Assisted suicide

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S Korea's top court upholds 'right to die' ruling

South Korea's top court on Thursday authorised doctors to halt life-sustaining treatment for a comatose woman, approving a request for euthanasia for the first time in the country. The supreme court, upholding a lower court decision, supported a request by the family of the 76-year-old that she be allowed to die with dignity.

Under current law the removal of a respirator from brain-dead patients is regarded as murder. But the family said that extending life using medical devices would prolong the woman's "painful and meaningless" existence.

The woman was declared brain dead in February last year after she sustained cerebral damage and fell into a coma while undergoing a lung examination at the Severance Hospital in Seoul.

Three months later her children filed a court petition after the hospital rejected their request that she be allowed to die in peace and with dignity.

A court last November approved their request for removal of a life support system, saying she had no chance of recovery and her wish to die could be inferred.

An appeal court upheld that decision in February but the hospital took the case to the top court.The supreme court said the termination of life-sustaining treatments requires "careful

judgement."However, it said, treatment can be stopped by making a presumption about the wish of the

patient. Maintaining a brain-dead state damaged "human dignity" when there was no chance of recovery.

"If it is obvious that the patient will die soon... we can conclude that she or he has already entered a phase of death," the court said.

"In this case, we must respect the patient's will because forced life-sustaining treatment may damage human dignity."

In the current case, it said, the woman had told her family she did not want to be kept alive artificially if any problem arose with her hospital treatment.

Local religious communities have been split on the subject of euthanasia. Activists have warned against abuse of the ruling.

The Korea Medical Association said it would draw up new guidelines for doctors on the subject.The supreme court "acknowledged the patient's right to make a decision on meaningless life-

sustaining treatment," spokesman Choa Hun-Jong told reporters.But he said such situations should be allowed only when a patient has no chance of recovery.In 2007 a father was given a four-year suspended jail term for the removal of a respirator from

his brain-dead son.

S Korea did not legalize euthanasia

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Yesterday, the Euthanasia Prevention Coalition wrote a letter to the AFP news service stating that their report: S Korea legalizes euthanasia for terminally ill was wrong.

This is the statement that we sent to the AFP news service:The following article from your news service is not clear, it says that South Korea will legalize

euthanasia and then the article is about removing life support from terminally ill people. The article states: "They agreed that doctors could stop prolonged life-sustaining treatment, based only on prior written or oral statements from patients."

It appears that South Korea has approved the withdrawal of life-sustaining treatment which is not euthanasia. Euthanasia is the direct and intentional killing of a person for reasons of mercy. This has not been legalized in South Korea

The article doesn't refer to the issue of fluids and food, and therefore until I see the actual guidelines I must say that euthanasia has not being legalized in South Korea, but rather discontinuing life-sustaining treatment has been approved.

You need to be more careful with your reporting because these ethical issues effect many people and if you incorrectly report on an issue you create confusion.

Today I received the South Korean – End-of-life guidelines from a Korean physician. It is clear that S Korea did not legalize euthanasia. The guidelines concern the rules that must be followed before a physician can withdraw or withhold medical treatment.

The guidelines state:* They are for terminally ill patients, but do not apply to PVS patients, unless the PVS patient is

terminally ill.* They are for extraordinary treatments only (eg. Respirators, CPR). Ordinary treatments such

as fluids and food should be maintained.* Apply to adult patients, based on prior written statements. - The statement should be prepared after counseling with doctor(s) with a 2 week mandatory

deliberation period.- Oral statements of patients are accepted, when it can be proven.- Can be withdrawn anytime* A national review committee on end-of-life care will be established.* Hospital ethics committees on end-of-life care will be established.The guidelines did not approve:* Surrogate decision is not allowed for adult patients, but partially allowed for minors and

people with mental disabilities.It is clear that euthanasia has not been legalized in S Korea. The guidelines do not approve of

euthanasia by dehydration either. It is also clear that the South Korea guidelines are more cautious than most national end-of-life

guidelines in the western world. While I share the concern about how "terminally ill" may be defined, these guidelines do not appear to be designed to open the floodgate.

It appears that the AFP news service is intentionally confusing the public concerning what euthanasia actually is. AFP also wrongly stated that the German court recently approved euthanasia. AFP needs to publish a retraction of their incorrect news article.

South Korean court orders removal of life support from comatose woman...

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"No man shall murder--and it is murder, My children, when he shall give the excuse of saying an individual is no longer living or a part of the world because he has become emaciated, because he lives only with prayers and the help of all scientific means." -  Our Lady of the Roses, June 5, 1976

LifeSiteNews.com reported on December 1, 2008:A ruling by the Seoul Western District Court ordering doctors to remove life support, including

feeding tubes, from a comatose woman has ignited controversy in Korea over whether the ruling will lead to assisted suicide and euthanasia.

This ruling is reportedly the first of its kind in Korea, where current law bans any form of assisted suicide. According to The Korea Times, in a similar 1997 case a family was convicted of murder for having assisted in the removal of a ventilator from a patient.

The case involves a 75-year-old woman, identified as Kim Ok-kyung, who fell into what has been reported as both a "coma" and a "persistent vegitative state" in February while undergoing a lung examination. The patient’s family filed a court request in May asking the hospital to take the woman off life-support, claiming that extending Kim's life using medical devices would prolong her "painful and meaningless" existence. The Seoul Western District court accepted the request to halt treatment, ordering the removal of feeding and ventilator tubes on Friday.

Judge Kim Cheon-soo stressed that the decision should not be seen as a blanket approval for euthanasia, but is confined only to those for whom medical treatment has no impact.

"The patient can ask doctors to remove life support if it causes physical and mental pain and hurts human dignity and personality. Considering her hopeless state, the expected years left in her life and her age, the patient is assumed to have expressed her wish to die a natural death with the life support removed," Cheon-soo said in his ruling, adding that, "Doctors from Seoul National University Hospital and Asan Medical Center have confirmed that she is expected to survive up to three or four months at best. In this condition, further treatment is meaningless.''

Park Jung-woo, secretary-general of the Archdiocese of Seoul Life and Ethics Committee said in a Korea Times report, "Patients should receive the best care possible, but how one accepts death is also important when there's no chance of recovery. A patient choosing to withdraw his own treatment is one thing, but removing treatment from someone else is different."

Alex Schadenberg of the Euthanasia Prevention Coalition told LifeSiteNews that there is a significant and profound difference between removal of a respirator, which would allow natural death to follow, and removal of a feeding tube which would cause death by dehydration and is therefore active euthanasia.

"The decision from the Seoul Western District Court is concerning because it means that they have now authorised the decision to enable physicians to intentionally dehydrate their patients to death. When we intentionally dehydrate a person to death who is not otherwise dying, the intent of the omission is to deliberately cause the death of the person, which is euthanasia," Schadenberg said.

"The court should have limited its judgment to the withdrawal of the ventilator," Schadenberg explained. "When a ventilator is withdrawn, the death that might occur is not caused by the removal of the ventilator, but rather by the (pre-existing) medical condition."

According to many ethical experts assisted ventilation can be considered “extraordinary” treatment, and therefore can be licit to refuse or remove, in certain circumstances. The provision of food and hydration, on the other hand, is merely “ordinary” treatment and cannot legitimately be withdrawn.

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"We must remember that when we allow one person in society to intentionally cause the death of another person in society, it is impossible to provide safeguards that will protect people who are vulnerable, depressed or socially devalued," Schadenberg warned. "We must strive for a culture that cares and not kills its vulnerable citizens."

Tread Carefully When You Help to Die Assisted Suicide Laws Around the World

Updated 01 March 2005www.assistedsuicide.org

Compiled by Derek Humphry, former editor of World Right-to-Die NewsletterAssisted suicide laws around the world are clear in some nations but unclear – if they exist at all

– in others. Just because a country has not defined its criminal code on this specific action does not mean all assisters will go free. It is a complicated state of affairs. A great many people instinctively feel that suicide and assisted suicide are such individual acts of freedom and free will that they assume there are no legal prohibitions. This fallacy has brought many people into trouble with the law. While suicide is no longer a crime – and where it is because of a failure to update the law it is not enforced – assistance remains a crime almost everywhere by some statute or other. I’ll try to explain the hodge-podge.

For example, it is correct that Sweden has no law specifically proscribing assisted suicide. Instead the prosecutors might charge an assister with manslaughter – and do. In 1979 the Swedish right-to-die leader Berit Hedeby went to prison for a year for helping a man with MS to die. Neighbouring Norway has criminal sanctions against assisted suicide by using the charge "accessory to murder". In cases where consent was given and the reasons compassionate, the courts pass lighter sentences. A recent law commission voted down de-criminalizing assisted suicide by a 5-2 vote.

A retired Norwegian physician, Christian Sandsdalen, was found guilty of wilful murder in 2000. He admitted giving an overdose of morphine to a woman chronically ill after 20 years with MS who begged for his help. It cost him his medical license but he was not sent to prison. He appealed the case right up to the Supreme Court and lost every time. Dr. Sandsdalen died at 82 and his funeral was packed with Norway’s dignitaries, which is consistent with the support always given by intellectuals to euthanasia.

Finland has nothing in its criminal code about assisted suicide. Sometimes an assister will inform the law enforcement authorities of him or her of having aided someone in dying, and provided the action was justified, nothing more happens. Mostly it takes place among friends, who act discreetly. If Finnish doctors were known to practice assisted suicide or euthanasia, the situation might change, although there have been no known cases.

Germany has had no penalty for either suicide or assisted suicide since 1751, although it rarely happens there due to the hangover taboo caused by Nazi mass murders, plus powerful, contemporary, church influences. Direct killing by euthanasia is a crime. In 2000 a German appeal court cleared a Swiss clergyman of assisted suicide because there was no such offence, but convicted him of bringing the drugs into the country. There was no imprisonment.

France does not have a specific law banning assisted suicide, but such a case could be prosecuted under 223-6 of the Penal Code for failure to assist a person in danger. Convictions are rare and punishments minor. France bans all publications that advise on suicide - Final Exit has been banned since l991 but few nowadays take any notice of the order. Since l995 there has been a fierce debate on the subject, which may end in law reform eventually. Denmark has no specific law

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banning assisted suicide. In Italy the action is legally forbidden, although pro-euthanasia activists in Turin and Rome are pressing hard for law reform. Luxembourg does not forbid assistance in suicide because suicide itself is not a crime. Nevertheless, under 410-1 of its Penal Code a person could be penalized for failing to assist a person in danger. In March 2003 legislation to permit euthanasia was lost in the Luxembourg Parliament by a single vote.

Tolerance for euthanasia appears in the strangest of places. For instance, in Uruguay it seems a person must appear in court, yet Article 27 of the Penal Code (effective 1934) says: "The judges are authorized to forego punishment of a person whose previous life has been honorable where he commits a homicide motivated by compassion, induced by repeated requests of the victim." So far as I can tell, there have been no judicial sentences for mercy killing in Uruguay.In England and Wales there is a possibility of up to 14 years imprisonment for anybody assisting a suicide. Oddly, suicide itself is not a crime, having been decriminalized in 1961. Thus it is a crime to assist in a non-crime. In Britain, no case may be brought without the permission of the Director of Public Prosecutions in London, which rules out hasty, local police prosecutions. It has been a long, uphill fight for the British – there have been eight Bills or Amendments introduced into Parliament between 1936-2003, all trying to modify the law to allow careful, hastened death. None has succeeded, but the Joffe Bill currently before Parliament is getting more serious consideration than any similar measure. As in France, there are laws banning a publication if it leads to a suicide or assisted suicide. But Final Exit can be seen in bookstores in both countries.

The law in Canada is almost the same as in England; indeed, a prosecution has recently (2002) been brought in B.C. against a grandmother, Evelyn Martens, for counselling and assisting the suicide of two dying people. Mrs. Marten was acquitted on all counts in 2004. One significant difference between English and Canadian law is that no case may be pursued by the police without the approval of the Director of Public Prosecutions in London. This clause keeps a brake on hasty police actions.

Assisted suicide is a crime in the Republic of Ireland. In 2003 police in Dublin began proceedings against an American Unitarian minister, George D Exoo, for allegedly assisting in the suicide of a woman who had mental health problems. He responded that he had only been present to comfort the woman, and read a few prayers. This threatened and much publicized case had disappeared by 2005.

CONSENT IRRELEVANTSuicide has never been illegal under Scotland's laws. There is no Scots authority of whether it

is criminal to help another to commit suicide, and this has never been tested in court. The killing of another at his own request is murder, as the consent of the victim is irrelevant in such a case. A person who assists another to take their own life, whether by giving advice or by the provision of the means of committing suicide, might be criminally liable on a number of other grounds such as: recklessly endangering human life, culpable homicide (recklessly giving advice or providing the means, followed by the death of the victim), or wicked recklessness.

Hungary has one of the highest suicide rates in the world, caused mainly by the difficulties the peasant population has had with adapting to city life. Assistance in suicide or attempted suicide is punishable by up to five years imprisonment. Euthanasia practiced by physicians was ruled as illegal by Hungary's Constitutional Court (April 2003), eliciting this stinging comment from the journal Magyar Hirlap: "Has this theoretically hugely respectable body failed even to recognize that we should make legal what has become practice in everyday life." The journal predicted that the ruling would put doctors under commercial pressure to keep patients alive artificially.

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Russia, too, has no tolerance of any form of assisted suicide, nor did it during the 60-year Soviet rule. The Russian legal system does not recognize the notion of 'mercy-killing'. Moreover, the 1993 law 'On Health Care of Russian Citizens' strictly prohibits the practice of euthanasia. A ray of commonsense can be seen in Estonia (after getting its freedom from the Soviet bloc) where lawmakers say that as suicide is not punishable the assistance in suicide is also not punishable.

The only four places that today openly and legally, authorize active assistance in dying of patients, are:

1. Oregon (since l997, physician-assisted suicide only); 2. Switzerland (1941, physician and non-physician assisted suicide only);

3. Belgium (2002, permits 'euthanasia' but does not define the method;

4. Netherlands (voluntary euthanasia and physician-assisted suicide lawful since April 2002 but permitted by the courts since l984).

Two doctors must be involved in Oregon, Belgium, and the Netherlands, plus a psychologist if there are doubts about the patient's competency. But that is not stipulated in Switzerland, although at least one doctor usually is because the right-to-die societies insist on medical certification of a hopeless or terminal condition before handing out the lethal drugs.

The Netherlands permits voluntary euthanasia as well as physician-assisted suicide, while both Oregon and Switzerland bar death by injection.

Dutch law enforcement will crack down on any non-physician assisted suicide they find, recently sentencing an old man to six months imprisonment for helping a sick, old woman to die.

Switzerland alone does not bar foreigners, but careful watch is kept that the reasons for assisting are altruistic, as the law requires. In fact, only one of the four groups in that country, DIGNITAS, chooses to assist foreigners. When this willingness was published in newspapers worldwide, sick people from all over Europe, and occasionally America, started trekking to Switzerland to get a hastened death. In 2001 the Swiss National Council confirmed the assisted suicide law but kept the prohibition of voluntary euthanasia.

Belgian law speaks only of 'euthanasia' being available under certain conditions. 'Assisted suicide' appears to be a term that Belgians are not familiar with. It is left to negotiation between the doctor and patient as to whether death is by lethal injection or by prescribed overdose. The patient must be a resident of Belgium (pop.: 10 million), though not necessarily a citizen. In its first full year of implementation, 203 people received euthanasia from a doctor.

All three right-to-die organizations in Switzerland help terminally ill people to die by providing counselling and lethal drugs. Police are always informed. As we have said, only one group, DIGNITAS in Zurich, will accept foreigners who must be either terminal, or severely mentally ill, or clinically depressed beyond treatment. (Note: Dutch euthanasia law has caveats permitting assisted suicide for the mentally ill in rare and incurable cases, provided the person is competent.)

The Oregon Death With Dignity Act came under heavy pressure from the US Federal government in 2001 when Attorney General John Ashcroft issued a directive essentially and immediately gutting the law. This brought on a public outcry that the Federal government was nullifying a law twice voted on by Oregon citizens. A disqualification of democracy! An interference with states' rights! Immediately the state of Oregon went to court (2002) to nullify the directive, won at the first stage, but the appeals are likely to continue until 2004. Since l980, right-to-die groups have tried to change the laws in Washington State, California, Michigan, Maine,

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Hawaii, and Vermont, so far without success. Thus in the USA, Oregon stands alone and under great pressure.

In 2005 the US Supreme Court agreed to the federal government's request for it to decide whether Oregon's law was constitutional. The case concerned not so much the ethical correctness of physician-assisted suicide but turned legally on whether it was the federal government or the states which controlled dangerous drugs, as used by doctors in Oregon. The court's decision, expected in early 2006, will affect pain control throughout America.

New Zealand forbids assistance under 179 of the New Zealand Crimes Act, l961, but cases were rare and the penalties lenient. Then, out-of-the-blue in New Zealand in 2003 a writer, Lesley Martin, was charged with the assisted suicide of her mother that she had described in a book. Ms. Martin was convicted of manslaughter by using excessive morphine and served half of a fifteen-month prison sentence. She remained unrepentent. That same year the country's parliament voted 60-57 not to legalize a form of euthanasia similar to the Dutch model.

Similarly, Colombia's Constitutional Court in 1997 approved medical voluntary euthanasia but its parliament has never ratified it. So the ruling stays in limbo until a doctor challenges it. Assisted suicide remains a crime.

RARE IN JAPANJapan has medical voluntary euthanasia approved by a high court in l962 in the Yamagouchi

case, but instances are extremely rare, seemingly because of complicated taboos on suicide, dying and death in that country, and a reluctance to accept the same individualism that Americans and Europeans enjoy. The Japan Society for Dying with Dignity is the largest right-to-die group in the world with more than 100,000 paid up members. Currently, the Society feels it wise to campaign only for passive euthanasia – good advance directives about terminal care, and no futile treatment. Voluntary euthanasia and assisted suicide are rarely talked about, which seems strange to Westerners who have heard so much about the culture of ritual suicide, hari kari, in Japanese history. This is because, one Society official explained: "In Japan, everything is hierarchical, including academics, and government organization, and this makes it difficult for the medical staff and those who offer psychiatric care to join forces to treat the dying."

Another factor in Japan's backwardness on euthanasia is that some 80 percent of their people die in hospitals, compared to about 35 percent in the Netherlands, 35 percent in America, with as low as 25 percent in Oregon which has a physician-assisted suicide law. Euthanasia is essential an in-home action.

The right-to-die movement has been strong in Australia since the early l970s, spurred by the vast distances in the outback country between patients and doctors. Families were obliged to care for their dying, experienced the many harrowing difficulties, and many became interested in euthanasia. The Northern Territory of Australia actually had legal voluntary euthanasia and assisted suicide for seven months until the Federal Parliament stepped in and repealed the law in l997. Only four people were able to use it, all helped to die by the undaunted Dr. Philip Nitschke, who now runs the progressive organization, Exit International (formerly 'Final Exit Australia'). Other states have since attempted to change the law, most persistently South Australia, but so far unsuccessfully.

In a rare show of mercy and understanding, a judge in the Supreme Court of Victoria, Australia, in July 2003 sentenced a man to 18 months jail – but totally suspended the custody. Alex Maxwell had pleaded guilty to 'aiding and abetting' the suicide of his terminally ill wife, actions that the

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judge said were motivated by compassion, love, and humanity and thus did not deserve imprisonment. This was a trend in the right direction.

EUROPE ON THE MOVEThe strongest indication that the Western world is moving gradually to allow assisted suicide

for the dying and the incurable rather than to permitting voluntary euthanasia comes from a huge survey that the Council of Europe did in 2002. It received answers from 34 Central Asian and European states, plus the USA and Russia. Not a few replied that such terms were nowhere to be seen in their laws so had difficulty answering.

Asked if legislation or rules made euthanasia possible, only one country (Netherlands) answered in the affirmative (Belgium had not yet passed its similar law) and 25 nations said definitely not. Asked if they had any professional codes of practice on assisted suicide, eight countries said that they did, while 21 said no.

Some of the other questions had revealing answers: Is the term 'assisted suicide' used in your country: Yes 18; No 5. Do criminal sanctions against assisted suicide exist: Yes 23; No 4.

If so, have they ever been applied: Yes 6; No 6.

The Council of Europe, representing 45 nations, did not let the matter rest there. Its Social, Health and Family Affairs Committee approved a report which called on European states to consider decriminalizing euthanasia. This was a massive step forward for the previously ignored right-to-die movement.

The commonsense of the Committee's approach is shown in the draft report by Swiss Rapporteur Dick Marty:

1. Nobody has the right to impose on the terminally-ill and the dying the obligation to live out their life in unbearable suffering and anguish where they themselves have persistently expressed the wish to end it.

2. There is no implied obligation on any health worker to take part in an act of euthanasia, nor can such an act be interpreted as the expression of lesser consideration for human life.

3. Governments of Council of Europe member states are asked to collect and analyse empirical evidence about end-of-life decisions; to promote public discussion of such evidence; to promote comparative analysis of such evidence in the framework of the Council of Europe; and, in the light of such evidence and public discussion, to consider whether enabling legislation authorising euthanasia should be envisaged.

Advance Directive or Euthanasia?

South Korea's recent decision is being called a legalization of physician-assisted suicide and even euthanasia. It is, however, neither. When a competent patient makes an informed decision to refuse life-sustaining treatment, the person is not requesting a hastened death with medication, and this is wholly different from the Oregon and Washington Death with Dignity Acts.

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There is virtual unanimity in US state law and in our medical profession that the patients’ wishes should be respected when they’ve requested to withdraw or withhold life-sustaining treatment. By Supreme Court precedent, withdrawing or withholding life saving treatment has been allowed in the US since 1976.

South Korea’s Health Ministry recently agreed upon a set of rules which would allow doctors to honor patients’ health care advance directives to withhold life-sustaining procedures. According to the rules, “After a two-week period of consideration with a doctor, patients should express their willingness in a letter of intent or in words that can be proved. These intentions can be withdrawn any time.” Korea’s Health Ministry will recommend these rules to the National Assembly for consideration.

The voter-approved Death with Dignity Acts allow a physician to provide a patient with a life-ending dose of medication, upon the patient’s request, which the patient intends to use to end his or her own life. One key safeguard in these laws — and a distinction from euthanasia — is the patient must self administer the life-ending medication.

Euthanasia, on the other hand, typically refers to a physician taking an active role in administering the lethal medication, often by injection. This practice is in no way related to physician-aid in dying through Death with Dignity laws since it removes the important elements of autonomy and self-determination.

The Death with Dignity National Center works hard to promote and educate people about the importance of Death with Dignity Acts throughout the US. These laws provide guidelines for very specific end-of-life care for the terminally ill and lend peace of mind to the patients and their doctors when faced with perhaps the most difficult decision of their lives.

ASSISTED SUICIDE: (Protocols) 1995 "Assistance with suicide is one of the most profound and meaningful requests a patient can make of a physician. If the patient and the physician agree that there are no acceptable alternatives and that all the required conditions have been met, the lethal medication should ideally be taken in the physicians presence." However of the commentary offered, the following was particularly noted. " It is of the utmost importance not to abandon the patient at this critical moment. We must make sure that any policies or laws enacted to allow assisted suicide do not require that he patient be left alone at the moment of death in order for the assisters to be safe from prosecution". Some people say that this is wrong and that in any case, suffering may be alleviated by drugs. But the doctor/author of the article said that there is "no empirical evidence that all physical suffering associated with illness can be effectively relieved." Lastly, and in my opinion the most important aspect, the issue is not necessarily dying in pain but in an "undignified, unaesthetic, absurd, and existentially unacceptable conditions." As the authors final statement, terminally ill patients who do choose to take their lives often die alone so as not to place their families or care givers in legal jeopardy.

Why Assisted Suicide Must Not Be LegalizedMarilyn GoldenPolicy Analyst

Prologue

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In 1999, faced with a bill in the California legislature to legalize assisted suicide, the Disability Rights Education and Defense Fund (DREDF) joined ten other nationally prominent disability organizations in adopting a position against the legalization of assisted suicide and euthanasia.1 (see sidebar)

The 1999 California bill went down to defeat, due in part to an opposition coalition spanning the political spectrum from left to right. That coalition represented disability rights organizations, workers, poor people, physicians and other health-care workers, hospice organizations, Catholics, and right-to-life organizations. The opposition to legalization of assisted suicide is often mischaracterized as composed of religious conservatives, but most current opposition coalitions include many persons and organizations whose opposition is based on their progressive politics.

A similar coalition defeated a referendum on the same proposal in Maine in 2000. What happened in Maine is a perfect example of the general public's typical reaction to assisted suicide proposals. Early polls showed strong support, before the general public was educated about the dangers of legalization. As this education occurred, the polls slowly but steadily shifted, with the opposition gaining in each. At the time of the election, polls showed the opposition exceeding the support, and the referendum failed.

Since then, DREDF has worked with similar coalitions in California, Hawaii, and Vermont to defeat the same bill.

The Reasons DREDF Opposes Legalization of Assisted Suicide

Assisted suicide seems, at first blush, like a good thing to have available. But on closer inspection, there are many reasons legalization is a very serious mistake. Supporters often focus solely on superficial issues of choice and self-determination. It is crucial to look deeper.

We must separate our private wishes for what we each may hope to have available for ourselves some day and, rather, focus on the significant dangers of legalizing assisted suicide as public policy in this society as it operates today. Assisted suicide would have many unintended consequences.

• A very few helped - a great many harmed.The movement for legalization of assisted suicide is driven by anecdotes of people who suffer

greatly in the period before death. But the overwhelming majority of these anecdotes describes either situations for which legal alternatives exist today, or situations in which the individual would not be legally eligible for assisted suicide. It is legal in every U.S. state for an individual to create an advance directive that requires the withdrawal of treatment under any conditions the person wishes. It is legal for a patient to refuse any treatment or to require any treatment to be withdrawn. It is legal to receive sufficient painkillers to be comfortable, even if they might hasten death. And if someone who is imminently dying is in significant discomfort, it is legal for the individual to be sedated to the point that the discomfort is relieved. Moreover, if someone has a chronic illness that is not terminal, that individual is not eligible for assisted suicide under any proposal in the U.S., nor under the Oregon Death with Dignity Act (Oregon is the only state where assisted suicide is legal). Furthermore, any individual whose illness has brought about depression that affects the individual's judgment is also ineligible, according to every U.S. proposal as well as Oregon's law. Consequently, the number of people whose situations would actually be eligible for assisted suicide is extremely low.

The very small number of people who may benefit from legalizing assisted suicide will tend to be affluent, white, and in possession of good health insurance coverage. At the same time, large numbers of people, particularly among those less privileged in society, would be at significant risk of harm.

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Managed care and assisted suicide - a deadly mix.Perhaps the most significant problem is the deadly mix between assisted suicide and profit-

driven managed health care. Again and again, health maintenance organizations (HMOs) and managed care bureaucracies have overruled physicians' treatment decisions. These actions have sometimes hastened patients' deaths. The cost of the lethal medication generally used for assisted suicide is about $35 to $50, far cheaper than the cost of treatment for most long-term medical conditions. The incentive to save money by denying treatment already poses a significant danger. This danger would be far greater if assisted suicide is legal.

Assisted suicide is likely to accelerate the decline in quality of our health care system. A 1998 study from Georgetown University's Center for Clinical Bioethics underscores the link between profit—driven managed health care and assisted suicide. The research found a strong link between cost—cutting pressure on physicians and their willingness to prescribe lethal drugs to patients, were it legal to do so. The study warns that there must be "a sobering degree of caution in legalizing [assisted suicide] in a medical care environment that is characterized by increasing pressure on physicians to control the cost of care" (Sulmasy et al., 1998).

The deadly impact of legalizing assisted suicide would fall hardest on socially and economically disadvantaged people who have less access to medical resources and who already find themselves discriminated against by the health care system. As Paul Longmore, Professor of History at San Francisco State University and a foremost disability advocate on this subject, has stated, "Poor people, people of color, elderly people, people with chronic or progressive conditions or disabilities, and anyone who is, in fact, terminally ill will find themselves at serious risk" (Longmore, 1999).

Rex Greene, M.D., Medical Director of the Dorothy E. Schneider Cancer Center at Mills Health Center in San Mateo, California and a leader in bioethics, health policy and oncology, underscored the heightened danger to the poor. He said, "The most powerful predictor of ill health is [people's] income. [Legalization of assisted suicide] plays right into the hands of managed care."2

Supporters of assisted suicide frequently say that HMOs will not use this procedure as a way to deal with costly patients. They cite a 1998 study in the New England Journal of Medicine that estimated the savings of allowing people to die before their last month of life at $627 million. Supporters argue that this is a mere .07% of the nation's total annual health care costs. But significant problems in this study make it an unsuitable basis for claims about assisted suicide's potential impact. The researchers based their findings on the average cost to Medicare of patients with only four weeks or less to live. Yet assisted suicide proposals (as well as the law in Oregon) define terminal illness as having six months to live. The researchers also assumed that about 2.7% of the total number of people who die in the U.S. would opt for assisted suicide, based on reported assisted suicide and euthanasia deaths in the Netherlands. But the failure of large numbers of Dutch physicians to report such deaths casts considerable doubt on this estimate. And how can one compare the U.S. to a country that has universal health care? Taken together, these factors would skew the costs much higher (Rowen, 1999).

• Fear, bias, and prejudice against disability.Fear, bias, and prejudice against disability play a significant role in assisted suicide. Who ends

up using assisted suicide? Supporters advocate its legalization by arguing that it would relieve untreated pain and discomfort at the end of life. But all but one of the people in Oregon who were reported to have used that state's assisted suicide law during its first year wanted suicide not because of pain, but for fear of losing functional ability, autonomy, or control of bodily functions

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(Oregon Health Division, 1999). Oregon's subsequent reports have documented similar results. Furthermore, in the Netherlands, more than half the physicians surveyed say the main reason given by patients for seeking death is "loss of dignity" (Birchard, 1999).

This fear of disability typically underlies assisted suicide. Said one assisted suicide advocate, "Pain is not the main reason we want to die. It's the indignity. It's the inability to get out of bed or get onto the toilet ... [People] ... say, ‘I can't stand my mother – my husband – wiping my behind.' It's about dignity" (Leiby, 1996). But as many thousands of people with disabilities who rely on personal assistance have learned, needing help is not undignified, and death is not better than reliance on assistance. Have we gotten to the point that we will abet suicides because people need help using the toilet?

Diane Coleman, President and Founder of Not Dead Yet, a grassroots disability organization opposed to legalizing assisted suicide, has written that the "public image of severe disability as a fate worse than death … become(s) grounds for carving out a deadly exception to longstanding laws and public policies about suicide intervention services … Legalizing assisted suicide means that some people who say they want to die will receive suicide intervention, while others will receive suicide assistance. The difference between these two groups of people will be their health or disability status, leading to a two-tiered system that results in death to the socially devalued group" (Coleman, 2002).

• Undiagnosed depression underlies requests for assisted suicide. Suicide requests from people with terminal illness are usually based on fear and depression. As

Herbert Hendin, M.D., Medical Director of the American Foundation for Suicide Prevention and a leading U.S. expert on suicide, stated in Congressional testimony in 1996, "a request for assisted suicide is … usually made with as much ambivalence as are most suicide attempts. If the doctor does not recognize that ambivalence as well as the anxiety and depression that underlie the patient's request for death, the patient may become trapped by that request and die in a state of unrecognized terror" (Hendin, 1996).

Most cases of depression among terminally ill people can be successfully treated.3 (U.S. Catholic Conference, 2001). Yet primary care physicians are generally not experts in diagnosing depression. Where assisted suicide is legalized, the depression remains undiagnosed, and the only treatment consists of a lethal prescription.

• Supposed safeguards are illusory.Assisted suicide proposals and Oregon's law are based on the faulty assumption that it is possible to

make a clear distinction between those who are terminally ill with six months to live, and everyone else. Everyone else is supposedly protected and not eligible for assisted suicide. But it is extremely common for medical prognoses of a short life expectancy to be wrong. Studies show that only cancer patients show a predictable decline, and even then, it's only in the last few weeks of life. With every disease other than cancer, there is no predictability at all (Lamont, 1999; Maltoni, 1994; Christakis and Iwashyna, 1998; Lynn, 1997). Prognoses are based on statistical averages, which are nearly useless in predicting what will happen to an individual patient. Thus, the potential effect of assisted suicide is extremely broad, far beyond the supposedly narrow group its proponents claim. The affected group could include many people who may be mistakenly diagnosed as terminal but who have many meaningful years of life ahead of them.

This also poses considerable danger to people with new or progressive disabilities or diseases. Research overwhelmingly shows that people with new disabilities frequently go through initial despondency and suicidal feelings, but later adapt well and find great satisfaction in their lives (Harris,

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1986; Gerhart, 1994; Cameron, 1994; Ray and West, 1984; Stensman, 1985; Whiteneck, 1985; Eisenberg and Saltz, 1991). However, the adaptation usually takes considerably longer than the mere two week waiting period required by assisted suicide proposals and Oregon's law. People with new diagnoses of terminal illness appear to go through similar stages (New York State Task Force, 1994). In that early period before one learns the truth about how good one's quality of life can be, it would be all too easy, if assisted suicide is legal, to make the final choice, one that is irrevocable.

• Other alleged safeguards.Neither do other alleged safeguards offer any real protections. In Oregon's law and similar

proposals, physicians are not permitted to write a lethal prescription under inappropriate conditions that are defined in the law. This is seen as a "safeguard." But in several Oregon cases, suicidal patients engaged in "doctor shopping." When the first physician each of these patients approached refused to comply with the request for assisted suicide because the patient didn't meet the conditions of the law, the patient sought out another physician who agreed. The compliant physicians were often assisted suicide advocates. Such was the case of Kate Cheney, age 85, as described in The Oregonian in October 1999. Her physician refused to prescribe lethal medication, because he thought the request, rather than being Ms. Cheney's free choice, actually resulted from pressure by her assertive daughter who felt burdened with care giving. So the family found another doctor, and Ms. Cheney soon used the prescribed drugs and died.

Another purported safeguard is that physicians are required to discuss alternatives to assisted suicide. However, there is no requirement that these alternatives be made available. Kate Cheney's case exemplifies this. Further, the Kate Cheney case demonstrates the shocking laxness with which safeguards in Oregon are being followed. Ms. Cheney decided to take the lethal medication after spending just a week in a nursing home, to give her family a break from caretaking. The chronology shows that Cheney felt she had only three choices: burdening her family, the hell of a nursing home, or death.

After reading about the case of Kate Cheney, Diane Coleman of Not Dead Yet sent a letter via the Internet to Dr. Robert Richardson, a physician involved in Cheney's care. It stated, in part:

In my role as a long term care advocate, I have heard for years of Oregon's claim to operate the most progressive long-term care programs in the country, model programs that emphasize in-home and community based services, even for the most frail elderly. What in-home services was Ms. Cheney receiving? How is it that Ms. Cheney had to spend a week in a nursing home to give her family respite from caregiving? Did Ms. Cheney and her family know of other respite options? If not, who failed to tell them? How can their actions have been based on the informed consent promised in Oregon's law? Or did the family choose the nursing home respite option with the knowledge of other alternatives (an even more disturbing possibility)? What ongoing support options were explored to reduce the daily need for family caregiving? There are many ways to resolve the feeling of being a burden on family, and the family's feelings of being burdened. In what depth were these issues explored? In this context, family relationships are complex, and the emotional dynamics could not realistically be uncovered in a brief consultation.

It appears from the newspaper account, as well as your response to Dr. Hamilton, that these issues were not meaningfully addressed. Ms. Cheney appears to have been given the message that she had three choices - to be a burden on family, to go to a nursing home, or to die. After a week in a nursing home, an experience I wouldn't wish on my opponents except perhaps to

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educate them, it appears that Ms. Cheney felt she had only one option. How is this a voluntary and uncoerced decision based on informed consent? (Coleman, 2002, p. 226)

Coleman never received an answer from Dr. Richardson.There is one foolproof safeguard in current assisted suicide proposals and Oregon's law - but it is

for HMOs and physicians: the "good faith" standard. This "safeguard" provides that no person will be subject to any form of legal liability if they acted in "good faith." The claim of a "good faith" effort to meet the requirements of the law is virtually impossible to disprove. Moreover, this particular provision renders all other "safeguards" effectively unenforceable. Even more alarming, for all other medical procedures, practitioners are liable under a much stronger legal standard, that of negligence. Yet, even if negligent, practitioners of assisted suicide will not be found violating the law, as long as they practice in good faith.

Diane Coleman continues, "…is society really ready to ignore the risks, tolerate the abuse, marginalize or cover up the mistakes, and implicitly agree that some lives - many lives - are expendable, in order to enact a law that immunizes health care providers and other participants in assisted suicide?" (Coleman, 2002, p. 227)

• So-called "narrow" proposals will inevitably expand. Proponents claim that assisted suicide will be narrowly limited to those who are terminally ill,

but these so-called "narrow" proposals will inevitably be expanded. The New York State Task Force on Life and the Law wrote in 1997: "Once society authorizes assisted suicide for ... terminally ill patients experiencing unrelievable suffering, it will be difficult if not impossible to contain the option to such a limited group. Individuals who are not (able to make the choice for themselves), who are not terminally ill, or who cannot self-administer lethal drugs will also seek the option of assisted suicide, and no principled basis will exist to deny (it)" (New York State Task Force, 1997).

The longest experience we have with assisted suicide is in the Netherlands, where active euthanasia as well as assisted suicide are practiced. The Netherlands has become a frightening laboratory experiment because assisted suicide and euthanasia have meant that "pressure for improved palliative care appears to have evaporated," according to Herbert Hendin, M.D., in his Congressional testimony in 1996. Hendin was one of only three foreign observers given the opportunity to study these medical practices in the Netherlands in depth, to discuss specific cases with leading practitioners, and to interview Dutch government-sponsored euthanasia researchers. He documented how assisted suicide and euthanasia have become not the rare exception, but the rule for people with terminal illness in the Netherlands.

"Over the past two decades," Hendin continued, "the Netherlands has moved from assisted suicide to euthanasia, from euthanasia for the terminally ill to euthanasia for the chronically ill, from euthanasia for physical illness to euthanasia for psychological distress and from voluntary euthanasia to nonvoluntary and involuntary euthanasia. Once the Dutch accepted assisted suicide it was not possible legally or morally to deny more active medical (assistance to die), i.e. euthanasia, to those who could not effect their own deaths. Nor could they deny assisted suicide or euthanasia to the chronically ill who have longer to suffer than the terminally ill or to those who have psychological pain not associated with physical disease. To do so would be a form of discrimination. Involuntary euthanasia has been justified as necessitated by the need to make decisions for patients not [medically] competent to choose for themselves" (Hendin, 1996). Hendin describes how, for a substantial number of people in the Netherlands, physicians have ended their patients' lives without consultation with the patients.

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U.S. advocates of legalization, attempting to distinguish the Oregon experience from that in the Netherlands, argue that the numbers of reported users of assisted suicide in Oregon are low. But in fact the number of people requesting lethal drugs has grown. In the beginning, the numbers were low in the Netherlands as well, but usage grew along with social acceptance of the practice. There is no reason to believe that legalization in the U.S. would not be followed, in twenty years or more, with the kind of extraordinary growth that has taken place in the Netherlands.

Furthermore, assisted suicide proponents and medical personnel alike have established that taking lethal drugs by mouth is often ineffective in fulfilling its intended purpose. The body expels the drugs through vomiting, or the person falls into a lengthy state of unconsciousness rather than dying promptly, as assisted suicide advocates wish. Such ineffective suicide attempts happen in a substantial percentage of cases. Estimates range from 15% to 25% (JAMA, 1998, p. 512; Humphrey, 1994). The way to prevent these "problems," in the view of euthanasia advocates, is by legalizing lethal injections by physicians - that is, legalizing active euthanasia. This is an inevitable next step if society first accepts assisted suicide as a legitimate legal option.

Assisted suicide proponents tell us that none of these things will happen here. But why not? How can the proponents, or anyone, stop it? If the next step is wrong, then taking this step is tantamount to taking the next step.

• Claims of free choice are illusory.Assisted suicide purports to be about free choice and self-determination. But there is significant

danger that many people would take this "escape" due to external pressure. For example, elderly individuals who don't want to be a financial or caretaking burden on their families might choose assisted death. In Oregon's third year Report, "a startling 63% of [reported cases] cited fear of being a ‘burden on family, friends or caregivers' as a reason for their suicide" (United States Conference of Catholic Bishops, 2001).

Also very troubling, research has documented widespread elder abuse in this country. The perpetrators are often family members (National Elder Abuse Incidence Study, 1996).4 Such abuse could easily lead to pressures on elders to "choose" assisted suicide.

In addition, leaders and researchers in the African-American and Latino communities have expressed their fears that pressures to choose death would be applied disproportionately to their communities (Page, 1999; Montemayor, 1999; Ann Arbor News, 1997; Detroit Free Press, 1997).

Still others would undergo assisted suicide because they lack good health care, or in-home support, and are terrified about going to a nursing home. As Diane Coleman noted regarding Oregon's law, "Nor is there any requirement that sufficient home and community-based long-term care services be provided to relieve the demands on family members and ease the individual's feelings of being a ‘burden' … The inadequacy of the in-home long-term care system is central to the assisted suicide and euthanasia debate" (Coleman, 2002, p. 224).

While the proponents of legalization argue that it would guarantee choice, assisted suicide would actually result in deaths due to a lack of choice. Real choice would require adequate home and community-based long-term care; universal health insurance; housing that is available, accessible, and affordable; and other social supports. In a perverse twist, widespread acceptance of assisted suicide is likely to reduce pressure on society to provide these very kinds of support services, thus reducing genuine options even further,5 just as Herbert Hendin observed that widespread use of euthanasia in the Netherlands has substantially decreased pressure there for improved palliative care, by decreasing demand for it (Hendin, 1996).

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As Paul Longmore has stated, "Given the absence of any real choice, death by assisted suicide becomes not an act of personal autonomy, but an act of desperation. It is fictional freedom; it is phony autonomy" (Longmore, 1999).

Handbook for Mortals : Hastening Death : Arguments against physician-assisted suicide

Legalizing physician-assisted suicide is a part of the debate about improving end-of-life care. It can't be seen as a quick and easy way to protect patients from inadequate care arrangements. Too many people still suffer needlessly, often because doctors and families just do not know how to serve people who are dying. Many suffer because doctors fail to provide adequate medication for pain. To legalize physician-assisted suicide, some believe, would make real reform, such as better pain control, less likely. Without those reforms, patients end up with no prospects to live well while dying. In this scenario, making suicide an option is not offering a genuine choice.

Many people fear that physician-assisted suicide will create a climate in which some people are pressured into committing suicide. The very old, the very poor, or minorities and other vulnerable populations might be encouraged to hasten death, rather than to "burden" their families or the health care system. Again, this is not a genuine choice, but a social issue, one that stems from how our society cares for its elders and for the poor, and whether minority groups can get good health care. In either case, making suicide available does not solve the underlying social problem. Even for those who have adequate financial and social resources, having physician-assisted suicide available could create a troubling new situation. Seriously ill and disabled persons could feel that they had to justify a choice to stay alive. They could feel that suicide is, in some sense, "expected" by family or friends. As a society, we have never asked people to justify their being alive, and it seems likely that asking them to do so would run risks of being quite difficult or demeaning.

Finally the safeguards built into the proposed statutes will be very difficult to implement. "Terminal illness," "competent" patients, and "voluntary action" are each very ambiguous categories. Waiting times and restrictions on the help avail-able are likely to create tragic situations that push public opinion toward loosening restrictions.

A 1997 study conducted by the American Medical Association (AMA) found that more than half of Americans believe physician-assisted suicide should be legal. However, when people are told about alternatives to the technological treatments so many of us fear, and about the availability of pain control and hospice care, their support for physician-assisted suicide goes down to under one-fifth. This study seems to show that when people are informed about all of their end-of-life choices, they are less likely to opt for suicide.

Pros and cons of assisted suicide

THE ARGUMENTS FOR: Choosing how we die is a basic human freedom. If an individual's quality of life is terrible, they

should have the right to stop suffering.

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As the recent case of disabled rugby player Daniel James showed, hundreds of British people have travelled abroad for an assisted suicide, and the Crown Prosecution Service can't prosecute the people who help them. So our euthanasia laws are, in their present state, unworkable.

Since 1961, suicide has been legal. Helping somebody who wants to die in a peaceful, painless way should also be legal.

The majority of British people are in favour of legalising euthanasia. A recent YouGov survey revealed that 86 per cent supported it.

The safeguards work. Euthanasia clinics are professionally run centres that ensure their patients are making a considered and correct decision.

THE ARGUMENTS AGAINST: In Oregon, a recent study of people who took their lives with assisted suicide revealed that one

in every six were suffering from depression. This should not be allowed to be a factor in a human's choice to die.

Life is sacred. Helping to end it is morally unacceptable. Advances in medicine will mean that we can cure diseases and disabilities that were once

considered untreatable. So a terminally ill patient may, in the future, have a bearable quality of life. Terminally ill people are vulnerable members of society. Some might feel under psychological

pressure to ease the burden on their families. Although assisted suicide is understandable in cases like that of the multiple sclerosis sufferer

Debbie Purdy, legalising it risks turning it into a lifestyle choice. 

30 Logical Reasons Against Physician-Assisted Suicide

by Jane St. Clair Author of Walk Me to Midnight

The issue of assisted suicide was on the ballot in the state of Washington in November 2008.  At that time I pledged to give voters one new reason every day for thirty days why they should vote against this so I took out a new ad in the Seattle Times every day until Election Day.

Our opponents presented their views emotionally,  and they wanted to talk about religion.  We wanted to talk about the issues, logic, reason and history. They had ten times the money we did.

Despite help from celebrities like Martin Sheen, we lost this. Over 20,000 people have read this article. My reasons remain sound and logical, and I am

glad I was part of this effort, even though we lost in Washington. Reason #30- No on Assisted Suicide Sunday, November 2 Today’s AD-Some terminally ill

people recover and get well.A hospice nurse told me about a lovely 24-year-old given three months to live. Five years later,

she is still with us and the mother of a child.Every good doctor knows that medicine is an art as well as a science. No one can predict with

100% certainty who will live and who will die. Although it is rare, some terminally ill people can and do get better. Everyone who works in hospice can tell you at least one story attesting to that. They personally knew a patient who beat the odds and is still vertical today.

Offer them suicide and you take everything away from them. You take away hope. You take away their lives.

Reason 29: No on Assisted Suicide Saturday, November 1 Today’s Ad: Doctors make mistakes in medical care.

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This week, the Mississippi Supreme Court upheld a $4 million award to the family of a woman misdiagnosed with cancer and then given a lethal dose of painkillers.The 66-year-old woman received massive doses of painkillers at a hospice for cancer, which an autopsy showed she never had, according to court records.

That’s just this week’s news. It happens all the time.For more horror stories from families who suffered this way, see

http://www.hospicepatients.org/The JOURNAL of the AMERICAN MEDICAL ASSOCIATION (JAMA) Vol 284, No 4,

reports that medical errors may be the third leading cause of death in the United States at 225,000 deaths per year. Half are medical mistakes, including 2,000 deaths/year from unnecessary surgery; 7000 deaths/year from medication errors in hospitals; 20,000 deaths/year from other errors in hospitals; and 80,000 deaths/year from infections in hospitals.

Do you want to give doctors the right to administer suicide medications? Hey, mistakes happen.

Reason 28- No on Assisted Suicide Friday October 31 Today’s AD-Assisted suicide laws give societal approval to suicide.

These laws create a world where everyone agrees it’s okay to check out at certain times. In fact, we’ll help you do it. We’ll make it legal. Society approves. This creates more suicides among people who are not sick, and leads to increased medical killings. It creates incentives to do less medical research and to save money on medical care by offering people poison pills. This is already happening in Oregon. According to a report from the Oregon Health Authority called “Suicides in Oregon: Trends and Risk Factors,” Oregon’s suicide rate is now 35 times the national average.  It had been declining before voters in Oregon made assisted suicide legal,  thus making all suicides socially acceptable.

In the Netherlands, assisted suicide has moved into mercy killings of deformed babies, and into allowing mentally ill people to kill themselves rather than seek treatment. There is no reason to believe the United States would do any better if such laws are passed here.

Reason 27- No on Assisted Suicide October 30 Thursday Today’s AD No one, not even incapacitated people, needs an assisted suicide.

This is the worst case scenario argument from people who want assisted suicide laws. It goes like this: people who are paralyzed cannot commit suicide themselves. Therefore, they are denied a right. Therefore, we have to pass assisted suicide laws.

First of all, assisted suicide laws are written only for the terminally ill. Someone like Christopher Reeve and Terri Shiavo may have been too incapacitated to commit suicide but they were not terminally ill. Assisted suicide laws have nothing to do with their cases.

The vast majority of people who are terminally ill do not become incapacitated until the very end. They have plenty of time to kill themselves without help. If they ask friends and doctors to help them commit suicide once they become incapacitated, they are often looking for approval of their act or sympathy for their condition. It’s no one’s job to kill another person, and unfair to ask that of doctors and family members.

Reason #26- No on Assisted Suicide October 29 Today’s AD You already have control over your final illness.

Many people believe that assisted suicide laws are bad for society, but they want them just in case they personally need them. They want control over their dying process. It’s a me-first attitude.

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What they do not understand is that they already have control of their dying process. My own grandfather pulled out his feeding tubes and respirator himself, telling his doctor and his son that he was an old man and his time had come.

You already can kill yourself any time you want. You have the right to refuse any medical treatment at any time. You can choose pain relief only. You can choose to be completed doped up and unconscious.  You can tell your hospice nurses and caretakers to keep everyone out of your room, if you want control over who sees you when you are sick. You already have control, and you don’t need assisted suicide.

Reason #25- No on Assisted Suicide October 28 Today’s AD-We can come up with better ways of helping the dying besides assisted suicide.

A young man was diagnosed with HIV in the Netherlands. Even though his doctors told him he could live many years free of symptoms, he asked for an doctor-assisted suicide. No one talked to this young man and helped him work through his feelings of depression and of being overwhelmed by his own diagnosis. His culture accepts suicide, so that was that, and he ended his life in despair.

In our own country, oncologists routinely walk away from cancer patients they have been treating for months or even years once they are terminal. The person’s death becomes a personal failure on the part of the physician, even though it’s nothing of the kind. The only failure is the doctor’s lack of caring and lack of courage to stay involved. Caring is not always curing, but every bit as important. If you only think in terms of curing and winning battles against illness, you walk away from your “losers” and you walk away from caring.

We can come up with better ways of dealing with death than this, but we never will if we pass assisted suicide laws.

Reason #24- No on Assisted Suicide October 27 Today’s AD Oregon offers terminally ill people assisted suicide in lieu of medical care.

Oregon and the Netherlands, where assisted suicide is legal, keep expanding it. This passage, written by Dr. Herbert Hendin in Psychiatric Times, sums up what’s happened in the Netherlands:“The Netherlands has moved from assisted suicide to euthanasia, from euthanasia for the terminally ill to euthanasia for the chronically ill, from euthanasia for physical illness to euthanasia for psychological distress and from voluntary euthanasia to involuntary euthanasia (called “termination of the patient without explicit request”).”

The Dutch now end the lives of psychiatric patients and deformed babies.In Oregon, medical systems are already offering people assisted suicide in lieu of

chemotherapy. Cancer victim Randy Stroup got a letter from the state saying it would pay for his assisted suicide or painless death, but not his chemotherapy.  See “Oregon Offers Terminal Patients

Reason #23- No on Assisted Suicide October 26 Today’s AD Assisted suicide laws give more power to the government, not the individual.

On the surface, it looks like you gain a new “right” when you vote for assisted suicide. Actually, you turn over more power to the government and medical establishment.

You already have the power to commit suicide at any time. But if you sign a paper agreeing to have your doctor do it for you, you are turning over your power to someone else. You are creating a mechanism for the government and medical people to enter into decisions as to who lives and who dies. You are taking away the power of the individual. If the federal government takes over even more of the medical care system, you will be turning over your right-to-decide to the federal government.

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Reason #22- No on Assisted Suicide October 25 Today’s AD-Assisted suicide laws removes incentive to do medical research.

If cancer patients routinely kill themselves rather than undergo treatment, you have removed a reason to perform medical research to cure cancer. Research scientists receive funding based on how much money illnesses are costing insurance companies and how many people suffer from them. If an illness is rare, it gets less funding.

Also, think about the parents of terminally ill children. They will move mountains to cure that child. Rich parents fund research. Average people find breakthroughs themselves, like the parents in Lorenzo’s Oil.

Suicide laws remove such incentives for medical research and human progress. Reason #21- No on Assisted Suicide October 24 Big financial interests, such as

governments and insurance companies, are often behind assisted suicide laws.When are you dead? When your brain dies? When your heart stops beating? When you stop

breathing? When you are in an irreversible coma? No one really has come up with a working definition of death, so the concept gets abused, especially since death involves money.

The longer we keep sick people alive, the more they cost us. Last illnesses cost more than any other medical category. About one-third of Medicare’s budget goes for costs incurred in the last one year of life, and 40% of that goes for expenses in the last one month of life. If we convince you that you have no hope for a future, we save money on your care and make money on your organs. If we convince you to die early, we inherit your money more quickly. The government saves on Social Security and Medicare. Your company saves pension money.

So. Are you going to let such financial interests promote assisted suicide as a new public policy?

Reason #20- No on Assisted Suicide October 23 Today’s AD Christopher Reeve considered assisted suicide.

In his autobiography,”Still Me,” Reeve describes the despair he felt after becoming paralyzed in a riding accident. Within seconds, he went from being a handsome, extremely physically fit person to one who could not move from the neck down. He could speak and drink through straws, and that was pretty much it.

He asked his wife to help him commit suicide, and she said, “I understand how you feel, but you’re still you and I love you.” Hence, the title of the book.

What Reeve confesses is that he was testing her to see if she was willing to take over his care.He went on to live a life of example. Not only did he write an inspiring book, he also acted in

and directed several movies and worked tirelessly to get funding for victims of paralysis. He never gave up trying to walk. He became a real superman.

Reason #19- No on Assisted Suicide October 22 Today’s AD Assisted suicide asks too much of loved ones.

In the movies and on TV shows, the dying person is always in excruciating pain and crying out for help to the only one who will listen: an old friend or spouse or daughter or whatever. The writer presents the scene as totally hopeless unless the loved one helps the dying person commit suicide.

This is, of course, absolute nonsense.The correct response is, “I can’t do that, but I can stay by you, love you, help you through this,

make sure you get pain relief, counseling and help. We can get through this together. Please don’t ask me to hurt someone I care about. I love you.”

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By the way,  pain relief has never been more effective. You can already choose to stay doped up and unconscious until you pass away.

Reason #18- No on Assisted Suicide October 21 Today’s AD-Assisted suicide laws put poor people at risk.

This is the Martin Sheen argument against assisted suicide. He is making radio ads in Washington partly because he believes that assisted suicide laws will put poor people and those without health insurance at an extreme disadvantage within the medical system. Think of the money we’d save on CAT scans, x-rays, medicine, nursing care, rehabilitation, disability payments, etc if we had this cheap alternative: suicide.

Martin Sheen is right.Reason #17- No on Assisted Suicide October 20 Today’s AD-Suicide interrupts a natural

path to wisdom.At the very end of human life, everything happens faster and better. When you don’t have

much time, you prioritize. People become more authentic when they are dying, which is why courts give so much credence to a person’s “last words.”

Hospice nurses have shared many stories with me about how people come to realize new things about themselves, what was really important to them after all, who loved them and whom they really love, what the meaning of life is and what the afterlife, if any, looks like to them. They may go through a period of regrets, sorrow and mourning before they find wisdom, but it’s there. If you cut off your life too soon, you miss your chance for wisdom.  The vast majority of people want to live every last minute of their lives, and don’t want to be pressured by assisted suicide laws to end them.

Reason #16- No on Assisted Suicide October 19 Today’s AD-The first Nazi victims were terminally ill people.

The Nazi party used very emotional propaganda films about terminally ill people who needed the compassion of assisted suicide. Today we Americans are watching similar movies like “Million Dollar Baby,” which got the 2004 Academy Award for Best Picture. The most effective Nazi film told the heart-breaking story of a doctor’s wife who begged her husband to kill her.

Once they sold the German people on assisted suicide and had some doctors on board, the Nazi party moved into the concept of “useless eaters.” Germany was in a terrible depression in the 1930s, worse than America’s. “Useless eaters” were criminally insane, severely handicapped children, very very elderly, etc. Once they eliminated “useless eaters,” the Nazis went on to killing —- well, you’ve got the idea.

For more information, go to article “Hitler, the Nazis and Four Arguments Against Assisted Suicide.”

Reason #15- No on Assisted Suicide October 18 Today’s AD-Assisted suicide laws cannot be written so as to prevent abuse.

This is the reason the American Medical Association opposes assisted suicide. Doctors know that there is no way to control assisted suicide once you make it legal. There is no foolproof way to write the law without opening it to abuse.In Oregon and the Netherlands, for example, assisted suicide laws require two physicians to “sign off” on a suicide. However, some doctors “sign off” routinely without examining patients. One Dutch doctor hurried up a suicide because he needed the bed for another patient. You can’t write a law that covers every contingency so there’s no way to control what happens to your patients once you open that door.

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Reason #14- No on Assisted Suicide October 17 Today’s AD-Dying people can be treated for depression.

Many people who are terminally ill are not depressed. At the end of her life, my sister became like a poet or artist, sitting outside and just taking in the beauty of everything. She got an enhanced sense of life, everything became so incredibly beautiful to her because it was not going to last very much longer. However, some terminally ill people are depressed and talk about suicide. If they get antidepressant medications, a good psychologist and a caring spiritual counselor, they can recover emotionally. They often find the courage to face the final work of dying: reconciliations, settling of old disputes, telling others how much they have meant to them, and so forth.  Suicide is always an act of despair, and it’s not good to leave the planet in despair.

Reason 13- No on Assisted Suicide Today’s AD October 16 -The arguments for assisted suicide are all based on emotion.

Emotion is a kind of thought, but emotions are unreliable. We feel empathy when we see a dying person. Our first impulse is to hurry it along, end his suffering. However, behind that emotion of empathy hides a judgment: that person’s life is not worth living and needs to end now.

We can have a similar emotion when we see someone very very old or in a wheelchair or someone like Terri Shiavo. That life is not worth living. Are you feeling compassion or making a judgment?

Reason #12- No on Assisted Suicide October 15 Today’s AD- Assisted suicide sets a bad example for other people.

A handsome young man, the father of two young children with a beautiful wife, a brilliant scientist passionate about his life’s work, was dying much much too young. Yet Randy Pausch inspired us all with his incredible “Last Lecture.” He knew he was dying, but he looked back to check on his two young sons, to make sure they and his wife would be all right, and to leave them and all of us all with a little bit of wisdom. When he was toward the end, his doctor said, “Randy, this may be it.”

He answered, “I’ll get back to you on that.”Those were his last words.He took control and he did it his way. We are all grateful for his example.For more information on Randy Pusch, go to http://download.srv.cs.cmu.edu/~pausch/.Reason #11- No on Assisted Suicide Today’s AD October 14 -Insurance companies love

assisted suicide.About 27% of Medicare’s annual $327 billion budget goes to care for patients in their final

year of life. That’s a lot of money, and one poison pill is so much cheaper.You may be young and think that this is a great way to save money in the middle of a health

care crisis. You may even think the elderly have a crappy quality of life. The insurance companies believe that too. They like doctors to help people commit suicide. It saves money.

However, what’s going to happen when it’s your turn to die?Reason #10 Today’s AD October 13 -The American Medical Association opposes assisted

suicide.Here’s the American Medical Association’s statement as it appears on their website:

Physician-assisted suicide occurs when a physician facilitates a patient’s death by providing the necessary means and/or information to enable the patient to perform the life-ending act (eg, the physician provides sleeping pills and information about the lethal dose, while aware that the patient

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may commit suicide). It is understandable, though tragic, that some patients in extreme duress–such as those suffering from a terminal, painful, debilitating illness–may come to decide that death is preferable to life.

However, allowing physicians to participate in assisted suicide would cause more harm than good.

Physician-assisted suicide is fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks. Instead of participating in assisted suicide, physicians must aggressively respond to the needs of patients at the end of life. Patients should not be abandoned once it is determined that cure is impossible. Multidisciplinary interventions should be sought including specialty consultation, hospice care, pastoral support, family counseling, and other modalities. Patients near the end of life must continue to receive emotional support, comfort care, adequate pain control, respect for patient autonomy, and good communication.

Reason #9- No on Assisted Suicide Today’s AD October 12 -Allowing assisted suicide increases teen suicides.

American teens kill themselves at a rate of about one every two hours. About 19% of our teens tell researchers they have experienced depression, and half of those have had suicidal thoughts. Our kids take three times the number of prescription drugs for depression, anxiety and other mental health conditions than do European teens. We have watched them glamorize death in vampire-worship, the Goth culture, and suicide pacts.  We have seen kids hold hands and jump in front of trains, believing they are going on to some twilight fantasy of Bella and Edward.  Gee Mom, I’m only seventeen.

By okaying assisted suicide laws, we are telling our teenagers that suicide is okay and necessary sometimes. Do you really think that’s a good idea?

Reason #8- No on Assisted Suicide Today’s AD October 11 – You don’t need a doctor to commit suicide.

Assisted suicide gets lumped into abortion issues, but the two are very very different. You don’t need a doctor to commit suicide. There are many ways to do it, and it’s not my place to show you how (even though I am a crime writer and know a lot about painless quick poisons and such).

Suicide is an intensely private act. You don’t need to involve anyone else, and society is better off not approving of it.

Reason #7- No on Assisted Suicide Today’s AD October 10 – Skilled hospice caregivers can control physical pain.

Some people are more afraid of physical pain than of actually dying.There is no need for that fear because of modern pain control methods. I watched both my

parents and my sister die from cancers that had spread through their bodies, and they did not feel pain, even in their last days. Morphine and other drugs did the trick, and they were not even that sedated.

One reason hospice nurses can control pain is that they don’t have to worry about addiction and can use higher levels of medications. They know how to look for and take care of blockages and other problems. Please do not be afraid of pain.

Reason #6- No on Assisted Suicide Today’s AD October 9 – The American Nurses Association opposes assisted suicide.

Official Position: “The American Nurses Association (ANA) believes that the nurse should not participate in assisted suicide. Such an act is in violation of the Code for Nurses with Interpretive

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Statements (Code for Nurses) and the ethical traditions of the profession. Nurses, individually and collectively, have an obligation to provide comprehensive and compassionate end-of-life care which includes the promotion of comfort and the relief of pain, and at times, foregoing life-sustaining treatments.”

Today’s Ad #5- No on Assisted Suicide October 8 -All humans have dignity, even the sick and dying.

One old man was taking care of his wife who had Alzheimer’s disease. His friends said, “Why do you put so much into her care? Can’t you see what she has become?” The old man answers, “Maybe, but I remember who she was.”

No matter where you are in your life, you are still human and you have the dignity of being human. Babies are helpless but they have human dignity. People with terrible handicaps, scars, amputations, mental illness — they still have human dignity. No one and no sickness can take your human dignity away from you. You are still someone’s spouse, someone’s parent, someone’s child, someone’s loved one. No matter what happens to you, you are still you. No one can take that from you, no matter what.

Today’s Ad #4- No on Assisted Suicide October 8 – Suicidal people have a diminished capacity to make the decision to end their lives.

If you tell a psychologist that you are suicidal, he or she has the power to put you in a hospital because you are a danger to yourself. Legally, you have diminished capacity and are unable to make important and rational decisions.

If you say a dying person has a good enough reason to kill his/herself, why not a person in a wheelchair? Someone whose family was killed in an accident? Someone who faces financial ruin? Suicidal people need treatment for depression, not help committing suicide.

Today’s Ad #3- No on Assisted Suicide October 7 – Assisted suicide laws put pressure on dying people to end their lives.

One hospice nurse told me that he has seen families fight over estates and money even as their relative lay dying and could listen to them. The attitude was: Please get this over so we can get our inheritance.

Likewise, in the Terri Schiavo case, her ex-husband stood to gain money and freedom to remarry once she died.

On the other hand, it is very hard for most people to stay near someone they love who is dying. If you want to get your pet’s life over, multiple that by thousands when it’s a person you love. You really want it over, but that’s making it about you. The loving attitude is “I want every possible moment with you. Take your time.”

Today’s Ad#2- No on Assisted Suicide October 5 – Assisted suicide laws make doctors accessories of fact to homicide.

“Accessories before the fact” is a legal term. Let’s say you buy someone a gun, knowing that he plans to kill someone with it. You are an accessory before the fact of homicide and could go to jail for doing that. Similarly, when a doctor provides a dying person with poisons, knowing that the person is going to kill himself, he is an accessory before the fact. This is why the other side now wants to call it “compassion and choices” in dying rather than assisted suicide.

Assisted suicide laws are written so as that all doctors get off the hook for helping murder someone. It becomes a legal parsing of morality. Isn’t that what we hate about lawyers?

Today’s Ad #1- No on Assisted Suicide October 4 – Assisted suicide laws create a world without caring or love.

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When we think of people who showed great love and compassion — the Good Samaritans and Mother Teresas of the world –we think of how they stopped and they took the time to help others.

When they saw suffering, they didn’t shoot the person to put him out of his misery. That creates a world without love or caring. Do you want your kids to grow up in a world like that? When people are so sad they want to die, they need love and understanding.

Killing is not compassion. That is Orwellian Newspeak, a language without meaning. If love is death and mercy is killing, then words mean nothing.

All humans know what love is. Love is compassion. Caring is compassion. I’ll walk with you no matter what. I’ll stay with you no matter what. I love you. We both know what that involves.

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