New Zealand End of Life Choice Act Will Allow Non-Voluntary Death

By Margaret Dore, Esq., MBA* 

Justice Mallon

On June 16, 2020, Justice Jillian Mallon issued a judgment describing the End of Life Choice Act as limited to voluntary euthanasia and/or physician-assisted suicide. (Judgment, page 1). 

The Act, however, also allows non-voluntary death. One reason is that assisted dying (euthanasia and assisted suicide) is described as being performed by a "medical practitioner." 

In practice, medical practitioners are allowed to provide medical treatment on a non-voluntary basis. For a common example, consider automobile accidents. Medical practitioners are allowed to treat accident victims on a non-voluntary basis if circumstances are determined to warrant such action. If the patient is unconscious and unable to give consent, medical treatment determined necessary by medical practitioners is nonetheless allowed to go forward.

Australia: If Assisted Dying Is a Right, Must It Be Made Available to Everyone?

Queensland Parliament

By Margaret Dore, Esq.

A Queensland Australia Parliamentary Committee has made recommendations concerning voluntary assisted dying or VAD, meaning euthanasia and assisted suicide.[1]

Of special interest is the Committee's Recommendation 17, referring to "rights" of the patients to access VAD. The recommendation states:

The committee recommends that any voluntary assisted dying scheme in Queensland provides health practitioners who may have a conscientious objection to participating in voluntary assisted dying to opt not to participate, provided that the rights of the patients to access the scheme are also protected.  (Emphasis added).[2]

A suggestion that Bishop Tutu confuses assisted suicide with “switching off life support.” If so, perhaps we are to blame.

By Margaret Dore, Esq., MBA*

www.margaretdore.com

www.choiceillusion.org

An assisted suicide bill is coming up for a vote in the UK House of Lords.  The bill, HL Bill 6, is based on similar laws in Oregon and Washington State, USA.

Assisted Suicide and HL Bill 6

HL Bill 6, like the Oregon and Washington laws on which it is based, applies to patients who have been given 6 months or less to live.  Such patients may, in fact, have years to live.  One reason is that doctors’ predictions of life expectancy can be wrong.  See Margaret Dore, “Falconer Assisted Suicide Bill: ‘Eligible’ Patients May Have Years, Even Decades, to Live,” Choice is an Illusion, July 12, 2014.

Bishop Tutu’s Remarks

I don't know Bishop Tutu, but I have seen him speak and I admire him very much.  He has now, however, voiced his support for “assisted dying”, with reference to the death of Nelson Mandela.

According to a New Zealand blog post, Bishop Tutu may be confusing the withdrawal of life support with assisted suicide.  The post says in part:

Interesting that Bishop Tutu now admits publicly that Mandela was indeed on life support and that “prolonging his life was an affront to his dignity”, according to an article on BBC.com.

Switching off life support is, regardless, different from euthanasia and assisted suicide.  When life support is switched off the patient doesn't necessarily die. Consider, for example, this case from Washington State reported in the Seattle Weekly:

[I]nstead of dying as expected, the man slowly began to get better. [Dr. J. Randall Curtis] doesn't know exactly why, but guesses that for that patient, "being off the ventilator was probably better than being on it.  He was more comfortable, less stressed." Curtis says the man lived for at least a year afterwards. 

With assisted suicide and euthanasia, the patient deliberately kills himself or is killed by another person.  See e.g., AMA Code of Medical Ethics, Opinion 2.21 (defining euthanasia).  Moreover, that patient could have had years to live.

The Blame is on us

Perhaps the blame for the confusion should be placed on us and the language of the debate in which both sides have been referring to assisted suicide and euthanasia as “assisted dying.”  Perhaps it’s time for those of us who oppose legalization to call a spade a spade and eliminate the misleading term, “assisted dying” from our vocabulary. Our very lives may depend on it.

*  Margaret Dore is an attorney in Washington State USA where assisted suicide is legal.  She is also President of Choice is an Illusion, a human rights organization opposed to assisted suicide and euthanasia. Her publications include Margaret K. Dore, "''Death with Dignity': What Do We Advise Our Clients?," King County Bar Association, Bar Bulletin, May 2009 (regarding Washington's law).  See also Margaret Dore, Quick Facts About Assisted Suicide, at http://www.choiceillusion.org/2013/11/quick-facts-about-assisted-suicide_11.html

Oregon's New Statistics

By Margaret Dore, Esq.

Oregon's assisted suicide statistics are out for 2012.[1]

This annual report is similar to prior years.  The preamble implies that the deaths were voluntary (self-administered), but the information reported does not address that subject.[2]

Oregon's assisted suicide law allows the lethal dose to be administered without oversight.[3]  This creates the opportunity for an heir, or someone else who will benefit from the patient's death, to administer the lethal dose to the patient without his consent, for example, when the patient is asleep.  Who would know?

The new Oregon report provides the following demographics:  

"Of the 77 DWDA deaths during 2012, most (67.5%) were aged 65 years or older; the median age was 69 years.  As in previous years, most were white (97.4%), [and] well-educated (42.9% had at least a baccalaureate degree) . . . ."[4]  Most (51.4%) had private health insurance.[5]

Typically persons with these attributes are seniors with money, which would be the middle class and above, a group disproportionately victims of financial abuse and exploitation.[6]

As set forth above, Oregon's law is written so as to allow the lethal dose to be administered to patients without their consent and without anyone knowing how they died.  The law thus provides the opportunity for the perfect crime.  Per the new report, the persons dying (or killed) under that law are  disproportionately seniors with money, a group disproportionately victimized by financial abuse and exploitation.

Oregon's new report is consistent with elder abuse.

Footnotes:

[1]  The new report can be viewed here: http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year15.pdf and http://choiceisanillusion.files.wordpress.com/2013/01/year-15-2012.pdf
[2]  Id.
[3]  Oregon's law can be viewed here:  http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Pages/ors.aspx
[4]  Report cited at note 1.
[5]  Id.
[6]  See "Broken Trust:  Elders, Family, and Finances," a Study on Elder Financial Abuse Prevention, by the MetLife Mature Market Institute, the National Committee for the Prevention of Elder Abuse, and the Center for Gerontology at Virginia Polytechnic Institute, March 2009.

UK govt agrees to investigate "death pathway"

Article below regarding abuse of the Liverpool Pathway, from Michael Cook of Bio Edge.

A problem also in the US and Canada.  See, for example, Kate Kelly's article about her mother and "VSED" by clicking here

With some doctors abusing the power they already have with the Liverpool Pathway, etc., why would you give them more power to effect patient death, i.e., by legalizing assisted suicide and/or euthanasia?

The problem will only get worse.

* * *

http://www.bioedge.org/index.php/bioethics/bioethics_article/10293
by Michael Cook | Oct 27, 2012 |

Pressure from the British media has forced an investigation into the controversial Liverpool Care Pathway by National Health Service and the Association of Palliative Medicine.

The medical establishment appears very reluctant to question the LCP. Only a few days ago 22 organisations signed a consensus statement supporting it. It quoted the Parliamentary Under Secretary of State for Health, Earl Howe:

"The Liverpool Care Pathway has sometimes been accused of being a way of withholding treatment, including hydration and nutrition. That is not the case. It is used to prevent dying patients from having the distress of receiving treatment or tests that are not beneficial and that may in fact cause harm rather than good."

But the campaign by the Daily Mail and the Telegraph has been relentless. "When well over 100,000 are dying on the LCP each year, the suspicion inevitably arises that the pathway is being used to hasten death and free up beds," said the Daily Mail in an editorial.

Neurologist Patrick Pullicino contends that the LCP has made euthanasia a "standard way of dying on the NHS". He and his supporters were scathing about the consensus statement: 

"It is self-evident that stopping fluids whilst giving narcotics and sedatives hastens death... The median time to death on the Liverpool Care Pathway is now 29 hours. Statistics show that even patients with terminal cancer and a poor prognosis may survive months or more if not put on the LCP."

The investigation coordinated by the NHS will examine poor experiences under the LCP, which everyone acknowledges do happen. The NHS will talk to family members of people who have died on the pathway, investigate complaints and speak with clinicians. "Poor experiences must be explored, acknowledged and learnt from," says Professor Mayur Lakhani, Chair of the Dying Matters Coalition.

Will the investigation result in a thorough revision of the LCP? Even though the medical establishment admits that there are problems, it may not admit that they are due to the basic framework. The Consultant Nurses in Palliative Care Reference Group is already interpreting criticisms as dangerous and offensive. "Counter-productive comments", it says, are "deeply offensive to public servants who abide by clear codes of conduct and the law".

What about the seriously ill or disabled people who want to live?

http://doughtyblog.dailymail.co.uk/2012/10/what-about-the-seriously-ill-or-disabled-people-who-want-to-live.html

The "Liverpool Pathway":  "It comes down to this: there are a lot of people who believe that, rather than trying to help their loved ones, hospitals have been keen to kill them off."

What about the seriously ill or disabled people who want to live?

By Stephen Doughty, 12 October 2012 6:56 PM

We have heard an awful lot about the suffering of people who bear terrible afflictions or disabilities and who wish to die. We have heard very little about the desperately sick who want to live, and the families who stand by them in hope.

It is looking like we have got this the wrong way round.

The highly organised campaign for assisted dying has brought together pressure groups, think tanks, celebrities like Sir Terry Pratchett, and some fairly prominent politicians, notably in recent years Tony Blair’s Lord Chancellor and one-time flatmate, Lord Falconer.

It has been based around a brilliantly conceived series of legal cases in which the judiciary have been presented with deeply affecting hard cases. Each one has asked for a modest legal concession, usually involving human rights and the 1961 law that makes helping with a suicide a serious crime.

The individuals who have brought these cases are sometimes merely sympathetic and at others pitiable, as in the recent instance of Tony Nicklinson, the 58-year-old victim of 'locked-in syndrome' who lost his call for help from his doctor to die in the High Court in August. Mr Nicklinson died a few days after his legal defeat.

Occasionally the legal campaigns have scored successes. The most notable was that of multiple sclerosis sufferer Debbie Purdy, who persuaded the Law Lords that the Director of Public Prosecutions should provide guidance on whether her husband might face prosecution for assisted suicide, were he to help her travel to the Dignitas clinic in Zurich to die.

As a result of the Purdy case, DPP Keir Starmer QC introduced rules on assisted dying prosecutions that mean no-one is likely to be prosecuted, with the risk of a 14-year-jail term, if they help in the death of someone who is a suffering relative or friend, and if they act out of compassion rather than malice or greed.

However you paint it, this is a major change in the law as set down by Parliament, a law which takes no account of the motives of the individual aiding and abetting the suicide.

Indeed, Mr Starmer has brought no prosecutions against anybody from the trail of stricken families who have helped members travel to Switzerland to die.

What is interesting is that, despite all the campaigning, all the high-profile court cases, all the BBC interviews, all the endless hand-wringing about the cruelty of keeping those who are suffering alive against their will, few people seem to want to take advantage of the new right to die.

We do not have very recent figures, but I would guess that no more than 200 British people have died at Dignitas since the clinic became well-known here in 2003.

It is a number small enough to raise the question of how big, really, is the demand for assisted dying?

The campaign for assisted dying has certainly been effective in influencing care of the incapacitated in the Health Service.

It was surely a factor in the successful passage of the Mental Capacity Act, pushed through by Lord Falconer in the teeth of a rebellion by backbench Labour MPs, which gave legal status to living wills. These mean people can leave orders for their doctors to kill them by withdrawing nourishment and fluid by tube if they become too sick to speak for themselves.

The assisted dying campaign formed the background to the introduction of the Liverpool Care Pathway into hospitals across the country. This, for those who have not noticed, is the system by which medical staff withdraw treatment from those judged to be close to death, in the cause of easing their passing. It often involves heavy sedation and the removal of nourishment and fluid tubes.

I do not wish to try to step into the shoes of those medical professionals and care workers who deal every day with people at the extreme end of life and in the depths of the worst illnesses. I have no qualifications or knowledge to second guess their decisions, and no intention of criticising those who work with great professionalism and compassion in jobs that are far beyond my capability.

But all the indications suggest there are many families who are unhappy with the way in which their relatives have died in hospitals, and that they are increasingly willing to complain about it.

Many of these people may be speaking out of misdirected grief. As one well-informed MP put it to me this week, very few expect a loved one who goes into hospital to die, but people do have the habit of dying. Some of those complaining may be troublemakers, some inspired by political or religious agendas.

Nevertheless there seem to be a lot of them. And they are not celebrities or legal grandees or Westminster faces. They are little people, people like you and me, not the kind you usually hear on the radio or see on the TV.

The courageous Professor Patrick Pullicino, the hospital consultant who defied the NHS consensus to speak out against the Liverpool Care Pathway this summer, reckoned it is used in around 130,000 deaths each year. That is a number that dwarfs the assisted dying lobby.

I think we are going to hear a lot more about the Liverpool Care Pathway, and I think the medical professions, the Department of Health, and a number of politicians are going to have to put some time into considering what has been happening.

It comes down to this: there are a lot of people who believe that, rather than trying to help their loved ones, hospitals have been keen to kill them off.

They believe that, while the assisted dying lobby has been parading in the courts and publicising itself on the BBC, assisted dying has quietly become a reality in our hospitals.