Wednesday, December 18, 2013

"But Doctor, I Want To Live": The Other Side Of The "Dignified Death" Debate

http://www.forbes.com/sites/davidshaywitz/2013/12/18/but-doctor-i-want-to-live-the-other-side-of-the-dignified-death-debate/

The emerging narrative about “Do Not Resuscitate” (DNR) orders is that they are not utilized frequently enough.

Doctors, it is said, are reluctant to have this discussion with patients, and patients are typically unlikely to
David Shaywitz, MD
initiate such a conversation with their physician.  As a result, there are dreadful stories of dying patients who suffer excruciating, highly-medicalized deaths rather than one with the dignity the sufferers might have preferred.  Such deaths, policy experts note, would also seem to constitute a regrettable waste of healthcare resources.

This is a powerful storyline because in many cases, it’s unfortunately true.  Many patients have experienced precisely the sort of end-of-life care they never would have wanted.  In some cases, these patients never formally codified their wishes, in other instances, patient wishes were tragically, at times incomprehensibly disregarded by the healthcare system.

Many have also complained (I’m one of them) that an ACA provision that would have allowed Medicare reimbursement for a proactive doctor-patient conversation about end-of-life care was withdrawn due to the misguided uproar ignited by some vocal critics.

But there’s another perspective as well, one highlighted by a recent experience I just learned about, involving the mother of a friend.

The patient in question is a 97 year old crusty Italian lady who had been living on her own, in generally good health, for a long time.  A month or so ago, her primary care doctor diagnosed her with anemia, and transfused her but didn’t initiate a workup, apparently assuming it wouldn’t be indicated in a patient of this age.  Shortly thereafter, the elderly woman presented to the emergency room with more severe anemia, and evidence of a GI bleed.

The woman was stabilized with transfusions, and as usual, entirely lucid.  The doctors told her they assumed she wouldn’t want a workup or any interventions, and would prefer to be made comfortable.
No, she said, I’m OK with interventions.

Then, the topic of DNR:  interventions might be dangerous in a patient of her age, the doctors told her.  If an intervention occurs, and something goes wrong, we assume you wouldn’t want extraordinary measures?

No, that would be OK too, she told them.

Really? You realize how violent and painful these might be, they asked, employing the same scare tactics I remember from my medicine residency, when overworked surgical consultants would occasionally try to talk a patient out of getting a procedure like a sinus tap.

That’s OK, she said.  I want to live.

In the end, the woman was scoped and discovered to have an easily-treated lesion (an arterial-venous malformation), which was quickly cauterized.  The woman tolerated the procedure well, is recovering nicely, and is slated to return home shortly.

This story deeply resonated with me, evoking my own experience with my Uncle Marvin  – see here and here. It also doesn’t strike me as all that unusual or exceptional, and highlights with unusual clarity the potential hazards of the push towards DNRs.

The big concern is that virtuous physicians – perhaps intending to do good for the patient,  perhaps (in the context of “parsimony”) intending to conserve societal resources and do good for the world at large – will undervalue a patient’s will to live or right to live.

Unfortunately, it’s probably not all that uncommon for a doctor to pressure a patient into making a decision the doctor earnestly believes is best; some would say it happens every day.

Both my uncle and the elderly lady profiled above were able to resist unreasonable physician pressure and successfully exert their autonomy.  What about the many other patients who are persuaded –bullied? — by their doctor into declining treatments they might actually desire?

I appreciate the importance and virtue of proactive DNR conversations between patient and doctor, and recognize the good that can, should, and must emerge from these essential conversations.

What worries me, however, is the righteousness driving some of the doctors who are leading these discussions – a deep-seated conviction that they’re better positioned than patients to know what’s the right choice for patients, and perhaps even “ethically” obliged to guide patients in this direction.

It’s arrogance masquerading as virtue, and endangers patient autonomy.

Sunday, December 15, 2013

Judge dismisses appeal; Montana group pleased that court addressed Baxter

Helena Montana - On December 13, 2013, District Court Judge Mike Menehan dismissed MAAS's appeal with the Montana Medical Examiners Board. The order ruled that the appeal was moot due to the Board's having recently rescinded "Position Statement No. 20."  (Order, pp. 5-8).  The order also refers to Montana's assisted suicide case, Baxter v. State, as providing a defense to a homicide charge, as follows:
On December 31, 2009, the Montana Supreme Court issued its opinion in Baxter v. State, 2009 MT 449, 354 Mont. 234, 224 P.3d 1211, in which it held that under section 45-2-211 MCA, a terminally ill patient's consent to physician aid in dying constitutes a statutory defense to a physician charged with the criminal offense of homicide.  (Order, page 2, lines 17-21).
This part of the order is consistent with Greg Jackson's and Matt Bowman's article, Baxter Case Analysis, Spring 2010 ("the Court's narrow decision didn't even "legalize" assisted suicide"). Available at http://www.montanansagainstassistedsuicide.org/p/baxter-case-analysis.html

Since Baxter, there have been two bills proposed in the Montana Legislature to legalize assisted suicide.  Both bills, SB 167 and SB 220, have failed.  Assisted suicide is not legal in Montana.

MAAS is disappointed with the dismissal, but pleased with that the order addresses Baxter, over which there is ongoing controversy as to its meaning.  MAAS will likely appeal.

* * *

For information about problems with assisted suicide and how it puts people at risk, see  http://www.montanansagainstassistedsuicide.org/p/quick-facts-about-assisted-suicide.html

Saturday, December 14, 2013

Montana Judge Hears Assisted Suicide Arguments


http://www.kxlf.com/news/montana-judge-hears-assisted-suicide-arguments/
Posted: Dec 11, 2013 4:38 PM by Sanjay Talwani - MTN News

HELENA - The issue of physician assisted suicide was in court Tuesday [December 10, 2013]
Judge Michael Menehan
Montanans Against Assisted Suicide is arguing that a policy position by the Montana Board of Medical Examiners implies that physician assisted suicide may be legal. 
A lawyer for the Board says that the position - since rescinded, says no such thing. Michael Fanning says the group bringing the lawsuit has no real case is trying to force the issue to the Montana Supreme Court.
The position paper, written in response to doctor inquiries, said that the board would handle complaints related to assisted suicide on a case-by-case basis as it would other cases.
Margaret Dore
Attorney for Montanans
Against Assisted Suicide (MAAS)
Margaret Dore, an attorney for MAAS, said the paper overstepped the Board's authority and implied to many that assisted suicide was legal in Montana.
"They are a board that is comprised of 11 doctors and two members of the public," she said. "It has no expertise to be making a pronouncement, that aid in dying is legal in Montana. That's the role of the legislature or a court and they are neither."
She said that such an understanding had huge implications in devaluing the lives of the sick and elderly.
That position paper - in response to the lawsuit - has since been rescinded by the Board and scrubbed from its website. But Dore said court action was still needed to prevent the Board from reinstating such a position.
She repeatedly asked District Judge Mike Menahan to weigh in on a Montana Supreme Court ruling known as Baxter, that envisions potential defenses to doctors charged with homicide for assisting with suicide.
But Menehan said it wasn't the role of a district judge to rule on a Montana Supreme Court order.
Craig Charlton
Attorney for MAAS
Michael Fanning, an attorney for the Board, said MAAS had no standing to bring the lawsuit, has suffered no damages from the Board's rescinded position and was simply jockeying to get the case before the Montana Supreme Court in hopes of overturning the Baxter ruling.
"This most certainly is a political question, a philosophical question or an academic debate, but it is not a lawsuit," he said. "In fact, this is a feigned case. It was contrived simply to bring this matter before you."
Menahan did not immediately rule on the case.
[Montanans Against Assisted Suicide is also represented by attorney Craig Charlton].

Monday, November 11, 2013

Quick Facts About Assisted Suicide

By Margaret Dore, Esq.*
October 7, 2013  
1.  Assisted Suicide

Assisted suicide means that someone provides the means and/or information for another person to commit suicide.  When a physician is involved, the practice is physician-assisted suicide.[1]

2. The Oregon and Washington Laws

In Oregon, physician-assisted suicide was legalized in 1997 via a ballot measure.[2]  In Washington State, a similar law was passed via another ballot measure in 2008 and went into effect in 2009.[3]  

3.  Throwing Away Your Life

The Oregon and Washington laws apply to state residents predicted to have less than six months to live.[5]  Such persons are not necessarily dying.  Doctors can be wrong.[6]  Moreover, treatment can lead to recovery.  Consider Jeanette Hall, who was diagnosed with cancer and given six months to a year to live.[7]  She was adamant that she would "do" Oregon’s law, but her doctor, Ken Stevens, convinced her to be treated instead.[8] Today, she is thrilled to be alive, 13 years later.[9]

With legal assisted suicide, people with years to live are encouraged to throw away their lives.


4.  A Recipe for Elder Abuse

The Washington and Oregon laws are a recipe for elder abuse. The most obvious reason is due to a lack of oversight when the lethal dose is administered.[10] For example, there are no witnesses required at the death; the death is allowed occur in private.[11] With this situation, the opportunity is created for an heir, or some other person who will benefit from the patient’s death, to administer the lethal dose to the patient without her consent.  Even if she struggled, who would know?

For more detail about Washington's law, which is similar to Oregon's law, read a short article by clicking here or here.


5. Empowering the Healthcare System

In Oregon, patients desiring treatment under the Oregon Health Plan have been offered assisted suicide instead. 

The most well known cases involve Barbara Wagner and Randy Stroup.[12] Each wanted treatment.[13] The Plan denied their requests and offered to pay for their suicides instead.[14] Neither Wagner nor Stroup saw this scenario as a celebration of their "choice." Wagner said: "I'm not ready to die."[15] Stroup said: "This is my life they’re playing with."[16]

Wagner and Stroup were steered to suicide. Moreover, it was the Oregon Health Plan, a government entity, doing the steering.[17]  For more detail about the current situation, read the affidavit of Kenneth Stevens, by clicking here.

6.  Increased Suicide in Oregon

Oregon's suicide rate, which excludes suicides under its physician-assisted suicide law, has been "increasing significantly" since 2000.[18] 

Just three years prior, Oregon legalized physician-assisted suicide. This increased suicide rate is consistent with a suicide contagion in which removing the stigma from one type of suicide encouraged other suicides. 

7.  Proposed Expansion in Washington State

Washington State legalized physician-assisted suicide in March 2009.  Less than there years later, there were discussions to expand that law to direct euthanasia of non-terminal people. See, for example, Brian Faller, "Perhaps it's time to expand Washington's Death with Dignity Act, The Olympian, November 16, 2011.[19]  More disturbing to me, on March 8, 2012, there was a Seattle Times column causally suggesting euthanasia for people unable to support themselves, which would be involuntary euthanasia.  See Jerry Large, "Planning for old age at a premium," The Seattle Times, March 8, 2012 at  http://seattletimes.nwsource.com/text/2017693023.html ("After Monday's column,  . . . a few [readers] suggested that if you couldn't save enough money to see you through your old age, you shouldn't expect society to bail you out. At least a couple mentioned euthanasia as a solution.") (Emphasis added). 

Prior to our law's being passed, I never heard anyone talk like this. 

Don't make our mistake.

Margaret Dore is an attorney in Washington State where assisted suicide is legal.  She is also President of Choice is an Illusion, a nonprofit corporation opposed to assisted suicide.  For more information, see www.margaretdore.com andwww.choiceillusion.org 

[1]  Compare: American Medical Association, Code of Medical Ethics, Opinion 2.211, available at http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion2211.page
[2]  The Oregon and Washington laws are similar.  For a short article about Washington’s law, see Margaret K. Dore, "'Death with Dignity': What Do We Advise Our Clients?," King County Bar Association, Bar Bulletin, May 2009, available athttps://www.kcba.org/newsevents/barbulletin/BView.aspx?Month=05&Year=2009&AID=article5.htm
[3]  Id.
[5]  See ORS 127.800 s.1.01(12) and RCW 70.245.010(13).
[6]  See e.g., Nina Shapiro, "Terminal Uncertainty: Washington’s new "Death With Dignity" law allows doctors to help people commit suicide—once they’ve determined that the patient has only six months to live. But what if they’re wrong?," 01/14/09, available athttp://www.seattleweekly.com/2009-01-14/news/terminal-uncertainty 
[7]  See Jeanette Hall, Letter to the editor, "She pushed for legal right to die, and - thankfully - was rebuffed, Boston Globe, October 4, 2011 ("I am so happy to be alive!), available athttp://www.boston.com/bostonglobe/editorial_opinion/letters/articles/2011/10/04/she_pushed_for_legal_right_to_die_and___thankfully___was_rebuffed/ Kenneth Stevens MD, Letter to the Editor, "Oregon mistake costs lives," The Advocate, the official publication of the Idaho State Bar, Sept. 2010, (scroll down to last letter atwww.margaretdore.com/info/Stevens.pdf ).
[8]  Id.
[9]  Per her telephone call today.
[10]  The Oregon and Washington Acts can be viewed in their entirety here and here.
[11]  Id.
[12]  See Susan Donaldson James, "Death Drugs Cause Uproar in Oregon," ABC News, August 6, 2008, athttp://abcnews.go.com/Health/story?id=5517492&page=1; "Letter noting assisted suicide raises questions," KATU TV, July 30, 2008, athttp://www.katu.com/news/specialreports/26119539.html ; and Ken Stevens, MD, Letter to Editor, "Oregon mistake costs lives," The Advocate, the official publication of the Idaho State Bar, September 2011, to view, scroll down to bottom of second page here:http://www.margaretdore.com/info/September_Letters.pdf
[13] Id.
[14] Id.
[15] KATU TV at note 12
[16] ABC News at note 12
[17]  See also Affidavit of Ken Stevens MD (Leblanc v. Canada), with attachments, available athttp://maasdocuments.files.wordpress.com/2012/09/signed-stevens-aff-9-18-12.pdf  
[18]  See "Suicides in Oregon: Trends and Risk Factors," Oregon Department of Human Services, Public Health Division, September 2010, page 6, ("Deaths relating to the death with Dignity Act (physician-assisted suicides) are not classified as suicides by Oregon law and therefore excluded from this report"), available athttp://epcdocuments.files.wordpress.com/2011/10/or_suicide_report_001.pdf
See also Oregon Health Authority, News Release, "Rising suicide rate in Oregon reaches higher than national average," September 9, 2010, ("suicide rates have been increasing significantly since 2000") available athttp://www.oregon.gov/DHS/news/2010news/2010-0909a.pdf
[19] Available at http://www.theolympian.com/2011/11/16/1878667/perhaps-its-time-to-expand-washingtons.html

Sunday, October 27, 2013

Dr. Kenneth Stevens and Jeanette Hall in Quebec!


http://ca.finance.yahoo.com/news/physician-assisted-suicide-encourages-people-143000132.html

Physician-assisted suicide encourages people with years to live to throw away their lives: an Oregon cancer doctor and his patient tell their story and warn Quebecers
MONTREAL, Oct. 25, 2013 /CNW Telbec/ - The Coalition of Physicians for Social Justice presented a doctor and his patient from Oregon where assisted suicide is legal. 
Dr. Kenneth Stevens is a practicing cancer doctor with more than 40 years' experience. He is also a Professor Emeritus and a former Chair of the Department of Radiation Oncology, Oregon Health & Sciences University,Portland, Oregon. He has treated thousands of patients with cancer. 
Jeanette Hall, Dr. Stevens' patient, is thrilled to be alive 13 years after he talked her out of "doing" Oregon's law, i.e., killing herself with a lethal dose of barbiturates. 

In 2000, Jeanette was diagnosed with cancer by another doctor and told that she had six months to a year to live. This was without treatment. The other doctor had referred her to Dr. Stevens for radiation and chemotherapy. Jeanette, however, had voted for Oregon's law. She had made a firm decision to go forward with Oregon's law instead.

Dr. Stevens did not believe in assisted suicide. He also believed that Jeanette's prospects for treatment were good. He convinced her to be treated instead of doing Oregon's law.

Dr. Stevens talked about how the mere existence of legal assisted suicide steered Jeanette Hall to suicide. He also talked about how financial incentives in Oregon's government health plan also steer patients to suicide. Dr. Stevens warned that if assisted suicide or euthanasia is legalized in Quebec, then the Quebec government health program could follow a similar pattern, that is, to pay for people to die, but not to live.

Dr. Paul Saba, a family physician and co-president of the Coalition of Physicians for Social Justice explained how Quebec's proposed euthanasia law would encourage people, including young adults with treatable conditions, to agree to euthanasia and throw away their lives. The Coalition's position against euthanasia is supported by the World Medical Association representing nine million physicians.

For additional information and references including videos visit coalitionmd.org.

SOURCE Coalition of Physicians for Social Justice

Thursday, October 10, 2013

Canada's Carter Case: WE WON!!!!!!

EUTHANASIA PREVENTION COALITION APPLAUDS RULING OF BC APPEAL COURT ON ASSISTED SUICIDE
Media Release - TorontoThursday October 10, 2013 /CNW/
The BC Court of Appeal has struck down the decision by Justice Smith and upheld the current laws which protect Canadians from euthanasia and assisted suicide.

The Euthanasia Prevention Coalition (EPC) intervened in the BC assisted suicide case in order to uphold the principles of Parliamentary sovereignty and basic human rights. EPC is pleased that the Court has followed the lead of Canadian Parliament, the Supreme Court of Canada, and of the majority of Parliaments and Supreme Courts around the world in finding that the prohibitions against assisted suicide represent an important protection against abuse of vulnerable people.

EPC legal counsel Hugh Scher states:
EPC is concerned about the safety, security and equality of people with disabilities and seniors, which is central to the protections set out under the Charter of Rights and Freedoms and our Criminal Code. 
EPC-BC chair Dr. William Johnston states:
The debate is over whether what the suicidal person proposes – to kill themselves – is a goal which should be shared and facilitated by the state. I suggest there are alternate goals like the treatment of depression and other symptoms, to which the state should apply itself. When someone has lost hope for the future, finds no meaning in their life, and sees only one solution – death – we recognize a suicidal depression. That bleak tunnel vision should evoke suicide prevention, not euthanasia.
Disability rights advocate Amy Hasbrouck of Toujours Vivant - Not Dead Yet states:
People with disabilities, chronic illness and seniors are negatively affected by assisted suicide and euthanasia because it leads to the impression that our lives are lacking in meaning and value as compared to other Canadians.
EPC Executive Director, Alex Schadenberg states:
The evidence is clear that in jurisdictions where these practices have been legalized, there have been significant abuses of vulnerable people. For example, studies in Belgium demonstrate that 32% of people killed under the Belgian law were killed without consent and without their own request, in breach of a fundamental condition of that law. 
Not one of these doctors has been prosecuted.
In the event today's ruling is appealed to the Supreme Court of Canada, EPC will seek to intervene with a view to protecting the dignity and equality of all Canadians, particularly those who are most vulnerable to the risks of abuse from assisted suicide.

Please consider a generous donation to help us cover expenses and to prepare for the next round.  Thank you for your support!  To donate,click here.

For further information, please contact:
Dr. William Johnston, (Vancouver) EPC-BC Chair: (604) 220-2042 –willjohnston@shaw.ca
Alex Schadenberg, (London) EPC Executive Director: (519) 851-1434 – info@epcc.ca
Amy Hasbrouck, (Montreal) Tourjours Vivant - Not Dead Yet: (450) 921-3057 – info@tv-ndy.ca