The Leblanc Case: A Recipe for Elder Abuse and a Threat to the Individual

By Margaret Dore

January 26, 2012

"Those who believe that legal assisted
suicide/euthanasia will assure their

autonomy and choice are naive."

William Reichel, MD

Montreal Gazette,

May 30, 2010[1]

A.  Introduction

Leblanc vs. Attorney General of Canada brings a constitutional challenge to Canada's law prohibiting aiding or abetting a suicide.  Leblance also seeks to legalize assisted suicide and euthanasia as a medical treatment.  In 2010, a bill in the Canadian Parliament seeking a similar result was overwhelmingly defeated. 

Legalization of assisted suicide and/or euthanasia under Leblanc will create new paths of elder abuse.  This is contrary to Canadian public policy.  Legalization will also empower the health care system to the detriment of individual patients. 

Not Dead Yet on Final Exit Network & Hospice

http://notdeadyetnewscommentary.blogspot.com/2012/01/georgia-response-letters-to-op-ed-by.html

Georgia:  Response Letters to op-ed by Final Exit Network (FEN) President Wendell Stephenson

On January 7, the Atlanta Journal-Constitution published an op-ed by Wendell Stephenson, current president of the Final Exit Network (FEN).  "Ensuring death with dignity" is no longer freely available at the AJC site, but the same essay was published in December last year in the Metrowest Daily News and can still be read here.

It's the usual conflation of terminal illness with chronic illness, sensationalist language describing FEN members and supporters as victims of oppression, etc.  This blog will probably be revisiting Stephenson's piece in the near future.

In the meantime, his op-ed drew some strong reactions that were published in the letters section of the AJC on January 15.  There were three letters - the first one agreeing with Stephenson and the following letters  disagreeing with him.  The letters can all be found on this page.

The first of the two taking issue with Stephenson and his op-ed was written by Eleanor Smith, a long-time disability rights leader and activist who is the founder of Concrete Change, an international network whose goal is to make all new homes visitable.  Her letter:

Right-to-die argument blurs a key distinction

“Ensuring death with dignity” (Opinion, Jan. 7) blurs the distinction between the freedom to end one’s own life, which cannot be denied, and the freedom to have others end one’s life, which endangers the lives of people less valued by society.

The elderly couple referred to in this column chose to inform their assisted-living facility of their intention to starve themselves to death (which the administration, unsurprisingly, could not support). They could have chosen instead to check out of the institution for a short stay with their children. I suspect organizational (rather than personal) advice led to this public confrontation.

Older and/or disabled people can be expensive to support. It is reprehensible to select them as the population encouraged to die before their time — rather than supporting them to live and making them feel welcome in the world.


Eleanor Smith, Decatur

The next letter was from Jennifer Hale, executive director, the Georgia Hospice and Palliative Care Organization.  Her letter:

Final Exit leader’s essay ‘inherently misleading’

The piece by Wendell Stephenson of the Final Exit Network attempting to link the philosophy of hastened death and assisted suicide — or, as he terms it, “self-deliverance” — with the ideals of dignity at the end of life provided through state-licensed and federally certified hospice care providers is absolutely wrong, inherently misleading and seems mildly predatory from my perspective (“Ensuring death with dignity,” Opinion, Jan. 7).

At the Georgia Hospice and Palliative Care Organization, it is our mission to provide education, information and advocacy to the public and to providers of end-of-life care to raise awareness of the options available to every person and improve on the quality of that care. Nowhere on the Final Exit Network’s website could I find where there was any support for families.

The couple mentioned in this piece made a decision about how they wished to spend the end of their lives. Hospice did not help them make this decision and did not help them carry it out. Hospice helped them return to their family’s residence and provided them with physical and emotional support and ongoing bereavement care for the family.


Jennifer Hale, executive director, the Georgia Hospice and Palliative Care Organization

Hale's letter opens with a strong and harsh assessment of both Stephenson and the Final Exit Network.

It's too bad that her concluding words contain a glaring contradiction of her claim that hospice played no role in helping the couple in question "carry out" their death through starvation and dehydration.  When she says that hospice gave the couple "physical and emotional support," that means they facilitated the process - at least to the extent that they made the couple as comfortable as possible and as free from the more unpleasant sensations of starvation and dehydration as they could manage.  That is a lot of help.  Similarly, I have concerns that "ongoing bereavement care for the family" means helping everyone in the family feel OK with themselves for their own sanction and support of the couple's long suicide through starvation and dehydration.  That, too, is a lot of help.

Maybe Ms. Hale could take a second stab at clarifying what hospice is and is not.  Because this last couple of sentences didn't help me at all.  --Stephen Drake

Ken Stevens MD: "legalizing assisted suicide can result in decreased patient choice"

Assisted Suicide
http://www.sltrib.com/sltrib/opinion/53280042-82/suicide-patients-assisted-oregon.html.csp

Updated Jan 19, 2012 01:01AM

Patty Henetz' "Do Utahns have the right to choose how they die?" (Tribune, Jan. 8) refers to the legalization of assisted suicide in Oregon. Utahns should understand that legalizing assisted suicide can result in decreased patient choice.

I have been a cancer doctor in Oregon for more than 40 years. The combination of assisted-suicide legalization and prioritized medical care based on prognosis has created a danger for my patients on the Oregon Health Plan (Medicaid).

The plan limits medical care and treatment for patients with a 5 percent or less likelihood of surviving five years. Patients in that category who have a good chance of living another three years and who want to live cannot receive surgery, chemotherapy or radiation therapy. However, the plan will cover the patient's suicide.

Oregon law says only patients with no more than six months to live are eligible for voluntary suicide, but the plan nonetheless offers suicide to patients in this category.

The mere presence of legal assisted suicide steers patients toward suicide. One patient was adamant to use the law. I convinced her to be treated. Eleven years later she is thrilled to be alive.

Kenneth Stevens, M.D.

Sherwood, Ore.

Hawaii: Assisted Suicide Not Lawful, Says State

http://www.staradvertiser.com/s?action=login&f=y&id=137466873

A 103-year-old act does not let doctors kill, the attorney general's office tells proponents

By B.J. Reyes

POSTED: 01:30 a.m. HST, Jan 17, 2012

An obscure 1909 law intended to ease suffering of Hansen's disease patients does not make physician-assisted suicide legal in Hawaii, according to an opinion by the state attorney general's office.

The opinion, dated Dec. 8, was in response to an inquiry from state Sen. Josh Green, chairman of the Senate Health Committee, who sought clarification of the law amid reports that supporters of physician-assisted suicide were seeking a patient willing to test the statute.

 

An obscure 1909 law intended to ease suffering of Hansen's disease patients does not make physician-assisted suicide legal in Hawaii, according to an opinion by the state attorney general's office.

 

The opinion, dated Dec. 8, was in response to an inquiry from state Sen. Josh Green, chairman of the Senate Health Committee, who sought clarification of the law amid reports that supporters of physician-assisted suicide were seeking a patient willing to test the statute. Login for more...

Utah: New Website!

Click here to see the website: Utah Against Assisted Suicide:  "Choice" is an Illusion!

Massachusetts voters, reject Petition 11-12

http://www.washingtontimes.com/news/2012/jan/11/massachusetts-voters-reject-petition-1112/

If adopted this November, a ballot initiative in Massachusetts will legalize physician-assisted suicide for patients whose conditions are predicted to produce death within six months. Initiative Petition 11-12 claims to ensure that the patient's decision to commit suicide is voluntary. That claim, however, is misleading.

The initiative petition requires that two persons witness the patient's written request for a lethal prescription. One witness, however, can have a financial interest in the patient's death. That person can be the only witness present when the lethal drug is taken. Thus, an interested heir could pressure the patient, and no one would know because no objective witness is required when the drug is taken. Also, the petition would require the death certificate fraudulently to list the patient's underlying condition, rather than the lethal drug, as the cause of death.

Initiative Petition 11-12 uses terms like life-ending "medication" and death in a "humane and dignified manner." But there is nothing medicinal about poison and nothing dignified about the prospects for the abuse the initiative petition would allow. It is a bad law that the voters of Massachusetts should reject decisively.

STEPHEN L. MIKOCHIK
Professor emeritus
Temple Law School

The Emperor has no Clothes: "VSED"

Euthanasia proponents have a new campaign promoting starvation and dehydration.  VSED: "Voluntarily" stopping eating and drinking.  Below, Kate Kelly provides a real life example:  "I watched her suffer." 

______________________________________________

Mild stroke led to mother's forced starvation

By Kate Kelly

I watched an old woman die of hunger and thirst.  She had Alzheimer's, this old woman, and was child-like, trusting, vulnerable, with a child's delight at treats of chocolate and ice cream, and a child's fear and frustration when tired or ill.

I watched her die for six days and nights.

I watched her suffer, and I listened to the medical practitioners, to a son who legally decided her fate, and to an eldest daughter who advised him and told me that the old woman, my mother, was "comfortable," except when she was "in distress," at which times the nurses medicated her to make her "comfortable" again.

I watched the old woman develop ulcerations inside her mouth as she became more and more dehydrated; the caregivers assured me these were not painful.

Canada: The Danger of Euthanasia: "If euthanasia were legal, the wife, not wanting to die, would still be a victim"

http://www.ottawacitizen.com/opinion/Danger+euthanasia/5935217/story.html

 

By Alex Schadenberg, Ottawa Citizen January 2, 2012
 

Re: Time to rethink euthanasia, Dec. 29.

Marcel Lavoie implies that legalizing euthanasia would stop violent deaths in the elderly, such as the death of Doreen Flann by stabbing.

In many of these deaths, the perpetrator-husband also kills himself for a murder-suicide.

 

In Oregon, where assisted-suicide has been legal since 1997, murdersuicide has not been eliminated. Indeed, murder-suicide follows the national pattern.

Moreover, according to Donna Cohen, an expert on murder-suicide, the typical case involves a depressed, controlling husband who shoots his ill wife: "The wife does not want to die and is often shot in her sleep. If she was awake at the time, there are usually signs that she tried to defend herself."

If euthanasia were legal, the wife, not wanting to die, would still be a victim.

Our laws against assisted suicide and euthanasia are in place to protect vulnerable people. Assisted suicide and/or euthanasia should not be legalized in Canada.

[For more indepth information, see Dominique Bourget, MD, Pierre Gagne, MD, Laurie Whitehouse, PhD, "Domestic Homicide and Homicide-Suicide:  The Older Offender," Journal of the American Academy of Psychiatry and the Law, September 2010 (Canadian study);  Don Colburn, "Recent murder-suicides follow the national pattern," The Oregonian, November 17, 2009; and “Murder-suicides in Elderly Rise: Husbands commit most murder-suicides – without wives’ consent” ]

Alex Schadenberg,

London Ont., Canada
Executive Director,

Euthanasia Prevention Coalition

Canada: No Right to be Killed by Others

http://www.nationalpost.com/todays-paper/right+killed+others/5931282/story.html

Re: Poll: 67% Support Assisted Suicide, Dec. 30.

I am greatly perplexed when I hear euthanasia proponents talk about a "basic human right to die," when there is no such thing. We are all going to die anyway, so let's please be honest and call it what it is: The right to be killed by somebody else. I am deeply disturbed by people who overlook the failure of the euthanasia experiments in other countries. Why do they coldly dismiss all those hundreds of people who have been euthanized without their consent? Do they consider them collateral damage? Would they call for an absolute right to drive for everybody, even if they knew lots of innocent people would be killed by incompetent drivers? I don't think so.

Canada rightly forbade capital punishment, due to the fact that no system can guarantee that no one will be killed by mistake. We have the freedom to make choices, but those choices should not hinder the safety of others, especially our most vulnerable.

Rene Leiva, physician, Ottawa.

Canada: "Justice Smith seemed skepical of Mr. Arvay's argument"

This Report is from the Farewell Foundation for the Carter Case, December 16, 2011:

 

Zero-Tolerance for Wrongful Death

 

Joe Arvay submitted that Canada's closing argument amounts to a "zero-tolerance" policy because it says Parliament can't enact a law that "might create even the 'risk' that one person might die who should not have died."  Arvay said Canada's counsel is "simply wrong" and clarified that Parliament could "leave the matter unregulated as a private matter between the physician and patient," but he hoped government would create some sort of law to regulate assisted death.

 

Justice Smith pointed out that Canada did not have capital punishment because of the risk that one wrongful death of an innocent person is too many.  "What do you say to that?"

 

Mr. Arvay answered "Let us put to rest once and for all the complete red herring of capital punishment.. Canada says capital punishment was abolished 'precisely because even the best justice system in the world makes mistakes that, if capital punishment were an option, would result in the death of innocent individuals.' . It need hardly be mentioned that we can assume that everyone on death row wants to live and is being killed involuntarily.  Involuntary death is not only not sought in this case, it is the polar opposite of what is sought in this case - the right to control one's own life and death."

 

Justice Smith seemed skeptical at Mr. Arvay's argument.  She pointed out that some voluntary deaths may involve people who do not really mean to die. In answer, Arvay said that the risks had to be reconciled somehow, that we don't live in a totally risk free world and that the Court should look at the risks that are already inherent in the medical system every day.  Arvay said that if Justice Smith chose to strike the law, the federal parliament had the option of crafting the best law humanely possible.

 

To view the entire report, go here: 

http://farewellfoundation.ca/wordpress/?p=356 

Hawaii: Attorney General Opinion Attached

Per Jim Hochberg, Hawaii State Senator Joshua Green, MD, has authorized release of the Attorney General's opinion rejecting C & C's claim that assisted suicide is "already legal" in Hawaii.  The opinion states in part:

"Dear Senator Green:

Re: Hawaii law on assistance with dying

You have asked (1) whether §453-1, Hawaii Revised Statutes (HRS), authorizes a physician to assist a terminally ill patient with dying when requested by or on behalf of the patient, and (2) whether any criminal laws prohibit aid in dying.

We are assuming that a physician’s assistance with dying would consist of prescribing a lethal dose of medication that a terminally ill patient could take to bring on a swifter and possibly more peaceful death than would otherwise ensue. Our analysis addresses only this method of assistance. Briefly, (1) we do not believe that §453-1 provides authority for a physician to assist with dying, and (2) a physician who provided such assistance could be charged under Hawaii’s manslaughter statute. . . ."

To view the entire opinion, click here.

Hawaii: Attorney General Rejects C & C Claim that Assisted Suicide is "Already Legal"

The Attorney General of Hawaii has issued a formal opinion rejecting Compassion & Choices' claim that physician-assisted suicide, termed "aid in dying," is legal in Hawaii.

A press release issued by the Alliance Defense Fund describes that Senator Josh Green, MD had requested the opinion from Attorney General David Louie.[1]  The press release states:

"[T]he attorney general's legal opinion states that state law "does not authorize physicians to assist terminally ill patients with dying" and "a physician who provided assistance with death could be charged under Hawaii's manslaughter statute."

The press release also quotes Honolulu attorney Jim Hochberg:  "[N]o one should believe the recent falsehoods that pro-death proponents have spread about [Hawaii] law."

* * * 

[1]  To view the ADF Press Release, click here 

Press Release: Mass Against Assisted Suicide

FOR IMMEDIATE RELEASE 

Massachusetts Assisted Suicide Initiative a Recipe for Elder Abuse

Choice is an Illusion, a nonprofit corporation opposed to assisted suicide, has launched a new website agianst the Massachusetts "death with dignity" initiative.  The website's name is "Mass Against Assisted Suicide." 

Margaret Dore, President of Choice is an Illusion and an elder law attorney, states: "The initiative's introduction declares that the process will be 'entirely voluntary' for the patient.  The act, as written, does not deliver on this promise.  The act is instead a recipe for elder abuse."

The proposed act has an application process to obtain a lethal dose for the purpose of causing the patient's death.  The act allows the patient's heir, who will benefit financially from the death, to actively help the patient sign up for the lethal dose.  Dore states:  "The act allows an heir to participate as one of two witnesses on the lethal dose request form.  The act also allows someone else to speak for the patient." 

"This does not meet the stink test," said Dore. "Signing away your life under the proposed act has less protection than signing a will."

Dore explained that when signing a will, similar conduct can create a presumption of fraud and undue influence.

Dore also pointed out that there is no oversight once the lethal dose of has been filled under the proposed act.

"The death is not required to be witnessed by disinterested persons," Dore said.  "Indeed, no one is required to be present." 

"Without disinterested witnesses, the opportunity is created for an heir, or someone else who will benefit from the death, to administer the lethal dose to the patient without his consent.  Who would know?"

This year in New Hampshire, a similar "death with dignity" act was defeated in the House of Representatives by a vote of 234 to 99. 

Former New Hampshire State Representative Nancy Elliott said: "Assisted suicide laws empower heirs and others to pressure and abuse older people to cut short their lives.  This is especially an issue when the older person has money.  There is no assisted suicide bill that you can write to correct this huge problem."

* * *

To view the new website, go here:  http://www.massagainstassistedsuicide.org  To learn more about "Choice" is an Illusion, visit:  www.choiceillusion.org  To learn about the New Hampshire bill that failed, go here:  http://www.choiceillusionnewhampshire.org/2011/05/new-hampshire-defeats-assisted-suicide.html

* * *

Margaret Dore is President of Choice is an Illusion and an elder law attorney. Contact her at 206-389-1754 or margaretdore@margaretdore.com.  See also http://www.margaretdore.org/  Contact Former New Hampshire State RepresentativeNancy Elliott at mmknhrep@gmail.com