Judge dismisses appeal; Montana group pleased that court addressed Baxter

Helena Montana - On December 13, 2013, District Court Judge Mike Menehan dismissed MAAS's appeal with the Montana Medical Examiners Board. The order ruled that the appeal was moot due to the Board's having recently rescinded "Position Statement No. 20."  (Order, pp. 5-8).  The order also refers to Montana's assisted suicide case, Baxter v. State, as providing a defense to a homicide charge, as follows:

On December 31, 2009, the Montana Supreme Court issued its opinion in Baxter v. State, 2009 MT 449, 354 Mont. 234, 224 P.3d 1211, in which it held that under section 45-2-211 MCA, a terminally ill patient's consent to physician aid in dying constitutes a statutory defense to a physician charged with the criminal offense of homicide.  (Order, page 2, lines 17-21).

This part of the order is consistent with Greg Jackson's and Matt Bowman's article, Baxter Case Analysis, Spring 2010 ("the Court's narrow decision didn't even "legalize" assisted suicide"). Available at http://www.montanansagainstassistedsuicide.org/p/baxter-case-analysis.html

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

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

* * *

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

Montana Judge Hears Assisted Suicide Arguments

http://www.kxlf.com/news/montana-judge-hears-assisted-suicide-arguments/

Posted: Dec 11, 2013 4:38 PM by Sanjay Talwani - MTN News

HELENA - The issue of physician assisted suicide was in court Tuesday [December 10, 2013]

Judge Michael Menehan

Montanans Against Assisted Suicide is arguing that a policy position by the Montana Board of Medical Examiners implies that physician assisted suicide may be legal. 

A lawyer for the Board says that the position - since rescinded, says no such thing. Michael Fanning says the group bringing the lawsuit has no real case is trying to force the issue to the Montana Supreme Court.

The position paper, written in response to doctor inquiries, said that the board would handle complaints related to assisted suicide on a case-by-case basis as it would other cases.

Margaret Dore
Attorney for Montanans
Against Assisted Suicide (MAAS)

Margaret Dore, an attorney for MAAS, said the paper overstepped the Board's authority and implied to many that assisted suicide was legal in Montana.

"They are a board that is comprised of 11 doctors and two members of the public," she said. "It has no expertise to be making a pronouncement, that aid in dying is legal in Montana. That's the role of the legislature or a court and they are neither."

She said that such an understanding had huge implications in devaluing the lives of the sick and elderly.

That position paper - in response to the lawsuit - has since been rescinded by the Board and scrubbed from its website. But Dore said court action was still needed to prevent the Board from reinstating such a position.

She repeatedly asked District Judge Mike Menahan to weigh in on a Montana Supreme Court ruling known as Baxter, that envisions potential defenses to doctors charged with homicide for assisting with suicide.

But Menehan said it wasn't the role of a district judge to rule on a Montana Supreme Court order.

Craig Charlton

Attorney for MAAS

Michael Fanning, an attorney for the Board, said MAAS had no standing to bring the lawsuit, has suffered no damages from the Board's rescinded position and was simply jockeying to get the case before the Montana Supreme Court in hopes of overturning the Baxter ruling.

"This most certainly is a political question, a philosophical question or an academic debate, but it is not a lawsuit," he said. "In fact, this is a feigned case. It was contrived simply to bring this matter before you."

Menahan did not immediately rule on the case.

[Montanans Against Assisted Suicide is also represented by attorney Craig Charlton].

Quick Facts About Assisted Suicide

By Margaret Dore, Esq.*
October 7, 2013  

1.  Assisted Suicide

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

2. The Oregon and Washington Laws

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

3.  Throwing Away Your Life

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

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


4.  A Recipe for Elder Abuse

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

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


5. Empowering the Healthcare System

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

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

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

6.  Increased Suicide in Oregon

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

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

7.  Proposed Expansion in Washington State

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

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

Don't make our mistake.

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

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

Dr. Kenneth Stevens and Jeanette Hall in Quebec!

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

Physician-assisted suicide encourages people with years to live to throw away their lives: an Oregon cancer doctor and his patient tell their story and warn Quebecers

MONTREAL, Oct. 25, 2013 /CNW Telbec/ - The Coalition of Physicians for Social Justice presented a doctor and his patient from Oregon where assisted suicide is legal. 

Dr. Kenneth Stevens is a practicing cancer doctor with more than 40 years' experience. He is also a Professor Emeritus and a former Chair of the Department of Radiation Oncology, Oregon Health & Sciences University,Portland, Oregon. He has treated thousands of patients with cancer. 

Jeanette Hall, Dr. Stevens' patient, is thrilled to be alive 13 years after he talked her out of "doing" Oregon's law, i.e., killing herself with a lethal dose of barbiturates. 

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

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

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

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

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

SOURCE Coalition of Physicians for Social Justice

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

EUTHANASIA PREVENTION COALITION APPLAUDS RULING OF BC APPEAL COURT ON ASSISTED SUICIDE

Media Release - Toronto, Thursday October 10, 2013 /CNW/

The BC Court of Appeal has struck down the decision by Justice Smith and upheld the current laws which protect Canadians from euthanasia and assisted suicide.

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

EPC legal counsel Hugh Scher states:

EPC is concerned about the safety, security and equality of people with disabilities and seniors, which is central to the protections set out under the Charter of Rights and Freedoms and our Criminal Code. 

EPC-BC chair Dr. William Johnston states:

The debate is over whether what the suicidal person proposes – to kill themselves – is a goal which should be shared and facilitated by the state. I suggest there are alternate goals like the treatment of depression and other symptoms, to which the state should apply itself. When someone has lost hope for the future, finds no meaning in their life, and sees only one solution – death – we recognize a suicidal depression. That bleak tunnel vision should evoke suicide prevention, not euthanasia.

Disability rights advocate Amy Hasbrouck of Toujours Vivant - Not Dead Yet states:

People with disabilities, chronic illness and seniors are negatively affected by assisted suicide and euthanasia because it leads to the impression that our lives are lacking in meaning and value as compared to other Canadians.

EPC Executive Director, Alex Schadenberg states:

The evidence is clear that in jurisdictions where these practices have been legalized, there have been significant abuses of vulnerable people. For example, studies in Belgium demonstrate that 32% of people killed under the Belgian law were killed without consent and without their own request, in breach of a fundamental condition of that law. 

Not one of these doctors has been prosecuted.

In the event today's ruling is appealed to the Supreme Court of Canada, EPC will seek to intervene with a view to protecting the dignity and equality of all Canadians, particularly those who are most vulnerable to the risks of abuse from assisted suicide.

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

For further information, please contact:

Dr. William Johnston, (Vancouver) EPC-BC Chair: (604) 220-2042 –willjohnston@shaw.ca

Alex Schadenberg, (London) EPC Executive Director: (519) 851-1434 – info@epcc.ca

Amy Hasbrouck, (Montreal) Tourjours Vivant - Not Dead Yet: (450) 921-3057 – info@tv-ndy.ca

Cherelle Samuel: They Drugged My Grandmother and Fed Us Lies

Edited by Margaret Dore, click here to view original

From beginning to end my grandma was a fighter who was battling stage IV stomach cancer and was given 6 months to live back in January she outlived their time table, but the story doesn't end with a closed book.

I moved in with her in March this year and was with her every step of the way so my final decision came from what I thought was from the heart.  We had a few good months where we would go out and she would go to gamble. She always kept a smile on her face up until the last few days we had with her.

A Chilling Prospect for Disabled People

http://www.notdeadyet.org/2013/09/op-ed-assisted-suicide-a-chilling-prospect-for-disabled-people-by-tanni-grey-thompson.html

By Tanni Grey-Thompson

As posted by Not Dead Yet

        Stephen Hawking has expressed the view, in the course of a BBC interview, that people “who have a terminal illness and are in great pain should have the right to choose to end their own life”. They do, of course, have that right now:       ending your own life isn’t a criminal offence. What Professor Hawking means, presumably, is that the law should be changed to legalise what is being euphemistically called ‘assisted dying’ – or, to put it another way, that doctors should   be licensed to supply lethal drugs to terminally ill people to help them commit suicide.

There is, in fact, a Private Member’s bill, in the name of Lord Falconer, before the House of Lords at this moment proposing just that. Professor Hawking believes that “there must be safeguards that the person concerned genuinely wants to end their life and they are not being pressurised into it”. This is a fair enough caution to sound. What is remarkable, however, is that Lord Falconer’s ‘assisted dying’ bill does not contain any specific safeguards to ensure that these and other conditions are met.

Professor Hawking states that “human beings should not be allowed to suffer any more than animals”. This is a well-worn argument of the euthanasia lobby – that we put down suffering animals out of kindness, so why don’t we do the same for humans? But what those who use this argument seem to overlook is that people don’t always take their pets to be put down out of compassion: they sometimes do so because they are a nuisance or because they are proving expensive to treat or to feed. Is that the sort of society we want to see?

Those of us with disabilities are all too familiar with the view that many in society take of us – that they wouldn’t want to live with our limitations and that our lives are less worth living than the lives of others. I myself have encountered such attitudes: I have been told that ‘people like me’ do ‘a good job’, I have had it put to me by a medic that I should not have children and I have even been patted on the head by a colleague. The Paralympics, in which I have had the opportunity to participate, is sadly an all too rare occasion in which people with disabilities are valued.

Legalising ‘assisted dying’ for terminally ill people illness reinforces prejudices about people with disabilities. Terminal illness and physical disability aren’t, of course, the same thing – many people with disabilities aren’t terminally ill. But terminal illness can often bring with it disability of one kind or another and it’s not a big step in popular perceptions to see the two as in some way linked.

That’s why the majority of people with disabilities, including me, are afraid of a law that would offer a lesser standard of protection to seriously ill people than to others. Anyone who is inclined to discount such fears should read the report of Lord Falconer’s self-styled ‘commission on assisted dying’: it is on the recommendations of this unofficial and self-appointed group that his Private Member’s bill rests. Their report recommends that physician-assisted suicide should not be offered to people with disabilities who are not terminally ill “at this point in time“. It is those italicised words that send a chill down the spine of many people with physical disabilities. Lord Falconer’s ‘assisted dying’ bill may be well-intended. But it risks becoming a law to cater for the strong rather than to protect the weak.

POLST: What is it and why should you oppose it?

By Julie Grimstad

The POLST (Physician Orders for Life-Sustaining Treatment) form is a standard document that, when signed by a designated healthcare professional, dictates whether to withhold or administer certain forms of medical treatment and/or care. POLST is known by different acronyms in various states (MOST, MOLST, POST, etc.). 

A brightly colored form that is very visible in a patient's medical chart, POLST has boxes to check off indicating that a patient does or does not want cardiopulmonary resuscitation (CPR), antibiotics, nutrition and hydration, etc. Trained "facilitators"—usually not physicians—discuss treatment options with patients. After filling out the form with a patient, the facilitator presents it to be signed by a designated healthcare professional—someone who may never have seen or talked to the patient. The completed POLST form is not simply an expression of a patient’s treatment preferences; it is a set of physician's orders which must be followed.

POLST medical orders travel with the patient from one healthcare setting to the next and even home to be followed by EMT's in the event of a medical emergency. The first order in many POLST-type forms is "FIRST follow these orders, THEN contact Physician, Advanced Practice Nurse, or Physician Assistant for further orders if indicated."[i]

POLST is tilted toward non-treatment and can encourage premature withdrawal of treatment from patients who, but for the denial of treatment, would not die. Facilitators present options for treatment as if they are morally neutral, even though certain decisions may lead to euthanasia by omission. Groups that promote euthanasia and assisted suicide, such as Compassion & Choices (formed by the merger of Compassion in Dying—a Hemlock Society spin-off—and End of Life Choices), strongly endorse POLST. This is a big RED FLAG.

Judge upholds count of assisted suicide

http://www.philly.com/philly/health/20130802_Judge_upholds_count_of_assisted_suicide.html#hLRSrC4PBjvmaCti.99

POTTSVILLE, Pa. - A judge on Thursday upheld charges against a Philadelphia woman accused of helping her 93-year-old father commit suicide through a morphine overdose at his home here, where he was in hospice.

Prosecutors in Schuylkill County charged Barbara Mancini, 57, with aiding suicide. The judge refused to drop the charges after a preliminary hearing.

Pottsville police say Mancini handed Joseph Yourshaw a bottle of liquid morphine at his home in February, leading to his death four days later. The death certificate, which listed the immediate cause as "morphine toxicity" that complicated high blood pressure and heart disease, was issued in June.

Mancini, who was trained as a nurse, remains free on bail. Her lawyer could not be reached for comment Thursday evening. The local district attorney's office asked the state to prosecute the case due to a conflict of interest.

An end-of-life advocacy group called for the charges to be dropped, saying the U.S. Supreme Court allows dying patients to receive adequate pain relief, even if it hastens their death. "Attorney General [Kathleen] Kane should leave Barbara and her family alone so they can grieve over their loss," Barbara Coombs Lee, president of Denver-based Compassion and Choices, said in a statement.*

*Compassion & Choices is the former Hemlock Society.  To learn more about C & C, read:  and Theresa Schrempp, Esq.,  "Compassion & Choices is a Successor to the Hemlock Society" and Senator Jennifer Fielder on Compassion & Choices: "Beware of Vultures." 

Or, go to these links:  http://www.montanansagainstassistedsuicide.org/2012/12/compassion-choices-is-successor.html and http://www.montanansagainstassistedsuicide.org/2013/06/beware-of-vultures-senator-jennifer.html 

Texas Women Underwent Chemo After False Diagnosis

http://news.yahoo.com/texas-woman-underwent-chemo-after-false-diagnosis-132745549.html

William Holt 5 hours ago Health

A woman from Victoria, Texas, underwent several rounds of chemotherapy, only to find out that she never had cancer to begin with, reports CBS’s Houston affiliate, KHOU.

Herlinda Garcia, 54, was diagnosed with stage 4 terminal breast cancer after she had a benign tumor removed from her left breast. Through the next seven months and eight rounds of chemotherapy, she felt her body and mind deteriorating.

“Everything was swollen,” Garcia told KHOU. “I lost my eyebrows, my eyelashes. It’s really hard. I can’t explain how I felt. It’s like I was in a dream.”

Certain that her life was coming to an end, the part-time civil process worker gave away most of her belongings and wrote a bucket list.

"I just wanted to give up on everything," Garcia said.

But when she decided to seek help for her growing anxiety at Citizens Medical Center, a series of scans revealed a new reality: Garcia never had cancer.

At MD Anderson Cancer Center in Houston, a second opinion confirmed what doctors at Citizens Medical Center had discovered.

“I was happy, but at the same time, I had anger,” Garcia said. “The damage had been done.”

For her pain and suffering, a Victoria County jury awarded Garcia $367,000. Garcia said she hopes her experience will lead others to always seek a second opinion.

“I know I’m never going to feel the same because of what I went through,” she said. “It changed my life.”

The "Liverpool Care Pathway," Hospice and Palliative Care Abuse

The "Liverpool Care Pathway" (LCP)  is a system of hospice/palliative care in the UK.  In the last few years, the system has come under fire as "stealth euthanasia" in which patients are put on the LCP "without consent" and without "being allowed, food, fluids and medication."  See the BBC article set forth below: “Liverpool Care Pathway: Your experiences.”

I periodically receive similar complaints from people in the US and Canada.  Consider, for example, this letter by an elder care facility owner in Washington State where assisted suicide is legal:

"Since the [assisted suicide] act passed, we have . . . noticed that some members of the medical profession are quick to bring out the morphine to begin comfort care without considering treatment.  Sometimes they do this on their own without telling the client and/or the family member in charge of the client's care." 

http://www.montanansagainstassistedsuicide.org/2012/07/dear-montana-board-of-medical-examiners.html

Consider also, this letter published in a Montana newspaper:

“If these terrible deaths happen when aid in dying (assisted suicide and euthanasia) is not legal, what will happen if these practices are made legal? Doctors will have even more power to take away patient choice."

http://www.montanansagainstassistedsuicide.org/2013/04/dont-give-doctors-more-power-to-abuse.html

Margaret Dore, Attorney at Law
President, Choice is an Illusion, a nonprofit corporation

___


"Liverpool Care Pathway: Your Experiences"

http://www.bbc.co.uk/news/health-23301360

The LCP was developed to support dying patients

 

The Liverpool Care Pathway (LCP) should be phased out, an independent review is expected to say.

The system was designed to allow terminally-ill patients to die peacefully and with dignity.

However, the LCP has come under criticism with some believe it is being used to speed up the process of dying. There have been some reports of patients being put on it without consent and not being allowed, food, fluids and medication.

Here, [three] family members of those who have been on the Liverpool Care Pathway, share their experiences of the programme. [There are two unfavorable views and one favorable view of the LCP]

Kayleigh Hollobone

Two years ago, when I was 22, I lost my 56-year-old mother to cancer.

During the six months from her diagnosis in January 2012 until her death, she was unknowingly to us put on the LCP. She was deprived of fluids and any source of nutritional supplement without even the slightest consent or conversation with me or my family.

It was only after my absolute insistence and persistence that my mother received fluids and that was after over 36 hours without any.

It scares me that people who do not have bossy and demanding families, like me and mine, to fight for them will be left or even encouraged to die via the LCP.

My mother survived another three months. We got to hear her laugh and joke again and importantly my mother got to say her goodbyes. Had the enforced LCP been allowed to continue, those few important months of time with my mother would have without a doubt been taken away from me and my family.


I can't stress how important me and my family feel about the process of the LCP. It needs to be readdressed - the memories it could have deprived me of are invaluable. She wrote me a letter that I will have forever and it will always be the most treasured item I possess.

Helen Redshaw

"The Liverpool Care Pathway aided her in a gentle and thoughtful way”

My mother passed away from cancer just three months ago. The Liverpool Care Pathway was used and I have nothing but praise for it. We had help from night nurses through the NHS Beacon program, Marie Curie and Macmillan, all of which gave exemplary care. Leaflets on the LCP were given to us and time was taken by all to fully explain why and how it would work. 

Towards the end, my mother couldn't swallow and didn't want food - this was her body getting ready to die. It was slow and peaceful, and she was my mother until about the day before when we all knew she was leaving.

There was no prolonging of life. She was ready to go and the Liverpool Care Pathway aided her in a gentle and thoughtful way. It wasn't the refusal to give her food and drink; she no longer wanted it.

She had as natural an early death as can be and I am thankful as it helped me and my family cope as we saw her slip away. This is something that should be offered and explained to patients and family and I have nothing but support for it.

William Hughes

My father Professor Robert Hughes was subjected to this technique without my or his consent. When it became clear that his cancer of the prostrate became untreatable I was asked what I wanted to do and I told them clearly that I wanted him to die with dignity.

I was assured by the staff at the hospital that would happen, that he would have died a dignified death. He didn't. He was sedated, unconscious and died within three days looking like something from Belsen concentration camp.

He was not given water or food but instead put on a driver syringe containing diamorphine, midazolam and cyclizine. The first two of those drugs would down a horse. . .

Sadly there is no going back. I didn't know that once started, it's irreversible.

No one makes this clear. This is the main part, if not for some the final part, of the LCP.

In the new scheme when that comes out, if they allow these two drugs to be continued to be used, it is euthanasia, plain and simple.

Excuse the mess!

If the website "looks funny," it's because we're doing some updates.

Thank you for your patience and please consider making a donation to keep this website alive.

Thank you so much!

Choice is an Illusion

Beware of Vultures

"[I]t seems odd that the top lobby spender in Montana this year was Compassion and Choices, a 'nonprofit' group that spent $160,356 advocating for legalization of assisted suicide."

By Senator Jennifer Fielder

As we wrangled through the budget this spring, the beautiful state capitol began to feel like a big, ripe carcass with a dark cloud of vultures circling about. 

Senator Jennifer Fielder

The magnitude of money in government attracts far more folks who want to be on the receiving end than it does those who just want fair and functional government. Until that ratio improves, it may be impossible to rein in unnecessary regulation and spending. 

Special interest groups spent over $6 million dollars on lobbyists to pressure Montana legislators during the 2013 session. Seems like a lot of money, until you compare it to the billions of taxpayer dollars at stake. Does the average taxpayer stand a chance against organized forces like that?

As your Senator one of my main duties is to sort out who wants your money, or a change in a law, and why. Getting to the bottom of it takes work. It would certainly help if well-intentioned citizens would do a little more research before clamoring onto any particular bandwagons as well.

We have to be careful not to be fooled by catchy slogans, shallow campaign propaganda, biased media reports, or plays on our emotions which, too often, conceal a multitude of hidden agendas. 

For example, it seems odd that the top lobby spender in Montana this year was Compassion and Choices, a “nonprofit” group that spent $160,356 advocating for legalization of assisted suicide. The second biggest spender was MEA-MFT, the teachers and public employees union who spent $120,319 pushing for state budget increases.

I earned a reputation for asking a lot of questions. I certainly didn’t take this job to rubber stamp anything. It's my duty to determine whether a proposal relates to an essential, necessary service of fair and functional government, or if it is motivated by piles of money to be gained from ill-advised government decisions.

You see, there is so much money in government that almost everything in government is about the money. The usual tactic is to disguise a ploy as “the humane thing to do”. . . .

Some groups work very hard to provide factual information about their issue. Others stoop to the lowest of lows to invoke heart wrenching emotions, twisted half-truths, or outright lies. You really have to look carefully for all the angles.

Assisted suicide is another issue that can be highly emotional. There are deep and valid concerns on both sides of this life and death debate. But I found myself wondering, “Where does all the lobby money come from?” If it really is about a few terminally ill people who might seek help ending their suffering, why was more money spent on promoting assisted suicide than any other issue in Montana?

Could it be that convincing an ill person to end their life early will help health insurance companies save a bundle on what would have been ongoing medical treatment? How much would the government gain if it stopped paying social security, Medicare, or Medicaid on thousands of people a few months early? How much financial relief would pension systems see? Why was the proposed law to legalize assisted suicide [SB 220] written so loosely? Would vulnerable old people be encouraged to end their life unnecessarily early by those seeking financial gain? 

When considering the financial aspects of assisted suicide, it is clear that millions, maybe billions of dollars, are intertwined with the issue being marketed as “Compassion and Choices”. Beware.

Public issues are not easy, and they are not always about money. But often times they are. If we want fair and functional government, we need to look deeper than most people are willing to look.. . .

* * *
Published as Communication from Your State Senator, "Beware of Vultures," by Montana State Senator Jennifer Fielder, Sanders County Ledger, http://www.scledger.net, page 2, 6-4-13. Senator Fielder lives in Thompson Falls MT, representing Montana State Senate District 7.

Maine House Says No to Physician-Assisted Suicide (95-43)

http://bangordailynews.com/2013/05/31/politics/maine-house-says-no-to-physician-assisted-suicide-law/print/

 

By Matthew Stone, BDN Staff

 

Posted May 31, 2013, at 3 p.m.

 

AUGUSTA, Maine — The Maine House on Friday rejected a bill that would allow terminally ill patients to order lethal doses of medication from their doctors. The bill also would free doctors from legal liability for helping to end a consenting patient’s life.

House members voted 95-43 against the measure, which is sponsored by Rep. Joseph Brooks, an independent from Winterport. The bill next heads to the Senate.

Brooks’ bill, LD 1065, would allow a patient and his or her doctor to sign companion end-of-life care agreements. Those agreements would be signed after the two have discussed the patient’s medical condition and treatment options and the patient has rejected life-extending treatments and agreed to accept “care that is ordered or delivered by the physician that may hasten or bring about the patient’s death.”

The bill also would free doctors from criminal liability or the possibility of professional discipline for helping a consenting patient end his or her life.

The vote followed an emotional debate on the House floor in which lawmakers described their experiences caring for parents and friends as their lives ended.

Brooks said ill patients should be able to decide to end their lives when they can die in dignity.

“Dignity was important to this mill laborer,” he said of his father. “Had he been aware that he was lying in a hospital bed in the living room of his home not in control of anything, he would have probably said, ‘Please help me with this.’”

“How many of us have lost or seen others lose loved ones who linger painfully and unnecessarily for long periods?” asked Rep. Roberta Beavers, D-South Berwick. “We treat ill pets more humanely than we treat ill parents.”

But in letting doctors administer lethal doses of medication, the assisted-suicide bill would go too far, said Rep. Ann Dorney, D-Norridgewock. End-of-life care has changed for the better in recent years, said Dorney, a physician.

“We have very good end-of-life care. We have very good hospice care. We have very good palliative care,” she said. “I guess I’m not sure we need this bill.”

Dorney also worried about the prospect of a guardian who makes medical decisions for a patient making the decision to end that patient’s life.

Rep. Deborah Sanderson, R-Chelsea, said she wouldn’t want to rob a patient of a natural end to life.

“I sat with my mom the last five days of her life. I slept in a wheelchair by her bed,” Sanderson said. “The night before my mother passed, my mother said, ‘It’s not like what I thought it would be.’ She said, ‘It’s peaceful.’ And I was very glad to hear that.”

The Maine House’s rejection of the physician-assisted suicide legislation came more than a week after Vermont Gov. Peter Shumlin signed a similar measure into law in that state. Vermont’s law was the first in the nation to be approved through the legislative process.

Physician-assisted suicide measures on the books in Oregon and Washington passed through public votes.

In Maine, voters rejected a physician-assisted suicide ballot measure in 1990.

http://bangordailynews.com/2013/05/31/politics/maine-house-says-no-to-physician-assisted-suicide-law/ printed on June 2, 2013

Vermont: Jackowski: Assisted suicide is not the answer

http://vtdigger.org/2013/05/20/jackowski-assisted-suicide-is-not-the-answer/

Posted By Opinion On May 20, 2013 @ 11:00 pm

Editor’s note: This op-ed is by Rosemarie Jackowski, an advocacy journalist and peace activist who is the author of “Banned in Vermont.”

The “assisted suicide bill” does exactly what it is designed not to do. It will eliminate choice for the most vulnerable. Unintended consequences are sure to follow. We need more, not fewer rights. Government-approved suicide as an end-of-life option does not give more rights — in reality it takes them away.

Some legislators promise “safeguards.” There are no safeguards that can ensure that there will not be abuse. Some of the most vulnerable will be pressured to end it all for the convenience and sometimes for the financial benefit of others. Patients will be unduly influenced into giving in to family members. Many elderly/disabled have loving supportive families. It is those who do not who are at the highest risk. There is no way that abuse can be prevented. Imagine being isolated with caregivers — Stockholm syndrome.

The assisted suicide law will deprive many of choice. Recent history shows that more than 300 cases of reported abuse of the disabled/elderly have been ignored by the state. This is evidence that the state cannot protect the vulnerable. The assisted suicide law will add another layer of risk. It will make things worse.

Not what Vermont needs

http://www.timesargus.com/apps/pbcs.dll/article?AID=/20130517/OPINION02/705179982?template=printart

May 17, 2013

By Rep. Anne Donahue
 
Wake up, Dorothy. You’re not in Oregon anymore.

The final week of the political path to death with dignity in Vermont was a reminder of how a cadre of politicians can want something so desperately that they push it through even if abandoning key promises.

For months — no, for years — Vermonters have been told that Oregon’s experience of physician-assisted suicide has demonstrated that extending this compassionate option to persons who want it comes at no risk to the vulnerable.

The mantra has been Oregon. Oregon protections. Oregon data. Everything has worked flawlessly in Oregon, so if we follow the exact model as Oregon, we can ignore the fears of the naysayers.

When the Senate was short one vote in February to pass the Oregon model, it sent a narrow bill to the House that focused instead on independent actions of a patient rather than on prescriptions for intentionally lethal medication. It was roundly criticized for lacking the protections of the Oregon bill.

The House restored the Oregon, active-prescription version. Proponents were emphatic on the House floor that it was because every one of the Oregon protections were locked into place that members could be assured there could be no coercion, no errors in diagnosis, and no one making the choice lacking full informed consent.

When it pingponged back, the Senate still couldn’t muster the votes to pass it. So a few backers patched and pasted an assorted set of new and old language together directed exclusively at gaining the one extra vote needed.

Gone were both the Oregon model and any model that left the doctor out of the role of prescribing lethal drugs. Enter the land of political Oz.

Sen. Claire Ayer, who had been the most vigorous in attacking what the Senate had passed via a floor amendment in February, now pressed for the new hybrid, though acknowledging that it was drafted “on the fly.”

Eradicated by the Senate were fully 29 separate protective provisions that the House had required in its Oregon version, some of them small, some of them huge. Among the huge ones:

— There is no longer any written informed consent required.

— A guardian or an agent for an advance directive is no longer barred from taking the place of a direct patient request.

— There is no longer any requirement that the patient actually be able to “self-administer.”

— There is no longer a second opinion required to assess whether a patient has the rational judgment capacity to make an informed decision.

— There are no requirements for follow-up by the Department of Health. The required review of patient files is gone. The requirement to collect statistical data and publish annual reports is gone.

This last is particularly ironic, because it has been the patient information and report data from Oregon that has been the basis for assuring Vermonters that all is well in Oregon.

The new Vermont bill sunsets even the “Oregon-lite” approach in 2016, then eliminates all remaining structural protections. But there isn’t any data being required to assess how the process works in those first three years.

Despite all this, House members who wanted to see a bill pass stuck by what they had so strongly criticized before: a bill that no longer maintained many of the long-promised protections. Only a few looked twice and voted against accepting what the Senate had done. The winning vote margin dropped from 17 to 10.

Our radical new social policy that endorses having doctors write prescriptions that will kill their patients, cobbled together by just a few individuals from bits and pieces of language drafted on the fly, was passed by two votes in the Senate and 10 votes in the House.

But no, Dorothy. We’re no longer in Oregon.

Rep. Anne Donahue, a Republican from Northfield, is a member of the House Human Services Committee, which passed the Oregon-style bill on a 7-4 vote in April. She was an opponent.

---

Vermont: House Passes Irresponsible Assisted Suicide Law

By Margaret Dore, Esq.

A.  Introduction

Yesterday, the Vermont House passed S.77, which if signed by the Governor, will create new legal paths of abuse and exploitation against persons who fall within its terms.  This article focuses on two of those paths.

B.  Abuse and Exploitation in the United States

Met Life Mature Market Institute has issued two landmark studies on elder abuse in the United States.  In the first study, from 2009, the estimated annual financial loss by victims was $2.6 billion.[1]  In the second study, from 2011, the estimated annual loss was increased to $2.9 billion.[2]  Again, these are yearly figures.

The Met Life studies also describe how financial abuse can be a catalyst for other types of abuse.  These are three examples from the second report:

• Two elderly women were beaten to death with a crowbar by their trusted handyman.  He took and pawned all of their valuables.
• A 74-year-old man was stomped to death during a home invasion burglary.
• A son and his two friends extracted money from his dying mother by threatening to burn down her home and throw her dog against a wall.[3]

Abuse and exploitation are not limited to the elderly.  Last year, a 46 year old lottery winner died the day after receiving his winnings.[4] The cause of death was found to be cyanide poisoning.[5]

C.  S.77

1.  Patients may have years to live

S.77 legalizes physician-assisted suicide, which means that a doctor writes a prescription for a lethal dose of medication for the purpose of a patient's committing suicide.[6]  Under S.77, the patient is required to have a "terminal condition," defined as having a medical prediction of less that six months to live.[7]  Such patients are not necessarily dying and can have years to live.  This is because doctor predictions of life expectancy can be wrong and because the requirement of six months to live is based on the patient' s not being treated.[8]  

2.  How S.77 works

Under S.77, there is a formal application process to obtain a lethal dose.[9]  S.77 also requires that in 2016, that this formal process be replaced with a streamlined procedure with these five requirements:

(1) the physician determines that the patient is capable and does not have impaired judgment;

(2) the physician informs the patient of all feasible end-of-life services, including palliative care, comfort care, hospice care, and pain control;

(3) the physician prescribes a dose of medication that may be lethal to the patient;

(4) the physician advises the patient of all foreseeable risks related to the prescription; and

(5) the patient makes an independent decision to self-administer a lethal dose of the medication.[10]

Also, when applying for the lethal dose, patients may be requesting it "just in case." i.e., without a definite intent to take it.[11]

Once the lethal dose is picked up at the pharmacy, there is no oversight.[12]  The death is not required to be witnessed.[13] Indeed, no one is required to be present.[14] 

D.  New Paths of Abuse

1.  No witnesses at the death

As noted above, S.77 does not require witnesses at the death. Without disinterested witnesses, the opportunity is created for the patient’s heir, or for another person who will benefit financially from the patient's death, to administer the lethal dose to the patient without his consent.  Even if he struggled, who would know? 

2.  An expansion of scope 

Under the streamlined procedure scheduled to come into effect in 2016, the scope of S.77 will be expanded to patients who have no intention of engaging in assisted suicide.  As described below, patients prescribed medication for the purpose of cure or treatment will be at risk of being killed under S.77. 

Consider this scenario in which all five requirements of the streamlined procedure are met:

The patient is a competent woman with cancer.  Without surgery, she is terminal as defined in S.77 (she is expected to die in less than six months).  But, with surgery, her  prospects are good.  As part of informed consent, the doctor informs her about the risks of the surgery and end of life services including palliative care, comfort care, hospice care, and pain control.

With the stress of her situation, the woman has been experiencing insomnia, for which the doctor prescribes Pentobarbital (nembutal).[15]   If taken in excess, Pentobarbital may be lethal.[16].  He prescribes a month's supply and advises the woman of the foreseeable risks.  She obtains the prescription but doesn't take any.  The bottle with the unused prescription is in her home. She is scheduled for surgery in a few days.  She has no intention of killing herself.  The doctor has no intention of her killing herself.

A family member, interested in an inheritance, tricks the woman into drinking the pentobarbital mixed with water by saying that it's another medication - say for sinus congestion.[17]

He leaves.  She dies.

The situation looks like a suicide.

If it comes out later that the family member was present when the woman "self-administered" the drug, he's  immune from liability. This is because S.77 states:

"[N]o person shall be subject to civil or criminal liability solely for being present when a patient with a terminal condition self-administers a lethal dose of medication or for not acting to prevent the patient from self-administering a lethal dose of medication."[18]

So the woman was not in control of her fate.  She is legally murdered by her heir.

E.  Conclusion

S.77, as passed by the House for the Governor's signature, is a dangerous and irresponsible bill, in which there is no oversight over administration of the lethal dose such that it can be administered without the patient's consent.  Once the streamlined procedure goes into effect, patients engaged in drug treatments will also be unwittingly under its scope.  Their doctors and the medical profession will also be compromised.  Even if you are for assisted suicide, not this bill.

Footnotes
[1]  The MetLife Study: "Broken Trust:  Elders, Family and Finances, " 2009, available at https://www.metlife.com/assets/cao/mmi/publications/studies/mmi-study-broken-trust-elders-family-finances.pdf
[2] "The MetLife Study of Elder Financial Abuse:  Crimes of Occasion, Desperation, and Predation Against America's Elders," 2011, available at https://www.metlife.com/assets/cao/mmi/publications/studies/2011/mmi-elder-financial-abuse.pdf
[3]  Id., page 17.
[4]  Associated Press, "Urooj Khan Update:  Widow, siblings of poisoned Chicago lottery winner battle over estate, documents say," available at http://www.cbsnews.com/2102-504083_162-57563293.html
[5]  Id.
[6]  Cf. AMA Code of Medical Ethics, Opinion 2.211, available at http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion2211.page 
[7]  A copy of S.77, "An act relating to patient choice and control at end of life," as passed by the Senate and the House, can be viewed here:  http://choiceisanillusion.files.wordpress.com/2013/05/s-77-house-final-version-05-13-13.pdf  The definition of "terminal condition" is in § 5281(a)(10)("Terminal condition" means an incurable and irreversible disease which would, within reasonable medical judgment, result in death within six months).
[8]  See Nina Shapiro, Terminal Uncertainty — Washington's new 'Death with Dignity' law allows doctors to help people commit suicide — once they've determined that the patient has only six months to live. But what if they're wrong?, Seattle Weekly, January 14, 2009, available at www.seattleweekly.com/2009-01-14/news/terminal-uncertainty.  See also Affidavit of Kenneth Stevens, MD, September 18, 2012, available at http://choiceisanillusion.files.wordpress.com/2012/10/signed-ken-stevens-affidavit_001.pdf ; and Affidavit of John Norton (when he was eighteen years old, he was told that he would die of ALS and paralysis in three to five years; he is now 75 years old).  Available at http://www.massagainstassistedsuicide.org/2012/09/john-norton-cautionary-tale.html
[9]  In S.77, the formal application process is contained in § 5283, Requirements for Prescription and Documentation, available at http://choiceisanillusion.files.wordpress.com/2013/05/s-77-senate-version-as-of-05-08-13.pdf and http://choiceisanillusion.files.wordpress.com/2013/05/s-77-house-final-version-05-13-13.pdf
[10]  S.77, Sec. 2, Repeal (stating that 5283 will be repealed on July 1, 2016).  See also S.77, Sec. 3 (providing that § § 5289 and 5290 will take effect on July 1, 2016)
[11]  I have had two cases in which my client's parent signed up for the lethal dose.  In both cases, the parents did not have a set wish to take the lethal dose. They signed up "just in case."
[12]  See S.77 in its entirety, at http://choiceisanillusion.files.wordpress.com/2013/05/s-77-senate-version-as-of-05-08-13.pdf and http://choiceisanillusion.files.wordpress.com/2013/05/s-77-house-final-version-05-13-13.pdf
[13]  Id.
[14]  Id.
[15]  See http://www.drugs.com/mtm/pentobarbital.html
[16]  Id.
[17]  Pentobarbital is water and alcohol soluble so that it could be put in a cold medicine solution.  See http://www.drugs.com/pro/nembutal.html 
[18]  S.77 § 5284