relatives, is unethical. Doctor-assisted suicide, like euthanasia, is unethical … This NZMA position is not dependent on euthanasia and doctor-assisted suicide remaining unlawful. Even if they were to become legal, or decriminalised, the NZMA would continue to regard them as unethical.” The World Medical Association Resolution on Euthanasia “strongly encourages all National Medical Associations and physicians to refrain from participating in euthanasia, even if national law allows it or decriminalizes it under certain conditions”.
  • The Australia and New Zealand Society of Palliative Medicine (ANZSPM) Position Statement on Euthanasia (2017) states: “In accordance with best practice guidelines internationally, the discipline of Palliative Medicine does not include the practices of euthanasia or physician assisted suicide.”
  • The Scotland Report on Assisted Suicide reports that both supporters and opponents of the Assisted Suicide Bill acknowledge that “the involvement of healthcare professionals in assisted suicide, even if it were legal, would not amount to ‘medical treatment’” (n. 207).  Similarly, Boudreau and Somerville note “… healing and euthanizing are simply not miscible [able to be combined] and euthanasia can never be considered ‘medical treatment’” (p. 63).
  • The most common recent argument for Assisted Suicide/Euthanasia, “that patients have a right to control when and how they die – in fact points to the involvement not of doctors but of legal agencies as decision makers, plus technicians as agents” (p. 323).
  • In Oregon, the most common reasons for requesting assisted suicide are social/existential rather than medical; 90% are concerned about losing autonomy; 90% are concerned about being unable to engage in enjoyable activities; 65% are concerned about loss of dignity; and 49% fear being a burden on family and/or friends/caregivers. Only 35% cite inadequate pain control or concerns about inadequate pain control as one of their reasons.

Conclusion: Euthanasia and assisted suicide are not medical treatment. “Doctors are not necessary in the regulation or practice of assisted suicide.  They are included only to provide a cloak of medical legitimacy”. 

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Why doctors get it wrong about when you will die

by Jules Montague, The Guardian, 2 June 2015

Dr Montague, a consultant neurologist in London, explains why “it’s difficult to predict exactly when a patient is going to die, or, sometimes, if they are going to die at all.”

Why is it so difficult to prognosticate?

Every patient is different, every disorder is different, every disorder within a disorder is different. People are unpredictable, their illness even more so. But there exist other subtleties that are harder to admit to.

In my first week as an intern, I spoke to the family of an 85-year-old patient, Nora. She lay gasping, racked by sepsis, her skin bruised from intravenous drips, her legs swollen from heart failure, her consciousness clouded from all of it.

“How long has she got, doctor?”

“We’ll be lucky if she’s here in the morning,” I replied.

We were indeed lucky the next morning. We were also lucky for the next week and the month after that, at which point Nora went home, happy and healthy.

It takes experience to know that sometimes you don’t know.

Click here to read the full article.

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10 Questions for David Seymour: #2

by Care Alliance, 13 July 2017

Click here to view the 10 Questions For David Seymour website, with questions (and answers!) being added between 12 July and 25 July.

#2 Are people with mental illness in or out?

  • “Rarely in those societies with liberalised assisted dying laws are psychiatrists involved in the decision-making for individuals requesting early death. This role is fulfilled by non-specialists.” (Macleod, Sandy. “Assisted dying in liberalised jurisdictions and the role of psychiatry: A clinician’s view.” Australian & New Zealand Journal of Psychiatry 46.10 (2012): 936-945).
  • Legalising either euthanasia or assisted suicide in the current New Zealand context where it is readily acknowledged that specialist mental health and addiction services “are experiencing increasing pressure” (p. 3) places a significantly large number of vulnerable people (162,222 in 2015) in an extremely risky situation

Conclusion: Persons with mental health conditions would be eligible under the David Seymour Bill.

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‘We need an Assisted Living Bill, not an Assisted Dying Bill’

by Liz Carr, ITV News, 14 August 2015

Liz Carr is an actress, comedian and campaigner for Not Dead Yet UK.

In 2015 she wrote about her opposition to the Assisted Dying Bill then being considered by the UK parliament. (It was subsequently overwhelmingly rejected by 330 votes to 118.)

I’m not religious, I’m not anti-choice and yet I, along with many other disabled people who are involved in the international organisation Not Dead Yet, oppose the legalisation of assisted suicide.

We believe that if the Assisted Dying Bill passes, that some people’s lives will be ended without their consent, through mistakes and abuse.

No safeguards have ever been enacted or proposed that can prevent this outcome – which can never be undone. The only guaranteed safeguard is to not legalise assisted suicide.

And we’re not alone in thinking this.

Not one organisation of disabled people supports assisted suicide and the majority of doctors, i.e. those who would be licensed under this bill to provide the lethal drugs, do not want this bill passed either.

The British Medical Association, the Royal Colleges of Physicians, General Practitioners and Surgeons, the Association for Palliative Medicine and the British Geriatric Society, all oppose changing the law.

As someone who has spent a lot of her life needing extensive health care, I am relieved to hear this. I wouldn’t be alive without the NHS but I recognise that it is currently understaffed and under resourced. Against a backdrop of longer shifts, difficulty in obtaining appointments and the rationing of certain treatments, should we really be pushing further pressures onto our reluctant doctors?

Click here to read the full article.

And click here to follow Not Dead Yet Aotearoa on Facebook.

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Michelle Carter: the Unacceptable Face of Assisted Suicide

by Kevin Yuill, Spiked, 27 June 2017

Dr Yuill reflects on the case of Massachusetts woman Michelle Carter who was recently convicted of involuntary manslaughter for sending her boyfriend hundreds of texts encouraging him to commit suicide.

Carter had initially attempted to dissuade her boyfriend from suicide, urging him to get help. But by July 2014 she was urging him to end his life in a series of texts. When Roy expressed concerns about his family, Carter blithely replied: ‘Everyone will be sad for a while, but they will get over it and move on… They’ll always carry u in their hearts.’

Her motive seemed to be attention. She tweeted after the event: ‘Such a beautiful soul gone too soon. I’ll always remember your bright light and smile. You’ll forever be in my heart, I love you Conrad.’ One of Roy’s younger sisters testified that Carter texted her on the day of his death: ‘Find him yet?’ Three days later, she added: ‘I will never understand why this had to happen.’ She even organised a suicide-prevention fundraiser in his name. 

Dr Yuill asks “If her text messages were wrong, surely ‘assisted dying’ is wrong?”

How can we delineate between those like Roy who are manipulated into suicide and those who are determined but want help to die? We can’t. The only way we can be certain that someone has come to the decision themselves is if they take the action with no assistance. As soon as assistance is offered, particularly to those in age or disability categories, it becomes a joint venture. The second party must take some responsibility for the action.

The case also tests our moral and legal attitudes to suicide. Is it wrong? Is it a crime? If it is not inherently wrong, how can assisting a suicide be wrong?

It is still wrong.

Click here to read the full article.

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