Assisted suicide

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, 4ore#?s top court upholds ?right to die? ruli6g

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 7 -year-old that she be allowed to die with dignity. !nder current law the removal of a respirator from brain-dead patients is regarded as murder. "ut the family said that e#tending life using medical devices would prolong the woman's $painful and meaningless$ e#istence. The woman was declared brain dead in %ebruary last year after she sustained cerebral damage and fell into a coma while undergoing a lung e#amination at the Severance &ospital in Seoul. Three months later her children filed a court petition after the hospital re'ected their request that she be allowed to die in peace and with dignity. ( court last )ovember 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. (n appeal court upheld that decision in %ebruary but the hospital too* the case to the top court. The supreme court said the termination of life-sustaining treatments requires $careful 'udgement.$ &owever, it said, treatment can be stopped by ma*ing a presumption about the wish of the patient. +aintaining a brain-dead state damaged $human dignity$ when there was no chance of recovery. $,f it is obvious that the patient will die soon... we can conclude that she or he has already entered a phase of death,$ the court said. $,n this case, we must respect the patient's will because forced life-sustaining treatment may damage human dignity.$

,n the current case, it said, the woman had told her family she did not want to be *ept alive artificially if any problem arose with her hospital treatment. -ocal religious communities have been split on the sub'ect of euthanasia. (ctivists have warned against abuse of the ruling. The Korea +edical (ssociation said it would draw up new guidelines for doctors on the sub'ect. The supreme court $ac*nowledged the patient's right to ma*e a decision on meaningless lifesustaining treatment,$ spo*esman .hoa &un-/ong told reporters. "ut he said such situations should be allowed only when a patient has no chance of recovery. ,n 0117 a father was given a four-year suspended 'ail term for the removal of a respirator from his brain-dead son.

S Korea did not legalize euthanasia

2esterday, the 3uthanasia 4revention .oalition wrote a letter to the (%4 news service stating that their report5 S Korea legali6es euthanasia for terminally ill was wrong. This is the statement that we sent to the (%4 news service5 The following article from your news service is not clear, it says that South Korea will legali6e euthanasia and then the article is about removing life support from terminally ill people. The article states5 $They agreed that doctors could stop prolonged life-sustaining treatment, based only on prior written or oral statements from patients.$ ,t appears that South Korea has approved the withdrawal of life-sustaining treatment which is not euthanasia. 3uthanasia is the direct and intentional *illing of a person for reasons of mercy. This has not been legali6ed in South Korea The article doesn't refer to the issue of fluids and food, and therefore until , see the actual guidelines , must say that euthanasia has not being legali6ed in South Korea, but rather discontinuing life-sustaining treatment has been approved. 2ou 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 , received the South Korean 7 3nd-of-life guidelines from a Korean physician. ,t is clear that S Korea did not legali6e euthanasia. The guidelines concern the rules that must be followed before a physician can withdraw or withhold medical treatment. The guidelines state5 8 They are for terminally ill patients, but do not apply to 49S patients, unless the 49S patient is terminally ill. 8 They are for e#traordinary treatments only :eg. ;espirators, .4;<. =rdinary treatments such as fluids and food should be maintained. 8 (pply to adult patients, based on prior written statements.
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- The statement should be prepared after counseling with doctor:s< with a 0 wee* mandatory deliberation period. - =ral statements of patients are accepted, when it can be proven. - .an be withdrawn anytime 8 ( national review committee on end-of-life care will be established. 8 &ospital ethics committees on end-of-life care will be established. The guidelines did not approve5 8 Surrogate decision is not allowed for adult patients, but partially allowed for minors and people with mental disabilities. ,t is clear that euthanasia has not been legali6ed in S Korea. The guidelines do not approve of euthanasia by dehydration either. ,t is also clear that the South Korea guidelines are more cautious than most national end-of-life guidelines in the western world. >hile , share the concern about how $terminally ill$ may be defined, these guidelines do not appear to be designed to open the floodgate. ,t appears that the (%4 news service is intentionally confusing the public concerning what euthanasia actually is. (%4 also wrongly stated that the ?erman court recently approved euthanasia. (%4 needs to publish a retraction of their incorrect news article.

South Korean court orders removal of life support from comatose woman...
"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 @ecember A, 011B5 ( ruling by the Seoul >estern @istrict .ourt 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 *ind in Korea, where current law bans any form of assisted suicide. (ccording to The Korea Times, in a similar ACC7 case a family was convicted of murder for having assisted in the removal of a ventilator from a patient.

The case involves a 7D-year-old woman, identified as Kim =*-*yung, who fell into what has been reported as both a $coma$ and a $persistent vegitative state$ in %ebruary while undergoing a lung e#amination. The patientEs family filed a court request in +ay as*ing the hospital to ta*e the woman off life-support, claiming that e#tending Kim's life using medical devices would prolong her $painful and meaningless$ e#istence. The Seoul >estern @istrict court accepted the request to halt treatment, ordering the removal of feeding and ventilator tubes on %riday. /udge Kim .heon-soo stressed that the decision should not be seen as a blan*et approval for euthanasia, but is confined only to those for whom medical treatment has no impact. $The patient can as* doctors to remove life support if it causes physical and mental pain and hurts human dignity and personality. .onsidering her hopeless state, the e#pected years left in her life and her age, the patient is assumed to have e#pressed her wish to die a natural death with the life support removed,$ .heon-soo said in his ruling, adding that, $@octors from Seoul )ational !niversity &ospital and (san +edical .enter have confirmed that she is e#pected to survive up to three or four months at best. ,n this condition, further treatment is meaningless.'' 4ar* /ung-woo, secretary-general of the (rchdiocese of Seoul -ife and 3thics .ommittee said in a Korea Times report, $4atients should receive the best care possible, but how one accepts death is also important when there's no chance of recovery. ( patient choosing to withdraw his own treatment is one thing, but removing treatment from someone else is different.$ (le# Schadenberg of the 3uthanasia 4revention .oalition told -ifeSite)ews 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. $The decision from the Seoul >estern @istrict .ourt is concerning because it means that they have now authorised the decision to enable physicians to intentionally dehydrate their patients to death. >hen we intentionally dehydrate a person to death who is not otherwise dying, the intent of the omission is to deliberately cause the death of the person, which is euthanasia,$ Schadenberg said. $The court should have limited its 'udgment to the withdrawal of the ventilator,$ Schadenberg e#plained. $>hen a ventilator is withdrawn, the death that might occur is not caused by the removal of the ventilator, but rather by the :pre-e#isting< medical condition.$ (ccording to many ethical e#perts assisted ventilation can be considered Fe#traordinaryG 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 FordinaryG treatment and cannot legitimately be withdrawn. $>e must remember that when we allow one person in society to intentionally cause the death of another person in society, it is impossible to provide safeguards that will protect people who are vulnerable, depressed or socially devalued,$ Schadenberg warned. $>e must strive for a culture that cares and not *ills its vulnerable citi6ens.$
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Tread Carefully When You Help to Die Assisted Suicide Laws Around the World
Updated 01 March 200 www.assistedsuicide.org

Compiled by Derek Humphry, former editor of World Right-to-Die Newsletter (ssisted suicide laws around the world are clear in some nations but unclear 7 if they e#ist at all 7 in others. /ust because a country has not defined its criminal code on this specific action does not mean all assisters will go free. ,t is a complicated state of affairs. ( 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. >hile suicide is no longer a crime 7 and where it is because of a failure to update the law it is not enforced 7 assistance remains a crime almost everywhere by some statute or other. ,Ell try to e#plain the hodge-podge. %or e#ample, it is correct that Sweden has no law specifically proscribing assisted suicide. ,nstead the prosecutors might charge an assister with manslaughter 7 and do. ,n AC7C the Swedish right-to-die leader "erit &edeby went to prison for a year for helping a man with +S to die. )eighbouring Norwa! has criminal sanctions against assisted suicide by using the charge $accessory to murder$. ,n cases where consent was given and the reasons compassionate, the courts pass lighter sentences. ( recent law commission voted down de-criminali6ing assisted suicide by a D-0 vote. ( retired )orwegian physician, .hristian Sandsdalen, was found guilty of wilful murder in 0111. &e admitted giving an overdose of morphine to a woman chronically ill after 01 years with +S who begged for his help. ,t cost him his medical license but he was not sent to prison. &e appealed the case right up to the Supreme .ourt and lost every time. @r. Sandsdalen died at B0 and his funeral was pac*ed with )orwayEs dignitaries, which is consistent with the support always given by intellectuals to euthanasia. "inland 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 'ustified, nothing more happens. +ostly it ta*es place among friends, who act discreetly. ,f %innish doctors were *nown to practice assisted suicide or euthanasia, the situation might change, although there have been no *nown cases. #erman! has had no penalty for either suicide or assisted suicide since A7DA, although it rarely happens there due to the hangover taboo caused by )a6i mass murders, plus powerful, contemporary, church influences. @irect *illing by euthanasia is a crime. ,n 0111 a ?erman 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. "rance does not have a specific law banning assisted suicide, but such a case could be prosecuted under 00H- of the 4enal .ode for failure to assist a person in danger. .onvictions are rare and punishments minor. %rance bans all publications that advise on suicide - Final E it has
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been banned since lCCA but few nowadays ta*e any notice of the order. Since lCCD there has been a fierce debate on the sub'ect, which may end in law reform eventually. $enmar% has no specific law banning assisted suicide. ,n &tal! the action is legally forbidden, although pro-euthanasia activists in Turin and ;ome are pressing hard for law reform. Lu'em(ourg does not forbid assistance in suicide because suicide itself is not a crime. )evertheless, under IA1-A of its 4enal .ode a person could be penali6ed for failing to assist a person in danger. ,n +arch 011H legislation to permit euthanasia was lost in the -u#embourg 4arliament by a single vote. Tolerance for euthanasia appears in the strangest of places. %or instance, in Urugua! it seems a person must appear in court, yet (rticle 07 of the 4enal .ode :effective ACHI< says5 $The 'udges are authori6ed to forego punishment of a person whose previous life has been honorable where he commits a homicide motivated by compassion, induced by repeated requests of the victim.$ So far as , can tell, there have been no 'udicial sentences for mercy *illing in !ruguay. ,n )ngland and *ales there is a possibility of up to AI years imprisonment for anybody assisting a suicide. =ddly, suicide itself is not a crime, having been decriminali6ed in AC A. Thus it is a crime to assist in a non-crime. ,n "ritain, no case may be brought without the permission of the @irector of 4ublic 4rosecutions in -ondon, which rules out hasty, local police prosecutions. ,t has been a long, uphill fight for the "ritish 7 there have been eight "ills or (mendments introduced into 4arliament between ACH -011H, all trying to modify the law to allow careful, hastened death. )one has succeeded, but the /offe "ill currently before 4arliament is getting more serious consideration than any similar measure. (s in %rance, there are laws banning a publication if it leads to a suicide or assisted suicide. "ut Final E it can be seen in boo*stores in both countries. The law in +anada is almost the same as in 3nglandJ indeed, a prosecution has recently :0110< been brought in "... against a grandmother, 3velyn +artens, for counselling and assisting the suicide of two dying people. +rs. +arten was acquitted on all counts in 011I. =ne significant difference between 3nglish and .anadian law is that no case may be pursued by the police without the approval of the @irector of 4ublic 4rosecutions in -ondon. This clause *eeps a bra*e on hasty police actions. (ssisted suicide is a crime in the ;epublic of &reland. ,n 011H police in @ublin began proceedings against an (merican !nitarian minister, ?eorge @ 3#oo, for allegedly assisting in the suicide of a woman who had mental health problems. &e responded that he had only been present to comfort the woman, and read a few prayers. This threatened and much publici6ed case had disappeared by 011D.

+,NS)N- &..)L)/0NSuicide has never been illegal under Scotland1s 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 *illing of another at his own request is murder, as the consent of the victim is irrelevant in such a case. ( person who assists another to ta*e 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 as5 rec*lessly endangering human life, culpable homicide :rec*lessly giving advice or providing the means, followed by the death of the victim<, or wic*ed rec*lessness.
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2ungar! 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. (ssistance in suicide or attempted suicide is punishable by up to five years imprisonment. 3uthanasia practiced by physicians was ruled as illegal by &ungary's .onstitutional .ourt :(pril 011H<, eliciting this stinging comment from the 'ournal !agyar Hirlap" $&as this theoretically hugely respectable body failed even to recogni6e that we should ma*e legal what has become practice in everyday life.$ The 'ournal predicted that the ruling would put doctors under commercial pressure to *eep patients alive artificially. .ussia, too, has no tolerance of any form of assisted suicide, nor did it during the 1-year Soviet rule. The ;ussian legal system does not recogni6e the notion of 'mercy-*illing'. +oreover, the ACCH law '=n &ealth .are of ;ussian .iti6ens' strictly prohibits the practice of euthanasia. ( ray of commonsense can be seen in )stonia :after getting its freedom from the Soviet bloc< where lawma*ers say that as suicide is not punishable the assistance in suicide is also not punishable. The only four places that today openly and legally, authori6e active assistance in dying of patients, are5 A. ,regon :since lCC7, physician-assisted suicide only<J 0. Switzerland :ACIA, physician and non-physician assisted suicide only<J H. 3elgium :0110, permits 'euthanasia' but does not define the methodJ I. Netherlands :voluntary euthanasia and physician-assisted suicide lawful since (pril 0110 but permitted by the courts since lCBI<. Two doctors must be involved in =regon, "elgium, and the )etherlands, plus a psychologist if there are doubts about the patient's competency. "ut that is not stipulated in Swit6erland, 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 )etherlands permits voluntary euthanasia as well as physician-assisted suicide, while both =regon and Swit6erland bar death by in'ection. @utch law enforcement will crac* down on any non-physician assisted suicide they find, recently sentencing an old man to si# months imprisonment for helping a sic*, old woman to die. Swit6erland alone does not bar foreigners, but careful watch is *ept that the reasons for assisting are altruistic, as the law requires. ,n fact, only one of the four groups in that country, @,?),T(S, chooses to assist foreigners. >hen this willingness was published in newspapers worldwide, sic* people from all over 3urope, and occasionally (merica, started tre**ing to Swit6erland to get a hastened death. ,n 011A the Swiss )ational .ouncil confirmed the assisted suicide law but *ept the prohibition of voluntary euthanasia. "elgian law spea*s only of 'euthanasia' being available under certain conditions. '(ssisted suicide' appears to be a term that "elgians are not familiar with. ,t is left to negotiation between the doctor and patient as to whether death is by lethal in'ection or by prescribed overdose. The patient
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must be a resident of "elgium :pop.5 A1 million<, though not necessarily a citi6en. ,n its first full year of implementation, 01H people received euthanasia from a doctor. (ll three right-to-die organi6ations in Swit6erland help terminally ill people to die by providing counselling and lethal drugs. 4olice are always informed. (s we have said, only one group, @,?),T(S in Kurich, will accept foreigners who must be either terminal, or severely mentally ill, or clinically depressed beyond treatment. :)ote5 @utch euthanasia law has caveats permitting assisted suicide for the mentally ill in rare and incurable cases, provided the person is competent.< The =regon @eath >ith @ignity (ct came under heavy pressure from the !S %ederal government in 011A when (ttorney ?eneral /ohn (shcroft issued a directive essentially and immediately gutting the law. This brought on a public outcry that the %ederal government was nullifying a law twice voted on by =regon citi6ens. ( disqualification of democracyL (n interference with states' rightsL ,mmediately the state of =regon went to court :0110< to nullify the directive, won at the first stage, but the appeals are li*ely to continue until 011I. Since lCB1, rightto-die groups have tried to change the laws in >ashington State, .alifornia, +ichigan, +aine, &awaii, and 9ermont, so far without success. Thus in the !S(, =regon stands alone and under great pressure. ,n 011D the !S Supreme .ourt agreed to the federal government's request for it to decide whether =regon'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 =regon. The court's decision, e#pected in early 011 , will affect pain control throughout (merica. New 4ealand forbids assistance under A7C of the )ew Kealand .rimes (ct, lC A, but cases were rare and the penalties lenient. Then, out-of-the-blue in )ew Kealand in 011H a writer, -esley +artin, was charged with the assisted suicide of her mother that she had described in a boo*. +s. +artin was convicted of manslaughter by using e#cessive morphine and served half of a fifteenmonth prison sentence. She remained unrepentent. That same year the country's parliament voted 1-D7 not to legali6e a form of euthanasia similar to the @utch model. Similarly, +olom(ia1s .onstitutional .ourt in ACC7 approved medical voluntary euthanasia but its parliament has never ratified it. So the ruling stays in limbo until a doctor challenges it. (ssisted suicide remains a crime.

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5apan has medical voluntary euthanasia approved by a high court in lC 0 in the 2amagouchi case, but instances are e#tremely rare, seemingly because of complicated taboos on suicide, dying and death in that country, and a reluctance to accept the same individualism that (mericans and 3uropeans en'oy. The /apan Society for @ying with @ignity is the largest right-to-die group in the world with more than A11,111 paid up members. .urrently, the Society feels it wise to campaign only for passive euthanasia 7 good advance directives about terminal care, and no futile treatment. 9oluntary euthanasia and assisted suicide are rarely tal*ed about, which seems strange to >esterners who have heard so much about the culture of ritual suicide, hari *ari, in /apanese
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history. This is because, one Society official e#plained5 $,n /apan, everything is hierarchical, including academics, and government organi6ation, and this ma*es it difficult for the medical staff and those who offer psychiatric care to 'oin forces to treat the dying.$ (nother factor in /apan's bac*wardness on euthanasia is that some B1 percent of their people die in hospitals, compared to about HD percent in the )etherlands, HD percent in (merica, with as low as 0D percent in =regon which has a physician-assisted suicide law. 3uthanasia is essential an inhome action. The right-to-die movement has been strong in 0ustralia since the early lC71s, spurred by the vast distances in the outbac* country between patients and doctors. %amilies were obliged to care for their dying, e#perienced the many harrowing difficulties, and many became interested in euthanasia. The Northern -erritor! of 0ustralia actually had legal voluntary euthanasia and assisted suicide for seven months until the %ederal 4arliament stepped in and repealed the law in lCC7. =nly four people were able to use it, all helped to die by the undaunted @r. 4hilip )itsch*e, who now runs the progressive organi6ation, 3#it ,nternational :formerly '%inal 3#it (ustralia'<. =ther states have since attempted to change the law, most persistently South (ustralia, but so far unsuccessfully. ,n a rare show of mercy and understanding, a 'udge in the Supreme .ourt of 9ictoria, (ustralia, in /uly 011H sentenced a man to AB months 'ail 7 but totally suspended the custody. (le# +a#well had pleaded guilty to 'aiding and abetting' the suicide of his terminally ill wife, actions that the 'udge said were motivated by compassion, love, and humanity and thus did not deserve imprisonment. This was a trend in the right direction.

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The strongest indication that the >estern 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 .ouncil of 3urope did in 0110. ,t received answers from HI .entral (sian and 3uropean states, plus the !S( and ;ussia. )ot a few replied that such terms were nowhere to be seen in their laws so had difficulty answering. (s*ed if legislation or rules made euthanasia possible, only one country :)etherlands< answered in the affirmative :"elgium had not yet passed its similar law< and 0D nations said definitely not. (s*ed if they had any professional codes of practice on assisted suicide, eight countries said that they did, while 0A said no. Some of the other questions had revealing answers5

,s the term 'assisted suicide' used in your country5 2es ABJ )o D. @o criminal sanctions against assisted suicide e#ist5 2es 0HJ )o I. ,f so, have they ever been applied5 2es J )o .

The .ouncil of 3urope, representing ID nations, did not let the matter rest there. ,ts Social, &ealth and %amily (ffairs .ommittee approved a report which called on 3uropean states to
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consider decriminali6ing euthanasia. This was a massive step forward for the previously ignored right-to-die movement. The commonsense of the .ommittee's approach is shown in the draft report by Swiss ;apporteur @ic* +arty5 A. )obody 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 e#pressed the wish to end it. 0. There is no implied obligation on any health wor*er to ta*e part in an act of euthanasia, nor can such an act be interpreted as the e#pression of lesser consideration for human life. H. ?overnments of .ouncil of 3urope member states are as*ed to collect and analyse empirical evidence about end-of-life decisionsJ to promote public discussion of such evidenceJ to promote comparative analysis of such evidence in the framewor* of the .ouncil of 3uropeJ 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 legali6ation of physician-assisted suicide and even euthanasia. ,t is, however, neither. >hen a competent patient ma*es 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 =regon and >ashington @eath with @ignity (cts. There is virtual unanimity in !S state law and in our medical profession that the patientsE wishes should be respected when theyEve requested to withdraw or withhold life-sustaining treatment. "y Supreme .ourt precedent, withdrawing or withholding life saving treatment has been allowed in the !S since AC7 . South KoreaEs &ealth +inistry recently agreed upon a set of rules which would allow doctors to honor patientsE health care advance directives to withhold life-sustaining procedures. (ccording to the rules, F(fter a two-wee* period of consideration with a doctor, patients should e#press their willingness in a letter of intent or in words that can be proved. These intentions can be withdrawn any time.G KoreaEs &ealth +inistry will recommend these rules to the )ational (ssembly for consideration. The voter-approved @eath with @ignity (cts allow a physician to provide a patient with a lifeending dose of medication, upon the patientEs request, which the patient intends to use to end his or her own life. =ne *ey safeguard in these laws M and a distinction from euthanasia M is the patient must self administer the life-ending medication.
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3uthanasia, on the other hand, typically refers to a physician ta*ing an active role in administering the lethal medication, often by in'ection. This practice is in no way related to physician-aid in dying through @eath with @ignity laws since it removes the important elements of autonomy and self-determination. The @eath with @ignity )ational .enter wor*s hard to promote and educate people about the importance of @eath with @ignity (cts throughout the !S. 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: BProtocolsC $88A DAssist#6ce 3ith suicide is o6e o> the /ost pro>ou6d #6d /e#6i6g>ul re!uests # p#tie6t c#6 /#ke o> # phEsici#6. I> the p#tie6t #6d the phEsici#6 #gree th#t there #re 6o #ccept#ble #lter6#tives #6d th#t #ll the re!uired co6ditio6s h#ve bee6 /etF the leth#l /edic#tio6 should ide#llE be t#ke6 i6 the phEsici#6s prese6ce.D .o3ever o> the co//e6t#rE o>>eredF the >ollo3i6g 3#s p#rticul#rlE 6oted. D It is of the ut ost i portance not to a!andon the patient at this critical o ent" We ust a#e sure that any policies or laws enacted to allow assisted suicide do not re$uire that he patient !e left alone at the o ent of death in order for the assisters to !e safe fro prosecution D. ,o/e people s#E th#t this is 3ro6g #6d th#t i6 #6E c#seF su>>eri6g /#E be #llevi#ted bE drugs. 'ut the doctor/#uthor o> the #rticle s#id th#t there is D6o e/piric#l evide6ce th#t #ll phEsic#l su>>eri6g #ssoci#ted 3ith ill6ess c#6 be e>>ectivelE relieved.D G#stlEF #6d i6 /E opi6io6 the /ost i/port#6t #spectF the issue is 6ot 6ecess#rilE dEi6g i6 p#i6 but i6 #6 Du6dig6i>iedF u6#estheticF #bsurdF #6d eHiste6ti#llE u6#ccept#ble co6ditio6s.D As the #uthors >i6#l st#te/e6tF ter/i6#llE ill p#tie6ts 3ho do choose to t#ke their lives o>te6 die #lo6e so #s 6ot to pl#ce their >#/ilies or c#re givers i6 leg#l Ieop#rdE.

Why Assisted Suicide Must Not Be Legalized

Marilyn Golden Policy Analyst Prologue 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
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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. Managed care and assisted suicide - a deadly mix.
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Perhaps the most significant problem is the deadly mix between assisted suicide and profitdriven 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 profitdriven managed health care and assisted suicide. The research found a strong link between costcutting 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 (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
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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, 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
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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 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).
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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. 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. %urthermore, assisted suicide proponents and medical personnel ali*e have established that ta*ing lethal drugs by mouth is often ineffective in fulfilling its intended purpose. The body e#pels 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. 3stimates range from ADN to 0DN :/(+(, ACCB, p. DA0J &umphrey, ACCI<. The way to prevent these $problems,$ in the view of euthanasia advocates, is by legali6ing lethal in'ections by physicians - that is, legali6ing active euthanasia. This is an inevitable ne#t 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
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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). 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 physicianassisted suicide

-egali6ing physician-assisted suicide is a part of the debate about improving end-of-life care. ,t can't be seen as a quic* and easy way to protect patients from inadequate care arrangements. Too many people still suffer needlessly, often because doctors and families 'ust do not *now how to serve people who are dying. +any suffer because doctors fail to provide adequate medication for pain. To legali6e physician-assisted suicide, some believe, would ma*e real reform, such as better pain control, less li*ely. >ithout those reforms, patients end up with no prospects to live well while dying. ,n this scenario, ma*ing suicide an option is not offering a genuine choice.
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+any 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. (gain, 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. ,n either case, ma*ing suicide available does not solve the underlying social problem. 3ven 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 'ustify a choice to stay alive. They could feel that suicide is, in some sense, $e#pected$ by family or friends. (s a society, we have never as*ed people to 'ustify their being alive, and it seems li*ely that as*ing them to do so would run ris*s of being quite difficult or demeaning. %inally 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. >aiting times and restrictions on the help avail-able are li*ely to create tragic situations that push public opinion toward loosening restrictions. ( ACC7 study conducted by the (merican +edical (ssociation :(+(< found that more than half of (mericans believe physician-assisted suicide should be legal. &owever, 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 li*ely to opt for suicide.

Pros and cons of assisted suicide

-2) 0.#UM)N-S ",.7 .hoosing how we die is a basic human freedom. ,f an individual's quality of life is terrible, they should have the right to stop suffering. (s the recent case of disabled rugby player @aniel /ames showed, hundreds of "ritish people have travelled abroad for an assisted suicide, and the .rown 4rosecution Service can't prosecute the people who help them. So our euthanasia laws are, in their present state, unwor*able. Since AC A, suicide has been legal. &elping somebody who wants to die in a peaceful, painless way should also be legal. The ma'ority of "ritish people are in favour of legalising euthanasia. ( recent 2ou?ov survey revealed that B per cent supported it. The safeguards wor*. 3uthanasia clinics are professionally run centres that ensure their patients are ma*ing a considered and correct decision.
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-2) 0.#UM)N-S 0#0&NS-7 ,n =regon, a recent study of people who too* their lives with assisted suicide revealed that one in every si# were suffering from depression. This should not be allowed to be a factor in a human's choice to die. -ife is sacred. &elping to end it is morally unacceptable. (dvances 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. (lthough assisted suicide is understandable in cases li*e that of the multiple sclerosis sufferer @ebbie 4urdy, legalising it ris*s turning it into a lifestyle choice.

! "ogical #easons Against Physician-Assisted $uicide

by /ane St. .lair (uthor of Walk !e to !idnight #he issue of assisted sui$ide was on the ballot in the state of Washington in No%ember &''() *t that time + pledged to gi%e %oters one new reason e%ery day for thirty days why they should %ote against this so + took out a new ad in the ,eattle #imes e%ery day until Ele$tion Day) -ur opponents presented their %iews emotionally, and they wanted to talk about religion) We wanted to talk about the issues, logi$, reason and history) #hey had ten times the money we did) Despite help from $elebrities like !artin ,heen, we lost this) -%er &',''' people ha%e read this arti$le) !y reasons remain sound and logi$al, and + am glad + was part of this effort, e%en though we lost in Washington) .eason 890: No on 0ssisted Suicide Sunda!; Novem(er 2 -oda!<s 0$:Some terminall! ill people recover and get well. ( hospice nurse told me about a lovely 0I-year-old given three months to live. %ive years later, she is still with us and the mother of a child. 3very good doctor *nows that medicine is an art as well as a science. )o one can predict with A11N certainty who will live and who will die. (lthough it is rare, some terminally ill people can and do get better. 3veryone who wor*s in hospice can tell you at least one story attesting to that. They personally *new a patient who beat the odds and is still vertical today. =ffer them suicide and you ta*e everything away from them. 2ou ta*e away hope. 2ou ta*e away their lives.
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.eason 2=7 No on 0ssisted Suicide Saturda!; Novem(er 1 -oda!<s 0d7 $octors ma%e mista%es in medical care. This wee*, the +ississippi Supreme .ourt upheld a OI million award to the family of a woman misdiagnosed with cancer and then given a lethal dose of pain*illers.The -year-old woman received massive doses of pain*illers at a hospice for cancer, which an autopsy showed she never had, according to court records. ThatEs 'ust this wee*Es news. ,t happens all the time. %or more horror stories http5PPwww.hospicepatients.orgP from families who suffered this way, see

The /=!;)(- of the (+3;,.() +3@,.(- (SS=.,(T,=) :/(+(< 9ol 0BI, )o I, reports that medical errors may be the third leading cause of death in the !nited States at 00D,111 deaths per year. &alf are medical mista*es, including 0,111 deathsPyear from unnecessary surgeryJ 7111 deathsPyear from medication errors in hospitalsJ 01,111 deathsPyear from other errors in hospitalsJ and B1,111 deathsPyear from infections in hospitals. @o you want to give doctors the right to administer suicide medicationsQ &ey, mista*es happen. .eason 2>: No on 0ssisted Suicide "rida! ,cto(er 91 -oda!<s 0$:0ssisted suicide laws give societal approval to suicide. These laws create a world where everyone agrees itEs o*ay to chec* out at certain times. ,n fact, weEll help you do it. >eEll ma*e it legal. Society approves. This creates more suicides among people who are not sic*, and leads to increased medical *illings. ,t creates incentives to do less medical research and to save money on medical care by offering people poison pills. This is already happening in =regon. (ccording to a report from the =regon &ealth (uthority called FSuicides in =regon5 Trends and ;is* %actors,G =regonEs suicide rate is now HD times the national average. ,t had been declining before voters in =regon made assisted suicide legal, thus ma*ing all suicides socially acceptable. ,n the )etherlands, assisted suicide has moved into mercy *illings of deformed babies, and into allowing mentally ill people to *ill themselves rather than see* treatment. There is no reason to believe the !nited States would do any better if such laws are passed here. .eason 2?: No on 0ssisted Suicide ,cto(er 90 -hursda! -oda!<s 0$ No one; not even incapacitated people; needs an assisted suicide. This is the worst case scenario argument from people who want assisted suicide laws. ,t goes li*e this5 people who are paraly6ed cannot commit suicide themselves. Therefore, they are denied a right. Therefore, we have to pass assisted suicide laws.

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%irst of all, assisted suicide laws are written only for the terminally ill. Someone li*e .hristopher ;eeve and Terri Shiavo may have been too incapacitated to commit suicide but they were not terminally ill. (ssisted suicide laws have nothing to do with their cases. The vast ma'ority of people who are terminally ill do not become incapacitated until the very end. They have plenty of time to *ill themselves without help. ,f they as* friends and doctors to help them commit suicide once they become incapacitated, they are often loo*ing for approval of their act or sympathy for their condition. ,tEs no oneEs 'ob to *ill another person, and unfair to as* that of doctors and family members. .eason 82@: No on 0ssisted Suicide ,cto(er 2= -oda!<s 0$ Aou alread! have control over !our final illness. +any people believe that assisted suicide laws are bad for society, but they want them 'ust in case they personally need them. They want control over their dying process. ,tEs a me-first attitude. >hat they do not understand is that they already have control of their dying process. +y 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. 2ou already can *ill yourself any time you want. 2ou have the right to refuse any medical treatment at any time. 2ou can choose pain relief only. 2ou can choose to be completed doped up and unconscious. 2ou can tell your hospice nurses and careta*ers to *eep everyone out of your room, if you want control over who sees you when you are sic*. 2ou already have control, and you donEt need assisted suicide. .eason 82 : No on 0ssisted Suicide ,cto(er 2> -oda!<s 0$:*e can come up with (etter wa!s of helping the d!ing (esides assisted suicide. ( young man was diagnosed with &,9 in the )etherlands. 3ven though his doctors told him he could live many years free of symptoms, he as*ed for an doctor-assisted suicide. )o one tal*ed to this young man and helped him wor* through his feelings of depression and of being overwhelmed by his own diagnosis. &is culture accepts suicide, so that was that, and he ended his life in despair. ,n our own country, oncologists routinely wal* away from cancer patients they have been treating for months or even years once they are terminal. The personEs death becomes a personal failure on the part of the physician, even though itEs nothing of the *ind. The only failure is the doctorEs lac* of caring and lac* of courage to stay involved. .aring is not always curing, but every bit as important. ,f you only thin* in terms of curing and winning battles against illness, you wal* away from your FlosersG and you wal* away from caring. >e can come up with better ways of dealing with death than this, but we never will if we pass assisted suicide laws. .eason 82B: No on 0ssisted Suicide ,cto(er 2? -oda!<s 0$ ,regon offers terminall! ill people assisted suicide in lieu of medical care.
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=regon and the )etherlands, where assisted suicide is legal, *eep e#panding it. This passage, written by @r. &erbert &endin in 4sychiatric Times, sums up whatEs happened in the )etherlands5 FThe )etherlands 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 Ftermination of the patient without e#plicit requestG<.G The @utch now end the lives of psychiatric patients and deformed babies. ,n =regon, medical systems are already offering people assisted suicide in lieu of chemotherapy. .ancer victim ;andy Stroup got a letter from the state saying it would pay for his assisted suicide or painless death, but not his chemotherapy. See F=regon =ffers Terminal 4atients .eason 829: No on 0ssisted Suicide ,cto(er 2@ -oda!<s 0$ 0ssisted suicide laws give more power to the government; not the individual. =n the surface, it loo*s li*e you gain a new FrightG when you vote for assisted suicide. (ctually, you turn over more power to the government and medical establishment. 2ou already have the power to commit suicide at any time. "ut if you sign a paper agreeing to have your doctor do it for you, you are turning over your power to someone else. 2ou are creating a mechanism for the government and medical people to enter into decisions as to who lives and who dies. 2ou are ta*ing away the power of the individual. ,f the federal government ta*es over even more of the medical care system, you will be turning over your right-to-decide to the federal government. .eason 822: No on 0ssisted Suicide ,cto(er 2 removes incentive to do medical research. -oda!<s 0$:0ssisted suicide laws

,f cancer patients routinely *ill themselves rather than undergo treatment, you have removed a reason to perform medical research to cure cancer. ;esearch scientists receive funding based on how much money illnesses are costing insurance companies and how many people suffer from them. ,f an illness is rare, it gets less funding. (lso, thin* about the parents of terminally ill children. They will move mountains to cure that child. ;ich parents fund research. (verage people find brea*throughs themselves, li*e the parents in .oren/o0s -il) Suicide laws remove such incentives for medical research and human progress. .eason 821: No on 0ssisted Suicide ,cto(er 2B 3ig financial interests; such as governments and insurance companies; are often (ehind assisted suicide laws. >hen are you deadQ >hen your brain diesQ >hen your heart stops beatingQ >hen you stop breathingQ >hen you are in an irreversible comaQ )o one really has come up with a wor*ing definition of death, so the concept gets abused, especially since death involves money.
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The longer we *eep sic* people alive, the more they cost us. -ast illnesses cost more than any other medical category. (bout one-third of +edicareEs budget goes for costs incurred in the last one year of life, and I1N of that goes for e#penses in the last one month of life. ,f we convince you that you have no hope for a future, we save money on your care and ma*e money on your organs. ,f we convince you to die early, we inherit your money more quic*ly. The government saves on Social Security and +edicare. 2our company saves pension money. So. (re you going to let such financial interests promote assisted suicide as a new public policyQ .eason 820: No on 0ssisted Suicide ,cto(er 29 -oda!<s 0$ +hristopher .eeve considered assisted suicide. ,n his autobiography,GStill +e,G ;eeve describes the despair he felt after becoming paraly6ed in a riding accident. >ithin seconds, he went from being a handsome, e#tremely physically fit person to one who could not move from the nec* down. &e could spea* and drin* through straws, and that was pretty much it. &e as*ed his wife to help him commit suicide, and she said, F, understand how you feel, but youEre still you and , love you.G &ence, the title of the boo*. >hat ;eeve confesses is that he was testing her to see if she was willing to ta*e over his care. &e went on to live a life of e#ample. )ot only did he write an inspiring boo*, he also acted in and directed several movies and wor*ed tirelessly to get funding for victims of paralysis. &e never gave up trying to wal*. &e became a real superman. .eason 81=: No on 0ssisted Suicide ,cto(er 22 -oda!<s 0$ 0ssisted suicide as%s too much of loved ones. ,n the movies and on T9 shows, the dying person is always in e#cruciating pain and crying out for help to the only one who will listen5 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, F, canEt do that, but , can stay by you, love you, help you through this, ma*e sure you get pain relief, counseling and help. >e can get through this together. 4lease donEt as* me to hurt someone , care about. , love you.G "y the way, pain relief has never been more effective. 2ou can already choose to stay doped up and unconscious until you pass away. .eason 81>: No on 0ssisted Suicide ,cto(er 21 -oda!<s 0$:0ssisted suicide laws put poor people at ris%.

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This is the +artin Sheen argument against assisted suicide. &e is ma*ing radio ads in >ashington partly because he believes that assisted suicide laws will put poor people and those without health insurance at an e#treme disadvantage within the medical system. Thin* of the money weEd save on .(T scans, #-rays, medicine, nursing care, rehabilitation, disability payments, etc if we had this cheap alternative5 suicide. +artin Sheen is right. .eason 81?: No on 0ssisted Suicide ,cto(er 20 -oda!<s 0$:Suicide interrupts a natural path to wisdom. (t the very end of human life, everything happens faster and better. >hen you donEt have much time, you prioriti6e. 4eople become more authentic when they are dying, which is why courts give so much credence to a personEs Flast words.G &ospice nurses have shared many stories with me about how people come to reali6e new things about themselves, what was really important to them after all, who loved them and whom they really love, what the meaning of life is and what the afterlife, if any, loo*s li*e to them. They may go through a period of regrets, sorrow and mourning before they find wisdom, but itEs there. ,f you cut off your life too soon, you miss your chance for wisdom. The vast ma'ority of people want to live every last minute of their lives, and donEt want to be pressured by assisted suicide laws to end them. .eason 81@: No on 0ssisted Suicide ,cto(er 1= -oda!<s 0$:-he first Nazi victims were terminall! ill people. The )a6i party used very emotional propaganda films about terminally ill people who needed the compassion of assisted suicide. Today we (mericans are watching similar movies li*e F+illion @ollar "aby,G which got the 011I (cademy (ward for "est 4icture. The most effective )a6i film told the heart-brea*ing story of a doctorEs wife who begged her husband to *ill her. =nce they sold the ?erman people on assisted suicide and had some doctors on board, the )a6i party moved into the concept of Fuseless eaters.G ?ermany was in a terrible depression in the ACH1s, worse than (mericaEs. F!seless eatersG were criminally insane, severely handicapped children, very very elderly, etc. =nce they eliminated Fuseless eaters,G the )a6is went on to *illing M- well, youEve got the idea. %or more information, go to article F&itler, the )a6is and %our (rguments (gainst (ssisted Suicide.G .eason 81 : No on 0ssisted Suicide ,cto(er 1> -oda!<s 0$:0ssisted suicide laws cannot (e written so as to prevent a(use. This is the reason the (merican +edical (ssociation opposes assisted suicide. @octors *now that there is no way to control assisted suicide once you ma*e it legal. There is no foolproof way to write the law without opening it to abuse.,n =regon and the )etherlands, for e#ample, assisted suicide laws require two physicians to Fsign offG on a suicide. &owever, some doctors Fsign offG
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routinely without e#amining patients. =ne @utch doctor hurried up a suicide because he needed the bed for another patient. 2ou canEt write a law that covers every contingency so thereEs no way to control what happens to your patients once you open that door.

.eason 81B: No on 0ssisted Suicide ,cto(er 1? -oda!<s 0$:$!ing people can (e treated for depression. +any people who are terminally ill are not depressed. (t the end of her life, my sister became li*e a poet or artist, sitting outside and 'ust ta*ing 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. &owever, some terminally ill people are depressed and tal* about suicide. ,f 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 wor* of dying5 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 itEs not good to leave the planet in despair. .eason 19: No on 0ssisted Suicide -oda!<s 0$ ,cto(er 1@ :-he arguments for assisted suicide are all (ased on emotion. 3motion is a *ind of thought, but emotions are unreliable. >e feel empathy when we see a dying person. =ur first impulse is to hurry it along, end his suffering. &owever, behind that emotion of empathy hides a 'udgment5 that person0s life is not worth li%ing and needs to end now) >e can have a similar emotion when we see someone very very old or in a wheelchair or someone li*e Terri Shiavo. #hat life is not worth li%ing) (re you feeling compassion or ma*ing a 'udgmentQ Reason #12- No on Assisted Suicide October 15 Todays AD- Assisted suicide sets a bad example or ot!er people" ( handsome young man, the father of two young children with a beautiful wife, a brilliant scientist passionate about his lifeEs wor*, was dying much much too young. 2et ;andy 4ausch inspired us all with his incredible F-ast -ecture.G &e *new he was dying, but he loo*ed bac* to chec* on his two young sons, to ma*e sure they and his wife would be all right, and to leave them and all of us all with a little bit of wisdom. >hen he was toward the end, his doctor said, F;andy, this may be it.G &e answered, F,Ell get bac* to you on that.G Those were his last words. &e too* control and he did it his way. >e are all grateful for his e#ample. %or more information on ;andy 4usch, go to http5PPdownload.srv.cs.cmu.eduPRpauschP.

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.eason 811: No on 0ssisted Suicide -oda!<s 0$ ,cto(er 1B :&nsurance companies love assisted suicide. (bout 07N of +edicareEs annual OH07 billion budget goes to care for patients in their final year of life. ThatEs a lot of money, and one poison pill is so much cheaper. 2ou may be young and thin* that this is a great way to save money in the middle of a health care crisis. 2ou may even thin* the elderly have a crappy quality of life. The insurance companies believe that too. They li*e doctors to help people commit suicide. ,t saves money. &owever, whatEs going to happen when itEs your turn to dieQ .eason 810 -oda!<s 0$ ,cto(er 19 :-he 0merican Medical 0ssociation opposes assisted suicide. &ereEs the (merican +edical (ssociationEs statement as it appears on their website5 4hysician-assisted suicide occurs when a physician facilitates a patientEs death by providing the necessary means andPor 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 may commit suicide<. ,t is understandable, though tragic, that some patients in e#treme duress7such as those suffering from a terminal, painful, debilitating illness7may come to decide that death is preferable to life. 2owever; allowing ph!sicians to participate in assisted suicide would cause more harm than good. 4hysician-assisted suicide is fundamentally incompatible with the physicianEs role as healer, would be difficult or impossible to control, and would pose serious societal ris*s. ,nstead of participating in assisted suicide, physicians must aggressively respond to the needs of patients at the end of life. 4atients should not be abandoned once it is determined that cure is impossible. +ultidisciplinary interventions should be sought including specialty consultation, hospice care, pastoral support, family counseling, and other modalities. 4atients near the end of life must continue to receive emotional support, comfort care, adequate pain control, respect for patient autonomy, and good communication. .eason 8=: No on 0ssisted Suicide -oda!<s 0$ ,cto(er 12 :0llowing assisted suicide increases teen suicides. (merican teens *ill themselves at a rate of about one every two hours. (bout ACN of our teens tell researchers they have e#perienced depression, and half of those have had suicidal thoughts. =ur *ids ta*e three times the number of prescription drugs for depression, an#iety and other mental health conditions than do 3uropean teens. >e have watched them glamori6e death in vampireworship, the ?oth culture, and suicide pacts. >e have seen *ids hold hands and 'ump in front of trains, believing they are going on to some twilight fantasy of "ella and 3dward. ?ee +om, ,Em only seventeen.
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"y o*aying assisted suicide laws, we are telling our teenagers that suicide is o*ay and necessary sometimes. @o you really thin* thatEs a good ideaQ .eason 8>: No on 0ssisted Suicide -oda!<s 0$ ,cto(er 11 C Aou don<t need a doctor to commit suicide. (ssisted suicide gets lumped into abortion issues, but the two are very very different. 2ou donEt need a doctor to commit suicide. There are many ways to do it, and itEs not my place to show you how :even though , am a crime writer and *now a lot about painless quic* poisons and such<. Suicide is an intensely private act. 2ou donEt need to involve anyone else, and society is better off not approving of it. .eason 8?: No on 0ssisted Suicide -oda!<s 0$ ,cto(er 10 C S%illed hospice caregivers can control ph!sical 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. , 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. +orphine and other drugs did the tric*, and they were not even that sedated. =ne reason hospice nurses can control pain is that they donEt have to worry about addiction and can use higher levels of medications. They *now how to loo* for and ta*e care of bloc*ages and other problems. 4lease do not be afraid of pain. .eason 8@: No on 0ssisted Suicide -oda!<s 0$ ,cto(er = C -he 0merican Nurses 0ssociation opposes assisted suicide. =fficial 4osition5 FThe (merican )urses (ssociation :()(< believes that the nurse should not participate in assisted suicide. Such an act is in violation of the .ode for )urses with ,nterpretive Statements :.ode for )urses< and the ethical traditions of the profession. )urses, 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 lifesustaining treatments.G -oda!<s 0d 8 : No on 0ssisted Suicide ,cto(er > :0ll humans have dignit!; even the sic% and d!ing. =ne old man was ta*ing care of his wife who had (l6heimerEs disease. &is friends said, F>hy do you put so much into her careQ .anEt you see what she has becomeQG The old man answers, F+aybe, but , remember who she was.G )o matter where you are in your life, you are still human and you have the dignity of being human. "abies are helpless but they have human dignity. 4eople with terrible handicaps, scars, amputations, mental illness M they still have human dignity. )o one and no sic*ness can ta*e your
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human dignity away from you. 2ou are still someoneEs spouse, someoneEs parent, someoneEs child, someoneEs loved one. )o matter what happens to you, you are still you. )o one can ta*e that from you, no matter what. -oda!<s 0d 8B: No on 0ssisted Suicide ,cto(er > C Suicidal people have a diminished capacit! to ma%e the decision to end their lives. ,f 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. -egally, you have diminished capacity and are unable to ma*e important and rational decisions. ,f you say a dying person has a good enough reason to *ill hisPherself, why not a person in a wheelchairQ Someone whose family was *illed in an accidentQ Someone who faces financial ruinQ Suicidal people need treatment for depression, not help committing suicide. -oda!<s 0d 89: No on 0ssisted Suicide ,cto(er ? C 0ssisted suicide laws put pressure on d!ing people to end their lives. =ne 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 was5 1lease get this o%er so we $an get our inheritan$e) -i*ewise, in the Terri Schiavo case, her e#-husband stood to gain money and freedom to remarry once she died. =n the other hand, it is very hard for most people to stay near someone they love who is dying. ,f you want to get your petEs life over, multiple that by thousands when itEs a person you love. 2ou really want it over, but thatEs ma*ing it about you. The loving attitude is F, want every possible moment with you. Ta*e your time.G -oda!<s 0d82: No on 0ssisted Suicide ,cto(er accessories of fact to homicide. C 0ssisted suicide laws ma%e doctors

F(ccessories before the factG is a legal term. -etEs say you buy someone a gun, *nowing that he plans to *ill someone with it. 2ou are an accessory before the fact of homicide and could go to 'ail for doing that. Similarly, when a doctor provides a dying person with poisons, *nowing that the person is going to *ill himself, he is an accessory before the fact. This is why the other side now wants to call it Fcompassion and choicesG in dying rather than assisted suicide. (ssisted suicide laws are written so as that all doctors get off the hoo* for helping murder someone. ,t becomes a legal parsing of morality. ,snEt that what we hate about lawyersQ -oda!<s 0d 81: No on 0ssisted Suicide ,cto(er B C 0ssisted suicide laws create a world without caring or love. >hen we thin* of people who showed great love and compassion M the ?ood Samaritans and +other Teresas of the world 7we thin* of how they stopped and they too* the time to help others.
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>hen they saw suffering, they didnEt shoot the person to put him out of his misery. That creates a world without love or caring. @o you want your *ids to grow up in a world li*e thatQ >hen people are so sad they want to die, they need love and understanding. Killing is not compassion. That is =rwellian )ewspea*, a language without meaning. ,f love is death and mercy is *illing, then words mean nothing. (ll humans *now what love is. -ove is compassion. .aring is compassion. ,Ell wal* with you no matter what. ,Ell stay with you no matter what. , love you. >e both *now what that involves.